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Sample records for femoral fixation device

  1. COMPARISON OF VOLUMES OCCUPIED BY DIFFERENT INTERNAL FIXATION DEVICES FOR FEMORAL NECK FRACTURES

    PubMed Central

    Lauxen, Daniel; Schwartsmann, Carlos Roberto; Silva, Marcelo Faria; Spinelli, Leandro de Freitas; Strohaecker, Telmo Roberto; Souza, Ralf Wellis de; Zimmer, Cinthia Gabriely; Boschin, Leonardo Carbonera; Gonçalves, Ramiro Zilles; Yépez, Anthony Kerbes

    2015-01-01

    Objective: The objective of this paper is to measure the volume occupied by the most widely used internal fixation devices for treating femoral neck fractures, using the first 30, 40 and 50 mm of insertion of each screw as an approximation. The study aimed to observe which of these implants caused least bone aggression. Methods: Five types of cannulated screws and four types of dynamic hip screws (DHS) available on the Brazilian market were evaluated in terms of volume differences through water displacement. Results: Fixation with two cannulated screws presented significantly less volume than shown by DHS, for insertions of 30, 40 and 50 mm (p=0.01, 0.012 and 0.013, respectively), fixation with three screws did not show any statistically significant difference (p= 0.123, 0.08 and 0.381, respectively) and fixation with four cannulated screws presented larger volumes than shown by DHS (p=0.072, 0.161 and 0.033). Conclusions: Fixation of the femoral neck with two cannulated screws occupied less volume than DHS, with a statistically significant difference. The majority of screw combinations did not reach statistical significance, although fixation with four cannulated screws presented larger volumes on average than those occupied by DHS. PMID:27047886

  2. Optimizing Stability in Femoral Neck Fracture Fixation.

    PubMed

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

    2015-10-01

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

  3. A Novel Guidewire Aiming Device to Improve the Accuracy of Guidewire Insertion in Femoral Neck Fracture Surgery Using Cannulated Screw Fixation.

    PubMed

    Yin, Wenjing; Xu, Haitao; Xu, Peijun; Hu, Tu; An, Zhiquan; Zhang, Changqing; Sheng, Jiagen

    2016-01-01

    BACKGROUND The aim of this study was to improve the accuracy of guidewire insertion in the femoral neck fracture surgery using cannulated screw fixation. MATERIAL AND METHODS A novel aiming device was designed and manufactured. Between January 2010 and June 2012, 64 femoral neck fracture patients were included into the study. All 64 patients were divided into 2 groups randomly. The aiming device was used during the operation for patients in the experimental group, but not in the control group. RESULTS There were no statistically significant differences in operative time or bleed volume between the groups (P>0.05). The frequency of guidewire drilling was significantly lower in the experimental group than in the control group (P<0.05). The angle between the first cannulated screw and the central axis of the femoral neck in coronal plane and sagittal plane, and the distance between the bottom cannulated screw and the medial calcar femorale rim, were significantly smaller in the experimental group than in the control group (P<0.05). CONCLUSIONS The aiming device is simple in structure and easy to use. It could help surgeons to accurately insert cannulated screw guidewires. The aiming device is suitable for broad clinical use. PMID:27529374

  4. A Novel Guidewire Aiming Device to Improve the Accuracy of Guidewire Insertion in Femoral Neck Fracture Surgery Using Cannulated Screw Fixation

    PubMed Central

    Yin, Wenjing; Xu, Haitao; Xu, Peijun; Hu, Tu; An, Zhiquan; Zhang, Changqing; Sheng, Jiagen

    2016-01-01

    Background The aim of this study was to improve the accuracy of guidewire insertion in the femoral neck fracture surgery using cannulated screw fixation. Material/Methods A novel aiming device was designed and manufactured. Between January 2010 and June 2012, 64 femoral neck fracture patients were included into the study. All 64 patients were divided into 2 groups randomly. The aiming device was used during the operation for patients in the experimental group, but not in the control group. Results There were no statistically significant differences in operative time or bleed volume between the groups (P>0.05). The frequency of guidewire drilling was significantly lower in the experimental group than in the control group (P<0.05). The angle between the first cannulated screw and the central axis of the femoral neck in coronal plane and sagittal plane, and the distance between the bottom cannulated screw and the medial calcar femorale rim, were significantly smaller in the experimental group than in the control group (P<0.05). Conclusions The aiming device is simple in structure and easy to use. It could help surgeons to accurately insert cannulated screw guidewires. The aiming device is suitable for broad clinical use. PMID:27529374

  5. Updated Outcomes of Prophylactic Femoral Fixation.

    PubMed

    Kreul, Sarah M; Sorger, Joel I; Rajamanickam, Victoria P; Heiner, John P

    2016-01-01

    Despite an increasing number of patients with metastatic bone disease (MBD), minimal data exist regarding outcomes of patients undergoing prophylactic femoral fixation for MBD when compared with other frequently performed orthopedic operations, such as hemiarthroplasty of the femur. The authors performed a retrospective database review evaluating these procedures due to similar operative times and patient populations and also reviewed common comorbidities such as body mass index (BMI). The goal was to provide updated results of prophylactic femoral fixation and evaluate whether certain patient risk factors (eg, BMI) altered 30-day survival for patients with MBD. The authors reviewed 1849 patients with and without MBD treated by prophylactic fixation and hemiarthroplasty from 2006 to 2011 identified in the American College of Surgeons National Surgical Quality Improvement Program database. There were no significant differences in complications between patients undergoing surgical treatment for impending or actual femoral fracture. In addition, there were no differences between the 217 patients with MBD in either the hemiarthroplasty or prophylactic fixation groups because the rate of death within 30 days postoperatively was 5.56% and 3.30%, respectively (P=.526). When comparing BMI, obese patients had higher rates of wound infection, and underweight patients were more likely to develop pneumonia or die within 30 days postoperatively. Patients with impending femur fractures benefit from prophylactic fixation and perform as well in the short term as patients undergoing hemiarthroplasty. Certain BMI categories (underweight or obese) contributed to poorer outcomes. These findings provide updated information for discussing risks and benefits with surgical candidates.

  6. Subchondral insufficiency fracture of the femoral head after internal fixation for femoral neck fracture: histopathological investigation.

    PubMed

    Sonoda, Kazuhiko; Yamamoto, Takuaki; Motomura, Goro; Kido, Hidehiko; Iwamoto, Yukihide

    2014-08-01

    Late segmental collapse after internal fixation for femoral neck fracture is the phenomenon observed in post-traumatic osteonecrosis of the femoral head (ON), which has generally been reported to occur over a year or more after internal fixation. Subchondral insufficiency fracture of the femoral head (SIF) has also been recognized to cause femoral head collapse, however, only two cases of SIF after internal fixation for femoral neck fracture have been reported. We report a case with femoral head collapse observed 5 months after internal fixation for femoral neck fracture, which was histopathologically diagnosed as SIF. Clinically, differentiating SIF from ON is important because some cases of SIF have been reported to heal without surgical treatments. The timing of femoral head collapse after femoral neck fracture may be different between SIF and post-traumatic ON.

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

    PubMed Central

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

    2016-01-01

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

  8. Femoral neck-shaft angle in extra-capsular proximal femoral fracture fixation; does it make a TAD of difference?

    PubMed

    Walton, N P; Wynn-Jones, H; Ward, M S; Wimhurst, J A

    2005-11-01

    The effect of femoral neck-shaft angle and implant type on the accuracy of lag screw placement in extra-capsular proximal femoral fracture fixation was investigated. Radiographs of all extra-capsular proximal femoral fractures seen in one unit over 18 months were reviewed. Of 399 cases, 307 (237 female, 70 male) were included in the study as they had no contra-lateral proximal femoral metal work. Femoral neck-shaft angle (NSA) of the uninjured hip and magnification adjusted tip-apex distance (TAD) of femoral head lag screw were measured. Type of fixation implant was 135 degrees classic hip screw (CHS) (n=144) or 130 degrees intra-medullary hip screw (IMHS) (n=163). Mean contra-lateral NSA was 130.2 degrees (112.9--148 degrees ) and 64 patients (58 female, 6 male) had a NSA <125 degrees . Mean adjusted TAD was 18.7 mm (5.8--43.8mm) and 88.9% of cases had a TAD of less than 25 mm. TAD values were significantly greater using an IMHS if NSA was <125 degrees than if NSA was >125 degrees (p=0.028). This was not the case with the CHS. The use of the 130 degrees -IMHS in patients with a NSA <125 degrees leads to poorer lag screw placement than if NSA >125 degrees and caution is advocated when using this device in such cases.

  9. 21 CFR 886.1290 - Fixation device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Fixation device. 886.1290 Section 886.1290 Food... DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1290 Fixation device. (a) Identification. A fixation device is an AC-powered device intended for use as a fixation target for the patient...

  10. 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. PMID:25437087

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

    PubMed

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

    2013-07-01

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

  12. Femoral Aperture Fixation Improves Anterior Cruciate Ligament Graft Function When Added to Cortical Suspensory Fixation

    PubMed Central

    Porter, Mark D.; Shadbolt, Bruce

    2016-01-01

    Background: Recommendations for bone tunnel placement during anterior cruciate ligament (ACL) reconstruction have become more precise. However, these recommendations differ neither with the choice of graft nor with the method of fixation used. The influence of the method of femoral fixation used on the biomechanical function of a soft tissue ACL graft remains unknown. Hypothesis: Our null hypothesis was that adding femoral aperture fixation to femoral cortical fixation, using the same bone tunnels, will not alter the control of anterior translation (AT) and internal rotation (IR) during ACL reconstruction using a hamstring graft. Study Design: Controlled laboratory study. Methods: A total of 22 patients with an acute isolated ACL rupture underwent reconstruction using a single-bundle autologous hamstring graft. Computer navigation was used intraoperatively to plot the AT and IR during the pivot-shift test before reconstruction, after ACL reconstruction using cortical suspensory fixation, and after the addition of femoral aperture fixation. Statistical analysis (analysis of variance) was used to compare the AT and IR during the pivot shift at each stage in the procedure. Results: Before ACL reconstruction, the mean (±SD) AT was 14.2 ± 7.3 mm and mean IR was 17.2° ± 5.5°. After reconstruction using femoral cortical suspension, these figures were significantly reduced to 6.2 ± 3.5 mm and 12.5° ± 3.20°, respectively (P < .001). The addition of the aperture fixation was associated with a further significant reduction to 4.6 ± 3.2 mm and 10.4° ± 2.7°, respectively (P < .001). Conclusion: The addition of femoral aperture fixation to suspensory fixation results in a significant reduction in both the AT and IR that occurs during the pivot-shift assessment immediately after ACL reconstruction using autologous hamstring graft. Clinical Relevance: The most precise positioning of bone tunnels during soft tissue ACL reconstruction needs to take into consideration

  13. Femoral Aperture Fixation Improves Anterior Cruciate Ligament Graft Function When Added to Cortical Suspensory Fixation

    PubMed Central

    Porter, Mark D.; Shadbolt, Bruce

    2016-01-01

    Background: Recommendations for bone tunnel placement during anterior cruciate ligament (ACL) reconstruction have become more precise. However, these recommendations differ neither with the choice of graft nor with the method of fixation used. The influence of the method of femoral fixation used on the biomechanical function of a soft tissue ACL graft remains unknown. Hypothesis: Our null hypothesis was that adding femoral aperture fixation to femoral cortical fixation, using the same bone tunnels, will not alter the control of anterior translation (AT) and internal rotation (IR) during ACL reconstruction using a hamstring graft. Study Design: Controlled laboratory study. Methods: A total of 22 patients with an acute isolated ACL rupture underwent reconstruction using a single-bundle autologous hamstring graft. Computer navigation was used intraoperatively to plot the AT and IR during the pivot-shift test before reconstruction, after ACL reconstruction using cortical suspensory fixation, and after the addition of femoral aperture fixation. Statistical analysis (analysis of variance) was used to compare the AT and IR during the pivot shift at each stage in the procedure. Results: Before ACL reconstruction, the mean (±SD) AT was 14.2 ± 7.3 mm and mean IR was 17.2° ± 5.5°. After reconstruction using femoral cortical suspension, these figures were significantly reduced to 6.2 ± 3.5 mm and 12.5° ± 3.20°, respectively (P < .001). The addition of the aperture fixation was associated with a further significant reduction to 4.6 ± 3.2 mm and 10.4° ± 2.7°, respectively (P < .001). Conclusion: The addition of femoral aperture fixation to suspensory fixation results in a significant reduction in both the AT and IR that occurs during the pivot-shift assessment immediately after ACL reconstruction using autologous hamstring graft. Clinical Relevance: The most precise positioning of bone tunnels during soft tissue ACL reconstruction needs to take into consideration

  14. Custom Knee Device for Knee Contractures After Internal Femoral Lengthening.

    PubMed

    Bhave, Anil; Shabtai, Lior; Ong, Peck-Hoon; Standard, Shawn C; Paley, Dror; Herzenberg, John E

    2015-07-01

    The development of knee flexion contractures is among the most common problems and complications associated with lengthening the femur with an internal device or external fixator. Conservative treatment strategies include physical therapy, serial casting, and low-load prolonged stretching with commercially available splinting systems. The authors developed an individually molded, low-cost custom knee device with polyester synthetic conformable casting material to treat knee flexion contractures. The goal of this study was to evaluate the results of treatment with a custom knee device and specialized physical therapy in patients who had knee flexion contracture during femoral lengthening with an intramedullary lengthening femoral nail. This retrospective study included 23 patients (27 limbs) who underwent femoral lengthening with an internal device for the treatment of limb length discrepancy. All patients had a knee flexion contracture raging from 10° to 90° during the lengthening process and were treated with a custom knee device and specialized physical therapy. The average flexion contracture before treatment was 36°. The mean amount of lengthening was 5.4 cm. After an average of 3.8 weeks of use of the custom knee device, only 2 of 27 limbs (7.5%) had not achieved complete resolution of the flexion contracture. The average final extension was 1.4°. Only 7 of 27 limbs (26%) required additional soft tissue release. The custom knee device is an inexpensive and effective method for treating knee flexion contracture after lengthening with an internal device.

  15. 21 CFR 886.1290 - Fixation device.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Fixation device. 886.1290 Section 886.1290 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1290 Fixation device. (a) Identification. A...

  16. 21 CFR 886.1290 - Fixation device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Fixation device. 886.1290 Section 886.1290 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1290 Fixation device. (a) Identification. A...

  17. Correlation Between Residual Displacement and Osteonecrosis of the Femoral Head Following Cannulated Screw Fixation of Femoral Neck Fractures

    PubMed Central

    Wang, Chen; Xu, Gui-Jun; Han, Zhe; Jiang, Xuan; Zhang, Cheng-Bao; Dong, Qiang; Ma, Jian-Xiong; Ma, Xin-Long

    2015-01-01

    Abstract 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. PMID:26632739

  18. Locking plate fixation of distal femoral fractures is a challenging technique: a retrospective review

    PubMed Central

    Toro, Giuseppe; Calabrò, Giampiero; Toro, Antonio; de Sire, Alessandro; Iolascon, Giovanni

    2015-01-01

    Summary Distal femoral fractures have typically a bimodal occurrence: in young people due to a high-energy trauma and in older people related to a low-energy trauma. These fractures are associated to a very high morbidity and mortality in elderly. Distal femoral fractures might be treated with plates, intramedullary nails, external fixations, and prosthesis. However, difficulties in fracture healing and the rate of complications are important clinical issues. The purpose of this retrospective review was to present our experience in treatment of distal femoral fracture in a sample of older people in order to evaluate the technical pitfalls and strategies used to face up the fractures unsuccessfully treated with locking plates. We included people aged more than 65 years, with a diagnosis of distal femoral fracture, treated with locking plates. We considered ‘unsuccessfully treated’ the cases with healing problems or hardware failures. Of the 12 patients (9 females and 3 males; mean aged 68.75 ± 3.31 years) included, we observed 3 ‘unsuccessfully cases’, 2 due to nonunions and 1 due to an early hardware failure, all treated using a condylar blade plate with a bone graft. One patient obtained a complete fracture healing after 1 year and in the other cases there was a nonunion. We observed as most common technical pitfalls: inadequate plate lengthening, fracture bridging, and number of locking screws. The use of locking plates is an emerging technique to treat these fractures but it seems more challenging than expected. In literature there is a lack of evidences about the surgical management of distal femoral fractures that is still an important challenge for the orthopaedic surgeon that has to be able to use all the fixation devices available. PMID:27134634

  19. Biomechanical optimization of different fixation modes for a proximal femoral L-osteotomy

    PubMed Central

    Tai, Ching-Lung; Chen, Weng-Pin; Chen, Hsih-Hao; Lin, Chien-Yu; Lee, Mel S

    2009-01-01

    Background Numerous proposed surgical techniques have had minimal success in managing greater trochanter overgrowth secondary to retarded growth of the femoral capital epiphysis. For reconstruction of residual hip deformities, a novel type of proximal femur L-osteotomy was performed with satisfactory results. Although the clinical outcome was good, the biomechanical characteristics of the femur after such an osteotomy have not been clearly elucidated. Therefore, this study presents a three dimensional finite element analysis designed to understand the mechanical characteristics of the femur after the L-osteotomy. Methods A patient with left hip dysplasia was recruited as the study model for L-osteotomy. The normal right hip was used as a reference for performing the corrective surgery. Four FEA models were constructed using different numbers of fixation screws but the same osteotomy lengths together with four FEA models with the same number of fixation screws but different osteotomy lengths. The von Mises stress distributions and femoral head displacements were analyzed and compared. Results The results revealed the following: 1). The fixation devices (plate and screws) sustained most of the external loading, and the peak value of von Mises stress on the fixation screws decreased with an increasing number of screws. 2). Additional screws are more beneficial on the proximal segment than on the distal segment for improving the stability of the postoperative femur. 3). The extent of osteotomy should be limited because local stress might be concentrated in the femoral neck region with increasing length of the L-osteotomy. Conclusion Additional screw placement on the proximal segment improves stability in the postoperative femur. The cobra-type plate with additional screw holes in the proximal area might improve the effectiveness of L-osteotomies. PMID:19744345

  20. Complications Using Bioabsorbable Cross-Pin Femoral Fixation: A Case Report and Review of the Literature

    PubMed Central

    Hasan, Saqib; Nayyar, Samir; Onyekwelu, Ikemefuna; Kalra, Kunal; Gyftopoulos, Soterios; Jazrawi, Laith M.

    2011-01-01

    The use of bioabsorbable cross-pin transcondylar fixation has remained a viable option for femoral fixation in anterior cruciate ligament reconstruction. Although numerous biomechanical studies have demonstrated high fixation strength and minimal slippage with use of this method of fixation, there have been increasing reports of a variety of clinical complications associated with these implants. We reviewed the literature for all complications associated with the Bio-TransFix implant and present a case report of a patient status after ACL reconstruction using Bio-TransFix cross-pin femoral fixation with iliotibial band friction syndrome from a broken cross-pin four month post-operatively. PMID:22606541

  1. Femoral locking plate failure salvaged with hexapod circular external fixation: a report of two cases.

    PubMed

    Ferreira, N; Marais, L C

    2016-08-01

    Femoral non-unions are difficult to treat even for the experienced orthopaedic trauma surgeon. If the non-union follows failure of modern stable internal fixation, the complexity of the management is further increased. We report two cases of stiff hypertrophic femoral non-unions after failed locking plate fixation that were successfully treated with a new hexapod circular external fixator. In addition to providing the necessary stability for functional rehabilitation and union, the hexapod circular fixator software allows gradual correction of deformities in order to restore the normal mechanical alignment of the limb. PMID:27234444

  2. A Technique of Superficial Medial Collateral Ligament Reconstruction Using an Adjustable-Loop Suspensory Fixation Device.

    PubMed

    Deo, Shaneel; Getgood, Alan

    2015-06-01

    This report describes superficial medial collateral ligament reconstruction of the knee using a novel method of graft fixation with the ACL Tightrope RT (Arthrex, Naples, FL). After tibial fixation with either a standard interference screw or staple, femoral fixation of the semitendinosus tendon is performed with the adjustable-loop suspensory fixation device, which allows for both initial graft tensioning and re-tensioning after cyclical knee range of motion. This provides the ability for the graft to accommodate for resultant soft-tissue creep and stress relaxation, thereby allowing for optimal soft-tissue tension and reduction in laxity at the end of the procedure. PMID:26258041

  3. A Technique of Superficial Medial Collateral Ligament Reconstruction Using an Adjustable-Loop Suspensory Fixation Device.

    PubMed

    Deo, Shaneel; Getgood, Alan

    2015-06-01

    This report describes superficial medial collateral ligament reconstruction of the knee using a novel method of graft fixation with the ACL Tightrope RT (Arthrex, Naples, FL). After tibial fixation with either a standard interference screw or staple, femoral fixation of the semitendinosus tendon is performed with the adjustable-loop suspensory fixation device, which allows for both initial graft tensioning and re-tensioning after cyclical knee range of motion. This provides the ability for the graft to accommodate for resultant soft-tissue creep and stress relaxation, thereby allowing for optimal soft-tissue tension and reduction in laxity at the end of the procedure.

  4. A Technique of Superficial Medial Collateral Ligament Reconstruction Using an Adjustable-Loop Suspensory Fixation Device

    PubMed Central

    Deo, Shaneel; Getgood, Alan

    2015-01-01

    This report describes superficial medial collateral ligament reconstruction of the knee using a novel method of graft fixation with the ACL Tightrope RT (Arthrex, Naples, FL). After tibial fixation with either a standard interference screw or staple, femoral fixation of the semitendinosus tendon is performed with the adjustable-loop suspensory fixation device, which allows for both initial graft tensioning and re-tensioning after cyclical knee range of motion. This provides the ability for the graft to accommodate for resultant soft-tissue creep and stress relaxation, thereby allowing for optimal soft-tissue tension and reduction in laxity at the end of the procedure. PMID:26258041

  5. 21 CFR 868.5770 - Tracheal tube fixation device.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Tracheal tube fixation device. 868.5770 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5770 Tracheal tube fixation device. (a) Identification. A tracheal tube fixation device is a device used to hold a tracheal tube...

  6. 21 CFR 868.5770 - Tracheal tube fixation device.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Tracheal tube fixation device. 868.5770 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5770 Tracheal tube fixation device. (a) Identification. A tracheal tube fixation device is a device used to hold a tracheal tube...

  7. 21 CFR 868.5770 - Tracheal tube fixation device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Tracheal tube fixation device. 868.5770 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5770 Tracheal tube fixation device. (a) Identification. A tracheal tube fixation device is a device used to hold a tracheal tube...

  8. 21 CFR 868.5770 - Tracheal tube fixation device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Tracheal tube fixation device. 868.5770 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5770 Tracheal tube fixation device. (a) Identification. A tracheal tube fixation device is a device used to hold a tracheal tube...

  9. 21 CFR 868.5770 - Tracheal tube fixation device.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Tracheal tube fixation device. 868.5770 Section... (CONTINUED) MEDICAL DEVICES ANESTHESIOLOGY DEVICES Therapeutic Devices § 868.5770 Tracheal tube fixation device. (a) Identification. A tracheal tube fixation device is a device used to hold a tracheal tube...

  10. Medial Closing-Wedge Distal Femoral Osteotomy: Fixation With Proximal Tibial Locking Plate

    PubMed Central

    Tírico, Luís Eduardo Passarelli; Demange, Marco Kawamura; Bonadio, Marcelo Batista; Helito, Camilo Partezani; Gobbi, Riccardo Gomes; Pécora, José Ricardo

    2015-01-01

    Distal femoral varus osteotomy is a well-established procedure for the treatment of lateral compartment cartilage lesions and degenerative disease, correcting limb alignment and decreasing the progression of the pathology. Surgical techniques can be performed with a lateral opening-wedge or medial closing-wedge correction of the deformity. Fixation methods for lateral opening-wedge osteotomies are widely available, and there are various types of implants that can be used for fixation. However, there are currently only a few options of implants for fixation of a medial closing-wedge osteotomy on the market. This report describes a medial, supracondylar, V-shaped, closing-wedge distal femoral osteotomy using a locked anterolateral proximal tibial locking plate that fits anatomically to the medial side of the distal femur. This is a great option as a stable implant for a medial closing-wedge distal femoral osteotomy. PMID:26870647

  11. Augmentation of femoral neck fracture fixation with an injectable calcium-phosphate bone mineral cement.

    PubMed

    Stankewich, C J; Swiontkowski, M F; Tencer, A F; Yetkinler, D N; Poser, R D

    1996-09-01

    The first goal of this study was to determine if augmentation with an injectable, in situ setting, calcium-phosphate cement that is capable of being remodeled and was designed to mimic bone mineral significantly improved the strength and stiffness of fixation in a cadaveric femoral neck fracture model. The second goal was to determine if greater increases in fixation strength were achieved as the bone density of the specimen decreased. Sixteen pairs of fresh cadaveric human femora with a mean age of 70.9 years (SD = 17.2 years) were utilized. The bone density of the femoral neck was measured with dual-energy x-ray absorptiometry. The femoral head was impacted vertically with the femoral shaft fixed in 12 degrees of adduction using a materials testing machine to create a fully displaced fracture. Following fracture, 30% inferior comminution was created in each specimen. One randomly chosen femur from each pair underwent anatomic reduction and fixation with three cannulated cancellous bone screws, 7 mm in diameter, in an inverted triangle configuration. The contralateral femur underwent the same fixation augmented with calcium-phosphate cement. Specimens were preconditioned followed by 1.000 cycles to one body weight (611.6 N) at 0.5 Hz to simulate single-limb stance loading. The stiffness in the first cycle was observed to be significantly greater in cement-augmented specimens compared with unaugmented controls (p < 0.05). After cycling, each specimen was loaded at 10 mm/min until complete displacement of the fracture surface and failure of fixation occurred. Specimens augmented with bone mineral cement failed at a mean of 4,573 N (SD = 1,243 N); this was significantly greater (p < 0.01) than the mean for controls (3,092 N, SD = 1,258 N). The relative improvement in fixation strength (augmented/control x 100%) was not inversely correlated to femoral neck bone density (p = 0.25, R2 = 0.09), was weakly correlated to the volume of cement injected (p = 0.07, R2 = 0

  12. Biomechanical analyses of static and dynamic fixation techniques of retrograde interlocking femoral nailing using nonlinear finite element methods.

    PubMed

    Shih, Kao-Shang; Hsu, Ching-Chi; Hsu, Tzu-Pin; Hou, Sheng-Mou; Liaw, Chen-Kun

    2014-02-01

    Femoral shaft fractures can be treated using retrograde interlocking nailing systems; however, fracture nonunion still occurs. Dynamic fixation techniques, which remove either the proximal or distal locking screws, have been used to solve the problem of nonunion. In addition, a surgical rule for dynamic fixation techniques has been defined based on past clinical reports. However, the biomechanical performance of the retrograde interlocking nailing systems with either the traditional static fixation technique or the dynamic fixation techniques has not been investigated by using nonlinear numerical modeling. Three-dimensional nonlinear finite element models were developed, and the implant strength, fixation stability, and contact area of the fracture surfaces were evaluated. Three types of femoral shaft fractures (a proximal femoral shaft fracture, a middle femoral shaft fracture, and a distal femoral shaft fracture) fixed by three fixation techniques (insertion of all the locking screws, removal of the proximal locking screws, or removal of the distal locking screws) were analyzed. The results showed that the static fixation technique resulted in sufficient fixation stability and that the dynamic fixation techniques decreased the failure risk of the implant and produced a larger contact area of the fracture surfaces. The outcomes of the current study could assist orthopedic surgeons in comprehending the biomechanical performances of both static and dynamic fixation techniques. In addition, the surgeons could also select a fixation technique based on the specific patient situation using the numerical outcomes of this study.

  13. In situ fixation of slipped capital femoral epiphysis with Steinmann pins

    PubMed Central

    2011-01-01

    Background and purpose Slipped capital femoral epiphysis (SCFE) is often treated by surgical fixation; however, no agreement exists regarding technique. We analyzed the outcome of in situ fixation with Steinmann pins. Patients and methods All 67 subjects operated for slipped capital femoral epiphysis at Haukeland University Hospital during the period 1990–2007 were included. All were treated by in situ fixation with 2 or 3 parallel Steinmann pins (8 mm threads at the medial end). The follow-up evaluation consisted of clinical examination and hip radiographs. Radiographic outcome was based on measurements of slip progression, growth of the femoral neck, leg length discrepancy, and signs of avascular necrosis and chondrolysis. Results 67 subjects (41 males) were operated due to unilateral slips (n = 47) or bilateral slips (n = 20). Mean age at time of diagnosis was 13 (7.2–16) years. Mean age at follow-up was 19 (14–30) years, with a mean postoperative interval of 6.0 (2–16) years. The operated femoral neck was 9% longer at skeletal maturity than at surgery, indicating continued growth of the femoral neck. At skeletal maturity, 12 subjects had radiographic features suggestive of a previous asymptomatic slip of the contralateral hip. The total number of bilateral cases of SCFE was 32, i.e half of the children had bilateral SCFE. 3 subjects required additional surgery and mild avascular necrosis of the femoral head was seen in 1 patient. None had slip progression or chondrolysis. Interpretation In situ pinning of SCFE with partly threaded Steinmann pins appears to be a feasible and safe method, with few complications. The technique allows further growth of the femoral neck. PMID:21504367

  14. Delayed fixation of displaced bilateral, atraumatic, femoral neck fractures in a patient with pregnancy related osteomalacia.

    PubMed

    Docker, Charles; Starks, Ian; Wade, Roger; Wynn-Jones, Charles

    2011-06-01

    We present the case of a woman diagnosed with simultaneous displaced intracapsular femoral neck fractures following the birth of her second child. No traumatic event was identified. Diagnosis was delayed as the cause of her pain was thought to be non-skeletal in origin. Radiological and serological investigations were diagnostic of osteomalacia. Surgical fixation of her fractures was further delayed due to profound hypocalcaemia. Despite the delays, fixation with bilateral dynamic hip screws resulted in union with no evidence of avascular necrosis at 2 years follow-up. We believe this to be the first report of atraumatic bilateral femoral neck fractures and it shows that a good result can be achieved even in the presence of delayed fixation.

  15. Autologous Hamstring Anterior Cruciate Ligament Graft Failure Using the Anteromedial Portal Technique With Suspensory Femoral Fixation

    PubMed Central

    Galdi, Balazs; Reyes, Allan; Brabston, Eugene W.; Levine, William N.

    2015-01-01

    Background: The anteromedial portal technique for drilling of the femoral tunnel during anterior cruciate ligament (ACL) reconstruction has been advocated by many surgeons as allowing improved access to the anatomical footprint. Furthermore, suspensory fixation of soft tissue grafts has become popularized because of complications associated with cross-pin fixation. Concerns regarding the use of both have recently arisen. Purpose: To raise awareness of the increased risk of graft failure when using the anteromedial portal technique with suspensory femoral fixation during ACL reconstruction. Study Design: Cohort study; Level of evidence, 3. Methods: From November 1998 to August 2012, a total of 465 primary ACL reconstructions were performed using quadrupled hamstring autograft tendons, with drilling of the femoral tunnel performed via the transtibial portal. Graft fixation on the femur was achieved with cross-pin fixation, while interference screw fixation was used on the tibia. From September 2012 to October 2013, there were 69 reconstructions performed through an anteromedial portal. While there was no change in graft choice, a change was made to using suspensory femoral fixation. No other surgical or postoperative rehabilitation changes were made. Results: During the 14-year period in which ACL reconstructions were performed via the transtibial portal and with cross-pin fixation, 2 graft failures (0.4% failure rate) were reported. After switching to the anteromedial portal with suspensory fixation, 7 graft failures (10.1% failure rate) were reported over a 13-month period. These were 5 male and 2 female patients, with a mean age of 18.8 years—all elite athletes. The same surgical technique was used in all patients, and all patients had at least an 8 mm–diameter graft. Patients were cleared to return to sport at an average of 8.4 months postoperatively, after completing functional performance tests. Of the 7 patients, 6 sustained a rerupture of the graft within

  16. Distal femoral derotational osteotomy with external fixation for correction of excessive femoral anteversion in patients with cerebral palsy.

    PubMed

    Skiak, Eyad; Karakasli, Ahmet; Basci, Onur; Satoglu, Ismail S; Ertem, Fatih; Havitcioglu, Hasan

    2015-09-01

    Patients with cerebral palsy (CP) disorder often develop rotational hip deformity. Increasing deformities impair already diminished walking abilities; femoral osteotomies are often performed to maintain and improve walking abilities. Fixation of osteotomies with condylar plates has been used successfully, but does not often enable immediate postoperative full weight-bearing. To avoid considerable postoperative rehabilitation deficit and additional bone loss because of inactivity, a postoperative treatment with full weight-bearing, is therefore, desirable. Self-tapping Schanz screws with a unilateral external fixator crossing the knee joint providing stronger anchoring in osteopenic bone might fulfill these demands. A retrospective study was carried out on 27 ambulatory CP patients, mean age 17.5 years (range 9-22 years); 11 patients with bilateral severe intoeing deformities underwent a supracondylar femoral osteotomy between September 2008 and April 2012. All patients were allowed to bear their full weight postoperatively. The aim of this study was to describe the technique, the results of this technique, to evaluate the time required for bone healing, and the type of complications associated with a distal derotational femoral osteotomy fixed with a uniaxial external fixator crossing the knee joint. A total of 27 patients were studied [mean weight 48.8 kg (range 29.8-75 kg)]. The mean preoperative rotation included internal rotation of 69° and external rotation of 17°. All patients were evaluated clinically and radiographically for a minimum of 1 year after surgery. There was a significant decrease in the mean medial rotation from 69° to 32° (P=0.00034). The lateral rotation increased significantly from preoperative 17° to postoperative 45° (P=0.0011). The femoral anteversion decreased significantly from a mean of 55° preoperatively to a mean 17° postoperatively (P=0.030). All patients, except one, achieved solid fusion uneventfully. One patient was a

  17. Functional outcome after successful internal fixation versus salvage arthroplasty of patients with a femoral neck fracture

    PubMed Central

    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.

    2014-01-01

    Objectives To determine patient independency, health-related and disease-specific quality of life (QOL), gait pattern, and muscle strength in patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture. Design Secondary cohort study to a randomized controlled trial. Setting Multicenter trial in the Netherlands, including 14 academic and non-academic hospitals Patients Patients after salvage arthroplasty for failed internal fixation of a femoral neck fracture were studied. A comparison was made with patients who healed uneventfully after internal fixation. Intervention None (observatory study) Main outcome measurements Patient characteristics, SF-12, and WOMAC scores were collected. Gait parameters were measured using plantar pressure measurement. Maximum isometric forces of the hip muscles were measured using a handheld dynamometer. Differences between the fractured and contralateral leg were calculated. Groups were compared using univariate analysis. Results Of 248 internal fixation patients (median age 72 years), salvage arthroplasty was performed in 68 patients (27%). Salvage arthroplasty patients had a significantly lower WOMAC score (median 73 versus 90, P=0.016) than patients who healed uneventfully after internal fixation. Health-related QOL (SF-12) and patient independency did not differ significantly between the groups. Gait analysis showed a significantly impaired progression of the center of pressure in the salvage surgery patients (median ratio −8.9 versus 0.4, P=0.013) and a significant greater loss of abduction strength (median −25.4 versus −20.4 N, P=0.025). Conclusion Despite a similar level of dependency and QOL, salvage arthroplasty patients have inferior functional outcome than patients who heal after internal fixation of a femoral neck fracture. PMID:24835623

  18. Use of the trochanteric flip osteotomy to facilitate internal fixation of a femoral head fracture

    PubMed Central

    Gillespie, James A.; Marsh, Andrew G.; Patil, Sanjeev R.

    2016-01-01

    We report the case of a 42-year-old male who suffered a fracture–dislocation of the femoral head. After a closed reduction of the hip, this proceeded to an open reduction with internal fixation of the fractured femoral head, in addition to labral repair and micro-fracture of an articular cartilage defect. After considering the risks to the femoral head blood supply, the trochanteric flip osteotomy was used. This provided ample and safe exposure. At 14 months follow-up, the patient-reported outcome measures are favourable: modified Harris Hip Score (81/100), the non-arthritic hip score (92.5/100) and SF-12 (41/48). PMID:27470013

  19. Use of the trochanteric flip osteotomy to facilitate internal fixation of a femoral head fracture.

    PubMed

    Gillespie, James A; Marsh, Andrew G; Patil, Sanjeev R

    2016-01-01

    We report the case of a 42-year-old male who suffered a fracture-dislocation of the femoral head. After a closed reduction of the hip, this proceeded to an open reduction with internal fixation of the fractured femoral head, in addition to labral repair and micro-fracture of an articular cartilage defect. After considering the risks to the femoral head blood supply, the trochanteric flip osteotomy was used. This provided ample and safe exposure. At 14 months follow-up, the patient-reported outcome measures are favourable: modified Harris Hip Score (81/100), the non-arthritic hip score (92.5/100) and SF-12 (41/48). PMID:27470013

  20. Applying Cross-Pin System in Both Femoral and Tibial Fixation in Anterior Cruciate Ligament Reconstruction Using Hamstring Tendons.

    PubMed

    Qi, Wei; Liu, Yujie; Xue, Jing; Li, Haifeng; Wang, Junliang; Qu, Feng

    2015-10-01

    Use of the RigidFix Cross Pin System (DePuy Mitek, Raynham, MA) is a popular technique for femoral fixation of grafts in anterior cruciate ligament reconstruction (ACLR). However, tibial fixation is still limited to the use of interference screws and post fixation, and few surgeons apply the femoral RigidFix system in tibial fixation. Meanwhile, tunnel enlargement is still a problem that affects the outcome of ACLR with hamstring grafts. We have used the femoral RigidFix system in femoral and tibial fixation. The rod top of the guide frame should be placed under the level of the subchondral bone at the proximal end of the tibial tunnel to ensure that the pins will not be inserted into the joint. The pins are inserted through the center of the lateral tibia. Using our technique, the fixation points of the femur and tibia are close to the anterior cruciate ligament insertions, and full contact of the graft with the tunnel wall can be accomplished. On the basis of our preliminary observations and investigation, we are optimistic about the prospect of performing ACLR using the RigidFix system in femoral and tibial fixation. PMID:26697293

  1. Tension band wiring for proximal femoral varus osteotomy fixation in children.

    PubMed

    Maranho, Daniel Augusto; Pagnano, Rodrigo Gonçalves; Volpon, José Batista

    2014-08-01

    For proximal varus osteotomy of the femur in children, a stable fixation, is a concern regarding the safety and the protection of the surgery. The methods of fixation are mostly represented by plating systems; however, the tension band wiring is a simple and eligible option for fixation of proximal femur osteotomy. The purpose of this retrospective case series study is to evaluate outcomes and bone remodelation after using the tension band wiring technique to fixate proximal femoral varus osteotomies in children.The study enrolled 20 patients who underwent femoral varus osteotomy to treat Legg-Calvé-Perthes disease and other causes of necrosis of the femoral head. The mean patient age at the time of surgery was 7.4 ± 2.3 years (range, 4.3-13.8 y), and the follow-up period averaged 10 ± 4.3 years (range, 4.7-20.8 y). To assess the effects of the osteotomy at the neck-shaft angle and its evolution over time, radiographs obtained preoperatively and during the follow-up were analyzed. The neck-shaft angle was measured independently by 2 observers, and intraclass correlation coefficients (ICCs) were assessed for reliability.The ICC analysis showed good reliability. There was a significant reduction in the neck-shaft angle (P < 0.001) between the preoperative and the immediate postoperative periods, with an estimated difference of 14.3°. Between the immediate and the early postoperative periods, the estimated difference was 2.1°, which indicated a significant increase in the neck-shaft angle (P = 0.003). Between the early postoperative period and the final evaluation, there was a significant increase (P < 0.001), with an estimated difference of 7.0°. No implant failures or other complications were observed, but 1 case of peri-implant femoral fracture occurred >17 years postsurgery.The tension band wiring technique proved to be a simple and effective method for fixating proximal femoral varus osteotomy in children.The level IV is appropriated for our study (case

  2. Secure fixation of femoral bone plug with a suspensory button in anatomical anterior cruciate ligament reconstruction with bone-patellar tendon-bone graft

    PubMed Central

    TAKETOMI, SHUJI; INUI, HIROSHI; NAKAMURA, KENSUKE; YAMAGAMI, RYOTA; TAHARA, KEITARO; SANADA, TAKAKI; MASUDA, HIRONARI; TANAKA, SAKAE; NAKAGAWA, TAKUMI

    2015-01-01

    Purpose the efficacy and safety of using a suspensory button for femoral fixation in anatomical anterior cruciate ligament (ACL) reconstruction with bone-patellar tendon-bone (BPTB) graft have not been established. The purpose of the current study was to evaluate bone plug integration onto the femoral socket and migration of the bone plug and the EndoButton (EB) (Smith & Nephew, Andover, MA, USA) after rectangular tunnel ACL reconstruction with BPTB autograft. Methods thirty-four patients who underwent anatomical rectangular ACL reconstruction with BPTB graft using EB for femoral fixation and in whom three-dimensional (3D) computed tomography (CT) was performed one week and one year after surgery were included in this study. Bone plug integration onto the femoral socket, bone plug migration, soft tissue interposition, EB migration and EB rotation were evaluated on 3D CT. The clinical outcome was also assessed and correlated with the imaging outcomes. Results the bone plug was integrated onto the femoral socket in all cases. The incidence of bone plug migration, soft tissue interposition, EB migration and EB rotation was 15, 15, 9 and 56%, respectively. No significant association was observed between the imaging outcomes. The postoperative mean Lysholm score was 97.1 ± 5.0 points. The postoperative side-to-side difference, evaluated using a KT-2000 arthrometer, averaged 0.5 ± 1.3 mm. There were no complications associated with EB use. Imaging outcomes did not affect the postoperative KT side-to-side difference. Conclusions the EB is considered a reliable device for femoral fixation in anatomical rectangular tunnel ACL reconstruction with BPTB autograft. Level of evidence Level IV, therapeutic case series. PMID:26889465

  3. Management of Femoral Shaft Fracture in Klippel-Trenaunay Syndrome with External Fixator

    PubMed Central

    Gupta, Yogendra; Jha, Ranjib Kumar; Karn, Navin Kumar; Sah, Sanjaya Kumar; Mishra, Bibhuti Nath; Bhattarai, Manoj Kumar

    2016-01-01

    Klippel-Trenaunay syndrome (KTS) is a rare complex malformation characterized by the clinical triad of capillary malformations, soft tissue and bone hypertrophy, and venous/lymphatic malformation. Fractures of long bones in such cases are challenging to treat. A 12-year-old female with this syndrome presented with femoral shaft fracture of right thigh. She was initially kept on skeletal traction for two weeks and then she underwent closed reduction and immobilization with external fixator with uneventful intraoperative and postoperative period. Fracture united at four and half months. PMID:26885423

  4. An Assessment of the Biological Fixation of a Retrieved Mayo Femoral Component

    PubMed Central

    Meldrum, Russell D; Willie, Bettina M; Bloebaum, Roy D

    2003-01-01

    Implant analysis was conducted on a retrieved Mayo femoral prosthesis that has a non-anatomic design with two distinct surfaces intended for osseous fixation. The prosthesis itself has a circumferential grit-blasted region interposed with the porous surfaces and involving the entire proximal stem. In addition, there are pads of mesh porous coating on the anterior, posterior, and medial surfaces proximally. A single, radiographically stable stem retrieved after 18 months secondary to recurrent dislocations was examined for osseous fixation by measurement of trabecular bone into the porous-coated and onto the grit-blasted surfaces of the stem. Results showed 17% ± 7% bone ingrowth into the porous coated areas and 20% ± 16% osseointegration onto the grit-blasted surfaces. These results are similar to percentages of ingrowth seen with more conventional, anatomic design prostheses. PMID:14575260

  5. Biomechanical analysis and clinical effects of bridge combined fixation system for femoral fractures.

    PubMed

    Wang, Da-xing; Xiong, Ying; Deng, Hong; Jia, Fu; Gu, Shao; Liu, Bai-lian; Li, Qun-hui; Pu, Qi; Zhang, Zhong-Zi

    2014-09-01

    This work aimed to compare the stress distribution and mechanical properties of our bridge combined fixation system and commonly used metal locking plate screw system by finite element analysis and by using the Zwick/Z100 testing machine. In addition, we also investigated the clinical outcome of our bridge combined fixation system for femoral fractures in 59 patients from June 2005 to January 2013. As a result, the stress distribution in the bone plate and screws of metal locking plate screw system during walking and climbing stairs was significantly lower than that of metal locking plate screw system. No significant difference in the displacement was observed between two systems. The equivalent bending stiffness of bridge combined fixation system was significantly lower than that of metal locking plate screw system. There were no significant differences in the bending strength, yield load, and maximum force between two systems. All the cases were followed up for 12-24 months (average 18 months). The X-ray showed bone callus was formed in most patients after 3 months, and the fracture line was faint and disappeared at 6-9 months postoperatively. No serious complications, such as implant breakage and wound infection, occurred postoperatively. According to self-developed standard for bone healing, clinical outcomes were rated as excellent or good in 55 out of 59 patients (success rate: 93.2%). Therefore, our findings suggest that our bridge combined fixation system may be a promising approach for treatment of long-bone fractures.

  6. Pediatric anterior cruciate ligament femoral fixation: the trans-iliotibial band endoscopic portal for direct visualization of ideal button placement.

    PubMed

    Mistovich, R Justin; O'Toole, Patrick O J; Ganley, Theodore J

    2014-06-01

    Pediatric and adolescent anterior cruciate ligament reconstruction is a commonly performed procedure that has been increasing in incidence. Multiple techniques for graft fixation have been described. Button-based femoral cortical suspension fixation of the anterior cruciate ligament graft allows for fast, secure fixation with strong load-to-failure biomechanical properties. The biomechanical properties of button-based femoral cortical suspension fixation are especially beneficial with soft-tissue grafts such as hamstring autografts. Confirmation of a successfully flipped button can be achieved with intraoperative fluoroscopy or indirect viewing; however, these techniques do not provide direct visualization of the flipped button. Our trans-iliotibial band endoscopic portal allows the surgeon to safely and directly visualize the flipped button on the lateral femoral cortex and ensure that there is no malpositioning in the form of an incompletely flipped button or from soft-tissue interposition between the button and the lateral femoral cortex. This portal therefore allows for direct visual confirmation that the button is fully flipped and resting flush against the femoral cortex, deep to the iliotibial band and vastus lateralis.

  7. Periprosthetic femoral fracture--a biomechanical comparison between Vancouver type B1 and B2 fixation methods.

    PubMed

    Moazen, Mehran; Mak, Jonathan H; Etchels, Lee W; Jin, Zhongmin; Wilcox, Ruth K; Jones, Alison C; Tsiridis, Eleftherios

    2014-03-01

    Current clinical data suggest a higher failure rate for internal fixation in Vancouver type B1 periprosthetic femoral fracture (PFF) fixations compared to long stem revision in B2 fractures. The aim of this study was to compare the biomechanical performance of several fixations in the aforementioned fractures. Finite element models of B1 and B2 fixations, previously corroborated against in vitro experimental models, were compared. The results indicated that in treatment of B1 fractures, a single locking plate can be without complications provided partial weight bearing is followed. In case of B2 fractures, long stem revision and bypassing the fracture gap by two femoral diameters are recommended. Considering the risk of single plate failure, long stem revision could be considered in all comminuted B1 and B2 fractures. PMID:24035619

  8. Total Hip Arthroplasty for Failed Internal Fixation After Femoral Neck Fracture Versus That for Acute Displaced Femoral Neck Fracture: A Comparative Study.

    PubMed

    Yang, Zhouyuan; Liu, Huifang; Xie, Xiaowei; Tan, Zhen; Qin, Tianqiang; Kang, Pengde

    2015-08-01

    The outcome of total hip arthroplasty (THA) for failed internal fixation after femoral neck fracture (FNF) versus that for acute displaced femoral neck fracture is still controversial. This study retrospectively analyzed a consecutive series of 130 THAs for acute displaced FNF (64, group I) and for failed internal fixation (66, group II). Results showed THAs in group II were more technically demanding procedures with longer operative time and larger amounts of drainage compared to that in group I. Furthermore, multivariate analysis revealed that the associations between THAs (group II) and hip complications were notable (OR=4.15, P=0.017). These increased risks should be paid much attention to, not only for choosing the appropriate treatment option, but also for providing effective perioperative care.

  9. Cam deformity and hip degeneration are common after fixation of a slipped capital femoral epiphysis

    PubMed Central

    Klit, Jakob; Gosvig, Kasper; Magnussen, Erland; Gelineck, John; Kallemose, Thomas; Søballe, Kjeld; Troelsen, Anders

    2014-01-01

    Background and purpose — Slipped capital femoral epiphysis is thought to result in cam deformity and femoroacetabular impingement. We examined: (1) cam-type deformity, (2) labral degeneration, chondrolabral damage, and osteoarthritic development, and (3) the clinical and patient-reported outcome after fixation of slipped capital femoral epiphysis (SCFE). Methods — We identified 28 patients who were treated with fixation of SCFE from 1991 to 1998. 17 patients with 24 affected hips were willing to participate and were evaluated 10–17 years postoperatively. Median age at surgery was 12 (10–14) years. Clinical examination, WOMAC, SF-36 measuring physical and mental function, a structured interview, radiography, and MRI examination were conducted at follow-up. Results — Median preoperative Southwick angle was 22o (IQR: 12–27). Follow-up radiographs showed cam deformity in 14 of the 24 affected hips and a Tönnis grade > 1 in 1 affected hip. MRI showed pathological alpha angles in 15 affected hips, labral degeneration in 13, and chondrolabral damage in 4. Median SF-36 physical score was 54 (IQR: 49–56) and median mental score was 56 (IQR: 54–58). These scores were comparable to those of a Danish population-based cohort of similar age and sex distribution. Median WOMAC score was 100 (IQR: 84–100). Interpretation — In 17 patients (24 affected hips), we found signs of cam deformity in 18 hips and early stages of joint degeneration in 10 hips. Our observations support the emerging consensus that SCFE is a precursor of cam deformity, FAI, and joint degeneration. Neither clinical examination nor SF-36 or WOMAC scores indicated physical compromise. PMID:25175666

  10. Progressive femoral cortical and cancellous bone density loss after uncemented tapered-design stem fixation

    PubMed Central

    Nowak, Tobias E; Haeberle, Lothar; Mueller, Lars P; Kress, Alexander; Voelk, Michael; Pfander, David; Forst, Raimund; Schmidt, Rainer

    2010-01-01

    Background Aseptic implant loosening and periprosthetic bone loss are major problems after total hip arthroplasty (THA). We present an in vivo method of computed tomography (CT) assisted osteodensitometry after THA that differentiates between cortical and cancellous bone density (BD) and area around the femoral component. Method Cortical and cancellous periprosthetic femoral BD (mg CaHA/mL), area (mm2) and contact area between the prothesis and cortical bone were determined prospectively in 31 patients 10 days, 1 year, and 6 years after uncemented THA (mean age at implantation: 55 years) using CT-osteodensitometry. Results 6 years postoperatively, cancellous BD had decreased by as much as 41% and cortical BD by up to 27% at the metaphyseal portion of the femur; this decrease was progressive between the 1-year and 6-year examinations. Mild cortical hypertrophy was observed along the entire length of the diaphysis. No statistically significant changes in cortical BD were observed along the diaphysis of the stem. Interpretation Periprosthetic CT-assisted osteodensitometry has the technical ability to discriminate between cortical and cancellous bone structures with respect to strain-adapted remodeling. Continuous loss of cortical and cancellous BD at the femoral metaphysis, a homeostatic cortical strain configuration, and mild cortical hypertrophy along the diaphysis suggest a diaphyseal fixation of the implanted stem. CT-assisted osteodensitometry has the potential to become an effective instrument for quality control in THA by means of in vivo determination of periprosthetic BD, which may be a causal factor in implant loosening after THA. PMID:20180716

  11. Design and Optimization of Resorbable Silk Internal Fixation Devices

    NASA Astrophysics Data System (ADS)

    Haas, Dylan S.

    Limitations of current material options for internal fracture fixation devices have resulted in a large gap between user needs and hardware function. Metal systems offer robust mechanical strength and ease of implantation but require secondary surgery for removal and/or result in long-term complications (infection, palpability, sensitivity, etc.). Current resorbable devices eliminate the need for second surgery and long-term complications but are still associated with negative host response as well as limited functionality and more difficult implantation. There is a definitive need for orthopedic hardware that is mechanically capable of immediate fracture stabilization and fracture fixation during healing, can safely biodegrade while allowing complete bone remodeling, can be resterilized for reuse, and is easily implantable (self-tapping). Previous work investigated the use of silk protein to produce resorbable orthopedic hardware for non- load bearing fracture fixation. In this study, silk orthopedic hardware was further investigated and optimized in order to better understand the ability of silk as a fracture fixation system and more closely meet the unfulfilled market needs. Solvent-based and aqueous-based silk processing formulations were cross-linked with methanol to induce beta sheet structure, dried, autoclaved and then machined to the desired device/geometry. Silk hardware was evaluated for dry, hydrated and fatigued (cyclic) mechanical properties, in vitro degradation, resterilization, functionalization with osteoinductive molecules and implantation technique for fracture fixation. Mechanical strength showed minor improvements from previous results, but remains comparable to current resorbable fixation systems with the advantages of self-tapping ability for ease of implantation, full degradation in 10 months, ability to be resterilized and reused, and ability to release molecules for osteoinudction. In vivo assessment confirmed biocompatibility, showed

  12. Medial patello-femoral ligament (MPFL) reconstruction using suture anchors fixation: preliminary results

    PubMed Central

    Calanna, Filippo; Pulici, Luca; Carimati, Giulia; Quaglia, Alessandro; Volpi, Piero

    2016-01-01

    Summary Purpose several surgical techniques have been described for the MPFL reconstruction, using many femoral and patellar fixation techniques and different grafts (autograft, allograft, synthetic). The goal of our study is to evaluate the safety and efficacy of MPFL reconstruction using Juggerknot™ (BIOMET, Warsaw, Indiana) suture anchors fixation with a clinical evaluation pre/post surgery of our patients with objective patellofemoral (PF) instability. Methods from January 2013 to March 2015, 19 patients underwent isolated MPFL reconstruction using Juggerknot™ (BIOMET, Warsaw, Indiana) suture anchors fixation. All patients were operated by the same surgeon using the same technique. Patients were evaluated by the same operator during pre surgery phase and at least at 6 months of follow up, using clinical evaluation (apprehension sign, patellar glide test, ROM) and 4 different scores (Tegner, Vas, Lysholm, Kujala). The possible complications and dislocation following surgery were investigated. Results no patellar dislocation and complications were found at follow up. A clinical evaluation improvement was recorded at follow up: all patients achieved a full range of knee motion; apprehension sign from 89% positivity (17 cases) decreased up to 11% (2 cases); glide test from 100% (19 cases) positivity decreased up to 0% (0 cases). Median VAS score decreased significantly (p<0.05) from a median pre-operative value of 8 (min:5 max:10) to 2 (min:0 max:7). Mean Kujala score improved significantly (p<0.05) from 65.23 ± 18.64 pre-operatively to 94.69 ± 6.40. Mean Lysholm score improved significantly (p<0.05) from 64.30 ± 19.29 pre-operatively to 94.72 ± 4.02. Mean Tegner score decreased from 6.15 ± 1.06 pre-operatively to 5.69 ± 0.85. Conclusions in this preliminary study, a clinical assessment of patients undergoing surgery with the Juggerknot ™ (BIOMET, Warsaw, Indiana) suture anchor fixation in MPFL reconstruction, has shown promising results, revealing easy

  13. Osteosynthesis of ununited femoral neck fracture by internal fixation combined with iliac crest bone chips and muscle pedicle bone grafting

    PubMed Central

    Baksi, D D; Pal, A K; Baksi, D P

    2016-01-01

    Background: Ununited femoral neck fracture is seen commonly in developing countries due to delayed presentation or failure of primary internal fixation. Such fractures, commonly present with partial or total absorption of femoral neck, osteonecrosis of femoral head in 8–30% cases with upward migration of trochanter posing problem for osteosynthesis, especially in younger individuals. Several techniques for treatment of such conditions are described like osteotomies or nonvascularied cortical or cancellous bone grafting provided varying degrees of success in terms of fracture union but unsatisfactory long term results occurred due to varying incidence of avascular necrosis (AVN) of femoral head. Moreover, in presence of AVN of femoral head neither free fibular graft nor cancellous bone graft is satisfactory. The vascularied bone grafting by deep circumflex iliac artery based on iliac crest bone grafting, free vascularied fibular grafting and muscle pedicle periosteal grafting showed high incidence of success rate. Osteosynthesis is the preferred treatment of choice in ununited femoral neck fracture in younger individuals. Materials and Methods: Of the 293 patients operated during the period from June 1977 to June 2009, 42 were lost to followup. Seven patients with gluteus medius muscle pedicle bone grafting (MPBG) were excluded. Thus, out of 244 patients, 208 (85.3%) untreated nonunion and 36 (14.7%) following failure of primary internal fixation were available for studies. Time interval between the date of injury and operation in untreated nonunion cases was mean 6.5 months and in failed internal fixation cases was mean 11.2 months. Ages of the patients varied from 16 to 55 years. Seventy patients had partial and 174 had subtotal absorption of the femoral neck. Evidence of avascular necrosis (AVN) femoral head was found histologically in 135 (54.3%) and radiologically in 48 (19.7%) patients. The patients were operated by open reduction of fracture, cannulated hip

  14. A Comparison of Internal Fixation and Bipolar Hemiarthroplasty for the Treatment of Reverse Oblique Intertrochanteric Femoral Fractures in Elderly Patients

    PubMed Central

    Park, Bong-Ju; Min, Woong-Bae

    2015-01-01

    Purpose To compare the clinical and radiological results between internal fixation using the proximal femoral nail system and bipolar hemiarthroplasty (BHA) in reverse oblique intertrochanteric hip fractures in elderly patients. Materials and Methods From January 2005 to July 2012, we reviewed the medical records of 53 patients who had been treated surgically for reverse oblique intertrochanteric fracture and had been followed-up on for a minimum of two years. All patients were ≥70 years of age, and divided into two groups for retrospective evaluation. One group was treated with internal fixation using the proximal femoral nail system (31 cases), and the other group was treated with BHA (22 cases). Results Early ambulation postoperatively and less pain at postoperative three month were significantly superior in the BHA group. However, by 24 months postoperatively, the internal fixation group exhibited higher Harris scores and correspondingly less pain than the BHA group. There were no significant differences in union rate, duration of hospitalization or lateral wall fracture healing between the two groups. Four patients in the internal fixation group underwent reoperation. Conclusion In the treatment of intertrochanteric fracture of the reverse oblique type, open reduction and internal fixation should be considered to be the better choice for patients with good health and bone quality. However, in cases of severe comminition of fracture and poor bone quality, BHA is an alternative offering advantages including early ambulation, less pain at early stages, and a lower risk of reoperation. PMID:27536619

  15. Examination of rotational fixation of the femoral component in total hip arthroplasty. A mechanical study of micromovement and acoustic emission.

    PubMed

    Sugiyama, H; Whiteside, L A; Kaiser, A D

    1989-12-01

    Rotational loosening has recently emerged as an important cause of failure of the femoral component of total hip arthroplasties. This study was designed to investigate the role played by torsional loads in loosening of cementless femoral components and to evaluate three cementing techniques involving a combination of canal irrigation, manual insertion, and vacuum mixing combined with pressure injection of the cement for their ability to improve rotational fixation. Rotational micromotion and subsidence were measured in 24 preserved human anatomic specimen femora. Acoustic emission (AE) technique was applied as a non-destructive method for evaluating material failure during loading. From the micromovement data, torque to 50 mu subsidence and torque to failure were surprisingly low with cementless fixation and with poor cement technique but were markedly improved with pulsed irrigation. Further improvement was achieved by pressure injection and vacuum mixing of the cement. However, AE was detected even in the most carefully performed cement specimens under torsional-loading conditions commonly occurring in daily activities. These signs of microfailure of the cement mantle at relatively low torsional loads suggest that the mode of failure of deeply penetrated cement is by microfracture of the cement mantle. The poor performance suggests that cementless fixation of intramedullary stems provides unsatisfactory fixation against torsional loading. There is need for major improvements in fixation mechanisms and techniques. The signs of failure of the cement mantle at normally occurring torsional loads suggest that even the best cement technique is prone to failure in torsion when exposed to normal daily use. PMID:2582663

  16. Evaluation of Absorbable Mesh Fixation Devices at Various Deployment Angles

    PubMed Central

    Zihni, Ahmed M.; Cavallo, Jaime A.; Thompson, Dominic M.; Chowdhury, Nabeel H.; Frisella, Margaret M.; Matthews, Brent D.; Deeken, Corey R.

    2014-01-01

    BACKGROUND Hernia repair failure may occur due to suboptimal mesh fixation by mechanical constructs before mesh integration. Construct design and acute penetration angle may alter mesh-tissue fixation strength. We compared acute fixation strengths of absorbable fixation devices at various deployment angles, directions of loading, and construct orientations. METHODS Porcine abdominal walls were sectioned. Constructs were deployed at 30, 45, 60, and 90 degree angles to fix mesh to the tissue specimens. Lap-shear testing was performed in upward, downward, and lateral directions in relation to the abdominal wall cranial-caudal axis to evaluate fixation. Absorbatack™ (AT), SorbaFix™ (SF), and SecureStrap™ in vertical (SSV) and horizontal (SSH) orientations in relation to the abdominal wall cranial-caudal axis were tested. Ten tests were performed for each combination of device, angle, and loading direction. Failure types and strength data were recorded. ANOVA with Tukey-Kramer adjustments for multiple comparisons and chi-square tests were performed as appropriate (p<0.05 considered significant). RESULTS At 30 degrees, SSH and SSV had greater fixation strengths (12.95 N, 12.98 N, respectively) than SF (5.70 N; p=0.0057, p=0.0053, respectively). At 45 degrees, mean fixation strength of SSH was significantly greater than SF (18.14 N, 11.40 N; p=0.0002). No differences in strength were identified at 60 or 90 degrees. No differences in strength were noted between SSV and SSH with different directions of loading. No differences were noted between SS and AT at any angle. Immediate failure was associated with SF (p<0.0001) and the 30 degree tacking angle (p<0.01). CONCLUSIONS Mesh-tissue fixation was stronger at acute deployment angles with SS compared to SF constructs. The 30 degree angle and the SF device were associated with increased immediate failures. Varying construct and loading direction did not generate statistically significant differences in the fixation

  17. The use of silk-based devices for fracture fixation

    NASA Astrophysics Data System (ADS)

    Perrone, Gabriel S.; Leisk, Gary G.; Lo, Tim J.; Moreau, Jodie E.; Haas, Dylan S.; Papenburg, Bernke J.; Golden, Ethan B.; Partlow, Benjamin P.; Fox, Sharon E.; Ibrahim, Ahmed M. S.; Lin, Samuel J.; Kaplan, David L.

    2014-03-01

    Metallic fixation systems are currently the gold standard for fracture fixation but have problems including stress shielding, palpability and temperature sensitivity. Recently, resorbable systems have gained interest because they avoid removal and may improve bone remodelling due to the lack of stress shielding. However, their use is limited to paediatric craniofacial procedures mainly due to the laborious implantation requirements. Here we prepare and characterize a new family of resorbable screws prepared from silk fibroin for craniofacial fracture repair. In vivo assessment in rat femurs shows the screws to be self-tapping, remain fixed in the bone for 4 and 8 weeks, exhibit biocompatibility and promote bone remodelling. The silk-based devices compare favourably with current poly-lactic-co-glycolic acid fixation systems, however, silk-based devices offer numerous advantages including ease of implantation, conformal fit to the repair site, sterilization by autoclaving and minimal inflammatory response.

  18. Epidural catheter fixation. A comparison of subcutaneous tunneling versus device fixation technique

    PubMed Central

    Sharma, Ashima; Parasa, Sujay Kumar; Tejvath, Kiran; Ramachandran, Gopinath

    2016-01-01

    Background and Aims: The technique of securing the epidural catheter has a major bearing on the efficacy of epidural analgesia. Specific fixator devices, for e.g., Lockit epidural catheter clamp, which successfully prevents catheter migration, are available. The possibility of catheter snapping and surgical retrieval has been reported with tunneling of catheters. These techniques have not been compared for safety, efficacy and appropriateness of achieving secure epidural catheter fixation in the postoperative period. Material and Methods: A total of 200 patients who required postoperative epidural analgesia were included. They were randomized into two groups: Group I (n = 100) in whom epidural catheters were tunneled vertically in the paravertebral subcutaneous tissue and group II (n = 100) wherein a Lockit device was used to fix the catheter. Likert score was used to quantify patient's comfort during procedure. The techniques were compared for migration, catheter dislodgement, local trauma, catheter snapping and catheter obstruction. Results: 12% of tunneled catheters had migrated significantly outward. 22% of patients had erythema and 77% had significant procedural discomfort in group I. In group II, 3% catheters had kinked and 14% had erythema from device adhesive. Conclusion: Our results support the use of Lockit device as a safe and comfortable fixation device compared to subcutaneous tunneling of catheters. PMID:27006544

  19. Biplane double-supported screw fixation (F-technique): a method of screw fixation at osteoporotic fractures of the femoral neck.

    PubMed

    Filipov, Orlin

    2011-10-01

    The present work introduces a method of screw fixation of femoral neck fractures in the presence of osteoporosis, according to an original concept of the establishment of two supporting points for the implants and their biplane positioning in the femoral neck and head. The provision of two steady supporting points for the implants and the highly increased (obtuse) angle at which they are positioned allow the body weight to be transferred successfully from the head fragment onto the diaphysis, thanks to the strength of the screws, with the patient's bone quality being of least importance. The position of the screws allows them to slide under stress with a minimal risk of displacement. The method was developed in search of a solution for those patients for whom primary arthroplasty is contraindicated. The method has been analysed in relation to biomechanics and statics. For the first time, a new function is applied to a screw fixation-the implant is presented as a simple beam with an overhanging end.

  20. Fixation Stability Measurement Using Two Types of Microperimetry Devices

    PubMed Central

    Liu, Hongting; Bittencourt, Millena G.; Sophie, Raafay; Sepah, Yasir J.; Hanout, Mostafa; Rentiya, Zubir; Annam, Rachel; Scholl, Hendrik P. N.; Nguyen, Quan Dong

    2015-01-01

    Purpose We compared the fixation stability measurements obtained with two microperimeters, the Micro Perimeter 1 (MP-1) and the Spectral OCT/SLO (OCT/SLO), in subjects with and without maculopathies. Methods A total of 41 eyes with no known ocular diseases and 45 eyes with maculopathies were enrolled in the study. Both eyes of each participant had a 20-second fixation test using the MP-1 and OCT/SLO. The bivariate contour ellipse area (BCEA) was used for fixation stability evaluation. Results In the normal group, BCEA was 2.93 ± 0.32 log minarc2 on OCT/SLO and 2.89 ± 0.30 log minarc2 on MP-1. In the maculopathy group, BCEA was 3.05 ± 0.41 log minarc2 on OCT/SLO and 3.15 ± 0.46 log minarc2 on MP-1. There was no statistically significant difference between the BCEA measured by OCT/SLO and by MP-1 in both groups. A moderate correlation was found between the two devices (r = 0.45, P < 0.001). The sample size during the fixation test was 535.5 ± 14.6 pairs of coordinates in the normal group and 530.7 ± 14.9 pairs in the maculopathy group with MP-1, while it was 72.3 ± 6.9 and 59.9 ± 10.1, respectively, with OCT/SLO. This was due to different tracking frequencies between the two microperimeters. Conclusion Fixation stability assessment yields similar results using the OCT/SLO and MP-1. A major difference in sampling rate between the two microperimeters does not significantly affect BCEA measurements. Translational Relevance Fixation stability assessments are comparable and interchangeable between the OCT/SLO and the MP-1. PMID:25774329

  1. Snapping scapular syndrome secondary to rib intramedullary fixation device

    PubMed Central

    Zaidenberg, Ezequiel E.; Rossi, Luciano A.; Bongiovanni, Santiago L.; Tanoira, Ignacio; Maignon, Gaston; Ranalletta, Maximiliano

    2015-01-01

    Background Scapulo-thoracic joint disorders, including bursitis and crepitus, are commonly misdiagnosed problems and can be a source of persistent pain and dysfunction Presentation of the case This article describes an unusual case of a snapping scapula syndrome secondary to a migration through the lateral cortex of a rib splint intramedullary fixation device into the scapulothoracic joint. Discussion Recently, the operative fixation of multiple ribs fractures with intramedullary fixation devices has become popular. Despite the good outcomes with new rib splint designs, concern remains about the potential complications related to potential loss of fracture reduction with migration of the wire resulting in pain or additional injury to the surrounding tissues. Conclusion Surgeons should pay attention to any protrusion of intramedullary rib implants, especially in the evaluation of routine X-rays following surgical treatment. We should be aware of the possibility of this rare cause of snapping scapula syndrome to avoid delayed diagnosis and consider removing the implant will resolve the pain. PMID:26629853

  2. Successful Angioplasty of a Superficial Femoral Artery Stenosis Caused by a Suture-Mediated Closure Device

    SciTech Connect

    Gemmete, Joseph J. Dasika, Narasimham; Forauer, Andrew R.; Cho, Kyung; Williams, David M.

    2003-08-15

    We report the successful angioplasty of an acute arterial narrowing after suture-mediated closure (SMC) of a femoral arterial puncture. A 75-year-old woman underwent a cerebral arteriogramvia a right common femoral artery puncture. The arteriotomy site was closed with a SMC device. Four days after placement the patient complained of pain in her right calf after walking. An arteriogram 7 days after SMC showed a severe focal stenosis at the origin of the superficial femoral artery involving the presumed puncture site. The lesion was successfully treated with balloon angioplasty. The patient at 6 months was asymptomatic.

  3. Technique of Open Reduction and Internal Fixation of Comminuted Proximal Humerus Fractures With Allograft Femoral Head Metaphyseal Reconstruction.

    PubMed

    Parada, Stephen A; Makani, Amun; Stadecker, Monica J; Warner, Jon J P

    2015-10-01

    Proximal humerus fractures are common injuries that can require operative treatment. Different operative techniques are available, but the hallmark of fixation for 3- and 4-part fractures is a locking-plate-and-screw construct. Despite advances in this technology, obtaining anatomical reduction and fracture union can be difficult, and complications (eg, need for revision) are not uncommon. These issues can be addressed by augmenting the fixation with an endosteally placed fibular allograft. Although biomechanical and clinical results have been good, the technique can lead to difficulties in future revision to arthroplasty, a common consequence of failed open reduction and internal fixation. The technique described, an alternative to placing a long endosteal bone graft, uses a trapezoidal, individually sized pedestal of allograft femoral head to facilitate the reduction and healing of the humeral head and tuberosity fragments in a displaced 3- or 4-part fracture of the proximal humerus. It can be easily incorporated with any plate-and-screw construct and does not necessitate placing more than 1 cm of bone into the humeral intramedullary canal, limiting the negative effects on any future revision to arthroplasty.

  4. Compression-plate fixation of femoral shaft fractures in children aged 8 to 12 years.

    PubMed

    Fyodorov, I; Sturm, P F; Robertson, W W

    1999-01-01

    Twenty-one patients between the ages of 8 and 12 years with 23 femoral-shaft fractures underwent dynamic compression plating (DCP) between August 1993 and February 1996. Eleven patients had isolated femoral-shaft fractures, five had associated long-bone injuries, and five had multiple organ injuries. A 4.5-mm DCP plate was used in each case. Patients were kept non-weight bearing with crutches for an average of 8 weeks. Hardware failure occurred in two patients at 6 weeks. One was treated with revision plating, and the other, with spica casting. Both healed uneventfully. No other complications occurred. All patients were radiographically and clinically healed at last follow-up.

  5. Arthroscopically confirmed femoral button deployment.

    PubMed

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

    2014-06-01

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

  6. Arthroscopically confirmed femoral button deployment.

    PubMed

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

    2014-06-01

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

  7. Suitability of Exoseal Vascular Closure Device for Antegrade Femoral Artery Puncture Site Closure

    SciTech Connect

    Schmelter, Christopher Liebl, Andrea; Poullos, Nektarios; Ruppert, Volker; Vorwerk, Dierk

    2013-06-15

    Purpose. To assess the efficacy and safety of the Exoseal vascular closure device for antegrade puncture of the femoral artery. Methods. In a prospective study from February 2011 to January 2012, a total of 93 consecutive patients received a total of 100 interventional procedures via an antegrade puncture of the femoral artery. An Exoseal vascular closure device (6F) was used for closure in all cases. Puncture technique, duration of manual compression, and use of compression bandages were documented. All patients were monitored by vascular ultrasound and color-coded duplex sonography of their respective femoral artery puncture site within 12 to 36 h after angiography to check for vascular complications. Results. In 100 antegrade interventional procedures, the Exoseal vascular closure device was applied successfully for closure of the femoral artery puncture site in 96 cases (96 of 100, 96.0 %). The vascular closure device could not be deployed in one case as a result of kinking of the vascular sheath introducer and in three cases because the bioabsorbable plug was not properly delivered to the extravascular space adjacent to the arterial puncture site, but instead fully removed with the delivery system (4.0 %). Twelve to 36 h after the procedure, vascular ultrasound revealed no complications at the femoral artery puncture site in 93 cases (93.0 %). Minor vascular complications were found in seven cases (7.0 %), with four cases (4.0 %) of pseudoaneurysm and three cases (3.0 %) of significant late bleeding, none of which required surgery. Conclusion. The Exoseal vascular closure device was safely used for antegrade puncture of the femoral artery, with a high rate of procedural success (96.0 %), a low rate of minor vascular complications (7.0 %), and no major adverse events.

  8. The biomechanical effect of bone quality and fracture topography on locking plate fixation in periprosthetic femoral fractures.

    PubMed

    Leonidou, Andreas; Moazen, Mehran; Lepetsos, Panagiotis; Graham, Simon M; Macheras, George A; Tsiridis, Eleftherios

    2015-02-01

    Optimal management of periprosthetic femoral fractures (PFF) around a well fixed prosthesis (Vancouver B1) remains controversial as adequate fixation needs to be achieved without compromising the stability of the prosthesis. The aim of this study was to highlight the effect of bone quality i.e. canal thickness ratio (CTR), and fracture topography i.e. fracture angle and its position in relation to the stem, on the biomechanics of a locking plate for a Vancouver B1 fracture. A previously corroborated simplified finite element model of a femur with a cemented total hip replacement stem was used in this study. Canal thickness ratio (CTR) and fracture topography were altered in several models and the effect of these variations on the von Mises stress on the locking plate as well as the fracture displacement was studied. Increasing the CTR led to reduction of the von Mises stress on the locking plate as well as the fracture movement. In respect to the fracture angle with the medial cortex, it was shown that acute angles resulted in lower von Mises stress on the plate as opposed to obtuse angles. Furthermore, acute fracture angles resulted in lower fracture displacement compared to the other fractures considered here. Fractures around the tip of the stem had the same biomechanical effect on the locking plate. However, fractures more distal to the stem led to subsequent increase of stress, strain, and fracture displacement. Results highlight that in good bone quality and acute fracture angles, single locking plate fixation is perhaps an appropriate management method. On the contrary, for poor bone quality and obtuse fracture angles alternative management methods might be required as the fixation might be under higher risk of failure. Clinical studies for the management of PFF are required to further support our findings.

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

    PubMed

    He, Wenye; Zhang, Wei

    2015-03-01

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

  10. DESIGN AND BIOMECHANICAL EVALUATION OF A RODENT SPINAL FIXATION DEVICE

    PubMed Central

    Shahrokni, Maryam; Zhu, Qingan; Liu, Jie; Tetzlaff, Wolfram; Oxland, Thomas R.

    2016-01-01

    Structured Abstract Study Design An in vitro and in vivo study in rats. Objectives To design a novel rat spinal fixation device and investigate its biomechanical effectiveness in stabilizing the spine up to eight weeks post injury. Methods A fixation device made of polyetheretherketone was designed to stabilize the spine via bilateral clamping pieces. The device effectiveness was assessed in a Sprague-Dawley rat model after it was applied to a spine with a fracture-dislocation injury produced at C5–C6. Animals were euthanized either immediately (n=6) or eight weeks (n=9) post-injury and the C3-T1 segment of the cervical spine was removed for biomechanical evaluation. Segments of intact spinal columns (C3-T1) (n=6) served as uninjured controls. In these tests, anterior-posterior shear forces were applied to the C3 vertebra to produce flexion and extension bending moments at the injury site (peak 12.8Nmm). The resultant two-dimensional motions at the injury site (i.e. C5–C6) were measured using digital imaging and reported as ranges of motion (ROM) or neutral zones (NZ). Results Flexion/extension ROMs (average ± S.D.) were 18.1 ± 3.3°, 19.9 ± 7.5°, and 1.5 ± 0.7°, respectively for the intact, injured/fixed, and injured/8-week groups, with the differences being highly significant for the injured/8-week group (p=0.0002). Flexion/extension NZs were 3.4 ± 2.8°, 5.0 ± 2.4°, and 0.7 ± 0.5°, respectively for the intact, injured/fixed, and injured/8-week groups, with the differences being significant for the injured/8-week group (p =0.04). Conclusion The device acutely stabilizes the spine and promotes fusion at the site of injury. PMID:22289899

  11. Mechanical testing of a device for subcutaneous internal anterior pelvic ring fixation versus external pelvic ring fixation

    PubMed Central

    2014-01-01

    Background Although useful in the emergency treatment of pelvic ring injuries, external fixation is associated with pin tract infections, the patient’s limited mobility and a restricted surgical accessibility to the lower abdomen. In this study, the mechanical stability of a subcutaneous internal anterior fixation (SIAF) system is investigated. Methods A standard external fixation and a SIAF system were tested on pairs of Polyoxymethylene testing cylinders using a universal testing machine. Each specimen was subjected to a total of 2000 consecutive cyclic loadings at 1 Hz with sinusoidal lateral compression/distraction (+/−50 N) and torque (+/− 0.5 Nm) loading alternating every 200 cycles. Translational and rotational stiffness were determined at 100, 300, 500, 700 and 900 cycles. Results There was no significant difference in translational stiffness between the SIAF and the standard external fixation when compared at 500 (p = .089), 700 (p = .081), and 900 (p = .266) cycles. Rotational stiffness observed for the SIAF was about 50 percent higher than the standard external fixation at 300 (p = .005), 500 (p = .020), and 900 (p = .005) cycles. No loosening or failure of the rod-pin/rod-screw interfaces was seen. Conclusions In comparison with the standard external fixation system, the tested device for subcutaneous internal anterior fixation (SIAF) in vitro has similar translational and superior rotational stiffness. PMID:24684828

  12. The Correlation between the Fracture Types and the Complications after Internal Fixation of the Femoral Neck Fractures

    PubMed Central

    Jo, Suenghwan; Lee, Hyeon Jun

    2016-01-01

    Purpose This study aims to determine the correlation between the fracture patterns and the complications in patients with femoral neck fracture treated with internal fixation. Materials and Methods The study comprises 45 patients with femoral neck fracture treated with multiple screws or compression hip screw between May 2008 and April 2012. The mean age was 48 years at the time of the surgery and the mean duration from initial injury to surgery was 20 hours. The fracture patterns were identified according to the anatomical location, the Garden classification and the Pauwels classification. The occurrence of nonunion and avascular necrosis were reviewed with clinical results including Harris hip score and Lunceford hip function test. The correlation between the fracture pattern and occurrence of complications were analyzed. Results Fracture site union was achieved in 40 hips with the average union time of 17 weeks. Five nonunions occurred which showed high likelihood to occur in subcapital type, displaced (Garden stage III or IV) and Pauwels type III fractures (P<0.05). Avascular necrosis was developed in 10 hips which was mostly in subcapital type and Pauwels type III fracture but no statistical significance was found (P>0.05). The mean Harris hip score was 91 points, and Lunceford functional results were excellent in 15 hips, good in 24, fair in 4 and poor in 2. Conclusion There was high risk of nonunion in subcapital type fracture, displaced fracture (Garden stage III and IV) and vertically oriented fracture (Pauwels type III). Careful attention is needed in these fracture types. PMID:27536642

  13. A Novel Internal Fixator Device for Peripheral Nerve Regeneration

    PubMed Central

    Chuang, Ting-Hsien; Wilson, Robin E.; Love, James M.; Fisher, John P.

    2013-01-01

    Recovery from peripheral nerve damage, especially for a transected nerve, is rarely complete, resulting in impaired motor function, sensory loss, and chronic pain with inappropriate autonomic responses that seriously impair quality of life. In consequence, strategies for enhancing peripheral nerve repair are of high clinical importance. Tension is a key determinant of neuronal growth and function. In vitro and in vivo experiments have shown that moderate levels of imposed tension (strain) can encourage axonal outgrowth; however, few strategies of peripheral nerve repair emphasize the mechanical environment of the injured nerve. Toward the development of more effective nerve regeneration strategies, we demonstrate the design, fabrication, and implementation of a novel, modular nerve-lengthening device, which allows the imposition of moderate tensile loads in parallel with existing scaffold-based tissue engineering strategies for nerve repair. This concept would enable nerve regeneration in two superposed regimes of nerve extension—traditional extension through axonal outgrowth into a scaffold and extension in intact regions of the proximal nerve, such as that occurring during growth or limb-lengthening. Self-sizing silicone nerve cuffs were fabricated to grip nerve stumps without slippage, and nerves were deformed by actuating a telescoping internal fixator. Poly(lactic co-glycolic) acid (PLGA) constructs mounted on the telescoping rods were apposed to the nerve stumps to guide axonal outgrowth. Neuronal cells were exposed to PLGA using direct contact and extract methods, and they exhibited no signs of cytotoxic effects in terms of cell morphology and viability. We confirmed the feasibility of implanting and actuating our device within a sciatic nerve gap and observed axonal outgrowth following device implantation. The successful fabrication and implementation of our device provides a novel method for examining mechanical influences on nerve regeneration. PMID

  14. Machining of a bioactive nanocomposite orthopedic fixation device.

    PubMed

    Sparnell, Amie; Aniket; El-Ghannam, Ahmed

    2012-08-01

    Bioactive ceramics bond to bone and enhance bone formation. However, they have poor mechanical properties which restrict their machinability as well as their application as load bearing implants. The goal of this study was to machine bioactive fixation screws using a silica-calcium phosphate nanocomposite (SCPC50). The effect of compact pressure, holding time, and thermal treatment on the microstructure, machinability, and mechanical properties of SCPC50 cylinders were investigated. Samples prepared by powder metallurgy technique at compact pressure range of 100-300 MPa and treated at 900°C/1 h scored a poor machinability rating of (1/5) due to the significant formation of amorphous silicate phase at the grain boundaries. On the other hand, lowering of compact pressure and sintering temperature to 30 MPa/3 h and 700°C/2 h, respectively, minimized the formation of the amorphous phase and raised the machinability rating to (5/5). The modulus of elasticity and ultimate strength of machinable SCPC50 were 10.8 ± 2.0 GPa and 72.8 ± 22.8 MPa, respectively, which are comparable to the corresponding values for adult human cortical bone. qRT-PCR analyses showed that bone cells attached to SCPC50 significantly upregulated osteocalcin mRNA expression as compared to the cells on Ti-6Al-4V. Moreover, cells attached to SCPC50 produced mineralized bone-like tissue within 8 days. On the other hand, cells attached to Ti-6Al-4V failed to produce bone mineral under the same experimental conditions. Results of the study suggest that machinable SCPC50 has the potential to serve as an attractive new material for orthopedic fixation devices.

  15. Medial Patellofemoral Ligament Reconstruction Using a Femoral Loop Button Fixation Technique

    PubMed Central

    Godin, Jonathan A.; Karas, Vasili; Visgauss, Julia D.; Garrett, William E.

    2015-01-01

    Medial patellofemoral ligament (MPFL) reconstruction is a common procedure used to treat both acute and chronic patellar instability. Although many variations of MPFL reconstruction have been described, there is no consensus regarding the optimal surgical technique. We describe a technique for MPFL reconstruction with a looped gracilis tendon autograft using suture anchors to secure the graft to the patella and a suspensory loop button system for fixation to the femur. This technique replicates the native shape of the MPFL while minimizing the risk of patellar fracture and allowing for gradual tensioning of the graft. PMID:26900561

  16. Wedgeless 'V' shaped distal femoral osteotomy with internal fixation for genu valgum in adolescents and young adults.

    PubMed

    Gupta, Vikas; Kamra, Gaurav; Singh, Davinder; Pandey, Ketan; Arora, Sumit

    2014-06-01

    The treatment of angular malalignment includes restoration of normal mechanical axis alignment and joint orientation.The supracondylar wedgeless distal femoral 'V' osteotomy, as a treatment modality, is sparsely explored in the literature. This study was conducted at a tertiary level teaching referral hospital from October 2010 to September 2012. Forty six lower limbs (in 30 patients) were operated with a wedgeless 'V' osteotomy that was fixed with a buttress 'L' plate. The pre-operative deformity, post-operative correction and knee range of movement were noted. Mobilisation was started at 3 weeks after surgery and full weight-bearing was allowed at 3 months. The knee score by Bostman et al. was used for functional outcome. The mean age of the patients in our study was 16.9 years (range: 15 years to 23 years). The patients were followed up for a mean period of 19.8 months (range, 15 months to 29 months). The mean radiological tibiofemoral angle was 22.2 degrees (range, 16 degrees to 29 degrees) before surgery, that improved to a mean postoperative value of 5.1 degrees (range, 0 degrees to 10 degrees) (p < 0.001). The mean preoperative lateral distal femoral angle was 79.23 degrees that improved to a mean value of 89.13 degrees after surgery (p < 0.001). The mean mechanical axis deviation was 19.56 mm before surgery that improved to a mean postoperative value of 3.7 mm (p < 0.001). All patients reached a correction of the deformity and 44 cases out of a total of 46 had an excellent functional outcome, 2 patients had a good functional outcome. None had an unsatisfactory outcome. Two cases had a deep wound infection that subsided after implant removal. None of the cases had other complications. The distal femoral 'V' shaped osteotomy is a simple procedure for the correction of genu valgum in individuals nearing skeletal maturity and is easy to perform. It has the advantage of being wedgeless as it does not cause limb length discrepancy. Internal fixation helps in

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

    PubMed Central

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

    2015-01-01

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

  18. An analysis of screw fixation of the femoral component in cementless hip arthroplasty.

    PubMed

    Martin, J W; Sugiyama, H; Kaiser, A D; Van Hoech, J; Whiteside, L A

    1990-01-01

    A cementless hip stem that allows screw fixation of the collar to cortical bone in the calcar region was found to achieve enhanced rotational stability when implanted in preserved cadaveric human femora. Although the implants with screws showed less tendency for subsidence than the implants without screws, rotational micromotion was not found to be statistically different under light loading conditions. When implanted in composite bone, the addition of screws in the configuration tested was associated with significant metal-on-metal wear during combined compression and rotational cyclic loading. This finding is of concern due to potential wear particle toxicity and possible lowered fatigue life of the prosthesis. Therefore, specific design changes are recommended. PMID:2243211

  19. Adolescent Femoral Chondral Fragment Fixation With Poly-L-Lactic Acid Chondral Darts.

    PubMed

    Morris, John K; Weber, Alexander E; Morris, Mark S

    2016-01-01

    Large chondral injuries without attached bone are uncommon. This report describes a 14-year-old boy who had a unique stress reaction between the bone and the overlying cartilage, predominantly of the anterior lateral femoral condyle, during a week-long basketball camp, resulting in complete displacement of a 2.5 × 2.5-cm full-thickness articular cartilage lesion. There was a 6-day interval from the time of the injury to the first office appointment. Scheduling of magnetic resonance imaging and insurance approval took another week, and then surgery scheduling, including insurance approval and arranging for surgical supplies, took another week. Three weeks after the initial injury, the patient underwent diagnostic arthroscopy and open arthrotomy, and the cartilage-free fragment was returned to the donor site and fixed with poly-L-lactic acid chondral darts. Considerable delamination of the shoulders of the defect was noted on preoperative magnetic resonance imaging and at the time of surgery, suggesting an unusual prodromal stress reaction. Although there was no underlying subchondral bone on the free cartilage fragment, the injury healed. The patient had return of full knee range of motion and strength. Magnetic resonance imaging performed 3 months postoperatively showed healed cartilage. At 1 year of clinical follow-up, the patient had no clinical sequelae from the initial injury and had returned to competitive basketball. Prompt recognition of this injury pattern and subsequent surgical repair are necessary because the window of opportunity closes as fibrous healing occurs and the cartilage fragment deforms. The poly-L-lactic acid chondral dart system was instrumental to the success of this case. PMID:26840696

  20. Adolescent Femoral Chondral Fragment Fixation With Poly-L-Lactic Acid Chondral Darts.

    PubMed

    Morris, John K; Weber, Alexander E; Morris, Mark S

    2016-01-01

    Large chondral injuries without attached bone are uncommon. This report describes a 14-year-old boy who had a unique stress reaction between the bone and the overlying cartilage, predominantly of the anterior lateral femoral condyle, during a week-long basketball camp, resulting in complete displacement of a 2.5 × 2.5-cm full-thickness articular cartilage lesion. There was a 6-day interval from the time of the injury to the first office appointment. Scheduling of magnetic resonance imaging and insurance approval took another week, and then surgery scheduling, including insurance approval and arranging for surgical supplies, took another week. Three weeks after the initial injury, the patient underwent diagnostic arthroscopy and open arthrotomy, and the cartilage-free fragment was returned to the donor site and fixed with poly-L-lactic acid chondral darts. Considerable delamination of the shoulders of the defect was noted on preoperative magnetic resonance imaging and at the time of surgery, suggesting an unusual prodromal stress reaction. Although there was no underlying subchondral bone on the free cartilage fragment, the injury healed. The patient had return of full knee range of motion and strength. Magnetic resonance imaging performed 3 months postoperatively showed healed cartilage. At 1 year of clinical follow-up, the patient had no clinical sequelae from the initial injury and had returned to competitive basketball. Prompt recognition of this injury pattern and subsequent surgical repair are necessary because the window of opportunity closes as fibrous healing occurs and the cartilage fragment deforms. The poly-L-lactic acid chondral dart system was instrumental to the success of this case.

  1. Mechanical failures after fixation with proximal femoral nail and risk factors

    PubMed Central

    Koyuncu, Şemmi; Altay, Taşkın; Kayalı, Cemil; Ozan, Fırat; Yamak, Kamil

    2015-01-01

    Background This study aims at assessing the clinical results, radiographic findings, and associated complications after osteosynthesis of trochanteric hip fractures with proximal femoral nail (PFN). Methods A total of 152 patients with hip fractures who underwent osteosynthesis with PFN were included. The hip fracture types in the patients included in the study were classified according to the American Orthopedic/Orthopedic Trauma Association (AO/OTA). AO/OTA A1, A2, and A3 type fractures were found in 24 (15.8%), 107 (70.4%), and 21 (13.8%) patients, respectively. The Baumgaertner scale was used to assess the degree of postoperative reduction. The Salvati–Wilson hip function (SWS) scoring system was used to evaluate functional results. After a follow-up period, clinical and radiographic results were evaluated and complications were assessed. The relationship between the complications and SWS score, age, sex, fracture type, reduction quality, and time from the fracture to surgery was evaluated. Results Eighty-five (55.9%) female patients and 67 (44.1%) male patients were enrolled in the study. Seventy-nine (51.9%) patients had left hip fractures, and 73 (48.1%) had right hip fractures. The mean age was 76 (range 21–93) years, and the mean follow-up duration was 23.6 (range 7–49) months. Postoperatively, one patient (0.6%) had a poor reduction, 16 patients (10.5%) had an acceptable reduction, and 135 patients (88.9%) had a good reduction according to the above criteria. The SWS scores were excellent, good, moderate, and poor in 91 (59.8%), 45 (29.6%), 15 (9.8%), and one (0.6%) patients, respectively. Late postoperative complications were seen in 27 patients (17.7%). A total of 14 patients (9.2%) underwent a revision procedure for mechanical complications. Conclusion The study results suggest that the quality of fracture reduction is an important factor that affects the revision rate and SWS score in patients with mechanical complications after osteosynthesis

  2. In vivo biomechanical evaluation of nail-plate fixation of femoral neck fractures of rehabilitated patients.

    PubMed

    Mizrahi, J; Kantarovski, A; Najenson, T; Susak, Z

    1985-01-01

    A major advantage of internal fixation of intertrochanteric fractures is that it can normally be followed by early and fast rehabilitation of the patient, finding expression in weight bearing and locomotion abilities of the patients. Complications which nevertheless occur, are mostly of mechanical origin. The purpose of our study was to evaluate the biomechanical performance of rehabilitated patients treated with four different types of nail-plates. Forty nine patients (12 men and 37 women) with walking ability, and with an average age of 70.5 years, were tested on a 10 m walkway, instrumented for the monitoring of the time distance parameters of the stride. This method of evaluation is especially suitable for pathological gait, free or supported, as it does not impose any constraints on the natural and individual walking trend of the patient. The average time elapsed between the actual fracture and the locomotor test was 764 days, implying that the investigated patients formed a homogeneous, well-rehabilitated group. The main average stride results were as follows: contact time 1.25 sec, double contact time 0.41 sec, stride length 68.2 cm, velocity 51.39 cm/sec and symmetry 0.51. No significant differences were found in these parameters between the subgroups of patients using different nail-plates. These results show that while the biomechanical performance of the patients with their implants was satisfactory (good walking symmetry) this group can be characterized by its smaller stride and slower gait, compared to those of a healthy population of the same age.

  3. Strength analysis of clavicle fracture fixation devices and fixation techniques using finite element analysis with musculoskeletal force input.

    PubMed

    Marie, Cronskär

    2015-08-01

    In the cases, when clavicle fractures are treated with a fixation plate, opinions are divided about the best position of the plate, type of plate and type of screw units. Results from biomechanical studies of clavicle fixation devices are contradictory, probably partly because of simplified and varying load cases used in different studies. The anatomy of the shoulder region is complex, which makes it difficult and expensive to perform realistic experimental tests; hence, reliable simulation is an important complement to experimental tests. In this study, a method for finite element simulations of stresses in the clavicle plate and bone is used, in which muscle and ligament force data are imported from a multibody musculoskeletal model. The stress distribution in two different commercial plates, superior and anterior plating position and fixation including using a lag screw in the fracture gap or not, was compared. Looking at the clavicle fixation from a mechanical point of view, the results indicate that it is a major benefit to use a lag screw to fixate the fracture. The anterior plating position resulted in lower stresses in the plate, and the anatomically shaped plate is more stress resistant and stable than a regular reconstruction plate.

  4. Evaluation of 3 Fixation Devices for Tibial-Sided Anterior Cruciate Ligament Graft Backup Fixation.

    PubMed

    Verioti, Christopher A; Sardelli, Matthew C; Nguyen, Tony

    2015-07-01

    We conducted a study to biomechanically evaluate 3 methods of tibial-sided fixation for anterior cruciate ligament reconstruction: fully threaded interference screw only, interference screw backed with 4.75-mm SwiveLock anchor, and fully threaded bio-interference screw backed with 4.5-mm bicortical screw (all Arthrex). Thirty skeletally mature porcine tibiae were used. The first group was prepared by graft fixation within the tibial tunnel using only an interference screw. The second and third groups included an interference screw with 2 types of secondary fixation: 4.5-mm bicortical post and SwiveLock anchor. Mechanical testing consisted of 500 cycles between 50 and 250 N at 1 Hz, followed by a pull to failure conducted at 20 mm per minute. Ultimate load-to-failure testing demonstrated the largest mean (SD) load tolerated in the post/washer group, 1148 (186) N, versus the SwiveLock group, 1007 (176) N, and the screw-only group, 778 (139) N. There was no statistical difference between the 2 backup fixation groups. Use of a SwiveLock anchor as backup fixation at the tibial side in soft-tissue anterior cruciate ligament reconstruction is a safe, effective alternative to a bicortical post and provides statistically equivalent pullout strength with unlikely requirement for future hardware removal.

  5. Reconstruction of the anterior cruciate ligament by means of an anteromedial portal and femoral fixation using Rigidfix☆☆☆

    PubMed Central

    Inácio, André Manoel; Lopes Júnior, Osmar Valadão; Kuhn, André; Saggin, José Idílio; Fernandes Saggin, Paulo Renato; de Freitas Spinelli, Leandro; de Castro, Daniela Medeiros

    2014-01-01

    Objective To evaluate a series of patients who underwent surgery for reconstruction of the anterior cruciate ligament with flexor tendons, by means of the anteromedial transportal technique using Rigidfix for femoral fixation, and to analyze the positioning of the pins by means of tomography. Methods Thirty-two patients were included in the study. The clinical evaluation was done using the Lysholm, subjective IKDC and Rolimeter. All of them underwent computed tomography with 3D reconstruction in order to evaluate the entry point and positioning of the Rigidfix pins in relation to the joint cartilage of the lateral condyle of the femur. Results The mean Lysholm score obtained was 87.81 and the subjective IKDC was 83.72. Among the 32 patients evaluated, 43% returned to activities that were considered to be very vigorous, 9% vigorous, 37.5% moderate and 12.5% light. In 16 patients (50%), the distal entry point of the Rigidfix pin was located outside of the cartilage (extracartilage); in seven (21.87%), the distal pin injured the joint cartilage (intracartilage); and in nine (28.12%), it was at the border of the lateral condyle of the femur. Conclusion The patients who underwent ACL reconstruction by means of the anteromedial transportal using the Rigidfix system presented satisfactory clinical results over the length of follow-up evaluated. However, the risk of lesions of the joint cartilage from the distal Rigidfix pin needs to be taken into consideration when the technique via an anteromedial portal is used. Further studies with larger numbers of patients and longer follow-up times should be conducted for better evaluation. PMID:26229871

  6. A device for continuous monitoring of true central fixation based on foveal birefringence.

    PubMed

    Gramatikov, Boris; Irsch, Kristina; Müllenbroich, Marie; Frindt, Nicole; Qu, Yinhong; Gutmark, Ron; Wu, Yi-Kai; Guyton, David

    2013-09-01

    A device for continuous monitoring of central fixation utilizes birefringence, the property of the Henle fibers surrounding the human fovea, to change the polarization state of light. A circular scan of retinal birefringence, where the scanning circle encompasses the fovea, allows identification of true central fixation-an assessment much needed in various applications in ophthalmology, psychology, and psychiatry. The device allows continuous monitoring for central fixation over an extended period of time in the presence of fixation targets and distracting stimuli, which may be helpful in detecting attention deficit hyperactivity disorder, autism spectrum disorders, and other disorders characterized by changes in the subject's ability to maintain fixation. A proof-of-concept has been obtained in a small study of ADHD patients and normal control subjects.

  7. The Weak Link in Anterior Cruciate Ligament Reconstruction: What is the Evidence for Graft Fixation Devices?

    PubMed

    Campbell, Kirk A; Looze, Christopher; Bosco, Joseph A; Strauss, Eric J

    2016-03-01

    Anterior cruciate ligament (ACL) rupture is a common injury that mostly affects young adults. The mechanisms of injury and surgical treatment have been extensively studied in both the laboratory and clinical arenas; however, great controversy still exists in regards to the best surgical technique, graft choice, and graft fixation device. In the area graft fixation, multiple breakthroughs have occurred in terms of fixation devices. These devices generally fall within the broad categories of interference screw, cross-pins, or cortical-based devices. Furthermore, some of these devices are available in either metal or bioabsorbable materials, which adds to the already great variety of options. Although biomechanically these devices have been shown to be able to withstand the typical forces experienced by the ACL graft during the early phases of rehabilitation before the graft has fully incorporated into the bone, little is known about the clinical outcomes. It is well recognized that graft fixation is the weakest link in the early postoperative period after ACL reconstruction. This review of the outcomes of ACL fixation devices explores some of the evidence available for the different devices. PMID:26977545

  8. The potential application of functionally graded material for proximal femoral nail antirotation device.

    PubMed

    Gong, He; Wang, Lizhen; Zheng, Dong; Fan, Yubo

    2012-09-01

    Proximal femoral nail antirotation (PFNA) device is an intramedullary nail system designing for the treatment of trochanteric fractures. It is composed of a helical neck blade, a nail and a distal locking bolt. There were some reports of femoral shaft fractures even after the fractures were healed. The stress shielding effects of the PFNA device made of stiff titanium alloy on the bone-remodeling behavior of the host femur and the uneven distribution of interface shear stress may contribute to this complication. Recently, a new class of composite called functionally graded material (FGM) was developed, that consisted a gradual pattern of material composition and/or microstructures, and was introduced in dental implant and cementless hip stem. Accordingly, in this paper, we hypothesized that FGM might be used as the material of the nail in PFNA device with the material composition of the nail gradually shifting from more stiff at the proximal side of the femur to more flexible 'iso-elastic' towards the distal side. This hypothesis can be evaluated from the long-term remodeling behavior of host femur and the stress distributions in the PFNA device and bone.

  9. [Treatment of the femoral, tibia and humeral shaft fractures in children with the use of intramedullary nailing or external fixation, a long term study].

    PubMed

    Kołecka, Ewa; Niedzielski, Kryspin Ryszard; Lipczyk, Zbigniew; Flont, Paweł

    2009-01-01

    The treatment of long bones shaft fractures with intramedullary nailing and external fixation is gaining popularity nowadays. The aim of this study was to analyze operative methods of treatment of the long bones shafts fractures in children. We compared outcomes of surgical treatment with the use of external fixation and flexible nails. The study group consisted of 127 patients (4 to 18 years old) who were operated on in our hospital during the period 1990-2005: 90 patients with femoral shaft fractures, 31 with tibia fractures and 6 with humeral fractures. In 81 children we performed fixation with Wagner's tool and in 46 cases we used Prevot or Ender nails. The follow up (performed at least one year after treatment cessation) included clinical examination and X-ray imaging. Union in an almost anatomical position was obtained in 126 patients. There was one fracture-healing complication ( nonunion- due to to early hardware removal). The study showed many advantages of the surgical treatment: minimal invasiveness, short hospitalization period, early rehabilitation. In our group both methods of management were comparable. We recommend intramedullary nailing in closed, transverse fractures and external fixator in open, multifragmentary and possibly unstable fractures. PMID:19777945

  10. Attention attraction in an ophthalmic diagnostic device using sound-modulated fixation targets.

    PubMed

    Gramatikov, Boris I; Rangarajan, Shreya; Irsch, Kristina; Guyton, David L

    2016-08-01

    This study relates to eye fixation systems with combined optical and audio systems. Many devices for eye diagnostics and some devices for eye therapeutics require the patient to fixate on a small target for a certain period of time, during which the eyes do not move and data from substructures of one or both eyes are acquired and analyzed. With young pediatric patients, a monotonously blinking target is not sufficient to retain attention steadily. We developed a method for modulating the intensity of a point fixation target using sounds appropriate to the child's age and preference. The method was realized as a subsystem of a Pediatric Vision Screener which employs retinal birefringence scanning for detection of central fixation. Twenty-one children, age 2-18, were studied. Modulation of the fixation target using sounds ensured the eye fixated on the target, and with appropriate choice of sounds, performed significantly better than a monotonously blinking target accompanied by a plain beep. The method was particularly effective with children of ages up to 10, after which its benefit disappeared. Typical applications of target modulation would be as supplemental subsystems in pediatric ophthalmic diagnostic devices, such as scanning laser ophthalmoscopes, optical coherence tomography units, retinal birefringence scanners, fundus cameras, and perimeters.

  11. Attention attraction in an ophthalmic diagnostic device using sound-modulated fixation targets.

    PubMed

    Gramatikov, Boris I; Rangarajan, Shreya; Irsch, Kristina; Guyton, David L

    2016-08-01

    This study relates to eye fixation systems with combined optical and audio systems. Many devices for eye diagnostics and some devices for eye therapeutics require the patient to fixate on a small target for a certain period of time, during which the eyes do not move and data from substructures of one or both eyes are acquired and analyzed. With young pediatric patients, a monotonously blinking target is not sufficient to retain attention steadily. We developed a method for modulating the intensity of a point fixation target using sounds appropriate to the child's age and preference. The method was realized as a subsystem of a Pediatric Vision Screener which employs retinal birefringence scanning for detection of central fixation. Twenty-one children, age 2-18, were studied. Modulation of the fixation target using sounds ensured the eye fixated on the target, and with appropriate choice of sounds, performed significantly better than a monotonously blinking target accompanied by a plain beep. The method was particularly effective with children of ages up to 10, after which its benefit disappeared. Typical applications of target modulation would be as supplemental subsystems in pediatric ophthalmic diagnostic devices, such as scanning laser ophthalmoscopes, optical coherence tomography units, retinal birefringence scanners, fundus cameras, and perimeters. PMID:27245750

  12. Effects of femoral component material properties on cementless fixation in total hip arthroplasty. A comparison study between carbon composite, titanium alloy, and stainless steel.

    PubMed

    Otani, T; Whiteside, L A; White, S E; McCarthy, D S

    1993-02-01

    Carbon-fiber-reinforced-carbon composite material is an attractive implant material because its modulus of elasticity can be made similar to that of cortical bone. This study investigated the effect of femoral prosthesis elastic modulus on cementless implant fixation. Distal, as well as proximal, relative micromovements between implant and bone were measured in two testing protocols (axial-load and torsional-load), comparing identically shaped carbon composite (modulus of elasticity = 18.6 GPa), Ti6Al4V (100 GPa), and 630 stainless steel (200 GPa) prostheses. In the axial-load test, proximal mediolateral micromotions were significantly larger in the flexible composite stem than in the two metals. In the torsional-load test, rotational micromotions and "slop" displacements in the flexible stem were significantly larger proximally and significantly smaller distally than in the two metals. While these results suggest that proximal stress transfer may be improved by a flexible stem, they raise the possibility of increased proximal micromotion, and suggest that improved proximal fixation may be necessary to achieve clinical success with flexible composite femoral components.

  13. Simulation-based particle swarm optimization and mechanical validation of screw position and number for the fixation stability of a femoral locking compression plate.

    PubMed

    Lee, Chian-Her; Shih, Kao-Shang; Hsu, Ching-Chi; Cho, Tomas

    2014-01-01

    Locking compression plates (LCPs) have been used to fix femoral shaft fractures. Previous studies have attempted to identify the best LCP screw positions and numbers to achieve the fixation stability. However, the determined screw positions and numbers were mainly based on the surgeons' experiences. The aim of this study was to discover the best number and positions of LCP screws to achieve acceptable fixation stability. Three-dimensional numerical models of a fractured femur with the LCP were first developed. Then, the best screw position and number of LCPs were determined by using a simulation-based particle swarm optimization algorithm. Finally, the results of the numerical study were validated by conducting biomechanical tests. The results showed that the LCP with six locking screws resulted in the necessary fixation stability, and the best combination of positions of locking screws inserted into the LCP was 1-5-6-7-8-12 (three locking screws on either side of the bone fragment with two locking screws as close as practicable to the fracture site). In addition, the numerical models and algorithms developed in this study were validated by the biomechanical tests. Both the numerical and experimental results can provide clinical suggestions to surgeons and help them to understand the biomechanics of LCP systems.

  14. Posterior Wall Capture and Femoral Artery Stenosis Following Use of StarClose Closing Device: Diagnosis and Therapy

    SciTech Connect

    Stefanczyk, Ludomir; Elgalal, Marcin T.; Szubert, Wojciech; Grzelak, Piotr; Szopinski, Piotr; Majos, Agata

    2013-10-15

    A case of femoral artery obstruction following application of a StarClose type arterial puncture closing device (APCD) is presented. Ultrasonographic and angiographic imaging of this complication was obtained. The posterior wall of the vessel was accidentally caught in the anchoring element of the nitinol clip. This complication was successfully resolved by endovascular treatment and the implantation of a stent.

  15. The biomechanics of plate fixation of periprosthetic femoral fractures near the tip of a total hip implant: cables, screws, or both?

    PubMed

    Shah, S; Kim, S Y R; Dubov, A; Schemitsch, E H; Bougherara, H; Zdero, R

    2011-09-01

    Femoral shaft fractures after total hip arthroplasty (THA) remain a serious problem, since there is no optimal surgical repair method. Virtually all studies that examined surgical repair methods have done so clinically or experimentally. The present study assessed injury patterns computationally by developing three-dimensional (3D) finite element (FE) models that were validated experimentally. The investigation evaluated three different constructs for the fixation of Vancouver B1 periprosthetic femoral shaft fractures following THA. Experimentally, three bone plate repair methods were applied to a synthetic femur with a 5 mm fracture gap near the tip of a total hip implant. Repair methods were identical distal to the fracture gap, but used cables only (construct A), screws only (construct B), or cables plus screws (construct C) proximal to the fracture gap. Specimens were oriented in 15 degrees adduction to simulate the single-legged stance phase of walking, subjected to 1000 N of axial force, and instrumented with strain gauges. Computationally, a linearly elastic and isotropic 3D FE model was developed to mimic experiments. Results showed excellent agreement between experimental and FE strains, yielding a Pearson linearity coefficient, R2, of 0.92 and a slope for the line of best data fit of 1.06. FE-computed axial stiffnesses were 768 N/mm (construct A), 1023 N/mm (construct B), and 1102 N/mm (construct C). FE surfaces stress maps for cortical bone showed Von Mises stresses, excluding peaks, of 0-8 MPa (construct A), 0-15 MPa (construct B), and 0-20 MPa (construct C). Cables absorbed the majority of load, followed by the plates and then the screws. Construct A yielded peak stress at one of the empty holes in the plate. Constructs B and C had similar bone stress patterns, and can achieve optimal fixation. PMID:22070022

  16. Biomechanical properties of a structurally optimized carbon-fibre/epoxy intramedullary nail for femoral shaft fracture fixation.

    PubMed

    Samiezadeh, Saeid; Fawaz, Zouheir; Bougherara, Habiba

    2016-03-01

    Intramedullary nails are the golden treatment option for diaphyseal fractures. However, their high stiffness can shield the surrounding bone from the natural physiologic load resulting in subsequent bone loss. Their stiff structure can also delay union by reducing compressive loads at the fracture site, thereby inhibiting secondary bone healing. Composite intramedullary nails have recently been introduced to address these drawbacks. The purpose of this study is to evaluate the mechanical properties of a previously developed composite IM nail made of carbon-fibre/epoxy whose structure was optimized based on fracture healing requirements using the selective stress shielding approach. Following manufacturing, the cross-section of the composite nail was examined under an optical microscope to find the porosity of the structure. Mechanical properties of the proposed composite intramedullary nail were determined using standard tension, compression, bending, and torsion tests. The failed specimens were then examined to obtain the modes of failure. The material showed high strength in tension (403.9±7.8MPa), compression (316.9±10.9MPa), bending (405.3±8.1MPa), and torsion (328.5±7.3MPa). Comparing the flexural modulus (41.1±0.9GPa) with the compressive modulus (10.0±0.2GPa) yielded that the material was significantly more flexible in compression than in bending. This customized flexibility along with the high torsional stiffness of the nail (70.7±2.0Nm(2)) has made it ideal as a fracture fixation device since this unique structure can stabilize the fracture while allowing for compression of fracture ends. Negligible moisture absorption (~0.5%) and low porosity of the laminate structure (< 3%) are other advantages of the proposed structure. The findings suggested that the carbon-fibre/epoxy intramedullary nail is flexible axially while being relatively rigid in bending and torsion and is strong enough in all types of physiologic loading, making it a potential

  17. Biomechanical properties of a structurally optimized carbon-fibre/epoxy intramedullary nail for femoral shaft fracture fixation.

    PubMed

    Samiezadeh, Saeid; Fawaz, Zouheir; Bougherara, Habiba

    2016-03-01

    Intramedullary nails are the golden treatment option for diaphyseal fractures. However, their high stiffness can shield the surrounding bone from the natural physiologic load resulting in subsequent bone loss. Their stiff structure can also delay union by reducing compressive loads at the fracture site, thereby inhibiting secondary bone healing. Composite intramedullary nails have recently been introduced to address these drawbacks. The purpose of this study is to evaluate the mechanical properties of a previously developed composite IM nail made of carbon-fibre/epoxy whose structure was optimized based on fracture healing requirements using the selective stress shielding approach. Following manufacturing, the cross-section of the composite nail was examined under an optical microscope to find the porosity of the structure. Mechanical properties of the proposed composite intramedullary nail were determined using standard tension, compression, bending, and torsion tests. The failed specimens were then examined to obtain the modes of failure. The material showed high strength in tension (403.9±7.8MPa), compression (316.9±10.9MPa), bending (405.3±8.1MPa), and torsion (328.5±7.3MPa). Comparing the flexural modulus (41.1±0.9GPa) with the compressive modulus (10.0±0.2GPa) yielded that the material was significantly more flexible in compression than in bending. This customized flexibility along with the high torsional stiffness of the nail (70.7±2.0Nm(2)) has made it ideal as a fracture fixation device since this unique structure can stabilize the fracture while allowing for compression of fracture ends. Negligible moisture absorption (~0.5%) and low porosity of the laminate structure (< 3%) are other advantages of the proposed structure. The findings suggested that the carbon-fibre/epoxy intramedullary nail is flexible axially while being relatively rigid in bending and torsion and is strong enough in all types of physiologic loading, making it a potential

  18. Titanium alloys as fixation device material for cranioplasty and its safety in electroconvulsive therapy.

    PubMed

    Kaido, Takanobu; Noda, Takamasa; Otsuki, Taisuke; Kaneko, Yuu; Takahashi, Akio; Nakai, Tetsuji; Nabatame, Maki; Tani, Mariko

    2011-03-01

    Here, we report the case of a patient successfully treated by a series of electroconvulsive therapy (ECT) who had implanted skull fixation devices made of titanium alloy. The patient was a 57-year-old man with bipolar I disorder. He was hospitalized for the treatment of manic symptoms of bipolar I disorder with pharmacotherapy and ECT. He sustained a fall and hit his head hard on the ground. Acute subdural hematoma developed, and emergent surgery to remove the hematoma was carried out. Cranioplasty was performed using fixation devices made of titanium alloy (Ti 6Al-4V). In order to control his manic symptoms, a series of ECT was readministered from 1 week after surgery. No adverse effects occurred. Devices must be investigated and chosen very carefully for permanent implantation, especially in patients during a course of ECT.

  19. Regional alterations in long bone 85Sr clearance produced by internal fixation devices. Part II. Histomorphometry.

    PubMed

    Simmons, D J; Daum, W J; Calhoun, J H

    1988-01-01

    The effects of each of the surgical stages involved in compression plating on the development of cortical thinning and porosity were assessed in the intact midshaft, stress-shielded femoral segments of adult mongrel dogs 6 months postoperatively. The data were evaluated in terms of a postsurgical tetracycline-based measure of remodeling and terminal 85Sr clearance (SrC) values for the plated segments of bone. Drilling had no effect on any parameter. Screw application was associated with minimal cortical thinning (p less than 0.05), while plate fixation clearly promoted thinning (p less than 0.01) and porosity (p less than 0.05). The percentage of labeled osteons, a measure of remodeling activity, increased only after plate fixation (p less than 0.05), and the labeling patterns suggested that most osteons had formed during the first 4 postsurgical months. That none of these changes were correlated with the 6-month SrC values suggests that the development of plate-induced osteopenia involves disparate histomorphometric time constants, rather than lack of any association. PMID:3225712

  20. Early postoperative failure of a new intramedullary fixation device for midshaft clavicle fractures.

    PubMed

    Wilson, David J; Weaver, DeWayne L; Balog, Todd P; Arrington, Edward D

    2013-11-01

    The Sonoma CRx device (Sonoma Orthopedic Products, Santa Rosa, California) is a recently introduced intramedullary device with a flexible shaft that becomes rigid once actuated to allow deployment within the sigmoidal contour of the clavicular shaft. Medial intramedullary cortical purchase is obtained by grippers and lateral purchase through a locking bicortical buttressing screw. This article describes 2 cases of early hardware failure using this device. In both cases, early postoperative radiographs demonstrate adequate initial fracture reduction and implant position. Both patients sustained repeat injuries, one under low physiologic load and the other after returning to mixed martial arts 4 months postoperatively. Implant failure was noted after reinjury in both cases. Complete healing and full return to function was documented for both patients at 2 years. Proper patient selection and counseling regarding the limitations of this intramedullary fixation device are important. Biomechanical comparison of this implant to plate fixation under physiologic loads of combined axial compression and torsion may shed light on differences in fixation stability. PMID:24200452

  1. An external fixation method and device to study fracture healing in rats.

    PubMed

    Mark, Hans; Bergholm, Jan; Nilsson, Anders; Rydevik, Björn; Strömberg, Lennart

    2003-08-01

    We wished to establish a reproducible model for fracture fixation to be used in fracture healing research and therefore developed an external fixation construct and surgical procedure adapted to Sprague-Dawley rats. We evaluated the mechanical properties of the construct in brass rods and rat bone, in an Instron test machine with axial and transverse loading, and the in vivo performance. We found that the mechanical properties of the construct in brass rods were predictable and could be repeated in rat femora. In all tests, the axial load was about 10 times the transverse for the same degree of deformation. The stiffness among fixators was uniform. 1 mm pins caused about 50% less stiffness than 1.2 mm pins in axial loading of rat bone (p < 0.001) and brass rods (p < 0.001) as well as in transverse loading of brass rods (p < 0.001). Loosening of 1 or 2 screws that lock the pins to the fixator reduced stiffness by about 50% in axial loading of rat bone (p = 0.009) and brass rods (p = 0.05). A change in the distance between the bone surface and the fixator was linearly related to the stiffness in axial loading of rat bone (p < 0.001) and brass rods (p < 0.001) and in transverse loading of brass rods (p < 0.001). If the bone ends touched each other, the axial stiffness of the construct increased almost 10 times (265 N/mm), as compared to a fracture gap size of 2 mm (31 N/mm). In vivo experiments had a complication rate of less than 10% when we used 1.2 mm pins, 6 mm offset and rats weighing 350-450 g. Our method and device for experimental external fixation of rat femora are reliable and the findings are reproducible. These can be used in bone repair and fracture healing research. PMID:14521302

  2. Finite element analysis of a bone healing model: 1-year follow-up after internal fixation surgery for femoral fracture

    PubMed Central

    Jiang-jun, Zhou; Min, Zhao; Ya-bo, Yan; Wei, Lei; Ren-fa, Lv; Zhi-yu, Zhu; Rong-jian, Chen; Wei-tao, Yu; Cheng-fei, Du

    2014-01-01

    Objective: Finite element analysis was used to compare preoperative and postoperative stress distribution of a bone healing model of femur fracture, to identify whether broken ends of fractured bone would break or not after fixation dislodgement one year after intramedullary nailing. Method s: Using fast, personalized imaging, bone healing models of femur fracture were constructed based on data from multi-slice spiral computed tomography using Mimics, Geomagic Studio, and Abaqus software packages. The intramedullary pin was removed by Boolean operations before fixation was dislodged. Loads were applied on each model to simulate a person standing on one leg. The von Mises stress distribution, maximum stress, and its location was observed. Results : According to 10 kinds of display groups based on material assignment, the nodes of maximum and minimum von Mises stress were the same before and after dislodgement, and all nodes of maximum von Mises stress were outside the fracture line. The maximum von Mises stress node was situated at the bottom quarter of the femur. The von Mises stress distribution was identical before and after surgery. Conclusion : Fast, personalized model establishment can simulate fixation dislodgement before operation, and personalized finite element analysis was performed to successfully predict whether nail dislodgement would disrupt femur fracture or not. PMID:24772140

  3. MR imaging and cervical fixation devices: evaluation of ferromagnetism, heating, and artifacts at 1.5 Tesla.

    PubMed

    Shellock, F G

    1996-01-01

    The purpose of this study was to assess ferromagnetism, heating, and artifacts for cervical fixation devices exposed to a 1.5 T MR system. Cervical fixation devices (three halos, one tong and two halo vests) were evaluated for compatibility with MR procedures. Ferromagnetism was determined using a previously described technique. Heating was evaluated by measuring temperatures at various positions on the cervical fixation devices while applied to a volunteer subject before and during the use of various pulse sequences, including an magnetization transfer contrast (MTC) sequence. Artifacts associated with routine clinical MR imaging of the cervical spine were qualitatively evaluated with the cervical fixation devices applied to a volunteer subject. None of the devices displayed attraction to the magnetic field. The temperature changes were +/-1.5 degrees C in each instance. The MTC pulse sequence produced a sensation of "heating" the skull pins that may have been caused by vibration of the cervical fixation device. The MR images of the cervical spine were obtained without apparent artifacts using each routine, clinical pulse sequence. The lack of ferromagnetism, negligible heating, and capability of obtaining diagnostically acceptable studies of the cervical spine indicate that MR imaging performed at 1.5 T or less may be conducted safely in patients with each of the cervical fixation devices tested using conventional pulse sequences. PMID:9071001

  4. Analysis of using antirotational device on cephalomedullary nail for proximal femoral fractures☆☆☆

    PubMed Central

    Takano, Marcelo Itiro; de Moraes, Ramon Candeloro Pedroso; de Almeida, Luis Gustavo Morato Pinto; Queiroz, Roberto Dantas

    2014-01-01

    Objective To analyze the influence of femoral neck diameter in the positioning of the sliding screw in cefalomedulares nails for treatment of unstable transtrochanteric fractures. Methods Prospectively throughout 2011, patients with unstable fractures transtrochanteric undergoing osteosynthesis with cephalomedullary nail using antirotacional device. They were evaluated for sex, age and fracture classification according to Tronzo. Through digital radiographs angle reduction, tip apex distance (TAD), stem diameter and measures between the positioning of the screws and the limits of the cervix were measured. Results Of the 58 patients, 42 (72.4%) were female and 16 (27.6%) were male. 33 patients were classified as Tronzo III (56.9%), 6 patients as Tronzo IV (10.4%) and 19 as Tronzo V (19.8%). The majority were in between the eighth and ninth decade of life. The average reduction in the angle was 130.05° for females and 129.4° for males. The TAD average was 19.7 mm for females and 21.6 for males. The average diameter of the neck and head vary with statistical significance between men and women. In 19 patients the placement of the sliding bolt can be optimal. If the ideal positioning was not possible, the mean displacement for non‐infringement of higher cortical neck was 4.06 mm. Conclusion The optimal placement would not be possible for the majority of the population, for the average diameter of the neck of the sample. PMID:26229767

  5. Safety and Effectiveness of Closure Devices Applied to a Stented Common Femoral Artery: A Retrospective Analysis.

    PubMed

    Shammas, Nicolas W; Shammas, Gail A; Harris, Thomas; Voelliger, Cara M; Shammas, Andrew N; Jerin, Michael

    2016-09-01

    Bailout stenting of the common femoral artery (CFA) may become necessary with failed balloon angioplasty or atherectomy or in case of bleeding requiring a covered stent over the arteriotomy site. Reaccessing the CFA through a previously placed stent may occur during angiography. The safety and effectiveness of applying a closure device, or manual compression to achieve hemostasis through an accessed stented CFA are unknown. All patients in our practice that underwent CFA stenting were identified using billing records for 3 years (January 1, 2010-February 28, 2013). Patients were included if there has been documentation of access through the stented CFA segment on angiography. In-hospital and up to 2 weeks postdischarge major adverse events were recorded from medical records. A total of 48 patients were included in the study. The mean age was 65.9 ± 10.9 years, males 60.4%. Perclose (Abbott Vascular, Santa Clara, CA) was used in 85.7%, AngioSeal (St. Jude Medical, St. Paul, MN) in 8.3%, Mynx (Access Closure, Santa Clara, CA) in 2%, and manual compression in 4% of the patients. Major adverse events consisted of in-hospital mortality in two patients: one probably related to index access-site thrombosis complicated by subsequent acute renal failure following reintervention; the other mortality was related to major bleeding possibly related to the index access site. The remaining patients had no adverse events and there were no reported problems at 2 weeks follow-up. Accessing and applying closure device in stented CFA can be accomplished successfully in approximately 96% of the patients with low major adverse events. PMID:27574383

  6. Feasibility and Safety of Vascular Closure Devices in an Antegrade Approach to Either the Common Femoral Artery or the Superficial Femoral Artery

    SciTech Connect

    Gutzeit, Andreas Schie, Bram van Schoch, Eric; Hergan, Klaus; Graf, Nicole Binkert, Christoph A.

    2012-10-15

    Introduction: The purpose of the present study was to analyze complications following antegrade puncture of the common femoral artery (CFA) and the superficial femoral artery (SFA) using vascular closure systems (VCS). Methods: A single-center, retrospective study was performed after obtaining approval from the institutional review board and informed consent from all patients. At our center, the CFA or SFA are used for arterial access. All patients were evaluated clinically on the same day. If there was any suspicion of an access site problem, Duplex ultrasound was performed. Results: Access location was the CFA in 50 patients and the SFA in 130 patients. The sheath size ranged from 4F to 10F. Two patients had to be excluded because of lack of follow-up. Successful hemostasis was achieved in 162 of 178 cases (91 %). The following complications were observed in 16 patients (8.9 %): 4 pseudoaneurysms (2.2 %), 11 hematomas (6.2 %), and 1 vascular occlusion (0.5 %). The two pseudoaneurysms healed spontaneously, in one case an ultrasound-guided thrombin injection was performed, and one aneurysm was compressed manually. No further medical therapy was needed for the hematomas. The one vascular occlusion was treated immediately with angioplasty using a contralateral approach. No significant difference was noted between the CFA and the SFA group with respect to complications (p = 1.000). Conclusions: The use of closure devices for an antegrade approach up to 10F is feasible and safe. No differences in low complication rates were observed between CFA and SFA.

  7. Three-dimensional stabilization provided by the external spinal fixator compared to two internal fixation devices: a biomechanical in vitro flexibility study.

    PubMed

    Lund, Teija; Nydegger, Thomas; Rathonyi, Gabor; Nolte, Lutz-Peter; Schlenzka, Dietrich; Oxland, Thomas R

    2003-10-01

    We performed an in vitro study to investigate the stabilization (i.e. motion reduction) provided by the external spinal fixator (ESF), and to compare the three configurations of the ESF with two internal fixation techniques. Six human cadaveric lumbar spine specimens (L3-S1) were subjected to multidirectional flexibility testing in six configurations: (1) intact, (2) ESF in neutral, (3) ESF in distraction, (4) ESF in compression, (5) translaminar facet screw fixation, and (6) internal transpedicular fixation. Both the ESF and the internal fixation systems stabilized the specimens from L4 to S1. In each testing configuration, pure bending moments of flexion-extension, bilateral axial rotation, and bilateral lateral bending were applied to the uppermost vertebra stepwise to a maximum of 10 Nm. The rigid body motion between the vertebrae was measured using an optoelectronic camera system, and custom software was used to calculate the intervertebral rotations. For each applied motion in all testing configurations, the total range of motion (ROM) of L4-S1 is reported. All three ESF configurations stabilized the spine significantly when compared to the intact specimen. The ESF in compression provided significantly more stabilization in flexion-extension than the two other ESF configurations, but no other significant differences were found between the three ESF modes. In flexion-extension the ESF stabilized the spine significantly when compared with the two internal fixation devices. Only in bilateral lateral bending was the ESF inferior to internal transpedicular fixation in providing stabilization. The results of the present study suggest that the ESF provides a high degree of stabilization for preoperative assessment of selected low back pain patients. Whether other non-mechanical factors affect the pain relief experienced by the patients remains unknown.

  8. Negative pressure wound therapy and external fixation device: a simple way to seal the dressing.

    PubMed

    Bulla, Antonio; Farace, Francesco; Uzel, André-Pierre; Casoli, Vincent

    2014-07-01

    Negative pressure therapy is widely applied to treat lower limb trauma. However, sealing a negative pressure dressing in the presence of an external fixation device may be difficult and time consuming. Therefore, screws, pins, wires, etc, may preclude the vacuum, preventing the plastic drape to perfectly adhere to the foam. To maintain the vacuum, we tried to prevent air leaking around the screws putting bone wax at the junction between the pins and the plastic drape. This solution, in our hands, avoids air leakage and helps maintain vacuum in a fast and inexpensive way. PMID:24296597

  9. Surgical outcome following arthroscopic fixation of acromioclavicular joint disruption with the tightrope device.

    PubMed

    Thiel, Eric; Mutnal, Amar; Gilot, Gregory J

    2011-07-07

    The objective of this study was to evaluate the preliminary radiographic and clinical results of grade IV and V acromioclavicular joint disruption repair using the arthroscopic Arthrex acromioclavicular TightRope (Naples, Florida) fixation technique. Numerous procedures have been described for surgical management of acromioclavicular joint disruption. The TightRope device involves an arthroscopic technique that allows nonrigid anatomic fixation of the acromioclavicular joint. A cohort of 10 men and 2 women with a mean age of 43 years (range, 25-61 years) underwent the acromioclavicular joint TightRope procedure between April 2007 and October 2009. Eleven patients had either Rockwood grade IV or V disruptions and 1 sustained a distal third clavicle fracture with acromioclavicular joint disruption. Data was collected from a chart review. Patients were evaluated clinically, radiographically, by the simple shoulder test, and by overall satisfaction. There were 2 failures of reduction and 1 loss of reduction at final radiographic follow-up. The rate of fixation failure was 16.6%. All patients had >110° of total elevation. The majority of patients obtained satisfactory functional results according to the Simple Shoulder Test averaging 11 of 12 questions answered positively (range, 7-12; standard deviation, 1.50) and 11 of 12 patients were satisfied with the procedure. At final phone interview at approximately 2 years postoperatively, 6 patients were lost to follow-up. The remaining patients were all satisfied with the procedure and no patients reported subjective loss of reduction or deterioration of function. Simple Shoulder Test average was maintained with 11 of 12 positively answered questions (range, 7-12; standard deviation, 2.0) This case series revealed a high rate of fixation failure with the TightRope system. Still, most patients were satisfied with the procedure and achieved high functional shoulder results.

  10. [The characteristics of the technical instrumental support for the osteosynthesis of femoral neck fractures using the Seppo fixator].

    PubMed

    Mel'tser, R I; Oshukova, S M; Ivanova, I U; Dudanov, I P

    1997-01-01

    Operative treatment of fractures of the femur neck is the method of choice. The authors prefer the A. Seppo construction out of great number of fixtures but it is difficult to introduce and remove this fixture due to its complexity. To make the procedure of such interventions easier the authors propose a marking device, a screwdriver and a device allowing the fixture's curvature to be regulated. The modification of the technique and using a specially developed extractor is explained by difficulties in removing the fixture by common methods. The variant of the improved instrumental tooling proposed by the authors makes the operation more handy and practicable.

  11. The Inflammatory Response to Femoral Arterial Closure Devices: A Randomized Comparison Among FemoStop, AngioSeal, and Perclose

    SciTech Connect

    Jensen, Jens Saleh, Nawzad; Jensen, Ulf; Svane, Bertil; Joensson, Anders; Tornvall, Per

    2008-07-15

    The objectives of this study were to investigate whether the systemic inflammatory response differs, in patients undergoing coronary angiography, among the arterial closure devices FemoStop, AngioSeal, and Perclose. The study is a prospective and randomized study. We measured pre- and postprocedural C-reactive protein (CRP), fibrinogen, and interleukin-6 (IL-6) plasma levels and collected clinical and procedural data on 77 patients who underwent coronary angiography because of stable angina pectoris. Patients were randomized to the following device: FemoStop (mechanical compression), AngioSeal (anchor and collagen sponge), or Perclose (nonabsorbable suture). No patient group experienced an increased incidence of vascular complications. There were no differences among the three groups regarding CRP, fibrinogen, or IL-6 values before or after coronary angiography. IL-6 levels increased 6 h after the procedure in all groups (p < 0.01), however, the increase did not differ among the groups. After 30 days there were no increased values of CRP or fibrinogen. We conclude that the femoral arterial closure devices AngioSeal and Perclose do not enhance an inflammatory response after a diagnostic coronary angiography, measured by CRP, fibrinogen, and IL-6, compared to femoral arterial closure using a mechanical compression device.

  12. A laboratory investigation to assess the influence of cement augmentation of screw and plate fixation in a simulation of distal femoral fracture of osteoporotic and non-osteoporotic bone.

    PubMed

    Wähnert, D; Lange, J H; Schulze, M; Gehweiler, D; Kösters, C; Raschke, M J

    2013-10-01

    The augmentation of fixation with bone cement is increasingly being used in the treatment of severe osteoporotic fractures. We investigated the influence of bone quality on the mechanics of augmentation of plate fixation in a distal femoral fracture model (AO 33 A3 type). Eight osteoporotic and eight non-osteoporotic femoral models were randomly assigned to either an augmented or a non-augmented group. Fixation was performed using a locking compression plate. In the augmented group additionally 1 ml of bone cement was injected into the screw hole before insertion of the screw. Biomechanical testing was performed in axial sinusoidal loading. Augmentation significantly reduced the cut-out distance in the osteoporotic models by about 67% (non-augmented mean 0.30 mm (sd 0.08) vs augmented 0.13 mm (sd 0.06); p = 0.017). There was no statistical reduction in this distance following augmentation in the non-osteoporotic models (non-augmented mean 0.15 mm (sd 0.02) vs augmented 0.15 mm (sd 0.07); p = 0.915). In the osteoporotic models, augmentation significantly increased stability (p = 0.017). PMID:24078541

  13. Mechanical Behaviour of Umbrella-Shaped, Ni-Ti Memory Alloy Femoral Head Support Device during Implant Operation: A Finite Element Analysis Study

    PubMed Central

    Yi, Wei; Tian, Qing; Dai, Zhipeng; Liu, Xiaohu

    2014-01-01

    A new instrument used for treating femoral head osteonecrosis was recently proposed: the umbrella-shaped, Ni-Ti memory femoral head support device. The device has an efficacy rate of 82.35%. Traditional radiographic study provides limited information about the mechanical behaviour of the support device during an implant operation. Thus, this study proposes a finite element analysis method, which includes a 3-step formal head model construction scheme and a unique material assignment strategy for evaluating mechanical behaviour during an implant operation. Four different scenarios with different constraints, initial positions and bone qualities are analyzed using the simulation method. The max radium of the implanted device was consistent with observation data, which confirms the accuracy of the proposed method. To ensure that the device does not unexpectedly open and puncture the femoral head, the constraint on the impact device should be strong. The initial position of sleeve should be in the middle to reduce the damage to the decompression channel. The operation may fail because of poor bone quality caused by severe osteoporosis. The proposed finite element analysis method has proven to be an accurate tool for studying the mechanical behaviour of umbrella-shaped, Ni-Ti memory alloy femoral head support device during an implant operation. The 3-step construct scheme can be implemented with any kind of bone structure meshed with multiple element types. PMID:24960038

  14. Characterization of short-fibre reinforced thermoplastics for fracture fixation devices.

    PubMed

    Brown, S A; Hastings, R S; Mason, J J; Moet, A

    1990-10-01

    This study focuses on determining the effects of clinically relevant procedures on the flexural and fracture toughness properties of three short-fibre thermoplastic composites for potential application as fracture fixation devices. The procedures included sterilization, heat contouring and saline soaking. The three materials tested were polysulphone, polybutylene terephthalate and polyetheretherketone, all reinforced with 30% short carbon fibres. The polysulphone composite showed significant degradation in mechanical properties due to saline soaking. The polybutylene terephthalate exhibited significant degradation of mechanical properties following both contouring and saline soaking. The polyetheretherketone composite, however, exhibited no degradation in mechanical properties. The results demonstrated that flexion and fracture toughness testing were effective for determining the response of the composites to different applied conditions and demonstrated the stability of polyetheretherketone subjected to these treatments. Scanning electron microscopy demonstrated the most effective fibre-matrix bonding to be in the polyetheretherketone.

  15. A New Case of Fracture of a Modular Femoral Neck Device After a Total Hip Arthroplasty

    PubMed Central

    Trieb, Klemens; Stadler, Nicola

    2015-01-01

    This report addresses a new case of a modular femoral neck fracture after total hip arthroplasty. A now seventy-three-year- old overweight female underwent total hip replacement of the right hip because of osteoarthritis in the year 2002. Then, years later, the head and the polyethylene were changed due to wear. In October 2014, the patient was transferred from the trauma department of her hometown to our department after she had slipped and fallen directly on her right hip. The x-rays done at the trauma department have shown no periprosthetic fracture but a fracture of the modular neck. Therefore, the patient was transferred to our department in order to undergo a revision arthroplasty with change of the stem and head after splitting the femur. PMID:26157528

  16. Oxinium femoral head damage generated by a metallic foreign body within the polyethylene cup following recurrent dislocation episodes.

    PubMed

    Gibon, E; Scemama, C; David, B; Hamadouche, M

    2013-11-01

    Oxinium femoral heads are supposed to be more scratch-resistant thanks to their oxidized layer. However, damages to this thin layer can jeopardize implant's properties. Following revision total hip arthroplasty performed for recurrent posterior dislocations, the Oxinium femoral head initially implanted was observed to be dramatically damaged. A metallic foreign body from a trochanteric fixation wire was found within the polyethylene cup. Only few cases of damaged Oxinium femoral heads have been reported and all were related to either dislocation or reduction of THA. The aim of this report is to describe a non-reported mechanism of damaged Oxinium femoral head due to a broken trochanteric fixation wire device. Any broken metallic wire from a transtrochanteric approach should be carefully followed to detect migration within the polyethylene cup. If such a migration occurs, revision surgery should be rapidly scheduled.

  17. JetStream atherectomy for treating iatrogenic occlusion of a stented common femoral artery following deployment of angio-seal closure device.

    PubMed

    Shammas, Nicolas W

    2013-09-01

    We report a case of a stented common femoral artery acute occlusion following deployment of an Angio-Seal closure device treated successfully with JetStream atherectomy under distal embolic protection using a NAV6 filter. The JetStream device, with its rotational atherectomy and continuous active aspiration feature, was effective in restoring normal flow to the distal lower extremity and eliminated the subtotal occlusion. Debris was captured in the filter and was retrieved successfully. The NAV6 filter seems uniquely suited for use in conjunction with the JetStream device because its filter is detached from the wire, allowing free wire movement with atherectomy. The JetStream device with NAV6 embolic capture system appears to be an effective method in treating stented common femoral artery occlusion following Angio-Seal deployment. PMID:23995724

  18. Fixation filter, device for the rapid in situ preservation of particulate samples

    NASA Astrophysics Data System (ADS)

    Taylor, C. D.; Edgcomb, V. P.; Doherty, K. W.; Engstrom, I.; Shanahan, T.; Pachiadaki, M. G.; Molyneaux, S. J.; Honjo, S.

    2015-02-01

    Niskin bottle rosettes have for years been the workhorse technology for collection of water samples used in biological and chemical oceanography. Studies of marine microbiology and biogeochemical cycling that aim to analyze labile organic molecules including messenger RNA, must take into account factors associated with sampling methodology that obscure an accurate picture of in situ activities/processes. With Niskin sampling, the large and often variable times between sample collection and preservation on deck of a ship, and the sometimes significant physico-chemical changes (e.g., changes in pressure, light, temperature, redox state, etc.) that water samples and organisms are exposed to, are likely to introduce artifacts. These concerns are likely more significant when working with phototrophs, deep-sea microbes, and/or organisms inhabiting low-oxygen or anoxic environments. We report here the development of a new technology for the in situ collection and chemical preservation of particulate microbial samples for a variety of downstream analyses depending on preservative choice by the user. The Fixation Filter Unit, version 3 (FF3) permits filtration of water sample through 47 mm diameter filters of the user's choice and upon completion of filtration, chemically preserves the retained sample within 10's of seconds. The stand-alone devices can be adapted to hydrocasting or mooring-based platforms.

  19. The Use of ExoSeal Vascular Closure Device for Direct Antegrade Superficial Femoral Artery Puncture Site Hemostasis

    SciTech Connect

    Rimon, Uri Khaitovich, Boris; Yakubovich, Dmitry; Bensaid, Paul Golan, Gil; Silverberg, Daniel

    2015-06-15

    PurposeThis study was designed to assess the efficacy and safety of the ExoSeal vascular closure device (VCD) to achieve hemostasis in antegrade access of the superficial femoral artery (SFA).MethodsWe retrospectively reviewed the outcome of ExoSeal VCD used for hemostasis in 110 accesses to the SFA in 93 patients between July 2011 and July 2013. All patients had patent proximal SFA based on computer tomography angiography or ultrasound duplex. Arterial calcifications at puncture site were graded using fluoroscopy. The SFA was accessed in an antegrade fashion with ultrasound or fluoroscopic guidance. In all patients, 5–7F vascular sheaths were used. The ExoSeal VCD was applied to achieve hemostasis at the end of the procedure. All patients were clinically examined and had ultrasound duplex exam for any puncture site complications during the 24 h postprocedure.ResultsIn all procedures, the ExoSeal was applied successfully. We did not encounter any device-related technical failure. There were four major complications in four patients (3.6 %): three pseudoaneurysms, which were treated with direct thrombin injection, and one hematoma, which necessitated transfusion of two blood units. All patients with complications were treated with anticoagulation preprocedure or received thrombolytic therapy.ConclusionsThe ExoSeal VCD can be safely used for antegrade puncture of the SFA, with a high procedural success rate (100 %) and a low rate of access site complications (3.6 %)

  20. Refined methodology for implantation of a head fixation device and chronic recording chambers in non-human primates.

    PubMed

    Lanz, F; Lanz, X; Scherly, A; Moret, V; Gaillard, A; Gruner, P; Hoogewoud, H M; Belhaj-Saif, A; Loquet, G; Rouiller, E M

    2013-10-15

    The present study was aimed at developing a new strategy to design and anchor custom-fitted implants, consisting of a head fixation device and a chronic recording chamber, on the skull of adult macaque monkeys. This was done without the use of dental resin or orthopedic cement, as these modes of fixation exert a detrimental effect on the bone. The implants were made of titanium or tekapeek and anchored to the skull with titanium screws. Two adult macaque monkeys were initially implanted with the head fixation device several months previous to electrophysiological investigation, to allow optimal osseous-integration, including growth of the bone above the implant's footplate. In a second step, the chronic recording chamber was implanted above the brain region of interest. The present study proposes two original approaches for both implants. First, based on a CT scan of the monkey, a plastic replicate of the skull was obtained in the form of a 3D print, used to accurately shape and position the two implants. This would ensure a perfect match with the skull surface. Second, the part of the implants in contact with the bone was coated with hydroxyapatite, presenting chemical similarity to natural bone, thus promoting excellent osseous-integration. The longevity of the implants used here was 4 years for the head fixation device and 1.5 years for the chronic chamber. There were no adverse events and daily care was easy. This is clear evidence that the present implanting strategy was successful and provokes less discomfort to the animals.

  1. Refined methodology for implantation of a head fixation device and chronic recording chambers in non-human primates.

    PubMed

    Lanz, F; Lanz, X; Scherly, A; Moret, V; Gaillard, A; Gruner, P; Hoogewoud, H M; Belhaj-Saif, A; Loquet, G; Rouiller, E M

    2013-10-15

    The present study was aimed at developing a new strategy to design and anchor custom-fitted implants, consisting of a head fixation device and a chronic recording chamber, on the skull of adult macaque monkeys. This was done without the use of dental resin or orthopedic cement, as these modes of fixation exert a detrimental effect on the bone. The implants were made of titanium or tekapeek and anchored to the skull with titanium screws. Two adult macaque monkeys were initially implanted with the head fixation device several months previous to electrophysiological investigation, to allow optimal osseous-integration, including growth of the bone above the implant's footplate. In a second step, the chronic recording chamber was implanted above the brain region of interest. The present study proposes two original approaches for both implants. First, based on a CT scan of the monkey, a plastic replicate of the skull was obtained in the form of a 3D print, used to accurately shape and position the two implants. This would ensure a perfect match with the skull surface. Second, the part of the implants in contact with the bone was coated with hydroxyapatite, presenting chemical similarity to natural bone, thus promoting excellent osseous-integration. The longevity of the implants used here was 4 years for the head fixation device and 1.5 years for the chronic chamber. There were no adverse events and daily care was easy. This is clear evidence that the present implanting strategy was successful and provokes less discomfort to the animals. PMID:23933327

  2. Investigation of metallic and carbon fibre PEEK fracture fixation devices for three-part proximal humeral fractures.

    PubMed

    Feerick, Emer M; Kennedy, Jim; Mullett, Hannan; FitzPatrick, David; McGarry, Patrick

    2013-06-01

    A computational investigation of proximal humeral fracture fixation has been conducted. Four devices were selected for the study; a locking plate, intramedullary nail (IM Nail), K-wires and a Bilboquet device. A 3D model of a humerus was created using a process of thresholding based on the grayscale values of a CT scan of an intact humerus. An idealised three part fracture was created in addition to removing a standard volume from the humeral head as a representation of bone voids that occur as a result of the injury. All finite element simulations conducted represent 90° arm abduction. Simulations were conducted to investigate the effect of filling this bone void with calcium phosphate cement for each device. The effect of constructing devices from carbon fibre polyetheretherketone (CFPEEK) was investigated. Simulations of cement reinforced devices predict greater stability for each device. The average unreinforced fracture line opening (FLO) is reduced by 48.5% for metallic devices with a lesser effect on composite devices with FLO reduced by 23.6%. Relative sliding (shear displacement) is also reduced between fracture fragments by an average of 58.34%. CFPEEK device simulations predict reduced stresses at the device-bone interface.

  3. Extra-articular extraosseous migration of a bioabsorbable femoral interference screw after ACL reconstruction.

    PubMed

    Sharma, Vivek; Curtis, Christine; Micheli, Lyle

    2008-10-01

    Anterior cruciate ligament (ACL) reconstruction is quite commonly used to treat anterior knee instability. Surgeon preference and patient functional goals determine graft selection and graft fixation techniques. Interference screws are considered a safe and effective device for graft fixation in surgical ACL reconstruction. Poly-L-lactide acid (PLLA) bioabsorbable interference screws are becoming increasingly popular in ACL reconstruction surgery. There are several reasons why they may be more advantageous than metallic screws, including reduced graft laceration during insertion, ease of performance of revision procedures, avoidance of graft injury encountered with aperture fixation using metallic screws, and fewer artifacts on magnetic resonance images (MRI). Few studies describe complications associated with PLLA bioabsorbable screws, particularly extra-articular screw migration. This article presents a case of an extra-articular extraosseous migration of the femoral bioabsorbable interference screw. This case further demonstrates the problem of the femoral bioabsorbable interference screw.

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

    PubMed

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

    2014-10-01

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

  5. 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

  6. 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.

  7. A Novel Technique Using Customized Headgear for Fixation of Rigid External Distraction Device in an Infant With Crouzon Syndrome.

    PubMed

    Hariri, Firdaus; Rahman, Zainal Ariff Abdul; Mahdah, Saridah; Mathaneswaran, Vickneswaran; Ganesan, Dharmendra

    2015-11-01

    Rigid external distraction device is often indicated for superior midfacial advancement in pediatric syndromic craniosynostosis patients. Even though the technique is proven reliable to treat the functional issues related to the craniofacial deformity, major complications associated with its fixation, such as intracranial pin perforation and migration have been reported. We report a novel technique of using a customized headgear to prevent intracranial pin perforation over a very thin temporal bone region in an 8-month-old infant with Crouzon syndrome who underwent monobloc Le Fort III distraction osteogenesis using a combination of bilateral internal and a rigid external distraction device. The customized headgear provides a protective platform at the temporal region thus preventing intracranial pin perforation and allows stable fixation during the early phase of consolidation period to prevent central component relapse. The headgear can be used short term when rigid external distractor is indicated in infant patient but requires close monitoring because of risks of skin necrosis and temporal region indentation. PMID:26594993

  8. Fixation using alternative implants for the treatment of hip fractures (FAITH): design and rationale for a multi-centre randomized trial comparing sliding hip screws and cancellous screws on revision surgery rates and quality of life in the treatment of femoral neck fractures

    PubMed Central

    2014-01-01

    Background Hip fractures are a common type of fragility fracture that afflict 293,000 Americans (over 5,000 per week) and 35,000 Canadians (over 670 per week) annually. Despite the large population impact the optimal fixation technique for low energy femoral neck fractures remains controversial. The primary objective of the FAITH study is to assess the impact of cancellous screw fixation versus sliding hip screws on rates of revision surgery at 24 months in individuals with femoral neck fractures. The secondary objective is to determine the impact on health-related quality of life, functional outcomes, health state utilities, fracture healing, mortality and fracture-related adverse events. Methods/Design FAITH is a multi-centre, multi-national randomized controlled trial utilizing minimization to determine patient allocation. Surgeons in North America, Europe, Australia, and Asia will recruit a total of at least 1,000 patients with low-energy femoral neck fractures. Using central randomization, patients will be allocated to receive surgical treatment with cancellous screws or a sliding hip screw. Patient outcomes will be assessed at one week (baseline), 10 weeks, 6, 12, 18, and 24 months post initial fixation. We will independently adjudicate revision surgery and complications within 24 months of the initial fixation. Outcome analysis will be performed using a Cox proportional hazards model and likelihood ratio test. Discussion This study represents major international efforts to definitively resolve the treatment of low-energy femoral neck fractures. This trial will not only change current Orthopaedic practice, but will also set a benchmark for the conduct of future Orthopaedic trials. Trial registration The FAITH trial is registered at ClinicalTrials.gov (Identifier NCT00761813). PMID:24965132

  9. Cost effectiveness of total hip arthroplasty in osteoarthritis: comparison of devices with differing bearing surfaces and modes of fixation.

    PubMed

    Pulikottil-Jacob, R; Connock, M; Kandala, N-B; Mistry, H; Grove, A; Freeman, K; Costa, M; Sutcliffe, P; Clarke, A

    2015-04-01

    Many different designs of total hip arthroplasty (THA) with varying performance and cost are available. The identification of those which are the most cost-effective could allow significant cost-savings. We used an established Markov model to examine the cost effectiveness of five frequently used categories of THA which differed according to bearing surface and mode of fixation, using data from the National Joint Registry for England and Wales. Kaplan-Meier analyses of rates of revision for men and women were modelled with parametric distributions. Costs of devices were provided by the NHS Supply Chain and associated costs were taken from existing studies. Lifetime costs, lifetime quality-adjusted-life-years (QALYs) and the probability of a device being cost effective at a willingness to pay £20 000/QALY were included in the models. The differences in QALYs between different categories of implant were extremely small (< 0.0039 QALYs for men or women over the patient's lifetime) and differences in cost were also marginal (£2500 to £3000 in the same time period). As a result, the probability of any particular device being the most cost effective was very sensitive to small, plausible changes in quality of life estimates and cost. Our results suggest that available evidence does not support recommending a particular device on cost effectiveness grounds alone. We would recommend that the choice of prosthesis should be determined by the rate of revision, local costs and the preferences of the surgeon and patient. PMID:25820881

  10. Ag/SiO(x)C(y) plasma polymer coating for antimicrobial protection of fracture fixation devices.

    PubMed

    Khalilpour, Poroshat; Lampe, Kai; Wagener, Michael; Stigler, Brigitte; Heiss, Christian; Ullrich, Matthias S; Domann, Eugen; Schnettler, Reinhard; Alt, Volker

    2010-07-01

    Implant-related infections are often devastating situations in orthopaedic trauma surgery particularly if multiresistant bacteria are involved. Protection of the implant surface by an antimicrobial coating exhibiting activity against multiresistant bacterial strains is of high interest. Aim of this study was to investigate the antimicrobial effects of an Ag/SiO(x)C(y) plasma polymer coating for fracture fixation devices, such as nails, plates, and external fixators, including tests against methicillin-resistant Staphylococcus aureus (MRSA) and its biocompatibility. The antimicrobial activity of the coating deposited onto 12 x 3 mm(2) stainless steel implants was tested in vitro against Staphylococcus aureus, Staphylococcus epidermidis, and MRSA using different testing methods (ASTM E-2810, JIS Z 2801, proliferation assay). Additionally, the coated devices were implanted into the paravertebral muscle of rabbits and explanted after 2, 7, 14, and 28 days to test the remaining ex vivo antimicrobial activity. For biocompatibility assessment the Ag/SiO(x)C(y) plasma polymer coating was tested in vitro according to ISO 10993-5. The Ag/SiO(x)C(y) coating exhibited excellent antimicrobial activity against all tested bacterial strains in all three in vitro tests. Ex vivo testing proved suppression of more than 99.9 % of bacterial proliferation by the coating compared to non-coated samples even after 28 days. ISO 10993-5 showed good biocompatibility of the coating without any indications of cytotoxic effects. In summary, Ag/SiO(x)C(y) plasma polymer coating showed excellent antimicrobial activity including effectiveness against MRSA and good in vitro biocompatibility. Therefore, it possesses high potential as a prophylactic agent in orthopaedic trauma surgery.

  11. In vitro and in vivo evaluation of a polylactic acid-bioactive glass composite for bone fixation devices.

    PubMed

    Vergnol, Gwenaelle; Ginsac, Nathalie; Rivory, Pascaline; Meille, Sylvain; Chenal, Jean-Marc; Balvay, Sandra; Chevalier, Jérôme; Hartmann, Daniel J

    2016-01-01

    Poly(lactic acid) is nowadays among the most used bioabsorbable materials for medical devices. To promote bone growth on the material surface and increase the degradation rate of the polymer, research is currently focused on organic-inorganic composites by adding a bioactive mineral to the polymer matrix. The purpose of this study was to investigate the ability of a poly(L,DL-lactide)-Bioglass® (P(L,DL)LA-Bioglass(®) 45S5) composite to be used as a bone fixation device. In vitro cell viability testing of P(l,dl)LA based composites containing different amounts of Bioglass(®) 45S5 particles was investigated. According to the degradation rate of the P(L,DL)LA matrix and the cytocompatibility experiments, the composite with 30 wt % of Bioglass® particles seemed to be the best candidate for further investigation. To study its behavior after immersion in simulated physiological conditions, the degradation of the composite was analyzed by measuring its weight loss and mechanical properties and by proceeding with X-ray tomography. We demonstrated that the presence of the bioactive glass significantly accelerated the in vitro degradation of the polymer. A preliminary in vivo investigation on rabbits shows that the addition of 30 wt % of Bioglass(®) in the P(L,DL)LA matrix seems to trigger bone osseointegration especially during the first month of implantation. This composite has thus strong potential interest for health applications.

  12. In vitro and in vivo evaluation of a polylactic acid-bioactive glass composite for bone fixation devices.

    PubMed

    Vergnol, Gwenaelle; Ginsac, Nathalie; Rivory, Pascaline; Meille, Sylvain; Chenal, Jean-Marc; Balvay, Sandra; Chevalier, Jérôme; Hartmann, Daniel J

    2016-01-01

    Poly(lactic acid) is nowadays among the most used bioabsorbable materials for medical devices. To promote bone growth on the material surface and increase the degradation rate of the polymer, research is currently focused on organic-inorganic composites by adding a bioactive mineral to the polymer matrix. The purpose of this study was to investigate the ability of a poly(L,DL-lactide)-Bioglass® (P(L,DL)LA-Bioglass(®) 45S5) composite to be used as a bone fixation device. In vitro cell viability testing of P(l,dl)LA based composites containing different amounts of Bioglass(®) 45S5 particles was investigated. According to the degradation rate of the P(L,DL)LA matrix and the cytocompatibility experiments, the composite with 30 wt % of Bioglass® particles seemed to be the best candidate for further investigation. To study its behavior after immersion in simulated physiological conditions, the degradation of the composite was analyzed by measuring its weight loss and mechanical properties and by proceeding with X-ray tomography. We demonstrated that the presence of the bioactive glass significantly accelerated the in vitro degradation of the polymer. A preliminary in vivo investigation on rabbits shows that the addition of 30 wt % of Bioglass(®) in the P(L,DL)LA matrix seems to trigger bone osseointegration especially during the first month of implantation. This composite has thus strong potential interest for health applications. PMID:25677798

  13. An Uncemented Spreading Stem for the Fixation in the Metaphyseal Femur: A Preliminary Report

    PubMed Central

    Burger, Daniel; Pumberger, Matthias; Fuchs, Bruno

    2016-01-01

    Surgical treatment to restore full range of motion and full weight bearing after extensive femoral bone resection in patients with primary or metastatic femoral tumours is individually challenging. Especially when the remaining distal or proximal bone is very short, a rigid fixation of an implant is difficult to achieve due to the reverse funnel shape of the metaphysis. Herein, we present a novel implant design using a spreading mechanism in the distal part of the prosthesis for rigid, uncemented fixation in the remaining femoral bone after extensive tumour resection of the femur. We present the outcome of 5 female patients who underwent implantation of this spreading stem after extensive proximal or distal femoral bone resection. There was no radiological or clinical loosening or implant-related revision surgery in our follow-up (mean 21.46 months, range 3.5–46 months). This uncemented spreading stem may therefore represent an alternative option for fixation of a prosthetic device in the remaining metaphyseal femur. PMID:27293377

  14. An Anterior Cruciate Ligament Reconstruction Technique With 4-Strand Semitendinosus Grafts, Using Outside-In Tibial Tunnel Drilling and Suspensory Fixation Devices

    PubMed Central

    Colombet, Philippe; Graveleau, Nicolas

    2015-01-01

    We describe an anatomic single-bundle anterior cruciate ligament reconstruction using a 4-strand semitendinosus graft fixed with 2 Pullup adjustable suspensory fixation systems (SBM, Lourdes, France). Outside-in full tibial tunnel drilling represents a secure option for length management of the graft. The preferred graft choice is a 4-strand semitendinosus autologous graft. A special technique is used to stitch the graft with a figure-of-8 stitch to load the 4 strands. The Pullup adjustable loop is equipped with 2 buttons of different sizes: a small button for the standard Pullup system on the femoral side and a large button for the Pullup XL system on the tibial side. With this method, graft tension is equally distributed among the 4 strands and the graft cannot bottom out in the tibial tunnel in case of inadequate graft length. PMID:26697313

  15. Biomechanical Study of Acetabular Tridimensional Memoryalloy Fixation System

    NASA Astrophysics Data System (ADS)

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

    2011-07-01

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

  16. Atypical periprosthetic femoral fracture: a case report.

    PubMed

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

    2016-08-01

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

  17. Current concepts in total femoral replacement

    PubMed Central

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

    2015-01-01

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

  18. Clinical Evaluation of an Unsintered Hydroxyapatite/Poly-L-Lactide Osteoconductive Composite Device for the Internal Fixation of Maxillofacial Fractures

    PubMed Central

    Sukegawa, Shintaro; Kanno, Takahiro; Katase, Naoki; Shibata, Akane; Takahashi, Yuka; Furuki, Yoshihiko

    2016-01-01

    Introduction: OSTEOTRANS MX (Takiron Co, Ltd, Osaka, Japan) is a resorbable osteosynthetic material composed of an unsintered hydroxyapatite/poly-l-lactide composite, and its osteoconductive capacity has been documented. The authors here report their clinical experience using OSTEOTRANS MX. Methods: The authors treated 35 patients (19 men, 16 women; age, 14–88 years; mean ± standard deviation, 38.4 ± 19.9 years) with maxillofacial fractures. The authors used standard surgery to stabilize fractures in all patients, fitting resorbable plates (thickness, 1.0 or 1.4 mm) and screws (diameter, 2 mm) according to Arbeitsgemeinschaft für Osteosynthesefragen/Association (AO) for the Study of Internal Fixation guidelines. Results: All patients eventually achieved satisfactory healing with favorable restoration of form and function without foreign body reaction. Complications occurred in 3 patients—plate exposure in 2 and discomfort in 1. However, fracture sites healed in all patients. Scanning electron microscopy revealed that the devices bonded directly to the bone without interposition of nonmineralized tissue. Conclusion: OSTEOTRANS MX is a useful material with few complications. Its osteoconductive bioactivity is advantageous for the early functional improvement of maxillofacial fractures. PMID:27428913

  19. Surgical Versus Percutaneous Femoral Access for Delivery of Large-Bore Cardiovascular Devices (from the PARTNER Trial).

    PubMed

    McCabe, James M; Huang, Pei-Hsiu; Cohen, David J; Blackstone, Eugene H; Welt, Frederick G P; Davidson, Michael J; Kaneko, Tsuyoshi; Eng, Marvin H; Allen, Keith B; Xu, Ke; Lowry, Ashley M; Lei, Yang; Rajeswaran, Jeevanantham; Brown, David L; Mack, Michael J; Webb, John G; Smith, Craig R; Leon, Martin B; Eisenhauer, Andrew C

    2016-05-15

    It is unclear if surgical exposure confers a risk advantage compared with a percutaneous approach for patients undergoing endovascular procedures requiring large-bore femoral artery access. From the randomized controlled Placement of Aortic Transcatheter Valve trials A and B and the continued access registries, a total of 1,416 patients received transfemoral transcatheter aortic valve replacement, of which 857 underwent surgical, and 559 underwent percutaneous access. Thirty-day rates of major vascular complications and quality of life scores were assessed. Propensity matching was used to adjust for unmeasured confounders. Overall, there were 116 major vascular complications (8.2%). Complication rates decreased dramatically during the study period. In unadjusted analysis, major vascular complications were significantly less common in the percutaneous access group (35 [6.3%] vs 81 [9.5%] p = 0.032). However, among 292 propensity-matched pairs, there was no difference in major vascular complications (22 [7.5%] vs 28 [9.6%], p = 0.37). Percutaneous access was associated with fewer total in-hospital vascular complications (46 [16%] vs 66 [23%], p = 0.036), shorter median procedural duration (97 interquartile range [IQR 68 to 166] vs 121 [IQR 78 to 194] minutes, p <0.0001), and median length of stay (4 [IQR 2 to 8] vs 6 [IQR 3 to 10] days, p <0.0001). There were no significant differences in quality of life scores at 30 days. Surgical access for large-bore femoral access does not appear to confer any advantages over percutaneous access and may be associated with more minor vascular complications. PMID:27036077

  20. A Novel Device for True Lumen Re-Entry After Subintimal Recanalization of Superficial Femoral Arteries: First-in-Man Experience and Technical Description

    SciTech Connect

    Airoldi, Flavio Faglia, Ezio Losa, Sergio Tavano, Davide; Latib, Azeem; Mantero, Manuela Lanza, Gaetano Clerici, Giacomo

    2011-02-15

    Subintimal angioplasty (SAP) is frequently performed for the treatment of critical limb ischemia (CLI) and has been recognized as an effective technique for these patients. Nevertheless, this approach is limited by the lack of controlled re-entry into the true lumen of the target vessel. We describe a novel device for true lumen re-entry after subintimal recanalization of superficial femoral arteries (SFA). We report our experience with six patients treated between April 2009 and January 2010 with a novel system designed to facilitate true lumen re-entry. The device was advanced by ipsilateral antegrade approach through a 6-French sheath. Successful reaccess into the true lumen was obtained in five of six patients without complications. The patient in whom the reaccess to the true lumen was not possible underwent successful bypass surgery. At 30 days follow-up, the SFA was patent in all patients according to echo-Doppler examination. Our preliminary experience indicates that this novel re-entry device increases the success rate of percutaneous revascularization of chronically occluded SFA.

  1. Use of Huckstep nail in the periimplant femoral shaft fracture

    PubMed Central

    Kim, Hong Kyun; Noh, Kyu Cheol; Chung, Kook Jin; Hwang, Ji Hyo

    2012-01-01

    87-year-old female underwent open reduction of distal femoral fracture and internal fixation with locking compression plate and bone graft. She was operated for ipsilateral proximal femoral fractures and stabilized by intramedullary interlocked nail 5 years ago. She developed stress fracture proximal to locked plate. We inserted Huckstep nail after removal of the previous operated proximal femoral nail without removing the remaining plate and screws. At 15 month followup the fractures have united. The Huckstep nail has multiple holes available for screw fixation at any level in such difficult situations. PMID:23325980

  2. 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

  3. 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 ...

  4. Network Meta-analysis of Randomized Trials on the Safety of Vascular Closure Devices for Femoral Arterial Puncture Site Haemostasis.

    PubMed

    Jiang, Jun; Zou, Junjie; Ma, Hao; Jiao, Yuanyong; Yang, Hongyu; Zhang, Xiwei; Miao, Yi

    2015-09-08

    The safety of vascular closure devices (VCDs) is still debated. The emergence of more related randomized controlled trials (RCTs) and newer VCDs makes it necessary to further evaluate the safety of VCDs. Relevant RCTs were identified by searching PubMed, EMBASE, Google Scholar and the Cochrane Central Register of Controlled Trials electronic databases updated in December 2014. Traditional and network meta-analyses were conducted to evaluate the rate of combined adverse vascular events (CAVEs) and haematomas by calculating the risk ratios and 95% confidence intervals. Forty RCTs including 16868 patients were included. Traditional meta-analysis demonstrated that there was no significant difference in the rate of CAVEs between all the VCDs and manual compression (MC). Subgroup analysis showed that FemoSeal and VCDs reported after the year 2005 reduced CAVEs. Moreover, the use of VCDs reduced the risk of haematomas compared with MC. Network meta-analysis showed that AngioSeal, which might be the best VCD among all the included VCDs, was associated with reduced rates of both CAVE and haematomas compared with MC. In conclusion, the use of VCDs is associated with a decreased risk of haematomas, and FemoSeal and AngioSeal appears to be better than MC for reducing the rate of CAVEs.

  5. 21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  6. 21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

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

  7. 21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  8. 21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

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

    Code of Federal Regulations, 2011 CFR

    2011-04-01

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

  10. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  11. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  12. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  13. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Knee joint femoral (hemi-knee) metallic uncemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint femoral (hemi-knee) metallic uncemented prosthesis. (a) Identification. A knee joint femoral...

  14. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint femoral (hemi-knee) metallic uncemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint femoral (hemi-knee) metallic uncemented prosthesis. (a) Identification. A knee joint femoral...

  15. Adjustable stiffness, external fixator for the rat femur osteotomy and segmental bone defect models.

    PubMed

    Glatt, Vaida; Matthys, Romano

    2014-01-01

    The mechanical environment around the healing of broken bone is very important as it determines the way the fracture will heal. Over the past decade there has been great clinical interest in improving bone healing by altering the mechanical environment through the fixation stability around the lesion. One constraint of preclinical animal research in this area is the lack of experimental control over the local mechanical environment within a large segmental defect as well as osteotomies as they heal. In this paper we report on the design and use of an external fixator to study the healing of large segmental bone defects or osteotomies. This device not only allows for controlled axial stiffness on the bone lesion as it heals, but it also enables the change of stiffness during the healing process in vivo. The conducted experiments have shown that the fixators were able to maintain a 5 mm femoral defect gap in rats in vivo during unrestricted cage activity for at least 8 weeks. Likewise, we observed no distortion or infections, including pin infections during the entire healing period. These results demonstrate that our newly developed external fixator was able to achieve reproducible and standardized stabilization, and the alteration of the mechanical environment of in vivo rat large bone defects and various size osteotomies. This confirms that the external fixation device is well suited for preclinical research investigations using a rat model in the field of bone regeneration and repair. PMID:25350129

  16. The Mechanics of External Fixation

    PubMed Central

    Rozbruch, S. Robert

    2006-01-01

    External fixation has evolved from being used primarily as a last resort fixation method to becoming a main stream technique used to treat a myriad of bone and soft tissue pathologies. Techniques in limb reconstruction continue to advance largely as a result of the use of these external devices. A thorough understanding of the biomechanical principles of external fixation is useful for all orthopedic surgeons as most will have to occasionally mount a fixator throughout their career. In this review, various types of external fixators and their common clinical applications are described with a focus on unilateral and circular frames. The biomechanical principles that govern bony and fixator stability are reviewed as well as the recommended techniques for applying external fixators to maximize stability. Additionally, we have illustrated methods for managing patients while they are in the external frames to facilitate function and shorten treatment duration. PMID:18751766

  17. The effect of changing the sequence of cuff inflation and device fixation with the LMA-Supreme® on device position, ventilatory complications, and airway morbidity: a clinical and fiberscopic study

    PubMed Central

    2014-01-01

    Background The conventional sequence when using supraglottic airway devices is insertion, cuff inflation and fixation. Our hypothesis was that a tighter fit of the cuff and tip could be achieved with a consequently lower incidence of air leak, better separation of gastrointestinal and respiratory tracts and less airway morbidity if the device were first affixed and the cuff then inflated. Methods Our clinical review board approved the study (public registry number DRKS00003174). An LMA Supreme® was inserted into 184 patients undergoing lower limb arthroscopy in propofol-remifentanil anaesthesia who were randomly assigned to either the control (inflation then fixation; n = 92) or study group (fixation then inflation; n = 92). The cuff was inflated to 60 cmH2O. The patients’ lungs were ventilated in pressure-controlled mode with 5 cmH2O PEEP, Pmax to give 6 ml kg-1 tidal volume, and respiratory rate adjusted to end-tidal CO2 of 4.8 and 5.6 kPa. Correct cuff and tip position were determined by leak detection, capnometry trace, oropharyngeal leak pressure, suprasternal notch test, and lube-tube test. Bowl and cuff position and the presence of glottic narrowing were assessed by fiberscopic examination. Postoperative dysphagia, hoarseness and sore throat were assessed with a questionnaire. Ventilatory impairment was defined as a tidal volume < 6 ml kg-1 with Pmax at oropharyngeal leak pressure, glottic narrowing was defined as an angle between the vocal cords under 16 degrees. Results The incidence of incorrect device position (18% vs. 21%), failed ventilation (10% vs. 9%), leak pressure (24.8 vs. 25.2 cmH2O, p = 0.63), failed lube-tube test (16.3% vs. 17.6%) and glottic narrowing (19.3% vs. 14.1%, p = 0.35) was similar in both groups (control vs. study, resp.). When glottic narrowing occurred, it was more frequently associated with ventilatory impairment in the control group (77% vs. 39%; p = 0.04). Airway morbidity was more common in the

  18. Computed Tomography Analysis of Postsurgery Femoral Component Rotation Based on a Force Sensing Device Method versus Hypothetical Rotational Alignment Based on Anatomical Landmark Methods: A Pilot Study.

    PubMed

    Kreuzer, Stefan W; Pourmoghaddam, Amir; Leffers, Kevin J; Johnson, Clint W; Dettmer, Marius

    2016-01-01

    Rotation of the femoral component is an important aspect of knee arthroplasty, due to its effects on postsurgery knee kinematics and associated functional outcomes. It is still debated which method for establishing rotational alignment is preferable in orthopedic surgery. We compared force sensing based femoral component rotation with traditional anatomic landmark methods to investigate which method is more accurate in terms of alignment to the true transepicondylar axis. Thirty-one patients underwent computer-navigated total knee arthroplasty for osteoarthritis with femoral rotation established via a force sensor. During surgery, three alternative hypothetical femoral rotational alignments were assessed, based on transepicondylar axis, anterior-posterior axis, or the utilization of a posterior condyles referencing jig. Postoperative computed tomography scans were obtained to investigate rotation characteristics. Significant differences in rotation characteristics were found between rotation according to DKB and other methods (P < 0.05). Soft tissue balancing resulted in smaller deviation from anatomical epicondylar axis than any other method. 77% of operated knees were within a range of ±3° of rotation. Only between 48% and 52% of knees would have been rotated appropriately using the other methods. The current results indicate that force sensors may be valuable for establishing correct femoral rotation. PMID:26881086

  19. 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

  20. 21 CFR 888.3010 - Bone fixation cerclage.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Bone fixation cerclage. 888.3010 Section 888.3010...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3010 Bone fixation cerclage. (a) Identification. A bone fixation cerclage is a device intended to be implanted that is made of alloys, such...

  1. 21 CFR 888.3010 - Bone fixation cerclage.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Bone fixation cerclage. 888.3010 Section 888.3010...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3010 Bone fixation cerclage. (a) Identification. A bone fixation cerclage is a device intended to be implanted that is made of alloys, such...

  2. 21 CFR 888.3010 - Bone fixation cerclage.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Bone fixation cerclage. 888.3010 Section 888.3010...) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3010 Bone fixation cerclage. (a) Identification. A bone fixation cerclage is a device intended to be implanted that is made of alloys, such...

  3. Navigated femoral shaft fracture treatment: current status.

    PubMed

    Hawi, Nael; Haentjes, Jonas; Suero, Eduardo M; Liodakis, Emmanouil; Krettek, Christian; Stübig, Timo; Hüfner, Tobias; Citak, Musa

    2012-01-01

    Femoral malrotation is a common complication after internal fixation of a femoral shaft fracture. The only valid, objective monitoring method is computer tomography-assisted torsion measurement between the proximal and distal femur; unfortunately, this can only be carried out postoperatively. A difference of 15° compared to the contralateral femur is seen as an indication for revision. With the development of computer-assisted surgery, new possibilities for performing torsion control and correction intraoperatively has been introduced. These methods also allow for navigation-assisted definition of the optimal incision site, intramedullary access, femoral nail and interlocking. The main problem lies in the extra time of surgery, which is due to performing all the steps of the surgery navigated. The solution for this problem is "hybrid navigation", in which the surgeon can select the steps he needs from the navigation system, depending on his experience or surgical technique.

  4. Femoral Component Survival in Hybrid Total Knee Arthroplasty.

    PubMed

    Perry, Clayton R; Perry, Kevin I

    2016-05-01

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

  5. Femoral Component Survival in Hybrid Total Knee Arthroplasty.

    PubMed

    Perry, Clayton R; Perry, Kevin I

    2016-05-01

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

  6. Corrosion at the stem-sleeve interface of a modular titanium alloy femoral component as a reason for impaired disengagement.

    PubMed

    Fraitzl, Christian R; Moya, Luis E; Castellani, Lorenzo; Wright, Timothy M; Buly, Robert L

    2011-01-01

    Modularity in sleeved femoral components allows the exchange of the stem without disruption of the fixation between the sleeve and the surrounding bone at revision surgery. Failure to disengage the stem from the sleeve would represent an unnecessary compromise from the intended usefulness of the modular design. We report the results of an examination of 22 modular titanium alloy femoral components retrieved after 0.0 to 8.8 years in vivo. In 7 implants, the stem-sleeve interface could not be disengaged without cutting through the components or using mechanical force. Moderate to severe corrosion was detected in all 7 of these cases. Corrosive surface changes were observed in an additional 6 interfaces. There was no correlation with the length of time that the devices had been implanted. When only the stem is to be revised, orthopedic surgeons should be aware of difficulties in disengagement and anticipate alternative surgical procedures.

  7. Progressive slippage after pinning for slipped capital femoral epiphysis.

    PubMed

    Sanders, James O; Smith, William J; Stanley, Earl A; Bueche, Matthew J; Karol, Lori A; Chambers, Henry G

    2002-01-01

    The authors retrospectively reviewed seven cases of progressive slipped capital femoral epiphysis after screw fixation. All seven patients initially presented with chronic symptoms, and five had an acute exacerbation of symptoms with the appearance of an acute-on-chronic slip. Of the other two, one had obvious motion at the proximal femoral physis and the other had increased symptoms but did not have an obvious acute slip radiographically. All underwent percutaneous screw fixation. In four patients a single screw was placed, and in three patients two screws were placed. No patient became symptom-free after surgery. Slip progression was noted on average 5 months after treatment. Radiographs in all patients revealed an increase in slip severity and loss of screw purchase in the femoral neck while fixation in the proximal femoral epiphysis remained secure. One patient had hypothyroidism and another Cushing disease, both diagnosed after the slipped epiphysis. Slips occurring in children with underlying endocrinopathies, and unstable slips in children with a history of antecedent knee or hip pain (commonly called an acute-on-chronic slip) may be susceptible to screw fixation failure. In such patients, close radiographic follow-up, particularly in the presence of continued symptoms, is required to document slip progression and fixation failure as soon as possible.

  8. A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study

    PubMed Central

    Hwang, Jin-Ho; Garg, Anant Kumar; Oh, Jong-Keon; Oh, Chang-Wug; Lee, Sung-Jae; Myung-Rae, Cho; Kim, Min-Keun; Kim, Hyun

    2012-01-01

    Objective: Despite new developments in the management of osteoporotic fractures, complications like screw cutout are still found in the fixation of proximal femur fractures even with biomechanically proven better implants like proximal femoral nail antirotation (PFNA). The purpose of this cadaveric study was to investigate the biomechanical stability of this device in relation to two common positions (center-center and inferior-center) of the helical blade in the femoral head in unstable trochanteric fractures. Materials and Methods: Eight pairs of human cadaveric femurs were used; in one group [center-center (C-C) group], the helical blade of PFNA was fixed randomly in central position both in anteroposterior and lateral view, whereas in the other group it was fixed in inferior one-third position in anteroposterior and in central position in lateral view [inferior-center (I-C) group]. Unstable intertrochanteric fracture was created and each specimen was loaded cyclically till load to failure Results: Angular and rotational displacements were significantly higher within the C-C group compared to the I-C group in both unloaded and loaded condition. Loading to failure was higher in the I-C group compared to the C-C group. No statistical significance was found for this parameter. Correlations between tip apex distance, cyclic loading which lead to femoral head displacement, and ultimate load to failure showed a significant positive relationship. Conclusion: The I-C group was superior to the C-C group and provided better biomechanical stability for angular and rotational displacement. This study would be a stimulus for further experimental studies with larger number specimens and complex loading protocols at multicentres. PMID:23325963

  9. Biomechanical analysis on transverse tibial fixation in anterior cruciate ligament reconstructions☆

    PubMed Central

    Filho, Edmar Stieven; Mendes, Mariane Henseler Damaceno; Claudino, Stephanie; Baracho, Filipe; Borges, Paulo César; da Cunha, Luiz Antonio Munhoz

    2015-01-01

    Objective To verify whether the combination of tibial cross pin fixation and femoral screw fixation presents biomechanical advantages when compared to femoral cross pin fixation and tibial screw fixation for the reconstruction of the anterior cruciate ligament (ACL). Methods Thirty-eight porcine knees and bovine extensor digitorum tendons were used as the graft materials. The tests were performed in three groups: (1) standard, used fourteen knees, and the grafts were fixated with the combination of femoral cross pin and a tibial screw; (2) inverted, used fourteen knees with an inverted combination of tibial cross pin and a femoral screw; (3) control, ten control tests performed with intact ACL. After the grafts fixation, all the knees were subjected to tensile testing to determine yield strength and ultimate strength. Results There was no statistically significant difference in survival techniques in regard to strength, yield load and tension. There was a higher survival compared in the standard curves of yield stress (p < 0.05). Conclusion There is no biomechanical advantage, observed in animal models testing, in the combination of tibial cross pin fixation and femoral screw when compared to femoral cross pin fixation and tibial screw. PMID:26229913

  10. Stress fractures of the femur after ACL reconstruction with transfemoral fixation.

    PubMed

    Arriaza, Rafael; Señaris, Jose; Couceiro, Gonzalo; Aizpurua, Jesus

    2006-11-01

    The ACL reconstruction with hamstring tendons has become increasingly popular, in part because it is assumed that the complication rate associated with the technique and their severity are lower than with patellar tendon. Two cases of stress reaction of the medial supracondylar area of the femur after ACL reconstruction with hamstring tendons using BioTransfix (Arthrex, Naples, FL, USA) devices for fixation within femur are presented. Both patients were professional athletes (one soccer and one basketball player), and it is hypothesized that the accelerated rehabilitation program used might have represented a risk factor for stress fractures when associated with the guide pin exit hole in the medial femoral cortex. To our knowledge, no such cases have been published to date, but it is important to consider this possibility if an unexplained pain arises in the rehabilitation process of an ACL reconstruction using transfemoral fixation.

  11. Five-Lumen Antibiotic-Impregnated Femoral Central Venous Catheters in Severely Burned Patients: An Investigation of Device Utility and Catheter-Related Bloodstream Infection Rates.

    PubMed

    Friedman, Bruce C; Mian, Mohammad A H; Mullins, Robert F; Hassan, Zaheed; Shaver, Joseph R; Johnston, Krystal K

    2015-01-01

    The objective of this study is to determine the catheter-related bloodstream infection (CRBSI) rate in a severely burned patient population, many of whom required prolonged use of central venous catheters (CVCs). Between January 2008 and June 2012, 151 patients underwent placement of 455 five-lumen minocycline/rifampin-impregnated CVCs. CRBSI was defined as at least one blood culture (>100,000 colonies) and one simultaneous roll-plate CVC tip culture (>15 colony forming units) positive for the same organism. Most patients had accidental burns (81.5%) with a mean TBSA of 50%. A mean of three catheters were inserted per patient (range, 1-25). CVCs were inserted in the femoral vein (91.2%), subclavian vein (5.3%), and internal jugular vein (3.3%). Mean overall catheter indwell time was 8 days (range, 0-39 days). The overall rate of CRBSI per 1000 catheter days was 11.2; patients with a TBSA >60% experienced significantly higher rates of CRBSI than patients with a TBSA ≤60% (16.2 vs 7.3, P = .01). CVCs placed through burned skin were four times more likely to be associated with CRBSI than CVCs placed through intact skin. The most common infectious organism was Acinetobacter baumannii. Deep venous thrombosis developed in eleven patients (7%). The overall rate of CRBSI was 11.2, consistent with published rates of CRBSI in burn patients. Thus, femoral placement of 5-lumen CVCs did not result in increased CRBSI rates. These data support the safety of femoral CVC placement in burn patients, contrary to the Centers for Disease Control recommendation to avoid femoral CVC insertion.

  12. 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.

  13. 21 CFR 888.3020 - Intramedullary fixation rod.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Intramedullary fixation rod. 888.3020 Section 888.3020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3020 Intramedullary fixation rod. (a) Identification. An intramedullary fixation rod...

  14. 21 CFR 888.3020 - Intramedullary fixation rod.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Intramedullary fixation rod. 888.3020 Section 888.3020 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3020 Intramedullary fixation rod. (a) Identification. An intramedullary fixation rod...

  15. Acid-resistant calcium silicate-based composite implants with high-strength as load-bearing bone graft substitutes and fracture fixation devices.

    PubMed

    Wei, Chung-Kai; Ding, Shinn-Jyh

    2016-09-01

    To achieve the excellent mechanical properties of biodegradable materials used for cortical bone graft substitutes and fracture fixation devices remains a challenge. To this end, the biomimetic calcium silicate/gelatin/chitosan oligosaccharide composite implants were developed, with an aim of achieving high strength, controlled degradation, and superior osteogenic activity. The work focused on the effect of gelatin on mechanical properties of the composites under four different kinds of mechanical stresses including compression, tensile, bending, and impact. The evaluation of in vitro degradability and fatigue at two simulated body fluid (SBF) of pH 7.4 and 5.0 was also performed, in which the pH 5.0 condition simulated clinical conditions caused by bacterial induced local metabolic acidosis or tissue inflammation. In addition, human mesenchymal stem cells (hMSCs) were sued to examine osteogenic activity. Experimental results showed that the appropriate amount of gelatin positively contributed to failure enhancement in compressive and impact modes. The 10wt% gelatin-containing composite exhibits the maximum value of the compressive strength (166.1MPa), which is within the reported compressive strength for cortical bone. The stability of the bone implants was apparently affected by the in vitro fatigue, but not by the initial pH environments (7.4 or 5.0). The gelatin not only greatly enhanced the degradation of the composite when soaked in the dynamic SBF solution, but effectively promoted attachment, proliferation, differentiation, and formation of mineralization of hMSCs. The 10wt%-gelatin composite with high initial strength may be a potential implant candidate for cortical bone repair and fracture fixation applications. PMID:27254281

  16. Femoral hernia repair

    MedlinePlus

    Femorocele repair; Herniorrhaphy; Hernioplasty - femoral ... During surgery to repair the hernia, the bulging tissue is pushed back in. The weakened area is sewn closed or strengthened. This repair ...

  17. Traumatic subchondral fracture of the femoral head in a healed trochanteric fracture

    PubMed Central

    Lee, Sang Yang; Niikura, Takahiro; Iwakura, Takashi; Kurosaka, Masahiro

    2014-01-01

    An 82-year-old woman sustained a trochanteric fracture of the left femur after a fall. Fracture fixation was performed using proximal femoral nail antirotation (PFNA) II, and she was able to walk with a T-cane after 3 months. Eleven months following the operation, the patient presented with left hip pain after a fall. Radiographs showed a subchondral collapse of the femoral head located above the blade tip. The authors removed the PFNA-II and subsequently performed cemented bipolar hemiarthroplasty. Histological evaluation of the femoral head showed osteoporosis with no evidence of osteonecrosis. Repair tissue, granulation tissue and callus formation were seen at the collapsed subchondral area. Based on these findings, a traumatic subchondral fracture of the femoral head in a healed trochanteric fracture was diagnosed. A traumatic subchondral fracture of the femoral head may need to be considered as a possible diagnosis after internal fixation of the trochanteric fracture. PMID:25015169

  18. Transverse femoral implant prominence: four cases demonstrating a preventable complication for ACL reconstruction.

    PubMed

    Argintar, Evan; Scherer, Benjamin; Jordan, Tom; Klimkiewicz, John

    2010-12-01

    Anterior cruciate ligament (ACL) tear is a commonly occurring injury that often demands surgical reconstruction. Although the utility of this operation is widely accepted, many specific components, including graft fixation technique, remain controversial. Many clinicians favor transverse femoral implant fixation for soft tissue ACL grafts. This technique can be accomplished successfully; however, in a minority of the cases, the femoral implant can be excessively prominent, leading to iatrogenic postoperative iliotibial band syndrome. This article presents 4 patients that developed postoperative iliotibial band syndrome resulting from transverse femoral implant prominence. Despite achievement of knee ligamentous stability, implant prominence compromised final clinical results following ACL reconstruction. Through change in Lysholm value, we reviewed the clinical outcomes of these patients following femoral implant hardware removal for treatment of iliotibial band syndrome. On hardware removal, all patients demonstrated complete symptomatic improvement, mirroring an average Lysholm value increase of 38. We believe transverse femoral implant prominence is avoidable, and subsequent iliotibial band syndrome is a preventable postoperative complication.

  19. Clinical and Analytical Evaluation of a Single-Vial Stool Collection Device with Formalin-Free Fixative for Improved Processing and Comprehensive Detection of Gastrointestinal Parasites.

    PubMed

    Couturier, Brianne A; Jensen, Ryan; Arias, Nora; Heffron, Michael; Gubler, Elyse; Case, Kristin; Gowans, Jason; Couturier, Marc Roger

    2015-08-01

    Microscopic examination of feces is a standard laboratory method for diagnosing gastrointestinal parasite infections. In North America, the ovum and parasite (O&P) examination is typically performed using stool that is chemically fixed in polyvinyl alcohol (PVA) and formalin, after which the stool is concentrated by filtration to enhance sensitivity. Mini Parasep solvent-free (SF) tubes allow collection and concentration within a single collection vial. The goal of the study was to determine whether consolidated processing and concentration with the Parasep tubes using an alcohol-based fixative (Alcorfix) provide O&P examinations equivalent to or better than those done by processing of PVA-formalin-fixed stool using a SpinCon concentration device. Parasep tubes revealed filtration performance equivalent to that of the SpinCon concentration device using PVA-formalin-fixed stool containing protozoa. Specimens cocollected in Parasep tubes containing PVA-formalin and Alcorfix revealed comparable morphology and staining for various protozoa. Alcorfix effectively fixed live Cryptosporidium and microsporidia such that morphology and staining were conserved for modified acid-fast and modified trichrome stains. A work flow analysis revealed significant time savings for batches of 10 or 30 O&P specimens in tubes with Alcorfix compared to the amount of time that it took to analyze the same number of specimens in tubes with PVA-formalin. The direct hands-on time savings with Mini Parasep tubes were 17 min and 41 s and 32 min and 1 s for batches of 10 and 30 specimens, respectively. Parasep tubes containing Alcorfix provide significant work flow advantages to laboratories that process medium to high volumes of O&P specimens by streamlining processing and converting to a single tube. These improvements in work flow, reduction of the amount of formalin used in the laboratory, and equivalent microscopy results are attractive advancements in O&P testing for North American

  20. Clinical and Analytical Evaluation of a Single-Vial Stool Collection Device with Formalin-Free Fixative for Improved Processing and Comprehensive Detection of Gastrointestinal Parasites

    PubMed Central

    Couturier, Brianne A.; Jensen, Ryan; Arias, Nora; Heffron, Michael; Gubler, Elyse; Case, Kristin; Gowans, Jason

    2015-01-01

    Microscopic examination of feces is a standard laboratory method for diagnosing gastrointestinal parasite infections. In North America, the ovum and parasite (O&P) examination is typically performed using stool that is chemically fixed in polyvinyl alcohol (PVA) and formalin, after which the stool is concentrated by filtration to enhance sensitivity. Mini Parasep solvent-free (SF) tubes allow collection and concentration within a single collection vial. The goal of the study was to determine whether consolidated processing and concentration with the Parasep tubes using an alcohol-based fixative (Alcorfix) provide O&P examinations equivalent to or better than those done by processing of PVA-formalin-fixed stool using a SpinCon concentration device. Parasep tubes revealed filtration performance equivalent to that of the SpinCon concentration device using PVA-formalin-fixed stool containing protozoa. Specimens cocollected in Parasep tubes containing PVA-formalin and Alcorfix revealed comparable morphology and staining for various protozoa. Alcorfix effectively fixed live Cryptosporidium and microsporidia such that morphology and staining were conserved for modified acid-fast and modified trichrome stains. A work flow analysis revealed significant time savings for batches of 10 or 30 O&P specimens in tubes with Alcorfix compared to the amount of time that it took to analyze the same number of specimens in tubes with PVA-formalin. The direct hands-on time savings with Mini Parasep tubes were 17 min and 41 s and 32 min and 1 s for batches of 10 and 30 specimens, respectively. Parasep tubes containing Alcorfix provide significant work flow advantages to laboratories that process medium to high volumes of O&P specimens by streamlining processing and converting to a single tube. These improvements in work flow, reduction of the amount of formalin used in the laboratory, and equivalent microscopy results are attractive advancements in O&P testing for North American

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

    PubMed

    Song, Kwang Soon; Lee, Si Wook

    2015-01-01

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

  2. Mechanical properties and cytocompatibility of oxygen-modified β-type Ti-Cr alloys for spinal fixation devices.

    PubMed

    Liu, Huihong; Niinomi, Mitsuo; Nakai, Masaaki; Cho, Ken; Narita, Kengo; Şen, Mustafa; Shiku, Hitoshi; Matsue, Tomokazu

    2015-01-01

    In this study, various amounts of oxygen were added to Ti-10Cr (mass%) alloys. It is expected that a large changeable Young's modulus, caused by a deformation-induced ω-phase transformation, can be achieved in Ti-10Cr-O alloys by the appropriate oxygen addition. This "changeable Young's modulus" property can satisfy the otherwise conflicting requirements for use in spinal implant rods: high and low moduli are preferred by surgeons and patients, respectively. The influence of oxygen on the microstructures and mechanical properties of the alloys was examined, as well as the bending springback and cytocompatibility of the optimized alloy. Among the Ti-10Cr-O alloys, Ti-10Cr-0.2O (mass%) alloy shows the largest changeable Young's modulus following cold rolling for a constant reduction ratio. This is the result of two competing factors: increased apparent β-lattice stability and decreased amounts of athermal ω phase, both of which are caused by oxygen addition. The most favorable balance of these factors for the deformation-induced ω-phase transformation occurred at an oxygen concentration of 0.2mass%. Ti-10Cr-0.2O alloy not only exhibits high tensile strength and acceptable elongation, but also possesses a good combination of high bending strength, acceptable bending springback and great cytocompatibility. Therefore, Ti-10Cr-0.2O alloy is a potential material for use in spinal fixture devices. PMID:25449914

  3. Mechanical properties and cytocompatibility of oxygen-modified β-type Ti-Cr alloys for spinal fixation devices.

    PubMed

    Liu, Huihong; Niinomi, Mitsuo; Nakai, Masaaki; Cho, Ken; Narita, Kengo; Şen, Mustafa; Shiku, Hitoshi; Matsue, Tomokazu

    2015-01-01

    In this study, various amounts of oxygen were added to Ti-10Cr (mass%) alloys. It is expected that a large changeable Young's modulus, caused by a deformation-induced ω-phase transformation, can be achieved in Ti-10Cr-O alloys by the appropriate oxygen addition. This "changeable Young's modulus" property can satisfy the otherwise conflicting requirements for use in spinal implant rods: high and low moduli are preferred by surgeons and patients, respectively. The influence of oxygen on the microstructures and mechanical properties of the alloys was examined, as well as the bending springback and cytocompatibility of the optimized alloy. Among the Ti-10Cr-O alloys, Ti-10Cr-0.2O (mass%) alloy shows the largest changeable Young's modulus following cold rolling for a constant reduction ratio. This is the result of two competing factors: increased apparent β-lattice stability and decreased amounts of athermal ω phase, both of which are caused by oxygen addition. The most favorable balance of these factors for the deformation-induced ω-phase transformation occurred at an oxygen concentration of 0.2mass%. Ti-10Cr-0.2O alloy not only exhibits high tensile strength and acceptable elongation, but also possesses a good combination of high bending strength, acceptable bending springback and great cytocompatibility. Therefore, Ti-10Cr-0.2O alloy is a potential material for use in spinal fixture devices.

  4. 21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

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

  5. 21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hip joint femoral (hemi-hip) metallic cemented or... Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis is a device intended to be...

  6. 21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

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

  7. 21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

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

  8. 21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint femoral (hemi-hip) metallic cemented or... Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis is a device intended to be...

  9. Morphological Study of the Newly Designed Cementless Femoral Stem

    PubMed Central

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

    2014-01-01

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

  10. Biomechanical Concepts for Fracture Fixation.

    PubMed

    Bottlang, Michael; Schemitsch, Christine E; Nauth, Aaron; Routt, Milton; Egol, Kenneth A; Cook, Gillian E; Schemitsch, Emil H

    2015-12-01

    Application of the correct fixation construct is critical for fracture healing and long-term stability; however, it is a complex issue with numerous significant factors. This review describes a number of common fracture types and evaluates their currently available fracture fixation constructs. In the setting of complex elbow instability, stable fixation or radial head replacement with an appropriately sized implant in conjunction with ligamentous repair is required to restore stability. For unstable sacral fractures with vertical or multiplanar instabilities, "standard" iliosacral screw fixation is not sufficient. Periprosthetic femur fractures, in particular Vancouver B1 fractures, have increased stability when using 90/90 fixation versus a single locking plate. Far cortical locking combines the concept of dynamization with locked plating to achieve superior healing of a distal femur fracture. Finally, there is no ideal construct for syndesmotic fracture stabilization; however, these fractures should be fixed using a device that allows for sufficient motion in the syndesmosis. In general, orthopaedic surgeons should select a fracture fixation construct that restores stability and promotes healing at the fracture site, while reducing the potential for fixation failure.

  11. Novel posterior fixation keratoprosthesis

    NASA Astrophysics Data System (ADS)

    Lacombe, Emmanuel

    1992-08-01

    The keratoprosthesis is the last solution for corneally blind patients that cannot benefit from corneal transplants. Keratoprostheses that have been designed to be affixed anteriorly usually necessitate multi-step surgical procedures and are continuously subjected to the extrusion forces generated by the positive intraocular pressure; therefore, clinical results in patients prove inconsistent. We proposed a novel keratoprosthesis concept that utilizes posterior corneal fixation which `a priori' minimizes the risk of aqueous leakage and expulsion. This prosthesis is implanted in a single procedure thereby reducing the number of surgical complications normally associated with anterior fixation devices. In addition, its novel design makes this keratoprosthesis implantable in phakic eyes. With an average follow-up of 13 months (range 3 to 25 months), our results on 21 cases are encouraging. Half of the keratoprostheses were implanted in severe burn cases, with the remainder in cases of pseudo- pemphigus. Good visual results and cosmetic appearance were obtained in 14 of 21 eyes.

  12. Suspensory Anterior Tibial Fixation in the Anatomic Transtibial Posterior Cruciate Ligament Reconstruction

    PubMed Central

    Elazab, Ashraf; Lee, Yong Seuk; Kang, Seo Goo

    2016-01-01

    The transtibial technique is the most relevant among many surgical techniques for posterior cruciate ligament reconstruction, and many types of fixation devices are used for tibial fixation according to the technique and the length of the graft. However, bone density in the fixation areas should be taken into consideration when choosing the fixation device to achieve rigid and stable fixation. However, density is not a substantial issue for anteromedial cortical fixation using a cortical suspension device. We describe tibial fixation with a TightRope RT (Arthrex, Naples, FL), which is a cortical suspension device, in anatomic transtibial posterior cruciate ligament reconstruction. PMID:27073781

  13. Internal fixation: a historical review.

    PubMed

    Greenhagen, Robert M; Johnson, Adam R; Joseph, Alison

    2011-08-01

    Internal fixation has become a pillar of surgical specialties, yet the evolution of these devices has been relatively short. The first known description of medical management of a fracture was found in the Edwin Smith Papyrus of Ancient Egypt (circa 2600 bc). The first description of internal fixation in the medical literature was in the 18th century. The advancement of techniques and technology over the last 150 years has helped to preserve both life and function. The pace of advancement continues to accelerate as surgeons continue to seek new technology for osseous fixation. The authors present a thorough review of the history of internal fixation and the transformation into a multibillion dollar industry. PMID:21944395

  14. The use of a circular external skeletal fixation device for the management of long bone osteotomies in large ruminants: an experimental study.

    PubMed

    Aithal, H P; Singh, G R; Hoque, M; Maiti, S K; Kinjavdekar, P; Pawde, A M; Setia, H C

    2004-08-01

    The study was undertaken to evaluate the feasibility of a simple, inexpensive model of circular external fixator (CEF) for use in large ruminants. A simple model of CEF frames consisting of four full rings (13-19 cm diameter, 4 cm wide and 4 mm thick with 18-24 holes) connected by threaded rods (8 mm diameter, 10-15 cm long) and nuts was developed using mild (low carbon) steel and were nickel-plated. In the first phase of the study, three male cow calves were utilized to study the feasibility of application of the fixators in the metatarsus, tibia and radius, in reference of adaptation and tolerance by animals. In the second phase, the fixators were tested in osteotomized bones. Six bull calves of 1.5-2 years of age weighing about 200-250 kg were utilized for this purpose. After preparing the area for aseptic surgery, under xylazine (at 0.1 mg/kg, i.m.)-ketamine (i.v. till effect) general anaesthesia, the test bone (metatarsus, radius and tibia in two animals each) was approached through the medial surface and an osteotomy was created with a saw and chisel at the mid-diaphysis. The pre-constructed 4-ring CEF was mounted on the limb around the test bone in such a way that it formed a cylinder with the axis of the limb at the centre. Each ring was then fixed to the bone with a pair of beaded wires (316 SS) of 3.5 mm diameter. During the post-operative period, the animals were observed for any change in behaviour, tolerance of the fixators, the weight bearing on the test limb, the status of the fixator, and the level of reduction of the osteotomy, alignment and healing at different intervals. The fixation of CEF was easier in the metatarsus and radius than in the tibia. The inner ring diameters found adequate for metatarsus, radius and tibia were 13-15 cm, 15-17 cm and 17-19 cm, respectively. The fixators applied to different bones were well-tolerated, and the animals could lay down, stand and walk freely with the fixator without any problems. All the animals showed

  15. Percutaneous intraluminal recanalization of long, chronic superficial femoral and popliteal occlusions using the Frontrunner XP CTO device: a single-center experience.

    PubMed

    Charalambous, Nikolas; Schäfer, Philipp J; Trentmann, Jens; Hümme, Tim H; Stöhring, Christine; Müller-Hülsbeck, Stefan; Heller, Martin; Jahnke, Thomas

    2010-02-01

    The purpose of this study was to examine the safety and efficacy of the Frontrunner XP CTO (chronic total occlusion) Catheter (Cordis) for recanalization of long femoropopliteal artery occlusions. A Frontrunner catheter was used to treat 26 CTOs in SFA after guidewire failure (68.3 +/- 8.8 years). Sixty-seven percent of patients had severe claudication. Critical lower limb ischemia with rest pain or minor tissue loss was present in three and eight patients, respectively. All the lesions were considered complex (TASC B, C, and D); 68% of the lesions were heavily calcified. The mean lesion length was 17.6 cm (range, 10-42 cm). The initial attempt to cross the occlusion with the CTO guidewire V18 was unsuccessful in 26 of 76 limbs (34.26%). A secondary attempt using the Frontrunner catheter (crossover approach, 27%; antegrade, 73%) performed in all 26 failed cases was successful in 17 limbs (65.38%), increasing the technical success rate to 88.12%. The main reasons for failure with the Frontrunner were inability to cross the lesion due to heavy calcification (six of nine) and inability to re-enter the true lumen after subintimal passage of the occluded segment (three of nine). The mean fluoroscopy time was 22.9 min. Minor complications included one distal extension of the dissection with involvement of the first popliteal segment and one perforation in the occluded segment. No major complications were seen. In conclusion, recanalization with the Frontrunner CTO catheter is a simple and safe method with a high technical success rate in the endovascular treatment of long superficial femoral artery occlusions and should be an alternative method after guidewire failure.

  16. Total Hip Arthroplasty for Implant Rupture after Surgery for Atypical Subtrochanteric Femoral Fracture

    PubMed Central

    Ozaki, Yu; Ochi, Hironori; Watari, Taiji; Matsumoto, Mikio; Kaneko, Kazuo

    2016-01-01

    Treatment methods for delayed union and nonunion of atypical femoral fracture are still controversial. Moreover, no treatment method has been established for implant rupture caused by delayed union and nonunion. We encountered a 74-year-old female in whom nonunion-induced implant rupture occurred after treatment of atypical subtrochanteric femoral fracture with internal fixation using a long femoral nail. It was unlikely that sufficient fixation could be obtained by repeating osteosynthesis alone. Moreover, the patient was elderly and early weight-bearing activity was essential for early recovery of ADL. Based on these reasons, we selected one-stage surgery with total hip arthroplasty and osteosynthesis with inverted condylar locking plate as salvage procedures. Bone union was achieved at 6 months after surgery. This case illustrated that osteosynthesis-combined one-staged total hip arthroplasty could be considered as one of the options for nonunion-induced implant rupture of atypical femoral subtrochanteric fracture.

  17. Bilateral antegrade perfusion of the superficial femoral artery to prevent limb ischaemia during combined use of Impella CP left ventricular assist device and extracorporeal life support.

    PubMed

    Kizner, Lukasz; Flottmann, Christian; Horstkotte, Dieter; Gummert, Jan

    2016-08-01

    The combined use of extracorporeal cardiac life support and the Impella left ventricular assist device is feasible in severe cardiogenic shock. Ischaemic complications due to the arterial cannulation may occur. The following cases show how the use of a perfusion adapter for bilateral antegrade leg perfusion prevents malperfusion of the lower extremities.

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

    PubMed Central

    Walsh, Stewart

    2016-01-01

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

  19. Reconstruction of medial patello-femoral ligament: Comparison of two surgical techniques.

    PubMed

    Criscenti, G; De Maria, C; Sebastiani, E; Tei, M; Placella, G; Speziali, A; Vozzi, G; Cerulli, G

    2016-06-01

    The medial patello-femoral ligament is considered the most important passive patellar stabilizer and its proper functionality is essential for the patello-femoral joint stability. In this work, 18 human knees were randomly divided into two groups and reconstructed through two different surgical techniques: the "Through tunnel tendon" and the "Double converging tunnel" reconstructions. Subsequently, the samples were mechanically tested to evaluate the structural properties of reconstructed femur-MPFL-Patella complex (rFMPC). Particular attention was given to maintain the anatomical orientation between the patella and the graft. Both procedures showed lower stiffness and higher ultimate strain and absorbed energy compared to the native MPFL, but the advantages of the double converging tunnel technique are related to the restoration of the native MPFL sail-shape, to a better stress distribution on the patella, to the use of a single interference screw as fixation device and to the simplicity, rapidity and cost-effectivity of the surgical procedure. The evaluation of the structural properties of rMPFL is fundamental to evaluate the adequacy of the different techniques to restore the physiological structural properties of the native MPFL. PMID:26894660

  20. Rotational osteoplasty and bioabsorbable polylactate pin fixation in Pipkin type 2 fracture with acute osteochondral defect: a case report.

    PubMed

    Maluta, Tommaso; Micheloni, Gian Mario; Sandri, Andrea; Regis, Dario; Costanzo, Alessandro; Magnan, Bruno

    2016-01-01

    Pipkin fractures are relative rare high-energy lesions characterized by an intra-articular fracture of the femoral head after posterior hip dislocation. Early anatomic reduction and stable fixation are the main goals of treatment. This case evaluates the outcome of managing Pipkin type 2 fracture with acute osteochondral defect of the femoral head using "rotational osteoplasty" and bioabsorbable polylactate pin fixation. 24-year-old male patient was involved in a motorcycle accident, suffering from a left hip fracture-dislocation, and pelvic Computed Tomography revealed a Pipkin type 2 lesion. An open urgent treatment was performed. After  anatomic reduction of the femoral head fragment a large osteochondral defect in the anterior-superior weight bearing surface was evident. The pattern of the fracture allowed us to perform a "rotational osteoplasty" including rotation of the femoral head fragment, to obtain an osteochondral cartilage congruence of the anterior-superior surface. Stable fixation was obtained by three bioabsorbable polylactate pins. At four-year follow up the patient had an excellent outcome and Magnetic Resonance Imaging (MRI) showed fracture healing, minimal signs of arthritis, excluding osteonecrosis of the femoral head. The reported case confirms that Pipkin fractures are very insidious surgical urgencies. In selected cases, "rotational osteoplasty" may be an alternative to osteochondral transplant for acute osteochondral defect of the femoral head. Bioabsorbable polylactate pin fixation allowed us to have a stable fixation evaluating the bone healing process and vitality of femoral head by MRI. PMID:27104330

  1. 21 CFR 888.3380 - Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint femoral (hemi-hip) trunnion-bearing... Devices § 888.3380 Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis is a...

  2. 21 CFR 888.3380 - Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint femoral (hemi-hip) trunnion-bearing... Devices § 888.3380 Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis is a...

  3. 21 CFR 888.3380 - Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hip joint femoral (hemi-hip) trunnion-bearing... Devices § 888.3380 Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis is a...

  4. 21 CFR 888.3380 - Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint femoral (hemi-hip) trunnion-bearing... Devices § 888.3380 Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis is a...

  5. 21 CFR 888.3380 - Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint femoral (hemi-hip) trunnion-bearing... Devices § 888.3380 Hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) trunnion-bearing metal/polyacetal cemented prosthesis is a...

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

    PubMed

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

    2016-11-01

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

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

    PubMed Central

    Won, Yougun; Kim, Sang Bum; Kim, Sun Joong; Yang, Kyu-Hyun

    2016-01-01

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

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

    PubMed Central

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

    2015-01-01

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

  9. Coupling failure between stem and femoral component in a constrained revision total knee arthroplasty.

    PubMed

    Butt, Ahsan Javed; Shaikh, Aamir Hassan; Cameron, Hugh U

    2013-02-01

    Knee revision using constrained implants is associated with greater stresses on the implant and interface surfaces. The present report describes a case of failure of the screw coupling between the stem and the femoral component. The cause of the failure is surmised with outline of the treatment in this case with extensive femoral bone loss. Revision implant stability was augmented with the use of a cemented femoral stem, screw fixation and the metaphyseal sleeve of an S-ROM modular hip system (DePuy international Ltd).

  10. Simulated bone remodeling around two types of osseointegrated implants for direct fixation of upper-leg prostheses.

    PubMed

    Tomaszewski, P K; Verdonschot, N; Bulstra, S K; Rietman, J S; Verkerke, G J

    2012-11-01

    Direct attachment of an upper leg prosthesis to the skeletal system by a percutaneous implant is an alternative solution to the traditional socket fixation. In this study, we investigated long-term periprosthetic bone changes around two types of fixation implants using two different initial conditions, namely immediate post-amputation implantation and the conventional implantation after considerable time of socket prosthesis use. We questioned the difference in bone modeling response the implants provoked and if it could lead to premature bone fracture. Generic CT-based finite element models of an intact femoral bone and amputated bone implanted with models of two existing direct-fixation implants, the OPRA system (Integrum AB) and the ISP Endo/Exo prosthesis (ESKA Implants AG) were created for this study. Adaptive bone-remodeling simulations used the heel-strike and toe-off loads from a normal walking cycle. The bone loss caused by prolonged use of socket prosthesis had more severe effects on the ultimate bone quality than adaptation induced by the direct-fixation implants. Both implants showed considerable bone remodeling; the titanium screw implant (OPRA system) provoked more bone loss than the porous coated CoCrMo stem (ISP implant). The chance of the peri-prosthetic bone fracture remained higher for the post-socket case as compared to the direct amputation cases. In conclusion, both direct-fixation implants lead to considerable bone loss and bone loss is more severe after a prolonged period of post-socket use. Hence, from a biomechanical perspective it is better to limit the post-socket time and to re-design direct fixation devices to reduce bone loss and the probability of peri-prosthetic bone fractures.

  11. 21 CFR 888.3040 - Smooth or threaded metallic bone fixation fastener.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Smooth or threaded metallic bone fixation fastener... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3040 Smooth or threaded metallic bone fixation fastener. (a) Identification. A smooth or threaded metallic bone fixation...

  12. 21 CFR 888.3040 - Smooth or threaded metallic bone fixation fastener.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Smooth or threaded metallic bone fixation fastener... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3040 Smooth or threaded metallic bone fixation fastener. (a) Identification. A smooth or threaded metallic bone fixation...

  13. 21 CFR 888.3040 - Smooth or threaded metallic bone fixation fastener.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Smooth or threaded metallic bone fixation fastener... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3040 Smooth or threaded metallic bone fixation fastener. (a) Identification. A smooth or threaded metallic bone fixation...

  14. 21 CFR 888.3040 - Smooth or threaded metallic bone fixation fastener.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Smooth or threaded metallic bone fixation fastener... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3040 Smooth or threaded metallic bone fixation fastener. (a) Identification. A smooth or threaded metallic bone fixation...

  15. 21 CFR 888.3040 - Smooth or threaded metallic bone fixation fastener.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Smooth or threaded metallic bone fixation fastener... SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3040 Smooth or threaded metallic bone fixation fastener. (a) Identification. A smooth or threaded metallic bone fixation...

  16. Bipolar hemiarthroplasty in femoral neck fractures.

    PubMed

    Malhotra, R; Arya, R; Bhan, S

    1995-01-01

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

  17. Special topic: Ipsilateral femoral neck and shaft fractures--does evidence give us the answer?

    PubMed

    Boulton, Christina L; Pollak, Andrew N

    2015-03-01

    Ipsilateral fractures of the femoral neck and shaft are rare, high-energy injuries that typically occur in young polytrauma patients. The associated fracture of the neck is often vertical in nature and is more frequently non-displaced than in isolated femoral neck fractures. Historically the diagnosis of an associated femoral neck fracture was delayed or missed in approximately one third of cases. Studies have shown that detection can be significantly improved with the implementation of a protocolized approach to hip imaging in all patients with femoral shaft fractures. Prompt recognition of an associated femoral neck fracture allows for timely stabilization and may decrease the risks of non-union and avascular necrosis. In contrast, failure to recognize a non-displaced or minimally displaced associated neck fracture prior to fixation of the shaft can lead to displacement, a decrease in neck fixation options, a technically challenging secondary procedure and increased risk of long-term sequelae. A vast array of treatment strategies have been described for this combined injury. Published options range from spica casting to open reduction and internal fixation of both fractures and include almost all conceivable combinations in between. While timely surgical stabilization is now universally recommended for both shaft and neck, no consensus exists as to the most appropriate method of fixation for either fracture. Most authors recommend prompt, but not emergent, surgery with priority given to anatomic reduction and stabilization of the neck fracture by either closed or open methods. Fixation of the shaft fracture follows as patient condition allows. The rare nature of this injury makes it very challenging to study and most published series' are retrospective with very small sample sizes. In short, no scientificallycompelling study is available to definitively support any one implant choice or method of stabilzation over another for the treatment of associated fractures

  18. Latarjet Fixation

    PubMed Central

    Alvi, Hasham M.; Monroe, Emily J.; Muriuki, Muturi; Verma, Rajat N.; Marra, Guido; Saltzman, Matthew D.

    2016-01-01

    Background: Attritional bone loss in patients with recurrent anterior instability has successfully been treated with a bone block procedure such as the Latarjet. It has not been previously demonstrated whether cortical or cancellous screws are superior when used for this procedure. Purpose: To assess the strength of stainless steel cortical screws versus stainless steel cannulated cancellous screws in the Latarjet procedure. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen matched-pair shoulder specimens were randomized into 2 separate fixation groups: (1) 3.5-mm stainless steel cortical screws and (2) 4.0-mm stainless steel partially threaded cannulated cancellous screws. Shoulder specimens were dissected free of all soft tissue and a 25% glenoid defect was created. The coracoid process was osteomized, placed at the site of the glenoid defect, and fixed in place with 2 parallel screws. Results: All 10 specimens failed by screw cutout. Nine of 10 specimens failed by progressive displacement with an increased number of cycles. One specimen in the 4.0-mm screw group failed by catastrophic failure on initiation of the testing protocol. The 3.5-mm screws had a mean of 274 cycles (SD, ±171 cycles; range, 10-443 cycles) to failure. The 4.0-mm screws had a mean of 135 cycles (SD, ±141 cycles; range, 0-284 cycles) to failure. There was no statistically significant difference between the 2 types of screws for cycles required to cause failure (P = .144). Conclusion: There was no statistically significant difference in energy or cycles to failure when comparing the stainless steel cortical screws versus partially threaded cannulated cancellous screws. Clinical Relevance: Latarjet may be performed using cortical or cancellous screws without a clear advantage of either option. PMID:27158630

  19. Extended proximal femoral osteotomy. A new technique for femoral revision arthroplasty.

    PubMed

    Younger, T I; Bradford, M S; Magnus, R E; Paprosky, W G

    1995-06-01

    An osteotomy technique for removal of distally fixed cemented and cementless femoral components is described. The anterolateral proximal femur is cut for one third of its circumference, extended distally, and levered open on an anterolateral hinge of periosteum and muscle. This creates an intact muscle-osseous sleeve composed of the gluteus medius, greater trochanter, anterolateral femoral diaphysis, and vastus lateralis, and exposes the fixation surface as well as distal cement. This technique combines the advantages of an extremely wide exposure of component fixation surfaces and preservation of soft tissue attachments to cut bone. In addition, it allows alteration of the proximal femur to facilitate accurate and safe distal cement removal and canal machining under direct vision. The possibility of placing the component in varus is eliminated. The proximal femur is allowed to conform more accurately to the revision prosthesis, a weakened or damaged trochanter is protected from iatrogenic injury, and soft tissue tension can be adjusted. The osteotomy is then repaired with cerclage wires or cables. The first 20 patients treated with this technique are reviewed. Excellent cement and component removal and optimal revision component implantation were obtained with no change in postoperative regimen and reliable healing.

  20. Subcapital Correction Osteotomy for Malunited Slipped Capital Femoral Epiphysis

    PubMed Central

    Anderson, Lucas A.; Gililland, Jeremy; Pelt, Christoper; Peters, Christopher L.

    2013-01-01

    Background Slipped capital femoral epiphysis (SCFE), causing posterior and inferior displacement and retroversion of the femoral head, is a well-recognized etiology for femoroacetabular impingement (FAI) and can lead to premature arthritis in the young adult. The treatment of malunited SCFE remains controversial. Surgical dislocation and subcapital correction osteotomy (SCO) has been described as a powerful method to correct the proximal femoral deformity. Methods Between January 2003 and January 2010, 11 patients (12 hips) with closed femoral physes and symptomatic FAI from malunited SCFE were treated with surgical dislocation and SCO. We performed a retrospective review of patient histories, physical exams, operative findings, and pre and postoperative anteroposterior (AP) and groin lateral (GLat) radiographs. Mean follow-up was 61 months. Results There were 4 female and 7 male patients with an average age of 15 years at the time of SCO. On the AP radiograph the mean inferior femoral head displacement (AP epiphyseal-neck angle) was significantly improved (-26° to -6°, p<0.001). On the groin lateral radiograph the mean posterior femoral head displacement (Lateral epiphyseal-neck angle) was significantly improved (-45° to -3°, p<0.001). The mean alpha angle was also significantly improved on both views (AP: 85° to 56°, P<0.001; GLat: 85° to 46°, p<0.001). Operative findings included one femoral osteochondral defect, 8 Outerbridge grade 3-4 acetabular cartilage lesions, and 10 labral lesions. Significant improvement of the mean Harris hip score (HHS) was seen at latest follow-up (54 to 77, p=0.016). Complications occurred in 4 of the 12 cases with AVN in two patients, a worse postoperative HHS in one patient, and failure of fixation treated successfully with revision open reduction internal fixation in one patient. Conclusions Subcapital correction osteotomy as an adjunct to surgical dislocation and osteochondroplasty can be used to correct the deformity of

  1. Tibial Fixation Properties of a Continuous-Loop ACL Hamstring Graft Construct with Suspensory Fixation in Porcine Bone.

    PubMed

    Smith, Patrick A; DeBerardino, Thomas M

    2015-12-01

    The aim of this article is to compare tibial fixation strength of suspensory fixation for a quadrupled semitendinosus continuous loop all-inside anterior cruciate ligament (ACL) construct versus a doubled semitendinosus and gracilis graft fixated with an interference screw. Biomechanical testing was conducted using human hamstring allografts and porcine tibias. Constructs were cycled from 50 to 250 N for 500 cycles followed by a pull to failure. The average load to failure of tibial suspensory fixation of the all-inside continuous loop construct (1,012 N) was statistically different compared with the tibial interference screw group (612 N) (p < 0.001). The cyclic displacement of the continuous loop construct (2.5 mm) was not statistically different from the interference screw construct (1.9 mm). For both the groups, approximately half the overall cyclic displacement occurred with the first cycle. Tibial side suspensory fixation of a novel all-inside continuous loop hamstring graft provided suitable strength for tibial fixation for ACL reconstruction. The continuous loop construct had a significantly higher load to failure compared with the use of an interference screw, and cyclic loading was comparable. Use of hamstring soft tissue grafts is very common for ACL reconstruction. An all-inside ACL reconstruction is based on a continuous loop construct utilizing a single semitendinosus graft that is quadrupled employing suspensory fixation on both the femoral and tibial side. Suspensory fixation on the femoral side been previously reported, but this is the first report of strength of this method of suspensory fixation on the tibia. PMID:25347056

  2. Mid-term Results of Revision Total Hip Arthroplasty Using Modular Cementless Femoral Stems

    PubMed Central

    Jang, Hyung-Gyu; Min, Byung-Woo; Ye, Hee-Uk; Lim, Kyung-Hwan

    2015-01-01

    Purpose The purpose of this study was to evaluate the clinical and radiological results of revision total hip arthroplasty using modular distal fixation stems for proximal femoral deficiency. Materials and Methods Forty-five patients (47 hips) were analyzed more than 24 months after revision total hip arthroplasty that used modular distal fixation stems and was performed between 2006 and 2012. There were proximal femoral defects in all cases. Preoperative femoral defect classification revealed Paprosky type II in 31 cases, type IIIA in 7, and type IIIB in 9. The mean duration of follow-up was 53.4 (25-100) months. We evaluated the Harris hip score (HHS), walking ability according to Koval as clinical parameters, stem stability, and stem position change as radiographic parameters. Kaplan-Meier survival analysis was performed. Results The average HHS improved form 39.5 points to 91.3 points and walking ability also improved in most cases; all patients had stable fixation of the femoral stem. Postoperative complications included 5 cases of infection and 2 cases of dislocation. The survival rate with the end point of re-revision surgery due to infection or dislocation was 86% after 8-year follow-up. Conclusion Cementless revision total hip arthroplasty using modular femoral stems is useful because the stems can be stably fixed on the diaphyseal portion of the femur, which has relatively good bone quality at mid-term follow-up. PMID:27536616

  3. Efficacies of surgical treatments based on Harris hip score in elderly patients with femoral neck fracture

    PubMed Central

    Liang, Chengwei; Yang, Fengjian; Lin, Weilong; Fan, Yongqian

    2015-01-01

    Aim: To compare the efficacies of four surgical treatments, i.e., total hip arthroplasty (THA), internal fixation (IF), hemiarthroplasty (HA), and artificial femoral head replacement (artificial FHR), by performing a network meta-analysis based on Harris hip score (HHS) in elderly patients with femoral neck fracture. Methods: In strict accordance with specific inclusion and exclusion criteria, randomized controlled trails (RCTs) were screened and selected from a larger group of studies that were retrieved through a comprehensive search of scientific literature databases, further complimented by manual search. The resultant high-quality data from final selected studies were analyzed using Stata 12.0 software. Results: A total of 3680 studies were initially retrieved from database search, and 15 RCTs were eventually incorporated into this meta-analysis, containing 1781 elderly patients who had undergone various surgical treatments for femoral neck fracture (THA group = 604; HA group = 604; IF group = 495; artificial FHR group = 78). Our major result revealed a statistically significant difference in HHS of femoral neck fracture when HA and IF groups were compared with THA. No differences were detected in the HHS of femoral neck fracture undergoing artificial FHR and THA. The surface under the cumulative ranking curves (SUCRA) value of HHS, in elderly patients with femoral neck fracture after surgery, revealed that IF has the highest value. Conclusions: The current network meta-analysis results suggest that IF is the superlative surgical procedure for femoral neck fracture patients, and IF significantly improves the HHS in femoral neck fracture patients. PMID:26221216

  4. Total femoral replacement.

    PubMed

    Nerubay, J; Katznelson, A; Tichler, T; Rubinstein, Z; Morag, B; Bubis, J J

    1988-04-01

    Between 1973 and 1983, 19 patients with sarcoma of the femur were treated by adjuvant chemotherapy, excision of the entire femur, and replacement by a total femoral prosthesis. Five patients had excellent and nine had good functional results. Twelve patients died an average of 23 months after the procedure and seven are at present disease free. This limb-saving procedure permits rapid rehabilitation, prevents severe psychological problems, and improves the quality of life.

  5. An electronically instrumented internal fixator for the assessment of bone healing

    PubMed Central

    Kowald, B.; Seide, K.; Aljudaibi, M.; Faschingbauer, M.; Juergens, C.; Gille, J.

    2016-01-01

    Objectives The monitoring of fracture healing is a complex process. Typically, successive radiographs are performed and an emerging calcification of the fracture area is evaluated. The aim of this study was to investigate whether different bone healing patterns can be distinguished using a telemetric instrumented femoral internal plate fixator. Materials and Methods An electronic telemetric system was developed to assess bone healing mechanically. The system consists of a telemetry module which is applied to an internal locking plate fixator, an external reader device, a sensor for measuring externally applied load and a laptop computer with processing software. By correlation between externally applied load and load measured in the implant, the elasticity of the osteosynthesis is calculated. The elasticity decreases with ongoing consolidation of a fracture or nonunion and is an appropriate parameter for the course of bone healing. At our centre, clinical application has been performed in 56 patients suffering nonunion or fracture of the femur. Results A total of 39 cases of clinical application were reviewed for this study. In total, four different types of healing curves were observed: fast healing; slow healing; plateau followed by healing; and non-healing. Conclusion The electronically instrumented internal fixator proved to be valuable for the assessment of bone healing in difficult healing situations. Cost-effective manufacturing is possible because the used electronic components are derived from large-scale production. The incorporation of microelectronics into orthopaedic implants will be an important innovation in future clinical care. Cite this article: B. Kienast, B. Kowald, K. Seide, M. Aljudaibi, M. Faschingbauer, C. Juergens, J. Gille. An electronically instrumented internal fixator for the assessment of bone healing. Bone Joint Res 2016;5:191–197. DOI: 10.1302/2046-3758.55.2000611. PMID:27226357

  6. Open reduction of a lateral femoral notch associated with an acute anterior cruciate ligament tear.

    PubMed

    Garth, W P; Wilson, T

    2001-10-01

    The lateral notch is a radiographic sign that describes a depression in the lateral femoral condyle near the terminal sulcus. The sign was first described in association with chronic instability in an anterior cruciate ligament-deficient knee. Recently, the senior author, after a prospective study, reported that these lateral notches might occur acutely at the time of anterior cruciate ligament injury. We report such a case in which the lateral femoral condylar depression fracture resulted in symptoms of lateral compartment incongruity. Open reduction and internal fixation were required. Anterior cruciate ligament reconstruction was performed as a staged procedure 2 months after fracture reduction. The postoperative result has been excellent for over 5 years. This case is an example that lateral femoral notches may be acute and a source of symptoms. In some cases, reduction and fixation of significant depressions in association with ligament reconstruction can alleviate these symptoms and may improve the patient's long-term result.

  7. Internal fixation in a combat theater hospital.

    PubMed

    Large, Thomas M; Bonds, Cale; Howard, Michael

    2013-08-01

    Limited data are available on the use of internal fixation in combat zone hospitals. The authors performed a retrospective review of 713 surgical cases during 2 Operation Enduring Freedom deployments to a Level III theater hospital in 2007 and 2009 to 2010. The epidemiology and short- to intermediate-term outcomes of patients treated with internal fixation devices were studied. The authors found that, with judicious use, internal fixation under a damage control protocol in a combat theater hospital can be performed with acceptable complication rates. PMID:23937739

  8. Troubleshooting the Femoral Attachment During Medial Patellofemoral Ligament Reconstruction

    PubMed Central

    Burrus, M. Tyrrell; Werner, Brian C.; Conte, Evan J.; Diduch, David R.

    2015-01-01

    The medial patellofemoral ligament (MPFL) has been recognized as an important soft tissue restraint in preventing lateral patellar translation. As many patients with acute or chronic patellar instability will have a deficient MPFL, reconstruction of this ligament is becoming more common. Appropriately, significant research has been undertaken regarding graft biomechanics and techniques, as intraoperative errors in graft placement often result in poor patient outcomes. Although the research has not answered all of the dilemmas encountered during reconstruction, publications consistently emphasize the importance of re-establishing an anatomic femoral attachment. The purpose of this study was to briefly review the current literature on MPFL reconstruction. Graft selection and patellar graft attachment and fixation are discussed, but the main focus is the femoral attachment as this is where most errors are seen and, unfortunately, where getting it right appears to matter the most. Using a sawbones knee model, the concepts of an MPFL graft that is “high and tight” or “low and loose” are presented, with the goal of providing physicians with intraoperative tools to adjust an incorrectly placed femoral MPFL attachment. This model is also used to justify the recommendation of graft fixation in 30° to 45° of knee flexion. PMID:26535373

  9. Biomechanical evaluation of maxillary Lefort Ι fracture with bioabsorbable osteosynthesis internal fixation.

    PubMed

    Wu, Wei; Zhou, Jiang; Xu, Chong-Tao; Zhang, Jie; Jin, Yan-Jiao; Sun, Geng-Lin

    2014-12-01

    The aim of this study was to apply biomechanical analysis model to evaluate the effects of bioabsorbable internal fixation devices on maxillary Lefort Ι fracture. CT scan technology and the finite element software (ansys) were used to establish three-dimensional finite element models of five resorbable internal fixation devices in maxillary Lefort Ι fractures. We used the model to calculate the stress of the upper jaw and internal fixation. We further analyzed the stability of fixation under four occlusions. The fixation using two bioabsorbable plates was not stable. The zygomaticomaxillary pillars fixation is more stable than other fixations. The stability of fracture fixation was influenced with the molar occlusion. The current study developed a functional three-dimensional finite element model of bioabsorbable internal fixation and compared the stability of five fixation methods for maxillary Lefort Ι fractures. The results would facilitate the application of bioabsorbable materials in dental clinic.

  10. Cortical screw support in femoral neck fractures. A radiographic analysis of 87 fractures with a new mensuration technique.

    PubMed

    Lindequist, S

    1993-06-01

    In 87 femoral neck fractures, operated on with 2 von Bahr screws and followed for up to 2 years, the positions of the fixating screws were determined with a new mensuration technique which compensates for the variations in hip rotation in routine radiographs. The union rate of the fractures was related to the position of the screws. A posterior placement of the proximal screw and an inferior placement of the distal screw in both the femoral head and neck improved the outcome substantially.

  11. Uncemented custom femoral components in hip arthroplasty

    PubMed Central

    2010-01-01

    Background and purpose We have developed an individually designed, uncemented femoral component for achievement of improved strain distribution and fixation to the bone, to make uncemented stems more applicable in femurs of abnormal size and shape, and to improve the joint mechanics. Here we describe the design of the implant and present the results of a prospective clinical study with at least 7 years of follow-up. Patients and methods The prostheses are produced by CAD-CAM technique. The design of the stem is based on CT information, and the neck design is based on the surgeon's planning of the center of rotation, femoral head offset, and leg length correction. The first-generation stem produced before 2001 had a proximal HA coating and a sand-blasted distal part that was down-scaled to avoid contact with compact bone. The second-generation stem had a porous coating beneath the HA layer and the distal part of the stem was polished. The implant was used in 762 hips (614 patients) from 1995 until 2009. 191 of these hips were followed for 7 years and 83 others were followed for 10 years, and these hips are included in the present study. Mean age at surgery was 48 (20–65) years. Congenital dysplasia of the hip was the reason for osteoarthritis in 46% and 57% of the hips in respective groups. Merle d'Aubigné score was recorded in 152 and 75 hips in the two groups. Prostheses followed for 10 years, and almost all in the 7-year group, were first-generation stems. Results The 7- and 10-year cumulative revision rates were 1.1% and 2.4%, respectively, with stem revision for any reason as endpoint. The clinical results were similar at 7 and 10 years, with Merle d'Aubigné scores of 17. Intraoperative trochanteric fissures occurred in 2 of the 191 operations (1.0%); both healed after wiring. In hips followed for 7 years, 2 periprosthetic fractures occurred; exchange of the stem was necessary in both. One additional fracture occurred between 7 and 10 years, and it was

  12. The effects of the collar on total hip femoral component subsidence.

    PubMed

    Whiteside, L A; Amador, D; Russell, K

    1988-06-01

    Twenty-four preserved autopsy femurs were used to evaluate the effect of the collar and tight distal fit on noncemented femoral component subsidence, micromotion, and load to failure. Ten collared implants (five with tight and five with loose distal fit) and 14 collarless implants (seven with tight and seven with loose distal fit) were inserted with press-fit technique. They were compressively loaded in an Instron machine (Instron, Canton, Massachusetts) at 25-kg increments with 20 cycles applied at each load level. Subsidence was significantly decreased, and load to failure increased by the collar. None of the parameters was significantly affected by tight fit of the cylindrical distal stem. Tightening of the collarless implant by subsidence could not be relied upon to achieve fixation, and may not be reliable in a clinical situation. Improved rigidity of fixation and increased strength achieved by seating on the collar are distinctive advantages for pain control and biologic fixation of noncemented femoral components. PMID:3370866

  13. Profunda femoris artery pseudoaneurysm following revision for femoral shaft fracture nonunion

    PubMed Central

    Valli, Federico; Teli, Marco GA; Innocenti, Marco; Vercelli, Ruggero; Prestamburgo, Domenico

    2013-01-01

    Femoral artery pseudoaneurysms (FAPs) have been described following internal fixation of intertrocantheric, subtrocantheric and intracapsular femoral neck fractures as well as core decompression of the femoral head. The diagnosis of FAP is usually delayed because of non-specific clinical features like pain, haematoma, swelling, occasional fever and unexplained anaemia. Because of the insidious onset and of the possible delayed presentation of pseudoaneurysms, orthopaedic and trauma surgeons should be aware of this complication. We report a case of Profunda Femoris arterial branch pseudoaneurysm, diagnosed in a 40-year-old male 4 wk after revision with Kuntscher intramedullary nail of a femoral shaft nonunion. The diagnosis was achieved by computed tomography angiography and the lesion was effectively managed by endovascular repair. The specific literature and suggestions for treatment are discussed in the paper. PMID:23878785

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

    PubMed

    Jawad, Muhammad Umar; Brien, Earl W

    2014-02-01

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

  15. A case of femoral fracture in klippel trenaunay syndrome.

    PubMed

    Nahas, Sam; Wong, Fabian; Back, Diane

    2014-01-01

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

  16. Transpedicular vertebral body augmentation reinforced with pedicle screw fixation in fresh traumatic A2 and A3 lumbar fractures: comparison between two devices and two bone cements.

    PubMed

    Korovessis, Panagiotis; Vardakastanis, Konstantinos; Repantis, Thomas; Vitsas, Vasilios

    2014-07-01

    This retrospective study compares efficacy and safety of balloon kyphoplasty (BK) with calcium phosphate (Group A) versus KIVA implant with PMMA (Group B) reinforced with three vertebrae pedicle screw constructs for A2 and A3 single fresh non-osteoporotic lumbar (L1-L4) fractures in 38 consecutive age- and diagnosis-matched patient populations. Extracanal leakage of both low-viscosity PMMA and calcium phosphate (CP) as well as the following roentgenographic parameters: segmental kyphosis (SKA), anterior (AVBHr) and posterior (PVBHr) vertebral body height ratio, spinal canal encroachment (SCE) clearance, and functional outcome measures: VAS and SF-36, were recorded and compared between the two groups. All patients in both groups were followed for a minimum 26 (Group A) and 25 (Group B) months. Extracanal CP and PMMA leakage was observed in four (18 %) and three (15 %) vertebrae/patients of group A and B, respectively. Hybrid fixation improved AVBHr, SKA, SCE, but PVBHr only in group B. VAS and SF-36 improved postoperatively in the patients of both groups. Short-segment construct with the novel KIVA implant restored better than BK-fractured lumbar vertebral body, but this had no impact in functional outcome. Since there was no leakage difference between PMMA and calcium phosphate and no short-term adverse related to PMMA use were observed, we advice the use of PMMA in fresh traumatic lumbar fractures.

  17. Development of thermo-mechanical processing for fabricating highly durable β-type Ti-Nb-Ta-Zr rod for use in spinal fixation devices.

    PubMed

    Narita, Kengo; Niinomi, Mitsuo; Nakai, Masaaki; Hieda, Junko; Oribe, Kazuya

    2012-05-01

    The mechanical strength of a beta titanium alloy such as Ti-Nb-Ta-Zr alloy (TNTZ) can be improved significantly by thermo-mechanical treatment. In this study, TNTZ was subjected to solution treatment, cold caliber rolling, and cold swaging before aging treatment to form a rod for spinal fixation. The {110}(β) are aligned parallel to the cross-section with two strong peaks approximately 180° apart, facing one another, in the TNTZ rods subjected to cold caliber rolling and six strong peaks at approximately 60° intervals, facing one another, in the TNTZ rods subjected to cold swaging. Therefore, the TNTZ rods subjected to cold swaging have a more uniform structure than those subjected to cold caliber rolling. The orientation relationship between the α and β phases is different. A [110](β)//[121](α), (112)(β)//(210)(α) orientation relationship is observed in the TNTZ rods subjected to aging treatment at 723 K after solution treatment and cold caliber rolling. On the other hand, a [110](β)//[001](α), (112)(β)//(200)(α) orientation relationship is observed in TNTZ rod subjected to aging treatment at 723 K after cold swaging. A high 0.2% proof stress of about 1200 MPa, high elongation of 18%, and high fatigue strength of 950 MPa indicate that aging treatment at 723 K after cold swaging is the optimal thermo-mechanical process for a TNTZ rod.

  18. [Femoral neck fracture].

    PubMed

    Gierer, P; Mittlmeier, T

    2015-03-01

    The incidence of femoral neck fractures increases exponentially with rising age. Young patients are rarely affected but when they are it is mostly due to high energy accidents, whereas older patients suffer from femoral neck fractures by low energy trauma due to osteoporotic changes of the bone mineral density. Treatment options have not essentially changed over the last few years. Non-operative treatment may be a choice in non-dislocated and impacted fractures. Due to the high risk of secondary fracture displacement prophylactic screw osteosynthesis is recommended even in Garden type I fractures. Osteosynthetic fracture stabilization with cannulated screws or angle stable sliding screws, is usually applied in non-displaced fractures and fractures in younger patients. Older patients need rapid mobilization after surgery; therefore, total hip arthroplasty and hemiarthroplasty are commonly used with a low incidence of secondary complications. In addition to sufficient operative treatment a guideline conform osteoprosis therapy should be initiated for the prophylaxis of further fractures and patients should undertake a suitable rehabilitation.

  19. Treatment of ununited femoral neck fractures in young adults using low-intensity pulsed ultrasound: Report of 2 cases

    PubMed Central

    Lee, Sang Yang; Niikura, Takahiro; Iwakura, Takashi; Kuroda, Ryosuke; Kurosaka, Masahiro

    2016-01-01

    Introduction Delayed union and non-union of displaced femoral neck fractures remains a difficult clinical problem for orthopaedic surgeons. In the physiologically young patient, every effort should be made to preserve the native hip joint. We present two cases of ununited femoral neck fractures in young adults who were successfully treated with low-intensity pulsed ultrasound (LIPUS) and showed satisfactory results. Presentation of case 1 A 41-year-old woman was involved in a motor vehicle crash and was diagnosed with displaced femoral neck fracture. Eleven months after internal fixation, a computed tomography (CT) scan revealed the presence of non-union of the femoral neck. LIPUS treatment was therefore initiated. After eight months, the fracture was completely consolidated. Presentation of case 2 A 39-year-old man was involved in a cycling accident and was diagnosed with displaced femoral neck fracture. Thirteen weeks after internal fixation, a CT scan revealed delayed union of the femoral neck. LIPUS treatment was therefore initiated. After six months, the fracture was completely consolidated. Conclusion We suggest use of LIPUS as a possible treatment approach for delayed union and non-union of displaced femoral neck fractures in young patients before considering further surgical intervention. PMID:26942332

  20. Coronal plane partial articular fractures of the distal femoral condyle: current concepts in management.

    PubMed

    Arastu, M H; Kokke, M C; Duffy, P J; Korley, R E C; Buckley, R E

    2013-09-01

    Coronal plane fractures of the posterior femoral condyle, also known as Hoffa fractures, are rare. Lateral fractures are three times more common than medial fractures, although the reason for this is not clear. The exact mechanism of injury is likely to be a vertical shear force on the posterior femoral condyle with varying degrees of knee flexion. These fractures are commonly associated with high-energy trauma and are a diagnostic and surgical challenge. Hoffa fractures are often associated with inter- or supracondylar distal femoral fractures and CT scans are useful in delineating the coronal shear component, which can easily be missed. There are few recommendations in the literature regarding the surgical approach and methods of fixation that may be used for this injury. Non-operative treatment has been associated with poor outcomes. The goals of treatment are anatomical reduction of the articular surface with rigid, stable fixation to allow early mobilisation in order to restore function. A surgical approach that allows access to the posterior aspect of the femoral condyle is described and the use of postero-anterior lag screws with or without an additional buttress plate for fixation of these difficult fractures. PMID:23997126

  1. Removal of a broken guide wire entrapped in a fractured femoral neck.

    PubMed

    Zhu, Qing-hua; Ye, Tian-wen; Guo, Yong-fei; Wang, Chong-li; Chen, Ai-min

    2013-01-01

    Guide wire plays an important role in the fixation of femoral neck fracture with dynamic hip screw (DHS). Breakage of a guide wire during operation is a very rare condition. We met such a dilemma in DHS fixation of a 54-year-old male patient who sustained Garden type IV fracture of the right femoral neck. The distal end of the guide wire broke and was entrapped in the fractured femoral neck. We tried to get the broken part out by a cannulated drill. Reaming was started with the cannulated drill slowly rotating around the guide K-wire until the reamer fully contained the target under fluoroscope. A bone curette was used to get the broken wire out but failed, so we had to use the cannuated drill to dredge this bone tunnel. Finally the broken wire end was taken out, mixed with blood and bone fragments. Through the existing drilling channel, DHS fixation was easily finished. The patient had an uneventful recovery without avascular necrosis of femoral head or non-union of the fracture at one year's follow-up. A few methods can be adopted to deal with the broken guide wire. The way used in our case is less invasive but technically challenging. When the guide wire is properly positioned, this method is very practical and useful. PMID:23910678

  2. Malunion in displaced intracapsular fracture of femoral neck: A rare case.

    PubMed

    Verma, Nikhil; Singh, M P; Ul Haq, Rehan; Aggarwal, Aditya N; Jain, Anuj

    2015-01-01

    Intracapsular fracture of femoral neck is treated by anatomical reduction (preferably closed) and cannulated cancellous lag screw fixation. Malunion of these fractures have been described in the coronal plane (coxa valga or coxa vara). We reported a case of young adult patient with displaced intracapsular fracture of femoral neck that had malunited in sagittal plane with callus formation with excellent functional outcome. The radiographs revealed intracapsular fracture of femoral neck right side (Garden type 4 and Pauwel type 3). The patient was operated and closed reduction and internal fixation with three cannulated cancellous screws was performed. The postoperative radiograph revealed a loss of reduction in the lateral view. Due to this technical error, the patient was counselled for revision fixation for which he refused. At 9 months we observed union of the fracture in the displaced position by callus formation. Harris hip score at 2 years was 96 that indicate excellent functional outcome and the radiographs did not reveal any evidence of avascular necrosis of femoral head. We advised revision surgery to our patient as he had increased chances of implant failure and nonunion. However he refused the revision surgery and was continued with the suboptimal reduction. However, the fracture united and that too with callus formation, which is not a described phenomenon in neck of femur fracture. PMID:26777718

  3. Mesh fixation alternatives in laparoscopic ventral hernia repair.

    PubMed

    Muysoms, Filip E; Novik, Bengt; Kyle-Leinhase, Iris; Berrevoet, Frederik

    2012-12-01

    Since the introduction of laparoscopic ventral hernia repair, there has been an ongoing dispute over the optimal method of fixating the mesh against the abdominal wall. In general, one could say that the more penetrating the fixation used, the stronger the fixation, but at the cost of increased acute postoperative pain. The occurrence of chronic pain in some patients has led to the search for less permanent penetrating fixation, but without risking a less stable mesh fixation and increased recurrences due to shift or shrinkage of the mesh. Avoiding transfascial sutures by using a double crown of staples has been proposed and recently absorbable fixation devices have been developed. Some surgeons have proposed fixation with glue to reduce the number of staples, or even eliminate them entirely. The continuously increasing multitude of marketed meshes and fixating devices leads to unlimited options in mesh fixation combination and geometry. Therefore, we will never be able to get a clear view on the benefits and pitfalls of every specific combination. Clearance of the anterior abdominal wall from peritoneal fatty tissue and correct positioning of the mesh with ample overlap of the hernia defect are possibly as important as the choice of mesh and fixation. Other topics that are involved in successful outcomes but not addressed in this article are adequate training in the procedure, appropriate selection of patients, and careful adhesiolysis to minimize accidental visceral injuries. PMID:23225589

  4. Expert tibia nail for subtrochanteric femoral fracture to prevent thermal injury

    PubMed Central

    Lee, Kyung-Jae; Min, Byung-Woo; Jung, Jae-Hoon; Kang, Mi-Kyung; Kim, Min-Ji

    2015-01-01

    Introduction Subtrochanteric femoral fractures are relatively uncommon, accounting for 7–15% of all hip fractures and treatment of these fractures are considered challenge for orthopaedic surgeons. Although several treatment options are reported with up to 90% of satisfactory results, the choice of the appropriate implant is still a matter of debate. Some authors reported thermal injury after reaming for intramedullary nail fixation in patients with narrow medullary canal. Presentation of case A 21-year-old female patient was admitted to our hospital because of right subtrochanteric femoral fracture. The narrowest diameter of medullary canal of her femur was about 7 mm but she refused open reduction and internal fixation with plate due to large scar formation. We used expert tibia nail instead of femoral intramedullary nail to prevent thermal injury. Discussion Subtrochanteric femoral fractures are difficult to treat because of their biomechanical and anatomical characteristics. Although several implants are reported for the surgical treatment of these fractures, intramedullary nails have been advocated due to their biological and biomechanical advantages. However, under certain circumstances with associated injury or anatomic difference we might consider another treatment options. Conclusion Expert tibia nail may be considered one of the treatment options for subtrochanteric femoral fracture with narrow medullary canal. We also emphasize the importance of preoperative evaluation of the medullary canal size for these risky fractures. PMID:25839435

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

    PubMed Central

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

    2015-01-01

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

  6. Femoral approach to lead extraction.

    PubMed

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

    2015-03-01

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

  7. [Pathogenesis of atypical femoral fracture].

    PubMed

    Iwata, Ken; Mashiba, Tasuku

    2016-01-01

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

  8. Angioseal use after antegrade femoral arteriotomy in patients undergoing percutaneous revascularization for critical limb ischemia: a case series.

    PubMed

    Biondi-Zoccai, Giuseppe G L; Fusaro, Massimiliano; Tashani, Abdulkafi; Mollichelli, Nadia; Medda, Massimo; De Giacobbi, Graziella; Inglese, Luigi

    2007-06-12

    Antegrade femoral artery access is commonly used for percutaneous transluminal revascularization of ipsilateral lower limbs in patients with critical limb ischemia. While hemostasis at the end of the procedure can be achieved by manual compression, this may lead to an increase in local vascular complications. Femoral artery closure devices, such as the Angioseal collagen plug and anchor device, have been approved and shown of benefit after retrograde femoral artery catheterization. To date, there are however no data on the use of such arteriotomy closure device after antegrade femoral access. We hereby report a case series of five patients in whom Angioseal was successfully used after antegrade femoral puncture and below-the-knee percutaneous transluminal angioplasty. In all cases the device enabled immediate and complete hemostasis without major complications, despite the intense antithrombotic regimen, including heparin, aspirin, and clopidogrel in all patients, as well as glycoprotein IIb/IIIa inhibitors (in two patients) and fibrinolytic therapy (in one). PMID:17052791

  9. Internal fixation after fracture or osteotomy of the femur in young children with polyostotic fibrous dysplasia.

    PubMed

    Benedetti Valentini, Matteo; Ippolito, Ernesto; Catellani, Francesco; Farsetti, Pasquale

    2015-07-01

    Children from 4 to 7 years of age with polyostotic fibrous dysplasia (PFD) may need internal fixation of the femur for either fracture or osteotomy. At that age, the small size of the femur allows only the use of small intramedullary nails. However, titanium elastic nails and rigid intramedullary pediatric interlocking femoral nails - good for fracture or osteotomy fixation in the normal femur - are not indicated in PFD. From 2009 to 2011, we treated eight cases of PFD femoral fracture and deformity by internal fixation with a custom-modified adult humeral nail to which a spiral blade was connected. The 7-mm thick nail fit properly into the small femoral shaft and the spiral blade conferred ideal mechanical support to the femoral neck. Three cases had replacement of the humeral nail with a more appropriate adult femoral nail 3 years after the index procedure when the femur had reached an adequate size. In the maximum follow-up period of 4 years, few complications were observed.

  10. Percutaneous external fixator pins with bactericidal micron-thin sol-gel films for the prevention of pin tract infection.

    PubMed

    Qu, Haibo; Knabe, Christine; Radin, Shula; Garino, Jonathan; Ducheyne, Paul

    2015-09-01

    Risk of infection is considerable in open fractures, especially when fracture fixation devices are used to stabilize the fractured bones. Overall deep infection rates of 16.2% have been reported. The infection rate is even greater, up to 32.2%, with external fixation of femoral fractures. The use of percutaneous implants for certain clinical applications, such as percutaneous implants for external fracture fixation, still represents a challenge today. Currently, bone infections are very difficult to treat. Very potent antibiotics are needed, which creates the risk of irreversible damage to other organs, when the antibiotics are administered systemically. As such, controlled, local release is being pursued, but no such treatments are in clinical use. Herein, the use of bactericidal micron-thin sol-gel films on metallic fracture fixation pins is reported. The data demonstrates that triclosan (2,4,4'-trichloro-2'-hydroxydiphenylether), an antimicrobial agent, can be successfully incorporated into micron-thin sol-gel films deposited on percutaneous pins. The sol-gel films continuously release triclosan in vitro for durations exceeding 8 weeks (longest measured time point). The bactericidal effect of the micron-thin sol-gel films follows from both in vitro and in vivo studies. Inserting percutaneous pins in distal rabbit tibiae, there were no signs of infection around implants coated with a micron-thin sol-gel/triclosan film. Healing had progressed normally, bone tissue growth was normal and there was no epithelial downgrowth. This result was in contrast with the results in rabbits that received control, uncoated percutaneous pins, in which abundant signs of infection and epithelial downgrowth were observed. Thus, well-adherent, micron-thin sol-gel films laden with a bactericidal molecule successfully prevented pin tract infection.

  11. Lower reoperation rate for cemented femoral stem than for uncemented femoral stem in primary total hip arthroplasty following a displaced femoral neck fracture

    PubMed Central

    Andersen, Michelle F.; Jakobsen, Thomas; Bensen, Anne S.; Krarup, Niels

    2015-01-01

    Introduction: Acute displaced femoral neck fractures are often treated with cemented hemiarthroplasty (HA). There is increasing evidence that total hip arthroplasty (THA) may be a better alternative, but the degree to which the fixation of the femoral stem used affects the outcome is not fully known. The aim of this study is to compare rates of operative complications and implant survival following THA treatment of displaced femoral neck fractures with either a cemented or an uncemented femoral stem. Methods: The study consists of two groups of patients (N = 334), who were treated for a displaced femoral neck fracture with THA at the Regional Hospital of Viborg during 2007–2012. The first group (50.9%) had uncemented (Corail®) stem while the second group (49.1%) had cemented (Exeter®) stem implanted. Nearly all patients had uncemented dual mobility cup (Saturne®) as acetabular component and were followed up to three months postoperatively. Data regarding rates of implant survival and operative complications were obtained by retrospective review of medical records. Results: We found a statistically significant difference regarding rates of postoperative reoperation with 1.2% (95% CI 0.005–0.03) for cemented and 5.9% (95% CI 0.02–0.09) for uncemented stem (p = 0.02). The main causes for reoperation were peri-prosthetic fractures and deep infections. There was no difference regarding dislocation or peroperative complications. Rates of dislocation were 4.3% (95% CI 0.012–0.07) for cemented and 3.5% (95% CI 0.008–0.06) for uncemented stem (p = 0.72). Rates of peroperative complications were 6.1% (95% CI 0.024–0.1) for cemented and 8.2% (95% CI 0.04–0.12) for uncemented stem (p = 0.1). Discussion: Our results indicate that cemented femoral stem is superior to cementless when rates of reoperation are compared. PMID:27163081

  12. BIOMECHANICAL STUDY OF TRANSCORTICAL OR TRANSTRABECULAR BONE FIXATION OF PATELLAR TENDON GRAFT WITH BIOABSORBABLE PINS IN ACL RECONSTRUCTION IN SHEEP

    PubMed Central

    Albano, Mauro Batista; Borges, Paulo César; Namba, Mario Massatomo; da Silva, João Luiz Vieira; de Assis Pereira Filho, Francisco; Filho, Edmar Stieven; Matias, Jorge Eduardo Fouto

    2015-01-01

    Objective: To determine the initial resistance of fixation using the Rigid Fix® system, and compare it with traditional fixation methods using metal interference screws; and to evaluate the resistance of the fixation with the rigid fix system when the rotational position of the bone block is altered in the interior of the femoral tunnel. Methods: forty ovine knee specimens (stifle joints) were submitted to anterior cruciate ligament reconstruction (ACL) using a bone-tendon-bone graft. In twenty specimens, the Rigid Fix method was used; this group was subdivided into two groups: ten knees the pins transfixed only the spongious area of the bone block, and ten for fixation passing through the layer of cortical bone. In the twenty remaining specimens, the graft was fixed with 9mm metal interference screws. Results: comparison of the RIGIDFIX® method with the metal interference screw fixation method did not show any statistically significant differences in terms of maximum load and rigidity; also, there were no statistically significant differences when the rotational position of the bone block was altered inside the femoral tunnel. For these evaluations, a level of significance of p < 0.017 was considered. Conclusion: fixation of the bone-tendon-bone graft with 2 bioabsorbable pines, regardless of the rotational position inside the femoral tunnel, gave a comparable fixation in terms of initial resistance to the metal interference screw, in this experimental model. PMID:27027081

  13. The influence of hip rotation on femoral offset in plain radiographs

    PubMed Central

    Frink, Michael; Gulati, Aashish; Murray, David; Renkawitz, Tobias; Bücking, Benjamin; Ruchholtz, Steffen; Boese, Christoph Kolja

    2014-01-01

    Background and purpose Adequate restoration of femoral offset (FO) is critical for successful outcome after hip arthroplasty or fixation of hip fracture. Previous studies have identified that hip rotation influences the projected femoral offset (FOP) on plain anteroposterior (AP) radiographs, but the precise effect of rotation is unknown. Patients and methods We developed a novel method of assessing rotation-corrected femoral offset (FORC), tested its clinical application in 222 AP hip radiographs following proximal femoral nailing, and validated it in 25 cases with corresponding computed tomography (CT) scans. Results The mean FORC was 57 (29–93) mm, which differed significantly (p < 0.001) from the mean FOP 49 (22–65) mm and from the mean femoral offset determined by the standard method: 49 (23–66) mm. FORC correlated closely with femoral offset assessed by CT (FOCT); the Spearman correlation coefficient was 0.94 (95% CI: 0.88–0.97). The intraclass correlation coefficient for the assessment of FORC by AP hip radiographs correlating the repeated measurements of 1 observer and of 2 independent blinded observers was 1.0 and 1.0, respectively. Interpretation Hip rotation affects the FOP on plain AP radiographs of the hip in a predictable way and should be adequately accounted for. PMID:24954484

  14. A complication during femoral broaching in total hip arthroplasty: a case report.

    PubMed

    Waldstein, Wenzel; Boettner, Friedrich

    2013-01-01

    Press-fit component fixation is one of the primary goals in uncemented total hip arthroplasty. When aiming at proximal load transfer, the stem size has to be selected with regard to the shape of the proximal femoral canal. This can be challenging in patients with 'champagne flute' femurs with a relatively narrow diaphysis, especially when a long stem femoral component is used. The present case report describes a complication during femoral broaching for a primary uncemented femoral component. Because of the narrow diaphysis, the distal portion of the broach got caught in the narrow canal and it became impossible to remove the broach with conventional techniques. Via a second distal incision, the femur was split from the distal tip of the broach to approximately 5 cm distal of the femoral neck cut along the posterior aspects of the femur. This loosened the broach enough to allow for an uncomplicated removal. The longitudinal split was secured with cables before a similar size primary implant was press fitted into the femoral canal. PMID:23961301

  15. Misdiagnosis of pathological femoral fracture in a patient with intramuscular hemangioma: A case report

    PubMed Central

    YU, XIAOLONG; NIE, TAO; ZHANG, BIN; DAI, MIN; LIU, HUCHENG; ZOU, FAN

    2016-01-01

    Hemangioma is a common disease; however, intramuscular hemangioma (IH) presenting with a pathological fracture is extremely rare. The present study reports a case of a 46-year-old male patient that suffered from IH of the right thigh, presenting with a pathological femoral fracture. The patient was initially diagnosed with a traumatic femoral fracture, and routine open reduction and internal fixation were performed at a local hospital. However, 20 days subsequent to surgery, gradual swelling and soreness around the incision were observed. The incision eventually ruptured during squatting for bowel movement, which led to extensive blood loss. Based on computed tomography (CT) and deep femoral artery arteriography, IH presenting with a pathological femoral fracture was diagnosed. The patient underwent artery embolization, from which he recovered well. At the 6-month follow-up, the femoral fracture was revealed to have healed, and a CT scan demonstrated no evidence of recurrence; however, continuous observation using CT is required in order to determine the long-term outcome. To the best of our knowledge, this is the first case of a misdiagnosed pathological femoral fracture in a patient with IH reported in the English literature. PMID:27347124

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

    PubMed

    Marecek, Geoffrey S; Routt, M L Chip

    2014-09-01

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

  17. Total knee arthroplasty with concurrent femoral and tibial osteotomies in osteogenesis imperfecta.

    PubMed

    Wagner, Russell; Luedke, Colten

    2014-01-01

    Three total knee arthroplasties (TKA) with concurrent femoral and/or tibial osteotomies in 2 patients with osteogenesis imperfecta were performed from 2004 to 2009. The 2 patients were followed for a mean of 6 years. One patient with concurrent TKA, and femoral and tibial osteotomies developed a nonunion of the tibial site that responded to open reduction and internal fixation with iliac crest bone graft. The second patient underwent right TKA with bi-level tibial osteotomies, which healed uneventfully, allowing pain free, unassisted ambulation. The same patient then elected to undergo left TKA with bi-level tibial osteotomies. Intraoperatively he sustained a minor tibial plateau fracture requiring the use of a stemmed component and postoperatively, he developed a nonunion at the proximal site and valgus malunion of the distal site. Revision of fixation was performed at both osteotomy sites, and both healed within 3 months. Both patients are now pain free and ambulate without assistance.

  18. 21 CFR 878.3250 - External facial fracture fixation appliance.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false External facial fracture fixation appliance. 878.3250 Section 878.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices §...

  19. 21 CFR 878.3250 - External facial fracture fixation appliance.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false External facial fracture fixation appliance. 878.3250 Section 878.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices §...

  20. 21 CFR 878.3250 - External facial fracture fixation appliance.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false External facial fracture fixation appliance. 878.3250 Section 878.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices §...

  1. 21 CFR 878.3250 - External facial fracture fixation appliance.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false External facial fracture fixation appliance. 878.3250 Section 878.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices §...

  2. 21 CFR 878.3250 - External facial fracture fixation appliance.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false External facial fracture fixation appliance. 878.3250 Section 878.3250 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices §...

  3. Midterm Results of Consecutive Periprosthetic Femoral Fractures Vancouver Type A and B

    PubMed Central

    Trieb, Klemens; Fiala, Rainer; Briglauer, Christian

    2016-01-01

    Surgical treatment of periprosthetic femoral fractures has a high complication and mortality rate of more than 10%. The aim of this study is to report the outcome of a consecutive single center patient group. Thirty-four consecutive patients (mean age 81.2+/-8.5 years, 14 male, 20 female) with a periprosthetic femoral fracture Vancouver type A (n=5) or type B (n=29) were followed-up after 43.2 months, none of the patients were lost to follow-up. Nineteen of the patients were treated through change of the stem and cerclage fixation, five by plates and ten by cerclage cables. One successfully treated infection was observed. No further complications have been reported peri- or postoperatively, therefore resulting in 2.9% overall complication rate. These results demonstrate that precisely selected revision surgery protocol following periprosthetic femoral fractures within elderly multimorbid patients may lead to beneficial outcomes at a low risk of complications. PMID:27777712

  4. Photographic fixative poisoning

    MedlinePlus

    Photographic developer poisoning; Hydroquinone poisoning; Quinone poisoning; Sulfite poisoning ... Hydroquinones Quinones Sodium thiosulfate Sodium sulfite/bisulfite Boric acid Photographic fixative can also break down (decompose) to form sulfur dioxide gas.

  5. Removal of well-fixed fixed femoral stems.

    PubMed

    Laffosse, J-M

    2016-02-01

    The removal of a well-fixed prosthetic stem raises technical challenges. The objective is not only to remove the material, but also to prepare the implantation of a new prosthesis. Cemented stems are only very rarely unremovable; extraction of the cement mantle and plug raises the greatest difficulties. The main risk is cortex perforation, and a radiograph should be obtained at the slightest doubt. The removal of cementless stems carries a higher risk of fracture. Difficulties should be anticipated based on thorough familiarity with the implant design and on evaluations of implant fixation and bone stock. The intramedullary approach is usually sufficient to extract a cemented or cementless, well fixed, standard stem. Routine use of a transfemoral approach is warranted only in the following situations: revision surgery for infection, S-shaped stem, long stem, curvature or angulation of the femoral shaft, or unfeasible hip dislocation. However, the possibility that the intramedullary approach may need to be converted to a transfemoral approach should be anticipated. Thus, preoperative planning must include determination of the optimal length of a femoral osteotomy or femoral flap, should one be needed, and the surgeon must have access to all the revision implants and tools that might be needed for re-implantation. Experience with the various techniques is indispensable, as a well-performed extensive approach is associated with less morbidity than a fracture or trajectory error. There are three main techniques, which are described here: intramedullary extraction of a cementless stem, intramedullary extraction of a cemented stem, and transfemoral extraction through an extended trochanterotomy. The patients should receive detailed information on the difficulties of femoral stem removal and on the available solutions. PMID:26797009

  6. Pseudopathologic fracture of the femoral neck

    SciTech Connect

    Pope, T.L. Jr.; Keats, T.E.; Goldner, R.; Stelling, C.B.; Logan, M.

    1981-11-01

    We have seen two cases of traumatic subcapital fractures of the femoral neck which resembled pathologic fractures on plain radiography. We have named this entity pseudopathologic fracture of the femoral neck and offer suggestions for why it occurs.

  7. Analysis of mechanical strength to fixing the femoral neck fracture in synthetic bone type Asnis

    PubMed Central

    Freitas, Anderson; Lula, Welder Fernandes; de Oliveira, Jonathan Sampaio; Maciel, Rafael Almeida; Souto, Diogo Ranier de Macedo; Godinho, Patrick Fernandes

    2014-01-01

    OBJECTIVE: To analyze the results of biomechanical assays of fixation of Pauwels type III femoral neck fracture in synthetic bone, using 7.5mm cannulated screws in inverted triangle formation, in relation to the control group. METHODS: Ten synthetic bones were used, from a domestic brand, divided into two groups: test and control. In the test group, a 70° tilt osteotomy of the femoral neck was fixated using three cannulated screws in inverted triangle formation. The resistance of this fixation and its rotational deviation were analyzed at 5mm displacement (phase 1) and 10mm displacement (phase 2). The control group was tested in its integrity until the fracture of the femoral neck occurred. The Mann-Whitney test was used for group analysis and comparison. RESULTS: The values in the test group in phase 1, in samples 1-5, showed a mean of 579N and SD =77N. Rotational deviations showed a mean of 3.33°, SD = 2.63°. In phase 2, the mean was 696N and SD =106N. The values of the maximum load in the control group had a mean of 1329N and SD=177N. CONCLUSION: The analysis of mechanical strength between the groups determined a statistically significant lower value in the test group. Level of Evidence III, Control Case. PMID:25246851

  8. KIRSCHNER WIRE VERSUS TITANIUM ELASTIC NAILS IN PEDIATRIC FEMORAL SHAFT FRACTURES

    PubMed Central

    Isik, Cengiz; Kurtulmus, Tuhan; Saglam, Necdet; Saka, Gursel; Akpinar, Fuat; Sarman, Hakan

    2015-01-01

    ABSTRACT Objective: To evaluate the effectiveness of intramedullary fixation using the Kirschner-wire (K-wire) compared to the titanium elastic nail (TEN) in pediatric femoral shaft fractures. Methods: A sample of 42 pediatric patients with a mean age of 6.55±2.42 years (range 4-11 years) presenting femoral shaft fractures underwent intramedullary fixation using the K-wire or TEN. Results: There was no significant difference found between groups, of which 16 (38.1%) patients were treated with K-wire and 26 (61.9%) patients were treated with TEN in terms of union duration. Moreover, none of the patients showed nonunion or a delayed union. Conclusions: The use of adjusted K-wire instead of TEN in the intramedullary fixation of femoral shaft fractures in selected children may be an advantageous surgical option due to the lower cost, easy accessibility and no need for a second surgery for implant removal. Level of Evidence III, Retrospective Study. PMID:26981033

  9. Better Axial Stiffness of a Bicortical Screw Construct Compared to a Cable Construct for Comminuted Vancouver B1 Proximal Femoral Fractures.

    PubMed

    Griffiths, Jamie T; Taheri, Arash; Day, Robert E; Yates, Piers J

    2015-12-01

    The aim of this study was to biomechanically evaluate the Locking attachment plate (LAP) construct in comparison to a Cable plate construct, for the fixation of periprosthetic femoral fractures after cemented total hip arthroplasty. Each construct incorporated a locking compression plate with bi-cortical locking screws for distal fixation. In the Cable construct, 2 cables and 2 uni-cortical locking screws were used for proximal fixation. In the LAP construct, the cables were replaced by a LAP with 4 bi-cortical locking screws. The LAP construct was significantly stiffer than the cable construct under axial load with a bone gap (P=0.01). The LAP construct offers better axial stiffness compared to the cable construct in the fixation of comminuted Vancouver B1 proximal femoral fractures.

  10. Operative management of Hoffa fracture of the femoral condyle.

    PubMed

    Sahu, Ramji Lal; Gupta, Pratiksha

    2014-01-01

    Hoffa fracture is a rare injury consisting of unicondylar tangential posterior fracture of the distal femur and only very few cases have been reported in the literature. These fractures are due to high energy trauma and conservative treatment generally yields poor results, but rigid internal fixation allows early functional rehabilitation and decreases the incidence of complications. The purpose of the study was to prospectively analyse the clinico-radiological and functional outcome following open surgical treatment. From July 2005 to July 2010, 22 patients (14 males and 8 females) were recruited from Emergency and outpatient department having closed and open Hoffa fracture of the femoral condyle. All patients were operated under general or spinal anesthesia. Post-operatively, all the patients were followed for 12 months. Fractures were united in a mean time of 10 weeks (range from 6 - 16 weeks) depending on the type of fracture pattern. Fractures were reduced anatomically in all except in one patient. During follow-up, there were no losses of reduction or fixation. Full weight bearing were started in the mean time of 8.8 weeks. Mean duration of hospital stay were 9.8 days. Complications were stiffness and pain in one patient, collateral laxity in one patient and progression of arthritis in one patient. The results were excellent in 90.90% and good in 9.09% patients. Finally, we conclude that the early anatomical reduction and rigid fixation with screws provide best results and minimal complications. PMID:25130151

  11. A trapdoor procedure for chondroblastoma of the femoral head: a case report.

    PubMed

    Iwai, Toshiya; Abe, Satoshi; Miki, Yuji; Tokizaki, Toru; Matsuda, Kenta; Wakimoto, Nobuhiro; Nakamura, Sigeru; Imamura, Tetsuo; Matsushita, Takashi

    2008-08-01

    Chondroblastoma located in the femoral head is one of the locations accounting for frequent recurrence. One of the reasons for this is the difficulty in obtaining appropriate surgical access to it for adequate removal of tumors. The authors present and illustrate a trapdoor procedure for the surgical treatment of chodroblastoma in the epiphysis of the femoral head. The surgical approach was made over the great trochanter and a trochanteric osteotomy was performed. The capsulotomy was made anteriorly and posteriorly, and the hip was dislocated anteriorly. Using a scalpel and an osteotome, the edges of a trapdoor segment were sharply dissected and the rectangular segment was lifted back to reveal an underlying subchondral tumor. The tumor tissue was thoroughly curetted and autologous cancellous bone was grafted. The trapdoor was replaced without any additional fixation, and the femoral head was reduced. The patient recovered good hip function without pain, and showed no recurrence of chondroblastoma at 5 years after surgery. The trapdoor procedure enabled sufficient access to complete curettage and autologous cancellous bone grafting for the chondroblastoma of the femoral head. This procedure proved to be a useful surgical approach for the treatment of chodroblastoma in the epiphysis of the femoral head in this case. PMID:18026969

  12. Dynamic Simulation of the Effects of Graft Fixation Errors During Medial Patellofemoral Ligament Reconstruction

    PubMed Central

    Elias, John J.; Kelly, Michael J.; Smith, Kathryn E.; Gall, Kenneth A.; Farr, Jack

    2016-01-01

    Background: Medial patellofemoral ligament (MPFL) reconstruction is performed to prevent recurrent instability, but errors in femoral fixation can elevate graft tension. Hypothesis: Errors related to femoral fixation will overconstrain the patella and increase medial patellofemoral pressures. Study Design: Controlled laboratory study. Methods: Five knees with patellar instability were represented with computational models. Kinematics during knee extension were characterized from computational reconstruction of motion performed within a dynamic computed tomography (CT) scanner. Multibody dynamic simulation of knee extension, with discrete element analysis used to quantify contact pressures, was performed for the preoperative condition and after MPFL reconstruction. A standard femoral attachment and graft resting length were set for each knee. The resting length was decreased by 2 mm, and the femoral attachment was shifted 5 mm posteriorly. The simulated errors were also combined. Root-mean-square errors were quantified for the comparison of preoperative patellar lateral shift and tilt between computationally reconstructed motion and dynamic simulation. Simulation output was compared between the preoperative and MPFL reconstruction conditions with repeated-measures Friedman tests and Dunnett comparisons against a control, which was the standard MPFL condition, with statistical significance set at P < .05. Results: Root-mean-square errors for simulated patellar tilt and shift were 5.8° and 3.3 mm, respectively. Patellar lateral tracking for the preoperative condition was significantly larger near full extension compared with the standard MPFL reconstruction (mean differences of 8 mm and 13° for shift and tilt, respectively, at 0°), and lateral tracking was significantly smaller for a posterior femoral attachment (mean differences of 3 mm and 4° for shift and tilt, respectively, at 0°). The maximum medial pressure was also larger for the short graft with a

  13. Improving carbon fixation pathways

    SciTech Connect

    Ducat, DC; Silver, PA

    2012-08-01

    A recent resurgence in basic and applied research on photosynthesis has been driven in part by recognition that fulfilling future food and energy requirements will necessitate improvements in crop carbon-fixation efficiencies. Photosynthesis in traditional terrestrial crops is being reexamined in light of molecular strategies employed by photosynthetic microbes to enhance the activity of the Calvin cycle. Synthetic biology is well-situated to provide original approaches for compartmentalizing and enhancing photosynthetic reactions in a species independent manner. Furthermore, the elucidation of alternative carbon-fixation routes distinct from the Calvin cycle raises possibilities that novel pathways and organisms can be utilized to fix atmospheric carbon dioxide into useful materials.

  14. Bone ingrowth through porous titanium granulate around a femoral stem: histological assessment in a six-month canine hemiarthroplasty model.

    PubMed

    Turner, Thomas M; Urban, Robert M; Hall, Deborah J; Andersson, Gunnar B J

    2007-01-01

    The procedure of using of porous titanium granules for cementless fixation of a hip replacement femoral stem was studied in a hemiarthroplasty model in 10 canines for 6 months. A vibrating instrument was used to facilitate both the delivery and distribution of the irregularly shaped porous titanium granules into the femoral canal as well as the subsequent insertion of a titanium alloy stem into the intramedullary bed of granules. Histological examination revealed lamellar bone formation through the mantle of porous titanium granules in continuity with the surrounding cortex resulting in the formation of an integrated mantle of bone and titanium granulate around the prosthesis. PMID:17578819

  15. Femoral Varus Osteotomy for Hip Instability after Traumatic Fracture Dislocations of the Hip Associated with Femoral Head Fractures: A Report of Two Cases

    PubMed Central

    Nakamura, Junichi; Takahashi, Kazuhisa

    2016-01-01

    Fracture of the femoral head and the acetabulum with traumatic dislocation of the hip is a severe injury representing various types and unfavorable outcome. We showed a 45-year-old man with Pipkin type-IV fracture and coxa valga. An immediate closed reduction was achieved followed by open reduction and internal fixation via a posterior approach 6 days later. However, dislocation occurred three times without traumatic events after three weeks. CT demonstrated no displacement of posterior fragments or implant failure. Femoral intertrochanteric varus osteotomy was performed to gain concentric stability and successfully resolved recurrent dislocation. Another 45-year-old woman with Pipkin type-IV fracture and coxa valga also underwent closed reduction initially and then continued conservative treatment. After eight weeks, when she started gait training, progressive pain became symptomatic. Persistent hip pain at weight bearing was not improved in spite of arthroscopic synovectomy and osteochondroplasty. Two years after injury, femoral intertrochanteric varus osteotomy was indicated and her refractory pain was resolved gradually. We suggest that femoral varus osteotomy should be considered for superolateral subluxation associated fracture dislocation of the hip in Pipkin type-IV and coxa valga. PMID:27293934

  16. Femoral Varus Osteotomy for Hip Instability after Traumatic Fracture Dislocations of the Hip Associated with Femoral Head Fractures: A Report of Two Cases.

    PubMed

    Miyamoto, Shuichi; Nakamura, Junichi; Iida, Satoshi; Suzuki, Chiho; Ohtori, Seiji; Orita, Sumihisa; Takahashi, Kazuhisa

    2016-01-01

    Fracture of the femoral head and the acetabulum with traumatic dislocation of the hip is a severe injury representing various types and unfavorable outcome. We showed a 45-year-old man with Pipkin type-IV fracture and coxa valga. An immediate closed reduction was achieved followed by open reduction and internal fixation via a posterior approach 6 days later. However, dislocation occurred three times without traumatic events after three weeks. CT demonstrated no displacement of posterior fragments or implant failure. Femoral intertrochanteric varus osteotomy was performed to gain concentric stability and successfully resolved recurrent dislocation. Another 45-year-old woman with Pipkin type-IV fracture and coxa valga also underwent closed reduction initially and then continued conservative treatment. After eight weeks, when she started gait training, progressive pain became symptomatic. Persistent hip pain at weight bearing was not improved in spite of arthroscopic synovectomy and osteochondroplasty. Two years after injury, femoral intertrochanteric varus osteotomy was indicated and her refractory pain was resolved gradually. We suggest that femoral varus osteotomy should be considered for superolateral subluxation associated fracture dislocation of the hip in Pipkin type-IV and coxa valga. PMID:27293934

  17. Treatment of Midshaft Clavicle Fractures: Application of Local Autograft With Concurrent Plate Fixation.

    PubMed

    Slette, Erik L; Mikula, Jacob D; Turnbull, Travis Lee; Hackett, Thomas R

    2016-06-01

    Currently, open reduction-internal fixation using contoured plates or intramedullary nails is considered the standard operative treatment for midshaft clavicle fractures because of the immediate rigid stability provided by the fixation device. In addition, autologous iliac crest bone graft has proved to augment osteosynthesis during internal fixation of nonunion fractures through the release of osteogenic factors. The purpose of this article is to describe a surgical technique developed to reduce donor-site morbidity and improve functional and objective outcomes after open reduction-internal fixation with autologous bone graft placement through local autograft harvesting and concurrent plate fixation. PMID:27656378

  18. Fixation of a human rib by an intramedullary telescoping splint anchored by bone cement.

    PubMed

    Liovic, Petar; Šutalo, Ilija D; Marasco, Silvana F

    2016-09-01

    A novel concept for rib fixation is presented that involves the use of a bioresorbable polymer intramedullary telescoping splint. Bone cement is used to anchor each end of the splint inside the medullary canal on each side of the fracture site. In this manner, rib fixation is achieved without fixation device protrusion from the rib, making the splint completely intramedullary. Finite element analysis is used to demonstrate that such a splint/cement composite can preserve rib fixation subjected to cough-intensity force loadings. Computational fluid dynamics and porcine rib experiments were used to study the anchor formation process required to complete the fixation. PMID:26733094

  19. Suture-mediated closure of antegrade femoral arteriotomy following infrainguinal intervention.

    PubMed

    Khosla, Sandeep; Kunjummen, Binu; Guerrero, Mayra; Manda, Ravi; Razminia, Mansoor; Ahmed, Aziz

    2002-12-01

    Antegrade femoral arterial access has been less commonly adopted for infrainguinal intervention due to increased risk of retroperitoneal hemorrhage secondary to noncompressibility of arteriotomy site. We evaluated the efficacy and safety of suture-mediated closure of antegrade femoral arteriotomy using the Closer device. Twelve consecutive patients undergoing infrainguinal intervention (females, 5; mean body weight, 69 +/- 16 kg; limb threatening ischemia, 50%) underwent repair of the antegrade femoral arteriotomy immediately postprocedure using the Closer. Indications for antegrade access were excessive iliac tortuosity (6/12), long femoral artery occlusion (5/12), and bilateral aortoiliac bifurcation stents (1/12). The acute procedural success (immediate hemostasis without need for manual compression) was 100%. The mean time to ambulation was 3.9 +/- 1.5 hr and the procedure-related length of stay was 18 +/- 5.5 hr. In conclusion, repair of antegrade arterial puncture is safe and effective following infrainguinal intervention. PMID:12455086

  20. Fixation produced by conflict.

    PubMed

    Karsh, E B

    1970-05-15

    All rats given a choice between a rewarded alternative and a conflict alternative (rewarded and punished) developed position fixations when the position of the alternatives was reversed. In contrast, all animals given one rewarded alternative and another nonrewarded (or punished and nonrewarded) alternative learned to choose the rewarded side during 25 successive reversals.

  1. The Fixation of Nitrogen.

    ERIC Educational Resources Information Center

    Andrew, S. P. S.

    1978-01-01

    Discusses the fixation of atmospheric nitrogen in the form of ammonia as one of the foundations of modern chemical industry. The article describes ammonia production and synthesis, purifying the hydrogen-nitrogen mix, nitric acid production, and its commericial plant. (HM)

  2. Update: Biological Nitrogen Fixation.

    ERIC Educational Resources Information Center

    Wiseman, Alan; And Others

    1985-01-01

    Updates knowledge on nitrogen fixation, indicating that investigation of free-living nitrogen-fixing organisms is proving useful in understanding bacterial partners and is expected to lead to development of more effective symbioses. Specific areas considered include biochemistry/genetics, synthesis control, proteins and enzymes, symbiotic systems,…

  3. Fixation produced by conflict.

    PubMed

    Karsh, E B

    1970-05-15

    All rats given a choice between a rewarded alternative and a conflict alternative (rewarded and punished) developed position fixations when the position of the alternatives was reversed. In contrast, all animals given one rewarded alternative and another nonrewarded (or punished and nonrewarded) alternative learned to choose the rewarded side during 25 successive reversals. PMID:5444066

  4. Distal Femoral Complications Following Antegrade Intramedullary Nail Placement

    PubMed Central

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

    2015-01-01

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

  5. Conservative treatment of a femoral neck fracture following nail removal.

    PubMed

    Legnani, Claudio; Dondi, Alessandra; Pietrogrande, Luca

    2013-07-01

    With increased longevity, the management of fragility fractures in the elderly is becoming more frequent. In particular, hip fractures have considerable importance due to the significant morbidity and mortality. A 67-year-old woman underwent intramedullary nail (IMN) removal inserted for a pertrochanteric fracture that had occurred 20 months earlier. This was indicated due to continuous discomfort related to the protruding apex of the implant over the great trochanter. Due to pain persistence two days after surgery, a computed tomography (CT) scan was performed, documenting a minimally displaced impacted subcapital femoral neck fracture. Conservative management with close radiographic follow-up was conducted. After six months, the patient had returned to previous daily activities and a satisfactory range of motion was achieved without pain on walking. The purpose of our paper is to discuss the decision of removing hardware in the elderly osteoporotic patient and to analyze the possibility to conservatively treat an impacted minimally displaced subcapital fracture occurring after the removal of an IMN inserted previously for the treatment of a trochanteric fracture. In the elderly population with decreased bone quality, the removal of intramedullary implants of the proximal femur should be carefully evaluated, and osteoporotic patients undergoing reduction and fixation of femoral fractures should be encouraged to start antiosteoporotic therapy (bisphosphonate, teriparatide) to reduce the risk of further bone loss. Conservative treatment should be considered for the management of lesser symptomatic minimally displaced impacted fractures, where the inherent stability of the fracture allows rapid healing without further surgical attempts.

  6. Bone impregnated hip screw in femoral neck fracture: Clinicoradiological results

    PubMed Central

    Sundar Raj, PK; Nuuman, Jiju A; Pattathil, Amish Sunder

    2015-01-01

    Background: Femoral neck fractures are treated either by internal fixation or arthroplasty. Usually, cannulated cancellous screws are used for osteosynthesis of fracture neck of femur. The bone impregnated hip screw (BIHS) is an alternative implant, where osteosyntehsis is required in femoral neck fracture. Materials and Methods: The BIHS is a hollow screw with thread diameter 8.3 mm, shank diameter 6.5 mm and wall thickness 2.2 mm and holes in the shaft of the screw with diameter 2 mm, placed in a staggered fashion. Biomechanical and animal experimental studies were done. Clinical study was done in two phases: Phase 1 in a group of volunteers, only with BIHS was used in a pilot study and phase 2 comparative study was done in a group with AO cannulated screws and the other group treated with BIHS. Results: In the phase 1 study, out of 15 patients, only one patient had delayed union. In phase 2, there were 78 patients, 44 patients in BIHS showed early union, compared to the rest 34 cases of AO cannulated screws Out of 44 patients with BIHS, 41 patients had an excellent outcome, 2 had nonunions and one implant breakage was noted. Conclusions: Bone impregnated hip screw has shown to provide early solid union since it incorporates the biomechanical principles and also increases the osteogenic potential and hence, found superior to conventional cannulated cancellous screw. PMID:26015608

  7. [Infection following centro-medullary nailing of diaphyseal femoral and tibial fractures].

    PubMed

    Lortat-Jacob, A; Sutour, J M; Beaufils, P

    1986-01-01

    The authors have treated 51 cases of infection arising after intramedullary nailing of the femur or tibia. In 3 cases amputation was required, 48 united, but 10 were still draining. The final result was obtained after an average of 15 months. An average of four procedures per patient were needed. All the cases were septic non-unions at the onset of treatment, except 18 cases which had already united. In these cases, simple removal of the femoral nail led to rapid healing. In contrast, healing was less easy to obtain in the tibia. In 33 septic non-unions, 12 femoral and 21 tibial, the best results at the femoral level were obtained by retaining the nail in situ. At the tibial level, retention of the nail was rarely followed by bony union. Removal of the nail and the use of external fixation gave good results for the infection, but rarely resulted in bony union (1 case out of 14). The failures were treated by further operation of bone resection and grafting. The authors recommend, in cases of tibial septic non-union after nailing that primary removal of the nail should be associated with bony resection and external fixation, followed by reconstructive grafting, either by open cancellous grafting extending to the fibula or conventional tibio fibular grafting. In 8 cases, 7 in the femur and 1 in the tibia, the infection extended throughout the entire diaphysis and in 3 of these cases, a large diaphyseal resection was required. PMID:3823510

  8. Adjuvant Teriparatide Therapy for Surgical Treatment of Femoral Fractures; Does It Work?

    PubMed Central

    Kim, Jung Taek; Jeong, Hyung Jun; Lee, Soong Joon; Kim, Hee Joong

    2016-01-01

    Purpose Atypical femoral fracture (AFF), periprosthetic femoral fracture (PPFF) and femoral nonunion (FNU) are recalcitrant challenges for orthopedic surgeons. Teriparatide (TPTD) had been demonstrated to have anabolic effects on bone in various studies. We postulated that adjuvant TPTD after operation would enhance biologic stimulation for bone formation. We investigated (1) whether the adjuvant TPTD could achieve satisfactory union rate of surgically challenging cases such as displaced AFF, PPFF and FNU; (2) whether the adjuvant TPTD could promote development of abundant callus after surgical fixation; (3) whether the adjuvant TPTD had medically serious adverse effects. Materials and Methods Thirteen patients who agreed to off label use of TPTD in combination of operation were included in this retrospective case series. Median patients' age was 68.7 years, and there were three male and ten female patients. Their diagnoses were nonunion in six patients and acute fracture in seven. Medical records and radiographic images were reviewed. Results Twelve of thirteen fractures were united both clinically and radiologically within a year after adjuvant TPTD. Union completed radiologically median 5.4 months and clinically 5.7 months after the medication, respectively. Callus appeared abundantly showing median 1.4 of fracture healing response postoperatively. There was no serious adverse reaction of medication other than itching, muscle cramp, or nausea. Conclusion Even appropriate surgical treatment is a mainstay of treatment for AFF, PPFF, and FNU, the current report suggested that adjuvant TPTD combined with stable fixation results in satisfactory outcome for the challenging fractures of femur. PMID:27777917

  9. External Fixation: Principles and Applications.

    PubMed

    Bible, Jesse E; Mir, Hassan R

    2015-11-01

    The modularity and ease of application of modern external fixation has expanded its potential use in the management of fractures and other musculoskeletal conditions. In fracture care, it can be used for provisional and definitive fixation. Short-term provisional applications include "damage control" and periarticular fracture fixation. The risk:benefit ratio of added stability needs to be assessed with each fixator. Soft-tissue management is critical during pin insertion to lessen the risk of loosening and infection. Although provisional fixation is safe for early conversion to definitive fixation, several factors affect the timing of definitive surgery, including the initial injury, external fixator stability, infection, and the physiologic state of the patient. PMID:26306568

  10. Fixation techniques for the anterior cruciate ligament reconstruction: early follow-up. A systematic review of level I and II therapeutic studies.

    PubMed

    Speziali, Andrea; Delcogliano, Marco; Tei, Matteo; Placella, Giacomo; Bartoli, Matteo; Menghi, Amerigo; Cerulli, Giuliano

    2014-12-01

    The purpose of our study was that to systematically review the fixation techniques for the ACL reconstruction and associated clinical outcomes at the early follow-up. Systematic search on three electronic databases (Cochrane register, Medline and Embase) of fixation devices used for primary ACL reconstruction with doubled semitendinosus and gracilis and bone-patellar tendon-bone autografts in randomized clinical trials of level I and II of evidence published from January 2001 to December 2011. Therapeutic studies collected were with a minimum 12-month follow-up, and the clinical outcomes were evaluated by at least one of International Knee Documentation Committee, Lysholm and Tegner functional scales and at least one of the following knee stability tests: arthrometric AP tibial translation, Lachman test and pivot-shift test. Nineteen articles met the inclusion criteria. At the femoral side cross-pin, metallic interference screw, bioabsorbable interference screw, and suspensory device were used in 32.3, 27.3, 24.8, 15.5% of patients, respectively. At the tibial side fixation was achieved with metallic interference screw, bioabsorbable interference screw, screw and plastic sheath, screw post and cross-pin in 38.7, 31, 15.7, 12.8, and 1.7% of patients, respectively. Side-to-side anterior-posterior tibial translation was 1.9 ± 0.9, 1.5 ± 0.9, 1.5 ± 0.8, 2.2 ± 0.4 mm for metallic interference screw, bioabsorbable screw, cross-pin and suspensory device, respectively. At least two-third of all the patients achieved good-to-excellent clinical outcomes. Rate of failure was 6.1, 3.3, 1.7 and 1.2% for bioabsorbable interference screw, metallic interference screw, cross-pin and suspensory device, respectively. Clinical outcomes are good to excellent in almost two-third of the patients but several pitfalls that affect the current fixation techniques as graft tensioning such as graft-tunnel motion are still unaddressed. PMID:25269758

  11. CARBON DIOXIDE FIXATION.

    SciTech Connect

    FUJITA,E.

    2000-01-12

    Solar carbon dioxide fixation offers the possibility of a renewable source of chemicals and fuels in the future. Its realization rests on future advances in the efficiency of solar energy collection and development of suitable catalysts for CO{sub 2} conversion. Recent achievements in the efficiency of solar energy conversion and in catalysis suggest that this approach holds a great deal of promise for contributing to future needs for fuels and chemicals.

  12. The Anaform endoprosthesis: a proplast-coated femoral endoprosthesis.

    PubMed

    Keet, G G; Runne, W C

    1989-09-01

    The Anaform endoprosthesis study is a prospective trial by 12 orthopedic surgeons from six different hospitals in the Netherlands begun September 1984. As of March 1, 1988, 510 prostheses had been implanted, 60 with a follow up of more than 3 years. Of the 181 patients with a follow up of more than 2 years, 92% had a Harris hip score of more than 80 points. Apart from the main series, the prosthesis was used in 35 patients for revision of a cemented prosthesis, of whom 13 had a follow up of more than 2 years. Of these, ten patients (73%) had a Harris hip score of more than 80 points. Most patients studied were more than 65 years old. Fixation by ingrowth of fibrous tissue in a 2 mm thick, soft, flexible, low-modulus stem coating can provide painless function, clinical stabilization, and normal gait. The Anaform femoral endoprosthesis seems to be of advantage in the young patient as a method of cementless fixation. When necessary, removal without bone destruction is easy.

  13. Advantages and disadvantages of pinless external fixation.

    PubMed

    Thomas, S R; Giele, H; Simpson, A H

    2000-12-01

    The AO pinless external fixator (PEF) uses trocar tipped clamps to grip the outer tibial cortex rather than pins to transfix it. Its main advantage is to avoid further contamination of the medullary canal in open tibial fractures where a nail may subsequently be used. We tested the anatomical safety of this device and its effect on plastic surgical procedures compared with a standard unilateral external fixator (UEF).The PEF and UEF were placed on two amputated limbs which were then dissected. Structures at risk were traced on ten cadaver limbs. We found that important anatomical structures were endangered by the PEF and that safe zones could not always be defined. The UEF avoided these structures. Plastic surgical approaches were made more difficult by the PEF which imposed limitations on local flap design and endangered the arterial perforators which supply them. We conclude that safety is compromised by the PEF because margins for error are small. It poses additional problems in soft tissue reconstruction and highlights the need for co-operation between plastic surgical and orthopaedic teams in choice of fixation device.

  14. Low-energy diaphyseal femoral fractures associated with bisphosphonate use and severe curved femur: a case series.

    PubMed

    Sasaki, Satoshi; Miyakoshi, Naohisa; Hongo, Michio; Kasukawa, Yuji; Shimada, Yoichi

    2012-09-01

    Recent reports have raised concerns about low-energy subtrochanteric and diaphyseal femoral fractures after long-term bisphosphonate treatment, which may be associated with severely suppressed bone turnover (SSBT). However, diaphyseal femoral fractures without bisphosphonate treatment have also been reported in patients with severely curved femur, which are commonplace in the elderly. The purpose of this study was therefore to investigate associations between occurrence of such fractures, bisphosphonate use, and curvature of the femur. Nine consecutive elderly patients treated for low-energy diaphyseal femoral fractures between 2005 and 2010 were retrospectively reviewed. Three patients sustained bilateral fractures. Eight patients were administered bisphosphonates and one patient was administered raloxifene. Duration of osteoporosis treatment, type of fractures, surgical procedure, cortical thickness and curvature of opposite femur were evaluated. The cortical thickness and femoral curvature were further compared with those of 24 control subjects without fractures. The mean duration of drug administration was 3.6 years. All fractures showed similar X-ray patterns of simple transverse fracture with medial spike. Only one femur showed thickening of the femoral cortex. One case was treated with locking plate fixation, while the other cases were operated with intramedullary nails (9 antegrade nails, 2 retrograde nails). One femur treated with retrograde nail showed delayed bone union. The femoral curvature was significantly higher in the low-energy fracture group than the control group (P < 0.01); however, cortical thickness did not show a significant difference between the groups. In addition to SSBT, increased femoral curvature might be a causative factor for low-energy diaphyseal femoral fracture in the elderly.

  15. In vivo implant fixation of carbon fiber-reinforced PEEK hip prostheses in an ovine model.

    PubMed

    Nakahara, Ichiro; Takao, Masaki; Bandoh, Shunichi; Bertollo, Nicky; Walsh, William R; Sugano, Nobuhiko

    2013-03-01

    Carbon fiber-reinforced polyetheretherketone (CFR/PEEK) is theoretically suitable as a material for use in hip prostheses, offering excellent biocompatibility, mechanical properties, and the absence of metal ions. To evaluate in vivo fixation methods of CFR/PEEK hip prostheses in bone, we examined radiographic and histological results for cementless or cemented CFR/PEEK hip prostheses in an ovine model with implantation up to 52 weeks. CFR/PEEK cups and stems with rough-textured surfaces plus hydroxyapatite (HA) coatings for cementless fixation and CFR/PEEK cups and stems without HA coating for cement fixation were manufactured based on ovine computed tomography (CT) data. Unilateral total hip arthroplasty was performed using cementless or cemented CFR/PEEK hip prostheses. Five cementless cups and stems and six cemented cups and stems were evaluated. On the femoral side, all cementless stems demonstrated bony ongrowth fixation and all cemented stems demonstrated stable fixation without any gaps at both the bone-cement and cement-stem interfaces. All cementless cases and four of the six cemented cases showed minimal stress shielding. On the acetabular side, two of the five cementless cups demonstrated bony ongrowth fixation. Our results suggest that both cementless and cemented CFR/PEEK stems work well for fixation. Cup fixation may be difficult for both cementless and cemented types in this ovine model, but bone ongrowth fixation on the cup was first seen in two cementless cases. Cementless fixation can be achieved using HA-coated CFR/PEEK implants, even under load-bearing conditions.

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

    PubMed Central

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

    2015-01-01

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

  17. Association between injury to the retinacula of Weitbrecht and femoral neck fractures: anatomical and clinical observations

    PubMed Central

    Mei, Jiong; Ni, Ming; Wang, Guoliang; Jia, Guangyao; Liu, Shiwei; Cui, Xueliang; Jiang, Chao; Wang, Hua; Dai, Yahui; Quan, Kun; Chen, Rui

    2015-01-01

    Currently, there is no objective indicator for surgical procedures in elderly patients with femoral neck fractures. The purpose of this study was to determine the severity of damage to the retinacula of Weitbrecht based on the type of femoral neck fracture, anatomical and clinical observations. Data from 44 patients treated with artificial femoral head replacement were analyzed for the association between Garden type fracture and severity of injury to Weitbrecht’s retinacula. Additionally, 18 cases (Pauwels type III fracture) after Watson-Jones surgical approach and internal fixations were used to investigate the bone healing and femoral head necrosis. Among 44 patients (Garden type was III-IV, 79.6%), significant associations were found between Garden type fracture and lateral (P < 0.001), anterior (P = 0.045), and medial (P = 0.004) retinacular injury. Significant positive Spearman correlation coefficients between Garden type and the severity of injury to Weitbrecht’s retinacula were Ρ = 0.561 with P < 0.001 for lateral, Ρ = 0.338 with P = 0.025 for anterior, and Ρ = 0.469 with P = 0.001 for medial retinacula. Additionally, 4 out of 18 Pauwels type III fracture cases were observed severe damages on Weitbrecht’s retinacula and resulting bone necrosis. In conclusion, this study provided the anatomical and histological correlations between fracture displacement and degree of retinacula injury. PMID:26770357

  18. Outcome of double bundle anterior cruciate ligament reconstruction using crosspin and aperture fixation

    PubMed Central

    Joshi, Deepak; Jain, Vineet; Goyal, Ankit; Bahl, Vibhu; Modi, Prashant; Chaudhary, Deepak

    2014-01-01

    Background: Double bundle anterior cruciate ligament (DBACL) reconstruction is said to reproduce the native anterior cruciate ligament (ACL) anatomy better than single bundle anterior cruciate ligament, whether it leads to better functional results is debatable. Different fixation methods have been used for DBACL reconstruction, the most common being aperture fixation on tibial side and cortical suspensory fixation on the femoral side. We present the results of DBACL reconstruction technique, wherein on the femoral side anteromedial (AM) bundle is fixed with a crosspin and aperture fixation was done for the posterolateral (PL) bundle. Materials and Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing. Methods: Out of 157 isolated ACL injury patients who underwent ACL reconstruction, 100 were included in the prospective study. Arthroscopic DBACL reconstruction was done using ipsilateral hamstring autograft. AM bundle was fixed using Transfix (Arthrex, Naples, FL, USA) on the femoral side and bio interference screw (Arthrex, Naples, FL, USA) on the tibial side. PL bundle was fixed on femoral as well as on tibial side with a biointerference screw. Patients were evaluated using KT-1000 arthrometer, Lysholm score, International Knee Documentation Committee (IKDC) Score and isokinetic muscle strength testing. Results: The KT-1000 results were evaluated using paired t test with the P value set at 0.001. At the end of 1

  19. The potential application of a Cobalt Chrome Molybdenum femoral stem with functionally graded orthotropic structures manufactured using Laser Melting technologies.

    PubMed

    Hazlehurst, K B; Wang, C J; Stanford, M

    2013-12-01

    The cementless fixation of porous coated femoral stems is a common technique employed for Total Hip Arthroplasty (THA). With the rate of revision surgery appearing to rise and younger more active patients requiring primary surgery it can be thought that alternative methods for increasing implant longevity need to be considered. The stress shielding of periprosthetic bone still remains a contributing factor to implant loosening, caused through a mismatch in stiffness between the implant and the bone. However, the ability to achieve stiffness matching characteristics is being realised through the use of Additive Layer Manufacturing (ALM) technologies and Functionally Graded Materials (FGM). This paper proposes an alternative design methodology for a monoblock Cobalt Chrome Molybdenum (CoCrMo) femoral stem. It hypothesises that a femoral stem suitable for cementless fixation can be manufactured using Laser Melting (LM) technology offering orthotropic functionally graded porous structures with similar mechanical properties to human bone. The structure and mechanical properties of the natural femur have been used as a basis for the design criteria which hypothesises that through a combination of numerical analysis and physical testing, an optimal design can be proposed to provide a lightweight, customised femoral stem that can reduce the risk of implant loosening through stress shielding whilst maintaining bone-implant interface stability.

  20. The femoral sulcus in total knee arthroplasty.

    PubMed

    Lingaraj, Krishna; Bartlett, John

    2009-05-01

    The position of the femoral sulcus relative to the midline of the distal femoral resection in total knee arthroplasty (TKA) was studied to determine if centralized placement of the femoral component on the distal femur was justified in terms of aligning the prosthetic sulcus with the native femoral sulcus. The location of the femoral sulcus was studied in 112 consecutive patients undergoing TKA. The mean sulcus position was 0.7 mm lateral to the midline of the distal femoral resection (SD 1.4, 95% CI, 0.5-1.0 mm). However, the variation in sulcus positions ranged from 4 mm medial to 4 mm lateral to the midline. The mean sulcus position in valgus knees was 1.0 mm lateral to the midline (SD 1.8), and that in varus knees was 0.7 mm lateral to the midline (SD 1.2) (P = 0.501). It appears prudent to centre the femoral component on the native sulcus rather than the midline of the distal femoral resection, so as to ensure accurate alignment of the prosthetic sulcus with the native sulcus and to encourage normal patella tracking.

  1. Displaced fractures of the femoral shaft in children. Unique features and therapeutic options.

    PubMed

    Greene, W B

    1998-08-01

    The decision analysis for managing femoral shaft fractures in children should included such factors as the possibility of child abuse, overgrowth, and the potential for remodeling. Direct and indirect costs must be understood. Factors to consider in determining treatment include the age of the child, the extent of the soft tissue injury, and associated injuries. Non-operative methods, universally used in the past to treat these injuries, still are indicated, but operative modalities should be considered for a greater number of pediatric femoral fractures. Early enthusiasm for external fixation and rigid intramedullary rodding has been tempered by a greater awareness of their particular complications. The role of flexible intramedullary rodding, however, is expanding.

  2. [Prevention of postpuncture iatrogenic pseudoaneurysms of femoral arteries after coronary interventions for myocardial infarction].

    PubMed

    Fokin, A A; Kireev, K A; Moskvicheva, M G; Kireeva, T S

    2016-01-01

    The study was aimed at analysing strategies of prevention of puncture-related complications in patients with myocardial infarction undergoing subjected to emergency coronary interventions by means of a femoral arterial access. We carried out a retrospective comparative analysis of two strategies aimed at preventing false aneurysms of femoral arteries: Group One (232 cases) - elective use of special devices for closure of puncture defects in patients with high risk of haemorrhage (previously performed thrombolytic therapy; exogenous obesity of the second-third degree, 2-3 degree arterial hypertension, use of 2b/3a blood platelet receptors inhibitors); Group Two (525) cases - conventional routine use of these technologies. Puncture defects were closed using by means of devices Cordis Exoseal and St.Jude Angio-Seal. The obtained results suggested advantage of the conventional approach: demonstrating a statistically significant (p < 0.05) decrease in the total incidence of false aneurysms of femoral arteries (from 5.2 to 1.9%) and the frequency of cases requiring surgical suturing of the defect in the femoral artery (from 1.7 to 0.2%). In the conditions of an intensive flow of emergency patients presenting with acute coronary pathology and requiring coronary interventions, devices for closing defects in the femoral arterial access make it possible to level puncture complications. Over the examined period of 2013-2014 there were performed more than 600 closures of defects of the femoral artery by means of the Cordis ExoSeal. These devices proved to be efficient, reliable, and very simple to use. A decrease in the incidence rate of puncture-related complications was also associated with rational prescription administration of drugs influencing positively various links of haemostasis. PMID:27336346

  3. Bacterial alternative nitrogen fixation systems.

    PubMed

    Joerger, R D; Bishop, P E

    1988-01-01

    The introduction briefly reviews some of the salient features of the well-characterized conventional molybdo-enzyme system for N2 fixation. This is followed by a brief account of the discovery of an alternative N2 fixation system that does not require molybdenum in the N2-fixing bacterum Azotobacter vinelandii. The next section cites observations from the early literature on N2 fixation suggesting may not always require molybdenum. Next, recent evidence for an alternative N2 fixation system in A. vinelandii is discussed. A brief description of our discovery of an alternative nitrogenase which is not a molybdenum or vanadium enzyme is presented, followed by a summary of recent papers describing an alternative vanadium-containing nitrogenase. Available information on the genetics and regulation of alternative N2 fixation systems is discussed. Finally, the possible/probable presence of alternative N2 fixation systems in bacteria other than Azotobacter species is covered.

  4. Effect of pin location on stability of pelvic external fixation.

    PubMed

    Kim, W Y; Hearn, T C; Seleem, O; Mahalingam, E; Stephen, D; Tile, M

    1999-04-01

    Pelvic external fixators allow two locations of pin purchase: anterosuperior (into the iliac crest) and anteroinferior (into the supraacetabular dense bone, between the anterior superior and anterior inferior iliac spine). The purpose of this study was to compare the stability of these two methods of fixation on Tile Type B1 (open book) and C (unstable) pelvic injuries. Five unembalmed cadaveric pelves (mean age, 68 years; four males and one female) were loaded vertically in a servohydraulic testing machine in a standing posture. The AO tubular system and Orthofix were used. On each pelvis, a Type B1 injury was simulated. Each external fixator was applied in each location in random order. Cyclic loads were applied through the sacral body to a maximum of approximately 200 N while force and displacement of the pelvic ring were recorded digitally. Sacroiliac joint motion was quantified tridimensionally with displacement transducers, mounted on the sacrum and contacting a target fixed to the posterior superior iliac spine. A Type C injury was created and augmented with two iliosacral lag screws, and the tests were repeated. For the Type B1 injuries with anteroinferior pin purchase, the mean stiffness was 201.2 N/mm for the AO frame and 203.2 N/mm for the Orthofix. For the anterosuperior frames the mean stiffness was 143.9 N/mm for the AO frame and 163.3 N/mm for the Orthofix. For Type B1 and Type C injuries, the anteroinferior location of pin purchase resulted in significantly reduced sacroiliac joint separation. There were no significant differences between the frame types. Dissection of the preinserted anatomic specimen revealed no evidence of injury to the lateral femoral cutaneous nerve after blunt dissection and drilling with protective drill sleeves. It is concluded that the anteroinferior location of external fixation pins is a safe technique with the potential for increased stability of fixation.

  5. The Short-term Clinical Outcome of Total Hip Arthroplasty Using Short Metaphyseal Loading Femoral Stem

    PubMed Central

    Choi, Yoo Wang

    2016-01-01

    Purpose The purpose of this study was to retrospectively evaluate the short-term clinical and radiological outcomes of total hip arthroplasty (THA) with short metaphyseal loading femoral stem. Materials and Methods We retrospectively reviewed the records of 56 cases in 47 patients who had undergone THA with short metaphyseal loading femoral stem from April 2010 to December 2011. There were 20 males and 27 females. The mean age was 54 years (range, 26-77 years). The average follow up period was 4.6 years. Clinical results were evaluated by Harris hip scores (HHS) before the operation and at the last follow-up. Radiographic analysis was done by evaluating osteolysis, loosening, stress shielding, and alignement. Results The mean HHS significantly improved from 45 (range, 15-58) preoperatively to 98 (range, 85-100) at the last follow-up. In radiographic analyses, there was no evidence of osteolysis or loosening around the stems and the acetabuluar components. All cases showed rounding off of the calcar, grade 1 bone resorption of the proximal femur. With regard to implant alignment, 51 femoral component (91.1%) were in neutral position, and 5 (8.9%) were in varus position. There was 1 intraoperative fracture treated by cerclage wiring and no case was revised during follow-up period. Conclusion Although longer follow-up is needed to confirm the durability of the short metaphyseal loading femoral stem, this short stem might provide stable fixation without diaphyseal fixation and demonstrated good clinical result at mean 4.6 year short term follow-up. PMID:27536649

  6. Endovascular Treatment of Complications of Femoral Arterial Access

    SciTech Connect

    Tsetis, Dimitrios

    2010-06-15

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

  7. Nitrogen fixation apparatus

    DOEpatents

    Chen, Hao-Lin

    1984-01-01

    A method and apparatus for achieving nitrogen fixation includes a volumetric electric discharge chamber. The volumetric discharge chamber provides an even distribution of an electron beam, and enables the chamber to be maintained at a controlled energy to pressure (E/p) ratio. An E/p ratio of from 5 to 15 kV/atm of O.sub.2 /cm promotes the formation of vibrationally excited N.sub.2. Atomic oxygen interacts with vibrationally excited N.sub.2 at a much quicker rate than unexcited N.sub.2, greatly improving the rate at which NO is formed.

  8. Arthroscopic fixation of cell free polymer-based cartilage implants with a bioinspired polymer surface on the hip joint: a cadaveric pilot study.

    PubMed

    Lahner, Matthias; Duif, Christian; Ficklscherer, Andreas; Kaps, Christian; Kalwa, Lukas; Seidl, Tobias

    2014-01-01

    This study investigates the adhesion capacity of a polyglycolic acid- (PGA-) hyaluronan scaffold with a structural modification based on a planar polymer (PM) surface in a cadaver cartilage defect model. Two cadaver specimens were used to serially test multiple chondral matrices. In a cadaver hip model, cell free polymer-based cartilage implants with a planar bioinspired PM surface (PGA-PM-scaffolds) were implanted arthroscopically on 10 mm × 15 mm full-thickness femoral hip cartilage lesions. Unprocessed cartilage implants without a bioinspired PM surface were used as control group. The cartilage implants were fixed without and with the use of fibrin glue on femoral hip cartilage defects. After 50 movement cycles and removal of the distraction, a rearthroscopy was performed to assess the outline attachment and integrity of the scaffold. The fixation techniques without and with fibrin fixation showed marginal differences for outline attachment, area coverage, scaffold integrity, and endpoint fixation after 50 cycles. The PGA-PM-scaffolds with fibrin fixation achieved a higher score in terms of the attachment, integrity, and endpoint fixation than the PGA-scaffold on the cartilage defect. Relating to the outline attachment, area coverage, scaffold integrity, and endpoint fixation, the fixation with PGA-PM-scaffolds accomplished significantly better results compared to the PGA-scaffolds (P = 0.03752, P = 0.03078, P = 0.00512, P = 0.00512). PGA-PM-scaffolds demonstrate increased observed initial fixation strength in cadaver femoral head defects relative to PGA-scaffold, particularly when fibrin glue is used for fixation.

  9. Arthroscopic Fixation of Cell Free Polymer-Based Cartilage Implants with a Bioinspired Polymer Surface on the Hip Joint: A Cadaveric Pilot Study

    PubMed Central

    Lahner, Matthias; Duif, Christian; Ficklscherer, Andreas; Kaps, Christian; Kalwa, Lukas; Seidl, Tobias

    2014-01-01

    This study investigates the adhesion capacity of a polyglycolic acid- (PGA-) hyaluronan scaffold with a structural modification based on a planar polymer (PM) surface in a cadaver cartilage defect model. Two cadaver specimens were used to serially test multiple chondral matrices. In a cadaver hip model, cell free polymer-based cartilage implants with a planar bioinspired PM surface (PGA-PM-scaffolds) were implanted arthroscopically on 10 mm × 15 mm full-thickness femoral hip cartilage lesions. Unprocessed cartilage implants without a bioinspired PM surface were used as control group. The cartilage implants were fixed without and with the use of fibrin glue on femoral hip cartilage defects. After 50 movement cycles and removal of the distraction, a rearthroscopy was performed to assess the outline attachment and integrity of the scaffold. The fixation techniques without and with fibrin fixation showed marginal differences for outline attachment, area coverage, scaffold integrity, and endpoint fixation after 50 cycles. The PGA-PM-scaffolds with fibrin fixation achieved a higher score in terms of the attachment, integrity, and endpoint fixation than the PGA-scaffold on the cartilage defect. Relating to the outline attachment, area coverage, scaffold integrity, and endpoint fixation, the fixation with PGA-PM-scaffolds accomplished significantly better results compared to the PGA-scaffolds (P = 0.03752, P = 0.03078, P = 0.00512, P = 0.00512). PGA-PM-scaffolds demonstrate increased observed initial fixation strength in cadaver femoral head defects relative to PGA-scaffold, particularly when fibrin glue is used for fixation. PMID:25247185

  10. Measurement of repositioning accuracy during fractionated stereotactic radiotherapy for intracranial tumors using noninvasive fixation of BrainLAB radiotherapy equipment

    SciTech Connect

    Takahashi, Takeo . E-mail: taketaka@saitama-med.ac.jp; Nishimura, Keiichiro; Hondo, Mikito; Okada, Takenori; Osada, Hisato; Honda, Norinari

    2006-11-15

    Purpose: A noninvasive fixation mask device is used for stereotactic radiotherapy (SRT) in our hospital. Fractionated SRT is useful because it results in less damage to normal tissues, for which the positioning accuracy of the removable noninvasive fixation device is important. We examined the repositioning accuracy of a BrainLAB removable noninvasive fixation device on the coordinates of computed tomography (CT) for treatment planning. Methods and Materials: The subjects were 13 patients who had undergone head SRT. The removable noninvasive fixation mask device used was a noninvasive fixation device for the BrainLAB system. The accuracy of the irradiation apparatus was evaluated using Winston-Lutz test film, and the repositioning accuracy of the fixation device was examined using differences in the distance on the X, Y, and Z coordinates between the treatment planning and repositioning times determined by comparing the relative coordinates. The evaluation was performed using the relative coordinates of the standard and test points. Results: The accuracy of the irradiation center with the apparatus was within 0.5 mm. In the 13 patients, the difference in the distance between the treatment planning and repositioning procedures ranged from 0.1 to 2.080 mm, and an accuracy of within 2 mm was obtained in 84.6% of the patients using the fixation device. Conclusion: The BrainLAB noninvasive SRT fixation device was considered useful for routine treatment with high accuracy.

  11. Management of neglected femoral neck fracture in above knee amputated limb: A case report.

    PubMed

    Meena, Umesh; Meena, Ramesh; S, Balaji; Gaba, Sahil

    2015-01-01

    The treatment of an above knee amputee who has sustained a fracture of the femoral neck is a chal- lenging situation for both the orthopedic surgeon and the rehabilitation team. These fractures may be managed acutely either by reduction and internal fixation or by endoprosthetic replacement based on the same criteria as in any other patient with otherwise intact limbs.We present a neglected case treated successfully with valgus osteotomy. We conclude that these fractures should be treated with the same urgency and expertise as similar fractures in non-amputees as long-term survival and good quality of life can be expected. PMID:26917032

  12. Salvage of failed osteosynthesis of an intracapsular fracture of the femoral neck using two cannulated compression screws and a vascularised iliac crest bone graft.

    PubMed

    Xiaobing, Y; Dewei, Z

    2015-07-01

    We evaluated the outcome of treatment of nonunion of an intracapsular fracture of the femoral neck in young patients using two cannulated screws and a vascularised bone graft. A total of 32 patients (15 women and 17 men, with a mean age of 36.5 years; 20 to 50) with failed internal fixation of an intracapsular fracture were included in the study. Following removal of the primary fixation, two cannulated compression screws were inserted with a vascularised iliac crest bone graft based on the ascending branch of the lateral femoral circumflex artery. At a mean follow-up of 6.8 years (4 to 10), union was achieved in 27 hips (84%). A total of five patients with a mean age of 40.5 years (35 to 50) had a persistent nonunion and underwent total hip arthroplasty as also did two patients whose fracture united but who developed osteonecrosis of the femoral head two years post-operatively. Statistical analysis showed that younger patients achieved earlier and more reliable union (p < 0.001). The functional outcome, as assessed by the Harris Hip score, was better in patients aged < 45 years compared with those aged > 45 years (p < 0.001). These findings suggest that further fixation using two cannulated compression screws and a vascularised iliac crest bone graft is an effective salvage treatment in patients aged < 45 years, in whom osteosynthesis of a displaced intracapsular fractures of the femoral neck has failed.

  13. Osteoporotic hip fractures: the burden of fixation failure.

    PubMed

    Broderick, J M; Bruce-Brand, R; Stanley, E; Mulhall, K J

    2013-01-01

    Osteoporotic hip fractures are a major cause of morbidity and mortality in the elderly. Furthermore, reduced implant anchorage in osteoporotic bone predisposes towards fixation failure and with an ageing population, even low failure rates represent a significant challenge to healthcare systems. Fixation failure in fragility fractures of the hip ranges from 5% in peritrochanteric fractures through to 15% and 41% in undisplaced and displaced fractures of the femoral neck, respectively. Our findings, in general, support the view that failed internal fixation of these fragility fractures carries a poor prognosis: it leads to a twofold increase in the length of hospital stay and a doubling of healthcare costs. Patients are more likely to suffer a downgrade in their residential status upon discharge with a consequent increase in social dependency. Furthermore, the marked disability and reduction in quality of life evident before salvage procedures may persist at long-term followup. The risk, of course, for the elderly patient with a prolonged period of decreased functioning is that the disability becomes permanent. Despite this, however, no clear link between revision surgery and an increase in mortality has been demonstrated in the literature.

  14. Efficacy Evaluation for the Treatment of Subcapital Femoral Neck Fracture in Young Adults by Capsulotomy Reduction and Closed Reduction

    PubMed Central

    Liu, Cong; Liu, Meng-Ting; Li, Peng; Xu, Hong-Hai

    2015-01-01

    Background: Subcapital femoral neck fracture in young adults has many complications, and the incidence is increasing year-by-year. The selection of the proper operation method to avoid them is an ambiguous matter. This study aimed to evaluate the treatment effect of subcapital femoral neck fracture by the capsulotomy and internal fixation with iliac bone grafting or closed reduction and internal fixation in young adults. Methods: From March 2003 to February 2010, 65 young patients with subcapital femoral neck fractures were treated, including 39 males and 26 females with average age of 34.5 years (range, 19–50 years); 29 cases of the left side and 36 cases of the right side. They were randomly divided into Group A with 34 cases treated by closed reduction and internal fixation and Group B with 31 cases treated by the capsulotomy and internal fixation with iliac bone grafting. The two groups had no significant differences in sex, age, body mass index and preoperative Harris Hip Score. The observation criteria involved the length of the incision, blood loss, operation time, nonunion rate, avascular necrosis of the femoral head (ANFH) rate and Harris Hip Score. Results: Four of 65 patients were lost follow-up, and the follow-up rate was 93.8%, the average follow-up time was 38.7 months (range, 33–47 months). In Group A, the incision length was 5.1 ± 2.2 cm, blood loss was 84.0 ± 13.2 ml, and operation time was 52.9 ± 10.2 min. In Group B, the incision length was 15.4 ± 4.6 cm, blood loss was 396.0 ± 21.3 ml, and operation time was 116.5 ± 15.3 min. Nonunion occurred in 8 patients (25.2%) in Group A and 1 patient (3.3%) in Group B. ANFH occurred in 9 patients (29.1%) in Group A and 2 patients (6.7%) in Group B. Postoperative Harris Hip Score was 89.0 ± 5.6 in Group A and 95.0 ± 4.5 in Group B. The above index of two groups was considered statistically significant (P < 0.05). Conclusions: Capsulotomy and internal fixation with iliac bone grafting can improve

  15. 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

  16. [Medial femoral neck fracture. Controversies in treatment].

    PubMed

    Raaymakers, E L F B; Schafroth, M

    2002-02-01

    The treatment of the medial femoral neck fracture remains controversial until today. The goal of this paper is therefore, based on the literature, to show guidelines for optimal treatment: conservative treatment vs. operation, osteosynthesis vs. prosthesis, timing for osteosynthesis, open vs. closed reduction, choice of implant for osteosynthesis, postoperative treatment (weight bearing vs. non weight bearing), Pauwels-Osteotomy vs. prosthesis in cases op pseudarthrosis, femoral head prosthesis vs. total hip arthroplasty, bipolar vs. monopolar femoral head prosthesis, choice of classification. Further we want to point out which statements are evidence based and where we need further investigation.

  17. Does high-flexion total knee arthroplasty promote early loosening of the femoral component?

    PubMed

    Zelle, Jorrit; Janssen, Dennis; Van Eijden, Jolanda; De Waal Malefijt, Maarten; Verdonschot, Nico

    2011-07-01

    High-flexion knee replacements have been developed to accommodate a large range of motion (RoM > 120°). Knee implants that allow for higher flexion may be more sensitive to femoral loosening as the knee load is relatively high during deep knee flexion, which could result in an increased failure potential at the implant-cement interface of the femoral component. A 3D finite element knee model was developed including a posterior-stabilized high-flexion knee replacement to analyze the stress state at the femoral implant-cement interface during a full squatting movement (RoM ≤ 155°). During deep flexion (RoM > 120°), tensile and shear stress concentrations were found at the implant-cement interface beneath the proximal part of the anterior flange. Particularly, the shear stresses at this interface location increased during high flexion, from a peak stress of 4.03 MPa at 90° to 6.89 MPa at 140° of flexion. Tensile stresses were substantially lower, having a peak stress of 0.72 MPa at 100° of flexion. Using data from earlier interface strength experiments, none of the interface beneath the anterior flange was predicted to fail in the normal flexion range (RoM ≤ 120°), whereas the prediction increased to 2.2% of the interface during deeper knee flexion. Thigh-calf contact reduced the knee forces, interface load, and failure risk beyond 140-145° of flexion. Based on the more critical stresses at the femoral fixation site between 120° and 145° of flexion, we conclude that the femoral component has a higher risk of loosening at high-flexion angles.

  18. Current concept in dysplastic hip arthroplasty: Techniques for acetabular and femoral reconstruction.

    PubMed

    Bicanic, Goran; Barbaric, Katarina; Bohacek, Ivan; Aljinovic, Ana; Delimar, Domagoj

    2014-09-18

    Adult patients with developmental dysplasia of the hip develop secondary osteoarthritis and eventually end up with total hip arthroplasty (THA) at younger age. Because of altered anatomy of dysplastic hips, THA in these patients represents technically demanding procedure. Distorted anatomy of the acetabulum and proximal femur together with conjoined leg length discrepancy present major challenges during performing THA in patients with developmental dysplasia of the hip. In addition, most patients are at younger age, therefore, soft tissue balance is of great importance (especially the need to preserve the continuity of abductors) to maximise postoperative functional result. In this paper we present a variety of surgical techniques available for THA in dysplastic hips, their advantages and disadvantages. For acetabular reconstruction following techniques are described: Standard metal augments (prefabricated), Custom made acetabular augments (3D printing), Roof reconstruction with vascularized fibula, Roof reconstruction with pedicled iliac graft, Roof reconstruction with autologous bone graft, Roof reconstruction with homologous bone graft, Roof reconstruction with auto/homologous spongious bone, Reinforcement ring with the hook in combination with autologous graft augmentation, Cranial positioning of the acetabulum, Medial protrusion technique (cotyloplasty) with chisel, Medial protrusion technique (cotyloplasty) with reaming, Cotyloplasty without spongioplasty. For femoral reconstruction following techniques were described: Distraction with external fixator, Femoral shortening through a modified lateral approach, Transtrochanteric osteotomies, Paavilainen osteotomy, Lesser trochanter osteotomy, Double-chevron osteotomy, Subtrochanteric osteotomies, Diaphyseal osteotomies, Distal femoral osteotomies. At the end we present author's treatment method of choice: for acetabulum we perform cotyloplasty leaving only paper-thin medial wall, which we break during acetabular

  19. Fibrous dysplasia, shepherd's crook deformity and an intra-capsular femoral neck fracture.

    PubMed

    Al-Mouazzen, Louay; Rajakulendran, Karthig; Ahad, Nurul

    2013-11-01

    Fibrous dysplasia (FD) is a rare bone disorder in which normal medullary bone is replaced by fibro-osseous tissue. It typically presents in childhood with pain, skeletal deformities, gait abnormalities and occasionally, fatigue fractures. The management of FD remains a challenge. Surgical procedures have been developed to provide symptom relief, correct skeletal deformity and offer mechanical support in cases at risk of fracture. However, there is a paucity of data on the management of acute femoral neck fractures in the adult population with FD. We report the case of a 23-year-old man with a shepherd's crook deformity secondary to FD, who sustained an intra-capsular femoral neck fracture whilst playing football. The patient initially underwent closed reduction and internal fixation with cannulated screws. However, during the procedure, a guide wire broke whilst inside the femoral head. The patient was referred to the senior author, who undertook a second operation to remove the metalwork and correct the varus deformity using a closing-wedge femoral osteotomy, whilst achieving osteosynthesis at the fracture site. At 1-year follow-up, the patient is pain-free and demonstrates a full range of movement. These cases can be technically demanding and carry a greater risk of complication. It is important that preoperative planning is undertaken and surgery performed by individuals with experience in managing FD and complex femoral neck fractures. Correction of the skeletal deformity whilst fixing the fracture will help restore the mechanical axis and reduce the risk of a recurrent fracture. PMID:24036944

  20. 21 CFR 888.3010 - Bone fixation cerclage.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Bone fixation cerclage. 888.3010 Section 888.3010 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... cobalt-chromium-molybdenum, and that consists of a metallic ribbon or flat sheet or a wire. The device...

  1. 21 CFR 888.3010 - Bone fixation cerclage.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Bone fixation cerclage. 888.3010 Section 888.3010 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED... cobalt-chromium-molybdenum, and that consists of a metallic ribbon or flat sheet or a wire. The device...

  2. Eighth international congress on nitrogen fixation

    SciTech Connect

    Not Available

    1990-01-01

    This volume contains the proceedings of the Eighth International Congress on Nitrogen Fixation held May 20--26, 1990 in Knoxville, Tennessee. The volume contains abstracts of individual presentations. Sessions were entitled Recent Advances in the Chemistry of Nitrogen Fixation, Plant-microbe Interactions, Limiting Factors of Nitrogen Fixation, Nitrogen Fixation and the Environment, Bacterial Systems, Nitrogen Fixation in Agriculture and Industry, Plant Function, and Nitrogen Fixation and Evolution.

  3. A displaced stress fracture of the femoral neck in an adolescent female distance runner with female athlete triad: A case report.

    PubMed

    Okamoto, Shinichi; Arai, Yuji; Hara, Kunio; Tsuzihara, Takashi; Kubo, Toshikazu

    2010-01-01

    This report presents a case of a displaced stress fracture of the femoral neck in an adolescent female distance runner with amenorrhea. Both reduction and internal fixation were performed early after the injury. At 24 months postoperatively, magnetic resonance imaging and bone scintigraphy showed no positive signs of femoral head necrosis and bone union was confirmed on plain X-ray. A medical examination for the presence of the signs of the female athlete triad by checking weight, calorie intake and menstrual cycles is most important to prevent such stress fractures. Athletes as well as their coaches or parents therefore need to understand female athlete triad. PMID:20205723

  4. 21 CFR 888.3030 - Single/multiple component metallic bone fixation appliances and accessories.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ..., supracondylar, or condylar fractures of the femur; for fusion of a joint; or for surgical procedures that..., such as screws and nails, or bolts, nuts, and washers. These devices are used for fixation of...

  5. 21 CFR 888.3030 - Single/multiple component metallic bone fixation appliances and accessories.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ..., supracondylar, or condylar fractures of the femur; for fusion of a joint; or for surgical procedures that..., such as screws and nails, or bolts, nuts, and washers. These devices are used for fixation of...

  6. 21 CFR 888.3030 - Single/multiple component metallic bone fixation appliances and accessories.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ..., supracondylar, or condylar fractures of the femur; for fusion of a joint; or for surgical procedures that..., such as screws and nails, or bolts, nuts, and washers. These devices are used for fixation of...

  7. 21 CFR 888.3030 - Single/multiple component metallic bone fixation appliances and accessories.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ..., supracondylar, or condylar fractures of the femur; for fusion of a joint; or for surgical procedures that..., such as screws and nails, or bolts, nuts, and washers. These devices are used for fixation of...

  8. 21 CFR 888.3030 - Single/multiple component metallic bone fixation appliances and accessories.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ..., supracondylar, or condylar fractures of the femur; for fusion of a joint; or for surgical procedures that..., such as screws and nails, or bolts, nuts, and washers. These devices are used for fixation of...

  9. 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

  10. Outcome and incidence of periprosthetic supracondylar femoral fractures in TKA

    PubMed Central

    Singh, Somesh P; Bhalodiya, Haresh P

    2013-01-01

    Background: Periprosthetic supracondylar femoral fractures following total knee arthroplasty (TKA) are infrequent, but is a devastating complication. The purpose of this study was to evaluate the incidence and outcomes of periprosthetic supracondylar femoral fractures following TKA using nonoperative as well as open reduction and internal fixation (ORIF) techniques. Materials and Methods: Between January 2004 and December 2010, we followed 3,920 operated patients of total knee arthroplasty (TKA) and identified 23 patients with periprosthetic supracondylar fractures. A retrospective analysis of the records of these patients was conducted. Details regarding pre fracture status, treatment offered and the present status were also recorded and analyzed. Time from index arthroplasty to periprosthetic fracture ranged from five days to six years. There were 17 women and 6 men and the average age was 68.26 years (range 52-83 years). Of the 23 patients, 20 patients were treated by operative method, whereas only three patients with relatively undisplaced fractures were treated nonoperatively. Results: The total incidence of periprosthetic fractures in operated cases of TKA was 0.58%. Three patients had infection after surgery. As per radiological assessment, two of three conservatively treated cases had malunion, whereas among 20 cases treated operatively, 16 had primary union with one malunion. Two patients had union after bone grafting, whereas two had nonunion. The average reduction in the knee score after fracture was 20.53%. Twenty one patients were able to achieve limited but independent activity. Conclusions: Desirable results for periprosthetic fractures can be obtained if proper and timely intervention is done, taking into account the other comorbid conditions. However, short duration of followup and small number of patients were major limiting factors in this study. PMID:24379465

  11. Femoral Strength after Induced Lesions in Rats (Rattus norvegicus)

    PubMed Central

    Belill, Kathryn A; Settle, Timothy L; Angel, C Roselina; Kim, Seon-Woo; Rothwell, Stephen W

    2014-01-01

    Rats are a common model for the study of bone healing, with the cranium, femur, and tibia being the bones studied most frequently. This study examines noncritical-sized lesions that would allow rats to continue to bear weight without the need for fixation but that are sufficiently large to enable characterization of the healing process. We compared the femoral bone strength associated with 3 lesion sizes selected for use in future studies. Sprague–Dawley rats (age, 10 to 16 wk) were used to assess the ultimate breaking strength, stress, and break force of normal, unmanipulated femurs. We then created lesions of 3 different sizes in the mid- to distal diaphysis of the left and right femurs and characterized the associated decreases in bone strength. Femurs (n= 85) for this study were collected through tissue sharing from rats used in other acute surgical procedures and were tested by using a 3-point bending flexural materials-testing machine. Our hypothesis was that, as a model for bone healing, 3 induced lesions of different sizes would show incremental and proportional decreases in femoral strength, with the intermediate-sized (1.5-mm) lesion demonstrating a decrease of 20% to 40%. A lesion of 1.5 mm yielded a decrease in strength of 17% for both the left and right femurs. The strength of left femurs carrying intermediate lesions was significantly less than that of control, uninjured femur bones. In addition to providing validation for our own future bone-healing project, these data are a useful baseline for other investigators studying bone healing in a rat femur model. PMID:24956210

  12. Bilateral stress fractures of femoral neck in non-athletes: a report of four cases.

    PubMed

    Naik, Monappa-A; Sujir, Premjit; Tripathy, Sujit-Kumar; Vijayan, Sandeep; Hameed, Shamsi; Rao, Sharath-K

    2013-01-01

    Femoral neck stress fractures (FNSFs) are rare, constituting only 5% of all stress fractures in young adults. These fractures are usually seen in athletes, military recruits and patients with underlying metabolic diseases. The treatment of FNSFs is still controversial because of the inherent complications associated with the treatment procedure. We came across 4 cases of bilateral FNSFs in non-athletic individuals who were manual labourers without underlying bony disorders. Two patients with FNSFs and coxa vara deformity on both sides were managed by subtrochanteric valgus osteotomy and dynamic hip screw fixation. One of the remaining two patients was treated by cannulated cancellous screw fixation on one side and subtrochanteric valgus osteotomy on the other side. The fourth patient received subtrochanteric valgus osteotomy on one side and bipolar hemiarthroplasty on the other side after failed cannulated screw fixation. All the fractures healed without any complications. No evidence of avascular necrosis or arthritis was noted in our series. Subtrochanteric valgus osteotomy restores normal neck-shaft angle in patients suffering from FNSFs combined with coxa vara deformity. Moreover, it helps to bring the forces acting around the hip to normal biomechanical levels, leading to fracture union and better results. Replacement arthroplasty is recommended to patients who fail to achieve bony union after fixation.

  13. 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.

  14. 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.

  15. Profunda anchor technique for ipsilateral antegrade approach in endovascular treatment of superficial femoral artery ostial occlusion.

    PubMed

    Pua, Uei

    2015-04-01

    Endovascular treatment of the superficial femoral artery (SFA) is challenging in the presence of flush ostial occlusion. One of the main challenges is the availability of access sites for intervention. Contralateral retrograde femoral access followed by cross-over and antegrade intervention while commonly used, may not be feasible in cases of altered iliac anatomy (e.g. kissing iliac stents). Ipsilateral antegrade intervention using common femoral artery (CFA) access in these instances while possible is typically challenging due to inadequate working length of the CFA for interrogation of the SFA ostium, compounded by the lack of sheath stability. The "profunda anchor" technique uses a buddy wire in the profunda femoris artery (PFA) to stabilize the sheath and allow catheter manipulation for antegrade intervention at the level of the SFA ostium. The PFA is further used as a conduit for deployment of closure device to avoid interference with the treated SFA. PMID:25522981

  16. Profunda Anchor Technique for Ipsilateral Antegrade Approach in Endovascular Treatment of Superficial Femoral Artery Ostial Occlusion

    SciTech Connect

    Pua, Uei

    2015-04-15

    Endovascular treatment of the superficial femoral artery (SFA) is challenging in the presence of flush ostial occlusion. One of the main challenges is the availability of access sites for intervention. Contralateral retrograde femoral access followed by cross-over and antegrade intervention while commonly used, may not be feasible in cases of altered iliac anatomy (e.g. kissing iliac stents). Ipsilateral antegrade intervention using common femoral artery (CFA) access in these instances while possible is typically challenging due to inadequate working length of the CFA for interrogation of the SFA ostium, compounded by the lack of sheath stability. The “profunda anchor” technique uses a buddy wire in the profunda femoris artery (PFA) to stabilize the sheath and allow catheter manipulation for antegrade intervention at the level of the SFA ostium. The PFA is further used as a conduit for deployment of closure device to avoid interference with the treated SFA.

  17. Femoral Bone Plug in Total Knee Replacement.

    PubMed

    Vulcano, Ettore; Regazzola, Gianmarco M V; Murena, Luigi; Ronga, Mario; Cherubino, Paolo; Surace, Michele F

    2015-10-01

    The intramedullary alignment guides used in total knee replacement disrupt the intramedullary vessels, resulting in greater postoperative blood loss. The use of an autologous bone plug to seal the intramedullary femoral canal has been shown to be effective in reducing postoperative bleeding. The authors present a simple technique to create a bone plug from the anterior chamfer femoral cut to perfectly seal the intramedullary canal of the femur. PMID:26488774

  18. Design of new generation femoral prostheses using functionally graded materials: a finite element analysis.

    PubMed

    Oshkour, A A; Abu Osman, N A; Yau, Y H; Tarlochan, F; Abas, W A B Wan

    2013-01-01

    This study aimed to develop a three-dimensional finite element model of a functionally graded femoral prosthesis. The model consisted of a femoral prosthesis created from functionally graded materials (FGMs), cement, and femur. The hip prosthesis was composed of FGMs made of titanium alloy, chrome-cobalt, and hydroxyapatite at volume fraction gradient exponents of 0, 1, and 5, respectively. The stress was measured on the femoral prosthesis, cement, and femur. Stress on the neck of the femoral prosthesis was not sensitive to the properties of the constituent material. However, stress on the stem and cement decreased proportionally as the volume fraction gradient exponent of the FGM increased. Meanwhile, stress became uniform on the cement mantle layer. In addition, stress on the femur in the proximal part increased and a high surface area of the femoral part was involved in absorbing the stress. As such, the stress-shielding area decreased. The results obtained in this study are significant in the design and longevity of new prosthetic devices because FGMs offer the potential to achieve stress distribution that more closely resembles that of the natural bone in the femur.

  19. Design of new generation femoral prostheses using functionally graded materials: a finite element analysis.

    PubMed

    Oshkour, A A; Abu Osman, N A; Yau, Y H; Tarlochan, F; Abas, W A B Wan

    2013-01-01

    This study aimed to develop a three-dimensional finite element model of a functionally graded femoral prosthesis. The model consisted of a femoral prosthesis created from functionally graded materials (FGMs), cement, and femur. The hip prosthesis was composed of FGMs made of titanium alloy, chrome-cobalt, and hydroxyapatite at volume fraction gradient exponents of 0, 1, and 5, respectively. The stress was measured on the femoral prosthesis, cement, and femur. Stress on the neck of the femoral prosthesis was not sensitive to the properties of the constituent material. However, stress on the stem and cement decreased proportionally as the volume fraction gradient exponent of the FGM increased. Meanwhile, stress became uniform on the cement mantle layer. In addition, stress on the femur in the proximal part increased and a high surface area of the femoral part was involved in absorbing the stress. As such, the stress-shielding area decreased. The results obtained in this study are significant in the design and longevity of new prosthetic devices because FGMs offer the potential to achieve stress distribution that more closely resembles that of the natural bone in the femur. PMID:23516951

  20. Design process of cementless femoral stem using a nonlinear three dimensional finite element analysis

    PubMed Central

    2014-01-01

    Background Minimal available information concerning hip morphology is the motivation for several researchers to study the difference between Asian and Western populations. Current use of a universal hip stem of variable size is not the best option for all femur types. This present study proposed a new design process of the cementless femoral stem using a three dimensional model which provided more information and accurate analysis compared to conventional methods. Methods This complete design cycle began with morphological analysis, followed by femoral stem design, fit and fill analysis, and nonlinear finite element analysis (FEA). Various femur parameters for periosteal and endosteal canal diameters are measured from the osteotomy level to 150 mm below to determine the isthmus position. Results The results showed better total fit (53.7%) and fill (76.7%) canal, with more load distributed proximally to prevent stress shielding at calcar region. The stem demonstrated lower displacement and micromotion (less than 40 μm) promoting osseointegration between the stem–bone and providing primary fixation stability. Conclusion This new design process could be used as a preclinical assessment tool and will shorten the design cycle by identifying the major steps which must be taken while designing the femoral stem. PMID:24484753

  1. Primary stability recognition of the newly designed cementless femoral stem using digital signal processing.

    PubMed

    Baharuddin, Mohd Yusof; Salleh, Sh-Hussain; Hamedi, Mahyar; Zulkifly, Ahmad Hafiz; Lee, Muhammad Hisyam; Mohd Noor, Alias; Harris, Arief Ruhullah A; Abdul Majid, Norazman

    2014-01-01

    Stress shielding and micromotion are two major issues which determine the success of newly designed cementless femoral stems. The correlation of experimental validation with finite element analysis (FEA) is commonly used to evaluate the stress distribution and fixation stability of the stem within the femoral canal. This paper focused on the applications of feature extraction and pattern recognition using support vector machine (SVM) to determine the primary stability of the implant. We measured strain with triaxial rosette at the metaphyseal region and micromotion with linear variable direct transducer proximally and distally using composite femora. The root mean squares technique is used to feed the classifier which provides maximum likelihood estimation of amplitude, and radial basis function is used as the kernel parameter which mapped the datasets into separable hyperplanes. The results showed 100% pattern recognition accuracy using SVM for both strain and micromotion. This indicates that DSP could be applied in determining the femoral stem primary stability with high pattern recognition accuracy in biomechanical testing. PMID:24800230

  2. Nonvascularized fibular grafting in nonunion of femoral neck fracture: A systematic review.

    PubMed

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

    2016-01-01

    Nonunion of femoral neck fractures following primary fixation and neglected femoral neck fracture in young adults is a challenging task. Every effort should be directed toward hip joint salvage in these patients. Among different available options of hip salvage, nonvascularized fibular graft (NVFG) osteosynthesis is simple, easy to perform, and a successful technique. In this review, the available literature on NVFG in neglected and nonunion femoral neck fractures has been analyzed. After review of 15 articles on NVFG, the average nonunion rate was estimated to be 7.86% (range 0-31%). Six articles that evaluated the preoperative and postoperative osteonecrosis reported improvement in 50% patients. The clinical and/or functional outcome was good to excellent in 56-96% patients following fibular osteosynthesis. Few complications such as coxa vara deformity, limb shortening, and intraarticular penetration of the graft or hardware have been reported. However, there are minimal donor site morbidities such as mild ankle pain, transient loss of toe flexors and extensors and transient lateral popliteal nerve palsy. PMID:27512214

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

    PubMed Central

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

    2015-01-01

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

  4. [In situ pinning with Kirschner wires for chronic juvenile slipped capital femoral epiphysis].

    PubMed

    Sibiński, Marcin; Drobniewski, Marek; Synder, Marek

    2007-01-01

    Fixation in situis the most common method of management for different degrees of slip of the proximal capital femoral epiphysis. The aim of our study is to retrospectively analyze final results and complications after in situ pinning with Kirschner wires for stabile slipped capital femoral epiphysis. We retrospectively reviewed clinical records and radiographs of 61 children (17 girls and 33 boys) at the average age of 11.8 years. The average follow-up period was 7.4 years, minimum 3 years. In slips 300 and less (38 hips) vast majority of patients had very good and good subjective results (pain and function), 5% and 8% has satisfactory objective (limping and range of motion) and radiological results respectively. In slips between 30-60 degrees (23 hips) 75%, 60% and 70% had satisfactory subjective, objective and radiological results respectively. One child had chodrolysis that resolved at later follow up. There was no case of AVN. In 6 cases wires migration was found. In situ spinning with Kirschnerwires is simple safe and gives satisfactory results. This method of treatment especially recommended in younger, skeletally immature children with remaining growth of femoral neck. PMID:18402003

  5. Nonvascularized fibular grafting in nonunion of femoral neck fracture: A systematic review

    PubMed Central

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

    2016-01-01

    Nonunion of femoral neck fractures following primary fixation and neglected femoral neck fracture in young adults is a challenging task. Every effort should be directed toward hip joint salvage in these patients. Among different available options of hip salvage, nonvascularized fibular graft (NVFG) osteosynthesis is simple, easy to perform, and a successful technique. In this review, the available literature on NVFG in neglected and nonunion femoral neck fractures has been analyzed. After review of 15 articles on NVFG, the average nonunion rate was estimated to be 7.86% (range 0–31%). Six articles that evaluated the preoperative and postoperative osteonecrosis reported improvement in 50% patients. The clinical and/or functional outcome was good to excellent in 56–96% patients following fibular osteosynthesis. Few complications such as coxa vara deformity, limb shortening, and intraarticular penetration of the graft or hardware have been reported. However, there are minimal donor site morbidities such as mild ankle pain, transient loss of toe flexors and extensors and transient lateral popliteal nerve palsy. PMID:27512214

  6. The pattern of femoral diaphyseal fractures in children admitted in Sarawak General Hospital.

    PubMed

    Rasit, A H; Mohammad, A W; Pan, K L

    2006-02-01

    Trend towards changing the face of management for pediatric femoral fractures tends to advocate operative treatment. This study was undertaken to review our current practice in the wake of recent progress in the management of pediatric femoral fractures. Fifty patients with femoral diaphyseal fracture treated in Sarawak General Hospital were reviewed retrospectively after an average follow-up of 2.6 years. There were 36 boys and 14 girls, with a mean age of 6.2 years (range five months to 14 years). Children under six years of age constituted the majority of the patients. Half of the fractures were caused by road traffic accident. Nine patients had associated injuries. The most common site of fracture was at the middle third (N=31). The treatment regimens were delayed hip spica (DHS) in 16, immediate hip spica (IHS) in 24, plate osteosynthesis (PO) in five, titanium elastic nailing (TEN) in five, and external fixation (EF) in one. The minimum hospital stay was two days, and the maximum 33 days (mean, 9.7 days). Malunion was the commonest complication. Conservative treatment is the preferred option for children under six years of age. It is cost-effective with minimal complication. The other treatment options are reserved for specific indication in older children. Diaphyseal fractures of the femur in children can be adequately managed non-operatively.

  7. Primary Stability Recognition of the Newly Designed Cementless Femoral Stem Using Digital Signal Processing

    PubMed Central

    Salleh, Sh-Hussain; Hamedi, Mahyar; Zulkifly, Ahmad Hafiz; Lee, Muhammad Hisyam; Mohd Noor, Alias; Harris, Arief Ruhullah A.; Abdul Majid, Norazman

    2014-01-01

    Stress shielding and micromotion are two major issues which determine the success of newly designed cementless femoral stems. The correlation of experimental validation with finite element analysis (FEA) is commonly used to evaluate the stress distribution and fixation stability of the stem within the femoral canal. This paper focused on the applications of feature extraction and pattern recognition using support vector machine (SVM) to determine the primary stability of the implant. We measured strain with triaxial rosette at the metaphyseal region and micromotion with linear variable direct transducer proximally and distally using composite femora. The root mean squares technique is used to feed the classifier which provides maximum likelihood estimation of amplitude, and radial basis function is used as the kernel parameter which mapped the datasets into separable hyperplanes. The results showed 100% pattern recognition accuracy using SVM for both strain and micromotion. This indicates that DSP could be applied in determining the femoral stem primary stability with high pattern recognition accuracy in biomechanical testing. PMID:24800230

  8. Stereotactic atlantoaxial transarticular screw fixation.

    PubMed

    Laherty, R W; Kahler, R J; Walker, D G; Tomlinson, F H

    2005-01-01

    Atlantoaxial stabilisation can be performed using a variety of surgical techniques. Developments in spinal instrumentation and stereotactic technology have been incorporated into these procedures. We have recently adopted frameless stereotaxy to assist in such operations. A retrospective study of patients treated by the authors and using frameless stereotaxy from 2001 to 2002 was performed. Each patient underwent pre-operative fine-cut CT in the position of fixation. Using these images, screw trajectory was planned. Stereotaxis and fluoroscopy was utilised during fixation. A post-operative CT was performed. There were nine patients. Bilateral screw placement was achieved in eight. In the remaining case stereotactic planning predicted the single screw fixation. There were no post-operative complications. Post-operative CT showed screw placement corresponding to the planned trajectory in all 17 screws. Stabilisation was achieved in all. Stereotactic atlantoaxial screw fixation is an accessible, safe and accurate method for the management of C1-2 instability. PMID:15639416

  9. Molecular Biology of Nitrogen Fixation

    ERIC Educational Resources Information Center

    Shanmugam, K. T.; Valentine, Raymond C.

    1975-01-01

    Reports that as a result of our increasing knowledge of the molecular biology of nitrogen fixation it might eventually be possible to increase the biological production of nitrogenous fertilizer from atmospheric nitrogen. (GS)

  10. Improve the Efficiency of Surgery for Femoral Shaft Fractures with A Novel Instrument: A Randomized Controlled Trial

    PubMed Central

    Hsu, Peichun; Qin, Hui; An, Zhiquan; Zhang, Changqing; Sheng, Jiagen

    2016-01-01

    Objective To improve the efficacy of closed reduction and wire guiding during intramedullary nail internal fixation in femoral shaft fractures. Methods A novel instrument was designed and manufactured. Sixty-eight patients were enrolled from February 2011 to December 2013. The instrument designed was used during the operation in the experimental group, but not in the control group. Results All patients exhibited fracture union, excluding 1 patient in the experimental group and 2 in the control group who had non-union; all of whom achieved fracture union with reoperation. There were no statistically significant differences in operative blood loss or duration of hospital stay between the groups (P > 0.05). The operative time, frequency of wire drilling, and number of open reduction cases, were significantly smaller in the experimental group than in the control group (P < 0.05). Conclusion Femoral shaft fractures are difficult to reduce using general methods; the novel instrument showed high clinical value and proved effective and safe in assisting with closed reduction and intramedullary nail fixation for femoral shaft fractures. Trial Registration ChiCTR ChiCTR-ICR-15007335 PMID:27115752

  11. Prediction of femoral head collapse in osteonecrosis.

    PubMed

    Volokh, K Y; Yoshida, H; Leali, A; Fetto, J F; Chao, E Y S

    2006-06-01

    The femoral head deteriorates in osteonecrosis. As a consequence of that, the cortical shell of the femoral head can buckle into the cancellous bone supporting it. In order to examine the buckling scenario we performed numerical analysis of a realistic femoral head model. The analysis included a solution of the hip contact problem, which provided the contact pressure distribution, and subsequent buckling simulation based on the given contact pressure. The contact problem was solved iteratively by approximating the cartilage by a discrete set of unilateral linear springs. The buckling calculations were based on a finite element mesh with brick elements for the cancellous bone and shell elements for the cortical shell. Results of 144 simulations for a variety of geometrical, material, and loading parameters strengthen the buckling scenario. They, particularly, show that the normal cancellous bone serves as a strong supporting foundation for the cortical shell and prevents it from buckling. However, under the development of osteonecrosis the deteriorating cancellous bone is unable to prevent the cortical shell from buckling and the critical pressure decreases with the decreasing Young modulus of the cancellous bone. The local buckling of the cortical shell seems to be the driving force of the progressive fracturing of the femoral head leading to its entire collapse. The buckling analysis provides an additional criterion of the femoral head collapse, the critical contact pressure. The buckling scenario also suggests a new argument in speculating on the femoral head reinforcement. If the entire collapse of the femoral head starts with the buckling of the cortical shell then it is reasonable to place the reinforcement as close to the cortical shell as possible.

  12. 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.

  13. Femoral Tunnel Malposition in ACL Revision Reconstruction

    PubMed Central

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

    2013-01-01

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

  14. Bone graft materials in fixation of orthopaedic implants in sheep.

    PubMed

    Babiker, Hassan

    2013-07-01

    Bone graft is widely used within orthopaedic surgery especially in revision joint arthroplasty and spine fusion. The early implant fixation in the revision situation of loose joint prostheses is important for the long-term survival. Bone autograft has been considered as gold standard in many orthopaedic procedures, whereas allograft is the gold standard by replacement of extensive bone loss. However, the use of autograft is associated with donor site morbidity, especially chronic pain. In addition, the limited supply is a significant clinical challenge. Limitations in the use of allograft include the risk of bacterial contamination and disease transmission as well as non-union and poor bone quality. Other bone graft and substitutes have been considered as alternative in order to improve implant fixation. Hydroxyapatite and collagen type I composite (HA/Collagen) have the potential in mimicking skeletal bones. The osteoconductive properties of the composite might be improved by adding bone marrow aspirate (BMA), which can be harvested during surgery. Other alternatives to bone graft are demineralised bone matrix (DBM) and human cancellous bone (CB). DBM is prepared by acid extraction of human bone and includes bone collagen, morphogenetic proteins and growth factors. The combination of DBM with CB and with allograft might improve the healing potential of these grafts around non-cemented orthopaedic implants and thereby the implant fixation. Study I investigates the effect of HA/Collagen composite alone and in combination with BMA on the early fixation of porous coated titanium implants. In addition, the study compares also the effect of autograft with the gold standard allograft. By using a sheep model, the implants were inserted in the trabecular bone of femoral condyles. The test biomaterials were placed in a well defined peri-implant gap. After the observation period, the bone-implant specimens were harvested and evaluated mechanically by a destructive push

  15. What is new in distal femur periprosthetic fracture fixation?

    PubMed

    Tosounidis, Theodoros H; Giannoudis, Peter V

    2015-12-01

    Distal femoral periprosthetic fractures are on the rise. Increased mortality of these injuries is also evident from recent data. Their incidence and risk factors have been extensively reported in the past but new data are being available that merit attention. The increased incidence and the even higher projected incidence should direct the focus of future strategies to the education of surgeons, relevant capacity of hospital and reconfiguration of health care resources. New and potentially modifiable risk factors should be taken into consideration to the informed consent process and new studies should be developed to clarify the causative relationship of the new risk factors such as the peptic ulcer disease and the COPD. The main internal fixation techniques remain the lateral locking plating and the retrograde intramedullary nailing. New techniques in plating are the supplementary medial plate in selected cases and the far cortical locking. Nailing is considered a valid option especially in fractures located well above the anterior flange of the femoral component of the arthroplasty. Results and outcomes from good quality studies are still sparse regarding the comparison between plating and nailing. Interprosthetic fractures constitute an entity that is lately gaining considerable attention. The best method of management of these injuries is still evolving with considerable amount of work being done in the clinical and biomechanical level.

  16. Far-forward fracture stabilization: external fixation versus splinting.

    PubMed

    Camuso, Matthew R

    2006-01-01

    With improvements in body armor, soldiers often survive previously fatal injuries but incur devastating extremity trauma. Orthopaedic and general surgeons in forward-deployed areas must be well-versed in the selection and application of both external fixation and splinting devices in order to best preserve life and limb of the wounded. The surgeon must consider tactical environment, injury severity, injury location, available resources, and his or her own level of experience. Advantages to using external fixation in the field include preventing future injury to the traumatized soft-tissue envelope, reducing the risk of infection, minimizing fracture hemorrhage, providing pain control, and facilitating medical evacuation. Splinting is reserved for closed, low-energy, stable fractures of either the upper or lower extremity and for unstable fractures that are not amenable to battlefield external fixation; because of the risks of compartment syndrome, casts are avoided. PMID:17003182

  17. The Trends in Treatment of Femoral Neck Fractures in the Medicare Population from 1991 to 2008

    PubMed Central

    Miller, Benjamin J.; Lu, Xin; Cram, Peter

    2013-01-01

    Background: We examined trends in the treatment of femoral neck fractures over the last two decades. Methods: We used Medicare Part A administrative data to identify patients hospitalized for closed femoral neck fracture from 1991 to 2008. We used codes from the International Classification of Diseases, Ninth Revision, to categorize treatment as nonoperative, internal fixation, hemiarthroplasty, and total hip arthroplasty. We examined differences in treatment according to hospital hip fracture volume, hospital location (rural or urban), and teaching status. Results: Our sample consisted of 1,119,423 patients with intracapsular hip fractures occurring from 1991 to 2008. We found a generally stable trend over time in the percentage of patients managed with nonoperative treatment, internal fixation, hemiarthroplasty, and total hip arthroplasty. We found little difference in surgical treatment across different groups of hospitals (high volume compared with low volume, urban compared with rural, and teaching compared with nonteaching). The percentage of acute care hospitals treating hip fractures remained fairly constant (74.8% in 1991 to 1993 and 69.0% in 2006 to 2008). The median number of hip fractures treated per hospital did not change (thirty-three in 1991 to 1993 and thirty-three in 2006 to 2008). There was no increase in the percentage of fractures treated in high-volume hospitals over time (57.7% in 1991 to 1993 and 57.1% in 2006 to 2008) and little reduction in the percentage of fractures treated in low-volume hospitals (5.8% in 1991 to 1993 and 5.5% in 2006 to 2008). Conclusions: There has been little change in the trends of operative and nonoperative treatment for proximal femoral fractures over the last two decades, and there was little evidence of regionalization of hip fracture treatment to higher-volume hospitals. PMID:24048563

  18. RANDOMIZED PROSPECTIVE STUDY COMPARING TRANSVERSE AND EXTRACORTICAL FIXATION IN ANTERIOR CRUCIATE LIGAMENT RECONSTRUCTION

    PubMed Central

    da Silva Guarilha, Eduardo; de Andrade Fígaro Caldeira, Paulo Roberto; de Almeida Lira Neto, Ozorio; Navarro, Marcelo Schmidt; Milani, Antonio; Filho, Mario Carneiro

    2015-01-01

    Objective: This study had the objective of prospectively comparing transverse fixation (Cross-Pin™) with extracortical fixation (EZLoc™) for the femur, in surgical reconstruction of the anterior cruciate ligament, from a clinical, biomechanical and functional point of view. Methods: Between April 2007 and November 2009, 50 patients with acute or chronic anterior cruciate ligament injuries underwent arthroscopic reconstruction using the homologous flexor tendons (gracilis and semitendinosus). Randomization of the femoral fixation method was done by means of a draw at the time of the procedure. Patients were excluded if they presented multiple ligament lesions, fractures, previous surgery, autoimmune disease and impairment of the contralateral knee. The Lysholm scale, SF36 quality-of-life questionnaire and KT1000™ arthrometer were used. Results: After a mean follow-up of 18.1 months, there were no statistically significant differences between the groups regarding the Lysholm scale and KT1000™ measurements. However, the SF36 questionnaire showed a statistical difference such that transverse fixation was superior regarding pain and vitality. Conclusion: Both techniques were shown to be efficient for transfemoral fixation, but with almost no statistically significant difference between them. We believe that new studies will be necessary for better understanding of these differences. PMID:27042646

  19. Femoral lipectomy increases postprandial lipemia in women.

    PubMed

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

    2015-07-01

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

  20. 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

  1. Finite Element Analysis of Sacroiliac Joint Fixation under Compression Loads

    PubMed Central

    Bruna-Rosso, Claire; Arnoux, Pierre-Jean; Bianco, Rohan-Jean; Godio-Raboutet, Yves; Fradet, Léo

    2016-01-01

    Background Sacroiliac joint (SIJ) is a known chronic pain-generator. The last resort of treatment is the arthrodesis. Different implants allow fixation of the joint, but to date there is no tool to analyze their influence on the SIJ biomechanics under physiological loads. The objective was to develop a computational model to biomechanically analyze different parameters of the stable SIJ fixation instrumentation. Methods A comprehensive finite element model (FEM) of the pelvis was built with detailed SIJ representation. Bone and sacroiliac joint ligament material properties were calibrated against experimentally acquired load-displacement data of the SIJ. Model evaluation was performed with experimental load-displacement measurements of instrumented cadaveric SIJ. Then six fixation scenarios with one or two implants on one side with two different trajectories (proximal, distal) were simulated and assessed with the FEM under vertical compression loads. Results The simulated S1 endplate displacement reduction achieved with the fixation devices was within 3% of the experimentally measured data. Under compression loads, the uninstrumented sacrum exhibited mainly a rotation motion (nutation) of 1.38° and 2.80° respectively at 600 N and 1000 N, with a combined relative translation (0.3 mm). The instrumentation with one screw reduced the local displacement within the SIJ by up to 62.5% for the proximal trajectory vs. 15.6% for the distal trajectory. Adding a second implant had no significant additional effect. Conclusion A comprehensive finite element model was developed to assess the biomechanics of SIJ fixation. SIJ devices enable to reduce the motion, mainly rotational, between the sacrum and ilium. Positioning the implant farther from the SIJ instantaneous rotation center was an important factor to reduce the intra-articular displacement. Clinical relevance Knowledge provided by this biomechanical study enables improvement of SIJ fixation through optimal implant

  2. 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

  3. Outcomes of Surgical Treatment of Periprosthetic Femoral Fractures in Cementless Hip Arthroplasty

    PubMed Central

    Kim, Min-Wook; Lee, Jung-Ho; Park, Ji-Hoon

    2015-01-01

    Purpose We aimed to evaluate the results of surgical treatment of periprosthetic femoral fractures in cementless total hip arthroplasty (THA). Materials and Methods From June 2002 to May 2012, 40 patients who could be followed-up for more than 1 year after surgery were enrolled in this study. The mean duration of follow-up was 28.5 months (range, 15-97 months) and the average age at the time of surgery was 71.5 years (range, 38-89 years). The fracture types were determined by using the Vancouver classification. Among intraoperative fractures, there were type A in 3 hips, type B2 in 2 hips and type B3 in one. Among postoperative fractures, type AG was present in 5 hips, type AL in 2 hips, type B1 in 15 hips, type B2 in 6 hips, type B3 in 3 hips, and type C in 3 hips. Evaluation of the results was based on bony union, stability of the prosthesis, postoperative complications, and Harris hip score at the final follow-up. Results Bony union was achieved in all but one case and the average time for bony union was 21 weeks. The mean Harris hip score was 86 at the final follow-up. Clinical results were above good in 34 of 40 hips (85.0%). Stem loosening occurred in one patient with a type B1 fracture treated with open reduction and plate fixation. Nonunion was observed in 1 patient with an AG type fracture. Conclusion Open reduction and fixation using a plate with a screw and cerclage wiring provided good results for periprosthetic fractures in patients who had a stable femoral stem without bone defects. Revision surgery with a cementless long stem should be considered in patients with an unstable stem or suspected stability in B1 type of THA using a proximal fixation type. PMID:27536618

  4. Autograft Transfer from the Ipsilateral Femoral Condyle in Depressed Tibial Plateau Fractures

    PubMed Central

    Sferopoulos, N.K

    2014-01-01

    Introduction : The rationale for operative treatment of depressed tibial plateau fractures is anatomic reduction, stable fixation and grafting. Grafting options include autogenous bone graft or bone substitutes. Methods : The autograft group included 18 patients with depressed tibial plateau fractures treated with autogenous bone grafting from the ipsilateral femoral condyle following open reduction and internal fixation. According to Schatzker classification, there were 9 type II, 4 type III, 2 type IV and 3 type V lesions. The average time to union and the hospital charges were compared with the bone substitute group. The latter included 17 patients who had an excellent outcome following treatment of split and/or depressed lateral plateau fractures, using a similar surgical technique but grafting with bone substitutes (allografts). Results : Excellent clinical and radiological results were detected in the autograft group after an average follow-up of 28 months (range 12-37). The average time to union in the autograft group was 14 weeks (range 12-16), while in the bone substitute group it was 18 weeks (range 16-20). The mean total cost was 1276 Euros for the autograft group and 2978 Euros for the bone substitute group. Discussion : The use of autogenous graft from the ipsilateral femoral condyle following open reduction and internal fixation of depressed tibial plateau fractures provided enough bone to maintain the height of the tibial plateau and was not associated with any donor site morbidity. Using this method, the surgical time was not significantly elongated and the rehabilitation was not affected. It also exhibited faster fracture healing without postoperative loss of reduction and it was less expensive than the use of bone substitutes. PMID:25317215

  5. Complications encountered while using thin-wire-hybrid-external fixation modular frames for fracture fixation. A retrospective clinical analysis and possible support for "Damage Control Orthopaedic Surgery".

    PubMed

    Lerner, A; Chezar, A; Haddad, M; Kaufman, H; Rozen, N; Stein, H

    2005-05-01

    One hundred ninety eight adult patients who had sustained long bone fractures were treated by external fixation from admission to bone healing and consolidation. Of these, 135 had sustained high-energy injuries, 39 of them had suffered multi-system injuries. Superficial pin track infection was the most common complication, occurring predominantly in pins located in the femur, upper tibia and upper humerus. There were no cases of deep infection or osteomyelitis. One patient with a femoral shaft fracture developed a DVT although he was on preventive low molecular weight heparin, i.e. sc Clexane 40 mg daily. There were no cases of PE or ARDS. External fixation systems are a minimal invasive surgical modality, which allow three-dimensional fracture fixation after closed or minimal open reduction. They require a good command of surgical anatomy, but provide an optimal preservation of the fracture's soft tissue envelope, the critical biological factor for new bone formation and fracture healing. Recent publications have suggested that in the critically ill patient, minimally invasive fracture fixation surgery may prevent the perpetuation of a reactive, life threatening inflammatory reaction (the "second hit") which may induce the development of multiple organ dysfunction (MODS).

  6. Micromotion of cemented and uncemented femoral components.

    PubMed

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

    1991-01-01

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

  7. Emergency intravenous access through the femoral vein.

    PubMed

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

    1984-04-01

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

  8. Uncemented femoral revision arthroplasty using a modular tapered, fluted titanium stem

    PubMed Central

    Wirtz, Dieter C; Gravius, Sascha; Ascherl, Rudolf; Forst, Raimund; Noeth, Ulrich; Maus, Uwe M; Zeiler, Günther; Moritz C, Deml

    2014-01-01

    Background and purpose — Due to the relative lack of reports on the medium- to long-term clinical and radiographic results of modular femoral cementless revision, we conducted this study to evaluate the medium- to long-term results of uncemented femoral stem revisions using the modular MRP-TITAN stem with distal diaphyseal fixation in a consecutive patient series. Patients and methods — We retrospectively analyzed 163 femoral stem revisions performed between 1993 and 2001 with a mean follow-up of 10 (5–16) years. Clinical assessment included the Harris hip score (HHS) with reference to comorbidities and femoral defect sizes classified by Charnley and Paprosky. Intraoperative and postoperative complications were analyzed and the failure rate of the MRP stem for any reason was examined. Results — Mean HHS improved up to the last follow-up (37 (SD 24) vs. 79 (SD 19); p < 0.001). 99 cases (61%) had extensive bone defects (Paprosky IIB–III). Radiographic evaluation showed stable stem anchorage in 151 cases (93%) at the last follow-up. 10 implants (6%) failed for various reasons. Neither a breakage of a stem nor loosening of the morse taper junction was recorded. Kaplan-Meier survival analysis revealed a 10-year survival probability of 97% (95% CI: 95–100). Interpretation — This is one of the largest medium- to long-term analyses of cementless modular revision stems with distal diaphyseal anchorage. The modular MRP-TITAN was reliable, with a Kaplan-Meier survival probability of 97% at 10 years. PMID:25175667

  9. Interference screw fixation of hamstring vs patellar tendon grafts for anterior cruciate ligament reconstruction.

    PubMed

    Aune, A K; Ekeland, A; Cawley, P W

    1998-01-01

    The present study was designed to investigate the fixation strength of a quadruple semitendinosus-gracilis graft compared with a middle-third bone-patellar tendon-bone graft using a new interference screw developed to fix hamstrings grafts for ACL reconstructions (RCL Smith & Nephew Donjoy). Five pairs of human cadaveric knees from donors with a mean age of 43 (range 33-52) years were used. One knee of each pair was randomly allocated to be reconstructed on the femoral side with a semitendinosus-gracilis graft from the same donor using RCL screw fixation. As the control, the contralateral knee was correspondingly reconstructed with a bone-patellar tendon-bone graft using the same interference screw. The grafts were pulled out at a velocity of 30 mm/s by an axially applied load using a MTS machine. The mean (SD) failure load for the bone-patellar tendon-bone graft fixations was 505 (25) N, 110% stronger than the mean failure load for the semitendinosus-gracilis graft fixations, which was 240 (47) N (P = 0.003). The stiffness for the patellar tendon-bone graft fixations was 46 (11) N/mm, 120% stiffer than the semitendinosus-gracilis graft fixations, which was 22 (11) N/mm (P = 0.01). This study shows that the interference screw principle used for ACL reconstructions with hamstrings tendons is inferior to that for bone-patellar tendon-bone reconstructions although the screw was developed especially for soft-tissue fixation in bone tunnels. PMID:9604194

  10. Entrapment of the StarClose Vascular Closure System After Attempted Common Femoral Artery Deployment

    SciTech Connect

    Durack, Jeremy C. Thor Johnson, D.; Fidelman, Nicholas; Kerlan, Robert K.; LaBerge, Jeanne M.

    2012-08-15

    A complication of the StarClose Vascular Closure System (Abbott, Des Plaines, IL) after a transarterial hepatic chemoembolization is described. After attempted clip deployment, the entire device became lodged in the tissues overlying the common femoral artery and could not be removed percutaneously. Successful removal of the device required surgical cutdown for removal and arterial repair. Entrapment of the StarClose vascular closure deployment system is a potentially serious complication that has been reported in the Manufacturer and User Facility Device Experience database, but has not been recognized in the literature.

  11. Blood flow interpretation in femoral pseudoaneurysm

    NASA Astrophysics Data System (ADS)

    Suh, Sang-Ho; Choi, Young Ho; Kim, Hyoung-Ho; Jeon, Min-Gyu; Doh, Deog-Hee

    2013-06-01

    A femoral artery pseudoaneurysm is one complication of vascular intervention, and the incidence is increasing. Early management is then needed to avoid potential dangers from it. It differs from a true aneurysm in that it doesn't include any component of the vascular wall, and is not studied as much as a true aneurysm. Here, a model of a femoral pseudoaneurysm was made and a Computational Fluid Dynamics(CFD) simulation was verified with PIV experiment. Afterwards, a CFD simulation with two different models was performed to look for any findings which may help in developing new treatment methods.

  12. 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

  13. Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature

    PubMed Central

    Keyhani, Sohrab; Vaziri, Arash Sharafat; shafiei, Hossein; Mardani-Kivi, Mohsen

    2015-01-01

    A rare and devastating complication following anterior cruciate ligament (ACL) revision reconstruction is femoral fracture. A 35-year old male soccer player with a history of ACL tear from one year ago, who underwent arthroscopic ACL reconstruction and functioned well until another similar injury caused ACL re-rupture. Revision of ACL reconstruction was performed and after failure of graft tension during the pumping, a fluoroscopic assessment showed a femoral condyle fracture. The patient referred to our knee clinic and was operated on in two stages first fixation of the fracture and then ACL re-revision after fracture healing was complete. Not inserting multiple guide pins, keeping a safe distance from the posterior cortex and giving more attention during graft tensioning, especially in revision surgeries, are all small points that can reduce the risk of fracture during the revision of ACL reconstruction. PMID:26110183

  14. The use of short carbon fibre reinforced thermoplastic plates for fracture fixation.

    PubMed

    Gillett, N; Brown, S A; Dumbleton, J H; Pool, R P

    1985-03-01

    Thermoplastic plates of Nylon 6-10 and Polybutylene terephthalate reinforced with 30% short randomly oriented carbon fibres were tested for internal fixation of canine femoral transverse midshaft fractures. The elastic modulus of the plates was one-half that of bone: however, ultimate strength and strain in bending were comparable to bone. The fractures healed with moderate callus formation which was completely remodelled by 8 to 12 wk post surgery. Although a moderate inflammatory reaction to occasional particulate debris was noted, the materials appeared to possess the proper elastic moduli to allow sufficient support for the healing fracture without protecting the remodelling process.

  15. Intraocular lens fixation with dacron.

    PubMed

    Peyman, G A; Koziol, J E

    1978-10-01

    To overcome the problem of postoperative lens dislocation, we evaluated a new means of lens fixation. Our experimental studies in rabbits and primates demonstrated that Dacron polyethylene terephtalate induced a cellular reaction from either the anterior or posterior iris surface when placed in contact with the iris, thereby establishing a bond between the Dacron fibers and the iris. Dacron mesh can be attached to the distal portion of either the anterior or posterior loops of a Binkhorst iris clip (4-loop) lens. In the rabbit eye, lens fixation occurred within five days; in the primate eye, 30 days. When combined with silk, Dacron produced tissue ingrowth in the primate eye within 14 days. No unwanted reaction occurred in any animal with the Dacron and silk combination. Being biodegradable, the silk induced faster cellular ingrowth than the Dacron. However, Dacron, which is not biodegradable, provided a permanent means of fixation. PMID:155053

  16. Indirect Blood Pressure Measuring Device

    NASA Technical Reports Server (NTRS)

    Hum, L.; Cole, C. E.

    1973-01-01

    Design and performance of a blood pressure recording device for pediatric use are reported. A strain gage transducer with a copper-beryllium strip as force sensing element is used to monitor skin movements and to convert them into electrical signals proportional to those displacements. Experimental tests with this device in recording of force developed above the left femoral artery of a dog accurately produced a blood pressure curve.

  17. Outcome of uncemented primary femoral stems for treatment of femoral head osteonecrosis.

    PubMed

    Hungerford, Marc W; Hungerford, David S; Jones, Lynne C

    2009-04-01

    Cementless total hip replacement has been advocated for patients with osteonecrosis of the femoral head. This study examined the outcome of the femoral stem of four generations of an uncemented, proximally porous-coated, chrome-cobalt total hip prosthesis. There were 158 cases in 141 osteonecrosis patients (74 men, 67 women) who had a mean age of 46 years (range, 17-83 years). The mean follow-up was 103 months (range, 20-235 months). The femoral components of 144 cases were not revised and had a mean Harris hip score of 84 (+/-15) at final follow-up. Of the 14 revisions (8.9%), the primary reasons for revision were loosening or significant osteolysis. There were one infection and one chronic dislocation. Proximally porous-coated, anatomic, press-fit stems provide excellent long-term results in patients with osteonecrosis of the femoral head.

  18. Femoral fractures in the extremely elderly

    PubMed Central

    Guido, Giulio; Giannotti, Stefano; Bottai, Vanna; Ghilardi, Marco; Bianchi, Maria Giulia; Ceglia, Michael James

    2011-01-01

    Summary At the Trauma Unit of Pisa we performed an observational study reviewing nineties that about 200 patients were treated and underwent surgery for femoral neck fracture from 1998 to 2005. The clinical and radiographic results obtained were discrete, with a mortality of 42.5%, the survivors are still having a good quality of life. PMID:22461814

  19. Femoral Neck Version Affects Medial Femorotibial Loading

    PubMed Central

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

    2013-01-01

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

  20. 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

  1. Prevention of Thumb Web Space Contracture With Multiplanar External Fixation.

    PubMed

    Harper, Carl M; Iorio, Matthew L

    2016-09-01

    Thumb web space contracture following hand trauma can be disabling with numerous reconstructive procedures existing to correct the resultant deformity. Following marked soft tissue injury to the hand we utilized the Stryker Hoffmann II Micro External Fixator System to link the first and second metacarpals by a multiplanar system using 1.6 or 2.0 mm self-drilling half-pins and 3 mm carbon fiber connecting rods. This facilitated placement of the thumb in maximal palmar abduction as well as allowed adjustment of thumb position throughout the postoperative period. This technique was performed on 5 patients. Two patients were treated with a first web space external fixator for table saw injuries to the radial aspect of the hand. An additional 2 patients were treated with a first web space external fixator following metacarpophalangeal joint capsular release in the setting of thermal burns. A fifth patient underwent second ray amputation, trapeziectomy and trapezoidectomy for squamous cell carcinoma with subsequent stabilization with the external fixator. The external fixator was left in place until soft tissues were healed (average 5.5 wk). The patients were allowed to mobilize their hand in as much as the external fixator allowed, and no device-associated complications were noted. Thumb web space was preserved with passive and supple thumb circumduction and web space abduction/adduction in all patients at an average follow-up of 5 months. The average Quick Dash Score was 35±5 and the average Modern Activity Subjective Survey of 2007 was 30±8.

  2. Prevention of Thumb Web Space Contracture With Multiplanar External Fixation.

    PubMed

    Harper, Carl M; Iorio, Matthew L

    2016-09-01

    Thumb web space contracture following hand trauma can be disabling with numerous reconstructive procedures existing to correct the resultant deformity. Following marked soft tissue injury to the hand we utilized the Stryker Hoffmann II Micro External Fixator System to link the first and second metacarpals by a multiplanar system using 1.6 or 2.0 mm self-drilling half-pins and 3 mm carbon fiber connecting rods. This facilitated placement of the thumb in maximal palmar abduction as well as allowed adjustment of thumb position throughout the postoperative period. This technique was performed on 5 patients. Two patients were treated with a first web space external fixator for table saw injuries to the radial aspect of the hand. An additional 2 patients were treated with a first web space external fixator following metacarpophalangeal joint capsular release in the setting of thermal burns. A fifth patient underwent second ray amputation, trapeziectomy and trapezoidectomy for squamous cell carcinoma with subsequent stabilization with the external fixator. The external fixator was left in place until soft tissues were healed (average 5.5 wk). The patients were allowed to mobilize their hand in as much as the external fixator allowed, and no device-associated complications were noted. Thumb web space was preserved with passive and supple thumb circumduction and web space abduction/adduction in all patients at an average follow-up of 5 months. The average Quick Dash Score was 35±5 and the average Modern Activity Subjective Survey of 2007 was 30±8. PMID:27203276

  3. Pathophysiology of infections after internal fixation of fractures.

    PubMed

    Schmidt, A H; Swiontkowski, M F

    2000-01-01

    Infection complicating internal fixation of fractures is a serious complication that is difficult to treat. Whenever metallic devices are implanted in vivo, successful biointegration requires that host cells colonize the highly reactive implant surface. Bacteria such as staphylococci can also become adherent to metallic or polymeric implants and will compete with host cells for colonization of the implant surface. Once adherent, these bacteria form a biofilm and undergo phenotypic changes that make them resistant to the normal host immune response as well as to antibiotics. Furthermore, metallic implants themselves cause specific deficits in the function of the local immune system that may render the host response to infection inadequate. Any associated soft-tissue injury causes even greater impairment of local immune function. Despite the potentially detrimental impact of internal fixation, fracture stability is of paramount importance in achieving fracture union and in preventing infection. It has been demonstrated in animal models that contaminated fractures without internal fixation develop clinical infection more commonly than similar fractures treated with internal fixation at the time of colonization. Because of the potential for infection whenever internal fixation is utilized, appropriate prophylactic antibiotic coverage for staphylococci and Gram-negative organisms should be provided. Open wounds and severely damaged soft tissues require aggressive management so that a viable soft-tissue envelope is maintained around the implant. Host factors such as smoking and malnourishment should be corrected. Early diagnosis and aggressive treatment of implant-related infection with antibiotics, debridement, and maintenance of stable internal fixation are essential to successful treatment.

  4. Measuring dwell time percentage from head-mounted eye-tracking data--comparison of a frame-by-frame and a fixation-by-fixation analysis.

    PubMed

    Vansteenkiste, Pieter; Cardon, Greet; Philippaerts, Renaat; Lenoir, Matthieu

    2015-01-01

    Although analysing software for eye-tracking data has significantly improved in the past decades, the analysis of gaze behaviour recorded with head-mounted devices is still challenging and time-consuming. Therefore, new methods have to be tested to reduce the analysis workload while maintaining accuracy and reliability. In this article, dwell time percentages to six areas of interest (AOIs), of six participants cycling on four different roads, were analysed both frame-by-frame and in a 'fixation-by-fixation' manner. The fixation-based method is similar to the classic frame-by-frame method but instead of assigning frames, fixations are assigned to one of the AOIs. Although some considerable differences were found between the two methods, a Pearson correlation of 0.930 points out a good validity of the fixation-by-fixation method. For the analysis of gaze behaviour over an extended period of time, the fixation-based approach is a valuable and time-saving alternative for the classic frame-by-frame analysis. PMID:25529829

  5. A mini external fixator for hand and finger fractures constructed from readily available materials.

    PubMed

    Walter, Frank L; Papandrea, Rick F

    2011-12-01

    Phalangeal and metacarpal fractures with severe comminution and/or soft tissue compromise can present a challenge for the orthopedic surgeon. Maintaining viability of the soft tissues while providing rigid fixation of bony injuries is the goal when treating these injuries. Commercially available mini external fixators can help to achieve these goals. However, these devices are costly and are not always available when the surgeon needs them. In this technique study, we discuss the implementation of a mini external fixator using readily available implements in the operating room that is efficient, cost effective, and easy to apply.

  6. Missing nitrogen fixation in the Benguela region

    NASA Astrophysics Data System (ADS)

    Wasmund, Norbert; Struck, Ulrich; Hansen, Anja; Flohr, Anita; Nausch, Günther; Grüttmüller, Annett; Voss, Maren

    2015-12-01

    Opposing opinions on the importance of nitrogen fixation in the northern Benguela upwelling region provoked us to investigate the magnitude of nitrogen fixation in front of northern Namibia and southern Angola. Measurements of nitrogen fixation rates using the 15N method at 66 stations during seven cruises from 2008 to 2014 showed that, in general, the 15N content in the biomass did not increase after tracer incubation with 15N2, indicating that no nitrogen fixation occurred. Correspondingly, the filamentous nitrogen-fixing cyanobacterium Trichodesmium was almost not present. The abundant picocyanobacteria did obviously not perform nitrogen fixation to a significant degree. The artificial improvement of conditions for nitrogen fixation in mesocosm experiments, including phosphate and iron additions and a warmer temperature, failed to induce nitrogen fixation. A plausible explanation of these findings is a lack of conditioned cells for nitrogen fixation in the Benguela region.

  7. First metatarsophalangeal joint arthrodesis: current fixation options.

    PubMed

    Moon, Jared L; McGlamry, Michael C

    2011-04-01

    This article reviews the current literature on first metatarsophalangeal joint arthrodesis rates using various forms of fixation, as well as reviewing biomechanical studies comparing the strengths of the different fixation options that are available.

  8. Use of a Computed Tomography Based Approach to Validate Noninvasive Devices to Measure Rotational Knee Laxity

    PubMed Central

    Neumann, Simon; Maas, Stefan; Waldmann, Danièle; Ricci, Pierre-Louis; Zürbes, Arno; Arnoux, Pierre-Jean; Walter, Frédéric; Kelm, Jens

    2015-01-01

    The purpose of this study is to validate a noninvasive rotational knee laxity measuring device called “Rotameter P2” with an approach based on Computed Tomography (CT). This CT-approach using X-rays is hence invasive and can be regarded as a precise reference method that may also be applied to similar devices. An error due to imperfect femur fixation was observed but can be neglected for small torques. The most significant estimation error is due to the unavoidable soft tissues rotation and hence flexibility in the measurement chain. The error increases with the applied torque. The assessment showed that the rotational knee angle measured with the Rotameter is still overestimated because of thigh and femur displacement, soft tissues deformation, and measurement artefacts adding up to a maximum of 285% error at +15 Nm for the Internal Rotation of female volunteers. This may be questioned if such noninvasive devices for measuring the Tibia-Femoral Rotation (TFR) can help diagnosing knee pathologies and investigate ligament reconstructive surgery. PMID:27347541

  9. Use of a Computed Tomography Based Approach to Validate Noninvasive Devices to Measure Rotational Knee Laxity.

    PubMed

    Neumann, Simon; Maas, Stefan; Waldmann, Danièle; Ricci, Pierre-Louis; Zürbes, Arno; Arnoux, Pierre-Jean; Walter, Frédéric; Kelm, Jens

    2015-01-01

    The purpose of this study is to validate a noninvasive rotational knee laxity measuring device called "Rotameter P2" with an approach based on Computed Tomography (CT). This CT-approach using X-rays is hence invasive and can be regarded as a precise reference method that may also be applied to similar devices. An error due to imperfect femur fixation was observed but can be neglected for small torques. The most significant estimation error is due to the unavoidable soft tissues rotation and hence flexibility in the measurement chain. The error increases with the applied torque. The assessment showed that the rotational knee angle measured with the Rotameter is still overestimated because of thigh and femur displacement, soft tissues deformation, and measurement artefacts adding up to a maximum of 285% error at +15 Nm for the Internal Rotation of female volunteers. This may be questioned if such noninvasive devices for measuring the Tibia-Femoral Rotation (TFR) can help diagnosing knee pathologies and investigate ligament reconstructive surgery.

  10. Use of a Computed Tomography Based Approach to Validate Noninvasive Devices to Measure Rotational Knee Laxity.

    PubMed

    Neumann, Simon; Maas, Stefan; Waldmann, Danièle; Ricci, Pierre-Louis; Zürbes, Arno; Arnoux, Pierre-Jean; Walter, Frédéric; Kelm, Jens

    2015-01-01

    The purpose of this study is to validate a noninvasive rotational knee laxity measuring device called "Rotameter P2" with an approach based on Computed Tomography (CT). This CT-approach using X-rays is hence invasive and can be regarded as a precise reference method that may also be applied to similar devices. An error due to imperfect femur fixation was observed but can be neglected for small torques. The most significant estimation error is due to the unavoidable soft tissues rotation and hence flexibility in the measurement chain. The error increases with the applied torque. The assessment showed that the rotational knee angle measured with the Rotameter is still overestimated because of thigh and femur displacement, soft tissues deformation, and measurement artefacts adding up to a maximum of 285% error at +15 Nm for the Internal Rotation of female volunteers. This may be questioned if such noninvasive devices for measuring the Tibia-Femoral Rotation (TFR) can help diagnosing knee pathologies and investigate ligament reconstructive surgery. PMID:27347541

  11. Complications of rigid internal fixation.

    PubMed

    Campbell, Chris A; Lin, Kant Y

    2009-03-01

    Over the past 20 years, there have been many advances in the development of bone fixation systems used in the practice of craniomaxillofacial surgery. As surgical practices have evolved, the complications of each technologic advance have changed accordingly. Interfragmentary instability of interosseous wiring has been replaced by the risk of exposure, infection, and palpability of plate and screw fixation systems. The improved rigidity of plate fixation requires anatomic alignment of fracture fragments. Failure to obtain proper alignment has led to the phenomenon known as "open internal fixation" of fracture fragments without proper reduction. The size of the plates has decreased to minimize palpability and exposure. However limitations in their application have been encountered due to the physiologic forces of the muscles of mastication and bone healing. In the pediatric population, the long-standing presence of plates in the cranial vault resulted in reports of transcranial migration and growth restriction. These findings led to the development of resorbable plating systems, which are associated with self-limited plate palpability and soft tissue inflammatory reactions. Any rigid system including these produces growth restriction in varying amounts. In this discussion, we review the reported complication rates of miniplating and microplating systems as well as absorptive plating systems in elective and traumatic craniofacial surgery.

  12. Understanding Nitrogen Fixation

    SciTech Connect

    Paul J. Chirik

    2012-05-25

    synthesis of ammonia, NH{sub 3}, from its elements, H{sub 2} and N{sub 2}, via the venerable Haber-Bosch process is one of the most significant technological achievements of the past century. Our research program seeks to discover new transition metal reagents and catalysts to disrupt the strong N {triple_bond} N bond in N{sub 2} and create new, fundamental chemical linkages for the construction of molecules with application as fuels, fertilizers and fine chemicals. With DOE support, our group has discovered a mild method for ammonia synthesis in solution as well as new methods for the construction of nitrogen-carbon bonds directly from N{sub 2}. Ideally these achievements will evolve into more efficient nitrogen fixation schemes that circumvent the high energy demands of industrial ammonia synthesis. Industrially, atmospheric nitrogen enters the synthetic cycle by the well-established Haber-Bosch process whereby N{sub 2} is hydrogenated to ammonia at high temperature and pressure. The commercialization of this reaction represents one of the greatest technological achievements of the 20th century as Haber-Bosch ammonia is responsible for supporting approximately 50% of the world's population and serves as the source of half of the nitrogen in the human body. The extreme reaction conditions required for an economical process have significant energy consequences, consuming 1% of the world's energy supply mostly in the form of pollution-intensive coal. Moreover, industrial H{sub 2} synthesis via the water gas shift reaction and the steam reforming of methane is fossil fuel intensive and produces CO{sub 2} as a byproduct. New synthetic methods that promote this thermodynamically favored transformation ({Delta}G{sup o} = -4.1 kcal/mol) under milder conditions or completely obviate it are therefore desirable. Most nitrogen-containing organic molecules are derived from ammonia (and hence rely on the Haber-Bosch and H{sub 2} synthesis processes) and direct synthesis from

  13. Options for acetabular fixation surfaces.

    PubMed

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

    2007-01-01

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

  14. Binocular Fixation Disparity in Single Word Displays

    ERIC Educational Resources Information Center

    Paterson, Kevin B.; Jordan, Timothy R.; Kurtev, Stoyan

    2009-01-01

    It has been claimed that the recognition of words displayed in isolation is affected by the precise location at which they are fixated. However, this putative role for fixation location has yet to be reconciled with the finding from reading research that binocular fixations are often misaligned and, therefore, more than 1 location in a word is…

  15. The impact of proximal femoral morphology on failure strength with a mid-head resection short-stem hip arthroplasty.

    PubMed

    Olsen, Michael; Al Saied, Mohamed; Morison, Zachary; Sellan, Michael; Waddell, James P; Schemitsch, Emil H

    2014-12-01

    Mid-head resection short-stem hip arthroplasty is a conservative alternative to conventional total hip replacement and addresses proximal fixation challenges in patients not suitable for hip resurfacing. It is unclear whether proximal femoral morphology impacts the ultimate failure load of mid-head resection implanted femurs, thus the aim of this study was to investigate the effect of native neck-shaft angle (NSA) and coronal implant alignment on proximal femoral strength. In total, 36 synthetic femurs with two different proximal femoral morphologies were utilized in this study. Of them, 18 femurs with a varus NSA of 120° and 18 femurs with a valgus NSA of 135° were each implanted with a mid-head resection prosthesis. Femurs within the two different femoral morphology groups were divided into three equal coronal implant alignment groups: 10° valgus, 10° varus or neutral alignment. Prepared femurs were tested for stiffness and to failure in axial compression. There was no significant difference in stiffness nor failure load between femurs implanted with valgus-, varus- or neutrally aligned implants in femurs with a NSA of 120° (p = 0.396, p = 0.111, respectively). Femurs implanted in valgus orientation were significantly stiffer and failed at significantly higher loads than those implanted in varus alignment in femurs with a NSA of 135° (p = 0.001, p = 0.007, respectively). A mid-head resection short-stem hip arthroplasty seems less sensitive to clinically relevant variations of coronal implant alignment and may be more forgiving upon implantation in some femoral morphologies, however, a relative valgus component alignment is recommended.

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

    PubMed Central

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

    2013-01-01

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

  17. A simple method of intramedullary fixation for proximal interphalangeal arthrodesis.

    PubMed

    Canales, Michael B; Razzante, Mark C; Ehredt, Duane J; Clougherty, Coleman O

    2014-01-01

    Lesser digital arthrodesis has become one of the most widely used techniques in foot and ankle surgery. When performing digital arthrodesis, surgeons have an abundance of options for implantable devices. We provide information on a simple method of achieving successful arthrodesis. An intramedullary Kirschner wire is implanted into the proximal phalanx with the intermediate phalanx compressed over the wire for rigid internal fixation to avoid the use of an external device. We have had results similar to those from the published data of more expensive implants. PMID:24846156

  18. A simple method of intramedullary fixation for proximal interphalangeal arthrodesis.

    PubMed

    Canales, Michael B; Razzante, Mark C; Ehredt, Duane J; Clougherty, Coleman O

    2014-01-01

    Lesser digital arthrodesis has become one of the most widely used techniques in foot and ankle surgery. When performing digital arthrodesis, surgeons have an abundance of options for implantable devices. We provide information on a simple method of achieving successful arthrodesis. An intramedullary Kirschner wire is implanted into the proximal phalanx with the intermediate phalanx compressed over the wire for rigid internal fixation to avoid the use of an external device. We have had results similar to those from the published data of more expensive implants.

  19. Loosening of the femoral component of total hip replacement after plugging the femoral canal.

    PubMed

    Harris, W H; McCarthy, J C; O'Neill, D A

    1982-01-01

    A roentgen follow-up study was done of 171 total hip replacements at an average of 3.3 years (range 2 to 5 years) after insertion to assess the loosening rate in older adult patients (average age 60 years) in whom the medullary canal was plugged. The cement (Simplex P) was introduced using a cement gun. The femoral components used were CAD and HD-2 in design, made of chrome cobalt alloy. Evaluation was made according to three categories of loosening: definite (requiring evidence of migration of the component or the cement), probable (requiring a continuous radiolucent zone around the cement mantle in one or more radiographic views), or possible (requiring a radiolucent zone that occupied 50% or more of the cement-bone interface in one or more views but was not continuous). One hip was revised for a loose femoral component. Another patient has asymptomatic subsidence of the femoral component. Thus the total incidence of definitely loose femoral components was 1.1%. No hip was classified as probably loose. Seven hips (4%) were rated as possibly loose. Compared to four other reported series of similar groups of patients followed for like duration, this incidence of definitely loose components is statistically significantly less than in nonplugged canals. The other differences among the series compared, such as stem design, type of cement introduction, modulus of elasticity of the metal used, presence or absence of a collar, and dates during which the surgery was done, are also discussed. Plugging the femoral canal; introducing the cement with a cement gun; using a femoral stem that largely fills the medullary canal, has a collar, and has a rounded rectangular cross section with no medial stress risers made of a superalloy with a modulus of elasticity of about 200 GPa--all these factors were associated with a low (1.1%) incidence of femoral component loosening at 3 years. PMID:7166501

  20. Influence of the crosshead rate on the mechanical properties of fixation systems of ACL tendon grafts.

    PubMed

    Martel, Oscar; Cárdenes, Juan F; Garcés, Gerardo; Carta, José A

    2009-11-01

    Anterior cruciate ligament (ACL) reconstruction is one of the most important aspects of knee surgery. For this purpose, several fixation devices have been developed, although the interference screw is the most frequently used. The most typical biomechanical test of these devices consists of placing them in a testing machine and subjecting them to a pull-out test. However, insufficient attention has been paid to the influence of the displacement test rate on the mechanical properties of the fixation system. The aim of this study is to compare the influence of the crosshead rate in the biomechanical test of two different devices for the fixation of ACL tendon grafts. One hundred in vitro tests were performed using porcine tibiae and bovine tendons. The fixation devices used were (1) an interference screw and (2) a new expansion device. All ACL reconstructions were subjected to pull-out test to failure. Five crosshead rates were employed in a range from 30 mm/min to 4000 mm/min. Statistical analyses of the results show that, for the two devices, the rate has a significant effect on both maximum force and stiffness. Moreover, the new expansion device showed lesser dependency on the crosshead rate than the interference screw.

  1. Mechanical Comparison of Headless Screw Fixation and Locking Plate Fixation for Talar Neck Fractures.

    PubMed

    Karakasli, Ahmet; Hapa, Onur; Erduran, Mehmet; Dincer, Cemal; Cecen, Berivan; Havitcioglu, Hasan

    2015-01-01

    For talar neck fractures, open reduction and internal fixation have been thought to facilitate revascularization and prevent osteonecrosis. Newer screw systems allow for placement of cannulated headless screws, which provide compression by virtue of a variable pitch thread. The present study compared the biomechanical fixation strength of cannulated headless variable-pitch screw fixation and locking plate fixation. A reproducible talar neck fracture was created in 14 fresh cadaver talar necks. Talar head fixation was then performed using 2 cannulated headless variable-pitch 4-mm/5-mm diameter (4/5) screws (Acutrak; Acumed, Hillsboro, OR) and locking plate fixation. Headless variable-pitch screw fixation had lower failure displacement than did locking plate fixation. No statistically significant differences were found in failure stiffness, yield stiffness (p = .655), yield load (p = .142), or ultimate load between the 2 fixation techniques. Cannulated headless variable-pitch screw fixation resulted in better failure displacement than locking plate fixation in a cadaveric talus model and could be considered a viable option for talus fracture fixation. Headless, fully threaded, variable-pitch screw fixation has inherent advantages compared with locking plate fixation, because it might cause less damage to the articular surface and can compress the fracture for improved reduction. Additionally, plate fixation can increase the risk of avascular necrosis owing to the wider incision and dissection of soft tissues.

  2. Nonbridging external fixation of distal radius fractures.

    PubMed

    Eichenbaum, Matthew D; Shin, Eon K

    2010-08-01

    Surgical management of distal radius fractures continues to evolve because of their high incidence in an increasingly active elderly population. Traditional radiocarpal external fixation relies on ligamentotaxis for fracture reduction but has several drawbacks. Nonbridging external fixation has evolved to provide early wrist mobility in the setting of anatomic fracture reduction. Several studies of the nonbridging technique have demonstrated satisfactory results in isolated nonbridging external fixation series and in comparison with traditional spanning external fixation. Nonbridging external fixation for surgical treatment of distal radius fractures can be technically demanding and requires at least 1 cm of intact volar cortex in the distal fracture fragment for successful implementation.

  3. Results of triple muscle (sartorius, tensor fascia latae and part of gluteus medius) pedicle bone grafting in neglected femoral neck fracture in physiologically active patients

    PubMed Central

    Mishra, Pankaj Kumar; Gupta, Anuj; Gaur, Suresh Chandra

    2014-01-01

    Background: Femoral neck fractures are notorious for complications like avascular necrosis and nonunion. In developing countries, various factors such as illiteracy, low socioeconomic status, ignorance are responsible for the delay in surgery. Neglected fracture neck femur always poses a formidable challenge. The purpose of this study was to evaluate the results of triple muscle pedicle bone grafting using sartorius, tensor fasciae latae and part of gluteus medius in neglected femoral neck fracture. Materials and Methods: This is a retrospective study with medical record of 50 patients, who were operated by open reduction, internal fixation along with muscle pedicle bone grafting by the anterior approach. After open reduction, two to three cancellous screws (6.5 mm) were used for internal fixation in all cases. A bony chunk of the whole anterior superior iliac spine of 1 cm thickness, 1 cm width and 4.5 cm length, taken from the iliac crest comprised of muscle pedicle of sartorius, tensor fascia latae and part of gluteus medius. Then the graft with all three muscles mobilized and put in the trough made over the anterior or anterosuperior aspect of the femoral head. The graft was fixed with one or two 4.5 mm self-tapping cortical screw in anterior to posterior direction. Results: 14 patients were lost to followup. The results were based on 36 patients. We observed that in our series, there was union in 34, out of 36 (94.4%) patients. All patients were within the age group of 15-51 years (average 38 years) with displaced neglected femoral neck fracture of ≥30 days. Mean time taken for full clinicoradiological union was 14 weeks (range-10-24 weeks). Conclusion: Triple muscle pedicle bone grafting gives satisfactory results for neglected femoral neck fracture in physiologically active patients. PMID:25298553

  4. Periprosthetic fractures around the femoral stem: overcoming challenges and avoiding pitfalls

    PubMed Central

    Chen, Antonia F.

    2015-01-01

    Management of periprosthetic fractures around the femoral stem after total hip arthroplasty (THA) represents a significant challenge and optimal treatment remains controversial. The most common treatment paradigm involves treating fractures around a well-fixed stem with osteosynthesis, whereas fractures around a loose stem require revision arthroplasty and those with poor bone require augmentation with bone graft. Paradoxically, the literature reports a higher rate of failure for osteosynthesis around prostheses considered to be well-fixed. Such a high rate of poor outcomes may result not only from difficult fracture fixation and compromised biologic healing, but also from unrecognized peri-implant pathology. Therefore, proper preoperative and intraoperative evaluation is key, and a subset of patients may benefit from alternative management. We review the appropriate methods for evaluation and treatment of Vancouver type B fractures with particular emphasis on avoiding missteps that can lead to failure. PMID:26539451

  5. Displaced femoral neck fractures in the elderly: hemiarthroplasty versus total hip arthroplasty.

    PubMed

    Macaulay, William; Pagnotto, Michael R; Iorio, Richard; Mont, Michael A; Saleh, Khaled J

    2006-05-01

    The incidence of femoral neck fracture among the elderly in the United States is expected to increase dramatically because of the anticipated explosion in the population aged 65 years and older, increased life expectancy, and the rising incidence of osteoporosis. The resulting public health implications may be significant, with annual hospital admissions resulting from hip fracture projected to increase to 700,000 by 2050, and with annual spending on hip fracture care expected to exceed 15 billion dollars within a few years. The decision to perform internal fixation, unipolar hemiarthroplasty, bipolar hemiarthroplasty, or THA must be based on patient mental status, living arrangement, level of independence and activity, and bone and joint quality.

  6. Interlocking intramedullary nail stabilization of a femoral fracture in a dog with osteomyelitis.

    PubMed

    Muir, P; Johnson, K A

    1996-10-01

    Complications developed in a dog that underwent intramedullary pin and cerclage wire fixation of a comminuted femoral fracture. The fracture was unstable, the intramedullary pin protruded through the skin over the hip, and Staphylococcus sp was isolated from the fracture site. The loose pin was removed, and the fracture was restabilized with a 6.0-mm interlocking intramedullary nail and 3 interlocking screws. Cephalexin was given orally for 6 weeks. Eight weeks after the second surgery, the fracture was healed radiographically. Seventeen months later, the dog had a persistent mild lameness that was associated with low-grade osteomyelitis. The lameness resolved after the implants were removed, and antibiotics were administered. In human beings, interlocking intramedullary nail stabilization is an accepted treatment for open and contaminated fractures. Chronic infection of bone may be attributable to bacteria in biofilm surrounding implants, necessitating implant removal for resolution.

  7. Enhanced Lapidus arthrodesis: crossed screw technique with middle cuneiform fixation further reduces sagittal mobility.

    PubMed

    Galli, Melissa M; McAlister, Jeffrey E; Berlet, Gregory C; Hyer, Christopher F

    2015-01-01

    Persistent medial column sagittal mobility can be encountered despite successful first tarsometatarsal stabilization if fixation has been limited to the first tarsometatarsal joint. The purpose of the present cadaveric research was to quantify the effect of a third point of fixation from the base of the first metatarsal to the middle cuneiform compared with the traditional isolated first tarsometatarsal fixation. Ten matched pairs of below-the-knee specimens, with a known cause of death, sex, ethnicity, and age, height, weight, and body mass index at death, were used for our examination. Portable fluoroscopy aided with the accurate placement of all points of fixation. Measurements of movement were obtained using the validated Klaue device. The 20 matched below-the-knee specimens were from 10 cadavers (2 female and 8 male donors, aged 72.8 ± 9.3 years, body mass index 21.1 ± 4.2 kg/m(2)). The sagittal plane motion of the first ray was 7.45 ± 1.82 mm before fixation. With isolated first tarsometatarsal fixation, the sagittal motion decreased to 4.41 ± 1.51 mm and decreased further to 3.12 ± 1.06 mm, with the addition of middle cuneiform fixation. Statistically significant enhancement of the stability of sagittal first ray motion was noted with the addition of the first metatarsal to middle cuneiform pin, even after simulated Lapidus fixation. Our findings suggest that first metatarsal to middle cuneiform fixation can be beneficial if excessive sagittal motion is present after standard 2-point fixation and can play a role in the prevention of recurrence and complications. PMID:25456344

  8. Femoral taperosis: an accident waiting to happen?

    PubMed

    Wassef, A J; Schmalzried, T P

    2013-11-01

    A modular femoral head-neck junction has practical advantages in total hip replacement. Taper fretting and corrosion have so far been an infrequent cause of revision. The role of design and manufacturing variables continues to be debated. Over the past decade several changes in technology and clinical practice might result in an increase in clinically significant taper fretting and corrosion. Those factors include an increased usage of large diameter (36 mm) heads, reduced femoral neck and taper dimensions, greater variability in taper assembly with smaller incision surgery, and higher taper stresses due to increased patient weight and/or physical activity. Additional studies are needed to determine the role of taper assembly compared with design, manufacturing and other implant variables.

  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. Alternative reliable techniques in femoral torsion measurement.

    PubMed

    Delialioglu, M Onder; Tasbas, Bulent A; Bayrakci, Kenan; Daglar, Bulent; Kurt, Murat; Agar, Mustafa; Gunel, Ugur

    2006-01-01

    The clinical and conventional bi-planar determinations of femoral torsion were compared with the tomographic technique, the reliability of which was confirmed. Femoral torsions were measured with the trochanteric prominence angle test, the sinus-wave bi-planar conventional radiographic technique, the modified Hermann bi-planar conventional radiographic technique and the limited three-dimensional volumetric tomography technique in 34 femora of 17 patients. There was a strong correlation between the modified Hermann and the limited tomography techniques for 14 intact and 20 fractured femora. If limited three-dimensional volumetric tomography cannot be obtained, the modified Hermann bi-planar conventional radiographic technique must be used in patients who have scarring about the proximal femur and obesity. Otherwise use of the trochanteric prominence angle test is much more cost-effective and is as accurate as the limited three-dimensional volumetric tomography technique.

  11. Microwave sterilization of femoral head allograft.

    PubMed

    Dunsmuir, Robert A; Gallacher, Grace

    2003-10-01

    The potential shortage of allograft bone has led to the need to investigate other sources of bone for allografts. Some allograft bone donated from primary total hip arthroplasty recipients must be discarded or treated to become usable as a result of bacterial contamination. Femoral head allografts were contaminated with Staphylococcus aureus and Bacillus subtilis. A domestic microwave oven was used. The contaminated bone was exposed to microwave irradiation for different time periods. The samples were then cultured to attempt to grow the two bacterial species. The contaminated bone samples failed to grow any organisms after 2 min of exposure to microwave irradiation. This study shows that sterilization of femoral head allografts contaminated with S. aureus and B. subtilis can be achieved with microwave irradiation in a domestic microwave oven. This method of sterilization of bone allografts is cheap, easily used, and an effective way to process contaminated bone. PMID:14532216

  12. Femoral shaft stress fractures in athletes.

    PubMed

    Hershman, E B; Lombardo, J; Bergfeld, J A

    1990-01-01

    Stress fractures of the femoral shaft in athletes occur most commonly in the proximal third of the femur. They can, however, also be found in the mid- or distal third. Conservative treatment is highly successful in healing these fractures without complications. Athletes can usually return to activity in 8 to 14 weeks. Recognition of the symptoms characteristic of these fractures (vague thigh pain, diffuse tenderness, no trauma) will assist early diagnosis. Early definitive diagnosis can be made by radionuclide scanning or later, by plain radiography, if symptoms have been present for a sufficient period. Diagnosis is not limited to novice runners since runners with significant mileage, or baseball or basketball players, can develop femoral shaft stress fractures.

  13. Comparison of Femoral Neck Stress Fractures in Pediatric versus Young Adult Athletes

    PubMed Central

    Heyworth, Benton E.; Quinn, Bridget; Ehrlichman, Lauren; Bixby, Sarah; Ackerman, Kathryn; Yen, Yi-Meng; Boyle, Matthew John; Kim, Young-Jo; Millis, Michael B.

    2016-01-01

    patients (6%). More significant treatment interventions were pursued in the pediatric group (spica casting: n=2, operative screw fixation, n=4) than the adult group, all of whom demonstrated healing with activity modification, with varying degrees of weight bearing protection and medical optimization of metabolic bone health. There was no difference in the mean time to healing (13.3 weeks), or in the mean time to return to sports (Peds: 16wks, Adults: 13wks) between groups. There was a significant correlation between time to RTS and the extent of the femoral neck edema (p=0.048). Conclusion: Pediatric caregivers should be aware of femoral neck stress fractures in young athletes, an entity historically described almost exclusively in adults. Stress fractures in pediatric and adolescent patients are more likely to occur higher on the neck than adult patients, and both sexes in children may be affected to a greater degree than in adult counterparts, in whom females are affected much more commonly. Groin pain and participation in running sports are common in both groups, while multi-sport pediatric athlete patients may be more likely to be affected than in the adult population. More significant treatment interventions may be warranted in children. To avoid the catastrophic sequella of a displaced femoral neck fracture, proactive diagnostic workup and consideration of interventions such as spica casting or surgical screw fixation should be exercised given concerns related to non-compliance in this population.

  14. Application of nano composites in the fixation and processing of histological material.

    PubMed

    Burkadze, G; Kikalishvili, N; Kargareteli, V

    2015-04-01

    The pathological examination is one of the longest in the list of medical tests. Most of this time is spent on preparation of the microslide, which involves the following phases: fixation, processing, cutting and staining. Our objective was to develop optimal regime of fixation and processing (namely, 1 and 2 stage of processing) by applying Nano composites for the development of quick, cheap and qualitative protocol of material processing. 24 various types and concentration Nano composite fixation device were used in study, made by applying single-layer, surface modified carbon nanotubes in the conditions of ultrasound treatment by UP200HT device. Also was developed Nano tubular network integration method in bio-material in the conditions of ultrasound treatment, when besides Nano composite fixation devices various Nano composite reagents (namely, 0.003% and 0.005% Nano composite alcohols) were used in material processing. There were carried out 126 experiments in sum and experiments were checked through standard processing. Fixation devices produced from formalin and alcohol base showed good result of fixation - by using them in the conditions of ultrasound treatment, practically 24 times decreased the period of fixation (as a standard of fixation was applied minimal rate of ASCO/Cap guideline dated by 2008 - 6 hours). The best way was considered Nano composite fixation device of NH2 functionalization of the 0.002% concentration on alcohol base A19 (according to the fixation rate 15 minutes with ultrasound maintenance). Nano tubular network integration method enabled us to have decreased the number of alcohols of ascending concentration and delay time in them. High time efficiency factor - Tk = 47.5% (time of new processing/ standard processing time X100) and high efficiency factor of the expense of reagents - Rk = 33% (number of reagents spent at the time of new processing/number of spent reagents at the time of standard processing X100) is obtained as a result

  15. Application of nano composites in the fixation and processing of histological material.

    PubMed

    Burkadze, G; Kikalishvili, N; Kargareteli, V

    2015-04-01

    The pathological examination is one of the longest in the list of medical tests. Most of this time is spent on preparation of the microslide, which involves the following phases: fixation, processing, cutting and staining. Our objective was to develop optimal regime of fixation and processing (namely, 1 and 2 stage of processing) by applying Nano composites for the development of quick, cheap and qualitative protocol of material processing. 24 various types and concentration Nano composite fixation device were used in study, made by applying single-layer, surface modified carbon nanotubes in the conditions of ultrasound treatment by UP200HT device. Also was developed Nano tubular network integration method in bio-material in the conditions of ultrasound treatment, when besides Nano composite fixation devices various Nano composite reagents (namely, 0.003% and 0.005% Nano composite alcohols) were used in material processing. There were carried out 126 experiments in sum and experiments were checked through standard processing. Fixation devices produced from formalin and alcohol base showed good result of fixation - by using them in the conditions of ultrasound treatment, practically 24 times decreased the period of fixation (as a standard of fixation was applied minimal rate of ASCO/Cap guideline dated by 2008 - 6 hours). The best way was considered Nano composite fixation device of NH2 functionalization of the 0.002% concentration on alcohol base A19 (according to the fixation rate 15 minutes with ultrasound maintenance). Nano tubular network integration method enabled us to have decreased the number of alcohols of ascending concentration and delay time in them. High time efficiency factor - Tk = 47.5% (time of new processing/ standard processing time X100) and high efficiency factor of the expense of reagents - Rk = 33% (number of reagents spent at the time of new processing/number of spent reagents at the time of standard processing X100) is obtained as a result

  16. Evolution of the Hoffmann Fixators.

    PubMed

    Seligson, David

    2015-09-01

    Dr. Raoul Hoffmann of Geneva, Switzerland with the collaboration of Henri Jaquet developed the original Hoffmann external fixateur as a system for treating broken bones without necessarily opening a fracture site to reposition the bone ends. This system has evolved to a more flexible, modular concept with input from surgeons and engineers. In this chapter the modifications of the Hoffmann family of fixators are traced and the important steps in the development of the concept and the instrumentation emphasized. PMID:26458297

  17. Fixation strategies for retinal immunohistochemistry.

    PubMed

    Stradleigh, Tyler W; Ishida, Andrew T

    2015-09-01

    Immunohistochemical and ex vivo anatomical studies have provided many glimpses of the variety, distribution, and signaling components of vertebrate retinal neurons. The beauty of numerous images published to date, and the qualitative and quantitative information they provide, indicate that these approaches are fundamentally useful. However, obtaining these images entailed tissue handling and exposure to chemical solutions that differ from normal extracellular fluid in composition, temperature, and osmolarity. Because the differences are large enough to alter intercellular and intracellular signaling in neurons, and because retinae are susceptible to crush, shear, and fray, it is natural to wonder if immunohistochemical and anatomical methods disturb or damage the cells they are designed to examine. Tissue fixation is typically incorporated to guard against this damage and is therefore critically important to the quality and significance of the harvested data. Here, we describe mechanisms of fixation; advantages and disadvantages of using formaldehyde and glutaraldehyde as fixatives during immunohistochemistry; and modifications of widely used protocols that have recently been found to improve cell shape preservation and immunostaining patterns, especially in proximal retinal neurons. PMID:25892361

  18. Fixation Strategies For Retinal Immunohistochemistry

    PubMed Central

    Stradleigh, Tyler W.; Ishida, Andrew T.

    2015-01-01

    Immunohistochemical and ex vivo anatomical studies have provided many glimpses of the variety, distribution, and signaling components of vertebrate retinal neurons. The beauty of numerous images published to date, and the qualitative and quantitative information they provide, indicate that these approaches are fundamentally useful. However, obtaining these images entailed tissue handling and exposure to chemical solutions that differ from normal extracellular fluid in composition, temperature, and osmolarity. Because the differences are large enough to alter intercellular and intracellular signaling in neurons, and because retinae are susceptible to crush, shear, and fray, it is natural to wonder if immunohistochemical and anatomical methods disturb or damage the cells they are designed to examine. Tissue fixation is typically incorporated to guard against this damage and is therefore critically important to the quality and significance of the harvested data. Here, we describe mechanisms of fixation; advantages and disadvantages of using formaldehyde and glutaraldehyde as fixatives during immunohistochemistry; and modifications of widely used protocols that have recently been found to improve cell shape preservation and immunostaining patterns, especially in proximal retinal neurons. PMID:25892361

  19. TREATMENT OF PROXIMAL FEMORAL EPIPHYSIOLYSIS WITH SUBTROCHANTERIC OSTEOTOMY BY THE ILIZAROV METHOD

    PubMed Central

    Spinelli, Leandro de Freitas; Faccioni, Samuel; Kim, Jung Ho; Calieron, Luis Gustavo; Mendieta Rojas, Juan Carlo

    2015-01-01

    Objectives: To evaluate the treatment of severe proximal femoral epiphysiolysis through subtrochanteric osteotomy using the Ilizarov method and to propose a new method for calculating the necessary correction. Methods: A case study was carried out among patients affected by severe proximal femoral epiphysiolysis who underwent subtrochanteric osteotomy with external multiplanar fixation and were evaluated postoperatively using the modified Southwick classification. A method was developed for calculating the angular correction needed for the surgical procedure. Results: Thirteen hips were analyzed: four left hips (30.8%) and nine right hips (69.2%). The majority of the patients (61.5%) were male, with a mean age of 14 years. In relation to pain and function, the results were excellent for 30.8%, good for 46.2% and regular for 23.0%, and none of the patients presented poor results. Regarding mobility, the results were excellent for 46.2%, good for 30.8% and regular for 23.0%. Radiographically, the results were excellent for 7.7%, good for 69.2%, regular for 15.4% and poor for 7.7%. Conclusions: Percutaneous treatment of severe proximal epiphysiolysis using the Ilizarov method is a good treatment option with good indices for improvement of pain and function. The proposed calculation method can help in planning surgical procedures, with variations between calculated and measured angles of the order of 3°. PMID:27019350

  20. Prophylactic pinning for slipped capital femoral epiphysis: does it affect proximal femoral morphology?

    PubMed

    Cousins, Gerard R; Campbell, Donald M; Wilson, Neil I L; Maclean, Jamie G B

    2016-05-01

    This study was designed to determine whether prophylactic pinning of the unaffected hip in unilateral slipped capital femoral epiphysis affects the proximal femoral morphology. Twenty-four hips prophylactically pinned were compared with 26 cases observed. The articulotrochanteric distance (ATD) and the trochanteric-trochanteric distance (TTD) were measured. Postoperative radiographs were compared with final follow-up radiographs. The final TTD : ATD ratio was higher (P=0.048) in the pinned group, suggesting relative coxa vara/breva. There was a smaller difference between the two hips in the prophylactically pinned group (0.7) as opposed to those observed (1.47). Prophylactic pinning does not cause growth to stop immediately but alters the proximal femoral morphology.

  1. Treatment of Unstable Intertrochanteric Fractureswith Proximal Femoral Nail Antirotation II: Our Experience in Indian Patients§

    PubMed Central

    Kumar, G.N. Kiran; Sharma, Gaurav; Khatri, Kavin; Farooque, Kamran; Lakhotia, Devendra; Sharma, Vijay; Meena, Sanjay

    2015-01-01

    Introduction: Unstable intertrochanteric fractures are difficult to manage and the choice of implant is critical for fracture fixation. The purpose of this study was to evaluate the functional and radiological outcome of proximal femoral nail antirotationII (PFNA II) in the treatment of unstable intertrochanteric fractures. Materials and Methods: We reviewed 45 patients of unstable intertrochanteric fractures, who were treated with the PFNA II between 2011 and 2013. Of which, 3 patients were died within 6 months of follow up. Hence, 42 patients were available for the study including 26 men and 16 women. The mean age was 61 years (range, 35 -90). Clinical evaluation was done using Harris hip score. The position of the blade in the femoral head was evaluated using Cleveland zones and tip apex distance. The fracture reduction was assessed using the Garden Alignment Index and postoperative fracture gap (mm) measurement. Results: The mean follow up period was 15.3 months (range, 9-27). Excellent to good results were accounted for 78% of cases according to Harris hip score. No cases of cut out or breakage of the implant noted. Implant removal was done in 2 patients due to persistent anterior thigh pain. Conclusion: We recommend PFNA II for fixation of unstable intertrochanteric fractures with less operative time and low complication rate. However, proper operative technique is important for achieving fracture stability and to avoid major complications. PMID:27468839

  2. Surgical prevention of femoral neck fractures in elderly osteoporotic patients. A literature review

    PubMed Central

    Chiarello, Eugenio; Tedesco, Giuseppe; Cadossi, Matteo; Capra, Paola; Terrando, Silvio; Miti, Andrea; Giannini, Sandro

    2016-01-01

    Summary Fragility fractures of the femur are one of the major causes of morbidity and mortality worldwide. The incidence of new contralateral hip fractures in elderly osteoporotic patients ranges from 7 to 12% within 2 years after the first fracture. Secondary prevention can be divided in: pharmacological therapy based on the prescription of anti-osteoporotic drugs with different mechanism of action and non-pharmacological therapy which is based on modification of environmental risk factors, on a healthy diet with daily supplements of calcium and vitamin D and calcium and on the use of hip protectors. Recently a new form of prevention is becoming achievable: surgical prevention; the rationale of surgical reinforcement is the need to increase the resistance of the femoral neck to the compression and distraction forces acting on it. In this paper we analyse all the experimental and “on the market” device available for the surgical prevention of femoral neck fracture. PMID:27252744

  3. Less invasive surgery using external fixator for the treatment of subtrochanteric femur fracture in a high-risk geriatric patient.

    PubMed

    Atik, O Şahap; Can, Fatih I; Şenol, M Selçuk; Eren, Toygun K

    2016-08-01

    A 90-year-old female patient was admitted to our clinic complaining of pain in her left hip which occurred due to fall from a chair. Her medical history included memory loss and mental changes associated with Alzheimer's disease and depression. Patient's cooperation and orientation were weak. Range of motion of the left hip was restricted and painful. Radiographs of the left hip demonstrated subtrochanteric comminuted fracture of femur. Laboratory tests revealed anemia and liver insufficiency. Departments of internal medicine and anesthesiology reported high risk for surgery. Surgery was performed under spinal anesthesia on radiolucent table and in supine position. Using fluoroscopy, subtrochanteric comminuted fracture of femur was reduced. Proximally, two Schanz screws were placed through femoral neck and head in axial plane, and distally, three Schanz screws were placed through femoral shaft in coronal plane. Finally, fixation of the screws was achieved with an external fixator which was made of carbon fiber rods. Patient was allowed to sit in the bed and move around with a wheelchair as of the day of surgery. No infection or loosening of fixator occurred. PMID:27499322

  4. Femoral neck structure and function in early hominins.

    PubMed

    Ruff, Christopher B; Higgins, Ryan

    2013-04-01

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

  5. [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.

  6. A Novel Murine Model of Established Staphylococcal Bone Infection in the Presence of a Fracture Fixation Plate to Study Therapies Utilizing Antibiotic-laden Spacers after Revision Surgery

    PubMed Central

    Inzana, Jason A.; Schwarz, Edward M.; Kates, Stephen L.; Awad, Hani A.

    2014-01-01

    Mice are the small animal model of choice in biomedical research due to the low cost and availability of genetically engineered lines. However, the devices utilized in current mouse models of implant-associated bone infection have been limited to intramedullary or trans-cortical pins, which are not amenable to treatments involving extensive debridement of a full-thickness bone loss and placement of a segmental antibiotic spacer. To overcome these limitations, we developed a clinically faithful model that utilizes a locking fracture fixation plate to enable debridement of an infected segmental bone defect (full-thickness osteotomy) during a revision surgery, and investigated the therapeutic effects of placing an antibiotic-laden spacer in the segmental bone defect. To first determine the ideal time point for revision following infection, a 0.7 mm osteotomy in the femoral mid-shaft was stabilized with a radiolucent PEEK fixation plate. The defect was inoculated with bioluminescent Staphylococcus aureus, and the infection was monitored over 14 days by bioluminescent imaging (BLI). Osteolysis and reactive bone formation were assessed by X-ray and micro-computed tomography (micro-CT). The active bacterial infection peaked by 5 days post-inoculation, however the stability of the implant fixation became compromised by 10–14 days post-inoculation due to osteolysis around the screws. Thus, day 7 was defined as the ideal time point to perform the revision surgery. During the revision surgery, the infected tissue was debrided and the osteotomy was widened to 3 mm to place a poly-methyl methacrylate spacer, with or without vancomycin. Half of the groups also received systemic vancomycin for the remaining 21 days of the study. The viable bacteria remaining at the end of the study were measured using colony forming unit assays. Volumetric bone changes (osteolysis and reactive bone formation) were directly measured using micro-CT image analysis. Mice that were treated with

  7. Biodegradable nanofiber-membrane for sustainable release of lidocaine at the femoral fracture site as a periosteal block: In vitro and in vivo studies in a rabbit model.

    PubMed

    Chou, Ying-Chao; Cheng, Yi-Shiun; Hsu, Yung-Heng; Yu, Yi-Hsun; Liu, Shih-Jung

    2016-04-01

    The aim of this study was to evaluate the efficacy of a biodegradable, lidocaine-embedded, nanofibrous membrane for the sustainable analgesic release onto fragments of a segmental femoral fracture site. Membranes of three different lidocaine concentrations (10%, 30%, and 50%) were produced via an electrospinning technique. In vitro lidocaine release was assessed by high-performance liquid chromatography. A femoral segmental fracture, with intramedullary Kirschner-wire fixation and polycaprolactone stent enveloping the fracture site, was set-up in a rabbit model for in vivo assessment of post-operative recovery of activity. Eighteen rabbits were randomly assigned to three groups (six rabbits per group): group A comprised of rabbits with femoral fractures and underwent fixation; group B comprised of a comparable fracture model to that of group A with the implantation of lidocaine-loaded nanofibers; and group C, the control group, received only anesthesia. The following variables were measured: change in body weight, food and water intake before and after surgery, and total activity count post-surgery. All membranes eluted effective levels of lidocaine for more than 3 weeks post-surgery. Rabbits in group B showed faster recovery of activity post-operatively, compared with those in group A, which confirmed the pain relief efficacy of the lidocaine-embedded nanofibers. Nanofibers with sustainable lidocaine release have adequate efficacy and durability for pain relief in rabbits with segmental long bone fractures.

  8. Knee megaprosthesis: a salvage solution for severe open and complex distal femoral fracture associated with an ipsilateral brachial plexus injury (a case report with literature review).

    PubMed

    Ennaciri, Badr; Vasile, Christian; Lebredonchel, Thierry; Berrada, Mohamed Saleh; Montbarbon, Eric; Beaudouin, Emmanuel

    2015-01-01

    Complex distal femoral fractures in the young patient often occur as a result of high velocity trauma. Timely recognition and treatment is everything in such a situation, and it needs a robust staged management pathway to optimize the chance of limb preservation. We report a case of a motorcyclist admitted to the department of orthopedics at Chambery hospital, France, with a complex comminuted and open distal femoral fracture of the left leg, associated with a brachial plexus injury to the ipsilateral upper limb. On arrival to the emergency department, damage control stabilization and surgery was commenced, debridement of contaminated non-viable tissue, abundant antiseptic lavage and application of external fixation coupled with the use of antibiotic spacer. Following normalization of inflammatory markers and ensuring no clinical signs of infection, subsequent management consisted of joint reconstruction to achieve a functional knee. The external fixator and femoral spacer was removed and a modular megaprosthesis was implanted with a lateral gastrocnemius flap to cover the exposed knee joint and reinforce the extensor apparatus. Nerve graft to the left brachial plexus injury was performed at University Hospital of Grenoble. Our patient entered an intensive rehabilitation program and at 1 year follow-up achieved good knee function and sensation to the left upper limb. PMID:26421102

  9. [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.

  10. Easy method of centralized fixation of endotracheal tube in cleft lip and palate surgery.

    PubMed

    Bajaj, S P; Chavan, Navdeep; Sharma, Arun

    2012-01-01

    As we all know that fixation of endotracheal tube is very important aspect in cleft palate and maxillofacial surgery. During cleft palate and oral surgery various methods of fixation and modified tubes are deviced to make surgery safer and ergonomically better. Our method consist of 3 point fixation of tube (RAE) with dynaplast, which is freely available, cheap and good Adhesive quality. Dynaplast divided into 3 phalanges (one central and two lateral) and one portion undivided as central limb. This undivided central limb is fixed in centre of chin and other 3 phalanges wrap around tube on either side. This fixation totally takes away any lateral movements of tube. This method can be used with any tube (RAE/ Oxford/Flexometallic). Our method is described for its simplicity, ease and convinence and result which impart universally similar results with all different members of our anesthetist team.

  11. Biomechanical comparison between CentraLoc and Intrafix fixation of quadrupled semitendinosus-gracilis allografts in cadaveric tibiae with low bone mineral density.

    PubMed

    Krupp, R; Nyland, J; Smith, C; Nawab, A; Burden, R; Caborn, D N M

    2007-08-01

    Supplementary or back-up tibial tunnel fixation of a quadruple semitendinosus-gracilis (STG) graft is often performed when the knee surgeon questions the integrity of intra-tunnel fixation. Back-up fixation devices such as staples however may contribute to increased knee pain and dysfunction. Both primary extra-tunnel and intra-tunnel fixation devices may provide sufficient quadruple STG graft fixation in a tibial tunnel to preclude the need for back-up fixation. This biomechanical study compared the fixation of quadruple STG allografts in standard drilled tunnels prepared in low apparent bone mineral density (BMD) cadaveric tibiae using either an Intrafix device with primary intra-tunnel fixation in a region of predominantly cancellous trabecular bone, or a CentraLoc device with primary extra-tunnel fixation in a region of predominantly cortical bone. The study hypothesis was that the CentraLoc device would display superior fixation in these low apparent BMD cadaveric tibiae. Matched pair tibiae and quadruple STG allografts were divided into two groups of seven specimens each. Extraction drilled tunnels matched allograft diameter. Constructs were pretensioned on a servo hydraulic device between 10 and 50 N for 10 cycles and isometric pretensioned at 50 N for 1 min prior to undergoing 500 loading cycles (50-250 N) and load to failure testing (20 mm/min). The CentraLoc group displayed superior load at failure (448.4+/-171 N vs. 338.4+/-119 N, P=0.04) and survived more loading cycles (410+/-154 cycles vs. 196+/-230 cycles, P=0.04) than the Intrafix group. Most CentraLoc group specimens (6/7, 85.7%) failed by device pullout with intact quadruple STG allograft strands while all Intrafix group specimens (7/7, 100%) failed by slippage of one or more strands (P=0.005). PMID:17490882

  12. Overcoming fixation with repeated memory suppression.

    PubMed

    Angello, Genna; Storm, Benjamin C; Smith, Steven M

    2015-01-01

    Fixation (blocks to memories or ideas) can be alleviated not only by encouraging productive work towards a solution, but, as the present experiments show, by reducing counterproductive work. Two experiments examined relief from fixation in a word-fragment completion task. Blockers, orthographically similar negative primes (e.g., ANALOGY), blocked solutions to word fragments (e.g., A_L_ _GY) in both experiments. After priming, but before the fragment completion test, participants repeatedly suppressed half of the blockers using the Think/No-Think paradigm, which results in memory inhibition. Inhibiting blockers did not alleviate fixation in Experiment 1 when conscious recollection of negative primes was not encouraged on the fragment completion test. In Experiment 2, however, when participants were encouraged to remember negative primes at fragment completion, relief from fixation was observed. Repeated suppression may nullify fixation effects, and promote creative thinking, particularly when fixation is caused by conscious recollection of counterproductive information.

  13. Fixation of titanium and hydroxyapatite-coated implants in arthritic osteopenic bone.

    PubMed

    Søballe, K; Hansen, E S; Brockstedt-Rasmussen, H; Hjortdal, V E; Juhl, G I; Pedersen, C M; Hvid, I; Bünger, C

    1991-12-01

    Retrieval studies of porous-coated prostheses have demonstrated deficient bony ingrowth in high percentages. Possible reasons for this are lack of initial mechanical stability and the presence of osteopenia. The authors studied ingrowth of osteopenic bone into titanium alloy (Ti) porous-coated implants with and without hydroxyapatite (HA) coating in an experimental dog model. Unilateral osteopenia of the knee with a 20% reduced bone density as judged by computed tomography (CT) scanning (P less than .001) was induced in 12 mature dogs by weekly intraarticular injections of Carragheenin into the right knee for 12 weeks, with the left knee serving as control. Ti porous-coated cylinders were inserted in press-fit bilaterally in the lateral femoral condyles in six dogs. HA-coated titanium plugs were implanted similarly in another sex-, age-, and weight-matched group of six dogs. Bony ingrowth after 4 weeks was significantly reduced for Ti implants in osteopenic bone compared to control bone, but HA-coated implants were covered by equal amounts of bone tissue. Bone-implant shear strength of Ti implants also was reduced in osteopenic bone compared to control bone. In control bone, the anchorage of Ti implants was stronger than HA-coated implants, whereas the fixation of Ti and HA-coated implants was equal in the osteopenic bone. The results demonstrate that the bony fixation of Ti porous-coated implants is weakened by the presence of experimentally induced osteopenia. However, the fixation of HA-coated implants was not affected by the osteopenic condition in the surrounding bone. The fixation of Ti and HA-coated implants was equal in osteopenic bone, whereas the fixation of Ti porous-coated implants was superior to that of HA-coated implants in control bone. PMID:1663154

  14. Suture Button Fixation Treatment of Chronic Lisfranc Injury in Professional Dancers and High-Level Athletes.

    PubMed

    Charlton, Timothy; Boe, Chelsea; Thordarson, David B

    2015-12-01

    Chronic Lisfranc injury is a subtle and severe injury in high-level athletes, including dancers. This patient population is generally intolerant of intra-articular screw fixation and can develop significant post-traumatic arthritis with potentially career ending complications. Flexible fixation with suture-button devices provides potential restoration of physiologic motion at the joint, with appropriate support for healing that may facilitate return to en pointe activities for dancers. We hypothesized that the suture-button device would restore motion at the Lisfranc joint and allow for return to activities in this particular population without the limitations and complications of rigid fixation. We operated on seven dancers and high-level athletes with diagnosed Lisfranc injuries by installing a suture-button device. All patients had failed conservative management after late presentation. They were allowed to return to sport in 6 months, preoperative and postoperative American Orthopaedic Foot and Ankle Score (AOFAS) foot scores were obtained, and patients were followed for a minimum of 15 months. All seven returned to full activities in 6 months, with radiographic evidence of fixation and no complications to date. AOFAS foot scores improved from an average of 65 preoperatively to an average of 97 postoperatively at latest follow-up. It is concluded that flexible fixation with suture-button type device represents a viable alternative to screw fixation or fusion that may allow dancers and athletes to return to previous levels of activity after Lisfranc injury. This case series represents to our knowledge the first application of this device to a unique population that requires flexibility at the Lisfranc joint for performance.

  15. Modeling fixation locations using spatial point processes.

    PubMed

    Barthelmé, Simon; Trukenbrod, Hans; Engbert, Ralf; Wichmann, Felix

    2013-10-01

    Whenever eye movements are measured, a central part of the analysis has to do with where subjects fixate and why they fixated where they fixated. To a first approximation, a set of fixations can be viewed as a set of points in space; this implies that fixations are spatial data and that the analysis of fixation locations can be beneficially thought of as a spatial statistics problem. We argue that thinking of fixation locations as arising from point processes is a very fruitful framework for eye-movement data, helping turn qualitative questions into quantitative ones. We provide a tutorial introduction to some of the main ideas of the field of spatial statistics, focusing especially on spatial Poisson processes. We show how point processes help relate image properties to fixation locations. In particular we show how point processes naturally express the idea that image features' predictability for fixations may vary from one image to another. We review other methods of analysis used in the literature, show how they relate to point process theory, and argue that thinking in terms of point processes substantially extends the range of analyses that can be performed and clarify their interpretation.

  16. Nitrogen fixation method and apparatus

    DOEpatents

    Chen, H.L.

    1983-08-16

    A method and apparatus for achieving nitrogen fixation includes a volumetric electric discharge chamber. The volumetric discharge chamber provides an even distribution of an electron beam, and enables the chamber to be maintained at a controlled energy to pressure (E/p) ratio. An E/p ratio of from 5 to 15 kV/atm of O[sub 2]/cm promotes the formation of vibrationally excited N[sub 2]. Atomic oxygen interacts with vibrationally excited N[sub 2] at a much quicker rate than unexcited N[sub 2], greatly improving the rate at which NO is formed. 1 fig.

  17. Nitrogen fixation method and apparatus

    DOEpatents

    Chen, Hao-Lin

    1983-01-01

    A method and apparatus for achieving nitrogen fixation includes a volumetric electric discharge chamber. The volumetric discharge chamber provides an even distribution of an electron beam, and enables the chamber to be maintained at a controlled energy to pressure (E/p) ratio. An E/p ratio of from 5 to 15 kV/atm of O.sub.2 /cm promotes the formation of vibrationally excited N.sub.2. Atomic oxygen interacts with vibrationally excited N.sub.2 at a much quicker rate than unexcited N.sub.2, greatly improving the rate at which NO is formed.

  18. Eosinophilic granuloma of the capital femoral epiphysis.

    PubMed

    Goto, Takahiro; Nemoto, Tetsuo; Ogura, Koichi; Imanishi, Jungo; Hozumi, Takahiro; Funata, Nobuaki

    2011-05-01

    Eosinophilic granuloma occurs almost exclusively in the diaphysis or metaphysis, when tubular bones are affected. The investigators present an extremely rare case of eosinophilic granuloma arising at the epiphysis of the femoral head in an 8-year-old boy. Plain radiographs and computed tomography showed a well-circumscribed radiolucent lesion, suggesting chondroblastoma or Brodie's abscess. However, the findings on magnetic resonance images were different from typical features of chondroblastoma or Brodie's abscess. The lesion was curetted. Histological diagnosis was eosinophilic granuloma. Differential diagnoses of a radiolucent lesion at the epiphysis in a child should include, though quite rare, eosinophilic granuloma.

  19. Impact of intraprosthetic drilling on the strength of the femoral stem in periprosthetic fractures: A finite element investigation.

    PubMed

    Brand, Stephan; Bauer, Michael; Petri, Maximilian; Schrader, Julian; Maier, Hans J; Krettek, Christian; Hassel, Thomas

    2016-07-01

    Treatment of periprosthetic femur fractures after total hip arthroplasty remains a major challenge in orthopedic surgery. Recently, a novel surgical technique using intraprosthetic screw fixation has been suggested. The purpose of this study was to evaluate the influence of drilling the femoral hip stem on integrity and strength of the implant. The hypothesis was that intraprosthetic drilling and screw fixation would not cause the load limit of the prosthesis to be exceeded and that deformation would remain within the elastic limit. A sawbone model with a conventional straight hip stem was used and a Vancouver C periprosthetic fracture was created. The fracture was fixed with a nine-hole less invasive stabilization system plate with two screws drilled and inserted through the femoral hip stem. Three different finite element models were created using ANSYS software. The models increased in complexity including joint forces and stress risers from three different dimensions. A variation of drilling positions was analyzed. Due to the complexity of the physiological conditions in the human femur, the most complex finite element model provided the most realistic results. Overall, significant changes in the stresses to the prosthesis caused by the drilling procedure were observed. While the stresses at the site of the bore hole decreased, the load increased in the surrounding stem material. This effect is more pronounced and further the holes were apart, and it was found that increasing the number of holes could counteract this. The maximum load was still found to be in the area of the prosthesis neck. No stresses above the load limit of titanium alloy were detected. All deformations of the prosthesis stem remained in the elastic range. These results may indicate a potential role for intraprosthetic screw fixation in the future treatment of periprosthetic femur fractures. PMID:27272200

  20. REVISION TOTAL HIP ARTHROPLASTY USING A MODULAR CEMENTLESS DISTAL FIXATION PROSTHESIS: THE ZMR® HIP SYSTEM. CLINICAL AND RADIOGRAPHIC ANALYSIS OF 30 CASES

    PubMed Central

    Canella, Richard Prazeres; de Alencar, Paulo Gilberto Cimbalista; Ganev, Gerson Gandhi; de Vincenzi, Luiz Fernando

    2015-01-01

    Objective: To evaluate the clinical and radiographic results from 30 cases of revision of total hip arthroplasty using a modular cementless distal fixation prosthesis: the ZMR® Hip System. Method: Between July 2005 and December 2008, 30 operations were performed, on 14 men and 14 women. Two male patients had bilateral surgery. The mean age was 59.2 years (29-81 years), with a mean follow-up of 24 months. The Paprosky classification was used for periprosthetic bone loss, and the Harris Hip Score (HHS) was used to evaluate clinical results. On radiographs, distal migration of the femoral stem was defined in accordance with Sporer. Proximal bone remodeling was classified using the Callaghan criteria. Results: The mean preoperative HHS was 39, and there was a significant increase to 93 points in the final evaluation, which indicated excellent clinical results. No femoral stem migration greater than 5 mm (Sporer) was observed on radiographs, thus suggesting that all the femoral prostheses presented osseointegration and remained stable from the time of the surgery until the final evaluation. The proximal femoral remodeling was either type B or type C in 29 hips, according to Callaghan. Seven patients had complications, but without interfering with osseointegration of the femoral components. Conclusion: Our results from revision of total hip arthroplasty using the ZMR® Hip System were extremely encouraging, and all the components became osseointegrated and remained fixed at the time of the final evaluation. PMID:27022553

  1. An Ex Vivo Model in Human Femoral Heads for Histopathological Study and Resonance Frequency Analysis of Dental Implant Primary Stability

    PubMed Central

    Hernández-Cortés, Pedro; Galindo-Moreno, Pablo; Catena, Andrés; Ortega-Oller, Inmaculada; Salas-Pérez, José; Gómez-Sánchez, Rafael; Aguilar, Mariano; Aguilar, David

    2014-01-01

    Objective. This study was designed to explore relationships of resonance frequency analysis (RFA)—assessed implant stability (ISQ values) with bone morphometric parameters and bone quality in an ex vivo model of dental implants placed in human femoral heads and to evaluate the usefulness of this model for dental implant studies. Material and Methods. This ex vivo study included femoral heads from 17 patients undergoing surgery for femoral neck fracture due to osteoporosis (OP) (n = 7) or for total prosthesis joint replacement due to severe hip osteoarthrosis (OA) (n = 10). Sixty 4.5 × 13 mm Dentsply Astra implants were placed, followed by RFA. CD44 immunohistochemical analysis for osteocytes was also carried out. Results. As expected, the analysis yielded significant effects of femoral head type (OA versus OA) (P < 0.001), but not of the implants (P = 0.455) or of the interaction of the two factors (P = 0.848). Bonferroni post hoc comparisons showed a lower mean ISQ for implants in decalcified (50.33 ± 2.92) heads than in fresh (66.93 ± 1.10) or fixated (70.77 ± 1.32) heads (both P < 0.001). The ISQ score (fresh) was significantly higher for those in OA (73.52 ± 1.92) versus OP (67.13 ± 1.09) heads. However, mixed linear analysis showed no significant association between ISQ scores and morphologic or histomorphometric results (P > 0.5 in all cases), and no significant differences in ISQ values were found as a function of the length or area of the cortical layer (both P > 0.08). Conclusion. Although RFA-determined ISQ values are not correlated with morphometric parameters, they can discriminate bone quality (OP versus OA). This ex vivo model is useful for dental implant studies. PMID:24995307

  2. Fixation of Intertrochanteric Valgus Osteotomy with T Plate in Treatment of Developmental Coxa Vara

    PubMed Central

    Khairy, Hosam Mohamed

    2016-01-01

    Background Although the valgus subtrochanteric osteotomy is considered as a standard surgical treatment for coxa vara, there is no consensus on the optimal method of fixation and osteotomy technique. Fixation of the osteotomy has been achieved by various methods including external fixation and internal fixation with pins and cerclage and a variety of plates. The aim of this study is the evaluation of the results of developmental coxa treated by Y intertrochanteric valgus osteotomy fixed with a T-buttress plate compared with other methods of fixation in the literature. Methods Eighteen corrective valgus intertrochanteric femoral osteotomies were performed in 18 patients (18 hips) for treatment of unilateral developmental coxa vara deformity and fixed with a T plate. There were 12 males and 6 females. The right hip was affected in 10 patients and the left hip in 8 patients. Clinically, patients were evaluated by Larson hip score. Radiographically, anteroposterior view of the pelvis and frog leg lateral views of the affected hip were taken preoperatively and compared with the findings at the final follow-up. Results The average follow-up was 29 months (range, 24 to 36 months). Clinical results showed improvement of the mean Larson hip score from 57.8 to 97.0 (p < 0.001). Radiological results showed that all osteotomies were completely united in 2.4 months (range, 2 to 3 months) with the achievement of the planned correction angle. The average correction of Hilgenreiner's epiphyseal angle improved from 78.2° to 27.8° (p < 0.001) at the final follow-up. The femoral neck shaft angle was improved from 93.7° to 129.9° (p < 0.001) at the final follow-up. Shortening of the affected limb was corrected from 2.8 cm to 1.3 cm (p < 0.001) at the last follow-up. No major serious complications were recorded in the present study. Conclusions Intertrochanteric valgus osteotomy of the proximal femur fixed with a T plate may be efficient for treatment of developmental coxa vara

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

    PubMed

    Yamamoto, Noriaki; Shimakura, Taketoshi; Takahash, Hideaki

    2013-07-01

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

  4. Acetabular liner fixation by cement.

    PubMed

    Jiranek, William A

    2003-12-01

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

  5. [Spinal anesthesia using a low dose of isobaric bupivacaine in a patient with pulmonary artery hypertension and mixed obstructive and restrictive lung disease undergoing repeated femoral fracture surgery].

    PubMed

    Uzawa, Koji; Hakone, Masako; Nakazawa, Harumasa; Yasuda, Hiroyuki; Moriyama, Kiyoshi; Yorozu, Tomoko

    2014-02-01

    A 75-year-old woman with primary pulmonary hypertension was on medical therapy and ambulatory oxygen inhalation therapy for 7 years. The patient had right femoral fracture and was admitted to our hospital. She had also suffered from asthma for 2 years, and her vital capacity was 1.35 l with forced expiratory volume in 1 second 0.79 l, and with her mean pulmonary artery pressure 60 mmHg. Open reduction and internal fixation were performed under spinal anesthesia using isobaric bupivacaine 6 mg with fentanyl 10 microg, and the patient was discharged on postoperative 31 day with no major complications. One year after the surgery, she had left femoral fracture, and surgery was performed under spinal anesthesia using isobaric bupivacaine 6 mg with fentanyl 10 microg. With its minimal effects on hemodynamics, we speculate that spinal anesthesia using a low dose of isobaric bupivacaine can be a choice for patients with pulmonary hypertension. PMID:24601108

  6. In vivo bone tunnel remodeling in symptomatic patients after ACL reconstruction: a retrospective comparison of articular and extra-articular fixation

    PubMed Central

    Mathis, Dominic T.; Rasch, Helmut; Hirschmann, Michael T.

    2015-01-01

    Summary Background there is only a paucity of studies dealing with bone remodeling within the tunnels after anterior cruciate ligament (ACL) reconstruction. The objective of this study was to evaluate the influence of tendon graft type and surgical fixation technique on bone tunnel remodeling in patients with symptomatic knees after ACL reconstruction. Methods in a retrospective study 99mTc-HDP bone tracer uptake (BTU) in SPECT/CT of 57 knees with symptoms of pain and/or instability after ACL reconstruction was investigated. All 57 knees were subdivided according their anatomy (femur and tibia), fixation (articular versus extra-articular fixation) and graft types into eight groups: femoral-articular versus extra-articular fixation using bone-patellar tendon-bone (BPTB) and hamstring autografts; tibial-articular versus extra-articular fixation using patellar tendon and hamstring autografts; BTU grading for each area of the localisation scheme were recorded. Tunnel diameter and length was measured in the CT scans. Results BTU was higher for the articular fixation in the femur and for the extra-articular fixation in the tibial tunnel. Patellar tendon graft fixation showed a significantly higher BTU in the superior-lateral and posterior-central area of the tibia, meaning the areas of the tibial tunnel near the entrance into the joint. Tunnel enlargement correlated significantly with increased BTU (p<0.05). Conclusion assessment of in vivo bone tunnel remodelling in symptomatic patients after ACL reconstruction revealed different patterns of BTU with regards to graft and fixation method. PMID:26958543

  7. In vitro load measurement using an instrumented spinal fixation device.

    PubMed

    Rohlmann, A; Riley, L H; Bergmann, G; Graichen, F

    1996-09-01

    An AO spinal fixateur interne was modified to study the effects of a corpectomy on implant performance. A hermetically sealed cartridge containing strain gauges and an inductively powered telemetry unit was integrated into the threaded portion of the original implant. Five cadaveric spines were instrumented with the modified implant spanning a single lumbar vertebra. The spines were tested in axial compression, torsion, flexion, extension and lateral bending. Measurements of the three forces and moments within the implant were performed in the intact spine and repeated following a corpectomy and corpectomy plus complete posterior ligamentous injury. The bending moment, increased following corpectomy in all testing modes. The largest increase was in the flexion bending moment, which increased from 155 Nmm to 3328 Nmm following corpectomy.

  8. Awake craniotomy using electromagnetic navigation technology without rigid pin fixation.

    PubMed

    Morsy, Ahmed A; Ng, Wai Hoe

    2015-11-01

    We report our institutional experience using an electromagnetic navigation system, without rigid head fixation, for awake craniotomy patients. The StealthStation® S7 AxiEM™ navigation system (Medtronic, Inc.) was used for this technique. Detailed preoperative clinical and neuropsychological evaluations, patient education and contrast-enhanced MRI (thickness 1.5mm) were performed for each patient. The AxiEM Mobile Emitter was typically placed in a holder, which was mounted to the operating room table, and a non-invasive patient tracker was used as the patient reference device. A monitored conscious sedation technique was used in all awake craniotomy patients, and the AxiEM Navigation Pointer was used for navigation during the procedure. This offers the same accuracy as optical navigation, but without head pin fixation or interference with intraoperative neurophysiological techniques and surgical instruments. The application of the electromagnetic neuronavigation technology without rigid head fixation during an awake craniotomy is accurate, and offers superior patient comfort. It is recommended as an effective adjunctive technique for the conduct of awake surgery.

  9. Awake craniotomy using electromagnetic navigation technology without rigid pin fixation.

    PubMed

    Morsy, Ahmed A; Ng, Wai Hoe

    2015-11-01

    We report our institutional experience using an electromagnetic navigation system, without rigid head fixation, for awake craniotomy patients. The StealthStation® S7 AxiEM™ navigation system (Medtronic, Inc.) was used for this technique. Detailed preoperative clinical and neuropsychological evaluations, patient education and contrast-enhanced MRI (thickness 1.5mm) were performed for each patient. The AxiEM Mobile Emitter was typically placed in a holder, which was mounted to the operating room table, and a non-invasive patient tracker was used as the patient reference device. A monitored conscious sedation technique was used in all awake craniotomy patients, and the AxiEM Navigation Pointer was used for navigation during the procedure. This offers the same accuracy as optical navigation, but without head pin fixation or interference with intraoperative neurophysiological techniques and surgical instruments. The application of the electromagnetic neuronavigation technology without rigid head fixation during an awake craniotomy is accurate, and offers superior patient comfort. It is recommended as an effective adjunctive technique for the conduct of awake surgery. PMID:26249245

  10. Open reduction and internal fixation of proximal humerus fractures.

    PubMed

    Drosdowech, Darren S; Faber, Kenneth J; Athwal, George S

    2008-10-01

    Open reduction of proximal humeral fractures has the advantage of providing direct control over each fracture fragment and permitting anatomic reduction and fixation with advanced devices. Modern fixed-angle locking plates designed specifically for proximal humerus fractures have allowed the expansion of surgical indications permitting surgeons to address more complicated fractures. Advanced preoperative imaging and fluoroscopy allow a better understanding of fracture patterns and permit the surgeon to use this knowledge intraoperatively. Research is required to further validate fracture classification systems, to develop surgical guidelines for decision making, and to compare the outcomes of the various treatments options for proximal humerus fractures.

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

    PubMed Central

    Fukui, Kiyokazu; Kaneuji, Ayumi; Matsumoto, Tadami

    2015-01-01

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

  12. Cement augmentation of implants--no general cure in osteoporotic fracture treatment. A biomechanical study on non-displaced femoral neck fractures.

    PubMed

    Hofmann-Fliri, Ladina; Nicolino, Tomas I; Barla, Jorge; Gueorguiev, Boyko; Richards, R Geoff; Blauth, Michael; Windolf, Markus

    2016-02-01

    Femoral neck fractures in the elderly are a common problem in orthopedics. Augmentation of screw fixation with bone cement can provide better stability of implants and lower the risk of secondary displacement. This study aimed to investigate whether cement augmentation of three cannulated screws in non-displaced femoral neck fractures could increase implant fixation. A femoral neck fracture was simulated in six paired human cadaveric femora and stabilized with three 7.3 mm cannulated screws. Pairs were divided into two groups: conventional instrumentation versus additional cement augmentation of screw tips with 2 ml TraumacemV+ each. Biomechanical testing was performed by applying cyclic axial load until failure. Failure cycles, axial head displacement, screw angle changes, telescoping and screw cut-out were evaluated. Failure (15 mm actuator displacement) occurred in the augmented group at 12,500 cycles (± 2,480) compared to 15,625 cycles (± 4,215) in the non-augmented group (p = 0.041). When comparing 3 mm vertical displacement of the head no significant difference (p = 0.72) was detected between the survival curves of the two groups. At 8,500 load-cycles (early onset failure) the augmented group demonstrated a change in screw angle of 2.85° (± 0.84) compared to 1.15° (± 0.93) in the non-augmented group (p = 0.013). The results showed no biomechanical advantage with respect to secondary displacement following augmentation of three cannulated screws in a non-displaced femoral neck fracture. Consequently, the indication for cement augmentation to enhance implant anchorage in osteoporotic bone has to be considered carefully taking into account fracture type, implant selection and biomechanical surrounding. PMID:26177609

  13. Biochemical Approaches to Improved Nitrogen Fixation

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Improving symbiotic nitrogen fixation by legumes has emerged again as an important topic on the world scene due to the energy crisis and lack of access to nitrogen fertilizer in developing countries. We have taken a biochemical genomics approach to improving symbiotic nitrogen fixation in legumes. L...

  14. Infection in fracture fixation: can we influence infection rates through implant design?

    PubMed

    Moriarty, T Fintan; Schlegel, U; Perren, S; Richards, R Geoff

    2010-03-01

    Musculoskeletal infection is one of the most common complications associated with surgical fixation of bones fractured during trauma. These infections usually involve bacterial colonisation and biofilm formation on the fracture fixation device itself, as well as infection of the surrounding tissues. Antibiotic prophylaxis, wound debridement and postsurgical care can reduce the incidence of, but do not prevent, these infections. Much research and development has been focussed on ways to further reduce the incidence of infection and in the following short review we describe our experiences investigating the contribution of the basic design of fracture fixation devices on the susceptibility to infection. It has been shown in animal studies that device size, shape, mode of action and material and topography play an interrelated role in the susceptibility to infection. Although direct extrapolation from animal studies to the clinical setting is difficult, close consideration of the design factors that can reduce the incidence of infection in animal models is expected to help minimise the incidence of infection associated with any clinically implemented fracture fixation device.

  15. Microsaccades counteract visual fading during fixation.

    PubMed

    Martinez-Conde, Susana; Macknik, Stephen L; Troncoso, Xoana G; Dyar, Thomas A

    2006-01-19

    Our eyes move continually, even while we fixate our gaze on an object. If fixational eye movements are counteracted, our perception of stationary objects fades completely, due to neural adaptation. Some studies have suggested that fixational microsaccades refresh retinal images, thereby preventing adaptation and fading. However, other studies disagree, and so the role of microsaccades remains unclear. Here, we correlate visibility during fixation to the occurrence of microsaccades. We asked subjects to indicate when Troxler fading of a peripheral target occurs, while simultaneously recording their eye movements with high precision. We found that before a fading period, the probability, rate, and magnitude of microsaccades decreased. Before transitions toward visibility, the probability, rate, and magnitude of microsaccades increased. These results reveal a direct link between suppression of microsaccades and fading and suggest a causal relationship between microsaccade production and target visibility during fixation.

  16. Staged Columnar Fixation of Bicondylar Tibial Plateaus: A Cheaper Alternative to External Fixation.

    PubMed

    Perdue, Aaron; Greenberg, Sarah E; Sathiyakumar, Vasanth; Thakore, Rachel V; Mir, Hassan R; Obremskey, William T; Sethi, Manish K

    2016-01-01

    The objective of this study was to compare complication rates and costs of staged columnar fixation (SCF) to external fixation for bicondylar tibial plateau fractures. Patients who received SCF or temporary external fixation across a 3-year period at a major level I trauma center underwent a retrospective chart review for associated complications. Fisher's exact analysis was used to determine any statistical difference in complication rates between both groups. However, there was no significant difference in complication rates between the SCF and external fixator groups. Average medial plate costs for SCF were $2131 compared with an average external fixator cost of $4070 (p < .0001). Given that all patients with external fixation undergo eventual medial and lateral plating, savings with SCF include $4070 plus operative costs for removing the fixator. As our health care system focuses on cost-cutting efforts, orthopaedic trauma surgeons must explore cheaper and equally effective treatment alternatives. PMID:27082883

  17. Eighth international congress on nitrogen fixation. Final program

    SciTech Connect

    Not Available

    1990-12-31

    This volume contains the proceedings of the Eighth International Congress on Nitrogen Fixation held May 20--26, 1990 in Knoxville, Tennessee. The volume contains abstracts of individual presentations. Sessions were entitled Recent Advances in the Chemistry of Nitrogen Fixation, Plant-microbe Interactions, Limiting Factors of Nitrogen Fixation, Nitrogen Fixation and the Environment, Bacterial Systems, Nitrogen Fixation in Agriculture and Industry, Plant Function, and Nitrogen Fixation and Evolution.

  18. Validation of a femoral critical size defect model for orthotopic evaluation of bone healing: a biomechanical, veterinary and trauma surgical perspective.

    PubMed

    Drosse, Inga; Volkmer, Elias; Seitz, Sebastian; Seitz, Hermann; Penzkofer, Rainer; Zahn, Klaus; Matis, Ulrike; Mutschler, Wolf; Augat, Peter; Schieker, Matthias

    2008-03-01

    Numerous in vivo studies have been conducted to investigate bone regeneration in orthotopic defect models, but a reliably standardized critical-size defect (CSD) model in small animals is still lacking in tissue-engineering research. Utilizing the expertise of trauma surgeons, veterinary surgeons, and engineers, we evaluated the optimal fixation strategy for in vivo application in terms of surgical suitability and conducted biomechanical studies for 3 fixation devices. Fixation strategies were an external fixation device made of polymethylmethacrylate, widely used in animal care; a self-constructed external clamp-fixation device, designed and manufactured using rapid prototyping techniques; and commercially available 1.2-mm titanium plates used in hand surgery. The CSD was 6 mm in size. Biomechanical testing included compression, 4-point bending, and torsion tests. The surgical procedure was optimized in vitro and validated in a clinical setting in athymic rats in vivo. Despite differences in the results of the biomechanical tests, all fixation devices tested proved suitable for the intended purpose. In conclusion, the evaluated model for stabilizing a CSD in a rat's femur can reliably be used for standardized bone regeneration studies in small animals.

  19. Complement fixation by rheumatoid factor.

    PubMed Central

    Tanimoto, K; Cooper, N R; Johnson, J S; Vaughan, J H

    1975-01-01

    The capacity for fixation and activation of hemolytic complement by polyclonal IgM rheumatoid factors (RF) isolated from sera of patients with rheumatoid arthritis and monoclonal IgM-RF isolated from the cryoprecipitates of patients with IgM-IgG mixed cryoglobulinemia was examined. RF mixed with aggregated, reduced, and alkylated human IgG (Agg-R/A-IgG) in the fluid phase failed to significantly reduce the level of total hemolytic complement, CH50, or of individual complement components, C1, C2, C3, and C5. However, sheep erythrocytes (SRC) coated with Agg-R/A-IgG or with reduced and alkylated rabbit IgG anti-SRC antibody were hemolyzed by complement in the presence of polyclonal IgM-RF. Human and guinea pig complement worked equally well. The degree of hemolysis was in direct proportion to the hemagglutination titer of the RF against the same coated cells. Monoclonal IgM-RF, normal human IgM, and purified Waldenström macroglobulins without antiglobulin activity were all inert. Hemolysis of coated SRC by RF and complement was inhibited by prior treatment of the complement source with chelating agents, hydrazine, cobra venom factor, specific antisera to C1q, CR, C5, C6, or C8, or by heating at 56 degrees C for 30 min. Purified radiolabeled C4, C3, and C8 included in the complement source were bound to hemolysed SRC in direct proportion to the degree of hemolysis. These data indicate that polyclonal IgM-RF fix and activate complement via the classic pathway. The system described for assessing complement fixation by isolated RF is readily adaptable to use with whole human serum. PMID:1078825

  20. Dinitrogen fixation in aphotic oxygenated marine environments

    PubMed Central

    Rahav, Eyal; Bar-Zeev, Edo; Ohayon, Sarah; Elifantz, Hila; Belkin, Natalia; Herut, Barak; Mulholland, Margaret R.; Berman-Frank, Ilana

    2013-01-01

    We measured N2 fixation rates from oceanic zones that have traditionally been ignored as sources of biological N2 fixation; the aphotic, fully oxygenated, nitrate (NO−3)-rich, waters of the oligotrophic Levantine Basin (LB) and the Gulf of Aqaba (GA). N2 fixation rates measured from pelagic aphotic waters to depths up to 720 m, during the mixed and stratified periods, ranged from 0.01 nmol N L−1 d−1 to 0.38 nmol N L−1 d−1. N2 fixation rates correlated significantly with bacterial productivity and heterotrophic diazotrophs were identified from aphotic as well as photic depths. Dissolved free amino acid amendments to whole water from the GA enhanced bacterial productivity by 2–3.5 fold and N2 fixation rates by ~2-fold in samples collected from aphotic depths while in amendments to water from photic depths bacterial productivity increased 2–6 fold while N2 fixation rates increased by a factor of 2 to 4 illustrating that both BP and heterotrophic N2 fixation were carbon limited. Experimental manipulations of aphotic waters from the LB demonstrated a significant positive correlation between transparent exopolymeric particle (TEP) concentrations and N2 fixation rates. This suggests that sinking organic material and high carbon (C): nitrogen (N) micro-environments (such as TEP-based aggregates or marine snow) could support high heterotrophic N2 fixation rates in oxygenated surface waters and in the aphotic zones. Indeed, our calculations show that aphotic N2 fixation accounted for 37 to 75% of the total daily integrated N2 fixation rates at both locations in the Mediterranean and Red Seas with rates equal or greater to those measured from the photic layers. Moreover, our results indicate that that while N2 fixation may be limited in the surface waters, aphotic, pelagic N2 fixation may contribute significantly to new N inputs in other oligotrophic basins, yet it is currently not included in regional or global N budgets. PMID:23986748

  1. Determinants of femoral geometry and structure during adolescent growth.

    PubMed

    van der Meulen, M C; Ashford, M W; Kiratli, B J; Bachrach, L K; Carter, D R

    1996-01-01

    Our goal was to understand developmental determinants of femoral structure during growth and sexual maturation by relating femoral measurements to gender and developmental factors (age, pubertal stage, height, and body mass). The bone mineral content of the femur was measured by dual energy x-ray absorptiometry in 101 healthy Caucasian adolescents and young adults, 9-26 years of age. After some simplifying assumptions had been made, cross-sectional geometric properties of the femoral midshaft were estimated. Two geometry-based structural indicators, the section modulus and whole bone strength index, were calculated to assess the structural characteristics of the femur. Femoral strength, as described by these structural indicators, increased dramatically from childhood through young adulthood. Regressions were performed between these femoral measurements and the developmental factors. Our data show that of age, pubertal stage, body mass, and height, body mass is the strongest predictor of femoral cross-sectional properties, and the correlation of body mass with femoral cross-sectional structure is independent of gender. A model including all four developmental factors and gender did not substantially increase the accuracy of predictions compared with the model with body mass alone. In light of previous research, we hypothesize that body mass is an indicator of in vivo loading and that this in vivo loading influences the cross-sectional growth of the long bones.

  2. 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

  3. Ultrastructure and X-ray microanalysis of epiphyseal growth cartilage of femoral head processed by rapid-freezing and freeze-substitution.

    PubMed

    Sumii, H; Inoue, H

    1993-04-01

    Epiphyseal growth cartilage of the femoral head obtained from Wistar rats was investigated after fixation by a rapid-freezing and freeze-substitution. Liquid helium was used in order to achieve a fast cooling rate without ice-crystal damage during the rapid freezing. Use of the rapid-freezing and freeze-substitution procedure provided better ultrastructural preservation of the chondrocyte than conventional chemical fixation methods. This procedure allowed a more reliable approach to electron probe analysis. X-ray microanalysis of the specimens confirmed that calcium is not detected in the initial matrix vesicles as a result of the freezing process. The results suggest that calcium release from precipitates occurs in the free state without any detectable formation of hydroxyapatite at the initial stage of calcification and that calcium is not tightly bound to the matrix vesicles.

  4. Salient in space, salient in time: Fixation probability predicts fixation duration during natural scene viewing.

    PubMed

    Einhäuser, Wolfgang; Nuthmann, Antje

    2016-09-01

    During natural scene viewing, humans typically attend and fixate selected locations for about 200-400 ms. Two variables characterize such "overt" attention: the probability of a location being fixated, and the fixation's duration. Both variables have been widely researched, but little is known about their relation. We use a two-step approach to investigate the relation between fixation probability and duration. In the first step, we use a large corpus of fixation data. We demonstrate that fixation probability (empirical salience) predicts fixation duration across different observers and tasks. Linear mixed-effects modeling shows that this relation is explained neither by joint dependencies on simple image features (luminance, contrast, edge density) nor by spatial biases (central bias). In the second step, we experimentally manipulate some of these features. We find that fixation probability from the corpus data still predicts fixation duration for this new set of experimental data. This holds even if stimuli are deprived of low-level images features, as long as higher level scene structure remains intact. Together, this shows a robust relation between fixation duration and probability, which does not depend on simple image features. Moreover, the study exemplifies the combination of empirical research on a large corpus of data with targeted experimental manipulations. PMID:27627736

  5. Immaturity of Visual Fixations in Dyslexic Children.

    PubMed

    Tiadi, Aimé; Gérard, Christophe-Loïc; Peyre, Hugo; Bui-Quoc, Emmanuel; Bucci, Maria Pia

    2016-01-01

    To our knowledge, behavioral studies recording visual fixations abilities in dyslexic children are scarce. The object of this article is to explore further the visual fixation ability in dyslexics compared to chronological age-matched and reading age-matched non-dyslexic children. Fifty-five dyslexic children from 7 to 14 years old, 55 chronological age-matched non-dyslexic children and 55 reading age-matched non-dyslexic children participated to this study. Eye movements from both eyes were recorded horizontally and vertically by a video-oculography system (EyeBrain(®) T2). The fixation task consisted in fixating a white-filled circle appearing in the center of the screen for 30 s. Results showed that dyslexic children produced a significantly higher number of unwanted saccades than both groups of non-dyslexic children. Moreover, the number of unwanted saccades significantly decreased with age in both groups of non-dyslexic children, but not in dyslexics. Furthermore, dyslexics made more saccades during the last 15 s of fixation period with respect to both groups of non-dyslexic children. Such poor visual fixation capability in dyslexic children could be due to impaired attention abilities, as well as to an immaturity of the cortical areas controlling the fixation system.

  6. Immaturity of Visual Fixations in Dyslexic Children

    PubMed Central

    Tiadi, Aimé; Gérard, Christophe-Loïc; Peyre, Hugo; Bui-Quoc, Emmanuel; Bucci, Maria Pia

    2016-01-01

    To our knowledge, behavioral studies recording visual fixations abilities in dyslexic children are scarce. The object of this article is to explore further the visual fixation ability in dyslexics compared to chronological age-matched and reading age-matched non-dyslexic children. Fifty-five dyslexic children from 7 to 14 years old, 55 chronological age-matched non-dyslexic children and 55 reading age-matched non-dyslexic children participated to this study. Eye movements from both eyes were recorded horizontally and vertically by a video-oculography system (EyeBrain® T2). The fixation task consisted in fixating a white-filled circle appearing in the center of the screen for 30 s. Results showed that dyslexic children produced a significantly higher number of unwanted saccades than both groups of non-dyslexic children. Moreover, the number of unwanted saccades significantly decreased with age in both groups of non-dyslexic children, but not in dyslexics. Furthermore, dyslexics made more saccades during the last 15 s of fixation period with respect to both groups of non-dyslexic children. Such poor visual fixation capability in dyslexic children could be due to impaired attention abilities, as well as to an immaturity of the cortical areas controlling the fixation system. PMID:26924975

  7. Kennedy Space Center Fixation Tube (KFT)

    NASA Technical Reports Server (NTRS)

    Richards, Stephanie E.; Levine, Howard G.; Romero, Vergel

    2016-01-01

    Experiments performed on the International Space Station (ISS) frequently require the experimental organisms to be preserved until they can be returned to earth for analysis in the appropriate laboratory facility. The Kennedy Fixation Tube (KFT) was developed to allow astronauts to apply fixative, chemical compounds that are often toxic, to biological samples without the use of a glovebox while maintaining three levels of containment (Fig. 1). KFTs have been used over 200 times on-orbit with no leaks of chemical fixative. The KFT is composed of the following elements: a polycarbonate main tube where the fixative is loaded preflight, the sample tube where the plant or other biological specimens is placed during operations, the expansion plug, actuator, and base plug that provides fixative containment (Fig. 2). The main tube is pre-filled with 25 mL of fixative solution prior to flight. When actuated, the specimen contained within the sample tube is immersed with approximately 22 mL (+/- 2 mL) of the fixative solution. The KFT has been demonstrated to maintain its containment at ambient temperatures, 4degC refrigeration and -100 C freezing conditions.

  8. 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.

  9. 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

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

    PubMed Central

    Lee, Ju Hong

    2015-01-01

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

  11. Fixational eye movements in amblyopia and strabismus.

    PubMed

    Ciuffreda, K J; Kenyon, R V; Stark, L

    1979-11-01

    Horizontal eye position was monitored using a photoelectric method during monocular and binocular fixation in four patients having amblyopia without strabismus, thirteen patients having constant strabismus with amblyopia, and five patients having intermittent strabismus. Four abnormalities of fixation were found: increased drift, saccadic intrusions, manifest nystagmus, and latent nystagmus. Increased drift was related to the presence of amblyopia, while saccadic intrusions and nystagmus were related to the presence of strabismus. Understanding dynamic aspects of oculomotor control can provide insight into clinical assessment of fixation in amblyopia and strabismus.

  12. Distal Humerus Fractures: Open Reduction Internal Fixation.

    PubMed

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

    2015-11-01

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

  13. Modified arthroscopic suture fixation of a displaced tibial eminence fracture.

    PubMed

    Lehman, Ronald A; Murphy, Kevin P; Machen, M Shaun; Kuklo, Timothy R

    2003-02-01

    This study describes a new arthroscopic method using a whip-stitch technique for treating a displaced type III tibial eminence fracture. A 12-year-old girl who sustained a displaced type III tibial eminence fracture was treated with arthroscopic fixation using the Arthrosew disposable suture device (Surgical Dynamics, Norwalk, CT) to place a whip stitch into the anterior cruciate ligament (ACL). The Arthrex ACL guide (Arthrex, Naples, FL) was used to reduce the avulsed tibial spine fragment. Sutures were then passed through the tibial tunnel and secured over a bony bridge with the knee in 20 degrees of flexion. At 9 months, the patient has a full range of motion with normal Lachman and anterior drawer testing, and she has returned to competitive basketball. Radiographs show complete fracture healing. KT-1000 and isokinetic testing at 9-month follow-up show only minimal side-to-side differences. The Arthrosew device provides a significant advantage in the treatment of type III and IV fractures of the tibial eminence by obtaining arthroscopic fixation within the substance of the ACL, thus obviating arthrotomy and hardware placement. This technique also restores the proper length and tension to the ACL, and provides a simplified, reproducible method of treatment for this injury.

  14. Modeling and simulation of physical performance of a external unilateral mechatronic orthopaedic fixator - bone system.

    PubMed

    Lesniewska, A; Choromanski, W; Deszczynski, J; Dobrzynski, G

    2006-01-01

    Restricted element study of the fracture healing by external fixation device was investigated. The analyses were performed under an axial and variable loaded boundary conditions. The effect of different fracture size and different distance between bone and the external fixator device on the stress distribution was investigated. The results show that stresses in the external fixator device are highest at the beginning of the fracture healing process, and are gradually decreasing with the time of the treatment. The analyses were carried out using the commercial package CATIA P3 V5R11. This allowed to build a three-dimensional model more similar to the geometrical architecture of the long bone as well as of the external fixator. Three-dimensional restricted element model also allowed a collection of more realistic results. However, the accuracy of the results depends not only on the quality of the model geometry but also on the material properties assigned to the model components. It also depends on the accuracy in the simulation of the finite element model and the optimized mesh generation.

  15. Neural correlates of fixation duration in natural reading: Evidence from fixation-related fMRI.

    PubMed

    Henderson, John M; Choi, Wonil; Luke, Steven G; Desai, Rutvik H

    2015-10-01

    A key assumption of current theories of natural reading is that fixation duration reflects underlying attentional, language, and cognitive processes associated with text comprehension. The neurocognitive correlates of this relationship are currently unknown. To investigate this relationship, we compared neural activation associated with fixation duration in passage reading and a pseudo-reading control condition. The results showed that fixation duration was associated with activation in oculomotor and language areas during text reading. Fixation duration during pseudo-reading, on the other hand, showed greater involvement of frontal control regions, suggesting flexibility and task dependency of the eye movement network. Consistent with current models, these results provide support for the hypothesis that fixation duration in reading reflects attentional engagement and language processing. The results also demonstrate that fixation-related fMRI provides a method for investigating the neurocognitive bases of natural reading.

  16. Neural correlates of fixation duration in natural reading: Evidence from fixation-related fMRI.

    PubMed

    Henderson, John M; Choi, Wonil; Luke, Steven G; Desai, Rutvik H

    2015-10-01

    A key assumption of current theories of natural reading is that fixation duration reflects underlying attentional, language, and cognitive processes associated with text comprehension. The neurocognitive correlates of this relationship are currently unknown. To investigate this relationship, we compared neural activation associated with fixation duration in passage reading and a pseudo-reading control condition. The results showed that fixation duration was associated with activation in oculomotor and language areas during text reading. Fixation duration during pseudo-reading, on the other hand, showed greater involvement of frontal control regions, suggesting flexibility and task dependency of the eye movement network. Consistent with current models, these results provide support for the hypothesis that fixation duration in reading reflects attentional engagement and language processing. The results also demonstrate that fixation-related fMRI provides a method for investigating the neurocognitive bases of natural reading. PMID:26151101

  17. Greater Trochanteric Fixation Using a Cable System for Partial Hip Arthroplasty: A Clinical and Finite Element Analysis

    PubMed Central

    Ozan, Fırat; Koyuncu, Şemmi; Pekedis, Mahmut; Altay, Taşkın; Yıldız, Hasan; Toker, Gökhan

    2014-01-01

    The aim of the study was to investigate the efficacy of greater trochanteric fixation using a multifilament cable to ensure abductor lever arm continuity in patients with a proximal femoral fracture undergoing partial hip arthroplasty. Mean age of the patients (12 men, 20 women) was 84.12 years. Mean follow-up was 13.06 months. Fixation of the dislocated greater trochanter with or without a cable following load application was assessed by finite element analysis (FEA). Radiological evaluation was based on the distance between the fracture and the union site. Harris hip score was used to evaluate final results: outcomes were excellent in 7 patients (21.8%), good in 17 patients (53.1%), average in 5 patients (15.6%), and poor in 1 patient (9.3%). Mean abduction angle was 20.21°. Union was achieved in 14 patients (43.7%), fibrous union in 12 (37.5%), and no union in 6 (18.7%). FEA showed that the maximum total displacement of the greater trochanter decreased when the fractured bone was fixed with a cable. As the force applied to the cable increased, the displacement of the fractured trochanter decreased. This technique ensures continuity of the abductor lever arm in patients with a proximal femoral fracture who are undergoing partial hip arthroplasty surgery. PMID:25177703

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

    PubMed

    Hohmann, Erik

    2016-01-01

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

  19. Ocular Fixation Abnormality in Patients with Autism Spectrum Disorder

    ERIC Educational Resources Information Center

    Shirama, Aya; Kanai, Chieko; Kato, Nobumasa; Kashino, Makio

    2016-01-01

    We examined the factors that influence ocular fixation control in adults with autism spectrum disorder (ASD) including sensory information, individuals' motor characteristics, and inhibitory control. The ASD group showed difficulty in maintaining fixation especially when there was no fixation target. The fixational eye movement characteristics of…

  20. External Fixation of Open Humerus Factures

    PubMed Central

    Marsh, JL; Mahoney, Craig R; Steinbronn, Dave

    1999-01-01

    Fifteen patients with open shaft of humerus fractures were treated with a monolateral external fixator. Nine patients presented with nerve palsies. Two radial nerves were disrupted and required grafting. Of the seven others, six spontaneously recovered and one brachial plexus partially improved. All fractures healed. The average duration of external fixation was 21 weeks. Four patients required additional procedures prior to healing (external fixator reapplication - 2, plating and bone grafting - 2). Two of these four experienced breakage of 4.5 mm external fixation pins. Eight patients developed pin tract infections, which all resolved with local care and antibiotics. Thirteen patients were contacted at an average of 63 months after injury. Eleven reported they were satisfied with their result, nine had no functional limits, and eight reported no pain. PMID:10847515

  1. Bicondylar tibial fractures: Internal or external fixation?

    PubMed

    Kumar, Gunasekaran; Peterson, Nicholas; Narayan, Badri

    2011-03-01

    Bicondylar fractures of the tibia, representing the Schatzker V and VI fractures represent a challenging problem. Any treatment protocol should aim at restoring articular congruity and the metaphyseo-diaphsyeal dissociation (MDD)-both of these are equally important to long-term outcome. Both internal and external fixations have their proponents, and each method of treatment is associated with its unique features and complications. We review the initial and definitive management of these injuries, and the advantages and disadvantages of each method of definitive fixation. We suggest the use of a protocol for definitive management, using either internal or external fixation as deemed appropriate. This protocol is based on the fracture configuration, local soft tissue status and patient condition. In a nutshell, if the fracture pattern and soft tissue status are amenable plate fixation (single or double) is performed, otherwise limited open reduction and articular surface reconstruction with screws and circular frame is performed. PMID:21430865

  2. Protein detection in gels without fixation.

    PubMed

    Joo, Won-A; Speicher, David W

    2007-05-01

    A number of alternative methods are described for detecting proteins in polyacrylamide gels that do not require fixation of the protein either prior to staining or in conjunction with staining. The primary advantage of avoiding fixation is that this makes it easier to remove proteins of interest from the gels for subsequent analysis. In general, the sensitivity of protein detection methods that avoid fixation is lower than for detection methods using fixation. For any given method, sensitivity is dependent on the volume of the protein band within the gel; hence, sensitivity is highest for sharp, narrow bands. Techniques described in this unit include protocols for protein detection in gels by SDS precipitation, preparation of contact blots, staining with imidazole-zinc, and use of the fluorescent labels IAEDANS and fluorescamine. Several additional methods, including the use of tryptophan fluorescence, guide strips, and minimal protein staining, are discussed in the Commentary.

  3. Periprosthetic fracture fixation in osteoporotic bone.

    PubMed

    Lenz, Mark; Lehmann, Wolfgang; Wähnert, Dirk

    2016-06-01

    Fixation techniques of periprosthetic fractures are far from ideal although the number of this entity is rising. The presence of an intramedullary implant generates its own fracture characteristics since stiffness is altered along the bone shaft and certain implant combinations affect load resistance of the bone. Influencing factors are cement fixation of the implant, intramedullary locking and extramedullary or intramedullary localization of the implant and the cortical thickness of the surrounding bone. Cerclage wires are ideally suited to fix radially displaced fragments around an intramedullary implant but they are susceptible to axial and torsional load. Screws should be added if these forces have to be neutralized. Stability of the screw fixation itself can be enhanced by embracement configuration around the intramedullary implant. Poor bone stock quality, often being present in metaphyseal areas limits screw fixation. Cement augmentation is an attractive option in this field to enhance screw purchase. PMID:27338227

  4. Femoral Placement of Totally Implantable Venous Access Ports in Patients with Bilateral Breast Cancer

    PubMed Central

    Almasi-Sperling, V.; Hieber, S.; Lermann, J.; Strahl, O.; Beckmann, M. W.; Lang, W.; Sagban, T. A.

    2016-01-01

    Purpose: Aim of this study was to determine the rate of complications following femoral placement of totally implantable venous access ports (f-TIVAP) in women with bilateral breast cancer, with a special focus on long-term function, deep vein thrombosis (DVT), and port infection. Methods: 73 patients with bilateral breast cancer treated between October 2000 and January 2013 with placement of an f-TIVAP using a transfemoral approach were retrospectively reviewed. All patients were followed up, and all complications of f-TIVAP were recorded. Results: The median age was 62.5 years (range: 35–86 years). Four patients received f-TIVAP under local anesthesia, and 69 underwent placement under general anesthesia. Mean follow-up was 33.7 months (SD 25.9; range: 0.2–93.5 months). Complications over the entire period of observation included infections in 21 %, DVT in 19 % and catheter occlusion in 12 %. Patients receiving chemotherapy who developed leukopenia were more likely to experience DVT at the access site (p = 0.037). There was a trend towards a higher infection rate when the device was used more often (p = 0.084). Conclusion: Although the rates of complications in the longer term, especially device infections and DVTs, appeared to be relatively high, TIVAP implantation using femoral vein access is recommended in patients with bilateral breast cancer not suitable for cephalic vein cut-down. PMID:26855441

  5. Methanotrophy Induces Nitrogen Fixation in Boreal Mosses

    NASA Astrophysics Data System (ADS)

    Tiirola, M. A.

    2014-12-01

    Many methanotrophic bacterial groups fix nitrogen in laboratory conditions. Furthermore, nitrogen (N) is a limiting nutrient in many environments where methane concentrations are highest. Despite these facts, methane-induced N fixation has previously been overlooked, possibly due to methodological problems. To study the possible link between methanotrophy and diazotrophy in terrestrial and aquatic habitats, we measured the co-occurrence of these two processes in boreal forest, peatland and stream mosses using a stable isotope labeling approach (15 N2 and 13 CH4 double labeling) and sequencing of the nifH gene marker. N fixation associated with forest mosses was dependent on the annual N deposition, whereas methane stimulate N fixation neither in high (>3 kg N ha -1 yr -1) nor low deposition areas, which was in accordance with the nifH gene sequencing showing that forest mosses (Pleurozium schreberi and Hylocomium splendens ) carried mainly cyanobacterial N fixers. On the other extreme, in stream mosses (Fontinalis sp.) methane was actively oxidized throughout the year, whereas N fixation showed seasonal fluctuation. The co-occurrence of the two processes in single cell level was proven by co-localizing both N and methane-carbon fixation with the secondary ion mass spectrometry (SIMS) approach. Methanotrophy and diazotrophy was also studied in peatlands of different primary successional stages in the land-uplift coast of Bothnian Bay, in the Siikajoki chronosequence, where N accumulation rates in peat profiles indicate significant N fixation. Based on experimental evidence it was counted that methane-induced N fixation explained over one-third of the new N input in the younger peatland successional stages, where the highest N fixation rates and highest methane oxidation activities co-occurred in the water-submerged Sphagnum moss vegetation. The linkage between methanotrophic carbon cycling and N fixation may therefore constitute an important mechanism in the rapid

  6. Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty: A retrospective study.

    PubMed

    Zhang, Zhendong; Zhuo, Qi; Chai, Wei; Ni, Ming; Li, Heng; Chen, Jiying

    2016-08-01

    Periprosthetic femoral fracture (PFF) is a complicated complication of both primary and revision hip arthroplasty with an increasing incidence. The present study aimed to summarize the clinical characteristics and identify the risk factors for PFF which would be potentially helpful in the prevention and treatment of PFF.We retrospectively analyzed the clinical data of 89 cases of PFF, and a case-control study was designed to identify the potential risk for intraoperative and postoperative PFF in both primary and revision hip arthroplasty.The overall incidence of PFF was 2.08% (intraoperative: 1.77%, postoperative: 0.30%, revision: 13.60%, and primary: 0.97%). The most commonly used treatment strategy was fixation with cerclage wire or band for intraoperative PFF, whereas long stem revision with plate or cortical allograft strut fixation was the main treatment strategy for postoperative PFF. The risk factors for intraoperative PFF in primary total hip arthroplasty (THA) included the diagnosis of development dysplasia of the hip (DDH) (odds ratio [OR] = 5.01, 95%CI, 1.218-20.563, P=0.03) and CBR ≥ 0.49 (OR = 3.34, 95%CI, 1.138-9.784, P = 0.03). The increased age was associated with increased incidence of postoperative PFF in primary THA (OR = 1.09, 95%CI, 1.001-1.194, P = 0.04). As for the intraoperative PFF in revision THA, we found that receiving multiple operations before revision (OR = 2.45, 95%CI, 1.06-5.66, P = 0.04), revisions due to prosthetic joint infection (OR = 6.72, 95%CI, 1.007-44.832, P = 0.04), the presence of cementless implant before revision (OR = 13.54, 95%CI, 3.103-59.08, P = 0.001), and femoral deformity (OR = 8.03, 95%CI, 1.656-38.966, P = 0.01) were all risk factors.Screening for high-risk patients, preoperative templating, and detailed discharge instructions may be the potential strategies to reduce the incidence of PFF. The treatment of PFFs should take into account Vancouver

  7. Clinical characteristics and risk factors of periprosthetic femoral fractures associated with hip arthroplasty

    PubMed Central

    Zhang, Zhendong; Zhuo, Qi; Chai, Wei; Ni, Ming; Li, Heng; Chen, Jiying

    2016-01-01

    Abstract Periprosthetic femoral fracture (PFF) is a complicated complication of both primary and revision hip arthroplasty with an increasing incidence. The present study aimed to summarize the clinical characteristics and identify the risk factors for PFF which would be potentially helpful in the prevention and treatment of PFF. We retrospectively analyzed the clinical data of 89 cases of PFF, and a case–control study was designed to identify the potential risk for intraoperative and postoperative PFF in both primary and revision hip arthroplasty. The overall incidence of PFF was 2.08% (intraoperative: 1.77%, postoperative: 0.30%, revision: 13.60%, and primary: 0.97%). The most commonly used treatment strategy was fixation with cerclage wire or band for intraoperative PFF, whereas long stem revision with plate or cortical allograft strut fixation was the main treatment strategy for postoperative PFF. The risk factors for intraoperative PFF in primary total hip arthroplasty (THA) included the diagnosis of development dysplasia of the hip (DDH) (odds ratio [OR] = 5.01, 95%CI, 1.218–20.563, P=0.03) and CBR ≥ 0.49 (OR = 3.34, 95%CI, 1.138–9.784, P = 0.03). The increased age was associated with increased incidence of postoperative PFF in primary THA (OR = 1.09, 95%CI, 1.001–1.194, P = 0.04). As for the intraoperative PFF in revision THA, we found that receiving multiple operations before revision (OR = 2.45, 95%CI, 1.06–5.66, P = 0.04), revisions due to prosthetic joint infection (OR = 6.72, 95%CI, 1.007–44.832, P = 0.04), the presence of cementless implant before revision (OR = 13.54, 95%CI, 3.103–59.08, P = 0.001), and femoral deformity (OR = 8.03, 95%CI, 1.656–38.966, P = 0.01) were all risk factors. Screening for high-risk patients, preoperative templating, and detailed discharge instructions may be the potential strategies to reduce the incidence of PFF. The treatment of PFFs should take

  8. Brodie's abscess of the femoral neck simulating osteoid osteoma.

    PubMed

    Gulati, Yash; Maheshwari, Aditya V

    2007-10-01

    Subacute osteomyelitis (Brodie's abscess) is essentially a problem of diagnosis, and there may be considerable difficulty in distinguishing it from other benign and malignant bone lesions. Though reported in the metaphyseal region of the femur, Brodie's abscess is rarer in the femoral neck. The authors present a case of Brodie's abscess in the femoral neck, which clinico-radiologically simulated an osteoid osteoma. Retrospectively, the presence of a cortical sinus tract should have aroused suspicion.

  9. Tips and Tricks in Mallet Fracture Fixation.

    PubMed

    Chin, Yuin Cheng; Foo, Tun-Lin

    2016-10-01

    We describe three steps to aid fracture assessment and fixation in the extensor block pin technique for mallet fractures. The first step is the use of fluoroscopy in the initial assessment to determine indication for fixation. Next is the use of supplementary extension block pin to control larger dorsal fragments. The third technique described details the steps of open reduction of nascently malunited fractures. PMID:27595969

  10. Nitrogen fixation and CO/sub 2/ metabolism: proceedings

    SciTech Connect

    Ludden, P.W.; Burris, J.E.

    1985-01-01

    Photosynthesis and nitrogen fixation are key metabolic processes which lead to the production of reduced carbon and nitrogen compounds. These compounds are essential for the maintenance and continuation of life on earth. In this volume many recent advances in the study of nitrogen fixation and photosynthetic carbon dioxide fixation are presented. The papers were presented in seven sessions. These sessions were the biochemistry of the legume nodule, genetics and molecular biology of nitrogen fixation, enzymes and cofactors involved in inorganic nitrogen reductions, aspects of nitrogen fixation by associations and symbioses, physiology of free-living nitrogen fixers, interactions between carbon metabolism and nitrogen fixation, photorespiration in plants, and photosynthetic carbon fixation. (DT)

  11. 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.

  12. Variable Nitrogen Fixation in Wild Populus

    PubMed Central

    Doty, Sharon L.; Sher, Andrew W.; Fleck, Neil D.; Khorasani, Mahsa; Bumgarner, Roger E.; Khan, Zareen; Ko, Andrew W. K.; Kim, Soo-Hyung; DeLuca, Thomas H.

    2016-01-01

    The microbiome of plants is diverse, and like that of animals, is important for overall health and nutrient acquisition. In legumes and actinorhizal plants, a portion of essential nitrogen (N) is obtained through symbiosis with nodule-inhabiting, N2-fixing microorganisms. However, a variety of non-nodulating plant species can also thrive in natural, low-N settings. Some of these species may rely on endophytes, microorganisms that live within plants, to fix N2 gas into usable forms. Here we report the first direct evidence of N2 fixation in the early successional wild tree, Populus trichocarpa, a non-leguminous tree, from its native riparian habitat. In order to measure N2 fixation, surface-sterilized cuttings of wild poplar were assayed using both 15N2 incorporation and the commonly used acetylene reduction assay. The 15N label was incorporated at high levels in a subset of cuttings, suggesting a high level of N-fixation. Similarly, acetylene was reduced to ethylene in some samples. The microbiota of the cuttings was highly variable, both in numbers of cultured bacteria and in genetic diversity. Our results indicated that associative N2-fixation occurred within wild poplar and that a non-uniformity in the distribution of endophytic bacteria may explain the variability in N-fixation activity. These results point to the need for molecular studies to decipher the required microbial consortia and conditions for effective endophytic N2-fixation in trees. PMID:27196608

  13. Variable Nitrogen Fixation in Wild Populus.

    PubMed

    Doty, Sharon L; Sher, Andrew W; Fleck, Neil D; Khorasani, Mahsa; Bumgarner, Roger E; Khan, Zareen; Ko, Andrew W K; Kim, Soo-Hyung; DeLuca, Thomas H

    2016-01-01

    The microbiome of plants is diverse, and like that of animals, is important for overall health and nutrient acquisition. In legumes and actinorhizal plants, a portion of essential nitrogen (N) is obtained through symbiosis with nodule-inhabiting, N2-fixing microorganisms. However, a variety of non-nodulating plant species can also thrive in natural, low-N settings. Some of these species may rely on endophytes, microorganisms that live within plants, to fix N2 gas into usable forms. Here we report the first direct evidence of N2 fixation in the early successional wild tree, Populus trichocarpa, a non-leguminous tree, from its native riparian habitat. In order to measure N2 fixation, surface-sterilized cuttings of wild poplar were assayed using both 15N2 incorporation and the commonly used acetylene reduction assay. The 15N label was incorporated at high levels in a subset of cuttings, suggesting a high level of N-fixation. Similarly, acetylene was reduced to ethylene in some samples. The microbiota of the cuttings was highly variable, both in numbers of cultured bacteria and in genetic diversity. Our results indicated that associative N2-fixation occurred within wild poplar and that a non-uniformity in the distribution of endophytic bacteria may explain the variability in N-fixation activity. These results point to the need for molecular studies to decipher the required microbial consortia and conditions for effective endophytic N2-fixation in trees. PMID:27196608

  14. Variable Nitrogen Fixation in Wild Populus.

    PubMed

    Doty, Sharon L; Sher, Andrew W; Fleck, Neil D; Khorasani, Mahsa; Bumgarner, Roger E; Khan, Zareen; Ko, Andrew W K; Kim, Soo-Hyung; DeLuca, Thomas H

    2016-01-01

    The microbiome of plants is diverse, and like that of animals, is important for overall health and nutrient acquisition. In legumes and actinorhizal plants, a portion of essential nitrogen (N) is obtained through symbiosis with nodule-inhabiting, N2-fixing microorganisms. However, a variety of non-nodulating plant species can also thrive in natural, low-N settings. Some of these species may rely on endophytes, microorganisms that live within plants, to fix N2 gas into usable forms. Here we report the first direct evidence of N2 fixation in the early successional wild tree, Populus trichocarpa, a non-leguminous tree, from its native riparian habitat. In order to measure N2 fixation, surface-sterilized cuttings of wild poplar were assayed using both 15N2 incorporation and the commonly used acetylene reduction assay. The 15N label was incorporated at high levels in a subset of cuttings, suggesting a high level of N-fixation. Similarly, acetylene was reduced to ethylene in some samples. The microbiota of the cuttings was highly variable, both in numbers of cultured bacteria and in genetic diversity. Our results indicated that associative N2-fixation occurred within wild poplar and that a non-uniformity in the distribution of endophytic bacteria may explain the variability in N-fixation activity. These results point to the need for molecular studies to decipher the required microbial consortia and conditions for effective endophytic N2-fixation in trees.

  15. Maxwellian Eye Fixation during Natural Scene Perception

    PubMed Central

    Duchesne, Jean; Bouvier, Vincent; Guillemé, Julien; Coubard, Olivier A.

    2012-01-01

    When we explore a visual scene, our eyes make saccades to jump rapidly from one area to another and fixate regions of interest to extract useful information. While the role of fixation eye movements in vision has been widely studied, their random nature has been a hitherto neglected issue. Here we conducted two experiments to examine the Maxwellian nature of eye movements during fixation. In Experiment 1, eight participants were asked to perform free viewing of natural scenes displayed on a computer screen while their eye movements were recorded. For each participant, the probability density function (PDF) of eye movement amplitude during fixation obeyed the law established by Maxwell for describing molecule velocity in gas. Only the mean amplitude of eye movements varied with expertise, which was lower in experts than novice participants. In Experiment 2, two participants underwent fixed time, free viewing of natural scenes and of their scrambled version while their eye movements were recorded. Again, the PDF of eye movement amplitude during fixation obeyed Maxwell's law for each participant and for each scene condition (normal or scrambled). The results suggest that eye fixation during natural scene perception describes a random motion regardless of top-down or of bottom-up processes. PMID:23226987

  16. Maxwellian eye fixation during natural scene perception.

    PubMed

    Duchesne, Jean; Bouvier, Vincent; Guillemé, Julien; Coubard, Olivier A

    2012-01-01

    When we explore a visual scene, our eyes make saccades to jump rapidly from one area to another and fixate regions of interest to extract useful information. While the role of fixation eye movements in vision has been widely studied, their random nature has been a hitherto neglected issue. Here we conducted two experiments to examine the Maxwellian nature of eye movements during fixation. In Experiment 1, eight participants were asked to perform free viewing of natural scenes displayed on a computer screen while their eye movements were recorded. For each participant, the probability density function (PDF) of eye movement amplitude during fixation obeyed the law established by Maxwell for describing molecule velocity in gas. Only the mean amplitude of eye movements varied with expertise, which was lower in experts than novice participants. In Experiment 2, two participants underwent fixed time, free viewing of natural scenes and of their scrambled version while their eye movements were recorded. Again, the PDF of eye movement amplitude during fixation obeyed Maxwell's law for each participant and for each scene condition (normal or scrambled). The results suggest that eye fixation during natural scene perception describes a random motion regardless of top-down or of bottom-up processes. PMID:23226987

  17. Quantification of the Interrelationship between Brachial-Ankle and Carotid-Femoral Pulse Wave Velocity in a Workplace Population

    PubMed Central

    Cheng, Yi-Bang; Li, Yan; Sheng, Chang-Sheng; Huang, Qi-Fang; Wang, Ji-Guang

    2016-01-01

    Background Brachial-ankle pulse wave velocity (PWV) is increasingly used for the measurement of arterial stiffness. In the present study, we quantified the interrelationship between brachial-ankle and carotid-femoral PWV in a workplace population, and investigated the associations with cardiovascular risk factors and carotid intima-media thickness (IMT). Methods Brachial-ankle and carotid-femoral PWV were measured using the Omron-Colin VP1000 and SphygmoCor devices, respectively. We investigated the interrelationship by the Pearson's correlation analysis and Bland-Altman plot, and performed sensitivity and specificity analyses. Results The 954 participants (mean ± standard deviation age 42.6 ± 14.2 years) included 630 (66.0%) men and 203 (21.3%) hypertensive patients. Brachial-ankle (13.4 ± 2.7 m/s) and carotid-femoral PWV (7.3 ± 1.6 m/s) were significantly correlated in all subjects (r = 0.75) as well as in men (r = 0.72) and women (r = 0.80) separately. For arterial stiffness defined as a carotid-femoral PWV of 10 m/s or higher, the sensitivity and specificity of brachial-ankle PWV of 16.7 m/s or higher were 72 and 94%, respectively. The area under the receiver operating characteristic curve was 0.953. In multiple stepwise regression, brachial-ankle and carotid-femoral PWV were significantly (p < 0.001) associated with age (partial r = 0.33 and 0.34, respectively) and systolic blood pressure (partial r = 0.71 and 0.66, respectively). In addition, brachial-ankle and carotid-femoral PWV were significantly (p < 0.001) associated with carotid IMT (r = 0.57 and 0.55, respectively) in unadjusted analysis, but not in analysis adjusted for cardiovascular risk factors (p ≥ 0.08). Conclusions Brachial-ankle and carotid-femoral PWV were closely correlated, and had similar determinants. Brachial-ankle PWV can behave as an ease-of-use alternative measure of arterial stiffness for assessing cardiovascular risk. PMID:27195246

  18. Effect of insulating layer material on RF-induced heating for external fixation system in 1.5 T MRI system.

    PubMed

    Liu, Yan; Kainz, Wolfgang; Qian, Songsong; Wu, Wen; Chen, Ji

    2014-09-01

    The radio frequency (RF)-induced heating is a major concern when patients with medical devices are placed inside a magnetic resonance imaging (MRI) system. In this article, numerical studies are applied to investigate the potentials of using insulated materials to reduce the RF heating for external fixation devices. It is found that by changing the dielectric constant of the insulation material, the RF-induced heating at the tips of devices can be altered. This study indicates a potential technique of developing external fixation device with low MRI RF heating.

  19. External fixator configurations in tibia fractures: 1D optimization and 3D analysis comparison.

    PubMed

    Roseiro, Luis M; Neto, M Augusta; Amaro, Ana; Leal, Rogerio P; Samarra, Miguel C

    2014-01-01

    The use of external fixation devices in orthopedic surgery is very common in open tibial fractures. A properly applied fixator may improve the healing process while one improperly applied might delay the healing process. The several external fixator systems used in clinical today, can be categorized into uniplanar-unilateral, uniplanar-bilateral, biplanar and multiplanar. The stability on the fracture focus and, therefore, the fracture healing process, is related with the type of external fixator configuration that is selected. The aim of this study is to discuss the principles for the successful application of unilateral-uniplanar external fixation, the assembly of its components, for the case of a transverse fractures using computational models. In this context, the fixation stiffness characteristics are evaluated using a simplified 1D finite element model for the tibia and external fixator. The beams are modeled with realistic cross-sectional geometry and material properties instead of a simplified model. The VABS (the Variational Asymptotic Beam Section analysis) methodology is used to compute the cross-sectional model for the generalized Timoshenko model, which was embedded in the finite element solver FEAP. The use of Timoshenko beam theory allows accounting for several kinds of loads, including torsion moments. Optimal design is performed with respect to the assembly of fixator components using a genetic algorithm. The optimization procedure is based on the evaluation of an objective function, which is dependent on the displacement at the fracture focus. The initial and optimal results are compared by performing a 3D analysis, for which different three-dimensional finite element models are created. The geometrical model of a tibia is created on the basis of data acquired by CAT scan, made for a healthy tibia of a 22 year old male. The 3D comparison of the 1D optimal results show a clear improvement on the objective function for the several load cases and

  20. Assessment of external fixator reusability using load- and cycle-dependent tests.

    PubMed

    Matsuura, Maiko; Lounici, Smain; Inoue, Nozomu; Walulik, Stephen; Chao, Edmund Y S

    2003-01-01

    No standard method has been established for investigating repeated use of an external fixator. The purpose of the current study was to establish a fatigue testing method for assessing fixator frame reuse. A unilateral DynaFix trade mark external fixator system was tested using high-load and low-cycle (900-150 N at 5 Hz) and low-load and high-cycle (450-100 N at 10 Hz) tests (assumed one use of 500,000 and 1 million cycles, respectively). These loading conditions were selected to simulate single clinical use and to satisfy Food and Drug Administration requirements. In the high-load low-cycle test, substantial failure of the serrated joint occurred before completion of the first simulated use. In the low-load high-cycle test, all fixators completed three simulated clinical uses without failure, although (1/4) of the serrated joint components had hairline cracks. The high-load low-cycle test identified the fixator components which should be examined and replaced if reuse of the fixator is to be considered. Wear and deformation of the set screw on the rotary joint and telescoping mechanisms were observed in the low-load high-cycle test but not in the high-load low-cycle test. Therefore, if the unilateral DynaFix trade mark fixators are being considered for reusability, the number of reuses should be limited as the whole structure of the device will experience fatigue damage as the loading cycle increases.