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Sample records for acetabular fractures treated

  1. Central acetabular fracture with dislocation treated by minimally invasive plate osteosynthesis.

    PubMed

    2015-06-01

    Central acetabular fractures with dislocation are usually the result of high-energy trauma, resulting in joint incongruity, and are frequently associated with other injuries. Open reduction and internal fixation has been the standard treatment for acetabular fractures, but it is associated with extensive surgical trauma, and complications such as haematoma formation, iatrogenic nerve injury, and heterotopic ossification. We present the case of a 63-year-old female who sustained a central acetabular fracture of the hip with dislocation as a result of an automobile collision. Closed reduction of the dislocation was performed, and the fracture was managed by minimally invasive plate osteosynthesis using a specially prepared plate. At 01 year postoperatively, radiographs showed the fracture to have been well-healed with good congruity of the joint. However, heterotopic ossification of the joint was noted. The technique allowed reduction of the fracture with minimal surgical trauma.

  2. Central acetabular fracture with dislocation treated by minimally invasive plate osteosynthesis.

    PubMed

    2015-06-01

    Central acetabular fractures with dislocation are usually the result of high-energy trauma, resulting in joint incongruity, and are frequently associated with other injuries. Open reduction and internal fixation has been the standard treatment for acetabular fractures, but it is associated with extensive surgical trauma, and complications such as haematoma formation, iatrogenic nerve injury, and heterotopic ossification. We present the case of a 63-year-old female who sustained a central acetabular fracture of the hip with dislocation as a result of an automobile collision. Closed reduction of the dislocation was performed, and the fracture was managed by minimally invasive plate osteosynthesis using a specially prepared plate. At 01 year postoperatively, radiographs showed the fracture to have been well-healed with good congruity of the joint. However, heterotopic ossification of the joint was noted. The technique allowed reduction of the fracture with minimal surgical trauma. PMID:26060171

  3. Arthroscopic Reduction and Transportal Screw Fixation of Acetabular Posterior Wall Fracture: Technical Note.

    PubMed

    Park, Jin Young; Chung, Woo Chull; Kim, Che Keun; Huh, Soon Ho; Kim, Se Jin; Jung, Bo Hyun

    2016-06-01

    Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note. PMID:27536654

  4. Arthroscopic Reduction and Transportal Screw Fixation of Acetabular Posterior Wall Fracture: Technical Note

    PubMed Central

    Park, Jin young; Kim, Che Keun; Huh, Soon Ho; Kim, Se Jin; Jung, Bo Hyun

    2016-01-01

    Acetabular fractures can be treated with variable method. In this study, acetabular posterior wall fracture was treated with arthroscopic reduction and fixation using cannulated screw. The patient recovered immediately and had a satisfactory outcome. In some case of acetabular fracture could be good indication with additional advantages of joint debridement and loose body removal. So, we report our case with technical note. PMID:27536654

  5. Traumatic Periprosthetic Acetabular Fracture Treated with One-Stage Exchange and Bone Reconstruction Using a Synthetic Bone Graft Substitute

    PubMed Central

    2016-01-01

    A case of a traumatic periprosthetic acetabular fracture in an elderly patient, which was treated by one-stage hip exchange with implantation of an antiprotrusio cage and reconstruction of the acetabular bone loss with an injectable calcium sulphate/hydroxyapatite bone graft substitute, is reported. The paste-like bone graft substitute was injected through the holes of the antiprotrusio cage. After a setting time of 15 minutes, a low-profile cup was cemented onto the cage using polymethylmethacrylate and a new stem was inserted. The patient was encouraged to ambulate three days postoperatively weight-bearing as tolerated. At the one-year follow-up visit the patient was ambulatory and full weight-bearing without any walking aids. The follow-up radiographs demonstrated stable position and articulation of the revision hip arthroplasty with no signs of loosening of the antiprotrusio cage. However, the most interesting finding was that the bone graft substitute had remodelled to a great extent into bone. This calcium sulphate/hydroxyapatite composite shows high osteoconductive potential and can be used to regenerate bone stock in revision arthroplasty. PMID:27446621

  6. Total hip arthroplasty for acute acetabular fractures: a review of the literature.

    PubMed

    Jauregui, Julio J; Clayton, Adrian; Kapadia, Bhaveen H; Cherian, Jeffrey J; Issa, Kimona; Mont, Michael A

    2015-05-01

    There have been many advances in the treatment of acetabular fractures; however, the role of total hip arthroplasty (THA) as part of acute fracture management is not well-defined. The indications to acutely manage an acetabular fracture with THA include patients who were older than 65 years of age, who had extensive intra-articular comminution, impaction of the acetabular dome, a displaced-impacted femoral neck fracture, presented with severe osteopenia or osteoporosis, or preexisting osteoarthritis. Implant survivorship and clinical outcomes were favorable with low complications when managing an acetabular fracture with THA. THA may be an effective option for treating acetabular fractures in appropriately selected patients.

  7. A Novel Approach for Treatment of Acetabular Fractures

    PubMed Central

    Xue, Zichao; Qin, Hui; Ding, Haoliang; An, Zhiquan

    2016-01-01

    Background There is no single approach that provides adequate exposure for treatment of all types of acetabular fractures. We describe our experience with an easier, relatively less invasive pubic symphysis approach (PSA) for the treatment of acetabular fractures. Material/Methods Between March 2011 and March 2012, fifteen patients with acetabular fracture underwent surgery using the PSA technique. Fracture reduction and treatment outcomes were assessed by clinical and radiological examination. Operation time, intraoperative blood loss and postoperative complications were documented. Results Mean operative time was 222±78 minutes. Average blood loss was 993±361 mL. Anatomical reduction was achieved in all patients. Minimum follow-up period was 31 months. Postoperative hypoesthesia in the area of innervation of the lateral femoral cutaneous nerve was reported in one patient, with spontaneous recovery at one month after surgery. No complications were reported during the follow-up period. At the most recent follow up, clinical outcomes were graded as “excellent” in six patients, “good” in eight patients and “fair” in one patient based on the modified Merle d’Aubigné-Postel score. Conclusions PSA appears to be a timesaving and safe approach for treatment of acetabular fractures that affords good visual access and allows for excellent fracture reduction. Our preliminary results revealed a much lower incidence of complications than traditional approaches, suggesting PSA is an alternative for treatment of acetabular fractures. PMID:27734825

  8. [Acetabular fractures in the elderly. Outcome of open reduction and internal fixation].

    PubMed

    Tosounidis, G; Culemann, U; Bauer, M; Holstein, J H; Garcia, P; Kurowski, R; Pizanis, A; Aghayev, E; Pohlemann, T

    2011-08-01

    The aim of this study was to analyze the clinical outcome and incidence of hip arthritis in elderly patients with acetabular fractures. Because of poor bone quality in the elderly, even a low-energy trauma may lead to an acetabular fracture. An anatomical reconstruction of the acetabulum is necessary to achieve sufficient stability also for a potential hip arthroplasty. So far, there is very limited information on the outcome of acetabular fractures in the elderly. During a period of 6 years (2001-2006), 48 patients older than 60 years were admitted to our department with an acetabular fracture. Thirty-nine patients were treated operatively and nine patients non-operatively. Twenty-nine operatively treated patients were followed up. Nineteen of them were assessed using EQ-5D, SF-12 and Merle d'Aubigné questionnaires in addition to their clinical examination. Ten other surgical patients were only examined using the questionnaires. Of the 29 patients that were followed up, 5 underwent total hip arthroplasty due to secondary post-traumatic hip arthritis after open reduction and internal fixation (ORIF). The range of motion of the operated hip was comparable to that of the non-operated contralateral side. However, the internal rotation was found to be slightly decreased at the operated side when compared to the non-operated contralateral side. Merle d'Aubigné score and physical and mental SF-12 score components as well as quality of life were better in patients treated with ORIF compared to those patients that were treated by secondary hip arthroplasty. Regarding the different treatment strategies (ORIF vs primary hip arthroplasty vs non-operative treatment) of acetabular fractures in the elderly, data from the literature are conflicting. Our results indicate that ORIF represents a good treatment option for acetabular fractures in the elderly. In patients that did not develop secondary hip arthritis, a good clinical outcome and quality of life was documented. PMID

  9. Heterotopic ossification prophylaxis following operative treatment of acetabular fracture.

    PubMed

    Johnson, E E; Kay, R M; Dorey, F J

    1994-08-01

    Eighty seven patients with 88 fractures were retrospectively reviewed to assess the effect of postoperative prophylaxis on the formation of heterotopic ossification (HO). Sixty eight patients with 69 acetabular fractures were followed for an average of 21 months (range, 3-98 months). The grade of HO was assessed using the Brooker classification system. Thirty four fractures had no prophylactic treatment, 30 were treated prophylactically with indomethacin, two with radiation therapy, and three with both indomethacin and radiation. Twenty (59%) of 34 untreated fractures developed HO, of which nine (26%) were Grade III or IV. Thirteen (43%) of 30 fractures treated with indomethacin developed HO, of which 5 (16%) were Grade III and none were Grade IV. Twenty one of 24 fractures were stabilized through the extended iliofemoral approach; 13 of these had no prophylaxis. Eleven of the 13 developed HO; eight were Grade III or IV (62%). Seven of eight fractures treated with indomethacin following the extended iliofemoral approach developed HO; one was Grade III (13%) and non Grade IV. There was no significant difference between 13 patients who were not treated prophylactically and 18 indomethacin treated patients stabilized through the Kocher-Langenbeck approach. Only one of 11 patients had HO (Grade I) following an ilioinguinal approach. Postoperative radiation therapy, with or without indomethacin, resulted in three patients with Grade 0 HO (all radiated 1-4 days post surgery), one with Grade II (radiated postoperative Day 8), and one with Grade III HO (significant delay in surgery with preoperative Grade III HO of the hip).(ABSTRACT TRUNCATED AT 250 WORDS)

  10. Occult internal iliac arterial injury identified during open reduction internal fixation of an acetabular fracture: a report of two cases.

    PubMed

    Chaus, George W; Heng, Marilyn; Smith, Raymond M

    2015-07-01

    We present two cases of occult internal iliac arterial injury identified during operative reduction of a widely displaced posterior column posterior wall acetabular fracture. This complication was not recognised until reduction of the column fracture. There were no preoperative signs or symptoms indicative of a vascular injury. These cases emphasise the heightened awareness one must have when treating widely displaced posterior column fractures of the acetabulum, especially those fractures with extension into the greater sciatic notch, as previously formed clot can become dislodged and hemostasis lost. We also present management options when this complication occurs. We believe any surgeon treating acetabular fractures should be aware of this serious and potentially fatal complication.

  11. Modified Kocher-Langenbeck approach in combined surgical exposures for acetabular fractures management

    PubMed Central

    Magu, Narender Kumar; Rohilla, Rajesh; Singh, Amanpreet; Wadhwani, Jitendra

    2016-01-01

    Background: Displaced fractures of the acetabulum are best treated with anatomical reduction and rigid internal fixation. Adequate visualization of some acetabular fracture types may necessitate extensile or combined anterior and posterior approaches. Simultaneous anterior iliofemoral and posterior Kocher-Langenbeck (K-L) exposures with two surgical teams have also been described. To assess whether modified Kocher-Langenbeck (K-L) approach can substitute standard K-L approach in the management of elementary acetabular fractures other than the anterior wall and anterior column fractures and complement anterior surgical approaches in the management of complex acetabular fractures. Materials and Methods: 20 patients with transverse and associated acetabular fractures requiring posterior exposure were included in this prospective study. In 9 cases (7 transverse, 1 transverse with posterior wall, and 1 posterior column with posterior wall), stabilization was done through modified K-L approach. In 11 cases (3 transverse and 8 associated fractures), initial stabilization through iliofemoral approach was followed by modified K-L approach. Results: The average operative time was 183 min for combined approach and 84 min for modified K-L approach. The postoperative reduction was anatomical in 17 patients and imperfect in 3 patients. The radiological outcome was excellent in 15, good in 4, and poor in one patient. The clinical outcome was excellent in 15, good in 3 and fair and poor in 1 each according to modified Merle d’Aubigne and Postel scoring system. Conclusion: We believe that modified K-L approach may be a good alternative for the standard K-L approach in the management of elementary fractures and associated fractures of the acetabulum when combined with an anterior surgical approach. It makes the procedure less invasive, shortens the operative time, minimizes blood loss and overcomes the exhaustion and fatigue of the surgical team. PMID:27053812

  12. Nonunion of acetabular fractures: evaluation with interactive multiplanar CT

    SciTech Connect

    Kuhlman, J.E.; Fishman, E.K.; Ney, D.R.; Brooker, A.F. Jr.; Magid, D.

    1989-01-01

    Nonunions involving fractures of the acetabulum are reportedly rare, with few citings and little discussion in the literature. It is possible that acetabular nonunions go undetected because imaging of the acetabulum is difficult by conventional radiography. We report two cases of fracture nonunion involving the weight-bearing surface of the acetabulum diagnosed with the aid of computed tomography (CT) and a newly developed interactive 2D/3D orthotool that uniquely processes and reformats routine CT data. The interactive 2D/3D orthotool is a sophisticated computer program that allows dynamic viewing of standard multiplanar reconstructions in the axial, coronal, and sagittal planes as well as multiple oblique projections. The 2D/3D orthotool provides on screen correlation of two-dimensional multiplanar images with three-dimensional reconstructions of the pelvis. The authors found this capability ideally suited for studying fractures with off-axis orientation such as those through the acetabular dome, greatly facilitating the diagnosis of nonunion.

  13. Coronal Acetabular Fractures: The Anterior Approach in Computed Tomography-Navigated Minimally Invasive Percutaneous Fixation

    SciTech Connect

    Jacob, Augustinus Ludwig; Suhm, Norbert; Kaim, Achim; Regazzoni, Pietro; Steinbrich, Wolfgang; Messmer, Peter

    2000-09-15

    Purpose: To demonstrate the technical feasibility of the anterior approach to the coronal roof component of carefully selected acetabular fractures in computed tomography (CT)-navigated closed reduction and percutaneous fixation (CRPF).Methods: Four patients with nondisplaced or slightly displaced coronal fractures of the acetabular roof were treated with percutaneous screw fixation. Screws were implanted over guidepins placed under CT navigation. Mean clinical and radiological follow-up was 16 months.Results: All screws could be placed as intended. There were no peri- or postoperative complications. Radiological follow-up showed primary osseous union. Clinical results were excellent according to a median Merle-d'Aubigne score of 18.Conclusion: Nondisplaced or slightly displaced coronally oriented fractures of the acetabular roof can be treated by minimally invasive percutaneous CT-navigated fixation through an anterior approach that does not endanger the sciatic nerve. Early clinical results are encouraging. Close cooperation between trauma surgeons and radiologists and careful selection of cases is mandatory.

  14. Total Hip Arthroplasty Using Modular Trabecular Metal Acetabular Components for Failed Treatment of Acetabular Fractures: A Mid-term Follow-up Study

    PubMed Central

    Huang, De-Yong; Zhang, Liang; Zhou, Yi-Xin; Zhang, Chun-Yu; Xu, Hui; Huang, Yong

    2016-01-01

    Background: Porous-coated cups have been widely used in acetabular reconstruction after failed treatment of acetabular fractures, and good results have been reported with the use of these cups; however, the durability and functionality of modular trabecular metal (TM) acetabular components in acetabular reconstruction after failed treatment of acetabular fractures remain unclear. This study aimed to examine the radiographic and clinical outcomes associated with the use of modular TM acetabular components for failed treatment of acetabular fractures to assess the durability and functionality of these components in acetabular reconstruction after failed treatment of acetabular fractures. Methods: A total of 41 patients (41 hips) underwent total hip arthroplasty (THA) using modular TM acetabular components for failed treatment of acetabular fractures at our hospital between January 2007 and December 2012. Among these patients, two were lost to follow-up. Therefore, 39 patients (39 hips) were finally included in this study. The Harris hip score before and after the surgery, satisfaction level of the patients, and radiographic results were assessed. Results: The mean Harris hip score increased from 34 (range, 8–52) before surgery to 91 (range, 22–100) at the latest follow-up examination (P < 0.001). The results were excellent for 28 hips, good for six, fair for three, and poor for two. Among the 39 patients, 25 (64%) and 10 (26%) were very satisfied and somewhat satisfied, respectively. All cups were found to be fully incorporated, and no evidence of cup migration or periacetabular osteolysis was noted. Conclusions: Despite the technically demanding nature of the procedure, THA using modular TM acetabular components showed good durability and functionality and may be an effective reconstruction option for failed treatment of acetabular fractures. PMID:27064033

  15. ANALYSIS OF THE SEGMENTAL IMPACTION OF FEMORAL HEAD FOLLOWING AN ACETABULAR FRACTURE SURGICALLY MANAGED

    PubMed Central

    Guimarães, Rodrigo Pereira; Kaleka, Camila Cohen; Cohen, Carina; Daniachi, Daniel; Keiske Ono, Nelson; Honda, Emerson Kiyoshi; Polesello, Giancarlo Cavalli; Riccioli, Walter

    2015-01-01

    Objective: Correlate the postoperative radiographic evaluation with variables accompanying acetabular fractures in order to determine the predictive factors for segmental impaction of femoral head. Methods: Retrospective analysis of medial files of patients submitted to open reduction surgery with internal acetabular fixation. Within approximately 35 years, 596 patients were treated for acetabular fractures; 267 were followed up for at least two years. The others were excluded either because their follow up was shorter than the minimum time, or as a result of the lack of sufficient data reported on files, or because they had been submitted to non-surgical treatment. The patients were followed up by one of three surgeons of the group using the Merle d'Aubigné and Postel clinical scales as well as radiological studies. Results: Only tow studied variables-age and amount of postoperative reductionshowed statistically significant correlation with femoral head impaction. Conclusions: The quality of reduction-anatomical or with up to 2mm residual deviation-presents a good radiographic evolution, reducing the potential for segmental impaction of the femoral head, a statistically significant finding. PMID:27004191

  16. New tool for applying traction during open reduction and internal fixation of acetabular fractures.

    PubMed

    Lien, Fang-Chieh

    2012-04-01

    Open reduction and internal fixation is used to treat complex acetabular fractures. Traction on the femur is necessary to reduce the acetabulum and is accomplished by surgical assistants or with mechanical devices. To overcome the disadvantages of various traction methods, the author designed a simple, novel traction device that can be used on an ordinary orthopedic or radiolucent operating table and has advantages over manual traction and commercial traction tables. The device consists of a horizontal cross-bar supported over the patient by 2 free-standing legs and is constructed from commercially available parts.

  17. The Retroacetabular Angle Determines the Safe Angle for Screw Placement in Posterior Acetabular Fracture Fixation

    PubMed Central

    Tadros, Ayman M. A.; Oxland, Thomas R.; O'Brien, Peter

    2013-01-01

    Introduction. A method for the determination of safe angles for screws placed in the posterior acetabular wall based on preoperative computed tomography (CT) is described. It defines a retroacetabular angle and determines its variation in the population. Methods. The retroacetabular angle is the angle between the retroacetabular surface and the tangent to the posterior acetabular articular surface. Screws placed through the marginal posterior wall at an angle equal to the retroacetabular angle are extraarticular. Medial screws can be placed at larger angles whose difference from the retroacetabular angle is defined as the allowance angles. CT scans of all patients with acetabular fractures treated in our institute between September 2002 to July 2007 were used to measure the retroacetabular angle and tangent. Results. Two hundred thirty one patients were included. The average (range) age was 42 (15–74) years. The average (range) retroacetabular angle was 39 (30–47) degrees. The average (range) retroacetabular tangent was 36 (30–45) mm. Conclusions. Placing the screws at an average (range) angle of 39 (33–47) degrees of anterior inclination with the retroacetabular surface makes them extraarticular. Angles for medial screws are larger. Safe angles can be calculated preoperatively with a computer program. PMID:24959359

  18. 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

  19. Treatment of postoperative sciatic nerve palsy after total hip arthroplasty for postoperative acetabular fracture: A case report.

    PubMed

    Kanda, Akio; Kaneko, Kazuo; Obayashi, Osamu; Mogami, Atsuhiko; Morohashi, Itaru

    2016-11-01

    Acetabular fracture is usually treated with osteosynthesis. However, in the case of an intra-articular fracture, osteosynthesis can result in arthropathy of the hip joint and poor long-term results, hence, total hip arthroplasty is required. However, in total hip arthroplasty for postoperative acetabular fracture, sciatic nerve palsy tends to develop more commonly than after primary total hip arthroplasty. This is a case report of a 57-year-old Japanese male who had internal skeletal fixation for a left acetabular fracture that had occurred 2 years earlier. One year later, he developed coxarthrosis and severe pain of the hip joint and total hip arthroplasty was performed. After the second surgery, he experienced pain along the distribution of the sciatic nerve and weakness of the muscles innervated by the peroneal nerve, indicating sciatic nerve palsy. We performed a third operation, and divided adhesions around the sciatic nerve. Postoperatively, the anterior hip joint pain and the buttocks pain when the hip was flexed were improved. Abduction of the fifth toe was also improved. However, the footdrop and sensory disturbance were not improved. A year after the third operation, sensory disturbance was slightly improved but the footdrop was not improved. We believe the sciatic nerve palsy developed when we dislocated the hip joint as the sciatic nerve was excessively extended as the hip joint flexed and internally rotated. Sciatic nerve adhesion can occur easily in total hip replacement for postoperative acetabular fracture; hence, adhesiotomy should be conducted before performing hip dislocation to prevent injury caused by nerve tension. The patient agreed that the details of this case could be submitted for publication. The work has been reported in line with the CARE criteria and cite. PMID:27672438

  20. Biomechanical Analysis of the Fixation System for T-Shaped Acetabular Fracture.

    PubMed

    Fan, Yanping; Lei, Jianyin; Zhu, Feng; Li, Zhiqiang; Chen, Weiyi; Liu, Ximing

    2015-01-01

    This study aims to evaluate the biomechanical mechanism of fixation systems in the most frequent T-shaped acetabular fracture using finite element method. The treatment of acetabular fractures was based on extensive clinical experience. Three commonly accepted rigid fixation methods (double column reconstruction plates (P × 2), anterior column plate combined with posterior column screws (P + PS), and anterior column plate combined with quadrilateral area screws (P + QS)) were chosen for evaluation. On the basis of the finite element model, the biomechanics of these fixation systems were assessed through effective stiffness levels, stress distributions, force transfers, and displacements along the fracture lines. All three fixation systems can be used to obtain effective functional outcomes. The third fixation system (P + QS) was the optimal method for T-shaped acetabular fracture. This fixation system may reduce many of the risks and limitations associated with other fixation systems.

  1. Pelvic, acetabular and hip fractures: What the surgeon should expect from the radiologist.

    PubMed

    Molière, S; Dosch, J-C; Bierry, G

    2016-01-01

    Pelvic ring fractures when caused by trauma, either violent or in demineralized bone, generally consist of injuries in both the anterior (pubic symphysis and rami) and posterior (iliac wing, sacrum, sacroiliac joint) portions. Injury classifications are based on injury mechanism and pelvic stability, and are used to determine treatment. Acetabular fractures, associated or not to pelvic ring disruption, are classified on the basis of fracture line, into elementary fractures of the acetabular walls, columns and roof, and into complex fractures. Fractures of the proximal end of the femur occur often on demineralized bone following low-energy trauma. The fractures are categorized by anatomic location (neck, trochanter and subtrochanteric region) and degree of displacement. These variables determine the risk of osteonecrosis of the femoral head, which is the main complication of such fractures.

  2. Decreased Lumbar Lordosis and Deficient Acetabular Coverage Are Risk Factors for Subchondral Insufficiency Fracture

    PubMed Central

    2016-01-01

    Subchondral insufficiency fracture (SIF) of the femoral head occurs in the elderly and recipients of organ transplantation. Osteoporosis and deficient lateral coverage of the acetabulum are known risk factors for SIF. There has been no study about relation between spinopelvic alignment and anterior acetabular coverage with SIF. We therefore asked whether a decrease of lumbar lordosis and a deficiency in the anterior acetabular coverage are risk factors. We investigated 37 patients with SIF. There were 33 women and 4 men, and their mean age was 71.5 years (59-85 years). These 37 patients were matched with 37 controls for gender, age, height, weight, body mass index and bone mineral density. We compared the lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, acetabular index, acetabular roof angle, acetabular head index, anterior center-edge angle and lateral center-edge angle. Lumbar lordosis, pelvic tilt, sacral slope, lateral center edge angle, anterior center edge angle, acetabular index and acetabular head index were significantly different between SIF group and control group. Lumbar lordosis (OR = 1.11), lateral center edge angle (OR = 1.30) and anterior center edge angle (OR = 1.27) had significant associations in multivariate analysis. Decreased lumbar lordosis and deficient anterior coverage of the acetabulum are risk factors for SIF as well as decreased lateral coverage of the acetabulum. PMID:27550496

  3. Methods and Guidelines for Venous Thromboembolism Prevention in Polytrauma Patients with Pelvic and Acetabular Fractures

    PubMed Central

    Chana-Rodríguez, Francisco; Mañanes, Rubén Pérez; Rojo-Manaute, José; Haro, José Antonio Calvo; Vaquero-Martín, Javier

    2015-01-01

    Sequential compression devices and chemical prophylaxis are the standard venous thromboembolism (VTE) prevention for trauma patients with acetabular and pelvic fractures. Current chemical pharmacological contemplates the use of heparins or fondaparinux. Other anticoagulants include coumarins and aspirin, however these oral agents can be challenging to administer and may need monitoring. When contraindications to anticoagulation in high-risk patients are present, prophylactic inferior vena cava filters can be an option to prevent pulmonary emboli. Unfortunately strong evidence about the most effective method, and the timing of their commencement, in patients with pelvic and acetabular fractures remains controversial. PMID:26312115

  4. Biomechanical analysis of the acetabular buttress-plate: are complex acetabular fractures in the quadrilateral area stable after treatment with anterior construct plate-1/3 tube buttress plate fixation?

    PubMed Central

    Wu, Yong-De; Cai, Xian-Hua; Liu, Xi-Ming; Zhang, Hong-Xi

    2013-01-01

    OBJECTIVE: The acetabular buttress-plate has been widely used in treating difficult cases with satisfying clinical results. However, the biomechanical properties of a postoperative acetabular fracture fixed by the buttress-plate are not clear. The purpose of this study was to evaluate the biomechanical properties of stability after the anterior tube buttress-plate fixation of complex acetabular fractures in the quadrilateral area. METHODS: A construct was proposed based on anterior construct plate - 1/3 tube buttress plate fixation for acetabular both-column fractures. Two groups of six formalin-preserved cadaveric pelvises were analyzed: (1) group A, the normal pelvis and (2) group B, anterior construct plate-1/3 tube buttress plate with quadrilateral area fixation. The displacements were measured, and cyclical loads were applied in both standing and sitting simulations. RESULTS: As the load was added, the displacements were A

  5. Temporary Balloon Occlusion of the Abdominal Aorta in Treatment of Complex Acetabular Fracture

    PubMed Central

    Hao, Zhenhai; Zhou, Dongsheng; Wang, Fu; Li, Lianxin; He, Jiliang

    2016-01-01

    Background The aim of this study was to explore the efficacy of temporary balloon occlusion of the abdominal aorta assisting open reduction and internal fixation (ORIF) in the treatment of complex acetabular fracture. Material/Methods From August 2000 to October 2011, a total of 48 patients with complex acetabular fracture were enrolled in this study. Average operative time, intraoperative blood loss volume, blood transfusion volume, satisfactory reduction, and postoperative functional recovery rate were recorded and compared between the 2 groups. Results A significant difference was observed between the 2 groups in operative time (P=0.003). For intraoperative blood loss and blood transfusion, ORIF combined with temporary balloon occlusion of abdominal aorta techniques appeared to be superior to normal ORIF (blood loss: P=0.007; and blood transfusion: P=0.019, respectively). However, no differences were observed in postoperative blood loss or transfusion (P>0.05). Patients in group A showed better hip function than those in group B (group A: a good-to-excellent rate of 77.8%; group B: a good-to-excellent rate of 78.3%; P>0.05). With regard to the incidence of postoperative complications, there were no significant differences between the 2 groups (group A: 9/18; group B: 11/23; P=0.890). Conclusions In the treatment of complex acetabular fracture, temporary balloon occlusion of the abdominal aorta is a reliable technique to assist ORIF surgery to staunch the flow of blood. PMID:27367975

  6. [Aseptic, simultaneous and bilateral mobilisation due to an acetabular shell fracture in a 43 year-old patient].

    PubMed

    Ceretti, M; Fanelli, M; Pappalardo, S

    2014-01-01

    The acetabular shell mobilization is the main long-term complication in total hip replacement. Metal-back fracture has also to be considered among the possible causes of shell mobilization. A case is presented of bilateral acetabular shell mobilization due to the trabecular covering de-soldering from the metal-back in a 43 year-old patient, 13-14 years after the first surgery. PMID:24360788

  7. [Aseptic, simultaneous and bilateral mobilisation due to an acetabular shell fracture in a 43 year-old patient].

    PubMed

    Ceretti, M; Fanelli, M; Pappalardo, S

    2014-01-01

    The acetabular shell mobilization is the main long-term complication in total hip replacement. Metal-back fracture has also to be considered among the possible causes of shell mobilization. A case is presented of bilateral acetabular shell mobilization due to the trabecular covering de-soldering from the metal-back in a 43 year-old patient, 13-14 years after the first surgery.

  8. Supra-acetabular fixation and sacroiliac screws for treating unstable pelvic ring injuries: preliminary results from 20 patients☆

    PubMed Central

    Guimarães, Rodrigo Pereira; de Góes Ribeiro, Arthur; Ulson, Oliver; de Ávila, Ricardo Bertozzi; Ono, Nelson Keiske; Polesello, Giancarlo Cavalli

    2016-01-01

    Objective To analyze the treatment results from 20 patients who underwent an alternative osteosynthesis method as definitive treatment for pelvic ring fractures. Methods A retrospective analysis was conducted on a series of 20 patients with pelvic ring fractures (Tile type C) and a high risk of postoperative infection, who were treated at Santa Casa de Misericórdia de São Paulo between August 2004 and December 2012. The patients underwent percutaneous supra-acetabular external fixation in association with cannulated 7.0 mm iliosacral screws. Results The patients’ mean age was 40 years (range 22–77 years) and the mean length of follow-up was 18.5 months (range 3–69 months). At the end of the treatment, ten patients (50%) were classified as having good results, nine patients (45%) had fair results and one patient (5%) did not have any improvement. Six patients presented complications, and paresthesia of the lateral femoral cutaneous nerve was the most frequent of these (two patients). Conclusion Supra-acetabular external fixation in association with iliosacral percutaneous osteosynthesis is a good definitive treatment method for patients with a high risk of postoperative infection. PMID:27069879

  9. Modified ilioinguinal approach in combined surgical exposures for displaced acetabular fractures involving two columns.

    PubMed

    Wang, Peng; Zhu, Xiaodong; Xu, Peng; Zhang, Yan; Wang, Lubo; Liu, Xiangyan; Mu, Weidong

    2016-01-01

    The purpose of this study is to assess the advantages of modified ilioinguinal approach in combined surgical exposures for displaced acetabular fractures involving two columns management. 73 patients with displaced acetabular fractures involving two columns underwent open reduction and internal fixation through combined surgical approaches between 2006 and 2014 in our hospital. The modified ilioinguinal approach combined with Kocher-Langenbeck approach group (group A) included 46 patients. The standard ilioinguinal approach combined with Kocher-Langenbeck approach group (group B) included 27 patients. Outcome was assessed in operative time, blood loss, function outcomes and complications. In group A, the average operative time was 123.2 min, and the average blood loss was 586.2 ml. Anatomic reduction was achieved in 39 patients (84.8 %). The functional recovery was good in 37 patients (80.4 %). Complications related to the approach were observed in 10 patients (21.7 %). In group B, the average operative time was 161.5 min, and the average blood loss was 830 ml. Anatomic reduction was achieved in 24 patients (88.9 %). The functional recovery was good in 22 patients (81.5 %). Complications related to the approach were observed in 9 patients (33.3 %). This study demonstrates that both combined approaches permits good postoperative function results for treatment of acetabular fractures involving two columns. However, the modified ilioinguinal approach combined with Kocher-Langenbeck approach provides less operative time, blood loss and complications. PMID:27652175

  10. A feasibility study into the use of three-dimensional printer modelling in acetabular fracture surgery.

    PubMed

    Yu, A W; Duncan, J M; Daurka, J S; Lewis, A; Cobb, J

    2015-01-01

    There are a number of challenges associated with the operative treatment of acetabular fractures. The approach used is often extensive, while operative time and perioperative blood loss can also be significant. With the proliferation of 3D printer technology, we present a fast and economical way to aid the operative planning of complex fractures. We used augmented stereoscopic 3D CT reconstructions to allow for an appreciation of the normal 3D anatomy of the pelvis on the fractured side and to use the models for subsequent intraoperative contouring of pelvic reconstruction plates. This leads to a reduction in the associated soft tissue trauma, reduced intraoperative time and blood loss, minimal handling of the plate, and reduced fluoroscopic screening times. We feel that the use of this technology to customize implants, plates, and the operative procedure to a patient's unique anatomy can only lead to improved outcomes.

  11. The Association of Femoral Neck Stress Fractures with Femoral Acetabular Impingement

    PubMed Central

    Safran, Marc R.; Goldin, Michael; Anderson, Christian; Fredericson, Michael; Stevens, Kathryn J.

    2013-01-01

    Objectives: To determine if there is an increased incidence of femoral acetabular impingement (FAI) in patients presenting with stress fractures of the femoral neck. Methods: After IRB approval, the imaging studies of 25 athletes (22 females, 3 males, mean age 26, range 19 - 39 years) with femoral neck stress injuries were assessed for the presence of features suggesting FAI, including acetabular retroversion, coxa profunda, abnormal femoral head-neck junction, fibrocystic change, os acetabulae, labral tear and chondral injury. All subjects had to have an adequate AP Pelvis radiograph, a lateral radiograph of the affected hip, and an MRI of the affected hip. The alpha angle, anterior offset ratio, and center to edge (CE) angle were measured on radiographs. The grade of stress injury was determined on MR images. All images and measurements were made by a musculoskeletal fellowship trained radiologist, a fellowship trained orthopaedic surgeon, an orthopaedic sports medicine fellow and a physical medicine and rehabilitation resident. Charts were reviewed to determine treatment of the stress fracture, outcome and final follow up, as well as to determine if the patient had any further treatment for their hip. Results: Of the 25 hips (18 right, 7 left) with femoral neck stress reactions, 9 were grade 2 (bone marrow edema), 5 were grade 3 (high T2 and low T1 marrow signal), and 11 were grade 4 (stress fracture). Twenty patients (80%) had coxa profunda - where the floor of the cotyloid fossa touches or extends beyond the ilioischial line (incidence in general population is 15.2% of males, and 19.4% of females). Coxa profunda, defined by the floor of the cotyloid fossa touching or extending beyond the ilioischial line and a center edge angle of more than 35o, was present in 28% of subjects. Acetabular retroversion as assessed by the crossover sign was present in 42% (normal incidence is 5% of population). Center edge angle was greater than 35o in 20% and greater than 40 o

  12. Femoroacetabular impingement with chronic acetabular rim fracture - 3D computed tomography, 3D magnetic resonance imaging and arthroscopic correlation

    PubMed Central

    Chhabra, Avneesh; Nordeck, Shaun; Wadhwa, Vibhor; Madhavapeddi, Sai; Robertson, William J

    2015-01-01

    Femoroacetabular impingement is uncommonly associated with a large rim fragment of bone along the superolateral acetabulum. We report an unusual case of femoroacetabular impingement (FAI) with chronic acetabular rim fracture. Radiographic, 3D computed tomography, 3D magnetic resonance imaging and arthroscopy correlation is presented with discussion of relative advantages and disadvantages of various modalities in the context of FAI. PMID:26191497

  13. Usefulness of Arthroscopic Treatment of Painful Hip after Acetabular Fracture or Hip Dislocation

    PubMed Central

    Hwang, Jung-Taek; Lee, Woo-Yong; Kang, Chan; Kim, Dong-Yeol; Zheng, Long

    2015-01-01

    Background Painful hip following hip dislocation or acetabular fracture can be an important signal for early degeneration and progression to osteoarthritis due to intraarticular pathology. However, there is limited literature discussing the use of arthroscopy for the treatment of painful hip. The purpose of this retrospective study was to analyze the effectiveness and benefit of arthroscopic treatment for patients with a painful hip after major trauma. Methods From July 2003 to February 2013, we reviewed 13 patients who underwent arthroscopic treatment after acetabular fracture or hip dislocation and were followed up for a minimum of 2 postoperative years. The degree of osteoarthritis based on the Tonnis classification pre- and postoperatively at final follow-up was determined. Clinical outcomes were evaluated using visual analogue scale for pain (VAS) and modified Harris hip score (MHHS), and range of motion (ROM) of the hip pre- and postoperatively at final follow-up. Results There were nine male and four female patients with a mean age at surgery of 28 years (range, 20 to 50 years). The mean follow-up period of the patients was 59.8 months (range, 24 to 115 months), and the mean interval between initial trauma and arthroscopic treatment was 40.8 months (range, 1 to 144 months). At the final follow-up, VAS and MHHS improved significantly from 6.3 and 53.4 to 3.0 and 88.3, respectively (p = 0.002 and p < 0.001, respectively). However, there were no significant differences in hip flexion, abduction, adduction, external rotation, and internal rotation as minor improvements from 113.1°, 38.5°, 28.5°, 36.5°, and 22.7° to 118.5°, 39.0°, 29.2°, 38.9°, and 26.5° were observed, respectively (p = 0.070, p = 0.414, p = 0.317, p = 0.084, and p = 0.136, respectively). None of the patients exhibited progression of osteoarthritis of the hip at the final follow-up. Conclusions Arthroscopic treatment after acetabular fracture or hip dislocation is effective and delays

  14. An Effective and Feasible Method, “Hammering Technique,” for Percutaneous Fixation of Anterior Column Acetabular Fracture

    PubMed Central

    Zhang, Lihai; Zhang, Wei; Li, Tongtong; Li, Jiantao; Chen, Hua

    2016-01-01

    Objective. The objective of this study was to evaluate the effectiveness and advantages of percutaneous fixation of anterior column acetabular fracture with “hammering technique.” Materials and Methods. We retrospectively reviewed 16 patients with percutaneous fixation of anterior column acetabular fracture with “hammering technique.” There were 11 males and 5 females with an average age of 38.88 years (range: 24–54 years) in our study. Our study included 7 nondisplaced fractures, 6 mild displaced fractures (<2 mm), and 5 displaced fractures (>2 mm). The mean time from injury to surgery was 4.5 days (range: 2–7 days). Results. The average of operation time was 27.56 minutes (range: 15–45 minutes), and the mean blood loss was 55.28 mL (range: 15–100 mL). The mean fluoroscopic time was 54.78 seconds (range: 40–77 seconds). The first pass of the guide wire was acceptable without cortical perforation or intra-articular perforation in 88.89% (16/18) of the procedures, and the second attempt was in 11.11% (2/18). Conclusion. Our study suggested that percutaneous fixation of anterior column acetabular fracture with “hammering technique” acquired satisfying surgical and clinical outcomes. It may be an alternative satisfying treatment for percutaneous fixation of anterior column acetabular fracture by 2D fluoroscopy using a C-arm with less fluoroscopic time. PMID:27493962

  15. Indomethacin versus radiation therapy for prophylaxis against heterotopic ossification in acetabular fractures: a randomised, prospective study.

    PubMed

    Moore, K D; Goss, K; Anglen, J O

    1998-03-01

    We report a prospective, randomised, blinded clinical comparison of the use of indomethacin or radiation therapy for the prevention of heterotopic ossification (HO) in 75 adults who had open reduction and internal fixation of acetabular fractures through either a Kocher-Langenbeck, a combined ilioinguinal and Kocher-Langenbeck, or an extended iliofemoral approach. Indomethacin, 25 mg, was given three times daily for six weeks. Radiation with 800 cGy was delivered within three days of operation. Plain radiographs were reviewed and given Brooker classification scores by three independent observers who were unaware of the method of prophylaxis. One patient died from unrelated causes and two were lost to follow-up, leaving 72, 33 in the radiation group and 39 in the indomethacin group, available for evaluation at a mean of 12 months (6 to 48). There was no significant difference in the two groups in terms of age, gender, injury severity score, estimated blood loss, delay to surgery, head injury, presence of femoral head dislocation, or operating time, and no complications due to either method of treatment. The final extent of HO was already present by six weeks in all patients who were followed up. Three patients in the radiation group and five who received indomethacin developed HO of Brooker grade III. Two patients in the indomethacin group developed Brooker IV changes; both had failed to receive proper doses of the drug. Cochran-Armitage analysis showed no significant difference between the two treatment groups as regards the formation of HO. Indomethacin and single-dose radiation therapy are both safe and effective for the prevention of HO after operation for acetabular fractures. Radiation therapy is, however, approximately 200 times more expensive than indomethacin therapy at our institution and has other risks.

  16. Prophylactic radiotherapy against heterotopic ossification following internal fixation of acetabular fractures: a comparative estimate of risk

    PubMed Central

    Nasr, P; Yip, G; Scaife, J E; House, T; Thomas, S J; Harris, F; Owen, P J; Hull, P

    2014-01-01

    Objective: Radiotherapy (RT) is effective in preventing heterotopic ossification (HO) around acetabular fractures requiring surgical reconstruction. We audited outcomes and estimated risks from RT prophylaxis, and alternatives of indometacin or no prophylaxis. Methods: 34 patients underwent reconstruction of acetabular fractures through a posterior approach, followed by a 8-Gy single fraction. The mean age was 44 years. The mean time from surgery to RT was 1.1 days. The major RT risk is radiation-induced fatal cancer. The International Commission on Radiological Protection (ICRP) method was used to estimate risk, and compared with a method (Trott and Kemprad) specifically for estimating RT risk for benign disease. These were compared with risks associated with indometacin and no prophylaxis. Results: 28 patients (82%) developed no HO; 6 developed Brooker Class I; and none developed Class II–IV HO. The ICRP method suggests a risk of fatal cancer in the range of 1 in 1000 to 1 in 10,000; the Trott and Kemprad method suggests 1 in 3000. For younger patients, this may rise to 1 in 2000; and for elderly patients, it may fall to 1 in 6000. The risk of death from gastric bleeding or perforation from indometacin is 1 in 180 to 1 in 900 in older patients. Without prophylaxis risk of death from reoperation to remove HO is 1 in 4000 to 1 in 30,000. Conclusion: These results are encouraging, consistent with much larger series and endorse our multidisciplinary management. Risk estimates can be used in discussion with patients. Advances in knowledge: The risk from RT prophylaxis is small, it is safer than indometacin and substantially overlaps with the range for no prophylaxis. PMID:25089852

  17. Direct reduction technique for superomedial dome impaction in geriatric acetabular fractures.

    PubMed

    Laflamme, G-Yves; Hebert-Davies, Jonah

    2014-02-01

    The treatment of acetabular fractures in the elderly patients remains challenging. The "Gull Sign," which was recently described, was 100% predictive of failure of reduction and/or fixation. However, we believe that adequate reduction can be achieved and lead to good functional outcomes. Our technique differs from classic methods because it uses an anterior intrapelvic approach (the modified Stoppa) to obtain direct reduction of the impacted fragments. Access to the impacted superomedial dome is achieved by mobilizing the quadrilateral fragment, thus allowing direct visualization of the impacted articular surface. After reduction, definitive fixation is obtained with 3.5-mm cortical screws positioned in the subchondral bone directly over the Gull fragment. Our technique was performed in 9 patients, with a mean follow-up of 2.8 years. The quality of reduction was within 3 mm in 7 patients (78%). The overall conversion rate to total hip arthroplasty was 33%. All patients undergoing total hip arthroplasty either had initial malreduction or suffered an early loss of reduction. Other complications included 1 case of heterotopic ossification (Brooker type II) and 1 case of deep vein thrombosis. There were no infections. The average Harris Hip Score was 81. Good reduction of superior medial dome impaction can be obtained and maintained in the well-selected geriatric patient. We believe that, appropriately used, this direct reduction technique can be an important adjunct to surgeons dealing with this troublesome fracture.

  18. Open reduction and internal fixation of osteoporotic acetabular fractures through the ilio-inguinal approach: use of buttress plates to control medial displacement of the quadrilateral surface.

    PubMed

    Peter, Robin E

    2015-01-01

    The number of acetabular fractures in the geriatric population requiring open reduction and internal fixation is increasing. Fractures with medial or anterior displacement are the most frequent types, and via the ilio-inguinal approach buttress plates have proved helpful to maintain the quadrilateral surface or medial acetabular wall. Seven to ten hole 3.5 mm reconstruction plates may be used as buttress plates, placed underneath the usual pelvic brim plate. This retrospective study presents our results with this technique in 13 patients at a minimum follow-up of 12 months (average, 31 months). 85% of the patients had a good result. The early onset of post-traumatic osteoarthritis necessitated total hip arthroplasty in two patients (15%) at 12 and 18 months follow-up, respectively. This treatment option should be considered in the surgeon's armamentarium when fixing these challenging cases.

  19. A Novel Fixation System for Acetabular Quadrilateral Plate Fracture: A Comparative Biomechanical Study

    PubMed Central

    Zha, Guo-Chun; Sun, Jun-Ying; Dong, Sheng-Jie; Zhang, Wen; Luo, Zong-Ping

    2015-01-01

    This study aims to assess the biomechanical properties of a novel fixation system (named AFRIF) and to compare it with other five different fixation techniques for quadrilateral plate fractures. This in vitro biomechanical experiment has shown that the multidirectional titanium fixation (MTF) and pelvic brim long screws fixation (PBSF) provided the strongest fixation for quadrilateral plate fracture; the better biomechanical performance of the AFRIF compared with the T-shaped plate fixation (TPF), L-shaped plate fixation (LPF), and H-shaped plate fixation (HPF); AFRIF gives reasonable stability of treatment for quadrilateral plate fracture and may offer a better solution for comminuted quadrilateral plate fractures or free floating medial wall fracture and be reliable in preventing protrusion of femoral head. PMID:25802849

  20. Nanotechnology for treating osteoporotic vertebral fractures

    PubMed Central

    Gao, Chunxia; Wei, Donglei; Yang, Huilin; Chen, Tao; Yang, Lei

    2015-01-01

    Osteoporosis is a serious public health problem affecting hundreds of millions of aged people worldwide, with severe consequences including vertebral fractures that are associated with significant morbidity and mortality. To augment or treat osteoporotic vertebral fractures, a number of surgical approaches including minimally invasive vertebroplasty and kyphoplasty have been developed. However, these approaches face problems and difficulties with efficacy and long-term stability. Recent advances and progress in nanotechnology are opening up new opportunities to improve the surgical procedures for treating osteoporotic vertebral fractures. This article reviews the improvements enabled by new nanomaterials and focuses on new injectable biomaterials like bone cements and surgical instruments for treating vertebral fractures. This article also provides an introduction to osteoporotic vertebral fractures and current clinical treatments, along with the rationale and efficacy of utilizing nanomaterials to modify and improve biomaterials or instruments. In addition, perspectives on future trends with injectable bone cements and surgical instruments enhanced by nanotechnology are provided. PMID:26316746

  1. Nanotechnology for treating osteoporotic vertebral fractures.

    PubMed

    Gao, Chunxia; Wei, Donglei; Yang, Huilin; Chen, Tao; Yang, Lei

    2015-01-01

    Osteoporosis is a serious public health problem affecting hundreds of millions of aged people worldwide, with severe consequences including vertebral fractures that are associated with significant morbidity and mortality. To augment or treat osteoporotic vertebral fractures, a number of surgical approaches including minimally invasive vertebroplasty and kyphoplasty have been developed. However, these approaches face problems and difficulties with efficacy and long-term stability. Recent advances and progress in nanotechnology are opening up new opportunities to improve the surgical procedures for treating osteoporotic vertebral fractures. This article reviews the improvements enabled by new nanomaterials and focuses on new injectable biomaterials like bone cements and surgical instruments for treating vertebral fractures. This article also provides an introduction to osteoporotic vertebral fractures and current clinical treatments, along with the rationale and efficacy of utilizing nanomaterials to modify and improve biomaterials or instruments. In addition, perspectives on future trends with injectable bone cements and surgical instruments enhanced by nanotechnology are provided. PMID:26316746

  2. Arthroscopic treatment of bucket-handle labral tear and acetabular fracture.

    PubMed

    Stabile, Kathryne J; Neumann, Julie A; Mannava, Sandeep; Howse, Elizabeth A; Stubbs, Allston J

    2014-04-01

    Traumatic hip dislocations are associated with chondral and labral pathology as well as loose bodies that can be incarcerated in the joint. These types of injury often lead to traumatic arthritis. In some cases an osseo-labral fragment may become incarcerated in the joint that is not readily visualized preoperatively. In place of open surgery, hip arthroscopy permits a technique to remove loose bodies and repair labral tears to restore joint congruity and achieve fracture reduction and fixation. PMID:24904778

  3. Advances in treating exposed fractures.

    PubMed

    Nogueira Giglio, Pedro; Fogaça Cristante, Alexandre; Ricardo Pécora, José; Partezani Helito, Camilo; Lei Munhoz Lima, Ana Lucia; Dos Santos Silva, Jorge

    2015-01-01

    The management of exposed fractures has been discussed since ancient times and remains of great interest to present-day orthopedics and traumatology. These injuries are still a challenge. Infection and nonunion are feared complications. Aspects of the diagnosis, classification and initial management are discussed here. Early administration of antibiotics, surgical cleaning and meticulous debridement are essential. The systemic conditions of patients with multiple trauma and the local conditions of the limb affected need to be taken into consideration. Early skeletal stabilization is necessary. Definitive fixation should be considered when possible and provisional fixation methods should be used when necessary. Early closure should be the aim, and flaps can be used for this purpose. PMID:26229904

  4. Advances in treating exposed fractures.

    PubMed

    Nogueira Giglio, Pedro; Fogaça Cristante, Alexandre; Ricardo Pécora, José; Partezani Helito, Camilo; Lei Munhoz Lima, Ana Lucia; Dos Santos Silva, Jorge

    2015-01-01

    The management of exposed fractures has been discussed since ancient times and remains of great interest to present-day orthopedics and traumatology. These injuries are still a challenge. Infection and nonunion are feared complications. Aspects of the diagnosis, classification and initial management are discussed here. Early administration of antibiotics, surgical cleaning and meticulous debridement are essential. The systemic conditions of patients with multiple trauma and the local conditions of the limb affected need to be taken into consideration. Early skeletal stabilization is necessary. Definitive fixation should be considered when possible and provisional fixation methods should be used when necessary. Early closure should be the aim, and flaps can be used for this purpose.

  5. Quadrilateral plate fractures of the acetabulum: an update.

    PubMed

    White, Grace; Kanakaris, Nikolaos K; Faour, Omar; Valverde, Jose Antonio; Martin, Miguel Angel; Giannoudis, Peter V

    2013-02-01

    Acetabular fractures with quadrilateral plate involvement form a heterogeneous group of fractures, which are not specifically defined by any current classification system. Their incidence is increasing due to the rising number of elderly osteoporotic fractures. They have always been notoriously difficult fractures to treat. We present a systematic review of conservative and operative management and their respective outcomes over the last century.

  6. Late sciatic nerve axonotmesis following acetabular reconstruction plate.

    PubMed

    Moreta, J; Foruria, X; Labayru, F

    2016-01-01

    Sciatic nerve injuries associated with acetabular fractures can be post-traumatic, perioperative or postoperative. Late postoperative injury is very uncommon and can be due to heterotopic ossifications, muscular scarring, or implant migration. A case is presented of a patient with a previous transverse acetabular fracture treated with a reconstruction plate for the posterior column. After 17 years, she presented with progressive pain and motor deficit in the sciatic territory. Radiological and neurophysiological assessments were performed and the patient underwent surgical decompression of the sciatic nerve. A transection of the nerve was observed that was due to extended compression of one of the screws. At 4 years postoperatively, her pain had substantially diminished and the paresthesias in her leg had resolved. However, her motor symptoms did not improve. This case report could be relevant due to this uncommon delayed sciatic nerve injury due to prolonged hardware impingement.

  7. Periprosthetic fractures of the acetabulum during cup insertion: posterior column stability is crucial.

    PubMed

    Laflamme, G-Yves; Belzile, Etienne L; Fernandes, Julio C; Vendittoli, Pascal A; Hébert-Davies, Jonah

    2015-02-01

    Periprosthetic hip fractures around acetabular components are rare with little information available to guide surgical management of these complex injuries. A retrospective review of intraoperative isolated acetabular periprosthetic fractures from three tertiary surgical units was done. A total of 32 patients were identified with 9 initially missed. Acetabular components were stable (type 1) in 11 patients with no failures; unstable (type 2) in 12 patients and treated with supplemental fixation. Non-union and displacement were correlated with absent posterior column plating. Missed fractures (type 3) had the highest reoperation rate. Anterior patterns all healed, whereas fractures with posterior column instability had a 67% failure rate. Periprosthetic acetabular fracture can heal successfully with posterior column stability. Plating is mandatory for large posterior wall fragments to achieve osteointegration.

  8. Treating Tibia Fractures With Far Cortical Locking Implants.

    PubMed

    Rice, Christopher; Christensen, Thomas; Bottlang, Michael; Fitzpatrick, Dan; Kubiak, Erik

    2016-01-01

    Compared with conventional plating, the relatively new technology of far cortical locking (FCL) allows for more flexible fixation. Increased flexibility of FCL constructs is thought to better stimulate secondary osteosynthesis and lead to improved healing for certain fracture patterns. We conducted a study to compare healing rates and complications of tibial fractures treated with FCL or standard plating techniques. Twenty-two patients with fractures of the tibia (Orthopaedic Trauma Association 41ABC, 42C, 43C) were included in the study. Twelve tibia fractures were treated with FCL and 10 with standard plating (locking or nonlocking). Mean follow-up was 47 weeks in the FCL group and 41 weeks in the control group. The fracture healing rate was 92% in the FCL group and 100% in the control group (difference not statistically significant). Of note, there were 2 open fractures in the FCL group and 0 in the control group. The groups had similar complication rates. Our study data suggest FCL implants are not inferior to conventional plating techniques. Given that FCL-treated fractures tended to be more complex, the groups' similar fracture healing rates may indicate improved fracture healing with FCL technology, but this possibility requires further investigation. PMID:26991582

  9. Extremely high fracture rate of a modular acetabular component with a sandwich polyethylene ceramic insertion for THA: a preliminary report.

    PubMed

    Kircher, Jörn; Bader, Rainer; Schroeder, Bettina; Mittelmeier, Wolfram

    2009-09-01

    Improvements of ceramic components and design changes have reduced failure rates over the past 30 years in total hip arthroplasty. We present a series of n = 11 cases with ceramic failure out of n = 113 implantations, from which n = 66 were ceramic-on-ceramic (n = 50 with ceramic insert with sandwich in polyethylene and n = 16 with directly fixed ceramic inlay) and n = 47 ceramic on polyethylene bearings, between 1999 and 2001 after introduction of a new implantation system to the market. The overall fracture rate of ceramic for the whole series (n = 113) was 9.7%. For the combination ceramic head with UHMW-PE (n = 47) the fracture rate was 2.1%. For the combination ceramic with ceramic (n = 66) the fracture rate was 15.2%. For the combination ceramic with ceramic sandwich in PE (n = 50) the failure rate was 18%. Only three patients experienced a trauma. Demography of patients (age, gender, body weight and BMI) was not statistically different between patients with failed ceramics and the rest of the patients making patient-specific risk factors unlikely to be an explanation for the failures. Retrospective X-ray analysis of the cup positioning did not show significant difference between failed and non-failed implants in terms of mean cup inclination and version making also operation-specific factors unlikely to be the only reason of this high failure rate. Therefore, manufacturer-specific factors such as design features may have contributed to this high failure rate. Further analysis of the whole series with biomechanical testing of the retrieved material needs to be performed. PMID:18568354

  10. Osteopathic diagnosis of an acetabular injury.

    PubMed

    Morthland, Tim; Cote, Nicholas S; Humphrey, Jon; Fulk, Doug

    2010-05-01

    Physical findings demarking pathologic somatovisceral reflex activity and fascial strain patterns may lead the osteopathic physician to diagnoses that are masked within the initial presentation of a patient. The authors present a case report that demonstrates the use of osteopathic principles in the diagnosis of a chronic acetabular fracture and acetabular labral tear in a 19-year-old man. The injuries resulted from a posterior hip dislocation sustained during a basketball game more than 1 year before presentation. Osteopathic manipulative treatment and diagnostic techniques also relieved the patient's persistent thoracic pain, nausea, and vomiting. Subsequent orthopedic repair had the potential to avert or delay degenerative hip disease in the patient.

  11. Two cases of surgically treated feline patellar fractures.

    PubMed

    Guillaumot, P; Scotti, S; Carozzo, C; Bouvy, B; Genevois, J-P

    2008-01-01

    A transverse patellar fracture in a six-month-old cat was successfully treated by figure-of-eight dorsal wiring of the patella. A longitudinal patellar fracture with luxation of a large medial fragment in a 2.5-year-old cat was treated by lateral marginal patellectomy with a positive outcome. While adding material to the few veterinary reports in that species, in this brief communication, the authors discuss the aetiology, diagnosis, and the treatment of the presented cases with regards to findings in previously published feline cases. PMID:18545720

  12. Two cases of surgically treated feline patellar fractures.

    PubMed

    Guillaumot, P; Scotti, S; Carozzo, C; Bouvy, B; Genevois, J-P

    2008-01-01

    A transverse patellar fracture in a six-month-old cat was successfully treated by figure-of-eight dorsal wiring of the patella. A longitudinal patellar fracture with luxation of a large medial fragment in a 2.5-year-old cat was treated by lateral marginal patellectomy with a positive outcome. While adding material to the few veterinary reports in that species, in this brief communication, the authors discuss the aetiology, diagnosis, and the treatment of the presented cases with regards to findings in previously published feline cases.

  13. Current management of posterior wall fractures of the acetabulum.

    PubMed

    Moed, Berton R; Kregor, Philip J; Reilly, Mark C; Stover, Michael D; Vrahas, Mark S

    2015-01-01

    The general goals for treating an acetabular fracture are to restore congruity and stability of the hip joint. These goals are no different from those for the subset of fractures of the posterior wall. Nevertheless, posterior wall fractures present unique problems compared with other types of acetabular fractures. Successful treatment of these fractures depends on a multitude of factors. The physician must understand their distinctive radiologic features, in conjunction with patient factors, to determine the appropriate treatment. By knowing the important points of posterior surgical approaches to the hip, particularly the posterior wall, specific techniques can be used for fracture reduction and fixation in these often challenging fractures. In addition, it is important to develop a complete grasp of potential complications and their treatment. The evaluation and treatment protocols initially developed by Letournel and Judet continue to be important; however, the surgeon also should be aware of new information published and presented in the past decade.

  14. Abnormal treating pressures in MHF (massive hydraulic fracturing) treatments

    SciTech Connect

    Medlin, W.L.; Fitch, J.L.

    1983-01-01

    Abnormal treating pressures are observed during massive hydraulic fracturing (MHF) treatments in the Mesa Verde Formation of the Piceance Basin, Colorado. Data from 3 widely separated wells and in several zones per well all show a pressure increase during MHF treatments, called pressure growth. This pressure growth is at least semi-permanent. The elevated instantaneous shut-in pressures do not return to initial values over periods of several days. The magnitude of this pressure growth is highly variable. One possible cause of pressure growth is fracture branching. Pressure growth seems to be dependent on both pumping rate and fluid viscosity. 16 references.

  15. Fracture resistance of endodontically treated premolars with direct composite restorations

    PubMed Central

    Moezizadeh, Maryam; Mokhtari, Nastaran

    2011-01-01

    Purpose: To determine the fatigue resistance and failure mode of endodontically treated premolars using direct composite resin restorations. Materials and Methods: Eighty-four human premolars were divided into seven groups of 12, prepared as follows: Intact teeth used in Group 1 as control, the second group covers the endodontically treated teeth, restored with direct onlays using Z250 composite resin, the next two groups (i.e. 3,4) were similar to the second group, but subjected to 1 and 2 million fatigue load cycles, respectively. Groups 5, 6, 7 were similar to groups 2, 3, 4, however, in these groups Tetric Ceram was used as the restorative material. All specimens were loaded using a Universal Testing Machine until fracture occurred. One-way Anova andTukey's HSD tests were used to analyze the data of onlay groups. Results: All specimens withstood the masticating simulation. The mean fracture strength for Goups 1 to 7 was: 1276.92, 1373.47, 1269/70, 486/35, 484/12, 1130/49, 1113/79 Newton, respectively. No statistically significant differences were found between the groups in fracture strength and failure mode. Conclusions: No statistically significant differences in fracture strength were found between sound teeth and composite onlays that were subjected to 1 and 2 million fatigue load cycles. PMID:22025833

  16. Lateral decubitus for treating pertrochanteric fractures using cephalomedullary nails☆

    PubMed Central

    de Oliveira, Elton João Nunes; Hungria, José Octávio Soares; Bellan, Davi Gabriel; Borracini, Jonas Aparecido

    2015-01-01

    Objective To perform a retrospective radiographic evaluation on the fracture reduction and implant position in the femoral head among patients with pertrochanteric fractures who had been treated using a cephalomedullary nail in lateral decubitus; and to assess factors that might interfere with the quality of the fracture reduction and with the implant position in using this technique. Methods Nineteen patients with a diagnosis of pertrochanteric fractures of the femur who had been treated using cephalomedullary nails in lateral decubitus were evaluated. For outpatient radiographic evaluations, we used the anteroposterior view of the pelvis and lateral view of the side affected. We measured the cervicodiaphyseal angle, tip-apex distance (TAD), spatial position of the cephalic element in relation to the head, and the bispinal diameter. To make an anthropometric assessment, we used the body mass index. Two groups of patients were created: one in which all the criteria were normal (TAD ≤25 mm, cervicodiaphyseal angle between 130° and 135° and cephalic implant position in the femoral head in the central–central quadrant); and another group presenting alterations in some of the criteria for best prognosis. Results Female patients predominated (57.9%) and the mean age was 60 years. Seven patients presented a central–central cephalic implant position. One patient present a cervicodiaphyseal angle >135° and the maximum TAD was 32 mm; consequently, 12 patients presented some altered criteria (63.2%). None of the characteristics evaluated differed between the patients with all their criteria normal and those with some altered criteria, or showed any statistically significant association among them (p > 0.05). Conclusion The technique described here enabled good reduction and good positioning of the implant, independent of the anthropometric indices and type of fracture. PMID:26401500

  17. Segmental fractures of the tibia treated by circular external fixation.

    PubMed

    Giotakis, N; Panchani, S K; Narayan, B; Larkin, J J; Al Maskari, S; Nayagam, S

    2010-05-01

    We have carried out a retrospective review of 20 patients with segmental fractures of the tibia who had been treated by circular external fixation. We describe the heterogeneity of these fractures, their association with multiple injuries and the need for multilevel stability with the least compromise of the biology of the fracture segments. The assessment of outcome included union, complications, the measurement of the functional IOWA knee and ankle scores and the general health status (Short-form 36). The mean time to union was 21.7 weeks (12.8 to 31), with no difference being observed between proximal and distal levels of fracture. Complications were encountered in four patients. Two had nonunion at the distal level, one a wire-related infection which required further surgery and another shortening of 15 mm with 8 degrees of valgus which was clinically insignificant. The functional scores for the knee and ankle were good to excellent, but the physical component score of the short-form 36 was lower than the population norm. This may be explained by the presence of multiple injuries affecting the overall score. PMID:20436007

  18. Abnormal treating pressures in massive hydraulic fracturing treatments

    SciTech Connect

    Medlin, W.L.; Fitch, J.L.

    1988-05-01

    Abnormal treating pressures were observed during massive hydraulic fracturing (MHF) treatments in the Mesa Verde formation of the Piceance basin, CO. Data from three widely separated wells and in several zones per well showed a pressure increase during MHF treatments that the authors call ''pressure growth.'' This pressure growth was at least semipermanent. The elevated instantaneous shut-in pressures (ISIP's) did not return to initial values over periods of several days. The magnitude of this pressure growth is highly variable. When its value is less than about 2,300 psi (15.9 MPa), the MHF treatments are usually completed and results are obtained that are within normal expectations. When its value exceeds 2,300 psi (15.9 MPa), sandout occurs and the fracture length estimated from production data is much less than that calculated with crack propagation models. Temperature logs indicate little or only modest vertical extension of the fractures above the perforations. These data, along with sandouts, point to a large increase in fracture width in response to pressure growth. One possible cause of pressure growth is fracture branching. A multiplicity of branches could produce a plastic-like effect. Laboratory measurements have ruled out plasticity as the cause. The stress/strain behavior of the rock is similar to that of rocks where no pressure growth occurs. Pressure growth seems to depend on both pumping rate and fluid viscosity. Thus, there is some hope for its mitigation through treatment design. Also, pressure growth appears to correlate negatively with pay-zone quality. This suggests that the phenomenon can be exploited as a fluid-diversion technique.

  19. Combined Type II Odontoid Fracture with Jefferson's Fracture Treated with Temporary Internal Fixation.

    PubMed

    Pawar, Abhijit Yuvaraj; O'Leary, Patrick F

    2015-12-01

    An 18-year-old male presented after a motor vehicle rollover accident. Computed tomography (CT) scan confirmed the diagnosis of Type II odontoid fracture. Considering the patient's young age and the limitations of C1-C2 fusion including significant loss of cervical rotation, temporary internal fixation with a lateral mass fixation of C1 and pedicle fixation of C2 without fusion was done. CT scan done at 6-month follow-up visit showed healed odontoid fracture and excellent C1-C2 alignment. At ninth postoperative month, internal fixation was removed. Patient had normal movements of cervical spine at 1-year follow-up. Temporary internal fixation can be an important tool in the armamentarium of the surgeon in treating type II odontoid fractures in young adults and children. This strategy avoids the complications halo fixation and immobilizes the unstable C1-C2 segment without fusion. Removal of the internal fixation after healing allows restoration of the rotational motion. PMID:26713132

  20. Combined Type II Odontoid Fracture with Jefferson's Fracture Treated with Temporary Internal Fixation.

    PubMed

    Pawar, Abhijit Yuvaraj; O'Leary, Patrick F

    2015-12-01

    An 18-year-old male presented after a motor vehicle rollover accident. Computed tomography (CT) scan confirmed the diagnosis of Type II odontoid fracture. Considering the patient's young age and the limitations of C1-C2 fusion including significant loss of cervical rotation, temporary internal fixation with a lateral mass fixation of C1 and pedicle fixation of C2 without fusion was done. CT scan done at 6-month follow-up visit showed healed odontoid fracture and excellent C1-C2 alignment. At ninth postoperative month, internal fixation was removed. Patient had normal movements of cervical spine at 1-year follow-up. Temporary internal fixation can be an important tool in the armamentarium of the surgeon in treating type II odontoid fractures in young adults and children. This strategy avoids the complications halo fixation and immobilizes the unstable C1-C2 segment without fusion. Removal of the internal fixation after healing allows restoration of the rotational motion.

  1. Bipolar hemiarthroplasty in femoral neck fractures.

    PubMed

    Malhotra, R; Arya, R; Bhan, S

    1995-01-01

    Thirty-two elderly patients with a femoral neck fracture treated by bipolar hemiarthroplasty and 36 patients (matched for age) with an Austin-Moore hemiarthroplasty were followed-up and compared. Bipolar replacement resulted in a higher percentage of satisfactory results, less postoperative pain, greater range of movement, more rapid return to unassisted activity, fewer unsatisfactory results and no acetabular erosion. The device functioned as bipolar in all the cases studied for inner-bearing motion.

  2. Comparison of 50 vertebral compression fractures treated with surgical (kyphoplasty) or non surgical approach

    PubMed Central

    Giannotti, Stefano; Carmassi, Fabio; Bottai, Vanna; Dell’Osso, Giacomo; Gazzarri, Francesco; Guido, Giulio

    2012-01-01

    Summary The presence of a vertebral fracture increases the risk of a new fracture within a year by at least five times and the risk further increases in case of recurrent fractures (domino effect). The pain and fracture kyphosis can compromise respiratory function. Many patients sustain serious cardiovascular, musculoskeletal, metabolic, and immune complications related to immobility and bedrest. This study is a clinical and radiological assessment of a consecutive cohort of 50 patients with vertebral fractures. We made comparison of 25 vertebral compression fractures treated with surgical (kyphoplasty) or non surgical approach. Systematic reviews of this procedure have shown significantly improved back pain and quality of life compared to conservative therapy. When performed by a well-trained practitioner in appropriately selected patients, kyphoplasty is a safe and effective treatment for fresh vertebral compression fractures. PMID:23289035

  3. Increased Fracture Collapse after Intertrochanteric Fractures Treated by the Dynamic Hip Screw Adversely Affects Walking Ability but Not Survival

    PubMed Central

    Fang, Christian; Gudushauri, Paata; Wong, Tak-Man; Lau, Tak-Wing; Pun, Terence; Leung, Frankie

    2016-01-01

    In osteoporotic hip fractures, fracture collapse is deliberately allowed by commonly used implants to improve dynamic contact and healing. The muscle lever arm is, however, compromised by shortening. We evaluated a cohort of 361 patients with AO/OTA 31.A1 or 31.A2 intertrochanteric fracture treated by the dynamic hip screw (DHS) who had a minimal follow-up of 3 months and an average follow-up of 14.6 months and long term survival data. The amount of fracture collapse and shortening due to sliding of the DHS was determined at the latest follow-up and graded as minimal (<1 cm), moderate (1-2 cm), or severe (>2 cm). With increased severity of collapse, more patients were unable to maintain their premorbid walking function (minimal collapse = 34.2%, moderate = 33.3%, severe = 62.8%, and p = 0.028). Based on ordinal regression of risk factors, increased fracture collapse was significantly and independently related to increasing age (p = 0.037), female sex (p = 0.024), A2 fracture class (p = 0.010), increased operative duration (p = 0.011), poor reduction quality (p = 0.000), and suboptimal tip-apex distance of >25 mm (p = 0.050). Patients who had better outcome in terms of walking function were independently predicted by younger age (p = 0.036), higher MMSE marks (p = 0.000), higher MBI marks (p = 0.010), better premorbid walking status (p = 0.000), less fracture collapse (p = 0.011), and optimal lag screw position in centre-centre or centre-inferior position (p = 0.020). According to Kaplan-Meier analysis, fracture collapse had no association with mortality from 2.4 to 7.6 years after surgery. In conclusion, increased fracture collapse after fixation of geriatric intertrochanteric fractures adversely affected walking but not survival. PMID:26955637

  4. Anterograde Fixation Module for Posterior Acetabular Column Fracture: Computer-Assisted Determination of Optimal Entry Point, Angle, and Length for Screw Insertion

    PubMed Central

    Xu, Yongqiang; Lin, Chuangxin; Zhang, Lifeng; Lin, Miaoxiong; Lai, Jianqiang; Cao, Shenglu; Peng, Geng; Feng, Kai; Yan, Ge; Cai, Daozhang; Wang, Gang

    2016-01-01

    Background The aim of this study was to provide valid data for a plate-screw fixation model for fractured posterior-anterior columns of the acetabulum. Material/Methods Nineteen cadaveric bony hemi-pelvis specimens were obtained and 50 healthy adults were enrolled. The modified Stoppa approach and computed tomography (CT) imaging were used to collect the measured parameter data of the module. Results The measured parameter data were as follows: OP, 0.96±0.32 cm in females and 0.92±0.16 cm in males (P>0.05); PI, 0.98±0.28 cm in females, and 0.75±0.23 cm in males (P>0.05); ∠θ, 59.68°±6.28° in females and 56.75°±3.22° in males (P>0.05); and ∠ϕ, 41.27°±2.76° in females and 34.31°±2.78° in males (P<0.05). The corresponding CT image data were as follows: PI, 1.08±0.22 cm in females and 0.85±0.27 cm in males (P>0.05); OP, 1.06±0.29 cm in females and 1.12±0.24 cm in males (P>0.05); ∠θ, 55.33°±4.00° in females and 55. 50°±3.43° in males (P>0.05); and ∠ϕ was 39.21°±2.45°in females and 35.58°±2.31°in males (P<0.05). No significant difference with respect to sex and side existed between specimens and healthy adults (P>0.05). Conclusions The measured parameter data obtained in healthy adults and cadaveric specimens provided an anatomic basis for the designation of the guide module, and thus confirmed the accuracy and safety of screw placement in fractured columns of the acetabulum. PMID:27584820

  5. Anterograde Fixation Module for Posterior Acetabular Column Fracture: Computer-Assisted Determination of Optimal Entry Point, Angle, and Length for Screw Insertion.

    PubMed

    Xu, Yongqiang; Lin, Chuangxin; Zhang, Lifeng; Lin, Miaoxiong; Lai, Jianqiang; Cao, Shenglu; Peng, Geng; Feng, Kai; Yan, Ge; Cai, Daozhang; Wang, Gang

    2016-01-01

    BACKGROUND The aim of this study was to provide valid data for a plate-screw fixation model for fractured posterior-anterior columns of the acetabulum. MATERIAL AND METHODS Nineteen cadaveric bony hemi-pelvis specimens were obtained and 50 healthy adults were enrolled. The modified Stoppa approach and computed tomography (CT) imaging were used to collect the measured parameter data of the module. RESULTS The measured parameter data were as follows: OP, 0.96±0.32 cm in females and 0.92±0.16 cm in males (P>0.05); PI, 0.98±0.28 cm in females, and 0.75±0.23 cm in males (P>0.05); Ðϴ, 59.68°±6.28° in females and 56.75°±3.22° in males (P>0.05); and Ðφ, 41.27°±2.76° in females and 34.31°±2.78° in males (P<0.05). The corresponding CT image data were as follows: PI, 1.08±0.22 cm in females and 0.85±0.27 cm in males (P>0.05); OP, 1.06±0.29 cm in females and 1.12±0.24 cm in males (P>0.05); Ðϴ, 55.33°±4.00° in females and 55. 50°±3.43° in males (P>0.05); and Ðφ was 39.21°±2.45°in females and 35.58°±2.31°in males (P<0.05). No significant difference with respect to sex and side existed between specimens and healthy adults (P>0.05). CONCLUSIONS The measured parameter data obtained in healthy adults and cadaveric specimens provided an anatomic basis for the designation of the guide module, and thus confirmed the accuracy and safety of screw placement in fractured columns of the acetabulum. PMID:27584820

  6. Outcome of humeral shaft fractures treated by functional cast brace

    PubMed Central

    Pal, Jitendra Nath; Biswas, Prahas; Roy, Avik; Hazra, Sunit; Mahato, Somnath

    2015-01-01

    Background: Functional brace application for isolated humeral shaft fracture persistently yields good results. Nonunion though uncommon involves usually the proximal third shaft fractures. Instead of polyethylene bivalve functional brace four plaster sleeves wrapped and molded with little more proximal extension expected to prevent nonunion of proximal third fractures. Periodic compressibility of the cast is likely to yield a better result. This can be applied on the 1st day of the presentation as an outpatient basis. Comprehensive objective scoring system befitting for fracture humeral shaft is a need. Materials and Methods: Sixty six (male = 40, female = 26) unilateral humeral shaft fractures of mean age 34.4 years (range 11–75 years) involving 38 left and 28 right hands were included in this study during April 2008 to December 2012. Fractures involved proximal (n = 18), mid (n = 35) and distal (n = 13) of humerus. Transverse, oblique, comminuted and spiral orientations in 18, 35 and 13 patients respectively. One had segmental fracture and three had a pathological fracture with cystic bone lesion. Mechanisms of injuries as identified in this study were road traffic accidents 57.6% (n = 38), fall 37.9% (n = 25). 12.1% (n = 8) had radial nerve palsy 7.6% (n = 5) had Type I open fracture. Four plaster strips of 12 layers and 5–7.5 cm broad depending on the girth of arm were prepared. Arm was then wrapped with single layer compressed cotton. Lateral and medial strips were applied and then after molding anterior and posterior strips were applied in such a way that permits full elbow range of motion and partial abduction of the shoulder. Care was taken to prevent adherence of one strip with other except in the proximal end. Limb was then put in loose collar and cuff sling intermittently allowing active motion of the elbow ROM and pendular movement of the shoulder. Weekly tightening of the cast by fresh layers of bandage over the existing cast brace continued

  7. An interdisciplinary approach to treat crown-root-fractured tooth

    PubMed Central

    Sun, Ying Chun; Li, Ying; Tong, Jian; Gao, Ping

    2013-01-01

    Restoration of a crown-root subgingival fractured tooth, especially at anterior aesthetic zones is still a great challenge for restorative dentists. Crown lengthening procedure alone has the disadvantage of high gingival curve of the final restoration, which was not discontinuous to adjacent teeth and thus compromise cosmetic outcomes. The objective of this report is to display a new interdisciplinary approach which combining endodontic root canal treatment, orthodontic extrusion, periodontal crown lengthening surgery and prosthodontic post-core-crown restoration procedures to restore a crown-root subgingival fractured maxillary central incisor and achieved a satisfied cosmetic result. Computer-based spectrophotometer was also used to accurately select colour without objective interference to achieve ideal cosmetic effects. PMID:24249958

  8. An interdisciplinary approach to treat crown-root-fractured tooth.

    PubMed

    Sun, Ying Chun; Li, Ying; Tong, Jian; Gao, Ping

    2013-07-01

    Restoration of a crown-root subgingival fractured tooth, especially at anterior aesthetic zones is still a great challenge for restorative dentists. Crown lengthening procedure alone has the disadvantage of high gingival curve of the final restoration, which was not discontinuous to adjacent teeth and thus compromise cosmetic outcomes. The objective of this report is to display a new interdisciplinary approach which combining endodontic root canal treatment, orthodontic extrusion, periodontal crown lengthening surgery and prosthodontic post-core-crown restoration procedures to restore a crown-root subgingival fractured maxillary central incisor and achieved a satisfied cosmetic result. Computer-based spectrophotometer was also used to accurately select colour without objective interference to achieve ideal cosmetic effects.

  9. Fracture strength of endodontically treated premolars: An In-vitro evaluation

    PubMed Central

    Pradeep, PR; Kumar, VC Sunil; Bantwal, Sunil Rao; Gulati, Gurinderjeet Singh

    2013-01-01

    Background: The aim of this study is to measure the invitro fracture strength of endodontically treated maxillary premolars restored with silver amalgam, composite resins and bonded amalgam. Materials & Methods: Sixty mature maxillary premolars free of caries, restoration or fracture extracted for orthodontic purpose or periodontal reasons were selected. The teeth were randomly divided into six groups of 10 teeth each. Group I: Intact teeth, Group II: Access opening only, Group III: Standard MOD cavity preparation + superimposed endodontic access (Unrestored). In Group IV, Group V & Group VI preparation was done as in Group III and they were restored with amalgam, bonded amalgam and composite resins respectively. All the teeth were thermo cycled and were mounted on custom made rings and the fracture strength was calculated with an Instron testing machine and the results were analysed statistically. Results: Group I showed the highest fracture resistance followed by Group II . The difference in the values between the two groups were not significant. Group III showed the lowest fracture resistance the decrease in fracture strength was highly statistically significant when compared to all other groups investigated in the present study. Fracture strength of teeth restored with Group IV, Group V, Group VI did not differ significantly from each other. Conclusion: Fracture strength of intact natural teeth was superior to all the teeth tested in the study. Fracture strength of endodontically treated teeth restored with conventional amalgam, bonded amalgam and composite resin did not differ significantly from each other. Bonding of restorations to tooth structure has failed to bring about any improvement in the strength of the teeth tested. How to cite this article: Pradeep PR, Kumar VC, Bantwal SR, Gulati GS. Fracture strength of endodontically treated premolars: An In-vitro evaluation. J Int Oral Health 2013; 5(6):9-17 . PMID:24453439

  10. Porous Tantalum Buttress Augments for Severe Acetabular Posterior Column Deficiency.

    PubMed

    Meneghini, R Michael; Hull, Jason R; Russo, Glenn S; Lieberman, Jay R; Jiranek, William A

    2015-11-01

    In revision total hip arthroplasty (THA), consensus is lacking regarding the optimal method for reconstruction of the most severe acetabular defects. Porous tantalum (TM) buttress augments were designed for the most severe postero-superior defects. The purpose of this study was to report the results of a consecutive series of acetabular reconstructions utilizing TM buttress augments. Eight complex acetabular reconstructions utilizing a TM buttress augment were performed at two centers. All were Paprosky 3A or Paprosky 3B bone loss classification, with severe superior and posterior column deficiency where wedge augments were insufficient for mechanical support. The acetabular cup sizes ranged from 64-78, and a buttress shim was used in 7 of 8 cases. Clinical and radiographic follow-up averaged 16.5 months (range, 10-28) and no cases were lost to follow-up. There were no cases of clinical or radiographic loosening, and no case had required reoperation or revision. All patients except one were ambulating with either no assist device or a single cane at final follow-up. There was one complication of an iliac wing fracture noted incidentally on postoperative x-rays in the lone patient in whom a buttress shim was not used. At short-term follow-up, TM acetabular buttress augments appear to effectively substitute for the use of structural allografts or cages, which would otherwise be used in this challenging setting. The potential for biologic fixation is promising for the durability of these reconstructions; however, longer-term follow-up is required for full evaluation.

  11. Options for acetabular fixation surfaces.

    PubMed

    Klika, Alison K; Murray, Trevor G; Darwiche, Hussein; Barsoum, Wael K

    2007-01-01

    Aseptic loosening is the most common cause for revision total hip arthroplasty (THA). Due to poor long-term results with cemented acetabular components, cementless implants that rely on biologic fixation became popular in the United States for both primary and revision procedures in the early 1980s. Cementless acetabular components used in THA have been reported to have superior radiographic performance compared with cemented fixation, although the optimal method of acetabular fixation remains controversial. Cementless acetabular components require initial implant stability to allow for bone ingrowth and remodeling into the acetabular shell, providing long-term durability of the prosthesis. Many improved implant materials are available to facilitate bone growth and remodeling, including the 3 most common surface treatments; fibermesh, sintered beads, and plasma spray coatings. Recently added to these are porous metal surfaces, which have increased porosity and optimal pore sizes when compared with titanium fibermesh. The most studied of these materials is the titanium fibermesh fixation surface, which has demonstrated a mechanical failure rate of 1% at 10 to 15 years. This technology utilizes the diffusion bonding process to attach fiber metal pads to a titanium substrate using heat and pressure. The sintered bead fixation surface offers a porous coating of various sizes of spherical beads, achieved by the sintering process, and has been shown to provide long-term fixation. While there are less long-term published data regarding the titanium plasma spray surface, its early results have provided evidence of its durability, even in the face of significant osteolysis. The most recently added alternative fixation surface is porous tantalum metal, which offers potentially greater bone ingrowth and bone graft incorporation due to its high porosity (80%) and low modulus of elasticity (3 MPa). Porous tantalum implants have shown early favorable clinical results and have

  12. Progression of a Fracture Site Impaction as a Prognostic Indicator of Impacted Femoral Neck Fracture Treated with Multiple Pinning

    PubMed Central

    Yoon, Pil Whan; Shin, Young Ho; Yoo, Jeong Joon; Yoon, Kang Sup

    2012-01-01

    Background We evaluated the clinical and radiologic results of impacted femoral neck fractures treated with multiple pinning and determined the influence of the progression of impaction at the fracture site on clinical outcome. Methods There were 34 patients with a mean age of 65.5 years. The mean follow-up period was 3.4 years. Progression of fracture site impaction was measured using an articulo-trochanteric distance index and the percentage decrease in the articulo-trochanteric distance index between follow-up intervals. The failure of treatment was clarified as non-union and avascular necrosis. Other characteristics of the patients, including mean waiting time for surgery, preoperative Singh index score, and body mass index, were also measured to evaluate the influence on the clinical outcome of surgery. Results There were 6 fractures which were not treated successfully (3 non-union, 8.8% and 3 avascular necrosis, 8.8%). The mean percentage decrease of the articulo-trochanteric distance index within the first 6 weeks after surgery was 4.5% in the successful group and 25.1% in the failure group (p < 0.001). There was also a significant mean percentage decrease in the articulo-trochanteric distance index between 6 weeks and 3 months (p < 0.001). Conclusions Primary stabilization with Knowles pins for impacted femoral neck fractures had a reasonable clinical outcome with low morbidity. Despite a significant difference of a mean percentage decrease in the articulo-trochanteric distance index between the successful group and the failure group, we could not verify it as a risk factor for failure of treatment because the odds ratio was not statistically significant. PMID:22379557

  13. [Fractures of the acetabulum: complications and joint replacement].

    PubMed

    Herath, S C; Holstein, J H; Pizanis, A; Pohlemann, T

    2014-08-01

    Acetabular fractures assume a special role amongst the fractures of the pelvis, because they involve a major weight-bearing joint. As those fractures mostly result from exposure to great force, and because of their location in an anatomically complex region, a high rate of complications has to be anticipated. Besides general and perioperative complications long-term consequences, especially post-traumatic arthrosis, are relevant problems when it comes to treating fractures of the acetabulum. The primary reconstruction of the acetabulum, as well as a possibly necessary prosthetic replacement of the hip joint, makes high demands on the diagnostic and operative capabilities of the attending physician. Exact knowledge of the specific risks and pitfalls for each type of fracture and for the specific surgical techniques is crucial for a successful treatment. Due to the much worse long-term outcome when compared to primary total hip replacement in patients with osteoarthritis, acetabular fractures should, regardless of the patient's age, whenever possible be treated by operative reconstruction.

  14. Acetabular Reconstruction in Total Hip Arthroplasty.

    PubMed

    Shon, Won Yong; Santhanam, Siva Swaminathan; Choi, Jung Woo

    2016-03-01

    The difficulties encountered in dealing with the bone deficient acetabulum are amongst the greatest challenges in hip surgery. Acetabular reconstruction in revision total hip arthroplasty can successfully be achieved with hemispherical components featuring a porous or roughened ingrowth surface and options for placement of multiple screws for minor acetabular defect. Acetabular component selection is mostly based on the amount of bone loss present. In the presence of combined cavitary and segmental defects without superior acetabular coverage, reconstructions with a structural acetabular allograft protected by a cage or a custom-made triflange cage have been one of preferred surgical options. The use of a cage or ring over structural allograft bone for massive uncontained defects in acetabular revision can restore host bone stock and facilitate subsequent rerevision surgery to a certain extent. But high complication rates have been reported including aseptic loosening, infection, dislocation and metal failure. On the other hand, recent literature is reporting satisfactory outcomes with the use of modular augments combined with a hemispherical shell for major acetabular defect. Highly porous metals have been introduced for clinical use in arthroplasty surgery over the last decade. Their higher porosity and surface friction are ideal for acetabular revision, optimizing biological fixation. The use of trabecular metal cups in acetabular revision has yielded excellent clinical results. This article summarizes author's experience regarding revision acetabular reconstruction options following failed hip surgery including arthroplasty. PMID:27536638

  15. Intertrochanteric fractures in elderly high risk patients treated with Ender nails and compression screw

    PubMed Central

    Gangadharan, Sidhartha; Nambiar, MR

    2010-01-01

    Background: Ender and Simon Weidner popularized the concept of closed condylocephlic nailing for intertrochanteric fractures in 1970. The clinical experience of authors revealed that Ender nailing alone cannot provide secure fixation in elderly patients with osteoporosis. Hence we conducted a study to evaluate the efficacy of a combined fixation procedure using Ender nails and a cannulated compression screw for intertrochanteric fractures. Materials and Methods: 76 patients with intertrochanteric fractures were treated using intramedullary Ender nails and cannulated compression screw from January 2004 to December 2007. The mean age of the patients was 80 years (range 70-105 years).Using the Evan’s system of classification 49 were stable and 27 unstable fractures. Inclusion criteria was high risk elderly patients (age > 70 years) with intertrochanteric fracture. The exclusion criteria included patients with pressure sores over the trochanteric region. Many patients had pre-existing co-morbidities like diabetes mellitus, hypertension, COPD, ischemic heart disease, CVA and coronary artery bypass surgery. The two Ender nails of 4.5mm each were passed across the fracture site into the proximal neck. This was reinforced with a 6.5 mm cannulated compression screw passed from the sub trochanteric region, across the fracture into the head. Results: The mean follow-up was 14 months (range 9-19 months) Average time to fracture union was 10 weeks (range 6-16 weeks). The mean knee ROM was 130° (± 5°). There was no case of nail penetration into hip joint. In five cases with advanced osteoporosis there was minimal migration of Ender nails distally. Conclusions: The Ender nailing combined with compression screw fixation in cases of intertrochanteric fractures in high risk elderly patients could achieve reliable fracture stability with minimal complications. PMID:20697482

  16. UNSTABLE FEMORAL FRACTURES TREATED WITH TITANIUM ELASTIC INTRAMEDULLARY NAILS, IN CHILDREN

    PubMed Central

    Soni, Jamil Faissal; Schelle, Gisele; Valenza, Weverley; Pavelec, Anna Carolina; Souza, Camila Deneka Arantes

    2015-01-01

    Objective: To evaluate the indications, epidemiology, associated lesions, complications and prognosis among children with unstable femoral diaphysis fractures who were treated with titanium elastic intramedullary nails. Method: This was a retrospective analysis on 24 patients aged 5-12 years with unstable femoral diaphysis fractures who underwent surgical treatment with elastic titanium intramedullary nails at the Cajuru University Hospital, Curitiba-PR, between April 2002 and March 2008, with a minimum follow-up of 36 months. The epidemiological data, angular deviations, leg shortening and bone consolidation were evaluated. Results: The medical files of 113 cases operated between April 2002 and March 2008 were reassessed. From these, 24 cases of unstable femoral diaphysis fractures treated with elastic titanium intramedullary nails with retrograde insertion were included in the study. There were two bilateral fractures and two exposed fractures. Seven patients were female and 17 were male, and the mean age was 8.3 years. The following were presented at the end of the study: shortening, varus or valgus displacement, final retrocurvatum or antecurvatum of zero, and absence of delayed consolidation or pseudarthrosis. Conclusions: The elastic titanium intramedullary nails were easily placed and removed. We believe that using elastic titanium intramedullary nails is a good option for fixation of unstable femoral fractures in children. PMID:27047868

  17. In vivo fractures of endodontically treated posterior teeth restored with amalgam.

    PubMed

    Hansen, E K; Asmussen, E; Christiansen, N C

    1990-04-01

    The cumulative survival rate (retention of both cusps) and the fracture pattern of 1639 endodontically treated posterior teeth were assessed in a retrospective study. All teeth had an MO/DO or an MOD cavity restored with amalgam without cuspal overlays. The 20-year survival rate of teeth with an MO/DO cavity was markedly higher than that of teeth with an MOD cavity. The lowest survival rate was found for the upper premolars with an MOD cavity: 28% of these teeth fractured within 3 years after endodontic therapy, 57% were lost after 10 years, and 73% after 20 years. Generally, the cusp most prone to fracture was the lingual one, and lingual fractures caused significantly more damage to the periodontal tissues than did facial or total crown fractures. The severity of periodontal damage increased with posterior location of the tooth. By far the most serious failures, irrespective of the cavity type, were found for the upper second molar, as 10 of 29 fractures led to extraction. It is concluded that amalgam, especially in MOD cavities, is an unacceptable material for restoration of endodontically treated posterior teeth if used without cuspal overlays. PMID:2132209

  18. Long Term Results of Liner Polyethylene Cementation Technique in Revision for Peri-acetabular Osteolysis.

    PubMed

    Rivkin, Gurion; Kandel, Leonid; Qutteineh, Bilal; Liebergall, Meir; Mattan, Yoav

    2015-06-01

    Patients with peri-acetabular osteolysis around a well fixed cementless acetabular component may be treated with liner exchange. When the locking mechanism is unreliable or unavailable, cementing the liner into the fixed acetabular component is a feasible option. The purpose of this study was to evaluate the clinical and radiographic long term results of this technique. Forty hip revisions with liner cementation in 37 patients were performed. The minimum follow up was 10 years. Modified Harris Hip Score and recent x rays were reviewed. Four hips were re-revised. Two patients were diagnosed with exacerbation of osteolysis but refused revision. Dislocation rate was relatively high (16%). Liner cementation technique in revision hip surgery is useful in patients with a well fixed metal backed acetabular component.

  19. Nonoperatively treated forearm shaft fractures in children show good long-term recovery

    PubMed Central

    Sinikumpu, Juha-Jaakko; Victorzon, Sarita; Antila, Eeva; Pokka, Tytti; Serlo, Willy

    2014-01-01

    Background and purpose — The incidence of forearm shaft fractures in children has increased and operative treatment has increased compared with nonoperative treatment in recent years. We analyzed the long-term results of nonoperative treatment. Patients and methods — We performed a population-based age- and sex-matched case-control study in Vaasa Central Hospital, concerning fractures treated in the period 1995–1999. There were 47 nonoperatively treated both-bone forearm shaft fractures, and the patients all participated in the study. 1 healthy control per case was randomly selected and evaluated for comparison. We analyzed clinical and radiographic outcomes of all fractures at a mean of 11 (9–14) years after the trauma. Results — The main outcome, pronosupination of the forearm, was not decreased in the long term. Grip strength was also equally as good as in the controls. Wrist mobility was similar in flexion (85°) and extension (83°) compared to the contralateral side. The patients were satisfied with the outcome, and pain-free. Radiographally, 4 cases had radio-carpal joint degeneration and 4 had a local bone deformity. Interpretation — The long-term outcome of nonoperatively treated both-bone forearm shaft fractures in children was excellent. PMID:25238437

  20. Fracture resistance of endodontically treated single rooted premolars restored with Sharonlay: An in vitro study

    PubMed Central

    Sharath Chandra, S. M.; Agrawal, Nishtha; Sujatha, I.; Sivaji, K.

    2016-01-01

    Aims: The aim of this study is to compare in vitro the fracture resistance of the endodontically treated tooth restored with a novel design Sharonlay, with the two component restorative method, i.e., post with separate onlay, and onlay without post. Subjects and Methods: 45 single-rooted mandibular second premolars were taken, and root canal treatment was performed. Teeth were then randomly divided into three groups (n = 15) based on the type of restoration given: Group I - metal onlay with cast post extension (Sharonlay), Group II - metal onlay with prefabricated metal post (Mani post system), Group III - metal onlay over endodontically treated tooth obturated with Gutta-percha (control group). Fracture resistance was checked using the Instron universal testing machine and the fracture patterns were analyzed. Results: According to the values recorded, Group I showed maximum mean fracture resistance followed by Groups II and III. Statistically significant difference was found between Groups I and II and Groups I and III and statistically significant difference was found between Groups II and III. Conclusion: A single unit component Sharonlay, gives higher fracture resistance to a premolar as compared to (a) metal onlay with prefabricated metal post and (b) metal onlay over endodontically treated tooth. PMID:27217643

  1. Magnetic resonance evaluation of acetabular residual dysplasia in developmental dysplasia of the hip: a preliminary study of 27 patients.

    PubMed

    Douira-Khomsi, Wièm; Smida, Mahmoud; Louati, Hela; Hassine, Lilia Ben; Bouchoucha, Sami; Saied, Walid; Ladeb, Mohamed-Fethi; Ghachem, Maher Ben; Bellagha, Ibtissem

    2010-01-01

    Thirty-one hips in 27 young girls, treated for developmental dysplasia of the hip in the authors' institute since 2003, showed persistent radiographic evidence of residual acetabular dysplasia. These hips were registered as candidates for pelvic osteotomy. A prospective study was conducted and these hips were evaluated by magnetic resonance imaging (MRI); the average age of the patients was 5 years. MRI measurement of acetabular angle and acetabular head index in 2 different landmarks (bone and cartilage) was performed. The results were correlated with plain radiographic film evolution. MRI studies revealed sufficient cartilaginous acetabular coverage in 27 hips, cartilaginous acetabular dysplasia in 2 hips, and short acetabulum in 2 others. The 27 hips with thick cartilage of the acetabular roof were subsequently followed up by plain radiographs. The average follow-up period was 2.1 years. The authors observed a spontaneous progressive ossification of the cartilaginous acetabular roof in all the 27 cases. In 4 cases, the correction of the acetabular angle was complete. They concluded that MRI promotes more accurate selection of patients for pelvic osteotomy and aids in the choice of the most appropriate type of osteotomy. Clinical imaging examples are presented and need to be further evaluated.

  2. Fracture resistance of endodontically treated teeth restored with a bulkfill flowable material and a resin composite

    PubMed Central

    Isufi, Almira; Plotino, Gianluca; Grande, Nicola Maria; Ioppolo, Pietro; Testarelli, Luca; Bedini, Rossella; Al-Sudani, Dina; Gambarini, Gianluca

    2016-01-01

    Summary Aim To determine and compare the fracture resistance of endodontically treated teeth restored with a bulk fill flowable material (SDR) and a traditional resin composite. Methods Thirty maxillary and 30 mandibular first molars were selected based on similar dimensions. After cleaning, shaping and filling of the root canals and adhesive procedures, specimens were assigned to 3 subgroups for each tooth type (n=10): Group A: control group, including intact teeth; Group B: access cavities were restored with a traditional resin composite (EsthetX; Dentsply-Italy, Rome, Italy); Group C: access cavities were restored with a bulk fill flowable composite (SDR; Dentsply-Italy), except 1.5 mm layer of the occlusal surface that was restored with the same resin composite as Group B. The specimens were subjected to compressive force in a material static-testing machine until fracture occurred, the maximum fracture load of the specimens was measured (N) and the type of fracture was recorded as favorable or unfavorable. Data were statistically analyzed with one-way analysis of variance (ANOVA) and Bonferroni tests (P<0.05). Results No statistically significant differences were found among groups (P<0.05). Fracture resistance of endodontically treated teeth restored with a traditional resin composite and with a bulk fill flowable composite (SDR) was similar in both maxillary and mandibular molars and showed no significant decrease in fracture resistance compared to intact specimens. Conclusions No significant difference was observed in the mechanical fracture resistance of endodontically treated molars restored with traditional resin composite restorations compared to bulk fill flowable composite restorations. PMID:27486505

  3. Evaluation of Tibial Condyle Fractures Treated with Ilizarov Fixation, A Prospective Study

    PubMed Central

    Reddy R, Sandeep; Shah, Harshad M; Golla, Dinesh Kumar; Ganesh D J, Niranthara; Kumar P, Ashok

    2014-01-01

    Background: Tibial plateau fractures are associated with significant soft tissue injuries which increases the risks of complications and must be considered when managing tibial plateau fractures. Various modalities of treatment are available for treatment of these fractures but Ilizarov fixation has a special advantage over others. Review of literature shows many studies of Ilizarov fixation in the treatment of tibial plateau fractures with variable results. Aim of our study was to evaluate tibial condyle fractures treated by Ilizarov fixation. Materials and Methods: Study included 43 patients with Schatzker type II and above tibial plateau fractures treated by ilizarov fixation. Standard trauma evaluation, a meticulous musculoskeletal and neurologic examination was carried out. All patients underwent Ilizarov fixation by same team of surgeons. Clinicoradilogical assessment of the patients carried out at regular intervals. Results: Our study included 43 cases of tibial plateau of various types except type I. Mean time for radiological union was 24.51 wk (range 15 to 32 wk). Mean fixator period was 26.6 wk( 16-34 wk). The functional results were measured by Lyshom’s and Hohl and Luck score. The mean Lyshom’s score was at the end of one year was 82.16. At end of one year by Hohl and Luck grading 11 patients had fair, 23 had good and 9 had excellent results. Conclusion: High energy tibial plateau fractures can be definitively treated with Ilizarov external fixation. Treatment with this method gives good union rates and less risk of infection. Closed reduction, minimal soft tissue damage and early mobilization are the key to low complications. PMID:25584250

  4. EPIDEMIOLOGICAL PROFILE OF PATIENTS WITH PROXIMAL HUMERUS FRACTURE TREATED AT HOSPITAL SÃO PAULO, BRAZIL

    PubMed Central

    de Oliveira, Ana Paula Cortes; Mestieri, Mariana Christovam; Pontin, José Carlos Baldocchi

    2015-01-01

    ABSTRACT Objective: To analyze the epidemiological aspects of proximal humerus fractures and describe the profile of patients with proximal humerus fractures hospitalized and treated at Hospital São Paulo, between 2008 and 2013. Methods: Hospital records were retrospectively analyzed for surgically treated patients diagnosed with proximal humerus fracture. Age, gender, injury mechanism, length of hospital stay, performed treatment and associated diseases were considered. Results: From all patients studied, 52 were female at their sixth decade of life. As for the injury mechanism, fall from height was the main cause for women (88.46%) and for man it was motorcycle accidents (31.42%). Fixation with locked plate was the most frequently used treatment. Conclusion: Most patients were female in their fifth decade of life, injured mainly by fall from height. Fixation with locked plate was the most frequently used treatment and the patients were admitted for 7 days, on average. Level of Evidence II, Retrospective Study. PMID:26981037

  5. A technique to remove a well-fixed titanium-coated RM acetabular cup in revision hip arthroplasty.

    PubMed

    Judas, Fernando M J; Dias, Rui F; Lucas, Francisco M

    2011-01-01

    A major concern during revision hip arthroplasty is acetabular bone loss and bleeding during the extraction of well-fixed cementless acetabular cup, because no interface exists between the host bone and the cup. Forceful removal of such component using curved gouges and osteotomes often leads to extended bone loss and compromises reimplantation of a new socket. In the following case report, we removed a well-fixed polyethylene titanium-coated RM acetabular cup with 20 years of follow-up, by significant wear of the polyethylene layer. The isoelastic femoral stem was also removed by mechanical failure. We report a technique for removal of the cementless acetabular cup using powered acetabular reamers. The RM cup was sequentially reamed and when the polyethylene layer was thin enough, the remaining cup was removed easily by hand tools. The acetabular bone stock is preserved and the risks of bone fractures and bleeding are minimized. To our knowledge, these principles were applied only in cemented cups. We have used this technique in 10 cases with excellent results and no complications were noted. This is a simple, reproducible, non-costly, non-timing consuming, safe and successful technique to remove well-fixed titanium-coated RM acetabular cups.

  6. Effect of Different Instrumentation Techniques on Vertical Root Fracture Resistance of Endodontically Treated Teeth

    PubMed Central

    Tavanafar, Saeid; Karimpour, Azadeh; Karimpour, Hamideh; Mohammed Saleh, Abdulrahman; Hamed Saeed, Musab

    2015-01-01

    Statement of the Problem Vertical root fractures are catastrophic events that often result in tooth extraction. Many contributing factor are associated with increasing incidence of vertical root fracture. Root canal preparation is one of the predisposing factors which can increase the root susceptibility to vertical fracture. Purpose The aim of this study was to compare the effects of three different instrumentation techniques on vertical root fracture resistance of endodontically treated teeth. Materials and Methods In this study, 120 freshly extracted mandibular premolar teeth of similar dimensions were decoronated and randomly divided into control (n=30), nickel-titanium hand K-file (HF, n=30), BioRaCe rotary file (BR, n=30), and WaveOne reciprocating single-file (WO, n=30) groups. After cleaning and shaping the root canals, AH26 was used as canal sealer, and obturation was completed using the continuous wave technique. The root canals were embedded vertically in standardised autopolymerising acrylic resin blocks, and subjected to a vertical load to cause vertical root fracture. The forces required to induce fractures were measured using a universal testing machine. ANOVA and Tukey’s post-hoc test were used to analyse the data. Results All experimental groups showed statistically significant reductions in fracture resistance as compared with the control group. There was a statistically significant difference between the HF and BR groups. The WO group did not differ significantly from the HF group or the BR group. Conclusion All three instrumentation techniques caused weakening of the structure of the roots, and rendered them susceptible to fracture under lesser load than unprepared roots. The fracture resistance of roots prepared with the single-file reciprocating technique was similar to that of those prepared with NiTi hand and rotary instrumentation techniques. PMID:26106635

  7. [Importance of revision- and tumor-endoprosthetics in the treatment of periprosthetic fractures of the lower extremity].

    PubMed

    Prodinger, P M; Harrasser, N; Suren, C; Pohlig, F; Mühlhofer, H; Schauwecker, J; von Eisenhart-Rothe, R

    2016-04-01

    Periprosthetic fractures of hip and knee prostheses are gaining clinical significance due to the increasing numbers of of primary arthroplasties. Additionally, these fractures are often associated with poor bone quality or present in patients after multiple revision procedures and concomitant excessive bone defects precluding those patients to be adequately treated by conventional osteosynthesis. Revision implants provide a wide range of options for the treatment of these fractures in order to achieve good clinical results. In the acetabular region cavitary defects associated with periprosthetic fractures can be treated by the use of megacups. Extensive segmental defects and pelvic discontinuity necessitate the use of cups with additional iliac support or even customized implants. Proximal femoral fractures can usually be fixed with modular stems and diaphyseal anchorage. Periprosthetic knee joint fractures can be treated with revision implants with modular sleeves or augment-combinations allowing sufficient bridging of bony defects. Functional reconstruction or refixation of the extensor mechanism is of crucial importance. PMID:27008214

  8. Pulmonary embolism following ankle fractures treated without an operation - an analysis using National Health Service data.

    PubMed

    Jameson, Simon S; Rankin, Kenneth S; Desira, Nicola L; James, Philip; Muller, Scott D; Reed, Mike R; Rangan, Amar

    2014-08-01

    The majority of ankle fractures are stable and can be treated without an operation, most commonly with cast immobilisation. Based on concerns regarding the risk of a venous thromboembolic event (VTE) while immobilised, there is currently debate as to whether these patients should receive VTE prophylaxis for the duration of treatment. Rates of pulmonary embolism (PE) in this patient group are unknown. This retrospective cohort study was designed to identify patients treated without an operation for ankle fracture and determine the occurrence of PE and inpatient mortality within 90 days of injury using the English National Health Service administrative databases. Logistic regression models were used to assess the influence of age, gender and Charlson co-morbidity score on these outcomes. We identified 14777 adult patients over a 54-month period (April 2007-September 2011) that met our linkage and inclusion criteria (isolated, unilateral closed ankle fracture that did not require hospitalisation). Mean age was 46.4 years (range 18-99) and the majority had a Charlson 0 score (97.7%). There were 32 (0.22%) PEs within 90 days of the fracture (including in one patient who subsequently died). After adjustment, Charlson score of ≥1 was associated with a greater risk of PE (Odds ratio = 11.97, p < 0.001) compared to Charlson 0. Risk for these patients was 2.08%. In total, fifteen patients (0.11%) died in hospital within 90 days. Pulmonary embolism is rare following ankle fractures treated without an operation. Patients with multiple co-morbidities are at a higher risk. Based on this evidence, an ankle fracture treated without an operation does not appear to be an indication for routine VTE prophylaxis.

  9. Outcome of unstable fractures of metacarpal and phalangeal bones treated by bone tie

    PubMed Central

    Kamath, Jagannath B; Jayasheelan, Nikil; Savur, Amaranth; Mathews, Rejith

    2016-01-01

    Background: Unstable fractures of the metacarpal and phalangeal bones of the hand need surgical stabilization which should be rigid enough for early active mobilization. Conventional methods of open reduction and stabilization in the form of composite fixation or screws with or without plates have served the purpose but can be definitely improvised addressing both biological and mechanical principles of fixation. Materials and Methods: 34 patients (29 males and 5 females) with an average age of 32 years (range 10–64 years) with unstable fractures of the metacarpal and phalangeal bones of hand who were treated with the modified bone tie between June 2009 and June 2013 were included in this study. 42 fractures, involving the 31 metacarpals and 11 phalanges were included. We have not used this technique in fractures involving the terminal phalanges. Thirty nine of the fractures were treated with K-wires along with the modified bone tie, whereas the other two cases were treated with modified bone tie alone and in one case the bone tie has been used along with the external fixator. The nature of injuries were Road Traffic Accident (n = 24), domestic/industrial injuries (n = 8) and blast (n = 2) injuries. Etiology was crush (n = 24), blunt (n = 7) and incised (n = 3) injuries, respectively. Twenty seven patients were involved with single fractures (either metacarpal or the phalanges), 6 patients had two fractures (both metacarpals or phalanges or one each of metacarpal and phalanx), and 1 patient had three fractures in this study. Dominant hand was involved in 14 patients (40%). Results: We achieved excellent to good results in 83% of 42 fractures within an average period of 10 weeks. Postoperative grip strength of 85% was achieved with in an average period of 12 weeks. Twenty six (20 metacarpals and 6 phalanges) of the 42 fractures regained >85% of the total active movements (TAMs) compared to the contralateral side were considered excellent results. All patients were

  10. Imaging of the acetabular labrum.

    PubMed

    Thomas, James D; Li, Zhi; Agur, Anne M; Robinson, Philip

    2013-07-01

    The evaluation and proposed relevance of acetabular labral tears has rapidly evolved over the last decade due to the recognition of femoroacetabular impingement, an increase in the number of surgical options, and improved imaging of the hip with MR arthrography and 3-T MR protocols. The acetabular labrum, stabilizing the hip joint, provides a seal, enhancing fluid lubrication, maintains synovial pressure, and prevents direct contact of the articular surfaces. The labrum takes on a weightbearing role at the extremes of motion with excessive forces seen in a great number of athletic activities thought to contribute to tearing. Approximately 25% of labral tears are not associated with any specific injury or traumatic event with the underlying etiology thought to be repetitive microtrauma. This article reviews the anatomy of the acetabular labrum and discusses the five most commonly occurring etiologies of labral tears: trauma, femoroacetabular impingement, hip hypermobility, dysplasia, and degeneration. We also review the surgical and MR classification of labral tears and describe potential pitfalls in image interpretation. PMID:23787979

  11. Fracture resistance of endodontically treated teeth restored with ceramic inlays and different base materials.

    PubMed

    Saridag, Serkan; Sari, Tugrul; Ozyesil, Atilla Gokhan; Ari Aydinbelge, Hale

    2015-01-01

    This study evaluated the fracture resistance of endodontically treated teeth restored with different base materials and mesioocclusal-distal (MOD) ceramic inlays. Fifty mandibular molars were assigned into five groups (n=10 per group). Group1 (control) comprised intact molar teeth without any treatment. Teeth in other groups were subjected to root canal treatment and restored with MOD ceramic inlays on different base materials. In Group 2, base material was zinc phosphate cement; Group 3's was glass ionomer cement; Group 4's was composite resin, and Group 5's was composite resin reinforced with fiber. Finally, a continuous occlusal load was applied until fracture occurred. Mean fracture resistance of Group 1 (3,027 N) was significantly higher than the other groups (890, 1,070, 1,670, 1,226 N respectively). Fracture resistance of Group 4 was statistically comparable with Group 5 and significantly higher than Groups 2 and 3 (p<0.05; Tukey's HSD). Use of different base materials under ceramic inlay restorations could affect the fracture resistance of endodontically treated teeth. PMID:25740162

  12. EPIDEMIOLOGY OF ACETABULUM FRACTURES TREATED AT THE INSTITUTO NACIONAL DE TRAUMATOLOGIA E ORTOPEDIA (INTO)

    PubMed Central

    Dias, Marcus Vinícius Fernandes; Goldsztajn, Flavio; Guimarães, João Matheus; Grizendi, José Afraneo; Correia, Marcos; Rocha, Tito Henrique

    2015-01-01

    Objectives: The purpose of this study was to review the epidemiological aspects of displacement fractures of the acetabulum that had been treated surgically at the National Institute of Traumatology and Orthopedics (INTO). Methods: We retrospectively analyzed 126 acetabulum fractures that had been treated surgically at INTO between March 2006 and November 2008. The following factors were taken into account: age, sex, trauma mechanism, injury classification, time elapsed between trauma and surgery, affected side and associated bone injuries. Results: 76.8% were male; the mean age was 39.6 years. The trauma mechanism was traffic accidents in 59%; the time that elapsed between injury and surgery was on average 16.4 days; 55% of the cases were on the right side; 30% of the patients presented associated fractures. Conclusion: Most of the patients were male, in an economically active age group, and were victims of traffic accidents. Edge and/or posterior column fractures were the most frequent types. Associated injuries were common and most of the fractures operated in our service came to us late. PMID:27022597

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

    PubMed

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

    2015-11-01

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

  14. Retrospective study of mandibular angle fractures treated with three different fixation systems

    PubMed Central

    Bhatt, Krushna; Arya, Satyavrat; Bhutia, Ongkila; Pandey, Sandeep; Roychoudhury, Ajoy

    2015-01-01

    Aim: To evaluate the outcomes of mandibular angle fractures treated with metal 2.0 mm locking, metal 2.0 mm nonlocking, and 2.5 mm resorbable systems. Study Design: Retrospective cohort study. Materials and Methods: Trauma records were screened for linear angle fractures treated with open-reduction and internal semi-rigid fixation with single metal/bioresorbable plates, and baseline variables were tabulated. The outcome variable was the presence or absence of any complication. Statistical Analysis Used: The Fisher's exact test and analysis of covariance (ANCOVA) using STATA 11. Results: A total of 60 case records of over four years were included. The mean age of the patients was 27.4 (SD 9.7) years. Fifty-five were male and five female. There were 20 nonlocking and 16 locking metal miniplates and 24 bioresorbable plates. In 55 (91.6%) cases there was a third molar in the fracture line. In 51/55 (92.7%) cases the third molar was retained. In seven patients postoperative complications were seen. There was no difference between the complication rates of the three treatment groups. Infection was the most common complication followed by delayed union and hardware failure. Conclusions: This retrospective study found no difference in the complication rate when fractures of the mandibular angle were treated with locking or nonlocking miniplates or bioresorbable plates. PMID:26668450

  15. A new approach to endodontic treatment and operative procedure in nonendodontically treated posterior crown root fractures.

    PubMed

    González-López, Santiago; González-Villafranca, María Purificación; Bolaños-Carmona, María Victoria; Menéndez-Nuñez, Mario

    2009-11-01

    We report a case of nonendodontically treated first upper premolar crown root fracture in which the palatal cusp fracture extended below the cementoenamel junction. Reattachment of the palatal cusp in its original position by acid-etch and flowable composite allowed the creation of a standard access opening as in an intact tooth, avoiding apex location errors and contamination of the root canal. During crown-lengthening surgery, the palatal cusp fragment was hollowed out and used as a natural individual matrix for placement of the core material.

  16. A Case of Distal Femur Medial Condyle Hoffa Type II(C) Fracture Treated with Headless Screws

    PubMed Central

    Merh, Aditya; Shah, Malkesh; Golwala, Paresh

    2016-01-01

    Coronal plane fractures of the distal femur are less frequent compared to sagittal plane fractures. They were described by Hoffa in 1904 and are known as Hoffa fractures (AO type B3). They are isolated fractures of the femoral condyle and rare in occurrence. The objective in the treatment of these fractures is to achieve anatomical reduction of the articular surface and a stable fixation to prevent joint damage in future and prevent post-traumatic arthritis of the joint. We report the case of a young male patient who had a rare type of medial Hoffa fracture which was treated by open reduction and internal fixation using headless Herbert screws using a posterior approach. The fracture was united in eight weeks, and the patient had a full range of knee movement. We advocate this approach and modality of treatment for Hoffa type II(C) fractures.

  17. Computed tomography of thoracic and lumbar spine fractures that have been treated with Harrington instrumentation

    SciTech Connect

    Golimbu, C.; Firooznia, H.; Rafii, M.; Engler, G.; Delman, A.

    1984-06-01

    Twenty patients with fractures of the thoracic and lumbar spine underwent computed tomography (CT) following Harrington distraction instrumentation and a spinal fusion. CT was done to search for a cause of persistent cord or nerve root compression in those patients who failed to improve and completely recover their partial neurologic deficit (14 cases). The most common abnormality was the presence of residual bone fragments originating in the burst fracture of a vertebral body displaced posteriorly, into the spinal canal. In patients with complications in the late recovery period, CT found exuberant callus indenting the canal or lack of fusion of the bone grafts placed in the anterolateral aspect of the vertebral bodies. This experience indicates that CT is the modality of choice for spinal canal evaluation in those patients who fail to have an optimal clinical course following fractures of the thoracic and lumbar spine treated with Harrington rods.

  18. [Resistance to fracture of direct restorations with cuspal coverage in endodontically treated upper bicuspids].

    PubMed

    Takahashi, C U; De Cara, A A; Contin, I

    2001-01-01

    Endodontically treated teeth are considered more susceptible to fracture because of the loss of tooth structure. The aim of this study was to evaluate the increase of resistance to fracture of upper bicuspids that underwent endodontic access and were restored with composite resin, with cuspal coverage. Forty extracted human maxillary premolars were divided in 4 groups: I--intact teeth; II--teeth with endodontic access and MOD preparation, restored with composite resin, without cuspal coverage; III--teeth with endodontic access, MOD preparation and occlusal reduction, restored with composite resin, with cuspal coverage; IV--teeth with endodontic access and MOD preparation, without any restoration. The test specimens were submitted to compression test up to their fracture. The test of Turkey and the ANOVA analysis were used to compare and test the results. The teeth from group III (with cuspal coverage) presented with significantly greater resistance to fracture, when compared with those from groups II (restored without cuspal coverage) and IV (not restored). The composite restoration with cuspal coverage can be considered an alternative for endodontically treated premolars.

  19. Pregnancy-associated osteoporosis with seven vertebral compression fractures, a case treated with strontium ranelate.

    PubMed

    Zarattini, Guido; Buffoli, Pierangelo; Isabelli, Giuliana; Marchese, Marcella

    2014-05-01

    This paper shows a case of pregnancy-associated osteoporosis (PAO) with seven vertebral compression fractures treated with strontium ranelate and supplementation of calcium and cholecalciferol. Clinical evaluation, laboratory and radiological results are analyzed in the case-report to demonstrate that strontium ranelate is a good option to restore quickly the value of bone mineral density in the treatment of a case of PAO. PMID:25285146

  20. Finite element analysis of three commonly used external fixation devices for treating Type III pilon fractures.

    PubMed

    Ramlee, Muhammad Hanif; Kadir, Mohammed Rafiq Abdul; Murali, Malliga Raman; Kamarul, Tunku

    2014-10-01

    Pilon fractures are commonly caused by high energy trauma and can result in long-term immobilization of patients. The use of an external fixator i.e. the (1) Delta, (2) Mitkovic or (3) Unilateral frame for treating type III pilon fractures is generally recommended by many experts owing to the stability provided by these constructs. This allows this type of fracture to heal quickly whilst permitting early mobilization. However, the stability of one fixator over the other has not been previously demonstrated. This study was conducted to determine the biomechanical stability of these external fixators in type III pilon fractures using finite element modelling. Three-dimensional models of the tibia, fibula, talus, calcaneus, navicular, cuboid, three cuneiforms and five metatarsal bones were reconstructed from previously obtained CT datasets. Bones were assigned with isotropic material properties, while the cartilage was assigned as hyperelastic springs with Mooney-Rivlin properties. Axial loads of 350 N and 70 N were applied at the tibia to simulate the stance and the swing phase of a gait cycle. To prevent rigid body motion, the calcaneus and metatarsals were fixed distally in all degrees of freedom. The results indicate that the model with the Delta frame produced the lowest relative micromovement (0.03 mm) compared to the Mitkovic (0.05 mm) and Unilateral (0.42 mm) fixators during the stance phase. The highest stress concentrations were found at the pin of the Unilateral external fixator (509.2 MPa) compared to the Mitkovic (286.0 MPa) and the Delta (266.7 MPa) frames. In conclusion, the Delta external fixator was found to be the most stable external fixator for treating type III pilon fractures.

  1. Displaced avulsion fractures of the posterior cruciate ligament: Treated by stellate steel plate fixation

    PubMed Central

    Li, Lijun; Tian, Wei

    2015-01-01

    Background: The open reduction with internal fixation is an effective approach for treatment of avulsion fracture of posterior cruciate ligament. The previously used internal fixation materials including hollow screws, absorbable screw, tension bands and sutures have great defects such as insufficient fixation strength, susceptibility to re-fracture, etc. Stellate steel plate is novel material for internal fixation which has unique gear-like structure design. We used stellate steel plate for treatment of displaced avulsion fractures of posterior cruciate ligament in this study. Materials and Methods: 14 patients (9 men, 5 women; aged, 19–35 years; mean age, 28 years) with displaced avulsion fractures of the tibial insertion of the posterior cruciate ligament were retrospectively analyzed between June 2009 and June 2011. The mean duration from injury to the operation was 8.3 days (range 6–15 days). All the patients were treated with open reduction and internal fixation of a stellate steel plate (DePuy, Raynham, MA 02767, USA). The Lysholm-Tegner knee function score criteria were used to analyze results. Results: The mean followup was 24.6 months (range 18–32 months). After 6 months, all the fractures healed and knee joint activity was normal, with no knee stiffness or instability. The Lysholm-Tegner scores were 97.1 ± 1.7 points at the final followup. Conclusion: Owing to its unique gear structure, the stellate steel plate design can effectively fix an avulsion fracture block and it is a simple operation with short postoperative rehabilitation time and firm fixation. PMID:26015605

  2. Fracture resistance of endodontically treated teeth: effect of tooth coloured post material and surface conditioning.

    PubMed

    Toman, Muhittin; Toksavul, Suna; Sarikanat, Mehmet; Nergiz, Ibrahim; Schmage, Petra

    2010-03-01

    This in vitro study evaluated the effects of the different endodontic posts and surface conditioning on the fracture resistance and fracture modes of endodontically treated teeth. The experimental groups consisted of zirconia ceramic post with a glasss-ceramic core [A], zirconia ceramic post with a composite core [B], glass fiber composite post (FRC) with a composite core [C], and titanium post with a composite core [D]. All posts in these groups were cemented with self-adhesive resin cement (Rely X Unicem Aplicap) combination with tribochemical silica coating (TSC). Groups E, F, G and H comprised the same post-and-core materials as the first 4 groups but cemented with the same resin cement without TSC. Specimens were subjected to thermal cycling between 5 degrees C and 55 degrees C for a total of 5000 cycles with 30s per cycle. Static load was applied to the palatal surface of each specimen until they were fractured. Statistical analysis was conducted using analysis of variance (ANOVA) followed by post-hoc comparisons (Tukey). The fracture resistance was significantly affected by the post material (P < 0.001) and surface conditioning (P < 0.001; two-way ANOVA). The application of TSC to post surface decreased the fracture resistance of zirconia ceramic post with composite core (p=0.002; Tukey) and glass FRC post with composite core (p=0.029; Tukey). No catastrophic failure was observed for groups B, C, D, E, F and G. Under the testing conditions used, the titanium post/composite core that had been silicoated exhibited the highest fracture resistance.

  3. Functional outcome of Schatzker type V and VI tibial plateau fractures treated with dual plates

    PubMed Central

    Prasad, G Thiruvengita; Kumar, T Suresh; Kumar, R Krishna; Murthy, Ganapathy K; Sundaram, Nandkumar

    2013-01-01

    Background: Dual plate fixation in comminuted bicondylar tibial plateau fractures remains controversial. Open reduction and internal fixation, specifically through compromised soft tissues, has historically been associated with major wound complications. Alternate methods of treatment have been described, each with its own merits and demerits. We performed a retrospective study to evaluate the functional outcome of lateral and medial plate fixation of Schatzker type V and VI fractures through an anterolateral approach, and a medial minimally invasive approach or a posteromedial approach. Materials and Methods: We treated 46 tibial plateau fractures Schatzker type V and VI with lateral and medial plates through an anterolateral approach and a medial minimal invasive approach over an 8 years period. Six patients were lost to followup. Radiographs in two planes were taken in all cases. Immediate postoperative radiographs were assessed for quality of reduction and fixation. The functional outcome was evaluated according to the Oxford Knee Score criteria on followup. Results: Forty patients (33 men and 7 women) who completed the followup were included in the study. There were 20 Schatzker type V fractures and 20 Schatzker type VI fractures. The mean duration of followup was 4 years (range 1-8 years). All patients had a satisfactory articular reduction defined as ≤2 mm step-off or gap as assessed on followup. All patients had a good coronal and sagittal plane alignment, and articular width as assessed on supine X-rays of the knee in the anteroposterior (AP) and lateral views. The functional outcome, as assessed by the Oxford Knee Score, was excellent in 30 patients and good in 10 patients. All patients returned to their pre-injury level of activity and employment. There were no instances of deep infection. Conclusions: Dual plate fixation of severe bicondylar tibial plateau fractures is an excellent treatment option as it provides rigid fixation and allows early knee

  4. Acetabular liner fixation by cement.

    PubMed

    Jiranek, William A

    2003-12-01

    Many situations in revision THA require the exchange of a PE liner in the setting of a well-fixed cementless acetabular shell. Unfortunately, a replacement liner is not always available, the locking mechanism of the metal shell may be damaged or incompatible with the desired liner, or the shell is malpositioned. Revision of a well-fixed cementless acetabular shell has been associated with considerable morbidity. This raises several questions: can a new PE liner be fixed in the existing shell using bone cement, and if so, which techniques can improve the end result, and in which patients should they be used? Biomechanical testing of cemented PE liners has shown initial fixation strengths that exceed conventional locking mechanisms. It is not known during what period this initial fixation will fail, but clinical reports with followup of as many as 6 years have shown survival in approximately 90% of cases. These studies have shown the importance of proper patient selection, accurate sizing of the PE liner, careful preparation of the substrate of the liner and the shell, and good cement technique. The potential advantages of this technique are less surgical morbidity, more rapid surgery and patient recovery, the ability to incorporate antibiotics in the cement, and more liner options.

  5. Lunate Osteochondral Fracture Treated by Excision: A Case Report and Literature Review

    PubMed Central

    Saberi, Sadegh; Arabzadeh, Aidin; Farhoud, Amir Reza

    2016-01-01

    Introduction Lunate fracture is a rare injury. Most reports are associated with other wrist injuries such as perilunate dislocation and distal radius fracture. Isolated lunate fracture has been reported even more rarely. The choice of treatment and outcomes are consequently undetermined. Case Presentation In this case report we will describe a lunate avulsion fracture as an isolated injury after a fall from nine meters treated operatively by excision of the comminuted avulsed fragment. After 33 months of follow-up radiographs showed no sign of degenerative joint disorder on simple X-ray, but slight Volar Intercalated Segment Instability (VISI) by a capitolunate angle of 26 degrees was noted. Clinically, the patient was pain free near full wrist and forearm range of motion and could perform his previous vocational and recreational tasks without any limitations. Conclusions Despite apparently good short and mid-term clinical outcome, slight volar intercalated segment instability after 33 months of follow-up revealed that lunotriquetral ligament function was probably lost, which led to static instability. This ligament injury may be missed primarily. Excision of the avulsed osteochondral fragment should be the last option of treatment and most attempts should be tried to fix and/or restore the normal anatomy of ligamentous structure. PMID:27626007

  6. Cost implications of the physiotherapy management of complex tibial fractures treated with circular frames.

    PubMed

    Barron, E; Rambani, R; Bailey, H; Sharma, H K

    2013-11-01

    Seventy-three consecutive patients with complex tibial fractures treated with an Ilizarov frame or Taylor Spatial Frame received physiotherapy between April 2008 and April 2010. Data were collected prospectively, and physiotherapy input was recorded (in minutes) for the patients identified. This included treatment received as an inpatient as well as an outpatient. The data were categorized for proximal, middle and distal third tibial fractures for analysis. The average cost of physiotherapy for an inpatient with an Ilizarov frame is £121.82 per case, whereas that for an outpatient receiving treatment for trauma was calculated as £404.60. The combined average cost of physiotherapy to support treatment of a complex tibial fracture with a fine wire fixator is £546.27. Treatment involving circular frames is complex and expensive, and the high physiotherapy cost is not reflected in Healthcare Resource Group codes. This cost calculation will help service units, and NHS Trusts develop realistic costing plans to support treatment. Cost implications of the physiotherapy management of complex tibial fractures using the Ilizarov technique. PMID:23943063

  7. [Progressive intra-acetabular dislocation of bipolar hip prostheses: four cases].

    PubMed

    Tabutin, J; Damotte, A

    2004-02-01

    Certain complications, such as acetabular erosion or cup dissociation, are specific to bipolar prostheses. Progressive intra-acetabular dislocation has not been reported to date. We report 4 cases. Four elderly women developed progressive intra-acetabular dislocation after implantation of a bipolar prosthesis for femoral neck fractures. The metal-backed cup verticalized progressively and the ball gradually dislocated into the acetabulum, eroding it. Revision was undertaken with a hemispheric bone ingrowth cup and partial grafting. Follow-up was then uneventful. This phenomenon is different from the acute intra-acetabular dislocation that may occur after rupture of the anti-dissociation mechanism (polyethylene ring) incorporated in the design of new implant models, or after dissociation between the ball and the cup during closed reduction of a dislocation, the cup catching on the acetabular rim. It is not due to a variation in the neck-head angles (we observed varus, valgus, and neutral angles) nor to a problem between the modular head and the neck (at the morse cone taper). For us, the cause of this progressive intra-acetabular dislocation is poor cup design associated with a weak retention system. If the centers of the inner and outer spheres are superimposed, the cup has a natural tendency to drop into varus because of its weight. This becomes even worse if the center of the outer sphere is medial to the ball center. The cup should be designed so that the center of the outer sphere (bipolar cup) lies lateral to the center of the inner sphere (ball) creating a valgus torque for the cup. Designing a bipolar cup is not as a simple matter as it may seem. We emphasize the importance of the position of the rotation centers.

  8. Cup-cage construct for acute fractures of the acetabulum, re-defining indications.

    PubMed

    Chana-Rodríguez, Francisco; Villanueva-Martínez, Manuel; Rojo-Manaute, Jose; Sanz-Ruíz, Pablo; Vaquero-Martín, Javier

    2012-12-01

    Acetabular fractures in the elderly are challenging injuries. The use of a trabecular metal acetabular cage was investigated as the treatment option in a series of elderly patients with acetabular fractures. At a 2-year follow up, 6 elderly patients were found to have mimimum pain, increased function, and increased scores using the Merle d'Aubigné and Postel system modified by Charnley. Radiographically, the areas of morsellised autograft that surrounded the cups were seen to have incorporated uniformly well, and the acetabular fractures were healed within six months after surgery. No mechanical failure, screw breakage, loosening, or migration was noticed. This novel indication of the cup-cage construction that uses revision techniques, for selected patients and fractures, to achieve an acute stable reconstruction, should be considered as an alternative reconstruction option in elderly patients presenting with acetabular fractures.

  9. Outcome of supracondylar fractures of the humerus in children treated by closed reduction and percutaneous pinning.

    PubMed

    Devkota, P; Khan, J A; Acharya, B M; Pradhan, N Ms; Mainali, L P; Singh, M; Shrestha, S K; Rajbhandari, A P

    2008-01-01

    Supracondylar fractures of humerus in children are common injuries. Displaced fractures are inherently unstable. Conservative treatment results in malunion. Open reduction and internal fixation (ORIF) is more invasive and recovery is prolonged. From September 2004 to September 2005, 102 displaced supracondylar fractures of humerus, aged between one and half year to 13 years, were treated using close reduction and percutaneous Kirschner (K) wire fixation under c-arm fluoroscopy. Seventy nine patients were treated by cross K-wires and in twenty three cases lateral two K-wires were put. Above elbow plaster of paris back slab was applied in all cases for at least four weeks. Back slab, K-wires were removed after four weeks and elbow range of motion exercise was started. Results were analyzed using Flynn's criteria. All patients were followed up to 14th week postoperatively. In cross K-wire group(N=79) 70.8% had excellent, 22.7% good, 3.8% fair and 2.5% had poor results at eight weeks follow up which was improved to 91.1% excellent, 6.3 good, 1.2% fair and 1.26% poor results at 14 weeks follow up. In lateral K-wire group (N=23) 70% had excellent, 21.7% good, 4.3% fair and 4.3% had poor result at eighth week which was improved to 91.3% excellent, 4.3% good, 4.3% fair and no poor result at 14th week follow up. Eight patients got superficial pin tract infection and seven patients sustained ulnar nerve injury post operatively. We recommend this procedure for displaced supracondylar fractures in children as it is safe and cost effective procedure with acceptable complication rates. PMID:18709034

  10. Optimization of acetabular component orientation using DOE

    NASA Astrophysics Data System (ADS)

    Krepelka, Mircea; Toth-Taşcǎu, Mirela

    2012-09-01

    Stress shielding is increasingly recognized as an important cause of acetabular component failure. Several studies have been focused on improving the acetabular component placement to reduce the risk of dislocation, impingement and range of motion but little is known of its influence on implant-bone interface pressures. This study employs experimental design, 3D reconstruction and FE simulation to identify the most significant factors for acetabular component behavior and predict the best configuration of acetabular spatial orientation angles within the constraints of the Lewinnek's safe zone in order to minimize peak contact pressures. Data analysis by response surface method revealed that the magnitude of periacetabular pressures was significantly reduced by the anteversion angle at its lowest value as well as the abduction angle located at the central point value, which corresponded to a 40° abduction and 5° anteversion of cup orientation.

  11. Importance of maintaining the basic stress pathway above the acetabular dome during acetabular reconstruction.

    PubMed

    Nie, Yong; Pei, Fuxing; Shen, Bin; Kang, Pengde; Li, Zongming

    2016-01-01

    The basic stress pathway above the acetabular dome is important for the maintenance of implant stability in press-fit acetabular reconstruction of total hip arthroplasty. However, information on the basic stress pathway and its impact factors remains unclear. The objective of this study was to investigate the effects of the orientations and positions of the acetabular component on the basic stress pathway. The basic stress pathway above the acetabular dome was defined as two parts: 3D basic trabecular bone stress distribution and quantified basic cortical bone stress level, using two subject-specific finite element normal hip models. The effects were then analysed by generating 32 reconstructed acetabular cases with different cup abduction and anteversion angles within a range of 35-50° and 10-25°, respectively, and 12 cases with different hip centre heights within a range of 0-15 mm above the acetabular dome. The 3D trabecular stress distribution decreased remarkably in all cases, while the 80% of the basic cortical bone stress level was maintained in cases when the acetabular component was positioned at 10° or 15° anteversion and 40° or 45° abduction angles. The basic stress pathway above the acetabular dome was disturbed when the superior displacement of the hip centre exceeded 5 mm above the anatomical hip centre. Positioning the acetabular component correctly contributes to maintain the stress balance between the acetabular cup and the bone during acetabular reconstruction, thus helping restore the normal hip biomechanics and preserve the stability of the implants.

  12. Contemporary demographics and complications of patients treated for open ankle fractures.

    PubMed

    Ovaska, Mikko T; Madanat, Rami; Honkamaa, Maija; Mäkinen, Tatu J

    2015-08-01

    Open ankle fractures are rare injuries with a high likelihood of wound complications and subsequent infections. There is limited information about the complications and outcomes of these injuries in different age groups. The aim of this study was to assess the contemporary demographics and complications related to this injury. We performed a chart review of all the 3030 patients treated for ankle fractures at a Level 1 trauma centre from 2006 to 2011. 137 (4.5%) patients had an open ankle fracture. The demographic data, injury mechanism, comorbidities, and fracture type were collected. Treatment, complications, length of stay and number of outpatient visits were also recorded. The mean age of the patients was 60 years and 56% were women. Most fractures were Weber type B with a medial sided wound (93%). Only 20% of the fractures were the result of high-energy trauma, and 31% were Gustilo grade III injuries. Immediate internal fixation was performed in 82% of patients, and the wound was primarily closed in most cases (80%). The incidence of postoperative wound necrosis and deep infection was 18% and 17%, respectively. There were more deep infections if pulsatile lavage was used during the wound debridement (p=0.029). About 14 (10%) patients required a flap reconstruction to cover the soft-tissue defect. Every other patient (54%) had a complication, and 21 patients (15%) suffered a long-term disability related to the injury. The number complications did not differ for nighttime and daytime operations (p=0.083). High-energy injuries were more common in younger patients (p<0.001) and these patients also had more lateral sided open wounds than older patients (p=0.002). Interestingly, younger patients also had significantly more complications (p=0.024), suffered more often from chronic pain (p=0.003), and required more flap reconstructions (p=0.026), reoperations (p=0.026), and outpatient clinic visits (p=0.006). Open ankle fractures have a high complication rate and

  13. [Early results of proximal femoral fractures treated with FENIX modular hemiarthroplasty].

    PubMed

    Görski, Radosław; Górecki, Andrzej; Olszewski, Paweł; Biedrzycki, Jerzy; Skowronek, Paweł

    2010-01-01

    The article discusses preliminary clinical results in patients with proximal femoral fractures treated with hemiarthroplasty using a FENIX implant. The study group comprised 41 subjects aged 69 to 97 (median age 82.3 year). The follow-up study provided data on 26 subjects (63.4%), among which 15 attended the check-up, 5 subjects refused to visit at the Department and 6 subjects were reported as deceased. Median follow-up period amounted to 6.8 month (1 to 22 months). General hospitalization-related complications occurred in 8 patients (19.5%). During hospitalization no deaths occurred, in the deceased group 3 patients died within 12 months after surgery, while another 3 died after the twelve-month postoperative period (median of 13.3%). According to Merle d'Aubigne-Postel score favorable long-term results were observed in 9 patients (59.9%), 13 patients regained the level of motor function similar to the functional ability prior to fracture. The need to postpone the surgery due to general health status and impaired pre-operative motor function are significant negative prognostic factors. The results obtained were compared with previous efficacy studies on femoral fracture treatment using an Austin-Moore implant. Functional ability and self-reliance was higher in the FENIX group. FENIX arthroplasty effectively helps patients regain self-reliance and motor function thanks to its modular characteristics and anatmoical construction. PMID:20496778

  14. A Novel Thresholding Based Algorithm for Detection of Vertical Root Fracture in Nonendodontically Treated Premolar Teeth

    PubMed Central

    Johari, Masume; Esmaeili, Farzad; Andalib, Alireza; Garjani, Shabnam; Saberkari, Hamidreza

    2016-01-01

    In this paper, an efficient algorithm is proposed for detection of vertical root fractures (VRFs) in periapical (PA), and cone-beam computed tomography (CBCT) radiographs of nonendodontically treated premolar teeth. PA and CBCT images are divided into some sub-categories based on the fracture space between the two fragments as small, medium, and large for PAs and large for CBCTs. These graphics are first denoised using the combination of block matching 3-D filtering, and principle component analysis model. Then, we proposed an adaptive thresholding algorithm based on the modified Wellner model to segment the fracture and canal. Finally, VRFs are identified with a high accuracy through applying continuous wavelet transform on the segmented radiographs and choosing the most optimal value for sub-images based on the lowest interclass variance. Performance of the proposed algorithm is evaluated utilizing the different tested criteria. Results illustrate that the range of specificity deviations for PA and CBCT radiographs are 99.69 ± 0.22 and 99.02 ± 0.77, respectively. Furthermore, the sensitivity changes from 61.90 to 77.39 in the case of PA and from 79.54 to 100 in the case of CBCT. Based on our statistical evaluation, the CBCT imaging has the better performance in comparison with PA ones, so this technique could be a useful tool for clinical applications in determining the VRFs. PMID:27186535

  15. Outcome of porous tantalum acetabular components for Paprosky type 3 and 4 acetabular defects.

    PubMed

    Batuyong, Eldridge D; Brock, Hugh S; Thiruvengadam, Nikhil; Maloney, William J; Goodman, Stuart B; Huddleston, James I

    2014-06-01

    Porous tantalum acetabular implants provide a potential solution for dealing with significant acetabular bone loss. This study reviews 24 acetabular revisions using tantalum implants for Paprosky type 3 and 4 defects. The mean Harris Hip Score improved from 35 ± 19 (range, 4-71) to 88 ± 14 (range, 41-100), p < 0.0001. Postoperative radiographs showed radiolucent lines in 14 hips with a mean width of 1.3 ± 1.0 mm (range, 0.27-4.37 mm). No gaps enlarged and 71% of them disappeared at a mean of 13 ± 10 months (range, 3-29 months). At a mean follow-up of 37 ± 14 months (range, 24-66 months), 22 reconstructions showed radiograpic evidence of osseointegration (92%). The two failures were secondary to septic loosening. When dealing with severe acetabular bone loss, porous tantalum acetabular components show promising short-term results.

  16. [Atypical fracture of metatarsal bone in a patient with multiple myeloma who was treated long-term with bisphosphonates].

    PubMed

    Adam, Z; Sprláková-Puková, A; Chaloupka, R; Krejčí, M; Pour, L; Král, Z; Mayer, J

    2013-11-01

    The first reports found in professional literature on the use of bisphosphonates as a treatment date back to 1972. We found the first report on the use of a bisphosphonate comprising nitrogen in its molecule in a publication from 1990. Some of the adverse effects of the particular types of bisphosphonates were described in the registration studies. At least two serious adverse effects of this group of medicines had not been described until 2000. We found the first description of jaw osteonecrosis in relation to the longterm application of bisphosphonates in a publication from 2002 and we found the first description of an atypical bone fracture originating without a corresponding traumatic event in a location with no presence of an osteolytic focus in an article from 2006. These so  called atypical fractures, which are also called fractures without a corresponding traumatic event (low energy fractures), have been described to have occurred in femurs, in the pelvis and less frequently in the metatarsal area. "Atypical fractures" are linked to longterm administration of bisphosphonates, which significantly increases the bone density and impedes osteolysis but it simultaneously increases the fragility of bones and decreases their flexibility. The definition of an atypical fracture of the skeleton emphasises the fact that such fractures occur with an inadequately minimal force (energy) in the aforementioned predilection locations. In the following text we are describing a patient who has been treated for a multiple myeloma with an atypical fracture of the Metatarsal bone 2. This fracture occurred during a regular walk without any excessive load and the patient could not recall any corresponding injury or longer walking. The patient had been administered bisphosphonates for 34 months before the atypical metatarsal fracture occurred. The metatarsal bone fracture was treated through a nonweight  bearing regime for the sole and the pain diminished within a single month

  17. [Atypical fracture of metatarsal bone in a patient with multiple myeloma who was treated long-term with bisphosphonates].

    PubMed

    Adam, Z; Sprláková-Puková, A; Chaloupka, R; Krejčí, M; Pour, L; Král, Z; Mayer, J

    2013-11-01

    The first reports found in professional literature on the use of bisphosphonates as a treatment date back to 1972. We found the first report on the use of a bisphosphonate comprising nitrogen in its molecule in a publication from 1990. Some of the adverse effects of the particular types of bisphosphonates were described in the registration studies. At least two serious adverse effects of this group of medicines had not been described until 2000. We found the first description of jaw osteonecrosis in relation to the longterm application of bisphosphonates in a publication from 2002 and we found the first description of an atypical bone fracture originating without a corresponding traumatic event in a location with no presence of an osteolytic focus in an article from 2006. These so  called atypical fractures, which are also called fractures without a corresponding traumatic event (low energy fractures), have been described to have occurred in femurs, in the pelvis and less frequently in the metatarsal area. "Atypical fractures" are linked to longterm administration of bisphosphonates, which significantly increases the bone density and impedes osteolysis but it simultaneously increases the fragility of bones and decreases their flexibility. The definition of an atypical fracture of the skeleton emphasises the fact that such fractures occur with an inadequately minimal force (energy) in the aforementioned predilection locations. In the following text we are describing a patient who has been treated for a multiple myeloma with an atypical fracture of the Metatarsal bone 2. This fracture occurred during a regular walk without any excessive load and the patient could not recall any corresponding injury or longer walking. The patient had been administered bisphosphonates for 34 months before the atypical metatarsal fracture occurred. The metatarsal bone fracture was treated through a nonweight  bearing regime for the sole and the pain diminished within a single month

  18. Influence of fiber posts on the fracture resistance of endodontically treated premolars with different dental defects.

    PubMed

    Hou, Qian-Qian; Gao, Yi-Ming; Sun, Lei

    2013-09-01

    This study aimed to evaluate the influence of quartz fiber post placement on the fracture resistance of endodontically treated premolars with different dental defects under dynamic loading. Fifty extracted single-rooted mandibular premolars were randomized into five groups. Each group was prepared according to numbers of residual walls ranged from 0 to 4. Then each group was divided into two subgroups with one restored with quartz fiber posts and the other without posts. In no-post groups, gutta percha point 2 mm below cemento-enamel junction was removed. Composite resin was adapted to the well and used to shape the core directly. Each tooth was restored with a complete metal crown. Dynamic loading was carried out in a masticatory simulator with a nominal load of 50 N at 2 Hz for 300 000 loading cycles. Then a quasi-statically load was applied in a universal testing machine 30° to the long axis with a crosshead speed of 1 mm⋅min(-1) until fracture. Data were analyzed with one-way analysis of variance and pairwise comparison (P<0.05). No specimens failed during dynamic loading. The fracture resistance enhanced with the increase of numbers of coronal walls and the differences were significant (P<0.05). Placement of fiber posts had a significant effect when fewer than two walls remained (P<0.05), but it had no significant influence in groups with two, three or four walls (P>0.05). Fiber post did not change failure mode, and the fracture pattern was mainly favorable. More dentin walls need to be retained in clinic. When no less than two walls remained, a fiber post is not always necessary. PMID:23907677

  19. Hemisection: A Treatment Option for an Endodontically treated Molar with Vertical Root Fracture.

    PubMed

    Anitha, S; Rao, Deepika S C

    2015-02-01

    Vertical root fractures (VRF) in endodontically treated teeth have long been reported and pose diagnostic difficulties. A hemisection/root resection procedures removes the fractured fragments completely, and retains a portion of the compromized tooth offers a predictable treatment option. The key to this rests in ideal case selection involving balancing all indications and contraindications. The success of the treatment depends on careful case selection based on a firm set of guidelines. This article presents a case with VRF in an endodontic treated molar. This article describes the case of a 65-year-old man with a VRF on the mesial root and a healthy periodontium supporting the distal root making it ideal for retention as well as restoration and support of the final prosthesis. Also, the patient was motivated to try and save as much of the tooth as possible. Postoperatively no untoward complication was reported making it an alternative treatment option in patients with VRF in a molar, willing to retain the remaining tooth portion. With all other factors balanced, it allows for retaining the remaining intact portion of the tooth structure. PMID:25906809

  20. Recurrent bilateral metatarsal "stress-and-insufficiency" fractures in a levodopa-treated young woman with Parkinson's disease.

    PubMed

    Verdet, M; Nicolau, J; Lefaucheur, R; Maltête, D; Derrey, S; Daragon, A

    2013-03-01

    Levodopa treatment of Parkinson's disease is very effective, but many types of adverse events can complicate the disease course, especially dyskinesias. As reported by Lee et al. (Calcif Tissue Int 86:132-41, 2010), levodopa intake is associated with increased homocysteinemia that is known to be linked to poorer bone quality and, consequently, osteoporotic fractures. Herein, we report the case of a young woman who suffered recurrent metatarsal fractures in the context of levodopa-treated early-onset Parkinson's disease.

  1. Natural acetabular orientation in arthritic hips

    PubMed Central

    Goudie, S. T.; Deakin, A. H.; Deep, K.

    2015-01-01

    Objectives Acetabular component orientation in total hip arthroplasty (THA) influences results. Intra-operatively, the natural arthritic acetabulum is often used as a reference to position the acetabular component. Detailed information regarding its orientation is therefore essential. The aim of this study was to identify the acetabular inclination and anteversion in arthritic hips. Methods Acetabular inclination and anteversion in 65 symptomatic arthritic hips requiring THA were measured using a computer navigation system. All patients were Caucasian with primary osteoarthritis (29 men, 36 women). The mean age was 68 years (SD 8). Mean inclination was 50.5° (SD 7.8) in men and 52.1° (SD 6.7) in women. Mean anteversion was 8.3° (SD 8.7) in men and 14.4° (SD 11.6) in women. Results The difference between men and women in terms of anteversion was significant (p = 0.022). In 75% of hips, the natural orientation was outside the safe zone described by Lewinnek et al (anteversion 15° ± 10°; inclination 40° ± 10°). Conclusion When using the natural acetabular orientation to guide component placement, it is important to be aware of the differences between men and women, and that in up to 75% of hips natural orientation may be out of what many consider to be a safe zone. Cite this article: Bone Joint Res 2015;4:6–10. PMID:25628463

  2. Comparison of fracture resistance and failure pattern of endodontically treated premolars with different esthetic onlay systems: An in vitro study

    PubMed Central

    Mynampati, Praffulla; Babu, Mandava Ramesh; Saraswathi, Devabhaktuni Disha; Kumar, Janga Ravi; Gudugunta, Leneena; Gaddam, Divya

    2015-01-01

    Aim: To compare the fracture resistance and modes of failures of three different aesthetic MOD onlays on endodontically treated premolars. Materials and Methods: Forty sound maxillary premolars were selected of which 10 untreated teeth were taken as control (Group I). The other thirty premolars were subjected to standardized MOD onlay preparations and root canal treatments and divided into 3 equal groups. Onlays were prepared in Group II- Indirect composite, Group III- Lithium Disilicate ceramic and Group IV- Full Zirconia. All onlays were cemented using Multilink Automix. All the 40 samples were subjected to fracture resistance testing on Universal testing machine. Also fractured specimens were observed under stereo-microscope for modes of failure. Results: Group IV presented the highest fracture resistance. Groups II and III presented no significant difference in fracture resistance from each other (P > 0.05). Group II and Group III showed significantly lower fracture resistance values than Group I. Coming to modes of failure, only Group IV had showed no cracks in any of the restorations. Conclusion: Full Zirconia MOD onlays increased the fracture resistance of endodontically treated premolars to a significantly higher level than the sound teeth. PMID:25829694

  3. Outcome of proximal humerus fractures treated by PHILOS plate internal fixation. Experience of a district general hospital.

    PubMed

    Shahid, Rizwan; Mushtaq, Abid; Northover, Julian; Maqsood, Mohammad

    2008-10-01

    Proximal humerus fractures have been a challenge to achieve stable fixation. PHILOS (Proximal Humerus internal locking system) is part of the latest generation of locking compression plates for proximal humeral fracture fixation. We aim to assess the clinical and functional outcome of proximal humeral fractures (2-part, 3-part and 4-part) treated with the PHILOS plate. We prospectively reviewed 50 patients who had a proximal humeral fracture treated with the PHILOS plate from September 2002 to September 2006 in our institution. Clinical outcome was measured using the patient-based Oxford shoulder and DASH scoring systems. Five patients died and four were lost to follow-up. Eleven patients had 2-part, eleven 3-part and eighteen 4-part fractures. Mean follow-up time was 21.7 months (range: 6-44 months). Radiological union was achieved within 8 weeks in 40/41 fractures; complications were noted in four cases. Better results were achieved in younger than in older patients, and in male than in female patients. The number of fracture fragments did not appear to affect the results, but associated dislocation of the humeral head was a pejorative factor. Our study has shown that the PHILOS plate is a reliable implant. A direct correlation was observed between Oxford shoulder and DASH scores.

  4. One-year mortality after isolated pelvic fractures with posterior ring involvement in elderly patients.

    PubMed

    Bible, Jesse E; Kadakia, Rishin J; Wegner, Adam; Richards, Justin E; Mir, Hassan R

    2013-06-01

    Previous 1-year mortality studies of pelvic fractures in elderly patients have focused on pubic rami fractures, in elderly patients with multiple injuries, or both. Baseline information on the 1-year mortality of isolated pelvic fractures in elderly patients is unavailable. The purpose of this study was to evaluate the 1-year mortality of elderly patients (aged 60 years or older) after isolated pelvic fractures with posterior ring involvement (Orthopaedic Trauma Association type 61-B and C). All patients aged 60 years or older treated for pelvic injuries at a single Level I trauma center over a 12-year period were retrospectively reviewed (N=1223). Exclusion criteria were associated injuries to other body systems (Abbreviated Injury Scale greater than 2), ballistic injuries, long bone fractures, concurrent acetabular fractures, and type 61-A fractures or isolated pubic rami fractures without posterior involvement. Mortality data were obtained from the Social Security Death Index. Seventy patients met the inclusion criteria. Patients treated nonoperatively were significantly older compared with those treated operatively. However, the Charlson Comorbidity Index did not significantly differ between treatment groups. A significantly higher percentage of type-B fractures (83.0%) were treated nonoperatively compared with type-C fractures, which were treated operatively 88.2% of the time. Mortality rates at 3 and 6 months and 1 year postoperatively were 7.1%, 11.4%, and 12.9%, respectively. These results suggest that the 1-year mortality rates of isolated pelvic fractures in elderly patients are lower than those reported previously for hip fractures and pelvic fractures with concurrent injuries. Although age was identified as a significant variable differing between patients treated operatively vs nonoperatively, comorbidities were not. PMID:23746012

  5. Fractures

    PubMed Central

    Hall, Michael C.

    1963-01-01

    Recent studies on the epidemiology and repair of fractures are reviewed. The type and severity of the fracture bears a relation to the age, sex and occupation of the patient. Bone tissue after fracture shows a process of inflammation and repair common to all members of the connective tissue family, but it repairs with specific tissue. Cartilage forms when the oxygen supply is outgrown. After a fracture, the vascular bed enlarges. The major blood supply to healing tissue is from medullary vessels and destruction of them will cause necrosis of the inner two-thirds of the cortex. Callus rapidly mineralizes, but full mineralization is achieved slowly; increased mineral metabolism lasts several years after fracture. PMID:13952119

  6. [Investigation on biomechanics behavior using three-dimensional finite element analysis for femur shaft fracture treated with locking compression plate].

    PubMed

    He, Qinli; Jiang, Wei; Luo, Jiaoming

    2014-08-01

    Based on the CT data and the structure characteristics of the femoral fractures during different healing stages, medical FE models of fractured femur treated with locking compression plate (LCP)were built. Under the physiological load of a standard body weight (70 kg) and the constraint condition, the stress distributions of LCP and fractured femur during healing were calculated by means of three-dimensional finite element analysis (3D-FEA). The results showed that the stress distribution in the LCP and the fractured femur was similar, during the initial stage which there was no newly formed bone or soft tissue in fracture site. The maximum von Mises stress (371.23,272.76 MPa) in the fractured femur was much higher than that in natural femur, and the intensive stress was concentrated mainly in the proximal area of the fractured femur. With the growth of bony callus bone in fracture site, the intensity of stress in proximal femur decreased. Contrasted to the two cases mentioned above, the value of the maximum von Mises stress (68. 17 MPa) in bony callus bone stage decreased significantly, and was lower than the safe strength of natural bone. Therefore, appropriate training which is benefitial for the growth to new bone could be arranged for the better rehabilitation.

  7. Inflammatory biomarker profiling in elderly patients with acute hip fracture treated with heparins.

    PubMed

    Knesek, Michael John; Litinas, Evangelos; Adiguzel, Cafer; Hopkinson, William; Hoppensteadt, Debra; Lassen, Michael; Fareed, Jawed

    2010-02-01

    Hip fracture is common in the elderly patients with associated high risk of venous thromboembolic complications. Pathogenic activation results in the generation of various surrogate markers in plasma. This study is designed to identify unique biomarkers in elderly patients with hip fracture using protein chip array enzyme-linked immunosorbent assay (ELISA) methods. Plasma from a randomized hip fracture study (PK-532; n = 341) treated with either enoxaparin (40 mg once daily) or unfractionated heparin (UFH; 5000 IU twice daily) were collected prior to and at 1, 3, 5, and 7 days. A total of 52 samples were analyzed using proteomic surface-enhanced laser desorption/ ionization-time of flight (SELDI-TOF) mass spectrometry to identify unique biomarkers in the molecular weight range of 0 to 150 kd. Twenty-nine healthy volunteer's and pooled plasma from total hip replacement/total knee replacement patients with a unique biomarker at 11.9 kd were used as quality controls. In the 29 healthy individuals, the biomarker profile did not reveal the presence of any unique peak in comparison to the reference normal human plasma (NHP). Plasma obtained prior to surgery exhibits unique biomarkers in 4 of 52 (7.6%) of the samples. On day 1 postoperatively, 41 of 51 (80.3%) showed a distinct peak at 11.9 kd. On day 3, 43 of 49 (87.8%) patients showed the presence of this biomarker most often at its strongest intensity. In all, 22 of 44 (50%) showed this biomarker on day 5 and 4 of 23 (17.9%) on day 7. C-reactive protein (CRP), tumor necrosis factor alpha (TNF-alpha), and serum amyloid A were also increased after surgery. Tissue factor pathway inhibitor (TFPI) antigen levels were increased due to the treatment modalities.

  8. Hip Arthroscopy for Incarcerated Acetabular Labrum following Reduction of Traumatic Hip Dislocation: Three Case Reports

    PubMed Central

    Hwang, Jung-Mo; Lee, Woo-Yong; Noh, Chang-Kyun; Zheng, Long

    2016-01-01

    Traumatic hip fracture-dislocations are associated with chondral and labral pathology as well as loose bodies that can be incarcerated in the hip joint. Incarceration, such as interposed labrum between acetabulum and femoral head that is not readily visualized preoperatively, is a rare but important cause of pain and can potentially be a source for early degeneration and progression to osteoarthritis. We present three cases, arthroscopic surgery of incarcerated acetabular osseo-labral fragment following reduction of traumatic hip fracture-dislocation. PMID:27777919

  9. Subchondral Insufficiency Fracture of the Femoral Head treated with Core Decompression and Bone Void Filler Support

    PubMed Central

    Patel, Hiren; Kamath, Atul F.

    2016-01-01

    Subchondral insufficiency fracture of the femoral head (SIFFH) is characterized by acute onset hip pain without overt trauma. It appears as a low intensity band with bone marrow edema on T1-weighted MRI. The most common course of treatment is protected weight bearing for a period of several weeks. Total hip arthroplasty (THA) has been commonly used if the patient does not respond to the initial protected weight bearing treatment. We present a case of a 48-year-old male with SIFFH who was treated with core hip decompression and bone void filler as a hip-preserving alternative to THA. The patient has an excellent clinical and radiographic result at final follow up. Core hip decompression with bone void filler is a less invasive alternative to THA, and may be a preferred initial treatment strategy for SIFFH in the young and active patient who has failed conservative measures. PMID:27517074

  10. Fracture resistance of endodontically treated teeth restored with indirect composite inlay and onlay restorations – An in vitro study

    PubMed Central

    Alshiddi, Ibraheem F.; Aljinbaz, Amjad

    2015-01-01

    Objective The purpose of this in vitro study was to evaluate and compare the fracture resistance and fracture mode of extensive indirect inlay and onlay composite resin restorations performed for endodontically treated premolars. Materials and methods A total of 55 extracted maxillary premolars were randomly divided into four groups. The first group (n = 15) remained untreated to serve as a positive control; the second group (n = 15) was endodontically treated with inlay cavities prepared and restored with indirect composite inlay restorations; the third group (n = 15) was also endodontically treated with onlay cavities prepared and restored with indirect composite onlay restorations; and the fourth group (n = 10) was endodontically treated with mesio-occlusodistal (MOD) cavities prepared and left unrestored to serve as negative controls. Dual cure indirect composite resin was used to fabricate the inlay and onlay restorations performed for the second and third groups, respectively. All teeth were subjected to compressive axial loading test using a metal ball (6 mm in diameter) in a universal testing machine (Instron 1195) with a cross-head speed of 0.5 mm/min until a fracture occurred. Statistical analysis of fracture resistance and fracture mode were performed with analysis of variance (ANOVA) (α = 0.05) and Kruskal–Wallis (α = 0.05) tests, respectively. Results For the four treatment groups, the mean fracture resistance values were 1326.9 N, 1500.1 N, 1006.1 N, and 702.7 N, respectively. Statistical analyses showed no significant differences between the mean fracture resistance of the intact tooth group and the inlay restoration group (p > 0.05), while significant differences were observed between the mean fracture resistance of all the other groups (p < 0.05). The Kruskal–Wallis test showed statistically significant differences between the fracture modes of the four groups. Conclusion Within the limitations of this study

  11. Postoperative bedrest improves the alignment of thoracolumbar burst fractures treated with the AO spinal fixator

    PubMed Central

    Dang, Yen; Yen, David; Hopman, Wilma M.

    2009-01-01

    Background A loss of reduction due to inadequate support of the anterior column when using short-segment instrumentation to treat burst fracture and novel methods for support of the anterior column through a posterior approach to augment posterior instrumentation have been reported in the literature. We hypothesized that if anterior column support is an important adjunct to posterior short-segment instrumentation, then avoidance of axial load until sufficient anterior column healing occurs, allowing load-sharing with the implant, would improve spinal alignment at follow-up. Methods We conducted a retrospective cohort study in which consecutive patients who had instrumentation and fusion with the AO spinal fixator were immediately ambulated after surgery or had 4 weeks of bedrest. We measured kyphosis and wedge angles preoperatively, immediately postoperatively and at the time of final follow-up. We used radiologic measures to assess instrumentation and bone failure. Results We found significant differences in the mean loss of wedge and kyphosis angle correction between patients immediately ambulated and those who had 4 weeks of bedrest (0.71º v. − 4.73º for wedge and 1.81º v. − 6.55º for kyphosis, respectively). There was significant correlation between instrumentation and bone failure in both the immediate ambulation and bedrest groups. Conclusion Bedrest improves the maintenance of intraoperative sagittal alignment correction, which is in agreement with the theory that inadequate support of the anterior spinal column is the mechanism for loss of reduction when using short-segment instrumentation to treat burst fractures. Therefore, addressing the anterior column directly through anterior surgery or by employing novel techniques in posterior surgery is recommended if one of the goals of treatment is to maintain the sagittal correction achieved at the time of surgery. Trying to achieve this goal by addressing posterior implant design or bone quality alone

  12. The effect of amount of lost tooth structure and restorative technique on fracture resistance of endodontically treated premolars

    PubMed Central

    Bassir, Mahshid Mohammadi; Labibzadeh, Akram; Mollaverdi, Fatemeh

    2013-01-01

    Aim: Endodontic treatment generally reduces the fracture resistance of teeth. The purpose of this study was to evaluate the fracture resistance and the mode of fracture of endodontically treated human premolars with different amounts of remaining tooth structure. Materials and Methods: Seventy non-carious human premolars were randomly assigned into 7 groups. Group 1 (ST) did not receive any preparation. The teeth in groups 2-7 received root canal treatment and different preparations. Group 2 (MO-NF): Mesio-occlusal preparation without filling; Group 3 (MOD-NF): Mesio-occluso-distal preparation without filling; Group 4 (MO-F): Mesio-occlusal preparation with direct composite restoration (Z250); Group 5 (MOD-F): Mesio-occluso-distal preparation with direct composite restoration (Z250); Group 6 (CC-D): Mesio-occluso-distal preparation with cusp reduction and direct composite restoration (Z250); Group 7 (CC-InD): Mesio-occluso-distal preparation with cusp reduction and indirect composite restoration (Gradia GC). The fracture resistance (N) was assessed under compressive load in a universal testing machine (Zwick) perpendicular to the occlusal surface at a cross-head speed of 1 mm/min, and the mode of fracture was assessed under stereomicroscope. Statistical analysis: Data was analyzed by Kruskal – Wallis and Mann – Whitney tests and the mode of fracture was analyzed by Chi-square test (P < 0.05). Results: Statistical analysis showed that MO and MOD cavity preparations significantly reduced the fracture resistance of sound teeth. Direct composite restorations can improve the fracture resistance, and Groups 7 and 6 presented the highest fracture resistance values. Conclusions: Teeth with adhesive restorations showed significantly higher fracture resistance values as compared with the non-restored ones. PMID:24082569

  13. Acromial approach for treating glenoid fractures: A report of two cases and a literature review

    PubMed Central

    AO, RONGGUANG; YU, BAOQING; SHI, JIFEI; LI, ZEXIANG; ZHU, YALONG

    2015-01-01

    Surgery is usually recommended for displaced glenoid fractures, with open reduction and internal fixation as the standard operative treatment. Three approaches have been recommended in the reduction of glenoid fractures: Anterior, posterior and combined; however, a traditional approach may be difficult due to a high position or a comminuted Ideberg type III fracture. The combined approach results in a longer incision and more soft tissue injury when associated with an acromial fracture. The present study describes two complicated glenoid fractures: One case was a comminuted Ideberg type III fracture associated with an Ogawa type II acromial fracture; the second case was an Ideberg type IV fracture with associated superior shoulder suspensory complex injuries. In these cases, the acromial approach was modified to achieve satisfactory exposure and fixation of the complicated fracture. After a 1-year follow-up, the patients had a satisfactory outcome. PMID:26640532

  14. Fractures

    MedlinePlus

    ... commonly happen because of car accidents, falls, or sports injuries. Other causes are low bone density and osteoporosis, which cause weakening of the bones. Overuse can cause stress fractures, which are very small cracks in the ...

  15. The acetabular point: a morphological and ontogenetic study

    PubMed Central

    RISSECH, C.; SAÑUDO, J. R.; MALGOSA, A.

    2001-01-01

    The acetabular point was analysed by studying human pelvic bones from 326 individuals ranging from newborns to age 97 y. The bones were categorised into 3 groups according to the degree of fusion for the 3 elements of the pelvis: nonfused (59), semifused (5) and fused (262). The acetabular point in immature pelvic bones is clearly represented by the point of the fusion lines for each bony element at the level of the acetabular fossa. In adult pelvic bones the acetabular fossa has an irregular clover-leaf shape, the superior lobe being smaller than the anterior and posterior lobes. Cross-sectional analysis of acetabular morphology suggested that the acetabular point in adult pelvic bones is always represented by the indentation between the superior and the anterior lobes of the acetabular fossa. PMID:11465866

  16. Uncemented acetabular components with femoral head autograft for acetabular reconstruction in developmental dysplasia of the hip: a concise follow-up report at a mean of twenty years.

    PubMed

    Abdel, Matthew P; Stryker, Louis S; Trousdale, Robert T; Berry, Daniel J; Cabanela, Miguel E

    2014-11-19

    We previously reported the five to twelve-year results of total hip arthroplasty with an uncemented acetabular component and an autogenous femoral head graft in forty-four consecutive hips with developmental dysplasia. The goal of the present study was to report the implant survival rate, status of bone grafts, and clinical outcomes in thirty-five of these hips (in twenty-nine patients) followed for a mean of 21.3 years. Functional, radiographic, and survivorship results were examined. Radiographic analysis revealed an average cup inclination angle of 43° and a mean arc of cup coverage by the graft of 30°. The twenty-year survivorship free from acetabular revision was 66% (twelve acetabular revisions; eight since our previous report). Of the twelve revisions, nine were for liner wear and/or osteolysis, one was for a liner fracture, one was for aseptic loosening, and one was for instability. All bone grafts healed to the pelvis. The graft facilitated revision cup placement as no additional structural grafts or metal augments were required. We concluded that an uncemented porous-coated socket used in conjunction with a bulk femoral head autograft provides good long-term fixation and restores bone stock. PMID:25410505

  17. Comparison of fracture resistance of endodontically treated teeth using different coronal restorative materials: An in vitro study

    PubMed Central

    Monga, Prashant; Sharma, Vivek; Kumar, Sukesh

    2009-01-01

    Aim/Objective: To evaluate the in vitro effect of bonded restorations on the fracture resistance of root canal-treated teeth. Materials and Methods: One hundred twenty extracted, maxillary, permanent premolars were collected. After preparing the access cavity, the teeth were biomechanically prepared and obturated. Samples were divided into six groups based on the type of restorative material used to restore them. Teeth were embedded in acrylic resin and their fracture strength was measured using a Universal Testing Machine. Data were evaluated statistically using one-way ANOVA-F and unpaired t-test. Results: Teeth restored with bonded amalgam and composite resin showed higher fracture resistance than those restored with conventional amalgam. Fracture strengths of bonded restorations and intact teeth were not statistically different. The results suggested that the group restored with conventional amalgam had the lowest fracture resistance. No statistically significant differences were found between the bonded amalgam and composite resin groups. Conclusion: Conventional amalgam core showed the least fracture resistance whereas; composite resin and bonded amalgam core showed fracture resistance was similar to that of natural tooth. PMID:20543925

  18. [Intramedullary osteosynthesis in treating intertrochanteric fracture of the femur, based on our own experience using Gamma nails and Ender rods].

    PubMed

    Bednarenko, Marcin; Kotela, Ireneusz; Zieńzuk, Witold; Korzec, Artur

    2008-01-01

    Intertrochanteric fractures have always posed an interdisciplinary medical problem. Most frequently it happens between 7th and 8th decades of life. The majority of them are due to osteoporosis. Both for a medical doctor and surgeon they face quite a challenge when it comes to treating a patient with a fracture of the proximal epiphysis of the femur. Recently, the outcome of the fracture treatment has improved greatly due to introduction of modern methods of intramedullary and periosteal fusion. In this study we present a possible utilization of Gamma nails, its advantages and disadvantages compared with the stabilisation achieved using Ender rods. We analyzed the outcome of treatment of 198 patients treated for intertrochanteric fractures of the femur. We present advantages and disadvantages of both methods of stabilization. We stress the importance of the correct reduction of the bone even if requiring opening. We also point to difficulties that accompany both types of stabilization. The final results reveal a considerably better outcome in patients treated using Gamma nails, especially if fractures were instable. PMID:18669108

  19. Irreducible Atlanto-Axial Dislocation in Neglected Odontoid Fracture Treated with Single Stage Anterior Release and Posterior Instrumented Fusion

    PubMed Central

    Rathod, Ashok Keshav; Chaudhary, Kshitij Subhash

    2016-01-01

    It is a well-know fact that type 2 odontoid fractures frequently go into nonunion. If left untreated, patients may develop irreducible atlantoaxial dislocation (AAD). We describe the surgical management of two patients with neglected odontoid fractures and irreducible AAD treated with single stage anterior release followed by posterior instrumented fusion. Both patients presented with history of neglected trauma and progressive myelopathy. Traction under anesthesia failed to achieve reduction of AAD. Anterior release was done by trans-oral approach in one patient and retrophayngeal approach in the other. Posterior fixation was performed with transarticular screws in both the patients. Both patients had full neurological recovery and demonstrated fusion at follow-up. Anterior release followed by posterior instrumented correction may be an effective alternative to the traditional means of treating irreducible dislocations associated with neglected odontoid fractures. PMID:27114778

  20. Fracture resistance of endodontically treated canines restored with different sizes of fiber post and all-ceramic crowns

    PubMed Central

    Alkumru, Hasan Necdet; Akalin, Buket

    2016-01-01

    PURPOSE The aim of this study was to determine the fracture resistance and the mode of fracture of endodontically treated teeth restored with different fiber posts and all-ceramic crowns. MATERIALS AND METHODS Two glass fiber reinforced post systems in two different sizes and polyethylene fiber ribbon in two different thicknesses (n=10) were used. The specimens, restored with all-ceramic crowns, were subjected to a compressive load (in N) delivered at a 130-degree angle to the long axis until a fracture could be noted. The results were analyzed statistically with a One-Way ANOVA test (P<.05). RESULTS Statistically significant differences were observed between the mean fracture resistance values of Postec, Snowlight, and Kerr Connect thin specimens (P<.0095). The Postec results (395.70 N) were found to be significantly higher than the others. No statistical difference was observed among the thick specimens (P<.2657). The mean fracture resistance values of the Snowlight thick samples were found to be higher than those of the Snowlight thin samples. The specimens were always fractured around the cemento-enamel junction at the palatinal side. No post fracture was observed for the thin Snowlight and Kerr Connect specimens or for the thick Postec and Kerr Connect specimens. Among the common failure types of the specimens, the worst was observed to be the root fracture failure. The highest post dislodgement failure result (80%) was obtained from the thin Kerr Connect specimen. CONCLUSION In terms of optimizing fracture resistance, the fiber post size selection should be done according to the forces applied to the restored teeth. PMID:27141261

  1. Relationship Between Developmental Dislocation of the Hip in Infant and Acetabular Dysplasia at Skeletal Maturity

    PubMed Central

    Okano, Kunihiko; Yamaguchi, Kazumasa; Ninomiya, Yoshikazu; Matsubayashi, Shohei; Aoyagi, Kiyoshi; Osaki, Makoto; Enomoto, Hiroshi; Takahashi, Katsuro

    2015-01-01

    Abstract Previous reports demonstrated 8–60% patients treated for developmental dislocation of hip (DDH) in infancy have residual acetabular dysplasia (AD) at skeletal maturity. AD patients reportedly exhibit abnormal morphology of the pelvis, high rates of comorbid spinal congenital anomalies and high bone mineral density. These physical findings suggest that AD patients have genetic background. We examined the percentage of AD patients with hip pain at skeletal maturity having a history of DDH in infancy and the correlation between the severity of AD at skeletal maturity and history of DDH treatment to investigate the relationship between AD and DDH. A total of 245 patients were radiographically examined for any history of DDH treatment in infancy. The study included 226 women and 19 men with a mean age at examination of 40.7 years (range 17–59 years). Eighty-eight patients (36%) had a history of DDH treatment (DDH group) and the remaining 157 patients (64%) had no history of DDH treatment (non-DDH group). The average age was lower and acetabular angle was larger in the DDH group. There was a significant increasing trend of the percentage of DDH patients associated with the severity of AD classified with CE, acetabular angle, and acetabular roof angle. Our data suggest that there are several AD patients without a history of DDH in Japan, and AD in patients without a history of DDH has different characteristics from AD in patients with a history of DDH. PMID:25569642

  2. Relationship between developmental dislocation of the hip in infant and acetabular dysplasia at skeletal maturity.

    PubMed

    Okano, Kunihiko; Yamaguchi, Kazumasa; Ninomiya, Yoshikazu; Matsubayashi, Shohei; Aoyagi, Kiyoshi; Osaki, Makoto; Enomoto, Hiroshi; Takahashi, Katsuro

    2015-01-01

    Previous reports demonstrated 8-60% patients treated for developmental dislocation of hip (DDH) in infancy have residual acetabular dysplasia (AD) at skeletal maturity. AD patients reportedly exhibit abnormal morphology of the pelvis, high rates of comorbid spinal congenital anomalies and high bone mineral density. These physical findings suggest that AD patients have genetic background. We examined the percentage of AD patients with hip pain at skeletal maturity having a history of DDH in infancy and the correlation between the severity of AD at skeletal maturity and history of DDH treatment to investigate the relationship between AD and DDH.A total of 245 patients were radiographically examined for any history of DDH treatment in infancy. The study included 226 women and 19 men with a mean age at examination of 40.7 years (range 17-59 years).Eighty-eight patients (36%) had a history of DDH treatment (DDH group) and the remaining 157 patients (64%) had no history of DDH treatment (non-DDH group). The average age was lower and acetabular angle was larger in the DDH group. There was a significant increasing trend of the percentage of DDH patients associated with the severity of AD classified with CE, acetabular angle, and acetabular roof angle.Our data suggest that there are several AD patients without a history of DDH in Japan, and AD in patients without a history of DDH has different characteristics from AD in patients with a history of DDH. PMID:25569642

  3. USE OF THE PFO® NUT IN TREATING FRACTURES OF THE PROXIMAL THIRD OF THE HUMERUS IN PATIENTS WITH BONE FRAGILITY

    PubMed Central

    Miyazaki, Alberto Naoki; Fregoneze, Marcelo; Santos, Pedro Doneux; da Silva, Luciana Andrade; Pires, Davi Calixto; Mota Neto, Jose da; de Camargo Rossato, Luis Henrique; Checchia, Sergio Luiz

    2015-01-01

    Objective: To evaluate the clinical results from application of the PFO® bone fixation nut, which was developed for use with 4.5 mm cortical screws, and to analyze any complications or bone reactions caused by this synthesis in porotic bone. Method: Between May 1999 and November 2007, the PFO® nut was used on 23 patients who underwent osteosynthesis with a PFS 80® plate in the proximal segment, to treat acute fractures, pseudarthrosis or defective consolidations. The average age of the patients was 69 years, and the average length of follow-up was 40 months. Results: Only one patient did not present consolidation. The complications observed were: two cases of medial cortical fracture; one case of loosening of the nut; three cases of bone reabsorption around the PFO®, but two of these without clinical repercussions; and one case in which the fracture failed to consolidate, with consequent loosening of the fracture. Conclusion: The authors conclude that the use of the PFO® nut is a practical and effective alternative for osteosynthesis in patients with fractures of the proximal segment or sequelae from fractures of the humerus associated with bone fragility PMID:27019836

  4. Fracture resistance of structurally compromised and normal endodontically treated teeth restored with different post systems: An in vitro study

    PubMed Central

    Mortazavi, Vajihesadat; Fathi, Mohammadhossein; Katiraei, Najmeh; Shahnaseri, Shirin; Badrian, Hamid; Khalighinejad, Navid

    2012-01-01

    Background: With the aim of developing methods that could increase the fracture resistance of structurally compromised endodontically treated teeth, this study was conducted to compare the effect of three esthetic post systems on the fracture resistance and failure modes of structurally compromised and normal roots. Materials and Methods: Forty five extracted and endodontically treated maxillary central teeth were assigned to 5 experimental groups (n=9). In two groups, the post spaces were prepared with the corresponding drills of the post systems to be restored with double taper light posts (DT.Light-Post) (group DT.N) and zirconia posts (Cosmopost) (group Zr.N). In other 3 groups thin wall canals were simulated to be restored with Double taper Light posts (DT.W), double taper Light posts and Ribbond fibers (DT+R.W) and Zirconia posts (Zr.W). After access cavity restoration and thermocycling, compressive load was applied and the fracture strength values and failure modes were evaluated. Data were analyzed using two-way ANOVA, Tukey and Fisher exact tests (P<0.05). Results: The mean failure loads (N) were 678.56, 638.22, 732.44, 603.44 and 573.67 for groups DT.N, Zr.N, DT.W, DT+R.W and Zr.w respectively. Group DT+R.W exhibited significantly higher resistance to fracture compared to groups Zr.N, DT.W and Zr.w (P<0.05). A significant difference was detected between groups DT.N and Zr.W (P=0.027). Zirconia posts showed significantly higher root fracture compared to fiber posts (P=0.004). Conclusion: The structurally compromised teeth restored with double taper light posts and Ribbond fibers showed the most fracture resistance and their strengths were comparable to those of normal roots restored with double taper light posts. More desirable fracture patterns were observed in teeth restored with fiber posts. PMID:22623936

  5. Effect of noble metal alloy post and core material on the fracture resistance of endodontically treated teeth.

    PubMed

    Toksavul, Suna; Toman, Muhittin; Sarikanat, Mehmet; Nergiz, Ibrahim; Schmage, Petra

    2010-03-01

    The aim of this study was to investigate the effect of one particular brand of post and core system (ER Post) consisted of different post and core materials on the fracture resistance of endodontically treated teeth. Fifty caries-free maxillary central incisors were randomly assigned to five groups (n=10). All teeth were sectioned at the cemento-enamel junction except for the teeth in the control group. Four experimental groups consisted of cast gold post-and-core group (GG), Heraplat post/cast gold core group (HG), titanium post/composite core (TC), and titanium post/cast gold core (TG). The control group (ETT) consisted of endodontically treated teeth without posts. All posts were cemented in the roots with zinc phosphate cement. Following thermal cycling (5000 cycles between 5 degrees C and 55 degrees C with a dwell time of 30 seconds) a static load was applied to 2 mm below the incisal edge on the palatal surface of each specimen until they were fractured. Fracture data obtained and statistically analyzed with one-way ANOVA and a Tukey's test (p<0.05). Means of the fracture resistance during static loading were: 423.76 N (GG), 529.46 N (HG), 389.08 N (TC), 408.7 N (TG), 404.4 N (ETT, control). Heraplat post with cast gold core exhibited the highest fracture load than the other groups (p<0.05). Specimens in groups HG and ETT (control) showed the most repairable failure. Heraplat post with cast gold core had the highest fracture resistance of endodontically treated teeth.

  6. A case report of reattachment of fractured root fragment and resin-composite reinforcement in a compromised endodontically treated root.

    PubMed

    Lui, J L

    2001-10-01

    The composite reinforcement technique has been used clinically to salvage damaged root-filled teeth compromised by caries, trauma, developmental abnormalities, internal resorption and iatrogenic causes. This clinical case report describes the use of the technique to reattach a fractured fragment in a compromised endodontically treated root besides reinforcing it for continued function in the mouth. Factors of clinical importance related to this additional application; including reattachment of tooth fragments, post crown retention, coronal microleakage and fracture resistance and strength, are also briefly discussed.

  7. A case report of reattachment of fractured root fragment and resin-composite reinforcement in a compromised endodontically treated root.

    PubMed

    Lui, J L

    2001-10-01

    The composite reinforcement technique has been used clinically to salvage damaged root-filled teeth compromised by caries, trauma, developmental abnormalities, internal resorption and iatrogenic causes. This clinical case report describes the use of the technique to reattach a fractured fragment in a compromised endodontically treated root besides reinforcing it for continued function in the mouth. Factors of clinical importance related to this additional application; including reattachment of tooth fragments, post crown retention, coronal microleakage and fracture resistance and strength, are also briefly discussed. PMID:11678543

  8. 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

  9. Diagnosis of vertical root fracture with cone-beam computerized tomography in endodontically treated teeth: three case reports.

    PubMed

    Miyagaki, Daniela Cristina; Marion, Jefferson; Randi Ferraz, Caio Cézar

    2013-01-01

    A definitive diagnosis of vertical root fracture (VRF) is often a challenging task for clinicians. This is because two dimensional periapical radiographs are usually unable to detect the fracture line due to the direction of the X-ray beam. This report presents a set of 3 cases of endodontically treated teeth that were diagnosed with VRFs based on findings from clinical, radiographic, and cone-beam computerized tomographic (CBCT) examinations. After extraction, VRFs were confirmed in all cases. The presence of periodontal pockets or other signs which would compromise the correct diagnosis could not be detected in all three cases. Fracture lines were only visible with the aid of CBCT which provided useful information for the diagnosis and management of VRF. However, the clinical and radiographic data should not be discarded, but used in conjunction with CBCT. PMID:23717335

  10. Bone growth stimulators. New tools for treating bone loss and mending fractures.

    PubMed

    Whitfield, James F; Morley, Paul; Willick, Gordon E

    2002-01-01

    the main focus of this article is necessarily the currently most promising of the anabolic agents, the potent parathyroid hormone (PTH) and certain of its 31- to 38-aminoacid fragments, which are either in or about to be in clinical trial or in the case of Lilly's Forteo [hPTH-(1-34)] tentatively approved by the Food and Drug Administration for treating osteoporosis and mending fractures.

  11. Effect of Post Material and Length on Fracture Resistance of Endodontically Treated Premolars: An In-Vitro Study

    PubMed Central

    Amarnath, G S; Swetha, M U; Muddugangadhar, B C; Sonika, Radhika; Garg, Ashu; Rao, T R Poonam

    2015-01-01

    Background: Endodontically treated teeth with posts are more prone to fracture. Hence, the purpose of this study was to investigate the in-vitro fracture resistance of devitalized teeth and mode of failure restored with posts of different materials and different lengths. Materials and Methods: Sixty freshly extracted human mandibular premolars were endodontically treated and then restored with 1 of 2 prefabricated posts: Stainless-steel (SS) and glass-fiber (fiber posts [FP]) with intraradicular lengths of 4, 5 or 10 mm (n = 10). Following core restoration, a static compressive load was applied perpendicular to the long-axis of the teeth. Initial failure of each specimen was recorded in Newton. The mode of failure was also determined radiographically. The data were analyzed using two-way ANOVA and Tukey's post-hoc analysis with Bonferroni adjustment. Results: Analysis indicated significant differences (P < 0.001) among the groups. Among the SS posts, SS/7 (246 N) exhibited the highest failure load and SS/4 (122 N) the lowest. FP/10 (140.5 N) exhibited the highest failure load among the FP and FP/4 (68.5 N) the lowest. SS posts showed post pull out, followed by core fracture while FP showed core debonding, followed by core fracture as the primary mode of failure. Conclusion: Fracture resistance of the teeth proportionately increased with increase in the length of FP while it decreased with that of metal post. SS posts showed greater fracture resistance than FP when 90° load was applied. PMID:26229366

  12. Constrained captive acetabular cup for recurrent dislocation of hemiarthroplasty in elderly: A case series

    PubMed Central

    Rajeev, Aysha; Banaszkiewicz, Paul

    2016-01-01

    Introduction Hemiarthroplasty of the hip is one of the commonest procedures done for intracapsular fractures of the neck of femur in elderly. Dislocation of the hemiarthroplasty is a recognised and significant complication. This is associated with considerable morbidity and mortality. The treatment options include closed manipulation, skin and skeletal traction, conversion to total hip replacement, exploration and open reduction and leaving it out of the acetabulum. Presentation of case A retrospective review of ten patients with recurrent and failed closed manipulative reduction of hemiarthroplasty who underwent revision using a cemented captive acetabular cup and cement to cement revision of femoral component with Exeter CDH stem was carried out. The follow up period was two years and the functional outcomes were assessed using Harris hip scores. Discussion The management of recurrent dislocations of hemiarthroplasty in elderly patient are very challenging. Even though various treatment options are described most of them are associated with increased morbidity and mortality and prevent these patients from early mobilisation. The use of captive acetabular avoid repeated dislocations, prolonged bed rest, wearing of a brace and all the complications associated with sustained immobilization. The drawbacks of using constrained cups are hip pain, limited hip movements and loosening. Conclusion We describe a new method of treatment of this difficult condition with a cemented constrained acetabular captive cup and cement to cement revision using a CDH femoral stem. This method prevents further dislocations and will give good functional outcomes thus reducing the high morbidity and mortality. PMID:27129135

  13. Retrograde Transpubic Approach for Percutaneous Radiofrequency Ablation and Cementoplasty of Acetabular Metastasis

    PubMed Central

    Bauones, Salem; Freire, Veronique; Moser, Thomas P.

    2015-01-01

    We report a case of painful and disabling anterior acetabular bone metastasis treated with bipolar radiofrequency ablation and cementoplasty. Due to the high risk of complications related to the proximity of the femoral neurovascular structures with a direct approach, we successfully performed a retrograde transpubic approach under combined CT and fluoroscopic guidance. In the present report, we describe this approach detailing its indications, advantages, and the technical tips to achieve a safe and satisfactory procedure. PMID:26491595

  14. Osteonecrosis and femoro-acetabular impingement: sequelae of developmental dysplasia of the hip

    PubMed Central

    Cheung, Jason Pui Yin; Chow, Wang; To, Michael

    2012-01-01

    A 2-year-old girl with developmental dysplasia of the right hip underwent open reduction and capsulorrhaphy via the anterior approach with hip spica casting in an internally rotated position. During her 26 years of follow-up, she was found to have osteonecrosis and subsequently cam-type femoro-acetabular impingement at 28 years of age. She was treated with surgical dislocation of the hip and osteochondroplasty to recreate the normal contour of the head and neck offset. PMID:22605717

  15. Management of Symphysis and Parasymphysis Mandibular Fractures in Children Treated with MacLennan Splint: Stability and Early Results

    PubMed Central

    Bhat, Manohar; Sharma, Anupama; Sharma, Rajesh

    2015-01-01

    ABSTRACT Objective: The aim of this study was to assess the safety and efficiency of MacLennan splint in symphysis and parasymphysis mandibular fractures in children. Study design: Six patients (four boys and two girls, mean age 3 years, range between 2 and 5 years) were operated on parasymphysis fractures of children. The mean follow-up time was 12 months. MacLennan splint was applied in these case upto 3 weeks. Results: Primary healing of the fractured mandible was observed in all patients. Postoperative complications were minor and transient. The outcome of the operation was not endangered. Adverse tissue reaction like infection, malocclusion, swelling and growth restrictions did not occur during observation period. Conclusion: MacLennan splint is having various advantages like faster mobilization and the avoidance of secondary removal operations. Based on this preliminary results MacLennan splints are safe and efficient in the treatment of pediatric mandible fracture. How to cite this article: Khairwa A, Bhat M, Sharma A, Sharma R. Management of Symphysis and Parasymphysis Mandibular Fractures in Children Treated with MacLennan Splint: Stability and Early Results. Int J Clin Pediatr Dent 2015;8(2):127-132. PMID:26379381

  16. The Influence of Composite Thickness with or without Fibers on Fracture Resistance of Direct Restorations in Endodontically Treated Teeth

    PubMed Central

    Torabzadeh, Hassan; Ghassemi, Amir; Sanei, Masoud; Razmavar, Sara; Sheikh-Al-Eslamian, Seyedeh Mahsa

    2014-01-01

    Introduction: This in vitro study evaluated the influence of composite thickness (with or without fiber reinforcement) on fracture resistance of direct restorations in endodontically treated teeth. Methods and Materials: Fifty-six intact human premolars were chosen and randomly divided into four groups (n=14). After preparation of a mesio-occluso-distal (MOD) cavities and cusp reduction, the teeth were endodontically treated. Subsequently, the samples were restored with composite resin using the following protocols: group 1; composite onlay with cusp coverage of 1.5 mm, group 2; composite onlay with cusp coverage of 2.5 mm, group 3; composite onlay (including resin-impregnated fiber) with cusp coverage of 1.5 mm and group 4; composite onlay (including resin-impregnated fiber) with cusp coverage of 2.5 mm. The fracture resistance of teeth in all test groups was calculated by subjecting them to a progressively increasing compressive axial force in the universal testing machine with the cross-head speed of 1 mm/min to the point of fracture. The data were analyzed using the Kruskal-Wallis test. Results: The mean fracture strengths and obtained standard error were 1263.85±74.03 N, 1330.26±128.01 N, 1344.92±64.40 N and 1312.54±75.63 N for groups 1 to 4, respectively. Statistical analysis revealed no significant difference between groups. Conclusion: Cusp coverage of 1.5 and 2.5 mm in MOD access cavities with or without insertion of resin impregnated fiber had similar fracture rates in the endodontically treated teeth. PMID:25031597

  17. Comparison of fracture resistance of endodontically treated teeth restored with nanohybrid, silorane, and fiber reinforced composite: An in vitro study

    PubMed Central

    Bilgi, Priyanka Shripad; Shah, Nimisha Chinmay; Patel, Parth Pinakinbhai; Vaid, Deepa S

    2016-01-01

    Background: The present study was undertaken to evaluate the most suitable restorative for badly mutilated endodontically treated teeth. Aims: To evaluate and compare the fracture resistance of endodontically treated premolars restored with conventional nanohybrid, silorane composite with glass fibers and newer fiber-reinforced composite in mesio-occluso-distal (MOD) cavities. Materials and Methods: Sixty extracted human maxillary premolars were selected. Fifteen intact teeth served as positive controls (Group 1). Endodontic therapy was done in the remaining 45 teeth. MOD cavities were prepared in all the teeth with standardized dimensions and were randomly divided into three groups (Group 2 - nanohybrid + glass fibers, Group 3 - silorane + glass fibers, and Group 4 – fiber-reinforced composite). Restorations were done for all groups. Fracture resistance was measured by Instron universal testing machine. Statistical Analysis Used: One-way anova test and Tukey's post hoc test. Results: Highest fracture resistance was shown by intact teeth group followed by fiber-reinforced composite, nanohybrid, and silorane, respectively. Statistically Significant difference was revealed by anova test (P < 0.0001) and Tukey's post hoc test (P < 0.0001). Conclusions: Among the experimental groups, fiber-reinforced composite showed the highest fracture resistance. Statistically significant difference was observed for all the groups. PMID:27563188

  18. Navigated Acetabular Cup Fixation for Acetabular Deformity or Revision Total Hip Arthroplasty

    PubMed Central

    Yoon, Jung-Ro; Yu, Jung Jin; Seo, Hyo-Sung

    2014-01-01

    Purpose To evaluate the usefulness of navigated acetabular cup fixation for total hip arthroplasty in patients with acetabular deformity or revision total hip arthroplasty. Materials and Methods This study enrolled 28 patients with at least 12 months' follow-up. The safe zone of the acetabular cup was defined as 40°±10°in inclination and 15°±10°in anteversion. The authors used the navigation and radiographic data to determine whether the acetabular cup was located within the safe zone or not. To evaluate the clinical outcomes, preoperative and last follow-up Harris hip scores were checked, and the occurrence of complications was evaluated. Results According to the navigation data, the mean inclination and anteversion were 38.5°±4.7°(range, 32°-50°) and 16.6°±4.0°(range, 8°-23°), respectively. According to the radiographic data the mean inclination and anteversion were 40.5°±4.6°(range, 32°-50°) and 19.4°±4.2°(range, 8°-25°), respectively. In both cases, all values were within the safe zone. Harris hip score was improved in all patients from preoperative 52.3±14.4 points (range, 29-87 points) to 88.0±9.0 points (range, 65-99 points) at the last follow-up. There was no dislocation or loosening of both cases. Conclusion Navigated acetabular cup fixation is a useful technique for total hip arthroplasty in patients with acetabular deformity or revision total hip arthroplasty because it prevents the malposition and related complications. PMID:27536573

  19. Geriatric fractures about the hip: divergent patterns in the proximal femur, acetabulum, and pelvis.

    PubMed

    Sullivan, Matthew P; Baldwin, Keith D; Donegan, Derek J; Mehta, Samir; Ahn, Jaimo

    2014-03-01

    Geriatric acetabular, pelvis, and subtrochanteric femur fractures are poorly understood and rapidly growing clinical problems. The purpose of this study was to describe the epidemiologic trends of these injuries as compared with traditional fragility fractures about the hip. From 1993 to 2010, the Nationwide Inpatient Sample (NIS) recorded more than 600 million Medicare-paid hospital discharges. This retrospective study used the NIS to compare patients with acetabular fractures (n=87,771), pelvic fractures (n=522,831), and subtrochanteric fractures (n=170,872) with patients with traditional hip fractures (intertrochanteric and femoral neck, n=3,495,742) with regard to annual trends over an 18-year period in incidence, length of hospital stay, hospital mortality, transfers from acute care institutions, and hospital charges. Traditional hip fractures peaked in 1996 and declined by 25.7% by 2010. During the same 18-year period, geriatric acetabular fractures increased by 67%, subtrochanteric femur fractures increased by 42%, and pelvic fractures increased by 24%. Hospital charges, when controlling for inflation, increased roughly 50% for all fracture types. Furthermore, transfers from outside acute care hospitals for definitive management stayed elevated for acetabular fractures as compared with traditional hip fractures, suggesting a greater need for tertiary care of acetabular fractures. Geriatric acetabular fractures are rapidly increasing, whereas traditional hip fractures continue to decline. Patients with these injuries are more likely to be transferred from their hospital of presentation to another acute care institution, possibly increasing costs and complications. This is likely related to their complexity and the lack of consensus regarding optimal management.

  20. Effect of Retained Austenite on the Fracture Toughness of Quenching and Partitioning (Q&P)-Treated Sheet Steels

    NASA Astrophysics Data System (ADS)

    Wu, Riming; Li, Wei; Zhou, Shu; Zhong, Yong; Wang, Li; Jin, Xuejun

    2014-04-01

    Fracture toughness K IC was measured by double edge-notched tension (DENT) specimens with fatigue precracks on quenching and partitioning (Q&P)-treated high-strength (ultimate tensile strength [UTS] superior to 1200 MPa) sheet steels consisting of 4 to 10 vol pct of retained austenite. Crack extension force, G IC, evaluated from the measured K IC, is used to analyze the role of retained austenite in different fracture behavior. Meanwhile, G IC is deduced by a constructed model based on energy absorption by martensite transformation (MT) behavior of retained austenite in Q&P-treated steels. The tendency of the change of two results is in good agreement. The Q&P-treated steel, quenched at 573 K (300 °C), then partitioned at 573 K (300 °C), holding for 60 seconds, has a fracture toughness of 74.1 MPa·m1/2, which is 32 pct higher than quenching and tempering steel (55.9 MPa·m1/2), and 16 pct higher than quenching and austempering (QAT) steel (63.8 MPa·m1/2). MT is found to occur preferentially at the tips of extension cracks on less stable retained austenite, which further improves the toughness of Q&P steels; on the contrary, the MT that occurs at more stable retained austenite has a detrimental effect on toughness.

  1. 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

  2. The treatment of complex proximal humeral fractures: analysis of the results of 55 cases treated with PHILOS plate.

    PubMed

    Fattoretto, D; Borgo, A; Iacobellis, C

    2016-08-01

    Complex proximal humerus fractures are often difficult to treat. Their frequency is high, especially in the elderly, and their treatment is still controversial. The aim of this study was to analyze the clinical and radiological results achieved by patients with complex proximal humerus fractures, treated with PHILOS plate only. A cohort of 55 patients was selected. The mean age was 63.4 (range 33-89), while the mean follow-up time was 21.5 months (range 6-75). Clinical outcome was evaluated with the "Constant-Murley shoulder score." All the informations about the presence of complications were gathered, and radiological images were used to calculate the head-shaft angle. The overall mean Constant score was 61.93 ± 18.59, the Individual CS was 70 ± 20 % and the Relative CS was 83 ± 23 %. No significant differences were found between fractures Neer 3 and Neer 4 and between the surgical approaches (delta-split vs. delto-pectoral). Six patients had a fracture with dislocation, seven patients (12.7 %) had complications while in four patients a head-shaft angle beyond the normal range was found. Osteosynthesis with PHILOS plate is stable in the greater part of the cases, and it allows an earlier rehabilitation and so a good functional result, which could be compromised by a prolonged immobilization. Therefore, PHILOS plate is a good option for the treatment of complex proximal humerus fractures.

  3. Biomechanical Study of Acetabular Tridimensional Memoryalloy Fixation System

    NASA Astrophysics Data System (ADS)

    Liu, Xin-Wei; Xu, Shuo-Gui; Zhang, Yun-Tong; Zhang, Chun-Cai

    2011-07-01

    We developed the acetabular tridimensional memoryalloy fixation system (ATMFS), which is made of NiTi shape memory alloy, according to the specific mechanical properties of biological memory material, NiTi shape memory alloy and measured distribution of contact area and pressure between the acetabulum and the femoral head of cadaveric pelvis. Seven formalin-preserved cadaveric pelves were used for this investigation. Pressure-sensitive film was used to measure contact area and pressure within the anterior, superior, and posterior regions of the acetabulum. The pelves were loaded under the following four conditions: (1) intact; (2) following a creation posterior wall fracture defect; (3) following reduction and standard internal fixation with reconstruction plate; and (4) following reduction and internal fixation with a new shape memory alloy device named ATMFS. A posterior wall fracture was created along an arc of 40° to 90° about the acetabulur rim. Creation of a posterior wall defect resulted in increased load in the superior acetabulum (1485 N) as compared to the intact condition (748 N, P = 0.009). Following reduction and internal fixation, the load distributed to the superior acetabulum (1545 N) was not statistically different from the defect condition. Following the fixation with ATMFS, the load seen at the superior region of the actabulum (964 N) was familiar with fixation with reconstruction plate and was not different from intact state ( P = 0.45). These data indicate that the use of ATMFS as a fracture internal fixation device resulted a partial restoration of joint loading parameters toward the intact state. ATMFS fixation may result in a clinical benefit.

  4. Fracture Strength of Endodontically Treated Teeth Restored with Casting Post and Core and Glass-Fiber with Composite Core

    PubMed Central

    Saatian, Sedigheh

    2006-01-01

    INTRODUCTION: Prefabricated metal and ceramic posts can be used with different kinds of core materials as an alternative to the conventional casting post and cores. It is unclear how these post and core systems can withstand different kind of forces in the mouth. The purpose of this study was to compare the fracture strength of endodontically treated, crowned maxillary incisors restored with casting post and cores and glass- fiber post with composite core and to evaluate their mode of fractures. MATERIALS AND METHODS: Thirty caries free, human maxillary central incisors with incisoapical length of 23 ± 1 mm were divided into two groups. After root canal treatment procedures and decronation of teeth 2mm above cementoenamel junction, Grope 1 was restored with glass- fiber posts and composite cores and group 2 received casting post and cores. Teeth were prepared with a circumferential shoulder including a 1-2 mm ferrule and 0.5 mm bevel; all posts were cemented with an adhesive resin and teeth were restored with complete coverage crowns. Loads were applied at an angle of 135 degrees using a universal testing machine. Compression force was applied until the specimens fractured. RESULTS: The median fracture strengths of groups 1 and 2 were 459 and 686 respectively (p<0.5). In group I, all fractures occurred in incisal third of roots. In groups II, 40% of fractures were in apical third and middle of roots. CONCLUSION: Within the limitation of this study, the results suggested that glass fiber with composite cores can be used as an alternative to cast posts and cores in anterior teeth when creating 2mm ferrule effect was possible in normal occlusion. Clinical trial is required to verify these in vitro results. PMID:24470803

  5. Fracture resistance of endodontically treated maxillary central incisors with varying ferrule heights and configurations: In vitro study

    PubMed Central

    Singh, Smita; Thareja, Prerna

    2014-01-01

    Objective: The objective of this study is to determine the best ferrule configuration of endodontically treated teeth. Materials and Methods: A total of 40 freshly extracted maxillary central incisors were collected. Teeth were allocated into following four groups of each having 10 teeth. Group 1 teeth restored with crowns (CRN), Group 2 endodontically treated teeth restored with crowns (RCT and CRN), Group 3 endodontically treated teeth restored with cast dowel cores and crowns incorporating uniform 2 mm ferrule (2 FRL), Group 4 endodontically treated teeth restored with cast dowel cores and crowns incorporating uniform 1 mm ferrule (1 FRL). Crown preparation was performed with varying ferrule heights, crowns were cemented with resin modified glass ionomer cement and were kept in 100% humidity for 3 days, all specimens were loaded to failure in a universal testing machine at 0.5 mm/min. Results were obtained in the form of kilo Newton and Newton. Result: The statistical analysis applied was an analysis of variance to detect the presence of group differences. Pair wise comparisons between the groups were analyzed with the Tukey Kramer significant difference test for multiple comparisons. Conclusion: Ferrule had a significant role in the fracture resistance of custom cast post core restored teeth. Endodontically treated maxillary central incisors with a uniform 2 mm ferrule were more fracture resistant than those with a uniform 1 mm ferrule. PMID:24778504

  6. Cement Calcaneoplasty: An Innovative Method for Treating Nonunion in Calcaneal Insufficiency Fracture.

    PubMed

    Godavitarne, Charles; Fawzy, Ernest; Giancola, Giorgio; Louette, Luc

    2016-01-01

    Insufficiency type stress fractures are common in older patients with osteoporosis. Persistent pain after nonunion of these fractures can be disabling, with the management options often limited. We aimed to assess the suitability of fluoroscopic-guided injection of bone cement into a persistently symptomatic nonuniting calcaneal insufficiency fracture. To the best of our knowledge, this technique has not previously been described in the published data. After local subcutaneous anesthesia, the midpoint of the fracture site was accessed by trocar insertion under radiographic guidance, and bone cement was injected directly into the site. A preprocedure visual analog scale pain score of 90 of 100 was recorded. This had improved to 0 of 100 at the 12-month follow-up point after the procedure. The aim of the present case report was to raise awareness of percutaneous calcaneoplasty, which we believe to be a safe and well-tolerated technique for the management of osteoporotic insufficiency fracture of the calcaneus. We propose that this technique be considered when conservative methods aimed at promoting fracture healing have failed. PMID:26875768

  7. Hip Arthroscopy in the Presence of Acetabular Dysplasia

    PubMed Central

    Jayasekera, Narlaka; Aprato, Alessandro; Villar, Richard N

    2015-01-01

    Purpose : Hip arthroscopy is a well established therapeutic intervention for an increasing number of painful hip conditions. Developmental dysplasia of the hip (DDH) is commonly associated with intra-articular hip pathology. However, some surgeons perceive patients with hip dysplasia as poor candidates for hip arthroscopy. Our aim was to describe early outcomes of arthroscopic treatment for patients with DDH, who also had femoroacetabular impingement (FAI) treated when necessary, and to compare these outcomes against a control group of patients without DDH. Methods : Prospective case-control study of 68 consecutive hip arthroscopy patients assessed with a modified Harris Hip Score (mHHS) preoperatively and at six weeks, six months, and one year after surgery. Presence of DDH was determined using a standard anteroposterior (AP) pelvic radiograph to measure the centre-edge angle (CEA) of Wiberg, with a CEA < 20º used as threshold for diagnosis of DDH. Results : 12 patients (eight female and four male) with acetabular dysplasia and mean CEA of 15.4º (9º to 19º). The control, nondysplastic group comprised 54 patients (23 females and 31 males) with a mean CEA of 33.1º (22º to 45º). All patients in the dysplastic group had a labral tear and 11 (91.7%) had associated femoral cam impingement lesion addressed at arthroscopy. Our study demonstrates a significant (p=0.02) improvement in outcome in the dysplastic group at one year using the mHHS. Conclusion : Hip arthroscopy in the presence of DDH is effective in relieving pain for at least one year after surgery although does not address underlying acetabular abnormality. PMID:26069512

  8. Bone Repair on Fractures Treated with Osteosynthesis, ir Laser, Bone Graft and Guided Bone Regeneration: Histomorfometric Study

    NASA Astrophysics Data System (ADS)

    dos Santos Aciole, Jouber Mateus; dos Santos Aciole, Gilberth Tadeu; Soares, Luiz Guilherme Pinheiro; Barbosa, Artur Felipe Santos; Santos, Jean Nunes; Pinheiro, Antonio Luiz Barbosa

    2011-08-01

    The aim of this study was to evaluate, through the analysis of histomorfometric, the repair of complete tibial fracture in rabbits fixed with osteosynthesis, treated or not with infrared laser light (λ780 nm, 50 mW, CW) associated or not to the use of hydroxyapatite and guided bone regeneration (GBR). Surgical fractures were created, under general anesthesia (Ketamina 0,4 ml/Kg IP and Xilazina 0,2 ml/Kg IP), on the dorsum of 15 Oryctolagus rabbits that were divided into 5 groups and maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet and had water ad libidum. On groups II, III, IV and V the fracture was fixed with wire osteosynthesis. Animals of groups III and V were grafted with hydroxyapatite and GBR technique used. Animals of groups IV and V were irradiated at every other day during two weeks (16 J/cm2, 4×4 J/cm2). Observation time was that of 30 days. After animal death (overdose of general anesthetics) the specimes were routinely processed to wax and underwent histological analysis by light microscopy. The histomorfometric analysis showed an increased bone neoformation, increased collagen deposition, less reabsorption and inflammation when laser was associated to the HATCP. It is concluded that IR laser light was able to accelerate fracture healing and the association with HATCP and GBR resulted on increased deposition of CHA.

  9. Unusual Cause of Hip Pain: Intrusion of the Acetabular Labrum

    PubMed Central

    Jang, Se-Ang; Byun, Young-Soo; Jeong, Dae-Geun; Han, In-Ho; Kim, Min-Guek

    2015-01-01

    Femoroacetabular impingement and dysplatic hip joint is well known cause of osteoarthritis. In these diseases, labral tear and subsequent cartilage damage is thought to be main pathophysiology of development of osteoarthritis. If there are no known bony abnormalities, we called it as idiopathic osteoarthritis. Normal appearance of acetabular labrum is a continuous, usually triangular structure that attaches to the bony rim of the acetabulum and is completed at the inferior portion by the transverse acetabular ligament over the acetabular notch. A few authors reported intra-articular labrum and its relation to the development of osteoarthritis. But they didn't comment the primary bony abnormality especially acetabulum. We'd like to report x-ray, computed tomogram, magnetic resonance arthrogram and arthroscopic findings of a case had double contour sign of acetabular dome combined with intrusion of acetabular labrum. PMID:27536602

  10. The jumbo acetabular component for acetabular revision: Curtain Calls and Caveats.

    PubMed

    Lachiewicz, P F; Watters, T S

    2016-01-01

    The 'jumbo' acetabular component is now commonly used in acetabular revision surgery where there is extensive bone loss. It offers high surface contact, permits weight bearing over a large area of the pelvis, the need for bone grafting is reduced and it is usually possible to restore centre of rotation of the hip. Disadvantages of its use include a technique in which bone structure may not be restored, a risk of excessive posterior bone loss during reaming, an obligation to employ screw fixation, limited bone ingrowth with late failure and high hip centre, leading to increased risk of dislocation. Contraindications include unaddressed pelvic dissociation, inability to implant the component with a rim fit, and an inability to achieve screw fixation. Use in acetabulae with < 50% bone stock has also been questioned. Published results have been encouraging in the first decade, with late failures predominantly because of polyethylene wear and aseptic loosening. Dislocation is the most common complication of jumbo acetabular revisions, with an incidence of approximately 10%, and often mandates revision. Based on published results, a hemispherical component with an enhanced porous coating, highly cross-linked polyethylene, and a large femoral head appears to represent the optimum tribology for jumbo acetabular revisions. PMID:26733644

  11. An Effective Approach for Optimization of a Composite Intramedullary Nail for Treating Femoral Shaft Fractures.

    PubMed

    Samiezadeh, Saeid; Tavakkoli Avval, Pouria; Fawaz, Zouheir; Bougherara, Habiba

    2015-12-01

    The high stiffness of conventional intramedullary (IM) nails may result in stress shielding and subsequent bone loss following healing in long bone fractures. It can also delay union by reducing compressive loads at the fracture site, thereby inhibiting secondary bone healing. This paper introduces a new approach for the optimization of a fiber-reinforced composite nail made of carbon fiber (CF)/epoxy based on a combination of the classical laminate theory, beam theory, finite-element (FE) method, and bone remodeling model using irreversible thermodynamics. The optimization began by altering the composite stacking sequence and thickness to minimize axial stiffness, while maximizing torsional stiffness for a given range of bending stiffnesses. The selected candidates for the seven intervals of bending stiffness were then examined in an experimentally validated FE model to evaluate their mechanical performance in transverse and oblique femoral shaft fractures. It was found that the composite nail having an axial stiffness of 3.70 MN and bending and torsional stiffnesses of 70.3 and 70.9 N⋅m², respectively, showed an overall superiority compared to the other configurations. It increased compression at the fracture site by 344.9 N (31%) on average, while maintaining fracture stability through an average increase of only 0.6 mm (49%) in fracture shear movement in transverse and oblique fractures when compared to a conventional titanium-alloy nail. The long-term results obtained from the bone remodeling model suggest that the proposed composite IM nail reduces bone loss in the femoral shaft from 7.9% to 3.5% when compared to a conventional titanium-alloy nail. This study proposes a number of practical guidelines for the design of composite IM nails.

  12. An Effective Approach for Optimization of a Composite Intramedullary Nail for Treating Femoral Shaft Fractures.

    PubMed

    Samiezadeh, Saeid; Tavakkoli Avval, Pouria; Fawaz, Zouheir; Bougherara, Habiba

    2015-12-01

    The high stiffness of conventional intramedullary (IM) nails may result in stress shielding and subsequent bone loss following healing in long bone fractures. It can also delay union by reducing compressive loads at the fracture site, thereby inhibiting secondary bone healing. This paper introduces a new approach for the optimization of a fiber-reinforced composite nail made of carbon fiber (CF)/epoxy based on a combination of the classical laminate theory, beam theory, finite-element (FE) method, and bone remodeling model using irreversible thermodynamics. The optimization began by altering the composite stacking sequence and thickness to minimize axial stiffness, while maximizing torsional stiffness for a given range of bending stiffnesses. The selected candidates for the seven intervals of bending stiffness were then examined in an experimentally validated FE model to evaluate their mechanical performance in transverse and oblique femoral shaft fractures. It was found that the composite nail having an axial stiffness of 3.70 MN and bending and torsional stiffnesses of 70.3 and 70.9 N⋅m², respectively, showed an overall superiority compared to the other configurations. It increased compression at the fracture site by 344.9 N (31%) on average, while maintaining fracture stability through an average increase of only 0.6 mm (49%) in fracture shear movement in transverse and oblique fractures when compared to a conventional titanium-alloy nail. The long-term results obtained from the bone remodeling model suggest that the proposed composite IM nail reduces bone loss in the femoral shaft from 7.9% to 3.5% when compared to a conventional titanium-alloy nail. This study proposes a number of practical guidelines for the design of composite IM nails. PMID:26458035

  13. Effect of novel restoration techniques on the fracture resistance of teeth treated endodontically: An in vitro study.

    PubMed

    Kemaloglu, Hande; Emin Kaval, Mehmet; Turkun, Murat; Micoogullari Kurt, Seniha

    2015-01-01

    The aim was to evaluate the effects of fiber-reinforced composite restorations and a bulk-fill resin composite on the fracture strength of mandibular premolars treated endodontically. Standard mesio-occluso-distal (MOD) cavities were prepared in 48 mandibular premolars. Following root canal treatment, teeth were assigned to four groups: Group 1, nano-hybrid resin composite; Group 2, polyethylene woven fiber plus nano-hybrid resin composite; Group 3, short fiber-reinforced resin composite plus nano-hybrid resin composite; and Group 4, bulk-fill resin composite plus nano-hybrid resin composite. Then, the teeth were subjected to the fracture toughness test. The data were analyzed statistically using one-way ANOVA, followed by Tukey's post-hoc test. The fiber-reinforced groups had better results than the nano-hybrid and bulk-fill composites (p<0.05), while the bulk-fill and nano-hybrid composite restorations gave similar results (p>0.05). Fiber-reinforcement improved the fracture strength of teeth with large MOD cavities treated endodontically. Bulk-fill composites can be used reliably as well as nano-hybrid composites.

  14. Effect of citric acid irrigation on the fracture resistance of endodontically treated roots

    PubMed Central

    Arslan, Hakan; Barutcigil, Cagatay; Karatas, Ertugrul; Topcuoglu, Huseyin Sinan; Yeter, Kubra Yesildal; Ersoy, Ibrahim; Ayrancı, Leyla Benan

    2014-01-01

    Objective: The aim of this study was to evaluate the effect of citric acid irrigation on root fracture in different concentrations and at various time exposures on root fracture. Materials and Methods: Forty-eight human mandibular incisors with similar dimensions were selected. The specimens were decoronated, then divided into 6 groups as follows: A group without instrumentation and filling (G1) and the 5 other groups with canal preparation and irrigation of distilled water (G2), 10% citric acid for 1 min (G3), 50% citric acid for 1 min (G4), 10% citric acid for 10 min (G5), and 50% citric acid for 10 min (G6). In the experimental groups, the canals were obturated and subjected to the strength test. Statistical analysis was performed using Kruskal-Wallis test (P = 0.05). Results: G6 showed the highest fracture resistance (629.97 N), and G3 showed the lowest fracture resistance (507.76 N). However, there was no statistically significant difference among the groups. Conclusions: The results of this study suggest that use of citric acid is safe in terms of fracture resistance. PMID:24966750

  15. Correlation of Hip Fracture with Other Fracture Types: Toward a Rational Composite Hip Fracture Endpoint

    PubMed Central

    Colón-Emeric, Cathleen; Pieper, Carl F.; Grubber, Janet; Van Scoyoc, Lynn; Schnell, Merritt L; Van Houtven, Courtney Harold; Pearson, Megan; Lafleur, Joanne; Lyles, Kenneth W.; Adler, Robert A.

    2016-01-01

    Purpose With ethical requirements to the enrollment of lower risk subjects, osteoporosis trials are underpowered to detect reduction in hip fractures. Different skeletal sites have different levels of fracture risk and response to treatment. We sought to identify fracture sites which cluster with hip fracture at higher than expected frequency; if these sites respond to treatment similarly, then a composite fracture endpoint could provide a better estimate of hip fracture reduction. Methods Cohort study using Veterans Affairs and Medicare administrative data. Male Veterans (n=5,036,536) aged 50-99 years receiving VA primary care between1999-2009 were included. Fractures were ascertained using ICD9 and CPT codes and classified by skeletal site. Pearson correlation coefficients, logistic regression and kappa statistics, were used to describe the correlation between each fracture type and hip fracture within individuals, without regards to the timing of the events. Results 595,579 (11.8%) men suffered 1 or more fractures and 179,597 (3.6%) suffered 2 or more fractures during the time under study. Of those with one or more fractures, rib was the most common site (29%), followed by spine (22%), hip (21%) and femur (20%). The fracture types most highly correlated with hip fracture were pelvic/acetabular (Pearson correlation coefficient 0.25, p<0.0001), femur (0.15, p<0.0001), and shoulder (0.11, p<0.0001). Conclusions Pelvic, acetabular, femur, and shoulder fractures cluster with hip fractures within individuals at greater than expected frequency. If we observe similar treatment risk reductions within that cluster, subsequent trials could consider use of a composite endpoint to better estimate hip fracture risk. PMID:26151123

  16. Role of Dentin Compositional Changes and Structural Loss on Fracture Predilection in Endodontically Treated Teeth

    NASA Astrophysics Data System (ADS)

    Ossareh, Arezou

    The aim of this study was to examine the role of chemical compositional changes and iatrogenic dentin structural loss on the mechanical response of teeth to force and resistance to fracture. The experiments were divided into three phases. In phase 1, experimental studies were performed to evaluate the effect of chemicals used during treatment on ultrastructure, composition and resistance to fracture of dentin. In phase 2, experimental studies were used to evaluate the influence of dentin removal and remaining dentin volume on the resistance to fracture and microcrack formation in root dentin. In phase 3 finite element analysis was carried out to examine the influence of dentin loss on the stress distribution in root dentin. The combination of experimental and numerical analysis highlighted the role of remaining dentin volume and moment of inertia on root dentin biomechanics.

  17. Effect of Intra-Orifice Barriers on the Fracture Resistance of Endodontically Treated Teeth – An Ex-Vivo Study

    PubMed Central

    Aboobaker, Shaheen; Gopal, Rajesh; Jituri, Sandeep; Veetil, Fazalu Rahman Pothu

    2015-01-01

    Introduction: The purpose of this study was to evaluate and compare the fracture resistance of roots obturated with guttapercha using bonded amalgam, GC Light cure GIC (resin modified glass ionomer cement) and Tetric N Flow (flowable hybrid composite) as different intra orifice barriers. Materials and Methods: Eighty freshly extracted mandibular premolars with straight roots were reduced to 14 mm from the coronal aspect. All canals were enlarged to size 30 and specimens were obturated with gutta percha cones, except for control group specimens the coronal 3 mm of root fillings of all other group specimens were removed with the aid of heated plugger. All samples were randomly divided into 4 groups of 20 specimens each. They were control, Fuji GC LC GIC, Tetric N Flow and Bonded Amalgam. After the placement of the intra orifice barrier materials, specimens stored at 37oC and 100% humidity for one week to allow the materials to set completely. After one week, all the groups were subjected to fracture resistance testing by using Universal testing machine. Results: Data was analysed for significance by ANOVA (Analysis of variance) and further pair wise comparison was performed by Benferroni test. Level of significance was taken as 0.05. Tetric N Flow group showed better fracture resistance as compared to all other groups and Control group is least among the groups. Fracture resistance of Tetric N Flow compared with bonded amalgam was statistically significant. Conclusion: Tetric N Flow and Fuji GC LC GIC can be used as intra-orifice barriers with good fracture resistance in endodontically treated teeth. PMID:25859518

  18. [Difficulties and complications while treating long bone fractures with locked intramedullary nailing].

    PubMed

    Blacha, J; Gaweda, K

    1997-01-01

    Retrospective assessment of results of treatment for femoral or tibial fracture and/or malunion in 33 patients (10 females and 23 males) operated on at Orthopedic Department in Lublin during last 4 years are presented. All patients had locked intramedullary nailing done, all fractures healed. Pitfalls and complications of the method at every stage of treatment are presented on the basis of literature and author's own experience. Means for avoidance of the complications are discussed. The method of locked intramedullary nailing proved to be liberal for technical errors at surgery.

  19. Does medial support decrease major complications of unstable proximal humerus fractures treated with locking plate?

    PubMed Central

    2013-01-01

    Background The purpose of this study was to evaluate the role of medial support and clinical factors responsible on outcomes and major complications associated with treatment of unstable proximal humerus fractures using a locking plate and suture augmentation. Methods Sixty-three cases in 62 patients (42 female, 20 male) were evaluated between September 2004 and October 2008. Cases were divided into either a medial support group (36 cases) or non-medial support group (27 cases). Clinical and radiographic evaluations included Neer’s evaluation criteria, the neck-shaft angle using the Paavolainen method, and complications. We analyzed the correlation between bone- and fracture- related complications and three independent clinical variables, such as the presence of medial support, fracture type, and osteoporosis by way of multivariate logistic regression. Results There were statistically significant differences in the overall incidence of complications based on the presence of medial support (p = 0.014) and preoperative fracture type (p = 0.018), but no differences based on the presence of osteoporosis (p = 0.157). According to multivariate logistic regression analysis, the restoration of medial support was the most reliable factor to prevent bone- and fracture- related complications. In addition, when we compared the incidence of bone- and fracture-related complications in the presence or absence of medial support among 30 patients with osteoporosis, the group with restoration of medial support had only one complication of humeral head osteonecrosis despite the presence of osteoporosis (5.9% vs. 46.2%, p = 0.025). According to Neer’s criteria, excellent or satisfactory clinical results accounted for seventy-three percent of the total cases (46 of 63 cases). Seventy-eight percent (49 of 55 cases) showed good radiographic results by the Paavolainen method. There were 14 complications in 13 of 63 cases (20.6%). Conclusions In the treatment of unstable proximal

  20. The influence of acetabular inclination angle on the penetration of polyethylene and migration of the acetabular component: a prospective, radiostereometric study on cemented acetabular components.

    PubMed

    Kadar, T; Furnes, O; Aamodt, A; Indrekvam, K; Havelin, L I; Haugan, K; Espehaug, B; Hallan, G

    2012-03-01

    In this prospective study we studied the effect of the inclination angle of the acetabular component on polyethylene wear and component migration in cemented acetabular sockets using radiostereometric analysis. A total of 120 patients received either a cemented Reflection All-Poly ultra-high-molecular-weight polyethylene or a cemented Reflection All-Poly highly cross-linked polyethylene acetabular component, combined with either cobalt-chrome or Oxinium femoral heads. Femoral head penetration and migration of the acetabular component were assessed with repeated radiostereometric analysis for two years. The inclination angle was measured on a standard post-operative anteroposterior pelvic radiograph. Linear regression analysis was used to determine the relationship between the inclination angle and femoral head penetration and migration of the acetabular component. We found no relationship between the inclination angle and penetration of the femoral head at two years' follow-up (p = 0.9). Similarly, our data failed to reveal any statistically significant correlation between inclination angle and migration of these cemented acetabular components (p = 0.07 to p = 0.9).

  1. Comminuted radial head fractures treated by the Acumed anatomic radial head system

    PubMed Central

    Mou, Zhefei; Chen, Maohua; Xiong, Yan; Fan, Zhihang; Wang, Aimin; Wang, Ziming

    2015-01-01

    Objective: The treatment of comminuted radial head fractures is still challenging. A radial head replacement is more effective in comminuted radial head fractures. The aim of this paper was to present the medium-term results of the Acumed anatomic radial head system (AARHS). Methods: This study was performed on 12 patients with traumatic elbow fracture and instability between 2008 and 2011 of whom 12 were reviewed at a mean follow-up of 60.8 months (19 to 77 months). The evaluation included a record of pain, function, muscle strength, contracture and rotation. The outcome was assessed using the Hospital for Special Surgery total elbow scoring and a modified Disability of Arm Shoulder Hand (DASH) questionnaire. Results: The average flexion and extension arc was 130° (range, 110° to 140°). The mean range of elbow supination was 75° (rang, 60° to 85°) and pronation 80° (range, 65° to 90°). There were no complications such as infection, implant loosening, instability of the elbow, cubitus valgus, osteoporosis of the capitellum, or pain in the forearm and wrist. The mean DASH score was 11.9/100 (0 to 25/100). Conclusion: The radial head replacement with the AARHS can provide effectively stability and good clinic results at the middle term following up. Our experience has encouraged us to continue using the AARHS in comminuted fractures, especially when instability of elbow is a potential problem. PMID:26131250

  2. Failure of dual radius hydroxyapatite-coated acetabular cups

    PubMed Central

    D'Angelo, Fabio; Molina, Mauro; Riva, Giacomo; Zatti, Giovanni; Cherubino, Paolo

    2008-01-01

    Introduction Many kind of hydroxyapatite-coated cups were used, with favorable results in short term studies; it was supposed that its use could improve osteointegration of the cup, enhancing thus stability and survivorship. The purpose of this study is to analyze the long term behavior of the hemispheric HA coated, Dual Radius Osteonics cup and to discuss the way of failure through the exam of the revised components and of both periacetabular and osteolysis tissue. Materials and Methods Between 1994 and 1997, at the Department of Orthopedic Sciences of the Insubria University, using the posterolateral approach, were implanted 276 Dual Radius Osteonics® in 256 patients, with mean age of 63 years. Results At a mean follow-up of 10 years (range 8–12 years), 183 cups in 165 patients, were available for clinical and radiographical evaluation. 22 Cups among the 183 were revised (11%). The cause of revision was aseptic loosening in 17 cases, septic loosening in one case, periprosthetic fracture in another case, osteolysis and polyethylene wear in two cases and, finally, recurrent dislocations in the last one. In the remaining patients, mean HHS increased from a preoperative value of 50,15 to a postoperative value of 92,69. The mean polyethylene wear was 1,25 mm (min. 0,08, max. 3,9 mm), with a mean annual wear of 0,17 mm. The mean acetabular migration on the two axis was 1,6 mm and 1,8 mm. Peri-acetabular osteolysis were recorded in 89% of the implants (163 cases). The cumulative survivorship (revision as endpoint) at the time was 88,9%. Conclusion Our study confirms the bad behavior of this type of cup probably related to the design, to the method of HA fixation. The observations carried out on the revised cup confirm these hypotheses but did not clarify if the third body wear could be a further problem. Another interesting aspect is the high incidence of osteolysis, which are often asymptomatic becoming a problem for the surgeon as the patient refuses the

  3. Evaluation and treatment of young adults with femoro-acetabular impingement secondary to Perthes' disease.

    PubMed

    Eijer, H; Podeszwa, D A; Ganz, R; Leunig, M

    2006-01-01

    Hip pain and loss of motion in young adults with previous Legg-Calve-Perthes-Disease may be caused by anterior femoro-acetabular impingement. Eleven patients (12 hips) with the chief complaint of groin pain and significant proximal femoral deformity were treated. Gadolinium-enhanced magnetic resonance arthrography in ten patients indicated labral injury and adjacent acetabular cartilage lesions in nine hips. A surgical dislocation of each hip confirmed that there was impingement induced intra-articular injury consistent with the pathology indicated on the MRI. Reshaping of the femoral head, with correction of the femoral head/neck offset, and treatment of the acetabular rim pathology was performed for each hip in conjunction with other procedures for the proximal femur. Correction of the impingement and increased range of motion could be visualized intra-operatively. At a mean follow-up of 33 months, half of all patients were pain-free and all had improvement in pain compared with preoperatively. Ten patients had an improved range of motion and two a slight decrease. No additional necrosis following the dislocation of the femoral head was seen.; PMID:19219805

  4. [Analysis of the Basic Stress Pathway Above Acetabular Dome].

    PubMed

    Nie, Yong; Ma, Jun; Haung, Qiang; Hu, Qinsheng; Shi, Xiaojun; Pei, Fuxing

    2015-08-01

    The basic stress pathway above the acetabular dome is important for the maintenance of implant stability in acetabular reconstruction of total hip arthroplasty (THA). The purpose of this study was to describe the basic stress pathway to provide evidence for clinical acetabular reconstruction guidance of THA. A subject-specific finite element (FE) model was developed from CT data to generate 3 normal hip models and a convergence study was conducted to determine the number of pelvic trabecular bone material properties using 5 material assignment plans. In addition, in the range of 0 to 20 mm above the acetabular dome, the models were sectioned and the stress pathway was defined as two parts, i.e., 3D, trabecular bone stress distribution and quantified cortical bone stress level. The results showed that using 100 materials to define the material property of pelvic trabecular bone could assure both the accuracy and efficiency of the FE model. Under the same body weight condition, the 3D trabecular bone stress distributions above the acetabular dome were consistent, and especially the quantified cortical bone stress levels were all above 20 MPa and showed no statistically significant difference (P>0.05). Therefore, defining the basic stress pathway above the acetabular dome under certain body weight condition contributes to design accurate preoperative plan for acetabular reconstruction, thus helping restore the normal hip biomechanics and preserve the stability of the implants. PMID:26710451

  5. Fracture Resistance of Endodontically Treated Maxillary Premolars Restored by Various Direct Filling Materials: An In Vitro Study.

    PubMed

    Mincik, Jozef; Urban, Daniel; Timkova, Silvia; Urban, Renata

    2016-01-01

    The aim of this study is to compare the effect of various restorative materials on fracture resistance in maxillary premolars. Premolars (n = 64) with no restorations or cracks were selected. MOD cavities were prepared considering the buccolingual width to be equal to half of the intercuspal distance. The specimens were randomly divided into 8 groups, 8 specimens each: group A intact teeth, group B unfilled cavity, group C composite made by oblique layering technique, group D composite with 2 mm cusp coverage, group E bulk-filled posterior composite, group F glass-ionomer, group G amalgam, and group H composite with proximal boxes. The specimens were subjected to an axial compression load with the mean values of fracture resistance in group A: 1289 N, group B: 181.75 N, group C: 445.38 N, group D: 645.88 N, group E: 355.13 N, group F: 352.00 N, group G: 191.38 N, and group H: 572.00 N. There was no significant difference between groups B and G, between C and D, E, and F, and between group D and H. All other measurements were statistically significant. We conclude that composite restoration with cusp coverage is the most ideal nonprosthetic solution for endodontically treated teeth. Cusp coverage increases the fracture resistance compared to the conventional cavity design. PMID:27656212

  6. Fracture Resistance of Endodontically Treated Maxillary Premolars Restored by Various Direct Filling Materials: An In Vitro Study

    PubMed Central

    Mincik, Jozef; Timkova, Silvia; Urban, Renata

    2016-01-01

    The aim of this study is to compare the effect of various restorative materials on fracture resistance in maxillary premolars. Premolars (n = 64) with no restorations or cracks were selected. MOD cavities were prepared considering the buccolingual width to be equal to half of the intercuspal distance. The specimens were randomly divided into 8 groups, 8 specimens each: group A intact teeth, group B unfilled cavity, group C composite made by oblique layering technique, group D composite with 2 mm cusp coverage, group E bulk-filled posterior composite, group F glass-ionomer, group G amalgam, and group H composite with proximal boxes. The specimens were subjected to an axial compression load with the mean values of fracture resistance in group A: 1289 N, group B: 181.75 N, group C: 445.38 N, group D: 645.88 N, group E: 355.13 N, group F: 352.00 N, group G: 191.38 N, and group H: 572.00 N. There was no significant difference between groups B and G, between C and D, E, and F, and between group D and H. All other measurements were statistically significant. We conclude that composite restoration with cusp coverage is the most ideal nonprosthetic solution for endodontically treated teeth. Cusp coverage increases the fracture resistance compared to the conventional cavity design. PMID:27656212

  7. Grade 3 open tibial shaft fractures treated with a circular frame, functional outcome and systematic review of literature.

    PubMed

    Dickson, D R; Moulder, E; Hadland, Y; Giannoudis, P V; Sharma, H K

    2015-04-01

    We report on the surgical and functional outcome of 22 patients with Grade 3 open tibial fractures treated with circular frame. All cases united and there were no re-fractures or amputations. All patients were assessed at a minimum of 1-year post frame removal. Assessment included clinical examination, IOWA ankle and knee scores, Olerud and Molander ankle score and EuroQol EQ-5D. Clinical scores were either good or excellent in over half of the patients in all knee and ankle scores. There was a significant positive correlation between functional outcomes and the EQ-5D score. The EQ-5D mean health state visual analogue score was comparable to the general UK population despite patients scoring less than the average UK population in three of the five domains. 36% reported some difficulties in walking and 41% had problems with pain. 14% had difficulties with self-care and 46% had difficulties with their usual activities. 14% had problems with anxiety or depression. Systematic review of the literature suggests, in the management of open tibial fractures, circular frames provide equivalent or superior surgical outcomes in comparison with other techniques. Our study finds the application of a circular frame also results in a good functional outcome in the majority of cases. PMID:25648287

  8. Fracture Resistance of Endodontically Treated Maxillary Premolars Restored by Various Direct Filling Materials: An In Vitro Study

    PubMed Central

    Mincik, Jozef; Timkova, Silvia; Urban, Renata

    2016-01-01

    The aim of this study is to compare the effect of various restorative materials on fracture resistance in maxillary premolars. Premolars (n = 64) with no restorations or cracks were selected. MOD cavities were prepared considering the buccolingual width to be equal to half of the intercuspal distance. The specimens were randomly divided into 8 groups, 8 specimens each: group A intact teeth, group B unfilled cavity, group C composite made by oblique layering technique, group D composite with 2 mm cusp coverage, group E bulk-filled posterior composite, group F glass-ionomer, group G amalgam, and group H composite with proximal boxes. The specimens were subjected to an axial compression load with the mean values of fracture resistance in group A: 1289 N, group B: 181.75 N, group C: 445.38 N, group D: 645.88 N, group E: 355.13 N, group F: 352.00 N, group G: 191.38 N, and group H: 572.00 N. There was no significant difference between groups B and G, between C and D, E, and F, and between group D and H. All other measurements were statistically significant. We conclude that composite restoration with cusp coverage is the most ideal nonprosthetic solution for endodontically treated teeth. Cusp coverage increases the fracture resistance compared to the conventional cavity design.

  9. Complicated Crown-Root Fracture Treated Using Reattachment Procedure: A Single Visit Technique

    PubMed Central

    Rajput, Akhil; Talwar, Sangeeta; Ataide, Ida; Verma, Mahesh; Wadhawan, Neeraj

    2011-01-01

    Complicated crown-root fracture of maxillary central and lateral incisors is common in case of severe trauma or sports-related injury. It happens because of their anterior positioning in oral cavity and protrusive eruptive pattern. On their first dental visit, these patients are in pain and need emergency care. Because of impaired function, esthetics, and phonetics, such patients are quite apprehensive during their emergency visit. Successful pain management with immediate restoration of function, esthetics and phonetics should be the prime objective while handling such cases. This paper describes immediate treatment of oblique crown root fracture of maxillary right lateral incisor with reattachment procedure using light transmitting fiber post. After two and half years, the reattached fragment still has satisfying esthetics and excellent function. PMID:22690345

  10. Effect of fibre-reinforced composite on the fracture resistance of endodontically treated teeth.

    PubMed

    Ozsevik, Abdul Semih; Yildirim, Cihan; Aydin, Ugur; Culha, Emre; Surmelioglu, Derya

    2016-08-01

    The aim of this study is to evaluate the fracture resistance of root-filled teeth restored with fibre-reinforced composite (everX posterior). Fifty mandibular molars were divided into five groups (n = 10). Group 1: no treatment was applied (intact teeth). Group 2-5: canals were prepared and root filled. Group 2: no coronal restoration was placed. Group 3: teeth were coronally restored with composite. Group 4: composite restorations were performed following polyethylene fibre insertion at the cavity base. Group 5: composite resin placed over everX posterior. After thermocycling (5-55°C, 5000×), fracture resistance was measured. Mean force load for each sample was recorded in Newtons (N). Results were statistically analysed with one-way analysis of variance and post hoc Tukey's tests. The mean force required to fracture samples and standard deviations are as follows: group 1: 2859.5 ± 551.27 N, group 2: 318.97 ± 108.67 N, group 3: 1489.5 ± 505.04 N, group 4: 1958.3 ± 362.94 N, group 5: 2550.7 ± 586.1 N. everX posterior (group 5) was higher than groups 2, 3 and 4 (P < 0.05). There were no significant differences between everX posterior and intact teeth (P > 0.05). Placing fibre-reinforced composite under composite increased the fracture strength of root-filled teeth to the level of intact teeth.

  11. Management and Followup of Complicated Crown Fractures in Young Patients Treated with Partial Pulpotomy

    PubMed Central

    Ojeda-Gutierrez, Francisco; Martinez-Marquez, Brenda; Arteaga-Larios, Soraya; Ruiz-Rodriguez, M. Socorro; Pozos-Guillen, Amaury

    2013-01-01

    Two cases of young patients with traumatized permanent teeth having complicated crown fractures are reported. Endodontic management included partial pulpotomy by the Cvek technique; restorative management included resin restoration and reattachment of the teeth fragments. Treatments were considered successful in all cases according to the following criteria: absence of clinical symptoms, absence of X-ray signs of pathology, and presence of pulpal vitality 6 to 25 months after treatment. PMID:23864963

  12. [Results of treating forearm bone shaft fractures with a 3.5 mm self compressive plate].

    PubMed

    Małecki, P; Kaleta, M; Tokarowski, A; Kusz, D; Wójcik, B

    1997-01-01

    Results of 29 forearm bones shaft fracture treatment with 3.5mm self compressive plate in 26 patients aged 18-64 (mean 33) are presented. Open reduction with 3.5mm self compressive plate fixation has been performed in all cases. Anderson et al criteria were used to assess functional and radiological outcome. Excellent and good functional results were achieved in 25 cases, one was rated fair, no poor results were observed. PMID:9490253

  13. Greater Trochanter Reconstruction in Unstabl Intertrochanteric Fractures Treated With Cemented Bipolar Hemiarthroplasty: A Technical Note.

    PubMed

    Subramanian, G V; Guravareddy, A V; Reddy, Anil Kumar K R; Chiranjeevi, T

    2012-01-01

    Cemented Bipolar arthroplasty is an established method for treatment of comminuted Intertrochanteric fractures. Reconstruction of greater trochanter is an essential technical step to avoid complications like abductor lurch gait. We here describe a technique of reconstruction and fixation of greater trochanter using cancellous screws with wide washers made of reconstruction plate and tension band wiring. This gives a stable fixation of greater trochanter and avoids cut out, slippage of implants. PMID:27298870

  14. Bone fractures among postmenopausal patients with endocrine-responsive early breast cancer treated with 5 years of letrozole or tamoxifen in the BIG 1-98 trial

    PubMed Central

    Rabaglio, M.; Sun, Z.; Castiglione-Gertsch, M.; Hawle, H.; Thürlimann, B.; Mouridsen, H.; Campone, M.; Forbes, J. F.; Paridaens, R. J.; Colleoni, M.; Pienkowski, T.; Nogaret, J.-M.; Láng, I.; Smith, I.; Gelber, R. D.; Goldhirsch, A.; Coates, A. S.

    2009-01-01

    Background: To compare the incidence and timing of bone fractures in postmenopausal women treated with 5 years of adjuvant tamoxifen or letrozole for endocrine-responsive early breast cancer in the Breast International Group (BIG) 1-98 trial. Methods: We evaluated 4895 patients allocated to 5 years of letrozole or tamoxifen in the BIG 1-98 trial who received at least some study medication (median follow-up 60.3 months). Bone fracture information (grade, cause, site) was collected every 6 months during trial treatment. Results: The incidence of bone fractures was higher among patients treated with letrozole [228 of 2448 women (9.3%)] versus tamoxifen [160 of 2447 women (6.5%)]. The wrist was the most common site of fracture in both treatment groups. Statistically significant risk factors for bone fractures during treatment included age, smoking history, osteoporosis at baseline, previous bone fracture, and previous hormone replacement therapy. Conclusions: Consistent with other trials comparing aromatase inhibitors to tamoxifen, letrozole was associated with an increase in bone fractures. Benefits of superior disease control associated with letrozole and lower incidence of fracture with tamoxifen should be considered with the risk profile for individual patients. PMID:19474112

  15. In Hospital and 3-Month Mortality and Functional Recovery Rate in Patients Treated for Hip Fracture by a Multidisciplinary Team

    PubMed Central

    Rostagno, Carlo; Buzzi, Roberto; Campanacci, Domenico; Boccacini, Alberto; Cartei, Alessandro; Virgili, Gianni; Belardinelli, Andrea; Matarrese, Daniela; Ungar, Andrea; Rafanelli, Martina; Gusinu, Roberto; Marchionni, Niccolò

    2016-01-01

    Objectives Medical comorbidities affect outcome in elderly patients with hip fracture. This study was designed to preliminarily evaluate the usefulness of a hip-fracture unit led by an internal medicine specialist. Methods In-hospital and 3-month outcomes in patients with hip fracture were prospectively evaluated in 121 consecutive patients assessed before and followed after surgery by a multidisciplinary team led by internal medicine specialist; 337 consecutive patients were recalled from ICD-9 discharge records and considered for comparison regarding in-hospital mortality. Results In the intervention period, patients treated within 48 hours were 54% vs. 26% in the historical cohort (P<0.0001). In-hospital mortality remained stable at about 2.3 per 1000 person-days. At 3 months, 10.3% of discharged patients had died, though less than 8% of patients developed postoperative complications (mainly pneumonia and respiratory failure). The presence of more than 2 major comorbidities and the loss of 3 or more BADL were independent predictors of death. 50/105 patients recovered previous functional capacity, but no independent predictor of functional recovery could be identified. Mean length of hospital stay significantly decreased in comparison to the historical cohort (13.6± 4.7 vs 17 ± 5 days, p = 0.0001). Combined end-point of mortality and length of hospitalization < 12 days was significantly lower in study period (27 vs 34%, p <0.0132). Conclusions Identification and stabilization of concomitant clinical problems by internal medicine specialists may safely decrease time to surgery in frail subjects with hip fracture. Moreover, integrated perioperative clinical management may shorten hospital stay with no apparent increase in in-hospital mortality and ultimately improve the outcome. These results are to be confirmed by a larger study presently ongoing at our institution. PMID:27389193

  16. Residual stress and damage-induced critical fracture on CO2 laser treated fused silica

    SciTech Connect

    Matthews, M; Stolken, J; Vignes, R; Norton, M

    2009-11-02

    Localized damage repair and polishing of silica-based optics using mid- and far-IR CO{sub 2} lasers has been shown to be an effective method for increasing optical damage threshold in the UV. However, it is known that CO{sub 2} laser heating of silicate surfaces can lead to a level of residual stress capable of causing critical fracture either during or after laser treatment. Sufficient control of the surface temperature as a function of time and position is therefore required to limit this residual stress to an acceptable level to avoid critical fracture. In this work they present the results of 351 nm, 3 ns Gaussian damage growth experiments within regions of varying residual stress caused by prior CO{sub 2} laser exposures. Thermally stressed regions were non-destructively characterized using polarimetry and confocal Raman microscopy to measure the stress induced birefringence and fictive temperature respectively. For 1 {approx} 40s square pulse CO{sub 2} laser exposures created over 0.5-1.25 kW/cm{sup 2} with a 1-3 mm 1/e{sup 2} diameter beam (T{sub max} {approx} 1500-3000 K), the critical damage site size leading to fracture increases weakly with peak temperature, but shows a stronger dependence on cooling rate, as predicted by finite element hydrodynamics simulations. Confocal micro-Raman was used to probe structural changes to the glass over different thermal histories and indicated a maximum fictive temperature of 1900K for T{sub max} {ge} 2000 K. The effect of cooling rate on fictive temperature caused by CO{sub 2} laser heating are consistent with finite element calculations based on a Tool-Narayanaswamy relaxation model.

  17. Total hip arthroplasty after rotational acetabular osteotomy.

    PubMed

    Ito, Hideya; Takatori, Yoshio; Moro, Toru; Oshima, Hirofumi; Oka, Hiroyuki; Tanaka, Sakae

    2015-03-01

    In this study, we aimed to determine whether the outcomes of total hip arthroplasty (THA) after rotational acetabular osteotomy (RAO) are equal to those of primary THA, and to elucidate the characteristics of THA after RAO. The clinical and radiographic findings of THA after RAO (44 hips), with minimum 24 months of follow-up, were compared with a matched control group of 58 hips without prior RAO. We found that the outcomes in terms of functional scores and complication rates did not differ between THA after RAO and THA without previous pelvic osteotomy, indicating that the results of THA after RAO are equivalent to those of primary THA. Although THA after RAO requires technical considerations, similar clinical outcomes to primary THA can be expected. PMID:25456635

  18. P31 - Long-Term Prospective Study of Osteoporotic Patients Treated with Percutaneous Vertebroplasty after Fragility Fractures

    PubMed Central

    Mazzantini, M.; Torre, C.; Di Munno, O.

    2010-01-01

    Introduction: The purpose of this study was to evaluate factors that could increase the occurrence of new vertebral fractures (VFx) after percutaneous vertebroplasty (PVP) procedures. Methods: In our prospective study, we included patients of both sexes with osteoporosis (OP) and at least one painful VFx. We performed a baseline biochemical evaluation (including vitamin D plasma levels) and collected demographic, BMD, and clinical data. One hundred and fifteen patients were treated with PVP and assigned to oral bisphosphonates plus Ca and vitamin D. The patients returned for follow-up visits after 1, 3, and 6 months, and every 6 months thereafter. X-rays of the dorsolumbar spine were repeated every 12 months, or in the event of pain that may indicate VFx occurrence. Results: The mean follow-up duration was 39 +/− 16 months (range, 15–79). Thirty-two patients (27.8%) sustained new fragility VFx, all symptomatic. All the fractured patients agreed to undergo a new PVP. We compared the patients who had sustained new VFx to those who had not, and found significantly lower BMI, total hip, and femoral neck T-scores in the group with new VFx. Furthermore, baseline plasma levels of 25(OH) vitamin D (25(OH)D) were significantly lower in this group. Analysis of plasma levels of 25(OH)D 12 months after PVP showed that a significant difference still persisted: 22 +/− 12 (group with new VFx) vs 41 +/− 22 ng/ml (group with no VFx; p < 0.01). Conclusions: We found that in patients with OP treated with PVP, the incidence of new VFx was 27.8% after 39 months; low BMI, BMD, and vitamin D are factors associated with increased risk of new VFx in patients treated with PVP.

  19. Wear of highly crosslinked polyethylene acetabular components

    PubMed Central

    Callary, Stuart A; Solomon, Lucian B; Holubowycz, Oksana T; Campbell, David G; Munn, Zachary; Howie, Donald W

    2015-01-01

    Background and purpose Wear rates of highly crosslinked polyethylene (XLPE) acetabular components have varied considerably between different published studies. This variation is in part due to the different techniques used to measure wear and to the errors inherent in measuring the relatively low amounts of wear in XLPE bearings. We undertook a scoping review of studies that have examined the in vivo wear of XLPE acetabular components using the most sensitive method available, radiostereometric analysis (RSA). Methods A systematic search of the PubMed, Scopus, and Cochrane databases was performed to identify published studies in which RSA was used to measure wear of XLPE components in primary total hip arthroplasty (THA). Results 18 publications examined 12 primary THA cohorts, comprising only 260 THAs at 2–10 years of follow-up. The mean or median proximal wear rate reported ranged from 0.00 to 0.06 mm/year. However, differences in the manner in which wear was determined made it difficult to compare some studies. Furthermore, differences in RSA methodology between studies, such as the use of supine or standing radiographs and the use of beaded or unbeaded reference segments, may limit future meta-analyses examining the effect of patient and implant variables on wear rates. Interpretation This scoping review confirmed the low wear rates of XLPE in THA, as measured by RSA. We make recommendations to enhance the standardization of reporting of RSA wear results, which will facilitate early identification of poorly performing implants and enable a better understanding of the effects of surgical and patient factors on wear. PMID:25301435

  20. An In Vitro Study on the Effects of Post-Core Design and Ferrule on the Fracture Resistance of Endodontically Treated Maxillary Central Incisors

    PubMed Central

    Sreedevi, S; Sanjeev, R; Raghavan, Rekha; Abraham, Anna; Rajamani, T; Govind, Girish Kumar

    2015-01-01

    Background: Endodontically treated teeth have significantly different physical and mechanical properties compared to vital teeth and are more prone to fracture. The study aims to compare the fracture resistance of endodontically treated teeth with and without post reinforcement, custom cast post-core and prefabricated post with glass ionomer core and to evaluate the ferrule effect on endodontically treated teeth restored with custom cast post-core. Materials and Methods: A total of 40 human maxillary central incisors with similar dimensions devoid of any root caries, restorations, previous endodontic treatment or cracks were selected from a collection of stored extracted teeth. An initial silicone index of each tooth was made. They were treated endodontically and divided into four groups of ten specimens each. Their apical seal was maintained with 4 mm of gutta-percha. Root canal preparation was done and then post core fabrication was done. The prepared specimens were subjected to load testing using a computer coordinated UTM. The fracture load results were then statistically analyzed. One-way ANOVA was followed by paired t-test. Results: 1. Reinforcement of endodontically treated maxillary central incisors with post and core, improved their fracture resistance to be at par with that of endodontically treated maxillary central incisor, with natural crown. 2. The fracture resistance of endodontically treated maxillary central incisors is significantly increased when restored with custom cast post-core and 2 mm ferrule. Conclusion: With 2 mm ferrule, teeth restored with custom cast post-core had a significantly higher fracture resistance than teeth restored with custom cast post-core or prefabricated post and glass ionomer core without ferrule. PMID:26464537

  1. [Hip Fracture--Epidemiology, Management and Liaison Service. What do we need to close care gaps in treating hip fracture?--How to include the UK experience into the care in Japan].

    PubMed

    Takahashi, Hideaki E

    2015-04-01

    Various care gaps are noted in and between acute and rehabilitation hospitals, and after discharge from hospitals in Japan. In the most of acute care hospitals physicians take care of elderly fractured patients only by a request of orthopaedic team. This made a mean time until surgery was 4.5 days (2011). A critical pathway in treating hip fracture has certainly shortened days in the acute hospitals, care gaps may exist between hospitals. Although osteoporosis medication has started on discharge, it may be discontinued at home, in health or social care facilities under the care of primary care physicians. Even though it was estimated approximately 160,000 hip fractures per year in Japan, management of patients' address is not well established after discharge. In order to include the UK experience in Japan, two proposals were made for hospitals in treating hip fracture as follows. 1. Clinical auditing may be added to improve quality of care. An audit protocol is to be developed multidisciplinarily by orthopaedic surgeons and geriatricians, with interprofessional collaboration. 2. A fracture liaison service is to be established to make interprofessional care-mix possible, such as an increase of adherence of osteoporosis drugs and prevention of falls after discharge. A fracture liaison coordinator is to be assigned to the service in making a team approach possible to a patient and his/her family.

  2. Metatarsal fractures.

    PubMed

    Rammelt, Stefan; Heineck, Jan; Zwipp, Hans

    2004-09-01

    Metatarsal fractures are relatively common and if malunited, a frequent source of pain and disability. Nondisplaced fractures and fractures of the second to fourth metatarsal with displacement in the horizontal plane can be treated conservatively with protected weight bearing in a cast shoe for 4-6 weeks. In most displaced fractures, closed reduction can be achieved but maintenance of the reduction needs internal fixation. Percutaneous pinning is suitable for most fractures of the lesser metatarsals. Fractures with joint involvement and multiple fragments frequently require open reduction and plate fixation. Transverse fractures at the metaphyseal-diaphyseal junction of the fifth metatarsal ("Jones fractures") require an individualized approach tailored to the level of activity and time to union. Avulsion fractures of the fifth metatarsal bone are treated by open reduction and tension-band wiring or screw fixation if displaced more than 2 mm or with more that 30% of the joint involved. The metatarsals are the most common site of stress fractures, most of which are treated nonoperatively. Symptomatic posttraumatic deformities need adequate correction, in most cases by osteotomy across the former fracture site.

  3. Influence of clearance on the time-dependent performance of the hip following hemiarthroplasty: A finite element study with biphasic acetabular cartilage properties

    PubMed Central

    Li, Junyan; Hua, Xijin; Jin, Zhongmin; Fisher, John; Wilcox, Ruth K.

    2014-01-01

    Hip hemiarthroplasty is a common treatment for femoral neck fracture. However, the acetabular cartilage may degenerate after hemiarthroplasty leading to postoperative failure and the need for revision surgery. The clearance between the acetabular cartilage and head of the prosthesis is one of the potential reasons for this failure. In this study, the influence of joint clearance on the biomechanical function of a generic hip model in hemiarthroplasty was investigated using biphasic numerical simulation. Both a prolonged loading period of 4000 s and dynamic gait load of 10 cycles were considered. It was found that a larger clearance led to a higher stress level, a faster reduction in load supported by the fluid and a faster cartilage consolidation process. Additionally, the mechanical performance of the acetabular cartilage in the natural model was similar to that in the hemiarthroplasty model with no clearance but different from the hemiarthroplasty models with clearances of 0.5 mm and larger. The results demonstrated that a larger clearance in hip hemiarthroplasty is more harmful to the acetabular cartilage and prosthesis heads with more available dimensions (i.e. smaller increments in diameter) could be manufactured for surgeons to achieve a lower clearance, and reduced contact stress in hemiarthroplasty surgeries. PMID:24957488

  4. ASA III osteoporotic fracture in 62 patients treated with vertebroplasty under local anesthesia.

    PubMed

    Emre, Tuluhan Yunus; Gökcen, H Bahadır; Atbaşı, Zafer; Kavadar, Gülis; Enercan, Meriç; Ozturk, Cagatay

    2016-01-01

    Vertebroplasty is a minimally invasive procedure that may be performed under either local or general anesthesia. In this study, we aimed at assessing the outcomes of the vertebroplasty performed under local anesthesia in patients at high risk of general anesthesia. Vertebroplasty was performed under local anesthesia in the treatment of a total of 62 patients (68 vertebrae in total) with osteoporotic vertebral fractures between 2011 and 2013. None of the patients had a history of trauma. Patients who were classified as ASA III during the preoperative examinations were included in the study. VAS scores were evaluated before the surgery, on the first postoperative day, and in week 1 and in month 1 after the surgery. The average age was 77.5 years (age range 53-102). An average of 2 cc of cement was injected to 22 patients (35.5 %), and an average of 3 cc of cement was injected to 40 patients (64.5 %). The mean VAS scores were 7.52 (6-9) before the procedure, 3.55 (2-5) on the first day, 2.03 (0-4) in week 1 and 0.87 (0-2) in month 1 postoperatively. Asymptomatic cement embolism was detected in one patient. No other complications were observed in the study group. Vertebroplasty performed under local anesthesia is an effective and safe procedure in terms of pain control and early ambulation and is bereft of the complications associated with general anesthesia.

  5. Does pulsed low intensity ultrasound allow early return to normal activities when treating stress fractures? A review of one tarsal navicular and eight tibial stress fractures.

    PubMed

    Brand, J C; Brindle, T; Nyland, J; Caborn, D N; Johnson, D L

    1999-01-01

    We sought to evaluate the efficacy of daily pulsed low intensity ultrasound (LIUS) with early return to activities for the treatment of lower extremity stress fractures. Eight patients (2 males, 6 females) with radiographic and bone scan confirmed tibial stress fractures participated in this study. Additionally, a case report of a tarsal navicular stress fracture is described. All patients except one were involved in athletics. Prior to the study, subjects completed a 5 question, 10 cm visual analog scale (VAS) regarding pain level (10 = extreme pain, 1 = no pain) and were assessed for functional performance. Subjects received 20-minute LIUS treatments 5 times a week for 4 weeks. Subjects maintained all functional activities during the treatment period. Seven patients with posterior-medial stress fractures participated without a brace. Subjects were re-tested after 4 weeks of treatment. Mann-Whitney U tests (VAS data) and paired t-tests (functional tests) assessed statistical significance (p<0.05). Although the intensity of practice was diminished in some instances, no time off from competitive sports was prescribed for the patients with the tibial stress fractures. The patient with the anterior tibial stress fracture underwent tibial intramedullary nailing at the conclusion of a season of play. In this uncontrolled experience, treatment of tibial stress fractures with daily pulsed LIUS was effective in pain relief and early return to vigorous activity without bracing for the patients with posterior-medial stress fractures.

  6. Outcomes of long bone fractures treated by open intramedullary nailing at the St. Ann's Bay Hospital, Jamaica.

    PubMed

    Barnes, D; McDowell, D

    2010-10-01

    Between May 2001 to August 2004, 35 patients had open nailing of long bones. There were 40 fractures fixed. Of these 40 fractures, there were 25 femoral fractures, 11 were tibial fractures and 4 were humeral fractures. There were 33 (82.5%) closed fractures and 7 (17.5%) open fractures. In the group of patients with open fractures, there were two Grade I, two Grade II and three Grade IIIB. Seven (20%) patients were lost to follow-up; all of whom had closed fractures. The final analysis as it relates to complications was done using 28 patients with 32 fractures. The majority of fractures healed without significant complication. All the patients with closed fractures went on to bony union. There was one non-union and three delayed unions. There were two infections (osteomyelitis) and this was from the open fracture cohort. This represents an infection rate of 28.6% in this cohort. Two (7.0%) patients had persistent pain and one (3.6%) patient had early removal of the nail because of failure of fixation. The mean time from injury to surgery for the fractured femur was 15.5 (range 0-49) days; fractured tibia 24.4 (range 0-40), days and fractured humerus 41.5 (20-81) days. The mean hospital stay was 18.9 (range 9-37) days for patients with fractured femur; for fractured tibia, it was 20.5 (range 3-82) days and for fractured humerus, it was 22.7 (range 3-82) days. The mean postoperative stay was 4.1 (range 1-14) days for fractured femur, 4.5 (range 1-14) days for fractured tibia and 4.0 (range 1-10) days for fractured humerus. The mean time to healing (consolidation) as defined by X-rays was 5.0 (range 3-11) months for fractured femur 5.2 (range 3-11) months for tibia and 7.0 (range 6-8) months for fractured humerus.

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

    PubMed

    Melik, N; Togninalli, D; Biegger, P

    1994-12-01

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

  8. Open-configuration MRI study of femoro-acetabular impingement.

    PubMed

    Yamamura, Mitsuyoshi; Miki, Hidenobu; Nakamura, Nobuo; Murai, Masakazu; Yoshikawa, Hideki; Sugano, Nobuhiko

    2007-12-01

    Femoro-acetabular impingement has been proposed as a causative factor of primary hip osteoarthritis. However, primary osteoarthritis of the hip is infrequent in Japan and other Asian countries, even though the hips of Asians frequently sustain impingement, since the Asian lifestyle commonly requires a larger range of hip motion than the Western lifestyle. Therefore, using open-configuration MRI, we investigated whether impingement actually occurs during some traditional Japanese hip positions. The hips of 5 healthy Japanese females were examined in 5 sitting postures: 1) sitting straight; 2) bowing while sitting straight; 3) sitting cross-legged; 4) W-sitting; and 5) squatting. The impingement point was detected by multiple plane reconstructed (MPR) views along with the acetabular rim depicted circumferentially. Impingement was considered to have occurred when, on MRI, the anterior femoral head-neck junction approached the acetabular rim and the femoral head was seen to float from the bottom of the acetabulum with the acetabular rim acting as a fulcrum. Impingement was observed in all volunteers in the W-sitting position, and in 2 of 5 volunteers during squatting. These findings show that impingement occurs frequently during daily Japanese activities. Thus, depending on race, femoro-acetabular impingement might not always cause primary osteoarthritis of the hip. (c) 2007 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:1582-1588, 2007. PMID:17600811

  9. Accuracy of the modified Hardinge approach in acetabular positioning

    PubMed Central

    Goyal, Prateek; Lau, Adrian; McCalden, Richard; Teeter, Matthew G.; Howard, James L.; Lanting, Brent A.

    2016-01-01

    Background The surgical approach chosen for total hip arthroplasty (THA) may affect the positioning of the acetabular component. The purpose of this study was to examine the accuracy in orienting the acetabular component using the modified Hardinge approach. Methods We used our institutional arthroplasty database to identify patients with primary, press-fit, hemispherical acetabular components of a metal-on-polyethylene THA performed between 2003 and 2011. Patients with radiographs obtained 1–3 years after the index procedure were included for measurement of anteversion and inclination angles. Acceptable values of anteversion and abduction angles were defined as 15° ± 10° and 40° ± 10°, respectively. Results We identified 1241 patients from the database, and the modified Hardinge approach was used in 1010 of the patients included in our analysis. The acetabular component was anteverted in the acceptable zone in 54.1% of patients. The abduction angle was within the defined range in 79.2% of patients. Combined anteversion and abduction angles within the defined zone were present in 43.6% of patients. Conclusion Consistent with studies examining accuracy from other approaches, our study reveals that the modified Hardinge approach was only moderately accurate in positioning the acetabular component in the acceptable zone. PMID:27240130

  10. Effect of ferrule height and glass fibre post length on fracture resistance and failure mode of endodontically treated teeth.

    PubMed

    Abdulrazzak, Shurooq S; Sulaiman, Eshamsul; Atiya, Basim K; Jamaludin, Marhazlinda

    2014-08-01

    The purpose of this study was to evaluate the combined effect of ferrule height and post length on fracture resistance and failure mode of endodontically treated teeth restored with glass fibre posts, composite resin cores and crowns. Ninety human maxillary central incisors were endodontically treated and divided into three groups (n = 30) according to the ferrule heights: 4, 2 and 0 mm, respectively. Post spaces in each group were prepared at 2/3, 1/2 and 1/3 of the root length (n = 10). The specimens were received fibre posts, composite resin core build up and cast metal crowns. After thermocycling, compressive static load was applied at an angle of 135° to the crowns. Two-way analysis of variance showed significant differences in the failure load in the ferrule height groups, no significant differences in post length groups and no significant interaction between ferrule heights and post lengths. More restorable failure modes were observed. PMID:24118334

  11. Computer-Assisted Rotational Acetabular Osteotomy for Patients with Acetabular Dysplasia

    PubMed Central

    Kobayashi, Naomi; Ike, Hiroyuki; Kubota, So; Saito, Tomoyuki

    2016-01-01

    Rotational acetabular osteotomy (RAO) is a well-established surgical procedure for patients with acetabular dysplasia, and excellent long-term results have been reported. However, RAO is technically demanding and precise execution of this procedure requires experience with this surgery. The usefulness of computer navigation in RAO includes its ability to perform three-dimensional (3D) preoperative planning, enable safe osteotomy even with a poor visual field, reduce exposure to radiation from intraoperative fluoroscopy, and display the tip position of the chisel in real time, which is educationally useful as it allows staff other than the operator to follow the progress of the surgery. In our results comparing 23 hips that underwent RAO with navigation and 23 hips operated on without navigation, no significant difference in radiological assessment was observed. However, no perioperative complications were observed in the navigation group whereas one case of transient femoral nerve palsy was observed in non-navigation group. A more accurate and safer RAO can be performed using 3D preoperative planning and intraoperative assistance with a computed tomography-based navigation system. PMID:26929806

  12. Computer-Assisted Rotational Acetabular Osteotomy for Patients with Acetabular Dysplasia.

    PubMed

    Inaba, Yutaka; Kobayashi, Naomi; Ike, Hiroyuki; Kubota, So; Saito, Tomoyuki

    2016-03-01

    Rotational acetabular osteotomy (RAO) is a well-established surgical procedure for patients with acetabular dysplasia, and excellent long-term results have been reported. However, RAO is technically demanding and precise execution of this procedure requires experience with this surgery. The usefulness of computer navigation in RAO includes its ability to perform three-dimensional (3D) preoperative planning, enable safe osteotomy even with a poor visual field, reduce exposure to radiation from intraoperative fluoroscopy, and display the tip position of the chisel in real time, which is educationally useful as it allows staff other than the operator to follow the progress of the surgery. In our results comparing 23 hips that underwent RAO with navigation and 23 hips operated on without navigation, no significant difference in radiological assessment was observed. However, no perioperative complications were observed in the navigation group whereas one case of transient femoral nerve palsy was observed in non-navigation group. A more accurate and safer RAO can be performed using 3D preoperative planning and intraoperative assistance with a computed tomography-based navigation system.

  13. Comparative evaluation of fracture resistance of glass fiber reinforced, carbon, and quartz post in endodontically treated teeth: An in-vitro study

    PubMed Central

    Sharma, Shweta; Attokaran, George; Singh, Kunwar S.; Jerry, Jeethu J.; Ahmed, Naima; Mitra, Nirban

    2016-01-01

    Aim and Objectives: Use of posts improves the physical properties of endodontically-treated teeth. Different post types are developed such as metal, custom-made, carbon, and quartz. The present study was conducted to evaluate the fracture resistance of glass fiber-reinforced, carbon, and quartz post in endodontically-treated teeth. Materials and Methods: Forty extracted human maxillary incisor teeth were decoronated and endodontically treated and equally divided into 4 groups; control, glass fiber-reinforced, carbon, and quartz posts. No post was used in the control group. Post space was prepared and cemented with different posts and subjected to universal testing machine to check fracture resistance. The data were statistically analyzed using t-test and analysis of variance to compare the mean difference between groups (SPSS version 20, IBM). Results: Quartz type of endodontic post showed good fracture resistance compared to carbon and resin-reinforced post. Least resistance was observed in the control group without post. Conclusion: Quartz, carbon, and glass fiber-reinforced posts show good resistance to fracture, and hence can be used in endodontically-treated teeth to enhance their strength. PMID:27583227

  14. Multiple Acetabular Revisions in THA - Poor Outcome Despite Maximum Effort

    PubMed Central

    Bischel, O; Seeger, JB; Krüge, M; Bitsch, BG

    2012-01-01

    A consecutive series of 52 acetabular revisions was evaluated retrospectively. Inclusion criteria for all patients were at least one former exchange of the acetabular component. Reconstruction was performed with reliable techniques and implants other than extensively porous coated device (e.g. tantalum). The mean follow up was 5.63 (0.01-14.05) years. Cumulative survival at 14.05 years with removal of the acetabular component due to aseptic loosening or the worst case criterion (removal of the acetabular component for any cause and/or lost to follow-up) as the end point was 66.38 (95 % C.-I.: 47.80-84.96) % and 58.42 (95 % C.-I.: 41.01-75.83) %, respectively. The cumulative survival rate with mechanical failure of the acetabular reconstruction as the endpoint was significantly lower in patients with two or more previous revisions in comparison to those with only one former procedure (log rank test: p=0,0112 respectively). The mean Merle d’Aubignée-score improved from 7.3 (0-14) preoperatively to 10.6 (0-17) points at latest follow up examination. Survival of acetabular reconstructions with common techniques and implants is decreasing with the number of previous revisions. This may cause major concerns with regard to the rising number of patients needing repeated revisions. Maximizing durability of primary THA, precise preoperative planning as well as improved techniques and implants for revision may decrease this problem in the long term. PMID:23193432

  15. Intrinsic mechanical behavior of femoral cortical bone in young, osteoporotic and bisphosphonate-treated individuals in low- and high energy fracture conditions

    DOE PAGES

    Zimmermann, Elizabeth A.; Schaible, Eric; Gludovatz, Bernd; Schmidt, Felix N.; Riedel, Christoph; Krause, Matthias; Vettorazzi, Eik; Acevedo, Claire; Hahn, Michael; Püschel, Klaus; et al

    2016-02-16

    Bisphosphonates are a common treatment to reduce osteoporotic fractures. This treatment induces osseous structural and compositional changes accompanied by positive effects on osteoblasts and osteocytes. Here, we test the hypothesis that restored osseous cell behavior, which resembles characteristics of younger, healthy cortical bone, leads to improved bone quality. Microarchitecture and mechanical properties of young, treatment-naïve osteoporosis, and bisphosphonate-treated cases were investigated in femoral cortices. Tissue strength was measured using three-point bending. Collagen fibril-level deformation was assessed in non-traumatic and traumatic fracture states using synchrotron small-angle x-ray scattering (SAXS) at low and high strain rates. The lower modulus, strength and fibrilmore » deformation measured at low strain rates reflects susceptibility for osteoporotic low-energy fragility fractures. Independent of age, disease and treatment status, SAXS revealed reduced fibril plasticity at high strain rates, characteristic of traumatic fracture. We find the significantly reduced mechanical integrity in osteoporosis may originate from porosity and alterations to the intra/extrafibrillar structure, while the fibril deformation under treatment indicates improved nano-scale characteristics. In conclusion, losses in strength and fibril deformation at low strain rates correlate with the occurrence of fragility fractures in osteoporosis, while improvements in structural and mechanical properties following bisphosphonate treatment may foster resistance to fracture during physiological strain rates.« less

  16. Intrinsic mechanical behavior of femoral cortical bone in young, osteoporotic and bisphosphonate-treated individuals in low- and high energy fracture conditions.

    PubMed

    Zimmermann, Elizabeth A; Schaible, Eric; Gludovatz, Bernd; Schmidt, Felix N; Riedel, Christoph; Krause, Matthias; Vettorazzi, Eik; Acevedo, Claire; Hahn, Michael; Püschel, Klaus; Tang, Simon; Amling, Michael; Ritchie, Robert O; Busse, Björn

    2016-02-16

    Bisphosphonates are a common treatment to reduce osteoporotic fractures. This treatment induces osseous structural and compositional changes accompanied by positive effects on osteoblasts and osteocytes. Here, we test the hypothesis that restored osseous cell behavior, which resembles characteristics of younger, healthy cortical bone, leads to improved bone quality. Microarchitecture and mechanical properties of young, treatment-naïve osteoporosis, and bisphosphonate-treated cases were investigated in femoral cortices. Tissue strength was measured using three-point bending. Collagen fibril-level deformation was assessed in non-traumatic and traumatic fracture states using synchrotron small-angle x-ray scattering (SAXS) at low and high strain rates. The lower modulus, strength and fibril deformation measured at low strain rates reflects susceptibility for osteoporotic low-energy fragility fractures. Independent of age, disease and treatment status, SAXS revealed reduced fibril plasticity at high strain rates, characteristic of traumatic fracture. The significantly reduced mechanical integrity in osteoporosis may originate from porosity and alterations to the intra/extrafibrillar structure, while the fibril deformation under treatment indicates improved nano-scale characteristics. In conclusion, losses in strength and fibril deformation at low strain rates correlate with the occurrence of fragility fractures in osteoporosis, while improvements in structural and mechanical properties following bisphosphonate treatment may foster resistance to fracture during physiological strain rates.

  17. Intrinsic mechanical behavior of femoral cortical bone in young, osteoporotic and bisphosphonate-treated individuals in low- and high energy fracture conditions

    PubMed Central

    Zimmermann, Elizabeth A.; Schaible, Eric; Gludovatz, Bernd; Schmidt, Felix N.; Riedel, Christoph; Krause, Matthias; Vettorazzi, Eik; Acevedo, Claire; Hahn, Michael; Püschel, Klaus; Tang, Simon; Amling, Michael; Ritchie, Robert O.; Busse, Björn

    2016-01-01

    Bisphosphonates are a common treatment to reduce osteoporotic fractures. This treatment induces osseous structural and compositional changes accompanied by positive effects on osteoblasts and osteocytes. Here, we test the hypothesis that restored osseous cell behavior, which resembles characteristics of younger, healthy cortical bone, leads to improved bone quality. Microarchitecture and mechanical properties of young, treatment-naïve osteoporosis, and bisphosphonate-treated cases were investigated in femoral cortices. Tissue strength was measured using three-point bending. Collagen fibril-level deformation was assessed in non-traumatic and traumatic fracture states using synchrotron small-angle x-ray scattering (SAXS) at low and high strain rates. The lower modulus, strength and fibril deformation measured at low strain rates reflects susceptibility for osteoporotic low-energy fragility fractures. Independent of age, disease and treatment status, SAXS revealed reduced fibril plasticity at high strain rates, characteristic of traumatic fracture. The significantly reduced mechanical integrity in osteoporosis may originate from porosity and alterations to the intra/extrafibrillar structure, while the fibril deformation under treatment indicates improved nano-scale characteristics. In conclusion, losses in strength and fibril deformation at low strain rates correlate with the occurrence of fragility fractures in osteoporosis, while improvements in structural and mechanical properties following bisphosphonate treatment may foster resistance to fracture during physiological strain rates. PMID:26879146

  18. Intrinsic mechanical behavior of femoral cortical bone in young, osteoporotic and bisphosphonate-treated individuals in low- and high energy fracture conditions

    NASA Astrophysics Data System (ADS)

    Zimmermann, Elizabeth A.; Schaible, Eric; Gludovatz, Bernd; Schmidt, Felix N.; Riedel, Christoph; Krause, Matthias; Vettorazzi, Eik; Acevedo, Claire; Hahn, Michael; Püschel, Klaus; Tang, Simon; Amling, Michael; Ritchie, Robert O.; Busse, Björn

    2016-02-01

    Bisphosphonates are a common treatment to reduce osteoporotic fractures. This treatment induces osseous structural and compositional changes accompanied by positive effects on osteoblasts and osteocytes. Here, we test the hypothesis that restored osseous cell behavior, which resembles characteristics of younger, healthy cortical bone, leads to improved bone quality. Microarchitecture and mechanical properties of young, treatment-naïve osteoporosis, and bisphosphonate-treated cases were investigated in femoral cortices. Tissue strength was measured using three-point bending. Collagen fibril-level deformation was assessed in non-traumatic and traumatic fracture states using synchrotron small-angle x-ray scattering (SAXS) at low and high strain rates. The lower modulus, strength and fibril deformation measured at low strain rates reflects susceptibility for osteoporotic low-energy fragility fractures. Independent of age, disease and treatment status, SAXS revealed reduced fibril plasticity at high strain rates, characteristic of traumatic fracture. The significantly reduced mechanical integrity in osteoporosis may originate from porosity and alterations to the intra/extrafibrillar structure, while the fibril deformation under treatment indicates improved nano-scale characteristics. In conclusion, losses in strength and fibril deformation at low strain rates correlate with the occurrence of fragility fractures in osteoporosis, while improvements in structural and mechanical properties following bisphosphonate treatment may foster resistance to fracture during physiological strain rates.

  19. Arthroscopic Technique for Acetabular Labral Reconstruction Using Iliotibial Band Autograft.

    PubMed

    Chahla, Jorge; Soares, Eduardo; Bhatia, Sanjeev; Mitchell, Justin J; Philippon, Marc J

    2016-06-01

    The dynamic function of the acetabular labrum makes it an important structure for both hip stability and motion. Because of this, injuries to the labrum can cause significant dysfunction, leading to altered hip kinematics. Labral repair is the gold standard for symptomatic labral tears to keep as much labral tissue as possible; however, in cases where the labrum has been injured to such a degree that it is either deficient or repair is not possible, arthroscopic labral reconstruction is preferred. This article describes our preferred approach for reconstruction of the acetabular labrum using iliotibial band autograft.

  20. Arthroscopic Technique for Acetabular Labral Reconstruction Using Iliotibial Band Autograft.

    PubMed

    Chahla, Jorge; Soares, Eduardo; Bhatia, Sanjeev; Mitchell, Justin J; Philippon, Marc J

    2016-06-01

    The dynamic function of the acetabular labrum makes it an important structure for both hip stability and motion. Because of this, injuries to the labrum can cause significant dysfunction, leading to altered hip kinematics. Labral repair is the gold standard for symptomatic labral tears to keep as much labral tissue as possible; however, in cases where the labrum has been injured to such a degree that it is either deficient or repair is not possible, arthroscopic labral reconstruction is preferred. This article describes our preferred approach for reconstruction of the acetabular labrum using iliotibial band autograft. PMID:27656395

  1. Acetabular Labral Tears in Patients with Sports Injury

    PubMed Central

    Kang, Chan; Cha, Soo-Min

    2009-01-01

    Background We wanted to investigate acetabular labral tears and their correlation with femoroacetabular impingement in patients with sports injury. Methods Among 111 patients who were diagnosed with the acetabular labral tears after arthroscopic treatment from January 2004 to December 2007, we selected 41 patients with sports injury. There were 12 cases of Taekwondo injury, 5 of golf injury, 4 of soccer injury, 3 of gymnastics injury, 2 of Hapkido injury, 2 of aerobics injury, 2 of rock-climbing injury, 2 of fitness training injury and 9 of other sports injuries. We checked the subtypes of acetabular labral tears and the accompanying femoroacetabular impingement. For the cases with accompanying femoroacetabular impingement, we investigated the subtypes according to the types of sports, gender and age. At last follow-up, we checked the Harris Hip Score (HHS), the Hip Outcome Score (HOS) sports scale and the percentage of patients who returned to their sports activity. Results The average age of symptomatic onset was 26 years (range, 12 to 65 years). The ratio of males to females was 29 : 12. An average duration of the hip pain was 17 months (range, 1 to 60 months). The degenerative type of acetabular labral tears was the most prevalent with 32 cases (78%), and there were 9 cases (22%) of the partial tear type. Thirty cases (73%) were accompanied by femoroacetabular impingement. The average age of the 23 cases (56%) of the cam-type was 23 years (range, 12 to 48 years), and it was more likely to occur in men (87%) and for people practicing martial arts such as Taekwondo or Hapkido. An average age of the 5 cases (12%) of the pincer-type was 26 (range, 16 to 43 years), it usually occurred in women (60%) and for non-martial arts such as golf and gymnastics. There were 2 cases of the mixed type (cam + pincer-type). At 27 months follow-up, the HHS was 61 to 92 points, the HOS sports scale increased 43 to 75%, and the rate of returning to sports was 71%. Conclusions In

  2. Intra-articular Fractures of the Sigmoid Notch of the Distal Radius: Analysis of Progression to Distal Radial Ulnar Joint Arthritis and Impact on Upper Extremity Function in Surgically Treated Fractures.

    PubMed

    Vitale, Mark A; Brogan, David M; Shin, Alexander Y; Berger, Richard A

    2016-03-01

    Background Studies have established an increased risk of radiocarpal joint posttraumatic arthritis in patients with displaced intra-articular fractures of the distal radius, although this phenomenon has yet to be evaluated in the distal radioulnar joint (DRUJ). Purpose We hypothesized that patients with displaced intra-articular fractures of the sigmoid notch would have a higher prevalence of DRUJ arthritis and greater upper extremity dysfunction after operative treatment of distal radius fractures compared with fractures without sigmoid notch involvement. We also hypothesized that the degree of sigmoid notch incongruity would be correlated with the grade of DRUJ arthritis and the severity of upper extremity dysfunction. Patients and Methods A retrospective review was conducted on surgically treated patients with distal radius fractures with pre- and/or postoperative computed tomography (CT) scans. Patients were divided into groups based on presence or absence of fracture extension into the sigmoid notch. Within the sigmoid notch group, postoperative CT scans were used to measure sigmoid notch fracture step-off and diastasis (mm), as well as volar or dorsal DRUJ subluxation (%). Patients were administered Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaires and radiographs were obtained to grade DRUJ arthritis using the Kellgren-Lawrence (KL) radiographic criteria. Results Thirty-three patients were included (19 with sigmoid notch involvement and 14 without) with an average radiographic follow-up of 6.3 years (range: 3.5-10.1 years). DASH scores were available for all patients, and radiographic follow-up was available in 24 patients (73%). A trend toward higher grade of DRUJ arthritis and poorer average DASH was found in those with sigmoid notch involvement, but was not statistically different. In the sigmoid notch group there were poorer DASH scores in patients with coronal step-off > 1.0-mm (p < 0.05). There were no significant

  3. A Prospective Study on Radiological and Functional Outcome of Displaced Tongue Type Intra-Articular Calcaneal Fractures Treated by Percutaneous Screw Fixation

    PubMed Central

    Hegde, Anoop; Mathias, Lawrence John; Shetty, Vikram; Shetty, Ashwin

    2016-01-01

    Introduction Calcaneal fractures have posed a challenge to orthopaedic surgeon for many years. The major problem is to reconstruct the fracture and improve healing of the fracture and also the surrounding tissues. Anatomic restoration of the three-dimensional anatomy of the calcaneum is the goal of surgical management of calcaneal fractures. Over the years, various techniques have been developed to accomplish this goal. Aim To determine the functional outcome in displaced tongue-type calcaneal fracture treated by percutaneous screw fixation. Materials and Methods A prospective study was conducted from October 2012 and September 2014. A total of 23 patients with intra-articular ‘tongue type’ calcaneal fractures were included in the study. Complete clinical and radiological evaluation was done. The surgical procedure encompassed closed reduction and fixation with two criss-cross 6.5 mm cannulated cancellous across the fracture site under fluoroscopic guidance. Postoperatively, on day three ankle and toe mobilization was begun. Non-weight bearing crutch mobilization was begun on postoperative day three. Reviews were done at 6 weeks, 12 weeks and 24 weeks postoperatively. At 6 weeks partial weight bearing mobilization was started. Full weight bearing was begun at 12 weeks. The patient was finally reviewed at 24 weeks and assessment of ankle function was done as per the Maryland foot scoring system. Radiographs were compared and preoperative and postoperative Gissane’s and Bohler’s angles were also compared. The results were analysed as per descriptive statistics (frequency, percentage). The complications noted were documented. Results Of the 23 patients under the study, three had excellent results with mean score of 90, 17 had good results with mean score of 82.94 and three had fair results with mean score of 74. Only one patient had subtalar arthritis as a complication. No other complications were seen. Conclusion Percutaneous screw fixation of tongue type

  4. Intraoperative computed tomography navigation for transpedicular screw fixation to treat unstable thoracic and lumbar spine fractures: clinical analysis of a case series (CARE-compliant).

    PubMed

    Lee, Ching-Yu; Wu, Meng-Huang; Li, Yen-Yao; Cheng, Chin-Chang; Hsu, Chu-Hsiang; Huang, Tsung-Jen; Hsu, Robert Wen-Wei

    2015-05-01

    Transpedicular screw (TPS) fixation in unstable thoracic and lumbar (TL) spine fractures remains technically difficult because of destroyed anatomical landmarks, unstable gross segments, and discrepancies in anatomic orientation using conventional anatomic landmarks, fluoroscopic guidance, or computed tomography (CT)-based navigation. In this study, we evaluated the safety and accuracy of TPS placement under intraoperative computed tomography (iCT) navigation in managing unstable TL spine fractures.From 2010 to 2013, we retrospectively reviewed the Spine Operation Registry records of patients who underwent posterior instrumented fusion to treat unstable TL spine fractures via the iCT navigation system. An unstable spine fracture was identified as AO/Magerl classification type B or type C.In all, 316 screws in 37 patients with unstable TL spine fractures were evaluated and involved 7 thoracic, 23 thoracolumbar junctional, and 7 lumbar fractures. The accuracy of TPS positioning in the pedicle without breach was 98% (310/316). The average number of iCT scans per patient was 2.1 (range 2-3). The average total radiation dose to patients was 15.8 mSv; the dose per single level exposure was 2.7 mSv. The TPS intraoperative revision rate was 0.6% (2/316) and no neurovascular sequela was observed. TPS fixation using the iCT navigation system obtained a 98% accuracy in stabilizing unstable TL spine fractures. A malplaced TPS could be revised during real-time confirmation of the TPS position, and no secondary operation was required to revise malplaced screws.The iCT navigation system provides accurate and safe management of unstable TL spine fractures. In addition, operating room personnel, including surgeons and nurses, did not need to wear heavy lead aprons as they were not exposed to radiation. PMID:25997042

  5. The impact of treatment compliance on fracture risk in women with breast cancer treated with aromatase inhibitors in the United Kingdom.

    PubMed

    Schimdt, Nina; Jacob, Louis; Coleman, Robert; Kostev, Karel; Hadji, Peyman

    2016-01-01

    No study has yet analyzed the impact of compliance with aromatase inhibitor(AI) treatments on fracture risk in a real-world setting in women with breast cancer. In this study, 8732 women with BC treated with AI, 8732 treated with tamoxifen (TAM), and 8732 age-matched women without BC selected from the Disease Analyzer database (IMS Health) were included. The main outcome measure was the impact of compliance with AI treatment on fracture risk. Demographic data included age, body mass index (BMI), and smoking status. Alcohol dependency, dementia, bone density, visual disturbances, diabetes, and use of corticosteroids were also assessed. Kaplan-Meier curves were used to analyze the proportion of patients with fracture over time, and multivariate Cox regression models were performed to assess the adjusted fracture risk. Mean age was 67.3 years. 17.6, 8.7, and 8.8 % of AI, TAM, and non-cancer patients, respectively, were diagnosed with fracture within 5 years after the index date (p < 0.001). The proportion of women receiving AI with fracture increased with treatment compliance, rising from 8.6 % when treatment persisted for less than a year to 18.0 % when it persisted for between 4 and 5 years (p < 0.001). By contrast, the proportion of fractures in women with BC receiving TAM for the same time periods decreased from 13.0 to 7.9 % (p < 0.001). The risk of fracture was higher in women with BC using AI than in the non-cancer group (HR = 3.00; p < 0.0001). Finally, current smoking status, BMI, dementia, and prescription of corticosteroids had significant impacts on fracture risk. Compliance with AI treatment in women with BC is associated with a clear increase in the risk of fracture, which is much higher than previously reported.

  6. [Fractures of the proximal end of the humerus treated by the Kapandji centro-medullary nailing technic. A review of 21 cases].

    PubMed

    Monin, S; van Innis, F

    1999-06-01

    Over a 7 years period (from September 1989 to April 1996), 25 patients have been treated for proximal humeral fractures using Kapandji's method of internal fixation. Twenty-one were available for evaluation. The mean follow-up was 3 years 9 months. Various indications were found, with a majority of 2 and 3-part fractures. Complications were frequent, the most common being pin migration, but the functional results following Constant scores are very good. The technique is easy, quick, non- invasive and inexpensive. The approach is direct and avoids opening the elbow joint. PMID:10427799

  7. Medium-term results of cementation of a highly cross-linked polyethylene liner into a well-fixed acetabular shell in revision hip arthroplasty.

    PubMed

    Lim, Seung-Jae; Lee, Keun-Ho; Park, Shin-Hyung; Park, Youn-Soo

    2014-03-01

    The present study was undertaken to document outcomes of cementation of a highly cross-linked polyethylene (PE) liner into a well-fixed acetabular metal shell in 36 hips. All operations were performed by a single surgeon using only one type of liner. Patients were followed for a mean of 6.1 years (range, 3-8 years). Mean Harris hip score improved from 58 points preoperatively to 91 points postoperatively. There were no cases of PE liner dislodgement or progressive osteolysis. 1 hip (2.8%) required revision surgery for acetabular cup loosening with greater trochanteric fracture. Complications included 1 peroneal nerve palsy and 1 dislocation. The results of this study and previous reports demonstrated that cementation of highly cross-linked PE liner into well-fixed metal shell could provide good midterm durability.

  8. The potential for bone loss in acetabular structures following THA.

    PubMed

    Manley, Michael T; Ong, Kevin L; Kurtz, Steven M

    2006-12-01

    Attempts to preserve periacetabular bone stock following total hip replacement have largely ignored the potential for stress shielding in the acetabulum. We sought to quantify the change in stress distribution in acetabular bone with components of varying material stiffness by developing a high-resolution 3-D finite element model from CT scans of a young female donor. Periprosthetic bone stresses and strains on the left pelvis were compared with hemispherical cups of various material properties and with a horseshoe shaped polymeric design described in the recent literature. We observed unphysiologic periacetabular bone stress and strain fields for all designs tested. For hemispherical components, reduction of the acetabular shell material modulus caused modest changes in bone stress compared to the changes in implant geometry. The horseshoe shaped cup more effectively loaded the acetabular structures than the hemispherical design. Our results suggest stress and strain fields in pelvic structures after introduction of hemispherical acetabular components predict inevitable bone adaptation that can not be resolved by changes in implant material properties alone. Radical changes in implant design may be necessary for long-term maintenance of supporting structures in the reconstructed acetabulum.

  9. Anatomy, histologic features, and vascularity of the adult acetabular labrum.

    PubMed

    Seldes, R M; Tan, V; Hunt, J; Katz, M; Winiarsky, R; Fitzgerald, R H

    2001-01-01

    Acetabular labrum tears have been implicated as a cause of hip pain in adult patients. Few studies describe the anatomy, histologic features, and microvasculature of the acetabular labrum and labral tears. Fifty-five embalmed and 12 fresh-frozen adult hips with a mean age of 78 years (range, 61-98 years) were studied. Of these, 96 % (53 of 55) of the hips had labral tears, with 74% of the tears located in the anterosuperior quadrant. Histologically, the fibrocartilaginous labrum was contiguous with the acetabular articular cartilage through a 1- to 2-mm zone of transition. A consistent projection of bone extends from the bony acetabulum into the substance of the labrum that is attached via a zone of calcified cartilage with a well-defined tidemark. Two distinct types of tears of the labrum were identified histologically. The first consisted of a detachment of the fibrocartilaginous labrum from the articular hyaline cartilage at the transition zone. The second consisted of one or more cleavage planes of variable depth within the substance of the labrum. Both types of labral tears were associated with increased microvessel formation seen within the tear. The acetabular labrum tear appears to be an acquired condition that is highly prevalent in aging adult hips. Labral tears occur early in the arthritic process of the hip and may be one of the causes of degenerative hip disease.

  10. Pharmacological treatment of heterotopic ossification following hip and acetabular surgery.

    PubMed

    Macfarlane, Robert J; Ng, Boon Han; Gamie, Zakareya; El Masry, Mohamed A; Velonis, Stylianos; Schizas, Constantin; Tsiridis, Eleftherios

    2008-04-01

    Heterotopic ossification is a common complication following total hip arthroplasty and surgery following acetabular trauma. It is associated with pain and a decreased range of movement. Prophylaxis is achieved by either non-steroidal anti-inflammatory drug treatment or localised irradiation therapy. The objective of this study was to evaluate the evidence for pharmacological agents used for the prophylaxis of heterotopic ossification following hip and acetabular surgery. The study used a comprehensive literature search to identify all major clinical studies investigating the pharmacological agents used in the prophylaxis of heterotopic ossification following hip and acetabular surgery. It was concluded that indometacin remains the 'gold standard' for heterotopic ossification prophylaxis following total hip arthroplasty and is the only drug proven to be effective against heterotopic ossification following acetabular surgery. Following total hip arthroplasty, other non-steroidal anti-inflammatory drugs, including naproxen and diclofenac, are equally as effective as indometacin and can be considered as alternative first-line treatments. Celecoxib is also of equal efficacy to indometacin and is associated with significantly fewer gastrointestinal side effects. However, serious concerns were raised over the safety of selective cyclooxygenase-2 inhibitors for the cardiovascular system and these should be used cautiously.

  11. Photoelastic analysis of stresses produced by different acetabular cups.

    PubMed

    Ries, M D; Salehi, A; Shea, J

    1999-12-01

    Porous-coated acetabular components can provide long-term biologic fixation to bone. However, the periacetabular stress patterns and mechanisms by which different types of cementless acetabular cups obtain initial stability is not clear. In the current study, periacetabular stresses produced by different cementless acetabular cup geometries were quantitated using a three-dimensional photoelastic model. The cup geometries consisted of trispiked, finned, hemispherical, and nonhemispherical (wider than a hemisphere at the periphery) geometries. The cup models were loaded incrementally in the photoelastic material to simulate periacetabular stress distributions at the time of implantation during surgery rather than under physiologic weightbearing loads. The peripheral stress distributions and their magnitudes induced by the trispiked and oversized hemispherical cups were similar, but the trispiked cup induced localized high stress regions where the spikes penetrate the bone model. The fins separated the periacetabular material into quadrants, which was associated with decreased peripheral stresses. A nonhemispherical geometry with a wider diameter at the rim than a hemisphere increased peripheral stresses more than an oversized hemispherical geometry and required less force to seat the implant. Although various cementless acetabular cups can perform well clinically, they produce different periacetabular stresses and appear to obtain initial fixation by different mechanisms. PMID:10611871

  12. Pneumothorax complicating isolated clavicle fracture.

    PubMed

    Hani, Redouane; Ennaciri, Badr; Jeddi, Idriss; El Bardouni, Ahmed; Mahfoud, Mustapha; Berrada, Mohamed Saleh

    2015-01-01

    Isolated clavicle fractures are among the commonest of traumatic fractures in the emergency department. Complications of isolated clavicle fractures are rare. Pneumothorax has been described as a complication of a fractured clavicle only rarely in English literature. In all the reported cases, the pneumothorax was treated by a thoracostomy and the clavicle fracture was treated conservatively. In our case, the pneumothorax required a chest drain insertion and the clavicle fracture was treated surgically with good result.

  13. Tritanium acetabular wedge augments: short-term results

    PubMed Central

    Restrepo, Camilo; Heller, Snir

    2016-01-01

    Background Reconstruction of acetabular defects in total hip arthroplasty (THA) presents a great challenge to orthopaedic surgeons. Previous studies have reported on the use and outcomes of trabecular metal acetabular augments for the reconstruction of acetabular defects. However, no study has been conducted evaluating the short-term results of tritanium acetabular wedge augments for the reconstruction of acetabular defects in THA. Methods A retrospective study was conducted using a prospective database at a single institution including primary and revision THA patients from January 2013 to December 2014. Patients were included if they received a tritanium acetabular wedge augment system and had a minimum of 2-year follow-up (average 2.2 years ±0.3, range, 2–2.6 years). Demographic data and outcomes data [Harris Hip Score—HHS and Short Form (SF)-36] was collected. Radiographic data was also collected on THA revision cases (Paprosky classification), developmental dysplasia of the hip (DDH) cases (Crowe classification), and radiographic follow-up using DeLee and Charnley’s classification system. Results There were 4 revision THA patients, 3 DDH patients, and 1 patient with posttraumatic arthritis. At the latest radiographic follow-up, there were no lucent lines in DeLee and Charnley Zones I, II or III. During the follow-up period, there was no open revision surgery. The SF-36 physical score significantly improved from preoperative measurement (29.6±2.2) to postoperative measurement (52.2±8.7, P=0.003), and the SF-36 mental score also significantly improved from preoperative assessment (34.5±4.5) to postoperative assessment (52.2±7.5, P=0.003). Total HHS scores also significantly improved postoperatively (P=0.02), with significant improvements in both the pain score (P=0.01) and function score (P=0.02). Conclusions Tritanium acetabular wedge augments in this short follow-up case series exhibit high clinical outcome scores, no radiographic lucency, and no

  14. An Isolated Displaced Fracture of the Coracoid Process Treated with Open reduction and internal fixation - A Case Report and Review of Literature

    PubMed Central

    Archik, Shreedhar; Nanda, Saurav Narayan; Tripathi, Sanjay; Choudhari, Ashlesh; Rajadhyaksha, Harshada

    2016-01-01

    Introduction: Isolated coracoid fractures are rare and few scattered cases are reported in literature. Coracoid fractures can be missed and the treatment for coracoid process fractures is still controversial. The case presented here is of an isolated coracoid process fracture which was treated surgically. Case Report: A 15-years old male presented after 4 days of injury complaining of persistent pain in the right shoulder following a jerk during bowling. Physical examination revealed tenderness in the left shoulder. There was pain on abduction and external rotation. The neurovascular examination was normal. Osseous avulsion of the distal tip of the coracoid process was confirmed by CT and MRI. The short head of the biceps and coracobrachialis was attached to the avulsed tip, while the pectoralis minor was attached to the coracoid base. The case was managed by open reduction and fixation with a 3.5mm cannulated screw and washer. Conclusion: Isolated coracoid fracture is a rare entity causing impairment of upper limb movement. It can be diagnosed more accurately by MRI scan and CT scan. In case of young highly demanding individuals like athletes surgical management may be a better option as compared to conservative treatment to achieve early use of the extremity, good radiological union and clinical function.

  15. Percutaneous manipulation of intra-articular debris after fracture-dislocation of the femoral head or acetabulum.

    PubMed

    Marecek, Geoffrey S; Routt, M L Chip

    2014-09-01

    Traumatic fracture-dislocation of the hip usually warrants prompt management by closed manipulative reduction. In some patients, debris malpositioned between the femoral head and the acetabular dome obstructs a completely concentric reduction of the injured hip. To avoid damage to the articular surfaces, the debris between them should be removed in a timely fashion. Techniques for removal include open approaches with or without fracture fixation or hip arthroscopy. Fracture fixation and hip arthroscopy have associated risks and potential complications, may require special equipment, and may not be familiar to all surgeons. The authors present a simple fluoroscopically guided technique for the percutaneous removal of intra-articular debris between the femoral head and the acetabular dome after traumatic femoral head or acetabular fracture-dislocation.

  16. Validation of neck axis distance as a radiographic measure for acetabular anteversion

    PubMed Central

    Nitschke, Ashley; Petersen, Brian; Lambert, Jeffery R.; Glueck, Deborah H.; Jesse, Mary Kristen; Strickland, Colin; Mei-Dan, Omer

    2016-01-01

    Excessive acetabular anteversion is an important treatment consideration in hip preservation surgery. There is currently no reliable quantitative method for determining acetabular anteversion utilizing radiographs alone. The three main purposes of this study were to: (i) define and validate the neck axis distance (NAD) as a new visual and reproducible semi-quantitative radiographic parameter used to measure acetabular anteversion; (ii) determine the degree of correlation between NAD and computed tomography (CT)-measured acetabular anteversion; (iii) establish a sensitive and specific threshold value for NAD to identify excessive acetabular anteversion. This retrospective cohort study included all patients presenting to a single institution over a 14-month period who had undergone a dedicated musculoskeletal CT pelvis along with a standardized anteroposterior (AP) pelvis radiograph. Trained observers measured the NAD on the AP pelvis radiograph and equatorial acetabular anteversion on CT for all hips. Mixed model analysis was used to find prediction equations, and ROC analysis was used to evaluate the diagnostic accuracy of NAD. NAD is a valid semi-quantitative predictor of acetabular anteversion and strongly correlates with CT-measured equatorial acetabular anteversion (P  <  0.0001). A NAD measurement of greater than 14 mm predicts excessive acetabular anteversion with 76% sensitivity and 78% specificity. NAD is an accurate radiographic predictor of acetabular anteversion, which may be readily used as an effective screening tool during the evaluation of patients with hip pain. PMID:27026824

  17. Implication of acetabular width on the anteroposterior pelvic radiograph of patients with developmental dysplasia of the hip.

    PubMed

    Nie, Yong; Pei, Fuxing; Shen, Bin; Kang, Pengde; Li, Zongming

    2015-03-01

    Radiographic parameters that can help acetabular reconstruction during total hip arthroplasty (THA) for patients with developmental dysplasia of the hip (DDH) are few. The radiographs of 138 dysplastic hips that had undergone cementless THA were evaluated regarding the acetabular width above the acetabular component and the coverage of the component by native bone. The acetabular reconstruction process was simulated using 3D models from CT data, and the acetabular component coverage was calculated in 3D space based on the measurement and algorithm we proposed. Significant positive correlation between the acetabular width and the acetabular component coverage was found. Our study introduced a useful parameter, which can mark the superior reference position of the acetabular component for acetabular reconstruction in DDH patients. PMID:25311162

  18. Lateral acetabular labral length is inversely related to acetabular coverage as measured by lateral center edge angle of Wiberg

    PubMed Central

    Petersen, Brian D.; Wolf, Bryan; Lambert, Jeffrey R.; Clayton, Carolyn W.; Glueck, Deborah H.; Jesse, Mary Kristen; Mei-Dan, Omer

    2016-01-01

    Patients with developmental dysplasia of the hip often have compensatory labral hypertrophy, which presumably lends stability to an unstable joint. Conversely, patients with acetabular overcoverage may have small or ossified labra. The purpose of this study is to explore the interaction of labral length with the degree of acetabular hip coverage. A retrospective cohort of patients with hip pain presenting to a hip preservation center, who had undergone hip magnetic resonance imaging and AP pelvis radiographs were studied. General linear multivariate models were used to assess the association between three measures of labral length (lateral, anterior and anterior inferior locations along the acetabular rim) and the X-ray derived lateral center edge angle (LCEA) of Wiberg. Of the three acetabular labral locations measured, only the lateral labrum was associated with LCEA Wiberg (P = 0.0008). Lateral labral length increases as LCEA of Wiberg decreases. The anterior and anterior inferior labral locations did not show a predictable increase in labral length as LCEA Wiberg decreased. PMID:27583157

  19. Lateral acetabular labral length is inversely related to acetabular coverage as measured by lateral center edge angle of Wiberg.

    PubMed

    Petersen, Brian D; Wolf, Bryan; Lambert, Jeffrey R; Clayton, Carolyn W; Glueck, Deborah H; Jesse, Mary Kristen; Mei-Dan, Omer

    2016-08-01

    Patients with developmental dysplasia of the hip often have compensatory labral hypertrophy, which presumably lends stability to an unstable joint. Conversely, patients with acetabular overcoverage may have small or ossified labra. The purpose of this study is to explore the interaction of labral length with the degree of acetabular hip coverage. A retrospective cohort of patients with hip pain presenting to a hip preservation center, who had undergone hip magnetic resonance imaging and AP pelvis radiographs were studied. General linear multivariate models were used to assess the association between three measures of labral length (lateral, anterior and anterior inferior locations along the acetabular rim) and the X-ray derived lateral center edge angle (LCEA) of Wiberg. Of the three acetabular labral locations measured, only the lateral labrum was associated with LCEA Wiberg (P = 0.0008). Lateral labral length increases as LCEA of Wiberg decreases. The anterior and anterior inferior labral locations did not show a predictable increase in labral length as LCEA Wiberg decreased. PMID:27583157

  20. Initial Results of an Acetabular Center Axis Registration Technique in Navigated Hip Arthroplasty with Deformed Acetabular Rims

    PubMed Central

    Wada, Hiroshi; Mishima, Hajime; Yoshizawa, Tomohiro; Sugaya, Hisashi; Nishino, Tomofumi; Yamazaki, Masashi

    2016-01-01

    Background In cementless total hip arthroplasty, imageless computer-assisted navigation is usually used to register the anterior pelvic plane (APP). The accuracy of this method is influenced by the subcutaneous tissues overlying the registration landmarks. On the other hand, the acetabular center axis (ACA) is determined from the acetabular rim. Precise registration of the ACA is possible because of direct palpation using a pointer. Imageless navigation using the ACA usually targets patients with normal acetabular morphology. The aim of this study was to investigate the accuracy of imageless navigation using the ACA instead of the APP in patients with normal or deformed acetabular rims. Methods The intraoperative cup position was compared with that obtained from the postoperative computed tomography (CT) images in 18 cases. Results The inclination angle derived from the navigation system was 3.4 ± 5.3 degrees smaller and the anteversion angle was 1.4 ± 3.1 degrees larger than those derived from the CT images. Conclusion The inclination cup angle of the navigation system was significantly inferior to the true value, particularly in cases with large anterior osteophytes. PMID:27073586

  1. An In Vitro Comparative Evaluation of Fracture Resistance of Custom Made, Metal, Glass Fiber Reinforced and Carbon Reinforced Posts in Endodontically Treated Teeth

    PubMed Central

    Sonkesriya, Subhash; Olekar, Santosh T; Saravanan, V; Somasunderam, P; Chauhan, Rashmi Singh; Chaurasia, Vishwajit Rampratap

    2015-01-01

    Background: Posts are used to enhance crown buildup in pulpless teeth with destructed crown portion. Different types of post are used in endodontically treated teeth. The aim of the present in vitro study was to evaluate fracture resistance of custom made, metal, glass fiber reinforced and carbon reinforced posts in endodontically treated teeth. Materials and Methods: An in vitro study was carried out on extracted 40 human maxillary central incisor teeth, which was divided into four groups with 10 samples in each group with custom made, metal post, glass fiber reinforced, and carbon reinforced posts. The samples were decoronated at cemento-enamel junction and endodontically treated. Post space was prepared and selected posts were cemented. The composite cores were prepared at the height of 5 mm and samples mounted on acrylic blocks. Later fracture resistance to the compressive force of samples was measured using Universal Testing Machine. Results: The maximum resistance to the compressive force was observed in carbon reinforced and glass fiber reinforced posts compared others which is statistically significant (P > 0.001) and least was seen in custom fabricated post. Conclusion: It is concluded that carbon reinforced fiber post and glass fiber posts showed good fracture resistance compared to custom made and metal posts. PMID:26028904

  2. Redislocation After a Failed Surgery to Treat C6/7 Fracture-Dislocation With Pedicular Fracture of the C6 Vertebra: Case Report of a Successful Revision Surgery, Analysis of the Causes, and Discussion of Revision Surgical Strategies.

    PubMed

    Yang, Yi; Ma, Litai; Li, Tao; Liu, Hao

    2016-03-01

    Cervical spinal fracture-dislocation with pedicular fracture of the vertebra has been little reported and the management of such a patient is difficult. Considering the little knowledge of this area, we present this special case of a successful revision surgery for the treatment of redislocation after a failed surgery to treat C6/7 fracture-dislocation with pedicular fracture of the C6 vertebra to share our experience.A 45-year-old male patient presented to our hospital with history of neck pain for 4 months. According to his medical records, he was involved in an architectural accident and diagnosed with C6/7 fracture-dislocation with pedicular fracture of the C6 vertebra (ASIA: D). A surgery of posterior lateral mass screw fixation (bilateral in C5 and C7; left side in C6) was performed in a different institution. However, 4 months after his primary surgery, he was still troubled by serious neck pain and muscle weakness in all right side limbs. The physical examination of the patient showed hypoesthesia in the right side limbs, myodynamia of the right side limbs weakened to Grade 4. Cervical X-rays, computed tomography (CT), and magnetic resonance imaging confirmed the redislocation of C6/7. A successful revision surgery of anterior cervical corpectomy and fusion (ACCF) with nanohydroxyapatite/polyamide 66 composite fulfilled with vertebral autograft plus anterior plate was performed. The 3 months postoperative X-rays and CT scan showed the good position of the implant and bony fusion. The patient's neck pain was relived and the neurological function recovered to ASIA E grade at the 3rd month follow-up.ACCF with nanohydroxyapatite/polyamide 66 composite fulfilled with vertebral autograft plus anterior plate is effective for the treatment of redislocation after a failed surgery in patients of fracture-dislocation with pedicular fracture. The best method to avoid such a failed surgery is a combined anterior-posterior approach surgery in our opinion. PMID:26962843

  3. The reinforcement effect of polyethylene fibre and composite impregnated glass fibre on fracture resistance of endodontically treated teeth: An in vitro study

    PubMed Central

    Luthria, Archana; Srirekha, A; Hegde, Jayshree; Karale, Rupali; Tyagi, Sanjana; Bhaskaran, Sajeev

    2012-01-01

    Aim: The aim of this study was to evaluate the fracture resistance of endodontically treated maxillary premolars with wide mesio-occluso-distal (MOD) cavities restored with either composite resin, or composite resin reinforced with different types of fibres. Materials and Methods: Fifty human maxillary premolars were selected. Five intact teeth served as positive controls. Endodontic therapy was carried out in the remaining forty-five teeth. Standardized MOD cavities were prepared in all the teeth. The teeth were restored with a nanocomposite using an incremental technique. These forty five teeth were randomly divided into three experimental groups (Group A, B and C) (n = 15). The teeth in Group A did not undergo any further procedures. The teeth in Group B and C were reinforced with composite impregnated glass fibre and polyethylene fibre, respectively. Fracture resistance was measured in Newtons (N). Results: The positive controls showed the highest mean fracture resistance (811.90 N), followed by Group B (600.49N), Group A (516.96N) and Group C (514.64N), respectively. One Way analysis of variance (ANOVA) test revealed a statistically significant difference between all the groups (P = 0.001). Post-hoc Tukey test revealed a moderately significant difference (P = 0.034) between Control and Group B, and a strongly significant difference between Control and Group A (P = 0.002), and Control and Group C (P = 0.001). Conclusions: Endodontic therapy and MOD cavity preparation significantly reduced the fracture resistance of endodontically treated maxillary premolars (P = 0.001). No statistically significant difference was found between the experimental groups (Group A, B and C) (P > 0.1). However, the fracture resistance of the composite impregnated glass fibre reinforced group was much higher than the others. PMID:23112487

  4. Effects of rotational acetabular osteotomy on the mechanical stress within the hip joint in patients with developmental dysplasia of the hip: a subject-specific finite element analysis.

    PubMed

    Ike, H; Inaba, Y; Kobayashi, N; Yukizawa, Y; Hirata, Y; Tomioka, M; Saito, T

    2015-04-01

    In this study we used subject-specific finite element analysis to investigate the mechanical effects of rotational acetabular osteotomy (RAO) on the hip joint and analysed the correlation between various radiological measurements and mechanical stress in the hip joint. We evaluated 13 hips in 12 patients (two men and ten women, mean age at surgery 32.0 years; 19 to 46) with developmental dysplasia of the hip (DDH) who were treated by RAO. Subject-specific finite element models were constructed from CT data. The centre-edge (CE) angle, acetabular head index (AHI), acetabular angle and acetabular roof angle (ARA) were measured on anteroposterior pelvic radiographs taken before and after RAO. The relationship between equivalent stress in the hip joint and radiological measurements was analysed. The equivalent stress in the acetabulum decreased from 4.1 MPa (2.7 to 6.5) pre-operatively to 2.8 MPa (1.8 to 3.6) post-operatively (p < 0.01). There was a moderate correlation between equivalent stress in the acetabulum and the radiological measurements: CE angle (R = -0.645, p < 0.01); AHI (R = -0.603, p < 0.01); acetabular angle (R = 0.484, p = 0.02); and ARA (R = 0.572, p < 0.01). The equivalent stress in the acetabulum of patients with DDH decreased after RAO. Correction of the CE angle, AHI and ARA was considered to be important in reducing the mechanical stress in the hip joint. PMID:25820887

  5. Effects of rotational acetabular osteotomy on the mechanical stress within the hip joint in patients with developmental dysplasia of the hip: a subject-specific finite element analysis.

    PubMed

    Ike, H; Inaba, Y; Kobayashi, N; Yukizawa, Y; Hirata, Y; Tomioka, M; Saito, T

    2015-04-01

    In this study we used subject-specific finite element analysis to investigate the mechanical effects of rotational acetabular osteotomy (RAO) on the hip joint and analysed the correlation between various radiological measurements and mechanical stress in the hip joint. We evaluated 13 hips in 12 patients (two men and ten women, mean age at surgery 32.0 years; 19 to 46) with developmental dysplasia of the hip (DDH) who were treated by RAO. Subject-specific finite element models were constructed from CT data. The centre-edge (CE) angle, acetabular head index (AHI), acetabular angle and acetabular roof angle (ARA) were measured on anteroposterior pelvic radiographs taken before and after RAO. The relationship between equivalent stress in the hip joint and radiological measurements was analysed. The equivalent stress in the acetabulum decreased from 4.1 MPa (2.7 to 6.5) pre-operatively to 2.8 MPa (1.8 to 3.6) post-operatively (p < 0.01). There was a moderate correlation between equivalent stress in the acetabulum and the radiological measurements: CE angle (R = -0.645, p < 0.01); AHI (R = -0.603, p < 0.01); acetabular angle (R = 0.484, p = 0.02); and ARA (R = 0.572, p < 0.01). The equivalent stress in the acetabulum of patients with DDH decreased after RAO. Correction of the CE angle, AHI and ARA was considered to be important in reducing the mechanical stress in the hip joint.

  6. Effect of different ferrule designs on the fracture resistance and failure pattern of endodontically treated teeth restored with fiber posts and allceramic crowns

    PubMed Central

    SHERFUDHIN, Haneef; HOBEICH, Joseph; CARVALHO, Carlos Augusto; N. ABOUSHELIB, Moustafa; SADIG, Walid; SALAMEH, Ziad

    2011-01-01

    Objective This study investigated the effect of different ferrule heights on endodontically treated premolars. Materials and Methods Fifty sound mandibular first premolars were endodontically treated and then restored with 7-mm fiber post (FRC Postec Plus #1 Ivoclar-Vivadent) luted with self-polymerized resin cement (Multilink, Ivoclar Vivadent) while the coronal section was restored with hybrid composite core build-up material (Tetric Ceram, Ivoclar-Vivadent), which received all-ceramic crown. Different ferrule heights were investigated: 1-mm circumferential ferrule without post and core (group 1 used as control), a circumferential 1-mm ferrule (group 2), non-uniform ferrule 2-mm buccally and 1-mm lingually (group 3), non-uniform ferrule 3-mm buccally and 2-mm lingually (group 4), and finally no ferrule preparation (group 5). The fracture load and failure pattern of the tested groups were investigated by applying axial load to the ceramic crowns (n=10). Data were analyzed statistically by one-way ANOVA and Tukey’s post-hoc test was used for pair-wise comparisons (α=0.05). Results There were no significant differences among the failure load of all tested groups (P<0.780). The control group had the lowest fracture resistance (891.43±202.22 N) and the highest catastrophic failure rate (P<0.05). Compared to the control group, the use of fiber post reduced the percentage of catastrophic failure while increasing the ferrule height did not influence the fracture resistance of the restored specimens. Conclusions Within the limitations of this study, increasing the ferrule length did not influence the fracture resistance of endodontically treated teeth restored with glass ceramic crowns. Insertion of a fiber post could reduce the percentage of catastrophic failure of these restorations under function. PMID:21437466

  7. Debonding of porous coating of a threaded acetabular component: retrieval analysis.

    PubMed

    Łapaj, Łukasz; Markuszewski, Jacek; Rybak, Tomasz; Wierusz-Kozłowska, Małgorzata

    2013-01-01

    This report presents a case of debonding of plasma sprayed porous titanium coating from a threaded acetabular component which caused aseptic loosening of the implant. Weight bearing after delamination caused abrasive damage of the acetabular shell, and particles of the coating embedded in the acetabular liner. Microscopic examination of periprosthetic tissues showed presence of metal particles and macrophage infiltration. Despite microscopic examination of the retrieved component the cause of debonding remains unclear. PMID:23127634

  8. Comparative Evaluation of Fracture Resistance of Endodontically Treated Teeth Obturated with Resin Based Adhesive Sealers with Conventional Obturation Technique: An In vitro Study

    PubMed Central

    Langalia, Akshay K; Dave, Bela; Patel, Neeta; Thakkar, Viral; Sheth, Sona; Parekh, Vaishali

    2015-01-01

    Background: To compare fracture resistance of endodontically treated teeth obturated with different resin-based adhesive sealers with a conventional obturation technique. Materials and Methods: A total of 60 Single canaled teeth were divided into five groups. The first group was taken as a negative control. The rest of the groups were shaped using ProFile rotary files (Dentsply Maillefer, Ballaigues, Switzerland). The second group was obturated with gutta-percha and a ZOE-based sealer Endoflas FS (Sanlor Dental Products, USA). The third group was obturated with gutta-percha and an epoxy-based sealer AH Plus (Dentsply, DeTrey, Germany). The fourth group was obturated with Resilon (Pentron Clinical Technologies, Wallingford, CT) and RealSeal sealer (Pentron Clinical Technologies). The fifth group was obturated with EndoREZ points and EndoREZ sealer (both from Ultradent, South Jordan, UT). Roots were then embedded into acrylic blocks and were then fixed into a material testing system and loaded with a stainless steel pin with a crosshead speed of 5 mm/min until fracture. The load at which the specimen fractured was recorded in Newtons. Results: It was found that forces at fracture were statistically significant for the newer resin systems, Resilon, and EndoREZ. Conclusion: It was concluded that roots obturated with newer resin systems (Resilon and EndoREZ) enhanced the root strength almost up to the level of the intact roots. PMID:25859099

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

    PubMed

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

    2012-01-01

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

  10. Difference in the acetabular cup orientation in standing and supine radiographs.

    PubMed

    Khan, Munir; Beckingsale, Tom; Marsh, Martin; Holland, Jim

    2016-09-01

    Acetabular orientation changes with that of the pelvis during lying and standing. This study was designed to measure these changes. We assessed 17 BHR replacements using EBRA software. The mean acetabular anteversion was more (p = 0.02) on erect than supine radiographs. Linear regression analysis showed that anteversion and inclination increased in some while decreased in others, and Bland and Altman analysis showed wide limits of agreement. The changes in acetabular orientation are thus subject to significant variations between the patients. We suggest studying the factors affecting acetabular orientation in standing to help reduce joint reaction forces and improve outcomes. PMID:27408490

  11. The effect of incomplete crown ferrules on fracture resistance and failure modes of endodontically treated maxillary incisors restored with quartz fiber post, composite core, and crowns

    PubMed Central

    Muangamphan, Panorjit; Sattapan, Boonrat; Kukiattrakoon, Boonlert; Thammasitboon, Kewalin

    2015-01-01

    Aim: To investigate the fracture resistance of restored endodontically treated teeth (RETT) with fiber posts, cores, and crowns with limited ferrules. Materials and Methods: Sixty maxillary anterior teeth were endodontically treated and decoronated 2 mm above the cemento-enamel junction, and then divided into 6 groups of 10 teeth each; Group circumferential ferrule (2FR), Group ferrule in the labial, mesial, and palatal region (2FR-LaMPa), Group ferrule in the labial, and palatal region (2FR-LaPa), Group 2FR-Pa and 2FR-La respectively, and Group 0FR (no ferrule). All 60 prepared teeth were then restored with quartz fiber posts, resin composite cores, and metal crowns. The specimens were subjected to load until failure occurred. Data were analyzed using one-way analysis of variance and Tukey's tests (α = 0.05). The mode of failure was determined under a stereoscope. Results: A statistical significant difference was found among groups 2FR-LaMPa, 2FR-Pa, 2FR-LaPa, and 2FR from the group 2FR-La, and from the group 0FR (P < 0.01). The predominant mode of failure was an oblique palatal to labial root fracture for the groups with remaining ferrules. Conclusion: For RETT that have incomplete crown ferrules, the location of the ferrules may affect their fracture resistance. PMID:26069401

  12. Acetabular Paralabral Cyst: An Unusual Cause of Femoral Vein Compression

    PubMed Central

    Kullar, Raj S.; Kapron, Ashley L.; Ihnat, Daniel; Aoki, Stephen K.; Maak, Travis G.

    2015-01-01

    Acetabular labral tears are a known cause of hip pain in the young, active patient. Labral tears can be due to trauma, femoroacetabular impingement, capsular laxity, dysplasia, and degenerative pathology. Paralabral cysts are relatively common in association with labral tears of the hip, with cysts seen on magnetic resonance imaging studies in as many as 50% to 70% of patients with labral tears. In some cases the cysts can become sizeable and cause neurovascular compression. Nonoperative interventions for the management of paralabral cysts in the shoulder and knee have shown high recurrence rates. In the shoulder and knee, arthroscopic debridement of paralabral cysts has shown good results with lower recurrence rates and resolution of neurovascular function. In the hip there is limited literature regarding surgical management of paralabral cysts. We present a surgical technique for arthroscopic decompression of acetabular paralabral cysts combined with labral repair. PMID:25973371

  13. Fracture Resistance of Endodontically-treated Maxillary Premolars Restored with Composite Resin along with Glass Fiber Insertion in Different Positions

    PubMed Central

    Jafari Navimipour, Elmira; Ebrahimi Chaharom, Mohammad Esmaeel; Alizadeh Oskoee, Parnian; Mohammadi, Narmin; Bahari, Mahmoud; Firouzmandi, Maryam

    2012-01-01

    Background and aims The aim was to evaluate the effect of three methods of fiber insertion on fracture resistance of root-filled maxillary premolars in vitro. Materials and methods Sixty extracted human maxillary premolars received endodontic treatment followed by preparation of mesioocclusodistal (MOD) cavities, with gingival cavosurface margin 1.5 mm coronal to the cementoenamel junction (CEJ). Subsequently, the samples were randomly divided into four groups: no-fiber group; occlusal fiber group (fiber was placed in the occlusal third); circumferential fiber group (fiber was placed circumferentially in the cervical third); and dual-fiber group (occlusal and circumferential fibers). Subsequent to restoring with composite resin and thermocycling, a compressive force was applied until fracture. Data was analyzed using one-way ANOVA and Tukey test at significance levels of P < 0.05 and P < 0.02, respectively. Results Fiber placement significantly increased fracture resistance. Fracture resistance in the dual-fiber group was significantly higher than that in the circumferential fiber group (P < 0.007); however, there were no significant differences between the dual-fiber and occlusal fiber groups (P = 0.706). The highest favorable fracture rate was observed in the circumferential fiber group (60%). Conclusion Composite resin restoration along with glass fiber in the occlusal and gingival thirds can be an acceptable treatment option for restoring root-filled upper premolars. PMID:23277858

  14. Association of oestrogen receptor gene polymorphism with the long-term results of rotational acetabular osteotomy.

    PubMed

    Yamanaka, Makoto; Ishijima, Muneaki; Tokita, Akifumi; Sakamoto, Yuko; Kaneko, Haruka; Maezawa, Katsuhiko; Nozawa, Masahiko; Kurosawa, Hisashi

    2009-08-01

    Acetabular dysplasia (AD) contributes to the development of osteoarthritis of the hip. A rotational acetabular osteotomy (RAO) is one of the methods of pelvic osteotomy to prevent or treat secondary osteoarthritis of the hip. Although most of the patients that undergo RAO show satisfactory results, some have poor results. This study investigated whether gene polymorphisms of both the vitamin D receptor (VDR) and oestrogen receptor (ER) are involved in both AD and the postoperative results following RAOs. Sixty-four Japanese patients with AD who were treated by an RAO were enrolled in this study (59 women and 5 men, aged 13-59, with an average age of 40.3). Gene polymorphisms of the VDR [ApaI and TaqI restriction fragment length polymorphisms (RFLPs)] and ER (PvuII and XbaI RFLPs) were determined in these patients. The relationship between both the AD and radiographic postoperative changes of the hip joint after an RAO with these gene polymorphisms were examined. The frequencies of ER gene polymorphism coded as pp (RFLP/PvuII) in patients with AD were statistically significantly different (p = .011) from those coded as both PP and Pp. The joint space width narrowed even after RAO in 90% of the patients with the pp gene polymorphism, while it narrowed in only 35% of the patients with either PP or Pp seven years or longer after an RAO. The PvuII polymorphism in the ER gene was associated with the postoperative result of an RAO, while no association was observed between the AD with VDR and ER gene polymorphisms.

  15. Preventive effect of risedronate on bone loss and frailty fractures in elderly women treated with anastrozole for early breast cancer.

    PubMed

    Sergi, Giuseppe; Pintore, Giulia; Falci, Cristina; Veronese, Nicola; Berton, Linda; Perissinotto, Egle; Basso, Umberto; Brunello, Antonella; Monfardini, Silvio; Manzato, Enzo; Coin, Alessandra

    2012-07-01

    The aim of this study was to assess the effect of adjuvant anastrozole, alone or associated with risedronate, on BMD and bone fracture risk in women more than 70 years old with hormone receptor-positive early breast cancer (EBC). In a group of 51 elderly women (aged 76.4 ± 5.0 years) considered for adjuvant aromatase inhibitors for EBC, 24 patients with T-scores ≥ -2 and no prevalent fractures received anastrozole 1 mg/day (group A), and 27 patients with T-scores < -2, or with T-scores ≥ -2 and prevalent fractures (group B), received anastrozole (1 mg/day) plus risedronate (35 mg/week). Both groups received supplementation with 1 g calcium carbonate and 800 IU vitamin D per day. Differences in BMD and frailty fractures were evaluated after 1 and 2 years. In group A, significant decreases in BMD were observed in the lumbar spine (Δ BMD, -0.030 ± 0.04 g/cm², P < 0.05), femoral neck (Δ BMD, -0.029 ± 0.05 g/cm², P < 0.05), and trochanter (Δ BMD, -0.026 ± 0.03 g/cm², P < 0.01) after 2 years. The greatest percent reduction in height (Hpr) emerged in the thoracic spine (3.6 ± 2.4%, P < 0.01), although only one incident vertebral fracture was observed. In group B, BMD increased in the lumbar spine (Δ BMD, 0.038 ± 0.04, P < 0.001), although no significant changes were seen in the hip regions. The decline in Hpr was negligible (about 1%). No incident fractures were observed at follow-up. In conclusion, anastrozole treatment for EBC in elderly women seems to have only mild negative effects on the femoral bone. Risedronate makes the use of anastrozole safer, even for osteopenic or osteoporotic elderly patients.

  16. Outcome of intertrochanteric fractures treated by intramedullary nail with two integrated lag screws: A study in Asian population

    PubMed Central

    Kim, Jong-Won; Kim, Tae-Young; Ha, Yong-Chan; Lee, Young-Kyun; Koo, Kyung-Hoi

    2015-01-01

    Background: The incidence of intertrochanteric fracture has increased during recent years as life expectancy has also increased. Currently, orthopedic surgeons use various fixation methods for intertrochanteric fractures like, intramedullary (IM) nailing or dynamic hip screws and plates. The intramedullary (IM) nail with two integrated lag screws has been used recently in intertrochanteric fractures to overcome Z-affect phenomenon. However, no study is available in an Asian population. This prospective study was undertaken to document the clinical and radiologic outcomes of the IM nail with two integrated lag screws and its limitations in Asian patients. Materials and Methods: Osteosynthesis was performed using InterTAN nail in 100 patients with an intertrochanteric fractures followed up for at least 1 year after surgery. We evaluated the recovery rates to prefracture status, time to bony union and the incidence of complications. Results: Seventy four patients were available for at least 1 year followup examinations. Forty-five patients (60.8%) recovered prefracture status. Mean time to bony union was 18.3 ± 8.6 weeks. Intraoperative technical problems related to an unavoidable superior positioning of the lag screw occurred in five cases. Postoperative complications requiring reoperation occurred in three patients; two cases of varus collapse with cut out and one case of periprosthetic fracture. Conclusions: The IM nail with two integrated lag screws showed favorable outcomes in Asian patients with an intertrochanteric fracture even though several complications that were not previously reported with this nail were found. The proper selection of patients and careful insertion of two lag screws should be mandatory in Asian patients. PMID:26229165

  17. Use of resin-bonded partial coverage ceramic restorations to treat incomplete fractures in posterior teeth: a clinical report.

    PubMed

    Liebenberg, W H

    1996-11-01

    The objective of restorative treatment of teeth with incomplete fractures is to minimize flexure of the compromised cusps to prevent propagation of the crack. These goals can be addressed with resin-bonded posterior ceramic restorations, but long-term integrity rests on the efficiency of the restoration's bond to the dental hard tissues. Success is dependent on diligent operative performance throughout the entire procedure. Some tips for achieving successful preparation, provisionalization, and partial-coverage restoration of the incompletely fractured posterior tooth are discussed.

  18. A Case of Nasu-Hakola Disease without Fractures or Consanguinity Diagnosed Using Exome Sequencing and Treated with Sodium Valproate

    PubMed Central

    Yamazaki, Kiyohiro; Yoshino, Yuta; Mori, Yoko; Ochi, Shinichiro; Yoshida, Taku; Ishimaru, Takashi; Ueno, Shu-ichi

    2015-01-01

    Nasu-Hakola disease (NHD) is a rare autosomal recessive neuropsychiatric disorder characterized by bone cysts, fractures, and cognitive impairment. Two genes are responsible for the development of NHD; TYROBP and TREM2. Although it presents with typical signs and symptoms, diagnosing this disease remains difficult. This case report describes a male with NHD with no family or past history of bone fractures who was diagnosed using exome sequencing. His frontal lobe psychiatric symptoms recovered partially following treatment with sodium valproate, but not with an antipsychotic. PMID:26598595

  19. Fracture resistance of endodontically treated maxillary premolars restored by silorane-based composite with or without fiber or nano-ionomer

    PubMed Central

    Shafiei, Fereshteh; Ghahramani, Yasamin; Fattah, Zahra

    2014-01-01

    PURPOSE This in vitro study investigated the fracture resistance of endodontically treated premolars restored using silorane- or methacrylate-based composite along with or without fiber or nano-ionomer base. MATERIALS AND METHODS Ninety-six intact maxillary premolars were randomly divided into eight groups (n = 12). G1 (negative control) was the intact teeth. In Groups 2-8, root canal treatment with mesio-occlusodistal preparation was performed. G2 (positive control) was kept unrestored. The other groups were restored using composite resin as follows: G3, methacrylate-based composite (Z250); G4, methacrylate composite (Z250) with polyethylene fiber; G5 and G6, silorane-based composite (Filtek P90) without and with the fiber, respectively; G7 and G8, methacrylate- and silorane-based composite with nano-ionomer base, respectively. After aging period and thermocycling for 1000 cycles, fracture strength was tested and fracture patterns were inspected. The results were analyzed using ANOVA and Tukey HSD tests (α=0.05). RESULTS Mean fracture resistance for the eight groups (in Newton) were G1: 1200 ± 169a, G2: 360 ± 93b, G3: 632 ± 196c, G4: 692 ± 195c, G5: 917 ± 159d, G6: 1013 ± 125ad, G7: 959 ± 148d, G8: 947 ± 105d (different superscript letters revealed significant difference among groups). Most of the fractures in all the groups were restorable, except Group 3. CONCLUSION Silorane-based composite revealed significantly higher strength of the restored premolars compared to that of methacrylate one. Fiber insertion demonstrated no additional effect on the strength of both composite restorations; however, it increased the prevalence of restorable fracture of methacrylate-based composite restored teeth. Using nano-ionomer base under methacrylate-based composite had a positive effect on fracture resistance and pattern. Only fiber-reinforced silorane composite restoration resulted in a strength similar to that of the intact teeth. PMID:25006384

  20. Nose fracture

    MedlinePlus

    Fracture of the nose; Broken nose; Nasal fracture; Nasal bone fracture; Nasal septal fracture ... A fractured nose is the most common fracture of the face. It ... with other fractures of the face. Sometimes a blunt injury can ...

  1. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hip joint (hemi-hip) acetabular metal cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip)...

  2. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint (hemi-hip) acetabular metal cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip)...

  3. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint (hemi-hip) acetabular metal cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip)...

  4. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint (hemi-hip) acetabular metal cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip)...

  5. 21 CFR 888.3370 - Hip joint (hemi-hip) acetabular metal cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint (hemi-hip) acetabular metal cemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3370 Hip joint (hemi-hip) acetabular metal cemented prosthesis. (a) Identification. A hip joint (hemi-hip)...

  6. Evaluation of fracture resistance of endodontically treated maxillary premolars, restored with ceromer or heat-pressed ceramic inlays and fixed with dual-resin cements.

    PubMed

    Ortega, V L; Pegoraro, L F; Conti, P C R; do Valle, A L; Bonfante, G

    2004-04-01

    The aim of this study was to evaluate the fracture resistance of endodontically maxillary premolars restored with mesio-occlusal-distal (MOD) inlays made with ceramic (IPS-Empress 2) and ceromer (Targis) and luted with three different dual-cured resin cements (Enforce, Variolink II, Panavia F). Sixty maxillary premolars were randomly distributed into six groups, according to their mesio-distal and facio-lingual dimensions. The teeth were endodontically treated and MOD cavities prepared. After the restorations were cemented, the samples were thermocycled and submitted to an axial compressive load by the action of a rounded end steel cylinder contacting the incline planes of occlusal surfaces of the teeth. The mode of fracture was analysed with a microscope. The best results were found with the combinations (cement/restorative material) Enforce/Targis (107.57 kgf) and Enforce/Empress (90.21 kgf) followed by Variolink II/Targis (86.44 kgf)-Variolink II/Empress (84.07 kgf) and Panavia F/Targis (82.43 kgf)-Panavia F/Empress (76.73 kgf). Analysis of variance (P < 0.05) showed a significant difference between Enforce and Panavia cements regardless of the restorative material. Considering the same luting agent there was no statistically significant difference between the restorative materials. Fracture of lingual cusps occurred in 55 of the 60 teeth and most of them were of the cohesive type.

  7. The curative effect comparison between prolonged third generation of gamma nail and prolonged dynamic hip screw internal fixation in treating femoral intertrochanteric fracture and the effect on infection.

    PubMed

    He, Wenye; Zhang, Wei

    2015-03-01

    The objective was to explore the curative effect of prolonged third generation of gamma nail (pTGN) and prolonged dynamic hip screw (pDHS) internal fixation in treating femoral intertrochanteric fracture, and analyze the incidence rate of infection for better clinical diagnosis and treatment. Sixty five patients with femoral intertrochanteric fracture during February, 2011-February, 2013 were selected and divided into two groups, with one receiving pTGN (control group) and the other one receiving pDHS internal fixation (observation group). The clinical effects of two groups were compared. In control group, the excellent and good rate was 78.13 %, the total effective rate was 87.5 %, and the total complication rate was 6.24 %; in observation group, the excellent and good rate was 78.79 %, the total effective rate was 90.91 %, the total complication rate was 6.06 %; there was no statistical difference between two groups (p > 0.05). The operation time, the intraoperative fluoroscopy time, and the total blood loss had statistically significant difference between two groups (p < 0.05); however, the differences of the total length of incision, the length of preoperative hospitalization, postoperative ambulatory episode, and the length of stay between two groups were not statistically significant (p > 0.05). Both pTGN and pDHS internal fixation were effective on femoral intertrochanteric fracture, with pDHS internal fixation having better overall efficiency.

  8. Anterior Reduction, Discectomy, and Three Cortical Iliac Bone Grafting With Instrumentation to Treat A Huge Tear Drop Fracture of the Axis: A Case Report and Literature Review.

    PubMed

    Ma, Litai; Yang, Yi; Gong, Quan; Ding, Chen; Liu, Hao; Hong, Ying

    2016-04-01

    Fractures of the axis body have been little reported and treatment strategies remain controversial and individualized. Not more than 10 cases of huge tear drop fracture of the axis (HTDFA) have been reported in previous studies and the treatment method varies from conservative treatment to an anterior, or posterior, approach surgery. Considering the sparse knowledge of HTDFA, we present a special case report to share our experience and to explore the safety and effectiveness of anterior reduction and fusion to treat HTDFA. A 24-year-old man was referred to our department; he presented with neck pain lasting for 12 h since being involved in a roll-over motor vehicle accident. His neck movement was limited but there was no neurological compromise. Physical examination of the patient showed myodynamia of four limbs Grade 5, Hoffmann sign (-), and Babinski sign (-). Three-dimensional reconstruction computed tomography (CT) confirmed a huge tear drop fracture of the anterior-inferior corner of the axis and discontinuity of the cortex of the axis. After discussion with the spinal surgeon team in the department and an effective conversation with the patient, surgery involving anterior reduction, discectomy, and three cortical iliac bone grafts with instrumentation after transnasal induction of general anesthesia was performed. The patient was instructed to wear a cervical collar until he returned to our department for a follow-up examination some 3 months after surgery. The 3-month postoperative x-ray and CT scan showed a good position of the implant and bony fusion at the C2/3 segment. Anterior reduction, discectomy, and three cortical iliac bone grafts with instrumentation to treat HTDFA are effective, safe, and simple. Of course, longer follow-up duration and more cases are warranted to verify this procedure. Anterior reduction, discectomy, and bone grafting with instrumentation are warranted for most HTDFA cases. However, if HTDFA incorporates other complex

  9. Anterior Reduction, Discectomy, and Three Cortical Iliac Bone Grafting With Instrumentation to Treat A Huge Tear Drop Fracture of the Axis

    PubMed Central

    Ma, Litai; Yang, Yi; Gong, Quan; Ding, Chen; Liu, Hao; Hong, Ying

    2016-01-01

    Abstract Fractures of the axis body have been little reported and treatment strategies remain controversial and individualized. Not more than 10 cases of huge tear drop fracture of the axis (HTDFA) have been reported in previous studies and the treatment method varies from conservative treatment to an anterior, or posterior, approach surgery. Considering the sparse knowledge of HTDFA, we present a special case report to share our experience and to explore the safety and effectiveness of anterior reduction and fusion to treat HTDFA. A 24-year-old man was referred to our department; he presented with neck pain lasting for 12 h since being involved in a roll-over motor vehicle accident. His neck movement was limited but there was no neurological compromise. Physical examination of the patient showed myodynamia of four limbs Grade 5, Hoffmann sign (–), and Babinski sign (–). Three-dimensional reconstruction computed tomography (CT) confirmed a huge tear drop fracture of the anterior–inferior corner of the axis and discontinuity of the cortex of the axis. After discussion with the spinal surgeon team in the department and an effective conversation with the patient, surgery involving anterior reduction, discectomy, and three cortical iliac bone grafts with instrumentation after transnasal induction of general anesthesia was performed. The patient was instructed to wear a cervical collar until he returned to our department for a follow-up examination some 3 months after surgery. The 3-month postoperative x-ray and CT scan showed a good position of the implant and bony fusion at the C2/3 segment. Anterior reduction, discectomy, and three cortical iliac bone grafts with instrumentation to treat HTDFA are effective, safe, and simple. Of course, longer follow-up duration and more cases are warranted to verify this procedure. Anterior reduction, discectomy, and bone grafting with instrumentation are warranted for most HTDFA cases. However, if HTDFA incorporates other

  10. A comparative study of trochanteric and basicervical fractures of the femur treated with the Ender and McLaughlin techniques.

    PubMed

    Indemini, E; Clerico, P; Fenoglio, E; Mariotti, U

    1982-09-01

    Endomedullary nailing as proposed by Ender is an important alternative in the treatment of trochanteric and basicervical fractures of the femur (Amici et al., 1980; Carret et al., 1980; Ender, 1970; Kempf et al., 1979; Zinghi et al., 1979). Rush's concept (Eiffel Tower, for the distal epiphysis) is reproposed with some variations and transposed to the femoral neck. The aim of the operation differs from that of the nail and plate technique in that, instead of trying to achieve anatomical reconstruction, an immediate functional by-pass of the fractured part is attempted. After using this technique for three years, we compared the old method, which we had not abandoned, the McLaughlin nail and plate, with the new Ender nail.

  11. Improving acetabular cup orientation in total hip arthroplasty by using smartphone technology.

    PubMed

    Peters, Frank M; Greeff, Richard; Goldstein, Neal; Frey, Chris T

    2012-08-01

    Acetabular cup placement in total hip arthroplasty is often difficult to assess, especially in the lateral position and using the posterior approach. Conventional techniques and computer-assisted surgery are the 2 most popular methods for proper placement of the acetabular cup in Lewinnek's safe zone of orientation (anteversion 15° ± 10° and lateral inclination 40° ± 10°). We developed a system that uses the accelerometer and camera function of the iPhone. A level indicator application and protractor application were downloaded to the iPhone and used to improve acetabular cup placement. This system has proven to be accurate and quick. Our series of 50 prospective cases showed good results with all our acetabular cups being placed within a narrow range in the safe zone and with less than 5% difference between the preoperative, intraoperative, and postoperative acetabular inclinations. PMID:22245126

  12. Minimally invasive surgery under fluoro-navigation for anterior pelvic ring fractures

    PubMed Central

    Zhou, Kai-Hua; Luo, Cong-Feng; Chen, Nong; Hu, Cheng-Fang; Pan, Fu-Gen

    2016-01-01

    Background: The incidence of pelvic fractures in trauma patients is reported to be 3–8.2%, with roughly half of these fractures being caused by high energy injuries with a potential for catastrophic hemorrhage and death. Indications for internal fixation of anterior pelvic ring are controversial. Because of fears of disturbing the pelvic hematoma and causing additional hemorrhage, open reduction and internal fixation of pelvic ring disruption is routinely delayed. In contrast to conventional surgery, percutaneous screw fixation is gaining popularity in the treatment of pelvic and acetabular fractures mainly because of minimal soft tissue damage, less operative blood loss, early surgical intervention and comfortable mobilization of the patient. Fluoro-navigation is a new surgical technique in orthopedic trauma surgery. This study is to investigate clinical results of fluoro-navigation surgery in anterior pelvic ring fractures. Materials and Methods: From January 2006 to October 2011, 23 patients with anterior pelvic ring fractures were treated with percutaneous cannulated screw under fluoro-navigation. There were 14 men and 9 women, with a mean age of 40.1 years (range 25–55). According to the AO and Orthopedic Trauma Association classification, there were seven A 2.1, two A 2.2, one A 2.3, six B 1.2, one B 2.1: 1, one B 2.2, one C 1.2, two C 1.3 and two C 2.3 types of fractures. Amongst these patients, 13 had posterior pelvic ring injuries, 8 had other injuries including urethral, lumbar vertebrae fractures and femoral fractures. All patients were operated when their general condition stabilized after emergency management. The mean time from injury to percutaneous screw fixation of the anterior pelvic ring fracture was 12 days (3–15 days). All the anterior ring fractures were fixed with cannulated screws by two senior surgeons. They were familiar with the navigation system and had gained much experience in the computer-assisted percutaneous placement of

  13. Outcomes of polyethylene liner cementation into a fixed metal acetabular shell with minimum follow-up of 7 years.

    PubMed

    Park, Myung-Sik; Yoon, Sun-Jung; Lee, Ju Rang

    2015-01-01

    Cementation of a polyethylene liner into the well-fixed shell is a convenient option for revision total hip arthroplasty. We retrospectively reviewed 45 patients who had liner cementation to investigate the risk factors which gave rise to major complications and reoperation. Patients were observed for a minimum of 7 years (range 7.8-14 years). Relevant risk factors (age, BMI, surgical approach, previous cup size and position, types of coated surface) were assessed with Cox regression analysis. The mean Harris Hip Score was improved from 62.5 (range 57-68) preoperatively to 87.1 (range 70-97). A total of 7 hips (15.5%) had acetabular component loosening that was treated with reoperation. Prevalence of acetabular component loosening was statistically significantly higher in hydroxyapatite-coated group (5 of 13) than in the Ti-coated group (2 of 32, p = 0.015). All recurrent dislocations occurred in patients treated with a posterior approach. Diameter of the previous metal shell of below 54 mm showed a lower 10-year survival rate than those greater than 54 mm in diameter. PE liner cementation in stable metal cup is a useful alternative option for carefully selected patients. Pre-existing HA-coated cups as well as small sized cups were indicative of poor outcomes.

  14. Risk Factors for the Failure of Spinal Burst Fractures Treated Conservatively According to the Thoracolumbar Injury Classification and Severity Score (TLICS): A Retrospective Cohort Trial

    PubMed Central

    Shen, Jieliang; Xu, Linfei; Zhang, Baolong; Hu, Zhenming

    2015-01-01

    Background The management of thoracolumbar (TL) burst fractures is still controversial. The thoracolumbar injury classification and severity score (TLICS) algorithm is now widely used to guide clinical decision making, however, in clinical practice, we come to realize that TLICS also has its limitations for treating patients with total scores less than 4, for which conservative treatment may not be optimal in all cases. Purpose The aim of this study is to identify several risk factors for the failure of conservative treatment of TL burst fractures according to TLICS algorithm. Methods From June 2008 to December 2013, a cohort of 129 patients with T10-l2 TL burst fractures with a TLISC score ≤3 treated non-operatively were identified and included into this retrospective study. Age, sex, pain intensity, interpedicular distance (IPD), canal compromise, loss of vertebral body height and kyphotic angle (KA) were selected as potential risk factors and compared between the non-operative success group and the non-operative failure group. Results One hundred and four patients successfully completed non-operative treatment, the other 25 patients were converted to surgical treatment because of persistent local back pain or progressive neurological deficits during follow-up. Our results showed that age, visual analogue scale (VAS) score and IPD, KA were significantly different between the two groups. Furthermore, regression analysis indicated that VAS score and IPD could be considered as significant predictors for the failure of conservative treatment. Conclusion The recommendation of non-operative treatment for TLICS score ≤3 has limitations in some patients, and VAS score and IPD could be considered as risk factors for the failure of conservative treatment. Thus, conservative treatment should be decided with caution in patients with greater VAS scores or IPD. If non-operative management is decided, a close follow-up is necessary. PMID:26284373

  15. Comparison of cone beam CT scans with enhanced photostimulated phosphor plate images in the detection of root fracture of endodontically treated teeth

    PubMed Central

    Bechara, B; McMahan, C A; Noujeim, M; Faddoul, T; Moore, W S; Teixeira, F B; Geha, H

    2013-01-01

    Objectives: Two-dimensional intraoral radiography is the most common tool for diagnosing root fractures (RFs). Cone beam CT (CBCT) is widely used to depict RFs in endodontically treated teeth. Beam hardening and other artefacts caused by gutta percha may result in an incorrect diagnosis when using CBCT only. A comparison of two CBCT machines with photostimulated phosphor (PSP) plate images enhanced with the equalization tool was carried out to detect RFs in endodontically treated teeth. Methods: 66 roots were collected, decoronated and treated endodontically using the same technique with gutta percha. 33 of these roots were randomly selected and fractured; the 2 root fragments were glued together with 1 layer of methyl methacrylate and placed randomly in 8 prepared beef rib fragments. Large fields of view (FOVs) were acquired with one CBCT unit and small FOVs with the second CBCT unit. Periapical radiographs (using intraoral PSP plates) were also acquired. A contrast enhancement tool was used when evaluating the PSP plate images. Results: Small FOV images had significantly higher accuracy (area under the receiver operating characteristic curve) and sensitivity in detecting RFs than PSP plates and large FOV images. The specificity of the enhanced PSP images was higher than, although not significantly higher than, the small FOV images and was significantly higher than the large FOV images. Conclusions: CBCT small FOVs should be acquired for depicting RFs of endodontically treated teeth. Images obtained using PSP plates had the lowest rate of false-positive results and their use can save the patient a radiation dose. PMID:23625067

  16. Changes in the radiological measurements of the tibiofibular syndesmal area in patients with Weber C ankle fractures who were treated with open reduction, internal fixation, and transyndesmal screw.

    PubMed

    Jasqui-Remba, S; Torres-Gómez, A; Salas-Morales, G A; Hernández-Martínez, A

    2015-01-01

    The tibiofibular syndesmosis provides stability to the ankle mortise. The ankle syndesmosis is compromised in all Weber C type injuries. The radiographic method described by Merle DAubigné considers the bony relationships as a measure of syndesmotic widening. We sought to investigate whether the patients with a C type ankle fracture treated with ORIF and placement of a transyndesmal screw have an increment of the tibiofibular space and decrease of the tibiofibular overlap after the transyndesmal screw is removed. Our sample included 52 patients with Weber C ankle fractures treated by ORIF and transyndesmal screw at a level II trauma center. We measured the tibiofibular clear space and tibiofibular overlap in each phase of the treatment. The transyndesmal screw was removed at day 55.56 (± 21.83). We found an increase of the tibiofibular overlap of 0.20 mm (± 2.29, p = 0.532); and 0.21 mm (± 0.97, p = 0.146) in the tibiofibular clear space. The changes of 2.38% in the tibiofibular overlap and 5.29% in the tibiofibular clear space between the postoperative and post-removal periods were not statistically significant. After removal of the syndesmal screw, there is a slight radiographic broadening of the syndesmosis; however, it is small and statistically not significant. PMID:27403518

  17. Changes in the radiological measurements of the tibiofibular syndesmal area in patients with Weber C ankle fractures who were treated with open reduction, internal fixation, and transyndesmal screw.

    PubMed

    Jasqui-Remba, S; Torres-Gómez, A; Salas-Morales, G A; Hernández-Martínez, A

    2015-01-01

    The tibiofibular syndesmosis provides stability to the ankle mortise. The ankle syndesmosis is compromised in all Weber C type injuries. The radiographic method described by Merle DAubigné considers the bony relationships as a measure of syndesmotic widening. We sought to investigate whether the patients with a C type ankle fracture treated with ORIF and placement of a transyndesmal screw have an increment of the tibiofibular space and decrease of the tibiofibular overlap after the transyndesmal screw is removed. Our sample included 52 patients with Weber C ankle fractures treated by ORIF and transyndesmal screw at a level II trauma center. We measured the tibiofibular clear space and tibiofibular overlap in each phase of the treatment. The transyndesmal screw was removed at day 55.56 (± 21.83). We found an increase of the tibiofibular overlap of 0.20 mm (± 2.29, p = 0.532); and 0.21 mm (± 0.97, p = 0.146) in the tibiofibular clear space. The changes of 2.38% in the tibiofibular overlap and 5.29% in the tibiofibular clear space between the postoperative and post-removal periods were not statistically significant. After removal of the syndesmal screw, there is a slight radiographic broadening of the syndesmosis; however, it is small and statistically not significant.

  18. Early Experience with a New Porous Hemispheric Acetabular Component.

    PubMed

    Berend, Keith R; Adams, Joanne B; Morris, Michael J; Lombardi, Adolph V

    2015-11-01

    A third-generation cementless acetabular system has been designed, building on the successes of a second-generation system that featured good congruity between the liner and hemispheric shell, and proven porous plasma-sprayed coating on titanium alloy substrate, by designing a ringless barb and groove locking mechanism and optimizing range of motion. These design features are amenable to modern, highly crosslinked polyethylenes. A retrospective review was performed to assess early outcomes. A query of our practice registry revealed 534 patients (576 hips) who underwent cementless total hip arthroplasty performed by three surgeons with the G7™ Acetabular System (Biomet, Warsaw, Indiana) between April 2013 and March 2014. All liners were vitamin E infused, highly crosslinked polyethylene with a neutral face. Heads used were 463 BIOLOX® delta (81%; CeramTec AG, Plochingen, Germany) and 112 cobalt-chromium (19%), with diameters of 32 mm in 238 (41%), 36 mm in 331 (58%), and 40 mm in 6. Minimum one-year follow-up was available for 400 hips. Mean follow-up was 15 months (range 10-24, SD 3.0). Harris hip scores improved from 50.7 preoperatively to 86.5 most recently. UCLA activity scale improved from 4.5 preoperatively to 5.4 most recently. Two patients required cup revision secondary to failure of biological fixation at 8.4 and 15.1 months respectively. Radiographic findings in all cases were satisfactory position and alignment with no radiolucencies observed. In this group, with very early follow-up, good results with a low rate of acetabular revision and no dislocations were achieved using a new hemispheric porous shell with ringless barb and groove locking mechanism and geometry. PMID:26680408

  19. Acute periprosthetic fractures of the acetabulum after total hip arthroplasty.

    PubMed

    Potty, Anish G; Corona, Jacqueline; Manning, Blaine T; Le, Amanda; Saleh, Khaled J

    2014-01-01

    Although periprosthetic fractures of the acetabulum are relatively uncommon after total hip arthroplasty, a variety of patient-, surgeon-, and implant-related risk factors can contribute to the occurrence of this serious complication. These risk factors, combined with the increased use of cementless acetabular cups, will likely result in an increased prevalence of these fractures in the future. By better understanding the risk factors, classification schemes, and treatment options for periprosthetic fractures of the acetabulum, orthopaedic surgeons can achieve better outcomes for their patients.

  20. Is labral hypotrophy correlated with increased acetabular depth?

    PubMed Central

    Toft, Felix; Anliker, Elmar; Beck, Martin

    2015-01-01

    Labral hypertrophy is a distinct feature in hip dysplasia. Occasionally, very small, hypotrophic labra are observed. However, there is no literature concerning this pathology. We investigated if the size of the labrum correlated with any radiologic parameters reflecting the amount of acetabular coverage. It was hypothezised that there is a negative correlation between labrum size and acetabular coverage. Labra were categorized into three groups depending on the relation between length of the articular sided surface and height of bony attachment. Labra with a height:length ratio of 2 were classified as hypotrophic, with a height:length ratio of 1 as normal and with a ratio of 0.5 as hypertrophic. Labral cross-sectional areas (CSA) were measured on radial magnetic resonance imaging-arthrography slices using the measuring tool of the PACS system of 20 hips with hypotrophic labra (group 1), 20 hips with normal labral appearance (group 2) and 10 hips with hypertrophic labra (group 3). These values were then analyzed against following parameters: neck-shaft-angle (NSA), lateral center-edge angle (LCE), acetabular index (AI), femoral extrusion index (FEI) and acetabular retroversion index (ARI). Analyses of variance were used to determine differences in mean values between the three groups. Mean labral CSA differed significantly between all groups (group 1: 12.1 ± 2.9 mm2; group 2: 25.2 ± 6.2 mm2; group 3: 41.1 ± 12.3 mm2; P < 0.001). NSA, LCE, AI and FEI all showed a significant difference between group 3 and 1 or 2. The ARI showed no difference between groups. Stepwise linear regression analyses showed a significant correlation between LCE angle and labral CSA with a corrected R2-value of 0.301. Labral CSA correlates with the LCE. No statistically significant difference between groups 1 and 2 concerning the LCE, AI or FEI could be identified. Nevertheless, group 1 had the highest mean coverage of all groups, hips with hypertrophic labra

  1. Reverse shoulder prosthesis as revision surgery after fractures of the proximal humerus, treated initially by internal fixation or hemiarthroplasty.

    PubMed

    Lollino, Nicola; Paladini, Paolo; Campi, Fabrizio; Merolla, Giovanni; Rossi, Paolo; Porcellini, Giuseppe

    2009-04-01

    Complex (3-4 fragments) fractures of the proximal humerus often have a bad outcome, whatever treatment is performed. When revision surgery is required, reverse shoulder prosthesis can improve function and reduce pain in these patients. We analysed whether the choice of the first treatment (hemiarthroplasty vs. reduction and fixation) can influence the outcome of revision surgery. Our data demonstrate that results are not significantly dependent on the choice of the first implant, even though there is a tendency for patients with previous hemiarthroplasty to have a worse outcome. PMID:19711168

  2. [Experience in using the surgical-orthodontic method proposed by V. V. Donskoĭ for treating mandibular fractures].

    PubMed

    Ivashchenko, N I

    1990-01-01

    The author analyzes his experience gained in the treatment of 200 patients with mandibular corner and denture fractures by the orthodontic surgery method developed by V. V. Donskoĭ. Uni- and bilateral mandibular corner fractures made up 164 cases, the rest were combined injuries to the corner on the one side and to the body or condyle on the other side. 195 patients were operated under conduction analgesia when sitting in the dental chair and in the rest 5 cases condyle osteosynthesis was carried out on the one side and Donskoĭ's osteosynthesis on the other side under general anesthesia. Surgical procedure did not differ from that described earlier. Kirschner's pin, annealed [correction of preburnt] to make it less elastic, was horizontally inserted into the mandibular branch at the level of the posterior dental necks through a mucosal puncture and then shaped to match mandibular denture and fixed to the teeth with wire ligatures. Mandibular traction was carried out for 3-7 days, if necessary. The mean patient's stay in hospital made up approximately 22.7 days, total number of invalidity days 30.1. Infectious inflammatory complications were recorded in 9 patients. The advantages of the described method are discussed and recommendations on its practical use are given.

  3. Biomechanical Evaluation of a Mandibular Spanning Plate Technique Compared to Standard Plating Techniques to Treat Mandibular Symphyseal Fractures

    PubMed Central

    Richardson, Matthew; Hayes, Jonathan; Jordan, J. Randall; Puckett, Aaron; Fort, Matthew

    2015-01-01

    Purpose. The purpose of this study is to compare the biomechanical behavior of the spanning reconstruction plate compared to standard plating techniques for mandibular symphyseal fractures. Materials and Methods. Twenty-five human mandible replicas were used. Five unaltered synthetic mandibles were used as controls. Four experimental groups of different reconstruction techniques with five in each group were tested. Each synthetic mandible was subjected to a splaying force applied to the mandibular angle by a mechanical testing unit until the construct failed. Peak load and stiffness were recorded. The peak load and stiffness were analyzed using ANOVA and the Tukey test at a confidence level of 95% (P < 0.05). Results. The two parallel plates' group showed statistically significant lower values for peak load and stiffness compared to all other groups. No statistically significant difference was found for peak load and stiffness between the control (C) group, lag screw (LS) group, and the spanning plate (SP1) group. Conclusions. The spanning reconstruction plate technique for fixation of mandibular symphyseal fractures showed similar mechanical behavior to the lag screw technique when subjected to splaying forces between the mandibular gonial angles and may be considered as an alternative technique when increased reconstructive strength is needed. PMID:26649332

  4. Assessment of the influence of Laser phototherapy on the bone repair process of complete fractures in tibiae of rabbits stabilized with semi-rigid internal fixation treated with or without MTA graft: a histological study

    NASA Astrophysics Data System (ADS)

    Soares, Luiz G. P.; Silva, Aline C. P.; Silva, Anna Paula L. T.; Neves, Bruno Luiz R. C.; Santos, Nicole R. S.; dos Santos, Jean N.; Pinheiro, Antonio L. B.

    2016-03-01

    Beside biomaterials, Laser phototherapy has shown positive effects as auxiliary therapy in bone repair process, especially when involving large bone losses. The aim of this histological study was to evaluate, by light microscopy, the influence of laser phototherapy on the repair of complete tibial fractures in rabbits treated or not with semi-rigid internal fixation and Mineral Trioxide Aggregate - MTA graft. Twelve Rabbits were randomly divided into four groups with three animals each. After general anesthesia, complete fractures were created in one tibia with a carborundum disk. All animals (groups I-IV) had the fracture stabilized with semi-rigid fixation (wire osteosynthesis - WO). Group I was routinely fixed with WO; groups II and IV fracture was filled by blood clot and MTA implant. In Groups III and IV fracture was filled by blood clot and further irradiated with laser (λ780 nm, 70 mW, CW, Φ = 0.04 cm2, 20.4 J/cm2, per session, t = 300s, 142.8 J/cm2 per treatment). The phototherapy protocol was applied immediately after the surgery and repeated each 48 hours during 15 days. Animal death occurred on the 30th postoperative day. After removal of the specimens, the samples were routinely processed, stained with HE and evaluated by light microscopy. Histologically, the group treated with MTA graft and irradiated with laser showed the fracture filled by a more organized and mature trabecular bone, when compared with all other groups. From the results of the present study, it may be concluded that the association of Laser phototherapy + MTA graft in fractures treated with WO improved bone repair when compared with fractures treated only with WO.

  5. A comparison of fracture resistance of endodontically treated teeth restored with bonded partial restorations and full-coverage porcelain-fused-to-metal crowns.

    PubMed

    Gupta, Abhishek; Musani, Smita; Dugal, Ramandeep; Jain, Nikhil; Railkar, Bhargavi; Mootha, Ajay

    2014-01-01

    The aim of this study was to evaluate the use of bonded partial restorations compared with full-coverage porcelain-fused-to-metal (PFM) crowns as a viable treatment option for endodontically treated posterior teeth. Forty-five recently extracted maxillary first premolars were collected, endodontically treated, and mounted in acrylic blocks. The specimens were randomly divided into three groups and prepared to receive their respective restorations. The teeth in group 1 received full-coverage porcelain-fused-to-metal crowns. The teeth in group 2 received bonded partial restorations made from pressed ceramics (lithium disilicate) involving a functional cusp (palatal). Finally, group 3 received bonded partial restorations made from pressed ceramics involving the buccal cusp and keeping a functional cusp (palatal) intact. All group 1 restorations were cemented using glass ionomer cement. Restorations in groups 2 and 3 were bonded using a dual-cured resin cement. All specimens were subjected to an aging process and tested for shear bond strength using a universal loading machine. The mean force applied in Newtons to cause failure for group I was 674.90 ± 94.16 N, for group 2, 463.46 ± 61.11 N, and for group 3, 849.33 ± 68.92 N. P values obtained using one-way analysis of variance showed a highly significant difference between groups 2 and 3 (P = .001), groups 1 and 2 (P = .001), and groups 1 and 3 (P = .001). The fracture modes observed in all groups involved restorations and tooth fracture. This in vitro study suggests that endodontically treated posterior teeth with intact functional cusps can be restored with bonded partial porcelain restorations. However, if the loss of tooth structure involves the functional cusp, full-coverage PFM crowns are the treatment of choice.

  6. The use of cementless acetabular component in revision surgery without pelvic discontinuity.

    PubMed

    Cherubino, Paolo; D'Angelo, Fabio; Surace, Michele Francesco; Murena, Luigi; Vulcano, Ettore

    2010-10-01

    Reconstruction of the failed acetabular component in total hip arthroplasty (THA) can be challenging. Although there are multiple reconstructive options available, a cementless acetabular component inserted with screws has been shown to have good intermediate-term results and is the reconstructive method of choice for the majority of acetabular revisions This reconstruction is feasible provided at least 50% of the implant contacts host bone. When such contact is not possible, and there is adequate medial and peripheral bone, techniques using alternative uncemented implants can be used for acetabular reconstruction. An uncemented cup can be placed at a "high hip center." Alternatively, the acetabular cavity can be progressively reamed to accommodate extra-large cups. Oblong cups, which take advantage of the oval-shaped cavity resulting from many failed acetabular components, can also be used. The success of these cementless techniques depends on the degree and location of bone loss. The correct indication to revision and the choice of the correct implant is the keystone for the success of this type of surgery and follows an accurate preoperative planning in order to understand the specific pathologic scenario. The aim of this paper is to review some technical options for the revision of the acetabular component also taking into account our personal experiences and series. PMID:21082580

  7. Role of the Acetabular Labrum in Load Support Across the Hip Joint

    PubMed Central

    Henak, Corinne R.; Ellis, Benjamin J.; Harris, Michael D.; Anderson, Andrew E.; Peters, Christopher L.; Weiss, Jeffrey A.

    2011-01-01

    The relatively high incidence of labral tears among patients presenting with hip pain suggests that the acetabular labrum is often subjected to injurious loading in vivo. However, it is unclear whether the labrum participates in load transfer across the joint during activities of daily living. This study examined the role of the acetabular labrum in load transfer for hips with normal acetabular geometry and acetabular dysplasia using subject-specific finite element analysis. Models were generated from volumetric CT data and analyzed with and without the labrum during activities of daily living. The labrum in the dysplastic model supported 4-11% of the total load transferred across the joint, while the labrum in the normal model supported only 1-2% of the total load. Despite the increased load transferred to the acetabular cartilage in simulations without the labrum, there were minimal differences in cartilage contact stresses. This was because the load supported by the cartilage correlated to the cartilage contact area. A higher percentage of load was transferred to the labrum in the dysplastic model because the femoral head achieved equilibrium near the lateral edge of the acetabulum. The results of this study suggest that the labrum plays a larger role in load transfer and joint stability in hips with acetabular dysplasia than in hips with normal acetabular geometry. PMID:21757198

  8. [Fractures of the forefoot].

    PubMed

    Richter, M

    2011-10-01

    Fractures of the forefoot are common and comprise approximately two thirds of all foot fractures. Forefoot fractures are caused by direct impact or the effect of indirect force. The forces exerted can range from repetitive minor load (stress fractures) to massive destructive forces (complex trauma). The clinical course in forefoot fractures is typically more favourable than in fractures of the mid- and hindfoot. The incidence of complications like infection or pseudarthrosis is low. Exceptions are rare fractures of the proximal shaft of the fifth metatarsal and the sesamoids with higher pseudarthrosis rates. Malunited metatarsal fractures can cause painful conditions that should even be treated operatively. Differences in structure and function of the different forefoot areas and specific fracture types require an adapted management of these special injuries.

  9. Automated measurement of anterior and posterior acetabular sector angles

    NASA Astrophysics Data System (ADS)

    Ibragimov, Bulat; Likar, Boštjan; Pernuš, Franjo; Vrtovec, Tomaž

    2012-03-01

    In this paper, we propose a segmentation algorithm by which anatomical landmarks on the pelvis are extracted from computed tomography (CT) images. The landmarks are used to automatically define the anterior (AASA) and posterior acetabular sector angles (PASA) describing the degree of hip misalignment. The center of each femoral head is obtained by searching for the point at which most intensity gradient vectors defined at edge points intersect. The radius of each femoral head is computed by finding the sphere, positioned at the center of the femoral head, for which the normalized sum of gradient vector magnitudes on the sphere surface is maximal. The anterior and posterior corners of each acetabulum are searched for on a curve representing the acetabulum and defined by dynamic programming. The femoral head centers and anterior and posterior corners are used to calculate the AASA and PASA. The algorithm was applied to CT images of 120 normal subjects and the results were compared to ground truth values obtained by manual segmentation. The mean absolute difference (+/- standard deviation) between the obtained and ground truth values was 1.3 +/- 0.3 mm for the femoral head centers and 2.1 +/- 1.3 degrees for the acetabular angles.

  10. Comparison of flanged and unflanged acetabular cup design

    PubMed Central

    2010-01-01

    Background and purpose Adequate depth of cement penetration and cement mantle thickness is important for the durability of cemented cups. A flanged cup, as opposed to unflanged, has been suggested to give a more uniform cement mantle and superior cement pressurization, thus improving the depth of cement penetration. This hypothesis was tested experimentally. Materials and methods The same cup design with and without flange (both without cement spacers) was investigated regarding intraacetabular pressure, cement mantle thickness, and depth of cement penetration. With machine control, the cups were inserted into open-pore ceramic acetabular models (10 flanged, 10 unflanged) and into paired cadaver acetabuli (10 flanged, 10 unflanged) with prior pressurization of the cement. Results No differences in intraacetabular pressures during cup insertion were found, but unflanged cups tended to migrate more towards the acetabular pole. Flanged cups resulted in thicker cement mantles because of less bottoming out, whereas no differences in cement penetration into the bone were observed. Interpretation Flanged cups do not generate higher cementation pressure or better cement penetration than unflanged cups. A possible advantage of the flange, however, may be to protect the cup from bottoming out, and there is possibly better closure of the periphery around the cup, sealing off the cement-bone interface. PMID:20860522

  11. [Wear and periprosthetic osteolysis of modular, hemispheric acetabular cups].

    PubMed

    Blacha, Jan; Bogacz, Alina

    2006-01-01

    Osteolysis associated with polyethylene wear has become one of the most prevalent complications associated with uncemented modular, hemispherical cups. Sixty-five consecutive total hip arthroplasties (ABG i, Howmedica, Stryker) were followed 6-12 years. Cumulative survivorship for the cup was 55.7% after 10 years. There were 20 cups revisions because of polyethylene wear and periprosthetic osteolysis (14 cups) or cup loosening (6 cups). Stability was assessed intraoperatively, 14 cups were revised, whereas 6 new polyethylene cups were cemented into stable metal-back of acetabular component. The average annual wear of revised cups was 0.32 mm. The annual wear of not revised cups was 0.12 mm. The differences were statistically significant (p = 0.002). The mean area of osteolysis was 472 mm2 (SD 257 mm2). There was no significant correlation between wear and area of osteolysis. There was significant correlation R = 0.54, p = 0.014) between time to revision and area of osteolysis. There were no significant differences of wear of polyethylene inlay or area of osteolysis between stable and unstable acetabular cups.

  12. Improving the detection of acetabular osteolysis using oblique radiographs.

    PubMed

    Southwell, D G; Bechtold, J E; Lew, W D; Schmidt, A H

    1999-03-01

    Visualisation of periacetabular osteolysis by standard anteroposterior (AP) radiographs underestimates the extent of bone loss around a metal-backed acetabular component. We have assessed the effectiveness of standard radiological views in depicting periacetabular osteolysis, and recommend additional projections which make these lesions more visible. This was accomplished using a computerised simulation of radiological views and a radiological analysis of simulated defects placed at regular intervals around the perimeter of a cadaver acetabulum. The AP view alone showed only 38% of the defects over all of the surface of the cup and failed to depict a 3 mm lesion over 83% of the cup. When combined with the AP view, additional 45 degree obturator-oblique and iliac-oblique projections increased the depiction, showing 81% of the defects. The addition of the 60 degree obturator-oblique view further improved the visualisation of posterior defects, increasing the rate of detection to 94%. Based on this analysis, we recommend using at least three radiographic views when assessing the presence and extent of acetabular osteolysis. PMID:10204936

  13. [Fractures of carpal bones].

    PubMed

    Lögters, T; Windolf, J

    2016-10-01

    Fractures of the carpal bones are uncommon. On standard radiographs fractures are often not recognized and a computed tomography (CT) scan is the diagnostic method of choice. The aim of treatment is to restore pain-free and full functioning of the hand. A distinction is made between stable and unstable carpal fractures. Stable non-displaced fractures can be treated conservatively. Unstable and displaced fractures have an increased risk of arthritis and non-union and should be stabilized by screws or k‑wires. If treated adequately, fractures of the carpal bones have a good prognosis. Unstable and dislocated fractures have an increased risk for non-union. The subsequent development of carpal collapse with arthrosis is a severe consequence of non-union, which has a heterogeneous prognosis.

  14. Total arthroplasty in displaced dysplastic hips with acetabular reconstruction and femoral shortening - technical note.

    PubMed

    Silva, Paulo; de Oliveira, Leandro Alves; Coelho, Danilo Lopes; do Amaral, Rogério Andrade; Rebello, Percival Rosa; de Moraes, Frederico Barra

    2014-01-01

    To describe a new procedure of total hip replacement in patient with severe developmental dysplasia of the left hip, using technique of acetabular reconstruction with autogenous bone grafts and subtrochanteric shortening femoral osteotomy. Total hip replacement done in January of 2003. The Eftekhar's classification was used and included type D, neglected dislocations. Bone graft incorporated in acetabular shelf and femoral osteotomy. Our contribution is the use of an Allis plate to better fix acetabular grafts, avoiding loosening, and cerclage around bone graft in femoral osteotomy site, which diminish pseudoarthrosis risk. This technique shows efficiency, allowing immediately resolution for this case with pain and range of motion of hip improvement. It also allows the acetabular dysplasia reconstruction, equalization of the limb length (without elevated risk of neurovascular lesion) and repairs the normal hip biomechanics due to the correction of the hip's center of rotation.

  15. Surgery for scapula process fractures

    PubMed Central

    Anavian, Jack; Wijdicks, Coen A; Schroder, Lisa K; Vang, Sandy

    2009-01-01

    Background Generally, scapula process fractures (coracoid and acromion) have been treated nonoperatively with favorable outcome, with the exception of widely displaced fractures. Very little has been published, however, regarding the operative management of such fractures and the literature that is available involves very few patients. Our hypothesis was that operative treatment of displaced acromion and coracoid fractures is a safe and effective treatment that yields favorable surgical results. Methods We reviewed 26 consecutive patients (27 fractures) treated between 1998 and 2007. Operative indications for these process fractures included either a painful nonunion, a concomitant ipsilateral operative scapula fracture, ≥ 1 cm of displacement on X-ray, or a multiple disruption of the superior shoulder suspensory complex. All patients were followed until they were asymptomatic, displayed radiographic fracture union, and had recovered full motion with no pain. Patients and results 21 males and 5 females, mean age 36 (18–67) years, were included in the study. 18 patients had more than one indication for surgery. Of the 27 fractures, there were 13 acromion fractures and 14 coracoid fractures. 1 patient was treated for both a coracoid and an acromion fracture. Fracture patterns for the acromion included 6 acromion base fractures and 7 fractures distal to the base. Coracoid fracture patterns included 11 coracoid base fractures and 3 fractures distal to the base. Mean follow-up was 11 (2–42) months. All fractures united and all patients had recovered full motion with no pain at the time of final follow-up. 3 patients underwent removal of hardware due to irritation from hardware components that were too prominent. There were no other complications. Interpretation While most acromion and coracoid fractures can be treated nonoperatively with satisfactory results, operative management may be indicated for displaced fractures and double lesions of the superior shoulder

  16. Revisions of Extensive Acetabular Defects with Impaction Grafting and a Cement Cup

    PubMed Central

    van Egmond, Nienke; De Kam, Daniel C. J.; Gardeniers, Jean W. M.

    2010-01-01

    Background Loosening of acetabular components often leads to bony defects. Management of extensive acetabular bone loss in hip revision arthroplasty can be a tremendous challenge. Questions/purposes We asked whether a reconstruction with impacted bone grafts will provide a durable and pain-free function in extensive acetabular defects. We specifically determined the (1) survival rates with the end point of revision for any reason, aseptic revision, and radiographic loosening; (2) visual analog scale (VAS) pain score, Harris hip score (HHS), and the Oxford Hip Questionnaire score (OHQS); (3) number of repeat revisions; (4) complications; and (5) radiographic loosening, wear, and radiolucencies. Patients and Methods We retrospectively followed 25 patients (27 hips) with extensive acetabular defects. No patient was lost to followup. Two patients died during followup. Minimum followup was 3 years (mean, 8.8 years; range, 3–14.1 years). Results Three patients (three hips) underwent repeat revision surgery and another two patients (two hips) had radiographically loose hips. The 10-year survival rate was 88% (95% confidence interval, 74.2%–100%) with the end point acetabular revision for any reason and 95% (95% confidence interval, 86.0%–100%) with the end point acetabular revision for aseptic loosening. The mean HHSs were 55 points before surgery and 72 points postoperatively. Conclusions Acetabular reconstruction with impaction bone grafting and a cemented cup is a reliable technique with a 10-year survival rate of 88% in patients with extensive acetabular deficiencies. Level of Evidence Level IV, case series. See the Guidelines for Authors for a complete description of levels of evidence. PMID:20931308

  17. Minimal backside surface changes observed in retrieved acetabular liners.

    PubMed

    Akbari, Abtin; Roy, Marcel E; Whiteside, Leo A; Katerberg, Brian J; Schnettgoecke, Daniel J

    2011-08-01

    Modular polyethylene liners offer versatility in total hip arthroplasty, but the locking mechanism may allow micromotion and backside wear. We evaluated the backside surface of 56 retrieved acetabular liners (mean 5.54 years in vivo, range 0.003-13.1 years) to determine whether damage correlated with liner age in vivo, patient factors associated with higher activity, and polyethylene quality. Half of the liners exhibited minimal damage, half exhibited no damage and none exhibited severe damage. Backside damage significantly correlated only to liner age in vivo. Ten of the 28 liners revised for osteolysis exhibited no backside damage, but the osteolytic cysts were peripheral and did not originate from screw holes. The results suggest that modular polyethylene liners in a porous titanium-coated shell with screw holes can be designed such that clinically significant backside wear is minimal. PMID:20875939

  18. Clinical and radiological results of hydroxyapatite-coated acetabular cups.

    PubMed

    Blacha, J; Gagała, J

    2004-12-01

    We prospectively studied a consecutive series of 60 primary total hip arthroplasties in 52 patients. All patients had a hydroxyapatite-coated hemispherical acetabular cup (OCTOFIT). Mean patient age was 52.5 (34-73) years. In 38 hips, a 28-mm and in 22 hips a 32-mm diameter cobalt-chrome femoral head was used. We could follow 53 hips for a mean of 81 (28-125) months. Four cups were revised because of osteolysis, and in another six cups, slight osteolysis without migration was seen. The average annual linear wear rate was 0.05 mm (+/-0.05) for 28-mm heads and 0.16 mm (+/-0.09) for 32-mm heads (p<0.0001). Survivorship analysis predicted a survival rate of 86+/-6.7% at 10 years.

  19. The concentric all-polyethylene Exeter acetabular component in primary total hip replacement.

    PubMed

    Veitch, S W; Whitehouse, S L; Howell, J R; Hubble, M J W; Gie, G A; Timperley, A J

    2010-10-01

    We report the outcome of the flangeless, cemented all-polyethylene Exeter acetabular component at a mean of 14.6 years (10 to 17) after operation. Of the 263 hips in 243 patients, 122 prostheses are still in situ; 112 patients (119 hips) have died, 18 hips have been revised, and three patients (four hips) were lost to follow-up. Radiographs at the final review were available for 110 of the 122 surviving hips. There were acetabular radiolucent lines in 54 hips (49%). Two acetabular components had migrated but neither patient required revision. The Kaplan-Meier survivorship at 15 years with 61 hips at risk with revision for any cause as the endpoint was 89.9% (95% confidence interval (CI) 84.6 to 95.2) and for aseptic loosening of the acetabular component or lysis 91.7% (95% CI 86.6 to 96.8). In 210 hips with a diagnosis of primary osteoarthritis, survivorship with revision for any cause as the endpoint was 93.2% (95% CI 88.1 to 98.3), and for aseptic loosening of the acetabular component 95.0% (95% CI 90.3 to 99.7). The cemented all-polyethylene Exeter acetabular component has an excellent long-term survivorship.

  20. Failure analysis of retrieved PE-UHMW acetabular liners.

    PubMed

    Laska, Anna; Archodoulaki, Vasiliki-Maria; Duscher, Bernadette

    2016-08-01

    Ultra-high molecular weight polyethylene (PE-UHMW) acetabular liners have a limited lifespan in a patient's body. There are many factors affecting the performance of the implant and furthermore the properties of the polymeric material are changing after implantation. In this work material changes according to structure and morphology and their implication on mechanical properties are in focus. The physical and mechanical properties of ten crosslinked (xL) PE-UHMW and nine conventional (conv) gamma-sterilized PE-UHMW hip components, used as sliding surface in total hip joint replacement, with different in-vivo times are compared. The evaluation of the retrieved acetabular liners is performed in view of crosslinking and conventional gamma-sterilization but also in terms of the influence of gender concerning alteration in properties. The oxidative degradation in the PE-UHMW is investigated by means of Fourier Transformed Infrared Spectroscopy (FTIR). The characterization of the morphology is carried out via differential scanning calorimetry (DSC). A depth profile of the micro-hardness and elastic modulus is taken over the cross-section of the components in order to find the influence of chemical constitution and morphology on the micro-mechanical properties. It could be shown that crosslinking and oxidative degradation influence the degree of crystallinity of the polymer. Oxidation occurs for both types of the material due to in-vivo time. Higher degree of crystallinity can be correlated to higher hardness and indentation modulus. No unequivocal superiority of crosslinked over conventional liners can be observed. The influence of sex concerning alteration of the evaluated properties matters but need to be further investigated. PMID:26849029

  1. Failure analysis of retrieved PE-UHMW acetabular liners.

    PubMed

    Laska, Anna; Archodoulaki, Vasiliki-Maria; Duscher, Bernadette

    2016-08-01

    Ultra-high molecular weight polyethylene (PE-UHMW) acetabular liners have a limited lifespan in a patient's body. There are many factors affecting the performance of the implant and furthermore the properties of the polymeric material are changing after implantation. In this work material changes according to structure and morphology and their implication on mechanical properties are in focus. The physical and mechanical properties of ten crosslinked (xL) PE-UHMW and nine conventional (conv) gamma-sterilized PE-UHMW hip components, used as sliding surface in total hip joint replacement, with different in-vivo times are compared. The evaluation of the retrieved acetabular liners is performed in view of crosslinking and conventional gamma-sterilization but also in terms of the influence of gender concerning alteration in properties. The oxidative degradation in the PE-UHMW is investigated by means of Fourier Transformed Infrared Spectroscopy (FTIR). The characterization of the morphology is carried out via differential scanning calorimetry (DSC). A depth profile of the micro-hardness and elastic modulus is taken over the cross-section of the components in order to find the influence of chemical constitution and morphology on the micro-mechanical properties. It could be shown that crosslinking and oxidative degradation influence the degree of crystallinity of the polymer. Oxidation occurs for both types of the material due to in-vivo time. Higher degree of crystallinity can be correlated to higher hardness and indentation modulus. No unequivocal superiority of crosslinked over conventional liners can be observed. The influence of sex concerning alteration of the evaluated properties matters but need to be further investigated.

  2. Mechanical resistance evaluation of a novel anatomical short glass fiber reinforced post in artificial endodontically treated premolar under rotational/lateral fracture fatigue testing.

    PubMed

    Wang, Hsuan-Wen; Chang, Yen-Hsiang; Lin, Chun-Li

    2016-01-01

    This study develops a novel anatomical short glass fiber reinforced (anatomical SGFR) post and evaluates the mechanical performance in artificial endodontically treated premolars. An anatomical SGFR fiber post with an oval shape and slot/notch designs was manufactured using an injection-molding machine. The three-point bending test and crown/core restorations using the anatomical SGFR and commercial cylindrical fiber posts under fatigue test were executed to understand the mechanical resistances. The results showed that static and dynamic rotational resistance were found significantly higher in the anatomical SGFR fiber post than in the commercial post. The endurance limitations at 1.2×10(6) cycles were 66.81 and 64.77 N for the anatomical SGFR and commercial fiber posts, respectively. The anatomical SGFR fiber post presented acceptable value of flexural strength and modulus, better fit adaption in the root canal resist torque more efficiency but was not a key issue in the lateral fracture resistance in an endodontically treated premolar. PMID:27041013

  3. Mechanical resistance evaluation of a novel anatomical short glass fiber reinforced post in artificial endodontically treated premolar under rotational/lateral fracture fatigue testing.

    PubMed

    Wang, Hsuan-Wen; Chang, Yen-Hsiang; Lin, Chun-Li

    2016-01-01

    This study develops a novel anatomical short glass fiber reinforced (anatomical SGFR) post and evaluates the mechanical performance in artificial endodontically treated premolars. An anatomical SGFR fiber post with an oval shape and slot/notch designs was manufactured using an injection-molding machine. The three-point bending test and crown/core restorations using the anatomical SGFR and commercial cylindrical fiber posts under fatigue test were executed to understand the mechanical resistances. The results showed that static and dynamic rotational resistance were found significantly higher in the anatomical SGFR fiber post than in the commercial post. The endurance limitations at 1.2×10(6) cycles were 66.81 and 64.77 N for the anatomical SGFR and commercial fiber posts, respectively. The anatomical SGFR fiber post presented acceptable value of flexural strength and modulus, better fit adaption in the root canal resist torque more efficiency but was not a key issue in the lateral fracture resistance in an endodontically treated premolar.

  4. Comparative evaluation of the effect of different crown ferrule designs on the fracture resistance of endodontically treated mandibular premolars restored with fiber posts, composite cores, and crowns: An ex-vivo study

    PubMed Central

    Dua, Nikita; Kumar, Bhupendra; Arunagiri, D.; Iqbal, Mohammad; Pushpa, S.; Hussain, Juhi

    2016-01-01

    Introduction: In cases of severe hard tissue loss, 2 mm circumferential ferrule is difficult to achieve which leads to incorporation of different ferrule designs. Aim: To compare and evaluate the effect of different crown ferrule designs on the fracture resistance of mandibular premolars restored with fiber posts, composite cores, and crowns. Materials and Methods: Fifty freshly extracted mandibular premolars were endodontically treated and divided into five groups: Group I - 2 mm circumferential ferrule above the cementoenamel junction (CEJ); Group II - 2 mm ferrule on the facial aspect above CEJ; Group III - 2 mm ferrule on the lingual aspect above CEJ; Group IV - 2 mm ferrule on the facial and lingual aspects above CEJ with interproximal concavities, and Group V - no ferrule (control group) and were later restored with fiber posts, composite cores, and crowns. Specimens were mounted on a universal testing machine, and compressive load was applied at a crosshead speed of 1 mm/min until fracture occurred. Results: The results showed that circumferential ferrule produced the highest mean fracture resistance and the least fracture resistance was found in the control group. Conclusion: Circumferential ferrule increases the fracture resistance of endodontically treated teeth restored with bonded post, core, and crown. PMID:27217642

  5. Tibial Stress Fractures in Athletes.

    PubMed

    Feldman, John J; Bowman, Eric N; Phillips, Barry B; Weinlein, John C

    2016-10-01

    Tibial stress fractures are common in the athlete. There are various causes of these fractures, the most common being a sudden increase in training intensity. Most of these injuries are treated conservatively; however, some may require operative intervention. Intervention is mostly dictated by location of the fracture and failure of conservative treatment. There are several surgical options available to the treating surgeon, each with advantages and disadvantages. The physician must understand the nature of the fracture and the likelihood for it to heal in a timely manner in order to best treat these fractures in this patient subset. PMID:27637660

  6. Atraumatic sternum fracture

    PubMed Central

    Abrahamsen, Sebastian Ørskov; Madsen, Christina Friis

    2014-01-01

    The spine, pelvic bones and long bones of the lower extremities are common sites for insufficiency fractures. Cases of sternum insufficiency fractures have rarely been reported among elderly patients. Insufficiency fractures tend to occur in bones with decreased mechanical strength especially among elderly patients, in postmenopausal women and patients with underlying diseases. We describe a case of spontaneous sternum insufficiency fracture in a healthy man, with no known risk factors to fracture, or previous history of fractures. Sternum insufficiency fracture is a rare cause of chest pain. This case serves to remind the emergency physician to remain vigilant for other non-cardiac, non-pulmonary and non-traumatic causes of chest pain, especially among patients with known risk factors such as osteoporosis, chronic obstructive pulmonary disease, rheumatoid arthritis, systemic lupus erythematosus and patients on long-term steroid treatment. If diagnosed correctly, these patients can be discharged and treated as outpatients as this case emphasises. PMID:25326566

  7. The combination of a mineral trioxide aggregate and an adhesive restorative approach to treat a crown-root fracture coupled with lateral root perforation in a mandibular second molar: a case report.

    PubMed

    Wang, P; Wang, S; Ni, L

    2009-01-01

    The current paper describes a modified treatment procedure for a traumatized mandibular left second molar resulting in a crown-root fracture and root perforation with the fracture line below the gingival attachment and alveolar bone crest. After the mobile crown-root fragment was extracted, the root perforation was obturated with mineral trioxide aggregate (MTA), and the subgingival defect was directly repaired with polyacid-modified resin composites (Ionosite Baseline). A 24-month recall showed no evidence of periodontal inflammation and no adverse symptoms, and the treated tooth exhibited good healing and normal function. PMID:19678457

  8. Radiological evaluation of the metal-bone interface of a porous tantalum monoblock acetabular component.

    PubMed

    Macheras, G A; Papagelopoulos, P J; Kateros, K; Kostakos, A T; Baltas, D; Karachalios, T S

    2006-03-01

    Between January 1998 and December 1998, 82 consecutive patients (86 hips) underwent total hip arthroplasty using a trabecular metal monoblock acetabular component. All patients had a clinical and radiological follow-up evaluation at six, 12 and 24 weeks, 12 months, and then annually thereafter. On the initial post-operative radiograph 25 hips had a gap between the outer surface of the component and the acetabular host bed which ranged from 1 to 5 mm. All patients were followed up clinically and radiologically for a mean of 7.3 years (7 to 7.5). The 25 hips with the 1 to 5 mm gaps were studied for component migration at two years using the Einzel-Bild-Roentgen-Analyse (EBRA) digital measurement method. At 24 weeks all the post-operative gaps were filled with bone and no acetabular component had migrated. The radiographic outcome of all 86 components showed no radiolucent lines and no evidence of lysis. No acetabular implant was revised. There were no dislocations or other complications. The bridging of the interface gaps (up to 5 mm) by the trabecular metal monoblock acetabular component indicates the strong osteoconductive, and possibly osteoinductive, properties of trabecular metal.

  9. An in vivo comparison of the orientation of the transverse acetabular ligament and the acetabulum.

    PubMed

    Griffin, Andrew R; Perriman, Diana M; Bolton, Claire J; Smith, Paul N

    2014-03-01

    Aligning the acetabular component with the Transverse Acetabular Ligament (TAL) to ensure optimal anteversion has been reported to reduce dislocation rates. However, to our knowledge in vivo measurement of the TAL angle has not yet been reported in a large cohort of normal hips. CT scans of 218 normal hips were analyzed. The TAL and four acetabular rim anteversion angles were measured (superiorly to inferiorly) relative to the anterior pelvic plane. The mean TAL anteversion angle was 20.5° ± 7.0°, and the acetabular rim angles from superior to inferior were 11.0° ± 12.9°, 19.9° ± 8.8°, 20.9° ± 6.2° and 25.1° ± 6.2° respectively. Both the TAL and the acetabular rim were significantly more anteverted in females than in males. The TAL anteversion angle was comparable to the predominant orientation (central rim section) of the native acetabulum while the superior acetabulum was comparatively retroverted and the inferior was relatively more anteverted.

  10. Acetabular rim and surface segmentation for hip surgery planning and dysplasia evaluation

    NASA Astrophysics Data System (ADS)

    Tan, Sovira; Yao, Jianhua; Yao, Lawrence; Summers, Ronald M.; Ward, Michael M.

    2008-03-01

    Knowledge of the acetabular rim and surface can be invaluable for hip surgery planning and dysplasia evaluation. The acetabular rim can also be used as a landmark for registration purposes. At the present time acetabular features are mostly extracted manually at great cost of time and human labor. Using a recent level set algorithm that can evolve on the surface of a 3D object represented by a triangular mesh we automatically extracted rims and surfaces of acetabulae. The level set is guided by curvature features on the mesh. It can segment portions of a surface that are bounded by a line of extremal curvature (ridgeline or crestline). The rim of the acetabulum is such an extremal curvature line. Our material consists of eight hemi-pelvis surfaces. The algorithm is initiated by putting a small circle (level set seed) at the center of the acetabular surface. Because this surface distinctively has the form of a cup we were able to use the Shape Index feature to automatically extract an approximate center. The circle then expands and deforms so as to take the shape of the acetabular rim. The results were visually inspected. Only minor errors were detected. The algorithm also proved to be robust. Seed placement was satisfactory for the eight hemi-pelvis surfaces without changing any parameters. For the level set evolution we were able to use a single set of parameters for seven out of eight surfaces.

  11. Early acetabular cartilage degeneration in a rabbit model of developmental dysplasia of the hip

    PubMed Central

    Zhang, Xiangxin; Meng, Qingxia; Ma, Ruixue; Chen, Guangxiang; Cheng, Liang; Shen, Jun

    2015-01-01

    Background: Mild developmental dysplasia of hip (DDH) causes high morbidity of osteoarthritis (OA) on adult. It is thought that change of collagen and proteoglycans in cartilage may be the direct reasons for osteoarthritis. Objective: To detect the changes of the expressions of type II collagen of acetabular cartilage in early DDH and to investigate the relevance between type II collagen and the degeneration mechanism of the acetabular cartilage. Methods: The rabbit model of DDH was successfully established by applying the method of knee extending and fixing with cylinder cast in which left lower extremity as experimental group and right one as control group, checking with X-ray after 5 weeks. The stains of H&E and toluidine blue were applied on the samples of acetabular cartilage to observe the morphological changes of chondrocytes and extracellular matrix (ECM). The immunohistochemical staining and Western-blot were employed to respectively qualify and quantitate the expression of type II collagen. Results: Pathohistology observing indicated the signs of retrogressive changes of acetabular cartilage in experimental group. Also, the positive stained cells in type II collagen in experimental group was higher based on immunohistochemiscal staining. The quantitative amounts of type II collagen by Western-blot in experimental group was higher significant difference existed between two groups (t = 2.18, P < 0.05). Conclusions: The expression of type II collagen is correlated to a degeneration of acetabular cartilage and increase obviously in early DDH. PMID:26550441

  12. Pelvic Incidence: A Predictive Factor for Three-Dimensional Acetabular Orientation—A Preliminary Study

    PubMed Central

    Bollini, Gérard; Legaye, Jean; Tardieu, Christine; Prat-Pradal, Dominique; Chabrol, Brigitte; Jouve, Jean-Luc; Duval-Beaupère, Ginette; Pélissier, Jacques

    2014-01-01

    Acetabular cup orientation (inclination and anteversion) is a fundamental topic in orthopaedics and depends on pelvis tilt (positional parameter) emphasising the notion of a safe range of pelvis tilt. The hypothesis was that pelvic incidence (morphologic parameter) could yield a more accurate and reliable assessment than pelvis tilt. The aim was to find out a predictive equation of acetabular 3D orientation parameters which were determined by pelvic incidence to include in the model. The second aim was to consider the asymmetry between the right and left acetabulae. Twelve pelvic anatomic specimens were measured with an electromagnetic Fastrak system (Polhemus Society) providing 3D position of anatomical landmarks to allow measurement of acetabular and pelvic parameters. Acetabulum and pelvis data were correlated by a Spearman matrix. A robust linear regression analysis provided prediction of acetabulum axes. The orientation of each acetabulum could be predicted by the incidence. The incidence is correlated with the morphology of acetabula. The asymmetry of the acetabular roof was correlated with pelvic incidence. This study allowed analysis of relationships of acetabular orientation and pelvic incidence. Pelvic incidence (morphologic parameter) could determine the safe range of pelvis tilt (positional parameter) for an individual and not a group. PMID:25006461

  13. Comparison of Isocentric C-Arm 3-Dimensional Navigation and Conventional Fluoroscopy for Percutaneous Retrograde Screwing for Anterior Column Fracture of Acetabulum

    PubMed Central

    He, Jiliang; Tan, Guoqing; Zhou, Dongsheng; Sun, Liang; Li, Qinghu; Yang, Yongliang; Liu, Ping

    2016-01-01

    Abstract Percutaneous screw insertion for minimally displaced or reducible acetabular fracture using x-ray fluoroscopy and computer-assisted navigation system has been advocated by some authors. The purpose of this study was to compare intraoperative conditions and clinical results between isocentric C-arm 3-dimensional (Iso-C 3D) fluoroscopy and conventional fluoroscopy for percutaneous retrograde screwing of acetabular anterior column fracture. A prospective cohort study was conducted. A total of 22 patients were assigned to 2 different groups: 10 patients in the Iso-C 3D navigation group and 12 patients in the conventional group. The operative time, fluoroscopic time, time of screw insertion, blood loss, and accuracy were analyzed between the 2 groups. There were significant differences in operative time, screw insertion time, fluoroscopy time, and mean blood loss between the 2 groups. Totally 2 of 12 (16.7%) screws were misplaced in the conventional fluoroscopy group, and all 10 screws were in safe zones in the navigation group. Percutaneous screw fixation using the Iso-C 3D computer-assisted navigation system significantly reduced the intraoperative fluoroscopy time and blood loss in percutaneous screwing for acetabular anterior column fracture. The Iso-C 3D computer-assisted navigation system provided a reliable and effective method for percutaneous screw insertion in acetabular anterior column fractures compared to conventional fluoroscopy. PMID:26765448

  14. Comparison of Isocentric C-Arm 3-Dimensional Navigation and Conventional Fluoroscopy for Percutaneous Retrograde Screwing for Anterior Column Fracture of Acetabulum: An Observational Study.

    PubMed

    He, Jiliang; Tan, Guoqing; Zhou, Dongsheng; Sun, Liang; Li, Qinghu; Yang, Yongliang; Liu, Ping

    2016-01-01

    Percutaneous screw insertion for minimally displaced or reducible acetabular fracture using x-ray fluoroscopy and computer-assisted navigation system has been advocated by some authors. The purpose of this study was to compare intraoperative conditions and clinical results between isocentric C-arm 3-dimensional (Iso-C 3D) fluoroscopy and conventional fluoroscopy for percutaneous retrograde screwing of acetabular anterior column fracture.A prospective cohort study was conducted. A total of 22 patients were assigned to 2 different groups: 10 patients in the Iso-C 3D navigation group and 12 patients in the conventional group. The operative time, fluoroscopic time, time of screw insertion, blood loss, and accuracy were analyzed between the 2 groups.There were significant differences in operative time, screw insertion time, fluoroscopy time, and mean blood loss between the 2 groups. Totally 2 of 12 (16.7%) screws were misplaced in the conventional fluoroscopy group, and all 10 screws were in safe zones in the navigation group. Percutaneous screw fixation using the Iso-C 3D computer-assisted navigation system significantly reduced the intraoperative fluoroscopy time and blood loss in percutaneous screwing for acetabular anterior column fracture.The Iso-C 3D computer-assisted navigation system provided a reliable and effective method for percutaneous screw insertion in acetabular anterior column fractures compared to conventional fluoroscopy.

  15. Osteoporotic vertebral fractures redux.

    PubMed

    Lentle, B C; Gordon, P; Ward, L

    2008-02-01

    Osteoporosis remains an important cause of morbidity and mortality especially in the elderly. This fact is largely due to fractures of the proximal femur and spine. As recently recognized, vertebral fractures are as much a threat to health and longevity as fractures of the proximal femur. In recent decades, the development of tools to evaluate fracture risk as well as medications to treat osteoporosis has altered the management of people who are at fracture risk. At the same time identification and management procedures concerning spinal fracturing are not very clear. Besides there is not even clear consensus about what exactly constitutes a vertebral fracture, particularly those of minor degree. While height loss is a simple and valuable tool to detect vertebral fractures, it is neither sensitive nor specific enough to replace radiographs. Some 65% of fractures cause no symptoms. Often vertebral fractures are misdiagnosed, especially if they have occurred silently and if the opportunity for diagnosis arises fortuitously. It is to the patient's benefit that radiologists report and physicians identify vertebral fractures evident on a chest or other radiograph, no matter how incidental to the immediate clinical indication for the examination. Technological evolution now allows dual-energy x-ray absorptiometry machines to be used to take spine images while doing a densitometry. The images are adequate, even if not of high radiographic quality, and, more important, the patient undergoes a smaller radiation dose than with conventional spinal radiographs. Such technology may promote fracture recognition. The recognition of vertebral fractures, as well as the prevention and treatment of further fractures, will likely do much to reduce both the burden of osteoporosis-related morbidity and mortality, as well as fracture-related costs to healthcare systems.

  16. Epidemiology of clavicle fractures.

    PubMed

    Postacchini, Franco; Gumina, Stefano; De Santis, Pierfrancesco; Albo, Francesco

    2002-01-01

    An epidemiologic study of 535 isolated clavicle fractures treated in a hospital of a large metropolis during an 11-year period was performed. Data regarding patient's age and sex, side involved, mechanism of injury, and season in which the fracture occurred were obtained from the clinical records. Radiographic classification was performed with the Allman system. Clavicle fractures represented 2.6% of all fractures and 44% of those in the shoulder girdle. Most patients were men (68%), and the left side was involved in 61% of cases. Fractures of the middle third of the clavicle, which were the most common (81%), were displaced in 48% of cases and comminuted in 19%. Fractures of the medial third were the least common (2%). The prevalence of midclavicular fractures was found to decrease progressively with age, starting from the first decade of life when they represented 88.2% of all clavicle fractures and were undisplaced in 55.5% of cases. In adults, the incidence of displaced fractures, independent of location, was higher than that of undisplaced fractures. Traffic accidents were the most common cause of the injury. In the period under study, the incidence of fractures showed no significant change over time and no seasonal variation. PMID:12378163

  17. Wear of a sequentially annealed polyethylene acetabular liner

    PubMed Central

    Gascoyne, Trevor C; Petrak, Martin J; Turgeon, Thomas R; Bohm, Eric R

    2014-01-01

    Background and purpose We previously reported on a randomized controlled trial (RCT) that examined the effect of adding tobramycin to bone cement after femoral stem migration. The present study examined femoral head penetration into both conventional and highly crosslinked polyethylene acetabular liners in the same group of RCT patients, with a minimum of 5 years of postoperative follow-up. Patients and methods Linear penetration of the femoral head into an X3 (Stryker) crosslinked polyethylene (XLPE) liner was measured in 18 patients (19 hips) using radiostereometric analysis (RSA). Femoral head penetration was also measured in 6 patients (6 hips) with a conventional polyethylene liner (CPE), which served as a control group. Results The median proximal femoral head penetration in the XLPE group after 5.5 years was 0.025 mm with a steady-state penetration rate of 0.001 mm/year between year 1 and year 5. The CPE liner showed a median proximal head penetration of 0.274 mm after 7.2 years, at a rate of 0.037 mm/year. Interpretation The Trident X3 sequentially annealed XLPE liner shows excellent in vivo wear resistance compared to non-crosslinked CPE liners at medium-term implantation. The rate of linear head penetration in the XLPE liners after > 5 years of follow-up was 0.001 mm/year, which is in close agreement with the results of previous studies. PMID:25140986

  18. Fluid-sorption phenomena in sterilized polyethylene acetabular prostheses.

    PubMed

    Clarke, I C; Starkebaum, W; Hosseinian, A; McGuire, P; Okuda, R; Salovey, R; Young, R

    1985-05-01

    The weight changes due to fluid-sorption were measured in 62 radiation-sterilized acetabular sockets and 10 unsterilized discs. The materials included two types of ultra-high molecular weight (UHMW) polyethylene (RCH 1000; Hi-Fax 1900) and a carbon-fibre-reinforced polyethylene (CFPE). The fluid absorption curve was consistently biphasic. In the first 30 d soak-period (Phase 1), the initial rate of fluid absorption averaged 153 micrograms/d for conventional UHMW polyethylene and 278 micrograms/d for carbon-fibre-reinforced polyethylene. In Phase 2, beyond 30 d and up to 400 d, fluid absorption reduced to linear rates of 27 micrograms/d for UHMW polyethylene and 43 micrograms/d for CFPE. The latter soak-weight-gain values corresponded to only 0.00016%/d and 0.00034%/d respectively. There was little difference in absorption rates between sterilized and unsterilized samples. However soak rates were generally higher in water compared to serum.

  19. Quantification of clearance and creep in acetabular wear measurements

    PubMed Central

    Gregory, Thomas; Vandenbussche, Eric

    2016-01-01

    Background This study aimed to measure femoral head penetration before occurrence of real wear, and to quantify the portions attributable respectively to clearance and plastic deformations in various acetabular designs. Methods We analyzed CT scans from 15 patients at ‘day five’ after total hip arthroplasty (THA). All patients received Exafit® femoral stems and 28 mm heads: 5 patients had cemented Durasul® all-PE cups, 5 patients had un-cemented Allofit® metal-backed cups, and 5 patients had un-cemented Stafit® dual-mobility cups. We also analyzed CT scans of samples of the three head-cup combinations to compare in vivo and in vitro measurements. Results The mean femoral head penetration measured on ‘day five’ was lower for all-PE cups (0.196 mm) than for metal-backed cups (0.551 mm) and dual-mobility cups (0.634 mm). Conclusions The present study indicates that isolated measurements of femoral head penetration include 0.15–0.46 mm of radial clearance and 0.05–0.27 mm of creep, and confirms that the majority of so-called bedding-in observed in the first post-operative months is not entirely due to wear. PMID:27162781

  20. The effect of acetabular cup size on the short-term stability of revision hip arthroplasty: a finite element investigation.

    PubMed

    Phillips, A T M; Pankaj; Usmani, A S; Howie, C R

    2004-01-01

    The study uses idealized two-dimensional finite element models to examine the behaviour of the acetabular construct following revision hip arthroplasty, carried out using the Slooff-Ling impaction grafting technique. The behaviour of bone graft was considered in detail, with non-linear elasticity and non-associated plasticity being adopted. Load was applied to the acetabular construct through a femoral head using smooth sliding surfaces. In particular, four models were subjected to two idealized cyclic load cases to investigate the effect of acetabular cup size on the short-term stability of the acetabular construct. The study suggests that benefits may be gained by using the largest practical size of acetabular cup. PMID:15376726

  1. The effect of acetabular cup size on the short-term stability of revision hip arthroplasty: a finite element investigation.

    PubMed

    Phillips, A T M; Pankaj; Usmani, A S; Howie, C R

    2004-01-01

    The study uses idealized two-dimensional finite element models to examine the behaviour of the acetabular construct following revision hip arthroplasty, carried out using the Slooff-Ling impaction grafting technique. The behaviour of bone graft was considered in detail, with non-linear elasticity and non-associated plasticity being adopted. Load was applied to the acetabular construct through a femoral head using smooth sliding surfaces. In particular, four models were subjected to two idealized cyclic load cases to investigate the effect of acetabular cup size on the short-term stability of the acetabular construct. The study suggests that benefits may be gained by using the largest practical size of acetabular cup.

  2. An assessment of fracture resistance of three composite resin core build-up materials on three prefabricated non-metallic posts, cemented in endodontically treated teeth: an in vitro study

    PubMed Central

    Pal, Bhupinder; Pujari, Prashant

    2015-01-01

    Endodontically treated teeth with excessive loss of tooth structure would require to be restored with post and core to enhance the strength and durability of the tooth and to achieve retention for the restoration. The non-metallic posts have a superior aesthetic quality. Various core build-up materials can be used to build-up cores on the posts placed in endodontically treated teeth. These materials would show variation in their bonding with the non-metallic posts thus affecting the strength and resistance to fracture of the remaining tooth structure. Aims. The aim of the study was to assess the fracture resistance of three composite resin core build-up materials on three prefabricated non-metallic posts, cemented in extracted endodontically treated teeth. Material and Methods. Forty-five freshly extracted maxillary central incisors of approximately of the same size and shape were selected for the study. They were divided randomly into 3 groups of 15 each, depending on the types of non-metallic posts used. Each group was further divided into 3 groups (A, B and C) of 5 samples each depending on three core build-up material used. Student’s unpaired ‘t’ test was also used to analyse and compare each group with the other groups individually, and decide whether their comparisons were statistically significant. Results. Luxacore showed the highest fracture resistance among the three core build-up materials with all the three posts systems. Ti-core had intermediate values of fracture resistance and Lumiglass had the least values of fracture resistance. PMID:25755926

  3. Clavicle fractures: individualizing treatment for fracture type.

    PubMed

    Housner, Jeffrey A; Kuhn, John E

    2003-12-01

    Clavicle fractures are common injuries in both children and adults. In most cases, the diagnosis can be made readily from the patient's history and physical examination. X-rays are helpful to confirm the diagnosis, to assess the severity of the fracture, and to follow interval healing. Most fractures are treated nonoperatively, and surgical intervention is typically reserved for unstable distal clavicle fractures. Nonoperative options involve either a sling-and-swathe or figure-of-eight splint. Return-to-play decisions should be individualized based on the age of the patient, location and severity of the fracture, degree of clinical and radiographic healing, and the sport in which the athlete will be participating.

  4. Use of porous tantalum for acetabular reconstruction in revision hip arthroplasty.

    PubMed

    Issack, Paul S

    2013-11-01

    ➤ Over the past decade, porous tantalum has emerged as a powerful tool for reconstruction of the failed acetabular component.➤ The increased porosity, high coefficient of friction, and favorable elastic modulus of porous tantalum compared with traditional titanium mesh or cobalt chromium acetabular components allow for greater bone ingrowth potential, implant stability, and host bone preservation, respectively, in porous tantalum shells.➤ Several studies have confirmed the excellent early and midterm results of porous tantalum reconstruction for revision hip arthroplasty.➤ Depending on the degree of bone loss, excellent results have been achieved with modular or revision porous tantalum shells, tantalum shells with tantalum augments, and cup-cage constructs.➤ These implants and techniques are greatly changing the approach to acetabular revision surgery and are providing constructs with greater stability and more physiologic biomechanical properties than those achieved through the use of traditional reconstructive methods.

  5. The results of acetabular impaction grafting in 129 primary cemented total hip arthroplasties.

    PubMed

    Wilson, Matthew J; Whitehouse, Sarah L; Howell, Jonathan R; Hubble, Matthew J W; Timperley, A John; Gie, Graham A

    2013-09-01

    Between 1995 and 2003, 129 cemented primary THAs were performed using full acetabular impaction grafting to reconstruct acetabular deficiencies. These were classified as cavitary in 74 and segmental in 55 hips. Eighty-one patients were reviewed at mean 9.1 (6.2-14.3) years post-operatively. There were seven acetabular component revisions due to aseptic loosening, and a further 11 cases that had migrated >5mm or tilted >5° on radiological review - ten of which reported no symptoms. Kaplan-Meier analysis of revisions for aseptic loosening demonstrates 100% survival at nine years for cavitary defects compared to 82.6% for segmental defects. Our results suggest that the medium-term survival of this technique is excellent when used for purely cavitary defects but less predictable when used with large rim meshes in segmental defects. PMID:23523217

  6. [Mecring threaded cup in total arthroplasty of the hip with acetabular protrusion].

    PubMed

    Bednarek, A; Blacha, J; Gagała, J

    1998-01-01

    Results of total arthroplasty of the hip with acetabular protrusion with the use of Mecring cup in 21 patients (25 hips) aged 25-75 years (mean 62) are reported. Morsalised impacted autografts were used to fill acetabular defect in all cases. There were 14 rheumatoid arthritis patients, 4 cases of osteoarthritis and 3 cases of Otto-Chrobak disease. Mean follow-up was 2.5 years (range 6 months-5 years). All autografts were incorporated after 6-9 months. Only one loosening and migration of the cup occurred. One patient died because of pulmonary embolism. Harris Hip Score increased from 37 points (22-49) preoperatively to 81 points (65-89) at the latest follow-up. Incorporation of autografts reinforced acetabular bottom and prevented recurrence of protrusion. Bone remodeling indicates restoring normal biomechanics of the hip.

  7. Oxidation and other property changes of retrieved sequentially annealed UHMWPE acetabular and tibial bearings.

    PubMed

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

    2015-04-01

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

  8. Impaction grafted bone chip size effect on initial stability in an acetabular model: Mechanical evaluation

    PubMed Central

    Holton, Colin; Bobak, Peter; Wilcox, Ruth; Jin, Zhongmin

    2013-01-01

    Introduction Acetabular bone defect reconstruction is an increasing problem for surgeons with patients undergoing complex primary or revision total hip replacement surgery. Impaction bone grafting is one technique that has favourable long-term clinical outcome results for patients who undergo this reconstruction method for acetabular bone defects. Creating initial mechanical stability of the impaction bone graft in this technique is known to be the key factor in achieving a favourable implant survival rate. Different sizes of bone chips were used in this technique to investigate if the size of bone chips used affected initial mechanical stability of a reconstructed acetabulum. Methodology Twenty acetabular models were created in total. Five control models were created with a cemented cup in a normal acetabulum. Then five models in three different groups of bone chip size were constructed. The three groups had an acetabular protrusion defect reconstructed using either; 2–4 mm3, 10 mm3 or 20 mm3 bone chip size for impaction grafting reconstruction. The models underwent compression loading up to 9500 N and displacement within the acetabular model was measured indicating the initial mechanical stability. Results This study reveals that, although not statistically significant, the largest (20 mm3) bone chip size grafted models have an inferior maximum stiffness compared to the medium (10 mm3) bone chip size. Interpretations Our study suggests that 10 mm3 size of bone chips provide better initial mechanical stability compared to smaller or larger bone chips. We dismissed the previously held opinion that the biggest practically possible graft is best for acetabular bone graft impaction. PMID:24396238

  9. Pathological fractures in children

    PubMed Central

    De Mattos, C. B. R.; Binitie, O.; Dormans, J. P.

    2012-01-01

    Pathological fractures in children can occur as a result of a variety of conditions, ranging from metabolic diseases and infection to tumours. Fractures through benign and malignant bone tumours should be recognised and managed appropriately by the treating orthopaedic surgeon. The most common benign bone tumours that cause pathological fractures in children are unicameral bone cysts, aneurysmal bone cysts, non-ossifying fibromas and fibrous dysplasia. Although pathological fractures through a primary bone malignancy are rare, these should be recognised quickly in order to achieve better outcomes. A thorough history, physical examination and review of plain radiographs are crucial to determine the cause and guide treatment. In most benign cases the fracture will heal and the lesion can be addressed at the time of the fracture, or after the fracture is healed. A step-wise and multidisciplinary approach is necessary in caring for paediatric patients with malignancies. Pathological fractures do not have to be treated by amputation; these fractures can heal and limb salvage can be performed when indicated. PMID:23610658

  10. Acetabular labral tears: focused review of anatomy, diagnosis, and current management.

    PubMed

    Huang, Ronald; Diaz, Claudio; Parvizi, Javad

    2012-05-01

    Acetabular labral tears have become an increasingly common diagnosis with the advancement of imaging techniques and hip arthroscopy. Therefore, understanding the anatomic significance, healing potential, and associated pathologies of labral tears is helpful. Furthermore, recognizing the clinical picture and understanding appropriate imaging techniques, such as magnetic resonance arthrography, are essential to making a correct diagnosis. This article reviews the relevant anatomy, diagnosis, and management of acetabular labral tears for physicians of all specialties who may be involved in the care of patients with labral tears. Short-term results of labral repair have been promising, but further studies are needed to clarify appropriate indications and long-term results of treatment. PMID:22759609

  11. Talar fractures: three case studies.

    PubMed

    Jimenez, A L; Morgan, J H

    2001-09-01

    Three case studies of fractures are presented that demonstrate the potential morbidity that these injuries can cause as well as the acceptable outcomes if treated appropriately. Two of the cases are talar fracture dislocations; the third is an osteochondral fracture of the talus. The importance of early treatment with open reduction and internal fixation is demonstrated. Success following surgical intervention in a nonhealed osteochondral fracture of the talus is also demonstrated.

  12. Pain clinic #15. Treatment of sciatic nerve causalgia following pelvic fracture.

    PubMed

    Sullivan, R J; Thomas, P S; Geel, C V

    1990-06-01

    Direct injury to the sciatic nerve may occur in patients who sustain acetabular/pelvic fractures. Sciatic nerve causalgia has been noted in patients who suffer posterior wall acetabular fracture with or without ipsilateral hip dislocation. Sympathetic nervous system dysfunction is considered the primary cause for this syndrome, although some investigators suggest central nervous system involvement. This report documents the treatment results of three patients suffering from sciatic nerve causalgia who were referred to the Pain Treatment Center during the past year. In each case, diagnosis was confirmed by sympathetic blockade. Treatment regimens varied and included nerve blocks, cryoanalgesia techniques, and transcutaneous electrical nerve stimulation therapy. The syndrome was relieved in these patients within four to six weeks. Patients were followed for six months after initial treatment. PMID:2367147

  13. Role of preoperative 3-dimensional computed tomography reconstruction in depressed skull fractures treated with craniectomy: a case report of forensic interest.

    PubMed

    Viel, Guido; Cecchetto, Giovanni; Manara, Renzo; Cecchetto, Attilio; Montisci, Massimo

    2011-06-01

    Patients affected by cranial trauma with depressed skull fractures and increased intracranial pressure generally undergo neurosurgical intervention. Because craniotomy and craniectomy remove skull fragments and generate new fracture lines, they complicate forensic examination and sometimes prevent a clear identification of skull fracture etiology. A 3-dimensional reconstruction based on preoperative computed tomography (CT) scans, giving a picture of the injuries before surgical intervention, can help the forensic examiner in identifying skull fracture origin and the means of production.We report the case of a 41-year-old-man presenting at the emergency department with a depressed skull fracture at the vertex and bilateral subdural hemorrhage. The patient underwent 2 neurosurgical interventions (craniotomy and craniectomy) but died after 40 days of hospitalization in an intensive care unit. At autopsy, the absence of various bone fragments did not allow us to establish if the skull had been stricken by a blunt object or had hit the ground with high kinetic energy. To analyze bone injuries before craniectomy, a 3-dimensional CT reconstruction based on preoperative scans was performed. A comparative analysis between autoptic and radiological data allowed us to differentiate surgical from traumatic injuries. Moreover, based on the shape and size of the depressed skull fracture (measured from the CT reformations), we inferred that the man had been stricken by a cylindric blunt object with a diameter of about 3 cm. PMID:21512384

  14. Assessment of bone healing on tibial fractures treated with wire osteosynthesis associated or not with infrared laser light and biphasic ceramic bone graft (HATCP) and guided bone regeneration (GBR): Raman spectroscopy study

    NASA Astrophysics Data System (ADS)

    Bastos de Carvalho, Fabíola; Aciole, Gilberth Tadeu S.; Aciole, Jouber Mateus S.; Silveira, Landulfo, Jr.; Nunes dos Santos, Jean; Pinheiro, Antônio L. B.

    2011-03-01

    The aim of this study was to evaluate, through Raman spectroscopy, the repair of complete tibial fracture in rabbits fixed with wire osteosynthesis - WO, treated or not with infrared laser light (λ 780nm, 50mW, CW) associated or not to the use of HATCP and GBR. Surgical fractures were created under general anesthesia (Ketamine 0.4ml/Kg IP and Xilazine 0.2ml/Kg IP), on the tibia of 15 rabbits that were divided into 5 groups and maintained on individual cages, at day/night cycle, fed with solid laboratory pelted diet and had water ad libidum. On groups II, III, IV and V the fracture was fixed with WO. Animals of groups III and V were grafted with hydroxyapatite + GBR technique. Animals of groups IV and V were irradiated at every other day during two weeks (16J/cm2, 4 x 4J/cm2). Observation time was that of 30 days. After animal death the specimens were kept in liquid nitrogen for further analysis by Raman spectroscopy. Raman spectroscopy showed significant differences between groups (p<0.001). It is concluded that IR laser light was able to accelerate fracture healing and the association with HATCP and GBR resulted on increased deposition of calcium hydroxyapatite.

  15. Sustained five-year benefit of autologous matrix-induced chondrogenesis for femoral acetabular impingement-induced chondral lesions compared with microfracture treatment.

    PubMed

    Fontana, A; de Girolamo, L

    2015-05-01

    The repair of chondral lesions associated with femoroacetabular impingement requires specific treatment in addition to that of the impingement. In this single-centre retrospective analysis of a consecutive series of patients we compared treatment with microfracture (MFx) with a technique of enhanced microfracture autologous matrix-induced chondrogenesis (AMIC). Acetabular grade III and IV chondral lesions measuring between 2 cm(2) and 8 cm(2) in 147 patients were treated by MFx in 77 and AMIC in 70. The outcome was assessed using the modified Harris hip score at six months and one, two, three, four and five years post-operatively. The outcome in both groups was significantly improved at six months and one year post-operatively. During the subsequent four years the outcome in the MFx group slowly deteriorated, whereas that in the AMIC group remained stable. Six patients in the MFx group subsequently required total hip arthroplasty, compared with none in the AMIC group We conclude that the short-term clinical outcome improves in patients with acetabular chondral damage following both MFx and AMIC. However, the AMIC group had better and more durable improvement, particularly in patients with large (≥ 4 cm(2)) lesions.

  16. Development of a non-invasive diagnostic technique for acetabular component loosening in total hip replacements.

    PubMed

    Alshuhri, Abdullah A; Holsgrove, Timothy P; Miles, Anthony W; Cunningham, James L

    2015-08-01

    Current techniques for diagnosing early loosening of a total hip replacement (THR) are ineffective, especially for the acetabular component. Accordingly, new, accurate, and quantifiable methods are required. The aim of this study was to investigate the viability of vibrational analysis for accurately detecting acetabular component loosening. A simplified acetabular model was constructed using a Sawbones(®) foam block. By placing a thin silicone layer between the acetabular component and the Sawbones block, 2- and 4-mm soft tissue membranes were simulated representing different loosening scenarios. A constant amplitude sinusoidal excitation with a sweep range of 100-1500 Hz was used. Output vibration from the model was measured using an accelerometer and an ultrasound probe. Loosening was determined from output signal features such as the number and relative strength of observed harmonic frequencies. Both measurement methods were sufficient to measure the output vibration. Vibrational analysis reliably detected loosening corresponding to both 2 and 4 mm tissue membranes at driving frequencies between 100 and 1000 Hz (p < 0.01) using the accelerometer. In contrast, ultrasound detected 2-mm loosening at a frequency range of 850-1050 Hz (p < 0.01) and 4-mm loosening at 500-950 Hz (p < 0.01). PMID:26054805

  17. Acetabular protrusio: surgical technique of dealing with a problem in depth.

    PubMed

    Mullaji, A B; Shetty, G M

    2013-11-01

    There are few reports describing the technique of managing acetabular protrusio in primary total hip replacement. Most are small series with different methods of addressing the challenges of significant medial and proximal migration of the joint centre, deficient medial bone and reduced peripheral bony support to the acetabular component. We describe our technique and the clinical and radiological outcome of using impacted morsellised autograft with a porous-coated cementless cup in 30 primary THRs with mild (n = 8), moderate (n = 10) and severe (n = 12) grades of acetabular protrusio. The mean Harris hip score had improved from 52 pre-operatively to 85 at a mean follow-up of 4.2 years (2 to 10). At final follow-up, 27 hips (90%) had a good or excellent result, two (7%) had a fair result and one (3%) had a poor result. All bone grafts had united by the sixth post-operative month and none of the hips showed any radiological evidence of recurrence of protrusio, osteolysis or loosening. By using impacted morsellised autograft and cementless acetabular components it was possible to achieve restoration of hip mechanics, provide a biological solution to bone deficiency and ensure long-term fixation without recurrence in arthritic hips with protrusio undergoing THR. PMID:24187349

  18. [A simulative biomechanical experiment on different position of none-cement acetabular components influencing the load distribution around acetabulum].

    PubMed

    Li, Dongsong; Liu, Jianguo; Li, Shuqiang; Fan, Honghui; Guan, Jikui

    2008-02-01

    In the present study, a three dimensional finite-element model of the human pelvic was reconstructed, and then, under different acetabular component position (the abduction angle ranges from 30 degrees to 70 degrees and the anteversion ranges from 5 degrees to 30degrees) the load distribution around the acetabular was evaluated by the computer biomechanical analysis program (Solidworks). Through the obtained load distribution results, the most even and reasonable range of the distribution was selected; therefore the safe range of the acetabular component implantation can be validated from the biomechanics aspect.

  19. Effects of recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) in grade III open tibia fractures treated with unreamed nails-A clinical and health-economic analysis.

    PubMed

    Alt, Volker; Borgman, Benny; Eicher, Alexander; Heiss, Christian; Kanakaris, Nikolaos K; Giannoudis, Peter V; Song, Fujian

    2015-11-01

    Recombinant human Bone Morphogenetic Protein-2 (rhBMP-2) is licensed in Europe for open tibia fractures treated with unreamed nails. However, there is limited data available on the specific use of rhBMP-2 in combination with unreamed nails for open tibia fractures. The intention of the current study was to evaluate the medical and health-economic effects of rhBMP-2 in Gustilo-Anderson grade III open tibia fractures treated with unreamed nails based on individual patient data from two previously published studies. Linear regression analysis was performed on raw data of 90 patients that were either treated by standard of care with soft tissue management and unreamed nailing (SOC group) (n=50) or with rhBMP-2 in addition to soft tissue management and unreamed nailing (rhBMP-2 group) (n=40). For all types of revision, a significant lower percentage of patients (27.5%) of the rhBMP-2 group had to be revised compared to 48% of the patients of the SOC group (p=0.04). When only invasive secondary interventions such as bone grafting and nail exchange were considered, there was also a statistically significant reduction in the rhBMP-2 group with a revision rate of 10.0% (4 of 40 patients) compared to the SOC group with a revision rate of 28.0% (14 of 50 patients) (p=0.01). Mean fracture healing time of 228 days in the rhBMP-2 compared to 266 days in the SOC group was not statistically significant (p=0.24). Health-economic analysis based on a societal perspective with calculation of overall treatment costs after initial surgery and including productivity losses revealed savings of €6,239 per patient for Germany and €4,752 for the UK in favour of rhBMP-2 which was mainly driven by reduction of productivity losses. In conclusion, rhBMP-2 reduces secondary interventions in patients with grade III open tibia fractures treated with an unreamed nail and its use leads to financial savings for Germany and the UK from a societal perspective.

  20. Comparison of Clinical Outcomes of Phalangeal Fracture Treated with Dorsolateral Approach or Post-middle Approach Using AO Mini Titanium Plate.

    PubMed

    Li, Guang; Liu, Shen; Chen, Guoting; Li, Zengchun; Liu, Yangzhou; Sun, Guixin; Lu, Qingyou; Li, Xia; Tan, Jun; Guan, Ming

    2015-12-01

    The aim of this study is to investigate the clinical outcomes of various fixation methods for proximal phalangeal fractures with Arbeitsgemeinschaft für Osteosynthesefragen (AO) mini titanium plate by dorsolateral approach or post-middle approach. Clinical results of 62 fingers of 53 patients with proximal phalangeal fracture were evaluated. For dorsolateral approach, the lateral bundle of the extensor tendon was drawn away to expose the fracture part of the bone. After reduction, the plate was located at the dorsolateral side of the bone. For post-middle approach, the extensor tendon was split to expose the fracture part of the bone. After reduction, the plate was fixed to the proximal phalangeal side of the bone, and the extensor tendon was repaired with 3-0 nonabsorbable silk sutures. We found low overall complication rates in both groups. The mean total active motion (TAM) for the dorsolateral group and post-middle group was 234.60° ± 22.63° and 221.08° ± 25.69°, respectively. There was a statistical significance between the two groups (P = 0.037 < 0.05), indicating that TAM was notably affected by various fixation methods. With AO mini titanium plate, movement in dorsolateral approach group was significantly higher than in post-middle approach group. Dorsolateral approach is an acceptable technique of incision for proximal phalangeal fractures. PMID:26730082

  1. A novel classification to guide total hip arthroplasty for adult acetabular dysplasia

    PubMed Central

    ZHU, CHEN; CHENG, MENG-QI; CHENG, TAO; MA, RUI-XIANG; KONG, RONG; GUO, YONG-YUAN; QIN, HUI; SHI, SI FENG; ZHANG, XIAN-LONG

    2013-01-01

    In the field of hip arthroplasties, the secondary fixation of the implants depends directly on the quality of the primary stability. A good acetabular fit and metaphyseal filling between the prostheses and implants improve the initial stabilization, and optimize the transmission of forces to the bone. A precise knowledge of the three-dimensional acetabular or femoral shape is essential to the selection of adapted implants. A total of 63 patients diagnosed with developmental dysplasia were analyzed by three-dimensional computed tomography (3DCT), and the preoperative radiographic and 3DCT images were used to assess the acetabular/femoral deformities and variations of the hips. All joints were classified as Crowe type I, and bilateral measurements were taken for 10 patients. The acetabular abnormalities were classified according to the type of deficiency and the section angles of the acetabulum, with 26 hips (36%) classified as an anterior deficiency, 13 hips (18%) as a posterior deficiency and 34 hips (46%) as a lateral deficiency. The femoral side deformities were divided into three types according to the anteversion angle of the femur. A gradual increase in anteversion angle led to secondary rotational anomalies, and a narrowing of the canal at the isthmus. A total of 35 hips (48%) were classified as an F1 type deficiency, femur anteversion angle (FAVA) <30°; 32 hips (44%) as F2-type, 30°≤ FAVA ≤40°, with mild abnormalities of the femoral canal rotation and the diameter of the isthmus; and 6 hips (8%) as F3 type, FAVA >40°, with significant abnormalities of the femoral canal rotation and the diameter of the isthmus. This novel classification for adult acetabular dysplasia may provide a useful guide for surgery, and enable an improved selection of a suitable prosthesis. PMID:23935749

  2. Ex vivo fracture resistance of endodontically treated maxillary central incisors restored with fiber-reinforced composite posts and experimental dentin posts

    PubMed Central

    Kathuria, Ambica; Kavitha, M; Khetarpal, Suchit

    2011-01-01

    Aim: To compare the fracture resistance of teeth restored with fiber-reinforced composite (FRC) posts and experimental dentin posts milled from human root dentin. Materials and Methods: Thirty maxillary central incisors were divided into three groups of ten each. Twenty teeth were restored with FRC posts and solid dentin posts and numbered as Groups 2 and 3 respectively while Group 1 acted as the control, without any post. The teeth were loaded at 135° angle to their long axes after core build-up and the failure loads were recorded. Results: One-way Analysis of Variance (ANOVA) and Bonferroni multiple comparisons revealed a significant difference among test groups with the control group showing the highest fracture resistance, followed by the dentin post group and lastly the FRC post group. Conclusions: Teeth restored with dentin posts exhibited better fracture resistance than those restored with FRC posts. PMID:22144812

  3. Tantalum acetabular augments in one-stage exchange of infected total hip arthroplasty: a case-control study.

    PubMed

    Klatte, Till Orla; Kendoff, Daniel; Sabihi, Reza; Kamath, Atul F; Rueger, Johannes M; Gehrke, Thorsten

    2014-07-01

    During the one-stage exchange procedure for periprosthetic joint infection (PJI) after total hip arthroplasty (THA), acetabular defects challenge reconstructive options. Porous tantalum augments are an established tool for addressing acetabular destruction in aseptic cases, but their utility in septic exchange is unknown. This retrospective case-control study presents the initial results of tantalum augmentation during one-stage exchange for PJI. Primary endpoints were rates of re-infection and short-term complications associated with this technique. Study patients had no higher risk of re-infection with equivalent durability at early follow-up with a re-infection rate in both groups of 4%. In conclusion, tantalum augments are a viable option for addressing acetabular defects in one-stage exchange for septic THA. Further study is necessary to assess long-term durability when compared to traditional techniques for acetabular reconstruction.

  4. Fracture resistance exhibited by endodontically treated and retreated teeth shaped by ProTaper NEXT versus WaveOne: An in vitro study

    PubMed Central

    Khalap, Neha Deepak; Hegde, Vibha; Kokate, Sharad

    2015-01-01

    Aim: To compare the fracture resistance exhibited by teeth after primary endodontic treatment and retreatment. Materials and Methods: One hundred freshly extracted human teeth were selected. 20 samples served as control (untreated). Eighty experimental samples were divided into two groups (n = 40) for instrumentation using rotary Protaper NEXT (PTN) or reciprocating WaveOne (WO) files and obturated using warm lateral compaction. Half of the samples (n = 20) from each group were subjected to a load. The remaining half were subjected to retreatment using Protaper universal retreatment files (RFs) followed by a file larger than the master apical file used in groups 1 and 2 and reobturated. Group A: Control, Group B: PTN + obturation, Group C: WO + obturation, Group D: RF + PTN + obturation and Group E: RF + WO + obturation. The retreatment specimens were also subjected to load and the readings acquired were statistically analyzed. Result: When compared between the groups, control group exhibited the highest fracture resistance (P < 0.01). When multiple tests were performed, Group E exhibited significantly less fracture resistance (P < 0.01). Conclusion: Endodontic treatment and retreatment both results in lowering the fracture resistance of a tooth. PMID:26752838

  5. Distal third humeri fractures treated using the Synthes™ 3.5-mm extra-articular distal humeral locking compression plate: clinical, radiographic and patient outcome scores

    PubMed Central

    Lewis, James; Rao, Prasad; Parfitt, Dan; Mohanty, Khitish; Ghandour, Adel

    2014-01-01

    Background Conventional management protocols for distal humeral extra-articular fractures (e.g. conservative, double columnar plating) are often associated with complications. We aimed to describe our experience of using the Synthes™ 3.5-mm extra-articular distal humeral locking compression plate for treatment of extra-articular distal humeral fractures. Methods We prospectively studied 23 consecutive patients who underwent fixation, in a tertiary trauma centre, over 2 years. Data, including patient demographics, duration of follow-up, patient satisfaction, visual analogue score (VAS), Oxford Elbow Score, and final outcome on discharge, were collected and analyzed. Results Of the 23 patients (12 males, 11 females; mean age 47.5 years; range 18 years to 89 years), all fractures united radiologically and clinically after the index procedure, with a mean time to fracture union of 15.7 weeks (range 9 weeks to 34 weeks) and a mean time to discharge of 17.8 weeks (range 13 weeks to 34 weeks). Oxford Elbow Score was 36.5 (range 11 to 48) at 4.6 months postoperatively; at 20 months follow-up, it was 40 (range 14 to 48) and the VAS was 8.5 (range 5 to 10). One patient had radial nerve neuropraxia pre-operatively, and one postoperatively, and both recovered uneventfully 3 months postoperatively. Neither superficial, nor deep infections were observed in this cohort. Conclusions The present study reports satisfactory outcome with the usage of the Synthes plate for extra-articular fracture management. It has become the technique of choice in our centre because it provides excellent results. PMID:27582964

  6. The incidence of fragility fractures in Italy.

    PubMed

    Ratti, Chiara; Vulcano, Ettore; La Barbera, Giuseppe; Canton, Gianluca; Murena, Luigi; Cherubino, Paolo

    2013-10-01

    Osteoporosis can significantly impact on the risk of developing a fracture. Thus, fragility fractures represent a challenge for health professionals and decision makers of the twenty-first century. The aim of this work is to review the literature concerning osteoporotic fractures in Italy in terms of incidence, rate of hospitalization, relative risk of a new fragility fracture, and costs for the national health system. It was estimated that the costs of treating proximal femur fragility fractures in 2002 summed up to 1 billion Euros. The number of fragility fractures in Italy was calculated as follows: 91.494 hip fractures, 61.009 clinical vertebral fractures, 57.401 humeral fragility fractures, and 94.045 forearm/wrist fragility fractures. The incidence of fragility fractures in Italy is very high, and osteoporosis is the leading cause of morbidity in the Italian population. PMID:24046040

  7. Evaluation and management of toe fractures.

    PubMed

    Hatch, Robert L; Hacking, Scott

    2003-12-15

    Fractures of the toe are one of the most common lower extremity fractures diagnosed by family physicians. Toe fractures most frequently are caused by a crushing injury or axial force such as stubbing a toe. Joint hyperextension and stress fractures are less common. Most patients have point tenderness at the fracture site or pain with gentle axial loading of the digit. Anteroposterior and oblique radiographs generally are most useful for identifying fractures, determining displacement, and evaluating adjacent phalanges and digits. Referral is indicated in patients with circulatory compromise, open fractures, significant soft tissue injury, fracture-dislocations, displaced intra-articular fractures, or fractures of the first toe that are unstable or involve more than 25 percent of the joint surface. Most children with fractures of the physis should be referred, but children with selected nondisplaced Salter-Harris types I and II fractures may be treated by family physicians. Stable, nondisplaced toe fractures should be treated with buddy taping and a rigid-sole shoe to limit joint movement. Displaced fractures of the lesser toes should be treated with reduction and buddy taping. Patients with displaced fractures of the first toe often require referral for stabilization of the reduction.

  8. Estimating fracture geometry in the naturally fractured Antrim Shale

    SciTech Connect

    Hopkins, C.W.; Frantz, J.H. Jr.; Hill, D.G.

    1995-12-31

    The Antrim Shale of the Michigan Basin has been an active gas play with over 3,500 wells drilled over the last 5 years. There is substantial evidence that the Antrim must be fracture stimulated to be economical and that two-stage treatments provide the best results. However, due to the shallow depths (500-2300 ft) and naturally fractured nature of the Antrim, fracture geometry is complex, and determination of optimal fracture treatments is not straight forward. Because historical field comparisons did not provide insight on the optimal fracture treatments, the Gas Research Institute (GRI) instituted a field-based project for the specific purpose of evaluating the geometry of hydraulic fractures in the Antrim. Open- and cased-hole tests were performed on two separate Antrim wells - a shallow producer (600 {+-} ft) and a deep producer (1550 {+-} ft). Open-hole testing and data collection consisted of in-situ stress and mechanical property testing with Halliburton`s THE{trademark} Tool (9 tests) and a detailed suite of geophysical logs including dipole sonic logs and natural fracture detection logs. Cased-hole testing consisted of pre- and post-fracture injection/falloff tests, minifracture treatments, multiple isotope tracer and tracer logs, and treating pressure and production data analysis. The shallow depths, low in-situ stresses, and extremely fractured nature of the Antrim probably results in the preferential opening of existing fractures instead of the creation of new fracture planes. As a result, the creation of multiple fractures and severe near wellbore tortuosity is likely. Therefore, the natural fractures are responsible for increased leakoff and will greatly impact created fracture geometry. The results also suggest that creating long propped hydraulic fractures in the Antrim is not likely due to the creation of multiple fractures.

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

    PubMed

    Chen, Xu; Li, Jian-Jun; Kong, Zhan; Yang, Dong-Xiang; Yuan, Xiang-Nan

    2011-01-01

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

  10. Early predictors of acetabular growth after closed reduction in late detected developmental dysplasia of the hip.

    PubMed

    Li, YiQiang; Xu, HongWen; Li, JingChun; Yu, LingJia; Liu, YuanZhong; Southern, Edward; Liu, HongSheng

    2015-01-01

    This study evaluates improvement of the acetabular index (AI) in patients with developmental dysplasia of the hip at 4 years after closed reduction, and determines the association between the final AI and a set of factors. Sixty-two patients (74 hips) treated with closed reduction were categorized into three groups according to age: group A (0-12 months, 18 hips), group B (13-18 months, 24 hips), and group C (>18 months, 32 hips). There was no difference in AI among the three groups before reduction (P=0.293). In groups A and C, the AI decreased significantly over time until 3 years after reduction and no differences were observed between the time points of 3 and 4 years. At 4 years after reduction, the AI of group C was significantly higher than that of groups A (P<0.001) and B (P=0.012). The overall AI improvement rate was 28.63%. The AI improvement rate of group A was significantly higher than that of group C (P=0.005). Pearson correlation analysis indicated no correlation between center-head distance discrepancy and the final AI (P=0.811). Linear regression suggested that age and initial AI correlated significantly with the final AI (R=0.617, F=15.031, P<0.001). Other factors, such as sex, center-edge angle of Wiberg, bilaterally involved, and avascular necrosis of the femoral head, showed no correlations with the final AI (P>0.05). According to the coefficients, initial AI (β1=0.432, P<0.001) had greater effect than age (β2=0.197, P=0.023) on the final AI. In conclusion, the AI decreases in all patients after reduction and stabilizes at 3 years after reduction. The AI improvement rate is correlated negatively with age. Age and initial AI are early predictors of the progress of AI after closed reduction in developmental dysplasia of the hip patients. PMID:25305044

  11. The economic impact of surgically treated peri-prosthetic hip fractures on a university teaching hospital in Wales 7.5-year study.

    PubMed

    Jones, Andrew R; Williams, Tim; Paringe, Vishal; White, Simon P

    2016-02-01

    The number of total hip replacements taking place across the UK continues to grow. In an ageing population, with people placing greater demands on their prostheses, the number of peri-prosthetic fractures is increasing. We studied the economic impact this has on a large teaching hospital. All patients with peri-prosthetic femoral fracture in a 7.5 year period were identified. Radiographic and case note analysis was performed. Costings from the finance departments were obtained. 90 cases were identified, 58 female and 32 male, with a mean age of 76 (range: 38-91). 89 of the cases were managed surgically, 66% undergoing revision and 33% receiving open reduction and internal fixation. According to the Vancouver Classification, 3% were Type A, 79% Type B and 18% Type C. The mean length of stay was 43 days. The mean cost of management was £31,370 (range: £6885-£112,327). Patients with type C fractures had the highest mean length of stay at 53 days and mean cost of £33,417. Including rehabilitation costs, our study illustrated a mean cost of £31,370, roughly four times the current basic NHS tariff of £8552. Although implant costs are greater, treatment with revision where appropriate allows earlier weight bearing, reduced length of stay and lower overall cost. PMID:26689495

  12. An in vitro comparative evaluation of different intraorifice barriers on the fracture resistance of endodontically treated roots obturated with gutta-percha

    PubMed Central

    Gupta, Abhishek; Arora, Vipin; Jha, Padmanabh; Nikhil, Vineeta; Bansal, Parul

    2016-01-01

    Aim: To compare and evaluate the root reinforcement potential of four different intraorifice barriers: Mineral trioxide aggregate (MTA), resin-modified glass ionomer cement (RMGIC), fiber-reinforced composite (FRC), and nanohybrid composite (NC). Materials and Methods: Seventy-five mandibular premolars were decoronated to a standardized length, and prepared and obturated with gutta-percha and AH Plus sealer. Except for control specimens, the coronal 3-mm gutta-percha was removed and filled with different materials. The specimens (75) were divided into five groups (n = 15) on the basis of the intraorifice barrier material used. Group 1: MTA, Group 2: RMGIC, Group 3: FRC, Group 4: NC, Group 5: no barrier (control). Fracture resistance of the specimens was tested. Results: Fracture resistance of roots was significantly affected by the type of intraorifice barrier used and the following pattern was observed: RMGIC > FRC > NC > MTA. Conclusion: Intraorifice barriers can be regarded as a viable choice to reduce the occurrence of postendodontic root fractures. Among the four tested materials, RMGIC showed the maximum reinforcement. PMID:27099413

  13. Augmentation of the transverse acetabular ligament in canine caudoventral hip luxation.

    PubMed

    Venzin, C; Montavon, P M

    2007-01-01

    Open surgical fixation was performed on four hip joints in three dogs who were suffering from caudoventral hip luxations for which closed reduction had previously failed. Stabilization of the joint was achieved with a ventral coxofemoral approach, which augmented the function of the transverse acetabular ligament using a sling implant through a bone tunnel (n = 1), a sling implant around two pelvic screws (n = 1), or an internal fixator plate (n = 2). Transverse acetabular ligament augmentation resulted in successful joint stabilization in all cases, and should be considered for the surgical reduction of caudoventral hip luxations in dogs. The use of an internal fixator plate, while preserving soft-tissue blood supply and resulting in minimal to no long-term arthritic changes, may provide an optimal outcome. PMID:18038012

  14. Advanced material modelling in numerical simulation of primary acetabular press-fit cup stability.

    PubMed

    Souffrant, R; Zietz, C; Fritsche, A; Kluess, D; Mittelmeier, W; Bader, R

    2012-01-01

    Primary stability of artificial acetabular cups, used for total hip arthroplasty, is required for the subsequent osteointegration and good long-term clinical results of the implant. Although closed-cell polymer foams represent an adequate bone substitute in experimental studies investigating primary stability, correct numerical modelling of this material depends on the parameter selection. Material parameters necessary for crushable foam plasticity behaviour were originated from numerical simulations matched with experimental tests of the polymethacrylimide raw material. Experimental primary stability tests of acetabular press-fit cups consisting of static shell assembly with consecutively pull-out and lever-out testing were subsequently simulated using finite element analysis. Identified and optimised parameters allowed the accurate numerical reproduction of the raw material tests. Correlation between experimental tests and the numerical simulation of primary implant stability depended on the value of interference fit. However, the validated material model provides the opportunity for subsequent parametric numerical studies.

  15. An increase in cranial acetabular version with age: implications for femoroacetabular impingement.

    PubMed

    Kopydlowski, Nathan J; Tannenbaum, Eric P; Bedi, Asheesh; Smith, Matthew V; Sekiya, Jon K

    2014-09-01

    This cadaveric study aimed to determine if acetabular retroversion demonstrates predictable changes with age that could inform understanding of factors that may contribute to the pathophysiology of femoroacetabular impingement. Two-hundred forty pelves were divided into young and old groups. Version was measured at the cranial (5mm below superior rim), central (transverse of acetabulum), and caudal (5mm above inferior rim) locations. The data showed a significant difference between young (10±10°) and old (13±9°) cranial version (P=.02). Cranial retroversion increases with age and may reflect a developmental component in the etiology of the focal rim impingement lesion or ossification of the damaged labrum. Global acetabular retroversion does not appear to change with age and may reflect a congenital etiology.

  16. Corrosion on the acetabular liner taper from retrieved modular metal-on-metal total hip replacements.

    PubMed

    Gascoyne, Trevor C; Dyrkacz, Richard M; Turgeon, Thomas R; Burnell, Colin D; Wyss, Urs P; Brandt, Jan-M

    2014-10-01

    Eight retrieved metal-on-metal total hip replacements displayed corrosion damage along the cobalt-chromium alloy liner taper junction with the Ti alloy acetabular shell. Scanning electron microscopy indicated the primary mechanism of corrosion to be grain boundary and associated crevice corrosion, which was likely accelerated through mechanical micromotion and galvanic corrosion resulting from dissimilar alloys. Coordinate measurements revealed up to 4.3mm(3) of the cobalt-chromium alloy taper surface was removed due to corrosion, which is comparable to previous reports of corrosion damage on head-neck tapers. The acetabular liner-shell taper appears to be an additional source of metal corrosion products in modular total hip replacements. Patients with these prostheses should be closely monitored for signs of adverse reaction towards corrosion by-products.

  17. Discrepancies in measuring acetabular coverage: revisiting the anterior and lateral center edge angles

    PubMed Central

    Hanson, Joey A.; Kapron, Ashley L.; Swenson, Kathryn M.; Maak, Travis G.; Peters, Christopher L.; Aoki, Stephen K.

    2015-01-01

    The lateral center edge angle (LCEA) and the anterior center edge angle (ACEA) are commonly used to assess acetabular coverage of the femoral head. There are two distinct methods found in the literature to obtain these angles, specifically, measuring to the most lateral bone edge versus the sclerotic lateral sourcil edge. A difference between these two methods may contribute to inconsistent estimates of acetabular coverage, and potentially lead to clinical misdiagnosis and treatment mismanagement. The objectives of this study were to quantify the difference between bone edge and sourcil edge measurements and to determine how the difference influences the classification of acetabular coverage in adult patients with suspected hip pathomorphology. Two observers completed the measurements independently using preoperative anteroposterior and false profile radiographs. Bland–Altman plots and paired t-tests were used to compare measurement methods. Bone and sourcil measurements of the LCEA and ACEA were significantly different (both P < 0.001). On average, the bone LCEA was 4° (95% limits of agreement = −2° to 10°) greater than the sourcil LCEA. The bone ACEA was, on average, 10° (95% limit of agreement = −2° to 22°) greater than the sourcil ACEA. The differences often led to different clinical classifications for the same hip. With a statistically and clinically significant difference in the quantification of acetabular coverage using bone edge versus sourcil edge methods for measuring the LCEA and ACEA in adult patients, it should be mandatory to clearly identify which method was used in each study. PMID:27011850

  18. An Unusual Complication Seen in a Six-Year-Old Girl Treated with Open Reduction and Pemberton Osteotomy for Neglected Developmental Dysplasia of the Hip: A Femoral Neck Fracture Sustained during Passive Motion under General Anesthesia.

    PubMed

    Uruc, Vedat; Karabulut, Samet

    2014-01-01

    Despite the screening programs for newborn children with hip ultrasonography, neglected developmental dysplasia of the hip (DDH) is still continuing to be a problem in the east and southeast parts of our country. The main complications are redislocation, avascular necrosis, and joint stiffness. We present an unusual complication, femoral neck fracture during passive motion under general anesthesia, of a six-year-old girl with neglected DDH treated by open reduction and Pemberton osteotomy without femoral shortening. The fracture was treated by open reduction and internal fixation combined with proximal femoral shortening. After 5 years the patient had excellent clinical results, no avascular necrosis was seen, and the radiologic appearance was type IA according to modified Severin classification. In conclusion older children with neglected DDH are more likely to have joint stiffness after open reduction. If there is even a little doubt about joint stiffness after open reduction, one should not refrain from femoral shortening. Also passive motion under general anesthesia should be applied very carefully with fluoroscopic control. PMID:24971184

  19. Elbow Fractures

    MedlinePlus

    ... and held together with pins and wires or plates and screws. Fractures of the distal humerus (see ... doctor. These fractures usually require surgical repair with plates and/or screw, unless they are stable. SIGNS ...

  20. Postural correction reduces hip pain in adult with acetabular dysplasia: a case report

    PubMed Central

    Lewis, Cara L.; Khuu, Anne; Marinko, Lee

    2015-01-01

    Developmental dysplasia of the hip is often diagnosed in infancy, but less severe cases of acetabular dysplasia are being detected in young active adults. The purpose of this case report is to present a non-surgical intervention for a 31-year-old female with mild acetabular dysplasia and an anterior acetabular labral tear. The patient presented with right anterior hip and groin pain, and she stood with the trunk swayed posterior to the pelvis (swayback posture). The hip pain was reproduced with the anterior impingement test. During gait, the patient maintained the swayback posture and reported 6/10 hip pain. Following correction of the patient’s posture, the patient’s pain rating was reduced to a 2/10 while walking. The patient was instructed to maintain the improved posture. At the 1 year follow-up, she demonstrated significantly improved posture in standing and walking. She had returned to recreational running and was generally pain-free. The patient demonstrated improvement on self-reported questionnaires for pain, function and activity. These findings suggest that alteration of posture can have an immediate and lasting effect on hip pain in persons with structural abnormality and labral pathology. PMID:25731688

  1. Articular cartilage friction increases in hip joints after the removal of acetabular labrum.

    PubMed

    Song, Yongnam; Ito, Hiroshi; Kourtis, Lampros; Safran, Marc R; Carter, Dennis R; Giori, Nicholas J

    2012-02-01

    The acetabular labrum is believed to have a sealing function. However, a torn labrum may not effectively prevent joint fluid from escaping a compressed joint, resulting in impaired lubrication. We aimed to understand the role of the acetabular labrum in maintaining a low friction environment in the hip joint. We did this by measuring the resistance to rotation (RTR) of the hip, which reflects the friction of the articular cartilage surface, following focal and complete labrectomy. Five cadaveric hips without evidence of osteoarthritis and impingement were tested. We measured resistance to rotation of the hip joint during 0.5, 1, 2, and 3 times body weight (BW) cyclic loading in the intact hip, and after focal and complete labrectomy. Resistance to rotation, which reflects articular cartilage friction in an intact hip was significantly increased following focal labrectomy at 1-3 BW loading, and following complete labrectomy at all load levels. The acetabular labrum appears to maintain a low friction environment, possibly by sealing the joint from fluid exudation. Even focal labrectomy may result in increased joint friction, a condition that may be detrimental to articular cartilage and lead to osteoarthritis.

  2. The biological approach in acetabular revision surgery: impaction bone grafting and a cemented cup.

    PubMed

    Colo, Ena; Rijnen, Wim H C; Schreurs, Berend Willem

    2015-01-01

    Acetabular impaction bone grafting (IBG) in combination with a cemented cup in revision total hip arthroplasty (THA) is a proven and well-recognised technique which has been used in clinical practice for more than 35 years. Nowadays, with cemented prostheses tending to lose a larger part of the THA market every year in primary and revision cases, and many young surgeons being only trained in implanting uncemented prostheses, this technique is considered by many as technically demanding and time consuming, making its use less appealing. Despite this image and many new innovative techniques using uncemented implants in acetabular revisions over the last 25 years, IBG with a cemented cup is still one of the few techniques that really can reconstitute bone and respects human biology. In this era of many biologically-based breakthroughs in medicine, it is hard to explain that the solution of most orthopaedic surgeons for the extensive bone defects as frequently seen during acetabular revision surgery, consists of implanting bigger and larger metal implants. This review aims to put the IBG method into a historical perspective, to describe the surgical technique and present the clinical results.

  3. The Burch-Schneider antiprotrusio cage in revision hip arthroplasty with acetabular bone defect.

    PubMed

    Blacha, Jan; Gagała, Jacek

    2004-10-30

    Background. This article presents early outcome of revision hip arthroplasties with massive defects of acetabular bone stock using the Burch-Schneider (B-S) antiprotrusio cage. Materials and methods. We prospectively followed 28 hips in 27 patients (17 women and 10 men). The average age of the patients was 68 years (range 40-82). Follow-up ranged from 12 to 53 months (ave. 25 months). Combined bone loss (type III according to the AAOS classification) was the most common (75% of the patients). Bone grafts (morselized and solid) were used to reconstruct deficient acetabula in 25 hips. Results. The patients were satisfied with the surgical result. The mean Harris Hip Score increased 36 points one year after operation and reached 80 points (range 56-93). The antiprotrusio cages were stable in all hips, even in 4 cases of inferior flange malposition. We found no measurable implant migration or graft resorption in any patient. Postoperative dislocation occurred in 3 hips (11%), two of them developed recurrent dislocations. There were no deep infections. Conclusions. Acetabular reconstruction using the Burch-Schneider antiprotrusio cage can be successfully used in managing massive acetabular defects in revision hip arthroplasty. The cage provides the basis for bone repair and protects grafts from excessive stress. Postoperative dislocation is the most common complication.

  4. Total hip arthroplasty with minimal invasive surgery in elderly patients with neck of femur fractures: our institutional experience.

    PubMed

    Bel, Jean-Christophe; Carret, Jean-Paul

    2015-01-01

    The purpose of this study was to investigate whether minimal invasive surgery (MIS) in elderly patients with neck of femur fractures would reduce the peri-operative complications and improve the post-operative ambulation and length of hospital stay in his cohort of patients. Forty elderly patients were treated with either total hip arthroplasty (THA) or bipolar prosthesis using MIS transgluteal approach. A matched reference group treated with a conventional surgical approach formed the control group. All procedures were performed by the same surgeon. Selection of acetabular component included Novae® uncemented press fit dual mobility concept socket or Bipolar Hemi-Arthroplasty (BHA). The femoral implant was Corail® uncemented stem or Fjord® cemented stem when primary instability was encountered. The follow-up was done for all patients and its minimum length was more than thirty-six months. The average length of the skin incision was 7 (6-8) SD 0.7 cm. Eighteen THA, twenty-two BHA, thirty-seven uncemented femoral stems and three cemented stems were implemented. The length of the procedure was the same as those of the reference group. The operative and post-operative blood loss and analgesic use were significantly decreased in the MIS group. Radiographic implants positioning was similar amongst the two groups. No skin complication, no primary infection, no death within ninety days and no dislocations were observed. MIS approach for implanting THA after a femoral neck fracture in the elderly appears to be a reliable procedure. PMID:26528934

  5. Spontaneous fractures of the mandible concept & treatment strategy

    PubMed Central

    Marcussen, Mette

    2016-01-01

    Background Spontaneous fractures of the mandible dispose a surgical challenge in comparisons to fractures caused by trauma due to several complicating factors. Additionally: controversies exist concerning the terminology of the field. Material and Methods We conducted a retrospective study of all patients with mandibular fractures, with exclusion of fractures of the coronoid process and the alveolar process, treated at the Department of Oral and Maxillofacial Surgery, Aalborg University Hospital, Denmark between February 2003 and February 2013. Data collected from the medical records included sex, age, cause of fracture, site of fracture, and treatment. Results We identified 517 patients with 684 mandible fractures. Twenty-five of these were spontaneous fractures and 659 fractures were of traumatic origin. Condylar fractures rarely occur spontaneously, but constitute the majority of the traumatic fractures. Excluding these fractures from the analysis, we found a non-surgical approach in 14 of 24 (58%) of the spontaneous fractures and 110 of 376 (29%) of the traumatic fractures. This was statistically significant. Conclusions We found a statistical significant difference in favor of non-surgical approach in spontaneous fractures and we discussed the treatment challenges of these fractures. We addressed the terminological controversies regarding pathological fractures, and suggested the term spontaneous fractures denoting a fracture occurring during normal jaw function being either pathological or non-pathological. Key words:Mandibular fractures, spontaneous fractures, pathological fractures, traumatic fractures, treatment. PMID:26636905

  6. Facial fractures.

    PubMed Central

    Carr, M. M.; Freiberg, A.; Martin, R. D.

    1994-01-01

    Emergency room physicians frequently see facial fractures that can have serious consequences for patients if mismanaged. This article reviews the signs, symptoms, imaging techniques, and general modes of treatment of common facial fractures. It focuses on fractures of the mandible, zygomaticomaxillary region, orbital floor, and nose. Images p520-a p522-a PMID:8199509

  7. Management of condylar fractures.

    PubMed

    Montazem, André H; Anastassov, George

    2009-03-01

    Management of condylar fractures remains a source of ongoing controversy. While it appears that many condylar fractures can be managed nonsurgically, recognition of cases that require surgical intervention and selection of an appropriate procedure are paramount to success in treating these injuries. There are a variety of special considerations that are peculiar to the condylar region. This article discusses anatomic considerations, classification of condylar fractures, indications for surgery, treatment options, and complications. The goals of treatment include restoration of function and esthetics. Careful consideration and attention to the principles of fracture management, and the role of the condyle as an articulating unit and growth center, must be taken into account for the successful management of these injuries.

  8. Fractures of the Femur. End Results*

    PubMed Central

    2008-01-01

    guidance [5]. We reproduce here an article in which Dr. Henderson reviewed 222 consecutive cases of femur fractures, 165 of which had been referred late because of complications of fractures treated elsewhere (clearly, by 1921, the Mayo Clinic was a referral source for others) [2]. Followup could not have been easy at a time when patients often came from a distance and travel was difficult, but it was described when available and in 40 of the 57 recent fractures, Henderson reported 87.5% were “cured.” Of the 165 old fractures, he was able to trace 143 (87%), a remarkable figure even today. He reported 90% of the femoral neck fractures were cured by various sorts of nonsurgical (6 patients) or surgical reconstructive (39 patients) means; 85% of the femoral shaft fractures were cured by either nonoperative (29 patients) or operative (69 patients) means. While he did not use the sort of outcomes we use today (the earliest orthopaedic outcome instruments were not introduced for four more decades: by Carroll B. Larson in 1963 [3] and William H. Harris in 1969 [1]), we can only presume Henderson meant union was achieved when patients were “cured” since nonunion or malunion would not have likely produced good results. That being the case, his rate of union was remarkable and would be enviable today in these sometimes difficult situations, attesting to his understanding of the individual situations and his skills. Melvin S. Henderson, MD is shown. Photograph is reproduced with permission and ©American Academy of Orthopaedic Surgeons. Fifty Years of Progress, 1983. References Harris WH. Traumatic arthritis of the hip after dislocation and acetabular fractures: treatment by mold arthroplasty: an end-result study using a new method of result evaluation. J Bone Joint Surg Am. 1969;51:737–755. Henderson MS. Fractures of the femur: end results. J Bone Joint Surg Am. 1921;3:520–528. Larson CB. Rating scale for hip disabilities. Clin Orthop Relat Res. 1963;31:85–93. Mostofi

  9. Magnetic resonance imaging evaluation of acetabular orientation in normal Chinese children.

    PubMed

    Li, YiQiang; Liu, YuanZhong; Zhou, QingHe; Chen, WeiDong; Li, JingChun; Yu, LingJia; Xu, HongWen; Xie, DengHui

    2016-09-01

    There are no data regarding the acetabular orientation on magnetic resonance imaging (MRI); this study investigates the changes of acetabular orientation with age in normal Chinese children.We retrospectively analyzed the medical records of children who underwent hip MRI examination at our hospital from January 2009 to December 2015. A total of 180 patients with normal MRI reading of the hip joints were included and were divided into 14 groups according to age: from 6 months of age and then for each year from 1 to 16 years. The bony and cartilage acetabular anteversion angle (AAA), acetabular inclination angle (AIA), and acetabular index (AI) were measured. Total bony and cartilage femoral head coverage angles were measured on axial section total femoral head coverage angle (a-TCA) and coronal section total femoral head coverage angle (c-TCA).The mean bony AAA and AIA were 12.2 ± 2.5° and 50.9 ± 2.5°, respectively; both of them stayed constant from the age of 6 months to 16 years. Similar results were found in cartilage AAA (12.1 ± 2.5°) and AIA (41.2 ± 3.0°). There was no difference between bony and cartilage AAA, but bony AIA was significantly larger than cartilage AIA. Bony AI was 24.1 ± 2.4° at the age of 6 months, decreasing to 12.5 ± 2.3° by 12 to 13 years of age; cartilage AI (5.9 ± 1.7°) maintained a steady value with age. The mean bony a-TCA and c-TCA at 6 months were 117.0 ± 5.8° and 127.5 ± 5.1°, increasing to 144.5 ± 4.6° and 140.7 ± 2.5° at the age of 16 years. However, the cartilage a-TCA (145.2 ± 7.2°) and c-TCA (154.1 ± 5.7°) did not change significantly with age.Both bony and cartilage AAA and AIA remain constant up to the age of 16 years in normal Chinese pediatric population. Although the cartilage coverage of femoral head by the acetabulum remains unchanged with age, the bony coverage of femoral head increases. PMID:27631258

  10. Characterization of Human Anterosuperior Acetabular Depression in Correlation With Labral Tears

    PubMed Central

    Kopydlowski, Nathan J.; Tannenbaum, Eric P.; Smith, Matthew V.; Sekiya, Jon K.

    2014-01-01

    Background: Labral tears often occur in the same quadrant of the acetabulum at a small depression previously referred to as the psoas valley. Understanding the anatomic variations of this depression could help us understand the etiology of labral tears. Purpose: To describe the location and dimensions of the depression located in the anterosuperior acetabular rim. The hypothesis was that the location of this depression would be consistent with the common location of acetabular labral tears described in the literature. Study Design: Controlled laboratory study. Methods: A total of 240 pelvic specimens were divided into 2 groups (n = 120 for each) according to age (younger age group: 21.36 ± 3.12 years [range, 14-24 years]; older age group: 42.30 ± 10.27 years, [range, 25-60 years]).Specimens were also categorized based on sex (mean age: 31.93 ± 12.31 years [male]; 32.08 ± 13.66 years [female]) and race (mean age: 31.45 ± 13.16 years [black]; 32.57 ± 12.82 years [white]). The depth and width of the acetabular depression were measured using a digital caliper, and the location was measured using a goniometer. Results: The psoas valley was observed in every specimen and was located in the anterosuperior quadrant of the acetabulum. Its depth was significantly greater (P < .001) in males (5.35 ± 1.60 mm) than in females (3.95 ± 1.31 mm). The width of the psoas valley was also greater (P < .001) in males (29.39 ± 3.98 mm) than in females (24.49 ± 4.80 mm). There were no differences in size or location of the depression between races or age groups. The psoas valley was located between 3.92 ± 0.42 o’clock anteriorly and 2.12 ± 0.77 o’clock posteriorly. Conclusion: The differences observed in the study data are believed to be a result of the different anatomic morphologies of the pelvis in males and females. This loss of bony support, caused by the depression, could be the underlying cause of weakening of the acetabular labrum as people age. Clinical Relevance

  11. Pediatric foot fractures.

    PubMed

    Ribbans, William J; Natarajan, Ramanathan; Alavala, Sairam

    2005-03-01

    Fractures of the foot in children usually have a good prognosis and generally are treated nonoperatively. Displaced fractures of the talus and calcaneus and tarsometatarsal dislocations are rare in children and their outcome is generally good in the younger child. Older adolescents with these injuries need treatment similar to how an adult would be treated for the same injury in order to achieve a good result. Foot fractures in children may pose a diagnostic challenge particularly in the absence of obvious radiographic changes. Repeated clinical examination and judicious use of imaging techniques such as isotope bone scans and magnetic resonance imaging are needed to establish a diagnosis. Knowledge of the anatomy and significance of accessory bones of the foot and disorders of the growing foot skeleton are helpful in managing injuries of child's foot. In this study, we review common injuries of a child's foot and include a discussion on differential diagnosis.

  12. Coccygeoplasty: treatment for fractures of the coccyx.

    PubMed

    Dean, L Mark; Syed, Mubin I; Jan, Solomon A; Patel, Neel A; Shaikh, Azim; Morar, Kamal; Shah, Omar

    2006-05-01

    Percutaneous vertebroplasty and sacroplasty are becoming common modalities of treatment for vertebral body compression fractures and sacral insufficiency fractures, respectively. The present report describes a case of a coccygeal fracture treated with injection of polymethylmethacrylate cement, which resulted in immediate relief of symptoms. It is suggested that this procedure be called coccygeoplasty.

  13. Acute tibial tubercle avulsion fractures.

    PubMed

    McKoy, Brodie E; Stanitski, Carl L

    2003-07-01

    Acute tibial tubercle avulsion fractures are uncommon, and these injuries typically occur in mature-appearing adolescent boys involved in jumping sports, particularly basketball. The developmental anatomy of the tibial tuberosity and the changes surrounding normal physiologic epiphysiodesis render this structure susceptible to acute avulsion fractures. Possible associated injuries include patellar and quadriceps avulsions, collateral and cruciate ligament tears, and meniscal damage. The treatment of this injury is based on the amount of displacement and associated injuries. Nondisplaced fractures are treated nonoperatively with cast immobilization. Displaced fractures require open reduction and internal fixation. Even in Type III injuries, the outcome is usually excellent.

  14. Bipartite patella fracture.

    PubMed

    Canizares, George H; Selesnick, F Harlan

    2003-02-01

    Bipartite patella fracture is an uncommon injury that has rarely been described in the literature. It can be quite debilitating in the competitive athlete and is often overlooked by the treating physician. A bone scan can be helpful in confirming the diagnosis, and appropriate treatment often results in a successful outcome.

  15. [Treatment of pediatric radial neck fractures: consideration of patient age and fracture dislocation].

    PubMed

    Eberl, R; Saxena, A; Fruhmann, J; Höllwarth, M E; Weinberg, A M

    2010-10-01

    Fractures of the radial neck represent approximately 5-10% of all injuries of the elbow in children. Depending on the degree of radial head displacement, either an operative intervention or conservative treatment is recommended. The medical records of 168 children treated between 1999 and 2008 were analyzed and fractures were classified according to the Judet classification system. The fractures were treated according to an algorithm depending on age and fracture dislocation and 103 type I, 21 type II, 30 type III and 14 type VI fractures were found. Conservative treatment was possible in 124 patients and 44 were treated operatively. The overall outcome was good. PMID:20237746

  16. Foot and Ankle Stress Fractures in Athletes.

    PubMed

    Greaser, Michael C

    2016-10-01

    The incidence of stress fractures in the general athletic population is less than 1%, but may be as high as 15% in runners. Stress fractures of the foot and ankle account for almost half of bone stress injuries in athletes. These injuries occur because of repetitive submaximal stresses on the bone resulting in microfractures, which may coalesce to form complete fractures. Advanced imaging such as MRI and triple-phase bone scans is used to evaluate patients with suspected stress fracture. Low-risk stress fractures are typically treated with rest and protected weight bearing. High-stress fractures more often require surgical treatment. PMID:27637667

  17. Distal clavicle fractures in children☆

    PubMed Central

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

    2015-01-01

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

  18. [Treatment of hip fractures in elderly patients].

    PubMed

    Hack, Juliana; Bliemel, Christopher; Ruchholtz, Steffen; Bücking, Benjamin

    2015-04-01

    Hip fractures are among the most common fractures in elderly people. The annual number of femoral fractures is even expected to increase because of an aging society. Due to the high number of comorbidities, there are special challenges in treating geriatric hip fracture patients, which require a multidisciplinary management. This includes surgical treatment allowing full weight bearing in the immediate postoperative period, osteoporosis treatment and falls prevention as well as an early ortho-geriatric rehabilitation program.

  19. Pelvic Insufficiency Fractures

    PubMed Central

    O’Connor, Timothy J.

    2014-01-01

    Pelvic insufficiency fractures may occur in the absence of trauma or as a result of low-energy trauma in osteoporotic bone. With a growing geriatric population, the incidence of pelvic insufficiency fracture has increased over the last 3 decades and will continue to do so. These fractures can cause considerable pain, loss of independence, and economic burden to both the patient and the health care system. While many of these injuries are identified and treated based on plain radiographs, some remain difficult to diagnose. The role of advanced imaging in these cases is discussed. In addition to treating the fracture, medical comorbidities contributing to osteoporosis should be identified and corrected. Specific attention has been given to 25-OH serum vitamin D screening and repletion. Treatment generally consists of providing pain control and assisting patients with mobilization while allowing weight bearing as tolerated. In those unable to do so, invasive techniques such as sacroplasty as well as internal fixation may be beneficial. The role of operative fixation in insufficiency fractures is also discussed. PMID:26246940

  20. Uncemented porous tantalum acetabular components: early follow-up and failures in 613 primary total hip arthroplasties.

    PubMed

    Noiseux, Nicolas O; Long, William J; Mabry, Tad M; Hanssen, Arlen D; Lewallen, David G

    2014-03-01

    Uncemented tantalum acetabular components were introduced in 1997. The purpose was to determine the 2- to 10-year results with this implant material in primary total hip arthroplasty. Our registry identified all primary total hip cases with porous tantalum cups implanted from 1997 to 2004. Clinical outcomes and radiographs were studied. 613 cases were identified. Seventeen percent of patients were lost to follow-up. Twenty-five reoperations were performed (4.4%). Acetabular cup removal occurred in 6 cases (1.2%). No cups were revised for aseptic loosening. Incomplete radiolucent lines were found on 9.3% of initial postoperative radiographs. At 2 years, 67% had resolved. Zero new radiolucent lines were detected. Two- to 10-year results of porous tantalum acetabular components for primary total hip arthroplasty demonstrate high rates of initial stability and apparent ingrowth.

  1. Late fiber metal shedding of the first and second-generation Harris Galante acetabular component. A report of 5 cases.

    PubMed

    Mayman, David J; González Della Valle, Alejandro; Lambert, Edward; Anderson, John; Wright, Timothy; Nestor, Bryan; Sculco, Thomas P; Salvati, Eduardo A

    2007-06-01

    Five patients presented with fiber metal mesh shedding of a Harris Galante II acetabular cup detected between 11 and 15 years after implantation. All patients presented with hip pain and 4 demonstrated gross acetabular loosening and fiber metal separation on preoperative radiographs. The remaining patient underwent revision surgery because of a liner dislodgment and had a radiographically well fixed shell. Loosening and fiber metal separation were detected intraoperatively. Scanning electron microscopy of the retrieved shells demonstrated isolated diffusion bonding marks in the areas where the mesh separated from the substrate and no evidence of corrosion. Progressive osteolysis in the iliac bone was evident in 4 of our cases. Progressive iliac osteolysis may lead to loss of bone support in well-fixed cups and excessive stresses transferred to the interface between the fiber metal mesh and the titanium substrate leading to the separation of the 2 layers. Fiber metal separation may contribute to long-term loosening in the Harris Galante acetabular component.

  2. Functional outcomes and cost estimation for extra-articular and simple intra-articular distal radius fractures treated with open reduction and internal fixation versus closed reduction and percutaneous Kirschner wire fixation

    PubMed Central

    Dzaja, Ivan; MacDermid, Joy C.; Roth, James; Grewal, Ruby

    2013-01-01

    Background We sought to compare direct costs and clinical and radiographic outcomes for distal radius fractures (DRF) treated with open reduction internal fixation with volar locking plates (VLP) versus closed reduction and percutaneous pinning (CRPP). Methods We identified patients with AO-type A and C1 DRFs from a prospective database. Outcomes were assessed at 6 weeks and at 3, 6 and 12 months, and surgical care costs were estimated. Results Twenty patients were treated with CRPP and 24 with VLP. There were no significant differences in patient-rated wrist evaluation (PRWE) scores between the 2 groups at any time point (mean 16.2 ± 23.1 in the CRPP group v. 21.5 ± 23.6 in the VLP group, p = 0.91). Overall alignment was maintained in both groups; however, there was a greater loss of radial height over time with CRPP than VLP (0.97 mm v. 0.25 mm, p = 0.018). The mean duration of surgery was longer for VLP than CRPP (113.9 ± 39.5 min v. 86.5 ± 7.8 min, p = 0.029), but there were fewer clinic visits (5.2 ± 1.4 v. 7.8 ± 1.3, p < 0.001) and fewer radiographs (7.4 ± 2.7 v. 9 ± 2.4, p = 0.031). The total cost per case was greater for VLP than CRPP ($1637.27 v. $733.91). Conclusion Based on PRWE scores, VLPs did not offer any significant advantage over CRPP in patients with simple fracture types between 3 and 12 months, but they were much more costly. Whether VLP offers any functional advantage earlier in recovery, thereby justifying their expense, requires further investigation in the form of a prospective randomized trial with a detailed cost analysis. PMID:24284144

  3. Pain Palliation by Percutaneous Acetabular Osteoplasty for Metastatic Hepatocellular Carcinoma

    SciTech Connect

    Hokotate, Hirofumi; Baba, Yasutaka; Churei, Hisahiko; Nakajo, Masayuki; Ohkubo, Kouichi; Hamada, Kenji

    2001-09-15

    A 68-year-old man with hepatocellular carcinoma and known skeletal metastasis developed right hip pain and gait disturbance due to an osteolytic metastasis in the right acetabulum. This was treated initially with chemoembolization and radiation therapy. When these procedures proved unsuccessful percutaneous injection of acrylic bone cement into the acetabulum was undertaken. Immediately after this procedure, he obtained sufficient pain relief and improved walking ability, which continued for 3 months until he died of hepatic insufficiency.

  4. Comparative Prospective Study of Load Distribution Projection Among Patients with Vertebral Fractures Treated with Percutaneous Vertebroplasty and a Control Group of Healthy Volunteers

    SciTech Connect

    Kelekis, Alexios Filippiadis, Dimitrios K. Vergadis, Chrysovalantis Tsitskari, Maria Nasis, Nikolaos Malagari, Aikaterini Kelekis, Nikolaos

    2013-04-12

    PurposeThrough a prospective comparison of patients with vertebral fractures and normal population, we illustrate effect of percutaneous vertebroplasty (PV) upon projection of load distribution changes.MethodsVertebroplasty group (36 symptomatic patients with osteoporotic vertebral fractures) was evaluated on an electronic baropodometer registering projection of weight bearing areas on feet. Load distribution between right and left foot (including rear-front of the same foot) during standing and walking was recorded and compared before (group V1) and the day after (group V2) PV. Control group (30 healthy asymptomatic volunteers-no surgery record) were evaluated on the same baropodometer.ResultsMean value of load distribution difference between rear-front of the same foot was 9.45 ± 6.79 % (54.72–45.28 %) upon standing and 14.76 ± 7.09 % (57.38–42.62 %) upon walking in the control group. Respective load distribution values before PV were 16.52 ± 11.23 and 30.91 ± 19.26 % and after PV were 10.08 ± 6.26 and 14.25 ± 7.68 % upon standing and walking respectively. Mean value of load distribution variation between the two feet was 6.36 and 14.6 % before and 4.62 and 10.4 % after PV upon standing and walking respectively. Comparison of load distribution variation (group V1–V2, group V1-control group) is statistically significant. Comparison of load distribution variation (group V2-control group) is not statistically significant. Comparison of load distribution variation among the two feet is statistically significant during walking but not statistically significant during standing.ConclusionsThere is a statistically significant difference when comparing load distribution variation prior vertebroplasty and that of normal population. After vertebroplasty, this difference normalizes in a statistically significant way. PV is efficient on equilibrium-load distribution improvement as well.

  5. Fracture pain-Traveling unknown pathways.

    PubMed

    Alves, Cecília J; Neto, Estrela; Sousa, Daniela M; Leitão, Luís; Vasconcelos, Daniel M; Ribeiro-Silva, Manuel; Alencastre, Inês S; Lamghari, Meriem

    2016-04-01

    An increase of fracture incidence is expected for the next decades, mostly due to the undeniable increase of osteoporotic fractures, associated with the rapid population ageing. The rise in sports-related fractures affecting the young and active population also contributes to this increased fracture incidence, and further amplifies the economical burden of fractures. Fracture often results in severe pain, which is a primary symptom to be treated, not only to guarantee individual's wellbeing, but also because an efficient management of fracture pain is mandatory to ensure proper bone healing. Here, we review the available data on bone innervation and its response to fracture, and discuss putative mechanisms of fracture pain signaling. In addition, the common therapeutic approaches to treat fracture pain are discussed. Although there is still much to learn, research in fracture pain has allowed an initial insight into the mechanisms involved. During the inflammatory response to fracture, several mediators are released and will putatively activate and sensitize primary sensory neurons, in parallel, intense nerve sprouting that occurs in the fracture callus area is also suggested to be involved in pain signaling. The establishment of hyperalgesia and allodynia after fracture indicates the development of peripheral and central sensitization, still, the underlying mechanisms are largely unknown. A major concern during the treatment of fracture pain needs to be the preservation of proper bone healing. However, the most common therapeutic agents, NSAIDS and opiates, can cause significant side effects that include fracture repair impairment. The understanding of the mechanisms of fracture pain signaling will allow the development of mechanisms-based therapies to effectively and safely manage fracture pain.

  6. Fracture pain-Traveling unknown pathways.

    PubMed

    Alves, Cecília J; Neto, Estrela; Sousa, Daniela M; Leitão, Luís; Vasconcelos, Daniel M; Ribeiro-Silva, Manuel; Alencastre, Inês S; Lamghari, Meriem

    2016-04-01

    An increase of fracture incidence is expected for the next decades, mostly due to the undeniable increase of osteoporotic fractures, associated with the rapid population ageing. The rise in sports-related fractures affecting the young and active population also contributes to this increased fracture incidence, and further amplifies the economical burden of fractures. Fracture often results in severe pain, which is a primary symptom to be treated, not only to guarantee individual's wellbeing, but also because an efficient management of fracture pain is mandatory to ensure proper bone healing. Here, we review the available data on bone innervation and its response to fracture, and discuss putative mechanisms of fracture pain signaling. In addition, the common therapeutic approaches to treat fracture pain are discussed. Although there is still much to learn, research in fracture pain has allowed an initial insight into the mechanisms involved. During the inflammatory response to fracture, several mediators are released and will putatively activate and sensitize primary sensory neurons, in parallel, intense nerve sprouting that occurs in the fracture callus area is also suggested to be involved in pain signaling. The establishment of hyperalgesia and allodynia after fracture indicates the development of peripheral and central sensitization, still, the underlying mechanisms are largely unknown. A major concern during the treatment of fracture pain needs to be the preservation of proper bone healing. However, the most common therapeutic agents, NSAIDS and opiates, can cause significant side effects that include fracture repair impairment. The understanding of the mechanisms of fracture pain signaling will allow the development of mechanisms-based therapies to effectively and safely manage fracture pain. PMID:26851411

  7. Cross-sectional Anatomy of Ilium for Guiding Acetabular Component Placement Using High Hip Center Technique in Asian Population

    PubMed Central

    Xiao, Jian-Lin; Zuo, Jian-Lin; Liu, Peng; Qin, Yan-Guo; Li, Xue-Zhou; Liu, Tong; Gao, Zhong-Li

    2015-01-01

    Background: Many clinical studies have been published involving the use of a high hip center (HHC), achieved good follow-up. However, there is a little anatomic guidance in the literature regarding the amount of bone stock available for initial implant coverage in this area of the ilium. The purpose of this study was to evaluate the thickness and width of the human ilium and related acetabular cup coverage for guiding acetabular component placement in HHC. Methods: A total of 120 normal hips in 60 cases of adult patients from lower extremities computer tomographic angiography Digital Imaging and Communications in Medicine data were chosen for the study. After importing the data to the mimics software, we chose the cross sections every 5-mm increments from the rotational center of the hip to the cephalic of the ilium according the body sagittal axis, then we measured the thickness and width of the ilium for each cross section in axial plane, calculated the cup coverage at each chosen section. Results: At the acetabular dome, the mean thickness and width of the ilium were 49.71 ± 4.88 mm and 38.92 ± 3.67 mm, respectively, whereas at 1 cm above the dome, decreased to 41.35 ± 5.13 and 31.13 ± 3.37 respectively, and 2 cm above the dome, decreased to 31.25 ± 4.04 and 26.65 ± 3.43, respectively. Acetabular cup averaged coverage for 40-, 50-, and 60-mm hemispheric shells, was 100%, 89%, and 44% at the acetabular dome, 100%, 43.7%, and 27.5% for 1 cm above the dome, and 37.5%, 21.9%, and 14.2% for 2 cm above the dome. Conclusions: HHC reconstructions within 1 cm above the acetabular dome will be an acceptable and smaller diameter prosthesis would be better. PMID:26063357

  8. [Supracondylar fractures in children].

    PubMed

    Petrov, N; Gucev, S; Kirkov, Lj; Dajljevik, S; Ruso, B

    1982-01-01

    In the Department of Pediatric surgery, during the last ten years, 190 patients with supracondylar fractures (second and third degree, according to Bauman's classification) have been treated. The operation was performed in only 5% of all hospitalized cases. There were only one patient with neurological and vascular complications in the early stage, but without any complications in the late stage. The presented cases showed a high percentage of flexion type of fractures. The conservative treatment by a reposition has given the most satisfactory results.

  9. Examination and treatment of a professional ballet dancer with a suspected acetabular labral tear: A case report.

    PubMed

    Khoo-Summers, Lynnette; Bloom, Nancy J

    2015-08-01

    Dancers are at risk for developing groin pain that is due to acetabular labral tears. Although surgical management of labral tears has been reported extensively, conservative management has been poorly described. This case report describes the examination, diagnosis, and treatment of groin pain in a professional ballet dancer with a suspected acetabular labral tear. Treatment focused on decreasing anterior hip joint stresses and improving the precision of hip motion through correction of alignment and movement impairments noted during functional activities and dance. Successful outcomes included a reduction in pain and return to professional ballet dancing. PMID:25725589

  10. Fractures of the cervical spine

    PubMed Central

    Marcon, Raphael Martus; Cristante, Alexandre Fogaça; Teixeira, William Jacobsen; Narasaki, Douglas Kenji; Oliveira, Reginaldo Perilo; de Barros Filho, Tarcísio Eloy Pessoa

    2013-01-01

    OBJECTIVES: The aim of this study was to review the literature on cervical spine fractures. METHODS: The literature on the diagnosis, classification, and treatment of lower and upper cervical fractures and dislocations was reviewed. RESULTS: Fractures of the cervical spine may be present in polytraumatized patients and should be suspected in patients complaining of neck pain. These fractures are more common in men approximately 30 years of age and are most often caused by automobile accidents. The cervical spine is divided into the upper cervical spine (occiput-C2) and the lower cervical spine (C3-C7), according to anatomical differences. Fractures in the upper cervical spine include fractures of the occipital condyle and the atlas, atlanto-axial dislocations, fractures of the odontoid process, and hangman's fractures in the C2 segment. These fractures are characterized based on specific classifications. In the lower cervical spine, fractures follow the same pattern as in other segments of the spine; currently, the most widely used classification is the SLIC (Subaxial Injury Classification), which predicts the prognosis of an injury based on morphology, the integrity of the disc-ligamentous complex, and the patient's neurological status. It is important to correctly classify the fracture to ensure appropriate treatment. Nerve or spinal cord injuries, pseudarthrosis or malunion, and postoperative infection are the main complications of cervical spine fractures. CONCLUSIONS: Fractures of the cervical spine are potentially serious and devastating if not properly treated. Achieving the correct diagnosis and classification of a lesion is the first step toward identifying the most appropriate treatment, which can be either surgical or conservative. PMID:24270959

  11. Current concept in dysplastic hip arthroplasty: Techniques for acetabular and femoral reconstruction.

    PubMed

    Bicanic, Goran; Barbaric, Katarina; Bohacek, Ivan; Aljinovic, Ana; Delimar, Domagoj

    2014-09-18

    Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty (THA) at younger age. Because of altered anatomy of dysplastic hips, THA in these patients represents technically demanding procedure. Distorted anatomy of the acetabulum and proximal femur together with conjoined leg length discrepancy present major challenges during performing THA in patients with developmental dysplasia of the hip. In addition, most patients are at younger age, therefore, soft tissue balance is of great importance (especially the need to preserve the continuity of abductors) to maximise postoperative functional result. In this paper we present a variety of surgical techniques available for THA in dysplastic hips, their advantages and disadvantages. For acetabular reconstruction following techniques are described: Standard metal augments (prefabricated), Custom made acetabular augments (3D printing), Roof reconstruction with vascularized fibula, Roof reconstruction with pedicled iliac graft, Roof reconstruction with autologous bone graft, Roof reconstruction with homologous bone graft, Roof reconstruction with auto/homologous spongious bone, Reinforcement ring with the hook in combination with autologous graft augmentation, Cranial positioning of the acetabulum, Medial protrusion technique (cotyloplasty) with chisel, Medial protrusion technique (cotyloplasty) with reaming, Cotyloplasty without spongioplasty. For femoral reconstruction following techniques were described: Distraction with external fixator, Femoral shortening through a modified lateral approach, Transtrochanteric osteotomies, Paavilainen osteotomy, Lesser trochanter osteotomy, Double-chevron osteotomy, Subtrochanteric osteotomies, Diaphyseal osteotomies, Distal femoral osteotomies. At the end we present author's treatment method of choice: for acetabulum we perform cotyloplasty leaving only paper-thin medial wall, which we break during acetabular

  12. Analysis of spinal alignment and pelvic parameters on upright radiographs: implications for acetabular development

    PubMed Central

    Pytiak, Andrew; Bomar, James D.; Peterson, Jonathan B.; Schmitz, Matthew R.; Pennock, Andrew T.; Wenger, Dennis R.; Upasani, Vidyadhar V.

    2016-01-01

    The purpose of this study was to correlate measures of sagittal spinopelvic alignment [lumbar lordosis (LL), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI)] and measures of acetabular coverage [lateral center edge angle (LCEA) and Tonnis angle] in asymptomatic adolescents on standing biplanar radiographs. We hypothesized that subjects with increased pelvic incidence and LL would have increased anterior PT and increased measures of acetabular coverage. Upright anteroposterior and lateral spinopelvic radiographs were obtained using EOS imaging technique. LCEA and Tonnis angle were calculated on the anteroposterior images and the lateral images were analyzed for LL, PI, PT and SS. LL was found to have a strong correlation with SS (rs = 0.786, P  <  0.001), moderate correlation with PI (rs  =  0.529, P  <  0.001), and a poor inverse correlation with PT (rs  = −0.167, P  =  0.018). However, LCEA was not found to be significantly correlated with PT (rs  =  0.084, P  =  0.238) and Tonnis angle was not found to be correlated with any of the sagittal spinopelvic measures. Healthy, asymptomatic adolescents with increased pelvic incidence and lumbar lordosis did not have increased anterior PT or increased measures of acetabular coverage. The correlations identified in previous cadaveric studies or clinical studies evaluating changes between supine and standing radiographs are not supported in this healthy adolescent population. Our findings may suggest that an individual’s acetabulum develops as a dynamic adaptation to one's particular sagittal spinopelvic alignment to optimize femoral head coverage. Level III. Diagnostic – Investigating a diagnostic test. PMID:27583160

  13. Differences in Acetabular Rim Thickness in Patients with Unilateral Symptomatic Pincer-Type Femoroacetabular Impingement

    PubMed Central

    Weber, Alexander E.; Kuhns, Benjamin; Cvetanovich, Gregory; Inoue, Nozomu; Nho, Shane Jay

    2016-01-01

    Objectives: The objective of this study was to identify the location and magnitude of difference in acetabular rim morphology between the symptomatic and asymptomatic acetabula in a cohort of patients with symptomatic unilateral pincer-type FAI. Methods: After IRB approval, computed tomography (CT) scans of 43 patients (22 males, 21 females) diagnosed with unilateral pincer-type FAI were obtained. CT images of both hips were imported in DICOM format and segmented into 3-dimensional (3D) hemi-pelvises using 3D reconstruction software (Mimics, Materialise, Leuven, Belgium). The point-cloud data of the asymptomatic hemi-pelvis was mirrored onto the symptomatic side. Protrusion of the symptomatic side was recorded as a positive value and appeared as red on the color map (Figure 1). Data was collected in 3° intervals and analyzed by quadrant using the clock face method; reflecting the 12-3, 3-6, 6-9, and 9-12 o’clock positions. Results: The symptomatic acetabular rim was on average 0.39 ± 0.36 mm thicker than the corresponding location on the asymptomatic rim. When the acetabular clock face was broken up into quadrants, reflecting the 12-3, 3-6, 6-9, and 9-12 o’clock positions, the 12-3 o’clock position demonstrated the greatest difference between symptomatic and asymptomatic sides (Table 1). The 12-3 o’clock quadrant demonstrated significantly greater difference between symptomatic and asymptomatic sides (0.53±0.22 mm) as compared to the 3-6 o’clock position (0.39±0.27 mm; p=0.006), the 6-9 o’clock position (0.34±0.05 mm; p<0.001), and the 9-12 o’clock position (0.33±0.03; p<0.001). There was no correlation between gender and magnitude of difference at any location. Conclusion: Small changes in acetabular rim morphology, on the order of 0.5 mm or less can be the difference between symptomatic pincer-type FAI and the asymptomatic state. Knowledge of the healthy, unaffected side in unilateral FAI may provide a better template for rim recession rather

  14. Assessment of failure of cemented polyethylene acetabular component due to bone remodeling: A finite element study.

    PubMed

    Ghosh, Rajesh

    2016-09-01

    The aim of the study is to determine failure of the cemented polyethylene acetabular component, which might occur due to excessive bone resorption, cement-bone interface debonding and fatigue failure of the cement mantle. Three-dimensional finite element models of intact and implanted pelvic bone were developed and bone remodeling algorithm was implemented for present analysis. Soderberg fatigue failure diagram was used for fatigue assessment of the cement mantle. Hoffman failure criterion was considered for prediction of cement-bone interface debonding. Results indicate fatigue failure of the cement mantle and implant-bone interface debonding might not occur due to bone remodeling.

  15. Influence of CBCT enhancement filters on diagnosis of vertical root fractures: a simulation study in endodontically treated teeth with and without intracanal posts

    PubMed Central

    Visconti, M A P G; Nascimento, H A; Dallemolle, R R; Ambrosano, G M; Freitas, D Q

    2015-01-01

    Objectives: To evaluate the influence of CBCT enhancement filters on the diagnosis of vertical root fractures (VRFs) in teeth with and without metal posts. Methods: The crowns of 40 uniradicular human teeth were removed and all roots were prepared. 20 teeth were randomly selected, and VRFs were induced using a universal testing machine. The i-CAT (Imaging Sciences International, Hatfield, PA) CBCT was used to scan teeth with and without intracanal metal posts using the following parameters: 0.2 voxel size, 8 × 8-cm scan size and acquisition time of 26.9 s. Images were evaluated by three observers with and without the use of the following filters: S9, smooth, smooth 3 × 3, sharpen, sharpen-mild and sharpen 3 × 3. Results: Intra- and interobserver agreement ranged from poor to moderate. Images with and without CBCT filters did not show significant differences regarding the area under the receiver operating characteristic curve, as well as sensitivity (p > 0.05). As for accuracy, the sharpen-mild filter was superior to the sharpen (p = 0.03), but these filters did not differ from all others. For specificity, S9, smooth and original images were superior to sharpen (p < 0.01). Results for teeth without posts differed from those for teeth with metal posts in all cases (p < 0.05). Conclusions: The use of enhancement filters in CBCT images has no influence on the diagnosis of VRFs in teeth with metal posts, and their use is not justified. PMID:25666446

  16. Comparing Single Versus Double Screw-Rod Anterior Instrumentation for Treating Thoracolumbar Burst Fractures with Incomplete Neurological Deficit: A Prospective, Randomized Controlled Trial

    PubMed Central

    Yu, Yu; Wang, Juan; Shao, Gaohai; Wang, Qunbo; Li, Bo

    2016-01-01

    Background Following a thoracolumbar burst fracture (TCBF), anterior screw-rods apply pressure upon the graft site. However, there is limited evidence comparing single screw-rod anterior instrumentation (SSRAI) to double screw-rod anterior instrumentation (DSRAI) for TCBFs. Our objective was to compare SSRAI versus DSRAI for TCBFs with incomplete neurological deficit. Material/Methods A total of 51 participants with T11-L2 TCBFs (AO classification: A3) were randomly assigned to receive SSRAI or DSRAI. Key preoperative, perioperative, and postoperative data were collected. Statistical analysis was conducted to determine the independent factors associated with inferior clinical outcomes, as well as the comparative efficacy of SSRAI and DSRAI. Results There were no significant differences in the key demographic and clinical characteristics between the two groups (all p>0.05). Smoking status was significantly associated with inferior three-month and six-month Denis pain scores (Wald statistic=4.246, p=0.039). Both SSRAI and DSRAI were significantly effective in improving three-month and six-month postoperative degree of kyphosis, three-month and six-month postoperative ASIA impairment scale scores, three-month and six-month postoperative Denis pain score, and three-month and six-month postoperative Denis work score (all p<0.001). Although there were no significant differences between DSRAI and SSRAI with respect to all outcomes (all p>0.05), DSRAI displayed significantly longer operating times, as well as significantly larger operative blood losses (both p<0.001). Conclusions SSRAI may be preferable over DSRAI for TCBFs with incomplete neurological deficit due to its lower operating time and amount of operative blood loss. PMID:27197020

  17. Fatigue Fractures

    PubMed Central

    Morris, James M.

    1968-01-01

    Fatigue (or stress) fracture of bone in military recruits has been recognized for many years. Most often it is a metatarsal bone that is involved but the tarsal bones, calcaneus, tibia, fibula, femur, and pelvis are occasionally affected. Reports of such fractures in the ribs, ulna and vertebral bodies may be found in the literature. In recent years, there has been increasing awareness of the occurrence of fatigue fractures in the civilian population. Weekend sportsmen, athletes in an early phase of training, and persons engaged in unaccustomed, repetitive, vigorous activity are potential victims of such a fracture. The signs and symptoms, roentgenographic findings, treatment and etiology of fatigue fractures are dealt with in this presentation. ImagesFigure 1.Figure 2.Figure 3.Figure 4.Figure 5.Figure 6. PMID:5652745

  18. Percutaneous Vertebroplasty for Osteoporotic Compression Fracture: Multivariate Study of Predictors of New Vertebral Body Fracture

    SciTech Connect

    Komemushi, Atsushi Tanigawa, Noboru; Kariya, Shuji; Kojima, Hiroyuki; Shomura, Yuzo; Komemushi, Sadao; Sawada, Satoshi

    2006-08-15

    Purpose. To investigate the risk factors and relative risk of new compression fractures following vertebroplasty. Methods. Initially, we enrolled 104 consecutive patients with vertebral compression fractures caused by osteoporosis. A total of 83 of the 104 patients visited our hospital for follow-up examinations for more than 4 weeks after vertebroplasty. Logistic regression analysis of the data obtained from these 83 patients was used to determine relative risks of recurrent compression fractures, using 13 different factors. Results. We identified 59 new fractures in 30 of the 83 patients: 41 new fractures in vertebrae adjacent to treated vertebrae; and 18 new fractures in vertebrae not adjacent to treated vertebrae. New fractures occurred in vertebrae adjacent to treated vertebrae significantly more frequently than in vertebrae not adjacent to treated vertebrae. Only cement leakage into the disk was a significant predictor of new vertebral body fracture after vertebroplasty (odds ratio = 4.633). None of the following covariates were associated with increased risk of new fracture: age, gender, bone mineral density, the number of vertebroplasty procedures, the number of vertebrae treated per procedure, the cumulative number of vertebrae treated, the presence of a single untreated vertebra between treated vertebrae, the presence of multiple untreated vertebrae between treated vertebrae, the amount of bone cement injected per procedure, the cumulative amount of bone cement injected, cement leakage into the soft tissue around the vertebra, and cement leakage into the vein.

  19. Technical considerations for surgical intervention of Jones fractures.

    PubMed

    Mendicino, Robert W; Hentges, Matthew J; Mendicino, Michael R; Catanzariti, Alan R

    2013-01-01

    Jones fractures are a common injury treated by foot and ankle surgeons. Surgical intervention is recommended because of the high rate of delayed union, nonunion, and repeat fracture, when treated conservatively. Percutaneous intramedullary screw fixation is commonly used in the treatment of these fractures. We present techniques that can increase the surgical efficiency and decrease the complications associated with percutaneous delivery of internal fixation.

  20. Reproducibility of Acetabular Landmarks and a Standardized Coordinate System Obtained from 3D Hip Ultrasound.

    PubMed

    Mabee, Myles; Dulai, Sukhdeep; Thompson, Richard B; Jaremko, Jacob L

    2015-10-01

    Two-dimensional (2D) ultrasound detection of developmental dysplasia of the hip (DDH) is limited by variation in acetabular appearance and alpha angle measurements, which change with position of the ultrasound probe. Three-dimensional (3D) ultrasound captures the entire acetabular shape, and a reproducible "standard central plane" may be generated, from two landmarks located on opposite ends of the acetabulum, for measurement of alpha angle and other indices. Two users identified landmarks on 51 3D ultrasounds, with ranging severity of disease, and inter- and intra-observer reproducibility of landmark and "standard plane" locations was compared; landmarks were chosen within 2 mm, and the "standard plane" rotation was reproducible within 10° between observers. We observed no difference in variability between alpha angles measured on the "standard plane" in comparison with 2D ultrasound. Applications of the standardized 3D ultrasound central plane will be to fuse serial ultrasounds for follow-up and development of new indices of 3D deformity. PMID:25394808

  1. Preliminary analysis on the MD-4® plasma-sprayed titanium acetabular component☆

    PubMed Central

    de Araújo Loures, Elmano; Simoni, Leandro Furtado; Leite, Isabel Cristina Gonçalves; Loures, Daniel Naya; Loures, Clarice Naya

    2015-01-01

    Objectives To evaluate the short-term performance of a type of implant manufactured in Brazil. Methods This study analyzed a cohort of 60 patients who underwent implantation of MD-4® acetabular components during primary hip arthroplasty procedures performed between January 1, 2010, and August 1, 2012. The patients were studied retrospectively with regard to clinical behavior, stability and radiological osseointegration. The patients were followed up for a minimum of 12 months and a maximum of 42 months (mean: 27) and were evaluated by means of the Harris Hip Score, SF-36 questionnaire and serial conventional radiographs. Results All the components were radiologically stable, without evidence of migration or progressive radiolucency lines. On average, the Harris Hip Score evolved from 36.1 to 92.1 (p < 0.001) and the SF-36 showed significant increases in all its domains (p < 0.001). No differences were observed among patients with osteoarthrosis, osteonecrosis, hip dysplasia or other conditions. Conclusions The short-term results showed clinical and radiological signs of stability and osseointegration of the implants, which may represent a predictive factor regarding medium-term survival of this acetabular component. PMID:26229918

  2. Validation of an optical system to measure acetabular shell deformation in cadavers.

    PubMed

    Dold, Philipp; Bone, Martin C; Flohr, Markus; Preuss, Roman; Joyce, Tom J; Deehan, David; Holland, James

    2014-08-01

    Deformation of the acetabular shell at the time of surgery can result in poor performance and early failure of the hip replacement. The study aim was to validate an ATOS III Triple Scan optical measurement system against a co-ordinate measuring machine using in vitro testing and to check repeatability under cadaver laboratory conditions. Two sizes of custom-made acetabular shells were deformed using a uniaxial/two-point loading frame and measured at different loads. Roundness measurements were performed using both the ATOS III Triple Scan optical system and a co-ordinate measuring machine and then compared. The repeatability was also tested by measuring shells pre- and post-insertion in a cadaver laboratory multiple times. The in vitro comparison with the co-ordinate measuring machine demonstrated a maximum difference of 5 µm at the rim and 9 µm at the measurement closest to the pole of the shell. Maximum repeatability was below 1 µm for the co-ordinate measuring machine and 3 µm for the ATOS III Triple Scan optical system. Repeatability was comparable between the pre-insertion (below 2 µm) and post-insertion (below 3 µm) measurements in the cadaver laboratory. This study supports the view that the ATOS III Triple Scan optical system fulfils the necessary requirements to accurately measure shell deformation in cadavers.

  3. Wear versus Thickness and Other Features of 5-Mrad Crosslinked UHMWPE Acetabular Liners

    PubMed Central

    Shen, Fu-Wen; Lu, Zhen

    2010-01-01

    Background The low wear rates of crosslinked polyethylenes provide the potential to use larger diameters to resist dislocation. However, this requires the use of thinner liners in the acetabular component, with concern that higher contact stresses will increase wear, offsetting the benefits of the crosslinking. Questions/purposes We asked the following questions: Is the wear of conventional and crosslinked polyethylene liners affected by ball diameter, rigidity of backing, and liner thickness? Are the stresses in the liner affected by thickness? Methods Wear rates were measured in a hip simulator and stresses were calculated using finite element modeling. Results Without crosslinking, the wear rate was 4% to 10% greater with a 36-mm diameter than a 28-mm diameter. With crosslinking, wear was 9% lower with a 36-mm diameter without metal backing and 4% greater with metal backing. Reducing the thickness from 6 mm to 3 mm increased the contact stress by 46%, but the wear rate decreased by 19%. Conclusions The reduction in wear with 5 Mrad of crosslinking was not offset by increasing the diameter from 28 mm to 36 mm or by using a liner as thin as 3 mm. Clinical Relevance The results indicate, for a properly positioned 5-Mrad crosslinked acetabular component and within the range of dimensions evaluated, neither wear nor stresses in the polyethylene are limiting factors in the use of larger-diameter, thinner cups to resist dislocation. PMID:20848244

  4. The role of acetabular and femoral osteotomies in reconstructive surgery of the hip: 2005 and beyond.

    PubMed

    Turgeon, Thomas R; Phillips, William; Kantor, Stephen R; Santore, Richard F

    2005-12-01

    Femoral and acetabular osteotomies have enduring and useful roles in the ongoing surgical treatment of patients with various hip conditions. The classic indication for intertrochanteric valgus osteotomy is to induce healing of femoral neck nonunions. Additional indications include posttraumatic deformity, limb-length inequality, certain cases of osteonecrosis, and adult sequelae of Legg-Calve-Perthes disease, and slipped capital femoral epiphysis. Isolated intertrochanteric osteotomy is only occasionally indicated for the treatment of arthritis secondary to dysplasia. Rotational osteotomies of the pelvis have overtaken the role once historically played by intertrochanteric osteotomy in the treatment of dysplasia-related hip anomalies. Ideal candidates have prearthritic, activity-related pain associated with radiographic dysplasia. It is imperative that the hip joint be congruous, free of fixed subluxation, and located in the natural acetabulum. Surgical treatment of associated acetabular labral tears and/or detachments and impingement lesions can be done at the same time through antecedent hip arthroscopy (same anesthetic) or open arthrotomy. The direction and magnitude of correction need to be customized to fit the nature of the dysplasia. A standard method of correction likely is to result in unwanted iatrogenic retroversion in some cases. Intertrochanteric osteotomy now is used as a complement to rotational osteotomy for the indications outlined above. PMID:16331002

  5. Early polyethylene wear and osteolysis with ABG acetabular cups (7- to 12-year follow-up)

    PubMed Central

    Livesley, Peter

    2005-01-01

    We reviewed 81 consecutive ABG I primary total hip replacements implanted in 72 patients between January 1993 and December 1998. The mean follow-up was 8.2 (range 7–12) years. There was significant polyethylene wear and osteolysis associated with the acetabular cup .The cumulative survival of the cup with revision being the end point at 8.2 years was 95.1% (95% CI: 92–97.6%). However, the cumulative survival of the cup with revision and aseptic loosening together was 72% (95% CI: 61–78%) and survival of the acetabular liner for wear was 62% (95% CI: 48–74%). Stem survival with revision being the end point was 100%. In spite of significant radiological failures of the cups, most patients remained asymptomatic. Though results of the ABG stems in this series were good, we advocate a regular follow-up of all these hips in view of the poor outcome of the cups. PMID:16283307

  6. Acetabular Reconstruction with Human and Bovine Freeze- Dried Bone Grafts and a Reinforcement Device

    PubMed Central

    Rosito, Ricardo; Galia, Carlos Roberto; Macedo, Carlos Alberto Souza; Moreira, Luis Fernando; Quaresma, Lourdes Maria Araújo C.; Palma, Humberto Moreira

    2008-01-01

    BACKGROUND This is a cohort trial (1997–2005) of 49 patients submitted to an acetabular component revision of a total hip arthroplasty, using impacted human and bovine freeze-dried cancellous bone grafts (H&FDBG) and a reinforcement device. OBJECTIVE To compare clinical/radiographic graft incorporation capability between cancellous bone grafts. PATIENTS/METHODS There were two groups: I (n=26) receiving human grafts and II (n=25) receiving bovine grafts. The average follow-up times were 55 and 49 months, respectively. Clinical analysis was based on the Merle d’Aubigné and Postel score, and the radiographic analysis involved an established score based on Conn’s et al. criteria for radiographic bone incorporation. RESULTS No clinical/radiographic differences were found between the groups and both showed an overall rate of 88.5% and 76% of graft incorporation (p=0.424). CONCLUSION The results presented here are comparable to those in the literature with the use of deep-FG. Therefore, cancellous bone grafts can be safely and adequately used in acetabular component revision in total hip arthroplasty. PMID:18719763

  7. Acute tibial tubercle avulsion fractures.

    PubMed

    Mosier, Susan M; Stanitski, Carl L

    2004-01-01

    A retrospective analysis of 18 patients with 19 acute tibial tubercle avulsion fractures was performed. Mean age at injury was 13 years 8 months. Mean follow-up time was 2 years 8 months. A group of four preadolescent patients ages 9 to 12 years at injury was identified. Participation in athletics, particularly basketball, resulted in 77% of fractures. There were one type IA, three type IB, two type IIA, six type IIB, two type IIIA, four type IIIB, and one type IV fractures. Fifteen fractures were treated with open reduction and internal fixation and four by closed reduction and cylinder cast immobilization. Three cases (15.7%) of extensor mechanism disruption were noted, two patellar tendon avulsions and one quadriceps avulsion. Final outcome was good in all patients regardless of fracture type or treatment. There were no complications.

  8. [Recent progress in orthopaedic managements of osteoporosis-related fractures].

    PubMed

    Yamamoto, Seizo

    2011-07-01

    Recent progress in orthopaedic treatment of osteoporosis-related fractures was reviewed. In the treatment of femoral neck fractures, impacted or nondisplaced type is treated by three cannulated cancellous pins. Displaced type of femoral neck fracture is treated by bipolar prosthesis. Results of femoral neck fractures are influenced by the complications of each patients. Osteoporotic spine fractures are commonly healed within 2 or 3 months. Spinal compression with paraparesis or paraplegia is unusual complication in burst type of spine fractures. Surgical decompression, bone grafting and stabilization with instrumentation can result in some correction of deformity and neurogenic recovery. Distal radius fractures are common fractures in the eldery. Recently advances includes external fixation and plate fixation for the comminuted fractures in the distal radius. Treatments of osteoporosis-related fractures are still difficult problems to be resolved. PMID:21774371

  9. The influence of the strength of bone on the deformation of acetabular shells: a laboratory experiment in cadavers.

    PubMed

    Bone, M C; Dold, P; Flohr, M; Preuss, R; Joyce, T J; Aspden, R M; Holland, J; Deehan, D

    2015-04-01

    Concerns have been raised that deformation of acetabular shells may disrupt the assembly process of modular prostheses. In this study we aimed to examine the effect that the strength of bone has on the amount of deformation of the acetabular shell. The hypothesis was that stronger bone would result in greater deformation. A total of 17 acetabular shells were inserted into the acetabula of eight cadavers, and deformation was measured using an optical measuring system. Cores of bone from the femoral head were taken from each cadaver and compressed using a materials testing machine. The highest peak modulus and yield stress for each cadaver were used to represent the strength of the bone and compared with the values for the deformation and the surgeon's subjective assessment of the hardness of the bone. The mean deformation of the shell was 129 µm (3 to 340). No correlation was found between deformation and either the maximum peak modulus (r² = 0.011, t = 0.426, p = 0.676) or the yield stress (r² = 0.024, t = 0.614, p = 0.549) of the bone. Although no correlation was found between the strength of the bone and deformation, the values for the deformation observed could be sufficient to disrupt the assembly process of modular acetabular components.

  10. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented...

  11. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint metal/metal semi-constrained, with an... Devices § 888.3330 Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with an uncemented...

  12. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hip joint metal/metal semi-constrained, with an... Devices § 888.3330 Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with an uncemented...

  13. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented...

  14. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/metal semi-constrained, with an... Devices § 888.3330 Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with an uncemented...

  15. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented...

  16. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint metal/metal semi-constrained, with an... Devices § 888.3330 Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with an uncemented...

  17. 21 CFR 888.3330 - Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint metal/metal semi-constrained, with an... Devices § 888.3330 Hip joint metal/metal semi-constrained, with an uncemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with an uncemented...

  18. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented...

  19. 21 CFR 888.3320 - Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hip joint metal/metal semi-constrained, with a... Devices § 888.3320 Hip joint metal/metal semi-constrained, with a cemented acetabular component, prosthesis. (a) Identification. A hip joint metal/metal semi-constrained, with a cemented...

  20. Custom 3D-printed acetabular implants in hip surgery--innovative breakthrough or expensive bespoke upgrade?

    PubMed

    Wyatt, Michael C

    2015-01-01

    Custom 3D-printed triflange acetabular cages are a new option in the armamentarium of the revision hip surgeon. This review article defines this technology, its indications, surgical method, advantages, disadvantages, use, current published literature and future applications. PMID:26351112

  1. Experimental evidence of impingement induced strains at the interface and the periphery of an embedded acetabular cup implant.

    PubMed

    Arndt, Christoph; Voigt, Christian; Steinke, Hanno; Salis-Soglio, Georg V; Scholz, Roger

    2012-01-01

    After total hip arthroplasty, impingement of implant components may occur during every-day patient activities causing increased shear stresses at the acetabular implant-bone interface. In the literature, impingement related lever-out moments were noted for a number of acetabular components. But there is little information about pelvic load transfer. The aim of the current study was to measure the three-dimensional strain distribution at the macrostructured hemispherical interface and in the periphery of a standard acetabular press-fit cup in an experimental implant-bone substitute model. An experimental setup was developed to simulate impingement loading via a lever arm representing the femoral component and the lower limb. In one experimental setup 12 strain gauges were embedded at predefined positions in the periphery of the acetabular cup implant inside a tray, using polyurethane composite resin as a bone substitute material. By incremental rotation of the implant tray in steps of 10 and 30 deg, respectively, the strains were measured at evenly distributed positions. With the described method 288 genuine strain values were measured in the periphery of an embedded acetabular cup implant in one experimental setup. In two additional setups the strains were evaluated at different distances from the implant interface. Both in radial and meridional interface directions strain magnitudes reach their peak near the rim of the cup below the impingement site. Values of equatorial strains vary near zero and reach their peaks near the rim of the cup on either side and in some distance from the impingement site. Interestingly, the maximum of averaged radial strains does not occur, as expected, close to the interface but at an interface offset of 5.6 mm. With the described experimental setup it is now possible to measure and display the three-dimensional strain distribution in the interface and the periphery of an embedded acetabular cup implant. The current study provides the

  2. Transgluteal posterior column screw stabilization for fractures of the acetabulum: a technical trick.

    PubMed

    Connelly, Camille L; Archdeacon, Michael T

    2012-10-01

    The traditional exposure of high posterior column or transverse acetabular fractures can pose a challenge for lag screw stabilization. The authors describe an adjunctive percutaneous transgluteal lag screw technique for the internal fixation of the high posterior column. In the senior author's experience, this technique has been helpful to achieve the optimal trajectory for a stable perpendicular lag screw to maintain an anatomical reduction. In our experience, this technique has been used in conjunction with the standard Kocher-Langenbeck exposure and posterior column plating techniques.

  3. Olecranon stress fracture in a weight lifter: a case report.

    PubMed

    Rao, P S; Rao, S K; Navadgi, B C

    2001-02-01

    Stress fractures have been reported in the upper limb of sportspeople involved in upper limb dominated events. Olecranon stress fractures have been cited in baseball pitchers, javelin throwers, and gymnasts. The unusual case of a stress fracture of the olecranon in a young weight lifter is reported here. The minimally displaced stress fracture was treated with tension band and two Kirschner wires. The fracture healed in four months and the patient returned to light sports activity after six months.

  4. Fracture Management

    MedlinePlus

    ... to hold the fracture in the correct position. • Fiberglass casting is lighter and stronger and the exterior ... with your physician if this occurs. • When a fiberglass cast is used in conjunction with a GORE- ...

  5. Stress Fractures of the Foot.

    PubMed

    Hossain, Munier; Clutton, Juliet; Ridgewell, Mark; Lyons, Kathleen; Perera, Anthony

    2015-10-01

    Stress fractures of the foot and ankle may be more common among athletes than previously reported. A low threshold for investigation is warranted and further imaging may be appropriate if initial radiographs remain inconclusive. Most of these fractures can be treated conservatively with a period of non-weight-bearing mobilization followed by gradual return to activity. Early surgery augmented by bone graft may allow athletes to return to sports earlier. Risk of delayed union, nonunion, and recurrent fracture is high. Many of the patients may also have risk factors for injury that should be modified for a successful outcome.

  6. Lisfranc fractures.

    PubMed

    Wright, Amanda; Gerhart, Ann E

    2009-01-01

    Injuries of the tarsometatarsal, or Lisfranc, joint are rarely seen. Lisfranc fractures and fracture dislocations are among the most frequently misdiagnosed foot injuries in the emergency department. A misdiagnosed injury may have severe consequences including chronic pain and loss of foot biomechanics. Evaluation of a foot injury should include a high level of suspicion of a Lisfranc injury, and a thorough work-up is needed for correct diagnosis.

  7. Multiple stress fractures of the tibia in a healthy adult.

    PubMed

    Lambros, G; Alder, D

    1997-10-01

    Multiple stress fractures in the same bone are a rare occurrence. This paper presents an unusual case of a 19-year-old, healthy man who sustained a pathologic fracture of the proximal tibia through a stress-fracture site. The radiographic examination of the tibia also revealed multiple stress fractures inferior to the pathologic fracture. Magnetic resonance imaging can be used to rule out neoplasm and to confirm the stress-fracture diagnosis. Multiple stress fractures in the same bone can be treated with cast immobilization.

  8. Does Robotic-Assisted Computer Navigation Affect Acetabular Cup Positioning in Total Hip Arthroplasty in the Obese Patient? A Comparison Study.

    PubMed

    Gupta, Asheesh; Redmond, John M; Hammarstedt, Jon E; Petrakos, Alexandra E; Vemula, S Pavan; Domb, Benjamin G

    2015-12-01

    Obese populations present challenges for acetabular cup placement during total hip arthroplasty (THA). This study examines the accuracy of acetabular cup inclination and version in the obese patient with robotic-assisted computer navigation. A total of 105 patients underwent robotic-assisted computer navigation THA with a posterior approach. Groups were divided on body mass index (BMI, kg/m(2)) of <30, 30-35, and >35. There was no statistical difference between the BMI <30 (n=59), BMI 30-35 (n=34) and BMI >35 (n=12) groups for acetabular inclination (P=0.43) or version (P=0.95). Robotic-assisted computer navigation provided accurate and reproducible placement of the acetabular cup within safe zones for inclination and version in the obese patient.

  9. Gravity-Driven Hydraulic Fractures

    NASA Astrophysics Data System (ADS)

    Germanovich, L. N.; Garagash, D.; Murdoch, L. C.; Robinowitz, M.

    2014-12-01

    This study is motived by a new method for disposing of nuclear waste by injecting it as a dense slurry into a hydraulic fracture that grows downward to great enough depth to permanently isolate the waste. Disposing of nuclear waste using gravity-driven hydraulic fractures is mechanically similar to the upward growth of dikes filled with low density magma. A fundamental question in both applications is how the injected fluid controls the propagation dynamics and fracture geometry (depth and breadth) in three dimensions. Analog experiments in gelatin [e.g., Heimpel and Olson, 1994; Taisne and Tait, 2009] show that fracture breadth (the short horizontal dimension) remains nearly stationary when the process in the fracture "head" (where breadth is controlled) is dominated by solid toughness, whereas viscous fluid dissipation is dominant in the fracture tail. We model propagation of the resulting gravity-driven (buoyant or sinking), finger-like fracture of stationary breadth with slowly varying opening along the crack length. The elastic response to fluid loading in a horizontal cross-section is local and can be treated similar to the classical Perkins-Kern-Nordgren (PKN) model of hydraulic fracturing. The propagation condition for a finger-like crack is based on balancing the global energy release rate due to a unit crack extension with the rock fracture toughness. It allows us to relate the net fluid pressure at the tip to the fracture breadth and rock toughness. Unlike the PKN fracture, where breadth is known a priori, the final breadth of a finger-like fracture is a result of processes in the fracture head. Because the head is much more open than the tail, viscous pressure drop in the head can be neglected leading to a 3D analog of Weertman's hydrostatic pulse. This requires relaxing the local elasticity assumption of the PKN model in the fracture head. As a result, we resolve the breadth, and then match the viscosity-dominated tail with the 3-D, toughness

  10. Lower reoperation rate for cemented femoral stem than for uncemented femoral stem in primary total hip arthroplasty following a displaced femoral neck fracture

    PubMed Central

    Andersen, Michelle F.; Jakobsen, Thomas; Bensen, Anne S.; Krarup, Niels

    2015-01-01

    Introduction: Acute displaced femoral neck fractures are often treated with cemented hemiarthroplasty (HA). There is increasing evidence that total hip arthroplasty (THA) may be a better alternative, but the degree to which the fixation of the femoral stem used affects the outcome is not fully known. The aim of this study is to compare rates of operative complications and implant survival following THA treatment of displaced femoral neck fractures with either a cemented or an uncemented femoral stem. Methods: The study consists of two groups of patients (N = 334), who were treated for a displaced femoral neck fracture with THA at the Regional Hospital of Viborg during 2007–2012. The first group (50.9%) had uncemented (Corail®) stem while the second group (49.1%) had cemented (Exeter®) stem implanted. Nearly all patients had uncemented dual mobility cup (Saturne®) as acetabular component and were followed up to three months postoperatively. Data regarding rates of implant survival and operative complications were obtained by retrospective review of medical records. Results: We found a statistically significant difference regarding rates of postoperative reoperation with 1.2% (95% CI 0.005–0.03) for cemented and 5.9% (95% CI 0.02–0.09) for uncemented stem (p = 0.02). The main causes for reoperation were peri-prosthetic fractures and deep infections. There was no difference regarding dislocation or peroperative complications. Rates of dislocation were 4.3% (95% CI 0.012–0.07) for cemented and 3.5% (95% CI 0.008–0.06) for uncemented stem (p = 0.72). Rates of peroperative complications were 6.1% (95% CI 0.024–0.1) for cemented and 8.2% (95% CI 0.04–0.12) for uncemented stem (p = 0.1). Discussion: Our results indicate that cemented femoral stem is superior to cementless when rates of reoperation are compared. PMID:27163081

  11. Fractures of the acetabulum in elderly patients: an update.

    PubMed

    Guerado, E; Cano, J R; Cruz, E

    2012-12-01

    The incidence of acetabular fractures in elderly patients is increasing. Poor bone quality and concomitant diseases are the main features of these patients. Fracture patterns are marked by a high degree of variability in terms of patient and fracture characteristics. Preoperative planning with plain radiographs and computed tomography, including 3-dimensional reconstructions, is recommended. Treatment remains challenging because of precarious general health, severe osteopenia, comminution, and associated femoral head damage. Treatment options available include closed management, open reduction with internal fixation, percutaneous fixation in situ, and acute or staged total hip arthroplasty (THA) whether alone or combined with osteosynthesis. In the case of significant destruction of the articular cartilage, primary THA may provide the best solution. Whichever surgical method is chosen, the objective is rapid mobilisation of the patient on a walker or crutches. Late local complications that may occur after nonoperative or operative treatment include posttraumatic arthritis, nonunion, malunion, wound infection, dislocation, intrusive hardware, nerve palsy, and heterotopic bone formation. In this article an overview of the current trends in the management of acetabulum fractures in the elderly is presented.

  12. Traumatic isolated coracoid fractures in the adolescent.

    PubMed

    Chitre, Amol R; Divecha, Hiren M; Hakimi, Mounir; Marynissen, Hans A J

    2012-01-01

    Coracoid fractures are rare injuries in themselves. Even rarer are isolated fractures of the coracoid in the skeletally immature patient. Due to the low numbers of these fractures, there is no true consensus on how to treat them. We report two cases of an isolated fracture of the coracoid. Case A is a 13-year-old boy who sustained the coracoid fracture following a skiing injury; case B is a 15-year-old boy who fell onto the right shoulder during a wheelbarrow race at school. Initial radiographs in case A suggested a displaced fracture; however, a CT scan taken after a short period of conservative treatment showed minimal displacement. In case B both the radiographs and CT scan showed no displacement. Both injuries were treated conservatively and united uneventfully with a full return to function. We advocate conservative management for these injuries in the skeletally immature patient. PMID:23304591

  13. Traumatic Isolated Coracoid Fractures in the Adolescent

    PubMed Central

    Chitre, Amol R.; Divecha, Hiren M.; Hakimi, Mounir; Marynissen, Hans A. J.

    2012-01-01

    Coracoid fractures are rare injuries in themselves. Even rarer are isolated fractures of the coracoid in the skeletally immature patient. Due to the low numbers of these fractures, there is no true consensus on how to treat them. We report two cases of an isolated fracture of the coracoid. Case A is a 13-year-old boy who sustained the coracoid fracture following a skiing injury; case B is a 15-year-old boy who fell onto the right shoulder during a wheelbarrow race at school. Initial radiographs in case A suggested a displaced fracture; however, a CT scan taken after a short period of conservative treatment showed minimal displacement. In case B both the radiographs and CT scan showed no displacement. Both injuries were treated conservatively and united uneventfully with a full return to function. We advocate conservative management for these injuries in the skeletally immature patient. PMID:23304591

  14. Metacarpal fractures in the athlete.

    PubMed

    Rettig, A C; Ryan, R; Shelbourne, K D; McCarroll, J R; Johnson, F; Ahlfeld, S K

    1989-01-01

    Fifty-six fractures of the metacarpal occurring in 53 athletes were studied from September 1985 to December 1986, regarding mechanism of injury, type of fracture, type of treatment, and time lost from sport. Age range of the patients was 8 to 28 years with greater than 77% being in the 14 to 18 year age range, the high school athlete. Twenty-nine of the fractures occurred in football, 14 in basketball, and the remainder were divided between various other sports. The most common mechanism of injury involved falls or hitting an object such as a helmet or another player. Fractures were evenly divided regarding which digit was involved in football, whereas most basketball injuries occurred in the fourth and fifth metacarpal. Fractures were analyzed as to type of radiographic appearance and this was correlated with time lost from competition or participation. No significant difference among fracture type regarding time lost was noted. Forty-six of the fractures (82%) were minimally displaced or undisplaced and were treated by means of simple casting and/or splinting whereas 10 were displaced. Two of the 10 underwent closed reduction and casting; 3 underwent closed reduction and percutaneous pin fixation; and 5 (9%) underwent open reduction internal fixation using AO type plates and screws. All fractures healed primarily clinically and radiographically. The average time lost from practice or competition in this group overall was 13.7 days, (range, 0 to 56 days). Average time lost from basketball was 19.8 days and from football 10.63 days overall. Average time lost from sport in stable fractures treated with casting or splinting was 12.3 days.(ABSTRACT TRUNCATED AT 250 WORDS)

  15. Thoracolumbar Spine Fractures in the Geriatric Fracture Center

    PubMed Central

    Folbert, E. C.; Kraai, M.; Smit, R. S.; Hegeman, J. H.; van der Velde, D.

    2014-01-01

    Introduction: Thoracolumbar spine fractures are common osteoporotic fractures among elderly patients. Several studies suggest that these fractures can be treated successfully with a nonoperative management. The aim of this study is to evaluate the conservative treatment of elderly patients with a vertebral fracture. Methods: This study is a retrospective cohort study, which included all patients with an age of 65 years and older, who were diagnosed with a vertebral fracture and where therefore admitted to the Geriatric Fracture Center over a period of 2 years. Primary outcome was the level of functioning 6 weeks and 3 months after admission. Results: We included 106 patients with 143 vertebral fractures, of which 61 patients were evaluated after 3 months. In our population, 53% of the patients had a fracture involving both middle and anterior columns. The majority of the patients functioned sufficiently 6 weeks and 3 months after admission. Analysis showed that age <80 years is an independent predictor of a sufficient level of functioning after 6 weeks. Discussion: The nonoperative treatment of elderly patients with a vertebral fracture leads to a sufficient level of functioning 6 weeks and 3 months after admission. In our population, only age <80 years is an independent predictor for a sufficient level of functioning 6 weeks after admission. The level of functioning at 6 weeks predicts the level of functioning 3 months after admission. On comparison, the level of functioning after early ambulation is equal to the level of functioning after immobilization. Where immobilization may lead to complications, early ambulation was not associated with new complications or neurological damage. Based on these advantages, the treatment of elderly patients with a fracture involving both middle and anterior columns may be altered from immobilization to mobilization in the future. PMID:25360330

  16. Early failure of a polyethylene acetabular liner cemented into a metal cup.

    PubMed

    Wilson, David A J; Corkum, Joseph P; Teeter, Matthew G; Holdsworth, David W; Dunbar, Michael J

    2012-05-01

    In 2002, a patient underwent revision total hip arthroplasty for polyethylene wear. The acetabular cup was well fixed, and it was decided to cement a new polyethylene liner into the existing cup. In 2006, the patient presented with inability to weight bear and easy subluxation of the hip. Revision surgery was performed, and all components were examined postoperatively. Investigation with microcomputed tomography revealed that the liner had plastically deformed at the superior pole resulting in the hip instability. The reasons for this are suspected to be related to the abducted nature of the original cup and an uneven cement mantle. This report suggests that cementation of polyethylene liners into metal cups has limitations and is not appropriate in all circumstances.

  17. Polyethylene sterilized without irradiation in a polished uncemented acetabular component-a clinical and radiographic analysis.

    PubMed

    Crockarell, John R

    2008-09-01

    Clinical and radiographic analysis of the Reflection uncemented acetabular component was performed. Features of this component include a polished inner shell and ethylene oxide sterilization. Clinical information was available for 158 hips (mean, 4.6 years follow-up). A total of 19 hips have undergone or were recommended revision, 8 for aseptic loosening or wear (5%). Wear analysis was performed for 38 hips with more than 5 years of follow-up (mean, 6.7 years). Osteolysis was present in 20 of these patients. Penetration rate averaged 0.15 mm/y. Patients with uncemented femoral fixation (vs cemented) had a significantly higher penetration rate. Increased volumetric wear was seen with uncemented femoral fixation, thin liners, and ceramic heads. This component demonstrated relatively high penetration and osteolysis rates. Continued surveillance is recommended, particularly for active patients with thin liners. PMID:18534518

  18. Wear patterns of, and wear volume formulae for, cylindrically elongated acetabular cup liners.

    PubMed

    Wu, James Shih-Shyn; Hsu, Shu-Ling; Chen, Jian-Horng

    2010-07-01

    This study analyzed the wear patterns of, and wear volume formulae for, cylindrically elongated acetabular cup liners. The geometric patterns of the wear surface were first classified, then wear volume formulae were derived by integral calculus. SolidWorks((R)) software or published formulae were used to verify the accuracy of the proposed formulae. The analytical results showed that the wear shape of the liner can be categorized into seven wear patterns, including the special case of wear at 90 degrees , and the seven corresponding wear formulae were derived. In addition, wear of the cylindrical elongation might add considerably to the volume loss of the liner, depending on the height and shape of the elongation and the depth and direction of the linear penetration, being maximally 21% in the investigated model. The proposed wear formulae and patterns will be useful for more accurate performance evaluation of existing hip components implanted in patients and for the designing of new hip components.

  19. Displacement and Stress Analysis around the Artificial Acetabular Cup in a Total Hip Replacement

    NASA Astrophysics Data System (ADS)

    Kakunai, Satoshi; Tachibana, Hiroyuki; Sakamoto, Tohru; Abo, Masayoshi; Ikeda, Daisaku; Fujiwara, Hiroo

    In order to improve the service life of the artificial acetabular cup in a total hip replacement, it is important to determine the best material and design, and to assess the mechanical behavior around the cup. In this study, electronic speckle interferometry (ESPI) and the two-dimensional finite element method (FEM) are employed to investigate the mechanical behavior. The influence of the cancellous bone and cup thickness on mechanical behavior around the cup was investigated. Good agreement of the cup model was found between the ESPI measurements and FEM predictions. The following results were obtained. (1) Cancellous bone with a porous structure can be measured by the ESPI method. (2) There are discontinuities of the displacement distribution in the transverse direction in each boundary region of the cup, bone cement and cancellous bone. (3) The maximum shear stress exists in the boundary region of the cup and bone cement.

  20. Fractures of Distal Radius: An Overview

    PubMed Central

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

    2014-01-01

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

  1. Simultaneous bilateral tibial tubercle avulsion fracture.

    PubMed

    Maar, D C; Kernek, C B; Pierce, R O

    1988-11-01

    Bilateral simultaneous tibial tubercle avulsion fractures are extremely rare. The present case was a 16-year-old boy who sustained bilateral simultaneous tibial tubercle avulsion fractures (Watson-Jones Type III) from jumping while playing basketball. Both fractures were treated successfully by open reduction and internal fixation with screws. Three years later, the patient had the screws removed because of knee pain and tenderness over the screws.

  2. Acetabular shell deformation as a function of shell stiffness and bone strength.

    PubMed

    Dold, Philipp; Pandorf, Thomas; Flohr, Markus; Preuss, Roman; Bone, Martin C; Joyce, Tom J; Holland, James; Deehan, David

    2016-04-01

    Press-fit acetabular shells used for hip replacement rely upon an interference fit with the bone to provide initial stability. This process may result in deformation of the shell. This study aimed to model shell deformation as a process of shell stiffness and bone strength. A cohort of 32 shells with two different wall thicknesses (3 and 4 mm) and 10 different shell sizes (44- to 62-mm outer diameter) were implanted into eight cadavers. Shell deformation was then measured in the cadavers using a previously validated ATOS Triple Scan III optical system. The shell-bone interface was then considered as a spring system according to Hooke's law and from this the force exerted on the shell by the bone was calculated using a combined stiffness consisting of the measured shell stiffness and a calculated bone stiffness. The median radial stiffness for the 3-mm wall thickness was 4192 N/mm (range, 2920-6257 N/mm), while for the 4-mm wall thickness the median was 9633 N/mm (range, 6875-14,341 N/mm). The median deformation was 48 µm (range, 3-187 µm), while the median force was 256 N (range, 26-916 N). No statistically significant correlation was found between shell stiffness and deformation. Deformation was also found to be not fully symmetric (centres 180° apart), with a median angle discrepancy of 11.5° between the two maximum positive points of deformation. Further work is still required to understand how the bone influences acetabular shell deformation.

  3. A double mobility acetabular implant for primary hip arthroplasty in patients at high risk of dislocation

    PubMed Central

    Middleton, RG; Young, P; Uzoigwe, C; Barkham, B; Yusoff, S; Minhas, THA

    2014-01-01

    Introduction Dislocation following total hip replacement continues to be a problem for which no completely satisfactory solution has been found. Several methods have been proposed to reduce the incidence of hip dislocations with varying degrees of success, including elevated rim liners, constrained liners and large diameter bearings. We present our experience with the double mobility acetabular component in patients at high risk of instability. Methods This was a retrospective review of 65 primary total hip arthroplasties in 55 patients (15 men, 40 women), performed between October 2005 and November 2009. The majority (80%) of patients had at least two and 26% had at least three risk factors for instability. The mean age was 76 years (range: 44–92 years). The patients were followed up for a mean duration of 60 months (range: 36–85 months). Results Fourteen patients died and one was lost to follow-up, leaving fifty hips for final assessment. Until the final follow-up appointment, no patients had dislocation and none required revision surgery. The mean Oxford hip score improved from 45.0 to 26.5 (p<0.0001). The mean Merle d’Aubigné pain score improved from 1.4 to 4.9 (p<0.0001), the walking score from 2.3 to 3.1 (p<0.07) and the absolute hip function score from 5.4 to 10.8 (p<0.0001). There were no clinical or radiographic signs of loosening. Conclusions The double mobility acetabular component was successful at preventing dislocation during early to medium-term follow-up. However, as data are still lacking with regard to polyethylene wear rates at the additional bearing surface, it would be prudent to restrict the use of this implant to selected patients at high risk of instability. PMID:25350182

  4. Measurement of lateral acetabular coverage: a comparison between CT and plain radiography

    PubMed Central

    Chadayammuri, Vivek; Garabekyan, Tigran; Jesse, Mary-Kristen; Pascual-Garrido, Cecilia; Strickland, Colin; Milligan, Kenneth; Mei-Dan, Omer

    2015-01-01

    We prospectively evaluated the degree of absolute agreement between measurements of lateral center-edge angle (LCEA) on plain radiography (XR) and computed tomography (CT) in a consecutive cohort of 205 patients (410 hips) undergoing hip arthroscopy. Preoperative measurements of the LCEA were performed bilaterally utilizing standardized anteroposterior radiographs and coronal reformatted CT scans. Demographic variables including age, gender, height, weight, BMI and clinical diagnosis were recorded for all patients. Overall, measured values of the LCEA were 2.1° larger on CT compared with XR (32.9° versus 30.8°, P < 0.001). Subgroup analysis revealed the highest mean difference in hips with acetabular dysplasia and concomitant cam-type femoroacetabular impingement (FAI) [mean difference (CT–XR) 5.5°, 95% confidence interval (CI) 3.7°–7.3°, P = 0.011], followed by hips with isolated acetabular dysplasia (mean difference [CT–XR] 4.9°, 95% CI 2.7°–7.0°, P < 0.001). In contrast, 119 (29.0%) of the hips demonstrated larger measurements of the LCEA on 25 XR relative to CT. Of these hips, 20 (16.8%) had pincer-FAI and 25 had cam-FAI (21.0%), representing a significantly higher proportion compared with all other clinical subgroups (P = 0.045 and 0.036, respectively). Our study demonstrates measured values of the LCEA are consistently inflated on CT relative to XR for a wide variety of hip pathologies, highlighting the need for standardization and validation of CT-based measurements to improve the quality of clinical decision making. Level of Evidence: Diagnostic Level II. PMID:27011864

  5. Galeazzi fracture.

    PubMed

    Atesok, Kivanc I; Jupiter, Jesse B; Weiss, Arnold-Peter C

    2011-10-01

    Galeazzi fracture is a fracture of the radial diaphysis with disruption at the distal radioulnar joint (DRUJ). Typically, the mechanism of injury is forceful axial loading and torsion of the forearm. Diagnosis is established on radiographic evaluation. Underdiagnosis is common because disruption of the ligamentous restraints of the DRUJ may be overlooked. Nonsurgical management with anatomic reduction and immobilization in a long-arm cast has been successful in children. In adults, nonsurgical treatment typically fails because of deforming forces acting on the distal radius and DRUJ. Open reduction and internal fixation is the preferred surgical option. Anatomic reduction and rigid fixation should be followed by intraoperative assessment of the DRUJ. Further intraoperative interventions are based on the reducibility and postreduction stability of the DRUJ. Misdiagnosis or inadequate management of Galeazzi fracture may result in disabling complications, such as DRUJ instability, malunion, limited forearm range of motion, chronic wrist pain, and osteoarthritis.

  6. Posterior dislocation of hip with ipsilateral intertrochanteric fracture: A report of two cases

    PubMed Central

    Ul Haq, Rehan; Kumar, Jaswant; Dhammi, IK; Jain, Anil K

    2016-01-01

    Posterior dislocations of the hip are known to be associated with fractures of the femoral head, neck, shaft, or posterior acetabular wall. However, its association with ipsilateral intertrochanteric fracture has only been anecdotally described in the English literature. We report two such cases managed by open reduction (OR) of the hip and internal fixation (IF) of the intertrochanteric fracture. The first case was a 26-year-old male who was managed by OR of the hip with IF of the intertrochanteric fracture with a dynamic hip screw and had a good functional result at 1-year followup. The second case was a 36-year-old female who was also managed by OR of the hip with IF of the head fragments with Herbert screw and IF of the intertrochanteric fracture with a dynamic condylar screw. The patient had a fair, functional result at 1-year followup. With the increase in high energy trauma, these fracture patterns have become more common, and there is an urgent need to review the existing classifications so that these fractures are better categorized, and treatment guidelines defined. PMID:27746503

  7. Pediatric Thighbone (Femur) Fracture

    MedlinePlus

    ... fractures in infants under 1 year old is child abuse. Child abuse is also a leading cause of thighbone fracture ... contact sports • Being in a motor vehicle accident • Child abuse Types of Femur Fractures (Classification) Femur fractures vary ...

  8. Radial head fractures--an update.

    PubMed

    Pike, Jeffrey M; Athwal, George S; Faber, Kenneth J; King, Graham J W

    2009-03-01

    Radial head fractures are the most common fractures occurring around the elbow. Although radial head fractures can occur in isolation, associated fractures and ligament injuries are common. Assembling the clinical presentation, physical examination, and imaging into an effective treatment plan can be challenging. The characteristics of the radial head fracture influence the technique used to optimize the outcome. Fragment number, displacement, impaction, and bone quality are considered when deciding between early motion, fragment excision, and radial head excision, repair, or replacement. Isolated, minimally displaced fractures without evidence of mechanical block can be treated nonsurgically with early active range of motion (ROM). Partial, displaced radial head fractures without evidence of mechanical block can be treated either nonsurgically or with open reduction internal fixation (ORIF), as current evidence does not prove superiority of either strategy. For displaced fractures with greater than 3 fragments, radial head replacement is recommended. Radial head arthroplasty may be preferred over tenuous fracture fixation in the setting of associated ligament injuries when maintenance of joint stability could be compromised by ineffective fracture fixation. PMID:19258159

  9. HUMERAL SHAFT FRACTURES

    PubMed Central

    Benegas, Eduardo; Ferreira Neto, Arnaldo Amado; Neto, Raul Bolliger; Santis Prada, Flavia de; Malavolta, Eduardo Angeli; Marchitto, Gustavo Oliveira

    2015-01-01

    Humeral shaft fractures (HSFs) represent 3% of the fractures of the locomotor apparatus, and the middle third of the shaft is the section most affected. In the majority of cases, it is treated using nonsurgical methods, but surgical indications in HSF cases are increasingly being adopted. The diversity of opinions makes it difficult to reach a consensus regarding the types of osteosynthesis, surgical technique and quantity and quality of synthesis materials that should be used. It would appear that specialists are far from reaching a consensus regarding the best method for surgical treatment of HSFs. We believe that less invasive methods, which favor relative stability, are the most appropriate methods, since the most feared complications are less frequent. PMID:27019833

  10. Acetabular revision with impaction bone grafting and a cemented polyethylene acetabular component: comparison of the Kaplan-Meier analysis to the competing risk analysis in 62 revisions with 25 to 30 years follow-up.

    PubMed

    Te Stroet, M A J; Keurentjes, J C; Rijnen, W H C; Gardeniers, J W M; Verdonschot, N; Slooff, T J J H; Schreurs, B W

    2015-10-01

    We present the results of 62 consecutive acetabular revisions using impaction bone grafting and a cemented polyethylene acetabular component in 58 patients (13 men and 45 women) after a mean follow-up of 27 years (25 to 30). All patients were prospectively followed. The mean age at revision was 59.2 years (23 to 82). We performed Kaplan-Meier (KM) analysis and also a Competing Risk (CR) analysis because with long-term follow-up, the presence of a competing event (i.e. death) prevents the occurrence of the endpoint of re-revision. A total of 48 patients (52 hips) had died or had been re-revised at final review in March 2011. None of the deaths were related to the surgery. The mean Harris hip score of the ten surviving hips in ten patients was 76 points (45 to 99). The KM survivorship at 25 years for the endpoint 're-revision for any reason' was 58.0% (95% confidence interval (CI) 38 to 73) and for 're-revision for aseptic loosening' 72.1% (95% CI 51 to 85). With the CR analysis we calculated the KM analysis overestimates the failure rate with respectively 74% and 93% for these endpoints. The current study shows that acetabular impaction bone grafting revisions provide good clinical results at over 25 years.

  11. A HIERARCHY OF COMPUTATIONALLY DERIVED SURGICAL AND PATIENT INFLUENCES ON METAL ON METAL PRESS-FIT ACETABULAR CUP FAILURE

    PubMed Central

    Clarke, S G; Phillips, A T M; Bull, A M J; Cobb, J P

    2014-01-01

    The impact of anatomical variation and surgical error on excessive wear and loosening of the acetabular component of large diameter metal on metal hip arthroplasties was measured using a multi-factorial analysis through 112 different simulations. Each surgical scenario was subject to eight different daily loading activities using finite element analysis. Excessive wear appears to be predominantly dependent on cup orientation, with inclination error having a higher influence than version error, according to the study findings. Acetabular cup loosening, as inferred from initial implant stability, appears to depend predominantly on factors concerning the area of cup-bone contact, specifically the level of cup seating achieved and the individual patient’s anatomy. The extent of press fit obtained at time of surgery did not appear to influence either mechanism of failure in this study. PMID:22513086

  12. Arcuate Fractures

    NASA Technical Reports Server (NTRS)

    2005-01-01

    [figure removed for brevity, see original site]

    In the upper left corner of this VIS image are a series of fractures. Where the fractures are exposed on the surface it is impossible to tell the plane of the fracture; however where the fractures are visible in the cliff wall it is possible to see that the fractures dip to the north. This image shows part of the caldera of Tharsis Tholus.

    Image information: VIS instrument. Latitude 1.7, Longitude 176.5 East (183.5 West). 19 meter/pixel resolution.

    Note: this THEMIS visual image has not been radiometrically nor geometrically calibrated for this preliminary release. An empirical correction has been performed to remove instrumental effects. A linear shift has been applied in the cross-track and down-track direction to approximate spacecraft and planetary motion. Fully calibrated and geometrically projected images will be released through the Planetary Data System in accordance with Project policies at a later time.

    NASA's Jet Propulsion Laboratory manages the 2001 Mars Odyssey mission for NASA's Office of Space Science, Washington, D.C. The Thermal Emission Imaging System (THEMIS) was developed by Arizona State University, Tempe, in collaboration with Raytheon Santa Barbara Remote Sensing. The THEMIS investigation is led by Dr. Philip Christensen at Arizona State University. Lockheed Martin Astronautics, Denver, is the prime contractor for the Odyssey project, and developed and built the orbiter. Mission operations are conducted jointly from Lockheed Martin and from JPL, a division of the California Institute of Technology in Pasadena.

  13. Better Way to Treat Seniors' Ankle Fractures?

    MedlinePlus

    ... quality of life can suffer as they lose mobility," added Willett. He is a professor of orthopedics, ... two groups in terms of pain, ankle motion, mobility or quality of life, the study found. Patients ...

  14. Study of the three-dimensional orientation of the labrum: its relations with the osseous acetabular rim

    PubMed Central

    Bonneau, Noémie; Bouhallier, July; Baylac, Michel; Tardieu, Christine; Gagey, Olivier

    2012-01-01

    Understanding the three-dimensional orientation of the coxo-femoral joint remains a challenge as an accurate three-dimensional orientation ensure an efficient bipedal gait and posture. The quantification of the orientation of the acetabulum can be performed using the three-dimensional axis perpendicular to the plane that passes along the edge of the acetabular rim. However, the acetabular rim is not regular as an important indentation in the anterior rim was observed. An innovative cadaver study of the labrum was developed to shed light on the proper quantification of the three-dimensional orientation of the acetabulum. Dissections on 17 non-embalmed corpses were performed. Our results suggest that the acetabular rim is better represented by an anterior plane and a posterior plane rather than a single plane along the entire rim as it is currently assumed. The development of the socket from the Y-shaped cartilage was suggested to explain the different orientations in these anterior and posterior planes. The labrum forms a plane that takes an orientation in between the anterior and posterior parts of the acetabular rim, filling up inequalities of the bony rim. The vectors VL, VA2 and VP, representing the three-dimensional orientation of the labrum, the anterior rim and the posterior rim, are situated in a unique plane that appears biomechanically dependent. The three-dimensional orientation of the acetabulum is a fundamental parameter to understand the hip joint mechanism. Important applications for hip surgery and rehabilitation, as well as for physical anthropology, were discussed. PMID:22360458

  15. Effect of acetabular cup abduction angle on wear of ultrahigh-molecular-weight polyethylene in hip simulator testing.

    PubMed

    Korduba, Laryssa A; Essner, Aaron; Pivec, Robert; Lancin, Perry; Mont, Michael A; Wang, Aiguo; Delanois, Ronald E

    2014-10-01

    The effect of acetabular component positioning on the wear rates of metal-on-polyethylene articulations has not been extensively studied. Placement of acetabular cups at abduction angles of more than 40° has been noted as a possible reason for early failure caused by increased wear. We conducted a study to evaluate the effects of different acetabular cup abduction angles on polyethylene wear rate, wear area, contact pressure, and contact area. Our in vitro study used a hip joint simulator and finite element analysis to assess the effects of cup orientation at 4 angles (0°, 40°, 50°, 70°) on wear and contact properties. Polyethylene bearings with 28-mm cobalt-chrome femoral heads were cycled in an environment mimicking in vivo joint fluid to determine the volumetric wear rate after 10 million cycles. Contact pressure and contact area for each cup abduction angle were assessed using finite element analysis. Results were correlated with cup abduction angles to determine if there were any differences among the 4 groups. The inverse relationship between volumetric wear rate and acetabular cup inclination angle demonstrated less wear with steeper cup angles. The largest abduction angle (70°) had the lowest contact area, largest contact pressure, and smallest head coverage. Conversely, the smallest abduction angle (0°) had the most wear and most head coverage. Polyethylene wear after total hip arthroplasty is a major cause of osteolysis and aseptic loosening, which may lead to premature implant failure. Several studies have found that high wear rates for cups oriented at steep angles contributed to their failure. Our data demonstrated that larger cup abduction angles were associated with lower, not higher, wear. However, this potentially "protective" effect is likely counteracted by other complications of steep cup angles, including impingement, instability, and edge loading. These factors may be more relevant in explaining why implants fail at a higher rate if

  16. Effect of acetabular cup abduction angle on wear of ultrahigh-molecular-weight polyethylene in hip simulator testing.

    PubMed

    Korduba, Laryssa A; Essner, Aaron; Pivec, Robert; Lancin, Perry; Mont, Michael A; Wang, Aiguo; Delanois, Ronald E

    2014-10-01

    The effect of acetabular component positioning on the wear rates of metal-on-polyethylene articulations has not been extensively studied. Placement of acetabular cups at abduction angles of more than 40° has been noted as a possible reason for early failure caused by increased wear. We conducted a study to evaluate the effects of different acetabular cup abduction angles on polyethylene wear rate, wear area, contact pressure, and contact area. Our in vitro study used a hip joint simulator and finite element analysis to assess the effects of cup orientation at 4 angles (0°, 40°, 50°, 70°) on wear and contact properties. Polyethylene bearings with 28-mm cobalt-chrome femoral heads were cycled in an environment mimicking in vivo joint fluid to determine the volumetric wear rate after 10 million cycles. Contact pressure and contact area for each cup abduction angle were assessed using finite element analysis. Results were correlated with cup abduction angles to determine if there were any differences among the 4 groups. The inverse relationship between volumetric wear rate and acetabular cup inclination angle demonstrated less wear with steeper cup angles. The largest abduction angle (70°) had the lowest contact area, largest contact pressure, and smallest head coverage. Conversely, the smallest abduction angle (0°) had the most wear and most head coverage. Polyethylene wear after total hip arthroplasty is a major cause of osteolysis and aseptic loosening, which may lead to premature implant failure. Several studies have found that high wear rates for cups oriented at steep angles contributed to their failure. Our data demonstrated that larger cup abduction angles were associated with lower, not higher, wear. However, this potentially "protective" effect is likely counteracted by other complications of steep cup angles, including impingement, instability, and edge loading. These factors may be more relevant in explaining why implants fail at a higher rate if

  17. Miniplate osteosynthesis of fractures of the edentulous mandible.

    PubMed

    Mugino, Hiroshi; Takagi, Shinji; Oya, Ryoichi; Nakamura, Syoichi; Ikemura, Kunio

    2005-12-01

    This study was performed to analyze treatment of fractures of the edentulous mandible and to discuss this method in relation to the mandibular height at the fracture site. Fifteen fracture sites in 11 patients with an edentulous mandible were retrospectively examined. These fractures were located: nine fractures in the mandibular body, three in the paramedian region, and three in the mandibular angle. Fractures in a mandible measuring more than 10 mm in the vertical height were treated with one miniplate. Fractures in an extremely atrophic mandible with 10 mm or less were treated using one or two miniplates, also using a modified Champy plate with 1.3 mm in thickness. A mandibular fracture with a height of 5 mm was treated with a combination of a microplate on the buccal side and a miniplate on the inferior border of the mandible with additional direct circumferential wiring. Oblique or splitting fractures were treated with direct circumferential wiring or a Herbert screw, at one fracture site each, respectively. Complications, including infection, fibrous union, nonunion and trismus, were not seen. In one patient, hypesthesia of the lower lip was, however, persistent 1 month after surgery. Miniplate osteosynthesis is the less invasive treatment, and it is suitable for fractures of the atrophic edentulous mandible, except for comminuted or defect fractures. To obtain stable fixation in severely atrophic mandibles, we need to consider the use of two miniplates or a combination with microplates. PMID:16311742

  18. Temporal and spatial distributions of directional counterface motion at the acetabular bearing surface in total hip arthroplasty.

    PubMed Central

    Pedersen, D. R.; Brown, T. D.; Maxian, T. A.; Callaghan, J. J.

    1998-01-01

    The motions of counterface articulation against the bearing surface of the acetabular liner strongly influence polyethylene wear debris production in contemporary total hip arthroplasty. However, the available body of relevant articular force and motion information is largely confined to resultant load excursions measured relative to instrumented femoral components, and/or to global angular motions (flexion, adduction, endorotation) of the joint. Analytical frameworks are here developed to transform such information into temporal and spatial variations of the resultant load and of the local counterface sliding velocity relative to an ordered set of discrete locations (e.g., finite element nodes) on the acetabular bearing surface. Whole-duty-cycle time histories of acetabular resultant load and counterface velocity distributions are presented for two important practical situations: human level walking gait, and a 23 degrees biaxial rocking hip simulation machine. The local counterface motions occurring in the simulator are characterized by higher velocities, smoother motion patterns, and wider directional variation than those occurring in human gait. PMID:9807707

  19. Sudden death from pelvic hemorrhage after bilateral central fracture dislocations of the hip due to an epileptic seizure.

    PubMed

    Hughes, C A; O'Briain, D S

    2000-12-01

    Fracture and dislocation of major joints may be caused by the forceful tonic muscular contractions of seizure activity. A 77-year-old man who was found dead in bed with no sign of external trauma had bilateral central fracture dislocations of the femoral head through the acetabular floor with fatal pelvic hemorrhage and extensive pulmonary fat and bone marrow embolism. He had epilepsy, but the last seizure was 6 years earlier, and he had long discontinued medication. The fractures were attributed to a new unwitnessed seizure. This is the twentieth case of central fracture dislocation of the hip since 1970, when better anesthesia eliminated convulsive therapy-induced fractures. The authors review these 20 cases. Seizures followed inflammation, infarction or neoplasia of the brain, eclampsia, metabolic or iatrogenic causes, or epilepsy (6 cases, 2 of which had no prior seizures for 5 years). There were 11 men (mean age, 64 years) and 9 women (mean age, 47 years). Fractures were unilateral in 13 and bilateral in 7. Additional fractures (in vertebrae, shoulders, or femur) were present in eight. Only eight had prior bone disease. Local symptoms led to diagnosis in most, but two were identified incidentally on imaging. The current patient was the only one to die suddenly, but six other patients presented with shock and three died (one of whom had injuries that led to a suspicion of manslaughter). Central fracture-dislocation of the hip is a rare and little known consequence of seizures, with strong potential for misdiagnosis and lethal complications.

  20. Galeazzi fractures: our modified classification and treatment regimen.

    PubMed

    Fayaz, H C; Jupiter, J B

    2014-02-01

    While diaphyseal fractures of the forearm are a common orthopedic injury, Galeazzi fractures are difficult to treat. The current knowledge on pathobiomechanics and modified therapeutic decisions implicate the need to devise an updated classification and treatment regimen of Galeazzi fractures. We challenge the concept that isolated fractures of the radius should be considered as a Galeazzi fractures as long as stability of the distal radioulnar joint is not proven. Contrary to others we demonstrate that the fracture location alone is not sufficient to determine the stability of the distal radioulnar joint.

  1. Metallosis after Exchange of the Femoral Head and Liner following Ceramic Acetabular Liner Dissociation in Total Hip Arthroplasty with a Modular Layered Acetabular Component.

    PubMed

    Takasago, Tomoya; Goto, Tomohiro; Wada, Keizo; Hamada, Daisuke; Iwame, Toshiyuki; Matsuura, Tetsuya; Nagamachi, Akihiro; Sairyo, Koichi

    2016-01-01

    The type of bearing material that should be used in revision surgery after the failure of ceramic-on-ceramic total hip arthroplasty (THA) remains controversial. In the case of ceramic fracture, the residual ceramic particles can cause consequent metallosis when metal implants are used for revision THA. On the other hand, in the case of THA failure without ceramic fracture, revision THA with a metal femoral head provides satisfactory results. We report an unusual case of progressive osteolysis due to metallosis that developed after revision THA for ceramic liner dissociation without a liner fracture performed using a metal femoral head and polyethylene liner. The residual metal debris and abnormal pumping motion of the polyethylene liner due to the breakage of the locking system or the aspherical metal shell being abraded by the ceramic head seemed to be the cause of the progressive osteolysis. PMID:27648325

  2. Metallosis after Exchange of the Femoral Head and Liner following Ceramic Acetabular Liner Dissociation in Total Hip Arthroplasty with a Modular Layered Acetabular Component

    PubMed Central

    Hamada, Daisuke; Iwame, Toshiyuki; Sairyo, Koichi

    2016-01-01

    The type of bearing material that should be used in revision surgery after the failure of ceramic-on-ceramic total hip arthroplasty (THA) remains controversial. In the case of ceramic fracture, the residual ceramic particles can cause consequent metallosis when metal implants are used for revision THA. On the other hand, in the case of THA failure without ceramic fracture, revision THA with a metal femoral head provides satisfactory results. We report an unusual case of progressive osteolysis due to metallosis that developed after revision THA for ceramic liner dissociation without a liner fracture performed using a metal femoral head and polyethylene liner. The residual metal debris and abnormal pumping motion of the polyethylene liner due to the breakage of the locking system or the aspherical metal shell being abraded by the ceramic head seemed to be the cause of the progressive osteolysis. PMID:27648325

  3. Metallosis after Exchange of the Femoral Head and Liner following Ceramic Acetabular Liner Dissociation in Total Hip Arthroplasty with a Modular Layered Acetabular Component

    PubMed Central

    Hamada, Daisuke; Iwame, Toshiyuki; Sairyo, Koichi

    2016-01-01

    The type of bearing material that should be used in revision surgery after the failure of ceramic-on-ceramic total hip arthroplasty (THA) remains controversial. In the case of ceramic fracture, the residual ceramic particles can cause consequent metallosis when metal implants are used for revision THA. On the other hand, in the case of THA failure without ceramic fracture, revision THA with a metal femoral head provides satisfactory results. We report an unusual case of progressive osteolysis due to metallosis that developed after revision THA for ceramic liner dissociation without a liner fracture performed using a metal femoral head and polyethylene liner. The residual metal debris and abnormal pumping motion of the polyethylene liner due to the breakage of the locking system or the aspherical metal shell being abraded by the ceramic head seemed to be the cause of the progressive osteolysis.

  4. Vertebral fractures in males with prolactinoma.

    PubMed

    Mazziotti, Gherardo; Porcelli, Teresa; Mormando, Marilda; De Menis, Ernesto; Bianchi, Antonio; Mejia, Carola; Mancini, Tatiana; De Marinis, Laura; Giustina, Andrea

    2011-06-01

    Data on osteoporotic fractures in hyperprolactinemia are limited. An increased prevalence of radiological vertebral fractures was recently observed in women with prolactin (PRL)-secreting adenoma, whereas it is unknown whether this observation may reflect a more general increased risk of fractures in this disease and whether the prevalence of fractures in males is affected by gonadal status. Thirty-two males (median age 47 years, range: 22-79) with PRL-secreting pituitary adenoma (10 with microadenoma and 22 with macroadenoma) and 64 control males, with normal PRL values and with comparable age to patients with hyperprolactinemia, were evaluated for vertebral fractures by a morphometric approach and for bone mineral density (BMD) by a dual-energy X-ray absorptiometry at lumbar spine. Vertebral fractures were shown in 12 patients with PRL-secreting adenoma (37.5%) and in 5 controls (7.8%, P < 0.001). Fractured patients had lower BMD T-score (P = 0.007) and longer duration of disease (P < 0.001) as compared to patients who did not fracture. Fractures occurred more frequently (P = 0.03) in patients with untreated hyperprolactinemia versus patients treated with cabergoline whose frequency of vertebral fractures was still higher than control subjects. The prevalence of vertebral fractures was not significantly different between eugonadal and hypogonadal patients (33.3% vs. 38.5%; P = 0.8). Moreover, no significant (P = 0.4) difference in serum testosterone values was found between fractured and not fractured males. Hyperprolactinemia is associated with high prevalence of radiological vertebral fractures in men with PRL-secreting adenoma. These findings would also suggest that PRL excess may produce negative skeletal effects independently of hypogonadism.

  5. Tibial shaft fractures in amateur footballers

    PubMed Central

    Lenehan, B; Fleming, P; Walsh, S; Kaar, K

    2003-01-01

    Background: Footballers constitute a unique group of patients with tibial shaft fractures. They tend to have excellent general health and well developed musculature in the leg, and their fractures are generally closed injuries caused by low velocity trauma. However, little has been reported on the outcome after tibial shaft fractures in this group. Objective: To identify patterns of injury, response to treatment, and functional outcome in such a group. Method: Fifty consecutive tibial shaft fractures in adult footballers treated at Merlin Park Regional Hospital over a five year period were analysed. Results: Most of the fractures were type A injuries (AO/ASIF classification). The incidence of complications was low. All patients reported good or excellent satisfaction with their outcome. However, only 54% of patients returned to playing competitive football. Conclusion: Tibial shaft fractures in amateur footballers are associated with good results when traditional outcome criteria are used, but many patients do not regain their previous level of function. PMID:12663363

  6. [Triple fracture of the shoulder suspensory complex].

    PubMed

    Tamimi Mariño, I; Martin Rodríguez, I; Mora Villadeamigo, J

    2013-01-01

    The superior suspensory complex of the shoulder (SSCS) is a ring shaped structure composed of bones and soft tissues that play a fundamental role in the stability of the shoulder joint. Isolated injuries of the SSCS are relatively common, but injuries that affect 3 components are extremely unusual. We present a triple injury of the SSCS in a 26 year old patient with a Neer type ii clavicular fracture, a Kuhn type iii acromion fracture and an Ogawa type i coracoid fracture. An open reduction and stabilization of the clavicle was performed with 2 Kirschner nails. The acromial fracture was synthesized with 2 cannulated screws, and the coracoid fracture was treated conservatively. After 24 months of follow up the patient had an excellent functional outcome according to the Constat-Murley shoulder score and QuickDASH scoring system, and all the fractures healed correctly.

  7. Combined Tibial Tubercle Avulsion Fracture and Patellar Avulsion Fracture: An Unusual Variant in an Adolescent Patient.

    PubMed

    Stepanovich, Matthew T; Slakey, Joseph B

    2016-01-01

    Traumatic extensor dysfunction of the knee in children is a rare injury, with the majority resulting from tibial tubercle avulsion fracture or patellar sleeve fracture. We report a rare case of combined patellar avulsion fracture and tibial tubercle fracture. With open anatomic reduction, both injuries were successfully treated. While many variations of tibial tubercle fracture have been reported, the authors believe this to be the first report in the English-language literature of this particular combined injury to the knee extensor mechanism in an adolescent. Advanced imaging with computed tomography provided vital information to aid with operative planning, especially since the majority of the unossified tubercle was not seen on plain radiographs, and all fracture fragments were originally believed to be from the tibial tubercle. Computed tomography distinguished the patellar fracture from the tibial tubercle fragments, verifying preoperatively the complexity of the injury. PMID:26761925

  8. [Sarmiento's method of conservative treatment of leg fractures].

    PubMed

    Dewijze, M; Pe, M; Tondeur, G

    1985-01-01

    The authors present a prospective series of 32 fractures of the tibia, treated by Sarmiento's technique. Consolidation of the fracture has been obtained in 3 to 4 months. Five open tibia fractures healed in 4 months. Functional recovery is complete in 90% of the cases. Two failures needed late surgical treatment (one centro-medullary nailing and one plate-fixation). These fractures are studied in detail. PMID:3984632

  9. Acute finger injuries: part II. Fractures, dislocations, and thumb injuries.

    PubMed

    Leggit, Jeffrey C; Meko, Christian J

    2006-03-01

    Family physicians can treat most finger fractures and dislocations, but when necessary, prompt referral to an orthopedic or hand surgeon is important to maximize future function. Examination includes radiography (oblique, anteroposterior, and true lateral views) and physical examination to detect fractures. Dislocation reduction is accomplished with careful traction. If successful, further treatment focuses on the concomitant soft tissue injury. Referral is needed for irreducible dislocations. Distal phalanx fractures are treated conservatively, and middle phalanx fractures can be treated if reduction is stable. Physicians usually can reduce metacarpal bone fractures, even if there is a large degree of angulation. An orthopedic or hand surgeon should treat finger injuries that are unstable or that have rotation. Collateral ligament injuries of the thumb should be examine with radiography before physical examination. Stable joint injuries can be treated with splinting or casting, although an orthopedic or hand surgeon should treat unstable joints.

  10. Capillary fracture of soft gels

    NASA Astrophysics Data System (ADS)

    Bostwick, Joshua B.; Daniels, Karen E.

    2013-10-01

    A liquid droplet resting on a soft gel substrate can deform that substrate to the point of material failure, whereby fractures develop on the gel surface that propagate outwards from the contact line in a starburst pattern. In this paper, we characterize (i) the initiation process, in which the number of arms in the starburst is controlled by the ratio of the surface tension contrast to the gel's elastic modulus, and (ii) the propagation dynamics showing that once fractures are initiated they propagate with a universal power law L∝t3/4. We develop a model for crack initiation by treating the gel as a linear elastic solid and computing the deformations within the substrate from the liquid-solid wetting forces. The elastic solution shows that both the location and the magnitude of the wetting forces are critical in providing a quantitative prediction for the number of fractures and, hence, an interpretation of the initiation of capillary fractures. This solution also reveals that the depth of the gel is an important factor in the fracture process, as it can help mitigate large surface tractions; this finding is confirmed with experiments. We then develop a model for crack propagation by considering the transport of an inviscid fluid into the fracture tip of an incompressible material and find that a simple energy-conservation argument can explain the observed material-independent power law. We compare predictions for both linear elastic and neo-Hookean solids, finding that the latter better explains the observed exponent.

  11. Facial Fracture Management in Northwest Nigeria

    PubMed Central

    Taiwo, Abdurrazaq Olanrewaju; Soyele, Olujide Oladele; Godwin, Ndubuizi Ugochukwu; Ibikunle, Adebayo Aremu

    2013-01-01

    Background: Facial fracture is gradually become a public health problem in our community due to the attendant morbidity and mortality. Hence, the aim of this study was to determine the pattern of facial fracture in Dental and Maxillofacial Surgery Department of Usmanu Danfodiyo University Teaching Hospital. This cross-sectional study was undertaken to provide information regarding gender, age, etiology, and diagnosis of patients with maxillofacial fractures. Materials and Methods: A 1-year review of patients diagnosed and treated for facial fractures in Usmanu Danfodiyo University Teaching Hospital between January 2011 and December 2011. The diagnosis was based on radiographic data and clinical examination. The main analysis outcome measures were etiology, age, gender, site, and treatment. Data were organized and presented by means of descriptive statistics and Pearson's Chi-square test. The level of significance adopted was 5%. Results: A total of 40 patients were treated in this period. Over 95% were male, 81% were caused by road traffic crash (RTC) and 86.4% were in the 21-30 years group. Most patients (52%) had mandibular fractures, and the most common site was the body. Most patients with midfacial fractures had fractures of the zygomaticomaxillary region (36%), while fractures of the parasymphyseal region were more common in the mandible 156 (31%). The most common treatment for jaw fractures was mandibulomaxillary fixation (MMF). Stable zygomatic complex fractures were reduced (elevated) intraorally, and unstable ones were supported by antral packs. Conclusions: This study highlights facial fractures secondary to RTC as a serious public health problem in our environment. Preventive strategies remain the cheapest way to reduce direct and indirect costs of the sequelae of RTC. It also bring to the fore the necessity to shift to open reduction and internal fixation (ORIF) of fractures. PMID:24741422

  12. Dilemmas in imaging for peri-acetabular osteotomy: the influence of patient position and imaging technique on the radiological features of hip dysplasia.

    PubMed

    Kosuge, D; Cordier, T; Solomon, L B; Howie, D W

    2014-09-01

    Peri-acetabular osteotomy is an established surgical treatment for symptomatic acetabular dysplasia in young adults. An anteroposterior radiograph of the pelvis is commonly used to assess the extent of dysplasia as well as to assess post-operative correction. Radiological prognostic factors include the lateral centre-edge angle, acetabular index, extrusion index and the acetabular version. Standing causes a change in the pelvis tilt which can alter certain radiological measurements relative to the supine position. This article discusses the radiological indices used to assess dysplasia and reviews the effects of patient positioning on these indices with a focus on assessment for a peri-acetabular osteotomy. Intra-operatively, fluoroscopy is commonly used and the implications of using fluoroscopy as a modality to assess the various radiological indices along with the effects of using an anteroposterior or posteroanterior fluoroscopic view are examined. Each of these techniques gives rise to a slightly different image of the pelvis as the final image is sensitive to the position of the pelvis and the projection of the x-ray beam. PMID:25183583

  13. Open Calcaneus Fractures and Associated Injuries.

    PubMed

    Worsham, Jacob R; Elliott, Mark R; Harris, Anthony M

    2016-01-01

    Open calcaneus fractures are usually the result of high-energy mechanisms and are associated with other orthopedic and whole body system injures. Understanding the difference between open versus closed fractures is essential for the provider, and they must be vigilant for the associated injuries that present with this condition. We performed a retrospective medical record review of 62 patients (64 calcaneus fractures) with open calcaneus fractures from January 2003 to January 2013 presenting at a level 1 trauma center. Sex, age, laterality, mechanism of injury, wound appearance, initial management, and associated injures were recorded. The most common mechanisms were motor vehicle accidents (35 [56.4%]) and falls from >6 ft (15 [24.1%]). Four (6.4%) patients had a posterior tibial artery transection. Eight (12.9%) patients had a femoral shaft fracture, 14 (22.5%) an ipsilateral ankle fracture, 16 (25.8%) a metatarsal fracture, and 11 (17.7%) had associated midfoot fractures. Of the midfoot fractures, 12 (19.3%) patients had a talus fracture and 5 (8.0%) a cuboid fracture. Spinal fractures were present in 9 (14.5%) of the patients, with lumbar fractures occurring in 6 (9.6%) patients. Fifteen (24.1%) patients had associated upper extremity fractures. Thirteen (20.9%) patients had an associated pulmonary injury, including 8 pneumothoraces. Ten (16.1%) patients had a closed head injury and 6 (9.6%) had an abdominal injury. Fifteen (23.4%) patients were treated with percutaneous wire fixation and 7 (10.9%) with open reduction internal fixation. A total of 44 (68.7%) fractures were treated without internal fixation. Overall, 5 (8.0%) patients with an open calcaneus fracture eventually underwent a below-the-knee amputation. Open calcaneus fractures are severe, high-energy injuries with the potential for considerable morbidity to the patient, given the high rate of concomitant orthopedic and whole body system injuries. Type III open injuries have an increased risk of

  14. Open Calcaneus Fractures and Associated Injuries.

    PubMed

    Worsham, Jacob R; Elliott, Mark R; Harris, Anthony M

    2016-01-01

    Open calcaneus fractures are usually the result of high-energy mechanisms and are associated with other orthopedic and whole body system injures. Understanding the difference between open versus closed fractures is essential for the provider, and they must be vigilant for the associated injuries that present with this condition. We performed a retrospective medical record review of 62 patients (64 calcaneus fractures) with open calcaneus fractures from January 2003 to January 2013 presenting at a level 1 trauma center. Sex, age, laterality, mechanism of injury, wound appearance, initial management, and associated injures were recorded. The most common mechanisms were motor vehicle accidents (35 [56.4%]) and falls from >6 ft (15 [24.1%]). Four (6.4%) patients had a posterior tibial artery transection. Eight (12.9%) patients had a femoral shaft fracture, 14 (22.5%) an ipsilateral ankle fracture, 16 (25.8%) a metatarsal fracture, and 11 (17.7%) had associated midfoot fractures. Of the midfoot fractures, 12 (19.3%) patients had a talus fracture and 5 (8.0%) a cuboid fracture. Spinal fractures were present in 9 (14.5%) of the patients, with lumbar fractures occurring in 6 (9.6%) patients. Fifteen (24.1%) patients had associated upper extremity fractures. Thirteen (20.9%) patients had an associated pulmonary injury, including 8 pneumothoraces. Ten (16.1%) patients had a closed head injury and 6 (9.6%) had an abdominal injury. Fifteen (23.4%) patients were treated with percutaneous wire fixation and 7 (10.9%) with open reduction internal fixation. A total of 44 (68.7%) fractures were treated without internal fixation. Overall, 5 (8.0%) patients with an open calcaneus fracture eventually underwent a below-the-knee amputation. Open calcaneus fractures are severe, high-energy injuries with the potential for considerable morbidity to the patient, given the high rate of concomitant orthopedic and whole body system injuries. Type III open injuries have an increased risk of

  15. Fractures of the fifth metatarsal; diagnosis and treatment.

    PubMed

    Zwitser, E W; Breederveld, R S

    2010-06-01

    Of all foot fractures the fifth metatarsal fracture is the most common. A complete clinical and radiological assessment is required to select the best treatment option. Nondisplaced tuberosity avulsion fractures can be treated non-operatively. Surgical treatment is indicated when the fracture is displaced more than 2mm or when more than 30% of the cubometatarsal joint is involved. Non or minimally displaced shaft fractures can be treated non-operatively. If the dislocation is more than 3-4mm or the angulation is more than 10 degrees, percutaneous K-wires, plate or screw fixation is indicated. The Jones fracture is known for prolonged healing time and non-union. The indication for surgical treatment of Jones' fractures depends on activity level and Torg classification: type I fractures are treated non-operatively. Type II fractures can be treated non-operatively or operatively, depending on patient activity level. Type III fractures have more complications and should be treated operatively. Several operation techniques have been described.

  16. The capsular ligaments provide more hip rotational restraint than the acetabular labrum and the ligamentum teres

    PubMed Central

    van Arkel, R. J.; Amis, A. A.; Cobb, J. P.; Jeffers, J. R. T.

    2015-01-01

    In this in vitro study of the hip joint we examined which soft tissues act as primary and secondary passive rotational restraints when the hip joint is functionally loaded. A total of nine cadaveric left hips were mounted in a testing rig that allowed the application of forces, torques and rotations in all six degrees of freedom. The hip was rotated throughout a complete range of movement (ROM) and the contributions of the iliofemoral (medial and lateral arms), pubofemoral and ischiofemoral ligaments and the ligamentum teres to rotational restraint was determined by resecting a ligament and measuring the reduced torque required to achieve the same angular position as before resection. The contribution from the acetabular labrum was also measured. Each of the capsular ligaments acted as the primary hip rotation restraint somewhere within the complete ROM, and the ligamentum teres acted as a secondary restraint in high flexion, adduction and external rotation. The iliofemoral lateral arm and the ischiofemoral ligaments were primary restraints in two-thirds of the positions tested. Appreciation of the importance of these structures in preventing excessive hip rotation and subsequent impingement/instability may be relevant for surgeons undertaking both hip joint preserving surgery and hip arthroplasty. Cite this article: Bone Joint J 2015; 97-B:484–91. PMID:25820886

  17. Accuracy of navigation-assisted acetabular component positioning studied by computed tomography measurements: methods and results.

    PubMed

    Ybinger, Thomas; Kumpan, W; Hoffart, H E; Muschalik, B; Bullmann, W; Zweymüller, K

    2007-09-01

    The postoperative position of the acetabular component is key for the outcome of total hip arthroplasty. Various aids have been developed to support the surgeon during implant placement. In a prospective study involving 4 centers, the computer-recorded cup alignment of 37 hip systems at the end of navigation-assisted surgery was compared with the cup angles measured on postoperative computerized tomograms. This comparison showed an average difference of 3.5 degrees (SD, 4.4 degrees ) for inclination and 6.5 degrees (SD, 7.3 degrees ) for anteversion angles. The differences in inclination correlated with the thickness of the soft tissue overlying the anterior superior iliac spine (r = 0.44; P = .007), whereas the differences in anteversion showed a correlation with the thickness of the soft tissue overlying the pubic tubercles (r = 0.52; P = .001). In centers experienced in the use of navigational tools, deviations were smaller than in units with little experience in their use. PMID:17826270

  18. Untreated acetabular dysplasia of the hip in the Navajo. A 34 year case series followup.

    PubMed

    Schwend, R M; Pratt, W B; Fultz, J

    1999-07-01

    Patients born in the Many Farms District of the Navajo Indian Reservation from 1955 to 1961 were studied. Five hundred forty-eight of the 628 infants born (87%) received clinical examinations and pelvic radiographs at some time during the first 4 years of their lives. Eighteen (3.3%) of the 548 infants examined had acetabular dysplasia. Because of traditional cultural beliefs, none of these children received medical treatment. Followup evaluations and radiographs were obtained in these 18 patients during early adolescence. In 10 of the original 18 patients followup evaluations and radiographs were obtained at an average age of 35 years. None of the dysplastic hips progressed to frank dislocation. The mean center edge angle improved from 7 degrees when the patients were 1 year of age, to 29 degrees when the patients were 12 years of age, to 30 degrees when the patients were 35 years of age. Despite overall improvement of hip measurements with maturity, eight hips in five of the 10 patients who were in their fourth decade of life and who were available for examination, had radiographic evidence of residual abnormalities. The hips in patients with subluxation during infancy were less likely to be normal as adults. The results of this 34-year followup study of untreated developmental hip dysplasia showed marked radiographic improvement in all patients during childhood; however, subtle abnormalities persisted in the radiographs of 40% of the hips. PMID:10416399

  19. The Relationship of Acetabular Dysplasia and Femoroacetabular Impingement to Hip Osteoarthritis: A Focused Review

    PubMed Central

    Royer, Nathaniel K.

    2012-01-01

    Hip osteoarthritis (OA) leads to significant functional limitations and economic burden. If modifiable risk factors for hip OA are identified, it may be possible to implement preventative measures. Bony abnormalities associated with acetabular dysplasia (AD) and femoroacetabular impingement (FAI) have been recently implicated as risk factors for hip osteoarthritis (OA). The purpose of this focused review is to summarize the available evidence describing the relationship between bony abnormalities and hip OA. A librarian-assisted database search using PubMed, Embase and Central was performed. Relevant articles were identified and assessed for inclusion criteria. The authors reviewed cohort and case control studies that reported on the association between abnormal hip morphology and hip OA. The available literature suggests that an association exists between bony abnormalities found in AD and FAI and hip OA and preliminary evidence suggests that AD is a risk factor for OA, however these conclusions are based on limited evidence. Prospective, longitudinal studies are needed to confirm the causal relationship between abnormal hip morphology and the future development of hip OA. PMID:22108232

  20. Tranexamic acid reduces the blood loss and blood transfusion requirements following peri-acetabular osteotomy.

    PubMed

    Wassilew, G I; Perka, C; Janz, V; Krämer, M; Renner, L

    2015-12-01

    We have investigated the effect of using tranexamic acid (TXA) during peri-acetabular osteotomy (PAO) on peri-operative blood loss and blood transfusion requirements. In addition we analysed whether the use of TXA was associated with an increased risk of venous thromboembolism (VTE) following this procedure. A consecutive series of 96 PAOs, performed by a single surgeon, were reviewed. A total of 48 patients received TXA and 48 did not. The TXA group received a continuous infusion of TXA at a rate of 10 mg/kg/h. The primary outcome measure was the requirement for blood transfusion. Secondary outcomes included total blood loss, the decrease in the level of haemoglobin in the blood, the length of hospital stay, and the complications of this treatment. The mean rate of transfusion was significantly lower in the TXA group (62.5% vs 12.5%, p < 0.001). The mean blood loss was also significantly reduced in the TXA group (1.9 L (standard deviation (SD) 0.9) vs 1.5 L (SD 0.7), p < 0.01). No post-operative episodes of VTE were identified in either group. The use of TXA reduced the blood loss and the rate of transfusion after PAO significantly, without adverse effects such as an increased rate of VTE.

  1. Retrieval analysis of a failed TriboFit polycarbonate urethane acetabular buffer.

    PubMed

    Biant, Leela C; Gascoyne, Trevor C; Bohm, Eric R; Moran, Matthew

    2016-03-01

    The purpose of this research was to determine the failure mechanisms and damage features of a TriboFit acetabular buffer implanted directly against a native, prepared acetabulum which was revised after 11months. Retrieval analyses were carried out via light microscopy, gravimetric wear assessment, and observer scoring of visible damage features on the buffer. The volume of material abraded from the backside of the buffer was estimated via three-dimensional reconstruction using a laser scanner. Scanning electron microscopy was used to confirm damage features and mechanisms. Severe abrasion to the backside of the buffer was the primary damage feature, while stippling damage was seen on the articular surface of the buffer. Material loss due to backside abrasion was approximated to be between 0.13360.085 g (gravimetric analyses) and 0.19360.053 g (three-dimensional reconstruction). Implantation of the TriboFit buffer against the patient's native acetabulum without a metal backing allowed for significant movement of the buffer against the bone, resulting in the abrasion seen on this implant. The stippling damage on the articular surface indicates an adhesive wear mechanism which exacerbates movement of the buffer against the acetabulum, thereby increasing backside abrasion.

  2. The Influence of Pelvic Ramus Fracture on the Stability of Fixed Pelvic Complex Fracture

    PubMed Central

    Lei, Jianyin; Zhang, Yue; Wu, Guiying; Wang, Zhihua; Cai, Xianhua

    2015-01-01

    This study aims to evaluate the biomechanical mechanism of pelvic ring injury for the stability of pelvis using the finite element (FE) method. Complex pelvic fracture (i.e., anterior column with posterior hemitransverse lesion) combined with pelvic ramus fracture was used to evaluate the biomechanics stability of the pelvis. Three FE fracture models (i.e., Dynamic Anterior Plate-Screw System for Quadrilateral Area (DAPSQ) for complex pelvic fracture with intact pubic ramus, DAPSQ for complex pelvic fracture with pubic ramus fracture, and DAPSQ for complex pelvic fracture with fixed pubic ramus fracture) were established to explore the biomechanics stability of the pelvis. The pubic ramus fracture leads to an unsymmetrical situation and an unstable situation of the pelvis. The fixed pubic ramus fracture did well in reducing the stress levels of the pelvic bone and fixation system, as well as displacement difference in the pubic symphysis, and it could change the unstable situation back to a certain extent. The pelvic ring integrity was the prerequisite of the pelvic stability and should be in a stable condition when the complex fracture is treated. PMID:26495033

  3. Radial head fracture - aftercare

    MedlinePlus

    Elbow fracture - radial head - aftercare ... to 2 weeks. If you have a small fracture and your bones did not move around much, ... to see a bone doctor (orthopedic surgeon). Some fractures require surgery to: Insert pins and plates to ...

  4. Dowel pinning for feline metacarpal and metatarsal fractures.

    PubMed

    Zahn, K; Kornmayer, M; Matis, U

    2007-01-01

    The goal of this retrospective study was to describe dowel pinning, and to compare the results of osteosynthesis and external coaptation of metacarpal and metatarsal fractures in cats. Evaluation of the medical records of 351 cats yielded 63 cats treated with dowel pinning, 35 cats treated with external coaptation and 14 cats treated with both methods within the same limb. All of the cats had been re-evaluated at an average of 2.8 years (six months - 15 years) postoperatively. Dowel pinning was superior to external coaptation when all fractured bones of a limb could be pinned. When internal fixation of multiple fractures was not feasible in all fractured bones due to comminution or fragments that were too short to pin, the outcome was not significantly different from cases treated with external coaptation alone. Malunion was seen in 16% of fractured bones in cats treated with external coaptation and occurred secondary to implant bending in 3% of fractured bones treated with dowel pinning. The latter refers to one operated cat, which had four metacarpal fractures in the same limb. Radiographs taken at re-evaluation showed implant migration within the medullary canal in two cats, although neither showed any signs of non-union or lameness. Non-union was seen in one operated cat, in which the fracture (MC IV) could not be completely reduced with a K-wire. Osteomyelitis did not occur. Dowel pinning is an easy, inexpensive and effective technique for repair of metacarpal and metatarsal fractures in cats.

  5. Fractured Surface

    NASA Technical Reports Server (NTRS)

    2005-01-01

    [figure removed for brevity, see original site] Context image for PIA03084 Fractured Surface

    These fractures and graben are part of Gordii Fossae, a large region that has undergone stresses which have cracked the surface.

    Image information: VIS instrument. Latitude 16.6S, Longitude 234.3E. 18 meter/pixel resolution.

    Note: this THEMIS visual image has not been radiometrically nor geometrically calibrated for this preliminary release. An empirical correction has been performed to remove instrumental effects. A linear shift has been applied in the cross-track and down-track direction to approximate spacecraft and planetary motion. Fully calibrated and geometrically projected images will be released through the Planetary Data System in accordance with Project policies at a later time.

    NASA's Jet Propulsion Laboratory manages the 2001 Mars Odyssey mission for NASA's Office of Space Science, Washington, D.C. The Thermal Emission Imaging System (THEMIS) was developed by Arizona State University, Tempe, in collaboration with Raytheon Santa Barbara Remote Sensing. The THEMIS investigation is led by Dr. Philip Christensen at Arizona State University. Lockheed Martin Astronautics, Denver, is the prime contractor for the Odyssey project, and developed and built the orbiter. Mission operations are conducted jointly from Lockheed Martin and from JPL, a division of the California Institute of Technology in Pasadena.

  6. Patellar fractures following total knee arthroplasty: a review.

    PubMed

    Sayeed, Siraj A; Naziri, Qais; Patel, Yashika D; Boylan, Matthew R; Issa, Kimona; Mont, Michael A

    2013-01-01

    There are several periprosthetic complications associated with total knee arthroplasty, with femoral fracture as the most common and patellar fractures as the second most common. Patellar fractures are challenging complications that occur almost exclusively on the resurfaced patellae, although unresurfaced patellar fractures have been reported in literature. The purpose of this study is to describe the anatomy of the patella, the etiology of patellar fractures, and strategies to treat and manage these fractures following knee arthroplasty. The vascular supply to the patella may be compromised during total knee arthroplasty and special care must be taken to preserve it. Vessel injury may result in further complications, most notably avascular necrosis with subsequent fracture. Other patient-, surgical-, and prosthetic-related factors can contribute to increased risk of patellar fracture. Patellar fractures are classified into three types. Type I fractures have an intact extensor mechanism with a stable implant. Type II fractures have a complete disruption of the extensor mechanism with or without a stable implant. Type III fractures, which are further subclassified into types IIIa and IIIb, have an intact extensor mechanism but a loose patellar component. While type IIIa fractures have reasonable remaining bone stock, type IIIb fractures have poor bone stock. Type I patellar fractures may be best managed nonoperatively, but types II and III patellar fractures often necessitate surgical intervention. Patellectomy should be reserved for comminuted fractures, as well as fractures in patients with poor bone stock. Larger prospective randomized studies are necessary to better evaluate the treatment algorithm for patellar fractures following total knee arthroplasty.

  7. Multiwell fracturing experiments. [Nitrogen foam fracture treatment

    SciTech Connect

    Warpinski, N.

    1985-01-01

    The objective of the Multiwell fracturing experiments is to test and develop the technology for the efficient stimulation of tight, lenticular gas sands. This requires basic understanding of: (1) fracture behavior and geometry in this complex lithologic environment, and (2) subsequent production into the created fracture. The intricate interplay of the hydraulic fracture with the lens geometry, the internal reservoir characteristics (fractures, reservoir breaks, etc.), the in situ stresses, and the mechanical defects (fracture, bedding, etc.) need to be defined in order to develop a successful stimulation program. The stimulation phase of the Multiwell Experiment is concerned with: (1) determining important rock/reservoir properties that influence or control fracture geometry and behavior, (2) designing fracture treatments to achieve a desired size and objectives, and (3) conducting post-treatment analyses to evaluate the effectiveness of the treatment. Background statement, project description, results and evaluation of future plans are presented. 5 refs., 2 figs., 2 tabs.

  8. Revision Total Hip Arthroplasty Using Tantalum Augment in Patients with Paprosky III or IV Acetabular Bone Defects: A Minimum 2-year Follow Up Study

    PubMed Central

    Jeong, Min; Kim, Hyung-Joo; Lim, Seung-Jae; Moon, Young-Wan

    2016-01-01

    Purpose The purpose of this study is to report the short-term outcomes of revision total hip arthroplasty (THA) using tantalum augments in patients with severe acetabular bone defects. Materials and Methods We retrospectively analyzed 15 revision THAs performed in 15 patients using tantalum augments between June 2010 and December 2013. Acetabular bone defects were Paprosky type IIIA in 7 hips, type IIIB in 7, and type IV in 1. The causes of revision surgery were aseptic loosening in 12 hips and deep infection in 3. Revisions were first in 1 hip, second in 3, and third in 11. Six patients were male and 9 female with a mean age of 59 years (range, 48-75 years). Mean follow-up was 29 months (range, 24-48 months). Results Mean Harris hip score was improved from 34 points (range, 12-54 points) preoperatively to 84 points (range, 38-90 points) at final follow-up. On the final follow-up radiographs, there were 12 hips (80.0%) with stable fixation of the acetabular cup, 2 (13.3%) with secondary stability after mild acetabular protrusion, and 1 (6.7%) with radiolucency around the acetabular cup without mechanical symptoms. Complications included one patient with acute hematogenous infection managed by surgical debridement and long-term antibiotic therapy. There were no cases with nerve palsy or dislocation during the follow-up period. Conclusion The present study showed satisfactory clinical and radiographic outcomes of revision THA using tantalum augments due to severe acetabular bone defects of Paprosky type III or IV at a minimum follow-up of 2 years. PMID:27536651

  9. Investigation of the metallurgical factors affecting hydrogen embrittlement of solution heat treated and aged Ti-3Al-8V-6Cr-4Mo-4Zr (wt.%) employing fracture, microscopy and desorption methods

    NASA Astrophysics Data System (ADS)

    Gaudett, Michelle Anne

    The effects of pre-dissolved hydrogen (H) on room temperature fracture initiation in Ti-3Al-8V-6Cr-4Mo-4Zr (wt%) have been investigated. The peak aged condition (STA) shows enhanced H embrittlement susceptibility compared to the solutionized condition (ST) as measured by reductions in the fracture initiation stress with H content and the introduction of intergranular (IG) fracture. Fracture initiation testing of cold worked, ST condition suggests that yield strength alone does not control H-assisted IG fracture initiation of the STA condition. Stroke rate studies, thermal desorption, transmission electron microscopy and x-ray diffraction investigations of H partitioning suggests that equilibrium hydriding and/or irreversible trapping do not singularly control IG fracture. Examination of additional metallurgical conditions show that grain boundary alpha colonies or films are not responsible for IG fracture. Deformation studies suggest that plastic deformation is concentrated at or near the grain boundaries in the STA condition. An increase in IG cracking with aging time is consistent with the segregation of a critical species to the grain boundaries. Therefore, a H-induced IG initiation mechanism that includes the deleterious effects of grain boundary segregation and deformation on the grain boundary fracture stress is proposed. Thermal desorption spectroscopy was employed to compare the hydrogen detrapping and desorption characteristics of the ST and STA conditions. Due to the oxide barrier that prevents H egress until high temperatures (˜350-400sp°C) and a dominant H desorption peak due to lattice H, resolution of possible trapping states was difficult. Modeling of H desorption showed that the ST and STA conditions do not have any trapping states of a binding energy greater than 65 kJ/mol. The limitations of the thermal desorption spectroscopy technique led us to examine and model the mechanism by which H desorbs from Ti-3Al-8V-6Cr-4Mo-4Zr. In the temperature

  10. Fracture Union in Closed Interlocking Nail in Humeral Shaft Fractures

    PubMed Central

    Sahu, Ramji Lal; Ranjan, Rajni; Lal, Ajay

    2015-01-01

    Background: Fracture shaft humerus is a major cause of morbidity in patients with upper extremity injuries. The aim of this study was to evaluate the outcome of interlocking nail in humeral shaft fractures. Methods: This study was conducted in the Department of Orthopedic Surgery in SMS and R Sharda University from January 2010 to November 2013. Seventy-eight patients were recruited from emergency and out-patient department having a close fracture of humerus shaft. All patients were operated under general anesthesia and closed reamed interlocking nailing was done. All patients were followed for 9 months. Results: Out of 78 patients, 69 patients underwent union in 90–150 days with a mean of 110.68 days. Complications found in four patients who had nonunion, and five patients had delayed union, which was treated with bone grafting. All the patients were assessed clinically and radiologically for fracture healing, joint movements and implant failure. The results were excellent in 88.46% and good in 6.41% patients. Complete subjective, functional, and clinical recovery had occurred in almost 100% of the patients. Conclusions: The results of the present study indicates that in the presence of proper indications, reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation of osteoporotic and pathologic fractures. PMID:26021495

  11. Fracture of a titanium sleeve-encased third-generation ceramic liner in a modern THA.

    PubMed

    Chotai, Pranit N; Su, Edwin P

    2011-10-01

    Due to their excellent tribology, ceramics are increasingly used for total hip arthroplasty (THA) in young patients. Fracture rates for contemporary ceramics range from 0% to 0.004%. Recently, ceramic liners are encased in a titanium sleeve to further decrease the chances of fracture. We encountered 1 case of a metal-encased acetabular liner fracture in a ceramic-on-ceramic articulation in a series of 764 hips. Our literature review revealed no reports of metal-encased ceramic liner fracture. A 60-year-old woman presented 27 months after a bilateral ceramic-on-ceramic THA. She reported mechanical grinding and clicking from the left hip on extension. There was no history of trauma or fall. Examination revealed a nonantalgic gait and audible-palpable crepitations on the left hip. Range of motion of the left hip was intact with no subluxation. Radiographs revealed fractured ceramic insert and an excessively anteverted socket on the left side. Intraoperative findings revealed gross impingement in the form of indentation of the metal femoral neck against the elevated metal rim encasing the liner. Revision THA was performed using an uncemented polyethylene liner while retaining the well-fixed cup and stem. The Harris Hip Score at 4.5-year follow-up was 100, with no evidence of osteolysis or polyethylene wear.

  12. Complications in the Treatment of Adolescent Clavicle Fractures

    PubMed Central

    Luo, T. David; Ashraf, Ali; Larson, A. Noelle; Stans, Anthony A.; Shaughnessy, William J.; McIntosh, Amy L.

    2015-01-01

    The authors’ study evaluates the complications associated with the treatment of clavicle fractures in adolescents. During the study period, 153 clavicle fractures occurred in patients between the ages of 14 and 17 years who were treated at the authors’ center, of which 23 (15.0%) were treated surgically. Compared to the fractures treated nonoperatively, the surgical fractures had greater shortening (mean, 2.0 vs 0.9 cm; P<.001) and were more likely to be comminuted (65.2% vs 23.1%; P<.001). Complications occurred in 21.7% of fractures treated surgically. One delayed union occurred in the nonoperative cohort, but no other complications or patients who required clavicular osteotomy for malunion. Pediatric fellowship-trained orthopedic surgeons treated 78 displaced fractures, resulting in 8 (10.3%) surgeries. Nonpediatric orthopedic specialists treated 46 displaced fractures, 15 (32.6%) of which were treated operatively (P=.0035). FigureA 15-year-old boy sustained a comminuted clavicle fracture from playing football. Preoperative radiograph showing significant clavicle shortening and a vertical fragment. PMID:25901621

  13. Stress fractures of the medial malleolus.

    PubMed

    Shelbourne, K D; Fisher, D A; Rettig, A C; McCarroll, J R

    1988-01-01

    Six athletes, all engaged in running activities at the time of injury, presented with tenderness over the medial malleolus and ankle effusion. Three patients had a fracture line which could be seen on radiographs. These patients were treated by open reduction and internal fixation using two 4.0 cancellous screws. The other three patients had normal radiographs but bone scans showed increased uptake over the medial malleolus. These patients were treated with cast and immobilization. We believe that each of these patients suffered a stress fracture of the medial malleolus. We suggest that the possibility of a stress fracture be considered in the differential diagnosis of patients who present with 1) chronic or subacute pain over the medial malleolus and ankle effusion, and 2) a history of running activity at the time of injury or running activities aggravating the pain. Bone scans appear to be more sensitive than radiographs in detecting a stress fracture of the medial malleolus. We propose that athletes with radiographic signs of a medial malleolar fracture who desire early return to full participation should be treated by open reduction and internal fixation. For these patients, early motion can be initiated. Other athletes whose fracture cannot be detected on radiographs but whose malleolus shows increased uptake in the area on bone scans can be treated nonsurgically with immobilization and then progressive increase in activity. All of our patients returned to full activity between 6 and 8 weeks after treatment was initiated.

  14. Post-deformation shape-recovery behavior of vitamin E-diffused, radiation crosslinked polyethylene acetabular components.

    PubMed

    Takahashi, Yasuhito; Tateiwa, Toshiyuki; Shishido, Takaaki; Masaoka, Toshinori; Kubo, Kosuke; Yamamoto, Kengo

    2016-10-01

    The in-vivo progression of creep and wear in ultra-high molecular weight polyethylene (UHMWPE) acetabular liners has been clinically evaluated by measuring radiographic penetration of femoral heads. In such clinical assessments, however, viscoelastic strain relaxation has been rarely considered after a removal of hip joint loading, potentially leading to an underestimation of the penetrated thickness. The objective of this study was to investigate shape-recovery behavior of pre-compressed, radiation crosslinked and antioxidant vitamin E-diffused UHMWPE acetabular liners, and also to characterize the effects of varying their internal diameter (ID) and wall thickness (WT). We applied uniaxial compression to the UHMWPE specimens of various ID (28, 32, 36mm) and WT (4.8, 6.8, 8.9mm) for 4320min under the constant load of 3000N, and subsequently monitored the strain-relaxation behavior as a function of time after unloading. It was observed that there was a considerable shape recovery of the components after removal of the external static load. Reducing ID and WT significantly accelerated the rate of creep strain recovery, and varying WT was more sensitive to the recovery behavior than ID. Creep deformation of the tested liners recovered mostly within the first 300min after unloading. Note that approximately half of the total recovery amount proceeded just within 5min after unloading. These results suggest a remarkably high capability of shape recovery of vitamin E-diffused highly crosslinked UHMWPE. In conclusion, the time-dependent shape recovering and the diameter-thickness effect on its behavior should be carefully considered when the postoperative penetration is quantified in highly crosslinked UHMWPE acetabular liners (especially on the non-weight bearing radiographs). PMID:27454526

  15. Excellent long-term results of the Müller acetabular reinforcement ring in primary total hip arthroplasty

    PubMed Central

    Sirka, Aurimas; Clauss, Martin; Tarasevicius, Sarunas; Wingstrand, Hans; Stucinskas, Justinas; Robertsson, Otto; Emil Ochsner, Peter; Ilchmann, Thomas

    2016-01-01

    Background and purpose — The original Müller acetabular reinforcement ring (ARR) shows favorable medium-term results for acetabular reconstruction in total hip arthroplasty, where it is used when the acetabular bone stock is deficient. However, there are no data regarding long-term survival of the device. We therefore investigated long-term survival and analyzed radiological modes of failure. Patients and methods — Between 1984 and 2002, 321 consecutive primary arthroplasties using an ARR were performed in 291 patients. The mean follow-up time was 11 (0–25) years, and 24 hips were lost to follow-up. For survival analysis, we investigated 321 hips and the end of the follow-up was the date of revision, date of death, or the last patient contact date with implant still in situ. Radiological assessment was performed for 160 hips with a minimum of 10 years of follow-up and with radiographs of sufficient quality. It included evaluation of osteolysis, migration, and loosening. Results — 12 ARR THAs were revised: 1 isolated ARR revision for aseptic loosening, 4 revisions of the ARR and the stem for aseptic loosening, 6 for infection, and 1 for recurrent dislocation. The cumulative revision rate for all components, for any reason, at 20 years was 15% (95% CI: 10–22), while for the ARR only it was 7% (95% CI: 4–12) for any reason and 3.4% (95% CI: 1–9) for aseptic loosening. 21 (13%) of 160 ARR THAs examined had radiological changes: 7 had osteolysis but were not loose, and 14 were radiologically loose but were not painful and not revised. Interpretation — Our data suggest that the long-term survival of the ARR is excellent. PMID:26471881

  16. Etiology and severity of impingement injuries of the acetabular labrum: what is the role of femoral morphology?

    PubMed

    Dy, Christopher J; Schroder, Steven J; Thompson, Matthew T; Alexander, Jerry W; Noble, Philip C

    2012-06-01

    Injuries to the acetabular labrum have been seen in association with femoroacetabular impingement, but recent studies have reported labral pathology in patients with normal hip morphology. The hypothesis of the current study was that labral lesions could occur without femoroacetabular impingement but that labral pathology would occur more commonly and more severely in hip joints that exhibit reduced head-neck offset. The presence, location, and severity of labral injury were recorded in 22 cadaveric specimens. Computed tomography was used to define the anatomic parameters of proximal femoral morphology. Three-dimensional modeling was used to simulate hip positions that typically cause labral impingement, including high flexion and internal rotation. Femoral morphology was compared between specimens with and without labral pathology using descriptive statistics. Labral pathology was seen in 15 of 22 specimens and was located in the anterosuperior portion of the labrum. No difference existed in age, femoral neck shaft angle, anteversion, acetabular depth, head diameter, alpha angle, or beta angle between specimens with and without labral pathology. The severity of labral pathology correlated with the alpha angle of the proximal femur. This study demonstrates that damage to the labrum may occur in hips with normal proximal femur morphology. However, the findings also indicate that the presence of morphologic features that increase the risk of impingement may predispose the hip joint to a characteristic pattern or severity of labral pathology. The results confirm the importance of considering both femoral morphology and athletic-type activities of the hip when determining the mechanism responsible for injury of the acetabular labrum.