Science.gov

Sample records for femoral epiphysis widening

  1. Slipped capital femoral epiphysis

    MedlinePlus

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

  2. [Slipped capital femoral epiphysis].

    PubMed

    Klein, C; Haraux, E; Leroux, J; Gouron, R

    2017-03-01

    Slipped capital femoral epiphysis (SFCE) is a disorder of the hip, characterized by a displacement of the capital femoral epiphysis from the metaphysic through the femoral growth plate. The epiphysis slips posteriorly and inferiorly. SCFE occurs during puberty and metabolic and epidemiologic risk factors, such as obesity are frequently found. Most chronic slips are diagnosed late. Sagittal hip X-rays show epiphysis slip. In case of untreated SCFE, a slip progression arises with an acute slip risk. Treatment is indicated to prevent slip worsening. The clinical and radiological classification is useful to guide treatment and it is predictive of the prognosis. In situ fixation of stable and moderately displaced SCFE with cannulated screws gives excellent results. Major complications are chondrolysis and osteonecrosis and the major sequelae are femoroacetabular impingement and early arthritis.

  3. Slipped capital femoral epiphysis following radiation and chemotherapy

    SciTech Connect

    Walker, S.J.; Whiteside, L.A.; McAlister, W.H.; Silverman, C.L.; Thomas, P.R.

    1981-01-01

    Patients who received radiation to the proximal femoral epiphysis and chemotherapy in childhood appear to have an increased risk of subsequently developing epiphyseolysis. Every effort should be made to exclude the proximal femoral epiphysis from the radiation port whenever possible. If the epiphyseal plate is widened and irregular and the adjacent bone is sclerotic, prophylactic pinning may be indicated even in the absence of a grossly visible slip.

  4. [Slipped upper femoral epiphysis (SUFE)].

    PubMed

    Wirth, T

    2011-08-01

    A slipped upper femoral epiphysis (SUFE) is the most common disease of the hip among adolescents. In the light of our current knowledge on the development of coxarthrosis, it represents a first line model case that has led to a series of novel ideas in the therapy for SUFE. The development of coxarthrosis from a cam impingement, i.e., the loss of offset of the neck of the femur and degenerative damage to the acetabular lip as its early form, is seen again in the clinical picture of slipped upper femoral epiphysis. Depending on the degree of slippage, we see a varying severity of the loss of offset and thus also different extents of the potential damage to the hip joint. This knowledge is by no means new. The questions of reorientation of the epiphysis of the humeral head and thus restoration of the anatomy of the coxal end of the femur have been addressed by renowned surgeons and answered with the development of widely varying procedures for surgical correction. However, within the framework of the surgical techniques introduced for treatment of impingement syndromes of the hip, these therapeutic options have been supplemented and broadened. The current discussion about the best therapeutic strategies emphasizes the fascination of the clinical entity of upper femoral epiphysis and constitutes a central component of this article. © Georg Thieme Verlag KG Stuttgart · New York.

  5. Ultrasonographic Diagnosis of Slipped Capital Femoral Epiphysis

    PubMed Central

    Palaniappan, Manikandan; Indiran, Venkatraman; Maduraimuthu, Prabakaran

    2017-01-01

    Summary Background Slipped capital femoral epiphysis (SCFE), a fracture through the physis with resultant slip of the epiphysis, is the most common hip abnormality in adolescents and is a major cause of early osteoarthritis. Plain radiograph is the initial modality used to evaluate patients with painful hip joints. Ultrasonography and magnetic resonance imaging (MRI), which do not involve radiation exposure, have also been used. This case report supports the view that ultrasound can be used as an initial, cost-effective and radiation-free modality for the evaluation of suspected SCFE. Case Report A 15-year-old male patient presented with pain in the right hip for 5 days, following a slip and fall accident while playing soccer. The patient was referred to the Department of Radio-diagnosis for ultrasound. A posterior displacement of the femoral head epiphysis with a physeal step was seen on the longitudinal section obtained over the right hip joint region. The anterior physeal step (APS) measured ~3.8 mm on the right side. The distance between the anterior rim of the acetabulum and the metaphysis measured ~20.4 mm on the affected right side and ~23.6 mm on the left side. A plain radiograph in frog leg position showed a widening of the right proximal physis below the right femoral head, with a medial and posterior slip of the right femoral head. A frontal radiograph of the pelvis taken six months before showed a widening of the proximal right femoral physis. Conclusions Although MRI appears to be the most sensitive modality for identifying slips early, ultrasound may be used as a cost-effective and radiation-free alternative before proceeding with further evaluation of suspected SCFE, especially considering the demographics of the affected population. PMID:28382187

  6. Ultrasonographic Diagnosis of Slipped Capital Femoral Epiphysis.

    PubMed

    Palaniappan, Manikandan; Indiran, Venkatraman; Maduraimuthu, Prabakaran

    2017-01-01

    Slipped capital femoral epiphysis (SCFE), a fracture through the physis with resultant slip of the epiphysis, is the most common hip abnormality in adolescents and is a major cause of early osteoarthritis. Plain radiograph is the initial modality used to evaluate patients with painful hip joints. Ultrasonography and magnetic resonance imaging (MRI), which do not involve radiation exposure, have also been used. This case report supports the view that ultrasound can be used as an initial, cost-effective and radiation-free modality for the evaluation of suspected SCFE. A 15-year-old male patient presented with pain in the right hip for 5 days, following a slip and fall accident while playing soccer. The patient was referred to the Department of Radio-diagnosis for ultrasound. A posterior displacement of the femoral head epiphysis with a physeal step was seen on the longitudinal section obtained over the right hip joint region. The anterior physeal step (APS) measured ~3.8 mm on the right side. The distance between the anterior rim of the acetabulum and the metaphysis measured ~20.4 mm on the affected right side and ~23.6 mm on the left side. A plain radiograph in frog leg position showed a widening of the right proximal physis below the right femoral head, with a medial and posterior slip of the right femoral head. A frontal radiograph of the pelvis taken six months before showed a widening of the proximal right femoral physis. Although MRI appears to be the most sensitive modality for identifying slips early, ultrasound may be used as a cost-effective and radiation-free alternative before proceeding with further evaluation of suspected SCFE, especially considering the demographics of the affected population.

  7. [Slipped capital femoral epiphysis associated with hyperparathyroidism. A case report].

    PubMed

    Khiari, Karima; Cherif, Lotfi; Ben Abdallah, Nejib; Maazoun, Imen; Hadj Ali, Insaf; Bentaarit, Chokri; Turki, Sami; Ben Maïz, Hedi

    2003-12-01

    Slippage of the upper femoral epiphysis can occur in association with multiple endocrine imbalances. A case of slipped femoral epiphysis with primary hyperparathyroidism is reported. The patient was an adolescent, 16 Years of age, who presented bilateral slipped epiphysis. Investigation showed that he had hypercalcemia (3.1 mmol/l) related to primary hyperparathyroidism. A parathyroid adenoma was removed. Outcome was favorable and the slipped femoral epiphyses did not require a specific treatment.

  8. Slipped Distal Femoral Epiphysis in Congenital Insensitivity to Pain

    PubMed Central

    Shaikh, M Javed; Rex, C; Vignesh, R; Chavan, Madhav

    2016-01-01

    Introduction: Congenital insensitivity to pain (CIP) is a rare disorder, and often presents to an orthopaedic surgeon as recurrent fractures, dislocations, pseudoarthrosis, osteomyelitis etc. Here, we report a case of congenital insensitivity to pain presenting with distal femoral physeal separation in a child. Case Report: A 12-year-old girl child came with complaints of limp while walking and swelling in the left knee for past 5 weeks. Mother gave a history that the girl is a known case of congenital insensitivity to pain with clear history of no pain on intramuscular injection since birth. She was born of consanguineous marriage and had no significant trauma, fever, other joint involvement or any features of rheumatism. On local examination, she had no bony tenderness, mild warmth, and moderate knee effusion with restricted range of movement. Plain radiograph showed epiphysiolysis of distal femur with widening of physis. Examination under anaesthesia demonstrated gross movement indicating lower femoral physeal separation. This unstable distal femoral epiphysis was treated under general anaesthesia with closed reduction, percutaneous cross pinning and above knee plaster cast. Conclusion: Congenital insensitivity to pain (CIP) is a rare disorder to diagnose. Emphasis is given on early diagnosis of orthopaedic problems and prompt treatment, educating parents and prevention of accidents. Physeal separation without significant trauma must prompt an orthopaedic surgeon to think about congenital insensitivity to pain as a differential diagnosis. PMID:27703943

  9. Valgus Slipped Capital Femoral Epiphysis in Patient with Hypopituitarism

    PubMed Central

    Fujiwara, Yasuhiro; Hayashida, Tatsuro; Murakami, Koji; Makio, Satoshi; Shimizu, Yuichi; Oka, Yoshinobu; Kim, Wook-Choel; Ogura, Taku; Kubo, Toshikazu

    2017-01-01

    Slipped capital femoral epiphysis (SCFE) is a common disease of adolescent and the epiphysis is positioned more posteromedially in relation to the femoral neck shaft with varus SCFE; however, posterolateral displacement of the capital epiphysis, valgus SCFE, occurs less frequently. We report a case of valgus SCFE in a 17-year-old boy with hypopituitarism. After falling down, he experienced difficulty in walking. The radiographs were inconclusive; however three-dimensional computed tomography images showed lateral displacement of the epiphysis on the right femoral head. Valgus SCFE was diagnosed. The patient underwent in situ pinning of both sides. In situ pinning on the left side was performed as a prophylactic pinning because of endocrine abnormalities. At the 1-year follow-up, he could walk without any difficulty and there were no signs of pain. The epiphysis is commonly positioned more posteromedially in relation to the femoral neck shaft with most SCFE, but, in this case, the epiphysis slipped laterally. Differential diagnosis included femoral neck fracture (Delbet-Colonna type 1); however, this was less likely due to the absence of other clinical signs. Therefore, we diagnosed the patient as SCFE. When children complain of leg pain and limp, valgus SCFE that may not be visualized on anteroposterior radiographs needs to be considered. PMID:28154765

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

    PubMed

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

    2015-01-01

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

  11. Idiopathic slipped capital femoral epiphysis in Amish children.

    PubMed

    Loder, Randall T; Nechleba, Jeffrey; Sanders, James O; Doyle, Patricia

    2005-03-01

    Of the many studies of slipped capital femoral epiphysis, none have specifically addressed Amish children. The Amish reflect a small gene pool relative to the general white North American population. Additional knowledge of the demographics of this disorder in Amish children may provide genetic insights. The purpose of this study was to review the demographics of slipped capital femoral epiphysis in the Amish population. A retrospective review of the cases of twenty-five Amish children with slipped capital femoral epiphysis treated at two institutions was performed. The child's gender, age, weight, height, and body mass index at the time of the diagnosis; duration of symptoms; laterality of the slip; birth weight; family history; and slip severity were recorded. The slip was classified as stable or unstable. Patients who had been included in a previously published multicenter study served as a control group. There were seventeen boys and eight girls with a total of thirty-three slipped capital femoral epiphyses; eight of the slips were bilateral. At the time of the diagnosis, the mean age (and standard deviation) was 13.4 +/- 1.6 years, the mean weight and height were 55.6 +/-12.4 kg and 155.5 +/- 10.2 cm, and the mean body mass index was 23.4 +/- 5.4 kg/m(2). The mean duration of symptoms was 6.6 +/-9.0 months. There were thirty-one stable and two unstable slips with a mean slip angle of 38 degrees +/- 20 degrees . Nine (39%) of twenty-three children for whom the information had been recorded had a positive family history of slipped capital femoral epiphysis, a rate that is higher than the 9% and 14.5% rates reported in two other series (p = 0.002). The Amish children were not as heavy as their non-Amish counterparts (55.6 +/- 12.4 kg compared with 66.4 +/- 17.7 kg, p = 0.0036). Although the children in this study were moderately heavy, they could not be classified as obese on the basis of weight-for-age or body-mass-index percentiles. The high prevalence of

  12. Surgical hip dislocation in treatment of slipped capital femoral epiphysis

    PubMed Central

    Elmarghany, Mohammed; Abd El-Ghaffar, Tarek M.; Seddik, Mahmoud; Akar, Ahmed; Gad, Yousef; Ragheb, Eissa; Aprato, Alessandro; Massè, Alessandro

    2017-01-01

    Background: Most surgeons advocate in situ fixation of the slipped epiphysis with acceptance of any persistent deformity in the proximal femur [Aronsson DD, Loder RT, Breur GJ, Weinstein SL (2006) Slipped capital femoral epiphysis: current concepts. J Am Acad Orthop Surg 14, 666–679]. This residual deformity can lead to osteoarthritis due to femoroacetabular cam impingement (FAI) [Leunig M, Slongo T, Ganz R (2008) Subcapital realignment in slipped capital femoral epiphysis: surgical hip dislocation and trimming of the stable trochanter to protect the perfusion of the epiphysis. Instr Course Lect 57, 499–507]. Objective: The primary aim of our study was to report the results of the technique of capital realignment with Ganz surgical hip dislocation and its reproducibility to restore hip anatomy and function. Patients and methods: This prospective case series study included 30 patients (32 hips, 13 left (Lt) hips, 19 right (Rt) hips) with stable chronic slipped capital femoral epiphysis (SCFE) after surgical correction with a modified Dunn procedure. This study included 22 males and eight females. The mean age of our patients was 14 years (10–18 years). The mean follow-up period was 14.5 months (6–36 months). Results: Thirty hips had excellent and good clinical and radiographic outcomes with respect to hip function and radiographic parameters. Two patients had fair to poor clinical outcome including three patients who developed Avascular Necrosis (AVN). The difference between those who developed AVN and those who did not develop AVN was statistically significant in postoperative clinical scores (p = 0.0000). The mean slip angle of the femoral head was 52.5° ± 14.6 preoperatively and was corrected to a mean value of 5.6° ± 8.2° with mean correction of 46.85° ± 14.9° (p = 0.0000). The mean postoperative alpha angle was 51.15° ± 4.2° with mean correction of 46.70 ± 14.20 (p = 0.0000). In our series, the mean postoperative Harris hip

  13. Femoral head epiphysis growth and development among Chinese children aged 0-5 years.

    PubMed

    Luo, Jiayou; Tang, Jin; Zhou, Libo; Zeng, Rong; Mou, Jinsong; Zhang, Lingli

    2009-05-01

    The aim of this study was to examine the pattern of femoral head epiphysis growth and development among Chinese children. Between January and December, 2007, we randomly sampled 1,450 healthy Chinese children (0-5 years old) from Hunan Provincial Children's Hospital in Changsha, Hunan, China. The diameter of femoral head epiphysis was measured by pelvic X-ray photography and processed by medical image processing software. The growth of femoral head epiphysis in girls was 2-3 months earlier than that in boys. The diameter of femoral head epiphysis increased with advancing age in both girls and boys, but the diameter of femoral head epiphysis in 2, 3, 4, 6, and 10-month-old girls was significantly larger than that in boys. Cubic regression equations between the diameter of femoral head epiphysis and age were created for boys and girls that could be used to predict the diameter of femoral head epiphysis. In conclusion, there was gender difference in femoral head epiphysis growth and development among Chinese children, and our prediction models will provide the guidance for early diagnosis of diseases related to the growth and development of the femoral head epiphysis.

  14. Slipped Capital Femoral Epiphysis and Primary Hyperparathyroidism: A Case Report

    PubMed Central

    Alghamdi, Anas A.; Ahmad, Maswood M.; Almalki, Mussa H.

    2016-01-01

    The aim of reporting this case is to highlight the association of two disorders, primary hyperparathyroidism (PHPT) and slipped capital femoral epiphysis (SCFE). They are usually seen in two different age groups and rarely together. PHPT is a rare cause of SCFE and only 10 cases have been reported in the literature worldwide. The patient in our report is a 13-year-old girl who presented to our clinic with bilateral knee pain and a waddling gait. Subsequent investigations showed that she had PHPT and SCFE with low bone mass. On admission, a parathyroidectomy was performed; then, the slipped femoral epiphyses were fixed with satisfactory results. A systematic algorithmic approach that was illustrated in a previously published case was used. Such cases should be managed with a systematic approach based on the patient’s clinical status to prevent future morbidity. A literature review was conducted by performing a Medline search of all reported cases of PHPT and SCFEs. PMID:27920593

  15. Increased intracapsular pressures after unstable slipped capital femoral epiphysis.

    PubMed

    Herrera-Soto, Jose A; Duffy, Michael F; Birnbaum, Mark A; Vander Have, Kelly L

    2008-01-01

    Osteonecrosis of the femoral head is the most dreaded complication associated with an unstable slipped capital femoral epiphysis (SCFE). We hypothesize that the hip joint pressure will be increased in unstable slips, confirming that emergent treatment and decompression are warranted. Thirteen unstable SCFE hips were evaluated. Hip pressure monitoring was performed. Postcapsulotomy measurements were also performed in all of the patients. Five of these under gentle manipulation. Six patients underwent measurement of the hip pressure on the unaffected side. The mean pressure on the affected hip was 48 mm Hg. The mean pressure on the unaffected side was 23 mm Hg. There was a significant increase in intraarticular hip pressure after attempted manipulation (mean, 75 mm Hg). Hip pressures are increased in unstable SCFE to levels higher for those of a compartment syndrome probably causing a tamponade effect. There is a need to perform a capsulotomy if manipulation is performed.

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

    PubMed Central

    2011-01-01

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

  17. EVOLUTION OF SLIPPED CAPITAL FEMORAL EPIPHYSIS AFTER NONSURGICAL TREATMENT

    PubMed Central

    Santili, Cláudio; Akkari, Miguel; Waisberg, Gilberto; Braga, Susana Reis; Kasahara, Akemi; Perez, Mauro Coura

    2015-01-01

    To evaluate the efficacy of conservative treatment of patients with slipped capital femoral epiphysis (SCFE) and the complications due to the progression of the disease. Methods: 18 patients (26 hips) seen consecutively from December 1996 to August 2006 at the Orthopedics Service of Santa Casa de Misericórdia de São Paulo, who had been referred from other services with a diagnosis of SCFE and were treated without surgery, were retrospectively analyzed. Results: Slip progression occurred in 19 hips (73%). Among the mild cases, eight remained mild, four became moderate and one became severe, according to the Southwick classification. Four out of the six originally moderate cases became severe and the two already severe cases worsened. Conclusion: Although today there is a consensus regarding the indication of surgical treatment for SCFE to prevent progression, some cases with confirmed diagnoses are still being treated conservatively. This is a major error, since it implies increased morbidity of the disease. PMID:27022585

  18. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis

    PubMed Central

    Oduwole, K. O.; de SA, D.; Kay, J.; Findakli, F.; Duong, A.; Simunovic, N.; Yen, Y-M.

    2017-01-01

    Objectives The purpose of this study was to evaluate the existing literature from 2005 to 2016 reporting on the efficacy of surgical management of patients with femoroacetabular impingement (FAI) secondary to slipped capital femoral epiphysis (SCFE). Methods The electronic databases MEDLINE, EMBASE, and PubMed were searched and screened in duplicate. Data such as patient demographics, surgical technique, surgical outcomes and complications were retrieved from eligible studies. Results Fifteen eligible level IV studies were included in this review comprising 261 patients (266 hips). Treatment groups included arthroscopic osteochondroplasty, surgical hip dislocation, and traditional open osteotomy. The mean alpha angle corrections were 32.14° (standard deviation (sd) 7.02°), 41.45° (sd 10.5°) and 6.0° (sd 5.21°), for arthroscopy, surgical hip dislocation, and open osteotomy groups, respectively (p < 0.05). Each group demonstrated satisfactory clinical outcomes across their respective scoring systems. Major complication rates were 1.6%, 10.7%, and 6.7%, for arthroscopy, surgical dislocation and osteotomy treatments, respectively. Conclusion In the context of SCFE-related FAI, surgical hip dislocation demonstrated improved correction of the alpha angle, albeit at higher complication and revision rates than both arthroscopic and open osteotomy treatments. Further investigation, including high-quality trials with standardised radiological and clinical outcome measures for young patients, is warranted to clarify treatment approaches and safety. Cite this article: K. O. Oduwole, D. de Sa, J. Kay, F. Findakli, A. Duong, N. Simunovic, Y. Yi-Meng, O. R. Ayeni. Surgical treatment of femoroacetabular impingement following slipped capital femoral epiphysis: A systematic review. Bone Joint Res 2017;6:472–480. DOI: 10.1302/2046-3758.68.BJR-2017-0018.R1. PMID:28790036

  19. Effects of Multiple Drilling on the Ischemic Capital Femoral Epiphysis of Immature Piglets

    PubMed Central

    Gong, Sun Young; Kim, Hyun Woo; Park, Hui-Wan; Lee, Seung Yup

    2011-01-01

    Purpose This study investigated the effects of multiple drilling on the immature capital femoral epiphysis following ischemic injury in a piglet model. Materials and Methods Ischemic necrosis of capital femoral epiphysis was induced bilaterally in 12 piglets using a cervical ligation method. Three weeks later, medial, central, and lateral 3 drill holes were made on the left femoral head using 0.062" K-wire. At 3, 6, 9, and 12 weeks following the multiple drilling, femoral heads were harvested from each three piglets. On histologic examination, percent of revascularization, percent of osteoblast surface, capital femoral epiphyseal quotient and proximal femoral growth plate height were evaluated. Untreated right femoral heads served as control. Results While percent of revascularization of left capital femoral epiphysis with multiple drilling was significantly higher than untreated control side (p<0.001), percent of osteoblast surface, capital femoral epiphyseal quotient and proximal femoral growth plate height showed no significant difference. Conclusion This study indicates that multiple drilling could promote revascularization of ischemic capital femoral epiphysis, and multiple drilling does not appear to produce bony physeal bars at short-term, if using small diameter drill. However, multiple drilling alone does not seem to prevent femoral head deformity or to promote new bone formation. PMID:21786447

  20. Slipped capital femoral epiphysis in a patient with Turner syndrome receiving growth hormone therapy.

    PubMed

    Nasrallah, Mona P; Der-Boghossian, Asdghig H; Haidar, Rachid K

    2012-01-01

    To report a case of slipped capital femoral epiphysis in a young patient with Turner syndrome (TS) receiving growth hormone therapy and to emphasize the importance of keeping this orthopedic condition in mind during management of this patient group. Clinical, laboratory, and radiographic findings are presented, and risk factors for slipped capital femoral epiphysis are discussed. A child with TS presented for medical assessment because of a limp but with no history of trauma or febrile illness. Growth hormone therapy had been administered for 1 year because of her short stature. Physical examination and pelvic radiography of the patient showed the presence of bilateral slipped capital femoral epiphysis. She underwent bilateral pinning in situ, and growth hormone therapy was terminated. At follow-up after more than 2 years, no sequelae were noted. Patients with TS are at high risk for developing certain orthopedic conditions, such as slipped capital femoral epiphysis. Furthermore, slipped capital femoral epiphysis is a known complication of growth hormone therapy in growing children. A limp, hip pain, knee pain, or thigh pain might be a symptom of slipped capital femoral epiphysis in patients with TS, especially those receiving growth hormone therapy. Prompt recognition and treatment of this condition are important for prevention of sequelae.

  1. Slipped capital femoral epiphysis in 17 Maine Coon cats.

    PubMed

    Borak, Danilo; Wunderlin, Nadja; Brückner, Michael; Schwarz, Günter; Klang, Andrea

    2017-01-01

    Objectives From May 2009 to January 2015, 208 Maine Coon cats presented to the Tierklinik Hollabrunn - a small animal referral and first-opinion centre - and 17 (8.17%) cats were diagnosed with a slipped capital femoral epiphysis (SCFE). Over the same time period, 29 (0.67%) of 4348 cats (all breeds) were diagnosed with SCFE. Methods Clinical and orthopaedic examinations and diagnostic imaging were performed on all affected Maine Coons. Age at first presentation, sex, body weight, body condition score (BCS), unilateral or bilateral manifestation of the disease, activity level and duration of lameness, age at neutering and known family history of disease were recorded. Sixteen of 17 Maine Coons were surgically treated. Surgically removed femoral tissue samples were histologically examined in 13 cases. Results The mean age at first presentation was 21.47 months; male to female ratio was 16:1; mean body weight was 7.5 kg (range 5.3-9.3 kg); and mean BCS was 5.06/9.0. Seven cats were bilaterally affected; the median duration of decreased activity level and lameness was 2 weeks; mean age at neutering was 7.7 months (range 3.0-12.0 months); and four cats were littermates. Fourteen femoral head and neck ostectomies, eight total hip replacements and one primary fixation were performed. All 13 histologically available samples confirmed the diagnosis of SCFE. Conclusions and relevance To date, SCFE has been reported only occasionally in Maine Coon cats. However, the results of this study showed that Maine Coons were approximately 12-fold more likely to develop SCFE than the overall population of cats presenting to the Tierklinik Hollabrunn over the same time period. Male sex, neutering, delayed physeal closure and breed-specific high body weight may play an important role in the pathogenesis of SCFE in Maine Coon cats.

  2. The Epidemiology and Demographics of Slipped Capital Femoral Epiphysis

    PubMed Central

    Loder, Randall T.; Skopelja, Elaine N.

    2011-01-01

    The etiology of slipped capital femoral epiphysis (SCFE) is unknown with many insights coming from epidemiologic/demographic information. A systematic medical literature review regarding SCFE was performed. The incidence is 0.33/100,000 to 24.58/100,000 children 8 to 15 years of age. The relative racial frequency, relative to Caucasians at 1.0, is 5.6 for Polynesians, 3.9 for Blacks, and 2.5 for Hispanics. The average age is 12.0 years for boys and 11.2 years for girls. The physiologic age when SCFE occurs is less variable than the chronologic age. The average symptom duration is 4 to 5 months. Most children are obese: >50% are >95th percentile weight for age with average BMI is 25–30 kg/m2. The onset of SCFE is in the summer when north of 40°N. Bilaterality ranges from 18 to 50%. In children with bilateral involvement, 50–60% present with simultaneous SCFEs and those who present with a unilateral SCFE and subsequently develop a contralateral SCFE do so within 18 months. The age at presentation is younger for those who present with a unilateral SCFE and later develop a contralateral SCFE. The age-weight, age-height, and height test are useful to differentiate between an idiopathic and atypical SCFE. PMID:24977061

  3. Valgus slipped capital femoral epiphysis: subcapital growth plate orientation analysis.

    PubMed

    Koczewski, Paweł

    2013-11-01

    The aim of the study was to determine the risk factors of unusual, lateral direction of epiphyseal displacement in primarily unilateral slipped capital femoral epiphysis (SCFE) patients with a special focus on radiological parameters of an unaffected hip. A total of 115 patients (75 boys, 40 girls), mean age 13.2 years (8.4-18.6), were analyzed. The mean follow-up time was 11 years (2-29). The proportion of valgus slip among SCFE patients was 11 of 115 cases (9.6%). The patients with valgus slip compared with the classic ones were predominantly females (55 vs. 33%), were younger (11.1 vs. 13.4 years), had a greater epiphyseal-shaft angle (67.4 vs. 59.1°), smaller displacement in the frontal plane (absolute value 6.7 vs. 15°), and a lower risk of contralateral slip (27 vs. 65%). There was no difference in the neck-shaft angle and epiphyseal-neck angle value. A more horizontal orientation of the subcapital growth plate, assessed by epiphyseal-shaft angle, can be considered a conducive factor in the valgus direction of epiphyseal slip in SCFE. In valgus SCFE cases, there is a smaller degree of epiphyseal displacement in both the sagittal and the coronal plane and a lower risk of consecutive contralateral slip.

  4. Biomechanical considerations in slipped capital femoral epiphysis and insights into prophylactic fixation.

    PubMed

    Leblanc, E; Bellemore, J M; Cheng, T; Little, D G; Birke, O

    2017-04-01

    Slipped capital femoral epiphysis (SCFE) is a deformity of the proximal femur secondary to widened and unstable physis. In stabilising the slip, gold standard treatments stop growth and involve premature physeal closure, which prevents the remodelling of the acquired deformity and creates a leg length discrepancy that may be significant in younger patients. We measured the impact of placing threaded screws across the proximal femoral physis by measuring the centre-trochanteric distance (CTD) and articulo-trochanteric distance (ATD) in participants with or without prophylactic fixation. We then compared the mechanical performance of static (stainless and titanium cannulated Synthes screws) and potentially growing implants (Synthes SCFE screw and Pega Medical Free Gliding screw) in a validated synthetic bone model. In the review of 30 non-fixed and 60 fixated hips over a mean follow-up of 1.9 years, we have noted a significant difference in pre/post CTD and ATD, as well as the change in CTD and ATD over time. In the biomechanical study, the newer implants allowing growth (Synthes SCFE screw and Pega Medical Free Gliding screw) were both shown to be at least non-inferior. The primary deformity of a SCFE in itself alters hip mechanics. Also, as confirmed in this study, there is a secondary deformity that is created by static fixation and relative trochanteric overgrowth. To help remodel mild deformities and prevent secondary trochanteric overgrowth, growing implants seem to be non-inferior to the more standard means of fixation in static testing.

  5. Femoral remodeling may influence patient outcomes in slipped capital femoral epiphysis.

    PubMed

    DeLullo, James A; Thomas, Eric; Cooney, Timothy E; McConnell, Sharon J; Sanders, James O

    2007-04-01

    Clinical studies of patients treated for slipped capital femoral epiphysis have found limited functional impairment and femoral neck deformity causing eventual coxarthrosis. Since patient-focused assessments minimize bias and reflect health-related quality of life status, we coupled their use to a clinical examination to obtain a more patient-centered picture of slipped capital femoral epiphyseal outcomes. The impact of residual deformity on outcomes also was examined. Of 78 patients treated for slipped capital femoral epiphyses between 1972 and 1998, 29 (38 hips) were evaluated at a mean followup of 7.6 years (range, 1.4-26 years). The average patient age was 21.8 years (range, 14.6-39 years), 55% were female, and the average body mass index was 28.7 (range, 16.1-50.2). Most slips were stable (92%, 35 of 38) and mild or moderate in severity (98%, 36 of 37). Followup examinations revealed slight deficits in range of motion, strength, and limb length. Radiographs showed slight improvements in head-shaft angle and reduced but persistent femoral neck deformity. Osteoarthritic changes were absent or negligible in 84% (32 of 38) of the hips. The average Iowa hip score was 90.5 (range, 51-100). Patient outcome scores for the AAOS Hip/Knee Questionnaire fell slightly below 50th percentile norms. Neither slip stability, severity, nor body mass index impacted outcome. Femoral neck deformity correlated with function, pain, and Boyer grade. Overall, patients had minor functional deficits and pain that may have been related to femoral neck deformity, but longer followup is warranted.

  6. Continuing Delay in the Diagnosis of Slipped Capital Femoral Epiphysis.

    PubMed

    Schur, Mathew D; Andras, Lindsay M; Broom, Alexander M; Barrett, Kody K; Bowman, Christine A; Luther, Herman; Goldstein, Rachel Y; Fletcher, Nicholas D; Millis, Michael B; Runner, Robert; Skaggs, David L

    2016-10-01

    To evaluate whether the time from symptom onset to diagnosis of slipped capital femoral epiphysis (SCFE) has improved over a recent decade compared with reports of previous decades. Retrospective review of 481 patients admitted with a diagnosis of SCFE at three large pediatric hospitals between January 2003 and December 2012. The average time from symptom onset to diagnosis of SCFE was 17 weeks (range, 0-to 169). There were no significant differences in time from symptom onset to diagnosis across 2-year intervals of the 10-year study period (P = .94). The time from evaluation by first provider to diagnosis was significantly shorter for patients evaluated at an orthopedic clinic (mean, 0 weeks; range, 0-0 weeks) compared with patients evaluated by a primary care provider (mean, 4 weeks; range, 0-52 weeks; r = 0.24; P = .003) or at an emergency department (mean, 6 weeks, range, 0-104 weeks; r = 0.36; P = .008). Fifty-two patients (10.8%) developed a second SCFE after treatment of the first affected side. The time from the onset of symptoms to diagnosis for the second episode of SCFE was significantly shorter (r = 0.19; P < .001), with mean interval of 11 weeks (range, 0-104 weeks) from symptom onset to diagnosis. There were significantly more cases of mildly severe SCFE, as defined by the Wilson classification scheme, in second episodes of SCFE compared with first episodes of SCFE (OR, 4.44; P = .001). Despite reports documenting a lag in time to the diagnosis of SCFE more than a decade ago, there has been no improvement in the speed of diagnosis. Decreases in both the time to diagnosis and the severity of findings for the second episode of SCFE suggest that the education of at-risk children and their families (or providers) may be of benefit in decreasing this delay. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Bilateral slipped capital femoral epiphysis occuring in an adult with acromegalic gigantism.

    PubMed

    Feydy, A; Carlier, R Y; Mompoint, D; Rougereau, G; Patel, A; Vallée, C

    1997-03-01

    The etiology of slipped capital femoral epiphysis is still unknown. Traumatic, endocrine, toxic, and mechanical causes have all been hypothesized. It is well documented that the highest incidence occurs during the adolescent growth spurt, suggesting the role of an endocrine abnormality. We report a case that supports this hypothesis.

  8. Osteotomy does not improve early outcome after slipped capital femoral epiphysis.

    PubMed

    Diab, Mohammad; Daluvoy, Sanjay; Snyder, Brian D; Kasser, James R

    2006-03-01

    We performed a retrospective, nonrandomized cohort study of unilateral, chronic, severe, stable slipped capital femoral epiphysis comparing five girls and five boys who underwent in-situ screw fixation alone with five girls and five boys who underwent in-situ screw fixation combined with staged flexion intertrochanteric femoral osteotomy to restore proximal femoral alignment. Functional outcome was measured by the Harris hip score, with 20% selected as a goal for improvement in functional outcome after corrective osteotomy. While flexion intertrochanteric femoral osteotomy improved hip range of motion, we found no significant difference in functional outcome between the two groups at early follow-up. This is a level 3 evidence study.

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

    PubMed Central

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

    2012-01-01

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

  10. Metaphyseal bone collapse mimicking slipped capital femoral epiphysis in severe renal osteodystrophy.

    PubMed

    Takao, Masaki; Hashimoto, Jun; Sakai, Takashi; Nishii, Takashi; Sugano, Nobuhiko; Yoshikawa, Hideki

    2012-11-01

    Slipped capital femoral epiphysis is a well-recognized skeletal complication of renal osteodystrophy in adolescence, which is distinct from idiopathic slipped capital femoral epiphysis in its etiology. We report a case of severe mixed-type renal osteodystrophy with metaphyseal bone collapse that mimicked slipped capital femoral epiphyses. Case history, laboratory and radiological evaluation, and bone biopsies are discussed. A 14-yr-old girl presented with left hip pain showing bilateral metaphyseal bone collapse accompanied with posterior-inferior displacement of capital femoral epiphyses after 2.5 yr of GH treatment. Blood chemistry, showing high levels of alkaline phosphatase and PTH, and a transiliac bone biopsy, indicating severe osteomalacia with osteitis fibrosa, along with serial computed tomography images of the hips from the presymptomatic stage, led to accurate diagnosis and successful treatment by administration of high-dose vitamin D. This case emphasizes the importance of controlling hyperparathyroidism well in children with chronic renal insufficiency, particularly at adolescence before initiating GH treatment. When children with renal insufficiency present with displacement of capital femoral epiphysis, it is necessary to evaluate the serum levels of alkaline phosphatase and PTH and metaphyseal bone quality below the physis.

  11. The modified Dunn procedure for slipped capital femoral epiphysis: the Bernese experience.

    PubMed

    Tannast, M; Jost, L M; Lerch, T D; Schmaranzer, F; Ziebarth, K; Siebenrock, K A

    2017-04-01

    Based on previous investigations on the vascular blood supply to the femoral head, a technique for anatomical reduction after slipped capital femoral epiphysis was developed. This technique is a modification of the original technique by Dunn using a retinacular soft-tissue flap. This allows the visual control of the epiphyseal vascular blood supply. We report the experience at the inventor's institution with a critical discussion of the available literature. Using a trochanteric osteotomy for surgical dislocation of the hip, a retinacular soft tissue flap is created containing the deep branch of the medial femoral circumflex artery, the external rotators and the capsule. The femoral epiphysis can be mobilised safely and reduced on the femoral neck after resection of the almost constantly present reactive metaphyseal callus. In our institution, the rate of avascular necrosis with 2% is comparably low to Dunn's original results. It is only present in cases where no bleeding was already evident before reduction of the epiphysis. The ten-year long-term results are favorable in these cases with a good functional result and only little progression of osteoarthritis. However, other authors have reported higher rates of avascular necrosis up to 24% in their initial experience. In experienced hands using the correct meticulous surgical technique, the results are favorable regarding the rates of avascular necrosis, the functional outcome and the development of radiographic osteoarthritis - even in acute and severe cases. Avascular necrosis is rare but can be observed if there is no evidence of intra-operative femoral head perfusion before and after reduction of the epiphysis.

  12. Potential influence of hormones in the development of slipped capital femoral epiphysis: a preliminary study.

    PubMed

    Papavasiliou, Kyriakos A; Kirkos, John M; Kapetanos, George A; Pournaras, John

    2007-01-01

    The potential influence of hormonal imbalance on the development of slipped capital femoral epiphysis was assessed through a prospective clinical study. The serum levels of T3, T4, thyroid-stimulating hormone, testosterone, estradiol, dehydroepiandrosterone-sulfate, follicle-stimulating hormone, luteinizing hormone, human growth hormone, adrenal cortex hormone and cortisol were evaluated in seven boys and seven girls. Forty-three out of 154 hormonal determinations (27.9%) were abnormal. The results showed increased incidence of pathological values mainly in the levels of follicle-stimulating-hormone, luteinizing-hormone and testosterone. No patient had clinical findings of endocrinopathy. A (possibly) temporary hormonal disorder may play a potentially significant role in the development of slipped capital femoral epiphysis.

  13. Biomechanical testing of bioabsorbable cannulated screws for slipped capital femoral epiphysis fixation.

    PubMed

    Kroeber, Markus W; Rovinsky, David; Haskell, Andrew; Heilmann, Moira; Llotz, Jeff; Otsuka, Norman

    2002-06-01

    This study compared cannulated 4.5-mm bioabsorbable screws made of self-reinforced poly-levolactic acid to cannulated 4.5-mm steel and titanium screws for resistance to shear stress and ability to generate compression in a polyurethane foam model of slipped capital femoral epiphysis fixation. The maximum shear stress resisted by the three screw types was similar (self-reinforced poly-levolactic acid 371 +/- 146 MPa, steel 442 +/- 43 MPa, and titanium 470 +/- 91 MPa). The maximum compression generated by both the self-reinforced poly-levolactic acid screw (68.5 +/- 3.3 N) and the steel screw (63.3 +/- 5.9 N) was greater than that for the titanium screw (3 +/- 1.4 N, P <.05). These data suggest cannulated self-reinforced poly-levolactic acid screws can be used in the treatment of slipped capital femoral epiphysis because of their sufficient biomechanical strength.

  14. Slipped capital femoral epiphysis in adults: case report and review of literature.

    PubMed

    Macía-Villa, C C; Sanchez-Lite, I; Medina-Luezas, J

    2016-06-23

    Slipped capital femoral epiphysis (SCFE) mainly affects overweight prepubertal children. It is usually idiopathic, but endocrinological diseases are proposed as the main cause. SCFE occurs before the closing of the femoral physis, which generally occurs at 18 years in males and 16 years in females, therefore it is considered a children's disease. However, there have been several reports of adults with SCFE and some familial cases. We present a case of bilateral SCFE in a 47 years old female with possible relationship with inhaled corticosteroids, and for the first time we collect and analyze all published cases in adults.

  15. Arthroscopic subcapital realignment osteotomy in chronic and stable slipped capital femoral epiphysis: early results.

    PubMed

    Roos, Bruno Dutra; Assis, Marcelo Camargo de; Roos, Milton Valdomiro; Camisa Júnior, Antero; Lima, Ezequiel Moreno Ungaretti; Pagani, Rodolfo Cavanus

    2017-01-01

    This study aimed to evaluate the clinical and radiographic outcomes, as well as the complications of arthroscopic subcapital realignment osteotomy in chronic and stable slipped capital femoral epiphysis (SCFE). As indicated by the literature review, this is the first time this type of arthroscopic osteotomy was described. Between June 2012 and December 2014, seven patients were submitted to arthroscopic subcapital realignment osteotomy in chronic and stable SCFE. The mean age was 11 years and 4 months, and the mean follow-up period was 16.5 months (6-36). Clinical results were evaluated using the Modified Harris Hip Score (MHHS), which was measured pre- and postoperatively. Radiographs were evaluated using the Southwick quantitative classification and the epiphysis-diaphysis angle (pre- and postoperatively). Complications were assessed. The mean preoperative MHHS was 35.8 points, and 97.5 points post-operatively (p < 0.05). Radiographically, five patients were classified as Southwick classification grade II and two as grade III. The mean correction of the epiphysis-diaphysis angle was 40°. No immediate postoperatively complications were observed. One patient presented femoral head avascular necrosis, without collapse or chondrolysis at the most recent follow-up (22 months). The arthroscopic technique presented for subcapital realignment osteotomy in chronic and stable SCFE showed satisfactory clinical and radiographic outcomes in a 16.5 months follow-up period.

  16. Prepubertal onset of slipped capital femoral epiphysis associated with hypothyroidism: a case report and literature review.

    PubMed

    Kadowaki, Saori; Hori, Tomohiro; Matsumoto, Hideki; Kanda, Kaori; Ozeki, Michio; Shirakami, Yu; Kawamoto, Norio; Ohnishi, Hidenori; Fukao, Toshiyuki

    2017-09-18

    Slipped capital femoral epiphysis (SCFE) is a common hip disorder characterized by displacement of the capital femoral epiphysis from the metaphysic through the femoral epiphyseal plate. SCFE usually occurs during puberty, with obesity a common risk factor. We experienced a rare case of SCFE associated with hypothyroidism in a prepubescent patient who was not obese. The patient was an 8-year-old boy suffering from bilateral SCFE with hypothyroidism. The patient's growth had started to slow at 4 years of age, and at 8 years he was of short stature. During his evaluation for SCFE management, primary hypothyroidism was diagnosed due to the presence of anti-thyroid peroxidase and anti-thyroglobulin antibodies. After the patient was treated for hypothyroidism, which improved his thyroid function, surgery was performed for bilateral SCFE. Among the 42 patients with SCFE associated with hypothyroidism in the literature, most SCFE occurred during puberty or in adults with delayed epiphyseal closure. Only two patients (4.8%), including the present patient, were ≤9 years old. Although being overweight or obese is common for patients with SCFE associated with hypothyroidism (76.0%), it was not observed in the present case. Persistent hypothyroidism, however, may be a risk factor for SCFE even before puberty and without obesity.

  17. [Growth and deformity after in situ fixation of slipped capital femoral epiphysis].

    PubMed

    Druschel, C; Placzek, R; Funk, J F

    2013-08-01

    For mild to moderate slipped capital femoral epiphysis (SCFE) in situ fixation is the current treatment standard. However, concerning the implant selection (screw versus k-wires) as well as the prophylactic stabilisation of the non-affected hip, controversies still exist. The aim of this study was to analyse femoral residual growth and femoral deformities after in situ fixation of SCFE either with k-wires or screws. We conducted a retrospective analysis of the radiographs of adolescents treated for SCFE in our department between 01/2003 and 02/2011. To evaluate femoral growth the articulo-trochanteric distance, centro-trochanteric distance, caput-collum-diaphyseal angle, pin-joint ratio and pin-physis ratio were determined. The femoral deformity was assessed by measuring the sphericity of the femoral head. Degenerative changes were evaluated in the final radiographs. Statistical analysis was performed concerning differences between therapeutically and prophylactically treated hips as well as stabilisations with k-wires and screws. A total of 22 patients (female : male = 14 : 8, mean age girls: 11 ± 1 years, boys: 13 ± 2 years) with 26 slipped capital femoral epiphyses was analysed. K-wires were used for fixation in 4 hips each therapeutically and prophylactically, 22 hips with SCFE and 14 non-affected hips were stabilised with screws. Treatment with screws did not lead to significantly earlier physeal closure than k-wire pinning. Regarding the femoral growth parameters a significant decrease in the articulo-trochanteric distance and CCD angle was detectable in all groups. The pin-joint ratio revealed an adequate residual growth in 58 % of the therapeutically and in 72 % of the prophylactically treated hips without significant difference between k-wires and screws. The pin-physis ratio demonstrated similar values. Regarding the femoral deformity the SCFE hips resulted in a significantly reduced sphericity, which remained unchanged during follow-up. The

  18. Improved Screw Placement for Slipped Capital Femoral Epiphysis (SCFE) using Robotically-Assisted Drill Guidance

    PubMed Central

    Koutenaei, Bamshad Azizi; Guler, Ozgur; Wilson, Emmanuel; Thoranaghatte, Ramesh U.; Oetgen, Matthew; Navab, Nassir; Cleary, Kevin

    2014-01-01

    Slipped Capital Femoral Epiphysis (SCFE) is a common hip displacement condition in adolescents. In the standard treatment, the surgeon uses intra-operative fluoroscopic imaging to plan the screw placement and the drill trajectory. The accuracy, duration, and efficacy of this procedure are highly dependent on surgeon skill. Longer procedure times result in higher radiation dose, to both patient and surgeon. A robotic system to guide the drill trajectory might help to reduce screw placement errors and procedure time by reducing the number of passes and confirmatory fluoroscopic images needed to verify accurate positioning of the drill guide along a planned trajectory. Therefore, with the long-term goals of improving screw placement accuracy, reducing procedure time and intra-operative radiation dose, our group is developing an image-guided robotic surgical system to assist a surgeon with pre-operative path planning and intra-operative drill guide placement. PMID:25333154

  19. Slipped capital femoral epiphysis: rising rates with obesity and aboriginality in South Australia.

    PubMed

    Nguyen, A R; Ling, J; Gomes, B; Antoniou, G; Sutherland, L M; Cundy, P J

    2011-10-01

    We analysed the incidence of slipped capital femoral epiphysis (SCFE) in South Australia, investigating possible associations between an increased incidence of SCFE, the local indigenous population and the Australian obesity epidemic during the last 20 years. Data including race, age and gender were collected to obtain a profile of the South Australian SCFE patient, and were then compared with epidemiological data for South Australian adolescents. We concluded that the incidence of both obesity and SCFE is increasing. We also noted that the median weight of SCFE patients has increased and the mean age at diagnosis has decreased. Despite weight profiles comparable with those of the general population, we noted that an indigenous child was three times more likely to develop SCFE than a non-indigenous child. As far as we know there is no published literature on the predisposition of Aboriginal Australians to SCFE.

  20. Transtrochanteric rotational osteotomy for avascular necrosis of the femoral head after unstable slipped capital femoral epiphysis: 10-year clinical results.

    PubMed

    Nakashima, Yasuharu; Yamamoto, Takuaki; Fukushi, Jun-Ichi; Motomura, Goro; Hamai, Satoshi; Kohno, Yusuke; Iwamoto, Yukihide

    2016-11-01

    Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric rotational osteotomy of the femoral head (TRO) for AVN. This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the follow-up period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads. The direction of rotation was anterior in 3 hips and posterior in 4. The Merle d'Aubigné-Postel score (MDPS) was used for clinical assessment, and joint degeneration was assessed with the Kellgren and Lawrence classification (KL-grade). The spherical intact area of the femoral head was moved to the weight-bearing portion, and subluxation was corrected via rotation combined with intentional varus positioning. The mean MDPS improved from 10.3 points to 15.6 points at 5 years, and it was maintained at 15.0 points by 10 years; 3 hips were excellent, 1 was good, 2 were fair, and 1 showed poor outcomes. No patient experienced re-collapse after TRO or required conversion to hip replacement or arthrodesis. After 10 years, degenerative changes became evident over time, and 2 hips progressed to KL-4 with a decreased MDPS. Although some joint degeneration is inevitable in the long-term, TRO is an effective salvage procedure for treating AVN after unstable SCFE. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  1. Cartilage Space Width in Slipped Capital Femoral Epiphysis: The Relationship to Cartilage Necrosis 1

    PubMed Central

    Ogden, John A.; Simon, Theodore R.; Southwick, Wayne O.

    1977-01-01

    The radiolucent cartilage space of eighty-three patients with unilateral or bilateral slipped capital femoral epiphysis was measured by a standardized technique. In the majority of patients, whether unilateral or bilateral involvement, there was bilateral narrowing of the cartilage space. In the unaffected hip of unilaterally involved patients, there was a progressive narrowing as skeletal maturity was attained. A concomitant anatomical study of cadaver hips, removed at autopsy from adolescent patients, showed a progressive narrowing of the cartilage as the proximal femur matured. Black females showed most narrowing (minimum cartilage space width), had the narrowest final cartilage space widths, and took the longest to attain this final width. While other racial, sexual and therapeutic groups failed to demonstrate statistically significant differences, the general trend was for females, Blacks, and patients treated by osteotomy to have more joint space narrowing. However, rewidening occurred in most of these affected joint spaces, in contrast to the progressive linear decrease observed in unaffected hips and anatomical specimens. On the basis of this study, we feel that cartilage space narrowing may be anticipated in the post-operative period in most patients treated for slipped capital femoral epiphysis. This narrowing appears to improve with time. Narrowing of greater than one-half the original width, in association with pain and limitation of joint function, probably represents “cartilage necrosis,” or pathologic joint space narrowing. Unless the narrowing remains less than one-half to two-thirds of the initial cartilage space for more than twenty-four to thirty-six months, probably no specific surgical treatment should be undertaken, other than observation and protected weight bearing during any painful phase. Plotting the roentgenographic cartilage space width during the three month to thirty-six month phase may be useful in monitoring and predicting the

  2. Slipped capital femoral epiphysis: a review of management in the hip impingement era

    PubMed Central

    Mahran, Mahmoud A.; Baraka, Mostafa M.; Hefny, Hany M.

    2017-01-01

    Slipped capital femoral epiphysis (SCFE) remains the most common adolescent hip disorder. Most cases present with stable slips, and in situ fixation is the most commonly adopted treatment worldwide. The introduction of the concept of femoroacetabular impingement and subsequent studies have revealed SCFE-related hip impingement to be a significant pre-arthritic condition, and the previously suggested remodeling of the proximal femur after in situ fixation has been called into question. Complex proximal femoral osteotomies and more recently intra-articular procedures via surgical hip dislocation have been employed. The literature is still lacking a strong evidence to undertake such aggressive procedures. Moreover, the application of a particular procedure regarding the nature of the slip, being stable or unstable, the degree of the slip, and the condition of the physis has not been extensively described in the literature. The purpose of this article is to outline the SCFE-related hip impingement, to review the best evidence for the current treatment options for both stable and unstable slips, and to develop an algorithm for decision making. PMID:28513428

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

    PubMed

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

    2016-06-27

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

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2015-01-01

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

  6. Delayed-onset slipped capital femoral epiphysis: case report of association with pituitary tumor.

    PubMed

    Brady, Robert L; Price, Andrew

    2010-03-01

    Slipped capital femoral epiphysis (SCFE) is an affliction of the hip presenting in adolescent children. There are several theories regarding the pathological cause of SCFE. The hormonal milieu during adolescence, combined with a deficiency in the physeal area of the growth plate, has been postulated as a possible etiology for its specific onset. In atypical circumstances, the early or late onset of SCFE may occur in the setting of unusual hormonal influences. This hormonal imbalance may be secondary to an underlying endocrinopathy-for example, hypothyroidism or hypogonadism. In this case, our patient presented with a clinically and radiographically unstable slip at the age of 22 years. His physical characteristics, along with confirmatory laboratory values and radiographs, indicated that the patient suffered from a disorder of delayed secondary growth. Subsequent thorough work-up revealed a large benign pituitary tumor that was causing severe panhypopituitarism. This article describes the presentation, diagnostic work-up and treatment of our patient with a delayed-onset SCFE in the setting of a pituitary tumor.

  7. Prediction of contralateral slipped capital femoral epiphysis using the modified Oxford bone age score.

    PubMed

    Popejoy, Debra; Emara, Khaled; Birch, John

    2012-01-01

    The purpose of the present study was to determine whether the modified Oxford bone score can be used as a predictor for the risk of developing contralateral slipped capital femoral epiphysis (SCFE) in children who present with a unilateral slip. We identified 260 patients treated for unilateral SCFE between 1980 and 2002 and followed them up to skeletal maturity or until development of contralateral slip. Exclusion criteria included patients with endocrine or metabolic disorder, Down syndrome, and those with radiographs inadequate to determine the modified Oxford bone score. The initial radiographs were given a score ranging from 16 to 26. Statistical analysis was used to determine whether the modified Oxford bone score was predictive of future development of contralateral slip. A linear regression model was used to estimate the probability of future development of a contralateral slip as related to the modified Oxford bone score. Of the 260 patients, 64 (24%) developed a contralateral slip, at an average of 10 months after initial presentation. Race, sex, age, and weight at initial presentation were not predictive of the development of contralateral slip. The modified Oxford score and a triradiate score of 1 were found to be significant (P<0.0001) predictors, with the modified Oxford score a better overall predictor. The modified Oxford bone age score is the best predictor of the risk of development of a contralateral SCFE in patients presenting with a unilateral slip. Controversy exists regarding prophylactic pinning of a normal hip in patients presenting with unilateral SCFE. The benefits of prophylactic pinning must outweigh risk. This study provides probability data for predicting a contralateral slip based on the modified Oxford bone maturity score that can be shared with families and allows physicians to decide their threshold for prophylactically pinning the contralateral hip in patients presenting with a unilateral slip. Therapeutic level IV, Case series.

  8. Seasonal Variation in Slipped Capital Femoral Epiphysis: New Findings Using a National Children's Hospital Database.

    PubMed

    Loder, Randall T; Schneble, Chris A

    2017-09-28

    Slipped capital femoral epiphysis (SCFE) demonstrates seasonal variation in certain latitudes but not others. Is such variation influenced by temperature differences, sunlight exposure and subsequent vitamin D production, or other climate variables? It was the purpose of this study to further investigate the seasonal variation in month of presentation for SCFE. Data for this study originated from the Pediatric Hospital Information System for all children with a diagnosis of SCFE from January 1, 2004 through December 31, 2014. From this database the patient's sex, ethnicity, hospital location, and month of presentation was determined. Only those patients treated primarily for SCFE were included. Geographic and climate data [latitude, average annual temperature, precipitation, climate type (Köppen-Geiger and Liss), horticultural plant zone hardiness, and sunlight exposure] for each of the 49 Pediatric Hospital Information System hospitals was determined. Seasonal variation was analyzed using cosinor analysis. A P<0.05 was considered statistically significant. There were 10,350 cases of SCFE with an overall peak presentation in mid August. For those living at a latitude of >35-degree N there was single peak, a less prominent double peak for those 31- to 35-degree N, and no variation for those <31-degree N. As the average annual temperature increased there was less seasonal variability. Humid, temperate and cold winter climates demonstrated seasonal variation, whereas other climate types did not. Those living in areas having <2500 hours of sunlight per year demonstrated seasonal variation. Further, areas having a photovoltaic solar production potential <5.0 kWh/m/d also demonstrated seasonal variation. We discovered new seasonal variation findings regarding SCFE. These are a double peak pattern for those between 31- and 35-degree N latitude; less variability as the average annual temperature increases; and sunlight exposure correlates with seasonal variability

  9. Acetabular cartilage and labral damage observed during surgical hip dislocation for stable slipped capital femoral epiphysis.

    PubMed

    Sink, Ernest L; Zaltz, Ira; Heare, Travis; Dayton, Michael

    2010-01-01

    Surgical hip dislocation allows the surgeon full visualization of the proximal femur and acetabulum. It also makes it possible to directly observe the pathologic relationship between the proximal femur and acetabular rim with hip motion. The purpose of this study is to classify acetabular cartilage and labral damage that is present at the time of surgical hip dislocation for the treatment of symptomatic stable slipped capital femoral epiphysis (SCFE) hips. A retrospective study was performed at 2 North American centers on patients with a stable SCFE who had a surgical hip dislocation for chronic symptoms. The severity of SCFE (slip angle) was measured as mild (0-30 degrees), moderate (30-60 degrees), and severe (60-90 degrees). The degree of acetabular and labral damage was classified in each patient according to the Beck classification used for femoroacetabular impingement. Thirty-nine hips in 36 patients that underwent open surgical dislocation for diagnosis of stable SCFE were included. The breakdown of the radiographic severity of the SCFE was 8 mild, 20 moderate, and 11 severe. Labral injury was observed in 34 of 39 hips. Using the Beck classification for labral injury, there were 21 type 1 injuries, 9 type 2 injuries, and 4 type 3 injuries. Cartilage injury was present in 33 of 39 hips. Using Beck classification for cartilage damage, there were 6 grade 0, 5 grade 1, 10 grade 2, 4 grade 3, 10 grade 4, and 4 grade 5 injuries. The average depth of cartilage damage was 5 mm (range, 2-10 mm). In this study, significant chondromalacia and labral injury was observed in hips afflicted with SCFE. Surgical hip dislocation allowed direct confirmation of the impingement of the prominent metaphysis on the acetabular labrum and cartilage.

  10. Development of flattening and apparent fragmentation following ischemic necrosis of the capital femoral epiphysis in a piglet model.

    PubMed

    Kim, Harry K W; Su, Phi-Huynh

    2002-08-01

    The repair response that follows ischemic necrosis of the immature femoral head and the biological processes that are responsible for the development of femoral head deformity and fragmentation have not been clearly defined. A piglet model was used to study the radiographic and histopathologic changes that occur prior to and during the development of femoral head deformity and fragmentation following ischemic necrosis. Twenty-five male piglets were studied. A nonabsorbable ligature was placed tightly around the femoral neck to disrupt the blood supply to the capital femoral epiphysis. The animals were killed three days to eight weeks following the induction of ischemia. Radiographs of whole and sectioned femoral heads were made, and the radiographic findings were correlated with the histopathologic changes observed in the specimens. Mild femoral head flattening was observed by four weeks after the induction of ischemia, and severe flattening and fragmentation were observed by eight weeks. The predominant repair response observed following revascularization was osteoclastic bone resorption. Prior to the development of flattening, a large area of osteoclastic bone resorption was observed in the central region of the femoral head. Many osteoclasts were present along the revascularization front, which we believe were responsible for active resorption of the necrotic trabecular bone. Appositional new-bone formation, the hallmark of the repair response in adult ischemic necrosis, was not observed in the area of bone resorption. Instead, the areas of resorbed bone were replaced with a fibrovascular tissue that persisted for up to eight weeks. Appositional new-bone formation was observed, but it was limited to small areas in which revascularization was not followed by osteoclastic bone resorption and in which necrotic trabecular bone was still present. The simultaneous presence of the areas of bone resorption and new-bone formation contributed to the fragmented

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

    PubMed Central

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

    2014-01-01

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

  12. Leptin Elevation as a Risk Factor for Slipped Capital Femoral Epiphysis Independent of Obesity Status.

    PubMed

    Halverson, Schuyler J; Warhoover, Tracy; Mencio, Gregory A; Lovejoy, Steven A; Martus, Jeffrey E; Schoenecker, Jonathan G

    2017-05-17

    Slipped capital femoral epiphysis (SCFE) is strongly associated with childhood obesity, yet the prevalence of obesity is orders of magnitude greater than the prevalence of SCFE. Therefore, it is hypothesized that obesity is not, by itself, a sufficient condition for SCFE, but rather one component of a multifactorial process requiring preexisting physeal pathology. Leptin elevation is seen to varying degrees in patients with obesity, and as leptin has been shown to cause physeal pathology similar to the changes seen in SCFE, we propose that leptin may be a factor distinguishing between patients with SCFE and equally obese children without hip abnormalities. Serum leptin levels were obtained from 40 patients with SCFE and 30 control patients with approximate body mass index (BMI) matching. BMI percentiles were calculated according to Centers for Disease Control and Prevention population data by patient age and sex. Patients were compared by demographic characteristics, leptin levels, odds of leptin elevation, and odds of SCFE. The odds of developing SCFE was increased by an odds ratio of 4.9 (95% confidence interval [CI], 1.31 to 18.48; p < 0.02) in patients with elevated leptin levels, regardless of obesity status, sex, and race. When grouping patients by their obesity status, non-obese patients with SCFE showed elevated median leptin levels at 5.8 ng/mL compared with non-obese controls at 1.7 ng/mL (p = 0.006). Similarly, obese patients with SCFE showed elevated median leptin levels at 17.9 ng/mL compared with equally obese controls at 10.5 ng/mL (p = 0.039). Serum leptin levels increased in association with obesity (p < 0.001), with an increase in leptin of 0.17 ng/mL (95% CI, 0.07 to 0.27 ng/mL) per BMI percentile point. To our knowledge, this study is the first to clinically demonstrate an association between elevated serum leptin levels and SCFE, regardless of BMI. This adds to existing literature suggesting that SCFE is a multifactorial process and that leptin

  13. A transepiphyseal fracture of the femoral neck in a child with 2 widely displaced Salter-Harris III fragments of the capital femoral epiphysis.

    PubMed

    Lee, Dae-Hee; Park, Jong-Woong; Lee, Soon-Hyuck

    2010-02-01

    To our knowledge, this is the first report of a transphyseal fracture of the femoral neck with a fracture of the capital femoral epiphysis involving 2 widely displaced Salter-Harris III fragments in a child. Preoperative surgical lateral radiographs of the hip of a 14-year-old boy clearly showed an anteriorly dislocated femoral head fragment. However, the overlapping ischium, soft tissue, and an anteriorly dislocated femoral head fragment caused a posteriorly dislocated fragment of the split femoral head to be overlooked on the radiographs. The emergent nature of the injury resulted in the performance of an open reduction without further imaging studies. Based on the initial evaluation, an anterior iliofemoral approach was chosen, which made it difficult to locate the posteriorly dislocated main fragment of the split femoral head. This case highlights that plain radiographs do not always provide adequate information for such injuries. Computed tomography or magnetic resonance imaging should be employed to enable accurate diagnosis and appropriate treatment for fracture-dislocations of the pediatric hip.

  14. MAGNETIC RESONANCE IMAGING FOR DIAGNOSING THE PRE-SLIP STAGE OF THE CONTRALATERAL PROXIMAL FEMORAL EPIPHYSIS IN PATIENTS WITH UNILATERAL EPIPHYSIOLYSIS

    PubMed Central

    Montenegro, Nei Botter; Junior, Victor Fruges; Grinfeld, Riccardo; Rodrigues, Marcelo Bordalo; Santos Pereira, Edgard dos; Gorios, Carlos

    2015-01-01

    To assess the importance of using conventional magnetic resonance imaging and T2 mapping to determine the pre-slip stage of the contralateral epiphysis in patients with a clinical and radiographic diagnosis of unilateral proximal femoral epiphysiolysis who were initially treated with in-situ fixation. Methods: This prospective clinical study on 11 patients with unilateral epiphysiolysis was conducted between February 2009 and August 2010, using magnetic resonance imaging on the contralateral hip. Results: We observed abnormalities in the proximal femoral capital physis of the contralateral unaffected hip, with edema under the growth plate in 27% of the patients assessed. Conclusion: Magnetic resonance imaging is an early and sensitive method for detecting the pre-slip stage of the proximal femoral epiphysis. PMID:27027035

  15. Effect of Arterial Deprivation on Growing Femoral Epiphysis: Quantitative Magnetic Resonance Imaging Using a Piglet Model

    PubMed Central

    Cheon, Jung-Eun; Kim, In-One; Kim, Woo Sun; Choi, Young Hun

    2015-01-01

    Objective To investigate the usefulness of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion MRI for the evaluation of femoral head ischemia. Materials and Methods Unilateral femoral head ischemia was induced by selective embolization of the medial circumflex femoral artery in 10 piglets. All MRIs were performed immediately (1 hour) and after embolization (1, 2, and 4 weeks). Apparent diffusion coefficients (ADCs) were calculated for the femoral head. The estimated pharmacokinetic parameters (Kep and Ve from two-compartment model) and semi-quantitative parameters including peak enhancement, time-to-peak (TTP), and contrast washout were evaluated. Results The epiphyseal ADC values of the ischemic hip decreased immediately (1 hour) after embolization. However, they increased rapidly at 1 week after embolization and remained elevated until 4 weeks after embolization. Perfusion MRI of ischemic hips showed decreased epiphyseal perfusion with decreased Kep immediately after embolization. Signal intensity-time curves showed delayed TTP with limited contrast washout immediately post-embolization. At 1-2 weeks after embolization, spontaneous reperfusion was observed in ischemic epiphyses. The change of ADC (p = 0.043) and Kep (p = 0.043) were significantly different between immediate (1 hour) after embolization and 1 week post-embolization. Conclusion Diffusion MRI and pharmacokinetic model obtained from the DCE-MRI are useful in depicting early changes of perfusion and tissue damage using the model of femoral head ischemia in skeletally immature piglets. PMID:25995692

  16. Slipped capital femoral epiphysis: is it worth the risk and cost not to offer prophylactic fixation of the contralateral hip?

    PubMed

    Clement, N D; Vats, A; Duckworth, A D; Gaston, M S; Murray, A W

    2015-10-01

    Controversy remains whether the contralateral hip should be fixed in patients presenting with unilateral slipped capital femoral epiphysis (SCFE). This retrospective study compares the outcomes and cost of those patients who had prophylactic fixation with those who did not. Between January 2000 and December 2010 a total of 50 patients underwent unilateral fixation and 36 had prophylactic fixation of the contralateral hip. There were 54 males and 32 females with a mean age of 12.3 years (9 to 16). The rate of a subsequent slip without prophylactic fixation was 46%. The risk of complications was greater, the generic health measures (Short Form-12 physical (p < 0.001) and mental (p = 0.004) summary scores) were worse. Radiographic cam lesions in patients presenting with unilateral SCFE were only seen in patients who did not have prophylactic fixation. Furthermore, prophylactic fixation of the contralateral hip was found to be a cost-effective procedure, with a cost per quality adjusted life year gained of £1431 at the time of last follow-up. Prophylactic fixation of the contralateral hip is a cost-effective operation that limits the morbidity from the complications of a further slip, and the diminished functional outcome associated with unilateral fixation. ©2015 The British Editorial Society of Bone & Joint Surgery.

  17. Radiation exposure during in-situ pinning of slipped capital femoral epiphysis hips: does the patient positioning matter?

    PubMed

    Mohammed, Riazuddin; Johnson, Karl; Bache, Ed

    2010-07-01

    Multiple radiographic images may be necessary during the standard procedure of in-situ pinning of slipped capital femoral epiphysis (SCFE) hips. This procedure can be performed with the patient positioned on a fracture table or a radiolucent table. Our study aims to look at any differences in the amount and duration of radiation exposure for in-situ pinning of SCFE performed using a traction table or a radiolucent table. Sixteen hips in thirteen patients who were pinned on radiolucent table were compared for the cumulative radiation exposure to 35 hips pinned on a fracture table in 33 patients during the same time period. Cumulative radiation dose was measured as dose area product in Gray centimeter2 and the duration of exposure was measured in minutes. Appropriate statistical tests were used to test the significance of any differences. Mean cumulative radiation dose for SCFE pinned on radiolucent table was statistically less than for those pinned on fracture table (P<0.05). The mean duration of radiation exposure on either table was not significantly different. Lateral projections may increase the radiation doses compared with anteroposterior projections because of the higher exposure parameters needed for side imaging. Our results showing decreased exposure doses on the radiolucent table are probably because of the ease of a frog leg lateral positioning obtained and thereby the ease of lateral imaging. In-situ pinning of SCFE hips on a radiolucent table has an additional advantage that the radiation dose during the procedure is significantly less than that of the procedure that is performed on a fracture table.

  18. Slipped capital femoral epiphysis and associated hypothyroidism. A review of the literature with two classic case examples.

    PubMed

    Moyer, James; Jacks, Laura; Hunter, Janel Darcy; Chan, Gilbert

    2016-04-01

    Slipped capital femoral epiphysis (SCFE) is a relatively common hip disorder often seen in overweight, peripubertal children. Although the exact etiology is uncertain, it is generally accepted that underlying endocrinopathies play a role in the pathogenesis. Hypothyroidism is the endocrine disorder cited most commonly in association with SCFE, and patients often have no history of thyroid dysfunction at the time of presentation. Despite being a well-recognized risk factor, recommendations for screening thyroid function in patients with typical presentations of SCFE have not been deemed cost-effective; however, there is data to support screening for hypothyroidism in patients with atypical presentations of SCFE or short stature. Hypothyroidism may have a significant impact on healing and bone union after surgical management of SCFE and there is a paucity of case reports in the literature describing potential peri- and postoperative complications. We performed a systematic review of the literature of all reported cases of SCFE with associated hypothyroidism using the search terms, which demonstrated a physiologic relationship between hypothyroidism and SCFE. Two case reports of SCFE in patients with hypothyroidism and associated complications are presented with the literature review. There is a physiologic relationship between thyroid dysfunction and SCFE, and we postulate that profound hypothyroidism may contribute to delayed healing or nonunion in patients undergoing operative management. We support the recommendation to screen patients with short stature, atypical presentation of SCFE, or perisistent nonunion after surgery. In cases of hypothyroidism, we recommend thyroid hormone replacement and laboratory confirmation of return to euthyroid state prior to operative intervention.

  19. Multi-scale finite element model of growth plate damage during the development of slipped capital femoral epiphysis.

    PubMed

    Farzaneh, S; Paseta, O; Gómez-Benito, M J

    2015-04-01

    Slipped capital femoral epiphysis (SCFE) is one of the most common disorders of adolescent hips. A number of works have related the development of SCFE to mechanical factors. Due to the difficulty of diagnosing SCFE in its early stages, the disorder often progresses over time, resulting in serious side effects. Therefore, the development of a tool to predict the initiation of damage in the growth plate is needed. Because the growth plate is a heterogeneous structure, to develop a precise and reliable model, it is necessary to consider this structure from both macro- and microscale perspectives. Thus, the main objective of this work is to develop a numerical multi-scale model that links damage occurring at the microscale to damage occurring at the macroscale. The use of this model enables us to predict which regions of the growth plate are at high risk of damage. First, we have independently analyzed the microscale to simulate the microstructure under shear and tensile tests to calibrate the damage model. Second, we have employed the model to simulate damage occurring in standardized healthy and affected femurs during the heel-strike stage of stair climbing. Our results indicate that on the macroscale, damage is concentrated in the medial region of the growth plate in both healthy and affected femurs. Furthermore, damage to the affected femur is greater than damage to the healthy femur from both the micro- and macrostandpoints. Maximal damage is observed in territorial matrices. Furthermore, simulations illustrate that little damage occurs in the reserve zone. These findings are consistent with previous findings reported in well-known experimental works.

  20. Idiopathic Cam Morphology Is Not Caused by Subclinical Slipped Capital Femoral Epiphysis: An MRI and CT Study.

    PubMed

    Monazzam, Shafagh; Bomar, James D; Pennock, Andrew T

    2013-12-01

    Cam impingement as a known sequelae of slipped capital femoral epiphysis (SCFE) has led to speculation that subclinical SCFEs may be the causative factor in idiopathic cam morphology; alternatively, others have implicated an abnormal extension of the growth plate as a causative factor. To investigate the growth plate tilt angle in 4 patient cohorts: normal patients, patients with idiopathic cam morphology (CamIP), patients with cam morphology secondary to known SCFE (CamSCFE), and patients with incidental findings of an asymptomatic cam (Camasymp). Case-control study; Level of evidence, 3. A database of 192 computed tomography scans of abdomens/pelvises of patients (ages, 5-19 years) with no known orthopaedic issues, reformatted to neutral tilt, inclination, and rotation, were utilized for the normal cohort, the Camasymp cohort, and to create an age- and sex-matched control cohort. In addition, a retrospective review of all patients treated for femoroacetabular impingement (FAI) with preoperative advance imaging was conducted, and patients were separated to CamIP and CamSCFE cohorts. The alpha angle and tilt angle were measured on each hip. Statistical analysis was performed. The mean tilt angle among the normal patients was 12.1°, with 1.9% of the variation in tilt angle being explained by age; each additional year of age decreased the tilt angle by 0.27° (P = .008). The tilt angle for the CamSCFE cohort (mean, 44.5°) was found to be significantly greater than both the CamIP cohort (mean, 5.9°; P < .001) and the control cohort (mean, 12.8°; P < .001). The tilt angle for the CamIP cohort was found to be significantly less than the control cohort (P = .003). The alpha angle and tilt angle were positively correlated in the CamIP cohort, but no correlation was found in the other cohorts. The mean tilt angle of the 18 hips in the Camasymp cohort was 13.9° ± 11.5° (range, -12° to 37°), with 12 hips (67%) in the tilt angle range of CamIP cohort and 6 in the

  1. Calcaneal Scoring as an Adjunct to Modified Oxford Hip Scores: Prediction of Contralateral Slipped Capital Femoral Epiphysis.

    PubMed

    Nicholson, Allen D; Huez, Coridon M; Sanders, James O; Liu, Raymond W; Cooperman, Daniel R

    2016-03-01

    In 2 recent studies, modified Oxford hip scores of 16 through 18 have been shown to predict an extremely high risk of contralateral slipping in unilateral slipped capital femoral epiphysis (SCFE). However, the modified Oxford system is not widely used. This may be due, in part, to the complexity of the scoring system, difficulty in viewing all 5 radiographic features on a single x-ray and phenotypic variation in the features. Ossification of the calcaneal apophysis provides an osteologic marker of skeletal maturation in relation to peak height velocity and has been described previously. We examine the value of the calcaneal apophyseal ossification sequence for predicting modified Oxford hip scores. We examined 279 pelvis and matching foot x-rays that were taken at the same session from 94 healthy children aged 3 to 18 years. A fellowship-trained pediatric orthopaedist determined the modified Oxford hip score for each hip radiograph. The calcaneal x-rays had been previously graded. Modified Oxford hip scores were compared with calcaneal scores for each set of matched hip and calcaneal x-rays. Stage 0 to 2 calcanei had 94% of corresponding hip radiographs rated as modified Oxford scores of 16 to 18. Stage 3 calcanei had 54% rated as 16 to 18 and 31% rated as scores 19 to 21. Stage 4 calcanei had 31% rated as scores 19 to 21, and 68% rated as scores 22 to 26. Stage 5 calcanei had 100% rated as 22 to 26. Using data from Popejoy and colleagues' study, the weighted risk of contralateral SCFE was 94% for calcaneal stage 0, 86.5% for calcaneal stage 1, 90.3% for calcaneal stage 2, 55.8% for calcaneal stage 3, 6.1% for calcaneal stage 4, and 0 for calcaneal stage 5. Calcaneal stages 0 to 3 correspond entirely to modified Oxford scores indicating elevated risk of contralateral SCFE. The calcaneal scoring system has potential for adjunctive use with the modified Oxford score for prediction of contralateral SCFE.

  2. Femoral and Tibial Tunnel Widening following Anterior Cruciate Ligament Reconstruction using Various Modalities of Fixation: A Prospective Observational Study

    PubMed Central

    Kanthila, Mahesha; Saya, Rama Prakasha; Vidyasagar, JVS

    2016-01-01

    Introduction Bone tunnel enlargement after Anterior Cruciate Ligament Reconstruction (ACL-R) is a well-accepted phenomenon but there are very few published data comparing the extent of tunnel widening by various methods of fixation after ACL-R. Aim To compare the femoral and tibial tunnel widening following ACL-R with different methods of fixation using CT scan. Materials and Methods This one year prospective study included all patients with chronic Anterior Cruciate Ligament (ACL) injury who underwent primary arthroscopic ACL-R using tripled hamstring tendon autograft. The graft was fixed to the tibial tunnel by Interference Screw (IFS) or Suture Disc (SD) and to the femoral tunnel by IFS, SD, Cross-Pin (CP) or Endo-button CL (Smith & Nephew). The widening of the tibial and femoral tunnels in different methods of fixation was assessed by Computed Tomography (CT) at 12 months follow-up; and was compared using paired sample test. Results A total of 63 patients were included in the study of which 58 (92%) were males and 5 (8%) were females, with a mean age of 29.1 ± 5.9 years. The tibial tunnel widening at one year follow-up was 1.680 ± 1.08794 (19.37%) and 1.517 ± 0.94834 mm (17.39%) by IFS and SD methods respectively. Femoral tunnel widening at one year follow-up was 1.294 ± 0.231, 1.809 ± 0.912, 1.320 ± 0.238, 1.779 ± 0.889 mm by IFS, SD, EB, and CP methods respectively. Femoral tunnel widening following suture disc method of fixation was very highly significant (p<0.001) in comparison with other methods. Conclusion Femoral tunnel and tibial tunnel widening varies with different methods of fixation and was maximum with suture disc method compared to others at one year follow-up after ACL-R. PMID:28050456

  3. Slipped Capital Femoral Epiphysis

    MedlinePlus

    ... Birth Control Family HealthInfants and Toddlers Kids and Teens Pregnancy and Childbirth Women Men SeniorsIn The NewsYour Health ... Birth Control Family HealthInfants and Toddlers Kids and Teens Pregnancy and Childbirth Women Men SeniorsIn The NewsYour Health ...

  4. Salter-Harris Type III and Type IV Combined Fracture of the Distal Femoral Epiphysis: A Case Report

    PubMed Central

    Aydin, Ali; Topal, Murat; Tuncer, Kutsi; Şenocak, Eyüp

    2012-01-01

    Distal femoral physeal fractures are not common but have a high rate of complications. They generally follow one of the patterns described in the Salter-Harris classification. We present a case of combination of Salter-Harris type III and type IV injury. Our case was a 15-year-old boy who had a motor vehicle accident. There was swelling, ecchymosis, severe pain, and valgus deformity, because of medial proximal fracture fragment, on the left knee. We deemed that Salter-Harris type III and type IV combination fracture in our case has not been previously reported. We prepared this paper in consideration of its contribution to the literature. PMID:22666265

  5. Salter-Harris Type III and Type IV Combined Fracture of the Distal Femoral Epiphysis: A Case Report.

    PubMed

    Aydin, Ali; Topal, Murat; Tuncer, Kutsi; Senocak, Eyüp

    2012-01-01

    Distal femoral physeal fractures are not common but have a high rate of complications. They generally follow one of the patterns described in the Salter-Harris classification. We present a case of combination of Salter-Harris type III and type IV injury. Our case was a 15-year-old boy who had a motor vehicle accident. There was swelling, ecchymosis, severe pain, and valgus deformity, because of medial proximal fracture fragment, on the left knee. We deemed that Salter-Harris type III and type IV combination fracture in our case has not been previously reported. We prepared this paper in consideration of its contribution to the literature.

  6. Hip shape and long-term hip function: a study of patients with in-situ fixation for slipped capital femoral epiphysis.

    PubMed

    Wall, Peter D H; Brown, Jamie S; Freshney, Sara; Parsons, Helen; Griffin, Damian R

    2013-01-01

    Slipped capital femoral epiphysis (SCFE) is a rare adolescent hip disease that leads to a hip shape abnormality. Typical treatment involves in-situ fixation. It is not known if the degree of initial hip shape abnormality associated with SCFE has a significant effect on long-term hip function. A cohort of patients aged 18-50 who had undergone in-situ fixation for SCFE from 1970 onwards in our institution provided IHOT-33 (hip function) outcome data. Frog lateral radiographs from the time of surgery were used to measure radiological hip shape using both Southwick angle and alpha angle. There were 38 patients (46 hips) SCFE patients who met the eligibility criteria. We obtained follow-up data for 32 patients (38 hips), 83% follow-up. Ten patients (20 hips) had bilateral SCFE. The mean follow-up was 12.7 years (95% CI 10.7-14.7). 32 patients matched for age and sex who had no history of SCFE provided control IHOT-33 outcome data. There was a significant difference (p<0.05) in long-term hip function between patients undergoing in-situ fixation for SCFE and the control population (mean IHOT-33 scores of 71.8 and 95.8 respectively). There was no significant (p>0.05) correlation between long-term hip function and Southwick angle or lateral alpha angle. The initial severity of hip shape abnormality due to SCFE was not a strong predictor of long-term hip function. Other extraneous factors not related to hip shape may have an equally if not more important role to play in the subsequent long-term outcome of SCFE.

  7. Comparative study of technique to obtain stem cells from bone marrow collection between the iliac crest and the femoral epiphysis in rabbits.

    PubMed

    Eça, Lilian Piñero; Ramalho, Renata Belmonte; Oliveira, Isis Sousa; Gomes, Paulo Oliveira; Pontes, Paulo; Ferreira, Alice Teixeira; Mazzetti, Marcelo Paulo Vaccari

    2009-01-01

    To assess the technique for the collection of rabbit bone marrow stem cells from different regions to be used as an experimental model in regenerative medicine. Thirty rabbits were allocated into 2 groups: GROUP A, n=8, animals that underwent bone marrow blood (BMB) harvesting from the iliac crest; and including 22 rabbits that underwent BMB harvesting from the femur epiphysis. After harvesting, mononuclear cells were isolated by density gradient centrifugation (Ficoll - Histopaque). The number of mononuclear cells per ml was counted in a Neubauer chamber and cell viability was checked through Tripan Blue method. Harvesting from the iliac crest yielded an average of 1 ml of BMB and 3,6.10(6) cells/ml over 1 hour of surgery, whereas an average of 3ml of BMB and 11,79.10(6) cells./ml were obtained in 30 min from the femur epiphysis with a reduced animal death rate. The analysis for the obtention of a larger number of mononuclear cells/ml from rabbit bone marrow blood was more satisfactory in the femur epiphysis than in the iliac crest.

  8. The effect of femoral tunnel widening on one-year clinical outcome after anterior cruciate ligament reconstruction using ZipLoop® technology for fixation in the cortical bone of the femur.

    PubMed

    Basson, Benjamin; Philippot, Rémi; Neri, Thomas; Meucci, Jean François; Boyer, Bertrand; Farizon, Frédéric

    2016-03-01

    The effect of femoral tunnel widening on clinical outcomes of anterior cruciate ligament (ACL) reconstruction has been rarely investigated. In this study, ACL reconstructions were performed using semitendinosus and gracilis (STG) tendon grafts and single cortical fixation on the femoral side. The aim was to analyze femoral tunnel widening at one year and to evaluate its effect on clinical and laximetric outcomes. A total of 46 patients were enrolled in this prospective continuous single-operator monocenter study. Clinical protocol included pre-operative and one-year evaluation with subjective and objective International Knee Documentation Committee (IKDC) clinical scores. Computed tomography (CT) scan was used for radiographic examination during the follow-up period. The femoral tunnel widening was measured as a three-dimensional (3D) image using OsiriX software. The cross-sectional area of each tunnel was measured at four different locations. The subjective preoperative IKDC score was 50 and one-year postoperative score was 81.8. The side-to-side difference in knee laxity decreased from 2.94 to 0.74 mm. The objective IKDC score during the final follow-up was rated A in 27 patients and B in 17. CT scan data revealed an average of 49.32% cone-shaped widening of the femoral tunnel. Femoral tunnel widening at the level of the joint (F4) was negatively correlated with the IKDC subjective score at one year. This study revealed a significant widening of the femoral tunnel by demonstrating its conical shape at one year post-surgery. A significant correlation could be established between femoral tunnel widening close to the joint and IKDC scores. Copyright © 2015 Elsevier B.V. All rights reserved.

  9. Widening Participation; Widening Capability

    ERIC Educational Resources Information Center

    Walker, Melanie

    2008-01-01

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

  10. Widening Participation; Widening Capability

    ERIC Educational Resources Information Center

    Walker, Melanie

    2008-01-01

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

  11. Osteochondritis of the Distal Tibial Epiphysis

    PubMed Central

    EL Hajj, Firass; Sebaaly, Amer; Kharrat, Khalil; Ghanem, Ismat

    2012-01-01

    Osteochondritis of the distal tibial epiphysis is a very rare entity. 9 cases have been described in 7 articles and 8 other cases have been mentioned in textbooks. This paper describes the 10th case of osteochondritis of the distal tibial epiphysis and summarizes the clinical and radiological presentations of the 9 other cases. The etiology of this entity is well debated in the literature. We believe that it results from a vascular abnormality in the distal tibial epiphysis associated with a mechanical stress (trauma, excessive overload, etc.). Since it is a self-limited disease, the prognosis is good and the younger the patient is the better the prognosis will be. In general, this entity responds well to conservative treatment. PMID:23193412

  12. Proximal Tibial Epiphysis Injury (Flexion Type, Salter-Harris Type 1).

    PubMed

    Israni, Pratik; Panat, Mangesh

    2016-01-01

    Fractures of the proximal tibial epiphysis rare. It has been estimated that fractures of the upper tibial epiphysis account for 0.5-3.1% of all epiphyseal injuries. Who had no neurovascular deficit, with fixed extension deformity at the left knee was treated early with closed reduction techniques. We present a case of a 16-year-old boy who while playing cricket on the road was hit by a car. The patient presented in emergency room with extremely swollen knee and soft tissue swelling (hemarthrosis), he was unable to lift his leg actively due to severe pain because of hamstrings spasm, and he had no wound over his left knee and had no other associated injuries. Plain radiographs were taken which revealed, separated proximal tibial epiphysis (salter harris Type 1 injury) The epiphysis was anteriorly displaced fracture line extending beyond growth plate through metaphysis and tibial tuberosity also displaced anteriorly, the proximal fibular epiphysis fragment was displaced anteriorly with no injury to femoral epiphysis and no patellar fracture, radiograph also revealed no intra-articular fracture as joint appears congruent. Under spinal anesthesia, under all aseptic precautions traction was applied for few minutes, the fracture was reduced closed as the hamstring spasm gave way, reduction was confirmed under image intensifier in both AP and lateral planes, and joint congruity was examined. Proximal fibular epiphysis also snapped back in place. Post-operative patient was immobilized with nil weight bearing for 4 weeks, check X-rays taken, he was mobilized in wheelchair. After 4 weeks slab was removed, K-wires were removed, and partial weight bearing was started with rehabilitation for full range of motion of the left knee. At 6 weeks, both the knee joints appeared symmetrical with no abnormalities or limb length discrepancy or instability with knee from 0° to 140°, with full weight bearing. Although less commonly seen, Salter-Harris Type 1 injuries to proximal tibial

  13. Proximal Tibial Epiphysis Injury (Flexion Type, Salter–Harris Type 1)

    PubMed Central

    Israni, Pratik; Panat, Mangesh

    2016-01-01

    Introduction: Fractures of the proximal tibial epiphysis rare. It has been estimated that fractures of the upper tibial epiphysis account for 0.5-3.1% of all epiphyseal injuries. Who had no neurovascular deficit, with fixed extension deformity at the left knee was treated early with closed reduction techniques. Case Report: We present a case of a 16-year-old boy who while playing cricket on the road was hit by a car. The patient presented in emergency room with extremely swollen knee and soft tissue swelling (hemarthrosis), he was unable to lift his leg actively due to severe pain because of hamstrings spasm, and he had no wound over his left knee and had no other associated injuries. Plain radiographs were taken which revealed, separated proximal tibial epiphysis (salter harris Type 1 injury) The epiphysis was anteriorly displaced fracture line extending beyond growth plate through metaphysis and tibial tuberosity also displaced anteriorly, the proximal fibular epiphysis fragment was displaced anteriorly with no injury to femoral epiphysis and no patellar fracture, radiograph also revealed no intra-articular fracture as joint appears congruent. Under spinal anesthesia, under all aseptic precautions traction was applied for few minutes, the fracture was reduced closed as the hamstring spasm gave way, reduction was confirmed under image intensifier in both AP and lateral planes, and joint congruity was examined. Proximal fibular epiphysis also snapped back in place. Post-operative patient was immobilized with nil weight bearing for 4 weeks, check X-rays taken, he was mobilized in wheelchair. After 4 weeks slab was removed, K-wires were removed, and partial weight bearing was started with rehabilitation for full range of motion of the left knee. At 6 weeks, both the knee joints appeared symmetrical with no abnormalities or limb length discrepancy or instability with knee from 0° to 140°, with full weight bearing. Conclusion: Although less commonly seen, Salter

  14. Widening Participation: What Works?

    ERIC Educational Resources Information Center

    Gorard, Stephen

    2007-01-01

    In this brief article, the author talks about what--other than money--works to widen higher education (HE) participation for adult learners. He also discusses the problems in trying to discover what works to widen participation for adults. One problem is that the decision to participate in any formal learning episode, including HE, is not a simple…

  15. [Treatment of beginning juvenile detachment of the femoral head, taking growth of the femoral neck into account (author's transl)].

    PubMed

    Engelhardt, P

    1979-10-01

    Prevention of further detachment is the primary aim in the immediate treatment of beginning juvenile detachment of the femoral head. Screwing of the epiphysis of the head, first introduced by M. E. Mueller (1965), has proved successful. Besides providing immediate mechanical stability, this method, however, results in premature ossification of the joint of the femoral neck. Epiphysiodesis has a particularly unfavourable effect in early childhood, because it inhibits proper growth of the leg and development of the mechanism of the hip joint on account of the shortened femoral neck. Spiking of the epiphysis with Krischner screw wires guarantees safe fixation of the epiphyseal head on the one hand, and sufficient freedom of femoral neck growth on the other. Surgical treatment requires knowledge of the changed hip joint anatomy of the child. Preoperative planning via drawing to determine the length and position of the implantate on the basis of standardised x-ray films, will help to prevent operative failures.

  16. Fractures of the proximal humeral epiphysis.

    PubMed

    Burgos-Flores, J; Gonzalez-Herranz, P; Lopez-Mondejar, J A; Ocete-Guzman, J G; Amaya-Alarcón, S

    1993-01-01

    Twenty-two patients with marked displacement of a fracture of the proximal humeral epiphysis have been treated with closed or open reduction and fixation by Kirschner wires. At an average follow-up of 6.8 years there have been good functional results in almost all patients (91.1), with better results in patients under 13 years of age particularly with less residual displacement or angulation. Since there is a greater occurrence of residual deformity and symmetria and limitation of motion in older patients, a more aggressive approach to correct the initial displacement and angulation is warranted in those over the age of 13 years.

  17. Widening ERTS applications

    NASA Technical Reports Server (NTRS)

    Mercanti, E. P.

    1974-01-01

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

  18. Widening ERTS applications

    NASA Technical Reports Server (NTRS)

    Mercanti, E. P.

    1974-01-01

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

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

    PubMed

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

    2016-03-01

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

  20. Salter-Harris type III fracture of the lateral femoral condyle with a ruptured posterior cruciate ligament: an uncommon injury pattern.

    PubMed

    Rafee, Asan; Kumar, A; Shah, S V

    2007-01-01

    We report a case of an obscure injury to the distal femoral epiphysis with an uncommon pattern in a 12-year-old boy following a road traffic accident. Initial plain radiographs of the knee were inconclusive. Further investigation with magnetic resonance imaging revealed Salter-Harris type III fracture of the lateral femoral condyle with a gap at the fracture site associated with avulsion of the posterior cruciate ligament. This potentially serious injury can be underestimated on plain radiographs and therefore any suspected injury to the distal femoral epiphysis should be thoroughly assessed and investigated to institute appropriate treatment and minimise the risk of long-term complications.

  1. Correlation between fixation systems elasticity and bone tunnel widening after ACL reconstruction

    PubMed Central

    Giorgio, Nicola; Moretti, Lorenzo; Pignataro, Paolo; Carrozzo, Massimiliano; Vicenti, Giovanni; Moretti, Biagio

    2016-01-01

    Summary Background Femoral and tibial tunnel widening (TW) after ACL reconstruction is a phenomenon increasing talk in the literature. It is underlying biological and mechanical causes. Objective The aim of this study was to evaluate the relationship between bone tunnel enlargement and two different ACL fixation systems. Patients and Methods 40 patient underwent ACL reconstruction with hamstring; randomly divided into group A with 20 patients treated with stiff systems (femoral Rigidfix and tibial interference screw), and into group B, with 20 patients treated with morel elastic system (femoral and tibial Tight-rope). Evaluated postoperatively with knee MRI at 40 days, 3 months, 6 months to measure bone tunnel diameters widening. Results At 40 days tunnel widening between two groups shows no statistically difference. At 3 months postoperatively, femoral bone tunnel widening amounted on average to 1.84 mm in middle of tunnel and 1 mm at the mouth in joint in group A, and respectively 3.2 mm and 2.5 mm in group B (p<0.05). Tibial tunnel widening was 1.24 mm at the mouth in joint and 1.3 mm in middle in group A and respectively 2.26 mm and 2.43 mm in group B (p<0.05). At 6 months femoral tunnel widening amounted on average to 2.45 mm in middle and 1.35 mm at the mouth in joint in group A and respectively 3.5 mm and 2.7 mm in group B (p<0.01). Tibial tunnel widening amounted on average to 1.27 at mouth in joint and 1 mm in middle of tunnel in group A and respectively 2.6 mm and 2.3 mm in group B (p<0.01). Conclusions This study results suggest elastic fixation system increases bone tunnel enlargement after ACL reconstruction with hamstring without correlation with worse clinical performance. Level of evidence IV. PMID:28217568

  2. Fibrous Dysplasia in the Epiphysis of the Distal Femur

    PubMed Central

    Noh, Jung Ho; Lee, Jae Woo

    2017-01-01

    Fibrous dysplasia is a common benign skeletal lesion that may involve a single bone or multiple bones. Although fibrous dysplasia can affect any bone, monostotic fibrous dysplasia of the long bone typically occurs in the diaphysis or metaphysis. We report a very rare case of monostotic fibrous dysplasia involving the epiphysis of the distal femur in a young man. PMID:28231652

  3. Increased lateral tibial posterior slope is related to tibial tunnel widening after primary ACL reconstruction.

    PubMed

    Sabzevari, Soheil; Rahnemai-Azar, Amir Ata; Shaikh, Humza S; Arner, Justin W; Irrgang, James J; Fu, Freddie H

    2017-03-04

    The purpose of the study was to determine the influence of femoral and tibial bone morphology on the amount of femoral and tibial tunnel widening after primary anatomic ACL reconstruction. It was hypothesized that tibial and femoral bone morphology would be significantly correlated with tunnel widening after anatomic ACL reconstruction. Forty-nine consecutive patients (mean age 21.8 ± 8.1 years) who underwent primary single-bundle anatomic ACL reconstruction with hamstring autograft were enrolled. Two blinded observers measured the bone morphology of tibia and femur including, medial and lateral tibial posterior slope, medial and lateral tibial plateau width, medial and lateral femoral condyle width, femoral notch width, and bicondylar width on preoperative magnetic resonance imaging (MRI) scans. Tibial and femoral tunnel width at three points (aperture, mid-section, and exit) were measured on standard anteroposterior radiograph from 1 week and 1 year postoperatively (mean 12.5 ± 2 months). Tunnel width measurements at each point were compared between 1 week and 1 year to calculate percent of tunnel widening over time. Multivariable linear regression was used to analyze correlations between bone morphology and tunnel widening. Increase in lateral tibial posterior slope was the only independent bony morphology characteristics that was significantly correlated with an increased tibial tunnel exit widening (R = 0.58). For every degree increase in lateral tibial posterior slope, a 3.2% increase in tibial tunnel exit width was predicted (p = 0.003). Excellent inter-observer and intra-observer reliability were determined for the measurements (ICC = 0.91 and 0.88, respectively). Increased lateral tibial posterior slope is an important preoperative anatomic factor that may predict tunnel widening at the tibial tunnel exit. In regard to clinical relevance, the results of this study suggest that lateral tibial posterior slope be measured

  4. Dynamic displacement of the femoral head by hamstring stretching in children with cerebral palsy.

    PubMed

    Chang, Chia Hsieh; Chen, Yu Ying; Wang, Chao Jan; Lee, Zhon Liau; Kao, Hsuan-Kai; Kuo, Ken N

    2010-01-01

    Hamstring stretching is an integral component in the treatment for knee flexion contracture in cerebral palsy (CP). As hamstrings span across hip and knee joints, passive stretching of hamstrings applies force to the hip that is often dysplasia in CP. The purpose of this study is to measure the dynamic displacement of femoral head produced by passive stretching of hamstrings and to determine the factors associated with the phenomenon. Children with spastic CP were studied using computerized tomography (CT) of the pelvis. Two sets of CT studies were carried out, one with the knee flexed and the hip flexed (resting) and the other with the knee extended and the hip flexed to simulate manual hamstrings stretching. The distance from pelvic baseline to the posterior margin of femoral epiphysis was measured on the CT images and compared between resting and stretching for dynamic displacement. The dynamic displacement of the femoral head was expressed by a ratio to femoral epiphysis diameter. Twenty-seven CP children had CT studies at a mean age of 6.8 years (range: 4.5 to 9.6 y). Ten children were ambulators with or without devices and the other 17 children were nonambulators. On plain radiographs of the pelvis, the mean Reimer's migration percentage was 39% (range: 13% to 92%). On CT scan, dynamic displacement by stretching was 4.7% (range: -3.8% to 16.1%) of femoral epiphysis diameter (P<0.001 by paired t test). The displacement in the 33 hips with migration percentage of greater than 30% was significantly greater than the displacement in the other 21 hips with migration percentage of less than 30% (7.4% vs. 0.5%, P=0.001). Passive stretching of spastic hamstrings in the hip flexion position resulted in dynamic posterior displacement of the femoral head. Medical professionals should be aware of this fact, especially in spastic CP children with a higher migration percentage on radiograph. Diagnostic II.

  5. Vascularized Fibular Grafting for Osteonecrosis of the Femoral Head With Unusual Indications

    PubMed Central

    Urbaniak, James R.

    2008-01-01

    We retrospectively reviewed the charts of 154 patients of various subgroups treated with the free vascularized fibular graft procedure for osteonecrosis of the femoral head (ONFH), evaluating pre- and postoperative Harris hip scores, hip range of motion, radiographs, and number of conversions to total hip arthroplasty (THA). Patients were followed a minimum of 1 year (mean, 6.8 years, range, 1 to 19 years). Athletes and patients with pyarthrosis-related osteonecrosis had high Harris hip scores at final review with scores of 94 and 97, respectively. Patients with ONFH after a slipped capital femoral epiphysis or following pregnancy had a low conversion rate to THA at 6% and 8%, respectively. Twenty-five percent of patients with transplant-related osteonecrosis of the femoral head were converted to THA at an average of 2.7 years. However, with select subsets of patients (athletes, pregnancy, organ transplant, femoral neck non-union, slipped capital femoral epiphysis, infection) the FVFG can result in a high rate of success. Level of Evidence: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence. PMID:18357495

  6. Microvascular features and ossification process in the femoral head of growing rats

    PubMed Central

    MORINI, SERGIO; PANNARALE, LUIGI; FRANCHITTO, ANTONIO; DONATI, SAARA; GAUDIO, EUGENIO

    1999-01-01

    In the epiphysis of long bones, different patterns of development of ossification processes have been described in different species. The development of the vascularisation of the femoral head has not yet been fully clarified, although its role in the ossification process is obvious. Our aim was to investigate ossification and vascular proliferation and their relationship, in growing rat femoral heads. Male Wistar rats aged ∼ 1, 5 and 8 wk and 4, 8 and 12 mo were used. Light microscopy frontal sections and vascular corrosion casts observed by scanning electron microscopy were employed. In the rat proximal femoral epiphysis, ossification develops from the medullary circulation of the diaphysis, quickly extending to the neck and the base of the head. Hypertrophic chondrocytes occupy the epiphyseal cartilage, and a physeal plate with regular cell columns is present. Starting from about the end of the third month one or more points of fibrovascular outgrowth, above the physeal line, can be observed in each sample. They are often placed centrally or, sometimes, peripherally. The fibrovascular outgrowths penetrate deeply into the cartilage and extend laterally. At age 8 mo, large fibro-osseous peduncles connect the epiphysis to the diaphyseal tissue. At 12 mo, the entire epiphysis appears calcified with an almost total absence of residual cartilage islands. This situation differs in man and in other mammals due both to differing thickness of the cartilage and to the presence of more extensive sources of blood vessels other than the diaphyseal microcirculation, as supplied by the teres ligament and Hunter's circle. In young rats, subchondral vessels and the synovial fluid could play a role in feeding the ossifying cartilage. Later, a loss of resistance of the physis due to marked degeneration of the cell columns, and extensive chondrocyte hypertrophy permit fibrovascular penetration starting from diaphyseal vessels rather than neighbouring vascular territories, such as

  7. Femoral nerve dysfunction

    MedlinePlus

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

  8. The Utility of the Proximal Epiphysis of the Fifth Metatarsal in Age Estimation

    PubMed Central

    Davies, Catriona M; Hackman, Lucina; Black, Sue

    2013-01-01

    Abstract Radiographs of 277 living individuals were assessed via a numerical scoring system to determine the timing of appearance and degree of fusion between the proximal epiphysis of the fifth metatarsal and its diaphysis. The epiphysis was observed to first appear in females at 8 years and 10 years in males and fuse by 14 years in females and 15 years in males. When assessing the level of agreement of category assignment, inter-observer agreement was 78% for females and 64% for males whereas intra-observer agreement was 77% for females and 86.1% for males. These results suggest that the maturation of the proximal epiphysis of the fifth metatarsal may be of value in age estimation in the child and that the scoring system is sufficiently robust to merit continued investigation. Previously this epiphysis has been considered an inconstant feature, but this research confirmed its presence in all individuals studied. PMID:23425260

  9. Clinical teaching: widening the definition.

    PubMed

    Thampy, Harish; Agius, Steven; Allery, Lynne

    2014-06-01

    In all medical specialities, trainees are increasingly encouraged to develop teaching skills alongside their clinical professional development. However, there have been few empirical UK-based studies that have examined trainees' attitudes and understanding of their own engagement with educational activities. This study therefore aimed to explore this in the context of general practitioner (GP) training using a qualitative approach. Twenty GP registrars from the North Western Deanery were recruited to four focus groups. The data obtained using a semi-structured topic guide were analysed for thematic content, and the rigour of this methodology was increased by peer checking of the coding. Participation was voluntary and ethical approval was obtained. The majority of registrars interviewed initially presumed that teaching role development was only in relation to educating those junior to them, and thus followed a vertical hierarchical structure; however, during focus group discussions, the registrars started to recognise a range of other teaching modalities that they had not previously noted. These included peer-to-peer teaching sessions, examination preparation groups and, indeed, the everyday education of patients during consultations. Although this study has been conducted in the context of GP training, it is plausible to suggest that skewed perceptions from trainees as to what constitutes teaching may indeed exist in other speciality training schemes. There is therefore a need to shift current thinking around teaching engagement away from the traditional senior-junior relationship, and instead widen the definition of what it means to be involved in teaching activities. © 2014 John Wiley & Sons Ltd.

  10. Correlation of ultrasound appearance, gross anatomy, and histology of the femoral nerve at the femoral triangle.

    PubMed

    Lonchena, Tiffany K; McFadden, Kathryn; Orebaugh, Steven L

    2016-01-01

    Correlation between ultrasound appearance, gross anatomic characteristics, and histologic structure of the femoral nerve (FN) is lacking. Utilizing cadavers, we sought to characterize the anatomy of the FN, and provide a quantitative measure of its branching. We hypothesize that at the femoral crease, the FN exists as a group of nerve branches, rather than a single nerve structure, and secondarily, that this transition into many branches is apparent on ultrasonography. Nineteen preserved cadavers were investigated. Ultrasonography was sufficient to evaluate the femoral nerve in nine specimens; gross dissection was utilized in all 19. Anatomic characteristics were recorded, including distances from the inguinal ligament to femoral crease, first nerve branch, and complete arborization of the nerve. The nerves from nine specimens were excised for histologic analysis. On ultrasound, the nerve became more flattened, widened, and less discrete as it coursed distally. Branching of the nerve was apparent in 12 of 18 images, with mean distance from inguinal ligament of 3.9 (1.0) cm. However, upon dissection, major branching of the femoral nerve occurred at 3.1 (1.0) cm distal to the inguinal ligament, well proximal to the femoral crease. Histologic analysis was consistent with findings at dissection. The femoral nerve arborizes into multiple branches between the inguinal ligament and the femoral crease. Initial branching is often high in the femoral triangle. As hypothesized, the FN exists as a closely associated group of nerve branches at the level of the femoral crease; however, the termination of the nerve into multiple branches is not consistently apparent on ultrasonography.

  11. Cloud Technology May Widen Genomic Bottleneck - TCGA

    Cancer.gov

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

  12. Ultrasound diagnosis of fracture-separation of the distal humeral chondro-epiphysis: a rare but important condition that a radiologist must not miss.

    PubMed

    Chu, Wai Pong

    2012-10-01

    Fracture-separation of the distal humeral epiphysis is a rare condition known to be associated with non-accidental injury. Ultrasound is useful in diagnosis of this important disease entity with the humeral epiphysis not yet ossified.

  13. Effect of pathological fracture on limb salvage surgery with preservation of the epiphysis in children with osteosarcoma of the distal femur: Two case reports.

    PubMed

    Zheng, Kai; Yu, Xiuchun; Chang, Zhengqi; Xu, Songfeng; Xu, Ming

    2016-04-01

    The outcome of limb salvage treatment for femoral osteosarcoma with pathological fractures in children is currently unknown. The aim of the present study was to present two cases of patients who received limb salvage surgery with preservation of the epiphysis at the Department of Orthopedics of The General Hospital of Jinan Military Commanding Region (Shandong, China). Between January, 2007 and January, 2013, two pediatric patients were admitted to our hospital with pathological fractures. One of the patients was a girl, aged 11 years, with confirmed osteosarcoma of the right distal femur; the other patient was a boy, aged 9 years, with osteosarcoma of the left distal femur. After receiving two cycles of neoadjuvant chemotherapy following tumor biopsy, the patients received limb salvage surgery with epiphyseal preservation, with wide resection of the tumor and biological reconstruction by allogeneic bone and fibular autograft, followed by 10 cycles of adjuvant chemotherapy. With a mean follow-up of 64 months, there were no postoperative complications, local recurrence or metastasis. The limb function recovered well, although limb shortening was observed. The female patient underwent a second fixation and limb lengthening after epiphyseal closure. Therefore, with effective neoadjuvant chemotherapy, limb salvage surgery with epiphyseal preservation is not contraindicated for pediatric patients with pathological fractures from femoral osteosarcoma. Biological reconstruction by allogeneic bone and vascularized fibular autograft following wide tumor resection is a viable option for such patients, with a good postoperative functional outcome.

  14. Widening Participation: A Post-War Scorecard

    ERIC Educational Resources Information Center

    Tight, Malcolm

    2012-01-01

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

  15. Widening Participation: A Post-War Scorecard

    ERIC Educational Resources Information Center

    Tight, Malcolm

    2012-01-01

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

  16. The utility of the proximal epiphysis of the fifth metatarsal in age estimation.

    PubMed

    Davies, Catriona M; Hackman, Lucina; Black, Sue

    2013-03-01

    Radiographs of 277 living individuals were assessed via a numerical scoring system to determine the timing of appearance and degree of fusion between the proximal epiphysis of the fifth metatarsal and its diaphysis. The epiphysis was observed to first appear in females at 8 years and 10 years in males and fuse by 14 years in females and 15 years in males. When assessing the level of agreement of category assignment, inter-observer agreement was 78% for females and 64% for males whereas intra-observer agreement was 77% for females and 86.1% for males. These results suggest that the maturation of the proximal epiphysis of the fifth metatarsal may be of value in age estimation in the child and that the scoring system is sufficiently robust to merit continued investigation. Previously this epiphysis has been considered an inconstant feature, but this research confirmed its presence in all individuals studied. © 2013 American Academy of Forensic Sciences.

  17. [Biogenic amines in the epiphysis and hypothalamus under normal conditions and following ovariectomy].

    PubMed

    Grishchenko, V I; Koliada, L D; Demidenko, D I

    1977-01-01

    Melatonin content in the epiphysis, serotonin, noradrenaline, dopamine-in the hypothalamus, gonadotropins--in the hypophysis of rats was studied under normal conditions and following ovariectomy; regularly of the estral cycle phases was studied as well. Two series of experiments were conducted on 120 rats with regular estral cycles. The animals were divided into groups according to the estral cycle phase. Melatonin concentration in the epiphysis, serotonin, noradrenaline, dopamine--in the hypothalamus was subject to variations coinciding with the estral cycle phases. Serotonin, noradrenaline, and dopamine content decreased in the hypophysis of ovariectomized rats in comparison with control; melatonin content rose in the epiphysis. There was no complete extinction of the estral cycle in the course of investigation (20 days). The action of castration on the sexual cycle depended on the phase at which the rats were subjected to ovariectomy. A reverse relationship existed between the melatonin content in the epiphysis and serotonin content in the hypothalamus, this serving as one of the important factors in the regulation of the sexual function.

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

    PubMed

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

    2005-07-05

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

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

    PubMed Central

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

    2005-01-01

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

  20. Working towards widening participation in nurse education.

    PubMed

    Young, Kate

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

  1. Transphyseal osseous bridges in experimental osteonecrosis of the femoral head of the rat. Histologic study of the bony bridges connecting the epiphyseal with the metaphyseal bony trabeculae through gaps in the physeal cartilage.

    PubMed

    Peskin, B; Shupak, A; Misselevich, I; Zinman, C; Levin, D; Jacob, Z; Reis, D N; Boss, J H

    2001-07-01

    In view of the lifelong persistence of the physis, the femoral head of rats may serve to model Perthes disease and slipped capital femoral epiphysis. To produce osteonecrosis, the blood supply of one femoral head of 133, 6-month-old animals was severed by circumferentially incising the periosteum of the neck and cutting the ligamentum teres. The rats were killed 7 days to 90 days postoperatively. Associated with resorption of the necrotic bone and marrow, remodeling of the epiphysis was characterized by an ingrowth of vascularized fibrous tissue, formation of new bone and some cartilage, architectural deformation and flattening of the head. In 22 of 83 rats killed 30 days or more postoperatively, gaps in the continuity of the physeal cartilage were occupied by osseous bridges, connecting newly formed epiphyseal bony trabeculae with either the preexisting or newly formed metaphyseal osseous trabeculae. This healing mode may follow ischemic death of physeal chondrocytes or be owing to another mechanism, e.g., release of mediatory substances of inflammation. These findings raise the possibility that fixation of the healing epiphysis of a child's previously necrotic femoral head to the metaphysis occurs by transphyseal osseous growth in cases in which the physis is involved in the necrotic process.

  2. Mandibular widening by intraoral distraction osteogenesis.

    PubMed

    Guerrero, C A; Bell, W H; Contasti, G I; Rodriguez, A M

    1997-12-01

    Transverse mandibular deficiency with crowding of the mandibular anterior teeth is frequently present in patients with Class I and II malocclusions. The hallmarks of treatment by compensating orthodontics, functional appliances or orthopaedic devices are instability, compromised periodontium and compromised facial aesthetics. A new surgical technique has been developed to widen the mandible. The method is based upon gradual osteodistraction following vertical interdental symphyseal osteotomy. Ten patients with transverse mandibular deficiency and significant dental crowding were treated by symphyseal distraction and subsequent non-extraction decompensating orthodontic treatment. Either an intraoral tooth-borne Hyrax appliance or a new custom-made bone-borne osteodistractor was used to gradually widen the mandible. The surgical procedures were accomplished under local anaesthesia and intravenous sedation in an ambulatory surgical setting using an individualized distraction protocol. The appliances were activated 7 days after symphyseal osteotomies, once each day at a rate of 1 mm per day and stabilized for 30-40 days after distraction. After the segments were distracted, non-extraction orthodontic alignment of the mandibular anterior teeth was accomplished. The symphyseal distraction gaps were bridged by new bony regenerate. Distraction osteogenesis provided an efficient surgical alternative to orthognathic surgery for widening the mandible and treatment of transverse mandibular deficiency without extraction of teeth.

  3. Femoral bowing plane adaptation to femoral anteversion

    PubMed Central

    Akman, Alp; Demirkan, Fahir; Sabir, Nuran; Oto, Murat; Yorukoglu, Cagdas; Kiter, Esat

    2017-01-01

    Background: Femoral bowing plane (FBP) is the unattended subject in the literature. More over the femoral shaft with its bowing is neglected in established anteversion determination methods. There is limited information about the relationship between FBP and anteversion. Thus we focused on this subject and hypothesized that there could be an adaptation of FBP to anteversion. Materials and Methods: FBP is determined on three-dimensional solid models derived from the left femoral computerized tomography data of 47 patients which were taken before for another reason and comparatively evaluated with anteversion. There were 20 women and 27 men. The mean age of patients was 56 years (range 21–84 years). Results: The anteversion values were found as the angle between a distal condylar axis (DCA) and femoral neck anteversion axis (FNAA) along an imaginary longitudinal femoral axis (LFA) in the true cranio-caudal view. The FBP was determined as a plane that passes through the centre-points of three pre-determinated sections on the femoral shaft. The angles between DCA, FNAA and FBP were comparatively evaluated. The independent samples t-test was used for statistical analysis. At the end, it was found that FBP lies nearly perpendicular to the anteversion axis for the mean of our sample which is around 89° in females and 93° in males (range 78–102°). On the other hand, FBP does not lie close to the sagittal femoral plane (SFP); instead, there is an average 12.5° external rotation relative to the SFP. FBP is correlated well with anteversion in terms of FBP inclination from SFP and femoral torsion (i.e., angle between FBP and femoral neck anteversion axis (P < 0.001; r = 0.680 and r = −0.682, respectively). Combined correlation is perfect (R2 = 1) as the FBP, SFP, and posterior femoral plane forms a triangle in the cranio-caudal view. Conclusions: We found that FBP adapts to anteversion. As FBP lies close to perpendicularity for the mean, femoral component positioning

  4. Femoral impaction grafting

    PubMed Central

    Scanelli, John A; Brown, Thomas E

    2013-01-01

    Femoral impaction grafting is a reconstruction option applicable to both simple and complex femoral component revisions. It is one of the preferred techniques for reconstructing large femoral defects when the isthmus is non-supportive. The available level of evidence is primarily derived from case series, which shows a mean survivorship of 90.5%, with revision or re-operation as the end-point, with an average follow-up of 11 years. The rate of femoral fracture requiring re-operation or revision of the component varies between several large case series, ranging from 2.5% to 9%, with an average of 5.4%. PMID:23362469

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

    PubMed

    Kurian, N J

    2007-10-01

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

  6. [Quantitative study of therapeutic efficacy on early intervention of hyperbaric oxygen to model of steroid-induced avascular osteonecrosis of femoral head by multi-slice perfusion imaging].

    PubMed

    Yang, Jin-cai; Pan, Zhen-yu; Gu, Hua; Li, Nan; Qian, Xiao-jun; Zhai, Ren-you; Wu, Lian-hua; Gao, Chun-jin

    2008-12-09

    To quantitatively evaluate the hemodynamic status in animal models of steroid-induced avascular osteonecrosis of femoral head (SANFH) by multislice CT (MSCT) perfusion imaging, and estimate the therapeutic efficacy on early intervention of hyperbaric oxygen (HBO) to improve the region blood flow (rBF) of ischemic femoral head. Forty-eight New Zealand male rabbits were injected with Escherichia coli endotoxin and methyl-prednisolone to establish SANFH models and then divided into 3 subgroups to undergo MSCT to measure the rBF, regional blood volume (rBV), and mean transit time (MTT) to obtain perfusion maps at the femoral head epiphysis, metaphysic, and neck of femur, and then were killed to undergo histological examination of the bilateral femoral heads 2, 4, and 6 weeks later respectively (Groups M(2), M(4), and M(6)). Twenty-four rabbits underwent HOB treatment after the second injection of E. c. endotoxin for 1-3 courses respectively (Groups H(1), H(2), and H(3)), and then underwent MSCT and pathological examination as described above. Eight rabbits were used as controls (Group N). (1) The rBF values of Groups M(2), M(4), and M(6) were all significantly lower than that of Group N (P < 0.001, < 0.001, and < 0.002). The rBF value of femoral head epiphysis of Group M(2) was remarkably lower than that of Group N, decreased to the lowest in Group M(4), and re-increased in Group M(6). The rBV value demonstrated similar change pattern in femoral head epiphysis. The MTT values of Groups M(2) and M(4) were longer than that of Group N, and then re-decreased in Group M(6). (2) It did differ significantly between the perfusion data of different femoral head anatomic regions in Groups M(2), M(4), M(6) and N (rBF: F = 52.190, P < 0.001; rBV: F = 42.677, P < 0.001; MTT: F = 3.09, P = 0.048). The changes of the perfusion data in femoral head epiphysis were more significant than those in other anatomic regions. (3) There were no statistically significant differences in the r

  7. [Penile enhancement surgery: widening and lengthening lipopenisculpture].

    PubMed

    Abecassis, M; Berreby, S; Boccara, D

    2010-04-01

    The male genitalia cosmetic surgery matches an ever growing need. The aim of this study is to describe our penile lengthening and widening procedures, the benefits and complications that could result from it. We perform these procedures since 1992 and treated close to 2000 patients. Thanks to our expertise and after succeeding in standardizing our techniques, we achieved a retrospective survey on 103 patients operated between 2004 and 2006. We describe here the two processes of our operating technique and we analyse the results obtained 1 month, 3 months and 1 year after the surgery. In most cases, combining a penis adipose tissue grafting, a suspensory ligament section and an adequate skin plasty is proven to be necessary in order to obtain both lengthening and widening increases. One year later, the increase is about 2.7 cm in length, corresponding to 28%, and 2.6 cm in circumference, corresponding to 27%. The complications (cutaneous necrosis, haematoma, lymphoedema, disharmonies), whenever they may exist, are most of the time spontaneously resolutive. Combining a penile fat tissue grafting with a suspensory ligament section allows us to answer to most of patients' expectations. However, several liposculpturing sessions might be necessary in order to get satisfactory results. Copyright 2009 Elsevier Masson SAS. All rights reserved.

  8. Stress fracture of the proximal humeral epiphysis in an elite junior badminton player.

    PubMed

    Boyd, K T; Batt, M E

    1997-09-01

    An elite junior badminton player presented with a chronic painful dominant shoulder after an intense training course. An acute stress fracture to the proximal humeral epiphysis was found. Two-plane radiography will identify abnormalities of the growth plate but comparative films of the unaffected side may also be required to differentiate subtle changes. Rest with subsequent rehabilitation is the appropriate management of these injuries although ideally they should be subjected to primary prevention.

  9. Stress fracture of the proximal humeral epiphysis in an elite junior badminton player.

    PubMed Central

    Boyd, K T; Batt, M E

    1997-01-01

    An elite junior badminton player presented with a chronic painful dominant shoulder after an intense training course. An acute stress fracture to the proximal humeral epiphysis was found. Two-plane radiography will identify abnormalities of the growth plate but comparative films of the unaffected side may also be required to differentiate subtle changes. Rest with subsequent rehabilitation is the appropriate management of these injuries although ideally they should be subjected to primary prevention. Images Figure 1 Figure 2 PMID:9298564

  10. Prediction of endotracheal tube size for pediatric patients from the epiphysis diameter of radius

    PubMed Central

    Cheon, Ji Hyun; Baek, Seung Hoon; Kim, Kyung Hoon

    2017-01-01

    Background Using a too big or a too small size of an endotracheal tube in pediatric patients would result in tracheal injury or insufficient ventilation. Determining the appropriate endotracheal tube size is important because using an inappropriate size can cause complications. This study was performed to predict the appropriate endotracheal tube size by measuring the transverse diameter of the epiphysis of the distal radius under the assumption that the growth rates of cartilages in the entire body are close to each other. Methods Fifty-eight children aged 3 to 10 years who required general anesthesia were intubated with an uncuffed endotracheal tube. The tube size was considered to be appropriate when leaks occurred at inspiratory peak pressures between 10 to 25 mmHg. The transverse diameters of the epiphysis were measured with an ultra-sonogram at the distal radius and the proximal phalanx of the third finger and the fifth finger. Correlations and prediction probabilities of measurements were evaluated. The number needed to harm (NNH), which indicates the number of patients who need to be intubated for one patient who needs tube exchange, was investigated. Results The Spearman's correlation coefficient between the endotracheal tube size and the epiphysis of the distal radius was 0.814, which was the biggest coefficient. For epiphysis of the proximal phalanx of the third finger and the fifth finger, the correlation coefficient was 0.704 and 0.701, respectively. If the Cole's formula was applied for selection of the tube size, the NNH would be 7. Conclusions The appropriate endotracheal tube size could be predicted by means of the epiphyseal transverse diameter of the distal radius rather than the circumference measurements of the phalanx. PMID:28184267

  11. Correlation of tunnel widening and tunnel positioning with short-term functional outcomes in single-bundle anterior cruciate ligament reconstruction using patellar tendon versus hamstring graft: a prospective study.

    PubMed

    Biswal, Udit Kumar; Balaji, Gopisankar; Nema, Sandeep; Poduval, Murali; Menon, Jagdish; Patro, Dilip Kumar

    2016-08-01

    To study the correlation between tunnel widening and tunnel position with short-term functional outcomes post-ACL reconstruction with patellar tendon and hamstring autografts in young adults. A total of 33 patients who underwent ACL reconstruction between October 2013 and February 2015 were included and followed up for 6 months. A standardized surgical technique was used for each graft type. Intra-op arthroscopy findings and drilled tunnel diameters were noted. They were followed up for 3 and 6 months. Radiological assessment was done at 3 and 6 months with clinical score assessment at 6 months. At 6 months, clinical scores were comparable in both groups. Tunnel widening in both femoral and tibial tunnel at 3 and 6 months were significantly higher in STG group (p values <0.05). The rate of widening was higher in 0-3 months and reduced in 3-6 months. There was statistically significant negative correlation between femoral tunnel widening by CT and IKDC score at 6 months (p value 0.049). We found a positive correlation between posterior positioning of femoral tunnel and Lysholm and IKDC scores. The correlation with Lysholm scores was statistically significant (p value 0.046). To conclude, tunnel widening is more with hamstrings graft. Femoral tunnel widening has significant negative correlation with that of IKDC scores at 6 months. Posterior femoral tunnel positioning and Lysholm scores at 6 months had significant correlation.

  12. Targeting of Widening Participation Measures by Elite Institutions: Widening Access or Simply Aiding Recruitment?

    ERIC Educational Resources Information Center

    Rainford, Jon

    2017-01-01

    The impact of widening participation policy and how it is enacted institutionally is a central concern to Higher Education. It is not simply about the admission of students from disadvantaged backgrounds, but also ensuring that these students complete their courses successfully. This work therefore goes far beyond those departments tasked with…

  13. Expression of matrix Gla protein and osteocalcin in the developing tibial epiphysis of mice.

    PubMed

    Liu, Hongrui; Guo, Jie; Wei, Shanliang; Lv, Shengyu; Feng, Wei; Cui, Jian; Hasegawa, Tomoka; Hongo, Hiromi; Yang, Yang; Li, Xiangzhi; Oda, Kimimitsu; Amizuka, Norio; Li, Minqi

    2015-01-01

    This study aimed to investigate the expression of matrix Gla protein (MGP) and osteocalcin (OCN) in the tibial epiphysis of developing mice. At 1, 2, 3, and 4 weeks after birth, tibiae were removed and processed for histochemical observations and western blot analyses under anesthesia. To evaluate bone volume, the specimens were scanned with Micro CT Scanner from the articular cartilage through the growth plate, along the long axis of tibia. At 1 week after birth, OCN reactivity was faint in the region of vascular invasion, while hardly any MGP reactivity was discernible. Subsequently, MGP reactivity was seen on the cartilaginous lacunar walls of hypertrophic chondrocytes, while OCN reactivity was evenly found not only in the bone matrix, but also in the cartilaginous lacunar walls and on the bone surfaces. Furthermore, double-immunostaining clearly showed that MGP reactivity appeared closer to the cartilage matrix than OCN reactivity until postnatal week 3. Interestingly, the immunoreactivities for MGP and OCN both showed tidemarks in the articular cartilage at postnatal week 4, and MGP reactivity was more intense than OCN reactivity. Statistical analyses showed an overall upward trend in MGP and OCN expression levels during tibial epiphysis development, even though OCN was more abundant than MGP at every time-point. Taken together, our findings suggest that the expression of MGP and OCN increased gradually in the murine developing tibial epiphysis, and the two mineral-associated proteins may occur at the same location during a particular period, but at different levels.

  14. Distraction osteogenesis to widen the mandible.

    PubMed

    Bell, W H; Harper, R P; Gonzalez, M; Cherkashin, A M; Samchukov, M L

    1997-02-01

    The purpose of this investigation was to elucidate the biology of distraction osteogenesis during mandibular widening. Midsymphyseal vertical interdental osteotomies were performed in nine Macaca mulatta monkeys. After a latency period a tooth-borne appliance was activated at a rate of 0.5 mm twice a day for 7-10 days. The appliance was then stabilized for a period of 4 or 8 weeks. The distraction gap at the inferior portion of the symphysis was bridged completely by new bony trabeculae. Bone formation in the interdental area was apparently related to the surgical technique. Newly formed bony trabeculae were oriented parallel to the direction of distraction. The location of the osteotomy site with an adequate margin of alveolar bone contiguous with the adjacent teeth was necessary for the induction of the distraction osteogenesis. Disproportional movement between superior and inferior portions of the distracted segments was noted.

  15. Thermally controlled widening of droplet etched nanoholes

    NASA Astrophysics Data System (ADS)

    Heyn, Christian; Schnüll, Sandra; Jesson, David E.; Hansen, Wolfgang

    2014-06-01

    We describe a method to control the shape of nanoholes in GaAs (001) which combines the technique of local droplet etching using Ga droplets with long-time thermal annealing. The cone-like shape of inverted nanoholes formed by droplet etching is transformed during long-time annealing into widened holes with flat bottoms and reduced depth. This is qualitatively understood using a simplified model of mass transport incorporating surface diffusion and evaporation. The hole diameter can be thermally controlled by varying the annealing time or annealing temperature which provides a method for tuning template morphology for subsequent nanostructure nucleation. We also demonstrate the integration of the combined droplet/thermal etching process with heteroepitaxy by the thermal control of hole depth in AlGaAs layers.

  16. Widening clinical applications of the SYNTAX Score.

    PubMed

    Farooq, Vasim; Head, Stuart J; Kappetein, Arie Pieter; Serruys, Patrick W

    2014-02-01

    The SYNTAX Score (http://www.syntaxscore.com) has established itself as an anatomical based tool for objectively determining the complexity of coronary artery disease and guiding decision-making between coronary artery bypass graft (CABG) surgery and percutaneous coronary intervention (PCI). Since the landmark SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) Trial comparing CABG with PCI in patients with complex coronary artery disease (unprotected left main or de novo three vessel disease), numerous validation studies have confirmed the clinical validity of the SYNTAX Score for identifying higher-risk subjects and aiding decision-making between CABG and PCI in a broad range of patient types. The SYNTAX Score is now advocated in both the European and US revascularisation guidelines for decision-making between CABG and PCI as part of a SYNTAX-pioneered heart team approach. Since establishment of the SYNTAX Score, widening clinical applications of this clinical tool have emerged. The purpose of this review is to systematically examine the widening applications of tools based on the SYNTAX Score: (1) by improving the diagnostic accuracy of the SYNTAX Score by adding a functional assessment of lesions; (2) through amalgamation of the anatomical SYNTAX Score with clinical variables to enhance decision-making between CABG and PCI, culminating in the development and validation of the SYNTAX Score II, in which objective and tailored decisions can be made for the individual patient; (3) through assessment of completeness of revascularisation using the residual and post-CABG SYNTAX Scores for PCI and CABG patients, respectively. Finally, the future direction of the SYNTAX Score is covered through discussion of the ongoing development of a non-invasive, functional SYNTAX Score and review of current and planned clinical trials.

  17. Proximal femoral epiphysiolysis during reduction of hip dislocation in adolescents.

    PubMed

    Herrera-Soto, Jose Antonio; Price, Charles T; Reuss, Bryan L; Riley, Patrick; Kasser, James R; Beaty, James H

    2006-01-01

    Traumatic hip dislocation is an uncommon injury in children. The urgency of closed reduction to prevent possible osteonecrosis may present some pitfalls. Adolescents with open proximal femoral physis may have sustained trauma to the physis at the time of dislocation that can lead to displacement of the epiphysis during the reduction maneuver. The purpose of this study is to report 5 cases with this complication and discuss potential etiology and management. All of the 5 patients were between 12 and 16 years old and underwent closed reduction under conscious sedation. Epiphysiolysis of the femoral head was diagnosed after reduction in all 5 patients. Every patient underwent emergent open reduction and internal fixation of the femur and open hip reduction. Avascular necrosis was identified in all 5 patients within 3 to 15 months postinjury. If there is any suspicion of associated physeal injury or if there is any physeal instability noted under fluoroscopy, an open reduction is recommended in the operating room under radiograph guidance to prevent displacement.

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  19. The Evolution of Government Policy on Widening Participation

    ERIC Educational Resources Information Center

    Greenbank, Paul

    2006-01-01

    This paper examines the evolution of government policy in England on widening participation. It traces government policy on widening participation in relation to social class from Robbins (1963) through Dearing (1997) to "The Future of Higher Education" (2003) and the passing of the Higher Education Act (2004). The paper concludes that…

  20. The Evolution of Government Policy on Widening Participation

    ERIC Educational Resources Information Center

    Greenbank, Paul

    2006-01-01

    This paper examines the evolution of government policy in England on widening participation. It traces government policy on widening participation in relation to social class from Robbins (1963) through Dearing (1997) to "The Future of Higher Education" (2003) and the passing of the Higher Education Act (2004). The paper concludes that…

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

    ERIC Educational Resources Information Center

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

    2007-01-01

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

  2. Outcasts on the inside: Graduates, Employability and Widening Participation

    ERIC Educational Resources Information Center

    Redmond, Paul

    2006-01-01

    The drive to widen access and participation in higher education is rapidly transforming the sector. Despite this, through an interplay of social, cultural and gender-related factors, students from "widening participation" backgrounds can all too frequently become, within their own institutions, "outcasts on the inside": formally accepted by the…

  3. Axial vessel widening in arborescent monocots.

    PubMed

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

    2014-02-01

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

  4. A case of osteoid osteoma in the distal radius epiphysis with atypical onset.

    PubMed

    Deveci, Alper; Fırat, Ahmet; Bozkurt, Murat; Hücümenoğlu, Sema

    2014-01-01

    We present a 16-year-old male patient, with a history of wrist trauma 3 months prior to admission, presented with widespread swelling, limitation of motion and pain that was unresponsive to anti-inflammatory drugs in the left wrist. A lesion compatible with osteoid osteoma in the distal epiphysis of the left radius was detected radiologically. Diagnosis of osteoid osteoma was confirmed with pathological examination of the lesion. Differential diagnosis is important as the atypical lesion occurred after trauma, making it difficult to distinguish from synovitis and infection in consideration of its location.

  5. Clinical and functional outcomes after operative management of Salter-Harris III and IV fractures of the proximal tibial epiphysis.

    PubMed

    Hill, Brian W; Rizkala, Amir R; Li, Mengnai

    2014-09-01

    Pediatric proximal tibial epiphysis fractures are uncommon and have subsequently received little attention in terms of treatment and outcomes. We studied the clinical and functional outcomes of 13 patients with Salter-Harris III and IV fractures of the proximal tibial epiphysis after operative fixation. Associated meniscus, ligamentous, or neurovascular injury was present in 100% of this cohort. Provisional external fixation and locked plating spanning the open physis were used in the majority of cases. The mean clinical follow-up was 15.69 months, where all fractures progressed to union. Good functional outcomes with a low complication rate are possible after operative fixation of these infrequent injuries.

  6. 3D-printed navigation template in proximal femoral osteotomy for older children with developmental dysplasia of the hip

    PubMed Central

    Zheng, Pengfei; Xu, Peng; Yao, Qingqiang; Tang, Kai; Lou, Yue

    2017-01-01

    To explore the feasibility of 3D-printed navigation template in proximal femoral varus rotation and shortening osteotomy for older children with developmental dysplasia of the hip (DDH). Between June 2014 and May 2015, navigation templates were designed and used for 12 DDH patients. Surgical information and outcomes were compared to 13 patients undergoing the same surgery but without navigation template. In template-guided patient group, operation time (21.08 min vs. 46.92 min), number of X-ray exposures (3.92 vs. 6.69), and occurrence of femoral epiphysis damage (0 vs. 0.92) were significantly decreased (P < 0.05). Furthermore, after 12–18 months follow-up, 66.7% and 16.7% of the hips in template-guided group were rated as excellent or good, respectively, according to the McKay criteria; 83.3% and 16.7% by using the Severin criteria respectively. By contrast, 46.2% and 23.1% of the hips in traditional operation group were classed as excellent or good, respectively, using the McKay criteria; 46.2% and 30.8% by using the Severin criteria respectively. The template-guided group achieved a better outcome; however, there was no significant difference. Application of the navigation template for older DDH children can reduce the operation time, radiation exposure, and epiphysis damage, which also simplifies surgery and improves precision. PMID:28322290

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

    PubMed

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

    2016-06-14

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

  8. The effects of enoxaparin on the reparative processes in experimental osteonecrosis of the femoral head of the rat.

    PubMed

    Norman, Doron; Miller, Yoav; Sabo, Edmund; Misselevich, Ines; Peskin, Bezalel; Zinman, Chaim; Levin, Daniel; Reis, Daniel N; Boss, Jochanan H

    2002-03-01

    The blood supply of one femoral head of 6-month-old rats was severed by incising the periosteum of the neck and cutting the ligamentum teres. The rats were killed on the 30th postoperative day and the femoral bones were obtained for semiquantification of the reparative processes in the necrotic heads. Fourteen rats were treated with enoxaparin and 14 untreated animals served as controls. Statistically, the amounts of necrotic bone in the epiphysis were less, the extent of remodeling of the femoral heads was milder, and the articular cartilage degeneration was slighter in the enoxaparin-treated than untreated rats. There was no significant difference in the quantities of newly formed bone in femoral heads of treated and untreated rats. These findings are in agreement with the known effects of unfractionated and low-molecular-weight heparins which enhance osteoclastic bone resorption and angiogenesis and decrease osteoblastic bone formation. The former activities, operative in minimizing the structural distortion of the femoral head, oppose the crucial event in the pathogenesis of post-osteonecrotic osteoarthritis.

  9. Normal radiological unossified hip joint space and femoral head size development during growth in 675 children and adolescents.

    PubMed

    Wegener, Veronika; Jorysz, Gabriele; Arnoldi, Andreas; Utzschneider, Sandra; Wegener, Bernd; Jansson, Volkmar; Heimkes, Bernhard

    2017-03-01

    Evaluation of hip joint space width during child growth is important to aid in the early diagnosis of hip pathology in children. We established reference values for hip joint space and femoral head size for each age. Hip joint space development during growth was retrospectively investigated medial and cranial in 1350 hip joints of children using standard anteroposterior supine plain pelvic radiographs. Maximum capital femoral epiphysis diameter and femoral radii were further more investigated. Hip joint space values show a slow decline during growth. Joint space was statistically significantly (p < 0.006) larger in boys than girls. Our hip joint space measurements on supine subjects seem slightly larger than those reported by Hughes on standing subjects. Evaluation of the femoral head diameter and the radii showed a size curve quite parallel to the known body growth charts. Radii medial and perpendicular to the physis are not statistically significantly different. We recommend to compare measurements of hip joint space at two locations to age dependent charts using the same imaging technique. During growth, a divergence in femoral head size from the expected values or loss of the spherical shape should raise the question of hip disorder. Clin. Anat. 30:267-275, 2017. © 2016 Wiley Periodicals, Inc.

  10. Femoral shaft osteotomy for obligate outward rotation due to SCFE.

    PubMed

    Stevens, Peter M; Anderson, Lucas; MacWilliams, Bruce A

    2017-04-01

    Slipped capital femoral epiphysis (SCFE) is an adolescent disease that leads to retroversion of the femoral neck and shaft, relative to the head. Observing that patients with SCFE must walk with an outward foot progression angle and externally rotate the leg in order to flex the hip, we have been performing a femoral shaft rotational osteotomy wherein we rotate the lower femur 45° inward, relative to the upper femur. By correcting retroversion, our goal is to improve functional hip and knee motion, thereby mitigating the effects of SCFE impingement. This is a retrospective review of five hips in four patients (two boys and two girls), average age 14.7 years (range 11 + 7-18 years) who underwent femoral midshaft rotational osteotomy for correction of acquired retroversion of the femur secondary to severe SCFE. We compared clinical findings at the outset to those at an average follow-up of 46 months (range 24-74 months). Pre- and post-gait analysis was performed in three patients. Two of the patients underwent elective arthroscopic osteochondroplasty to alleviate residual FAI: contralateral arthroscopy is pending in one. The first patient in this series received a hip arthroplasty, 62 months after his osteotomy, at age 23. Following midshaft osteotomy, all patients experienced improvement in comfort, gait and activities of daily living. With the patella neutral, they had improved range of hip flexion from an average preoperative flexion of <25° to a postoperative flexion of >90°. Two patients (both male) had delayed union and some loss of correction, secondary to broken interlocking screws; each healed with reamed, exchange nailing. The interlocking screws have since been redesigned and enlarged. Femoral shaft rotational osteotomy restores the functional range of hip motion, while correcting obligate out-toeing and improving knee kinematics. This procedure is technically straightforward, permitting progressive weight bearing, while avoiding the risk of AVN

  11. 3D geometric morphometric analysis of the proximal epiphysis of the hominoid humerus

    PubMed Central

    Arias-Martorell, Julia; Potau, Josep Maria; Bello-Hellegouarch, Gaëlle; Pastor, Juan Francisco; Pérez-Pérez, Alejandro

    2012-01-01

    In this study we perform a three-dimensional geometric morphometric (3D GM) analysis of the proximal epiphysis of the humerus in extant great apes, including humans, in order to accurately describe the functional anatomical differences between these taxa. In addition, a fossil hominin specimen of Australopithecus afarensis was included in a multivariate GM analysis in order to test the potential of this methodological approach for making locomotor inferences from fossil remains. The results obtained show significant differences in proximal humeral morphology among the taxa studied, which had thus far largely remained unnoticed. Based on morphofunctional considerations, these anatomical differences can be correlated to differences in the locomotor repertoires of the taxa, thus confirming that the proximal humerus is suitable for constructing paleobiological inferences about locomotion. Modern humans display markedly divergent features, which set them apart from both the extant great apes and the fossil hominin A. afarensis. The morphology of the proximal epiphysis of the humerus of the latter more closely resembles that of the orangutans, thus suggesting that despite hindlimb adaptations to bipedalism, the forelimb of this taxon was still functionally involved in arboreal behaviors, such as climbing or suspension. PMID:22946496

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

    PubMed

    Beckmann, Nicholas; Crawford, Lindsay

    2016-08-01

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

  13. Estimating legal age based on fusion of The proximal humeral epiphysis.

    PubMed

    Sánchez, María Benito; Codinha, Sónia; García, Alexandra Muñoz; Sánchez, José Antonio Sánchez

    2016-12-06

    The increasing demand which requires ascertaining the legal age of undocumented individuals who reach the various countries of the European Community means that new lines of research must be developed which help respond to questions posed by the Justice Administration. For this reason, this study has been designed on the basis of fusion times of the proximal humeral epiphysis. Moreover, the ultrasound scan has been used as the diagnostic method. It is a non-invasive technique, unlike the radiograph, which is used under current standards for the forensic diagnosis of age. Used as a study sample were the ultrasound images of the proximal humeral epiphysis among 221 individuals belonging to the Spanish population, of both genders, of ages ranging from 5 to 30 years. All of the images were classified into 6 stages of fusion based on the morphology of each. The results display differences among the six age groups proposed for each of the stages of fusion and are of great interest from the perspective of enforcing the Spanish Criminal Law Act on Minors, because Stage 4 would mean that the person being studied is under the age of 16 years in the case of males and 15 years in the case of females. These results, coupled with the use of ultrasound as a non-invasive diagnostic technique, make this study a very useful method when the use of radiographs is not possible.

  14. Distribution of CD105 and CD166 positive cells in the proximal epiphysis of developing rat humerus.

    PubMed

    Ozbey, Ozlem; Sahin, Zeliha; Acar, Nuray; Ustunel, Ismail

    2010-11-01

    The expression of cell surface receptors, CD105 and CD166, are characteristic of mesenchymal stem cells in cartilage. However, there is limited data regarding their immunolocalization in the cartilage of developing rat epiphysis. The purpose of this study was to determine the presence of CD105 and CD 166 positive cells in the proximal epiphysis of developing rat humerus and specify their zonal distribution with age. The tissues of rat humerus were taken on embryonic day 15 (E15), embryonic day 19 (E19), postnatal day 10 (PN10), postnatal day 20 (PN20) and adult rats and studied for the immunolocalization of CD105 and CD166. Our results showed that CD105 and CD166 positive cells were scattered in early stages of development of humerus epiphysis. For E15, only the hypertrophic zone was positive, whereas for E19 almost all zones of the epiphysis were positively stained for these markers. For PN10 and PN20, the CD105 and CD166 positive cells were mainly localized on the surface of the articular cartilage. In adult articular cartilage the CD105 and CD166 positive cells were localized in the superficial and transitional zones and in the upper regions of the deep zone. Our study provides evidence that in the developing cartilage tissue the localization of CD105 and CD166 positive cells is both dynamic and stage dependent, which may imply the existence of stem cell-like cells in cartilage from an early age to adult.

  15. [Mathematical models of the teenager's skeletal age evaluation based on CT scan and imaging reconstruction of medial clavicular epiphysis].

    PubMed

    Wei, Hua; Siyit, Telet; Wan, Lei; Ying, Chong-liang; Wang, Ya-hui

    2013-10-01

    To explore the correlation between CT volume rendering (VR) statistics and living age and to build the mathematical models for skeletal age evaluation based on the growth rules of medial clavicular epiphysis of teenagers in China. The thin layer CT scan and VR 3D imaging reconstruction of both sides of sternal ends of clavicles were examined for 684 teenagers aged from 15 to 25 in East and South China. The parameters of sternal end of clavicle including the longest diameter of epiphysis, the longest diameter of metaphysis, their length radio, area of epiphysis, area of metaphysic, their area ratio, and other data were measured and calculated in order to establish mathematical models of skeletal age evaluation. Fifty trained subjects were tested to verify the accuracy of the mathematical models. In the same age group, the length ratio and the area ratio had significant difference in genders (P < 0.05). The established mathematical models showed that the growth rules of medial clavicular epiphysis were highly correlated with the living ages. The accuracies of these models were higher than 70.5% +/- 1.0 year) and 82.5% (+/- 1.5 year). The mathematical models have easy operability and high accuracy. It can be used to confirm and sustain the conclusion of atlas method. Meanwhile, it is of great significance to study the other single skeletal age evaluation in the future.

  16. Tunnel widening after ACL reconstruction with aperture screw fixation or all-inside reconstruction with suspensory cortical button fixation: Volumetric measurements on CT and MRI scans.

    PubMed

    Mayr, Raul; Smekal, Vinzenz; Koidl, Christian; Coppola, Christian; Fritz, Josef; Rudisch, Ansgar; Kranewitter, Christof; Attal, René

    2017-10-01

    Tunnel widening after anterior cruciate ligament reconstruction (ACLR) is influenced by the surgical and fixation techniques used. Computed tomography (CT) is the most accurate image modality for assessing tunnel widening, but magnetic resonance imaging (MRI) might also be reliable for tunnel volume measurements. In the present study tunnel widening after ACLR using biodegradable interference screw fixation was compared with all-inside ACLR using button fixation, with tunnel volume changes being measured on CT and MRI scans. Randomized controlled trial; Level of evidence, 2. Thirty-three patients were randomly assigned to hamstring ACLR using a biodegradable interference screw or all-inside cortical button fixation. CT and MRI scanning were done at the time of surgery and six months after. Tunnel volume changes were calculated and compared. On CT, femoral tunnel volumes changed from the postoperative state (100%) to 119.8% with screw fixation and 143.2% with button fixation (P=0.023). The changes in tibial tunnel volumes were not significant (113.9% vs. 117.7%). The changes in bone tunnel volume measured on MRI were comparable with those on CT only for tunnels with interference screws. Tibial tunnels with button fixation were significantly underestimated on MRI scanning (P=0.018). All-inside ACLR using cortical button fixation results in increased femoral tunnel widening in comparison with ACLR with biodegradable interference screw fixation. MRI represents a reliable imaging modality for future studies investigating tunnel widening with interference screw fixation. Copyright © 2017 Elsevier B.V. All rights reserved.

  17. An uncommon Salter-Harris I fracture of the distal femoral physis with marked epiphyseal dislocation.

    PubMed

    Hale, Christopher; Forstater, Alan; O'Malley, Gerald

    2013-02-01

    This is a report of an uncommon Salter-Harris I fracture of the distal femoral physis with complete dislocation of the distal epiphysis. These fractures are most frequently sustained during sports injuries, with motor vehicle accidents as another leading cause. They are at high risk of nonanatomic healing with subsequent varus or valgus deformity or premature growth arrest of the physis with subsequent leg length difference. Although certain fractures of the distal femoral physis may be very rarely encountered in the emergency department, the unavailability of appropriate consult service or risk of vascular compromise may necessitate reduction by the emergency physician. This fracture-dislocation was reduced with intravenous opioid analgesia, gentle traction along the axis of the lower extremity, and firm but gentle manual reduction of the proximal femoral fragment. External casts alone have a high rate of failure in sustaining anatomic alignment, so percutaneous pinning is recommended as the definitive treatment. After reduction, this patient was transferred to a pediatric hospital capable of performing the necessary operative fixation.

  18. [The origin of femoral trochlear dysplasia: comparative anatomy, evolution, and growth of the patellofemoral joint].

    PubMed

    Tardieu, C; Dupont, J Y

    2001-06-01

    We performed a comparative analysis of the femoropatellar morphology examining the evolutionary aspects to search for the origin of trochelar dysplasia. Trochlear dysplasia is frequent in the human population and, when associated with morphological and positional abnormalities of the patella, can lead to patellar pain syndrome in minor cases or patellar dislocation in severe cases. There is no strict relationship between the observed anomalies and clinical expression. The shape of the articular surfaces is variable in mammals depending on their type of locomotion: unguligrade, digitigrade, plantigrade. In greater apes, the femoral diaphysis is straight and the trochlea is flat and symmetrical. The patella does not tend to dislocate laterally since the knee under load is always flexed. In human adults, the femoral diaphysis has a valgus obliquity angle of 8 degrees to 10 degrees. Consequently, the trochlea has a deepened sulcus and an elevated lateral lip, avoiding lateral patellar dislocation, especially during initial knee flexion. In the human newborn, the femoral diaphysis is vertical. As the child starts walking, the femoral obliquity angle develops between 1 and 7 years of age, inducing a secondary valgus of the extensor apparatus. This obliquity does not develop in non-walking children. Fossil femurs of australopithecus demonstrate that a high obliquity angle had appeared more than 3 million years ago, but also exhibit a poorly deepened trochlea and a slight elevation of the lateral facet. At 1.8 million years, the fossils have the oblique diaphysis, the strongly deepened sulcus and the strongly elevated lateral facet. The obliquity angle of the femoral diaphysis is the leading feature which initiated the later modifications of the patellofemoral joint that over 3 million years were never inscribed in the human genoma. Lateral trochleal lip and deep sulcus are features that were first acquired, then once selected, genetically assimilated, and now appear on

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

    PubMed Central

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

    2016-01-01

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

  20. Sonographic findings in an isolated widened fetal subarachnoid space.

    PubMed

    Tongsong, Theera; Puntachai, Pongsun; Tongprasert, Fuanglada; Srisupundit, Kasemsri; Luewan, Suchaya; Traisrisilp, Kuntharee

    2015-05-01

    The purpose of this series was to describe sonographic features of an isolated widened fetal subarachnoid space with a thin cerebral mantle and possible associations. Between January 2004 and December 2013, fetuses with a prenatal diagnosis of a widened subarachnoid space were prospectively recruited and followed. Histories of medical and familial diseases, as well as other demographic data such as drug exposure and lifestyles, were assessed and prospectively recorded. The women were investigated for possible associated factors. Ten pregnant women were recruited. Their fetuses showed various degrees of a widened subarachnoid space, ranging from 5 to 20 mm. Nearly all were diagnosed in the second half of pregnancy. Four cases had normal brain structures documented at midpregnancy anomaly screening. Only 1 case had a prenatal diagnosis of a widened subarachnoid space at 20 weeks' gestation. Two fetuses had exposure to alcohol in utero; 2 were proven to have cytomegalovirus infection; 1 had subarachnoid hemorrhage secondary to maternal use of warfarin; and 1 had a diagnosis of lissencephaly. Only 1 case in this series had normal postnatal development. A prenatal series of fetal widened subarachnoid spaces with possible associated factors is described. Although such relationships were not fully proven, they should be index cases for future studies.

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

    NASA Astrophysics Data System (ADS)

    Allen, Robert J.; Ajoku, Osinachi

    2016-06-01

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

  2. Prospective evaluation of femoral head viability following femoral neck fracture

    SciTech Connect

    Binkert, B.; Kroop, S.A.; Nepola, I.V.; Grantham, A.S.; Alderson, P.O.

    1984-01-01

    The bone scans of 33 patients (pts) with recent subcapital fractures (fx) of the femur were evaluated prospectively to determine their value in predicting femoral head visability. Each of the 33 pts (ll men, 22 women, age range 30-92) had a pre-operative bone scan within 72 hrs of the fx (23 pts within 24 hrs). Anterior and posterior planar views of both hips and pinhole views (50% of pts) were obtained 2 hrs after administration of Tc-99m HDP. The femoral head was classified as perfused if it showed the same activity as the opposite normal side or if it showed only slightly decreased activity. Femoral heads showing absent activity were classified as nonperfused. Overall, 20 of the 33 pts showed a photopenic femoral head on the side of the fx. Only 2 pts showed increased activity at hte site of the fx. Internal fixation of the fx was performed in 23 pts, 12 of whom had one or more follow-up scans. Five of these 12 pts showed absent femoral head activity on their initial scan, but 2 showed later reperfusion. The other 7 pts showed good perfusion initially, with only 1 later showing decreased femoral head activity. The other 10 pts (7 of whom had absent femoral head activity) had immediate resection of the femoral head and insertion of a Cathcart prosthesis. The results suggest that femoral head activity seen on a bone scan in the immediate post-fx period is not always a reliable indicator of femoral head viability. Decreased femoral head activity may reflect, in part, compromised perfusion secondary to post-traumatic edema, with or without anatomic disruption of the blood supply.

  3. Laparoscopic repair of femoral hernia

    PubMed Central

    Yang, Xue-Fei

    2016-01-01

    Laparoscopic repair of inguinal hernia is mini-invasive and has confirmed effects. Femoral hernia could be repaired through the laparoscopic procedures for inguinal hernia. These procedures have clear anatomic view in the operation and preoperatively undiagnosed femoral hernia could be confirmed and treated. Lower recurrence ratio was reported in laparoscopic procedures compared with open procedures for repair of femoral hernia. The technical details of laparoscopic repair of femoral hernia, especially the differences to laparoscopic repair of inguinal hernia are discussed in this article. PMID:27826574

  4. Data of aromatase inhibitors alone and in combination with raloxifene on microarchitecture of lumbar vertebrae and strength test in femoral diaphysis of VCD treated ovotoxic mice.

    PubMed

    Kalam, Abul; Talegaonkar, Sushama; Vohora, Divya

    2017-02-01

    Currently, the third generation aromatase inhibitors are the drugs of choice for treatment of early and advanced breast cancer in postmenopausal women. The negative impact of these drugs on bone health is the significant limiting factor during this therapy. Here we report the effect of two aromatase inhibitors viz. letrozole and exemestane alone and in combination with raloxifene on lumbar vertebrae and femoral diaphysis after one month of treatment but no discernible effects were observed on bone when tested by micro CT and strength test except in trabecular number which was reduced in lumbar vertebrae following letrozole and exemestane. Further studies with letrozole and exemestane should be done at higher doses for longer duration of time to check whether effects are observed in other parameters as well. The data is an extension of our published work in Mol. Cell Endocrinology (A. Kalam, S. Talegaonkar, D. Vohora, 2017) [1] describing letrozole-induced bone loss on femoral epiphysis and its reversal by raloxifene.

  5. Optimising magnetic resonance imaging-based evaluation of the ossification of the medial clavicular epiphysis: a multi-centre study.

    PubMed

    Schmidt, S; Henke, C A; Wittschieber, D; Vieth, V; Bajanowski, T; Ramsthaler, F; Püschel, K; Pfeiffer, H; Schmeling, A; Schulz, R

    2016-11-01

    Evaluation of the ossification of the medial clavicular epiphysis plays a key role in forensic age estimation, particularly in determining whether the age of 18 has been attained. A key research objective in the forensic age estimation field at present is to establish non-X-ray methods for investigating the clavicle. This paper looks at the use of magnetic resonance imaging for evaluating the developmental state of the medial clavicular epiphysis. Clavicle specimens obtained from autopsies of 125 female and 270 male subjects aged from 10 to 30 were examined using a 3-T magnetic resonance scanner. One FFE-3D-T1 gradient echo sequence and one 2D-T2 turbo spin echo sequence were acquired. In each case, two investigators undertook a consensual determination of the ossification stage of the medial clavicular epiphysis using recognised classification systems. To determine intra-observer and inter-observer agreement, 80 clavicle specimens were subjected to repeat evaluation. We present statistics relating to the ossification stages. The inclusion of established sub-stages of clavicular ossification offers an additional option for determining whether a subject has attained the age of 18 which is applicable in both sexes. For both sexes, the minimum ages for ossification stages 4 and 5 allow conclusions to be drawn about a subject's age at a point in time lying several years in the past. Magnetic resonance imaging is a valid investigatory procedure for determining the ossification stage of the medial clavicular epiphysis. This paper makes a contribution to expanding the range of methods available for forensic age estimation.

  6. Magnetic resonance imaging-based evaluation of ossification of the medial clavicular epiphysis in forensic age assessment.

    PubMed

    Schmidt, S; Ottow, C; Pfeiffer, H; Heindel, W; Vieth, V; Schmeling, A; Schulz, R

    2017-09-09

    Evaluation of the degree of ossification of the medial clavicular epiphysis plays a crucial role in determining with an adequate degree of probability whether legally relevant age boundaries after the age of 17 have been crossed. In view of the need to avoid unnecessary radiation exposure, establishing non-X-ray methods for investigating the clavicle has long been a key objective in forensic age assessment research. Based on magnetic resonance imaging examinations in a large sample of healthy subjects, the current study for the first time presents statistical measures which allow inferences to be drawn for forensic age assessment in both sexes. We undertook a prospective study of a reference sample of 334 female and 335 male German volunteers aged from 12 to 24 using a 3-T MRI scanner. A 3D FFE (fast field echo) T1-weighted sequence with fat saturation was acquired. To stage ossification of the medial clavicular epiphysis, we used the clavicular ossification staging systems described by Schmeling et al. and Kellinghaus et al. Ossification stage IIIc offers a means in both sexes of demonstrating that the age of 18 has been attained prior to complete ossification of the epiphyseal plate. In both sexes, if a subject has reached ossification stage IV, it can be stated that he or she has attained the age of 21. Magnetic resonance imaging is a valid diagnostic procedure for determining the ossification stage of the medial clavicular epiphysis.

  7. Widening Participation and Contextual Entry Policy in Accounting and Finance

    ERIC Educational Resources Information Center

    Rowbottom, N.

    2017-01-01

    The paper examines the performance of accounting and finance students entering university via a "widening participation" scheme that seeks to attract students who have been historically under-represented in higher education. Focus is placed on the policy of providing contextual entry offers that recognise that academic qualifications be…

  8. Widening and Deepening Questions in Web-Based Investigative Learning

    ERIC Educational Resources Information Center

    Kashihara, Akihiro; Akiyama, Naoto

    2016-01-01

    Web allows learners to investigate any question with a great variety of Web resources, in which they could construct a wider, and deeper knowledge. In such investigative learning process, it is important for them to deepen and widen the question, which involves decomposing the question into the sub-questions to be further investigated. This…

  9. On Widening Participation in Higher Education through Positive Discrimination

    ERIC Educational Resources Information Center

    Clayton, Matthew

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2006-01-01

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

  11. On Widening Participation in Higher Education through Positive Discrimination

    ERIC Educational Resources Information Center

    Clayton, Matthew

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Raven, Neil

    2015-01-01

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

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

    PubMed

    Huebner, Bryce; Sarkissian, Hagop

    2016-01-01

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

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

    ERIC Educational Resources Information Center

    Raven, Neil

    2015-01-01

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

  15. Widening Participation: Challenges Confronting a Research-Intensive University

    ERIC Educational Resources Information Center

    Cuthill, Michael; Schmidt, Christopher

    2011-01-01

    This article explores the challenges confronting a research-intensive Australian university in responding to the "widening participation" agenda outlined in the recent "Review of Higher Education". The university argued that it is not possible to respond effectively to this agenda without having a clear understanding of the…

  16. Re-Conceptualising Sustainable Widening Participation: Evaluation, Collaboration and Evolution

    ERIC Educational Resources Information Center

    Reed, Richard; King, Anna; Whiteford, Gail

    2015-01-01

    This article discusses the future of university-based programmes aimed at enabling the access and successful participation of students from traditionally under-represented backgrounds in higher education. It builds a case for adopting three strategies in ensuring the sustainability of widening access and participation work: (1) embedding…

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

    NASA Astrophysics Data System (ADS)

    Offei, Edward

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

  18. "Widening Gaps and the Need for Fresh Thinking"

    ERIC Educational Resources Information Center

    Martin, D'Arcy

    2004-01-01

    Since 1997, the key trend in work has been the widening gap between good jobs and bad jobs. CONFINTEA took place in the middle of an international boom in high-tech development, with attendant optimism around creation of a "knowledge economy". While the subsequent crash of this sector is no doubt temporary, it draws attention to the…

  19. From Policy to Practice: Pupils' Responses to Widening Participation Initiatives

    ERIC Educational Resources Information Center

    Baxter, Arthur; Tate, Jim; Hatt, Sue

    2007-01-01

    Recent widening participation policies have been subject to a number of criticisms; they focus on aspirations rather than differences in performance; they place less value on the aspirations of the "disadvantaged" comparing them to a middle class norm; they subordinate what was a radical agenda to the demands of the economy and so…

  20. The Past, Present and Future of Widening Participation Research

    ERIC Educational Resources Information Center

    Kettley, Nigel

    2007-01-01

    The provisions of the Higher Education Act (2004) have renewed interest in widening participation research. Therefore, this paper explores the development of this scholarly field, primarily in the United Kingdom, by examining major trends in the study of higher education. Political debates related to higher education, the prevailing structure of…

  1. Performance Indicators and Widening Participation in UK Higher Education

    ERIC Educational Resources Information Center

    Pugh, Geoff; Coates, Gwen; Adnett, Nick

    2005-01-01

    We investigate the relationship between the widening participation performance indicators adopted in UK higher education (HE) and the government's objective of increasing overall HE participation rates. We critically assess the development of performance monitoring in HE and identify weaknesses in the current performance indicators from the…

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

    ERIC Educational Resources Information Center

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

    2008-01-01

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

  3. "Widening Gaps and the Need for Fresh Thinking"

    ERIC Educational Resources Information Center

    Martin, D'Arcy

    2004-01-01

    Since 1997, the key trend in work has been the widening gap between good jobs and bad jobs. CONFINTEA took place in the middle of an international boom in high-tech development, with attendant optimism around creation of a "knowledge economy". While the subsequent crash of this sector is no doubt temporary, it draws attention to the…

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

    ERIC Educational Resources Information Center

    Chapman, Amy; Mangion, Antoine; Buchanan, Rachel

    2015-01-01

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

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

    ERIC Educational Resources Information Center

    Chapman, Amy; Mangion, Antoine; Buchanan, Rachel

    2015-01-01

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

  6. Re-Conceptualising Sustainable Widening Participation: Evaluation, Collaboration and Evolution

    ERIC Educational Resources Information Center

    Reed, Richard; King, Anna; Whiteford, Gail

    2015-01-01

    This article discusses the future of university-based programmes aimed at enabling the access and successful participation of students from traditionally under-represented backgrounds in higher education. It builds a case for adopting three strategies in ensuring the sustainability of widening access and participation work: (1) embedding…

  7. Standards, Standards, Standards: The Unintended Consequences of Widening Participation?

    ERIC Educational Resources Information Center

    Stuart, Mary

    2002-01-01

    Debate over widening access to higher education is narrowing to a focus on preservation of standards. Examination of the discourses of school policy, classroom environment, and peer culture shows how these competing cultures can work against efforts to increase participation. (Contains 17 references.) (SK)

  8. Mycotic femoral aneurysm.

    PubMed

    Wilson, Richard Scott; Bennett, Kenneth R

    2007-05-01

    After several weeks of fever and chills, a 31-year-old logger developed pain in his right thigh. Upon examination a tender, pulsating upper thigh mass was found with a long loud bruit arising from it. Severe aortic insufficiency was present; however, blood cultures were negative. An angiogram, captured blood with contrast spewing from the profunda femoral artery to fill a 5 x 10 cm sac. A false aneurysm was diagnosed and resected; numerous gram positive cocci were present in cut sections, but cultures from the cavity grew the gram negative bacteria Salmonella and Alcaligenes. After one month of intravenous ampicillin the aortic valve was replaced after being destroyed by endocarditis. Ampicillin was continued and recovery was uneventful. Mycotic aneurysms are commonly caused by Salmonella (10%), which was second only to Staphylococcus (30%). The femoral artery accounts for 38% of all mycotic aneurysms. They typically present with a pulsatile mass (52%), bruit (50%), and fever (48%). This diagnosis can be supported by leukocytosis (64-71%), positive blood cultures (50-85%), and a history of arterial trauma (51%) (injection drug use, intravascular procedure, or trauma) or endocarditis (10%).

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

    PubMed

    Rohde, Sigrun; Kienast, Felix; Bürgi, Matthias

    2004-10-01

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

  10. Femoral tunnel enlargement after anterior cruciate ligament reconstruction using RigidFix compared with extracortical fixation.

    PubMed

    Lopes, Osmar Valadao; de Freitas Spinelli, Leandro; Leite, Luiz Henrique Cunha; Buzzeto, Bruce Quatrin; Saggin, Paulo Renato Fernades; Kuhn, André

    2017-05-01

    The aim of this study was to compare femoral tunnel enlargement after anterior cruciate ligament (ACL) reconstruction surgery using hamstring autograft tendons fixed by bioabsorbable femoral trans-tunnel pins with that in patients in which the graft was fixed with extracortical fixation. Forty-three patients were randomly selected from our database and included in the study. Femoral tunnel diameter was measured by computed tomography in 20 patients who underwent ACL reconstruction via anteromedial portal technique using autologous quadruple hamstrings, fixed with two bioabsorbable trans-tunnel pins, RigidFix, on the femoral side and compared with 23 patients in whom extracortical fixation, EndoButton CL, was used. The diameter of the femoral tunnel was measured at a distance of 5 mm from the tunnel entrance and at the largest diameter along the tunnel axis. Data were compared with the diameter of the drill used during surgery. Clinical evaluation was performed using the Lysholm score, IKDC subjective score and anterior knee laxity measurements. Femoral tunnel enlargement 5 mm from the entrance and at the largest diameter was greater in the RigidFix group than the EndoButton group. There were no significant differences between the two groups regarding age, gender, post-operative Lysholm score, IKDC subjective score or knee laxity measurements. The present study showed greater enlargement of the femoral bone tunnel when a bioabsorbable trans-tunnel pin system was used with the medial portal technique when compared to extracortical fixation. These findings confirm that femoral tunnel widening should be considered when RigidFix was used in ACL reconstruction by anteromedial portal technique. III.

  11. Fourier analysis methodology of trabecular orientation measurement in the human tibial epiphysis

    PubMed Central

    HERRERA, M.; PONS, A. M.; ILLUECA, C.; ERADES, D.

    2001-01-01

    Methods to quantify trabecular orientation are crucial in order to assess the exact trajectory of trabeculae in anatomical and histological sections. Specific methods for evaluating trabecular orientation include the ‘point counting’ technique (Whitehouse, 1974), manual tracing of trabecular outlines on a digitising board (Whitehouse, 1980), textural analysis (Veenland et al. 1998), graphic representation of vectors (Shimizu et al. 1993; Kamibayashi et al. 1995) and both mathematical (Geraets, 1998) and fractal analysis (Millard et al. 1998). Optical and computer-assisted methods to detect trabecular orientation of bone using the Fourier transform were introduced by Oxnard (1982) later refined by Kuo & Carter (1991) (see also Oxnard, 1993, for a review), in the analysis of planar sections of vertebral bodies as well as in planar radiographs of cancellous bone in the distal radius (Wigderowitz et al. 1997). At present no studies have applied this technique to 2-D images or to the study of dried bones. We report a universal computer-automated technique for assessing the preferential orientation of the tibial subarticular trabeculae based on Fourier analysis, emphasis being placed on the search for improvements in accuracy over previous methods and applied to large stereoscopic (2-D) fields of anatomical sections of dried human tibiae. Previous studies on the trajectorial architecture of the tibial epiphysis (Takechi, 1977; Maquet, 1984) and research data about trabecular orientation (Kamibayashi et al. 1995) have not employed Fourier analysis. PMID:11273050

  12. Tunnel widening prevention with the allo-Achilles tendon graft in anterior cruciate ligament reconstruction: Surgical tips and short term followup

    PubMed Central

    Suh, Dong Won; Han, Seung Beom; Yeo, Woo Jin; Lee, Won Hee; Kwon, Jae Ho; Kyung, Bong Soo

    2017-01-01

    Background: Tunnel widening (TW) after anterior cruciate ligament (ACL) reconstruction can be a serious complication, and there is controversy over how to prevent it. This study aimed to suggest surgical approaches to prevent TW using an allo-Achilles tendon graft, and then to evaluate TW after these surgical tips were applied. Materials and Methods: Sixty two patients underwent ACL reconstruction with an allo-Achilles tendon graft. Four surgical approaches were used: Making a tibial tunnel by bone impaction, intraarticular reamer application, bone portion application for the femoral tunnel, and an additional bone plug application for the tibial tunnel. After more than 1-year, followup radiographs including anteroposterior and lateral views were taken in 29 patients encompassing thirty knees. The diameter of the tunnels at postoperation day 1 (POD1) and at followup was measured and compared. Results: In 18 knees (60%), there were no visible femoral tunnel margins on the radiographs at POD1 or followup. In the other 12 cases, which had visible femoral tunnel margins on followup radiographs, the mean femoral tunnel diameter was 8.6 mm. In the tibial tunnel, the mean diameters did not increase on all three levels (proximal, middle, and distal), and there was no statistically significant difference between the diameters at POD1 and followup. Conclusion: The suggested tips for surgery involving an allo-Achilles tendon graft can effectively prevent TW after ACL reconstruction according to this case series. These surgical tips can prevent TW. PMID:28400663

  13. Femoral offset following trochanteric femoral fractures: a prospective observational study.

    PubMed

    Buecking, Benjamin; Boese, Christoph Kolja; Seifert, Vinzenz; Ruchholtz, Steffen; Frink, Michael; Lechler, Philipp

    2015-10-01

    Reconstruction of the femoral offset reportedly improves outcome following total hip arthroplasty, but little is known of its influence following hip fractures. We aimed to establish the effect of the femoral offset on the medium-term functional outcome in elderly patients who had sustained trochanteric fractures requiring proximal femoral nailing. We measured the rotation corrected femoral offset (FORC) and relative femoral offset (FORL) on plain anteroposterior radiographs of the hip in 188 patients (58 male, 130 female) with a trochanteric fracture who underwent proximal femoral nailing at our institution. The primary outcome measure was the Harris hip score (HSS) 6 and 12 months postoperatively; the Barthel index was assessed as a secondary outcome. The mean FORC after surgery was 58 mm (±11 mm), while the mean FORL was 1.21 (±0.22). At final follow up, we found significant inverse relationships (Spearman's rank correlation coefficient, ρ) between FORC and FORL and the functional outcome assessed by the HSS (FORC: ρ = -0.207, p = 0.036; FORL: ρ = -0.247, p = 0.012), and FORL and the Barthel index (FORC: ρ = -147, p = 0.129; FORL: ρ = -0.192, p = 0.046). A consistent trend was observed after adjustment for confounding variables. Our results underline the biomechanical importance of the femoral offset for medium-term outcomes in elderly patients with trochanteric fractures. In contrast with the published findings on total hip arthroplasty, we found an inverse correlation between functional outcome and the extent of the reconstructed femoral offset. Level I - Prognostic study. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. A completely displaced Salter-Harris I fracture of the distal radial epiphysis with intact ulna: a case report and review of the literature.

    PubMed

    Beslikas, Th A; Dadoukis, D J; Nenopoulos, S P; Chrestoforides, J E

    2005-01-01

    We present a 12-year-old boy with a displaced fracture of the distal radial epiphysis type I according to the Salter-Harris classification. The distal radial epiphysis was completely dorsally displaced, while the distal ulna remained intact. The injury was result of a fall on the patient's outstretched hand. Closed reduction was applied and the forearm was immobilized with a long arm cast. In the radiological re-examination a week later, a complete re-displacement of the fracture was detected. Open reduction followed and interposed flexor tendons (flexor pollicis longus and flexor carpi radialis) were found in the anatomical position of the distal radial epiphysis. The displaced epiphysis was reduced and fixed with two Kirschner wires and a long arm cast for a period of 6 weeks. The follow-up examination 2 years later showed that the movement range of the wrist joint was not limited and skeletal growth of the radius was not disturbed. The failure of closed reduction in these fractures is due to anatomical obstacles such as periosteum, flexor tendons and pronator quadratus interposition. Repeated forceful manipulations to achieve closed reduction must be avoided because of the potential for a number of complications, such as growth arrest, compartment syndrome, and avascular necrosis of the epiphysis.

  15. The Case to Widen Defence Acquisition Research Paradigms

    DTIC Science & Technology

    2012-04-30

    expansion in the range of research paradigms employed is necessary in order to better understand, account for, and integrate social science issues into...Industry Chair, Defense Acquisition University Contracting as a Science David Lamm, Naval Postgraduate School The Case to Widen Defence...wide variety of course material ranging from project management to contract law. Mr. Branch’s clients included Computer Sciences Corporation, QSS

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

    NASA Astrophysics Data System (ADS)

    Sakaguchi, Hidetsugu

    2016-04-01

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

  17. Streambed adjustment and channel widening in eastern Nebraska

    USGS Publications Warehouse

    Rus, David L.; Dietsch, Benjamin J.; Simon, Andrew

    2003-01-01

    In eastern Nebraska, stream straightening and dredging efforts since the 1890s have disturbed the natural equilibrium of stream channels and have led to streambed adjustment by degradation and subsequent channel widening. This report describes a study to evaluate the effect these disturbances have had on stream channels in eastern Nebraska. Two sets of survey data were collected approximately 2 years apart during 1996-99 at 151 primary sites. Additionally, historical streambed-elevation data (dating back to the 1890s) were compiled from several sources for the primary sites and 45 supplemental sites, and relevant disturbances were identified for each of eight basin groupings. Streambed-elevation data sets were used to estimate the amount of change to the streambed at the sites over the time period of the data. Recent channel widening was documented for 73 of the primary sites by comparing the two survey sets. The majority of observed streambed-gradation responses appear to be related to the various straightening efforts and to the effects of grade-control structures in the study area. Channel responses were complicated by the presence of multiple disturbances. However, in many cases, the streambed-elevation data sets provide a reliable representation of the past streambed gradation, with some sites showing 6 to 7 meters of degradation since they were straightened. Many sites that had been straightened showed considerable degradation following the disturbance. This indicates that eastern Nebraska stream channels can regain equilibrium mainly through the slope adjustment process of head-ward-progressing degradation. Bank failures were documented at sites in all eight of the basin groupings analyzed, and widening rates were computed at 64 of 73 sites. Observed bank widening in the Big Blue River Basin, a relatively unstraightened basin, indicates that other disturbances besides stream-channel straightening may be causing channel responses in the basin and possibly in

  18. Cross Pins versus Endobutton Femoral Fixation in Hamstring Anterior Cruciate Ligament Reconstruction: Minimum 4-Year Follow-Up

    PubMed Central

    Kong, Chae-Gwan; Kim, Geon-Hyeong; Ahn, Chi-Young

    2012-01-01

    Purpose We aimed to compare cross-pin fixation and Endobutton femoral fixation for hamstring anterior cruciate ligament (ACL) reconstruction with respect to clinical and radiographic results, including tunnel widening and the progression of knee osteoarthritis (OA). Materials and Methods Between August 2002 and August 2005, 126 autogenous hamstring ACL reconstructions were performed using either cross pins or Endobutton for femoral fixation. Fifty-six of 75 patients in the cross-pin group and 35 of 51 patients in the Endobutton group were followed up for a minimum of 4 years. We compared the clinical and radiological results between the groups using the International Knee Documentation Committee (IKDC) evaluation form, the KT-2000 arthrometer side to side difference, the amount of tunnel widening and the advancement of OA on radiographs. Results There were no significant differences in the IKDC grades between the groups at the 4 year follow-up. There was no significant difference in the side to side difference according to KT-2000 arthrometer testing. Also, there were no significant differences in terms of tunnel widening or advancement of OA on radiographs. Conclusions Endobutton femoral fixation showed good results that were comparable to those of cross pins fixation in hamstring ACL reconstruction. PMID:22570850

  19. Review of common conditions associated with periodontal ligament widening

    PubMed Central

    Mortazavi, Hamed

    2016-01-01

    Purpose The aim of this article is to review a group of lesions associated with periodontal ligament (PDL) widening. Materials and Methods An electronic search was performed using specialized databases such as Google Scholar, PubMed, PubMed Central, Science Direct, and Scopus to find relevant studies by using keywords such as “periodontium”, “periodontal ligament”, “periodontal ligament space”, “widened periodontal ligament”, and “periodontal ligament widening”. Results Out of nearly 200 articles, about 60 were broadly relevant to the topic. Ultimately, 47 articles closely related to the topic of interest were reviewed. When the relevant data were compiled, the following 10 entities were identified: occlusal/orthodontic trauma, periodontal disease/periodontitis, pulpo-periapical lesions, osteosarcoma, chondrosarcoma, non-Hodgkin lymphoma, progressive systemic sclerosis, radiation-induced bone defect, bisphosphonate-related osteonecrosis, and osteomyelitis. Conclusion Although PDL widening may be encountered by many dentists during their routine daily procedures, the clinician should consider some serious related conditions as well. PMID:28035300

  20. A comparison of reversed locking compression-distal femoral plates and blade plates in osteotomies for young adult hip pathology.

    PubMed

    MacLean, Simon B M; Evans, Scott; O'Hara, John N

    2013-01-01

    The aim of this study was to compare fixation of proximal femoral osteotomies using reverse contralateral LCP-Distal Femoral Plates (LCP-DF) with the more traditional blade plate technique. This was a retrospective review over six years of a single surgeon's practice within a tertiary orthopaedic unit. Patient demographics were collected, along with indication for surgery. Radiological outcomes, fixation failures and the need for revision surgery were recorded. Forty-six patients were identified; 23 patients in the LCP-DF plate group (7 females, 16 males. Mean age 18.3 years old) and 23 patients in the blade plate group (6 females, 17 males. Mean age 19.1 years old). The patients' presenting conditions were; 26 Perthes'; eight hip dysplasia; 11 slipped capital femoral epiphysis; one fibrous dysplasia. Osteotomy type included; 13 Double osteotomy, 11 Imhauser; 13 pure valgus; eight valgus + rotation; There was one revision for implant failure in the LCP-DF group. In the blade plate group, there were four implant failures--three requiring revision operations (p = 0.155). In the LCP-DF group the mean neck-shaft angle difference compared to the contralateral side (if normal) or 135 degrees (if abnormal) was 0.58°. In the condylar plate group the mean difference was 4.37°. The use of a contralateral LCP-DF plate in the reverse contralateral position to stabilise proximal femoral osteotomies in our cohort confers advantages over blade plate technology. We have found that the plate is stiffer, is easier to use and provides increased screw placement options over standard proximal femoral locking plates.

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

    PubMed Central

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

    2016-01-01

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

  2. 32 CFR 644.422 - Authorized widening of a public highway, street, or alley.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Authorized widening of a public highway, street... and Easement Interests § 644.422 Authorized widening of a public highway, street, or alley. 40 U.S.C... authorized widening of a public highway, street, or alley. The conveyance may be made with or without...

  3. 32 CFR 644.422 - Authorized widening of a public highway, street, or alley.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 4 2011-07-01 2011-07-01 false Authorized widening of a public highway, street... and Easement Interests § 644.422 Authorized widening of a public highway, street, or alley. 40 U.S.C... authorized widening of a public highway, street, or alley. The conveyance may be made with or without...

  4. 32 CFR 644.422 - Authorized widening of a public highway, street, or alley.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 32 National Defense 4 2014-07-01 2013-07-01 true Authorized widening of a public highway, street... and Easement Interests § 644.422 Authorized widening of a public highway, street, or alley. 40 U.S.C... authorized widening of a public highway, street, or alley. The conveyance may be made with or without...

  5. 32 CFR 644.422 - Authorized widening of a public highway, street, or alley.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 32 National Defense 4 2012-07-01 2011-07-01 true Authorized widening of a public highway, street... and Easement Interests § 644.422 Authorized widening of a public highway, street, or alley. 40 U.S.C... authorized widening of a public highway, street, or alley. The conveyance may be made with or without...

  6. 32 CFR 644.422 - Authorized widening of a public highway, street, or alley.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 32 National Defense 4 2013-07-01 2013-07-01 false Authorized widening of a public highway, street... and Easement Interests § 644.422 Authorized widening of a public highway, street, or alley. 40 U.S.C... authorized widening of a public highway, street, or alley. The conveyance may be made with or without...

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

    ERIC Educational Resources Information Center

    Stuart, Mary

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

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

    ERIC Educational Resources Information Center

    Stuart, Mary

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

  9. Acute hip pain in the nonambulatory infant: Salter-Harris type I fracture in the capital femoral epiphysis without a traumatic history.

    PubMed

    Gross, Shari L; Orndorff, Douglas G; Romness, Mark; Poelstra, Kornelis A

    2006-05-01

    An otherwise healthy 11-month-old girl was brought to the hospital after her parents noted the acute onset of right hip pain and refusal to bear weight. No abnormalities were seen in the initial radiographs, laboratory values were within reference range, and noninvasive workup was negative for septic arthritis. The parents reported a recent minor fall from a standing position, but stated that the child seemed to return to normal without pain after a few minutes of crying. A hemarthrosis without purulence was found upon joint aspiration, and the patient improved significantly after administration of anti-inflammatory medication. Follow-up radiographs 13 days after initial presentation showed an extremely rare Salter-Harris type I proximal physeal fracture well into the healing process.

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

    PubMed Central

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

    2016-01-01

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

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

    PubMed

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

    2016-08-01

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

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

    PubMed Central

    Ufuk, Furkan; Agladioglu, Kadir; Karabulut, Nevzat

    2016-01-01

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

  13. Bone loss from the human distal tibia epiphysis during 24 days of unilateral lower limb suspension

    PubMed Central

    Rittweger, Jörn; Winwood, Keith; Seynnes, Olivier; de Boer, Maarten; Wilks, Desirée; Lea, Rosalind; Rennie, Michael; Narici, Marco

    2006-01-01

    Bone loss during immobilization is well documented. Currently, the only means of studying this in human beings is bed rest, which is resource intensive and inconvenient for the subjects. Unilateral lower limb suspension (ULLS) has been suggested as an alternative, but has not previously been demonstrated to cause bone loss. The main aim of our study was to test the hypothesis that ULLS would cause bone loss determined by peripheral quantitative computed tomography (pQCT). We investigated eight young healthy volunteers (19.1 ± 0.7 years; body mass index, 22.4 ± 2.6 kg m−2), who underwent ULLS for 24 days; their right foot was suspended with a strap attached to the shoulder so the knee angle was 10 deg and they wore a left shoe with a 7.5 cm sole to allow clearance of the right foot and used bilateral crutches to perambulate. Bone scans were obtained by pQCT from the distal epiphyses and from the diaphyses of the tibia in each leg twice before suspension, at days 7, 14 and 21 of the ULLS, and at days 4, 9, 35 and 90 of recovery. After 21 days of ULLS, bone mineral content of the peripheral portion of the epiphysis of the suspended tibia was reduced by 0.89 ± 0.48% (from 280.9 ± 34.5 to 278.4 ± 34.2 mg mm−1, P < 0.001) but no changes were observed in its central portion or in the unsuspended tibia. In the peripheral epiphyseal portion, significant bone loss (by 0.32 ± 0.54%, P = 0.045) occurred as early as day 7 of ULLS. We have demonstrated, for the first time, that in humans bone is lost during ULLS at rates comparable to those seen with bed rest, without alteration in limb fluid volumes thus validating the technique and raising important questions about the mechanisms involved. PMID:17023509

  14. Femoral Head and Neck Excision.

    PubMed

    Harper, Tisha A M

    2017-07-01

    Femoral head and neck excision is a surgical procedure that is commonly performed in small animal patients. It is a salvage procedure that is done to relieve pain in the coxofemoral joint and restore acceptable function of the limb. Femoral head and neck excision is most commonly used to treat severe osteoarthritis in the coxofemoral joint and can be done in dogs and cats of any size or age. The procedure should not be overused and ideally should not be done when the integrity of the coxofemoral joint can be restored. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Femoral revision with taper stems: results at ten years follow-up.

    PubMed

    Cherubino, Paolo; Fagetti, Alessandro; D'Angelo, Fabio; Surace, Michele Francesco

    2010-10-01

    In the case of extensively damaged meta-diaphyseal femoral bone with cortices thinning and widened femoral canal, tapered stems allow a good primary fixation and early weight-bearing. A retrospective review was conducted to evaluate long-term results of modular revision taper stems implanted from March 1999 to December 2002. Sixty-five consecutive hip revision surgeries were performed, mostly for aseptic loosening (75% of the cases). Femoral bone stock defects were classified according to AAOS's criteria and consisted mainly in type II (cavitary defects, 44.6%) and type III (combined defects, 33.9%). A trochanteric osteotomy was performed in 25 cases (38%) to remove primary implants that were cemented in 35 cases (54%). The mean postoperative follow-up was 109 months (range, 76 to 131 months). Clinical assessment at follow-up showed a significantly improved mean Harris Hip Score from 42 points preoperatively to 81 points postoperatively, while the x-ray examination did show a satisfactory distal integration of the stem in all cases and satisfactory reconstitution of the femoral bone stock in 47% of cases. The average subsidence of the stem at follow-up was less than one millimeter. According to data analysis, a leg-length discrepancy exceeding 15 millimeters caused significantly worse functional outcome and pain.

  16. Volar lunate dislocation associated with a Salter-Harris Type III fracture of the distal radial epiphysis in an 8 year-old child.

    PubMed

    Sharma, H; Azzopardi, T; Sibinski, M; Wilson, N

    2007-02-01

    Carpal fracture-dislocations in children are extremely rare injuries and are easily missed or misdiagnosed. An 8 year-old boy who presented with a volar lunate dislocation associated with a Salter Harris Type III injury of the distal radial epiphysis is reported. Open reduction without internal fixation followed by plaster immobilisation achieved good short-term results.

  17. Detecting a disruption of blood flow to the femoral head after ischemic injury using 4 different techniques: a preliminary study.

    PubMed

    Standefer, Karen Divita; Pierce, William A; Sucato, Daniel J; Kim, Harry K W

    2012-01-01

    Disruption of blood flow to the femoral head can have a detrimental effect on the clinical outcome after a closed or open reduction for the treatment of developmental dysplasia of the hip and after a treatment of slipped capital femoral epiphysis. Availability of a clinically reliable and easy-to-use technique to monitor the blood flow before, during, and after a therapeutic intervention may allow early detection and more effective management of this complication. An experimental investigation was performed to evaluate 4 different sensors/techniques for their ability to detect an acute disruption of blood flow to the immature femoral head. Under general anesthesia, the femoral heads of 10 immature pigs were exposed and total head ischemia was induced by ligating the femoral neck and transecting the ligamentum teres. Blood flow was assessed before and after the induction of ischemia using 1 of 4 techniques. The following sensors/techniques were evaluated: fiber optic pressure (FOP), piezoelectric pressure, partial pressure of oxygen, and laser Doppler flowmetry (LDF). The time taken to observe a 50% reduction of the preischemia level was determined and the sensor outputs were monitored until each reached a steady level. All techniques demonstrated a reduction in their respective measurements after a disruption of blood flow to the femoral head. However, the response time differed, even between the 2 pressure sensors (FOP and piezoelectric pressure at 3 and 15 min, respectively). The fastest response time for a 50% reduction was observed with the LDF (2 min) and the FOP (3 min) sensors. The partial pressure of oxygen was the slowest to change, taking over 30 minutes. Technique-dependent advantages and disadvantages were seen. The FOP sensor was fragile and susceptible to the positioning of the sensor tip. The LDF sensor was susceptible to motion artifact. The LDF and the FOP sensors demonstrated a rapid decline in their respective measurements after the induction of

  18. Femoral head cartilage disarticulation disorder

    USDA-ARS?s Scientific Manuscript database

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

  19. Cardiac resynchronization therapy: Femoral approach.

    PubMed

    Brandão, Luís; Miranda, Rita; Almeida, Sofia; Ribeiro, Luciano; Alvarenga, Carlos; João, Isabel; Pereira, Hélder

    2017-04-01

    We describe the case of a 62-year-old female patient with bilateral subclavian vein occlusion, in whom a cardiac resynchronization system was implanted via a femoral vein. Copyright © 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.

  20. Widening Expertise in Space Science in Developing Countries

    NASA Astrophysics Data System (ADS)

    Willmore, P.

    For some time, COSPAR has been planning a programme of capacity-building workshops to be held in developing countries with the intention of widening expertise in space science and promoting the use of data archives from space missions. The first of these was held at Instituto Nacional de Pesquisas Espaciais (INPE), São José dos Campos, Brazil from 4-13th December 2001. The next two will be held at the Udaipur Solar Observatory, Udaipur, India and in Beijing, China, respectively, during 2003. The workshops are innovative in character, and their objectives and their concepts will be described, as well as the experience gained from the first workshop in Brazil.

  1. Imaging appearance of entrapped periosteum within a distal femoral Salter-Harris II fracture.

    PubMed

    Chen, Johnathan; Abel, Mark F; Fox, Michael G

    2015-10-01

    Salter Harris II fractures of the distal femur are associated with a high incidence of complications, especially premature physeal closure. Many risk factors for this high rate of premature physeal closure have been proposed. More recently, entrapment of periosteum within the physis has been suggested as an additional predisposing factor for premature physeal closure. The radiographic diagnosis of entrapped soft tissues, including periosteum, can be suggested in the setting of a Salter-Harris II fracture when the fracture does not reduce and physeal widening >3 mm remains. We report a patient who sustained a distal femoral Salter-Harris II fracture following a valgus injury. The patient had persistent distal medial physeal widening >5 mm following attempted reduction. A subsequent MRI revealed a torn periosteum entrapped within the distal femoral physis. Following removal of the periosteum, the patient developed a leg length discrepancy which required physiodesis of the contralateral distal femur. We present this case to raise awareness of the importance of having a high index of suspicion of periosteal entrapment in the setting of Salter-Harris II fractures since most consider entrapped periosteum an indication for surgery.

  2. Alteration of femoral bone morphology and density in COX-2−/− mice

    PubMed Central

    Robertson, Galen; Xie, Chao; Chen, Di; Awad, Hani; Schwarz, Edward M.; O’Keefe, Regis J.; Guldberg, Robert E.; Zhang, Xinping

    2009-01-01

    A role of COX-2 in pathological bone destruction and fracture repair has been established; however, few studies have been conducted to examine the involvement of COX-2 in maintaining bone mineral density and bone micro-architecture. In this study, we examined bone morphology in multiple trabecular and cortical regions within the distal and diaphyseal femur of 4-month-old wild-type and COX-2−/− mice using micro-computed tomography. Our results demonstrated that while COX-2−/− female mice had normal bone geometry and trabecular microarchitecture at 4 months of age, the male knockout mice displayed reduced bone volume fraction within the distal femoral metaphysis. Furthermore, male COX-2−/− mice had a significant reduction in cortical bone mineral density within the central cortical diaphysis and distal epiphysis and metaphysis. Consistent with the observed reduction in cortical mineral density, biomechanical testing via 4-point-bending showed that male COX-2−/− mice had a significant increase in postyield deformation, indicating a ductile bone phenotype in male COX-2−/− mice. In conclusion, our study suggests that genetic ablation of COX-2 may have a sex-related effect on cortical bone homeostasis and COX-2 plays a role in maintaining normal bone micro-architecture and density in mice. PMID:16731065

  3. Alteration of femoral bone morphology and density in COX-2-/- mice.

    PubMed

    Robertson, Galen; Xie, Chao; Chen, Di; Awad, Hani; Schwarz, Edward M; O'Keefe, Regis J; Guldberg, Robert E; Zhang, Xinping

    2006-10-01

    A role of COX-2 in pathological bone destruction and fracture repair has been established; however, few studies have been conducted to examine the involvement of COX-2 in maintaining bone mineral density and bone micro-architecture. In this study, we examined bone morphology in multiple trabecular and cortical regions within the distal and diaphyseal femur of 4-month-old wild-type and COX-2-/- mice using micro-computed tomography. Our results demonstrated that while COX-2-/- female mice had normal bone geometry and trabecular microarchitecture at 4 months of age, the male knockout mice displayed reduced bone volume fraction within the distal femoral metaphysis. Furthermore, male COX-2-/- mice had a significant reduction in cortical bone mineral density within the central cortical diaphysis and distal epiphysis and metaphysis. Consistent with the observed reduction in cortical mineral density, biomechanical testing via 4-point-bending showed that male COX-2-/- mice had a significant increase in postyield deformation, indicating a ductile bone phenotype in male COX-2-/- mice. In conclusion, our study suggests that genetic ablation of COX-2 may have a sex-related effect on cortical bone homeostasis and COX-2 plays a role in maintaining normal bone micro-architecture and density in mice.

  4. [Epiphyseolysis of the femoral head: new aspects of diagnostics and therapy].

    PubMed

    Funk, J F; Lebek, S

    2014-08-01

    Slipped capital femoral epiphysis (SCFE) is the most common hip disease in adolescents and is always surgically treated with the aim to avoid further slippage and to reduce the risk of degenerative arthritis at young age. A summary of the etiology, pathogenesis, clinical features, radiographic imaging and current therapy concepts is given. A selective review of the literature was performed. With an increasing body mass index in adolescents the incidence of SCFE also increases. The diagnostic routine is comprised of a clinical examination with the evaluation of Drehmann's sign and a radiographic evaluation including anterior-posterior aspect and frog's legs view. In situ stabilization with a single screw is the standard treatment for the most prevalent mild or moderate stable slippages. In cases of acute slippage a gentle reduction maneuver may be attempted. Hardware removal must not be performed before epiphyseal closure. Common bilateral but not simultaneous occurrence of the disease requires prophylactic pinning of the unaffected side by default, at least in central Europe. Various surgical treatment options exist to reduce the femoroacetabular impingement caused by the slippage. Current treatment algorithms result in satisfactory long-term outcomes. If the risk of developing degenerative arthritis after SCFE may be reduced even more with modern arthroscopic or open surgical procedures to restore the anatomic pre-slip conditions has to be confirmed through further long-term studies. The implementation of programs to prevent obesity in adolescents may also reduce the incidence of SCFE.

  5. [Femoral shaft fractures in children].

    PubMed

    Dietz, H-G; Schlickewei, W

    2011-05-01

    Femoral shaft fractures in children represent 1.5% of all fractures in childhood. Up to the age of 4 years, conservative treatment in a hip spica or short-term overhead traction is the therapy of choice. Femoral shaft fractures between the age of 5 and 16 years should be treated surgically. In over 90% of these cases elastic stable intramedullary nailing (ESIN) is the premier treatment option. Additional end caps can be used for unstable fractures and in length discrepancy. The external fixator and the locking plate are reserved for fractures with severe soft tissue injuries, vascular problems and some specific situations mentioned later on. By adhering to these standards good results can be achieved with a low complication rate.

  6. [Osteonecrosis of the femoral head].

    PubMed

    Lafforgue, Pierre

    2002-03-15

    The femoral head is the main location of avascular osteonecrosis. The lesion remains asymptomatic for several months or years before causing non specific hip pain. Risk factors have been identified, mainly femoral neck fractures, corticosteroid therapy and related conditions (lupus erythematosus, organ transplantations), alcohol abuse, dyslipidemia, sickle cell disease, HIV infection, caisson workers, Gaucher's disease, male sex. When typical radiological signs are lacking, MRI is the best investigation. Progression toward hip joint damage highly depends on the necrotic volume assessed at MRI. The combination of plain radiographs which help staging the severity of osteonecrosis, and MRI which indicates the prognosis of the lesion, determines the therapeutic options: symptomatic pain relief therapies or surgical treatment (core decompression, osteotomy or total hip replacement).

  7. Arthroplasty in Femoral Head Osteonecrosis

    PubMed Central

    Nam, Dong Cheol; Jung, Kwangyoung

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Lightfoot, Nic

    2009-01-01

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

  9. Joining the Dots between Teacher Education and Widening Participation in Higher Education

    ERIC Educational Resources Information Center

    Duckworth, Vicky; Thomas, Liz; Bland, Derek

    2016-01-01

    In England and Australia, higher education institutions are required to widen participation in higher education by including students from under-represented and non-traditional groups. Widening participation is most effective when it starts early--during compulsory education and other forms of pre-tertiary education. Higher education institutions…

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

    ERIC Educational Resources Information Center

    Suh, Suhyun; Malchow, Ashley; Suh, Jingyo

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Greenbank, Paul

    2007-01-01

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

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

    ERIC Educational Resources Information Center

    McCulloch, Alistair; Thomas, Liz

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Suh, Suhyun; Malchow, Ashley; Suh, Jingyo

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Lightfoot, Nic

    2009-01-01

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

  15. How Effective Are Collaborative Approaches for Widening Participation in Further Education and Training?

    ERIC Educational Resources Information Center

    Giwa, Moore

    2008-01-01

    This study examines the different types, and effectiveness, of collaboration used by providers to widen participation in further education and training in England between 2001 and 2003. The first section, an introduction, sets a scene for the study and definitions are offered for the main terminology--collaboration and widening participation. The…

  16. Subsidence of collarless uncemented femoral stems in total hips replacements performed for trauma.

    PubMed

    Pentlow, Alanna K; Heal, James S

    2012-06-01

    Collarless, uncemented, femoral stems give excellent results in elective hip replacements but few studies look at outcomes in trauma patients. The presence of osteoporosis and subsequent widened femoral canal may compromise the mechanical stability of uncemented femoral stems resulting in early subsidence. The aim of this study was to assess whether early subsidence occurred when collarless uncemented stems were used to treat trauma patients. Post-operative radiographs of 46 patients, mean age 71, who underwent an uncemented, collarless, total hip replacement for trauma, were reviewed. The difference in distance from the calcar to the prosthesis tip between the immediate post operative radiograph and the subsequent follow-up radiograph was calculated and adjusted for magnification. The same procedure was performed on 36 age-matched patients, who underwent elective hip replacements for osteoarthritis. Hospital notes were reviewed to assess for complications and DEXA scans reviewed for trauma patients where available. The mean femoral stem subsidence was significantly greater in the fracture cohort than in elective patients (p=0.001) with mean subsidence of 4.27 mm (range 0.02-22.05 mm) and 1.57 mm (range 0-5.5 mm), respectively. In the fracture cohort there were 4 revisions within 6 months of surgery, 1 for infection and 3 for femoral stem subsidence leading to dislocation. There were no revisions in the elective cohort. This study showed that collarless uncemented stems subsided significantly more when performed for fractures and had a high early revision rate. We recommend that uncemented collarless should not be used in trauma patients requiring total hip replacement. Copyright © 2011 Elsevier Ltd. All rights reserved.

  17. Drug conjugation to hyaluronan widens therapeutic indications for ovarian cancer

    PubMed Central

    Montagner, Isabella Monia; Merlo, Anna; Carpanese, Debora; Zuccolotto, Gaia; Renier, Davide; Campisi, Monica; Pasut, Gianfranco; Zanovello, Paola; Rosato, Antonio

    2015-01-01

    Management of ovarian cancer still requires improvements in therapeutic options. A drug delivery strategy was tested that allows specific targeting of tumor cells in combination with a controlled release of a cytotoxic molecule. To this aim, the efficacy of a loco-regional intraperitoneal treatment with a bioconjugate (ONCOFID-S) derived by chemical linking of SN-38, the active metabolite of irinotecan (CPT-11), to hyaluronan was assessed in a mouse model of ovarian carcinomatosis. In vitro, the bioconjugate selectively interacted with ovarian cancer cells through the CD44 receptor, disclosed a dose-dependent tumor growth inhibition efficacy comparable to that of free SN-38 drug, and inhibited Topoisomerase I function leading to apoptosis by a mechanism involving caspase-3 and -7 activation and PARP cleavage. In vivo, the intraperitoneal administration of ONCOFID-S in tumor-bearing mice did not induce inflammation, and evidenced an improved therapeutic efficacy compared with CPT-11. In conclusion, SN-38 conjugation to hyaluronan significantly improved the profile of in vivo tolerability and widened the field of application of irinotecan. Therefore, this approach can be envisaged as a promising therapeutic strategy for loco-regional treatment of ovarian cancer. PMID:26097871

  18. On the Impact of Widening Vector Registers on Sequence Alignment

    SciTech Connect

    Daily, Jeffrey A.; Kalyanaraman, Anantharaman; Krishnamoorthy, Sriram; Ren, Bin

    2016-09-22

    Vector extensions, such as SSE, have been part of the x86 since the 1990s, with applications in graphics, signal processing, and scientific applications. Although many algorithms and applications can naturally benefit from automatic vectorization techniques, there are still many that are difficult to vectorize due to their dependence on irregular data structures, dense branch operations, or data dependencies. Sequence alignment, one of the most widely used operations in bioinformatics workflows, has a computational footprint that features complex data dependencies. In this paper, we demonstrate that the trend of widening vector registers adversely affects the state-of-the-art sequence alignment algorithm based on striped data layouts. We present a practically efficient SIMD implementation of a parallel scan based sequence alignment algorithm that can better exploit wider SIMD units. We conduct comprehensive workload and use case analyses to characterize the relative behavior of the striped and scan approaches and identify the best choice of algorithm based on input length and SIMD width.

  19. Tropical widening in models, reanalyses, and satellite observations

    NASA Astrophysics Data System (ADS)

    Davis, S. M.; Rosenlof, K. H.; Young, P. J.

    2012-12-01

    Poleward migration of the latitudinal edge of the tropics of ~0.25 - 3° decade-1 has been reported in several recent studies based on satellite, radiosonde, and reanalysis data covering the past ~30 years. Disagreements between models and observations have been noted, and to date, it has been unclear to what extent this large range of trends can be explained by the use of different data sources, time periods, and edge definitions. In this presentation, we address these issues by applying a suite of tropical edge latitude diagnostics based on tropopause height, winds, precipitation/evaporation, and outgoing longwave radiation (OLR) to six reanalyses and four satellite data sets. These diagnostics include both previously used definitions and new definitions designed for more robust detection. The wide range of widening trends is shown to be primarily due to the use of different data sets and edge definitions, and only secondarily due to varying start/end dates. We also show that the large trends (> ~ 1° decade-1) previously reported in tropopause and OLR diagnostics are partially due to the use of subjective definitions based on absolute thresholds. Statistically significant Hadley cell expansion based on the mean meridional streamfunction of ~1.0° decade-1 is present in all but one reanalysis, whereas other diagnostics yield trends of -0.5 - 0.8° decade-1 that are mostly insignificant. These results are compared to coupled model trends calculated over both the 20th and 21st centuries.

  20. Femoral Nerve Palsy with Patella Fracture

    PubMed Central

    Lee, Sang Hyoung; Lee, Tong Joo; Woo, Min Su

    2013-01-01

    Femoral neuropathy may be associated with various etiologies and can cause severe walking disability. We present the case of a 25-year-old woman who underwent surgical repair for a patella fracture and complained of lower extremity pain, paresthesia, and weakness postoperatively. Electromyography and magnetic resonance imaging (MRI) revealed partial peripheral neuropathy of the left femoral nerve associated with the patella fracture. To our knowledge, this is the first reported case of femoral neuropathy associated with a patella fracture. PMID:24369003

  1. Tissue sparing total femoral arthroplasty: technical note.

    PubMed

    Willimon, Samuel Clifton; Bolognesi, Michael P; Attarian, David E

    2011-01-01

    It is predicted that the number of revision hip and knee arthroplasties will double by the years 2026 and 2015, respectively. As the burden of end-stage prosthetic disease increases, there will be a greater potential need for total femoral arthroplasty. This report describes a patient with a femoral neck fracture nonunion with an ipsilateral multiply revised failed total knee arthroplasty treated by a tissue sparing total femoral arthroplasty. The technique is described, and potential benefits are reviewed.

  2. [Type I Salter-Harris lesion of the distal humeral epiphysis in children under one year of age. Case report and literature review].

    PubMed

    Suárez Ayala, Fabián Mauricio; Ramiro Domínguez, Anel; Matus Jiménez, Juan

    2010-01-01

    The pure physeal lesion of the distal humeral epiphysis is an uncommon and difficult-to-diagnose condition due to the absence of calcified ossification centers during the first three months of life, which usually leads to delaying the diagnosis or to misdiagnosis. However, the prognosis is good and complications are few. We report the case of a 3-month-old female patient who was admitted for open reduction and fixation with Kirschner nails.

  3. Quantitative comparison of bone mineral density characteristics of the distal epiphysis of third metacarpal bones from Thoroughbred racehorses with or without condylar fracture.

    PubMed

    Bogers, Sophie H; Rogers, Chris W; Bolwell, Charlotte; Roe, Wendi; Gee, Erica; McIlwraith, C Wayne

    2016-01-01

    To compare regional proportions and spatial distributions of volumetric bone mineral density (BMDv) of the palmar aspect of the distal epiphysis of the third metacarpal bone (McIII) in limbs with or without a condylar fracture from Thoroughbred racehorses. McIIIs from cadavers of Thoroughbred racehorses with (n = 6 bones) and without (8) a condylar fracture. BMDv and spatial distributions of BMDv in peripheral quantitative CT images of the distal epiphysis of McIIIs were quantitatively assessed with spatial analysis software. Relative proportions of voxels within 9 threshold categories of BMDv and spatial statistics for BMDv distribution were compared between fractured and nonfractured limbs. No significant differences in BMDv characteristics were identified between fractured and nonfractured limbs, although fractured limbs had a lower proportion of voxels in the BMDv thresholds 700 to < 800 mg/cm(3) and 800 to < 900 mg/cm(3) but a higher proportion of voxels in the BMDv threshold 1,000 to < 1,100 mg/cm(3) for the central condylar region of the medial condyle. Results of spatial analysis reflected the response of bone to race training rather than differences between fractured and nonfractured limbs. In both limb groups, uniform clusters of low BMDv with areas of high BMDv were identified. BMDv characteristics of the distal epiphysis of McIII reflected training load, and fracture characteristics were subtle. Serial imaging techniques in conjunction with detailed training data are required to elucidate the onset of the pathological response to load in horses.

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

    PubMed

    McMichael, Anthony J; Butler, Colin D

    2006-12-01

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

  5. Widening educational differences in cancer survival in Norway.

    PubMed

    Kravdal, Håkon

    2014-04-01

    All-cause and cause-specific mortality have long been known to be associated with various indicators of socio-economic status, and social gradients have been shown also for cancer survival. In recent decades, several studies have reported increasing social differentials in mortality rates. This study aims to investigate the development with respect to cancer survival, which has not been done before. Discrete-time hazard regression models for cancer deaths among women and men diagnosed with cancer 1970-2007 at age 30-89 were estimated, using register data encompassing the entire Norwegian population. The analysis was based on >200,000 cancer deaths during over 2 million person-years of exposure among >440,000 individuals diagnosed with cancer. There has been an increasing advantage for women of all educational categories when compared with those with only compulsory schooling. No such widening of the educational gap has appeared with respect to cancer survival among men. Increasing educational differentials in health at the time of diagnosis, health behaviour and cancer treatment seem plausible, and would to some extent accord with the increasing social gaps in all-cause or cause-specific mortality rates that have been reported in other studies. Also, it is not impossible that such trends in the educational gradients in health and treatment are stronger for women than for men, though such sex differences have not been indicated in mortality studies. There is no obvious explanation for the complete absence of change in the education effects among men.

  6. Corporatization of pain medicine: implications for widening pain care disparities.

    PubMed

    Meghani, Salimah H

    2011-04-01

    The current health care system in the United States is structured in a way that ensures that more opportunity and resources flow to the wealthy and socially advantaged. The values intrinsic to the current profit-oriented culture are directly antithetical to the idea of equitable access. A large body of literature points to disparities in pain treatment and pain outcomes among vulnerable groups. These disparities range from the presence of disproportionately higher numbers and magnitude of risk factors for developing disabling pain, lack of access to primary care providers, analgesics and interventions, lack of referral to pain specialists, longer wait times to receive care, receipt of poor quality of pain care, and lack of geographical access to pharmacies that carry opioids. This article examines the manner in which the profit-oriented culture in medicine has directly and indirectly structured access to pain care, thereby widening pain treatment disparities among vulnerable groups. Specifically, the author argues that the corporatization of pain medicine amplifies disparities in pain outcomes in two ways: 1) directly through driving up the cost of pain care, rendering it inaccessible to the financially vulnerable; and 2) indirectly through an interface with corporate loss-aversion/risk management culture that draws upon irrelevant social characteristics, thus worsening disparities for certain populations. Thus, while financial vulnerability is the core reason for lack of access, it does not fully explain the implications of corporate microculture regarding access. The effect of corporatization on pain medicine must be conceptualized in terms of overt access to facilities, providers, pharmaceuticals, specialty services, and interventions, but also in terms of the indirect or covert effect of corporate culture in shaping clinical interactions and outcomes. Wiley Periodicals, Inc.

  7. [Effect of continuous femoral nerve catheter length on blockade of femoral nerve, lateral femoral cutaneous nerve and obturator nerve].

    PubMed

    Zhu, Feng; Hu, Yan; Zhang, Wei

    2013-02-18

    To assess the effects of length of continuous femoral catheter on blockade of femoral nerve, lateral femoral cutaneous nerve and obturator nerve. In the study, 70 patients with American Association of Anesthesiologist grades I-II undergoing total knee arthroplasty were randomly divided into three groups, femoral nerve catheters were inserted 5 cm, 10 cm or 20 cm with assistance of a nerve stimulator, patient-controlled analgesia pumps were connected after load of 30 mL 0.3% ropivacaine via the catheters. Sensory blockade of the femoral nerve, lateral femoral cutaneous nerve and obturator nerve were recorded at 24 h postoperatively. Visual analog scale (VAS) pain scores during rest and motion were recorded at 24 h and 48 h postoperatively. The blockade effect of lateral femoral nerve in the 20 cm group was the best. There was no significant difference in sensory blockade between the 5 cm group and the 10 cm group. There was no significant difference in VAS score among the three groups. When continuous femoral nerve block is used for postoperative analgesia after total knee arthroplasty surgery, the catheters that are inserted 5 cm, 10 cm or 20 cm could provide similar and satisfying analgesia effect.

  8. Outcomes after trifocal femoral fractures.

    PubMed

    Griffin, Michelle; Dick, Alastair G; Umarji, Shamim

    2014-01-01

    Trifocal femur fractures are those of the femoral neck, diaphysis, and distal femur. These high-energy injuries predominantly occur in young people with the potential for long-term complications and disability. We present the cases of two men who were treated with proximal dynamic hip screws and distal periarticular locking plates to effectively manage trifocal femur fractures. Our cases have shown union at 2 years with good functional outcomes without the need for reintervention. We provide evidence for a successful surgical treatment option for these rare and complex injuries.

  9. Outcomes after Trifocal Femoral Fractures

    PubMed Central

    Griffin, Michelle; Dick, Alastair G.; Umarji, Shamim

    2014-01-01

    Trifocal femur fractures are those of the femoral neck, diaphysis, and distal femur. These high-energy injuries predominantly occur in young people with the potential for long-term complications and disability. We present the cases of two men who were treated with proximal dynamic hip screws and distal periarticular locking plates to effectively manage trifocal femur fractures. Our cases have shown union at 2 years with good functional outcomes without the need for reintervention. We provide evidence for a successful surgical treatment option for these rare and complex injuries. PMID:24800097

  10. Unusual presentation of a femoral stress fracture

    PubMed Central

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

    2013-01-01

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

  11. Relaxation response in femoral angiography.

    PubMed

    Mandle, C L; Domar, A D; Harrington, D P; Leserman, J; Bozadjian, E M; Friedman, R; Benson, H

    1990-03-01

    Immediately before they underwent femoral angiography, 45 patients were given one of three types of audiotapes: a relaxation response tape recorded for this study, a tape of contemporary instrumental music, or a blank tape. All patients were instructed to listen to their audiotape during the entire angiographic procedure. Each audiotape was played through earphones. Radiologists were not told the group assignment or tape contents. The patients given the audiotape with instructions to elicit the relaxation response (n = 15) experienced significantly less anxiety (P less than .05) and pain (P less than .001) during the procedure, were observed by radiology nurses to exhibit significantly less pain (P less than .001) and anxiety (P less than .001), and requested significantly less fentanyl citrate (P less than .01) and diazepam (P less than .01) than patients given either the music (n = 14) or the blank (n = 16) control audiotapes. Elicitation of the relaxation response is a simple, inexpensive, efficacious, and practical method to reduce pain, anxiety, and medication during femoral angiography and may be useful in other invasive procedures.

  12. Interrelationship of the Risser sign, knee epiphysis, and bone age in determining skeletal maturity: a case-control study.

    PubMed

    Kim, Hak Jun; Yoon, Jung-Ro; Modi, Chetna; Modi, Hitesh; Song, Hae-Ryong; Song, Sang-Youn

    2011-05-01

    The purpose of our study was to correlate the chronological age with Risser staging, knee epiphyseal closure, and bone age by the Tanner and Whitehouse (TW3) or Greulich and Pyle (GP) method simultaneously, to find out the most correlated methods used to calculate the age in a Korean population. A case-control study was carried out in 293 children between the age of 9 and 18 years. Skeletal age was estimated by using the atlas of the GP and TW3 methods; knee epiphysis closure and the Risser staging were also noted. Spearman's correlation coefficient test showed that in both the sexes the GP method is more correlated (r=0.58 for female patients, range: 0.55-0.61; and 0.58 for male patients, range: 0.54-0.61) with the Risser staging and physeal stages of the knee joint than the TW3 method (r=0.52 for female patients, range: 0.44-0.61; and 0.55 for male patients, range: 0.48-0.61) in Korean children. Our results suggested that by using the combination of Risser sign, knee epiphyseal closure, and GP bone age, one can calculate a person's chronological age most accurately.

  13. Intra-epiphyseal stress injury of the proximal tibial epiphysis: preliminary experience of magnetic resonance imaging findings.

    PubMed

    Tony, G; Charran, A; Tins, B; Lalam, R; Tyrrell, P N M; Singh, J; Cool, P; Kiely, N; Cassar-Pullicino, V N

    2014-11-01

    Stress induced injuries affecting the physeal plate or cortical bone in children and adolescents, especially young athletes, have been well described. However, there are no reports in the current English language literature of stress injury affecting the incompletely ossified epiphyseal cartilage. We present four cases of stress related change to the proximal tibial epiphysis (PTE) along with their respective magnetic resonance imaging (MRI) appearances ranging from subtle oedema signal to a pseudo-tumour like appearance within the epiphyseal cartilage. The site and pattern of intra-epiphyseal injury is determined by the type of tissue that is affected, the maturity of the skeleton and the type of forces that are transmitted through the tissue. We demonstrate how an awareness of the morphological spectrum of MRI appearances in intra-epiphyseal stress injury and the ability to identify concomitant signs of stress in other nearby structures can help reduce misdiagnosis, avoid invasive diagnostic procedures like bone biopsy and reassure patients and their families. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  14. Articulated hip distraction: a treatment option for femoral head avascular necrosis in adolescence.

    PubMed

    Gomez, Jaime A; Matsumoto, Hiroko; Roye, David P; Vitale, Michael G; Hyman, Joshua E; van Bosse, Harold J P; Marangoz, Salih; Sala, Debra A; Stein, Matthew I; Feldman, David S

    2009-03-01

    To describe the clinical outcomes of adolescent patients treated with articulated hip distraction (AHD) for avascular necrosis (AVN) of the femoral head. Outcomes were examined in order to better understand the usefulness of and indications for performing hip arthrodiastasis in this patient population. : Retrospective review was performed on 31 hips with femoral head AVN treated with AHD. Mean age at treatment was 14.7 years. Preoperative and follow-up pain and physical limitations, as well as follow-up range of motion, were assessed. Follow-up assessment was obtained at 18.7 years. Time of follow-up was 57.4 months after distraction. The etiologies of AVN were the following: 10 slipped capital femoral epiphysis (SCFE), 5 idiopathic AVN, 3 with hip dysplasia, and 12 others. There was a significant difference in pain preoperatively and postoperatively (P<0.001), most patients (78.6%, n=22) had less pain after the treatment. Multivariate regression model demonstrated that patients with SCFE were likely to have less improvement in pain than patients with other etiologies (odds ratio, 22.7; P=0.035). All patients had activity limitations before the treatment; at the postoperative assessment, half of our patients (n=14) reported no limitations in their regular daily activities. Eight patients had minor complications with the fixator. At follow-up, 5 patients (17.2%) converted to total hip replacement or arthrodesis. Survival rates were 90.6% at 5 years, 77.7% at 10 years, and 38.8% at 15 years. Hip distraction arthroplasty in adolescent patients with symptomatic AVN reduces the amount of pain and limitation in daily activities at a follow-up of 4.7 years. Arthrodiastasis is not the final solution to AVN. With longer follow-up, patient's symptoms increases. Patients with AVN secondary to SCFE do not seem to benefit from this procedure as much as other patients do. Articulated hip distraction is a safe and appropriate procedure to perform in these patients. The procedure

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

    ClinicalTrials.gov

    2016-10-06

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

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

    ClinicalTrials.gov

    2017-06-23

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

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

    ClinicalTrials.gov

    2016-08-03

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

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

    ClinicalTrials.gov

    2016-10-06

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

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

    ClinicalTrials.gov

    2017-06-27

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

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

    ClinicalTrials.gov

    2016-05-09

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

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

    ClinicalTrials.gov

    2016-10-06

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

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

    ClinicalTrials.gov

    2017-03-02

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

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

    ClinicalTrials.gov

    2017-06-23

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

  4. FDA Widens Access to 'Cooling Cap' to Stop Hair Loss in Cancer Patients

    MedlinePlus

    ... FDA Widens Access to 'Cooling Cap' to Stop Hair Loss in Cancer Patients Treatment now OK'd ... cancer patients may be able to ward off hair loss during chemotherapy treatment. A cooling cap approved ...

  5. Medial joint space widening of the ankle in displaced Tillaux and Triplane fractures in children.

    PubMed

    Gourineni, Prasad; Gupta, Asheesh

    2011-10-01

    Tillaux and Triplane fractures occur in children predominantly from external rotation mechanism. We hypothesized that in displaced fractures, the talus would shift laterally along with the distal fibula and the distal tibial epiphyseal fragment increasing the medial joint space. Consecutive cases evaluated retrospectively. Level I and Level II centers. Twenty-two skeletally immature patients with 14 displaced Triplane fractures and eight displaced Tillaux fractures were evaluated for medial joint space widening. Measurement of fracture displacement and medial joint space widening before and after intervention. Thirteen Triplane and six Tillaux fractures (86%) showed medial space widening of 1 to 9 mm and equal to the amount of fracture displacement. Reduction of the fracture reduced the medial space to normal. There were no known complications. Medial space widening of the ankle may be a sign of ankle fracture displacement. Anatomic reduction of the fracture reduces the medial space and may improve the results in Tillaux and Triplane fractures.

  6. Treatment of neglected femoral neck fracture

    PubMed Central

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

    2015-01-01

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

  7. Rising CO2 widens the transpiration-photosynthesis optimality space

    NASA Astrophysics Data System (ADS)

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

    2016-04-01

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

  8. Lateral femoral cutaneous neuralgia: an anatomical insight.

    PubMed

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

    2003-07-01

    A detailed anatomic study was carried out on the lateral femoral cutaneous nerve to better understand the etiology and treatment of lateral femoral cutaneous neuralgia. As it passed from the pelvis into the thigh, the lateral femoral cutaneous nerve ran through an "aponeuroticofascial tunnel," beginning at the iliopubic tract and ending at the inguinal ligament; as it passed through the tunnel, an enlargement in its side-to-side diameter was observed, suggesting that the fascial structures proximal to the inguinal ligament may be implicated in the genesis of lateral femoral cutaneous neuralgia. The finding of pseudoneuromas at this location, distant from the inguinal ligament, supports this hypothesis. The anterior superior iliac spine is located approximately 0.7 cm from the lateral femoral cutaneous nerve and serves as the bony landmark for nerve localization. Within the first 3 cm of leaving the pelvis, the lateral femoral cutaneous nerve was observed deep to the fascia lata; therefore, surgical dissection within the subcutaneous fascia may be conducted with relative impunity near the anterior superior iliac spine just inferior to the inguinal ligament. In 36% of cases there was no posterior branch of the nerve, which is correlated to lateral femoral cutaneous neuralgia symptoms often being limited to the anterior branch region. An accessory nerve was found in 30% of cases. Copyright 2003 Wiley-Liss, Inc.

  9. An unusual complication of femoral vein catheterisation: pneumoperitoneum.

    PubMed

    Yildizdas, D; Tepe, T; Parlak, M; Akcali, M

    2007-12-01

    A 2-month-old girl with severe pneumonia required a central venous line. Femoral vein catheterisation was attempted but insertion was difficult. Pneumoperitoneum developed, which is a rare complication of femoral vein catheterisation. It is important when undertaking femoral vein catheterisation to use the correct landmarks in the femoral triangle below the inguinal ligament and an appropriate size of catheter.

  10. Unilateral Isolated Proximal Femoral Focal Deficiency

    PubMed Central

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

    2013-01-01

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

  11. A biomechanical comparison of proximal femoral nails and locking proximal anatomic femoral plates in femoral fracture fixation

    PubMed Central

    Ozkan, Korhan; Türkmen, İsmail; Sahin, Adem; Yildiz, Yavuz; Erturk, Selim; Soylemez, Mehmet Salih

    2015-01-01

    Background: The incidence of fractures in the trochanteric area has risen with the increasing numbers of elderly people with osteoporosis. Although dynamic hip screw fixation is the gold standard for the treatment of stable intertrochanteric femur fractures, treatment of unstable intertrochanteric femur fractures still remains controversial. Intramedullary devices such as Gamma nail or proximal femoral nail and proximal anatomic femur plates are in use for the treatment of intertrochanteric femur fractures. There are still many investigations to find the optimal implant to treat these fractures with minimum complications. For this reason, we aimed to perform a biomechanical comparison of the proximal femoral nail and the locking proximal anatomic femoral plate in the treatment of unstable intertrochanteric fractures. Materials and Methods: Twenty synthetic, third generation human femur models, obtained for this purpose, were divided into two groups of 10 bones each. Femurs were provided as a standard representation of AO/Orthopedic Trauma Associationtype 31-A2 unstable fractures. Two types of implantations were inserted: the proximal femoral intramedullary nail in the first group and the locking anatomic femoral plate in the second group. Axial load was applied to the fracture models through the femoral head using a material testing machine, and the biomechanical properties of the implant types were compared. Result: Nail and plate models were locked distally at the same level. Axial steady load with a 5 mm/m velocity was applied through the mechanical axis of femur bone models. Axial loading in the proximal femoral intramedullary nail group was 1.78-fold greater compared to the plate group. All bones that had the plate applied were fractured in the portion containing the distal locking screw. Conclusion: The proximal femoral intramedullary nail provides more stability and allows for earlier weight bearing than the locking plate when used for the treatment of

  12. The effects of knee immobilization on marrow adipocyte hyperplasia and hypertrophy at the proximal rat tibia epiphysis.

    PubMed

    Trudel, Guy; Uhthoff, Hans K; Solanki, Sanjay; Laneuville, Odette

    2017-09-01

    Marrow adipose deposition is observed during aging and in association with extended periods of immobility. The objective of this study was to determine the contribution of adipocyte hypertrophy and hyperplasia to bone marrow fat deposition induced by immobilization of the rat knee joint for 2, 4, 16 or 32 weeks. Histomorphometric analyses compared immobilized to sham-operated proximal tibia from age and gender matched rats to assess the contribution of aging and duration of immobilization on the number and size of marrow adipocytes. Results indicated that marrow adipose tissue increased with the duration of immobilization and was significant larger at 16 weeks compared to the sham-operated group (0.09956±0.13276mm(2) vs 0.01990±0.01100mm(2), p=0.047). The marrow adipose tissue was characterized by hyperplasia of adipocytes with a smaller average size after 2 and 4 weeks of immobilization (at 2 weeks hyperplasia: 68.86±33.62 vs 43.57±24.47 adipocytes/mm(2), p=0.048; at 4 weeks hypotrophy: 0.00036±0.00019 vs 0.00046±0.00023mm(2), p=0.027), and by adipocyte hypertrophy after 16 weeks of immobilization (0.00083±0.00049 vs 0.00046±0.00028mm(2), p=0.027) compared to sham-operated. Both immobilized and sham-operated groups showed marrow adipose conversion with age; immobilized (p=0.008; sham: p=0.003). Overall, fat deposition in the bone marrow of the proximal rat tibia epiphysis and induced by knee joint immobilization was characterized by hyperplasia of small adipocytes in the early phase and by adipocyte hypertrophy in the later phase. Mediators of marrow fat deposition after immobilization and preventive countermeasures need to be investigated. Copyright © 2017 Elsevier GmbH. All rights reserved.

  13. Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture

    PubMed Central

    Oh, Chi Hun; Yi, Ju Won

    2013-01-01

    We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications. PMID:24009910

  14. Meralgia paresthetica and femoral acetabular impingement: a possible association.

    PubMed

    Ahmed, Aiesha

    2010-12-11

    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. Femoral acetabular impingement; Lateral femoral cutaneous nerve; Dysesthesia; Nerve conduction studies.

  15. 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

  16. Evaluation of carbonate apatite blocks fabricated from dicalcium phosphate dihydrate blocks for reconstruction of rabbit femoral and tibial defects.

    PubMed

    Kanazawa, Masayuki; Tsuru, Kanji; Fukuda, Naoyuki; Sakemi, Yuta; Nakashima, Yasuharu; Ishikawa, Kunio

    2017-06-01

    This study aimed to evaluate in vivo behavior of a carbonate apatite (CO3Ap) block fabricated by compositional transformation via a dissolution-precipitation reaction using a calcium hydrogen phosphate dihydrate [DCPD: CaHPO4·2H2O] block as a precursor. These blocks were used to reconstruct defects in the femur and tibia of rabbits, using sintered dense hydroxyapatite (HAp) blocks as the control. Both the CO3Ap and HAp blocks showed excellent tissue response and good osteoconductivity. HAp block maintained its structure even after 24 weeks of implantation, so no bone replacement of the implant was observed throughout the post-implantation period in either femoral or tibial bone defects. In contrast, CO3Ap was resorbed with increasing time after implantation and replaced with new bone. The CO3Ap block was resorbed approximately twice as fast at the metaphysis of the proximal tibia than at the epiphysis of the distal femur. The CO3Ap block was resorbed at an approximately linear change over time, with complete resorption was estimated by extrapolation of data at approximately 1-1.5 years. Hence, the CO3Ap block fabricated in this study has potential value as an ideal artificial bone substitute because of its resorption and subsequent replacement by bone.

  17. Flows In Model Human Femoral Arteries

    NASA Technical Reports Server (NTRS)

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

    1990-01-01

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

  18. MRI Anatomy of the Tibial ACL Attachment and Proximal Epiphysis in a Large Population of Skeletally Immature Knees: Reference Parameters for Planning Anatomic Physeal-Sparing ACL Reconstruction.

    PubMed

    Swami, Vimarsha Gopal; Mabee, Myles; Hui, Catherine; Jaremko, Jacob Lester

    2014-07-01

    To aid in performing anatomic physeal-sparing anterior cruciate ligament (ACL) reconstruction, it is important for surgeons to have reference data for the native ACL attachment positions and epiphyseal anatomy in skeletally immature knees. To characterize anatomic parameters of the ACL tibial insertion and proximal tibial epiphysis at magnetic resonance imaging (MRI) in a large population of skeletally immature knees. Cross-sectional study; Level of evidence, 3. The ACL tibial attachment site and proximal epiphysis were examined in 570 skeletally immature knees with an intact ACL (age, 6-15 years) using 1.5-T proton density-weighted sagittal MRI; also measured were the tibial anteroposterior diameter; anterior, central, and posterior ACL attachment positions; vertical height of the epiphysis; and maximum oblique epiphyseal depth extending from the ACL tibial attachment center to the tibial tuberosity. In adolescents (11-15 years of age), the center of the ACL's tibial attachment was 51.5% ± 5.7% of the anteroposterior diameter of the tibia, with no significant differences between sexes or age groups (P > .05 in all cases). Mean vertical epiphyseal height was 15.9 ± 1.7 mm in the adolescent group, with significant differences between 11-year-olds (15.2 ± 1.5 mm) and 15-year-olds (16.6 ± 1.6 mm), P < .001, and between males (16.6 ± 1.5 mm) and females (14.8 ± 1.4), P < .001. Mean maximum oblique depth was 30.0 ± 5.3 mm, with a significant difference between 11-year-olds (26.7 ± 4.9 mm) and 15-year-olds (32.7 ± 5.1 mm), P < .001, and between males (29.7 ± 6.4 mm) and females (27.8 ± 5.2 mm), P < .001. The maximum oblique depth occurred at a mean angle of ~50°, and this angle did not change with age or sex. There was a significant moderate correlation (r = 0.39, P < .001) between epiphyseal vertical height and maximum oblique depth. The center of the ACL tibial attachment was consistently near 51% of the anteroposterior diameter, regardless of age or sex

  19. Current Concepts in Paediatric Femoral Shaft Fractures

    PubMed Central

    John, Rakesh; Sharma, Siddhartha; Raj, Gopinathan Nirmal; Singh, Jujhar; C., Varsha; RHH, Arjun; Khurana, Ankit

    2017-01-01

    Pediatric femoral shaft fractures account for less than 2% of all fractures in children. However, these are the most common pediatric fractures necessitating hospitalization and are associated with prolonged hospital stay, prolonged immobilization and impose a significant burden on the healthcare system as well as caregivers. In this paper, the authors present a comprehensive review of epidemiology, aetiology, classification and managemement options of pediatric femoral shaft fractures. PMID:28603567

  20. Femoral nerve entrapment: a new insight.

    PubMed

    Vázquez, M T; Murillo, J; Maranillo, E; Parkin, I G; Sanudo, J

    2007-03-01

    Compression of the femoral nerve in the iliac fossa has been reported as a consequence of several pathologies, but never as a result of muscular compression. Aberrant slips of iliacus, however, have occasionally been reported to cover or split the femoral nerve. This study aimed to assess such variations as potential factors in femoral nerve compression. A large and homogeneous sample of 121 embalmed cadavers (242 specimens) was studied. Statistical comparisons were made using the chi-squared test. Muscular slips from iliacus and psoas, piercing or covering the femoral nerve, were found in 19 specimens (7.9%). No significant differences by sex or side were found. The more frequent variation was piercing of the femoral nerve by a muscular slip (17 specimens, 7.0%). The nerve then entered the thigh as one or more branches. The less frequent variation found was a muscular slip or sheet covering the femoral nerve as it lay on iliacus (2 specimens, 0.8%). Each disposition may be a potential risk for nerve entrapment.

  1. Periosteal entrapment in distal femoral physeal fractures: harbinger for premature physeal arrest ?

    PubMed

    Segal, Lee S; Shrader, M Wade

    2011-10-01

    We report on two patients who sustained Salter-Harris II fractures of the distal femur with physeal widening after being tackled in football games. Preoperative MRI indicated entrapped periosteum at the physeal fracture site for both patients. Both patients underwent open reduction of the physeal fracture with removal of the entrapped periosteum and achieving an anatomic reduction. Follow-up MRI's revealed premature physeal arrest. Subsequent procedures were performed to address sequelae of premature physeal arrest. The presence of physeal widening and entrapped periosteum may reflect high-energy trauma to the physis. This can result in injury to both the epiphyseal blood supply and to the physeal cartilage (germinal zone) resulting in physeal arrest despite anatomic reduction after removal of the entrapped periosteum. Upon literature review, pre-operative MRI demonstrating entrapped periosteum has not been previously reported. We hypothesize that the presence of entrapped periosteum following distal femoral physeal fractures may be associated with an increased risk for premature physeal arrest.

  2. Treatment of periprosthetic femoral fractures following total hip arthroplasty with femoral component revision.

    PubMed

    Springer, Bryan D; Berry, Daniel J; Lewallen, David G

    2003-11-01

    Revision total hip arthroplasty is indicated for most periprosthetic fractures that occur around the stem of the femoral implant. The purpose of the present study was to assess the results and complications of revision total hip arthroplasty for the treatment of periprosthetic femoral fractures. We evaluated 118 hips in 116 patients who underwent revision total hip arthroplasty because of an acute Vancouver type-B periprosthetic femoral fracture. The femoral implant used for the revision was a cemented stem in forty-two hips, a proximally porous-coated uncemented stem in twenty-eight, an extensively porous-coated stem in thirty, and an allograft-prosthesis composite or tumor prosthesis in eighteen. The mean duration of follow-up was 5.4 years. Kaplan-Meier analysis demonstrated that the probability of survival was 90% at five years and 79.2% at ten years with revision or removal of the femoral implant for any reason as the end point. Sixteen femoral components were rerevised: ten were rerevised because of loosening; three, because of loosening in association with a fracture nonunion; two, because of recurrent dislocation; and one, because of a new periprosthetic fracture. Additionally, six femoral implants were resected because of deep infection (five) or prosthetic loosening (one). Radiographs of the ninety-six hips with a surviving implant showed that twenty-one had evidence of loosening of the femoral implant, four had a nonunion of the femoral fracture, and two had both a nonunion and loosening of the femoral implant. Revision total hip arthroplasty for the treatment of a periprosthetic fracture around the stem of the femoral implant successfully restored function for most patients. The greatest long-term problems were prosthetic loosening and fracture nonunion. Better results were seen when an uncemented, extensively porous-coated stem was used.

  3. Analysis of risk factors for femoral head necrosis after internal fixation in femoral neck fractures.

    PubMed

    Wang, Tao; Sun, Jun-Ying; Zha, Guo-Chun; Jiang, Tao; You, Zhen-Jun; Yuan, De-Jing

    2014-12-01

    Femoral head necrosis is a rare but devastating complication following femoral neck fracture. The reported incidence of avascular necrosis after femoral neck fracture fixation varies widely, and there is no consensus regarding its risk factors. The aim of this study was to analyze the risk factors for femoral head necrosis after internal fixation in femoral neck fracture. This retrospective study included 166 patients with femoral neck fractures treated with surgical reduction and internal fixation at the authors' institution from January 2004 to December 2008. Eight patients died for reasons unrelated to the surgery, and 12 patients were lost to follow-up. The remaining 146 patients (146 fractures) were followed until union or until conversion to total hip arthroplasty. The patients included 61 males and 85 females with an average age of 47.5 years (range, 18-68 years). The authors analyzed the following factors: age, sex, Garden classification, reduction quality, surgical methods, injury-to-surgery interval, preoperative traction, weight-bearing time, and implant removal. All patients were followed for a mean of 52 months (range, 6-90 months). The incidence of femoral head necrosis was 14.4% (21/146). Garden classification (P=.012), reduction quality (P=.008), implant removal (P=.020), and preoperative traction (P=.003) were significantly associated with femoral head necrosis. Patient age (P=.990), sex (P=.287), injury-to-surgery interval (P=.360), weight-bearing time (P=.868), and surgical methods (P=.987) were not significantly associated with femoral head necrosis. In multivariate logistic regression analysis, implant removal was not a significant risk factor for femoral head necrosis development (P=.498). Garden classification, reduction quality, and preoperative traction had a significant effect on femoral head necrosis development. Copyright 2014, SLACK Incorporated.

  4. Comparison of plain radiography, computed tomography, and magnetic resonance imaging in the evaluation of bone tunnel widening after anterior cruciate ligament reconstruction.

    PubMed

    Marchant, Milford H; Willimon, S Clifton; Vinson, Emily; Pietrobon, Ricardo; Garrett, William E; Higgins, Laurence D

    2010-08-01

    Bone tunnel widening poses a problem for graft fixation during revision anterior cruciate ligament (ACL) reconstruction. Large variability exists in the utilization of imaging modalities for evaluating bone tunnels in pre-operative planning for revision ACL reconstruction. The purpose of this study was to identify the most reliable imaging modality for identifying bone tunnels and assessing tunnel widening, and specifically, to validate the reliability of radiographs, MRI, and CT using intra- and inter-observer testing. Data was retrospectively collected from twelve patients presenting for revision ACL surgery. Five observers twice measured femoral and tibial tunnels at their widest point using digital calipers in coronal and sagittal planes. Measurements were corrected for magnification. Tunnel identification, diameter measurements, and cross-sectional area (CSA) calculations were recorded. A categorical classification of tunnel measurements was created to apply clinical significance to the measurements. Using kappa statistics, intra- and inter-observer reliability testing was performed. CT demonstrated excellent intra- and inter-observer reliability for tunnel identification. Intra- and inter-observer reliability was significantly less for MRI and radiographs. CT revealed superior reliability versus either radiographs or MRI for CSA analysis. Intra-observer kappa scores for tibial CSA using CT, radiographs, and MRI were 0.66, 0.5, and 0.37, respectively. Inter-observer kappa scores for tibial CSA using CT, radiographs, and MRI were 0.65, 0.39, and 0.32, respectively. Our results demonstrate CT is the most reliable imaging modality for evaluation of ACL bone tunnels as proven by superior intra- and inter-observer testing results when compared to MRI and radiographs. Radiographs and MRI were not reliable, even for simply identifying the presence of a bone tunnel.

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

    PubMed

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

    2013-07-01

    This study assesses femoral neck shortening and its effect on gait pattern and muscle strength in patients with femoral neck fractures treated with internal fixation. Seventy-six patients from a multicenter randomized controlled trial participated. Patient characteristics and Short Form 12 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were collected. Femoral neck shortening, gait parameters, and maximum isometric forces of the hip muscles were measured and differences between the fractured and contralateral leg were calculated. Variables of patients with little or no shortening, moderate shortening, and severe shortening were compared using univariate and multivariate analyses. Median femoral neck shortening was 1.1 cm. Subtle changes in gait pattern, reduced gait velocity, and reduced abductor muscle strength were observed. Age, weight, and Pauwels classification were risk factors for femoral neck shortening. Femoral neck shortening decreased gait velocity and seemed to impair gait symmetry and physical functioning. In conclusion, internal fixation of femoral neck fractures results in permanent physical limitations. The relatively young and healthy patients in our study seem capable of compensating. Attention should be paid to femoral neck shortening and proper correction with a heel lift, as inadequate correction may cause physical complaints and influence outcome. Copyright 2013, SLACK Incorporated.

  6. Chondrocytes are released as viable cells during cartilage resorption associated with the formation of intrachondral canals in the rat tibial epiphysis.

    PubMed

    Alvarez, Jesús; Costales, Lorena; López-Muñiz, Alfonso; López, José M

    2005-06-01

    The development of cartilage canals is the first event of the ossification of the epiphyses in mammals. Canal formation differs from vascular invasion during primary ossification, since the former involves resorption of resting cartilage and is uncoupled from bone deposition. To learn more about the fate of resorbed chondrocytes during this process, we have carried out structural, cell proliferation, and in situ hybridization studies during the first stages of ossification of the rat tibial proximal epiphysis. Results concerning the formation of the cartilage canals implied the release of resting chondrocytes from the cartilage matrix to the canal cavity. Released chondrocytes had a well-preserved structure, expressed type-II collagen, and maintained the capacity to divide. All these data suggested that chondrocytes released into the canals remained viable for a specific time. Analysis of the proliferative activity at different regions of the cartilage canals showed that the percentage of proliferative chondrocytes at areas of active cartilage resorption was significantly higher than that in zones of low resorption. These results are consistent with the hypothesis that resting chondrocytes surrounding canals have a role in supplying cells for the development of the secondary ossification center. Since released chondrocytes are at an early stage of differentiation greatly preceding their entry into the apoptotic pathway and are exposed to a specific matrix, cellular, and humoral microenvironment, they might differentiate to other cell types and contribute to the ossification of the epiphysis.

  7. Widening of the inferior alveolar canal: a case report with atypical lymphocytic infiltration of the nerve.

    PubMed

    Vartiainen, Veli Matti; Siponen, Maria; Salo, Tuula; Rosberg, Jukka; Apaja-Sarkkinen, Meeri

    2008-10-01

    Widening of the inferior alveolar (mandibular) canal is a rare radiological finding. It is most often associated with neurofibromatosis. Rarely, a malignant process such as lymphoma may cause ill-defined enlargement of the mandibular canal. We present a unique case of a 33-year-old male who gradually developed sensory loss of his left lower lip and cheek and a well-defined tube-like widening of his left mandibular canal. The histopathological findings of the lesion were unusual in that they indicated atypical lymphocytic infiltration of the nerve tissue. The differential diagnoses regarding the clinical, radiological, and histopathological findings are discussed.

  8. Femoral tunnel malposition in ACL revision reconstruction.

    PubMed

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

    2012-11-01

    The Multicenter Anterior Cruciate Ligament (ACL) Revision Study (MARS) group was formed to study a large cohort of revision ACL reconstruction patients. The purpose of this subset analysis study of the MARS database is to describe specific details of femoral tunnel malposition and subsequent management strategies that surgeons chose in the revision setting. The design of this study is a case series. The multicenter MARS database is compiled from a questionnaire regarding 460 ACL reconstruction revision cases returned by 87 surgeons. This subset analysis described technical aspects and operative findings in specifically those cases in which femoral tunnel malposition was cited as the cause of primary ACL reconstruction failure. Of the 460 revisions included for study, 276 (60%) cases cited a specific "technical cause of failure." Femoral tunnel malposition was cited in 219 (47.6%) of 460 cases. Femoral tunnel malposition was cited as the only cause of failure in 117 cases (25.4%). Surgeons judged the femoral tunnel too vertical in 42 cases (35.9%), too anterior in 35 cases (29.9%), and too vertical and anterior in 31 cases (26.5%). Revision reconstruction involved the drilling of an entirely new femoral tunnel in 91 cases (82.1%). For primary reconstruction, autograft tissue was used in 82 cases (70.1%). For revision reconstruction, autograft tissue was used in 61 cases (52.1%) and allograft tissue in 56 cases (47.9%). Femoral tunnel malposition in primary ACL reconstruction was the most commonly cited reason for graft failure in this cohort. Graft selection is widely variable among surgeons. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  9. Aetiology of femoral hernias revisited: bilateral femoral hernia in a young male (two cases).

    PubMed

    Kochupapy, R T; Ranganathan, G; Dias, S; Shanahan, D

    2013-01-01

    Bilateral femoral hernias are less common in men than in women and rare in young adults. Only one case of a bilateral femoral hernia in a young man has been reported in the literature before. Three main theories have been postulated for femoral hernias. The theory that they are an acquired disease is the most accepted due to the common occurrence of such hernias in multiparous women but the theory lacks enough evidence. We report two cases in young men. Anatomical variations in the femoral canal could be the primary aetiological factor in these patients. A unilateral femoral hernia in young men with acquired aetiological factors requires a clinical examination of the opposite side.

  10. Analysis of the temporal regression of the QRS widening induced by bupivacaine after Intralipid administration. Study in an experimental porcine model.

    PubMed

    Zaballos, M; Sevilla, R; González, J; Callejo, D; de Diego, C; Almendral, J; Quintela, O; Anadón, M J

    2016-01-01

    The principal mechanism of cardiac toxicity of bupivacaine relates to the blockade of myocardial sodium channels, which leads to an increase in the QRS duration. Recently, experimental studies suggest that lipid emulsion is effective in reversing bupivacaine cardiac toxicity. We aimed to evaluate the temporal evolution of the QRS widening induced by bupivacaine with the administration of Intralipid. Twelve pigs were anesthetized with intravenous sodium thiopental 5mg kg(-1) and sevoflurane 1 MAC (2.6%). Femoral artery and vein were canalized for invasive monitoring, analysis of blood gases and determination of bupivacaine levels. After instrumentation and monitoring, a bupivacaine bolus of 4-6 mg kg(-1) was administered in order to induce a 150% increase in QRS duration (defined as the toxic point). The pigs were randomized into two groups of six individuals. Intralipid group (IL) received 1.5 mL kg(-1)of IL over one minute, followed by an infusion of 0.25 mL kg min(-1). Control group (C) received the same volume of a saline solution. The electrocardiographic parameters were recorded, and blood samples were taken after bupivacaine and 1, 5, 10 and 30 minutes after Intralipid/saline administration. Bupivacaine (4.33±0.81 mg/kg in IL group and 4.66±1.15 mg/kg in C group) induced similar electrocardiographic changes in both groups; mean maximal percent increase in QRS interval was 184±62% in IL group, and 230±56% in control group (NS). Lipid administration reversed the QRS widening previously impaired by bupivacaine. After ten minutes of the administration of IL, the mean QRS interval decreased to 132±56% vs. 15±76% relative to the maximum widening induced by bupivacaine, in IL and C group, respectively. Intralipid reversed the lengthening of QRS interval induced by the injection of bupivacaine. Time to normalization of electrocardiographic parameters can last more than 10 minutes. While the phenomena of cardiac toxicity persist, resuscitation measures and

  11. A new technique for femoral and tibial tunnel bone grafting using the OATS harvesters in revision anterior cruciate ligament reconstruction.

    PubMed

    Said, Hatem G; Baloch, Khalid; Green, Marcus

    2006-07-01

    Revision anterior cruciate ligament (ACL) reconstruction is becoming more frequent, especially in specialized centers, because of the large numbers of primary ACL procedures performed. In 2-stage revisions, bone grafting of the tunnels may be undertaken if the primary position was inaccurate or if osteolysis has caused widening of the tunnels. This will allow the desired placement of the new tunnels without the risk of loss of structural integrity. It is technically difficult to deliver and impact bone graft into the femoral tunnel with the standard surgical and arthroscopic instruments. We describe a new technique for femoral and tibial tunnel impaction grafting in 2-stage ACL revisions, using the OATS grafting instruments (Osteochondral Autologous Transfer System; Arthrex, Naples, FL). The appropriately sized OATS harvester is chosen 1 mm larger than the tunnel size and is used to harvest bone graft from the iliac crest through a percutaneous approach. This provides a cylindrical graft, which is delivered to the femoral tunnel through the arthroscopic portal. The inside punch of the harvester is tapped and this allows delivery of the graft in a controlled manner and its impaction into the tunnel. The same is repeated for the tibial tunnel while providing support for the proximal end of the tunnel.

  12. Femoral lipectomy increases postprandial lipemia in women

    PubMed Central

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

    2015-01-01

    Femoral subcutaneous adipose tissue (SAT) appears to be cardioprotective compared with abdominal SAT, possibly through better triglyceride (TG) sequestration. We hypothesized that removal of femoral SAT would increase postprandial TG through a reduction in dietary fatty acid (FA) storage. Normal-weight (means ± SD; BMI 23.9 ± 2.6 kg/m2) women (n = 29; age 45 ± 6 yr) were randomized to femoral lipectomy (LIPO) or control (CON) and followed for 1 yr. Regional adiposity was measured by DEXA and CT. A liquid meal labeled with [14C]oleic acid was used to trace the appearance of dietary FA in plasma (6-h postprandial TG), breath (24-h oxidation), and SAT (24-h [14C]TG storage). Fasting LPL activity was measured in abdominal and femoral SAT. DEXA leg fat mass was reduced after LIPO vs. CON (Δ−1.4 ± 0.7 vs. 0.1 ± 0.5 kg, P < 0.001) and remained reduced at 1 yr (−1.1 ± 1.4 vs. −0.2 ± 0.5 kg, P < 0.05), as did CT thigh subcutaneous fat area (−39.6 ± 36.6 vs. 4.7 ± 14.6 cm2, P < 0.05); DEXA trunk fat mass and CT visceral fat area were unchanged. Postprandial TG increased (5.9 ± 7.7 vs. −0.6 ± 5.3 × 103 mg/dl, P < 0.05) and femoral SAT LPL activity decreased (−21.9 ± 22.3 vs. 10.5 ± 26.5 nmol·min−1·g−1, P < 0.05) 1 yr following LIPO vs. CON. There were no group differences in 14C-labeled TG appearing in abdominal and femoral SAT or elsewhere. In conclusion, femoral fat remained reduced 1 yr following lipectomy and was accompanied by increased postprandial TG and reduced femoral SAT LPL activity. There were no changes in storage of meal-derived FA or visceral fat. Our data support a protective role for femoral adiposity on circulating TG independent of dietary FA storage and visceral adiposity. PMID:25968576

  13. Medial Patellofemoral Ligament Reconstruction Femoral Tunnel Accuracy

    PubMed Central

    Hiemstra, Laurie A.; Kerslake, Sarah; Lafave, Mark

    2017-01-01

    Background: Medial patellofemoral ligament (MPFL) reconstruction is a procedure aimed to reestablish the checkrein to lateral patellar translation in patients with symptomatic patellofemoral instability. Correct femoral tunnel position is thought to be crucial to successful MPFL reconstruction, but the accuracy of this statement in terms of patient outcomes has not been tested. Purpose: To assess the accuracy of femoral tunnel placement in an MPFL reconstruction cohort and to determine the correlation between tunnel accuracy and a validated disease-specific, patient-reported quality-of-life outcome measure. Study Design: Case series; Level of evidence, 4. Methods: Between June 2008 and February 2014, a total of 206 subjects underwent an MPFL reconstruction. Lateral radiographs were measured to determine the accuracy of the femoral tunnel by measuring the distance from the center of the femoral tunnel to the Schöttle point. Banff Patella Instability Instrument (BPII) scores were collected a mean 24 months postoperatively. Results: A total of 155 (79.5%) subjects had adequate postoperative lateral radiographs and complete BPII scores. The mean duration of follow-up (±SD) was 24.4 ± 8.2 months (range, 12-74 months). Measurement from the center of the femoral tunnel to the Schöttle point resulted in 143 (92.3%) tunnels being categorized as “good” or “ideal.” There were 8 failures in the cohort, none of which occurred in malpositioned tunnels. The mean distance from the center of the MPFL tunnel to the center of the Schöttle point was 5.9 ± 4.2 mm (range, 0.5-25.9 mm). The mean postoperative BPII score was 65.2 ± 22.5 (range, 9.2-100). Pearson r correlation demonstrated no statistically significant relationship between accuracy of femoral tunnel position and BPII score (r = –0.08; 95% CI, –0.24 to 0.08). Conclusion: There was no evidence of a correlation between the accuracy of MPFL reconstruction femoral tunnel in relation to the Schöttle point and

  14. An Exploration of Progression Rates of Widening Participation Students on to an Integrated Master of Engineering

    ERIC Educational Resources Information Center

    Humphries-Smith, Tania; Hunt, Clive

    2017-01-01

    This paper reports on an investigation into the potential to widen participation to Higher Education provided by a flexible learning MEng Engineering. The MEng is part of an integrated programme that provides progression routes from a traditional day release Apprenticeship, through HNC, FdEng at a Further Education College to a flexible learning…

  15. School Principals Speaking Back to Widening Participation Policies in Higher Education

    ERIC Educational Resources Information Center

    Blackmore, Jill; Hutchison, Kirsten; Keary, Anne

    2017-01-01

    This paper examines school principal responses to the policy discourse of widening participation in higher education. As a critical analysis of how policy is produced, read and responded to by principals [Bacchi, C., 2009. "Analysing policy: what's the problem represented to be?" New York: Pearson], the paper questions the assumptions…

  16. Widening and Increasing Post-16 Mathematics Participation: Pathways, Pedagogies and Politics

    ERIC Educational Resources Information Center

    Noyes, Andrew; Wake, Geoff; Drake, Pat

    2011-01-01

    This paper explores the potential impact of a national pilot initiative in England aimed at increasing and widening participation in advanced mathematical study through the creation of a new qualification for 16- to 18-year-olds. This proposed qualification pathway--"Use of Mathematics"--sits in parallel with long-established,…

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

    ERIC Educational Resources Information Center

    Mavelli, Luca

    2014-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Greenbank, Paul

    2006-01-01

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

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

    PubMed

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

    2011-12-01

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

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

    ERIC Educational Resources Information Center

    O'Brien, Mark

    2013-01-01

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

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

    ERIC Educational Resources Information Center

    Thompson, Jane, Ed.

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

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

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

    ERIC Educational Resources Information Center

    Mavelli, Luca

    2014-01-01

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

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

    ERIC Educational Resources Information Center

    Burke, Penny

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Wilkins, Andrew; Burke, Penny Jane

    2015-01-01

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

  7. Widening Participation in Higher Education: Funding Decisions for 2001-02 to 2003-04. Request.

    ERIC Educational Resources Information Center

    Higher Education Funding Council for England, Bristol.

    This document provides feedback on the Higher Education Funding Council for England's (HEFCE's) consultation on new proposals for widening participation in higher education and outlines the decisions that have been made following the consultation. A summary of responses to the consultation is included in Annex B. As a result of the consultation,…

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

    ERIC Educational Resources Information Center

    Colorado Children's Campaign, 2009

    2009-01-01

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

  9. Designing Student Groupwork in Management Education: Widening the Palette of Options

    ERIC Educational Resources Information Center

    Holtham, Clive W.; Melville, Robert R.; Sodhi, ManMohan S.

    2006-01-01

    The authors describe innovation in practice through the unusual deployment of teams in a master's in management core course. Two parallel uses of teams were made, both drawing on the jigsaw team method, in one case with the team supporting individual work. The experiences support the idea of widening the palette of types of groupwork used in…

  10. Widening Participation in Higher Education: A Social Justice Analysis of Student Loans in Tanzania

    ERIC Educational Resources Information Center

    Msigwa, Faustina M.

    2016-01-01

    Financing of higher education (HE) through provision of student loans has become the most popular strategy globally for funding undergraduate degrees; hence, widening participation in HE depends crucially on socially just distribution of loans. Tanzanian financial assistance policy aims to support students from low-socio-economic status (SES)…

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

    ERIC Educational Resources Information Center

    David, Miriam E.

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Gale, Trevor

    2015-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  14. "It's Making Contacts": Notions of Social Capital and Implications for Widening Access to Medical Education

    ERIC Educational Resources Information Center

    Nicholson, S.; Cleland, J. A.

    2017-01-01

    In the UK widening access (WA) activities and policies aim to increase the representation from lower socio-economic groups into Higher Education. Whilst linked to a political rhetoric of inclusive education such initiatives have however failed to significantly increase the number of such students entering medicine. This is compounded by a…

  15. Strategies for Widening Participation in Higher Education: A Guide to Good Practice.

    ERIC Educational Resources Information Center

    Higher Education Funding Council for England, Bristol.

    The Higher Education Funding Council for England (HEFCE) recently held two seminars that addressed the relationships between widening participation in higher education, learning and teaching, and strategic planning. In recognition of these relationships and in order to enable a coordinated approach, the HEFCE commissioned this guide and a…

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

    ERIC Educational Resources Information Center

    Allen, Jo; Baker, Joseph J.

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Callender, Claire

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Dalton, Jon C.; Crosby, Pamela C.

    2015-01-01

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

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

    PubMed

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

    2006-01-01

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

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

    ERIC Educational Resources Information Center

    Lundvall, Suzanne; Meckbach, Susanne

    2012-01-01

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

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

    ERIC Educational Resources Information Center

    Thompson, Jane, Ed.

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

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

    ERIC Educational Resources Information Center

    Dalton, Jon C.; Crosby, Pamela C.

    2015-01-01

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

  3. Widening Participation in Higher Education: A Social Justice Analysis of Student Loans in Tanzania

    ERIC Educational Resources Information Center

    Msigwa, Faustina M.

    2016-01-01

    Financing of higher education (HE) through provision of student loans has become the most popular strategy globally for funding undergraduate degrees; hence, widening participation in HE depends crucially on socially just distribution of loans. Tanzanian financial assistance policy aims to support students from low-socio-economic status (SES)…

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Burke, Penny

    2012-01-01

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

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

    ERIC Educational Resources Information Center

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

    2011-01-01

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

  7. The observed widening of the tropics during the late 20th century and its mechanisms

    NASA Astrophysics Data System (ADS)

    Reichler, T.

    2007-12-01

    Several lines of research indicate that the Tropics have been widening by a few degree latitudes over the past decades and that this widening may continue into the future. Associated with this widening are important shifts in precipitation and other climate elements, raising the question of what are the exact reasons behind the expansion. There is evidence that the increase in tropospheric static stability associated with global warming is driving this shift, but there may be other still unknown factors. Here, we investigate the relative roles of various stratospheric and tropospheric processes for the tropical expansion and conduct attribution experiments with stratosphere and non-stratosphere resolving versions of the latest GFDL general circulation model. The model is forced with different combinations of sea surface temperatures, carbon dioxide, halogen, and ozone concentrations. The impact of each of these factors and of stratospheric model resolution is isolated by comparing different pairs of simulations that differ by only one of these factors. The results highlight that both, tropospheric and stratospheric climate change, play a prominent role for the recent observed widening of the Tropics. We discuss the significance of these results for the future evolution of the tropical width and its realistic prediction.

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

    ERIC Educational Resources Information Center

    McCaig, Colin; Adnett, Nick

    2009-01-01

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

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

    ERIC Educational Resources Information Center

    Cooper, Troy

    2010-01-01

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

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

    ERIC Educational Resources Information Center

    Reddy, Peter A.; Moores, Elisabeth

    2008-01-01

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

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

    ERIC Educational Resources Information Center

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

    2005-01-01

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

  12. [Fracture arthroplasty of femoral neck fractures].

    PubMed

    Braun, K F; Hanschen, M; Biberthaler, P

    2016-04-01

    A paradigm shift in the treatment of elderly patients has recently taken place leading to an increase in joint replacement surgery. The aim of this article is to highlight new developments and to present a treatment algorithm for femoral neck fractures. The age limit must be individually determined considering the comorbidities and perioperative risk profile. Pertrochanteric femoral fractures are nearly exclusively treated by osteosynthesis regardless of age. The situation for femoral neck fractures is more complex. Patients younger than 65 years should generally be treated by osteosynthesis but patients older than 65 years benefit from hemiarthroplasty or total hip arthroplasty. In patients aged between 65 and 75 years with high functional demands and a justifiable perioperative risk, total joint replacement is the treatment of choice. In physically less active patients older than 75 years and poor general condition, preference should be given to hemiarthroplasty.

  13. Optimizing Stability in Femoral Neck Fracture Fixation.

    PubMed

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

    2015-10-01

    Optimizing stability of femoral neck fracture fixation is important in obtaining a successful outcome. The mechanical problems and strategies for achieving optimal stability differ depending on patients' age and degree of osteoporosis. Femoral neck fractures in younger adults usually result from high-energy trauma and have a vertical fracture pattern. Strategies for optimizing fixation stability in this group include placing additional screws at right angles to the fracture plane and medial buttress plate augmentation. In elderly patients, screw position relative to the intact cortical femoral neck bone is of critical importance. Additional strategies for optimizing fixation stability in this group include the concept of length stable fixation, use of adjunctive calcium phosphate cement, and use of novel fixed angle fixation implants. Copyright 2015, SLACK Incorporated.

  14. The terminal branches of the medial femoral circumflex artery: the arterial supply of the femoral head.

    PubMed

    Lazaro, L E; Klinger, C E; Sculco, P K; Helfet, D L; Lorich, D G

    2015-09-01

    This study investigates and defines the topographic anatomy of the medial femoral circumflex artery (MFCA) terminal branches supplying the femoral head (FH). Gross dissection of 14 fresh-frozen cadaveric hips was undertaken to determine the extra and intracapsular course of the MFCA's terminal branches. A constant branch arising from the transverse MFCA (inferior retinacular artery; IRA) penetrates the capsule at the level of the anteroinferior neck, then courses obliquely within the fibrous prolongation of the capsule wall (inferior retinacula of Weitbrecht), elevated from the neck, to the posteroinferior femoral head-neck junction. This vessel has a mean of five (three to nine) terminal branches, of which the majority penetrate posteriorly. Branches from the ascending MFCA entered the femoral capsular attachment posteriorly, running deep to the synovium, through the neck, and terminating in two branches. The deep MFCA penetrates the posterosuperior femoral capsular. Once intracapsular, it divides into a mean of six (four to nine) terminal branches running deep to the synovium, within the superior retinacula of Weitbrecht of which 80% are posterior. Our study defines the exact anatomical location of the vessels, arising from the MFCA and supplying the FH. The IRA is in an elevated position from the femoral neck and may be protected from injury during fracture of the femoral neck. We present vascular 'danger zones' that may help avoid iatrogenic vascular injury during surgical interventions about the hip.

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

    PubMed Central

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

    2016-01-01

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

  16. Management of femoral head osteonecrosis: Current concepts

    PubMed Central

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

    2015-01-01

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

  17. Anatomy of the medial femoral circumflex artery with respect to the vascularity of the femoral head.

    PubMed

    Zlotorowicz, M; Szczodry, M; Czubak, J; Ciszek, B

    2011-11-01

    We performed a series of 16 anatomical dissections on Caucasian cadaver material to determine the surgical anatomy of the medial femoral circumflex artery (MFCA) and its anastomoses. These confirmed that the femoral head receives its blood supply primarily from the MFCA via a group of posterior superior nutrient arteries and the posterior inferior nutrient artery. In terms of anastomoses that may also contribute to the blood supply, the anastomosis with the inferior gluteal artery, via the piriformis branch, is the most important. These dissections provide a base of knowledge for further radiological studies on the vascularity of the normal femoral head and its vascularity after dislocation of the hip.

  18. The Widening Gender Gap and Its Influence on Contemporary Postsecondary Campuses: Perceptions of Senior Student Affairs Officers

    ERIC Educational Resources Information Center

    Schellpfeffer, Shane E.

    2012-01-01

    Throughout the past 30 years, a gender gap in postsecondary education in the United States has steadily widened. The widening postsecondary gender gap, described as the difference between the number of males and females in both enrollment and degree attainment in postsecondary education, has recently garnered significant attention. The purpose of…

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

    ERIC Educational Resources Information Center

    Taylor, Yvette

    2008-01-01

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

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

    ERIC Educational Resources Information Center

    Taylor, Yvette

    2008-01-01

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

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

    DOEpatents

    Guha, Subhendu; Ovshinsky, Stanford R.

    1988-10-04

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

  2. Salter-Harris type IV fracture of the proximal phalanx of the thumb with rotation of the epiphysis: Outcome 10 years following open reduction and K-wire fixation.

    PubMed

    Al-Qattan, Mohammad M

    2017-01-01

    Salter-Harris type IV fracture of the proximal phalanx with 90° rotation of the epiphysis is very rare. We report on a case of Salter-Harris type IV fracture of the proximal phalanx of the thumb with rotation of the epiphysis and document the outcome 10 years after surgery. A 5-year old boy presented with Salter-Harris type IV fracture of the thumb with 90° rotation of the epiphysis. Open reduction and K-wire fixation was done. Ten years later, the injured thumb was smaller in width when compared to the contralateral thumb, although there was no length discrepancy. Clinically, there was full range of motion. Radiologically, the physis was still open but there were minor irregularities at the adjacent metaphyseal base and epiphysis. The diaphysis of the injured proximal phalanx had a constricted appearance when compared to the contralateral normal side. After an extensive literature review, we found one reported case which was similar to our case and had long term assessment. At skeletal maturity, there was complete remodeling and full range of motion of the digit with no shortening. The X-ray showed a constricted diaphysis of the proximal phalanx with an identical appearance to our case. We present a rare case of Salter-Harris type IV fracture of the proximal phalanx of the thumb with rotation of the epiphysis. Long term outcome was satisfactory but there was diaphyseal constriction leading to a narrower thumb. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  3. Postoperative femoral component rotation and femoral anteversion after total knee arthroplasty in patients with distal femoral deformity.

    PubMed

    Lim, Hong-Chul; Bae, Ji-Hoon; Kim, Seung-Ju

    2013-08-01

    We asked whether total knee arthroplasty (TKA) in patients with distal femoral deformity (DFD) would change femoral component rotation (FCR) and investigated the correlation between DFD and femoral anteversion (FA). 75 patients were divided into two groups according to the preoperative posterior condylar angle (PCA); group A without DFD (PCA<7°), group B with DFD (PCA>7°). We evaluated the different angles on the CT scan: (1) PCA, (2) angle between the line which is perpendicular to the Whiteside's line and PCL (WLP), and (3) FA. The mean FCRs were external rotation of 0.21°+2.75° in group A and internal rotation of 4.48°+2.51° in group B (P=0.001). The mean preoperative and postoperative FAs were similar in group A but were significantly different in group B (P=0.035). DFD resulted in excessive internal rotation of the femoral component. There was a secondary decrease in FA in patients with DFD. Copyright © 2013 Elsevier Inc. All rights reserved.

  4. Hydromorphodynamic effects of the width ratio and local tributary widening on discordant confluences

    NASA Astrophysics Data System (ADS)

    Guillén-Ludeña, S.; Franca, M. J.; Alegria, F.; Schleiss, A. J.; Cardoso, A. H.

    2017-09-01

    River training works performed in the last couple of centuries constrained the natural dynamics of channel networks in locations that include the confluences between tributaries and main channels. As a result, the dynamics of these confluences are currently characterized by homogeneous flow depths, flow velocities, and morphologic conditions, which are associated with impoverished ecosystems. The widening of river reaches is seen as a useful measure for river restoration, as it enhances the heterogeneity in flow depths, flow velocities, sediment transport, and bed substrates. The purpose of this study is to analyze the effects of local widening of the tributary mouth as well as the effects of the ratio between the width of the tributary and that of the main channel on the flow dynamics and bed morphology of river confluences. For that purpose, 12 experiments were conducted in a 70° laboratory confluence. In these experiments, three unit-discharge ratios were tested (qr = 0.37, 0.50, and 0.77) with two width ratios and two tributary configurations. The unit-discharge ratio is defined as the unit discharge in the tributary divided by that of the main channel, measured upstream of the confluence. The width ratio, which is defined as the width of the tributary divided by that of the main channel, was modified by changing the width of the main channel from 0.50 to 1.00 m (corresponding to Br = 0.30 and 0.15 respectively). The tributary configurations consisted of (i) a straight reach with a constant width (the so-called reference configuration) and (ii) a straight reach with a local widening at the downstream end (the so-called widened configuration). During the experiments, a uniform sediment mixture was continuously supplied to both channels. This experimental setup is novel among existing experimental studies on confluence dynamics, as it addresses new confluence configurations and includes a continuous sediment supply to both channels. The experiments were run

  5. Pathologic femoral neck fractures in children.

    PubMed

    Shrader, M Wade; Schwab, Joseph H; Shaughnessy, William J; Jacofsky, David J

    2009-02-01

    Pathologic fractures in children occur in a variety of malignant and benign pathologic processes. Pediatric pathologic femoral neck fractures are particularly rare. Until now, all reported cases have been isolated cases, small series, or cases reported in series of adult pathologic hip fractures. The present article is the first report of a relatively large series of pathologic femoral neck fractures in a pediatric population. We identified pathologic femoral neck fractures, including 2 basicervical fractures, in 15 children (9 boys, 6 girls) ranging in age from 18 months to 15 years (mean age, 9 years) and treated between 1960 and 2000. The pathologic diagnoses were fibrous dysplasia (5 children), unicameral bone cyst (2), Ewing's sarcoma (2), osteomyelitis (2), leukemia (1), rhabdomyosarcoma (1), osteogenesis imperfecta (1), and osteopetrosis (1). Treatment methods, including time to reduction and fixation, were reviewed in detail. One patient was lost to follow-up. All others were followed until union; mean long-term follow-up was 7 years (range, 1-16 years). All patients ultimately went on to union. Mean time to union was 19 weeks (range, 5-46 weeks). However, 2 patients died before 2 years. There was a 40% complication rate, with limb-length discrepancy being the most common (4 children). No patient developed avascular necrosis. Pathologic femoral neck fractures are rare in children. Pediatric patients who present with a pathologic hip fracture are at significant risk for complications. Physicians and family should be alerted to the prolonged course involved in treating these fractures to union.

  6. EPIDEMIOLOGICAL STUDY OF CHILDREN DIAPHYSEAL FEMORAL FRACTURES

    PubMed Central

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

    2015-01-01

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

  7. Femoral Prosthesis Infection by Rhodotorula mucilaginosa▿

    PubMed Central

    Savini, Vincenzo; Sozio, Federica; Catavitello, Chiara; Talia, Marzia; Manna, Assunta; Febbo, Fabio; Balbinot, Andrea; Di Bonaventura, Giovanni; Piccolomini, Raffaele; Parruti, Giustino; D'Antonio, Domenico

    2008-01-01

    This case report is a case history of a femoral prosthesis infection caused by Rhodotorula mucilaginosa in a human immunodeficiency virus patient. Though the pathogenicity of this organism for bone tissue has been previously reported, this is the first reported case of an orthopedic prosthesis infection by this species of the genus Rhodotorula. PMID:18753353

  8. Femoral development in chronically centrifuged rats

    NASA Technical Reports Server (NTRS)

    Smith, S. D.

    1977-01-01

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

  9. [Femoral venous catheter: an unusual complication].

    PubMed

    Garcia, P; Mora, A; Trambert, P; Maler, E; Courant, P

    2000-08-01

    We report an erratic course of a venous femoral catheter which was in the abdominal cavity in a patient with an haemoperitoneum and an hepatic injury. This complication led to an inefficiency of the transfusion and a worsening of the haemoperitoneum.

  10. Influence of Femoral Component Design on Retrograde Femoral Nail Starting Point.

    PubMed

    Service, Benjamin C; Kang, William; Turnbull, Nathan; Langford, Joshua; Haidukewych, George; Koval, Kenneth J

    2015-10-01

    Our experience with retrograde femoral nailing after periprosthetic distal femur fractures was that femoral components with deep trochlear grooves posteriorly displace the nail entry point resulting in recurvatum deformity. This study evaluated the influence of distal femoral prosthetic design on the starting point. One hundred lateral knee images were examined. The distal edge of Blumensaat's line was used to create a ratio of its location compared with the maximum anteroposterior condylar width called the starting point ratio (SPR). Femoral trials from 6 manufacturers were analyzed to determine the location of simulated nail position in the sagittal plane compared with the maximum anteroposterior prosthetic width. These measurements were used to create a ratio, the femoral component ratio (FCR). The FCR was compared with the SPR to determine if a femoral component would be at risk for retrograde nail starting point posterior to the Blumensaat's line. The mean SPR was 0.392 ± 0.03, and the mean FCR was 0.416 ± 0.05, which was significantly greater (P = 0.003). The mean FCR was 0.444 ± 0.06 for the cruciate retaining (CR) trials and was 0.393 ± 0.04 for the posterior stabilized trials; this difference was significant (P < 0.001). The FCR for the femoral trials studied was significantly greater than the SPR for native knees and was significantly greater for CR femoral components compared with posterior stabilized components. These findings demonstrate that many total knee prostheses, particularly CR designs, are at risk for a starting point posterior to Blumensaat's line.

  11. Correlation Between Femoral Neck Shaft Angle and Surgical Management in Trainees With Femoral Neck Stress Fractures.

    PubMed

    Chalupa, Robyn L; Rivera, Jessica C; Tennent, David J; Johnson, Anthony E

    2016-01-01

    The most common overuse injury leading to medical discharge of military recruits is a stress fracture. One of the high-risk stress fractures is of the lateral femoral neck which risks osteonecrosis of the femoral head, the need for arthroplasty and permanent disability. To prevent fracture progression early surgical intervention is recommended. Surgical repairs are performed in about 25% of cases of femoral neck stress fractures at military treatment facilities. Hip geometry is an important intrinsic risk for stress fractures. Loads in the average loading direction will not cause a fracture, but loads of extreme magnitude or extreme orientation may. The purpose of this study was to determine if, in the presence of femoral neck stress fracture, there is a correlation between femoral neck shaft angle, surgical treatment and outcomes. The results of this study suggest there is no correlation between return to full military duty rates, treatment, femoral neck shaft angle or fracture grade on MRI. Patients who underwent surgical fixation had greater fracture grade and pain than those that did not have surgery. Individuals who did not return to duty tended to have higher pain scores at initial evaluation.

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

    PubMed Central

    2016-01-01

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

  13. Magnetic resonance imaging of the distal radial epiphysis: a new criterion of maturity for determining whether the age of 18 has been completed?

    PubMed

    Timme, M; Ottow, C; Schulz, R; Pfeiffer, H; Heindel, W; Vieth, V; Schmeling, A; Schmidt, S

    2017-03-01

    To improve the accuracy of forensic age estimation where there is no legal basis for carrying out x-ray examinations, it would be useful to establish non-x-ray imaging techniques. The objective of this study was to provide reference data for the magnetic resonance imaging-based evaluation of the ossification stage of the distal radius. Furthermore, we tested a new criterion of the maturity of the distal radial epiphysis for determining whether an individual has completed the age of 18. We investigated 668 MRI scans of the distal radial epiphysis from 333 female and 335 male subjects ranging in age from 12 to 24. To determine the ossification stage, we used the clavicular ossification staging systems described by Schmeling et al. and Kellinghaus et al. Ossification stage IV as described by Schmeling et al. was divided into two sub-stages, IVa and IVb, depending on whether or not it was possible to identify a triple-banded meta-epiphyseal zone of calcification. All study subjects were able to be assigned to an ossification stage without ambiguity. We present statistics relating to the distribution of ossification stages divided by sex. The age of the youngest female subject assessed as ossification stage IVb was 16.8, the age of the youngest male subject 18.6. The youngest age at which female subjects were assessed as ossification stage V was 22.3; for male subjects it was 23.1. Further independent studies should be carried out to determine whether ossification stage IVb can indeed be used to reliably determine whether a male subject has completed the age of 18.

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

    PubMed

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

    2016-10-01

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

  15. Widening Rings

    NASA Image and Video Library

    2010-03-18

    Saturn rings and its moon Rhea are imaged before a crescent of the planet in this image captured by NASA Cassini spacecraft. The shadows of the rings continue to grow wider after their disappearing act during the planet August 2009 equinox.

  16. Effect of the anodization voltage on the pore-widening rate of nanoporous anodic alumina.

    PubMed

    Rahman, Mohammad Mahbubur; Garcia-Caurel, Enric; Santos, Abel; Marsal, Lluis F; Pallarès, Josep; Ferré-Borrull, Josep

    2012-08-23

    A detailed study of the pore-widening rate of nanoporous anodic alumina layers as a function of the anodization voltage was carried out. The study focuses on samples produced under the same electrolyte and concentration but different anodization voltages within the self-ordering regime. By means of ellipsometry-based optical characterization, it is shown that in the pore-widening process, the porosity increases at a faster rate for lower anodization voltages. This opens the possibility of obtaining three-dimensional nanostructured nanoporous anodic alumina with controlled thickness and refractive index of each layer, and with a refractive index difference of up to 0.24 between layers, for samples produced with oxalic acid electrolytes.

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

    SciTech Connect

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

    2014-04-16

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

  18. Effect of the anodization voltage on the pore-widening rate of nanoporous anodic alumina

    PubMed Central

    2012-01-01

    A detailed study of the pore-widening rate of nanoporous anodic alumina layers as a function of the anodization voltage was carried out. The study focuses on samples produced under the same electrolyte and concentration but different anodization voltages within the self-ordering regime. By means of ellipsometry-based optical characterization, it is shown that in the pore-widening process, the porosity increases at a faster rate for lower anodization voltages. This opens the possibility of obtaining three-dimensional nanostructured nanoporous anodic alumina with controlled thickness and refractive index of each layer, and with a refractive index difference of up to 0.24 between layers, for samples produced with oxalic acid electrolytes. PMID:22916731

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

    PubMed Central

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

    2013-01-01

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

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

    PubMed

    Bruner, Emiliano; Holloway, Ralph L

    2010-02-01

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

  1. [Plastic widening of the aorta associated with implantation of valvular prosthesis].

    PubMed

    Actis Dato, A; Borio, L; Panero, G B; De Michelis, M

    1975-04-04

    Widening of the supravalvular aorta by means of a lozenge-shaped dacron patch was performed in 9 cases of stenosis and/or aorta insufficiency. Marked improvement was noted in the 8 patients followed up: the transvalvular gradient was not significant and neither haemolytic anaemia nor hyperhaemolysis were present. This expedient is both useful and indicated in cases where the calibre of the descending aorta is small.

  2. Flecainide widens the excitable gap at pivot points of premature turning wavefronts in rabbit ventricular myocardium.

    PubMed

    Danse, P W; Garratt, C J; Allessie, M A

    2001-09-01

    The mechanisms by which Class IC drugs slow the rate of functional reentrant arrhythmias are not completely understood. We hypothesized that flecainide widens the excitable gap beyond the pivot point of premature turning wavefronts. In eight perfused subepicardial layers of rabbit left ventricle, a linear lesion was made by radiofrequency (RF) ablation parallel to the fiber orientation. One end of the RF lesion was extended by a short incision. Pacing next to the lesion induced a wavefront propagating with a sharp U-turn around the end of the lesion in either the clockwise or counterclockwise direction. A high-density mapping electrode (240 electrodes, 350-microm resolution) was used to record unipolar electrograms at the pivot point. During control, the shortest V1-V2 interval proximal to the pivot point was 162 +/- 12 msec compared with 173 +/- 13 msec distal to the pivot point (difference 11 +/- 8 msec; P < 0.01). After infusion of flecainide 2 mg/L, the shortest V1-V2 interval proximal and distal to the pivot point were 217 +/- 29 msec and 244 +/- 36 msec (difference 27 +/- 16 msec; P < 0.01). Due to the increase in V1-V2 interval at the pivot point, flecainide widened the temporal excitable gap in the returning limb of the turning wavefront from 30 +/- 11 msec to 55 +/- 22 msec (P < 0.01). High-density mapping at the pivot point revealed that this widening of the excitable gap was due to both macroscopic discontinuous conduction and functional conduction block at the pivot point. Flecainide widens the excitable gap in the returning limb of premature U-turning wavefronts by causing macroscopic discontinuous conduction and functional conduction block at the pivot point.

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

    NASA Astrophysics Data System (ADS)

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

    2008-01-01

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

  4. Ever-Widening Horizons: Hemingway’s War Literature, 1923 to 1940

    DTIC Science & Technology

    2005-03-09

    Distribution Unlimited 9 March 2005 Ever-Widening Horizons: Hemingway’s War Literature, 1923 to 1940 I. Introduction Ernest Hemingway has permeated our...and Modern Memory. New York: Oxford UP, 1975. Gajdusek, Robert E. "The Suspended Woman in the Work of Ernest Hemingway ." Hemingway : Up in Michigan...1999. 204-24. Hedges, Chris. "On War." The New York Review of Books 16 Dec. 2004: 8-14. Hemingway , Ernest . The Complete Short Stories of Ernest

  5. WIDEN: A tool for medical image management in multicenter clinical trials.

    PubMed

    Chauvie, Stéphane; Biggi, Alberto; Stancu, Alexandru; Cerello, Piergiorgio; Cavallo, Anna; Fallanca, Federico; Ficola, Umberto; Gregianin, Michele; Guerra, Ugo Paolo; Chiaravalloti, Agostino; Schillaci, Orazio; Gallamini, Andrea

    2014-06-01

    Background It has been proposed that in clinical trials in which the therapeutic strategy is driven by functional imaging, central review of the images should be done in real time. Purpose We report our experience with a new tool for image exchange and review, called Web-Based Imaging Diagnosis by Expert Network (WIDEN), which we implemented for the HD0607 prospective multicenter Italian clinical trial in which Hodgkin lymphoma treatment was adapted based on results of an interim positron emission tomography (PET) scan performed after the first two cycles of chemotherapy. Methods We used WIDEN for general management of the clinical trial, site imaging qualification, image exchange, workflow control, blinded independent central review, inter-observer variability assessment, consensus creation, audit, and statistical analysis. Results As of February 2013, the interim PET was available for 512 patients; upon central review, 103 of the scans were judged to be positive and 409 to be negative. The median scan uploading and downloading times were 1 min, 25 s and 1 min, 55 s, respectively; the average and median times for diagnosis exchange were 47 h, 53 min and 37 h, 43 min, respectively. The binary concordance between pairs of reviewers (Cohen's kappa) ranged from 0.72 to 0.85. The 5-point scale concordance among all reviewers (Krippendorf's alpha) was 0.77. Conclusions WIDEN proved to be an effective tool for medical imaging exchange and online review. Data security, simplicity, feasibility, and prompt scan review were demonstrated. Central reviews were completed promptly.

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

    PubMed Central

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

    2013-01-01

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

  7. Intracorporeal knotting of a femoral nerve catheter.

    PubMed

    Ghanem, Mohamed; Schnoor, Jörg; Wiegel, Martin; Josten, Christoph; Reske, Andreas W

    2015-01-01

    Peripheral nerve catheters are effective and well-established tools to provide postoperative analgesia to patients undergoing orthopedic surgery. The performance of these techniques is usually considered safe. However, placement of nerve catheters may be associated with a considerable number of side effects and major complications have repeatedly been published. In this work, we report on a patient who underwent total knee replacement with spinal anesthesia and preoperative insertion of femoral and sciatic nerve catheters for postoperative analgesia. During insertion of the femoral catheter, significant resistance was encountered upon retracting the catheter. This occurred due to knotting of the catheter. The catheter had to be removed by operative intervention which has to be considered a major complication. The postoperative course was uneventful. The principles for removal of entrapped peripheral catheters are not well established, may differ from those for neuroaxial catheters, and range from cautious manipulation up to surgical intervention.

  8. Intracorporeal knotting of a femoral nerve catheter

    PubMed Central

    Ghanem, Mohamed; Schnoor, Jörg; Wiegel, Martin; Josten, Christoph; Reske, Andreas W.

    2015-01-01

    Peripheral nerve catheters are effective and well-established tools to provide postoperative analgesia to patients undergoing orthopedic surgery. The performance of these techniques is usually considered safe. However, placement of nerve catheters may be associated with a considerable number of side effects and major complications have repeatedly been published. In this work, we report on a patient who underwent total knee replacement with spinal anesthesia and preoperative insertion of femoral and sciatic nerve catheters for postoperative analgesia. During insertion of the femoral catheter, significant resistance was encountered upon retracting the catheter. This occurred due to knotting of the catheter. The catheter had to be removed by operative intervention which has to be considered a major complication. The postoperative course was uneventful. The principles for removal of entrapped peripheral catheters are not well established, may differ from those for neuroaxial catheters, and range from cautious manipulation up to surgical intervention. PMID:26504733

  9. Spontaneous stress fractures of the femoral neck

    SciTech Connect

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

    1985-02-01

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

  10. Femoral bifurcation disease: balloon or knife.

    PubMed

    Bosiers, Marc; Deloose, Koen

    2009-10-01

    Arterial occlusive disease at the level of the femoral bifurcation mostly occurs in combination with inflow and/or outflow lesions. Surgical endarterectomy of the femoral bifurcation is a well-proven low-risk and easy surgical intervention with known durable success, while, although proven to be safe, evidence is lacking about the durability of the endovascular approach. Based on the evidence at hand, the surgical approach should be recommended for the vast majority of patients and the endovascular approach should only be indicated as the first strategy in selected cases presenting with factors that might compromise the outcome of surgery in the groin. If feasible, the hybrid approach with endarterectomy at the level of the bifurcation and endovascular repair of the inflow and outflow lesions is preferred in patients with multilevel disease.

  11. When femoral fracture fixation fails: salvage options.

    PubMed

    Petrie, J; Sassoon, A; Haidukewych, G J

    2013-11-01

    Most hip fractures treated with modern internal fixation techniques will heal. However, failures occasionally occur and require revision procedures. Salvage strategies employed during revision are based on whether the fixation failure occurs in the femoral neck, or in the intertrochanteric region. Patient age and remaining bone stock also influence decision making. For fractures in young patients, efforts are generally focused on preserving the native femoral head via osteotomies and repeat internal fixation. For failures in older patients, some kind of hip replacement is usually selected. Disuse osteopenia, deformity, bone loss, and stress-risers from previous internal fixation devices all pose technical challenges to successful reconstruction. Attention to detail is important in order to minimise complications. In the majority of cases, good outcomes have been reported for the various salvage strategies.

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

    SciTech Connect

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

    2004-09-15

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

  13. Synchronous femoral hernias diagnosed during endoscopic inguinal hernia repair.

    PubMed

    Putnis, Soni; Wong, April; Berney, Christophe

    2011-12-01

    During totally extraperitoneal (TEP) endoscopic repair of inguinal hernias, it is possible to see the internal opening of the femoral canal. The aim of our study was to determine the incidence of synchronous femoral hernias found in patients undergoing TEP endoscopic inguinal hernia repair. This was a retrospective review of prospectively collected data on 362 consecutive patients who underwent 484 TEP endoscopic inguinal hernia repairs during a 5-year period, May 2005 to May 2010. During surgery, both inguinal and femoral canal orifices were routinely inspected. The presence of unilateral or bilateral inguinal and femoral hernias was recorded and repaired accordingly. There were a total of 362 patients. More males (343, 95%) underwent a TEP hernia repair than females (19, 5%). There were more cases of unilateral (240/362, 66%) than bilateral (122/362, 34%) inguinal hernias. A total of 18 cases of synchronous femoral hernias were found during operation. There was a higher incidence of femoral hernia in females (7/19, 37%) compared to males (11/343, 3%) (P < 0.001). None of the femoral hernias were clinically detectable preoperatively. Females undergoing elective inguinal hernia repair are more likely to have a synchronous femoral hernia than males. We suggest that all women presenting with an inguinal hernia also have a formal assessment of the femoral canal. TEP endoscopic inguinal hernia repair is an ideal approach as both inguinal and femoral orifices can be assessed and hernias repaired simultaneously during surgery.

  14. [Avascular necrosis of the femoral head].

    PubMed

    Porubský, Peter; Trč, Tomáš; Havlas, Vojtěch; Smetana, Pavel

    Avascular necrosis of the femoral head in adults is not common, but not too rare diseases. In orthopedic practice, it is one of the diseases that are causing implantation of hip replacement at a relatively early age. In the early detection and initiation of therapy can delay the implantation of prosthesis for several years, which is certainly more convenient for the patient and beneficial. This article is intended to acquaint the reader with the basic diagnostic procedures and therapy.

  15. Subtrochanteric fractures after retrograde femoral nailing

    PubMed Central

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

    2015-01-01

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

  16. Monitoring femoral component installation using vibration testing.

    PubMed

    Giardini, Seana; Cornwell, Phillip; Meneghini, R Michael

    2005-01-01

    With emerging minimally invasive surgical techniques in total hip arthroplasty, there has been anecdotal evidence of an increase in fractures associated with the insertion of the prosthesis into the femur. The diminished visibility associated with minimally invasive surgical techniques necessitates a greater emphasis on the surgeon's tactile and auditory senses. These senses are used to ascertain the femoral component position of maximum stability and interference fit, as well as to prevent further component impaction and subsequent fracture of the femur. The work described herein attempts to identify a means to supplement the surgeon's tactile and auditory senses by using damage identification techniques normally used in civil and mechanical structures to monitor the insertion process of the prosthesis. It is hypothesized that vibration characteristics of the impact process may be used intraoperatively to determine at what position the femoral component has reached appropriate interference fit and stability in the femur. Such information may be used to prevent further impaction of the femoral component past a threshold that could result in a periprosthetic fracture. A piezoelectric accelerometer and impact hammer will be used to monitor the impact process. The acceleration time history data were analyzed by using low and high pass filters to allow frequency analysis of the time history signals. This paper will summarize features derived from the measured data that will be used to develop an insertion process termination indicator.

  17. Severity of Asynchronous Slipped Capital Femoral Epiphyses in Skeletally Immature Versus More Skeletally Mature Patients.

    PubMed

    Nowicki, Philip D; Silva, Selina; Toelle, Lisa; Strohmeyer, Greg; Wahlquist, Trevor; Li, Ying; Farley, Frances A; Caird, Michelle S

    2017-01-01

    Routine prophylactic screw fixation for skeletally immature patients with slipped capital femoral epiphysis (SCFE) continues to be debated. The purpose of this study was to assess the slip severity of a second SCFE in skeletally immature versus more mature patients and determine necessity of contralateral hip prophylactic screw fixation. All patients treated for SCFE at 3 pediatric hospitals over a 10-year time period (January 1, 2002 to December 31, 2011) were evaluated. Patients were included if they had a unilateral SCFE and a contralateral asynchronous SCFE, and were divided into immature (Oxford triradiate score 1) versus more mature (Oxford triradiate score 2 and 3) groups. Data evaluation included age, time between slips, body mass index, Southwick angles of first then second SCFEs, and follow-up duration. There were a total of 45 patients: 16 patients in the skeletally immature and 29 patients in the more mature group. Average age at first SCFE in immature patients was 10.9 years and in more mature patients 12.1 years (P=0.70). Age at second SCFE in immature patients was 11.5 years and in more mature patients 13.0 years (P=0.023). Average time between SCFEs was 6.6 months for immature and 11.4 months for more mature patients (P=0.093). Southwick angles for immature patient first and second SCFEs were 25 and 12.9 degrees, respectively, and for more mature patient first and second SCFEs were 31 and 21 degrees, respectively. Southwick angles were higher at first and second slips in the more mature group, significant only at the second slip (P=0.032). SCFE severity at initial event was predictive of severity of second SCFE regardless of maturity (P=0.043). Regression analysis of slip severity against multiple patient factors demonstrated triradiate score was not a factor assessing subsequent SCFE magnitude (P=0.099). There was no significant difference between first and second SCFEs regardless of skeletal maturity but severity of initial SCFE did correlate with

  18. Femoral stem fracture and in vivo corrosion of retrieved modular femoral hips.

    PubMed

    Huot Carlson, J Caitlin; Van Citters, Douglas W; Currier, John H; Bryant, Amber M; Mayor, Michael B; Collier, John P

    2012-08-01

    A series of 78 retrieved modular hip devices were assessed for fretting and corrosion. Damage was common at both the head-neck junction (54% showing corrosion; 88% showing fretting) and at the stem-sleeve junction (88% corrosion; 65% fretting). Corrosion correlated to in vivo duration, patient activity, and metal (vs ceramic) femoral heads but did not correlate to head carbon content. Femoral stem fatigue fracture was observed in seven retrievals; all had severe corrosion, were under increased stress, and were in vivo longer than the non-fractured cohort. This study emphasizes the potential for stem fracture when small diameter femoral stems with large offsets are used in heavy and active patients. Designs which reduce fretting and corrosion in modular implants is warranted as patients demand longer lasting implants.

  19. Hybrid approach to limb salvage in the setting of an infected femoral-femoral bypass graft.

    PubMed

    Jones, Douglas W; Meltzer, Andrew J; Schneider, Darren B

    2014-08-01

    Prosthetic vascular graft infection in patients with advanced peripheral arterial disease can lead to multiple additional procedures, including extra-anatomic bypass or even amputation. We report the case of an 88-year-old woman with critical limb ischemia and an infected prosthetic femoral-femoral bypass graft. Using a planned hybrid 2-stage approach, we performed endovascular recanalization of the native left iliac arterial system using remote access via the superficial femoral artery to avoid infected groin wounds. Recanalization of the patient's Trans-Atlantic Inter-Society Consensus II D chronic iliac occlusion allowed for removal of the infected graft and placement of a profunda femoris artery to proximal posterior tibial artery bypass, thereby restoring inflow and avoiding the infected left groin. Newer endovascular techniques coupled with open surgical options may lead to limb salvage in patients with previously unreconstructable peripheral arterial disease.

  20. Management and outcome of interprosthetic femoral fractures.

    PubMed

    Platzer, Patrick; Schuster, Rupert; Luxl, Monika; Widhalm, Harald Kurt; Eipeldauer, Stefan; Krusche-Mandl, Irena; Ostermann, Roman; Blutsch, Beate; Vécsei, Vilmos

    2011-11-01

    Interprosthetic femoral fractures following ipsilateral hip and knee arthroplasty are a rare but serious complication in clinical practice. In most cases, adequate management of these injuries might constitute a challenging problem. However, the literature provides only few data regarding the treatment and outcome of interprosthetic femoral fractures, and there are only few classifications available, which might assist in finding an appropriate treatment concept. The purpose of this study was to analyse our experience in the management of interprosthetic femoral fractures following ipsilateral hip and knee joint replacement. We reviewed the clinical and radiographic records of 23 patients (15 female and eight male, average age: 79.2 years) with an interprosthetic fracture after ipsilateral hip and knee joint replacement between 1992 and 2008. For the classification of interprosthetic femoral fractures, the fractures were divided into three types, depending on the fracture site and the adjacency to the prostheses. All patients underwent operative stabilisation, either by lateral plate fixation (n=19), by revision arthroplasty using a long stem (n=2) or by plate fixation and revision arthroplasty (n=2). Referring to the clinical outcome, 16 patients returned to their pre-injury activity level and were satisfied with their clinical outcome. In six patients, we saw a relevant decrease of hip or knee function and severe limitations in gait and activities of daily living. We had a mean Harris Hip Score (HHS) of 78.4 points, and a mean Knee injury and Osteoarthritis Outcome Score (KOOS) of 71.8 points. Relating to the radiographic outcome, successful fracture healing was achieved in 19 of 22 patients (86%) within 6 months. Failures of reduction and fixation were noted in four (18%) of 22 patients. We had a satisfactory outcome following individualised treatment of interprosthetic femoral fractures following ipsilateral hip and knee joint replacement. Compared to the rare

  1. Large ceramic femoral heads: what problems do they solve?

    PubMed

    Rodriguez, J A; Cooper, H J

    2013-11-01

    Large ceramic femoral heads offer several advantages that are potentially advantageous to patients undergoing both primary and revision total hip replacement. Many high-quality studies have demonstrated the benefit of large femoral heads in reducing post-operative instability. Ceramic femoral heads may also offer an advantage in reducing polyethylene wear that has been reported in vitro and is starting to become clinically apparent in mid-term clinical outcome studies. Additionally, the risk of taper corrosion at a ceramic femoral head-neck junction is clearly lower than when using a metal femoral head. With improvements in the material properties of both modern ceramic femoral heads and polyethylene acetabular liners that have reduced the risk of mechanical complications, large ceramic heads have gained popularity in recent years.

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

    PubMed

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

    2010-02-01

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

  3. Femoral neuropathy and meralgia paresthetica secondary to an iliacus hematoma.

    PubMed

    Yi, Tae Im; Yoon, Tae Hee; Kim, Joo Sup; Lee, Ga Eun; Kim, Bo Ra

    2012-04-01

    Compressive femoral and lateral femoral cutaneous neuropathies from an iliacus hematoma are unusual presentation. We report a case of a 16-year-old boy who developed right femoral and lateral femoral cutaneous neuropathies as a complication of traumatic ipsilateral iliacus hematoma formation. The patient complained of numbness in the right thigh and calf as well as right leg weakness, and pain in the right inguinal area. Nerve conduction study and needle electromyography identified the neuropathies. After the electrodiagnostic studies, the pelvic bone MRI revealed a large, 9×5×4.5 cm right iliacus hematoma. As a result, diagnosis of a right iliacus hematoma compressing the femoral and lateral femoral cutaneous nerves was made, and the patient underwent an operation to remove the hematoma. Symptoms and neurological signs showed notable improvement after surgical decompression. Subsequent follow-up electrodiagnostic studies after 11 weeks demonstrated regeneration evidence.

  4. Femoral Neuropathy and Meralgia Paresthetica Secondary to an Iliacus Hematoma

    PubMed Central

    Yi, Tae Im; Kim, Joo Sup; Lee, Ga Eun; Kim, Bo Ra

    2012-01-01

    Compressive femoral and lateral femoral cutaneous neuropathies from an iliacus hematoma are unusual presentation. We report a case of a 16-year-old boy who developed right femoral and lateral femoral cutaneous neuropathies as a complication of traumatic ipsilateral iliacus hematoma formation. The patient complained of numbness in the right thigh and calf as well as right leg weakness, and pain in the right inguinal area. Nerve conduction study and needle electromyography identified the neuropathies. After the electrodiagnostic studies, the pelvic bone MRI revealed a large, 9×5×4.5 cm right iliacus hematoma. As a result, diagnosis of a right iliacus hematoma compressing the femoral and lateral femoral cutaneous nerves was made, and the patient underwent an operation to remove the hematoma. Symptoms and neurological signs showed notable improvement after surgical decompression. Subsequent follow-up electrodiagnostic studies after 11 weeks demonstrated regeneration evidence. PMID:22639754

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

    NASA Astrophysics Data System (ADS)

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

    2010-12-01

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

  6. Femoral neck structure and function in early hominins.

    PubMed

    Ruff, Christopher B; Higgins, Ryan

    2013-04-01

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

  7. Tropical Belt Widening And Positive Ozone Trends In The African Upper Troposphere

    NASA Astrophysics Data System (ADS)

    Cammas, J.; Thouret, V.; Noiret, T.; Sauvage, B.; Nedelec, P.; Smit, H. M.; Volz-Thomas, A.

    2011-12-01

    Based on various metrics (satellite data, model analyses), evidence has been reported recently that the width of the tropics has expanded by 1-2 degrees of latitude per decade as an unequivocal sign of climate change in the tropics (e.g. Seidel et al., 2008). A high societal impact is expected because of the concomitant poleward shift of meteorological regimes such as subsidence and particularly precipitation. The present study investigates the tropical belt widening over Africa from airborne in-situ measurements collected routinely between 1995 and 2009 as part of the MOZAIC programme (Measurements of ozone and water vapour by Airbus in-service aircraft, Marenco et al., 1998). Metrics of the width of the tropical band are defined with observations of winds, relative humidity and the ozone mixing ratio. To our knowledge, this is the first time that the widening of the tropical band has been investigated using in-situ data. A 14-year time series of airborne in-situ measurements of wind, relative humidity and ozone in the African upper troposphere is used to assess the rate of increase of the width of the tropical belt and the ozone trend. The results show a statistically robust rate of expansion of 2.4 degrees latitude per decade, mainly due to a poleward expansion of the southern boundary of the tropical belt. The upper tropospheric ozone trend was derived to about 0.6 ppbv/year. Such an increase of ozone in a widening tropospheric reservoir represents a key observation of tropical climate change, and can serve as an excellent indicator for future changes in this important region of the earth, if the measurement programme is continued.

  8. [Z-osteotomy of distal fibula to correct widened ankle mortice after fracture].

    PubMed

    Tao, Xu; Tang, Kanglai; Zhou, Jianbo

    2012-07-01

    To analyse the clinical outcomes of the Z-osteotomy of the distal fibula to correct widened mortice of the ankle after fracture. Between September 2009 and February 2011, 5 patients (5 feet) with widened ankle mortice after fracture underwent Z-osteotomy. There were 4 males and 1 female, aged from 23 to 58 years (mean, 38 years). At 3 months after operation of internal fixation when function exercises were done, patients got pains. The interval between trauma and operation ranged from 5 to 36 months (mean, 13.2 months). Lateral pressure test showed positive in 2 cases and negative in 3 cases. American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot score was 50.2 +/- 17.3. Primary healing of incision was achieved in all cases. Five patients were followed up 9 to 24 months (mean, 15.6 months). Mild to moderate swelling of the affected limb and anterolateral skin numbness of the ipsilateral dorsal foot occurred, and gradually improved. The clinical exam and radiology showed bone union at 12-15 weeks (mean, 13.5 weeks). Postoperative range of motion of ankle had no significant improvement. AOFAS ankle-hindfoot scores were 76.8 +/- 11.2 at 6 months after operation, and 85.4 +/- 3.2 at last follow-up, showing significant differences when compared with preoperative score (P < 0.05). Shortened fibula is the main cause of widened ankle mortice after fracture; Z-osteotomy can effectively reduce the width of the ankle mortice, increase the stability of ankle joint, and decrease the complication rate.

  9. [The widened "empty" internal auditory meatus. A new differential diagnosis of the small acousticus neurinoma].

    PubMed

    Grehn, S; Helms, J

    1976-02-01

    Six patients with symptoms suggestive of acoustic neuromas showed a wided, contrastfilled internal auditory meatus during positive contrast meatography on tomographic cuts. These results suggest that widening of the internal auditory meatus may not always be due to a space-occupying lesion. The explanation for these findings is not known. No comparable findings have been published in the relevant literature. Surgical intervention, which is frequently harmful and carried out because of a misdiagnosed acoustic neuroma can only be avoided by carrying out cisternography with positive contrast materials and tomography in the Stenvers' and Schüller projection.

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

    PubMed

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

    2016-06-01

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

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

    PubMed

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

    2016-07-01

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

  12. Tunnel widening after hamstring anterior cruciate ligament reconstruction is influenced by the type of graft fixation used: a prospective randomized study.

    PubMed

    Fauno, Peter; Kaalund, Søren

    2005-11-01

    To compare the incidence of tunnel widening (TW) in patients undergoing anterior cruciate ligament (ACL) reconstruction with hamstring graft using either (group A) transfemoral fixation implant (Transfix; Arthrex, Naples, FL) and an interference screw (Arthrex) in the tibial tunnel or (group B) extracortical fixation (EndoButton; Smith & Nephew Endoscopy, Andover, MA) in the femur and bicortical screw and washer distal to the tibial tunnel. Prospective randomized study. One hundred patients were included and randomized and 87 patients were assessed at a 1-year follow-up. The evaluation included standardized radiographs, KT-1000 data, International Knee Documentation Committee (IKDC) ratings, and Lysholm score. The diameter of the tunnel at the 1 year follow-up was, after correction for magnification, compared with the tunnel diameter of the radiograph from 2 weeks postoperatively. A more than 2-mm enlargement was considered TW. In group A in which transfixation in the femur and interference screw in the tibia was used, 7 of 41 patients had developed femoral TW and 5 of 41 tibial TW. In group B, 20 of 46 patients had TW in the femur and 16 of 46 in the tibia (P < .05, chi-square test). No significant difference was found with respect to Lysholm score, IKDC, or arthrometric evaluation. There was a significant reduction of TW in both the femur and the tibia using fixation points close to the joint, compared with the system where the distance between the fixation points is long. We conclude that the position of the fixation sites and type of fixation device are major factors in the development of TW after ACL surgery. Level I, therapeutic study in a prospective randomized clinical trial.

  13. Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures.

    PubMed

    Wang, Chen; Xu, Gui-Jun; Han, Zhe; Jiang, Xuan; Zhang, Cheng-Bao; Dong, Qiang; Ma, Jian-Xiong; Ma, Xin-Long

    2015-11-01

    The aim of the study was to introduce a new method for measuring the residual displacement of the femoral head after internal fixation and explore the relationship between residual displacement and osteonecrosis with femoral head, and to evaluate the risk factors associated with osteonecrosis of the femoral head in patients with femoral neck fractures treated by closed reduction and percutaneous cannulated screw fixation.One hundred and fifty patients who sustained intracapsular femoral neck fractures between January 2011 and April 2013 were enrolled in the study. All were treated with closed reduction and percutaneous cannulated screw internal fixation. The residual displacement of the femoral head after surgery was measured by 3-dimensional reconstruction that evaluated the quality of the reduction. Other data that might affect prognosis were also obtained from outpatient follow-up, telephone calls, or case reviews. Multivariate logistic regression analysis was applied to assess the intrinsic relationship between the risk factors and the osteonecrosis of the femoral head.Osteonecrosis of the femoral head occurred in 27 patients (18%). Significant differences were observed regarding the residual displacement of the femoral head and the preoperative Garden classification. Moreover, we found more or less residual displacement of femoral head in all patients with high quality of reduction based on x-ray by the new technique. There was a close relationship between residual displacement and ONFH.There exists limitation to evaluate the quality of reduction by x-ray. Three-dimensional reconstruction and digital measurement, as a new method, is a more accurate method to assess the quality of reduction. Residual displacement of the femoral head and the preoperative Garden classification were risk factors for osteonecrosis of the femoral head. High-quality reduction was necessary to avoid complications.

  14. Femoral shaft medialisation and neck-shaft angle in unstable pertrochanteric femoral fractures.

    PubMed

    Pajarinen, J; Lindahl, J; Savolainen, V; Michelsson, O; Hirvensalo, E

    2004-12-01

    We analysed the time-dependent mean changes in the femoral neck length, neck-shaft angle and hip offset in a randomised study comprising 48 patients who were treated with the dynamic hip screw (DHS) or the proximal femoral nail (PFN) for an unstable intertrochanteric femoral fracture. As a consequence of fracture compression, the mean post-operative neck length was significantly shorter in patients treated with the DHS. During the first 6 weeks after the operation, a mean decrease of 4.6 degrees was observed in the neck-shaft angle, but there was not a significant difference between the treatment groups. The radiographic measures remained virtually unaffected during the interval from 6 weeks to 4 months in both groups. When the operated hip was compared to the opposite hip, patients who had received the DHS showed significantly greater medialisation of the femoral shaft at 4 months than those treated with the PFN. We thus recommend that unstable intertrochanteric fractures should be initially reduced in a slight valgus position in order to achieve an outcome after healing that is as normal as possible. As a result of differences in operative technique and implant stability, the PFN may be superior to the DHS in retaining the anatomical relations in the hip region in unstable intertrochanteric fractures.

  15. Pitfalls of femoral titanium elastic nailing.

    PubMed

    Salonen, A; Lahdes-Vasama, T; Mattila, V M; Välipakka, J; Pajulo, O

    2015-06-01

    Despite several potential complications of elastic intramedullary nailing, it is currently the treatment of choice for femoral diaphyseal fractures in school-aged children. This study aimed to critically evaluate the complications of titanium elastic nailing in pediatric femoral shaft fractures. This study evaluated patients with a diaphyseal femoral fracture treated with titanium elastic nailing (TEN) in Tampere University Hospital in Finland. The study group included 32 children with a mean age of 9 years during a 5-year period, from 1 January 2003 to 31 December 2007. Data were collected from medical records and x-rays. Mean follow-up time was 42 months. Of 32 patients, 9 (28%) reported a postoperative complication. Complications were associated with nail prominence in five (16%) patients and instability in four (12%) patients. In patients with nail prominence, the titanium elastic nailing-nail ends were unbent and 10-35 mm outside the cortex of the distal femur. The nail prominence caused pain and delayed knee mobilization until the nail was removed after a mean time of 4 months. In patients with fracture instability, the mean titanium elastic nailing-nail/medullary canal diameter ratio was 46% and periosteal callus formation was 5.4 mm at the first control. In those with stable fractures, the values were 66% and 9.2 mm, respectively. Based on this study, two types of pitfalls in a small volume center were found. Titanium elastic nail ends were left unbent and too long. We recommend palpating the nail ends to exclude nail prominence and to verify free movement of the knee after nail cutting and bending. Fracture instability was caused by inserting titanium elastic nailing-nails that were too narrow. To avoid this complication, careful preoperative planning to select the proper-size titanium elastic nailing-nails and intraoperative testing of fracture stability under continuous fluoroscopy after the operation is advised. © The Finnish Surgical Society 2014.

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

    PubMed

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

    2012-10-01

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

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

    PubMed

    Goldin-Meadow, Susan

    2014-09-19

    The goal of this paper is to widen the lens on language to include the manual modality. We look first at hearing children who are acquiring language from a spoken language model and find that even before they use speech to communicate, they use gesture. Moreover, those gestures precede, and predict, the acquisition of structures in speech. We look next at deaf children whose hearing losses prevent them from using the oral modality, and whose hearing parents have not presented them with a language model in the manual modality. These children fall back on the manual modality to communicate and use gestures, which take on many of the forms and functions of natural language. These homemade gesture systems constitute the first step in the emergence of manual sign systems that are shared within deaf communities and are full-fledged languages. We end by widening the lens on sign language to include gesture and find that signers not only gesture, but they also use gesture in learning contexts just as speakers do. These findings suggest that what is key in gesture's ability to predict learning is its ability to add a second representational format to communication, rather than a second modality. Gesture can thus be language, assuming linguistic forms and functions, when other vehicles are not available; but when speech or sign is possible, gesture works along with language, providing an additional representational format that can promote learning. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

  18. Lobar Dementia due to Extreme Widening of Virchow-Robin Spaces in One Hemisphere.

    PubMed

    Buerge, Christine; Steiger, Gregor; Kneifel, Stefan; Wetzel, Stephan; Wollmer, M Axel; Probst, Alphonse; Baumann, Thomas P

    2011-05-01

    Widened perivascular spaces known as Virchow-Robin spaces (VRS) are often seen on MRI and are usually incidental findings. It is unclear if enlarged VRS can be associated with neurological deficits. In this report, we describe a case of lobar dementia associated with unusual VRS widening in one cerebral hemisphere. A 77-year-old woman, seen at a memory clinic, presented with progressive cognitive decline, left hemianopsia, and mild pyramidal signs on the left side. On MRI, unusually wide VRS were visible, predominantly in the right centrum semiovale and the right temporo-occipital white matter. The clinical syndrome was consistent with the extent and location of the abnormally dilated VRS. The high MR signal in white matter bridges between the VRS suggested parenchymal damage, possibly representing gliotic white matter. No evidence for another etiology was found on cerebral MRI and rCBF SPECT. As a conclusion, enlarged VRS in one cerebral hemisphere may be associated with cognitive change and neurological deficits.

  19. Ergonomic considerations in school environments - the need for widening the scope.

    PubMed

    Jayaratne, Kapila

    2012-01-01

    Behaviour patterns specific to children pose them at greater risk of environmental hazards than adults. Ergonomics is the science of matching human interaction with the proximate environment. Conventionally ergonomic principles were applied on adult work places to ensure safety of the working environment. With emerging scientific evidence, school environments are being a focus to apply ergonomic principles. Children spend more time within schools during critical developmental stages of their life. Everybody feels that the schools are safe places, but they are not. A multitude of ergonomic hazards have been identified in school settings. Widespread mismatches between anthropometry and school furniture, heavy schoolbag carriage and unhealthy bag behaviour are significant. Negative effects range from general tiredness, musculoskeletal pains, spinal deviations, shoulder level shifts, injuries and psychological disturbances. There are fragmented efforts to widen ergonomic concepts to health care professionals and other stakeholders of child health. Addressing ergonomic issues will ensure that children, the future productive generation contributing to economic growth and development of a country, are provided with opportunities in a healthy environment. This paper emphasizes the need for a concerted effort on widening the scope of ergonomics to cater for the evolving demand.

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

    PubMed Central

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

    2016-01-01

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

  1. Phimosis. Preputial plasty using transversal widening on the dorsal side with EMLA local anesthetic cream.

    PubMed

    Dessanti, Antonio; Ginesu, Giorgio; Iannuccelli, Marco; Balata, Antonio

    2005-04-01

    In the United States, the treatment of choice for the correction of phimosis is circumcision, whereas in European countries, the condition is usually treated by preputial plasty using Duhamel's method or modified versions. We report our experience in correcting phimosis by preputial plasty using transversal widening on the dorsal side with EMLA local anesthetic cream. Twenty-six patients with phimosis were operated on by preputial plasty, under local anesthesia with EMLA cream. A transversal incision is made on the dorsal side of the ring of prepuce, like 3 contiguous Ts, the middle one inverted with the long arm on the preputial mucosa side. The 2 small mucocutaneous flaps of the prepuce are separated and then sutured with interrupted stitches, thus transforming the incisions from T to V. No postoperative complications were observed. At 1-year follow-up, the cosmetic and functional results were satisfactory. The technique of preputial plasty that the authors present enlarges the stenotic ring of prepuce by a transversal widening on the dorsal side. The ring of prepuce obtained is wide and symmetrical on its dorsal and ventral sides and therefore cosmetically and functionally satisfactory. It is a good alternative to the more radical circumcision technique.

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

    PubMed Central

    Goldin-Meadow, Susan

    2014-01-01

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

  3. Overgrowth of the femoral neck after hip fractures in children.

    PubMed

    Kuo, Feng-Chih; Kuo, Shu-Jui; Ko, Jih-Yang

    2016-04-26

    Overgrowth after pediatric femoral shaft fractures is well documented; however, overgrowth of the femoral neck after hip fractures has not been especially reported previously. The purpose of this study was to evaluate the incidence and characteristics of femoral neck overgrowth after hip fractures in children. From January 1990 to December 2012, there were 30 consecutive patients with pediatric hip fractures. We retrospectively reviewed the medical record of all the patients, including age at injury, gender, injury mechanism, fracture type, methods of treatment, time to bony union, and complications. The functional outcome was evaluated by Ratliff's criteria. The radiography of the pelvis was performed in controlled positions of abduction and external rotation. The length of the femoral neck was measured by two observers. The overgrowth of the femoral neck was defined as lengthening more than 3 mm in comparison with the uninjured hip. At a mean follow-up of 4.9 years (range 2-8 years), 12 patients (40 %) had an overgrowth of the femoral neck. The average overgrowth of the femoral neck was 6.2 mm (range 3.2-8.5 mm). The patients with femoral neck overgrowth were younger (p = 0.0002), have lower rate of avascular necrosis of the femoral head (p = 0.0006), and have better functional outcome (p = 0.0026). Our results provide evidence that overgrowth of the femoral neck following hip fractures may occur in children and the overgrowth phenomenon in the femoral neck was a predictor of good outcomes after treatment.

  4. Role of Sonography in Clinically Occult Femoral Hernias.

    PubMed

    Brandel, David W; Girish, Gandikota; Brandon, Catherine J; Dong, Qian; Yablon, Corrie; Jamadar, David A

    2016-01-01

    The purpose of this article is to evaluate the diagnostic accuracy of sonography in clinically occult femoral hernias and to describe our sonographic technique. The clinical and imaging data for 93 outpatients referred by general surgeons, all of whom underwent sonographic evaluation and surgery, were reviewed retrospectively. Of these, 55 patients who underwent surgical exploration for groin hernias within 3 months of sonography and met all inclusion criteria were included in the study. The sonographic technique involves using the pubic tubercle as an osseous landmark to identify and appropriately visualize the femoral canal. The Valsalva maneuver is then used to differentiate the movement of normal fat (a potential pitfall) from true herniation in the femoral canal. Surgical findings were used as the reference standard by which sonographic results were judged. Two-by-two contingency tables were used to calculate the sensitivity, specificity, positive predictive value, and negative predictive value. In these 55 patients, surgery revealed 15 femoral hernias. Eight femoral hernias occurred in women, and 7 occurred in men. For diagnosing femoral hernias, sonography demonstrated sensitivity of 80%, specificity of 88%, a positive predictive value of 71%, and a negative predictive value of 92%. True-positive cases of femoral hernias have a sonographic appearance of a hypoechoic sac with speckled internal echoes. When examining during the Valsalva maneuver, a femoral hernia passes deep to the inguinal ligament, expands the femoral canal, displacing the normal canal fat, and effaces the femoral vein. Sonography can exclude femoral hernias with high confidence in light of its exceptional negative predictive value. With attention to technique and imaging criteria, the diagnostic accuracy of sonography can be enhanced.

  5. Femoral neck preservation in total hip replacement.

    PubMed

    Pipino, F; Molfetta, L

    1993-01-01

    Preservation of the femoral neck in hip arthroplasty creates a particular biomechanical situation which is clearly different from what is found even after partial neck removal. The femoral neck consists in fact of a "cylinder of cortical bone" that can be used as the "base" for anchoring the stem to the femur, in contrast to the press-fit procedure or other solutions. The mechanical and biological advantages are as follows: 1) Primary triplanar stem stability, in particular rotational stability. Rotational movements of the stem are blocked by the tough lateral cortical cylinder of the neck. Resistance to varus-valgus stress and collapse is also increased vertically and frontally. 2) Proximal cortical fixation. Primary fixation of the stem is provided by the neck cortex, whereas its mid-distal part is merely held by the metaphyseal cancellous bone and the tip is undersized with respect to the medullary canal. 3) Stress loads distributed along physiological lines of stress. Retention of the neck permits preservation of the trabecular systems, along which the stress is distributed towards the diaphysis and the greater trochanter. 4) Elasticity of the bone-prosthesis system. Most of the stem is contained within the metaphyseal cancellous bone that lies between the prosthesis and the cortical bone, creating a bone-prosthesis module with variable and integrated elasticity. 5) Preservation of the bone-stock. The amount of residual bone following implant of the prosthesis increases, not only because of the presence of the femoral neck, but also as a result of the preservation of most of the metaphyseal cancellous bone. There is therefore greater bone-ingrowth, which is also favoured by the fewer changes in the endosteal blood supply. 6) Prosthesis revision is simpler, since the stem can easily be removed and a second neck resection performed. Our clinical and experimental studies, together with those of Freeman et al., confirm that the femoral neck is present for a long

  6. An anatomical measurement of medial femoral torsion.

    PubMed

    Kim, Ha Y; Lee, Sang K; Lee, Neung K; Choy, Won S

    2012-11-01

    Medial femoral torsion (MFT) can be corrected with derotational osteotomy. Derotational osteotomies can be performed in the proximal or the distal part of the femur. Similar results have been reported for these two procedures. The aim of this study was to evaluate the pathologic location of the MFT by measuring the degree of infratrochanteric and supratrochanteric torsion (STT) of the femur using computed tomography (CT) scans. The current study was carried out in patients with the chief complaint of an in-toeing gait because of the MFT. Sixty-seven patients were enrolled in the study. Forty-one patients (72 lower extremities) were included in the intervention group; 20 patients were included in the cerebral palsy (CP) group (35 lower extremities) and 21 patients were included in the developmental MFT group [developmental femoral torsional (DF) group, 37 lower extremities]. The control group included 26 patients (33 lower extremities) with uninjured limbs with a femoral or a tibial fracture. In this study, torsional angles [MFT, STT and infratrochanteric torsion (ITT)] were measured on CT scan using picture archiving and communication system measurement tools. To measure the STT and ITT, the most prominent points of the lesser and the greater trochanter were marked on CT scans; these two points were connected and were defined as the intertrochanteric line (ITL). The angle between the ITL and the axis of the femoral neck was defined as the STT. The angle between the ITL and the axis of the condylar axis was defined as the ITT. Two authors measured the MFT, STT, and ITT angles of each femur independently. The twisting of the femur had occurred in a different location for each case. In all groups, however, STT was reduced with increasing age; this change was statistically significantly. ITT of the each group showed a random distribution. The means of the ITT in the control group and the DF group did not change significantly, and that of the CP group tended to decrease

  7. Is a CT-scan of the medial clavicle epiphysis a good exam to attest to the 18-year threshold in forensic age estimation?

    PubMed

    Houpert, Tyffanie; Rérolle, Camille; Savall, Frédéric; Telmon, Norbert; Saint-Martin, Pauline

    2016-03-01

    Computed tomography (CT) scan of the medial clavicular epiphysis is one of the methods recommended by the Study Group on Forensic Age Diagnostics to estimate the age of living individuals. The aim of our study was to assess the relationship between the skeletal maturation of the sternal end of the clavicle and the chronological age in a sample of French individuals, using a nine-stage classification. We retrospectively reviewed 319 chest CT-scans of individuals aged 15-30 years old (252 males, 67 females). Among males and females, all individuals with a complete fusion, or an ongoing fusion of more than one third of the total surface of the metaphysis were at least 18 years old. Our results were consistent with data in the literature indicating that individuals with a complete fused clavicle were at least 18 years old. Similar studies with the same methods allow for creating a database of samples from different countries to confirm the validity of this method and its excellent results in forensic age estimation of living individuals.

  8. Compromised bone strength index in the hemiparetic distal tibia epiphysis among chronic stroke patients: the association with cardiovascular function, muscle atrophy, mobility, and spasticity

    PubMed Central

    Pang, Marco Y.C.; Ashe, Maureen C.; Eng, Janice J.

    2011-01-01

    Purpose To identify the determinants of the bone strength index (BSI) at the distal tibia in chronic stroke patients. Methods Sixty-three chronic stroke survivors underwent scanning of the distal tibia at the 4% site on both sides using peripheral quantitative computed tomography. The primary outcomes were trabecular bone mineral density (BMD) (mg/cm3), total BMD (mg/cm3), total bone area (mm2), and BSI (g2/cm4). Cardiovascular fitness, leg lean mass, gait velocity, and spasticity were also measured. Results Scans from 45 subjects were deemed to have acceptable quality and were included for subsequent analysis. The paretic side had significantly lower trabecular BMD, total BMD, and BSI than the non-paretic side (p<0.05). However, the total bone area demonstrated no significant side-to-side difference (p>0.05). After adjusting for relevant biological factors, peakoxygen consumption, leg muscle mass, gait velocity remained positively associated with tibial BSI on both sides (R2 change=6.9–14.2%), whereas spasticity of the paretic leg was negatively associated with tibial BSI on the same side (R2 change=4.8%). Conclusions Cardiovascular function, muscle atrophy, mobility, and spasticity are independently associated with BSI of the distal tibia epiphysis among chronic stroke patients. PMID:19882095

  9. Age estimation using CT imaging of the third molar tooth, the medial clavicular epiphysis, and the spheno-occipital synchondrosis: a multifactorial approach.

    PubMed

    Bassed, Richard B; Briggs, Christopher; Drummer, Olaf H

    2011-10-10

    A multi-factorial method for estimating age was devised based on the development of the 3rd molar tooth, the medial clavicular epiphysis, and the spheno-occipital synchondrosis, using multiple regression as the means to construct age estimation formulae and CT scanning as the imaging modality. The sample consisted of approximately 600 individuals from a contemporary Australian population, between the ages of 15 and 25 years, who were admitted to the Victorian Institute of Forensic Medicine, Melbourne, Australia, for the purposes of medico-legal death investigation. Results show that the spheno-occipital synchondrosis does not contribute to the age estimation model for this age cohort. The regression computation for the 3rd molar tooth and medial clavicle, when combined into a single multiple regression calculation, provides a robust model with tighter age ranges at the 95% confidence interval (CI) than when each age marker is used individually. This research provides a method to estimate age for unknown age Australian individuals in the problematic age group of 15-25 years with greater precision than previously possible.

  10. Compressive femoral neuropathy: a rare complication of anticoagulation.

    PubMed

    Ong, H S

    2007-03-01

    The most common coagulation disorder associated with warfarin use is bleeding, but compressive femoral neuropathy is an unusual presentation. A 63-year-old man with compressive femoral neuropathy from an iliacus haematoma is reported. The diagnosis was confirmed on magnetic resonance imaging and treated conservatively with good clinical response and radiological evidence of resolution.

  11. Routine femoral head fluoroscopy to reduce complications in coronary catheterization

    PubMed Central

    Jacobi, Joshua A.; Schussler, Jeffrey M.

    2009-01-01

    We tested whether routine preprocedure fluoroscopy of the femoral head would improve sheath placement or reduce the incidence of groin complications. Patients were randomized to receive either fluoroscopy or “blind” sheath placement using palpation alone. The location of the femoral sheath was established by femoral artery angiography. Sheath placement in relation to the femoral head, arterial location, and complication rates were compared. Placement was considered “ideal” if the sheath was in the common femoral artery and in the top or middle third of the femoral head. A total of 256 patients were enrolled. There was no difference in average age, body mass index (BMI), or rate of anticoagulation between the groups. There was no major bleeding in either group. The overall risk of minor bleeding was not statistically different. The treatment group showed higher “ideal” placement relative to the femoral head. In patients who had a BMI ≥30 kg/m2, the difference between the groups was statistically significant (treatment 69% vs control 50%). In conclusion, routine femoral fluoroscopy prior to sheath placement in coronary angiography and angioplasty did not significantly alter bleeding or complication rates but did increase the likelihood of ideal placement, especially in obese patients. PMID:19169390

  12. Peripheral blood stem cell transplantation for ischemic femoral head necrosis.

    PubMed

    Song, H-J; Lan, B-Sh; Cheng, B; Zhang, K-F; Yan, H-W; Wang, W-Zh; Gao, Z-Q

    2010-06-01

    Avascular necrosis of the femoral head (ANFH) is a highly mutilating disease. There is no effective way to treat femoral head ischemia. This study was designed to show the curative effects of peripheral blood stem cell transplantation to induce vascular regeneration and improve ischemic femoral head necrosis in rabbits. Twenty New Zealand white rabbits underwent ischemic femoral head necrosis in both hindlimbs using liquid-nitrogen refrigeration. One cohort of rats was intraperitoneally injected with granulocyte-specific colony-stimulating factor (250 microg/kg/d), and control animals received equivalent saline solution. The right side was used as the transplantation group and the left as the control. After separation of peripheral blood, a stem cell suspension was poured into the right femoral artery and saline solution into the left femoral artery. At 4 weeks after peripheral stem cell transplantation, standing ability and activity of the the transplanted right hindlimb were remarkably improved, but there were no obvious changes in the control limbs. The experimental rabbits underwent arteriography of bilateral femoral heads, which indicated increased and thickened blood supply to the transplanted right hindlimb compared with the left control. Peripheral blood stem cell transplantation improved ischemic femoral head necrosis.

  13. Cemented femoral stems in patients with DDH.

    PubMed

    Garcia-Cimbrelo, E

    2007-01-01

    Total hip arthroplasty is the procedure of choice for most adult patients with symptomatic arthrosis secondary to developmental dysplasia (DDH), but it requires complex reconstructive techniques, is usually performed in young patients, and has an increased risk of complications. THA is indicated in presence of severe pain and when osteotomy is contraindicated. The complexity of surgery is related to the degree of dysplasia. Anatomic abnormalities in the acetabulum and femur are the cause of the complexity and complications of this procedure. Acetabular bone deficiency requires reconstructive techniques before implanting the cup at the anatomic acetabular location, such as bone autograft augmentation, implanting the cup at higher level of the hip center and cup medialization. Femoral shortening and special cemented or uncemented stems are currently used to avoid intraoperative complications. While a cemented stem needs metaphyseal femoral shortening, subtrochanteric shortening requires a cementless stem. Because of these patients' age, alternative bearing surfaces, such as alumina-on-alumina couples are recommended when possible. Although the long-term results of total hip arthroplasty in DDH are inferior to those in a general population, the results show a high level of pain relief and functional improvement.

  14. Failed internal fixation of femoral neck fractures.

    PubMed

    Hoelsbrekken, Sigurd Erik; Opsahl, Jan-Henrik; Stiris, Morten; Paulsrud, Øyvind; Strømsøe, Knut

    2012-06-12

    There are two types of surgical treatment for fractures of the femoral neck; internal fixation and arthroplasty. Internal fixation is associated with a higher risk of complications such as secondary displacement, non-union and avascular necrosis. To improve treatment results of internal fixation, we have tried to identify procedure related risk-factors associated with fixation failure. A retrospective study was conducted based on the medical records and X-ray images of 337 patients sustaining intracapsular fractures of the hip during the period 1999-2000. The patients were treated with closed reduction and internal fixation at Oslo University Hospital, Aker. The reduction of the fracture and the placement of the fixation implants were evaluated and scored (six points representing best achievable result). Fixation failed in 23 (18,3 %) out of 126 patients with displaced fractures awarded six points for the reduction. In contrast, fixation failed in five (50 %) out of ten patients given a score of three points or less (p = 0.017). The risk of non-union increased when patients were treated more than 48 hours after the initial injury. In this group, 5 (25 %) out of 20 patients developed non-union compared to 16 (8 %) out of 200 patients treated within 48 hours (p = 0.014). Our findings emphasize the importance of achieving anatomical reduction of displaced femoral neck fractures, and to perform surgery within 48 hours unless an acute medical condition needs to be stabilized.

  15. Femoral head banking: NUH tissue bank experience.

    PubMed

    Nather, Aziz; David, Vikram

    2007-04-01

    National University Hospital Tissue Bank protocol follows guidelines recommended by the American Association of Tissue Banks and the European Association of Tissue Banks using donor selection criteria: medical history, clinical examination, chart review and laboratory tests for acquired immunodeficiency syndrome (AIDS), hepatitis B, hepatitis C, syphilis, and specimen for culture/sensitivity tests. For living donors, repeat testing is performed for AIDS and hepatitis C approximately 180 days after procurement. Femoral heads are procured using the "sterile double jar technique" and stored at -80 degrees C. Our first study of 273 consecutive potential donors undergoing hemiarthroplasty from 1989 to 1994 showed that a high percentage (42.5%) was unsuitable for use. A second study involving 175 potential donors was conducted from 1995 to 2003 after hepatitis C screening was introduced. The bacterial contamination rates in both studies (3.5% and 5.7%) are low. The incidence of other diseases also are low: hepatitis B, 2.3% and syphilis, 1.8% in the first study and hepatitis B, 5.7%; hepatitis C, 0.6%; and syphilis, 5.1% in the second cohort. No cases of AIDS were reported in either study. By 2003, femoral heads were transplanted in 205 patients with a low complication rate of 2.9%.

  16. Femoral bone marrow aspiration in live mice.

    PubMed

    Chung, Young Rock; Kim, Eunhee; Abdel-Wahab, Omar

    2014-07-05

    Serial sampling of the cellular composition of bone marrow (BM) is a routine procedure critical to clinical hematology. This protocol describes a detailed step-by-step technical procedure for an analogous procedure in live mice which allows for serial characterization of cells present in the BM. This procedure facilitates studies aimed to detect the presence of exogenously administered cells within the BM of mice as would be done in xenograft studies for instance. Moreover, this procedure allows for the retrieval and characterization of cells enriched in the BM such as hematopoietic stem and progenitor cells (HSPCs) without sacrifice of mice. Given that the cellular composition of peripheral blood is not necessarily reflective of proportions and types of stem and progenitor cells present in the marrow, procedures which provide access to this compartment without requiring termination of the mice are very helpful. The use of femoral bone marrow aspiration is illustrated here for cytological analysis of marrow cells, flow cytometric characterization of the hematopoietic stem/progenitor compartment, and culture of sorted HSPCs obtained by femoral BM aspiration compared with conventional marrow harvest.

  17. Continuous blood gas monitoring in femoral arteries

    NASA Astrophysics Data System (ADS)

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

    1995-05-01

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

  18. [Distal femoral periprosthetic fractures: classification and therapy].

    PubMed

    Tomás, T; Nachtnebl, L; Otiepka, P

    2010-06-01

    Periprosthetic fracture is one of the most serious complication of total knee arthroplasty. In our retrospective clinical study we designed our classification with rules for treatment of those fractures. During the last thirty years we treated 53 distal femoral periprosthetic fractures in our orthopaedic department. In our clinical study we reviewed our group of distal femoral periprosthetic fractures with on the basis of X-ray findings, the treatment method used and treatment outcomes. According to our findings we divided distal femoral periprosthetic fractures into six groups: Type I Nondisplaced fractures, 5.7%; treatment failure rate, 33%. Type II a Fractures with lateral comminution (the most often type of fractures), 37.7%; treatment failure rate, 20%. Type II b Fractures with medial comminution, 7.5%; treatment failure rate, 60%. Type II c Fractures above TKA (the second most often type), 34%; treatment failure rate, 18%. Type II d Comminuted fractures, 5.7%; treatment failure rate, 18%. Type IIIFractures with loosening of TKA, 9.4%; treatment failure rate, 20%. For the treatment of fractures we used various methods according to the type of fracture: Plate osteosynthesis in 32 cases, with failure in seven. Three failures in IIa group due to incorrect osteosynthesis with condylar plate, treated by reosteosteosynthesis with same implant. One in IIb group treated primarily with cement plomb, after second failure treated with revision total knee arthroplasty. Two failures in IIc group, treated by reosteosynthesis with spongioplasty using the same implant. One failure in III group solved with revision TKA. Intramedullary nail in nine cases , with failure in two. One failure in IIb group treated by reosteosynthesis with condylar plate and cement plombage. One in IIc group due to infection, solved with extraction of material and second stage revision TKA. Conservative treatment in three cases,with failure in two. One in I group treated with condylar plate. One in

  19. Distal femoral osteotomy using a novel deformity reduction device.

    PubMed

    Panichi, Enrico; Cappellari, Fulvio; Olimpo, Matteo; Piras, Lisa A; Radasch, Robert; Ferretti, Antonio; Peirone, Bruno

    2016-09-20

    Distal femoral osteotomy is a surgical procedure used to correct patellar luxation, secondary to a femoral deformity. A distal femoral osteotomy using the tibial plateau levelling osteotomy-jig to temporarily provide stability of the distal femoral osteotomy, maintaining limb alignment in the frontal and axial planes prior to internal plate fixation of the osteotomy, has been described. This report describes a novel jig named Deformity Reduction Device (DRD). This device was developed with the specific aim of increasing precision and predictability during corrective osteotomy execution in order to be consistent with the preoperative planning. The distal femoral osteotomy DRD-assisted procedure is described in detail, discussing the theoretical and practical principles of the application.

  20. Extensively coated cementless femoral components in revision hip arthroplasty.

    PubMed

    Greidanus, N; Antoniou, J; Paprosky, W

    2000-01-01

    A septic loosening and osteolysis can compromise the available host bone in patients requiring revision hip arthroplasty. Secure fixation of revision femoral components may not be possible if reliant only on proximal femoral bone for biologic fixation or cement interdigitation. The challenge for the revision arthroplasty surgeon is to find the best method to secure the implant in a femur with deficient bone proximally that will provide stability for load bearing and motion. In addition to providing stability, the implant must be durable and maintain long-term fixation. With over 16 years of experience with fully porous coated femoral revision implants, we have found that maximizing prosthetic-bone fit in the proximal femoral diaphyseal bone provides reliable long-term fixation in the majority of femoral revision cases.

  1. Extensively Coated Cementless Femoral Components in Revision Hip Arthroplasty.

    PubMed

    Greidanus, Nelson; Antoniou, John; Paprosky, Wayne

    2000-10-01

    A septic loosening and osteolysis can compromise the available host bone in patients requiring revision hip arthroplasty. Secure fixation of revision femoral components may not be possible if reliant only on proximal femoral bone for biologic fixation or cement interdigitation. The challenge for the revision arthroplasty surgeon is to find the best method to secure the implant in a femur with deficient bone proximally that will provide stability for load bearing and motion. In addition to providing stability, the implant must be durable and maintain long-term fixation. With over 16 years of experience with fully porous coated femoral revision implants, we have found that maximizing prosthetic-bone fit in the proximal femoral diaphyseal bone provides reliable long-term fixation in the majority of femoral revision cases.

  2. [Widened forwarding total laryngectomy ("squared laryngectomy"). Hints of surgical techniques and personal experience].

    PubMed

    Croce, A; Moretti, A; Bianchedi, M; Neri, G; Falcone, G

    1995-10-01

    Primitive T4 laryngeal neoplasms with anterior invasion and neoplasm recurring after partial and subtotal intervention often invade the soft prelaryngeal tissues and in these cases the neoplastic illness can be no longer be controlled be "organ surgery". The widened forwarding total laryngectomy, "squared" or "carrè" laryngectomy according to some Authors of French School, is a surgical procedure not "on an organ" but "in an area" or "region" which proposes to delete, in one step, the larynx, the bone hyoid, the fasciae and the prelaryngeal muscles, the thyroid gland and, if necessary, a more or less large quantity of anterior cervical skin. If the removal involves a vast cutaneous area, it is necessary to mend the loss of substance by wrapping around a miocutaneous flap of pectoralis mayor muscle. In the last five years, 4 male patients, between 48 and 73 years, were treated with widened forwarding total laryngectomy. They were all carriers of epidermoid laryngeal carcinomas with various degrees of differentation: primitive in one patients, recidivist after performance of partial (cordectomy) and subtotal (two Labayle) surgery in the other three patients. In the only case of T4 primitive laryngeal neoplasm it was necessary to carry out a functional neck dissection bilaterally. Loss of substance always required the use of a miocutaneous flap of pectoralis mayor muscle except in one patient in which the removal of the prelaryngeal tissues was limited and therefore it was possible to make a direct seam. We always completely removed the thyroid gland, the prelaryngeal muscular system and skin of the preceding stomy (in the Labayle) sparing, on the other hand, the hyoid bone. Only one patient, who died due to recurrence a year after surgery, underwent complemental percutaneous radiotherapy. At present, three patients are alive and NED: one after 5 years, the others are in excellent conditions although the follow-up is still brief. According to our experience, we can

  3. A possible widening of the tropical Hadley cell over the past decades

    NASA Astrophysics Data System (ADS)

    Reichler, T.; Held, I.

    2005-12-01

    The tropical Hadley cell is an important feature of the general circulation of the atmosphere. The meridional overturning associated with the Hadley cell sets the stage for many tropical-extratropical interactions, and interannual variability and long-term trends of the Hadley cell can give rise to great impacts upon the variability of global climate. We investigate long-term trends of the meridional extent of the Hadley cell using a wide range of observational and model derived data. All data sources show a consistent widening trend of the Hadley cell, which amounts to a few degrees latitude during the past decades. In other words, the tropics have been increasing at the expense of the extratropics. The trend is consistent with other recent findings of decadal changes in the tropical atmosphere. The findings of this study raise the question for the reasons behind those changes and carries implications about future climate change and its resultant impact on global climate.

  4. Attribution of the local Hadley cell widening in the Southern Hemisphere

    NASA Astrophysics Data System (ADS)

    Kim, Y. H.; Min, S. K.; Son, S. W.; Choi, J.

    2016-12-01

    This study conducts an attribution analysis of long-term changes in the southern edge of local Hadley Cell (HC) during austral summer for the past three decades (1979-2009). HC edges are defined as the latitudes of maximum sea level pressure in the Southern Hemisphere (SH) subtropics, and long-term variations of local HC edges are compared between multi-reanalyses with those from CMIP5 multi-model simulations using an optimal fingerprinting technique. Observed local HC exhibits the poleward expansion in the Atlantic and Indian Ocean regions, which are successfully reproduced by the CMIP5 models simulated including anthropogenic forcing (ANT) but with a weaker amplitude. The detection analyses further show that ANT signals are detected robustly in both Atlantic and Indian HC trends. More importantly, anthropogenic forcings other than greenhouse gas forcing are found to be clearly detected in isolation, indicating a possible attribution of the observed local HC widening over these regions to stratospheric ozone depletion.

  5. Explaining the Widening Education Gap in Mortality among U.S. White Women

    PubMed Central

    Montez, Jennifer Karas; Zajacova, Anna

    2013-01-01

    Over the last half century the gap in mortality across education levels grew in the United States, and since the mid-1980s the growth was especially pronounced among white women. The reasons for the growth among white women are unclear. We investigated three explanations—social-psychological factors, economic circumstances, and health behaviors—for the widening education gap in mortality across 1997-2006 among white women 45-84 years of age. We used data from the National Health Interview Survey Linked Mortality File (N=46,744; deaths=4,053). We found little support for social-psychological factors; however, economic circumstances and health behaviors jointly explained the growing education gap in mortality to statistical nonsignificance. Employment and smoking were the most important individual components. Increasing high school graduation rates, reducing smoking prevalence, and designing work-family policies that help women find and maintain desirable employment may reduce mortality inequalities among women. PMID:23723344

  6. Meander cutoffs nonlocally accelerate upstream and downstream migration and channel widening

    NASA Astrophysics Data System (ADS)

    Schwenk, Jon; Foufoula-Georgiou, Efi

    2016-12-01

    The hydrologic and sediment dynamics within and near cutoffs have long been studied, establishing them as effective agents of rapid local geomorphic change. However, the morphodynamic impact of individual cutoffs at the reachwide scale remains unknown, mainly due to insufficient observations of channel adjustments over large areal extents and at high temporal frequency. Here we show via annually resolved, Landsat-derived channel masks of the dynamic meandering Ucayali River in Peru that cutoffs act as perturbations that nonlocally accelerate river migration and drive channel widening both upstream and downstream of the cutoff locations. By tracking planform changes of individual meander bends near cutoffs, we find that the downstream distance of cutoff influence scales linearly with the length of the removed reach. The discovery of nonlocal cutoff influence supports the hypothesis of "avalanche"-type behavior in meander cutoff dynamics and presents new challenges in modeling and prediction of rivers' self-adjusting responses to perturbations.

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

    PubMed

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

    2016-09-01

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

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

    PubMed

    Bruccoleri, Rebecca E; Burns, Michele M

    2016-03-01

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

  9. Explaining the widening education gap in mortality among U.S. white women.

    PubMed

    Montez, Jennifer Karas; Zajacova, Anna

    2013-06-01

    Over the past half century the gap in mortality across education levels has grown in the United States, and since the mid-1980s, the growth has been especially pronounced among white women. The reasons for the growth among white women are unclear. We investigated three explanations-social-psychological factors, economic circumstances, and health behaviors-for the widening education gap in mortality from 1997 to 2006 among white women aged 45 to 84 years using data from the National Health Interview Survey Linked Mortality File (N = 46,744; 4,053 deaths). Little support was found for social-psychological factors, but economic circumstances and health behaviors jointly explained the growing education gap in mortality to statistical nonsignificance. Employment and smoking were the most important individual components. Increasing high school graduation rates, reducing smoking prevalence, and designing work-family policies that help women find and maintain desirable employment may reduce mortality inequalities among women.

  10. Mandibular Canal Widening and Bell's Palsy: Sequelae of Perineural Invasion in Oral Cancer.

    PubMed

    Sundar, Gopinath Thilak Parepady; Sherigar, Vishwanath; Shetty, Sameep S; Satya, Shree; Gohil, Sourabh M

    2016-01-01

    Perineural invasion is an underrecognized route of metastatic spread along the nerve bundles within the nerve sheath into the surrounding tissues. It hinders the ability to establish local control as tumour cells can traverse along nerve tracts well beyond the extent of any local invasion rendering them inoperable and unresectable. Perineural invasion is a marker of poor prognosis. Oral submucous fibrosis with oral cancer constitutes a clinicopathologically distinct disease. Our case highlights an enigmatic presentation of oral submucous fibrosis and its coexistence with oral cancer presenting with unusual neurological disturbance of the inferior alveolar nerve and facial nerve and diffuse widening of the mandibular canal. The objective of this case report is to enumerate the significance of perineural invasion in determining the course of the disease and necessitate the need for future studies that can shed light on molecular mediators and pathogenesis of perineural spread.

  11. Mandibular Canal Widening and Bell's Palsy: Sequelae of Perineural Invasion in Oral Cancer

    PubMed Central

    Sundar, Gopinath Thilak Parepady; Sherigar, Vishwanath; Satya, Shree; Gohil, Sourabh M.

    2016-01-01

    Perineural invasion is an underrecognized route of metastatic spread along the nerve bundles within the nerve sheath into the surrounding tissues. It hinders the ability to establish local control as tumour cells can traverse along nerve tracts well beyond the extent of any local invasion rendering them inoperable and unresectable. Perineural invasion is a marker of poor prognosis. Oral submucous fibrosis with oral cancer constitutes a clinicopathologically distinct disease. Our case highlights an enigmatic presentation of oral submucous fibrosis and its coexistence with oral cancer presenting with unusual neurological disturbance of the inferior alveolar nerve and facial nerve and diffuse widening of the mandibular canal. The objective of this case report is to enumerate the significance of perineural invasion in determining the course of the disease and necessitate the need for future studies that can shed light on molecular mediators and pathogenesis of perineural spread. PMID:28025626

  12. Do population-based interventions widen or narrow socioeconomic inequalities? The case of breastfeeding promotion

    PubMed Central

    Yang, Seungmi; Platt, Robert W; Dahhou, Mourad; Kramer, Michael S

    2014-01-01

    Background: Despite numerous population-based randomized intervention trials, the impact of such interventions on socioeconomic inequalities has rarely been examined. We used data from a large cluster-randomized trial to assess the impact of a breastfeeding promotion intervention on socioeconomic inequalities in breastfeeding (exclusivity and duration) and in child cognitive ability at early school age. Methods: The Promotion of Breastfeeding Intervention Trial (PROBIT) randomized 31 Belarusian maternity hospitals and their affiliated polyclinics either to receive a breastfeeding promotion intervention modelled on the WHO/UNICEF Baby-Friendly Hospital Initiative or to continue the standard practices in effect at the time of randomization. We estimated and compared inequalities in discontinuation of exclusive breastfeeding before 3 months and of any breastfeeding before 12 months and in child verbal IQ at age 6.5 years, across maternal education strata between the two intervention arms. Findings: Socioeconomic inequalities in discontinuing exclusive breastfeeding before 3 months were negligible in the control group. However, graded inequalities by maternal education emerged in the intervention group {relative risk [RR] = 1.12 [95% confidence interval (CI): 1.04, 1.20] for partial university and RR = 1.20 [95% CI: 1.11, 1.31] for secondary education or less vs complete university; risk difference [RD] = 0.06 [95% CI: 0.03, 0.09] and 0.10 [95% CI: 0.06, 0.14], respectively}. For discontinuing any breastfeeding before 12 months, small socioeconomic gradients in the control group were widened in the intervention group (RR = 1.04 and 1.16, respectively, for mothers with secondary education or less). Despite these differential effects on breastfeeding, however, we observed a small, nonsignificant reduction in socioeconomic inequalities in child verbal IQ at age 6.5 years. Conclusions: A population-based intervention to promote breastfeeding slightly widened socioeconomic

  13. Field-widened Michelson interferometer system as the spectroscopic filter of high-spectral-resolution lidar

    NASA Astrophysics Data System (ADS)

    Cheng, Zhongtao; Liu, Dong; Zhou, Yudi; Yang, Yongying; Zhang, Yupeng; Luo, Jing; Bai, Jian; Liu, Chong; Shen, Yibing

    2016-05-01

    We propose and develop a field-widened Michelson interferometer (FWMI) system to act as a new type of spectroscopic filter in HSRL application. Due to the field widening characteristic, the FWMI can allow relatively large off-axis incident angle, and can be designed to any desirable wavelength. The theoretical foundations of the FWMI are introduced in this paper, and the developed prototype interferometer is described. It consists of a solid arm made of the glass H-ZF52 with the dimension of 37.876 mm, and an air gap with the length of 20.382 mm. These two interference arms are connected to a cube beam splitter to constitute a Michelson interferometer. Due to the matched dimensions and refractive indices of the two arms, the experimental testing results show that the OPD variation of the developed FWMI is about 0.04 lambda and the RMS is less than 0.008 lambda when the incident angle is as much as 1.5 degree (half angle). The cumulative wavefront distortion caused by the FWMI is less than 0.1 lambda PV value and 0.02 lambda RMS value. To lock the filtering frequency of the FWMI to the laser transmitter, a frequency locking system, which is actually an electro-optic feedback loop, is established. The setup and principle of this frequency locking system are also described in detail. Good locking accuracy of the FWMI about 27MHz is demonstrated through the frequency locking technique. All these results validate the feasibility of this developed FWMI system as a spectroscopic filter of an HSRL.

  14. Movement of the Distal Carpal Row During Narrowing and Widening of the Carpal Arch Width

    PubMed Central

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

    2012-01-01

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

  15. Widening of Protostellar Outflows: An Infrared Outflow Survey in Low-luminosity Objects

    NASA Astrophysics Data System (ADS)

    Hsieh, Tien-Hao; Lai, Shih-Ping; Belloche, Arnaud

    2017-04-01

    We present an outflow survey toward 20 low-luminosity objects (LLOs), namely, protostars with an internal luminosity lower than 0.2 {L}⊙ . Although a number of studies have reported the properties of individual LLOs, the reasons for their low luminosity remain uncertain. To answer this question, we need to know the evolutionary status of LLOs. Protostellar outflows are found to widen as their parent cores evolve, and therefore the outflow opening angle could be used as an evolutionary indicator. The infrared scattered light escapes out through the outflow cavity and highlights the cavity wall, giving us the opportunity to measure the outflow opening angle. Using the Canada-France-Hawaii Telescope, we detected outflows toward eight LLOs out of 20 at Ks band, and based on archival Spitzer IRAC1 images, we added four outflow-driving sources from the remaining 12 sources. By fitting these images with radiative transfer models, we derive the outflow opening angles and inclination angles. To study the widening of outflow cavities, we compare our sample with the young stellar objects from Arce & Sargent and Velusamy et al. in a plot of opening angle versus bolometric temperature taken as an evolutionary indicator. Our LLO targets match well the trend of increasing opening angle with bolometric temperature reported by Arce & Sargent and are broadly consistent with that reported by Velusamy et al., suggesting that the opening angle could be a good evolutionary indicator for LLOs. Accordingly, we conclude that at least 40% of the outflow-driving LLOs in our sample are young Class 0 objects.

  16. The cancer survival gap between elderly and middle-aged patients in Europe is widening.

    PubMed

    Quaglia, Alberto; Tavilla, Andrea; Shack, Lorraine; Brenner, Hermann; Janssen-Heijnen, Maryska; Allemani, Claudia; Colonna, Marc; Grande, Enrico; Grosclaude, Pascale; Vercelli, Marina

    2009-04-01

    The present study is aimed to compare survival and prognostic changes over time between elderly (70-84 years) and middle-aged cancer patients (55-69 years). We considered seven cancer sites (stomach, colon, breast, cervix and corpus uteri, ovary and prostate) and all cancers combined (but excluding prostate and non-melanoma skin cancers). Five-year relative survival was estimated for cohorts of patients diagnosed in 1988-1999 in a pool of 51 European populations covered by cancer registries. Furthermore, we applied the period-analysis method to more recent incidence data from 32 cancer registries to provide 1- and 5-year relative survival estimates for the period of follow-up 2000-2002. A significant survival improvement was observed from 1988 to 1999 for all cancers combined and for every cancer site, except cervical cancer. However, survival increased at a slower rate in the elderly, so that the gap between younger and older patients widened, particularly for prostate cancer in men and for all considered cancers except cervical cancer in women. For breast and prostate cancers, the increasing gap was likely attributable to a larger use of, respectively, mammographic screening and PSA test in middle-aged with respect to the elderly. In the period analysis of the most recent data, relative survival was much higher in middle-aged patients than in the elderly. The differences were higher for breast and gynaecological cancers, and for prostate cancer. Most of this age gap was due to a very large difference in survival after the 1st year following the diagnosis. Differences were much smaller for conditional 5-year relative survival among patients who had already survived the first year. The increase of survival in elderly men is encouraging but the lesser improvement in women and, in particular, the widening gap for breast cancer suggest that many barriers still delay access to care and that enhanced prevention and clinical management remain major issues.

  17. Widening rural-urban disparities in life expectancy, U.S., 1969-2009.

    PubMed

    Singh, Gopal K; Siahpush, Mohammad

    2014-02-01

    There is limited research on rural-urban disparities in U.S. life expectancy. This study examined trends in rural-urban disparities in life expectancy at birth in the U.S. between 1969 and 2009. The 1969-2009 U.S. county-level mortality data linked to a rural-urban continuum measure were analyzed. Life expectancies were calculated by age, gender, and race for 3-year time periods between 1969 and 2004 and for 2005-2009 using standard life-table methodology. Differences in life expectancy were decomposed by age and cause of death. Life expectancy was inversely related to levels of rurality. In 2005-2009, those in large metropolitan areas had a life expectancy of 79.1 years, compared with 76.9 years in small urban towns and 76.7 years in rural areas. When stratified by gender, race, and income, life expectancy ranged from 67.7 years among poor black men in nonmetropolitan areas to 89.6 among poor Asian/Pacific Islander women in metropolitan areas. Rural-urban disparities widened over time. In 1969-1971, life expectancy was 0.4 years longer in metropolitan than in nonmetropolitan areas (70.9 vs 70.5 years). By 2005-2009, the life expectancy difference had increased to 2.0 years (78.8 vs 76.8 years). The rural poor and rural blacks currently experience survival probabilities that urban rich and urban whites enjoyed 4 decades earlier. Causes of death contributing most to the increasing rural-urban disparity and lower life expectancy in rural areas include heart disease, unintentional injuries, COPD, lung cancer, stroke, suicide, and diabetes. Between 1969 and 2009, residents in metropolitan areas experienced larger gains in life expectancy than those in nonmetropolitan areas, contributing to the widening gap. Published by American Journal of Preventive Medicine on behalf of American Journal of Preventive Medicine.

  18. Distal femoral physeal growth arrest secondary to a cemented proximal femoral endoprosthetic replacement.

    PubMed

    Gaston, C L; Tillman, R M; Grimer, R J

    2011-05-01

    We report a case of spontaneous physeal growth arrest of the distal femur in a nine-year-old child with Ewing's sarcoma of the proximal femur treated with chemotherapy and endoprosthetic replacement. Owing to the extent of disuse osteoporosis at the time of surgery, the entire intramedullary canal up to the distal femoral physis was filled with cement. Three years later, the femur remained at its pre-operative length of 19 cm. Pre-operative calculations of further growth failed to account for the growth arrest, and the initial expandable growing prosthesis inserted has been revised to a longer one in order to address the leg-length discrepancy. To our knowledge, this is the only reported case of distal femoral physeal growth arrest following cemented endoprosthetic replacement of the proximal femur.

  19. Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture.

    PubMed

    Min, Byung-Woo; Kim, Sung-Jin

    2011-05-18

    The reported incidence of avascular necrosis after femoral neck fracture fixation varies widely, and there is no consensus regarding its risk factors. We evaluated the incidence of avascular necrosis of the femoral head with the use of contemporary techniques for femoral neck fracture fixation. We then sought to determine what potential risk factors influenced the development of avascular necrosis.Between 1990 and 2005, one hundred sixty-three intracapsular femoral neck fractures in 163 patients were treated with internal fixation at our level-I trauma center. All patients were monitored until conversion to total hip arthroplasty or for a minimum of 2 years postoperatively. Ten patients (10 hips) died and 7 patients (7 hips) were lost to follow-up. The remaining 146 patients (146 hips) had a mean 5.2 years of follow-up (range, 3 months to 17 years). The incidence of avascular necrosis was 25.3% (37 hips). The average time to diagnosis of avascular necrosis was 18.8 months (range, 3-47 months). Patient sex, age, interval from injury to surgery, and mechanism of injury were statistically not associated with the development of avascular necrosis. The quality of fracture reduction, adequacy of fixation, degree of displacement, and comminution of the posterior cortex were significantly associated. After we controlled for patient and radiographic characteristics, multivariate analyses indicated that the important predictors for avascular necrosis are poor reduction (odds ratio=13.889) and initial displacement of the fracture (odds ratio=4.693). Copyright 2011, SLACK Incorporated.

  20. Defining the common femoral artery: Insights from the femoral arterial access with ultrasound trial.

    PubMed

    Seto, Arnold H; Tyler, Jeffrey; Suh, William M; Harrison, Alexander T; Vera, Jesus A; Zacharias, Soni J; Daly, Timothy S; Sparling, Jeffrey M; Patel, Pranav M; Kern, Morton J; Abu-Fadel, Mazen

    2017-06-01

    We sought to establish the typical location of the common femoral artery (CFA) bifurcation, the origin and most inferior reflection of the inferior epigastric artery (IEA) relative to the femoral head (FH) and whether patient demographics predicted anatomical variations. In the absence of ultrasound guidance or prior imaging, the precise location of the CFA bifurcation and IEA can only be determined following access site angiography. Fluoroscopic landmarks are commonly used to estimate the location of the CFA bifurcation, but the position of the IEA is less well characterized. Prospectively collected data on 989 patients with femoral angiography in the FAUST trial were analyzed. The level of CFA bifurcation and the origin and most inferior reflection of the IEA were classified by angiography. Logistic regression was used to explore whether baseline demographics were associated with anatomic variations. The CFA bifurcation occurs below the middle 1/3(rd) of the femoral head in 95% of patients, and no patient factors are predictive of a high bifurcation. The IEA origin has a more variable anatomically pattern, with high BSA, male gender, and white race associated with a low IEA origin. Operators should attempt to access the CFA at the level of the middle 1/3(rd) of the FH to maximize the chance of CFA cannulation. However, this location carries an 11% risk of being at or above the IEA origin. Baseline demographics were of limited utility for predicting anatomic variants of the CFA bifurcation and the course of the IEA. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  1. Painful Spastic Hip Dislocation: Proximal Femoral Resection

    PubMed Central

    Albiñana, Javier; Gonzalez-Moran, Gaspar

    2002-01-01

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

  2. Intestinal Obstruction due to Bilateral Strangulated Femoral Hernias

    PubMed Central

    Nikolopoulos, Ioannis; Oderuth, Eshan; Ntakomyti, Eleni; Kald, Bengt

    2014-01-01

    Introduction. Femoral hernias are at high risk of strangulation due to the narrow femoral canal and femoral ring. This can lead to symptoms of obstruction or strangulation requiring emergency surgery and possible bowel resection. To our knowledge, there is only one previous published report of bilateral strangulated femoral hernia. We present our case of this phenomenon. Case Report. An 86-year-old woman presented with symptoms of small bowel obstruction. Examination revealed two tender lumps in the area of the femoral triangle. CT scan revealed bilateral femoral hernias. Both hernias were repaired and a small bowel resection on the right side was performed with side to side anastomosis. She made an uneventful recovery. Conclusion. Bilateral femoral hernias are a rare occurrence with only one reported case of bilateral strangulation. Our case highlights the importance of meticulous history taking and clinical examination as any delay in diagnosis will increase the risk of mortality and morbidity for the patient. Hernias should always be considered as a cause if one presents with symptoms of abdominal pain or obstruction. PMID:25057426

  3. Femoral neck radiography: effect of flexion on visualization.

    PubMed

    Garry, Steven C; Jhangri, Gian S; Lambert, Robert G W

    2005-06-01

    To determine whether flexion improves radiographic visualization of the femoral neck when the femur is externally rotated. Five human femora, with varying neck-shaft and anteversion angles, were measured and immobilized. Degree of flexion required to bring the femoral neck horizontal was measured, varying the rotation. Next, one bone was radiographed in 16 positions, varying rotation in 15 degrees and flexion in 10 degrees increments. Radiographs were presented in randomized blinded fashion to 15 staff radiologists for scoring of femoral neck visualization. Following this, all 5 bones were radiographed in 4 positions of rotation and at 0 degree and 20 degrees flexion, and blinded randomized review of radiographs was repeated. Comparisons between angles and rotations were made using the Mann-Whitney test. The flexion angle required to bring the long axis of the femoral neck horizontal correlated directly with the degree of external rotation (p < 0.05). Visualization of the femoral neck in the extended position progressively deteriorated from 15 degrees internal rotation to 30 degrees external rotation (p < 0.01). However, when 20 degrees flexion was applied to bones in external rotation, visualization significantly improved at 15 degrees (p < 0.05) and 30 degrees (p < 0.01). Flexion of the externally rotated femur can bring the femoral neck into horizontal alignment, and a relatively small amount (20 degrees) of flexion can significantly improve radiographic visualization. This manoeuvre could be useful for radiography of the femoral neck when initial radiographs are inadequate because of external rotation of the leg.

  4. Femoral Access and Delivery of Continuous Renal Replacement Therapy Dose.

    PubMed

    Bellomo, Rinaldo; Mårtensson, Johan; Lo, Serigne; Kaukonen, Kirsi-Maija; Cass, Alan; Gallagher, Martin

    2016-01-01

    The study aims to describe the use of dialysis catheters in critically ill patients treated with continuous renal replacement therapy (CRRT) and to study the impact of femoral versus non-femoral access on CRRT dose. Statistical analysis and predictive modelling of data from the Randomized Evaluation of Normal vs. Augmented Level renal replacement therapy trial. The femoral vein was the first access site in 937 (67%) of 1,399 patients. These patients had higher Acute Physiology and Chronic Health Evaluation and Sequential Organ Failure Assessment scores (p = 0.009) and lower pH (p < 0.001) but similar mortality to patients with non-femoral access (44 vs. 45%; p = 0.63). Lower body weight was independently associated with femoral access placement (OR 0.97, 95% CI 0.96-0.98). Femoral access was associated with a 1.03% lower CRRT dose (p = 0.05), but a 4.20% higher dose was achieved with 13.5 Fr catheters (p = 0.03). Femoral access was preferred in lighter and sicker patients. Catheter gauge had greater impact than catheter site in CRRT dose delivery. Video Journal Club "Cappuccino with Claudio Ronco" at http://www.karger.com/?doi=439581. © 2015 S. Karger AG, Basel.

  5. Measuring femoral and rotational alignment: EOS system versus computed tomography.

    PubMed

    Folinais, D; Thelen, P; Delin, C; Radier, C; Catonne, Y; Lazennec, J Y

    2013-09-01

    Computed tomography (CT) is currently the reference standard for measuring femoral and tibial rotational alignment. The EOS System is a new biplanar low-dose radiographic device that allows 3-dimensional lower-limb modelling with automated measurements of femoral and tibial rotational alignment (torsion). Femoral and tibial torsion measurements provided by the EOS System are equivalent to those obtained using CT. In a retrospective analysis of 43 lower limbs in 30 patients, three senior radiologists measured femoral and tibial torsion on both CT and EOS images. Agreement between CT and EOS values was assessed by computing Pearson's correlation coefficient and interobserver reproducibility by computing the intraclass correlation coefficient (ICC). Femoral torsion was 13.4° by EOS vs. 13.7° by CT (P=0.5) and tibial torsion was 30.8° by EOS vs. 30.3° by CT (P=0.4). Strong associations were found between EOS and CT values for both femoral torsion (P=0.93) and tibial torsion (P=0.89). With EOS, the ICC was 0.93 for femoral torsion and 0.86 for tibial torsion; corresponding values with CT were 0.90 and 0.92. The EOS system is a valid alternative to CT for lower-limb torsion measurement. EOS imaging allows a comprehensive evaluation in all three planes while substantially decreasing patient radiation exposure. Level III, case-control. Copyright © 2013. Published by Elsevier Masson SAS.

  6. Percutaneous femoral arterial and venous catheterisation during neonatal intensive care.

    PubMed

    Wardle, S P; Kelsall, A W; Yoxall, C W; Subhedar, N V

    2001-09-01

    Femoral vessel catheterisation is generally avoided in the neonatal period because of technical difficulties and the fear of complications. To review the use of femoral arterial and venous catheters inserted percutaneously on the neonatal intensive care unit. Infants admitted to one of two regional neonatal intensive care units who underwent femoral vessel catheterisation were identified. Information collected included basic details, indication for insertion of catheter, type of catheter and insertion technique, duration of use, and any catheter related complications. Sixty five femoral catheters were inserted into 53 infants. The median gestational age was 29 weeks (range 23-40). Twenty three femoral arterial catheters (FACs) were inserted into 21 infants and remained in situ for a median of three days (range one to eight). Twelve (52%) FACs remained in place until no longer required, and four (17%) infants developed transient ischaemia of the distal limb. Forty two femoral venous catheters (FVCs) were inserted into 40 infants and remained in situ for a median of seven days (range 1-29). Twenty seven (64%) FVCs remained in place until no longer required, and eight (19%) catheters were removed because of catheter related bloodstream infection. FACs and FVCs are useful routes of vascular access in neonates when other sites are unavailable. Complications from femoral vessel catheterisation include transient lower limb ischaemia with FACs and catheter related bloodstream infection.

  7. Percutaneous femoral arterial and venous catheterisation during neonatal intensive care

    PubMed Central

    Wardle, S; Kelsall, A; Yoxall, C; Subhedar, N

    2001-01-01

    BACKGROUND—Femoral vessel catheterisation is generally avoided in the neonatal period because of technical difficulties and the fear of complications.
AIM—To review the use of femoral arterial and venous catheters inserted percutaneously on the neonatal intensive care unit.
METHODS—Infants admitted to one of two regional neonatal intensive care units who underwent femoral vessel catheterisation were identified. Information collected included basic details, indication for insertion of catheter, type of catheter and insertion technique, duration of use, and any catheter related complications.
RESULTS—Sixty five femoral catheters were inserted into 53 infants. The median gestational age was 29 weeks (range 23-40). Twenty three femoral arterial catheters (FACs) were inserted into 21infants and remained in situ for a median of three days (range one to eight). Twelve (52%) FACs remained in place until no longer required, and four (17%) infants developed transient ischaemia of the distal limb. Forty two femoral venous catheters (FVCs) were inserted into 40 infants and remained in situ for a median of seven days (range 1-29). Twenty seven (64%) FVCs remained in place until no longer required, and eight (19%) catheters were removed because of catheter related bloodstream infection.
CONCLUSIONS—FACs and FVCs are useful routes of vascular access in neonates when other sites are unavailable. Complications from femoral vessel catheterisation include transient lower limb ischaemia with FACs and catheter related bloodstream infection.

 PMID:11517206

  8. Femoral articular geometry and patellofemoral stability.

    PubMed

    Iranpour, Farhad; Merican, Azhar M; Teo, Seow Hui; Cobb, Justin P; Amis, Andrew A

    2017-06-01

    Patellofemoral instability is a major cause of anterior knee pain. The aim of this study was to examine how the medial and lateral stability of the patellofemoral joint in the normal knee changes with knee flexion and measure its relationship to differences in femoral trochlear geometry. Twelve fresh-frozen cadaveric knees were used. Five components of the quadriceps and the iliotibial band were loaded physiologically with 175N and 30N, respectively. The force required to displace the patella 10mm laterally and medially at 0°, 20°, 30°, 60° and 90° knee flexion was measured. Patellofemoral contact points at these knee flexion angles were marked. The trochlea cartilage geometry at these flexion angles was visualized by Computed Tomography imaging of the femora in air with no overlying tissue. The sulcus, medial and lateral facet angles were measured. The facet angles were measured relative to the posterior condylar datum. The lateral facet slope decreased progressively with flexion from 23°±3° (mean±S.D.) at 0° to 17±5° at 90°. While the medial facet angle increased progressively from 8°±8° to 36°±9° between 0° and 90°. Patellar lateral stability varied from 96±22N at 0°, to 77±23N at 20°, then to 101±27N at 90° knee flexion. Medial stability varied from 74±20N at 0° to 170±21N at 90°. There were significant correlations between the sulcus angle and the medial facet angle with medial stability (r=0.78, p<0.0001). These results provide objective evidence relating the changes of femoral profile geometry with knee flexion to patellofemoral stability. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Femoral lengthening with a motorized intramedullary nail

    PubMed Central

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

    2015-01-01

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

  10. Our Experience with Patello femoral joint replacement

    PubMed Central

    Ramos, Pablo; Arteaga, Gonzalo; Vargas, Medardo; Naranjo, Juan

    2017-01-01

    Background: Ten to fifteen percent of knee arthritis is reported to be isolated patellofemoral arthritis. Total knee arthroplasty is not recommended for isolated patella femoral arthritis particularly in young patients. We present the retrospective review our series in 7 years. Objectives: The aim of this presentation is to describe our experience in the management of patellofemoral osteoarthritis with the use of the partial patellofemoral arthroplasty, as well as to delineate the pitfalls and causes of revision in our initial series of 153 cases. Methods: between 2009 and 2016, our group performed 157 patellofemoral arthroplasties (PFA) 74% being in women, and 26% in men, the mean age for women was 58 yrs. And 38 yrs. for men, our initial 13 cases were managed with the Avon prosthesis (Stryker Corporation Kalamazoo, Michigan), and then we switched to the Vanguard PF (Zimmer-Biomet Warsaw In), both systems are an On-Lay design that is more flexible for addressing dysplastic trochleas that are more common in our population. Results: We performed a Knee Osteoarthritis Outcome Score (KOOS) for the assessment of the success of the procedure and obtained 87% of patients with excellent results (95 to 100), 10% with fair results (70 to 90) and 3% with poor outcomes (50), we performed a total of 3 revisions due to pain or progress to global arthritis. Conclusion: The PFA is a successful, safe and reproducible surgery that can be used in the group of patients that have isolated patellofemoral osteoarthritis. It requires a thorough knowledge of the patello femoral joint biomechanics, and physiopathology.

  11. Retrograde femoral interlocking nail in complex fractures.

    PubMed

    Anup, Khare; Mehra, M M

    2002-06-01

    Retrograde interlocking nail was used as the method of fixation in 35 different cases of combination of complex femoral fractures. We performed this procedure in fractures of femoral shaft associated with fracture neck femur, pathological fractures of proximal third of femur with trochanteric pathology, ipsilateral fracture of femur and tibia in polytrauma cases with multiple other injuries, in highly obese patients with fracture shaft femur. This technique was also used in cases of pregnancy with fracture shaft femur and in unstable pelvic fracture or dislocation hip associated with fracture shaft femur. Operative technique involved with retrograde insertion of un-reamed, non-cannulated custom made nail through entrance portal in intercondylar notch was applied for fixation of the shaft femur fracture. The other associated fracture around hip was stabilized separately using suitable implant according to type of fracture. In cases of ipsilateral fracture of femur and tibia, femur was stabilized by retrograde interlocking nail and tibia was stabilized by antigrade interlocking nail through same incision at the same sitting. The case was followed up for three years; the average union time was 12 to 18 weeks. Out of 35 cases, 31 cases regained full knee movement. Out of the remaining 4 cases, 2 cases could regain up to 90 degrees of movement, these were old fractures and non-cooperative patients. In one case, patellofemoral arthritis was developed because of an operative error where a nail was not put inside the articular surface. Mal-union was observed in an early case of the series and implant failure was nil. Retrograde interlocking nail was used as the method of fixation in complex fracture problems. Multiple fractures of long bones can be stabilized in one stage, preventing multiple operations at different stages in polytraumatized patients. This resulted in early recovery, lesser hospital stay, and early rehabilitation of patient with good results and is

  12. Treatment strategies for intramedullary nailing of femoral shaft fractures.

    PubMed

    Wild, Michael; Gehrmann, Sebastian; Jungbluth, Pascal; Hakimi, Mohssen; Thelen, Simon; Betsch, Marcel; Windolf, Joachim; Wenda, Klaus

    2010-10-11

    Intramedullary nailing has become the gold standard to treat femoral shaft fractures. It is unknown which nailing technique orthopedic surgeons prefer. The goal of this study was to determine current techniques and perioperative complications of intramedullary nailing of diaphyseal femoral fractures. Fifty-one institutions in 26 countries participated in an international survey to assess detailed descriptions of preferred operative strategies and perioperative complications. Altogether, 517 cases of diaphyseal femoral fractures were collected. The Internet-based survey incorporated information about fracture classification, time to operation, Injury Severity Score, type of nail, and operative technique, as well as perioperative complications such as infection, femoral neck fracture, and hardware failure. The preferred position for implantation was supine (91.1%). Most surgeons used a traction table (57.1%) and an antegrade implantation technique (84.5%). Intraoperative fractures of the femoral neck occurred in 1.2% of cases when a traction table was used and in 0.2% if no traction table was used, but without statistical significance (P>.16). In 59.2% of the cases, an isolated femur fracture was present, while the rest sustained multiple injuries. In polytrauma patients and patients with severe thorax injuries, most surgeons chose a delayed treatment with intramedullary femoral nails. Interestingly, 38.0% of the patients with severe thorax injuries were treated on the first day with intramedullary femoral nails. The total rate of complications for intramedullary femoral nailing was low (4.9%), but a high rate of intraoperative femoral neck fractures was observed (1.4%). Copyright 2010, SLACK Incorporated.

  13. Quadriceps force after TKA with femoral single radius.

    PubMed

    Ostermeier, Sven; Stukenborg-Colsman, Christina

    2011-06-01

    New implant designs have incorporated a single radius instead of a multiple radius to the femoral component in order to improve the mechanical function after TKA. We investigated the amount of quadriceps force required to extend the knee during an isokinetic extension cycle of different total knee designs, focusing on the radius of the femoral component (single vs. multiple). Human knee specimens (n = 12, median patient age 68 (63-70) years) were tested in a kinematic knee-simulating machine untreated and after implantation of 2 types of knee prosthesis systems, one with a single femoral radius design and one with a multiple femoral radius design. During the test cycle, a hydraulic cylinder, which simulated the quadriceps muscle, applied sufficient force to the quadriceps tendon to produce a constant extension moment of 31 Nm. The quadriceps extension force was measured from 120° to full knee extension. The shape of the quadriceps force curve was typically sinusoidal before and after TKA, reaching a maximum value of 1,493 N at 110°. With the single femoral radius design, quadriceps force was similar to that of the normal knee: 1,509 N at 110° flexion (p = 0.4). In contrast, the multiple femoral radius design showed an increase in quadriceps extension force relative to the normal knee, with a maximum of 1,721 N at 90° flexion (p = 0.03). The single femoral radius design showed lower maximum extension forces than the multiple femoral radius design. In addition, with the single femoral radius design maximum quadriceps force needed to extend a constant extension force shifted to higher degrees of knee flexion, representing a more physiological quadriceps force pattern, which could have a positive effect on knee function after TKA.

  14. Femoral artery pseudoaneurysm as a complication of angioplasty. How can it be prevented?

    PubMed Central

    Gupta, Prabha Nini; Salam Basheer, Abdul; Sukumaran, Gireesh Gomaty; Padmajan, Sabin; Praveen, Satheesan; Velappan, Praveen; Nair, Bigesh Unnikrishnan; Nair, Sandeep Govindan; Kunjuraman, Usha Kumari; Madthipat, Unnikrishnan; R, Jayadevan

    2013-01-01

    Femoral pseudoaneurysm is a common complication of repeated femoral puncture during cardiac catheterisation. We describe here the development of femoral pseudoaneurysms in a patient with Takayasu's arteritis, which healed in response to conservative treatment, and review the literature on the prevention and treatment of femoral pseudoaneurysm. PMID:27326111

  15. Bilateral Femoral Neck Stress Fracture in Child: A Case Report

    PubMed Central

    Lee, Gun-Woo; Yoon, Taek-Rim; Eshnazarovich, Eshnazarov Kamolhuja

    2016-01-01

    A femoral neck stress fracture in child is rare, particularly in bilateral case. It is easy to miss initially or may be misdiagnosed. The authors experienced a case of bilateral femoral neck stress fracture in a 10-year-old boy with bilateral hip. The patient was successfully healed by conservative treatment. We report this rare case with a review of the literature. A femoral neck stress fracture should be included in the differential diagnosis in children who present with sustained hip or groin pain. PMID:27777920

  16. Neurapraxia of the femoral nerve in a modern dancer.

    PubMed

    Sammarco, G J; Stephens, M M

    1991-01-01

    We have presented a case of an acute onset femoral nerve neurapraxia in a pure modern dancer. Repeated mild stretching of the femoral nerve during an established dance routine over a period of several months is implicated as the etiology. The thigh muscles quickly weakened, but regained strength within 3 months. Electromyographic evidence of specific femoral nerve injury initially was negative, but was evident 6 weeks following injury. Overuse syndrome in dancers can cause rapid loss of strength. Other conditions such as herniated intervertebral disc, acute hemorrhage, trauma, iliopsoas rupture, and acute stretching must be ruled out. Complete recovery was the natural outcome.

  17. Iliopsoas tendonitis caused by overhang of a collared femoral prosthesis.

    PubMed

    Brew, Christopher J; Stockley, Ian; Grainger, Andrew J; Stone, Martin H

    2011-04-01

    Pain after total hip arthroplasty can be due to a variety of causes, one of the less common being iliopsoas tendonitis. We report an unusual case of iliopsoas tendonitis caused by overhang of the femoral calcar by a collared femoral prosthesis resulting in impingement on the iliopsoas tendon. An ultrasound-guided corticosteroid and local anesthetic diagnostic injection to the site of impingement confirmed the diagnosis with temporary symptom relief. Revision of the femoral stem to a collarless prosthesis resulted in immediate and complete resolution of symptoms.

  18. Bilateral impacted femoral neck fracture in a renal disease patient.

    PubMed

    Devkota, Pramod; Ahmad, Shiraz

    2013-09-01

    Spontaneous bilateral femoral neck facture in a renal disease patient is not common. We report a case of 47-year-old female patient with chronic renal failure and on regular hemodialysis for the past 5 years who sustained bilateral impacted femoral neck fracture without history of trauma and injury and refused any surgical intervention. The patient was mobilised on wheel chair one year after the fractures. The cause of the fracture and the literature review of the bilateral femoral neck fracture in renal disease are discussed.

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

    ERIC Educational Resources Information Center

    Bathmaker, Ann-Marie

    2016-01-01

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

  20. Disproportionate Sacrifices: Ricoeur's Theories of Justice and the Widening Participation Agenda for Higher Education in the UK

    ERIC Educational Resources Information Center

    Watts, Michael

    2006-01-01

    Ricoeur's theories of justice are used here to examine the injustice of the utilitarian drive to widen participation in higher education in the UK and, in particular, the attribution of low aspirations and achievements to those young people who do not participate in higher education. Government policy is considered through Ricoeur's theory of the…

  1. Achievement Gaps for Students with Disabilities: Stable, Widening, or Narrowing on a State-Wide Reading Comprehension Test?

    ERIC Educational Resources Information Center

    Schulte, Ann C.; Stevens, Joseph J.; Elliott, Stephen N.; Tindal, Gerald; Nese, Joseph F. T.

    2016-01-01

    Reading comprehension growth trajectories from 3rd to 7th grade were estimated for 99,919 students on a state reading comprehension assessment. We examined whether differences between students in general education (GE) and groups of students identified as exceptional learners were best characterized as stable, widening, or narrowing. The groups…

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

    ERIC Educational Resources Information Center

    Effah, Paul

    2011-01-01

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

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

    ERIC Educational Resources Information Center

    Center on Budget and Policy Priorities, Washington, DC.

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

  4. Achievement Gaps for Students with Disabilities: Stable, Widening, or Narrowing on a State-Wide Reading Comprehension Test?

    ERIC Educational Resources Information Center

    Schulte, Ann C.; Stevens, Joseph J.; Elliott, Stephen N.; Tindal, Gerald; Nese, Joseph F. T.

    2016-01-01

    Reading comprehension growth trajectories from 3rd to 7th grade were estimated for 99,919 students on a state reading comprehension assessment. We examined whether differences between students in general education (GE) and groups of students identified as exceptional learners were best characterized as stable, widening, or narrowing. The groups…

  5. Widening Access to Higher Education for Disabled Students: The Intersection of Socio-Economic Background and Impairment

    ERIC Educational Resources Information Center

    Weedon, Elisabet

    2016-01-01

    The proportion of disabled students in higher education across the UK has increased over the last 20 years as a result of equalities legislation and widening access measures promoted by the Scottish Government. For monitoring and reporting purposes, disabled students have often been treated as a homogeneous group. Drawing on an analysis of…

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

    DOEpatents

    Guha, Subhendu; Ovshinsky, Stanford R.

    1990-02-02

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

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

    ERIC Educational Resources Information Center

    Wood, Denise; Willems, Julie

    2012-01-01

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

  8. A Consideration of the Case for Using Life Story Interviews in the Evaluation of Widening Access Interventions

    ERIC Educational Resources Information Center

    Raven, Neil

    2016-01-01

    Whilst published data sources exist for evaluating interventions aimed at widening higher education access, there is value for practitioners in conducting their own research. However, recognition of the contribution afforded by generating new data raises questions over which research methods to utilise. One method relatively new to widening…

  9. Making Evidence Work: A Framework for Monitoring, Tracking and Evaluating Widening Participation Activity across the Student Lifecycle

    ERIC Educational Resources Information Center

    Raven, Neil

    2016-01-01

    The need for a robust evidence base able to demonstrate the impact of widening participation activity across the student lifecycle has been emphasised in recent guidance to the higher education sector. However, with competing demands on their time this is likely to represent a challenge for practitioners. Yet, there is wide recognition of the need…

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

    ERIC Educational Resources Information Center

    Wood, Denise; Willems, Julie

    2012-01-01

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

  11. Marketisation and Widening Participation in English Higher Education: A Critical Discourse Analysis of Institutional Access Policy Documents

    ERIC Educational Resources Information Center

    McCaig, Colin

    2015-01-01

    This paper uses critical discourse analysis of English higher education institutions' policy statements about access to explore the changing ways that institutions have used language to shift their market positionality away from widening participation for all and the process of higher education to "fair access" (i.e. social mobility for…

  12. The Widening Gap: Why America's Working Families Are in Jeopardy and What Can Be Done about It.

    ERIC Educational Resources Information Center

    Heymann, Jody

    This book examines the lives of America's working families from all social classes and ethnic groups and the familial obligations they must deal with, arguing that there is a widening gap between the demands of the workplace and the well-being of America's families. Chapter one provides an overview of the problems of longer work days, outdated…

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

    ERIC Educational Resources Information Center

    Archer, Louise

    2007-01-01

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

  14. Dependence-Deconstruction: Widening Participation and Traditional-Entry Students Transitioning from School to Higher Education in Ireland

    ERIC Educational Resources Information Center

    Keane, Elaine

    2011-01-01

    Equality and quality in higher education (HE) are frequently juxtaposed in the literature. This paper presents evidence to contest deficit assumptions about widening participation, particularly the belief that entering HE with "non-traditional" entry qualifications lowers standards. Drawing on a three-year constructivist grounded theory…

  15. Widening Access to Higher Education for Disabled Students: The Intersection of Socio-Economic Background and Impairment

    ERIC Educational Resources Information Center

    Weedon, Elisabet

    2016-01-01

    The proportion of disabled students in higher education across the UK has increased over the last 20 years as a result of equalities legislation and widening access measures promoted by the Scottish Government. For monitoring and reporting purposes, disabled students have often been treated as a homogeneous group. Drawing on an analysis of…

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

    SciTech Connect

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

    2011-01-01

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

  17. 77 FR 51527 - Notice of Availability for the Final Environmental Impact Statement for the Proposed Widening of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-24

    ... other waters of the United States associated with the proposed widening of the Pascagoula Lower Sound... Department of the Army; Corps of Engineers Notice of Availability for the Final Environmental Impact... AGENCY: Department of the Army, U.S. Army Corps of Engineers, DoD ACTION: Notice of availability. SUMMARY...

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

    ERIC Educational Resources Information Center

    Bathmaker, Ann-Marie

    2016-01-01

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

  19. A Consideration of the Case for Using Life Story Interviews in the Evaluation of Widening Access Interventions

    ERIC Educational Resources Information Center

    Raven, Neil

    2016-01-01

    Whilst published data sources exist for evaluating interventions aimed at widening higher education access, there is value for practitioners in conducting their own research. However, recognition of the contribution afforded by generating new data raises questions over which research methods to utilise. One method relatively new to widening…

  20. Changes in Anterior Segment Morphology and Predictors of Angle Widening after Laser Iridotomy in South Indian Eyes.

    PubMed

    Zebardast, Nazlee; Kavitha, Srinivasan; Krishnamurthy, Palaniswamy; Friedman, David S; Nongpiur, Monisha E; Aung, Tin; Quigley, Harry A; Ramulu, Pradeep Y; Venkatesh, Rengaraj

    2016-12-01

    To compare anterior segment optical coherence tomography (ASOCT) angle morphology before and after laser peripheral iridotomy (LPI) in a cohort of South Indian subjects with primary angle-closure suspect (PACS) or primary angle-closure/primary angle-closure glaucoma (PAC/PACG) and to examine baseline parameters associated with angle widening. Prospective observational study. A total of 244 subjects aged ≥30 years with PACS or PAC/PACG in at least 1 eye. The ASOCT images and angle gonioscopic grades were analyzed for all subjects at baseline and 2 weeks after LPI. Multivariable linear and logistic regression models were used to determine predictors of angle widening (change in mean angle opening distance [AOD750]) and angle opening (all 4 quadrants with trabecular meshwork [TM] visible on gonioscopy after LPI). Change in ASOCT parameters with LPI and baseline predictors of angle widening. Laser peripheral iridotomy resulted in angle widening on ASOCT with significant increases in AOD750, angle recess area, and trabecular iris surface area (P < 0.05 for all). Gonioscopically, 44.7% of all subjects had open angles in all 4 quadrants after LPI, with a greater percentage of angles open in the PACS group compared with the PAC/PACG group (52.4% vs. 36.4%; P = 0.01). In multivariable regression analyses, greater postoperative angle widening as defined by change in AOD750 was associated with shorter baseline AOD750 and axial length, and greater baseline anterior chamber depth, iris curvature, and lens vault (P ≤ 0.002 for all). Gonioscopic angle opening after LPI was more common with wider baseline angle width (modified Shaffer grade) and lower cup-to-disc ratio (P < 0.001 for both). In a South Indian population with PACS or PAC/PACG, LPI results in significant anterior chamber angle widening seen on both ASOCT and gonioscopy, although some degree of persistent iridotrabecular contact was present in approximately half of PACS eyes and approximately two thirds of PAC

  1. Vertical shear fractures of the femoral neck. A biomechanical study.

    PubMed

    Baitner, A C; Maurer, S G; Hickey, D G; Jazrawi, L M; Kummer, F J; Jamal, J; Goldman, S; Koval, K J

    1999-10-01

    A biomechanical cadaver study was performed to compare the strength and stability of three cannulated cancellous lag screws with a sliding hip screw for fixation of a vertically oriented fracture of the femoral neck (Pauwels Type III). Using eight matched pairs of human cadaveric femurs, vertically oriented femoral neck osteotomies were created, reduced, and randomized to one of the two fixation methods. The constructs were tested with incremental axial loading from 100 N to 1200 N and cyclical loading at 1000 N for 10,000 cycles; fracture displacements and ultimate load to failure were determined. The specimens stabilized using a sliding hip screw showed less inferior femoral head displacement, less shearing displacement at the osteotomy site, and a much greater load to failure than did those stabilized with multiple cancellous lag screws. These results support the use of a sliding hip screw for treatment of vertically oriented fractures of the femoral neck.

  2. Abnormalities of proximal femoral growth after severe Perthes' disease.

    PubMed

    Sponseller, P D; Desai, S S; Millis, M B

    1989-08-01

    We studied the pattern of proximal femoral growth after severe Perthes' disease (Catterall grade III or IV) by retrospective analysis of serial radiographs in 52 hips (46 patients). Our aim was to determine the relationship between proximal femoral growth abnormalities and metaphyseal cysts, epiphyseal extrusion, physeal narrowing, and extensive epiphyseal necrosis. The average follow-up after treatment was 9.8 years (range 4 to 16 years), and 37 of the hips were followed to skeletal maturity. Slowing of proximal femoral growth was common: symmetrical abnormality was seen in 26 hips and asymmetrical abnormality in nine. However, definite premature closure of the proximal femoral physis was seen in only three hips. Abnormality seemed to be due to altered growth velocity rather than to bar formation in most cases. Metaphyseal cysts, epiphyseal extrusion and physeal narrowing during the active stage of the disease, alone or in combination, were found to be neither sensitive nor specific predictors of the subsequent growth pattern.

  3. Acute femoral neuropathy secondary to an iliacus muscle hematoma.

    PubMed

    Seijo-Martínez, M; Castro del Río, M; Fontoira, E; Fontoira, M

    2003-05-15

    We present a patient with a spontaneous iliacus muscle hematoma, appearing immediately after a minor physical maneuver, presenting with pain and femoral neuropathy initially evidenced by massive quadriceps muscle fasciculations. A magnetic resonance imaging (MRI) study of the pelvic area confirmed the diagnosis, showing a hematoma secondary to a partial muscle tear. The patient was managed conservatively, and the continuous muscle activity ceased in 3 days, with progressive improvement of the pain and weakness. The recovery was complete. Femoral neuropathy is uncommon and usually due to compression from psoas muscle mass lesions of diverse nature, including hematomas. Usually subacute, femoral neuropathy may present acutely in cases of large or strategically placed compressive femoral nerve lesions, and may require surgical evacuation. The case presented herein is remarkable since the muscle hematoma appeared after a nonviolent maneuver, fasciculations were present at onset, and conservative management was sufficient for a full recovery.

  4. Giant cell tumor of the femoral neck: case report.

    PubMed

    Silva, Paulo; Amaral, Rogério Andrade do; Oliveira, Leandro Alves de; Moraes, Frederico Barra de; Chaibe, Eduardo Damasceno

    2016-01-01

    The authors present the case of a patient with a giant cell tumor of the left femoral neck, with adjacent progressive invasion of bone tissue. Initial treatment was done with local curettage and autologous bone graft from fibula, electrocauterization and filling with methyl methacrylate. A local tumoral relapse was present after one year; therefore a new surgical procedure was necessary, with proximal femoral wide resection and unconventional endoprosthesis fixation. The article discusses the clinical aspects and surgical treatment. This report aimed to demonstrate the necessity to perform wide resection for giant cell tumor of the femoral neck, prioritizing total resection of the tumor and its local extension, preserving limb integrity and demonstrating the complete failure of preserving surgery in cases of femoral neck involvement.

  5. Mechanisms of stem subsidence in femoral impaction allografting.

    PubMed

    Albert, Carolyne; Frei, Hanspeter; Duncan, Clive; Fernlund, Goran

    2011-01-01

    Failure of the femoral component of total hip arthroplasty is often accompanied by bone loss that can pose a significant challenge to the orthopaedic surgeon. Femoral impaction allografting has attractive potential for restoring bone stock in deficient femurs. However, there have been reports of problematic postoperative stem subsidence with this procedure. Subsidence is highly variable among patients, and there is disagreement over the mechanisms that cause it. This article reviews the various mechanisms that can contribute to subsidence in femoral impaction allografting. Variables such as graft density, cement penetration profile, use of synthetic graft substitutes, or other graft additives are discussed, as well as their potential impact on subsidence. Finally, recommendations are made for future studies aiming to reduce the risk of excessive subsidence in femoral impaction allografting.

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

    PubMed

    Matziolis, G; Roehner, E

    2015-04-01

    The different landmarks for determination of the rotation of the femoral component are shown and specific pros and cons are discussed. The videos demonstrate how to identify them intraoperatively. Georg Thieme Verlag KG Stuttgart · New York.

  7. Sufficient penetration of peracetic acid into drilled human femoral heads.

    PubMed

    Brosig, H; Jacker, H-J; Borchert, H-H; Kalus, U; Dörner, T; von Versen, R; Pruss, A

    2005-01-01

    Chemical sterilisation methods for musculoskeletal transplants have the problem of penetration into all tissue strata. The present study examined if a peracetic acid/ethanol solution penetrated to a sufficient extent into specifically prepared femoral heads. To this effect, 10 femoral heads have been provided with drillings (diameter 2 mm, depth 10 mm) at a distance of 15 mm (series B) and placed in a diffusion chamber with sterilisation solution. From an additional central drilling at the femoral neck junction, the sample drawing was made after 30 min each over a period of 4 h for the iodometric determination of peracetic acid (PAA) concentration. Ten femoral heads, which did contain only the central drilling, served as controls (series A). In 9 of the examined femoral heads of series A the defined minimum concentration of PAA of 0.2% (inactivation of bacteria, spores, fungi) has been clearly exceeded over the complete period of measurement. About 0.8% PAA (inactivation of viruses) was achieved within 4 h only with six femoral heads. Nine out of the 10 examined femoral heads in series B show a clearly improved penetration behaviour which was expressed in smaller standard deviations, a faster increase in concentration, as well as in higher starting and final concentrations (approx. 0.9%) of PAA. Previous drying in air leads to a faster penetration into the centre of the bone. Standardised drilling of de-cartilaged femoral heads creates favourable conditions for the penetration of the PAA sterilisation solution into the whole tissue and guarantees a sufficient inactivation of microorganisms.

  8. Proximal femoral replacement for the treatment of periprosthetic fractures.

    PubMed

    Klein, Gregg R; Parvizi, Javad; Rapuri, Venkat; Wolf, Christopher F; Hozack, William J; Sharkey, Peter F; Purtill, James J

    2005-08-01

    A periprosthetic fracture around the femoral component is a rare but potentially problematic complication after total hip arthroplasty. Reconstruction can be challenging, especially when severe bone stock deficiency is encountered. Proximal femoral replacement is one method of treating the severely deficient proximal part of the femur. The present report describes the outcomes of revision total hip arthroplasty with use of a proximal femoral replacement in a cohort of patients who had a Vancouver type-B3 periprosthetic fracture. With use of a computerized institutional database, all patients in whom a Vancouver type-B3 fracture (characterized by severe proximal bone deficiency and a loose femoral stem) had been treated with a proximal femoral replacement were identified. A modular femoral replacement with proximal porous coating had been used in all cases. The twenty-one patients who were identified had had a mean age of 78.3 years (range, fifty-two to ninety years) at the time of the index operation. The clinical and radiographic records of these patients were reviewed. At the time of the latest follow-up (mean, 3.2 years), all but one of the patients were able to walk and had minimal to no pain. Complications included persistent wound drainage that was treated with incision and drainage (two hips), dislocation (two hips), refracture of the femur distal to the stem (one hip), and acetabular cage failure (one hip). Despite a relatively high complication rate, we believe that proximal femoral replacement is a viable option for the treatment of periprosthetic fractures in older patients with severe bone deficiency. If a proximal femoral replacement is used, the stability of the hip must be tested diligently intraoperatively and a constrained acetabular liner should be utilized if instability is encountered. In order to enhance the bone stock, the proximal part of the femur, however poor in quality, should be retained for reapproximation onto the implant.

  9. The accuracy of femoral intramedullary guides in total knee arthroplasty.

    PubMed

    Reed, S C; Gollish, J

    1997-09-01

    Of the technical factors important in achieving a successful total knee arthroplasty, limb alignment has been demonstrated to be most influential in determining implant survival. Intramedullary femoral guide systems rely on placement of the intramedullary rod along the anatomic axis of the femur. In this article, the accuracy of the femoral intramedullary guide is investigated using radiographs and a mathematical model. The femoral anatomic axis was drawn on 40 consecutive, preoperative, 3-ft standing radiographs. Using a mathematical model, the potential angular error in the distal femoral cut from aberrant placement of the intramedullary rod was estimated. Calculated values correlated with measured values from plain radiographs and an intramedullary guide template. The anatomic axis was found to exit the distal femur at an average of 6.6 mm medial to the center of the femoral notch. Substantial malalignment error resulted from minor malposition of the intramedullary rod. Most books and diagrams demonstrating the use of intramedullary guides indicate that the entry point is at the center of the femoral notch. These results show that the true entry point is medial to the center of the notch, and rod placement error results in excessive valgus alignment. Preoperative drawing of the anatomic axis on a 3-ft or 18-inch anteroposterior radiograph is recommended. The results both demonstrate the importance of correct use of the guide and heighten cognizance among surgeons performing total knee arthroplasty as to the limitations of the intramedullary guides.

  10. Femoral neck shaft angle in men with fragility fractures.

    PubMed

    Tuck, S P; Rawlings, D J; Scane, A C; Pande, I; Summers, G D; Woolf, A D; Francis, R M

    2011-01-01

    Introduction. Femoral neck shaft angle (NSA) has been reported to be an independent predictor of hip fracture risk in men. We aimed to assess the role of NSA in UK men. Methods. The NSA was measured manually from the DXA scan printout in men with hip (62, 31 femoral neck and 31 trochanteric), symptomatic vertebral (91), and distal forearm (67) fractures and 389 age-matched control subjects. Age, height, weight, and BMD (g/cm(2): lumbar spine, femoral neck, and total femur) measurements were performed. Results. There was no significant difference in mean NSA between men with femoral neck and trochanteric hip fractures, so all further analyses of hip fractures utilised the combined data. There was no difference in NSA between those with hip fractures and those without (either using the combined data or analysing trochanteric and femoral neck shaft fractures separately), nor between fracture subjects as a whole and controls. Mean NSA was smaller in those with vertebral fractures (129.2° versus 131°: P = 0.001), but larger in those with distal forearm fractures (129.8° versus 128.5°: P = 0.01). Conclusions. The conflicting results suggest that femoral NSA is not an important determinant of hip fracture risk in UK men.

  11. Osteoid Osteoma of the Femoral Neck in Athletes: Two Case Reports Differentiating From Femoral Neck Stress Injuries.

    PubMed

    Cordova, Christopher B; Dembowski, Scott C; Johnson, Michael R; Combs, John J; Svoboda, Steven J

    2016-01-01

    The diagnosis of an intra-articular osteoid osteoma can be a challenging and lengthy process, with reports of delayed diagnosis of greater than 2 years. In the young, athletic patient with an atraumatic onset of groin pain, an overuse injury or muscle strain is the most likely etiology. However, an overuse injury of femoral neck stress fracture must be identified because of the potentially disastrous outcome of fracture completion. The similar clinical presentation of a femoral neck stress fracture and intra-articular osteoid osteoma of the femoral neck can further delay the diagnosis of the osteoid osteoma. In a patient with these differential diagnoses that do not improve with a period of nonweightbearing activity, a more intensive workup must ensue. The purpose of this case report is to describe the initial presentations, subsequent follow-up, and imaging findings leading to the diagnosis of osteoid osteoma as well as to differentiate an osteoid osteoma from femoral neck stress injuries.

  12. Nineteen year results of THA using modular 9 mm S-ROM femoral component in patients with small femoral canals.

    PubMed

    Drexler, Michael; Dwyer, Tim; Marmor, Meir; Abolghasemian, Mansour; Chakravertty, Rajesh; Chechik, Ofir; Cameron, Hugh U

    2013-10-01

    A retrospective analysis was undertaken of 30 consecutive THA performed in 25 patients with hypoplastic proximal femurs, who had received a 9-mm uncemented modular S-ROM stem. The mean patient age was 42 years (17-69 years), mean height was 152.5 cm (130-170.5 cm), mean weight was 63 kg (39-90 kg), and mean follow-up period was 19 years (range, 12-23 years). Subsidence was seen in 2 hips, with asymptomatic femoral osteolysis present in 11 hips; overall survival of the femoral stem was 93.3%, with two revisions of the femoral component required for aseptic loosening. After a mean follow-up of 19 years, the use of the S-ROM 9 mm femoral stem in the patient with the small femur was associated with a low revision rate due to aseptic loosening of the stem.

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

    PubMed

    Fan, Yingling; Song, Yan

    2009-09-01

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

  14. Attribution of the local Hadley cell widening in the Southern Hemisphere

    NASA Astrophysics Data System (ADS)

    Kim, Yeon-Hee; Min, Seung-Ki; Son, Seok-Woo; Choi, Jung

    2017-01-01

    This study conducts an attribution analysis of long-term changes in the southern edge of the local Hadley cell (HC) during austral summer for the past three decades (1979-2009). The southern edges of the local overturning circulations (local HC) are defined as the latitudes of maximum sea level pressure in the Southern Hemisphere subtropics, and the long-term variations of local HC edges from multireanalyses are compared with those from Coupled Model Intercomparison Project Phase 5 (CMIP5) multimodel simulations by using the optimal fingerprinting technique. The observed local HC exhibits a poleward expansion in the Atlantic and Indian Ocean regions, which is successfully reproduced by the CMIP5 models including anthropogenic forcing (ANT) but with a weaker amplitude. The detection analyses further show that ANT signals are detected robustly in both Atlantic and Indian HC trends. More importantly, anthropogenic forcings other than greenhouse gas forcing are found to be clearly detected in isolation, indicating a possible attribution of the observed local HC widening over these regions to stratospheric ozone depletion.

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

    NASA Astrophysics Data System (ADS)

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

    2015-08-01

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

  16. An Inexpensive Field-Widened Monolithic Michelson Interferometer for Precision Radial Velocity Measurements

    NASA Astrophysics Data System (ADS)

    Mahadevan, Suvrath; Ge, Jian; Fleming, Scott W.; Wan, Xiaoke; DeWitt, Curtis; van Eyken, Julian C.; McDavitt, Dan

    2008-09-01

    We have constructed a thermally compensated field-widened monolithic Michelson interferometer that can be used with a medium-resolution spectrograph to measure precise Doppler radial velocities of stars. Our prototype monolithic fixed-delay interferometer is constructed with off-the-shelf components and assembled using a hydrolysis bonding technique. We installed and tested this interferometer in the Exoplanet Tracker (ET) instrument at the Kitt Peak 2.1 m telescope, an instrument built to demonstrate the principles of dispersed fixed-delay interferometry. An iodine cell allows the interferometer drift to be accurately calibrated, relaxing the stability requirements on the interferometer itself. When using our monolithic interferometer, the ET instrument has no moving parts (except the iodine cell), greatly simplifying its operation. We demonstrate differential radial velocity precision of a few m s-1 on well known radial velocity standards and planet bearing stars when using this interferometer. Such monolithic interferometers will make it possible to build relatively inexpensive instruments that are easy to operate and capable of precision radial velocity measurements. A larger multiobject version of the Exoplanet Tracker will be used to conduct a large scale survey for planetary systems as part of the Sloan Digital Sky Survey III (SDSS III). Variants of the techniques and principles discussed in this paper can be directly applied to build large monolithic interferometers for such applications, enabling the construction of instruments capable of efficiently observing many stars simultaneously at high velocity precision.

  17. System optimization of a field-widened Michelson interferometric spectral filter for high spectral resolution lidar

    NASA Astrophysics Data System (ADS)

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

    2011-06-01

    High spectral resolution lidars (HSRLs) have recently shown great value in aerosol measurements form aircraft and are being called for in future space-based aerosol remote sensing applications. A quasi-monolithic field-widened, off-axis Michelson interferometer had been developed as the spectral discrimination filter for an HSRL currently under development at NASA Langley Research Center (LaRC). The Michelson filter consists of a cubic beam splitter, a solid arm and an air arm. The input light is injected at 1.5° off-axis to provide two output channels: standard Michelson output and the reflected complementary signal. Piezo packs connect the air arm mirror to the main part of the filter that allows it to be tuned within a small range. In this paper, analyses of the throughput wavephase, locking error, AR coating, and tilt angle of the interferometer are described. The transmission ratio for monochromatic light at the transmitted wavelength is used as a figure of merit for assessing each of these parameters.

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

    PubMed Central

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

    1997-01-01

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

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

    PubMed

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

    2016-04-04

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

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

    PubMed

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

    2013-03-10

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

  1. Polarized high-spectral-resolution lidar based on field-widened Michelson interferometer

    NASA Astrophysics Data System (ADS)

    Liu, Dong; Cheng, Zhongtao; Luo, Jing; Yang, Yongying; Zhang, Yupeng; Zhou, Yudi; Bai, Jian; Liu, Chong; Shen, Yibing

    2016-05-01

    A polarized high-spectral-resolution lidar (HSRL) based on a field-widened Michelson interferometer (FWMI) is developed in Zhejiang University, China, which is intended to profile various atmospheric aerosol optical properties simultaneously, such as the backscatter coefficient, the extinction coefficient, depolarization ratio, lidar ratio, etc. Due to the enlarged field-of-view (FOV) of the FWMI spectroscopic filter compared with the conventional Fabry-Perot interferometer (FPI) filter, we can expand the angular acceptable angle of the HSRL system to about 1 degree yet without any degradation of the spectral discrimination, enhancing the photon efficiency considerably. In this paper, we describe the developed FWMI-based polarized HSRL system comprehensively. The instrument configuration parameters and overall systematic structure are first presented. Then the FWMI subsystem, as the core apparatus of this HSRL, is particularly focused on. Instrumental calibration approach and the data retrieval are also discussed in detail. To our knowledge, this HSRL system is the first new generation of lidar which employs the FWMI spectroscopic filter in China, and great potential will be shown with the gradually improved engineering design in near future.

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

    SciTech Connect

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

    2014-08-11

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

  3. "It's making contacts": notions of social capital and implications for widening access to medical education.

    PubMed

    Nicholson, S; Cleland, J A

    2017-05-01

    In the UK widening access (WA) activities and policies aim to increase the representation from lower socio-economic groups into Higher Education. Whilst linked to a political rhetoric of inclusive education such initiatives have however failed to significantly increase the number of such students entering medicine. This is compounded by a discourse that portrays WA applicants and students as lacking the essential skills or attributes to be successful in medical education. Much of the research in this area to date has been weak and it is critical to better understand how WA applicants and students negotiate medical admissions and education to inform change. To address this gap we amalgamated a larger dataset from three qualitative studies of student experiences of WA to medicine (48 participants in total). Inductively analysing the findings using social capital as a theoretical lens we created and clustered codes into categories, informed by the concepts of "weak ties" and "bridging and linking capital", terms used by previous workers in this field, to better understand student journeys in medical education. Successful applicants from lower socio-economic groups recognise and mobilise weak ties to create linking capital. However once in medical school these students seem less aware of the need for, or how to create, capital effectively. We argue WA activities should support increasing the social capital of under-represented applicants and students, and future selection policy needs to take into account the varying social capital of students, so as to not overtly disadvantage some social groups.

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

    NASA Astrophysics Data System (ADS)

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

    2003-01-01

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

  5. Clear widens the field for observations of the Sun with multi-conjugate adaptive optics

    NASA Astrophysics Data System (ADS)

    Schmidt, Dirk; Gorceix, Nicolas; Goode, Philip R.; Marino, Jose; Rimmele, Thomas; Berkefeld, Thomas; Wöger, Friedrich; Zhang, Xianyu; Rigaut, François; von der Lühe, Oskar

    2017-01-01

    The multi-conjugate adaptive optics (MCAO) pathfinder Clear on the New Solar Telescope in Big Bear Lake has provided the first-ever MCAO-corrected observations of the Sun that show a clearly and visibly widened corrected field of view compared to quasi-simultaneous observations with classical adaptive optics (CAO) correction. Clear simultaneously uses three deformable mirrors, each conjugated to a different altitude, to compensate for atmospheric turbulence. While the MCAO correction was most effective over an angle that is approximately three times wider than the angle that was corrected by CAO, the full 53'' field of view did benefit from MCAO correction. We further demonstrate that ground-layer-only correction is attractive for solar observations as a complementary flavor of adaptive optics for observational programs that require homogenous seeing improvement over a wide field rather than diffraction-limited resolution. We show illustrative images of solar granulation and of a sunspot obtained on different days in July 2016, and present a brief quantitative analysis of the generalized Fried parameters of the images. The movies associated to Fig. 1 are available at http://www.aanda.org

  6. Band gap widening at random CIGS grain boundary detected by valence electron energy loss spectroscopy

    NASA Astrophysics Data System (ADS)

    Keller, Debora; Buecheler, Stephan; Reinhard, Patrick; Pianezzi, Fabian; Bissig, Benjamin; Carron, Romain; Hage, Fredrik; Ramasse, Quentin; Erni, Rolf; Tiwari, Ayodhya N.

    2016-10-01

    Cu(In,Ga) Se2 (CIGS) thin film solar cells have demonstrated very high efficiencies, but still the role of nanoscale inhomogeneities in CIGS and their impact on the solar cell performance are not yet clearly understood. Due to the polycrystalline structure of CIGS, grain boundaries are very common structural defects that are also accompanied by compositional variations. In this work, we apply valence electron energy loss spectroscopy in scanning transmission electron microscopy to study the local band gap energy at a grain boundary in the CIGS absorber layer. Based on this example, we demonstrate the capabilities of a 2nd generation monochromator that provides a very high energy resolution and allows for directly relating the chemical composition and the band gap energy across the grain boundary. A band gap widening of about 20 meV is observed at the grain boundary. Furthermore, the compositional analysis by core-loss EELS reveals an enrichment of In together with a Cu, Ga and Se depletion at the same area. The experimentally obtained results can therefore be well explained by the presence of a valence band barrier at the grain boundary.

  7. Widening the SLP lens: how can we improve the wellbeing of people with communication disabilities globally.

    PubMed

    Wickenden, Mary

    2013-02-01

    This article responds to Wylie, McAllister, Davidson, and Marshall (2013) by arguing that the wellbeing of people with communication disabilities in the global south will be improved if speech and language pathologists widen their lens considerably. The numbers of speech-language pathologists (SLPs) in the Majority World is and will remain infinitesimally small. Therefore, to make any meaningful impact the profession needs to engage in debates and activities outside the health and service provision arenas, getting involved cross-sectorally and at various policy levels. It is contended that, although the World Report on Disability is a useful summary of the status quo, actually SLPs need to harness two other seminal documents: The International Classification of Functioning, Disability and Health and, more particularly, the United Nations Convention on the Rights of People with Disabilities in order to drive change. Historically the profession's focus has been on impairments, and current moves to social models are welcome. However, SLPs need to embrace human rights approaches and broader frameworks of inclusive community development, using global initiatives such as community-based rehabilitation to improve the lives of people with communication disabilities. Why SLPs should become critically engaged, particularly at the macro level, is explored.

  8. Correlation technique for the compensation of diffraction widening of optical reference signals.

    PubMed

    Sáez-Landete, José; Alonso, José; Sanchez-Brea, Luis Miguel; Morlanes, Tomás; Bernabeu, Eusebio

    2009-09-01

    Two-grating measurement systems are routinely employed for high-resolution measurements of angular and linear displacement. Usually, these systems incorporate zero reference codes (ZRCs) to obtain a zero reference signal (ZRS), which is used as a stage-homing signal. This signal provides absolute information of the position to the otherwise relative information provided by the two-grating incremental subsystems. A zero reference signal is commonly obtained illuminating the superposition of two identical pseudorandom codes and registering the transmitted light by means of a photodiode. To increase the resolution of the system, a reduction of the grating period and the ZRC widths is required. Due to this reduction, the diffractive effects produce a widening of the ZRS and, in turn, a loss of the measuring accuracy. In this work, we propose a method to narrow the distorted signal obtained with a Lau-based encoder, reinstating the accuracy of the ZRS. The method consists of the inclusion of a correlation mask on the detector. A theoretical model to design the mask has been developed, and experimental results have been obtained that validate the proposed technique.

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

    PubMed

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

    2015-12-01

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

  10. Genetic Drift Widens the Expected Cline but Narrows the Expected Cline Width

    PubMed Central

    Polechová, Jitka; Barton, Nick

    2011-01-01

    Random genetic drift shifts clines in space, alters their width, and distorts their shape. Such random fluctuations complicate inferences from cline width and position. Notably, the effect of genetic drift on the expected shape of the cline is opposite to the naive (but quite common) misinterpretation of classic results on the expected cline. While random drift on average broadens the overall cline in expected allele frequency, it narrows the width of any particular cline. The opposing effects arise because locally, drift drives alleles to fixation—but fluctuations in position widen the expected cline. The effect of genetic drift can be predicted from standardized variance in allele frequencies, averaged across the habitat: 〈F〉. A cline maintained by spatially varying selection (step change) is expected to be narrower by a factor of 1−〈F〉 relative to the cline in the absence of drift. The expected cline is broader by the inverse of this factor. In a tension zone maintained by underdominance, the expected cline width is narrower by about 1 – 〈F〉 relative to the width in the absence of drift. Individual clines can differ substantially from the expectation, and we give quantitative predictions for the variance in cline position and width. The predictions apply to clines in almost one-dimensional circumstances such as hybrid zones in rivers, deep valleys, or along a coast line and give a guide to what patterns to expect in two dimensions. PMID:21705747

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

    PubMed

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

    2012-01-16

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

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

    PubMed

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

    2015-05-04

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

  13. Endovascular Treatment of a Ruptured Profunda Femoral Artery Branch After Fogarty Thrombectomy of a Femoro-Femoral Crossover Arterial Graft: A Case Report and Review of the Literature

    SciTech Connect

    Manousaki, Eirini; Tsetis, Dimitrios; Kostas, Theodoros; Katsamouris, Asterios

    2010-02-15

    We present a very rare case of a life-threatening rupture of a profunda femoral artery distal branch after a Fogarty thrombectomy of a thrombosed crossover synthetic graft between the ipsilateral common femoral artery and a contralateral iliac-popliteal graft; the bleeding profunda femoral artery branch was successfully embolized with metallic coils through the axillary artery approach.

  14. [Distal femoral fixation of the iliotibial tract].

    PubMed

    Lobenhoffer, P; Gerich, T; Lattermann, C

    1994-03-01

    Two femoral fixation areas were defined in the distal iliotibial tract (ITT) system. They were named supracondylar insertion and insertion near the septum. Biomechanical studies on these insertions revealed tension peaks in the insertion near the septum with anterior translation of the knee, with varus stress and rotational movements. We conclude that the fibers inserting here are secondary restraints against anterior and lateral knee instability. 5 lateral extraarticular procedures were investigated to evaluate their biomechanical effect on knee instability. A standardized cadaver knee model was used with two basic experiments: an excentric quadriceps contraction from 0 to 90 degrees of flexion and an anterior translation with 100 N in 30 degrees of flexion. 5 knees were investigated for each procedure. Results from the excentric quadriceps contraction study imply reduced ACL strain with all extraarticular procedures except the Andrews tenodesis. The quantitative effect was related to the mechanical strength of the fixation of the ITT. All lateral procedures reduced ACL strain with anterior translation of the knee. The last part of the study included simultaneous registration of rotation and translation of the knee. We demonstrated a close relation of decreased ACL strain due to a lateral procedure and pathological external rotation of the knee. The knee no longer reached the physiological neutral rotation angle after an effective lateral tenodesis procedure. The significance of this effect is not clear at the present time.

  15. Hyperbaric oxygen therapy in femoral head necrosis.

    PubMed

    Camporesi, Enrico M; Vezzani, Giuliano; Bosco, Gerardo; Mangar, Devanand; Bernasek, Thomas L

    2010-09-01

    We evaluated hyperbaric oxygen (HBO) therapy on a cohort of patients with femoral head necrosis (FHN). This double-blind, randomized, controlled, prospective study included 20 patients with unilateral FHN. All were Ficat stage II, treated with either compressed oxygen (HBO) or compressed air (HBA). Each patient received 30 treatments of HBO or HBA for 6 weeks. Range of motion, stabilometry, and pain were assessed at the beginning of the study and after 10, 20, and 30 treatments by a blinded physician. After the initial 6-week treatment, the blind was broken; and all HBA patients were offered HBO treatment. At this point, the study becomes observational. Pretreatment, 12-month. and 7 year-follow-up magnetic resonance images were obtained. Statistical comparisons were obtained with nonparametric Mann-Whitney U test. Significant pain improvement for HBO was demonstrated after 20 treatments. Range of motion improved significantly during HBO for all parameters between 20 and 30 treatments. All patients remain substantially pain-free 7 years later: none required hip arthroplasty. Substantial radiographic healing of the osteonecrosis was observed in 7 of 9 hips. Hyperbaric oxygen therapy appears to be a viable treatment modality in patients with Ficat II FHN. Copyright 2010. Published by Elsevier Inc.

  16. Reconstruction of femoral length from fragmentary femora

    PubMed Central

    Offei, Eric Bekoe; Osabutey, Casmiel Kwabena

    2016-01-01

    The reconstruction of femoral length (FL) from fragmentary femora is an essential step in estimating stature from fragmentary skeletal remains in forensic investigations. While regression formulae for doing this have been suggested for several populations, such formulae have not been established for Ghanaian skeletal remains. This study, therefore, seeks to derive regression formulae for reconstruction of FL from fragmentary femora of skeletal samples obtained from Ghana. Six measurements (vertical head diameter, transverse head diameter, bicondylar breadth, epicondylar breadth, sub-trochanteric anterior-posterior diameter, and sub-trochanteric transverse diameter) were acquired from different anatomical portions of the femur and the relationship between each acquired measurement and FL was analyzed using linear regression. The results indicated significantly moderate-to-high correlations (r=0.580–0.818) between FL and each acquired measurement. The error estimates of the regression formulae were relatively low (i.e., standard error of estimate, 13.66–19.28 mm), suggesting that the discrepancies between actual and estimated stature were relatively low. Compared with other measurements, sub-trochanteric transverse diameter was the best estimate of FL. In the absence of a complete femur, the regression formulae based on the assessed measurements may be used to infer FL, from which stature can be estimated in forensic investigations. PMID:27722014

  17. Computer-assisted femoral head resurfacing.

    PubMed

    Hodgson, Antony J; Inkpen, Kevin B; Shekhman, Mark; Anglin, Carolyn; Tonetti, Jerome; Masri, Bassam A; Duncan, Clive P; Garbuz, Donald S; Greidanus, Nelson V

    2005-01-01

    Femoral head resurfacing is re-emerging as a surgical option for younger patients who are not yet candidates for total hip replacement. However, this procedure is more difficult than total hip replacement, and the mechanical jigs typically used to align the implant produce significant variability in implant placement and take a significant amount of time to position properly. We propose that a computer-assisted surgical (CAS) technique could reduce implant variability with little or no increase in operative time. We describe a new CAS technique for this procedure and demonstrate in a cadaver study of five paired femurs that the CAS technique in the hands of a novice surgeon markedly reduced the varus/valgus variability of the implant relative to the pre-operative plan (2 degrees standard deviation for CAS versus 5 degrees for a mechanical jig operated by an expert surgeon). We also show that the mechanical jig resulted in significantly retroverted implant placement. There was no significant difference in operative time between the two techniques.

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

    PubMed Central

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

    2016-01-01

    Recently, we experienced a case where the diagnosis and management of a deep femoral artery rupture was delayed. This vascular complication occurred during the insertion of a distal interlocking screw of a proximal femoral nail for the fixation of an intertrochanteric femur fracture. A 79-year-old male patient was diagnosed with a right intertrochanteric fracture after a fall. We fixed the fracture with a proximal femoral nail (Zimmer® Natural Nail™ System). One day after the procedure, the patient complained of pain and swelling on the anteromedial side of his middle thigh followed by hypotension, anemia and prolonged thigh swelling. Computed tomography angiography was performed 7 days after the procedure. We found a pseudoaneurysm of the perforating artery caused by injury to the deep femoral artery and an intramuscular hematoma in the anterior thigh muscle. We successfully treated the pseudoaneurysm using coil embolization. Throughout the management of intertrochanteric femoral fractures, it is important to be aware and monitor signs and symptoms related to the possibility of blood vessel damage. When a patient presents with swelling and pain on the middle thigh and/or unexplained anemia postoperatively, the possibility that these symptoms are caused by an injury to the femoral artery must be considered. PMID:27536645

  19. Distal femoral cut in total knee arthroplasty in a Brazilian population☆

    PubMed Central

    Costa, Marcos Areias Vieira; Mozella, Alan de Paula; Cobra, Hugo Alexandre de Araujo Barros

    2015-01-01

    Objective To determine the ideal angle for making the distal femoral cut in total knee arthroplasty in a Brazilian population. Methods Panoramic radiographs of the lower limbs bearing weight from 79 patients (57 women and 22 men) were studied, totaling 107 knees with an indication for total knee arthroplasty. The femoral anatomical axis, femoral mechanical axis and cervical-diaphyseal angle were traced out. The angle of the femoral cut was determined from the meeting point between the femoral anatomical and mechanical axes. The ideal degree of femoral valgus was compared between men and women and between knees presenting varus and valgus alignment of the lower limb. The ideal distal femoral cut was also correlated with the cervical-diaphyseal angle. Results The ideal femoral valgus angle ranged from 4.2 to 8.6 degrees, with a mean of 6.3 degrees. There was no statistically significant difference in the distal femoral cut between patients with coronal varus and valgus alignment (p = 0.180). Comparing men and women, there was no statistically significant difference regarding the ideal femoral valgus between the groups (p = 0.057). The cervical-diaphyseal angle presented an inverse relationship with the distal femoral cut. Conclusions The mean angle between the femoral mechanical and anatomical axes was 6.3 degree. Neither preoperative coronal alignment nor sex had any influence on the distal femoral cut. The cervical-diaphyseal angle presented an inverse relationship with the distal femoral cut. PMID:26229933

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

    SciTech Connect

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

    2015-11-17

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