The anterolateral acromial approach for fractures of the proximal humerus.

PubMed

Gardner, Michael J; Boraiah, Sreevathsa; Helfet, David L; Lorich, Dean G

2008-02-01

Displaced and unstable fractures of the proximal humerus are notoriously difficult to manage. Successful surgical treatment requires finding the appropriate balance between adequate exposure for reduction and rigid fixation and minimizing soft tissue dissection. The anterolateral acromial approach was developed to allow less invasive treatment of proximal humerus fractures. The plane of the avascular anterior deltoid raphe is utilized, and the axillary nerve is identified and protected. Anterior dissection near the critical blood supply is avoided, substantial muscle retraction is minimized, and the lateral plating zone is directly accessed. Over a 4-year period, 52 patients with acute displaced fractures of the proximal humerus were treated with the anterolateral acromial approach and either a locking plate or an intramedullary nail. Twenty-three patients were evaluated clinically at a minimum follow-up of 1 year (average, 28 months) by clinical examination for range of motion and nerve function and a QuickDASH score. There were no axillary nerve deficits postoperatively related to the approach, and the average QuickDASH score was 25.2 (0, best; 100, worst). This approach allowed direct access to the lateral fracture planes for fracture reduction and plate placement or safe nail and interlocking screw placement.

A comparative biomechanical analysis of implants for the stabilization of proximal humerus fractures.

PubMed

Füchtmeier, B; May, R; Fierlbeck, J; Hammer, J; Nerlich, M

2006-01-01

A new humerus nail (Sirus) has become available for the treatment of fractures of the proximal humerus. The aim of the study was the biomechanical comparison of this implant with established systems. 12 matched pairs of human humeri were employed for testing. Three randomized groups were formed (n = 4 pairs). A bending moment of 7.5 Nm and a torsional moment of 8.3 Nm were applied in a test of five loading cycles to all intact bones. Loading was consistently initiated at the distal epiphysis. The consequent deformation at the distal epiphysis was continuously recorded. Then an osteotomy with a defect of 5 mm was created to simulate an unstable subcapital humerus fracture. For paired comparison, one of each pair was stabilized with the Sirus proximal humerus nail. The other side was fixed with a reference implant. The following groups were created.: Group I: Sirus versus Proximal humerus nail (PHN) with spiral blade. Group II: Sirus versus PHILOS plate. Group III: Sirus versus 4.5 mm AO T-plate. The proximal humerus nail (Sirus) demonstrated significantly higher stiffness values than the reference implants for both bending and torsional load. The following values were recorded at a bending moment of 7.5 Nm: Sirus 14.2 mm, PHN 20.7 mm, PHILOS plate 28.1 mm, 4.5 AO T-plate 29.3 mm p < 0.0012). The values at 8.3 Nm torsional moment were: Sirus 8.5 degrees , PHN 12.3 degrees , PHILOS plate 16.4 degrees , 4.5 AO T-Platte 15.6 degrees (p < 0.002). The intramedullary load carriers were biomechanically superior when compared to the plating systems in the fracture model presented here. Supplementary, the Sirus Nail showed higher stiffness values than the PHN. However, the latter are gaining in importance due to the possibility of minimal invasive implantation. Whether this will be associated with functional advantages requires further clinical investigation.

Epidemiology of humerus fractures in the United States: nationwide emergency department sample, 2008.

PubMed

Kim, Sunny H; Szabo, Robert M; Marder, Richard A

2012-03-01

To evaluate the occurrence of emergency department (ED) visits due to humerus fractures in the US. We analyzed the 2008 Nationwide Emergency Department Sample, which contained approximately 28 million ED records. We identified the cases of interest using diagnostic codes for proximal, shaft, and distal humerus fractures. In 2008, approximately 370,000 ED visits in the US resulted from humerus fractures. Proximal humerus fractures were the most common, accounting for 50% of humerus fractures. The incidence rate of proximal humerus fractures followed the shape of an exponential function in the age groups 40-84 years for women (R(2) = 97.9%) and 60-89 years for men (R(2) = 98.2%). After the exponential increase in these age intervals, the growth rate of proximal humerus fracture slowed and eventually decreased. The peak occurrence of distal humerus fractures was in children ages 5-9 years; however, elderly women had an increased risk. As the baby boomer generation ages, unless fracture prevention programs improve, more than 490,000 ED visits due to humerus fractures are expected in 2030 when the youngest of the baby boomers turn age 65 years. Compared to epidemiologic studies in Japan and European countries, the incidence rates of humerus fractures are substantially higher in the US. The high incidence rate of humerus fractures in the expanding elderly population may contribute to the recent trend of rapid increase in shoulder arthroplasty in the US. Rigorous safety measures to reduce falls and improved preventive treatments of osteoporosis are needed. Copyright © 2012 by the American College of Rheumatology.

Percutaneous insertion of a proximal humeral locking plate: an anatomic study.

PubMed

Smith, Jason; Berry, Greg; Laflamme, Yves; Blain-Pare, Etienne; Reindl, Rudy; Harvey, Edward

2007-02-01

This cadaveric study sought to evaluate the feasibility of applying a locking proximal humerus plate with a novel minimally invasive technique. A unique pre-contoured locking plate was placed on cadaveric proximal humeri through a described minimally invasive approach. Proximity of the plate and screws to the axillary nerve and their respective surgical tracks were quantified. Safe screw hole placement with respect to the axillary nerve was determined. Risk of entrapment of the nerve beneath the plate was evaluated. Three of the holes near the middle of the locking plate consistently intersected the course of the axillary nerve and were unsafe for percutaneous placement of the screws. The axillary nerve could be palpated during the course of surgery and easily protected from injury. No entrapment of the axillary nerve occurred using this minimally invasive technique. The screw-in locking guide cannot be used with this technique as it caused tenting of the axillary nerve. Placement of a locking proximal humerus plate via a minimally invasive lateral trans-deltoid approach is safe if the locking screws are limited to superior and inferior holes. This can be done safely without entrapment of the axillary beneath the plate. Plate fixation of proximal humerus fractures may now be more desirable with the use of this approach.

[Augmentation technique on the proximal humerus].

PubMed

Scola, A; Gebhard, F; Röderer, G

2015-09-01

The treatment of osteoporotic fractures is still a challenge. The advantages of augmentation with respect to primary in vitro stability and the clinical use for the proximal humerus are presented in this article. In this study six paired human humeri were randomized into an augmented and a non-augmented group. Osteosynthesis was performed with a PHILOS plate (Synthes®). In the augmented group the two screws finding purchase in the weakest cancellous bone were augmented. The specimens were tested in a 3-part fracture model in a varus bending test. The augmented PHILOS plates withstood significantly more load cycles until failure. The correlation to bone mineral density (BMD) showed that augmentation could partially compensate for low BMD. The augmentation of the screws in locked plating in a proximal humerus fracture model is effective in improving the primary stability in a cyclic varus bending test. The targeted augmentation of two particular screws in a region of low bone quality within the humeral head was almost as effective as four screws with twice the amount of bone cement. Screw augmentation combined with a knowledge of the local bone quality could be more effective in enhancing the primary stability of a proximal humerus locking plate because the effect of augmentation can be exploited more effectively limiting it to the degree required. The technique of augmentation is simple and can be applied in open and minimally invasive procedures. When the correct procedure is used, complications (cement leakage into the joint) can be avoided.

Review of fixation techniques for the four-part fractured proximal humerus in hemiarthroplasty.

PubMed

Baumgartner, Daniel; Nolan, Betsy M; Mathys, Robert; Lorenzetti, Silvio Rene; Stüssi, Edgar

2011-07-18

The clinical outcome of hemiarthroplasty for proximal humeral fractures is not satisfactory. Secondary fragment dislocation may prevent bone integration; the primary stability by a fixation technique is therefore needed to accomplish tuberosity healing. Present technical comparison of surgical fixation techniques reveals the state-of-the-art approach and highlights promising techniques for enhanced stability. A classification of available fixation techniques for three- and four part fractures was done. The placement of sutures and cables was described on the basis of anatomical landmarks such as the rotator cuff tendon insertions, the bicipital groove and the surgical neck. Groups with similar properties were categorized. Materials used for fragment fixation include heavy braided sutures and/or metallic cables, which are passed through drilling holes in the bone fragments. The classification resulted in four distinct groups: A: both tuberosities and shaft are fixed together by one suture, B: single tuberosities are independently connected to the shaft and among each other, C: metallic cables are used in addition to the sutures and D: the fragments are connected by short stitches, close to the fragment borderlines. A plurality of techniques for the reconstruction of a fractured proximal humerus is found. The categorisation into similar strategies provides a broad overview of present techniques and supports a further development of optimized techniques. Prospective studies are necessary to correlate the technique with the clinical outcome.

Review of fixation techniques for the four-part fractured proximal humerus in hemiarthroplasty

PubMed Central

2011-01-01

Introduction The clinical outcome of hemiarthroplasty for proximal humeral fractures is not satisfactory. Secondary fragment dislocation may prevent bone integration; the primary stability by a fixation technique is therefore needed to accomplish tuberosity healing. Present technical comparison of surgical fixation techniques reveals the state-of-the-art approach and highlights promising techniques for enhanced stability. Method A classification of available fixation techniques for three- and four part fractures was done. The placement of sutures and cables was described on the basis of anatomical landmarks such as the rotator cuff tendon insertions, the bicipital groove and the surgical neck. Groups with similar properties were categorized. Results Materials used for fragment fixation include heavy braided sutures and/or metallic cables, which are passed through drilling holes in the bone fragments. The classification resulted in four distinct groups: A: both tuberosities and shaft are fixed together by one suture, B: single tuberosities are independently connected to the shaft and among each other, C: metallic cables are used in addition to the sutures and D: the fragments are connected by short stitches, close to the fragment borderlines. Conclusions A plurality of techniques for the reconstruction of a fractured proximal humerus is found. The categorisation into similar strategies provides a broad overview of present techniques and supports a further development of optimized techniques. Prospective studies are necessary to correlate the technique with the clinical outcome. PMID:21762540

Automated trabecular bone histomorphometry

NASA Technical Reports Server (NTRS)

Polig, E.; Jee, W. S. S.

1985-01-01

The toxicity of alpha-emitting bone-seeking radionuclides and the relationship between bone tumor incidence and the local dosimetry of radionuclides in bone are investigated. The microdistributions of alpha-emitting radionuclides in the trabecular bone from the proximal humerus, distal humerus, proximal ulna, proximal femur, and distal femur of six young adult beagles injected with Am-241 (three with 2.8 micro-Ci/kg and three with 0.9 micro-Ci/kg) are estimated using a computer-controlled microscope photometer system; the components of the University of Utah Optical Track Scanner are described. The morphometric parameters for the beagles are calculated and analyzed. It is observed that the beagles injected with 0.9 micro-Ci of Am-241/kg showed an increase in the percentage of bone and trabecular bone thickness, and a reduction in the width of the bone marrow space and surface/volume ratio. The data reveal that radiation damage causes abnormal bone structure.

[Reconstruction and balance of soft tissue in hemi-shoulder replacement for patients with four-part fracture of the proximal humerus].

PubMed

Wu, Xing; Lou, Lie-ming; Chen, Zheng-rong; Zhang, Guang-jian

2008-10-01

To explore the effective skills of reconstruction and balance of soft tissue in hemi-shoulder replacement for patients with four-part fracture of the proximal humerus in order to avoid postoperative complications of joint instability and great tubercle displacement. From June 2002 to June 2006, 25 patients with Neer four-part fracture of the proximal humerus were adopted in the study which included 15 females and 10 males, with the mean age of 66 years (ranged from 56 years to 80 years). They were treated with humeral head replacement and should joint reparation simultaneously by modified operation approach and reconstruction and balance skills of soft tissue. The mean duration of follow-up was 2.3 years (ranged from 1 to 4.5 years). No infection, nerve damage and prosthesis loosing were found in all cases. Two cases of infra-forward dislocation or subluxation occurred due to affected limb placed on abduction splint postoperatively. One case occurred prosthesis upward displacement due to early active abduction exercise but no complains. Neither joint instability nor displacement and malunion of great tubercle were found in other patients. According to Neer scoring system, 6 cases were rated as excellent, 15 as good and 5 as fair. The good and excellent rate was 84%. In hemi-shoulder replacement for patients with Neer four-part fracture the modified operation approach and reconstruction and balance of soft tissue skills combined with rational rehabilitation exercise can prevent postoperative shoulder joint instability and displacement and malunion of great tubercle.

Biomechanical Comparison of 3 Inferiorly Directed Versus 3 Superiorly Directed Locking Screws on Stability in a 3-Part Proximal Humerus Fracture Model.

PubMed

Donohue, David M; Santoni, Brandon G; Stoops, T Kyle; Tanner, Gregory; Diaz, Miguel A; Mighell, Mark

2018-06-01

To quantify the stability of 3 points of inferiorly directed versus 3 points of superiorly directed locking screw fixation compared with the full contingent of 6 points of locked screw fixation in the treatment of a 3-part proximal humerus fracture. A standardized 3-part fracture was created in 10 matched pairs (experimental groups) and 10 nonmatched humeri (control group). Osteosynthesis was performed using 3 locking screws in the superior hemisphere of the humeral head (suspension), 3 locking screws in the inferior hemisphere (buttress), or the full complement of 6 locking screws (control). Specimens were tested in varus cantilever bending (7.5 Nm) to 10,000 cycles or failure. Construct survival (%) and the cycles to failure were compared. Seven of 10 controls survived the 10,000-cycle runout (70%: 8193 average cycles to failure). No experimental constructs survived the 10,000-cycle runout. Suspension and buttress screw groups failed an average of 331 and 516 cycles, respectively (P = 1.00). The average number of cycles to failure and the number of humeri surviving the 10,000-cycle runout were greater in the control group than in the experimental groups (P ≤ 0.006). Data support the use of a full contingent of 6 points of locking screw fixation over 3 superior or 3 inferior points of fixation in the treatment of a 3-part proximal humerus fracture with a locking construct. No biomechanical advantage to the 3 buttress or 3 suspension screws used in isolation was observed.

Postoperative Evaluation of Reduction Loss in Proximal Humeral Fractures: A Comparison of Plain Radiographs and Computed Tomography.

PubMed

Jia, Xiao-Yang; Chen, Yan-Xi; Qiang, Min-Fei; Zhang, Kun; Li, Hao-Bo; Jiang, Yu-Chen; Zhang, Yi-Jie

2017-05-01

To compare postoperative CT images with plain radiographs for measuring prognostic factors of reduction loss of fractures of the proximal part of the humerus. A total of 65 patients who sustained fractures of the proximal humerus treated with locking plates from June 2012 to October 2015 were retrospectively analyzed. There were 24 men and 41 women, with a mean age of 60.0 years (range, 22-76 years). According to the Neer classification system of proximal humeral fracture, there were 26 two-part, 27 three-part and 12 four-part fractures of the proximal part of the humerus, and all fractures were treated with open reduction and internal fixation (ORIF) using locked plating. All postoperative CT images and plain radiographs of the patients were obtained. Prognostic factors of the reduction loss were the change of neck shaft angle (NSA) and the change of humeral head height (HHH). The change of NSA and HHH were evaluated by the difference between postoperative initial and final follow-up measurement. Reduction loss was defined as the change ≥10° for NSA or ≥5 mm for HHH. The NSA and HHH were measured using plain radiographs and 3-D CT images, both initially and at final follow-up. The paired t-test was used for comparison of NSA, change of NSA, HHH, and change of HHH between two image modalities. The differences between two image modalities in the assessment of reduction loss were examined using the χ 2 -test (McNemar test). Intraclass correlation coefficients (ICC) were used to assess the intra-observer and inter-observer reliability. 3-D CT images (ICC range, 0.834-0.967) were more reliable in all parameters when compared with plain radiographs (ICC range, 0.598-0.915). Significant differences were found between the two image modalities in all parameters (plain radiographs: initial NSA = 133.6° ± 3.8°, final NSA = 130.0° ± 1.9°, initial HHH = 17.9 ± 0.9 mm, final HHH = 15.8 ± 1.5 mm; 3-D CT: initial NSA = 131.4° ± 3.4°, final NSA = 128.8° ± 1.7°, initial HHH = 16.8 ± 1.2 mm, final HHH = 14.5 ± 1.1 mm; all P < 0.05). In the assessment of reduction loss, the percentage was 16.9% (11/65) for the plain radiographs and 7.7% (5/65) for the 3-D CT scans (P < 0.05). For the 5 patients with reduction loss, which were observed by two imaging modalities, the mean Constant-Murley score was 61.0 ± 1.6. The patients with reduction loss, observed only in plain radiographs but not CT images, had good shoulder function (Constant-Murley score: 82.7 ± 1.0). Our data reveal that 3-D CT images are more reliable than plain radiographs in the assessment of the prognostic factors of reduction loss of fractures of the proximal part of the humerus with treatment of locking plates; this reliable CT technique can serve as an effective guideline for the subsequent clinical management of patients. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Upper-extremity phocomelia reexamined: a longitudinal dysplasia.

PubMed

Goldfarb, Charles A; Manske, Paul R; Busa, Riccardo; Mills, Janith; Carter, Peter; Ezaki, Marybeth

2005-12-01

In contrast to longitudinal deficiencies, phocomelia is considered a transverse, intercalated segmental dysplasia. Most patients demonstrate severe, but not otherwise classifiable, upper-extremity deformities, which usually cannot be placed into one of three previously described phocomelia groups. Additionally, these phocomelic extremities do not demonstrate true segmental deficits; the limb is also abnormal proximal and distal to the segmental defect. The purpose of this investigation was to present evidence that upper-extremity abnormalities in patients previously diagnosed as having phocomelia in fact represent a proximal continuum of radial or ulnar longitudinal dysplasia. The charts and radiographs of forty-one patients (sixty extremities) diagnosed as having upper-extremity phocomelia were reviewed retrospectively. On the basis of the findings on the radiographs, the disorders were categorized into three groups: (1) proximal radial longitudinal dysplasia, which was characterized by an absent proximal part of the humerus, a nearly normal distal part of the humerus, a completely absent radius, and a radial-sided hand dysplasia; (2) proximal ulnar longitudinal dysplasia, characterized by a short one-bone upper extremity that bifurcated distally and by severe hand abnormalities compatible with ulnar dysplasia; and (3) severe combined dysplasia, with type A characterized by an absence of the forearm segment (i.e., the radius and ulna) and type B characterized by absence of the arm and forearm (i.e., the hand attached to the thorax). Twenty-nine limbs in sixteen patients could be classified as having proximal radial longitudinal dysplasia. Systemic medical conditions such as thrombocytopenia-absent radius syndrome were common in those patients, but additional musculoskeletal conditions were rare. Twenty limbs in seventeen patients could be classified as having proximal ulnar longitudinal dysplasia. Associated musculoskeletal abnormalities, such as proximal femoral focal deficiency, were common in those patients. Eleven limbs in ten patients were identified as having severe combined dysplasia, which was type A in seven of them and type B in four. Four patients with severe combined dysplasia had congenital cardiac anomalies, and four had associated musculoskeletal abnormalities. Three of the four patients with the type-B disorder had a contralateral ulnar longitudinal dysplasia. We propose that cases previously classified as upper-extremity phocomelia represent a spectrum of severe longitudinal dysplasia, as none of the sixty extremities that we studied demonstrated a true intercalary deficiency. These findings have both developmental and genetic implications.

Reverse total shoulder replacement for nonunion of a fracture of the proximal humerus.

PubMed

Zafra, M; Uceda, P; Flores, M; Carpintero, P

2014-09-01

Patients with pain and loss of shoulder function due to nonunion of a fracture of the proximal third of the humerus may benefit from reverse total shoulder replacement. This paper reports a prospective, multicentre study, involving three hospitals and three surgeons, of 35 patients (28 women, seven men) with a mean age of 69 years (46 to 83) who underwent a reverse total shoulder replacement for the treatment of nonunion of a fracture of the proximal humerus. Using Checchia's classification, nine nonunions were type I, eight as type II, 12 as type III and six as type IV. The mean follow-up was 51 months (24 to 99). Post-operatively, the patients had a significant decrease in pain (p < 0.001), and a significant improvement in flexion, abduction, external rotation and Constant score (p < 0.001), but not in internal rotation. A total of nine complications were recorded in seven patients: six dislocations, one glenoid loosening in a patient who had previously suffered dislocation, one transitory paresis of the axillary nerve and one infection. Reverse total shoulder replacement may lead to a significant reduction in pain, improvement in function and a high degree of satisfaction. However, the rate of complications, particularly dislocation, was high. ©2014 The British Editorial Society of Bone & Joint Surgery.

Proceedings of the 2010 AFMS Medical Research Symposium. Volume 3. Enroute Track: Abstracts and Presentations

DTIC Science & Technology

2011-03-15

comparison of proximal tibia, proximal humerus and distal femur infusion rates under high pressure using the EZ-IO Intraosseous device on an adult...contaminated complex musculoskeletal wounds. METHODS: We adapted a previously characterized caprine model. Under anesthesia , complex musculoskeletal...of proximal tibia, proximal humerus and distal femur infusion rates under high pressure using the EZ-IO Intraosseous device on an adult swine model

Management of proximal humeral fractures in the nineteenth century: an historical review of preradiographic sources.

PubMed

Brorson, Stig

2011-04-01

The diagnosis and treatment of fractures of the proximal humerus have troubled patients and medical practitioners since antiquity. Preradiographic diagnosis relied on surface anatomy, pain localization, crepitus, and impaired function. During the nineteenth century, a more thorough understanding of the pathoanatomy and pathophysiology of proximal humeral fractures was obtained, and new methods of reduction and bandaging were developed. I reviewed nineteenth-century principles of (1) diagnosis, (2) classification, (3) reduction, (4) bandaging, and (5) concepts of displacement in fractures of the proximal humerus. A narrative review of nineteenth-century surgical texts is presented. Sources were identified by searching bibliographic databases, orthopaedic sourcebooks, textbooks in medical history, and a subsequent hand search. Substantial progress in understanding fractures of the proximal humerus is found in nineteenth-century textbooks. A rational approach to understanding fractures of the proximal humerus was made possible by an appreciation of the underlying functional anatomy and subsequent pathoanatomy. Thus, new principles of diagnosis, pathoanatomic classifications, modified methods of reduction, functional bandaging, and advanced concepts of displacement were proposed, challenging the classic management adhered to for more than 2000 years. The principles for modern pathoanatomic and pathophysiologic understanding of proximal humeral fractures and the principles for classification, nonsurgical treatment, and bandaging were established in the preradiographic era.

Displaced Proximal Humerus Fractures: is a Sling as Good as a Plate?

PubMed

Steinhaus, Michael E; Dare, David M; Gulotta, Lawrence V

2016-10-01

The treatment of displaced proximal humerus fractures is challenging and complex, as its success is predicated on multiple factors. While it is clear that a majority of proximal humerus fractures may be treated nonoperatively, it is less clear which patients benefit from surgical management. The PROFHER trial, a randomized controlled study, used patient-reported outcomes to compare surgical to nonsurgical management of displaced proximal humerus fractures. The purpose of this review is to highlight the strengths and weaknesses of the PROFHER trial and to assess the validity of its conclusion in the context of existing literature. The authors found no difference in the Oxford Shoulder Score (OSS) between the surgical and nonsurgical groups. Additionally, no difference was found between groups in any of the secondary outcomes, which included the Short-Form 12 (SF-12) health survey, surgical and fracture-related complications, additional surgery or therapy, inpatient medical complications, and mortality. They concluded that the recent increase in surgical management of proximal humerus fractures is perhaps unwarranted. While the randomization was successful and the pragmatic design may enable greater generalizability, this study possesses numerous flaws inherent in such an ambitious endeavor, including an inability to identify specific factors which explain the lack of superiority of surgical management. Despite its weaknesses, this study is a valuable datapoint which encourages surgeons to reexamine their surgical indications for this injury.

Complex proximal humeral fractures: a prospective study of 22 cases treated using the "Bilboquet" device.

PubMed

Doursounian, L; Kilinc, A; Cherrier, B; Nourissat, G

2011-02-01

Despite recent improvements in surgical devices, complex proximal humerus fractures internal fixation still encounters frequent mechanical failures. The aim of this study was to confirm that the Bilboquet device (a design mimicking the cup-and-ball game) helps solving mechanical difficulties associated with these fractures internal fixation and to present a simplified version of the original surgical procedure. This non-randomised prospective study included 22 fractures in 22 patients, mean age: 70 years. According to the Neer classification there were three-part fractures in seven cases and four-part fractures in 15 cases. Fractures were all reduced and treated by internal fixation in a simplified surgical procedure using the Bilboquet device. Mean postoperative follow-up was 34 months. The mean Constant score was 66 and the weighted Constant score was 86. Mean active forward elevation was 108° and mean active external rotation was 28°. No per- or postoperative complications occurred. Initial reduction of the tuberosity was incomplete in four cases. Union was obtained in all fractures. There was no secondary tilting of the head, and no migration or pseudarthrosis of the tuberosities. Five patients developed postoperative avascular necrosis of the humeral head. The Bilboquet staple component provides a supporting platform for the entire humeral head area. This peripheral stabilization associated with tension band wiring explains the lack of secondary displacement in these cases. Although the Bilboquet device provides a solution to the mechanical problems of complex fractures of the proximal humerus, it does not solve the problem of secondary avascular necrosis of the humeral head, which occurred in 23% of the patients in this series and in 33% of patients in the four-part fractures subgroup. IV (non-randomised prospective study). Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Scapulo-humeral arthrodesis using a pedicled scapular pillar graft following resection of the proximal humerus.

PubMed

Padiolleau, G; Marchand, J B; Odri, G A; Hamel, A; Gouin, F

2014-04-01

Scapulo-humeral arthrodesis (SHA) is a proven reconstruction method in patients with proximal humerus malignancies requiring resection of the shoulder abduction apparatus (rotator cuff and deltoid muscles) or its nerve supply. Standard practice consists in using a pedicled fibular flap. We use instead a pedicled autologous bone graft harvested from the ipsilateral scapular pillar. The objective of this study was to assess functional outcomes and radiological healing after SHA using a pedicled scapular pillar graft. We retrospectively reviewed the charts of the 12 patients managed at a single center by a single surgeon between 1994 and 2011. SHA was performed using a vascularised ipsilateral scapular pillar graft after proximal humerus resection to treat a bone malignancy. The graft was harvested from the ipsilateral scapular pillar, pedicled on the circumflex scapular artery, fitted into the remaining proximal humerus, and secured to the glenoid using screws. A humerus-scapular spine plate was added to stabilize the arthrodesis. Radiographic results were assessed on standard radiographs obtained at last follow-up. Functional outcomes were evaluated using the MusculoSkeletalTumour Society (MSTS) score and Toronto Extremity Salvage Score (TESS). After a mean follow-up of 4.9 years, 87.5% of SHA junctions were healed, mean MSTS score was 71%, and mean TESS score was 70%. The outcomes in our patients were similar to those reported after SHA using a pedicled fibular flap. However, our technique does not require microsurgery. It is simple, reproducible, and effective. Its indications of choice are intra- or extra-articular resection of the proximal humerus including the attachments of the rotator cuff and deltoid muscle tendons or the nerves supplying these muscles. Level IV (retrospective study). Copyright © 2014 Elsevier Masson SAS. All rights reserved.

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

PubMed

Fattoretto, D; Borgo, A; Iacobellis, C

2016-08-01

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

Proximal humerus fractures: a comparative biomechanical analysis of intra and extramedullary implants.

PubMed

Füchtmeier, B; May, R; Hente, R; Maghsudi, M; Völk, M; Hammer, J; Nerlich, M; Prantl, L

2007-08-01

The biomechanical stability of a newly developed humerus nail (Sirustrade mark) for the treatment of fractures of the proximal humerus was analyzed in comparison to established systems. In total, three randomized groups were formed (n = 4 pairs) from 12 matched pairs of human cadaver humeri. All intact bones were mechanically characterized by five subsequent load cycles under bending and torsional loading. The bending moment at the osteotomy was 7.5 N m the torsional moment was 8.3 N m over the hole specimen length. Loading was consistently initiated at the distal epiphysis and the deformation at the distal epiphysis was continuously recorded. Prior to implant reinforcement, a defect of 5 mm was created to simulate an unstable subcapital humerus fracture. For paired comparison, one humerus of each pair was stabilized with the Sirus proximal humerus nail while the counterpart was stabilized by a reference implant. In detail, the following groups were created: Sirus versus Proximal humerus nail (PHN) with spiral blade (group I); Sirus versus PHILOS plate (group II); Sirus versus 4.5 mm AO T-plate (group III). The Sirus nail demonstrated significantly higher stiffness values compared to the reference implants for both bending and torsional loading. The following distal epiphyseal displacements were recorded for a bending moment of 7.5 N m at the osteotomy: Sirus I: 8.8 mm, II: 8.4 mm, III: 7.7 mm (range 6.9-10.9), PHN 21.1 mm (range 15.7-25.2) (P = 0.005), PHILOS plate 27.5 mm (range 21.6-35.8) (P < 0.001), 4.5 AO T-plate 26.3 mm (range 24.3-33.9) (P = 0.01). The rotations corresponding to 8.3 N m torsional moment were: Sirus I: 9.1 degrees , II: 9.3 degrees , III: 10.6 degrees (range 7.5-12.2), PHN 13.5 degrees (range 10.3-15.6) (P = 0.158), PHILOS plate 15.6 degrees (range 13.7-20.8) (P = 0.007), 4.5 AO T-Platte 14.1 degrees (range 11.5-19.7) (P = 0.158). The intramedullary load carriers were biomechanically superior when compared to the plating systems in the fracture model presented here. Supplementary, the Sirus Nail showed higher stiffness values than the PHN. However, the latter are gaining in importance due to the possibility of minimal invasive implantation. Whether this will be associated with functional advantages requires further clinical investigation.

[Measurement of screw length through drilling technique in osteosynthesis of the proximal humerus fractures].

PubMed

Avcı, Cem Coşkun; Gülabi, Deniz; Sağlam, Necdet; Kurtulmuş, Tuhan; Saka, Gürsel

2013-01-01

This study aims to investigate the efficacy of screw length measurement through drilling technique on the reduction of intraarticular screw penetration and fluoroscopy time in osteosynthesis of proximal humerus fractures. Between January 2008 and June 2012, 98 patients (34 males, 64 females; mean age 64.4 years; range 35 to 81 years) who underwent osteosynthesis using locking anatomical proximal humerus plates (PHILOS) in our clinic with the diagnosis of Neer type 2, 3 or 4 were included. Two different surgical techniques were used to measure proximal screw length in the plate and patients were divided into two groups based on the technique used. In group 1, screw length was determined by a 3 mm blunt tipped Kirschner wire without fluoroscopic control. In group 2, bilateral fluoroscopic images for each screw at least were obtained. Intraarticular screw penetration was detected in five patients (10.6%) in group 1, and in 19 patients (37.3%) in group 2. The mean fluoroscopic imaging time was 10.6 seconds in group 1 and 24.8 seconds in group 2, indicating a statistically significant difference. Screw length measurement through the drilling technique significantly reduces the intraarticular screw penetration and fluoroscopy time in osteosynthesis of proximal humerus fractures using PHILOS plates.

Injection of Unicameral Bone Cysts with Bone Marrow Aspirate and Demineralized Bone Matrix Avoids Open Curettage and Bone Grafting in a Retrospective Cohort.

PubMed

Gundle, Kenneth R; Bhatt, Etasha M; Punt, Stephanie E; Bompadre, Viviana; Conrad, Ernest U

2017-01-01

Many treatment options exist for unicameral bone cysts (UBC), without clear evidence of superiority. Meta-analyses have been limited by small numbers of patients in specific anatomic and treatment subgroups. The purpose of this study was to report the outcomes of injecting bone marrow aspirate and demineralized bone matrix (BMA/DBM) for the treatment of proximal humerus UBC. Fifty-one patients with proximal humerus lesions treated by BMA/DBM injection were retrospectively reviewed from a single academic medical center. The mean number of injections performed per patient was 2.14 (range 1-5). Eleven patients underwent only one injection (22%), an additional 19 patients completed treatment after two injections (37%), four patients healed after three injections (8%), and one patient healed after four injections (2%). The cumulative success rate of serial BMA/DBM injections was 22% (11/51), 58% (30/51), 67% (34/51), and 69% (35/51). Eleven patients (22%) ultimately underwent open curettage and bone grafting, and five patients (10%) were treated with injection of calcium phosphate bone substitute. A BMA/DBM injection strategy avoided an open procedure in 78% of patients with a proximal humerus UBC. The majority of patients underwent at least 2 injection treatments. Level IV retrospective cohort study.

[Operative treatment of proximal humeral four-part fractures in elderly patients: comparison of two angular-stable implant systems].

PubMed

Kuhlmann, T; Hofmann, T; Seibert, O; Gundlach, G; Schmidt-Horlohé, K; Hoffmann, R

2012-04-01

Although being one of the most common fractures in elderly patients, there is still no standardised treatment protocol for four-part fractures of the proximal humerus. However, a wide variety of angular-stable implants is available. The present retrospective study compares the clinical and radiological outcome following operative treatment of four-part fractures of the proximal humerus with the Philos system (Philos, proximal humeral internal locking system, Synthes GmbH, Umkirch Germany) and the angular-stable Königsee plate system (Königsee Implantate GmbH, Allendorf, Germany) in patients older than 65 years. From July 2005 until December 2007 we identified 77 patients with a four-part fracture of the proximal humerus who were treated operatively with one of the two implant systems. Of the patients, 17 could not be located so that in total 60 patients (78 %) participated in this study. The mean age of the 30 patients (10 m, 20 f) in the Philos group was 69 years (65-92), whereas the mean age of the 30 patients (11 m, 19 f) in the Königsee group was 71 years (65-93). A comprehensive assessment was performed after a median of 17 months (12-24), including physical examination, radiographic examination and completion of the disabilities of the arm, shoulder and hand score (DASH) and the Constant score (CS) as patient-oriented, limb-specific questionnaires. Neither in the Philos nor in the Königsee group could excellent results be achieved. Using the CS 13 patients (43 %) of the Philos group achieved a good and 15 (50 %) a satisfactory result. Bad results were found in 2 patients (7 %). The mean CS was 61.53 points. In the Königsee group mean CS was 61.76 points. In detail, 14 patients (47 %) treated with the Königsee implant were rated as good and 15 (50 %) as satisfactory. Only 1 patient (3 %) was rated as poor. No significant statistical differences were found between the groups. Mean DASH score in the Philos group was 56.30 points and 55.37 points in the Königsee group. Again, no statistical difference was found. Partial humeral head necrosis was observed in 2 patients of the Philos and 1 of the Königsee group. In the remaining patients uneventful fracture consolidation was observed. There were no complications requiring further surgical intervention. To the date of follow-up all implants were still in situ and none of the patients reported discomfort with respect to the hardware. In this study we were able to demonstrate that good and satisfactory results can be achieved in the majority of patients, regardless of whether a Philos or a Königsee system was used. Significant differences between the two groups could not be found in any of the performed examinations. Both implants seem to be suitable in four-part fractures of the proximal humerus. However, the Königsee plate represents a more cost-effective option compared to the Philos system. © Georg Thieme Verlag KG Stuttgart · New York.

Three-part head-splitting proximal humerus fracture through a unicameral bone cyst.

PubMed

Younghein, John A; Eskander, Mark S; DeAngelis, Nicola A; Wixted, John J

2012-06-01

Unicameral bone cysts are rare in adults and are most often found incidentally on radiographs. However, they can persist from the adolescent period and may be present in locations that predispose to or exacerbate fractures.This article describes a case of a healthy 40-year-old woman who sustained a proximal humerus trauma that involved a large unicameral bone cyst, resulting in a 3-part head-splitting fracture. The epiphyseal location of the cyst contributed to the severity and extent of the fracture that resulted from a simple fall. Given the age of the patient, open reduction and internal fixation with a locking plate and lag screws was performed. The patient chose open reduction and internal fixation to preserve a hemiarthroplasty procedure in case of future revision. Successful humeral head reconstruction was achieved, and the patient fully recovered. One year postoperatively, the patient underwent arthroscopic debridement to alleviate subjective stiffness and decreased range of motion.Multipart head-splitting fractures require complex repair strategies. The gold standard for the treatment of these injuries is hemiarthroplasty. However, the decision process is difficult in a young patient given the average survival of autoplastic prostheses and the added difficulty of later revision. The current case demonstrates the complexity of decision making resulting from a rare injury in a young, healthy patient and shows that open reduction and internal fixation can provide acceptable reconstruction in such situations. Copyright 2012, SLACK Incorporated.

Is the Clavicula Pro Humero Technique of Value for Reconstruction After Resection of the Proximal Humerus in Children?

PubMed

Barbier, Dominique; De Billy, Benoît; Gicquel, Philippe; Bourelle, Sophie; Journeau, Pierre

2017-10-01

There are several options for reconstruction of proximal humerus resections after wide resection for malignant tumors in children. The clavicula pro humero technique is a biologic option that has been used in the past, but there are only scant case reports and small series that comment on the results of the procedure. Because the longevity of children mandates a reconstruction with potential longevity not likely to be achieved by other techniques, the clavicula pro humero technique may be a potential option in selected patients. (1) How successful is the clavicula pro humero procedure in achieving local tumor control? (2) What is the frequency of nonunion? (3) What are the complications of the procedure? (4) What scores do patients achieve (on the Musculoskeletal Tumor Society (MSTS) and the Toronto Extremity Salvage Score (TESS) after this procedure? Four university hospitals performed the clavicula pro humero technique in eight children aged 8 to 18 years between June 2006 and February 2014. During that period, general indications for this approach included all reconstructions of the proximal humerus for malignant tumors in children older than 8 years. All patients were followed for a mean of 40 months (range, 25-86 months); one patient was lost to followup before 2 years. The tumor resections removed the rotator cuff muscles in all patients, glenohumeral joint in five, and deltoid muscle in three. The median length of the bone defect after resection was 20 cm (range, 7-25 cm). It was reduced to 9 cm (range, 0-17 cm) or 27% (range, 0%-64%) of the total humerus length after clavicular rotation. Direct osteosynthesis (one patient), induced membrane technique (one patient), or vascularized fibular autograft (six patients) was used to complete the defect after rotation of the clavicle if necessary. Presence of union (defined as bone healing before 10 months, as assessed by disappearance of the osteotomy on AP and lateral view radiographs), and complications were determined by chart review performed by a surgeon not involved in patient care. Function assessed by the MSTS and the TESS scores were determined by the patients with their families. None of the patients had tumor recurrence. One patient died of pulmonary metastases before the 2-year followup. Proximal and distal bone unions were achieved before 10 months without an additional surgical procedure in two and six of seven patients, respectively. Fourteen local complications occurred resulting in nine revision operations. The main complication was aseptic proximal pseudarthrosis (five patients); other complications included one proximal junction fracture, one clavicle fracture complicated by clavicle osteolysis, one distal junction fracture, one necrosis of the skin paddle of the fibular autograft, one glenoclavicular ossification, and one distal pseudarthrosis complicated by a fracture of this distal junction. Function, as assessed by the MSTS score, was a median of 23 of 30 (range, 11-27). The median TESS score was 82% (range, 75%-92%). Shoulder ROM (median; range) in abduction, front elevation, and external and internal rotations were 70°(30°-90°), 75°(30°-85°), 10°(0°-20°), and 80°(80°-100°), respectively. Three of the seven patients reported dissatisfaction with the cosmetic appearance. The clavicula pro humero technique achieved oncologic local control after resection and reconstruction of proximal humerus tumors in children. Although union times are approximately 2 years and some patients underwent augmentation with other grafts, it eventually provides a solid, painless, biologic, and stable reconstruction and creates a mobile acromioclavicular joint and generally good function. Nonunion of the proximal junction is the main complication of this technique. We cannot directly compare this technique with other reconstruction options, and longer followup is needed, but this may be a useful reconstruction option to consider in select pediatric patients with sarcomas of the proximal humerus. Level IV, therapeutic study.

Injection of Unicameral Bone Cysts with Bone Marrow Aspirate and Demineralized Bone Matrix Avoids Open Curettage and Bone Grafting in a Retrospective Cohort

PubMed Central

Gundle, Kenneth R.; Bhatt, Etasha M.; Punt, Stephanie E.; Bompadre, Viviana; Conrad, Ernest U.

2017-01-01

Background: Many treatment options exist for unicameral bone cysts (UBC), without clear evidence of superiority. Meta-analyses have been limited by small numbers of patients in specific anatomic and treatment subgroups. The purpose of this study was to report the outcomes of injecting bone marrow aspirate and demineralized bone matrix (BMA/DBM) for the treatment of proximal humerus UBC. Methods: Fifty-one patients with proximal humerus lesions treated by BMA/DBM injection were retrospectively reviewed from a single academic medical center. Results: The mean number of injections performed per patient was 2.14 (range 1-5). Eleven patients underwent only one injection (22%), an additional 19 patients completed treatment after two injections (37%), four patients healed after three injections (8%), and one patient healed after four injections (2%). The cumulative success rate of serial BMA/DBM injections was 22% (11/51), 58% (30/51), 67% (34/51), and 69% (35/51). Eleven patients (22%) ultimately underwent open curettage and bone grafting, and five patients (10%) were treated with injection of calcium phosphate bone substitute. Conclusion: A BMA/DBM injection strategy avoided an open procedure in 78% of patients with a proximal humerus UBC. The majority of patients underwent at least 2 injection treatments. Level of Evidence: Level IV retrospective cohort study. PMID:28694887

Clinical comparison between open plating and minimally invasive plate osteosynthesis for displaced proximal humeral fractures: A prospective randomized controlled trial.

PubMed

Sohn, Hoon-Sang; Jeon, Yoon Sang; Lee, JuHan; Shin, Sang-Jin

2017-06-01

Recently, minimally invasive plate osteosynthesis (MIPO) has been widely used for the treatment of proximal humeral fractures. However, there is concern about whether the MIPO in comminuted proximal humeral fractures is also comparable to open plating. The purpose of this study was to compare the clinical and radiographic outcomes of open plating and MIPO for acute displaced proximal humeral fractures. In this prospective, randomized controlled study, 107 patients who had an acute proximal humeral fracture were randomized to either the open plating or MIPO techniques. Forty-five patients treated with open plating and 45 with the MIPO technique who were followed up at least 1year were evaluated. Shoulder functional assessment, operating time, several radiographic parameters, and complications were evaluated at final follow-up. The mean follow-up period was 15.0 months in the open plating and 14.3 months in the MIPO technique. There were no statistically significant differences in functional assessment scores and radiographic parameters between the two groups. High complications rates were found in 4-part fracture in both surgical methods The average operation time in the MIPO group were significantly lower compared to the open plating group (p<0.05). This study showed MIPO in proximal humerus fractures had similar clinical and radiographic outcomes compared to the open plating. However, the MIPO technique in proximal humerus fracture provided significantly shorter operation time than the open plating. Copyright © 2017 Elsevier Ltd. All rights reserved.

OSTEOCHONDROMA OF THE PROXIMAL HUMERUS WITH FRICTIONAL BURSITIS AND SECONDARY SYNOVIAL OSTEOCHONDROMATOSIS.

PubMed

De Groote, J; Geerts, B; Mermuys, K; Verstraete, K

2015-01-01

We report a case of multiple hereditary exostosis in a 33-year old patient with clinical symptoms of pain and impression of a growing mass of the left shoulder alerting potential risk of malignant transformation of an osteochondroma. Imaging studies illustrated perilesional bursitis surrounding an osteochondroma of the proximal humerus. Malignant transformation was excluded with MRI. Fragments of the osteochondroma were dislocated in the inflammatory synovial bursa illustrating a case of secondary synovial osteochondromatosis.

Proximal Humerus Fractures: Evaluation and Management in the Elderly Patient

PubMed Central

Grawe, Brian

2018-01-01

Introduction: Proximal humerus fractures are common in the elderly. The evaluation and management of these injuries is often controversial. The purpose of this study is to review recent evidence and provide updated recommendations for treating proximal humerus fractures in the elderly. Methods: A literature review of peer-reviewed publications related to the evaluation and management of proximal humerus fractures in the elderly was performed. There was a focus on randomized controlled trials and systematic reviews published within the last 5 years. Results: The incidence of proximal humerus fractures is increasing. It is a common osteoporotic fracture. Bone density is a predictor of reduction quality and can be readily assessed with anteroposterior views of the shoulder. Social independence is a predictor of outcome, whereas age is not. Many fractures are minimally displaced and respond acceptably to nonoperative management. Displaced and severe fractures are most frequently treated operatively with intramedullary nails, locking plates, percutaneous techniques, or arthroplasty. Discussion: Evidence from randomized controlled trials and systematic reviews is insufficient to recommend a treatment; however, most techniques have acceptable or good outcomes. Evaluation should include an assessment of the patient’s bone quality, social independence, and surgical risk factors. With internal fixation, special attention should be paid to medial comminution, varus angulation, and restoration of the calcar. With arthroplasty, attention should be paid to anatomic restoration of the tuberosities and proper placement of the prosthesis. Conclusion: A majority of minimally displaced fractures can be treated conservatively with early physical therapy. Treatment for displaced fractures should consider the patient’s level of independence, bone quality, and surgical risk factors. Fixation with percutaneous techniques, intramedullary nails, locking plates, and arthroplasty are all acceptable treatment options. There is no clear evidence-based treatment of choice, and the surgeon should consider their comfort level with various procedures during the decision-making process. PMID:29399372

Epidemiology of fragility fractures in Sakaiminato, Japan: incidence, secular trends, and prognosis.

PubMed

Tsukutani, Y; Hagino, H; Ito, Y; Nagashima, H

2015-09-01

We investigated the incidence of fragility fractures from 2010 to 2012 in Sakaiminato, Japan. The incidence rates of limb fractures in Sakaiminato were lower than in Caucasian populations but had increased relative to data obtained in Japan in the 1990s. Clinical vertebral fractures occurred at higher rates in Sakaiminato than in Caucasian populations. To elucidate the incidence and prognosis of fragility fractures in Sakaiminato, Japan. A survey of all hip, distal radius, proximal humerus, and clinical vertebral fractures was performed from 2010 to 2012 in patients aged 50 or older in Sakaiminato city, Tottori prefecture, Japan. The age- and gender-specific incidence rates (per 100,000 person-years) were calculated based on the population of Sakaiminato city each year. The incidence rates of hip, distal radius, and proximal humerus fractures were compared with previous reports. We conducted a follow-up study assessing patients within 1 year following their initial treatment at two Sakaiminato hospitals. The age-adjusted incidence rates in population aged 50 years or older (per 100,000 person-years) of hip, distal radius, proximal humerus, and clinical vertebral fractures were, respectively, 217, 82, 26, and 412 in males and 567, 432, 96, and 1229 in females. Age-specific incidence rates of hip, distal radius, and proximal humerus fractures all increased since the 1990s. Our study also revealed that anti-osteoporotic pharmacotherapy was prescribed 1 year post-fracture at rates of 29, 20, 30, and 50 % for patients with hip, distal radius, proximal humerus, and clinical vertebral fractures, respectively. The incidence rates of limb fractures in Sakaiminato were substantially lower than Caucasian populations in northern Europe but had increased relative to data obtained in Japan in the 1990s. Unlike upper and lower limb fractures, clinical vertebral fractures occurred at higher rates in our study population than in other Asian and North European countries.

Reverse total shoulder arthroplasty for acute head-splitting, 3- and 4-part fractures of the proximal humerus in the elderly.

PubMed

Grubhofer, Florian; Wieser, Karl; Meyer, Dominik C; Catanzaro, Sabrina; Beeler, Silvan; Riede, Ulf; Gerber, Christian

2016-10-01

Anatomic reduction and stable internal fixation of complex proximal humeral fractures in the elderly is challenging. Secondary displacement, screw perforation, and humeral head necrosis are common complications. The outcome of hemiarthroplasty is unpredictable and strongly dependent on the uncertain healing of the greater tuberosity. This multicenter study retrospectively analyzes the midterm results of primary reverse total shoulder arthroplasty for the treatment of acute, complex fractures of the humerus in an elderly population. Fifty-two shoulders in 51 patients with a mean age of 77 years treated with reverse total shoulder arthroplasty for an acute, complex fracture of the proximal humerus were clinically and radiographically analyzed after a mean follow-up period of 35 months (range, 12-90 months). There were no intraoperative complications. Revision surgery was performed in 4 shoulders. At final follow-up, the absolute and relative Constant scores averaged 62 points (range, 21-83 points) and 86% (range, 30%-100%), respectively, with a mean Subjective Shoulder Value of 83% (range, 30%-100%). Of the patients, 92% rated the treatment outcome as excellent or good. Patients with a resected or secondarily displaced greater tuberosity had an inferior clinical outcome to those with a healed greater tuberosity. The midterm clinical results are predictably good, with low complication rates and a rapid postoperative recovery of painfree everyday function. If secondary displacement of the greater tuberosity occurs, revision surgery may warrant consideration in view of potential improvement of ultimate outcome. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Analysis of fractal dimensions of rat bones from film and digital images

NASA Technical Reports Server (NTRS)

Pornprasertsuk, S.; Ludlow, J. B.; Webber, R. L.; Tyndall, D. A.; Yamauchi, M.

2001-01-01

OBJECTIVES: (1) To compare the effect of two different intra-oral image receptors on estimates of fractal dimension; and (2) to determine the variations in fractal dimensions between the femur, tibia and humerus of the rat and between their proximal, middle and distal regions. METHODS: The left femur, tibia and humerus from 24 4-6-month-old Sprague-Dawley rats were radiographed using intra-oral film and a charge-coupled device (CCD). Films were digitized at a pixel density comparable to the CCD using a flat-bed scanner. Square regions of interest were selected from proximal, middle, and distal regions of each bone. Fractal dimensions were estimated from the slope of regression lines fitted to plots of log power against log spatial frequency. RESULTS: The fractal dimensions estimates from digitized films were significantly greater than those produced from the CCD (P=0.0008). Estimated fractal dimensions of three types of bone were not significantly different (P=0.0544); however, the three regions of bones were significantly different (P=0.0239). The fractal dimensions estimated from radiographs of the proximal and distal regions of the bones were lower than comparable estimates obtained from the middle region. CONCLUSIONS: Different types of image receptors significantly affect estimates of fractal dimension. There was no difference in the fractal dimensions of the different bones but the three regions differed significantly.

The surgical manegement of metastases to humerus-clinical evaluation.

PubMed

Chrobok, Adam; Spindel, Jerzy; Miszczyk, Leszek; Koczy, Bogdan; Pilecki, Bogdan; Jarosz, Adam; Mrozek, Tomasz

2003-06-30

Background. The humerus is a common localisation of cancer metastases. The restoration of anatomical order and tumor resection within humerus is important for patients quality of everyday life and for their pain relief. The surgical treatment is one of the most important part of the whole oncological ways of tratment.
The study objective was a clinical assesment of tumor resection and reconstruction within humerus according to matastasis localisation and the choice of surgical technique.
Material and methods. In the years 1999-2002 19 patients underwent surgery due to pathological fracture or/and cancer metastasis within humerus. The shaft localisation of the tumor was found in 8 cases and in 11 patients the metastatic foci were found in proximnal diaphysis. In patients with proximal diaphysis localisation of the tumor the partial resection with subsequent joint exchange procedure was made. The humeral shaft metastatic cancer changes were treated by the segmental resection with subsequent surgical cement filling or auto/allogenical bone grafting combined with intramedullary nail or AO/ASIF plate stabilisation. The average follow-up period was 8,5 months.
Results. In patients after resection with shoulder joint alloplasty according to the Enneking test a very good result was found in 7 and very good in 4 cases.
In patients with femoral shaft metastatic tumor locaslisation, 6 good and 2 fair results were found. In 1 patient after 2 months rehabilitation a reoperation was needed due to the mechanical destabilisation. The best results were found in patients after intramedullary nailing.An acute soft tissue inflamation requiering surgical treatment was found in 1 patient after shoulder joint replacement.
Conclusions. After clinical analysis of the material we highly recomend the partial humeral bone resection with subsequent shoulder alloplasty in patients with proximal humeral diaphysis metastatic localisation. In cases with shaft localisation a better results were found after intramedullary nailing compared to common plate technique.

Performance and Longevity of a Novel Intraosseous Device in a Goat (Capra hircus) Model

PubMed Central

Jackson, Erin E; Ashley, T Clay; Snowden, Karen F; Gresham, Vincent C; Budke, Christine M; Eichelberger, Bunita M; Taylor, Destiny A

2011-01-01

We performed 2 studies to assess the function and longevity of a novel intraosseous catheter device. For study 1, 9 goats were assigned to 3 groups (intraosseous catheter in the proximal humerus, intraosseous catheter in the proximal tibia, or standard jugular catheter). Devices in the tibia remained in place for less time than did those in the humerus, and no goats exhibited radiographic evidence of resulting damage or structural change in surrounding bone. Positive bacterial cultures were found in all 9 goats at various time points. In study 2, 18 goats were assigned to 2 groups (intraosseous catheter in the wing of the ilium or proximal humerus). Samples for serial aerobic and anaerobic blood cultures and CBC were collected while devices remained in use. Clinical monitoring and removal criteria were identical those for study 1. Catheters in the ilium remained in place for less than 24 h on average, and those in the humerus remained in place for an average of 2.5 d. Several goats with proximal humeral catheters demonstrated moderate lameness after removal, and radiographic evidence of periosteal bone growth was noted in another goat. Bloodwork indicated mild elevations of WBC counts from baseline in some cases. Bacterial growth was found in samples from 4 of 18 goats at various time points. Our study indicated that intraosseous catheters may remain safely in place for more than 24 h, but animals should be monitored closely for negative side effects for several days after removal. PMID:21640033

Initial varus displacement of proximal humerus fractures results in similar function but higher complication rates.

PubMed

Capriccioso, Christina E; Zuckerman, Joseph D; Egol, Kenneth A

2016-04-01

To investigate the effect of initial varus or valgus surgical neck alignment on outcomes of patients who sustained proximal humerus fractures treated with open reduction and internal fixation (ORIF). An institutional review board approved database of proximal humerus fractures treated with locked plates was reviewed. Of 185 fractures in the database, 101 fractures were identified and met inclusion criteria. Initial varus displacement was seen in 47 fractures (OTA types 11.A2.2, A3.1, A3.3, B1.2, B2.2, C1.2, C2.2, or C2.3) and initial valgus displacement was observed in 54 fractures (OTA types 11.A2.3, B1.1, C1.1, or C2.1). All patients were treated in a similar manner and examined by the treating physician at standard intervals. Functional outcomes were quantified via the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and physical examination data at 12 months. Radiographs were reviewed for complications of healing. Additionally, complication rate and reoperation rate were investigated. Patients who presented with initial varus displacement had an average age of 59.3 years, while patients in the valgus group had an average age of 62.4 years. Overall, there was no statistically significant difference in age, sex distribution, BMI, fracture parts, screws used, or implant plate type between the two groups. At a minimum 12 months follow up, there was no significant difference in DASH scores between those presenting with varus versus valgus fracture patterns. In addition, no significant differences were seen in final shoulder range of motion in any plane. Overall, 30 patients included in this study developed a complication. A significantly greater number of patients in the initial varus cohort developed complications (40.4%), as compared to 20.3% of patients in the initial valgus cohort (P=0.03). Fourteen patients in this study underwent reoperation. Nine of these patients were in the varus cohort, while 5 were in the valgus cohort (P=0.15). In this study, initial surgical neck displacement in varus or valgus was found to not significantly affect functional outcome. Based upon our findings, patients with varus displaced proximal humerus fractures are at a greater risk of developing postoperative complications than those who present with initial valgus displaced fracture patterns. Copyright © 2016 Elsevier Ltd. All rights reserved.

Falling Down on the Job: Evaluation and Treatment of Fall Risk Among Older Adults With Upper Extremity Fragility Fractures.

PubMed

McDonough, Christine M; Colla, Carrie H; Carmichael, Donald; Tosteson, Anna N A; Tosteson, Tor D; Bell, John-Erik; Cantu, Robert V; Lurie, Jonathan D; Bynum, Julie P W

2017-03-01

Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline. The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk. Observational cohort. Participants were fee-for-service beneficiaries age 66 to 99 treated as outpatients for proximal humerus or distal radius/ulna ("wrist") fragility fractures. -Participants were studied using Carrier and Outpatient Hospital files. The proportion of patients evaluated or treated for fall risk up to 6 months after proximal humerus or wrist fracture from 2007-2009 was examined based on evaluation, treatment, and diagnosis codes. Time to evaluation and number of treatment sessions were calculated. Logistic regression was used to analyze patient characteristics that predicted receiving evaluation or treatment. Narrow (gait training) and broad (gait training or therapeutic exercise) definitions of service were used. There were 309,947 beneficiaries who sustained proximal humerus (32%) or wrist fracture (68%); 10.7% received evaluation or treatment for fall risk or gait issues (humerus: 14.2%; wrist: 9.0%). Using the broader definition, the percentage increased to 18.5% (humerus: 23.4%; wrist: 16.3%). Factors associated with higher likelihood of services after fracture were: evaluation or treatment for falls or gait prior to fracture, more comorbidities, prior nursing home stay, older age, humerus fracture (vs wrist), female sex, and white race. Claims analysis may underestimate physician and physical therapist fall assessments, but it is not likely to qualitatively change the results. A small proportion of older adults with upper extremity fracture received fall risk assessment and treatment. Providers and health systems must advance efforts to provide timely evidence-based management of fall risk in this population. © 2017 American Physical Therapy Association

Falling Down on the Job: Evaluation and Treatment of Fall Risk Among Older Adults With Upper Extremity Fragility Fractures

PubMed Central

Colla, Carrie H.; Carmichael, Donald; Tosteson, Anna N. A.; Tosteson, Tor D.; Bell, John-Erik; Cantu, Robert V.; Lurie, Jonathan D.; Bynum, Julie P. W.

2017-01-01

Abstract Background: Clinical practice guidelines recommend fall risk assessment and intervention for older adults who sustain a fall-related injury to prevent future injury and mobility decline. Objective: The aim of this study was to describe how often Medicare beneficiaries with upper extremity fracture receive evaluation and treatment for fall risk. Design: Observational cohort. Methods: Participants were fee-for-service beneficiaries age 66 to 99 treated as outpatients for proximal humerus or distal radius/ulna (“wrist”) fragility fractures. -Participants were studied using Carrier and Outpatient Hospital files. The proportion of patients evaluated or treated for fall risk up to 6 months after proximal humerus or wrist fracture from 2007–2009 was examined based on evaluation, treatment, and diagnosis codes. Time to evaluation and number of treatment sessions were calculated. Logistic regression was used to analyze patient characteristics that predicted receiving evaluation or treatment. Narrow (gait training) and broad (gait training or therapeutic exercise) definitions of service were used. Results: There were 309,947 beneficiaries who sustained proximal humerus (32%) or wrist fracture (68%); 10.7% received evaluation or treatment for fall risk or gait issues (humerus: 14.2%; wrist: 9.0%). Using the broader definition, the percentage increased to 18.5% (humerus: 23.4%; wrist: 16.3%). Factors associated with higher likelihood of services after fracture were: evaluation or treatment for falls or gait prior to fracture, more comorbidities, prior nursing home stay, older age, humerus fracture (vs wrist), female sex, and white race. Limitations: Claims analysis may underestimate physician and physical therapist fall assessments, but it is not likely to qualitatively change the results. Conclusions: A small proportion of older adults with upper extremity fracture received fall risk assessment and treatment. Providers and health systems must advance efforts to provide timely evidence-based management of fall risk in this population. PMID:28340130

Biomechanical effect of the configuration of screw hole style on locking plate fixation in proximal humerus fracture with a simulated gap: A finite element analysis.

PubMed

Zhang, Ya-Kui; Wei, Hung-Wen; Lin, Kang-Ping; Chen, Wen-Chuan; Tsai, Cheng-Lun; Lin, Kun-Jhih

2016-06-01

Locking plate fixation for proximal humeral fractures is a commonly used device. Recently, plate breakages were continuously reported that the implants all have a mixture of holes allowing placement of both locking and non-locking screws (so-called combi plates). In commercialized proximal humeral plates, there still are two screw hole styles included "locking and dynamic holes separated" and "locking hole only" configurations. It is important to understand the biomechanical effect of different screw hole style on the stress distribution in bone plate. Finite element method was employed to conduct a computational investigation. Three proximal humeral plate models with different screw hole configurations were reconstructed depended upon an identical commercialized implant. A three-dimensional model of a humerus was created using process of thresholding based on the grayscale values of the CT scanning of an intact humerus. A "virtual" subcapital osteotomy was performed. Simulations were performed under an increasing axial load. The von Mises stresses around the screw holes of the plate shaft, the construct stiffness and the directional displacement within the fracture gap were calculated for comparison. The mean value of the peak von Mises stresses around the screw holes in the plate shaft was the highest for combi hole design while it was smallest for the locking and dynamic holes separated design. The stiffness of the plate-bone construct was 15% higher in the locking screw only design (132.6N/mm) compared with the combi design (115.0N/mm), and it was 4% higher than the combi design for the locking and dynamic holes separated design (119.5N/mm). The displacement within the fracture gap was greatest in the combi hole design, whereas it was smallest for the locking hole only design. The computed results provide a possible explanation for the breakages of combi plates revealed in clinical reports. The locking and dynamic holes separated design may be a better configuration to reduce the risk of plate fracture. Copyright © 2016 Elsevier Ltd. All rights reserved.

Biomechanical comparison of orthogonal versus parallel double plating systems in intraarticular distal humerus fractures.

PubMed

Atalar, Ata C; Tunalı, Onur; Erşen, Ali; Kapıcıoğlu, Mehmet; Sağlam, Yavuz; Demirhan, Mehmet S

2017-01-01

In intraarticular distal humerus fractures, internal fixation with double plates is the gold standard treatment. However the optimal plate configuration is not clear in the literature. The aim of this study was to compare the biomechanical stability of the parallel and the orthogonal anatomical locking plating systems in intraarticular distal humerus fractures in artificial humerus models. Intraarticular distal humerus fracture (AO13-C2) with 5 mm metaphyseal defect was created in sixteen artificial humeral models. Models were fixed with either orthogonal or parallel plating systems with locking screws (Acumed elbow plating systems). Both systems were tested for their stiffness with loads in axial compression, varus, valgus, anterior and posterior bending. Then plastic deformation after cyclic loading in posterior bending and load to failure in posterior bending were tested. The failure mechanisms of all the samples were observed. Stiffness values in every direction were not significantly different among the orthogonal and the parallel plating groups. There was no statistical difference between the two groups in plastic deformation values (0.31 mm-0.29 mm) and load to failure tests in posterior bending (372.4 N-379.7 N). In the orthogonal plating system most of the failures occurred due to the proximal shaft fracture, whereas in the parallel plating system failure occurred due to the shift of the most distal screw in proximal fragment. Our study showed that both plating systems had similar biomechanical stabilities when anatomic plates with distal locking screws were used in intraarticular distal humerus fractures in artificial humerus models. Copyright © 2016 Turkish Association of Orthopaedics and Traumatology. Production and hosting by Elsevier B.V. All rights reserved.

In vivo three-dimensional elbow biomechanics during forearm rotation.

PubMed

Omori, Shinsuke; Miyake, Junichi; Oka, Kunihiro; Tanaka, Hiroyuki; Yoshikawa, Hideki; Murase, Tsuyoshi

2016-01-01

It is unclear how elbow kinematics changes during forearm rotation. This study investigated in vivo 3-dimensional elbow kinematics during forearm rotation. We studied 12 normal elbows using in vivo 3-dimensional computed tomography data in maximum forearm supination, neutral, and maximum pronation with the elbows in extension. We measured the motion of the radius and ulna relative to the humerus using a markerless bone registration technique and the contact area of the radiocapitellar joint, proximal radioulnar joint, and ulnohumeral joint using a proximity mapping method. When the forearm rotated from the supinated position to the pronated position, the radius showed significant varus rotation, internal rotation, and extension relative to the humerus. The center of the radial head significantly translated anteriorly, proximally, and laterally. The ulna significantly rotated in valgus, and the deepest point on the sagittal ridge of the trochlear notch translated medially with forearm pronation. The contact area of the radiocapitellar joint was largest in pronation. The contact area of the proximal radioulnar joint was largest in supination. The contact area of the ulnohumeral joint showed no significant change during forearm rotation. In pronation, because of the proximal migration of the radial head, the radiocapitellar joint was most congruent compared with other positions. The proximal radioulnar joint was most congruent in supination. The ulnohumeral joint congruency was not affected by forearm rotation. This study provides useful information for understanding 3-dimensional elbow motion and joint osseous stability related to forearm rotation. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Severe humeral erosion in a bedridden patient: a comprehensive intervention to prevent bone fracture.

PubMed

Ferriero, Giorgio; Brunetto, Alessandro; Sartorio, Francesco; Vercelli, Stefano

2004-12-01

This article reports a 1-yr prospective study related to a bedridden patient with rotator cuff tear arthropathy featuring severe erosion of the proximal part of the humerus. To prevent spontaneous humeral fracture, a comprehensive intervention was planned. This included drug therapy for osteoporosis and pain, nurse team training on patient handling techniques, and patient and caregiver education. After 1 yr, clinical and radiologic findings are stable.

The prediction of cyclic proximal humerus fracture fixation failure by various bone density measures.

PubMed

Varga, Peter; Grünwald, Leonard; Windolf, Markus

2018-02-22

Fixation of osteoporotic proximal humerus fractures has remained challenging, but may be improved by careful pre-operative planning. The aim of this study was to investigate how well the failure of locking plate fixation of osteoporotic proximal humerus fractures can be predicted by bone density measures assessed with currently available clinical imaging (realistic case) and a higher resolution and quality modality (theoretical best-case). Various density measures were correlated to experimentally assessed number of cycles to construct failure of plated unstable low-density proximal humerus fractures (N = 18). The influence of density evaluation technique was investigated by comparing local (peri-implant) versus global evaluation regions; HR-pQCT-based versus clinical QCT-based image data; ipsilateral versus contralateral side; and bone mineral content (BMC) versus bone mineral density (BMD). All investigated density measures were significantly correlated with the experimental cycles to failure. The best performing clinically feasible parameter was the QCT-based BMC of the contralateral articular cap region, providing significantly better correlation (R 2  = 0.53) compared to a previously proposed clinical density measure (R 2  = 0.30). BMC had consistently, but not significantly stronger correlations with failure than BMD. The overall best results were obtained with the ipsilateral HR-pQCT-based local BMC (R 2  = 0.74) that may be used for implant optimization. Strong correlations were found between the corresponding density measures of the two CT image sources, as well as between the two sides. Future studies should investigate if BMC of the contralateral articular cap region could provide improved prediction of clinical fixation failure compared to previously proposed measures. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

Long-term use of nerve block catheters in paediatric patients with cancer related pathologic fractures

PubMed Central

BURGOYNE, L. L.; PEREIRAS, L. A.; BERTANI, L. A.; KADDOUM, R. N.; NEEL, M.; FAUGHNAN, L. G.; ANGHELESCU, D. L.

2013-01-01

SUMMARY We report three cases of children with osteosarcoma and pathologic fractures treated with long-term continuous nerve blocks for preoperative pain control. One patient with a left distal femoral diaphysis fracture had a femoral continuous nerve block catheter for 41 days without complications. Another with a fractured left proximal femoral shaft had three femoral continuous nerve block catheters for 33, 26 and 22 days respectively. The third patient, whose right proximal humerus was fractured, had a brachial plexus continuous nerve block catheter for 36 days without complication. In our experience, prolonged use of continuous nerve block is safe and effective in children with pathologic fractures for preoperative pain control. PMID:22813501

Anterior transposition of the radial nerve--a cadaveric study.

PubMed

Yakkanti, Madhusudhan R; Roberts, Craig S; Murphy, Joshua; Acland, Robert D

2008-01-01

The radial nerve is at risk during the posterior plating of the humerus. The purpose of this anatomic study was to assess the extent of radial nerve dissection required for anterior transposition through the fracture site (transfracture anterior transposition). A cadaver study was conducted approaching the humerus by a posterior midline incision. The extent of dissection of the nerve necessary for plate fixation of the humerus fracture was measured. An osteotomy was created to model a humeral shaft fracture at the spiral groove (OTA classification 12-A2, 12-A3). The radial nerve was then transposed anterior to the humeral shaft through the fracture site. The additional dissection of the radial nerve and the extent of release of soft tissue from the humerus shaft to achieve the transposition were measured. Plating required a dissection of the radial nerve 1.78 cm proximal and 2.13 cm distal to the spiral groove. Transfracture anterior transposition of the radial nerve required an average dissection of 2.24 cm proximal and 2.68 cm distal to the spiral groove. The lateral intermuscular septum had to be released for 2.21 cm on the distal fragment to maintain laxity of the transposed nerve. Transfracture anterior transposition of the radial nerve before plating is feasible with dissection proximal and distal to the spiral groove and elevation of the lateral intermuscular septum. Potential clinical advantages of this technique include enhanced fracture site visualization, application of broader plates, and protection of the radial nerve during the internal fixation.

[Humerus varus: correction by proximal valgus osteotomy with precontourned plate fixation in children].

PubMed

Tallón-López, J; Domínguez-Amador, J J; Andrés-García, J A

2014-01-01

Varus deformity of the proximal humerus in children is a little known pathology due to its low incidence of presentation. Progress has been made in recent years in understanding the possible etiology and pathophysiological causes. Radiological criteria for diagnosis and functional impairment that occurs have also been defined. However, there are few reports in the literature about the surgical treatment of this deformity in children. In this paper we present a case of surgical treatment of this deformity by corrective osteotomy fixed with precontoured external maleolar plate osteosynthesis. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

Spatial mapping of humeral head bone density.

PubMed

Alidousti, Hamidreza; Giles, Joshua W; Emery, Roger J H; Jeffers, Jonathan

2017-09-01

Short-stem humeral replacements achieve fixation by anchoring to the metaphyseal trabecular bone. Fixing the implant in high-density bone can provide strong fixation and reduce the risk of loosening. However, there is a lack of data mapping the bone density distribution in the proximal humerus. The aim of the study was to investigate the bone density in proximal humerus. Eight computed tomography scans of healthy cadaveric humeri were used to map bone density distribution in the humeral head. The proximal humeral head was divided into 12 slices parallel to the humeral anatomic neck. Each slice was then divided into 4 concentric circles. The slices below the anatomic neck, where short-stem implants have their fixation features, were further divided into radial sectors. The average bone density for each of these regions was calculated, and regions of interest were compared using a repeated-measures analysis of variance with significance set at P < .05. Average apparent bone density was found to decrease from proximal to distal regions, with the majority of higher bone density proximal to the anatomic neck of the humerus (P < .05). Below the anatomic neck, bone density increases from central to peripheral regions, where cortical bone eventually occupies the space (P < .05). In distal slices below the anatomic neck, a higher bone density distribution in the medial calcar region was also observed. This study indicates that it is advantageous with respect to implant fixation to preserve some bone above the anatomic neck and epiphyseal plate and to use the denser bone at the periphery. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

Biomechanical analysis of plate systems for proximal humerus fractures: a systematic literature review.

PubMed

Jabran, Ali; Peach, Chris; Ren, Lei

2018-04-27

Proximal humerus fractures are the third most common in the human body but their management remains controversial. Open reduction and internal fixation with plates is one of the leading modes of operative treatment for these fractures. The development of technologies and techniques for these plates, during the recent decades, promise a bright future for their clinical use. A comprehensive review of in vitro biomechanical studies is needed for the comparison of plates' mechanical performance and the testing methodologies. This will not only guide clinicians with plate selection but also with the design of future in vitro biomechanical studies. This review was aimed to systematically categorise and review the in vitro biomechanical studies of these plates based on their protocols and discuss their results. The technologies and techniques investigated in these studies were categorised and compared to reach a census where possible. Web of Science and Scopus database search yielded 62 studies. Out of these, 51 performed axial loading, torsion, bending and/or combined bending and axial loading while 11 simulated complex glenohumeral movements by using tendons. Loading conditions and set-up, failure criteria and performance parameters, as well as results for each study, were reviewed. Only two studies tested four-part fracture model while the rest investigated two- and three-part fractures. In ten studies, synthetic humeri were tested instead of cadaveric ones. In addition to load-displacement data, three-dimensional motion analysis systems, digital image correlation and acoustic emission testing have been used for measurement. Overall, PHILOS was the most tested plate and locking plates demonstrated better mechanical performance than non-locking ones. Conflicting results have been published for their comparison with non-locking blade plates and polyaxial locking screws. Augmentation with cement [calcium phosphate or poly(methyl methacrylate)] or allografts (fibular and femoral head) was found to improve bone-plate constructs' mechanical performance. Controversy still lies over the use of rigid and semi-rigid implants and the insertion of inferomedial screws for calcar region support. This review will guide the design of in vitro and in silico biomechanical tests and also supplement the study of clinical literature.

Is it safe to preserve the deltoid when resecting the proximal humerus for a primary malignant bone tumour? A comparative study.

PubMed

Cladière-Nassif, V; Bourdet, C; Audard, V; Babinet, A; Anract, P; Biau, D

2017-09-01

Resection of the proximal humerus for the primary malignant bone tumour sometimes requires en bloc resection of the deltoid. However, there is no information in the literature which helps a surgeon decide whether to preserve the deltoid or not. The aim of this study was to determine whether retaining the deltoid at the time of resection would increase the rate of local recurrence. We also sought to identify the variables that persuade expert surgeons to choose a deltoid sparing rather than deltoid resecting procedure. We reviewed 45 patients who had undergone resection of a primary malignant tumour of the proximal humerus. There were 29 in the deltoid sparing group and 16 in the deltoid resecting group. Imaging studies were reviewed to assess tumour extension and soft-tissue involvement. The presence of a fat rim separating the tumour from the deltoid on MRI was particularly noted. The cumulative probability of local recurrence was calculated in a competing risk scenario. There was no significant difference (adjusted p = 0.89) in the cumulative probability of local recurrence between the deltoid sparing (7%, 95% confidence interval (CI) 1 to 20) and the deltoid resecting group (26%, 95% CI 8 to 50). Patients were more likely to be selected for a deltoid sparing procedure if they presented with a small tumour (p = 0.0064) with less bone involvement (p = 0.032) and a continuous fat rim on MRI (p = 0.002) and if the axillary nerve could be identified (p = 0.037). A deltoid sparing procedure can provide good local control after resection of the proximal humerus for a primary malignant bone tumour. A smaller tumour, the presence of a continuous fat rim and the identification of the axillary nerve on pre-operative MRI will persuade surgeons to opt for a deltoid resecting procedure. Cite this article: Bone Joint J 2017;99-B:1244-9. ©2017 The British Editorial Society of Bone & Joint Surgery.

Treatment of proximal humerus fractures with locking plates: a systematic review.

PubMed

Thanasas, Christos; Kontakis, George; Angoules, Antonios; Limb, David; Giannoudis, Peter

2009-01-01

Locking plates with special configuration for the anatomic region of the proximal humerus have been introduced recently to address the difficulties of stabilizing proximal humeral fractures. The purpose of this study was to carry out a systematic review of the literature on the efficacy and early to medium term functional results of locking plates for stabilization of proximal humeral fractures. Using the PubMed database, a systematic review of the English and German literature was carried out in order to assess the efficacy and complications related to the use of these plates and the patients' functional outcome, using the key words "locking plates proximal humeral fractures," "angular stability plates proximal humeral fractures," "PHILOS plate," and "LPHP plate." Our criteria for eligibility were clinical studies with more than ten cases followed-up, adult patients, and adequate data provided at least in terms of implant related complications. Articles written in English and German language were included. Exclusion criteria were: studies dealing exclusively with 2-part fractures (since this category has a more favorable outcome); experimental studies; case reports; and, literature other than English or German. Each one of the articles was evaluated for quality of the study using the Structured Effectiveness Quality Evaluation Scale (SEQES). Twelve studies including 791 patients met the inclusion criteria. Patients in these studies continued to improve up to one year, achieving a mean Constant score of 74.3. The incidence of the reported complications was: avascular necrosis 7.9%, screw cut-out 11.6% and re-operation rate 13.7%. The high incidence of cut-out may be secondary to the rigidity of the implant in combination with medial inadequate support, in cases compromised by severe underlying osteoporotic bone. Definition of indications for the use of locking plates and attention on technical aspects of applying them would help optimization of the results. Systematic Review.

Site and Severity of the Increased Humeral Retroversion in Symptomatic Baseball Players: A 3-dimensional Computed Tomographic Analysis.

PubMed

Itami, Yasuo; Mihata, Teruhisa; Shibano, Koji; Sugamoto, Kazuomi; Neo, Masashi

2016-07-01

Humeral retroversion in baseball players is greater in the dominant shoulder than in the nondominant shoulder. However, the site and severity of the humeral rotational deformity remain unclear. To evaluate the site of side-to-side differences in humeral retroversion in baseball players and the severity of these changes through 3-dimensional computed tomographic (3D CT) bone models. Cross-sectional study; Level of evidence, 3. From 2008 to 2014, we studied 25 baseball players (12 pitchers, 13 fielders) who underwent surgery for throwing-related injuries (shoulder injury, 15 players; elbow injury, 10 players). The mean age (±SD) at the time of surgery was 20.0 ± 5.9 years. A reconstructed 3D CT model of the entire humerus was divided into 15 segments of equal height (overall mean, 21.4 ± 1.0 mm). The side-to-side difference in humeral retroversion in each segment was calculated by superimposing the model of the dominant side over the mirror-image model of the nondominant side. The overall mean increase in humeral retroversion was 13.0° ± 6.2° on the dominant side. Significant side-to-side differences in retroversion were present throughout the humerus. The largest side-to-side difference in humeral retroversion was seen at the insertions of the internal rotator muscles (2.5° ± 4.3°) and around the proximal physis (2.5° ± 1.4°). At the insertions of shoulder capsule and rotator cuff tendons, the superior half of the humeral head was more retroverted than the inferior half (P < .0001). The side-to-side difference in humeral retroversion was significantly greater in the pitchers (16.2° ± 5.1°) than in the fielders (10.0° ± 5.7°) (P = .009), particularly at the proximal physis. Baseball players exhibited significant side-to-side differences in humeral retroversion at multiple sites throughout the humerus, including the proximal humerus near the epiphyseal plate and at the insertions of the internal rotator muscles, the middle of the humeral shaft, and the distal third of the humerus. Therefore, the increased humeral retroversion at multiple sites throughout the humerus needs to be considered when we perform physical examinations, provide treatment, or undertake biomechanical studies for any throwing-related injuries. © 2016 The Author(s).

Fixation of 4-part fractures of the proximal humerus: Can we identify radiological criteria that support locking plates or IM nailing? Comparative, retrospective study of 107 cases.

PubMed

Gadea, F; Favard, L; Boileau, P; Cuny, C; d'Ollone, T; Saragaglia, D; Sirveaux, F

2016-12-01

No objective criteria exist to help surgeons choose between IM nailing and plate fixation for 4-part fractures of the proximal humerus. The goal of this study was to identify radiological criteria that would make one technique a better choice than the other. This was a comparative, multicentre, retrospective study of 54 cases of antegrade nailing and 53 cases of plating performed between 1st January 2009 and 31 December 2011 for 4-part fractures of the proximal humerus. All patients had a minimum radiological and clinical follow-up of 18 months. The functional outcomes were evaluated using the weighted Constant score; a poor result was defined as a weighted Constant score<70%. The following radiological criteria were evaluated during the preoperative assessment and at the last follow-up: initial displacement and reduction of humeral head and tuberosities; morphology of the medial column (i.e. calcar comminution, posteromedial hinge, size of metaphyseal head extension); occurrence of avascular necrosis (AVN). After an average follow-up of 42 months, the weighted Constant scores and rate of poor outcomes were 77% and 48% in the nail group and 81% and 38% in the plate group, respectively (ns). The humeral head was reduced into an anatomical position, valgus or varus in 57%, 30% and 13% of cases in the nail group, and 58%, 29% and 13% in the plate group, respectively. The tuberosities healed in an anatomical position in 72% of nail cases and 70% of plate cases (ns). Only the presence of a medial hinge preoperatively had an effect on the functional outcomes in the nail and plate groups: the weighted Constant scores (P=0.05) and rate of poor outcomes (P=0.02) were 82% and 52% in the nail group and 97% and 9% in the plate group, respectively. The complication rates were comparable: the rates of AVN and articular screw penetration were 17% and 11% in the nail group, and 15% and 11% in the plate group, respectively. The surgical revision rate was 18.5% in the nail group and 30% in the plate group. If the medial hinge is preserved, we recommend locking plate fixation. In other cases, either technique can be used as long as the general rules of internal fixation are applied: reduction of the tuberosities, varus correction and stabilization of the calcar area. IV, retrospective study. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Allograft-prosthetic composite reverse total shoulder arthroplasty for reconstruction of proximal humerus tumor resections.

PubMed

King, Joseph J; Nystrom, Lukas M; Reimer, Nickolas B; Gibbs, C Parker; Scarborough, Mark T; Wright, Thomas W

2016-01-01

Proximal humerus reconstructions after resection of tumors are challenging. Early success of the reverse shoulder arthroplasty for reconstructions has recently been reported. The reverse allograft-prosthetic composite offers the advantage of improved glenohumeral stability compared with hemiarthroplasty for proximal humeral reconstructions as it uses the deltoid for stability. This article describes the technique for treating proximal humeral tumors, including preoperative planning, biopsy principles, resection pearls, soft tissue tensioning, and specifics about reconstruction using the reverse allograft-prosthetic composite. Two cases are presented along with the functional outcomes with use of this technique. Biomechanical considerations during reconstruction are reviewed, including techniques to improve the deltoid compression force. Reported instability rates are less with reverse shoulder arthroplasty reconstruction as opposed to hemiarthroplasty or total shoulder arthroplasty reconstructions of tumor resections. Reported functional outcomes are promising for the reverse allograft-prosthetic composite reconstructions, although complications are reported. Reverse allograft-prosthetic composites are a promising option for proximal humeral reconstructions, although nonunion of the allograft-host bone junction continues to be a challenge for this technique. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

PROMIS Physical Function Computer Adaptive Test Compared With Other Upper Extremity Outcome Measures in the Evaluation of Proximal Humerus Fractures in Patients Older Than 60 Years.

PubMed

Morgan, Jordan H; Kallen, Michael A; Okike, Kanu; Lee, Olivia C; Vrahas, Mark S

2015-06-01

To compare the PROMIS Physical Function Computer Adaptive Test (PROMIS PF CAT) to commonly used traditional PF measures for the evaluation of patients with proximal humerus fractures. Prospective. Two Level I trauma centers. Forty-seven patients older than 60 years with displaced proximal humerus fractures treated between 2006 and 2009. Evaluation included completion of the PROMIS PF CAT, the Constant Shoulder Score, the Disabilities of the Arm, Shoulder, and Hand (DASH) and the Short Musculoskeletal Functional Assessment (SMFA). Observed correlations among the administered PF outcome measures. On average, patients responded to 86 outcome-related items for this study: 4 for the PROMIS PF CAT (range: 4-8 items), 6 for the Constant Shoulder Score, 30 for the DASH, and 46 for the SMFA. Time to complete the PROMIS PF CAT (median completion time = 98 seconds) was significantly less than that for the DASH (median completion time = 336 seconds, P < 0.001) and for the SMFA (median completion time = 482 seconds, P < 0.001). PROMIS PF CAT scores correlated statistically significantly and were of moderate-to-high magnitude with all other PF outcome measure scores administered. This study suggests using the PROMIS PF CAT as a sole PF outcome measure can yield an assessment of upper extremity function similar to those provided by traditional PF measures, while substantially reducing patient assessment time.

Fishtail deformity--a delayed complication of distal humeral fractures in children.

PubMed

Narayanan, Srikala; Shailam, Randheer; Grottkau, Brian E; Nimkin, Katherine

2015-06-01

Concavity in the central portion of the distal humerus is referred to as fishtail deformity. This entity is a rare complication of distal humeral fractures in children. The purpose of this study is to describe imaging features of post-traumatic fishtail deformity and discuss the pathophysiology. We conducted a retrospective analysis of seven cases of fishtail deformity after distal humeral fractures. Seven children ages 7-14 years (five boys, two girls) presented with elbow pain and history of distal humeral fracture. Four of the seven children had limited range of motion. Five children had prior grade 3 supracondylar fracture treated with closed reduction and percutaneous pinning. One child had a medial condylar fracture and another had a lateral condylar fracture; both had been treated with conservative casting. All children had radiographs, five had CT and three had MRI. All children had a concave central defect in the distal humerus. Other imaging features included joint space narrowing with osteophytes and subchondral cystic changes in four children, synovitis in one, hypertrophy or subluxation of the radial head in three and proximal migration of the ulna in two. Fishtail deformity of the distal humerus is a rare complication of distal humeral fractures in children. This entity is infrequently reported in the radiology literature. Awareness of the classic imaging features can result in earlier diagnosis and appropriate treatment.

A new internal fixation technique for fractures of the proximal humerus--the Bilboquet device: a report on 26 cases.

PubMed

Doursounian, L; Grimberg, J; Cazeau, C; Jos, E; Touzard, R C

2000-01-01

We describe a novel internal fixation device and report on 26 patients (mean age, 70 years) whose proximal humeral fractures were managed with this technique. The 2-part titanium implant consists of a circular staple impacted into the humeral head cancellous bone and a spigoted diaphyseal stem that inserts into the staple "cup." Of the 26 cases reviewed, 16 had 3-part fractures and 10 had 4-part fractures. Mean follow-up was 25.9 months. In the 16 3-part fractures, the mean active forward elevation was 114 degrees and the results were as follows: excellent, 7; good, 5; fair, 3; poor, 1. In the 10 4-part fracture patients, the mean active forward elevation was 101 degrees and the results were as follows: excellent, 2; good, 4; fair, 3; poor, 1. There were 5 cases of avascular necrosis and 1 case of tuberosity nonunion. Only 2 cases needed conversion to hemiarthroplasty. The new technique should simplify the surgery of these fractures and reduce the need for arthroplasty.

Primary extraskeletal myxoid chondrosarcoma of bone: Report of three cases and review of the literature.

PubMed

Finos, L; Righi, A; Frisoni, T; Gambarotti, M; Ghinelli, C; Benini, S; Vanel, D; Picci, P

2017-05-01

Extraskeletal myxoid chondrosarcoma is a rare neoplasm of soft tissue. The usual location is in deep parts of the proximal extremities and limb girdles in middle-aged adults. The bone location as primary location is extremely rare and few cases are reported. We present three cases arising in bone with molecular confirmation using both RT-PCR and FISH analysis. Patients include two men and one woman with an age of 62, 69 and 73 years old. The mean size of the lesion was 13cm (range 8-18cm). Tumors arose in the iliac bone in two cases and in the proximal humerus in the other case. At time of diagnosis the three cases show bone cortex and soft tissue involvement. On imaging, lesions have a lobular pattern, are purely lytic, but take up contrast medium after injection. Two patients are alive with disease (local recurrence and lung metastasis) after five years and five years and six months, respectively and one patient died of disease two years after the diagnosis. The primary extraskeletal myxoid chondrosarcoma of bone seems to have a more aggressive behavior than the soft tissue counterpart. The molecular confirmation of diagnosis using RT-PCR is necessary to do the differential diagnosis with other entities, in particular with myoepithelioma that shows similar morphological features and EWSR1 and FUS genes rearrangement. Copyright © 2017 Elsevier GmbH. All rights reserved.

Three-dimensional analysis of the proximal humeral and glenoid geometry using MicroScribe 3D digitizer.

PubMed

Owaydhah, Wejdan H; Alobaidy, Mohammad A; Alraddadi, Abdulrahman S; Soames, Roger W

2017-07-01

To understand the geometry of the proximal humerus and glenoid fossa to facilitate the design of components used in shoulder arthroplasty. The aim is to evaluate the geometry of the proximal humerus and glenoid fossa and their relationship using a MicroScribe 3D digitizer. Scans and measurements were obtained from 20 pairs of dry proximal humeri and scapulae [10 female and 10 male cadavers: median age 81 years (range 70-94 years)] using a MicroScribe 3D digitizer and Rhinoceros software. Means (±SD) of humeral inclination, medial wall angle of the bicipital groove, and radius of the humeral head values were 135 ± 11°, 39 ± 19°, and 14 ± 3 mm, respectively. Means (±SD) of glenoid height and width were 35 ± 4 and 26 ± 4 mm, while the means (±SD) of the angles of glenoid inclination, retroversion, and rotation were 87 ± 32°, 96 ± 10°, and 9 ± 6°, respectively. A significant difference in glenoid height (P ≤ 0.002) and width (P ≤ 0.0001) was observed between males and females, despite them having almost an identical radius of the humeral head, glenoid inclination, retroversion, and angle of rotation. There was also a significant difference (P ≤ 0.01) in the angle of glenoid retroversion between the right and left sides. Using a MicroScribe 3D digitizer, the glenoid fossa was observed to be significantly smaller in females than males; furthermore, there was a difference in glenoid retroversion between the right and left sides.

Shoulder joint abduction motion test bench: a new shoulder test bench for in vitro experiments with active muscle force simulation.

PubMed

Onder, Ursula; Blauth, Michael; Kralinger, Franz; Schmoelz, Werner

2012-05-30

In our society the average age is increasing, as are the number of proximal humeral head fractures. For fixation of these fractures, an increasing number of implants are available. New fixation devices should be compared biomechanically with established methods in a standardized fashion. The test bench that was designed was intended to simulate abduction motion of the humerus actively induced by muscle forces. We used three pneumatic muscles to apply forces to the tendons of the musculus supraspinatus and the bifid musculus deltoideus. Thus, it was possible to create an active abduction in the scapular plane. Two different fracture models (with and without medial support) were stabilised with an angular stable plate in sawbone models to reproduce a known clinical outcome with the newly designed test setup. The resultant force acting on the proximal humerus reached approximately 47% BW (per cent body weight), which amounted to 329.0 N (SD: 21.76). The supraspinatus reached maximum forces of 254.7 N (SD: 20.1) and the deltoid muscle 258.9 N (SD: 16.5). Fracture gap instrumentation with medial support resulted in a significantly reduced per-cycle fracture gap motion. The performance evaluation showed that the simulator produced predicable, reproducible movements with physiological muscle force magnitudes.

A Preoperative Planning Tool: Aggregate Anterior Approach to the Humerus With Quantitative Comparisons.

PubMed

Phelps, Kevin D; Harmer, Luke S; Crickard, Colin V; Hamid, Nady; Sample, Katherine M; Andrews, Erica B; Seymour, Rachel B; Hsu, Joseph R

2018-06-01

Extensile approaches to the humerus are often needed when treating complex proximal or distal fractures that have extension into the humeral shaft or in those fractures that occur around implants. The 2 most commonly used approaches for more complex fractures include the modified lateral paratricipital approach and the deltopectoral approach with distal anterior extension. Although the former is well described and quantified, the latter is often associated with variable nomenclature with technical descriptions that can be confusing. Furthermore, a method to expose the entire humerus through an anterior extensile approach has not been described. Here, we illustrate and quantify a technique for connecting anterior humeral approaches in a stepwise fashion to form an aggregate anterior approach (AAA). We also describe a method for further distal extension to expose 100% of the length of the humerus and compare this approach with both the AAA and the lateral paratricipital in terms of access to critical bony landmarks, as well as the length and area of bone exposed.

Biomechanical Analysis of a Novel Intercalary Prosthesis for Humeral Diaphyseal Segmental Defect Reconstruction.

PubMed

Zhao, Li-Ming; Tian, Dong-Mu; Wei, Yue; Zhang, Jun-Hui; Di, Zheng-Lin; He, Zhi-Yong; Hu, Yong-Cheng

2018-02-01

To study the biomechanical properties of a novel modular intercalary prosthesis for humeral diaphyseal segmental defect reconstruction, to establish valid finite element humerus and prosthesis models, and to analyze the biomechanical differences in modular intercalary prostheses with or without plate fixation. Three groups were set up to compare the performance of the prosthesis: intact humerus, humerus-prosthesis and humerus-prosthesis-plate. The models of the three groups were transferred to finite element software. Boundary conditions, material properties, and mesh generation were set up for both the prosthesis and the humerus. In addition, 100 N or 2 N.m torsion was loaded to the elbow joint surface with the glenohumeral joint surface fixed. Humeral finite element models were established according to CT scans of the cadaveric bone; reverse engineering software Geomagic was used in this procedure. Components of prosthetic models were established using 3-D modeling software Solidworks. To verify the finite element models, the in vitro tests were simulated using a mechanical testing machine (Bionix; MTS Systems Corporation, USA). Starting with a 50 N preload, the specimen was subjected to 5 times tensile (300 N) and torsional (5 N.m) strength; interval time was 30 min to allow full recovery for the next specimen load. Axial tensile and torsional loads were applied to the elbow joint surface to simulate lifting heavy objects or twisting something, with the glenohumeral joint surface fixed. Stress distribution on the humerus did not change its tendency notably after reconstruction by intercalary prosthesis whether with or without a plate. The special design which included a plate and prosthesis effectively diminished stress on the stem where aseptic loosening often takes place. Stress distribution major concentrate upon two stems without plate addition, maximum stress on proximal and distal stem respectively diminish 27.37% and 13.23% under tension, 10.66% and 11.16% under torsion after plate allied. The novel intercalary prosthesis has excellent ability to reconstruct humeral diaphyseal defects. The accessory fixation system, which included a plate and prosthesis, improved the rigidity of anti-tension and anti-torsion, and diminished the risk of prosthetic loosening and dislocation. A finite element analysis is a kind of convenient and practicable method to be used as the confirmation of experimental biomechanics study. © 2018 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

Fracture line morphology of complex proximal humeral fractures.

PubMed

Hasan, Afsana P; Phadnis, Joideep; Jaarsma, Ruurd L; Bain, Gregory I

2017-10-01

The aim of this study was to assess proximal humeral fracture patterns using 3-dimensional computed tomography images and relate them to the normal osseous landmarks and soft-tissue attachments. Forty-eight 3-dimensional computed tomography scans of proximal humeral fractures were retrospectively collected, and the fractures were transcribed onto proximal humeral templates. We analyzed the common location and orientation of the fracture lines, with a focus on fractures of the articular surface, tuberosities, metaphysis, and proximal diaphysis. These fractures were compared with the attachments of the rotator cuff and glenohumeral capsule. Fifty-two percent of the fractures involved the articular surface. No fractures passed through the bicipital groove, and fractures were more commonly found on the posterior lesser tuberosity and on the anterior greater tuberosity, coinciding with the intervals between the rotator cuff tendon insertions. Intracapsular fractures of the calcar were more common (68%) than extracapsular fractures (32%). On the anterolateral aspect of the proximal humerus, fractures radiated from the articular margin, vertically down through the tuberosity zone between the rotator cuff footprints, meeting horizontally oriented fractures in the metaphyseal zone. On the posterior aspect, vertical fractures from the tuberosity zone continued downward to the metaphyseal zone adjacent to the infraspinatus and teres minor footprints. Fractures of the proximal humerus follow characteristic patterns. Fractures frequently split the greater tuberosity and are closely related to the intervals of the rotator cuff attachments. Crown Copyright © 2017. Published by Elsevier Inc. All rights reserved.

Subchondral architecture in bones of the canine shoulder.

PubMed Central

Simkin, P A; Heston, T F; Downey, D J; Benedict, R S; Choi, H S

1991-01-01

The distal scapula and proximal humerus from each shoulder of nine adult dogs were slab-sectioned, cleaned of soft tissues, embedded in white plastic and stained black with a silver stain. These preparations were then photographed for automated, digital, morphometric analysis of subchondral bone structure. Comparison of transverse and coronal sections through the left and right shoulders demonstrated essential isometry of trabecular patterns within each bone. Comparison of the scapula and humerus revealed significant differences in bony architecture. The subchondral plate was an average of 5.6 times thicker under the glenoid fossa than in the opposing humeral head. Deeper trabecular structure also differed with the trabecular bone volume (density) in the humerus being greater than that in the scapula. This difference reflects a greater trabecular density in the humerus with comparable trabecular thickness in both bones. These structural differences are consistent with previous functional studies of the same two bones that revealed greater mechanical stiffness beneath the glenoid fossa and greater hydraulic resistance within the humeral head. Images Fig. 1 Fig. 2 (cont.) Fig. 2 Fig. 3 PMID:2050567

Arm Injuries and Disorders

MedlinePlus

... your body, three of them are in your arm: the humerus, radius, and ulna. Your arms are also made up of muscles, joints, tendons, ... Injuries to any of these parts of the arm can occur during sports, a fall, or an ...

Optimizing intramedullary entry location on the proximal humerus based on variations of neck-shaft angle.

PubMed

Jeong, Jinyoung; Jung, Hyun-Woo

2015-09-01

The purpose of this study was to define the relationship between the humeral neck-shaft angle (NSA) and variations in the ideal entry portal aligned with the long axis of the intramedullary canal of the proximal humerus. Three-dimensional images of 36 cadaveric humeri with various NSAs were reconstructed by a computerized surgical simulation program. The anteroposterior, mediolateral, and linear distances between a line from the center of the proximal medullary canal to the bicipital groove were measured. Differences among humeri with various NSAs were analyzed. The intramedullary axis line was located a mean of 9 ± 2 mm posteriorly and 11 ± 3 mm medially from the bicipital groove. The axis line was 9 ± 2 mm posterior and 11 ± 2 mm medial with a standard NSA. The axis line in humeri with a varus NSA was 8 ± 2 mm posteriorly and 9 ± 2 mm medially, whereas the axis line was 10 ± 3 mm posteriorly and 14 ± 3 mm medially with a valgus NSA. The differences in the mediolateral distances between the groups were significant (P < .00009). Care should be taken in choosing the entry portal position in humeri with various NSAs as the entry portal position differs according to the NSA. It is recommended that the location of the entry portal be moved toward the center of the humeral head to align with the centerline of the intramedullary canal in humeri with a valgus NSA in particular. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Evidence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon.

PubMed

Tosounidis, Theodoros; Hadjileontis, Constantine; Triantafyllou, Christos; Sidiropoulou, Varvara; Kafanas, Antonios; Kontakis, George

2013-03-01

The primary purpose of this study was to investigate the sympathetic innervation of the long head of the biceps brachii tendon LHB via immunohistochemical staining for protein S-100 and neuropeptide Y (NPY) in patients with complex proximal humerus fractures, in individuals with chronic biceps tendinosis in the setting of large rotator cuff tears (RC), and in cadaveric samples with no previously reported shoulder pathology. We investigated the presence of sympathetic innervation and α1-adrenergic receptors of the long head of the biceps brachii tendon (LHB) in patients with complex proximal humerus fractures and individuals with chronic biceps tendinosis in the setting of large rotator cuff tears (RC). The correlation of morphological features with immunohistochemical evidence of neural element presence was also investigated. Forty-one LHB tendon specimens were examined. Seventeen were harvested from patients who underwent hemiarthroplasty for proximal humerus fractures, 14 were from individuals with biceps tendinosis in the context of a large RC tear, and ten were from cadaveric controls with no previous shoulder pathology. Histologic examination was performed using hematoxylin and eosin. Immunohistochemistry was used to detect the expression of the protein S-100, neuropeptide Y, and α1-adrenergic receptors, as well as to characterize the potential neural differentiation of tendon cells. A strong correlation between the expression of NPY/S-100, α1-adrenergic/S-100, and α1-adrenergic/NPY was found. The LHB tendon has sympathetic innervation and α1-adrenergic receptors in acute and chronic pathological conditions. Our results provide useful guidance on the management of tendinosis and the handling of the LHB in hemiarthroplasties for fractures.

Cost analysis of the surgical treatment of fractures of the proximal humerus: an evaluation of the determinants of cost and comparison of the institutional cost of treatment with the national tariff.

PubMed

Sabharwal, S; Carter, A W; Rashid, A; Darzi, A; Reilly, P; Gupte, C M

2016-02-01

The aims of this study were to estimate the cost of surgical treatment of fractures of the proximal humerus using a micro-costing methodology, contrast this cost with the national reimbursement tariff and establish the major determinants of cost. A detailed inpatient treatment pathway was constructed using semi-structured interviews with 32 members of hospital staff. Its content validity was established through a Delphi panel evaluation. Costs were calculated using time-driven activity-based costing (TDABC) and sensitivity analysis was performed to evaluate the determinants of cost The mean cost of the different surgical treatments was estimated to be £3282. Although this represented a profit of £1138 against the national tariff, hemiarthroplasty as a treatment choice resulted in a net loss of £952. Choice of implant and theatre staffing were the largest cost drivers. Operating theatre delays of more than one hour resulted in a loss of income Our findings indicate that the national tariff does not accurately represent the cost of treatment for this condition. Effective use of the operating theatre and implant discounting are likely to be more effective cost containment approaches than control of bed-day costs. This cost analysis of fractures of the proximal humerus reinforces the limitations of the national tariff within the English National Health Service, and underlines the importance of effective use of the operating theatre, as well as appropriate implant procurement where controlling costs of treatment is concerned. ©2016 The British Editorial Society of Bone & Joint Surgery.

Reverse shoulder arthroplasty in 3 and 4 part proximal humeral fractures in patients aged more than 65 years: Results and complications.

PubMed

Villodre-Jiménez, J; Estrems-Díaz, V; Diranzo-García, J; Bru-Pomer, A

The treatment of 3and 4 part proximal humeral fractures in elderly patients is still controversial. The frequent co-existence of poor quality bone and rotator cuff abnormalities in patients with multiple clinical conditions and with difficulties for physical rehabilitation leads to disappointing clinical results, even when the radiological images are acceptable. To evaluate the clinical, radiological, and functional results in patients over 65 years old with complex proximal humerus fractures treated with reverse shoulder arthroplasty. A prospective review was carried out on 30 patients (26 women and 4 men) with proximal humeral fractures treated with reverse shoulder arthroplasty in our department. The mean age was 74.9 years (SD=6.3), and the mean follow-up was 34.5 months (SD=19.3). Clinical and functional results were acceptable, with a mean forward flexion of 124° and a mean external rotation of 13°. The mean abbreviated Constant abbreviated score was 49.1 (SD=14.1), 27 (SD=6.3) in the UCLA scale, and 32.2 (SD=19.2) in the QuickDASH questionnaire. The large majority (80%) of the patients are pain free, and they do not need medication to do daily activities. The complication rate was 13.3%. We consider that reverse shoulder arthroplasty is a valid option to treat 3and 4 part proximal humeral fractures in elderly patients. The surgical goals should include the anatomical reconstruction of the tuberosities, avoiding enlargement of the operated arm greater than 2cm. Copyright © 2016 SECOT. Publicado por Elsevier España, S.L.U. All rights reserved.

Reverse Shoulder Arthroplasty for the Treatment of 3 and 4- Part Fractures of the Humeral Head in the Elderly

PubMed Central

Gigis, Ioannis; Nenopoulos, Alexandros; Giannekas, Dimitrios; Heikenfeld, Roderich; Beslikas, Theodoros; Hatzokos, Ippokratis

2017-01-01

Background: Proximal humeral fractures in elderly patients present with severe comminution and osteoporotic bone quality. Reverse shoulder arthroplasty has lately been proven beneficial in treating patients with complex proximal humeral fractures. The above technique is recommended and has better results in elderly than in younger individuals. Methods: We performed a literature search in the databases Pubmed, Medline, EMBASE and Cochrane Library for published articles between 1970 and 2016 using the terms: proximal humerus fractures and reverse shoulder arthroplasty. Results: Significant benefits with the use of reverse prosthesis, especially in patients older than 70 years with a proximal humeral fracture, include reduced rehabilitation time as well as conservation of a fixed fulcrum for deltoid action in case of rotator cuff failure. Compared with hemiarthroplasty and internal fixation, reverse prosthesis may be particularly useful and give superior outcomes in older patients, due to comminuted fractures in osteopenic bones. However, significant disadvantages of this technique are potential complications and a demanding learning curve.Therefore, trained surgeons should follow specific indications when applying the particular treatment of proximal humeral fractures and be familiar with the surgical technique. Conclusion: Although long-term results and randomized studies for reverse prosthesis are lacking, short and mid- term outcomes have given promising results encouraging more shoulder surgeons to use this type of prosthesis in proximal humeral fractures. PMID:28400879

Continuous decompression with intramedullary nailing for the treatment of unicameral bone cysts.

PubMed

Masquijo, Julio Javier; Baroni, Eduardo; Miscione, Horacio

2008-08-01

To evaluate the efficacy of decompression of unicameral bone cysts (UBCs) of the long bones with intramedullary nailing and to compare responses to treatment according to location. We evaluated 48 consecutive patients treated between January 1988 and June 2000. Mean age was 10.3 years. Mean follow-up was 9.8 years. Evaluation was performed according to the radiographic criteria of Capanna. UBCs were located in the proximal humerus (n = 24), humeral shaft (n = 2), proximal femur (n = 19), distal tibia (n = 2) and fibula (n = 1). A total of 62.5% presented a pathological fracture. Successful results were observed in 89.5% (26 total healing, 17 healing with residual radiolucent areas), and there were four recurrences and, in one case, no response to treatment. There was more healing in the humerus than in the femur (92.3% versus 84.2%), and more tendency to restitution ad integrum, although the difference was not statistically significant (P = 0.1499). Intramedullary nailing is a minimally invasive method, which permits early stability and decompresses the cyst allowing healing. Significant differences were not observed among results from different locations.

Emerging Indications for Reverse Shoulder Arthroplasty.

PubMed

Urch, Ekaterina; Dines, Joshua S; Dines, David M

2016-01-01

Historically, reverse shoulder arthroplasty was reserved for older, low-demand patients in whom rotator cuff arthropathy was diagnosed. Other common indications included sequelae of previously treated proximal humerus fractures, failed anatomic total shoulder arthroplasty, tumor resection, and rheumatoid arthritis in the elderly population. Unpredictable implant durability and high complication rates have limited the use of reverse shoulder arthroplasty to a narrow group of patients. Over the past decade, however, research has led to an improved understanding of the biomechanics behind reverse shoulder prostheses, which has improved implant design and surgical techniques. Consequently, orthopaedic surgeons have slowly begun to expand the indications for reverse shoulder arthroplasty to include a wider spectrum of shoulder pathologies. Recent studies have shown promising results for patients who undergo reverse shoulder arthroplasty for the treatment of acute proximal humerus fractures, massive rotator cuff tears without arthropathy, primary osteoarthritis, and chronic anterior dislocation, as well as for younger patients who have rheumatoid arthritis. These data suggest that, with judicious patient selection, reverse shoulder arthroplasty can be an excellent treatment option for a growing patient cohort.

On the importance of considering disease subtypes: Earliest detection of a parosteal osteosarcoma? Differential diagnosis of an osteosarcoma in an Anglo-Saxon female.

PubMed

Ferrante di Ruffano, Lavinia; Waldron, Tony

2016-12-30

A case of potentially dedifferentiated parosteal osteosarcoma was found in the proximal humerus of an adult female buried in the late Anglo-Saxon cemetery of Cherry Hinton, Cambridgeshire, UK. Key features include a large, dense, lobulated mass attached to the medial metaphysis of the proximal humerus by a broad-based attachment, accompanied by cortical destruction and widespread spiculated periosteal reaction. Radiographic images confirm medullary involvement, lack of continuity between the cortex and external mass, a radiolucent cleavage plane and possible radiolucent zones within the bony masses. Differential diagnoses considered include osteochondroma, myositis ossificans, fracture callus, as well as the primary malignancies of osteosarcoma and chondrosarcoma, and their various subtypes. The macroscopic and radiographic analysis of the tumor is described and discussed within clinical and paleopathological contexts. One of only 19 uncontested examples of osteosarcoma from past human populations, most of which remain unconfirmed, this case represents what we believe to be the earliest, and probably singular, bioarcheological example of parosteal osteosarcoma in human history. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

The humeroscapular bone of the great horned owl (Bubo virginianus) and other raptors.

PubMed

Smith, B J; Smith, S A

1992-03-01

A small, separate, bony density dorsal to the shoulder joint is radiographically visible in several species of large hawks and owls. Gross dissection and histological examination show the bone to lie on the deep surface of the major deltoid muscle in intimate association with the dorsal coracohumeral ligament of the shoulder joint. The tendon of the supracoracoideus muscle passes immediately cranial to the humeroscapular bone. Two ligaments distinct from the shoulder joint capsule attach the humeroscapular bone to the proximal humerus: one passes to the proximal edge of the pectoral crest of the humerus, and the other passes to the ventral tubercle of the humerus. The bone was described as the humeroscapular bone in reference to a similar fibrocartilaginous structure possessed by some birds. The humeroscapular bone is present in the great horned owl (Bubo virginianus), the screech owl (Otus asio), the barred owl (Strix varia), the red-tailed hawk (Buteo jamaicencis), the Cooper's hawk (Accipiter cooperii), and the sharp-shinned hawk (Accipiter striatus). The bone is absent in the barn owl (Tyto alba), the osprey (Pandion haliaetus), the golden eagle (Aquila chysaetos), and the turkey vulture (Cathartes aura), though some of these species possessed a similar fibrocartilaginous structure. Whether the humeroscapular structure develops as bone or cartilage in a given species may be related to other morphological features of the wing, and/or to characteristics of the predatory behavior of the species. Clinicians and anatomists dealing with birds of prey must be aware of the presence of the humeroscapular bone to avoid misinterpreting it as a fracture fragment.

Clinical outcome and complications using a polyaxial locking plate in the treatment of displaced proximal humerus fractures. A reliable system?

PubMed

Königshausen, M; Kübler, L; Godry, H; Citak, M; Schildhauer, T A; Seybold, D

2012-02-01

The surgical treatment of displaced proximal humeral fractures (ORIF) is a perpetual challenge to the surgeon. For this reason, the principle of polyaxiality was developed to provide an improved primary stability of the fracture through better anchorage of the screws, especially in osteoporotic bone. The aim of this study was to present clinical results with the polyaxial locking plate in the operative treatment of proximal humerus fractures in order to determine whether the technique of polyaxiality leads to better functional outcome and lower complication rates in comparison to monoaxial plates in the literature. Seventy-three patients with displaced proximal humeral fractures were treated surgically with the polyaxial locking Suture Plate™ (Arthrex(®)) between 03/2007 and 06/2009. Fifty-two of the patients (mean age, 69.9 ± 12.1) were included in a radiographical and clinical examination using the Constant score (CS) and the Disabilities of the Arm, Shoulder and Hand score (DASH). The follow-up examinations were on average 13.9 ± 4.5 months (10-27 months) after surgical treatment. The mean CS of the patients was 66.0 ± 13.7 points, the age- and gender-related CS was 90.9% ± 20.0% and the mean DASH score was 23.8 ± 19.8 points for the injured side. The patients with a nearly anatomical reduction of their fracture (n = 13) reached a significantly higher CS (75.1 ± 8.5; p = 0.004) and DASH-score (13.6 ± 11.6; p = 0.043) and none of these patients had a complication. The complications were identified in 12 (23.1%) cases, 5 of which involved loss of reduction. All of these 5 cases were lacking of initial medial column support and 4 of which were type C2.3 AO-Classification. The data show that the combination of angular stability with the possibility of variable polyaxial screw direction is a good concept for reduction and fixation of displaced proximal humeral fractures, but anatomical reduction and medial support remain important preconditions for a good outcome. However, a significantly lower rate of complications or better clinical outcome than that reported in the literature could not be found. Copyright © 2011 Elsevier Ltd. All rights reserved.

The effect of in situ augmentation on implant anchorage in proximal humeral head fractures.

PubMed

Unger, Stefan; Erhart, Stefanie; Kralinger, Franz; Blauth, Michael; Schmoelz, Werner

2012-10-01

Fracture fixation in patients suffering from osteoporosis is difficult as sufficient implant anchorage is not always possible. One method to enhance implant anchorage is implant/screw augmentation with PMMA-cement. The present study investigated the feasibility of implant augmentation with PMMA-cement to enhance implant anchorage in the proximal humerus. A simulated three part humeral head fracture was stabilised with an angular stable plating system in 12 pairs of humeri using six head screws. In the augmentation group the proximal four screws were treated with four cannulated screws, each augmented with 0.5ml of PMMA-cement, whereas the contra lateral side served as a non-augmented control. Specimens were loaded in varus-bending or axial-rotation using a cyclic loading protocol with increasing load magnitude until failure of the osteosynthesis occurred. Augmented specimens showed a significant higher number of load cycles until failure than non-augment specimens (varus-bending: 8516 (SD 951.6) vs. 5583 (SD 2273.6), P=0.014; axial-rotation: 3316 (SD 348.8) vs. 2050 (SD 656.5), P=0.003). Non-augmented specimens showed a positive correlation of load cycles until failure and measured bone mineral density (varus-bending: r=0.893, P=0.016; axial-rotation: r=0.753, P=0.084), whereas no correlation was present in augmented specimens (varus-bending: r=0,258, P=0.621; axial-rotation r=0.127, P=0.810). These findings suggest that augmentation of cannulated screws is a feasible method to enhance implant/screw anchorage in the humeral head. The improvement of screw purchase is increasing with decreasing bone mineral density. Copyright © 2012 Elsevier Ltd. All rights reserved.

Malignant transformation of a unicameral bone cyst in a cat.

PubMed

Berger, Björn; Brühschwein, Andreas; Eddicks, Lina; Meyer-Lindenberg, Andrea

2016-04-01

A unicameral bone cyst in the proximal humerus of a 3-year-old Norwegian forest cat was diagnosed by dynamic contrast-enhanced magnetic resonance imaging, surgical exploration, and histopathology. Surgical curettage and incorporation of bone cement led to full recovery. An osteosarcoma developed at the surgical site 17 months later. Thoracic radiographs showed pulmonary lesions consistent with metastasis.

Malignant transformation of a unicameral bone cyst in a cat

PubMed Central

Berger, Björn; Brühschwein, Andreas; Eddicks, Lina; Meyer-Lindenberg, Andrea

2016-01-01

A unicameral bone cyst in the proximal humerus of a 3-year-old Norwegian forest cat was diagnosed by dynamic contrast-enhanced magnetic resonance imaging, surgical exploration, and histopathology. Surgical curettage and incorporation of bone cement led to full recovery. An osteosarcoma developed at the surgical site 17 months later. Thoracic radiographs showed pulmonary lesions consistent with metastasis. PMID:27041754

Massive subacromial-subdeltoid bursitis with rice bodies secondary to an orthopedic implant.

PubMed

Urruela, Adriana M; Rapp, Timothy B; Egol, Kenneth A

2012-09-01

Both early and late complications following open reduction and internal fixation of proximal humerus fractures have been reported extensively in the literature. Although orthopedic implants are known to cause irritation and inflammation, to our knowledge, this is the first case report to describe a patient with rice bodies secondary to an orthopedic implant. Although the etiology of rice bodies is unclear, histological studies reveal that they are composed of an inner amorphous core surrounded by collagen and fibrin. The differential diagnosis in this case included synovial chondromatosis, infection, and the formation of a malignant tumor. Additional imaging studies, such as magnetic resonance imaging, and more specific tests were necessary to differentiate the rice bodies due to bursitis versus neoplasm, prior to excision. The patient presented 5 years following open reduction and internal fixation of a displaced proximal humerus fracture, with swelling in the area of the previous surgical site. Examination revealed a large, painless tumor-like mass on the anterior aspect of the shoulder. The patient's chief concern was the unpleasant aesthetic of the mass; no pain was reported. Upon excision of the mass, the patient's full, painless range of motion returned.

Rate of avascular necrosis and time to surgery in proximal humerus fractures.

PubMed

Archer, L A; Furey, A

2016-12-01

Avascular necrosis (AVN) of the humeral head is a devastating complication of proximal humeral fracture (PHF) that often results in long-term morbidity for the patient. Rates of AVN depend on the number of fracture fragments and are highly variable. The literature suggests that timely stable and anatomic reduction may decrease the rate at which AVN develops after PHF. To our knowledge, there is no literature published investigating a temporal relationship between the timing of PHF fixation and rates of AVN. Operative records of one orthopedic trauma surgeon were used to identify patients that underwent open reduction internal fixation for PHF at our institution between 2007 and 2012. Radiographs at presentation were reviewed and used to classify the fractures into two, three or four parts. Date and time of the initial radiograph were recorded as were the date and time of available intra-operative fluoroscopic images. The time from presentation radiograph to operative fixation was calculated (hours). Available follow-up plain films were then reviewed and evaluated for the presence or absence of humeral head AVN. Time to surgery (less than or greater than 72 h) and patient age did not correlate with development of AVN after PHF (p > 0.26). Notably, the number of fracture fragments did influence the rate of AVN identified in patients with PHF (p = 0.002). Early operative intervention does not appear to decrease the rate of development of avascular necrosis after PHF.

A closer look at the "Protopithecus" fossil assemblages: new genus and species from Bahia, Brazil.

PubMed

Halenar, Lauren B; Rosenberger, Alfred L

2013-10-01

The recently extinct large-bodied New World monkey Protopithecus brasiliensis Lund 1836 was named based on a distal humerus and proximal femur found in the Lagoa Santa cave system in the southeastern Brazilian state of Minas Gerais. These bones are from an animal about twice the size of the largest extant platyrrhines. One hundred and seventy-five years later, a nearly complete skeleton was discovered in the Toca da Boa Vista caves in the neighboring state of Bahia and was allocated to the same taxon as it was the first platyrrhine fossil of comparable size found since the originals. Our detailed study of the equivalent elements, however, reveals important morphological differences that do not correspond to intraspecific variation as we know it in related platyrrhine taxa. The presence of both an expanded brachioradialis flange on the humerus and gluteal tuberosity on the femur of the Bahian skeleton distinguishes it from the Lagoa Santa fossil as well as from all other platyrrhines. Further cranial and postcranial evidence suggests a closer relationship of the former with the alouattine Alouatta, while the limited Lund material fits more comfortably with the ateline clade. Therefore, we propose to limit P. brasiliensis Lund to the distal humerus and proximal femur from Lagoa Santa and erect a new genus and species for the skeleton from Toca da Boa Vista. Cartelles coimbrafilhoi was a large-bodied frugivore with a relatively small brain and diverse locomotor repertoire including both suspension and climbing that expands the range of platyrrhine biodiversity beyond the dimensions of the living neotropical primates. Copyright © 2013 Elsevier Ltd. All rights reserved.

Osteomalacia: a case series of patients with atypical clinical orthopaedic presentations.

PubMed

Fok, A W M; Ng, T P

2010-12-01

Osteomalacia is uncommon in an affluent subtropical city like Hong Kong, where sunlight exposure is adequate and nutritional support is good. We present three patients who had osteomalacia with different presentations. A 74-year-old male with oncogenic osteomalacia presented with multiple bone pain. His biochemical markers returned to normal 4 days postoperatively after resection of a second toe giant cell tumour of tendon sheath. A 62-year-old woman with a history of liver problem and proximal muscle weakness was admitted with atraumatic fracture of the left distal humerus due to osteomalacia. An 81-year-old vegetarian woman with inadequate sun exposure complained of multiple bone pains. Subsequent investigation revealed dietary- and sunlight-deficient osteomalacia with multiple bony abnormalities including marked femur bowing.

Musculoskeletal changes in mice from 20-50 cGy of simulated galactic cosmic rays.

PubMed

Bandstra, Eric R; Thompson, Raymond W; Nelson, Gregory A; Willey, Jeffrey S; Judex, Stefan; Cairns, Mark A; Benton, Eric R; Vazquez, Marcelo E; Carson, James A; Bateman, Ted A

2009-07-01

On a mission to Mars, astronauts will be exposed to a complex mix of radiation from galactic cosmic rays. We have demonstrated a loss of bone mass from exposure to types of radiation relevant to space flight at doses of 1 and 2 Gy. The effects of space radiation on skeletal muscle, however, have not been investigated. To evaluate the effect of simulated galactic cosmic radiation on muscle fiber area and bone volume, we examined mice from a study in which brains were exposed to collimated iron-ion radiation. The collimator transmitted a complex mix of charged secondary particles to bone and muscle tissue that represented a low-fidelity simulation of the space radiation environment. Measured radiation doses of uncollimated secondary particles were 0.47 Gy at the proximal humerus, 0.24-0.31 Gy at the midbelly of the triceps brachii, and 0.18 Gy at the proximal tibia. Compared to nonirradiated controls, the proximal humerus of irradiated mice had a lower trabecular bone volume fraction, lower trabecular thickness, greater cortical porosity, and lower polar moment of inertia. The tibia showed no differences in any bone parameter. The triceps brachii of irradiated mice had fewer small-diameter fibers and more fibers containing central nuclei. These results demonstrate a negative effect on the skeletal muscle and bone systems of simulated galactic cosmic rays at a dose and LET range relevant to a Mars exploration mission. The presence of evidence of muscle remodeling highlights the need for further study.

The Clinical and Economic Impact of Generic Locking Plate Utilization at a Level II Trauma Center.

PubMed

Mcphillamy, Austin; Gurnea, Taylor P; Moody, Alastair E; Kurnik, Christopher G; Lu, Minggen

2016-12-01

In today's climate of cost containment and fiscal responsibility, generic implant alternatives represent an interesting area of untapped resources. As patents have expired on many commonly used trauma implants, generic alternatives have recently become available from a variety of sources. The purpose of this study was to examine the clinical and economic impact of a cost containment program using high quality, generic orthopaedic locking plates. The implants available for study were anatomically precontoured plates for the clavicle, proximal humerus, distal radius, proximal tibia, distal tibia, and distal fibula. Retrospective review. Level II Trauma center. 828 adult patients with operatively managed clavicle, proximal humerus, distal radius, proximal tibia, tibial pilon, and ankle fractures. Operative treatment with conventional or generic implants. The 414 patients treated with generic implants were compared with 414 patients treated with conventional implants. There were no significant differences in age, sex, presence of diabetes, smoking history or fracture type between the generic and conventional groups. No difference in operative time, estimated blood loss or intraoperative complication rate was observed. No increase in postoperative infection rate, hardware failure, hardware loosening, malunion, nonunion or need for hardware removal was noted. Overall, our hospital realized a 56% reduction in implant costs, an average savings of $1197 per case, and a total savings of $458,080 for the study period. Use of generic orthopaedic implants has been successful at our institution, providing equivalent clinical outcomes while significantly reducing implant expenditures. Based on our data, the use of generic implants has the potential to markedly reduce operative costs as long as quality products are used. Therapeutic Level III.

Locking plate fixation provides superior fixation of humerus split type greater tuberosity fractures than tension bands and double row suture bridges.

PubMed

Gaudelli, Cinzia; Ménard, Jérémie; Mutch, Jennifer; Laflamme, G-Yves; Petit, Yvan; Rouleau, Dominique M

2014-11-01

This paper aims to determine the strongest fixation method for split type greater tuberosity fractures of the proximal humerus by testing and comparing three fixation methods: a tension band with No. 2 wire suture, a double-row suture bridge with suture anchors, and a manually contoured calcaneal locking plate. Each method was tested on eight porcine humeri. A osteotomy of the greater tuberosity was performed 50° to the humeral shaft and then fixed according to one of three methods. The humeri were then placed in a testing apparatus and tension was applied along the supraspinatus tendon using a thermoelectric cooling clamp. The load required to produce 3mm and 5mm of displacement, as well as complete failure, was recorded using an axial load cell. The average load required to produce 3mm and 5mm of displacement was 658N and 1112N for the locking plate, 199N and 247N for the double row, and 75N and 105N for the tension band. The difference between the three groups was significant (P<0.01). The average load to failure of the locking plate (810N) was significantly stronger than double row (456N) and tension band (279N) (P<0.05). The stiffness of the locking plate (404N/mm) was significantly greater than double row (71N/mm) and tension band (33N/mm) (P<0.01). Locking plate fixation provides the strongest and stiffest biomechanical fixation for split type greater tuberosity fractures. Copyright © 2014 Elsevier Ltd. All rights reserved.

Decreased Hip, Lower Leg, and Humeral Fractures but Increased Forearm Fractures in Highly Active Individuals.

PubMed

Stattin, Karl; Hållmarker, Ulf; Ärnlöv, Johan; James, Stefan; Michaëlsson, Karl; Byberg, Liisa

2018-06-22

It is not known how physical exercise affects the risk of different types of fractures, especially in highly active individuals. To investigate this association, we studied a cohort of 118,204 men and 71,757 women who from 1991 to 2009 participated in Vasaloppet, a long-distance cross-country skiing race in Sweden, and 505,194 nonparticipants frequency-matched on sex, age, and county of residence from the Swedish population. Participants ranged from recreational exercisers to world-class skiers. Race participation, distance of race run, number of races participated in, and finishing time were used as proxies for physical exercise. Incident fractures from 1991 to 2010 were obtained from national Swedish registers. Over a median follow-up of 8.9 years, 53,175 fractures of any type, 2929 hip, 3107 proximal humerus, 11,875 lower leg, 11,733 forearm, and 2391 vertebral fractures occurred. In a Cox proportional hazard regression analysis using time-updated exposure and covariate information, participation in the race was associated with an increased risk of any type of fracture (hazard ratio [HR], 1.02; 95% CI, 1.00 to 1.05); forearm fractures had an HR, 1.11 with a 95% CI, 1.06 to 1.15. There was a lower risk of hip (HR, 0.75; 95% CI, 0.67 to 0.83), proximal humerus (HR, 0.90; 95% CI, 0.82 to 0.98), and lower leg fractures (HR, 0.93; 95% CI, 0.89 to 0.97), whereas the HR of vertebral fracture was 0.97 with a 95% CI, 0.88 to 1.07. Among participants, the risk of fracture was similar irrespective of race distance and number of races run. Participants close to the median finishing time had a lower risk of fracture compared with faster and slower participants. In summary, high levels of physical exercise were associated with a slightly higher risk of fractures of any type, including forearm fractures, but a lower risk of hip, proximal humerus, and lower leg fractures. © 2018 American Society for Bone and Mineral Research. © 2018 American Society for Bone and Mineral Research.

[An evaluation of eight cases of intraosseous lipoma].

PubMed

Sahin, Yilmaz; Dabak, Nevzat; Selçuk, M Bekir; Bariş, Y Sancar

2007-01-01

We retrospectively evaluated patients with intraosseous lipoma. The study included eight patients (5 males, 3 females; mean age 39 years; range 23 to 60 years) who were treated between 1997 and 2005 for intraosseous lipoma. Localizations of the lipomas were the calcaneus in six patients, proximal humerus in one patient, and proximal femur in one patient. The presenting complaints were heel pain in patients with calcaneal involvement, and shoulder pain associated with proximal humeral involvement. In one patient, detection of intraosseous lipoma in the left proximal femur was incidental during examination for right hip pain. According to the Milgram classification, five of the intraosseous lipomas were stage 1, while two calcaneal lesions and one femoral lesion were stage 2. Treatment consisted of excisional biopsy, curettage, and allografting under regional or general anesthesia. The diagnosis was confirmed histopathologically in all cases. The mean follow-up period was 28 months (range 9 to 110 months). Complaints of heel pain and shoulder pain resolved within four and five months, respectively. No infection or skin necrosis occurred at the wound site. No neurovascular complications developed during or after surgery. Radiological consolidation of the implanted bone allografts were complete by a mean of three months (range 2 to 4 months). No pathological fractures or recurrences were encountered. Treatment of intraosseous lipomas with curettage and grafting is effective in relieving pain and preventing possible pathological fractures.

A High-Grade Chondrosarcoma of Calcaneum Mimicking as a Benign Pathology: Delayed Diagnosis and Management.

PubMed

Baba, Muzamil Ahmad; Nazir, Naila; Shabeer, Maajid; Mir, Bashir Ahmed; Kawoosa, Altaf Ahmad

2016-10-01

This case is presented to highlight a rare case of chondrosarcoma of calcaneum in a young adult mimicking as a benign pathology and to highlight the diagnosis and early management of such cases to prevent complications and even death. Chondrosarcoma constitutes less than 10% of all primary malignancies of bone and occurs mostly in proximal locations such as pelvis, proximal femur, and proximal humerus. We present a case of high-grade chondrosarcoma at a very rare site, calcaneum of a 40-year-old male that was mimicking as a benign pathology. This case report highlights the importance of proper clinical examination, evaluation, and suspicion for benign occurring lesions to prevent complications related to a delay in diagnosis. Therapeutic, Level IV: Case study. © 2016 The Author(s).

Post-surgical rehabilitative approach to fragility fractures.

PubMed

Gimigliano, F; Iolascon, G; Riccio, I; Frizzi, L; Gimigliano, R

2013-10-01

Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. The most frequent sites of fragility fractures are the hip, the distal radius, the spine, the proximal humerus, and the ankle. In most cases, a surgical approach with subsequent rehabilitative treatment is required. The general aims of rehabilitation are to increase functioning and improve patients' activities, participation level, and quality of life.

Chondrosarcoma third metacarpal: Diagnosis and management options.

PubMed

Sharma, Vipin; Verma, Lucky; Chander, Bal; Sharma, Seema

2018-01-01

Chondrosarcoma is a rare malignant tumor of cartilage commonly arising in the pelvis, proximal femur, and humerus, but quite uncommon in the small bones of the hand. Although limited surgical procedures such as curettage are mentioned as a management option in low-grade chondrosarcomas, they tend to have a high rate of recurrences. Hence, wide excision is recommended as a treatment option even in low-grade chondrosarcomas of the hand.

Stress shielding of the humerus in press-fit anatomic shoulder arthroplasty: review and recommendations for evaluation.

PubMed

Denard, Patrick J; Raiss, Patric; Gobezie, Reuben; Edwards, T Bradley; Lederman, Evan

2018-06-01

Uncemented press-fit humeral stems were developed with the goal of decreasing operative time, preserving bone stock, and easing revision. In recent years, short stems and stemless humeral implants have also become available. These press-fit humeral implants have varying designs that can lead to changes in stress distribution in the proximal humerus. Such stress shielding manifests as bony adaptations and may affect long-term functional outcome and the ability to perform revision. However, current studies of humeral fixation during total shoulder arthroplasty are complicated because a variety of classification systems have been used to report findings. The purpose of this report is to review the current literature on press-fit fixation of the humeral component during total shoulder arthroplasty and propose minimum requirements for radiographic descriptions of stress shielding. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Stemless shoulder arthroplasty: a literature review

PubMed Central

PETRICCIOLI, DARIO; BERTONE, CELESTE; MARCHI, GIACOMO

2015-01-01

The design of humeral implants for shoulder arthroplasty has evolved over the years. The new-generation modular shoulder prostheses have an anatomical humeral stem that replicates the three-dimensional parameters of the proximal humerus. An anatomical reconstruction is the best way to restore stability and mobility of the prosthetic shoulder and improve implant durability. However, a perfect anatomical match is not always possible in, for example, patients with post-traumatic osteoarthritis of the shoulder and deformities in the metaphyseal region. To avoid stem-related complications while retaining the advantages of the fourth generation of shoulder implants, different stemless implants have been developed. The stemless shoulder prosthesis is a new concept in shoulder arthroplasty. The authors review the indications, surgical technique, clinical and radiological midterm results, and complications of these humeral implants. PMID:26151038

Midterm results of surgical treatment of displaced proximal humeral fractures in children.

PubMed

Pavone, Vito; de Cristo, Claudia; Cannavò, Luca; Testa, Gianluca; Buscema, Antonio; Condorelli, Giuseppe; Sessa, Giuseppe

2016-07-01

To analyse the clinical outcomes of 26 children treated surgically for displaced proximal humerus fracture. From January 2008 to December 2012, 26 children/adolescents (14 boys, 12 girls) were treated surgically for displaced fractures at the proximal extremity of the humerus. Ten were grade III and 16 were grade IV according to the Neer-Horowitz classification with a mean age of 12.8 ± 4.2 years. Twenty young patients were surgically treated with a closed reduction and direct percutaneous pinning; six required an open approach. To obtain a proper analysis, we compared the Costant scores with the contralateral shoulder (Δ Costant). The mean follow-up period was 34 months (range 10-55). Two grade IV patients showed a loss in the reduction after percutaneous treatment. This required open surgery with a plate and screws. On average, the treated fractures healed at 40 days. The mean Δ Costant score was 8.43 (range 2-22). There was a statistically significant improvement in the mean Δ Costant score in grade III patients. In grade IV patients, there was a significant improvement in the mean Δ Costant score in those treated with open surgery versus mini-invasive surgery. Our study shows excellent results with percutaneous k-wires. This closed surgery had success in these patients, and the excellent outcomes noted here lead us to prefer the mini-invasive surgical approach in NH grade III fractures. In grade IV, the best results were noted in patients treated with open surgery. We suggest an open approach for these patients. III.

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

PubMed

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

2016-05-01

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. clinicaltrials.gov Identifier: NCT02700867.

Unicameral bone cyst of the proximal tibia in a five year old girl.

PubMed

Tahririan, Mohammadali; Motiffard, Mehdi

2012-01-01

Unicameral bone cysts (UBCs) are benign, osteolytic lesions which are often asymptomatic and are commonly seen in the proximal of humerus and femur. The average age at diagnosis is 9-11 years and there is a male preponderance with a male-to-female ratio of approximately 2-2.5 to 1. We describe a case of 5-year-old girl who presented to orthopedic clinic with a 4-month history of painful limping. Plain radiography of the right knee demonstrated a well-defined lytic lesion in the proximal of the tibia. Open biopsy and then curettage and bone grafting with bone- substitute was performed. The diagnosis of this condition requires a high index of suspicion. This report demonstrates that all UBCs do not have the same clinical patterns and with adequate attention good results can be achieved.

Unicameral bone cyst of the scaphoid: a report of two cases.

PubMed

Javdan, Mohammad; Zarezadeh, Abolghasem; Gaulke, Raulf; Eshaghi, Mohammad Amin; Shemshaki, Hamidreza

2012-08-01

Unicameral bone cysts are benign, fluid-filled lesions that occur mostly in long bones (proximal humerus, 50-60%; femur, 30%) of male children aged 5 to 15 years. Occurrence in the scaphoid of an adult is rare. We report 2 such patients who presented with wrist pain, with and without a history of trauma. Both underwent curettage and bone grafting (harvested from the distal radius) and achieved good functional recovery.

Proximal third humeral shaft fractures -- a fracture entity not fully characterized by conventional AO classification.

PubMed

Stedtfeld, H W; Biber, R

2014-01-01

The retrospective study was made to evaluate the fracture patterns at the proximal humeral shaft for which the long version of a standard proximal humeral nail (PHNLV) has been used. The indication has been decided by the individual surgeons. Over a five year period 72 consecutive PHNLV cases of an acute fracture were identified and were included in the study. Mean patient age was 68.9 years. Gender ratio was m/f=22/50. 86.1% of the patients fractured their humerus by a fall, the rest by a high velocity accident. We analysed patient comorbidity, ASA score, osteoporosis, social status before accident, additional injuries affecting local soft tissues or other anatomic regions. We analysed the expansion of the fractures, dividing the humerus into five zones. Fracture morphology was categorized according to the standard AO/ASIF classification (if applicable). Comorbidities were found in 76.4% of the patients. Almost all patients (93.1%) had been living independently at home before the accident. 47.2% of patients had osteoporosis in their medical history. Five patients (6.9%) had a primary palsy of the radial nerve. Six fractures chosen for PHNLV fixation were clearly restricted to the humeral head. The remaining 66 fractures were located in the humeral shaft (AO region 12). There were 5 segmental fractures. Of the remaining 67 fractures affecting the proximal third of the humeral shaft 49.3 percent extended into the humeral head. 98 percent of these fractures displayed spiral morphology. Proximal humeral shaft fractures are amazingly similar to subtrochanteric and distal tibial shaft fractures: Spiral fracture types with different grades of comminution are absolutely dominant; a great proportion of the fractures extend into the humeral head with growing tendency of displacement if located closer to the humeral head. Diverging traction of deltoid and pectoralis muscle causes typical displacement if the fracture line runs in between their attachments substantiating the term 'intermuscular fracture'. A distinct classification system for proximal humeral shaft fractures seems meaningful and is proposed. There is clear evidence of specific characteristics which differentiate proximal third humeral shaft fractures from those of midshaft and distal third. They explain the specific problems of reduction and fixation. If disrespected they will lead to higher rates of therapeutic failure. Copyright © 2013 Elsevier Ltd. All rights reserved.

Articular scaling and body mass estimation in platyrrhines and catarrhines: Modern variation and application to fossil anthropoids.

PubMed

Perry, Jonathan M G; Cooke, Siobhán B; Runestad Connour, Jacqueline A; Burgess, M Loring; Ruff, Christopher B

2018-02-01

Body mass is an important component of any paleobiological reconstruction. Reliable skeletal dimensions for making estimates are desirable but extant primate reference samples with known body masses are rare. We estimated body mass in a sample of extinct platyrrhines and Fayum anthropoids based on four measurements of the articular surfaces of the humerus and femur. Estimates were based on a large extant reference sample of wild-collected individuals with associated body masses, including previously published and new data from extant platyrrhines, cercopithecoids, and hominoids. In general, scaling of joint dimensions is positively allometric relative to expectations of geometric isometry, but negatively allometric relative to expectations of maintaining equivalent joint surface areas. Body mass prediction equations based on articular breadths are reasonably precise, with %SEEs of 17-25%. The breadth of the distal femoral articulation yields the most reliable estimates of body mass because it scales similarly in all major anthropoid taxa. Other joints scale differently in different taxa; therefore, locomotor style and phylogenetic affinity must be considered when calculating body mass estimates from the proximal femur, proximal humerus, and distal humerus. The body mass prediction equations were applied to 36 Old World and New World fossil anthropoid specimens representing 11 taxa, plus two Haitian specimens of uncertain taxonomic affinity. Among the extinct platyrrhines studied, only Cebupithecia is similar to large, extant platyrrhines in having large humeral (especially distal) joints. Our body mass estimates differ from each other and from published estimates based on teeth in ways that reflect known differences in relative sizes of the joints and teeth. We prefer body mass estimators that are biomechanically linked to weight-bearing, and especially those that are relatively insensitive to differences in locomotor style and phylogenetic history. Whenever possible, extant reference samples should be chosen to match target fossils in joint proportionality. Copyright © 2017 Elsevier Ltd. All rights reserved.

First Partial Skeleton of a 1.34-Million-Year-Old Paranthropus boisei from Bed II, Olduvai Gorge, Tanzania

PubMed Central

Domínguez-Rodrigo, Manuel; Pickering, Travis Rayne; Baquedano, Enrique; Mabulla, Audax; Mark, Darren F.; Musiba, Charles; Bunn, Henry T.; Uribelarrea, David; Smith, Victoria; Diez-Martin, Fernando; Pérez-González, Alfredo; Sánchez, Policarpo; Santonja, Manuel; Barboni, Doris; Gidna, Agness; Ashley, Gail; Yravedra, José; Heaton, Jason L.; Arriaza, Maria Carmen

2013-01-01

Recent excavations in Level 4 at BK (Bed II, Olduvai Gorge, Tanzania) have yielded nine hominin teeth, a distal humerus fragment, a proximal radius with much of its shaft, a femur shaft, and a tibia shaft fragment (cataloged collectively as OH 80). Those elements identified more specifically than to simply Hominidae gen. et sp. indet are attributed to Paranthropus boisei. Before this study, incontrovertible P. boisei partial skeletons, for which postcranial remains occurred in association with taxonomically diagnostic craniodental remains, were unknown. Thus, OH 80 stands as the first unambiguous, dentally associated Paranthropus partial skeleton from East Africa. The morphology and size of its constituent parts suggest that the fossils derived from an extremely robust individual who, at 1.338±0.024 Ma (1 sigma), represents one of the most recent occurrences of Paranthropus before its extinction in East Africa. PMID:24339873

Clinical Utility and Pitfalls of Ultrasound Guided Foreign Body Removal in War Fighters

DTIC Science & Technology

2012-10-01

surgeon noted that the 3 foreign bodies implanted in the third thigh with the traditional surgical removal were placed in the subcutaneous fat and...Conference Chicago, IL 16-17 April, 2005 235. Unique Aspects of Pediatric Fractures Course Moderator/Speaker AOCR Mid Year Conference Chicago...Otolaryngol Head Neck Surg. 2003; Mar;129(3):305-9 38. Jones GP, Seguin J, Shiels WE II: Salter-Harris II Fracture of the Proximal Humerus in a Preterm

The factors influencing the decision making of operative treatment for proximal humeral fractures.

PubMed

Hageman, Michiel G J S; Jayakumar, Prakash; King, John D; Guitton, Thierry G; Doornberg, Job N; Ring, David

2015-01-01

The factors influencing the decision making of operative treatment for fractures of the proximal humerus are debated. We hypothesized that there is no difference in treatment recommendations between surgeons shown radiographs alone and those shown radiographs and patient information. Secondarily, we addressed (1) factors associated with a recommendation for operative treatment, (2) factors associated with recommendation for arthroplasty, (3) concordance with the recommendations of the treating surgeons, and (4) factors affecting the inter-rater reliability of treatment recommendations. A total of 238 surgeons of the Science of Variation Group rated 40 radiographs of patients with proximal humerus fractures. Participants were randomized to receive information about the patient and mechanism of injury. The response variables included the choice of treatment (operative vs nonoperative) and the percentage of matches with the actual treatment. Participants who received patient information recommended operative treatment less than those who received no information. The patient information that had the greatest influence on treatment recommendations included age (55%) and fracture mechanism (32%). The only other factor associated with a recommendation for operative treatment was region of practice. There was no significant difference between participants who were and were not provided with information regarding agreement with the actual treatment (operative vs nonoperative) provided by the treating surgeon. Patient information-older age in particular-is associated with a higher likelihood of recommending nonoperative treatment than radiographs alone. Clinical information did not improve agreement of the Science of Variation Group with the actual treatment or the generally poor interobserver agreement on treatment recommendations. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Unicameral bone cyst of the proximal tibia in a five year old girl

PubMed Central

Tahririan, Mohammadali; Motiffard, Mehdi

2012-01-01

Unicameral bone cysts (UBCs) are benign, osteolytic lesions which are often asymptomatic and are commonly seen in the proximal of humerus and femur. The average age at diagnosis is 9-11 years and there is a male preponderance with a male-to-female ratio of approximately 2-2.5 to 1. We describe a case of 5-year-old girl who presented to orthopedic clinic with a 4-month history of painful limping. Plain radiography of the right knee demonstrated a well-defined lytic lesion in the proximal of the tibia. Open biopsy and then curettage and bone grafting with bone- substitute was performed. The diagnosis of this condition requires a high index of suspicion. This report demonstrates that all UBCs do not have the same clinical patterns and with adequate attention good results can be achieved. PMID:23248665

[Influence of the Weather on the Incidence of Fractures in the Elderly].

PubMed

Burget, F; Foltán, O; Kraus, J; Kudrna, K; Novák, M; Ulrych, J

2016-01-01

PURPOSE OF THE STUDY The incidence of geriatric fractures (proximal femur, distal radius, proximal humerus and thoracolumbar spine injuries) in the population increases with ageing. However, the role of weather conditions, such as icy and slippery winter, should not be overlooked. A deeper insight into this relationship may bring about a better understanding of the fracture aetiology and thus allow for improvement in the prevention of fractures in elderly people. MATERIAL AND METHODS This prospective study included 676 patients (469 women and 207 men) aged 65 and over. Relationships between the incidence of geriatric fractures in these patients and the season, weather phenomena (i.e., air temperature, atmospheric pressure, air humidity, wind speed, visibility, rain, snow, mist and storm) and global biometeorological data in the period from 1 January 2012 to 31 December 2013 were investigated. Patients with high velocity trauma or those with pathological fractures were excluded. Time (day/night), the place of injury (outdoor/indoor/home environment), comorbidities and chronicuse medication were also recorded. Weather forecast records with weather health loads (biotropic indices) were obtained from the commercial service Weather Underground and the Czech Hydrometeoro-logical Institute. The results were statistically analysed using the Statistika 12 programme. RESULTS The incidence of fractures was higher in winter months but there was no statistically significant correlation between the number of fractures and various weather characteristics (temperature, atmospheric pressure, air humidity, wind speed, visibility, rainfall, snow, mist or storm). On the other hand, a relationship between the incidence of geriatric fractures and the biometeorological data (biotropic index) for that day was significant (r = 0.65, p= 0.0401). The majority of fractures occurred during the daytime (83.7%) and in the indoor environment (83.1%); of the latter fractures, 85.2% were home injuries. The most frequent comorbidities included cardiovascular disease (36.2%), obesity (31.1%) and diabetes mellitus (25.4%). DISCUSSION Studies investigating seasonal patterns in relation to the incidence of geriatric fractures are contradictory. Sixteen previous studies have examined seasonal variations and the incidence of some types of geriatric fractures in different parts of the world. The majority of them have dealt with hip fractures, three with forearm injuries and one compared the incidence of hip, distal forearm, proximal humerus and ankle fractures in the four seasons of the year. Of 13 studies in geographic areas located north of 40°latitude, eight showed no seasonal variation in the incidence of fractures, four recorded an increase in the number of fractures in winter and two showed an increased number of fractures in summer. Three of them also studied the effect of daily temperature. Only one study paid attention to biometeorological data and related the biotropic index to the number of injuries treated at the emergency department. Three studies showed that fractures occurred most frequently in the home environment and during the daytime. CONCLUSIONS This study did not prove any statistically significant relationship between the incidence of geriatric fractures and different weather phenomena. Nevertheless, it showed a higher incidence of fractures in winter, from December to February. Most fractures occurred in indoor environments and during the day. A high value of the biotropic index was significantly related to the incidence of geriatric fractures. The most frequent comorbidities included cardiovascular disease, obesity and diabetes mellitus. Key words: geriatric fracture, season, weather, biometeorological forecast.

Morphology of the limbs in the semi-fossorial desert rodent species of Tympanoctomys (Octodontidae, Rodentia)

PubMed Central

Perez, M. Julieta; Barquez, Ruben M.; Diaz, M. Monica

2017-01-01

Abstract Here, a detailed description of the forelimbs and hindlimbs of all living species of the genus Tympanoctomys are presented. These rodents, highly adapted to desert environments, are semi-fossorial with capacity to move on the surface as well as to build burrows. The shape, structure, and size of the limbs are described. Contrary to what was expected for scratch digging semi-fossorial species, Tympanoctomys have slender humerus, radius and ulna; with narrow epicondyles of the humerus and short olecranon of the ulna with poorly developed processes. Following our descriptions, no intrageneric morphological variation regarding to the configuration of the limbs was detected, probably due to phylogenetic proximity, and not related to specific variations in response to different use of substrates or habits. The obtained results constitute a source of previously unpublished information as well as an important base for future analysis in different studies, such as morphometric, morpho-functional, or phylogenetic researches. PMID:29118644

Cementless anatomical prosthesis for the treatment of 3-part and 4-part proximal humerus fractures: cadaver study and prospective clinical study with minimum 2 years followup

PubMed Central

Obert, Laurent; Saadnia, Rachid; Loisel, François; Uhring, Julien; Adam, Antoine; Rochet, Séverin; Clappaz, Pascal; Lascar, Tristan

2016-01-01

Introduction: The purpose of this study was to evaluate the functional and radiological outcomes of a cementless, trauma-specific locked stem for 3- and 4-part proximal humeral fractures. Materials and methods: This study consisted of two parts: a cadaver study with 22 shoulders and a multicenter prospective clinical study of 23 fracture patients evaluated at least 2 years after treatment. In the cadaver study, the locked stem (HumelockTM, FX Solutions) and its instrumentation were evaluated. In the clinical study, five senior surgeons at four different hospitals performed the surgical procedures. An independent surgeon evaluated the patients using clinical (Constant score, QuickDASH) and radiological (X-rays, CT scans) outcome measures. Results: The cadaver study allowed us to validate the height landmarks relative to the pectoralis major tendon. In the clinical study, at the review, abduction was 95° (60–160), forward flexion was 108° (70–160), external rotation (elbow at body) was 34° (0–55), the QuickDASH was 31 (4.5–59), the overall Constant score was 54 (27–75), and the weighted Constant score was 76 (31.5–109). Discussion: This preliminary study of hemiarthroplasty (HA) with a locked stem found results that were at least equivalent to published series. As all patients had at least a 2-year follow-up, integration of the locked stem did not cause any specific complications. These results suggest that it is possible to avoid using cement when hemiarthroplasty is performed for the humeral stem. This implant makes height adjustment and transosseous suturing of the tuberosities more reproducible. PMID:27194107

Clinical Utility and Pitfalls of Ultrasound Guided Foreign Body Removal in War Fighters

DTIC Science & Technology

2011-10-01

implanted in the third thigh with the traditional surgical removal were placed in the subcutaneous fat and not the muscle which made locating the...16-17 April, 2005 235. Unique Aspects of Pediatric Fractures Course Moderator/Speaker AOCR Mid Year Conference Chicago, IL 16-17 April, 2005...Mar;129(3):305-9 38. Jones GP, Seguin J, Shiels WE II: Salter-Harris II Fracture of the Proximal Humerus in a Preterm Infant. Am J Perinatol

Investigating a potential biological treatment to prevent pathological fractures caused by unicameral bone cysts in children under 8 years.

PubMed

Ramos-Pascua, Luis R; Sánchez-Herraéz, Sergio; Casas-Ramos, Paula; Molnar Fuentes, Sebastián; Santos Sánchez, José Ángel

2014-10-01

There is no consensus on when and how to treat unicameral bone cysts (UBCs), partly because of a lack of knowledge of the aetiology. To review the different treatment techniques for UBCs and to describe our results with a single injection of autogenous bone marrow (BM) mixed with demineralised bone matrix (DBM) in very young children. We reviewed five patients under the age of 8 years with UBCs treated by percutaneous aspiration and a single injection of BM associated with DBM. The cyst was located in the proximal humerus in four patients and in the proximal femur in one patient. Assessment of the need for surgery was based on the clinical and radiographic suspicion of new pathological fractures. The administration of a second injection, when necessary, was based on the surgeon's judgement regarding the risk of fracture. The mean follow-up after first injection was 41 months. There were no complications related to the procedure, except a non-displaced fracture, which healed without problems. All patients were pain free and progressively resumed their activities without restriction until a new fracture occurred in two cases. According to Capanna's classification, only one case healed completely (grade 1), one lesion was classified as grade 2, and there were three recurrences at 11, 12 and 27 months after initial treatment (grade 3). The final outcome was treatment failure for three out of the five patients. Two patients were treated with a second injection and one patient is waiting for surgery. A single injection of aspirated autogenous BM mixed with DBM in very young children with active UBCs at risk of fracture is very simple, comfortable and safe. Nevertheless, the results seem to be unpredictable and are probably more dependent on the natural evolution of the cyst than on the treatment. Further comparative studies with larger sample numbers are needed.

[Treatment of posttraumatic cubitus varus in children and adolescents. Supracondylar humeral osteotomy using radial external fixation].

PubMed

Slongo, T

2015-06-01

Precise adaptable fixation of a supracondylar humerus osteotomy with a radial/lateral external fixator to correct posttraumatic cubitus varus. Acquired, posttraumatic cubitus varus as a result of a malhealed and unsatisfactorily treated supracondylar humerus fracture. Idiopathic, congenital cubitus varus (very seldom) if the child (independent of age and after complete healing) is cosmetically impaired; stability of the elbow is reduced due to malalignment (hyperextension); secondary problems and pain (e. g., irritation of the ulnar nerve) are expected or already exist; or there is an explicit wish of the child/parents (relative indication). In principle there are no contraindications provided that the indication criteria are filled. The common argument of age does not represent a contraindication in our opinion, since angular remodeling at the distal end of the humerus is practically nonexistent. Basically, the surgical technique of the radial external fixator is used as previously described for stabilization of complex supracondylar humeral fractures. With the patient in supine position, the arm is placed freely on an arm table. Using a 4-5 cm long skin incision along the radial, supracondylar, the extracapsular part of the distal humerus is prepared, whereby great caution regarding the radial nerve is advised. In contrast to the procedure used in radial external fixation for supracondylar humeral fracture treatment, two Schanz screws are always fixed in each fragment at a distance of 1.5-2 cm. The osteotomy must allow the fragment to freely move in all directions. The proximal and distal two Schanz screws are then connected with short 4 mm carbon or stainless steel rods. These two rods are connected with each other over another rod using the tub-to-tub technique. Now the preliminary correction according the clinical situation can be performed and the clamps are tightened. Anatomical axis and function are checked. If these are radiologically and clinically perfect, all clamps are definitively tightened; if the alignment or the function is not perfect, then further adjustments can be made. Due to the excellent stability, further immobilization not necessary. Immediate functional follow-up treatment performed according to pain. Adequate healing is usually expected within 6 weeks. At this time the external fixator can be removed in the fracture clinic. Because the whole operation is performed in an extraarticular manner and the mobility of the elbow is not affected, deterioration of function has never been observed. Also regarding the cosmetic/anatomical situation, good results are expected because they were already achieved intraoperatively.

SHOULDER ARTHROPLASTY RECORDS

PubMed Central

Filho, Geraldo Motta; Galvão, Marcus Vinicius; Monteiro, Martim; Cohen, Marcio; Brandão, Bruno

2015-01-01

The study's objective is to evaluate the characteristics and problems of patients who underwent shoulder arthroplasties between July 2004 and November 2006. Methodology: During the period of the study, 145 shoulder arthroplasties were performed. A prospective protocol was used for every patient; demographic, clinical and surgical procedure data were collected. All gathered data were included in the data base. The patients were divided in three major groups: fractures, degenerative diseases and trauma sequels. Information obtained from the data base was correlated in order to determine patients' epidemiologic, injuries, and surgical procedure profiles. Results: Of the 145 shoulder arthroplasties performed, 37% presented trauma sequels, 30% degenerative diseases, and 33% proximal humerus fracture. 12% of the cases required total arthroplasties and 88% partial arthroplasties. Five major complications were observed on early postoperative period. Conclusion: Shoulder arthroplasties have become a common procedure in orthopaedic practice. Surgical records are important in evidencing progressive evolution and in enabling future clinical outcomes evaluation. PMID:26998463

Concomitant upper limb fractures and short-term functional recovery in hip fracture patients: does the site of upper limb injury matter?

PubMed

Di Monaco, Marco; Castiglioni, Carlotta; Vallero, Fulvia; Di Monaco, Roberto; Tappero, Rosa

2015-05-01

The aim of this study was to evaluate functional recovery in a subgroup of hip fracture patients who sustained a simultaneous fracture at the upper limb, taking into account the site of upper limb injury. Of 760 patients admitted consecutively to the authors' rehabilitation hospital because of a fall-related hip fracture, 700 were retrospectively investigated. Functional outcome was assessed using Barthel Index scores. In 49 of the 700 patients, a single fall resulted in both a hip fracture and a fracture of either wrist (n = 34) or proximal humerus (n = 15). The patients with concomitant shoulder fractures had lower median Barthel Index scores after rehabilitation (70 vs. 90, P = 0.003), lower median Barthel Index effectiveness (57.1 vs. 76.9, P = 0.018), and prolonged median length of stay (42 vs. 36 days, P = 0.011) than did the patients with isolated hip fractures. Significant differences persisted after adjustment for six potential confounders. The adjusted odds ratio for achieving a Barthel Index score lower than 85 was 6.71 (95% confidence interval, 1.68-26.81; P = 0.007) for the patients with concomitant shoulder fractures. Conversely, no prognostic disadvantages were associated with concomitant wrist fractures. Data show a worse functional recovery and a prolonged length of stay in the subgroup of hip fracture patients who sustained a concomitant fracture at the proximal humerus, but not at the wrist.

External fixation for severe open fractures of the humerus caused by missiles.

PubMed

Zinman, C; Norman, D; Hamoud, K; Reis, N D

1997-10-01

To evaluate the use of external fixation of the humerus after missile injuries. Retrospective. University medical center. Twenty-six soldiers with twenty-six open Gustilo type III fractures. Immediate external fixation. Clinical, functional, social, and rehabilitation criteria were evaluated. Excellent in fourteen patients (61%), good in four (17%), fair in three (13%), and poor in two (9%). All fractures eventually healed. External fixation is the preferred initial treatment for stabilizing severe open missile fractures of the humerus. Its use, together with radical debridement of dead bone, has reduced the incidence of chronic infection and improved the prognosis of vascular repairs. As a result, the rate of morbidity and upper limb amputation has been reduced significantly, compared with our previous experience.

Healing bone lesion defects using injectable CaSO4 /CaPO4 -TCP bone graft substitute compared to cancellous allograft bone chips in a canine model.

PubMed

Hall, Deborah J; Turner, Thomas M; Urban, Robert M

2018-04-16

CaSO 4 /CaPO 4 -TCP bone graft substitute has been shown to be effective for treatment of bone lesion defects, but its mechanical, histological, and radiographic characteristics have not been studied in direct comparison with a conventional treatment such as cancellous allograft bone. Thirteen canines had a critical-size axial defect created bilaterally into the proximal humerus. CaSO 4 /CaPO 4 -TCP bone graft substitute (PRO-DENSE™, Wright Medical Technology) was injected into the defect in one humerus, and an equal volume of freeze-dried cancellous allograft bone chips was placed in the contralateral defect. The area fraction of new bone, residual graft, and fibrous tissue and the compressive strength and elastic modulus of bone within the defects were determined after 6, 13, or 26 weeks and correlated with radiographic changes. The data were analyzed using Friedman and Mann-Whitney tests. There was more bone in defects treated with the CaSO 4 /CaPO 4 -TCP bone graft substitute compared to defects treated with cancellous bone allograft at all three time points, and the difference at 13 weeks was significant (p = 0.025). The new bone was significantly stronger and stiffer in defects treated with the CaSO 4 /CaPO 4 -TCP bone graft substitute compared to defects treated with cancellous bone allograft at 13 (p = 0.046) and 26 weeks (p = 0.025). At 26 weeks, all defects treated with CaSO 4 /CaPO 4 -TCP bone graft substitute demonstrated complete healing with new bone, whereas healing was incomplete in all defects treated with cancellous allograft chips. The CaSO 4 /CaPO 4 -TCP bone graft substitute could provide faster and significantly stronger healing of bone lesions compared to the conventional treatment using freeze-dried cancellous allograft bone. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater, 2018. © 2018 Wiley Periodicals, Inc.

Visualization of 3D elbow kinematics using reconstructed bony surfaces

NASA Astrophysics Data System (ADS)

Lalone, Emily A.; McDonald, Colin P.; Ferreira, Louis M.; Peters, Terry M.; King, Graham J. W.; Johnson, James A.

2010-02-01

An approach for direct visualization of continuous three-dimensional elbow kinematics using reconstructed surfaces has been developed. Simulation of valgus motion was achieved in five cadaveric specimens using an upper arm simulator. Direct visualization of the motion of the ulna and humerus at the ulnohumeral joint was obtained using a contact based registration technique. Employing fiducial markers, the rendered humerus and ulna were positioned according to the simulated motion. The specific aim of this study was to investigate the effect of radial head arthroplasty on restoring elbow joint stability after radial head excision. The position of the ulna and humerus was visualized for the intact elbow and following radial head excision and replacement. Visualization of the registered humerus/ulna indicated an increase in valgus angulation of the ulna with respect to the humerus after radial head excision. This increase in valgus angulation was restored to that of an elbow with a native radial head following radial head arthroplasty. These findings were consistent with previous studies investigating elbow joint stability following radial head excision and arthroplasty. The current technique was able to visualize a change in ulnar position in a single DoF. Using this approach, the coupled motion of ulna undergoing motion in all 6 degrees-of-freedom can also be visualized.

Supraintercondylar fractures of the humerus--treatment by the Vigliani osteosynthesis.

PubMed

Fama, G

1987-03-01

Nineteen cases of supraintercondylar fractures of the humerus treated by the Vigliani osteosynthesis technique are described. This consists of wide transolecranon exposure of the fracture, stabilisation of the epiphyseal fragments with a transcondylar screw, and of the metaphyseo-epiphyseal junction with two condylo-diaphyseal "Eiffel Tower" Kirschner wires. The ulnar nerve is transposed anteriorly and the operation is carried out early in order to prevent neural disturbances and intra and/or periarticular ossification. The results confirm the validity of this method, which respects the delicate structure of this part of the humerus. Postoperative plaster is necessary as an indispensable complement to "minimum" osteosynthesis but this is quite free from risk. The importance of careful and gradual mobilisation of the elbow is also confirmed. Finally, this method combines the advantages of stable osteosynthesis in compression (screw and nut) at the epiphyseal site, with those of elastic osteosynthesis (Kirschner wires) at the metaphyseo-epiphyseal junction.

Accuracy in identifying the elbow rotation axis on simulated fluoroscopic images using a new anatomical landmark.

PubMed

Wiggers, J K; Snijders, R M; Dobbe, J G G; Streekstra, G J; den Hartog, D; Schep, N W L

2017-11-01

External fixation of the elbow requires identification of the elbow rotation axis, but the accuracy of traditional landmarks (capitellum and trochlea) on fluoroscopy is limited. The relative distance (RD) of the humerus may be helpful as additional landmark. The first aim of this study was to determine the optimal RD that corresponds to an on-axis lateral image of the elbow. The second aim was to assess whether the use of the optimal RD improves the surgical accuracy to identify the elbow rotation axis on fluoroscopy. CT scans of elbows from five volunteers were used to simulate fluoroscopy; the actual rotation axis was calculated with CT-based flexion-extension analysis. First, three observers measured the optimal RD on simulated fluoroscopy. The RD is defined as the distance between the dorsal part of the humerus and the projection of the posteromedial cortex of the distal humerus, divided by the anteroposterior diameter of the humerus. Second, eight trauma surgeons assessed the elbow rotation axis on simulated fluoroscopy. In a preteaching session, surgeons used traditional landmarks. The surgeons were then instructed how to use the optimal RD as additional landmark in a postteaching session. The deviation from the actual rotation axis was expressed as rotational and translational error (±SD). Measurement of the RD was robust and easily reproducible; the optimal RD was 45%. The surgeons identified the elbow rotation axis with a mean rotational error decreasing from 7.6° ± 3.4° to 6.7° ± 3.3° after teaching how to use the RD. The mean translational error decreased from 4.2 ± 2.0 to 3.7 ± 2.0 mm after teaching. The humeral RD as additional landmark yielded small but relevant improvements. Although fluoroscopy-based external fixator alignment to the elbow remains prone to error, it is recommended to use the RD as additional landmark.

Prognostic factors of early metastasis and mortality in dogs with appendicular osteosarcoma after receiving surgery: an individual patient data meta-analysis.

PubMed

Schmidt, A F; Nielen, M; Klungel, O H; Hoes, A W; de Boer, A; Groenwold, R H H; Kirpensteijn, J

2013-11-01

Recently an aggregated data meta-analysis showed that serum alkaline phosphatase (SALP) and proximal humerus location are predictors for shorter survival in canine osteosarcoma. To identify additional prognostic factors of mortality and metastasis an individual patient data meta-analysis (IPDMA) was conducted. Individual patient data from 20 studies, identified via the VSSO society, were pooled. Univariable and multivariable hazard ratios (HR) for metastasis and mortality were assessed, using stratified Cox models. The study included 1405 dogs who received surgical treatment, of which the metastasis status was measured in 1155 dogs and mortality status in 1336 dogs; median survival was 256 days. High versus normal SALP and weight (kg) were associated with an increase in hazard of metastasis [HR 1.34 (95%CI 1.07; 1.68) and HR 1.02 (per kg increase) (95%CI 1.01; 1.03)] and for mortality [HR 1.43 (95%CI 1.16; 1.77) and HR 1.02 (95%CI 1.01; 1.02)]. Distal radius tumor was associated with a lower hazard of metastasis compared to other locations: HR 0.75 (95%CI 0.58; 0.96). Proximal humerus and distal femur or proximal tibia location were related with an increased mortality: HR 1.53 (95%CI 1.26; 1.84) and HR 1.23 (95%CI 1.01; 1.49) compared to other locations. Older age (years) was associated with a higher hazard for mortality [HR 1.06 per year (95%CI 1.03; 1.09)] but not for metastasis: HR 1.03 (95%CI 0.99; 1.06). These results confirm findings from a recent aggregated data meta-analysis and (in addition) showed that tumor location, SALP, weight were prognostic factors for both mortality and metastasis. Age was a prognostic factor for mortality but not for metastasis. Copyright © 2013 Elsevier B.V. All rights reserved.

The impact of public versus private insurance on trauma patients.

PubMed

Jentzsch, Thorsten; Neuhaus, Valentin; Seifert, Burkhardt; Osterhoff, Georg; Simmen, Hans-Peter; Werner, Clément M L; Moos, Rudolf

2016-01-01

The socioeconomic status has been associated with disparities in the incidence and mortality of traumatic injuries. However, there is a lack of studies on the level of health insurance with regard to various epidemiologic data of traumatic injuries, which this study opted to clarify. All consecutive 6595 patients admitted to a level one trauma center in 2012 and 2013 were included in this retrospective cohort study. Patients were grouped according to their health insurance status (public versus private extended health care insurance) and compared with regard to several epidemiologic variables, that is, the type of injuries, inhospital outcome, and surgical procedures. Public insurance coverage was significantly more common than private insurance (75% versus 25%). Public insurance was associated with younger age, male sex, transfers to another hospital or mental institution, head concussions, head fractures, and increased mortality. Contrarily, patients with private insurance were more often associated with longer hospital stay, discharge to a rehabilitation clinic, fractures of the proximal humerus, and shoulder dislocations. However, there were no significant differences for the remaining majority of studied variables. In a trauma setting, the level of insurance does not seem to play a crucial role in most types of injuries and surgical procedures in a country with a high level of obligatory health care coverage. Nonetheless, it appears that publicly insured patients are more commonly younger, males, transferred to another hospital more often, more prone to head trauma, and subject to increased mortality, whereas privately insured patients show longer hospital stays, increased transfers to rehabilitation clinics, and more fractures of the proximal humerus. Copyright © 2016 Elsevier Inc. All rights reserved.

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

Parosteal osteosarcoma dedifferentiating into telangiectatic osteosarcoma: importance of lytic changes and fluid cavities at imaging.

PubMed

Azura, M; Vanel, D; Alberghini, M; Picci, P; Staals, E; Mercuri, M

2009-07-01

This study was performed to assess the imaging findings in cases of parosteal osteosarcoma dedifferentiated into telangiectatic osteosarcoma. Parosteal osteosarcoma is a low-grade well-differentiated malignant tumor. Dedifferentiation into a more aggressive lesion is frequent and usually visible on imaging as a central lytic area in a sclerotic mass. Only one case of differentiation into a telangiectatic osteosarcoma has been reported. As it has practical consequences, with a need for aggressive chemotherapy, we looked for this rather typical imaging pattern. Review of 199 cases of surface osteosarcomas (including 86 parosteal, of which 23 were dedifferentiated) revealed lesions suggesting a possible telangiectatic osteosarcoma on imaging examinations in five cases (cavities with fluid). Histology confirmed three cases (the two other only had hematoma inside a dedifferentiated tumor). There were three males, aged 24, 28, and 32. They had radiographs and CT, and two an MR examination. Lesions involved the distal femur, proximal tibia, and proximal humerus. The parosteal osteosarcoma was a sclerotic, regular mass, attached to the cortex. A purely lytic mass, partially composed of fluid cavities was easily detected on CT and MR. It involved the medullary cavity twice, and remained outside the bone once. Histology confirmed the two components in each case. Two patients died of pulmonary metastases and one is alive. Knowledge of this highly suggestive pattern should help guide the initial biopsy to diagnose the two components of the tumor, and guide aggressive treatment.

How bone quality may influence intraoperative and early postoperative problems after angular stable open reduction-internal fixation of proximal humeral fractures.

PubMed

Spross, Christian; Zeledon, Rebeca; Zdravkovic, Vilijam; Jost, Bernhard

2017-09-01

With the introduction of the deltoid tuberosity index (DTI), a simple radiographic tool has become available to measure bone mineral density of the proximal humerus. The aim of this study was to assess the influence of local bone mineral density on the early failure rate after angular stable open reduction-internal fixation of proximal humeral fractures (PHFs). We retrospectively followed up all patients treated with angular stable implants for PHFs from 2007 to 2014. The fractures were classified according to Neer, and the DTI, metaphyseal head extension (MHE), medial hinge displacement, and quality of reduction were assessed. Failures were defined as head screw cutouts. The study included 146 patients (mean age, 66 years; range, 20-94 years). The mean follow-up period was 11 months (range, 3-94 months). Of the fractures, 91% were classified as 2- or 3-part fractures and 9% as 4-part fractures. The mean DTI was 1.44 (range, 1.19-2.11), and the mean MHE was 12 mm (range, 0-48 mm). The reduction result was at least acceptable in 80% of fractures. Screw cutouts were found in 23%. The DTI and MHE were the most significant preoperative predictors for the reduction result. The DTI (P = .036) and age (P = .02) were independent preoperative factors, and a good reduction (P = .001) was the only intraoperative factor influencing cutout. This study proves that good bone quality and a long MHE are helpful for the reduction. Furthermore, good bone quality, a younger age, and a good reduction prevent later cutout. We conclude that local bone quality is a relevant factor in the treatment plan for PHFs. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Phocomelia: Case report and differential diagnosis.

PubMed

Osadsky, Captain Rasto

2011-01-01

While rarely seen in the present-day Western world, phocomelia is not uncommon in underdeveloped countries. Phocomelia is an abnormality in which the limbs are not fully formed. It may be inherited as an autosomal recessive or dominant disorder. This case concerns a 12-year-old Afghan boy with multiple skeletal anomalies, most prominently of his right arm, including aplasia of the entire proximal humerus, hypoplasia of the clavicle and scapula, and absence of the radial ray and thumb. A hypoplastic left thumb was also present. Other anomalies included thoracic scoliosis, upper thoracic hemivertebrae, and mild cardiomegaly. The differential diagnosis and likely diagnosis are discussed.

Assessment of modified gold surfaced titanium implants on skeletal fixation

PubMed Central

Zainali, Kasra; Danscher, Gorm; Jakobsen, Thomas; Baas, Jorgen; Møller, Per; Bechtold, Joan E.; Soballe, Kjeld

2013-01-01

Noncemented implants are the primary choice for younger patients undergoing total hip replacements. However, the major concern in this group of patients regarding revision is the concern from wear particles, periimplant inflammation, and subsequently aseptic implant loosening. Macrophages have been shown to liberate gold ions through the process termed dissolucytosis. Furthermore, gold ions are known to act in an anti-inflammatory manner by inhibiting cellular NF-κB-DNA binding. The present study investigated whether partial coating of titanium implants could augment early osseointegration and increase mechanical fixation. Cylindrical porous coated Ti-6Al-4V implants partially coated with metallic gold were inserted in the proximal region of the humerus in ten canines and control implants without gold were inserted in contralateral humerus. Observation time was 4 weeks. Biomechanical push out tests and stereological histomorphometrical analyses showed no statistically significant differences in the two groups. The unchanged parameters are considered an improvement of the coating properties, as a previous complete gold-coated implant showed inferior mechanical fixation and reduced osseointegration compared to control titanium implants in a similar model. Since sufficient early mechanical fixation is achieved with this new coating, it is reasonable to investigate the implant further in long-term studies. PMID:22847873

Kinematic constraints associated with the acquisition of overarm throwing part II: upper extremity actions.

PubMed

Stodden, David F; Langendorfer, Stephen J; Fleisig, Glenn S; Andrews, James R

2006-12-01

The purposes of this study were to: (a) examine the differences within 11 specific kinematic variables and an outcome measure (ball velocity) associated with component developmental levels of humerus and forearm action (Roberton & Halverson, 1984), and (b) if the differences in kinematic variables were significantly associated with the differences in component levels, determine potential kinematic constraints associated with skilled throwing acquisition. Significant differences among component levels in five of six humerus kinematic variables (p <.01) and all five forearm kinematic variables (p < .01) were identified using multivariate analysis of variance. These kinematic variables represent potential control parameters and, therefore, constraints on overarm throwing acquisition.

Vascularized fibular epiphyseal transfer for proximal humeral reconstruction in children with a primary sarcoma of bone.

PubMed

Stevenson, J D; Doxey, R; Abudu, A; Parry, M; Evans, S; Peart, F; Jeys, L

2018-04-01

Aims Preserving growth following limb-salvage surgery of the upper limb in children remains a challenge. Vascularized autografts may provide rapid biological incorporation with the potential for growth and longevity. In this study, we aimed to describe the outcomes following proximal humeral reconstruction with a vascularized fibular epiphyseal transfer in children with a primary sarcoma of bone. We also aimed to quantify the hypertrophy of the graft and the annual growth, and to determine the functional outcomes of the neoglenofibular joint. Patients and Methods We retrospectively analyzed 11 patients who underwent this procedure for a primary bone tumour of the proximal humerus between 2004 and 2015. Six had Ewing's sarcoma and five had osteosarcoma. Their mean age at the time of surgery was five years (two to eight). The mean follow-up was 5.2 years (1 to 12.2). Results The overall survival at five and ten years was 91% (confidence interval (CI) 95% 75% to 100%). At the time of the final review, ten patients were alive. One with local recurrence and metastasis died one-year post-operatively. Complications included seven fractures, four transient nerve palsies, and two patients developed avascular necrosis of the graft. All the fractures presented within the first postoperative year and united with conservative management. One patient had two further operations for a slipped fibular epiphysis of the autograft, and a hemi-epiphysiodesis for lateral tibial physeal arrest. Hypertrophy and axial growth were evident in nine patients who did not have avascular necrosis of the graft. The mean hypertrophy index was 65% (55% to 82%), and the mean growth was 4.6 mm per annum (2.4 to 7.6) in these nine grafts. At final follow-up, the mean modified functional Musculoskeletal Tumour Society score was 77% (63% to 83%) and the mean Toronto Extremity Salvage Score (TESS) was 84% (65% to 94%). Conclusion Vascularized fibular epiphyseal transfer preserves function and growth in young children following excision of the proximal humerus for a malignant bone tumour. Function compares favourably to other limb-salvage procedures in children. Longer term analysis is required to determine if this technique proves to be durable into adulthood. Cite this article: Bone Joint J 2018;100-B:535-41.

Three-dimensional assessment of curvature, torsion, and canal flare index of the humerus of skeletally mature nonchondrodystrophic dogs.

PubMed

Smith, Emily J; Marcellin-Little, Denis J; Harrysson, Ola L A; Griffith, Emily H

2017-10-01

OBJECTIVE To assess 3-D geometry of the humerus of dogs and determine whether the craniocaudal canal flare index (CFI) is associated with specific geometric features. SAMPLE CT images (n = 40) and radiographs (38) for 2 groups of skeletally mature nonchondrodystrophic dogs. PROCEDURES General dimensions (length, CFI, cortical thickness, and humeral head offset), curvature (shaft, humeral head, and glenoid cavity), version (humeral head and greater tubercle), and torsion were evaluated on CT images. Dogs were allocated into 3 groups on the basis of the craniocaudal CFI, and results were compared among these 3 groups. The CT measurements were compared with radiographic measurements obtained for another group of dogs. RESULTS Mean ± SD humeral head version was -75.9 ± 9.6° (range, -100.7° to -59.4°). Mean mechanical lateral distal humeral angle, mechanical caudal proximal humeral angle, and mechanical cranial distal humeral angle were 89.5 ± 3.5°, 50.2 ± 4.5°, and 72.9 ± 7.8°, respectively, and did not differ from corresponding radiographic measurements. Mean humeral curvature was 20.4 ± 4.4° (range, 9.6° to 30.5°). Mean craniocaudal CFI was 1.74 ± 0.18 (range, 1.37 to 2.10). Dogs with a high craniocaudal CFI had thicker cranial and medial cortices than dogs with a low craniocaudal CFI. Increased body weight was associated with a lower craniocaudal CFI. Radiographic and CT measurements of craniocaudal CFI and curvature differed significantly. CONCLUSIONS AND CLINICAL RELEVANCE CT-based 3-D reconstructions allowed the assessment of shaft angulation, torsion, and CFI. Radiographic and CT measurements of shaft curvature and CFI may differ.

Is the assessment of the central skeleton sufficient for osseous staging in breast cancer patients? A retrospective approach using bone scans.

PubMed

Krammer, Julia; Engel, Dorothee; Schnitzer, Andreas; Kaiser, Clemens G; Dinter, Dietmar J; Brade, Joachim; Schoenberg, Stefan O; Wasser, Klaus

2013-06-01

By analyzing bone scans we aimed to determine whether the assessment of the central skeleton is sufficient for osseous staging in breast cancer patients. This might be of interest for future staging modalities, especially positron emission tomography/computed tomography, usually sparing the peripheral extremities, as well as the skull. In this retrospective study, a total of 837 bone scans for initial staging or restaging of breast cancer were included. A total of 291 bone scans in 172 patients were positive for bone metastases. The localization and distribution of the metastases were re-evaluated by two readers in consensus. The extent of the central skeleton involvement was correlated to the incidence of peripheral metastases. In all 172 patients bone metastases were seen in the central skeleton (including the proximal third of humerus and femur). In 34 patients (19.8 %) peripheral metastases of the extremities (distally of the proximal third of humerus and femur) could be detected. Sixty-four patients (37.2 %) showed metastases of the skull. Summarizing the metastases of the distal extremities and skull, 79 patients (45.9 %) had peripheral metastases. None of the patients showed peripheral metastases without any affliction of the central skeleton. The incidence of peripheral metastases significantly correlated with the extent of central skeleton involvement (p<0.001). Regarding bone scans, an isolated metastatic spread to the peripheral skeleton without any manifestation in the central skeleton seems to be the exception. Thus, the assessment of the central skeleton should be sufficient in osseous breast cancer staging and restaging. However, in case of central metastases, additional imaging of the periphery should be considered for staging and restaging.

Medicaid payer status is linked to increased rates of complications after treatment of proximal humerus fractures.

PubMed

Sabesan, Vani J; Petersen-Fitts, Graysen; Lombardo, Daniel; Briggs, Daniel; Whaley, James

2017-06-01

Low socioeconomic status and Medicaid insurance as a primary payer have been associated with major disparities in resource utilization and risk-adjusted outcomes for patients undergoing total joint arthroplasty. With the expansion of Medicaid through the Affordable Care Act in 2014, examination of these disparities has become increasingly relevant for the treatment of proximal humerus fracture (PHF). The Healthcare Cost and Utilization Project Nationwide Inpatient Sample database was used to identify patients who were treated for PHF from 2002 to 2012. Primary outcomes included treatment type, surgical fixation method, in-hospital complications, mean length of stay, and mean total charges for Medicaid patients vs. a matched privately insured cohort. In an effort to minimize confounding variables, each Medicaid patient was matched to a privately insured patient on the basis of gender, race, year of procedure, and age. Of the 678,831 patients treated with PHF, 4.9% (33,263) had Medicaid as the primary payer during the 10-year period. Medicaid patients were found to have a significantly higher risk (P < .05) of postoperative in-hospital complications, including postoperative infection (odds ratio [OR], 2.00 [1.37-2.93]), wound complications (OR, 1.69 [1.04-2.75]), and acute respiratory distress syndrome (OR, 1.34 [1.15-1.59]). Medicaid patients have a significantly higher risk for certain postoperative hospital complications and consume more resources after treatment for PHFs. Additional work is needed to understand the optimal treatment type for Medicaid patients and to understand the complex interplay between socioeconomic status and outcomes to ensure appropriate resource allocation and risk stratification. Copyright © 2016 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A geometric morphometrics comparative analysis of Neandertal humeri (epiphyses-fused) from the El Sidrón cave site (Asturias, Spain).

PubMed

Rosas, Antonio; Pérez-Criado, Laura; Bastir, Markus; Estalrrich, Almudena; Huguet, Rosa; García-Tabernero, Antonio; Pastor, Juan Francisco; de la Rasilla, Marco

2015-05-01

A new collection of 49,000 year old Neandertal fossil humeri from the El Sidrón cave site (Asturias, Spain) is presented. A total of 49 humeral remains were recovered, representing 10 left and 8 right humeri from adults, adolescents, and a juvenile (not included in the analyses). 3D geometric morphometric (GM) methods as well as classic anthropological variables were employed to conduct a broad comparative analysis by means of mean centroid size and shape comparisons, principal components analysis, and cluster studies. Due to the fragmentary nature of the fossils, comparisons were organized in independent analyses according to different humeral portions: distal epiphysis, diaphysis, proximal epiphysis, and the complete humerus. From a multivariate viewpoint, 3D-GM analyses revealed major differences among taxonomic groups, supporting the value of the humerus in systematic classification. Notably, the Australopithecus anamensis (KP-271) and Homo ergaster Nariokotome (KNM-WT 15000) distal humerus consistently clusters close to those of modern humans, which may imply a primitive condition for Homo sapiens morphology. Australopithecus specimens show a high degree of dispersion in the morphospace. The El Sidrón sample perfectly fits into the classic Neandertal pattern, previously described as having a relatively wide olecranon fossa, as well as thin lateral and medial distodorsal pillars. These characteristics were also typical of the Sima de los Huesos (Atapuerca) sample, African mid-Pleistocene Bodo specimen, and Lower Pleistocene TD6-Atapuerca remains and may be considered as a derived state. Finally, we hypothesize that most of the features thought to be different between Neandertals and modern humans might be associated with structural differences in the pectoral girdle and shoulder joint. Copyright © 2015 Elsevier Ltd. All rights reserved.

Diversity and evolution of the Confuciusornithidae: Evidence from a new 131-million-year-old specimen from the Huajiying Formation in NE China

NASA Astrophysics Data System (ADS)

Navalón, Guillermo; Meng, Qingjin; Marugán-Lobón, Jesús; Zhang, Yuguang; Wang, Baopeng; Xing, Hai; Liu, Di; Chiappe, Luis M.

2018-02-01

The Huajiying Formation contains the earliest deposits of the Jehol Biota, representing the world's second oldest avifauna. This avifauna includes the early confuciusornithid Eoconfuciusornis zhengi, the oldest occurrence of this clade and one of the earliest divergences of pygostylian birds. Although E. zhengi shows unique traits, the holotype's immature age makes comparisons with the better known Confuciusornis sanctus problematic. As a result, the taxonomic validity of E. zhengi is controversial. We describe a small, osteologically adult confuciusornithid from the same deposits as E. zhengi. The new fossil is most similar to E. zhengi but also shares traits with the stratigraphically younger Confuciusornis. The humerus of the new fossil is straighter and more slender, and bears a less dorsally-developed deltopectoral crest compared with similarly-sized and smaller specimens of Confuciusornis. The morphology of the humerus is intermediate between E. zhengi and Confuciusornis and its proximal portion is pierced by a small deltopectoral foramen, absent in the holotype of E. zhengi. However, this foramen is much smaller than in any other confuciusornithid. Shape analyses (geometric morphometrics) of the humerus of confuciusornithids of different ages and representatives of other basal avians and closely-related non-avian theropods supports our observations and indicate that the humeral differences between the holotype of E. zhengi and the new specimen are not easily explained as ontogenetic variation within a single species. However, the limited number of early confuciursornithids does not allow us to confidently interpret such differences as interspecific. Nonetheless, these analyses support the morphological distinctiveness of the early confuciusornithids from the Huajiying Formation and suggest a stepwise acquisition of the unique humeral morphology of Confuciusornithidae.

A small azhdarchoid pterosaur from the latest Cretaceous, the age of flying giants.

PubMed

Martin-Silverstone, Elizabeth; Witton, Mark P; Arbour, Victoria M; Currie, Philip J

2016-08-01

Pterosaur fossils from the Campanian-Maastrichtian of North America have been reported from the continental interior, but few have been described from the west coast. The first pterosaur from the Campanian Northumberland Formation (Nanaimo Group) of Hornby Island, British Columbia, is represented here by a humerus, dorsal vertebrae (including three fused notarial vertebrae), and other fragments. The elements have features typical of Azhdarchoidea, an identification consistent with dominance of this group in the latest Cretaceous. The new material is significant for its size and ontogenetic stage: the humerus and vertebrae indicate a wingspan of ca 1.5 m, but histological sections and bone fusions indicate the individual was approaching maturity at time of death. Pterosaurs of this size are exceedingly rare in Upper Cretaceous strata, a phenomenon commonly attributed to smaller pterosaurs becoming extinct in the Late Cretaceous as part of a reduction in pterosaur diversity and disparity. The absence of small juveniles of large species-which must have existed-in the fossil record is evidence of a preservational bias against small pterosaurs in the Late Cretaceous, and caution should be applied to any interpretation of latest Cretaceous pterosaur diversity and success.

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.

An integer programming model for distal humerus fracture fixation planning.

PubMed

Maratt, Joseph D; Peaks, Ya-Sin A; Doro, Lisa Case; Karunakar, Madhav A; Hughes, Richard E

2008-05-01

To demonstrate the feasibility of an integer programming model to assist in pre-operative planning for open reduction and internal fixation of a distal humerus fracture. We describe an integer programming model based on the objective of maximizing the reward for screws placed while satisfying the requirements for sound internal fixation. The model maximizes the number of bicortical screws placed while avoiding screw collision and favoring screws of greater length that cross multiple fracture planes. The model was tested on three types of total articular fractures of the distal humerus. Solutions were generated using 5, 9, 21 and 33 possible screw orientations per hole. Solutions generated using 33 possible screw orientations per hole and five screw lengths resulted in the most clinically relevant fixation plan and required the calculation of 1,191,975 pairs of screws that resulted in collision. At this level of complexity, the pre-processor took 104 seconds to generate the constraints for the solver, and a solution was generated in under one minute in all three cases. Despite the large size of this problem, it can be solved in a reasonable amount of time, making use of the model practical in pre-surgical planning.

Review of literature of radial nerve injuries associated with humeral fractures-an integrated management strategy.

PubMed

Li, YuLin; Ning, GuangZhi; Wu, Qiang; Wu, QiuLi; Li, Yan; Feng, ShiQing

2013-01-01

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. 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; I(2) = 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. 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.

Inhalant abuse of 1,1-difluoroethane (DFE) leading to heterotopic ossification: a case report

PubMed Central

Little, Jill; Hileman, Barbara; Ziran, Bruce H

2008-01-01

Background Heterotopic ossification (HO) is the formation of mature, lamellar bone within soft tissues other than the periosteum. There are three recognized etiologies of HO: traumatic, neurogenic, and genetic. Presently, there are no definitively documented causal factors of HO. The following factors are presumed to place a patient at higher risk: 60 years of age or older, male, previous HO, hypertrophic osteoarthritis, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, prior hip surgery, and surgical risk factors. Case presentation A 33-year-old male, involved in a motor vehicle crash, sustained an irreducible acetabulum fracture/dislocation, displaced proximal humerus fracture, and an impacted pilon fracture. During the time of injury, he was intoxicated from inhaling the aerosol propellant used in "dust spray" cans (1,1-difluoroethane, C2H4F2). Radiographs identified rapid pathologic bone formation about the proximal humeral metaphysis, proximal femur, elbow, and soft tissue several months following the initial injury. Discussion The patient did not have any genetic disorders that could have attributed to the bone formation but had some risk factors (male, fracture with dislocation). Surgically, the recommended precautions were followed to decrease the chance of HO. Although the patient did not have neurogenic injuries, the difluoroethane in dusting spray can cause damage to the central nervous system. Signals may have been mixed causing the patient's body to produce bone instead of tissue to strengthen the injured area. Conclusion What is unusual in this case is the rate at which the pathological bone formation appeared, which was long outside the 4–6 week window in which HO starts to appear. The authors are not certain as to the cause of this rapid formation but suspect that the patient's continued abuse of inhaled aerosol propellants may be the culprit. PMID:18973696

Inhalant abuse of 1,1-difluoroethane (DFE) leading to heterotopic ossification: a case report.

PubMed

Little, Jill; Hileman, Barbara; Ziran, Bruce H

2008-10-30

Heterotopic ossification (HO) is the formation of mature, lamellar bone within soft tissues other than the periosteum. There are three recognized etiologies of HO: traumatic, neurogenic, and genetic. Presently, there are no definitively documented causal factors of HO. The following factors are presumed to place a patient at higher risk: 60 years of age or older, male, previous HO, hypertrophic osteoarthritis, ankylosing spondylitis, diffuse idiopathic skeletal hyperostosis, prior hip surgery, and surgical risk factors. A 33-year-old male, involved in a motor vehicle crash, sustained an irreducible acetabulum fracture/dislocation, displaced proximal humerus fracture, and an impacted pilon fracture. During the time of injury, he was intoxicated from inhaling the aerosol propellant used in "dust spray" cans (1,1-difluoroethane, C2H4F2). Radiographs identified rapid pathologic bone formation about the proximal humeral metaphysis, proximal femur, elbow, and soft tissue several months following the initial injury. The patient did not have any genetic disorders that could have attributed to the bone formation but had some risk factors (male, fracture with dislocation). Surgically, the recommended precautions were followed to decrease the chance of HO. Although the patient did not have neurogenic injuries, the difluoroethane in dusting spray can cause damage to the central nervous system. Signals may have been mixed causing the patient's body to produce bone instead of tissue to strengthen the injured area. What is unusual in this case is the rate at which the pathological bone formation appeared, which was long outside the 4-6 week window in which HO starts to appear. The authors are not certain as to the cause of this rapid formation but suspect that the patient's continued abuse of inhaled aerosol propellants may be the culprit.

Short stature and growth hormone deficiency in a girl with encephalocraniocutaneous lipomatosis and Jaffe-Campanacci syndrome: a case report.

PubMed

Choi, Eun Mi; Jung, Nani; Shim, Ye Jee; Choi, Hee Joung; Kim, Joon Sik; Kim, Heung Sik; Song, Kwang Soon; Lee, Hee Jung; Kim, Sang Pyo

2016-12-01

A 9-year-old Tajikistani girl presented to Keimyung University Dongsan Medical Center for evaluation of a skin lesion on her left eyelid, focal alopecia, unilateral ventricular dilatation, and aortic coarctation. She was diagnosed with encephalocraniocutaneous lipomatosis (ECCL) according to Moog's diagnostic criteria. Café-au-lait spots were found on the left side of her trunk. Multiple nonossifying fibromas were found on her left proximal humerus, left distal femur, both proximal tibias, and left proximal fibula, suggesting Jaffe-Campanacci syndrome (JCS), following imaging of the extremities. Many JCS cases with multiple Café-au-lait macules, multiple nonossifying fibromas may actually have Neurofibromatosis type-1 (NF1). Thus, comprehensive molecular analysis to exclude NF1 mutation was performed using her blood sample. The NF1 mutation was not found. Her height was under the 3rd percentile and her bone age was delayed as compared with her chronological age. Baseline growth hormone (GH) level was below the normal range. Using the insulin stimulation and levo-dihydroxyphenylalanine tests, GH deficiency was confirmed. We present a case of GH deficiency with typical features of ECCL and JCS.

Assessment of modified gold surfaced titanium implants on skeletal fixation.

PubMed

Zainali, Kasra; Danscher, Gorm; Jakobsen, Thomas; Baas, Jorgen; Møller, Per; Bechtold, Joan E; Soballe, Kjeld

2013-01-01

Noncemented implants are the primary choice for younger patients undergoing total hip replacements. However, the major concern in this group of patients regarding revision is the concern from wear particles, periimplant inflammation, and subsequently aseptic implant loosening. Macrophages have been shown to liberate gold ions through the process termed dissolucytosis. Furthermore, gold ions are known to act in an anti-inflammatory manner by inhibiting cellular NF-κB-DNA binding. The present study investigated whether partial coating of titanium implants could augment early osseointegration and increase mechanical fixation. Cylindrical porous coated Ti-6Al-4V implants partially coated with metallic gold were inserted in the proximal region of the humerus in ten canines and control implants without gold were inserted in contralateral humerus. Observation time was 4 weeks. Biomechanical push out tests and stereological histomorphometrical analyses showed no statistically significant differences in the two groups. The unchanged parameters are considered an improvement of the coating properties, as a previous complete gold-coated implant showed inferior mechanical fixation and reduced osseointegration compared to control titanium implants in a similar model. Since sufficient early mechanical fixation is achieved with this new coating, it is reasonable to investigate the implant further in long-term studies. Copyright © 2012 Wiley Periodicals, Inc.

Potential ecotoxic effects of polychlorinated biphenyls on Xenopus laevis.

PubMed

Qin, Zhan-Fen; Zhou, Jing-Ming; Cong, Lin; Xu, Xiao-Bai

2005-10-01

We examined potential ecotoxic effects of polychlorinated biphenyl (PCB)3, PCB5, Aroclor 1254, and Aroclor 1242 on Xenopus laevis. Tadpoles were exposed to PCBs from stage 46/47 (system of Nieuwkoop and Faber) to the completion of metamorphosis. We demonstrated, to our knowledge for the first time, forelimb malformations caused by PCBs (malformation rate, > 70%). The malformed forelimbs were fixed in the adduction-backward rotation position and could not move. Therefore, malformed male frogs were destined to have no offspring, because they could not grasp the females with their forelimbs to mate. Alcian blue-alizarin red double-staining indicated that the forelimb malformation resulted from the shoulder abnormality. Compared with the normal shoulder joint, the proximal humerus with the humerus inter-rotated 90 degrees in the abnormal shoulder joint. Moreover, testes from more than a third of male frogs with exposed to PCBs exhibited feminization to different degrees at gross morphology and histology, with fewer or abnormal spermatogonia and oocytes. Gonadal abnormalities would lead directly to reproductive dysfunction and population decline. These results suggest that PCBs have potentially ecotoxic effects on amphibian populations. We infer that PCBs could play roles in amphibian malformations and population declines, at least at sites that are polluted heavily with PCBs.

Applicability of T1-weighted MRI in the assessment of forensic age based on the epiphyseal closure of the humeral head.

PubMed

Ekizoglu, Oguzhan; Inci, Ercan; Ors, Suna; Kacmaz, Ismail Eralp; Basa, Can Doruk; Can, Ismail Ozgur; Kranioti, Elena F

2018-05-26

This work investigates the value of magnetic resonance imaging analysis of proximal epiphyseal fusion in research examining the growth and development of the humerus and its potential utility in establishing forensic age estimation. In this study, 428 proximal humeral epiphyses (patient age, 12-30 years) were evaluated with T1-weighted turbo spin echo (T1 TSE) sequences in coronal oblique orientation on shoulder MRI images. A scoring system was created following a combination of the Schmeling and Kellinghaus methods. Spearman's rank correlation analysis revealed a significant positive relationship between age and ossification stage of the proximal humeral epiphysis (all subjects: rho = 0.664, p < 0.001; males: 0.631, p < 0.001; females: rho = 0.651, p < 0.001). The intra- and inter-observer reliability assessed using Cohen's kappa statistic was κ = 0.898 and κ = 0.828, respectively. The earliest age of epiphysis closure was 17 years for females and 18 years for males. MRI of the proximal humeral epiphysis can be considered advantageous for forensic age estimation of living individuals in a variety of situations, ranging from monitoring public health to estimating the age of illegal immigrants/asylum seekers, minors engaged in criminal activities, and illegal participants in competitive sports, without the danger of radiation exposure.

Measurement of humerus and radius bone mineral content in the term and preterm infant

DOE Office of Scientific and Technical Information (OSTI.GOV)

Vyhmeister, N.R.; Linkhart, T.A.

1988-07-01

We compared two anatomic sites for single-photon absorptiometric measurement of bone mineral content (BMC) in term and preterm infants. The distal one third of the radius and the midportion of the humerus were evaluated for measurements of BMC with an unmodified, commercially available bone densitometer. We assessed reproducibility of BMC and bone width (BW) measurements and defined normal at-birth ranges of BMC, BW, and BMC/BW ratio for infants with gestational ages of 24 to 42 weeks. Humerus BMC correlated with gestational age, birth weight, and BW of patients and did not differ from humerus BMC values determined over the samemore » range of gestational ages at another center. Representative serial measurements of two very low birth weight (VLBW) infants are presented to demonstrate the feasibility of using humerus BMC in longitudinal studies to assess changes in bone mineralization. We conclude that bone densitometer measurements of mid-humerus BMC can be successfully performed and are preferable to similar measurements of the radius for VLBW infants. Normal humerus BMC values were defined for use in diagnosis and evaluation of the efficacy of treatment in VLBW infants who are at high risk of developing osteopenia of prematurity.« less

Modified rush pin technique for two- or three-part proximal humeral fractures.

PubMed

Mallick, A; Hearth, M; Singh, S; Pandey, R

2008-12-01

To report the outcomes of modified Rush pin fixation for proximal humeral fractures. 42 men and 20 women aged 19 to 94 (mean, 64) years with 2- or 3-part proximal humeral fractures underwent reduction and fixation using the modified Rush pin technique. 11 patients died from reasons unrelated to the surgery. Of 40 (out of 51) patients completing a subjective functional assessment using an Oxford Shoulder Questionnaire, 28 (70%) had 2-part and 10 (25%) had 3-part displaced fractures, and the remaining 2 (5%) had fracture-dislocations (one being 2-part and one 3-part). 25 (63%) patients were very satisfied (including one with a 3-part fracture after 6 months of rehabilitation), 7 (17%) were moderately satisfied, and 8 (20%) were not satisfied. There were 8 complications, including pin cut-out from the proximal fragment (n=2), proximal pin migration (n=2), distal pin migration (n=1), cortical perforation during surgery (n=1), mild ulnar nerve symptoms (n=1). No patients had non-union, myositis ossificans, avascular necrosis of the humeral head, or axillary nerve injury. The modified Rush pin fixation minimises tissue dissection; the implants are cheap and readily available; and the technical expertise is easily learnt. This technique is a suitable alternative of fixing proximal humeral fractures, especially in the elderly.

The Bare Area of the Proximal Ulna: An Anatomic Study With Relevance to Chevron Osteotomy.

PubMed

Ao, Rongguang; Zhang, Xu; Li, Dejian; Chen, Fancheng; Zhou, Jianhua; Yu, Baoqing

2017-06-01

A chevron osteotomy of the ulna is widely used to obtain intra-articular access to the elbow in the treatment of type C distal humerus fractures. The trochlear notch of the proximal ulna is divided into 2 articular parts by the "bare area." Ideally, the olecranon osteotomy should be centered on the bare area to minimize damage to the joint cartilage. The goals of this study were to describe the anatomy of the bare area and design an ideal chevron-shaped osteotomy. We dissected 38 cadaver elbows and measured the width of the bare area, the distance between the tip of the triceps insertion and the area on the olecranon cortex corresponding to the bare area. We then designed a chevron osteotomy to stay within the bare area and measured the distance from the tip of the triceps insertion to the osteotomy apex as well as the angle of the osteotomy plane and the angle of the chevron cuts. The bare area existed in all 38 cadavers. The mean longitudinal and transverse widths were 4.0 mm (range, 1.0-8.6 mm) and 19.0 mm (range, 16.9-23.8 mm), respectively. The mean distance between the tip of the triceps insertion and the area on the olecranon cortex corresponding to the bare area was 19.0 mm (range, 16.0-23.0 mm). The mean transverse and longitudinal widths of the cortical notch were 3.0 mm (range, 1.6-4.5 mm) and 8.0 mm (range, 6.5-14.8 mm), respectively. The mean distance between the tip of the triceps insertion and the osteotomy apex was 22.0 mm (range, 18.0-24.0 mm) and the mean angle between the osteotomy surface and the vertical plane corresponding to the tangent plane was 20° (range, 10° to 25°). The mean angle of the V shape was 140° (range, 130° to 150°). Using the narrowest edge lacking cartilage (lateral or medial side) as a point of reference to locate the bare area, the designed chevron osteotomy entered the joint in the bare area in most specimens and decreased associated damage to the joint cartilage. This study describes the anatomy of the bare area and the design of the ideal chevron-shaped osteotomy to treat type C distal humerus fractures. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Bone cysts: unicameral and aneurysmal bone cyst.

PubMed

Mascard, E; Gomez-Brouchet, A; Lambot, K

2015-02-01

Simple and aneurysmal bone cysts are benign lytic bone lesions, usually encountered in children and adolescents. Simple bone cyst is a cystic, fluid-filled lesion, which may be unicameral (UBC) or partially separated. UBC can involve all bones, but usually the long bone metaphysis and otherwise primarily the proximal humerus and proximal femur. The classic aneurysmal bone cyst (ABC) is an expansive and hemorrhagic tumor, usually showing characteristic translocation. About 30% of ABCs are secondary, without translocation; they occur in reaction to another, usually benign, bone lesion. ABCs are metaphyseal, excentric, bulging, fluid-filled and multicameral, and may develop in all bones of the skeleton. On MRI, the fluid level is evocative. It is mandatory to distinguish ABC from UBC, as prognosis and treatment are different. UBCs resolve spontaneously between adolescence and adulthood; the main concern is the risk of pathologic fracture. Treatment in non-threatening forms consists in intracystic injection of methylprednisolone. When there is a risk of fracture, especially of the femoral neck, surgery with curettage, filling with bone substitute or graft and osteosynthesis may be required. ABCs are potentially more aggressive, with a risk of bone destruction. Diagnosis must systematically be confirmed by biopsy, identifying soft-tissue parts, as telangiectatic sarcoma can mimic ABC. Intra-lesional sclerotherapy with alcohol is an effective treatment. In spinal ABC and in aggressive lesions with a risk of fracture, surgical treatment should be preferred, possibly after preoperative embolization. The risk of malignant transformation is very low, except in case of radiation therapy. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

The gender- and age-specific 10-year and lifetime absolute fracture risk in Tromsø, Norway.

PubMed

Ahmed, Luai A; Schirmer, Henrik; Bjørnerem, Ashild; Emaus, Nina; Jørgensen, Lone; Størmer, Jan; Joakimsen, Ragnar M

2009-01-01

Aim of this study is to estimate the gender- and age-specific 10-year and lifetime absolute risks of non-vertebral and osteoporotic (included hip, distal forearm and proximal humerus) fractures in a large cohort of men and women. This is a population-based 10 years follow-up study of 26,891 subjects aged 25 years and older in Tromsø, Norway. All non-vertebral fractures were registered from 1995 throughout 2004 by computerized search in radiographic archives. Absolute risks were estimated by life-table method taking into account the competing risk of death. The absolute fracture risk at each year of age was estimated for the next 10 years (10-year risk) or up to the age of 90 years (lifetime risk). The estimated 10-year absolute risk of all non-vertebral fracture was higher in men than women before but not after the age of 45 years. The 10-year absolute risk for non-vertebral and osteoporotic fractures was over 10%, respectively, in men over 65 and 70 years and in women over 45 and 50 years of age. The 10-year absolute risks of hip fractures at the age of 65 and 80 years were 4.2 and 18.6% in men, and 9.0 and 24.0% in women, respectively. The risk estimates for distal forearm and proximal humerus fractures were under 5% in men and 13% in women. The estimated lifetime risks for all fracture locations were higher in women than men at all ages. At the age of 50 years, the risks were 38.1 and 24.8% in men and 67.4 and 55.0% in women for all non-vertebral and osteoporotic fractures, respectively. The estimated gender- and age-specific 10-year and lifetime absolute fracture risk were higher in Tromsø than in other populations. The high lifetime fracture risk reflects the increased burden of fractures in this cohort.

Hemiarthroplasty for proximal humerus fracture and consequences of a comminuted greater tubercle fragment.

PubMed

Hoel, S; Jensen, T G; Falster, O; Ulstrup, A

2016-04-01

A prerequisite for a satisfying functional result in the treatment of comminuted fractures of the proximal humerus with hemiarthroplasty is anatomical reduction, fixation and healing of the tuberculi around the prosthetic neck in order to restore normal function of the rotator cuff. This was a retrospective study to examine the outcome after hemiarthroplasty using a prosthetic stem designed to optimise re-attachment and healing of the tuberculi (Aequalis; Tornier and Global Fx, DePuy). A special emphasis was on the effect on outcome a comminuted greater tubercle might have. At follow-up, clinical results were evaluated using the Constant score and WOOS index. All patients had radiographs taken of the injured shoulder. Quality of tubercle healing and prosthetic height were estimated; acromiohumeral distance was registered as well as greater tubercle comminution and resorption. Thirty-four patients with 35 hemiarthroplasties were included. Mean age was 71 years (range 47-88) at the time of injury. At follow-up (mean 38 months, range 23-67), the mean Constant score was 44 points (range 18-87). The mean WOOS index was 58 (range 15-96). A comminuted tubercle was associated with tubercle resorption and superior migration of the arthroplasty. Also, there was a correlation for the functional Constant score, but for the WOOS index, there was none. Like several other studies, we generally saw a group of patients with limited pain but poor range of movement in the shoulder. Our hypothesis was that comminution of the greater tubercle would correlate with both rotator cuff arthropathic radiographical features and more detrimental functional scores than average. Thus, a subtype of fracture could be identified at the time of injury and perhaps be allocated to a different treatment than hemiarthroplasty. Due to a limited number of patients in this study, we are unable to make any strong statistically supported conclusions regarding this hypothesis. Level 4 evidence.

Allograft-Prosthetic Composite Reconstruction for Massive Proximal Humeral Bone Loss in Reverse Shoulder Arthroplasty.

PubMed

Sanchez-Sotelo, Joaquin; Wagner, Eric R; Sim, Franklin H; Houdek, Matthew T

2017-12-20

Reverse total shoulder arthroplasty (RTSA) performed in the setting of massive proximal humeral bone loss often requires special reconstructive techniques. Restoration of the proximal part of the humerus with an allograft provides a number of theoretical benefits, including implant support, restoration of humeral length, deltoid tensioning, and an opportunity to repair the posterior aspect of the cuff to improve strength in external rotation and repair of the subscapularis to improve stability. However, reverse allograft-prosthesis composites (APCs) are costly, are technically demanding to use, and can be compromised by progressive allograft resorption. Between 2005 and 2012, the lead author used an APC reconstruction in 8 primary and 18 revision RTSAs (26 patients; mean age, 62 years; mean body mass index, 27.9 kg/m). The indications for the primary RTSAs included severe proximal humeral bone loss after trauma (n = 5) and tumor resection (n = 3). The indications in the revision setting were failed hemiarthroplasty (n = 11), anatomic total shoulder arthroplasty (n = 4), and reverse arthroplasty (n = 3). The most common reason for revision was instability (n = 10). A compression plate was used for graft-to-host fixation in all shoulders. Shoulders were assessed for pain, motion, American Shoulder and Elbow Surgeons (ASES) score, Simple Shoulder Test (SST) score, Neer score, revision or reoperation, radiographic evidence of graft union or resorption, and implant fixation. The mean duration of follow-up was 4 years (range, 2 to 10 years). RTSA using an APC construct resulted in substantial improvements in pain scores (p < 0.0001), elevation (p < 0.0001), and external rotation (p = 0.004). With the numbers available, there were no significant differences in clinical outcomes between primary and revision cases. No patients required revision surgery for nonunion at the host-allograft junction. The mean time to union was 7 months, with 1 patient requiring bone-grafting for delayed union. Other complications included dislocation, deep infection, graft fracture, and periprosthetic fracture distal to the previous APC construct in 1 patient each. The 2 and 5-year revision-free survival rate was 96%. Reconstruction of proximal humeral bone loss with an APC at the time of primary or revision RTSA is safe and effective, with acceptable functional outcomes and complication rates. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

The Influence of Local Bone Density on the Outcome of One Hundred and Fifty Proximal Humeral Fractures Treated with a Locking Plate.

PubMed

Kralinger, Franz; Blauth, Michael; Goldhahn, Jörg; Käch, Kurt; Voigt, Christine; Platz, Andreas; Hanson, Beate

2014-06-18

There is biomechanical evidence that bone density predicts the mechanical failure of implants. The aim of this prospective study was to evaluate the influence of local bone mineral density on the rate of mechanical failure after locking plate fixation of proximal humeral fractures. We enrolled 150 patients who were from fifty to ninety years old with a closed, displaced proximal humeral fracture fixed with use of a locking plate from July 2007 to April 2010. There were 118 women and thirty-two men who had a mean age of sixty-nine years. Preoperative computed tomography (CT) scans were done to assess bone mineral density of the contralateral humerus, and dual x-ray absorptiometry of the distal end of the radius of the unaffected arm was conducted within the first six weeks postoperatively. At follow-up evaluations at six weeks, three months, and one year postoperatively, pain, shoulder mobility, strength, and multiple functional and quality-of-life outcome measures (Disabilities of the Arm, Shoulder and Hand [DASH] questionnaire; Shoulder Pain and Disability Index [SPADI]; Constant score; and EuroQuol-5D [EQ-5D]) were done and standard radiographs were made. We defined mechanical failure as all complications related to bone quality experienced within one year. After locking plate fixation, fifty-three (35%) of 150 patients had mechanical failure; loss of reduction and secondary screw loosening with perforation were common. CT assessments of local bone mineral density showed no difference between patients with and without mechanical failure (89.82 versus 91.51 mg/cm 3 , respectively; p = 0.670). One-year DASH, SPADI, and Constant scores were significantly better for patients without mechanical failure (p ≤ 0.05). We did not find evidence of an association between bone mineral density and the rate of mechanical failures, which may suggest that patients with normal bone mineral density are less prone to sustain a proximal humeral fracture. Future studies should target other discriminating factors between patients with and without mechanical failure. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

The size of the supraspinatus outlet during elevation of the arm in the frontal and sagittal plane: a 3-D model study.

PubMed

Meskers, Carel G M; van der Helm, Frans C T; Rozing, Piet M

2002-05-01

To quantify the size of the supraspinatus outlet as it is dictated by both the three-dimensional geometry of the shoulder and the relative orientation of the humerus with respect to the scapula during motions of the arm. Previously obtained data of shoulder kinematics were brought into a geometrical model of the shoulder, derived from a cadaver study. Knowledge of the parameters dictating the size of the supraspinatus outlet is essential for a better understanding of the impingement syndrome of the shoulder. A geometrical model, based on fitting spheres to various anatomical items of the shoulder was derived from three-dimensional position data of the gleno-humeral joint and coraco-acromial arch of 32 cadaver shoulders. Kinematical data were collected from 10 healthy volunteers. The geometrical and kinematical data were combined to study the supraspinatus outlet during elevation of the humerus in the frontal and sagittal plane. No single geometry parameter correlated significantly with the initial size of the outlet. During arm elevation, the greater tuberosity was moved away from the coraco-acromial arch quite effectively resulting in narrowing of the outlet during elevation in the frontal plane from 60 degrees to 120 degrees only. Deviations from the average were quite substantial. This was caused by kinematical and especially geometrical variability. The size of the outlet is dictated by both the geometry and kinematics of the gleno-humeral joint. Assessment of the individual susceptibility to impingement requires three-dimensional viewing techniques including three-dimensional movements of both the scapula and humerus. Little is known about etiology and pathogenesis of various shoulder disorders such as the impingement syndrome. The supraspinatus outlet plays probably a key role. More knowledge on the architecture of the outlet is required for a better understanding.

Osteology of Galeamopus pabsti sp. nov. (Sauropoda: Diplodocidae), with implications for neurocentral closure timing, and the cervico-dorsal transition in diplodocids

PubMed Central

Mateus, Octávio

2017-01-01

Diplodocids are among the best known sauropod dinosaurs. Numerous specimens of currently 15 accepted species belonging to ten genera have been reported from the Late Jurassic to Early Cretaceous of North and South America, Europe, and Africa. The highest diversity is known from the Upper Jurassic Morrison Formation of the western United States: a recent review recognized 12 valid, named species, and possibly three additional, yet unnamed ones. One of these is herein described in detail and referred to the genus Galeamopus. The holotype specimen of Galeamopus pabsti sp. nov., SMA 0011, is represented by material from all body parts but the tail, and was found at the Howe-Scott Quarry in the northern Bighorn Basin in Wyoming, USA. Autapomorphic features of the new species include a horizontal canal on the maxilla that connects the posterior margin of the preantorbital and the ventral margin of the antorbital fenestrae, a vertical midline groove marking the sagittal nuchal crest, the presence of a large foramen connecting the postzygapophyseal centrodiapophyseal fossa and the spinopostzygapophyseal fossa of mid- and posterior cervical vertebrae, a very robust humerus, a laterally placed, rugose tubercle on the concave proximal portion of the anterior surface of the humerus, a relatively stout radius, the absence of a distinct ambiens process on the pubis, and a distinctly concave posteroventral margin of the ascending process of the astragalus. In addition to the holotype specimen SMA 0011, the skull USNM 2673 can also be referred to Galeamopus pabsti. Histology shows that the type specimen SMA 0011 is sexually mature, although neurocentral closure was not completed at the time of death. Because SMA 0011 has highly pneumatized cervical vertebrae, the development of the lamination appears a more important indicator for individual age than neurocentral fusion patterns. SMA 0011 is one of very few sauropod specimens that preserves the cervico-dorsal transition in both vertebrae and ribs. The association of ribs with their respective vertebrae shows that the transition between cervical and dorsal vertebrae is significantly different in Galeamopus pabsti than in Diplodocus carnegii or Apatosaurus louisae, being represented by a considerable shortening of the centra from the last cervical to the first dorsal vertebra. Diplodocids show a surprisingly high diversity in the Morrison Formation. This can possibly be explained by a combination of geographical and temporal segregation, and niche partitioning. PMID:28480132

Severe neurologic manifestations of fat embolism syndrome in a polytrauma patient.

PubMed

Makarewich, Chris A; Dwyer, Kevin W; Cantu, Robert V

2015-01-01

Fat embolism syndrome (FES) is most commonly diagnosed when the classic triad of respiratory difficulty, neurologic abnormalities, and petechial rash are present in the appropriate clinical setting. Neurologic manifestations can range from headache, confusion, and agitation to stupor and, less commonly, coma. This article describes a case of FES with severe neurologic sequelae without typical pulmonary involvement in a polytrauma patient with proximal humerus and L1 compression fractures. The case highlights the importance of considering FES in the patient with deteriorating mental status in the setting of multiple fractures, particularly in the absence of other characteristic clinical findings. Early recognition allows for the anticipation of other complications, such as respiratory distress and the potential need for mechanical ventilation.

A shift in anterior–posterior positional information underlies the fin-to-limb evolution

PubMed Central

Onimaru, Koh; Kuraku, Shigehiro; Takagi, Wataru; Hyodo, Susumu; Sharpe, James; Tanaka, Mikiko

2015-01-01

The pectoral fins of ancestral fishes had multiple proximal elements connected to their pectoral girdles. During the fin-to-limb transition, anterior proximal elements were lost and only the most posterior one remained as the humerus. Thus, we hypothesised that an evolutionary alteration occurred in the anterior–posterior (AP) patterning system of limb buds. In this study, we examined the pectoral fin development of catshark (Scyliorhinus canicula) and revealed that the AP positional values in fin buds are shifted more posteriorly than mouse limb buds. Furthermore, examination of Gli3 function and regulation shows that catshark fins lack a specific AP patterning mechanism, which restricts its expression to an anterior domain in tetrapods. Finally, experimental perturbation of AP patterning in catshark fin buds results in an expansion of posterior values and loss of anterior skeletal elements. Together, these results suggest that a key genetic event of the fin-to-limb transformation was alteration of the AP patterning network. DOI: http://dx.doi.org/10.7554/eLife.07048.001 PMID:26283004

Unicameral Bone Cysts of the Pelvis

PubMed Central

Hammoud, Sommer; Weber, Kristy; McCarthy, Edward F

2005-01-01

Unicameral bone cysts of the pelvis are extremely rare. This study summarizes the clinical, radiologic and pathologic features of 16 cases. Patients ranged in age from nine to 69. Most lesions were in the anterior portion of the iliac wing; many appeared to be related to an open iliac crest apophysis. This suggests that the pathogenesis of unicameral bone cysts in this portion of the ilium is similar to that seen in the proximal humerus and the proximal femur. The correct diagnosis was made preoperatively in only five cases. This indicates that, although they are well documented, unicameral bone cysts of the pelvis remain a diagnostic problem. Patients received a spectrum of treatments from curettage to observation. There appeared to be no difference in the outcome after any form of treatment. Therefore, unicameral bone cysts of the pelvis can be managed conservatively. The choice to manage patients conservatively depends on making the correct diagnosis based on clinical history and imaging. The most effective imaging is a combination of plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI). PMID:16089077

Unicameral bone cysts of the pelvis: a study of 16 cases.

PubMed

Hammoud, Sommer; Weber, Kristy; McCarthy, Edward F

2005-01-01

Unicameral bone cysts of the pelvis are extremely rare. This study summarizes the clinical, radiologic and pathologic features of 16 cases. Patients ranged in age from nine to 69. Most lesions were in the anterior portion of the iliac wing; many appeared to be related to an open iliac crest apophysis. This suggests that the pathogenesis of unicameral bone cysts in this portion of the ilium is similar to that seen in the proximal humerus and the proximal femur. The correct diagnosis was made preoperatively in only five cases. This indicates that, although they are well documented, unicameral bone cysts of the pelvis remain a diagnostic problem. Patients received a spectrum of treatments from curettage to observation. There appeared to be no difference in the outcome after any form of treatment. Therefore, unicameral bone cysts of the pelvis can be managed conservatively. The choice to manage patients conservatively depends on making the correct diagnosis based on clinical history and imaging. The most effective imaging is a combination of plain radiographs, computed tomography (CT) and magnetic resonance imaging (MRI).

Increased severity of type III supracondylar humerus fractures in the preteen population.

PubMed

Fletcher, Nicholas D; Schiller, Jonathan R; Garg, Sumeet; Weller, Amanda; Larson, A Noelle; Kwon, Michael; Browne, Richard; Copley, Lawson; Ho, Christine

2012-09-01

Supracondylar humerus fractures are the most common operative fractures in children; however, no studies describe the older child with this injury. The purpose of this study was to compare Gartland type III supracondylar humerus fractures in children older than 8 years of age with those in younger children than age 8. We hypothesized that there would be more complications in older children, reflecting a higher-energy injury mechanism. A retrospective chart review of supracondylar humerus fractures managed at a single level I pediatric trauma institution from 2004 to 2007 was performed. Patients with type III fractures were divided into groups based on age at presentation greater or less than 8. Baseline demographics, fracture characteristics, mechanism of injury, operative technique, and complications were analyzed. A consecutive series of 1297 pediatric patients with surgically treated supracondylar humerus fractures was retrospectively reviewed including 873 (67.3%) type III fractures. Of those, 160 (18.3%) patients were older than age 8 at time of injury. Older children were more likely to have fractures from high-energy mechanisms (45.1% vs. 28.7%, P<0.001) and more open fracture (3.8% vs. 1.3%, P=0.0097). There was no difference in preoperative or iatrogenic neuropraxias between groups. There was a shorter delay between presentation and surgery in older children (mean, 217 vs. 451 min, P<0.0001). Three or more pins were used more often in older patients (61.8% in older children vs. 43.6% in younger children, P<0.0001). Major complications including reoperation, loss of fixation, or compartment syndrome were rare in both groups (1.1% in younger group vs. 0.6% in older group, P=1.000). There was a trend toward more pin site infections in older children (3.75% vs. 1.56%, P=0.071). Physical therapy was required nearly 4 times more frequently in older children for management of residual stiffness (20.0% vs. 5.7%, P<0.0001). Children older than 8 years of age have a higher rate of open supracondylar humerus fractures, although nerve injury rates are similar. Surgeons placed more pins for fixation of fractures in older patients and elbow stiffness requiring physical therapy occurred more commonly after surgical intervention. III Retrospective cohort.

Forelimb bone curvature in terrestrial and arboreal mammals

PubMed Central

Henderson, Keith; Pantinople, Jess; McCabe, Kyle; Milne, Nick

2017-01-01

It has recently been proposed that the caudal curvature (concave caudal side) observed in the radioulna of terrestrial quadrupeds is an adaptation to the habitual action of the triceps muscle which causes cranial bending strains (compression on cranial side). The caudal curvature is proposed to be adaptive because longitudinal loading induces caudal bending strains (increased compression on the caudal side), and these opposing bending strains counteract each other leaving the radioulna less strained. If this is true for terrestrial quadrupeds, where triceps is required for habitual elbow extension, then we might expect that in arboreal species, where brachialis is habitually required to maintain elbow flexion, the radioulna should instead be cranially curved. This study measures sagittal curvature of the ulna in a range of terrestrial and arboreal primates and marsupials, and finds that their ulnae are curved in opposite directions in these two locomotor categories. This study also examines sagittal curvature in the humerus in the same species, and finds differences that can be attributed to similar adaptations: the bone is curved to counter the habitual muscle action required by the animal’s lifestyle, the difference being mainly in the distal part of the humerus, where arboreal animals tend have a cranial concavity, thought to be in response the carpal and digital muscles that pull cranially on the distal humerus. PMID:28462036

Interpretation of Post-operative Distal Humerus Radiographs After Internal Fixation: Prediction of Later Loss of Fixation.

PubMed

Claessen, Femke M A P; Stoop, Nicky; Doornberg, Job N; Guitton, Thierry G; van den Bekerom, Michel P J; Ring, David

2016-10-01

Stable fixation of distal humerus fracture fragments is necessary for adequate healing and maintenance of reduction. The purpose of this study was to measure the reliability and accuracy of interpretation of postoperative radiographs to predict which implants will loosen or break after operative treatment of bicolumnar distal humerus fractures. We also addressed agreement among surgeons regarding which fracture fixation will loosen or break and the influence of years in independent practice, location of practice, and so forth. A total of 232 orthopedic residents and surgeons from around the world evaluated 24 anteroposterior and lateral radiographs of distal humerus fractures on a Web-based platform to predict which implants would loosen or break. Agreement among observers was measured using the multi-rater kappa measure. The sensitivity of prediction of failure of fixation of distal humerus fracture on radiographs was 63%, specificity was 53%, positive predictive value was 36%, the negative predictive value was 78%, and accuracy was 56%. There was fair interobserver agreement (κ = 0.27) regarding predictions of failure of fixation of distal humerus fracture on radiographs. Interobserver variability did not change when assessed for the various subgroups. When experienced and skilled surgeons perform fixation of type C distal humerus fracture, the immediate postoperative radiograph is not predictive of fixation failure. Reoperation based on the probability of failure might not be advisable. Diagnostic III. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

Kinematic Constraints Associated with the Acquisition of Overarm Throwing Part II: Upper Extremity Actions

ERIC Educational Resources Information Center

Stodden, David F.; Langendorfer, Stephen J.; Fleisig, Glenn S.; Andrews, James R.

2006-01-01

The purposes of this study were to: (a) examine the differences within 11 specific kinematic variables and an outcome measure (ball velocity) associated with component developmental levels of humerus and forearm action (Roberton & Halverson, 1984), and (b) if the differences in kinematic variables were significantly associated with the differences…

Studying Upper-Limb Kinematics Using Inertial Sensors Embedded in Mobile Phones

PubMed Central

Bennett, Paul

2015-01-01

Background In recent years, there has been a great interest in analyzing upper-limb kinematics. Inertial measurement with mobile phones is a convenient and portable analysis method for studying humerus kinematics in terms of angular mobility and linear acceleration. Objective The aim of this analysis was to study upper-limb kinematics via mobile phones through six physical properties that correspond to angular mobility and acceleration in the three axes of space. Methods This cross-sectional study recruited healthy young adult subjects. Humerus kinematics was studied in 10 young adults with the iPhone4. They performed flexion and abduction analytical tasks. Mobility angle and lineal acceleration in each of its axes (yaw, pitch, and roll) were obtained with the iPhone4. This device was placed on the right half of the body of each subject, in the middle third of the humerus, slightly posterior. Descriptive statistics were calculated. Results Descriptive graphics of analytical tasks performed were obtained. The biggest range of motion was found in pitch angle, and the biggest acceleration was found in the y-axis in both analytical tasks. Focusing on tridimensional kinematics, bigger range of motion and acceleration was found in abduction (209.69 degrees and 23.31 degrees per second respectively). Also, very strong correlation was found between angular mobility and linear acceleration in abduction (r=.845) and flexion (r=.860). Conclusions The use of an iPhone for humerus tridimensional kinematics is feasible. This supports use of the mobile phone as a device to analyze upper-limb kinematics and to facilitate the evaluation of the patient. PMID:28582241

Preliminary Study to Test the Feasibility of Sex Identification of Human (Homo sapiens) Bones Based on Differences in Elemental Profiles Determined by Handheld X-ray Fluorescence.

PubMed

Nganvongpanit, Korakot; Buddhachat, Kittisak; Brown, Janine L; Klinhom, Sarisa; Pitakarnnop, Tanita; Mahakkanukrauh, Pasuk

2016-09-01

Sex assignment of human remains is a crucial step in forensic anthropological studies. The aim of this study was to examine elemental differences between male and female bones using X-ray fluorescence (XRF) and determine if elemental profiling could be used for sex discrimination. Cranium, humerus, and os coxae of 60 skeletons (30 male, 30 female) from the Chiang Mai University Skeletal Collection were scanned by XRF and differences in elemental profiles between male and female bones determined using discriminant analysis. In the cranium, three elements (S, Ca, Pb) were significantly higher in males and five elements (Si, Mn, Fe, Zn, Ag) plus light elements (atomic number lower than 12) were higher in females. In humerus and os coxae, nine elements were significantly higher in male and one element was higher in female samples. The accuracy rate for sex estimation was 60, 63, and 61 % for cranium, humerus, and os coxae, respectively, and 67 % when data for all three bones were combined. We conclude that there are sex differences in bone elemental profiles; however, the accuracy of XRF analyses for discriminating between male and female samples was low compared to standard morphometric and molecular methods. XRF could be used on small samples that cannot be sexed by traditional morphological methods, but more work is needed to increase the power of this technique for gender assignment.

Three-Dimensional Magnetic Resonance Imaging of Glenohumeral Dysplasia in Neonatal Brachial Plexus Palsy.

PubMed

Eismann, Emily A; Laor, Tal; Cornwall, Roger

2016-01-20

Existing quantitative measurements of glenohumeral dysplasia in children with unresolved neonatal brachial plexus palsy (NBPP) have been mostly limited to the axial plane. The purpose of this study was to describe the three-dimensional (3D) pathoanatomy of glenohumeral dysplasia using 3D magnetic resonance imaging (MRI) reformations. 3D MRI reformations of the scapula, glenoid labrum, and proximal part of the humerus were created from a volume-acquisition proton-density-weighted MRI sequence of both the affected and the unaffected shoulder of seventeen children less than six years of age with unresolved NBPP who had not undergone shoulder surgery. Glenoid retroversion and posterior humeral head displacement were measured on axial 2D images. Humeral head displacement in all planes, labral circumference, glenoid retroversion, glenoid declination, and scapular morphometric values were measured on 3D reformations. Contiguity of the humeral head with the labrum and the shape of the glenoid were classified. Measurements were compared between the affected and unaffected sides. On 3D evaluation, the humeral head was completely posteriorly translated in ten patients but was never outside the glenoid labrum. Instead, in these patients, the humeral head was eccentrically articulating with the dysplastic glenoid and was contained by a posteriorly elongated labrum. Glenoid dysplasia was not limited to the axial plane. Less declination of the glenoid in the coronal plane correlated with greater 3D glenoid retroversion. Glenoid retroversion resulted from underdevelopment of the posterior aspect of the glenoid rather than overdevelopment of the anterior aspect of the glenoid. 3D measurements of greater glenoid retroversion and less declination correlated with 2D measurements of glenoid retroversion and posterior humeral head displacement. Posterior humeral head displacement in NBPP should not be considered a simple "dislocation." Glenohumeral dysplasia is not limited to the axial plane. Abnormal glenoid declination may have potential implications for the evaluation and treatment of shoulder weakness and contractures. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Direct U-series analysis of the Lezetxiki humerus reveals a Middle Pleistocene age for human remains in the Basque Country (northern Iberia).

PubMed

de-la-Rúa, Concepción; Altuna, Jesús; Hervella, Monserrat; Kinsley, Leslie; Grün, Rainer

2016-04-01

In 1964, a human humerus was found in a sedimentary deposit in Lezetxiki Cave (Basque Country, northern Iberia). The first studies on the stratigraphy, associated mammal faunal remains and lithic implements placed the deposits containing the humerus into the Riss glacial stage. Direct chronometric evidence has so far been missing, and the previous chronostratigraphic framework and faunal dating gave inconsistent results. Here we report laser ablation U-series analyses on the humerus yielding a minimum age of 164 ± 9 ka, corresponding to MIS 6. This is the only direct dating analysis of the Lezetxiki humerus and confirms a Middle Pleistocene age for this hominin fossil. Morphometric analyses suggest that the Lezetxiki humerus has close affinities to other Middle Pleistocene archaic hominins, such as those from La Sima de los Huesos at Atapuerca. This emphasizes the significance of the Lezetxiki fossil within the populations that predate the Neanderthals in south-western Europe. It is thus an important key fossil for the understanding of human evolution in Europe during the Middle Pleistocene, a time period when a great morphological diversity is observed but whose phylogenetic meaning is not yet fully understood. Copyright © 2016 Elsevier Ltd. All rights reserved.

[Surprisingly old skeleton found at Bornheim-Uedorf (Rhein-Sieg-Kreis)--Research results in forensic medicine, anthropology and archaeology].

PubMed

Zesch, Stephanie; Doberentz, Elke; Schmauder, Michael; Rosendahl, Wilfried; Madea, Burkhard

2016-01-01

On April 15th 2014, human skeletal remains were found during digging activities for constructing a new building at Bornheim-Uedorf (Rhein-Sieg-Kreis) near the river Rhine (about 20 meters) in a pit measuring 10 by 10 meters and having a depth of about 150 cm. The skeletal remains were preserved quite well considering the fact that they were located so near to the Rhine, although several skeletal parts were missing. The preserved skeletal remains comprised some skull fragments (including two ear bones of the right side), right scapula, both humeri, left ulna, left radius, left metacarpal bone 2, right metacarpal bones 1, 3 and 4, rib fragments, three thoracic vertebrae, all lumbar vertebrae, one sacral vertebra, pelvis fragments, left femur, proximal part of the left tibial diaphysis, right tibia and diaphysis of both fibulae. The anthropological analysis revealed that the skeletal remains belonged to a 20-to-30-year-old presumably male individual with a body height of about 163 to 173 cm (depending on the formula used for body height estimation). Evidence of intense physical activity and traumatological findings could not be detected on the preserved bones. Periosteal reactions on the bone surface caused by nonspecific bacterial infection were found on the right humerus close to the elbow and on both tibiae, especially the left one. Besides the skeletal remains, metal fragments were recovered--among them an arrowhead, which was typologically classified as an early medieval finding (6th to 7th century). Radiocarbon dating of a bone sample revealed an age of 1561 ± 19 a BP corresponding to a calibrated age of 436 to 540 AD (1 sigma). So, the archaeological classification of the recovered skeleton into the early medieval period was verified. Amongst the human remains, there was also a metatarsal bone of cattle with cut marks. The animal bone as well as the metal fragments indicated that the find was part of an early medieval burial with typical grave goods.

A New Basal Sauropodomorph Dinosaur from the Lower Jurassic Navajo Sandstone of Southern Utah

PubMed Central

Sertich, Joseph J. W.; Loewen, Mark A.

2010-01-01

Background Basal sauropodomorphs, or ‘prosauropods,’ are a globally widespread paraphyletic assemblage of terrestrial herbivorous dinosaurs from the Late Triassic and Early Jurassic. In contrast to several other landmasses, the North American record of sauropodomorphs during this time interval remains sparse, limited to Early Jurassic occurrences of a single well-known taxon from eastern North America and several fragmentary specimens from western North America. Methodology/Principal Findings On the basis of a partial skeleton, we describe here a new basal sauropodomorph dinosaur from the Lower Jurassic Navajo Sandstone of southern Utah, Seitaad ruessi gen. et sp. nov. The partially articulated skeleton of Seitaad was likely buried post-mortem in the base of a collapsed dune foreset. The new taxon is characterized by a plate-like medial process of the scapula, a prominent proximal expansion of the deltopectoral crest of the humerus, a strongly inclined distal articular surface of the radius, and a proximally and laterally hypertrophied proximal metacarpal I. Conclusions/Significance Phylogenetic analysis recovers Seitaad as a derived basal sauropodomorph closely related to plateosaurid or massospondylid ‘prosauropods’ and its presence in western North America is not unexpected for a member of this highly cosmopolitan clade. This occurrence represents one of the most complete vertebrate body fossil specimens yet recovered from the Navajo Sandstone and one of the few basal sauropodomorph taxa currently known from North America. PMID:20352090

Unicameral bone cysts: general characteristics and management controversies.

PubMed

Pretell-Mazzini, Juan; Murphy, Robert Francis; Kushare, Indranil; Dormans, John P

2014-05-01

Unicameral bone cysts are benign bone lesions that are often asymptomatic and commonly develop in the proximal humerus and femur of skeletally immature patients. The etiology of these lesions remains unknown. Most patients present with a pathologic fracture, but these cysts can be discovered incidentally, as well. Radiographically, a unicameral bone cyst appears as a radiolucent lesion with cortical thinning and is centrally located within the metaphysis. Although diagnosis is frequently straightforward, management remains controversial. Because the results of various management methods are heterogeneous, no single method has emerged as the standard of care. New minimally invasive techniques involve cyst decompression with bone grafting and instrumentation. These techniques have yielded promising results, with low rates of complications and recurrence reported; however, prospective clinical trials are needed to compare these techniques with current evidence-based treatments.

Transfer of Motor Learning Is More Pronounced in Proximal Compared to Distal Effectors in Upper Extremities

PubMed Central

Aune, Tore K.; Aune, Morten A.; Ingvaldsen, Rolf P.; Vereijken, Beatrix

2017-01-01

The current experiment investigated generalizability of motor learning in proximal versus distal effectors in upper extremities. Twenty-eight participants were divided into three groups: training proximal effectors, training distal effectors, and no training control group (CG). Performance was tested pre- and post-training for specific learning and three learning transfer conditions: (1) bilateral learning transfer between homologous effectors, (2) lateral learning transfer between non-homologous effectors, and (3) bilateral learning transfer between non-homologous effectors. With respect to specific learning, both training groups showed significant, similar improvement for the trained proximal and distal effectors, respectively. In addition, there was significant learning transfer to all three transfer conditions, except for bilateral learning transfer between non-homologous effectors for the distal training group. Interestingly, the proximal training group showed significantly larger learning transfer to other effectors compared to the distal training group. The CG did not show significant improvements from pre- to post-test. These results show that learning is partly effector independent and generalizable to different effectors, even though transfer is suboptimal compared to specific learning. Furthermore, there is a proximal-distal gradient in generalizability, in that learning transfer from trained proximal effectors is larger than from trained distal effectors, which is consistent with neuroanatomical differences in activation of proximal and distal muscles. PMID:28943857

Studying Upper-Limb Kinematics Using Inertial Sensors Embedded in Mobile Phones.

PubMed

Roldan-Jimenez, Cristina; Cuesta-Vargas, Antonio; Bennett, Paul

2015-05-20

In recent years, there has been a great interest in analyzing upper-limb kinematics. Inertial measurement with mobile phones is a convenient and portable analysis method for studying humerus kinematics in terms of angular mobility and linear acceleration. The aim of this analysis was to study upper-limb kinematics via mobile phones through six physical properties that correspond to angular mobility and acceleration in the three axes of space. This cross-sectional study recruited healthy young adult subjects. Humerus kinematics was studied in 10 young adults with the iPhone4. They performed flexion and abduction analytical tasks. Mobility angle and lineal acceleration in each of its axes (yaw, pitch, and roll) were obtained with the iPhone4. This device was placed on the right half of the body of each subject, in the middle third of the humerus, slightly posterior. Descriptive statistics were calculated. Descriptive graphics of analytical tasks performed were obtained. The biggest range of motion was found in pitch angle, and the biggest acceleration was found in the y-axis in both analytical tasks. Focusing on tridimensional kinematics, bigger range of motion and acceleration was found in abduction (209.69 degrees and 23.31 degrees per second respectively). Also, very strong correlation was found between angular mobility and linear acceleration in abduction (r=.845) and flexion (r=.860). The use of an iPhone for humerus tridimensional kinematics is feasible. This supports use of the mobile phone as a device to analyze upper-limb kinematics and to facilitate the evaluation of the patient. ©Cristina Roldan-Jimenez, Antonio Cuesta-Vargas, Paul Bennett. Originally published in JMIR Rehabilitation and Assistive Technology (http://rehab.jmir.org), 20.05.2015.

Reliability and validity in measurement of true humeral retroversion by a three-dimensional cylinder fitting method.

PubMed

Saka, Masayuki; Yamauchi, Hiroki; Hoshi, Kenji; Yoshioka, Toru; Hamada, Hidetoshi; Gamada, Kazuyoshi

2015-05-01

Humeral retroversion is defined as the orientation of the humeral head relative to the distal humerus. Because none of the previous methods used to measure humeral retroversion strictly follow this definition, values obtained by these techniques vary and may be biased by morphologic variations of the humerus. The purpose of this study was 2-fold: to validate a method to define the axis of the distal humerus with a virtual cylinder and to establish the reliability of 3-dimensional (3D) measurement of humeral retroversion by this cylinder fitting method. Humeral retroversion in 14 baseball players (28 humeri) was measured by the 3D cylinder fitting method. The root mean square error was calculated to compare values obtained by a single tester and by 2 different testers using the embedded coordinate system. To establish the reliability, intraclass correlation coefficient (ICC) and precision (standard error of measurement [SEM]) were calculated. The root mean square errors for the humeral coordinate system were <1.0 mm/1.0° for comparison of all translations/rotations obtained by a single tester and <1.0 mm/2.0° for comparison obtained by 2 different testers. Assessment of reliability and precision of the 3D measurement of retroversion yielded an intratester ICC of 0.99 (SEM, 1.0°) and intertester ICC of 0.96 (SEM, 2.8°). The error in measurements obtained by a distal humerus cylinder fitting method was small enough not to affect retroversion measurement. The 3D measurement of retroversion by this method provides excellent intratester and intertester reliability. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Scaffolding Critical Thinking in the Zone of Proximal Development

ERIC Educational Resources Information Center

Wass, Rob; Harland, Tony; Mercer, Alison

2011-01-01

This paper explores student experiences of learning to think critically. Twenty-six zoology undergraduates took part in the study for three years of their degree at the University of Otago, New Zealand. Vygotsky's developmental model of the Zone of Proximal Development (ZPD) provided a framework as we examined how critical thinking was developed.…

[Total reverse shoulder replacement. Evaluation of the clinical results and complications in a series of 52 cases].

PubMed

Cáceres-Sánchez, L; Mesa-Mateo, A; Barrionuevo-Sánchez, F J; García-Benítez, B; Expósito-Triano, S

2015-01-01

To evaluate the clinical results and analyse the complications of total reverse shoulder replacement performed in our centre over an 8 year period. A retrospective study was conducted on 50 patients (52 shoulders), with a mean age of 70.15 years (range 51 to 84 years) between December 2004 and December 2012, who received a total reverse shoulder replacement, all performed by the same surgeon. The results have been evaluated according to clinical data, radiography study, a satisfaction scale, and the Constant scale, with a minimum follow-up of 16 months. Five of the cases (9.62%) had been intervened due to fractures of the proximal end of the humerus, 6 cases (11.53%) as surgical consequence of a prosthesis revision, 10 cases (19.23%) due to fracture sequelae, and 30 cases (59.62%) were patients with arthropathy due to a massive fracture of the rotator cuff. After a mean follow up of 35.78 months (range, 16-82), satisfactory clinical results were obtained in 80% of cases, with a mean preoperative Constant of 27.7 points, and reaching 67.1 points 12 months after the operation. On the visual analogue scale, 8.25 points were obtained before the surgery, which decreased to 2.25 points 12 months later. The complications rate was 15.38%, which were due to an intra-operative fracture (1.92%), deep infection (3.84%), instability (3.84%), and early mechanical loosening (3.84%). Scapular notching was observed in the radiographic study in 9 (17.3%) cases. After the results obtained, it could be said that total reverse shoulder replacement achieved encouraging results in the short term for the treatment of glenohumeral arthrosis and massive tears of the rotary cuff. On analysing our series, it can be seen that the complications rate is much higher when it is used to treat fracture sequelae in which there is a loss of proximal humerus bone stock. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

Development of a model osseo-magnetic link for intuitive rotational control of upper-limb prostheses.

PubMed

Rouse, Elliott J; Nahlik, David C; Peshkin, Michael A; Kuiken, Todd A

2011-04-01

The lack of proprioceptive feedback is a serious deficiency of current prosthetic control systems. The Osseo-Magnetic Link (OML) is a novel humeral or wrist rotation control system that could preserve proprioception. It utilizes a magnet implanted within the residual bone and sensors mounted in the prosthetic socket to detect magnetic field vectors and determine the bone's orientation. This allows the use of volitional bone rotation to control a prosthetic rotator. We evaluated the performance of the OML using a physical model of a transhumeral residual limb. A small Neodymium-Iron-Boron magnet was placed in a model humerus, inside a model upper arm. Four three-axis Hall-effect sensors were mounted on a ring 3 cm distal to the magnet. An optimization algorithm based on Newton's method determined the position and orientation of the magnet within the model humerus under various conditions, including bone translations, interference, and magnet misalignment. The orientation of the model humerus was determined within 3° for rotations centered in the arm; an additional 6° error was found for translations 20 mm from center. Adjustments in sensor placement may reduce these errors. The results demonstrate that the OML is a feasible solution for providing prosthesis rotation control while preserving rotational proprioception.

Cosmetic arm lengthening with monorail fixator.

PubMed

Agrawal, Hemendra Kumar; Singh, Balvinder; Garg, Mohit; Khatkar, Vipin; Batra, Sumit; Sharma, Vinod Kumar

2015-01-01

Upper limb length discrepancy is a rare occurrence. Humerus shortening may need specialized treatment to restore the functional and cosmetic status of upper limb. We report a case of humerus lengthening of 9 cm with a monorail external fixator and the result was observed during a 2-year follow-up. Humerus lengthening needs specialized focus as it is not only a cosmetic issue but also a functional demand. The monorail unilateral fixator is more functional and cosmetically acceptable, and thus becomes an effective treatment option.

Minimal invasive surgery for unicameral bone cyst using demineralized bone matrix: a case series.

PubMed

Cho, Hwan Seong; Seo, Sung Hwa; Park, So Hyun; Park, Jong Hoon; Shin, Duk Seop; Park, Il Hyung

2012-07-29

Various treatments for unicameral bone cyst have been proposed. Recent concern focuses on the effectiveness of closed methods. This study evaluated the effectiveness of demineralized bone matrix as a graft material after intramedullary decompression for the treatment of unicameral bone cysts. Between October 2008 and June 2010, twenty-five patients with a unicameral bone cyst were treated with intramedullary decompression followed by grafting of demineralized bone matrix. There were 21 males and 4 female patients with mean age of 11.1  years (range, 3-19 years). The proximal metaphysis of the humerus was affected in 12 patients, the proximal femur in five, the calcaneum in three, the distal femur in two, the tibia in two, and the radius in one. There were 17 active cysts and 8 latent cysts. Radiologic change was evaluated according to a modified Neer classification. Time to healing was defined as the period required achieving cortical thickening on the anteroposterior and lateral plain radiographs, as well as consolidation of the cyst. The patients were followed up for mean period of 23.9 months (range, 15-36 months). Nineteen of 25 cysts had completely consolidated after a single procedure. The mean time to healing was 6.6 months (range, 3-12 months). Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture. None of these four cysts needed a second intervention until the last follow-up. Two of 25 patients required a second intervention because of cyst recurrence. All of the two had a radiographical healing of cyst after mean of 10 additional months of follow-up. A minimal invasive technique including the injection of DBM could serve as an excellent treatment method for unicameral bone cysts.

Hormonal and biochemical parameters and osteoporotic fractures in elderly men.

PubMed

Center, J R; Nguyen, T V; Sambrook, P N; Eisman, J A

2000-07-01

Low testosterone has been associated with hip fracture in men in some studies. However, data on other hormonal parameters and fracture outcome in men is minimal. This study examined the association between free testosterone (free T) estradiol (E2), sex hormone-binding globulin (SHBG), 25-hydroxyvitamin D [25(OH)D], parathyroid hormone (PTH), insulin-like growth factor I (IGF-I), and fracture in 437 elderly community-dwelling men. Age, height, weight, quadriceps strength, femoral neck bone mineral density (FN BMD), and fracture data (1989-1997) also were obtained. Fractures were classified as major (hip, pelvis, proximal tibia, multiple rib, vertebral, and proximal humerus) or minor (remaining distal upper and lower limb fractures). Fifty-four subjects had a fracture (24 major and 30 minor). There was no association between minor fractures and any hormonal parameter. Risk of major fracture was increased 2-fold for each SD increase in age, decrease in weight and height, and increase in SHBG, and risk of major fracture was increased 3-fold for each SD decrease in quadriceps strength, FN BMD, and 25(OH)D (univariate logistic regression). Independent predictors of major fracture were FN BMD, 2.7 (1.5-4.7; odds ratio [OR]) and 95% confidence interval [CI]); 25(OH)D, 2.8 (1.5-5.3); and SHBG, 1.7 (1.2-2.4). An abnormal value for three factors resulted in a 30-fold increase in risk but only affected 2% of the population. It is not immediately apparent how 25(OH)D and SHBG, largely independently of BMD, may contribute to fracture risk. They may be markers for biological age or health status not measured by methods that are more traditional and as such may be useful in identifying those at high risk of fracture.

An anatomical and mechanical analysis of the douc monkey (genus Pygathrix), and its role in understanding the evolution of brachiation.

PubMed

Byron, C D; Granatosky, M C; Covert, H H

2017-12-01

Pygathrix is an understudied Asian colobine unusual among the Old World monkeys for its use of arm-swinging. Little data exists on the anatomy and mechanics of brachiation in this genus. Here, we consider this colobine to gain insight into the parallel evolution of suspensory behavior in primates. This study compares axial and appendicular morphological variables of Pygathrix with other Asian colobines. Additionally, to assess the functional consequences of Pygathrix limb anatomy, kinematic and kinetic data during arm-swinging are included to compare the douc monkey to other suspensory primates (Ateles and Hylobates). Compared to more pronograde species, Pygathrix and Nasalis share morphology consistent with suspensory locomotion such as its narrower scapulae and elongated clavicles. More distally, Pygathrix displays a gracile humerus, radius, and ulna, and shorter olecranon process. During suspensory locomotion, Pygathrix, Ateles, and Hylobates all display mechanical convergence in limb loading and movements of the shoulder and elbow, but Pygathrix uses pronated wrist postures that include substantial radial deviation during arm-swinging. The adoption of arm-swinging represents a major shift within at least three anthropoid clades and little data exist about its transition. Across species, few mechanical differences are observed during arm-swinging. Apparently, there are limited functional solutions to the challenges associated with moving bimanually below branches, especially in more proximal forelimb regions. Morphological data support this idea that the Pygathrix distal forelimb differs from apes more than its proximal end. These results can inform other studies of ape evolution, the pronograde to orthograde transition, and the convergent ways in which suspensory locomotion evolved in primates. © 2017 Wiley Periodicals, Inc.

Prognostic factors in canine appendicular osteosarcoma – a meta-analysis

PubMed Central

2012-01-01

Background Appendicular osteosarcoma is the most common malignant primary canine bone tumor. When treated by amputation or tumor removal alone, median survival times (MST) do not exceed 5 months, with the majority of dogs suffering from metastatic disease. This period can be extended with adequate local intervention and adjuvant chemotherapy, which has become common practice. Several prognostic factors have been reported in many different studies, e.g. age, breed, weight, sex, neuter status, location of tumor, serum alkaline phosphatase (SALP), bone alkaline phosphatase (BALP), infection, percentage of bone length affected, histological grade or histological subtype of tumor. Most of these factors are, however, only reported as confounding factors in larger studies. Insight in truly significant prognostic factors at time of diagnosis may contribute to tailoring adjuvant therapy for individual dogs suffering from osteosarcoma. The objective of this study was to systematically review the prognostic factors that are described for canine appendicular osteosarcoma and validate their scientific importance. Results A literature review was performed on selected studies and eligible data were extracted. Meta-analyses were done for two of the three selected possible prognostic factors (SALP and location), looking at both survival time (ST) and disease free interval (DFI). The third factor (age) was studied in a qualitative manner. Both elevated SALP level and the (proximal) humerus as location of the primary tumor are significant negative prognostic factors for both ST and DFI in dogs with appendicular osteosarcoma. Increasing age was associated with shorter ST and DFI, however, was not statistically significant because information of this factor was available in only a limited number of papers. Conclusions Elevated SALP and proximal humeral location are significant negative prognosticators for canine osteosarcoma. PMID:22587466

Prognostic factors in canine appendicular osteosarcoma - a meta-analysis.

PubMed

Boerman, Ilse; Selvarajah, Gayathri T; Nielen, Mirjam; Kirpensteijn, Jolle

2012-05-15

Appendicular osteosarcoma is the most common malignant primary canine bone tumor. When treated by amputation or tumor removal alone, median survival times (MST) do not exceed 5 months, with the majority of dogs suffering from metastatic disease. This period can be extended with adequate local intervention and adjuvant chemotherapy, which has become common practice. Several prognostic factors have been reported in many different studies, e.g. age, breed, weight, sex, neuter status, location of tumor, serum alkaline phosphatase (SALP), bone alkaline phosphatase (BALP), infection, percentage of bone length affected, histological grade or histological subtype of tumor. Most of these factors are, however, only reported as confounding factors in larger studies. Insight in truly significant prognostic factors at time of diagnosis may contribute to tailoring adjuvant therapy for individual dogs suffering from osteosarcoma. The objective of this study was to systematically review the prognostic factors that are described for canine appendicular osteosarcoma and validate their scientific importance. A literature review was performed on selected studies and eligible data were extracted. Meta-analyses were done for two of the three selected possible prognostic factors (SALP and location), looking at both survival time (ST) and disease free interval (DFI). The third factor (age) was studied in a qualitative manner. Both elevated SALP level and the (proximal) humerus as location of the primary tumor are significant negative prognostic factors for both ST and DFI in dogs with appendicular osteosarcoma. Increasing age was associated with shorter ST and DFI, however, was not statistically significant because information of this factor was available in only a limited number of papers. Elevated SALP and proximal humeral location are significant negative prognosticators for canine osteosarcoma.

[Seasonal distribution of diagnoses and DRG in trauma surgery].

PubMed

von Dercks, N; Melz, R; Hepp, P; Marquass, B; Theopold, J; Josten, C

2011-11-01

Recording DRGs and diagnoses allows their distribution to be shown over the course of the year. Thus, cumulative seasonal occurrence of diseases can be detected. From 2004 to 2010 we recorded 22,293 main diagnoses and DRGs at the clinic for trauma surgery. Injuries with the same localization and treatment were pooled. The most frequent injuries were concussion, followed by spinal and lower leg fractures. They showed no seasonal accumulation. Proximal fractures of the humerus occurred approx. 25% more often in winter and ankle fractures about 33% more frequently. The diagnosis of osteoarthritis of the knee is twice as high in the winter as in the summer. It has to be verified if logistic conclusions of these results can lead to more efficiency in a hospital. The underlying analysis is applicable for every hospital and poses a valid controlling tool.

Occupational therapy interventions for shoulder conditions: a systematic review.

PubMed

von der Heyde, Rebecca L

2011-01-01

The objectives of this systematic review were (1) to identify, evaluate, and synthesize the research literature of relevance to occupational therapy regarding interventions for work-related shoulder conditions and (2) to interpret and apply the research literature to occupational therapy. Twenty-two studies were reviewed for this study-16 of Level I evidence, 2 of Level II evidence, and 4 of Level III evidence. In this systematic review, limited evidence from Level I studies was found to support exercise for shoulder pain; manual therapy and laser for adhesive capsulitis; conservative management of shoulder instability; early intervention without immobilization for specific, nondisplaced proximal humerus fractures; and exercise, joint mobilizations, and laser for patients with shoulder impingement. Further prospective studies are necessary for the delineation of specific surgical and therapeutic variables that facilitate positive outcomes in the treatment of patients with shoulder conditions.

Shape and size of the body vs. musculoskeletal stress markers.

PubMed

Myszka, Anna; Piontek, Janusz

2010-01-01

The objective of this paper is to assess the relationship between the degree of development of muscle attachment sites (musculoskeletal stress markers - MSM1) and the length and circumference measurements of long bones and the body build expressed with the reconstructed values of body height (BH) and body mass (BM). The bone material (102 male and 99 female skeletons) used in the study was collected in the medieval burial ground in Cedynia, Poland. The authors analyzed 10 musculoskeletal stress markers located on the scapula (2), humerus (2), radius (2), femur (2) and tibia (2). The frequency and the degree of expression of muscle attachment size was carried out using the scale prepared by Myszka (2007). The scale encompassed three degrees of expression of muscle attachment size. Only changes of robusticity type (nonpathological changes) were taken into account. The assessment of body build of individuals was carried out according to the method proposed by Vancata & Charvátová (2001). Body height was reconstructed from the length of the humerus and femur using eight equations. Body mass was reconstructed from the measurements of the breadth of the proximal and distal sections of the femur and tibia (mechanical method) using twenty one equations. The equations were developed for different reference populations. The same equations were used for men and women. The correlation between the MSM and the length and circumference measurements of the bones was analyzed using the principal components analysis and the Gamma correlation coefficient. The strength of the correlation between the reconstructed body build traits (BH, BM) and the moderate degree of musculoskeletal stress markers expression was studied based on the principal components method and the Pearson correlation coefficient. A linear correlation was found between musculoskeletal stress markers and the circumference measurements and the reconstructed body mass, but no relationship with body height and the length measurements of long bones was revealed. From previous research it is evident that the relationship between the MSM and metric skeletal traits does not occur in every population. Divergent findings necessitate further corroboration of results on diverse skeletal material.

Aerodynamic Analyses and Database Development for Ares I Vehicle First Stage Separation

NASA Technical Reports Server (NTRS)

Pamadi, Bandu N.; Pei, Jing; Pinier, Jeremy T.; Holland, Scott D.; Covell, Peter F.; Klopfer, Goetz, H.

2012-01-01

This paper presents the aerodynamic analysis and database development for the first stage separation of the Ares I A106 Crew Launch Vehicle configuration. Separate databases were created for the first stage and upper stage. Each database consists of three components: isolated or free-stream coefficients, power-off proximity increments, and power-on proximity increments. The power-on database consists of three parts, all plumes firing at nominal conditions, the one booster deceleration motor out condition, and the one ullage settling motor out condition. The isolated and power-off incremental databases were developed using wind tunnel test data. The power-on proximity increments were developed using CFD solutions.

Sall4-Gli3 system in early limb progenitors is essential for the development of limb skeletal elements.

PubMed

Akiyama, Ryutaro; Kawakami, Hiroko; Wong, Julia; Oishi, Isao; Nishinakamura, Ryuichi; Kawakami, Yasuhiko

2015-04-21

Limb skeletal elements originate from the limb progenitor cells, which undergo expansion and patterning to develop each skeletal element. Posterior-distal skeletal elements, such as the ulna/fibula and posterior digits develop in a Sonic hedgehog (Shh)-dependent manner. However, it is poorly understood how anterior-proximal elements, such as the humerus/femur, the radius/tibia and the anterior digits, are developed. Here we show that the zinc finger factors Sall4 and Gli3 cooperate for proper development of the anterior-proximal skeletal elements and also function upstream of Shh-dependent posterior skeletal element development. Conditional inactivation of Sall4 in the mesoderm before limb outgrowth caused severe defects in the anterior-proximal skeletal elements in the hindlimb. We found that Gli3 expression is reduced in Sall4 mutant hindlimbs, but not in forelimbs. This reduction caused posteriorization of nascent hindlimb buds, which is correlated with a loss of anterior digits. In proximal development, Sall4 integrates Gli3 and the Plzf-Hox system, in addition to proliferative expansion of cells in the mesenchymal core of nascent hindlimb buds. Whereas forelimbs developed normally in Sall4 mutants, further genetic analysis identified that the Sall4-Gli3 system is a common regulator of the early limb progenitor cells in both forelimbs and hindlimbs. The Sall4-Gli3 system also functions upstream of the Shh-expressing ZPA and the Fgf8-expressing AER in fore- and hindlimbs. Therefore, our study identified a critical role of the Sall4-Gli3 system at the early steps of limb development for proper development of the appendicular skeletal elements.

Thoracic limb morphology of the red panda (Ailurus fulgens) evidenced by osteology and radiography.

PubMed

Makungu, Modesta; Groenewald, Hermanus B; du Plessis, Wencke M; Barrows, Michelle; Koeppel, Katja N

2015-07-15

The red panda (Ailurus fulgens) is distributed primarily in the Himalayas and southern China. It is classified as a vulnerable species by the International Union for Conservation of Nature. The aim of this study was to describe the normal osteology and radiographic anatomy of the thoracic limb of the red panda. Radiography of the right thoracic limb was performed in seven captive adult red pandas. Radiographic findings were correlated with bone specimens from three adult animals. The scapula was wide craniocaudally and presented with a large area for the origin of the teres major muscle. The square-shaped major tubercle did not extend proximal to the head of the humerus. The medial epicondyle was prominent. A supracondylar foramen was present. The radial tuberosity and sesamoid bone for the abductor digiti I longus were prominent. The accessory carpal bone was directed palmarolaterally. Metacarpal bones were widely spread. The thoracic limb morphology of the red panda evidenced by osteology and radiography indicated flexibility of the thoracic limb joints and well-developed flexor and supinator muscles, which are important in arboreal quadrupedal locomotion. Knowledge gained during this study may prove useful in identifying skeletal material or remains and diagnosing musculoskeletal diseases and injuries of the thoracic limb.

Isolated Avulsion of the Tendon of Insertion of the Infraspinatus and Supraspinatus Muscles in Five Juvenile Labrador Retrievers.

PubMed

Mikola, Karoliina; Piras, Alessandro; Hakala, Laura

2018-06-02

 Five juvenile Labrador Retrievers between the ages of 6 and 8 months were presented to our referral centres with a history of intermittent forelimb lameness.  The clinical examination revealed the presence of bilateral orthopaedic problems in four out of five cases.  Radiographic and computed tomography examinations showed the presence of a radiolucent defect corresponding to the area of insertion of the infraspinatus or supraspinatus tendons on the proximal humerus. Three dogs were concurrently affected by elbow disease on the contralateral forelimb and one dog with bilateral infraspinatus avulsion also had osteochondritis dissecans affecting both shoulder joints.  Avulsion of the insertion of the infraspinatus tendon in four dogs and of the supraspinatus tendon in one dog.  According to the current literature, the incidence of infraspinatus and supraspinatus tendinopathies in adult Labrador Retrievers is higher than in other breeds. In our five cases, the patients were juvenile and the nature of the injury was an avulsion of the tendinous insertion. Avulsion of the tendon of insertion of the infraspinatus or supraspinatus has been poorly described in the veterinary literature, and this would represent the first series of cases affecting juvenile Labrador Retrievers. Schattauer GmbH Stuttgart.

Failed Reverse Total Shoulder Arthroplasty Caused by Recurrent Candida glabrata Infection with Prior Serratia marcescens Coinfection

PubMed Central

Skedros, John G.; Keenan, Kendra E.; Updike, Wanda S.; Oliver, Marquam R.

2014-01-01

This report describes a 58-year-old insulin-dependent diabetic male patient who initially sustained a proximal humerus fracture from a fall. The fracture fixation failed and then was converted to a humeral hemiarthroplasty, which became infected with Candida glabrata and Serratia marcescens. After these infections were believed to be cured with antibacterial and antifungal treatments and two-stage irrigation and debridement, he underwent conversion to a reverse total shoulder arthroplasty. Unfortunately, the C. glabrata infection recurred and, nearly 1.5 years after implantation of the reverse total shoulder, he had a resection arthroplasty (removal of all implants and cement). His surgical and pharmacologic treatment concluded with (1) placement of a tobramycin-impregnated cement spacer also loaded with amphotericin B, with no plan for revision arthroplasty (i.e., the spacer was chronically retained), and (2) chronic use of daily oral fluconazole. We located only three reported cases of Candida species causing infection in shoulder arthroplasties (two C. albicans, one C. parapsilosis). To our knowledge, a total shoulder arthroplasty infected with C. glabrata has not been reported, nor has a case of a C. glabrata and S. marcescens periprosthetic coinfection in any joint. In addition, it is well known that S. marcescens infections are uncommon in periprosthetic joint infections. PMID:25431708

Outcomes for a large metaphyseal volume hemiarthroplasty in complex fractures of the proximal humerus.

PubMed

White, Jonathan J E; Soothill, John R; Morgan, Marie; Clark, David I; Espag, Marius P; Tambe, Amol A

2017-03-01

A large metaphyseal volume shoulder hemiarthroplasty has been in use within our department since 2008; however, no clinical outcome data are available for this prosthesis apart from the designer surgeon series. During a 5-year period, data were collected for 40 patients (30 women, 10 men) treated consecutively with the Zimmer Anatomical Shoulder Fracture hemiarthroplasty system (Zimmer, Warsaw, IN, USA). The final analysis included 26 patients. The median age was 79 years (range, 58-91 years), and the median follow-up was 3.7 years (range, 2.0-5.8 years). The median Constant Score was 34 points (range, 16-70 points), and the median Oxford Shoulder Score was 27 points (range, 5-46 points). The greater tuberosity healed satisfactorily in 12 patients. Resorption of the greater tuberosity was seen radiologically in 18 patients. The presence of resorption had no significant effect on the Constant Score (P = .264) or the Oxford Shoulder Score (P = .469). Three patients (12%) required revision. This is the first report from a nondesigner center for outcomes for this prosthesis to date. The results demonstrate reduced functional performance compared with the designer series. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Avascular Necrosis of Trochlea After Supracondylar Humerus Fractures in Children.

PubMed

Etier, Brian E; Doyle, J Scott; Gilbert, Shawn R

2015-10-01

Avascular necrosis (AVN) is a rare but important complication after supracondylar humerus fractures. Posttraumatic humerus deformity was first reported in 1948 and sporadically thereafter. AVN deformity has been classified as type A (AVN of the lateral ossification center) and type B (AVN of the entire medial crista and a metaphyseal portion). In this article, we present 5 cases of AVN after supracondylar humerus fracture, discuss the importance of late clinical findings, and postulate a mechanism of AVN in nondisplaced fractures. Five cases of AVN after supracondylar humerus fracture were reviewed from the Children's of Alabama database. Four of the 5 patients were female. Four patients sustained a Gartland type III fracture, and 1 patient sustained a nondisplaced Gartland type I fracture. Age at time of injury ranged from 5 years to 10 years. All patients had an asymptomatic clinical period after treatment and re-presented 6 months to 7 years later with elbow pain or loss of motion. All patients were treated symptomatically. AVN of the trochlea has a late clinical presentation. The cause of this complication is interruption of the trochlea blood supply. In displaced fractures, the medial and/or lateral vessels are injured, leading to type A or type B deformity. In nondisplaced fractures, the lateral vessels are interrupted by tamponade because of encased fracture hematoma; this presents as a type A deformity. Both type A and type B deformities can be clinically significant. AVN of the trochlea should be considered in patients with late presentation of pain or loss of motion after treatment of supracondylar humerus fractures.

Femoral curvature variability in modern humans using three-dimensional quadric surface fitting.

PubMed

Chapman, Tara; Sholukha, Victor; Semal, Patrick; Louryan, Stéphane; Rooze, Marcel; Van Sint Jan, Serge

2015-12-01

This study analysed femoral curvature in a population from Belgium in conjunction with other morphological characteristics by the use of three-dimensional (3D) quadric surfaces (QS) modelled from the bone surface. 3D models were created from computed tomography data of 75 femoral modern human bones. Anatomical landmarks (ALs) were palpated in specific bony areas of the femur (shaft, condyles, neck and head). QS were then created from the surface vertices which enclose these ALs. The diaphyseal shaft was divided into five QS shapes to analyse curvature in different parts of the shaft. Femoral bending differs in different parts of the diaphyseal shaft. The greatest degree of curvature was found in the distal shaft (mean 4.5° range 0.2°-10°) followed by the proximal (mean 4.4° range 1.5°-10.2°), proximal intermediate (mean 3.7° range 0.9°-7.9°) and distal intermediate (mean 1.8° range 0.2°-5.6°) shaft sections. The proximal and distal angles were significantly more bowed than the intermediate proximal and the intermediate distal angle. There was no significant difference between the proximal and distal angle. No significant correlations were found between morphological characteristics and femoral curvature. An extremely large variability of femoral curvature with several bones displaying very high or low degrees of femoral curvature was also found. 3D QS fitting enables the creation of accurate models which can discriminate between different patterns in similar curvatures and demonstrates there is a clear difference between curvature in different parts of the shaft.

From My Place: Teaching the Holocaust and Judaism at the University of Mississippi Fifty-Three Years after James Meredith

ERIC Educational Resources Information Center

Johnson, Willa M.

2016-01-01

This essay explores classroom dynamics when students identify and connect their own painful experiences to structural racism or ethnocentrism exhibited in the Holocaust or parts of Jewish history. The intrusion of this proximal knowledge can be an obstacle to student learning. If engaged by professors, however, I argue that proximal knowledge can…

Comparison of three surgical treatment options for unicameral bone cysts in humerus.

PubMed

Mavčič, Blaž; Saraph, Vinay; Gilg, Magdalena M; Bergovec, Marko; Brecelj, Janez; Leithner, Andreas

2018-04-23

Treatment of unicameral bone cysts (UBC) in the humerus with drainage screws is scarcely reported in the literature. The aim of this retrospective study was to compare drainage screws and alternative treatment methods with respect to the number of required surgical procedures to achieve sufficient UBC healing, postoperative fractures/recurrences/complications, and radiological outcome. Medical archives of two tertiary orthopedic referral centers were screened for all patients who were treated surgically for humeral UBC in the period 1991-2015 with a histologically/cytologically confirmed diagnosis. Sex, age, all surgical procedures, fractures, complications, recurrences, and the final radiological outcome were compared between patients treated with drainage screws, elastic intramedullary nails, or curettage with optional grafting. The study included 106 operated patients with a mean age of 10.3 years, with a mean follow-up of 5.7 years. The average number of UBC-related surgical procedures in sex-matched and age-matched treatment groups was 2.7 with drainage screws, 2.8 with intramedullary nails, and 3.5 with curettage/grafting (P=0.54). Intramedullary nails (odds ratio 0.20) and older age (odds ratio for each year 0.83) predicted a lower risk of postoperative UBC recurrence. Patients with drainage screws had the highest UBC recurrence rates and the lowest rates of changed initial treatment method. There was no difference between the treatment groups in the postoperative fracture rate, complications, or the final radiological outcome. UBC treatment in the humerus therefore requires approximately three surgical procedures, irrespective of the treatment modality chosen. Adding an elastic intramedullary nail to a humeral UBC cyst may reduce recurrence risk and prevent further fractures. Level III - therapeutic retrospective comparative study.

Limb lengthening in achondroplasia.

PubMed

Chilbule, Sanjay K; Dutt, Vivek; Madhuri, Vrisha

2016-01-01

Stature lengthening in skeletal dysplasia is a contentious issue. Specific guidelines regarding the age and sequence of surgery, methods and extent of lengthening at each stage are not uniform around the world. Despite the need for multiple surgeries, with their attendant complications, parents demanding stature lengthening are not rare, due to the social bias and psychological effects experienced by these patients. This study describes the outcome and complications of extensive stature lengthening performed at our center. Eight achondroplasic and one hypochondroplasic patient underwent bilateral transverse lengthening for tibiae, humeri and femora. Tibia lengthening was carried out using a ring fixator and bifocal corticotomy, while a monolateral pediatric limb reconstruction system with unifocal corticotomy was used for the femur and humerus. Lengthening of each bone segment, height gain, healing index and complications were assessed. Subgroup analysis was carried out to assess the effect of age and bone segment on the healing index. Nine patients aged five to 25 years (mean age 10.2 years) underwent limb lengthening procedures for 18 tibiae, 10 femora and 8 humeri. Four patients underwent bilateral lengthening of all three segments. The mean length gain for the tibia, femur and humerus was 15.4 cm (100.7%), 9.9 cm (52.8%) and 9.6 cm (77.9%), respectively. Healing index was 25.7, 25.6 and 20.6 days/cm, respectively, for the tibia, femur and humerus. An average of 33.3% height gain was attained. Lengthening of both tibia and femur added to projected height achieved as the 3(rd) percentile of standard height in three out of four patients. In all, 33 complications were encountered (0.9 complications per segment). Healing index was not affected by age or bone segment. Extensive limb lengthening (more than 50% over initial length) carries significant risk and should be undertaken only after due consideration.

Relationship Between Humeral Retroversion and Length of Baseball Career Before the Age of 16 Years.

PubMed

Nakase, Chihiro; Mihata, Teruhisa; Itami, Yasuo; Takeda, Atsushi; Neo, Masashi

2016-09-01

Humeral retroversion physiologically decreases during growth. However, in throwing athletes, the external forces caused by repetitive throwing are thought to increase humeral retroversion on the dominant side compared with that on the nondominant side. To investigate the correlation between humeral retroversion and length of baseball career before age 16 years. Cross-sectional study; Level of evidence, 3. A total of 112 high school baseball players (32 pitchers and 80 position players) with a mean age of 15.6 years (range, 15-16 years) were enrolled in the study. All participants completed questionnaires regarding their player position and the age when they started baseball and were given physical examinations. Shoulder range of motion and humeral retroversion were assessed on the dominant and nondominant sides. Humeral retroversion (rotation angle of the proximal humerus relative to the distal humerus) was measured ultrasonographically. Humeral retroversion was significantly greater on the dominant side than on the nondominant side in both pitchers (P < .0001) and position players (P = .0005). The side-to-side difference in humeral retroversion in pitchers (13.9° ± 11.2°) was significantly greater than that in position players (9.0° ± 11.1°, P = .0361). In pitchers, there was a significant negative correlation between humeral retroversion and the age at which the players had started baseball (P = .033, β = -2.494). These results suggest that humeral retroversion increases with decreasing age at commencement of a baseball career before age 16 years in pitchers. © 2016 The Author(s).

The management of nonunion and malunion of the distal humerus--a 30-year experience.

PubMed

Jupiter, Jesse B

2008-01-01

This personal series of nonunions of the distal humerus reviews unique features of this problem, categorizes them according to unique anatomic features, and presents pitfalls and pearls in the management of these complex reconstructive problems.

Interpreting the three-dimensional orientation of vascular canals and cross-sectional geometry of cortical bone in birds and bats.

PubMed

Pratt, Isaac V; Johnston, James D; Walker, Ernie; Cooper, David M L

2018-06-01

Cortical bone porosity and specifically the orientation of vascular canals is an area of growing interest in biomedical research and comparative/paleontological anatomy. The potential to explain microstructural adaptation is of great interest. However, the determinants of the development of canal orientation remain unclear. Previous studies of birds have shown higher proportions of circumferential canals (called laminarity) in flight bones than in hindlimb bones, and interpreted this as a sign that circumferential canals are a feature for resistance to the torsional loading created by flight. We defined the laminarity index as the percentage of circumferential canal length out of the total canal length. In this study we examined the vascular canal network in the humerus and femur of a sample of 31 bird and 24 bat species using synchrotron micro-computed tomography (micro-CT) to look for a connection between canal orientation and functional loading. The use of micro-CT provides a full three-dimensional (3D) map of the vascular canal network and provides measurements of the 3D orientation of each canal in the whole cross-section of the bone cortex. We measured several cross-sectional geometric parameters and strength indices including principal and polar area moments of inertia, principal and polar section moduli, circularity, buckling ratio, and a weighted cortical thickness index. We found that bat cortices are relatively thicker and poorly vascularized, whereas those of birds are thinner and more highly vascularized, and that according to our cross-sectional geometric parameters, bird bones have a greater resistance to torsional stress than the bats; in particular, the humerus in birds is more adapted to resist torsional stresses than the femur. Our results show that birds have a significantly (P = 0.031) higher laminarity index than bats, with birds having a mean laminarity index of 0.183 in the humerus and 0.232 in the femur, and bats having a mean laminarity index of 0.118 in the humerus and 0.119 in the femur. Counter to our expectation, the birds had a significantly higher laminarity index in the femur than in the humerus (P = 0.035). To evaluate whether this discrepancy was a consequence of methodology we conducted a comparison between our 3D method and an analogue to two-dimensional (2D) histological measurements. This comparison revealed that 2D methods significantly underestimate (P < 0.001) the amount of longitudinal canals by an average of 20% and significantly overestimate (P < 0.001) the laminarity index by an average of 7.7%, systematically mis-estimating indices of vascular canal orientations. In comparison with our 3D results, our approximated 2D measurement had the same results for comparisons between the birds and bats but found significant differences only in the longitudinal index between the humerus and the femur for both groups. The differences between our 3D and pseudo-2D results indicate that differences between our findings and the literature may be partially based in methodology. Overall, our results do not support the hypothesis that the bones of flight are more laminar, suggesting a complex relation between functional loading and microstructural adaptation. © 2018 The Authors. Journal of Anatomy published by John Wiley & Sons Ltd on behalf of Anatomical Society.

Three-dimensional magnetic resonance imaging of physeal injury: reliability and clinical utility.

PubMed

Lurie, Brett; Koff, Matthew F; Shah, Parina; Feldmann, Eric James; Amacker, Nadja; Downey-Zayas, Timothy; Green, Daniel; Potter, Hollis G

2014-01-01

Injuries to the physis are common in children with a subset resulting in an osseous bar and potential growth disturbance. Magnetic resonance imaging allows for detailed assessment of the physis with the ability to generate 3-dimensional physeal models from volumetric data. The purpose of this study was to assess the interrater reliability of physeal bar area measurements generated using a validated semiautomated segmentation technique and to highlight the clinical utility of quantitative 3-dimensional (3D) physeal mapping in pediatric orthopaedic practice. The Radiology Information System/Picture Archiving Communication System (PACS) at our institution was searched to find consecutive patients who were imaged for the purpose of assessing a physeal bar or growth disturbance between December 2006 and October 2011. Physeal segmentation was retrospectively performed by 2 independent operators using semiautomated software to generate physeal maps and bar area measurements from 3-dimensional spoiled gradient recalled echo sequences. Inter-reliability was statistically analyzed. Subsequent surgical management for each patient was recorded from the patient notes and surgical records. We analyzed 24 patients (12M/12F) with a mean age of 11.4 years (range, 5-year to 15-year olds) and 25 physeal bars. Of the physeal bars: 9 (36%) were located in the distal tibia; 8 (32%) in the proximal tibia; 5 (20%) in the distal femur; 1 (4%) in the proximal femur; 1 (4%) in the proximal humerus; and 1 (4%) in the distal radius. The independent operator measurements of physeal bar area were highly correlated with a Pearson correlation coefficient (r) of 0.96 and an intraclass correlation coefficient for average measures of 0.99 (95% confidence interval, 0.97-0.99). Four patients underwent resection of the identified physeal bars, 9 patients were treated with epiphysiodesis, and 1 patient underwent bilateral tibial osteotomies. Semiautomated segmentation of the physis is a reproducible technique for generating physeal maps and accurately measuring physeal bars, providing quantitative and anatomic information that may inform surgical management and prognosis in patients with physeal injury. Level IV.

Supracondylar process syndrome: two cases of median nerve neuropathy due to compression by the ligament of Struthers.

PubMed

Shon, Hyun-Chul; Park, Ji-Kang; Kim, Dong-Soo; Kang, Sang-Woo; Kim, Kook-Jong; Hong, Seok-Hyun

2018-01-01

The supracondylar process is a beak-shaped bony process on the anteromedial aspect of the distal humerus. The ligament of Struthers is a fibrous band extending from the tip of the process to the medial epicondyle. The median nerve and brachial artery pass under the ligament of Struthers and consequently can be compressed, causing supracondylar process syndrome. As a rare cause of proximal median nerve entrapment, supracondylar process syndrome is triggered when the median nerve is located in the superficial or deep layer of the ligament of Struthers as a result of anatomical variation. The supracondylar process can be easily detected on X-ray images obtained in oblique views but may not be identified in only anteroposterior or lateral views. In this article, we present 2 cases of supracondylar process syndrome and describe the process of diagnosis and treatment and results of a literature review.

Resuscitation in massive obstetric haemorrhage using an intraosseous needle.

PubMed

Chatterjee, D J; Bukunola, B; Samuels, T L; Induruwage, L; Uncles, D R

2011-04-01

A 38-year-old woman experienced a massive postpartum haemorrhage 30 minutes after emergency caesarean delivery. The patient became severely haemodynamically compromised with an unrecordable blood pressure. Rapid fluid resuscitation was limited by the capacity of the intravenous cannula in place at the time and inability to establish additional vascular access using conventional routes in a timely manner. An intraosseous needle was inserted in the proximal humerus at the first attempt and administration of resuscitation fluid by this route subsequently enabled successful placement of further intravenous lines. Blood and blood products were deployed in conjunction with intra-operative cell salvage and transoesophageal Doppler cardiac output monitoring was used to assess adequacy of volume replacement. Haemorrhage control was finally achieved with the use of recombinant factor VIIa and hysterectomy. © 2011 The Authors. Anaesthesia © 2011 The Association of Anaesthetists of Great Britain and Ireland.

Hyoid Bone and Thyroid Cartilage Metastases from Sigmoid Colon Adenocarcinoma: A Case Report.

PubMed

Bracanovic, Djurdja; Vukovic, Vesna; Janovic, Aleksa; Radosavljevic, Davorin; Rakocevic, Zoran

2017-05-05

Secondary tumours of the hyoid bone and thyroid cartilage are extremely rare. In this paper, we present a case of the hyoid bone and thyroid cartilage metastases in a patient treated for sigmoid colon adenocarcinoma. Four years after sigmoid colon adenocarcinoma was diagnosed and treated with surgery and chemotherapy, the patient developed bone metastases in the left sacroiliac joint and right proximal humerus. Although the patient did not complain of any related symptoms, in a bone scintigraphy the accumulation of Technetium-99m was incidentally detected in the two sites of the anterior neck. On ultrasound examination there were two hyperechoic and heterogeneous masses with calcifications placed in front of the hyoid bone and thyroid cartilage. Computerized tomography demonstrated massive hyoid bone and thyroid cartilage destruction. In patients with progressive sigmoid colon adenocarcinoma, destruction of the hyoid bone and thyroid cartilage could be suspected for metastases.

[Postoperative implant-associated osteomyelitis of the shoulder: Hardware-retaining revision concept using temporary drainage].

PubMed

Schnetzke, M; Aytac, S; Herrmann, P; Wölfl, C; Grützner, P A; Heppert, V; Guehring, T

2015-06-01

Posttraumatic and postoperative osteomyelitis (PPO) is a subgroup of bone infections with increasing importance. However, to date no standardized reoperation concept exists particularly for patients with PPO of the shoulder region. Therefore the purpose of this study was to evaluate a revision concept including débridement, irrigation, and insertion of temporary drainage with hardware retention until healing. A total of 31 patients with PPO were included with a proximal humerus fracture (n = 14), clavicle fracture (n = 10), or AC-joint separation (n = 7). In all, 27 of these patients could be followed for > 1 year. Hardware retention until fracture or ligament healing could be achieved in > 83%. Six patients required follow-up débridement due to recurrent infections, but then were unremarkable. Clinical outcome showed excellent Constant scores (91.6 ± 2.8). A cost-efficient, simple, and successful revision concept for patients with PPO of the shoulder region is described.

A late Jurassic pterosaur (Reptilia, Pterodactyloidea) from northwestern Patagonia, Argentina

NASA Astrophysics Data System (ADS)

Codorniú, Laura; Gasparini, Zulma; Paulina-Carabajal, Ariana

2006-03-01

A small to medium-sized pterodactyloid pterosaur (wingspan approximately 1.10 m) from the Upper Jurassic (middle-late Tithonian) marine deposits of the Vaca Muerta Formation of Patagonia (Los Catutos area, central Neuquén Province, Argentina) is reported. The specimen lacks the skull but constitutes a nearly complete postcranial skeleton, which includes cervical and dorsal vertebrae; a few thoracic ribs; both pectoral girdles; the left pelvic girdle; a proximal right wing (humerus, ulna, and radius) and metacarpal IV; a left wing that lacks only wing phalanx four; and both hindlimbs, the right one without the foot. Ontogenetic features suggest that the new fossil corresponds to a relatively mature individual, probably a subadult. Observed characters support its assignment to the Archaeopteroactyloidea, a basal clade within the Pterodactyloidea. This specimen is the second pterosaur from Los Catutos and the most complete Jurassic pterosaur so far known from South America.

Acromioclavicular Joint Dislocation with Ipsilateral Mid Third Clavicle, Mid Shaft Humerus and Coracoid Process Fracture - A Case Report.

PubMed

Sharma, Naveen; Mandloi, Avinash; Agrawal, Ashish; Singh, Shailendra

2016-01-01

The clavicle, humerus and acromioclavicular (AC) joint separately are very commonly involved in traumatic injuries around the shoulder. Acromioclavicular joint dislocation with distal clavicle fracture is a well recognized entity in clinical practice. AC joint dislocation with mid shaft clavicle fracture is uncommon and only few cases have been reported in literature. However, to the best of our knowledge, this is the first case report to describe an acromioclavicular dislocation with ipsilateral mid shaft clavicle, mid shaft humerus and coracoid process fracture. Fractures of the humerus and clavicle along with the acromioclavicular joint dislocation were fixed at the same setting. A 65-year-old male met with a high velocity road traffic accident. Plain radiographs showed displaced mid third clavicle fracture with acromioclavicular joint dislocation with mid shaft humerus fracture. Surgical fixation was planned for humerus with interlocking nail, clavicle with locking plate and acromioclavicular joint with reconstruction of coracoclavicular ligaments. Intraoperatively, coracoid process was found to have a comminuted fracture. The operative plan had to be changed on table as coracoclavicular fixation was not possible. So acromioclavicular joint fixation was done using tension band wiring and the coracoclavicular ligament was repaired using a 2-0 ethibond. The comminuted coracoid fracture was managed conservatively. K wires were removed at 6 weeks. Early mobilization was started. In acromioclavicular joint injuries, clavicle must be evaluated for any injury. Although it is more commonly associated with distal clavicle fractures, it can be associated with middle third clavicle fractures. As plain radiographs, AP view are most of the times insufficient for viewing integrity of coracoid process, either special views like Stryker notch or CT scan may help in diagnosing such concealed injuries. When associated with fractures of the humerus and clavicle, anatomical restoration of acromioclavicular joint along with anatomical reduction and a rigid fixation of associated fractures is essential. Proper rehabilitation protocol is a must for achieving promising results. In our case, we were able to achieve a stable surgical fixation of both the fractures as well as AC joint, which enabled us to start early joint mobilization and rehabilitation.

Clearing the Cervical Spine in a War Zone: What Other Injuries Matter?

PubMed

Drew, Jennifer; Chou, Victoria B; Miller, Catriona; Borg, Bryson; Ingalls, Nichole; Shackelford, Stacy

2015-07-01

Cervical spine clearance requires clinicians to assess the reliability of physical examination based on a patient's mental status and distracting injuries. Distracting injuries have never been clearly defined in military casualties. Retrospective review was conducted of patients entered into Department of Defense Trauma Registry January 2008 to August 2013, identifying blunt trauma patients with cervical spine injury and Glasgow Coma Score ≥ 14. Physical examination and radiology results were abstracted from medical records and injury diagnoses were obtained from Department of Defense Trauma Registry. Groups were compared, p-value of < 0.05 was considered significant. A total of 149 patients met study criteria; 20 patients (13%) had a negative clinical examination of the cervical spine. Coexisting injuries identified in patients with negative physical examination included injuries in proximity to the neck (head, thoracic spine, chest, or humerus) in 17 (85%) patients. In 3 patients (15%), coexisting injuries were not in proximity to the neck and included pelvic, femur, and tibia fractures. All patients without coexisting injury (n = 37) had a positive physical examination. Physical examination of multitrauma casualties with neck injury may be unreliable when distracting injuries are present. When no distracting injuries were present, the physical examination was accurate in all patients. Reprint & Copyright © 2015 Association of Military Surgeons of the U.S.

Treatment of the external epicondylitis of the humerus with a magnetic field

NASA Technical Reports Server (NTRS)

Degen, I. L.

1974-01-01

The therapeutic effect of a constant and varying magnetic field on epicondylitis of the humerus is studied on ninety patients. Good results are obtained from the treatment (recovery of 80%, considerable improvement in 14.5%). The method is recommended for clinical application.

THE RESPONSE OF X-IRRADIATED LIMBS OF ADULT URODELES TO NORMAL TISSUE GRAFTS. I. EFFECTS OF AUTOGRAFTS OF SIXTY-DAY FOREARM REGENERATES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Stinson, B.D.

1963-06-01

Results are reported of autoplastic transplantation of parts of nonirradiated, regenerated forelimb to the contralateral x-irradiated forelimb in adult Triturus viridescens. The right forelimbs were exposed to various doses of localized irradiation (1000 to 5000 r) followed by amputation of both left and right forelimbs through the mid forearm. Left limbs regenerated normally, but irradiated right limbs failed to exhibit any significant degree of regenerative activity over a 3-month period. Both forelimbs were reamputated through the distal humerus and observed for an additional two months. Left limbs produced normal regenerates, but irradiated right limbs gave no gross evidence of regenerationmore » at any of the radiation dose levels. Normal left regenerates were reamputated immediately distal to the elbow on the 60th day after the second amputation; the severed forearm was trimmed with scissors along anterior and posterior borders and denuded of skin over its proximal half, leaving an essentially complete forearm region as a normal autograft. This was implanted into the irradiated right upper arm stump, after ablation of the distal half of its humerus, with normal proximodistal polarity in all cases. The irradiated stump was reamputated through the distal portion of the implanted normal autograft two weeks after implantation, and was observed for four months. Periodic gross observations showed that over 90% of irradiated upper arms formed regenerates at a rate which paralleled that of nonirradiated controls. However, regenerates formed on irradiated upper arms exhibited a restriction of morphogenetic capacity, only 60% attaining 3- and 4-digit stages. Most of the morphologically more complex regenerates which developed on the irradiated upper arm stumps manifested left limb asymmetry despite their formation on right irradiated stumps, suggesting a relation between the asymmetry of the normal graft and that of the resulting regenerate. All regenerates which developed on irradiated upper arms showed marked deficiencies in the restoration of a complete proximodistal structural pattern appropriate to the level of amputation through the irradiated stump. However, the actual pattern produced was appropriate to the level of amputation through the implanted normal autograft. These findings support the hypothesis that normal grafts promote the formation of regenerates on irradiated limbs through the autonomous developmental activity of the transected graft. (BBB)« less

Limb Bone Structural Proportions and Locomotor Behavior in A.L. 288-1 ("Lucy").

PubMed

Ruff, Christopher B; Burgess, M Loring; Ketcham, Richard A; Kappelman, John

2016-01-01

While there is broad agreement that early hominins practiced some form of terrestrial bipedality, there is also evidence that arboreal behavior remained a part of the locomotor repertoire in some taxa, and that bipedal locomotion may not have been identical to that of modern humans. It has been difficult to evaluate such evidence, however, because of the possibility that early hominins retained primitive traits (such as relatively long upper limbs) of little contemporaneous adaptive significance. Here we examine bone structural properties of the femur and humerus in the Australopithecus afarensis A.L. 288-1 ("Lucy", 3.2 Myr) that are known to be developmentally plastic, and compare them with other early hominins, modern humans, and modern chimpanzees. Cross-sectional images were obtained from micro-CT scans of the original specimens and used to derive section properties of the diaphyses, as well as superior and inferior cortical thicknesses of the femoral neck. A.L. 288-1 shows femoral/humeral diaphyseal strength proportions that are intermediate between those of modern humans and chimpanzees, indicating more mechanical loading of the forelimb than in modern humans, and by implication, a significant arboreal locomotor component. Several features of the proximal femur in A.L. 288-1 and other australopiths, including relative femoral head size, distribution of cortical bone in the femoral neck, and cross-sectional shape of the proximal shaft, support the inference of a bipedal gait pattern that differed slightly from that of modern humans, involving more lateral deviation of the body center of mass over the support limb, which would have entailed increased cost of terrestrial locomotion. There is also evidence consistent with increased muscular strength among australopiths in both the forelimb and hind limb, possibly reflecting metabolic trade-offs between muscle and brain development during hominin evolution. Together these findings imply significant differences in both locomotor behavior and ecology between australopiths and later Homo.

Limb Bone Structural Proportions and Locomotor Behavior in A.L. 288-1 ("Lucy")

PubMed Central

Ruff, Christopher B.; Burgess, M. Loring; Ketcham, Richard A.; Kappelman, John

2016-01-01

While there is broad agreement that early hominins practiced some form of terrestrial bipedality, there is also evidence that arboreal behavior remained a part of the locomotor repertoire in some taxa, and that bipedal locomotion may not have been identical to that of modern humans. It has been difficult to evaluate such evidence, however, because of the possibility that early hominins retained primitive traits (such as relatively long upper limbs) of little contemporaneous adaptive significance. Here we examine bone structural properties of the femur and humerus in the Australopithecus afarensis A.L. 288–1 ("Lucy", 3.2 Myr) that are known to be developmentally plastic, and compare them with other early hominins, modern humans, and modern chimpanzees. Cross-sectional images were obtained from micro-CT scans of the original specimens and used to derive section properties of the diaphyses, as well as superior and inferior cortical thicknesses of the femoral neck. A.L. 288–1 shows femoral/humeral diaphyseal strength proportions that are intermediate between those of modern humans and chimpanzees, indicating more mechanical loading of the forelimb than in modern humans, and by implication, a significant arboreal locomotor component. Several features of the proximal femur in A.L. 288–1 and other australopiths, including relative femoral head size, distribution of cortical bone in the femoral neck, and cross-sectional shape of the proximal shaft, support the inference of a bipedal gait pattern that differed slightly from that of modern humans, involving more lateral deviation of the body center of mass over the support limb, which would have entailed increased cost of terrestrial locomotion. There is also evidence consistent with increased muscular strength among australopiths in both the forelimb and hind limb, possibly reflecting metabolic trade-offs between muscle and brain development during hominin evolution. Together these findings imply significant differences in both locomotor behavior and ecology between australopiths and later Homo. PMID:27902687

Three edible wild mushrooms from Nigeria: their proximate and mineral composition.

PubMed

Alofe, F V; Odeyemi, O; Oke, O L

1996-01-01

The pilei (caps) and the stipes (stalks) of the button and early open-cap (cup) stages of Lentinus subnudus, Psathyrella atroumbonata and Termitomyces striatus were assayed separately for their proximate and mineral composition. The differences observed in the contents of some of the proximate components seem to be related to species and mushroom parts. P. atroumbonata was richest in crude and true protein, L. subnudus was richer in crude fiber, ash and carbohydrates. Mineral contents appeared to be dependent on type and parts of the mushrooms analysed. The three mushrooms were good sources of magnesium, zinc and iron. L. subnudus contained between 14.83 and 20.00 ppm of iron, P. atroumbonata contained between 20.01 and 22.09 ppm and T. striatus contained between 17.13 and 22.93 ppm of iron. The pilei of P. atroumbonata and T. striatus are very good sources of zinc. Zinc contents for the pilei of P. atroumbonata were 63.81 and 64.94 ppm respectively. Zinc contents for T. striatus were 90.45 and 92.49 ppm respectively.

The postcranial skeletal maturation of Australopithecus sediba.

PubMed

Cameron, Noel; Bogin, Barry; Bolter, Debra; Berger, Lee R

2017-07-01

In 2008, an immature hominin defined as the holotype of the new species Australopithecus sediba was discovered at the 1.9 million year old Malapa site in South Africa. The specimen (MH1) includes substantial post-cranial skeletal material, and provides a unique opportunity to assess its skeletal maturation. Skeletal maturity indicators observed on the proximal and distal humerus, proximal ulna, distal radius, third metacarpal, ilium and ischium, proximal femur and calcaneus were used to assess the maturity of each bone in comparison to references for modern humans and for wild chimpanzees (Pan troglodytes). In comparison to humans the skeletal maturational ages for Au. sediba correspond to between 12.0 years and 15.0 years with a mean (SD) age of 13.1 (1.1) years. In comparison to the maturational pattern of chimpanzees the Au. sediba indicators suggest a skeletal maturational age of 9-11 years. Based on either of these skeletal maturity estimates and the body length at death of MH1, an adult height of 150-156 cm is predicted. We conclude that the skeletal remains of MH1 are consistent with an ape-like pattern of maturity when dental age estimates are also taken into consideration. This maturity schedule in australopiths is consistent with ape-like estimates of age at death for the Nariokotome Homo erectus remains (KMN-WT 15000), which are of similar postcranial immaturity to MH1. The findings suggest that humans may have distinctive and delayed post-cranial schedules from australopiths and H. erectus, implicating a recent evolution of somatic and possibly life history strategies in human evolution. © 2017 Wiley Periodicals, Inc.

No Side-to-Side Difference in Humeral Retroversion in Baseball Players with Shoulder Disorders Using a True Three-Dimensional Measurement Technique: Validation and Comparison

PubMed Central

Saka, Masayuki; Yamauchi, Hiroki; Yoshioka, Toru; Hamada, Hidetoshi; Gamada, Kazuyoshi

2014-01-01

Objectives: Increased humeral retroversion in the throwing shoulder is considered to exist in many baseball players and is often considered as a cause of internal rotation deficit. However, retroversion angles using two-dimensional (2D) methods utilized in previous studies did not correlated with a true three-dimensional measurement technique (3D retroversion) in our study. The purposes of this study were to determine 1) if significant side-to-side differences in retroversion exist, and 2) the relationships between retroversion and glenohumeral range of motion (ROM) in baseball players with a shoulder disorder. Methods: Fourteen male baseball players (age: 21.4 ± 1.5 years; mean ± standard deviation) with a throwing shoulder disorder were enrolled, including 11 in the collegiate and 3 in the adult levels, comprising 5 pitchers and 9 position players. The mean age when the athletes had started playing baseball was 9.1 years (range, 6 to 10 years) and the mean playing experience was 12.1 years (range, 9 to 17 years). Patients with history of fracture or surgery in the shoulder or elbow were excluded. Outcome measurements included a 3D retroversion angle and glenohumeral ROM in bilateral shoulders. Patients underwent CT scan at 1.0 mm slice pitch for the bilateral humerus and geometric bone models were created. The 3D retroversion angle was defined as an angle between the projected humeral neck line (connecting the spherical center of the humeral head and the cylindrical axis of the humeral shaft) onto the horizontal plane and the flexion-extension axis of the distal humerus obtained by a cylinder-fitting method for the capitulum and trochlea (intratester reliability: ICC 0.98, standard error of measurement: 1.7º). The CT slices for the proximal and distal humerus were used to measure a 2D-CT retroversion angle using a reported convention. An indirect measurement of retroversion was performed using a bicipital grove-ulna angle by an ultrasound images dusing a reported convention. Glenohumeral ROM measurements included internal rotation (IR) and horizontal adduction (HAd) in the supine position with the scapula manually stabilized on the treatment table. Independent t tests were used to determine if significant side-to-side differences exist in retroversion and glenohumeral ROM. Pearson correlation coefficients were used to determine the association between retroversion and glenohumeral ROM in the throwing shoulders. Statistical analysis was performed with PASW Statistics 18 (SPSS, Inc, Chicago, IL). An alpha level of 0.05 was set a priori for statistical significance. Results: No significant difference was found in 3D retroversion between the throwing and non-throwing shoulders (P = .182). The throwing shoulders demonstrated decreased IR and HAd compared with the non-throwing shoulders (P < .001 and P = .002, respectively). There were no significant correlations between retroversion and glenohumeral ROM for the throwing shoulders (Table). The 2D-CT retroversion and bicipital grove-ulna angles were greater in the throwing shoulder (P = .007 and .009, respectively). Conclusion: Contradicted to the previous studies, no side-to-side difference in retroversion and no association between retroversion and glenohumeral ROM were observed in the baseball players with a shoulder disorder. We believe that deficit in shoulder IR and HAd may be attributed to soft tissue tightness. The results of the previous studies involving humeral retroversion should be reassessed.

Community water fluoridation, bone mineral density, and fractures: prospective study of effects in older women.

PubMed

Phipps, K R; Orwoll, E S; Mason, J D; Cauley, J A

2000-10-07

To determine whether fluoridation influences bone mineral density and fractures in older women. Multicentre prospective study on risk factors for osteoporosis and fractures. Four community based centres in the United States. 9704 ambulatory women without bilateral hip replacements enrolled during 1986-8; 7129 provided information on exposure to fluoride. Bone mineral density of the lumbar spine, proximal femur, radius, and calcaneus plus incident fractures (fractures that occurred during the study) of vertebrae, hip, wrist, and humerus. Women were classified as exposed or not exposed or having unknown exposure to fluoride for each year from 1950 to 1994. Outcomes were compared in women with continuous exposure to fluoridated water for the past 20 years (n=3218) and women with no exposure during the past 20 years (n=2563). In women with continuous exposure mean bone mineral density was 2.6% higher at the femoral neck (0.017 g/cm(2), P<0.001), 2.5% higher at the lumbar spine (0.022 g/cm(2), P<0.001), and 1.9% lower at the distal radius (0.007 g/cm(2), P=0.002). In women with continuous exposure the multivariable adjusted risk of hip fracture was slightly reduced (risk ratio 0.69, 95% confidence interval 0.50 to 0.96, P=0.028) as was the risk of vertebral fracture (0.73, 0.55 to 0.97, P=0.033). There was a non-significant trend toward an increased risk of wrist fracture (1.32, 1.00 to 1.71, P=0.051) and no difference in risk of humerus fracture (0.85, 0.58 to 1.23, P=0.378). Long term exposure to fluoridated drinking water does not increase the risk of fracture.

Community water fluoridation, bone mineral density, and fractures: prospective study of effects in older women

PubMed Central

Phipps, Kathy R; Orwoll, Eric S; Mason, Jill D; Cauley, Jane A

2000-01-01

Objective To determine whether fluoridation influences bone mineral density and fractures in older women. Design Multicentre prospective study on risk factors for osteoporosis and fractures. Setting Four community based centres in the United States. Participants 9704 ambulatory women without bilateral hip replacements enrolled during 1986-8; 7129 provided information on exposure to fluoride. Main outcome measures Bone mineral density of the lumbar spine, proximal femur, radius, and calcaneus plus incident fractures (fractures that occurred during the study) of vertebrae, hip, wrist, and humerus. Results Women were classified as exposed or not exposed or having unknown exposure to fluoride for each year from 1950 to 1994. Outcomes were compared in women with continuous exposure to fluoridated water for the past 20 years (n=3218) and women with no exposure during the past 20 years (n=2563). In women with continuous exposure mean bone mineral density was 2.6% higher at the femoral neck (0.017 g/cm2, P<0.001), 2.5% higher at the lumbar spine (0.022 g/cm2, P<0.001), and 1.9% lower at the distal radius (0.007 g/cm2, P=0.002). In women with continuous exposure the multivariable adjusted risk of hip fracture was slightly reduced (risk ratio 0.69, 95% confidence interval 0.50 to 0.96, P=0.028) as was the risk of vertebral fracture (0.73, 0.55 to 0.97, P=0.033). There was a non-significant trend toward an increased risk of wrist fracture (1.32, 1.00 to 1.71, P=0.051) and no difference in risk of humerus fracture (0.85, 0.58 to 1.23, P=0.378). Conclusions Long term exposure to fluoridated drinking water does not increase the risk of fracture. PMID:11021862

The Distal Humerus Axial View: Assessment of Displacement in Medial Epicondyle Fractures.

PubMed

Souder, Christopher D; Farnsworth, Christine L; McNeil, Natalie P; Bomar, James D; Edmonds, Eric W

2015-01-01

The assessment and treatment of childhood medial epicondyle humerus fractures continues to be associated with significant debate. Several studies demonstrate that standard radiographic views are unable to accurately portray the true displacement. Without reliable ways to assess the amount of displacement, how can we debate treatment and outcomes? This study introduces a novel imaging technique for the evaluation of medial epicondyle fractures. An osteotomy of a cadaveric humerus was performed to simulate a medial epicondyle fracture. Plain radiographs were obtained with the fracture fragment displaced anteriorly in 2-mm increments between 0 and 18 mm. Anteroposterior (AP), internal oblique (IR), lateral (LAT), and distal humerus axial (AXIAL) views were performed. Axial images were obtained by positioning the central ray above the shoulder at 15 to 20 degrees from the long axis of the humerus, centered on the distal humerus. Displacement (mm) was measured by 7 orthopaedic surgeons on digital radiographs. At 10 mm displacement, AP views underestimated displacement by 5.5±0.6 mm and IR views underestimated by 3.8±2.1 mm. On LAT views, readers were not able to visualize fragments with <10 mm displacement. Displacement ≥10 mm from LAT views was overestimated by 1 reader by up to 4.6 mm and underestimated by others by up to 18.0 mm. AXIAL images more closely estimated the true amount of displacement, with a mean 1.5±1.1 mm error in measurement for <10 mm displacement and a mean 0.8±0.7 mm error for displacements of ≥10 mm. AXIAL measurements correlated strongly with the actual displacement (r=0.998, P<0.05); AP measurements did not (r=0.655, P=0.55). Intraclass correlation coefficient (ICC) was 0.257 for AP and IR measurements; ICC was 0.974 for AXIAL measurements. Standard imaging, consisting of AP, IR, and LAT radiographs, consistently underestimates the actual displacement of medial epicondyle humerus fractures. The newly described AXIAL projection more accurately and reliably demonstrated the true displacement while reducing the need for advanced imaging such as computed tomography. This simple view can be easily obtained at a clinic visit, enhancing the surgeon's ability to determine the true displacement.

Reidentification of avian embryonic remains from the cretaceous of mongolia.

PubMed

Varricchio, David J; Balanoff, Amy M; Norell, Mark A

2015-01-01

Embryonic remains within a small (4.75 by 2.23 cm) egg from the Late Cretaceous, Mongolia are here re-described. High-resolution X-ray computed tomography (HRCT) was used to digitally prepare and describe the enclosed embryonic bones. The egg, IGM (Mongolian Institute for Geology, Ulaanbaatar) 100/2010, with a three-part shell microstructure, was originally assigned to Neoceratopsia implying extensive homoplasy among eggshell characters across Dinosauria. Re-examination finds the forelimb significantly longer than the hindlimbs, proportions suggesting an avian identification. Additional, postcranial apomorphies (strut-like coracoid, cranially located humeral condyles, olecranon fossa, slender radius relative to the ulna, trochanteric crest on the femur, and ulna longer than the humerus) identify the embryo as avian. Presence of a dorsal coracoid fossa and a craniocaudally compressed distal humerus with a strongly angled distal margin support a diagnosis of IGM 100/2010 as an enantiornithine. Re-identification eliminates the implied homoplasy of this tri-laminate eggshell structure, and instead associates enantiornithine birds with eggshell microstructure composed of a mammillary, squamatic, and external zones. Posture of the embryo follows that of other theropods with fore- and hindlimbs folded parallel to the vertebral column and the elbow pointing caudally just dorsal to the knees. The size of the egg and embryo of IGM 100/2010 is similar to the two other Mongolian enantiornithine eggs. Well-ossified skeletons, as in this specimen, characterize all known enantiornithine embryos suggesting precocial hatchlings, comparing closely to late stage embryos of modern precocial birds that are both flight- and run-capable upon hatching. Extensive ossification in enantiornithine embryos may contribute to their relatively abundant representation in the fossil record. Neoceratopsian eggs remain unrecognized in the fossil record.

Distance from the growth plate and Its relation to the outcome of unicameral bone cyst treatment.

PubMed

Haidar, Saadallah George; Culliford, David J; Gent, Edward David; Clarke, Nicholas M P

2011-04-01

Interventions to treat unicameral bone cysts vary. Nonetheless, regardless of the intervention modality, the outcome is not certain. The purpose of this study was to determine if the distance between the growth plate and the cyst can be used to predict the outcome of the treatment. Retrospectively, we assessed the outcome of 39 interventions in nineteen children that were performed between 1994 and 2003. Seventeen different modalities of treatment were employed. There were three female and sixteen male patients. The average age was 8 years. Nine cysts were in the greater trochanter area, three were in the femoral capital area and seven were in the proximal humerus. According to the cyst's distance from the growth plate, at the intervention time, there were 18 cases within less than 2 cm and 21 cases of more than 2 cm. Complete healing was achieved in 10 children (employing seven different modalities). In nine of them, the cysts were more than 2 cm away from the growth plate. In one child, the cyst was within less than 2 cm of the growth plate, however, treatment here involved epiphyseodesis. This study confirmed that, regardless of intervention modality, complete healing was not achievable in those cysts that are within less than 2 cm of an active growth plate. Complete healing was possible in those cysts that are more than 2 cm away from the growth plate. The 2-cm distance from the growth plate could be used as a predictor of treatment outcome of unicameral bone cysts.

Functional outcomes of "floating elbow" injuries in adult patients.

PubMed

Yokoyama, K; Itoman, M; Kobayashi, A; Shindo, M; Futami, T

1998-05-01

To assess elbow function, complications, and problems of floating elbow fractures in adults receiving surgical treatment. Retrospective clinical review. Level I trauma center in Kanagawa, Japan. Fourteen patients with fifteen floating elbow injuries, excluding one immediate amputation, seen at the Kitasato University Hospital from January 1, 1984, to April 30, 1995. All fractures were managed surgically by various methods. In ten cases, the humeral and forearm fractures were treated simultaneously with immediate fixation. In three cases, both the humeral and forearm fractures were treated with delayed fixation on Day 1, 4, or 7. In the remaining two cases, the open forearm fracture was managed with immediate fixation and the humerus fracture with delayed fixation on Day 10 or 25. All subjects underwent standardized elbow evaluations, and results were compared with an elbow score based on a 100-point scale. The parameters evaluated were pain, motion, elbow and grip strength, and function during daily activities. Complications such as infections, nonunions, malunions, and refractures were investigated. Mean follow-up was forty-three months (range 13 to 112 months). At final follow-up, the mean elbow function score was 79 points, with 67 percent (ten of fifteen) of the subjects having good or excellent results. The functional outcome did not correlate with the Injury Severity Score of the individual patients, the existence of open injuries or neurovascular injuries, or the timing of surgery. There were one deep infection, two nonunions of the humerus, two nonunions of the forearm, one varus deformity of the humerus, and one forearm refracture. Based on the present data, we could not clarify the factors influencing the final functional outcome after floating elbow injury. These injuries, however, potentially have many complications, such as infection or nonunion, especially when there is associated brachial plexus injury. We consider that floating elbow injuries are severe injuries and that surgical stabilization is needed; beyond that, there are no specific forms of surgical treatment to reliably guarantee excellent results.

Limb lengthening in achondroplasia

PubMed Central

Chilbule, Sanjay K; Dutt, Vivek; Madhuri, Vrisha

2016-01-01

Background: Stature lengthening in skeletal dysplasia is a contentious issue. Specific guidelines regarding the age and sequence of surgery, methods and extent of lengthening at each stage are not uniform around the world. Despite the need for multiple surgeries, with their attendant complications, parents demanding stature lengthening are not rare, due to the social bias and psychological effects experienced by these patients. This study describes the outcome and complications of extensive stature lengthening performed at our center. Materials and Methods: Eight achondroplasic and one hypochondroplasic patient underwent bilateral transverse lengthening for tibiae, humeri and femora. Tibia lengthening was carried out using a ring fixator and bifocal corticotomy, while a monolateral pediatric limb reconstruction system with unifocal corticotomy was used for the femur and humerus. Lengthening of each bone segment, height gain, healing index and complications were assessed. Subgroup analysis was carried out to assess the effect of age and bone segment on the healing index. Results: Nine patients aged five to 25 years (mean age 10.2 years) underwent limb lengthening procedures for 18 tibiae, 10 femora and 8 humeri. Four patients underwent bilateral lengthening of all three segments. The mean length gain for the tibia, femur and humerus was 15.4 cm (100.7%), 9.9 cm (52.8%) and 9.6 cm (77.9%), respectively. Healing index was 25.7, 25.6 and 20.6 days/cm, respectively, for the tibia, femur and humerus. An average of 33.3% height gain was attained. Lengthening of both tibia and femur added to projected height achieved as the 3rd percentile of standard height in three out of four patients. In all, 33 complications were encountered (0.9 complications per segment). Healing index was not affected by age or bone segment. Conclusion: Extensive limb lengthening (more than 50% over initial length) carries significant risk and should be undertaken only after due consideration. PMID:27512222

The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF).

PubMed

Joeris, Alexander; Lutz, Nicolas; Blumenthal, Andrea; Slongo, Theddy; Audigé, Laurent

2017-04-01

Background and purpose - To achieve a common understanding when dealing with long bone fractures in children, the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO PCCF) was introduced in 2007. As part of its final validation, we present the most relevant fracture patterns in the upper extremities of a representative population of children classified according to the PCCF. Patients and methods - We included children and adolescents (0-17 years old) diagnosed with 1 or more long bone fractures between January 2009 and December 2011 at the university hospitals in Bern and Lausanne (Switzerland). Patient charts were retrospectively reviewed and fractures were classified from standard radiographs. Results - Of 2,292 upper extremity fractures in 2,203 children and adolescents, 26% involved the humerus and 74% involved the forearm. In the humerus, 61%, and in the forearm, 80% of single distal fractures involved the metaphysis. In adolescents, single humerus fractures were more often epiphyseal and diaphyseal fractures, and among adolescents radius fractures were more often epiphyseal fractures than in other age groups. 47% of combined forearm fractures were distal metaphyseal fractures. Only 0.7% of fractures could not be classified within 1 of the child-specific fracture patterns. Of the single epiphyseal fractures, 49% were Salter-Harris type-II (SH II) fractures; of these, 94% occurred in schoolchildren and adolescents. Of the metaphyseal fractures, 58% showed an incomplete fracture pattern. 89% of incomplete fractures affected the distal radius. Of the diaphyseal fractures, 32% were greenstick fractures. 24 Monteggia fractures occurred in pre-school children and schoolchildren, and 2 occurred in adolescents. Interpretation - The pattern of pediatric fractures in the upper extremity can be comprehensively described according to the PCCF. Prospective clinical studies are needed to determine its clinical relevance for treatment decisions and prognostication of outcome.

Quantitative determination of selenium and mercury, and an ICP-MS semi-quantitative scan of other elements in samples of eagle tissues collected from the Pacific Northwest--Summer 2011

USGS Publications Warehouse

May, Thomas; Walther, Mike; Brumbaugh, William

2013-01-01

Eagle tissues from dead eagle carcasses were collected by U.S. Fish and Wildlife Service personnel at various locations in the Pacific Northwest as part of a study to document the occurrence of metal and metalloid contaminants. A group of 182 eagle tissue samples, consisting of liver, kidney, brain, talon, feather, femur, humerus, and stomach contents, were quantitatively analyzed for concentrations of selenium and mercury by atomic absorption techniques, and for other elements by semi-quantitative scan with an inductively coupled plasma-mass spectrometer. For the various tissue matrices analyzed by an ICP-MS semiquantitative scan, some elemental concentrations (micrograms per gram dry weight) were quite variable within a particular matrix; notable observations were as follows: lead concentrations ranged from 0.2 to 31 in femurs, 0.1 to 29 in humeri, 0.1 to 54 in talons, less than (<) 0.05 to 120 in livers, <0.05 to 34 in kidneys, and 0.05 to 8 in brains; copper concentrations ranged from 5 to 9 in feathers, 8 to 47 in livers, 7 to 43 in kidneys, and 7 to 28 in brains; cadmium concentrations ranged from 0.1 to 10 in kidneys. In stomach contents, concentrations of vanadium ranged from 0.08 to 5, chromium 2 to 34, manganese 1 to 57, copper 2 to 69, arsenic <0.05 to 6, rubidium 1 to 13, and barium <0.5 to 18. Selenium concentrations from highest to lowest based on the matrix mean were as follows: kidney, liver, feather, brain, stomach content, talon, femur, and humerus. For mercury, the highest to lowest concentrations were feather, liver, talon, brain, stomach content, femur, and humerus.

The AO Pediatric Comprehensive Classification of Long Bone Fractures (PCCF)

PubMed Central

Joeris, Alexander; Lutz, Nicolas; Blumenthal, Andrea; Slongo, Theddy; Audigé, Laurent

2017-01-01

Background and purpose To achieve a common understanding when dealing with long bone fractures in children, the AO Pediatric Comprehensive Classification of Long Bone Fractures (AO PCCF) was introduced in 2007. As part of its final validation, we present the most relevant fracture patterns in the upper extremities of a representative population of children classified according to the PCCF. Patients and methods We included children and adolescents (0–17 years old) diagnosed with 1 or more long bone fractures between January 2009 and December 2011 at the university hospitals in Bern and Lausanne (Switzerland). Patient charts were retrospectively reviewed and fractures were classified from standard radiographs. Results Of 2,292 upper extremity fractures in 2,203 children and adolescents, 26% involved the humerus and 74% involved the forearm. In the humerus, 61%, and in the forearm, 80% of single distal fractures involved the metaphysis. In adolescents, single humerus fractures were more often epiphyseal and diaphyseal fractures, and among adolescents radius fractures were more often epiphyseal fractures than in other age groups. 47% of combined forearm fractures were distal metaphyseal fractures. Only 0.7% of fractures could not be classified within 1 of the child-specific fracture patterns. Of the single epiphyseal fractures, 49% were Salter-Harris type-II (SH II) fractures; of these, 94% occurred in schoolchildren and adolescents. Of the metaphyseal fractures, 58% showed an incomplete fracture pattern. 89% of incomplete fractures affected the distal radius. Of the diaphyseal fractures, 32% were greenstick fractures. 24 Monteggia fractures occurred in pre-school children and schoolchildren, and 2 occurred in adolescents. Interpretation The pattern of pediatric fractures in the upper extremity can be comprehensively described according to the PCCF. Prospective clinical studies are needed to determine its clinical relevance for treatment decisions and prognostication of outcome. PMID:27882802

Melorheostosis: case report with 20-year follow-up.

PubMed

Pavone, Vito; Evola, Roberto Francesco; Di Giorgio, Angelo; Ruggieri, Martino; Ardito, Salvatore

2008-05-01

The authors report on a typical case of melorheostosis observed in an 18-year-old man, localized in the II digit of the right hand causing tumefaction and irregular pain. At 20-year follow-up, the patient showed a radiographical slight worsening of the lesion. Radiographic examination showed a mild increase in cortical and endosteal hyperostosis with bone shape alteration in the II digit of the right hand, slight cortical and endosteal hyperostosis at the level of right shoulder girdle involving the humerus. The other part of the skeleton was not affected. Clinical examination revealed swelling and tumefaction of the forefinger of the right hand and reduced articular motion both in proximal and distal interphalangeal joint and metacarpal phalangeal joint. The reminder of the clinical examination was normal. Melorheostosis is an uncommon mesenchymal disorder characterized by a chondral hyperostosis of the long bones associated to a sclerosis of the spongious bone. The etiology of this affection is unknown: the most accredited hypothesis is a developmental anomaly with a sequential sclerotomes distribution. Both genders may be affected, with the long tubular bones of the lower limbs more involved. This anomaly is often asymptomatic but maybe accompanied by pain with a smooth symptom progression and periodic exacerbations. Therapy is mainly symptomatic and comprises anti-inflammatory drugs or surgical approach for removal of soft tissue that may preclude daily activities. This case report demonstrates that melorheostosis is a relatively benign disorder with mildly progressive course.

Comparison of the Fluid Resuscitation Rate with and without External Pressure Using Two Intraosseous Infusion Systems for Adult Emergencies, the CITRIN (Comparison of InTRaosseous infusion systems in emergency medicINe)-Study

PubMed Central

Gries, André; Hossfeld, Björn; Bechmann, Ingo; Bernhard, Michael

2015-01-01

Introduction Intraosseous infusion is recommended if peripheral venous access fails for cardiopulmonary resuscitation or other medical emergencies. The aim of this study, using body donors, was to compare a semi-automatic (EZ-IO®) device at two insertion sites and a sternal intraosseous infusion device (FASTR™). Methods Twenty-seven medical students being inexperienced first-time users were randomized into three groups using EZ-IO and FASTR. The following data were evaluated: attempts required for successful placement, insertion time and flow rates with and without external pressure to the infusion. Results The first-pass insertion success of the EZ-IO tibia, EZ-IO humerus and FASTR was 91%, 77%, and 95%, respectively. Insertion times (MW±SD) did not show significant differences with 17±7 (EZ-IO tibia) vs. 29±42 (EZ-IO humerus) vs. 33±21 (FASTR), respectively. One-minute flow rates using external pressures between 0 mmHg and 300 mmHg ranged between 27±5 to 69±54 ml/min (EZ-IO tibia), 16±3 to 60±44 ml/min (EZ-IO humerus) and 53±2 to 112±47 ml/min (FASTR), respectively. Concerning pressure-related increases in flow rates, negligible correlations were found for the EZ-IO tibia in all time frames (c = 0.107–0.366; p≤0.013), moderate positive correlations were found for the EZ-IO humerus after 5 minutes (c = 0.489; p = 0.021) and strong positive correlations were found for the FASTR in all time frames (c = 0.63–0.80; p≤0.007). Post-hoc statistical power was 0.62 with the given sample size. Conclusions The experiments with first-time users applying EZ-IO and FASTR in body donors indicate that both devices may be effective intraosseous infusion devices, likely suitable for fluid resuscitation using a pressure bag. Variations in flow rate may limit their reliability. Larger sample sizes will prospectively be required to substantiate our findings. PMID:26630579

Comparison of the Fluid Resuscitation Rate with and without External Pressure Using Two Intraosseous Infusion Systems for Adult Emergencies, the CITRIN (Comparison of InTRaosseous infusion systems in emergency medicINe)-Study.

PubMed

Hammer, Niels; Möbius, Robert; Gries, André; Hossfeld, Björn; Bechmann, Ingo; Bernhard, Michael

2015-01-01

Intraosseous infusion is recommended if peripheral venous access fails for cardiopulmonary resuscitation or other medical emergencies. The aim of this study, using body donors, was to compare a semi-automatic (EZ-IO®) device at two insertion sites and a sternal intraosseous infusion device (FASTR™). Twenty-seven medical students being inexperienced first-time users were randomized into three groups using EZ-IO and FASTR. The following data were evaluated: attempts required for successful placement, insertion time and flow rates with and without external pressure to the infusion. The first-pass insertion success of the EZ-IO tibia, EZ-IO humerus and FASTR was 91%, 77%, and 95%, respectively. Insertion times (MW ± SD) did not show significant differences with 17 ± 7 (EZ-IO tibia) vs. 29 ± 42 (EZ-IO humerus) vs. 33 ± 21 (FASTR), respectively. One-minute flow rates using external pressures between 0 mmHg and 300 mmHg ranged between 27 ± 5 to 69 ± 54 ml/min (EZ-IO tibia), 16 ± 3 to 60 ± 44 ml/min (EZ-IO humerus) and 53 ± 2 to 112 ± 47 ml/min (FASTR), respectively. Concerning pressure-related increases in flow rates, negligible correlations were found for the EZ-IO tibia in all time frames (c = 0.107-0.366; p ≤ 0.013), moderate positive correlations were found for the EZ-IO humerus after 5 minutes (c = 0.489; p = 0.021) and strong positive correlations were found for the FASTR in all time frames (c = 0.63-0.80; p ≤ 0.007). Post-hoc statistical power was 0.62 with the given sample size. The experiments with first-time users applying EZ-IO and FASTR in body donors indicate that both devices may be effective intraosseous infusion devices, likely suitable for fluid resuscitation using a pressure bag. Variations in flow rate may limit their reliability. Larger sample sizes will prospectively be required to substantiate our findings.

Management of unicameral bone cyst by using freeze dried radiation sterilized bone allograft impregnate with autogenous bone marrow.

PubMed

Datta, N K; Das, K P; Alam, M S; Kaiser, M S

2014-07-01

Unicameral bone cyst is a common benign bone tumor and most frequent cause of the pathological fracture in children. We have started a prospective study for that treatment of unicameral bone cyst by using freeze dried radiation sterilized bone allograft impregnated with autogenous bone marrow in the department of Orthopaedics, Bangabandhu Sheikh Mujib Medical University (BSMMU) during May 1999 to April 2012. Aim of this study was to see Freeze dried radiation sterilized bone allograft impregnate with autogenous bone marrow a satisfactory graft material in the treatment of unicameral bone cyst as well as factors such as patients age, sex, cyst size and site of lesion influence on cyst healing. A total 35 patients of unicameral bone cyst were operated. In this study out of 35 patients, male were 22(62.86%) and female were 13(37.14). Male Female ratio 22:13(1.70:1) Age of the patients ranging from 2 years 6 month to 20 years, mean age 12.18 years more common 11 years to 20 years 29(82.86%) patients. Common bones sites involvements are proximal end of Humerus 20(57.14%), proximal end of Femur 7(20 %), proximal end of Tibia 3(8.57%), Calcanium 2(5.71%), proximal end of Ulna 1(2.86%), shaft of Radius 1(2.86%) and Phalanx 1(2.86%). Final clinical outcome of unicameral bone cyst treated by thorough curettage of cavity and tightly filled with freeze dried radiation sterilized bone allograft impregnate with autogenous bone marrow in which healed (success rate) 88.57% (31) and recurrence rate is 11.43% (4). P value is <0.001. Follow up period was 6 month to 11 years. From our study it was realized that freeze dried radiation sterilized bone allograft impregnated with autogenous bone marrow is useful graft material for healing of the lesional area as well as restoring structural integrity for the treatment of unicameral bone cyst.

[Meta-analysis of risk factors of recurrence in patients with giant cell tumor on extremities].

PubMed

Li, Rongrui; Hu, Yongcheng

2014-12-23

To explore the risk factors of giant cell tumor on extremities for patients with postoperative recurrence. The literature reports published before June 2014 were searched in the electronic databases of CBM, CNKI, PUBNED, MEDLINE and EMBASE. Meta-analysis was performed by software Review Manager (Version 5.3). The odds ratios (OR) of gender, age, tumor site, Campanacci Classification, pathological fracture, selection of treatment and soft tissue invasion were analyzed with heterogeneity test. Publication bias were tested by funnel plot and fail-safe number.Sensitivity analysis was performed to assess the stability. A total of 15 case-control studies were identified. Age, location and type of surgery were associated with tumor recurrence. The combined OR (95%CI) was 1.83 (1.04-3.24) P = 0.04 for aged <20 years, 0.52(0.31-0.86) P = 0.01 for aged >40 years, 1.60 (1.06-2.42) P = 0.02 for distal radius, 0.35 (0.14-0.90) P = 0.03 for proximal humerus, 3.64 (1.88-7.04) P = 0.0001 for curettage,0.56 (0.35-0.91) P = 0.02 for curettage with PMMA, 1.79 (1.11-2.88) P = 0.02 for curettage with bone graft and adjuvant and 0.29 (0.12-0.66) P = 0.003 for resection respectively. There were not significant relationship between tumor recurrence and gender, tumor location (distal femur, proximal femur, distal tibia, proximal tibia), Jaffe staging, Campanacci classification,Enneking classification, pathological fracture, soft tissue invasion, extensive curettage, curettage with bone graft, curettage with polymethylmethacrylate and adjuvant (P > 0.05). Youth (aged <20 years), distal radius, curettage and curettage with bone graft and adjuvant are the risk factors for recurrence of giant cell tumor.However, advanced age (aged >40 years), proximal tibia, curettage with PMMA and resection appear to have lower risks for tumor recurrence.

Minimal invasive surgery for unicameral bone cyst using demineralized bone matrix: a case series

PubMed Central

2012-01-01

Background Various treatments for unicameral bone cyst have been proposed. Recent concern focuses on the effectiveness of closed methods. This study evaluated the effectiveness of demineralized bone matrix as a graft material after intramedullary decompression for the treatment of unicameral bone cysts. Methods Between October 2008 and June 2010, twenty-five patients with a unicameral bone cyst were treated with intramedullary decompression followed by grafting of demineralized bone matrix. There were 21 males and 4 female patients with mean age of 11.1 years (range, 3–19 years). The proximal metaphysis of the humerus was affected in 12 patients, the proximal femur in five, the calcaneum in three, the distal femur in two, the tibia in two, and the radius in one. There were 17 active cysts and 8 latent cysts. Radiologic change was evaluated according to a modified Neer classification. Time to healing was defined as the period required achieving cortical thickening on the anteroposterior and lateral plain radiographs, as well as consolidation of the cyst. The patients were followed up for mean period of 23.9 months (range, 15–36 months). Results Nineteen of 25 cysts had completely consolidated after a single procedure. The mean time to healing was 6.6 months (range, 3–12 months). Four had incomplete healing radiographically but had no clinical symptom with enough cortical thickness to prevent fracture. None of these four cysts needed a second intervention until the last follow-up. Two of 25 patients required a second intervention because of cyst recurrence. All of the two had a radiographical healing of cyst after mean of 10 additional months of follow-up. Conclusions A minimal invasive technique including the injection of DBM could serve as an excellent treatment method for unicameral bone cysts. PMID:22839754

Geographic variation in gorilla limb bones.

PubMed

Jabbour, Rebecca S; Pearman, Tessa L

2016-06-01

Gorilla systematics has received increased attention over recent decades from primatologists, conservationists, and paleontologists. Studies of geographic variation in DNA, skulls, and teeth have led to new taxonomic proposals, such as recognition of two gorilla species, Gorilla gorilla (western gorilla) and Gorilla beringei (eastern gorilla). Postcranial differences between mountain gorillas (G. beringei beringei) and western lowland gorillas (G. g. gorilla) have a long history of study, but differences between the limb bones of the eastern and western species have not yet been examined with an emphasis on geographic variation within each species. In addition, proposals for recognition of the Cross River gorilla as Gorilla gorilla diehli and gorillas from Tshiaberimu and Kahuzi as G. b. rex-pymaeorum have not been evaluated in the context of geographic variation in the forelimb and hindlimb skeletons. Forty-three linear measurements were collected from limb bones of 266 adult gorillas representing populations of G. b. beringei, Gorilla beringei graueri, G. g. gorilla, and G. g. diehli in order to investigate geographic diversity. Skeletal elements included the humerus, radius, third metacarpal, third proximal hand phalanx, femur, tibia, calcaneus, first metatarsal, third metatarsal, and third proximal foot phalanx. Comparisons of means and principal components analyses clearly differentiate eastern and western gorillas, indicating that eastern gorillas have absolutely and relatively smaller hands and feet, among other differences. Gorilla subspecies and populations cluster consistently by species, although G. g. diehli may be similar to the eastern gorillas in having small hands and feet. The subspecies of G. beringei are distinguished less strongly and by different variables than the two gorilla species. Populations of G. b. graueri are variable, and Kahuzi and Tshiaberimu specimens do not cluster together. Results support the possible influence of higher-altitude Pleistocene refugia on patterns of geographic variation in gorillas. Copyright © 2016 Elsevier Ltd. All rights reserved.

Elemental Analysis of Bone, Teeth, Horn and Antler in Different Animal Species Using Non-Invasive Handheld X-Ray Fluorescence.

PubMed

Buddhachat, Kittisak; Klinhom, Sarisa; Siengdee, Puntita; Brown, Janine L; Nomsiri, Raksiri; Kaewmong, Patcharaporn; Thitaram, Chatchote; Mahakkanukrauh, Pasuk; Nganvongpanit, Korakot

2016-01-01

Mineralized tissues accumulate elements that play crucial roles in animal health. Although elemental content of bone, blood and teeth of human and some animal species have been characterized, data for many others are lacking, as well as species comparisons. Here we describe the distribution of elements in horn (Bovidae), antler (Cervidae), teeth and bone (humerus) across a number of species determined by handheld X-ray fluorescence (XRF) to better understand differences and potential biological relevance. A difference in elemental profiles between horns and antlers was observed, possibly due to the outer layer of horns being comprised of keratin, whereas antlers are true bone. Species differences in tissue elemental content may be intrinsic, but also related to feeding habits that contribute to mineral accumulation, particularly for toxic heavy metals. One significant finding was a higher level of iron (Fe) in the humerus bone of elephants compared to other species. This may be an adaptation of the hematopoietic system by distributing Fe throughout the bone rather than the marrow, as elephant humerus lacks a marrow cavity. We also conducted discriminant analysis and found XRF was capable of distinguishing samples from different species, with humerus bone being the best source for species discrimination. For example, we found a 79.2% correct prediction and success rate of 80% for classification between human and non-human humerus bone. These findings show that handheld XRF can serve as an effective tool for the biological study of elemental composition in mineralized tissue samples and may have a forensic application.

Elemental Analysis of Bone, Teeth, Horn and Antler in Different Animal Species Using Non-Invasive Handheld X-Ray Fluorescence

PubMed Central

Buddhachat, Kittisak; Klinhom, Sarisa; Siengdee, Puntita; Brown, Janine L.; Nomsiri, Raksiri; Kaewmong, Patcharaporn; Thitaram, Chatchote; Mahakkanukrauh, Pasuk; Nganvongpanit, Korakot

2016-01-01

Mineralized tissues accumulate elements that play crucial roles in animal health. Although elemental content of bone, blood and teeth of human and some animal species have been characterized, data for many others are lacking, as well as species comparisons. Here we describe the distribution of elements in horn (Bovidae), antler (Cervidae), teeth and bone (humerus) across a number of species determined by handheld X-ray fluorescence (XRF) to better understand differences and potential biological relevance. A difference in elemental profiles between horns and antlers was observed, possibly due to the outer layer of horns being comprised of keratin, whereas antlers are true bone. Species differences in tissue elemental content may be intrinsic, but also related to feeding habits that contribute to mineral accumulation, particularly for toxic heavy metals. One significant finding was a higher level of iron (Fe) in the humerus bone of elephants compared to other species. This may be an adaptation of the hematopoietic system by distributing Fe throughout the bone rather than the marrow, as elephant humerus lacks a marrow cavity. We also conducted discriminant analysis and found XRF was capable of distinguishing samples from different species, with humerus bone being the best source for species discrimination. For example, we found a 79.2% correct prediction and success rate of 80% for classification between human and non-human humerus bone. These findings show that handheld XRF can serve as an effective tool for the biological study of elemental composition in mineralized tissue samples and may have a forensic application. PMID:27196603

Cadaveric Study of the Articular Branches of the Shoulder Joint.

PubMed

Eckmann, Maxim S; Bickelhaupt, Brittany; Fehl, Jacob; Benfield, Jonathan A; Curley, Jonathan; Rahimi, Ohmid; Nagpal, Ameet S

This cadaveric study investigated the anatomic relationships of the articular branches of the suprascapular (SN), axillary (AN), and lateral pectoral nerves (LPN), which are potential targets for shoulder analgesia. Sixteen embalmed cadavers and 1 unembalmed cadaver, including 33 shoulders total, were dissected. Following dissections, fluoroscopic images were taken to propose an anatomical landmark to be used in shoulder articular branch blockade. Thirty-three shoulders from 17 total cadavers were studied. In a series of 16 shoulders, 16 (100%) of 16 had an intact SN branch innervating the posterior head of the humerus and shoulder capsule. Suprascapular sensory branches coursed laterally from the spinoglenoid notch then toward the glenohumeral joint capsule posteriorly. Axillary nerve articular branches innervated the posterolateral head of the humerus and shoulder capsule in the same 16 (100%) of 16 shoulders. The AN gave branches ascending circumferentially from the quadrangular space to the posterolateral humerus, deep to the deltoid, and inserting at the inferior portion of the posterior joint capsule. In 4 previously dissected and 17 distinct shoulders, intact LPNs could be identified in 14 (67%) of 21 specimens. Of these, 12 (86%) of 14 had articular branches innervating the anterior shoulder joint, and 14 (100%) of 14 LPN articular branches were adjacent to acromial branches of the thoracoacromial blood vessels over the superior aspect of the coracoid process. Articular branches from the SN, AN, and LPN were identified. Articular branches of the SN and AN insert into the capsule overlying the glenohumeral joint posteriorly. Articular branches of the LPN exist and innervate a portion of the anterior shoulder joint.

Intralesional curettage and cementation for low-grade chondrosarcoma of long bones: retrospective study and literature review.

PubMed

Mermerkaya, Musa Ugur; Bekmez, Senol; Karaaslan, Fatih; Danisman, Murat; Kosemehmetoglu, Kemal; Gedikoglu, Gokhan; Ayvaz, Mehmet; Tokgozoglu, Ahmet Mazhar

2014-11-10

Various treatment strategies for low-grade chondrosarcomas with variable outcomes have been reported in the literature. The aim of this study was to assess the oncological and functional outcomes associated with intralesional curettage followed by adjuvant therapy comprising high-speed burring, thermal cauterization, and bone cementation with polymethylmethacrylate. We performed a retrospective review of 21 consecutive patients with intramedullary low-grade chondrosarcoma of long bones treated by intralesional curettage and adjuvant therapy comprising high-speed burring, thermal cauterization, and cementation at our institution from 2007 to 2012. The average age of the patients was 48.7 (range, 18-71) years. There were 7 male and 14 female patients. The mean follow-up period was 58.4 (range, 26-85) months after surgery. The treated lesions were located in the proximal humerus (n=10), proximal tibia (n=6), and distal femur (n=5). At the average follow-up time point of 58.4 (range, 26-85) months, no patient had developed local recurrence and no distant metastases were observed. The average Musculoskeletal Tumor Society score among all 21 patients was 95% (84-100). The combination of intralesional curettage, application of high-speed burring, thermal cauterization, and cementation is an effective treatment strategy for low-grade intramedullary chondrosarcoma of long bones. Excellent oncological and functional results can be obtained.

Reconstruction of the proximal humerus with a composite of extracorporeally irradiated bone and endoprosthesis following excision of high grade primary bone sarcomas.

PubMed

Moran, Matthew; Stalley, Paul D

2009-10-01

Functional reconstruction of the shoulder joint following excision of a malignant proximal humeral tumour is a difficult proposition. Eleven patients with primary osteosarcoma or Ewing's sarcoma underwent reconstruction with a composite of extra-corporeally irradiated autograft with the addition of a long stemmed hemiarthroplasty. At a mean follow-up of 5.8 years two patients had died from disseminated disease and one patient had undergone amputation for local recurrence. The eight patients with a surviving limb were examined clinically and radiographically. The mean Toronto Extremity Salvage Score was 74 and Musculo-Skeletal Tumour Society score 66. Rotation was well preserved but abduction (mean 32 degrees ) and flexion (40 degrees ) were poor. There was a high rate of secondary surgery, with five out of eleven patients requiring re-operation for complications of reconstruction surgery. Radiographic estimate of graft remaining at follow up was 71%. There were no infections, revisions or radiographic failures. Whilst the reconstructions were durable in the medium term, the functional outcome was no better than with other reported reconstructive methods. The composite technique was especially useful in subtotal humeral resections, allowing preservation of the elbow joint even with very distal osteotomy. Bone stock is restored, which may be useful for future revision surgery in this young group of patients.

Pathology and the posture of the La Chapelle-aux-Saints Neandertal.

PubMed

Trinkaus, E

1985-05-01

The depiction of the Neandertals as incompletely erect was based primarily on Boule's (1911, 1912a, 1913) analysis of the La Chapelle-aux-Saints 1 partial skeleton. The inaccurate aspects of Boule's postural reconstruction were corrected during the 1950s. However, it has come to be believed, following Straus and Cave (1957), that Boule's errors of reconstruction were due to the diseased condition of the La Chapelle-aux-Saints 1 remains, rather than to Boule's misinterpretation of morphology. The abnormalities on the La Chapelle-aux-Saints 1 postcranium include: lower cervical, upper thoracic, and lower thoracic intervertebral degenerative joint disease (DJD), a distal fracture of a mid-thoracic rib, extensive DJD of the left hip, DJD of the right fifth proximal interphalangeal articulation, bilateral humeral head eburnation, and minor exostosis formation on the right humerus, ulna, and radius. These were associated with extensive alveolar inflammation including apical abscesses and antemortem tooth loss, some temporomandibular DJD, bilateral auditory exostoses, and minimal occipital condyle DJD. None of these abnormalities significantly affected Boule's Neandertal postural reconstruction, and a review of his analysis indicates that early twentieth century interpretations of skeletal morphology (primarily of the cranium, cervical vertebrae, lumbar and sacral vertebrae, proximal femora and tibiae, posterior tarsals, and hallucial tarsometatarsal joint), combined with Boule's evolutionary preconceptions, were responsible for his mistaken view of Neandertal posture.

Genetic Interactions Between Shox2 and Hox Genes During the Regional Growth and Development of the Mouse Limb

PubMed Central

Neufeld, Stanley J.; Wang, Fan; Cobb, John

2014-01-01

The growth and development of the vertebrate limb relies on homeobox genes of the Hox and Shox families, with their independent mutation often giving dose-dependent effects. Here we investigate whether Shox2 and Hox genes function together during mouse limb development by modulating their relative dosage and examining the limb for nonadditive effects on growth. Using double mRNA fluorescence in situ hybridization (FISH) in single embryos, we first show that Shox2 and Hox genes have associated spatial expression dynamics, with Shox2 expression restricted to the proximal limb along with Hoxd9 and Hoxa11 expression, juxtaposing the distal expression of Hoxa13 and Hoxd13. By generating mice with all possible dosage combinations of mutant Shox2 alleles and HoxA/D cluster deletions, we then show that their coordinated proximal limb expression is critical to generate normally proportioned limb segments. These epistatic interactions tune limb length, where Shox2 underexpression enhances, and Shox2 overexpression suppresses, Hox-mutant phenotypes. Disruption of either Shox2 or Hox genes leads to a similar reduction in Runx2 expression in the developing humerus, suggesting their concerted action drives cartilage maturation during normal development. While we furthermore provide evidence that Hox gene function influences Shox2 expression, this regulation is limited in extent and is unlikely on its own to be a major explanation for their genetic interaction. Given the similar effect of human SHOX mutations on regional limb growth, Shox and Hox genes may generally function as genetic interaction partners during the growth and development of the proximal vertebrate limb. PMID:25217052

Genetic interactions between Shox2 and Hox genes during the regional growth and development of the mouse limb.

PubMed

Neufeld, Stanley J; Wang, Fan; Cobb, John

2014-11-01

The growth and development of the vertebrate limb relies on homeobox genes of the Hox and Shox families, with their independent mutation often giving dose-dependent effects. Here we investigate whether Shox2 and Hox genes function together during mouse limb development by modulating their relative dosage and examining the limb for nonadditive effects on growth. Using double mRNA fluorescence in situ hybridization (FISH) in single embryos, we first show that Shox2 and Hox genes have associated spatial expression dynamics, with Shox2 expression restricted to the proximal limb along with Hoxd9 and Hoxa11 expression, juxtaposing the distal expression of Hoxa13 and Hoxd13. By generating mice with all possible dosage combinations of mutant Shox2 alleles and HoxA/D cluster deletions, we then show that their coordinated proximal limb expression is critical to generate normally proportioned limb segments. These epistatic interactions tune limb length, where Shox2 underexpression enhances, and Shox2 overexpression suppresses, Hox-mutant phenotypes. Disruption of either Shox2 or Hox genes leads to a similar reduction in Runx2 expression in the developing humerus, suggesting their concerted action drives cartilage maturation during normal development. While we furthermore provide evidence that Hox gene function influences Shox2 expression, this regulation is limited in extent and is unlikely on its own to be a major explanation for their genetic interaction. Given the similar effect of human SHOX mutations on regional limb growth, Shox and Hox genes may generally function as genetic interaction partners during the growth and development of the proximal vertebrate limb. Copyright © 2014 by the Genetics Society of America.

[Comparison of clinical effect on locking plate for proximal humeral fracture with or without application of inferomedial screws].

PubMed

Guo, Xiu-wu; Fan, Jian; Yuan, Feng

2016-06-01

To compare clinical outcomes of locking plate for proximal humeral fracture whether application of inferomedial screws. From January 2012 to July 2013, 46 patients with proximal humeral fracture underwent locking plates were retrospectively analyzed. There were 25 males and 21 females aged from 29 to 80 years old with an average of 55.1 years old. Among them, 25 patients were treated with inferomedial screws (support group), including 13 males and 12 females aged from 38 to 80 years old with an average of (55.8 ± 11.8) years old; 8 cases were part two fracture,10 cases were part three fracture and 7 cases were part four fracture according to Neer classification. Twenty-one patients were treated without inferomedial screws (non-support group), including 12 males and 9 females aged from 29 to 79 years old with an average of (54.2 ± 14.8)years old; 6 cases were part two fracture, 9 cases were part three fracture and 6 cases were part four fracture according to Neer classification. Operative time, fracture healing time and complications were observed and compared, Neer scoring of shoulder joint were used to evaluate clinical effect. All patients were followed up from 12 to 41 months with an average of 15.6 months. Operative time and fracture healing time in support group was (1.6 ± 0.4) h and (3.0 ± 0.6) months, and (1.5 ± 0.4) h and (3.1 ± 0.6) months in non-support group, while there was no statistical difference in operative time and fracture healing time between two groups. There was significant differences in Neer score between support group (89.7± 4.9) and non-support group (83.1 ± 7.1). No complication occurred in support group,while 4 cases occurred complications in non-support group. Locking plate with inferomedial screws for proximal humeral fracture has advantages of stable fixation, less complications, quick recovery of function and satisfied clinical effect.

The Effects of Age, Adiposity, and Physical Activity on the Risk of Seven Site‐Specific Fractures in Postmenopausal Women

PubMed Central

Lacombe, Jason; Cairns, Benjamin J; Green, Jane; Reeves, Gillian K; Beral, Valerie

2016-01-01

ABSTRACT Risk factors for fracture of the neck of the femur are relatively well established, but those for fracture at other sites are little studied. In this large population study we explore the role of age, body mass index (BMI), and physical activity on the risk of fracture at seven sites in postmenopausal women. As part of the Million Women Study, 1,154,821 postmenopausal UK women with a mean age of 56.0 (SD 4.8) years provided health and lifestyle data at recruitment in 1996 to 2001. All participants were linked to National Health Service (NHS) hospital records for day‐case or overnight admissions with a mean follow‐up of 11 years per woman. Adjusted absolute and relative risks for seven site‐specific incident fractures were calculated using Cox regression models. During follow‐up, 4931 women had a fracture of the humerus; 2926 of the forearm; 15,883 of the wrist; 9887 of the neck of the femur; 1166 of the femur (not neck); 3199 a lower leg fracture; and 10,092 an ankle fracture. Age‐specific incidence rates increased gradually with age for fractures of forearm, lower leg, ankle, and femur (not neck), and steeply with age for fractures of neck of femur, wrist, and humerus. When compared to women with desirable BMI (20.0 to 24.9 kg/m2), higher BMI was associated with a reduced risk of fracture of the neck of femur, forearm, and wrist, but an increased risk of humerus, femur (not neck), lower leg, and ankle fractures (p < 0.001 for all). Strenuous activity was significantly associated with a decreased risk of fracture of the humerus and femur (both neck and remainder of femur) (p < 0.001), but was not significantly associated with lower leg, ankle, wrist, and forearm fractures. Postmenopausal women are at a high lifetime risk of fracture. BMI and physical activity are modifiable risk factors for fracture, but their associations with fracture risk differ substantially across fracture sites. © 2016 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals, Inc. on behalf of American Society for Bone and Mineral Research (ASBMR) PMID:26950269

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 and that a proportion of these patients may, therefore, have been effectively managed non-operatively. Cite this article: Mr B. J. F. Dean. A review of current surgical practice in the operative treatment of proximal humeral fractures: Does the PROFHER trial demonstrate a need for change? Bone Joint Res 2016;5:178–184. DOI: 10.1302/2046-3758.55.2000596. PMID:27179004

A review of current surgical practice in the operative treatment of proximal humeral fractures: Does the PROFHER trial demonstrate a need for change?

PubMed

Dean, B J F; 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

2016-05-01

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. 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. 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). 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 and that a proportion of these patients may, therefore, have been effectively managed non-operatively.Cite this article: Mr B. J. F. Dean. A review of current surgical practice in the operative treatment of proximal humeral fractures: Does the PROFHER trial demonstrate a need for change? Bone Joint Res 2016;5:178-184. DOI: 10.1302/2046-3758.55.2000596. © 2016 Dean et al.

Melorheostosis of the humerus: a rare differential diagnosis of carpal tunnel syndrome.

PubMed

De Vos, J; Mulliez, A; De Loore, G

2010-04-01

Melorheostosis is an uncommon and rare linear hyperostosis, which can be complicated by soft tissue changes. We present a case of this disorder in the humerus, clinically referred because of carpal tunnel syndrome. Although treatment is usually conservative, in this case, a neurolysis and resection of the sclerotic bone were done with good clinical result. Copyright 2010 Elsevier Masson SAS. All rights reserved.

Axillary nerve injury.

PubMed

Perlmutter, G S

1999-11-01

Axillary nerve injury remains the most common peripheral nerve injury to affect the shoulder. It most often is seen after glenohumeral joint dislocation, proximal humerus fracture, or a direct blow to the deltoid muscle. Compression neuropathy has been reported to occur in the quadrilateral space syndrome, although the true pathophysiology of this disorder remains unclear. The axillary nerve is vulnerable during any operative procedure involving the inferior aspect of the shoulder and iatrogenic injury remains a serious complication of shoulder surgery. During the acute phase of injury, the shoulder should be rested, and when clinically indicated, a patient should undergo an extensive rehabilitation program emphasizing range of motion and strengthening of the shoulder girdle muscles. If no axillary nerve recovery is observed by 3 to 6 months after injury, surgical exploration may be indicated, especially if the mechanism of injury is consistent with nerve rupture. Patients who sustain injury to the axillary nerve have a variable prognosis for nerve recovery although return of function of the involved shoulder typically is good to excellent, depending on associated ligamentous or bony injury.

An animal model in sheep for biocompatibility testing of biomaterials in cancellous bones

PubMed Central

Nuss, Katja MR; Auer, Joerg A; Boos, Alois; Rechenberg, Brigitte von

2006-01-01

Background The past years have seen the development of many synthetic bone replacements. To test their biocompatibility and ability for osseointegration, osseoinduction and -conduction requires their placement within bone preferably in an animal experiment of a higher species. Methods A suitable experimental animal model in sheep with drill holes of 8 mm diameter and 13 mm depth within the proximal and distal humerus and femur for testing biocompatibility issues is introduced. Results This present sheep model allows the placing of up to 8 different test materials within one animal and because of the standardization of the bone defect, routine evaluation by means of histomorphometry is easily conducted. This method was used successfully in 66 White Alpine Sheep. When the drill holes were correctly placed no complications such as spontaneous fractures were encountered. Conclusion This experimental animal model serves an excellent basis for testing the biocompatibility of novel biomaterials to be used as bone replacement or new bone formation enhancing materials. PMID:16911787

An animal model in sheep for biocompatibility testing of biomaterials in cancellous bones.

PubMed

Nuss, Katja M R; Auer, Joerg A; Boos, Alois; von Rechenberg, Brigitte

2006-08-15

The past years have seen the development of many synthetic bone replacements. To test their biocompatibility and ability for osseointegration, osseoinduction and -conduction requires their placement within bone preferably in an animal experiment of a higher species. A suitable experimental animal model in sheep with drill holes of 8 mm diameter and 13 mm depth within the proximal and distal humerus and femur for testing biocompatibility issues is introduced. This present sheep model allows the placing of up to 8 different test materials within one animal and because of the standardization of the bone defect, routine evaluation by means of histomorphometry is easily conducted. This method was used successfully in 66 White Alpine Sheep. When the drill holes were correctly placed no complications such as spontaneous fractures were encountered. This experimental animal model serves an excellent basis for testing the biocompatibility of novel biomaterials to be used as bone replacement or new bone formation enhancing materials.

Proximate and elemental analysis of five selected medicinal plants of family Solanaceae.

PubMed

Hameed, Ishfaq; Hussain, Farrukh

2015-07-01

The proximate analysis revealed the presence of ash, moisture, protein, fiber, fats and carbohydrate. ANOVA showed that ash and moisture contents was non significant between the plant parts and phenological stages. Crude protein was non significant between the plant parts and phenological stages except for Datura innoxia parts but not for its phenolgical stages, while crude fats were non significant between the plant parts and phenological stages except for Solanum nigrum and Solanum surattense parts but not for their phenolgical stages. Crude fiber was non significant between the plant parts and phenological stages except for Datura innoxia parts but not for its phenolgical stages. And carbohydrates was non significant between the plant parts and phenological stages except for the phenolgical stages of Solanum surattense and Withania coagulans. The mineral analysis showed the presence of Cr, Zn, Cu, Mn, Fe, Ca, K, Mg and Na in the roots, stems, leaves, flowers and fruits of the plants in three different phenological stages. Only the micro-minerals were present in traces while the macro-minerals were present high quantities as compared to the micro-minerals.

Comparative limb bone loading in the humerus and femur of the tiger salamander: testing the 'mixed-chain' hypothesis for skeletal safety factors.

PubMed

Kawano, Sandy M; Economy, D Ross; Kennedy, Marian S; Dean, Delphine; Blob, Richard W

2016-02-01

Locomotion imposes some of the highest loads upon the skeleton, and diverse bone designs have evolved to withstand these demands. Excessive loads can fatally injure organisms; however, bones have a margin of extra protection, called a 'safety factor' (SF), to accommodate loads that are higher than normal. The extent to which SFs might vary amongst an animal's limb bones is unclear. If the limbs are likened to a chain composed of bones as 'links', then similar SFs might be expected for all limb bones because failure of the system would be determined by the weakest link, and extra protection in other links could waste energetic resources. However, Alexander proposed that a 'mixed-chain' of SFs might be found amongst bones if: (1) their energetic costs differ, (2) some elements face variable demands, or (3) SFs are generally high. To test whether such conditions contribute to diversity in limb bone SFs, we compared the biomechanical properties and locomotor loading of the humerus and femur in the tiger salamander (Ambystoma tigrinum). Despite high SFs in salamanders and similar sizes of the humerus and femur that would suggest similar energetic costs, the humerus had lower bone stresses, higher mechanical hardness and larger SFs. SFs were greatest in the anatomical regions where yield stresses were highest in the humerus and lowest in the femur. Such intraspecific variation between and within bones may relate to their different biomechanical functions, providing insight into the emergence of novel locomotor capabilities during the invasion of land by tetrapods. © 2016. Published by The Company of Biologists Ltd.

Left-handed skeletally mature baseball players have smaller humeral retroversion in the throwing arm than right-handed players.

PubMed

Takenaga, Tetsuya; Goto, Hideyuki; Sugimoto, Katsumasa; Tsuchiya, Atsushi; Fukuyoshi, Masaki; Nakagawa, Hiroki; Nozaki, Masahiro; Takeuchi, Satoshi; Otsuka, Takanobu

2017-12-01

It is known that the humeral retroversion of baseball players is greater in the throwing arm than in the nonthrowing arm. An investigation measuring dry bone specimens also showed that the right humerus had greater retroversion than the left. Considering these facts, it was hypothesized that humeral retroversion would differ between right- and left-handed players. This study aimed to compare the bilateral humeral retroversion between right- and left-handed skeletally mature baseball players. We investigated 260 (196 right-handed and 64 left-handed) male baseball players who belonged to a college or amateur team. Bilateral humeral retroversion was assessed using an ultrasound-assisted technique (humeral torsion angle [HTA]) as described by previous studies. Analysis of covariance, adjusted for handedness and baseball position, assessed the effect of throwing arm dominance on HTA. In comparison of the throwing arm, HTA was significantly smaller in left-handed (left humerus) than in right-handed (right humerus) players (77° vs. 81°; P < .001). In comparison of the nonthrowing arm, HTA was significantly greater in left-handed (right humerus) than in right-handed (left humerus) players (73° vs. 69°; P < .001). The mean side-to-side difference of HTA was significantly smaller in left-handed than in right-handed players (3° vs. 12°; P < .001). Humeral retroversion of left-handed skeletally mature baseball players was significantly smaller in the throwing arm, greater in the nonthrowing arm, and smaller in side-to-side differences than that of right-handed players. These findings may be key to understanding some of the biomechanical differences between right- and left-handed baseball players. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A comparison between orthogonal and parallel plating methods for distal humerus fractures: a prospective randomized trial.

PubMed

Lee, Sang Ki; Kim, Kap Jung; Park, Kyung Hoon; Choy, Won Sik

2014-10-01

With the continuing improvements in implants for distal humerus fractures, it is expected that newer types of plates, which are anatomically precontoured, thinner and less irritating to soft tissue, would have comparable outcomes when used in a clinical study. The purpose of this study was to compare the clinical and radiographic outcomes in patients with distal humerus fractures who were treated with orthogonal and parallel plating methods using precontoured distal humerus plates. Sixty-seven patients with a mean age of 55.4 years (range 22-90 years) were included in this prospective study. The subjects were randomly assigned to receive 1 of 2 treatments: orthogonal or parallel plating. The following results were assessed: operating time, time to fracture union, presence of a step or gap at the articular margin, varus-valgus angulation, functional recovery, and complications. No intergroup differences were observed based on radiological and clinical results between the groups. In our practice, no significant differences were found between the orthogonal and parallel plating methods in terms of clinical outcomes, mean operation time, union time, or complication rates. There were no cases of fracture nonunion in either group; heterotrophic ossification was found 3 patients in orthogonal plating group and 2 patients in parallel plating group. In our practice, no significant differences were found between the orthogonal and parallel plating methods in terms of clinical outcomes or complication rates. However, orthogonal plating method may be preferred in cases of coronal shear fractures, where posterior to anterior fixation may provide additional stability to the intraarticular fractures. Additionally, parallel plating method may be the preferred technique used for fractures that occur at the most distal end of the humerus.

[Treatment of proximal ulna and olecranon fractures by reconstruction plate combined with tension band wiring].

PubMed

Teng, Lin; Zhong, Gang; Xiao, Cong; Liu, Gang; Xiang, Zhou; Cen, Shiqiang; Huang, Fuguo

2011-01-01

OBJECTIVE To review the efficacy of reconstruction plate combined with tension band wiring for treating proximal ulna and olecranon fractures. Between November 2004 and September 2009, 10 patients with proximal ulna and olecranon fractures were treated by reconstruction plate combined with tension band wiring. There were 6 males and 4 females with an average age of 45.3 years (range, 21-75 years). Five fractures were caused by traffic accident, 2 by falling from height, 2 by tumbling, and 1 by a machine strangulation. The locations were the left side and the right side in 5 cases respectively. One case was open fracture (Gustilo II) and the other 9 were closed fractures. Olecranon fractures included 4 cases of traverse fractures and 6 cases of comminuted fractures, and proximal ulna fractures included 6 cases of comminuted fractures and 4 cases of oblique fractures. The combined fractures included 6 radial head fractures, 4 coronoid process fractures, 2 proximal humerus fractures, and 3 scapula fractures; other injury included 1 elbow dislocation and 1 shoulder dislocation. Two patients had secondary operation; the other 8 patients received the primary operations and the time from injury to operation varied from 7 days to 20 days, with an average of 11 days. One case had infection at the incision 1 week after operation, and recovered after 2 months of antibiotics and debridement; incisions healed by first intention in other 9 patients. All patients were followed up 12-64 months (mean, 40.5 months). The X-ray films showed that fracture healing was achieved at 10-24 weeks (mean, 12 weeks). There was no ulnar nerve symptom in all cases. Heterotopic ossification occurred in 1 case at 2 months and stiffness of the elbow in 1 case at 3 months after operation; they were both cured after symptomatic treatment. Proximal migration of Kirschner wires was found in 1 case at 6 months after operation, whose implants were taken out at 9 months after the first operation because fracture had healed. At last follow-up, the flexion and extension are of the elbow averaged 92.8 degrees (range, 23-130 degrees), and the arc of forearm rotation averaged 124.4 degrees (range, 42-175 degrees). According to the American Hospital for Special Surgery (HSS) evaluation method, the results were classified as excellent in 6 cases, good in 2, fair in 1, and poor in 1. Treating proximal ulna and olecranon fractures by reconstruction plate combined with tension band wiring allows patients to do postoperative exercise early and could effectively avoid complications.

Fracture of supracondylar process of the humerus.

PubMed

Suresh, S S

2008-07-01

The supracondylar process of the humerus is a rare skeletal anomaly, which is usually an incidental finding while an X-ray is done for some other purpose. The process can fracture resulting in pain and tender mobile swelling over the medial aspect of the arm, and consequent neurovascular symptoms, or entrapment neuropathies. The anomaly, which fractured in a clinical situation, is described, followed by a review of the literature.

First-line management of distal humerus fracture by total elbow arthroplasty in geriatric traumatology: Results in a 21-patient series at a minimum 2years' follow-up.

PubMed

Lami, D; Chivot, M; Caubere, A; Galland, A; Argenson, J N

2017-10-01

Total elbow arthroplasty (TEA) is one option in distal humerus fracture in elderly osteoporotic patients. The study hypothesis was that, in patients aged 70years or more, TEA provides functional results and ranges of motion compatible with everyday activity, with a complications rate equal to or lower than with internal fixation, and no loss of autonomy or cognitive impairment. In this retrospective study, 21 patients receiving TEA for distal humerus fracture were included. Mean follow-up was 3.2years, with functional (Quick DASH and MEPS), cognitive (MMSE), autonomy-related (ADL) and radiological assessment (Morrey). Mean MEPS was 84 and QuickDASH 32.4. Mean extension deficit was 22°, and mean flexion 125°. There was no loss of autonomy or cognitive impairment. The complications rate was 9.5%. There were no revision surgeries. TEA proved reliable in comminuted distal humerus fracture in elderly patients. Functional results were comparable to those in the literature, and the complications rate was lower. Long-term implant survival needs confirmation to validate this option as a treatment of choice in these indications in geriatric traumatology. Retrospective non-comparative, single-center. 4. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

Geometric morphometrics analysis of the hind wing of leaf beetles: proximal and distal parts are separate modules.

PubMed

Ren, Jing; Bai, Ming; Yang, Xing-Ke; Zhang, Run-Zhi; Ge, Si-Qin

2017-01-01

The success of beetles is mainly attributed to the possibility to hide the hindwings under the sclerotised elytra. The acquisition of the transverse folding function of the hind wing is an important event in the evolutionary history of beetles. In this study, the morphological and functional variances in the hind wings of 94 leaf beetle species (Coleoptera: Chrysomelinae) is explored using geometric morphometrics based on 36 landmarks. Principal component analysis and Canonical variate analysis indicate that changes of apical area, anal area, and middle area are three useful phylogenetic features at a subtribe level of leaf beetles. Variances of the apical area are the most obvious, which strongly influence the entire venation variance. Partial least squares analysis indicates that the proximal and distal parts of hind wings are weakly associated. Modularity tests confirm that the proximal and distal compartments of hind wings are separate modules. It is deduced that for leaf beetles, or even other beetles, the hind wing possibly exhibits significant functional divergences that occurred during the evolution of transverse folding that resulted in the proximal and distal compartments of hind wings evolving into separate functional modules.

Complex proximal humerus fractures: Hertel's criteria reliability to predict head necrosis.

PubMed

Campochiaro, G; Rebuzzi, M; Baudi, P; Catani, F

2015-09-01

The risk of post-traumatic humeral head avascular necrosis (AVN), regardless of the treatment, has a high reported incidence. In 2004, Hertel et al. stated that the most relevant predictors of ischemia after intracapsular fracture treated with osteosynthesis are the calcar length, medial hinge integrity and some specific fracture types. Based on Hertel's model, the purpose of this study is to evaluate both its reliability and weaknesses in our series of 267 fractures, assessing how the anatomical configuration of fracture, the quality of reduction and its maintenance were predictive of osteonecrosis development, and so to suggest a treatment choice algorithm. A retrospective study, level of evidence IV, was conducted to duly assess the radiographic features of 267 fractures treated from 2004 to 2010 following Hertel's criteria treated with open reduction and internal fixation by angular stability plates and screws. The average age was 65.2 years. The average follow-up was 28.3 ± 17.0 months. The percentage of AVN, the quality and maintenance of reduction obtained during surgery were evaluated. The AVN incidence was 3.7 %. No significant correlation with gender, age and fracture type was found. At the last follow-up X-ray, only 30 % presented all Hertel's good predictors in the AVN group, 4.7 % in the non-AVN group (p < 0.05). About quality of reduction in the AVN group, it was poor in 50 %; while in the non-AVN group, it was poor in 3.4 % (p < 0.05). Four patients with AVN were symptomatic, and three needed a second surgery. Hertel's criteria are important in the surgical planning, but they are not sufficient: an accurate evaluation of the calcar area fracture in three planes is required. All fractures involving calcar area should be studied with CT.

Traumatic inferior shoulder dislocation: a review of management and outcome.

PubMed

Nambiar, Mithun; Owen, David; Moore, Peter; Carr, Ashley; Thomas, Malcolm

2018-02-01

Traumatic inferior shoulder dislocation (ISD) is rare, estimated to occur in 0.5% of all shoulder dislocations. We describe the demographics, natural history and outcome of this injury. The aim of the study is to provide a summary of the demographics, clinical presentation, management and outcome of patients who suffer ISD METHODS: We conducted a systematic review of the English language literature on ISD using PubMed, Medline, CINHAL, Cochrane Database and Evidence-Based Medicine Reviews. Articles were examined independently by two of the authors and data were extracted using a standard form. Descriptive statistics were performed. 199 patients were identified, from 101 articles. Mean age was 44 years (range 13-94 years). All cases were caused by trauma, with falls accounting for 44% of all cases. There were three reported cases (2%) of open dislocations and 29 cases (15%) of bilateral ISD. Proximal humerus and scapular fractures were reported in 39 and 8% of patients, respectively. Neurological injury after dislocation was noted in 58 patients (29%). Vascular injury was noted in 20 patients (10%), which included axillary arterial injury in 19 patients and an upper limb deep vein thrombosis in one patient. Follow-up data were available for 107 patients (54%), with an average duration of 2.7 years (1 week-32 years). Avascular necrosis (AVN) was noted between 8 weeks and 2 years after initial injury in three patients (1.5%). Clinical and radiographic assessment of ISD is key to diagnosis and successful reduction. Patients can be treated with shoulder immobilisation for 2-3 weeks. In the setting of ongoing pain or instability, further imaging should be performed. The outcome of ISD is generally favourable.

Fat embolism syndrome: Case report of a clinical conundrum

PubMed Central

Nandi, Roneeta; Venkategowda, Pradeep Marur; Mutkule, Dnyaneshwar; Rao, Surath Manimala

2014-01-01

Fat embolism syndrome is a rare clinical condition associated with trauma, particularly of long bones. FES after fracture of neck of femur or head of humerus is uncommon. We report a case of FES following fracture in neck of femur and head of humerus in a man with history of mitral valve replacement, on long-term oral anticoagulant therapy, with an alleged history of convulsions. Our dilemma in clinical diagnosis is discussed. PMID:25190956

The Rubber Stopper: A Simple and Inexpensive Technique to Prevent Pin Tract Infection following Kirschner Wiring of Supracondylar Fractures of Humerus in Children.

PubMed

Santy, J E; Kamal, J; Abdul-Rashid, A H; Ibrahim, S

2015-07-01

Percutaneous pinning after closed reduction is commonly used to treat supracondylar fractures of the humerus in children. Minor pin tract infections frequently occur. The aim of this study was to prevent pin tract infections using a rubber stopper to reduce irritation of the skin against the Kirschner (K) wire following percutaneous pinning. Between July 2011 and June 2012, seventeen children with closed supracondylar fracture of the humerus of Gartland types 2 and 3 were treated with this technique. All patients were treated with closed reduction and percutaneous pinning and followed up prospectively. Only one patient, who was a hyperactive child, developed pin tract infection due to softening of the plaster slab. We found using the rubber stopper to be a simple and inexpensive method to reduce pin tract infections following percutaneous pinning.

The Rubber Stopper: A Simple and Inexpensive Technique to Prevent Pin Tract Infection following Kirschner Wiring of Supracondylar Fractures of Humerus in Children

PubMed Central

Santy, JE; Abdul-Rashid, AH; Ibrahim, S

2015-01-01

Percutaneous pinning after closed reduction is commonly used to treat supracondylar fractures of the humerus in children. Minor pin tract infections frequently occur. The aim of this study was to prevent pin tract infections using a rubber stopper to reduce irritation of the skin against the Kirschner (K) wire following percutaneous pinning. Between July 2011 and June 2012, seventeen children with closed supracondylar fracture of the humerus of Gartland types 2 and 3 were treated with this technique. All patients were treated with closed reduction and percutaneous pinning and followed up prospectively. Only one patient, who was a hyperactive child, developed pin tract infection due to softening of the plaster slab. We found using the rubber stopper to be a simple and inexpensive method to reduce pin tract infections following percutaneous pinning. PMID:28435603

Humerus fracture bending risk function for the 50th percentile male.

PubMed

Santago, Anthony C; Cormier, Joseph M; Duma, Stefan M

2008-01-01

The increase in upper extremity injuries in automobile collisions, because of the widespread implantation of airbags, has lead to an increased focus in humerus injury criteria. Risk functions for upper extremity injury that can be used in instrumented upper extremities would be useful. This paper presents a risk function for humerus injury for the 50th percentile male based on bending fracture moment data gathered from previous studies. The data was scaled using two scaling factors, one for mass and one for rate, and the Weibull survival analysis model was then used to develop the risk function. It was determined that a 25% risk of injury corresponds to a 214 Nm bending load, a 50% risk of injury corresponds to a 257 Nm bending load, and a 75% risk of injury corresponds to a 296 Nm bending load. It is believed the risk function can be used with an instrumented upper extremity during vehicle testing.

(Un)importance of physical therapy in treatment of displaced supracondylar humerus fractures in children.

PubMed

Ducic, Sinisa; Bumbasirevic, Marko; Radlovic, Vladimir; Bukumiric, Zoran; Bukva, Bojan; Abramovic, Dusan

2015-09-01

Elbow joint stiffness is a common complication following supracondylar humerus fractures. In prospective study, dynamics of establishing a full range of motion in the elbow joint following the treatment of supracondylar humerus fractures were assessed, together with the effects of physical therapy on improvement in the range of motion. Two groups of patients were observed. Physical therapy was administered to the first group, comprised of 25 patients. The second group, comprised of 28 patients, underwent no physical therapy. In the first few months following treatment, the range of motion was significantly greater in the patients who had undergone physical therapy, but after 12 months, the range of motion was almost equal in the two groups. This study has shown that it takes about 12 months to establish a full range of motion after the injury, and that it is not necessary to apply physical therapy in patients with elbow fractures.

[Avulsion of the Proximal Hamstring Insertion. Case Reports].

PubMed

Mizera, R; Harcuba, R; Kratochvíl, J

2016-01-01

Proximal hamstring avulsion is an uncommon muscle injury with a lack of consensus on indications and the timing and technique of surgery. Poor clinical symptoms and difficulties in the diagnostic process can lead to a false diagnosis. The authors present three cases of proximal hamstring avulsion, two complete and one partial ruptures of the biceps femoris muscle. MRI and ultrasound scans were used for optimal treatment alignment. Acute surgery reconstruction (< 4 weeks) was done in two patients. Re-attachment of the full thickness ruptures was performed to the original place and secured by suture anchors, the partial rupture was fixed by a simple suture. Two patients were free of any symptoms at 6 months after surgery, the last one had pain in the subgluteal area and a mild deficit in hamstring strength. Two interesting systematic reviews published on the treatment of proximal hamstring avulsion are discussed in the final part of the paper. Key words: hamstring, rupture, avulsion.

Journal of Special Operations Medicine. Volume 8, Edition 1, Winter 2008

DTIC Science & Technology

2008-01-01

Open, comminuted humerus fracture , treated with external fixation. • Partial transection of the brachial artery. This injury was effectively...would have lost his arm had it not been for the excellent treatment in the field and the rapid evacuation to surgical care. • Three fractured ribs, one of...Soldier with GSW to his left thigh and buttock and left inferior pelvic ac- etabular and rami fractures with communication into the pelvic cavity, with a

SUPRACONDYLAR FRACTURE OF THE HUMERUS IN CHILDREN: FIXATION WITH TWO CROSSED KIRSCHNER WIRES

PubMed Central

Carvalho, Roni Azevedo; Filho, Nelson Franco; Neto, Antonio Batalha Castello; Reis, Giulyano Dias; Dias, Marcos Pereira

2015-01-01

Objective: To analyze and present the surgical results from unstable supracondylar fractures of the humerus in children, treated by means of reduction and percutaneous fixation using two crossed Kirschner wires. Methods: A cross-sectional study was conducted on 20 children, taking into consideration sex, age at the time of the fracture, age at the time of the assessment, side affected, type and mechanism of trauma, postoperative complications and radiographic and clinic variables. Results: Ten fractures were observed in the left arm and ten in the right arm. The age at the time of the fracture ranged from 2 to 13 years (mean: 5.9 ± 2.48 years). Three fractures were classified as type II and 17 as type III. The length of follow-up ranged from four months to three years. Baumann's angle ranged from 69 to 100 (mean: 78.3) and cubitus varus was observed in four patients (values ranging from 84 to 100). According to the modified Flynn's criteria, 20 cases presented satisfactory outcomes: 17 excellent (85%), two good (10%) and one regular (5%). Two patients presented limited range of motion, two had paresthesia in the cubital region and one had transient neuropraxia of the ulnar nerve for six weeks. Conclusion: Percutaneous fixation with two crossed Kirschner wires leads to good results when carried out under direct viewing and with isolation of the ulnar nerve. PMID:27047887

Radiographic pattern of skeletal trauma in children seen in a tertiary hospital in Sagamu, South West Nigeria.

PubMed

Olatunji, A A; Thanni, L O A

2013-03-01

The study was aimed at identifying the pattern of skeletal trauma in the paediatric age group as it relates to the causes. A retrospective analysis of the records on the request cards, case notes, radiographs and reports (where available) of all children aged one day to 15 years who were referred to the radiology department of Olabisi Onabanjo University Teaching Hospital, Sagamu was carried out. Fractures were analysed with respect to sex, age, causes, type and location of fracture. The analysis spanned a period of twenty-eight months during which a total of three hundred and twenty eight radiographs were analysed. The mean ages of male and female patients were 5.4±4.6 and 5.1±4.6 years, respectively, with a range of 0.2-15 years. Normal radiographs were found in 124 (37.80%) patients,53.1 (16.1%) had 55 fractures, and 39 (11.9%) had soft tissue swelling. Fractures were found most commonly in male children and in the age range 4-6 years. Fractures occur three times more in the upper limbs, and the bones most frequently affected are the humerus, radius, and the ulna in descending order. Most of the fractures were due to Road Traffic Injury (RTI) seen in 18.9%, falls seen in 18.9%, and birth trauma, which was responsible for 7.5%. The most frequently involved bone in fractures is the humerus followed by the femur bone. Skull fractures occur mostly in the parietal bone. Fractures are still mostly investigated with plain radiographs. Fractures are more frequent in male children and in the 4-6 year age range; it is seen more in the upper limb bones especially in the humerus. Skull fractures are relatively rare. Half of the fractures occur in the distal and mid portions of long bones. This study has also high lighted the importance of road traffic injury and falls as aetiological factors in fracture occurring in children. Effort should be made to ease deliveries in order to reduce the incidence of birth trauma.

Experiment K-6-02. Biomedical, biochemical and morphological alterations of muscle and dense, fibrous connective tissues during 14 days of spaceflight

NASA Technical Reports Server (NTRS)

Vailas, A.; Zernicke, R.; Grindeland, R.; Kaplanski, A.

1990-01-01

Findings on the connective tissue response to short-term space flight (12 days) are discussed. Specifically, data regarding the biochemical, biomechanical and morphological characteristics of selected connective tissues (humerus, vertebral body, tendon and skeletal muscle) of growing rats is given. Results are given concerning the humerus cortical bone, the vertebral bone, nutritional effects on bone biomechanical properties, and soft tense fiber connective tissue response.

Do race-specific definitions of short long bones improve the detection of down syndrome on second-trimester genetic sonograms?

PubMed

Harper, Lorie M; Gray, Diana; Dicke, Jeffrey; Stamilio, David M; Macones, George A; Odibo, Anthony O

2010-02-01

The purpose of this study was to determine whether the use of race-specific definitions of short femur and humerus lengths improves Down syndrome detection. This was a retrospective cohort study over 16 years. For each self-reported maternal race (white, African American, Hispanic, and Asian), we evaluated the efficiency of Down syndrome detection using published race-specific formulas compared with a standard formula for short femur and humerus lengths (observed versus expected lengths < or =0.91 and < or =0.89, respectively). The sensitivity, specificity, and 95% confidence intervals for each parameter were compared. Screening performance was compared by areas under the receiver operating characteristic curves. Of 58,710 women, 209 (0.3%) had a diagnosis of a fetus with Down syndrome. Although the race-based formula increased sensitivity in each population, the increase was statistically significant only in the white population, whereas a decrease in specificity was statistically significant in all 4 populations, as denoted by nonoverlapping confidence intervals. The area under the receiver operating characteristic curve for the model using the race-specific definition of short femur length was 0.67 versus 0.65 compared with the standard definition, and for humerus length it was 0.70 versus 0.71. The use of race-based formulas for the determination of short femur and humerus lengths did not significantly improve the detection rates for Down syndrome.

Intercondylar humerus fracture- parallel plating and its results.

PubMed

Kumar, Sanjiv; Singh, Sudhir; Kumar, Dharmender; Kumar, Neeraj; Verma, Reetu

2015-01-01

Intercondylar fracture of humerus is one of the commonest fractures of young adult and counts for about 30% of all elbow fractures. The treatment of these fractures continues to present challenges despite advances in internal fixation. Although orthogonal plating use to provid adequate functional results in these fractures, parallel plating is said to be mechanically more stable construct thus allowing early mobilization and better range of motion. AIM of the study is to assess the clinical as well functional results of these fractures treated with parallel plating. Prospective study in a tertiary care hospital. A total of 23 fresh patients of intercondylar fracture of humerus from Jan 2013 to May 2014 were included in the study and were treated with parallel plating. These patients were followed at 3, 6, 12, 24 weeks and at 1year of follow up and assessed in terms of time for union, range of motion, MAYO score, DASH score and complication rate. At final follow up Mayo score was 96.32±04.96 from 5.00±01.26 and DASH SCORE was 31.42±2.04 which dropped from 150±05.34, Range of motion improved from 21.38±05.70 to 116.1±07.92 with 100% union rate and complications less than 19%. Parallel plating for intercondylar fracture of humerus is excellent method of fixation and results are similar to those treated with orthogonal plating.

Unicameral Bone Cysts in the Humerus: Treatment Outcomes.

PubMed

Kadhim, Muayad; Sethi, Samir; Thacker, Mihir M

2016-06-01

Several treatment modalities have been described for the treatment of unicameral bone cysts (UBC). The aim of this study was to examine the outcome of various treatment modalities of UBC in a specific anatomic location, the humerus. This study is a retrospective case-only study of patients with humeral UBC with minimum follow-up of 1 year. Medical records and radiographs were assessed and UBC healing status was determined based on most recent follow-up radiographs and divided into 3 groups (healed, partially healed, and not healed). Descriptive statistics were utilized to summarize study outcome. Sixty-eight patients (54 boys and 14 girls) with humeral UBC comprised the study population. Sixty-four cases (94.1%) presented with a pathologic fracture. Fifty-one cases were in the proximal metaphysis and 17 were in the diaphysis. Mean age at diagnosis was 9.2±3.7 years, and mean follow-up was 4.0±2.6 years. Twenty-five patients were treated with observation, 38 by injection (27 with steroids and 11 with bone marrow), and 5 by open surgery. Patients who underwent open surgery had relatively larger cyst length, width, and cyst index, and all healed or partially healed at last follow-up. UBC persistence was observed in 29% of diaphyseal and 27.5% of metaphyseal cysts. Of the 19 patients with persistence, 8 were treated with observation, 9 with steroid injection, and 2 with bone marrow injection. Inner wall disruption before injection was performed in 17 patients (24% did not heal), whereas 21 patients did not have inner wall disruption (33% did not heal). Twenty patients received >1 injection. Eleven patients complained of pain at the last visit (8 had a persistent cyst, 2 were partially healed, and 1 had a healed UBC). Complete healing of humeral UBC is challenging to achieve irrespective of treatment modality. UBCs treated with open surgery tended to heal better. Unhealed cysts were more likely to be associated with pain. Level III-a retrospective comparative study.

The paleobiology of Amphipithecidae, South Asian late Eocene primates.

PubMed

Kay, Richard F; Schmitt, Daniel; Vinyard, Christopher J; Perry, Jonathan M G; Shigehara, Nobuo; Takai, Masanaru; Egi, Naoko

2004-01-01

Analysis of the teeth, orbital, and gnathic regions of the skull, and fragmentary postcranial bones provides evidence for reconstructing a behavioral profile of Amphipithecidae: Pondaungia, Amphipithecus, Myanmarpithecus (late middle Eocene, Myanmar) and Siamopithecus (late Eocene, Thailand). At 5-8 kg, Pondaungia, Amphipithecus, and Siamopithecus are perhaps the largest known Eocene primates. The dental and mandibular anatomy suggest that large-bodied amphipithecids were hard-object feeders. The shape of the mandibular corpus and stiffened symphysis suggest an ability to resist large internal loads during chewing and to recruit significant amounts of muscle forces from both the chewing and non-chewing sides of the jaw so as to increase bite force during mastication. The large spatulate upper central incisor of Pondaungia and projecting robust canines of all the larger amphipithecids suggest that incisal food preparation was important. The molars of Siamopithecus, Amphipithecus, and Pondaungia have weak shearing crests. This, and the thick molar enamel found in Pondaungia, suggests a diet of seeds and other hard objects low in fiber. In contrast, Myanmarpithecus was smaller, about 1-2 kg; its cheek teeth suggest a frugivorous diet and do not imply seed eating. Postcranial bones (humerus, ulna, and calcaneus) of a single large amphipithecid individual from Myanmar suggest an arboreal quadrupedal locomotor style like that of howler monkeys or lorises. The humeral head is rounded, proximally oriented, and the tuberosities are low indicating an extremely mobile glenohumeral joint. The great thickness of the midshaft cortical bone of the humerus implies enhanced ability to resist bending and torsion, as seen among slow moving primate quadrupeds. The elbow joint exhibits articular features for enhanced stability in habitually flexed positions, features also commonly found in slow moving arboreal quadrupeds. The short distal load arm of the calcaneus is consistent with, but not exclusive to, slow, arboreal quadrupedalism, and suggests no reliance on habitual leaping.

EZ-IO(®) intraosseous device implementation in German Helicopter Emergency Medical Service.

PubMed

Helm, Matthias; Haunstein, Benedikt; Schlechtriemen, Thomas; Ruppert, Matthias; Lampl, Lorenz; Gäßler, Michael

2015-03-01

Intraosseous access (IO) is a rapid and safe alternative when peripheral venous access is difficult. Our aim was to summarize the first three years experience with the use of a semi-automatic IO device (EZ-IO(®)) in German Helicopter Emergency Medical Service (HEMS). Included were all patients during study period (January 2009-December 2011) requiring an IO access performed by HEMS team. Outcome variables were IO rate, IO insertion success rates, site of IO access, type of EZ-IO(®) needle set used, strategy of vascular access, procedure related problems and operator's satisfaction. IO rate was 0.3% (348/120.923). Overall success rate was 99.6% with a first attempt success rate of 85.9%; there was only one failure (0.4%). There were three insertion sites: proximal tibia (87.2%), distal tibia (7.5%) and proximal humerus (5.3%). Within total study group IO was predominantly the second-line strategy (39% vs. 61%, p<0.001), but in children<7 years, in trauma cases and in cardiac arrest IO was more often first-line strategy (64% vs. 28%, p<0.001; 48% vs. 34%, p<0.032; 50% vs. 29%, p<0.002 respectively). Patients with IO access were significantly younger (41.7±28.7 vs. 56.5±24.4 years; p<0.001), more often male (63.2% vs. 57.7%; p=0.037), included more trauma cases (37.3% vs. 30.0%; p=0.003) and more often patients with a NACA-Score≥5 rating (77.0% vs. 18.6%; p<0.001). Patients who required IO access generally presented with more severely compromised vital signs associated with the need for more invasive resuscitation actions such as intubation, chest drains, CPR and defibrillation. In 93% EZ-IO(®) needle set handling was rated "good". Problems were reported in 1.6% (needle dislocation 0.8%, needle bending 0.4% and parafusion 0.4%). The IO route was generally used in the most critically ill of patients. Our relatively low rate of usage would indicate that this would be compatible with the recommendations of established guidelines. The EZ-IO(®) intraosseous device proved feasible with a high success rate in adult and pediatric emergency patients in HEMS. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Interventions for treating proximal humeral fractures in adults.

PubMed

Handoll, Helen H G; Ollivere, Benjamin J; Rollins, Katie E

2012-12-12

Fractures of the proximal humerus are common injuries. The management, including surgical intervention, of these fractures varies widely. This is an update of a Cochrane review first published in 2001 and last updated in 2010. To review the evidence supporting the various treatment and rehabilitation interventions for proximal humeral fractures. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and other databases, and bibliographies of trial reports. The full search ended in January 2012. All randomised controlled trials pertinent to the management of proximal humeral fractures in adults were selected. Two people performed independent study selection, risk of bias assessment and data extraction. Only limited meta-analysis was performed. Twenty-three small randomised trials with a total of 1238 participants were included. Bias in these trials could not be ruled out. Additionally there is a need for caution in interpreting the results of these small trials, which generally do not provide sufficient evidence to conclude that any non-statistically significant finding is 'evidence of no effect'.Eight trials evaluated conservative treatment. One trial found an arm sling was generally more comfortable than a less commonly used body bandage. There was some evidence that 'immediate' physiotherapy compared with that delayed until after three weeks of immobilisation resulted in less pain and potentially better recovery in people with undisplaced or other stable fractures. Similarly, there was evidence that mobilisation at one week instead of three weeks alleviated short term pain without compromising long term outcome. Two trials provided some evidence that unsupervised patients could generally achieve a satisfactory outcome when given sufficient instruction for an adequate self-directed exercise programme.Six heterogeneous trials, involving a total of 270 participants with displaced and/or complex fractures, compared surgical versus conservative treatment. Pooled results of patient-reported functional scores at one year from three trials (153 participants) showed no statistically significant difference between the two groups (standardised mean difference -0.10, 95% CI -0.42 to 0.22; negative results favour surgery). Quality of life based on the EuroQol results scores from three trials (153 participants) showed non-statistically significant differences between the two groups at three time points up to 12 months. However, the pooled EuroQol results at two years (101 participants) from two trials run concurrently from the same centre were significantly in favour of the surgical group. There was no significant difference between the two groups in mortality (8/98 versus 5/98; RR 1.55, 95% CI 0.55 to 4.36; 4 trials). Significantly more surgical group patients had additional or secondary surgery (18/112 versus 5/111; RR 3.36, 95% CI 1.33 to 8.49; 5 trials). This is equivalent to an extra operation in one of every nine surgically treated patients.Different methods of surgical management were tested in seven small trials. One trial comparing two types of locking plate versus a locking nail for treating two-part surgical neck fractures found some evidence of better function after plate fixation but also of a higher rate of surgically-related complications. One trial comparing a locking plate versus minimally invasive fixation with distally inserted intramedullary nails found some evidence of a short-term benefit for the nailing group. Compared with hemiarthroplasty, tension-band fixation of severe injuries using wires was associated with a higher re-operation rate in one trial. Two trials found no important differences between 'polyaxial' and 'monaxial' screws combined with locking plate fixation. One trial produced some preliminary evidence that tended to support the use of medial support locking screws in locking plate fixation. One trial found better functional results for one of two types of hemiarthroplasty.Very limited evidence suggested similar outcomes from early versus later mobilisation after either surgical fixation (one trial) or hemiarthroplasty (one trial). There is insufficient evidence to inform the management of these fractures. Early physiotherapy, without immobilisation, may be sufficient for some types of undisplaced fractures. It remains unclear whether surgery, even for specific fracture types, will produce consistently better long term outcomes but it is likely to be associated with a higher risk of surgery-related complications and requirement for further surgery.There is insufficient evidence to establish what is the best method of surgical treatment, either in terms of the use of different categories of surgical intervention (such as plate versus nail fixation, or hemiarthroplasty versus tension-wire fixation) or different methods of performing an intervention in the same category (such as different methods of plate fixation). There is insufficient evidence to say when to start mobilisation after either surgical fixation or hemiarthroplasty.

Gender Differences in Motor Skills of the Overarm Throw

PubMed Central

Gromeier, Michael; Koester, Dirk; Schack, Thomas

2017-01-01

In this cross-sectional study, the qualitative and quantitative throwing performance of male and female athletes (6 to 16 years of age) was analyzed. The goal of this study was to assess whether there were gender based qualitative and quantitative differences in throwing performance of young athletes, throughout three different age bands (childhood, pubescence, and adolescence). Furthermore, we explored whether all components of the throwing movement are equally affected by gender differences. Focus was placed on five essential components of action: trunk, forearm, humerus, stepping, and backswing. Therefore, children and adolescents (N = 96) were invited to throw three times from three different distances, while aiming at a target placed at shoulder height. The participants were aspiring athletes, competitive in the sport handball. For analyzing the quality of movement the component approach of Halverson and Roberton (1984) was used. The throwing accuracy was noted and used to evaluate the quantitative performance of the throwing movement. Throughout three different age bands, no statistically significant difference was found between genders in throwing accuracy, i.e., quantitative performance. Regarding the qualitative evaluation of the throwing movement, male and female athletes differed significantly. The component approach yielded higher scores for male than for female participants. As expected, with increasing age qualitative and quantitative performance of male and female athletes improved. These results suggest that there are gender-specific differences in qualitative throwing performance, but not necessarily in quantitative throwing performance. Exploration shows that differences in the qualitative throwing performance were seen in specific components of action. Male and female athletes demonstrated similar movement patterns in humerus and forearm actions, but differed in trunk, stepping, and backswing actions. PMID:28261142

Ultrastructural characterization of atrial natriuretic peptide receptors (ANP-R) mRNA expression in rat kidney cortex.

PubMed

Grandclément, B; Morel, G

1998-06-01

Atrial natriuretic peptide (ANP) and two complementary peptides named brain natriuretic peptide and C-type natriuretic peptide are involved in diuresis, natriuresis, hypotension and vasorelaxation. Their actions are mediated by highly selective and specific ANP receptors. Three subtypes have been characterized and cloned: ANP receptor A, -B and -C. In the present study, the mRNA for each subtype was detected by ultrastructural in situ hybridization on ultrathin sections of Lowicryl-embedded tissue and frozen tissue. The distribution of mRNA (visualized by gold particles) for each subtype was found to differ in different cells of the nephron. The three subtypes of this receptor family were expressed in all the parts of the nephron, but their expression levels were different. The ANPR-A mRNA was the most abundant in cells of glomerulus, proximal and distal tubules. The subtype C was the least expressed mRNA in glomerulus. In contrast, the subcellular localization of the three mRNAs was similar; they were found in the cytoplasmic matrix and the euchromatin of the nucleus. In conclusion, the differential expression of these mRNAs in kidney cortex indicates that these three peptides act directly in differing parts of nephron regions which are the glomerulus, the proximal and distal tubules.

Evaluation of regression-based 3-D shoulder rhythms.

PubMed

Xu, Xu; Dickerson, Clark R; Lin, Jia-Hua; McGorry, Raymond W

2016-08-01

The movements of the humerus, the clavicle, and the scapula are not completely independent. The coupled pattern of movement of these bones is called the shoulder rhythm. To date, multiple studies have focused on providing regression-based 3-D shoulder rhythms, in which the orientations of the clavicle and the scapula are estimated by the orientation of the humerus. In this study, six existing regression-based shoulder rhythms were evaluated by an independent dataset in terms of their predictability. The datasets include the measured orientations of the humerus, the clavicle, and the scapula of 14 participants over 118 different upper arm postures. The predicted orientations of the clavicle and the scapula were derived from applying those regression-based shoulder rhythms to the humerus orientation. The results indicated that none of those regression-based shoulder rhythms provides consistently more accurate results than the others. For all the joint angles and all the shoulder rhythms, the RMSE are all greater than 5°. Among those shoulder rhythms, the scapula lateral/medial rotation has the strongest correlation between the predicted and the measured angles, while the other thoracoclavicular and thoracoscapular bone orientation angles only showed a weak to moderate correlation. Since the regression-based shoulder rhythm has been adopted for shoulder biomechanical models to estimate shoulder muscle activities and structure loads, there needs to be further investigation on how the predicted error from the shoulder rhythm affects the output of the biomechanical model. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Sex determination in skeletal remains from the medieval Eastern Adriatic coast – discriminant function analysis of humeri

PubMed Central

Bašić, Željana; Anterić, Ivana; Vilović, Katarina; Petaros, Anja; Bosnar, Alan; Madžar, Tomislav; Polašek, Ozren; Anđelinović, Šimun

2013-01-01

Aim To investigate the usefulness of humerus measurement for sex determination in a sample of medieval skeletons from the Eastern Adriatic Coast. Additional aim was to compare the results with contemporary female population. Methods Five humerus measurements (maximum length, epicondylar width, maximum vertical diameter of the head, maximum and minimum diameter of the humerus at midshaft) for 80 male and 35 female medieval and 19 female contemporary humeri were recorded. Only sufficiently preserved skeletons and those with no obvious pathological or traumatic changes that could affect the measurements were included. For ten samples, analysis of DNA was performed in order to determine sex using amelogenin. Results The initial comparison of men and women indicated significant differences in all five measures (P < 0.001). Discriminant function for sex determination indicated that as much as 85% of cases could be properly categorized, with better results in men (86%) than women (80%). Furthermore, the comparison of the medieval and contemporary women did not show significant difference in any of the measured features. Sex results obtained by anthropological and DNA analysis matched in all 10 cases. Conclusion The results indicate that humerus measurement in Croatian medieval population may be sufficient to determine the sex of the skeleton. Furthermore, it seems that secular changes have not substantially affected contemporary population, suggesting that the results of this study are transferable to contemporary population as well. PMID:23771758

Magnetic resonance anatomy of the superior part of the rotator cuff in normal shoulders, assessment and practical implication.

PubMed

Michelin, Paul; Trintignac, Adrien; Dacher, Jean Nicolas; Carvalhana, Gilbert; Lefebvre, Valentin; Duparc, Fabrice

2014-12-01

The superior part of the rotator cuff consists of the anterior (SSa) and posterior (SSp) parts of the supraspinatus tendon, the infraspinatus (IS) tendon plus the articular capsule. An overlap of the distal SSp tendon by the anterior part of the IS one has been anatomically demonstrated; the insertion area of the IS is more anterior than currently believed. The aim of our study was to assess this complex architecture through standard MRI scans. Twenty-five healthy volunteers underwent a shoulder MRI. Three planes T2 fat saturation sequences were read in consensus by two radiologists. The SSa, the SSp, the IS tendons and the articular capsule were assessed for visibility. The patterns of demarcation of each structure from adjacent ones were assessed. The width and the thickness of each tendinous band were measured on sagittal images. The SSa, the SSp and the IS tendons were distinguishable in all patients. The anterior part of the IS tendon overlapped the SSp tendon to reach a quite anterior insertion into the greater tuberosity of the humerus. The SSa, the SSp and the IS tendons were 6.5-3.4, 15.1-2.8 and 26.8-2.2 mm wide and thick, respectively. MR images of the normal superior rotator cuff are consistent with latest anatomical descriptions. The distal superposition of the IS over the SSp tendon should be considered regarding the linear increased signal areas and the commonly named "partial thickness ruptures" of the superior rotator cuff as well as the fatty infiltration of the IS muscle.

Factors influencing interlocking screw failure in unreamed small diameter nails--a biomechanical study using a distal tibia fracture model.

PubMed

Weninger, Patrick; Schueller, Michael; Jamek, Michael; Stanzl-Tschegg, Stefanie; Redl, Heinz; Tschegg, Elmar K

2009-05-01

Unreamed tibia nails with small diameters are increasingly used for fracture fixation. However, little is known about the fatigue strength of proximal and distal interlocking screws in those nails. To date, no data are available reporting on mechanical differences of solid compared to cannulated tibial nails. The aim of this study was to assess the fatigue strength of proximal and distal interlocking screws of solid and cannulated small diameter tibia nails. We created a distal tibia fracture model (AO/OTA 43 A3) using 16 Sawbones. After fracture stabilization with one of four different nail types (Expert Tibial Nail, VersaNail, T2 Tibial Nailing System, Connex), mechanical testing was performed in three loading series (40,000 cycles each) with incremental loads. Timing and type of interlocking screw failure were assessed. Interlocking screw failure was observed significantly earlier (after a mean interval of 57,042 cycles) in cannulated tibial nails (VersaNail, T2) compared to solid nails (after a mean interval of 88,415 cycles; P < 0.001). Proximal interlocking screw failure was recorded if oblique screws were used proximally (VersaNail, T2, Connex). No distal interlocking screw failure was recorded in the Connex nail. Two- and three-part fractures of proximal or distal interlocking screws were observed in all specimen. Proximal and distal interlocking screw failure has to be considered in small diameter nails in case of delayed fracture healing. To support our results, further experimental studies and clinical series are necessary.

Percutaneous Method of Management of Simple Bone Cyst

PubMed Central

Lakhwani, O. P.

2013-01-01

Introduction. Simple bone cyst or unicameral bone cysts are benign osteolytic lesions seen in metadiaphysis of long bones in growing children. Various treatment modalities with variable outcomes have been described in the literature. The case report illustrates the surgical technique of minimally invasive method of treatment. Case Study. A 14-year-old boy was diagnosed as active simple bone cyst proximal humerus with pathological fracture. The patient was treated by minimally invasive percutaneous curettage with titanium elastic nail (TENS) and allogenic bone grafting mixed with bone marrow under image intensifier guidance. Results. Pathological fracture was healed and allograft filled in the cavity was well taken up. The patient achieved full range of motion with successful outcome. Conclusion. Minimally invasive percutaneous method using elastic intramedullary nail gives benefit of curettage cyst decompression and stabilization of fracture. Allogenic bone graft fills the cavity and healing of lesion by osteointegration. This method may be considered with advantage of minimally invasive technique in treatment of benign cystic lesions of bone, and the level of evidence was therapeutic level V. PMID:23819089

Rich but poor: life in the Roman period with extreme rheumatoid arthritis.

PubMed

Bašić, Željana; Jerković, Ivan; Kružić, Ivana; Anđelinović, Šimun

2017-01-01

In a Sidonian sarcophagus, from the Late Antique/early Christian period, skeletal remains of two persons were found. One of them, male, 30-50 years old, was found almost completely ankylosed, with highly osteoporotic bones and prominent erosion of joint surfaces. We diagnosed rheumatoid arthritis based on the eroded odontoid process, mandibular condyles, distal humerus, proximal and distal ulna, as well ankylosed hand and foot bones. Despite the fact that ankyloses of vertebrae and sacroiliac joint could point towards ankylosing spondylitis, the lack of typical vertebral ankyloses and new bone formation led to exclusion. In a practical sense, due to the advanced stage of the disease, the man was fixed in the supine position, on the left, with his head turned to the right. Apparently, he could not move and had problems with chewing and breathing. But, the high standard of provided healthcare probably enabled him to survive in advanced stages of the disease. This case shed light on the antiquity of the disease, its medical, and social context and provided the example of most extreme osteological changes reported in the paleopathological and medical literature.

An Abnormal Bone Lesion of the Scapula in a Collegiate Basketball Player: A Case Report

PubMed Central

O'Brien, Matthew S.; Donnell, Allison; Miller, Jason; Iven, Val Gene; Pascale, Mark

2013-01-01

Objective: To present the case of a bone lesion of the scapula in a collegiate basketball player. Background: A 19-year-old National Collegiate Athletic Association Division I male basketball player presented with pain in the posterior region of the right shoulder. During practice, he was performing a layup when his arm was forced into hyperflexion by a defender. Evaluation revealed a bone lesion involving the scapular spine and base of the acromion. Differential Diagnosis: Acromioclavicular joint sprain, subacromial bursitis, subscapular bursitis, humeral head contusion, acromial fracture. Treatment: The patient was treated for 2 months with therapeutic modalities and rehabilitation exercises. Because of persistent pain and the risk of a pathologic fracture, open surgical biopsy and bone grafting were then undertaken. Uniqueness: Most simple bone cysts affect the proximal humerus and femur, whereas our patient's lesion was in the acromial complex. Conclusions: Athletic trainers should be alert to the unusual possibility of bone cysts, which are usually identified incidentally when radiographs are obtained for other reasons. Most simple bone cysts are asymptomatic, but a pathologic fracture can occur with trauma. PMID:23725460

Record-Breaking Pain: The Largest Number and Variety of Forelimb Bone Maladies in a Theropod Dinosaur.

PubMed

Senter, Phil; Juengst, Sara L

2016-01-01

Bone abnormalities are common in theropod dinosaur skeletons, but before now no specimen was known with more than four afflicted bones of the pectoral girdle and/or forelimb. Here we describe the pathology of a specimen of the theropod dinosaur Dilophosaurus wetherilli with eight afflicted bones of the pectoral girdle and forelimb. On its left side the animal has a fractured scapula and radius and large fibriscesses in the ulna and the proximal thumb phalanx. On its right side the animal has abnormal torsion of the humeral shaft, bony tumors on the radius, a truncated distal articular surface of metacarpal III, and angular deformities of the first phalanx of the third finger. Healing and remodeling indicates that the animal survived for months and possibly years after its ailments began, but its right third finger was permanently deformed and lacked the capability of flexion. The deformities of the humerus and the right third finger may be due to developmental osteodysplasia, a condition known in extant birds but unreported in non-avian dinosaurs before now.

Outcomes, and factors affecting outcomes, following shoulder hemiarthroplasty for proximal humeral fracture repair.

PubMed

Liu, Jie; Li, Shao-Hua; Cai, Zheng-Dong; Lou, Lie-Ming; Wu, Xing; Zhu, Yu-Chang; Wu, Wei-Ping

2011-09-01

Hemiarthroplasty has been applied to treat proximal humeral fracture with variable outcomes. The purpose of this retrospective study was to assess factors affecting outcome in patients following hemiarthroplasty for proximal humeral fracture (PHF) repair. Patients with proximal humeral fractures treated over a 6-year period were included. Indications for hemiarthroplasty were severe three-part fractures associated with osteoporosis; four-part fractures with or without dislocation; splitting of the humeral head, or >45% collapse of the humeral head. Surgery outcome and postoperative complications were main outcome measures in this study. Thirty-three of 47 patients were included in the final analysis (mean age 64.3 years, range 43-82). Mean postoperative follow-up was 44.4 (range 36-57) months. Postoperative complications (shoulder dislocation, mild shoulder subluxation, heterotopic ossification) occurred in seven patients. Healing of the greater and lesser tubercles was abnormal or poor in 18 patients. These patients had significantly higher pain scores (4.0 ± 1.1 vs. 2.2 ± 1.1) and significantly lower capacities for active lifting (79.3 ± 9.6 vs. 121.7 ± 24.3), external rotation (20.7 ± 3.7 vs. 39.2 ± 10.3), and Neer scores (79.2 ± 5.7 vs. 90.6 ± 3.6) versus patients who exhibited complete healing (all P < 0.001). Patient age, type of surgical approach, and fracture type were not major influencers of outcome. In conclusion, the healing of the greater and lesser tubercles is the major determinant of outcome following hemiarthroplasty for PHF repair.

Effect of Proximity of Features on the Damage Threshold During Submicron Additive Manufacturing Via Two-Photon Polymerization

DOE PAGES

Saha, Sourabh K.; Divin, Chuck; Cuadra, Jefferson A.; ...

2017-05-12

Two-photon polymerization (TPP) is a laser writing process that enables fabrication of millimeter scale three-dimensional (3D) structures with submicron features. In TPP, writing is achieved via nonlinear two-photon absorption that occurs at high laser intensities. Thus, it is essential to carefully select the incident power to prevent laser damage during polymerization. Currently, the feasible range of laser power is identified by writing small test patterns at varying power levels. Here in this paper, we demonstrate that the results of these tests cannot be generalized, because the damage threshold power depends on the proximity of features and reduces by as muchmore » as 47% for overlapping features. We have identified that this reduction occurs primarily due to an increase in the single-photon absorptivity of the resin after curing. We have captured the damage from proximity effects via X-ray 3D computed tomography (CT) images of a non-homogenous part that has varying feature density. Part damage manifests as internal spherical voids that arise due to boiling of the resist. We have empirically quantified this proximity effect by identifying the damage threshold power at different writing speeds and feature overlap spacings. In addition, we present a first-order analytical model that captures the scaling of this proximity effect. Based on this model and the experiments, we have identified that the proximity effect is more significant at high writing speeds; therefore, it adversely affects the scalability of manufacturing. The scaling laws and the empirical data generated here can be used to select the appropriate TPP writing parameters.« less

Effect of Proximity of Features on the Damage Threshold During Submicron Additive Manufacturing Via Two-Photon Polymerization

DOE Office of Scientific and Technical Information (OSTI.GOV)

Saha, Sourabh K.; Divin, Chuck; Cuadra, Jefferson A.

Two-photon polymerization (TPP) is a laser writing process that enables fabrication of millimeter scale three-dimensional (3D) structures with submicron features. In TPP, writing is achieved via nonlinear two-photon absorption that occurs at high laser intensities. Thus, it is essential to carefully select the incident power to prevent laser damage during polymerization. Currently, the feasible range of laser power is identified by writing small test patterns at varying power levels. Here in this paper, we demonstrate that the results of these tests cannot be generalized, because the damage threshold power depends on the proximity of features and reduces by as muchmore » as 47% for overlapping features. We have identified that this reduction occurs primarily due to an increase in the single-photon absorptivity of the resin after curing. We have captured the damage from proximity effects via X-ray 3D computed tomography (CT) images of a non-homogenous part that has varying feature density. Part damage manifests as internal spherical voids that arise due to boiling of the resist. We have empirically quantified this proximity effect by identifying the damage threshold power at different writing speeds and feature overlap spacings. In addition, we present a first-order analytical model that captures the scaling of this proximity effect. Based on this model and the experiments, we have identified that the proximity effect is more significant at high writing speeds; therefore, it adversely affects the scalability of manufacturing. The scaling laws and the empirical data generated here can be used to select the appropriate TPP writing parameters.« less

Isolation, cryotomography, and three-dimensional reconstruction of centrioles.

PubMed

Guichard, Paul; Hamel, Virginie; Neves, Aitana; Gönczy, Pierre

2015-01-01

Centrioles and basal bodies (referred to hereafter as centrioles for simplicity) are microtubule-based cylindrical organelles that are typically ∼450-nm long and ∼250nm in diameter. The centriole is composed of three distinct regions: the distal part characterized by microtubule doublets, the central core that harbors microtubule triplets, which are also present in the proximal part that also contains the cartwheel, a structure crucial for centriole assembly. The cartwheel was initially revealed by conventional electron microscopy of resin-embedded samples and is thought to impart the near universal ninefold symmetry of centrioles. Deciphering the native architecture of the cartwheel has proven challenging owing to its small dimensions and the difficulties in isolating it. Here, we present a method to purify and analyze the structure of the exceptionally long Trichonympha centriole by cryotomography and subtomogram averaging. Using this method, we revealed the native architecture of the proximal cartwheel-containing region at ∼40Å-resolution. This method can be applied as a general strategy for uncovering the structure of centrioles in other species. Copyright © 2015 Elsevier Inc. All rights reserved.

A Unique Branching Pattern of the Axillary Artery: A Case Report

PubMed Central

Bagoji, Ishwar B.; Hadimani, Gavishiddappa A.; Bannur, Balappa M.; Patil, B.G.; Bharatha, Ambadasu

2013-01-01

During routine dissection classes for under graduate students, we found a unique and unusual case regarding the anomalous branching in the third part of the axillary artery was terminated into subscapular arterial trunk, superficial brachial artery and deep brachial artery. The subscapular arterial trunk was origin of several important arteries as the circumflex scapular, thoracodorsal, posterior circumflex humeral, thoraco-acromial and lateral thoracic arteries. The deep brachial artery in the arm gave anterior circumflex humeral artery at the surgical neck of humerus, which terminated in the cubital fossa by dividing into radial and ulnar arteries. The superficial brachial artery gave two profunda brachii arteries, both of which passed through spiral groove, along with radial nerve and three muscular branches, to brachialis muscle. This variation is very rare. As per our knowledge, we did not find any literature which explained variations which were similar to this. The normal and abnormal anatomy of the axillary region has practical importance among vascular radiologists and surgeons and it should be known for making an accurate diagnostic interpretation. PMID:24551680

A unique branching pattern of the axillary artery: a case report.

PubMed

Bagoji, Ishwar B; Hadimani, Gavishiddappa A; Bannur, Balappa M; Patil, B G; Bharatha, Ambadasu

2013-12-01

During routine dissection classes for under graduate students, we found a unique and unusual case regarding the anomalous branching in the third part of the axillary artery was terminated into subscapular arterial trunk, superficial brachial artery and deep brachial artery. The subscapular arterial trunk was origin of several important arteries as the circumflex scapular, thoracodorsal, posterior circumflex humeral, thoraco-acromial and lateral thoracic arteries. The deep brachial artery in the arm gave anterior circumflex humeral artery at the surgical neck of humerus, which terminated in the cubital fossa by dividing into radial and ulnar arteries. The superficial brachial artery gave two profunda brachii arteries, both of which passed through spiral groove, along with radial nerve and three muscular branches, to brachialis muscle. This variation is very rare. As per our knowledge, we did not find any literature which explained variations which were similar to this. The normal and abnormal anatomy of the axillary region has practical importance among vascular radiologists and surgeons and it should be known for making an accurate diagnostic interpretation.

The shape of the hominoid proximal femur: a geometric morphometric analysis

PubMed Central

Harmon, Elizabeth H

2007-01-01

As part of the hip joint, the proximal femur is an integral locomotor component. Although a link between locomotion and the morphology of some aspects of the proximal femur has been identified, inclusive shapes of this element have not been compared among behaviourally heterogeneous hominoids. Previous analyses have partitioned complex proximal femoral morphology into discrete features (e.g. head, neck, greater trochanter) to facilitate conventional linear measurements. In this study, three-dimensional geometric morphometrics are used to examine the shape of the proximal femur in hominoids to determine whether femoral shape co-varies with locomotor category. Fourteen landmarks are recorded on adult femora of Homo, Pan, Gorilla, Pongo and Hylobates. Generalized Procrustes analysis (GPA) is used to adjust for position, orientation and scale among landmark configurations. Principal components analysis is used to collapse and compare variation in residuals from GPA, and thin-plate spline analysis is used to visualize shape change among taxa. The results indicate that knucklewalking African apes are similar to one another in femoral shape, whereas the more suspensory Asian apes diverge from the African ape pattern. The shape of the human and orangutan proximal femur converge, a result that is best explained in terms of the distinct requirements for locomotion in each group. These findings suggest that the shape of the proximal femur is brought about primarily by locomotor behaviour. PMID:17310545

The effect of the remplissage procedure on shoulder range of motion: a cadaveric study.

PubMed

Omi, Rei; Hooke, Alexander W; Zhao, Kristin D; Matsuhashi, Tomoya; Goto, Akira; Yamamoto, Nobuyuki; Sperling, John W; Steinmann, Scott P; Itoi, Eiji; An, Kai-Nan

2014-02-01

The purpose of this in vitro biomechanical study was to assess the effects of the remplissage procedure for small- and large-sized Hill-Sachs lesions (HSLs) on shoulder range of motion (ROM) with a special interest in the apprehension position. HSLs of 50% and 100% of the glenoid width were simulated in 7 cadaveric shoulders as small and large lesions, respectively, and the postoperative condition was reproduced by placing suture anchors on the articular surface and tying down the infraspinatus at the medial edge of the would-be lesion site. ROMs were measured in abduction, internal rotation, and external rotation with the humerus in the adducted and abducted position. In addition, the ROM was measured in the anterior apprehension position, in which 2 torques of external rotation and extension were applied simultaneously, and external rotation and horizontal extension ROMs were measured with the humerus in different abduction angles (20°, 40°, and 60°). For standard ROMs, the procedure for the 50% HSL maintained complete ROMs, whereas the procedure for the 100% HSL significantly decreased external rotation ROM with the humerus in both the adducted and abducted positions, as well as abduction ROM. In the apprehension position, remplissage for the 50% HSL decreased extension ROM with the humerus abducted to 40° and 60°. Remplissage for the 100% HSL significantly decreased both external and extension ROMs regardless of the humeral abduction angle. In the cadaveric model with an intact humeral head and the simulated postoperative condition, the remplissage procedure for a large HSL caused significant restrictions in ROM of abduction in the scapular plane and external rotation with the humerus in both adduction and abduction. It also caused significant restrictions in both external rotation and extension ROMs in the apprehension position. The indication for the remplissage procedure for the larger HSL should be considered carefully, especially for the competitive throwing athlete who needs exceptional external rotation ROM for optimal overhead throwing performance. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Hox gene expression in the specialized limbs of the Iberian mole (Talpa occidentalis).

PubMed

Bickelmann, Constanze; van der Vos, Wessel; de Bakker, Merijn A G; Jiménez, Rafael; Maas, Saskia; Sánchez-Villagra, Marcelo R

2017-01-01

Fossorial talpid moles use their limbs predominantly for digging, which explains their highly specialized anatomy. The humerus is particularly short and dorsoventrally rotated, with broadened distal and proximal parts where muscles attach and which facilitate powerful abductive movements. The radius and ulna are exceptionally robust and short. The ulna has an expanded olecranon process. The femur is generalized, but the fused tibia-fibula complex is short and robust. To understand the developmental bases of these specializations, we studied expression patterns of four 5' Hox genes in the fossorial Iberian mole (Talpa occidentalis). These genes are known to play major roles in patterning the developing limb skeleton in the mouse, with which comparisons were made (Mus musculus, C57BL/6Jico strain). We find that HoxA9 expression is spatially expanded in the developing stylopodial area in the mole forelimb, compared to the less specialized mouse forelimb and mole hind limb. HoxD9 expression does not extend into the thoracic body wall in the mole forelimb in contrast to the mouse, and is also reduced in the presumptive zeugopodium in mole forelimb, compared to mouse. Expression of HoxD11 is upregulated in the mole in the postaxial area of the hind limb zeugopod, compared to the mouse. On the other hand, HoxD13 is downregulated in the postaxial zeugopodial area in the forelimb of the mole, compared to the mouse. The differences in the expression patterns of these 5' Hox genes between Talpa and Mus are an indication of the developmental changes going hand in hand with anatomical digging adaptations in the mole adult. © 2016 Wiley Periodicals, Inc.

Morphological integration in the forelimb of musteloid carnivorans

PubMed Central

Fabre, Anne-Claire; Goswami, Anjali; Peigné, Stéphane; Cornette, Raphaël

2014-01-01

The forelimb forms a functional unit that allows a variety of behaviours and needs to be mobile, yet at the same time stable. Both mobility and stability are controlled, amongst others, at the level of the elbow joint. This joint is composed of the humero-ulnar articulation, mainly involved during parasagittal movements; and the radio-ulnar articulation, mainly allowing rotation. In contrast, the humero-radial articulation allows both movements of flexion–extension and rotation. Here, we study the morphological integration between each bone of the forelimb at the level of the entire arm, as well as at the elbow joint, in musteloid carnivorans. To do so, we quantitatively test shape co-variation using surface 3D geometric morphometric data. Our results show that morphological integration is stronger for bones that form functional units. Different results are obtained depending on the level of investigation: for the entire arm, results show a greater degree of shape co-variation between long bones of the lower arm than between the humerus and either bone of the lower arm. Thus, at this level the functional unit of the lower arm is comprised of the radius and ulna, permitting rotational movements of the lower arm. At the level of the elbow, results display a stronger shape co-variation between bones allowing flexion and stability (humerus and ulna) than between bones allowing mobility (ulna and radius and humerus and radius). Thus, the critical functional unit appears to be the articulation between the humerus and ulna providing the stability of the joint. PMID:24836555

[Meta analysis of parallel versus perpendicular double plating for distal humerus fracture of type C in adults].

PubMed

Li, B B; Lin, F; Cai, L H; Chen, Y; Lin, Z J

2017-08-01

Objective: To evaluate the effects of parallel versus perpendicular double plating for distal humerus fracture of type C. Methods: A standardized comprehensive literature search was performed by PubMed, Embase, Cochrane library, CMB, CNKI and Medline datebase.Randomized controlled studies on comparison between parallel versus perpendicular double plating for distal humerus fracture of type C before December 2015 were enrolled in the study.All date were analyzed by the RevMan 5.2 software. Results: Six studies, including 284 patients, met the inclusion criteria.There were 155 patients in perpendicular double plating group, 129 patients in parallel double plating group.The results of Meta-analysis indicated that there were statistically significant difference between the two groups in complications ( OR =2.59, 95% CI : 1.03 to 6.53, P =0.04). There was no significant difference between the two groups in surgical duration ( MD =-1.84, 95% CI : -9.06 to 5.39, P =0.62), bone union time ( MD =0.09, 95% CI : -0.06 to 0.24, P =0.22), Mayo Elbow Performance Score ( MD =0.09, 95% CI : -0.06 to 0.24, P =0.22), Range of Motions ( MD =-0.92, 95% CI : -4.65 to 2.81, P =0.63) and the rate of excellent and good results ( OR =0.64, 95% CI : 0.27 to 1.52, P =0.31). Conclusion: Both perpendicular and parallel double plating are effective in distal humerus fracture of type C, parallel double plating has less complications.

Single surgeon experience with robot-assisted ureteroureterostomy for pathologies at the proximal, middle, and distal ureter in adults.

PubMed

Lee, Ziho; Llukani, Elton; Reilly, Christopher E; Mydlo, Jack H; Lee, David I; Eun, Daniel D

2013-08-01

To describe our initial experience with robot-assisted ureteroureterostomy (RUU) at the proximal, middle, and distal ureter. Twelve consecutive patients underwent RUU by a single surgeon (D.D.E.) between July 2009 and November 2012. Indications included three iatrogenic injuries, two impacted stones, two ureterovaginal fistulas, two idiopathic ureteral strictures refractory to conservative treatment, one primary transitional cell carcinoma of the ureter, one colon cancer metastasis to the ureter, and one invasive endometriosis. There were two proximal, three middle, and seven distal ureteral pathologies. Tension-free anastomosis was achieved in all 12 patients. All patients with proximal and middle ureteral pathology received concomitant downward nephropexy (DN) as a standard part of RUU. Mean age of patients at the time of surgery was 52 years (range 30-69), mean body mass index was 30.0 kg/m(2) (range 21-38), mean operative room time was 190 minutes (range 104-354), mean estimated blood loss was 181 mL (range 50-400), and mean length of excised ureter on pathologic analysis was 2.0 cm (range 1.0-4.5). There was one intraoperative complication in which liver and gallbladder laceration occurred during trocar placement. Mean length of hospital stay was 1.4 days (range 1-5), and there were no postoperative complications. Mean follow up was 10 months (range 3-36). One patient had a ureteral stricture recurrence at 7 months postoperatively that led to renal unit loss and eventual nephrectomy. RUU is feasible, safe, and demonstrates good outcomes for pathologies at the proximal, middle, and distal ureter. Concomitant DN during RUU may assist in achieving a tension-free anastomosis for proximal and middle ureteral repairs.

Using Stimulus Fading without Escape Extinction to Increase Compliance with Toothbrushing in Children with Autism

ERIC Educational Resources Information Center

Bishop, Michele R.; Kenzer, Amy L.; Coffman, Christine M.; Tarbox, Courtney M.; Tarbox, Jonathan; Lanagan, Taira M.

2013-01-01

Routine toothbrushing is an essential part of good oral hygiene. This study investigated the use of stimulus fading without escape extinction to increase compliance with toothbrushing with three children with autism spectrum disorder (ASD). A 30-step stimulus fading hierarchy was implemented; gradually increasing the proximity of the toothbrush to…

Comparative study of nail sampling techniques in onychomycosis.

PubMed

Shemer, Avner; Davidovici, Batya; Grunwald, Marcelo H; Trau, Henri; Amichai, Boaz

2009-07-01

Onychomycosis is a common problem. Obtaining accurate laboratory test results before treatment is important in clinical practice. The purpose of this study was to compare results of curettage and drilling techniques of nail sampling in the diagnosis of onychomycosis, and to establish the best technique and location of sampling. We evaluated 60 patients suffering from distal and lateral subungual onychomycosis and lateral subungual onychomycosis using curettage and vertical and horizontal drilling sampling techniques from three different sites of the infected nail. KOH examination and fungal culture were used for detection and identification of fungal infection. At each sample site, the horizontal drilling technique has a better culture sensitivity than curettage. Trichophyton rubrum was by far the most common pathogen detected by both techniques from all sampling sites. The drilling technique was found to be statistically better than curettage at each site of sampling, furthermore vertical drilling from the proximal part of the affected nail was found to be the best procedure for nail sampling. With each technique we found that the culture sensitivity improved as the location of the sample was more proximal. More types of pathogens were detected in samples taken by both methods from proximal parts of the affected nails.

Occlusion of an Intraosseous Arteriovenous Malformation With Percutaneous Injection of Polymethylmethacrylate

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ierardi, Anna Maria, E-mail: amierardi@yahoo.it; Mangini, Monica, E-mail: monica.mangini@tin.it; Vaghi, Massimo, E-mail: vaghim@yahoo.it

Primary intraosseous arteriovenous malformations are rare. Many minimally invasive procedures can be considered preoperative steps and/or definitive treatment. The case reported regards a young woman with a voluminous arteriovenous extratroncular infiltrating malformation of the humerus. She underwent several treatments, but none of them was completely occlusive. The last treatment consisted of direct percutaneous puncture of the intraosseous alteration and injection of polymethylmethacrylate (PMMA), which is normally used in percutaneous vertebroplasty. We obtained complete occlusion of the humerus lytic lesion. To the best of our knowledge, this represents the first case of intraosseous AVM treated by percutaneous injection of PMMA.

Development of a novel method for surgical implant design optimization through noninvasive assessment of local bone properties.

PubMed

Schiuma, D; Brianza, S; Tami, A E

2011-03-01

A method was developed to improve the design of locking implants by finding the optimal paths for the anchoring elements, based on a high resolution pQCT assessment of local bone mineral density (BMD) distribution and bone micro-architecture (BMA). The method consists of three steps: (1) partial fixation of the implant to the bone and creation of a reference system, (2) implant removal and pQCT scan of the bone, and (3) determination of BMD and BMA of all implant-anchoring locations along the actual and alternative directions. Using a PHILOS plate, the method uncertainty was tested on an artificial humerus bone model. A cadaveric humerus was used to quantify how the uncertainty of the method affects the assessment of bone parameters. BMD and BMA were determined along four possible alternative screw paths as possible criteria for implant optimization. The method is biased by a 0.87 ± 0.12 mm systematic uncertainty and by a 0.44 ± 0.09 mm random uncertainty in locating the virtual screw position. This study shows that this method can be used to find alternative directions for the anchoring elements, which may possess better bone properties. This modification will thus produce an optimized implant design. Copyright © 2010 IPEM. Published by Elsevier Ltd. All rights reserved.

Glenohumeral Function of the Long Head of the Biceps Muscle

PubMed Central

Chalmers, Peter N.; Cip, Johannes; Trombley, Robert; Cole, Brian J.; Wimmer, Markus A.; Romeo, Anthony A.; Verma, Nikhil N.

2014-01-01

Background: Optimal treatment of superior labral anterior-posterior (SLAP) tears is controversial, in part because the dynamic role of the long head of the biceps muscle (LHBM) in the glenohumeral joint is unclear. The aim of this study was to determine dynamic LHBM behavior during shoulder activity by studying (1) the electromyographic activity of the LHBM during shoulder motion, (2) the effect of elbow immobilization on this activity, and (3) the effect of a load applied to the distal humerus on this activity. Hypothesis: The LHBM would not play a significant role in active glenohumeral range of motion. Study Design: Controlled laboratory study. Methods: Thirteen normal volunteers underwent surface electromyography (EMG) measurement of the LHBM, short head biceps muscle (SHBM), deltoid, infraspinatus, and brachioradialis during shoulder motion from the neutral position (0° of rotation, flexion, and abduction) to 45° of flexion, 90° of flexion, 45° of abduction, and 90° of abduction. These motions were repeated both with and without splint immobilization of the forearm and elbow at 100° of flexion and neutral rotation and with and without a 1-kg weight placed on the lateral distal humerus. Results: Mean EMG activity within the LHBM and the SHBM was low (≤11.6% ± 9.1%). LHBM activity was significant increased by flexion and abduction (P < .049 in all cases), while SHBM activity was not. EMG activity from the middle head of the deltoid was significantly increased by loading with the shoulder positioned away from the body (ie, in abduction or flexion). When compared with the unloaded state, the addition of a distal humeral load significantly increased LHBM activity in 45° of abduction (P = .028) and 90° of flexion (P = .033) despite forearm and elbow immobilization. The SHBM showed similar trends. Conclusion: In normal volunteers with forearm and elbow immobilization and application of a load to the distal humerus, LHBM EMG activity is increased by both glenohumeral flexion and abduction, suggesting that this muscle plays a dynamic role in glenohumeral motion with higher demand activities. Clinical Relevance: Biceps tenodesis may result in dynamic change within the glenohumeral joint with higher demand activities. PMID:26535304

In-depth proteomic analysis of the byssus from marine mussel Mytilus coruscus.

PubMed

Qin, Chuan-Li; Pan, Qi-Dong; Qi, Qi; Fan, Mei-Hua; Sun, Jing-Jing; Li, Nan-Nan; Liao, Zhi

2016-07-20

Mussels attach to various submerged surfaces by using the byssus, which contains different proteins and is a promising source of water-resistant bio-adhesives for potential use in biotechnological and medical applications. The protein composition of the byssus has not yet been fully understood although at least eleven byssal proteins were characterized previously. In order to increase genomic resources and identify new byssal proteins from mussel Mytilus coruscus, high-throughput Illumina sequencing was undertaken on the foot, and 79,997,776 paired-ends reads were generated, yielding a library containing 88,825ft unigenes. The M. coruscus byssus was divided into three parts, the proximal thread, the distal thread, and the plaque. Byssal proteins from each part of the byssus were analyzed by shotgun-LTQ analysis. The MS/MS spectra were searched against the foot unigenes dataset and 48 byssal proteins were identified from the M. coruscus byssus. From the whole set, 17, 5, and 11 proteins were exclusive to the proximal thread, the distal thread, and the plaque, respectively. These data can be used as a resource for further studies on the roles of byssal proteins in the deposition of different byssus parts (thread vs. plaque) or in the different mechanical properties (tenacity vs. adhesion). Byssal proteins are the major component that controls different aspects of the byssal formation process and thus a source of bioactive molecules that would offer interesting perspectives in biomaterials and bio-adhesive fields. In this paper, we characterized the protein set from different partsof Mytilus coruscus byssus by a combination of transcriptome/proteome technical. A whole set of 48 byssal proteins were described here, including proteins of collagen-like, C1q domain-containing, protease inhibitor-like, tyrosinase-like, SOD, and others. Thread (the distal portion and the proximal portion) and plaque showed distinct protein composition. Of the whole byssal protein set, 11 are exclusive to the plaque, 17 are exclusive to the proximal thread, and 5 are exclusive to the distal thread. Only four proteins are shared by all the three parts of the byssus. The new byssal proteins reported here represent a significant expansion of the knowledge base of Mytilus byssal proteins, and are important for further exploring the mechanism of adhesion in mussel. Copyright © 2016 Elsevier B.V. All rights reserved.

Distribution of Longitudinal Wave Velocities in Bovine Cortical Bone in vitro

NASA Astrophysics Data System (ADS)

Yamato, Yu; Kataoka, Hideo; Matsukawa, Mami; Yamazaki, Kaoru; Otani, Takahiko; Nagano, Akira

2005-06-01

The distribution of longitudinal wave velocities and longitudinal moduli in a bovine femoral cortical bone was experimentally investigated. In all parts of the long cylindrical bone, the velocities and longitudinal moduli in the axial direction were the highest. In the anterior (A) part, the velocities in the axial direction were high and almost constant, whereas the velocities in the proximal postero medial (PM) and distal postero lateral (PL) parts markedly decreased. Classifying the cortical bone into three structures (plexiform, Haversian, and porotic), we clarify the velocity distributions in the bone with discussion from an anatomical point of view.

Utility of Postoperative Antibiotics After Percutaneous Pinning of Pediatric Supracondylar Humerus Fractures.

PubMed

Schroeder, Nicholas O; Seeley, Mark A; Hariharan, Arun; Farley, Frances A; Caird, Michelle S; Li, Ying

2017-09-01

Pediatric supracondylar humerus fractures are common injuries that are often treated surgically with closed reduction and percutaneous pinning. Although surgical-site infections are rare, postoperative antibiotics are frequently administered without evidence or guidelines for their use. With the increasing prevalence of antibiotic-resistant organisms and heightened focus on health care costs, appropriate and evidence-based use of antibiotics is needed. We hypothesized that postoperative antibiotic administration would not decrease the rate of surgical-site infection. A billing query identified 951 patients with operatively treated supracondylar humerus fractures at our institution over a 15-year period. Records were reviewed for demographic data, perioperative antibiotic use, and the presence of surgical-site infection. Exclusion criteria were open fractures, open reduction, pathologic fractures, metabolic bone disease, the presence of other injuries that required operative treatment, and follow-up <2 weeks after pin removal. χ and Fisher exact test were used to compare antibiotic use to the incidence of surgical-site infection. Six hundred eighteen patients met our inclusion criteria. Two hundred thirty-eight patients (38.5%) received postoperative antibiotics. Eleven surgical-site infections were identified for an overall rate of 1.8%. The use of postoperative antibiotics was not associated with a lower rate of surgical-site infection (P=0.883). Patients with a type III fracture (P<0.001), diminished preoperative vascular (P=0.001) and neurological status (P=0.019), and postoperative hospital admission (P<0.001) were significantly more likely to receive postoperative antibiotics. Administration of postoperative antibiotics after closed reduction and percutaneous pinning of pediatric supracondylar humerus fractures does not decrease the rate of surgical-site infection. Level III-therapeutic.

Supracondylar humerus fractures in children: the effect of weather conditions on their risk.

PubMed

Sinikumpu, Juha-Jaakko; Pokka, Tytti; Hyvönen, Hanna; Ruuhela, Reija; Serlo, Willy

2017-02-01

Supracondylar humerus fractures are the most common fractures of the elbow in children. Many environmental factors such as weather conditions may affect the risk of these fractures. The purpose of the study was to analyze the effect of weather conditions (temperature, rainfall, wind) on fracture risk in children <16 years of age during the extended summer time period with the absence of snow cover. All children <16 years of age with an outdoor supracondylar humerus fracture between May 1 and September 30 in a defined geographical area during the decade of 2000-2009 were included. Daily meteorological recordings for altogether 1526 study days were reviewed from the national weather service and the association of weather conditions and fractures were analyzed. A majority (79.7%, N = 181) of the fractures occurred on dry days versus rainy days (20.3%) (P = 0.011), and risk of a fracture was 3.5-fold higher on dry days as compared with rainy days (crude OR 3.5, 3.41-3.59, P < 0.001). The weather was warm, instead of cool or hot, when the majority of the fractures (N = 147, 64.8%) occurred (P = 0.008): Warm temperatures (15-24.9 °C) increased the fracture risk 2.6-fold (crude OR 2.64, 2.59-2.70, P < 0.001), compared with cool (<15 °C) days. The fracture incidence did not change according to the wind speed (P = 0.171). The findings were similar through the school term and summer vacation. Dry and warm weather conditions increase the risk of outdoor supracondylar humerus fractures in children during the time period with the absence of snow cover.

[Modified osteotomy of olecranon for the management of inter-condylar fracture of the humerus].

PubMed

Mei, Zheng-Feng; Lei, Wen-Tao; Huang, Dong-Hui; Zhao, Qi-Hui; Qu, Hang-Bo; Ni, Lian-Zhi

2017-01-25

To explore the surgical method and clinical outcome of modified osteotomy of olecranon for the treatment of inter-condylar fracture of humerus. From May 2007 to December 2012, 32 patients of intercondylar fracture of humerus were treated surgically through the approach of modified osteotomy of olecranon. The patients were 21 males and 11 females with a mean age of 46.3 years (ranged 18 to 65 years). Nineteen fractures occurred on the right extremity and 13 on the left extremity. According to the AO classification, type C1 fracture was found in 7, C2 in 11 and C3 in 14. Five patients suffered from open fracture (Gustilo type Iin 3, type II in 2). Other fractures occurred in 6 patients and the primary injury of nerve occurred 6. The healing of the osteotomy was evaluated with physical examination and plain X-ray film, and the function of elbow was assessed according to Cassebaum scale. All the patients were followed from 9 months to 5 years(average, 1.9 years). All the osteotomies healed at 7.4 weeks averagely after operation, and no nonunion, delayed union, fracture of ulna olecranon were found. Two cases had little pain on the elbow, heterotopic ossification occurred in 2 cases and cutting bone block loosed in 1 case. The function of the elbow showed excellent in 19 cases, good in 8, fair in 4 and poor in 1. The use of the approach of modified olecranon osteotomy for surgical management of intercondylar fracture of humerus has some advantages, it provides satisfactory stability with simple technical procedures avoiding inter-articular invasion, and it facilitates rehabilitation exercises and providing good results with low complication rates.

Outcome of Surgical Fixation of Lateral Column Distal Humerus Fractures.

PubMed

Von Keudell, Arvind; Kachooei, Amir R; Moradi, Ali; Jupiter, Jesse B

2016-05-01

The purpose of this study was to report the long-term outcome and complications of surgically fixated lateral unicondylar distal humerus fractures. Retrospective Review. Two level 1 Trauma Centers, Massachusetts General Hospital and Brigham and Women's Hospital. Between 2002 and 2014, 24 patients treated with open reduction and internal fixation for lateral unicondylar distal humerus fractures (OTA/AO type B1 fractures) were retrospectively reviewed. Open reduction and internal fixation. Union rates, early complications, functional outcome, and the range of elbow motion were evaluated. Disabilities of the arm, shoulder, and hand, Mayo elbow Performance Index, satisfaction, pain scale, and American Shoulder and Elbow Surgeons. The mean age of patients was 46 ± 23 years at the time of surgery. The average final flexion/extension arc of motion was 108°. Reoperations were performed in 9 of 24 elbows after an average 21 ± 31 months. Twenty of the 24 patients were available for the clinical follow-up at an average of 70 months (range: 16-144 months). Disabilities of the arm, shoulder, and hand averaged at 10.8 ± 11.7 points, satisfaction at 9.5 ± 1.2, American Shoulder and Elbow Surgeons score at 88.5 ± 13.3 points at final follow-up. Based on the functional classification proposed by Jupiter, 16 demonstrated good to excellent results, 2 fair and 2 poor result. Outcome of open reduction and internal fixation of isolated lateral column distal humerus fractures can result in high union rates with acceptable outcome scores and high patient satisfaction despite a high reoperation rate. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Innervation pattern of the suprascapular nerve within supraspinatus: a three-dimensional computer modeling study.

PubMed

Hermenegildo, J A; Roberts, S L; Kim, S Y

2014-05-01

The relationship between the innervation pattern of the suprascapular nerve (SSN) and the muscle architecture of supraspinatus has not been thoroughly investigated. The supraspinatus is composed of two architecturally distinct regions: anterior and posterior. Each of these regions is further subdivided into three parts: superficial, middle and deep. The purpose of this study was to investigate the course of the SSN throughout the volume of supraspinatus and to relate the intramuscular branches to the distinct regions and parts of the supraspinatus. The SSN was dissected in thirty formalin embalmed cadaveric specimens and digitized throughout the muscle volume in six of those specimens. The digitized data were modeled using Autodesk(®) Maya(®) 2011. The three-dimensional (3D) models were used to relate the intramuscular innervation pattern to the muscle and tendon architecture defined by Kim et al. (2007, Clin Anat 20:648-655). The SSN bifurcated into two main trunks: medial and lateral. All parts of the anterior region were predominantly innervated by the medial trunk and its proximal and medial branches, whereas all parts of the posterior region predominantly by the lateral trunk and its posterolateral and/or posteromedial branches. The posterior region also received innervation from the proximal branch of the medial trunk in half of the specimens. These findings provide evidence that the anterior and posterior regions are distinct with respect to their innervation. The 3D map of the innervation pattern will aid in planning future clinical studies investigating muscle activation patterns and provide insight into possible injury of the nerve with supraspinatus pathology and surgical techniques. Copyright © 2013 Wiley Periodicals, Inc.

The Neandertals of northeastern Iberia: new remains from the Cova del Gegant (Sitges, Barcelona).

PubMed

Quam, Rolf; Sanz, Montserrat; Daura, Joan; Robson Brown, Kate; García-González, Rebeca; Rodríguez, Laura; Dawson, Heidi; Rodríguez, Rosa Flor; Gómez, Sandra; Villaescusa, Lucía; Rubio, Ángel; Yagüe, Almudena; Ortega Martínez, María Cruz; Fullola, Josep Maria; Zilhão, João; Arsuaga, Juan Luis

2015-04-01

The present study describes a new juvenile hominin mandible and teeth and a new juvenile humerus from level V of the GP2 gallery of Cova del Gegant (Spain). The mandible (Gegant-5) preserves a portion of the right mandibular corpus from the M1 distally to the socket for the dc mesially, and the age at death is estimated as 4.5-5.0 years. Gegant-5 shows a single mental foramen located under the dm1/dm2 interdental septum, a relatively posterior placement compared with recent hominins of a similar developmental age. The mental foramen in Gegant-5 is also placed within the lower half of the mandibular corpus, as in the previously described late adolescent/adult mandible (Gegant-1) from this same Middle Paleolithic site. The Gegant-5 canine shows pronounced marginal ridges, a distal accessory ridge, and a pronounced distolingual tubercle. The P3 shows a lingually-displaced protoconid cusp tip and a distal accessory ridge. The P4 shows a slightly asymmetrical crown outline, a continuous transverse crest, a mesially placed metaconid cusp tip, a slight distal accessory ridge, and an accessory lingual cusp. The M1 shows a Y5 pattern of cusp contact and a well-developed and deep anterior fovea bounded posteriorly by a continuous midtrigonid crest. Gegant-4 is the distal portion of a left humerus from a juvenile estimated to be between 5 and 7 years old at death. The specimen shows thick cortical bone. Although fragmentary, the constellation of morphological and metric features indicates Neandertal affinities for these specimens. Their spatial proximity at the site and similar ages at death suggest these remains may represent a single individual. The addition of these new specimens brings the total number of Neandertal remains from the Cova del Gegant to five, and this site documents the clearest evidence for Neandertal fossils associated with Middle Paleolithic stone tools in this region of the Iberian Peninsula. Copyright © 2015 Elsevier Ltd. All rights reserved.

Proximal humeral fractures: the role of calcium sulphate augmentation and extended deltoid splitting approach in internal fixation using locking plates.

PubMed

Somasundaram, K; Huber, C P; Babu, V; Zadeh, H

2013-04-01

The aim of our study is to analyse the results of our surgical technique for the treatment of proximal humeral fractures and fracture dislocations using locking plates in conjunction with calcium sulphate bone-substitute augmentation and tuberosity repair using high-strength sutures. We used the extended deltoid-splitting approach for fracture patterns involving displacement of both lesser and greater tuberosities and for fracture-dislocations. Optimal surgical management of proximal humeral fractures remains controversial. Locking plates have become a popular method of fixation. However, failure of fixation may occur if they are used as the sole method of fixation in comminuted fractures, especially in osteopenic bone. We retrospectively analysed 22 proximal humeral fractures in 21 patients; 10 were male and 11 female with an average age of 64.6 years (range 37-77). Average follow-up was 24 months. Eleven of these fractures were exposed by the extended deltoid-splitting approach. Fractures were classified according to Neer and Hertel systems. Preoperative radiographs and computed tomography (CT) scans in three- and four-part fractures were done to assess the displacement and medial calcar length for predicting the humeral head vascularity. According to the Neer classification, there were five two-part, six three-part, five four-part fractures and six fracture-dislocations (two anterior and four posterior). Results were assessed clinically with disabilities of the arm, shoulder and hand (DASH) scores, modified Constant and Murley scores and serial postoperative radiographs. The mean DASH score was 16.18 and the modified Constant and Murley score was 64.04 at the last follow-up. Eighteen out of twenty-two cases achieved good clinical outcome. All the fractures united with no evidence of infection, failure of fixation, malunion, tuberosity failure, avascular necrosis or adverse reaction to calcium sulphate bone substitute. There was no evidence of axillary nerve injury. Four patients had a longer recovery period due to stiffness, associated wrist fracture and elbow dislocation. The CaSO4 bone substitute was replaced by normal appearing trabecular bone texture at an average of 6 months in all patients. In our experience, we have found the use of locking plates, calcium sulphate bone substitute and tuberosity repair with high-strength sutures to be a safe and reliable method of internal fixation for complex proximal humeral fractures and fracture-dislocations. Furthermore, we have also found the use of the extended deltoid-splitting approach to be safe and to provide excellent exposure facilitating accurate reduction for fixation of the fracture patterns involving displacement of both lesser and greater tuberosities and for fracture-dislocations. Copyright © 2012 Elsevier Ltd. All rights reserved.

Nonunion of the humerus following intramedullary nailing treated by Ilizarov hybrid fixation.

PubMed

Raschke, M; Khodadadyan, C; Maitino, P D; Hoffmann, R; Südkamp, N P

1998-02-01

A case of a posttraumatic humeral shaft nonunion, after intramedullary stabilization with a Seidel nail, is presented. Severe osteoporosis, an oligotrophic nonunion, subclinical infection, and adhesive capsulitis of the glenohumeral joint were present. Due to the subclinical infection and severe osteoporosis, other major invasive therapeutic options such as intramedullary nailing or compression plating and bone grafting were not applicable. Nonoperative treatment was also not indicated secondary to the pain and disability present. External fixation with the Ilizarov hybrid fixator seemed to offer a minimally invasive treatment modality without the need of additional bone grafting. After fourteen weeks of "callus massage," consisting of closed alternating compression and distraction with an Ilizarov hybrid fixator, osseous consolidation was achieved. Eight months after Ilizarov treatment the patient had returned to work as a mechanic. At the one-year follow-up examination, the patient presented pain free and with near normal shoulder and elbow motion, with stable osseous consolidation of the humerus. In some cases of nonunion of the humerus shaft, when standard treatment options are not recommended, external fixation with an Ilizarov hybrid fixator may offer a salvage procedure with a successful clinical outcome.

Management of Pediatric Supracondylar Humerus Fractures With Vascular Injury.

PubMed

Sanders, James O; Heggeness, Michael H; Murray, Jayson N; Pezold, Ryan C; Sevarino, Kaitlyn S

2016-02-01

The American Academy of Orthopaedic Surgeons has developed the Appropriate Use Criteria (AUC) document Management of Pediatric Supracondylar Humerus Fractures With Vascular Injury. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The AUC clinical patient scenarios were derived from patient indications that generally accompany a pediatric supracondylar humerus fracture with vascular injury, as well as from current evidence-based clinical practice guidelines and supporting literature. The 6 patient scenarios and 18 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Next, the Review Panel, a separate group of volunteer physicians, independently reviewed these materials to ensure that they were representative of patient scenarios that clinicians are likely to encounter in daily practice. Finally, the multidisciplinary Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3).

The molecular response of bone to growth hormone during skeletal unloading: regional differences

NASA Technical Reports Server (NTRS)

Bikle, D. D.; Harris, J.; Halloran, B. P.; Currier, P. A.; Tanner, S.; Morey-Holton, E.

1995-01-01

Hind limb elevation of the growing rat provides a good model for the skeletal changes that occur during space flight. In this model the bones of the forelimbs (normally loaded) are used as an internal control for the changes that occur in the unloaded bones of the hind limbs. Previous studies have shown that skeletal unloading of the hind limbs results in a transient reduction of bone formation in the tibia and femur, with no change in the humerus. This fall in bone formation is accompanied by a fall in serum osteocalcin (bone Gla protein, BGP) and bone BGP messenger RNA (mRNA) levels, but a rise in bone insulin-like growth factor-I (IGF-I) protein and mRNA levels and resistance to the skeletal growth-promoting actions of IGF-I. To determine whether skeletal unloading also induced resistance to GH, we evaluated the response of the femur and humerus of sham and hypophysectomized rats, control and hind limb elevated, to GH (two doses), measuring mRNA levels of IGF-I, BGP, rat bone alkaline phosphatase (RAP), and alpha 1(1)-procollagen (coll). Hypophysectomy (HPX) decreased the mRNA levels of IGF-I, BGP, and coll in the femur, but was either less effective or had the opposite effect in the humerus. GH at the higher dose (500 micrograms/day) restored these mRNA levels to or above the sham control values in the femur, but generally had little or no effect on the humerus. RAP mRNA levels were increased by HPX, especially in the femur. The lower dose of GH (50 micrograms/day) inhibited this rise in RAP, whereas the higher dose raised the mRNA levels and resulted in the appearance of additional transcripts not seen in controls. As for the other mRNAs, RAP mRNA in the humerus was less affected by HPX or GH than that in the femur. Hind limb elevation led to an increase in IGF-I, coll, and RAP mRNAs and a reduction in BGP mRNA in the femur and either had no effect or potentiated the response of these mRNAs to GH. We conclude that GH stimulates a number of markers of bone formation by raising their mRNA levels, and that skeletal unloading does not block this response, but the response varies substantially from bone to bone.

Comparative trends in incident fracture rates for all long-term care and community-dwelling seniors in Ontario, Canada, 2002-2012.

PubMed

Papaioannou, A; Kennedy, C C; Ioannidis, G; Cameron, C; Croxford, R; Adachi, J D; Mursleen, S; Jaglal, S

2016-03-01

In this population-based study, we compared incident fracture rates in long-term care (LTC) versus community seniors between 2002 and 2012. Hip fracture rates declined more rapidly in LTC than in the community. An excess burden of fractures occurred in LTC for hip, pelvis, and humerus fractures in men and hip fractures only in women. This study compares trends in incident fracture rates between long-term care (LTC) and community-dwelling seniors ≥65 years, 2002-2012. This is a population-based cohort study using administrative data. Measurements were age/sex-adjusted incident fracture rates and rate ratios (RR) and annual percent change (APC). Over 11 years, hip fracture rates had a marked decline occurring more rapidly in LTC (APC, -3.49 (95% confidence interval (CI), -3.97, -3.01)) compared with the community (APC, -2.93 (95% CI, -3.28, -2.57); p < 0.05 for difference in slopes). Humerus and wrist fracture rates decreased; however, an opposite trend occurred for pelvis and spine fractures with rates increasing over time in both cohorts (all APCs, p < 0.05). In 2012, incident hip fracture rates were higher in LTC than the community (RRs: women, 1.55 (95% CI, 1.45, 1.67); men, 2.18 (95% CI, 1.93, 2.47)). Higher rates of pelvis (RR, 1.48 (95% CI, 1.22, 1.80)) and humerus (RR, 1.40 (95% CI, 1.07, 1.84)) fractures were observed in LTC men, not women. In women, wrist (RR, 0.76 (95% CI, 0.71, 0.81)) and spine (RR, 0.52 (95% CI, 0.45, 0.61)) fracture rates were lower in LTC than the community; in men, spine (RR, 0.75 (95% CI, 0.57, 0.98) but not wrist fracture (RR, 0.91 (95% CI, 0.67, 1.23)) rates were significantly lower in LTC than the community. Previous studies in the community have shown declining hip fracture rates over time, also demonstrated in our study but at a more rapid rate in LTC. Rates of humerus and wrist fractures also declined. An excess burden of fractures in LTC occurred for hip fractures in women and for hip, pelvis, and humerus fractures in men.

Developmental ossification sequences of the appendicular and axial skeleton in Kuttanad duck embryos (Anas platyrhynchos domesticus)

PubMed Central

Firdous, A.D.; Maya, S.; Massarat, K.; Baba, M.A.

2016-01-01

The processes of ossification sequences are poorly investigated for birds in general, even for domestic and experimental species and when it comes to the waterfowl it is almost negligible. Such sequences constitute a rich source of data on character evolution, and may even provide phylogenetic information. A pre-hatch developmental study on ossification sequences of axial and appendicular skeletal system in Kuttanad duck embryos was undertaken using 78 viable embryos. From day 3 to day 7 of incubation no ossification densities were seen both by alizarin red staining and computerized radiography. The first indication of ossification as small ossification centers in skull bones, clavicle, scapula, humerus, radius and ulna in forelimb and ilium, pubis femur and fibula in hind limb were observed on the 9th day of incubation. The ossification of the body of the ribs started at the 11th day of incubation towards the proximal extremity. On day 13th the ossification process of vertebrae was started from cervical end. The variation in appearance of the ossification centers in different bones at different stages of incubation period suggests relative importance of phylogeny to the sequences. PMID:26862514

Pediatric and adolescent anterior shoulder instability: clinical management of first-time dislocators.

PubMed

Lin, Kenneth M; James, Evan W; Spitzer, Elad; Fabricant, Peter D

2018-02-01

The purpose of this review is to discuss the epidemiology, pathoanatomy, diagnosis, and clinical management of pediatric and adolescent patients following a first-time shoulder dislocation. Shoulder instability is becoming increasingly common as pediatric and adolescent patients engage in earlier organized sports competition. Recommended treatment following a first-time glenohumeral dislocation event in adolescents depends on several factors, but surgical stabilization is becoming more frequently performed. Surgical indications include bony Bankart lesion, ALPSA lesion, bipolar injury (e.g. Hill-Sachs humeral head depression fracture) or off-season injury in an overhead or throwing athlete. Complications following surgical treatment are rare but most commonly are associated with recurrent instability. Young children (eg. open proximal humerus growth plate), individuals averse to surgery, or in-season athletes who accept the risk of redislocation may complete an accelerated rehabilitation program for expedited return to play in the absence of the structural abnormalities listed above. Following a first-time dislocation event in pediatric and adolescent patients, a detailed discussion of the risks and benefits of nonoperative versus operative management is critical to match the recommended treatment with the patient's injury pattern, risk factors, and activity goals.

The cervical mucus plug inhibits, but does not block, the passage of ascending bacteria from the vagina during pregnancy.

PubMed

Hansen, Lea K; Becher, Naja; Bastholm, Sara; Glavind, Julie; Ramsing, Mette; Kim, Chong J; Romero, Roberto; Jensen, Jørgen S; Uldbjerg, Niels

2014-01-01

To evaluate the microbial load and the inflammatory response in the distal and proximal parts of the cervical mucus plug. Experimental research. Twenty women with a normal, singleton pregnancy. Vaginal swabs and specimens from the distal and proximal parts of the cervical mucus plug. Immunohistochemistry, enzyme-linked immunosorbent assay, quantitative polymerase chain reaction and histology. The total bacterial load (16S rDNA) was significantly lower in the cervical mucus plug compared with the vagina (p = 0.001). Among women harboring Ureaplasma parvum, the median genome equivalents/g were 1574 (interquartile range 2526) in the proximal part, 657 (interquartile range 1620) in the distal part and 60,240 (interquartile range 96,386) in the vagina. Histological examinations and quantitative polymerase chain reaction revealed considerable amounts of lactobacilli and inflammatory cells in both parts of the cervical mucus plug. The matrix metalloproteinase-8 concentration was decreased in the proximal part of the plug compared with the distal part (p = 0.08). The cervical mucus plug inhibits, but does not block, the passage of Ureaplasma parvum during its ascending route from the vagina through the cervical canal. © 2013 Nordic Federation of Societies of Obstetrics and Gynecology.

Preliminary Geologic Map of the Southern Funeral Mountains and Adjacent Ground-Water Discharge Sites, Inyo County, California, and Nye County, Nevada

USGS Publications Warehouse

Fridrich, Christopher J.; Thompson, Ren A.; Slate, Janet L.; Berry, M.E.; Machette, Michael N.

2008-01-01

This map covers the southern part of the Funeral Mountains, and adjacent parts of four structural basins - Furnace Creek, Amargosa Valley, Opera House, and central Death Valley. It extends over three full 7.5-minute quadrangles, and parts of eleven others - a total area of about 950 square kilometers. The boundaries of this map were drawn to include all of the known proximal hydrogeologic features that may affect the flow of ground water that discharges from the springs of the Furnace Creek wash area, in the west-central part of the map. These springs provide the major potable water supply for Death Valley National Park.

Multifocal avascular necrosis after liver transplantation: an unusual presentation of the antiphospholipid syndrome.

PubMed

Mundo, J; Peris, P; Monegal, A; Navasa, M; Cervera, R; Guañiabens, N

2006-01-01

We describe the case of a 31-year-old man who presented with an antiphospholipid syndrome (APS), which manifested as multifocal avascular necrosis (AVN) one year after orthotopic liver transplantation. The patient developed multiple AVN affecting hips, left knee, humerus and tarsal bones just after withdrawal of corticosteroid therapy. Three years later when lupus anticoagulant was detected, he began anticoagulant treatment and no further AVN episodes were observed. It is important to be aware of this clinical manifestation of APS, especially in these cases where it can be easily overlooked because of corticosteroid therapy.

Functional trade-offs in the limb bones of dogs selected for running versus fighting.

PubMed

Kemp, T J; Bachus, K N; Nairn, J A; Carrier, D R

2005-09-01

The physical demands of rapid and economical running differ from the demands of fighting in ways that may prevent the simultaneous evolution of optimal performance in these two behaviors. Here, we test an hypothesis of functional trade-off in limb bones by measuring mechanical properties of limb bones in two breeds of domestic dog (Canis lupus familiaris L.) that have undergone intense artificial selection for running (greyhound) and fighting (pit bull) performance. The bones were loaded to fracture in three-point static bending. To correct for the effect of shear, we estimated the shear stress in the cross section and added energy due to shear stress to the tensile energy. The proximal limb bones of the pit bulls differed from those of the greyhounds in having relatively larger second moments of area of mid-diaphyseal cross sections and in having more circular cross-sectional shape. The pit bulls exhibited lower stresses at yield, had lower elastic moduli and failed at much higher levels of work. The stiffness of the tissue of the humerus, radius, femur and tibia was 1.5-2.4-fold greater in the greyhounds than in the pit bulls. These bones from the pit bulls absorbed 1.9-2.6-fold more energy before failure than did those of the greyhounds. These differences between breeds were not observed in the long bones of the feet, metacarpals and metatarsals. Nevertheless, the results of this analysis suggest that selection for high-speed running is associated with the evolution of relatively stiff, brittle limb bones, whereas selection for fighting performance leads to the evolution of limb bones with relatively high resistance to failure.

Restoration of the joint geometry and outcome after stemless TESS shoulder arthroplasty

PubMed Central

von Engelhardt, Lars V; Manzke, Michael; Breil-Wirth, Andreas; Filler, Timm J; Jerosch, Joerg

2017-01-01

AIM To evaluate the joint geometry and the clinical outcome of stemless, anatomical shoulder arthroplasty with the TESS system. METHODS Twenty-one shoulders with a mean follow-up 18 of months were included. On scaled digital radiographs the premorbid center of rotation (CoR) was assessed and compared to the CoR of the prosthesis by using the MediCAD® software. Additionally, the pre- and post-operative geometry of the CoR was assessed in relation to the glenoid, the acromion as well as to the proximal humerus. Radiological changes, such as radiolucencies, were also assessed. Clinical outcome was assessed with the Constant and DASH score. RESULTS Both, the Constant and DASH scores improved significantly from 11% to 75% and from 70 to 30 points, P < 0.01 respectively. There were no significant differences regarding age, etiology, cemented or metal-backed glenoids, etc. (P > 0.05). The pre- and postoperative humeral offset, the lateral glenohumeral offset, the height of the CoR, the acromiohumeral distance as well as neck-shaft angle showed no significant changes (P > 0.05). The mean deviation of the CoR of the prosthesis from the anatomic center was 1.0 ± 2.8 mm. Three cases showed a medial deviation of more than 3 mm. These deviations of 5.1, 5.7 and 7.6 mm and were caused by an inaccurate humeral neck cut. These 3 patients showed a relatively poor outcome scoring. CONCLUSION TESS arthroplasty allows an anatomical joint reconstruction with a very good outcome. Outliers described in this study sensitize the surgeon for an accurate humeral neck cut. PMID:29094010

Site- and compartment-specific changes in bone with hindlimb unloading in mature adult rats

NASA Technical Reports Server (NTRS)

Bloomfield, S. A.; Allen, M. R.; Hogan, H. A.; Delp, M. D.

2002-01-01

The purpose of this study was to examine site- and compartment-specific changes in bone induced by hindlimb unloading (HU) in the mature adult male rat (6 months old). Tibiae, femora, and humeri were removed after 14, 21, and 28 days of HU for determination of bone mineral density (BMD) and geometry by peripheral quantitative computed tomography (pQCT), mechanical properties, and bone formation rate (BFR), and compared with baseline (0 day) and aging (28 day) controls. HU resulted in 20%-21% declines in cancellous BMD at the proximal tibia and femoral neck after 28 day HU vs. 0 day controls (CON). Cortical shell BMD at these sites was greater (by 4%-6%) in both 28 day HU and 28 day CON vs. 0 day CON animals, and nearly identical to that gain seen in the weight-bearing humerus. Mechanical properties at the proximal tibia exhibited a nonsignificant decline after HU vs. those of 0 day CON rats. At the femoral neck, a 10% decrement was noted in ultimate load in 28 day HU rats vs. 28 day CON animals. Middiaphyseal tibial bone increased slightly in density and area during HU; no differences in structural and material properties between 28 day HU and 28 day CON rats were noted. BFR at the tibial midshaft was significantly lower (by 90%) after 21 day HU vs. 0 day CON; this decline was maintained throughout 28 day HU. These results suggest there are compartment-specific differences in the mature adult skeletal response to hindlimb unloading, and that the major impact over 28 days of unloading is on cancellous bone sites. Given the sharp decline in BFR for midshaft cortical bone, it appears likely that deficits in BMD, area, or mechanical properties would develop with longer duration unloading.

[Assessment of therapeutic results for simple bone cyst with percutaneous injection of autogenous bone marrow].

PubMed

Wang, Enbo; Zhao, Qun; Zhang, Lijun

2006-09-01

To evaluate the therapeutic results of percutaneous injection of autogenous bone marrow for simple bone cyst and to analyze the prognostic factors of the treatment. From March 2000 to June 2005, 31 patients with simple bone cysts were treated by percutaneous injection of autogenous bone marrow. Of 31 patients, there were 18 males and 13 females, aged 5 years and 7 months to 15 years. The locations were proximal humerus in 18 cases, proximal femur in 7 cases and other sites in 6 cases. Two cases were treated with repeated injections. The operative process included percutaneous aspiration of fluid in the bone cysts and injection of autogenous bone marrow aspirated from posterior superior iliac spine. The mean volume of marrow injected was 40 ml (30-70 ml). No complications were noted during treatment. Thirty patients were followed for an average of 2.2 years (1-5 years) with 2 cases out of follow-up. After one injection of bone marrow, 9 cysts (29.0%) were healed up completely, 7 cysts (22.6%) basically healed up, 13 cysts (41.9%) healed up partially and 2 (6.5%) had no response. The satisfactory and effective rates were 67.7% and 93.5% respectively. There was significant difference between active stage group and resting stage group(P<0.05). There were no statistically significant difference in therapeutic results between groups of different ages, lesion sites or bone marrow hyperplasia(P>0.05). Percutaneous injection of autogenous bone marrow is a safe and effective method to treat simple bone cyst, but repeated injections is necessary for some patients. The therapeutic results are better in cysts at resting stage than those at active stage.

Andreas Vesalius' five hundreth anniversary: initiation of the rotator cuff concept.

PubMed

Brinkman, Romy J; Hage, J Joris

2015-12-01

The rotator cuff concept refers to the four scapulohumeral muscles that stabilize and rotate the humerus relative to the scapula. To date, the first description of the rotator cuff remained unidentified. In light of the 500th birthday of Andreas Vesalius (1515-1564) we searched his 1543 masterwork "Fabrica Corporis Humani Libri Septem" for references to the morphology and function of the rotator cuff muscles. Even though he distinguished three rather than four scapulohumeral muscles, Vesalius recognized the need for structures that prevent dislocation of the shoulder inherent to the morphology of the humeral caput and scapular socket. He recorded "three strong ligaments" and the "three muscles that rotate the arm" of which the tendons completely "embrace the ligaments of the joint" as such structures. Vesalius defined the rotator cuff concept avant la lettre.

Positional error and time-activity patterns in near-highway proximity studies: an exposure misclassification analysis

PubMed Central

2013-01-01

Background The growing interest in research on the health effects of near-highway air pollutants requires an assessment of potential sources of error in exposure assignment techniques that rely on residential proximity to roadways. Methods We compared the amount of positional error in the geocoding process for three different data sources (parcels, TIGER and StreetMap USA) to a “gold standard” residential geocoding process that used ortho-photos, large multi-building parcel layouts or large multi-unit building floor plans. The potential effect of positional error for each geocoding method was assessed as part of a proximity to highway epidemiological study in the Boston area, using all participants with complete address information (N = 703). Hourly time-activity data for the most recent workday/weekday and non-workday/weekend were collected to examine time spent in five different micro-environments (inside of home, outside of home, school/work, travel on highway, and other). Analysis included examination of whether time-activity patterns were differentially distributed either by proximity to highway or across demographic groups. Results Median positional error was significantly higher in street network geocoding (StreetMap USA = 23 m; TIGER = 22 m) than parcel geocoding (8 m). When restricted to multi-building parcels and large multi-unit building parcels, all three geocoding methods had substantial positional error (parcels = 24 m; StreetMap USA = 28 m; TIGER = 37 m). Street network geocoding also differentially introduced greater amounts of positional error in the proximity to highway study in the 0–50 m proximity category. Time spent inside home on workdays/weekdays differed significantly by demographic variables (age, employment status, educational attainment, income and race). Time-activity patterns were also significantly different when stratified by proximity to highway, with those participants residing in the 0–50 m proximity category reporting significantly more time in the school/work micro-environment on workdays/weekdays than all other distance groups. Conclusions These findings indicate the potential for both differential and non-differential exposure misclassification due to geocoding error and time-activity patterns in studies of highway proximity. We also propose a multi-stage manual correction process to minimize positional error. Additional research is needed in other populations and geographic settings. PMID:24010639

Positional error and time-activity patterns in near-highway proximity studies: an exposure misclassification analysis.

PubMed

Lane, Kevin J; Kangsen Scammell, Madeleine; Levy, Jonathan I; Fuller, Christina H; Parambi, Ron; Zamore, Wig; Mwamburi, Mkaya; Brugge, Doug

2013-09-08

The growing interest in research on the health effects of near-highway air pollutants requires an assessment of potential sources of error in exposure assignment techniques that rely on residential proximity to roadways. We compared the amount of positional error in the geocoding process for three different data sources (parcels, TIGER and StreetMap USA) to a "gold standard" residential geocoding process that used ortho-photos, large multi-building parcel layouts or large multi-unit building floor plans. The potential effect of positional error for each geocoding method was assessed as part of a proximity to highway epidemiological study in the Boston area, using all participants with complete address information (N = 703). Hourly time-activity data for the most recent workday/weekday and non-workday/weekend were collected to examine time spent in five different micro-environments (inside of home, outside of home, school/work, travel on highway, and other). Analysis included examination of whether time-activity patterns were differentially distributed either by proximity to highway or across demographic groups. Median positional error was significantly higher in street network geocoding (StreetMap USA = 23 m; TIGER = 22 m) than parcel geocoding (8 m). When restricted to multi-building parcels and large multi-unit building parcels, all three geocoding methods had substantial positional error (parcels = 24 m; StreetMap USA = 28 m; TIGER = 37 m). Street network geocoding also differentially introduced greater amounts of positional error in the proximity to highway study in the 0-50 m proximity category. Time spent inside home on workdays/weekdays differed significantly by demographic variables (age, employment status, educational attainment, income and race). Time-activity patterns were also significantly different when stratified by proximity to highway, with those participants residing in the 0-50 m proximity category reporting significantly more time in the school/work micro-environment on workdays/weekdays than all other distance groups. These findings indicate the potential for both differential and non-differential exposure misclassification due to geocoding error and time-activity patterns in studies of highway proximity. We also propose a multi-stage manual correction process to minimize positional error. Additional research is needed in other populations and geographic settings.

Application and measurement properties of EQ-5D to measure quality of life in patients with upper extremity orthopaedic disorders: a systematic literature review.

PubMed

Grobet, Cécile; Marks, Miriam; Tecklenburg, Linda; Audigé, Laurent

2018-04-13

The EuroQol-5 Dimension (EQ-5D) is the most widely used generic instrument to measure quality of life (QoL), yet its application in upper extremity orthopaedics as well as its measurement properties remain largely undefined. We implemented a systematic literature review to provide an overview of the application of EQ-5D in patients with upper extremity disorders and analyse its measurement properties. We searched Medline, EMBASE, Cochrane and Scopus databases for clinical studies including orthopaedic patients with surgical interventions of the upper extremity who completed the EQ-5D. For all included studies, the use of EQ-5D and quantitative QoL data were described. Validation studies of EQ-5D were assessed according to COSMIN guidelines and standard measurement properties were examined. Twenty-three studies were included in the review, 19 of which investigated patients with an intervention carried out at the shoulder region. In 15 studies, EQ-5D assessed QoL as the primary outcome. Utility index scores in non-trauma patients generally improved postoperatively, whereas trauma patients did not regain their recalled pre-injury QoL levels. EQ-5D measurement properties were reported in three articles on proximal humerus fractures and carpal tunnel syndrome. Positive ratings were seen for construct validity (Spearman correlation coefficient ≥ 0.70 with the Short Form (SF)-12 or SF-6D health surveys) and reliability (intraclass correlation coefficient ≥ 0.77) with intermediate responsiveness (standardised response means: 0.5-0.9). However, ceiling effects were identified with 16-48% of the patients scoring the maximum QoL. The methodological quality of the three articles varied from fair to good. For surgical interventions of the upper extremity, EQ-5D was mostly applied to assess QoL as a primary outcome in patients with shoulder disorders. Investigations of the measurement properties were rare, but indicate good reliability and validity as well as moderate responsiveness in patients with upper extremity conditions.

Progressive skeletal benefits of physical activity when young as assessed at the midshaft humerus in male baseball players.

PubMed

Warden, S J; Weatherholt, A M; Gudeman, A S; Mitchell, D C; Thompson, W R; Fuchs, R K

2017-07-01

Physical activity benefits the skeleton, but there is contrasting evidence regarding whether benefits differ at different stages of growth. The current study demonstrates that physical activity should be encouraged at the earliest age possible and be continued into early adulthood to gain most skeletal benefits. The current study explored physical activity-induced bone adaptation at different stages of somatic maturity by comparing side-to-side differences in midshaft humerus properties between male throwing athletes and controls. Throwers present an internally controlled model, while inclusion of control subjects removes normal arm dominance influences. Throwing athletes (n = 90) and controls (n = 51) were categorized into maturity groups (pre, peri, post-early, post-mid, and post-late) based on estimated years from peak height velocity (<-2, -2 to 2, 2 to 4, 4 to 10, and >10 years). Side-to-side percent differences in midshaft humerus cortical volumetric bone mineral density (Ct.vBMD) and bone mineral content (Ct.BMC); total (Tt.Ar), medullary (Me.Ar), and cortical (Ct.Ar) areas; average cortical thickness (Ct.Th); and polar Strength Strain Index (SSI P ) were assessed. Significant interactions between physical activity and maturity on side-to-side differences in Ct.BMC, Tt.Ar, Ct.Ar, Me.Ar, Ct.Th, and SSI P resulted from the following: (1) greater throwing-to-nonthrowing arm differences than dominant-to-nondominant arm differences in controls (all p < 0.05) and (2) throwing-to-nonthrowing arm differences in throwers being progressively greater across maturity groups (all p < 0.05). Regional analyses revealed greatest adaptation in medial and lateral sectors, particularly in the three post-maturity groups. Years throwing predicted 59% of the variance of the variance in throwing-to-nonthrowing arm difference in SSI P (p < 0.001). These data suggest that physical activity has skeletal benefits beginning prior to and continuing beyond somatic maturation and that a longer duration of exposure to physical activity has cumulative skeletal benefits. Thus, physical activity should be encouraged at the earliest age possible and be continued into early adulthood to optimize skeletal benefits.

Relationship between humeral geometry and shoulder muscle power among suspensory, knuckle-walking, and digitigrade/palmigrade quadrupedal primates.

PubMed

Kikuchi, Yasuhiro; Takemoto, Hironori; Kuraoka, Akio

2012-01-01

Shoulder morphology is functionally related to different patterns of locomotion in primates. To investigate this we performed a quantitative analysis of the relationship between cortical bone thickness (Cbt) of the muscle/tendon attachment site on the humerus and physiological cross-sectional area (PCSA) of the shoulder muscle in primates with different locomotory habits. The deltoid, subscapularis, supraspinatus, and infraspinatus were investigated. A chimpanzee, a gibbon, a baboon, two species of macaque, a lutong, a capuchin, and a squirrel monkey were included in the study. The total length of the humerus was measured and the values were converted into three-dimensional reconstructed data on a computer by computed tomography. The Cbt values were obtained from the volumes divided by the areas of the muscle/tendon attachment sites of the humerus by computer analysis. Muscle mass, muscle fascicle length, and muscle pennation angle were measured and PCSA was calculated using these parameters. A relatively high Cbt and small PCSA were characteristic of the gibbon. The gibbon's high Cbt suggests that passive tension in the muscle/tendon attachment site of suspensory primates (brachiators) may be greater than that of quadrupedal primates, whereas the relatively small PCSA indicates an association with a large amount of internal muscle fascia to endure the passive stress of brachiation. Although chimpanzees undertake some suspensory locomotion, the results for this species resemble those of the digitigrade/palmigrade quadrupedal primates rather than those of the suspensory primate. However, the deltoid and subscapularis in chimpanzee differ from those of the other primates and appear to be affected by the peculiar locomotion of knuckle-walking, i.e. the moment arm of forelimb in chimpanzees is relatively longer than that of digitigrade/palmigrade quadrupedal primates. Hence, a large PCSA in the deltoid and subscapularis may contribute to sustaining the body weight during locomotion. On the other hand, a thin cortical bone relative to a large PCSA was a feature of the cercopithecids, indicating that digitigrade/palmigrade quadrupedal locomotion produces less tension at the muscle/tendon attachment sites compared with that produced by brachiators. © 2011 The Authors. Journal of Anatomy © 2011 Anatomical Society of Great Britain and Ireland.

Neuronal NOS localises to human airway cilia.

PubMed

Jackson, Claire L; Lucas, Jane S; Walker, Woolf T; Owen, Holly; Premadeva, Irnthu; Lackie, Peter M

2015-01-30

Airway NO synthase (NOS) isoenzymes are responsible for rapid and localised nitric oxide (NO) production and are expressed in airway epithelium. We sought to determine the localisation of neuronal NOS (nNOS) in airway epithelium due to the paucity of evidence. Sections of healthy human bronchial tissue in glycol methacrylate resin and human nasal polyps in paraffin wax were immunohistochemically labelled and reproducibly demonstrated nNOS immunoreactivity, particularly at the proximal portion of cilia; this immunoreactivity was blocked by a specific nNOS peptide fragment. Healthy human epithelial cells differentiated at an air-liquid interface (ALI) confirmed the presence of all three NOS isoenzymes by immunofluorescence labelling. Only nNOS immunoreactivity was specific to the ciliary axonemeand co-localised with the cilia marker β-tubulin in the proximal part of the ciliary axoneme. We report a novel localisation of nNOS at the proximal portion of cilia in airway epithelium and conclude that its independent and local regulation of NO levels is crucial for normal cilia function. Copyright © 2014 Elsevier Inc. All rights reserved.

Gross anatomy of the intestine and its mesentery in the nutria (Myocastor coypus).

PubMed

Pérez, W; Lima, M; Bielli, A

2008-11-01

The intestines and mesentery of the nutria (Myocastor coypus) have not been fully described. In the present study 30 adult nutrias were studied using gross dissection. The small intestine was divided into the duodenum, jejunum and ileum as usual. The duodenum started at the pylorus with a cranial portion, which dilated forming a duodenal ampulla. The ileum was located within the concavity of the caecum and attached to the coiled caecum by means of the iliocaecal fold. The ascending colon had two ansae, one proximal and one distal. The proximal ansa was fixed to the caecum by the caecocolic fold. The base of the caecum and a short proximal part of the ascending colon belonging to the proximal ansa were attached to the mesoduodenum descendens. The distal ansa of the ascending colon had a proximal part which was sacculated and a distal part which was smooth. The two parts of the distal ansa of the ascending colon were parallel and joined by a flexure of variable localisation. The smooth part of the distal ansa of the ascending colon was attached to the initial portion of the descending colon by a peritoneal fold. The short transverse colon was directly attached to the mesoduodenum and greater omentum. In conclusion, we have described the anatomy of the intestines of the nutria and its mesentery in detail, and provided a nomenclature list adapted to the Nomina Anatomica Veterinaria.

Effect of strain of layer and age at photostimulation on egg production, egg quality, and bone strength.

PubMed

Silversides, F G; Korver, D R; Budgell, K L

2006-07-01

Bone strength in layers is a concern for economic reasons and animal welfare concerns. Bone characteristics were investigated in 3 strains of hens: Babcock B-300, a small-bodied commercial white-egg layer; ISA-Brown, a commercial brown-egg layer; and an unselected Brown Leghorn line (BL). After being reared together in a single pen with 8 h of light per day, hens were caged with 14 h of light per day. Half of the hens were caged at 18 wk of age and the other half at 20 wk of age, resulting in a 2-wk difference in the age at photostimulation. Body weights, egg production, feed efficiency, and egg quality were measured throughout production. At 15, 25, 50, and 74 wk of age, hens were euthanized for sampling of the radius and the humerus. Breaking strength of the radius and humerus was measured, and the area and density of trabecular (largely medullary bone) and cortical bone were measured using quantitative computed tomography. Egg production and feed conversion of ISA-Brown hens was as good as or better than that of Babcock B-300 hens, and both commercial strains had higher production than the BL. Photostimulation late delayed sexual maturity and improved albumen and shell characteristics but had only minor effects on egg production and did not affect the yolk weight. The delayed photostimulation resulting from caging 2 wk later affected the radius by increasing the area of the trabecular space at 50 wk of age and the density of the bone in the trabecular space at 74 wk of age. Breaking strength of the humerus at 25 wk of age was greater for the birds that were photostimulated late but was not different later in the trial. The humerus, but not the radius, of the BL had a greater breaking strength than that of the commercial strains, suggesting that selection has decreased humeral breaking strength.

Mid-humerus adaptation in fast pitch softballers and the impact of throwing mechanics

PubMed Central

Bogenschutz, Elizabeth D.; Smith, Heather D.; Warden, Stuart J.

2011-01-01

Purpose Throwing is a vigorous activity that generates large internal loads. There is limited evidence of the effect of these loads on bone adaptation. The aim of this study was to investigate the: 1) magnitude of bone adaptation within the midshaft humerus of female fast-pitch softball players and 2) influence of throwing mechanics (windmill vs. overhand throwing) on the magnitude of adaptation. Methods Midshaft humeral bone mass, structure and estimated strength were assessed via peripheral quantitative computed tomography in fast-pitch softball players (throwers; n=15) and matched controls (controls; n=15). The effect of throwing was examined by comparing dominant-to-nondominant differences in throwers to controls, while the influence of mechanics was determined by comparing dominant-to-nondominant differences in throwers who primarily play as pitcher (windmill thrower), catcher (overhand thrower) or fielder (overhand thrower). Results Throwers had greater dominant-to-nondominant difference in midshaft humeral bone mass, structure and estimated strength relative to controls (all P<0.05). The largest effect was for estimated torsional strength with throwers having a mean dominant-to-nondominant difference of 22.5% (range, 6.7% to 43.9%) compared to 4.4% (range, -8.3% to 17.5%) in controls (P<0.001). Throwing mechanics appeared to influence the magnitude of skeletal adaptation, with overhand throwers having more than double dominant-to-nondominant difference in midshaft humeral bone mass, structure and estimated strength than windmill throwers (all P<0.05). Conclusion Throwing induces substantial skeletal adaptation at the midshaft humerus of the dominant upper extremity. Throwing mechanics appears to the influence the magnitude of adaptation as catchers and fielders (overhand throwers) had twice as much adaptation as pitchers (windmill throwers). The latter finding may have implications for skeletal injury risk at the midshaft humerus in throwing athletes. PMID:21311354

Biomechanical measurements of stiffness and strength for five types of whole human and artificial humeri.

PubMed

Aziz, Mina S R; Nicayenzi, Bruce; Crookshank, Meghan C; Bougherara, Habiba; Schemitsch, Emil H; Zdero, Radovan

2014-05-01

The human humerus is the third largest longbone and experiences 2-3% of all fractures. Yet, almost no data exist on its intact biomechanical properties, thus preventing researchers from obtaining a full understanding of humerus behavior during injury and after being repaired with fracture plates and nails. The aim of this experimental study was to compare the biomechanical stiffness and strength of "gold standard" fresh-frozen humeri to a variety of humerus models. A series of five types of intact whole humeri were obtained: human fresh-frozen (n = 19); human embalmed (n = 18); human dried (n = 15); artificial "normal" (n = 12); and artificial "osteoporotic" (n = 12). Humeri were tested under "real world" clinical loading modes for shear stiffness, torsional stiffness, cantilever bending stiffness, and cantilever bending strength. After removing geometric effects, fresh-frozen results were 585.8 ± 181.5 N/mm2 (normalized shear stiffness); 3.1 ± 1.1 N/(mm2 deg) (normalized torsional stiffness); 850.8 ± 347.9 N/mm2 (normalized cantilever stiffness); and 8.3 ± 2.7 N/mm2 (normalized cantilever strength). Compared to fresh-frozen values, statistical equivalence (p ≥ 0.05) was obtained for all four test modes (embalmed humeri), 1 of 4 test modes (dried humeri), 1 of 4 test modes (artificial "normal" humeri), and 1 of 4 test modes (artificial "osteoporotic" humeri). Age and bone mineral density versus experimental results had Pearson linear correlations ranging from R = -0.57 to 0.80. About 77% of human humeri failed via a transverse or oblique distal shaft fracture, whilst 88% of artificial humeri failed with a mixed transverse + oblique fracture. To date, this is the most comprehensive study on the biomechanics of intact human and artificial humeri and can assist researchers to choose an alternate humerus model that can substitute for fresh-frozen humeri.

Treatment of pediatric supracondylar humerus fractures in the community hospital.

PubMed

Payvandi, Soheil A; Fugle, Michael J

2007-06-01

Supracondylar fractures of the humerus are among the most common elbow injuries in the pediatric population. Because of the significant morbidity associated with treating displaced pediatric supracondylar humerus fractures, most community-based orthopedic surgeons prefer to transfer these injuries to specialty children's hospitals. Our intention in writing this article was to document and evaluate the results we obtained using the lateral diverging pin technique to treat patients at our community hospital. In doing so, we set out to determine if our results were comparable to those of specialty hospitals, allowing us in the future to eliminate the inconvenience placed on patients and their families when being transferred to a specialty facility. We retrospectively reviewed the patients treated surgically at our institution for a closed Gartland type II or type III supracondylar distal humerus fracture during the months of September and October of 2005. The medical records and radiographs of all children who had been treated for a displaced extension-type supracondylar humerus fractures were evaluated. The data recorded from the chart review included the age and sex of the patients, preoperative and postoperative neurovascular status, operative techniques (2 vs 3 lateral entry point Kirschner wires), and the operative time (start to close). The radiographs were reviewed to determine the Gartland type of fracture and the Baumann angle on the anteroposterior film immediately postoperative and at the time of fracture union. Four Gartland type II and 3 Gartland type III fractures were identified during the study period. There were 3 boys and 4 girls with a mean age of 6.29 years (range, 3.92-8.58 years). The mean immediate postoperative Baumann angle was 18.29 degrees (range, 10-25 degrees). At the time of fracture union, the mean Baumann angle was 19.0 degrees (range, 14-22 degrees). The mean range-of-motion loss as compared with the extension loss (range, 10-2 degrees) and 4.57 degrees of flexion loss (range, 10-2 degrees). The mean operative time was 20.43 minutes (range, 7-37 minutes). Our results show the change in Baumann angle and loss of range of motion compare favorably with results of studies done at specialty hospitals. We believe that the divergent lateral pinning technique, in combination with postoperative splinting and a sling can provide excellent results while eliminating the risk of injury to the ulnar nerve. With this knowledge, we feel that the advantage to treating these fractures at a community hospital is the elimination of the anxiety, stress, and time spent waiting in the emergency department of multiple hospitals.

Computed tomography analysis of guinea pig bone: architecture, bone thickness and dimensions throughout development

PubMed Central

Witkowska, Agata; Alibhai, Aziza; Hughes, Chloe; Price, Jennifer; Klisch, Karl; Sturrock, Craig J.

2014-01-01

The domestic guinea pig, Cavia aperea f. porcellus, belongs to the Caviidae family of rodents. It is an important species as a pet, a source of food and in medical research. Adult weight is achieved at 8–12 months and life expectancy is ∼5–6 years. Our aim was to map bone local thickness, structure and dimensions across developmental stages in the normal animal. Guinea pigs (n = 23) that had died of natural causes were collected and the bones manually extracted and cleaned. Institutional ethical permission was given under the UK Home Office guidelines and the Veterinary Surgeons Act. X-ray Micro Computed Tomography (microCT) was undertaken on the left and right scapula, humerus and femur from each animal to ascertain bone local thickness. Images were also used to undertake manual and automated bone measurements, volumes and surface areas, identify and describe nutrient, supratrochlear and supracondylar foramina. Statistical analysis between groups was carried out using ANOVA with post-hoc testing. Our data mapped a number of dimensions, and mean and maximum bone thickness of the scapula, humerus and femur in guinea pigs aged 0–1 month, 1–3 months, 3–6 months, 6 months–1 year and 1–4 years. Bone dimensions, growth rates and local bone thicknesses differed between ages and between the scapula, humerus and femur. The microCT and imaging software technology showed very distinct differences between the relative local bone thickness across the structure of the bones. Only one bone showed a singular nutrient foramen, every other bone had between 2 and 5, and every nutrient canal ran in an oblique direction. In contrast to other species, a supratrochlear foramen was observed in every humerus whereas the supracondylar foramen was always absent. Our data showed the bone local thickness, bone structure and measurements of guinea pig bones from birth to 4 years old. Importantly it showed that bone development continued after 1 year, the point at which most guinea pigs have reached full weight. This study is the first to show the high abundance (100% in this study) of the supratrochlear foramen within the guinea pig humerus and the complete absence of a supracondylar foramen, which is different to many other species and may also affect potential fracture points and frequencies. Understanding bone morphology and growth is essential in not only understanding the requirements of the healthy guinea pig, but also necessary in order to investigate disease states. PMID:25289194

Computed tomography analysis of guinea pig bone: architecture, bone thickness and dimensions throughout development.

PubMed

Witkowska, Agata; Alibhai, Aziza; Hughes, Chloe; Price, Jennifer; Klisch, Karl; Sturrock, Craig J; Rutland, Catrin S

2014-01-01

The domestic guinea pig, Cavia aperea f. porcellus, belongs to the Caviidae family of rodents. It is an important species as a pet, a source of food and in medical research. Adult weight is achieved at 8-12 months and life expectancy is ∼5-6 years. Our aim was to map bone local thickness, structure and dimensions across developmental stages in the normal animal. Guinea pigs (n = 23) that had died of natural causes were collected and the bones manually extracted and cleaned. Institutional ethical permission was given under the UK Home Office guidelines and the Veterinary Surgeons Act. X-ray Micro Computed Tomography (microCT) was undertaken on the left and right scapula, humerus and femur from each animal to ascertain bone local thickness. Images were also used to undertake manual and automated bone measurements, volumes and surface areas, identify and describe nutrient, supratrochlear and supracondylar foramina. Statistical analysis between groups was carried out using ANOVA with post-hoc testing. Our data mapped a number of dimensions, and mean and maximum bone thickness of the scapula, humerus and femur in guinea pigs aged 0-1 month, 1-3 months, 3-6 months, 6 months-1 year and 1-4 years. Bone dimensions, growth rates and local bone thicknesses differed between ages and between the scapula, humerus and femur. The microCT and imaging software technology showed very distinct differences between the relative local bone thickness across the structure of the bones. Only one bone showed a singular nutrient foramen, every other bone had between 2 and 5, and every nutrient canal ran in an oblique direction. In contrast to other species, a supratrochlear foramen was observed in every humerus whereas the supracondylar foramen was always absent. Our data showed the bone local thickness, bone structure and measurements of guinea pig bones from birth to 4 years old. Importantly it showed that bone development continued after 1 year, the point at which most guinea pigs have reached full weight. This study is the first to show the high abundance (100% in this study) of the supratrochlear foramen within the guinea pig humerus and the complete absence of a supracondylar foramen, which is different to many other species and may also affect potential fracture points and frequencies. Understanding bone morphology and growth is essential in not only understanding the requirements of the healthy guinea pig, but also necessary in order to investigate disease states.

Mechanical design of mussel byssus: material yield enhances attachment strength

PubMed

Bell; Gosline

1996-01-01

The competitive dominance of mussels in the wave-swept rocky intertidal zone is in part due to their ability to maintain a secure attachment. Mussels are tethered to the substratum by a byssus composed of numerous extracellular, collagenous threads secreted by the foot. Each byssal thread has three serially arranged parts: a corrugated proximal region, a smooth distal region and an adhesive plaque. This study examines the material and structural properties of the byssal threads of three mussel species: Mytilus californianus, M. trossulus, and M. galloprovincialis. Tensile tests in general reveal similar material properties among species: the proximal region has a lower initial modulus, a lower ultimate stress and a higher ultimate strain than the distal region. The distal region also yields at a stress well below its ultimate value. In whole thread tests, the proximal region and adhesive plaque are common sites of structural failure and are closely matched in strength, while the distal region appears to be excessively strong. We propose that the high strength of the distal region is the byproduct of a material designed to yield and extend before structural failure occurs. Experimental and theoretical evidence is presented suggesting that thread yield and extensibility provide two important mechanisms for increasing the overall attachment strength of the mussel: (1) the reorientation of threads towards the direction of applied load, and (2) the 'recruitment' of more threads into tension and the consequent distribution of applied load over a larger cross-sectional area, thereby reducing the stress on each thread. This distal region yield behavior is most striking for M. californianus and may be a key to its success in extreme wave-swept environments.

Feeding strategies as revealed by the section moduli of the humerus bones in bipedal theropod dinosaurs

NASA Astrophysics Data System (ADS)

Lee, Scott; Richards, Zachary

2015-03-01

The section modulus of a bone is a measure of its ability to resist bending torques. Carnivorous dinosaurs presumably had strong arm bones to hold struggling prey during hunting. Some theropods are believed to have become herbivorous and such animals would not have needed such strong arms. In this work, the section moduli of the humerus bones of bipedal theropod dinosaurs (from Microvenator celer to Tyrannosaurus rex) are studied to determine the maximum bending loads their arms could withstand. The results show that bending strength is not of uniform importance to these magnificent animals. The predatory theropods had strong arms for use in hunting. In contrast, the herbivorous dinosaurs had weaker arms.

Representational Similarity of Body Parts in Human Occipitotemporal Cortex.

PubMed

Bracci, Stefania; Caramazza, Alfonso; Peelen, Marius V

2015-09-23

Regions in human lateral and ventral occipitotemporal cortices (OTC) respond selectively to pictures of the human body and its parts. What are the organizational principles underlying body part responses in these regions? Here we used representational similarity analysis (RSA) of fMRI data to test multiple possible organizational principles: shape similarity, physical proximity, cortical homunculus proximity, and semantic similarity. Participants viewed pictures of whole persons, chairs, and eight body parts (hands, arms, legs, feet, chests, waists, upper faces, and lower faces). The similarity of multivoxel activity patterns for all body part pairs was established in whole person-selective OTC regions. The resulting neural similarity matrices were then compared with similarity matrices capturing the hypothesized organizational principles. Results showed that the semantic similarity model best captured the neural similarity of body parts in lateral and ventral OTC, which followed an organization in three clusters: (1) body parts used as action effectors (hands, feet, arms, and legs), (2) noneffector body parts (chests and waists), and (3) face parts (upper and lower faces). Whole-brain RSA revealed, in addition to OTC, regions in parietal and frontal cortex in which neural similarity was related to semantic similarity. In contrast, neural similarity in occipital cortex was best predicted by shape similarity models. We suggest that the semantic organization of body parts in high-level visual cortex relates to the different functions associated with the three body part clusters, reflecting the unique processing and connectivity demands associated with the different types of information (e.g., action, social) different body parts (e.g., limbs, faces) convey. Significance statement: While the organization of body part representations in motor and somatosensory cortices has been well characterized, the principles underlying body part representations in visual cortex have not yet been explored. In the present fMRI study we used multivoxel pattern analysis and representational similarity analysis to characterize the organization of body maps in human occipitotemporal cortex (OTC). Results indicate that visual and shape dimensions do not fully account for the organization of body part representations in OTC. Instead, the representational structure of body maps in OTC appears strongly related to functional-semantic properties of body parts. We suggest that this organization reflects the unique processing and connectivity demands associated with the different types of information different body parts convey. Copyright © 2015 the authors 0270-6474/15/3512977-09$15.00/0.

[The 3-dimensional organization of the nucleolus and nucleolus-organizer regions of differentiated cells. IV. The structural and functional heterogeneity of the nucleoli in the epithelium of the proximal nephron in the mouse].

PubMed

Chelidze, P V; Dzidziguri, D V; Zarandiia, M A; Georgobiani, N M; Tumanishvili, G D

1993-01-01

By means of stereological and morphometrical analysis, the ultrastructure of nucleoli in epitheliocytes of mouse kidney cortex proximal tubuli has been studied. In accordance to the nucleolar composition, three main groups of nephrocytes with different levels of rRNA and protein synthesis were defined. Functional heterogeneity of proximal tubuli epithelium was established by correlation between different variants of ultrastructural organization of nucleoli and the total RNA synthesis activity, determined by 3H-uridine incorporation intensity. It has been shown that a greater part of cells (about 52%) in the nephron proximal section, which is characterized by slow RNA synthesis, causing a low functional activity of these cells, presumably represents a reparative cellular reserve. Such cells, defined as the 1st group cells, have resting, ring-shaped nucleoli with one fibrillar centre, and nucleoli similar to the ring-shaped ones but containing 2-3 fibrillar centres. Nucleoli of the 2nd group of nephrocytes (about 37%), most actively incorporating labeled precursor, contain 4-6 fibrillar centres. Their structural organization is closer to the reticular type of nucleoli. The 3rd most actively labeled group of nephrocytes includes cells with typical reticulated nucleoli. The number of fibrillar centres in the reticulated nucleoli is much higher (18-22) than in the 1st and 2nd groups of nephrocytes. Structural and functional polymorphism of nephrocytes was revealed not only in the proximal part of one nephron. During the increase in functional activity of nephrocytes, caused by unilateral nephrectomy, the quantitative correlation between cells related to these different groups was seen to change. The number of cells of the 1st group decreased by 24%, whereas that in the 2nd and 3rd groups increased by 9 and 15%, respectively. Nucleoli with 2-3 fibrillar centres are considered as transitional forms between the inactive ring-shaped nucleoli and the active reticulated nucleoli. Differences in the ultrastructure of nucleoli may be considered as an evidence of functional heterogeneity of nephrocytes within the proximal segment of nephron.

Variation in the insertion of the latissimus dorsi & its clinical importance.

PubMed

Bhatt, C R; Prajapati, B; Patil, D S; Patel, V D; Singh, Binodkumar G P; Mehta, C D

2013-01-01

The latissimus dorsi is the larger, flat, dorso-lateral muscle on the trunk, posterior to the arm, and partly covered by the trapezius on its median dorsal region. Origin of the latissimus dorsi is from spinous processes of thoracic T7-T12, thoracolumbar fascia, iliac crest and inferior 3 or 4 ribs, inferior angle of scapula and insertion on floor of intertubercular groove of the humerus. We have studied 50 cadavers in the different medical colleges in which we found 2% case of anterior and posterior slip of the muscle fibers with their extension up to the pectoralis major and teres major respectively. Usually, latissimus dorsi involve in extension, adduction, transverse extension also known as horizontal abduction, flexion from an extended position, and internal rotation of the shoulder joint. It also has a synergistic role in extension and lateral flexion of the lumbar spine. The latissimus dorsi may be used for the tendon graft surgeries. Tight latissimus dorsi has been shown to be one cause of chronic shoulder pain and chronic back pain. Because the latissimus dorsi connects the spine to the humerus, tightness in this muscle can manifest as either sub-optimal glenohumeral joint function (which leads to chronic shoulder pain) or tendinitis in the tendinous fasciae connecting the latissimus dorsi to the thoracic and lumbar spine. Latissimus dorsi used for pedicle transplant rotator cuff repair reconstruction of breast, face, scalp and cranium defect. The extra slip of the latissimus dorsi may puzzle any transplant operations. We as anatomist discuss the clinical implication of the extra slip of latissimus dorsi.

Variation in the insertion of the latissimus dorsi & its clinical importance

PubMed Central

Bhatt, C.R.; Prajapati, B.; Patil, D.S.; Patel, V.D.; Singh, Binodkumar G.P.; Mehta, C.D.

2013-01-01

The latissimus dorsi is the larger, flat, dorso-lateral muscle on the trunk, posterior to the arm, and partly covered by the trapezius on its median dorsal region. Origin of the latissimus dorsi is from spinous processes of thoracic T7–T12, thoracolumbar fascia, iliac crest and inferior 3 or 4 ribs, inferior angle of scapula and insertion on floor of intertubercular groove of the humerus. We have studied 50 cadavers in the different medical colleges in which we found 2% case of anterior and posterior slip of the muscle fibers with their extension up to the pectoralis major and teres major respectively. Usually, latissimus dorsi involve in extension, adduction, transverse extension also known as horizontal abduction, flexion from an extended position, and internal rotation of the shoulder joint. It also has a synergistic role in extension and lateral flexion of the lumbar spine. The latissimus dorsi may be used for the tendon graft surgeries. Tight latissimus dorsi has been shown to be one cause of chronic shoulder pain and chronic back pain. Because the latissimus dorsi connects the spine to the humerus, tightness in this muscle can manifest as either sub-optimal glenohumeral joint function (which leads to chronic shoulder pain) or tendinitis in the tendinous fasciae connecting the latissimus dorsi to the thoracic and lumbar spine. Latissimus dorsi used for pedicle transplant rotator cuff repair reconstruction of breast, face, scalp and cranium defect. The extra slip of the latissimus dorsi may puzzle any transplant operations. We as anatomist discuss the clinical implication of the extra slip of latissimus dorsi. PMID:24403744

Upper extremity interaction with a helicopter side airbag: injury criteria for dynamic hyperextension of the female elbow joint.

PubMed

Duma, Stefan M; Hansen, Gail A; Kennedy, Eric A; Rath, Amber L; McNally, Craig; Kemper, Andrew R; Smith, Eric P; Brolinson, P Gunnar; Stitzel, Joel D; Davis, Martin B; Bass, Cameron R; Brozoski, Frederick T; McEntire, B Joseph; Alem, Nabih M; Crowley, John S

2004-11-01

This paper describes a three part analysis to characterize the interaction between the female upper extremity and a helicopter cockpit side airbag system and to develop dynamic hyperextension injury criteria for the female elbow joint. Part I involved a series of 10 experiments with an original Army Black Hawk helicopter side airbag. A 5(th) percentile female Hybrid III instrumented upper extremity was used to demonstrate side airbag upper extremity loading. Two out of the 10 tests resulted in high elbow bending moments of 128 Nm and 144 Nm. Part II included dynamic hyperextension tests on 24 female cadaver elbow joints. The energy source was a drop tower utilizing a three-point bending configuration to apply elbow bending moments matching the previously conducted side airbag tests. Post-test necropsy showed that 16 of the 24 elbow joint tests resulted in injuries. Injury severity ranged from minor cartilage damage to more moderate joint dislocations and severe transverse fractures of the distal humerus. Peak elbow bending moments ranged from 42.4 Nm to 146.3 Nm. Peak bending moment proved to be a significant indicator of any elbow injury (p = 0.02) as well as elbow joint dislocation (p = 0.01). Logistic regression analyses were used to develop single and multiple variate injury risk functions. Using peak moment data for the entire test population, a 50% risk of obtaining any elbow injury was found at 56 Nm while a 50% risk of sustaining an elbow joint dislocation was found at 93 Nm for the female population. These results indicate that the peak elbow bending moments achieved in Part I are associated with a greater than 90% risk for elbow injury. Subsequently, the airbag was re-designed in an effort to mitigate this as well as the other upper extremity injury risks. Part III assessed the redesigned side airbag module to ensure injury risks had been reduced prior to implementing the new system. To facilitate this, 12 redesigned side airbag deployments were conducted using the same procedures as Part I. Results indicate that the re-designed side airbag has effectively mitigated elbow injury risks induced by the original side airbag design. It is anticipated that this study will provide researchers with additional injury criteria for assessing upper extremity injury risk caused by both military and automotive side airbag deployments.

Experiences with sheep as an animal model for shoulder surgery: strengths and shortcomings.

PubMed

Turner, A Simon

2007-01-01

Sheep (and goats) are a convenient large-animal model for rotator cuff repair because of availability, ease of handling and housing, animal cost, and acceptance to society as a research animal. Tenotomy of the infraspinatus tendon and subsequent reattachment to the proximal humerus is useful to address the biomechanical, histologic, and biochemical processes of rotator cuff repair. Detaching this tendon and immediately reattaching it does not represent the clinical picture but serves as a relatively rapid way to screen different suture anchors, suture patterns, scaffolds, growth factors, and other biologics or a combination of these treatments to enhance the healing process. To minimize spontaneous reattachment and reproduce a chronic rotator cuff injury, the end of the tendon can be covered and then reattached 4 weeks later if bone-to-tendon healing is to be evaluated. This chronic model is useful to understand the biology (degree of muscle atrophy and fatty infiltration) of rotator cuff muscles as well as innovative methods of repair. Close-stall confinement is required during the convalescence in acute and chronic studies. Ultrasound in the awake animal can be used to monitor gap formation and tissue organization. Sheep have also been used to determine whether capsular healing after plication is equivalent to open capsular shift.

Functional-adaptive anatomy of the forelimb in the Didelphidae, and the paleobiology of the Paleocene marsupials Mayulestes ferox and Pucadelphys andinus.

PubMed

Argot, C

2001-01-01

An attempt to determine the locomotor activities of Mayulestes ferox (Borhyaenoidea) and Pucadelphys andinus (Didelphoidea) from the early Paleocene site of Tiupampa (Bolivia) is presented. The functional anatomy of the forelimbs of these South American marsupials is compared to that of some living didelphids: Caluromys philander, Micoureus demerarae, Marmosa murina, Didelphis marsupialis, Monodelphis brevicaudata and Metachirus nudicaudatus. Deductions from bone morphology to myology and locomotor behavior in the fossils are inferred from the comparisons with living forms. Some features of the postcranial skeleton, indicative of arboreal adaptations, are found in the extinct marsupials: anteriorly projected acromion, hemispherical head of the humerus, extended humeral lateral epicondylar ridge, medially protruding humeral entepicondyle, proximal ulnar posterior convexity, and deep flexor fossa on the medial side of the ulna. But other features are related to a more terrestrial pattern: the well-developed tubercles of the humeral head, the elongated olecranon process of the ulna, and the oval shape of the radial head. Mayulestes had clear arboreal abilities, but, as a predaceous mammal, probably hunted on the ground. Pucadelphys was less specialized, close to the living Monodelphis, a terrestrial insectivorous form with some skeletal features related to arboreal locomotion that are probably plesiomorphic for marsupials. Copyright 2001 Wiley-Liss, Inc.

Localized accumulation of lead within and among bones from lead-dosed goats

DOE Office of Scientific and Technical Information (OSTI.GOV)

Cretacci, Yan; Department of Environmental Health Sciences, School of Public Health, The University at Albany, P.O. Box 509, Albany, NY 12201-0509; Parsons, Patrick J., E-mail: pparsons@wadsworth.org

2010-01-15

The principal aim of this study was to gain a better understanding of where lead (Pb) accumulates and how it is distributed, within the bones of dosed goats. Adult goats were periodically dosed with Pb over a number of years for the primary purpose of producing blood pools containing endogenously bound Pb, for the New York State Blood Lead Proficiency Testing Program. Bone samples (e.g., primarily tibia, femur, humerus, and radius) were collected post-mortem from 11 animals and were analyzed for Pb content by acid digestion and electrothermal atomic absorption spectrometry (ETAAS or GFAAS). Average tibia Pb levels were foundmore » to correlate strongly with the cumulative Pb dose (r{sup 2}=0.81). However, the concentration of Pb in different bones and even within a small area of the same bone varied tremendously. Blood-rich trabecular (spongy) bone, such as the patella and calcaneus, were much more enriched in Pb than was cortical (compact) bone. In some dosed animals, the Pb concentration in the tibia was markedly higher at the proximal and distal ends of the bone compared to the mid-shaft. The implications of these findings with regard to the noninvasive measurement of lead in bone by XRF methods are discussed.« less

Thickness Distribution of Glenohumeral Joint Cartilage.

PubMed

Schleich, Christoph; Bittersohl, Bernd; Antoch, Gerald; Krauspe, Rüdiger; Zilkens, Christoph; Kircher, Jörn

2017-04-01

High-resolution 3-dimensional cartilage-specific magnetic resonance imaging (MRI) was performed at 3 T to test the following hypotheses: (1) there is a nonuniform cartilage thickness distribution both on the proximal humerus and on the glenoid surface and (2) the glenohumeral joint as a combined system is congruent with the level of the joint cartilage surface without substantial radial mismatch. Inclusion of 38 volunteers (19 females, mean age 24.34 ± 2.22 years; range 21-29 years) in a prospective study. Measurements of: cartilage thickness in 3 regions and 3 zones; radius of both circles (glenoid and humeral cartilage) for congruency calculation using 3-T MRI with 3-dimensional dual-echo steady-state sequence with water excitation. A homogenous mean cartilage thickness (1.2-1.5 mm) and slightly higher values for the glenoidal articulating surface radii both in the mid-paracoronar section (2.4 vs. 2.1 cm, P < 0.001) and in the mid-paraaxial section (2.4 vs. 2.1 cm, P < 0.001) compared with the humeral side were observed. The concept of a radial mismatch between the humeral head and the glenoid in healthy human subjects can be confirmed. This study provides normative data for the comparison of joint cartilage changes at the shoulder for future studies.

Avoiding superior tilt in reverse shoulder arthroplasty: a review of the literature and technical recommendations.

PubMed

Laver, Lior; Garrigues, Grant E

2014-10-01

Superior tilt of the baseplate component in reverse total shoulder arthroplasty leads to tensile baseplate forces and may be a contributor to early loosening. The risk factors for this implant malposition include inadequate exposure through a superior approach and superior glenoid bone deficiency that obscures the native glenoid tilt. Here we review our preoperative evaluation and surgical management strategies to avoid superior tilt. Adequate exposure with a superior approach can be achieved but requires not just proper surgical technique but also careful patient selection. We propose that the superior approach be considered only for acute proximal humerus fractures or in patients when the following criteria are met: no prior open surgery on the shoulder; more than 30° of passive external rotation at 0° of abduction; no medial humeral osteophytes; and any superior migration must be reducible with a sulcus test during examination under anesthesia. Avoiding superior tilt when there is significant superior glenoid erosion can be accomplished with humeral head autograft, most easily performed through a deltopectoral approach. Preoperative templating is critical to determine proper graft thickness, inclination, reaming depth, and harvest technique. Copyright © 2014 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Primary osseous tumours of the elbow: 60 years of registry experience

PubMed Central

Halai, Mansur; Gupta, Sanjay; Wallace, David; Rymaszewski, Lech; Mahendra, Ashish

2015-01-01

Background We present the largest series of surgically treated primary bone tumours of the elbow in the English literature (75 cases). We sought to identify characteristics specific to these lesions and recommend an investigatory protocol. Methods The national registry and case notes were reviewed between 1954-2014. Tumours were classified according to Enneking's spectrum. Results There were no benign latent cases in this series as these were managed locally. All patients presented with persistent rest pain, with or without swelling. The distal humerus, in contrast to the proximal radius and ulna, was responsible for the majority and the more aggressive cases. Misdiagnosis was evident in 13% of cases; most of which were attributed to simple bone cysts. All patients that were referred required surgical intervention to either establish the diagnosis or for treatment. Benign tumours had a 19% recurrence rate, with giant cell tumour the most aggressive. Malignant tumours carried 39% local recurrence rate and a 5-year mortality of 61%. Conclusions The suspicion of a tumour should be raised in the patient with unremitting, unexplained, non-mechanical bony elbow pain. These echo the NICE recommendations and we recommend prompt specialist referral. With high rates of local recurrence, we recommend close postoperative monitoring. PMID:27582988

Skeletal unloading induces resistance to insulin-like growth factor I

NASA Technical Reports Server (NTRS)

Bikle, D. D.; Harris, J.; Halloran, B. P.; Morey-Holton, E. R.

1994-01-01

In previous studies with a hindlimb elevation model, we demonstrated that skeletal unloading transiently inhibits bone formation. This effect is limited to the unloaded bones (the normally loaded humerus does not cease growing), suggesting that local factors are of prime importance. IGF-I is one such factor; it is produced in bone and stimulates bone formation. To determine the impact of skeletal unloading on IGF-I production and function, we assessed the mRNA levels of IGF-I and its receptor (IGF-IR) in the proximal tibia and distal femur of growing rats during 2 weeks of hindlimb elevation. The mRNA levels for IGF-I and IGF-IR rose during hindlimb elevation, returning toward control values during recovery. This was accompanied by a 77% increase in IGF-I levels in the bone, peaking at day 10 of unloading. Changes in IGF binding protein levels were not observed. Infusion of IGF-I (200 micrograms/day) during 1 week of hindlimb elevation doubled the increase in bone mass of the control animals but failed to reverse the cessation of bone growth in the hindlimb-elevated animals. We conclude that skeletal unloading induces resistance to IGF-I, which may result secondarily in increased local production of IGF-I.

Thickness Distribution of Glenohumeral Joint Cartilage

PubMed Central

Schleich, Christoph; Bittersohl, Bernd; Antoch, Gerald; Krauspe, Rüdiger; Zilkens, Christoph; Kircher, Jörn

2016-01-01

High-resolution 3-dimensional cartilage-specific magnetic resonance imaging (MRI) was performed at 3 T to test the following hypotheses: (1) there is a nonuniform cartilage thickness distribution both on the proximal humerus and on the glenoid surface and (2) the glenohumeral joint as a combined system is congruent with the level of the joint cartilage surface without substantial radial mismatch. Inclusion of 38 volunteers (19 females, mean age 24.34 ± 2.22 years; range 21-29 years) in a prospective study. Measurements of: cartilage thickness in 3 regions and 3 zones; radius of both circles (glenoid and humeral cartilage) for congruency calculation using 3-T MRI with 3-dimensional dual-echo steady-state sequence with water excitation. A homogenous mean cartilage thickness (1.2-1.5 mm) and slightly higher values for the glenoidal articulating surface radii both in the mid-paracoronar section (2.4 vs. 2.1 cm, P < 0.001) and in the mid-paraaxial section (2.4 vs. 2.1 cm, P < 0.001) compared with the humeral side were observed. The concept of a radial mismatch between the humeral head and the glenoid in healthy human subjects can be confirmed. This study provides normative data for the comparison of joint cartilage changes at the shoulder for future studies. PMID:28345405

Measurement Properties of the Smartphone-Based B-B Score in Current Shoulder Pathologies

PubMed Central

Pichonnaz, Claude; Duc, Cyntia; Gleeson, Nigel; Ancey, Céline; Jaccard, Hervé; Lécureux, Estelle; Farron, Alain; Jolles, Brigitte M.; Aminian, Kamiar

2015-01-01

This study is aimed at the determination of the measurement properties of the shoulder function B-B Score measured with a smartphone. This score measures the symmetry between sides of a power-related metric for two selected movements, with 100% representing perfect symmetry. Twenty healthy participants, 20 patients with rotator cuff conditions, 23 with fractures, 22 with capsulitis, and 23 with shoulder instabilities were measured twice across a six-month interval using the B-B Score and shoulder function questionnaires. The discriminative power, responsiveness, diagnostic power, concurrent validity, minimal detectable change (MDC), minimal clinically important improvement (MCII), and patient acceptable symptom state (PASS) were evaluated. Significant differences with the control group and significant baseline—six-month differences were found for the rotator cuff condition, fracture, and capsulitis patient groups. The B-B Score was responsive and demonstrated excellent diagnostic power, except for shoulder instability. The correlations with clinical scores were generally moderate to high, but lower for instability. The MDC was 18.1%, the MCII was 25.2%, and the PASS was 77.6. No floor effect was observed. The B-B Score demonstrated excellent measurement properties in populations with rotator cuff conditions, proximal humerus fractures, and capsulitis, and can thus be used as a routine test to evaluate those patients. PMID:26506355

Shoulder Arthroplasty, from Indications to Complications: What the Radiologist Needs to Know.

PubMed

Lin, Dana J; Wong, Tony T; Kazam, Jonathan K

2016-01-01

The replaced shoulder is increasingly encountered by the radiologist, both on a dedicated and incidental basis, in this era of the growing population of aging patients wishing to preserve their mobility and function. Knowledge of the normal biomechanics of the glenohumeral joint-particularly the function of the rotator cuff and the unique relationship of the humeral head to the glenoid-is essential for understanding the need for shoulder replacement and its subsequent complications, because the intent of shoulder arthroplasty is to approximate the normal joint as closely as possible. The most common indications for shoulder arthroplasty are osteoarthritis, inflammatory arthritis, proximal humerus fractures, irreparable rotator cuff tears, rotator cuff arthropathy, and avascular necrosis of the humeral head. Knowledge of the key imaging features of these indications helps facilitate a correlative understanding between the initial diagnosis and the choice of which type of arthroplasty is used-total shoulder arthroplasty, reverse total shoulder arthroplasty, or partial joint replacement (humeral head resurfacing arthroplasty or hemiarthroplasty). The preoperative requirements and usual postoperative appearance of each arthroplasty type are summarized, as well as the complications of shoulder arthroplasty, including those unique to or closely associated with each type of arthroplasty and those that can be encountered with any type of shoulder arthroplasty. ©RSNA, 2016.

A 3-dimensional-printed patient-specific guide system for minimally invasive plate osteosynthesis of a comminuted mid-diaphyseal humeral fracture in a cat.

PubMed

Oxley, Bill

2018-04-01

To report the use of a 3-dimensional (3D)-printed patient-specific reduction guide system to facilitate minimally invasive plate osteosynthesis (MIPO) of a humeral fracture in a cat. Case report. A 9-year-old male neutered domestic short hair cat weighing 4.4 kg. A 9-year-old male domestic short hair cat was presented with a comminuted, mid-diaphyseal left humeral fracture. Computed tomographic data were processed to yield 3D mesh representations of both humeri and subsequently manipulated in computer-aided design software. The mirrored, intact humerus was used as a template for appropriate spatial orientation of the major proximal and distal fracture fragments. Patient-specific Ellis pin orientation guides and a reduction guide were designed and 3D printed. The guide system was used intraoperatively to align the major fracture fragments before application of locking internal fixation via standard MIPO surgical portals. Internal fixation of the fracture resulted in appropriate bone alignment. Recovery was uncomplicated, with early return to normal limb function and radiographic evidence of advanced fracture healing after 4 months. A 3D-printed patient-specific reduction guide system facilitated accurate alignment of a comminuted humeral fracture during MIPO without intraoperative imaging. © 2018 The American College of Veterinary Surgeons.

Bone growth and turnover in progesterone receptor knockout mice.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rickard, David J.; Iwaniec, Urszula T.; Evans, Glenda

2008-05-01

The role of progesterone receptor (PR) signaling in skeletal metabolism is controversial. To address whether signaling through the PR is necessary for normal bone growth and turnover, we performed histomorphometric and mCT analyses of bone from homozygous female PR knockout (PRKO) mice at 6, 12, and 26 weeks of age. These mice possess a null mutation of the PR locus, which blocks the gene expression of A and B isoforms of PR. Body weight gain, uterine weight gain and tibia longitudinal bone growth was normal in PRKO mice. In contrast, total and cortical bone mass were increased in long bonesmore » of post-pubertal (12 and 26-week-old) PRKO mice, whereas cancellous bone mass was normal in the tibia but increased in the humerus. The striking 57% decrease in cancellous bone from the proximal tibia metaphysis which occurred between 6 and 26 weeks in WT mice was abolished in PRKO mice. The improved bone balance in aging PRKO mice was associated with elevated bone formation and a tendency toward reduced osteoclast perimeter. Taken together, these findings suggest that PR signaling in mice attenuates the accumulation of cortical bone mass during adolescence and is required for early age-related loss of cancellous bone.« less

Disseminated Exophiala dermatitidis causing septic arthritis and osteomyelitis.

PubMed

Lang, Raynell; Minion, Jessica; Skinner, Stuart; Wong, Alexander

2018-06-04

Exophiala dermatitidis is a melanized fungus isolated from many environmental sources. Infections caused by Exophiala species are typically seen in immunocompromised hosts and manifest most commonly as cutaneous or subcutaneous disease. Systemic infections are exceedingly rare and associated with significant morbidity and mortality CASE PRESENTATION: A 28-year-old female originally from India presented with fevers, chills, weight loss and increasing back pain. She had a recent diffuse maculopapular rash that resulted in skin biopsy and a tentative diagnosis of sarcoidosis, leading to administration of azathioprine and prednisone. An MRI of her spine revealed a large paraspinal abscess requiring surgical intervention and hardware placement. Cultures from the paraspinal abscess grew a colony of dark pigmented mold. Microscopy of the culture revealed a melanized fungus, identified as Exophiala dermatitidis. Voriconazole was initially utilized, but due to relapse of infection involving the right iliac crest and left proximal humerus, she received a prolonged course of amphotericin B and posaconazole in combination and required 7 separate surgical interventions. Prolonged disease stability following discontinuation of therapy was achieved. Described is the first identified case of disseminated Exophiala dermatitidis causing osteomyelitis and septic arthritis in a patient on immunosuppressive therapy. A positive outcome was achieved through aggressive surgical intervention and prolonged treatment with broad-spectrum antifungal agents.

Deboning broiler chicken legs and wings by dislocation of articular cartilage followed by stripping periosteum.

PubMed

Nakano, T; Ozimek, L; Betti, M

2012-11-01

The yield of deboned meat is an important economic factor affecting the profit of the meat industry. This study was undertaken to determine whether the yield of boneless meat from broiler chicken leg (thigh and drumstick) and wing (drumette and winglet) is improved by introducing a new deboning method consisting of articular cartilage dislocation followed by stripping periosteum. A total of 44 broiler chicken carcasses were used in the deboning experiment. Right and left legs or wings from the first 22 carcasses were assigned to the new and ordinary hand deboning methods, respectively. For the remaining 22 carcasses, right and left legs or wings were assigned to the ordinary and new methods, respectively. The weight of residue, composed of bone and small amounts of cartilage and noncartilaginous tissues obtained after deboning, was then compared between the right and left legs or wings to see the difference between the 2 methods. The removal of tibia, fibula, humerus, radius, or ulna resulted in formation of a hollow in boneless meat obtained. There was no difference (P > 0.05) between the right and left legs or wings in the weight of residue obtained after deboning as expected. The weight of residue was less (P < 0.05) with the new method compared with the ordinary method in all chicken parts examined. The difference of residue weight between the 2 methods accounted for 10, 12, 14, and 21% of the weight of residue obtained by the ordinary method in thigh, drumstick, drumette, and winglet, respectively. The new method may be useful to deboners at home kitchens as well as the poultry meat industry. The present study also showed the development of a secondary ossification center at the proximal end of the carpometacarpus of chickens. This is, to our knowledge, the first report of development of secondary ossification center in chicken wings.

Anatomy, histology and elemental profile of long bones and ribs of the Asian elephant (Elephas maximus).

PubMed

Nganvongpanit, Korakot; Siengdee, Puntita; Buddhachat, Kittisak; Brown, Janine L; Klinhom, Sarisa; Pitakarnnop, Tanita; Angkawanish, Taweepoke; Thitaram, Chatchote

2017-09-01

This study evaluated the morphology and elemental composition of Asian elephant (Elephas maximus) bones (humerus, radius, ulna, femur, tibia, fibula and rib). Computerized tomography was used to image the intraosseous structure, compact bones were processed using histological techniques, and elemental profiling of compact bone was conducted using X-ray fluorescence. There was no clear evidence of an open marrow cavity in any of the bones; rather, dense trabecular bone was found in the bone interior. Compact bone contained double osteons in the radius, tibia and fibula. The osteon structure was comparatively large and similar in all bones, although the lacuna area was greater (P < 0.05) in the femur and ulna. Another finding was that nutrient foramina were clearly present in the humerus, ulna, femur, tibia and rib. Twenty elements were identified in elephant compact bone. Of these, ten differed significantly across the seven bones: Ca, Ti, V, Mn, Fe, Zr, Ag, Cd, Sn and Sb. Of particular interest was the finding of a significantly larger proportion of Fe in the humerus, radius, fibula and ribs, all bones without an open medullary cavity, which is traditionally associated with bone marrow for blood cell production. In conclusion, elephant bones present special characteristics, some of which may be important to hematopoiesis and bone strength for supporting a heavy body weight.

Pullout strength of monocortical and bicortical screws in metaphyseal and diaphyseal regions of the canine humerus.

PubMed

Vaughn, Denty Paul; Syrcle, Jason Alan; Ball, John E; Elder, Steven H; Gambino, Jennifer Michele; Griffin, Russell L; McLaughlin, Ronald M

2016-11-23

Monocortical screws are commonly employed in locking plate fixation, but specific recommendations for their placement are lacking and use of short monocortical screws in metaphyseal bone may be contraindicated. Objectives of this study were to evaluate axial pullout strength of two different lengths of monocortical screws placed in various regions of the canine humerus compared to bicortical screws, and to derive cortical thickness and bone density values for those regions using quantitative computed tomography analysis (QCT). The QCT analysis was performed on 36 cadaveric canine humeri for six regions of interest (ROI). A bicortical, short monocortical, or 50% transcortical 3.5 mm screw was implanted in each ROI and axial pullout testing was performed. Bicortical screws were stronger than monocortical screws in all ROI except the lateral epicondylar crest. Short monocortical metaphyseal screws were weaker than those placed in other regions. The 50% transcortical screws were stronger than the short monocortical screws in the condyle. A linear relationship between screw length and pullout strength was observed. Cortical thickness and bone density measurements were obtained from multiple regions of the canine humerus using QCT. Use of short monocortical screws may contribute to failure of locking plate fixation of humeral fractures, especially when placed in the condyle. When bicortical screw placement is not possible, maximizing monocortical screw length may optimize fixation stability for distal humeral fractures.

The antiquity of riverine adaptations in Iniidae (Cetacea, Odontoceti) documented by a humerus from the late Miocene of the Ituzaingó Formation, Argentina.

PubMed

Gutstein, Carolina Simon; Cozzuol, Mario Alberto; Pyenson, Nicholas D

2014-06-01

"River dolphins" are a paraphyletic group of toothed whales (Odontoceti) that represent independent secondary invasions of freshwater habitats. Different "river dolphin" lineages display suites of convergent morphological specializations that commonly reflect adaptations to riverine and freshwater environments, such as longirostry, reduced orbits, and wide, paddle-like flippers. One lineage, the Iniidae, is presently endemic to South America, and includes several extinct Neogene taxa along with their sole extant genus, Inia (the Amazon River dolphin). We report here a humerus recovered from the late Miocene deposits of the Ituzaingó Formation in the Paraná Basin of Argentina. The specimen exhibits diagnostic features of the family Iniidae, including a scapular-sternal joint of the humerus, which is a unique anatomical connection among mammals. This joint permits enhanced parasagittal adduction of the flipper as a control surface, relative to other odontocetes, providing Inia with a high degree of maneuverability in its structurally complex and heterogenous riverine habitat. This unique anatomical connection, here documented from the late Miocene (∼9 million years-6.5 million years old), not only provides the oldest diagnostic record for Iniidae, but it also indicates a similar habitat use for this lineage, a finding coincident with the current paleoenvironmental interpretation for the Ituzaingó Formation. Copyright © 2014 Wiley Periodicals, Inc.

Analysis of intraosseous samples in endotoxemic shock--an experimental study in the anaesthetised pig.

PubMed

Strandberg, G; Larsson, A; Lipcsey, M; Berglund, L; Eriksson, M

2014-03-01

Intraosseous (IO) access is used in emergency situations to allow rapid initiation of treatment. IO access is also sometimes used for blood sampling, although data on accuracy of such sampling in critical illness are limited. There is also a potential risk that bone marrow fragments in IO samples may damage laboratory equipment. It is ethically questionable to perform a simultaneous comparison between IO and arterial/venous sampling in critically ill humans. We have, thus, studied the analytical performance of IO sampling in a porcine septic shock model using a cartridge-based analyser. Eight pigs with endotoxin-induced septic shock were sampled hourly for 6 h, and analysed for blood gases, acid base status, haemoglobin, glucose and lactate using point of care instruments. Samples were taken from three IO cannulae (tibia bilaterally, one with infusion, and humerus), one arterial and one venous. An interaction test was used to assess changes in agreement between methods over time. Bland–Altman plots were constructed to study bias between methods. There were, to a varying extent, differences between IO and arterial/venous levels for all studied variables, but agreement did not change significantly during the experiment. A general finding was a large dispersion of differences between methods. IO sample values should be treated with caution in this setting but may add useful information to the clinical picture. The tibia or humerus may be used for sampling. IO infusion decreases agreement, thus sampling during infusion should be avoided.

Abnormalities of the axial and proximal appendicular skeleton in adults with Laron syndrome (growth hormone insensitivity).

PubMed

Kornreich, L; Konen, O; Schwarz, M; Siegel, Y; Horev, G; Hershkovitz, I; Laron, Z

2008-02-01

To investigate abnormalities in the skeleton (with the exclusion of the skull, cervical spine, hands and feet) in patients with Laron syndrome, who have an inborn growth hormone resistance and congenital insulin-like growth factor-1 (IGF-1) deficiency. The study group was composed of 15 untreated patients with Laron syndrome (seven male and eight female) aged 21-68 years. Plain films of the axial and appendicular skeleton were evaluated retrospectively for abnormalities in structure and shape. The cortical width of the long bones was evaluated qualitatively and quantitatively (in the upper humerus and mid-femur), and the cortical index was calculated and compared with published references. Measurements were taken of the mid-anteroposterior and cranio-caudal diameters of the vertebral body and spinous process at L3, the interpedicular distance at L1 and L5, and the sacral slope. Thoracic and lumbar osteophytes were graded on a 5-point scale. Values were compared with a control group of 20 healthy persons matched for age. The skeleton appeared small in all patients. No signs of osteopenia were visible. The cortex of the long bones appeared thick in the upper limbs in 11 patients and in the lower limbs in four. Compared with the reference values, the cortical width was thicker than average in the humerus and thinner in the femur. The vertebral diameters at L3 and the interpedicular distances at L1 and L5 were significantly smaller in the patients than in the control subjects (P<0.001); however, at L5 the canal was wider, relative to the vertebral body. The study group had a higher rate of anterior osteophytes in the lumbar spine than the controls had, and their osteophytes were also significantly larger. In the six patients for whom radiographs of the upper extremity in its entirety were available on one film, the ulna appeared to be rotated. In one 22-year-old man, multiple epiphyses were still open. Congenital IGF-1 deficiency leads to skeletal abnormalities characterized by small bones, narrow spinal canal, and delayed bone age. The limitation in elbow distensibility common to patients with Laron syndrome may be related to a marked retroversion of the humeral head.

Marked pathological changes proximal and distal to the site of rupture in acute Achilles tendon ruptures.

PubMed

Maffulli, Nicola; Longo, Umile Giuseppe; Maffulli, Gayle D; Rabitti, Carla; Khanna, Anil; Denaro, Vincenzo

2011-04-01

A laboratory study was performed to evaluate the histopathological features of the macroscopically intact portion of the Achilles tendon in patients undergoing surgery for an acute rupture of the Achilles tendon. Tendon samples were harvested from 29 individuals (21 men, 8 women; mean age: 46 ± 12) who underwent repair of an Achilles tendon tear tear, and from 11 male patients who died of cardiovascular events (mean age: 61). Three pieces of tendon were harvested: at the rupture site, 4 cm proximal to the site of rupture, 1 cm proximal to the insertion of the Achilles tendon on the calcaneum. Slides were assessed using a semiquantitative grading scale assessing fiber structure and arrangement, rounding of the nuclei, regional variations in cellularity, increased vascularity, decreased collagen stainability, and hyalinization. Intra-observer reliability of the subscore readings was calculated. The pathological features were significantly more pronounced in the samples taken from the site of rupture than in the samples taken proximally and distal to it (0.008 < P < 0.01). There were no significant differences in the mean pathologic sum-scores in the samples taken proximally and distal to the site of rupture. Unruptured Achilles tendons, even at an advanced age, and ruptured Achilles tendons are clearly part of two distinct populations, with the latter demonstrating histopathological evidence of failed healing response even in areas macroscopically normal.

Friendship quality, social preference, proximity prestige, and self-perceived social competence: interactive influences on children's loneliness.

PubMed

Zhang, Fengjuan; You, Zhiqi; Fan, Cuiying; Gao, Chuang; Cohen, Robert; Hsueh, Yeh; Zhou, Zongkui

2014-10-01

The purpose of this study was to test an integrative model in which peer relations at different levels of social complexity (friendship quality, social preference, and proximity prestige) are associated with children's loneliness, with children's self-perceived social competence acting as a mediator of these associations. A middle childhood sample of 509 Chinese children (233 girls and 276 boys; 3rd to 6th grade) completed a battery of sociometric and self-report questionnaires. Bootstrap analysis showed that self-perceived social competence mediated the relations between each peer variable and loneliness. In the integrative model tested with SEM, the mediating effect of self-perceived social competence in the relation between friendship quality and loneliness and between social preference and loneliness remained significant. However, self-perceived social competence no longer mediated the association between proximity prestige and loneliness, when considering the simultaneous influences of the three peer variables (friendship quality, social preference, and proximity prestige). The whole model accounted for 56% of the variance in loneliness. These findings suggest that self-perceived social competence played an important role in children's loneliness, that the quality and the quantity of direct peer relations (friendship quality, social preference, and part of proximity prestige) were associated with loneliness, and that indirect friends had a relatively lower but significant influence on children's loneliness. The results are discussed in terms of their implications for preventing children's loneliness. Copyright © 2014 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Interactive effects of nutrition, environment, and rat-strain on cortical and vertebral bone geometry and biomechanics

NASA Technical Reports Server (NTRS)

Zernicke, R. F.; Li, K.-C.; Salem, G. J.; Vailas, A. C.; Grindeland, R. E.

1990-01-01

An investigation was conducted to generate comparative data on the sensitivity of cortical- and vertebral-bone adaptations in two different rat strains maintained at conditions typical for spaceborne experiments conducted by U.S.A. and USSR. The effects of cage environment, diet, and rat-strain on the cortical (humerus) and vertebral (T7) bones of male Taconic-Sprague-Dawley and Czechoslovakian-Wistar rats were investigated using different flight-simulation cages (one rat/cage for U.S.A.; ten rats/cage for USSR conditions) and fed either U.S.A. or USSR diet. The results showed significant effects of these factors on the humeral and vertebral geometry and mechanical properties, as well as significant interactive effects on the mechanical properties of the humerus.

Osteonecrosis

MedlinePlus

... humerus). Knees. Shoulders. Ankles. It is also called: Avascular necrosis. Aseptic necrosis. Ischemic necrosis. Who gets it? Anyone ... Fast Facts Oral Health and Bone Disease Osteonecrosis (Avascular Necrosis), Questions and Answers about Last Reviewed: 10/30/ ...

[Supracondylar humerus fracture in childhood--an efficacy study. Results of a multicenter study by the Pediatric Traumatology Section of the German Society of Trauma Surgery--II: Costs and effectiveness of the treatment].

PubMed

von Laer, L; Günter, S M; Knopf, S; Weinberg, Annelie M

2002-03-01

The following are the results and conclusions of a retrospective research study done on 886 patients with supracondylar fractures of the humerus. The study evaluates how effective the treatment procedures of the fractures are. The patients' fractures were categorized into four groups. It made it easier to differentiate between dislocated and undislocated fractures (see part I Weinberg A et al.). The following parameters were established to evaluate the treatment procedures and to create relevancy to the final outcome depending on the degree of difficulty of the fractures: Length of hospitalization, amount of repositioning procedures (including if an open or closed procedure was needed), amount of post repositioning procedures and the recommended change of therapy, method of retention and fixation, necessary metal removal, amount of check ups needed. The amount of x-ray exams could not be established due to insufficient documentation. The study showed a rather random pattern regarding length of hospitalization and the amount of check ups especially among type I and II patients. Open versus closed repositioning procedures did not seem to be advantageous. The implanted wires did not prevent infections. It just increased the treatment procedure by another hospitalization and anesthesia to remove the implanted wires. Physical therapy was not necessary and was only prescribed in cases of prolonged immobilization. The results of this study generated consequences regarding treatment procedures and developed a more efficient treatment protocol: Type I and II (dislocated and undislocated fractures in one plane) will be treated conservatively on an out-patient basis. Type I in a cast. Type II in a blount or plaster cast with flexed angle between 100 degrees and 130 degrees. Type III an IV (dislocated and undislocated fractures in two or three planes) will be treated if possible with a closed repositioning procedure. Otherwise a close repositioning procedure will be necessary and followed with some kind of KD-osteosynthese to capture the fracture. The patient will be hospitalized for a short period. The blount procedure will not be sufficient for this type of fracture. Therapy and procedure will be translated put in a perspective research study.

Pediatric distal femur fixation by proximal humeral plate.

PubMed

Abdelgawad, Amr Atef; Kanlic, Enes M

2013-12-01

Distal femoral metaphyseal fractures are common injuries in children. Multiple treatment options have been described for this type of injury. For older children with distal metaphyseal fracture, there is still no optimal method of fixation. We propose that the commonly used proximal humeral plate can provide good method of fixation for this fracture in adolescents. Two children (12 and 14 years old) with distal metaphyseal femoral fracture were treated with proximal humeral plate. We describe the surgical technique and postoperative management. The two children healed with good alignment and full range of motion of the knee. No external immobilization (other than knee immobilizer for the first 2 weeks) was used. We concluded that proximal humeral plate can provide adequate fixation for teenagers with distal femoral metaphyseal fracture. It is readily available; provide multiple options for screw fixation in the distal part of the fracture and fits easily on the distal part of the femur proximal to the physis. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Developing bones are differentially affected by compromised skeletal muscle formation

PubMed Central

Nowlan, Niamh C.; Bourdon, Céline; Dumas, Gérard; Tajbakhsh, Shahragim; Prendergast, Patrick J.; Murphy, Paula

2010-01-01

Mechanical forces are essential for normal adult bone function and repair, but the impact of prenatal muscle contractions on bone development remains to be explored in depth in mammalian model systems. In this study, we analyze skeletogenesis in two ‘muscleless’ mouse mutant models in which the formation of skeletal muscle development is disrupted; Myf5nlacZ/nlacZ:MyoD−/− and Pax3Sp/Sp (Splotch). Ossification centers were found to be differentially affected in the muscleless limbs, with significant decreases in bone formation in the scapula, humerus, ulna and femur, but not in the tibia. In the scapula and humerus, the morphologies of ossification centers were abnormal in muscleless limbs. Histology of the humerus revealed a decreased extent of the hypertrophic zone in mutant limbs but no change in the shape of this region. The elbow joint was also found to be clearly affected with a dramatic reduction in the joint line, while no abnormalities were evident in the knee. The humeral deltoid tuberosity was significantly reduced in size in the Myf5nlacZ/nlacZ:MyoD−/− mutants while a change in shape but not in size was found in the humeral tuberosities of the Pax3Sp/Sp mutants. We also examined skeletal development in a ‘reduced muscle’ model, the Myf5nlacZ/+:MyoD−/− mutant, in which skeletal muscle forms but with reduced muscle mass. The reduced muscle phenotype appeared to have an intermediate effect on skeletal development, with reduced bone formation in the scapula and humerus compared to controls, but not in other rudiments. In summary, we have demonstrated that skeletal development is differentially affected by the lack of skeletal muscle, with certain rudiments and joints being more severely affected than others. These findings indicate that the response of skeletal progenitor cells to biophysical stimuli may depend upon their location in the embryonic limb, implying a complex interaction between mechanical forces and location-specific regulatory factors affecting bone and joint development. PMID:19948261

[A case control study of perpendicular or parallel double plate for the treatment of young and middle-aged patients with type C fractures of distal humerus].

PubMed

Yu, Ye-Feng; Dai, Jia-Ping; Sheng, Jian-Ming; Zhou, Xiao

2017-06-25

To compare clinical outcomes of perpendicular or parallel double plate in treating type C fractures of distal humerus in adults. From March 2009 and March 2013, 40 adult patients with type C distal humerus fractures were treated. The patients were divided into two groups according to fixed form. In perpendicular group(group A), there were 13 males and 9 females with a mean age of (37.56±9.24) years old(ranged 18 to 56);while in parallel plating group(group B), including 11 males and 7 females, with a mean age of (41.35±9.03) year old(ranged 20 to 53). All fractures were fresh and closed without blood vessels or nerve damaged. Incision length, operating time, blood loss, hospital stay, preoperative and postoperative radiological change, range of activity of elbow joint, Mayo score, flexor and extensor elbow strength, and postoperative complications were observed and compared. All incisions were healed well. One patient occurred myositis ossificans between two groups. Two patients in group A and 1 patient in group B occurred elbow joint stiffness. All fractures were obtained bone union. Group A were followed up from 20 to 36 months with an average of (25.2±7.1) months, while group B were followed up from 18 to 35 months with an average of(24.3±6.0) months. There were significant differences in blood loss and operative time, while there was no obvious meaning in incision length, hospital stay, muscle strength, fracture healing time, range of activity of elbow joint. Mayo score of group A was 82.27±10.43, 6 cases obtained excellent results, 12 good, 3 moderate and 1 poor;in group B was 81.94±12.02, 5 cases obtained excellent results, 9 good, 3 moderate and 1 poor;and there were no statistical significance between two groups. There was no significant differences in clinical effects between perpendicular and parallel double plate for adult patients with type C distal humerus fractures, while the operation should choose according to facture and proficiency of operator.

Gastrointestinal Nutrient Infusion Site and Eating Behavior: Evidence for A Proximal to Distal Gradient within the Small Intestine?

PubMed

Alleleyn, Annick M E; van Avesaat, Mark; Troost, Freddy J; Masclee, Adrian A M

2016-02-26

The rapidly increasing prevalence of overweight and obesity demands new strategies focusing on prevention and treatment of this significant health care problem. In the search for new and effective therapeutic modalities for overweight subjects, the gastrointestinal (GI) tract is increasingly considered as an attractive target for medical and food-based strategies. The entry of nutrients into the small intestine activates so-called intestinal "brakes", negative feedback mechanisms that influence not only functions of more proximal parts of the GI tract but also satiety and food intake. Recent evidence suggests that all three macronutrients (protein, fat, and carbohydrates) are able to activate the intestinal brake, although to a different extent and by different mechanisms of action. This review provides a detailed overview of the current evidence for intestinal brake activation of the three macronutrients and their effects on GI function, satiety, and food intake. In addition, these effects appear to depend on region and length of infusion in the small intestine. A recommendation for a therapeutic approach is provided, based on the observed differences between intestinal brake activation.

Analysis of anatomic periarticular tibial plate fit on normal adults.

PubMed

Goyal, Kanu S; Skalak, Anthony S; Marcus, Randall E; Vallier, Heather A; Cooperman, Daniel R

2007-08-01

Implant manufacturers are producing anatomically contoured periarticular plates to improve the treatment of proximal tibia fractures. We assessed the accuracy of the designation anatomic. We applied eight-hole medial and lateral anatomically contoured periarticular plates to 101 cadaveric tibiae. The tibiae and the plate fits were mapped, quantified, and analyzed using a MicroScribe G2LX digitizer, Rhinoceros software, and MATLAB software. By corresponding the clinical appearance of good fit with our digital findings, we created numerical criteria for plate fit in three planes: coronal (volume of free space between the plate and bone), sagittal (alignment with the tibial plateau and shaft), and axial (match in curvature between the proximal horizontal part of the plate and the tibial plateau). An anatomic fit should mirror the shape of the tibia in all three planes, and only four medial and four lateral plate fits qualified. Recognizing and understanding the substantial variations in fit that exist between anatomically contoured plates and the tibia may help lead to a more stable fixation and prevent malreduction of the fracture and/or soft tissue impingement.

The proximal gastric corpus is the most responsive site of motilin-induced contractions in the stomach of the Asian house shrew.

PubMed

Dudani, Amrita; Aizawa, Sayaka; Zhi, Gong; Tanaka, Toru; Jogahara, Takamichi; Sakata, Ichiro; Sakai, Takafumi

2016-07-01

The migrating motor complex (MMC) is responsible for emptying the stomach during the interdigestive period, in preparation for the next meal. It is known that gastric phase III of MMC starts from the proximal stomach and propagates the contraction downwards. We hypothesized that a certain region of the stomach must be more responsive to motilin than others, and that motilin-induced strong gastric contractions propagate from that site. Stomachs of the Suncus or Asian house shrew, a small insectivorous mammal, were dissected and the fundus, proximal corpus, distal corpus, and antrum were examined to study the effect of motilin using an organ bath experiment. Motilin-induced contractions differed in different parts of the stomach. Only the proximal corpus induced gastric contraction even at motilin 10(-10) M, and strong contraction was induced by motilin 10(-9) M in all parts of the stomach. The GPR38 mRNA expression was also higher in the proximal corpus than in the other sections, and the lowest expression was observed in the antrum. GPR38 mRNA expression varied with low expression in the mucosal layer and high expression in the muscle layer. Additionally, motilin-induced contractions in each dissected part of the stomach were inhibited by tetrodotoxin and atropine pretreatment. These results suggest that motilin reactivity is not consistent throughout the stomach, and an area of the proximal corpus including the cardia is the most sensitive to motilin.

Arthrodesis of the knee with an intramedullary nail.

PubMed

Donley, B G; Matthews, L S; Kaufer, H

1991-07-01

The cases of twenty patients who had an arthrodesis in which an intramedullary nail was used for stabilization were reviewed at an average follow-up of six years. The predominant indications were infection after total knee arthroplasty and post-traumatic pain and instability. Other indications included aseptic loosening of the components of a total knee arthroplasty, reconstruction after resection of a giant-cell tumor, non-union of a fracture of the distal part of the femur or the proximal part of the tibia, and failed external-compression arthrodesis. Success was achieved in seventeen patients (85 per cent), and functional stability immediately postoperatively was gained in all twenty. Of the three patients in whom the arthrodesis failed, all had sustained an intraoperative fracture, and infection eventually developed. Of the twelve nails that were secured to the greater trochanter with a loop of stainless-steel wire, none showed evidence of proximal migration. Of the eight nails that were not thus secured, two migrated proximally, necessitating removal of the nail. Two drawbacks to this operation are the long duration and the large amount of blood that is lost. The major advantage is that a high percentage of patients have progression to a stable fusion despite serious problems. Furthermore, all but seven patients (including the six who had a tumor or who had sustained an intraoperative fracture) were able to bear full weight by the second postoperative week. Only a few patients needed an external support for walking.

Proximity Operations and Docking Sensor Development

NASA Technical Reports Server (NTRS)

Howard, Richard T.; Bryan, Thomas C.; Brewster, Linda L.; Lee, James E.

2009-01-01

The Next Generation Advanced Video Guidance Sensor (NGAVGS) has been under development for the last three years as a long-range proximity operations and docking sensor for use in an Automated Rendezvous and Docking (AR&D) system. The first autonomous rendezvous and docking in the history of the U.S. Space Program was successfully accomplished by Orbital Express, using the Advanced Video Guidance Sensor (AVGS) as the primary docking sensor. That flight proved that the United States now has a mature and flight proven sensor technology for supporting Crew Exploration Vehicles (CEV) and Commercial Orbital Transport Systems (COTS) Automated Rendezvous and Docking (AR&D). NASA video sensors have worked well in the past: the AVGS used on the Demonstration of Autonomous Rendezvous Technology (DART) mission operated successfully in spot mode out to 2 km, and the first generation rendezvous and docking sensor, the Video Guidance Sensor (VGS), was developed and successfully flown on Space Shuttle flights in 1997 and 1998. 12 Parts obsolescence issues prevent the construction of more AVGS units, and the next generation sensor was updated to allow it to support the CEV and COTS programs. The flight proven AR&D sensor has been redesigned to update parts and add additional capabilities for CEV and COTS with the development of the Next Generation AVGS at the Marshall Space Flight Center. The obsolete imager and processor are being replaced with new radiation tolerant parts. In addition, new capabilities include greater sensor range, auto ranging capability, and real-time video output. This paper presents some sensor hardware trades, use of highly integrated laser components, and addresses the needs of future vehicles that may rendezvous and dock with the International Space Station (ISS) and other Constellation vehicles. It also discusses approaches for upgrading AVGS to address parts obsolescence, and concepts for minimizing the sensor footprint, weight, and power requirements. In addition, the testing of the brassboard and proto-type NGAVGS units will be discussed along with the use of the NGAVGS as a proximity operations and docking sensor.

Geometrical correction of the e-beam proximity effect for raster scan systems

NASA Astrophysics Data System (ADS)

Belic, Nikola; Eisenmann, Hans; Hartmann, Hans; Waas, Thomas

1999-06-01

Increasing demands on pattern fidelity and CD accuracy in e- beam lithography require a correction of the e-beam proximity effect. The new needs are mainly coming from OPC at mask level and x-ray lithography. The e-beam proximity limits the achievable resolution and affects neighboring structures causing under- or over-exposion depending on the local pattern densities and process settings. Methods to compensate for this unequilibrated does distribution usually use a dose modulation or multiple passes. In general raster scan systems are not able to apply variable doses in order to compensate for the proximity effect. For system of this kind a geometrical modulation of the original pattern offers a solution for compensation of line edge deviations due to the proximity effect. In this paper a new method for the fast correction of the e-beam proximity effect via geometrical pattern optimization is described. The method consists of two steps. In a first step the pattern dependent dose distribution caused by back scattering is calculated by convolution of the pattern with the long range part of the proximity function. The restriction to the long range part result in a quadratic sped gain in computing time for the transformation. The influence of the short range part coming from forward scattering is not pattern dependent and can therefore be determined separately in a second step. The second calculation yields the dose curve at the border of a written structure. The finite gradient of this curve leads to an edge displacement depending on the amount of underground dosage at the observed position which was previously determined in the pattern dependent step. This unintended edge displacement is corrected by splitting the line into segments and shifting them by multiples of the writers address grid to the opposite direction.

Sex determination using discriminant analysis of upper and lower extremity bones: New approach using the volume and surface area of digital model.

PubMed

Lee, U-Young; Kim, In-Beom; Kwak, Dai-Soon

2015-08-01

This study used 110 CT images taken from donated Korean cadavers to create 3-D models of the following upper and lower limb bones: the clavicle, scapula, humerus, radius, ulna, hip bone (os coxa), femur, patella (knee cap), tibia, talus, and calcaneus. In addition, the bone volume and surface area were calculated to determine sex differences using discriminant analysis. Significant sex differences were found in all bones with respect to volume and surface area (p<0.01). The order of volume was the same in females and males (femur>hip bone>tibia>humerus>scapula), although the order of surface area was different. The largest surface area in men was the femur and in women was the hip bone (p<0.01). An interesting finding of this study was that the ulna is the bone with the highest accuracy for sex determination (94%). When using the surface area of multiple bones, the maximum accuracy (99.4%) was achieved. The equation was as follows: (discriminant equation of surface area; female<0

Melorheostosis in the upper extremity.

PubMed

Yildirim, Cengiz; Ozyürek, Selahattin; Ciçek, Engin Ilker; Kuskucu, Mesih

2009-04-01

Melorheostosis is a rare mesodermal disease affecting the skeleton and adjacent soft tissues. Often it is incidentally detected on radiographs. In the standard radiology and orthopedics literature, melorheostosis is described as a "flowing hyperostosis, resembling dripping candle wax as an incidental radiographic finding." A 22-year-old man presented with a 2-year history of right-hand pain. Radiologic evaluation of the hand showed massive sclerotic changes in the first and second metacarpal and phalangeal bones on the right side. Further radiographic evaluation of the right upper extremity revealed the same sclerotic changes in the right scapula, humerus, radius, and scaphoid. Computed tomography (CT) scans showed a high attenuation undulating cortical hyperostosis with a "dripping candle wax appearance" involving the radial and/or dorsal aspects of humerus, radius, scaphoid, and first and second ray bones of the hand. Radionuclide triphasic bone scintigraphy showed diffuse homogenous radiotracer uptake within the entire right upper extremity involving the scapula, humerus, radius, scaphoid, and first and second metacarpals and phalangeal bones of the hand. The patient was followed conservatively, and 1-year follow-up revealed no change in the clinical, laboratory, or radiological findings. The diagnosis of melorheostosis was made on the basis of the characteristic distribution, location, and combined radiographic, CT, and radionuclide imaging features of the abnormalities. Conservative treatment was recommended for the patient. After 26 months of follow-up, despite the persistence of the radiologic findings, the patient is currently well, with no painful symptoms unless he performs forceful exercise.

Morphology and structure of Homo erectus humeri from Zhoukoudian, Locality 1

PubMed Central

Wei, Pianpian; He, Jianing; Liu, Wu

2018-01-01

Background Regional diversity in the morphology of the H. erectus postcranium is not broadly documented, in part, because of the paucity of Asian sites preserving postcranial fossils. Yet, such an understanding of the initial hominin taxon to spread throughout multiple regions of the world is fundamental to documenting the adaptive responses to selective forces operating during this period of human evolution. Methods The current study reports the first humeral rigidity and strength properties of East Asian H. erectus and places its diaphyseal robusticity into broader regional and temporal contexts. We estimate true cross-sectional properties of Zhoukoudian Humerus II and quantify new diaphyseal properties of Humerus III using high resolution computed tomography. Comparative data for African H. erectus and Eurasian Late Pleistocene H. sapiens were assembled, and new data were generated from two modern Chinese populations. Results Differences between East Asian and African H. erectus were inconsistently expressed in humeral cortical thickness. In contrast, East Asian H. erectus appears to exhibit greater humeral robusticity compared to African H. erectus when standardizing diaphyseal properties by the product of estimated body mass and humeral length. East Asian H. erectus humeri typically differed less in standardized properties from those of side-matched Late Pleistocene hominins (e.g., Neanderthals and more recent Upper Paleolithic modern humans) than did African H. erectus, and often fell in the lower range of Late Pleistocene humeral rigidity or strength properties. Discussion Quantitative comparisons indicate that regional variability in humeral midshaft robusticity may characterize H. erectus to a greater extent than presently recognized. This may suggest a temporal difference within H. erectus, or possibly different ecogeographical trends and/or upper limb loading patterns across the taxon. Both discovery and analysis of more adult H. erectus humeri are critical to further evaluating and potentially distinguishing between these possibilities. PMID:29372121

A Novel Minimally Invasive Technique for Treatment of Unicameral Bone Cysts

PubMed Central

Zaghloul, Ahmed; Haddad, Behrooz; Khan, Wasim; Grimes, Lisa; Tucker, Keith

2015-01-01

Management of unicameral bone cysts (UBC) remain controversial. These cysts seldom heal spontaneously or even after pathological fracture. Sometimes these cysts can be very large and incredibly troublesome to the patient. Various treatments exist with variable success rates. We present our experience of treating these lesions by continuous drainage. Over a seven year period, six patients with unicameral bone cysts were treated by inserting a modified drain into the wall of the cyst. The aim of surgery was to place the drain in a dependent area of the cyst, through the cortex allowing for continuous drainage. This was achieved through a small incision under radiographic control. A cement restrictor (usually used for femoral canal plugging during total hip replacements) was modified and inserted to prevent closure of the drain site. A redivac drain was passed through the plug into the cyst. The drain was left in place for a week to establish an epithelialized pathway which hopefully would remain patent, into the subcutaneous tissues, after the drain had been removed. There were four males and two females in the group and the age range was 6 -12 years. Four of the lesions were in the upper humerus, one in the proximal femur and the other one in the proximal tibia. Healing was rated according to the modified Neer classification. Grade 1 (healed) and Grade 2 (healed with defect) was defined as excellent outcome. Persistent /Recurrent cysts (Grade 3 and 4) were noted as unsatisfactory. Five cases were completely healed. Only one had a further fracture and there were no recurrent fractures. All the patients reported complete comfort and they all were able to re-engage in recreational activities without restriction. We think that reducing the intra-medullary pressure in these lesions will lead to healing. We report a safe and minimally invasive technique for the management of UBC. PMID:26587064

A Novel Minimally Invasive Technique for Treatment of Unicameral Bone Cysts.

PubMed

Zaghloul, Ahmed; Haddad, Behrooz; Khan, Wasim; Grimes, Lisa; Tucker, Keith

2015-01-01

Management of unicameral bone cysts (UBC) remain controversial. These cysts seldom heal spontaneously or even after pathological fracture. Sometimes these cysts can be very large and incredibly troublesome to the patient. Various treatments exist with variable success rates. We present our experience of treating these lesions by continuous drainage. Over a seven year period, six patients with unicameral bone cysts were treated by inserting a modified drain into the wall of the cyst. The aim of surgery was to place the drain in a dependent area of the cyst, through the cortex allowing for continuous drainage. This was achieved through a small incision under radiographic control. A cement restrictor (usually used for femoral canal plugging during total hip replacements) was modified and inserted to prevent closure of the drain site. A redivac drain was passed through the plug into the cyst. The drain was left in place for a week to establish an epithelialized pathway which hopefully would remain patent, into the subcutaneous tissues, after the drain had been removed. There were four males and two females in the group and the age range was 6 -12 years. Four of the lesions were in the upper humerus, one in the proximal femur and the other one in the proximal tibia. Healing was rated according to the modified Neer classification. Grade 1 (healed) and Grade 2 (healed with defect) was defined as excellent outcome. Persistent /Recurrent cysts (Grade 3 and 4) were noted as unsatisfactory. Five cases were completely healed. Only one had a further fracture and there were no recurrent fractures. All the patients reported complete comfort and they all were able to re-engage in recreational activities without restriction. We think that reducing the intra-medullary pressure in these lesions will lead to healing. We report a safe and minimally invasive technique for the management of UBC.

Description of the incidence, clinical presentation and outcome of proximal limb and pelvic fractures in Hong Kong racehorses during 2003-2014.

PubMed

McGlinchey, L; Hurley, M J; Riggs, C M; Rosanowski, S M

2017-11-01

Few studies have described incidences of proximal limb and pelvic fracture (PLPF) in Thoroughbred racehorses occurring on race day and during training. Information regarding clinical presentations and future racing careers in cases of PLPF is limited. To describe the incidence, clinical presentation and outcome of PLPF sustained by horses in racing and training at the Hong Kong Jockey Club (HKJC) between 2003 and 2014. Retrospective cohort study. Horses with PLPF confirmed by nuclear scintigraphy, ultrasonography, radiography or post-mortem examination were identified using veterinary clinical records. Training and racing data for case horses were described. Incidences of fractures were estimated per 1000 horses in training and per 1000 race starts for fractures sustained during racing. Descriptive statistics were used to describe the study population. A total of 129 instances of PLPF were sustained by 108 racehorses. The most commonly fractured bone was the humerus (49.6%), followed by the tibia (29.4%). Nine horses sustained fatal fractures, eight of which occurred during racing. The incidence of fracture during racing was 0.30 per 1000 starts. Two-thirds of fractures occurred during training. The majority of horses presented with grade 3 lameness (n = 42 of 119 injury events, 35.3%). All horses presenting with grade 5 lameness sustained fatal injuries. Following noncatastrophic injury, all horses underwent box rest and 81 horses subsequently resumed racing; 45 of these won a race. Horses were retired at a median of 25 months (interquartile range: 15-36 months) after injury. Protocols for resting non-training racehorses at the HKJC and for recording rehabilitation regimens post-injury prevented the calculation of horse days at risk. The incidence of PLPF at the HKJC is low. Non-fatal PLPF is not necessarily a career-ending injury and many horses resume racing successfully following conservative treatment. © 2017 EVJ Ltd.

Risk of fragility fracture among patients with sarcoidosis: a population-based study 1976-2013.

PubMed

Ungprasert, P; Crowson, C S; Matteson, E L

2017-06-01

Incidence of fragility fracture of a population-based cohort of 345 patients with sarcoidosis was compared with age and sex-matched comparators. The incidence of fragility fracture was higher among patients with sarcoidosis with hazard ratio (HR) of 2.18. Several chronic inflammatory disorders increase the risk of fragility fracture. However, little is known about the risk of fragility fracture in patients with sarcoidosis. This study was conducted using a previously identified population-based cohort of 345 patients with incident sarcoidosis from Olmsted County, Minnesota. Diagnosis of sarcoidosis required physician diagnosis supported by biopsy showing non-caseating granuloma, radiographic evidence of intrathoracic sarcoidosis, and compatible clinical presentations without evidence of other granulomatous diseases. Sex and age-matched subjects randomly selected from the same underlying population were used as comparators. Medical records of cases and comparators were reviewed for baseline characteristics and incident fragility fracture. Fragility fractures were observed in 34 patients with sarcoidosis, corresponding to a cumulative incidence of 5.6% at 10 years, while 18 fragility fractures were observed among comparators for a cumulative incidence of 2.4% at 10 years. The HR of fragility fractures among cases compared with comparators was 2.18 (95% confidence interval [CI], 1.23-3.88). The risk of fragility fracture by site was significantly higher among patients with sarcoidosis, and was due to a higher rate of distal forearm fracture (HR 3.58; 95% CI 1.53-8.40). Statistically non-significant increased risk was also observed in proximal femur (HR 1.66; 95% CI 0.45-6.06) and proximal humerus (HR 3.27; 95% CI 0.66-16.21). Risk of vertebral fracture was not increased (HR 1.00; 95% CI 0.32-3.11). Patients with sarcoidosis have an increased risk of fragility fracture which is primarily driven by the higher incidence of distal forearm fracture.

Floor Proximity Emergency Escape Path Marking Systems Incorporating Photoluminescent Elements

DOT National Transportation Integrated Search

1997-07-24

This advisory circular (AC) provides guidance material for use in demonstrating : compliance with the provisions of part 25 of the Federal Aviation Regulations : (FAR) regarding floor proximity emergency escape path marking systems (FPEEPMS) : which ...

Giant distal humeral geode.

PubMed

Maher, M M; Kennedy, J; Hynes, D; Murray, J G; O'Connell, D

2000-03-01

We describe the imaging features of a giant geode of the distal humerus in a patient with rheumatoid arthritis, which presented initially as a pathological fracture. The value of magnetic resonance imaging in establishing this diagnosis is emphasized.

Dual small fragment plating improves screw-to-screw load sharing for mid-diaphyseal humeral fracture fixation: a finite element study.

PubMed

Kosmopoulos, Victor; Luedke, Colten; Nana, Arvind D

2015-01-01

A smaller humerus in some patients makes the use of a large fragment fixation plate difficult. Dual small fragment plate constructs have been suggested as an alternative. This study compares the biomechanical performance of three single and one dual plate construct for mid-diaphyseal humeral fracture fixation. Five humeral shaft finite element models (1 intact and 4 fixation) were loaded in torsion, compression, posterior-anterior (PA) bending, and lateral-medial (LM) bending. A comminuted fracture was simulated by a 1-cm gap. Fracture fixation was modelled by: (A) 4.5-mm 9-hole large fragment plate (wide), (B) 4.5-mm 9-hole large fragment plate (narrow), (C) 3.5-mm 9-hole small fragment plate, and (D) one 3.5-mm 9-hole small fragment plate and one 3.5-mm 7-hole small fragment plate. Model A showed the best outcomes in torsion and PA bending, whereas Model D outperformed the others in compression and LM bending. Stress concentrations were located near and around the unused screw holes for each of the single plate models and at the neck of the screws just below the plates for all the models studied. Other than in PA bending, Model D showed the best overall screw-to-screw load sharing characteristics. The results support using a dual small fragment locking plate construct as an alternative in cases where crutch weight-bearing (compression) tolerance may be important and where anatomy limits the size of the humerus bone segment available for large fragment plate fixation.

Lectin histochemistry of goblet cell sugar residues in the gut of the chick embryo and of the newborn.

PubMed

Bryk, S G; Sgambati, E; Gheri Bryk, G

1999-04-01

The anlage of duodenum, ileum and colon were removed from chick embryos of day 8-21 of incubation and from 1-day-old chicks. A battery of seven different horseradish peroxidase-conjugated lectins (PNA, SBA, DBA, Con A, WGA, LTA and UEAI) was used to study the carbohydrate residues of the glycoconjugates in the goblet cells of the three parts of the intestine. The main results can be summarized as follows: differences in lectin binding were absent in the proximal and distal parts of the duodenum, ileum and colon. Lectin histochemistry showed differences among the three intestinal segments for the time of appearance of the oligosaccharides in the goblet mucus. In the colonic goblet cells of 1-day-old chicks, LTA and UEAI lectins showed two different types of linkage of alpha-L-fucose. This is the first demonstration of UEAI reactive sites in Gallus domesticus.

Anatomy of the collateral ligaments of the feline elbow joint: functional implications.

PubMed

Engelke, E; Pfarrer, C; Waibl, H

2011-04-01

Cats show a higher capability to supinate their forearms than dogs. This suggests a special arrangement of the collateral ligaments of the feline elbow joint. Therefore, the course of the ligaments was examined in 13 adult cats. The size of the ligaments was measured, and effects of passive joint movements were studied. Ligaments of five additional cats were examined histologically. The lateral collateral ligament (LCL) had a superficial and deep part, both originating from the humerus. The free humeral portion of the LCL was short and contained fibrous cartilage. Fibre bundles of the deep part inserted into the annular ligament, while the remaining deep fibres and the superficial part inserted with a long antebrachial portion on the radius. The medial collateral ligament (MCL) originated from the humeral epicondyle and divided into cranial and caudal parts. The caudal part inserted medioproximally on the ulna, while the cranial part attached primarily with a long thin part to the caudal aspect of the radius. During supination, the MCL loosened thus allowing medial widening of the joint space, up to 2 mm. A specific feature of the feline elbow is the long thin part of the MCL. Its course through a special furrow distal to the medial coronoid causes the tightening of the feline MCL during pronation. Apart from that, the feline collateral ligaments combine the features of both human and canine cubital anatomy. This explains the range of supination in cats, which is intermediate between humans and dogs. © 2010 Blackwell Verlag GmbH.

The role of proximal versus distal stomach resection in the weight loss seen after vertical sleeve gastrectomy

PubMed Central

Kulkarni, Bhushan V.; LaSance, Kathleen; Sorrell, Joyce E.; Lemen, Lisa; Woods, Stephen C.; Seeley, Randy J.

2016-01-01

The mechanisms involved in the weight loss seen after vertical sleeve gastrectomy (VSG) are not clear. The rat stomach has two morphologically and functionally distinct proximal and distal parts. The rat model for VSG involves complete removal of the proximal part and 80% removal of the distal part along the greater curvature. The purpose of this study was to understand the potential independent contributions of removal of these distinct gastric sections to VSG outcomes. We prepared four surgical groups of male Long-Evans rats: VSG, sham surgery (control), selective proximal section removal (PR), and selective distal section removal (DR). Gastric emptying rate (GER) was highest after VSG compared with all other groups. However, PR, in turn, had significantly greater GER compared with both DR and sham groups. The surgery-induced weight loss followed the same pattern with VSG causing the greatest weight loss and PR having greater weight loss compared with DR and sham groups. The results were robust for rats fed regular chow or a high-fat diet. Body mass analysis revealed that the weight loss was due to the loss of fat mass, and there was no change in lean mass after the surgeries. In conclusion, removal of the proximal stomach contributes to most, but not all, of the physiological impact of VSG. PMID:27581811

Impact crater outflows on Venus: Morphology and emplacement mechanisms

USGS Publications Warehouse

Chadwick, D. John; Schaber, Gerald G.

1993-01-01

Many of the 932 impact craters discovered by the Magellan spacecraft at Venus are associated with lobate flows that originate at or near the crater rim. They extend for several to several hundred kilometers from the crater, and they commonly have a strong radar backscatter. A morphologic study of all identifiable crater outflows on Venus has revealed that many individual flows each consist of two areas, defined by distinct morphologic features. These two areas appear to represent two stages of deposition for each flow. The part of the flow that is generally deposited closest to the crater tends to be on the downrange side of the crater, flows in the downrange direction, and it is interpreted to be a late-stage ejecta. In many cases, this proximal part of the flow is too thin to completely bury the large blocks in subjacent ejecta deposits. Dendritic channels, present in many proximal flows, appear to have drained liquid from the proximal part in the downhill direction, and they debouch to feed the outer part of the flows. This distal part flows downhill, fills small grabens, and is ponded by ridges, behavior that mimics that of volcanic lava flows. The meandering and dendritic channels and the relation of the distal flows to topography strongly suggest that the distal portion is the result of coalescence and slow drainage of impact melt from the proximal portion. Impact melt forms a lining to the transient crater and mixes turbulently with solid clasts, and part of this mixture may be ejected to form the proximal part of the flow during the excavation stage of crater development. A statistical study of the Venusian craters has revealed that, in general, large craters produced by impacts with relatively low incidence angles to the surface are more likely to produce flows than small craters produced by higher-angle impacts. The greater flow production and downrange focusing of the proximal flows with decreasing incidence angle indicate a strong control of the flows by the impactor flight direction, and a high downrange velocity imparted to the proximal flow material in lower angle impacts. On the Moon, small flows interpreted to be composed of impact melt are observed atop the ejecta of large, fresh craters; on Earth, melt-rich suevite deposits form the uppermost layer of ejecta of some fresh craters. These features, albeit much smaller, may be analogous to the flows on Venus. Numerical models have predicted that larger volumes of impact melt would be produced on Venus than on the cooler terrestrial bodies due to high atmospheric and target temperatures, perhaps 3 times the volume produced on the Moon for a given crater diameter.

FE analysis of SMA-based bio-inspired bone-joint system

NASA Astrophysics Data System (ADS)

Yang, S.; Seelecke, S.

2009-10-01

This paper presents the finite element (FE) analysis of a bio-inspired bone-joint system. Motivated by the BATMAV project, which aims at the development of a micro-air-vehicle platform that implements bat-like flapping flight capabilities, we study the actuation of a typical elbow joint, using shape memory alloy (SMA) in a dual manner. Micro-scale martensitic SMA wires are used as 'metal muscles' to actuate a system of humerus, elbow joint and radius, in concert with austenitic wires, which operate as flexible joints due to their superelastic character. For the FE analysis, the humerus and radius are modeled as standard elastic beams, while the elbow joint and muscle wires use the Achenbach-Muller-Seelecke SMA model as beams and cable elements, respectively. The particular focus of the paper is on the implementation of the above SMA model in COMSOL.

Bone Lengthening in the Pediatric Upper Extremity.

PubMed

Farr, Sebastian; Mindler, Gabriel; Ganger, Rudolf; Girsch, Werner

2016-09-07

➤Bone lengthening has been used successfully for several congenital and acquired conditions in the pediatric clavicle, humerus, radius, ulna, and phalanges.➤Common indications for bone lengthening include achondroplasia, radial longitudinal deficiency, multiple hereditary exostosis, brachymetacarpia, symbrachydactyly, and posttraumatic and postinfectious growth arrest.➤Most authors prefer distraction rates of <1 mm/day for each bone in the upper extremity except the humerus, which can safely be lengthened by 1 mm/day.➤Most authors define success by the amount of radiographic bone lengthening, joint motion after lengthening, and subjective patient satisfaction rather than validated patient-related outcome measures.➤Bone lengthening of the upper extremity is associated with a high complication rate, with complications including pin-track infections, fixation device failure, nerve lesions, nonunion, fracture of regenerate bone, and joint dislocations. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

Pulmonary carcinoma in a great horned owl (Bubo virginianus).

PubMed

Rettenmund, Christy; Sladky, Kurt K; Rodriguez, Daniel; Petersen, Michael; Pinkerton, Marie E; Rao, Deepa

2010-03-01

Pulmonary carcinoma was diagnosed in an 18+-year-old captive female great horned owl (Bubo virginianus). The owl presented with a history of progressive weakness and sudden onset of frank blood in the droppings. On physical examination, the owl had multiple white to yellow plaques in the oral cavity, decreased air sac sounds on the right side, dyspnea (during manual restraint), and reduced pectoral musculature. Whole-body radiographs revealed obliteration of the right-sided air sacs, a soft tissue plaque/density in the left caudal thoracic air sac, soft tissue opacity over the coelomic organs, and increased medullary opacity in the distal right humerus. The owl died during anesthetic recovery, and the body was submitted for necropsy. Although the clinical signs, physical examination results, radiographic signs, and gross pathology supported a diagnosis of mycotic infection, such as aspergillosis, histopathology confirmed pulmonary carcinoma with metastases to the air sacs and humerus.

Variation of the latissimus dorsi

PubMed Central

Shah, Ishani P; Yadav, Amit; Mehta, Rujuta; Thatte, Mukund

2014-01-01

A typical muscle variation of latissimus dorsi — the axillary arch is represented by the muscular or fibromuscular slip detached from the anteroinferior border of the musculus latissimus dorsi passing over the axilla under the axillary fascia crossing the medial side of the brachial plexus to continue as a septum intermusculare mediale brachii distally to the medial epicondyle of humerus. The full extent of the muscle is rarely present. Slips of muscle extend from the latissimus dorsi at the inferior angle of scapula to insert into pectoralis major (Langer), coracobrachilis, biceps or coracoid process forming what is described as a common variant - the muscular axillary arch. We report three cases of variants of latissimus dorsi, one of which has not been reported in the literature before. PMID:25593441

The ulnar collateral ligament of the human elbow joint. Anatomy, function and biomechanics.

PubMed Central

Fuss, F K

1991-01-01

The posterior portion of the ulnar collateral ligament, which arises from the posterior surface of the medial epicondyle, is taut in maximal flexion. The anterior portion, which takes its origin from the anterior and inferior surfaces of the epicondyle, contains three functional fibre bundles. One of these is taut in maximal extension, another in intermediate positions between middle position and full flexion while the third bundle is always taut and serves as a guiding bundle. Movements of the elbow joint are checked by the ligaments well before the bony processes forming the jaws of the trochlear notch lock into the corresponding fossae on the humerus. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4 PMID:2050566

Variation of the latissimus dorsi.

PubMed

Shah, Ishani P; Yadav, Amit; Mehta, Rujuta; Thatte, Mukund

2014-01-01

A typical muscle variation of latissimus dorsi - the axillary arch is represented by the muscular or fibromuscular slip detached from the anteroinferior border of the musculus latissimus dorsi passing over the axilla under the axillary fascia crossing the medial side of the brachial plexus to continue as a septum intermusculare mediale brachii distally to the medial epicondyle of humerus. The full extent of the muscle is rarely present. Slips of muscle extend from the latissimus dorsi at the inferior angle of scapula to insert into pectoralis major (Langer), coracobrachilis, biceps or coracoid process forming what is described as a common variant - the muscular axillary arch. We report three cases of variants of latissimus dorsi, one of which has not been reported in the literature before.

Diagnosis and treatment of infraspinatus tendon-bursa ossification in a Eurasian Dog.

PubMed

Ungru, Julia; Hungerbühler, Stephan; Henninger, Wolfgang; Klupiec, Petra; Bödeker, Julia; Langer, Anna; Fehr, Michael; Harms, Oliver

2018-04-01

A 4-year-old male Eurasian Dog presented at our veterinary clinic with a history of perpetual forelimb lameness in both thoracic limbs. In the clinical exploration, direct pressure over the infraspinatus tendon of insertion caused pain in both thoracic forelimbs and a firm band-like structure was palpable. No improvement was observed after treatment with rest, non-steroidal anti-inflammatory drugs and an intralesional injection of a long-acting glucocorticoid. Radiographic examination, ultrasonographic exploration and computed tomography were performed, identifying ossified structures lateral to the proximal humerus and an irregular roughened periosteum at the insertion and tendon of the infraspinatus muscle on both sides. There were more distinct alterations on the right thoracic limb. The imaging results led to a diagnosis of an infraspinatus tendon-bursa ossification accompanied by a chronic tendinopathy/tendovaginitis, accentuated on the right side. The dog was subjected to physiotherapy and autologous conditioned plasma (ACP) was injected into the insertion of the infraspinatus muscle of both thoracic limbs. After 5 months of physiotherapy and two injections of ACP with an interval of one week in both forelimbs, the dog showed no signs of lameness. This case report describes the diagnosis and management of infraspinatus tendon-bursa ossification in a Eurasian Dog. To the authors' knowledge, this condition has previously not been described in this breed of dog. Schattauer GmbH.

Video-assisted microwave ablation for the treatment of a metastatic lung lesion in a dog with appendicular osteosarcoma and hypertrophic osteopathy.

PubMed

Mazzaccari, Kaitlyn; Boston, Sarah E; Toskich, Beau B; Bowles, Kristina; Case, J Brad

2017-11-01

To describe video-assisted microwave ablation (VAMA) for the treatment of a metastatic lung lesion secondary to right forelimb osteosarcoma in a dog. Case report. A 10-year-old female spayed mixed breed dog with a metastatic lung lesion secondary to appendicular osteosarcoma. An osteosarcoma of the right distal scapula and proximal humerus that was suspected to be a radiation-induced osteosarcoma was treated with limb amputation and carboplatin chemotherapy. The patient developed pulmonary metastatic lesions and hypertrophic osteopathy (HO). VAMA of a metastatic lesion in the right caudal lung lobe was performed 227 days after amputation. The procedure was performed without complication. Follow-up information with the referring veterinarian 40 days after VAMA indicated that the patient was stable and that the clinical signs of HO had resolved. Thoracic radiographs taken by the referring veterinarian (RDVM) at monthly intervals showed that the previously treated metastatic lesion was stable. At 134 days from VAMA, the patient presented to the RDVM for lethargy and dyspnea and was transferred to an emergency clinic. The patient arrested and died 136 days from the VAMA procedure while hospitalized. A postmortem was not performed. VAMA for pulmonary metastatic lesions is technically feasible and allows for the treatment of symptoms associated with HO and minimally invasive management of pulmonary metastases in the case reported. © 2017 The American College of Veterinary Surgeons.

PreFix™ external fixator used to treat a floating shoulder injury caused by gunshot wound.

PubMed

Vogels, J; Pommier, N; Cursolle, J-C; Belin, C; Tournier, C; Durandeau, A

2014-10-01

Open fractures of the shoulder are extremely rare, and their treatment is a major challenge for surgeons. Only cases encountered in military settings have been reported thus far. Such fractures are often the result of ballistic trauma, which causes extensive damage to both bony and soft tissues. Since these injuries are associated with a high risk of infection and the presence of comminuted fractures, external fixation is necessary for repair. Use of external fixators and revascularization techniques has reduced the number of cases requiring shoulder amputation or disarticulation. Injury to the proximal extremity of the humerus, acromion, and clavicle further complicates the treatment. No published studies have described the assembly of external fixators for fractures in the scapular region with significant bone loss. In addition, no cases have been described in civilian settings. However, with an increase in urban violence and the traffic of illegal arms, civilian surgeons are now encountering an increasing number of patients with these injuries. In this report, we not only present a rare case of floating shoulder injury in a civilian setting but also provide an overview of the existing treatment strategies for this type of trauma, with special focus on the use of external fixators in elective shoulder arthrodesis and on military cases. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Normal Skeletal Maturation and Imaging Pitfalls in the Pediatric Shoulder.

PubMed

Zember, Jonathan S; Rosenberg, Zehava S; Kwong, Steven; Kothary, Shefali P; Bedoya, Maria A

2015-01-01

A growing number of magnetic resonance (MR) imaging studies of the shoulder are being performed as a result of greater and earlier participation of children and adolescents in competitive sports such as softball and baseball. However, scant information is available regarding the MR imaging features of the normal sequential development of the shoulder. The authors discuss the radiographic and MR imaging appearances of the normal musculoskeletal maturation patterns of the shoulder, with emphasis on (a) development of secondary ossification centers of the glenoid (including the subcoracoid and peripheral glenoid ossification centers); (b) development of preossification and secondary ossification centers of the humeral head and the variable appearance and number of the secondary ossification centers of the distal acromion, with emphasis on the formation of the os acromiale; (c) development of the growth plates, glenoid bone plates, glenoid bare area, and proximal humeral metaphyseal stripe; and (d) marrow signal alterations in the distal humerus, acromion, and clavicle. In addition, the authors discuss various imaging interpretation pitfalls inherent to the normal skeletal maturation of the shoulder, examining clues that may help distinguish normal development from true disease (eg, osteochondral lesions, labral tears, abscesses, fractures, infection, tendon disease, acromioclavicular widening, and os acromiale). Familiarity with the timing, location, and appearance of maturation patterns in the pediatric shoulder is crucial for correct image interpretation. ©RSNA, 2015.

Retrospective Evaluation of Whole Body Computed Tomography for Tumor Staging in Dogs with Primary Appendicular Osteosarcoma.

PubMed

Talbott, Jessica L; Boston, Sarah E; Milner, Rowan J; Lejeune, Amandine; Souza, Carlos H de M; Kow, Kelvin; Bacon, Nicholas J; Hernandez, Jorge A

2017-01-01

To evaluate whole body computed tomography (CT) for staging canine appendicular osteosarcoma. Retrospective case series. Client-owned dogs diagnosed with appendicular osteosarcoma (n=39). Medical records for client-owned dogs diagnosed with appendicular osteosarcoma from August 2008 to July 2014 were reviewed. Dogs were included if they had a confirmed diagnosis of appendicular osteosarcoma and were staged using whole body CT. Data collected included signalment, body weight, primary tumor location, serum alkaline phosphatase (ALP) activity, findings on 3-view thoracic radiographs, cytologic or histologic results, and findings on CT. Thirty-nine dogs (median age 8.5 years; median body weight 37 kg) had osteosarcoma of the distal radius (n=17), proximal humerus (11) and other sites. Serum ALP activity was elevated in 14 dogs. Bone metastasis was not detected in any dog on whole body CT. Pulmonary metastasis was considered definitive on CT based on board certified radiologist assessment in 2/39 dogs (5%). Two additional dogs (2/39, 5%) had soft tissue masses diagnosed on CT, consistent with concurrent, non-metastatic malignancies. Bone metastases were not identified in any dog with whole body CT. Thoracic and abdominal CT detected lung lesions and concurrent neoplasia in dogs with primary appendicular osteosarcoma. Whole body CT may be a useful adjunct to other screening tests for disseminated malignancy. © 2016 The American College of Veterinary Surgeons.

Dinosaur evolution. A Jurassic ornithischian dinosaur from Siberia with both feathers and scales.

PubMed

Godefroit, Pascal; Sinitsa, Sofia M; Dhouailly, Danielle; Bolotsky, Yuri L; Sizov, Alexander V; McNamara, Maria E; Benton, Michael J; Spagna, Paul

2014-07-25

Middle Jurassic to Early Cretaceous deposits from northeastern China have yielded varied theropod dinosaurs bearing feathers. Filamentous integumentary structures have also been described in ornithischian dinosaurs, but whether these filaments can be regarded as part of the evolutionary lineage toward feathers remains controversial. Here we describe a new basal neornithischian dinosaur from the Jurassic of Siberia with small scales around the distal hindlimb, larger imbricated scales around the tail, monofilaments around the head and the thorax, and more complex featherlike structures around the humerus, the femur, and the tibia. The discovery of these branched integumentary structures outside theropods suggests that featherlike structures coexisted with scales and were potentially widespread among the entire dinosaur clade; feathers may thus have been present in the earliest dinosaurs. Copyright © 2014, American Association for the Advancement of Science.

Wall proximity corrections for hot-wire readings in turbulent flows

NASA Technical Reports Server (NTRS)

Hebbar, K. S.

1980-01-01

This note describes some details of recent (successful) attempts of wall proximity corrections for hot-wire measurements performed in a three-dimensional incompressible turbulent boundary layer. A simple and quite satisfactory method of estimating wall proximity effects on hot-wire readings is suggested.

In vitro assessment of the contact mechanics of reverse-engineered distal humeral hemiarthroplasty prostheses.

PubMed

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

2014-11-01

Distal humeral hemiarthroplasty alters cartilage contact mechanics, which may predispose to osteoarthritis. Current prostheses do not replicate the native anatomy, and therefore contribute to these changes. We hypothesized that prostheses reverse-engineered from the native bone shape would provide similar contact patterns as the native articulation. Reverse-engineered hemiarthroplasty prostheses were manufactured for five cadaveric elbows based on CT images of the distal humerus. Passive flexion trials with constant muscle forces were performed with the native articulation intact while bone motions were recorded using a motion tracking system. Motion trials were then repeated after the distal humerus was replaced with a corresponding reverse-engineered prosthesis. Contact areas and patterns were reconstructed using computer models created from CT scan images combined with the motion tracker data. The total contact areas, as well as the contact area within smaller sub-regions of the ulna and radius, were analyzed for changes resulting from hemiarthroplasty using repeated-measures ANOVAs. Contact area at the ulna and radius decreased on average 42% (SD 19%, P=.008) and 41% (SD 42%, P=.096), respectively. Contact area decreases were not uniform throughout the different sub-regions, suggesting that contact patterns were also altered. Reverse-engineered prostheses did not reproduce the same contact pattern as the native joints, possibly because the thickness of the distal humerus cartilage layer was neglected when generating the prosthesis shapes or as a consequence of the increased stiffness of the metallic implants. Alternative design strategies and materials for hemiarthroplasty should be considered in future work. Copyright © 2014 Elsevier Ltd. All rights reserved.

The role of proximal body information on anticipatory judgment in tennis using graphical information richness.

PubMed

Fukuhara, Kazunobu; Ida, Hirofumi; Ogata, Takahiro; Ishii, Motonobu; Higuchi, Takahiro

2017-01-01

Recent studies have reported that skilled tennis players are likely to use proximal body information for anticipating the direction of their opponent's forehand shot. However, in these studies, the visual stimuli did not include visual information about the ball. Skilled players may have used proximal information owing to the lack of distal information. To address this issue, we developed a novel methodological approach using computer graphics (CG) images in which the entire body was presented by a combination of point-light display (i.e., poor graphical information, PLD) and polygons (i.e., rich graphical information). Using our novel methodological approach, we examined whether skilled tennis players use proximal body information when anticipating shot directions. Fifteen skilled tennis players and fifteen novice players tried to anticipate shot directions by observing four CG forehand strokes (ALPOL: all body parts were represented with polygon; RAPLD: racket and arm were represented with PLD; BOPLD: body parts without racket and arm were represented with PLD; and ALPLD: all body parts were represented with PLD). Our intention in creating CG models with such combinations (i.e., RAPLD and BOPLD) was that because of the richer graphical information provided by polygons compared to PLD, the participant's anticipatory judgment would be influenced more by body parts expressed with polygons. The results showed that for skilled players, anticipatory judgment was more accurate when they observed RAPLD than when they observed BOPLD and ALPLD. In contrast, for novice players, there were no differences in the accuracy of anticipatory judgments with the four CG models. Only skilled players made more accurate anticipatory judgments when body regions were expressed with rich graphical information, and the racket and arm were expressed with poor graphical information. These suggest that skilled players used proximal information to effectively anticipate shot directions.

Differentiation of chondrocytes and scleroblasts during dorsal fin skeletogenesis in flounder larvae.

PubMed

Suzuki, Tohru; Haga, Yutaka; Takeuchi, Toshio; Uji, Susumu; Hashimoto, Hisashi; Kurokawa, Tadahide

2003-01-01

In teleosts, the embryonic fin fold consists of a peridermis, an underlying epidermis and a small number of mesenchymal cells. Beginning from such a simple structure, the fin skeletons, including the proximal and distal radials and lepidotrichia (finrays), develop in the dorsal fin fold at the larval stage. Their process of skeletogenesis and embryonic origin are unclear. Using flounder larvae, we report the differentiation process for chondrocytes and scleroblasts prior to fin skeletogenesis and the effects of retinoic acid (RA) on it. In early larvae, the mesenchymal cells grow between the epidermis and spinal cord to form a line of periodical condensations, which are proximal radial primordia, to produce chondrocytes. The prescleroblasts, which ossify the proximal radial cartilages, differentiate in the mesenchymal cells remaining between the cartilages. Then, mesenchymal condensations occur between the distal ends of the proximal radials, forming distal radial primordia, to produce chondrocytes. Simultaneously, condensations occur between the distal radial primordia and peridermis, which are lepidotrichia primordia, to produce prescleroblasts. Exogenous RA specifically inhibits the mesenchymal condensation prior to the proximal radial formation together with the down-regulation of sonic hedgehog (shh) and patched (pta) expression, resulting in the loss of proximal radials. Thus, it was indicated that differentiation of the precursor cells of radials and lepidotrichia begins in the proximal part of the fin fold and that the initial mesenchymal condensation prior to the proximal radial formation is highly susceptible to the effects of RA. Lepidotrichia formation does not occur where proximal radials are absent, indicating that lepidotrichia differentiation requires interaction with the radial cartilages. To examine the suggestion that neural crest cells contribute to the medial fin skeletons, we localized the HNK-1 positive cells in flounder embryos and slug and msxb-positive cells in pufferfish, Fugu rubripes, embryos. That the positive cells commonly arrive at the proximal part of the fin fold does not contradict the suggestion, but their final destiny as radial chondrocytes or lepidotrichia scleroblasts, should be further investigated.

Three-in-one gage

NASA Technical Reports Server (NTRS)

Garecht, D. M.

1988-01-01

The Three-in-One Gage is a three way gage designed to measure pressure, temperature, and displacement at the same port continuously. The Two-in-One Gage is a two way gage designed to measure pressure and temperature in the same port continuously. The Two-in-One is an adaptation of the Three-in-One to incorporate dual seals, however, without the proximity sensor. The Three-in-One is assembled using two Type K thermocouples, 1 Kulite Pressure Transducer, and one Kaman Proximity Displacement Sensor. Tests of performance were completed.

A Large Ornithurine Bird (Tingmiatornis arctica) from the Turonian High Arctic: Climatic and Evolutionary Implications

NASA Astrophysics Data System (ADS)

Bono, Richard K.; Clarke, Julia; Tarduno, John A.; Brinkman, Donald

2016-12-01

Bird fossils from Turonian (ca. 90 Ma) sediments of Axel Heiberg Island (High Canadian Arctic) are among the earliest North American records. The morphology of a large well-preserved humerus supports identification of a new volant, possibly diving, ornithurine species (Tingmiatornis arctica). The new bird fossils are part of a freshwater vertebrate fossil assemblage that documents a period of extreme climatic warmth without seasonal ice, with minimum mean annual temperatures of 14 °C. The extreme warmth allowed species expansion and establishment of an ecosystem more easily able to support large birds, especially in fresh water bodies such as those present in the Turonian High Arctic. Review of the high latitude distribution of Northern Hemisphere Mesozoic birds shows only ornithurine birds are known to have occupied these regions. We propose physiological differences in ornithurines such as growth rate may explain their latitudinal distribution especially as temperatures decline later in the Cretaceous. Distribution and physiology merit consideration as factors in their preferential survival of parts of one ornithurine lineage, Aves, through the K/Pg boundary.

Sediment accumulation rates and high-resolution stratigraphy of recent fluvial suspension deposits in various fluvial settings, Morava River catchment area, Czech Republic

NASA Astrophysics Data System (ADS)

Sedláček, Jan; Bábek, Ondřej; Kielar, Ondřej

2016-02-01

We present a comprehensive study concerning sedimentary processes in fluvial sediment traps within the Morava River catchment area (Czech Republic) involving three dammed reservoirs, four meanders and oxbow lakes, and several natural floodplain sites. The objective of the study was to determine sediment accumulation rates (SAR), estimate erosion rates, calculating these using a combination of the 137Cs method and historical data. Another purpose of this study was to provide insight into changing erosion and accumulation rates over the last century. Extensive water course modifications were carried out in the Morava River catchment area during the twentieth century, which likely affected sedimentation rates along the river course. Other multiproxy stratigraphic methods (X-ray densitometry, magnetic susceptibility, and visible-light reflectance spectrometry) were applied to obtain additional information about sediment infill. Sediment stratigraphy revealed distinct distal-to-proximal patterns, especially in reservoirs. Granulometrically, silts and sandy silts prevailed in sediments. Oxbow lakes and meanders contained larger amounts of clay and organic matter, which is the main difference between them and reservoirs. Pronounced 137Cs peaks were recorded in all studied cores (maximum 377 Bq·kg- 1), thus indicating Chernobyl fallout from 1986 or older events. Calculated sediment accumulation rates were lowest in distal parts of reservoirs (0.13-0.58 cm/y) and floodplains (0.45-0.88 cm/y), moderately high rates were found in proximal parts of reservoirs and oxbow lakes (2.27-4.4 cm/y), and the highest rates in some oxbow lakes located near the river (6-8 cm/y). The frequency of the inundation still can be high in some natural areas as in the Litovelské Pomoraví protected area, whereas the decreasing frequency of the inundation in other modified parts can contribute to a lower sedimentation rate. The local effects such as difference between SARs in oxbow lakes and reservoirs, different grain size distribution in both systems, and high variability in thickness of their proximal and distal parts play a crucial role in the analysis of regional accumulation rates. Local effects are much stronger than regional effects, such as rainfall and land use. Combined with the low resolution of time scales (usually only three datums are available: reservoir construction datum, 137Cs fallout event, and top of sediment), these effects may obscure the general trends of regionally increasing or decreasing net SARs, making the analysis of erosion rates from the sedimentary record an extremely difficult task.

Low bone mass density at multiple skeletal sites, including the appendicular skeleton in amenorrheic runners.

PubMed

Pettersson, U; Stålnacke, B; Ahlénius, G; Henriksson-Larsén, K; Lorentzon, R

1999-02-01

The aim of this study was to investigate any difference in bone mass at different sites between female long-distance runners with amenorrhea and those with eumenorrhea. We compared 10 amenorrheic and 10 eumenorrheic athletes to determine whether athletes with amenorrhea have lower BMD in multiple skeletal regions, including weight-bearing lower limbs. The amenorrheic group had experienced menstrual dysfunction ranging from 3 to 43 months. As a further control group, 16 eumenorrheic soccer players were compared with the former two running groups regarding their BMD measurements. The two groups were matched for age, height, and amount of training. Areal bone mineral density (BMD) was measured and was found to be significantly lower in the total body, humerus, spine, lumbar spine, pelvis, femoral neck, trochanter, total femur, femur diaphysis, tibia diaphysis and in the nonweight-bearing head of the femur in the amenorrheic group. Body weight, BMI, fat mass, and body fat percent were significantly lower in the amenorrheic group. The differences in the BMD of the head, humerus, femoral neck, total femur, femur diaphysis, and tibia diaphysis disappeared when adjusted for body weight. Compared with the soccer group, the amenorrheic subjects had significantly lower BMD values at all sites except for the head, Ward's triangle, and femur diaphysis. Blood samples were obtained in the two running groups for analysis of osteocalcin, carboxy terminal telopeptide (ICTP), procollagen I (PICP), and estradiol. There were no significant differences between the groups but there was a strong tendency towards a lower estradiol level and a higher osteocalcin level in the amenorrheic group. A free estradiol index (FE2) was derived as the ratio of estradiol to sex hormone binding globulin (SHBG) and was significantly lower in the amenorrheic group. No difference in their daily intake of total energy, protein, carbohydrates, fiber, calcium, and vitamin D was observed. However, both groups showed a surprisingly low energy intake in relation to their training regimens. Stepwise regression analyses revealed that weight was the best predictor of spine BMD in both groups. Estradiol and FE2 were significant predictors of the BMD of the proximal femur in the eumenorrheic group, but did not predict any BMD site in the amenorrheic group. In conclusion, amenorrhea in athletic women affects trabecular and cortical bone in both axial and appendicular skeleton. However, some of the discrepancy can be explained by a lower body weight. Physical weight-bearing activity does not seem to completely compensate for the side effects of reduced estrogen levels even in weight-bearing bones in the lower extremity and spine.

Skin strain patterns provide kinaesthetic information to the human central nervous system.

PubMed Central

Edin, B B; Johansson, N

1995-01-01

1. We investigated the contribution of skin strain-related sensory inputs to movement perception and execution in five normal volunteers. The dorsal and palmar skin of the middle phalanx and the proximal interphalangeal (PIP) joint were manipulated to generate specific strain patterns in the proximal part of the index finger. To mask sensations directly related to this manipulation, skin and deeper tissues were blocked distal to the mid-portion of the proximal phalanx of the index finger by local anaesthesia. 2. Subjects were asked to move their normal right index finger either to mimic any perceived movements of the anaesthetized finger or to touch the tip of the insentient finger. 3. All subjects readily reproduced actual movements induced by the experimenter at the anaesthetized PIP joint. However, all subjects also generated flexion movements when the experimenter did not induce actual movement but produced deformations in the sentient proximal skin that were similar to those observed during actual PIP joint flexion. Likewise, the subjects indicated extension movement at the PIP joint when strain patterns corresponding to extension movements were induced. 4. In contrast, when the skin strain in the proximal part of the index finger was damped by a ring applied just proximal to the PIP joint within the anaesthetized skin area, both tested subjects failed to perceive PIP movements that actually took place.(ABSTRACT TRUNCATED AT 250 WORDS) Images Figure 2 Figure 3 PMID:7473253

Regions of conservation and divergence in the 3' untranslated sequences of genomic RNA from Ross River virus isolates.

PubMed

Faragher, S G; Dalgarno, L

1986-07-20

The 3' untranslated (UT) sequences of the genomic RNAs of five geographic variants of the alphavirus Ross River virus (RRV) were determined and compared with the 3' UT sequence of RRV T48, the prototype strain. Part of the 3' UT region of Getah virus, a close serological relative of RRV, was also sequenced. The RRV 3' UT region varies markedly in length between variants. Large deletions or insertions, sequence rearrangements and single nucleotide substitutions are observed. A sequence tract of 49 to 58 nucleotides, which is repeated as four blocks in the RRV T48 3' UT region, occurs only once in the 3' UT region of one RRV strain (NB5092), indicating that the existence of repeat sequence blocks is not essential for RRV replication. However, the precise sequence of the 3' proximal copy of the repeat block and its position relative to the poly(A) tail were identical in all RRV isolates examined, suggesting that it has an important role in RRV replication. Nucleotide substitutions between RRV variants are distributed non-randomly along the length of the 3' UT region. The sequence of 120 to 130 nucleotides adjacent to the poly(A) tail is strongly conserved. Getah virus RNA contains three repeat sequence blocks in the 3' UT region. These are similar in sequence to those in RRV RNA but differ in their arrangement. Homology between the RRV and Getah 3' UT sequences is greatest in the 3' proximal repeat sequence block that shows three differences in 49 nucleotides. The 3' proximal repeat in Getah RNA occurs at the same position, relative to the poly(A) tail, as in all RRV variants. The RRV and Getah virus 3' UT sequences show extensive homology in the region between the 3' proximal repeat and the poly(A) tail but, apart from the repeat blocks themselves, they show no significant homology elsewhere.

[Clinical report of hereditary motor and sensory neuropathy with proximal dominance in Shiga prefecture].

PubMed

Takahashi, Mitsuo; Mitsui, Yoshiyuki; Yorifuji, Shiro; Nakamura, Yuusaku; Tsukamoto, Yoshihumi; Nishimoto, Kazuhiro

2007-09-01

We followed eight hereditary motor and sensory neuropathy patients with proximal dominance (HMSN-P) in Shiga prefecture from 1984 to 2007. There were 4 men and 4 women from two families showing autosomal and dominant prepotency. These families were related by marriage. The average onset of disease was at 53.4 +/- 8.9 (40-68) years-old. Initial symptoms were difficulty of standing up, difficulty elevating their arms, limping, or numbness. The main feature was neurogenic muscular atrophy with proximal dominance. All deep tendon reflexes were decreased or nonexistent. Paresthesia in the hands and feet and/or decreased vibratory sense in the legs were found in six patients. High CK blood levels were recognized in three patients. EMG in four patients revealed neurogenic pattern. Nerve conduction study was conducted in two patients. MCV of the median nerve and of the tibial posterior nerve, also SCV of the median nerve and of the sural nerve were within normal range in all nerves. Amplitudes of sensory action potential or of M wave were decreased or nonexistent in five of eight nerves, and distal latency of M waves was delayed in three of four nerves. These data suggests dysfunction of distal parts of the peripheral nerve fibers and axonal degeneration of the nerve trunk. Seven patients have died, and their average death age was 69.1 +/- 8.2 (52-77) years-old. Their average affected period was 16.6 (4-30) years. Their clinical history resembles Okinawa-type HMSN-P, but without the painful muscle cramps which are distinctive Okinawa-type signs.

[Seasonal variation of proximate composition in three commercially important species in the Gulf of Nicoya, Puntarenas, Costa Rica].

PubMed

Rodríguez, Cristian Fonseca; Solera, Fabián Chavarriá; Mejía-Arana, Fernando

2013-03-01

Nutritional value of seafood for human consumption is worldwide recognized. Some information have been generated in other countries, nevertheless, there is limited information describing the chemical composition of some fishery important species caught in the Gulf of Nicoya. For this reason, we studied the levels of proximal components of the edible parts (fresh) of three commercially important species. The meat samples of snook Centropomus unionesis, the shrimp Trachypenaeus byrdi and the bivalve Polymesoda radiata, were collected from the Puntarenas local fish market during the fishing season of February 2009 to January 2010. Proximate composition analysis was determined according to AOAC methodology, and evaluated the moisture content, and protein and lipid composition of shellfish meats. The results indicated that the moisture content ranged from 74.6-80.6g/100g for snook 76.9-80.0g/100g for shrimp and 77.9-89.5g/100g for green mussel. After the moisture, the protein was the most abundant chemical fraction (6.8 to 21g/100g) showing the highest values in February for the shrimp and green mussel, and December for snook. The largest fluctuations in the lipid content were found in the snook, ranging from 0.7g/100g to 5.6g/100g; the highest values in this fraction were found in shrimp, green mussel and snook, for July, February and April samples respectively. Considering these results, we concluded that fish and shrimp species studied are a good alternative for human consumption as a source of protein and low lipid content.

Subclinical hypervitaminosis A in rat: measurements of bone mineral density (BMD) do not reveal adverse skeletal changes.

PubMed

Lind, P M; Johansson, S; Rönn, M; Melhus, H

2006-01-05

We have previously shown that subclinical hypervitaminosis A in rats causes fragile bones. To begin to investigate possible mechanisms for Vitamin A action we extended our previous study. Forty-five mature female Sprague-Dawley rats were divided into three groups, each with 15 animals. They were fed a standard diet containing 12IU Vitamin A per g pellet (control, C), or a standard diet supplemented with 120 IU ("10xC") or 600 IU ("50xC") Vitamin A/g pellet for 12 weeks. At the end of the study, serum retinyl esters were elevated 4- and 20-fold. Although neither average food intake nor final body weights were significantly different between groups, a dose-dependent reduction in serum levels of Vitamin D and E, but not Vitamin K, was found. In the 50xC-group the length of the humerus was the same as in controls, but the diameter was reduced (-4.1%, p<0.05). Peripheral quantitative computed tomography (pQCT) at the diaphysis showed that bone mineral density (BMD) was unchanged and that periosteal circumference had decreased significantly (-3.7%, p<0.05). Ash weight of the humerus was not affected, but since bone volume decreased, volumetric BMD, as measured by the bone ash method, even increased (+2.5%, p<0.05). In conclusion, interference with other fat-soluble Vitamins is a possible indirect mechanism of Vitamin A action. Moreover, BMD measurements do not reveal early adverse skeletal changes induced by moderate excesses of Vitamin A in rats. Since the WHO criterium for osteoporosis is based on BMD, further studies are warranted to examine whether this is also true in humans.

Prediction of elbow joint contact mechanics in the multibody framework.

PubMed

Rahman, Munsur; Cil, Akin; Stylianou, Antonis P

2016-03-01

Computational multibody musculoskeletal models of the elbow joint that are capable of simultaneous and accurate predictions of muscle and ligament forces, along with cartilage contact mechanics can be immensely useful in clinical practice. As a step towards producing a musculoskeletal model that includes the interaction between cartilage and muscle loading, the goal of this study was to develop subject-specific multibody models of the elbow joint with discretized humerus cartilage representation interacting with the radius and ulna cartilages through deformable contacts. The contact parameters for the compliant contact law were derived using simplified elastic foundation contact theory. The models were then validated by placing the model in a virtual mechanical tester for flexion-extension motion similar to a cadaver experiment, and the resulting kinematics were compared. Two cadaveric upper limbs were used in this study. The humeral heads were subjected to axial motion in a mechanical tester and the resulting kinematics from three bones were recorded for model validation. The maximum RMS error between the predicted and measured kinematics during the complete testing cycle was 2.7 mm medial-lateral translation and 9.7° varus-valgus rotation of radius relative to humerus (for elbow 2). After model validation, a lateral ulnar collateral ligament (LUCL) deficient condition was simulated and, contact pressures and kinematics were compared to the intact elbow model. A noticeable difference in kinematics, contact area, and contact pressure were observed for LUCL deficient condition. LUCL deficiency induced higher internal rotations for both the radius and ulna during flexion and an associated medial shift of the articular contact area. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

Proximal opening wedge osteotomy with wedge-plate fixation compared with proximal chevron osteotomy for the treatment of hallux valgus: a prospective, randomized study.

PubMed

Glazebrook, Mark; Copithorne, Peter; Boyd, Gordon; Daniels, Timothy; Lalonde, Karl-André; Francis, Patricia; Hickey, Michael

2014-10-01

Hallux valgus with an increased intermetatarsal angle is usually treated with a proximal metatarsal osteotomy. The proximal chevron osteotomy is commonly used but is technically difficult. This study compares the proximal opening wedge osteotomy of the first metatarsal with the proximal chevron osteotomy for the treatment of hallux valgus with an increased intermetatarsal angle. This prospective, randomized multicenter (three-center) study was based on the clinical outcome scores of the Short Form-36, the American Orthopaedic Foot & Ankle Society forefoot questionnaire, and the visual analog scale for pain, activity, and patient satisfaction. Subjects were assessed prior to surgery and at three, six, and twelve months postoperatively. Surgeon preference was evaluated based on questionnaires and the operative times required for each procedure. No significant differences were found for any of the patients' clinical outcome measurements between the two procedures. The proximal opening wedge osteotomy was found to lengthen, and the proximal chevron osteotomy was found to shorten, the first metatarsal. The intermetatarsal angles improved (decreased) significantly, from 14.8° ± 3.2° to 9.1° ± 2.9 (mean and standard deviation) after a proximal opening wedge osteotomy and from 14.6° ± 3.9° to 11.3° ± 4.0° after a proximal chevron osteotomy (p < 0.05 for both). Operative time required for performing a proximal opening wedge osteotomy is similar to that required for performing a proximal chevron osteotomy (mean and standard deviation, 67.1 ± 16.5 minutes compared with 69.9 ± 18.6 minutes; p = 0.510). Opening wedge and proximal chevron osteotomies have comparable radiographic outcomes and comparable clinical outcomes for pain, satisfaction, and function. The proximal opening wedge osteotomy lengthens, and the proximal chevron osteotomy shortens, the first metatarsal. The proximal opening wedge osteotomy was subjectively less technically demanding and was preferred by the orthopaedic surgeons in this study. Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2014 by The Journal of Bone and Joint Surgery, Incorporated.

Universal functions of nuclear proximity potential for Skyrme nucleus-nucleus interaction in a semiclassical approach

NASA Astrophysics Data System (ADS)

Gupta, Raj K.; Singh, Dalip; Kumar, Raj; Greiner, Walter

2009-07-01

The universal function of the nuclear proximity potential is obtained for the Skyrme nucleus-nucleus interaction in the semiclassical extended Thomas-Fermi (ETF) approach. This is obtained as a sum of the spin-orbit-density-independent and spin-orbit-density-dependent parts of the Hamiltonian density, since the two terms behave differently, the spin-orbit-density-independent part mainly attractive and the spin-orbit-density-dependent part mainly repulsive. The semiclassical expansions of kinetic energy density and spin-orbit density are allowed up to second order, and the two-parameter Fermi density, with its parameters fitted to experiments, is used for the nuclear density. The universal functions or the resulting nuclear proximity potential reproduce the 'exact' Skyrme nucleus-nucleus interaction potential in the semiclassical approach, within less than ~1 MeV of difference, both at the maximum attraction and in the surface region. An application of the resulting interaction potential to fusion excitation functions shows clearly that the parameterized universal functions of nuclear proximity potential substitute completely the 'exact' potential in the Skyrme energy density formalism based on the semiclassical ETF method, including also the modifications of interaction barriers at sub-barrier energies in terms of modifying the constants of the universal functions.

Esophagogastrostomy plus gastrojejunostomy: a novel reconstruction procedure after curative resection for proximal gastric cancer.

PubMed

Chen, Shicai; Li, Jianchang; Liu, Haiying; Zeng, Jun; Yang, Guohua; Wang, Jin; Lu, Weiqun; Yu, Nanrong; Huang, Zhiliang; Xu, Houwei; Zeng, Xiang

2014-03-01

The choice of surgical strategy for patients with proximal gastric cancer remains controversial. In this study, we recommend that a new reconstruction procedure be performed following proximal gastrectomy. We conducted a retrospective study involving 71 patients who underwent gastrectomy for proximal gastric cancer. Clinicopathological features, postoperative complications, nutritional status, and overall survival (OS) rate were compared among three different reconstruction approaches. There were 34 cases of proximal gastrectomy followed by esophagogastrostomy reconstruction (EG), 16 cases of total gastrectomy and Roux-en Y reconstruction (RY) and 21 cases of proximal gastrectomy followed by esophagogastrostomy plus gastrojejunostomy reconstruction (EGJ). Though the clinicopathological features, the nutritional status and OS rate were similar among the three groups of patients, the incidence of reflux esophagitis was significantly higher in the EG group (35.3%) than the RY (6.2%) and EGJ (9.6%) groups(P < 0.05). Few EGJ patients suffered from either reflux esophagitis or anastomotic stenosis. The EGJ reconstruction method helps to resolve the syndrome of reflux esophagitis. Our data indicates that it is a simple, safe, and effective reconstruction procedure for PGC.

[Finite element analysis of lumbar pelvic and proximal femur model with simulate lumbar rotatory manipulation].

PubMed

Hu, Hua; Xiong, Chang-Yuan; Han, Guo-Wu

2012-07-01

To study the changes of displacement and stress in the model of lumbar pelvic and proximal femur during lumbar rotatory manipulation. The date of lumbar pelvic and proximal femur CT scan by Mimics 10.01 software was established a lumbar pelvic and proximal femur geometric model, then the model was modified with Geomagic 9, at last the modified model was imported into hypermesh 10 and meshed with tetrahedron, at the same time,add disc and ligaments. According to the principle of lumbar rotatory manipulation,the lumbar rotatory manipulation were decomposed. The mechanical parameters assigned into the three-dimensional finite element model. The changes of displacement and stress in the model of lunbar pelvic and proximal femur under the four conditions were calculated with Abaqus model of Hypermesh 10. 1) Under the same condition,the displacement order of lumbar was L1>L2>L3>L5 L5, anterior column > middle column > posterior column. 2) Under the different conditions, the displacement order of lumbar,case 3>case 1>case 4>case 2. 3) Under the same conditions, the displacement order of lumbar inter-vertebral disc from L1,2 to L5S1 was L1,2>L2,3>L3,4>L4,5>L5S1, as for the same inter-vertebral disc, the order was: second quadrant>third quadrant>first quadrant>fourth quadrant. 4) Under the different conditions,the displacement order of the inter-vertebral disc was L1,2>L2,3>L3,4>L4,5>L5S1, but to same inter-vertebral disc: case 3>case 4>case 1 >case 2. 5) There were apparent displacement and stress concentration in pelvis and hip during the manipulation. 1) The principles of lumbar rotation manipulation closely related to the relative displacement caused by rotation of various parts of lumbar pelvic and proximal femur model; 2) During the process of lumbar rotatory manipulation, the angle of lateral bending and flexion can not be randomly increased; 3) During the process of lumbar rotatory manipulation, all the conditions of lumbar pelvic and proximal femur must be considered to determine indications and contraindications.

40 CFR Appendix F to Part 112 - Facility-Specific Response Plan

Code of Federal Regulations, 2014 CFR

2014-07-01

... into a wellhead protection area as defined by the Safe Drinking Water Act of 1986 (SDWA). 1 The...) Water intakes (drinking, cooling, or other); (2) Schools; (3) Medical facilities; (4) Residential areas... discharge; (2) Proximity to downgradient wells, waterways, and drinking water intakes; (3) Proximity to fish...

What Kinds of Things Cause Children's Reading Difficulties?

ERIC Educational Resources Information Center

Coltheart, Max

2015-01-01

The first part of this paper explains the distinction between proximal and distal causes of developmental disorders of cognition, with special reference to developmental disorders of reading. A number of different proximal causes of developmental disorders of reading have been identified. These correspond to a number of different patterns of…

Sprouty / FGF signaling regulates the proximal-distal feather morphology and the size of dermal papillae

PubMed Central

Yue, Zhicao; Jiang, Ting Xin; Wu, Ping; Widelitz, Randall B; Chuong, Cheng Ming

2013-01-01

In a feather, there are distinct morphologies along the proximal-distal axis. The proximal part is a cylindrical stalk (calamus), whereas the distal part has barb and barbule branches. Here we focus on what molecular signaling activity can modulate feather stem cells to generate these distinct morphologies. We demonstrate the drastic tissue remodeling during feather cycling which includes initiation, growth and resting phases. In the growth phase, epithelial components undergo progressive changes from the collar growth zone to the ramogenic zone, to maturing barb branches along the proximal- distal axis. Mesenchymal components also undergo progressive changes from the dermal papilla, to the collar mesenchyme, to the pulp along the proximal- distal axis. Over-expression of Spry4, a negative regulator of receptor tyrosine kinases, promotes barb branch formation at the expense of the epidermal collar. It even induces barb branches from the follicle sheath (equivalent to the outer root sheath in hair follicles). The results are feathers with expanded feather vane regions and small or missing proximal feather shafts (the calamus). Spry4 also expands the pulp region while reducing the size of dermal papillae, leading to a failure to regenerate. In contrast, over-expressing Fgf10 increases the size of the dermal papillae, expands collar epithelia and mesenchyme, but also prevents feather branch formation and feather keratin differentiation. These results suggest that coordinated Sprouty/FGF pathway activity at different stages is important to modulate feather epidermal stem cells to form distinct feather morphologies along the proximal-distal feather axis. PMID:23000358

Proximity correction of high-dosed frame with PROXECCO

NASA Astrophysics Data System (ADS)

Eisenmann, Hans; Waas, Thomas; Hartmann, Hans

1994-05-01

Usefulness of electron beam lithography is strongly related to the efficiency and quality of methods used for proximity correction. This paper addresses the above issue by proposing an extension to the new proximity correction program PROXECCO. The combination of a framing step with PROXECCO produces a pattern with a very high edge accuracy and still allows usage of the fast correction procedure. Making a frame with a higher dose imitates a fine resolution correction where the coarse part is disregarded. So after handling the high resolution effect by means of framing, an additional coarse correction is still needed. Higher doses have a higher contribution to the proximity effect. This additional proximity effect is taken into account with the help of the multi-dose input of PROXECCO. The dose of the frame is variable, depending on the deposited energy coming from backscattering of the proximity. Simulation proves the very high edge accuracy of the applied method.

Surgical anatomy of the radial nerve at the elbow.

PubMed

Artico, M; Telera, S; Tiengo, C; Stecco, C; Macchi, V; Porzionato, A; Vigato, E; Parenti, A; De Caro, R

2009-02-01

An anatomical study of the brachial portion of the radial nerve with surgical implications is proposed. Thirty specimens of arm from 20 fresh cadavers (11 male, 9 female) were used to examine the topographical relations of the radial nerve with reference to the following anatomical landmarks: acromion angle, medial and lateral epicondyles, point of division between the lateral and long heads of the triceps brachii, lateral intermuscular septum, site of division of the radial nerve into its superficial and posterior interosseous branches and entry and exit point of the posterior interosseous branch into the supinator muscle. The mean distances between the acromion angle and the medial and lateral levels of crossing the posterior aspect of the humerus were 109 (+/-11) and 157 (+/-11) mm, respectively. The mean length and calibre of the nerve in the groove were 59 (+/-4) and 6 (+/-1) mm, respectively. The division of the lateral and long heads of the triceps was found at a mean distance of 126 (+/-13) mm from the acromion angle. The mean distances between the lateral point of crossing the posterior aspect of the humerus and the medial and lateral epicondyles were 125 (+/-13) and 121 (+/-13) mm, respectively. The mean distance between the lateral point of crossing the posterior aspect of the humerus and the entry point in the lateral intermuscular septum (LIS) was 29 (+/-6) mm. The mean distances between the entry point of the nerve in the LIS and the medial and lateral epicondyles were 133 (+/-14) and 110 (+/-23) mm, respectively. Our study provides reliable and objective data of surgical anatomy of the radial nerve which should be always kept in mind by surgeons approaching to the surgery of the arm, in order to avoid iatrogenic injuries.

Effects of humerus intraosseous versus intravenous amiodarone administration in a hypovolemic porcine model.

PubMed

Holloway, Cpt Monica M; Jurina, Cpt Shannan L; Orszag, Cpt Joshua D; Bragdon, Lt George R; Green, Lt Rustin D; Garcia-Blanco, Jose C; Benham, Brian E; Adams, Ltc Timothy S; Johnson, Don

2016-01-01

To compare the effects of amiodarone administration by humerus intraosseous (HIO) and intravenous (IV) routes on return of spontaneous circulation (ROSC), time to maximum concentration (Tmax), maximum plasma drug concentration (Cmax), time to ROSC, and mean concentrations over time in a hypovolemic cardiac arrest model. Prospective, between subjects, randomized experimental design. TriService Research Facility. Yorkshire-cross swine (n = 28). Swine were anesthetized and placed into cardiac arrest. After 2 minutes, cardiopulmonary resuscitation was initiated. After an additional 2 minutes, amiodarone 300 mg was administered via the HIO or the IV route. Blood samples were collected over 5 minutes. The samples were analyzed using high-performance liquid chromatography tandem mass spectrometry. ROSC, Tmax, Cmax, time to ROSC, and mean concentrations over time. There was no difference in ROSC between the HIO and IV groups; each had five achieve ROSC and two that did not (p = 1). There was no difference in Tmax (p = 0.501) or in Cmax between HIO and IV groups (p = 0.232). Means ± standard deviations in seconds were 94.3 ± 78.3 compared to 115.7 ± 87.3 in the IV versus HIO groups, respectively. The mean ± standard deviation in nanograms per milliliter for the HIO was 49,041 ± 21,107 and 74,258 ± 33,176 for the IV group. There were no significant differences between the HIO and IV groups relative to time to ROSC (p = 0.220). A repeated analysis of variance indicated that there were no significant differences between the groups relative to concentrations over time (p > 0.05). The humerus intraosseous provides rapid and reliable access to administer life-saving medications during cardiac arrest.

Radiographic changes differ between two different short press-fit humeral stem designs in total shoulder arthroplasty.

PubMed

Denard, Patrick J; Noyes, Matthew P; Walker, J Brock; Shishani, Yousef; Gobezie, Reuben; Romeo, Anthony A; Lederman, Evan

2018-02-01

The purpose of this study was to compare the radiographic changes of the humerus in the short term after total shoulder arthroplasty with two different short-stem humeral components. The hypothesis was that there would be no difference in radiographic changes or functional outcome based on component type. A retrospective review was conducted of primary total shoulder arthroplasties performed with a short press-fit humeral component. Group A included a collarless humeral stem with an oval geometry and curved stem (Ascend or Ascend Flex; Wright Medical, Memphis, TN, USA). Group B included a humeral stem with a metaphyseal collar, rectangular geometry, and straight stem (Apex; Arthrex, Inc., Naples, FL, USA). Radiographic changes and functional outcome were evaluated at a minimum of 2 years postoperatively. There were 42 patients in group A and 35 patients in group B available for analysis. There was no difference in functional outcome between the groups. In group A, the mean total radiographic change score of the humerus was 3.9, with changes classified as low in 38% and high in 62%. In group B, the mean total radiographic change score of the humerus was 2.5, with changes classified as low in 77% and high in 23% (P < .001). Medial calcar osteolysis was present in 71% of group A compared with 28.5% of group B (P < .001). At short-term follow-up, there is no difference in functional outcome or revision between 2 different humeral stem designs. However, bone adaptive changes and the rate of medial calcar osteolysis are significantly different. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

A regression-based 3-D shoulder rhythm.

PubMed

Xu, Xu; Lin, Jia-hua; McGorry, Raymond W

2014-03-21

In biomechanical modeling of the shoulder, it is important to know the orientation of each bone in the shoulder girdle when estimating the loads on each musculoskeletal element. However, because of the soft tissue overlying the bones, it is difficult to accurately derive the orientation of the clavicle and scapula using surface markers during dynamic movement. The purpose of this study is to develop two regression models which predict the orientation of the clavicle and the scapula. The first regression model uses humerus orientation and individual factors such as age, gender, and anthropometry data as the predictors. The second regression model includes only the humerus orientation as the predictor. Thirty-eight participants performed 118 static postures covering the volume of the right hand reach. The orientation of the thorax, clavicle, scapula and humerus were measured with a motion tracking system. Regression analysis was performed on the Euler angles decomposed from the orientation of each bone from 26 randomly selected participants. The regression models were then validated with the remaining 12 participants. The results indicate that for the first model, the r(2) of the predicted orientation of the clavicle and the scapula ranged between 0.31 and 0.65, and the RMSE obtained from the validation dataset ranged from 6.92° to 10.39°. For the second model, the r(2) ranged between 0.19 and 0.57, and the RMSE obtained from the validation dataset ranged from 6.62° and 11.13°. The derived regression-based shoulder rhythm could be useful in future biomechanical modeling of the shoulder. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

The massive fossil humerus from the Oldowan horizon of Gombore I, Melka Kunture (Ethiopia, >1.39 Ma)

NASA Astrophysics Data System (ADS)

Di Vincenzo, Fabio; Rodriguez, Laura; Carretero, José Miguel; Collina, Carmine; Geraads, Denis; Piperno, Marcello; Manzi, Giorgio

2015-08-01

A well-preserved distal portion of a left humerus was discovered in 1976 during excavations directed by J. Chavaillon at the Gombore I site, in the Melka Kunture area (Ethiopia). The specimen, labelled Gombore IB-7594 (formally Melka Kunture 3, or MK3), was found in situ within unit 2 of level B, which is dated to >1.39 Ma and includes a rich Oldowan Paleolithic assemblage. Although MK3 has never been described in detail, it appeared in the literature several times and, from a taxonomic point of view, has been alternatively regarded as Homo, Australopithecus or Paranthropus. According to our analysis, MK3 exhibits a suite of features that fit the variability of the genus Homo and does not display any clear Australopithecus/Paranthropus affinity. Nevertheless, MK3 adds a great deal of variability to the genus Homo, at least as far as the Early Pleistocene fossil record is concerned. In particular, our quantitative approach, which combines traditional morphometric analyses and geometric morphometrics, highlights traits that are uncommon among the Plio-Pleistocene fossil record, while affinities with Mid-to-Late Pleistocene representatives of Homo are observed. In addition, the large size of MK3 suggests that this humerus belonged to an individual whose body weight approached 90 kg, far from the range of body size known for Homo representatives in the Early Pleistocene and as big as those of extant humans or even gorillas. We suggest that such peculiar features are of interest when regarded from an ecological perspective; thus, dimension and morphology of MK3 may be considered as an exaptation that became useful when early humans dispersed to high altitudes such as those of the upper Awash basin on the Ethiopian plateau, at heights above 2000 m.

Linkage analysis in a Dutch family with X-linked recessive congenital stationary night blindness (XL-CSNB).

PubMed

Berger, W; van Duijnhoven, G; Pinckers, A; Smits, A; Ropers, H H; Cremers, F

1995-01-01

Linkage analysis has been performed in a large Dutch pedigree with X-linked recessive congenital stationary night blindness (CSNB) by utilizing 16 DNA markers from the proximal short arm of the human X chromosome (Xp21.1-11.2). Thirteen polymorphic markers are at least partially informative and have enabled pairwise and multipoint linkage analysis. For three loci, i.e. DXS228, the monoamine oxidase B gene and the Norrie disease gene (NDG), multipoint linkage studies have yielded maximum lod scores of > 3.0 at a recombination fraction of zero. Analysis of recombination events has enabled us to rule out the possibility that the underlying defect in this family is allelic to RP3; the gene defect could also be excluded from the proximal part of the region known to carry RP2. Linkage data are consistent with a possible involvement of the NDG but mutations in the open reading frame of this gene have not been found.

Effects of the Proximal Home Environment on Language and Behavioral Outcomes in Children Prenatally Exposed to Cocaine

ERIC Educational Resources Information Center

Bono, Katherine E.; Dinehart, Laura H. Bolzani; Dobbins, Dionne R.; Claussen, Angelika H.

2008-01-01

Proximal environmental variables illustrate aspects of the environment that are experienced directly and specifically by the child. The current study examined the associations between three proximal environmental variables: (1) quality of the home environment, (2) regularity of family routines and (3) frequency of parenting daily hassles and…

Unusual localizations of unicameral bone cysts and aneurysmal bone cysts: A retrospective review of 451 cases.

PubMed

Aycan, Osman Emre; Çamurcu, İsmet Yalkın; Özer, Devrim; Arıkan, Yavuz; Kabukçuoğlu, Yavuz Selim

2015-06-01

Unicameral bone cysts (UBC) and aneurysmal bone cysts (ABC) are benign cystic lesions of bone which are easily diagnosed. However, unusual locations may lead to a false diagnosis. Therefore the aim of this retrospective study was to determine the frequency of unusual localizations. The authors studied 451 cases with histopathologically confirmed diagnosis of UBC or ABC, seen between 1981 and 2012. In the UBC group (352 cases) humerus, femur and calcaneus were found to be the most common sites, while acetabulum, scapula, scaphoid, lunatum, metacarpals, metatarsals, toe phalanges and ulna each accounted for less than 1%. In the ABC group (99 cases) the most common sites of involvement were femur, humerus and tibia, while finger phalanges, ilium, acetabulum, pubis, calcaneus, cuboid, and toe phalanges each accounted for only 1%. The differential diagnosis of cystic bone lesions should include both UBC and ABC. Pain complaints plead for the latter, except in case of fracture.

The role of total elbow arthroplasty in traumatology.

PubMed

Mansat, P; Bonnevialle, N; Rongières, M; Bonnevialle, P

2014-10-01

Fractures of the distal humerus account for 5% of osteoporotic fractures in subjects older than 60 years. A history of osteoporosis, co-morbidities, and joint comminution make their management difficult. The therapeutic options are limited to functional treatments, osteosynthesis, or either partial or total arthroplasty. Functional treatment of distal humerus fractures in the elderly subject provide inconsistent results, often with persistence of pain with a stiff or unstable elbow. Osteosynthesis remains the reference treatment for these fractures, following the principle of stable and rigid osteosynthesis allowing early mobilization. However, joint comminution and a history of osteoporosis occasionally make it impossible to meet this objective, with a considerable rate of complications and surgical revisions. Total elbow arthroplasty remains an alternative to osteosynthesis with very satisfactory immediate results restoring a painless, stable, and functional elbow. These results seem reproducible and sustainable over time. The complication rate is not uncommon with an approximately 10% surgical revision rate. Elbow hemiarthroplasty remains to be validated in this indication. V. Copyright © 2014 Elsevier Masson SAS. All rights reserved.

Surgical anatomy of latissimus dorsi muscle in transfers about the shoulder.

PubMed

Goldberg, Benjamin A; Elhassan, Bassem; Marciniak, Steven; Dunn, Jonathan H

2009-03-01

Transfer of the latissimus dorsi to the greater tuberosity has been used successfully in the treatment of massive rotator-cuff deficiency. For safe release and transfer of the tendon, the variations in the tendinous insertions of the latissimus dorsi and teres major onto the humerus need to be understood. In anatomical dissection of 12 cadavers, mean width of the latissimus tendon was 3.3 cm at its insertion, and mean length was 7.3 cm. In all specimens, there were fascial connections between the latissimus and teres major and between the latissimus and the long head of the triceps. There were 3 insertion patterns of the latissimus dorsi tendon onto the humerus with respect to the tendon of the teres major: completely separate (8 cadavers), loosely bound (3 cadavers), and completely joined (1 cadaver). If the latissimus dorsi were being transferred in the last type, the teres major would need to be transferred with the latissimus dorsi as a common musculotendinous unit.

[The Extended Deltoid-Split Approach for Plating Four-Part Proximal Humeral Fractures].

PubMed

Schiffer, G; Sayar, A; Thelen, U

2016-08-01

The deltoideopectoral approach is established as the gold standard in the surgical treatment of proximal humeral fractures. As an alternative, we demonstrate the extended deltoid approach with an intraoperative video. A direct lateral incision is performed and the anterior parts of the axillary nerve are identified and preserved. In our experience, this approach allows improved visualisation of the greater tuberosity and easier positioning of locking plates. Clinically relevant neurological injuries cannot be seen in our patients or in the literature. Georg Thieme Verlag KG Stuttgart · New York.

The Zone of Proximal "Teacher" Development

ERIC Educational Resources Information Center

Warford, Mark K.

2011-01-01

Toward the end of his short life, Lev Vygotsky found himself teaching teachers in a remote part of the USSR. Though his influence as a developmental psychologist is well-established, little is known about his approach to teacher development. This article applies the researcher's core concept, the zone of proximal development to teacher education.…

Bioceramic inlays do not improve mechanical incorporation of grit-blasted titanium stems in the proximal sheep femur.

PubMed

Keränen, Pauli; Koort, Jyri; Itälä, Ari; Ylänen, Heimo; Dalstra, Michel; Hupa, Mikko; Kommonen, Bertel; Aro, Hannu T

2010-03-15

The aim of the present study was to determine, if bioactive glass (BG) surface inlays improve osseointegration of titanium implants in the proximal femur of adult sheep. In simulation of uncemented primary stems (nine animals), only the proximal part of the implants was grit-blasted and three surface slots of the grit-blasted region were filled with sintered BG microspheres. Primary stems were implanted using press-fit technique. In revision stem simulation (eight animals), grit-blasting was extended over the whole implant and seven perforating holes of the stem were filled by sintered BG granules. Revision stems were implanted with a mixture of autogenous bone graft and BG granules. Comparison with solid partially or fully grit-blasted control stems implanted in the contralateral femurs was performed in the primary and revision stem experiments at 12 and 25 weeks, respectively. Implant incorporation was evaluated by torsional failure testing and histomorphometry. Only one-third of the primary stems anchored mechanically to bone. The revision stems incorporated better and the BG inlays of the revision stems showed ingrowth of new bone. However, there were no significant differences in the torsional failure loads between the stems with BG inlays and the control stems. In conclusion, surface BG inlays gave no measurable advantage in mechanical incorporation of grit-blasted titanium implants. Overall, the proximal sheep femur, characterized by minimal amount of cancellous bone and the presence of adipocytic bone marrow, seemed to present compromised bone healing conditions. (c) 2009 Wiley Periodicals, Inc.

97% accuracy of intra-articular glenohumeral injection with a modified (Delaware) posterior bone touch technique.

PubMed

Axe, Jeremie M; Axe, Michael J

2013-10-01

Unguided approaches have not demonstrated evidence of highly accurate intra-articular glenohumeral injections. The purpose of this study was to assess the accuracy of a posterior approach bone touch technique in conscious subjects without shoulder pathology as a first step in developing an accurate, reliable technique for use in patients. Twenty-six young subjects (age 22-26) without shoulder pathology (BMI 24 +/- 3), had bilateral shoulders injected while awake and seated. A 20 gauge 3.5-inch needle was introduced 1.5 cm below the scapular spine mid-way between the posterior lateral acromial corner and the posterior axillary crease. In Trial I, 20 shoulders were injected. After touching the humerus, the arm was oscillated. The needle advanced to 4-5 cm and 10 mL of dye injected. Pop and ease of flow were recorded. Immediate room change, spot fluoroscopy, and independent experienced radiology reading followed. In Trial II, 32 shoulders were injected. The technique was modified to touching the humerus, externally rotating the arm 25 degrees, and while remaining in bone contact, delivering 10 mL of dye. The same data as Trial I was recorded. In Trial I, 14/20 (70 percent) had dye within the glenohumeral joint. Five of seven failures were too anterior showing dye around the subscapularis muscle and all were associated with a pop. In Trial II, 31/32 (97 percent) had dye within glenohumeral joint. Twenty-three of 32 (72 percent) had a "pop," including the failure. Overall, 45/52 (87 percent) had dye within glenohumeral joint. Thirty-one of 52 (71 percent) of all shoulders had a "pop." Twenty-three of 52 (44 percent) shoulders had pain, resolving within 24 hours. A modified (Delaware) posterior bone touch technique for glenohumeral joint injection is 97 percent accurate in conscious healthy young subjects. Pop and ease of flow are not always indicative of correct needle placement. This study serves as an important first step in determining an optimum approach for injecting pathologic glenohumeral joints with corticosteroids or hyaluronic acid. IV Case Series.

The role of proximal body information on anticipatory judgment in tennis using graphical information richness

PubMed Central

Ida, Hirofumi; Ogata, Takahiro; Ishii, Motonobu; Higuchi, Takahiro

2017-01-01

Objective Recent studies have reported that skilled tennis players are likely to use proximal body information for anticipating the direction of their opponent’s forehand shot. However, in these studies, the visual stimuli did not include visual information about the ball. Skilled players may have used proximal information owing to the lack of distal information. To address this issue, we developed a novel methodological approach using computer graphics (CG) images in which the entire body was presented by a combination of point-light display (i.e., poor graphical information, PLD) and polygons (i.e., rich graphical information). Using our novel methodological approach, we examined whether skilled tennis players use proximal body information when anticipating shot directions. Methods and results Fifteen skilled tennis players and fifteen novice players tried to anticipate shot directions by observing four CG forehand strokes (ALPOL: all body parts were represented with polygon; RAPLD: racket and arm were represented with PLD; BOPLD: body parts without racket and arm were represented with PLD; and ALPLD: all body parts were represented with PLD). Our intention in creating CG models with such combinations (i.e., RAPLD and BOPLD) was that because of the richer graphical information provided by polygons compared to PLD, the participant’s anticipatory judgment would be influenced more by body parts expressed with polygons. The results showed that for skilled players, anticipatory judgment was more accurate when they observed RAPLD than when they observed BOPLD and ALPLD. In contrast, for novice players, there were no differences in the accuracy of anticipatory judgments with the four CG models. Conclusions Only skilled players made more accurate anticipatory judgments when body regions were expressed with rich graphical information, and the racket and arm were expressed with poor graphical information. These suggest that skilled players used proximal information to effectively anticipate shot directions. PMID:28704485

Properties of acetylcholine-induced relaxation of smooth muscle isolated from the proximal colon of the guinea-pig.

PubMed

Kodama, Youhei; Iino, Satoshi; Shigemasa, Yuhsuke; Suzuki, Hikaru

2010-01-01

The properties of mechanical responses elicited by stimulation with acetylcholine (ACh) were investigated in circular smooth muscle preparations isolated from the proximal colon of guinea-pig. Application of ACh (10(-8)-10(-6) M) for 3-5 min produced a biphasic response, with an initial contraction followed by a relaxation. Atropine inhibited the initial contraction, while N(ω)-nitro-L-arginine (L-NA) inhibited the relaxation, suggesting that the former was produced by activation of muscarinic receptors while the latter was produced by an elevated production of nitric oxide (NO). In the presence of atropine, the ACh-relaxation was attenuated by removal of the mucosa and abolished by removal of both submucosal and mucosal layers. The ACh-induced relaxation was also attenuated by either tetrodotoxin (TTX, 3 × 10(-7) M) or hexamethonium (10(-6) M). In the presence of atropine, transmural nerve stimulation (TNS) elicited a biphasic response, with an initial phasic contraction followed by a relaxation. The amplitude of TNS-induced relaxation was significantly reduced by hexamethonium or L-NA and was abolished by TTX. Both ACh and TNS produced relaxation in preparations isolated from the proximal colon, but not in those from the middle part of colon. Immunohistochemistry for neuronal nitric oxide synthase revealed no difference in the distribution of nitrergic nerves between the proximal and middle part of the colon, with nitrergic nerves in both the mucosal and submucosal layers as well as in the smooth muscle and myenteric layers. These results suggest that ACh induces NO production by excitation of postganglionic nerves distributed mainly in the mucosal and submucosal layers. In circular smooth muscle preparations isolated from the middle part of colon, ACh or TNS produced contractile responses alone, with no associated relaxation, suggesting that the ACh-activated postganglionic nitrergic nerves are distributed in the mucosal and submucosal layers of the proximal colon but not in the middle part of the colon.

Usefulness of two- and three-dimensional transesophageal echocardiography in the assessment of proximal left coronary system compression by a paraprosthetic aortic valve abscess.

PubMed

Ahmad, Amier; McElwee, Samuel K; Jiang, Amy Z; Barssoum, Kirolos N; Elkaryoni, Ahmed E; Arisha, Mohammed J; Srialluri, Swetha; Seghatol, Frank; Nanda, Navin C

2017-02-01

Paraprosthetic aortic valve abscess represents a rare, but lethal complication of infective endocarditis. We report a case of proximal left coronary system compression by a paraprosthetic aortic valve abscess whose detection was augmented using live/real time three-dimensional transesophageal echocardiography. Our case illustrates the usefulness of combined two- and three-dimensional transesophageal echocardiography in detecting this finding. © 2017, Wiley Periodicals, Inc.

Reservoir sedimentology of the Big Injun sandstone in Granny Creek field, West Virginia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Zou, Xiangdong; Donaldson, K.; Donaldson, A.C.

1992-01-01

Big Injun sandstones of Granny Creek oil field (WV) are interpreted as fluvial-deltaic deposits from core and geophysical log data. The reservoir consists of two distinctive lithologies throughout the field; fine-grained sandstones overlain by pebbly and coarse-grained sandstones. Lower fine-grained sandstones were deposited in westward prograding river-mouth bars, where distal, marine-dominant proximal, and fluvial-dominant proximal bar subfacies are recognized. Principal pay is marine-influenced proximal bar, where porosity ranges from 13 to 23% and permeability, up to 24 md. Thin marine transgressive shales and their laterally equivalent low-permeability sandstones bound time-rock sequences generally less than 10 meters thick. Where field mapped,more » width of prograding bar sequence is approximately 2.7 km (dip trend), measured from truncated eastern edge (pre-coarse-grained member erosional surface) to distal western margin. Dip-trending elongate lobes occur within marine-influenced proximal mouth-bar area, representing thickest part of tidally influenced preserved bar. Upper coarse-grained part of reservoir consists of pebbly sandstones of channel fill from bedload streams. Laterally persistent low permeability cemented interval in lower part commonly caps underlying pay zone and probably serves as seal to vertical oil migration. Southwest paleoflow trends based on thickness maps of unit portent emergence of West Virginia dome, which influences erosion patterns of pre-Greenbrier unconformity for this combination oil trap.« less

Variability of medial and posterior offset in patients with fourth-generation stemmed shoulder arthroplasty.

PubMed

Irlenbusch, Ulrich; Berth, Alexander; Blatter, Georges; Zenz, Peter

2012-03-01

Most anthropometric data on the proximal humerus has been obtained from deceased healthy individuals with no deformities. Endoprostheses are implanted for primary and secondary osteoarthritis, rheumatoid arthritis,humeral-head necrosis, fracture sequelae and other humeral-head deformities. This indicates that pathologicoanatomical variability may be greater than previously assumed. We therefore investigated a group of patients with typical shoulder replacement diagnoses, including posttraumatic and rheumatic deformities. One hundred and twenty-two patients with a double eccentrically adjustable shaft endoprosthesis served as a specific dimension gauge to determine in vivo the individual humeral-head rotation centres from the position of the adjustable prosthesis taper and the eccentric head. All prosthesis heads were positioned eccentrically.The entire adjustment range of the prosthesis of 12 mm medial/lateral and 6 mm dorsal/ventral was required. Mean values for effective offset were 5.84 mm mediolaterally[standard deviation (SD) 1.95, minimum +2, maximum +11]and 1.71 mm anteroposteriorly (SD 1.71, minimum −3,maximum 3 mm), averaging 5.16 mm (SD 1.76, minimum +2,maximum + 10). The posterior offset averaged 1.85 mm(SD 1.85, minimum −1, maximum + 6 mm). In summary, variability of the combined medial and dorsal offset of the humeral-head rotational centre determined in patients with typical underlying diagnoses in shoulder replacement was not greater than that recorded in the literature for healthy deceased patients.The range of deviation is substantial and shows the need for an adjustable prosthetic system.

Morphologic Variability of the Shoulder between the Populations of North American and East Asian.

PubMed

Cabezas, Andres F; Krebes, Kristi; Hussey, Michael M; Santoni, Brandon G; Kim, Hyuong Sik; Frankle, Mark A; Oh, Joo Han

2016-09-01

The aim of this study was to determine if there were significant differences in glenohumeral joint morphology between North American and East Asian populations that may influence sizing and selection of shoulder arthroplasty systems. Computed tomography reconstructions of 92 North American and 58 East Asian patients were used to perform 3-dimensional measurements. The proximal humeral position was normalized in all patients by aligning it with the scapular plane utilizing anatomic landmarks. Measurements were performed on the humerus and scapula and included coronal and axial humeral head radius, humeral neck shaft and articular arc angles, glenoid height and width, and critical shoulder angle. Glenohumeral relationships were also measured and included lateral distance to the greater tuberosity and acromion, abduction lever arm, and acromial index. Parametric and nonparametric statistical analyses were used to compare population metrics. East Asian glenohumeral measurements were significantly smaller for all linear metrics (p < 0.05), with the exception of acromial length, which was greater than in the North American cohort (p < 0.001). The increase in acromial length affected all measurements involving the acromion including abduction lever arms. No difference was found between the neck shaft and articular angular measurements. The East Asian population exhibited smaller shoulder morphometrics than their North American cohort, with the exception of an extended acromial overhang. The morphologic data can provide some additional factors to consider when choosing an optimal shoulder implant for the East Asian population, in addition to creating future designs that may better accommodate this population.

Gait abnormalities caused by selective anesthesia of the suprascapular nerve in horses.

PubMed

Devine, Dustin V; Jann, Henry W; Payton, Mark E

2006-05-01

To assess gait abnormalities associated with selective anesthesia of the suprascapular nerve (SSN) achieved by use of perineural catheterization and thereby determine the function of that nerve as it relates to gait in horses. 3 adult horses with no preexisting clinically apparent lameness at a walk. Each horse was anesthetized; the right SSN was exposed surgically for placement of a perineural catheter to permit delivery of 1 mL of 2% mepivacaine hydrochloride. Six hours after recovery from anesthesia, each horse was videotaped while walking (50-step data acquisition period) before and after administration of mepivacaine. Videotapes were reviewed and the proportion of abnormal steps before and after selective SSN anesthesia was assessed. A step was considered abnormal if a marked amount of scapulohumeral joint instability (ie, lateral luxation of the proximal portion of the humerus) was observed during the weight-bearing phase of the stride. Clinically apparent gait dysfunction was detected in all 3 horses following perineural administration of the local anesthetic agent. Anesthesia of the SSN resulted in scapulohumeral joint instability as evidenced by consistent lateral excursion of the shoulder region during the weight-bearing phase of gait at a walk. The proportion of abnormal steps before and after SSN anesthesia was significantly different in all 3 horses. These data support the role of the SSN in shoulder joint stability in horses and define SSN dysfunction as 1 mechanism by which the syndrome and gait dysfunction clinically referred to as sweeny may develop.

Fracture risk in patients with type 2 diabetes mellitus and possible risk factors: a systematic review and meta-analysis

PubMed Central

Moayeri, Ardeshir; Mohamadpour, Mahmoud; Mousavi, Seyedeh Fatemeh; Shirzadpour, Ehsan; Mohamadpour, Safoura; Amraei, Mansour

2017-01-01

Aim Patients with type 2 diabetes mellitus (T2DM) have an increased risk of bone fractures. A variable increase in fracture risk has been reported depending on skeletal site, diabetes duration, study design, insulin use, and so on. The present meta-analysis aimed to investigate the association between T2DM with fracture risk and possible risk factors. Methods Different databases including PubMed, Institute for Scientific Information, and Scopus were searched up to May 2016. All epidemiologic studies on the association between T2DM and fracture risk were included. The relevant data obtained from these papers were analyzed by a random effects model and publication bias was assessed by funnel plot. All analyses were done by R software (version 3.2.1) and STATA (version 11.1). Results Thirty eligible studies were selected for the meta-analysis. We found a statistically significant positive association between T2DM and hip, vertebral, or foot fractures and no association between T2DM and wrist, proximal humerus, or ankle fractures. Overall, T2DM was associated with an increased risk of any fracture (summary relative risk =1.05, 95% confidence interval: 1.04, 1.06) and increased with age, duration of diabetes, and insulin therapy. Conclusion Our findings strongly support an association between T2DM and increased risk of overall fracture. These findings emphasize the need for fracture prevention strategies in patients with diabetes. PMID:28442913

Hip dysplasia, pelvic obliquity, and scoliosis in cerebral palsy: a qualitative analysis using 3D CT reconstruction

NASA Astrophysics Data System (ADS)

Russ, Mark D.; Abel, Mark F.

1998-06-01

Five patients with cerebral palsy, hip dysplasia, pelvic obliquity, and scoliosis were evaluated retrospectively using three dimensional computed tomography (3DCT) scans of the proximal femur, pelvis, and lumbar spine to qualitatively evaluate their individual deformities by measuring a number of anatomical landmarks. Three dimensional reconstructions of the data were visualized, analyzed, and then manipulated interactively to perform simulated osteotomies of the proximal femur and pelvis to achieve surgical correction of the hip dysplasia. Severe deformity can occur in spastic cerebral palsy, with serious consequences for the quality of life of the affected individuals and their families. Controversy exists regarding the type, timing and efficacy of surgical intervention for correction of hip dysplasia in this population. Other authors have suggested 3DCT studies are required to accurately analyze acetabular deficiency, and that this data allows for more accurate planning of reconstructive surgery. It is suggested here that interactive manipulation of the data to simulate the proposed surgery is a clinically useful extension of the analysis process and should also be considered as an essential part of the pre-operative planning to assure that the appropriate procedure is chosen. The surgical simulation may reduce operative time and improve surgical correction of the deformity.

The race to decipher the top secrets of TOP mRNAs.

PubMed

Meyuhas, Oded; Kahan, Tamar

2015-07-01

Cells encountering hostile growth conditions, like those residing in the middle of a newly developing solid tumor, conserve resources and energy by downregulating protein synthesis. One mechanism in this response is the translational repression of multiple mRNAs that encode components of the translational apparatus. This coordinated translational control is carried through a common cis-regulatory element, the 5' Terminal OligoPyrimidine motif (5'TOP), after which these mRNAs are referred to as TOP mRNAs. Subsequent to the initial structural and functional characterization of members of this family, the research of TOP mRNAs has progressed in three major directions: a) delineating the landscape of the family; b) establishing the pathways that transduce stress cues into selective translational repression; and c) attempting to decipher the most proximal trans-acting factor(s) and defining its mode of action--a repressor or activator. The present chapter critically reviews the development in these three avenues of research with a special emphasis on the two "top secrets" of the TOP mRNA family: the scope of its members and the identity of the proximal cellular regulator(s). This article is part of a Special Issue entitled: Translation and Cancer. Copyright © 2014 Elsevier B.V. All rights reserved.

The value of applying a melatonin antagonist (Luzindole) in improving the success rate of the bipedal rat scoliosis model.

PubMed

Yang, Shuo; Zheng, Chaojun; Jiang, Jianyuan; Lu, Feizhou; Xia, Xinlei; Zhu, Wei; Jin, Xiang; Ma, Xiaosheng

2017-04-04

An ideal animal model has always been the key to research the pathogenesis and treatment of adolescent idiopathic scoliosis (AIS), while available methods have obvious disadvantages. The deficiency of melatonin has been proved relating to AIS. In this research, we intended to apply Luzindole, the melatonin antagonist, in bipedal rat model, for the block of combination of melatonin and its receptor, to inhibit the melatonin effect, and then to understand whether this method can effectively improve the scoliosis rate of bipedal rat model, and investigate the role of melatonin in scoliosis. To investigate the feasibility of improving the success rate of bipedal rat scoliosis model via intraperitoneal injection of melatonin antagonist (Luzindole). A total of 60 3-weeks-old Sprague-Dawley rats were included in this study, and were divided into 3 groups (A, B and C). Each group included 20 rats. Osteotomy of the bilateral proximal humerus and proximal tailbone was performed in group A and group B; intraperitoneal injection of Luzindole (0.2 mg/kg) was performed in group A and group C. X-rays were taken before the surgery, 1 month after the surgery, 3 months after the surgery, and 6 months after the surgery, to calculate the Cobb's angle of the spine (>10° was considered scoliosis). The weight of every rat was also measured at the same time. Rats were euthanized 6 months after surgery to determine the calmodulin level in thrombocytes. The rate of scoliosis in group A (14/20) was significantly higher than those in group B (6/20) and group C (0/20) (P < 0.05). The differences in the weights of the 3 groups were non-significant; as were differences in the calmodulin level in thrombocytes. The application of the melatonin antagonist of Luzindole can improve the success rate of the bipedal rat scoliosis model. Meanwhile, this study indicates that a decreased melatonin level is not the primary cause of scoliosis, but that it may increase the likelihood and severity of scoliosis.

The Tarsometatarsus of the Ostrich Struthio camelus: Anatomy, Bone Densities, and Structural Mechanics.

PubMed

Gilbert, Meagan M; Snively, Eric; Cotton, John

2016-01-01

The ostrich Struthio camelus reaches the highest speeds of any extant biped, and has been an extraordinary subject for studies of soft-tissue anatomy and dynamics of locomotion. An elongate tarsometatarsus in adult ostriches contributes to their speed. The internal osteology of the tarsometatarsus, and its mechanical response to forces of running, are potentially revealing about ostrich foot function. Computed tomography (CT) reveals anatomy and bone densities in tarsometatarsi of an adult and a young juvenile ostrich. A finite element (FE) model for the adult was constructed with properties of compact and cancellous bone where these respective tissues predominate in the original specimen. The model was subjected to a quasi-static analysis under the midstance ground reaction and muscular forces of a fast run. Anatomy-Metatarsals are divided proximally and distally and unify around a single internal cavity in most adult tarsometatarsus shafts, but the juvenile retains an internal three-part division of metatarsals throughout the element. The juvenile has a sparsely ossified hypotarsus for insertion of the m. fibularis longus, as part of a proximally separate third metatarsal. Bone is denser in all regions of the adult tarsometatarsus, with cancellous bone concentrated at proximal and distal articulations, and highly dense compact bone throughout the shaft. Biomechanics-FE simulations show stress and strain are much greater at midshaft than at force applications, suggesting that shaft bending is the most important stressor of the tarsometatarsus. Contraction of digital flexors, inducing a posterior force at the TMT distal condyles, likely reduces buildup of tensile stresses in the bone by inducing compression at these locations, and counteracts bending loads. Safety factors are high for von Mises stress, consistent with faster running speeds known for ostriches. High safety factors suggest that bone densities and anatomy of the ostrich tarsometatarsus confer strength for selectively critical activities, such as fleeing and kicking predators. Anatomical results and FE modeling of the ostrich tarsometatarsus are a useful baseline for testing the structure's capabilities and constraints for locomotion, through ontogeny and the full step cycle. With this foundation, future analyses can incorporate behaviorally realistic strain rates and distal joint forces, experimental validation, and proximal elements of the ostrich hind limb.

Deposition model of a Miocene barred wave- and storm-dominated shoreface and shelf, southeastern Malay basin, offshore west Malaysia

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ramli, N.

1986-01-01

The J sandstone is an important hydrocarbon-bearing reservoir in the southeastern part of the Malay basin. The lower and upper members of the J sandstone are composed of shoreface and offshore sediments. The shoreface sequence contains depositional structures characteristic of a barred wave- and storm-dominated shoreface. Each shoreface sequence is laterally associated with a series of stacked offshore bars. Offshore bars can be subdivided into proximal and distal types. Two types of proximal offshore bars have been identified: (1) proximal bars formed largely above fair-weather wave base (inner proximal bars), and (2) proximal bars formed below fair-weather wave base (outermore » proximal bars). The inner proximal bars are closely associated with the shoreface sequence and are similar to the middle and lower shoreface. The presence of poorly sorted, polymodal, very fine to very coarse-grained sandstone beneath well-sorted crestal sandstones of inner proximal bars suggests that these offshore bars may have been deposited rapidly by storms. The crests of the inner proximal offshore bars were subsequently reworked by fair-weather processes, and the crests of the outer proximal and distal offshore bars were reworked by waning storm currents and oscillatory waves. Thick marine shales overlying offshore bars contain isolated sheet sandstones. Each sheet sandstone exhibits features that may be characteristic of distal storm shelf deposits. 15 figures, 2 tables.« less

Paracetamol absorption from different sites in the human small intestine.

PubMed Central

Gramatté, T; Richter, K

1994-01-01

Site-specificity in the small intestinal absorption of paracetamol was investigated using a segmental intestinal steady state perfusion technique (triple-lumen tubing system) combined with simultaneous measurements of serum drug concentrations. Dissolved paracetamol was perfused over 160 min into different parts of the small intestine (65-210 cm beyond the teeth). Each of the four healthy subjects was studied twice with a proximal and a more distal site of perfusion. Serum drug concentrations were similar after proximal and distal perfusions. Mean drug absorption rates calculated from intestinal aspirate concentrations were similar in both parts of the intestine--proximal: 869 micrograms 30 cm-1 min-1 (95% CI: 659-1079) vs distal: 941 micrograms 30 cm-1 min-1 (794-1088). The absorption rate was related directly to the amount of paracetamol perfused per unit time as well as to the rate of transmucosal water fluxes. PMID:7917782

Geologic map of the southern Funeral Mountains including nearby groundwater discharge sites in Death Valley National Park, California and Nevada

USGS Publications Warehouse

Fridrich, C.J.; Thompson, R.A.; Slate, J.L.; Berry, M.E.; Machette, M.N.

2012-01-01

This 1:50,000-scale geologic map covers the southern part of the Funeral Mountains, and adjoining parts of four structural basins—Furnace Creek, Amargosa Valley, Opera House, and central Death Valley—in California and Nevada. It extends over three full 7.5-minute quadrangles, and parts of eleven others—an area of about 1,000 square kilometers (km2). The boundaries of this map were drawn to include all of the known proximal hydrogeologic features that may affect the flow of groundwater that discharges from springs of the Furnace Creek basin, in the west-central part of the map. These springs provide the main potable water supply for Death Valley National Park. Major hydrogeologic features shown on this map include: (1) springs of the Furnace Creek basin, (2) a large Pleistocene groundwater discharge mound in the northeastern part of the map, (3) the exposed extent of limestones and dolomites that constitute the Paleozoic carbonate aquifer, and (4) the exposed extent of the alluvial conglomerates that constitute the Funeral Formation aquifer.

In vitro fermentability and physicochemical properties of fibre substrates and their effect on bacteriological and morphological characteristics of the gastrointestinal tract of newly weaned piglets.

PubMed

Van Nevel, Christian J; Dierick, Noel A; Decuypere, Jaak A; De Smet, Stefaan M

2006-12-01

Fermentability of fibre has a great impact on the bacterial flora along the gastrointestinal tract of newly weaned piglets. Therefore, this parameter was determined by incubating in vitro different fibre substrates (chicory roots, sugar beet pulp, wheat bran and corn cobs) with contents of jejunum or caecum sampled from slaughtered pigs. Incubating with small intestinal contents, lactic acid was the only fermentation product. Fermentability was highest for chicory roots, followed by wheat bran and sugar beet pulp, while corn cobs were not fermented. Based on SCFA formed in the incubations with caecal contents, ranking of the fermentability of the fibre substrates was in the same order. The effect of adding different fibre substrates to diets of newly weaned piglets on bacteriological and morphological aspects of the gastrointestinal tract was also investigated. In Experiment 1 three groups of five piglets, weaned at four weeks of age, received a control feed (C), C supplemented with corn cobs (50 g/kg) or with chicory roots (20 g/kg). In Experiment 2, diet C was supplemented with sugar beet pulp (120 g/kg) or with wheat bran (75 g/kg). After three weeks animals were euthanized and digesta were sampled from stomach, proximal and distal jejunum, caecum and colon. Furthermore, mucosal scrapings were prepared and tissue samples were taken from jejunum, caecum and colon. Viscosity was determined for jejunal, caecal and colon contents. Corn cobs in the feed increased the number of total bacteria, lactobacilli and bifidobacteria in the stomach and proximal duodenum, while a decreased count of streptococci in distal jejunum contents was noted. Chicory roots increased the counts of Escherichia coli in the distal jejunum and on the mucosa, while sugar beet pulp decreased the number of lactobacilli on the mucosa only. Wheat bran seemed to increase the count of E. coli in jejunal digesta and on the mucosa, and also the number of lactobacilli in the stomach and jejunum. Bifidobacterial numbers were increased but only in the proximal part of the jejunum. Fibre substrates affected the concentration of lactate and SCFA in different parts of the intestinal tract. Feeding corn cobs increased villus length in the proximal jejunum by 13%. The number of intra-epithelial lymphocytes in the villous epithelium of proximal and distal jejunum was decreased by corn cobs and chicory roots supplementation while beet pulp and wheat bran had the opposite effect. In Experiment 1, apoptotic index of the mucosa of the distal jejunum was very low and decreased when corn cobs were fed. Mitotic index in the crypts was only affected by the wheat bran diet and a small decrease was noted. It was concluded that the fermentability of fibre was not an ideal criterion for predicting its effects on the flora. The effect of fibres on viscosity of digesta was negligible probably explaining the lack of clear and consistent influences on the intestinal mucosa.

Using three-dimensional computational modeling to compare the geometrical fitness of two kinds of proximal femoral intramedullary nail for Chinese femur.

PubMed

Zhang, Sheng; Zhang, Kairui; Wang, Yimin; Feng, Wei; Wang, Bowei; Yu, Bin

2013-01-01

The aim of this study was to use three-dimensional (3D) computational modeling to compare the geometric fitness of these two kinds of proximal femoral intramedullary nails in the Chinese femurs. Computed tomography (CT) scans of a total of 120 normal adult Chinese cadaveric femurs were collected for analysis. With the three-dimensional (3D) computational technology, the anatomical fitness between the nail and bone was quantified according to the impingement incidence, maximum thicknesses and lengths by which the nail was protruding into the cortex in the virtual bone model, respectively, at the proximal, middle, and distal portions of the implant in the femur. The results showed that PFNA-II may fit better for the Chinese proximal femurs than InterTan, and the distal portion of InterTan may perform better than that of PFNA-II; the anatomic fitness of both nails for Chinese patients may not be very satisfactory. As a result, both implants need further modifications to meet the needs of the Chinese population.

The best location for proximal locking screw for femur interlocking nailing: A biomechanical study

PubMed Central

Karaarslan, Ahmet A; Karakaşli, Ahmet; Aycan, Hakan; Çeçen, Berivan; Yildiz, Didem Venüs; Sesli, Erhan

2016-01-01

Background: Proximal locking screw deformation and screw fracture is a frequently seen problem for femur interlocking nailing that affects fracture healing. We realized that there is lack of literature for the right level for the proximal locking screw. We investigated the difference of locking screw bending resistance between the application of screws on different proximal femoral levels. Materials and Methods: We used a total of 80 proximal locking screws for eight groups, 10 screws for each group. Three-point bending tests were performed on four types of screws in two different trochanteric levels (the lesser trochanter and 20 mm proximal). We determined the yield points at three-point bending tests that a permanent deformation started in the locking screws using an axial compression testing machine. Results: The mean yield point value of 5 mm threaded locking screws applied 20 mm proximal of lesser trochanter was 1022 ± 49 (range 986–1057) (mean ± standard deviation, 95% confidence interval). On the other hand, the mean yield point value of the same type of locking screws applied on the lesser trochanteric level was 2089 ± 249 (range 1911–2268). Which means 103% increase of screw resistance between two levels (P = 0.000). In all screw groups, on the lesser trochanter line we determined 98–174% higher than the yield point values of the same type of locking screws in comparison with 20 mm proximal to the lesser trochanter (P = 0.000). Conclusion: According to our findings, there is twice as much difference in locking screw bending resistance between these two application levels. To avoid proximal locking screw deformation, locking screws should be placed in the level of the lesser trochanter in nailing of 1/3 middle and distal femur fractures. PMID:26955183

Still Separate, Still Unequal: Social Determinants of Playground Safety and Proximity Disparities in St. Louis.

PubMed

Arroyo-Johnson, Cassandra; Woodward, Krista; Milam, Laurel; Ackermann, Nicole; Komaie, Goldie; Goodman, Melody S; Hipp, J Aaron

2016-08-01

Physical activity among youth is shaped by the natural and built environment within which they live; however, few studies have focused on assessing playground safety and proximity in detail as part of the built environment for youth physical activity. We analyzed data on 100 publicly accessible playgrounds from Play Across St. Louis, a community-partnered study of the built environment for youth physical activity. Outcomes included overall playground safety, maintenance, and construction scores; distance to nearest playground; and distance to nearest top playground. Independent variables included neighborhood % youth, % black residents, % owner-occupied units, and % vacant units. Playgrounds in the city have varying degrees of safety and proximity. Mean overall playground safety score was 67.0 % (CI = 63.5, 70.4). Neighborhood % youth and % black residents were inversely associated with overall playground safety (p = 0.03 and p < 0.01) and maintenance (p < 0.01 and p < 0.0001). Mean distance to nearest playground was 638.1 and 1488.3 m to nearest top playground. Clusters of low safety scores were found in the northern and central areas while all high safety score clusters were found in the southern part of St. Louis. Public playground safety and proximity vary across St. Louis neighborhoods, especially by neighborhood demographics. Disparities in playground safety and proximity reveal an opportunity to develop community-wide interventions focused on playgrounds for youth activity. Further work is needed to examine the association between playground safety, proximity, and use and youth physical activity and weight.

In vivo kinematic analysis of the glenohumeral joint during dynamic full axial rotation and scapular plane full abduction in healthy shoulders.

PubMed

Kozono, Naoya; Okada, Takamitsu; Takeuchi, Naohide; Hamai, Satoshi; Higaki, Hidehiko; Ikebe, Satoru; Shimoto, Takeshi; Miake, Go; Nakanishi, Yoshitaka; Iwamoto, Yukihide

2017-07-01

The purpose of this study was to evaluate the kinematics of healthy shoulders during dynamic full axial rotation and scapular plane full abduction using three-dimensional (3D)-to-two-dimensional (2D) model-to-image registration techniques. Dynamic glenohumeral kinematics during axial rotation and scapular plane abduction were analysed in 10 healthy participants. Continuous radiographic images of axial rotation and scapular plane abduction were taken using a flat panel radiographic detector. The participants received a computed tomography scan to generate virtual digitally reconstructed radiographs. The density-based digitally reconstructed radiographs were then compared with the serial radiographic images acquired using image correlations. These 3D-to-2D model-to-image registration techniques determined the 3D positions and orientations of the humerus and scapula during dynamic full axial rotation and scapular plane full abduction. The humeral head centre translated an average of 2.5 ± 3.1 mm posteriorly, and 1.4 ± 1.0 mm superiorly in the early phase, then an average of 2.0 ± 0.8 mm inferiorly in the late phase during external rotation motion. The glenohumeral external rotation angle had a significant effect on the anterior/posterior (A/P) and superior/inferior (S/I) translation of the humeral head centre (both p < 0.05). 33.6 ± 15.6° of glenohumeral external rotation occurred during scapular plane abduction. The humeral head centre translated an average of 0.6 ± 0.9 mm superiorly in the early phase, then 1.7 ± 2.6 mm inferiorly in the late phase, and translated an average of 0.4 ± 0.5 mm medially in the early phase, then 1.6 ± 1.0 mm laterally in the late phase during scapular plane abduction. The humeral abduction angle had a significant effect on the S/I and lateral/medial (L/M) translation of the humeral head centre (both p < 0.05). This study investigated 3D translations of the humerus relative to the scapula: during scapular plane full abduction, the humerus rotated 33.6° externally relative to the scapula, and during external rotation motion in the adducted position, the humeral head centre translated an average of 2.5 mm posteriorly. Kinematic data will provide important insights into evaluating the kinematics of pathological shoulders. For clinical relevance, quantitative assessment of dynamic healthy shoulder kinematics might be a physiological indicator for the assessment of pathological shoulders.

Drifting Diaphyses: Asymmetry in Diametric Growth and Adaptation Along the Humeral and Femoral Length.

PubMed

Maggiano, Isabel S; Maggiano, Corey M; Tiesler, Vera G; Chi-Keb, Julio R; Stout, Sam D

2015-10-01

This study quantifies regional histomorphological variation along the human humeral and femoral diaphysis in order to gain information on diaphyseal growth and modeling drift patterns. Three thin sections at 40, 50, and 60% bone length were prepared from a modern Mexican skeletal sample with known age and sex to give a longitudinal perspective on the drifting cortex (12 adults and juveniles total, 7 male and 5 female). Point-count techniques were applied across eight cross-sectional regions of interest using the starburst sampling pattern to quantify percent periosteal and endosteal primary lamellar bone at each diaphyseal level. The results of this study show a posterio-medial drift pattern in the humerus with a posterior rotational trend along the diaphysis. In the femur, we observed a consistent lateral to anteriolateral drift and an increase in primary lamellar bone area of both, periosteal and endosteal origin, towards the distal part of the diaphysis. These observations characterize drifting diaphyses in greater detail, raising important questions about how to resolve microscopic and macroscopic cross-sectional analysis towards a more complete understanding of bone growth and mechanical adaptation. Accounting for modeling drift has the potential to positively impact age and physical activity estimation, and explain some of the significant regional variation in bone histomorphology seen within (and between) bone cross-sections due to differing ages of tissue formation. More study is necessary, however, to discern between possible drift scenarios and characterize populational variation. © 2015 Wiley Periodicals, Inc.

Site of impaction of ureteric calculi requiring surgical intervention.

PubMed

El-Barky, Ehab; Ali, Yusuf; Sahsah, Mohammed; Terra, Ali A; Kehinde, Elijah O

2014-02-01

Textbooks describe three narrowest anatomic sites in the ureter as the most likely places for ureteral calculi to lodge, these are: the pelvi-ureteric junction (PUJ), the point where the ureters cross over the iliac vessels and the ureterovesical junction (UVJ). The purpose of this study is to determine whether calculi causing ureteric obstruction and requiring surgical treatment are found mostly at these three narrowest anatomic points of the ureter. Three hundred consecutive patients with impacted ureteric calculi who required surgical intervention were studied. The location of the impacted calculus on the day of surgical intervention was categorized according to nine predetermined levels outlined in a designed diagram based on findings on non-contrast CT of kidneys, ureters and bladder. Two peaks in stone distribution in the ureters were encountered; the first was above the ischial spine in the proximal part of the lower third ureter (84 patients, 28%), while the second was at the level between L3 and L4 lumbar vertebrae (66 patients, 22%). Overall, the location of impacted calculi was as follows, 53, 34, 10 and 3% in the lower third ureter, upper third ureter, PUJ and mid ureter, respectively. This study demonstrates two peaks of calculi distribution in the ureter where ureteric calculi become impacted: the upper ureter below the PUJ and a second in the lower ureter, more proximal than the UVJ. There was an absence of the peak in stone location over the iliac vessels, that is, the mid ureter.

Observations on the macroscopic anatomy of the intestinal tract and its mesenteric folds in the pampas deer (Ozotoceros bezoarticus, Linnaeus 1758).

PubMed

Pérez, W; Clauss, M; Ungerfeld, R

2008-08-01

We described the macroscopic anatomy of the intestines and their peritoneal folds of five adult pampas deer (Ozotoceros bezoarticus), a cervid species considered to ingest a high proportion of grass in its natural diet. The mean (+/-SD) body weight was 17 (+/-2) kg. The small intestine and the caecocolon measured 495 (+/-37) cm and 237 (+/-24) cm in length, respectively, with an average ratio (small intestine:caecocolon) of 1.9 (+/-0.1). The ascending colon had two and a half centripetal gyri, a central flexure and two centrifugal gyri. The spiral ansa, which was similar to an ellipse, was fixed to the whole left face of the mesenterium. Apart from the peritoneal folds described in the Nomina Anatomica Veterinaria, three additional, hitherto not described folds were found: a fold that fixed the caecum to the proximal ansa of the ascending colon, one that joined the terminal part of the proximal ansa to the last centrifugal gyrus of the spiral ansa of the ascending colon, and one that linked the ascending duodenum to the proximal ansa of the ascending colon. When compared with published data from other cervids of different feeding niches, it appears that, among cervids, the ratio of small intestine to the caecocolon length does not reflect the natural diet.

[The biphalangy of the thumb. General review of the literature].

PubMed

Guillem, P; Demondion, X; Drizenko, A; Fontaine, C

1999-09-01

The thumb has only two phalanges whereas the other fingers present three. For two millennia, many anatomists tried to solve this riddle. Four different theories can be found in the review of literature, to explain what element misses in the radial column. In the first theory (Galen), the first metacarpal should be the proximal phalanx of the thumb. The particular ossification of the first metacarpal advocates for this theory. In the second theory (Sappey), the first metacarpal should result from the fusion between the true first metacarpal and the proximal phalanx of the thumb, and the proximal epiphysis should be constituted from both metacarpal and phalangeal parts. In the third theory (Paturet), the middle phalanx is thought to be missing. Apart morphological considerations, the main argument refers to symbrachydactyly, which consists in decreasing digital ray length (by reducing the middle phalanx), and usually affects digits excluding the thumb. In case the thumb is affected (in complex symbrachydactylies), the reduction concerns thus the first metacarpal, suggesting that the thumb middle phalanx has already disappeared. In the fourth theory (Pfitzner), the distal phalanx of the thumb should result from the fusion between the second and third phalanges of the thumb. This mechanism, named symphalangy, is well known in the foot, especially in the fifth toe, but also for the other toes, and even in the two ulnar fingers.

White Historical Activity Theory: Toward a Critical Understanding of White Zones of Proximal Development

ERIC Educational Resources Information Center

Leonardo, Zeus; Manning, Logan

2017-01-01

Best known for arguing that individual development is part of social and historical development Vygotsky's entry into education may be captured by his concept of the "zone of proximal development" (ZPD). ZPD has not yet been synthesized with a critical study of whiteness. When ZPD is used to explain racial disparities in the service of…

Small supernumerary marker chromosome derived from proximal p-arm of chromosome 2: identification by fluorescent in situ hybridization.

PubMed

Lasan Trcić, Ruzica; Hitrec, Vlasta; Letica, Ljiljana; Cuk, Mario; Begović, Davor

2003-08-01

Conventional cytogenetics detected an interstitial deletion of proximal region of p-arm of chromosome 2 in a 6-month-old boy with a phenotype slightly resembling Down's syndrome. The deletion was inherited from the father, whose karyotype revealed a small ring-shaped marker chromosome, in addition to interstitial deletion. Fluorescence in situ hybridization identified the marker, which consisted of the proximal region of the p-arm of chromosome 2, including a part of its centromere. This case shows that molecular cytogenetic analysis can reveal the mechanism of the formation of the marker chromosome.

Dual pathology proximal median nerve compression of the forearm.

PubMed

Murphy, Siun M; Browne, Katherine; Tuite, David J; O'Shaughnessy, Michael

2013-12-01

We report an unusual case of synchronous pathology in the forearm- the coexistence of a large lipoma of the median nerve together with an osteochondroma of the proximal ulna, giving rise to a dual proximal median nerve compression. Proximal median nerve compression neuropathies in the forearm are uncommon compared to the prevalence of distal compression neuropathies (eg Carpal Tunnel Syndrome). Both neural fibrolipomas (Refs. 1,2) and osteochondromas of the proximal ulna (Ref. 3) in isolation are rare but well documented. Unlike that of a distal compression, a proximal compression of the median nerve will often have a definite cause. Neural fibrolipoma, also called fibrolipomatous hamartoma are rare, slow-growing, benign tumours of peripheral nerves, most often occurring in the median nerve of younger patients. To our knowledge, this is the first report of such dual pathology in the same forearm, giving rise to a severe proximal compression of the median nerve. In this case, the nerve was being pushed anteriorly by the osteochondroma, and was being compressed from within by the intraneural lipoma. This unusual case highlights the advantage of preoperative imaging as part of the workup of proximal median nerve compression. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

[A new method of osteosynthesis in proximal humeral fractures: a new internal fixation device. Apropos of 17 cases followed over more than 2 years].

PubMed

Doursounian, L; Grimberg, J; Cazeau, C; Touzard, R C

1996-01-01

The authors describe a new internal fixation device, and report on 17 proximal humeral fractures managed with this technique. The fracture patterns, using Neer's classification were: 9 displaced three-part fractures, 4 displaced four-part fractures and 4 interior fracture dislocations (mean age of the patients: 70 years). The device is a two-part titanium device. The humeral component has a long vertical stem cemented in the humeral shaft; and a short proximal portion set at an angle of 135 degrees on the stem, with a neck and a Morse taper cone. The other part is a crown-shaped stapple, whose base is a perforated disk with a central Morse taper socket. The rim of the crown has five prongs which, together with the central socket, are impacted in the cancellous bone of the humeral head. The taper of the humeral component is inserted into the central socket of the stapple to provide fracture fixation. Tuberosities are reattached to the shaft with non absorbable sutures. Mean follow-up was 29 months. The global ratings were as follows: 4 excellent results, 6 good results, 4 fair results, 3 poor results. Mean active forward flexion: 100 degrees, and mean active external rotation 22 degrees. After exclusion of the 4 fracture-dislocations, the global rating became: 4 excellent results, 5 good results, 3 fair results, 1 poor result. Mean active forward flexion: 110 degrees and mean active external rotation: 31.5 degrees. There were no case of avascular necrosis in 13 patients. Complications requiring surgery occurred in one case: an upper protrusion of the stapple which required replacement of the stapple by a prosthetic humeral head. Other complications included: 2 asymptomatic partial protrusions of the stapple, 2 complete and two partial avascular necrosis in fracture-dislocations. Except for the fracture-dislocations our device confers several major benefits. The humeral head is preserved. Typical problems associated with joint replacement (dislocations, loosening, glenoid degeneration) are avoided. Humeral head conservation enhances healing of the tuberosities. Fixation could always be obtained, regardless of the complexity of the fracture pattern. An hemiarthroplasty (e.g. in case of avascular necrosis) is possible by the modular design of the device.

Genome sequencing of the extinct Eurasian wild aurochs illuminates the phylogeography and evolution of cattle

USDA-ARS?s Scientific Manuscript database

Interrogation of modern and ancient bovine genome sequences provides a valuable model to study the evolution of cattle. Here, we analyse the first complete wild aurochs (Bos primigenius) genome sequence using DNA extracted from a ~ 6,750 year-old humerus bone retrieved from a cave site in Derbyshire...

Epicondylitis in the athlete's elbow.

PubMed

Van Hofwegen, Christopher; Baker, Champ L; Baker, Champ L

2010-10-01

Epicondylitis is a diagnostic term that describes a pattern of pain and tenderness localized to the medial or lateral epicondyles of the distal humerus. The pathoanatomy, clinical presentation, and treatment of these disorders is described. Nonoperative treatment, operative techniques, postoperative care, and the results of treatment are discussed. Copyright © 2010 Elsevier Inc. All rights reserved.

The functional anatomy of Kager's fat pad in relation to retrocalcaneal problems and other hindfoot disorders.

PubMed

Theobald, P; Bydder, G; Dent, C; Nokes, L; Pugh, N; Benjamin, M

2006-01-01

Kager's fat pad is a mass of adipose tissue occupying Kager's triangle. By means of a combined magnetic resonance imaging, ultrasound, gross anatomical and histological study, we show that it has three regions that are closely related to the sides of the triangle. Thus, it has parts related to the Achilles and flexor hallucis longus (FHL) tendons and a wedge of fat adjacent to the calcaneus. The calcaneal wedge moves into the bursa during plantarflexion, as a consequence of both an upward displacement of the calcaneus relative to the wedge and a downward displacement of the wedge relative to the calcaneus. During dorsiflexion, the bursal wedge is retracted. The movements are promoted by the tapering shape of the bursal wedge and by its deep synovial infolds. Fibrous connections linking the fat to the Achilles tendon anchor and stabilize it proximally and thus contribute to the motility of its tip. We conclude that the three regions of Kager's fat pad have specialized functions: an FHL part which contributes to moving the bursal wedge during plantarflexion, an Achilles part which protects blood vessels entering this tendon, and a bursal wedge which we suggest minimizes pressure changes in the bursa. All three regions contribute to reducing the risk of tendon kinking and each may be implicated in heel pain syndromes.

Polycaprolactone/glass bioabsorbable implant in a rabbit humerus fracture model.

PubMed

Lowry, K J; Hamson, K R; Bear, L; Peng, Y B; Calaluce, R; Evans, M L; Anglen, J O; Allen, W C

1997-09-15

Research in improved materials and methods for internal fixation has centered on internal fixators made of bioabsorbable materials such as polylactic acid, polyglycolic acid, and polyparadioxanone. These materials have two problems: the first is a postoperative complication related to a delayed inflammatory response; and the second is low strength characteristics. An alternative material developed to alleviate these problems is a composite of phosphate glass fibers embedded in the polymer polycaprolactone, referred to as PCL. In this study, intramedullary pins made of PCL were compared to stainless steel pins in a rabbit humerus osteotomy model. Specimens were harvested at 0, 6, and 12 weeks postoperatively, radiographs and mechanical testing to failure were performed at each time interval, and tissue was examined microscopically at 6 and 12 weeks. Histologic results showed PCL pins to be well tolerated with minimal inflammation around the pin. Mechanical testing revealed the PCL fixation to be weaker initially than the stainless steel fixation. There was significant stress shielding of stainless-steel-healed rabbit humeri when compared to the PCL/bone humeri. All osteotomies immobilized with PCL healed with abundant periosteal callus production.

Anaplastic transformation of metastatic papillary thyroid carcinoma at shoulder mimicking soft tissue sarcoma.

PubMed

Kaushal, Seema; Sharma, Mehar Chand; Mathur, Sandeep R; Rastogi, Shishir; Bal, Chander Shekhar; Chumber, Sunil

2011-01-01

A 52-year-old woman presented with fracture upper end of the left humerus after trivial trauma and aspiration cytology from the lytic lesion in the upper humerus seen on X-ray revealed a metastatic papillary carcinoma from the thyroid. Total thyroidectomy confirmed the papillary carcinoma thyroid. Post-operatively, she was given radioactive iodine (I-131) ablation therapy for 8 years and was asymptomatic during this period; however, for the last 1 year, she has been complaining of swelling in the shoulder, which did not respond to palliative radiotherapy and rapidly increased in size. Disarticulation of the shoulder joint was performed, which showed anaplastic carcinoma on histopathological examination. Anaplastic transformation of papillary carcinoma at the metastatic sites is well documented in the literature and is rare. However, the same has not been reported at the shoulder and from India before. Although soft tissue sarcomas are most common at this site, however, the possibility of anaplastic transformation should be kept in the differential diagnosis of rapidly enlarging painful mass in a known case of metastatic thyroid carcinoma to prevent misdiagnosis.

Basic principles of fracture treatment in children.

PubMed

Ömeroğlu, Hakan

2018-04-01

This review aims to summarize the basic treatment principles of fractures according to their types and general management principles of special conditions including physeal fractures, multiple fractures, open fractures, and pathologic fractures in children. Definition of the fracture is needed for better understanding the injury mechanism, planning a proper treatment strategy, and estimating the prognosis. As the healing process is less complicated, remodeling capacity is higher and non-union is rare, the fractures in children are commonly treated by non-surgical methods. Surgical treatment is preferred in children with multiple injuries, in open fractures, in some pathologic fractures, in fractures with coexisting vascular injuries, in fractures which have a history of failed initial conservative treatment and in fractures in which the conservative treatment has no/little value such as femur neck fractures, some physeal fractures, displaced extension and flexion type humerus supracondylar fractures, displaced humerus lateral condyle fractures, femur, tibia and forearm shaft fractures in older children and adolescents and unstable pelvis and acetabulum fractures. Most of the fractures in children can successfully be treated by non-surgical methods.

32 CFR 750.44 - Claims not payable.

Code of Federal Regulations, 2010 CFR

2010-07-01

... death which was proximately caused, in whole or in part, by any negligence or wrongful act on the part... Chapter. (4) Federal Tort Claims Act. 28 U.S.C. 2671, 2672, and 2674-2680. (5) International Agreements...

The potential and prospects of proximal remote sensing of arthropod pests.

PubMed

Nansen, Christian

2016-04-01

Bench-top or proximal remote sensing applications are widely used as part of quality control and machine vision systems in commercial operations. In addition, these technologies are becoming increasingly important in insect systematics and studies of insect physiology and pest management. This paper provides a review and discussion of how proximal remote sensing may contribute valuable quantitative information regarding identification of species, assessment of insect responses to insecticides, insect host responses to parasitoids and performance of biological control agents. The future role of proximal remote sensing is discussed as an exciting path for novel paths of multidisciplinary research among entomologists and scientists from a wide range of other disciplines, including image processing engineers, medical engineers, research pharmacists and computer scientists. © 2015 Society of Chemical Industry. © 2015 Society of Chemical Industry.

Contrast radiographic study of venous drainage of the corpus cavernosum and the corpus spongiosum of the cat penis.

PubMed

Amiri, Ali Akbar; Gilanpour, Hassan; Veshkini, Abbas

2014-01-01

The aim of this study was to determine the drainage routes of the corpus cvernosum penis and the corpus spongiosum penis in the cat using contrast cavernosography. Five male cats, 1.5-2.5 years old, weighing between 4.5 and 5.5 kg were investigated. The cats were anesthetized and the root and the proximal part of the penis were exposed by an incision on the perineum reaching the scrotum. Each cat was radiographed in lateral and dorsal recumbency before and during injection of contrast medium into the erectile bodies. The corpus spongiosum penis was injected at the bulb of the penis and the corpus cavernosum penis at the root. Injection of contrast media into the cavernous bodies showed that both the external and internal iliac veins drain the erectile bodies into the caudal vena cava. Drainage from the corpus spongiosum penis was from the bulb for the proximal part and from the glans for the distal part. The corpus cavernosum penis was drained only proximally, from the crura. There was a network of veins above the pelvic symphysis and the drainage of erectile bodies where through various routes into the internal and external iliac veins.

Treatment of a Simple Bone Cyst Using a Cannulated Hydroxyapatite Pin

PubMed Central

Shirai, Toshiharu; Tsuchiya, Hiroyuki; Terauchi, Ryu; Tsuchida, Shinji; Mizoshiri, Naoki; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Miwa, Shinji; Kimura, Hiroaki; Takeuchi, Akihiko; Hayashi, Katsuhiro; Yamamoto, Norio; Kubo, Toshikazu

2015-01-01

Abstract Simple bone cysts (SBCs) are benign bone tumors. However, the treatment of SBCs remains controversial because of their healing rate and the invasiveness of surgery. The purpose of the present study was to evaluate the treatment of SBCs using a cannulated hydroxyapatite (HA) pin. A total of 43 patients (35 males, 8 females; mean age 12.1 years; age range, 5–22 years) with SBCs were treated with continuous decompression by inserting ceramic HA pins between 1989 and 2014. The SBCs were located in the calcaneus in 23, the humerus in 15, the femur in 3, and the pelvis in 2 cases. In all patients, minimal fenestration of the cyst wall and curettage and multiple drilling in the cyst wall were performed, followed by insertion of the HA pin. The mean follow-up period was 26.6 months. Operating time, healing period, risk factors for recurrence, and the cure rate were evaluated. Healing was achieved without intervention in 38 patients after a mean of 6.4 months. Two patients had persistent small residual cysts, which had no changes after 1 year at the latest follow-up. There were 5 patients with recurrences (humerus 4, femur 1), who were cured by curettage and artificial bone grafting. The final healing rate by cannulation only using an HA pin was 88.2%. On Fisher exact test, age, site of SBCs, and distance from the physis were found to be significantly associated with SBC recurrence (P < 0.05). In the present study, cannulation using an HA pin for SBCs was found to be a useful technique, particularly for calcaneal cysts, because it is a minimally invasive procedure with a high cure rate. In patients <10 years, involvement of the humerus and contact with the growth plate were significant risk factors for SBC recurrence. PMID:26107670

A new anchor augmentation technique with a cancellous screw in osteoporotic rotator cuff repair: an in vitro biomechanical study on sheep humerus specimens.

PubMed

Uruc, Vedat; Ozden, Raif; Dogramacı, Yunus; Kalacı, Aydıner; Hallaceli, Hasan; Küçükdurmaz, Fatih

2014-01-01

The aim of this study was to test a simple technique to augment the pullout resistance of an anchor in an over-drilled sheep humerus model. Sixty-four paired sheep humeri were harvested from 32 male sheep aged 18 months. Specimens were divided into an augmented group and non-augmented group. FASTIN RC 5-mm titanium screw anchors (DePuy Mitek, Raynham, MA) double loaded with suture material (braided polyester, nonabsorbable USP No. 2) were used in both groups. Osteoporosis was simulated by over-drilling with a 4.5-mm drill. Augmentation was performed by fixing 1 of the sutures 1.5 cm inferior to the anchor insertion site with a washer screw. This was followed by a pull-to-failure test at 50 mm/min. The ultimate load (the highest value of strength before anchor pullout) was recorded. A paired t test was used to compare the biomechanical properties of the augmented and non-augmented groups. In all specimens the failure mode was pullout of the anchor. The ultimate failure loads were statistically significantly higher in the augmented group (P < .0001). The mean pullout strength was 121.1 ± 10.17 N in the non-augmented group and 176.1 ± 10.34 N in the augmented group. The described augmentation technique, which is achieved by inferior-lateral fixation of 1 of the sutures of the double-loaded anchor to a fully threaded 6.5-mm cancellous screw with a washer, significantly increases the ultimate failure loads in the over-drilled sheep humerus model. Our technique is simple, safe, and inexpensive. It can be easily used in all osteoporotic patients and will contribute to the reduction of anchor failure. This technique might be difficult to apply arthroscopically. Cannulated smaller screws would probably be more practical for arthroscopic use. Further clinical studies are needed. Copyright © 2014 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

Expected lifetime numbers, risks, and burden of osteoporotic fractures for 50-year old Chinese women: a discrete event simulation incorporating FRAX.

PubMed

Jiang, Yawen; Ni, Weiyi

2016-11-01

This work was undertaken to provide an estimation of expected lifetime numbers, risks, and burden of fractures for 50-year-old Chinese women. A discrete event simulation model was developed to simulate the lifetime fractures of 50-year-old Chinese women at average risk of osteoporotic fracture. Main events in the model included hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, and other fracture. Fracture risks were calculated using the FRAX ® tool. Simulations of 50-year-old Chinese women without fracture risks were also carried out as a comparison to determine the burden of fractures. A 50-year-old Chinese woman at average risk of fracture is expected to experience 0.135 (95 % CI: 0.134-0.137) hip fractures, 0.120 (95 % CI: 0.119-0.122) clinical vertebral fractures, 0.095 (95 % CI: 0.094-0.096) wrist fractures, 0.079 (95 % CI: 0.078-0.080) humerus fractures, and 0.407 (95 % CI: 0.404-0.410) other fractures over the remainder of her life. The residual lifetime risk of any fracture, hip fracture, clinical vertebral fracture, wrist fracture, humerus fracture, and other fracture for a 50-year-old Chinese woman is 37.36, 11.77, 10.47, 8.61, 7.30, and 27.80 %, respectively. The fracture-attributable excess quality-adjusted life year (QALY) loss and lifetime costs are estimated at 0.11 QALYs (95 % CI: 0.00-0.22 QALYs) and US $714.61 (95 % CI: US $709.20-720.02), totaling a net monetary benefit loss of US $1,104.43 (95 % CI: US $904.09-1,304.78). Chinese women 50 years of age are at high risk of osteoporotic fracture, and the expected economic and quality-of-life burden attributable to osteoporotic fractures among Chinese women is substantial.

Intraoperative study on anthropometry and gender differences of the proximal tibial plateau at the arthroplasty resection surface.

PubMed

Yang, Bo; Yu, Jiakuo; Gong, Xi; Chen, Lianxu; Wang, Yongjian; Wang, Jian; Wang, Haijun; Zhang, Jiying

2014-01-01

The tibial plateau is asymmetric with a larger medial plateau. We observed from clinical practice that the shape of the tibial plateau does not always present a larger medial plateau. Tibial plateau also showed other shapes. The purpose of this study was to analyze the anthropometric data of the proximal tibia in a large group of Chinese patients undergoing total knee arthroplasty and to investigate the morphology of the resected proximal tibial surface and its gender differences. A total of 822 knees (164 males, 658 females) from the Chinese population were measured intraoperatively for medial anteroposterior (MAP) and lateral anteroposterior (LAP) dimensions of the resected proximal tibial surface. The difference of MAP and LAP (DML) was also calculated as MAP minus LAP. We then classified the data into three groups based on the DML (<-2, -2 to 2, and >2 mm) to analyze the morphology of the proximal tibia and its distribution between male and female. The shape of proximal tibial plateau was of three types: larger medial plateau type, symmetric type, and larger lateral plateau type. There were significant differences between males and females in relation to the shape distribution of the proximal tibial plateau (P < 0.05). Most of the proximal tibial plateau was asymmetric, with 517 of 822 (62.9%) tibia having a DML >2 mm and 120 of 822 (14.6%) tibia having a DML<-2 mm. Only 185 of 822 (22.5%) tibia had a DML between -2 and 2 mm. The results of this study can be used as a guideline to design tibial components with different DMLs to better match the different anthropometry of the resected tibial surface.

A quantitative method for evaluating inferior glenohumeral joint stiffness using ultrasonography.

PubMed

Tsai, Wen-Wei; Lee, Ming-Yih; Yeh, Wen-Lin; Cheng, Shih-Chung; Soon, Kok-Soon; Lei, Kin Fong; Lin, Wen-Yen

2013-02-01

Subluxation of the affected shoulder in post-stroke patients is associated with nerve disorders and muscle fatigue. Clinicians must be able to accurately and reliably measure inferior glenohumeral subluxation in patients to provide appropriate treatment. However, quantitative methods for evaluating the laxity and stiffness of the glenohumeral joint (GHJ) are still being developed. The aim of this study was to develop a new protocol for evaluating the laxity and stiffness of the inferior GHJ using ultrasonography under optimal testing conditions and to investigate changes in the GHJ from a commercially available humerus brace and shoulder brace. Multistage inferior displacement forces were applied to create a glide between the most cephalad point on the visible anterosuperior surface of the humeral head and coracoid process in seven healthy volunteers. GHJ stiffness was defined as the slope of the linear regression line between the glides and different testing loads. The testing conditions were defined by different test loading mechanisms (n=2), shoulder constraining conditions (n=2), and loading modes (n=4). The optimal testing condition was defined as the condition with the least residual variance of measured laxity to the calculated stiffness under different testing loads. A paired t-test was used to compare the laxity and stiffness of the inferior GHJ using different braces. No significant difference was identified between the two test loading mechanisms (t=0.218, p=0.831) and two shoulder constraining conditions (t=-0.235, p=0.818). We concluded that ultrasonographic laxity measurements performed using a pulley set loading mechanism was as reliable as direct loading. Additionally, constraining the unloaded shoulder was proposed due to the lower mean residual variance value. Moreover, pulling the elbow downward with loading on the upper arm was suggested, as pulling the elbow downward with the elbow flexed and loading on the forearm may overestimate stiffness and pain in the inferior GHJ at the loading point due to friction between the wide belt and skin. Furthermore, subjects wearing a humerus brace with a belt, which creates the effect of lifting the humerus toward the acromion, had greater GHJ stiffness compared to subjects wearing a shoulder brace without a belt to lift the humerus under the proposed testing conditions. This study provides experimental evidence that shoulder braces may reduce GHJ laxity under an external load, implying that the use of a humeral brace can prevent subluxation in post-stroke patients. The resulting optimal testing conditions for measuring the laxity and stiffness of the GHJ is to constrain the unloaded shoulder and bend the loaded arm at the elbow with loading on the upper arm using a pulley system. Copyright © 2011 IPEM. Published by Elsevier Ltd. All rights reserved.

Joint-preserving palliative surgery using self-locking screws of intramedullary nail and percutaneous cementoplasty for proximal humeral metastasis in the advanced cancer patients.

PubMed

Park, Jong Woong; Kim, Yong-Il; Kang, Hyun Guy; Kim, June Hyuk; Kim, Han Soo

2018-05-15

We introduced a palliative joint-preserving surgery using proximal self-locking screws of intramedullary (IM) nail and percutaneous cementoplasty (PC) in patients with proximal humeral metastases, including the head and neck, and evaluated the outcome of the surgical method. Twenty-three patients (mean age = 63.0 ± 11.8 years, M:F = 14:9) had IM nailing with a self-locking screw system and PC for the treatment of humeral head and neck metastases. Usually, three proximal locking screws were inserted after IM nailing, and 20.9 ± 8.0 ml of polymethylmethacrylate (PMMA) bone cement was injected in the perimetal osteolytic area. Regional anesthesia with interscalene block was performed in 87.0% (20/23), and the duration of surgery (from anesthesia to awakening) was approximately 40-55 min. Red blood cell was not transfused intra- and/or postoperatively in 65.2% (15/23). The localized preoperative pain (visual analog scale (VAS), 8.2 ± 3.1) was gradually decreased at postoperative 1 week (VAS, 4.9 ± 2.1) and at 6 weeks (VAS, 2.9 ± 2.1) (P < 0.001). Among nine patients who underwent F-18-FDG PET/CT, the proximal humeral metastasis around PC showed improved, stable, and aggravated states in five (55.6%), three (33.3%), and one patient (11.1%), respectively. Meanwhile, 88.8% (8/9) of patients showed aggravation at the naive bone metastasis area. The selection of the self-locking screw type of the IM nail and PC was helpful in preventing fixation failure for joint-preserving palliative surgery in the proximal humeral metastasis.

ANALYSIS OF METHODS FOR DETECTING THE PROXIMITY EFFECT IN QUASAR SPECTRA

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dall'Aglio, Aldo; Gnedin, Nickolay Y., E-mail: adaglio@aip.d

Using numerical simulations of structure formation, we investigate several methods for determining the strength of the proximity effect in the H I Ly{alpha} forest. We analyze three high-resolution ({approx}10 kpc) redshift snapshots (z-bar=4,3, and 2.25) of a Hydro-Particle-Mesh simulation to obtain realistic absorption spectra of the H I Ly{alpha} forest. We model the proximity effect along the simulated sight lines with a simple analytical prescription based on the assumed quasar luminosity and the intensity of the cosmic UV background (UVB). We begin our analysis investigating the intrinsic biases thought to arise in the widely adopted standard technique of combining multiplemore » lines of sight when searching for the proximity effect. We confirm the existence of these biases, albeit smaller than previously predicted with simple Monte Carlo simulations. We then concentrate on the analysis of the proximity effect along individual lines of sight. After determining its strength with a fiducial value of the UVB intensity, we construct the proximity effect strength distribution (PESD). We confirm that the PESD inferred from the simple averaging technique accurately recovers the input strength of the proximity effect at all redshifts. Moreover, the PESD closely follows the behaviors found in observed samples of quasar spectra. However, the PESD obtained from our new simulated sight lines presents some differences to that of simple Monte Carlo simulations. At all redshifts, we find a smaller dispersion of the strength parameters, the source of the corresponding smaller biases found when combining multiple lines of sight. After developing three new theoretical methods for recovering the strength of the proximity effect on individual lines of sight, we compare their accuracy to the PESD from the simple averaging technique. All our new approaches are based on the maximization of the likelihood function, albeit invoking some modifications. The new techniques presented here, in spite of their complexity, fail to recover the input proximity effect in an unbiased way, presumably due to some (unknown) higher order correlations in the spectrum. Thus, employing complex three-dimensional simulations, we provide strong evidence in favor of the PESD obtained from the simple averaging technique, as a method of estimating the UVB intensity, free of any intrinsic biases.« less

Proximate composition, fatty acid analysis and protein digestibility-corrected amino acid score of three Mediterranean cephalopods.

PubMed

Zlatanos, Spiros; Laskaridis, Kostas; Feist, Christian; Sagredos, Angelos

2006-10-01

Proximate composition, fatty acid analysis and protein digestibility-corrected amino acid score (PDCAAS) in three commercially important cephalopods of the Mediterranean sea (cuttlefish, octopus and squid) were determined. The results of the proximate analysis showed that these species had very high protein:fat ratios similar to lean beef. Docosahexaenoic, palmitic and eicosipentaenoic acid were the most abundant fatty acids among analyzed species. The amount of n-3 fatty acids was higher than that of saturated, monounsaturated and n-6 fatty acids. Despite the fact that cephalopods contain small amounts of fat they were found quite rich in n-3 fatty acids. Finally, PDCAAS indicated that these organisms had a very good protein quality.

Proximal hamstring morphology and morphometry in men: an anatomic and MRI investigation.

PubMed

Storey, R N; Meikle, G R; Stringer, M D; Woodley, S J

2016-12-01

The proximal musculo-tendinous junction (MTJ) is a common site of hamstring strain injury but the anatomy of this region is not well defined. A morphometric analysis of the proximal MTJs of biceps femoris long head (BFlh), semitendinosus (ST), and semimembranosus (SM) was undertaken from dissection of 10 thighs from five male cadavers and magnetic resonance imaging of 20 thighs of 10 active young men. The length, volume, and cross-sectional area of the proximal tendon, MTJ and muscle belly, and muscle-tendon interface area were calculated. In both groups, MTJs were reconstructed three-dimensionally. The proximal tendons and MTJs were expansive, particularly within SM and BFlh. Morphology varied between muscles although length measurements within individual muscles were similar in cadavers and young men. Semimembranosus had the longest proximal tendon (cadavers: mean 33.6 ± 2.0 cm; young men: mean 31.7 ± 1.6 cm) and MTJ (>20 cm in both groups) and the greatest muscle-tendon interface area, followed by BFlh and ST. Mean muscle belly volumes were more than three times greater in young men than elderly male cadavers (P < 0.001). These unique morphometric data contribute to a better understanding of hamstring anatomy, an important factor in the pathogenesis of hamstring strain injury. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Hematopoiesis and aging. V. A decline in hematocrit occurs in all aging female B6D2F1 mice

DOE Office of Scientific and Technical Information (OSTI.GOV)

Boggs, D.R.; Patrene, K.

Longitudinal studies of hematocrits were done in aging B6D2F1 female mice at 54, 64, 91, 105 and 115 weeks of age. A modest decline in hematocrit was observed in 41/42 mice; we have previously shown that the decreased hematocrit of aged as compared to young mice is due to an expansion of plasma volume. Mice which died spontaneously after 91 weeks had lower hematocrits at 91 weeks and 105 weeks than did those which survived to 115 weeks. At each time interval, a sub-group of mice was killed and uptake of /sup 59/Fe into blood, foreleg, spleen and liver wasmore » studied and total nucleated cells per humerus was determined. The results were generally compatible with the thesis that aging mice maintain normal rates of erythropoiesis under basal conditions. Thus, it would appear that a decrease in hematocrit can be considered an expected part of the aging process in this mouse.« less

Fragility and composition of growing rat bone after one week in spaceflight

NASA Technical Reports Server (NTRS)

Patterson-Buckendahl, P.; Arnaud, S. B.; Mechanic, G. L.; Martin, R. B.; Grindeland, R. E.; Cann, C. E.; Mrchanic, G. L. (Principal Investigator)

1987-01-01

To gain some insight into the early effects of spaceflight on skeletal metabolism, we quantified the major chemical constituents and a noncollagenous protein, osteocalcin, in the third-lumbar vertebrae and humeri from 8-wk-old rats that were part of the 7-day NASA Spacelab 3 flight experiments. The ratio of calcium to hydroxyproline in the humeral diaphysis increased from 8.5 in preflight to 9.8 in ground simulation control and only to 8.9 in flight bones. There was no demonstrable change in the fraction of nonmineralized collagen. Osteocalcin content was reduced in the humerus and vertebra. Reduced accumulation of mineral and osteocalcin with no associated decrease in collagen in flight animals suggests that both mineralization and collagen metabolism are impaired in growing animals during spaceflight within a few days after launch. Strength tests of the humeri of flight rats showed substantial deficits that appeared to be related, not only to the reduced bone mass, but also to the composition and quality of new bone formed.

Flow rate logging seepage meter

NASA Technical Reports Server (NTRS)

Reay, William G. (Inventor); Walthall, Harry G. (Inventor)

1996-01-01

An apparatus for remotely measuring and logging the flow rate of groundwater seepage into surface water bodies. As groundwater seeps into a cavity created by a bottomless housing, it displaces water through an inlet and into a waterproof sealed upper compartment, at which point, the water is collected by a collection bag, which is contained in a bag chamber. A magnet on the collection bag approaches a proximity switch as the collection bag fills, and eventually enables the proximity switch to activate a control circuit. The control circuit then rotates a three-way valve from the collection path to a discharge path, enables a data logger to record the time, and enables a pump, which discharges the water from the collection bag, through the three-way valve and pump, and into the sea. As the collection bag empties, the magnet leaves the proximity of the proximity switch, and the control circuit turns off the pump, resets the valve to provide a collection path, and restarts the collection cycle.

Towards completion of the early Eocene aviary: A new bird group from the Messel oil shale (Aves, Eopachypterygidae, fam. nov.).

PubMed

Mayr, Gerald

2015-09-08

A new avian species is described from the early Eocene Messel fossil site in Germany. Eopachypteryx praeterita, gen. et sp. nov. is a small bird and exhibits a characteristic morphology with a short and robust beak, a distinctively shaped coracoid, stout humerus, robust pectoral girdle skeleton, and short hindlimbs. Although similarities to the Paleogene Eocuculus as well as to some extant telluravian and strisorine taxa are noted, the phylogenetic affinities of the new species are unresolved. To account for the fact that the new species is clearly distinguished from any of the known fossil or extant avian taxa, it is here assigned to the new taxon Eopachypterygidae, fam. nov.. Eopachypteryx praeterita is represented by three partial skeletons. A further partial skeleton from Messel belongs to a second, unnamed species, which is tentatively referred to Eopachypteryx.