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Sample records for lateral humeral condyle

  1. Buried versus unburied Kirschner wires in the management of paediatric lateral condyle elbow fractures: a comparative study from a tertiary centre.

    PubMed

    Ormsby, Neal M; Walton, Roger D M; Robinson, Simon; Brookes-Fazakerly, Stephen; Chang, Fernando Yuen; McGonagle, Lorcan; Wright, David

    2016-01-01

    There is little consensus on whether Kirschner wire (K-wire) burial is preferable in the management of paediatric lateral humeral condyle fractures. We identified 124 patients from May 2008 to August 2014. Sixty received buried K-wires and 64 received unburied wires. We found no significant difference in the infection rates between groups, but a high rate of skin erosion (23%) in the buried group, with a subsequent high rate of infection in this subgroup (40%). We found a strong association of wire erosion following early surgery. There is a considerable cost saving associated with using unburied wires. We therefore recommend the routine use of unburied wires.

  2. Arthroscopic Microfracture Technique for Cartilage Damage to the Lateral Condyle of the Tibia

    PubMed Central

    Kan, Hiroyuki; Arai, Yuji; Nakagawa, Shuji; Inoue, Hiroaki; Minami, Ginjiro; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2015-01-01

    This report describes the use of arthroscopic microfracture to treat a 10-year-old female patient with extensive damage to the cartilage of the lateral condyle of the tibia before epiphyseal closure, resulting in good cartilage recovery. Magnetic resonance imaging showed a defect in part of the load-bearing surface of the articular cartilage of the condyle articular of the tibia. The patient was diagnosed with damage to the lateral condyle cartilage of the tibia following meniscectomy, and arthroscopic surgery was performed. The cartilage defect measured approximately 20 × 20 mm, and microfracture was performed. Arthroscopy performed four months postoperatively showed that the cartilage defect was completely covered with fibrous cartilage, and the patient was allowed to resume sports activities. Four years postoperatively, she has had no recurrence of pain or hydrarthrosis. PMID:26345523

  3. The role of the lateral pterygoid muscle in the sagittal fracture of mandibular condyle (SFMC) healing process.

    PubMed

    Liu, Chng-Kui; Liu, Ping; Meng, Fan-Wen; Deng, Bang-Lian; Xue, Yang; Mao, Tian-Qiu; Hu, Kai-Jin

    2012-06-01

    The aim of this study was to examine the role of the lateral peterygoid muscle in the reconstruction of the shape of the condyle during healing of a sagittal fracture of the mandibular condyle. Twenty adult sheep were divided into 2 groups: all had a unilateral operation on the right side when the anterior and posterior attachments of the discs were cut, and an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of the condylar neck. Ten sheep had the lateral pterygoid muscle cut, and the other 10 sheep did not. Sheep were killed at 4 weeks (n=2 from each group), 12 weeks (n=4), and 24 weeks (n=4) postoperatively. Computed tomograms (CT) were taken before and after operations. We dissected the joints, and recorded with the naked eye the shape, degree of erosion, and amount of calcification of the temporomandibular joint (TMJ). In the group in which the lateral peterygoid muscle had not been cut the joints showed overgrowth of new bone and more advanced ankylosis. Our results show that the lateral pterygoid muscle plays an important part in reconstructing the shape of the condyle during the healing of a sagittal fracture of the mandibular condyle, and combined with the dislocated and damaged disc is an important factor in the aetiology of traumatic ankylosis of the TMJ.

  4. Osteochondral lesion located at the lateral femoral condyle reconstructed by the transplantation of tissue-engineered cartilage in combination with a periosteum with bone block: a case report.

    PubMed

    Adachi, Nobuo; Ochi, Mitsuo; Uchio, Yuji; Iwasa, Junji; Furukawa, Seiji; Deie, Masataka

    2004-09-01

    We report herein the successful treatment of a patient with an osteochondral defect extending to the edge of the lateral femoral condyle by transplantation of tissue-engineered cartilage made ex vivo using atelocollagen gel covered by periosteum with a bone block to reconstruct the normal contour of the femoral condyle.

  5. A rare case of bilateral non-weight bearing posterior aspect of lateral femoral condyle osteochondral fracture and its management.

    PubMed

    Shaikh, Aamir Hassan; Stanclik, Jaroslaw; Murphy, Paul G D

    2014-01-01

    Osteochondral fracture of the lateral femoral condyle can be a real challenging injury to diagnose on initial presentation. The authors report a rare case of bilateral involvement of posterior aspect of lateral femoral condyle osteochondral fracture in a young 15-year-old boy. This was managed with excision of these osteochondral fragments, as the site involved was on the posterior non-weight bearing area of the femur along with chronicity of the injury dictating excision as a reasonable choice of management. Good outcome for such injury is based on an early diagnosis and prompt treatment along with an early rehabilitation for such cases. Our patient has an excellent 2 years outcome with a Knee Society score of 95 after undergoing excision of these osteochondral fragments in both knees in succession.

  6. Distal humeral fractures: impact of lateral approach and fracture-specific plating on radial nerve palsies.

    PubMed

    Eglseder, W Andrew

    2012-09-01

    We retrospectively reviewed supracondylar distal humeral fractures that had been treated with fracture-specific plating and definitive fixation through a lateral approach with a medial triceps mobilization technique. We determined the incidences of preoperative and postoperative radial nerve palsies (RNP) to evaluate the impact of the plating and fixation technique on RNP. Seventy-three patients treated at our institution from 2006 through 2009 were included in the study. The patients were assigned to 2 groups: 57 to the blunt injury group (motor vehicle collisions, falls, struck pedestrians, throwing) and 16 to the gunshot wound group. The incidence of known preoperative RNP in the blunt injury group was 27% (13 of 48 nonintubated patients); the incidence of known preoperative RNP in the gunshot wound group was 20% (2 of 10 nonintubated patients). The incidence of postoperative RNP for the combined groups of nonintubated patients who had intact radial nerve function preoperatively was 12% (5 of 43 patients). We found a high frequency of preoperative RNP, and we found postoperative RNP rates similar to those reported in the literature despite the use of the lateral approach medial triceps mobilization technique with a fracture-specific plate. PMID:22913991

  7. RISKS AND CONSEQUENCES OF USING THE TRANSPORTAL TECHNIQUE IN RECONSTRUCTING THE ANTERIOR CRUCIATE LIGAMENT: RELATIONSHIPS BETWEEN THE FEMORAL TUNNEL, LATERAL SUPERIOR GENICULAR ARTERY AND LATERAL EPICONDYLE OF THE FEMORAL CONDYLE

    PubMed Central

    Astur, Diego Costa; Aleluia, Vinicius; Santos, Ciro Veronese; Arliani, Gustavo Gonçalves; Badra, Ricardo; Oliveira, Saulo Gomes; Kaleka, Camila Cohen; Cohen, Moisés

    2015-01-01

    Objective: Define a security zone to avoid possibles vascular and ligamentar complications during anterior cruciate ligament reconstruction. Methods: Arthroscopic reconstruction using the transtibial and transportal technique in cadaver knees was performed followed by dissection and measurement of the distance between the femoral tunnel and the proximal attachment of the lateral collateral ligament and the femoral tunnel and the lateral superior genicular artery. Results: The measure of the analysed distances show us an aproximation between the major branch of the lateral superior genicular artery and the femoral insertion of the colateral lateral ligament and the femoral tunnel during the transportal technique. Conclusion: We realize that the use of technical ship it to arthroscopic ACL reconstruction has a higher probability of injury to the lateral geniculate artery and insertion of the lateral collateral ligament, promoting post-surgical complications such as instability of the knee, osteonecrosis of the femoral condyle and ligamentização graft. PMID:27047873

  8. Humeral Lateral Epicondylitis Complicated by Hydroxyapatite Dihydrite Deposition Disease: A Case Report

    PubMed Central

    Marchand, Andrée-Anne; O’Shaughnessy, Julie; Descarreaux, Martin

    2014-01-01

    Objective The aim of this case report is to differentiate the recovery timeline expected for patients with simple lateral epicondylitis from an abnormal recovery period, in which case an underlying condition should be suspected. Clinical features A 49-year-old woman presented to a chiropractic clinic with posterolateral right elbow pain. The history included chronic recurrent lateral elbow pain, followed by a traumatic event leading to sustained pain and disability. Intervention and outcomes Following a trial of conservative therapy including activity restrictions, soft tissue therapy, joint mobilizations, and therapeutic ultrasonography that led to no significant improvement, the patient was referred for diagnostic imaging that revealed hydroxyapatite dihydrite deposition disease. Conclusion This report describes a case for which lateral epicondylitis symptoms failed to resolve because of an underlying condition (hydroxyapatite dihydrite deposition disease). This case emphasizes that primary care practitioners treating lateral epicondylitis should consider referral for further investigations when positive results are not achieved. PMID:24711788

  9. Softening of the lateral condyle articular cartilage in the canine knee joint after long distance (up to 40 km/day) running training lasting one year.

    PubMed

    Arokoski, J; Jurvelin, J; Kiviranta, I; Tammi, M; Helminen, H J

    1994-07-01

    The effects of long distance running training (up to 40km/day) on the biomechanical properties of young canine articular cartilage were investigated using in situ indentation creep technique. The stiffness of articular cartilage was determined in the form of instantaneous and equilibrium shear moduli. The rate of cartilage deformation was also computed. Microspectrophotometric and polarized light microscopic analyses were made for determination of local glycosaminoglycan content and collagen organization, respectively. During a period of one year, the runner dogs (n = 10) underwent a gradually increased treadmill exercise up to 40 km/day, while the littermate control dogs (n = 10) lived normally in their cages. The equilibrium shear modulus of articular cartilage decreased significantly by 12 to 14% (p < 0.05) in the lateral, but not in the medial, condyles of femur and tibia. In the lateral condyles of the runner dogs, the deformation rate of cartilage increased by 16% (p < 0.05). Consequently, the articular cartilage response to running training was site-dependent. The simultaneous changes of the equilibrium shear modulus or the retardation time spectrum and the glycosaminoglycan content confirm the key role of proteoglycans in modulating the cartilage equilibrium stiffness and creep rate. The changes in the instant shear modulus appeared to be predominantly related to the alterations in the organization of the superficial collagen network. Although the running training did not create cartilage damage, we assume that the softening of the cartilage may with time jeopardize the ability of articular cartilage to maintain its normal structural and functional properties.

  10. 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

  11. Decreased scapular notching with lateralization and inferior baseplate placement in reverse shoulder arthroplasty with high humeral inclination

    PubMed Central

    Feeley, Brian T.; Zhang, Alan L.; Barry, Jeffery J.; Shin, Edward; Ho, Julianne; Tabaraee, Ehsan; Ma, C. Benjamin

    2014-01-01

    Background: Scapular notching is a radiographic finding of unknown clinical significance following reverse total shoulder arthroplasty (RTSA). The purpose of this study was to determine how baseplate position affects the incidence of scapular notching and measure the clinical outcomes. Hypothesis: We hypothesized that low base plate position on the glenoid and new prosthesis design with a higher humeral inclination angle would decrease the incidence of notching at 2 years follow-up. Materials and methods: A total of 54 patients with an average follow-up of 30 months met inclusion criteria and underwent radiographic analysis of scapular notching and radiographic measures to determine glenoid component placement. Clinical measures including visual analog score, American Shoulder and Elbow Surgeons (ASES) scores, and range of motion (ROM) were prospectively collected. Results: Thirty-nine of the 54 patients had no notching. 7 had Grade 1 notching, 7 had Grade 2 notching, one had Grade 3, and one had Grade 4 notching. Notching was associated with higher placement of the glenoid component as measured by peg-glenoid rim distance and base plate distance. All patients with no evidence of notching at 1-year, continued to have no notching after multi-year follow-up. Clinical outcome measures including ASES scores, ROM, and visual analog pain scores were improved at follow-up. Conclusion: We concluded that lower neck-shaft angle and low baseplate positioning led to a low incidence of significant scapular notching as only 6 out of 57 (16%) patients had notching Grade 2 and above. At short-term follow-up, this RTSA results in excellent clinical outcomes and a significantly lower scapular notching rate than traditional techniques. PMID:25258496

  12. Movements of temporomandibular condyles during swallowing.

    PubMed

    Čimić, Samir; Šimunković, Sonja Kraljević; Gospić, Renata Kevilj; Badel, Tomislav; Dulčić, Nikša; Ćatić, Amir

    2015-03-01

    There have been studies that investigated mandibular movements and positioning during swallowing, but the results were inconsistent, and still the exact position of the condyles during swallowing is unknown. The purpose of this investigation was to study the kinematics of the mandible and the condyles, and to determine the actual movement paths and position of mandible and condyles during the process of swallowing. The study was performed on a sample of 44 dental students. Measurements were done with an electronic axiograph. After non-occlusing attachment was fixed in the mouth, every subject swallowed for five times from the rest position. The final swallowing position of the left and the right condyles was measured in the sagittal plane. The final swallowing position of the sagittal incisal point was measured in sagittal, frontal and horizontal plane, and data was statistically analyzed. The condyles showed average movement toward posterior (left 0.17 mm, SD 0.28, right 0.16 mm, SD 0.25) and superior (left 0.14 mm, SD 0.20, right 0.14 mm, SD 0.23). Anterior and/or inferior position had 20% of participants. The average sagittal incisal point movement during swallowing was toward anterior (0.30 mm, SD 0.53) and superior (0.81 mm, SD 0.84). The mean mandibular lateral movement was 0.1 mm (SD 0.1). The results of the study suggest that retrusion during swallowing is not the rule, although on average there is a slight tendency of condylar movement toward posterior. Swallowing can be used as auxiliary method for determining vertical dimension of occlusion.

  13. Movements of temporomandibular condyles during swallowing.

    PubMed

    Čimić, Samir; Šimunković, Sonja Kraljević; Gospić, Renata Kevilj; Badel, Tomislav; Dulčić, Nikša; Ćatić, Amir

    2015-03-01

    There have been studies that investigated mandibular movements and positioning during swallowing, but the results were inconsistent, and still the exact position of the condyles during swallowing is unknown. The purpose of this investigation was to study the kinematics of the mandible and the condyles, and to determine the actual movement paths and position of mandible and condyles during the process of swallowing. The study was performed on a sample of 44 dental students. Measurements were done with an electronic axiograph. After non-occlusing attachment was fixed in the mouth, every subject swallowed for five times from the rest position. The final swallowing position of the left and the right condyles was measured in the sagittal plane. The final swallowing position of the sagittal incisal point was measured in sagittal, frontal and horizontal plane, and data was statistically analyzed. The condyles showed average movement toward posterior (left 0.17 mm, SD 0.28, right 0.16 mm, SD 0.25) and superior (left 0.14 mm, SD 0.20, right 0.14 mm, SD 0.23). Anterior and/or inferior position had 20% of participants. The average sagittal incisal point movement during swallowing was toward anterior (0.30 mm, SD 0.53) and superior (0.81 mm, SD 0.84). The mean mandibular lateral movement was 0.1 mm (SD 0.1). The results of the study suggest that retrusion during swallowing is not the rule, although on average there is a slight tendency of condylar movement toward posterior. Swallowing can be used as auxiliary method for determining vertical dimension of occlusion. PMID:26040084

  14. Distal humeral epiphyseal separation.

    PubMed

    Moucha, Calin S; Mason, Dan E

    2003-10-01

    Distal humeral epiphyseal separation is an uncommon injury that is often misdiagnosed upon initial presentation. To make a timely, correct diagnosis, the treating physician must have a thorough understanding of basic anatomical relationships and an awareness of the existence of this injury. This is a case of a child who sustained a separation of the distal humeral epiphysis, as well as multiple other bony injuries, secondary to child abuse.

  15. Robust femur condyle disambiguation on biplanar X-rays.

    PubMed

    Serrurier, Antoine; Quijano, Sergio; Nizard, Remy; Skalli, Wafa

    2012-12-01

    Three-dimensional (3D) reconstruction of the skeleton from biplanar X-rays relies on scarce information digitalised by an operator on both frontal and lateral radiographs. In clinical routine, difficulties occur for non-skilled operators to discriminate the medial from the lateral femur condyle on the lateral view. Our study proposes an algorithm able to detect automatically a possible inversion of the two condyles by the operator at an early stage of the reconstruction process. It relies on the computation of two 3D femur surfaces, one directly from the operator digitalisation and the other from the same digitalisation with medial and lateral condyles automatically swapped. Pairs of virtual biplanar X-rays are computed for both reconstructions and the closest pair to the original X-rays is selected on the basis of similarity measures, pointing the correct 3D surface. The algorithm shows a success rate higher than 85% for both asymptomatic and pathological femurs whatever the initial condyle digitalisation of the operator, bringing automatically non-skilled operators acting in clinical routine to the level of skilled operators. This study validates moreover the proof-of-concept of automatic shape adjustments of a 3D surface on the basis of similarity measures in the process of 3D reconstruction from biplanar X-rays. PMID:22349135

  16. Management of distal humeral coronal shear fractures

    PubMed Central

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

    2015-01-01

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

  17. An alternative method of osteosynthesis for distal humeral shaft fractures.

    PubMed

    Levy, Jonathan C; Kalandiak, Steven P; Hutson, James J; Zych, Gregory

    2005-01-01

    Treatment of extra-articular distal humerus shaft fractures with plating techniques is often difficult, as traditional centrally located posterior plates often encroach on the olecranon fossa, limiting distal osseous fixation. The use of a modified Synthes Lateral Tibial Head Buttress Plate (Synthes, Paoli, PA) allows for a centrally placed posterior plating of the humeral shaft that angles anatomically along the lateral column to treat far distal humeral shaft fractures. Fifteen patients treated in this manner were followed to radiographic and clinical union. There were no cases of instrumentation failure or loss of reduction.

  18. Osteochondroma of the mandibular condyle: Report of two surgical approaches.

    PubMed

    Lim, William; Weng, Lye Kok; Tin, Goh Bee

    2014-01-01

    Osteochondromas are common tumors of the long bones, but are rare in the craniofacial region. We detailed two different management of osteochondroma of the mandibular condyle treated utilizing three-dimensional (3D) imaging and computer-assisted planning. Simultaneous open temporomandibular joint and orthognathic surgeries were done to treat both the pathology and secondary facial asymmetry. An osteochondroma that presented as a bony mass at the lateral aspect of the left mandibular condyle of a 24-year-old Chinese female was treated with simultaneous orthognathic surgery and conservative excision. No recurrence was detected 7 months postsurgery. An osteochondroma that presented as a generalized enlargement of the right mandibular condyle of a 25-year-old Chinese male was treated with simultaneous orthognathic surgery and condylectomy. There were no significant issues 3 years postsurgery. Simultaneous orthognathic and temporomandibular joint surgeries are a viable option for the management of osteochondroma of the mandibular condyle. The availability of 3D imaging enabled better presurgical examination of the lesion, which directed treatment toward condylectomy or conservative excision.

  19. Giant osteochondroma of the mandibular condyle

    PubMed Central

    Sekhar, MR Muthu; Loganathan, S

    2015-01-01

    Osteochondroma or osteocartilaginous exostosis is an exophytic lesion that arises from the cortex of the bone and is cartilage-capped. Osteochondroma of the mandibular condyle is extremely rare. The following is a case report of an osteochondroma of the mandibular condyle removed via extended preauricular approach to the temporomandibular joint. PMID:26980978

  20. HUMERAL SHAFT FRACTURES

    PubMed Central

    Benegas, Eduardo; Ferreira Neto, Arnaldo Amado; Neto, Raul Bolliger; Santis Prada, Flavia de; Malavolta, Eduardo Angeli; Marchitto, Gustavo Oliveira

    2015-01-01

    Humeral shaft fractures (HSFs) represent 3% of the fractures of the locomotor apparatus, and the middle third of the shaft is the section most affected. In the majority of cases, it is treated using nonsurgical methods, but surgical indications in HSF cases are increasingly being adopted. The diversity of opinions makes it difficult to reach a consensus regarding the types of osteosynthesis, surgical technique and quantity and quality of synthesis materials that should be used. It would appear that specialists are far from reaching a consensus regarding the best method for surgical treatment of HSFs. We believe that less invasive methods, which favor relative stability, are the most appropriate methods, since the most feared complications are less frequent. PMID:27019833

  1. Correlation between anatomical parameters of intertubercular sulcus and retroversion angle of humeral head

    PubMed Central

    Pan, Zhaoxun; Chen, Jun; Qu, Lianjun; Cui, Yan; Sun, Chao; Zhang, Hongxin; Yang, Xiaoming; Guan, Qingli

    2015-01-01

    Objective: To obtain anatomical data on intertubercular sulcus of humerus, evaluate the correlation between intertubercular sulcus and retroversion angle of humeral head, to guide the positioning of torsion angle of prosthesis during total shoulder arthroplasty and provide references for shoulder prosthesis design. Methods: Using a Siemens Ultrahigh speed 64- rows multi-slices spiral CT scanner and 20 dried adult humeral specimens (intact specimen, no fractures or pathological damage), of these, left lateral in 10 cases, right lateral in 10 cases, male or female all inclusive, specimens are all provided by Anatomy Department of Weifang Medical College, scan ranged from the highest point of humeral head to the distal ends of trochlea. And scanned data were subjected to statistical analysis. Results: There is a linear correlation between the distance from intertubercular sulcus to central axis line of humeral head, position angle of intertubercular sulcus and retroversion angle of humeral head at the beginning slice of intertubercular sulcus. There is a linear correlation between position angle of intertubercular sulcus and retroversion angle of humeral head at the slice of surgical neck. Conclusion: There is a linear correlation between position of intertubercular sulcus and retroversion angle of humeral head, in total shoulder arthroplasty, using intertubercular sulcus as anatomical landmark will help to accurately position torsion angle of individualized prosthesis. Position angle of intertubercular sulcus is an objective, flexible positioning indicator. PMID:26131058

  2. The Use of Shoulder Hemiarthroplasty and Humeral Head Resurfacing: A Review of Current Concepts

    PubMed Central

    Widnall, James C; Dheerendra, Sujay K; MacFarlane, Robert J; Waseem, Mohammad

    2013-01-01

    Since Neer’s early work in the 1950s shoulder arthroplasty has evolved as a treatment option for various glenohumeral joint disorders. Both hemiarthroplasty and total shoulder prostheses have associated problems. This has led to further work with regards to potential resurfacing, with the aim of accurately restoring native proximal humeral anatomy while preserving bone stock for later procedures if required. Hemiarthroplasty remains a valuable treatment option in the low demand patient or in the trauma setting. Additional work is required to further define the role of humeral resurfacing, with the potential for it to become the gold standard for younger patients with isolated humeral head arthritis. PMID:24082971

  3. Archaic and modern human distal humeral morphology.

    PubMed

    Yokley, Todd R; Churchill, Steven E

    2006-12-01

    The morphology of the proximal ulna has been shown to effectively differentiate archaic or premodern humans (such as Homo heidelbergensis and H. neanderthalensis) from modern humans (H. sapiens). Accordingly, the morphology of adjacent, articulating elements should be able to distinguish these two broad groups as well. Here we test the taxonomic utility of another portion of the elbow, the distal humerus, as a discriminator of archaic and modern humans. Principal components analysis was employed on a suite of log-raw and log-shape distal humeral measures to examine differences between Neandertal and modern human distal humeri. In addition, the morphological affinities of Broken Hill (Kabwe) E.898, an archaic human distal humeral fragment from the middle Pleistocene of Zambia, and five Pliocene and early Pleistocene australopith humeri were assessed. The morphometric analyses effectively differentiated the Neandertals from the other groups, while the Broken Hill humerus appears morphologically similar to modern human distal humeri. Thus, an archaic/modern human dichotomy-as previously reported for proximal ulnar morphology-is not supported with respect to distal humeral morphology. Relative to australopiths and modern humans, Neandertal humeri are characterized by large olecranon fossae and small distodorsal medial and lateral pillars. The seeming disparity in morphological affinities of proximal ulnae (in which all archaic human groups appear distinct from modern humans) and distal humeri (in which Neandertals appear distinct from modern humans, but other archaic humans do not) is probably indicative of a highly variable, possibly transitional population of which our knowledge is hampered by sample-size limitations imposed by the scarcity of middle-to-late Pleistocene premodern human fossils outside of Europe.

  4. Adenocarcinoma metastatic to the mandibular condyle.

    PubMed

    Webster, K

    1988-07-01

    Two cases of metastatic lesions presenting in the mandibular condyle as Temporo-Mandibular Joint Pain Dysfunction Syndrome are presented with a discussion on the mechanisms of tumour metastases to bone.

  5. Regeneration ad integrum of the condyle head in a patient with temporomandibular disorders.

    PubMed

    Learreta, J A

    1999-07-01

    A 14-year-old who had suffered from a beta-hemolytic streptococcus infection presented with serious temporomandibular disorders, including a reabsorption of the condyle head on the right side, and reabsorption in the cavern of the left side. Her masticatory muscles were electronically deprogramed, achieving a mandibular position supported by a relaxed musculature. The patient's signs and symptoms subsequently disappeared. Study of the magnetic resonance image a year later clearly showed a regeneration ad integrum of the condyle head and a spontaneous reinsertion of the articular disk. The results suggest the need for use of electronic elements in order to treat patients with temporomandibular disorders effectively. PMID:10650410

  6. [Temporomandibular joint (TMJ): Condyle hyperplasia and condylectomy].

    PubMed

    Ferri, J; Raoul, G; Potier, J; Nicot, R

    2016-09-01

    The mandibular condyle is a special structure. Its embryology and physiology provide to the TMJ a particular behavior that explains the occurrence of specific diseases. Condyle hyperplasia is one of these disorders. It can be explained by a dysregulation of the prechondroblast cell layer within the cartilage cap providing an increase in volume first of the condyle, then of the ramus and finally of the entire affected hemiface. Mandible deformation affects the basal bone, leading to dento-alveolar deformations related to compensation attempts. Controversies, condylectomy is performed by many surgeons. This procedure allows for the correction of some of the dento-alveolar compensations. In some cases, an additional orthognathic surgery will be required to achieve a perfect result. PMID:27567190

  7. 21 CFR 872.3960 - Mandibular condyle prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Mandibular condyle prosthesis. 872.3960 Section... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3960 Mandibular condyle prosthesis. (a) Identification. A mandibular condyle prosthesis is a device that is intended to be implanted in the human jaw...

  8. Plating of proximal humeral fractures.

    PubMed

    Martetschläger, Frank; Siebenlist, Sebastian; Weier, Michael; Sandmann, Gunther; Ahrens, Philipp; Braun, Karl; Elser, Florian; Stöckle, Ulrich; Freude, Thomas

    2012-11-01

    The optimal treatment for proximal humeral fractures is controversial. Few data exist concerning the influence of the surgical approach on the outcome. The purpose of this study was to evaluate the clinical and radiological outcomes of proximal humeral fractures treated with locking plate fixation through a deltopectoral vs an anterolateral deltoid-splitting approach. Of 86 patients who met the inclusion criteria, 70 were available for follow-up examination. Thirty-three patients were treated through a deltopectoral approach and 37 through an anterolateral deltoid-splitting approach. In all cases, open reduction and internal fixation with a PHILOS locking plate (Synthes, Umkirch, Germany) was performed. Clinical follow-up included evaluation of pain, shoulder mobility, and strength. Constant score and Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed. A clinical neurological examination of the axillary nerve was also performed. Consolidation, reduction, and appearance of head necrosis were evaluated radiographically. After a mean follow-up of 33 months, Constant scores, DASH scores, and American Shoulder and Elbow Surgeons scores showed no significant differences between the groups. Clinical neurologic examination of the axillary nerve revealed no obvious damage to the nerve in either group. Deltopectoral and anterolateral detoid-splitting approaches for plate fixation of proximal humeral fractures are safe and provide similar clinical outcomes. The results of this study suggest that the approach can be chosen according to surgeon preference.

  9. Osteochondroma of the mandibular condyle: Resection and reconstruction using vertical sliding osteotomy of the mandibular ramus.

    PubMed

    González-Otero, Sergio; Navarro-Cuéllar, Carlos; Escrig-de Teigeiro, Margarita; Fernández-Alba-Luengo, Javier; Navarro-Vila, Carlos

    2009-04-01

    Osteochondroma is one of the most common benign bone tumours, although not in the craniofacial region. More than half of these appear in the coronoid process. It can appear on the mandibular condyle, especially in its medial half, and mainly affects women aged around forty years. We present the case of a 51-year-old woman with pain of several months' duration in the right temporomandibular joint (TMJ) and no other symptoms. Panoramic radiography showed an enlarged condyle with no subchondral cysts. Computed tomography showed a bony proliferation with benign signs and a scintigraphy revealed an increased uptake in the condyle. Due to the painful clinical symptoms, a surgical procedure using preauricular and retromandibular approaches was performed to excise the condyle. The resulting defect, which was 9 mm high, was reconstructed by means of a vertical sliding osteotomy of the mandibular ramus and two miniplates for osteosynthesis. Almost two years later, the patient is symptom-free and has a normal opening with no malocclusion or deviation in the opening pattern. We present and discuss different reconstruction options after condylectomy.

  10. No differences in morphological characteristics between hyperplastic condyle and class III condyle.

    PubMed

    Goulart, D R; Muñoz, P; Olate, S; de Moraes, M; Fariña, R

    2015-10-01

    The aim of this research was to compare the condylar morphology of patients with unilateral condylar hyperplasia (UCH) and patients with a class III skeletal relationship using cone beam computed tomography (CBCT). A prospective study was conducted on patients with facial asymmetry attending the division of oral and maxillofacial surgery of the study university in Chile. Fifteen patients with UCH and 15 with a class III skeletal relationship were selected. Linear measurements of the condylar processes were obtained at a scale of 1:1 using the software Ez3D Viewer Plus. Analysis of variance (ANOVA) and the paired t-test were used, considering P<0.05. Patients with UCH presented statistical differences between the hyperplastic condyle and non-hyperplastic condyle for anteroposterior and mediolateral diameters, condylar neck length, and ramus height. Patients with a class III skeletal relationship showed no differences between the right and left sides; the morphology of their condyles was similar to the condyles with hyperplasia and presented statistical differences when compared with the non-hyperplastic condyles (one-way ANOVA, P<0.05). The condylar morphology of UCH patients could be related to the development of a class III skeletal relationship. These findings provide an insight into the possibility of some class III patients presenting bilateral condylar hyperplasia.

  11. Regeneration of the mandibular condyle after unilateral condylectomy and myotomy of the masseter in lambs.

    PubMed

    Miyamoto, H; Matsuura, H; Singh, J; Goss, A N

    2002-04-01

    We investigated the degree of regeneration of the mandibular condyle after unilateral condylectomy and myotomy of the masseter in growing lambs. Four 10-week-old lambs had unilateral condylectomy and myotomy of the superficial layer of the masseter on the right side, and were killed 3 months later. The joints were examined radiologically and histologically. All joints showed poor regeneration of the condylar head. In the medial plane there was partial condylar and articular cartilage reformation, but in the lateral plane there was neither condylar nor cartilaginous reformation. The articular cartilage of the temporal bone was thicker in the medial plane and the disc was thicker in the central plane, than in unoperated joints. We conclude that unilateral condylectomy and myotomy of the masseter in the growing period results in poor regeneration of the condyle. PMID:12180201

  12. In vivo motion of femoral condyles during weight-bearing flexion after anterior cruciate ligament rupture using biplane radiography.

    PubMed

    Chen, Kaining; Yin, Li; Cheng, Liangjun; Li, Chuan; Chen, Cheng; Yang, Liu

    2013-01-01

    The purpose of this study was to investigate in vivo three- dimensional tibiofemoral kinematics and femoral condylar motion in knees with anterior cruciate ligament (ACL) deficiency during a knee bend activity. Ten patients with unilateral ACL rupture were enrolled. Both the injured and contralateral normal knees were imaged using biplane radiography at extension and at 15°, 30°, 60°, 90°, and 120° of flexion. Bilateral knees were next scanned by computed tomography, from which bilateral three-dimensional knee models were created. The in vivo tibiofemoral motion at each flexion position was reproduced through image registration using the knee models and biplane radiographs. A joint coordinate system containing the geometric center axis of the femur was used to measure the tibiofemoral motion. In ACL deficiency, the lateral femoral condyle was located significantly more posteriorly at extension and at 15° (p < 0.05), whereas the medial condylar position was changed only slightly. This constituted greater posterior translation and external rotation of the femur relative to the tibia at extension and at 15° (p < 0.05). Furthermore, ACL deficiency led to a significantly reduced extent of posterior movement of the lateral condyle during flexion from 15° to 60° (p < 0.05). Coupled with an insignificant change in the motion of the medial condyle, the femur moved less posteriorly with reduced extent of external rotation during flexion from 15° to 60° in ACL deficiency (p < 0.05). The medial- lateral and proximal-distal translations of the medial and lateral condyles and the femoral adduction-abduction rotation were insignificantly changed after ACL deficiency. The results demonstrated that ACL deficiency primarily changed the anterior-posterior motion of the lateral condyle, producing not only posterior subluxation at low flexion positions but also reduced extent of posterior movement during flexion from 15° to 60°. Key PointsThree-dimensional tibiofemoral

  13. Humeral surface replacement for osteoarthritis

    PubMed Central

    2013-01-01

    Background and purpose Humeral resurfacing has shown promising results for osteoarthritis, but revisions for glenoid erosion have been reported frequently. We investigated the hypothesis that preoperative glenoid wear and postoperative progress of glenoid erosion would influence the clinical outcome. Methods We reviewed 61 resurfacing hemiarthroplasties (55 patients) for primary osteoarthritis. 6 patients were lost to follow-up and 5 had undergone revision arthroplasty. This left 50 shoulders in 44 patients (mean age 66 years) that were followed for mean 30 (12–44) months. Complications, revisions, and the age- and sex-related Constant score were assessed. Radiographs were evaluated for loosening and glenoid erosion according to Walch. Results Of the 50 shoulders that were functionally assessed, the average age- and sex-related Constant score was 73%. In patients with preoperative type-B2 glenoids, at 49% it was lower than in type-A1 glenoids (81%, p = 0.03) and in type-B1 glenoids (84%, p = 0.02). The average age- and sex-related Constant score for patients with type-A2 glenoids (60%) was lower than for type-A1 and -B1 glenoids and higher than for type-B2 glenoids, but the differences were not statistically significant. In the total population of 61 shoulders, the radiographs showed postoperative glenoid erosion in 38 cases and no humeral prosthetic loosening. Revision arthroplasty was performed in 11 cases after 28 (7–69) months. The implant size had no statistically significant influence on the functional outcome. The size was considered to be adequate in 28 of the 50 functionally assessed shoulders. In 21 cases, the implant size was too large and in 1 case it was too small. Interpretation We found frequent postoperative glenoid erosion and a high rate of revision arthroplasty after humeral resurfacing for primary osteoarthritis. Oversizing of the implants was common, but it had no statistically significant influence on the functional outcome. Inferior

  14. Reconstruction of humeral length and centering of the prosthetic head in hemiarthroplasty for proximal humeral fractures.

    PubMed

    Greiner, Stefan H; Kääb, Max J; Kröning, Iris; Scheibel, Markus; Perka, Carsten

    2008-01-01

    Anatomic reconstruction of humeral length in hemiarthroplasty for complex proximal humeral fractures is difficult because reliable surgical landmarks are missing or are destroyed by the fracture. The pectoralis major tendon is a reliable landmark to determine prosthetic height intraoperatively. This study analyzed the clinical outcome, reconstruction of humeral length, centering of the prosthetic head in the glenoid, and tuberosity positioning and healing, using the pectoralis major tendon as a reference intraoperatively. The study included 30 patients. In 21 patients (group 1), humeral length reconstruction was performed using the pectoralis major tendon as a reference; in 9 (group 2), this reference was not used. Patients underwent a clinical and radiologic evaluation at a mean of 22.7 months. Group 1 showed significantly better results in clinical and radiologic values, especially in anatomic reconstruction of humeral length, than group 2. Clinical outcome depended significantly on greater tuberosity healing and centering of the prosthetic head in the glenoid. PMID:18621554

  15. [Surgical treatment of the occipital condyle fracture: case report].

    PubMed

    Gusmão, S S; Silveira, R L; Arantes, A

    2001-03-01

    We present a case of fracture of the occipital condyle showing neck pain, lesion of IX, X and XII cranial nerves and pyramidal syndrome of the four members. A review of the literature about the surgical treatment of the occipital condyle fracture is done.

  16. Expression of Superficial Zone Protein in Mandibular Condyle Cartilage

    PubMed Central

    Ohno, S; Schmid, T; Tanne, Y; Kamiya, T; Honda, K; Ohno-Nakahara, M; Swentko, N; Desai, T A; Tanne, K; Knudson, CB; Knudson, W

    2011-01-01

    Objective Superficial zone protein (SZP) has been shown to function in the boundary lubrication of articular cartilages of the extremities. However, the expression of SZP has not been clarified in mandibular cartilage which is a tissue that includes a thick fibrous layer on the surface. This study was conducted to clarify the distribution of SZP on the mandibular condyle and the regulatory effects of humoral factors on the expression in both explants and fibroblasts derived from mandibular condyle. Methods The distribution of SZP was determined in bovine mandibular condyle cartilage, and the effects of IL-1β and TGF-β on SZP expression were examined in condyle explants and, fibroblasts derived from the fibrous zone of condyle cartilage. Results SZP was highly distributed in the superficial zone of intact condyle cartilage. The SZP expression was up-regulated by TGF-β in both explants and cultured fibroblasts, whereas the expression was slightly down-regulated by IL-1β. A significant increase in accumulation of SZP protein was also observed in the culture medium of the fibroblasts treated with TGF-β. Conclusions These results suggest that SZP plays an important role in boundary lubrication of mandible condylar cartilage, is synthesized locally within the condyle itself and, exhibits differential regulation by cell mediators relevant to mandibular condyle repairing and pathologies. PMID:16563813

  17. Histomorphometric study on growing condyle of rat.

    PubMed

    Suzuki, S

    1986-03-01

    The purpose of this study was to carry out the histomorphometric assay on the mandibular condylar tissue of the growing rats. Male rats of the Wistar strain at the age of 3, 4, 6, 8 and 10 weeks were used. All rats were injected intravenously with tetracycline and calcein, respectively. They were killed 12 hours after calcein injection. Before embedding in acrylic resin, 3 reference points were marked directly on each condyle to establish the reference plane for the histomorphometry on the ground section. After preparing the ground section, the growth rate of the condyle was obtained by measuring the distance of the two different fluorescent labeling lines. Furthermore, the age-related changes of the relative distribution of the bone, calcified cartilage and prebone (uncalcified bone matrix) were measured under a light microscope by using a grid on the eyepiece reticle. The number of osteoblasts and osteoclasts were also calculated in the same specimen. The following results were obtained: The thickness of the cartilaginous layer and the growth rate of the endochondral bone formation decreased with age. The relative ratio of the bone area in the subchondral tissue increased constantly with age. PMID:3457644

  18. [Our physiotherapy treatment of articular fractures of the mandibular condyle].

    PubMed

    Lemière, E; Sicre, A; Vereecke, F; Brygo, A; Nicola, J; Ferri, J

    2003-04-01

    Physical therapy greatly contributes to improved function of the injured temporomandibular joint, particularly after trauma. In our unit, we use the Delaire rehabilitation method for patients presenting a fracture of the mandibular condyles. This method involves active mobilization, first with assistance, then with facilitation, and finally against resistance. A rehabilitation session starts with a preparation of the teguments and muscles associated with relaxation exercises. The joint is first mobilized by assisted movements if needed. When unassisted motion becomes possible, propulsion, diduction and open-close exercises are then performed with neuromuscular facilitation. When sufficient amplitudes have been achieved, the program proceeds with opposed exercises. By inducing propulsion and diduction (lateral pterygoid muscle) movements, physical therapy stimulates regeneration of the condylar unit, thus facilitating optimal functional rehabilitation. Posture and passive motion methods, which in our opinion are poorly adapted to the temporomandibular joint, are used little in our unit. Since condylar regeneration is controlled by functional factors, the lateral pterygoid muscle is an important element. Good functional outcome, and the absence of ankylosis, depends directly on the quality of active rehabilitation.

  19. 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

  20. TMJ in facial class III deformity. Condyle/fossa relations

    PubMed Central

    Muñoz, Gonzalo; Olate, Sergio; Cantín, Mario; Vásquez, Bélgica; del Sol, Mariano; Fariña, Rodrigo

    2014-01-01

    The aim of this study was to ascertain the joint space present in the TMJ of subjects diagnosed with Class III dentofacial deformity with an indication for orthognathic surgery. Fourteen subjects were recruited from the Division of Oral and Maxillofacial Surgery at the Universidad de La Frontera, Chile. All subjects were admitted to the study after signing an informed consent and undergoing cephalometric analyses to define the severity of the deformity. Then, the joint space was analyzed, studying a cone beam CT image of the TMJ, which was evaluated in the coronal and sagittal views, defining the most anterior, median and posterior joint space (sagittal view), as well as the lateral, median and medial joint space (coronal view). The data were recorded in millimeters by an observer and data were analyzed after measuring the same parameter at three different times. A student’s t-test was used for the analyses. Differences observed in both joints were not greater than 0.2 mm with spaces between 2 mm and 1.5 mm, thereby establishing the homogeneity of the sample, which presented no significant differences between the two joint spaces (right and left). It can be concluded that the joint space is symmetrical in both condyles and that no important changes are present compared to the results indicated in the international literature. PMID:25356133

  1. Osteochondroma of condyle: case discussion and review of treatment modalities

    PubMed Central

    Arora, Piyush; Deora, Shakti Singh; Kiran, Shital; Bargale, Seema Dinesh

    2014-01-01

    Temporomandibular joint (TMJ) forms a synovial articulation between the condyle and the cranium. It is a complex joint and shows hinge and gliding movements. Unlike other articulating heads, condyle grows with intramembranous ossification. TMJ is subjected to excessive loads throughout life as it supports essential functions such as mastication, deglutition, speech and respiration. Traumatic, neoplastic or non-neoplastic pathologies sometimes necessitate joint replacement therapy. Osteochondroma is one such benign tumour originating from condyle which requires surgical replacement of condyle with prosthesis. Various replacement methods have been designed in the past. Alloplastic grafts have been successfully used in joint replacement surgeries like hip joint, knee joint, etc. This case discussion supports the use of titanium-made condylar prosthesis for long-term functional stability of TMJ. PMID:24496065

  2. Vertical-split fracture of mandibular condyle and its sequelae.

    PubMed

    Hackett, J F; Sleeman, D J

    2001-11-24

    A case of vertical-split fracture of the right mandibular condyle and its sequelae is presented. The patient was a 16-year-old female being assessed for orthodontic treatment. Orthopantomograph and plain joint view radiographs showed a remodelled condyle which had suffered trauma 10 years previously. This type of fracture is unusual in nature but has not led to any secondary lack of growth, restriction of movement or facial asymmetry. PMID:11767857

  3. Humeral windows in revision total elbow arthroplasty

    PubMed Central

    Salama, Amir; Stanley, David

    2016-01-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery. PMID:27583011

  4. Humeral windows in revision total elbow arthroplasty.

    PubMed

    Peach, Chris A; Salama, Amir; Stanley, David

    2016-04-01

    The use of cortical windows for revision elbow arthroplasty has not previously been widely reported. Their use aids safe revision of a well fixed humeral prosthesis and can be used in the setting of dislocation, periprosthetic fracture or aseptic loosening of the ulnar component. We describe our technique and results of cortical windows in the distal humerus for revision elbow arthroplasty surgery. PMID:27583011

  5. Bony window approach for a traumatic bone cyst on the mandibular condyle: a case report with long-term follow-up

    PubMed Central

    2016-01-01

    Traumatic bone cyst (TBC) occurs preferentially on the mandibular symphysis and body, but rarely on the mandibular condyle. When TBC occurs in the condylar area, it can usually be related with or misdiagnosed as a temporomandibular joint disorder. A 15-year-old female patient visited the Temporomandibular Joint Clinic with a 5-year history of pain and noise localized in the left temporomandibular joint. On imaging, a well demarked oval-shaped radiolucent lesion was observed on the left condyle head. The patient underwent cyst enucleation and repositioning of the bony window on the lateral cortex of the affected condyle head under the impression of subchondral cyst or TBC; however, no cystic membrane was found. The bone defect resolved and showed no recurrence on the serial radiographic postoperative follow-up for 43 months after surgery.

  6. Bony window approach for a traumatic bone cyst on the mandibular condyle: a case report with long-term follow-up

    PubMed Central

    2016-01-01

    Traumatic bone cyst (TBC) occurs preferentially on the mandibular symphysis and body, but rarely on the mandibular condyle. When TBC occurs in the condylar area, it can usually be related with or misdiagnosed as a temporomandibular joint disorder. A 15-year-old female patient visited the Temporomandibular Joint Clinic with a 5-year history of pain and noise localized in the left temporomandibular joint. On imaging, a well demarked oval-shaped radiolucent lesion was observed on the left condyle head. The patient underwent cyst enucleation and repositioning of the bony window on the lateral cortex of the affected condyle head under the impression of subchondral cyst or TBC; however, no cystic membrane was found. The bone defect resolved and showed no recurrence on the serial radiographic postoperative follow-up for 43 months after surgery. PMID:27595088

  7. Bony window approach for a traumatic bone cyst on the mandibular condyle: a case report with long-term follow-up.

    PubMed

    Kim, Hyoung Keun; Lim, Jae-Hyung; Jeon, Kug-Jin; Huh, Jong-Ki

    2016-08-01

    Traumatic bone cyst (TBC) occurs preferentially on the mandibular symphysis and body, but rarely on the mandibular condyle. When TBC occurs in the condylar area, it can usually be related with or misdiagnosed as a temporomandibular joint disorder. A 15-year-old female patient visited the Temporomandibular Joint Clinic with a 5-year history of pain and noise localized in the left temporomandibular joint. On imaging, a well demarked oval-shaped radiolucent lesion was observed on the left condyle head. The patient underwent cyst enucleation and repositioning of the bony window on the lateral cortex of the affected condyle head under the impression of subchondral cyst or TBC; however, no cystic membrane was found. The bone defect resolved and showed no recurrence on the serial radiographic postoperative follow-up for 43 months after surgery. PMID:27595088

  8. Feasibility of purely endoscopic intramedullary fixation of mandibular condyle fractures.

    PubMed

    Frake, Paul C; Goodman, Joseph F; Joshi, Arjun S

    2015-01-01

    The investigators of this study hypothesized that fractures of the mandibular condyle can be repaired using short-segment intramedullary implants and purely endoscopic surgical technique, using a basic science, human cadaver model in an academic center. Endoscopic instrumentation was used through a transoral mucosal incision to place intramedullary implants of 2 cm in length into osteotomized mandibular condyles. The surgical maneuvers that required to insert these implants, including condyle positioning, reaming, implant insertion, and seating of the mandibular ramus, are described herein. Primary outcome was considered as successful completion of the procedure. Ten cadaveric mandibular condyles were successfully repaired with rigid intramedullary internal fixation without the use of external incisions. Both insertion of a peg-type implant and screwing a threaded implant into the condylar head were possible. The inferior portion of the implant remained exposed, and the ramus of the mandible was manipulated into position on the implant using retraction at the sigmoid notch. The results of this study suggest that purely endoscopic repair of fractures of the mandibular condyle is possible by using short-segment intramedullary titanium implants and a transoral endoscopic approach without the need for facial incisions or punctures. The biomechanical advantages of these intramedullary implants, including improved strength and resistance to mechanical failure compared with miniplates, have been recently established. The combination of improved implant design and purely endoscopic technique may allow for improved fixation and reduced surgical- and implant-related morbidity in the treatment of condylar fractures. PMID:25534058

  9. Overexpression of Dlx2 leads to postnatal condyle degradation

    PubMed Central

    Dai, Jiewen; Si, Jiawen; Zhu, Xiaofang; Zhang, Lei; Wu, Dandan; Lu, Jingting; Ouyang, Ningjuan; Wang, Xudong; Shen, Guofang

    2016-01-01

    Distal-less homeobox 2 (Dlx2), a member of the Dlx family of transcription factors, is important for the development of craniofacial tissues. Previous studies based on knock-out mutant mice revealed that Dlx2 primarily disturbed the development of tissues from maxillary arch. The present study used a transgenic mouse model to specifically overexpress Dlx2 in neural crest cells in order to investigate the role of Dlx2 overexpression in post-natal condyle in mice. The model was constructed and the phenotype observed using gross observation, micro-CT scan and histological examination. The model determined that overexpression of Dlx2 may lead to postnatal condyle malformation, subchondral bone degradation and irregular histological structure of the condylar cartilage. In addition, the expression of osteocalcin in the condyle region was markedly downregulated, whereas expression of msh homeobox 2 was upregulated. The results of the present study suggest that Dlx2 overexpression in cranial neural crest cells would disrupt the development of post-natal condyle, which demonstrates that the expression level and the spatiotemporal expression patterns of Dlx2 may be important in regulating the development of post-natal condyle in mice, and also offered a possible temporal-mandibular joint osteoarthritis model animal for future studies. PMID:27315306

  10. Evaluation of the reproducibility of the AO/ASIF classification for humeral shaft fractures☆

    PubMed Central

    Pignataro, Gustavo Soriano; Junqueira, André Elias; Matsunaga, Fabio Teruo; Matsumoto, Marcelo Hide; Belloti, João Carlos; Tamaoki, Marcel Jun Sugawara

    2015-01-01

    Objective To evaluate the reproducibility of the AO/Asif classification for humeral shaft fractures. Methods Consecutive radiographs of the arm in both anteroposterior and lateral view from 60 patients with humeral shaft fractures were analyzed. Six observers who were familiar with the AO/Asif classification (three shoulder and elbow surgery specialists and three general orthopedists) were selected to make the analysis, which was done at three different times. The data were subjected to statistical analysis using the kappa coefficient. Results The intra and interobserver concordance was statistically significant in all the analyses. Conclusions All the evaluators showed concordance between the three evaluations that was considered to be statistically significant. However, the highest values were found among the specialists. PMID:26417565

  11. Fragment fixation with a bone graft and dynamic staples for osteochondritis dissecans of the humeral capitellum.

    PubMed

    Harada, Mikio; Ogino, Toshihiko; Takahara, Masatoshi; Ishigaki, Daisuke; Kashiwa, Hideo; Kanauchi, Yumiko

    2002-01-01

    To attain bony union of the fragment in osteochondritis dissecans of the humeral capitellum, fragment fixation was performed with a bone graft and dynamic staples in 4 patients. The staples were inserted not from the articular surface but from the lateral aspect of the capitellum. All patients achieved bony union without complication, and 3 of them returned to playing competitive baseball. At final follow-up after surgery (mean, 7.5 years [range, 2.1-11 years]), 3 patients were able to throw a ball without pain and the remaining patient felt elbow dullness after he played recreational-level baseball as a pitcher. These results suggest that the procedure of fragment fixation with a bone graft and dynamic staples can provide satisfactory results for osteochondritis dissecans of the humeral capitellum with a large osteochondral fragment.

  12. Osteochondroma of mandibular condyle: A clinic-radiographic correlation

    PubMed Central

    More, Chandramani B.; Gupta, Swati

    2013-01-01

    Osteochondroma (OC) of temporo mandibular joint is a rare, slow growing, benign tumor that causes a progressive enlargement of the condyle, usually resulting in facial asymmetry, temporo mandibular joint (TMJ) dysfunction, limited mouth opening and malocclusion. Pain is rarely associated with this tumor. OC is composed of cartilaginous and osseous tissues. Radiographically, there is unilaterally enlarged condyle usually with an exophytic outgrowth of the tumor from the condylar head. We present a rare case of osteochondroma of right mandibular condyle in a 45-year-old male who reported with painless swelling over TMJ area and progressive limited mouth opening. Panoramic radiograph and computed tomography (CT) was performed for better evaluation of the pathological condition. This paper describes the clinico-radiographic features and differential diagnosis of OC. PMID:24082753

  13. Conservative orthodontic treatment of mandibular bilateral condyle fracture.

    PubMed

    Gašpar, Goran; Brakus, Ivan; Kovačić, Ivan

    2014-09-01

    Maxillofacial trauma is rare in children younger than the age of 5 years (range 0.6%-1.2%), and they can require different clinical treatment strategies compared with fractures in the adult population because of concerns regarding mandibular growth and development of dentition. A 5-year-old girl with a history of falling from a bicycle 7 hours earlier was referred to the department of oral and maxillofacial surgery. Multislice computed tomographic examination demonstrated a bilateral fracture of the mandibular condyle neck associated with minimal fracture of the alveolar ridge of the maxilla. The multislice computed tomographic scan also demonstrated dislocation on the right condyle neck and, on the left side, a medial inclination of approximately 45 degrees associated with greenstick fracture of the right parasymphysis region. In this particular case, orthodontic rubber elastics in combination with fixed orthodontic brackets provided good results in the treatment of bilateral condyle neck fractures associated with greenstick fracture of parasymphysis.

  14. Osteochondroma of Bilateral Mandibular Condyle with Review of Literature.

    PubMed

    Kamble, Vijaya; Rawat, Jitesh; Kulkarni, Ameya; Pajnigara, Nilufer; Dhok, Avinash

    2016-08-01

    Osteochondroma (OC) is a common slow growing tumour of bone. This lesion is frequently seen in the axial skeleton and is relatively uncommon in oral and maxillofacial region. In facial bones, it usually affects the mandibular condyle followed by coronoid process. Very few cases of condylar osteocondroma have been reported in the literature. The aim of this article was to present an atypical case of osteochondroma of bilateral mandibular condyle in an asymptomatic patient and facilitate making an exact diagnosis of it. To the best of our knowledge this is the 2(nd) case of this type reported in literature. PMID:27656529

  15. Osteochondroma of Bilateral Mandibular Condyle with Review of Literature

    PubMed Central

    Kamble, Vijaya; Kulkarni, Ameya; Pajnigara, Nilufer; Dhok, Avinash

    2016-01-01

    Osteochondroma (OC) is a common slow growing tumour of bone. This lesion is frequently seen in the axial skeleton and is relatively uncommon in oral and maxillofacial region. In facial bones, it usually affects the mandibular condyle followed by coronoid process. Very few cases of condylar osteocondroma have been reported in the literature. The aim of this article was to present an atypical case of osteochondroma of bilateral mandibular condyle in an asymptomatic patient and facilitate making an exact diagnosis of it. To the best of our knowledge this is the 2nd case of this type reported in literature. PMID:27656529

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

    PubMed Central

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

    2015-01-01

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

  17. Humeral head translation after a suprascapular nerve block.

    PubMed

    San Juan, Jun G; Kosek, Peter; Karduna, Andrew R

    2013-08-01

    Subacromial impingement syndrome is the most common shoulder disorder. Abnormal superior translation of the humeral head is believed to be a major cause of this pathology. The first purpose of the study was to examine the effects of suprascapular nerve block on superior translation of the humeral head and scapular upward rotation during dynamic shoulder elevation. The secondary purpose was to assess muscle activation patterns during these motions. Twenty healthy subjects participated in the study. Using fluoroscopy and electromyography, humeral head translation and muscle activation were measured before and after a suprascapular nerve block. The humeral head was superiorly located at 60 degrees of humeral elevation, and the scapula was more upwardly rotated from 30 to 90 degrees of humeral elevation after the block. The differences were observed during midrange of motion. In addition, the deltoid muscle group demonstrated increased muscle activation after the nerve block. The study's results showed a compensatory increase in humeral head translation, scapular upward rotation, and deltoid muscle activation due to the nerve block. These outcomes suggest that increasing muscular strength and endurance of the supraspinatus and infraspinatus muscles could prevent any increased superior humeral head translation. This may be beneficial in reducing shoulder impingement or rotator cuff tears over time. PMID:22927503

  18. Can scapular and humeral head position predict shoulder pain in adolescent swimmers and non-swimmers?

    PubMed

    McKenna, Leanda; Straker, Leon; Smith, Anne

    2012-12-01

    The aims of this study were to determine whether scapular and humeral head position can predict the development of shoulder pain in swimmers, whether those predictors were applicable to non-swimmers and the annual rate of shoulder pain in adolescent swimmers and non-swimmers. Forty-six adolescent swimmers and 43 adolescent non-swimmers were examined prospectively with a questionnaire and anthropometric measures. The questionnaire examined demographic and training variables. Anthropometric measures examined the distances between the T7 spinous process and the inferior scapula (Inferior Kibler) and T3 spinous process and the medial spine of the scapula (Superior Kibler), humeral head position in relation to the acromion using palpation, BMI and chest width. Shoulder pain was re-assessed 12 months later by questionnaire. Shoulder pain in swimmers was best predicted by a larger BMI (OR = 1.48, P = 0.049), a smaller Inferior Kibler distance in abduction (e.g. OR = 0.90, P = 0.009) and a smaller horizontal distance between the anterior humeral head and the anterior acromion (OR = 0.76, P = 0.035). These variables were not significantly predictive of shoulder pain in non-swimmers. Annual prevalence of shoulder pain was 23.9% in swimmers and 30.8% in non-swimmers (χ(2) = 0.50, P = 0.478).

  19. Conversion to Reverse Shoulder Arthroplasty: Humeral Stem Retention Versus Revision.

    PubMed

    Dilisio, Matthew F; Miller, Lindsay R; Siegel, Elana J; Higgins, Laurence D

    2015-09-01

    As the volume of shoulder arthroplasty procedures performed in the United States continues to increase, the predicted number of revision shoulder arthroplasties grows even higher. Conversion of failed shoulder arthroplasty to reverse total shoulder arthroplasty has become common. Many commercially available shoulder arthroplasty systems now offer a platform humeral stem that is used for both anatomic shoulder arthroplasty and reverse total shoulder arthroplasty. This study investigated whether retaining the humeral stem offers advantages over revising the humeral stem in conversion of failed shoulder arthroplasty to reverse total shoulder arthroplasty. The study included 26 patients (mean age, 68.46 years) with failed shoulder arthroplasty who underwent conversion to reverse total shoulder arthroplasty with a minimum 2-year follow-up (mean, 34.38 months). Patients who had retention of the humeral stem were compared with those who had stem revision. Humeral stem retention was associated with a significantly shorter operative time (178.92 vs 237 minutes, P=.02). Decreases in blood loss, complications, and length of hospitalization were observed, but the differences were not statistically significant. Minimal differences were observed for patient-reported outcomes. Of patients undergoing humeral stem removal, 21.4% had an intraoperative humeral shaft or tuberosity fracture compared with none in the stem retention group. Humeral stem retention was associated with decreased operative time compared with humeral stem revision in the conversion of failed shoulder arthroplasty to reverse total shoulder arthroplasty. The use of a platform shoulder arthroplasty system may benefit patients with failed shoulder arthroplasty undergoing conversion to reverse total shoulder arthroplasty by avoiding humeral stem revision. PMID:26375534

  20. Bilateral metastatic spread of testicular teratoma to mandibular condyles.

    PubMed

    Porter, S R; Chaudhry, Z; Griffiths, M J; Scully, C; Kabala, J; Whipp, E

    1996-09-01

    The clinical and radiological features of a patient with metastatic spread of testicular teratoma to both mandibular condyles are presented. It is suggested that in patients with known systemic malignancy, a local metastatic deposit should be considered as a possible cause of unexplained pain in the temporomandibular joints.

  1. Cone Beam Computed Tomographic Assessment of Bifid Mandibular Condyle

    PubMed Central

    Khojastepour, Leila; Kolahi, Shirin; Panahi, Nazi

    2015-01-01

    Objectives: Differential diagnosis of bifid mandibular condyle (BMC) is important, since it may play a role in temporomandibular joint (TMJ) dysfunctions and joint symptoms. In addition, radiographic appearance of BMC may mimic tumors and/or fractures. The aim of this study was to evaluate the prevalence and orientation of BMC based on cone beam computed tomography (CBCT) scans. Materials and Methods: This cross-sectional study was performed on CBCT scans of paranasal sinuses of 425 patients. In a designated NNT station, all CBCT scans were evaluated in the axial, coronal and sagittal planes to find the frequency of BMC. The condylar head horizontal angulations were also determined in the transverse plane. T-test was used to compare the frequency of BMC between the left and right sides and between males and females. Results: Totally, 309 patients with acceptable visibility of condyles on CBCT scans were entered in the study consisting of 170 (55%) females and 139 (45%) males with a mean age of 39.43±9.7 years. The BMC was detected in 14 cases (4.53%). Differences between males and females, sides and horizontal angulations of condyle of normal and BMC cases were not significant. Conclusion: The prevalence of BMC in the studied population was 4.53%. No significant difference was observed between males and females, sides or horizontal angulations of the involved and uninvolved condyles. PMID:27559345

  2. 21 CFR 872.4770 - Temporary mandibular condyle reconstruction plate.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... device that is intended to stabilize mandibular bone and provide for temporary reconstruction of the... surgical procedures requiring removal of the mandibular condyle and mandibular bone. This device is not intended for treatment of temporomandibular joint disorders. (b) Classification. Class II (special...

  3. 21 CFR 872.3960 - Mandibular condyle prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ...) Date PMA or notice of completion of a PDP is required. (1) Except as described in paragraph (c)(2) of this section, a PMA or a notice of completion of a PDP is required to be filed with the Food and Drug... other mandibular condyle prosthesis shall have an approved PMA or a declared completed PDP in...

  4. Chondrocyte distribution in the articular cartilage of human femoral condyles.

    PubMed Central

    Gilmore, R S; Palfrey, A J

    1988-01-01

    The distribution of chondrocytes throughout the total thickness of articular cartilage from the femoral condyles of infants, children and adults has been studied using serial sections cut parallel as well as perpendicular to the articular surface. The thickness of the articular cartilage was estimated in fixed sections. In one of the adult specimens, the thickness of the articular cartilage was estimated firstly by direct measurement of the cut surfaces of a series of blocks cut from both condyles and then from the number of parallel sections of the cartilage prepared from those blocks. Cell density was highest in the superficial zone of all specimens examined, declining to lower values in the deep zone of the cartilage. Within this pattern the infant specimens had the highest values for cell density and the adults the lowest, with values for children in an intermediate range. There was no significant variation in cell density across the condyles of the selected adult specimen. The absolute values for cartilage thickness depended on the method used, but in general total thickness was found to approximately double from late gestation to maturity. In the selected adult specimen, the cartilage was thickest just anterior and posterior to the main weight-bearing area of the condyles. PMID:3198480

  5. Ewing's sarcoma of proximal humeral epiphysis.

    PubMed

    Esmaili, Heydar Ali; Niknejad, Mohammad Taghi; Mohajeri, Shiva

    2015-02-01

    Ewing's sarcoma is one of the most common primary bone tumors of childhood. The tumor is almost always metaphyseal or diaphyseal, within long bones. In children, lesions of the epiphysis are often benign, with the most common diagnosis being chondroblastoma. Rarely, 1%-2% of Ewing sarcomas may involve epiphysis. We present a case of Ewing's sarcoma of the proximal humeral epiphysis in a 13-year-old boy. This case adds to previously reported cases of epiphyseal Ewing sarcoma and suggests that the diagnosis should be considered for pediatric epiphyseal lesions. PMID:25644805

  6. Fractures of the proximal humeral epiphysis.

    PubMed

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

    1993-01-01

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

  7. Anatomical and Functional Recovery of Intracapsular Fractures of the Mandibular Condyle: Analysis of 124 Cases after Closed Treatment

    PubMed Central

    Lee, Jong-Sung; Jeon, Eun-Gyu; Seol, Guk-Jin; Choi, So-Young; Kim, Jin-Wook; Kwon, Tae-Geon; Paeng, Jun-Young

    2014-01-01

    Purpose: The purpose of this study is to evaluate the influence of intracapsular fracture lines of the mandibular condyle on the anatomical and functional recovery after non-surgical closed treatment. Methods: Clinical and radiological follow-up of 124 patients with intracapsular fractures of the mandibular condyle was performed after closed treatment between 2005 and 2012. The intracapsular fractures were classified into three categories: type A (medial condylar pole fracture), type B (lateral condylar pole fracture with loss of vertical height) and type M (multiple fragments or comminuted fracture). Results: By radiological finding, fracture types B and M lost up to 24% vertical height of the mandibular condyle compared to the height on the opposite side. In Type M, moderate to severe dysfunction was observed in 33% of the cases. Bilateral fractures were significantly associated with the risk of temporomandibular joint (TMJ) dysfunction in fracture types A and B. Bilateral fracture and TMJ dysfunction were not statistically significantly associated in type M fractures. Conclusion: Most of the mandibular intracapsular condylar fractures recovered acceptably after conservative non-surgical treatment with functional rehabilitation, even with some anatomical shortening of the condylar height. The poor functional recovery encountered in type M fractures, especially in cases with additional fracture sites and bilateral fractures, points up the limitation of closed treatment in such cases. PMID:27489844

  8. A novel approach to neoplasms medial to the condyle: a condylectomy with anterior displacement of the condyle.

    PubMed

    Ye, Z-X; Yang, C; Chen, M-J; Abdelrehem, A

    2016-04-01

    Resecting neoplasms involving the infratemporal space has a high risk of damaging critical nerves and vessels, in addition to joint form and function. The purpose of this study was to introduce a novel approach to lesions medial to the condyle, which comprises a condylectomy with anterior displacement of the condyle. The indications evaluated using digital surgical simulation, the critical surgical technique, and the preliminary clinical effects are presented here. Five cases underwent this approach between January 2006 and December 2014. The common characteristics of the five masses were (1) that they were non-malignant neoplasms involving the posterior-medial region of the condyle; (2) the upper and lower borders were between the skull base and the lingula, while the anterior border did not exceed the coronoid process. All masses were resected successfully with no damage to any critical nerves or vessels. The average follow-up period was 29.8 months (range 6-56 months). There was no recurrence, secondary deformity, or facial paralysis. The average mouth opening improved from an original 27 mm to 34 mm after surgery. The condyles were well fixed, with no resorption, as shown on computed tomography scans. PMID:26748864

  9. Updated Classification System for Proximal Humeral Fractures

    PubMed Central

    Guix, José M. Mora; Pedrós, Juan Sala; Serrano, Alejandro Castaño

    2009-01-01

    Proximal humeral fractures can restrict daily activities and, therefore, deserve efficient diagnoses that minimize complications and sequels. For good diagnosis and treatment, patient characteristics, variability in the forms of the fractures presented, and the technical difficulties in achieving fair results with surgical treatment should all be taken into account. Current classification systems for these fractures are based on anatomical and pathological principles, and not on systematic image reading. These fractures can appear in many different forms, with many characteristics that must be identified. However, many current classification systems lack good reliability, both inter-observer and intra-observer for different image types. A new approach to image reading, following a well-designed set and sequence of variables to check, is needed. We previously reported such an image reading system. In the present study, we report a classification system based on this image reading system. Here we define 21 fracture characteristics and apply them along with classical Codman approaches to classify fractures. We base this novel classification system for classifying proximal humeral fractures on a review of scientific literature and improvements to our image reading protocol. Patient status, fracture characteristics and surgeon circumstances have been important issues in developing this system. PMID:19574487

  10. Humeral bone fragility in patients with shoulder prosthesis: a case of humeral periprosthetic refracture

    PubMed Central

    Giannotti, Stefano; Bottai, Vanna; Dell’Osso, Giacomo; Donati, Daniela; Bugelli, Giulia; De Paola, Gaia; Guido, Giulio

    2012-01-01

    Summary In recent decades there has been an increase in upper limb prosthetic surgery, primarily for the shoulder, for osteoarthritis disease and for traumatic pathology. It is occurring in parallel an increase in periprosthetic fractures of the humerus, although with less impact than other anatomical districts such as the hip. We report a case of humeral periprosthetic refracture in a 66-years-old female patient. The humerus bone quality is worse than in other districts in patient of the same age. The fragility humerus fracture are increasing, affecting relatively younger individuals than those with femoral neck fractures and represent an independent risk factor for the occurrence of subsequent fractures. Actually humeral BMD is underestimated by traditional densitometric evaluation techniques. PMID:22783338

  11. Conservative condylectomy for management of osteochondroma of the mandibular condyle.

    PubMed

    de Melo, Willian Morais; Pereira-Santos, Darklilson; Sonoda, Celso Koogi; de Moura, Walter Leal; de Paulo-Cravinhos, Julio César

    2013-05-01

    Osteochondroma is one of the most common benign tumors of the skeleton. This tumor is rare in the craniofacial region, with the most common sites of occurrence being the coronoid process of the mandible and the mandibular condyle. Traditionally, the treatments of these lesions include total condylectomy or local resection of the lesion. Conservative condylectomy procedure with reshaping of the remaining condylar neck and repositioning of the articular disk has been suggested. This article aimed to describe a 35-year-old woman with osteochondroma in the left mandibular condyle who was treated by conservative condylectomy. The patient has been free of recurrence for 2 years, showing good aesthetic and functional stability. PMID:23714962

  12. A geometric morphometric analysis of the medial tibial condyle of African hominids.

    PubMed

    Sylvester, Adam D

    2013-10-01

    Although the hominid knee has been heavily scrutinized, shape variation of the medial tibial condyle has yet to be described. Humans, chimpanzees, and gorillas differ in the shape of their medial femoral condyles and in their capacity for external and internal rotation of the tibia relative to the femur. I hypothesize that these differences should be reflected in the shape of the medial tibial condyle of these hominids. Here I use geometric morphometric techniques to uncover shape differences between the medial tibial condyles of humans, chimpanzees, and gorillas. Humans are distinguished from the other two species by having a much more oval-shaped medial tibial condyle, while those of chimpanzees and gorillas are more triangular in outline. Gorillas (especially males) are distinguished by having more concavely-curved condyles (mediolateral direction), which is interpreted as an effect of heavy loading through the medial compartment of the knee in conjunction with differences in the degree of arboreality.

  13. Revision of failed humeral head resurfacing arthroplasty

    PubMed Central

    Streubel, Philipp N.; Simone, Juan P.; Cofield, Robert H.; Sperling, John W.

    2016-01-01

    Purpose: The purpose of this study is to assess the outcomes of a consecutive series of patients who underwent revision surgery after humeral head resurfacing (HHR). Our joint registry was queried for all patients who underwent revision arthroplasty for failed HHR at our institution from 2005 to 2010. Eleven consecutive patients (average age 54 years; range 38-69 years) that underwent revision of 11 resurfacing arthroplasties were identified. The primary indication for resurfacing had been osteoarthritis in six, glenoid dysplasia in two, a chondral lesion in two, and postinstability arthropathy in one patient. The indication for revision was pain in 10 and infection in one patient. Seven patients had undergone an average of 1.9 surgeries prior to resurfacing (range 1-3). Materials and Methods: All patients were revised to stemmed arthroplasties, including one hemiarthroplasty, two reverse, and eight anatomic total shoulder arthroplasties at a mean 33 months after primary resurfacing (range 10-131 months). A deltopectoral approach was used in seven patients; four patients required an anteromedial approach due to severe scarring. Subscapularis attenuation was found in four cases, two of which required reverse total shoulder arthroplasty. Bone grafting was required in one glenoid and three humeri. Results: At a mean follow-up of 3.5 years (range 1.6-6.9 years), modified Neer score was rated as satisfactory in five patients and unsatisfactory in six. Abduction and external rotation improved from 73° to 88° (P = 0.32) and from 23° to 32° (P = 0.28) respectively. Reoperation was required in two patients, including one hematoma and one revision for instability. Conclusion: Outcomes of revision of HHR arthroplasty in this cohort did not improve upon those reported for revision of stemmed humeral implants. A comparative study would be required to allow for definitive conclusions to be made. PMID:26980986

  14. 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

  15. Tuberculous osteomyelitis of mandibular condyle: A rare encounter.

    PubMed

    Kumar, Sanjay; Mohan, S; Lav, Rupali; John, Bobby

    2015-01-01

    Tuberculosis (TB), one of the oldest known microbial infectious diseases affecting humans has continued to burden our healthcare system over generations. Conventionally, primary TB usually manifests as a pulmonary infection. However, the last decade has witnessed increasing reports of extrapulmonary infections. It's often atypical clinical presentations require a high degree of clinical suspicion, especially in the developing countries with a high incidence of this infectious disease. In this report, we present one such case of tuberculous osteomyelitis of the mandibular condyle where the patient reported with the complaint of swelling on the left side of the face with no apparent systemic manifestation. PMID:27390500

  16. Parosteal chondrosarcoma, a very rare condition of the mandibular condyle.

    PubMed

    Bernasconi, Giorgio; Preda, Lorenzo; Padula, Ernesto; Baciliero, Ugo; Sammarchi, Luigi; Bellomi, Massimo

    2004-01-01

    We present a rare case of parosteal chondrosarcoma of the madibular condyle. The patient was referred for a functional limitation of the left temporo-mandibular joint. CT and MRI examinations demonstrated a 3.5-cm cystic mass with a peripheral rim of contrast enhancement located in the left pterygo-maxillary space. The mass had partial intraarticular spread causing deformation and focal cortical erosion of the medial aspect of the condylar head. The lesion was surgically removed; the histological diagnosis was of low-grade chondrosarcoma.

  17. Total Humeral Endoprosthetic Replacement following Excision of Malignant Bone Tumors

    PubMed Central

    Kotwal, Suhel; Moon, Bryan; Lin, Patrick; Satcher, Robert; Lewis, Valerae

    2016-01-01

    Humerus is a common site for malignant tumors. Advances in adjuvant therapies and reconstructive methods provide salvage of the upper limb with improved outcomes. Reports of limb salvage with total humeral replacement in extensive humeral tumors are sparse. We undertook a retrospective study of 20 patients who underwent total humeral endoprosthetic replacement as limb salvage following excision of extensile malignant tumor from 1990 to 2011. With an average followup of 42.9, functional and oncological outcomes were analyzed. Ten patients were still alive at the time of review. Mean estimated blood loss was 1131 mL and duration of surgery was 314 minutes. Deep infection was encountered in one patient requiring debridement while mechanical loosening of ulnar component was identified in one patient. Subluxation of prosthetic humeral head was noted in 3 patients. Mean active shoulder abduction was 12.5° and active flexion was 15°. Incompetence of abduction mechanism was the major determinant of poor active functional outcome. Mean elbow flexion was 103.5° with 30.5° flexion contracture in 10 patients with good and useful hand function. Average MSTS score was 71.5%. Total humeral replacement is a reliable treatment option in restoring mechanical stability and reasonable functional results without compromising patient survival, with low complication rate. PMID:27042158

  18. Orthopaedic Approaches to Proximal Humeral Fractures Following Trauma

    PubMed Central

    Mafi, Reza; Khan, Wasim; Mafi, Pouya; Hindocha, Sandip

    2014-01-01

    Proximal humeral fractures have been a topic of discussion in medical literature dating back as far as 3rd century BC. Today, these fractures are the most common type of humeral fractures and account for about 5-6% of all fractures in adults with the incidence rising rapidly with age. In broad terms the management of proximal humeral fractures can be divided into two categories: conservative versus surgical intervention. The aim of treatment is to stabilize the fracture, aid better union and reduce pain during the healing process. Failure to achieve this can result in impairment of function, and significantly weaken the muscles inserting onto the proximal humerus. With the rising incidence of proximal humeral fractures, especially among the elderly, the short and long term burden for patients as well as the wider society is increasing. Furthermore, there is a lack of consistency in the definitive treatment and management of displaced fractures. This systematic review of literature compares the surgical treatment of proximal humeral fractures with their conservative management, by evaluating the available randomised controlled trials on this topic. PMID:25408786

  19. HUMERAL NAIL: COMPARISON OF THE ANTEGRADE AND RETROGRADE APPLICATION.

    PubMed

    Bencić, Ivan; Cengić, Tomislav; Prenc, Jakov; Bulatović, Nikola; Matejcić, Aljoša

    2016-03-01

    Application of humeral nail in the treatment of humeral shaft fractures is a relatively novel method of fracture fixation. Its application at Clinical Department of Traumatology, Sestre milosrdnice University Hospital Center began in 2001. The operative procedure should be performed using a minimally invasive technique without fracture opening in order to maintain optimal conditions for fracture healing including hematoma management. However, in everyday practice it is often impossible to obtain satisfactory fracture reduction using the closed procedure, so open reduction and additional fixation with wires or screws are mandatory. Over the last 14 years, fixation of fractures with the locking nail was performed in more than 400 patients. Cases of pseudarthrosis and pathological fractures were also managed successfully. There were more female patients. The mean time from injury to surgery was 2.4 days. Surgery was performed immediately upon admission to the emergency service whenever possible. This study comprised 234 patients with humeral shaft fractures treated with the humeral nail (antegrade insertion was applied in 103 and retrograde in 131 patients). The aim of the study was to stress out the complexity of appropriate operative treatment of humeral shaft fractures using intramedullary fixation, as well as the importance of proper reduction and stable fixation. PMID:27333726

  20. A Review of Management Options for Proximal Humeral Fractures

    PubMed Central

    Jordan, Robert W; Modi, Chetan S

    2014-01-01

    Proximal humeral fractures are common and although the majority can be managed non-operatively, the optimal treatment of displaced or complex fractures remains controversial. Non-operative treatment is typically selected for minimally displaced fractures where union rates are high and good or excellent outcomes can be expected in approximately 80% of cases. The aims of surgical fixation are to restore articular surface congruency, alignment and the relationship between the tuberosities and the humeral head. Hemiarthroplasty provides patients with reliable pain relief and its indications include fracture dislocations, humeral head splitting fractures and some three- and four- part fractures. The key areas of surgical technique that influence functional outcome include correctly restoring the humeral height, humeral version and tuberosity position. Function, however, is poor if the tuberosities either fail to unite or mal-unite. The interest in reverse shoulder arthroplasty as an alternative option has therefore recently increased, particularly in older patients with poor bone quality and tuberosity comminution. The evidence supporting this, however, is currently limited to multiple case series with higher level studies currently underway. PMID:25067968

  1. Bridging plate osteosynthesis of humeral shaft fractures.

    PubMed

    Livani, Bruno; Belangero, William Dias

    2004-06-01

    This study was approved by the Ethics Committee of the Faculty of Medical Sciences and developed during November 2000 and July 2001 in the Orthopedic and Traumatology Department of UNICAMP. There were 15 patients, 11 males, age between 14 and 66 years. All fractures were unilateral. Of the 15 patients eight were polytraumatised, two of them had open fractures. The others had an isolated fracture of the humerus, of which one was open. None of the patients had previous lesions of the radial nerve, but in two patients there was a lesion of the brachial plexus. All of the patients underwent a bridging plate osteosynthesis of the humeral shaft fractures using only two small incisions proximal and distal to the fracture site. We used broad or narrow D.C.P. plates for large fragments mostly with 12 holes, fixed with two or three screws at each end. All cases united with an average time of 8-12 weeks, with the exception of one case with a grade III open fracture and a brachial plexus lesion on the same side. We had no major complications. All patients recovered good function of the limb without significant residual deformity. PMID:15135278

  2. Pectoralis major insertional ratio in proximal humerus fractures: a method to reconstruct humeral head height in arthroplasty.

    PubMed

    Hasan, S Ashfaq; Rauls, Russell B; Cordell, Cari L; Heinzelmann, Andrew D; Siegel, Eric R

    2009-10-01

    A key factor for a successful outcome after hemiarthroplasty for a 4-part proximal humerus fracture is accurately restoring humeral length. Our hypothesis was that the pectoralis major insertion is not at a constant distance on the humerus, as has been previously suggested, but varies depending on the length of the humerus, and our goal was to determine if a consistent ratio exists for the insertion as it relates to total humeral length. Thirty-eight cadaver arms were dissected to expose the pectoralis major insertion. Using a digital caliper, measurements were made from the top of the humeral head to the superior aspect of the pectoralis major insertion (HP), and from the pectoralis insertion to the lateral epicondyle (PL). The predictive ability of PL for HP was examined via regression, and the average prediction error was computed. The final predictive regression model had the following formula: pHP=0.2323xPL, where pHP is predicted HP. This equation had an average prediction error of 4.11 mm. The PL can be measured intraoperatively during hemiarthroplasty for proximal humerus fractures. The proportionality relationship can then be used to predict HP with an average prediction error <5 mm. This relationship may facilitate accurate intraoperative reconstruction of prosthetic head height and enhance existing techniques for assessment of implant positioning.

  3. Occipital condyle fractures: report of five cases and literature review.

    PubMed

    Caroli, Emanuela; Rocchi, Giovanni; Orlando, Epimenio Ramundo; Delfini, Roberto

    2005-06-01

    Occipital condyle fractures (OCFs) are uncommon and potentially fatal lesions. After the advent of CT, prompt diagnosis can be readily made and consequently better prognosis of these patients is expected. Early recognition of some types of OCF is imperative to avoid fatal results. We analyzed 121 cases of OCF (116 from the literature and five of our own). Rarely patients with a deficit of the lower cranial nerves make a complete recovery. However, quoad vitam prognosis of patients with "pure OCFs" remains good. Immobilization provides good recovery of most OCFs, but delay of treatment can lead to serious morbidity. We want to emphasize that not only an OCF with instability of O-C1-C2 can be a fatal injury unless prompt surgical intervention, but a displacement and migration of the fractured condylar fragment can also result in a fatal outcome. A high level of suspicion is fundamental for the early diagnosis of these fractures, so that when a posterior basal cranial or occipital squama fracture occurs, a CT study of the occipital condyles becomes imperative.

  4. A simple technique for double plating of extraarticular distal humeral shaft fractures.

    PubMed

    Sharaby, Mohamed; Elhawary, Ahmed

    2012-12-01

    Plate fixation of extraarticular distal humeral shaft fracture is often difficult. Traditional techniques do not allow for stable fixation. A single DCP plate may have inadequate purchase in the distal fragment. The use of large plates extending distally over the lateral supracondylar ridge is often associated with pain and sometimes interferes with elbow range of motion. In this study, 22 patients with extra articular distal humeral fractures were managed with dual plating using a paratricipital approach. The first plate--a narrow DCP--was fixed on the dorsal surface of the humerus. The second plate--a small 3.5 reconstruction plate--was fixed on the dorsolateral surface. Elbow motion was started immediately after surgery. The average follow-up duration was 25 months. The mean elbow flexion/extension are was 4 degrees to 138 degrees. Infection was reported in two cases and was managed successfully with conservative measures. Postoperative radial nerve contusion was reported in one case with complete resolution within 3 months.

  5. Management of Humeral Shaft Fractures; Non-Operative Versus Operative

    PubMed Central

    Clement, Nicholas D.

    2015-01-01

    Context: Functional humeral bracing remains the gold standard for treatment of humeral shaft fractures. There is an increasing trend in the literature to perform operative fixation of these fractures. Evidence Acquisition: The aim of this systematic review was to compare the level one evidence for the outcome of non-operative with operative management of humeral shaft fractures in adults. A comprehensive electronic literature search of Medline and PubMed was performed with specific inclusion criteria to identify randomized controlled trials. Results: In total, seventeen different studies were identified from the search terms and combinations used. Only one study met the inclusion criteria; however, this was a published study protocol of an ongoing trial currently being conducted. One additional published protocol for an ongoing trial was also identified, but this was for a prospective comparative observational study. Although this latter study may not be level one evidence, it would offer great insight into the functional outcome of humeral shaft fractures and economic implications of operative management, which is currently not addressed in the literature. Two retrospective comparative studies were also identified, one of which demonstrated a significantly lower rate of nonunion and malunion in those patients undergoing operative management. Conclusions: This systematic review demonstrated a deficiency in the current literature of level one evidence available for the management of humeral shaft fractures. The current ongoing randomized control trail would offer a greater insight into the management of humeral shaft fractures and help confirm or refute the current literature. If this randomized control trial affirms the reduction in the rate of nonunion with operative fixation, a cost economic analysis is essential. As it would seem to offer operative management to all patients may be over treatment and not to offer this at all would undertreat. PMID:26401493

  6. The 5.5-year results of MegaOATS – autologous transfer of the posterior femoral condyle: a case-series study

    PubMed Central

    Braun, Sepp; Minzlaff, Philipp; Hollweck, Regina; Wörtler, Klaus; Imhoff, Andreas B

    2008-01-01

    Introduction Large osteochondral defects of the weight-bearing zones of femoral condyles in young and active patients were treated by autologous transfer of the posterior femoral condyle (large osteochondral autogenous transplantation system (MegaOATS)). The technique presented is a sound and feasible salvage procedure to address large osteochondral defects in weight-bearing zones. Methods Thirty-six patients between July 1996 and December 2000 were included. Thirty-three patients (10 females, 23 males) were evaluated by the Lysholm score and X-ray scans. A random sample of 16 individuals underwent magnetic resonance imaging analysis. The average age at the date of surgery was 34.3 (15 to 59) years, and the mean follow up was 66.4 (46 to 98) months. The mean defect size was 6.2 (2 to 10.5) cm2, in 27 patients affecting the medial femoral condyle and in six patients affecting the lateral femoral condyle. Trauma or osteochondrosis dissecans were pathogenetic in 82%. Results The Lysholm score in all 33 individuals showed a highly significant increase from a preoperative median 49.0 points to a median 86.0 points (P ≤ 0.001). Twenty-seven patients returned to recreational sports. X-ray scans showed a rounding of the osteotomy edge in 24 patients, interpreted as a partial remodelling of the posterior femoral condyle. Preoperative osteoarthritis in 17 individuals was related to significant lower Lysholm scores (P = 0.014), but progression in 17 patients did not significantly influence the score results (P = 0.143). All 16 magnetic resonance imaging examinations showed vital and congruent grafts. Conclusion Patients significantly improve in the Lysholm score, in daily-life activity levels and in return to recreational sports. Thirty-one out of 33 patients were comfortable with the results and would undergo the procedure again. The MegaOATS technique is therefore recommended as a salvage procedure for young individuals with large osteochondral defects in the weight

  7. Changes in mechanical properties of bone within the mandibular condyle with age.

    PubMed

    Huja, Sarandeep S; Rummel, Andrew M; Beck, Frank M

    2008-02-01

    The purpose of the study was to compare indentation modulus (IM) and hardness of condylar bone in young and adult dogs. In addition we desired to examine histologic sections for bone formation activity in the two groups. Mandibular condyles were obtained from adult (1- to 2-year-old) and young (approximately 5-m old) dogs. Two sections/condyle were obtained and one was processed for histomorphometry and the other for mechanical analyses. Indents were made on moist condylar trabecular bone to a depth of 500 nm at a loading rate of 10 nm/s using a custom-made hydration system to obtain IM and hardness. Histomorphometric analyses measured the bone volume/total volume (BV/TV%) and ratio of labeled to unlabeled bone within the condyle. Data were analyzed using a repeated-measures factorial analysis of variance and Tukey-Kramer method. Overall, the IM of the adult condyles (10.0+/-3.4 GPa, Mean+/-SD) were significantly (P<0.0001) higher than in young dogs (5.6+/-2.6 GPa). There was a greater bone mass in the young (60.2%) versus the adult condyles (42%). Also, significantly more labeled bone in the young (66.1%) condylar bone suggested higher bone forming activity than in adult condyles (27.5%). With age there is a change in mass and material properties in the trabecular bone of the mandibular condyle in dogs.

  8. Psychological stress alters microstructure of the mandibular condyle in rats.

    PubMed

    Li, Qiang; Zhang, Min; Chen, Yong-Jin; Zhou, Qiang; Wang, Ying-jie; Liu, Jia

    2013-02-17

    Psychological stress plays an important role in the occurrence and development of temporomandibular joint disorder (TMD). The correlation between psychological factors and TMD has been clinically shown, but the influence of psychological stress on the temporomandibular joint (TMJ) structure still lacks direct evidence. Here, we used communication box to establish the rat model of psychological stress. The stress level of animals was estimated by the elevated plus maze (EPM) test and hormonal assays. The histomorphology and three-dimensional microstructure of the rat condyles were observed by hematoxylin-eosin (HE) staining and Micro-CT, respectively. Compared with control rats, the anxious state of the stressed rats was evidenced by higher plasma adrenocorticotropic hormone (ACTH) and corticosterone (CORT), as well as lower ratios of open arm entries and time and lower time spent in open arms after 1, 2, 3, 4 and 5 week(s) post-exposure to psychological stimuli. HE staining and histomorphometric data analysis showed decreased thicknesses of the central and posterior condylar cartilages in stressed rats at weeks 3, 4 and 5, with the most obvious changes in the posterior part characterized by debonding and thinned fibrous layer, thickened proliferative layer, thinned mature layer and hypertrophic layer. Moreover, Micro-CT scanning revealed local lesion of the subchondral bone in the posterior condylar cartilages of stressed rats at week 5. Our findings indicate that pathologic changes of the histomorphology and three-dimensional microstructure occur in the condyles of stressed rats, hinting us a potential link between psychological factors and the pathogenesis or progression of TMD.

  9. Isolated musculocutaneous neuropathy caused by a proximal humeral exostosis.

    PubMed

    Juel, V C; Kiely, J M; Leone, K V; Morgan, R F; Smith, T; Phillips, L H

    2000-01-25

    We report an isolated musculocutaneous neuropathy caused by a proximal humeral osteochondroma that became symptomatic after the patient played recreational basketball. Lesion resection resulted in complete deficit resolution. Mass lesions involving the musculocutaneous nerve should be considered in patients with atraumatic, isolated musculocutaneous neuropathies that are recurrent or fail to recover, even in the setting of strenuous exercise.

  10. Mosaic arthroplasty of the medial femoral condyle in horses - An experimental study.

    PubMed

    Bodó, Gábor; Vásárhelyi, Gábor; Hangody, László; Módis, László

    2014-06-01

    One Arabian and 5 Hungarian half-bred horses were used to study the macroscopic and microscopic survival of autologous osteochondral grafts in the weight-bearing surface of the medial femoral condyle (MFC). Grafts were harvested from the cranial surface of the medial femoral trochlea (MFT) under arthroscopic control. Three of them were transplanted into the weight-bearing surface of the contralateral MFC using an arthrotomy approach. Three months later this transplantation procedure was repeated on the opposite stifle joints in the same animals, but at that time transplantation was performed arthroscopically. Follow-up arthroscopy was carried out 12 months after the first operations, and biopsies were taken from both the recipient and the donor sites for histological examination. During follow-up arthroscopy, the transplanted areas looked congruent and smooth. Microscopically, the characteristics of hyaline cartilage were present in 5 out of the 10 biopsies examined; however, in the other half of biopsies glycosaminoglycan (GAG) loss and change in the architecture of the transplanted cartilage was observed. In a 16-year-old horse, all grafts broke during harvesting, and thus transplantation was not performed. No radiological signs of osteoarthritic changes were detected 9 to 12 months after the operations in the donor and recipient joints. Clinically, no lameness or effusion was present three months after the transplantations.

  11. Mosaic arthroplasty of the medial femoral condyle in horses - An experimental study.

    PubMed

    Bodó, Gábor; Vásárhelyi, Gábor; Hangody, László; Módis, László

    2014-06-01

    One Arabian and 5 Hungarian half-bred horses were used to study the macroscopic and microscopic survival of autologous osteochondral grafts in the weight-bearing surface of the medial femoral condyle (MFC). Grafts were harvested from the cranial surface of the medial femoral trochlea (MFT) under arthroscopic control. Three of them were transplanted into the weight-bearing surface of the contralateral MFC using an arthrotomy approach. Three months later this transplantation procedure was repeated on the opposite stifle joints in the same animals, but at that time transplantation was performed arthroscopically. Follow-up arthroscopy was carried out 12 months after the first operations, and biopsies were taken from both the recipient and the donor sites for histological examination. During follow-up arthroscopy, the transplanted areas looked congruent and smooth. Microscopically, the characteristics of hyaline cartilage were present in 5 out of the 10 biopsies examined; however, in the other half of biopsies glycosaminoglycan (GAG) loss and change in the architecture of the transplanted cartilage was observed. In a 16-year-old horse, all grafts broke during harvesting, and thus transplantation was not performed. No radiological signs of osteoarthritic changes were detected 9 to 12 months after the operations in the donor and recipient joints. Clinically, no lameness or effusion was present three months after the transplantations. PMID:24334083

  12. Large osteochondroma of the mandibular condyle treated by condylectomy using a transzygomatic approach.

    PubMed

    Kumar, V V

    2010-02-01

    This article presents an interesting case of osteochondroma of the mandibular condyle with multiple projections in a 42-year-old man. Owing to the large size of the lesion, surgical condylectomy was performed using a transzygomatic approach. PMID:20060265

  13. Management of Humeral and Glenoid Bone Loss in Recurrent Glenohumeral Instability

    PubMed Central

    Rusen, Jamie; Leiter, Jeff; Chahal, Jaskarndip; MacDonald, Peter

    2014-01-01

    Recurrent shoulder instability and resultant glenoid and humeral head bone loss are not infrequently encountered in the population today, specifically in young, athletic patients. This review on the management of bone loss in recurrent glenohumeral instability discusses the relevant shoulder anatomy that provides stability to the shoulder joint, relevant history and physical examination findings pertinent to recurrent shoulder instability, and the proper radiological imaging choices in its workup. Operative treatments that can be used to treat both glenoid and humeral head bone loss are outlined. These include coracoid transfer procedures and allograft/autograft reconstruction at the glenoid, as well as humeral head disimpaction/humeroplasty, remplissage, humeral osseous allograft reconstruction, rotational osteotomy, partial humeral head arthroplasty, and hemiarthroplasty on the humeral side. Clinical outcomes studies reporting general results of these techniques are highlighted. PMID:25136461

  14. Relationship between mandibular condyle and angle fractures and the presence of mandibular third molars

    PubMed Central

    Mah, Deuk-Hyun; Moon, Seong-Yong; Oh, Ji-Su; You, Jae-Seek

    2015-01-01

    Objectives We retrospectively evaluated the impact of mandibular third molars on the occurrence of angle and condyle fractures. Materials and Methods This was a retrospective investigation using patient records and radiographs. The sample set consisted of 440 patients with mandibular fractures. Eruption space, depth and angulation of the third molar were measured. Results Of the 144 angle fracture patients, 130 patients had third molars and 14 patients did not. The ratio of angle fractures when a third molar was present (1.26 : 1) was greater than when no third molar was present (0.19 : 1; odds ratio, 6.58; P<0.001). Of the 141 condyle fractures patients, the third molar was present in 84 patients and absent in 57 patients. The ratio of condyle fractures when a third molar was present (0.56 : 1) was lower than when no third molar was present (1.90 : 1; odds ratio, 0.30; P<0.001). Conclusion The increased ratio of angle fractures with third molars and the ratio of condyle fractures without a third molar were statistically significant. The occurrence of angle and condyle fractures was more affected by the continuity of the cortical bone at the angle than by the depth of a third molar. These results demonstrate that a third molar can be a determining factor in angle and condyle fractures. PMID:25741462

  15. Changes in growth and morphology of the condyle following mandibular distraction in minipigs: Overloading or Underloading?

    PubMed Central

    Rafferty, Katherine L.; Sun, Zongyang; Egbert, Mark; Bakko, Daniel W.; Herring, Susan W.

    2007-01-01

    Objective: Loading of temporomandibular tissues during mandibular distraction may cause changes in condylar growth and cartilage thickness. This study examines the effects of distraction on the condyle in a large animal model by explicitly measuring growth and in vivo loading. Design: Unilateral mandibular distraction was carried out on twenty growing minipigs divided into three groups. One group underwent distraction but not consolidation, whereas the other two groups were allowed a period of consolidation of either one or two weeks. Animals received fluorochrome and 5-bromo-2'-deoxyuridine (BrdU) labeling and masticatory strain was measured from the condylar neck. Condylar strain was also recorded in an age-matched sample of eight animals that received no distraction surgery. Immunohistochemical procedures were used to identify dividing prechondroblasts and histological analysis was used to measure mineral apposition rate, count dividing cells, and measure the thickness of condylar cartilage. Results: Strain magnitude, particularly compressive strain, was much larger on the non-distraction side compared to the distraction side condyle. Compared to normal loading levels, the distraction side condyle was underloaded whereas the condyle on the intact side was overloaded. Mineral apposition and cartilage thickness were greater on the distraction side condyle compared to the opposite side. Differences between the sides were most pronounced in the group with no consolidation and became progressively reduced with consolidation time. Conclusions: Increased mineralization and cartilage thickness on the distraction side condyle is associated with reduced, not increased loading, perhaps because of disruption of the distraction side masseter muscle. PMID:17573035

  16. Injectable Biocomposites for Bone Healing in Rabbit Femoral Condyle Defects

    PubMed Central

    Liu, Zhengsheng; Wang, Xiumei; Cui, Fuzhai; Guo, Wenguang; Mao, Keya; Yang, Shuying

    2013-01-01

    A novel biomimetic bone scaffold was successfully prepared in this study, which was composed of calcium sulfate hemihydrate (CSH), collagen and nano-hydroxyapatite (nHAC). CSH/nHAC was prepared and observed with scanning electron microscope and rhBMP-2 was introduced into CSH/nHAC. The released protein content from the scaffold was detected using high performance liquid chromatography at predetermined time interval. In vivo bone formation capacity was investigated by means of implanting the scaffolds with rhBMP-2 or without rhBMP-2 respectively into a critical size defect model in the femoral condyle of rabbit. The releasing character of rhBMP-2 was that an initial burst release (37.5%) was observed in the first day, followed by a sustained release and reached 100% at the end of day 20. The CSH/nHAC showed a gradual decrease in degradation with the content of nHAC increase. The results of X-rays, Micro CT and histological observation indicated that more new bone was formed in rhBMP-2 group. The results implied that this new injectable bone scaffold should be very promising for bone repair and has a great potential in bone tissue engineering. PMID:24146770

  17. 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

  18. Motion of the Shoulder Complex During Multiplanar Humeral Elevation

    PubMed Central

    Ludewig, Paula M.; Phadke, Vandana; Braman, Jonathan P.; Hassett, Daniel R.; Cieminski, Cort J.; LaPrade, Robert F.

    2009-01-01

    Background: Many prior studies have evaluated shoulder motion, yet no three-dimensional analysis comparing the combined clavicular, scapular, and humeral motion during arm elevation has been done. We aimed to describe and compare dynamic three-dimensional motion of the shoulder complex during raising and lowering the arm across three distinct elevation planes (flexion, scapular plane abduction, and coronal plane abduction). Methods: Twelve subjects without a shoulder abnormality were enrolled. Transcortical pin placement into the clavicle, scapula, and humerus allowed electromagnetic motion sensors to be rigidly fixed. The subjects completed two repetitions of raising and lowering the arm in flexion, scapular, and abduction planes. Three-dimensional angles were calculated for sternoclavicular, acromioclavicular, scapulothoracic, and glenohumeral joint motions. Joint angles between humeral elevation planes and between raising and lowering of the arm were compared. Results: General patterns of shoulder motion observed during humeral elevation were clavicular elevation, retraction, and posterior axial rotation; scapular internal rotation, upward rotation, and posterior tilting relative to the clavicle; and glenohumeral elevation and external rotation. Clavicular posterior rotation predominated at the sternoclavicular joint (average, 31°). Scapular posterior tilting predominated at the acromioclavicular joint (average, 19°). Differences between flexion and abduction planes of humerothoracic elevation were largest for the glenohumeral joint plane of elevation (average, 46°). Conclusions: Overall shoulder motion consists of substantial angular rotations at each of the four shoulder joints, enabling the multiple-joint interaction required to elevate the arm overhead. Clinical Relevance: Improved knowledge of the normal motion of the shoulder during humeral elevation will improve the assessment of patients with shoulder motion abnormalities, planning for rehabilitation

  19. Locking Plate for Proximal Humeral Fracture in the Elderly Population: Serial Change of Neck Shaft Angle

    PubMed Central

    Pawaskar, Aditya C; Lee, Kee-Won; Kim, Jong-Min; Park, Jin-Woong; Aminata, Iman W; Jung, Hong-Jun; Chun, Jae-Myeung

    2012-01-01

    Background We conducted this radiographic study in the elderly population with proximal humeral fracture aiming to evaluate 1) the serial changes of neck-shaft angle after locking plate fixation and 2) find relationship between change in neck shaft angle and various factors such as age, fracture pattern, severity of osteoporosis, medial support and initial reduction angle. Methods Twenty-five patients who underwent surgical treatment for proximal humeral fracture with locking plate between September 2008 and August 2010 are included. True anteroposterior and axillary lateral radiographs were made postoperatively and at each follow-up visit. Measurement of neck shaft angle was done at immediate postoperative, 3 months postoperative and a final follow-up (average, 11 months; range, 8 to 17 months). Severity of osteoporosis was assessed using cortical thickness suggested by Tingart et al. Results The mean neck shaft angles were 133.6° (range, 100° to 116°) at immediate postoperative, 129.8° (range, 99° to 150°) at 3 months postoperative and 128.4° (range, 97° to 145°) at final follow-up. The mean loss in the neck-shaft angle in the first 3 months was 3.8° as compared to 1.3° in the period between 3 months and final follow-up. This was statistically significant (p = 0.002), indicating that most of the fall in neck shaft angle occurs in the first three months after surgery. Relationship between neck shaft angle change and age (p = 0.29), fracture pattern (p = 0.41), cortical thickness (p = 0.21), medial support (p = 0.63) and initial reduction accuracy (p = 0.65) are not statistically significant. Conclusions The proximal humerus locking plate maintains reliable radiographic results even in the elderly population with proximal humerus fracture. PMID:22949952

  20. Management of distal humeral fractures in the elderly.

    PubMed

    Strauss, Eric J; Alaia, Michael; Egol, Kenneth A

    2007-09-01

    Although relatively uncommon, fractures of the distal humerus in the elderly patient population are significant injuries of which optimal management is a subject of debate in orthopaedic literature. The combination of complex anatomy, poor bone quality and extensive comminution often seen with these fractures makes successful treatment difficult. Currently, most surgeons support surgical fixation of distal humeral fractures with the belief that restoration of the patient's native elbow joint provides the best opportunity for a good functional outcome. Others have proposed the use of total elbow arthroplasty as a primary treatment method for geriatric distal humeral fractures based on the difficulties associated with ORIF and the relatively low demands of this patient population. To date, there have been no prospective randomised trials comparing these two treatment alternatives, and a comparison of available outcome data shows good functional outcome for both forms of fracture management. With the aging of the population and an associated increase in the incidence of distal humeral fractures, the debate over the optimal treatment regime will undoubtedly continue. PMID:17723787

  1. The control of condylar growth: an experimental evaluation of the role of the lateral pterygoid muscle.

    PubMed

    Whetten, L L; Johnston, L E

    1985-09-01

    The present study used 21 male albino rats to test the hypothesis that lateral pterygoid traction regulates the growth of the mandibular condyle. The condyles, the rami, and the top of each glenoid fossa were marked with metallic implants, and, following bilateral section of the condylar neck, one lateral pterygoid muscle was extirpated. On the basis of the literal details of Petrovic's cybernetic model, it was assumed that the continued forward growth of the midface and the backward translation of the glenoid fossa would combine to produce a progressive disturbance in the buccal occlusion that would, in turn, generate a reflex contraction of the remaining lateral pterygoid muscle. Initially, however, growth of the isolated condyles would have little impact on the spatial position of the rest of the mandible. As a result, the condyles on the side with the intact lateral pterygoid should grow for a time at a maximal, open-circuit rate, whereas the experimental condyle, deprived of all muscle traction, should show only a minimal "commanded" rate of growth. The serial change in the position of the condylar and ramal implants was assessed cephalometrically for 6 weeks, and between-sides differences were analyzed by randomized block analysis of variance. The presence or absence of the lateral pterygoid muscle had no significant effect on the anteroposterior position of the condylar implants and only a slight, transitory effect on their vertical position. The translation of the ramal implants, however, was greatly affected by the condylotomy. On both control and experimental sides, the mandible collapsed upward and backward until contact between the growing condyle and ramus had been achieved, whereupon a downward and forward pattern of translatory growth was re-established. Although it could not be shown that lateral pterygoid traction per se is a significant factor in the growth of isolated condyles, it was concluded that the condyle is vitally important to the

  2. Multidisciplinary treatment of peripheral osteoma arising from mandibular condyle in patient presenting with facial asymmetry.

    PubMed

    Nojima, Kunihiko; Niizuma-Kosaka, Fumiko; Nishii, Yasushi; Sueishi, Kenji; Yamakura, Daiki; Ikumoto, Hideyuki; Ohata, Hitoshi; Inoue, Takashi

    2014-01-01

    While osteomas often occur in the orofacial area, it is relatively rare for one to occur in the temporomandibular joint area. Here, we report a patient who underwent multidisciplinary treatment including high condylectomy for peripheral osteoma arising in the left mandibular condyle. The patient was a 46-year-old woman with the chief complaint of facial asymmetry. Cephalometric analysis revealed skeletal anterior crossbite due to anterior deviation of the mandible, with chin deviation of 10 mm to the right. A computed tomography scan revealed bone hyperplasia in the mesiodistal and inner areas of the left mandibular condyle, which exhibited outward anterior displacement. Bone scintigraphy showed a circular area of strong radioisotope accumulation with indistinct boundaries, consistent with the lesion in the left mandibular condyle. The above findings led to a diagnosis of skeletal mandibular prognathism with facial asymmetry due to peripheral osteoma originating in the left mandibular condyle. After orthodontic treatment and surgical resection of the tumor and mandibular condyle, preservation and prosthetic treatment were undertaken. A well-balanced facial appearance and good occlusion were achieved.

  3. 21 CFR 888.3690 - Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Shoulder joint humeral (hemi-shoulder) metallic... Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis. (a) Identification. A shoulder joint... the proximal end of the humerus and to be fixed without bone cement (§ 888.3027). This device is...

  4. 21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Elbow joint humeral (hemi-elbow) metallic... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint... use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice...

  5. 21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Elbow joint humeral (hemi-elbow) metallic... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint... use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice...

  6. 21 CFR 888.3690 - Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Shoulder joint humeral (hemi-shoulder) metallic... Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis. (a) Identification. A shoulder joint... the proximal end of the humerus and to be fixed without bone cement (§ 888.3027). This device is...

  7. 21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Elbow joint humeral (hemi-elbow) metallic... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint... use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice...

  8. 21 CFR 888.3690 - Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Shoulder joint humeral (hemi-shoulder) metallic... Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis. (a) Identification. A shoulder joint... the proximal end of the humerus and to be fixed without bone cement (§ 888.3027). This device is...

  9. 21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Elbow joint humeral (hemi-elbow) metallic... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint... use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice...

  10. 21 CFR 888.3180 - Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Elbow joint humeral (hemi-elbow) metallic... Elbow joint humeral (hemi-elbow) metallic uncemented prosthesis. (a) Identification. An elbow joint... use without bone cement (§ 888.3027). (b) Classification. Class III. (c) Date PMA or notice...

  11. 21 CFR 888.3690 - Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Shoulder joint humeral (hemi-shoulder) metallic... Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis. (a) Identification. A shoulder joint... the proximal end of the humerus and to be fixed without bone cement (§ 888.3027). This device is...

  12. 21 CFR 888.3690 - Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Shoulder joint humeral (hemi-shoulder) metallic... Shoulder joint humeral (hemi-shoulder) metallic uncemented prosthesis. (a) Identification. A shoulder joint... the proximal end of the humerus and to be fixed without bone cement (§ 888.3027). This device is...

  13. Playing level achieved, throwing history, and humeral torsion in Masters baseball players.

    PubMed

    Whiteley, Rod; Adams, Roger; Ginn, Karen; Nicholson, Leslie

    2010-09-01

    Humeral torsion is thought to be beneficial for throwing. To examine this hypothesis, the throwing and non-throwing arms of 84 Masters baseball players over 35 years of age were measured for humeral torsion, and the highest playing level they achieved and their playing history were recorded. Regression analyses were used to obtain predictors of the highest playing level achieved, throwing arm humeral torsion, and side-to-side difference in humeral torsion. Equations accounting for 36%, 46%, and 12% of the variance respectively were produced. Achieving representative level playing status was associated with the number of seasons played under 16 years of age and having greater throwing arm humeral retrotorsion. Throwing arm humeral retrotorsion was associated with non-throwing arm humeral retrotorsion and an increased number of seasons played before the age of 16 years. A model in which repeated throwing develops an adaptive unilateral bone torsion along with growth in baseball expertise is proposed. Thus dominant arm humeral retrotorsion is a predictor of highest baseball playing level achieved, which in turn is influenced by genetic endowment (as seen in the torsion of the non-throwing arm) and amount of throwing activity, particularly prior to the age of 16.

  14. Heterogeneous nanomechanical properties of superficial and zonal regions of articular cartilage of the rabbit proximal radius condyle by atomic force microscopy.

    PubMed

    Tomkoria, Sara; Patel, Rupal V; Mao, Jeremy J

    2004-12-01

    Articular chondrocytes have been thought to reside in a homogenous matrix. The physical characteristics of the intercellular matrix of articular cartilage are not well characterized, especially at a nanoscopic scale. The present work tested the hypothesis that the nanomechanical properties of the intercellular matrices of articular cartilage in both the articulating surface and various cellular zones are non-homogeneous. Nanoindentation by atomic force microscopy was applied to the geometric center of the medial, lateral and groove regions of the superficial zone of the rabbit proximal radius cartilage, and then the intercellular matrices of chondrocytes from the superficial to calcifying zones in 40 microm increments. The elastic modulus of the articular surface of the medial condyle (1.46+/-0.11 MPa) was significantly higher than the lateral condyle (1.18+/-0.10 MPa), and the groove (0.96+/-0.07 MPa). There is a significant gradient increase in Young's moduli from the superficial zone (0.52+/-0.05 MPa) to calcifying zone (1.69+/-0.12 MPa). Thus, the nanomechanical properties of the intercellular matrices of the articulating surface are region-specific and likely related to articular function. Heterogeneous biophysical properties of intercellular matrices along the depth from the superficial to calcifying zones suggest that chondrocytes likely reside in a heterogeneous matrix.

  15. Is Loss of Fixation Following Locked Plating of Proximal Humeral Fractures Related to the Number of Screws and Their Positions in the Humeral Head?

    PubMed Central

    Maddah, Mohammad; Prall, Wolf C.; Geyer, Lucas; Wirth, Stefan; Mutschler, Wolf; Ockert, Ben

    2014-01-01

    The aim of the study was to examine the correlation between the chosen position of screws and the complications observed in patients who underwent locked plating of proximal humeral fractures. We evaluated radiographs of 367 patients treated by locked-plating for proximal humeral fractures. Radiographs were taken at one day, 6 weeks, 3 months and 6 months after surgery, and were analyzed for secondary fracture displacement, loss of fixation, cutting out of screws and necrosis of the humeral head. Secondary loss of fixation occurred in 58 cases (15.8%) and among those cutting out of screws was observed in 25 cases (6.8%). In cases of secondary loss of fixation a mean of 6.7 screws were used to fix the fracture (vs 6.6, P=0.425). There was neither significant correlation between position of screws and the occurrence of postoperative loss of fixation in Spearman correlation nor relationship from backward logistic regression analysis. Loss of fixation following locked plating of proximal humeral fractures does not relate to the number of screws and their positions in the humeral head. In consequence, anatomic fracture reduction and restoration of the humeral head-shaft angle are still important factors and should not be disregarded. PMID:25002940

  16. Post-traumatic bifid mandibular condyle: A case report and literature review.

    PubMed

    Woo, Min-Ho; Yoon, Kyu-Ho; Park, Kwan-Soo; Park, Jae-An

    2016-09-01

    Bifid mandibular condyle (BMC) is an uncommon morphological variant of the mandibular condyle. Although authors have proposed various etiologies for BMC, no consensus has emerged. In addition, varying findings have been reported regarding the epidemiological parameters of BMC (e.g., prevalence, gender ratio, and age), possibly due to its low incidence. BMC is occasionally associated with symptoms of the temporomandibular joint, such as ankylosis, pain, and trismus; however, it is difficult to detect this condition on conventional radiographs. This study reports a case of BMC with radiographic findings, and reviews the literature on the epidemiology of BMC. PMID:27672618

  17. Post-traumatic bifid mandibular condyle: A case report and literature review

    PubMed Central

    Woo, Min-Ho; Yoon, Kyu-Ho; Park, Jae-An

    2016-01-01

    Bifid mandibular condyle (BMC) is an uncommon morphological variant of the mandibular condyle. Although authors have proposed various etiologies for BMC, no consensus has emerged. In addition, varying findings have been reported regarding the epidemiological parameters of BMC (e.g., prevalence, gender ratio, and age), possibly due to its low incidence. BMC is occasionally associated with symptoms of the temporomandibular joint, such as ankylosis, pain, and trismus; however, it is difficult to detect this condition on conventional radiographs. This study reports a case of BMC with radiographic findings, and reviews the literature on the epidemiology of BMC. PMID:27672618

  18. Post-traumatic bifid mandibular condyle: A case report and literature review

    PubMed Central

    Woo, Min-Ho; Yoon, Kyu-Ho; Park, Jae-An

    2016-01-01

    Bifid mandibular condyle (BMC) is an uncommon morphological variant of the mandibular condyle. Although authors have proposed various etiologies for BMC, no consensus has emerged. In addition, varying findings have been reported regarding the epidemiological parameters of BMC (e.g., prevalence, gender ratio, and age), possibly due to its low incidence. BMC is occasionally associated with symptoms of the temporomandibular joint, such as ankylosis, pain, and trismus; however, it is difficult to detect this condition on conventional radiographs. This study reports a case of BMC with radiographic findings, and reviews the literature on the epidemiology of BMC.

  19. [MRI findings in the diagnosis of pseudotumoral humeral hydatid].

    PubMed

    Khadraoui, M B; Arifa-Achour, N; Mhiri-Souei, M; Elouni, F; Jemni, H; Mrad-Dali, K; Mokni, M; Ben Ayeche, M A; Tlili-Graiess, K

    2005-06-01

    Hydatidosis of bone is rare. Vertebral localizations predominate. Standard imaging may be misleading, suggestive of a malignant tumor or infection. We present the case of a patient with a humeral hydatid. This localization is very rare and presents an unusual radiographic aspect. Computed tomography produces an image suggestive of a tumor. The correct diagnosis can be established with MRI, particularly with the STIR sequence. In our patient, MRI enabled us to establish the diagnosis preoperatively and evaluate extension. MRI has been found to be highly contributive to the diagnosis of hydatidosis of bone and for assessment of intra- and peri-osseous extension.

  20. [Anterolateral extension of the lateral suboccipital approach: an anatomical study].

    PubMed

    Silveira, Roberto Leal; Gusmao, Sebastião

    2002-06-01

    We studied the extensions of the lateral suboccipital approach (LSOA) in seven cadaver heads, in the microsurgical laboratory, in order to establish the extensions necessary to approach the anterolateral area of the foramen magnum and the jugular foramen. The extensions (bone resection) were accomplished in five progressive steps: 1) suboccipital retrossigmoid craniectomy (LSOA retrocondylar); 2) extending the craniectomy with removal of half the occipital condyle (LSOA partial transcondylar); 3) extending the drilling of the occipital condyle to open the hypoglossal foramen, followed by removal of the jugular tubercle and opening the jugular foramen (LSOA transcondylar-transjugular); 4) complete drilling of the occipital condyle (LSOA complete transcondylar); 5) LSOA complete transcondylar plus removal of the atlas lateral mass up to the odontoid process (ASOL transcondylar-transjugular). We concluded that the extensions of LSOA should be adapted to the topography of the lesion: the LSOA retrocondylar for the lateral area of the foramen magnum; the LSOA partial transcondylar for the anterolateral portion; the LSOA transcondylar-transjugular to reach the jugular foramen; the LSOA complete transcondylar for the anterior part, and the LSOA complete transcondylar/translateral mass of the atlas for extradural lesions anterior to the foramen magnum.

  1. Fixation of proximal humeral prostheses and rotational micromotion.

    PubMed

    Harris, T E; Jobe, C M; Dai, Q G

    2000-01-01

    Twenty pairs of cadaveric humeri were used to compare the rotational stability of proximal humeral prostheses fixed by proximal cementation with the stability offered by press fit or full cementation. For each proximally cemented specimen, only the upper portion of the prosthesis was coated with cement. For the fully cemented specimens, a cement restrictor was used just distal to the prosthesis, and a finger-packing technique was used to fill the proximal humeral medullary canal. Torque was applied to the Morse taper of the prostheses, and rotational micromotion was measured at the level of the osteotomy. In each of 11 pairs of cadaveric humeri, one side was press fit and the contralateral side was proximally cemented; in each of 9 pairs, proximal cementation was compared with full cementation. Proximally cemented prostheses' micromotion was significantly less than that of press-fit prostheses (P = .0016). There was no difference in micromotion between proximal cementation and full cementation (P = .82). Proximal cementation increased initial fixation over press fit. Full cementation did not increase rotational stability.

  2. [Periprosthetic humeral fractures: Strategies and techniques of revision arthroplasty].

    PubMed

    Kirchhoff, C; Beirer, M; Brunner, U

    2016-04-01

    The primary aims when performing revision arthroplasty of periprosthetic humeral fractures (PHF) are preservation of bone stock, achieving fracture healing and preserving a stable prosthesis with the focus on regaining the preoperative shoulder-arm function. The indications for revision arthroplasty are given in PHF in combination with loosening of the stem. In addition, further factors must be independently clarified in the case of an anatomical arthroplasty. In this context secondary glenoid erosion as well as rotator cuff insufficiency are potential factors for an extended revision procedure. For the performance of revision surgery modular revision sets including long stems, revision glenoid and metaglene components as well as plate and cerclage systems are obligatory besides the explantation instrumentation. Despite a loosened prosthesis, a transhumeral removal of the stem along with a subpectoral fenestration are often required. Length as well as bracing of revision stems need to bridge the fracture by at least twice the humeral diameter. Moreover, in many cases a combined procedure using an additional distal open reduction and internal fixation (ORIF) plus cable cerclages as well as biological augmentation might be needed. Assuming an adequate preparation, the experienced surgeon is able to achieve a high fracture union rate along with an acceptable or even good shoulder function and to avoid further complications.

  3. An Unusual Metallic Foreign Body inside the Knee Medial Femoral Condyle

    PubMed Central

    Helito, Camilo Partezani; Faria, Carlos Eduardo Nunes; Bonadio, Marcelo Batista; Pecora, Jose Ricardo; Camanho, Gilberto Luis; Demange, Marco Kawamura

    2014-01-01

    Foreign bodies in the knee joint are uncommon, particularly those not related to surgical procedures. In this paper, we present a case of an intraosseous metallic foreign body situated in the medial femoral condyle for one year, causing pain, which was removed with complete resolution of the symptoms. PMID:25506452

  4. 78 FR 9010 - Dental Devices; Reclassification of Temporary Mandibular Condyle Prosthesis

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-07

    ..., 1993 (59 FR 65475; December 20, 1994). In response to a petition dated April 30, 1996 (FDA-1996-P-0253... malignant and benign tumors (63 FR 71743). In 2009, FDA published an order for the submission of information on mandibular condyle prostheses indicated for temporary reconstruction (74 FR 16214; April 9,...

  5. An Unusual Metallic Foreign Body inside the Knee Medial Femoral Condyle.

    PubMed

    Helito, Camilo Partezani; Faria, Carlos Eduardo Nunes; Bonadio, Marcelo Batista; Pecora, Jose Ricardo; Camanho, Gilberto Luis; Demange, Marco Kawamura

    2014-01-01

    Foreign bodies in the knee joint are uncommon, particularly those not related to surgical procedures. In this paper, we present a case of an intraosseous metallic foreign body situated in the medial femoral condyle for one year, causing pain, which was removed with complete resolution of the symptoms. PMID:25506452

  6. Ectopic third molar in the mandibular condyle: A review of the literature

    PubMed Central

    Iglesias-Martin, Fernando; Torres-Carranza, Eusebio; Prats-Golczer, Victoria-Eugenia; Garcia-Perla-Garcia, Alberto

    2012-01-01

    Objectives: To evaluate the etiopathogenesis, clinical features, therapeutic options, and surgical approaches for removal of ectopic third molars in the mandibular condyle. Study design: MEDLINE search of articles published on ectopic third molars in the mandibular condyle from 1980 to 2011. 14 well-documented clinical cases from the literature were evaluated together with a new clinical case provided by the authors, representing a sample of 15 patients. Results: We found a mean age at diagnosis of 48.6 years and a higher prevalence in women. In 14 patients, associated radiolucent lesions were diagnosed on radiographic studies and confirmed histopathologically as odontogenic cysts. Clinical symptoms were pain and swelling in the jaw or preauricular region, trismus, difficulty chewing, cutaneous fistula and temporomandibular joint dysfunction. Treatment included conservative management in one case and in the other cases, surgical removal by intra- or extraoral approaches, the latter being the most common approach carried out. In most reported cases, serious complications were not outlined. Conclusions: The etiopathogenic theory involving odontogenic cysts in the displacement of third molars to the mandibular condyle seems to be the most relevant. They must be removed if they cause symptoms or are associated with cystic pathology. The surgical route must be planned according to the location and position of the ectopic third molar, and the possible morbidity associated with surgery. Key words:Third molar, ectopic tooth, condyle, mandible. PMID:22926463

  7. Clinical results of using the proximal humeral internal locking system plate for internal fixation of displaced proximal humeral fractures.

    PubMed

    Norouzi, Masoud; Naderi, Mohammad Nasir; Komasi, Mehdi Hemmati; Sharifzadeh, Seyyed Reza; Shahrezaei, Mostafa; Eajazi, Alireza

    2012-05-01

    Proximal humerus fractures are accounting for 4-5% of all fractures with increasing incidence. Proximal Humeral Internal Locking System (PHILOS) plate is a new plate which permits early mobility and lowers the risk of complications. The aim of this study was to evaluate the functional outcome and the complication rate after using this plate. Between 2006-2008, 37 patients with displaced 2-, 3-, and 4-part fractures of the proximal humerus underwent surgery using PHILOS plate. The mean range of follow-up was 12 months. Twenty patients were aged 60 years and younger, and 17 were aged older than 60 years. The average American Shoulder and Elbow Surgeons (ASES) score at the final follow-up was 77.62. According to Michener and colleagues classification, 5.4% of patients had an excellent outcome, 72.9% were minimally functionally limited, 16.2% were moderately functionally limited, and 5.4% were maximally functionally limited. The average ASES score between patients 60 years and older and those 60 years and younger was not different significantly. One patient developed avascular necrosis of the humeral head, 2 patients developed an infection, and no patients developed a nonunion. Fixation with PHILOS plate can be considered a good method with high union rates for this kind of fracture, especially in the older population with osteoporotic bone.

  8. Why is the humeral retroversion of throwing athletes greater in dominant shoulders than in nondominant shoulders?

    PubMed

    Yamamoto, Nobuyuki; Itoi, Eiji; Minagawa, Hiroshi; Urayama, Masakazu; Saito, Hidetomo; Seki, Nobutoshi; Iwase, Takenobu; Kashiwaguchi, Shinji; Matsuura, Tetsuya

    2006-01-01

    A rotation angle of the proximal humerus relative to the elbow (bicipital-forearm angle) was measured by use of ultrasonography to determine the relationship between humeral retroversion and growth in dominant and nondominant shoulders of 66 elementary and junior high school baseball players. The subjects were aged 12 years on average. The bicipital-forearm angle was significantly smaller in dominant shoulders than in nondominant shoulders. This indicated that the retroversion angle was greater in dominant shoulders than in nondominant shoulders. Furthermore, there was a moderately positive correlation between age and the bicipital-forearm angle in both dominant and nondominant shoulders. From these data, we conclude that the humeral retroversion angle decreases with age, and the decrease is much smaller in dominant shoulders. We assume that the repetitive throwing motion does not increase the retroversion of the humeral head but rather restricts the physiologic derotation process of the humeral head during growth.

  9. Treatment of Humeral Fracture after Shoulder Arthroplasty using Functional Brace: A Case Report

    PubMed Central

    Terabayashi, Nobuo; Matsumoto, Kazu; Takigami, Iori; Ito, Yoshiki

    2016-01-01

    Introduction: A periprosthetic humeral fracture is rare after shoulder arthroplasty, and such cases have considerable problems. Patients with this kind of fracture are often complicated by osteopenia, other types of severe disease, or are elderly. Surgical treatment of this fracture type carries some risk, and surgeons may be unsure about the most appropriate approach to adopt. Case report: The present case occurred in a 78-year-old woman with an osteoporotic humeral bone, and chronic dislocation of shoulder after shoulder arthroplasty. There were many risk factors for revision surgery or ostheosynthesis. Therefore, we decided to treat the patient by functional bracing. Fortunately, complete radiographic union was confirmed at 17 weeks. She returned to daily life with good functional activity. Conclusion: In our opinion, it is acceptable to select functional bracing for periprosthetic humeral fractures after shoulder arthroplasty without stem loosening in elderly patients with an osteoporotic humeral bone. PMID:27299112

  10. Reduced humeral torsion predicts throwing-related injury in adolescent baseballers.

    PubMed

    Whiteley, Rod J; Adams, Roger D; Nicholson, Leslie L; Ginn, Karen A

    2010-07-01

    The amount of torsion in the humerus is determined by both genetic and activity-related factors, and affects the external rotation range of motion available at the shoulder. Previous research has shown athletes participating in throwing sports to have a greater amount of humeral retrotorsion in their dominant arm. The purpose of this study was to investigate the predictive ability of both the genetic and activity-related aspects of humeral torsion regarding throwing-related injury. The amount of humeral torsion in both arms of 35 high level adolescent male baseballers (mean age 16.6 years+/-0.6 years) was measured at study commencement. Significantly increased humeral retrotorsion in the dominant arm compared to the non-dominant arm was found (p=0.04). These athletes were followed for a period of 30 months, and any injury to their throwing arm which resulted in missing either a game or practice was recorded. ROC curve analysis was used to determine the predictive ability of humeral torsion with respect to the occurrence of injury to the throwing arm. Of the 35 athletes, 19 suffered a throwing arm injury. AUC values derived from ROC analysis showed humeral torsion in the non-dominant arm (AUC: 0.679, 95% CI: 0.502-0.857), as well as the average of the humeral torsion in both arms (0.692, 0.512-0.873), to be predictive of injury. Torsion in the dominant arm was not a significant throwing arm injury predictor. Thus non-dominant arm humeral torsion (the genetic contribution) was found to be the predictor of throwing arm injury.

  11. Proximal humeral osteoarticular allografts: technique, pearls and pitfalls, outcomes.

    PubMed

    Farfalli, German L; Ayerza, Miguel A; Muscolo, D Luis; Aponte-Tinao, Luis A

    2015-12-01

    Allograft transplantation is a biologic reconstruction option for massive bone defects after resection of bone sarcomas. This type of reconstruction not only restores bone stock but it also allows us to reconstruct the joint anatomically. These factors are a major concern, especially in a young and active population.We are describing indications, surgical techniques, pearls and pitfalls, and outcomes of proximal humeral osteoarticular allografts, done at present time in our institution.We found that allograft fractures and articular complications, as epiphyseal resorption and subchondral fracture, are the main complications observed in proximal humerus osteoarticular allograft reconstructions. Nevertheless, only fractures need a reconstruction revision. Joint complications may adversely affect the limb function, but for this reason, an allograft revision is rarely performed.

  12. Humeral fractures by arm wrestling in adult: a biomechanical study.

    PubMed

    Pedrazzini, Alessio; Pedrazzoni, Mario; De Filippo, Massimo; Nicoletto, Gianni; Govoni, Riccardo; Ceccarelli, Francesco

    2012-08-01

    Humeral shaft fractures may occur as a result of arm wrestling. We discuss the biomechanics of this rare injury mechanism. Using Strength of materials concepts, Computerized Tomography and Bone Density Scans we studied the biomechanical and anatomical conditions that predispose to this particular fracture. An unfavorable ratio between inner-outer diameter and a low bone mineral concentration in the distal third of humerus compared to other sections of bone were seen as critical aspects. The biomechanical study observed the primary importance of these factors to explain the typical shape and location of this fracture. These results indicate that each arm wrestler should be conscious of the risks of practicing this activity. (www.actabiomedica.it).

  13. Contact mechanics of reverse engineered distal humeral hemiarthroplasty implants.

    PubMed

    Willing, Ryan; King, Graham J W; Johnson, James A

    2015-11-26

    Erosion of articular cartilage is a concern following distal humeral hemiarthroplasty, because native cartilage surfaces are placed in contact with stiff metallic implant components, which causes decreases in contact area and increases in contact stresses. Recently, reverse engineered implants have been proposed which are intended to promote more natural contact mechanics by reproducing the native bone or cartilage shape. In this study, finite element modeling is used in order to calculate changes in cartilage contact areas and stresses following distal humeral hemiarthroplasty with commercially available and reverse engineered implant designs. At the ulna, decreases in contact area were -34±3% (p=0.002), -27±1% (p<0.001) and -14±2% (p=0.008) using commercially available, bone reverse engineered and cartilage reverse engineered designs, respectively. Peak contact stresses increased by 461±57% (p=0.008), 387±127% (p=0.229) and 165±16% (p=0.003). At the radius, decreases in contact area were -21±3% (p=0.013), -13±2% (p<0.006) and -6±1% (p=0.020), and peak contact stresses increased by 75±52% (p>0.999), 241±32% (p=0.010) and 61±10% (p=0.021). Between the three different implant designs, the cartilage reverse engineered design yielded the largest contact areas and lowest contact stresses, but was still unable to reproduce the contact mechanics of the native joint. These findings align with a growing body of evidence indicating that although reverse engineered hemiarthroplasty implants can provide small improvements in contact mechanics when compared with commercially available designs, further optimization of shape and material properties is required in order reproduce native joint contact mechanics.

  14. Endochondral ossification of the condyle in rats on a strontium or low-calcium diet.

    PubMed

    Nagayama, M; Saburi, N; Oka, T; Matsumoto, A

    1985-09-01

    The mechanism of abnormal endochondral ossification induced by administration of strontium salts was studied in the mandibular condyles of rats by radiographic, histologic, and histochemical methods. It was shown by radiographic and histologic findings that ossification of the mandibular ramus was clearly inhibited in rats fed a low-calcium diet and rats fed a strontium diet. The change in appearance of the mandibular condyles of the rats fed strontium was more severe than that in those fed low amounts of calcium. From the histochemical findings, it was suggested that the metabolic dysfunction of chondroitin sulfate, periodic acid-Schiff positive materials, and collagen in the hypertrophic zone of the condylar cartilage (or in the part corresponding to trabecular bone of the mandibular ramus) was one factor inhibiting normal endochondral ossification.

  15. Changed morphology and mechanical properties of cancellous bone in the mandibular condyles of edentate people.

    PubMed

    Giesen, E B W; Ding, M; Dalstra, M; van Eijden, T M G J

    2004-03-01

    Since edentate subjects have a reduced masticatory function, it can be expected that the morphology of the cancellous bone of their mandibular condyles has changed according to the altered mechanical environment. In the present study, the morphology of cylindrical cancellous bone specimens of the mandibular condyles of edentate subjects (n = 25) was compared with that of dentate subjects (n = 24) by means of micro-computed tomography and by the application of Archimedes' principle. Stiffness and strength were determined by destructive mechanical testing. Compared with dentate subjects, it appeared that, in edentate subjects, the bone was less dense and the trabecular structure was less plate-like. The regression models of stiffness and strength built from bone volume fraction and the trabecular orientation relative to the axis of the specimen were similar for both dentate and edentate subjects. This indicates that, under reduced mechanical load, the fundamental relationship between bone morphology and mechanical properties does not change. PMID:14981130

  16. Proliferative periostitis of the mandibular ramus and condyle: a case report

    PubMed Central

    Seok, Hyun; Kim, Seong-Gon

    2015-01-01

    Proliferative periostitis is a rare form of osteomyelitis that is characterized by new bone formation with periosteal reaction common causes of proliferative periostitis are dental caries, periodontitis, cysts, and trauma. While proliferative periostitis typically presents as a localized lesion, in this study, we describe an extensive form of proliferative periostitis involving the whole mandibular ramus and condyle. Because the radiographic findings were similar to osteogenic sarcoma, an accurate differential diagnosis was important for proper treatment. PMID:26339579

  17. Medial femoral condyle fracture following traumatic allogenic bone transfer – A case report

    PubMed Central

    Kondreddi, Vamsi; Roy, Kishore; Yalamanchili, Ranjith Kumar

    2015-01-01

    Open fractures can cause an “out-in” injury, wherein a foreign body can penetrate the skin causing fracture. There are few reports of allogenic bone getting embedded in soft tissue, but one causing fracture to the host bone has not been reported till date. We present a case, wherein a large cortical bony fragment from one individual penetrated the thigh of another person causing fracture of medial femoral condyle during a head-on collision involving two motorbikes. PMID:26155058

  18. Effect of alendronate on endochondral ossification in mandibular condyles of growing rats

    PubMed Central

    Bradaschia-Correa, V.; Barrence, F.A.C.; Ferreira, L.B.; Massa, L.F.; Arana-Chavez, V.E.

    2012-01-01

    The replacement of the calcified cartilage by bone tissue during the endochondral ossification of the mandibular condyle is dependent of the resorbing activity of osteoclats. After partial resorption, calcified cartilage septa are covered by a primary bone matrix secreted by osteoblasts. Osteoadherin (OSAD) is a small proteoglycan present in bone matrix but absent in cartilage during the endochondral ossification. The aim of this study was to analyze the effect of alendronate, a drug known to inhibit bone resorption by osteoclasts, on the endochondral ossification of the mandibular condyle of young rats, by evaluating the distribution of osteoclasts and the presence of OSAD in the bone matrix deposited. Wistar newborn rats (n=45) received daily injections of alendronate (n=27) or sterile saline solution as control (n=18) from the day of birth until the ages of 4, 14 and 30 days. At the days mentioned, the mandibular condyles were collected and processed for transmission electron microscopy analysis. Specimens were also submitted to tartrate resistant acid phosphatase (TRAP) histochemistry and ultrastructural immunodetection of OSAD. Alendronate treatment did not impede the recruitment and fusion of osteoclasts at the ossification zone during condyle growth, but they presented inactivated phenotype. The trabeculae at the ossification area consisted of cartilage matrix covered by a layer of primary bone matrix that was immunopositive to OSAD at all time points studied. Apparently, alendronate impeded the removal of calcified cartilage and maturation of bone trabeculae in the mandibular ramus, while in controls they occurred normally. These findings highlight for giving attention to the potential side-effects of bisphosphonates administered to young patients once it may represent a risk of disturbing maxillofacial development. PMID:22688305

  19. Endoscope-Assisted Transoral Fixation of Mandibular Condyle Fractures: Submandibular Versus Transoral Endoscopic Approach.

    PubMed

    Hwang, Na-Hyun; Lee, Yoon-Hwan; You, Hi-Jin; Yoon, Eul-Sik; Kim, Deok-Woo

    2016-07-01

    In recent years, endoscope-assisted transoral approach for condylar fracture treatment has attracted much attention. However, the surgical approach is technically challenging: the procedure requires specialized instruments and the surgeons experience a steep learning curve. During the transoral endoscopic (TE) approach several instruments are positioned through a narrow oral incision making endoscope maneuvering very difficult. For this reason, the authors changed the entry port of the endoscope from transoral to submandibular area through a small stab incision. The aim of this study is to assess the advantage of using the submandibular endoscopic intraoral approach (SEI).The SEI approach requires intraoral incision for fracture reduction and fixation, and 4 mm size submandibular stab incision for endoscope and traction wires. Fifteen patients with condyle neck and subcondyle fractures were operated under the submandibular approach and 15 patients with the same diagnosis were operated under the standard TE approach.The SEI approach allowed clear visualization of the posterior margin of the ramus and condyle, and the visual axis was parallel to the condyle ramus unit. The TE approach clearly shows the anterior margin of the condyle and the sigmoid notch. The surgical time of the SEI group was 128 minutes and the TE group was 120 minutes (P >0.05). All patients in the TE endoscope group were fixated with the trocar system, but only 2 lower neck fracture patients in the SEI group required a trocar. The other 13 subcondyle fractures were fixated with an angulated screw driver (P <0.05). There were no differences in complication and surgical outcomes.The submandibular endoscopic approach has an advantage of having more space with good visualization, and facilitated the use of an angulated screw driver. PMID:27380571

  20. Osteomyelitis of the condyle secondary to pericoronitis of a third molar: a case and literature review.

    PubMed

    Wang, R; Cai, Y; Zhao, Y F; Zhao, J H

    2014-09-01

    In this study, we report a very unusual case of a patient with osteomyelitis of the condyle secondary to pericoronitis of an impacted third molar. The patient was treated by removal of the impacted third molar, opening of the drainage, combined with systemic application of antibiotics for two weeks. This treatment option did not lead to any functional defects or facial asymmetry. The patient fully recovered and the disease did not recur.

  1. Proliferative periostitis of the mandibular ramus and condyle: a case report.

    PubMed

    Seok, Hyun; Kim, Seong-Gon; Song, Ji-Young

    2015-08-01

    Proliferative periostitis is a rare form of osteomyelitis that is characterized by new bone formation with periosteal reaction common causes of proliferative periostitis are dental caries, periodontitis, cysts, and trauma. While proliferative periostitis typically presents as a localized lesion, in this study, we describe an extensive form of proliferative periostitis involving the whole mandibular ramus and condyle. Because the radiographic findings were similar to osteogenic sarcoma, an accurate differential diagnosis was important for proper treatment.

  2. Ultrastructure of the articular surface of the condyle in temporomandibular arthropathy.

    PubMed

    Toller, P A; Wilcox, J H

    1978-02-01

    The ultrastructure of the surface of normal human mandibular condyles is described and compared with specimens from condyles in cases of degenerative joint disease (arthropathy). Normal surfaces exhibited a nearly structurless layer about 2 microns thick, which seemed to correspond with the lamina splendens of other joints. The underlying structure of dense interlacing bundles of collagen is described. Surfaces of all pathologic condyles showed loss of lamina splendens, alteration of collagen size, and evidence of dissociation of both the collagen and its surrounding ground substance. Deeper levels showed aggregations of bizarre structures, which the authors term "vermiform bodies," and which appear to be collections of abnormal amounts and types of elastic tissue. Its distribution suggests a stress elastosis, which may contribute to the loss of mechanical integrity of articular surfaces in arthropathy. The surface changes may be reflected at the clinical level as impairment of the normal low-friction qualities of joint components associated with limitation of movement and joint sounds. PMID:272604

  3. Traumatic dislocation of the mandibular condyle into the middle cranial fossa in an elderly patient.

    PubMed

    Tutela, John P; Verbist, Daniel E; Kelishadi, Shahrooz; Little, Jarrod A

    2013-09-01

    Dislocation of the mandibular condyle into the middle cranial fossa is a rare traumatic injury caused by transmission of upward force through the condyle onto the glenoid fossa resulting in fracture of the fossa and superior displacement of the condylar head. This type of injury occurs when the "safety mechanisms" of the mandible fail or are absent. The authors present the case of a 72-year-old female patient with multiple comorbidities who suffered a subcondylar fracture of the left mandible and dislocation of the right mandibular condyle into the middle cranial fossa after a fall. Bilateral external fixation of the mandible to the zygomatic arch was utilized to minimize operative time and provide definitive treatment. Many factors must be taken into account when determining the treatment modality for this type of injury, and the final decision should be tailored to each individual case based on several factors including the length of time between injury and presentation, concomitant neurologic deficit, age, and stability of the patient. The goals of treatment are reduction of the dislocation, avoidance of neurologic injury, and restoration of mandibular function. A multidisciplinary effort is necessary to optimize patient care.

  4. The effect of treatment with functional appliance on a pathologic growth pattern of the condyle.

    PubMed

    Melsen, B; Bjerregaard, J; Bundgaard, M

    1986-12-01

    Hemifacial microsomia causes asymmetry of the face frequently known to progress throughout the postnatal development if not submitted to any kind of treatment. According to the theoretic basis for treatment of hemifacial microsomia as presented by Harvold and associates, generation of the right muscle-bone interaction constitutes the necessary precondition for the bone apposition that produces facial symmetry. This theory was the basis for the treatment of three patients with abnormal condyles, one suffering from hemifacial microsomia, one patient with a unilateral condylar fracture followed by displacement and secondary resorption of the condyle, and one patient with bilateral loss of condylar cartilage as a result of trauma. The patients were treated with an activator a.m. Harvold, and the treatment results analyzed radiographically and clinically. The results demonstrated clearly that generation of an altered muscle balance is possible even though hemifacial microsomia patients suffer from absence of normal muscles--that is, normal functional matrix as well as absence of normal condyle--and that bone apposition required for establishment of symmetry can be achieved if the right microenvironment is established. It was, however, also obvious that treatment should be initiated as early as possible because the treatment result was dependent on both the timing and the cooperation of the patient.

  5. Femoral condyle curvature is correlated with knee walking kinematics in ungulates.

    PubMed

    Sylvester, Adam D

    2015-12-01

    The knee has been the focus of many studies linking mammalian postcranial form with locomotor behaviors and animal ecology. A more difficult task has been linking joint morphology with joint kinematics during locomotor tasks. Joint curvature represents one opportunity to link postcranial morphology with walking kinematics because joint curvature develops in response to mechanical loading. As an initial examination of mammalian knee joint curvature, the curvature of the medial femoral condyle was measured on femora representing 11 ungulate species. The position of a region of low curvature was measured using a metric termed the "angle to low curvature". This low-curvature region is important because it provides the greatest contact area between femoral and tibial condyles. Kinematic knee angles during walking were derived from the literature and kinematic knee angles across the gait cycle were correlated with angle to low curvature values. The highest correlation between kinematic knee angle and the angle to low curvature metric occurred at 20% of the walking gait cycle. This early portion of the walking gait cycle is associated with a peak in the vertical ground reaction force for some mammals. The chondral modeling theory predicts that frequent and heavy loading of particular regions of a joint surface during ontogeny will result in these regions being flatter than the surrounding joint surface. The locations of flatter regions of the femoral condyles of ungulates, and their association with knee angles used during the early stance phase of walking provides support for the chondral modeling theory.

  6. Femoral condyle curvature is correlated with knee walking kinematics in ungulates.

    PubMed

    Sylvester, Adam D

    2015-12-01

    The knee has been the focus of many studies linking mammalian postcranial form with locomotor behaviors and animal ecology. A more difficult task has been linking joint morphology with joint kinematics during locomotor tasks. Joint curvature represents one opportunity to link postcranial morphology with walking kinematics because joint curvature develops in response to mechanical loading. As an initial examination of mammalian knee joint curvature, the curvature of the medial femoral condyle was measured on femora representing 11 ungulate species. The position of a region of low curvature was measured using a metric termed the "angle to low curvature". This low-curvature region is important because it provides the greatest contact area between femoral and tibial condyles. Kinematic knee angles during walking were derived from the literature and kinematic knee angles across the gait cycle were correlated with angle to low curvature values. The highest correlation between kinematic knee angle and the angle to low curvature metric occurred at 20% of the walking gait cycle. This early portion of the walking gait cycle is associated with a peak in the vertical ground reaction force for some mammals. The chondral modeling theory predicts that frequent and heavy loading of particular regions of a joint surface during ontogeny will result in these regions being flatter than the surrounding joint surface. The locations of flatter regions of the femoral condyles of ungulates, and their association with knee angles used during the early stance phase of walking provides support for the chondral modeling theory. PMID:26414648

  7. Mechanical properties of cancellous bone in the human mandibular condyle are anisotropic.

    PubMed

    Giesen, E B; Ding, M; Dalstra, M; van Eijden, T M

    2001-06-01

    The objective of the present study was (1) to test the hypothesis that the elastic and failure properties of the cancellous bone of the mandibular condyle depend on the loading direction, and (2) to relate these properties to bone density parameters. Uniaxial compression tests were performed on cylindrical specimens (n=47) obtained from the condyles of 24 embalmed cadavers. Two loading directions were examined, i.e., a direction coinciding with the predominant orientation of the plate-like trabeculae (axial loading) and a direction perpendicular to the plate-like trabeculae (transverse loading). Archimedes' principle was applied to determine bone density parameters. The cancellous bone was in axial loading 3.4 times stiffer and 2.8 times stronger upon failure than in transverse loading. High coefficients of correlation were found among the various mechanical properties and between them and the apparent density and volume fraction. The anisotropic mechanical properties can possibly be considered as a mechanical adaptation to the loading of the condyle in vivo. PMID:11470118

  8. Prediction bands and intervals for the scapulo-humeral coordination based on the Bootstrap and two Gaussian methods.

    PubMed

    Cutti, A G; Parel, I; Raggi, M; Petracci, E; Pellegrini, A; Accardo, A P; Sacchetti, R; Porcellini, G

    2014-03-21

    Quantitative motion analysis protocols have been developed to assess the coordination between scapula and humerus. However, the application of these protocols to test whether a subject's scapula resting position or pattern of coordination is "normal", is precluded by the unavailability of reference prediction intervals and bands, respectively. The aim of this study was to present such references for the "ISEO" protocol, by using the non-parametric Bootstrap approach and two parametric Gaussian methods (based on Student's T and Normal distributions). One hundred and eleven asymptomatic subjects were divided into three groups based on their age (18-30, 31-50, and 51-70). For each group, "monolateral" prediction bands and intervals were computed for the scapulo-humeral patterns and the scapula resting orientation, respectively. A fourth group included the 36 subjects (42 ± 13 year-old) for whom the scapulo-humeral coordination was measured bilaterally, and "differential" prediction bands and intervals were computed, which describe right-to-left side differences. Bootstrap and Gaussian methods were compared using cross-validation analyses, by evaluating the coverage probability in comparison to a 90% target. Results showed a mean coverage for Bootstrap from 86% to 90%, compared to 67-70% for parametric bands and 87-88% for parametric intervals. Bootstrap prediction bands showed a distinctive change in amplitude and mean pattern related to age, with an increase toward scapula retraction, lateral rotation and posterior tilt. In conclusion, Bootstrap ensures an optimal coverage and should be preferred over parametric methods. Moreover, the stratification of "monolateral" prediction bands and intervals by age appears relevant for the correct classification of patients.

  9. The Development of Humeral Retrotorsion and Its Relationship to Throwing Sports

    PubMed Central

    Greenberg, Elliot M.; Fernandez-Fernandez, Alicia; Lawrence, J. Todd R.; McClure, Philip

    2015-01-01

    Context: Several investigations have noted that throwing athletes exhibit a more posteriorly oriented humeral head (humeral retrotorsion) in the dominant arm. This asymmetry is believed to represent an adaptive response to the stress of throwing that occurs during childhood. The significance of this alteration and factors that affect its development are currently not clear. Evidence Acquisition: Basic science, research studies, and review articles were searched through PubMed with search terms including humeral torsion, humeral retrotorsion, and with 1 of the following: pediatric, adult, baseball, pitching, shoulder, and range of motion. The references from each article were reviewed for further inclusion. This review included articles through March 2015. Study Design: Clinical review. Level of Evidence: Level 4. Results: The throwing motion creates stressors that result in bony adaptations that occur while skeletally immature. These osseous changes likely contribute to the observed shift in the arc of rotational range of motion noted in throwing athletes and may play a protective role against injury. However, too much or too little retrotorsion may predispose the shoulder to injury. The degree of “optimal” humeral retrotorsion and factors that influence its development are not fully understood. Conclusion: Evidence supports the assertion that the throwing motion creates stressors that alter bony anatomy while young. It is important to determine what specific factors affect this adaptation and its relationship to injury. PMID:26502441

  10. Iatrogenic Radial Nerve Palsy following Closed Reduction of a Simple Diaphyseal Humeral Fracture: Beware the Perfect X-Ray

    PubMed Central

    Jones, Morgan; O'Neill, Christopher

    2016-01-01

    Radial nerve injury is a recognised complication associated with humeral shaft fracture. A case of iatrogenic radial nerve injury is presented following fracture reduction. The relevant anatomy, challenges in management of humeral fractures with associated radial nerve injury, and the importance of detailed clinical assessment and documentation are discussed. PMID:27478658

  11. Quantification of anterior translation of the humeral head in the throwing shoulder. Manual assessment versus stress radiography.

    PubMed

    Ellenbecker, T S; Mattalino, A J; Elam, E; Caplinger, R

    2000-01-01

    Clinical evaluation of humeral head translation relies mainly on manual tests to measure laxity in the human shoulder. The purposes of this study were to determine whether side-to-side differences exist in anterior humeral head translation in professional baseball pitchers, to compare manual laxity testing with stress radiography for quantifying humeral head translation, and to test intrarater reliability of the manual humeral head translation and stress radiography tests. Twenty professional baseball pitchers underwent bilateral manual anterior humeral head translation and stress radiographic tests. Stress radiography was performed by imparting a 15-daN anterior load to the shoulder in 90 degrees of abduction with both neutral and 60 degrees of external rotation and recording the glenohumeral joint translation at rest and under stress in each position. Eight subjects were retested to assess the reliability of these methods. Results showed no significant difference between the dominant and nondominant extremity in the amount of anterior humeral head translation measured manually and with stress radiography, nor significant correlation between anterior humeral head translation measured manually and by stress radiography. Test-retest reliability was moderate-to-poor for the manual humeral head translation test and moderate for stress radiography.

  12. The impact of subsistence changes on humeral bilateral asymmetry in Terminal Pleistocene and Holocene Europe.

    PubMed

    Sládek, Vladimír; Ruff, Christopher B; Berner, Margit; Holt, Brigitte; Niskanen, Markku; Schuplerová, Eliška; Hora, Martin

    2016-03-01

    Analyses of upper limb bone bilateral asymmetry can shed light on manipulative behavior, sexual division of labor, and the effects of economic transitions on skeletal morphology. We compared the maximum (absolute) and directional asymmetry in humeral length, articular breadth, and cross-sectional diaphyseal geometry (CSG) in a large (n > 1200) European sample distributed among 11 archaeological periods from the Early Upper Paleolithic through the 20(th) century. Asymmetry in length and articular breadth is right-biased, but relatively small and fairly constant between temporal periods. Females show more asymmetry in length than males. This suggests a low impact of behavioral changes on asymmetry in length and breadth, but strong genetic control with probable sex linkage of asymmetry in length. Asymmetry in CSG properties is much more marked than in length and articular breadth, with sex-specific variation. In males, a major decline in asymmetry occurs between the Upper Paleolithic and Mesolithic. There is no further decline in asymmetry between the Mesolithic and Neolithic in males and only limited variation during the Holocene. In females, a major decline occurs between the Mesolithic and Neolithic, with resulting average directional asymmetry close to zero. Asymmetry among females continues to be very low in the subsequent Copper and Bronze Ages, but increases again in the Iron Age. Changes in female asymmetry result in an increase of sexual dimorphism during the early agricultural periods, followed by a decrease in the Iron Age. Sexual dimorphism again slightly declines after the Late Medieval. Our results indicate that changes in manipulative behavior were sex-specific with a probable higher impact of changes in hunting behavior on male asymmetry (e.g., shift from unimanual throwing to use of the bow-and-arrow) and food grain processing in females, specifically, use of two-handed saddle querns in the early agricultural periods and one-handed rotary querns in

  13. The impact of subsistence changes on humeral bilateral asymmetry in Terminal Pleistocene and Holocene Europe.

    PubMed

    Sládek, Vladimír; Ruff, Christopher B; Berner, Margit; Holt, Brigitte; Niskanen, Markku; Schuplerová, Eliška; Hora, Martin

    2016-03-01

    Analyses of upper limb bone bilateral asymmetry can shed light on manipulative behavior, sexual division of labor, and the effects of economic transitions on skeletal morphology. We compared the maximum (absolute) and directional asymmetry in humeral length, articular breadth, and cross-sectional diaphyseal geometry (CSG) in a large (n > 1200) European sample distributed among 11 archaeological periods from the Early Upper Paleolithic through the 20(th) century. Asymmetry in length and articular breadth is right-biased, but relatively small and fairly constant between temporal periods. Females show more asymmetry in length than males. This suggests a low impact of behavioral changes on asymmetry in length and breadth, but strong genetic control with probable sex linkage of asymmetry in length. Asymmetry in CSG properties is much more marked than in length and articular breadth, with sex-specific variation. In males, a major decline in asymmetry occurs between the Upper Paleolithic and Mesolithic. There is no further decline in asymmetry between the Mesolithic and Neolithic in males and only limited variation during the Holocene. In females, a major decline occurs between the Mesolithic and Neolithic, with resulting average directional asymmetry close to zero. Asymmetry among females continues to be very low in the subsequent Copper and Bronze Ages, but increases again in the Iron Age. Changes in female asymmetry result in an increase of sexual dimorphism during the early agricultural periods, followed by a decrease in the Iron Age. Sexual dimorphism again slightly declines after the Late Medieval. Our results indicate that changes in manipulative behavior were sex-specific with a probable higher impact of changes in hunting behavior on male asymmetry (e.g., shift from unimanual throwing to use of the bow-and-arrow) and food grain processing in females, specifically, use of two-handed saddle querns in the early agricultural periods and one-handed rotary querns in

  14. [Periprosthetic humeral fractures: Strategies and techniques for osteosynthesis].

    PubMed

    Kirchhoff, C; Brunner, U; Biberthaler, P

    2016-04-01

    The prevalence of periprosthetic humeral fractures (PHF) is currently low and accounts for 0.6-2.4%. Due to an increase in the rate of primary implantations a quantitative increase of PHF is to be expected in the near future. The majority of PHF occur intraoperatively during implantation with an increased risk for cementless stems and when performing total arthroplasty. Additional risk factors are in particular female gender and the severity of comorbidities. In contrast, postoperative PHF mostly due to low-energy falls, have a prevalence between 0.6% and 0.9% and are significantly less common. The prognosis and functional outcome following revision by open reduction internal fixation (ORIF) essentially depend on a thorough assessment of the indications for revision surgery, the operative treatment and the pretraumatic functional condition of the affected shoulder. In the armamentarium of periprosthetic ORIF of the humerus cerclage systems and locking implants as well as a combination of both play a central role. In comminuted fractures with extensive defect zones, severely thinned cortex or extensive osteolysis a biological augmentation of the ORIF should be considered. In this context when the indications are correctly interpreted, especially in the case of a stable anchored stem, various groups have reported that a high bony union rate can be achieved. As the treatment of PHF is complex it should be performed in dedicated centers in order to adequately address potential comorbidities, especially in the elderly population.

  15. Anatomy and histology of the transverse humeral ligament.

    PubMed

    Snow, Brian J; Narvy, Steven J; Omid, Reza; Atkinson, Roscoe D; Vangsness, C Thomas

    2013-10-01

    The classic literature describes the transverse humeral ligament (THL) as a distinct anatomic structure with a role in biceps tendon stability; however, recent literature suggests that it is not a distinct anatomic structure. The purpose of this study was to evaluate the gross and microscopic anatomy of the THL, including a specific investigation of the histology of this ligament. Thirty frozen, embalmed cadaveric specimens were dissected to determine the gross anatomy of the THL. Seven specimens were evaluated histologically for the presence of mechanoreceptors and free nerve endings. Two tissue layers were identified in the area described as the THL. In the deep layer, fibers of the subscapularis tendon were found to span the bicipital groove with contributions from the coracohumeral ligament and the supraspinatus tendon. Superficial to this layer was a fibrous fascial covering consisting of distinct bands of tissue. Neurohistology staining revealed the presence of free nerve endings but no mechanoreceptors. This study's findings demonstrate that the THL is a distinct structure continuous with the rotator cuff tendons and the coracohumeral ligament. The finding of free nerve endings in the THL suggests a potential role as a shoulder pain generator.

  16. Humeral retroversion and shoulder rotational mobility in young handball practitioners

    PubMed Central

    Quadros, Gustavo Aguiar; Döhnert, Marcelo Baptista

    2015-01-01

    ABSTRACT OBJECTIVE : To evaluate the prevalence of humeral retroversion and rotational mobility (RHH) in young handball practitioners and non-practitioners. METHODS : This is a cross-sectional study performed with two groups: the handball group, with 14 female students practicing handball and the control group, with 13 young participants non-practicing pitch sports. RESULTS : The handball group presented full rotational movement (FRM) hi-gher than the control group in both the dominant shoulder (p=0.001) and the non-dominant shoulder (p=0.0001). The mobility of active and passive internal rotation was significantly higher in handball players in both shoulders. The handball group presented lower internal rotation range of motion for the dominant shoulder as compared to the non-dominant shoul-der (p=0.001). CONCLUSION : Young handball practitioners, des-pite skeletally immature, showed a higher MRT than the control group. The handball group showed loss of internal rotation (medial) on the dominant shoulder as compared to the non--dominant shoulder. Level of Evidence II, Prospective Study. PMID:27057141

  17. Validity of measuring humeral torsion using palpation of bicipital tuberosities

    PubMed Central

    Dashottar, Amitabh; Borstad, John D.

    2012-01-01

    The magnitude of humeral torsion (HT) affects the internal and external rotation range of motion at the shoulder. Currently imaging is required to quantify the HT angle, however, factors such as cost and non-availability of imaging to musculoskeletal clinicians limits its use. The aim of this study was to examine the validity of palpation of the bicipital tuberosities as an alternative to imaging for quantifying HT angles. The bicipital-forearm angle, an indirect measure of HT, was measured using palpation and real-time ultrasound imaging in 25 subjects. The agreement among the two methods was excellent with the Intraclass Correlation Coefficient (3,k) = 0.92, and the mean difference between the two methods was −0.2° (SD 4.1°) with 95% limits of agreement of −8.3° to 7.9°. Pearson’s correlation coefficient (r) among the two methods was 0.85. In a clinical setting, palpation appears to be a practical alternative to US imaging for measuring HT. PMID:22489871

  18. Fracture Union in Closed Interlocking Nail in Humeral Shaft Fractures

    PubMed Central

    Sahu, Ramji Lal; Ranjan, Rajni; Lal, Ajay

    2015-01-01

    Background: Fracture shaft humerus is a major cause of morbidity in patients with upper extremity injuries. The aim of this study was to evaluate the outcome of interlocking nail in humeral shaft fractures. Methods: This study was conducted in the Department of Orthopedic Surgery in SMS and R Sharda University from January 2010 to November 2013. Seventy-eight patients were recruited from emergency and out-patient department having a close fracture of humerus shaft. All patients were operated under general anesthesia and closed reamed interlocking nailing was done. All patients were followed for 9 months. Results: Out of 78 patients, 69 patients underwent union in 90–150 days with a mean of 110.68 days. Complications found in four patients who had nonunion, and five patients had delayed union, which was treated with bone grafting. All the patients were assessed clinically and radiologically for fracture healing, joint movements and implant failure. The results were excellent in 88.46% and good in 6.41% patients. Complete subjective, functional, and clinical recovery had occurred in almost 100% of the patients. Conclusions: The results of the present study indicates that in the presence of proper indications, reamed antegrade intramedullary interlocked nailing appears to be a method of choice for internal fixation of osteoporotic and pathologic fractures. PMID:26021495

  19. Indirect ultrasound measurement of humeral torsion in adolescent baseball players and non-athletic adults: reliability and significance.

    PubMed

    Whiteley, Rod; Ginn, Karen; Nicholson, Leslie; Adams, Roger

    2006-08-01

    Accurate clinical interpretation of shoulder rotation range requires knowledge of the contribution of humeral torsion. This study compares the reliability of indirectly measuring humeral torsion using ultrasound visualisation with direct palpation and compares the degree of humeral torsion in a non-throwing adult population with a population of elite adolescent baseballers. The reliability of a novel method of indirectly measuring humeral torsion using palpation and ultrasound was established prior to using the ultrasound method to determine the amount of humeral torsion in both humeri of a group of 16 non-throwing subjects and 36 elite adolescent baseball players. Excellent inter-tester reliability was found for the ultrasound method of measuring humeral torsion in each arm (ICC 2,1: 0.98 and 0.94) but poor reliability for the direct palpation method (ICC 2,1: 0.51 and 0.49). Using the ultrasound method, side-to-side differences in humeral torsion ranged from 0 to 13 degrees for the non-throwing group and 0 to 29 degrees for the baseball players. This side-to-side difference was significant in the baseball players (p<0.001) but not significant in the non-throwing group (p=0.43). Whilst side-to-side differences in humeral torsion were noted between all subjects irrespective of arm dominance, only throwers demonstrated consistently greater humeral retrotorsion in their throwing arm. A reliable clinical tool for estimating humeral torsion, such as that employed in this study, will allow for a more valid prescription of interventions for the treatment of shoulder dysfunction.

  20. Humeral shaft fracture treatment in the elite throwing athlete: a unique application of flexible intramedullary nailing.

    PubMed

    Lee, Christopher S; Davis, Shane M; Ho, Hoang-Anh; Fronek, Jan

    2013-01-01

    Humeral shaft stress fractures are being increasingly recognized as injuries that can significantly impact throwing mechanics if residual malalignment exists. While minimally displaced and angulated injuries are treated nonoperatively in a fracture brace, the management of significantly displaced humeral shaft fractures in the throwing athlete is less clear. Currently described techniques such as open reduction and internal fixation with plate osteosynthesis and rigid antegrade/retrograde locked intramedullary nailing have significant morbidity due to soft tissue dissection and damage. We present a case report of a high-level baseball pitcher whose significantly displaced humeral shaft stress fracture failed to be nonoperatively managed and was subsequently treated successfully with unlocked, retrograde flexible intramedullary nailing. The athlete was able to return to pitching baseball in one year and is currently pitching in Major League Baseball. We were able to recently collect 10-year follow-up data. PMID:24369515

  1. Humeral Shaft Fracture Treatment in the Elite Throwing Athlete: A Unique Application of Flexible Intramedullary Nailing

    PubMed Central

    Lee, Christopher S.; Davis, Shane M.; Fronek, Jan

    2013-01-01

    Humeral shaft stress fractures are being increasingly recognized as injuries that can significantly impact throwing mechanics if residual malalignment exists. While minimally displaced and angulated injuries are treated nonoperatively in a fracture brace, the management of significantly displaced humeral shaft fractures in the throwing athlete is less clear. Currently described techniques such as open reduction and internal fixation with plate osteosynthesis and rigid antegrade/retrograde locked intramedullary nailing have significant morbidity due to soft tissue dissection and damage. We present a case report of a high-level baseball pitcher whose significantly displaced humeral shaft stress fracture failed to be nonoperatively managed and was subsequently treated successfully with unlocked, retrograde flexible intramedullary nailing. The athlete was able to return to pitching baseball in one year and is currently pitching in Major League Baseball. We were able to recently collect 10-year follow-up data. PMID:24369515

  2. Humeral shaft fracture treatment in the elite throwing athlete: a unique application of flexible intramedullary nailing.

    PubMed

    Lee, Christopher S; Davis, Shane M; Ho, Hoang-Anh; Fronek, Jan

    2013-01-01

    Humeral shaft stress fractures are being increasingly recognized as injuries that can significantly impact throwing mechanics if residual malalignment exists. While minimally displaced and angulated injuries are treated nonoperatively in a fracture brace, the management of significantly displaced humeral shaft fractures in the throwing athlete is less clear. Currently described techniques such as open reduction and internal fixation with plate osteosynthesis and rigid antegrade/retrograde locked intramedullary nailing have significant morbidity due to soft tissue dissection and damage. We present a case report of a high-level baseball pitcher whose significantly displaced humeral shaft stress fracture failed to be nonoperatively managed and was subsequently treated successfully with unlocked, retrograde flexible intramedullary nailing. The athlete was able to return to pitching baseball in one year and is currently pitching in Major League Baseball. We were able to recently collect 10-year follow-up data.

  3. Iatrogenic brachial artery injury during anterolateral plating of humeral shaft fracture.

    PubMed

    Kumar, Vishal; Behera, Prateek; Aggarwal, Sameer; Meena, Umesh Kumar

    2013-01-01

    There are several well defined indications for surgical management of humeral shaft fractures. Operative procedures on the humerus are associated with their own complications. Iatrogenic brachial artery injury as a complication of humeral shaft plating has not been reported previously. We report a case of a 48 years old female, who received operation at a district hospital and was referred to us when the surgeon could not palpate the pulse. CT angiogram showed that there was segmental non-opacification of the brachial artery. There was distal reformation and the thrombosis was decided to be managed conservatively. We believe that the arterial injury was a result of improper surgical technique and the segmental block might be due to improper use of plate holding forceps. This case report makes us aware of a rare complication of operative management of humeral shaft fractures and that basic principles of surgery must be always followed to prevent such injuries. PMID:24295587

  4. Arthroscopic Anatomic Humeral Head Reconstruction With Osteochondral Allograft Transplantation for Large Hill-Sachs Lesions

    PubMed Central

    Snir, Nimrod; Wolfson, Theodore S.; Hamula, Mathew J.; Gyftopoulos, Soterios; Meislin, Robert J.

    2013-01-01

    Anatomic reconstruction of the humeral head with osteochondral allograft has been reported as a solution for large Hill-Sachs lesions with or without glenoid bone loss. However, to date, varying techniques have been used. This technical note describes an arthroscopic reconstruction technique using fresh-frozen, side- and size-matched osteochondral humeral head allograft. Allograft plugs are press fit into the defect without internal fixation and seated flush with the surrounding articular surface. This technique restores the native articular contour of the humeral head without compromising shoulder range of motion. Potential benefits of this all-arthroscopic approach include minimal trauma to the soft tissue and articular surface without the need for hardware or staged reoperation. PMID:24266001

  5. Influence of food consistency and dental extractions on the rat mandibular condyle: a morphological, histological and immunohistochemical study.

    PubMed

    Endo, Y; Mizutani, H; Yasue, K; Senga, K; Ueda, M

    1998-06-01

    The purpose of this study was to investigate the relationship between food consistency and the growth of the mandibular condyle in rats. Secondly, the effect of dental extractions on cartilage of the mandibular condyle was examined in young adult rats fed foods of varying consistency. Thirty-six male Wistar rats were divided into four groups: (A) Solid diet--non-Extraction (non-Ext.) group; (B) Solid diet--Extraction (Ext.) group; (C) Powder diet--non-Ext. group; and (D) Powder diet--Ext. group. Extractions were performed at 12 weeks of age. The mandibular condyles were removed at 1, 4, and 8 weeks after the extractions. The shape of the mandibular condyles in the powder diet groups (C and D) was significantly narrower. In the Ext. groups (B and D), the thickness of the hypertrophic zone was reduced one week after the extractions. In the powder diet groups (C and D), the intensity of the staining of fibronectin decreased in the proliferative zone regardless of the extractions. In group B, a decreased intensity of this reaction was observed one week after the extractions. From these results, it appeared that food consistency and/or dental extractions affected the morphology of the mandibular condyle and the histological characteristics of the mandibular condylar cartilage.

  6. Morphological changes of condyles and Helkimo clinical dysfunction index in patients treated with Herbst--orthodontic appliance.

    PubMed

    Aidar, Luís Antônio de Arruda; Abrahão, Márcio; Yamashita, Hélio K; Dominguez, Gladys Cristina

    2013-01-01

    This study evaluated the morphological changes in the temporomandibular joint (TMJ) condyles and calculated the Helkimo clinical dysfunction index (CDI) in adolescents with Class II Division 1 malocclusion and mandibular retrognathism treated with the Herbst appliance (phase I) and fixed orthodontic appliances (phase II). Thirty-two consecutive adolescents underwent phase I, and 23 completed phase II. The TMJs were evaluated qualitatively using magnetic resonance imaging (MRI) at the beginning of treatment (T1), during phase I (T2), at the end of phase I (T3) and at the end of phase II (T4). The CDI was calculated at T1, T3 and T4. From T1 to T3 (p=0.326), there were no changes in condyle morphology in 86.0% of the TMJs. From T3 to T4 (p<0.05) and T1 to T4 (p<0.05), changes occurred in 39.1% and 43.4% of the condyles. No significant changes in CDI occurred from T1 to T3, T3 to T4 and T1 to T4 (p=1.000; 86.6%, 76.2% and 76.2% concordance). After phase I, there were practically no changes in condyle morphology. At the end of phase II, a mild flattening was observed in some condyles. It may be concluded that no significant changes occurred in CDI after both treatment phases.

  7. Experience Rate of Elbow Pain and Morphological Abnormality of Humeral Medial Epicondyle among Youth Baseball Players

    PubMed Central

    Kotoura, Yoshihiro; Morihara, Toru; Kida, Yoshikazu; Sukenari, Tsuyoshi; Furukawa, Ryuhei; Kabuto, Yukichi; MInami, Masataka; Onishi, Okihiro; Tsujihara, Takashi; Hojo, Tatsuya; Fujiwara, Hiroyoshi; Kubo, Toshikazu

    2016-01-01

    Objectives: The aim of this study was to investigate the experience rate of elbow pain and to clarify the relationship between morphological abnormality of the humeral medial epicondyle and positions among baseball players in elementary school (ES), junior high school (JHS) and high school (HS). Methods: In this study, 4353 baseball players who participated in our medical screening (2008-2015) were enrolled. There were 1545 players from ES, 1934 players from JHS, and 874 players from HS. We asked them to answer the questionnaire to investigate the experience of elbow pain, and the position they played. Ultrasonography of the humeral medial epicondyle was examined and irregularity, fragmentation, and malunion of the humeral medial epicondyle. The results were analyzed statistically. P < 0.05 was considered significant for all statistical analyses. Results: The experience rates of elbow pain among players in ES, JHS, and HS were 26.0%, 27.0%, and 68.3%. The rates of abnormality of humeral medial epicondyle among players in ES, JHS, and HS were 18.2%, 36.3%, and 39.9% (Table 1). The experience rate of elbow pain among pitchers and catchers was significantly higher than the fielders in ES (Table 2), however, there were no significant differences between positions in JHS and HS (Table 3,4). According to the rate of morphological abnormalities of humeral medial epicondyle, pitchers and catchers were significantly higher than fielders in ES, while only pitchers were significantly higher than the fielders in JHS and HS (Table 2,3,4). Conclusion: The experience rate of elbow pain among baseball players rose as the age increased, and the rate in HS was almost 70%. The rates of morphological abnormality of humeral medial epicondyle among pitchers and catchers were high and the tendency was observed from a young age. The primary prevention of elbow injuries in youth baseball players of all ages should be considered.

  8. Taxonomic identification of Lower Pleistocene fossil hominins based on distal humeral diaphyseal cross-sectional shape.

    PubMed

    Lague, Michael R

    2015-01-01

    The coexistence of multiple hominin species during the Lower Pleistocene has long presented a challenge for taxonomic attribution of isolated postcrania. Although fossil humeri are well-suited for studies of hominin postcranial variation due to their relative abundance, humeral articular morphology has thus far been of limited value for differentiating Paranthropus from Homo. On the other hand, distal humeral diaphyseal shape has been used to justify such generic distinctions at Swartkrans. The potential utility of humeral diaphyseal shape merits larger-scale quantitative analysis, particularly as it permits the inclusion of fragmentary specimens lacking articular morphology. This study analyzes shape variation of the distal humeral diaphysis among fossil hominins (c. 2-1 Ma) to test the hypothesis that specimens can be divided into distinct morphotypes. Coordinate landmarks were placed on 3D laser scans to quantify cross-sectional shape at a standardized location of the humeral diaphysis (proximal to the olecranon fossa) for a variety of fossil hominins and extant hominids. The fossil sample includes specimens attributed to species based on associated craniodental remains. Mantel tests of matrix correlation were used to assess hypotheses about morphometric relationships among the fossils by comparing empirically-derived Procrustes distance matrices to hypothetical model matrices. Diaphyseal shape variation is consistent with the hypothesis of three distinct morphotypes (Paranthropus, Homo erectus, non-erectus early Homo) in both eastern and southern Africa during the observed time period. Specimens attributed to non-erectus early Homo are unique among hominids with respect to the degree of relative anteroposterior flattening, while H. erectus humeri exhibit morphology more similar to that of modern humans. In both geographic regions, Paranthropus is characterized by a morphology that is intermediate with respect to those morphological features that differentiate

  9. Taxonomic identification of Lower Pleistocene fossil hominins based on distal humeral diaphyseal cross-sectional shape

    PubMed Central

    2015-01-01

    The coexistence of multiple hominin species during the Lower Pleistocene has long presented a challenge for taxonomic attribution of isolated postcrania. Although fossil humeri are well-suited for studies of hominin postcranial variation due to their relative abundance, humeral articular morphology has thus far been of limited value for differentiating Paranthropus from Homo. On the other hand, distal humeral diaphyseal shape has been used to justify such generic distinctions at Swartkrans. The potential utility of humeral diaphyseal shape merits larger-scale quantitative analysis, particularly as it permits the inclusion of fragmentary specimens lacking articular morphology. This study analyzes shape variation of the distal humeral diaphysis among fossil hominins (c. 2-1 Ma) to test the hypothesis that specimens can be divided into distinct morphotypes. Coordinate landmarks were placed on 3D laser scans to quantify cross-sectional shape at a standardized location of the humeral diaphysis (proximal to the olecranon fossa) for a variety of fossil hominins and extant hominids. The fossil sample includes specimens attributed to species based on associated craniodental remains. Mantel tests of matrix correlation were used to assess hypotheses about morphometric relationships among the fossils by comparing empirically-derived Procrustes distance matrices to hypothetical model matrices. Diaphyseal shape variation is consistent with the hypothesis of three distinct morphotypes (Paranthropus, Homo erectus, non-erectus early Homo) in both eastern and southern Africa during the observed time period. Specimens attributed to non-erectus early Homo are unique among hominids with respect to the degree of relative anteroposterior flattening, while H. erectus humeri exhibit morphology more similar to that of modern humans. In both geographic regions, Paranthropus is characterized by a morphology that is intermediate with respect to those morphological features that differentiate

  10. Segmentation of humeral head from axial proton density weighted shoulder MR images

    NASA Astrophysics Data System (ADS)

    Sezer, Aysun; Sezer, Hasan Basri; Albayrak, Songul

    2015-01-01

    The purpose of this study is to determine the effectiveness of segmentation of axial MR proton density (PD) images of bony humeral head. PD sequence images which are included in standard shoulder MRI protocol are used instead of T1 MR images. Bony structures were reported to be successfully segmented in the literature from T1 MR images. T1 MR images give more sharp determination of bone and soft tissue border but cannot address the pathological process which takes place in the bone. In the clinical settings PD images of shoulder are used to investigate soft tissue alterations which can cause shoulder instability and are better in demonstrating edema and the pathology but have a higher noise ratio than other modalities. Moreover the alteration of humeral head intensity in patients and soft tissues in contact with the humeral head which have the very similar intensities with bone makes the humeral head segmentation a challenging problem in PD images. However segmentation of the bony humeral head is required initially to facilitate the segmentation of the soft tissues of shoulder. In this study shoulder MRI of 33 randomly selected patients were included. Speckle reducing anisotropic diffusion (SRAD) method was used to decrease noise and then Active Contour Without Edge (ACWE) and Signed Pressure Force (SPF) models were applied on our data set. Success of these methods is determined by comparing our results with manually segmented images by an expert. Applications of these methods on PD images provide highly successful results for segmentation of bony humeral head. This is the first study to determine bone contours in PD images in literature.

  11. Pullulan/dextran/nHA macroporous composite beads for bone repair in a femoral condyle defect in rats.

    PubMed

    Schlaubitz, Silke; Derkaoui, Sidi Mohammed; Marosa, Lydia; Miraux, Sylvain; Renard, Martine; Catros, Sylvain; Le Visage, Catherine; Letourneur, Didier; Amédée, Joëlle; Fricain, Jean-Christophe

    2014-01-01

    The repair of bone defects is of particular interest for orthopedic, oral, maxillofacial, and dental surgery. Bone loss requiring reconstruction is conventionally addressed through bone grafting. Depending on the size and the location of the defect, this method has limits and risks. Biomaterials can offer an alternative and have features supporting bone repair. Here, we propose to evaluate the cellular penetration and bone formation of new macroporous beads based on pullulan/dextran that has been supplemented with nanocrystalline hydroxyapatite in a rat model. Cross-linked beads of 300-500 µm diameters were used in a lateral femoral condyle defect and analyzed by magnetic resonance imaging, micro-computed tomography, and histology in comparison to the empty defects 15, 30, and 70 days after implantation. Inflammation was absent for both conditions. For empty defects, cellularisation and mineralization started from the periphery of the defect. For the defects containing beads, cellular structures filling out the spaces between the scaffolds with increasing interconnectivity and trabecular-like organization were observed over time. The analysis of calcified sections showed increased mineralization over time for both conditions, but was more pronounced for the samples containing beads. Bone Mineral Density and Bone Mineral Content were both significantly higher at day 70 for the beads in comparison to empty defects as well as compared with earlier time points. Analysis of newly formed tissue around the beads showed an increase of osteoid tissue, measured as percentage of the defect surface. This study suggests that the use of beads for the repair of small size defects in bone may be expanded on to meet the clinical need for a ready-to-use fill-up material that can favor bone formation and mineralization, as well as promote vessel ingrowth into the defect site.

  12. Pullulan/dextran/nHA Macroporous Composite Beads for Bone Repair in a Femoral Condyle Defect in Rats

    PubMed Central

    Schlaubitz, Silke; Derkaoui, Sidi Mohammed; Marosa, Lydia; Miraux, Sylvain; Renard, Martine; Catros, Sylvain; Le Visage, Catherine; Letourneur, Didier; Amédée, Joëlle; Fricain, Jean-Christophe

    2014-01-01

    The repair of bone defects is of particular interest for orthopedic, oral, maxillofacial, and dental surgery. Bone loss requiring reconstruction is conventionally addressed through bone grafting. Depending on the size and the location of the defect, this method has limits and risks. Biomaterials can offer an alternative and have features supporting bone repair. Here, we propose to evaluate the cellular penetration and bone formation of new macroporous beads based on pullulan/dextran that has been supplemented with nanocrystalline hydroxyapatite in a rat model. Cross-linked beads of 300–500 µm diameters were used in a lateral femoral condyle defect and analyzed by magnetic resonance imaging, micro-computed tomography, and histology in comparison to the empty defects 15, 30, and 70 days after implantation. Inflammation was absent for both conditions. For empty defects, cellularisation and mineralization started from the periphery of the defect. For the defects containing beads, cellular structures filling out the spaces between the scaffolds with increasing interconnectivity and trabecular-like organization were observed over time. The analysis of calcified sections showed increased mineralization over time for both conditions, but was more pronounced for the samples containing beads. Bone Mineral Density and Bone Mineral Content were both significantly higher at day 70 for the beads in comparison to empty defects as well as compared with earlier time points. Analysis of newly formed tissue around the beads showed an increase of osteoid tissue, measured as percentage of the defect surface. This study suggests that the use of beads for the repair of small size defects in bone may be expanded on to meet the clinical need for a ready-to-use fill-up material that can favor bone formation and mineralization, as well as promote vessel ingrowth into the defect site. PMID:25330002

  13. Regional Variation of Bone Tissue Properties at the Human Mandibular Condyle

    PubMed Central

    Kim, Do-Gyoon; Jeong, Yong-Hoon; Kosel, Erin; Agnew, Amanda M.; McComb, David W.; Bodnyk, Kyle; Hart, Richard T.; Kim, Min Kyung; Han, Sang Yeun; Johnston, William M.

    2015-01-01

    The temporomandibular joint (TMJ) bears different types of static and dynamic loading during occlusion and mastication. As such, characteristics of mandibular condylar bone tissue play an important role in determining the mechanical stability of the TMJ under the macro-level loading. Thus, the objective of this study was to examine regional variation of the elastic, plastic, and viscoelastic mechanical properties of human mandibular condylar bone tissue using nanoindentation. Cortical and trabecular bone were dissected from mandibular condyles of human cadavers (9 males, 54 to 96 years). These specimens were scanned using microcomputed tomography to obtain bone tissue mineral distribution. Then, nanoindentation was conducted on the surface of the same specimens in hydration. Plastic hardness (H) at a peak load, viscoelastic creep (Creep/Pmax), viscosity (η), and tangent delta (tan δ) during a 30 second hold period, and elastic modulus (E) during unloading were obtained by a cycle of indentation at the same site of bone tissue. The tissue mineral and nanoindentation parameters were analyzed for the periosteal and endosteal cortex, and trabecular bone regions of the mandibular condyle. The more mineralized periosteal cortex had higher mean values of elastic modulus, plastic hardness, and viscosity but lower viscoelastic creep and tan δ than the less mineralized trabecular bone of the mandibular condyle. These characteristics of bone tissue suggest that the periosteal cortex tissue may have more effective properties to resist elastic, plastic, and viscoelastic deformation under static loading, and the trabecular bone tissue to absorb and dissipate time-dependent viscoelastic loading energy at the TMJ during static occlusion and dynamic mastication. PMID:25913634

  14. Brodie's abscess of medial distal femoral condyle after a thorn prick: rare clinical presentation.

    PubMed

    Nag, Hira-L; Kancherla, Ramprasad; Malpura, Aftab

    2012-01-01

    Thorn prick injuries are generally conceded frivolous and rarely demand medical attention. Howbeit deep seated injuries are well described in the literature. We presented a case of thorn prick injury to the knee that manifested as Brodie's abscess of the medial distal femoral condyle and synovitis. Magnetic resonance imaging (MRI) and ultrasonography could only construe the affliction but not spot the thorn. Arthrotomy was undertaken for exploration and debridement. Empirical therapy with initial systemic Cefotaxime and subsequent Ofloxacin worked well after the surgery. Deep seated injuries by a thorn prick may take a protracted and torpid course. Thorough curettage of the bony lesion and debridement are vital for proper manage- ment.

  15. Skeletal Tuberculosis Presenting as a Small Cystic Lesion in the Medial Femoral Condyle

    PubMed Central

    Elmi, Asghar; Tabrizi, Ali; Tolouei, Fardin Mirza

    2013-01-01

    Skeletal tuberculosis is an unusual disease involving bone and joints and it may have different manifestations. This report introduces a 25-year-old woman suffering from chronic knee pain without any response to conservative treatments for one year. X-ray was normal but CT-scan and MRI indicated a small lesion in medial condyle of the femur. The patient underwent percutaneous CT-guided biopsy. Following an evaluation of the obtained sample, tuberculous osteomyelitis was detected. After resection of the femoral mass and starting anti TB medical treatment, symptoms dramatically eliminated. PMID:25207301

  16. Humeral cross-sectional shape in suspensory primates and sloths.

    PubMed

    Patel, Biren A; Ruff, Christopher B; Simons, Erin L R; Organ, Jason M

    2013-04-01

    Studies on the cross-sectional geometry of long bones in African apes have documented that shape ratios derived from second moments of area about principle axes (e.g., Imax /Imin ) are often correlated with habitual locomotor behaviors. For example, humeral cross-sections tend to appear more circular in more arboreal and forelimb suspensory chimpanzees compared with terrestrial quadrupedal gorillas. These data support the hypothesis that cross-sections that are more circular in shape are adapted for multidirectional loading regimes and bending moments encountered when using acrobatic locomotor behaviors. Whether a more circular humerus reflects greater use of forelimb suspension in other primates and nonprimate mammals is unknown. In this study, cross-sections at or near midshaft of the humerus were obtained from anthropoid primates that differ in their use of forelimb suspension, as well as from two genera of suspensory sloths. Imax /Imin ratios were compared within and between groups, and correlations were made with behavioral data. In broad comparisons, observed differences in morphology follow predicted patterns. Humeri of suspensory sloths are circular. Humeri of the more suspensory hominoids tend to be more circular than those of quadrupedal taxa. Humeri of the suspensory atelines are similar to hominoids, while those of Cebus are more like nonsuspensory cercopithecoids. There is, however, considerable overlap between taxa and within finer comparisons variation between species are not in the predicted direction. Thus, although Imax /Imin ratios of the humerus are informative for characterizing generalized locomotor modes (i.e., forelimb suspensory vs. quadrupedal), additional structural information is needed for more fine-grained assessments of locomotion.

  17. Double Tension Band Osteosynthesis in Inter-Condylar Humeral Fractures

    PubMed Central

    Munde, Santosh Lakshmanrao; Bhatti, Mohmmed Javed; Siwach, R.C.; Gulia, Anil; Kundu, Z.S.; Bansal, Sanjeev; Middha, Sanjay

    2015-01-01

    Introduction Intercondylar humerus fractures are uncommon in orthopaedic practice. The treatment for the same has been described in the literature and include paragonal and orthogonal fixation by using plates. Tension band wiring as a treatment for the same is sparsely described in the literature. Aim To evaluate the effectiveness of "Double Tension Band wiring" method for the treatment of intercondylar fractures of humerus and compare the results with studies involving treatment with locked plates. Materials and Methods Twenty patients, all presenting with fresh fractures of the distal humerus, treated with double tension band wiring were retrospectively evaluated over a period of three years. Fractures were classified according to Jupiter classification of distal humeral fractures. There were 5 high T fractures, 13 low T fractures and 2 Y fractures. According to AO classification, all were C1 fractures. Average age of the patients was 56.20 years (32-70 years). There were 13 males and 07 females. Results Out of 20 cases treated with this method, rigid fixation and union was achieved in all of them. The average tourniquet time was 69 minutes with minimum of 50 minutes and maximum of 120 minutes. Radiological union was achieved at an average of 10.8 weeks (8-14weeks). Average range of motion was 104.5 degrees with maximum range of motion 120 degrees (10-130) and minimum of 70 degrees (30-100). Excellent or good results were obtained in 80% of the patients in our study. Conclusion Double tension band is a reliable, less demanding and cost effective method of fixation of intercondylar fractures of humerus. PMID:26816955

  18. Humeral cross-sectional shape in suspensory primates and sloths.

    PubMed

    Patel, Biren A; Ruff, Christopher B; Simons, Erin L R; Organ, Jason M

    2013-04-01

    Studies on the cross-sectional geometry of long bones in African apes have documented that shape ratios derived from second moments of area about principle axes (e.g., Imax /Imin ) are often correlated with habitual locomotor behaviors. For example, humeral cross-sections tend to appear more circular in more arboreal and forelimb suspensory chimpanzees compared with terrestrial quadrupedal gorillas. These data support the hypothesis that cross-sections that are more circular in shape are adapted for multidirectional loading regimes and bending moments encountered when using acrobatic locomotor behaviors. Whether a more circular humerus reflects greater use of forelimb suspension in other primates and nonprimate mammals is unknown. In this study, cross-sections at or near midshaft of the humerus were obtained from anthropoid primates that differ in their use of forelimb suspension, as well as from two genera of suspensory sloths. Imax /Imin ratios were compared within and between groups, and correlations were made with behavioral data. In broad comparisons, observed differences in morphology follow predicted patterns. Humeri of suspensory sloths are circular. Humeri of the more suspensory hominoids tend to be more circular than those of quadrupedal taxa. Humeri of the suspensory atelines are similar to hominoids, while those of Cebus are more like nonsuspensory cercopithecoids. There is, however, considerable overlap between taxa and within finer comparisons variation between species are not in the predicted direction. Thus, although Imax /Imin ratios of the humerus are informative for characterizing generalized locomotor modes (i.e., forelimb suspensory vs. quadrupedal), additional structural information is needed for more fine-grained assessments of locomotion. PMID:23408647

  19. Humeral fracture between a total elbow and total shoulder arthroplasty.

    PubMed

    Mavrogenis, Andreas F; Angelini, Andrea; Guerra, Enrico; Rotini, Roberto

    2011-04-01

    This article presents a case of a 71-year-old woman with a humeral fracture between a cementless reverse total shoulder arthroplasty and a cemented total elbow arthroplasty and discusses our treatment plan. Surgical treatment was performed after the patient was informed of possible complications and the benefits of surgery including: early, complete restoration of arm anatomy, greater functional improvement of the adjacent joints, and increased risk of nonunion with nonoperative treatment.The fracture was comminuted and extended proximally around the shoulder prosthesis. Through the posterior approach, the radial nerve was identified and protected. Both prostheses were found firmly fixed to bone. The fracture around the shoulder prosthesis was reduced first using a strut allograft and reduction clamps. Next, arm alignment restoration and distal humerus reduction were performed. The construct was neutralized with a 3.5-mm locking plate spanning the whole length of the humerus. The locking plate was positioned posterolaterally and the strut medially in a 90° to 90° configuration secured with wires and cables.A hinged elbow brace was applied for 6 weeks postoperatively. Active range of motion exercises of the wrist and hand and passive motion of the elbow and shoulder were started at 4 to 5 days postoperatively. At 2 weeks postoperatively, passive motion of the elbow and shoulder progressed to strengthening exercises. Thereafter, the patient underwent several weeks of physical therapy to restore motion, strength, and function of the upper extremity with instructions not to overload the arm and avoid heavy work and sports for as long as 1 year. At 10 months postoperatively, radiographs of the arm showed a stable construct; the patient had resumed full activities of daily living. PMID:21469626

  20. Osteochondroma of the mandibular condyle – Report of an atypical case and the importance of computed tomography

    PubMed Central

    Andrade, Neelam N.; Gandhewar, Trupti M.; Kapoor, Prathmesh; Thomas, Roy

    2014-01-01

    Osteochondroma is a rare tumor of the mandibular condyle. Much confusion seems to exist in the literature in differentiating these tumors from chondromas as well as condylar hyperplasias. Due to considerable overlapping features between chondromas and condylar hyperplasia, it is likely to get misdiagnosed, thereby resulting in inadvertent errors in the treatment. A case report of a 35 year old male patient with mandibular deviation and malocclusion is presented here. He initially went unnoticed for features of an osteochondroma of the mandibular condyle but was subsequently treated for the same. PMID:25737946

  1. Failure of the Stem-Condyle Junction of a Modular Femoral Stem in Revision Total Knee Arthroplasty.

    PubMed

    Boe, Chelsea C; Fehring, Keith A; Trousdale, Robert T

    2015-10-01

    Newer technologies have been established in modern revision total knee arthroplasty, including modular junctions, which allow customization of the prosthesis intraoperatively. We report a case of failure of the stem-condyle junction of a modular femoral component of a revision total knee implant, despite appearing well fixed on preoperative radiographs. Intraoperatively, there was dissociation of the condylar component from the well-fixed, cemented stem, creating motion at the stem-condyle junction. To our knowledge, this failure mode has not been reported in the literature.

  2. The correlation between mineralization degree and bone tissue stiffness in the porcine mandibular condyle.

    PubMed

    Willems, Nop M B K; Mulder, Lars; den Toonder, Jaap M J; Zentner, Andrej; Langenbach, Geerling E J

    2014-01-01

    The aim of this study was to correlate the local tissue mineral density (TMD) with the bone tissue stiffness. It was hypothesized that these variables are positively correlated. Cancellous and cortical bone samples were derived from ten mandibular condyles taken from 5 young and 5 adult female pigs. The bone tissue stiffness was assessed in three directions using nanoindentation. At each of three tested sides 5 indents were made over the width of 5 single bone elements, resulting in a total number of 1500 indents. MicroCT was used to determine the local TMD at the indented sites. The TMD and the bone tissue stiffness were higher in bone from the adult animals than from the young ones, but did not differ between cancellous and cortical bone. In the adult group, both the TMD and the bone tissue stiffness were higher in the center than at the surface of the bone elements. The mean TMD, thus ignoring the local mineral distribution, had a coefficient of determination (R(2)) with the mean bone tissue stiffness of 0.55, p < 0.05, whereas the correlation between local bone tissue stiffness and the concomitant TMD appeared to be weak (R (2) 0.07, p < 0.001). It was concluded that the mineralization degree plays a larger role in bone tissue stiffness in cancellous than in cortical bone. Our data based on bone from the mandibular condyle suggest that the mineralization degree is not a decisive determinant of the local bone tissue stiffness.

  3. Treatment of a Femur Nonunion with Microsurgical Corticoperiosteal Pedicled Flap from the Medial Femoral Condyle

    PubMed Central

    Guzzini, Matteo; Guidi, Marco; Civitenga, Carolina; Ferri, Germano; Ferretti, Andrea

    2016-01-01

    Introduction. The vascularized corticoperiosteal flap is harvested from the medial femoral condyle and it is nourished by the articular branch of the descending genicular artery and the superomedial genicular artery. This flap is usually harvested as a free flap for the reconstruction of bone defects at forearm, distal radius, carpus, hand, and recently at lower limb too. Case Report. A 50-year-old Caucasian man referred to our department for hypertrophic nonunion of the distal femur, refractory to the conservative treatments. The first surgical choice was the revision of the nail and the bone reconstruction with a corticoperiosteal pedicled flap from the medial femoral condyle. We considered union to have occurred 3.5 months after surgery when radiographs showed bridging of at least three of the four bony cortices and clinically the patient was able to walk with full weight bearing without any pain. At the last follow-up (25 months), the patient was completely satisfied with the procedure. Discussion. The corticoperiosteal flap allows a faster healing of fractures with a minimal morbidity at the donor site. We suggest that the corticoperiosteal pedicled flap graft is a reliable and effective treatment for distal femur nonunion. PMID:27064589

  4. Overexpressed TGF-β in subchondral bone leads to mandibular condyle degradation.

    PubMed

    Jiao, K; Zhang, M; Niu, L; Yu, S; Zhen, G; Xian, L; Yu, B; Yang, K; Liu, P; Cao, X; Wang, M

    2014-02-01

    Emerging evidence has implied that subchondral bone plays an important role during osteoarthritis (OA) pathology. This study was undertaken to investigate whether abnormalities of the condylar subchondral bone lead to temporomandibular joint (TMJ) OA. We used an osteoblast-specific mutant TGF-β1 transgenic mouse, the CED mouse, in which high levels of active TGF-β1 occur in bone marrow, leading to abnormal bone remodeling. Subchondral bone changes in the mandibular condyles were investigated by micro-CT, and alterations in TMJ condyles were confirmed by histopathological and immunohistochemical analysis. Abnormalities in the condylar subchondral bone, characterized as fluctuant bone mineral density and microstructure and increased but uncoupled activity of osteoclasts and osteoblasts, were apparent in the 1- and 4-month CED mouse groups, while obvious cartilage degradation, in the form of cell-free regions and proteoglycan loss, was observed in the 4-month CED group. In addition, increased numbers of apoptotic chondrocytes and MMP9- and VEGF-positive chondrocytes were observed in the condylar cartilage in the 4-month CED group, but not in the 1-month CED group, compared with their respective age-matched controls. This study demonstrated that progressive degradation of mandibular condylar cartilage could be induced by the abnormal remodeling of the underlying subchondral bone during TMJOA progression. PMID:24309371

  5. Architectural measures of the cancellous bone of the mandibular condyle identified by principal components analysis.

    PubMed

    Giesen, E B W; Ding, M; Dalstra, M; van Eijden, T M G J

    2003-09-01

    As several morphological parameters of cancellous bone express more or less the same architectural measure, we applied principal components analysis to group these measures and correlated these to the mechanical properties. Cylindrical specimens (n = 24) were obtained in different orientations from embalmed mandibular condyles; the angle of the first principal direction and the axis of the specimen, expressing the orientation of the trabeculae, ranged from 10 degrees to 87 degrees. Morphological parameters were determined by a method based on Archimedes' principle and by micro-CT scanning, and the mechanical properties were obtained by mechanical testing. The principal components analysis was used to obtain a set of independent components to describe the morphology. This set was entered into linear regression analyses for explaining the variance in mechanical properties. The principal components analysis revealed four components: amount of bone, number of trabeculae, trabecular orientation, and miscellaneous. They accounted for about 90% of the variance in the morphological variables. The component loadings indicated that a higher amount of bone was primarily associated with more plate-like trabeculae, and not with more or thicker trabeculae. The trabecular orientation was most determinative (about 50%) in explaining stiffness, strength, and failure energy. The amount of bone was second most determinative and increased the explained variance to about 72%. These results suggest that trabecular orientation and amount of bone are important in explaining the anisotropic mechanical properties of the cancellous bone of the mandibular condyle. PMID:14667134

  6. A retrospective analysis of growth of the constructed condyle-ramus in children with hemifacial microsomia.

    PubMed

    Mulliken, J B; Ferraro, N F; Vento, A R

    1989-10-01

    A retrospective analysis of changes in costochondral rib grafts used to construct the condyle-ramus in children with hemifacial microsomia (HFM) was made. The mean age at surgical correction was 6.5 years, and the average follow-up was 4.5 years. Direct measurements were made on panoramic radiographs. The condyle-ramus length was expressed as a percentage change comparing the constructed with the normal side. During the first 2 postoperative years, there was either no change or a slight decrease in the length of the rib graft. After 2 years, however, the costochondral graft elongated at a slow, irregular rate. The mode change was 11 percent over the postoperative study period. In four patients who exhibited rapid growth of the normal condyleramus (greater than the mean change of 0.94 cm), the constructed side failed to keep pace. In another group of four patients who exhibited moderate elongation of the normal side, the grafted side grew commensurately or demonstrated greater than normal percentage change in length. There was no correlation between the initial size of the costochondral graft, age at time of operation, or presenting type of mandibular deformity. These findings are discussed in terms of the intrinsic growth and the functional matrix theories of mandibular development.

  7. An impact of masticatory muscle function on IL-1beta and SOX9 expression in condyle.

    PubMed

    Manopinivate, Atith; Kaneko, Sawa; Soma, Kunimichi

    2006-03-01

    The importance of masticatory muscle function on the growth and differentiation of condyle was examined. The aim of this study was to investigate how reduced masticatory muscle function influences intrinsic regulatory factors which govern growth and differentiation of condylar cartilage. Masseter muscles of 3-week-old Wistar rats were resected bilaterally. Masseteric resected animals and corresponding control animals were sacrificed at 3, 6, 12 and 21 days post-resection. The condyles were then processed for histological and immunohistochemical analysis. The expression patterns of an inhibitory regulator (IL-1beta) and a master regulator (Sox9) of chondrogenesis in condylar cartilage of growing rats were investigated. Quantitative analysis shows that masseteric resection significantly increased the number of IL-1beta positive cells in proliferative layer. In contrast, the number of Sox9 positive cells was significantly decreased compared to the control animals. It can be concluded that the reduced articular function due to masseteric resection decreased condylar cartilage cell differentiation which led to the decrease in the thickness of condylar cartilage.

  8. Ultrastructural characterization of the rabbit mandibular condyle following experimental induction of anterior disk displacement.

    PubMed

    Sharawy, M; Ali, A M; Choi, W S; Larke, V

    2000-01-01

    Previous studies in our laboratory have shown that surgical induction of anterior disk displacement (ADD) in the rabbit craniomandibular joint (CMJ) leads to cellular and extracellular alterations consistent with osteoarthritis. Similar findings were also reported in human ADD as well as osteoarthritis of other joints. The purpose of this study was to further characterize these histopathological findings at the ultrastructural level. The right joint of 15 rabbits was exposed surgically and all discal attachments were severed except for the posterior attachment. The disk was then repositioned anteriorly and sutured to the zygomatic arch. The left joint served as a sham-operated control. Ten additional joints were used as nonoperated controls. Mandibular condyles were excised 2 weeks following surgery and processed for transmission electron microscopy. Experimental condyles showed neovascularization, fibrillation and vacuolation of the extracellular matrix and an increase in the number of apoptotic cells compared to controls. In addition, chondrocytes in osteoarthritic cartilage showed an increase in the amounts of rough endoplasmic reticulum and Golgi complex suggesting an increase in protein synthesis. The presence of thick collagen fibers in osteoarthritic cartilage supports our previous immunohistochemical results of the presence of type I collagen instead of normally existing type II collagen. It was concluded that surgical induction of ADD in the rabbit CMJ leads to ultrastructural changes in the mandibular condylar cartilage consistent with degenerative alterations known to occur in osteoarthritis. PMID:10899715

  9. A Stochastic Analysis of Glenoid Inclination Angle and Superior Migration of the Humeral Head

    PubMed Central

    Flieg, Nicholas G.; Gatti, Christopher J.; Doro, Lisa Case; Langenderfer, Joseph E.; Carpenter, James E.; Hughes, Richard E.

    2008-01-01

    Background Superior glenoid inclination, which is a relatively upward facing of the glenoid in the plane of the scapula, has been associated with rotator cuff pathology. Increased glenoid inclination may cause superior humeral head migration, which can cause impingement of the supraspinatus tendon. The purpose of this study was to test the hypothesis that inclination angle affects the probability of superior humeral head migration. Methods A three-dimensional model of the glenohumeral joint was developed in which muscle forces were modeled as random variables. Monte Carlo simulation was used to compute the probability that the glenohumeral reaction force was directed such that superior humeral head migration should occur. An electromyogram-driven model was used to estimate shoulder muscle forces in healthy volunteers performing arm elevation. Findings The model predicted that the probability of superior humeral head migration increased as glenoid inclination angle was increased. This finding was independent of the assumed shape of the muscle force probability distributions. Interpretation The results support the theory that glenoid inclination may be a risk factor for rotator cuff pathology. PMID:18280016

  10. Treatment of Humeral Shaft Fractures: Minimally Invasive Plate Osteosynthesis Versus Open Reduction and Internal Fixation

    PubMed Central

    Esmailiejah, Ali Akbar; Abbasian, Mohammad Reza; Safdari, Farshad; Ashoori, Keyqobad

    2015-01-01

    Background: The optimal technique for operative fixation of humeral shaft fractures remains controversial and warrants research. Objectives: The purpose of the current study was to compare the functional and clinical outcomes of conventional open reduction and internal fixation (ORIF) with minimally invasive plate osteosynthesis (MIPO) in patients with fractures in two-third distal humeral shaft. Patients and Methods: In the current prospective case-control study, 65 patients with humeral shaft fractures were treated using ORIF (33 patients) or MIPO (32 patients). Time of surgery, time of union, incidence of varus deformity and complications were compared between the two groups. Also, the university of California-Los Angeles (UCLA) shoulder rating scale and Mayo Elbow performance score (MEPS) were used to compare the functional outcomes between the two groups. Results: The median of union time was shorter in the MIPO group (4 months versus 5 months). The time of surgery and functional outcomes based on the UCLA and MEPS scores were the same. The incidence of varus deformity was more than 5° and was higher and the incidence of nonunion, infection and iatrogenic radial nerve injury were lower in the MIPO group; however, the differences were not significant. Conclusions: Due to the shorter union time, to some extent less complication rate and comparable functional and clinical results, the authors recommend to use the MIPO technique in treating the mid-distal humeral shaft fracture. PMID:26543844

  11. [Treatment of humeral diaphyseal fractures in adults using centro-medullary pinning. Operative technic and indications].

    PubMed

    de la Caffinière, J Y; Kassab, G; Ould Ouali, A

    1988-01-01

    The ascending intramedullary "pinning" technique is known for twenty-five years. Theoretically successful for the diaphyseal humeral fractures in adults, it appeared until now with some disadvantages which limited its use. By adding some modifications, the authors show that this technique is worthwhile in dislocation fractures in adults. PMID:3253848

  12. Posterior shoulder dislocation and humeral head necrosis in a recreational scuba diver with diabetes.

    PubMed

    Gorman, D F; Sandow, M J

    1992-11-01

    An insulin-dependent diabetic who was previously a recreational scuba diver suffered a posterior shoulder dislocation after a trivial injury and was subsequently found to have local necrosis of the humeral head. The only definite conclusion that can be reached is that this patient should not dive again.

  13. Distal humeral epiphyseal separation in a young athlete: a case report.

    PubMed

    Podesta, L; Sherman, M F; Bonamo, J R

    1993-11-01

    Elbow pain in the young throwing athlete can have numerous etiologies. Skeletally immature athletes commonly sustain epiphyseal injuries secondary to trauma and/or repetitive activity. The case of a 7-year-old Little League pitcher with the diagnosis of distal humeral epiphyseal separation is presented along with a review of the current literature.

  14. Radial nerve injury associated with humeral shaft fracture: a retrospective study

    PubMed Central

    Ricci, Flávia Pessoni Faleiros Macêdo; Barbosa, Rafael Inácio; Elui, Valéria Meirelles Carril; Barbieri, Cláudio Henrique; Mazzer, Nilton; Fonseca, Marisa de Cássia Registro

    2015-01-01

    Objective: To determine the profile of patients with humeral diaphyseal fractures in a tertiary hospital. Methods: We conducted a survey from January 2010 to July 2012, including data from patients classified under humeral diaphyseal fracture (S42.3) according to the International Classification of Diseases (ICD-10). The variables analyzed were: age, gender, presence of radial nerve injury, causal agent and the type of treatment carried out. Results: The main causes of trauma were car accidents. The radial nerve lesion was present in some cases and was caused by the same trauma that caused the fracture or iatrogenic injury. Most of these fractures occurred in the middle third of humeral diaphysis and was treated conservatively. Conclusion: The profile of patients with fracture of humeral shaft, in this specific sample, was composed mainly of adult men involved in traffic accidents; the associated radial nerve lesion was present in most of these fractures and its cause was strongly related to the trauma mechanism. Level of Evidence II, Retrospective Study. PMID:26327789

  15. Current concepts in the management of recurrent anterior gleno-humeral joint instability with bone loss

    PubMed Central

    Ramhamadany, Eamon; Modi, Chetan S

    2016-01-01

    The management of recurrent anterior gleno-humeral joint instability is challenging in the presence of bone loss. It is often seen in young athletic patients and dislocations related to epileptic seizures and may involve glenoid bone deficiency, humeral bone deficiency or combined bipolar lesions. It is critical to accurately identify and assess the amount and position of bone loss in order to select the most appropriate treatment and reduce the risk of recurrent instability after surgery. The current literature suggests that coracoid and iliac crest bone block transfers are reliable for treating glenoid defects. The treatment of humeral defects is more controversial, however, although good early results have been reported after arthroscopic Remplissage for small defects. Larger humeral defects may require complex reconstruction or partial resurfacing. There is currently very limited evidence to support treatment strategies when dealing with bipolar lesions. The aim of this review is to summarise the current evidence regarding the best imaging modalities and treatment strategies in managing this complex problem relating particularly to contact athletes and dislocations related to epileptic seizures. PMID:27335809

  16. Mechanical Quantification of Local Bone Quality in the Humeral Head: A Feasibility Study

    PubMed Central

    Scola, Alexander; Gebhard, Florian; Weckbach, Sebastian; Dehner, Christoph; Schwyn, Ronald; Fliri, Ladina; Röderer, Götz

    2013-01-01

    Objectives: Surgical treatment of proximal humerus fractures can be challenging due to osteoporosis. The weak bone stock makes stable implant anchorage difficult, which can result in low primary stability. Accordingly, significant failure rates, even with modern locking plates, are reported in the literature. Intraoperative knowledge of local bone quality could be helpful in improving results. This study evaluates the feasibility of local bone quality quantification using breakaway torque measurements. Materials and Methods: A torque measurement tool (DensiProbe™) was developed to determine local resistance to breakaway offered by the cancellous bone in the humeral head to quantify local bone quality. The tool was adapted to a standard locking plate (PHILOS, Synthes), allowing measurement in the positions of the six humeral head screws, as provided by the aiming device of the plate. Two hundred and seventy measurements were performed in 44 fresh cadaveric human humeri. Results: Handling of the tool was straight forward and provided reproducible results for the six different positions. The method allows discrimination between the respective positions with statistical significance, and thus provides reliable information on the local distribution of bone quality within the humeral head. Discussion: This study introduces a new method using breakaway torque to determine local bone quality within the humeral head in real time. Because DensiProbe is adapted to a standard locking plate, there is the potential for intraoperative application. The information provided could enable the surgeon to improve fixation of osteoporotic proximal humerus fractures. PMID:23730382

  17. Simultaneous Osteoperiosteal Autologous Iliac Crest Graft and Lateral Meniscus Allograft Transplantation for Osteochondral Lesion with Bony Defect and Lateral Discoid Meniscus Tear.

    PubMed

    Lee, Dhong Won; Kim, Jin Goo; Ha, Jeong Ku; Kim, Woo Jong

    2016-06-01

    The optimal treatment for combined osteochondritis dissecans (OCD) with considerable bony defect of the lateral femoral condyle (LFC) and torn discoid lateral meniscus is unclear. We present a case of a 15-year-old female who was a gymnast and had a large OCD lesion in the LFC combined with deficiency of the lateral meniscus. The patient underwent the "one-step" technique of osteoperiosteal autologous iliac crest graft and lateral meniscus allograft transplantation after a failure of meniscectomy with repair at another hospital. Twenty-four months postoperatively, clinical results were significantly improved. Follow-up imaging tests and second-look arthroscopy showed well incorporated structured bone graft and fibrous cartilage regeneration as well as stabilized lateral meniscus allograft. She could return to her sport without any pain or swelling. This "one-step" surgical technique is worth considering as a joint salvage procedure for massive OCD lesions with torn discoid lateral meniscus. PMID:27274475

  18. Simultaneous Osteoperiosteal Autologous Iliac Crest Graft and Lateral Meniscus Allograft Transplantation for Osteochondral Lesion with Bony Defect and Lateral Discoid Meniscus Tear.

    PubMed

    Lee, Dhong Won; Kim, Jin Goo; Ha, Jeong Ku; Kim, Woo Jong

    2016-06-01

    The optimal treatment for combined osteochondritis dissecans (OCD) with considerable bony defect of the lateral femoral condyle (LFC) and torn discoid lateral meniscus is unclear. We present a case of a 15-year-old female who was a gymnast and had a large OCD lesion in the LFC combined with deficiency of the lateral meniscus. The patient underwent the "one-step" technique of osteoperiosteal autologous iliac crest graft and lateral meniscus allograft transplantation after a failure of meniscectomy with repair at another hospital. Twenty-four months postoperatively, clinical results were significantly improved. Follow-up imaging tests and second-look arthroscopy showed well incorporated structured bone graft and fibrous cartilage regeneration as well as stabilized lateral meniscus allograft. She could return to her sport without any pain or swelling. This "one-step" surgical technique is worth considering as a joint salvage procedure for massive OCD lesions with torn discoid lateral meniscus.

  19. Simultaneous Osteoperiosteal Autologous Iliac Crest Graft and Lateral Meniscus Allograft Transplantation for Osteochondral Lesion with Bony Defect and Lateral Discoid Meniscus Tear

    PubMed Central

    Lee, Dhong Won; Ha, Jeong Ku; Kim, Woo Jong

    2016-01-01

    The optimal treatment for combined osteochondritis dissecans (OCD) with considerable bony defect of the lateral femoral condyle (LFC) and torn discoid lateral meniscus is unclear. We present a case of a 15-year-old female who was a gymnast and had a large OCD lesion in the LFC combined with deficiency of the lateral meniscus. The patient underwent the "one-step" technique of osteoperiosteal autologous iliac crest graft and lateral meniscus allograft transplantation after a failure of meniscectomy with repair at another hospital. Twenty-four months postoperatively, clinical results were significantly improved. Follow-up imaging tests and second-look arthroscopy showed well incorporated structured bone graft and fibrous cartilage regeneration as well as stabilized lateral meniscus allograft. She could return to her sport without any pain or swelling. This "one-step" surgical technique is worth considering as a joint salvage procedure for massive OCD lesions with torn discoid lateral meniscus. PMID:27274475

  20. The calcar screw in angular stable plate fixation of proximal humeral fractures - a case study

    PubMed Central

    2011-01-01

    Background With new minimally-invasive approaches for angular stable plate fixation of proximal humeral fractures, the need for the placement of oblique inferomedial screws ('calcar screw') has increasingly been discussed. The purpose of this study was to investigate the influence of calcar screws on secondary loss of reduction and on the occurrence of complications. Methods Patients with a proximal humeral fracture who underwent angular stable plate fixation between 01/2007 and 07/2009 were included. On AP views of the shoulder, the difference in height between humeral head and the proximal end of the plate were determined postoperatively and at follow-up. Additionally, the occurrence of complications was documented. Patients with calcar screws were assigned to group C+, patients without to group C-. Results Follow-up was possible in 60 patients (C+ 6.7 ± 5.6 M/C- 5.0 ± 2.8 M). Humeral head necrosis occurred in 6 (C+, 15.4%) and 3 (C-, 14.3%) cases. Cut-out of the proximal screws was observed in 3 (C+, 7.7%) and 1 (C-, 4.8%) cases. In each group, 1 patient showed delayed union. Implant failure or lesions of the axillary nerve were not observed. In 44 patients, true AP and Neer views were available to measure the head-plate distance. There was a significant loss of reduction in group C- (2.56 ± 2.65 mm) compared to C+ (0.77 ± 1.44 mm; p = 0.01). Conclusions The placement of calcar screws in the angular stable plate fixation of proximal humeral fractures is associated with less secondary loss of reduction by providing inferomedial support. An increased risk for complications could not be shown. PMID:21943090

  1. Minimal Invasive Percutaneous Osteosynthesis for Elderly Valgus Impacted Proximal Humeral Fractures with the PHILOS.

    PubMed

    Chen, Hang; Hu, Xiaochuan; Tang, Haochen; Yang, Guoyong; Xiang, Ming

    2015-01-01

    There is a growing concern about elderly valgus impacted proximal humeral fractures. The aim of this study was to evaluate the treatment and clinical outcomes following minimal invasive percutaneous plate osteosynthesis (MIPPO) with the proximal humeral internal locking system (PHILOS) for the treatment of elderly valgus impacted proximal humeral fracture. Between May 2008 and May 2012, 27 patients (average age 67.3, range 61-74) with valgus impacted proximal humeral fractures were enrolled in the study. The patients were treated with MIPPO using PHILOS-plate through the anterolateral delta-splitting approach. Rehabilitation exercises were done gradually. The NEER score and Constant-Murley score were used to evaluate shoulder function. All the patients were followed up by routine radiological imaging and clinical examination. There were 15 cases of II-part greater tuberosity fractures, 10 cases of III-part greater tuberosity fractures, and 2 cases of IV-part fractures according to the NEER classification. The surgery was successful in all patients with an average follow-up of 20.8 (range: 11-34) months. The fractures united in an average of 7.2 (6-14) weeks without implant loosening. According to NEER score, there were 17 excellent, 7 satisfactory, 2 unsatisfactory, and 1 poor. The mean Constant-Murley score was 89.4 ± 4.35. No complication including axillary nerve damage, postoperative nerve or vessel damage, infections, DVT, or death was observed. In conclusion, the MIPPO technique with the PHILOS through the anterolateral delta-splitting approach seems to be a safe and easy treatment for elderly valgus impacted proximal humeral fractures. A case-control study and longer follow-up time are needed.

  2. Minimal Invasive Percutaneous Osteosynthesis for Elderly Valgus Impacted Proximal Humeral Fractures with the PHILOS

    PubMed Central

    Chen, Hang; Hu, Xiaochuan; Tang, Haochen; Yang, Guoyong; Xiang, Ming

    2015-01-01

    There is a growing concern about elderly valgus impacted proximal humeral fractures. The aim of this study was to evaluate the treatment and clinical outcomes following minimal invasive percutaneous plate osteosynthesis (MIPPO) with the proximal humeral internal locking system (PHILOS) for the treatment of elderly valgus impacted proximal humeral fracture. Between May 2008 and May 2012, 27 patients (average age 67.3, range 61–74) with valgus impacted proximal humeral fractures were enrolled in the study. The patients were treated with MIPPO using PHILOS-plate through the anterolateral delta-splitting approach. Rehabilitation exercises were done gradually. The NEER score and Constant-Murley score were used to evaluate shoulder function. All the patients were followed up by routine radiological imaging and clinical examination. There were 15 cases of II-part greater tuberosity fractures, 10 cases of III-part greater tuberosity fractures, and 2 cases of IV-part fractures according to the NEER classification. The surgery was successful in all patients with an average follow-up of 20.8 (range: 11–34) months. The fractures united in an average of 7.2 (6–14) weeks without implant loosening. According to NEER score, there were 17 excellent, 7 satisfactory, 2 unsatisfactory, and 1 poor. The mean Constant-Murley score was 89.4 ± 4.35. No complication including axillary nerve damage, postoperative nerve or vessel damage, infections, DVT, or death was observed. In conclusion, the MIPPO technique with the PHILOS through the anterolateral delta-splitting approach seems to be a safe and easy treatment for elderly valgus impacted proximal humeral fractures. A case-control study and longer follow-up time are needed. PMID:26693491

  3. [Proposal for an auxiliary tool designed to reduce retake rates for lateral radiography of the knee joint].

    PubMed

    Yasuda, Yu; Sato, Hisaya; Ohsawa, Miwa; Takahashi, Kanji; Noda, Chikara; Sai, Syogo; Sukezaki, Fumio; Nakazawa, Yasuo

    2013-10-01

    The reproducibility of lateral radiography of the knee joint in the lateral position is low because patient positioning can be easily affected by passive rotation of the knee joint. We calculated the correction angle of the femoral external rotation and the lower leg elevation and developed our own auxiliary tool for obtaining a lateral view image. We were able to obtain, in a single attempt, an image with misalignment of the condyle limited to less than 7 mm. Our tool also contributed to the reduction of the re-imaging rate, suggesting its usefulness in contributing to a lower re-imaging rate for lateral radiography of the knee joint.

  4. Osteochondritis dissecans of the humeral capitellum. Diagnosis and treatment.

    PubMed

    Bradley, J P; Petrie, R S

    2001-07-01

    Elbow pain seen in the at-risk athlete, such as a baseball player (in particular, a pitcher) or gymnast, should raise suspicion for OCD. OCD of the humeral capitellum remains a difficult problem to treat. Once radiographic changes are obvious, long-term studies suggest that half of affected individuals will be symptomatic. Currently, the key to successful treatment is early detection. Gymnasts, in general, fare worse in returning to sport. The reason is not entirely clear but is likely related to the amount of force directed across the elbow and the nature of the sport. Pitchers sometimes can be returned, but to another position. Radiographs remain the screening test of choice but can give the surgeon a false sense of security, because changes early in the disease process may not be obvious radiographically. Views at 45 degrees flexion and contralateral elbow views are helpful. The advent of MR imaging now allows the practicing orthopaedic surgeon to assess very early lesions effectively that might otherwise be underappreciated on radiographs. With more advanced lesions, radiographic findings are more obvious and demonstrate the more classic capitellar fragment with a surrounding zone of lucency. MR imaging is this setting is helpful in assessing the overlying articular cartilage and, hence, the stability of the fragment. In the absence of obvious loose bodies or mechanical symptoms, rest is the first step in treatment. If symptoms persist, then operative intervention is indicated. About half of these patients heal with nonoperative treatment. Pretreatment assessment of fragment viability has not traditionally been incorporated into the treatment algorithm. Recent anecdotal evidence suggests that stability and viability of a fragment can be assessed using intravenous contrast. Knowledge of the fragment viability could allow those lesions likely to heal without surgical intervention to be distinguished from those requiring surgical intervention. The procedure should

  5. Lateral genomics.

    PubMed

    Doolittle, W F

    1999-12-01

    More than 20 complete prokaryotic genome sequences are now publicly available, each by itself an unparalleled resource for understanding organismal biology. Collectively, these data are even more powerful: they could force a dramatic reworking of the framework in which we understand biological evolution. It is possible that a single universal phylogenetic tree is not the best way to depict relationships between all living and extinct species. Instead a web- or net-like pattern, reflecting the importance of horizontal or lateral gene transfer between lineages of organisms, might provide a more appropriate visual metaphor. Here, I ask whether this way of thinking is really justified, and explore its implications.

  6. Comparison of Accuracy of Uncorrected and Corrected Sagittal Tomography in Detection of Mandibular Condyle Erosions: an Exvivo Study

    PubMed Central

    Naser, Asieh Zamani; Shirani, Amir Mansour; Hekmatian, Ehsan; Valiani, Ali; Ardestani, Pegah; Vali, Ava

    2010-01-01

    Background: Radiographic examination of TMJ is indicated when there are clinical signs of pathological conditions, mainly bone changes that may influence the diagnosis and treatment planning. The purpose of this study was to evaluate and to compare the validity and diagnostic accuracy of uncorrected and corrected sagittal tomographic images in the detection of simulated mandibular condyle erosions. Methods Simulated lesions were created in 10 dry mandibles using a dental round bur. Using uncorrected and corrected sagittal tomography techniques, mandibular condyles were imaged by a Cranex Tome X-ray unit before and after creating the lesions. The uncorrected and corrected tomography images were examined by two independent observers for absence or presence of a lesion. The accuracy for detecting mandibular condyle lesions was expressed as sensitivity, specificity, and validity values. Differences between the two radiographic modalities were tested by Wilcoxon for paired data tests. Inter-observer agreement was determined by Cohen's Kappa. Results: The sensitivity, specificity and validity were 45%, 85% and 30% in uncorrected sagittal tomographic images, respectively, and 70%, 92.5% and 60% in corrected sagittal tomographic images, respectively. There was a significant statistical difference between the accuracy of uncorrected and corrected sagittal tomography in detection of mandibular condyle erosions (P = 0.016). The inter-observer agreement was slight for uncorrected sagittal tomography and moderate for corrected sagittal tomography. Conclusion: The accuracy of corrected sagittal tomography is significantly higher than that of uncorrected sagittal tomography. Therefore, corrected sagittal tomography seems to be a better modality in detection of mandibular condyle erosions. PMID:22013461

  7. Combining of small fragment screws and large fragment plates for open reduction and internal fixation of periprosthetic humeral fractures.

    PubMed

    Seybold, Dominik; Citak, Mustafa; Königshausen, Matthias; Gessmann, Jan; Schildhauer, Thomas A

    2011-10-01

    Operative treatment of periprosthetic humeral fractures in elderly patients with osteoporotic bone requires a stable fixations technique. The combination of 3.5 cortical screws with washers in a 4.5 Arbeitsgemeinschaft für Osteosynthesefragen, Limited-contact dynamic compression plate or Locking plate, allows a stable periprosthetic fixation with the small 3.5 screws and 4.5 screws above and below the prosthesis, respectively. This combination is a cost-effective technique to treat periprosthetic humeral fractures.

  8. Hoffa's fracture - lateral meniscus obstructing the fracture reduction - a case report.

    PubMed

    Jain, Sumit Kumar; Jadaan, Mutaz; Rahall, Elias

    2015-02-01

    Hoffa's fracture is a coronal fracture of the posterior femoral condyle and is an unusual injury. It can be easily missed on plain radiographs. There is no dearth of literature on Hoffa's fracture, its various presentations, management and rehabilitation principles. The intra-articular nature of the fracture, vulnerable blood supply of the posterior femoral condyle, involvement of the weight bearing articular surface of the knee and the unstable fracture pattern necessitate the surgical management. We encountered an unusual case of Hoffa's fracture where the lateral meniscus was blocking the reduction of fractured fragments. The patient required mini arthrotomy to remove the meniscus from in between the bone fragments. The fracture was fixed with two anteroposterior screws and knee was immobilised in extension. A gentle knee range of movements was commenced after the wound had healed but weight bearing was delayed for 12 weeks. PMID:25554423

  9. Giant Prolactinoma Presenting with Neck Pain and Structural Compromise of the Occipital Condyles.

    PubMed

    Yecies, Derek; Ajlan, Abdulrazag; Ratliff, John; Ziskin, Jennifer; Hwang, Peter; Vogel, Hannes; Katznelson, Laurence; Harsh, Griffith

    2015-11-01

    Prolactinomas are the most common form of endocrinologically active pituitary adenoma; they account for ∼ 45% of pituitary adenomas encountered in clinical practice. Giant adenomas are those > 4 cm in diameter. Less than 0.5% of pituitary adenomas encountered in neurosurgical practice are giant prolactinomas. Patients with giant prolactinomas typically present with highly elevated prolactin levels, endocrinologic disturbances, and neurologic symptoms from mass-induced pressure. Described here is an unusual case of a giant prolactinoma presenting with neck pain and structural compromise of the occipital condyles. Transnasal biopsy of the nasopharyngeal portion of the mass obtained tissue consistent with an atypical prolactinoma with p53 reactivity and a high Ki-67 index of 5%. Despite the size and invasiveness of the tumor, the patient had resolution of his clinical symptoms, dramatic reduction of his hyperprolactinemia, and near-complete disappearance of his tumor following medical treatment.

  10. Giant Prolactinoma Presenting with Neck Pain and Structural Compromise of the Occipital Condyles

    PubMed Central

    Yecies, Derek; Ajlan, Abdulrazag; Ratliff, John; Ziskin, Jennifer; Hwang, Peter; Vogel, Hannes; Katznelson, Laurence; Harsh, Griffith

    2015-01-01

    Prolactinomas are the most common form of endocrinologically active pituitary adenoma; they account for ∼ 45% of pituitary adenomas encountered in clinical practice. Giant adenomas are those > 4 cm in diameter. Less than 0.5% of pituitary adenomas encountered in neurosurgical practice are giant prolactinomas. Patients with giant prolactinomas typically present with highly elevated prolactin levels, endocrinologic disturbances, and neurologic symptoms from mass-induced pressure. Described here is an unusual case of a giant prolactinoma presenting with neck pain and structural compromise of the occipital condyles. Transnasal biopsy of the nasopharyngeal portion of the mass obtained tissue consistent with an atypical prolactinoma with p53 reactivity and a high Ki-67 index of 5%. Despite the size and invasiveness of the tumor, the patient had resolution of his clinical symptoms, dramatic reduction of his hyperprolactinemia, and near-complete disappearance of his tumor following medical treatment. PMID:26623246

  11. Uptake and loss of plutonium from osteoclasts and macrophages in the mandibular condyle of the rat.

    PubMed

    Priest, N D; Giannola, S J

    1980-01-01

    Female rats were used to study the kinetics of plutonium transfer from the bone surfaces of the mandibular condyle to osteoclasts and macrophages. This study was made using autoradiographs prepared from plastic sections of the mineralized bones of animals which had been injected with 241 Pu citrate. Measurements of the concentration of plutonium in the osteoclasts and macrophages at different times after the injection of plutonium showed that plutonium was concentrated by osteoclasts from bone surfaces and was retained with a half-time of approximately 70 h. Subsequently, plutonium appeared to be transferred to macrophages. The results showed that plutonium was unlikely to be accumulated by macrophages as a result of their participation in bone resorption.

  12. Finite element analysis of patient-specific condyle fracture plates: a preliminary study.

    PubMed

    Aquilina, Peter; Parr, William C H; Chamoli, Uphar; Wroe, Stephen

    2015-06-01

    Various patterns of internal fixation of mandibular condyle fractures have been proposed in the literature. This study investigates the stability of two patient-specific implants (PSIs) for the open reduction and internal fixation of a subcondylar fracture of the mandible. A subcondylar fracture of a mandible was simulated by a series of finite element models. These models contained approximately 1.2 million elements, were heterogeneous in bone material properties, and also modeled the muscles of mastication. Models were run assuming linear elasticity and isotropic material properties for bone. The stability and von Mises stresses of the simulated condylar fracture reduced with each of the PSIs were compared. The most stable of the plate configurations examined was PSI 1, which had comparable mechanical performance to a single 2.0 mm straight four-hole plate. PMID:26000081

  13. Osteochondroma of the mandibular condyle. Report of a case with 5-year follow-up.

    PubMed

    Friedrich, Reinhard E; Scheuer, Hanna A; Fuhrmann, Andreas; Hagel, Christian; Zustin, Jozef

    2012-10-01

    In the current case, a 31-year-old patient who presented with a painful unilateral malocclusion and an unclear mass in the region of the right temporo-mandibular joint (TMJ) is reported. The malocclusion had been noticed by the patient a few months earlier. Chewing on the right side had become severely impaired and painful. The patient had no history of trauma to the TMJ. Plain radiographs and computed-tomographic scans depicted an enlarged and deformed mandibular condyle. A condylectomy was performed. The histological investigation of the specimen revealed an osteochondroma. The tumour did not express insulin-like growth factor-1 receptor. Five years following the surgical intervention, there has been no local recurrence and dental occlusion was re-established, without further treatment.

  14. Medial Femoral Condyle Free Flap for Nasal Reconstruction: New Technique for Full-Thickness Nasal Defects

    PubMed Central

    Battaglia, Paolo; Turri-Zenoni, Mario; Tamborini, Federico; Giudice, Marco; Sallam, Davide; Corno, Martina; Pietrobon, Giacomo; Valdatta, Luigi; Castelnuovo, Paolo

    2016-01-01

    Summary: The nose is a functionally complex organ implicated in breathing, olfaction, and phonation, with a critical role also in the aesthetic appearance of a person. This latter aspect should be carefully considered whenever a total or subtotal rhinectomy is performed for resection of locally advanced nasal cancer. To reconstruct large nasal defects, several techniques were described, including the use of cartilaginous grafts, bony grafts, local flaps, and free flaps. In cases of extensive full-thickness resections, free flaps probably represent the most adequate option. The aim of this report is to present the functional and aesthetical outcomes of a reconstruction of the nose after rhinectomy, using the medial femoral condyle free flap associated with the forehead flap. PMID:27757320

  15. Medialized Versus Lateralized Center of Rotation in Reverse Shoulder Arthroplasty.

    PubMed

    Streit, Jonathan J; Shishani, Yousef; Gobezie, Reuben

    2015-12-01

    Reverse shoulder arthroplasty may be performed using components that medialize or lateralize the center of rotation. The purpose of this prospective study was to directly compare 2 reverse shoulder arthroplasty designs. Two treatment groups and 1 control group were identified. Group I comprised 9 patients using a medialized Grammont-style (GRM) prosthesis with a neck-shaft angle of 155°. Group II comprised 9 patients using a lateralized (LAT) prosthesis with a neck-shaft angle of 135°. Pre- and postoperative assessment of range of motion, American Shoulder and Elbow Surgeons score, and visual analog scale pain score were performed. Radiographic measurements of lateral humeral offset and acromiohumeral distance were compared. The GRM prosthesis achieved greater forward flexion (143.9° vs 115.6°; P=.05), whereas the LAT achieved greater external rotation (35.0° vs 28.3°; P=.07). The lateral humeral offset was greater for the LAT prosthesis compared with the GRM prosthesis, but this distance was not significantly different from that found in the control group. The acromiohumeral distance was significantly greater in the GRM prosthesis group compared with both the LAT and the control groups. The results of this study confirm that different reverse shoulder arthroplasty designs produce radiographically different anatomy. Whereas the GRM prosthesis significantly alters the anatomy of the shoulder, the LAT design can preserve some anatomic relationships found in the normal shoulder. The clinical outcomes indicate that this may have an effect on range of motion, with traditional designs achieving greater forward flexion and lateralized designs achieving greater external rotation.

  16. Medialized Versus Lateralized Center of Rotation in Reverse Shoulder Arthroplasty.

    PubMed

    Streit, Jonathan J; Shishani, Yousef; Gobezie, Reuben

    2015-12-01

    Reverse shoulder arthroplasty may be performed using components that medialize or lateralize the center of rotation. The purpose of this prospective study was to directly compare 2 reverse shoulder arthroplasty designs. Two treatment groups and 1 control group were identified. Group I comprised 9 patients using a medialized Grammont-style (GRM) prosthesis with a neck-shaft angle of 155°. Group II comprised 9 patients using a lateralized (LAT) prosthesis with a neck-shaft angle of 135°. Pre- and postoperative assessment of range of motion, American Shoulder and Elbow Surgeons score, and visual analog scale pain score were performed. Radiographic measurements of lateral humeral offset and acromiohumeral distance were compared. The GRM prosthesis achieved greater forward flexion (143.9° vs 115.6°; P=.05), whereas the LAT achieved greater external rotation (35.0° vs 28.3°; P=.07). The lateral humeral offset was greater for the LAT prosthesis compared with the GRM prosthesis, but this distance was not significantly different from that found in the control group. The acromiohumeral distance was significantly greater in the GRM prosthesis group compared with both the LAT and the control groups. The results of this study confirm that different reverse shoulder arthroplasty designs produce radiographically different anatomy. Whereas the GRM prosthesis significantly alters the anatomy of the shoulder, the LAT design can preserve some anatomic relationships found in the normal shoulder. The clinical outcomes indicate that this may have an effect on range of motion, with traditional designs achieving greater forward flexion and lateralized designs achieving greater external rotation. PMID:26652330

  17. CONTRIBUTION TO THE ANATOMICAL STUDY OF THE CORTICOPERIOSTEAL FLAP OF THE MEDIAL FEMORAL CONDYLE

    PubMed Central

    Andrade, Rômulo Guimarães; Bufáiçal, Henrique Gubert; Oliveira, Leandro Alves de; Souza, Fabiano Inácio de; Kuwae, Mário Yoshihide; Teixeira da Silva, João Alírio

    2015-01-01

    Objective: to perform the anatomical study, in cadavers, of the corticoperiosteal flap of the medial femoral condyle, based on the medial genicular artery, evaluating challenges in dissection and the topographic patterns. Materials and methods: fifteen limbs from eight cadavers were studied, ages ranging from 19 to 74 years old. They were placed at supine position, and a longitudinal incision on the medial face of the lower part of the thigh was performed, exposing medial vastus and sartorius muscles, with descendent genicular vessels being also exposed. The distance between the descendent genicular artery and the medial articular line of the knee, the diameter of the vessel, the length of the pedicle, and the presence of the fasciocutaneous branch and its location were analyzed. Results: the distance between the origin of the descendent genicular artery and the medial articular line of the knee ranged from 11.2cm to 14.5cm, with an average of 12.63cm. The mean artery diameter was 2.5mm (from 2.25mm to 2.75mm). The distance between the descendent genicular artery and the fasciocutaneous branch ranged from 1.0 to 1.5cm. The mean length of the vascular pedicle was 7.01cm, ranging from 5.6cm to 8.6cm. Conclusion: the corticoperiosteal flap of the medial femoral condyle of the knee is easy to dissect, presents a constant vascular pedicle, with average length of 7.0cm and diameter of 2.5mm, enabling it to be indicated for microsurgical transplants. PMID:27004187

  18. Biomechanical benefits of anterior offsetting of humeral head component in posteriorly unstable total shoulder arthroplasty: A cadaveric study.

    PubMed

    Kim, Hyun-Min Mike; Chacon, Alexander C; Andrews, Seth H; Roush, Evan P; Cho, Edward; Conaway, William K; Kunselman, Allen R; Lewis, Gregory S

    2016-04-01

    Restoration of joint stability during total shoulder arthroplasty can be challenging in the face of severe glenoid retroversion. A novel technique of humeral head component anterior-offsetting has been proposed to address posterior instability. We evaluated the biomechanical benefits of this technique in cadaveric specimens. Total shoulder arthroplasty was performed in 14 cadaveric shoulders from 7 donors. Complementary shoulders were assigned to either 10° or 20° glenoid retroversion, with retroversion created by eccentric reaming. Two humeral head component offset positions were tested in each specimen: The anatomic (posterior) and anterior (reverse). With loads applied to the rotator cuff and deltoid, joint contact pressures and the force and energy required for posterior humeral head translation were measured. The force and energy required to displace the humeral head posteriorly increased significantly with the anterior offset position compared to the anatomic offset position. The joint contact pressures were significantly shifted anteriorly, and the joint contact area significantly increased with the anterior offset position. Anterior offsetting of the humeral head component increased the resistance to posterior humeral head translation, shifted joint contact pressures anteriorly, and increased joint contact area, thus, potentially increasing the joint stability in total shoulder arthroplasty with simulated glenoid retroversion. PMID:26356804

  19. A Case of Spontaneous Osteonecrosis of the Knee with Early and Simultaneous Involvement of the Medial Femoral Condyle and Medial Tibial Plateau

    PubMed Central

    Fujita, Shinya; Arai, Yuji; Honjo, Kuniaki; Nakagawa, Shuji; Kubo, Toshikazu

    2016-01-01

    Spontaneous osteonecrosis of the knee (SPONK) usually involves a single condyle, most often the medial femoral condyle (MFC). Involvement of the medial tibial plateau (MTP) is less common, occurring in about 2% of knees with SPONK. Early onset SPONK on the ipsilateral side of the medial compartment is very rare, with, to our knowledge, only four cases reported to date. We describe a very rare case of SPONK with early simultaneous development in the MFC and MTP. Serial plain radiographs and magnetic resonance imaging showed that SPONK in both condyles followed a similar progressive course. The pathological findings in these lesions were similar to those observed in subchondral insufficiency fractures. PMID:27242941

  20. The Adequacy of Diagnosis and Treatment for Osteoporosis in Patients with Proximal Humeral Fractures

    PubMed Central

    Kim, Tae In; Choi, Jun Ha; Kim, Sae Hoon

    2016-01-01

    Background The purpose of this study was to evaluate whether physicians' practice was adequate for the diagnosis and treatment of osteoporosis in patients with proximal humeral fracture over the age of 50 years, which is one of major osteoporotic fractures. Methods A retrospective nation-wide cohort study was performed using data collected in 2010 by the Korean Health Insurance Review Agency. The incidences of fractures around the hip, spine, and proximal humerus in patients more than 50 years of age, the frequencies of diagnostic bone density scan for osteoporosis, and the prescription for the osteoporosis medication were analyzed and compared. Results A search of database identified 48,351 hip fractures, 141,208 spine fractures, and 11,609 proximal humeral fractures in patients more than 50 years of age in 2010. Among these patients, 12,097 (25.0%) of hip fractures, 41,962 (29.7%) of spine fractures, and 1,458 (12.6%) of proximal humeral fractures underwent diagnostic bone density scan (p < 0.001); 4,773 (9.9%) of hip fractures, 27,261 (19.3%) of spine fractures, and 639 (5.5%) of proximal humeral fractures were managed with at least one medication approved for the treatment of osteoporosis (p < 0.001). Furthermore, 1,217 (2.5%) of hip fractures, 7,271 (5.2%) of spine fractures, and 188 (1.6%) of proximal humeral fractures received diagnostic bone density scans as well as osteoporosis medications (p < 0.001). Younger patients (50–69 years of age) were less likely to be evaluated and managed for osteoporosis relative to older patients (≥ 70 years of age) (p < 0.001); and men were less likely to be evaluated and managed for osteoporosis relative to women (p < 0.001). Conclusions Current physicians' practice pattern may be inadequate for the diagnosis and treatment of osteoporosis in patients of proximal humeral fractures over the age of 50 years. Additional study and educational programs are necessary to improve this care gap, beginning with physicians who are

  1. 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.

  2. Flexible Intramedullary Nailing of Pediatric Humeral Fractures: Indications, Techniques, and Tips.

    PubMed

    Kelly, Derek M

    2016-06-01

    Most proximal and diaphyseal pediatric humeral fractures can be treated successfully by closed means; however, certain patient factors or fracture characteristics may make surgical stabilization with flexible intramedullary nails (FIN) a better choice. Common indications for FIN of pediatric humeral fractures include unstable proximal-third fractures in children nearing skeletal maturity, unstable distal metaphyseal-diaphyseal junction fractures, shaft fractures in polytraumatized patients or patients with ipsilateral both-bone forearm fractures (floating elbow), and prophylactic stabilization of benign diaphyseal bone cysts or surgical stabilization of pathologic fractures. FIN can be safely inserted in an antegrade or retrograde manner depending on the fracture location and configuration. Careful dissection at the location of rod insertion can prevent iatrogenic nerve injuries. Rapid fracture union and return to full function can be expected in most cases. Implant prominence is the most common complication.

  3. Is MIPO in humeral shaft fractures really safe? Postoperative ultrasonographic evaluation.

    PubMed

    Livani, Bruno; Belangero, William; Andrade, Kleber; Zuiani, Guilherme; Pratali, Raphael

    2009-12-01

    In the last few years there has been great interest in minimally invasive plate osteosynthesis (MIPO) in the treatment of humeral shaft fractures. None of these studies showed the anatomical relationship between the radial nerve and the material of the implant in vivo. We performed postoperative ultrasonographic measurement of the distance between the radial nerve and the material implanted using the MIPO technique. Nineteen patients underwent postoperative ultrasound examinations. Group A comprised midshaft fractures and group B distal third fractures. The point of greatest proximity between the radial nerve and the implant was measured. In group A the distance was between 1.6 and 19.6 mm (mean: 9.3 mm) and in group B between 1.0 and 8.1 mm (mean: 4.0 mm). The ultrasound findings reveal that the radial nerve is quite close to the implant material, especially in the transition between the third and fourth quarters of the humeral shaft. PMID:18704415

  4. [Clinical experiences in the treatment of humeral shaft fractures with the Sarmiento brace].

    PubMed

    Kulenkampff, H A; Rustemeier, M

    1988-08-01

    13 humeral shaft fractures were treated by Sarmiento-brace. Fracture-bracing is a special conservative traumatological management, that permits early remedial gymnastics. Light weight, optimal cosmetic results and quickly rehabilitation of the injured arm are favorable. Cooperation in gymnastics and controls within short times by the doctor are necessary. All our patients of ages under 45 years achieved nearly normal articular function, that increases 95% in comparison to the opposite arm. External rotation and abduction of the shoulder decreased in elder persons. Loss of function could not be avoided completely in critical cases (upper and lower part of the humeral shaft). Side effects were swelling, angulation deficiencies up to 16 degrees and skin lesions. The rate of pseudarthrosis seems very small. In advanced cases of malignomas pathologic fractures were treated by bracing palliatively. Open fractures, vascular damage, nerve palsy, fractures that cannot be controlled by non operative means and multiple injured patients should be treated by operation. PMID:3176188

  5. Throwing in the Middle and Upper Paleolithic: inferences from an analysis of humeral retroversion.

    PubMed

    Rhodes, Jill A; Churchill, Steven E

    2009-01-01

    When in evolutionary history did long-range projectile weapons become an important component of hunting toolkits? The archeological evidence for the development of projectile weaponry is complex and generally indirect, and has led to different conclusions about the origin and spread of this technology. Lithic evidence from the Middle Stone Age (MSA) has led some researchers to suggest that true long- range projectile weaponry developed in Africa perhaps as early as 80,000 years ago, and was part of the subsistence toolkit carried by modern humans who expanded out of Africa after 50,000 years ago. Alternatively, temporal patterns in the morphology of pointed lithics has led others to posit an independent, convergent origin of projectile weaponry in Africa, the Near East, and Europe during the interval between 50,000-40,000 years ago. By either scenario, projectile weapons would not have been a component of the hunting arsenal of Neandertals, but may have been in use by European early modern humans and thus, projectile technology may have entered into the competitive dynamics that existed between these two groups. The origins of projectile weapons can be addressed, in part, through analyses of the skeletal remains of the prehistoric humans who made and used them. Habitual behavior patterns--including those related to the production and use of technology--can be imprinted on the skeleton through both genetic and epigenetic pathways. Recent studies in the field of sports medicine indicate that individuals who engage in habitual throwing have increased humeral retroversion angles in their throwing arms and a greater degree of bilateral asymmetry in retroversion angles than do non-throwers. This contribution investigates humeral torsion through analysis of the retroversion angle in samples of Eurasian Neandertals, European early modern humans of the middle and late Upper Paleolithic, and comparative samples of recent humans. This analysis was conducted under the

  6. Secondary Radial Nerve Palsy after Minimally Invasive Plate Osteosynthesis of a Distal Humeral Shaft Fracture

    PubMed Central

    Bichsel, Ursina; Nyffeler, Richard Walter

    2015-01-01

    Minimally invasive plate osteosynthesis is a widely used procedure for the treatment of fractures of the femur and the tibia. For a short time it is also used for the treatment of humeral shaft fractures. Among other advantages, the ambassadors of this technique emphasize the lower risk of nerve injuries when compared to open reduction and internal fixation. We report the case of secondary radial nerve palsy caused by percutaneous fixation of a plate above the antecubital fold. The nerve did not recover and the patient needed a tendon transfer to regain active extension of the fingers. This case points to the importance of adequate exposure of the bone and plate if a humeral shaft fracture extends far distally. PMID:26558125

  7. [Case Report - Bilateral humeral intraosseous access for CPR in a 3-years-old child].

    PubMed

    Hess, Thorsten; Böhmer, Roman; Arndt, Florian; Lorber, Gernot; Herrmann, Jochen; Püschel, Klaus; Kerner, Thoralf

    2016-07-01

    On-scene invasive emergency procedures, such as intraosseous puncture, are often unavoidable, when indicated, and present a challenge for the emergency physician. Personal, temporal or local conditions are often unsuitable. Even with regular intervention by the emergency medical service, "last resort" measures occur very infrequently, particularly in pediatric emergencies. For the first time, this case report presents the use of intraosseous access at the humeral head with children, with reference to indication, implementation, problems and risks. PMID:27479261

  8. Acute Operative Management of Humeral Shaft Fractures: Analysis of the National Trauma Data Bank.

    PubMed

    Matuszewski, Paul E; Kim, Tae Won; Gay, Andre N; Mehta, Samir

    2015-06-01

    Advances in surgical techniques have increased the role of early surgical intervention for isolated diaphyseal humerus fractures. The goal of this study was to investigate the following: (1) the current trend of operative treatment; (2) factors that affect surgical treatment; and (3) the effect of surgical fixation on length of stay, complication rates, and hospital disposition. The National Trauma Data Bank from 2004 to 2006 was analyzed. All patients with multiple injuries that included closed humeral shaft fractures and all patients with isolated humeral shaft fractures were included. Of 2312 total closed humeral shaft fractures, 1662 had a documented procedure code. A total of 47% of patients underwent surgical treatment. Surgically treated patients were on average 3.5 years older than those treated nonoperatively (P=.007). A total of 49% of white patients underwent early surgery vs 39% of nonwhite patients (P<.001). The operative group had a mean Injury Severity Score of 8.33 vs 9.0 in the nonoperative group (P=.04). Treatment at a Level I trauma center decreased the likelihood of surgery compared with treatment at a non-Level I trauma center (45% vs 57%, P<.001). Mean length of stay was 4.6 days for operative treatment vs 3.9 days for nonoperative treatment (P=.02). Of patients who underwent surgery, 78% were discharged to home compared with 69% of those managed nonoperatively (P<.001). Acute operative management of humeral shaft fractures correlated with a lower Injury Severity Score, a decreased length of stay, and less rehabilitation placement. Furthermore, older patients, white patients, and patients treated at a non-Level I trauma center were more likely to undergo acute surgical management. The reasons for these disparities are unclear and warrant further investigation.

  9. Existence of a rotational axial component in the human humeral medullary canal.

    PubMed

    Descamps, S; Moreel, P; Garcier, J M; Bouillet, B; Brehant, J; Tanguy, A

    2009-10-01

    To explain surgical findings, we studied the anatomy of the human humeral medullary canal on a series of 28 bones in 16 patients and 9 dried bones. A methodology is described to find angle of medullary canal on CT scans regarding to an epicondylar reference axis. We found a constant tri-dimensional spiral shape of the medullary canal in the distal part of the bone. The relations between this first description and the literature are discussed.

  10. Review of Literature of Radial Nerve Injuries Associated with Humeral Fractures—An Integrated Management Strategy

    PubMed Central

    Wu, Qiang; Wu, QiuLi; Li, Yan; Feng, ShiQing

    2013-01-01

    Background Radial nerve palsy associated with fractures of the shaft of the humerus is the most common nerve lesion complicating fractures of long bones. However, the management of radial nerve injuries associated with humeral fractures is debatable. There was no consensus between observation and early exploration. Methods and Findings The PubMed, Embase, Cochrane Central Register of Controlled Trials, Google Scholar, CINAHL, International Bibliography of the Social Sciences, and Social Sciences Citation Index were searched. Two authors independently searched for relevant studies in any language from 1966 to Jan 2013. Thirty studies with 2952 humeral fractures participants were identified. Thirteen studies favored conservative strategy. No significant difference between early exploration and no exploration groups (OR, 1.03, 95% CI 0.61, 1.72; I2 = 0.0%, p = 0.918 n.s.). Three studies recommend early radial nerve exploration in patients with open fractures of humerus with radial nerve injury. Five studies proposed early exploration was performed in high-energy humeral shaft fractures with radial nerve injury. Conclusions The conservative strategy was a good choice for patients with low-energy closed fractures of humerus with radial nerve injury. We recommend early radial nerve exploration (within the first 2 weeks) in patients with open fractures or high-energy closed fractures of humerus with radial nerve injury. PMID:24250799

  11. Treatment of Intercondylar Humeral Fractures With 3D-Printed Osteosynthesis Plates.

    PubMed

    Shuang, Feng; Hu, Wei; Shao, Yinchu; Li, Hao; Zou, Hongxing

    2016-01-01

    The aim of the study was to evaluate the efficacy custom 3D-printed osteosynthesis plates in the treatment of intercondylar humeral fractures.Thirteen patients with distal intercondylar humeral fractures were randomized to undergo surgery using either conventional plates (n = 7) or 3D-printed plates (n = 6) at our institution from March to October 2014. Both groups were compared in terms of operative time and elbow function at 6 month follow-up.All patients were followed-up for a mean of 10.6 months (range: 6-13 months). The 3D-printing group had a significantly shorter mean operative time (70.6 ± 12.1 min) than the conventional plates group (92.3 ± 17.4 min). At the last follow-up period, there was no significant difference between groups in the rate of patients with good or excellent elbow function, although the 3D-printing group saw a slightly higher rate of good or excellent evaluations (83.1%) compared to the conventional group (71.4%).Custom 3D printed osteosynthesis plates are safe and effective for the treatment of intercondylar humeral fractures and significantly reduce operative time. PMID:26817880

  12. Anterior plating as a surgical alternative in the treatment of humeral shaft non-union.

    PubMed

    Livani, Bruno; Belangero, William; Medina, Giovanna; Pimenta, Ciro; Zogaib, Rodrigo; Mongon, Mauricio

    2010-10-01

    This study included 15 patients with humeral shaft fractures who had no clinical, radiological or bone scan signs of healing after eight months. The patients were followed for a mean of 35.8 months. No patient was lost to follow-up. Anterior plating of humeral shaft nonunion via an anterior approach was performed using a straight plate and compression for well-vascularised non-unions and wave plating with a tricortical graft for poorly vascularised non-unions. All non-unions healed within 6-18 weeks (mean, nine weeks) without local complication. One patient had a mild decrease in elbow and shoulder range of motion. No neurovascular injury was observed. Anterior plating is a simple, safe and effective treatment for humeral shaft non-union. As this approach avoids the need for radial nerve visualisation and extensive soft-tissue dissection, and the healing time is similar to that of other methods, we suggest this treatment as an alternative option. PMID:19730860

  13. Anterior plating as a surgical alternative in the treatment of humeral shaft non-union

    PubMed Central

    Belangero, William; Medina, Giovanna; Pimenta, Ciro; Zogaib, Rodrigo; Mongon, Mauricio

    2009-01-01

    This study included 15 patients with humeral shaft fractures who had no clinical, radiological or bone scan signs of healing after eight months. The patients were followed for a mean of 35.8 months. No patient was lost to follow-up. Anterior plating of humeral shaft nonunion via an anterior approach was performed using a straight plate and compression for well-vascularised non-unions and wave plating with a tricortical graft for poorly vascularised non-unions. All non-unions healed within 6–18 weeks (mean, nine weeks) without local complication. One patient had a mild decrease in elbow and shoulder range of motion. No neurovascular injury was observed. Anterior plating is a simple, safe and effective treatment for humeral shaft non-union. As this approach avoids the need for radial nerve visualisation and extensive soft-tissue dissection, and the healing time is similar to that of other methods, we suggest this treatment as an alternative option. PMID:19730860

  14. UPPER LIMB TRACTION DEVICE FOR ANTEROGRADE INTRAMEDULLARY LOCKED NAIL OF HUMERAL SHAFT FRACTURES

    PubMed Central

    Corrêa, Mário Chaves; Gomes, Felipe Antônio; Linhares, Daniel Campos; Gonçalves, Lucas Braga Jacques; Vilela, José Carlos Souza; de Andrade, Ronaldo Percopi

    2015-01-01

    Diaphyseal fractures of the femur and tibia in adults are mostly treated surgically, usually by means of intramedullary locked-nail osteosynthesis. Some comminuted and/or highly deviated shaft fractures may present a veritable technical challenge. Fracture (or orthopedic) tables, which enable vertical, horizontal and rotational instrumental stabilization of the limb, greatly facilitate reduction and implant placement maneuvers and are widely used by orthopedic surgeons. Humeral shaft fractures are mostly treated nonsurgically. However, some cases with indications that are well defined in the literature require surgical treatment. They can be fixed by means of plates or intramedullary nails, using anterograde or retrograde routes. In the humerus, fracture reduction and limb stabilization maneuvers for implantation of intramedullary nails are done manually, usually by two assistants. Because muscle fatigue may occur, this option may be less efficient. The aim of this paper is to present an external upper-limb traction device for use in anterograde intramedullary locked-nail osteosynthesis of humeral shaft fractures that enables vertical, horizontal and rotational stabilization of the upper limb, in a manner similar to the device used for the lower limbs. The device is portable, of simple construction, and can be installed on any operating table equipped with side rails. It was used for surgical treatment of 29 humeral shaft fractures using an anterograde locked intramedullary nail. Our experience was extremely positive. We did not have any complications relating to its use and we believe that it notably facilitated the surgical procedures. PMID:27022560

  15. UPPER LIMB TRACTION DEVICE FOR ANTEROGRADE INTRAMEDULLARY LOCKED NAIL OF HUMERAL SHAFT FRACTURES.

    PubMed

    Corrêa, Mário Chaves; Gomes, Felipe Antônio; Linhares, Daniel Campos; Gonçalves, Lucas Braga Jacques; Vilela, José Carlos Souza; de Andrade, Ronaldo Percopi

    2010-01-01

    Diaphyseal fractures of the femur and tibia in adults are mostly treated surgically, usually by means of intramedullary locked-nail osteosynthesis. Some comminuted and/or highly deviated shaft fractures may present a veritable technical challenge. Fracture (or orthopedic) tables, which enable vertical, horizontal and rotational instrumental stabilization of the limb, greatly facilitate reduction and implant placement maneuvers and are widely used by orthopedic surgeons. Humeral shaft fractures are mostly treated nonsurgically. However, some cases with indications that are well defined in the literature require surgical treatment. They can be fixed by means of plates or intramedullary nails, using anterograde or retrograde routes. In the humerus, fracture reduction and limb stabilization maneuvers for implantation of intramedullary nails are done manually, usually by two assistants. Because muscle fatigue may occur, this option may be less efficient. The aim of this paper is to present an external upper-limb traction device for use in anterograde intramedullary locked-nail osteosynthesis of humeral shaft fractures that enables vertical, horizontal and rotational stabilization of the upper limb, in a manner similar to the device used for the lower limbs. The device is portable, of simple construction, and can be installed on any operating table equipped with side rails. It was used for surgical treatment of 29 humeral shaft fractures using an anterograde locked intramedullary nail. Our experience was extremely positive. We did not have any complications relating to its use and we believe that it notably facilitated the surgical procedures.

  16. Posterior humeral avulsion of the glenohumeral ligament (PHAGL) in anterior shoulder instability

    PubMed Central

    Vedova, Franco Della; Ibáñez, Maximiliano; Alvarez, Victoria; Lépore, Salvador; Sulzle, Vanina Ojeda; Galan, Hernán; Slullitel, Daniel

    2015-01-01

    Introduction: Bankart lesion is the anterior glenohumeral instability most common associated injury. Tears at glenohumeral ligaments can be intra substance or at humeral insertion, this location may be the cause of instability. Posterior humeral avulsion of the glenohumeral ligament (PHAGL) can be an isolated or associated cause of instability and it is usually related to the posterior glenohumeral instability. The aim of this article is to report the clinical assessment and postoperative outcomes of 6 patients with PHAGL with anterior shoulder instability. Materials and Methods: We evaluated six patients with PHAGL due to anterior glenohumeral instability arthroscopically repaired. All 6 patients developed the lesion after a sports-related trauma. Sixty six per cent of patients had associated intra-articular shoulder pathologies. The diagnosis with MRI arthrogram (with gadolinium) was performed preoperatively in 50% of patients. Postoperative evaluation was made with Rowe, ASES and WOSI scores. Results: All patients returned to their previous sports level. One patient had a recurrence. Postoperative scores results are WOSI: 13.13%, Rowe 83.33 and ASES 95.83. Discussion: Humeral avulsions of glenohumeral ligaments represent 25% of capsulolabral injuries. PHAGL injury was initially described as a cause of posterior instability, but according to two other series, our study shows that this lesion may also cause anterior instability. It is critical to have a high index of suspicion and make a correct arthroscopic examination to diagnose this injury, because arthroscopic repair of PHAGL has good postoperative outcomes.

  17. Treatment of Intercondylar Humeral Fractures With 3D-Printed Osteosynthesis Plates

    PubMed Central

    Shuang, Feng; Hu, Wei; Shao, Yinchu; Li, Hao; Zou, Hongxing

    2016-01-01

    Abstract The aim of the study was to evaluate the efficacy custom 3D-printed osteosynthesis plates in the treatment of intercondylar humeral fractures. Thirteen patients with distal intercondylar humeral fractures were randomized to undergo surgery using either conventional plates (n = 7) or 3D-printed plates (n = 6) at our institution from March to October 2014. Both groups were compared in terms of operative time and elbow function at 6 month follow-up. All patients were followed-up for a mean of 10.6 months (range: 6–13 months). The 3D-printing group had a significantly shorter mean operative time (70.6 ± 12.1 min) than the conventional plates group (92.3 ± 17.4 min). At the last follow-up period, there was no significant difference between groups in the rate of patients with good or excellent elbow function, although the 3D-printing group saw a slightly higher rate of good or excellent evaluations (83.1%) compared to the conventional group (71.4%). Custom 3D printed osteosynthesis plates are safe and effective for the treatment of intercondylar humeral fractures and significantly reduce operative time. PMID:26817880

  18. Reverse Shoulder Arthroplasty for Acute Proximal Humeral Fractures in the Geriatric Patient

    PubMed Central

    Stanbury, Spencer Jay; Voloshin, Ilya

    2011-01-01

    Proximal humeral fractures are frequently encountered in the elderly population. While the majority of these fractures can be managed nonoperatively, 2-, 3-, and 4-part fractures, head splitting, and complex fracture dislocations typically require operative management. Open reduction and internal fixation (ORIF) is a popular treatment option for displaced fractures. Advent of locking plates potentially imparts a better option for patients with osteoporotic bone. Hemiarthroplasty has traditionally been used in proximal humeral fractures not amendable to ORIF. While typically providing good pain control, results of hemiarthroplasty have demonstrated inconsistent shoulder motion. Tuberosity malposition or poor healing is a major culprit in unsatisfactory postoperative range of motion. Reverse shoulder arthroplasty has been used in the setting of rotator cuff arthropathy with successful results. Reverse shoulder arthroplasty has recently been used in the setting of acute proximal humeral fractures of the elderly individuals. This technology has shown promising results with mean active anterior elevation from 97° to 122° reported with complication rates of 15% to 28% in short-term studies. Long-term studies and higher level evidence studies with comparison to hemiarthroplasty and ORIF are needed. PMID:23569688

  19. [A trans-parotid approach to the osteosynthesis of fractures of the mandibular condyle. A study apropos of 30 cases].

    PubMed

    Jallut, Y; Tort, C; Aldegheri, A; Perrand, M; Silbert, I; Mourali, K

    1994-01-01

    The authors report a homogeneous series of 30 cases with fractures of the mandibular condyles treated by internal fixation with a mini-plaque via the transparotidial route. The patient were treated between 1987 and 1992, with a minimum follow-up of one year. The transparotidial route has the reputation of being dangerous because of the proximity of the facial nerve and the poor vascular supply to the condyle. It is described in detail. Indications are exclusively extra-articular fractures. Complications were observed although no definitive facial nerve paralysis was seen. The authors conclude that the best indications are subcondylian fractures with or without luxation. In cases with luxation, it is important to verify the menisco-ligament system simultaneously. The authors emphasize the complementary nature of this treatment with the functional method.

  20. Mesenchymal Stem Cells and Platelet Gel Improve Bone Deposition within CAD-CAM Custom-Made Ceramic HA Scaffolds for Condyle Substitution

    PubMed Central

    Ciocca, L.; Donati, D.; Ragazzini, S.; Dozza, B.; Rossi, F.; Fantini, M.; Spadari, A.; Romagnoli, N.; Landi, E.; Tampieri, A.; Piattelli, A.; Iezzi, G.; Scotti, R.

    2013-01-01

    Purpose. This study evaluated the efficacy of a regenerative approach using mesenchymal stem cells (MSCs) and CAD-CAM customized pure and porous hydroxyapatite (HA) scaffolds to replace the temporomandibular joint (TMJ) condyle. Methods. Pure HA scaffolds with a 70% total porosity volume were prototyped using CAD-CAM technology to replace the two temporomandibular condyles (left and right) of the same animal. MSCs were derived from the aspirated iliac crest bone marrow, and platelets were obtained from the venous blood of the sheep. Custom-made surgical guides were created by direct metal laser sintering and were used to export the virtual planning of the bone cut lines into the surgical environment. Sheep were sacrificed 4 months postoperatively. The HA scaffolds were explanted, histological specimens were prepared, and histomorphometric analysis was performed. Results. Analysis of the porosity reduction for apposition of newly formed bone showed a statistically significant difference in bone formation between condyles loaded with MSC and condyles without (P < 0.05). The bone ingrowth (BI) relative values of split-mouth comparison (right versus left side) showed a significant difference between condyles with and without MSCs (P < 0.05). Analysis of the test and control sides in the same animal using a split-mouth study design was performed; the condyle with MSCs showed greater bone formation. Conclusion. The split-mouth design confirmed an increment of bone regeneration into the HA scaffold of up to 797% upon application of MSCs. PMID:24073409

  1. Biomechanical Study of the Fixation Strength of Anteromedial Plating for Humeral Shaft Fractures

    PubMed Central

    Zheng, Yin-Feng; Zhou, Jun-Lin; Wang, Xiao-Hong; Shan, Lei; Liu, Yang

    2016-01-01

    Background: Open reduction and internal fixation with plate and screws are the gold standard for the surgical treatment of humeral shaft fractures, this study was to compare the mechanical properties of anteromedial, anterolateral, and posterior plating for humeral shaft fractures. Methods: A distal third humeral shaft fracture model was constructed using fourth-generation sawbones (#3404, composite bone). A total of 24 sawbones with a distal third humeral shaft fracture was randomly divided into three Groups: A, B, and C (n = 8 in each group) for anteromedial, anterolateral, and posterior plating, respectively. All sawbones were subjected to horizontal torsional fatigue tests, horizontal torsional and axial compressive fatigue tests, four-point bending fatigue tests in anteroposterior (AP) and mediolateral (ML) directions and horizontal torsional destructive tests. Results: In the horizontal torsional fatigue tests, the mean torsional angle amplitude in Groups A, B, and C were 6.12°, 6.53°, and 6.81°. In horizontal torsional and axial compressive fatigue tests, the mean torsional angle amplitude in Groups A, B, and C were 5.66°, 5.67°, and 6.36°. The mean plate displacement amplitude was 0.05 mm, 0.08 mm, and 0.10 mm. Group A was smaller than Group C (P < 0.05). In AP four-point bending fatigue tests, the mean plate displacement amplitude was 0.16 mm, 0.13 mm, and 0.20 mm. Group B was smaller than Group C (P < 0.05). In ML four-point bending fatigue tests, the mean plate displacement amplitude were 0.16 mm, 0.19 mm, and 0.17 mm. In horizontal torsional destructive tests, the mean torsional rigidity in Groups A, B, and C was 0.82, 0.75, and 0.76 N·m/deg. The yielding torsional angle was 24.50°, 25.70°, and 23.86°. The mean yielding torque was 18.46, 18.05, and 16.83 N·m, respectively. Conclusions: Anteromedial plating was superior to anterolateral or posterior plating in all mechanical tests except in AP four-point bending fatigue tests compared to the

  2. Morphological and cellular examinations of experimentally induced malocclusion in mice mandibular condyle.

    PubMed

    Jung, Jae-Kwang; Sohn, Wern-Joo; Lee, Youngkyun; Bae, Yong Chul; Choi, Jae-Kap; Kim, Jae-Young

    2014-02-01

    Occlusal alignment is known clinically to have a widespread influence on the stomatognathic system, including the temporomandibular joint and masticatory muscles. However, while occlusion is still an important determinant of most dental treatments, the exact effect of occlusal alignment is unclear because of a lack of conclusive scientific evidence. In this study, a malocclusion model system is used to examine the cellular and histologic alterations in the contralateral condyle of mice after a malocclusion was induced by a build-up of resin on the left maxillary molars. A significant decrease in the thickness of the condylar cartilage was found in the 1-week experimental group, together with increased apoptosis and decreased proliferation in the condylar head, which included cartilage and subchondral bone. Additionally, the number of TRAP-positive osteoclasts and MPO- and F4/80-positive inflammatory cells in the subchondral bone were significantly higher in the 1-week experimental group. Unbalanced malocclusion caused increased bone remodeling, as evidenced by increased osteoclastic activity and inflammatory responses (macrophages and neutrophils, respectively). However, these alterations in the 1-week experimental group were subsequently attenuated and restored almost to the baseline at 3 weeks after the induction of the malocclusion.

  3. A new automatic landmark extraction framework on ultrasound images of femoral condyles

    NASA Astrophysics Data System (ADS)

    Masson-Sibut, Agnès; Nakib, Amir; Petit, Eric; Leitner, François

    2012-03-01

    In Computer Assisted Orthopaedic Surgery (CAOS), surgeons have to acquire some anatomical landmarks as inputs to the system. To do so, they use manual pointers that are localized in the Operating Room (OR) space using an infrared camera. When the needed landmark is not reachable through an opening, it is palpated directly on skin and there is a loss of precision that can vary from several millimeters to centimeters depending on the thickness of soft tissues. In this paper, we propose a new framework based on three main steps to register the bone surface and extract automatically anatomical landmarks with an ultrasound probe. This framework is based on an oriented gradient calculation, a simulated-compound and a contour closure using a graph representation. The oriented gradient allows extracting a set of pixels that probably belong to the bone surface. The simulatedcompound step allows using ultrasound images properties to define a set of small segments which may belong to the bone surface, and the graph representation allows eliminating false positive detection among remaining segments. The proposed method has been validated on a database of 230 ultrasound images of anterior femoral condyles (on the knee). The average computation time is 0.11 sec per image, and average errors are: 0.54 mm for the bone surface extraction, 0.31 mm for the condylar line, and 1.4 mm for the trochlea middle.

  4. Dental panoramic image analysis for enhancement biomarker of mandibular condyle for osteoporosis early detection

    NASA Astrophysics Data System (ADS)

    Suprijanto; Azhari; Juliastuti, E.; Septyvergy, A.; Setyagar, N. P. P.

    2016-03-01

    Osteoporosis is a degenerative disease characterized by low Bone Mineral Density (BMD). Currently, a BMD level is determined by Dual Energy X-ray Absorptiometry (DXA) at the lumbar vertebrae and femur. Previous studies reported that dental panoramic radiography image has potential information for early osteoporosis detection. This work reported alternative scheme, that consists of the determination of the Region of Interest (ROI) the condyle mandibular in the image as biomarker and feature extraction from ROI and classification of bone conditions. The minimum value of intensity in the cavity area is used to compensate an offset on the ROI. For feature extraction, the fraction of intensity values in the ROI that represent high bone density and the ROI total area is perfomed. The classification will be evaluated from the ability of each feature and its combinations for the BMD detection in 2 classes (normal and abnormal), with the artificial neural network method. The evaluation system used 105 panoramic image data from menopause women which consist of 36 training data and 69 test data that were divided into 2 classes. The 2 classes of classification obtained 88.0% accuracy rate and 88.0% sensitivity rate.

  5. Microcomputed tomographic analysis of human condyles in unilateral condylar hyperplasia: increased cortical porosity and trabecular bone volume fraction with reduced mineralisation.

    PubMed

    Karssemakers, L H E; Nolte, J W; Tuinzing, D B; Langenbach, G E J; Raijmakers, P G; Becking, A G

    2014-12-01

    Unilateral condylar hyperplasia or hyperactivity is a disorder of growth that affects the mandible, and our aim was to visualise the 3-dimensional bony microstructure of resected mandibular condyles of affected patients. We prospectively studied 17 patients with a clinical presentation of progressive mandibular asymmetry and an abnormal single-photon emission computed tomographic (SPECT) scan. All patients were treated by condylectomy to arrest progression. The resected condyles were scanned with micro-CT (18 μm resolution). Rectangular volumes of interest were selected in 4 quadrants (lateromedial and superoinferior) of the trabecular bone of each condyle. Variables of bone architecture (volume fraction, trabecular number, thickness, and separation, degree of mineralisation, and degree of structural anisotrophy) were calculated with routine morphometric software. Eight of the 17 resected condyles showed clear destruction of the subchondral layer of cortical bone. There was a significant superoinferior gradient for all trabecular variables. Mean (SD) bone volume fraction (25.1 (6) %), trabecular number (1.69 (0.26) mm(-1)), trabecular thickness (0.17 (0.03) mm), and degree of mineralisation (695.39 (39.83) mg HA/cm(3)) were higher in the superior region. Trabecular separation (0.6 (0.16) mm) and structural anisotropy (1.84 (0.28)) were higher in the inferior region. The micro-CT analysis showed increased cortical porosity in many of the condyles studied. It also showed a higher bone volume fraction, greater trabecular thickness and trabecular separation, greater trabecular number, and less mineralisation in the condyles of the 17 patients compared with the known architecture of unaffected mandibular condyles. PMID:25219775

  6. Dominant-Limb Range-of-Motion and Humeral-Retrotorsion Adaptation in Collegiate Baseball and Softball Position Players

    PubMed Central

    Hibberd, Elizabeth E.; Oyama, Sakiko; Tatman, Justin; Myers, Joseph B.

    2014-01-01

    Context: Biomechanically, the motions used by baseball and softball pitchers differ greatly; however, the throwing motions of position players in both sports are strikingly similar. Although the adaptations to the dominant limb from overhead throwing have been well documented in baseball athletes, these adaptations have not been clearly identified in softball players. This information is important in order to develop and implement injury-prevention programs specific to decreasing the risk of upper extremity injury in softball athletes. Objective: To compare range-of-motion and humeral-retrotorsion characteristics of collegiate baseball and softball position players and of baseball and softball players to sex-matched controls. Design: Cross-sectional study. Setting: Research laboratories and athletic training rooms at the University of North Carolina at Chapel Hill. Patients or Other Participants: Fifty-three collegiate baseball players, 35 collegiate softball players, 25 male controls (nonoverhead athletes), and 19 female controls (nonoverhead athletes). Intervention(s): Range of motion and humeral retrotorsion were measured using a digital inclinometer and diagnostic ultrasound. Main Outcome Measure(s): Glenohumeral internal-rotation deficit, external-rotation gain, total glenohumeral range of motion, and humeral retrotorsion. Results: Baseball players had greater glenohumeral internal-rotation deficit, total–range-of-motion, and humeral-retrotorsion difference than softball players and male controls. There were no differences between glenohumeral internal-rotation deficit, total–range-of-motion, and humeral-retrotorsion difference in softball players and female controls. Conclusions: Few differences were evident between softball players and female control participants, although range-of-motion and humeral-retrotorsion adaptations were significantly different than baseball players. The throwing motions are similar between softball and baseball, but the

  7. Humeral external rotation handling by using the Bobath concept approach affects trunk extensor muscles electromyography in children with cerebral palsy.

    PubMed

    Grazziotin Dos Santos, C; Pagnussat, Aline S; Simon, A S; Py, Rodrigo; Pinho, Alexandre Severo do; Wagner, Mário B

    2014-10-20

    This study aimed to investigate the electromyographic activity of cervical and trunk extensors muscles in children with cerebral palsy during two handlings according to the Bobath concept. A crossover trial involving 40 spastic diplegic children was conducted. Electromyography (EMG) was used to measure muscular activity at sitting position (SP), during shoulder internal rotation (IR) and shoulder external rotation (ER) handlings, which were performed using the elbow joint as key point of control. Muscle recordings were performed at the fourth cervical (C4) and at the tenth thoracic (T10) vertebral levels. The Gross Motor Function Classification System (GMFCS) was used to assess whether muscle activity would vary according to different levels of severity. Humeral ER handling induced an increase on EMG signal of trunk extensor muscles at the C4 (P=0.007) and T10 (P<0.001) vertebral levels. No significant effects were observed between SP and humeral IR handling at C4 level; However at T10 region, humeral IR handling induced an increase of EMG signal (P=0.019). Humeral ER resulted in an increase of EMG signal at both levels, suggesting increase of extensor muscle activation. Furthermore, the humeral ER handling caused different responses on EMG signal at T10 vertebra level, according to the GMFCS classification (P=0.017). In summary, an increase of EMG signal was observed during ER handling in both evaluated levels, suggesting an increase of muscle activation. These results indicate that humeral ER handling can be used for diplegic CP children rehabilitation to facilitate cervical and trunk extensor muscles activity in a GMFCS level-dependent manner. PMID:25462474

  8. Combining of small fragment screws and large fragment plates for open reduction and internal fixation of periprosthetic humeral fractures

    PubMed Central

    Seybold, Dominik; Citak, Mustafa; Königshausen, Matthias; Gessmann, Jan; Schildhauer, Thomas A.

    2011-01-01

    Operative treatment of periprosthetic humeral fractures in elderly patients with osteoporotic bone requires a stable fixations technique. The combination of 3.5 cortical screws with washers in a 4.5 Arbeitsgemeinschaft für Osteosynthesefragen, Limited-contact dynamic compression plate or Locking plate, allows a stable periprosthetic fixation with the small 3.5 screws and 4.5 screws above and below the prosthesis, respectively. This combination is a cost-effective technique to treat periprosthetic humeral fractures. PMID:22223961

  9. The effect of humeral torsion on rotational range of motion in the shoulder and throwing performance.

    PubMed

    Roach, Neil Thomas; Lieberman, Daniel E; Gill, Thomas J; Palmer, William E; Gill, Thomas J

    2012-03-01

    Several recent studies have found that throwing athletes typically have lower humeral torsion (retroversion) and a greater range of external rotation at the shoulder than non-athletes. How these two parameters are related is debated. This study uses data from a sample of both throwers and non-throwers to test a new model that predicts torsion values from a range of motion data. The model proposes a series of predicted regressions which can help provide new insight into the factors affecting rotational range of motion at the shoulder. Humeral torsion angles were measured from computed tomography scans collected from 25 male subjects. These values are compared to predicted torsion values for the same subjects calculated from both kinematic and goniometric range-of-motion data. Results show that humeral torsion is negatively correlated (goniometric: r = -0.409, P = 0.047; kinematic: r = -0.442, P = 0.035) with external rotational range of motion and positively correlated (goniometric: r = 0.741, P < 0.001; kinematic: r = 0.559, P = 0.006) with internal rotational range of motion. The predicted torsion values are highly correlated (goniometric: r = 0.815, P < 0.001; kinematic: r = 0.617, P = 0.006) with actual torsion values. Deviations in the data away from predicted equations highlight significant differences between high torsion and low torsion individuals that may have significant functional consequences. The method described here may be useful for non-invasively assessing the degree of torsion in studies of the evolution and biomechanics of the shoulder and arm, and for testing hypotheses about the etiology of repetitive stress injuries among athletes and others who throw frequently.

  10. Humeral rotational osteotomy for shoulder deformity in obstetric brachial plexus palsy: which direction should I rotate?

    PubMed

    Abdelgawad, Amr A; Pirela-Cruz, Miguel A

    2014-01-01

    Shoulder internal rotation contracture is the most common deformity affecting the shoulder in patients with Obstetric Brachial Plexus Palsy. With progression of the deformity, the glenohumeral joint starts to subluxate and then dislocates. This is accompanied with bony changes of both the humerus and the glenoid. Two opposite direction humeral osteotomies have been proposed for this condition (internal rotation osteotomy (IRO) and external rotation osteotomy (ERO)). This fact of different direction osteotomies has not adequately been explained in the literature. Most orthopedic surgeons may not be able to fully differentiate between these two osteotomies regarding the indications, outcomes and effects on the joint. This review explains these differences in details.

  11. [Destruction of the Humeral Head in Sensory Deficit due to the Spinal Hemorhagia. Case Report].

    PubMed

    Kříž, J; Mikeš, J

    2015-01-01

    Degenerative changes of the shoulder are a common complication in patients after spinal cord injury. The main cause is chronic overload to the shoulder joint due to manual wheelchair propulsion and transfers. Reduced shoulder function has a significant impact on all aspects of daily life. Shoulder arthroplasty in this group of patients is a challenging procedure because of the unique demand on the shoulder. This report presents the case of a wheelchair user who additionally experienced a complete loss of sensation around her shoulder. As a result of a repetitive strain during transfers from the wheelchair to the ground, the humeral head was destroyed. PMID:26787187

  12. A review of current surgical practice in the operative treatment of proximal humeral fractures

    PubMed Central

    Jones, L. D.; Palmer, A. J. R.; Macnair, R. D.; Brewer, P. E.; Jayadev, C.; Wheelton, A. N.; Ball, D. E. J.; Nandra, R. S.; Aujla, R. S.; Sykes, A. E.; Carr, A. J.

    2016-01-01

    Objectives The PROximal Fracture of the Humerus: Evaluation by Randomisation (PROFHER) trial has recently demonstrated that surgery is non-superior to non-operative treatment in the management of displaced proximal humeral fractures. The objective of this study was to assess current surgical practice in the context of the PROFHER trial in terms of patient demographics, injury characteristics and the nature of the surgical treatment. Methods A total of ten consecutive patients undergoing surgery for the treatment of a proximal humeral fracture from each of 11 United Kingdom hospitals were retrospectively identified over a 15 month period between January 2014 and March 2015. Data gathered for the 110 patients included patient demographics, injury characteristics, mode of surgical fixation, the grade of operating surgeon and the cost of the surgical implants. Results A majority of the patients were female (66%, 73 of 110). The mean patient age was 62 years (range 18 to 89). A majority of patients met the inclusion criteria for the PROFHER trial (75%, 83 of 110). Plate fixation was the most common mode of surgery (68%, 75 patients), followed by intramedullary fixation (12%, 13 patients), reverse shoulder arthroplasty (10%, 11 patients) and hemiarthroplasty (7%, eight patients). The consultant was either the primary operating surgeon or supervising the operating surgeon in a large majority of cases (91%, 100 patients). Implant costs for plate fixation were significantly less than both hemiarthroplasty (p < 0.05) and reverse shoulder arthroplasty (p < 0.0001). Implant costs for intramedullary fixation were significantly less than plate fixation (p < 0.01), hemiarthroplasty (p < 0.0001) and reverse shoulder arthroplasty (p < 0.0001). Conclusions Our study has shown that the majority of a representative sample of patients currently undergoing surgical treatment for a proximal humeral fracture in these United Kingdom centres met the inclusion criteria for the PROFHER trial

  13. Elbow hemiarthroplasty for the management of distal humeral fractures: current technique, indications and results

    PubMed Central

    Watts, Adam C; Bain, Gregory I

    2016-01-01

    There has been a growing recent interest in the use of elbow hemiarthroplasty for the treatment of distal humeral trauma in select patients. However, the current available evidence regarding outcome after elbow hemiarthroplasty is limited to case series and biomechanical data. Consequently, the procedure remains unfamiliar to many surgeons. The aim of the present review is to outline the evidence regarding elbow hemiarthroplasty and to use this, along with the author’s experience, to better describe the indications, surgical technique and outcomes after this procedure. PMID:27583016

  14. The Floating Upper Limb: Multiple Injuries Involving Ipsilateral, Proximal, Humeral, Supracondylar, and Distal Radial Limb

    PubMed Central

    Manaan, Qazi; Bashir, Adil; Zahoor, Adnan; Mokhdomi, Taseem A.

    2016-01-01

    Floating arm injury represents a common yet complicated injury of the childhood severely associated with limb deformation and even morbidity, if not precisely addressed and credibly operated. Here, we report a rare floating upper limb case of a 9-year-old boy with multiple injuries of ipsilateral proximal humeral, supracondylar and distal radial limb. This is the first report to document such a combined floating elbow and floating arm injury in the same limb. In this report, we discuss the surgical procedures used and recovery of the patient monitored to ascertain the effectiveness of the method in limb reorganisation. PMID:27583121

  15. Elbow hemiarthroplasty for the management of distal humeral fractures: current technique, indications and results.

    PubMed

    Phadnis, Joideep; Watts, Adam C; Bain, Gregory I

    2016-07-01

    There has been a growing recent interest in the use of elbow hemiarthroplasty for the treatment of distal humeral trauma in select patients. However, the current available evidence regarding outcome after elbow hemiarthroplasty is limited to case series and biomechanical data. Consequently, the procedure remains unfamiliar to many surgeons. The aim of the present review is to outline the evidence regarding elbow hemiarthroplasty and to use this, along with the author's experience, to better describe the indications, surgical technique and outcomes after this procedure. PMID:27583016

  16. The Floating Upper Limb: Multiple Injuries Involving Ipsilateral, Proximal, Humeral, Supracondylar, and Distal Radial Limb.

    PubMed

    Manaan, Qazi; Bashir, Adil; Zahoor, Adnan; Mokhdomi, Taseem A; Danish, Qazi

    2016-09-01

    Floating arm injury represents a common yet complicated injury of the childhood severely associated with limb deformation and even morbidity, if not precisely addressed and credibly operated. Here, we report a rare floating upper limb case of a 9-year-old boy with multiple injuries of ipsilateral proximal humeral, supracondylar and distal radial limb. This is the first report to document such a combined floating elbow and floating arm injury in the same limb. In this report, we discuss the surgical procedures used and recovery of the patient monitored to ascertain the effectiveness of the method in limb reorganisation. PMID:27583121

  17. Arthroscopic repair of a humeral avulsion of the glenohumeral ligament lesion.

    PubMed

    Kon, Yoshiaki; Shiozaki, Hiroyuki; Sugaya, Hiroyuki

    2005-05-01

    We describe 3 cases of an all-arthroscopic technique for repair of a humeral avulsion of the glenohumeral ligament (HAGL) lesion and the postoperative clinical outcomes. From a technical perspective, the most critical part of the surgeries was the anchor insertion at an optimal position on the humerus in order to achieve proper tension of the glenohumeral ligament. The arm-free beach-chair position, which facilitates maximum internal rotation, use of a 70 degrees angled arthroscope, and an anterior-inferior trans-subscapularis tendon portal were considered key factors to accomplish this procedure.

  18. Glenohumeral internal rotation deficit in the asymptomatic professional pitcher and its relationship to humeral retroversion.

    PubMed

    Tokish, John M; Curtin, Michael S; Kim, Young-Kyu; Hawkins, Richard J; Torry, Michael R

    2008-01-01

    The purpose of this study was to determine if glenohumeral internal rotation deficits (GIRD) exist in an asymptomatic population of professional pitchers, and to assess whether these changes are primarily a bony or soft tissue adaptation. Twenty three, active, asymptomatic professional (Major League Baseball) pitchers volunteered for the study. Clinical measures of glenohumeral ranges of motion, laxity, GIRD, as well as radiographic measures of humeral retroversion were taken by two independent orthopaedic surgeons. Data comparing side to side differences in range of motion, laxity, and humeral retroversion were analyzed for statistical significance using a paired t-test for continuous data and a Chi-squared test for ordinal data, with a significance set at 0.05. Evaluations of statistical correlations between different measurement parameters were accomplished using a Pearson product moment correlation. We hypothesized GIRD will be positively correlated with humeral retroversion (HR) in the pitching arm. All clinical and radiographic measures were made in the field, at spring training, by physicians of both private and institutional based sports medicine practices. For the entire group, significant differences were exhibited for HR, external rotation at 90° and internal rotation at 90°, for dominant vs. non-dominant arms. GIRD of greater than 25° was noted in 10/23 of pitchers. In this group, HR was significantly increased and correlated to GIRD. No such increase or correlation was noted for the non-GIRD group. GIRD is a common finding in asymptomatic professional pitchers, and is related to humeral retroversion. Thus internal rotation deficits should not be used as the sole screening tool to diagnose the disabled throwing shoulder. Key pointsGIRD is relatively common in asymptomatic baseball pitchers (35-43%).Large ranges (-45 to 5°) and a large standard deviation (±16°) were noted suggesting that GIRD is quite variable in this population.GIRD is a variable

  19. Fractures of the occipital condyle clinical spectrum and course in eight patients

    PubMed Central

    Krüger, Antonio; Oberkircher, Ludwig; Frangen, Thomas; Ruchholtz, Steffen; Kühne, Christian; Junge, Andreas

    2013-01-01

    Introduction: Occipital condyle fractures (OCFs) are considered to be rare injuries. OCFs are now diagnosed more often because of the widespread use of computed tomography. Our aim is to report the incidence, treatment and long term outcome of 8 patients with OCFs. Materials and Methods: All patients presenting with multiple trauma from 1993 to 2006 were analyzed retrospectively. Characteristics and course of the treatment were evaluated. Follow-up was performed after 11,7 years (range 5,9 to 19,3 years). Results: Nine cases of OCF in 8 patients were identified. All injuries resulted from high velocity trauma. The average scores on the ISS Scale were 39,6 (24-75) and 7,3 (3-15) on the GCS. According to Anderson's classification, 5 cases of Type III and 4 cases of Type I fractures were identified. According to Tuli's classification, 5 cases of Type IIA and 4 cases of Type I were found. Indications for immobilization with the halo-vest were type III injuries according to Anderson's classification or Tuli's type IIA injuries, respectively. Patients with Tuli's type I injuries were treated with a Philadelphia collar for 6 weeks. In one patient with initial complete tetraplegia and one with incomplete neurological deficits the final follow-up neurologic examination showed no neurological impairment at all (Frankel-grade A to E, respectively B to E). At follow-up, 3 patients were asymptomatic. Four patients suffered from mild pain when turning their head, pain medication was necessary in one case only. Discussion: OCF's are virtually undetectable using conventional radiography. In cases of high velocity, cranio-cervical trauma or impaired consciousness, high resolution CT-scans of the craniocervical junction must be performed. We suggest immobilization using a halo device for type III injuries according to Anderson's classification or Tuli's type IIa injuries, respectively. Patients with Tuli's type I injuries should be treated with a Philadelphia collar. PMID:24744561

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

    PubMed Central

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

    2014-01-01

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

  1. Reconstruction of ramus-condyle unit with transport distraction osteogenesis: Report of eight cases and review of literature

    PubMed Central

    Mehrotra, Divya; Chellappa, Arul A.L.; Gupta, Chandan; Passi, Deepak; Kumar, Sumit

    2012-01-01

    Background/Aims This report and review of literature aimed to assess the feasibility of condylar distraction in humans and its esthetic and functional outcome. Methods We present a case series of eight TMJ ankylosis patients, where after a gap arthroplasty, ramus condyle unit was reconstructed using transport distraction to analyze its feasibility, esthetic and functional outcome and success. Results All patients had satisfactory mouth opening, and minimal pain in their follow-up period. Conclusion Condylar transport distraction osteogenesis holds promise for successful TMJ reconstruction and should be the method of choice as it does not involve secondary surgery or need for an alloplast. PMID:25737856

  2. Intraosseous ganglion cyst of the humeral head in a competitive flat water paddler: case report

    PubMed Central

    Muir, Brad; Kissel, Jaclyn A.; Yedon, Dominique Forand

    2011-01-01

    Objective To present the diagnostic and clinical features of an intraosseous ganglion cyst of the humeral head of a female flat water canoe athlete. Clinical Features An 18-year old female flat water canoeist complaining of right shoulder pain following a strenuous paddling training camp. Intervention and outcome A trial of passive care was conducted, including soft tissue therapy, spinal manipulative therapy, acupuncture, and rehabilitation. The patient seemed to be responding with treatment, but pain would always resume with paddling. A diagnostic ultrasound displayed mild thickening and effusion in the subacromial/subdeltoid bursae. Continued passive care was not able to resolve the symptoms and she underwent an MRI which revealed an intraosseus ganglion cyst subjacent to the lesser tuberosity and floor of the intertubercular groove. A subsequent MRA was ordered to assess the labrum, which was intact, but the cyst had progressed in size. She was referred to an orthopedic surgeon who performed surgery. Conclusion An IOG cyst within the humeral head is a rare, potentially painful condition that can mimic other pathologies including impingement and labral tear. It is important to be aware of the clinical features to obtain a prompt diagnosis and appropriate treatment of this condition. PMID:22131566

  3. Is MIPO in humeral shaft fractures really safe? Postoperative ultrasonographic evaluation

    PubMed Central

    Belangero, William; Andrade, Kleber; Zuiani, Guilherme; Pratali, Raphael

    2008-01-01

    In the last few years there has been great interest in minimally invasive plate osteosynthesis (MIPO) in the treatment of humeral shaft fractures. None of these studies showed the anatomical relationship between the radial nerve and the material of the implant in vivo. We performed postoperative ultrasonographic measurement of the distance between the radial nerve and the material implanted using the MIPO technique. Nineteen patients underwent postoperative ultrasound examinations. Group A comprised midshaft fractures and group B distal third fractures. The point of greatest proximity between the radial nerve and the implant was measured. In group A the distance was between 1.6 and 19.6 mm (mean: 9.3 mm) and in group B between 1.0 and 8.1 mm (mean: 4.0 mm). The ultrasound findings reveal that the radial nerve is quite close to the implant material, especially in the transition between the third and fourth quarters of the humeral shaft. PMID:18704415

  4. Minimally invasive plate osteosynthesis in the treatment of proximal humeral fracture

    PubMed Central

    Leung, F.; Chan, C. F.; Chow, S. P.

    2006-01-01

    The management of fractures of the proximal shaft of the humerus has been evolving since the development of new techniques and new implants in recent years. It seems that this kind of fracture has an increasing incidence in the older, osteoporotic population. In the last 2 years, we have operated on 17 patients, with an average age of 65, who had proximal humeral shaft fractures treated by minimally invasive percutaneous osteosynthesis (MIPO) technique using the metaphyseal locking compression plate. Our study evaluated the surgical technique used and the outcome for these patients with regards to their range of movement and shoulder function. Our results showed that all the patients could achieve at least 140º of shoulder abduction in the first 6 months after the operation, except for three patients who had shoulder impingement. These patients had an average Constant score of 76.8. All fractures had bony union at 6 months, except one, which was probably due to poor reduction in the initial operation. Another complication that we encountered was radial nerve neuropraxia. The ways to prevent these complications are discussed. In conclusion, MIPO fixation using the metaphyseal locking compression plate is a good option for the management of proximal humeral shaft fractures. It provides early functional recovery, but we had to pay special attention to some of the surgical details in order to minimise complications. PMID:17033765

  5. Effect of rotator cuff exercise on humeral rotation torque in healthy individuals.

    PubMed

    Moncrief, Scott A; Lau, Jeffery D; Gale, Judith R; Scott, Samuel A

    2002-05-01

    Conservative management of rotator cuff pathology often involves certain therapeutic exercises. Although a major goal of these exercises is to increase strength of the rotator cuff, little empirical evidence supports this assertion. In this study, 34 nonpathologic young adults were pretested using a LIDO Multijoint II isokinetic device for average and peak torque generated during internal and external rotation. Subjects were arbitrarily assigned to a right-arm- or left-arm-trained group, exercised for 4 weeks, and then posttested for changes in humeral rotation torque. Moderate but significant increases in torque (8-10%) as well as in total work done were observed in both groups, only in the trained arm. Subjects who trained the nondominant (left) arm experienced gains similar to those who trained the right arm. Gains were significant in the case of both internal and external rotation (also average as well as peak torque), with men and women experiencing the same relative increases. These data, in addition to supporting the use of selected exercises to increase humeral rotation torque in a healthy population, offer a potential model for the rehabilitation of patients with rotator cuff injury. PMID:11991780

  6. A Case of Bilateral Anterior Gleno-Humeral Dislocation following First Time Seizure

    PubMed Central

    Wheelton, Andrew; Dowen, Daniel

    2015-01-01

    Introduction: Bilateral anterior shoulder dislocation following a seizure has recently been demonstrated as being more common than previously believed with 44 cases in the literature. This case is unique as it was caused by a first time seizure and there was no associated fracture of the humerus. Case Report: A previously fit and well 32 year old man presented to the Emergency Department following a convulsive episode. On initial assessment he was drowsy and the focus of investigation was the cause of the seizure, he was prepared for transfer to the medical ward. As he became more alert he complained of bilateral shoulder pain. Further clinical exam highlighted he had reduced range of movement in the shoulder joint bilaterally with a symmetrical clinical appearance of gleno-humeral dislocation. Radiographs confirmed bilateral anterior gleno-humeral dislocations which were reduced under sedation uneventfully. Conclusion: Post ictal patients can be difficult to assess when drowsy. Although not all seizures require musculoskeletal examination attending medical staff should remain vigilant to the possibility of injury following seizure to afford prompt diagnosis and treatment. PMID:27299040

  7. Primum non nocere: a case of a humeral fracture in a patient with fibrodysplasia progressiva ossificans.

    PubMed

    Yewlett, Alun; Kitson, Jeff; Redfern, Andrew; Smith, Chris

    2016-01-01

    Fibrodysplasia progressiva ossificans (FPO) is an extremely rare condition characterized by abnormal heterotopic bone formation. The condition is eponymously known as 'stoneman' disease because patients can become effectively entombed within abnormal heterotopic bone. We present the first known case of a diaphyseal humeral fracture managed conservatively in an adult patient with this condition. This patient already had a pre-existing bony bar from a fusion mass involving the thoracic spine, scapula and ribs to her proximal humerus splinting the arm in a position of adduction with the palm of her hand facing towards her groin. This patient also suffered a concomitant unstable cervical spinal fracture for which full spinal precautions were needed. As a result of the rapid bone forming nature of her condition, the humeral fracture was placed in a position where the hand would face outwards to make perineal care and personal hygiene easier in that the fracture was expected to unite in this new position as a result of her FPO. PMID:27582999

  8. Humeral development from neonatal period to skeletal maturity--application in age and sex assessment.

    PubMed

    Rissech, Carme; López-Costas, Olalla; Turbón, Daniel

    2013-01-01

    The goal of the present study is to examine cross-sectional information on the growth of the humerus based on the analysis of four measurements, namely, diaphyseal length, transversal diameter of the proximal (metaphyseal) end of the shaft, epicondylar breadth and vertical diameter of the head. This analysis was performed in 181 individuals (90 ♂ and 91 ♀) ranging from birth to 25 years of age and belonging to three documented Western European skeletal collections (Coimbra, Lisbon and St. Bride). After testing the homogeneity of the sample, the existence of sexual differences (Student's t- and Mann-Whitney U-test) and the growth of the variables (polynomial regression) were evaluated. The results showed the presence of sexual differences in epicondylar breadth above 20 years of age and vertical diameter of the head from 15 years of age, thus indicating that these two variables may be of use in determining sex from that age onward. The growth pattern of the variables showed a continuous increase and followed first- and second-degree polynomials. However, growth of the transversal diameter of the proximal end of the shaft followed a fourth-degree polynomial. Strong correlation coefficients were identified between humeral size and age for each of the four metric variables. These results indicate that any of the humeral measurements studied herein is likely to serve as a useful means of estimating sub-adult age in forensic samples.

  9. Primum non nocere: a case of a humeral fracture in a patient with fibrodysplasia progressiva ossificans

    PubMed Central

    Kitson, Jeff; Redfern, Andrew; Smith, Chris

    2015-01-01

    Fibrodysplasia progressiva ossificans (FPO) is an extremely rare condition characterized by abnormal heterotopic bone formation. The condition is eponymously known as ‘stoneman’ disease because patients can become effectively entombed within abnormal heterotopic bone. We present the first known case of a diaphyseal humeral fracture managed conservatively in an adult patient with this condition. This patient already had a pre-existing bony bar from a fusion mass involving the thoracic spine, scapula and ribs to her proximal humerus splinting the arm in a position of adduction with the palm of her hand facing towards her groin. This patient also suffered a concomitant unstable cervical spinal fracture for which full spinal precautions were needed. As a result of the rapid bone forming nature of her condition, the humeral fracture was placed in a position where the hand would face outwards to make perineal care and personal hygiene easier in that the fracture was expected to unite in this new position as a result of her FPO. PMID:27582999

  10. Primum non nocere: a case of a humeral fracture in a patient with fibrodysplasia progressiva ossificans.

    PubMed

    Yewlett, Alun; Kitson, Jeff; Redfern, Andrew; Smith, Chris

    2016-01-01

    Fibrodysplasia progressiva ossificans (FPO) is an extremely rare condition characterized by abnormal heterotopic bone formation. The condition is eponymously known as 'stoneman' disease because patients can become effectively entombed within abnormal heterotopic bone. We present the first known case of a diaphyseal humeral fracture managed conservatively in an adult patient with this condition. This patient already had a pre-existing bony bar from a fusion mass involving the thoracic spine, scapula and ribs to her proximal humerus splinting the arm in a position of adduction with the palm of her hand facing towards her groin. This patient also suffered a concomitant unstable cervical spinal fracture for which full spinal precautions were needed. As a result of the rapid bone forming nature of her condition, the humeral fracture was placed in a position where the hand would face outwards to make perineal care and personal hygiene easier in that the fracture was expected to unite in this new position as a result of her FPO.

  11. Reverse shoulder arthroplasty for proximal humeral fractures: update on indications, technique, and results.

    PubMed

    Acevedo, Daniel C; Vanbeek, Corinne; Lazarus, Mark D; Williams, Gerald R; Abboud, Joseph A

    2014-02-01

    The introduction of the reverse shoulder arthroplasty has provided shoulder surgeons with more options for the treatment of complex proximal humeral fractures in the elderly. Early reported results suggest that the average functional outcome may be better than hemiarthroplasty in certain patients and specific clinical scenarios. In addition, these results seem to be reached more quickly with less dependence on rehabilitation. The reverse prosthesis may be particularly useful in patients aged older than 70 years, especially those with severely comminuted fractures in osteopenic bone. These factors likely have a negative impact on the results of hemiarthroplasty and internal fixation. Despite the potential benefits of reverse arthroplasty for fracture, there is a significant learning curve with the use of this prosthesis, and it has its own set of complications. The surgeon must show appropriate judgment when selecting a reverse arthroplasty in the setting of a proximal humeral fracture and, furthermore, be well acquainted with the surgical technique and prosthetic options at the time of surgery. Although the longevity of this prosthesis remains unknown, midterm outcomes are promising. PMID:24418780

  12. Medial Calcar Support and Radiographic Outcomes of Plate Fixation for Proximal Humeral Fractures

    PubMed Central

    Lin, Shih-Jie; Tsai, Yao-Hung; Yang, Tien-Yu; Shen, Shih-Hsun; Huang, Kuo-Chin; Lee, Mel S.

    2015-01-01

    Plate fixation remains one of the most popular surgical procedures for treating proximal humeral fractures (PHFx); however, substantial rates of complications have been reported in the literature. The objectives of the study were to examine how medial calcar support (MCS) affects the radiographic outcomes and to determine the prognostic factors predicting treatment failure. We performed a retrospective cohort study of 89 adult patients who had PHFx and were treated with plate fixation at our institution in 2007–2011. The enrolled patients were separated into two groups according to disruption of medial calcar. Our results revealed an increased rate of poor radiographic outcomes in patients with disrupted medial calcar. Osteonecrosis of the humeral head and redisplacement were the two radiographic outcomes which had a positive causality with disruption of medial calcar (P = 0.008 and 0.050, resp.). Deficient medial calcar, inadequate reduction, diabetes mellitus, chronic kidney disease, and chronic liver disease were all significant predictors for the development of osteonecrosis in patients after PHFx surgery. Inadequate reduction was also a predictor for redisplacement. We confirmed that the restoration of medial calcar as well as comorbid conditions plays key roles in treatment of patients having PHFx with disrupted medial calcar. PMID:25692132

  13. Signs and symptoms of temporomandibular disorders and radiologically observed abnormalities in the condyles of the temporomandibular joints of professional violin and viola players.

    PubMed

    Kovero, O; Könönen, M

    1995-04-01

    The frequency of temporomandibular disorders (TMDs) and radiologically observed abnormalities in the condyles of the temporomandibular joints (TMJs) of professional violin and viola players was investigated in 26 orchestra violinists/violists (VP group) and in their sex-, age-, and dentition-matched controls (C group). A routine clinical stomatognathic examination, a standardized interview, and radiography of the condyles were carried out for all subjects. The VP group showed a higher frequency of subjective symptoms and clinical signs of TMD, such as palpatory tenderness of masticatory muscles, TMJ clicking, painful mandibular movements, and deviation on opening or closing. There was no difference between the groups in terms of radiologic findings in the condyles. Weekly playing hours correlated positively with some signs of TMD. It is concluded that professional violin or viola playing might be a predisposing factor for TMD. PMID:7610780

  14. Conservative condylectomy alone for the correction of mandibular asymmetry caused by osteochondroma of the mandibular condyle: a report of five cases.

    PubMed

    Kim, Dong Sung; Kim, Jae-Young; Jeong, Chan-Woo; Park, Kwang-Ho; Huh, Jong-Ki

    2015-10-01

    We describe our experience with conservative condylectomy for the correction of facial asymmetry in five patients with osteochondroma of the mandibular condyle. All five patients presented with malocclusion and facial asymmetry, which are common clinical findings of osteochondroma involving the mandibular condyle. We performed conservative condylectomy without additional orthognathic surgery for all five patients, preserving the vertical height of the condylar process as much as possible. Following surgery, intermaxillary traction using a skeletal anchorage system with rubber elastics was performed on all patients to improve occlusion, and, when necessary, additional minimal orthodontic treatment was performed. The mean follow-up period was 42 months. At the last follow-up visit, all patients exhibited satisfactory facial symmetry and remodeling of the remaining condyle, with stable health and no signs of recurrence. In conclusion, conservative condylectomy alone, without subsequent orthognathic surgery, is adequate for the restoration of facial symmetry and the preservation of vertical condylar height in select patients with condylar osteochondroma. PMID:26568928

  15. Conservative condylectomy alone for the correction of mandibular asymmetry caused by osteochondroma of the mandibular condyle: a report of five cases

    PubMed Central

    Kim, Dong Sung; Kim, Jae-Young; Jeong, Chan-Woo; Park, Kwang-Ho

    2015-01-01

    We describe our experience with conservative condylectomy for the correction of facial asymmetry in five patients with osteochondroma of the mandibular condyle. All five patients presented with malocclusion and facial asymmetry, which are common clinical findings of osteochondroma involving the mandibular condyle. We performed conservative condylectomy without additional orthognathic surgery for all five patients, preserving the vertical height of the condylar process as much as possible. Following surgery, intermaxillary traction using a skeletal anchorage system with rubber elastics was performed on all patients to improve occlusion, and, when necessary, additional minimal orthodontic treatment was performed. The mean follow-up period was 42 months. At the last follow-up visit, all patients exhibited satisfactory facial symmetry and remodeling of the remaining condyle, with stable health and no signs of recurrence. In conclusion, conservative condylectomy alone, without subsequent orthognathic surgery, is adequate for the restoration of facial symmetry and the preservation of vertical condylar height in select patients with condylar osteochondroma. PMID:26568928

  16. Signs and symptoms of temporomandibular disorders and radiologically observed abnormalities in the condyles of the temporomandibular joints of professional violin and viola players.

    PubMed

    Kovero, O; Könönen, M

    1995-04-01

    The frequency of temporomandibular disorders (TMDs) and radiologically observed abnormalities in the condyles of the temporomandibular joints (TMJs) of professional violin and viola players was investigated in 26 orchestra violinists/violists (VP group) and in their sex-, age-, and dentition-matched controls (C group). A routine clinical stomatognathic examination, a standardized interview, and radiography of the condyles were carried out for all subjects. The VP group showed a higher frequency of subjective symptoms and clinical signs of TMD, such as palpatory tenderness of masticatory muscles, TMJ clicking, painful mandibular movements, and deviation on opening or closing. There was no difference between the groups in terms of radiologic findings in the condyles. Weekly playing hours correlated positively with some signs of TMD. It is concluded that professional violin or viola playing might be a predisposing factor for TMD.

  17. Tibial lengthening over humeral and tibial intramedullary nails in patients with sequelae of poliomyelitis: a comparative study.

    PubMed

    Chen, Daoyun; Chen, Jianmin; Jiang, Yao; Liu, Fanggang

    2011-06-01

    Leg discrepancy is common after poliomyelitis. Tibial lengthening is an effective way to solve this problem. It is believed lengthening over a tibial intramedullary nail can provide a more comfortable lengthening process than by the conventional technique. However, patients with sequelae of poliomyelitis typically have narrow intramedullary canals allowing limited space for inserting a tibial intramedullary nail and Kirschner wires. To overcome this problem, we tried using humeral nails instead of tibial nails in the lengthening procedure. In this study, we used humeral nails in 20 tibial lengthening procedures and compared the results with another group of patients who were treated with tibial lengthening over tibial intramedullary nails. The mean consolidation index, percentage of increase and external fixation index did not show significant differences between the two groups. However, less blood loss and shorter operating time were noted in the humeral nail group. More patients encountered difficulty with the inserted intramedullary nail in the tibial nail group procedure. The complications did not show a statistically significant difference between the two techniques on follow-up. In conclusion, we found the humeral nail lengthening technique was more suitable in leg discrepancy patients with sequelae of poliomyelitis.

  18. The Relationship Between Humeral Retrotorsion and Shoulder Range of Motion in Baseball Players With an Ulnar Collateral Ligament Tear

    PubMed Central

    Lee, Bobby Jean S.; Garrison, J. Craig; Conway, John E.; Pollard, Kalyssa; Aryal, Subhash

    2016-01-01

    Background: Humeral retrotorsion has been investigated in relation to shoulder range of motion (ROM) in healthy baseball players. Currently, there is limited information on the osseous anatomy and development of ulnar collateral ligament (UCL) tears. Purpose: To determine the relationship between humeral retrotorsion and shoulder ROM in baseball players with a UCL tear. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Fifty-four baseball players (mean age, 18.5 ± 2.0 years) with a UCL tear volunteered for this study. Participants were measured bilaterally for shoulder internal (IR) and external rotation (ER) ROM and humeral retrotorsion. Differences between sides (involved to uninvolved) were used to calculate the glenohumeral internal rotation deficit (GIRD), external rotation ROM difference (ERDiff), total rotational motion difference (TRM), and humeral retrotorsion difference (HTDiff). A multivariate regression analysis was performed with GIRD, ERDiff, and TRM regressing on HTDiff. Univariate analysis was performed to further evaluate the effect of the predictors on each outcome separately. To control for the effect of age, weight, duration of symptoms, and years of experience, the variables were included as covariates. An a priori level was set at P < .05. Results: There was a statistically significant relationship between the GIRD, ERDiff, and TRM results compared with HTDiff (P = .003). Independent analysis revealed a statistically significant relationship between GIRD and HTDiff (P = .004) and between ERDiff and HTDiff (P = .003) but no significant relationship between TRM and HTDiff (P = .999). After adjusting for age, weight, duration of symptoms, years of experience, dominant arm, and position, a significant relationship was found between GIRD and HTDiff (P = .05) and between ERDiff and HTDiff (P = .01). No significant relationship was found between TRM and HTDiff (P = .54). Adjusted univariate regression analysis determined that

  19. Treatment of humeral shaft aseptic nonunions in elderly patients with opposite structural allograft, BMP-7, and mesenchymal stem cells.

    PubMed

    Murena, Luigi; Canton, Gianluca; Vulcano, Ettore; Surace, Michele Francesco; Cherubino, Paolo

    2014-02-01

    Humeral shaft aseptic nonunions occur in 2% to 10% of patients managed conservatively and 10% to 15% of patients treated surgically. The complex muscular and neurovascular anatomy of the upper limb makes the surgical approach to the fracture site demanding and risky, especially when previous surgeries have been attempted. The clinical consequence of atrophic humeral shaft nonunions is a severe functional limitation that may significantly affect activities of daily living, especially in the elderly. The surgical treatment of humeral shaft nonunions is challenging for orthopedic surgeons. Patients with atrophic nonunions require both a stable fixation and enhancement of the biologic response because of the weak biologic reaction observed at the fracture site. The gold standard of treatment in elderly patients has not been described. Nonetheless, older age and comorbidities are associated with potentially malignant nonunions. This study reports the authors' experience using opposite cortical allograft combined with bone morphogenetic protein 7 and mesenchymal stem cells to treat humeral shaft atrophic nonunions in 2 elderly patients. The nonunion site healed at 4 months (patient 1) and 8 months (patient 2) postoperatively, with full return to activities of daily living and no pain. Neither patient reported complications of the radial nerve, which is at high risk of injury during this type of surgery. The only reported complication (patient 2) was an intraoperative longitudinal partial distal humeral fracture, probably caused by compression screw overtightening. The use of a locking plate and opposite cortical allograft, combined with BMP-7 and mesenchymal stem cells, represents a safe and effective treatment for malignant nonunions in older patients. PMID:24679209

  20. GS/DBM/PLA porous composite biomaterial for the treatment of infective femoral condyle defect in rats

    PubMed Central

    LIU, XIAOMING; YANG, LIN; LI, JING; ZHANG, YUMING; XU, WEIJUN; REN, YAN; LIU, BIWANG; YANG, BIAO; LI, BAOXING

    2016-01-01

    A bone defect resulting from open bone trauma may easily become infected; however, the administration of efficacious systemic antibiotics cannot be performed at safe levels. Previous studies have investigated anti-infective biomaterials that incorporate into bone and facilitate the direct application of high-concentration local antibiotics. In the present study, the effect of a novel porous composite with gentamicin sulfate (GS) in treating infected femoral condyle defects was investigated using a rat model. A novel porous composite biomaterial was prepared based on a supercritical carbon dioxide fluid technique that combined GS, demineralized bone matrix (DBM) and polylactic acid (PLA). A rat femoral condyle fracture model of infection was established. The GS/DBM/PLA composite biomaterial was implanted and its physicochemical characteristics, biocompatibility and ability to facilitate repair of infected bone defect were assessed. The GS/DBM/PLA composite biomaterial maintained the antibiotic activity of GS, with good anti-compression strength, porosity and biocompatibility. The results of the animal experiments indicated that the GS/DBM/PLA composite biomaterial exerted marked anti-infective effects and facilitated bone defect repair, while simultaneously controlling infection. Porous GS/DBM/PLA is therefore a promising composite biomaterial for use in bone tissue engineering. PMID:27284292

  1. Closed reduction of displaced or dislocated mandibular condyle fractures in children using threaded Kirschner wire and external rubber traction.

    PubMed

    Kim, J H; Nam, D H

    2015-10-01

    Most surgeons agree that closed treatment provides the best results for condylar fractures in children. Nevertheless, treatment of the paediatric mandibular condyle fracture that is severely displaced or dislocated is controversial. The purpose of this study was to investigate the long-term clinical and radiological outcomes following the treatment of displaced or dislocated condylar fractures in children using threaded Kirschner wire and external rubber traction. This procedure can strengthen the advantage of closed reduction and make up for the shortcomings of open reduction. From March 1, 2005 to December 25, 2011, 11 children aged between 4 and 12 years with displaced or dislocated mandibular condyle fractures were treated using threaded Kirschner wire and external rubber traction under portable C-arm fluoroscopy. All patients had unilateral displaced or dislocated condylar fractures. The follow-up period ranged from 24 to 42 months (mean 29.3 months). Normal occlusion and pain-free function of the temporomandibular joint, without deviation or limitation of jaw opening, was achieved in all patients. This closed reduction technique in displaced or dislocated condylar fractures in children offers a reliable solution in preventing the unfavourable sequelae of closed treatment and the open technique, such as altered morphology, functional disturbances, and facial nerve damage.

  2. Effect of low-intensity pulsed ultrasound (LIPUS) on mandibular condyle growth in rats analyzed with micro-CT.

    PubMed

    Sasaki, Kyozo; Motoyoshi, Mitsuru; Horinuki, Eri; Arai, Yoshinori; Shimizu, Noriyoshi

    2016-01-01

    This study examined the effects of a bite-jumping appliance combined with low-intensity pulsed ultrasound (LIPUS) stimulation on the mandibular condyle of growing rats using micro CT (mCT) and histological examinations. Twelve Wistar rats were divided into three groups of four individuals each: Group 1 was an untreated control group, Group 2 received bite-jumping appliances, and Group 3 received bite-jumping appliances and LIPUS stimulation (15 min/day, 2 weeks) to the temporomandibular region. We measured the length and three-dimensional bone volume of each rat's mandibular condyle using mCT. The condylar cartilage was observed after the rats had been sacrificed. There was no significant difference in condylar sagittal width among the groups. The bite-jumping appliance combined with LIPUS stimulation increased the condylar major axis, mandibular sagittal length and condylar bone volume to a greater degree than use of the bite-jumping appliance alone. Histological examination demonstrated hypertrophy of the condylar cartilage layers, the fibrous layer and hypertrophic cell layer of the rats treated with bite-jumping appliances combined with LIPUS stimulation in comparison to rats treated with bite-jumping appliances alone. (J Oral Sci 58, 415-422, 2016). PMID:27665982

  3. Humeral Head Arthroplasty and Meniscal Allograft Resurfacing of the Glenoid: A Concise Follow-up of a Previous Report and Survivorship Analysis.

    PubMed

    Bois, Aaron J; Whitney, Ian J; Somerson, Jeremy S; Wirth, Michael A

    2015-10-01

    The two to five-year results of humeral head arthroplasty and lateral meniscal allograft resurfacing of the glenoid in patients fifty-five years of age or younger were previously reported by the senior author (M.A.W.). The purpose of the present study was to report the survival rate, clinical findings, and radiographic results of the original thirty shoulders (thirty patients) followed for a mean duration of 8.3 years (range, five to twelve years). The scores on the visual analog scale for pain, American Shoulder and Elbow Surgeons scoring system, and Simple Shoulder Test were significantly improved at the latest follow-up evaluation compared with the preoperative findings (p < 0.001). Radiographic indices of posterior subluxation did not significantly increase from the immediate postoperative imaging to the latest radiographs, while the glenohumeral joint space demonstrated a gradual decrease. Nine (30%) of thirty shoulders were known to have undergone a reoperation. The present study demonstrated that biological glenoid resurfacing combined with hemiarthroplasty can provide significant improvement in shoulder function and pain relief in young patients with glenohumeral arthritis; however, mid-term follow-up at a mean of over eight years demonstrated a high reoperation rate. PMID:26446964

  4. Open reduction and fixation of proximal humeral fractures and fracture-dislocations.

    PubMed

    Moda, S K; Chadha, N S; Sangwan, S S; Khurana, D K; Dahiya, A S; Siwach, R C

    1990-11-01

    Open reduction and internal fixation was employed in the treatment of 25 severely displaced fractures and fracture-dislocations of the proximal humerus. Our aims were accurate reduction and stable fixation to allow early mobilisation and to achieve full functional recovery. In 15 fractures an AO T-plate was used and in 10 a bent semitubular plate was employed as a blade plate. Excellent or satisfactory results were obtained in all six patients with two-part fractures involving the surgical neck; in four of the five patients with three-part fractures involving the surgical neck and tuberosities; in nine of the 11 patients with fracture-dislocation; and in two of the three patients with split fractures of the humeral head. Overall results were good or satisfactory in 21 of the 25 cases. Unsatisfactory results were associated with rotator cuff damage.

  5. Humeral cortical thickness in female Bantu - its relationship to the incidence of femoral neck fracture

    SciTech Connect

    Bloom, R.A.; Pogrund, H.

    1982-03-01

    Measurements of the humeral cortical thickness demonstrate that generalised osteoporosis in female Bantu commences in the fifth decade and gradually increases until, in the ninth decade, all subjects are osteoporotic. The combined cortical thickness (CCT) of the humerus in young adults is very similar to that found previously in a white London population and the loss of cortex with age is very similar. It is concluded that the known low incidence of femoral neck fracture in Bantu is not due to a lower incidence of generalised osteoporosis but to environmental factors. The chief environmental factor postulated is the greater amount of physical work performed by the Bantu. A more careful mode of walking is suggested as a subsidiary cause.

  6. Little league shoulder: osteochondrosis of the proximal humeral epiphysis in boy baseball pitchers.

    PubMed

    Adams, J E

    1966-07-01

    Roentgenographic changes consistent with osteochondrosis of the proximal humeral epiphysis were observed in five young baseball pitchers complaining of shoulder pain in the throwing arm. The symptoms and findings were quite similar to the previously reported involvement of the medial epicondylar epiphysis or "Little Leaguer's elbow."The act of throwing a baseball hard is an abnormal whip-like action which places a forceful repetitious traction strain on the shoulder joint. Shoulder pain in youngsters engaged in organized competitive swimming programs can also be explained in this way. Since these entities became evident with the establishment of organized baseball programs for boys in this age group, better medical supervision and rule changes to limit the amount of pitching until the epiphyses close, are urgently needed.

  7. Ewing's sarcoma/primitive neuroectodermal tumor of the proximal humeral epiphysis.

    PubMed

    Morris, Parisa; Dickman, Paul S; Seidel, Matthew J

    2013-01-01

    Ewing's sarcoma/primitive neuroectodermal tumor (ES/PNET) of bone is a rare childhood tumor most commonly located in the metadiaphysis. In skeletally immature patients, lesions of the epiphysis are rarely malignant, with the most common diagnosis being chondroblastoma. This article presents a case of ES/PNET of the proximal humeral epiphysis in a 12-year-old boy. To the authors' knowledge, this is the first reported case of epiphyseal ES/PNET confirmed with molecular testing. Radiographs of the patient's painful shoulder showed a well-defined lytic lesion within the humeral epiphysis. Magnetic resonance imaging suggested a chondroid tumor with surrounding edema. Based on the imaging characteristics, the patient's age, and the lesion's location, a preliminary diagnosis of chondroblastoma was made. A trochar biopsy of the lesion demonstrated a small, round, blue cell tumor on frozen section. Subsequently, immunohistochemical staining was uniformly positive in a membrane pattern for CD99, and molecular diagnostic testing demonstrated a EWSR1/FLI1 fusion transcript, confirming the pathologic diagnosis of ES/PNET. Although metadiaphyseal locations for ES/PNET are most common, this case adds to previously reported cases of epiphyseal ES/PNET, suggesting that the diagnosis be considered for pediatric epiphyseal tumors. This case also demonstrates why following rigorous oncologic treatment algorithms by obtaining a limited trochar biopsy, even in the case of a confident radiographic diagnosis, is critically important; the biopsy results can lead to a major change in treatment and avoid contamination of a larger area of soft tissue and bone. PMID:23276342

  8. Use of a Proximal Humeral Locking Plate for Complex Ankle and Hindfoot Fusion.

    PubMed

    Shearman, Alexander D; Eleftheriou, Kyriacos Iordanis; Patel, Akash; Pradhan, Rajib; Rosenfeld, Peter Francis

    2016-01-01

    Arthrodesis of the ankle and hindfoot in the setting of major deformity is challenging and associated with substantial risks. Patients often have significant comorbidities that lead to unforgiving soft tissues, poor vascularity, and poor bone quality. This creates the high-risk scenario of poor wound healing and poor implant fixation. Complications can be devastating, leading to loss of the limb and sepsis. The use of locking plate technology might provide biomechanical and operative technique advantages in such patients. We retrospectively assessed the results of the modified use of the PHILOS(™) (Synthes(®), Zuchwil, Switzerland) proximal humeral locking plate in 21 patients (11 males, 10 females; mean age 56.1 years, range 25 to 74 years) who had undergone complex fusions, including tibiotalar (n = 4), tibiocalcaneal (n = 7), or tibiotalocalcaneal (n =10) fusions. The average follow-up period was 14.6 (median 10, range 6 to 49) months. Of the 21 fusions, 18 achieved union (85.7%) at an average period of 4.8 (median 4.3, range 3 to 12) months. The overall deep infection rate was 14.3%. Overall, 17 of the 21 patients (81%) were satisfied with the result (good to excellent), 1 reported the result was fair (4.8%), and 3 patients developed nonunion and were dissatisfied with the procedure (14.3%). The present study is the largest series to date of patients undergoing complex ankle and hindfoot arthrodesis with the use of a proximal humeral locking plate and confirms previous findings that the technique is reliable with union, satisfaction, and complication rates comparable to those of other techniques.

  9. Dynamic biomechanics of the human head in lateral impacts

    PubMed Central

    Zhang, Jiangyue; Yoganandan, Narayan; Pintar, Frank A.

    2009-01-01

    The biomechanical responses of human head (translational head CG accelerations, rotational head accelerations, and HIC) under lateral impact to the parietal-temporal region were investigated in the current study. Free drop tests were conducted at impact velocities ranging from 2.44 to 7.70 m/s with a 40 durometer, a 90 durometer flat padding, and a 90 durometer cylinder. Specimens were isolated from PMHS subjects at the level of occipital condyles, and the intracranial substance was replaced with brain simulant (Sylgard 527). Three tri-axial accelerometers were instrumented at the anterior, posterior, and vertex of the specimen, and a pyramid nine accelerometer package (pNAP) was used at the contra-lateral site. Biomechanical responses were computed by transforming accelerations measured at each location to the head CG. The results indicated significant “hoop effect” from skull deformation. Translational head CG accelerations were accurately measured by transforming the pNAP, the vertex accelerations, or the average of anterior/posterior acceleration to the CG. The material stiffness and structural rigidity of the padding changed the biomechanical responses of the head with stiffer padding resulting in higher head accelerations. At the skull fracture, HIC values were more than 2–3x higher than the frontal skull fracture threshold (HIC=1000), emphasizing the differences between frontal and lateral impact. Rotational head accelerations up to 42.1 krad/s2 were observed before skull fracture, indicating possible severe brain injury without skull fracture in lateral head impact. These data will help to establish injury criteria and threshold in lateral impacts for improved automotive protection and help clinicians understand the biomechanics of lateral head impact from improved diagnosis. PMID:20184848

  10. Dynamic biomechanics of the human head in lateral impacts.

    PubMed

    Zhang, Jiangyue; Yoganandan, Narayan; Pintar, Frank A

    2009-10-01

    The biomechanical responses of human head (translational head CG accelerations, rotational head accelerations, and HIC) under lateral impact to the parietal-temporal region were investigated in the current study. Free drop tests were conducted at impact velocities ranging from 2.44 to 7.70 m/s with a 40 durometer, a 90 durometer flat padding, and a 90 durometer cylinder. Specimens were isolated from PMHS subjects at the level of occipital condyles, and the intracranial substance was replaced with brain simulant (Sylgard 527). Three tri-axial accelerometers were instrumented at the anterior, posterior, and vertex of the specimen, and a pyramid nine accelerometer package (pNAP) was used at the contra-lateral site. Biomechanical responses were computed by transforming accelerations measured at each location to the head CG. The results indicated significant "hoop effect" from skull deformation. Translational head CG accelerations were accurately measured by transforming the pNAP, the vertex accelerations, or the average of anterior/posterior acceleration to the CG. The material stiffness and structural rigidity of the padding changed the biomechanical responses of the head with stiffer padding resulting in higher head accelerations. At the skull fracture, HIC values were more than 2-3x higher than the frontal skull fracture threshold (HIC=1000), emphasizing the differences between frontal and lateral impact. Rotational head accelerations up to 42.1 krad/s(2) were observed before skull fracture, indicating possible severe brain injury without skull fracture in lateral head impact. These data will help to establish injury criteria and threshold in lateral impacts for improved automotive protection and help clinicians understand the biomechanics of lateral head impact from improved diagnosis.

  11. Evaluation of three-dimensional position change of the condylar head after orthognathic surgery using computer-aided design/computer-aided manufacturing-made condyle positioning jig.

    PubMed

    Kim, Hyung-Mo; Baek, Seung-Hak; Kim, Tae-Yun; Choi, Jin-Young

    2014-11-01

    This study was performed to evaluate the efficacy of computer-aided design/computer-aided manufacturing (CAM/CAD)-made condyle positioning jig in orthognathic surgery. The sample consisted of 40 mandibular condyles of 20 patients with class III malocclusion who underwent bilateral sagittal split ramus osteotomy with semirigid fixation (6 men and 14 women; mean age, 25 y; mean amount of mandibular setback, 5.8 mm). Exclusion criteria were patients who needed surgical correction of the frontal ramal inclination and had signs and symptoms of the temporomandibular disorder before surgery. Three-dimensional computed tomograms were taken 1 month before the surgery (T1) and 1 day after the surgery (T2). The condylar position was evaluated at the T1 and T2 stages on the axial, frontal, and sagittal aspects in the three-dimensional coordinates. The linear change of the posterior border of the proximal segment of the ramus between T1 and T2 was also evaluated in 30 condyles (15 patients), with the exception of 10 condyles of 5 patients who received mandibular angle reduction surgery. There was no significant difference in the condylar position in the frontal and sagittal aspects (P > 0.05). Although there was a significant difference in the condylar position in the axial aspect (P < 0.01), the amount of difference was less than 1 mm and 1 degree; it can be considered clinically nonsignificant. In the linear change of the posterior border of the proximal segment of the ramus, the mean change was 1.4 mm and 60% of the samples showed a minimal change of less than 1 mm. The results of this study suggest that CAD/CAM-made condyle positioning jig is easy to install and reliable to use in orthognathic surgery.

  12. Using conservative condylectomy for management of a large osteochondroma of the mandibular condyle with 6-year follow-up.

    PubMed

    Santos, George Soares; Gomes, Julio Bisinotto; de Sousa Maia, Sergio; Bermejo, Patricia Rota; Shinohara, Elio Hitoshi; Sonoda, Celso Koogi; de Melo, Willian Morais

    2014-01-01

    Osteochondroma is a hamartomatous proliferation of cartilaginous tissue, which is the most common benign tumor of the long bones, but is relatively rare in the maxillofacial region. Most cases of mandibular condylar osteochondroma manifest with facial asymmetry or malocclusion with limited temporomandibular joint movements. Several approaches for management of this lesion have been proposed, as conservative condylectomy technique. This procedure has been suggested a valid approach to minimize facial asymmetry, contributing to the recovery of occlusion associated with no local tumor recurrence, and without condylar reconstruction procedure. Therefore, this article aims to describe a clinical report of a true osteochondroma of the mandibular condyle in a 35-year-old patient who was successfully treated using conservative condylectomy procedure. PMID:24469370

  13. Complete resection and immediate reconstruction with costochondral graft for recurrent aneurysmal bone cyst of the mandibular condyle.

    PubMed

    Ziang, Zhuo; Chi, Yang; Minjie, Chen; Yating, Qiu; Xieyi, Cai

    2013-11-01

    Aneurysmal bone cyst is a non-neoplastic expansile lesion characterized by replacement with fibro-osseous tissue and blood-filled cavernous spaces. Involvement of the condyle is rare, and only 11 cases have been reported in English-language literature to date. Its common treatment modalities are lesion excision or condylar resection, but recurrence is high in patients treated with the former. The authors reported a 19-year-old female patient with swelling of the right preauricular region, who had a surgical curettage history in another hospital. The lesion was completely resected and the jaw was immediately reconstructed with costochondral graft with the help of SurgiCase software. The patient has been symptom-free for 6 months postoperatively.

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

    PubMed Central

    Merh, Aditya; Shah, Malkesh; Golwala, Paresh

    2016-01-01

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

  15. 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

  16. Bilateral humeral lengthening in achondroplasia with unilateral external fixators: is it safe and does it improve daily life?

    PubMed

    Balci, H I; Kocaoglu, M; Sen, C; Eralp, L; Batibay, S G; Bilsel, K

    2015-11-01

    A retrospective study was performed in 18 patients with achondroplasia, who underwent bilateral humeral lengthening between 2001 and 2013, using monorail external fixators. The mean age was ten years (six to 15) and the mean follow-up was 40 months (12 to 104). The mean disabilities of the arm, shoulder and hand (DASH) score fell from 32.3 (20 to 40) pre-operatively to 9.4 (6 to 14) post-operatively (p = 0.037). A mean lengthening of 60% (40% to 95%) was required to reach the goal of independent perineal hygiene. One patient developed early consolidation, and fractures occurred in the regenerate bone of four humeri in three patients. There were three transient radial nerve palsies. Humeral lengthening increases the independence of people with achondroplasia and is not just a cosmetic procedure. PMID:26530664

  17. A Randomized Cadaver Study Comparing First-Attempt Success Between Tibial and Humeral Intraosseous Insertions Using NIO Device by Paramedics

    PubMed Central

    Szarpak, Lukasz; Truszewski, Zenon; Smereka, Jacek; Krajewski, Paweł; Fudalej, Marcin; Adamczyk, Piotr; Czyzewski, Lukasz

    2016-01-01

    Abstract Medical personnel may encounter difficulties in obtaining intravenous (IV) access during cardiac arrest. The 2015 American Heart Association guidelines and the 2015 European Resuscitation Council guidelines for cardiopulmonary resuscitation (CPR) suggest that rescuers establish intraosseous (IO) access if an IV line is not easily obtainable. The aim of the study was to compare the success rates of the IO proximal tibia and proximal humerus head access performed by paramedics using the New Intraosseous access device (NIO; Persys Medical, Houston, TX, USA) in an adult cadaver model during simulated CPR. In an interventional, randomized, crossover, single-center cadaver study, a semi-automatic spring-load driven NIO access device was investigated. In total, 84 paramedics with less than 5-year experience in Emergency Medical Service participated in the study. The trial was performed on 42 adult cadavers. In each cadaver, 2 IO accesses to the humerus head, and 2 IO accesses to the proximal tibia were obtained. The success rate of the first IO attempt was 89.3% (75/84) for tibial access, and 73.8% (62/84) for humeral access (P = 0.017). The procedure times were significantly faster for tibial access [16.8 (interquartile range, IQR, 15.1–19.9] s] than humeral access [26.7 (IQR, 22.1–30.9) s] (P < 0.001). Tibial IO access is easier and faster to put in place than humeral IO access. Humeral IO access can be an alternative method to tibial IO access. Trial Registration: clinicaltrials.gov Identifier: NCT02700867. PMID:27196493

  18. Preliminary results from osteosynthesis using Ender nails by means of a percutaneous technique, in humeral diaphysis fractures in adults☆

    PubMed Central

    Godinho, Glaydson Gomes; França, Flávio de Oliveira; Freitas, José Márcio Alves; Santos, Flávio Márcio Lago; Correa, Guilherme de Almeida Sellos; Maia, Lucas Russo

    2015-01-01

    Objective To demonstrate the clinical and functional results from treatment of humeral diaphysis fractures using Ender nails. Methods Eighteen patients who underwent osteosynthesis of humeral diaphysis fractures using Ender nails were evaluated. In addition to the clinical and radiographic evaluations, patients with a minimum of one year of follow-up were assessed by means of the Constant, American Shoulder and Elbow Surgeons (ASES), Mayo Clinic and Simple Shoulder Value (SSV) functional scores, and in relation to the degree of satisfaction with the final result. The fixation technique used was by means of an anterograde percutaneous route. Results All the patients achieved fracture consolidation, after a mean of 2.9 months (ranging from 2 to 4 months). The mean Constant score was 85.7 (ranging from 54 to 100) and the mean ASES score was 95.9 (ranging from 76 to 100). All the patients achieved the maximum score on the Mayo Clinic scale. Conclusion Fixation of humeral diaphysis fractures using Ender nails by means of a percutaneous technique was shown to be a method with promising preliminary results. PMID:26417566

  19. Robotic Assessment of Upper Limb Function after Proximal Humeral Fracture: Personal Experience as A Patient and Occupational Therapist.

    PubMed

    Nishimoto, Atsuko; Otaka, Yohei; Kasuga, Shoko; Otaka, Eri; Yamazaki, Kotaro; Ushiba, Junichi; Liu, Meigen

    2016-01-01

    Robotics is an emerging field in rehabilitation medicine. Robots have the potential to complement traditional clinical assessments because they can measure functions more precisely and quantitatively than current clinical assessments. We present a patient with a proximal humeral fracture whose recovery process was evaluated with an exoskeleton robotic device. The patient, a 34-year-old woman, suffered a left proximal humeral fracture while snowboarding. She is an occupational therapist and is the first author of this study. With conservative therapy, fracture union was seen on X-ray at 6 weeks post-injury. At that time, the patient was permitted to move her left upper limb actively within the tolerance of pain. We assessed the function of the injured upper limb at 6, 7, and 12 weeks post-injury with the KINARM exoskeleton robotic device and with conventional clinical measures. The active range of motion and the muscle strength of the left shoulder improved over time. Using robotic assessment, the precise movement profiles, position sense, and functional ability of both arms were quantified and also showed progressive improvement over time. Assessment with a robotic device of the recovery process after proximal humeral fracture allowed quantification of functional impairments that could not be felt subjectively nor identified with conventional clinical assessments. PMID:27665866

  20. [Muscle efficiency in total shoulder prosthesis implantation: dependence on position of the humeral head and rotator cuff function].

    PubMed

    Klages, A; Hurschler, C; Wülker, N; Windhagen, H

    2001-09-01

    Modern shoulder prostheses permit an anatomic reconstruction of the joint, although the biomechanical advantages are not proven. The goal of this study was to investigate the relationship between position of the humeral head and function of the shoulder prosthesis (muscle efficiency). Shoulder elevation-motion and rotator cuff defects were simulated in vitro in a robot-assisted shoulder simulator. The EPOCA Custom Offset shoulder prosthesis (Argomedical AG, Cham, CH) was implanted in seven normal shoulders (77 +/- 20 kg, 55 +/- 14 years). Active elevation was simulated by hydraulic cylinders, and scapulothoratic motion by a specially programmed industrial robot. Muscle efficiency (elevation-angle/muscle-force of the deltoid muscle) was measured in anatomic (ANA), medialised (MED) and lateralised (LAT) positions of the humeral head, with or without rotator cuff muscle deficiency. Medialisation increased efficiency by 0.03 +/- 0.04 deg/N (p = 0.022), lateralisation decreased it by 0.04 +/- 0.06 deg/N (p = 0.009). Supraspinatus muscle deficiency increased the deltoid force required to elevate the arm, and thus decreased efficiency (ANA p = 0.091, MED p = 0.018, LAT p = 0.028). The data confirm that the position of the humeral head affects the mechanics of total shoulder arthroplasty. Medialisation increases efficiency of the deltoid muscle and may prove useful in compensating isolated supraspinatus muscle deficiency. Lateralisation, in contrast, leads to an unfavorable situation.

  1. Mapping the Articular Contact Area of the Long Head of the Biceps Tendon on the Humeral Head

    PubMed Central

    Morris, Brent J.; Byram, Ian R.; Lathrop, Ray A.; Dunn, Warren R.; Kuhn, John E.

    2014-01-01

    The purpose of this investigation was to calculate the contact surface area of the long head of the biceps (LHB) in neutral position and abduction. We sought to determine whether the LHB articulates with the humeral head in a consistent pattern comparing articular contact area in neutral position and abduction. Eleven fresh frozen matched cadaveric shoulders were analyzed. The path of the biceps tendon on the articular surface of the humeral head and the total articular surface were digitized using a MicronTracker 2 H3-60 three-dimensional optical tracker. Contact surface area was significantly less in abduction than in neutral position (P = 0.002) with a median ratio of 41% (36%, 47.5%). Ratios of contact area in neutral position to full articular surface area were consistent between left and right shoulders (rho = 1, P = 0.017) as were ratios of abduction area to full articular surface area (rho = 0.97, P = 0.005). The articular contact surface area is significantly greater in neutral position than abduction. The ratios of articular contact surface areas to total humeral articular surface areas have a narrow range and are consistent between left and right shoulders of the same cadaver. PMID:25210631

  2. TREATMENT OF POST-TRAUMATIC HUMERAL FRACTURES AND COMPLICATIONS USING THE OSTEOLINE® EXTERNAL FIXATOR: A TREATMENT OPTION

    PubMed Central

    de Azevedo, Marcos Coelho; de Azevedo, Gualter Maldonado; Hayashi, Alexandre Yoshio; Dourado Nascimento, Paulo Emilio

    2015-01-01

    To evaluate the results obtained from treatment of humeral shaft fractures and their complications using the Osteoline® uniplanar external fixator. Methods: The radiographic and functional results from 78 patients with humeral shaft fractures treated using the uniplanar external fixation technique were retrospectively assessed. The patients' ages ranged from 23 to 71 years, with a mean of 47 years. Male patients predominated (79%). Out of the 78 patients, 45 presented open fractures, 14 presented pseudarthrosis and six presented synthesis failure. There were no losses during the follow-up and all the patients were discharged after fracture consolidation and functional recovery. The results were evaluated based on the studies by Catagni, as good, fair or poor. Results: Fracture consolidation was observed in 98% of the cases treated with uniplanar external fixation. Only one pseudarthrosis case required conversion to rigid internal fixation and autologous bone grafting. At the end of the treatment, all the patients were discharged with consolidated fractures, without pain, and good limb function. Conclusion: The external fixation described in this paper was shown to be an efficient and safe method for treating humeral shaft fractures and their complications. It preserved the local biological status and enabled passive and active movement immediately after surgery. PMID:27027026

  3. Lateral flow strip assay

    DOEpatents

    Miles, Robin R.; Benett, William J.; Coleman, Matthew A.; Pearson, Francesca S.; Nasarabadi, Shanavaz L.

    2011-03-08

    A lateral flow strip assay apparatus comprising a housing; a lateral flow strip in the housing, the lateral flow strip having a receiving portion; a sample collection unit; and a reagent reservoir. Saliva and/or buccal cells are collected from an individual using the sample collection unit. The sample collection unit is immersed in the reagent reservoir. The tip of the lateral flow strip is immersed in the reservoir and the reagent/sample mixture wicks up into the lateral flow strip to perform the assay.

  4. Chondral fracture of the lateral trochlea of the femur occurring in an adolescent: mechanism of injury.

    PubMed

    Oohashi, Yoshikazu; Oohashi, Yoshinori

    2007-11-01

    The trochlea of the femur is a very unusual site for chondral fracture. Little is known of the mechanism of injuries confined to the articular cartilage of the trochlea of the femur. A very unusual case of chondral fracture of the lateral trochlea of the femur occurring in an adolescent is reported here. The mechanism by which this injury occurred could be evaluated in this patient. The cartilage on the convex surface of the lateral trochlea was likely avulsed proximally by shear force of the patella during rapid extension of the weight-bearing knee from a flexed position. From a viewpoint of mechanism, this injury differs from the more usual osteochondral or chondral fractures of the weight bearing area of the femoral condyle, which are usually accompanied by twisting forces.

  5. Treatment of the humeral shaft fractures - minimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace: study protocol for a randomised controlled trial

    PubMed Central

    2013-01-01

    Background Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. Non-operative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Surgical treatment is reserved for specific conditions. Modern concepts of internal fixation of long bone shaft fractures advocate relative stabilisation techniques with no harm to fracture zone. Recently described, minimally invasive bridge plate osteosynthesis has been shown to be a secure technique with good results for treating humeral shaft fractures. There is no good quality evidence advocating which method is more effective. This randomised controlled trial will be performed to investigate the effectiveness of surgical treatment of humeral shaft fractures with bridge plating in comparison with conservative treatment with functional brace. Methods/Design This randomised clinical trial aims to include 110 patients with humeral shaft fractures who will be allocated after randomisation to one of the two groups: bridge plate or functional brace. Surgical treatment will be performed according to technique described by Livani and Belangero using a narrow DCP plate. Non-operative management will consist of a functional brace for 6 weeks or until fracture consolidation. All patients will be included in the same rehabilitation program and will be followed up for 1 year after intervention. The primary outcome will be the DASH score after 6 months of intervention. As secondary outcomes, we will assess SF-36 questionnaire, treatment complications, Constant score, pain (Visual Analogue Scale) and radiographs. Discussion According to current evidence shown in a recent systematic review, this study is one of the first randomised controlled trials designed to compare two methods to treat humeral shaft fractures (functional brace and bridge plate surgery). Trial registration Current Controlled Trials: ISRCTN

  6. Developed Design for Humeral Head Replacement Using 3D Surface Mapping

    NASA Astrophysics Data System (ADS)

    Salah, H. R.

    2014-12-01

    Assessment of dimensional and geometrical data on the humeral head replacement (HHR) objects is essential for solving the relevant designing problems in the physics of reverse engineering (RE). In this work, 2D-assessment for human humerus was performed using the computed tomography (CT) technique within the RE plan, after which the 2D images of humeral objects were converted into 3D images. The conversion was successful and indicated a clear difference in the 2D and 3D estimates of sizes and geometry of the humerus. The authors have analyzed and confirmed experimentally the statistical information on the relevant anatomical objects. The results of finite-element simulation of the compressive stresses affecting the geometry of 3D surface mapping were analyzed using SolidWorks software. For developing the biomechanical design of an HHR object suitable biomaterials were selected, and different metal-based biomaterials are discussed as applied at various loads. New methodology is presented for the size estimation of humeral head - both anatomical and artificial - in 3D-shape. A detailed interpretation is given for the results of CT D-measurements. Izmēru un ģeometrisko datu novērtējums, kas attiecas uz pleca kaula galviņas nomaiņas (PKGN) objektiem, nepieciešams, lai risinātu virkni reversīvās inženierijas (RI) problēmu. Šajā darbā cilvēka pleca kaula galviņas divdimensiju novērtējums tika veikts ar datortomogrāfijas palīdzību (RI) ietvaros, un pēc tam objekta divdimensiju attēlojums tika pārveidots trīsdimensiju. Pārveidojums bija sekmīgs, parādot pleca kaula galviņas izmēru un ģeometrijas atšķirības starp 2D un 3D novērtējumiem. Autori izanalizēja un eksperimentāli apstiprināja statistisko informāciju pēc dotā veida anatomiskiem objektiem. Saspiešanas sasprindzinājumi, kuri ietekmē trīsdimensiju virsmas attēlojuma ģeometriju, tika analizēti ar gala-elementu simulācijas metodi, lietojot programmu Solid

  7. Lateral Ulnar Collateral Ligament Reconstruction: An Analysis of Ulnar Tunnel Locations.

    PubMed

    Anakwenze, Oke A; Khanna, Krishn; Levine, William N; Ahmad, Christopher S

    2016-02-01

    We conducted a study to determine precise ulnar tunnel location during lateral ulnar collateral ligament reconstruction to maximize bony bridge and graft construct perpendicularity. Three-dimensional computer models of 15 adult elbows were constructed. These elbow models were manipulated for simulated 4-mm tunnel drilling. The proximal ulna tunnels were placed at the radial head-neck junction and sequentially 0, 5, and 10 mm posterior to the supinator crest. The bony bridges created by these tunnels were measured. Location of the humeral isometric point was determined and marked as the humeral tunnel location. Graft configuration was simulated. Using all the simulated ulna tunnels, we measured the proximal and distal limbs of the graft. In addition, we measured the degree of perpendicularity of the graft limbs. The ulnar tunnel bony bridge was significantly longer with more posterior placement of the proximal tunnel relative to the supinator crest. An increase in degree of perpendicularity of graft to ulnar tunnels was noted with posterior shifts in proximal tunnel location. Posterior placement of the proximal ulna tunnel allows for a larger bony bridge and a more geometrically favorable reconstruction.

  8. Lateral canthal surgery.

    PubMed

    Chong, Kelvin Kam-Lung; Goldberg, Robert A

    2010-08-01

    The lateral canthus is a delicate and complicated three-dimensional structure with function relevant to the health of the ocular surface. Dysfunction of the lateral canthus, due to aging changes or iatrogenic trauma, results in ocular morbidity ranging from chronic irritation to tearing to recalcitrant keratopathy. From an aesthetic standpoint, symmetric, normally positioned lateral canthi are cornerstones of youthful periorbital appearance, disruption of which leads to cosmetically significant deformity or asymmetry. Reconstruction of the lateral canthus is important in the rehabilitation of the aging eyelid and an unfortunate necessity after failed lateral canthal surgery. The common methods for improving or maintaining position, tone, and shape of the lower eyelid and lateral canthus use tightening or shortening the lower eyelid horizontally, keeping the canthal angle in an appropriate vertical level, and hugging the ocular surface. Many techniques have been described for the reconstruction of the lateral canthus in functional conditions or for aesthetic purposes. These methods have met with varying success. In this article, we begin with a discussion of the anatomy and physiology of the lateral canthus, followed by clinical examples of lateral canthal abnormalities and underlying pathophysiologies. A review of surgical options for the lateral canthus is presented with concluding remarks on postoperative complications. PMID:20524167

  9. Occipital Condyle Fracture with Accompanying Meningeal Spinal Cysts as a result of Cervical Spine Injury in 15-Year-Old Girl.

    PubMed

    Wiktor, Łukasz; Tomaszewski, Ryszard

    2015-01-01

    The occipital condyle fracture is rare injury of the craniocervical junction. Meningeal spinal cysts are rare tumors of the spinal cord. Depending on location, these lesions may be classified as extradural and subdural, but extradural spinal cysts are more common. We present the case of a 15-year-old girl who suffered from avulsion occipital condyle fracture treated with use of "halo-vest" system. We established that clinical effect after completed treatment is very good. Control MRI evaluation was performed 12 months after removal of "halo-vest" traction, and clinically silent extradural meningeal spinal cysts were detected at the ventral side of the spinal cord in the cervical segment of the spine. Due to clinically silent course of the disease, we decided to use the conservative treatment. The patient remains under control of our department. PMID:26543656

  10. [Treatment of fractures of the mandibular condyle. Experiences at the Department of Oral Medicine and Maxillofacial Surgery at Toulon-La-Seyne/Mer].

    PubMed

    Ribault, J Y; Lestage, F; Gacon, J; Vittel, P; Roubaudi, G; Pernice, L; Jeannenot, J; Laroche, D; Fourestier, J

    1997-11-01

    The fractures of the gnathic condyle are constantly increasing due to the violent impact on the chine. The functional treatment is essential for good results whereas the restitution of a functional joint, i.e. teeth that engage into one another, is satisfactory for the patient as it can also justify a possible surgical reduction in such cases when significant shifts of fragments resulting from the fractures are present.

  11. Endoscopic Excision of Supracondylar Humeral Spur for Decompression of the Median Nerve and Brachial Artery

    PubMed Central

    Bain, Gregory; Gupta, Prince; Phadnis, Joideep; Singhi, Prahalad K.

    2016-01-01

    The humeral supracondylar process and Struthers ligament comprise a relatively rare but well-known anatomic variant. They are usually asymptomatic but may produce clinical symptoms related to compression of the median nerve or brachial artery below the ligament. Previously, surgery has been performed with an open ligament release and supracondylar process excision. This article reports on the use of endoscopic findings and the method of ligament release and process excision. Endoscopy is a minimally invasive technique that provides excellent visualization and enables the surgeon to perform dissection with magnification and precision. It allows the surgeon to introduce open surgical techniques into the depths of the wound in a controlled manner. Because of the dead space created, there is a risk of hematoma formation. Many of the concepts used in open surgery are now being used for endoscopic surgery, and vice versa. The barriers and differences among endoscopic, arthroscopic, and open procedures are being broken down. We report another endoscopic technique, which is part of the ongoing evolution of musculoskeletal surgery. PMID:27073779

  12. A Pitfall in Fixation of Distal Humeral Fractures with Pre-Contoured Locking Compression Plate

    PubMed Central

    Jayakumar, Prakash; Ring, David

    2015-01-01

    Anatomically precontoured locking plates are intended to facilitate the fixation of articular fractures and particularly those associated with osteoporosis. Fractures of the distal humerus are relatively uncommon injuries where operative intervention can be exceptionally challenging. The distal humeral trochlea provides a very narrow anatomical window through which to pass a fixed-angle locking screw, which must also avoid the olecranon, coronoid, and radial fossae. We describe 3 patients (ages 27, 49, and 73 years) with a bicolumnar fracture of the distal humerus where very short distal locking screws were used. Intra-articular screw placement was avoided but loss of fixation occurred in two patients and a third was treated with a prolonged period of immobilization. We postulate that fixed-angle screw trajectories may make it difficult for the surgeon to place screws of adequate length in this anatomically confined region, and may lead to insufficient distal fixation. Surgical tactics should include placement of as many screws as possible into the distal fragment, as long as possible and that each screw passes through a plate without necessarily locking in. PMID:26110181

  13. Endoscopic Excision of Supracondylar Humeral Spur for Decompression of the Median Nerve and Brachial Artery.

    PubMed

    Bain, Gregory; Gupta, Prince; Phadnis, Joideep; Singhi, Prahalad K

    2016-02-01

    The humeral supracondylar process and Struthers ligament comprise a relatively rare but well-known anatomic variant. They are usually asymptomatic but may produce clinical symptoms related to compression of the median nerve or brachial artery below the ligament. Previously, surgery has been performed with an open ligament release and supracondylar process excision. This article reports on the use of endoscopic findings and the method of ligament release and process excision. Endoscopy is a minimally invasive technique that provides excellent visualization and enables the surgeon to perform dissection with magnification and precision. It allows the surgeon to introduce open surgical techniques into the depths of the wound in a controlled manner. Because of the dead space created, there is a risk of hematoma formation. Many of the concepts used in open surgery are now being used for endoscopic surgery, and vice versa. The barriers and differences among endoscopic, arthroscopic, and open procedures are being broken down. We report another endoscopic technique, which is part of the ongoing evolution of musculoskeletal surgery.

  14. Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible?

    PubMed Central

    Concha, Juan M.; Sandoval, Alejandro

    2009-01-01

    Minimally invasive plate osteosynthesis (MIPO) has been advocated as a safe approach to humeral shaft fracture management. We evaluated the reproducibility of this technique in a regional hospital. Thirty-five patients underwent MIPO of humerus shaft fractures. Fifteen patients had an open fracture, six a preoperative radial nerve palsy, and nine a concomitant thoracic, musculoskeletal or vascular injury. At an average 12-month follow-up, 91% of fractures healed after a mean of 12 weeks (range, 8–16). Two infections occurred. Final alignment averaged 4° of varus (range, 5° of valgus to 20° of varus). Active elbow ROM averaged 114° (range, 60–135°) and was less than 100° in nine elbows. Five of six preoperative radial nerve injuries recovered spontaneously. Healing and infection rates in this study are consistent with those reported in the literature. Lower elbow ROM and higher fracture angulation at healing were nevertheless found. MIPO is technically demanding and requires adequate intraoperative imaging and surgical experience in order to obtain adequate fracture alignment. Brachialis muscle scarring and inadequate postoperative rehabilitation may be involved in limited elbow range of motion. PMID:19844708

  15. Minimal invasive ostheosintesis for treatment of diaphiseal transverse humeral shaft fractures

    PubMed Central

    Zogaib, Rodrigo Kallás; Morgan, Steven; Belangero, Paulo Santoro; Fernandes, Hélio Jorge Alvachian; Belangero, William Dias; Livani, Bruno

    2014-01-01

    OBJECTIVE: To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through minimally invasive technique. METHODS: Inclusion criteria were adult patients with transverse diaphyseal fractures of the humerus closed, isolated or not occurring within 15 days of the initial trauma. Exclusion criteria were patients with compound fractures. RESULTS: In two patients, proximal screw loosening occurred, however, the fractures consolidated in the same mean time as the rest of the series. Consolidation with up to 5 degrees of varus occurred in five cases and extension deficit was observed in the patient with olecranon fracture treated with tension band, which was not considered as a complication. There was no recurrence of infection or iatrogenic radial nerve injury. CONCLUSION: It can be concluded that minimally invasive osteosynthesis with bridge plate can be considered a safe and effective option for the treatment of transverse fractures of the humeral shaft. Level of Evidence III, Therapeutic Study. PMID:24868188

  16. Endoscopic Excision of Supracondylar Humeral Spur for Decompression of the Median Nerve and Brachial Artery.

    PubMed

    Bain, Gregory; Gupta, Prince; Phadnis, Joideep; Singhi, Prahalad K

    2016-02-01

    The humeral supracondylar process and Struthers ligament comprise a relatively rare but well-known anatomic variant. They are usually asymptomatic but may produce clinical symptoms related to compression of the median nerve or brachial artery below the ligament. Previously, surgery has been performed with an open ligament release and supracondylar process excision. This article reports on the use of endoscopic findings and the method of ligament release and process excision. Endoscopy is a minimally invasive technique that provides excellent visualization and enables the surgeon to perform dissection with magnification and precision. It allows the surgeon to introduce open surgical techniques into the depths of the wound in a controlled manner. Because of the dead space created, there is a risk of hematoma formation. Many of the concepts used in open surgery are now being used for endoscopic surgery, and vice versa. The barriers and differences among endoscopic, arthroscopic, and open procedures are being broken down. We report another endoscopic technique, which is part of the ongoing evolution of musculoskeletal surgery. PMID:27073779

  17. Throwing fracture of the humeral shaft. An analysis of 90 patients.

    PubMed

    Ogawa, K; Yoshida, A

    1998-01-01

    Ninety patients with humeral shaft fractures sustained during throwing were analyzed to determine what caused their injuries. All patients were recreational baseball players: 89 were men and 1 was a woman. The average age was 25 years (range, 12 to 43). The throwing style, type of pitch, fielding position, and type of ball used varied; however, the patients sustained their fractures while performing a hard throw in 87 (97%) of the occurrences. The actual courses of the balls thrown ranged from sideways to straight forward. All fractures were external rotation spiral fractures; 25 patients (28%) had a medial butterfly fragment, and 14 patients (16%) had radial nerve palsy. Fractures were most likely to have occurred in the distal half of the humerus, although they occurred frequently in the proximal half in patients in their early teens. We conclude that 1) the fracture can occur at any time during the acceleration phase before ball release, 2) this type of fracture can occur in any recreational baseball player attempting to perform a hard throw, and 3) the cause of this fracture is the throwing action itself.

  18. Osteosynthesis of Proximal Humeral Fractures with the Fixed Angle PHILOS-plate.

    PubMed

    Klitscher, Daniela; Blum, Jochen; Andreas, Dominik; Hessmann, Martin; Kuechle, Raphael; du Prel, Jean-Baptist; Rommens, Pol Maria

    2008-02-01

    In a retrospective study we analyzed the functional and radiological outcome of 30 proximal humeral fractures, treated by PHILOS-plate, a fixed-angle device. Two of them were characterized as type Neer III, 14 as type Neer IV, 5 as type Neer V and 9 as type Neer VI. There were 2 2-part, 16 3-part and 12 4-part fractures. According to the constant-score, the normalized constant-score and the UCLA-score, good to excellent results were obtained in 66.7, 76.7 and 76.7%. Twenty-six (86.7%) patients had no or mild pain. Active forward flexion and active abduction over 90° was possible in 26 (86.7%) cases. Four (13.3%) patients developed partial avascular necrosis. Screw perforation was seen in 3 (10%) cases, delayed union in 1 (3.3%) case, malunion in 1 case and a loosening of plate and screws in another one. A secondary varus displacement of 5°-35° with a mean of 7° was found in 19 (63.3%) cases. The average time to union was 75 days. Fixation with PHILOS-plate is an adequate treatment for displaced 2- to 4-part fractures. Even in dislocated or 4-part fractures or in patients over 65 years good to excellent results were seen in the majority of cases.

  19. Reading Disability and Laterality.

    ERIC Educational Resources Information Center

    Sparrow, Sara S.

    The purpose of this study was to determine how retarded readers differed from normal readers in the various ways laterality is manifested. An additional purpose was to investigate the development of laterality as seen across several age levels. Subjects were 80 white male 9-, 10-, 11-, and 12-year-olds from regular classrooms in suburban…

  20. Preservation of condyle and disc in the surgical treatment of type III temporomandibular joint ankylosis: a long-term follow-up clinical study of 111 joints.

    PubMed

    Jakhar, S K; Agarwal, M; Gupta, D K; Tiwari, A D

    2013-06-01

    The purpose of this study was to establish the role of retaining the condyle and disc in the treatment of type III ankylosis, by clinical and computed tomography (CT) evaluation. A total of 90 patients with type III ankylosis met the inclusion criteria; 42 patients had left temporomandibular joint (TMJ) ankylosis, 27 patients had right TMJ ankylosis, and 21 had bilateral TMJ ankylosis, thus a total 111 joints were treated. Considerable improvements in mandibular movement and maximum mouth opening were noted in all patients. At the end of a minimum follow-up of 2 years, the mean inter-incisal mouth opening was 30.7 mm. Postoperative occlusion was normal in all patients, and open bite did not occur in any case because the ramus height was maintained through preservation of the pseudo-joint. Only three patients had recurrence of ankylosis, which was due to a lack of postoperative physiotherapy. The advantages of condyle and disc preservation in type III ankylosis are: (1) surgery is relatively safe; (2) the disc helps to prevent recurrence of ankylosis; (3) the existing ramus height is maintained; (4) the growth site is preserved; and (5) there is no need to reconstruct the joint with autogenous or alloplastic material. It is recommended that the disc and condyle are preserved in type III TMJ ankylosis.

  1. Lateral subtalar dislocation.

    PubMed

    Sharda, Praveen; DuFosse, Julian

    2008-07-01

    Subtalar dislocations are rare in routine orthopedic practice. While many of these dislocations are a result of high-energy injuries such as fall from a height or traffic accidents, it is not uncommon for patients to present after slipping down a few stairs. Two types of dislocation have been described, medial and lateral. The type of dislocation is described according to the position of the foot. In lateral subtalar dislocation the head of talus is found medially and the calcaneus is dislocated laterally. The navicular may lie dorsolateral to the talus. The reverse is true of lateral dislocation. Medial dislocation has been referred to as "basketball foot" due to its preponderance in basketball players.4 The deciding factor is the inverted or everted position of the foot when the force is dissipated through the weak talonavicular and talocalcaneal ligaments. This article presents a case of an adult with lateral subtalar dislocation following a fall.

  2. Early Postoperative Magnetic Resonance Imaging Findings After Autologous Osteochondral Plug Grafts For Osteochondritis Dissecans of the Humeral Capitellum

    PubMed Central

    Maruyama, Masahiro; Takahara, Masatoshi; Harada, Mikio; Satake, Hiroshi; Uno, Tomohiro; Takagi, Michiaki

    2016-01-01

    Objectives: Although good clinical outcomes of autologous osteochondral plug grafts for capitellar osteochondritis dissecans (OCD) have been reported, the timing of return to sports was various and still controversial. The period of graft incorporation and the lesion healing at repair site is important to establish the rehabilitation protocol, however there is little information. The aim of this study was to investigate early postoperative magnetic resonance imaging (MRI) findings and clinical outcomes after autologous osteochondral plug grafts for capitellar OCD. Methods: Fifteen young baseball players with advanced lesions of capitellar OCD underwent a procedure using autologous osteochondral plug grafts and underwent MRI (1.5 T) scan at 3 and 6 months, postoperatively. Their mean age at the time of surgery was 13.5 years (range, 13-15 years). Four lesions were classified as International Cartilage Repair Society (ICRS) OCD III and 11 lesions as OCD IV. The mean size of the lesions (sagittal × coronal) was 16 × 14 mm and the mean surface area was 181 mm2. One to two osteochondral plug grafts, with a mean diameter of 7 mm (range, 6-8 mm), were harvested from the lateral femoral condyle and transplanted to the defects. The mean reconstruction rate was 41% (range, 12%-65%), which was calculated as (total surface area of the grafts × 100%)/ (surface area of the lesion). Patients were allowed to begin throwing after 3 months and to return to sports after 6 months. The mean follow-up was 21 months (range, 12-36 months). The MRI findings were assessed graft incorporation, which was indicated by no T1-low-signal-intensity at the graft and no fluid surrounding the graft on T2-weighted fat-suppression (Figure 1), and the lesion healing according to the scoring system of Henderson (4, complete healing; 16, no healing). MRI were blinded and randomized, and two observers reviewed independently and conferred when they differed. Clinical outcomes were evaluated as elbow pain

  3. CD146 as a new marker for an increased chondroprogenitor cell sub-population in the later stages of osteoarthritis.

    PubMed

    Su, Xinlin; Zuo, Wei; Wu, Zhihong; Chen, Jun; Wu, Nan; Ma, Pei; Xia, Zenan; Jiang, Chao; Ye, Zixing; Liu, Sen; Liu, Jiaqi; Zhou, Guangqian; Wan, Chao; Qiu, Guixing

    2015-01-01

    Cartilage-derived mesenchymal stem cells (MSCs) have been isolated with different methods. In this study lateral and medial femoral condyles were respectively collected from patients with late-stage osteoarthritis during the total knee arthroplasty. After digestion of the cartilage tissues with type II collagenase and analysis by fluorescence-activated cell sorting (FACS) with CD146, a chondroprogenitor cell sub-population were isolated and purified. The expression of other MSC-associated markers in the CD146+ chondroprogenitors was analyzed by flow cytometry. Multi-lineage differentiation capacity of CD146+ chondroprogenitors was compared with that of unsorted chondrocytes and adipose-derived MSCs (ADMSCs). Higher percentage of CD146+ chondroprogenitors isolated from the medial femoral condyles was observed than that from the lateral. CD146+ chondroprogenitors expressed high levels of MSC-specific surface antigens, and showed higher chondrogenesis capacity than ADMSCs and unsorted chondrocytes in a 3D cell pellet culture model. Thus CD146 might be a new cell surface marker for cartilage progenitor cell population in the late-stage osteoarthritis. PMID:25266708

  4. Detection of exostosin glycosyltransferase gene mutations in patients with non-hereditary osteochondromas of the mandibular condyle

    PubMed Central

    Zhou, Qin; Yang, Chi; Chen, Min-Jie; Li, Ling-Zhi

    2016-01-01

    Exostosin glycosyltransferase (EXT) 1 and EXT2 have been identified as causative genes in osteochondroma; however, it is not known whether these genes are also involved in condylar osteochondromas. The aim of this study was to identify EXT1 and EXT2 mutations in patients with non-hereditary osteochondromas of the mandibular condyle. DNA was obtained from resected tissues (cartilage cap) of 12 patients with solitary condylar osteochondromas. The exons, 3′,5′-untranslated regions and intron-exon boundaries of EXT1 and EXT2 were amplified by polymerase chain reaction and the products were sequenced directly. Through direct sequencing, four genetic variations of EXT1 in 4 cases and three variations of EXT2 in 5 cases were identified. The intronic alteration of the EXT2 gene, occurring in 2 cases, was novel, whereas the other alterations had been previously reported. Nonsense somatic mutations were detected in tumor DNA. Our study extended the mutational spectrum in EXT1 and EXT2 and may facilitate a better understanding of the pathophysiology of condylar osteochondromas. PMID:27588195

  5. Shockwave therapy in the management of complex regional pain syndrome in medial femoral condyle of the knee.

    PubMed

    Notarnicola, Angela; Moretti, Lorenzo; Tafuri, Silvio; Panella, Antonio; Filipponi, Marco; Casalino, Alessio; Panella, Michele; Moretti, Biagio

    2010-06-01

    The aim of this prospective study was to assess the efficacy of shockwave (SW) therapy in the management of complex regional pain syndrome (CRPS). In this study, 30 patients (pts) who were affected by CRPS of the medial femoral condyle and unresponsive to previous standard physiotherapeutic and pharmacological treatment underwent 3 SW sessions at 72-h intervals, each consisting of 4000 shocks emitted by a MiniLith SL1 Storz electromagnetic generator. An energy flux density (EFD) of 0.035 or 0.09 mJ/mm(2) was used, depending on how well the patient endured the pain during the treatment. Satisfactory results were observed in 76.7% of the cases (23 pts) at the 2-month follow-up (FU) visit, and in 80% (24 pts) at the 6-month FU visit. The therapeutic effects of SW were caused by decreasing pain. The significant improvements we obtained bear witness to the potential value of SW therapy in the management of CRPS.

  6. Surgical Treatment for Occipital Condyle Fracture, C1 Dislocation, and Cerebellar Contusion with Hemorrhage after Blunt Head Trauma

    PubMed Central

    Sasaki, Nobuhiro; Fukuda, Miyuki; Hoshimaru, Minoru

    2016-01-01

    Occipital condyle fractures (OCFs) have been treated as rare traumatic injuries, but the number of reported OCFs has gradually increased because of the popularization of computed tomography (CT) and magnetic resonance imaging (MRI). The patient in this report presented with OCFs and C1 dislocation, along with traumatic cerebellar hemorrhage, which led to craniovertebral junction instability. This case was also an extremely rare clinical condition in which the patient presented with traumatic lower cranial nerve palsy secondary to OCFs. When the patient was transferred to our hospital, the occipital bone remained defective extensively due to surgical treatment of cerebellar hemorrhage. For this reason, concurrent cranioplasty was performed with resin in order to fix the occipital bone plate strongly. The resin-made occipital bone was used to secure a titanium plate and screws enabled us to perform posterior fusion of the craniovertebral junction. Although the patient wore a halo vest for 3 months after surgery, lower cranial nerve symptoms, including not only neck pain but also paralysis of the throat and larynx, improved postoperatively. No complications were detected during outpatient follow-up, which continued for 5 years postoperatively. PMID:27800203

  7. Lateral superlattice solar cells

    SciTech Connect

    Mascarenhas, A.; Zhang, Y.; Millunchick, J.M.; Twesten, R.D.; Jones, E.D.

    1997-10-01

    A novel structure which comprises of a lateral superlattice as the active layer of a solar cell is proposed. If the alternating regions A and B of a lateral superlattice ABABAB... are chosen to have a Type-II band offset, it is shown that the performance of the active absorbing region of the solar cell is optimized. In essence, the Type-II lateral superlattice region can satisfy the material requirements for an ideal solar cells active absorbing region, i.e. simultaneously having a very high transition probability for photogeneration and a very long minority carrier recombination lifetime.

  8. Amyotrophic Lateral Sclerosis

    MedlinePlus

    Amyotrophic lateral sclerosis (ALS) is a nervous system disease that attacks nerve cells called neurons in your ... people with ALS die from respiratory failure. The disease usually strikes between age 40 and 60. More ...

  9. Lateral orientation (image)

    MedlinePlus

    ... chest, and the ears are lateral to the head. A medial orientation is a position toward the midline of the body. An example of medial orientation is the eyes, which are medial to the ears on the head.

  10. Preventing errors in laterality.

    PubMed

    Landau, Elliot; Hirschorn, David; Koutras, Iakovos; Malek, Alexander; Demissie, Seleshie

    2015-04-01

    An error in laterality is the reporting of a finding that is present on the right side as on the left or vice versa. While different medical and surgical specialties have implemented protocols to help prevent such errors, very few studies have been published that describe these errors in radiology reports and ways to prevent them. We devised a system that allows the radiologist to view reports in a separate window, displayed in a simple font and with all terms of laterality highlighted in separate colors. This allows the radiologist to correlate all detected laterality terms of the report with the images open in PACS and correct them before the report is finalized. The system is monitored every time an error in laterality was detected. The system detected 32 errors in laterality over a 7-month period (rate of 0.0007 %), with CT containing the highest error detection rate of all modalities. Significantly, more errors were detected in male patients compared with female patients. In conclusion, our study demonstrated that with our system, laterality errors can be detected and corrected prior to finalizing reports.

  11. An Anatomical Study of the Nutrient Foramina of the Human Humeral Diaphysis.

    PubMed

    Xue, Zichao; Ding, Haoliang; Hu, Chuanzhen; Xu, Haitao; An, Zhiquan

    2016-05-16

    BACKGROUND Understanding the nutrient foramina is critical to clinical practice. An insult to the nutrient foramina can be caused by trauma and/or surgical dissection and lead to devascularization and bad outcomes. Few studies have looked at the humerus, and no studies have described relative information of humeral nutrient foramen related to anatomical structures that might be located by palpable landmarks. In this study, we analyzed the anatomical features of the nutrient foramina of the diaphyseal humerus and provide a discussion of clinical relevance. MATERIAL AND METHODS We dissected 19 cadavers and analyzed the relative positions of the foramina and surrounding muscles, and the number, direction, diameter, and location of the nutrient foramina. Foramina index and a new landmark index were used to calculate the location. We compared the data from both sides and the relationships between transverse and longitudinal locations, diameter and total length, and foramina index and landmark index were also analyzed. RESULTS The humeri had one or two main nutrient foramina located in a small area between the coracobrachialis and brachial muscles and oriented toward the elbow. The mean diameter was 1.11±0.32 mm. The mean index and landmark index were 43.76±4.94% and 42.26±5.35%, respectively. There were no differences between sides in terms of diameter, length, or nutrient foramina index. There were no significant correlations between transverse and longitudinal locations or diameter and total length. The foramina index and landmark index showed strong positive correlation (r=0.994, p<0.0001). CONCLUSIONS Our study provides details about the nutrient foramina that will benefit clinicians who treat injuries and diseases of the humerus. Surgeons should be mindful of soft tissue in the foraminal area during surgical procedures.

  12. Plating osteosynthesis of mid-distal humeral shaft fractures: minimally invasive versus conventional open reduction technique

    PubMed Central

    Zeng, Bingfang; He, Xiaojian; Chen, Qi; Hu, Shundong

    2009-01-01

    Results of two methods, conventional open reduction–internal plating and minimally invasive plating osteosynthesis (MIPO), in the treatment of mid-distal humeral shaft fractures were compared. Thirty-three patients were retrospectively analysed and divided into two groups. Group A (n = 17) patients were treated by MIPO and group B (n = 16) by conventional plating. The mean operation time in group A was 92.35 ± 57.68 minutes and 103.12 ± 31.08 minutes in group B (P = 0.513). Iatrogenic radial nerve palsy in group A was 0% (0/17) and 31.3% in group B (5/16 (P = 0.012). The mean fracture union time in group A was 15.29 ± 4.01 weeks (range 8–24 weeks), and 21.25 ± 13.67 weeks (range 10–58 weeks) in group B (P = 0.095). The mean UCLA end-result score in group A was 34.76 ± 0.56 points (range 33–35), and 34.38 ± 1.41 points (range 30–35) in group B (P = 0.299). The mean MEPI in group A was 99.41 ± 2.43 points (range 90–100) and 99.69 ± 1.25 points (range 95–100) in group B (P = 0.687). When compared to the conventional plating techniques, MIPO offers advantages in terms of reduced incidence of iatrogenic radial nerve palsies and accelerated fracture union and a similar functional outcome with respect to shoulder and elbow function. PMID:19301000

  13. An Anatomical Study of the Nutrient Foramina of the Human Humeral Diaphysis

    PubMed Central

    Xue, Zichao; Ding, Haoliang; Hu, Chuanzhen; Xu, Haitao; An, Zhiquan

    2016-01-01

    Background Understanding the nutrient foramina is critical to clinical practice. An insult to the nutrient foramina can be caused by trauma and/or surgical dissection and lead to devascularization and bad outcomes. Few studies have looked at the humerus, and no studies have described relative information of humeral nutrient foramen related to anatomical structures that might be located by palpable landmarks. In this study, we analyzed the anatomical features of the nutrient foramina of the diaphyseal humerus and provide a discussion of clinical relevance. Material/Methods We dissected 19 cadavers and analyzed the relative positions of the foramina and surrounding muscles, and the number, direction, diameter, and location of the nutrient foramina. Foramina index and a new landmark index were used to calculate the location. We compared the data from both sides and the relationships between transverse and longitudinal locations, diameter and total length, and foramina index and landmark index were also analyzed. Results The humeri had one or two main nutrient foramina located in a small area between the coracobrachialis and brachial muscles and oriented toward the elbow. The mean diameter was 1.11±0.32 mm. The mean index and landmark index were 43.76±4.94% and 42.26±5.35%, respectively. There were no differences between sides in terms of diameter, length, or nutrient foramina index. There were no significant correlations between transverse and longitudinal locations or diameter and total length. The foramina index and landmark index showed strong positive correlation (r=0.994, p<0.0001). Conclusions Our study provides details about the nutrient foramina that will benefit clinicians who treat injuries and diseases of the humerus. Surgeons should be mindful of soft tissue in the foraminal area during surgical procedures. PMID:27180828

  14. Risk factors for revision surgery following Humeral Head Replacement: 1,431 shoulders over 3 decades

    PubMed Central

    Singh, Jasvinder A.; Sperling, John; Cofield, Robert

    2011-01-01

    Objective Assess long-term risk of revision surgery and its predictors after undergoing humeral head replacement (HHR). Methods We used prospectively collected data from the Mayo Clinic Total Joint registry and other institutional electronic databases. Revision-free survival for HHR at 5-, 10- and 20-years was calculated using Kaplan-Meier survival analysis. We used univariate and multivariable-adjusted Cox regression analyses to examine the association of age, gender, body mass index (BMI), comorbidity assessed by Deyo-Charlson index, American Society of Anesthesiologist (ASA) class, implant fixation (cemented versus not) and underlying diagnosis with the risk of revision surgery. Hazard ratio with 95% confidence interval (CI) and p-values are presented. Results 1,359 patients underwent 1,431 shoulder HHRs during the study period, 1976–2008. The average age was 63 years, 63% were female, mean BMI was 28 kg/m2 and 60% implants were cemented. 114 HHRs were revised during the follow-up. At 5-, 10- and 20-years, the shoulder implant survival was 93.6% (95% CI, 92.1%–95%), 90% (95% CI, 88%–92%) and 85% (95% CI, 81.8%–88.4%) respectively. In multivariable-adjusted analyses, older age was associated with lower hazard of revision, hazard ratio, 0.97 (95% CI, 0.96–0.99; p-value<0.001) and higher BMI with higher hazard ratio of 1.04 (95% CI, 1.01–1.08; p-value=0.02). Conclusions Long-term survival of HHR at 20-years was excellent. Obesity and younger age are risk factors for higher revision rate after HHR. Further studies should investigate the biologic rationale for these important associations. Surgeons can discuss these differences in revision risk with patients, especially in young obese patients. PMID:21982347

  15. Force and acceleration corridors from lateral head impact.

    PubMed

    Yoganandan, Narayan; Zhang, Jiangyue; Pintar, Frank

    2004-12-01

    This study was conducted to provide force and acceleration corridors at different velocities describing the dynamic biomechanics of the lateral region of the human head. Temporo-parietal impact tests were conducted using specimens from ten unembalmed post-mortem human subjects. The specimens were isolated at the occipital condyle level, and pre-test x-ray and computed tomography images were obtained. They were prepared with multiple triaxial accelerometers and subjected to increasing velocities (up to 7.7 m/s) using free-fall techniques by impacting onto a force plate from which forces were recorded. A 40-durometer padding (50-mm thickness) material covering the force plate served as the impacting boundary condition. Computed tomography images obtained following the final impact test were used to identify pathology. Four specimens sustained skull fractures. Peak force, displacement, acceleration, energy, and head injury criterion variables were used to describe the dynamic biomechanics. Force and acceleration responses obtained from this experimental study along with other data will be of value in validating finite element models. The study underscored the need to enhance the sample size to derive probability-based human tolerance to side impacts.

  16. Bilateral osteochondritis dissecans of the lateral trochlea of the femur: a case report.

    PubMed

    Takahashi, Yoshimasa; Nawata, Koji; Hashiguchi, Hirokazu; Kawaguchi, Kei; Yamasaki, Daisuke; Tanaka, Hidetoshi

    2008-05-01

    Osteochondritis dissecans of the bilateral trochlea of femur is unusual case for orthopedic surgeon. The patient was a healthy 15-year-old male with symptomatic osteochondritis dissecans of the bilateral distal lateral femoral condyle of the trochlea. A surgery on the bilateral knee joints was performed simultaneously. The osteochondral free fragment of the right knee was resected by a minimum open surgery after arthroscopic evaluation. In the left knee the fragment was stabilized with multiple cortical bone pegs harvested from the proximal tibia. The surgery was successful, and the patient was able to play basketball 3 months postoperatively. The course of the right knee is currently under careful observation because of the possibility of recurrence. The left knee has remained in an excellent condition for 18 months following surgery with bone pegs.

  17. Laterally bendable belt conveyor

    SciTech Connect

    Peterson, W.J.

    1982-09-24

    An endless, laterally flexible and bendable belt conveyor particularly adapted for coal mining applications in facilitating the transport of the extracted coal up- or downslope and around corners in a continuous manner is disclosed. The conveying means includes a flat rubber belt reinforced along the middle portion thereof along which the major portion of the belt tension is directed so as to cause rotation of the tubular shaped belt when trammed around lateral turns thus preventing excessive belt bulging distortion between adjacent belt supports which would inhibit belt transport. Pretension induced into the fabric reinforced flat rubber belt by conventional belt take-up means supports the load conveyed when the belt conveyor is making lateral turns. The carrying and return portions of the belt are supported and formed into a tubular shape by a plurality of shapers positioned along its length. Each shaper is supported from above by a monorail and includes clusters of idler rollers which support the belt. Additional cluster rollers in each shaper permit the belt supporting roller clusters to rotate in response to the belt's operating tension imposed upon the cluster rollers by induced lateral belt friction forces. The freely rotating roller clusters thus permit the belt to twist on lateral curves without damage to itself while precluding escape of the conveyed material by effectively enclosing it in the tube-shaped, inner belt transport length.

  18. Laterally closed lattice homomorphisms

    NASA Astrophysics Data System (ADS)

    Toumi, Mohamed Ali; Toumi, Nedra

    2006-12-01

    Let A and B be two Archimedean vector lattices and let be a lattice homomorphism. We call that T is laterally closed if T(D) is a maximal orthogonal system in the band generated by T(A) in B, for each maximal orthogonal system D of A. In this paper we prove that any laterally closed lattice homomorphism T of an Archimedean vector lattice A with universal completion Au into a universally complete vector lattice B can be extended to a lattice homomorphism of Au into B, which is an improvement of a result of M. Duhoux and M. Meyer [M. Duhoux and M. Meyer, Extended orthomorphisms and lateral completion of Archimedean Riesz spaces, Ann. Soc. Sci. Bruxelles 98 (1984) 3-18], who established it for the order continuous lattice homomorphism case. Moreover, if in addition Au and B are with point separating order duals (Au)' and B' respectively, then the laterally closedness property becomes a necessary and sufficient condition for any lattice homomorphism to have a similar extension to the whole Au. As an application, we give a new representation theorem for laterally closed d-algebras from which we infer the existence of d-algebra multiplications on the universal completions of d-algebras.

  19. Laterally bendable belt conveyor

    DOEpatents

    Peterson, William J.

    1985-01-01

    An endless, laterally flexible and bendable belt conveyor particularly adapted for coal mining applications in facilitating the transport of the extracted coal up- or downslope and around corners in a continuous manner is disclosed. The conveying means includes a flat rubber belt reinforced along the middle portion thereof along which the major portion of the belt tension is directed so as to cause rotation of the tubular shaped belt when trammed around lateral turns thus preventing excessive belt bulging distortion between adjacent belt supports which would inhibit belt transport. Pretension induced into the fabric reinforced flat rubber belt by conventional belt take-up means supports the load conveyed when the belt conveyor is making lateral turns. The carrying and return portions of the belt are supported and formed into a tubular shape by a plurality of shapers positioned along its length. Each shaper is supported from above by a monorail and includes clusters of idler rollers which support the belt. Additional cluster rollers in each shaper permit the belt supporting roller clusters to rotate in response to the belt's operating tension imposed upon the cluster rollers by induced lateral belt friction forces. The freely rotating roller clusters thus permit the belt to twist on lateral curves without damage to itself while precluding escape of the conveyed material by effectively enclosing it in the tube-shaped, inner belt transport length.

  20. Diagnostic accuracy of cone beam computed tomography and conventional multislice spiral tomography in sheep mandibular condyle fractures

    PubMed Central

    Sirin, Y; Guven, K; Horasan, S; Sencan, S

    2010-01-01

    Objectives The aim of this study was to compare diagnostic accuracy of cone beam CT (CBCT) and multislice CT in artificially created fractures of the sheep mandibular condyle. Methods 63 full-thickness sheep heads were used in this study. Two surgeons created the fractures, which were either displaced or non-displaced. CBCT images were acquired by the NewTom 3G® CBCT scanner (NIM, Verona, Italy) and CT imaging was performed using the Toshiba Aquillon® multislice CT scanner (Toshiba Medical Systems, Otawara, Japan). Two-dimensional (2D) cross-sectional images and three-dimensional (3D) reconstructions were evaluated by two observers who were asked to determine the presence or absence of fracture and displacement, the type of fracture, anatomical localization and type of displacement. The naked-eye inspection during surgery served as the gold standard. Inter- and intra-observer agreements were calculated with weighted kappa statistics. The receiver operating characteristics (ROC) curve analyses were used to compare statistically the area under the curve (AUC) of both imaging modalities. Results Kappa coefficients of intra- and interobserver agreement scores varied between 0.56 – 0.98, which were classified as moderate and excellent, respectively. There was no statistically significant difference between the imaging modalities, which were both sensitive and specific for the diagnosis of sheep condylar fractures. Conclusions This study confirms that CBCT is similar to CT in the diagnosis of different types of experimentally created sheep condylar fractures and can provide a cost- and dose-effective diagnostic option. PMID:20729182

  1. The effect of local injection of the human growth hormone on the mandibular condyle growth in rabbit

    PubMed Central

    Feizbakhsh, Masood; Razavi, Mohammad; Minaian, Mohsen; Teimoori, Fatemeh; Dadgar, Sepideh; Maghsoodi, Shahlaa

    2014-01-01

    Background: The aim of this study was to evaluate the effect of local injection of human growth hormone (GH) in stimulating cartilage and bone formation in a rabbit model of temporomandibular joint (TMJ). Materials and Methods: In an experimental animal study, 16 male Albino New Zealand white rabbits aged 12 weeks were divided into two groups: In the first group (7 rabbits) 2 mg/kg/1 ml human GH and in the control group (9 rabbits) 1 ml normal saline was administered locally in both mandibular condyles. Injections were employed under sedation and by single experienced person. Injections were made for 6 times with 3 injections a week in the all test and control samples. Rabbits were sacrified at the 20th day from the beginning of study and TMJs were histologically examined. ANOVA (two-sided) with Dunnett post hoc test was used to compare data of bone and cartridge thickness while chi-square test was used to analyze hyperplasia and disk deformity data. P < 0.05 was considered as significant. Results: Cartilage layer thickness was greater in the GH-treated (0.413 ± 0.132) than the control group (0.287 ± 0.098) (P value = 0.02). Although bone thickness and condylar cartilage hyperplasia were greater in the GH-treated group, these differences were not statistically significant (P value = 0.189 and 0.083, respectively). There was no statistically significant difference between two groups regarding the disc deformity (P value = 0.46). Conclusion: Local injection of human GH in the TMJ is able to accelerate growth activity of condylar cartilage in rabbit. PMID:25225555

  2. Unusual atypical language lateralization.

    PubMed

    Khan, Muhammad T; Oghlakian, Roger; Koubeissi, Mohamad Z

    2016-01-01

    Determining the language-dominant hemisphere is essential for planning epilepsy surgery. A 60-year-old right-handed woman with epilepsy since age 16 failed a partial right anterior lobectomy at age 21. Later, a brain MRI found extensive right-sided cortical dysplasia and periventricular heterotopia. Subsequently, prolonged video-EEG monitoring localized her seizures to the right temporoparietal region. Functional MRI was inconclusive in lateralizing her language, prompting a Wada test, which strongly lateralized language to the right. This unique case of atypical language representation in a right-handed individual with an extensive right-hemispheric congenital malformation and seizure focus illustrates the important thorough presurgical language assessment. PMID:27668182

  3. Shape memory Ni-Ti alloy swan-like bone connector for treatment of humeral shaft nonunion

    PubMed Central

    Su, Jia-can; Liu, Xin-wei; Yu, Bao-qing; Li, Zhuo-dong

    2009-01-01

    From August 1990 to December 2007, 156 patients with humeral shaft nonunion were treated with our patented Ni-Ti shape memory alloy swan-like memory pressure connector (SMC). The SMC device cooled with ice before implantation was warmed to 40–50°C after implantation to produce balanced axial and compression forces to stabilise the fracture three-dimensionally. This combined with autologous bone grafting achieved bone tissue regeneration in the fracture and promoted smooth recovery of joint function, with a nonunion healing rate of 98.7% after a single SMC implantation. Failure of nonunion healing occurred in only two cases but was successfully managed by a further operation. Complications were not found in any of these patients apart from four with pre-existing radial nerve injuries. These results demonstrate the effectiveness of the SMC device for the management of humeral shaft nonunion. The device provides continuous compression of the fracture with minimal trauma to the local blood supply. PMID:19198838

  4. 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.

  5. Seasonal Temperature and Pin Site Care Regimen Affect the Incidence of Pin Site Infection in Pediatric Supracondylar Humeral Fractures

    PubMed Central

    Chen, Mei-Chuan; Lee, Wei-Chun; Yang, Wen-E; Chang, Chia-Hsieh

    2015-01-01

    Pin site infection is a common complication after fracture fixation and bone lengthening, and daily pin site care is recommended. Weather is a strong environmental factor of infection, but few articles studied the issue of weather and pin site infection. We performed a prospective comparative study of 61 children with supracondylar humeral fractures treated by closed reduction and percutaneous pinning. The patients were divided into high-temperature season or low-temperature season by the months they received surgery. The patients within each season were further allocated to 2 groups by the different postoperative pin site care methods of daily care or noncare. The infection rate per patient was significantly higher in the high-temperature season compared to low-temperature season (45% versus 19%, P = 0.045). In the high-temperature season, the infection rate per patient was significantly higher in the daily care group versus the noncare group (70% versus 20%, P = 0.001). In the low-temperature season, the infection rate per patient was not significantly different in the daily care group versus the noncare group (10% versus 27.3%, P = 0.33). We recommend that careful monitoring of infection signs, rather than pin site cleaning, would be appropriate in the treatment of pediatric supracondylar humeral fractures, especially during the summer months. PMID:26064957

  6. Reliability of a set of protractors for direct anatomical measurements around the glenoid and humeral head rims

    PubMed Central

    Amadi, Hippolite O; Fogg, Quentin A; Ugbolue, Ukadike C; Emery, Roger J H; Bull, Anthony M J

    2012-01-01

    Functional biomechanics studies of the glenohumeral (GH) soft tissues require an understanding of their sites of bony attachment. Anatomical positions of GH capsular structures have often been quantified relative to the rims of the glenoid and humeral head (HH). The aim of this study was twofold: (1) to quantify the reliability of a set of protractors that directly fit on to the glenoid and HH rims and (2) to use this to determine direct angular position referencing of landmarks and soft tissue attachment points. Three assessors independently used the protractors to assess nine prescribed landmarks on 30 dry bone specimens (15 glenoids and 15 HHs) recording the angular positions of the structures relative to the glenoid and HH. The collected data showed high levels of validity as indicated by the protractor’s intra- and inter-assessor reliabilities: 98.2 and 98.7% for the glenoid component, and 96.2 and 96.5% for the humeral component, respectively. The device could be useful in anatomical studies, description of defects and pathologies on glenohumeral articulation, and planning of scapular reconstructive surgery. PMID:22404237

  7. Iliotibial tract friction syndrome in athletes--an uncommon exertion syndrome on the lateral side of the knee.

    PubMed Central

    Orava, S.

    1978-01-01

    An uncommon exertion pain on the lateral side of the knee is described in 88 patients, in four of whom it was bilateral. The disorder is a result of the friction of the iliotibial tract over the lateral femoral epicondyle. The syndrome is the iliotibial tract friction syndrome of ITFS. All the patients in the material were active athletes or middle-aged joggers in regular training. The cases were seen over four years and four months. The mean age of them was approximately 25 years, and there were only nine women in the series. Th pain appeared usually after running and was localised on the outer femoral condyle, and often radiated downwards along the iliotibial tract. Conservative treatment and changes in training habits cured most cases. The disorder has not often been described in the literature, and seems to appear only in physically very active people, such as athletes or military recruits. PMID:687887

  8. Lateral Thinking of Prospective Teachers

    ERIC Educational Resources Information Center

    Lawrence, A. S. Arul; Xavier, S. Amaladoss

    2013-01-01

    Edward de Bono who invented the term "lateral thinking" in 1967 is the pioneer of lateral thinking. Lateral thinking is concerned with the generation of new ideas. Liberation from old ideas and the stimulation of new ones are twin aspects of lateral thinking. Lateral thinking is a creative skills from which all people can benefit…

  9. Lateral epicondylosis and calcific tendonitis in a golfer: a case report and literature review

    PubMed Central

    Yuill, Erik A.; Lum, Grant

    2011-01-01

    Objective To detail the progress of a young female amateur golfer who developed chronic left arm pain while playing golf 8 months prior to her first treatment visit. Clinical Features Findings included pain slightly distal to the lateral epicondyle of the elbow, decreased grip strength, and positive orthopedic testing. Diagnostic ultrasound showed thickening of the common extensor tendon origin indicating lateral epicondylosis. Radiographs revealed an oval shaped calcified density in the soft tissue adjacent to the lateral humeral epicondyle, indicating calcific tendonitis of the common extensor tendon origin. Intervention and Outcome Conventional care was aimed at decreasing the repetitive load on the common extensor tendon, specifically the extensor carpi radialis brevis. Soft tissue techniques, exercises and stretches, and an elbow brace helped to reduce repetitive strain. Outcome measures included subjective pain ratings, and follow up imaging 10 weeks after treatment began. Conclusion A young female amateur golfer with chronic arm pain diagnosed as lateral epicondylosis and calcific tendonitis was relieved of her pain after 7 treatments over 10 weeks of soft tissue and physical therapy focusing specifically on optimal healing and decreasing the repetitive load on the extensor carpi radialis brevis. PMID:22131570

  10. Laterally bendable belt conveyor

    SciTech Connect

    Peterson, W.J.

    1985-07-02

    An endless, laterally flexible and bendable belt conveyor particularly adapted for coal mining applications in facilitating the transport of the extracted coal up- or downslope and around corners in a continuous manner is disclosed. The conveying means includes a flat rubber belt reinforced along the middle portion thereof along which the major portion of the belt tension is directed so as to cause rotation of the tubular shaped belt when trammed around lateral turns thus preventing excessive belt bulging distortion between adjacent belt supports which would inhibit belt transport. Pretension induced into the fabric reinforced flat rubber belt by conventional belt take-up means supports the load conveyed when the belt conveyor is making laterial turns. The carrying and return portions of the belt are supported and formed into a tubular shape by a plurality of shapers positioned along its length. Each shaper is supported from above by a monorail and includes clusters of idler rolles which support the belt. Additional cluster rollers in each shaper permit the belt supporting roller clusters to rotate in response to the belt's operating tension imposed upon the cluster rollers by induced lateral belt friction forces. The freely rotating roller clusters thus permit the belt to twist on lateral curves without damage to itself while precluding escape of the conveyed material by effectively enclosing it in the tube-shaped, inner belt transport length.

  11. Humor in Later Life.

    ERIC Educational Resources Information Center

    Frazier, Billie H.

    This document contains a brief bibliography of peer-reviewed literature, with abstracts, on humor in later life. It is one of 12 bibliographies on aging prepared by the National Agricultural Library for its "Pathfinders" series of publications. Topics covered by the other 11 bibliographies include aging parents, adult children, dementia and…

  12. Holographic lateral shear interferometer.

    PubMed

    Malacara, D; Mallick, S

    1976-11-01

    A new type of lateral shear holographic interferometer is described. It can be used to test lenses as well as spherical and aspherical surfaces. A null pattern with straight fringes can be obtained for an aspherical surface, provided one has a prototype that can be used for making the hologram.

  13. Open reduction and internal fixation of extracapsular mandibular condyle fractures: a long-term clinical and radiological follow-up of 25 patients

    PubMed Central

    2014-01-01

    Background During the last 2 decades, many studies on the treatment of mandibular condyle fracture have been published. The incidence of mandibular condyle fractures is variable, ranging from 17.5% to 52% of all mandibular fractures. This retrospective study evaluated the long-term clinical and radiological outcomes after surgical treatment of 25 patients with a total of 26 extracapsular condyle fractures. Methods We used 2 types of surgical approaches, the retromandibular retroparotid or preauricular approach. Three kinds of rigid internal fixation plates were used—single plate, double plate, and trapezoidal plate. The following post-operative clinical parameters were evaluated: dental occlusion, facial nerve functionality, skin scarring, and temporomandibular joint functionality. All patients underwent post-operative orthopanoramic radiography and computed tomography. The patients were also monitored for complications such as Frey’s syndrome, infection, salivary fistula, plate fracture, and permanent paralysis of the facial nerve; the patient’s satisfaction was also recorded. Results Of the 25 patients, 80% showed occlusion recovery, 88% had no facial nerve injury, and 88% presented good surgical skin scarring. The patients showed early complete recovery of temporomandibular joint functionality and 72% of them were found to be asymptomatic. The postoperative radiographs of all patients indicated good recovery of the anatomical condylar region, and 80% of them had no postoperative complications. The average degree of patient satisfaction was 8.32 out of 10. Our results confirm that the technique of open reduction and internal fixation in association with postoperative functional rehabilitation therapy should be considered for treating patients with extracapsular condylar fractures. Conclusion The topic of condylar injury has generated more discussion and controversy than any other topic in the field of maxillofacial trauma. We confirm that open reduction and

  14. Internal Fixation Versus Nonoperative Treatment for Displaced 3-Part or 4-Part Proximal Humeral Fractures in Elderly Patients: A Meta-Analysis of Randomized Controlled Trials

    PubMed Central

    Li, Jing; Chen, Aimin

    2013-01-01

    Background A few studies focused on open reduction and internal fixation (ORIF) or nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients have been published, all of whom had a low number of patients. In this meta-analysis of randomized controlled trials (RCTs), we aimed to assess the effect of ORIF or nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients on the clinical outcomes and re-evaluate of the potential benefits of conservative treatment. Methods We searched PubMed and the Cochrane Central Register of Controlled Trials databases for randomized controlled trials comparing ORIF and nonoperative treatment of displaced 3-part or 4-part proximal humeral fractures in elderly patients. Our outcome measures were the Constant scores. Results: Three randomized controlled trials with a total of 130 patients were identified and analyzed. The overall results based on fixed-effect model did not support the treatment of open reduction and internal fixation to improve the functional outcome when compared with nonoperative treatment for treating elderly patients with displaced 3-part or 4-part proximal humeral fractures (WMD −0.51, 95% CI: −7.25 to 6.22, P = 0.88, I2 = 0%). Conclusions Although our meta-analysis did not support the treatment of open reduction and internal fixation to improve the functional outcome when compared with nonoperative treatment for treating elderly patients with displaced 3-part or 4-part proximal humeral fractures, this result must be considered in the context of variable patient demographics. Only a limited recommendation can be made based on current data. Considering the limitations of included studies, a large, well designed trial that incorporates the evaluation of clinically relevant outcomes in participants with different underlying risks of shoulder function is required to more adequately assess the role for ORIF or nonoperative

  15. Spontaneous hyaline cartilage regeneration can be induced in an osteochondral defect created in the femoral condyle using a novel double-network hydrogel

    PubMed Central

    2011-01-01

    Background Functional repair of articular osteochondral defects remains a major challenge not only in the field of knee surgery but also in tissue regeneration medicine. The purpose is to clarify whether the spontaneous hyaline cartilage regeneration can be induced in a large osteochondral defect created in the femoral condyle by means of implanting a novel double-network (DN) gel at the bottom of the defect. Methods Twenty-five mature rabbits were used in this study. In the bilateral knees of each animal, we created an osteochondral defect having a diameter of 2.4-mm in the medial condyle. Then, in 21 rabbits, we implanted a DN gel plug into a right knee defect so that a vacant space of 1.5-mm depth (in Group I), 2.5-mm depth (in Group II), or 3.5-mm depth (in Group III) was left. In the left knee, we did not apply any treatment to the defect to obtain the control data. All the rabbits were sacrificed at 4 weeks, and the gross and histological evaluations were performed. The remaining 4 rabbits underwent the same treatment as used in Group II, and real-time PCR analysis was performed at 4 weeks. Results The defect in Group II was filled with a sufficient volume of the hyaline cartilage tissue rich in proteoglycan and type-2 collagen. The Wayne's gross appearance and histology scores showed that Group II was significantly greater than Group I, III, and Control (p < 0.012). The relative expression level of type-2 collagen, aggrecan, and SOX9 mRNAs was significantly greater in Group II than in the control group (p < 0.023). Conclusions This study demonstrated that spontaneous hyaline cartilage regeneration can be induced in vivo in an osteochondral defect created in the femoral condyle by means of implanting the DN gel plug at the bottom of the defect so that an approximately 2-mm deep vacant space was intentionally left in the defect. This fact has prompted us to propose an innovative strategy without cell culture to repair osteochondral lesions in the femoral

  16. Diverse Aquatic Adaptations in Nothosaurus spp. (Sauropterygia)—Inferences from Humeral Histology and Microanatomy

    PubMed Central

    Klein, Nicole; Sander, P. Martin; Krahl, Anna; Scheyer, Torsten M.; Houssaye, Alexandra

    2016-01-01

    , and possibly sexual dimorphism. Humeral microanatomy documents the diversification of nothosaur species into different environments to avoid intraclade competition as well as competition with other marine reptiles. Nothosaur microanatomy indicates that knowledge of processes involved in secondary aquatic adaptation and their interaction are more complex than previously believed. PMID:27391607

  17. Diverse Aquatic Adaptations in Nothosaurus spp. (Sauropterygia)-Inferences from Humeral Histology and Microanatomy.

    PubMed

    Klein, Nicole; Sander, P Martin; Krahl, Anna; Scheyer, Torsten M; Houssaye, Alexandra

    2016-01-01

    , and possibly sexual dimorphism. Humeral microanatomy documents the diversification of nothosaur species into different environments to avoid intraclade competition as well as competition with other marine reptiles. Nothosaur microanatomy indicates that knowledge of processes involved in secondary aquatic adaptation and their interaction are more complex than previously believed. PMID:27391607

  18. Lateral flow assays.

    PubMed

    Koczula, Katarzyna M; Gallotta, Andrea

    2016-06-30

    Lateral flow assays (LFAs) are the technology behind low-cost, simple, rapid and portable detection devices popular in biomedicine, agriculture, food and environmental sciences. This review presents an overview of the principle of the method and the critical components of the assay, focusing on lateral flow immunoassays. This type of assay has recently attracted considerable interest because of its potential to provide instantaneous diagnosis directly to patients. The range and interpretation of results and parameters used for evaluation of the assay will also be discussed. The main advantages and disadvantages of LFAs will be summarized and relevant future improvements to testing devices and strategies will be proposed. Finally, the major recent advances and future diagnostic applications in the LFA field will be explored. PMID:27365041

  19. Lateral flow assays

    PubMed Central

    Koczula, Katarzyna M.

    2016-01-01

    Lateral flow assays (LFAs) are the technology behind low-cost, simple, rapid and portable detection devices popular in biomedicine, agriculture, food and environmental sciences. This review presents an overview of the principle of the method and the critical components of the assay, focusing on lateral flow immunoassays. This type of assay has recently attracted considerable interest because of its potential to provide instantaneous diagnosis directly to patients. The range and interpretation of results and parameters used for evaluation of the assay will also be discussed. The main advantages and disadvantages of LFAs will be summarized and relevant future improvements to testing devices and strategies will be proposed. Finally, the major recent advances and future diagnostic applications in the LFA field will be explored. PMID:27365041

  20. Lateral Attitude Change.

    PubMed

    Glaser, Tina; Dickel, Nina; Liersch, Benjamin; Rees, Jonas; Süssenbach, Philipp; Bohner, Gerd

    2015-08-01

    The authors propose a framework distinguishing two types of lateral attitude change (LAC): (a) generalization effects, where attitude change toward a focal object transfers to related objects, and (b) displacement effects, where only related attitudes change but the focal attitude does not change. They bring together examples of LAC from various domains of research, outline the conditions and underlying processes of each type of LAC, and develop a theoretical framework that enables researchers to study LAC more systematically in the future. Compared with established theories of attitude change, the LAC framework focuses on lateral instead of focal attitude change and encompasses both generalization and displacement. Novel predictions and designs for studying LAC are presented.

  1. Conjugal amyotrophic lateral sclerosis

    PubMed Central

    Dewitt, John D.; Kwon, Julia; Burton, Rebecca

    2012-01-01

    Amyotrophic lateral sclerosis (ALS) is a disease characterized by progressive degeneration of motor neurons in the motor cortex, brainstem, and spinal cord. The incidence of sporadic ALS is 1.5 to 2.7 in 100,000, and the prevalence is 5.2 to 6.0 in 100,000. Conjugal ALS is even rarer than sporadic ALS. We report a case of conjugal ALS encountered in our outpatient neurology clinic. PMID:22275781

  2. Hemispheric lateralization in reasoning.

    PubMed

    Turner, Benjamin O; Marinsek, Nicole; Ryhal, Emily; Miller, Michael B

    2015-11-01

    A growing body of evidence suggests that reasoning in humans relies on a number of related processes whose neural loci are largely lateralized to one hemisphere or the other. A recent review of this evidence concluded that the patterns of lateralization observed are organized according to two complementary tendencies. The left hemisphere attempts to reduce uncertainty by drawing inferences or creating explanations, even at the cost of ignoring conflicting evidence or generating implausible explanations. Conversely, the right hemisphere aims to reduce conflict by rejecting or refining explanations that are no longer tenable in the face of new evidence. In healthy adults, the hemispheres work together to achieve a balance between certainty and consistency, and a wealth of neuropsychological research supports the notion that upsetting this balance results in various failures in reasoning, including delusions. However, support for this model from the neuroimaging literature is mixed. Here, we examine the evidence for this framework from multiple research domains, including an activation likelihood estimation analysis of functional magnetic resonance imaging studies of reasoning. Our results suggest a need to either revise this model as it applies to healthy adults or to develop better tools for assessing lateralization in these individuals. PMID:26426534

  3. Complication rates and outcomes stratified by treatment modalities in proximal humeral fractures: a systematic literature review from 1970–2009

    PubMed Central

    2013-01-01

    Background The optimal treatment of complex, displaced proximal humeral fractures is controversial. A systematic literature review of the time period from 1970 to 2009 was conducted. The purpose was to evaluate the clinical success and complications of the available treatment modalities to determine specific treatment recommendations for the different fracture patterns. Methods The databases (PubMed/EMBASE) were searched for the time period (01/1970–09/2009). Study quality, treatment modalities, classification, outcome scores and complications of 200 publications including 9377 patients were analyzed. Interventions were compared by analysis of variance with subsequent Tukey’s-test. Complication rates among methods were compared by using Pearson’s-chi-square-test and pairwise comparisons using Fisher’s-two-tailed-exact-test. Results Hemiarthroplasty, angle-stable plate and non-operative treatment were used for 63% of the follow-up-patients. For 3- and 4-part fractures, patients with hemiarthroplasty [3-Part: 56.4 (lower/upper 95% confidence interval (CI): 43.3-68.7); 4-Part: 49.4 (CI: 42.2-56.7)] received a lower score than different surgical head-preserving methods such as ORIF [3-Part: 82.4 (CI: 76.6-86.9); 4-Part: 83.0 (CI:78.7-86.6)], intramedullary nailing [3-Part: 79.1 (CI:74.0-83.4)] or angle-stable plates [4-Part: 66.4 (CI: 59.7-72.4)]. The overall complication rate was 56%. The most common complications were fracture-displacement, malunion, humeral head necrosis and malreduction. The highest complication rates were documented for conventional plate and hemiarthroplasty and for AO-C, AO-A, for 3- and 4-part fractures. Only 25% of the data were reported with detailed classification results and the corresponding outcome scores. Discussion Despite the large amount of patients included, it is difficult to determine adequate recommendations for the treatment of proximal humeral fractures because a relevant lack of follow-up data impaired subsequent

  4. Popliteal vascular entrapment syndrome caused by variant lateral head of the gastrocnemius muscle leading to pulmonary artery embolism.

    PubMed

    Wang, Maohua; Zhang, Shiyi; Wu, Xuejun; Jin, Xing; Zhang, Jingyong

    2012-11-01

    A young man with popliteal vascular entrapment syndrome (PVES) presented with arterial occlusion, deep venous thrombosis (DVT), pulmonary artery embolism, and pulmonary hypertension. He received computer tomography (CT) and magnetic resonance imaging (MRI). Both CT and MRI showed that the left thrombosed popliteal vein and artery were entrapped by a variant lateral head of the gastrocnemius muscle. The anomalous slip originated from the lateral head of left gastrocnemius muscle and ended between the medial and lateral femoral condyles. PVES Type V was diagnosed. Compression of the popliteal vein without arterial compression can be explained by the more lateral location of the popliteal vein relative to the artery and its proximity to the lateral head of the gastrocnemius. Compression of the popliteal vein with arterial compression was found in this patient. Compression of popliteal vein and artery in this patient led to DVT and arterial occlusion. The case was the first reported case accompanied by popliteal vein and artery thrombosis caused by variant lateral head of the gastrocnemius muscle. Radiologists and doctors should continue to look for possible abnormalities in the popliteal fossa in young patients with peripheral vascular disease because early diagnosis of PVES allows better choices and outcomes of treatment.

  5. The classification of complex 4-part humeral fractures revisited: the missing fifth fragment and indications for surgery.

    PubMed

    Russo, Raffaele; Cautiero, Fabio; Della Rotonda, Giuseppe

    2012-05-01

    We describe a new classification of complex 4-part proximal humeral fractures (PHF). Its novelty lies in the involvement of fractures of the calcar area (i.e., the missing fifth fragment) in relation to fragments of the head, tuberosities and shaft. The classification consists of 6 groups (divided into 15 subgroups) of calcar fracture patterns. We hypothesized that this classification could aid surgical decision making in terms of osteosynthesis versus prothesis. To test this hypothesis, two shoulder surgeons, trained in the classification, re-examined the X-rays and CT scans of 100 cases of 4-part PHF to codify each calcar fracture pattern. CT scans proved to be essential for this process. We then theoretically assigned the most appropriate treatment to each subgroup. Subsequent verification of clinical records confirmed our hypothesis that this classification could help the surgeon to decide the best approach to complex 4-part PHF.

  6. Successful treatment of a humeral capitulum osteonecrosis with bone morphogenetic protein-7 combined with autologous bone grafting.

    PubMed

    Marsell, Richard; Hailer, Nils P

    2014-08-01

    We present the case of a 27-year-old female with subcortical osteonecrosis of the humeral capitulum. Percutaneous retrograde drilling of the lesion and application of recombinant human bone morphogenetic protein (BMP)-7 were combined with autologous bone grafting. At follow-up the patient was almost pain-free, had normalized her range of motion, and radiography showed consolidation of the lesion without any heterotopic bone formation. By timing surgery prior to subchondral collapse, biomechanical stability of the subchondral bone was maintained. To our knowledge, this is the first report on the treatment of an osteonecrosis in this location with a BMP, and this strategy could potentially be applied in other locations with juxta-articular osteonecrosis. PMID:25017508

  7. OSTEOSYNTHESIS OF PROXIMAL HUMERAL END FRACTURES WITH FIXED-ANGLE PLATE AND LOCKING SCREWS: TECHNIQUE AND RESULTS

    PubMed Central

    Cohen, Marcio; Amaral, Marcus Vinicius; Monteiro, Martim; Brandão, Bruno Lobo; Motta Filho, Geraldo Rocha

    2015-01-01

    Describe the results of proximal humeral fractures surgically treated with the Philos locking plate system. Method: Between March 2003 and October 2004 we prospectively reviewed 24 of 26 patients with proximal humerus fractures treated with a Philos plate. The mean follow-up time was 12 months and the mean age of patients was 57 years. Six patients had four-part proximal humerus fractures, 11 patients had three-part proximal humerus fractures, and nine patients had two-part proximal humerus fractures. Clinical evaluation was performed using the University of California at Los Angeles (UCLA) criteria. Results: The mean UCLA score was 30 points (17-34). All fractures showed union. Three patients showed fracture union at varus position. The mean UCLA score for these patients was 27 points. Conclusion: Osteosynthesis with Philos plate provides a stable fixation method with good functional outcome. PMID:26998460

  8. EVALUATION OF PATIENTS UNDERGOING FIXATION OF DIAPHYSEAL HUMERAL FRACTURES USING THE MINIMALLY INVASIVE BRIDGE-PLATE TECHNIQUE

    PubMed Central

    Superti, Mauro José; Martynetz, Fábio; Falavinha, Ricardo Sprenger; Fávaro, Rodrigo Caldonazzo; Boas, Luis Felipe Villas; Filho, Salim Mussi; Martynetz, Juliano; Ribas, Bruno

    2015-01-01

    Objective: The aim was to describe the experience of our group in treating humeral shaft fractures using the bridge–plate technique via an anterior approach. Methods: Seventeen patients with acute diaphyseal humeral fractures with an indication for surgical treatment who were operated in 2006–2010 were evaluated. The AO and Gustilo & Anderson classifications were used. All the patients were operated using the anterior bridge-plate technique and completed a follow–up period of at least twelve months. Results: Sixteen men and one woman were treated. Their mean age was 31.8 years (18–52). Among the injury mechanisms found were: five motorcycle accidents, four car accidents, three fractures due to firearm projectiles, two falls to the ground and finally, with one case each, assault, crushing and being run over. Eight patients had open fractures: two grade I, one grade II, four grade IIIa and one grade IIIb, according to the Gustilo-Anderson classification. In relation to the AO classification, we found: one 12A1, three 12A2, four 12A3, one 12B1, four 12 B2, three 12B3 and one 12C2. The mean postoperative follow-up was 25 months (12–48). As complications, two patients had pain in the elbow and a ROM deficit and one had deep infection. The mean time taken to achieve consolidation was 17.5 weeks. There was no loss of reduction, pseudarthrosis or malunion in this series of patients. Conclusion: The authors believe that the technique described has low rates of complications and morbidity, with good initial results, although the series is limited by the small sample. PMID:27042639

  9. Stemless humeral component in reverse shoulder prosthesis in patient with Parkinson’s disease: a case report

    PubMed Central

    Giannotti, Stefano; Bottai, Vanna; Dell’Osso, Giacomo; Bugelli, Giulia; Guido, Giulio

    2015-01-01

    Summary Introduction In patients with Parkinson’s disease falling is very common and for this reason, the prosthetic surgical indication in shoulder is reserved for special cases. PD has been linked to several interrelated factors that may contribute to failure of shoulder arthroplasty. Case presentation A 65-year-old woman with PD, severe pain, recurrent bursitis, swelling and functional limitation to all movements in left shoulder presented to our attention. Radiographic and CT exams show cuff-tear arthropathy. The patient was submitted to implantation of a Reverse Shoulder Comprehensive Nano cementless modular system (Biomet®, Warsaw, IN, USA) with anterosuperior surgical approach. We chose this kind of solution of stemless humeral component after bone mineral consideration. Discussion Reverse shoulder arthroplasty represents an option in the management of glenohumeral arthritis. Poor functional results of RTSA in patients with PD have been attributed to increased muscle tone, severity of tremor and an increased mortality rate. In general, post operative complications related to the humeral component are dominated by fractures (between 1 and 3%): in patients with PD this percentage is higher because of falls often occur. With a stemless implant revisions can be performed easily. Overall, the anterosuperior surgical exposure gives a low risk of postoperative instability. Conclusion In selected cases of patients with PD, after carefully analysis of bone quality, the use of a stemless component is of benefit in the possible revision cases for periprosthetic fractures and the use of an anterosuperior exposure reduces the percentage of instability. The results obtained about the pain relief are excellent in contrast with functional outcomes that remain poor. PMID:26136798

  10. Two-Dimensional Strain Fields on the Cross-Section of the Bovine Humeral Head Under Contact Loading

    PubMed Central

    Canal, Clare E.; Hung, Clark T.; Ateshian, Gerard A.

    2008-01-01

    The objective of this study was to provide a detailed experimental assessment of the two-dimensional cartilage strain distribution on the cross-section of immature and mature bovine humeral heads subjected to contact loading at a relatively rapid physiological loading rate. Six immature and six mature humeral head specimens were loaded against glass and strains were measured at the end of a 5 s loading ramp on the textured articular cross-section using digital image correlation analysis. The primary findings indicate that elevated tensile and compressive strains occur near the articular surface, around the center of the contact region. Few qualitative or quantitative differences were observed between mature and immature joints. Under an average contact stress of ~1.7 MPa, the peak compressive strains averaged −0.131 ± 0.048, which was significantly less than the relative change in cartilage thickness, −0.104 ± 0.032 (p < 0.05). The peak tensile strains were significantly smaller in magnitude, at 0.0325 ± 0.013. These experimental findings differ from a previous finite element analysis of articular contact, which predicted peak strains at the cartilage-bone interface even when accounting for the porous-hydrated nature of the tissue, its depth-dependent inhomogeneity, and the disparity between its tensile and compressive properties. These experimental results yield new insights into the local mechanical environment of the tissue and cells, and suggest that further refinements are needed in the modeling of contacting articular layers. PMID:18952212

  11. Scapular Resting Position and Gleno-Humeral Movement Dysfunction in Asymptomatic Racquet Players: A Case-Control Study

    PubMed Central

    Shimpi, Apurv P.; Bhakti, Shah; Roshni, Karnik; Rairikar, Savita A.; Shyam, Ashok; Sancheti, Parag K.

    2015-01-01

    Background: Racquet sports, especially lawn tennis and badminton have been gaining popularity in Asian countries like India. With this increase in popularity, the injury rate in the sport has also increased. Objectives: The study will help detect the presence of gleno-humeral movement dysfunction and scapular resting position abnormality in asymptomatic racquet players, thus providing basis for screening the players and allow the clinician to determine if the asymmetry is a normal adaptation in the player or an abnormal change associated with injury. Materials and Methods: 46 asymptomatic professional players were divided into a study group of 23 players (16 tennis and 7 badminton) and control group of 23 football players. Assessment of passive gleno-humeral range of motion and distance of spine and inferior angle of scapula from corresponding spinous process were measured bilaterally and between groups. Results: There was statistically significant reduction in range of internal rotation (62.17 ± 8.09), extension (39.78 ± 4.12) and an increase in the external rotation (106.95 ± 7.49) of dominant compared to non-dominant arm of racquet players and a statistically significant decrease in internal rotation (78.69 ± 10.24), extension (44.78 ± 3.19), adduction (37.39 ± 6.54) and an increase in external rotation (102.6 ± 5.19) of dominant arm of racquet players compared to football players. Study also showed statistically significant increase in the spino-scapular distance at the level of inferior angle of scapula (10.23 ± 1.43) on dominant side compared to non-dominant. Conclusions: The dominant side scapula of asymptomatic racquet players showed increased external rotation and elevation as compared to the non-dominant side. Also, reduced shoulder internal rotation, extension and adduction and gain in shoulder external rotation was observed on the dominant side of racquet players when compared to the control group. PMID:26715968

  12. Lateral Lumbar Interbody Fusion.

    PubMed

    Pawar, Abhijit; Hughes, Alexander; Girardi, Federico; Sama, Andrew; Lebl, Darren; Cammisa, Frank

    2015-12-01

    The lateral lumbar interbody fusion (LLIF) is a relatively new technique that allows the surgeon to access the intervertebral space from a direct lateral approach either anterior to or through the psoas muscle. This approach provides an alternative to anterior lumbar interbody fusion with instrumentation, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for anterior column support. LLIF is minimally invasive, safe, better structural support from the apophyseal ring, potential for coronal plane deformity correction, and indirect decompression, which have has made this technique popular. LLIF is currently being utilized for a variety of pathologies including but not limited to adult de novo lumbar scoliosis, central and foraminal stenosis, spondylolisthesis, and adjacent segment degeneration. Although early clinical outcomes have been good, the potential for significant neurological and vascular vertebral endplate complications exists. Nevertheless, LLIF is a promising technique with the potential to more effectively treat complex adult de novo scoliosis and achieve predictable fusion while avoiding the complications of traditional anterior surgery and posterior interbody techniques. PMID:26713134

  13. Lateral Lumbar Interbody Fusion

    PubMed Central

    Hughes, Alexander; Girardi, Federico; Sama, Andrew; Lebl, Darren; Cammisa, Frank

    2015-01-01

    The lateral lumbar interbody fusion (LLIF) is a relatively new technique that allows the surgeon to access the intervertebral space from a direct lateral approach either anterior to or through the psoas muscle. This approach provides an alternative to anterior lumbar interbody fusion with instrumentation, posterior lumbar interbody fusion, and transforaminal lumbar interbody fusion for anterior column support. LLIF is minimally invasive, safe, better structural support from the apophyseal ring, potential for coronal plane deformity correction, and indirect decompression, which have has made this technique popular. LLIF is currently being utilized for a variety of pathologies including but not limited to adult de novo lumbar scoliosis, central and foraminal stenosis, spondylolisthesis, and adjacent segment degeneration. Although early clinical outcomes have been good, the potential for significant neurological and vascular vertebral endplate complications exists. Nevertheless, LLIF is a promising technique with the potential to more effectively treat complex adult de novo scoliosis and achieve predictable fusion while avoiding the complications of traditional anterior surgery and posterior interbody techniques. PMID:26713134

  14. The effect of condylectomy on extreme lateral transcondylar approach to the anterior foramen magnum.

    PubMed

    Açikbaş, S C; Tuncer, R; Demirez, I; Rahat, O; Kazan, S; Sindel, M; Saveren, M

    1997-01-01

    The dorsolateral, suboccipital, transcondylar technique was used in this cadaveric study. The angle and distance measurements in the corridors were taken intradurally both superior and inferior of the foramen magnum level. In the first stage of this study, the findings which were gained from the standard lateral suboccipital approach were compared with the findings after condyle and lateral atlantal mass removal. After condylectomy, the approach to anterior foramen magnum via both corridors was found to be shorter and the lateral angle of the exposure of the anterior foramen magnum was found to be wider. The considerable shortening of the distances to the anterior foramen magnum, especially in the superior corridor, emphasises the necessity of combining standard approaches with condylectomy. In addition, it was found that after condylectomy, considerable widening of both transverse and longitudinal planes in the inferior corridor allows the surgeon greater access to work on lesions. Furthermore, the freed space between the superior corridor and the interior corridor, which was gained by condylectomy, shows that condylectomy provides a combined approach to the inferior and superior parts of the foramen magnum anteriorly. PMID:9248589

  15. 8. UPPER INSIDE CHORD, VERTICAL, LATERAL STRUT, UPPER LATERAL & ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    8. UPPER INSIDE CHORD, VERTICAL, LATERAL STRUT, UPPER LATERAL & GUSSET PLATE, ONE DIAGONAL BRACE - Enterprise Parker Truss Bridge, Spanning Smoky Hill River on K-43 Highway, Enterprise, Dickinson County, KS

  16. 7. UPPER INSIDE CHORD, VERTICAL, LATERAL STRUT, UPPER LATERAL & ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    7. UPPER INSIDE CHORD, VERTICAL, LATERAL STRUT, UPPER LATERAL & GUSSET PLATE, TWO DIAGONAL BRACES - Enterprise Parker Truss Bridge, Spanning Smoky Hill River on K-43 Highway, Enterprise, Dickinson County, KS

  17. Laterality and language experience.

    PubMed

    Hull, Rachel; Vaid, Jyotsna

    2006-09-01

    A meta-analysis was conducted on studies that examined hemispheric functional asymmetry for language in brain-intact monolingual and bilingual adults. Data from 23 laterality studies that directly compared bilingual and monolingual speakers on the same language were analysed (n = 1234). Variables examined were language experience (monolingual, bilingual), experimental paradigm (dichotic listening, visual hemifield presentation, and dual task) and, among bilinguals, the influence of second language proficiency (proficient vs nonproficient) and onset of bilingualism (early, or before age 6; and late, or after age 6). Overall, monolinguals and late bilinguals showed reliable left hemisphere dominance, while early bilinguals showed reliable bilateral hemispheric involvement. Within bilinguals, there was no reliable effect of language proficiency when age of L2 acquisition was controlled. The findings indicate that early learning of one vs. two languages predicts divergent patterns of cerebral language lateralisation in adulthood. PMID:16882556

  18. Lateral Flow Immunoassay.

    PubMed

    Ching, Kathryn H

    2015-01-01

    Lateral flow immunoassays (LFIAs) are a staple in the field of rapid diagnostics. These small handheld devices require no specialized training or equipment to operate, and generate a result within minutes of sample application. They are an ideal format for many types of home test kits, for emergency responders and for food manufacturers and producers looking for a quick evaluation of a given sample. LFIAs rely on high quality monoclonal antibodies that recognize the analyte of interest. As monoclonal antibody technology becomes more accessible to smaller laboratories, there has been increased interest in developing LFIA prototypes for potential commercial manufacture. In this chapter, the basics of designing and building an LFIA prototype are described. PMID:26160571

  19. Lateral conduction infrared photodetector

    DOEpatents

    Kim, Jin K.; Carroll, Malcolm S.

    2011-09-20

    A photodetector for detecting infrared light in a wavelength range of 3-25 .mu.m is disclosed. The photodetector has a mesa structure formed from semiconductor layers which include a type-II superlattice formed of alternating layers of InAs and In.sub.xGa.sub.1-xSb with 0.ltoreq.x.ltoreq.0.5. Impurity doped regions are formed on sidewalls of the mesa structure to provide for a lateral conduction of photo-generated carriers which can provide an increased carrier mobility and a reduced surface recombination. An optional bias electrode can be used in the photodetector to control and vary a cut-off wavelength or a depletion width therein. The photodetector can be formed as a single-color or multi-color device, and can also be used to form a focal plane array which is compatible with conventional read-out integrated circuits.

  20. Laterality and language experience.

    PubMed

    Hull, Rachel; Vaid, Jyotsna

    2006-09-01

    A meta-analysis was conducted on studies that examined hemispheric functional asymmetry for language in brain-intact monolingual and bilingual adults. Data from 23 laterality studies that directly compared bilingual and monolingual speakers on the same language were analysed (n = 1234). Variables examined were language experience (monolingual, bilingual), experimental paradigm (dichotic listening, visual hemifield presentation, and dual task) and, among bilinguals, the influence of second language proficiency (proficient vs nonproficient) and onset of bilingualism (early, or before age 6; and late, or after age 6). Overall, monolinguals and late bilinguals showed reliable left hemisphere dominance, while early bilinguals showed reliable bilateral hemispheric involvement. Within bilinguals, there was no reliable effect of language proficiency when age of L2 acquisition was controlled. The findings indicate that early learning of one vs. two languages predicts divergent patterns of cerebral language lateralisation in adulthood.

  1. Lateral Abdominal Wall Reconstruction

    PubMed Central

    Baumann, Donald P.; Butler, Charles E.

    2012-01-01

    Lateral abdominal wall (LAW) defects can manifest as a flank hernias, myofascial laxity/bulges, or full-thickness defects. These defects are quite different from those in the anterior abdominal wall defects and the complexity and limited surgical options make repairing the LAW a challenge for the reconstructive surgeon. LAW reconstruction requires an understanding of the anatomy, physiologic forces, and the impact of deinnervation injury to design and perform successful reconstructions of hernia, bulge, and full-thickness defects. Reconstructive strategies must be tailored to address the inguinal ligament, retroperitoneum, chest wall, and diaphragm. Operative technique must focus on stabilization of the LAW to nonyielding points of fixation at the anatomic borders of the LAW far beyond the musculofascial borders of the defect itself. Thus, hernias, bulges, and full-thickness defects are approached in a similar fashion. Mesh reinforcement is uniformly required in lateral abdominal wall reconstruction. Inlay mesh placement with overlying myofascial coverage is preferred as a first-line option as is the case in anterior abdominal wall reconstruction. However, interposition bridging repairs are often performed as the surrounding myofascial tissue precludes a dual layered closure. The decision to place bioprosthetic or prosthetic mesh depends on surgeon preference, patient comorbidities, and clinical factors of the repair. Regardless of mesh type, the overlying soft tissue must provide stable cutaneous coverage and obliteration of dead space. In cases where the fasciocutaneous flaps surrounding the defect are inadequate for closure, regional pedicled flaps or free flaps are recruited to achieve stable soft tissue coverage. PMID:23372458

  2. A CAD-CAM-prototyped temporomandibular condyle connected to a bony plate to support a free fibula flap in patients undergoing mandiblectomy: A pilot study with 5 years of follow up.

    PubMed

    Ciocca, Leonardo; Tarsitano, Achille; Marchetti, Claudio; Scotti, Roberto

    2016-07-01

    Reconstruction of the condyle after an ablative procedure with the aim of cancer elimination remains surgically challenging. This pilot study focused on mandibular condylar replacement using CAD-CAM temporomandibular prostheses connected to customized reconstructive plates to support free fibula flaps in oncological patients. Five patients underwent mandibular disarticulation resection, and two of them completed their 5-year follow ups. The condylar anatomy, the position of the condyle within the glenoid fossa, and glenoid anatomy were measured by superimposing pre- and postoperative CT images (obtained after 6 months and 5 years of follow up). When comparing condyle anatomy, the shift was no more than 0.19 mm; when calculating condyle downward displacement the values were inferior to 2.92 mm; when analyzing glenoid fossa thickness, in case #1, glenoid fossa thickness increased by 0.62 and 0.48 mm at the 6-month and 5-year follow ups, respectively, and in case #2 were 0.50 and -0.11 mm, respectively. The hypothesis that the absence of anatomical change would prevent biodynamic alteration of tissues of the articulation chamber (the glenoid fossa, the synovial liquid, and the disc) was confirmed by the preliminary findings of this study. PMID:27235153

  3. Migration of calcium deposits into subacromial-subdeltoid bursa and into humeral head as a rare complication of calcifying tendinitis: sonography and imaging.

    PubMed

    Della Valle, Valeria; Bassi, Emilio Maria; Calliada, Fabrizio

    2015-09-01

    Calcifying tendinitis of the shoulder is a common condition characterized by the deposition of calcium, predominantly hydroxyapatite crystals, in the rotator cuff. A rare complication of this condition is the migration of calcium deposits from tendons, usually the supraspinatus, into the subacromial-subdeltoid bursa or into the humeral greater tuberosity. These complications are responsible for intense acute shoulder pain and functional disability. Patient anamnesis and clinical symptoms must be considered to make the diagnosis, but imaging, particularly sonography, is often necessary, showing a typical presentation related to the locations of calcium deposits. We present sonographic and other imaging features of subacromial-subdeltoid bursitis and humeral osteitis related to the migration of calcium.

  4. Lateral compartment cartilage changes and lateral elbow pain.

    PubMed

    Rajeev, Aysha; Pooley, Joseph

    2009-02-01

    The aim of our study is to document the arthroscopic findings in resistant lateral elbow pain. We have reviewed the findings in a consecutive series of 117 elbow arthroscopies performed on patients with lateral elbow pain resistant to conservative treatment. We found established degenerative changes involving articular cartilage in 68 patients (59%). In 60 of these 68 patients (88%) the degenerative changes were confined to the lateral compartment and contrasted with a normal appearance of the articular cartilage of the medial compartment. Primary lateral compartment arthritis is more common than previously thought, it mostly affects a young population and could easily be misdiagnosed as lateral epicondylitis.

  5. Orthogonal Double Plating and Autologous Bone Grafting of Postoperative Humeral Shaft Nonunion – A Rare Case Report and Review of Literature

    PubMed Central

    Metikala, Sreenivasulu; Bhogadi, Prabhudheer

    2015-01-01

    Introduction: Nonunion following surgical stabilization of humeral shaft fractures, although infrequent, remains a challenge as limited surgical options are available. The difficulties in re-fixation are due to osteolysis produced by the loose implant components and disuse osteopenia of the entire bone segment. We share our experience in the management of a long standing diaphyseal nonunion of humerus following titanium LCP fixation. Case Report: A 58 years old woman presented with 20 months old nonunion following titanium LCP fixation of her closed humeral shaft fracture, done elsewhere. The interesting intraoperative findings, noteworthy, are about the extensive metallosis and the gross cortical defect measuring 10cm x 1cm x 1cm, corresponding to the foot print of the previous plate with exposed medullary canal. It was managed by debridement, dual plate fixation using 9 holed and 12 holed stainless steel LCPs in an orthogonal fashion and autologous bone grafting. The nonunion healed in 5 months and she regained all the movements except for terminal 10° of elbow extension and 15° of shoulder abduction at her final follow up of 30 months. According to Stewart and Hundley classification the final result was found to be good. Conclusion: We recommend the judicious use of long and short plates in 90-90 orientation along with autogenous bone grafting in the management of a long standing humeral shaft nonunion having extensive cortical resorption following surgical stabilization by plating. PMID:27299099

  6. Reflexive Planning for Later Life

    ERIC Educational Resources Information Center

    Denton, Margaret A.; Kemp, Candace L.; French, Susan; Gafni, Amiram; Joshi, Anju; Rosenthal, Carolyn J.; Davies, Sharon

    2004-01-01

    Informed by Giddens' (1991) concept of "reflexive life" planning and the notion of later life as a time of increasing social and financial risk, this research explores the idea of "reflexive planning for later life". We utilize a conceptual model that incorporates three types of planning for later life: public protection, self-insurance, and…

  7. Technique for 3-Dimesional (3D) Modeling of Osteoarticular Medial Femoral Condyle Vascularized Grafting to Replace the Proximal Pole of Unsalvagable Scaphoid Nonunions.

    PubMed

    Houdek, Matthew T; Matsumoto, Jane M; Morris, Jonathan M; Bishop, Allen T; Shin, Alexander Y

    2016-09-01

    This study describes a novel technique for the preoperative surgical planning for an osteoarticular medial femoral condyle (MFC) graft to replace the proximal pole of a scaphoid. In cases of proximal pole scaphoid nonunion or in Preiser disease, fragmentation of the articular surface can occur, leading to significant pain and disability. Osteoarticular MFC bone grafting can be used to treat these injuries by providing a vascularized osteoarticular surface. Using 3-dimensional imaging and printing we are able to precisely model the injured scaphoid, and also accurately plan the harvest of MFC osteoarticular graft. This technique allows for accurate preoperative planning of a complex 3-dimensional bone, and has improved our execution of the plan intraoperatively. PMID:27466049

  8. Technique for 3-Dimesional (3D) Modeling of Osteoarticular Medial Femoral Condyle Vascularized Grafting to Replace the Proximal Pole of Unsalvagable Scaphoid Nonunions.

    PubMed

    Houdek, Matthew T; Matsumoto, Jane M; Morris, Jonathan M; Bishop, Allen T; Shin, Alexander Y

    2016-09-01

    This study describes a novel technique for the preoperative surgical planning for an osteoarticular medial femoral condyle (MFC) graft to replace the proximal pole of a scaphoid. In cases of proximal pole scaphoid nonunion or in Preiser disease, fragmentation of the articular surface can occur, leading to significant pain and disability. Osteoarticular MFC bone grafting can be used to treat these injuries by providing a vascularized osteoarticular surface. Using 3-dimensional imaging and printing we are able to precisely model the injured scaphoid, and also accurately plan the harvest of MFC osteoarticular graft. This technique allows for accurate preoperative planning of a complex 3-dimensional bone, and has improved our execution of the plan intraoperatively.

  9. Diamond heteroepitaxial lateral overgrowth

    NASA Astrophysics Data System (ADS)

    Tang, Yung-Hsiu

    This dissertation describes improvements in the growth of single crystal diamond by microwave plasma-assisted chemical vapor deposition (CVD). Heteroepitaxial (001) diamond was grown on 1 cm. 2 a-plane sapphiresubstrates using an epitaxial (001) Ir thin-film as a buffer layer. Low-energy ion bombardment of the Ir layer, a process known as bias-enhanced nucleation, is a key step in achieving a high density of diamond nuclei. Bias conditions were optimized to form uniformly-high nucleation densities across the substrates, which led to well-coalesced diamond thin films after short growth times. Epitaxial lateral overgrowth (ELO) was used as a means of decreasing diamond internal stress by impeding the propagation of threading dislocations into the growing material. Its use in diamond growth requires adaptation to the aggressive chemical and thermal environment of the hydrogen plasma in a CVD reactor. Three ELO variants were developed. The most successful utilized a gold (Au) mask prepared by vacuum evaporation onto the surface of a thin heteroepitaxial diamond layer. The Au mask pattern, a series of parallel stripes on the micrometer scale, was produced by standard lift-off photolithography. When diamond overgrows the mask, dislocations are largely confined to the substrate. Differing degrees of confinement were studied by varying the stripe geometry and orientation. Significant improvement in diamond quality was found in the overgrown regions, as evidenced by reduction of the Raman scattering linewidth. The Au layer was found to remain intact during diamond overgrowth and did not chemically bond with the diamond surface. Besides impeding the propagation of threading dislocations, it was discovered that the thermally-induced stress in the CVD diamond was significantly reduced as a result of the ductile Au layer. Cracking and delamination of the diamond from the substrate was mostly eliminated. When diamond was grown to thicknesses above 0.1 mm it was found that

  10. Cosmetic Lateral Canthoplasty: Preserving the Lateral Canthal Angle

    PubMed Central

    Lee, Kyu Ho; Choi, Hong Lim; Jeong, Eui Cheol

    2016-01-01

    Cosmetic lateral canthoplasty, in which the size of the eye is increased by extending the palpebral fissure and decreasing the degree of the eye slant, has become a prevalent procedure for East Asians. However, it is not uncommon for there to be complications or unfavorable results after the surgery. With this in mind, the authors have designed a surgical method to reduce complications in cosmetic lateral canthoplasty by preserving the lateral canthal angle. We discuss here the anatomy required for surgery, the surgical methods, and methods for reducing complications during cosmetic lateral canthoplasty. PMID:27462563

  11. The evaluation of lateral pterygoid muscle pathologic changes and insertion patterns in temporomandibular joints with or without disc displacement using magnetic resonance imaging.

    PubMed

    Imanimoghaddam, M; Madani, A S; Hashemi, E M

    2013-09-01

    Temporomandibular joint (TMJ) disc displacement is a common disorder in patients with internal derangement. Certain anatomic features of TMJ may make the patient prone to this condition, namely lateral pterygoid muscle (LPM) insertion variations. The aim of this study was to investigate LPM attachments and their relationships with disc displacement and subsequent pathologic changes. A total of 26 patients with clinical temporomandibular disorders (TMDs) and a control group of 14 unaffected individuals were studied. Magnetic resonance images (MRIs) were taken to evaluate LPM insertion patterns, superior LPM head pathologic changes, and relative disc to condyle position. Data registration and analysis were done using SPSS v. 16.0. The most common variation (type I) was shown to be the superior head with two bundles, one attached to the disc and another to the condyle. No significant relationship between LPM insertion type and disc displacement or pathologic changes of the muscle was found. However, a link between disc displacement and muscle pathologic changes was established (P=0.001).

  12. Evolution of bone compactness in extant and extinct moles (Talpidae): exploring humeral microstructure in small fossorial mammals

    PubMed Central

    2013-01-01

    Background Talpids include forms with different degree of fossoriality, with major specializations in the humerus in the case of the fully fossorial moles. We studied the humeral microanatomy of eleven extant and eight extinct talpid taxa of different lifestyles and of two non-fossorial outgroups and examined the effects of size and phylogeny. We tested the hypothesis that bone microanatomy is different in highly derived humeri of fossorial taxa than in terrestrial and semi-aquatic ones, likely due to special mechanical strains to which they are exposed to during digging. This study is the first comprehensive examination of histological parameters in an ecologically diverse and small-sized mammalian clade. Results No pattern of global bone compactness was found in the humeri of talpids that could be related to biomechanical specialization, phylogeny or size. The transition zone from the medullary cavity to the cortical compacta was larger and the ellipse ratio smaller in fossorial talpids than in non-fossorial talpids. No differences were detected between the two distantly related fossorial clades, Talpini and Scalopini. Conclusions At this small size, the overall morphology of the humerus plays a predominant role in absorbing the load, and microanatomical features such as an increase in bone compactness are less important, perhaps due to insufficient gravitational effects. The ellipse ratio of bone compactness shows relatively high intraspecific variation, and therefore predictions from this ratio based on single specimens are invalid. PMID:23442022

  13. Uncommon Variant of Type II Monteggia Fracture with Concomitant Distal Humeral Fracture

    PubMed Central

    Matta, Jihad F.; El Rassi, George S.; Abd El Nour, Hicham G.; El Asmar, Rachel

    2015-01-01

    Monteggia fracture-dislocation, a common injury sustained by pediatric population, is a rare entity in adults. It was first observed by Giovanni Battista Monteggia and later classified by Bado into 4 groups. The term “Monteggia equivalent or variant” was introduced to describe certain injuries with similar radiographic pattern and biomechanism of injury. Since then various types and their variants have been described in the literature. We present a complex fracture pattern in a 55-year-old male not previously described in the literature along with its treatment modality and favorable outcome. PMID:26550509

  14. Strictly homogeneous laterally complete modules

    NASA Astrophysics Data System (ADS)

    Chilin, V. I.; Karimov, J. A.

    2016-03-01

    Let A be a laterally complete commutative regular algebra and X be a laterally complete A-module. In this paper we introduce a notion of homogeneous and strictly homogeneous A-modules. It is proved that any homogeneous A-module is strictly homogeneous A-module, if the Boolean algebra of all idempotents in A is multi-σ-finite.

  15. The significance of laterality effects.

    PubMed Central

    Warrington, E K; Pratt, R T

    1981-01-01

    Language laterality can be unequivocally ascertained by comparing the effects of unilateral ECT to the right and the left hemisphere. It has been shown in right-handed depressed patients that a unilateral treatment to the left hemisphere resulted in transient dysphasia whereas unilateral ECT to the right hemisphere did not. The language laterality in a small group of left-handed depressed patients has been ascertained. Evidence is presented to show that neither dichotic listening nor hand position for writing provide satisfactory indices of language laterality. The ear advantage was more closely related to strength of sinistrality than to language laterality--that is sidedness appears to overide brainedness. The results favour a spatial attention hypothesis rather than a structural hypothesis as the main determinant of laterality effects. PMID:7229640

  16. A Pascalian lateral drift sensor

    NASA Astrophysics Data System (ADS)

    Jansen, H.

    2016-09-01

    A novel concept of a layer-wise produced semiconductor sensor for precise particle tracking is proposed herein. In contrast to common semiconductor sensors, local regions with increased doping concentration deep in the bulk termed charge guides increase the lateral drift of free charges on their way to the read-out electrode. This lateral drift enables charge sharing independent of the incident position of the traversing particle. With a regular grid of charge guides the lateral charge distribution resembles a normalised Pascal's triangle for particles that are stopped in depths lower than the depth of the first layer of the charge guides. For minimum ionising particles a sum of binomial distributions describes the lateral charge distribution. This concept decouples the achievable sensor resolution from the pitch size as the characteristic length is replaced by the lateral distance of the charge guides.

  17. Distal third humeri fractures treated using the Synthes™ 3.5-mm extra-articular distal humeral locking compression plate: clinical, radiographic and patient outcome scores

    PubMed Central

    Lewis, James; Rao, Prasad; Parfitt, Dan; Mohanty, Khitish; Ghandour, Adel

    2014-01-01

    Background Conventional management protocols for distal humeral extra-articular fractures (e.g. conservative, double columnar plating) are often associated with complications. We aimed to describe our experience of using the Synthes™ 3.5-mm extra-articular distal humeral locking compression plate for treatment of extra-articular distal humeral fractures. Methods We prospectively studied 23 consecutive patients who underwent fixation, in a tertiary trauma centre, over 2 years. Data, including patient demographics, duration of follow-up, patient satisfaction, visual analogue score (VAS), Oxford Elbow Score, and final outcome on discharge, were collected and analyzed. Results Of the 23 patients (12 males, 11 females; mean age 47.5 years; range 18 years to 89 years), all fractures united radiologically and clinically after the index procedure, with a mean time to fracture union of 15.7 weeks (range 9 weeks to 34 weeks) and a mean time to discharge of 17.8 weeks (range 13 weeks to 34 weeks). Oxford Elbow Score was 36.5 (range 11 to 48) at 4.6 months postoperatively; at 20 months follow-up, it was 40 (range 14 to 48) and the VAS was 8.5 (range 5 to 10). One patient had radial nerve neuropraxia pre-operatively, and one postoperatively, and both recovered uneventfully 3 months postoperatively. Neither superficial, nor deep infections were observed in this cohort. Conclusions The present study reports satisfactory outcome with the usage of the Synthes plate for extra-articular fracture management. It has become the technique of choice in our centre because it provides excellent results. PMID:27582964

  18. Hemiarthroplasty of the shoulder joint using a custom-designed high-density nano-hydroxyapatite/polyamide prosthesis with a polyvinyl alcohol hydrogel humeral head surface in rabbits.

    PubMed

    Guo, Yongwen; Guo, Jun; Bai, Ding; Wang, Hang; Zheng, Xiaohui; Guo, Weihua; Tian, Weidong

    2014-07-01

    In this study, a novel custom-designed high-density nano-hydroxyapatite/polyamide (n-HA/PA) prosthesis with a polyvinyl alcohol (PVA) hydrogel humeral head surface was employed to repair the shoulder joint head for hemiarthroplasty in rabbits. The prosthesis was fabricated using three-dimensional computed tomography and computer-aided design and computer-aided manufacturing systems for perfect fitting. Sixteen New Zealand white rabbits underwent humeral head excision, and received the composite prostheses for hemiarthroplasty. The implant sites were free from suppuration and necrosis at all periods. The X-ray results showed that there was a clear space between the prosthesis head and the glenoid surface, and the joint capsules and surfaces of the glenoid and PVA were well preserved without any damage during the whole inspection period. A high density of bone was observed around the firmware part of the prosthesis. Histological results revealed that significant osteogenesis was surrounding the firmware part, and the joint space was clear and the cartilage of the upper joint surface was basically intact. There was no visible absorption of the joint surfaces even after 3 months of continuous functional motions. The maximum tensile strength between the prosthesis and host bone reached 2.63 MPa at the 12th week postimplantation. In conclusion, the customized prosthesis by combination of PVA and high-density n-HA/PA has excellent biocompatibility and biological fixation, and offers a promising substitute for both the cartilage and the bone of the humeral head in a rabbit model as level V evidence.

  19. Hemiarthroplasty of the shoulder joint using a custom-designed high-density nano-hydroxyapatite/polyamide prosthesis with a polyvinyl alcohol hydrogel humeral head surface in rabbits.

    PubMed

    Guo, Yongwen; Guo, Jun; Bai, Ding; Wang, Hang; Zheng, Xiaohui; Guo, Weihua; Tian, Weidong

    2014-07-01

    In this study, a novel custom-designed high-density nano-hydroxyapatite/polyamide (n-HA/PA) prosthesis with a polyvinyl alcohol (PVA) hydrogel humeral head surface was employed to repair the shoulder joint head for hemiarthroplasty in rabbits. The prosthesis was fabricated using three-dimensional computed tomography and computer-aided design and computer-aided manufacturing systems for perfect fitting. Sixteen New Zealand white rabbits underwent humeral head excision, and received the composite prostheses for hemiarthroplasty. The implant sites were free from suppuration and necrosis at all periods. The X-ray results showed that there was a clear space between the prosthesis head and the glenoid surface, and the joint capsules and surfaces of the glenoid and PVA were well preserved without any damage during the whole inspection period. A high density of bone was observed around the firmware part of the prosthesis. Histological results revealed that significant osteogenesis was surrounding the firmware part, and the joint space was clear and the cartilage of the upper joint surface was basically intact. There was no visible absorption of the joint surfaces even after 3 months of continuous functional motions. The maximum tensile strength between the prosthesis and host bone reached 2.63 MPa at the 12th week postimplantation. In conclusion, the customized prosthesis by combination of PVA and high-density n-HA/PA has excellent biocompatibility and biological fixation, and offers a promising substitute for both the cartilage and the bone of the humeral head in a rabbit model as level V evidence. PMID:24404998

  20. Management of peri-prosthetic fracture of the humerus with severe bone loss and loosening of the humeral component after total shoulder replacement.

    PubMed

    Sewell, M D; Kang, S N; Al-Hadithy, N; Higgs, D S; Bayley, I; Falworth, M; Lambert, S M

    2012-10-01

    There is little information about the management of peri-prosthetic fracture of the humerus after total shoulder replacement (TSR). This is a retrospective review of 22 patients who underwent a revision of their original shoulder replacement for peri-prosthetic fracture of the humerus with bone loss and/or loose components. There were 20 women and two men with a mean age of 75 years (61 to 90) and a mean follow-up 42 months (12 to 91): 16 of these had undergone a previous revision TSR. Of the 22 patients, 12 were treated with a long-stemmed humeral component that bypassed the fracture. All their fractures united after a mean of 27 weeks (13 to 94). Eight patients underwent resection of the proximal humerus with endoprosthetic replacement to the level of the fracture. Two patients were managed with a clam-shell prosthesis that retained the original components. The mean Oxford shoulder score (OSS) of the original TSRs before peri-prosthetic fracture was 33 (14 to 48). The mean OSS after revision for fracture was 25 (9 to 31). Kaplan-Meier survival using re-intervention for any reason as the endpoint was 91% (95% confidence interval (CI) 68 to 98) and 60% (95% CI 30 to 80) at one and five years, respectively. There were two revisions for dislocation of the humeral head, one open reduction for modular humeral component dissociation, one internal fixation for nonunion, one trimming of a prominent screw and one re-cementation for aseptic loosening complicated by infection, ultimately requiring excision arthroplasty. Two patients sustained nerve palsies. Revision TSR after a peri-prosthetic humeral fracture associated with bone loss and/or loose components is a salvage procedure that can provide a stable platform for elbow and hand function. Good rates of union can be achieved using a stem that bypasses the fracture. There is a high rate of complications and function is not as good as with the original replacement.

  1. Lateral Dominance and Reading Disability.

    ERIC Educational Resources Information Center

    Harris, Albert J.

    1979-01-01

    Theory and research on the relation of lateral dominance to the causation of reading disability are reviewed. Both direct and indirect measures of cerebral hemisphere functioning are considered. (SBH)

  2. Hyperaldosteronism: diagnosis, lateralization, and treatment.

    PubMed

    Harvey, Adrian M

    2014-06-01

    Primary hyperaldosteronism is an important and commonly unrecognized secondary cause of hypertension. This article provides an overview of the current literature with respect to screening, diagnosis, and lateralization. Selection and outcomes of medical and surgical treatment are discussed.

  3. Cerebral Laterality and Verbal Processes

    ERIC Educational Resources Information Center

    Sherman, Jay L.; And Others

    1976-01-01

    Research suggests that we process information by way of two distinct and functionally separate coding systems. Their location, somewhat dependent on cerebral laterality, varies in right- and left-handed persons. Tests this dual coding model. (Editor/RK)

  4. Lateral plantar pain: diagnostic considerations.

    PubMed

    Bahel, Aditya; Yu, Joseph S

    2010-07-01

    Injuries that target the bones of the midfoot are important causes of pain. The medial aspect of the midfoot has been extensively studied but the lateral plantar region has not received as much attention. The objective of this article is to review the differential diagnosis of lateral plantar pain, emphasizing on the common mechanisms of injury, and to identify characteristic imaging findings for these pathologic conditions.

  5. Evaluation of injectable strontium-containing borate bioactive glass cement with enhanced osteogenic capacity in a critical-sized rabbit femoral condyle defect model.

    PubMed

    Zhang, Yadong; Cui, Xu; Zhao, Shichang; Wang, Hui; Rahaman, Mohamed N; Liu, Zhongtang; Huang, Wenhai; Zhang, Changqing

    2015-02-01

    The development of a new generation of injectable bone cements that are bioactive and have enhanced osteogenic capacity for rapid osseointegration is receiving considerable interest. In this study, a novel injectable cement (designated Sr-BBG) composed of strontium-doped borate bioactive glass particles and a chitosan-based bonding phase was prepared and evaluated in vitro and in vivo. The bioactive glass provided the benefits of bioactivity, conversion to hydroxyapatite, and the ability to stimulate osteogenesis, while the chitosan provided a cohesive biocompatible and biodegradable bonding phase. The Sr-BBG cement showed the ability to set in situ (initial setting time = 11.6 ± 1.2 min) and a compressive strength of 19 ± 1 MPa. The Sr-BBG cement enhanced the proliferation and osteogenic differentiation of human bone marrow-derived mesenchymal stem cells in vitro when compared to a similar cement (BBG) composed of chitosan-bonded borate bioactive glass particles without Sr. Microcomputed tomography and histology of critical-sized rabbit femoral condyle defects implanted with the cements showed the osteogenic capacity of the Sr-BBG cement. New bone was observed at different distances from the Sr-BBG implants within eight weeks. The bone-implant contact index was significantly higher for the Sr-BBG implant than it was for the BBG implant. Together, the results indicate that this Sr-BBG cement is a promising implant for healing irregularly shaped bone defects using minimally invasive surgery.

  6. Evaluation of injectable strontium-containing borate bioactive glass cement with enhanced osteogenic capacity in a critical-sized rabbit femoral condyle defect model.

    PubMed

    Zhang, Yadong; Cui, Xu; Zhao, Shichang; Wang, Hui; Rahaman, Mohamed N; Liu, Zhongtang; Huang, Wenhai; Zhang, Changqing

    2015-02-01

    The development of a new generation of injectable bone cements that are bioactive and have enhanced osteogenic capacity for rapid osseointegration is receiving considerable interest. In this study, a novel injectable cement (designated Sr-BBG) composed of strontium-doped borate bioactive glass particles and a chitosan-based bonding phase was prepared and evaluated in vitro and in vivo. The bioactive glass provided the benefits of bioactivity, conversion to hydroxyapatite, and the ability to stimulate osteogenesis, while the chitosan provided a cohesive biocompatible and biodegradable bonding phase. The Sr-BBG cement showed the ability to set in situ (initial setting time = 11.6 ± 1.2 min) and a compressive strength of 19 ± 1 MPa. The Sr-BBG cement enhanced the proliferation and osteogenic differentiation of human bone marrow-derived mesenchymal stem cells in vitro when compared to a similar cement (BBG) composed of chitosan-bonded borate bioactive glass particles without Sr. Microcomputed tomography and histology of critical-sized rabbit femoral condyle defects implanted with the cements showed the osteogenic capacity of the Sr-BBG cement. New bone was observed at different distances from the Sr-BBG implants within eight weeks. The bone-implant contact index was significantly higher for the Sr-BBG implant than it was for the BBG implant. Together, the results indicate that this Sr-BBG cement is a promising implant for healing irregularly shaped bone defects using minimally invasive surgery. PMID:25591177

  7. Assessment of a polyelectrolyte multilayer film coating loaded with BMP-2 on titanium and PEEK implants in the rabbit femoral condyle

    PubMed Central

    Guillot, R.; Pignot-Paintrand, I.; Lavaud, J.; Decambron, A.; Bourgeois, E.; Josserand, V.; Logeart-Avramoglou, D.; Viguier, E.; Picart, C.

    2016-01-01

    The aim of this study was to evaluate the osseointegration of titanium implants (Ti-6Al-4V, noted here TA6V) and poly(etheretherketone) PEEK implants induced by a BMP-2-delivering surface coating made of polyelectrolyte multilayer films. The in vitro bioactivity of the polyelectrolyte film-coated implants was assessed using the alkaline phosphatase assay. BMP-2-coated TA6V and PEEK implants with a total dose of 9.3 µg of BMP-2 were inserted into the femoral condyles of New Zealand white rabbits and compared to uncoated implants. Rabbits were sacrificed 4 and 8 weeks after implantation. Histomorphometric analyses on TA6V and PEEK implants and microcomputed tomography on PEEK implants revealed that the bone-to-implant contact and bone area around the implants were significantly lower for the BMP-2-coated implants than for the bare implants. This was confirmed by scanning electron microscopy imaging. This difference was more pronounced at 4 weeks in comparison to the 8-week time point. However, bone growth inside the hexagonal upper hollow cavity of the screws was higher in the case of the BMP-2 coated implants. Overall, this study shows that a high dose of BMP-2 leads to localized and temporary bone impairment, and that the dose of BMP-2 delivered at the surface of an implant needs to be carefully optimized. PMID:26965394

  8. Optineurin and amyotrophic lateral sclerosis.

    PubMed

    Maruyama, Hirofumi; Kawakami, Hideshi

    2013-07-01

    Amyotrophic lateral sclerosis is a devastating disease, and thus it is important to identify the causative gene and resolve the mechanism of the disease. We identified optineurin as a causative gene for amyotrophic lateral sclerosis. We found three types of mutations: a homozygous deletion of exon 5, a homozygous Q398X nonsense mutation and a heterozygous E478G missense mutation within its ubiquitin-binding domain. Optineurin negatively regulates the tumor necrosis factor-α-induced activation of nuclear factor kappa B. Nonsense and missense mutations abolished this function. Mutations related to amyotrophic lateral sclerosis also negated the inhibition of interferon regulatory factor-3. The missense mutation showed a cyotoplasmic distribution different from that of the wild type. There are no specific clinical symptoms related to optineurin. However, severe brain atrophy was detected in patients with homozygous deletion. Neuropathologically, an E478G patient showed transactive response DNA-binding protein of 43 kDa-positive neuronal intracytoplasmic inclusions in the spinal and medullary motor neurons. Furthermore, Golgi fragmentation was identified in 73% of this patient's anterior horn cells. In addition, optineurin is colocalized with fused in sarcoma in the basophilic inclusions of amyotrophic lateral sclerosis with fused in sarcoma mutations, and in basophilic inclusion body disease. These findings strongly suggest that optineurin is involved in the pathogenesis of amyotrophic lateral sclerosis.

  9. Borehole optical lateral displacement sensor

    DOEpatents

    Lewis, R.E.

    1998-10-20

    There is provided by this invention an optical displacement sensor that utilizes a reflective target connected to a surface to be monitored to reflect light from a light source such that the reflected light is received by a photoelectric transducer. The electric signal from the photoelectric transducer is then imputed into electronic circuitry to generate an electronic image of the target. The target`s image is monitored to determine the quantity and direction of any lateral displacement in the target`s image which represents lateral displacement in the surface being monitored. 4 figs.

  10. 49 CFR 230.105 - Lateral motion.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Lateral motion. 230.105 Section 230.105... Tenders Running Gear § 230.105 Lateral motion. (a) Condemning limits. The total lateral motion or play... require additional lateral motion. (c) Non-interference with other parts. The lateral motion shall in...

  11. Living Arrangements in Later Life.

    ERIC Educational Resources Information Center

    Frazier, Billie H.

    This document contains a brief bibliography of peer-reviewed literature, with abstracts, on living arrangements in later life. It is one of 12 bibliographies on aging prepared by the National Agricultural Library for its "Pathfinders" series of publications. Topics covered by the other 11 bibliographies include aging parents, adult children,…

  12. Amyotrophic lateral sclerosis mimic syndromes

    PubMed Central

    Ghasemi, Majid

    2016-01-01

    Amyotrophic lateral sclerosis (ALS) misdiagnosis has many broad implications for the patient and the neurologist. Potentially curative treatments exist for certain ALS mimic syndromes, but delay in starting these therapies may have an unfavorable effect on outcome. Hence, it is important to exclude similar conditions. In this review, we discuss some of the important mimics of ALS. PMID:27326363

  13. Lateral facet syndrome of the patella. Lateral restraint analysis and use of lateral resection.

    PubMed

    Johnson, R P

    1989-01-01

    Thirty-eight knees in 34 patients with an average age of 22 years were diagnosed as having lateral facet syndrome (LFS), a painful compressive arthropathy of the lateral facet of the patella. This diagnosis was based on the physical findings of tenderness at the lateral patellofemoral joint line, tenderness over the vastus lateralis obliquus (VLO) tendon just above the patella, a positive medial apprehension test, and marked resistance to medial patellar displacement with the knee flexed 30 degrees. The most common complaints were patellar pain with activity, pain with prolonged knee flexion, intermittent knee swelling, and giving way. At surgery, the VLO, the lateral retinaculum (LR), and the anterior fibers of the iliotibial tract (ITT) were sequentially divided from the lateral border of the patella. Each was temporarily reattached to a cuff of soft tissue left on the patella using surgical clamps to determine its contribution to lateral restraint. The VLO was found to be the primary restraint in one-half of the knees. In one-third of the knees, all three of the structures contributed equally. In six knees, the primary restraint was the anterior fibers of the ITT, whereas the LR was the primary restraint in only two. The distal ends of these three structures were then resected to prevent rescarring and retethering. At a minimum follow-up period of two years, 87% had satisfactory relief of their patellar pain, had returned to normal activities, and had no or minimal physical findings of LFS. The procedure is recommended for patients who have failed other procedures and in those whose symptoms cannot be controlled by activity modification, exercises, bracing, or medication. PMID:2910595

  14. The Effect of Emboss Enhancement on Reliability of Landmark Identification in Digital Lateral Cephalometric Images

    PubMed Central

    Nikneshan, Sima; Mohseni, Sudeh; Nouri, Mahtab; Hadian, Hoora; Kharazifard, Mohammad Javad

    2015-01-01

    Background: Evaluation of the craniofacial bones is the oldest method to measure the facial proportion ratio in orthodontics. Objectives: The purpose of this study was to evaluate the effect of emboss enhancement on the reliability of landmark identification in digital lateral cephalometric images. Materials and Methods: Ten digital lateral cephalograms were selected from the archive of an oral and maxillofacial radiology center. Using DIGORA software, these images were saved in two formats; common images and 3D emboss images. On these images, 32 skeletal, dental, and soft tissue landmarks were marked at least twice with a 2-week interval by four observers (two radiologists and two orthodontists). In order to determine the position of the marked landmarks (in x and y coordinates), a software was designed. The statistical analysis was performed in SPSS software and the reliability of each observer was obtained by means of intraclass correlation coefficient (ICC). Results: In three skeletal landmarks [Orbit (Or), condyl top (Cond), and pogonion (Pog)], the enhancement caused significant reduction in the reliability, and in four skeletal [Anterior Nasal Spine (ANS), B, A, and Basion (Ba)], two dental (U1 root, L1 incisal), and one soft tissue landmark (Menton soft tissue), the enhancement increased the reliability of landmark detection between the two phases of the study. Totally, ICC of embossed images in both x and y coordinates were greater than the typical images, but the difference was not statistically significant. However, the effect of enhancement on the improvement of the reliability of landmark identification was higher in the x-axis than the y-axis. Conclusions: Using embossed images is only effective in increasing the reliability of detection in a few numbers of cephalometric landmarks. PMID:26060555

  15. Advantage of Minimally Invasive Lateral Approach Relative to Conventional Deltopectoral Approach for Treatment of Proximal Humerus Fractures

    PubMed Central

    Liu, Kuan; Liu, Peng-cheng; Liu, Run; Wu, Xing

    2015-01-01

    Background Despite the wide application of open reduction and internal fixation with locking plates for the treatment of proximal humeral fractures, the surgical invasive approach remains controversial. This study aimed to evaluate the pros and cons of the minimally invasive lateral approach for the treatment of proximal humeral fracture (PHF) in comparison with the deltopectoral approach. Material/Methods All patients who sustained a PHF and received open reduction and internal fixation (ORIF) surgery with locking plate through either minimally invasive subacromial approach or conventional deltopectoral approach between January 2008 and February 2012 were retrospectively analyzed. Patients were divided into the conventional group and min-group according to the surgical incision. Surgery-related information, postoperative radiography, complications, and shoulder functional measurement scores in a 2-year follow-up were collected and evaluated. Results Ninety-one patients meeting the inclusion criteria were included in this study. We observed a significant difference in both surgery time (81.8±18.3 vs. 91.0±18.4) (p=0.021) and blood loss (172±54.2 vs. 205±73.6) (p=0.016) between the min-group and conventional group. Compared to the conventional group, the min-group had significantly better Constant-Murley score and DASH score at early follow-up (p<0.05) and higher patients satisfaction rate (8.1±1.1 vs. 7.6±1.2) (p= 0.019). The multiple linear regression analysis indicated that age, PHF types, surgical groups, surgery time, and blood loss have significant effect on the activity of affected shoulder in both abduction and forward flexion (p<0.05) except for gender factor. While larger range of movement of the affected shoulder, mainly in the 2-part and 3-part fractures, was observed in the min-group, the conventional group obtained better movement in the 4-part fractures. Conclusions The minimally invasive lateral approach is the optimal alternative for the

  16. Lateralized processes in face recognition.

    PubMed

    Rhodes, G

    1985-05-01

    In this paper a model is presented in which face recognition is analysed into several stages, each of which may be independently lateralized. Evidence is reviewed which suggests that lateralization is important at all stages of processing a face. Early visuospatial processing, and the creation and comparison of facial representations, appear to be carried out more efficiently by the right hemisphere. Comparisons based on discrete, namable features of faces may yield a left hemisphere advantage. It is also proposed that faces may activate semantic information, including names, more efficiently in the left hemisphere. The model is useful in resolving inconsistencies in the degree and direction of asymmetries found in face-recognition tasks. Suggestions are also made for future research.

  17. Preserving Dignity in Later Life.

    PubMed

    São José, José Manuel

    2016-09-01

    This article examines how elders who receive social care in the community experience loss of dignity and how they preserve their dignity. Qualitative research revealed that loss of dignity is a major concern for these elders and that they preserve their dignity differently, ranging from actively engaging with life to detaching themselves from life. We conclude that, in later life, preserving dignity while receiving social care differs from preserving dignity in the context of health care, especially health care provided in institutional settings. Furthermore, preserving dignity in later life, while receiving social care, is a complex process, depending not only on performing activities and individual action and responsibility, but also on other actions, some of them involving a certain inactivity/passivity, and interactions with others, especially caregivers. This article offers some insights to developing better policies and care practices for promoting dignity in the context of community-based social care.

  18. Congenital lateral abdominal wall hernia.

    PubMed

    Montes-Tapia, Fernando; Cura-Esquivel, Idalia; Gutiérrez, Susana; Rodríguez-Balderrama, Isaías; de la O-Cavazos, Manuel

    2016-08-01

    Congenital abdominal wall defects that are located outside of the anterior wall are extremely rare and difficult to classify because there are no well accepted guidelines. There are two regions outside of the anterior wall: the flank or lateral wall; and the lumbar region. We report the case of a patient with an oval 3 cm-diameter hernia defect located above the anterior axillary line, which affects all layers of the muscular wall. An anorectal malformation consisting of a recto-vestibular fistula was also identified, and chest X-ray showed dextrocardia. The suggested treatment is repair of the defect before 1 year of age. Given that the anomalies described may accompany lateral abdominal wall hernia, it is important to diagnose and treat the associated defects.

  19. Preserving Dignity in Later Life.

    PubMed

    São José, José Manuel

    2016-09-01

    This article examines how elders who receive social care in the community experience loss of dignity and how they preserve their dignity. Qualitative research revealed that loss of dignity is a major concern for these elders and that they preserve their dignity differently, ranging from actively engaging with life to detaching themselves from life. We conclude that, in later life, preserving dignity while receiving social care differs from preserving dignity in the context of health care, especially health care provided in institutional settings. Furthermore, preserving dignity in later life, while receiving social care, is a complex process, depending not only on performing activities and individual action and responsibility, but also on other actions, some of them involving a certain inactivity/passivity, and interactions with others, especially caregivers. This article offers some insights to developing better policies and care practices for promoting dignity in the context of community-based social care. PMID:27456751

  20. Lateral gene transfer in eukaryotes.

    PubMed

    Andersson, J O

    2005-06-01

    Lateral gene transfer -- the transfer of genetic material between species -- has been acknowledged as a major mechanism in prokaryotic genome evolution for some time. Recently accumulating data indicate that the process also occurs in the evolution of eukaryotic genomes. However, there are large rate variations between groups of eukaryotes; animals and fungi seem to be largely unaffected, with a few exceptions, while lateral gene transfer frequently occurs in protists with phagotrophic lifestyles, possibly with rates comparable to prokaryotic organisms. Gene transfers often facilitate the acquisition of functions encoded in prokaryotic genomes by eukaryotic organisms, which may enable them to colonize new environments. Transfers between eukaryotes also occur, mainly into larger phagotrophic eukaryotes that ingest eukaryotic cells, but also between plant lineages. These findings have implications for eukaryotic genomic research in general, and studies of the origin and phylogeny of eukaryotes in particular.

  1. Lateral dampers for thrust bearings

    NASA Technical Reports Server (NTRS)

    Hibner, D. H.; Szafir, D. R.

    1985-01-01

    The development of lateral damping schemes for thrust bearings was examined, ranking their applicability to various engine classes, selecting the best concept for each engine class and performing an in-depth evaluation. Five major engine classes were considered: large transport, military, small general aviation, turboshaft, and non-manrated. Damper concepts developed for evaluation were: curved beam, constrained and unconstrained elastomer, hybrid boost bearing, hydraulic thrust piston, conical squeeze film, and rolling element thrust face.

  2. Cerebral lateralization in simultaneous interpretation.

    PubMed

    Fabbro, F; Gran, L; Basso, G; Bava, A

    1990-07-01

    Cerebral asymmetries for L1 (Italian), L2 (English), and L3 (French, German, Spanish, or Russian) were studied, by using a verbal-manual interference paradigm, in a group of Italian right-handed polyglot female students at the Scuola Superiore di Lingue Moderne per Interpreti e Traduttori (SSLM-School for Interpreters and Translators) of the University of Trieste and in a control group of right-handed monolingual female students at the Medical School of the University of Trieste. In an automatic speech production task no significant cerebral lateralization was found for the mother tongue (L1) either in the interpreting students or in the control group; the interpreting students were not significantly lateralized for the third language (L3), while weak left hemispheric lateralization was shown for L2. A significantly higher degree of verbal-manual interference was found for L1 than for L2 and L3. A significantly higher disruption rate occurred in the meaning-based mode of simultaneous interpretation (from L2 into L1 and vice versa) than in the word-for-word mode (from L2 into L1 and vice versa). No significant overall or hemispheric differences were found during simultaneous interpretation from L1 into L2 or from L2 into L1. PMID:2207622

  3. Identification and management of chronic shoulder pain in the presence of an MRA-confirmed humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion

    PubMed Central

    Karmali, Arif; McLeod, Jennifer

    2016-01-01

    Objective: To present the assessment and conservative management of chronic shoulder pain in the presence of a humeral avulsion of the inferior glenohumeral ligament (HAGL) lesion in an active individual. Clinical Features: A 47 year-old female office-worker with constant, deep, right shoulder pain with occasional clicking and catching claimed to have “tore something” in her right shoulder five years ago while performing reverse bicep curls. A physical exam led to differential diagnoses of a Superior Labrum Anterior to Posterior (SLAP) lesion, Bankart lesion, and bicipital tendinopathy. A Magnetic Resonance Arthrogram revealed a HAGL lesion. Intervention and Outcome: A conservative chiropractic treatment plan in addition to physical therapy was initiated. The patient reported 75% improvement in symptoms after 4 treatments over a four-week duration. Summary: This case demonstrates the successful implementation of a conservative plan of management suggesting that the treatment provided to this patient should be considered and attempted prior to arthroscopic surgery. PMID:27385837

  4. The Use of All-Arthroscopic Autologous Matrix-Induced Chondrogenesis for the Management of Humeral and Glenoid Chondral Defects in the Shoulder.

    PubMed

    Cuéllar, Adrián; Ruiz-Ibán, Miguel Ángel; Cuéllar, Ricardo

    2016-04-01

    Autologous matrix-induced chondrogenesis (AMIC) is often used for treating chondral defects in different joints. We describe an all-arthroscopic approach for the treatment of glenoid and humeral chondral lesions with this technique. AMIC starts with the use of microfractures of the damaged cartilage, followed by coverage of the defect with a type I/III collagen matrix (Chondro-Gide; Geistlich Pharma, Wolhusen, Switzerland) that is fixed with fibrin glue (Tissucol; Baxter, Warsaw, Poland). In a 1-step approach, the unstable cartilage is debrided, microfractures that penetrate up to the subchondral bone are performed, and the membranes are pasted to the lesion. Our technique reduces morbidity rates compared with traditional open surgery. The arthroscopic AMIC procedure is a viable, cost-effective treatment for the repair of chondral lesions of the shoulder.

  5. Effects of humeral head compression taping on the isokinetic strength of the shoulder external rotator muscle in patients with rotator cuff tendinitis

    PubMed Central

    Kim, Moon-Hwan; Oh, Jae-Seop

    2015-01-01

    [Purpose] The purpose of this study was to examine the effects of humeral head compression taping (HHCT) on the strength of the shoulder external rotator muscle in patients with rotator cuff tendinitis. [Subjects and Methods] Twenty patients with rotator cuff tendinitis were recruited. The shoulder external rotator strength was measured using a Biodex isokinetic dynamometer system. A paired t-test was performed to evaluate within-group differences in the strength of the shoulder external rotator muscle. [Results] Significantly higher shoulder external rotator peak torque and peak torque per body weight were found in the HHCT condition than in the no-taping condition. [Conclusion] HHCT may effectively increase the shoulder external rotator muscle strength in patients with rotator cuff tendinitis. PMID:25642053

  6. B-Mode Sonographic Assessment of the Posterior Circumflex Humeral Artery: The SPI-US Protocol-A Technical Procedure in 4 Steps.

    PubMed

    van de Pol, Daan; Maas, Mario; Terpstra, Aart; Pannekoek-Hekman, Marja; Kuijer, P Paul F M; Planken, R Nils

    2016-05-01

    Elite overhead athletes are at risk of vascular injury due to repetitive abduction and external rotation of the dominant arm. The posterior circumflex humeral artery (PCHA) is prone to degeneration, aneurysm formation, and thrombosis in elite volleyball players and baseball pitchers. The prevalence of PCHA-related thromboembolic complications is unknown in this population. However, the prevalence of symptoms associated with digital ischemia is 31% in elite volleyball players. A standardized noninvasive imaging tool will aid in early detection of PCHA injury, prevention of thromboembolic complications, and measurement reproducibility. A standardized vascular sonographic protocol for assessment of the proximal PCHA (SPI-US protocol [Shoulder PCHA Pathology and Digital Ischemia-Ultrasound protocol]) is presented.

  7. Successful Nonoperative Management of HAGL (Humeral Avulsion of Glenohumeral Ligament) Lesion With Concurrent Axillary Nerve Injury in an Active-Duty US Navy SEAL.

    PubMed

    Ernat, Justin J; Bottoni, Craig R; Rowles, Douglas J

    2016-01-01

    Humeral avulsion of the glenohumeral ligament (HAGL) is a lesion that has been recognized as a cause of recurrent shoulder instability. To our knowledge there are no reports of successful return to full function in young, competitive athletes or return to manual labor following nonoperative management of a HAGL lesion. A 26-year-old Navy SEAL was diagnosed with a HAGL injury, and associated traction injury of the axillary nerve as well as a partial tear of the rotator cuff. Operative intervention was recommended; however, due to issues with training and with inability to properly rehab with the axillary nerve injury, surgical plans were delayed. Interestingly, the patient demonstrated both clinical and radiographic magnetic resonance imaging healing of his lesion over an 18-month period. At 18 months the patient had returned to full active duty without pain or instability as a Navy SEAL. PMID:27552458

  8. B-Mode Sonographic Assessment of the Posterior Circumflex Humeral Artery: The SPI-US Protocol-A Technical Procedure in 4 Steps.

    PubMed

    van de Pol, Daan; Maas, Mario; Terpstra, Aart; Pannekoek-Hekman, Marja; Kuijer, P Paul F M; Planken, R Nils

    2016-05-01

    Elite overhead athletes are at risk of vascular injury due to repetitive abduction and external rotation of the dominant arm. The posterior circumflex humeral artery (PCHA) is prone to degeneration, aneurysm formation, and thrombosis in elite volleyball players and baseball pitchers. The prevalence of PCHA-related thromboembolic complications is unknown in this population. However, the prevalence of symptoms associated with digital ischemia is 31% in elite volleyball players. A standardized noninvasive imaging tool will aid in early detection of PCHA injury, prevention of thromboembolic complications, and measurement reproducibility. A standardized vascular sonographic protocol for assessment of the proximal PCHA (SPI-US protocol [Shoulder PCHA Pathology and Digital Ischemia-Ultrasound protocol]) is presented. PMID:27072158

  9. Traumatic shoulder dislocation with combined bankart lesion and humeral avulsion of the glenohumeral ligament in a professional basketball player: three-year follow-up of surgical stabilization.

    PubMed

    Shah, Aakash A; Selesnick, F Harlan

    2010-10-01

    Traumatic anterior shoulder instability has been well documented to have associated lesions such as a Bankart tear, humeral avulsion of the glenohumeral ligament (HAGL), Hill-Sachs lesion, fracture, and nerve injury. To our knowledge, the combined Bankart and HAGL injury in a single acute anterior shoulder dislocation has not yet been reported. We describe a traumatic first-time anterior-inferior shoulder dislocation in a professional basketball player with a combined Bankart and HAGL lesion. The patient underwent arthroscopic Bankart repair followed by open repair of the HAGL lesion with an open capsular shift reconstruction. At 3 years' follow-up, the patient had returned to an elite level of play, with an excellent outcome.

  10. 49 CFR 229.63 - Lateral motion.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 49 Transportation 4 2010-10-01 2010-10-01 false Lateral motion. 229.63 Section 229.63....63 Lateral motion. (a) Except as provided in paragraph (b), the total uncontrolled lateral motion... powered axles. (b) The total uncontrolled lateral motion may not exceed 11/4 inches on the center axle...

  11. Effects of humeral intraosseous versus intravenous epinephrine on pharmacokinetics and return of spontaneous circulation in a porcine cardiac arrest model: A randomized control trial

    PubMed Central

    Johnson, Don; Garcia-Blanco, Jose; Burgert, James; Fulton, Lawrence; Kadilak, Patrick; Perry, Katherine; Burke, Jeffrey

    2015-01-01

    Cardiopulmonary Resuscitation (CPR), defibrillation, and epinephrine administration are pillars of advanced cardiac life support (ACLS). Intraosseous (IO) access is an alternative route for epinephrine administration when intravenous (IV) access is unobtainable. Previous studies indicate the pharmacokinetics of epinephrine administration via IO and IV routes differ, but it is not known if the difference influences return of spontaneous circulation (ROSC). The purpose of this prospective, experimental study was to determine the effects of humeral IO (HIO) and IV epinephrine administration during cardiac arrest on pharmacokinetics, ROSC, and odds of survival. Swine (N = 21) were randomized into 3 groups: humeral IO (HIO), peripheral IV (IV) and CPR/defibrillation control. Cardiac arrest was induced under general anesthesia. The swine remained in arrest for 2 min without intervention. Chest compressions were initiated and continued for 2 min. Epinephrine was administered and serial blood samples collected for pharmacokinetic analysis over 4 min. Defibrillation and epinephrine administration proceeded according to ACLS guidelines continuing for 20 min or until ROSC. Seven HIO swine, 4 IV swine, and no control swine had ROSC. There were no significant differences in ROSC, maximum concentration; except at 30 s, and time-to-concentration-maximum between the HIO and IV groups. Significant differences existed between the experimental groups and the control. The HIO delivers a higher concentration of epinephrine than the IV route at 30 s which may be a survival advantage. Clinicians may consider using the IO route to administer epinephrine during CA when there is no preexisting IV access or when IV access is unobtainable. PMID:26468375

  12. Lateral movement of auxin in phototropism.

    PubMed

    Dela Fuente, R K; Leopold, A C

    1968-07-01

    Lateral movement of indoleacetic acid-1-(14)C in corn coleoptiles was measured as radioactivity moving laterally following unilateral application of the auxin. The data suggest that there is an endogenous lateral movement of auxin, and that phototropic stimulation of the coleoptile depresses lateral movement towards the light and enhances lateral movement away from the light. The lateral movement was found to be principally as indoleacetic acid. In experiments using sunflower hypocotyl sections, evidence is also presented to support the suggestion that lateral redistribution of auxin may be effected by a deflection of auxin around a barrier to basipetal transport.

  13. Direct lateral maneuvers in hawkmoths.

    PubMed

    Greeter, Jeremy S M; Hedrick, Tyson L

    2016-01-01

    We used videography to investigate direct lateral maneuvers, i.e. 'sideslips', of the hawkmoth Manduca sexta. M. sexta sideslip by rolling their entire body and wings to reorient their net force vector. During sideslip they increase net aerodynamic force by flapping with greater amplitude, (in both wing elevation and sweep), allowing them to continue to support body weight while rolled. To execute the roll maneuver we observed in sideslips, they use an asymmetric wing stroke; increasing the pitch of the roll-contralateral wing pair, while decreasing that of the roll-ipsilateral pair. They also increase the wing sweep amplitude of, and decrease the elevation amplitude of, the contralateral wing pair relative to the ipsilateral pair. The roll maneuver unfolds in a stairstep manner, with orientation changing more during downstroke than upstroke. This is due to smaller upstroke wing pitch angle asymmetries as well as increased upstroke flapping counter-torque from left-right differences in global reference frame wing velocity about the moth's roll axis. Rolls are also opposed by stabilizing aerodynamic moments from lateral motion, such that rightward roll velocity will be opposed by rightward motion. Computational modeling using blade-element approaches confirm the plausibility of a causal linkage between the previously mentioned wing kinematics and roll/sideslip. Model results also predict high degrees of axial and lateral damping. On the time scale of whole and half wing strokes, left-right wing pair asymmetries directly relate to the first, but not second, derivative of roll. Collectively, these results strongly support a roll-based sideslip with a high degree of roll damping in M. sexta. PMID:26740573

  14. Direct lateral maneuvers in hawkmoths

    PubMed Central

    Greeter, Jeremy S. M.; Hedrick, Tyson L.

    2016-01-01

    ABSTRACT We used videography to investigate direct lateral maneuvers, i.e. ‘sideslips’, of the hawkmoth Manduca sexta. M. sexta sideslip by rolling their entire body and wings to reorient their net force vector. During sideslip they increase net aerodynamic force by flapping with greater amplitude, (in both wing elevation and sweep), allowing them to continue to support body weight while rolled. To execute the roll maneuver we observed in sideslips, they use an asymmetric wing stroke; increasing the pitch of the roll-contralateral wing pair, while decreasing that of the roll-ipsilateral pair. They also increase the wing sweep amplitude of, and decrease the elevation amplitude of, the contralateral wing pair relative to the ipsilateral pair. The roll maneuver unfolds in a stairstep manner, with orientation changing more during downstroke than upstroke. This is due to smaller upstroke wing pitch angle asymmetries as well as increased upstroke flapping counter-torque from left-right differences in global reference frame wing velocity about the moth's roll axis. Rolls are also opposed by stabilizing aerodynamic moments from lateral motion, such that rightward roll velocity will be opposed by rightward motion. Computational modeling using blade-element approaches confirm the plausibility of a causal linkage between the previously mentioned wing kinematics and roll/sideslip. Model results also predict high degrees of axial and lateral damping. On the time scale of whole and half wing strokes, left-right wing pair asymmetries directly relate to the first, but not second, derivative of roll. Collectively, these results strongly support a roll-based sideslip with a high degree of roll damping in M. sexta. PMID:26740573

  15. Direct lateral maneuvers in hawkmoths.

    PubMed

    Greeter, Jeremy S M; Hedrick, Tyson L

    2016-01-01

    We used videography to investigate direct lateral maneuvers, i.e. 'sideslips', of the hawkmoth Manduca sexta. M. sexta sideslip by rolling their entire body and wings to reorient their net force vector. During sideslip they increase net aerodynamic force by flapping with greater amplitude, (in both wing elevation and sweep), allowing them to continue to support body weight while rolled. To execute the roll maneuver we observed in sideslips, they use an asymmetric wing stroke; increasing the pitch of the roll-contralateral wing pair, while decreasing that of the roll-ipsilateral pair. They also increase the wing sweep amplitude of, and decrease the elevation amplitude of, the contralateral wing pair relative to the ipsilateral pair. The roll maneuver unfolds in a stairstep manner, with orientation changing more during downstroke than upstroke. This is due to smaller upstroke wing pitch angle asymmetries as well as increased upstroke flapping counter-torque from left-right differences in global reference frame wing velocity about the moth's roll axis. Rolls are also opposed by stabilizing aerodynamic moments from lateral motion, such that rightward roll velocity will be opposed by rightward motion. Computational modeling using blade-element approaches confirm the plausibility of a causal linkage between the previously mentioned wing kinematics and roll/sideslip. Model results also predict high degrees of axial and lateral damping. On the time scale of whole and half wing strokes, left-right wing pair asymmetries directly relate to the first, but not second, derivative of roll. Collectively, these results strongly support a roll-based sideslip with a high degree of roll damping in M. sexta.

  16. Vision assisted aircraft lateral navigation

    NASA Astrophysics Data System (ADS)

    Mohideen, Mohamed Ibrahim; Ramegowda, Dinesh; Seiler, Peter

    2013-05-01

    Surface operation is currently one of the least technologically equipped phases of aircraft operation. The increased air traffic congestion necessitates more aircraft operations in degraded weather and at night. The traditional surface procedures worked well in most cases as airport surfaces have not been congested and airport layouts were less complex. Despite the best efforts of FAA and other safety agencies, runway incursions continue to occur frequently due to incorrect surface operation. Several studies conducted by FAA suggest that pilot induced error contributes significantly to runway incursions. Further, the report attributes pilot's lack of situational awareness - local (e.g., minimizing lateral deviation), global (e.g., traffic in the vicinity) and route (e.g., distance to next turn) - to the problem. An Enhanced Vision System (EVS) is one concept that is being considered to resolve these issues. These systems use on-board sensors to provide situational awareness under poor visibility conditions. In this paper, we propose the use of an Image processing based system to estimate the aircraft position and orientation relative to taxiway markings to use as lateral guidance aid. We estimate aircraft yaw angle and lateral offset from slope of the taxiway centerline and horizontal position of vanishing line. Unlike automotive applications, several cues such as aircraft maneuvers along assigned route with minimal deviations, clear ground markings, even taxiway surface, limited aircraft speed are available and enable us to implement significant algorithm optimizations. We present experimental results to show high precision navigation accuracy with sensitivity analysis with respect to camera mount, optics, and image processing error.

  17. Laterally Mounted Azobenzenes on Platforms.

    PubMed

    Hammerich, Melanie; Herges, Rainer

    2015-11-20

    Triazatriangulenium ions have previously been used as platforms to prepare self-assembled monolayers of functional molecules such as azobenzenes with vertical orientation and that are free-standing on gold surfaces. We have now prepared azobenzenes that are spanned between two posts which are attached on two platforms. Absorbed on a gold surface, the azobenzene should be laterally oriented at a distance of more than 4 Å above and thus electronically decoupled from the surface, and the system should perform a muscle-type movement upon isomerization. PMID:26551306

  18. Lateralization of aggression in fish.

    PubMed

    Bisazza, Angelo; de Santi, Andrea

    2003-05-15

    Recent research has suggested that lateralization of aggressive behaviors could follow an homogeneous pattern among all vertebrates. A left eye/right hemisphere dominance in eliciting aggressive responses has been demonstrated for all groups of tetrapods but teleost fish for which data is lacking. Here we studied differential eye use during aggressive interactions in three species of teleosts: Gambusia holbrooki, Xenotoca eiseni and Betta splendens. In the first experiment we checked for lateralization in the use of the eyes while the subject was attacking its own mirror image. In order to confirm the results, other tests were performed on two species and eye preference was scored during attacks or displays directed toward a live rival. All three species showed a marked preference for using the right eye when attacking a mirror image or a live rival. Thus, the direction of asymmetry in fish appears the opposite to that shown by all the other groups of vertebrates. Hypotheses on the origin of the difference are discussed.

  19. Lateralization of aggression in fish.

    PubMed

    Bisazza, Angelo; de Santi, Andrea

    2003-05-15

    Recent research has suggested that lateralization of aggressive behaviors could follow an homogeneous pattern among all vertebrates. A left eye/right hemisphere dominance in eliciting aggressive responses has been demonstrated for all groups of tetrapods but teleost fish for which data is lacking. Here we studied differential eye use during aggressive interactions in three species of teleosts: Gambusia holbrooki, Xenotoca eiseni and Betta splendens. In the first experiment we checked for lateralization in the use of the eyes while the subject was attacking its own mirror image. In order to confirm the results, other tests were performed on two species and eye preference was scored during attacks or displays directed toward a live rival. All three species showed a marked preference for using the right eye when attacking a mirror image or a live rival. Thus, the direction of asymmetry in fish appears the opposite to that shown by all the other groups of vertebrates. Hypotheses on the origin of the difference are discussed. PMID:12742249

  20. Deconvolution of Lateral Shear Interferograms

    NASA Astrophysics Data System (ADS)

    Ambrose, Joseph George

    1994-01-01

    This dissertation develops and presents an existing but little known method to provide an exact solution to the Wavefront Difference Equation routinely encountered in the reduction of Lateral Shear Interferograms (LSI). The method first suggested by Dr. Roland Shack treats LSI as a convolution of the wavefront with an odd impulse pair. This representation casts the Lateral Shear problem in terms of Fourier optics operators and filters with a simplified treatment of the reduction of the LSI possible. This work extends the original proposal applied to line scans of wavefronts to full two-dimensional recovery of the wavefront along with developing the associated mathematical theory and computer code to efficiently execute the wavefront reduction. Further, a number of applications of the wavefront reduction technique presented here are developed. The applications of the filtering technique developed here include optical imaging systems exhibiting the primary aberrations, a model of residual tool marks after fabrication and propagation of an optical probe through atmospheric turbulence. The computer program developed in this work resides on a PC and produces accurate results to a 1/500 wave when compared to ray traced input wavefronts. The combination of the relatively simple concept providing the basis of the reduction technique with the highly accurate results over a wide range of input wavefronts makes this a timely effort. Finally, the reduction technique can be applied to the accurate testing of aspheric optical components.

  1. Deconvolution of lateral shear interferograms

    NASA Astrophysics Data System (ADS)

    Ambrose, Joseph George

    This dissertation develops and presents an existing but little known method to provide an exact solution to the wavefront difference equation routinely encountered in the reduction of lateral shear interferograms (LSI). The method first suggested by Dr. Roland Shack treats LSI as a convolution of the wavefront with an odd impulse pair. This representation casts the lateral shear problem in terms of Fourier optics operators and filters with a simplified treatment of the reduction of the LSI possible. This work extends the original proposal applied to line scans of wavefronts to full two-dimensional recovery of the wavefront along with developing the associated mathematical theory and computer code to efficiently execute the wavefront reduction. Further, a number of applications of the wavefront reduction technique presented here are developed. The applications of the filtering technique developed here include optical imaging systems exhibiting the primary aberrations, a model of residual tool marks after fabrication, and propagation of an optical probe through atmospheric turbulence. The computer program developed resides on a PC and produces accurate results to a 1/500 wave when compared to ray traced input wavefronts. The combination of the relatively simple concept providing the basis of the reduction technique with the highly accurate results over a wide range of input wavefronts makes this a timely effort. Finally, the reduction technique can be applied to the accurate testing of aspheric optical components.

  2. [Bilateral Dislocation Fracture of the Humeral Head (Right AO 11C3.3; Left AO 11A1.3) without Direct Trauma Due to First Clinical Manifestation of Seizure - a Case Report and Review of the Literature].

    PubMed

    Ploeger, M M; Pennekamp, P H; Müller, M C; Kabir, K; Burger, C; Wirtz, D C; Schmolders, J

    2015-12-01

    The incidence of fractures among epileptics is frequent and mostly occurs by direct trauma due to falls caused by seizures. The risk of fractures is estimated to be 50 % higher in epileptics than in the general population. Most of the fractures affect the proximal femora and the hip joint. Dorsal shoulder dislocations occur frequently in epileptics. If they occur bilaterally, this is pathognomonic for seizuring. Besides this, shoulder dislocation and bilateral dislocation fractures of the humeral head, however, are far more rare even among epileptics but pathognomonic for seizure. In this case report we present a female patient with bilateral dislocation fracture of the humeral head due to first clinical manifestation of a tonic-clonic seizure without direct trauma.

  3. LATERAL EPICONDYLITIS OF THE ELBOW

    PubMed Central

    Cohen, Marcio; da Rocha Motta Filho, Geraldo

    2015-01-01

    Lateral epicondylitis, also known as tennis elbow, is a common condition that is estimated to affect 1% to 3% of the population. The word epicondylitis suggests inflammation, although histological analysis on the tissue fails to show any inflammatory process. The structure most commonly affected is the origin of the tendon of the extensor carpi radialis brevis and the mechanism of injury is associated with overloading. Nonsurgical treatment is the preferred method, and this includes rest, physiotherapy, cortisone infiltration, platelet-rich plasma injections and use of specific immobilization. Surgical treatment is recommended when functional disability and pain persist. Both the open and the arthroscopic surgical technique with resection of the degenerated tendon tissue present good results in the literature. PMID:27047843

  4. Lateral epicondylosis: emerging management options.

    PubMed

    Thompson, Carolyn; Visco, Christopher

    2015-01-01

    Lateral epicondylosis is one of the most prevalent disorders of the arm and results in significantly decreased function among the workforce and athletes. Historically, the disorder has been diagnosed clinically and treated as an inflammatory entity. Management strategies have included anti-inflammatory medications and techniques, including oral nonsteroidal anti-inflammatories, injected corticosteroid, and physical therapy with modalities. More recent literature postulates a degenerative or compressive etiology, directing some clinicians to try new, more regenerative management strategies such as platelet-rich plasma and stem cell injections. To date, literature evaluating these new treatment methods has shown positive results, although no definitive conclusions can be drawn. More research is needed to evaluate these new treatment methods, and a new look at the diagnosis of the disorder with ultrasound imaging may be reasonable to consider. PMID:25968855

  5. Teen Obesity May Mean Liver Disease Later

    MedlinePlus

    ... news/fullstory_159416.html Teen Obesity May Mean Liver Disease Later Study found risk increased as weight went ... obese could be at increased risk for severe liver disease later in life, a new study suggests. The ...

  6. Hemispheric Laterality in Music and Math

    ERIC Educational Resources Information Center

    Szirony, Gary Michael; Burgin, John S.; Pearson, L. Carolyn

    2008-01-01

    Hemispheric laterality may be a useful concept in teaching, learning, training, and in understanding more about human development. To address this issue, a measure of hemispheric laterality was compared to musical and mathematical ability. The Human Information Processing Survey (HIPS) instrument, designed to measure hemispheric laterality, was…

  7. Sewer Lateral Electro Scan Field Verification Pilot

    EPA Science Inventory

    Abstract:WERF selected a proposed research project to field test an emerging technology for inspecting sanitary sewer lateral pipes. The technology is called Electro Scan and is used to find defects in laterals that allow the infiltration of groundwater into the lateral. Electro ...

  8. A multicenter, prospective, randomized, controlled trial of open reduction--internal fixation versus total elbow arthroplasty for displaced intra-articular distal humeral fractures in elderly patients.

    PubMed

    McKee, Michael D; Veillette, Christian J H; Hall, Jeremy A; Schemitsch, Emil H; Wild, Lisa M; McCormack, Robert; Perey, Bertrand; Goetz, Thomas; Zomar, Mauri; Moon, Karyn; Mandel, Scott; Petit, Shirlet; Guy, Pierre; Leung, Irene

    2009-01-01

    We conducted a prospective, randomized, controlled trial to compare functional outcomes, complications, and reoperation rates in elderly patients with displaced intra-articular, distal humeral fractures treated with open reduction-internal fixation (ORIF) or primary semiconstrained total elbow arthroplasty (TEA). Forty-two patients were randomized by sealed envelope. Inclusion criteria were age greater than 65 years; displaced, comminuted, intra-articular fractures of the distal humerus (Orthopaedic Trauma Association type 13C); and closed or Gustilo grade I open fractures treated within 12 hours of injury. Both ORIF and TEA were performed following a standardized protocol. The Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) score were determined at 6 weeks, 3 months, 6 months, 12 months, and 2 years. Complication type, duration, management, and treatment requiring reoperation were recorded. An intention-to-treat analysis and an on-treatment analysis were conducted to address patients randomized to ORIF but converted to TEA intraoperatively. Twenty-one patients were randomized to each treatment group. Two died before follow-up and were excluded from the study. Five patients randomized to ORIF were converted to TEA intraoperatively because of extensive comminution and inability to obtain fixation stable enough to allow early range of motion. This resulted in 15 patients (3 men and 12 women) with a mean age of 77 years in the ORIF group and 25 patients (2 men and 23 women) with a mean age of 78 years in the TEA group. Baseline demographics for mechanism, classification, comorbidities, fracture type, activity level, and ipsilateral injuries were similar between the 2 groups. Operative time averaged 32 minutes less in the TEA group (P = .001). Patients who underwent TEA had significantly better MEPSs at 3 months (83 vs 65, P = .01), 6 months (86 vs 68, P = .003), 12 months (88 vs 72, P = .007), and 2 years (86 vs 73, P = .015

  9. Developmental dyscalculia and brain laterality.

    PubMed

    Shalev, R S; Manor, O; Amir, N; Wertman-Elad, R; Gross-Tsur, V

    1995-06-01

    The correlation between arithmetic dysfunction and brain laterality was studied in 25 children with developmental dyscalculia (DD). The children were tested on a standardized arithmetic battery and underwent a neurological and neuro-psychological evaluation. A diagnosis of left hemisphere dysfunction (n = 13) was based on right side soft neurological signs, performance IQ (PIQ) > verbal IQ (VIQ), dyslexia and intact visuo-spatial functions. The criteria for right hemisphere dysfunction (n = 12) were left body signs, VIQ > PIQ, impaired visuo-spatial functions and normal language skills. The groups were similar for age, gender, and socio-economic status. Our results showed that both groups scored more than 2 SD below the mean adjusted score on the arithmetic battery, but the left group was significantly worse in 3 areas: mastery of addition/subtraction, complex multiplication and division and visuo-spatial errors (p < 0.05). The data indicate that dysfunction of either hemisphere hampers arithmetic acquisition, but arithmetic impairment is more profound with left hemisphere dysfunction. PMID:7555012

  10. The multifunctional lateral geniculate nucleus.

    PubMed

    Weyand, Theodore G

    2016-02-01

    Providing the critical link between the retina and visual cortex, the well-studied lateral geniculate nucleus (LGN) has stood out as a structure in search of a function exceeding the mundane 'relay'. For many mammals, it is structurally impressive: Exquisite lamination, sophisticated microcircuits, and blending of multiple inputs suggest some fundamental transform. This impression is bolstered by the fact that numerically, the retina accounts for a small fraction of its input. Despite such promise, the extent to which an LGN neuron separates itself from its retinal brethren has proven difficult to appreciate. Here, I argue that whereas retinogeniculate coupling is strong, what occurs in the LGN is judicious pruning of a retinal drive by nonretinal inputs. These nonretinal inputs reshape a receptive field that under the right conditions departs significantly from its retinal drive, even if transiently. I first review design features of the LGN and follow with evidence for 10 putative functions. Only two of these tend to surface in textbooks: parsing retinal axons by eye and functional group and gating by state. Among the remaining putative functions, implementation of the principle of graceful degradation and temporal decorrelation are at least as interesting but much less promoted. The retina solves formidable problems imposed by physics to yield multiple efficient and sensitive representations of the world. The LGN applies context, increasing content, and gates several of these representations. Even if the basic concentric receptive field remains, information transmitted for each LGN spike relative to each retinal spike is measurably increased. PMID:26479339

  11. Retroviruses and amyotrophic lateral sclerosis

    PubMed Central

    Alfahad, Tariq; Nath, Avindra

    2013-01-01

    Amyotrophic lateral sclerosis (ALS) is a progressive, invariably fatal neurologic disorder resulting from upper and lower motor neuron degeneration, which typically develops during the sixth or seventh decade of life, and is diagnosed based on standard clinical criteria. Its underlying cause remains undetermined. The disease may occur with increased frequency within certain families, often in association with specific genomic mutations, while some sporadic cases have been linked to environmental toxins or trauma. Another possibility, first proposed in the 1970s, is that retroviruses play a role in pathogenesis. In this paper, we review the published literature for evidence that ALS is associated either with infection by an exogenous retrovirus or with the expression of human endogenous retroviral (HERV) sequences in cells of the central nervous system. A small percentage of persons infected with the human immunodeficiency virus-1 (HIV-1) or human T cell leukemia virus-1 (HTLV-1) develop ALS-like syndromes. While HTLV-1 associated ALS-like syndrome has several features that may distinguish it from classical ALS, HIV-infected patients may develop neurological manifestations that resemble classical ALS although it occurs at a younger age and they may show a dramatic improvement following the initiation of antiretroviral therapy. However, most patients with probable or definite ALS show no evidence of HIV-1 or HTLV-1 infection. In contrast, recent reports have shown a stronger association with HERV, as analysis of serum samples, and postmortem brain tissue from a number of patients with a classical ALS has revealed significantly increased expression of HERV-K, compared to controls. These findings suggest that endogenous retroviral elements are involved in the pathophysiology of ALS, but there is no evidence that they are the primary cause of the syndrome. PMID:23707220

  12. “8 Plate”: An Alternative Device to Fix Highly Recurrent Traumatic Anterior Gleno-Humeral Instability in Patients with Severe Impairment of the Anterior Capsule

    PubMed Central

    Tudisco, C; Bisicchia, S; Savarese, E; Ippolito, E

    2014-01-01

    Background: There is still debate about the best treatment option for highly recurrent anterior shoulder dislocation in patients with severe impairment of the anterior capsule and/or recurrence after either arthroscopic or open capsulorrhaphy. Materials and Methods: The clinical and radiological findings of 7 patients treated with an open capsulorrhaphy stabilized with an “8 plate” for a highly recurrent traumatic anterior shoulder dislocation with severe impairment of the anterior capsule and a large Bankart lesion were retrospectively reviewed. Follow-up evaluation included VAS for pain, Constant-Murley, Simple Shoulder Test, ASES, UCLA, Quick DASH, Rowe, Walsch-Duplay scores, as well as X-rays of the operated shoulder. Results: At follow-up none of the patients reported subsequent dislocations. Range of motion of the shoulder was complete in all cases, but one. Results of the functional scoring systems were satisfactory. X-rays showed no osteolysis and good position of the plate. Conclusion: To our knowledge, this is the first report in the literature about an open capsular tensioning and Bankart lesion repair performed with an “8 plate”. We believe that this is a reliable and effective procedure to address traumatic anterior re-dislocation of the gleno-humeral joint when the capsule is extensively torn and frayed or in revision cases. Moreover the “8 plate” is ideal to be applied in such a narrow space on the slant surface of the scapular neck close to the glenoid rim. PMID:25621080

  13. Flexible intramedullary nailing had better outcomes than kirschner wire fixation in children with distal humeral metaphyseal-diaphyseal junction fracture: a retrospective observational analysis

    PubMed Central

    Ge, Yi-Hua; Wang, Zhi-Gang; Cai, Hai-Qing; Yang, Jie; Xu, Yun-Lan; Li, Yu-Chan

    2014-01-01

    The effectiveness evaluation of flexible intramedullary nailing (FIN) and kirschner wire fixation (K-wire) used for MDJ fractures fixation have been described in multiple reports. But there have been few reports about comparison between FIN and K-wire in children with distal humeral MDJ fracture. In our retrospective study, Nineteen children received K-wire and twenty children received FIN, during the follow-up, six children in the K-wire group and one children in the FIN group was found to have postoperative cubitus varus; fixation method was an independent risk factor for postoperative cubitus varus (P = 0.001), fixation methods contributed significantly to operation time (t = 6.519, P < 0.001), surgical blood loss (t = 5.349, P < 0.001) and postoperative fracture healing time (t = 4.940, P < 0.001). We can conclude that FIN was related with lower incidence of postoperative cubitus varus, shorter operation time, less surgical blood loss and shorter fracture healing time compared to K-wire in children with MDJ fractures of the distal humerus. PMID:25419399

  14. [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

  15. A review of the evolution of intraosseous access in tactical settings and a feasibility study of a human cadaver model for a humeral head approach.

    PubMed

    Rush, Stephen; D'Amore, Jason; Boccio, Eric

    2014-08-01

    In the tactical setting, intraosseous (IO) access has become popular to treat hemorrhagic shock when peripheral intravenous access is difficult or impractical. The traditional sites most commonly used by combat medics, corpsmen, and Pararescuemen (PJs) include the sternum and tibial tuberosity. Recent studies have shown that the humeral head (HH) is an appropriate and effective access site for IO infusion and fluid resuscitation in the clinical setting. In this procedural feasibility study, we assessed the ability of 26 U.S. Air Force PJs to perform HH IO placement on fresh, unfixed human cadavers over two consecutive cadaver lab training sessions. Following a formal didactic session, which highlighted proper patient positioning and technique, the PJs were instructed to attempt to place an IO needle using both a drill and manual driver. Once performed, correct placement was reviewed by a physician and confirmed by aspiration of bone marrow. Rates of success were calculated on first and second pass. First pass success rates were 96% and 90.5% for the drill and driver, respectively. Both devices achieved 100% success by the second pass. Military field personnel would benefit from a HH approach, especially in the care and management of patients of explosive injuries.

  16. Summary of lateral-control research

    NASA Technical Reports Server (NTRS)

    Toll, Thomas A

    1947-01-01

    A summary has been made of the available information on lateral control. A discussion is given of the criterions used in lateral-control specifications, of the factors involved in obtaining satisfactory lateral control, and of the methods employed in making lateral-control investigations in flight and in wind tunnels. The available data on conventional flap-type ailerons having various types of aerodynamic balance are presented in a form convenient for use in design. The characteristics of spoiler devices and booster mechanisms are discussed. The effects of Mach number, boundary layer, and distortion of the wing or of the lateral-control system are considered insofar as the available information permits. An example is included to illustrate the use of the design data. The limitations of the available information and some of the lateral-control problems that remain to be solved are indicated.

  17. Artificial lateral line canal for hydrodynamic detection

    NASA Astrophysics Data System (ADS)

    Yang, Yingchen; Klein, Adrian; Bleckmann, Horst; Liu, Chang

    2011-07-01

    Fish use their lateral line system to detect minute water motions. The lateral line consists of superficial neuromasts and canal neuromasts. The response properties of canal neuromasts differ from those of superficial ones. Here, we report the design, fabrication, and characterization of an artificial lateral line canal system. The characterization was done under various fluid conditions, including dipolar excitation and turbulent flow. The experimental results with dipole excitation match well with a mathematical model. Canal sensors also demonstrate significantly better noise immunity compared with superficial ones. Canal-type artificial lateral lines may become important for underwater flow sensing.

  18. Vannevar Bush: Fifty Years Later

    NASA Astrophysics Data System (ADS)

    Lagowski, J. J.

    1995-12-01

    It is ironic that the 50th anniversary year of Vannevar Bush's Report to President Truman entitled "Science the Endless Frontier", which put into motion the eminently successful current system of education of scientists in this country occurs at a time when serious questions are being asked about the usefulness of that very system. Bush viewed his proposal to establish a national research foundation (later to be called the National Science Foundation) as a "social compact." Judgment of scientific merit would be delegated to expert peers in return for scientific progress, which would ultimately benefit the nation in terms of scientific needs--military security, economic productivity, and enhanced quality of life. Bush wanted the funding of basic research intertwined with training, and preferred to use universities for this purpose rather than industrial or national labs. Bush viewed college and university scientists as teachers and investigators. He believed university-based research would uniquely encourage and engage the next generation of scientists as no other institutional arrangement could. Bush did not trust industry's commitment to basic research, an instinct that proved prophetic. The academic reserve of scientists (PhD's in training and postdoctoral students) that existed before World War II, and upon which the United States could draw for its needs, which were primarily associated with defense efforts, was probably one of the defining factors in Bush's suggested strategy. Currently, that reserve of talent has gotten so large that it is the obvious throttle in the pipeline slowing the continued development of the university research enterprise. Since 1977, the rate at which we have trained new scientists exceeds an average of 4% annually. Since 1987, the "science work force"--PhD's--has grown at three times the rate of the general labor supply. Temporary positions for postdoctoral scientists have grown even faster (over 5% per year since 1989). To compound

  19. Laterality and Dyslexia: A Critical View.

    ERIC Educational Resources Information Center

    Hiscock, Merrill; Kinsbourne, Marcel

    1982-01-01

    Research is reviewed concerning the current state of knowledge about normal hemispheric specialization; distinctions among such terms as dominance, laterality, and lateralization; and models of abnormal cerebral organization in dyslexic children. The question of dyslexic subtypes is undertaken along such dimensions as handedness, eyedness, and…

  20. Laterality and Reading Proficiency in Children.

    ERIC Educational Resources Information Center

    Leong, Che Kan

    1980-01-01

    Discusses some current concepts of the laterality/reading relationship. An overview of Samuel T. Orton's hypotheses of cerebral dominance and "strephosymbolia" is provided, and both visual half-field and dichotic listening studies as direct, empirical tests of laterality are discussed. (MKM)

  1. Aeromonas hydrophila Lateral Flagellar Gene Transcriptional Hierarchy

    PubMed Central

    Wilhelms, Markus; Gonzalez, Victor; Merino, Susana

    2013-01-01

    Aeromonas hydrophila AH-3 lateral flagella are not assembled when bacteria grow in liquid media; however, lateral flagellar genes are transcribed. Our results indicate that A. hydrophila lateral flagellar genes are transcribed at three levels (class I to III genes) and share some similarities with, but have many important differences from, genes of Vibrio parahaemolyticus. A. hydrophila lateral flagellum class I gene transcription is σ70 dependent, which is consistent with the fact that lateral flagellum is constitutively transcribed, in contrast to the characteristics of V. parahaemolyticus. The fact that multiple genes are included in class I highlights that lateral flagellar genes are less hierarchically transcribed than polar flagellum genes. The A. hydrophila lafK-fliEJL gene cluster (where the subscript L distinguishes genes for lateral flagella from those for polar flagella) is exclusively from class I and is in V. parahaemolyticus class I and II. Furthermore, the A. hydrophila flgAMNL cluster is not transcribed from the σ54/LafK-dependent promoter and does not contain class II genes. Here, we propose a gene transcriptional hierarchy for the A. hydrophila lateral flagella. PMID:23335410

  2. Lateral displacement and rotational displacement sensor

    DOEpatents

    Duden, Thomas

    2014-04-22

    A position measuring sensor formed from opposing sets of capacitor plates measures both rotational displacement and lateral displacement from the changes in capacitances as overlapping areas of capacitors change. Capacitances are measured by a measuring circuit. The measured capacitances are provided to a calculating circuit that performs calculations to obtain angular and lateral displacement from the capacitances measured by the measuring circuit.

  3. Minimizing energy requirements for sprinkler laterals

    SciTech Connect

    Kincaid, D.C.

    1985-01-01

    A computer model was developed to utilize single sprinkler pattern tests in simulating stationary lateral sprinkler systems operating under variable wind conditions. The performance of a low pressure nozzle was compared to that of a standard high pressure round nozzle on a typical multiple set lateral system.

  4. Gender and Marital Happiness in Later Life

    ERIC Educational Resources Information Center

    Kaufman, Gayle; Taniguchi, Hiromi

    2006-01-01

    In this study, the authors examine the effect of gender ideology on marital happiness in later life. Studies of marital satisfaction in later life have tended to neglect such attitudes, although they have received increasing attention in the literature on younger marriages. The authors use data from married individuals who range in age from 51 to…

  5. Later Life: A Time to Learn

    ERIC Educational Resources Information Center

    Russell, Helen

    2008-01-01

    In this article, an emerging framework for investigating and interpreting the experiences of learning in later life is presented. This framework is contextualized by a study in which the lived experiences of later-life computer learners were investigated. Significant ontological and existential interpretations from the study provided insights into…

  6. Ultrasonographic Differentiation of Lateral Elbow Pain.

    PubMed

    Obuchowicz, R; Bonczar, M

    2016-05-01

    Lateral elbow pain is often attributed to degenerative or posttraumatic impairment of the common extensor tendon. Ultrasonography assesses the soft tissue structures of the lateral elbow, allowing the differentiation between various underlying processes, including angiofibroblastic degeneration, hyaline degeneration, and inflammation, and exclusion of other possible causes of pain such as posterior interosseous and lateral antebrachial nerve compression. Furthermore, the real-time imaging nature of ultrasonography enables the detection of impingement of the lateral synovial fold, degenerative changes in the elbow recess, and elbow posterolateral instability during dynamic maneuvers. Ultrasonography is widely accessible and well tolerated by patients, making it a perfect method for establishing an initial diagnosis and monitoring the healing process. This review describes the possible causes of lateral elbow pain and their ultrasonographic differentiation. PMID:27689169

  7. Ultrasonographic Differentiation of Lateral Elbow Pain

    PubMed Central

    Obuchowicz, R.; Bonczar, M.

    2016-01-01

    Lateral elbow pain is often attributed to degenerative or posttraumatic impairment of the common extensor tendon. Ultrasonography assesses the soft tissue structures of the lateral elbow, allowing the differentiation between various underlying processes, including angiofibroblastic degeneration, hyaline degeneration, and inflammation, and exclusion of other possible causes of pain such as posterior interosseous and lateral antebrachial nerve compression. Furthermore, the real-time imaging nature of ultrasonography enables the detection of impingement of the lateral synovial fold, degenerative changes in the elbow recess, and elbow posterolateral instability during dynamic maneuvers. Ultrasonography is widely accessible and well tolerated by patients, making it a perfect method for establishing an initial diagnosis and monitoring the healing process. This review describes the possible causes of lateral elbow pain and their ultrasonographic differentiation. PMID:27689169

  8. Ultrasonographic Differentiation of Lateral Elbow Pain

    PubMed Central

    Obuchowicz, R.; Bonczar, M.

    2016-01-01

    Lateral elbow pain is often attributed to degenerative or posttraumatic impairment of the common extensor tendon. Ultrasonography assesses the soft tissue structures of the lateral elbow, allowing the differentiation between various underlying processes, including angiofibroblastic degeneration, hyaline degeneration, and inflammation, and exclusion of other possible causes of pain such as posterior interosseous and lateral antebrachial nerve compression. Furthermore, the real-time imaging nature of ultrasonography enables the detection of impingement of the lateral synovial fold, degenerative changes in the elbow recess, and elbow posterolateral instability during dynamic maneuvers. Ultrasonography is widely accessible and well tolerated by patients, making it a perfect method for establishing an initial diagnosis and monitoring the healing process. This review describes the possible causes of lateral elbow pain and their ultrasonographic differentiation.

  9. Model to Design Drip Hose Lateral Line

    NASA Astrophysics Data System (ADS)

    Ludwig, Rafael; Cury Saad, João Carlos

    2014-05-01

    Introduction The design criterion for non-pressure compensating drip hose is normally to have 10% of flow variation (Δq) in the lateral line, corresponding to 20% of head pressure variation (ΔH). Longer lateral lines in drip irrigation systems using conventional drippers provide cost reduction, but it is necessary to obtain to the uniformity of irrigation [1]. The use of Δq higher levels can provide longer lateral lines. [4] proposes the use of a 30% Δq and he found that this value resulted in distribution uniformity over 80%. [1] considered it is possible to extend the lateral line length using two emitters spacing in different section. He assumed that the spacing changing point would be at 40% of the total length, because this is approximately the location of the average flow according with [2]. [3] found that, for practical purposes, the average pressure is located at 40% of the length of the lateral line and that until this point it has already consumed 75% of total pressure head loss (hf ). In this case, the challenge for designers is getting longer lateral lines with high values of uniformity. Objective The objective of this study was to develop a model to design longer lateral lines using non-pressure compensating drip hose. Using the developed model, the hypotheses to be evaluated were: a) the use of two different spacing between emitters in the same lateral line allows longer length; b) it is possible to get longer lateral lines using high values of pressure variation in the lateral lines since the distribution uniformity stays below allowable limits. Methodology A computer program was developed in Delphi® based on the model developed and it is able to design lateral lines in level using non-pressure compensating drip hose. The input data are: desired distribution uniformity (DU); initial and final pressure in the lateral line; coefficients of relationship between emitter discharge and pressure head; hose internal diameter; pipe cross-sectional area

  10. Dysregulation of 4q35- and muscle-specific genes in fetuses with a short D4Z4 array linked to facio-scapulo-humeral dystrophy.

    PubMed

    Broucqsault, Natacha; Morere, Julia; Gaillard, Marie-Cécile; Dumonceaux, Julie; Torrents, Julia; Salort-Campana, Emmanuelle; Maues De Paula, André; Bartoli, Marc; Fernandez, Carla; Chesnais, Anne Laure; Ferreboeuf, Maxime; Sarda, Laure; Dufour, Henry; Desnuelle, Claude; Attarian, Shahram; Levy, Nicolas; Nguyen, Karine; Magdinier, Frédérique; Roche, Stéphane

    2013-10-15

    Facio-scapulo-humeral dystrophy (FSHD) results from deletions in the subtelomeric macrosatellite D4Z4 array on the 4q35 region. Upregulation of the DUX4 retrogene from the last D4Z4 repeated unit is thought to underlie FSHD pathophysiology. However, no one knows what triggers muscle defect and when alteration arises. To gain further insights into the molecular mechanisms of the disease, we evaluated at the molecular level, the perturbation linked to the FSHD genotype with no a priori on disease onset, severity or penetrance and prior to any infiltration by fibrotic or adipose tissue in biopsies from fetuses carrying a short pathogenic D4Z4 array (n = 6) compared with fetuses with a non-pathogenic D4Z4 array (n = 21). By measuring expression of several muscle-specific markers and 4q35 genes including the DUX4 retrogene by an RT-PCR and western blotting, we observed a global dysregulation of genes involved in myogenesis including MYOD1 in samples with <11 D4Z4. The DUX4-fl pathogenic transcript was detected in FSHD biopsies but also in controls. Importantly, in FSHD fetuses, we mainly detected the non-spliced DUX4-fl isoform. In addition, several other genes clustered at the 4q35 locus are upregulated in FSHD fetuses. Our study is the first to examine fetuses carrying an FSHD-linked genotype and reveals an extensive dysregulation of several muscle-specific and 4q35 genes at early development stage at a distance from any muscle defect. Overall, our work suggests that even if FSHD is an adult-onset muscular dystrophy, the disease might also involve early molecular defects arising during myogenesis or early differentiation. PMID:23777630

  11. Investigation of the mechanical behavior of kangaroo humeral head cartilage tissue by a porohyperelastic model based on the strain-rate-dependent permeability.

    PubMed

    Thibbotuwawa, Namal; Oloyede, Adekunle; Senadeera, Wijitha; Li, Tong; Gu, YuanTong

    2015-11-01

    Solid-interstitial fluid interaction, which depends on tissue permeability, is significant to the strain-rate-dependent mechanical behavior of humeral head (shoulder) cartilage. Due to anatomical and biomechanical similarities to that of the human shoulder, kangaroos present a suitable animal model. Therefore, indentation experiments were conducted on kangaroo shoulder cartilage tissues from low (10(-4)/s) to moderately high (10(-2)/s) strain-rates. A porohyperelastic model was developed based on the experimental characterization; and a permeability function that takes into account the effect of strain-rate on permeability (strain-rate-dependent permeability) was introduced into the model to investigate the effect of rate-dependent fluid flow on tissue response. The prediction of the model with the strain-rate-dependent permeability was compared with those of the models using constant permeability and strain-dependent permeability. Compared to the model with constant permeability, the models with strain-dependent and strain-rate-dependent permeability were able to better capture the experimental variation at all strain-rates (p < 0.05). Significant differences were not identified between models with strain-dependent and strain-rate-dependent permeability at strain-rate of 5 × 10(-3)/s (p = 0.179). However, at strain-rate of 10(-2)/s, the model with strain-rate-dependent permeability was significantly better at capturing the experimental results (p < 0.005). The findings thus revealed the significance of rate-dependent fluid flow on tissue behavior at large strain-rates, which provides insights into the mechanical deformation mechanisms of cartilage tissues.

  12. Investigation of the mechanical behavior of kangaroo humeral head cartilage tissue by a porohyperelastic model based on the strain-rate-dependent permeability.

    PubMed

    Thibbotuwawa, Namal; Oloyede, Adekunle; Senadeera, Wijitha; Li, Tong; Gu, YuanTong

    2015-11-01

    Solid-interstitial fluid interaction, which depends on tissue permeability, is significant to the strain-rate-dependent mechanical behavior of humeral head (shoulder) cartilage. Due to anatomical and biomechanical similarities to that of the human shoulder, kangaroos present a suitable animal model. Therefore, indentation experiments were conducted on kangaroo shoulder cartilage tissues from low (10(-4)/s) to moderately high (10(-2)/s) strain-rates. A porohyperelastic model was developed based on the experimental characterization; and a permeability function that takes into account the effect of strain-rate on permeability (strain-rate-dependent permeability) was introduced into the model to investigate the effect of rate-dependent fluid flow on tissue response. The prediction of the model with the strain-rate-dependent permeability was compared with those of the models using constant permeability and strain-dependent permeability. Compared to the model with constant permeability, the models with strain-dependent and strain-rate-dependent permeability were able to better capture the experimental variation at all strain-rates (p < 0.05). Significant differences were not identified between models with strain-dependent and strain-rate-dependent permeability at strain-rate of 5 × 10(-3)/s (p = 0.179). However, at strain-rate of 10(-2)/s, the model with strain-rate-dependent permeability was significantly better at capturing the experimental results (p < 0.005). The findings thus revealed the significance of rate-dependent fluid flow on tissue behavior at large strain-rates, which provides insights into the mechanical deformation mechanisms of cartilage tissues. PMID:26275487

  13. Experiments and analysis of lateral piezoresistance gauges

    SciTech Connect

    Wong, M.K.W.

    1993-07-01

    The response of lateral piezoresistance gauges to shock wave uniaxial strain loading has been examined in a combined experimental and calculational effort. Plate impact experiments provided lateral gauge data which were analyzed using quasi-static and dynamic inclusion analyses. Experimental data showed that the response of the lateral gauge output depended upon the matrix material and gauge emplacement method. The calculations indicated that these differences were due to complex gauge-matrix interactions. These interactions were influenced by the stress and strain distributions in and around the gauge, plasticity effects, properties of the gauge and matrix materials, and emplacement conditions.

  14. Cosmetic Lateral Canthoplasty: Lateral Canthoplasty to Lengthen the Lateral Canthal Angle and Correct the Outer Tail of the Eye

    PubMed Central

    Yun, Byung Min

    2016-01-01

    There are many women who want larger and brighter eyes that will give a favorable impression. Surgical methods that make the eye larger and brighter include double eyelidplasty, epicanthoplasty, as well as lateral canthoplasty. Double eyelidplasty produces changes in the vertical dimension of the eyes, whereas epicanthoplasty and lateral canthoplasty create changes in the horizontal dimension of the eyes. Epicanthoplasty, a surgical procedure which enlarges the eye horizontally, is performed at the inner corner of the eye, whereas lateral canthoplasty enlarges the outer edge of the eye. In particular, if the slant of the palpebral fissure is raised and the horizontal dimension of the palpebral fissure is short, adjusting the slant of the palpebral fissure through lateral canthoplasty can achieve an enlargement of eye width and smoother features. Depending on the patient's condition, even better results can be achieved if this procedure is performed in conjunction with other procedures, such as double eyelidplasty, epicanthoplasty, eye roll formation surgery, fat graft, and facial bone contouring surgery. In this paper, the authors will introduce in detail their surgical method for a cosmetic lateral canthoplasty that lengthens the lateral canthal angle and corrects the outer tail of the eyes, in order to ease the unfavorable impression. PMID:27462564

  15. Cosmetic Lateral Canthoplasty: Lateral Canthoplasty to Lengthen the Lateral Canthal Angle and Correct the Outer Tail of the Eye.

    PubMed

    Chae, Soo Wook; Yun, Byung Min

    2016-07-01

    There are many women who want larger and brighter eyes that will give a favorable impression. Surgical methods that make the eye larger and brighter include double eyelidplasty, epicanthoplasty, as well as lateral canthoplasty. Double eyelidplasty produces changes in the vertical dimension of the eyes, whereas epicanthoplasty and lateral canthoplasty create changes in the horizontal dimension of the eyes. Epicanthoplasty, a surgical procedure which enlarges the eye horizontally, is performed at the inner corner of the eye, whereas lateral canthoplasty enlarges the outer edge of the eye. In particular, if the slant of the palpebral fissure is raised and the horizontal dimension of the palpebral fissure is short, adjusting the slant of the palpebral fissure through lateral canthoplasty can achieve an enlargement of eye width and smoother features. Depending on the patient's condition, even better results can be achieved if this procedure is performed in conjunction with other procedures, such as double eyelidplasty, epicanthoplasty, eye roll formation surgery, fat graft, and facial bone contouring surgery. In this paper, the authors will introduce in detail their surgical method for a cosmetic lateral canthoplasty that lengthens the lateral canthal angle and corrects the outer tail of the eyes, in order to ease the unfavorable impression. PMID:27462564

  16. Genetics Home Reference: amyotrophic lateral sclerosis

    MedlinePlus

    ... amytrophic lateral sclerosis and frontotemporal dementia, regulates endosomal trafficking. Hum Mol Genet. 2014 Jul 1;23(13): ... Accessibility FOIA Viewers & Players U.S. Department of Health & Human Services National Institutes of Health National Library of ...

  17. The National Report--Five Years Later.

    ERIC Educational Resources Information Center

    Stewart, Bob R.; And Others

    1993-01-01

    Six theme articles assess the impact five years later of the National Academy of Sciences report, "Understanding Agriculture." Topics discussed include strategic planning, agricultural education's mission, teacher education, policy research needs, and agricultural literacy. (SK)

  18. Individualized optimal surgical extent of the lateral neck in papillary thyroid cancer with lateral cervical metastasis.

    PubMed

    Park, Jae-Yong; Koo, Bon Seok

    2014-06-01

    Despite an excellent prognosis, cervical lymph node (LN) metastases are common in patients with papillary thyroid cancer (PTC). The presence of metastasis is associated with an increased risk of locoregional recurrence, which significantly impairs quality of life and may decrease survival. Therefore, it has been an important determinant of the extent of lateral LN dissection in the initial treatment of PTC patients with lateral cervical metastasis. However, the optimal extent of therapeutic lateral neck dissection (ND) remains controversial. Optimizing the surgical extent of LN dissection is fundamental for balancing the surgical morbidity and oncological benefits of ND in PTC patients with lateral neck metastasis. We reviewed the currently available literature regarding the optimal extent of lateral LN dissection in PTC patients with lateral neck metastasis. Even in cases with suspicion of metastatic LN at the single lateral level or isolated metastatic lateral LN, the application of ND including all sublevels from IIa and IIb to Va and Vb may be overtreatment, due to the surgical morbidity. When there is no suspicion of LN metastasis at levels II and V, or when multilevel aggressive neck metastasis is not found, sublevel IIb and Va dissection may not be necessary in PTC patients with lateral neck metastasis. Thus consideration of the individualized optimal surgical extent of lateral ND is important when treating PTC patients with lateral cervical metastasis.

  19. Brain and behavioral lateralization in invertebrates

    PubMed Central

    Frasnelli, Elisa

    2013-01-01

    Traditionally, only humans were thought to exhibit brain and behavioral asymmetries, but several studies have revealed that most vertebrates are also lateralized. Recently, evidence of left–right asymmetries in invertebrates has begun to emerge, suggesting that lateralization of the nervous system may be a feature of simpler brains as well as more complex ones. Here I present some examples in invertebrates of sensory and motor asymmetries, as well as asymmetries in the nervous system. I illustrate two cases where an asymmetric brain is crucial for the development of some cognitive abilities. The first case is the nematode Caenorhabditis elegans, which has asymmetric odor sensory neurons and taste perception neurons. In this worm left/right asymmetries are responsible for the sensing of a substantial number of salt ions, and lateralized responses to salt allow the worm to discriminate between distinct salt ions. The second case is the fruit fly Drosophila melanogaster, where the presence of asymmetry in a particular structure of the brain is important in the formation or retrieval of long-term memory. Moreover, I distinguish two distinct patterns of lateralization that occur in both vertebrates and invertebrates: individual-level and population-level lateralization. Theoretical models on the evolution of lateralization suggest that the alignment of lateralization at the population level may have evolved as an evolutionary stable strategy in which individually asymmetrical organisms must coordinate their behavior with that of other asymmetrical organisms. This implies that lateralization at the population-level is more likely to have evolved in social rather than in solitary species. I evaluate this new hypothesis with a specific focus on insects showing different level of sociality. In particular, I present a series of studies on antennal asymmetries in honeybees and other related species of bees, showing how insects may be extremely useful to test the

  20. Management of horizontally impacted dilacerated lateral incisor

    PubMed Central

    Katta, Anil Kumar; Peddu, Revathi; Vannala, Venkataramana; Dasari, Vaishnavi

    2015-01-01

    Impaction of maxillary lateral incisor with odontome and retained deciduous tooth is not often seen in regular dental practice. Impaction of anterior teeth cause generalized spacing which affects the esthetics of the face. Here we report a case of an 18-year-old patient with horizontally impacted dilacerated lateral incisor, which was bought into occlusion with the help of orthodontic tooth movement within a span of 18 months. PMID:26538954

  1. Lateral shear interferometry with holo shear lens

    NASA Astrophysics Data System (ADS)

    Joenathan, C.; Mohanty, R. K.; Sirohi, R. S.

    1984-12-01

    A simple method for obtaining lateral shear using holo shear lenses (HSL) has been discussed. This simple device which produces lateral shears in the orthogonal directions has been used for lens testing. The holo shear lens is placed at or near the focus of the lens to be tested. It has also been shown that HSL can be used in speckle shear interferometry as it performs both the functions of shearing and imaging.

  2. Laterality enhances cognition in Australian parrots.

    PubMed

    Magat, Maria; Brown, Culum

    2009-12-01

    Cerebral lateralization refers to the division of information processing in either hemisphere of the brain and is a ubiquitous trait among vertebrates and invertebrates. Given its widespread occurrence, it is likely that cerebral lateralization confers a fitness advantage. It has been hypothesized that this advantage takes the form of enhanced cognitive function, potentially via a dual processing mechanism whereby each hemisphere can be used to process specific types of information without contralateral interference. Here, we examined the influence of lateralization on problem solving by Australian parrots. The first task, a pebble-seed discrimination test, was designed for small parrot species that feed predominately on small seeds, which do not require any significant manipulation with the foot prior to ingestion. The second task, a string-pull problem, was designed for larger bodied species that regularly use their feet to manipulate food objects. In both cases, strongly lateralized individuals (those showing significant foot and eye biases) outperformed less strongly lateralized individuals, and this relationship was substantially stronger in the more demanding task. These results suggest that cerebral lateralization is a ubiquitous trait among Australian parrots and conveys a significant foraging advantage. Our results provide strong support for the enhanced cognitive function hypothesis.

  3. Possible evolutionary origins of cognitive brain lateralization.

    PubMed

    Vallortigara, G; Rogers, L J; Bisazza, A

    1999-08-01

    Despite the substantial literature on the functional architecture of the asymmetries of the human brain, which has been accumulating for more than 130 years since Dax and Broca's early reports, the biological foundations of cerebral asymmetries are still poorly understood. Recent advances in comparative cognitive neurosciences have made available new animal models that have started to provide unexpected insights into the evolutionary origins and neuronal mechanisms of cerebral asymmetries. Animal model-systems, particularly those provided by the avian brain, highlight the interrelations of genetic, hormonal and environmental events to produce neural and behavioural asymmetries. Novel evidences showing that functional and structural lateralization of the brain is widespread among vertebrates (including fish, reptiles and amphibians) have accumulated rapidly. Perceptual asymmetries, in particular, seem to be ubiquitous in everyday behaviour of most species of animals with laterally placed eyes; in organisms with wider binocular overlap (e.g., amphibians), they appear to be retained for initial detection of stimuli in the extreme lateral fields. We speculate that adjustment of head position and eye movements may play a similar role in mammals with frontal vision as does the choice for right or left lateral visual fields in animals with laterally placed eyes. A first attempt to trace back the origins of brain asymmetry to early vertebrates is presented, based on the hypothesis that functional incompatibility between the logical demands associated with very basic cognitive functions is central to the phenomenon of cerebral lateralization. PMID:10525173

  4. Listeners' impressions of speakers with lateral lisps.

    PubMed

    Silverman, E M

    1976-11-01

    This paper reports research conducted to determine whether the lateral lisp is a speech defect. The specific purpose of this research was to determine whether the lateral lisp calls adverse attention to the speaker. Two groups of broadcast communication students rates the concept "The Person Speaking" on a 49-scale semantic differential. One group performed the task after listening to a tape recording of a young woman reading contextual material with a simulated lateral lisp. The other group performed the task after listening to a recording of the same woman reading the material in a normal manner. Analyses of the scale values computed for the two conditions indicated that the lateral lisp called adverse attention to the speaker. A systematic replication was undertaken to assess the generality of this finding. The procedures of the original investigation were followed except that business administration students served as judges. The results replicated those of the original investigation. These data indicate that the lateral lisp is probably a speech defect and suggest that the practice of eliminating school speech services for children whose only speech difference is a lateral lisp should be reconsidered. PMID:994486

  5. Lateral restraint assembly for reactor core

    DOEpatents

    Gorholt, Wilhelm; Luci, Raymond K.

    1986-01-01

    A restraint assembly for use in restraining lateral movement of a reactor core relative to a reactor vessel wherein a plurality of restraint assemblies are interposed between the reactor core and the reactor vessel in circumferentially spaced relation about the core. Each lateral restraint assembly includes a face plate urged against the outer periphery of the core by a plurality of compression springs which enable radial preloading of outer reflector blocks about the core and resist low-level lateral motion of the core. A fixed radial key member cooperates with each face plate in a manner enabling vertical movement of the face plate relative to the key member but restraining movement of the face plate transverse to the key member in a plane transverse to the center axis of the core. In this manner, the key members which have their axes transverse to or subtending acute angles with the direction of a high energy force tending to move the core laterally relative to the reactor vessel restrain such lateral movement.

  6. Lateralization of cognitive processes in the brain.

    PubMed

    Hugdahl, K

    2000-12-01

    The lateralization of cognitive processes in the brain is discussed. The traditional view of a language-visuo/spatial dichotomy of function between the hemispheres has been replaced by more subtle distinctions. The use of magnetic resonance imaging (MRI) to study brain morphology has resulted in a renewed focus on the relationship between structural and functional asymmetry. Focus has been on the role played by the planum temporale area in the posterior part of the superior temporal gyrus for language asymmetry, and the possible significance of the larger left planum. The dichotic listening technique is used to illustrate the difference between bottom-up, or stimulus-driven laterality versus top-down, or instruction-driven laterality. It is suggested that the hemispheric dominance observed at any time is the sum result of the dynamic interaction between bottom-up and top-down processing tendencies. Stimulus-driven laterality dominance is always monitored and modulated through top-down cognitive processes, like shifting of attention and changes in arousal. A model of top-down modulation of bottom-up laterality is presented with special reference to the understanding of psychiatric disorders. PMID:11194413

  7. Predicting language lateralization from gray matter

    PubMed Central

    Josse, Goulven; Kherif, Ferath; Flandin, Guillaume; Seghier, Mohamed L; Price, Cathy J

    2009-01-01

    It has long been predicted that the degree to which language is lateralized to the left or right hemisphere might be reflected in the underlying brain anatomy. We investigated this relationship on a voxel by voxel basis across the whole brain using structural and functional MRI images from 86 healthy participants. Structural images were converted to gray matter probability images and language activation was assessed during naming and semantic decision. All images were spatially normalized to the same symmetrical template and lateralization images were generated by subtracting right from left hemisphere signal at each voxel. We show that the degree to which language was left or right lateralized was positively correlated with the degree to which gray matter density was lateralized. Post-hoc analyses revealed a general relationship between gray matter probability and BOLD signal. This is the first demonstration that structural brain scans can be used to predict language lateralization on a voxel by voxel basis in the normal healthy brain. PMID:19864564

  8. Language lateralization shifts with learning by adults.

    PubMed

    Plante, Elena; Almryde, Kyle; Patterson, Dianne K; Vance, Christopher J; Asbjørnsen, Arve E

    2015-05-01

    For the majority of the population, language is a left-hemisphere lateralized function. During childhood, a pattern of increasing left lateralization for language has been described in brain imaging studies, suggesting that this trait develops. This development could reflect change due to brain maturation or change due to skill acquisition, given that children acquire and refine language skills as they mature. We test the possibility that skill acquisition, independent of age-associated maturation can result in shifts in language lateralization in classic language cortex. We imaged adults exposed to an unfamiliar language during three successive fMRI scans. Participants were then asked to identify specific words embedded in Norwegian sentences. Exposure to these sentences, relative to complex tones, resulted in consistent activation in the left and right superior temporal gyrus. Activation in this region became increasingly left-lateralized with repeated exposure to the unfamiliar language. These results demonstrate that shifts in lateralization can be produced in the short term within a learning context, independent of maturation.

  9. Lateral stability in sideward cutting movements.

    PubMed

    Stacoff, A; Steger, J; Stüssi, E; Reinschmidt, C

    1996-03-01

    Sideward cutting movements occur frequently in sports activities, such as basketball, soccer, and tennis. These activities show a high incidence of injuries to the lateral aspect of the ankle. Consequently, the lateral stability of sport shoes seems important. The purpose of this study was to show the effect of different shoe sole properties (hardness, thickness, torsional stiffness) and designs on the lateral stability during sideward cutting movements. A film analysis was conducted including 12 subjects performing a cutting movement barefoot and with five different pairs of shoes each filmed in the frontal plane. A standard film analysis was conducted; for the statistical analysis, various parameters such as the range of motion in inversion and the angular velocity of the rearfoot were used. The results showed a large difference between the barefoot and shod conditions with respect to the lateral stability. Two shoes performed significantly better (P < 0.05) than the others with a decreased inversion movement and less slipping inside the shoe. The two shoes differed mainly in the shoe sole design (hollow inner core) and the upper (high-cut). It is concluded that lateral stability may be improved by altering the properties and design of the shoe sole as well as the upper.

  10. LOB Domain Proteins: Beyond Lateral Organ Boundaries.

    PubMed

    Xu, Changzheng; Luo, Feng; Hochholdinger, Frank

    2016-02-01

    LATERAL ORGAN BOUNDARIES DOMAIN (LBD) proteins defined by a conserved LATERAL ORGAN BOUNDARIES (LOB) domain are key regulators of plant organ development. Recent studies have expanded their functional diversity beyond the definition of lateral organ boundaries to pollen development, plant regeneration, photomorphogenesis, pathogen response, and specific developmental functions in non-model plants, such as poplar and legumes. The identification of a range of upstream regulators, protein partners, and downstream targets of LBD family members has unraveled the molecular networks of LBD-dependent processes. Moreover, it has been demonstrated that LBD proteins have essential roles in integrating developmental changes in response to phytohormone signaling or environmental cues. As we discuss here, these novel discoveries of LBD functions and their molecular contexts promote a better understanding of this plant-specific transcription factor family. PMID:26616195

  11. The Lateral Instability of Deep Rectangular Beams

    NASA Technical Reports Server (NTRS)

    Dumont, C; Hill, H N

    1937-01-01

    Experimental and analytical studies were made of solid and hollow deep rectangular beams to study their lateral instability under various conditions of loading and restraint. The tests were made on bars and tubes of 17ST aluminum alloy. Failure by lateral buckling occurred only in tests on the solid beams. It was found that, within the elastic range, the test results were in agreement with the classical theory for the lateral buckling of deep beams as given by Prandtl, Mitchell, and Timoshenko. The tests were extended to the inelastic range, where it was found that the substitution for Young's modulus of an average modulus of elasticity derived from the stress-strain curve made it possible to predict instability at high stresses.

  12. Stress and laterality - The comparative perspective.

    PubMed

    Ocklenburg, Sebastian; Korte, S Mechiel; Peterburs, Jutta; Wolf, Oliver T; Güntürkün, Onur

    2016-10-01

    Functional hemispheric asymmetries can vary over time and steroid hormones have been shown to be one of the factors that can modulate them. Research into this matter has mainly focused on sex steroid hormones (androgens, estrogens and progestogens), although there is increasing evidence that glucocorticoids which are related to the body's response to stress (e.g. cortisol or corticosterone) might also modulate functional hemispheric asymmetries. Here, we review studies in humans and non-human model species investigating the relation of stress and laterality. Results indicate a dual relationship of the two parameters. Both acute and chronic stress can affect different forms of lateralization in the human brain, often (but not always) resulting in greater involvement of the right hemisphere. Moreover, lateralization as a form of functional brain architecture can also represent a protective factor against adverse effects of stress. PMID:27321757

  13. Mitek Suspension of the Lateral Nasal Wall.

    PubMed

    White, James R; Hamilton, Grant S

    2016-02-01

    The nasal valve has long been described as the anatomical boundary most likely to inhibit nasal airflow and lead to subsequent nasal obstruction. Although many procedures can address this area to improve the nasal airway, for over 20 years, suture lateralization of the external nasal valve has been described as a minimally invasive technique that can improve nasal breathing. We report our modification of the standard technique in which we lateralize the placement of the bone-anchored suture and incorporate Gore-Tex within the nasal vestibular incision to prevent tissue migration. PMID:26862966

  14. [Lateral chest X-rays. Radiographic anatomy].

    PubMed

    García Villafañe, C; Pedrosa, C S

    2014-01-01

    Lateral chest views constitute an essential part of chest X-ray examinations, so it is fundamental to know the anatomy on these images and to be able to detect the variations manifested on these images in different diseases. The aim of this article is to review the normal anatomy and main normal variants seen on lateral chest views. For teaching purposes, we divide the thorax into different spaces and analyze each in an orderly way, especially emphasizing the anatomic details that are most helpful for locating lesions that have already been detected in the posteroanterior view or for detecting lesions that can be missed in the posteroanterior view.

  15. Amyotrophic Lateral Sclerosis: A Historical Perspective.

    PubMed

    Katz, Jonathan S; Dimachkie, Mazen M; Barohn, Richard J

    2015-11-01

    This article looks back in time to see where the foundational basis for the understanding of amyotrophic lateral sclerosis originated. This foundation was created primarily in France by Jean-Martin Charcot and his fellow countrymen and disciples, along with key contributions from early clinicians in England and Germany. The early work on amyotrophic lateral sclerosis provides a useful foundation for today's clinicians with respect to tying together genetic and biologic aspects of the disorder that have been discovered over the past few decades.

  16. Parameter Estimation of Lateral Spacecraft Fuel Slosh

    NASA Technical Reports Server (NTRS)

    Sudermann, James E.; Schlee, Keith L.

    2008-01-01

    Predicting the effect of fuel slosh on the attitude control system of a spacecraft or launch vehicle is a very important and challenging task. Whether the spacecraft is spinning or moving laterally, the dynamic effect of the fuel slosh helps determine whether the spacecraft will remain on its intended trajectory. Three categories of slosh can be caused by launch vehicle or spacecraft maneuvers when the fuel is in the presence of an acceleration field. These are bulk-fluid motion, subsurface wave motion (currents), and free-surface slosh. Each of these slosh types has a periodic component defined by either a spinning or a lateral motion. For spinning spacecraft, all three types of slosh can greatly affect stability. Bulk-fluid motion and free-surface slosh can affect the lateral-slosh characteristics. For either condition, an unpredicted coupled resonance between the spacecraft and its onboard fuel could threaten a mission. This ongoing research effort seeks to improve the accuracy and efficiency of modeling techniques used to predict these types of fluid motions for lateral motion. Particular efforts focus on analyzing the effects of viscoelastic diaphragms on slosh dynamics.

  17. Anterolateral Meniscofemoral Ligament of the Lateral Meniscus

    PubMed Central

    Kim, Young-Mo; Yeon, Kyu-Woong; Lee, Ki-Young

    2016-01-01

    Anatomical variations of the meniscus are a common anomaly that knee surgeons frequently encounter. However, anomalies of the anterior horn of the lateral meniscus (AHLM) are extremely rare. In this report, we present a newly discovered anomaly of the AHML: an anterolateral meniscofemoral ligament is described with clinical features and radiographic and arthroscopic findings.

  18. Lateral drug diffusion in human nails.

    PubMed

    Palliyil, Biji B; Li, Cong; Owaisat, Suzan; Lebo, David B

    2014-12-01

    The main objective of the current work is to demonstrate the process of passive lateral diffusion in the human nail plate and its effect on the passive transungual permeation of antifungal drug ciclopirox olamine (CPO). A water soluble dye, methyl red sodium salt (MR) was used to visualize the process of lateral diffusion using a novel suspended nail experiment. The decline in concentration of CPO correlates with that of concentration of MR from the proximal to the distal end of the nail in suspended nail study. Three toenails each were trimmed to 5 mm × 5 mm (25 mm(2)), 7 mm × 7 mm (49 mm(2)), and 9 mm × 9 mm (81 mm(2)) to study the extent and effect of lateral diffusion of the CPO on its in vitro transungual permeation. The permeation flux of CPO decreased as the surface area of the toenail increased. There was a positive correlation between the concentrations of CPO and MR in the area of application and in the peripheral area of the toenails of the three surface areas, confirming the findings in the suspended nail experiment. Profound lateral diffusion of CPO was demonstrated and shown to reduce the in vitro passive transungual drug permeation and prolong the lag-time in human toenails. The study data implies that during passive in vitro transungual permeation experiments, the peripheral nail around the area of drug application has to be kept to a minimum, in order to get reliable data which mimics the in vivo situation. PMID:24970585

  19. Quantifying lateral tissue heterogeneities in hadron therapy

    SciTech Connect

    Pflugfelder, D.; Wilkens, J. J.; Szymanowski, H.; Oelfke, U.

    2007-04-15

    In radiotherapy with scanned particle beams, tissue heterogeneities lateral to the beam direction are problematic in two ways: they pose a challenge to dose calculation algorithms, and they lead to a high sensitivity to setup errors. In order to quantify and avoid these problems, a heterogeneity number H{sub i} as a method to quantify lateral tissue heterogeneities of single beam spot i is introduced. To evaluate this new concept, two kinds of potential errors were investigated for single beam spots: First, the dose calculation error has been obtained by comparing the dose distribution computed by a simple pencil beam algorithm to more accurate Monte Carlo simulations. The resulting error is clearly correlated with H{sub i}. Second, the analysis of the sensitivity to setup errors of single beam spots also showed a dependence on H{sub i}. From this data it is concluded that H{sub i} can be used as a criterion to assess the risks of a compromised delivered dose due to lateral tissue heterogeneities. Furthermore, a method how to incorporate this information into the inverse planning process for intensity modulated proton therapy is presented. By suppressing beam spots with a high value of H{sub i}, the unfavorable impact of lateral tissue heterogeneities can be reduced, leading to treatment plans which are more robust to dose calculation errors of the pencil beam algorithm. Additional possibilities to use the information of H{sub i} are outlined in the discussion.

  20. One hand clapping: lateralization of motor control

    PubMed Central

    Welniarz, Quentin; Dusart, Isabelle; Gallea, Cécile; Roze, Emmanuel

    2015-01-01

    Lateralization of motor control refers to the ability to produce pure unilateral or asymmetric movements. It is required for a variety of coordinated activities, including skilled bimanual tasks and locomotion. Here we discuss the neuroanatomical substrates and pathophysiological underpinnings of lateralized motor outputs. Significant breakthroughs have been made in the past few years by studying the two known conditions characterized by the inability to properly produce unilateral or asymmetric movements, namely human patients with congenital “mirror movements” and model rodents with a “hopping gait”. Whereas mirror movements are associated with altered interhemispheric connectivity and abnormal corticospinal projections, abnormal spinal cord interneurons trajectory is responsible for the “hopping gait”. Proper commissural axon guidance is a critical requirement for these mechanisms. Interestingly, the analysis of these two conditions reveals that the production of asymmetric movements involves similar anatomical and functional requirements but in two different structures: (i) lateralized activation of the brain or spinal cord through contralateral silencing by cross-midline inhibition; and (ii) unilateral transmission of this activation, resulting in lateralized motor output. PMID:26082690