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Fracture of the lateral femoral condyle.
The patient was a 25-year-old man who was currently enrolled in a military basic-training program. He was evaluated by a physical therapist in a direct-access capacity for a chief complaint of right knee pain and swelling after his knee buckled and gave way during a training exercise on an obstacle course. The patient was evaluated by the physical therapist 2 days after his injury. Because the patient was unable to bear weight on his right lower extremity or flex his right knee to 90°, the physical therapist ordered radiographs of the right knee, which demonstrated a fracture of the lateral femoral condyle posteriorly. PMID:24289034
Carow, Scott D; Potter, Steven M
Osteochondritis dissecans of the lateral femoral condyle following total resection of the discoid lateral meniscus
Purpose: The purpose of this study was to describe the clinical presentation of 6 athletically active children with symptomatic osteochondritis dissecans (OCD) of the lateral femoral condyle following total resection for a torn discoid lateral meniscus and to discuss its cause. Type of Study: Case series. Methods: Six patients in whom OCD affecting the lateral femoral condyle developed after total
Hiroshi Mizuta; Eiichi Nakamura; Yutaka Otsuka; Satoshi Kudo; Katsumasa Takagi
Bilateral osteochondritis dissecans of the lateral femoral condyle following bilateral total removal of lateral discoid meniscus: a case report
Osteochondritis dissecans (OCD) of the lateral femoral condyle sometimes occurs with a discoid lateral meniscus. Recently,\\u000a it was reported that OCD of the lateral femoral condyle occurred after total removal of the lateral meniscus. We report the\\u000a case of a 12-year-old boy with bilateral OCD of the lateral femoral condyle following bilateral total removal for discoid\\u000a lateral meniscus. Valgus deviation
Yusuke Hashimoto; Gen Yoshida; Tomohiro Tomihara; Takeshi Matsuura; Shinji Satake; Kunikazu Kaneda; Nagakazu Shimada
Bilateral osteochondritis dissecans of the lateral femoral condyle following bilateral total removal of lateral discoid meniscus: a case report.
Osteochondritis dissecans (OCD) of the lateral femoral condyle sometimes occurs with a discoid lateral meniscus. Recently, it was reported that OCD of the lateral femoral condyle occurred after total removal of the lateral meniscus. We report the case of a 12-year-old boy with bilateral OCD of the lateral femoral condyle following bilateral total removal for discoid lateral meniscus. Valgus deviation of the knee after total removal and increased sporting activity might have concentrated excessive stress on the lateral condyles in the standing position. As a result, bilateral OCD might have occurred. Drilling of the areas of OCD on the bilateral lateral femoral condyles was done and the patient wore inner wedge arch supports postoperatively. After 2 years, neither knee pain nor arthrosis has occurred so far, but long-term follow-up of this patient is considered to be necessary. PMID:17985146
Hashimoto, Yusuke; Yoshida, Gen; Tomihara, Tomohiro; Matsuura, Takeshi; Satake, Shinji; Kaneda, Kunikazu; Shimada, Nagakazu
Lateral meniscus and lateral femoral condyle cartilage injury by retained cement after medial unicondylar knee arthroplasty.
The authors experienced an unusual case of a patient with a complex tear of the lateral meniscus and adjacent lateral femoral condyle cartilage injury in the contralateral compartment by retained cement, possibly located at the posteromedial side of the medial tibial component after unicondylar knee arthroplasty. Arthroscopic partial meniscectomy and cartilage microfracture were successfully performed. Two small cement fragments were removed from the posterolateral compartment. A sharp pain in the lateral side disappeared postoperatively and posterior knee pain was much reduced. PMID:18534478
Jung, Kwang Am; Lee, Su Chan; Song, Moon Bok
Reduction of superior-lateral intact mandibular condyle dislocation with bone traction hook
Lateral and superior-lateral dislocations of the intact condyle are a rare complication, following traumatic insult to the mandible. We report an unusual case of a 54-year-old male patient who experienced both types of dislocations of the intact condyles with symphysis fracture following a road-traffic accident. Under general anesthesia, conventional manipulation was unsuccessful in relocating the condyles into the glenoid fossa. After applying a percutaneous traction force, using a bone traction hook placed at the sigmoid notch, the displaced intact mandibular condyles were repositioned, and the symphyseal fracture was finally reduced and fixed. The mouth opening was within normal limits, and favorable occlusion was confirmed one month postoperatively. To our knowledge, this is the first case of dislocation of both intact condyles--associated with symphysis fracture--being reduced with bone traction hook.
Kim, Bong Chul; Kang Samayoa, Sara Rebeca
[Posteromedial dislocation of the elbow with lateral condyle and coronoid process fractures: a case report].
We report the occurrence of a rare injury in a teenager not yet described in the literature: the association of posteromedial elbow dislocation, lateral condyle and coronoid process fractures. The treatment required fixation of lateral condyle and coronoid process thanks to lateral and medial approaches and capsular fixation. This lesion is unstable, such as the terrible triad described in adults. It requires external and anterior stabilization of the elbow. The management of such injuries of the elbow is complex. It must consider both bone and ligament instability, and risk of injury to growth plates. PMID:24394235
Mirouse, G; Corcos, P; Casabianca, L; Guillon, P
Unusual presentation of a type 1 Monteggia equivalent lesion: simultaneous medial humeral condyle fracture with ipsilateral anterior dislocation of the radial head and acute plastic bowing of the ulna.
The authors describe a case of simultaneous anterior dislocation of the radial head with plastic deformation of the ulna and an ipsilateral medial humeral condyle fracture in a 6-year-old boy after a fall on an outstretched hand. This rare combination of injuries has not been described previously in the literature. Closed reduction of the dislocated radial head and percutaneous K-wire fixation of the medial humeral condyle fracture achieved an excellent result with full function. This rare combination of injuries is considered to be an unusual subtype of the Bado type I Monteggia equivalent lesion. The case emphasizes that when a fracture is detected around an elbow, other injuries in the region should be suspected. PMID:24769777
Kim, Young Sung; Lee, Ho Min; Kim, Jong Pil; Lim, Chang Rack
EMG activities of two heads of the human lateral pterygoid muscle in relation to mandibular condyle movement and biting force.
Electromyographic (EMG) activities of the superior (SUP) and inferior heads (INF) of the lateral pterygoid muscle (LPT) were recorded in humans during voluntary stepwise changes in biting force and jaw position that were adopted to exclude the effects of acceleration and velocity of jaw movements on the muscle activity. The SUP behaved like a jaw-closing muscle and showed characteristic activity in relation to the biting force. It showed a considerable amount of background activity (5-32% of the maximum) even in the intercuspal position without teeth clenching and reached a nearly maximum activity at relatively lower biting-force levels than the jaw-closing muscles during increment of the biting force. Stretch reflexes were found in the SUP, the function of which could be to stabilize the condyle against the biting force that pulls the condyle posteriorly. This notion was verified by examining the biomechanics on the temporomandibular joint. The complex movements of the mandibular condyle in a sagittal plane were decomposed into displacement in the anteroposterior direction (Ac) and angle of rotation (RAc) around a kinesiological specific point on the condyle. In relation to Ac, each head of the LPT showed quite a similar behavior to each other in all types of jaw movements across all subjects. Working ranges of the muscle activities were almost constant (Ac <3 mm for the SUP and Ac >3 mm for the INF). The amount of EMG activity of the SUP changed in inverse proportion to Ac showing a hyperbola-like relation, whereas that of the INF changed rather linearly. The EMG amplitude of the SUP showed a quasilinear inverse relation with RAc in the hinge movement during which the condyle rotated with no movement in the anteroposterior direction. This finding suggests that the SUP controls the angular relationship between the articular disk and the condyle. On the other hand, the position of the disk in relation to the maxilla, not to the condyle, is controlled indirectly by the INF because the disk is attached to the condyle by tendinous ligaments. PMID:10758122
Hiraba, K; Hibino, K; Hiranuma, K; Negoro, T
The prevalence and causation of tennis elbow (lateral humeral epicondylitis) in a population of workers in an engineering industry
Lateral humeral epicondylitis (tennis elbow) is often considered to be work related but the incidence and prevalence among industrial workers has not previously been studiedIn this study the prevalence of this condition and its relationship to some work factors was investigated in 540 workers in a modern engineering industryThe prevalence was 7-4% (40\\/540). Work was found to be the probable
A rare case of bilateral non-weight bearing posterior aspect of lateral femoral condyle osteochondral fracture and its management.
Osteochondral fracture of the lateral femoral condyle can be a real challenging injury to diagnose on initial presentation. The authors report a rare case of bilateral involvement of posterior aspect of lateral femoral condyle osteochondral fracture in a young 15-year-old boy. This was managed with excision of these osteochondral fragments, as the site involved was on the posterior non-weight bearing area of the femur along with chronicity of the injury dictating excision as a reasonable choice of management. Good outcome for such injury is based on an early diagnosis and prompt treatment along with an early rehabilitation for such cases. Our patient has an excellent 2?years outcome with a Knee Society score of 95 after undergoing excision of these osteochondral fragments in both knees in succession. PMID:24825555
Shaikh, Aamir Hassan; Stanclik, Jaroslaw; Murphy, Paul G D
Fixation of chondral fracture of the weight-bearing area of the lateral femoral condyle in an adolescent.
Purely chondral fractures of the distal femur associated with patellar dislocation are uncommon, and treatment varies from fixation to debridement and marrow stimulation techniques. The unusual case reported here involves an adolescent who underwent fixation of a purely chondral fracture involving a large weight-bearing portion of the lateral femoral condyle. Chondral fracture healing was confirmed on follow-up magnetic resonance imaging and arthroscopic examination. This case suggests that fixation of purely chondral fractures can be successful in weight-bearing areas of the knee. Level of evidence V. PMID:24414379
Chan, Chung Ming; King, Joseph J; Farmer, Kevin W
Bilateral combined discoid lateral menisci and lateral femoral condyle osteochondritis dissecans lesions in a division I varsity athlete: a case report.
Discoid menisci can be a source of pain for patients, and pose treatment challenges to the treating surgeon. Additional associated intra-articular pathology, specifically osteochondral defects, can further complicate the clinical picture. The incidence of lateral discoid meniscus is variable based on the population, with a range of 0.4 to 17%, with bilateral involvement in up to 19% of these cases. Osteochondritis dissecans (OCD) is exceedingly rare, with an incidence of 0.015% in one study; however, some authors have suggested a correlation between the development of OCD and the presence of an unstable or torn lateral discoid meniscus. We present a case, the first to our knowledge, of bilateral lateral femoral condyle OCD in the presence of bilateral, asymptomatic, complete lateral discoid menisci. PMID:23288777
Kilcoyne, Kelly G; Dickens, Jonathan F; Rue, John-Paul; Keblish, David J
Lateral Entry Fixation Using Three Divergent Pins for Displaced Paediatric Supracondylar Humeral Fractures
Background. Supracondylar fractures are the commonest elbow injury in children. Most displaced supracondylar fractures are manipulated and held with a medial/lateral entry or two lateral Kirschner wires. This clinical study has results purely from a three lateral divergent wire technique. Methods. Displaced supracondylar fractures were manipulated closed and three lateral divergent wires inserted. Primary study end points were range of movement and carrying angle relative to the contralateral uninjured elbow (Flynn's grading system) and presence of iatrogenic nerve or vessel injury. Results. 25 children between 3 and 10 years (median 5, range 3–10) suffered a displaced fracture (15 type III, 10 type IIB). 15 left-, 10 right-sided fractures, 14 boys and 11 girls). 23 were fixed primarily, of these 21 in the first 24 hours. 2 were delayed due to swelling. 2 were fixed secondarily with lateral k-wires after loss of position (from a primarily fixed crossed wire technique). One radial and one median nerve palsy sustained at injury settled. No iatrogenic nerve injuries occurred. 21 Excellent, 3 good and 1 poor result on Flynn's grading. Conclusions. The use of three wires on the lateral side in this cohort showed no evidence of slip in fracture position and no iatrogenic nerve injury.
Guy, Stephen Paul; Ponnuru, Ramakrishna Rao; Gella, Sreenadh; Tulwa, Nirmal
Comparative study of depth-dependent characteristics of equine and human osteochondral tissue from the medial and lateral femoral condyles.
Articular cartilage defects are common after joint injuries. When left untreated, the biomechanical protective function of cartilage is gradually lost, making the joint more susceptible to further damage, causing progressive loss of joint function and eventually osteoarthritis (OA). In the process of translating promising tissue-engineering cartilage repair approaches from bench to bedside, pre-clinical animal models including mice, rabbits, goats, and horses, are widely used. The equine species is becoming an increasingly popular model for the in vivo evaluation of regenerative orthopaedic approaches. As there is also an increasing body of evidence suggesting that successful lasting tissue reconstruction requires an implant that mimics natural tissue organization, it is imperative that depth-dependent characteristics of equine osteochondral tissue are known, to assess to what extent they resemble those in humans. Therefore, osteochondral cores (4-8 mm) were obtained from the medial and lateral femoral condyles of equine and human donors. Cores were processed for histology and for biochemical quantification of DNA, glycosaminoglycan (GAG) and collagen content. Equine and human osteochondral tissues possess similar geometrical (thickness) and organizational (GAG, collagen and DNA distribution with depth) features. These comparable trends further underscore the validity of the equine model for the evaluation of regenerative approaches for articular cartilage. PMID:22781206
Malda, J; Benders, K E M; Klein, T J; de Grauw, J C; Kik, M J L; Hutmacher, D W; Saris, D B F; van Weeren, P R; Dhert, W J A
Salter-Harris type III fracture of the lateral femoral condyle with a ruptured posterior cruciate ligament: an uncommon injury pattern.
We report a case of an obscure injury to the distal femoral epiphysis with an uncommon pattern in a 12-year-old boy following a road traffic accident. Initial plain radiographs of the knee were inconclusive. Further investigation with magnetic resonance imaging revealed Salter-Harris type III fracture of the lateral femoral condyle with a gap at the fracture site associated with avulsion of the posterior cruciate ligament. This potentially serious injury can be underestimated on plain radiographs and therefore any suspected injury to the distal femoral epiphysis should be thoroughly assessed and investigated to institute appropriate treatment and minimise the risk of long-term complications. PMID:16937138
Rafee, Asan; Kumar, A; Shah, S V
Bifid mandibular condyle: a rare disorder.
Bifid mandibular condyle is a rare disorder and little is known about the etiology and pathogenesis. We reported a patient with left bifid mandibular condyle with a history of trauma. There was no limitation of mouth opening but the patient was complaining of pain while chewing. Underdeveloped lateral head of the bifid condyle was excised at the level of condylar neck under general anesthesia. The patient healed without any problem. Microscopic evaluation of the excised condyle supported a congenital etiology. Although most cases of the bifid condyle discovered by chance it should be recognized and treated by plastic surgeons interested in craniomaxillofacial surgery. PMID:17119433
Tunçbilek, Gökhan; Cavdar, Günay; Mavili, M Emin
Retroversion of the humeral head in children with an obstetric brachial plexus lesion
e undertook a prospective MRI study to measure the retroversion of the humeral head in 33 consecutive infants with a mean age of 1 year 10 months (3 months to 7 years 4 months) who had an obstetric brachial plexus lesion (OBPL). According to a standardised MRI protocol both shoulders and humeral condyles were examined and the shape of the
J. A. van der Sluijs; W. J. R. van Ouwerkerk; A. de Gast; P. Wuisman; F. Nollet; R. A. Manoliu
Late-diagnosed large osteochondral fracture of the lateral femoral condyle in an adolescent: a case report.
In this case report, we describe a large osteochondral fracture of the anterolateral femoral condyle in an adolescent athlete while dancing. At 3 months after the misdiagnosed injury, the condylar defect was covered by a layer of disorganized fibrous tissue rich in blood vessels. To achieve good repair, an accurate curettage of the fractured surfaces, a precise reduction, and a stable internal fixation of the fragments were performed. Two poly-L-lactic acid bioabsorbable screws were used to obtain appropriate compression. At the 2-year follow-up, the patient was asymptomatic and had resumed her previous dancing activity. An MRI scan showed no interruptions of the cartilage layer at the boundary with the healthy tissue, but cartilage thinning and extensive subchondral remodeling were detected. PMID:23511583
Enea, Davide; Busilacchi, Alberto; Cecconi, Stefano; Gigante, Antonio
Bifid hyperplastic mandibular condyle.
Condylar hyperplasia is a rare non-neoplastic pathology associated with overgrowth of the mandibular condyle. Presentation of condylar hyperplasia with bifid mandibular condyle has never been reported in literature. Early management of the hyperplastic disorders of the mandibular condyle can prevent occlusal canting and developing asymmetric deformities. We report a case of 'Bifid Hyperplastic Mandibular Condyle' in a 14-year-old male with emphasis on early surgical intervention. To best of our knowledge, the present case is the first reported case of bifid mandibular condyle with condylar hyperplasia and 66th reported case of bifid mandibular condyle in living human population. PMID:24431890
Neelakandan, R S; Bhargava, Darpan
Results of treatment of displaced supracondylar humeral fractures in children by percutaneous lateral cross-wiring technique.
Seventy children with displaced type II and III supracondylar fractures of the humerus were managed with percutaneous lateral cross-wiring technique from January 2006 to January 2007. There were 54 boys and 16 girls with a mean age of 6.1 +/- 3.07 years. All patients were operated within 24 h after trauma using the Dorgans percutaneous lateral cross-wiring technique. Patients were followed up for a mean period of 6.1 +/- 2.6 months and assessed both radiologically for union; and functionally and cosmetically according to Flynn's criteria. All patients achieved solid union. Functionally, all patients achieved satisfactory results, while cosmetically, 91.4% of patients had satisfactory results and 8.6% had unsatisfactory results. The most frequently occurring complications were minor pin tract infection in six patients, deep infection in two patients, and 32 patients suffered excessive granulation tissue formation mostly around the proximal pin. There was no iatrogenic neurological injury either for the ulnar or for the radial nerves. The obtained results and minor complications reported signify this technique as a viable treatment method for displaced type II and III supracondylar fractures in children. PMID:18427917
El-Adl, Wael A; El-Said, Mohammed A; Boghdady, George W; Ali, Al-Sayed M
The double headed mandible condyle is a rare alteration that is frequently diagnosticated as an incidental finding in a panoramic radiograph. The different theories about its etiology are explained in this article. Symptoms described with bifid condyles vary from case to case, but in most instances are absent. Computer tomography is the ideal imaging method to evaluate the condyle morphology and to role out any degenerative process to achieve the differential diagnosis. Treatment is conservative for symptomatic patients with TMJ disorders, surgical treatment is described in literature in TMJ ankylosis that develops in bifid condyles secondary to trauma. PMID:15876974
Corchero-Martín, Guadalupe; Gonzalez-Terán, Tomás; García-Reija, María Fe; Sánchez-Santolino, Sergio; Saiz-Bustillo, Ramón
Bilateral Occipital Condyle Fracture
Occipital condyle fractures are a rare finding in trauma victims. Bilateral fractures are even more unusual and have typically been reported in autopsy studies. We treated two patients with bilateral occipital condyle fractures who had only minor symptoms. Anderson and Montesano's classification,1 possible cranial nerve palsies, diagnosis, and treatment of this rare fracture are discussed. ImagesFigure 1Figure 2
Schrodel, Markus H.; Kestlmeier, Ralph; Trappe, Anna E.
Bilateral bifid mandibular condyle: a case report.
Bilateral bifid mandibular condyle is a rarely seen malformation. The aetiology of bifid condyle is not completely understood, although developmental anomaly, traumas, condylar fracture, teratogenic embryopathy and surgical condylectomy may all be causative factors. Although a few studies on human dried skulls tried to shed light on this entity it remains obscure. As most bifid condyle subjects have no complaint related to temporamandibular joint(TMJ), the cases are generally diagnosed through incidental radiographic findings. The case of a 54-year-old female is presented. In a panoramic radiograph obtained after a clinical examination, bilateral bifid mandibular condyle was observed. The open-closed lateral radiograph of the TMJ (obtained using the TMJ-specific program of the panoramic device) demonstrated duplication of the right and left condyles. In order to better evaluate the TMJ morphology and to eliminate pathologies such as fractures that might be missed with conventional radiographs, a computed tomography scan was also obtained. The joint head orientation was observed in the mediolateral direction. The case is discussed in the context of the relevant literature. Until large population-based studies are undertaken and further experimental studies are performed, bifid condyle will remain an incidental finding of anatomic variation rather than a clinically informative observation. PMID:16938108
Açikgöz, A
Hypoplastic occipital condyle and third occipital condyle: Review of their dysembryology.
Disruption or embryologic derailment of the normal bony architecture of the craniovertebral junction (CVJ) may result in symptoms. As studies of the embryology and pathology of hypoplasia of the occipital condyles and third occipital condyles are lacking in the literature, the present review was performed. Standard search engines were accessed and queried for publications regarding hypoplastic occipital condyles and third occipital condyles. The literature supports the notion that occipital condyle hypoplasia and a third occipital condyle are due to malformation or persistence of the proatlas, respectively. The Pax-1 gene is most likely involved in this process. Clinically, condylar hypoplasia may narrow the foramen magnum and lead to lateral medullary compression. Additionally, this maldevelopment can result in transient vertebral artery compression secondary to posterior subluxation of the occiput. Third occipital condyles have been associated with cervical canal stenosis, hypoplasia of the dens, transverse ligament laxity, and atlanto-axial instability causing acute and chronic spinal cord compression. Treatment goals are focused on craniovertebral stability. A better understanding of the embryology and pathology related to CVJ anomalies is useful to the clinician treating patients presenting with these entities. PMID:23338989
Tubbs, R Shane; Lingo, Patrick Ryan; Mortazavi, Martin M; Cohen-Gadol, Aaron A
Post-traumatic bifid condyle: the pathogenesis analysis.
This study investigated the characteristic of bifid condyle secondary to temporomandibular joint (TMJ) trauma, aiming to analyse the pathogenesis of post-traumatic bifid condyle. Four cases identified as having bifid condyle secondary to TMJ trauma were involved in this study. The relative information extracted from the case records included patients' complaint, history of injury and radiographic appearance, which were used to analyse the characteristic and pathogenesis of post-traumatic bifid condyle. The results indicated that there was a correlation between condylar trauma degree and bifid condylar head appearance after trauma. For severe condylar fracture, it might result in Y-shaped condyle associated with TMJ ankylosis; and condylar groove could be associated with the slight trauma in condyle articulating surface. In conclusion, as a specific entity, post-traumatic bifid condyle may develop in cases with insufficient remodelling capacity after condyle trauma, and it seems that the severity degree of trauma, the site of trauma and its relation to the insertion of the lateral pterygoid muscles are factors associated with the appearance and orientation of bifid condyle. PMID:21752190
Li, Zhi; Djae, Kamardine Ahmed; Li, Zu-Bing
Proximal Humeral Fractures: Nailing
Treating proximal humeral fractures surgically has always been a challenge for the orthopaedic trauma surgeon. The challenge\\u000a was and is due to numerous factors such as the specific anatomy of the proximal humerus, problems of an adequate approach\\u000a and exposure of the fracture and different fracture fragments, possible iatrogenic injuries to the rotator cuff on approach\\u000a and the detrimental effects
Johannes Maria Rueger; Andreas Rücker; Daniel Briem; Lars Grossterlinden; Wolfgang Linhart
Humeral torsion revisited: a functional and ontogenetic model for populational variation.
Anthropological interest in humeral torsion has a long history, and several functional explanations for observed variation in the orientation of the humeral head have been proposed. Recent clinical studies have revived this topic by linking patterns of humeral torsion to habitual activities such as overhand throwing. However, the precise functional implications and ontogenetic history of humeral torsion remain unclear. This study examines the ontogeny of humeral torsion in a large sample of primarily immature remains from six different skeletal collections (n = 407). The results of this research confirm that humeral torsion displays consistent developmental variation within all populations of growing children; neonates display relatively posteriorly oriented humeral heads, and the level of torsion declines steadily into adulthood. As in adults, variation in the angle of humeral torsion in immature individuals varies by population, and these differences arise early in development. However, when examined in the context of the developing muscles of the shoulder complex, it becomes apparent that variation in the angle of humeral torsion is not necessarily related to specific habitual activities. Variability in this feature is more likely caused by a generalized functional imbalance between muscles of medial and lateral rotation that can be produced by a wide variety of upper limb activity patterns during growth. PMID:17657784
Cowgill, Libby W
Plating in Proximal Humeral Fractures
Improved imaging, updated knowledge regarding humeral head perfusion and adapted fixation techniques with implants having\\u000a better purchase also in osteopenic bone, have influenced the treatment of proximal humeral fractures in recent years. Demographic\\u000a evolution and a more active population even among the older age groups will increase the incidence of this fracture, which\\u000a is already the third most frequent fracture
Reto Babst; Felix Brunner
Double crush syndrome due to plating of humeral shaft fracture
Median nerve injury is rarely associated with the humeral shaft fracture. A Sixty two year old woman with a displaced humeral shaft fracture, developed a symptomatic carpal tunnel syndrome after plating with a screw protruding medially. 16 months later, the implants were removed and the symptoms gradually improved without carpal tunnel release surgery. A double crush syndrome resulted due to the proximal compression by the medially protruding screw and the distal compression by carpal tunnel. The proximal decompression produced by removal of the screw led to relief of the symptoms.
Huang, Yi-Gang; Chang, Shi-Min
Robust femur condyle disambiguation on biplanar X-rays.
Three-dimensional (3D) reconstruction of the skeleton from biplanar X-rays relies on scarce information digitalised by an operator on both frontal and lateral radiographs. In clinical routine, difficulties occur for non-skilled operators to discriminate the medial from the lateral femur condyle on the lateral view. Our study proposes an algorithm able to detect automatically a possible inversion of the two condyles by the operator at an early stage of the reconstruction process. It relies on the computation of two 3D femur surfaces, one directly from the operator digitalisation and the other from the same digitalisation with medial and lateral condyles automatically swapped. Pairs of virtual biplanar X-rays are computed for both reconstructions and the closest pair to the original X-rays is selected on the basis of similarity measures, pointing the correct 3D surface. The algorithm shows a success rate higher than 85% for both asymptomatic and pathological femurs whatever the initial condyle digitalisation of the operator, bringing automatically non-skilled operators acting in clinical routine to the level of skilled operators. This study validates moreover the proof-of-concept of automatic shape adjustments of a 3D surface on the basis of similarity measures in the process of 3D reconstruction from biplanar X-rays. PMID:22349135
Serrurier, Antoine; Quijano, Sergio; Nizard, Remy; Skalli, Wafa
Central chondrosarcoma of a pediatric mandibular condyle: A case report and review
Chondrosarcoma of mandibular condyle is an extremely rare clinical entity with only 18 cases reported till date. We report a rare case of central myxoid chondrosarcoma in a 7 year old male child with a complaint of slow growing bony hard swelling of left mandibular condyle. Panoramic radiography and CT scan revealed a 5×3cm osteosclerotic and osteolytic lesion with cortical perforation on the medial side of the left mandibular condyle with a cortical expansion of lateral side. Segmental mandibulectomy with disarticulation of the left condyle was done. To the best of our knowledge it is the first case of chondrosarcoma of the paediatric mandibular condyle to be reported. The etiopathogenesis, clinical, radiological diagnosis and various treatment modalities of chondrosarcoma are discussed
Kumar Reddy, D. Sathya; Kishore Kumar, R. V.; Gali, Rajasekhar; Kannubaddy, Sridhar Reddy; Rao, Mallikarjuna; Akheel, Mohammad
[Humeral head fracture and cuff].
During the past decade the evaluation of the rotator cuff in the management of proximal humeral fractures has received increasing attention. Different studies have investigated the pathomorphology, prevalence and impact of rotator cuff lesions on the outcome of non-operative or surgical treatment of proximal humeral fractures. Tendon defects, either chronic or trauma related, are observed mainly in the anterosuperior or posterosuperior aspect of the rotator cuff and present as partial- or full-thickness tears. Structural changes of the rotator cuff muscles including atrophy and fatty infiltration in the context of proximal humeral fractures have been inadequately investigated. The prevalence of coexisting rotator cuff pathology varies between 5 and greater than 50% depending on the method of evaluation, the fracture morphology and the age of the patient. The influence of a concomitant rotator cuff tear on the clinical outcome has not been conclusively investigated. However, different studies indicate that some lesions can be a source of persistent pain and functional deficit after conservative or surgical management of proximal humeral fractures. Therefore, a simultaneous repair of the rotator cuff defect during surgical reconstruction of the proximal humerus is indicated. PMID:22108771
Scheibel, M
Bifid mandibular condyle: CT and MRI appearance.
Bifid mandibular condyle (BMC) is a rare asymptomatic morphological alteration with no predilection for age group or gender. Its morphology varies from a shallow groove to two condylar heads with separate necks, oriented mediolaterally or anteroposteriorly. This report describes an unusual case of bilateral mediolateral bifid condyle in a 24-year-old female patient with the main complaint of mouth-opening limitation. MRI and CT findings revealed bilateral bifid condyle. PMID:22922936
Tutar, Onur; Bas, Ahmet; Gülsen, Gökçe; Bayraktarov, Elmar
[Occipital condyle fractures: a case report].
Occipital condyle fractures are rare, and conservative treatment is sufficient for many cases. Surgical treatment may be required if the condyle fracture is accompanied by atlantooccipital dislocation. Unfortunately, condyle fracture generally cannot be diagnosed with X-ray in the emergency department. Recently, computed tomography scans have been used more frequently, and enable easier diagnosis of these types of fractures. In this report, we describe a patient who admitted to our emergency department after a major trauma. She complained of neck pain, and maxillofacial trauma was more evident. Her cervical X-rays were normal, but cervical computed tomography revealed unilateral occipital condyle fracture. PMID:24936848
Dinç, Cem; Türko?lu, Mehmet Erhan; Tuncer, Cengiz; Aykanat, Omer; Ozçelik, Derya; Ozkan, Gamze
21 CFR 872.3960 - Mandibular condyle prosthesis.
Code of Federal Regulations, 2010 CFR
...2009-04-01 2009-04-01 false Mandibular condyle prosthesis. 872.3960 ...Prosthetic Devices § 872.3960 Mandibular condyle prosthesis. (a) Identification. A mandibular condyle prosthesis is a device...
21 CFR 872.3960 - Mandibular condyle prosthesis.
Code of Federal Regulations, 2010 CFR
...2010-04-01 2010-04-01 false Mandibular condyle prosthesis. 872.3960 ...Prosthetic Devices § 872.3960 Mandibular condyle prosthesis. (a) Identification. A mandibular condyle prosthesis is a device...
[Resurfacing of the humeral head : sensible indications].
Cup resurfacing of the humeral head is one of the possible prosthetic solutions for severe destruction of the glenohumeral joint. Because neurological complications are not uncommon after total shoulder arthroplasty using surface replacement, these cups are indicated when hemiarthroplasty is possible. The advantages of humeral head resurfacing are bone preservation and the technically easy exchange if revision is necessary; therefore, young patients are candidates for this type of endoprosthesis. At present humeral head resurfacing is indicated for osteoarthritic destruction of Walch types A1 and C, for rheumatic destruction with deficient cuff in younger patients, cuff arthropathy in younger patients with Seebauer types 1A and 1B, humeral head necrosis with normal glenoid and necrotic bone in less than one third of the humeral head and dislocation arthropathy in younger patients. PMID:23695191
Fink, B; Niemeier, A; Rüther, W
The false and the true bifid condyles.
The bifid mandibular condyle has been described as a condition of unknown aetiology and uncertain pathogenesis. Many see it as the product of accidental trauma or forceps delivery, with the two heads occurring one behind the other in the sagittal plane. In bioanthropological literature, "bifid condyle" often describes pitting in the sagittal plane, dividing the condyle mediolaterally. We examined 38 male and 16 female pre-European-contact Pacific islanders' adult mandibles, and 24 male and 29 female modern Indian mandibles, recording frequency, prominence and position of any condylar groove in both coronal and sagittal planes. We report the tenth known case of a bilaterally-bifid condyle. A groove was found almost twice as likely to occur on the left condyle of the Indians than of the Pacific Islanders, but equally likely to occur on the right side of both groups. That same finding applied to males and females. In order to avoid terminological ambiguity, we suggest that the term "bifid condyle" should be reserved for describing multiple condyles in the sagittal plane only - the true bifid condyle. An hypothesis is offered for the occurrence of the groove in the sagittal plane. PMID:18417126
Dennison, J; Mahoney, P; Herbison, P; Dias, G
Characterization of initial microfracture defects in human condyles.
Microfracture (MFX) is a cartilage repair technique that depends on cell migration from marrow-rich trabecular bone cavities into the cartilage lesion. This study tested the hypothesis that MFX awls with distinct geometry generate different hole shapes and variable bone marrow access in condyles with Grade III to IV lesions. Lateral and medial condyles from total knee arthroplasty (N = 24 male and female patients, 66 ± 9 years) were systematically microfractured ex vivo to 2 and 4 mm deep and the bone holes analyzed by micro-computed tomography. Subchondral bone in lesional condyles showed different degrees of sclerosis up to 2 mm deep ("porous," sclerotic, extremely dense). MFX holes ranged from 1.1 to 2.0 mm in diameter, and retained the awl shape with evidence of slight bone elastic rebound and bone compaction lining the holes that were increased by wider awl diameter and deeper MFX. Marrow access was significantly diminished by sclerosis for all three awls, with an average marrow access varying from 70% (nonlesional bone) to 40% (extremely dense bone). This study revealed that subchondral bone sclerosis can reach a critical limit beyond which MFX creates bone compaction and fissures instead of marrow access. PMID:23529699
Hoemann, Caroline D; Gosselin, Yoann; Chen, Hongmei; Sun, Jun; Hurtig, Mark B; Carli, Alberto; Stanish, William D
Humeral surface replacement for osteoarthritis
Background and purpose Humeral resurfacing has shown promising results for osteoarthritis, but revisions for glenoid erosion have been reported frequently. We investigated the hypothesis that preoperative glenoid wear and postoperative progress of glenoid erosion would influence the clinical outcome. Methods We reviewed 61 resurfacing hemiarthroplasties (55 patients) for primary osteoarthritis. 6 patients were lost to follow-up and 5 had undergone revision arthroplasty. This left 50 shoulders in 44 patients (mean age 66 years) that were followed for mean 30 (12–44) months. Complications, revisions, and the age- and sex-related Constant score were assessed. Radiographs were evaluated for loosening and glenoid erosion according to Walch. Results Of the 50 shoulders that were functionally assessed, the average age- and sex-related Constant score was 73%. In patients with preoperative type-B2 glenoids, at 49% it was lower than in type-A1 glenoids (81%, p = 0.03) and in type-B1 glenoids (84%, p = 0.02). The average age- and sex-related Constant score for patients with type-A2 glenoids (60%) was lower than for type-A1 and -B1 glenoids and higher than for type-B2 glenoids, but the differences were not statistically significant. In the total population of 61 shoulders, the radiographs showed postoperative glenoid erosion in 38 cases and no humeral prosthetic loosening. Revision arthroplasty was performed in 11 cases after 28 (7–69) months. The implant size had no statistically significant influence on the functional outcome. The size was considered to be adequate in 28 of the 50 functionally assessed shoulders. In 21 cases, the implant size was too large and in 1 case it was too small. Interpretation We found frequent postoperative glenoid erosion and a high rate of revision arthroplasty after humeral resurfacing for primary osteoarthritis. Oversizing of the implants was common, but it had no statistically significant influence on the functional outcome. Inferior results were found in the presence of increased eccentric preoperative glenoid wear. Total shoulder arthroplasty should be considered in these patients.
Bifid mandibular condyle: a case report.
The bifid mandibular condyle is a rare anomaly. A variety of causes are implicated with its development such as developmental origin and trauma. Because of the lack of epidemiological data, there is little information about the real incidence of this malformation. The purpose of this paper is to report a case of bifid mandibular condyle in a 20-year-old woman who referred to a private radiological clinic for routine dental examination. A panoramic radiography incidentally revealed a discrete modification of the left mandibular condyle. Magnetic resonance imaging (MRI) was taken and confirmed the diagnostic proposed. PMID:16617199
Ramos, Flávia Maria de Moraes; Filho, José Osmar de Vasconcelos; Manzi, Flávio Ricardo; Bóscolo, Frab Norberto; Almeida, Solange Maria de
Hominoid humeral morphology: 3D morphometric analysis.
Variation in humeral morphology among hominoids has long been recognized in relation to both phylogeny and behavior. Here, we use 3D landmark data to analyze humeral shape among hominoids, including hylobatids (n?=?37), Pongo (n?=?33), Homo (n?=?74), Pan (n?=?55), and Gorilla (n?=?45) to examine the relative influence of phylogenetic history vs. locomotor adaptation on humeral shape. Principal components analysis (PCA) of Procrustes shape data derived from 19 humeral type II or type III landmarks (Bookstein, 1991) for these taxa reveals the following: PC1, which primarily reflects the humeral torsion (or lack thereof) and relative diaphyseal and epiphyseal breadths, separates the relatively narrow-shafted, small articular dimensions and low humeral torsion Hylobates, and to a lesser extent, Pongo, humeri from those of the African hominoids. PC2, which largely contrasts shafts that are posteriorly convex (high PC2 scores) with antero-posteriorly straight humeral shafts (low PC2 scores) separates Homo, who tend to have A-P straighter shafts, from the more A-P bowed humeral shafts of the apes. These shape patterns suggest that the bowed shafts of Pan, Pongo, and Gorilla (and to a lesser extent, hylobatids) are due to the fact that in each of these taxa, the humerus is a weight-bearing bone, whereas the shafts of Homo are freed from locomotion. More subtle behavioral indicators are also elucidated, whereas cluster analyses (minimum spanning tree fit to a principal coordinates [PCO] plot and UPGMA dendrogram) reveal strong phylogenetic signals in the hominoid humerus as well. PMID:24132859
Holliday, Trenton W; Friedl, Lukáš
Arterial blood supply of the proximal humeral epiphysis
The arterial blood supply of the proximal humeral epiphysis is known to derive mainly from the anterior humeral circumflex a. (ACA), but this description may minimize the role of the posterior circumflex humeral a. (PCA). The studies of Laing [9] and Gerber [3] emphasized the role of the ACA and of its branches, the ascending anterolateral artery and arcuate artery
F. Duparc; J.-M. Muller; P. Frçger
[Arthroscopic fracture management in proximal humeral fractures].
Arthroscopy has become increasingly more established in the treatment of proximal humeral fractures. In addition to the known advantages of minimally invasive surgery fracture and implant positioning can be optimized and controlled arthroscopically and relevant intra-articular concomitant pathologies (e.g. biceps tendon complex and rotator cuff) can be diagnosed and treated. Arthroscopic techniques have proven to be advantageous in the treatment of various entities of greater tuberosity fractures, lesser tuberosity fractures (suture bridging technique) and subcapital humeral fractures (arthroscopic nailing). This article presents an overview on innovative arthroscopic modalities for treating proximal humeral fractures, describes the surgical techniques and the advantages compared to open procedures as well as initial clinical results. PMID:23515643
Lill, H; Katthagen, C; Jensen, G; Voigt, C
Impaction fracture of the medial femoral condyle.
The patient was a 20-year-old man who sustained a noncontact left knee hyperextension injury while playing soccer. In reviewing left knee radiographs that had previously been interpreted as normal, the physical therapist noted an abnormally deep depression of the medial condylopatellar sulcus, which was concerning for a possible impacted osteochondral fracture. After discussing the radiographic findings with a radiologist, the physical therapist ordered magnetic resonance imaging, which revealed a focal indentation of the anterior portion of the medial femoral condyle with adjacent bone marrow edema that was consistent with an impaction fracture of the medial femoral condyle. PMID:23812292
Mabry, Lance M; Ross, Michael D; Abbott, Jessica L
Bifid mandibular condyle: archaeological case report of a rare anomaly.
In this paper, an archaeological case of unilateral bifid mandibular condyle is presented. This uncommon anomaly is characterized by a division of the mandibular condylar head. In this case, the left condyle was divided into two articulating surfaces oriented mediolaterally; two articular facets on the anterior wall of the glenoid fossa for the double condyle were observed. The morphological and radiological analysis do not show any evidence of injuries or degenerative pathology. Taking into account the two main causes of bifid condyle suggested in the literature (traumatic and developmental), an embryopathy by teratogenic agents is proposed as a possible aetiology of the bifid condyle reported here. PMID:15533986
Jordana, X; García, C; Palacios, M; Chimenos, E; Malgosa, A
Mid-term results of complex distal humeral fractures.
The aim of this study was to assess outcomes following open reduction and internal fixation in complex fractures of the distal humerus. Between 2000 and 2006, 34 patients were operated for complex fractures of the distal humerus. Bone fixation was obtained with a reverse Y-shaped reconstruction plate in 13 cases and with double plating in 21 cases. At final follow-up, all the patients were assessed with the Mayo Elbow Performance Score. Satisfactory results were observed in 71% of the cases despite a high rate of complications. Age over 65 years is correlated with increased risk for an inferior postoperative result. Complex distal humeral fractures are difficult to treat and are associated with a high incidence of complications. It is therefore mandatory to obtain good anatomical reduction and a stable fixation of lateral and medial columns of the distal humerus. The results observed in older patients suggest that an alternative treatment for these patients may be joint replacement. PMID:21484440
Frattini, Marco; Soncini, Giovanni; Corradi, Maurizio; Panno, Bruno; Tocco, Silvio; Pogliacomi, Francesco
Improved repair of chondral and osteochondral defects in the ovine trochlea compared with the medial condyle.
Associations between topographic location and articular cartilage repair in preclinical animal models are unknown. Based on clinical investigations, we hypothesized that lesions in the ovine femoral condyle repair better than in the trochlea. Full-thickness chondral and osteochondral defects were simultaneously established in the weightbearing area of the medial femoral condyle and the lateral trochlear facet in sheep, with chondral defects subjected to subchondral drilling. After 6 months in vivo, cartilage repair and osteoarthritis development was evaluated by macroscopic, histological, immunohistochemical, and biochemical analyses. Macroscopic and histological articular cartilage repair and type-II collagen immunoreactivity were better in the femoral trochlea, regardless of the defect type. Location-independently, osteochondral defects induced more osteoarthritic degeneration of the adjacent cartilage than drilled chondral lesions. DNA and proteoglycan contents of chondral defects were higher in the condyle, reflecting physiological topographical differences. The results indicate that topographic location dictates the structural patterns and biochemical composition of the repair tissue in sheep. These findings suggest that repair of cartilage defects at different anatomical sites of the ovine stifle joint needs to be assessed independently and that the sheep trochlea exhibits cartilage repair patterns reflective of the human medial femoral condyle. PMID:23813860
Orth, Patrick; Meyer, Heinz-Lothar; Goebel, Lars; Eldracher, Mona; Ong, Mei Fang; Cucchiarini, Magali; Madry, Henning
Proximal humeral fracture treatment in adults.
Most proximal humeral fractures affect elderly patients and can be treated nonoperatively with good functional outcomes.The treatment of displaced three and four-part fractures remains controversial and depends on a variety of underlying factors related to the patient (e.g., comorbidity, functional demand), the fracture (e.g., osteoporosis), and the surgeon (e.g., experience).Throughout the literature, open reduction and locking plate osteosynthesis is associated with considerable complication rates, particularly in the presence of osteoporosis.Low local bone mineral density, humeral head ischemia, residual varus displacement, insufficient restoration of the medial column, and nonanatomic reduction promote failure of fixation and impair functional outcome.The outcome of hemiarthroplasty is closely related to tuberosity healing in an anatomic position to enable the restoration of rotator cuff function. Reverse shoulder arthroplasty may provide satisfactory shoulder function in geriatric patients with preexisting rotator cuff dysfunction or after the failure of first-line treatment. PMID:24500588
Maier, Dirk; Jaeger, Martin; Izadpanah, Kaywan; Strohm, Peter C; Suedkamp, Norbert P
Primary endoprosthesis in comminuted humeral head fractures in elderly patients
Summary \\u000a The purpose of this prospective study was to determine the early subjective and functional result and outcome after primary\\u000a implantation of humeral endoprosthesis in severely comminuted humeral head fractures in elderly patients. From 1993 to 1995,\\u000a 27 humeral head fractures (27 patients) were treated by primary implantation of a Neer II modular shoulder prosthesis. Of\\u000a these, 23 patients were
A. Boss; B. Hintermann
In Vivo Motion of Femoral Condyles During Weight-Bearing Flexion After Anterior Cruciate Ligament Rupture Using Biplane Radiography
The purpose of this study was to investigate in vivo three- dimensional tibiofemoral kinematics and femoral condylar motion in knees with anterior cruciate ligament (ACL) deficiency during a knee bend activity. Ten patients with unilateral ACL rupture were enrolled. Both the injured and contralateral normal knees were imaged using biplane radiography at extension and at 15°, 30°, 60°, 90°, and 120° of flexion. Bilateral knees were next scanned by computed tomography, from which bilateral three-dimensional knee models were created. The in vivo tibiofemoral motion at each flexion position was reproduced through image registration using the knee models and biplane radiographs. A joint coordinate system containing the geometric center axis of the femur was used to measure the tibiofemoral motion. In ACL deficiency, the lateral femoral condyle was located significantly more posteriorly at extension and at 15° (p < 0.05), whereas the medial condylar position was changed only slightly. This constituted greater posterior translation and external rotation of the femur relative to the tibia at extension and at 15° (p < 0.05). Furthermore, ACL deficiency led to a significantly reduced extent of posterior movement of the lateral condyle during flexion from 15° to 60° (p < 0.05). Coupled with an insignificant change in the motion of the medial condyle, the femur moved less posteriorly with reduced extent of external rotation during flexion from 15° to 60° in ACL deficiency (p < 0.05). The medial- lateral and proximal-distal translations of the medial and lateral condyles and the femoral adduction-abduction rotation were insignificantly changed after ACL deficiency. The results demonstrated that ACL deficiency primarily changed the anterior-posterior motion of the lateral condyle, producing not only posterior subluxation at low flexion positions but also reduced extent of posterior movement during flexion from 15° to 60°. Key Points Three-dimensional tibiofemoral kinematics and femoral condylar motion in ACL-deficient knees during upright weight-bearing flexion were measured using biplane radiography with the geometric center axis. ACL deficiency caused posterior subluxation of the lateral condyle with excess external femoral rotation at early flexion positions. On flexion from 15° to 60°, the lateral condyle moved slightly posteriorly in ACL deficiency leading to reduced extent of external femoral rotation.
Chen, Kaining; Yin, Li; Cheng, Liangjun; Li, Chuan; Chen, Cheng; Yang, Liu
Bifid mandibular condyle: Report of two cases of varied etiology.
Bifid condyle is a rare anatomic variation of mandibular condyle. It can be symptomatic or diagnosed incidentally on routine radiographic examination. No definite etiologic factor has been identified. It is suggested that bifid condyle could be a developmental anomaly or secondary to trauma. We are reporting two cases of bifid mandibular condyle. Both were diagnosed using computed tomography scan, which additionally revealed the associated pathosis in the angle of the mandible in first patient and the ankylosis of temporomandibular joint in the second patient. PMID:22442558
Faisal, Mohammad; Ali, Iqbal; Pal, U S; Bannerjee, Kalyan
Bilateral bifid mandibular condyle: case report and literature review.
Bifid mandibular condyle is an infrequent and normally asymptomatic morphological alteration of the mandibular condyle. Although the underlying cause is not clear, a number of theories have been proposed, including teratogenic effects in the embryo, vascular alterations during condyle development, and condylar remodeling following fracture. Since Schier first described this anomaly in 1948 in live individuals, further cases have been documented in the literature. We present a new case of bilateral bifid condyle. The disorder was asymptomatic and constituted a casual finding in a young male presenting for the surgical extraction of two impacted molars. PMID:16711276
Espinosa-Femenia, Mireia; Sartorres-Nieto, Marta; Berini-Aytés, Leonardo; Gay-Escoda, Cosme
Necrosis of the femoral condyles in a four-week-old foal: clinical, imaging and histopathological features.
A 4-week-old Thoroughbred filly foal with a history of sepsis was evaluated for right hindlimb lameness. Bilateral femoropatellar and femorotibial joint effusions were detected. Ultrasonography and radiography of the right stifle revealed signs of joint collapse and periarticular swelling. Computed tomography revealed abnormalities in the bone density of the medial femoral condyle of the right hindlimb and lateral femoral condyle of the left hindlimb. Euthanasia was recommended based on the severity of the lesions. Gross and microscopic examinations revealed extensive separation of the articular-epiphyseal cartilage complex from the subchondral bone of the femoral condyles. The histological features suggest an ischaemic aetiology; comparisons are made with lesions of osteochondrosis and avascular necrosis of bone. PMID:22594034
Haggett, E F; Foote, A K; Head, M J; McGladdery, A J; Powell, S E
Extended Neviaser portal approach to antegrade humeral nailing.
Certain arthropathies can distort the normal acromiohumeral relationship and make traditional anterolateral access to the proximal humerus for nailing difficult or impossible. This article presents a case of bilateral antegrade humeral nailing in which the Neviaser portal approach was used for humeral shaft fractures in a patient with distorted shoulder anatomy secondary to severe cuff tear arthropathy and rheumatoid arthritis. Based on a literature review, extending the traditional superomedial (Neviaser) portal to the shoulder to perform humeral nailing has never been described clinically. An 85-year-old woman with rheumatoid arthritis and bilateral cuff tear arthropathy presented after a mechanical fall from standing height with bilateral acute humeral shaft fractures. Preoperative fluoroscopy confirmed the inability to access the traditional starting point with an anterolateral approach due to a shield acromion resulting from cuff tear arthropathy and rheumatoid arthritis. Bilateral locked antegrade humeral nails were successfully placed through a 3-cm incision just off the medial border of the acromion and directly posterior to the acromioclavicular joint (the extended Neviaser portal approach). Postoperatively, the patient demonstrated early evidence of clinical and radiographic union. She was able to return to her preinjury function level, with an active range of motion comparable with her baseline. The Neviaser portal approach to antegrade humeral nailing is an effective solution to diaphyseal humeral fractures when access to the traditional anterolateral proximal humeral starting port is not possible due to distorted shoulder anatomy. PMID:23383679
Dilisio, Matthew F; Fitzgerald, Ryan E; Miller, Eric T
Is scapular endoprosthesis functionally superior to humeral suspension?
Humeral suspension was the most popular reconstructive procedure after total scapulectomy until the early 1990s. Since 1992 the senior author has been performing scapular endoprosthetic reconstruction after total scapulectomy whenever the rhomboids, latissimus dorsi, deltoid, and trapezius were preserved. We hypothesized that scapular endoprosthetic reconstruction resulted in better functional and cosmetic results than humeral suspension. From 1979 to 2003, 32 consecutive patients had total scapulectomies. Reconstructions included humeral suspensions in 16 patients and scapular endoprostheses in 16 patients. Functional and cosmetic results were compared retrospectively between the two groups. Patients with scapular endoprostheses had better functional results and superior cosmesis as compared with patients with humeral suspension. The mean Musculoskeletal Tumor Society scores for patients with scapular endoprostheses and humeral suspensions were 78.5% and 58.5% respectively. Seven patients with scapular endoprostheses had greater than 40 degrees abduction and 11 patients with humeral suspensions could not abduct the shoulder greater than 20 degrees. Twelve patients with humeral suspensions and none with scapular endoprostheses wore shoulder pads or customized orthoses for cosmetic purposes. After total scapulectomy, scapular endoprosthetic reconstruction led to better functional and cosmetic results than humeral suspension and therefore we recommend performing this reconstructive procedure whenever the rhomboids, latissimus dorsi, deltoid, and trapezius are preserved. PMID:17006374
Pritsch, Tamir; Bickels, Jacob; Wu, Chia Chun; Squires, Malcolm H; Malawer, Martin M
Aneurysmal Bone Cyst located in the Mandibular Condyle
A rare case of aneurysmal bone cyst (ABC) located in the mandibular condyle in a 10-year-old boy is presented. The patient came to our attention for a sudden swelling in the right temporomandibular region, the mouth opening was not reduced. A rapid growing mass, depicting soft tissue invasion, in the right condyle of the mandible was found. Clinically and radiographically
Sandro Pelo; Giulio Gasparini; Roberto Boniello; Alessandro Moro; Pier Francesco Amoroso
Role of hybrid monolateral fixators in managing humeral length and deformity correction
Background and purpose Humeral lengthening and deformity correction are now being done increasingly for various etiologies. Monolateral external fixators have advantages over traditional Ilizarov circular fixators; they are easy to apply, they are less bulky, and they are therefore more convenient for the patient. We assessed the effectiveness of hybrid monolateral lateral fixators in humeral lengthening and deformity correction. Methods We retrospectively reviewed 23 patients (40 humeri) with various pathologies who underwent lengthening—with or without deformity correction using monolateral external fixator—between 2003 and 2008. Mean age at the time of the surgery was 14 (10–22) years. The mean follow-up time was 3.4 (1–7) years. Results The average duration of external fixator use was 8.3 (6–19) months. The mean lengthening achieved was 8.8 (4–11) cm and percentage lengthening was 49% (19–73). The healing index was 28 (13–60) days/cm. The major complications were refracture in 3 humeri and varus angulation of 2 humeri. The minor complications were superficial pin tract infection (6 segments), transient radial nerve palsy (1 segment), and elbow flexion contracture (5 segments). All complications resolved. Interpretation Hybrid monolateral fixators can be used for humeral lengthening and deformity correction. The advantage over circular fixators is that they are less bulky and patients can perform their day-to-day activities with the fixator in situ.
Treatment of fractures adjacent to humeral prostheses.
Fifteen patients with fractures adjacent to a humeral prosthesis were treated between 1986 and 2002. There were 10 females and 5 males. The average age was 58 years. The fractures were classified as to location relative to the prosthesis. Type I fractures (N = 3) occurred proximal to the tip of the prosthesis. Type II fractures (N = 7) occurred in which the fracture line extended from the proximal portion of the humeral shaft to beyond the distal tip of the prosthesis. Type III (N = 5) fractures occurred entirely distal to the tip of the prosthesis. Two type I and 3 type II fractures were managed with a fracture orthosis. The remainder of the fractures were treated surgically with a combination of cerclage wires and long stem prosthesis. All fractures progressed to union at an average of 11 weeks. Average forward elevation for the group was 124 degrees . No patient required a shoulder spica or bone grafting to obtain union. Treatment resulted in fracture union, prosthesis stability, and a paucity of complications. PMID:18069012
Groh, Gordon I; Heckman, Michael M; Wirth, Michael A; Curtis, Ralph J; Rockwood, Charles A
Humeral bone fragility in patients with shoulder prosthesis: a case of humeral periprosthetic refracture
Summary In recent decades there has been an increase in upper limb prosthetic surgery, primarily for the shoulder, for osteoarthritis disease and for traumatic pathology. It is occurring in parallel an increase in periprosthetic fractures of the humerus, although with less impact than other anatomical districts such as the hip. We report a case of humeral periprosthetic refracture in a 66-years-old female patient. The humerus bone quality is worse than in other districts in patient of the same age. The fragility humerus fracture are increasing, affecting relatively younger individuals than those with femoral neck fractures and represent an independent risk factor for the occurrence of subsequent fractures. Actually humeral BMD is underestimated by traditional densitometric evaluation techniques.
Giannotti, Stefano; Bottai, Vanna; Dell'Osso, Giacomo; Donati, Daniela; Bugelli, Giulia; De Paola, Gaia; Guido, Giulio
Deep Lateral Femoral Notch: A Sign of Anterior Cruciate Ligament Disruption.
National Technical Information Service (NTIS)
The 'deep lateral femoral notch' sign refers to an osteochondral impaction injury of the lateral femoral condyle that is associated with disruption of the anterior cruciate ligament (ACL). At the time of injury, the tibia translates anteriorly relative to...
L. Folio T. G. Sanders
Tetrafid mandibular condyle: a unique case report and review of the literature.
Morphological changes such as bifid and trifid mandibular condyle are rare entities. The aim of the present report is to describe a unique morphological variation of the mandibular condyle which has four separate condylar heads (tetrafid mandibular condyle) and to discuss clinical and radiological differential diagnosis of tetrafid mandibular condyle with advanced imaging techniques. PMID:22065803
Sahman, H; Etöz, O A; Sekerci, A E; Etöz, M; Sisman, Y
Bilateral bifid mandibular condyles diagnosed with three-dimensional reconstruction
Bifid mandibular condyles (BMCs) are rare anomalies. The overwhelming majority of prior reports described their predominantly unilateral occurrence diagnosed by panoramic radiography. We present an even rarer case of bilateral BMC initially identified by panoramic radiography and confirmed with colour-enhanced three-dimensional CT. These images substantiate the theory that the secondary condyles arise from the neck of the mandible (Lopez-Lopez et al. Bifid condyle: review of the literature of the last 10 years and report of two cases. Cianio 2010; 28: 136–140).
Tanner, JM; Friedlander, AH; Chang, TI
Bilateral bifid mandibular condyles diagnosed with three-dimensional reconstruction.
Bifid mandibular condyles (BMCs) are rare anomalies. The overwhelming majority of prior reports described their predominantly unilateral occurrence diagnosed by panoramic radiography. We present an even rarer case of bilateral BMC initially identified by panoramic radiography and confirmed with colour-enhanced three-dimensional CT. These images substantiate the theory that the secondary condyles arise from the neck of the mandible (Lopez-Lopez et al. Bifid condyle: review of the literature of the last 10 years and report of two cases. Cianio 2010; 28: 136-140). PMID:22241877
Tanner, J M; Friedlander, A H; Chang, T I
Biomechanical testing of unstable humeral shaft fracture plating.
This study compared the biomechanical performance of 4.5-mm limited-contact dynamic compression plates (DCPs) and 3.5-mm locking compression plates (LCPs) for the fixation of unstable humeral shaft fractures. Composite humeri were divided into two groups: 3.5-mm LCPs and 4.5-mm DCPs. Osteotomy gaps of 5 mm, simulating diaphyseal comminution, were created. Stiffness tests were performed in anterior-posterior (AP) bending, medial-lateral (ML) bending, torsion, and axial compression. Results showed that while construct stiffnesses in ML bending and torsional loading are significantly higher for the 4.5 DCP group (p < .05), no statistically significant differences were observed in AP bending or axial compression. Fatigue characteristics under cyclic AP bending conditions were also evaluated, although no failures occurred. Data from the literature suggest that stiffness results for the LCP constructs perhaps afford sufficient fixation strength capable of supporting the physiologic loads most commonly applied during postoperative rehabilitation. However, results indicate that the DCP construct is mechanically advantageous for stabilizing diaphyseal comminuted fractures. PMID:19995496
Catanzarite, Joshua; Alan, Rodney; Baig, Rafath; Forno, Phil; Benson, Lisa
Percutaneous multiple K-wire fixation for humeral shaft fractures
umeral shaft fractures are one of the common injuries, following Musculo-skeletal trauma. Being the most important bone of the upper extremity involved in the skilled movements, the appropriate management of the humeral shaft fractures is very important. There are various modalities of management for the humeral shaft fractures ranging from non-operative to operative. Non-operative management techniques include; hanging cast, U-slab,
Abdul Q. Khan; Aftab A. Iraqi; Mohammad-Khalid A. Sherwani; Mazhar Abbas; Adesh Sharma
Osteochondritis dissecans of the humeral capitellum in identical twins
Osteochondritis dissecans (OCD) of the humeral capitellum is a disorder affecting mainly boys between the ages of 12 and 15 years. The exact etiology of OCD is not clear, but it is believed that repetitive trauma is the primary cause. Genetic factors are thought to play a secondary role in the pathogenesis. We present 17-year-old identical twins with similar MRI and arthroscopic findings, suggesting that genetic components are involved in the etiology of OCD of the humeral capitellum.
Pudas, Tomi; Koskinen, Seppo K; Hiltunen, Ari; Mattila, Kimmo T
Osteochondritis dissecans of the humeral capitellum in identical twins.
Osteochondritis dissecans (OCD) of the humeral capitellum is a disorder affecting mainly boys between the ages of 12 and 15 years. The exact etiology of OCD is not clear, but it is believed that repetitive trauma is the primary cause. Genetic factors are thought to play a secondary role in the pathogenesis. We present 17-year-old identical twins with similar MRI and arthroscopic findings, suggesting that genetic components are involved in the etiology of OCD of the humeral capitellum. PMID:23986847
Pudas, Tomi; Koskinen, Seppo K; Hiltunen, Ari; Mattila, Kimmo T
Humeral lengthening and deformity correction with the multiaxial correction system.
Limb lengthening for humeral length discrepancy is typically accomplished using a traditional monolateral external fixator frame or an Ilizarov-type device, which have distinct shortcomings for the correction of concomitant deformity and application to the upper extremity, respectively. A new monolateral frame, the multiaxial correction (MAC) system, provides advantage over other monolateral frames and Ilizarov-type devices for humeral lengthening and may achieve similar outcomes. The purpose of this study was to report on the use of the MAC system for limb lengthening in pediatric patients, each with humeral length discrepancy and deformity. Surgical technique for applying the frame to the humerus is described briefly. A retrospective review of all pediatric patients with humeral length discrepancy treated with the MAC system by one orthopedic surgeon at a major teaching hospital was performed. Clinical data, operative records, and radiographs were reviewed for each patient. A total of three humeri in three children were lengthened over a 3-year period. There were two girls and a boy, with a mean age of 10.3 ± 1.9 years. Etiologies for their discrepancies were osteomyelitis and posttraumatic physeal arrest. Mean initial humeral length discrepancy was 9.4 ± 2.3 cm. All patients had proximal varus deformities, which were partially corrected during treatment. Mean lengthening was 6.5 ± 0.8 cm, and mean healing index was 27.1 ± 4.1 days/cm. Mean follow-up was 23.0 ± 9.9 months. There were no major complications. In conclusion, the MAC system is well suited to the correction of humeral length discrepancies and associated humeral deformities in children. Level of evidence: level IV case series. PMID:21099438
McLawhorn, Alexander S; Sherman, Seth L; Blyakher, Arkady; Widmann, Roger F
A Review of Management Options for Proximal Humeral Fractures
Proximal humeral fractures are common and although the majority can be managed non-operatively, the optimal treatment of displaced or complex fractures remains controversial. Non-operative treatment is typically selected for minimally displaced fractures where union rates are high and good or excellent outcomes can be expected in approximately 80% of cases. The aims of surgical fixation are to restore articular surface congruency, alignment and the relationship between the tuberosities and the humeral head. Hemiarthroplasty provides patients with reliable pain relief and its indications include fracture dislocations, humeral head splitting fractures and some three- and four- part fractures. The key areas of surgical technique that influence functional outcome include correctly restoring the humeral height, humeral version and tuberosity position. Function, however, is poor if the tuberosities either fail to unite or mal-unite. The interest in reverse shoulder arthroplasty as an alternative option has therefore recently increased, particularly in older patients with poor bone quality and tuberosity comminution. The evidence supporting this, however, is currently limited to multiple case series with higher level studies currently underway.
Jordan, Robert W; Modi, Chetan S
[Contact analysis between artificial humeral head and glenoid fossa during humeral external rotation].
We developed a three-dimensional finite element model of the shoulder glenohumeral joint after shoulder arthroplasty including humerus shaft, scapular, scapular cartilage and eight muscles, while each of the muscles was simulated with 50 spring elements. To reduce the element number and improve the analytical precision, we used mixed tetrahedral and hexahedral elements in the model. We then used the model to calculate the biomechanics of the shoulder glenohumeral joint after hemiarthroplasty during humeral external rotation. Results showed that the maximum joint reaction force was 374.72 N and the maximum contact stress was 6. 573 MPa together with the contact ar eas at 40 degrees external rotation. These might be one of the reasons for prosthetic disarticulation, and would provide theoretical bases to prosthetic design. PMID:24804496
Zhang, Linlin; Zhu, Ming; Shen, Ling; Zheng, Feng
Surface replacement of the humeral head in rheumatoid arthritis
Introduction The concept of a newly developed cup arthroplasty (Durom Cup) involves the replacement of the destroyed joint surface of the humeral head with minimal bone resection. In cases of additional massive cuff tear, the cup can be placed in a more valgic position to articulate with the glenoid and the acromion. The aim of this prospective study was to
Bernd Fink; Joachim Singer; Ulrich Lamla; Wolfgang Rüther
Metallosis and pseudotumor after failed ORIF of a humeral fracture.
Metallosis following open reduction and internal fixation (ORIF) for fracture, usually presenting as a soft tissue mass, is barely discussed in the literature. In this case report, the imaging and pathological findings of metallosis after ORIF for a humeral fracture are presented and comprehensively discussed. PMID:22035401
Edelstein, Yudell; Ohm, Hyunsook; Rosen, Yale
Operative versus nonoperative treatment in complex proximal humeral fractures.
This updated meta-analysis investigated whether operative treatment is superior to nonoperative treatment in complex proximal humeral fractures. The authors searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE. Randomized controlled trials that evaluated operative vs nonoperative treatment for exclusively 3- or 4-part proximal humeral fractures were considered. Six studies with a total of 287 patients who had proximal humeral fractures were included. According to the meta-analysis, no statistically significant differences were found between operative and nonoperative treatment in Constant-Murley shoulder scores (Constant scores); Disabilities of the Arm, Shoulder, and Hand scores; total complication events; mortality; infection; nonunion; avascular necrosis; osteoarthritis; redisplacement of fractures; or dislocation or resorption of tuberosity. For health-related quality of life, EuroQol-5D (EQ-5D) favored operative treatment, but 15D scores showed no significant difference. Compared with nonoperative treatment, open reduction and internal fixation required significantly more additional surgeries (risk ratio, 6.50; 95% confidence interval, 1.54-27.50; P=.01), and more penetrations into joint space occurred (risk ratio, 9.56; 95% confidence interval, 2.27-40.13; P=.002). The limited evidence suggests that no convincing findings support the use of either open reduction and internal fixation or hemiarthroplasty for the treatment of complex proximal humeral fractures. The findings of the current study should be interpreted cautiously because of the modest sample size and the short follow-up period. PMID:24810816
Mao, Zhi; Zhang, Lihai; Zhang, Licheng; Zeng, Xiantao; Chen, Shuo; Liu, Daohong; Zhou, Zhirui; Tang, Peifu
Humeral lengthening by distraction osteogenesis: a safe procedure?
This study was conducted to assess the safety of humeral lengthening using an Ilizarov frame. We retrospectively reviewed 26 humeral segments in 17 patients that were lengthened at our department between 1993 and 2011. There were varying aetiologies including achondroplasia, epiphyseal dysplasia, Oilier disease, trauma or infection of the proximal humeral growth-plate, unicameral bone cyst and brachial plexus injury. Mean age at start of surgery was 17.05 years (range : 5-40). The mean lengthening achieved was 8.85 (3-13) cm. Mean lengthening percentage was 353% (range : 10-48). Average healing index was 30.56 days/cm (range : 17.46-4232). There was a significant difference in healing index between achondroplasia patients (28.79 days/cm) compared to others (33.41 days/cm). Minor problems included pin tract infection (14 segments). More important obstacles were temporary elbow flexion contracture (7 segments), premature consolidation (6 segments), radial nerve dysaesthesia (6 segments) and loosening of a Schanz screw (1 segment). Complications included one fracture and one progressive bowing after frame removal. One planned lengthening was not completely achieved. Despite a lot of obstacles, humeral lengthening using an Ilizarov frame provided a reliable method to treat the functional or cosmetic problems of upper limb shortening. PMID:24563967
Ruette, Peter; Lammens, Johan
Transient osteoporosis of the femoral condyle: a case report
In this paper, we describe a patient with transient osteoporosis of the femoral condyle. A differential diagnosis should be made for osteonecrosis, infectious disorders, and infiltrative neoplasms based on the normal laboratory findings and diffuse bone edema pattern in MRI. Since this disorder is self-limiting, both the surgeon and clinician should be aware of this condition and must avoid unnecessary
Takeshi Komatsu; Yoshinori Kadoya; Yukihide Minoda; Toshiaki Masada; Yoshiki Yamano
Early intrathoracic migration of Kirschner wires used for percutaneous osteosynthesis of a two-part humeral neck fracture: a case report.
We present an unusual case of early migration of three Kirschner wires used for percutaneous osteosynthesis of a two-part humeral neck fracture, causing hemothorax. An 85-year-old woman was admitted to the emergency room after casual accident. She was found to have suffered a two-part fracture of the surgical neck of the right humerus. The humeral fracture was treated by closed reduction and percutaneous osteosynthesis with three threaded Kirschner wires, which were bent subcutaneously. Ten days after the accident the patient presented with dyspnea and laterocervical pain. Plain X-rays and complementary CT demonstrated intrathoracic migration of the three Kirschner wires with hemothorax. Two of the wires were seen under the right clavicle and adjacent to the C7 vertebra. The third wire reached the lateral chest wall. Immediate surgery was performed, with withdrawal of the wires and placement of a drainage tube. The patient had an uneventful recovery after surgery. The humeral fracture resulted in a nonunion, which was well tolerated by the patient and was left untreated. The use of Kirschner wires for osteosynthesis of proximal humeral fractures may cause significant thoracic morbidity, even if various prophylactic measures, including the use of threaded wires, subcutaneous bending, and close radiographic follow-up, are adopted. The use of Kirschner wires should anyway be restricted to carefully selected cases, in order to avoid major complications. PMID:15278700
Mellado, J M; Calmet, J; García Forcada, I L; Saurí, A; Giné, J
Long-term follow-up of allograft reconstruction of segmental defects of the humeral head associated with posterior dislocation of the shoulder.
The purpose of this study is to report the long-term follow-up result of allograft reconstruction of segmental defect of the humeral head associated with posterior dislocation of the shoulder. Six men underwent operative management of defects of the humeral head involving 40% of the articular surface, following posterior dislocation of the humeral head. The period of time between dislocation and surgery ranged from 7 to 8 weeks. The defect in the head was filled with an allogeneic segment of humeral head contoured to restore the spherical shape. All the patients returned to their occupation 4 months later. All the cases were evaluated clinically and by radiographs and computed tomography (CT) scan at a mean of 122 (96-144) months after the operative procedure. Three men had no complaints of pain, instability, clicking or catching, whereas three had pain, clicking, catching and stiffness. The three patients with good clinical result showed also good radiographic result. The computed tomography (CT) confirmed incorporation of the allograft and no osteoarthrosis. Another patient had a good clinical and radiographic result until the eighth postoperative year. At 8-year follow-up examination, this patient developed shoulder osteoarthrosis and he had pain and stiffness. He needed an arthroplasty 10 years after the operation. The other two patients developed collapse of the graft and osteoarthrosis that were yet evident at 4-year follow-up. These patients required a shoulder arthroplasty 8 years after the procedure. We conclude that the treatment of segmental defects of the humeral head associated with posterior dislocations of the shoulder by allograft reconstruction has a good long-term follow-up result in 50% of the patients. PMID:23195206
Martinez, Angel Antonio; Navarro, Evelio; Iglesias, Daniel; Domingo, Javier; Calvo, Angel; Carbonel, Ignacio
Hemiarthroplasty for proximal humeral fracture: restoration of the Gothic arch.
Proximal humerus fractures are the most common fractures of the shoulder girdle, and initial management of these injuries often determines final outcome. When arthroplasty is used to manage proximal humeral fractures, surgery remains technically demanding, and outcomes have been unpredictable. Recent advances in both technique and prosthetic implants have led to more successful and reproducible results. Key technical points include restoration of the Gothic arch, anatomic tuberosity reconstruction, and minimal soft tissue dissection. PMID:18803974
Krishnan, Sumant G; Bennion, Phillip W; Reineck, John R; Burkhead, Wayne Z
Posterior condyle surface damage on retrieved femoral knee components.
Twenty-two retrieved femoral knee components were identified with posterior condyle surface damage on average at 99° flexion (range, 43°-135° flexion). Titanium alloy material transfer and abrasive surface damage were evident on cobalt-chromium alloy femoral components that were in contact with titanium alloy tibial trays. Surface damage on the retrieved Oxinium femoral components (Smith and Nephew, Inc, Memphis, Tenn) that were in contact with titanium alloy tibial trays showed gouging, associated with the removal and cracking of the oxide and exposure of the zirconium-niobium alloy substrate. Cobalt-chromium alloy femoral components that were in contact with cobalt-chromium alloy tibial trays showed abrasive wear. Contact between the femoral component and tibial tray should be avoided to prevent surface damage to the femoral condyles, which could potentially accelerate polyethylene wear in vivo. PMID:21570806
Burnell, Colin D C; Brandt, Jan-M; Petrak, Martin J; Bourne, Robert B
The results of functional (Sarmiento) bracing of humeral shaft fractures.
At the Department of Orthopaedics of the Kantonsspital Fribourg, 67 humeral shaft fractures were treated by Sarmiento bracing in a 15-year period. There were 54 isolated fractures and 13 fractures sustained as a component of polytrauma. Fifty-eight cases (87%) had healed clinically at a mean of 10 weeks; 9 cases failed to heal, so further treatment was carried out operatively. Of the conservatively managed fractures, 95% (55 cases) healed with an excellent or good result. Three patients noted a slight limitation of active range of motion, but all 58 patients returned to full duty at their jobs. Among 9 patients with delayed or nonunion leading to operative intervention, there were 6 cases with transverse fractures. Major reasons for failed conservative management were an incorrect indication, a significant axial deformity, or a hyperextended position of the fracture fragments. In our experience, active repositioning of humeral shaft fractures is not effective in avoiding a delay in fracture healing. The decision to use functional bracing in polytrauma patients should depend on the time of expected bedridden immobilization, on the presence of additional fractures of the ipsilateral upper extremity, and on the patient's need for crutches. The conservative treatment of humeral shaft fractures with the Sarmiento brace remains the treatment of choice, in spite of newer intramedullary operations that are allegedly minimally invasive and technically less complicated. PMID:11988725
Koch, Peter P; Gross, Dominique F L; Gerber, Christian
Posterior Condyle Surface Damage on Retrieved Femoral Knee Components
Twenty-two retrieved femoral knee components were identified with posterior condyle surface damage on average at 99° flexion (range, 43°-135° flexion). Titanium alloy material transfer and abrasive surface damage were evident on cobalt-chromium alloy femoral components that were in contact with titanium alloy tibial trays. Surface damage on the retrieved Oxinium femoral components (Smith and Nephew, Inc, Memphis, Tenn) that were
Colin D. C. Burnell; Jan-M. Brandt; Martin J. Petrak; Robert B. Bourne
Magnetic resonance imaging findings of true bifid mandibular condyle with duplicated mandibular fossa.
Bifid mandibular condyle (BMC) is a rare asymptomatic morphological alteration with no predilection for age group or gender. Its morphology varies from a shallow groove to two condylar heads with separate necks, oriented mediolaterally or anteroposteriorly. This report describes an unusual case of anteroposterior bifid condyle in a 39-year-old female patient with the main complaint of mouth-opening limitation and a deviation of the mandible to the left side. Magnetic resonance imaging (MRI) findings revealed a bifid condyle on the left side and duplicated mandibular fossa, with the articular disc over the anterior head. The MRI images in the open-mouth position revealed minimal movement of the condyle. Despite the increased number of mediolateral bifid mandibular condyle cases described in the literature, none of previously reported cases of BMC included an anteroposterior bifid condyle case with two distinct mandibular fossa. PMID:22674644
Melo, S L S; Melo, D P; Oenning, A C C; Haiter-Neto, F; Almeida, S M; Campos, P S F
Posttraumatic bifid and trifid mandibular condyle with bilateral temporomandibular joint ankylosis.
Trifid mandibular condyle is an exceedingly rare entity with only 5 cases reported to date. The etiology of the disorder is unknown, though like bifid mandibular condyle, a correlation with prior trauma is usually seen. We present a case of a 6-year-old child who presented with severe restriction of movements at the temporomandibular joint, with a history of trauma 2 years back. Imaging revealed bilateral temporomandibular joint ankylosis with trifid and bifid mandibular condyles. PMID:23524825
Jha, Abhishek; Khalid, Mohd; Sahoo, Biswajit
Locking Plate for Proximal Humeral Fracture in the Elderly Population: Serial Change of Neck Shaft Angle
Background We conducted this radiographic study in the elderly population with proximal humeral fracture aiming to evaluate 1) the serial changes of neck-shaft angle after locking plate fixation and 2) find relationship between change in neck shaft angle and various factors such as age, fracture pattern, severity of osteoporosis, medial support and initial reduction angle. Methods Twenty-five patients who underwent surgical treatment for proximal humeral fracture with locking plate between September 2008 and August 2010 are included. True anteroposterior and axillary lateral radiographs were made postoperatively and at each follow-up visit. Measurement of neck shaft angle was done at immediate postoperative, 3 months postoperative and a final follow-up (average, 11 months; range, 8 to 17 months). Severity of osteoporosis was assessed using cortical thickness suggested by Tingart et al. Results The mean neck shaft angles were 133.6° (range, 100° to 116°) at immediate postoperative, 129.8° (range, 99° to 150°) at 3 months postoperative and 128.4° (range, 97° to 145°) at final follow-up. The mean loss in the neck-shaft angle in the first 3 months was 3.8° as compared to 1.3° in the period between 3 months and final follow-up. This was statistically significant (p = 0.002), indicating that most of the fall in neck shaft angle occurs in the first three months after surgery. Relationship between neck shaft angle change and age (p = 0.29), fracture pattern (p = 0.41), cortical thickness (p = 0.21), medial support (p = 0.63) and initial reduction accuracy (p = 0.65) are not statistically significant. Conclusions The proximal humerus locking plate maintains reliable radiographic results even in the elderly population with proximal humerus fracture.
Pawaskar, Aditya C; Lee, Kee-Won; Kim, Jong-Min; Park, Jin-Woong; Aminata, Iman W; Jung, Hong-Jun; Chun, Jae-Myeung
Computed tomography imaging findings of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis: case report.
Bifid mandibular condyle is an uncommon entity described in the literature as having a controversial etiology. Despite the absence of clinical symptomatology, the radiologist must be aware and should have some knowledge of this abnormality, as well its implications regarding functional and morphological changes. TMJ ankylosis is a disabling disease with involvement of the mandibular condyle, articular fossa and base of the skull. The association of bifid condyle with temporomandibular joint ankylosis is rare and must be carefully evaluated. The purpose of this paper is to report a case of simultaneous bifid mandibular condyle and temporomandibular joint ankylosis and to describe its computed tomography imaging findings. PMID:17639206
Sales, Marcelo Augusto Oliveira; Oliveira, Jefferson Xavier; Cavalcanti, Marcelo Gusmăo Paraíso
Differences in scapular and humeral head position between swimmers and non-swimmers.
The aims of this study were to determine differences between swimmers/non-swimmers, males/females and dominant/non-dominant sides for scapular and humeral head position, while accounting for size, and to determine the relationship between scapular and humeral head position. 46 teenage swimmers (30 females) and 43 non-swimmers (28 females) were measured. The distances between (a) medial spine of the scapula and T3/4 (Superior Kibler), (b) inferior scapula and T7/8 (Inferior Kibler) and (c) anterior acromion and anterior humeral head were recorded while teenagers stood with their hands-on hips. There was no main effect difference between swimmers and non-swimmers for scapular or humeral head position. There were interactions for swim status/dominance (Superior Kibler; P=0.005, Inferior Kibler; P<0.001) and swim status/gender (Superior Kibler; P=0.027). The humeral head was significantly further from the acromion on the dominant side (adjusted mean difference=1.4 mm, P=0.004). Little relationship between scapular and humeral head position was evident. Clinicians should be aware that swim status, in combination with gender or dominance may affect scapular position but does not affect humeral head position. Where swimming had an effect, it minimized differences between genders and sides. The small dominance effect on the humeral head position is unlikely to be clinically detectable. PMID:20030781
McKenna, L; Straker, L; Smith, A; Cunningham, J
Playing level achieved, throwing history, and humeral torsion in Masters baseball players
Humeral torsion is thought to be beneficial for throwing. To examine this hypothesis, the throwing and non-throwing arms of 84 Masters baseball players over 35 years of age were measured for humeral torsion, and the highest playing level they achieved and their playing history were recorded. Regression analyses were used to obtain predictors of the highest playing level achieved, throwing
Rod Whiteley; Roger Adams; Karen Ginn; Leslie Nicholson
Traumatic humeral articular cartilage shear (THACS) lesion in a professional rugby player: a case report
A 20 year old male professional rugby player was seen at the clinic for evaluation of shoulder pain after rugby play. Magnetic resonance imaging showed extensive subchondral bone bruising of the humeral head with defect of the articular cartilage. Arthroscopy showed that the inferior half of the humeral head had extensive articular cartilage loss with nearly 70% of the inferior
I-H Jeon; W A Wallace
Treatment of Humeral Nonunions With Cancellous Allograft, Demineralized Bone Matrix, and Plate Fixation.
National Technical Information Service (NTIS)
Autologous iliac crest bone graft is routinely recommended in the treatment of humeral nonunions. Due to the risks inherent in autograft harvest, we evaluated 11 patients (mean age 62 years; 5 males and 6 females) with humeral nonunions who were treated w...
N. L. Taylor F. J. Raia B. E. Heyworth M. P. Rosenwasser
Outcome of locking compression plates in humeral shaft nonunions
Background: Nonunion of diaphyseal fractures of the humerus are frequently seen in clinical practice (incidence of up to 15% in certain studies) and osteosynthesis using dynamic compression plates, intra medullary nails and Ilizarov fixators have been reported previously. Locking compression plates (LCP) are useful in the presence of disuse osteoporosis, segmental bone loss and cortical defects that preclude strong fixation. We report a prospective followup study of the outcome of the use of LCP for humeral nonunion following failed internal fixation in which implants other than LCP had been used. Materials and Methods: Twenty four patients with nonunion of humeral shaft fractures following failed internal fixation were included in the study. The mean followup period was 3.4 years (range: 2.4 to 5.7 years) and the minimum followup period was 2 years. Mean age of the patients was 41.04 years (range: 24 to 57 years). All 24 patients underwent osteosynthesis using LCP and autologous bone grafting (cortico-cancellous iliac crest graft combined with or without fibular strut graft). Main outcome measurements included radiographic assessment of fracture union and pre and postoperative functional evaluation using the modified Constant and Murley scoring system. Results: 23 out of 24 fractures united following osteosynthesis. Average time to union was 16 weeks (range: 10 to 28 weeks). Complications included delayed union (n = 2), transient radial nerve palsy (n = 2) and persistent nonunion (n = 1). Functional evaluation using the Constant and Murley score showed excellent results in 11, good in 10, fair in two and poor outcome in one patient. Conclusions: Locking compression plating and cancellous bone grafting is a reliable option for achieving union in humeral diaphyseal nonunion with failed previous internal fixation and results in good functional outcome in patients with higher physiological demands.
Kumar, Malhar N; Ravindranath, V Pratap; Ravishankar, MR
Unilateral right occipital condyle to C2 level spinal cord infarction associated with ipsilateral vertebral artery stenosis and contralateral vertebral artery dissection: a case report
Objectives To illustrate the clinical presentation, diagnosis, management, and outcome of unilateral right occipital condyle to C2 level spinal cord infarction. Setting A teaching hospital in Taiwan. Findings A 37-year-old man presented with acute-onset severe right neck pain before weakness developed in both right limbs. Early diagnosis was delayed due to mild intervertebral herniation of the C4–C5 disk. Magnetic resonance imaging revealed unilateral right occipital condyle to C2 level infarction. Angiography showed stenosis of the right vertebral artery (foraminal and intradural segments), and dissection of the left vertebral artery at the C1–C2 level. At discharge, he walked with assistance; 2 weeks later, he walked independently. Conclusions An early diagnosis is difficult but important, as it facilitates appropriate treatment for better functional and survival outcomes. Accurate early diagnosis can be made with adequate knowledge of spinal cord infarction and high index of suspicion for this condition.
Wang, Chin-Man; Tsai, Wei-Lun; Lo, Yang-Lan; Chen, Ji-Yih; Wong, Alice M-K
Is Loss of Fixation Following Locked Plating of Proximal Humeral Fractures Related to the Number of Screws and Their Positions in the Humeral Head?
The aim of the study was to examine the correlation between the chosen position of screws and the complications observed in patients who underwent locked plating of proximal humeral fractures. We evaluated radiographs of 367 patients treated by locked-plating for proximal humeral fractures. Radiographs were taken at one day, 6 weeks, 3 months and 6 months after surgery, and were analyzed for secondary fracture displacement, loss of fixation, cutting out of screws and necrosis of the humeral head. Secondary loss of fixation occurred in 58 cases (15.8%) and among those cutting out of screws was observed in 25 cases (6.8%). In cases of secondary loss of fixation a mean of 6.7 screws were used to fix the fracture (vs 6.6, P=0.425). There was neither significant correlation between position of screws and the occurrence of postoperative loss of fixation in Spearman correlation nor relationship from backward logistic regression analysis. Loss of fixation following locked plating of proximal humeral fractures does not relate to the number of screws and their positions in the humeral head. In consequence, anatomic fracture reduction and restoration of the humeral head-shaft angle are still important factors and should not be disregarded.
Maddah, Mohammad; Prall, Wolf C.; Geyer, Lucas; Wirth, Stefan; Mutschler, Wolf; Ockert, Ben
Osteochondroma of the mandibular condyle: surgical excision followed by occlusal stabilization.
Osteochondroma of the mandibular condyle in adults can be treated by surgical excision, condylectomy followed by costochondral graft or orthognathic surgery. Such complex treatment plan may not be appropriate for patients with old age, affected with chronic osteochondroma of the condyle. In this clinical report, we present a patient with osteochondroma of the condyle treated by surgical excision. The patient's postoperative occlusion was a contraindication for orthognathic surgery because of the severe abrasion of the teeth and the chronic compensation of the dentition to the deviated mandible. Surgical excision of the lesion was carried out under general anesthesia, and the remaining condylar head was salvaged as much as possible. No graft materials or posthodontic condyle reconstruction was carried out. Because there was no occlusal stop to secure the mandible in a centric relation position of the condyle, a stabilization splint was delivered to position the condyle in a relatively stable position. The stability of the condyle position was evaluated by follow-up cone beam computed tomographic scans of the pathologic and the contralateral condyle, along with clinical factors such as occlusal contact points and mandible movements assayed by ARCUSdigma (KaVo). After significant condylar position was achieved, full prosthodontic reconstruction was performed to both the patient's and the dentist's satisfaction. PMID:22421872
Yoo, Ji-Yeon; Choi, Byung-Joon; Kwon, Yong-Dae; Lee, Deok-Won; Ohe, Joo-Young; Suh, Joon-Ho
Bilateral Osteochondritis Dissecans of the Femoral Condyles in Both Knees: A Report of Two Sibling Cases
Osteochondritis dissecans (OCD) of both femoral condyles is very rare, with no previously reported cases of bilateral OCD of both knees in two siblings. We report on a brother and sister with both femoral condyle OCD with a description of surgical technique and clinical results. Fixation using headless compressive screws, osteochondral autologous transplantation and autologous chondrocyte implantation were all successful.
Mascarenhas, Randy; Yoon, Hang Seob
Proximal humeral replacement using a fixed-fulcrum endoprosthesis.
Between 1997 and 2007, 68 consecutive patients underwent replacement of the proximal humerus for tumour using a fixed-fulcrum massive endoprosthesis. Their mean age was 46 years (7 to 87). Ten patients were lost to follow-up and 16 patients died. The 42 surviving patients were assessed using the Musculoskeletal Tumor Society (MSTS) Score and the Toronto Extremity Salvage Score (TESS) at a mean follow-up of five years and 11 months (one year to ten years and nine months). The mean MSTS score was 72.3% (53.3% to 100%) and the mean TESS was 77.2% (58.6% to 100%). Four of 42 patients received a new constrained humeral liner to reduce the risk of dislocation. This subgroup had a mean MSTS score of 77.7% and a mean TESS of 80.0%. The dislocation rate for the original prosthesis was 25.9; none of the patients with the new liner had a dislocation at a mean of 14.5 months (12 to 18). Endoprosthetic replacement for tumours of the proximal humerus using this prosthesis is a reliable operation yielding good results without the documented problems of unconstrained prostheses. The performance of this prosthesis is expected to improve further with a new constrained humeral liner, which reduces the risk of dislocation. PMID:21357964
Griffiths, D; Gikas, P D; Jowett, C; Bayliss, L; Aston, W; Skinner, J; Cannon, S; Blunn, G; Briggs, T W R; Pollock, R
Minimally invasive treatment of pathological fractures of the humeral shaft
Most patients with pathological fractures due to cancer metastasis have a limited life expectancy. Orthopaedic procedures, therefore, should be minimally invasive in order to avoid additional surgical morbidity. The purpose of this study was to analyse the results of minimally invasive approaches, including locked intramedullary nailing, followed by early postoperative radiation for pathological humeral shaft fractures. Twenty-four pathological fractures of the humerus diaphysis in 23 patients were treated with the prospective protocol, including antegrade unreamed intramedullary nailing and postoperative radiotherapy (20 Gy and five fractions). The patients and results of the surgery were evaluated by the Musculoskeletal Tumor Society upper extremity scoring system. All patients had a stable extremity, and the average function of 20 patients was 64% of the normal upper extremity function. Only one patient required revision surgery. The minimally invasive treatment of patients with pathological fractures of the humeral shaft with closed unreamed intramedullary nailing combined with adjuvant radiotherapy is an effective and safe procedure, even in seriously ill patients.
Erol, Bulent; Ozgen, Zerrin; Yildiz, Muzaffer
Morphologic features of the fetal mandibular condyle: layers, canals and microvascular pattern.
During organogenesis the mandibular condyle is divided by a fibrovascular septum, the persistence of which in the growing cartilage can lead to a bifid condyle. In this study we have evaluated the morphology of 3rd trimester human fetal temporomandibular (TMJ) specimens in order to determine the pattern of the vascular morphology associated with the layers and vascular canals (VCs) of the developing condyle (covering layers and condyle proper). Eleven human fetuses of 27-38cm crown-rump length were used for histological (hematoxylin-eosin, Van Gieson stain) and immunohistochemical evaluation (antibodies for bcl2 and CD34) and another two of 24 and 31cm, for TMJ microvasculature studies after black ink injections. With increasing fetal age, the intermediate loose lamina (LL) of the condylar proliferative layer evolves from a vascular-mesenchymal to a fibrillar pattern, via a transitory stage of a clear space that may be misdiagnosed as lower joint cavity (LJC). Within the condyle proper VCs may be present on its entire sagittal length, deepening variably towards the erosive zone and opened superiorly in the LL loose layer. Vessels of the evolving LL enter the condyle, directly or through the VCs; these vessels retract peripherally with increasing age and the intrinsic vessels of the condyle supplied from the erosive zone become prevalent. Vascular morphogenesis at the level of the LL seems comparable to that at the level of the LJC where characteristic glomeruli regress with increasing age. Lack of vascular regression and closure of central V-shaped defects of the condyle, as observed in 2/22 condyles, may represent a developmental substrate for condylar bifidism or a predisposing condition weakening the condyle, and making it more sensitive to trauma in childhood. PMID:21530206
Rusu, Mugurel Constantin; Pop, Florinel; Leonardi, Rosalia; Motoc, Andrei Gheorghe Marius; Jianu, Adelina Maria
Lateral epicondylitis of the elbow.
Lateral epicondylitis, or "tennis elbow," is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle. Repetitive occupational or athletic activities involving wrist extension and supination are thought to be causative. The typical symptoms include lateral elbow pain, pain with wrist extension, and weakened grip strength. The diagnosis is made clinically through history and physical examination; however, a thorough understanding of the differential diagnosis is imperative to prevent unnecessary testing and therapies. Most patients improve with nonoperative measures, such as activity modification, physical therapy, and injections. A small percentage of patients will require surgical release of the extensor carpi radialis brevis tendon. Common methods of release may be performed via percutaneous, arthroscopic, or open approaches. PMID:23398951
Tosti, Rick; Jennings, John; Sewards, J Milo
Occipital condyle screw placement and occipitocervical instrumentation using three-dimensional image-guided navigation.
Occipital condyle (OC) screws are an alternative cephalad fixation point in occipitocervical fusion. Safe placement of occipital, C1 lateral mass, and C2 pars screws have been described previously, but not OC screws. The craniocervical junction is complex, and a thorough understanding of the anatomy is needed. Three-dimensional (3D) image-guided navigation was used in six patients. There were no complications related to image-guided navigation during the placement of 12 OC screws and we found that this navigation can serve as a useful adjunct when placing an OC screw. Technical considerations of placing OC and C1 lateral mass screws are discussed with particular reference to patient positioning and the StealthStation® S7™ image-guided navigational platform (Medtronic, Minneapolis, MN, USA). The reference arc is attached to the head-clamp and faces forward. The optical camera and monitor are positioned at the head of the table for a direct, non-obstructed line-of-sight. To minimize intersegmental movement, the OC should not be drilled until all other screws have been placed. We conclude that 3D image-guided navigation is a useful adjunct that can be safely and effectively used for placement of instrumentation of the upper cervical spine including the OC. PMID:22356730
Le, Tien V; Burkett, Clint; Ramos, Edwin; Uribe, Juan S
The application of the Risdon approach for mandibular condyle fractures
Background Many novel approaches to mandibular condyle fracture have been reported, but there is a relative lack of reports on the Risdon approach. In this study, the feasibility of the Risdon approach for condylar neck and subcondylar fractures of the mandible is demonstrated. Methods A review of patients with mandibular condylar neck and subcondylar fractures was performed from March 2008 to June 2012. A total of 25 patients, 19 males and 6 females, had 14 condylar neck fractures and 11 subcondylar fractures. Results All of the cases were reduced using the Risdon approach. For subcondylar fractures, reduction and fixation with plates was done under direct vision. For condylar neck fractures, reduction and fixation was done with the aid of a trochar in adults and a percutaneous threaded Kirschner wire in children. There were no malunions or nonunions revealed in follow-up care. Mild transient neuropraxia of the marginal mandibular nerve was seen in 4 patients, which was resolved within 1–2 months. Conclusions The Risdon approach is a technique for reducing the condylar neck and subcondylar fractures that is easy to perform and easy to learn. Its value in the reduction of mandibular condyle fractures should be emphasized.
Prevalence of bifid mandibular condyle in a Turkish population.
The aim of this study was to determine the frequency of bifid mandibular condyle (BMC) using panoramic radiographs supported by different radiographic techniques. A retrospective study was carried out by evaluating panoramic radiographs of 18,798 patients referred to the Department of Dentomaxillofacial Radiology. T-tests were used to compare the frequency of BMC between left and right sides and between female and male patients. In this study, 98 patients (0.52%) were found to have BMC. Of these patients, 51 (52%) were females and 47 (48%) were males. Of the 98 patients, 71 (72.4%) had unilateral and 27 (27.6%) had bilateral BMC. A total of 125 BMCs were found in 98 patients. No statistically significant differences were found between the right and left BMCs or between female and male patients (P > 0.05). Because symptoms associated with BMC are either absent or minimal, it is usually discovered as an incidental finding during routine radiographic examination. Different appearances of BMC can be seen on panoramic radiographs. The exact orientation of the condyles can only be determined using 3D imaging techniques. BMC may be a more frequent condition in the Turkish population. PMID:22167027
Sahman, Halil; Sekerci, Ahmet E; Ertas, Elif T; Etoz, Meryem; Sisman, Yildiray
Trends in the surgical treatment of proximal humeral fractures - a nationwide 23-year study in Finland
Background Proximal humeral fractures are common osteoporotic fractures. Most proximal humeral fractures are treated non-surgically, although surgical treatment has gained popularity. The purpose of this study was to determine changes in the surgical treatment of proximal humeral fractures in Finland between 1987 and 2009. Methods The study covered the entire adult (>19 y) population in Finland over the 23-year period from 1st of January 1987 to 31st of December 2009. We assessed the number and incidence of surgically treated proximal humeral fractures in each year of observation and recorded the type of surgery used. The cohort study was based on data from Finnish National Hospital Discharge Register. Results During the 23-year study period, a total of 10,560 surgical operations for proximal humeral fractures were performed in Finland. The overall incidence of these operations nearly quadrupled between 1987 and 2009. After the year 2002, the number of patients treated with plating increased. Conclusion An increase in the incidence of the surgical treatment of proximal humeral fractures was seen in Finland in 1987–2009. Fracture plating became increasingly popular since 2002. As optimal indications for each surgical treatment modality in the treatment of proximal humeral fractures are not known, critical evaluation of each individual treatment method is needed.
Bone properties of the humeral head and resistance to screw cutout
Surgical treatment of fractures involving the proximal humeral head is hampered by complications. Screw cutout is the major pitfall seen in connection with rigid plating. We have exploited a bony explanation for this phenomenon. Materials and Methods: We examined the convex surface of the humeral head looking at the density and the topographical strength of the subchondral bone using mechanical testing of bone cylinders harvested from the humeral head. We also studied the osseous architecture of the subchondral bone and thickness of the boneplate of the humeral head using a 3-dimensional serial sectioning technique. Results: The bone strength and bone density correlated well and revealed large regional variations across the humeral head. Bone strength and stiffness of the trabecular bone came to a maximum in the most medial anterior and central parts of the humeral head, where strong textural anisotropy was also found. We found in particular a lower bone strength and density in the posterior and inferior regions of the humeral head. A rapid decline in bone strength within a few mm below a relatively thin subchondral plate was also reported. Clinical Relevance: We have in this paper explored some of the most important factors connected with screw stability at the cancellous bone level. We discovered large variations in bone density and bone strength across the joint surface rendering certain areas of the humeral head less suitable for screw placement. The use of rigid plate constructs with divergent screw directions will predictably place screws in areas of the humeral head comprising low density and low strength cancellous bone. New concepts of plates and plating techniques for the surgical treatment of complex fractures of the proximal humerus should take bone distribution, strength, and architecture into account.
Frich, Lars Henrik; Jensen, Niels Christian
Foramen magnum meningiomas: To drill or not to drill the occipital condyle? A series of 12 patients
Background: Despite the development of microsurgery and cranial base techniques, the surgical management of Foramen Magnum Meningiomas (FMM) continues to be a technical challenge to neurosurgeons. Controversy concerning the utility of systematic condyle drilling for approaching FMM has been raised. Our aim was to describe the surgical technique, analyze its safety, and the postoperative outcome in 12 consecutive FMM patients. Methods: From 1986 to 2011, 12 patients with FMM underwent operations in the Department of Neurosurgery at Servidores do Estado Hospital and in a private clinic. All patients were operated using a standard suboccipital craniectomy, preserving the occipital condyle, opening of the Foramen Magnum, and ipsilateral removal of the posterior arch of C1. Results: There was no operative mortality, nine patients achieved Glasgow Outcome Scale 4 or 5. Condylar resection was not deemed necessary in any case. Gross total resection was achieved in nine patients. After surgery, four patients developed lower cranial nerve weakness. There was no significant postoperative complication in the remaining patients. The average follow-up is 8.2 years. Conclusion The vast majority of FMM can be safely removed with a retrocondylar lateral suboccipital approach without condylar resection, using meticulous microsurgical techniques.
Lynch, Jose Carlos; Temponi, Vicente; Emmerich, Joao Claudio; Pereira, Celestino Esteves; Goncalves, Mariangela Barbi
Bifid mandibular condyle: CT and MR imaging appearance in two patients: case report and review of the literature.
We describe two cases of a bifid mandibular condyle. The first case is a 48-year-old woman with headaches and a pain and clicking sensation in her right jaw during mastication. The second case is an asymptomatic 17-year-old woman with a history of bilateral microtia and hemifacial microsomia. In both patients, the bifid condyle was first identified by CT and affected the temporomandibular joint. The imaging findings of both patients' bifid mandibular condyles led us to conclude that both patients likely had an abnormal development of the mandibular condyles. We believe that an intervening fibrous or vascular structure may have split the condyle into two heads. PMID:16091546
Shriki, Jabi; Lev, Raisa; Wong, Brian F; Sundine, Michael J; Hasso, Anton N
Protection of the Medial Femoral Condyle Articular Cartilage During Drilling of the Femoral Tunnel Through the Accessory Medial Portal in Anatomic Anterior Cruciate Ligament Reconstruction
Accurate positioning of the femoral tunnel in the native femoral anterior cruciate ligament (ACL) footprint requires drilling through an accessory medial portal (AMP). The AMP is located far medial and at a low level. Despite the benefits of drilling through the AMP, it is possible that the drill bit head will injure the articular cartilage of the medial femoral condyle as it slides along the guide pin to the femoral insertion of the ACL. Because more surgeons are now performing anatomic ACL reconstructions and shifting from transtibial drilling toward transportal drilling, the risk of this injury might be increasing, especially during the beginning of their learning curve. To avoid such injury, a bio-interference screw sheath is used. It is inserted through the AMP over the guide pin until it reaches near the medial wall of the lateral femoral condyle. The drill bit is inserted over the guide pin and through the bio-interference screw sheath. Using the bio-interference screw sheath not only protects the articular cartilage of the medial femoral condyle but also protects the medial meniscus, posterior cruciate ligament, and skin of the AMP from injury because of the close proximity of the drill bit head to these structures during transportal drilling.
Abdelkafy, Ashraf
Lateral sided snapping elbow caused by a meniscus: two case reports and literature review
Lateral sided snapping elbow is an unusual condition, and it is apt to be misdiagnosed as lateral epicondylitis. The causes\\u000a of lateral sided snapping elbow have been attributed to intraarticular loose bodies, instability, synovial plicae and torn\\u000a annular ligament. We report our experiences for treating lateral sided snapping elbow caused by a meniscus in the radio-humeral\\u000a joint. In the present
Shin-Taek KangTae-Ho Kim; Tae-Ho Kim
Occipital condyle fracture in a patient with neck pain
Background Occipital condyle fractures (OCF) are rare traumatic injuries and are of critical clinical importance because of the anatomic considerations of the occipitoatlantoaxial joint complex. OCF can be a diagnostic challenge because of the inability to diagnose this injury with plain radiographs. This is especially true in the emergency department (ED) setting. A high degree of clinical suspicion and careful investigation of the craniocervical junction is warranted in patients presenting to the ED with head and cervical trauma. Findings We present a case of a 45-year-old male who presented to the ED with complaints of neck pain and headache four days after an assault. The classification, clinical presentation, diagnosis, and management of his injury are discussed, and pertinent literature is reviewed. Conclusions OCF can be easily overlooked due to multiple factors; including the conscious state of the patient or the inability to diagnose it through plain radiographs. Early recognition and diagnosis of OCF is crucial to prevent neurological involvement.
Spontaneous bilateral humeral head fractures occurring simultaneously in a woman with rheumatoid arthritis
A 67-year-old woman with a 15-year history of seropositive rheumatoid arthritis developed acute night pain in both shoulders. Examination revealed bilateral swelling and joint mobility impairment. Ultrasonography disclosed joint effusions which were hemorrhagic on aspiration. Radiographs showed the presence of a four-part fracture of both humeral heads. Bilateral humeral head fractures can occur spontaneously in patients with rheumatoid arthritis and
D. Van Linthoudt; L. Malterre; A. Koestli
Gleno-humeral joint in the chimpanzee: comparative anatomical analysis for use in endoprosthetic replacement.
The gleno-humeral joint of the adult chimpanzee is morphologically compared to the human shoulder to assess the feasibility of this animal for use in experimental prosthetic replacement. The anatomical structure appears similar enough to man to warrant investigation of this animal as a vehicle for experimental implant design in the shoulder. Several anatomical structural differences were noted which necessitated modification of the fixturing segments of a "Floating Socket" total gleno-humeral endoprosthesis. PMID:875005
Buechel, F F
Primary endoprosthesis in comminuted humeral head fractures in patients over 60 years of age
The purpose of this study was to determine the early subjective and functional results after primary endoprosthesis replacement\\u000a for comminuted humeral head fractures in patients over 60 years old. Twenty comminuted humeral head fractures in 20 patients\\u000a were treated primarily (within 3.5 days (range 0–17 days) with a Neer II modular shoulder prosthesis, and were then followed\\u000a up for an
A.-P. Boss; B. Hintermann
Humeral head cysts and rotator cuff tears: an MR arthrographic study
Objective Humeral tuberosity cysts are a common finding, with previous reports suggesting they are related to rotator cuff tear or aging. The aim of this study was to investigate the characteristics of cysts in the tuberosities of the humeral head and their relationship with rotator cuff tear and age.Design and patients Shoulder MR arthrograms were reviewed in 120 consecutive patients—83 males (mean
Martin Williams; Robert G. W. Lambert; Gian S. Jhangri; Michael Grace; Jay Zelaso; Ben Wong; Sukhvinder S. Dhillon
Is Humeral Segmental Defect Replacement Device A Stronger Construct than Locked IM Nailing?
Intramedullary (IM) nailing is currently the most common method for treating patients with impending pathologic humeral fractures;\\u000a however, this treatment is associated with known complications primarily owing to violation of the rotator cuff during insertion.\\u000a A better option is needed. To determine if a humeral segmental replacement prosthesis would provide a stronger construct compared\\u000a with an IM nail in this
Robert Heck; Ruxandra Marinescu; Haden Janda; Seth Cooper; Jason Schroeder
Does the Second-generation Intercalary Humeral Spacer Improve on the First?
Since publication of the results of a first-generation intercalary humeral spacer, a newer design has been available that\\u000a addressed the weaknesses of the first. This study evaluated the hypothesis that the second-generation lap joint junction intercalary\\u000a humeral spacer reduced complications compared with the original male-female taper design. We retrospectively reviewed the\\u000a charts of 32 consecutive patients who had undergone placement
Timothy A. Damron; Taninnit Leerapun; Ronald R. Hugate; Thomas C. Shives; Franklin H. Sim
Mosaic arthroplasty of the medial femoral condyle in horses - An experimental study.
One Arabian and 5 Hungarian half-bred horses were used to study the macroscopic and microscopic survival of autologous osteochondral grafts in the weight-bearing surface of the medial femoral condyle (MFC). Grafts were harvested from the cranial surface of the medial femoral trochlea (MFT) under arthroscopic control. Three of them were transplanted into the weight-bearing surface of the contralateral MFC using an arthrotomy approach. Three months later this transplantation procedure was repeated on the opposite stifle joints in the same animals, but at that time transplantation was performed arthroscopically. Follow-up arthroscopy was carried out 12 months after the first operations, and biopsies were taken from both the recipient and the donor sites for histological examination. During follow-up arthroscopy, the transplanted areas looked congruent and smooth. Microscopically, the characteristics of hyaline cartilage were present in 5 out of the 10 biopsies examined; however, in the other half of biopsies glycosaminoglycan (GAG) loss and change in the architecture of the transplanted cartilage was observed. In a 16-year-old horse, all grafts broke during harvesting, and thus transplantation was not performed. No radiological signs of osteoarthritic changes were detected 9 to 12 months after the operations in the donor and recipient joints. Clinically, no lameness or effusion was present three months after the transplantations. PMID:24334083
Bodó, Gábor; Vásárhelyi, Gábor; Hangody, László; Módis, László
Occipital condyle fracture in a victim of a motor vehicle collision.
Occipital condyle fractures are rarely reported in the Emergency Medicine literature. It is unclear whether these fractures are rare or under-diagnosed. Occipital condyle fractures are associated with high-energy blunt trauma with significant cranial-cervical torque or axial loading. We report a case of a female patient with an occipital condyle fracture. The patient only complained of shoulder pain, but was found to have high cervical spine tenderness, after a moderate-speed front-end motor vehicle collision. Initial cervical spine radiographs were non-diagnostic. Computed tomography of the cervical spine demonstrated a non-displaced occipital condyle fracture. Conservative management with a semi-rigid cervical collar was successful in treating this patient's fracture. A review of the literature covers the diagnosis, radiographic findings, and management of this fracture. PMID:16982357
Mowafi, Hani O; Hickey, Kenneth S
Bifid condyle: review of the literature of the last 10 years and report of two cases.
Bifid mandibular condyle is a rare anomaly; there are several theories about its etiology, and it has been studied in both prehistoric and historic skulls, as well as in living human beings. It is a frequent, although unexpected, finding in asymptomatic individuals during radiological treatment. Presented here is a review of the literature over the past 10 years and two new cases of unilateral bifid condyle. Computerized tomography is usually considered the test of choice for establishing the differential diagnosis, although in certain cases, its use seems questionable. The distinction between bifid condyle and condylar notch or cleft has been described in the literature, it is proposed a criteria for defining bifid condyle depending on the level of the two heads. It is suggested that further testing such as MRI or CT be carried out only in cases where the therapeutic approach involves an active treatment. It is proposed that bifid condyle is described as that which presents two condylar heads emerging from the neck of the condyle or further down. PMID:20491236
López-López, José; Ayuso-Montero, Raúl; Salas, Enric Jané; Roselló-Llabrés, Xavier
Current fit of medial and lateral unicompartmental knee arthroplasty
Whether failure in unicompartmental knee arthroplasty (UKA) is related to implant design remains unclear. We hypothesize that current available UKAs fit within 2 mm. Forty-eight CTs of cadaveric knees were compared to current available UKA brands. Overall no-fit compared to at least one component within 2 mm is high (91.7%) and worse for males (100%) compared to females (83.3%). Good fit was observed for the medial but not for the lateral tibia plateau. Seven males (29.2%) had larger dimensions of more than 2 mm. For the widest UKA brand, 12 (57%) males and 2 females (8. 3%) had lateral femoral condyles 3 mm larger. Current UKA's in our sample population fit less on the lateral tibia and on femoral condyles.
Fitz, Wolfgang; Bliss, Robin; Losina, Elena
Bony changes at the lateral epicondyle of possible significance in tennis elbow syndrome
Examination of a large number (1232) of elbows from skeletal specimens revealed that 16% displayed a characteristic pattern of bone formation exactly underlying the area of exquisite point tenderness at the lateral humeral epicondyle found in clinical cases of tennis elbow. These changes are usually not seen on standard roentgenograms and can be missed, even at the time of surgery,
Gordon Edelson; Charles A. Kunos; Fina Vigder; Elias Obed
Dorgan's lateral cross-wiring of supracondylar fractures of the humerus in children: A retrospective review
IntroductionThe currently accepted treatment for displaced supracondylar humeral fractures in children is closed reduction and fixation with percutaneous Kirschner wires. The purpose of this study was to retrospectively review a novel cross-wiring technique where the cross-wire configuration is achieved solely from the lateral side, thereby reducing the risk of ulnar nerve injury.
Joseph M. Queally; Natasha Paramanathan; James C. Walsh; Cathal J. Moran; Fintan J. Shannon; Lester G. D'Souza
Bifid mandibular condyle with ankylosis in a 3-year-old child: A rare presentation and review.
Bifid mandibular condyle with ankylosis is an extremely rare condition and may arise as a developmental or traumatic defect. It may be associated with ankylosis. We here report a case of unilateral bifid mandibular condyle with ankylosis in a 3-year-old child. This is the youngest patient reported with the condition making it one of its first kind in the literature. The detailed description of the case, its radiological findings, and the literature on bifid condyles are reviewed. PMID:22114377
Mainali, Sneedha; Tandon, Shobha
Anatomy and histology of the transverse humeral ligament.
The classic literature describes the transverse humeral ligament (THL) as a distinct anatomic structure with a role in biceps tendon stability; however, recent literature suggests that it is not a distinct anatomic structure. The purpose of this study was to evaluate the gross and microscopic anatomy of the THL, including a specific investigation of the histology of this ligament. Thirty frozen, embalmed cadaveric specimens were dissected to determine the gross anatomy of the THL. Seven specimens were evaluated histologically for the presence of mechanoreceptors and free nerve endings. Two tissue layers were identified in the area described as the THL. In the deep layer, fibers of the subscapularis tendon were found to span the bicipital groove with contributions from the coracohumeral ligament and the supraspinatus tendon. Superficial to this layer was a fibrous fascial covering consisting of distinct bands of tissue. Neurohistology staining revealed the presence of free nerve endings but no mechanoreceptors. This study's findings demonstrate that the THL is a distinct structure continuous with the rotator cuff tendons and the coracohumeral ligament. The finding of free nerve endings in the THL suggests a potential role as a shoulder pain generator. PMID:24093707
Snow, Brian J; Narvy, Steven J; Omid, Reza; Atkinson, Roscoe D; Vangsness, C Thomas
Validity of measuring humeral torsion using palpation of bicipital tuberosities
The magnitude of humeral torsion (HT) affects the internal and external rotation range of motion at the shoulder. Currently imaging is required to quantify the HT angle, however, factors such as cost and non-availability of imaging to musculoskeletal clinicians limits its use. The aim of this study was to examine the validity of palpation of the bicipital tuberosities as an alternative to imaging for quantifying HT angles. The bicipital-forearm angle, an indirect measure of HT, was measured using palpation and real-time ultrasound imaging in 25 subjects. The agreement among the two methods was excellent with the Intraclass Correlation Coefficient (3,k) = 0.92, and the mean difference between the two methods was ?0.2° (SD 4.1°) with 95% limits of agreement of ?8.3° to 7.9°. Pearson's correlation coefficient (r) among the two methods was 0.85. In a clinical setting, palpation appears to be a practical alternative to US imaging for measuring HT.
Dashottar, Amitabh; Borstad, John D.
Mini-retromandibular access to the condyle in panfacial fractures.
Surgical management of panfacial fractures can be extremely challenging. The many fracture lines and lack of landmarks make it difficult to restore the facial skeletal morphology. Extracapsular fractures of the mandibular condyle require open reduction and internal fixation to restore the vertical and sagittal dimensions of the mandible, representing the base for further facial skeleton reconstruction. Six patients with panfacial fractures, including a bilateral extracapsular condylar fracture, were treated between January 2006 and November 2009. One patient underwent surgical procedure 60 days after the injury. The condylar fractures were treated via a mini-retromandibular access. Overall, the bone morphology restoration was good. In particular, all of the condylar fractures were reduced satisfactorily. No complication was detected, and no facial nerve lesion was observed. The literature contains many proposals for surgically accessing panfacial fractures. Open reduction and internal fixation of condylar fractures are crucial for restoring face height. The mini-retromandibular access is especially suitable, because it allows safe, rapid surgical management. PMID:22976684
Colletti, Giacomo; Biglioli, Federico
Injectable Biocomposites for Bone Healing in Rabbit Femoral Condyle Defects
A novel biomimetic bone scaffold was successfully prepared in this study, which was composed of calcium sulfate hemihydrate (CSH), collagen and nano-hydroxyapatite (nHAC). CSH/nHAC was prepared and observed with scanning electron microscope and rhBMP-2 was introduced into CSH/nHAC. The released protein content from the scaffold was detected using high performance liquid chromatography at predetermined time interval. In vivo bone formation capacity was investigated by means of implanting the scaffolds with rhBMP-2 or without rhBMP-2 respectively into a critical size defect model in the femoral condyle of rabbit. The releasing character of rhBMP-2 was that an initial burst release (37.5%) was observed in the first day, followed by a sustained release and reached 100% at the end of day 20. The CSH/nHAC showed a gradual decrease in degradation with the content of nHAC increase. The results of X-rays, Micro CT and histological observation indicated that more new bone was formed in rhBMP-2 group. The results implied that this new injectable bone scaffold should be very promising for bone repair and has a great potential in bone tissue engineering.
Liu, Zhengsheng; Wang, Xiumei; Cui, Fuzhai; Guo, Wenguang; Mao, Keya; Yang, Shuying
MR Imaging of Patients with Lateral Epicondylitis of the Elbow (Tennis Elbow): Importance of Increased Signal of the Anconeus Muscle
OBJECTIVE. The purpose of this study was to determine what changes might be detected on MR Images of patients with chronic lateral epicondylitis (tennis elbow) that could explain why some cases are resistant to therapy. SUBJECTS AND METHODS. Seven consecutive patients with chronic lateral epi- condylitis were included. The diagnosis was based on symptoms and signs charac- teristic of the
Marc Cool; Clayton V. Yamada
Nontraumatic bifid mandibular condyles in asymptomatic and symptomatic temporomandibular joint subjects
Purpose This study was performed to determine the prevalence of bifid mandibular condyles (BMCs) in asymptomatic and symptomatic temporomandibular joint (TMJ) subjects with no traumatic history, and to assess their impact on clinical and radiographic manifestations of TMJ. Materials and Methods A total of 3,046 asymptomatic and 4,378 symptomatic patients were included in the study. Cone-beam computed tomography (CBCT) images were reviewed for bifid condyles. T-tests were used to compare the frequency of BMCs when stratified by symptom, gender, and side. In BMC patients, the clinical features of pain and noise, osseous changes, and parasagittal positioning of the condyles were compared between the normally shaped condyle side and the BMC side using chi-squared tests. Results Fifteen (0.49%) asymptomatic and 22 (0.50%) symptomatic patients were found to have BMCs. Among the bilateral cases, the number of condyles were 19 (0.31%) and 25 (0.29%), respectively. No statistically significant differences were found between asymptomatic and symptomatic patients, between female and male patients, or between the right and left sides (p>0.05). Compared with the normally shaped condyle side, the BMC side showed no statistically significant differences in the distribution of pain and noise, parasagittal condylar position, or condylar osseous changes, with the exception of osteophytes. In the symptomatic group, osteophytes were found more frequently on the normally shaped condyle side than the BMC side (p<0.05). Conclusion BMCs tended to be identified as an incidental finding. The presence of BMC would not lead to any TMJ symptoms or cause osseous changes.
Cho, Bong-Hae
Distal humeral migration as a component of multidirectional shoulder instability. An anatomical study in autopsy specimens.
The object of the present study of autopsy specimens was to evaluate distal humeral migration during abduction allowed by sequential severance of capsular and ligamentous structures stabilizing the shoulder joint. A kinesiologic testing device continuously registered distal humeral migration, abduction angle, rotation, and flexion-extension. No distally directed force was applied to the humerus except the weight of the apparatus. Significant distal migration was recorded in the entire range of abduction (0 degrees -60 degrees) after solitary severance of the coracohumeral ligament as well as the proximal part of the anterior joint capsule. Further sectioning of the proximal part of the posterior capsule did not significantly increase distal humeral migration. Maximum distal migration (25 mm) was measured at 20 degrees of abduction. Applying an internal torque to the humerus significantly prevented distal migration as long as the posterior capsule was kept intact. Clinical testing for distal humeral migration should be performed with the shoulder joint at 20 degrees of abduction and neutral rotation. Furthermore, distal humeral migration can be significantly reduced by internal rotation of the humerus when the posterior joint capsule is intact. PMID:2302878
Helmig, P; Sřjbjerg, J O; Kjaersgaard-Andersen, P; Nielsen, S; Ovesen, J
Ilizarov treatment of humeral shaft nonunion in an antiepileptic drug patient with uncontrolled generalized tonic-clonic seizure activity
Nonunion of the humeral shaft in patients with antiepileptic drug associated metabolic bone disorder constitute a challenging surgical problem difficult to treat due to seizure activity, osteoporosis, and poor stabilization options. We report a case of nonunion of the humeral shaft in an antiepileptic drug patient with uncontrolled generalized tonic-clonic seizure activity successfully treated with Ilizarov external fixator and a
Vasileios S Sioros; Marios G Lykissas; Dimitrios Pafilas; Panayiotis Koulouvaris; Alexandros N Mavrodontidis
Evaluation of humeral head erosions in rheumatoid arthritis: a comparison of ultrasonography, magnetic resonance imaging, computed tomography and plain radiography
SUMMARY The value of ultrasonography ( US), magnetic resonance imaging (MRI ), computed tomography (CT ) and plain radiography (PR) in detecting bone erosions on the humeral head was evaluated in a study of 26 in-patients (26 shoulders) with rheumatoid arthritis (RA). MRI depicted humeral erosions in 25 (96%), US in 24 (92%), CT in 20 (77%) and PR in
Multidisciplinary treatment of peripheral osteoma arising from mandibular condyle in patient presenting with facial asymmetry.
While osteomas often occur in the orofacial area, it is relatively rare for one to occur in the temporomandibular joint area. Here, we report a patient who underwent multidisciplinary treatment including high condylectomy for peripheral osteoma arising in the left mandibular condyle. The patient was a 46-year-old woman with the chief complaint of facial asymmetry. Cephalometric analysis revealed skeletal anterior crossbite due to anterior deviation of the mandible, with chin deviation of 10 mm to the right. A computed tomography scan revealed bone hyperplasia in the mesiodistal and inner areas of the left mandibular condyle, which exhibited outward anterior displacement. Bone scintigraphy showed a circular area of strong radioisotope accumulation with indistinct boundaries, consistent with the lesion in the left mandibular condyle. The above findings led to a diagnosis of skeletal mandibular prognathism with facial asymmetry due to peripheral osteoma originating in the left mandibular condyle. After orthodontic treatment and surgical resection of the tumor and mandibular condyle, preservation and prosthetic treatment were undertaken. A well-balanced facial appearance and good occlusion were achieved. PMID:24717929
Nojima, Kunihiko; Niizuma-Kosaka, Fumiko; Nishii, Yasushi; Sueishi, Kenji; Yamakura, Daiki; Ikumoto, Hideyuki; Ohata, Hitoshi; Inoue, Takashi
Arthroscopic anatomic humeral head reconstruction with osteochondral allograft transplantation for large hill-sachs lesions.
Anatomic reconstruction of the humeral head with osteochondral allograft has been reported as a solution for large Hill-Sachs lesions with or without glenoid bone loss. However, to date, varying techniques have been used. This technical note describes an arthroscopic reconstruction technique using fresh-frozen, side- and size-matched osteochondral humeral head allograft. Allograft plugs are press fit into the defect without internal fixation and seated flush with the surrounding articular surface. This technique restores the native articular contour of the humeral head without compromising shoulder range of motion. Potential benefits of this all-arthroscopic approach include minimal trauma to the soft tissue and articular surface without the need for hardware or staged reoperation. PMID:24266001
Snir, Nimrod; Wolfson, Theodore S; Hamula, Mathew J; Gyftopoulos, Soterios; Meislin, Robert J
Humeral cross-sectional shape in suspensory primates and sloths.
Studies on the cross-sectional geometry of long bones in African apes have documented that shape ratios derived from second moments of area about principle axes (e.g., Imax /Imin ) are often correlated with habitual locomotor behaviors. For example, humeral cross-sections tend to appear more circular in more arboreal and forelimb suspensory chimpanzees compared with terrestrial quadrupedal gorillas. These data support the hypothesis that cross-sections that are more circular in shape are adapted for multidirectional loading regimes and bending moments encountered when using acrobatic locomotor behaviors. Whether a more circular humerus reflects greater use of forelimb suspension in other primates and nonprimate mammals is unknown. In this study, cross-sections at or near midshaft of the humerus were obtained from anthropoid primates that differ in their use of forelimb suspension, as well as from two genera of suspensory sloths. Imax /Imin ratios were compared within and between groups, and correlations were made with behavioral data. In broad comparisons, observed differences in morphology follow predicted patterns. Humeri of suspensory sloths are circular. Humeri of the more suspensory hominoids tend to be more circular than those of quadrupedal taxa. Humeri of the suspensory atelines are similar to hominoids, while those of Cebus are more like nonsuspensory cercopithecoids. There is, however, considerable overlap between taxa and within finer comparisons variation between species are not in the predicted direction. Thus, although Imax /Imin ratios of the humerus are informative for characterizing generalized locomotor modes (i.e., forelimb suspensory vs. quadrupedal), additional structural information is needed for more fine-grained assessments of locomotion. PMID:23408647
Patel, Biren A; Ruff, Christopher B; Simons, Erin L R; Organ, Jason M
Humeral head cysts: association with rotator cuff tears and age.
The objective of this study was to retrospectively evaluate the prevalence of the cystic changes at rotator cuff footprint on proximal humeral tuberosities and investigate their relationship with rotator cuff tears and patient age. Magnetic resonance (MR) images of 657 patients who underwent shoulder arthroscopy for treatment of rotator cuff disorders were reviewed to localize the cystic changes at anterior (supraspinatus insertion) and posterior (infraspinatus insertion) aspects of greater tuberosity (GT) and lesser tuberosity (subscapularis insertion). Preoperative MR reports as well as cyst size and locations on MR images were correlated with arthroscopic records of rotator cuff pathology (tear type, size, location and tendon involvement) and patient age. The prevalence of cystic changes was 9.1 % (60 patients) in the study population. Anterior GT cysts were found in 56 % of patients and were strongly associated with full-thickness (p < .001) and articular-sided partial-thickness rotator cuff tears (p = .02). Posterior GT and lesser tuberosity cysts were found in 27 and 17 % of patients, respectively, and were not significantly related to rotator cuff tears, although there was an increased trend of posterior cysts in patients with infraspinatus tears (p = .09). A significant relation was found between patient age and the cyst size (p = .01), while none of the cyst localizations were statistically related to age. Anterior GT cysts were more common in this patient group and demonstrated a strong association with rotator cuff disorders regardless of age. Posterior GT and lesser tuberosity cysts were less common and showed no association with rotator cuff pathology or patient age. PMID:23748696
Suluova, Fatih; Kanatli, Ulunay; Ozturk, Burak Yagmur; Esen, Erdinc; Bolukbasi, Selcuk
Axillary artery lesions from humeral neck fracture: A study in relation to repair
Whether axillary artery injuries associated with proximal humeral fractures must be repaired is uncertain. The present study reports three cases treated with various approaches. In case 1, the left humeral surgical neck was broken, the radial pulse disappeared and the arm temperature was significantly reduced. Computerized tomography angiography (CTA) revealed a 3-cm filling deficiency in the axillary artery. The injured artery was reconstructed with a segment of the greater saphenous vein after the fracture was reduced and fixed with a plate. In case 2, the axillary artery was compressed by the broken humeral segment, which caused the right hand to become cool. The fracture was fixed but the axillary artery embolism was not treated. In case 3, the humeral neck was broken with injury to the brachial plexus, although the patient's hand remained warm. Digital subtraction angiography (DSA) revealed that the axillary artery was injured badly but there was extensive collateral circulation. The proximal humeral fracture was reduced and fixed without artery reconstruction. The three cases all resulted in a good outcome with the bone healed and limb alive. No ischemic necrosis occurred. However, the neurapraxia did not dissappear completely. Axillary artery injury resulting from humeral neck fracture is a rare but disabling traumatic event. Early diagnosis based on signs of acute ischemia of the arm enables early treatment and a favourable outcome. An angiogram is the best way to diagnose the artery injury and evaluate the condition of the collateral circulation. The injured artery in a cold arm should be repaired, while in a warm arm reconstruction is unnecessary due to rich collateral circulation.
Rapid progressive atypical atraumatic osteonecrosis of humeral head: a case report.
Osteonecrosis of the humeral head is an uncommon and slow progressive condition. This condition is difficult to be recognized because its initial symptoms are nonspecific. Simple radiography is the standard tool to stage disease progression. However, plain radiographic findings of osteonecrosis are nearly normal in the initial stage. We report a case of 74 years old female patient who have suffered from painful limitation of the shoulder joint. She had no trauma history and no specific predisposing factors for osteonecrosis of the humeral head. To confirm, follow up radiography and shoulder magnetic resonance imaging were performed. PMID:24910734
Byun, Jang Won; Shim, Jae-Hang; Shin, Woo Jong; Cho, Sang Yoon
Rapid progressive atypical atraumatic osteonecrosis of humeral head: a case report
Osteonecrosis of the humeral head is an uncommon and slow progressive condition. This condition is difficult to be recognized because its initial symptoms are nonspecific. Simple radiography is the standard tool to stage disease progression. However, plain radiographic findings of osteonecrosis are nearly normal in the initial stage. We report a case of 74 years old female patient who have suffered from painful limitation of the shoulder joint. She had no trauma history and no specific predisposing factors for osteonecrosis of the humeral head. To confirm, follow up radiography and shoulder magnetic resonance imaging were performed.
Byun, Jang Won; Shin, Woo Jong; Cho, Sang Yoon
Primary Shoulder Arthroplasty Versus Conservative Treatment for Comminuted Proximal Humeral Fractures: A Systematic Literature Review
The objective was to identify whether arthroplasty or conservative treatment is the best available treatment for three- and four-part proximal humeral fractures by analyzing the outcome measure of the Constant score. We conducted an electronic search. The systematic review included 33 studies encompassing 1096 patients with three- or four-part proximal humeral fractures that used the Constant score as outcome measure. The mean Constant score in the conservative group was 66.5 and in the arthroplasty group was 55.5. The difference could be attributed to selection bias, unreliable classification of the fractures and inter-observer differences in the assessment of the Constant score.
den Hartog, Dennis; de Haan, Jeroen; Schep, Niels W.; Tuinebreijer, Wim E.
[Shoulder joint endoprosthesis in the treatment of multiple fractures of the humeral head. Development and value].
Fractures of the humeral head are still challenging to decisions of indications, surgical skills and physiotherapy. 3- and 4-part-fractures of the humeral head in younger adults are still dominated by reconstructive osteosynthesis. New developments in osteosynthesis materials allow the surgeon to make use of minimal invasive techniques more often. Treatment of elderly patients with these injuries has changed within the last years. When it is obvious that the goal of a stable osteosynthesis can not be reached, shoulder prosthesis has become a primary treatment in elderly patients. New designs in shoulder prosthesis seem to lead to better functional results. PMID:11398620
Tamborini, M; Wich, M; Ekkernkamp, A
Osteochondral allograft reconstruction of segmental defect of humeral head after posterior dislocation of the shoulder
Introduction Posterior shoulder dislocations are rare and almost 50% are associated with fractures of the humeral head. Although, there\\u000a are only few articles describing specific treatments for the humeral head defects.\\u000a \\u000a \\u000a \\u000a \\u000a Case report In this paper, authors described a typical case of a 42-year-old patient with a posterior shoulder dislocation initially misdiagnosed.\\u000a Patient had before undergone two surgeries of this shoulder for
Olivier Barbier; Xavier Bajard; Antoine Bouchard; Didier Ollat; Jean Pierre Marchaland; Lan Nguyen; Gilbert Versier
Early results in the treatment of proximal humeral fractures with a polyaxial locking plate
Objectives We report early results using a second generation locking plate, non-contact bridging plate (NCB PH®, Zimmer Inc. Warsaw, IN, USA), for the treatment of proximal humeral fractures. The NCB PH® combines conventional plating technique with polyaxial screw placement and angular stability.\\u000a \\u000a \\u000a \\u000a Design Prospective case series.\\u000a \\u000a \\u000a \\u000a Setting A single level-1 trauma center.\\u000a \\u000a \\u000a \\u000a Patients A total of 50 patients with proximal humeral fractures were treated
Johannes B. Erhardt; G. Roderer; K. Grob; T. N. Forster; K. Stoffel; M. S. Kuster
Mandibular condyle and infratemporal fossa reconstruction using vascularized costochondral and calvarial bone grafts
There are some difficulties in approaching and removing the lesion in infratemporal fossa because of its anatomical location. After wide excision of tumor lesion, it is also difficult for reconstruction of mandibular condyle and cranium base on infratemporal fossa. Besides, there are some possibilities of cerebrospinal fluid leakage, intracranial infection and bone resorption. It is also challenging for functional reconstruction that allows normal mandibular movement, preventing mandibular condyle from invaginating into the skull. In this report, we present 14-month follow-up results of a patient who had undergone posterior segmental mandibulectomy including condyle and infratemporal calvarial bone and mandible reconstruction with free vascularized costochondral rib and calvarial bone graft to restoration of the temporomandibular joint area.
Jang, Hyo Won; Kim, Nam-Kyoo; Lee, Won-Sang; Kim, Hyung Jun; Cha, In-Ho
Subarticular, cystlike lesion associated with avascular necrosis of the mandibular condyle: a case report.
Little is known about avascular necrosis of the mandibular condyle, which is necrosis of the epiphyseal or subarticular bone secondary to a diminished or disrupted blood supply in the absence of infection. We present a case of a large subarticular cystlike lesion that was found using cone-beam computed tomography (CBCT). There was an absence of osteoarthrosis, and the condylar articular surface was relatively intact. The patient's history, physical examination, and magnetic resonance images supported the diagnosis of avascular necrosis of the mandibular condyle. After 4 months of conservative therapy, new bone was observed in the cystlike marrow lesion, and a smooth articular surface was reestablished. Subarticular cystlike lesions without the collapse of the articular surface of mandibular condyles may be an early indicator of avascular necrosis. PMID:23375505
Lei, Jie; Liu, Mu-Qing; Yap, Adrian U Jin; Fu, Kai-Yuan
Analysis of patterns and treatment strategies for mandibular condyle fractures: review of 175 condyle fractures with review of literature.
This study aims to evaluate incidence, patterns and epidemiology of mandibular condylar fractures (MCF) to propose a treatment strategy for managing MCF and analyze the factors which influence the outcome. One hundred and seventy-five MCF's were evaluated over a four year period and their pattern was recorded in terms of displacement, level of fracture, age of incidence and dental occlusion. Of the 2,718 facial bone fractures, MCF incidence was the third most common at 18.39 %. Of 175 MCF 58.8 % were unilateral and 41.12 % were bilateral. 67 % of bilateral fractures and 43.8 % of unilateral fractures were associated with midline symphysis and contralateral parasymphysis fractures respectively. Most of the MCF was seen in the age group of above 16 years and 50 % of them were at subcondylar level (below the neck of the condyle). Majority of MCF sustained due to inter personal violence were undisplaced (72.7 %) and contrary to this majority of MCF sustained during road traffic accident were displaced. 62.9 % of total fractures required open reduction and rigid fixation and 37.1 % were managed with closed reduction. 80 % of MCF managed with closed reduction were in the age group of below 16 years. From this study it can be concluded that the treatment algorithm proposed for managing MCF is reliable and easy to adopt. We observed that absolute indication for open reduction of MCF is inability to achieve satisfactory occlusion by closed method and absolute contraindication for open reduction is condylar head fracture irrespective of the age of the patient. PMID:24431859
Reddy, N Viveka V; Reddy, P Bhaskar; Rajan, Ritesh; Ganti, Srinivas; Jhawar, D K; Potturi, Abhinand; Pradeep
Post-traumatic bifid condyle associated with temporomandibular joint ankylosis: report of a case and review of the literature.
Bifid condyle is a rare condition. Most initially reported cases were found in studies conducted on skeletal specimens. While increasing numbers are being reported on living persons, most of them are asymptomatic and have been found on routine dental radiographic examination for other dental complaints. Most of the cases of bifid condyle reported so far have occurred unilaterally and predominantly on the left side. Bifid condyle associated with temporomandibular joint ankylosis is very rare with only 2 cases reported in the English-language literature as far as we know. An additional case of bifid condyle associated with temporomandibular joint ankylosis, involving the right side of mandible, is presented as well as a review of the literature on bifid condyles including those associated with temporomandibular joint ankylosis. PMID:15897854
Daniels, John Spencer M; Ali, Iqbal
A biomechanical comparison of unilateral and bilateral String-of-Pearls™ locking plates in a canine distal humeral metaphyseal gap model.
Objective: To compare the in vitro biomechanical performance of two String-of-Pearls (SOP) plate constructs in a canine distal humeral metaphyseal gap model. Methods: Seven pairs of canine cadaveric humeri, including the elbow joints, were prepared. One group consisted of a unilateral medially placed SOP plate with bicortical screws (UNI). The second group consisted of bilateral caudo-medial and caudo-lateral SOP plates applied with monocortical screws (BI). A 2 cm ostectomy was performed immediately proximal to the supratrochlear foramen. Constructs were tested in torsion and axial compression. Results: The UNI constructs had significantly lower stiffness in torsion and axial compression than the BI group. However, UNI constructs had a significantly higher ultimate strength than BI constructs. All UNI constructs failed by bending of the transcondylar screw and SOP plate. All BI constructs failed by axial pullout of the distal most screws. Clinical significance: In stabilizing canine supracondylar humeral fractures as modeled here, both the UNI model and the BI model demonstrated biomechanical advantages. The incorporation of a transcondylar screw through the medial plate appears to be beneficial to construct strength. PMID:24763388
Hurt, R J; Syrcle, J A; Elder, S; McLaughlin, R
[Primary management of comminuted humeral head fracture in the elderly patient with a humerus head prosthesis].
The purpose of this prospective study was to determine the early subjective and functional result and outcome after primary implantation of humeral endoprosthesis in severely comminuted humeral head fractures in elderly patients. From 1993 to 1995, 27 humeral head fractures (27 patients) were treated by primary implantation of a Neer II modular shoulder prosthesis. Of these, 23 patients were women, 4 patients were men. The average age of patients was 76 (48-91) years. Postoperatively, one shoulder had to be mobilized under general anesthesia. Of the 27 patients 21 could be clinically examined after 16 (3-29) months postoperatively; 4 patients had died in the meantime, 2 did not come to the control examination because of a great distance and because they were happy. The average Constant Score was 48 (25-76) points; the difference to the other shoulder was 30 (18-69) points. Of the 21 patients 19 were satisfied by the result and 20 would reaccept the same procedure. These preliminary results suggest that primary shoulder prosthesis in humeral head fractures in the elderly patient is a valuable alternative option. PMID:9480556
Boss, A; Hintermann, B
Optimal positioning of the humeral component in the reverse shoulder prosthesis.
INTRODUCTION: Total reverse shoulder arthroplasty is becoming more and more the standard therapeutic practice for glenohumeral arthropathy with massive lesions of the rotator cuff. The biomechanical principle of this prosthesis is represented by the reversion of the normal anatomy of the shoulder joint. This non-anatomical prosthesis leads to a medialization of the rotation centre of the glenohumeral joint and also to a distalization of the humeral head. All that causes a deltoid tension increasing so allowing a larger abduction of the arm. Main complications of the reverse shoulder prosthesis are due to the joint instability, the scapular notching and the wear of the polyethylene insert. PURPOSE: The main goal of the present work is to study the effect of the positioning of the humeral component on the intrinsic stability of the reverse shoulder prosthesis. In particular, through finite element method simulations, the variation of the stability ratio of the shoulder joint has been calculated for both vertical and horizontal dislocating loads depending on the humeral stem version angle. Moreover, in order to estimate the wear of the polyethylene cup, some analyses have been developed to calculate the pressures on the polyethylene insert. RESULTS: The obtained results demonstrate the dislocation of a shoulder prosthesis and the wear of the polyethylene insert can be prevented or limited by conveniently varying the version angle of the humeral component. PMID:23719768
Nalbone, L; Adelfio, R; D'arienzo, M; Ingrassia, T; Nigrelli, V; Zabbara, F; Paladini, P; Campi, F; Pellegrini, A; Porcellini, G
Measurement of migration of a humeral head resurfacing prosthesis using radiostereometry without implant marking
Introduction Standard radiostereometric analysis of prosthetic migration requires that tantalum beads are inserted into the implant. For manufacturing reasons, this is not possible for humeral head resurfacing implants. We therefore used marker-free radiostereometry, developed for metal-backed acetabular cups, on a dummy model to validate the method for a humeral head resurfacing prosthesis. Material and methods 3 hemispherical resurfacing prostheses of different sizes were marked with tantalum beads and mounted in a sawbone. Standard and marker-free radiostereometry was then done repeatedly with gradual shifts of position of the prosthesis between each analysis. The marker-free algorithm was then compared to the standard to determine the accuracy. Results The accuracy for marker-free radiostereometry was 0.22–0.47 mm for translations and 0.92–1.56 degrees for rotations. Interpretation Based on our results, marker-free radiostereometry can be used to measure migration of humeral head resurfacing prostheses. This indicates that implant marking is not required when doing radiostereometry on humeral head resurfacing in clinical trials.
Optical and mechanical determination of poisson's ratio of adult bovine humeral articular cartilage
The equilibrium stiffness of articular cartilage is controlled by flow-independent elastie properties (Young's modulus, Es, and Poisson's ratio, vs) of the hydrated tissue matrix. In the current study, an optical (microscopic) method has been developed for the visualization of the boundaries of cylindrical bovine humeral head articular cartilage disks (n = 9), immersed in physiological solution, and compressed in unconfined
J. S. Jurvelin; M. D. Buschmann; E. B. Hunziker
Humeral cortical thickness in female Bantu — Its relationship to the incidence of femoral neck fracture
Measurements of the humeral cortical thickness demonstrate that generalised osteoporosis in female Bantu commences in the fifth decade and gradually increases until, in the ninth decade, all subjects are osteoporotic. The combined cortical thickness (CCT) of the humerus in young adults is very similar to that found previously in a white London population and the loss of cortex with age
Ronald A. Bloom; Hyman Pogrund
Treatment of distal humeral fractures using conventional implants. Biomechanical evaluation of a new implant configuration
BACKGROUND: In the face of costly fixation hardware with varying performance for treatment of distal humeral fractures, a novel technique (U-Frame) is proposed using conventional implants in a 180° plate arrangement. In this in-vitro study the biomechanical stability of this method was compared with the established technique which utilizes angular stable locking compression plates (LCP) in a 90° configuration. METHODS:
Markus Windolf; Edgardo Ramos Maza; Boyko Gueorguiev; Volker Braunstein; Karsten Schwieger
Avascular necrosis in proximal humeral fractures in patients treated with operative fixation: a meta-analysis
Background Proximal humeral fractures are common lesions of the elderly, but there are no established treatment guidelines. A surgical treatment for comminuted and displaced fractures of the proximal humerus was developed and is still evolving. The aim of this study was to perform a quantitative review to evaluate the risk of avascular necrosis (AVN) in patients with proximal humeral fractures who were treated by operative fixation compared with conservative treatment. Methods We searched the PubMed, MEDLINE, Springer, Elsevier Science Direct, Cochrane Library, Google Scholar, China National Knowledge Infrastructure (in Chinese), and Wanfang database (in Chinese) up to December 2013 to identify studies related to operative fixation and AVN in patients with proximal humeral fractures. Results Seven studies with a total of 291 patients (142 operative fixation cases and 149 conservative treatment cases) with proximal humeral fractures were considered in the meta-analysis. The overall meta-analysis showed no significant difference in the incidence of AVN between the two groups [odds ratio (OR) 1.42, 95% confidence interval (CI) 0.33–6.11, p?=?0.64]. The subgroup meta-analysis by study design (retrospective/prospective), sample size (?40/>40), and ethnicity (European/Asian) demonstrated similar results. However, the subgroup analysis by specific operative approach (plate fixation/tension band wiring fixation/others) indicated that plate fixation was associated with a higher rate of AVN than conservative treatment (OR 0.20, 95% CI 0.05–0.76, p?=?0.019). Conclusions Plate fixation was associated with a higher risk of AVN development than conservative treatment in patients with proximal humeral fractures.
Outcome of locking compression plating for proximal humeral fractures: a prospective study.
PURPOSE. To evaluate the outcome of open reduction and internal fixation using locking compression plates for proximal humeral fractures. METHODS. 54 men and 16 women aged 28 to 79 (mean, 54) years underwent open reduction and internal fixation using a locking compression plate for closed 2-part (n=22), 3-part (n=38), and 4-part (n=10) proximal humeral fractures. 10 of the patients also had dislocation of the humeral head; 4 had fractures extending to the shaft. Wound condition, functional outcome, bone union, amount of collapse, and malalignment were assessed. Functional outcome was assessed using the Constant-Murley score. RESULTS. The mean follow-up period was 15 (range, 6-24) months. All fractures achieved union after a mean of 9 (range, 6-12) weeks. The mean Constant- Murley scores for the injured and normal shoulders were 72 and 82, respectively (88% of normal). The final outcome was excellent in 14 patients, good in 28, moderate in 22, and poor in 6. In the latter 6 patients, 2 had screw penetration, 2 had plate impingement, one had a mal-reduced greater tuberosity, and one had adhesive capsulitis. All were preventable. In all, 18 patients had 20 complications: subacromial impingement of the plate (n=6), mal-reduction of the greater tuberosity (n=6), screw penetration (n=2), adhesive capsulitis (n=2), superficial infection (n=2), and haematoma (n=2); 12 of these complications were technique-related. CONCLUSION. Locking proximal humeral plates enabled stable fixation in all Neer-type proximal humeral fractures. Most complications were technique-related. PMID:24781604
Chowdary, U; Prasad, H; Subramanyam, P K
The calcar screw in angular stable plate fixation of proximal humeral fractures - a case study
Background With new minimally-invasive approaches for angular stable plate fixation of proximal humeral fractures, the need for the placement of oblique inferomedial screws ('calcar screw') has increasingly been discussed. The purpose of this study was to investigate the influence of calcar screws on secondary loss of reduction and on the occurrence of complications. Methods Patients with a proximal humeral fracture who underwent angular stable plate fixation between 01/2007 and 07/2009 were included. On AP views of the shoulder, the difference in height between humeral head and the proximal end of the plate were determined postoperatively and at follow-up. Additionally, the occurrence of complications was documented. Patients with calcar screws were assigned to group C+, patients without to group C-. Results Follow-up was possible in 60 patients (C+ 6.7 ± 5.6 M/C- 5.0 ± 2.8 M). Humeral head necrosis occurred in 6 (C+, 15.4%) and 3 (C-, 14.3%) cases. Cut-out of the proximal screws was observed in 3 (C+, 7.7%) and 1 (C-, 4.8%) cases. In each group, 1 patient showed delayed union. Implant failure or lesions of the axillary nerve were not observed. In 44 patients, true AP and Neer views were available to measure the head-plate distance. There was a significant loss of reduction in group C- (2.56 ± 2.65 mm) compared to C+ (0.77 ± 1.44 mm; p = 0.01). Conclusions The placement of calcar screws in the angular stable plate fixation of proximal humeral fractures is associated with less secondary loss of reduction by providing inferomedial support. An increased risk for complications could not be shown.
The anatomical relationship between the position of the auriculotemporal nerve and mandibular condyle.
Head, neck, face, and ear pains are commonly associated with disorders of the temporomandibular joint (TMJ). Several theories have been proposed regarding the functional relationship of the TMJ and the associated structures, and how they might contribute to certain painful conditions. This study was conducted to determine the anatomic relationship of the auriculotemporal nerve to the middle meningeal artery and the mandibular condyle. Forty human cadaver temporomandibular joints were dissected to locate the precise position of the auriculotemporal nerve to the mandibular condyle. The study findings revealed a significant variation in the relationship of the auriculotemporal nerve to the middle meningeal artery. The auriculotemporal nerve was found to be between 10-13 mm inferior to the superior surface of the condyle and 1-2 mm posterior to the neck of the condyle. The nerve was not found to be in a position that would likely create an entrapment with adjacent tissues. These findings may assist the clinician to locate the most appropriate injection site for an auriculotemporal nerve block. PMID:12889671
Fernandes, Paulo R B; de Vasconsellos, Henrique A; Okeson, Jeffrey P; Bastos, Ricardo L; Maia, Mey L T
The association of temporomandibular joint pain with abnormal bone marrow in the mandibular condyle
Purpose: This study investigated the association between temporomandibular joint pain and bone marrow alterations in the mandibular condyle seen on magnetic resonance (MR) images.Patients and Methods: The study was based on 112 temporomandibular joints in 112 patients with disc displacement without reduction. Thirty-four patients with abnormal bone marrow on MR images were compared with a control group of 78 patients
Tsukasa Sano; Per-Lennart Westesson; Tore A. Larheim; Ritsuo Takagi
Ectopic third molar in the mandibular condyle: A review of the literature
Objectives: To evaluate the etiopathogenesis, clinical features, therapeutic options, and surgical approaches for removal of ectopic third molars in the mandibular condyle. Study design: MEDLINE search of articles published on ectopic third molars in the mandibular condyle from 1980 to 2011. 14 well-documented clinical cases from the literature were evaluated together with a new clinical case provided by the authors, representing a sample of 15 patients. Results: We found a mean age at diagnosis of 48.6 years and a higher prevalence in women. In 14 patients, associated radiolucent lesions were diagnosed on radiographic studies and confirmed histopathologically as odontogenic cysts. Clinical symptoms were pain and swelling in the jaw or preauricular region, trismus, difficulty chewing, cutaneous fistula and temporomandibular joint dysfunction. Treatment included conservative management in one case and in the other cases, surgical removal by intra- or extraoral approaches, the latter being the most common approach carried out. In most reported cases, serious complications were not outlined. Conclusions: The etiopathogenic theory involving odontogenic cysts in the displacement of third molars to the mandibular condyle seems to be the most relevant. They must be removed if they cause symptoms or are associated with cystic pathology. The surgical route must be planned according to the location and position of the ectopic third molar, and the possible morbidity associated with surgery. Key words:Third molar, ectopic tooth, condyle, mandible.
Iglesias-Martin, Fernando; Torres-Carranza, Eusebio; Prats-Golczer, Victoria-Eugenia; Garcia-Perla-Garcia, Alberto
Evaluation of condyle defects using different reconstruction protocols of cone-beam computed tomography.
This study was conducted to investigate how well cone-beam computed tomography (CBCT) can detect simulated cavitary defects in condyles, and to test the influence of the reconstruction protocols. Defects were created with spherical diamond burs (numbers 1013, 1016, 3017) in superior and/or posterior surfaces of twenty condyles. The condyles were scanned, and cross-sectional reconstructions were performed with nine different protocols, based on slice thickness (0.2, 0.6, 1.0 mm) and on the filters (original image, Sharpen Mild, S9) used. Two observers evaluated the defects, determining their presence and location. Statistical analysis was carried out using simple Kappa coefficient and McNemar's test to check inter- and intra-rater reliability. The chi-square test was used to compare the rater accuracy. Analysis of variance (Tukey's test) assessed the effect of the protocols used. Kappa values for inter- and intra-rater reliability demonstrate almost perfect agreement. The proportion of correct answers was significantly higher than that of errors for cavitary defects on both condyle surfaces (p < 0.01). Only in identifying the defects located on the posterior surface was it possible to observe the influence of the 1.0 mm protocol thickness and no filter, which showed a significantly lower value. Based on the results of the current study, the technique used was valid for identifying the existence of cavities in the condyle surface. However, the protocol of a 1.0 mm-thick slice and no filter proved to be the worst method for identifying the defects on the posterior surface. PMID:24346048
Bastos, Luana Costa; Campos, Paulo Sérgio Flores; Ramos-Perez, Flávia Maria de Moraes; Pontual, Andrea dos Anjos; Almeida, Solange Maria
The Transverse Humeral LigamentA Separate Anatomical Structure or a Continuation of the Osseous Attachment of the Rotator Cuff?
Background:No study to date has isolated the anatomical nature of the transverse humeral ligament and its relationship to the biceps tendon and the anterosuperior portion of the rotator cuff.Hypothesis:There is no separate identifiable transverse humeral ligament, but rather the fibers covering the intertubercular groove are composed of a sling formed by fibers from the subscapularis and supraspinatus tendons.Study Design:Descriptive laboratory
Paul D. Gleason; Douglas P. Beall; Timothy G. Sanders; James L. Bond; Justin Q. Ly; Lorne L. Holland; Charles B. Pasque
Primary endoprosthesis in comminuted humeral head fractures in patients over 60 years of age.
The purpose of this study was to determine the early subjective and functional results after primary endoprosthesis replacement for comminuted humeral head fractures in patients over 60 years old. Twenty comminuted humeral head fractures in 20 patients were treated primarily (within 3.5 days (range 0-17 days) with a Neer II modular shoulder prosthesis, and were then followed up for an average of 32. 5 months (range 17-44 months). The average age of the patients was 77 years (range 63-91 years). The average post-operative Constant score was 52 points (range 30-76). This was significantly less than that of the contralateral side where the score was 80 points (range 53-100), P=0.0001. The average active abduction was 90 degrees (contralateral 157 degrees ) and active flexion 99 degrees (contralateral 161 degrees ). Eighteen of the 20 patients experienced relief of pain and would accept the same procedure again. PMID:10486031
Boss, A P; Hintermann, B
Trans-fracture transposition of the radial nerve during the open approach of humeral shaft fractures.
The radial nerve constitutes a major problem in humeral shaft fractures; it may be injured immediately or during closed reduction or open reduction and internal fixation with plate and screws. After fixation, the nerve always runs directly over the plate without any interposed structure. If a revision surgery is indicated, the nerve is at high risk as it is usually difficult to dissect from surrounding fibrotic scar tissue or callus formation. To avoid these complications, some authors reported transposition of the radial nerve through the fracture line. We present herein the surgical technique of the trans-fracture transposition of the radial nerve during open reduction and internal fixation of humeral shaft fractures, along with our preliminary results in 6 cases and a review of the literature. PMID:23412197
Chamseddine, Ali H; Zein, Hadi K; Alasiry, Abdullah A; Mansour, Nader A; Bazzal, Ali M
Mucinous Breast Cancer with Solitary Metastasis to Humeral Head: A Case Report
Breast cancer is the most common cause of metastatic deposits in the skeleton, and bone is the most common site of recurrence of breast cancer. Breast cancer metastasis most commonly affects the spine, ribs, pelvis, and proximal long bones; however, only 3.5% of breast cancer patients develop long-bone metastases. The humerus is the most common upper-extremity site for bony metastasis, and pathologic fractures can result. The patient in the current study presented with breast cancer and discovered to have humeral head metastasis during initial workup. The dilemma was in investigation the modality to confirm humeral head metastasis as there are many differential diagnoses with similar findings. After staging workup, the patient was treated with neoadjuvant chemotherapy followed by modified radical mastectomy and radiotherapy of the chest wall and the shoulder. The lesion in humerus was well healed.
Aljarrah, Adil; Al-Hashmi, Maryam; Malik, Kamran Ahmad; Sukhpal, Sawhney; Hussein, Samir; Al-Riyami, Marwa; Al-Moundhri, Mansour
Segond fracture: lateral capsular ligament avulsion.
Recently, there has been an emphasis placed on incorporating fundamental radiology in graduate level physical therapy curricula; however, the majority of practicing physical therapists never received formal radiology instruction. As health care changes, so must the role of the physical therapist. In a managed care environment, it is essential that physical therapists recognize basic radiographic findings and understand their clinical ramifications. The purpose of this article is to review the literature and provide commentary on avulsion fractures of the lateral tibial condyle, known as Segond fractures. Segond fractures typically occur by forced internal tibial rotation with the knee flexed. This mechanism placed tremendous force on the middle portion of the lateral capsule and associated meniscotibial ligament and results in a small bony avulsion. The Segond fracture is an important radiographic sign that is critical to recognize because it is generally associated with anterior cruciate ligament disruption. PMID:9007767
Davis, D S; Post, W R
Measurement of the anteroposterior translation of the humeral head using MRI
Summary. Anteroposterior translation of the humeral head within the glenohumeral joint was investigated using MRI. Ten normal shoulders,\\u000a 11 recurrent anterior dislocations, 10 stabilised shoulders after the Putti-Platt operation and one shoulder with multidirectional\\u000a instability, were scanned. The arm was positioned in internal and external rotation and in an overhead position. Gradient\\u000a echo volume acquisition scans were carried out, and
J. Kiss; E. G. McNally; A. J. Carr
Glenohumeral Internal Rotation Deficit in the Asymptomatic Professional Pitcher and its Relationship to Humeral Retroversion
The purpose of this study was to determine if glenohumeral internal rotation deficits (GIRD) exist in an asymptomatic population of professional pitchers, and to assess whether these changes are primarily a bony or soft tissue adaptation. Twenty three, active, asymptomatic professional (Major League Baseball) pitchers volunteered for the study. Clinical measures of glenohumeral ranges of motion, laxity, GIRD, as well as radiographic measures of humeral retroversion were taken by two independent orthopaedic surgeons. Data comparing side to side differences in range of motion, laxity, and humeral retroversion were analyzed for statistical significance using a paired t-test for continuous data and a Chi-squared test for ordinal data, with a significance set at 0.05. Evaluations of statistical correlations between different measurement parameters were accomplished using a Pearson product moment correlation. We hypothesized GIRD will be positively correlated with humeral retroversion (HR) in the pitching arm. All clinical and radiographic measures were made in the field, at spring training, by physicians of both private and institutional based sports medicine practices. For the entire group, significant differences were exhibited for HR, external rotation at 90° and internal rotation at 90°, for dominant vs. non-dominant arms. GIRD of greater than 25° was noted in 10/23 of pitchers. In this group, HR was significantly increased and correlated to GIRD. No such increase or correlation was noted for the non-GIRD group. GIRD is a common finding in asymptomatic professional pitchers, and is related to humeral retroversion. Thus internal rotation deficits should not be used as the sole screening tool to diagnose the disabled throwing shoulder. Key pointsGIRD is relatively common in asymptomatic baseball pitchers (35-43%).Large ranges (-45 to 5°) and a large standard deviation (±16°) were noted suggesting that GIRD is quite variable in this population.GIRD is a variable measure in the asymptomatic population, and therefore should not be used as sole proof for the disabled throwing shoulder.
Tokish, John M.; Curtin, Michael S.; Kim, Young-Kyu; Hawkins, Richard J.; Torry, Michael R.
Interlocking nailing of humeral shaft fractures: the Oxford experience 1991 to 1994
Forty-three patients with fractures of the humeral shaft were treated by locked intermedullary nailing, using the Russell-Taylor nailing system. Overall there were few technical problems with nail insertion. Additional fracture comminution occurred in five patients but affected stability in only one case. Twenty-six nails were inserted into 22 patients with pathological fractures. The objective of fracture stabilization and pain relief
T. E. J. Hems; T. P. S. Bhullar
Is MIPO in humeral shaft fractures really safe? Postoperative ultrasonographic evaluation
In the last few years there has been great interest in minimally invasive plate osteosynthesis (MIPO) in the treatment of\\u000a humeral shaft fractures. None of these studies showed the anatomical relationship between the radial nerve and the material\\u000a of the implant in vivo. We performed postoperative ultrasonographic measurement of the distance between the radial nerve and\\u000a the material implanted using
Bruno Livani; William Belangero; Kleber Andrade; Guilherme Zuiani; Raphael Pratali
Assessment of dynamic humeral centering in shoulder pain with impingement syndrome: a randomised clinical trial
ObjectivesTreatment for degenerative rotator cuff disease of the shoulder includes physiotherapy. Dynamic humeral centering (DHC) aims at preventing subacromial impingement, which contributes to the disease. The goal of this study was to assess the effectiveness of DHC.Method69 patients with shoulder pain and impingement syndrome were prospectively included in a single-centre randomised trial with a 12-month follow-up. Patients and assessor were
Johann Beaudreuil; Sandra Lasbleiz; Pascal Richette; Gérard Seguin; Christine Rastel; Mounir Aout; Eric Vicaut; Martine Cohen-Solal; Frédéric Lioté; Marie-Christine de Vernejoul; Thomas Bardin; Philippe Orcel
Does the technique of lateral cross-wiring (Dorgan's technique) reduce iatrogenic ulnar nerve injury?
In this study we compared the results of patients with displaced supracondylar humeral fractures who had been treated with\\u000a all lateral cross-wire and medio-lateral cross-wire fixation techniques. Only the 139 patients who were able to attend the\\u000a final examination were included in the assessment. The patients were allocated retrospectively into two groups according to\\u000a the pin configuration used. Group 1
Kaya Memisoglu; Cumhur Cevdet Kesemenli; Halil Atmaca
Scapula and humeral movement patterns and their relationship with pain: A preliminary investigation.
PURPOSE: Altered movement patterns may contribute to this shoulder pain following stroke. The purpose of this study was to examine scapular and humeral movement patterns in people with hemiparetic shoulder pain (HSP), and to explore the relationships between pain and these movement patterns. METHODS: Kinematic data from nine participants with HSP and twelve matched controls were collected as they performed scapular plane shoulder elevation. Correlation analyses were used to examine relationships between participants' ratings of pain and kinematic data. RESULTS: The HSP group had decreased humeral external rotation compared to the control group. Despite a trend toward decreased scapular upward rotation, there was considerable variation in scapular upward rotation movement patterns across the participants with HSP. Scapular tilt was not different between groups. There was an inverse relationship between pain and scapular upward rotation, indicating that those with more pain had less scapular upward rotation. CONCLUSIONS: People with HSP demonstrated scapular and humeral movement patterns that differed from controls, where some of the altered movement patterns were related to reported pain levels. Rehabilitation management of people with HSP may be improved by careful assessment of scapulohumeral movement patterns and treatments aimed at normalizing these patterns. PMID:22866060
Hardwick, Dustin D; Lang, Catherine E
Treatment of Femoral Shaft Fracture with an Interlocking Humeral Nail in Older Children and Adolescents
Purpose Rigid interlocking nailing for femoral shaft fracture is ideal for use in adolescents in terms of stability of the fracture and convenience for the patient. However, numerous authors have reported that rigid interlocking nailing has some limitations in this age group due to the risk of complications. We evaluated the results of intramedullary nailing for femoral shaft fractures with an interlocking humeral nail in older children and adolescents. Materials and Methods We retrospectively reviewed records of patients treated with an interlocking humeral nail. Radiographs were examined for proximal femoral change and evidence of osteonecrosis. Outcomes were assessed by major or minor complications that occurred after operative treatment. Results Twenty-four femoral shaft fractures in 23 patients were enrolled. The mean age at the time of operation was 12 years and 8 months and the mean follow-up period was 21 months. Bony union was achieved in all patients without any complications related to the procedure such as infection, nonunion, malalignment and limb length discrepancy. All fractures were clinically and radiographically united within an average eight weeks. No patients developed avascular necrosis of the femoral head and coxa valga. Conclusion Intramedullary nailing through the greater trochanter using a rigid interlocking humeral nail is effective and safe for the treatment of femoral shaft fractures in older children and adolescents.
Park, Hoon
Anatomical study of simple landmarks for guiding the quick access to humeral circumflex arteries
Background The posterior and anterior circumflex humeral artery (PCHA and ACHA) are crucial for the blood supply of humeral head. We aimed to identify simple landmarks for guiding the quick access to PCHA and ACHA, which might help to protect the arteries during the surgical management of proximal humeral fractures. Methods Twenty fresh cadavers were dissected to measure the distances from the origins of PCHA and ACHA to the landmarks (the acromion, the coracoid, the infraglenoid tubercle, the midclavicular line) using Vernier calipers. Results The mean distances from the origin of PCHA to the infraglenoid tubercle, the coracoid, the acromion and the midclavicular line were 27.7 mm, 50.2 mm, 68.4 mm and 75.8 mm. The mean distances from the origin of ACHA to the above landmarks were 26.9 mm, 49.2 mm, 67.0 mm and 74.9 mm. Conclusion Our study provided a practical method for the intraoperative identification as well as quick access of PCHA and ACHA based on a series of anatomical measurements.
Effect of alendronate on endochondral ossification in mandibular condyles of growing rats
The replacement of the calcified cartilage by bone tissue during the endochondral ossification of the mandibular condyle is dependent of the resorbing activity of osteoclats. After partial resorption, calcified cartilage septa are covered by a primary bone matrix secreted by osteoblasts. Osteoadherin (OSAD) is a small proteoglycan present in bone matrix but absent in cartilage during the endochondral ossification. The aim of this study was to analyze the effect of alendronate, a drug known to inhibit bone resorption by osteoclasts, on the endochondral ossification of the mandibular condyle of young rats, by evaluating the distribution of osteoclasts and the presence of OSAD in the bone matrix deposited. Wistar newborn rats (n=45) received daily injections of alendronate (n=27) or sterile saline solution as control (n=18) from the day of birth until the ages of 4, 14 and 30 days. At the days mentioned, the mandibular condyles were collected and processed for transmission electron microscopy analysis. Specimens were also submitted to tartrate resistant acid phosphatase (TRAP) histochemistry and ultrastructural immunodetection of OSAD. Alendronate treatment did not impede the recruitment and fusion of osteoclasts at the ossification zone during condyle growth, but they presented inactivated phenotype. The trabeculae at the ossification area consisted of cartilage matrix covered by a layer of primary bone matrix that was immunopositive to OSAD at all time points studied. Apparently, alendronate impeded the removal of calcified cartilage and maturation of bone trabeculae in the mandibular ramus, while in controls they occurred normally. These findings highlight for giving attention to the potential side-effects of bisphosphonates administered to young patients once it may represent a risk of disturbing maxillofacial development.
Bradaschia-Correa, V.; Barrence, F.A.C.; Ferreira, L.B.; Massa, L.F.; Arana-Chavez, V.E.
Bifid mandibular condyle with temporomandibular joint ankylosis: report of two cases and review of literature.
Bifid mandibular condyle is an uncommon entity with a controversial etiology. It can be developmental or acquired and rarely may be associated with temporomandibular joint (TMJ) ankylosis. Although the patient may be asymptomatic, the radiologist should be aware of this entity and its clinical implications. We report two cases of BMC, one developmental and the other secondary to trauma. Both were diagnosed using computed tomography, which additionally revealed the associated ankylosis of TMJ in both the patients. PMID:19521698
Gulati, Ajay; Virmani, V; Ramanathan, S; Verma, L; Khandelwal, N
Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture
The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Condylar fractures can be extracapsular or intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and dental occlusion, and the surgeonnds on the age of the patient, the co-existence of othefrom which it is difficult to recover aesthetically and functionally;an appropriate treatment is required to reconstruct the shape and achieve the function ofthe uninjured status. To do this, accurate diagnosis, appropriate reduction and rigid fixation, and complication prevention are required. In particular, as mandibular condyle fracture may cause long-term complications such as malocclusion, particularly open bite, reduced posterior facial height, and facial asymmetry in addition to chronic pain and mobility limitation, great caution should be taken. Accordingly, the authors review a general overview of condyle fracture.
Yang, Jung-Dug; Chung, Ho-Yun; Cho, Byung-Chae
Delayed hypoglossal nerve palsy following unnoticed occipital condyle fracture.
Occipital condylar fractures (OCFs) are rare and difficult to diagnose. The routine use of computed tomography (CT) scan in traumatology has however now made their diagnosis easier, with an estimated frequency of 4 to 19% of craniospinal traumatized patients and 0.4 to 0.7% of all severe traumatized patients in emergencies. This paper describes a patient who was not diagnosed with OCF during his first hospitalization after a road accident. However, 15 days later a left sided hypoglossal nerve palsy occurred. In this case report, we underline that an examination of the cranial nerve is a quick and easy procedure to screen each head trauma patient for occipital foramen fractures. Also, careful attention must be paid to X-Rays, CT scans and magnetic resonance imaging of the craniocervical junction. PMID:24475495
Rué, M; Jecko, V; Dautheribes, M; Vignes, J-R
Little Leaguer's shoulder (proximal humeral epiphysiolysis): MRI findings in four boys
Background Shoulder pain is a common problem among adolescent athletes. A possible cause of such pain that can be diagnosed on MRI is\\u000a a stress injury to the proximal humerus known as Little Leaguer's shoulder (proximal humeral epiphysiolysis).\\u000a \\u000a \\u000a \\u000a Objective Our objective was to describe the MRI appearance of Little Leaguer's shoulder.\\u000a \\u000a \\u000a \\u000a Materials and methods Four patients (all boys; age range 11–15 years; median 13 years)
Olufolajimi O. Obembe; Cree M. Gaskin; Matthew J. Taffoni; Mark W. Anderson
Use of a proximal humeral plate for a paediatric peri-prosthetic femoral fracture
In this case an 18-year-old female with cerebral palsy sustained a peri-prosthetic femoral fracture adjacent to a blade plate previously inserted for a femoral varus osteotomy. The injury was treated using a long proximal humeral locking plate. The existing blade plate was removed. The fracture was reduced and held, and a 10-hole PHILOS™ plate applied with near anatomical reduction. There were no post-operative complications. Radiographic union was confirmed at 11 months. To our knowledge, this is the first reported use of a PHILOS™ plate in the management of a femoral peri-prosthetic fracture and successfully demonstrated a straightforward method for revision fixation.
Shaw, C.R.; Badhesha, J.; Ayana, G.; Abu-Rajab, R.
Dicondylar humeral fracture stabilisation in a dog using a transilial rod and external fixation.
Repair of a Salter-Harris type IV dicondylar humeral fracture was performed on a 15-week-old pitbull terrier. Interfragmentary compression of the intracondylar component of the fracture was achieved with a transilial rod and locking nuts (Trans-ilial Rod; IMEX Veterinary, Inc.). The transilial rod was articulated with a modified type I external fixator which functioned as adjunctive stabilisation for the supracondylar component of the fracture. Fracture healing was confirmed radiographically five weeks following surgery. The dog had no appreciable lameness when examined 12 months after fracture repair. PMID:17725586
Au, K; Mattern, K L; Lewis, D D
Humeral Rotational Osteotomy for Shoulder Deformity in Obstetric Brachial Plexus Palsy: Which Direction Should I Rotate?
Shoulder internal rotation contracture is the most common deformity affecting the shoulder in patients with Obstetric Brachial Plexus Palsy. With progression of the deformity, the glenohumeral joint starts to subluxate and then dislocates. This is accompanied with bony changes of both the humerus and the glenoid. Two opposite direction humeral osteotomies have been proposed for this condition (internal rotation osteotomy (IRO) and external rotation osteotomy (ERO)). This fact of different direction osteotomies has not adequately been explained in the literature. Most orthopedic surgeons may not be able to fully differentiate between these two osteotomies regarding the indications, outcomes and effects on the joint. This review explains these differences in details.
Abdelgawad, Amr A; Pirela-Cruz, Miguel A
Bifid mandibular condyle: a study of the clinical features, patterns and morphological variations using CT scans.
Bifid Mandibular Condyle (BMC) are usually diagnosed on routine radiographic examination, is described in the literature as a rare entity. It is reported that BMC has no predilection by sex or ethnic background or the age. The etiopathogenesis of BMC still remains controversial and proper description of the condition is not defined owing to fewer reported cases. Dental professionals should have some knowledge of this anatomic abnormality, as well as its implications for function and appropriate treatment modalities, so that they can be alert to this potential diagnosis. This paper reports the largest series of BMC, using CT scans with history of trauma and presents some of the characteristic clinical features. PMID:23139565
Balaji, S M
Intraosseous ganglion cyst of the humeral head in a competitive flat water paddler: case report
Objective To present the diagnostic and clinical features of an intraosseous ganglion cyst of the humeral head of a female flat water canoe athlete. Clinical Features An 18-year old female flat water canoeist complaining of right shoulder pain following a strenuous paddling training camp. Intervention and outcome A trial of passive care was conducted, including soft tissue therapy, spinal manipulative therapy, acupuncture, and rehabilitation. The patient seemed to be responding with treatment, but pain would always resume with paddling. A diagnostic ultrasound displayed mild thickening and effusion in the subacromial/subdeltoid bursae. Continued passive care was not able to resolve the symptoms and she underwent an MRI which revealed an intraosseus ganglion cyst subjacent to the lesser tuberosity and floor of the intertubercular groove. A subsequent MRA was ordered to assess the labrum, which was intact, but the cyst had progressed in size. She was referred to an orthopedic surgeon who performed surgery. Conclusion An IOG cyst within the humeral head is a rare, potentially painful condition that can mimic other pathologies including impingement and labral tear. It is important to be aware of the clinical features to obtain a prompt diagnosis and appropriate treatment of this condition.
Muir, Brad; Kissel, Jaclyn A.; Yedon, Dominique Forand
Humeral development from neonatal period to skeletal maturity--application in age and sex assessment.
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. PMID:22588220
Rissech, Carme; López-Costas, Olalla; Turbón, Daniel
Aequalis Humeral Head Resurfacing in Glenohumeral Arthritis at a Minimum Followup of 2 Years
Aim. To evaluate results of Aequalis humeral head resurfacing in patients with end-stage glenohumeral arthritis at a minimum followup of two years. Patients and Methods. Twenty-one consecutive patients underwent humeral head resurfacing hemiarthroplasty between 2007 and 2009. Three patients did not fulfill the inclusion criteria. 18 patients with mean age of 75.1 years (range 58–91 years) and a mean duration of preoperative symptoms of 33.6 months (range 6–120 months) were analyzed. Patients' self-reported Oxford shoulder score (OSS) was collected prospectively and was used as an assessment tool to measure final outcome. Results. The mean initial OSS was 15 (range 3–29). The score improved by an average of 19.5 points at a mean followup of 36.3 months (range 24–54 months) to reach a mean final OSS of 34.5 (range 6–47). The improvement of OSS was highly significant with a two-tailed P value less than 0.0001. The overall patient satisfaction was 94%. Conclusion. This study demonstrates Aequalis shoulder resurfacing hemiarthroplasty as a reliable procedure, away from its originating center, for improvement of shoulder function as shown by the patients' self-reported outcome score (OSS) in end-stage glenohumeral arthritis at a minimum followup of 2 years.
Dwyer, Amitabh J.; Chambler, Andrew F. W.
Late Prosthetic Shoulder Hemiarthroplasty after Failed Management of Complex Proximal Humeral Fractures
Background. The purpose of this study was to report our experience with shoulder hemiarthroplasty in the context of old trauma. Methods. 33 patients with failed treatment for a complex proximal humeral fracture underwent prosthetic hemiarthroplasty. There were 15 men and 18 women with a mean age of 58.1 years. The average period from initial treatment was 14.9 months. Sequelae included 11 malunions, 4 nonunions, 15 cases with avascular necrosis (AVN) and 3 neglected posterior locked dislocations. Follow up investigation included radiological assessment and clinical evaluation using the Constant score and a visual analogue pain scale. Results. After a mean follow up of 82.5 months the median Constant score was 75.7 points, improved by 60% in comparison to preoperative values. Greater tuberosity displacement, large cuff tears and severe malunion were the factors most affected outcome. No cases of stem loosening or severe migration were noted. 60% of the patients were able to do activities up to shoulder level compared with 24% before reconstruction. Conclusions. Late shoulder hemiarthroplasty is technically difficult and the results are inferior to those reported for acute humeral head replacement, nonetheless remains a satisfactory reconstructive option when primary treatment fails.
Panagopoulos, A.; Tsoumpos, P.; Evangelou, K.; Georgiou, Christos; Triantafillopoulos, I.
Functional outcome following one-part proximal humeral fractures: a prospective study.
A prospective study was undertaken to determine if patients recover pre-injury level of shoulder function 1 year after 1 part proximal humeral fractures. Of the 67 patients enrolled, 43 were female and 24 male with an average age of 64.8 years (range, 25-90 years). All patients underwent a similar treatment protocol consisting of early therapy for range of shoulder motion and strengthening. Baseline demographics and functional assessment, including the American Shoulder and Elbow Surgeons (ASES) evaluation form and the SF-36, were obtained at the time of injury. Functional and demographic data were evaluated with a Student's t test. Fifty-four patients (80%) completed a 1-year follow-up. By 3 months, all patients attained radiographic and clinical evidence of union and no loss of reduction. At 1 year, the ASES score was similar to pre-injury status (93.7 vs 99.1; P = .12). The range of shoulder motion of the affected side was diminished compared to the unaffected extremity in internal rotation (P < .001) and external rotation (P < .001) but not forward flexion. Patients, who sustain minimally displaced proximal humeral fractures treated nonoperatively, largely returned to preoperative functional status at 1-year follow-up. Patients should be counseled and made aware of the decreased range of shoulder motion following this fracture. PMID:18207430
Tejwani, Nirmal C; Liporace, Frank; Walsh, Michael; France, Monet A; Zuckerman, Joseph D; Egol, Kenneth A
[The role of the condyle in the growth of the mandible and in facial balance].
The condyle is not responsible for the growth of the body of the mandible, as the latter does not extend in length caudally at the expense of the ascending rami (through the classical relocation phenomenon), but does so deep to these, at the level of the lower insertions of the sphenomandibular ligaments (i.e., from the inlet inner border of the inferior dental canals). Philogenetically and ontogenetically, its appearance reflects the adaptation of the mandible of mammals to the morphologic and functional changes that took place in their cephalic skeleton (more erect posture, more vigorous mastication). Its chief role in man is to stabilize the mandibular body and to allow it to be properly mobilized, although contributing also to its forward and downward movements (namely in its posterior aspect). As such, it plays an active role in mandibular growth, and this role varies according to the primary "potential" of the condylar cartilage. Such primary-type potential for condylar growth may be adequately assessed by studying the shape of the mandible, as well as through an analysis of craniofacial architecture. Most of the conventional diagrams depicting mandibular growth are defective. Another figurative system has to be innovated, that will differentiate each skeletal unit--body, condyle, coronoid process, angle, alveolodental arch--, the sum of which confers the shape, the size, and the multiple variations to the mandible as a whole. PMID:2188347
Delaire, J
Dislocation of the mandibular condyle into the middle cranial fossa causing an epidural haematoma.
Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of mandibular trauma due to anatomical and biomechanical factors. Owing to the proximity of the temporal glenoid fossa to the middle meningeal artery, there is the risk of serious sequelae in case of trauma. The authors report the case of a 36-year-old male patient, who was beaten up in a family dispute and presented with complex mandibular and maxillofacial fractures, including mandibular condyle intrusion into the middle cranial fossa causing extensive meningeal bleeding. The patient underwent immediate surgery, with evacuation of the epidural haematoma via a temporal approach. In addition open reduction and reconstruction of the temporal glenoid fossa via anatomic reduction of the fragments was performed. A functional occlusion was re-established via miniplate reconstruction of the complex mandibular body and ramus fractures. Prompt diagnosis and a multidisciplinary approach are essential to minimize the complications. Advanced imaging modalities of computed tomography are indicated. Treatment options should be individualized in particular in case of suspected neurological injury. PMID:21862340
Struewer, Johannes; Kiriazidis, Ilias; Figiel, Jens; Dukatz, Thomas; Frangen, Thomas; Ziring, Ewgeni
Surface and Subsurface Morphology of Bovine Humeral Articular Cartilage as Assessed by Atomic Force and Transmission Electron Microscopy
Maintenance of superficial structural integrity is essential for the load-bearing function of articular cartilage. In this study, we used atomic force microscopy (AFM) to image the 3-D surface and subsurface morphology of fresh bovine humeral head articular cartilage maintained in physiological solution. Complementary ultrastructural data were obtained by transmission electron microscopy (TEM) of cryoprocessed samples. The surface irregularities observed in
E. B. Hunziker
Intramedullary Nail versus Dynamic Compression Plate Fixation in Treating Humeral Shaft Fractures: Grading the Evidence through a Meta-Analysis
There is a debate regarding the choice of operative intervention in humeral shaft fractures that require surgical intervention. The choices for operative interventions include intramedullary nailing (IMN) and dynamic compression plate (DCP). This meta-analysis was performed to compare fracture union, functional outcomes, and complication rates in patients treated with IMN or DCP for humeral shaft fractures and to develop GRADE (Grading of Recommendations, Assessment, Development, and Evaluation)-based recommendations for using the procedures to treat humeral shaft fractures. A systematic search of all the studies published through December 2012 was conducted using the Medline, Embase, Sciencedirect, OVID and Cochrane Central databases. The randomized controlled trials (RCTs) and quasi-RCTs that compared IMN with DCP in treating adult patients with humeral shaft fractures and provided data regarding the safety and clinical effects were identified. The demographic characteristics, adverse events and clinical outcomes were manually extracted from all of the selected studies. Ten studies that included a total of 448 patients met the inclusion criteria. The results of a meta-analysis indicated that both IMN and DCP can achieve similar fracture union with a similar incidence of radial nerve injury and infection. IMN was associated with an increased risk of shoulder impingement, more restriction of shoulder movement, an increased risk of intraoperative fracture comminution, a higher incidence of implant failure, and an increased risk of re-operation. The overall GRADE system evidence quality was very low, which reduces our confidence in the recommendations of this system. DCP may be superior to IMN in the treatment of humeral shaft fractures. Because of the low quality evidence currently available, high-quality RCTs are required.
Ma, XinLong; Gao, Feng; Wei, Qiang; Jia, HaoBo; Feng, Rui; Yu, JingTao; Wang, Jie
Treatment of humeral shaft aseptic nonunions in elderly patients with opposite structural allograft, BMP-7, and mesenchymal stem cells.
Humeral shaft aseptic nonunions occur in 2% to 10% of patients managed conservatively and 10% to 15% of patients treated surgically. The complex muscular and neurovascular anatomy of the upper limb makes the surgical approach to the fracture site demanding and risky, especially when previous surgeries have been attempted. The clinical consequence of atrophic humeral shaft nonunions is a severe functional limitation that may significantly affect activities of daily living, especially in the elderly. The surgical treatment of humeral shaft nonunions is challenging for orthopedic surgeons. Patients with atrophic nonunions require both a stable fixation and enhancement of the biologic response because of the weak biologic reaction observed at the fracture site. The gold standard of treatment in elderly patients has not been described. Nonetheless, older age and comorbidities are associated with potentially malignant nonunions. This study reports the authors' experience using opposite cortical allograft combined with bone morphogenetic protein 7 and mesenchymal stem cells to treat humeral shaft atrophic nonunions in 2 elderly patients. The nonunion site healed at 4 months (patient 1) and 8 months (patient 2) postoperatively, with full return to activities of daily living and no pain. Neither patient reported complications of the radial nerve, which is at high risk of injury during this type of surgery. The only reported complication (patient 2) was an intraoperative longitudinal partial distal humeral fracture, probably caused by compression screw overtightening. The use of a locking plate and opposite cortical allograft, combined with BMP-7 and mesenchymal stem cells, represents a safe and effective treatment for malignant nonunions in older patients. PMID:24679209
Murena, Luigi; Canton, Gianluca; Vulcano, Ettore; Surace, Michele Francesco; Cherubino, Paolo
Prolonged-fresh preservation of intact whole canine femoral condyles for the potential use as osteochondral allografts
Defects in articular cartilage are often repaired with fresh osteochondral grafts. While fresh allografts provide viable chondrocytes, logistic limitations require surgical implantation within seven days of graft harvest. Here, we provide information on cold preservation of whole intact osteochondral materials that retains cartilage cell viability and function, and histologic and biochemical integrity for 28days. Canine femoral condyles were obtained and
James M. Williams; Amarjit S. Virdi; Tamara K. Pylawka; Ryland B. Edwards III; Mark D. Markel; Brian J. Cole
Regulatory effects of FGF2 on the growth of mandibular condyles and femoral heads from newborn rats
The secondary cartilage of the mandibular condyle is considered to be adaptive to functional factors. In the last decades, growth factors have also been shown to be potent regulators of cartilage metabolism. Moreover, it has been suggested that growth factors may differentially regulate the growth of primary and secondary cartilages. However, only a few studies have made a direct comparison
M. Delatte; J. W. Von den Hoff; A. M. Kuijpers-Jagtman
Modulation of Endochondral Development of the Distal Femoral Condyle by Mechanical Loading
Although previous theoretical modeling studies have predicted that various mechanical stresses accelerate or inhibit the ossification process of the neonatal chondroepiphysis, there is a paucity of experimental data to verify these models. The present study was designed to provide experimental evidence on whether the ossification of the chondroepiphysis is modulated by mechanical loading on the distal femoral condyle explant of the neonatal (5-day-old) rabbit in organ culture. Upon aseptic dissection, the right condyle explant was immersed in and fixated to an organ culture system, and received cyclic forces at 200 mN and 1 Hz for 12 h (N = 8) directly on its slightly convex articular surface, whereas the contralateral, left condyle explant was immersed separately in organ culture (N = 8). Subsequently, both loaded and control explants were placed in a bioreactor rotating at 20 rpm for 72 h. In each mechanically loaded specimen, a structure reminiscent of the secondary ossification center (SOC) appeared with an average area of 1.17 ± 0.13 mm2, or 15.2 ± 8.2% of the total epiphysis area. In contrast, no SOC was detected in any of the unloaded contralateral control specimens. The SOC in mechanically loaded specimens was stained intensively with fast green, whereas either the rest of the loaded epiphysis or the entire control epiphysis was stained intensely to safranin-O but lacked fast green staining. Immunolocalization revealed that the SOC of the mechanically loaded specimens expressed Runx 2 and osteopontin, both of which were absent in the unloaded control specimens. Type X collagen was expressed surrounding hypertrophic chondrocytes adjacent to the SOC, but was absent in the control specimen. Type II collagen and decorin were absent in the SOC of the loaded specimen, but were expressed throughout the rest of the loaded epiphysis and the unloaded control epiphysis. The intensity of type II collagen and decorin expression was significantly stronger among hypertrophic chondrocytes surrounding the SOC than the control. The numbers of hypertrophic chondrocytes surrounding the SOC and superior to metaphyseal bone were significantly higher in the loaded specimens than the unloaded controls. Taken together, mechanical stresses accelerate the formation of the secondary ossification center, and therefore modulate endochondral ossification.
Sundaramurthy, Sona; Mao, Jeremy J.
Treatment of Mandibular Condyle Fractures Using a Modified Transparotid Approach via the Parotid Mini-Incision: Experience with 31 Cases
Surgery for mandibular condyle fractures must allow direct vision of the fracture, reduce surgical trauma and achieve reduction and fixation while avoiding facial nerve injury. This prospective study was conducted to introduce a new surgical approach for open reduction and internal fixation of mandibular condyle fractures using a modified transparotid approach via the parotid mini-incision, and surgical outcomes were evaluated. The modified transparotid approach via the parotid mini-incision was applied and rigid internal fixation using a small titanium plate was carried out for 36 mandibular condyle fractures in 31 cases. Postoperative follow-up of patients ranged from 3 to 26 months; in the first 3 months after surgery, outcomes for all patients were analyzed by evaluating the degree of mouth opening, occlusal relationship, facial nerve function and results of imaging studies. The occlusal relationships were excellent in all patients and none had symptoms of intraoperative ipsilateral facial nerve injury. The mean degree of mouth opening was 4.0 (maximum 4.8 cm, minimum 3.0 cm). No mandibular deviations were noted in any patient during mouth opening. CT showed complete anatomical reduction of the mandibular condyle fracture in all patients. The modified transparotid approach via the smaller, easily concealed parotid mini-incision is minimally invasive and achieves anatomical reduction and rigid internal fixation with a simplified procedure that directly exposes the fracture site. Study results showed that this procedure is safe and feasible for treating mandibular condyle fracture, and offers a short operative path, protection of the facial nerve and satisfactory aesthetic outcomes.
Shi, Jun; Yuan, Hao; Xu, Bing
Comparison of Accuracy of Uncorrected and Corrected Sagittal Tomography in Detection of Mandibular Condyle Erosions: an Exvivo Study
Background: Radiographic examination of TMJ is indicated when there are clinical signs of pathological conditions, mainly bone changes that may influence the diagnosis and treatment planning. The purpose of this study was to evaluate and to compare the validity and diagnostic accuracy of uncorrected and corrected sagittal tomographic images in the detection of simulated mandibular condyle erosions. Methods Simulated lesions were created in 10 dry mandibles using a dental round bur. Using uncorrected and corrected sagittal tomography techniques, mandibular condyles were imaged by a Cranex Tome X-ray unit before and after creating the lesions. The uncorrected and corrected tomography images were examined by two independent observers for absence or presence of a lesion. The accuracy for detecting mandibular condyle lesions was expressed as sensitivity, specificity, and validity values. Differences between the two radiographic modalities were tested by Wilcoxon for paired data tests. Inter-observer agreement was determined by Cohen's Kappa. Results: The sensitivity, specificity and validity were 45%, 85% and 30% in uncorrected sagittal tomographic images, respectively, and 70%, 92.5% and 60% in corrected sagittal tomographic images, respectively. There was a significant statistical difference between the accuracy of uncorrected and corrected sagittal tomography in detection of mandibular condyle erosions (P = 0.016). The inter-observer agreement was slight for uncorrected sagittal tomography and moderate for corrected sagittal tomography. Conclusion: The accuracy of corrected sagittal tomography is significantly higher than that of uncorrected sagittal tomography. Therefore, corrected sagittal tomography seems to be a better modality in detection of mandibular condyle erosions.
Naser, Asieh Zamani; Shirani, Amir Mansour; Hekmatian, Ehsan; Valiani, Ali; Ardestani, Pegah; Vali, Ava
Humeral cortical thickness in female Bantu - its relationship to the incidence of femoral neck fracture
Measurements of the humeral cortical thickness demonstrate that generalised osteoporosis in female Bantu commences in the fifth decade and gradually increases until, in the ninth decade, all subjects are osteoporotic. The combined cortical thickness (CCT) of the humerus in young adults is very similar to that found previously in a white London population and the loss of cortex with age is very similar. It is concluded that the known low incidence of femoral neck fracture in Bantu is not due to a lower incidence of generalised osteoporosis but to environmental factors. The chief environmental factor postulated is the greater amount of physical work performed by the Bantu. A more careful mode of walking is suggested as a subsidiary cause.
Bloom, R.A.; Pogrund, H.
[Fractures of the humeral shaft: role of fasciculated nailing using Hackethal's method. Apropos of 129 cases].
This retrospective study was based on 141 diaphyseal fractures of the humerus, treated by Hackethal fasciculated pinning, among 371 fractures followed up during 10 years in our department. There were six preoperative radial paralyses. The mean consolidation delay was 65 days. Six fractures did not unite and there was no sepsis. The only immediate neurological postoperative complication was a regressive cubital paralysis. 72 fractures could be followed-up with a mean of 4 years, to establish a functional result chart. 94.4 per cent of the results were good and very good, 2 shoulder stiffness and only one elbow stiffness. The displaced fractures of the humeral diaphysis on D2 to D5 zones, as well as pathological fractures are good indications for Hackethal fasciculated pinning. PMID:1604016
Gayet, L E; Muller, A; Pries, P; Merienne, J F; Brax, P; Soyer, J; Clarac, J P
Complications and Outcomes of Minimally Invasive Percutaneous Plating for Proximal Humeral Fractures
Background The minimally invasive plate osteosynthesis (MIPO) technique using periarticular locking plates may be a good option for the repair of displaced proximal humeral fractures. However, axillary nerve complications related to this technique may be underestimated. The purpose of this study is to evaluate the outcomes of the minimally invasive plating, focusing on the complications. Methods The records of 21 consecutive patients treated for proximal humerus fractures using the MIPO technique with locking plates were retrospectively reviewed. These patients were treated between March 2009 and March 2011 with a minimum one-year follow-up. The clinical function, complications, and radiological bony union were evaluated. Results All of the patients, with one exception, showed at least 90 degrees of flexion and abduction at the shoulder joint six months postoperatively. The average Constant scores at three months, six months, and one year follow-ups were 74.0 (range, 62 to 90), 79.4 (range, 64 to 91), and 82.7 (range, 66 to 92), respectively. All of the patients achieved bony union within the average of 3.2 months (range, 2 to 6 months). There was one case of delayed union, one case of intra-articular screw penetration, and one case of axillary nerve paresis (incomplete injury), which did not completely recover during the one year of follow-up. Conclusions The MIPO technique using periarticular locking plates is a useful option for the treatment of selected cases of displaced proximal humeral fractures. However, nerve complications such as axillary nerve paresis should be considered along with implant-related complications when choosing patients for minimally invasive plating.
Jeong, Seong Yup
[Large intraosseous ganglion in the femoral condyle treated with resorbable cement: clinical case and differential diagnosis].
We report a case of a very large intraosseous ganglion in a patient with Down's syndrome. The lesion was located in the medial femoral condyle and was diagnosed with imaging techniques (X-rays, CAT scan, bone scan and magnetic resonance imaging) that allowed measuring it. Treatment consisted of curettage and filling of the defect with the skeletal repair system carbonated apatite resorbable cement which allowed for immediate early weight bearing during the postoperative period in a non-cooperative patient. We think the location and size of the lesion are of interest, as well as the peculiarities of the patient, which may help understand the pathophysiology of this entity. As far as we know, the use of resorbable cement to treat this kind of lesions has not been reported. PMID:24701765
Lax-Pérez, R; Ferrero-Manzanal, F; Murcia-Asensio, A; Lax-Pérez, A
Ectopic bone formation after medial femoral condyle graft to scaphoid nonunion.
Free vascularized bone graft from the medial femoral condyle has been described as a superior method for treatment of recalcitrant scaphoid nonunion with proximal pole avascularity and humpback deformity. Few complications and high union rates have been reported. In a series of three patients we describe an undesired volar ossification as a potential complication of the method. The risk of developing the ectopic bone formation can be minimized if the surgeon is aware of the strong osteogenic capacity of the periosteum. Meticulous dissection of the vascular bundle to the graft is mandatory to avoid the complication. Caution is warranted so as not to leave a periosteal sleeve under the vessels at the margin of the graft. PMID:24533246
Vedung, Torbjörn; Vinnars, Bertil
Shape memory Ni-Ti alloy swan-like bone connector for treatment of humeral shaft nonunion
From August 1990 to December 2007, 156 patients with humeral shaft nonunion were treated with our patented Ni-Ti shape memory alloy swan-like memory pressure connector (SMC). The SMC device cooled with ice before implantation was warmed to 40–50°C after implantation to produce balanced axial and compression forces to stabilise the fracture three-dimensionally. This combined with autologous bone grafting achieved bone tissue regeneration in the fracture and promoted smooth recovery of joint function, with a nonunion healing rate of 98.7% after a single SMC implantation. Failure of nonunion healing occurred in only two cases but was successfully managed by a further operation. Complications were not found in any of these patients apart from four with pre-existing radial nerve injuries. These results demonstrate the effectiveness of the SMC device for the management of humeral shaft nonunion. The device provides continuous compression of the fracture with minimal trauma to the local blood supply.
Su, Jia-can; Liu, Xin-wei; Yu, Bao-qing; Li, Zhuo-dong
Proposal of the movement trajectories for a superior extremity, to build the movement regulator of a trans-humeral prosthesis
Abstr~~t - This work obtains the patterns of movement trajectories during daily tasks of a right superior extremity, these patterns will be used to reproduce the movement in a Trans-Humeral prosthesis. In this way the movements of the prosthesis will come near to the natural movements of the superior extremity. The trajectories are obtained using three fluorescent spherical markers placed
Gilberto Diaz; Lorenzo Leija; R. Munoz; Arturo Vera
The incidence of hip, forearm, humeral, ankle, and vertebral fragility fractures in Italy: results from a 3-year multicenter study
Introduction We aimed to assess the incidence and hospitalization rate of hip and "minor" fragility fractures in the Italian population. Methods We carried out a 3-year survey at 10 major Italian emergency departments to evaluate the hospitalization rate of hip, forearm, humeral, ankle, and vertebral fragility fractures in people 45 years or older between 2004 and 2006, both men and women. These data were compared with those recorded in the national hospitalizations database (SDO) to assess the overall incidence of fragility fractures occurring at hip and other sites, including also those events not resulting in hospital admissions. Results We observed 29,017 fractures across 3 years, with hospitalization rates of 93.0% for hip fractures, 36.3% for humeral fractures, 31.3% for ankle fractures, 22.6% for forearm/wrist fractures, and 27.6% for clinical vertebral fractures. According to the analyses performed with the Italian hospitalization database in year 2006, we estimated an annual incidence of 87,000 hip, 48,000 humeral, 36,000 ankle, 85,000 wrist, and 155,000 vertebral fragility fractures in people aged 45 years or older (thus resulting in almost 410,000 new fractures per year). Clinical vertebral fractures were recorded in 47,000 events per year. Conclusions The burden of fragility fractures in the Italian population is very high and calls for effective preventive strategies.
Mesenchymal Stem Cells and Platelet Gel Improve Bone Deposition within CAD-CAM Custom-Made Ceramic HA Scaffolds for Condyle Substitution
Purpose. This study evaluated the efficacy of a regenerative approach using mesenchymal stem cells (MSCs) and CAD-CAM customized pure and porous hydroxyapatite (HA) scaffolds to replace the temporomandibular joint (TMJ) condyle. Methods. Pure HA scaffolds with a 70% total porosity volume were prototyped using CAD-CAM technology to replace the two temporomandibular condyles (left and right) of the same animal. MSCs were derived from the aspirated iliac crest bone marrow, and platelets were obtained from the venous blood of the sheep. Custom-made surgical guides were created by direct metal laser sintering and were used to export the virtual planning of the bone cut lines into the surgical environment. Sheep were sacrificed 4 months postoperatively. The HA scaffolds were explanted, histological specimens were prepared, and histomorphometric analysis was performed. Results. Analysis of the porosity reduction for apposition of newly formed bone showed a statistically significant difference in bone formation between condyles loaded with MSC and condyles without (P < 0.05). The bone ingrowth (BI) relative values of split-mouth comparison (right versus left side) showed a significant difference between condyles with and without MSCs (P < 0.05). Analysis of the test and control sides in the same animal using a split-mouth study design was performed; the condyle with MSCs showed greater bone formation. Conclusion. The split-mouth design confirmed an increment of bone regeneration into the HA scaffold of up to 797% upon application of MSCs.
Ciocca, L.; Donati, D.; Ragazzini, S.; Dozza, B.; Rossi, F.; Fantini, M.; Spadari, A.; Romagnoli, N.; Landi, E.; Tampieri, A.; Piattelli, A.; Iezzi, G.; Scotti, R.
Spontaneous osteonecrosis of the knee involving both the medial femoral condyle and the medial tibial plateau: report of three cases.
Spontaneous osteonecrosis of the knee (SPONK) usually involves a single condyle or plateau. The medial femoral condyle (MFC) is most often involved and spontaneous osteonecrosis of the medial tibial plateau (MTP) is a rare condition, representing only 2% of all necroses reported in the knee. SPONK involving both the MFC and the MTP is extremely rare. SPONK occurring in either the MFC or the MTP individually might extend to the corresponding side of the knee in the advanced end-stage; however, in that situation, significant degenerative changes would exist and it might be difficult to differentiate end-stage SPONK form severe osteoarthritis. SPONK affecting both the MFC and the MTP without significant secondary osteoarthritic changes has not been reported, even though it is difficult to know which occurs first. We have cared for three patients with histologically proven osteonecrosis of the MFC and MTP and report their radiologic features. PMID:18516591
Jung, Kwang Am; Lee, Su Chan; Hwang, Seung Hyun; Kim, Duk Su; Kim, Taek Keun
Panoramic radiography: effects of head alignment on the vertical dimension of the mandibular ramus and condyle region.
The aim of this study was to assess whether it is possible to derive accurate vertical measurements of the mandibular ramus and condyle from panoramic radiographs. A human dry skull was positioned in a panoramic machine. The skull was displaced along the sagittal and transverse plane and rotated around the vertical and transverse axes. A set of 252 digital radiographs with defined positioning errors was compared with a set of 42 radiographs in the 'ideal' position. The distances between the metal markers that had been attached at the angle of the mandible at a distance of 60 mm in the condyle region to produce fixed reference points on the radiographs were measured. Statistical differences were investigated using Friedman repeated measures analysis of variance on ranks followed by the Dunnett's test for the comparison against the control group in the ideal position (? = 0.05). Vertical measurements were significantly affected when the skull was rotated around the vertical (P < 0.001) or shifted along the transverse axis (P < 0.001). Misalignment of the head affected the vertical measurement of the mandibular ramus and condyle. However, asymmetries of more than 6 per cent are probably not due to patient positioning in the panoramic machine. PMID:21467122
Sadat-Khonsari, Reza; Fenske, Christian; Behfar, Leyli; Bauss, Oskar
Lateral clavicular autograft for repair of reverse hill-sachs defect.
Posterior dislocations of the shoulder joint can result in an impression fracture over the anteromedial humeral head, termed the reverse Hill-Sachs lesion, the presence of which can contribute to recurrent dislocations. Methods described to repair this defect include using allografts, iliac crest and coracoid process autografts, and bone graft substitutes. We describe a novel technique using the lateral end of the ipsilateral clavicle as an autograft in a 78 year old man with a reverse Hill Sachs lesion. This graft can be harvested through the same incision and does not compromise the stability of the acromioclavicular joint or any future shoulder arthroplasty. PMID:21552460
Shenoy, Ravikiran; Kamineni, Srinath
Treatment of the humeral shaft fractures - minimally invasive osteosynthesis with bridge plate versus conservative treatment with functional brace: study protocol for a randomised controlled trial
Background Humeral shaft fractures account for 1 to 3% of all fractures in adults and for 20% of all humeral fractures. Non-operative treatment is still the standard treatment of isolated humeral shaft fractures, although this method can present unsatisfactory results. Surgical treatment is reserved for specific conditions. Modern concepts of internal fixation of long bone shaft fractures advocate relative stabilisation techniques with no harm to fracture zone. Recently described, minimally invasive bridge plate osteosynthesis has been shown to be a secure technique with good results for treating humeral shaft fractures. There is no good quality evidence advocating which method is more effective. This randomised controlled trial will be performed to investigate the effectiveness of surgical treatment of humeral shaft fractures with bridge plating in comparison with conservative treatment with functional brace. Methods/Design This randomised clinical trial aims to include 110 patients with humeral shaft fractures who will be allocated after randomisation to one of the two groups: bridge plate or functional brace. Surgical treatment will be performed according to technique described by Livani and Belangero using a narrow DCP plate. Non-operative management will consist of a functional brace for 6 weeks or until fracture consolidation. All patients will be included in the same rehabilitation program and will be followed up for 1 year after intervention. The primary outcome will be the DASH score after 6 months of intervention. As secondary outcomes, we will assess SF-36 questionnaire, treatment complications, Constant score, pain (Visual Analogue Scale) and radiographs. Discussion According to current evidence shown in a recent systematic review, this study is one of the first randomised controlled trials designed to compare two methods to treat humeral shaft fractures (functional brace and bridge plate surgery). Trial registration Current Controlled Trials: ISRCTN24835397
Minimal invasive ostheosintesis for treatment of diaphiseal transverse humeral shaft fractures
OBJECTIVE: To evaluate patients with transverse fractures of the shaft of the humerus treated with indirect reduction and internal fixation with plate and screws through minimally invasive technique. METHODS: Inclusion criteria were adult patients with transverse diaphyseal fractures of the humerus closed, isolated or not occurring within 15 days of the initial trauma. Exclusion criteria were patients with compound fractures. RESULTS: In two patients, proximal screw loosening occurred, however, the fractures consolidated in the same mean time as the rest of the series. Consolidation with up to 5 degrees of varus occurred in five cases and extension deficit was observed in the patient with olecranon fracture treated with tension band, which was not considered as a complication. There was no recurrence of infection or iatrogenic radial nerve injury. CONCLUSION: It can be concluded that minimally invasive osteosynthesis with bridge plate can be considered a safe and effective option for the treatment of transverse fractures of the humeral shaft. Level of Evidence III, Therapeutic Study.
Zogaib, Rodrigo Kallas; Morgan, Steven; Belangero, Paulo Santoro; Fernandes, Helio Jorge Alvachian; Belangero, William Dias; Livani, Bruno
Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible?
Minimally invasive plate osteosynthesis (MIPO) has been advocated as a safe approach to humeral shaft fracture management. We evaluated the reproducibility of this technique in a regional hospital. Thirty-five patients underwent MIPO of humerus shaft fractures. Fifteen patients had an open fracture, six a preoperative radial nerve palsy, and nine a concomitant thoracic, musculoskeletal or vascular injury. At an average 12-month follow-up, 91% of fractures healed after a mean of 12 weeks (range, 8-16). Two infections occurred. Final alignment averaged 4° of varus (range, 5° of valgus to 20° of varus). Active elbow ROM averaged 114° (range, 60-135°) and was less than 100° in nine elbows. Five of six preoperative radial nerve injuries recovered spontaneously. Healing and infection rates in this study are consistent with those reported in the literature. Lower elbow ROM and higher fracture angulation at healing were nevertheless found. MIPO is technically demanding and requires adequate intraoperative imaging and surgical experience in order to obtain adequate fracture alignment. Brachialis muscle scarring and inadequate postoperative rehabilitation may be involved in limited elbow range of motion. PMID:19844708
Concha, Juan M; Sandoval, Alejandro; Streubel, Philipp N
The results of total humeral replacement following excision for primary bone tumour.
Rarely, the extent of a malignant bone tumour may necessitate resection of the complete humerus to achieve adequate oncological clearance. We present our experience with reconstruction in such cases using a total humeral endoprosthesis (THER) in 20 patients (12 male and eight female) with a mean age of 22 years (6 to 59). We assessed the complications, the oncological and functional outcomes and implant survival. Surgery was performed between June 2001 and October 2009. The diagnosis included osteosarcoma in nine, Ewing's sarcoma in eight and chondrosarcoma in three. One patient was lost to follow-up. The mean follow-up was 41 months (10 to 120) for all patients and 56 months (25 to 120) in survivors. There were five local recurrences (26.3%) and 11 patients were alive at time of last follow-up, with overall survival for all patients being 52% (95% confidence interval (CI) 23.8 to 74) at five years. The mean Musculoskeletal Tumor Society score for the survivors was 22 (73%; 16 to 23). The implant survival was 95% (95% CI 69.5 to 99.3) at five years. The use of a THER in the treatment of malignant tumours of bone is oncologically safe; it gives consistent and predictable results with low rates of complication. PMID:22933503
Puri, A; Gulia, A
Callus distraction for humeral nonunion with bone loss and limb shortening caused by chronic osteomyelitis.
Nonunion of the humerus with bone loss and shortening due to osteomyelitis is rare but difficult to treat. We describe our experience with a callus distraction technique using a monolateral external fixator for the treatment of this condition. Between October 1994 and January 2004, 11 patients were treated. There were seven males and four females, with a mean age of 14 years (10 to 17). The mean bone loss was 1.9 cm (1 to 2.7) and the mean length discrepancy in the upper limb was 5.6 cm (3.5 to 8.0). The mean follow-up was for 106 months (54 to 166). The mean external fixation index was 34.8 days/cm (29.8 to 40.5). The mean lengthening was 9.5 cm (5.5 to 13.4). There were seven excellent results, three good and one poor. There were nine excellent functional results and two good. The treatment of humeral nonunion with bone loss and shortening due to osteomyelitis by callus distraction is a safe and effective means of improving function and cosmesis. PMID:18539674
Liu, T; Zhang, X; Li, Z; Zeng, W; Peng, D; Sun, C
Arthroscopic repair of "peel-off" lesion of the posterior cruciate ligament at the femoral condyle.
Posterior cruciate ligament (PCL) injuries are uncommon, and most occur in association with other lesions. The treatment of PCL injuries remains controversial; in addition, PCL injuries have been documented to have a propensity to heal. In the literature several different patterns of PCL injury have been described including midsubstance tears/injuries, tibial bony avulsions, femoral bony avulsions, and femoral "peel-off" injuries. A peel-off injury is a complete or incomplete soft-tissue disruption of the PCL at its femoral attachment site without associated bony avulsion. In recent years arthroscopic repair of femoral avulsion and peel-off lesions of the PCL has been reported. In most of these articles, a transosseous repair with sutures passed through 2 bone tunnels into the medial femoral condyle has been described. We present a case of a femoral PCL avulsion in a 20-year-old collegiate football player with an associated medial collateral ligament injury, and we report about a novel technique for PCL repair using 2 No. 2 FiberWire sutures and two 2.9-mm PushLock anchors (Arthrex) to secure tensioning the ligament at its footprint. PMID:24749037
Rosso, Federica; Bisicchia, Salvatore; Amendola, Annunziato
A new automatic landmark extraction framework on ultrasound images of femoral condyles
NASA Astrophysics Data System (ADS)
In Computer Assisted Orthopaedic Surgery (CAOS), surgeons have to acquire some anatomical landmarks as inputs to the system. To do so, they use manual pointers that are localized in the Operating Room (OR) space using an infrared camera. When the needed landmark is not reachable through an opening, it is palpated directly on skin and there is a loss of precision that can vary from several millimeters to centimeters depending on the thickness of soft tissues. In this paper, we propose a new framework based on three main steps to register the bone surface and extract automatically anatomical landmarks with an ultrasound probe. This framework is based on an oriented gradient calculation, a simulated-compound and a contour closure using a graph representation. The oriented gradient allows extracting a set of pixels that probably belong to the bone surface. The simulatedcompound step allows using ultrasound images properties to define a set of small segments which may belong to the bone surface, and the graph representation allows eliminating false positive detection among remaining segments. The proposed method has been validated on a database of 230 ultrasound images of anterior femoral condyles (on the knee). The average computation time is 0.11 sec per image, and average errors are: 0.54 mm for the bone surface extraction, 0.31 mm for the condylar line, and 1.4 mm for the trochlea middle.
Masson-Sibut, Agnčs; Nakib, Amir; Petit, Eric; Leitner, François
Facial development disorders due to inhibition to endochondral ossification of mandibular condyle process caused by malnutrition.
ABSTRACT Objective: To analyze the effect of protein restriction on histomorphometric parameters of bone remodeling in mandibular condyle process and its possible influence in facial development in growing rats. Materials and Methods: Wistar rats weaned at the age of 21 days were assigned to one of the following groups: control (fed a regular hard diet ad libitum) and protein restricted (PR) (fed a hard diet lacking in protein ad libitum). The animals were euthanized on day 35 after the onset of the experiment. Mandibles were resected, fixed in 10% formalin, hemisected at the symphysis, and then radiographed in order to perform cephalometric studies of the condylar process length and the height of the lower alveolar process. Mandibles were then processed for light microscopy, and histomorphometric determinations were performed on histologic sections of the condylar process subchondral bone. Results: The PR group showed a significantly lower body weight than control group at the end of the experiment. The length of the condylar process was lower in the PR group; however, the diet used in this study did not affect the height of the lower alveolar process. The histomorphometric analysis showed that the PR group exhibited a statistically significant decrease in bone formation and bone volume in condylar process subchondral bone. Conclusion: Protein restriction inhibits bone formation and longitudinal growth in the mandibular condylar process. This result suggest that protein restriction can alter normal facial development. PMID:24160994
Martín, Adrián E; Pani, Maria Del R; Holgado, Nora Ruiz; López Miranda, Laura I; Meheris, Héctor E; Garat, Juan A
[A composite osteomusculocutaneous free flap from the medial femoral condyle: anatomic characteristics, clinical aspects, new applications].
Advances in plastic and reconstructive surgery allow an almost complete functional and aesthetic reconstruction after severe injuries. However, particularly the treatment of complex defects involving different tissue components is still challenging. The reconstruction requires a combined flap consisting of different tissues from an adequate donor area. In this context, we focused on anatomical and clinical aspects of transplants from the area of the medial femoral condyle. In this study, the anatomical characteristics and potentials of various flaps from the region of this region are described. Moreover, previous literature on this subject is put in context with both the results of our own anatomical study and our clinical experience. The supplying vessel is the descending genicular artery with its branches. In addition to the consistency in vessel length and diameter, the descending genicular artery has a continuous distribution in a periosteal, cutaneous and muscular branch. Due to this anatomical characteristic, this donor site offers the possibility for several customized transplants. Thus, the distal medial thigh is a versatile and reliable donor site for plastic surgical procedures. PMID:22495956
Rahmanian-Schwarz, A; Spetzler, V; Willkomm, L-M; Eisenschenk, A; Bernhard, H; Schaller, H-E
Arthroscopic Repair of "Peel-Off" Lesion of the Posterior Cruciate Ligament at the Femoral Condyle
Posterior cruciate ligament (PCL) injuries are uncommon, and most occur in association with other lesions. The treatment of PCL injuries remains controversial; in addition, PCL injuries have been documented to have a propensity to heal. In the literature several different patterns of PCL injury have been described including midsubstance tears/injuries, tibial bony avulsions, femoral bony avulsions, and femoral "peel-off" injuries. A peel-off injury is a complete or incomplete soft-tissue disruption of the PCL at its femoral attachment site without associated bony avulsion. In recent years arthroscopic repair of femoral avulsion and peel-off lesions of the PCL has been reported. In most of these articles, a transosseous repair with sutures passed through 2 bone tunnels into the medial femoral condyle has been described. We present a case of a femoral PCL avulsion in a 20-year-old collegiate football player with an associated medial collateral ligament injury, and we report about a novel technique for PCL repair using 2 No. 2 FiberWire sutures and two 2.9-mm PushLock anchors (Arthrex) to secure tensioning the ligament at its footprint.
Rosso, Federica; Bisicchia, Salvatore; Amendola, Annunziato
Finite element analysis of three patterns of internal fixation of fractures of the mandibular condyle.
The most stable pattern of internal fixation for fractures of the mandibular condyle is a matter for ongoing discussion. In this study we investigated the stability of three commonly used patterns of plate fixation, and constructed finite element models of a simulated mandibular condylar fracture. The completed models were heterogeneous in the distribution of bony material properties, contained about 1.2 million elements, and incorporated simulated jaw-adducting musculature. Models were run assuming linear elasticity and isotropic material properties for bone. This model was considerably larger and more complex than previous finite element models that have been used to analyse the biomechanical behaviour of differing plating techniques. The use of two parallel 2.0 titanium miniplates gave a more stable configuration with lower mean element stresses and displacements over the use of a single miniplate. In addition, a parallel orientation of two miniplates resulted in lower stresses and displacements than did the use of two miniplates in an offset pattern. The use of two parallel titanium plates resulted in a superior biomechanical result as defined by mean element stresses and relative movement between the fractured fragments in these finite element models. PMID:22981343
Aquilina, Peter; Chamoli, Uphar; Parr, William C H; Clausen, Philip D; Wroe, Stephen
NINDS Primary Lateral Sclerosis Information Page Table of Contents (click to jump to sections) What is Primary Lateral Sclerosis? ... is being done? Clinical Trials Organizations What is Primary Lateral Sclerosis? Primary lateral sclerosis (PLS) is a ...
Variant course of posterior circumflex humeral artery associated with the abnormal origin of radial collateral artery: could it mimic the quadrangular space syndrome?
Variations in the origin of axillary artery branches are common. But, distinctly abnormal course of its posterior circumflex humeral branch is rare. We are reporting a case of posterior circumflex humeral artery (PCHA) originating from the axillary artery, passing through lower triangular space to reach the scapular region where it accompanied the axillary nerve and posterior circumflex humeral vein to pass around surgical neck of humerus, deep to the fibers of deltoid. Other variations observed in this specimen were the radial collateral artery arising from the PCHA, middle collateral artery arising directly from the brachial artery and absence of profunda brachii artery. PCHA forming a hair pin loop, traversing through lower triangular space instead of quadrangular space taking a long course is being reported for the first time. Further, the clinical and surgical importance of this case especially in relation with quadrangular space syndrome and relevant literature is discussed. PMID:23109033
Mohandas Rao, Kappettu Gadahad; Somayaji, Shiroor Nagabhushan; Ashwini, Lagadamane Sathyanarayana; Ravindra, Swamy; Abhinitha, Padavinangadi; Rao, Ashutosh; Sapna, Marpalli; Jyothsna, Patil
Ramus hinges for excessive movements of the condyles: a new dimension in mandibular tripodal subperiosteal implants.
Some subperiosteal mandibular implants of the earlier designs failed because of bone resorption beneath the posterior portions of the implant. Conversely, bone loss was observed rarely in the anterior region. The resorption was more profound posteriorly because there can be as much as 250 lb. of biting force per square inch and the bone is more porous than in the symphyseal region, which receives about 25 lb. per square inch. The independent movements of the condyles and the inferior border of the mandible at the gonial angles have dictated the success or failure of conventional mandibular subperiosteal implants in many of the earlier designs. Often, the rigidity of the implant framework prevents its posterior portion from moving in unison with the flexion and flexibility of the condyles upon the opening and closing of the mouth. Flexure usually is 2-4 mm in range and varies according to the quality of bone, age, sex, and musculature of the patient. Approximately 2% of these patients demonstrate movements of up to 4 mm. This has influenced an altered approach to posterior design-especially with tripodal mandibular subperiosteal implants. A brief history of the contributions of the earlier pioneers and their important contributions to the subperiosteal implant follows: G. Dahl inserted the first mandibular subperiosteal implant and was awarded his patent in 1941. Gershkoff and Goldberg, were the first to report clinical cases with mandibular subperiosteal implants in the United States. N. Berman reported on a direct bone impression of the mandible and transosseous wiring of the implant to the bone for stabilization. I. Lew introduced his own surgical bone impression technique for the mandibular subperiosteal implant and had published case histories on maxillary and mandibular implants. B. D. Weinberg reported an early unilateral subperiosteal implant consisting of a latticework portion that seated over the bone connected to the protruding post by four uprights. Leonard I. Linkow reported on the posterior unilateral mandibular subperiosteal implant. He followed up with a 5-year report, an 8-year follow-up report, and a 12-year report. R. L. Bodine reported his experiences with mandibular subperiosteal implants. A. N. Cranin and P. Schnitman introduced the Brookdale bar for an improved support of an overdenture for the mandibular subperiosteal implants. L. I. Linkow made some significant changes in the mandibular subperiosteal implant. D. D'Alise reported on the O-ring design for retention of implant dentures. R. A. James reported on the support system and perigingival mechanism surrounding oral implants and changed the subperiosteal based on peri-implant tissue behavior. L. I. Linkow reported on an entirely new mandibular tripodal design concept as well as a distinct change in the surgical protocol for obtaining the bone impressions without exposing those parts of the body of the mandible from the mental nerves to the ascending rami. PMID:10483422
Linkow, L I; Ghalili, R
Arthroscopic Repair of a Posterior Bony Humeral Avulsion of the Glenohumeral Ligament With Associated Teres Minor Avulsion
Humeral avulsion of the inferior glenohumeral ligament (HAGL) has recently gained more recognition as a cause of shoulder instability. Posterior HAGL lesions, being much more infrequent than anterior disruptions, have only recently been documented as a notable cause of posterior instability. We detail the treatment of a previously unreported case of a posterior HAGL variant lesion consisting of a bony avulsion with involvement of the teres minor tendon. Arthroscopic fixation was facilitated by use of a "sheathless" arthroscopic approach with a 70° arthroscope and suture anchor.
Smith, Patrick A.; Nuelle, Clayton W.; Bradley, James P.
HUMeral Shaft Fractures: MEasuring Recovery after Operative versus Non-operative Treatment (HUMMER): a multicenter comparative observational study
Background Fractures of the humeral shaft are associated with a profound temporary (and in the elderly sometimes even permanent) impairment of independence and quality of life. These fractures can be treated operatively or non-operatively, but the optimal tailored treatment is an unresolved problem. As no high-quality comparative randomized or observational studies are available, a recent Cochrane review concluded there is no evidence of sufficient scientific quality available to inform the decision to operate or not. Since randomized controlled trials for this injury have shown feasibility issues, this study is designed to provide the best achievable evidence to answer this unresolved problem. The primary aim of this study is to evaluate functional recovery after operative versus non-operative treatment in adult patients who sustained a humeral shaft fracture. Secondary aims include the effect of treatment on pain, complications, generic health-related quality of life, time to resumption of activities of daily living and work, and cost-effectiveness. The main hypothesis is that operative treatment will result in faster recovery. Methods/design The design of the study will be a multicenter prospective observational study of 400 patients who have sustained a humeral shaft fracture, AO type 12A or 12B. Treatment decision (i.e., operative or non-operative) will be left to the discretion of the treating surgeon. Critical elements of treatment will be registered and outcome will be monitored at regular intervals over the subsequent 12 months. The primary outcome measure is the Disabilities of the Arm, Shoulder, and Hand score. Secondary outcome measures are the Constant score, pain level at both sides, range of motion of the elbow and shoulder joint at both sides, radiographic healing, rate of complications and (secondary) interventions, health-related quality of life (Short-Form 36 and EuroQol-5D), time to resumption of ADL/work, and cost-effectiveness. Data will be analyzed using univariate and multivariable analyses (including mixed effects regression analysis). The cost-effectiveness analysis will be performed from a societal perspective. Discussion Successful completion of this trial will provide evidence on the effectiveness of operative versus non-operative treatment of patients with a humeral shaft fracture. Trial registration The trial is registered at the Netherlands Trial Register (NTR3617).
Mandibular condyle erosion and sclerosis in pediatric patients treated with radiotherapy to the head and neck region.
Head and neck radiotherapy in children is associated with significant acute and late morbidities. Temporomandibular joint dysfunction and trismus has been widely reported in patients receiving radiotherapy for sarcomas and nasopharyngeal carcinoma; however, erosion of the mandibular condyle is a rare sequela of modern radiotherapy techniques. In this report, we present three cases of erosion of the temporomandibular joint amongst pediatric patients treated with radiotherapy for distinct head, neck and brain malignancies. Pediatr Blood Cancer 2014; 61:1479-1480. © 2014 Wiley Periodicals, Inc. PMID:24443276
Mercado, Catherine E; Little, Stephen B; Mazewski, Claire; Schwaibold, Frederick P; Esiashvili, Natia
Reliability of a set of protractors for direct anatomical measurements around the glenoid and humeral head rims
Functional biomechanics studies of the glenohumeral (GH) soft tissues require an understanding of their sites of bony attachment. Anatomical positions of GH capsular structures have often been quantified relative to the rims of the glenoid and humeral head (HH). The aim of this study was twofold: (1) to quantify the reliability of a set of protractors that directly fit on to the glenoid and HH rims and (2) to use this to determine direct angular position referencing of landmarks and soft tissue attachment points. Three assessors independently used the protractors to assess nine prescribed landmarks on 30 dry bone specimens (15 glenoids and 15 HHs) recording the angular positions of the structures relative to the glenoid and HH. The collected data showed high levels of validity as indicated by the protractor's intra- and inter-assessor reliabilities: 98.2 and 98.7% for the glenoid component, and 96.2 and 96.5% for the humeral component, respectively. The device could be useful in anatomical studies, description of defects and pathologies on glenohumeral articulation, and planning of scapular reconstructive surgery.
Amadi, Hippolite O; Fogg, Quentin A; Ugbolue, Ukadike C; Emery, Roger J H; Bull, Anthony M J
Osteo-periosteal-cutaneous flaps of the medial femoral condyle: a valuable modification for selected clinical situations.
In situations of bony nonunions with poor skin coverage, transplantation of vascularized soft tissue in addition to bone graft is desirable. The use of the corticoperiosteal vascularized bone graft from the medial femoral condyle is well described. There are only anecdotal reports about its use as an osteocutaneous flap. This article presents our results with the use of an osteocutaneous flap from the medial femoral condyle. Between 2004 and 2009, four patients were treated with supracondylar osteocutaneous flaps for bony nonunions (tibia, ankle, calcaneous) with concomitant soft tissue defects. The size of the osseous grafts ranged from 3 x 5 to 6 x 5 cm. The supplying cutaneous vessels were an unnamed perforator of the descending genicular artery (two cases) or the saphenous branch (two cases). The first three cases healed primarily. Bony union was achieved between 32 and 170 days. The follow-up of the fourth case was too short to achieve a bony union. There was no flap loss or surgery-related complications at the donor site. The transfer of free combined vascularized corticoperiosteal-cutaneous flaps seems to be ideally suited for postradiation-induced fractures or chronic nonunions with poor chances of spontaneous healing and a concomitant small skin defect. PMID:20143299
Pelzer, Michael; Reichenberger, Matthias; Germann, Günter
The glenohumeral joint - a mismatching system? A morphological analysis of the cartilaginous and osseous curvature of the humeral head and the glenoid cavity
Background Radial mismatch, glenohumeral conformity ratios and differences between cartilaginous and osseous radii highly depend on the measured plane. The comparison of cartilaginous radii between humeral head and glenoid in different planes provides new information to understand the degree of conformity during abduction of the upper limb. Methods To investigate the radii, CT-images in soft-tissue kernel of 9 specimen were analysed using an image visualization software. Statistical analysis of the obtained data was performed using the t-test. Results Measurements of the radii in the glenoid revealed a significantly larger radius for bone than cartilage, whereas for the humeral head the opposite was the case. Highest ratios for cartilage in the transverse plane were found in the inferior and central areas of the joint surface, whereas the smallest ratios were found in the superior area. The radial mismatch varied between 0.1 mm and 13.6 mm, depending on the measured plane. Conclusions The results suggest that in abduction, the cartilaginous guidance of the humeral head decreases. This might permit the humeral head an anterior-posterior shifting as well as superior-inferior translation. Surgical reconstruction of the normal glenohumeral relationships necessitates precise information about the glenohumeral morphology to ensure proper sizing and correct placement of prosthetic components and osteochondral allografts.
Extensor tendon and fascia sectioning of extensors at the musculotendinous unit in lateral epicondylitis.
Different surgical techniques exist to treat lateral epicondylitis. In most techniques, release of the common extensor origin is performed adjacent to the humeral epicondyle. The purpose of the present study was to assess the outcome of transverse sectioning of the intermuscular septum and the aponeuroses of the extensor carpi radialis brevis and extensor digitorum communis, 3 to 5 cm distally to the radial epicondyle. Forty-nine elbows were operated on in 44 patients. Subjective results were obtained after a mean followup of 33 months. Mean age of patients was 44 years. Mean disabilities of arm, shoulder and hand score was 6, mean visual analogue scale score for pain was 1 and for satisfaction 9. The result was excellent in 26, good in 15 and poor in 8 elbows following Spencer and Herndon. Mean absence from work was 40 days. We conclude that tendon release in the musculotendinous unit can be used to treat lateral epicondylitis. PMID:23926727
Barth, Joeri; Mahieu, Peter; Hollevoet, Nadine
[Case report: Free combined osteo-tendo-cutaneous flap from the medial femoral condyle for coverage of skin, tendon and bone defect on the back of the foot].
For the first time we present the case of a microsurgical reconstruction with an osteo-tendo-cutaneous free flap harvested from the medial femoral condyle for the coverage of a bone-tendon-soft tissue defect of the foot. PMID:23037805
Paier, S; Bürger, H K; Rab, M
Dynamic biomechanics of the human head in lateral impacts
The biomechanical responses of human head (translational head CG accelerations, rotational head accelerations, and HIC) under lateral impact to the parietal-temporal region were investigated in the current study. Free drop tests were conducted at impact velocities ranging from 2.44 to 7.70 m/s with a 40 durometer, a 90 durometer flat padding, and a 90 durometer cylinder. Specimens were isolated from PMHS subjects at the level of occipital condyles, and the intracranial substance was replaced with brain simulant (Sylgard 527). Three tri-axial accelerometers were instrumented at the anterior, posterior, and vertex of the specimen, and a pyramid nine accelerometer package (pNAP) was used at the contra-lateral site. Biomechanical responses were computed by transforming accelerations measured at each location to the head CG. The results indicated significant "hoop effect" from skull deformation. Translational head CG accelerations were accurately measured by transforming the pNAP, the vertex accelerations, or the average of anterior/posterior acceleration to the CG. The material stiffness and structural rigidity of the padding changed the biomechanical responses of the head with stiffer padding resulting in higher head accelerations. At the skull fracture, HIC values were more than 2–3x higher than the frontal skull fracture threshold (HIC=1000), emphasizing the differences between frontal and lateral impact. Rotational head accelerations up to 42.1 krad/s2 were observed before skull fracture, indicating possible severe brain injury without skull fracture in lateral head impact. These data will help to establish injury criteria and threshold in lateral impacts for improved automotive protection and help clinicians understand the biomechanics of lateral head impact from improved diagnosis.
Zhang, Jiangyue; Yoganandan, Narayan; Pintar, Frank A.
Straight proximal humeral nails are surrounded by more bone stock in comparison to bent nails in an experimental cadaveric study
Background In the management of proximal humeral fractures intramedullary implants with bent and straight shape of the proximal part of nail are available. Based on data from previous studies on bone distribution in the humeral head, we hypothesized, that higher densities might exist in the bone stock surrounding straight nails in comparison to their angulated counterparts. With a known positive correlation between bone density and mechanical stability, this could indicate potentially higher rigidity of osteosyntheses done with straight implants. Methods We performed high resolution peripheral quantitative computed tomographies of the potential straight and bent implant bearing regions of 27 cadaveric proximal humeri. The acquired data were analyzed for differences between straight and bent Volumes of Interest as well as intra- and interindividual bone stock distribution. Results For both straight and bent volumes of interest a considerably declining bone mineral density was found in craniocaudal direction. Mean densities of bent volumes were significantly lower in comparison to their corresponding straight counterparts (p?0.01) Intra-individual comparison yielded high bivariate correlations of the corresponding Volumes of Interest of the right and the left side (p?0.01). Conclusions Based on the volumetric data a statistically relevant biomechanical superiority of straight shaped implants can be assumed. Since we found a rapid decrease of bone density in cranio-caudal direction, intramedullary implants should be anchored as proximally in the subcortical area as possible to minimize the risk of displacement or cutout. The high correlation between the Volumes of Interest of the corresponding right and left sides could aid in preoperative planning when considering an intra- or extramedullary approach.
Lateral Neck Injury Assessments in Side Impact Using Post Mortem Human Subject Tests
Current neck injury criteria are based on matching upper cervical spine injuries from piglet tests to airbag deployment loads and pairing kinematics from child dummies. These "child-based" scaled data together with adult human cadaver tolerances in axial loading are used to specify neck injury thresholds in axial compression and tension, and flexion and extension moment about the occipital condyles; no thresholds are specified for any other force or moment including lateral bending. The objective of this study was to develop a testing methodology and to determine the lateral bending moment injury threshold under coronal loading. Post mortem human subjects (PMHS) were used. Specimens consisted of whole body and isolated head-neck complexes with intact musculature. Intact specimen positioning included: sitting PMHS upright on a rigid seat, supporting the torso by a plate, maintaining Frankfurt plane horizontal. Isolated head-neck complexes were fixed at T1 with the occiput connected via a custom apparatus to a testing device to induce lateral bending motion. Head angular and linear accelerations and angular velocities were computed using a pyramid nine accelerometer package on the head; specimen-specific physical properties including center of gravity and moments of inertia in the three-dimensions; and equations of equilibrium. These data were used to determine neck loads at the occipital condyles. No specimens sustained injuries, identified by palpation, x-rays, CT, and autopsy. Results from 24 tests indicated that PMHS head-neck complexes can tolerate 75 Nm of coronal moment at low axial load without failure, and this level may be used as an initial estimate of the injury reference value under lateral loading to the human head-neck complex.
Yoganandan, Narayan; Humm, John; Pintar, Frank A.; Wolfla, Christopher E.; Maiman, Dennis J.
Lateral neck injury assessments in side impact using post mortem human subject tests.
Current neck injury criteria are based on matching upper cervical spine injuries from piglet tests to airbag deployment loads and pairing kinematics from child dummies. These "child-based" scaled data together with adult human cadaver tolerances in axial loading are used to specify neck injury thresholds in axial compression and tension, and flexion and extension moment about the occipital condyles; no thresholds are specified for any other force or moment including lateral bending. The objective of this study was to develop a testing methodology and to determine the lateral bending moment injury threshold under coronal loading. Post mortem human subjects (PMHS) were used. Specimens consisted of whole body and isolated head-neck complexes with intact musculature. Intact specimen positioning included: sitting PMHS upright on a rigid seat, supporting the torso by a plate, maintaining Frankfurt plane horizontal. Isolated head-neck complexes were fixed at T1 with the occiput connected via a custom apparatus to a testing device to induce lateral bending motion. Head angular and linear accelerations and angular velocities were computed using a pyramid nine accelerometer package on the head; specimen-specific physical properties including center of gravity and moments of inertia in the three-dimensions; and equations of equilibrium. These data were used to determine neck loads at the occipital condyles. No specimens sustained injuries, identified by palpation, x-rays, CT, and autopsy. Results from 24 tests indicated that PMHS head-neck complexes can tolerate 75 Nm of coronal moment at low axial load without failure, and this level may be used as an initial estimate of the injury reference value under lateral loading to the human head-neck complex. PMID:22105394
Yoganandan, Narayan; Humm, John; Pintar, Frank A; Wolfla, Christopher E; Maiman, Dennis J
A lateral flow strip assay apparatus comprising a housing; a lateral flow strip in the housing, the lateral flow strip having a receiving portion; a sample collection unit; and a reagent reservoir. Saliva and/or buccal cells are collected from an individual using the sample collection unit. The sample collection unit is immersed in the reagent reservoir. The tip of the lateral flow strip is immersed in the reservoir and the reagent/sample mixture wicks up into the lateral flow strip to perform the assay.
Miles, Robin R. (Danville, CA) [Danville, CA; Benett, William J. (Livermore, CA) [Livermore, CA; Coleman, Matthew A. (Oakland, CA) [Oakland, CA; Pearson, Francesca S. (Livermore, CA) [Livermore, CA; Nasarabadi, Shanavaz L. (Livermore, CA) [Livermore, CA
This study addressed two issues regarding hypochondriasis of later life: (1) whether this disorder is related more to psychopathology or health problems; and (2) the relationship of hypochondriasis to other later-life problems of anxiety, depression and paranoid reactions. Sixty later-life (>55) psychiatric inpatients were given a battery of psychological scales: MMPI-Pa (Harris-Lingoes subscales), State-Trait Anxiety Scale, Beck Depression Inventory (somatic
Immogene Gouvia; Lee Hyer; William R. Harrison; Janet Warsaw; Denise Coutsouridis
Comparison of the condyle-fossa relationship between skeletal class III malocclusion patients with and without asymmetry: a retrospective three-dimensional cone-beam computed tomograpy study
Objective This study investigated whether temporomandibular joint (TMJ) condyle-fossa relationships are bilaterally symmetric in class III malocclusion patients with and without asymmetry and compared to those with normal occlusion. The hypothesis was a difference in condyle-fossa relationships exists in asymmetric patients. Methods Group 1 comprised 40 Korean normal occlusion subjects. Groups 2 and 3 comprised patients diagnosed with skeletal class III malocclusion, who were grouped according to the presence of mandibular asymmetry: Group 2 included symmetric mandibles, while group 3 included asymmetric mandibles. Pretreatment three-dimensional cone-beam computed tomography (3D CBCT) images were obtained. Right- and left-sided TMJ spaces in groups 1 and 2 or deviated and non-deviated sides in group 3 were evaluated, and the axial condylar angle was compared. Results The TMJ spaces demonstrated no significant bilateral differences in any group. Only group 3 had slightly narrower superior spaces (p < 0.001). The axial condylar angles between group 1 and 2 were not significant. However, group 3 showed a statistically significant bilateral difference (p < 0.001); toward the deviated side, the axial condylar angle was steeper. Conclusions Even in the asymmetric group, the TMJ spaces were similar between deviated and non-deviated sides, indicating a bilateral condyle-fossa relationship in patients with asymmetry that may be as symmetrical as that in patients with symmetry. However, the axial condylar angle had bilateral differences only in asymmetric groups. The mean TMJ space value and the bilateral difference may be used for evaluating condyle-fossa relationships with CBCT.
Kim, Hyoun Oak; Lee, Won; Kook, Yoon-Ah
Successful return to work after surgical repair of fracture of the medial condyle of the distal femur in two working farm dogs
CASE HISTORY: A 5-year-old male Heading dog (working Collie) and a 2-year-old female Huntaway each presented with non-weight-bearing lameness of a hindlimb after jumping or falling with the leg trapped in a gate or motorbike carrier.CLINICAL FINDINGS: Pain and swelling were localised to the stifle, and radiographs revealed a fracture of the medial condyle of the distal femur in each
S Davis; AJ Worth
Lateral superlattice solar cells.
National Technical Information Service (NTIS)
A novel structure which comprises of a lateral superlattice as the active layer of a solar cell is proposed. If the alternating regions A and B of a lateral superlattice ABABAB. are chosen to have a Type-II band offset, it is shown that the performance of...
A. Mascarenhas Y. Zhang J. M. Millunchick R. D. Twesten E. D. Jones
Is radiological shortening of the ramus a reliable guide to operative management of unilateral fractures of the mandibular condyle?
Several studies have published measurements of the height of the ramus on orthopantomographic (OPT) images of patients with unilateral fractures of the mandibular condyle as a possible quantitative measure for making decisions about treatment. However, we know of no studies that have described the accuracy and validity of such measurements. The aim of the present study was to assess the shortening of the ramus in patients with such fractures, and compare them with differences found in a control group. Seventy-four patients and 74 controls were studied. The height of the ramus on the fractured was less than that on the uninjured side, although this was not statistically significant (p=0.25). In the control group, 50 subjects (68%) had a difference in the ramal height of more than 2mm. Of 74 patients, 25 (34%) had a shorter, uninjured ramus on the opposite side. A Bland and Altman scatterplot showed 23 outliers (31%) among the patients, which exceeded the mean (SD 1.96) of the control group. The interobserver and intraobserver reliability both showed excellent agreement for all measurements made. Shortening of the ramus can be measured on OPT images. However, in a control group there was a large mean difference in height. Among the patients, 25/74 (34%) also had an uninjured ramus on the opposite side that was shorter than that on the fractured side. Measurement of the difference in height on an OPT image cannot be relied on as an absolute indication for intervention. PMID:24874527
Kommers, Sofie; Moghimi, Meshkan; Ven, Lisanne van de; Forouzanfar, Tymour
Arthroscopic assessment of human cartilage stiffness of the femoral condyles and the patella with a new tactile sensor.
We measured the stiffness of the cartilage of the human femoral condyles via an ultrasonic tactile sensor under arthroscopic control. The stiffness and the degeneration of articular cartilage were assessed in 105 knees in 74 patients (39 men, 35 women, age: 9-72 years) who underwent arthroscopic observation or surgery. Twenty-five knees suffered from traumatic cartilage injury, 14 from osteochondritis dissecans, 13 from osteoarthritis, 11 from meniscal injury and six from ligamentous injury, bipartita patellae (three knees), and symptomatic plica synovialis (two knees). The degeneration of cartilage was classified according to Outerbridge's grading system. The relationships between the stiffness and the grade of cartilage degeneration, and gender were analyzed. The stiffness of grade I (softening) and II (fissuring less than 0.5 inches in length) was significantly lower than that of intact cartilage. In contrast, the stiffness of grade IV (exposed subchondral bone) was significantly higher than that of any other group. The cartilage stiffness of the patella in women was significantly lower than that in men. The tactile sensor was useful for determining the intraoperative stiffness of healthy and diseased human cartilage in all grades. PMID:12135651
Uchio, Y; Ochi, M; Adachi, N; Kawasaki, K; Iwasa, J
Regional and temporal changes in the synthesis of matrix metalloproteinases and TIMP-1 during development of the rabbit mandibular condyle.
Connective tissues synthesise and secrete a family of matrix metalloproteinases (MMPs; collagenases, gelatinases and stromelysins) capable of degrading all the components of connective tissue matrices at physiological pH. We document the patterns of synthesis and distribution of MMPs and the tissue inhibitor of metalloproteinases-1 (TIMP-1) within the developing rabbit mandibular condyle using immunofluorescence microscopy. MMPs and TIMP-1 were detected both as bright intracellular accumulations within Golgi vesicles and also as diffuse matrix-bound extracellular deposits. Cells in the articular zone, proliferative zone, condylar cartilage and bone of the mandibular ramus were shown to produce all 3 classes of MMPs and TIMP-1 with the exception of stromelysin, which was not synthesised by cells of the bone of spongiosum. Temporal synthesis of MMPs and TIMP-1 within these regions varied during the period 18 d postcoitum to 14 d postnatum. Our results document unique patterns of MMP and TIMP-1 synthesis during embryonic and early postnatal development of condylar cartilage and support the concept that cells synthesise and secrete MMPs and TIMP-1 before undergoing proliferation and hypertrophy. A comparison of these results with data in the rabbit growth plate show many similarities, but some differences exist that probably reflect differences in the modes of growth of the 2 cartilages. Images Fig. 1 Fig. 2 Fig. 3 Fig. 4
Breckon, J J; Hembry, R M; Reynolds, J J; Meikle, M C
Lou Gehrig's disease; ALS; Upper and lower motor neuron disease; Motor neuron disease ... 74. Shaw PJ. Amyotrophic lateral sclerosis and other motor neuron diseases. In: Goldman L, Schafer AI, eds. Cecil Medicine . ...
Hemiarthroplasty of the shoulder joint using a custom-designed high-density nano-hydroxyapatite/polyamide prosthesis with a polyvinyl alcohol hydrogel humeral head surface in rabbits.
In this study, a novel custom-designed high-density nano-hydroxyapatite/polyamide (n-HA/PA) prosthesis with a polyvinyl alcohol (PVA) hydrogel humeral head surface was employed to repair the shoulder joint head for hemiarthroplasty in rabbits. The prosthesis was fabricated using three-dimensional computed tomography and computer-aided design and computer-aided manufacturing systems for perfect fitting. Sixteen New Zealand white rabbits underwent humeral head excision, and received the composite prostheses for hemiarthroplasty. The implant sites were free from suppuration and necrosis at all periods. The X-ray results showed that there was a clear space between the prosthesis head and the glenoid surface, and the joint capsules and surfaces of the glenoid and PVA were well preserved without any damage during the whole inspection period. A high density of bone was observed around the firmware part of the prosthesis. Histological results revealed that significant osteogenesis was surrounding the firmware part, and the joint space was clear and the cartilage of the upper joint surface was basically intact. There was no visible absorption of the joint surfaces even after 3 months of continuous functional motions. The maximum tensile strength between the prosthesis and host bone reached 2.63?MPa at the 12th week postimplantation. In conclusion, the customized prosthesis by combination of PVA and high-density n-HA/PA has excellent biocompatibility and biological fixation, and offers a promising substitute for both the cartilage and the bone of the humeral head in a rabbit model as level V evidence. PMID:24404998
Guo, Yongwen; Guo, Jun; Bai, Ding; Wang, Hang; Zheng, Xiaohui; Guo, Weihua; Tian, Weidong
Laterally bendable belt conveyor
An endless, laterally flexible and bendable belt conveyor particularly adapted for coal mining applications in facilitating the transport of the extracted coal up- or downslope and around corners in a continuous manner is disclosed. The conveying means includes a flat rubber belt reinforced along the middle portion thereof along which the major portion of the belt tension is directed so as to cause rotation of the tubular shaped belt when trammed around lateral turns thus preventing excessive belt bulging distortion between adjacent belt supports which would inhibit belt transport. Pretension induced into the fabric reinforced flat rubber belt by conventional belt take-up means supports the load conveyed when the belt conveyor is making lateral turns. The carrying and return portions of the belt are supported and formed into a tubular shape by a plurality of shapers positioned along its length. Each shaper is supported from above by a monorail and includes clusters of idler rollers which support the belt. Additional cluster rollers in each shaper permit the belt supporting roller clusters to rotate in response to the belt's operating tension imposed upon the cluster rollers by induced lateral belt friction forces. The freely rotating roller clusters thus permit the belt to twist on lateral curves without damage to itself while precluding escape of the conveyed material by effectively enclosing it in the tube-shaped, inner belt transport length.
Peterson, W.J.
Purpose To determine the frequency of right versus left eyes with unilateral amblyopia among children <18 years of age Design Analysis of data collected in randomized clinical trials conducted by the Pediatric Eye Disease Investigator Group. Methods The laterality of the amblyopic eye was analyzed in 2,635 subjects <18 years of age who participated in 9 multicenter prospective randomized treatment trials. Eligibility criteria for these clinical trials included unilateral amblyopia associated with strabismus, anisometropia or both, with visual acuity between 20/40 and 20/400. Logistic regression was used to assess the association of baseline and demographic factors with the laterality of amblyopia. Results Among subjects with anisometropic amblyopia (with or without strabismus), amblyopia was present more often in left than right eyes, with a relative prevalence of 59% in left eyes (95% confidence interval 57% to 62%, p<0.001 from a test of proportion = 50%). However, among subjects with strabismic only amblyopia there was no laterality predilection (relative prevalence of 50% in left eyes, 95% confidence interval 47% to 54%, P=0.94). Conclusion Anisometropic amblyopia, with or without strabismus, occurs more often in left eyes than right eyes. This finding of amblyopia laterality may be related to microtropia, sighting dominance or other forms of ocular dominance, developmental or neurological factors, and/or laterality in the development of refractive error.
Repka, Michael; Simons, Kurt; Kraker, Raymond
Laterally bendable belt conveyor
An endless, laterally flexible and bendable belt conveyor particularly adapted for coal mining applications in facilitating the transport of the extracted coal up- or downslope and around corners in a continuous manner is disclosed. The conveying means includes a flat rubber belt reinforced along the middle portion thereof along which the major portion of the belt tension is directed so as to cause rotation of the tubular shaped belt when trammed around lateral turns thus preventing excessive belt bulging distortion between adjacent belt supports which would inhibit belt transport. Pretension induced into the fabric reinforced flat rubber belt by conventional belt take-up means supports the load conveyed when the belt conveyor is making lateral turns. The carrying and return portions of the belt are supported and formed into a tubular shape by a plurality of shapers positioned along its length. Each shaper is supported from above by a monorail and includes clusters of idler rollers which support the belt. Additional cluster rollers in each shaper permit the belt supporting roller clusters to rotate in response to the belt's operating tension imposed upon the cluster rollers by induced lateral belt friction forces. The freely rotating roller clusters thus permit the belt to twist on lateral curves without damage to itself while precluding escape of the conveyed material by effectively enclosing it in the tube-shaped, inner belt transport length.
Peterson, William J. (Coraopolis, PA)
Atraumatic osteonecrosis of the humeral head after influenza A-(H1N1) v-2009 vaccination.
In the recent pandemic influenza A-(H1N1) v-2009 vaccination campaign, adjuvanted vaccines have been used because of their antigen-sparing effect. According to available reports, the rate of severe vaccination reactions has not increased, as compared with previous seasonal influenza vaccinations. Here we describe an adult female patient who was vaccinated with an AS03 adjuvanted split-virus vaccine injected into the left arm. She experienced a prolonged and painful local reaction for 4 weeks. During this time, persistent incapacitating pain shifted into the left shoulder. Magnetic resonance imaging (MRI) at the injection site detected atraumatic humeral head osteonecrosis in conjunction with bursitis of the rotator cuff region. Clinical and laboratory examination revealed no other underlying disease. Using analgetic medication and physical therapy, resting pain completely remitted within the following 14 weeks. Pain on exertion declined within the following 6 months. Atraumatic osteonecrosis, a relatively rare disorder which initially presents non-specific clinical symptoms, has never been associated with parenteral influenza vaccination. Although the available data cannot establish a causal relationship, our patient's clinical course - with a continuous transition from increased local post-vaccination reactions to symptoms of a severe shoulder lesion with osteonecrosis - raises the question of a pathogenetic link. Considering the vascular pathogenesis of osteonecrosis, we hypothesize that our patient's enhanced local immunologic reaction may have led to regional vasculitis as the cause of bone destruction. As mild forms of osteonecrosis may have escaped previous clinical attention, it is the purpose of our report to increase awareness of this exceptional event as a possible side effect of parenteral adjuvanted vaccination. PMID:21803092
Kuether, G; Dietrich, B; Smith, T; Peter, C; Gruessner, S
A lateral approach to the distal humerus following identification of the cutaneous branches of the radial nerve.
We describe a lateral approach to the distal humerus based on initial location of the superficial branches of the radial nerve, the inferior lateral cutaneous nerve of the arm and the posterior cutaneous nerve of the forearm. In 18 upper limbs the superficial branches of the radial nerve were located in the subcutaneous tissue between the triceps and brachioradialis muscles and dissected proximally to their origin from the radial nerve, exposing the shaft of the humerus. The inferior lateral cutaneous nerve of the arm arose from the radial nerve at the lower part of the spiral groove, at a mean of 14.2 cm proximal to the lateral epicondyle. The posterior cutaneous nerve of the forearm arose from the inferior lateral cutaneous nerve at a mean of 6.9 cm (6.0 to 8.1) proximal to the lateral epicondyle and descended vertically along the dorsal aspect of the forearm. The size and constant site of emergence between the triceps and brachioradialis muscles constitute a readily identifiable landmark to explore the radial nerve and expose the humeral shaft. PMID:19336821
Hannouche, D; Ballis, R; Raould, A; Nizard, R S; Masquelet, A C
OBJECTIVE To discuss the epidemiology, pathogenesis, diagnosis, expected course, prognosis, and treatment of amyotrophic lateral sclerosis (ALS), a degenerative disorder of the nervous system associated with progressive weakness. QUALITY OF EVIDENCE PubMed and the Cochrane Database of Systematic Reviews were searched using the MeSH headings "amyotrophic lateral sclerosis," "therapy," "epidemiology," and "etiology." Articles containing the best available evidence were reviewed. Most provided level II and III evidence. There were some level I drug trials. MAIN MESSAGE Amyotrophic lateral sclerosis is associated with progressive dysarthria, dysphagia, and weakness in the extremities. Diagnosis is based on physical examination, electrophysiology, and excluding other confounding conditions. There is no cure for this devastating disorder. Certain treatments, however, can improve survival and quality of life. CONCLUSION Because ALS is a complex disease, care of ALS patients is best provided at multidisciplinary clinics that specialize in managing patients with this disorder.
Shoesmith, Christen L.; Strong, Michael J.
A lateral meniscus tear incarcerated behind the popliteus tendon: a case report.
A 51-year-old male, sustained an injury to his left knee after being pinned between his motorcycle and a road barrier. In the ER, the patient complained of medial knee pain, and had a significant joint effusion. MRI demonstrated an ACL injury, medial meniscal tear, bone bruising and impaction at the lateral femoral condyle and tibial plateau, and a tear of the posterior horn of the lateral meniscus that was displaced behind the popliteus. Unfortunately, the patient also presented with a deep vein thrombosis and thus could not proceed to the operating room for two months. During this time, scar tissue developed around the lateral meniscus. The purpose of this report is to present an unusual variant of a common injury pattern previously unreported where the posterior horn of the lateral meniscus became incarcerated behind the popliteus tendon and was left in place. It is likely that our patient will develop osteoarthritis in the future, but considering the circumstances he received a favorable early clinical outcome. Early recognition and a mobile fragment are essential restoring a patient's original anatomical features and achieving an optimal clinical outcome. PMID:19897371
Eskander, Mark S; Drew, Jacob M; Osuch, Daniel B; Metzmaker, Jeff
Laterally bendable belt conveyor
An endless, laterally flexible and bendable belt conveyor particularly adapted for coal mining applications in facilitating the transport of the extracted coal up- or downslope and around corners in a continuous manner is disclosed. The conveying means includes a flat rubber belt reinforced along the middle portion thereof along which the major portion of the belt tension is directed so as to cause rotation of the tubular shaped belt when trammed around lateral turns thus preventing excessive belt bulging distortion between adjacent belt supports which would inhibit belt transport. Pretension induced into the fabric reinforced flat rubber belt by conventional belt take-up means supports the load conveyed when the belt conveyor is making laterial turns. The carrying and return portions of the belt are supported and formed into a tubular shape by a plurality of shapers positioned along its length. Each shaper is supported from above by a monorail and includes clusters of idler rolles which support the belt. Additional cluster rollers in each shaper permit the belt supporting roller clusters to rotate in response to the belt's operating tension imposed upon the cluster rollers by induced lateral belt friction forces. The freely rotating roller clusters thus permit the belt to twist on lateral curves without damage to itself while precluding escape of the conveyed material by effectively enclosing it in the tube-shaped, inner belt transport length.
Peterson, W.J.
Amyotrophic Lateral Sclerosis Association
Amyotrophic lateral sclerosis (ALS), most commonly known as Lou Gehrig's disease, is a progressive neurodegenerative disease that attacks nerve cells in the brain and spinal cord resulting in muscle weakness and atrophy. The ALS Association's national Web site provides comprehensive information on a wide variety of topics pertinent to ALS patients, caregivers, family members, and health care professionals. This well-organized,
Julie M. Smith
Lateral interactions in amblyopia
We studied lateral neural interactions in strabismic (n=6) and anisometropic amblyopes (n=3) by measuring reductions in the perceived contrast of a foveally viewed Gabor centred in a horizontal array of closely neighboring Gabors. Strabismic amblyopes, but not anisometropic amblyopes, failed to show the reduction in perceived contrast typical of normal vision [J. Opt. Soc. Amer. A 15 (1998) 1733] when
Dave Ellemberg; Robert F. Hess; A. Serge Arsenault
Lateral interactions in amblyopia
We studied lateral neural interactions in strabismic (n Ľ 6) and anisometropic amblyopes (n Ľ 3) by measuring reductions in the perceived contrast of a foveally viewed Gabor centred in a horizontal array of closely neighboring Gabors. Strabismic amblyopes, but not anisometropic amblyopes, failed to show the reduction in perceived contrast typical of normal vision (J. Opt. Soc. Amer. A
Dave Ellemberg; Robert F. Hess; A. Serge
NSDL National Science Digital Library
Have you ever wanted to delete a Facebook or Twitter post after it was published? It can be a good practice but can be tough to remember. Delete It Later allows users to schedule the posting of statuses, updates, and photos along with the option to schedule when the content will be removed. This version is compatible with all operating systems.
Isolated lateral rectus myositis.
Orbital myositis is a rare non-granulomatous inflammatory process within the orbit. Grave's disease and lymphoproliferative disorders are considered the most common cause of orbital myositis. The idiopathic form should be considered after exclusion of known causes or associations. Isolated orbital myositis is a very rare form of this disease. We report a case of an isolated lateral rectus myositis to draw the attention of physicians to this condition, as prompt treatment in our patient resulted in complete recovery. PMID:21063661
Obeid, Tahir H; Qanash, Sultan A; Abulaban, Ahmad A; Al-Shamy, Abdalrhman M
Laterally oscillating nitinol engine
This patent describes a laterally oscillating nitinol engine comprising: a first L-shaped drive member journalled for pivoting horizontal oscillation about the juncture of the legs of the L-shaped member, a second drive member journalled for pivoting about a point proximate the outboard end of the shorter leg of the L-shaped member at a distance from the pivot journal of the
Lateral internal sphincterotomy
Summary Lateral internal sphincterotomy proved to be effective in 99 per cent of the 418 procedures in which it was performed. The\\u000a complication rate of 5 per cent was an improvement over most of the rates reported in the medical literature and over our\\u000a previous experience with posterior sphincterotomy and anoplasty. Anal wounds and fissures healed faster than with previous\\u000a procedures.
Ralph V. Bailey; Robert J. Rubin; Eugene P. Salvati
The relationship between lateral meniscus shape and joint contact parameters in the knee: a study using data from the Osteoarthritis Initiative
Introduction The meniscus has an important role in force transmission across the knee, but a detailed three-dimensional (3D) morphometric shape analysis of the lateral meniscus to elucidate subject-specific function has not been conducted. The aim of this study was to perform 3D morphometric analyses of the lateral meniscus in order to correlate shape variables with anthropometric parameters, thereby gaining a better understanding of the relationship between lateral meniscus shape and its load-bearing function. Methods The lateral meniscus (LM) was manually segmented from magnetic resonance images randomly selected from the Osteoarthritis Initiative (OAI) non-exposed control subcohort. A 3D statistical shape model (SSM) was constructed to extract the principal morphological variations (PMV) of the lateral meniscus for 50 subjects (25 male and 25 female). Correlations between the principal morphological variations and anthropometric parameters were tested. Anthropometric parameters that were selected included height, weight, body mass index (BMI), femoral condyle width and axial rotation. Results The first principal morphological variation (PMV) was found to correlate with height (r?=?0.569), weight (r?=?0.647), BMI (r?=?0.376), and femoral condyle width (r?=?0.622). The third PMV was found to correlate with height (r?=?0.406), weight (r?=?0.312), and femoral condyle width (r?=?0.331). The percentage of the tibial plateau covered by the lateral meniscus decreases as anthropometric parameters relating to size of the subject increase. Furthermore, when the size of the subject increases, the posterior and anterior horns become proportionally longer and wider. Conclusion The correlations discovered suggest that variations in meniscal shape can be at least partially explained by the levels of loads transmitted across the knee on a regular basis. Additionally, as the size of the subject increases and body weight rises, the coverage percentage of the meniscus is reduced, suggesting that there would be an increase in the load-bearing by the cartilage. However, this reduced coverage percentage is compensated by the proportionally wider and longer meniscal horn.
The processing and characterization of animal-derived bone to yield materials with biomedical applications Part 1: Modifiable porous implants from bovine condyle cancellous bone and characterization of bone materials as a function of processing
A study on the development of a process to form materials suitable for biomedical xenograft implants from bovine cancellous bone is presented. Bone cubes cut from the condyle portion of bovine femurs sourced from abattoir waste were subjected to a defatting and subsequent deproteination procedure to produce shape-modifiable materials in which the biocompatible mineral calcium hydroxycarbonate apatite component was preserved
Glenn S. Johnson; Michael R. Mucalo; Michel A. Lorier
Does Lateral Knee Geometry Influence Bone Bruise Patterns after Anterior Cruciate Ligament Injury? A Report of two Cases
Bone bruise patterns are commonly seen after acute anterior cruciate ligament injuries; they represent a subchondral impaction injury that occurs in the lateral knee joint between the mid-lateral femoral condyle and the posterior lateral tibial plateau. These contusion patterns are present in the majority of noncontact ACL injuries. These injury patterns vary significantly in severity and this aspect is poorly understood. Edema patterns have gained increased interest in the literature of late; they may indicate the severity of the initial injury. They also may be correlated with the development of subsequent osteochondral defects and osteoarthritis. Given the location of this subchondral injury, it is plausible to assume that the geometry of the lateral femorotibial joint may play a role in ACL injury mechanism and severity of injury. We are reporting two cases of clinically identical ACL injuries. A patient with a flat lateral tibial plateau was noted to have a much larger bone edema pattern than a second patient with the highly convex lateral tibial plateau. This may shed light on the pathomechanics of ACL injury and suggests that an individual with a relatively flat tibial plateau has a stable lateral knee joint. Therefore, we hypothesize that much greater force is required to dislocate a flat and stable lateral femorotibial joint in a pivot shift pattern to produce an ACL injury. The greater force required results in a large bone edema pattern. Conversely, the individual with a relatively short and convex tibial plateau has an inherently unstable lateral joint and relatively smaller amounts of force would be needed to produce the identical injury to the ACL. As less force is required, smaller bone edema patterns result.
Westermann, Robert W; Wolf, Brian R; Wahl, Christopher J
Lateral conduction infrared photodetector
A photodetector for detecting infrared light in a wavelength range of 3-25 .mu.m is disclosed. The photodetector has a mesa structure formed from semiconductor layers which include a type-II superlattice formed of alternating layers of InAs and In.sub.xGa.sub.1-xSb with 0.ltoreq.x.ltoreq.0.5. Impurity doped regions are formed on sidewalls of the mesa structure to provide for a lateral conduction of photo-generated carriers which can provide an increased carrier mobility and a reduced surface recombination. An optional bias electrode can be used in the photodetector to control and vary a cut-off wavelength or a depletion width therein. The photodetector can be formed as a single-color or multi-color device, and can also be used to form a focal plane array which is compatible with conventional read-out integrated circuits.
Kim, Jin K. (Albuquerque, NM); Carroll, Malcolm S. (Albuquerque, NM)
Reflexive Planning for Later Life
ERIC Educational Resources Information Center
Informed by Giddens' (1991) concept of "reflexive life" planning and the notion of later life as a time of increasing social and financial risk, this research explores the idea of "reflexive planning for later life". We utilize a conceptual model that incorporates three types of planning for later life: public protection, self-insurance, and…
Denton, Margaret A.; Kemp, Candace L.; French, Susan; Gafni, Amiram; Joshi, Anju; Rosenthal, Carolyn J.; Davies, Sharon
Growth in the lateral part of the human skull during the second trimester.
The aim of the present study was to report dimensional changes in the lateral part of the prenatal human skull during the second trimester. The sample comprised 37 fetuses obtained in connection with requested autopsy. Gestational ages (GA) were available for 27 fetuses, ranging from 13 to 24 weeks. Crown-rump lengths (CRL) of 23 fetuses ranged from 78 to 228 mm. For 21 fetuses both CRL and GA were available. After excision of the midsagittal segment of the skulls by two paramedian sections from the frontal bone to the foramen magnum through the optic foramina, an incision was made through the middle of the occipital squama, bisecting the skull. The present study was based on the skull components of the resulting 74 lateral cranial tissue blocks. The tissue blocks were radiographed with a Hewlett Packard Faxitron unit. Seven reference points were digitized from each film and eight linear dimensions were calculated. Method errors ranged from 0.12 mm to 0.52 mm. The dimensions were related to crown-rump length (CRL) and lateral segment developmental stages (LSS). The increases in the linear dimensions of the anterior part of the lateral skull segments were similar to those found previously for the median skull segment. The dimensions of the anterior part of the lateral skull segments were found to increase by 150% during the second trimester, while those of the posterior part increased by 100% during the same period. Between maturity stages LSS 4 and 5 the dimensions increased by 30-50%, whereas less increase was observed between stages 5, 6, 7, and 8. This reduction was attributed to the progressive ossification of the cranial base. The almost horizontal distance from the mandibular condyle (condylion) to the anterior tympanic ring did not change significantly during the second trimester. Comparison of the bilateral skull segments showed no systematic asymmetry, but a significant individual biological variability in symmetry with standard deviations of 0.7-1.8 mm was found. PMID:8719349
Bach-Petersen, S; Solow, B; Fischer-Hansen, B; Kjaer, I
Early postoperative adherence of matrix-induced autologous chondrocyte implantation for the treatment of full-thickness cartilage defects of the femoral condyle.
Matrix-induced autologous chondrocyte implantation (MACI) is a tissue-engineering technique for the treatment of full-thickness articular cartilage defects and requires the use of a three-dimensional collagen type I-III membrane seeded with cultured autologous chondrocytes. The cell-scaffold construct is implanted in the debrided cartilage defect and fixed only with fibrin glue, with no periosteal cover or further surgical fixation. In a clinical pilot study, the MACI technique was used for the treatment of full-thickness, weight-bearing chondral defects of the femoral condyle in 16 patients. All patients were followed prospectively and the early postoperative attachment rate, 34.7 days (range: 22-47) after the scaffold implantation, was determined. With the use of high-resolution magnetic resonance imaging (MRI), the transplant was graded as completely attached, partially attached, or detached. In 14 of 16 patients (87.5%), a completely-attached graft was found, and the cartilage defect site was totally covered by the implanted scaffold and repair tissue. In one patient (6.25%), a partial attachment occurred with partial filling of the chondral defect. A complete detachment of the graft was found in one patient (6.25%), which resulted in an empty defect site with exposure of the subchondral bone. Interobserver variability for the MRI grading of the transplants showed substantial agreement (kappa=0.775) and perfect agreement (kappa(w)=0.99). In conclusion, the implantation and fixation of a cell-scaffold construct in a deep cartilage defect of the femoral condyle with fibrin glue and with no further surgical fixation leads to a high attachment rate 34.7 days after the implantation, as determined with high resolution MRI. PMID:16170579
Marlovits, Stefan; Striessnig, Gabriele; Kutscha-Lissberg, Florian; Resinger, Christoph; Aldrian, Silke M; Vécsei, Vilmos; Trattnig, Siegfried
Laterally oscillating nitinol engine
This patent describes a laterally oscillating nitinol engine comprising: a first L-shaped drive member journalled for pivoting horizontal oscillation about the juncture of the legs of the L-shaped member, a second drive member journalled for pivoting about a point proximate the outboard end of the shorter leg of the L-shaped member at a distance from the pivot journal of the L-shaped member, a bearing block secured to the end of longer leg of the L-shaped and having a guide hole. The second member extending through the guide hole and arranged to reciprocate therein, a shape memory alloy power element disposed in flexure secured at its ends to the bearing block and to the second member intermediate the sliding connection with the bearing block and the pivotal connection of the second member, means for disposing different temperature baths below the element whereby as the drive members oscillate about their journals the element alternately dips into one bath and then the other, and means for absorbing a portion of the energy developed by the engine and moving the power element from the cold bath to the hot bath.
Banks, R.
Gleno-Humeral arthritis in young patients: clinical and radiographic analysis of humerus resurfacing prosthesis and meniscus interposition
Recently, interest about glenoid resurfacing with lateral meniscus in osteoarthritis of the shoulder has been increasing.\\u000a Aim of this study is to evaluate the results of this procedure, from a clinical and a radiographic point of view. Constant\\u000a score, DASH (Disability of the Arm, Shoulder, and Elbow) questionnaire, some specific questions about satisfaction after surgery,\\u000a and radiographic exams were performed
Nicola Lollino; Andrea Pellegrini; Paolo Paladini; Fabrizio Campi; Giuseppe Porcellini
Lateral coupled cavity semiconductor laser
This patent describes a monolithic lateral-coupled laser array comprised of at least two stripe laser cavities of different effective length in close parallel proximity to each other for coupling of radiation. The longer of the stripe laser cavities is cleaved to provide separate parts, and the parts are cleaved coupled to form one strip laser cavity lateral coupled to the
J. Salzman; R. J. Lang; A. Yariv
Lateral Thinking and Technology Education
The emergence of lateral thinking in recent years is a natural reaction to the enormous increase of information a human being is "bombarded" with, in the post industrial revolution era. Vertical thinking, with its sequential and fixed-order rules, which has been the foundation of traditional education, is increasingly being complemented by lateral thinking which aims at freeing the mind from
Shlomo Waks
Cerebral lateralization and spatial ability
Frequencies of three cerebral dominance genotypes who show right or left ear superiority on a verbal dichotic listening test and left or right field superiority on a tachistoscopic lateral field test of perceptual dominance are deduced. A hypothesis is offered relating direction of cerebral dominance, as defined by genotype, to degree of lateral specialization and perceptual ability, and a theoretical
Jerre Levy
CT navigated lateral interbody fusion.
Lateral interbody fusion techniques are heavily reliant on fluoroscopy for retractor docking and graft placement, which expose both the patient and surgeon to high doses of radiation. Use of image-guided technologies with CT-based images, however, can eliminate this radiation exposure for the surgeon. We describe the surgical technique of performing lateral lumbar interbody fusion using CT navigation. PMID:23931938
Drazin, Doniel; Liu, John C; Acosta, Frank L
Incontinence after lateral internal sphincterotomy
PURPOSE: This study was designed to evaluate the anatomic and functional consequences of lateral internal sphincterotomy in patients who developed anal incontinence and in matched controls. METHODS: The study includes 13 patients with anal incontinence after lateral internal sphincterotomy and 13 controls who underwent the same operation and were continent and satisfied with the results of the procedure. Patients underwent
Julio García-Aguilar; Carlos Belmonte Montes; Jose Javier Perez; Linda Jensen; Robert D. Madoff; W. Douglas Wong
The Efficacy of Intra-Articular Injections for Pain Control Following the Closed Reduction and Percutaneous Pinning of Pediatric Supracondylar Humeral Fractures
Background: The purpose of this single-blinded, randomized, controlled trial was to compare the analgesic efficacy of intra-articular injections of bupivacaine or ropivacaine with that of no injection for postoperative pain control after the operative treatment of supracondylar humeral fractures in a pediatric population. Methods: Subjects (n = 124) were randomized to treatment with 0.25% bupivacaine (Group B) (n = 42), 0.20% ropivacaine (Group R) (n = 39), or no injection (Group C) (n = 43). The opioid doses and the times of administration as well as child-reported pain severity (Faces Pain Scale-Revised) and parent-reported pain severity (Total Quality Pain Management survey) were recorded. Results: The proportion of subjects who required morphine and/or fentanyl injections was significantly (p = 0.004) lower in Group B (10%) as compared with Group R (36%) and Group C (44%). On the basis of the log-rank test, the opioid-free survival rates were significantly greater in Group B as compared to Groups C and R. Total opioid consumption (morphine equivalent mg/kg) in the first seventy-two hours postoperatively was significantly less in Group B as compared with Group C (mean difference, 0.225; [95% confidence interval (CI), 0.0152 to 0.435]; p = 0.036). Parent-reported pain scores were also significantly lower in Group B as compared with both Group C (mean difference, 1.81 [95% CI, 0.38 to 3.25]; p = 0.014) and Group R (mean difference, 1.66; 95% CI, 0.20 to 3.12; p = 0.027). There were no significant differences across the three groups in terms of self-reported pain. Differences between Groups R and C were not significant for any of the outcome variables. Conclusions: The intra-articular injection of 0.25% bupivacaine significantly improves postoperative pain control following the closed reduction and percutaneous pinning of supracondylar humeral fractures in pediatric patients. Level of Evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Georgopoulos, Gaia; Carry, Patrick; Pan, Zhaoxing; Chang, Frank; Heare, Travis; Rhodes, Jason; Hotchkiss, Mark; Miller, Nancy H.; Erickson, Mark
Prospective evaluation of a pragmatic treatment rationale: open reduction and internal fixation of displaced and dislocated condyle and condylar head fractures and closed reduction of non-displaced, non-dislocated fractures
This prospective study evaluated outcomes of closed reduction (CR) in non-displaced, non-dislocated condyle and subcondylar fractures (Class I) and open reduction and internal fixation (ORIF) of displaced (Class II) and dislocated (Class IV) fractures. Forty-five patients with 51 fractures (six (13%) with bilateral fractures), 11 (25%) CR and 34 (75%) ORIF, were enrolled in a 1-year follow up that 20
C. A. Landes; R. Lipphardt
[Orthopedic problems in children with congenital insensitivity to pain].
Three children with congenital insensitivity to pain are described. Self-injuries of the tongue and fingers occurred during dentition. At infancy and early childhood fever of unknown origin and/or pneumoniae were observed in all children. All of them also suffered from osteomyelitis of various bones treated with antibiotics and surgery. The tibia and metatarsals were involved in one case, the tibia, metatarsals and the femur in second child and the jaw plus metatarsals in the third case. In one child the hip has been dislocated twice after minor trauma, lumbar arthropathy, distal femoral epiphyseal fusion causing shortening of the extremity by 4.5 cm, osteochondritis dissecans of the medial femoral condyle, elbow deformity after displaced fracture of the lateral humeral condyle and post-traumatic cataract were observed. PMID:10423911
Lejman, T; Su?ko, J
Effect of a ?-TCP collagen composite bone substitute on healing of drilled bone voids in the distal femoral condyle of rabbits.
In this study, we tested the performance and biocompatibility of a composite of ?-tricalcium phosphate (?-TCP) to collagen as a bone void filler (Cerasorb(®) Ortho Foam) in a rabbit distal femoral condyle model. ?-TCP is a completely resorbable synthetic calcium phosphate and the addition of a collagen matrix couples the osteoconductive effects of the two components. Furthermore, the malleable properties of the implant material during surgical applications for shape control will be enhanced. A critical size defect of 6 mm in diameter and 10 mm in depth was drilled into each distal femur of the rabbits. One hole was filled with the test substance and the other was left empty for control. After 1, 3, and 6 months the animals were killed and the degree of bone healing analyzed. In total, 18 animals were investigated. When the ?-TCP composite was used, histological, histomorphometric, and biomechanical evaluations revealed significantly better bone healing in terms of quantity and quality of the newly formed bone. Moreover, no signs of inflammation were observed in the animals and no allergic or foreign body reaction was noted. This suggests high biocompatibility and osteoconductivity of the investigated material to a bone void in an immune responsive species. PMID:24039106
Zheng, Hellen; Bai, Yajun; Shih, Mei-Shu; Hoffmann, Christiane; Peters, Fabian; Waldner, Christoph; Hübner, Wolf-Dietrich
Diminished Cartilage Creep Properties and Increased Trabecular Bone Density Following a Single, Sub-Fracture Impact of the Rabbit Femoral Condyle
Traumatic injury to articular cartilage can lead to post-traumatic arthritis. We used a custom pendulum device to deliver a single, near-fracture impact to the medial femoral condyles of rabbits. Impact was localized to a region ~3 mm in diameter, and impact stress averaged ~100 MPa. Animals were euthanized at 0, 1 and 6 months after impact. Cartilage mechanical properties from impacted and sham knees were evaluated by creep-indentation testing and periarticular trabecular bone was evaluated by microCT and histomorphometry. Impact caused immediate and statistically significant loss of cartilage thickness (-40% vs. sham) and led to a greater than two-fold increase in creep strain. From 0 to 6 months after impact, the ability of cartilage to recover from creep deformation became significantly impaired (percent recovery different from control at 1 and 6 months). At 1 month, there was a 33% increase in the trabecular bone volume fraction of the epiphysis beneath the site of impact compared to control, and increased bone formation was observed histologically. Taken together, these findings demonstrate that a single, high-energy impact below the fracture threshold leads to acute deleterious changes in the viscoelastic properties of articular cartilage that worsen with time, while at the same time stimulating increased bone formation beneath the impact site.
Borrelli, Joseph; Zaegel, Melissa A.; Martinez, Mario D.; Silva, Matthew J.
[Osteotomy for approaches to the knee joint. Tibial tubercle, lateral epicondyle of the femur and head of the fibula].
The present article summarizes the different osteotomy techniques for an extension of standard surgical approaches to the knee joint in selected patients. The aim is to achieve satisfactory exposure and reduce potential postoperative complications compared to alternative techniques, such as the V-Y plasty or the quadriceps snip procedures. Osteotomy of the tibial tubercle is a reasonable extension of the anteromedial or the anterolateral surgical approach in selected patients undergoing revision total knee replacement. This osteotomy will provide excellent surgical exposure of the knee without the risk of avulsion of the patellar tendon and will preserve the blood supply of the patella and the surrounding soft tissue. Moreover, functional clinical outcome will be improved by minimizing damage to the extensor mechanism. Osteotomy of the lateral femoral condyle gives excellent exposure of the posterolateral aspect of the knee joint which might be necessary in some patients with fractures of the posterolateral tibial plateau as well as patients undergoing open allograft transplantation of the lateral meniscus. An alternative option for an extended exposure to the posterolateral knee joint is accomplished by osteotomy or partial resection of the fibular head which is also described as having good clinical results and a low complication rate. PMID:23632649
Lorbach, O; Anagnostakos, K; Kohn, D
Lateral coupled cavity semiconductor laser
This patent describes a monolithic lateral-coupled laser array comprised of at least two stripe laser cavities of different effective length in close parallel proximity to each other for coupling of radiation. The longer of the stripe laser cavities is cleaved to provide separate parts, and the parts are cleaved coupled to form one strip laser cavity lateral coupled to the shorter laser cavity. A separate stripe contact varies the relative currents supplied to each laser cavity, including the cleaved coupled cavities of the longer of the stripe laser cavities.
Salzman, J.; Lang, R.J.; Yariv, A.
Borehole optical lateral displacement sensor
There is provided by this invention an optical displacement sensor that utilizes a reflective target connected to a surface to be monitored to reflect light from a light source such that the reflected light is received by a photoelectric transducer. The electric signal from the photoelectric transducer is then imputed into electronic circuitry to generate an electronic image of the target. The target`s image is monitored to determine the quantity and direction of any lateral displacement in the target`s image which represents lateral displacement in the surface being monitored. 4 figs.
Lewis, R.E.
Immunochromatographic lateral flow strip tests.
The immunochromatographic lateral flow strip test is a one-step test that facilitates low-cost, rapid identification of various analytes at the point of care. We have developed lateral flow strip tests for the specific qualitative or semiquantitative detection of antigens, antibodies, and haptens, such as drug residues. Here, we describe in detail the preparation of three examples of the strip tests for detection of (a) the infectious bursal disease virus; (b) Trichinella specific antibodies, and (c) Clenbuterol residues in urine samples. PMID:19159098
Zhang, Gaiping; Guo, Junqing; Wang, Xuannian
Dysregulation of 4q35- and muscle-specific genes in fetuses with a short D4Z4 array linked to facio-scapulo-humeral dystrophy.
Facio-scapulo-humeral dystrophy (FSHD) results from deletions in the subtelomeric macrosatellite D4Z4 array on the 4q35 region. Upregulation of the DUX4 retrogene from the last D4Z4 repeated unit is thought to underlie FSHD pathophysiology. However, no one knows what triggers muscle defect and when alteration arises. To gain further insights into the molecular mechanisms of the disease, we evaluated at the molecular level, the perturbation linked to the FSHD genotype with no a priori on disease onset, severity or penetrance and prior to any infiltration by fibrotic or adipose tissue in biopsies from fetuses carrying a short pathogenic D4Z4 array (n = 6) compared with fetuses with a non-pathogenic D4Z4 array (n = 21). By measuring expression of several muscle-specific markers and 4q35 genes including the DUX4 retrogene by an RT-PCR and western blotting, we observed a global dysregulation of genes involved in myogenesis including MYOD1 in samples with <11 D4Z4. The DUX4-fl pathogenic transcript was detected in FSHD biopsies but also in controls. Importantly, in FSHD fetuses, we mainly detected the non-spliced DUX4-fl isoform. In addition, several other genes clustered at the 4q35 locus are upregulated in FSHD fetuses. Our study is the first to examine fetuses carrying an FSHD-linked genotype and reveals an extensive dysregulation of several muscle-specific and 4q35 genes at early development stage at a distance from any muscle defect. Overall, our work suggests that even if FSHD is an adult-onset muscular dystrophy, the disease might also involve early molecular defects arising during myogenesis or early differentiation. PMID:23777630
Broucqsault, Natacha; Morere, Julia; Gaillard, Marie-Cécile; Dumonceaux, Julie; Torrents, Julia; Salort-Campana, Emmanuelle; Maues De Paula, André; Bartoli, Marc; Fernandez, Carla; Chesnais, Anne Laure; Ferreboeuf, Maxime; Sarda, Laure; Dufour, Henry; Desnuelle, Claude; Attarian, Shahram; Levy, Nicolas; Nguyen, Karine; Magdinier, Frédérique; Roche, Stéphane
Genetics Home Reference: Juvenile primary lateral sclerosis
... Recent literature OMIM Genetic disorder catalog Conditions > Juvenile primary lateral sclerosis On this page: Description Genetic changes ... Glossary definitions Reviewed July 2013 What is juvenile primary lateral sclerosis? Juvenile primary lateral sclerosis is a ...
Biomarkers for Amyotrophic Lateral Sclerosis.
National Technical Information Service (NTIS)
The invention provides a method for diagnosing amyotrophic lateral sclerosis (ALS) in a subject, a method for assessing the effectiveness of a drug in treating ALS, and a method for determining the site of onset of ALS in a subject. Each method comprises ...
R. P. Bowser S. Ranganathan
Lateral buckling of monorail beams
The resistances of steel I-section monorail beams to lateral buckling are difficult to assess because monorails are often not well restrained against twisting. Monorails are supported at intervals along the top flange, but are free along the bottom flange, except at supported ends where vertical stiffeners may restrain the bottom flange. The buckling resistance is increased by the loading which
N. S. Trahair
Functional Lateralization of the Brain.
ERIC Educational Resources Information Center
Research concerning lateralization of human brain functions is examined in light of the recent publication of the Kaufman Assessment Battery for Children. Following a review of research methodologies and functions ascribed to the hemispheres of the brain, differences are portrayed as complementary and coexisting modes of cognitive processing.…
Dean, Raymond S.
Lateral Violence: Nurse Against Nurse
Violence between and among workers is not unusual today. In health care, violence is a growing problem among nurses, as well as other disciplines. This independent study module focuses on lateral violence between and among nurses. The purpose of this independent study module is to increase nurses' awareness and understanding of the problem of violence between nurse co-workers in the
Patricia A. Rowell
Lateral diffusion in fluid systems
It is shown that an extension of the free-volume model introduced by Cohen and Turnbull (see Refs. 6-8), can serve as a starting point in the development of a microscopic theory of lateral diffusion in membranes and monolayers. (AIP)
MacCarthy, J.E.; Kozak, J.J.
Laterality of basic auditory perception
Laterality (left–right ear differences) of auditory processing was assessed using basic auditory skills: (1) gap detection, (2) frequency discrimination, and (3) intensity discrimination. Stimuli included tones (500, 1000, and 4000 Hz) and wide-band noise presented monaurally to each ear of typical adult listeners. The hypothesis tested was that processing of tonal stimuli would be enhanced by left ear (LE) stimulation
Yvonne S. Sininger; Anjali Bhatara
Laterality of basic auditory perception
Laterality (left–right ear differences) of auditory processing was assessed using basic auditory skills: (1) gap detection, (2) frequency discrimination, and (3) intensity discrimination. Stimuli included tones (500, 1000, and 4000 Hz) and wide-band noise presented monaurally to each ear of typical adult listeners. The hypothesis tested was that processing of tonal stimuli would be enhanced by left ear (LE) stimulation
Yvonne S. Sininger; Anjali Bhatara
Laterality of Basic Auditory Perception
Laterality (left-right ear differences) of auditory processing was assessed using basic auditory skills: 1) gap detection 2) frequency discrimination and 3) intensity discrimination. Stimuli included tones (500, 1000 and 4000 Hz) and wide-band noise presented monaurally to each ear of typical adult listeners. The hypothesis tested was: processing of tonal stimuli would be enhanced by left ear (LE) stimulation and noise by right ear (RE) presentations. To investigate the limits of laterality by 1) spectral width, a narrow band noise (NBN) of 450 Hz bandwidth was evaluated using intensity discrimination and 2) stimulus duration, 200, 500 and 1000 ms duration tones were evaluated using frequency discrimination. Results A left ear advantage (LEA) was demonstrated with tonal stimuli in all experiments but an expected REA for noise stimuli was not found. The NBN stimulus demonstrated no LEA and was characterized as a noise. No change in laterality was found with changes in stimulus durations. The LEA for tonal stimuli is felt to be due to more direct connections between the left ear and the right auditory cortex which has been shown to be primary for spectral analysis and tonal processing. The lack of a REA for noise stimuli is unexplained. Sex differences in laterality for noise stimuli were noted but were not statistically significant. This study did establish a subtle but clear pattern of LEA for processing of tonal stimuli.
Sininger, Yvonne S.; Bhatara, Anjali
Diagnosing and treating lateral epicondylitis.
Lateral epicondylitis is often encountered in primary care. Although its diagnosis can be fairly straightforward, its treatment is often difficult. This review examines the epidemiology, pathophysiology, and clinical presentation of tennis elbow. Management options are discussed. Images Figure 1 Figure 2 Figure 3 Figure 4
Geoffroy, P.; Yaffe, M. J.; Rohan, I.
Neuroimaging in Amyotrophic Lateral Sclerosis
Summary Amyotrophic lateral sclerosis (ALS) is a motor neuron disease characterized by progressive degeneration of upper motor neurons\\u000a (UMN) and lower motor neurons (LMN). While LMN dysfunction can be confirmed by electromyography (EMG) and muscle biopsy, UMN\\u000a involvement is more difficult to detect, particularly in the early phase. Objective and sensitive measures of UMN dysfunction\\u000a are needed for early diagnosis and
Sumei Wang; Elias R. Melhem; Harish Poptani; John H. Woo
Management of amyotrophic lateral sclerosis.
Motor Neuron Diseases (MNDs) are neurological disorders characterized by the selective and progressive degeneration of motor neurons. Amyotrophic Lateral Sclerosis (ALS), commonly known as Lou Gehrig's disease, is the most common. ALS causes diffuse muscle weakness and death secondary to respiratory failure. The diagnosis is made clinically, supported by electrodiagnostic testing. Although medications are limited, careful attention to breathing, nutrition, and patient mobility can have a major, positive impact on the course of the disease. PMID:24279194
Bali, Taha; Miller, Timothy M
Lateral dampers for thrust bearings
NASA Technical Reports Server (NTRS)
The development of lateral damping schemes for thrust bearings was examined, ranking their applicability to various engine classes, selecting the best concept for each engine class and performing an in-depth evaluation. Five major engine classes were considered: large transport, military, small general aviation, turboshaft, and non-manrated. Damper concepts developed for evaluation were: curved beam, constrained and unconstrained elastomer, hybrid boost bearing, hydraulic thrust piston, conical squeeze film, and rolling element thrust face.
Hibner, D. H.; Szafir, D. R.
School Readiness and Later Achievement
Using 6 longitudinal data sets, the authors estimate links between three key elements of school readiness—school-entry academic, attention, and socioemotional skills—and later school reading and math achievement. In an effort to isolate the effects of these school-entry skills, the authors ensured that most of their regression models control for cognitive, attention, and socioemotional skills measured prior to school entry, as
Greg J. Duncan; Chantelle J. Dowsett; Amy Claessens; Katherine Magnuson; Aletha C. Huston; Pamela Klebanov; Linda S. Pagani; Leon Feinstein; Mimi Engel; Jeanne Brooks-Gunn; Holly Sexton; Kathryn Duckworth; Crista Japel
Vision assisted aircraft lateral navigation
NASA Astrophysics Data System (ADS)
Surface operation is currently one of the least technologically equipped phases of aircraft operation. The increased air traffic congestion necessitates more aircraft operations in degraded weather and at night. The traditional surface procedures worked well in most cases as airport surfaces have not been congested and airport layouts were less complex. Despite the best efforts of FAA and other safety agencies, runway incursions continue to occur frequently due to incorrect surface operation. Several studies conducted by FAA suggest that pilot induced error contributes significantly to runway incursions. Further, the report attributes pilot's lack of situational awareness - local (e.g., minimizing lateral deviation), global (e.g., traffic in the vicinity) and route (e.g., distance to next turn) - to the problem. An Enhanced Vision System (EVS) is one concept that is being considered to resolve these issues. These systems use on-board sensors to provide situational awareness under poor visibility conditions. In this paper, we propose the use of an Image processing based system to estimate the aircraft position and orientation relative to taxiway markings to use as lateral guidance aid. We estimate aircraft yaw angle and lateral offset from slope of the taxiway centerline and horizontal position of vanishing line. Unlike automotive applications, several cues such as aircraft maneuvers along assigned route with minimal deviations, clear ground markings, even taxiway surface, limited aircraft speed are available and enable us to implement significant algorithm optimizations. We present experimental results to show high precision navigation accuracy with sensitivity analysis with respect to camera mount, optics, and image processing error.
Mohideen, Mohamed Ibrahim; Ramegowda, Dinesh; Seiler, Peter
The relationship of lateral anatomic structures to exiting guide pins during femoral tunnel preparation utilizing an accessory medial portal.
Anatomic reconstruction of the anterior cruciate ligament through an accessory medial portal has become increasingly popular. The purpose of this study is to describe the relationship of guide pin exit points to the lateral anatomic structures when preparing the anterior cruciate ligament femoral tunnel through an accessory medial portal. We utilized seven fresh frozen cadaveric knees. Utilizing an anteromedial approach, a guide wire was placed into the center of each bundle's footprint. Each guide wire was advanced through the lateral femoral cortex. The guide pins were passed at 90, 110, and 130 degrees of knee flexion. The distances from each guide pin to the closest relevant structures on the lateral side of the knee were measured. At 90 degrees the posterolateral bundle guide pin was closest to the lateral condyle articular cartilage (mean 5.4 +/- 2.2 mm) and gastrocnemius tendon (mean 5.7 +/- 2.1 mm). At 110 degrees the posterolateral bundle pin was closest to the gastrocnemius tendon (mean 4.5 +/- 3.4 mm). At 130 degrees the posterolateral bundle pin was closest to the gastrocnemius tendon (mean 7.2 +/- 5.5 mm) and lateral collateral ligament (mean 6.8 +/- 2.1 mm). At 90 degrees the anteromedial bundle guide pin was closest to the articular cartilage (mean 2.0 +/- 2.0 mm). At 110 degrees the anteromedial bundle pin was closest to the articular cartilage (mean 7.4 +/- 3.5 mm) and gastrocnemius tendon (mean 12.3 +/- 3.1 mm). At 130 degrees the AM bundle pin was closest to the gastrocnemius tendon (mean 8.2 +/- 3.2 mm) and LCL (mean 15.1 +/- 2.9 mm). Neither guide pin (anteromedial or posterolateral bundle) put the peroneal nerve at risk at any knee flexion angle. At low knee flexion angles the anteromedial and posterolateral bundle guide pins closely approximated multiple lateral structures when using an accessory medial arthroscopic portal. Utilizing higher flexion angles increases the margin of error when preparing both femoral tunnels. During preparation of the anterior cruciate ligament femoral tunnel through an accessory anteromedial portal the tunnels should be drilled in at least 110 degrees of knee flexion in order to move guide pin exit points away from important lateral knee structures. PMID:19760398
Farrow, Lutul D; Parker, Richard D
Imaging lesions of the lateral hip.
The lateral aspect of the hip is composed of a complex array of osseous and soft tissue structures. Both common and uncommon clinical entities are encountered in the lateral hip. This article briefly introduces fundamental imaging anatomy and the functional roles of different osseous and soft tissue structures in the lateral aspect of the hip, followed by a discussion of relevant imaging findings of lateral hip pathology. Greater trochanteric pain syndrome is frequently encountered in patients with lateral hip pain and encompasses a spectrum of soft tissue abnormalities including trochanteric and subgluteal bursitis, and tendinopathy or tears of the gluteal tendons. In addition, different types of injuries to the gluteal myotendinous unit and injuries to the indirect head of the rectus femoris, proximal iliotibial band, and the lateral joint capsular ligaments can present with lateral hip pain. Some of the less common soft tissue abnormalities of the lateral hip include Morel-Lavallée lesion and meralgia paresthetica. PMID:23787984
Pan, Judong; Bredella, Miriam A
Managing Complications of Diabetes in Later Life
... Download PDF Managing Complications of Diabetes in Later Life Download Join our e-newsletter! Resources Managing Complications of Diabetes in Later Life Tools and Tips Printer-friendly PDF Click here ...
Proximal humeral resection and reconstruction
Resection of the proximal humerus may be required for control of benign, primary malignant, or metastatic neoplasms. The defect created by such a resection may spare the shoulder cuff muscles and deltoid (Malawer type IA) or remove them (Malawer type IB). Reconstruction of these defects and restoration of some degree of shoulder function may be accomplished by a variety of
John M. Harrelson
Hereditary occurrence of lateral cervical fistulas.
Three cases of hereditary lateral cervical fistulas are reported. The patients had lateral cervical fistulas bilaterally and different types of auricular malformations. The mothers of the patients also had lateral cervical fistulas. Moreover, one mother had bilateral microtias and the other mothers bilateral preauricular fistulas. The literature is reviewed and discussed. PMID:3377420
Takato, T; Fukuda, O
Lateral violence in the perioperative setting.
Lateral violence is disruptive, bullying, intimidating, or unsettling behavior that occurs between nurses in the workplace. The perioperative setting fosters lateral violence because of the inherent stress of performing surgery; high patient acuity; a shortage of experienced personnel; work demands; and the restriction and isolation of the OR, which allows negative behaviors to be concealed more easily. Lateral violence affects nurses' health and well-being and their ability to care for patients. Interventions to reduce lateral violence include empowerment of staff members and zero tolerance for lateral violence. PMID:19434948
Bigony, Lorraine; Lipke, Tammy G; Lundberg, Ashley; McGraw, Carrie A; Pagac, Gretchen L; Rogers, Anne
[Genetics of amyotrophic lateral sclerosis].
Although the pathophysiology of amyotrophic lateral sclerosis remains currently unknown, involvement of genetic factors is worldwide accepted as a key clue in the motor neuron death. Since 1993 and the discovery of mutation in the SOD1 gene, number of genes linked to or promoting ALS had always growing. Among them, only four (SOD1, TARDBP, FUS and C9ORF72 genes) are unanimously recognized as convincing causative genetic factors for more than 60% of familial and probably 10% of sporadic ALS cases. Geographic origin of the studied populations tends to become one of the major items in the gene-ALS relationship: this was extremely stressed for C9ORF72. Concerning susceptibility genes factors, an increase of the risk of ALS is clearly shown for SMN1 and ATXN2 genes and accepted for some VEGF haplotypes. Finally, some modulating effects might also exist as underline for the relationships between ApoE and ALS that differ between European and North American studies. In inherited ALS, The European Federation of Neurological Societies (EFNS) edited rules that gave a legal frame to situations for which research of mutations were justified. Progress in the field of genetic raises major questions concerning the relevance of genetic studies from asymptomatic relatives. This first implies that the mutation identified in the proband case is perfectly characterized as a pathogenic mutation. PMID:24703222
Corcia, Philippe; Blasco, Hélčne; Camu, William
Examining lateral violence in the nursing workforce.
The decision to examine the phenomenon of lateral violence within the nursing workforce of a Southeastern tertiary care medical center evolved from the strong response of attendees to a nursing presentation on lateral violence. This paper describes the development and testing of the Lateral Violence in Nursing Survey. This questionnaire, designed to measure perceived incidence and severity of lateral violence, was administered online to 663 nursing staff participants. Forty-six percent of the study participants reported lateral violence as a "very serious" or "somewhat serious" problem, and 65% reported frequently observing lateral violence behaviors among coworkers. Education and effective leadership were found to mediate oppressive and negative behaviors, whereas ineffective leadership was found to exacerbate lateral violence. PMID:17987480
Stanley, Karen M; Martin, Mary M; Nemeth, Lynne S; Michel, Yvonne; Welton, John M
Evaluation of Lateral Movement of Piled Bridge Abutment Undergoing Lateral Soil Movement in Soft Ground
This paper describes the lateral movement of piled bridge abutments caused by backfills behind the abutments. To analyze the lateral movement of piled bridge abutments, a precise investigation was performed on the field monitoring data obtained from forty-three abutments where lateral movement has occurred. The investigation focuses not only on the lateral movement of the abutments, but also on the
Won-Pyo Hong; Kwang-Wu Lee
Retroviruses and amyotrophic lateral sclerosis
Amyotrophic lateral sclerosis (ALS) is a progressive, invariably fatal neurologic disorder resulting from upper and lower motor neuron degeneration, which typically develops during the sixth or seventh decade of life, and is diagnosed based on standard clinical criteria. Its underlying cause remains undetermined. The disease may occur with increased frequency within certain families, often in association with specific genomic mutations, while some sporadic cases have been linked to environmental toxins or trauma. Another possibility, first proposed in the 1970s, is that retroviruses play a role in pathogenesis. In this paper, we review the published literature for evidence that ALS is associated either with infection by an exogenous retrovirus or with the expression of human endogenous retroviral (HERV) sequences in cells of the central nervous system. A small percentage of persons infected with the human immunodeficiency virus-1 (HIV-1) or human T cell leukemia virus-1 (HTLV-1) develop ALS-like syndromes. While HTLV-1 associated ALS-like syndrome has several features that may distinguish it from classical ALS, HIV-infected patients may develop neurological manifestations that resemble classical ALS although it occurs at a younger age and they may show a dramatic improvement following the initiation of antiretroviral therapy. However, most patients with probable or definite ALS show no evidence of HIV-1 or HTLV-1 infection. In contrast, recent reports have shown a stronger association with HERV, as analysis of serum samples, and postmortem brain tissue from a number of patients with a classical ALS has revealed significantly increased expression of HERV-K, compared to controls. These findings suggest that endogenous retroviral elements are involved in the pathophysiology of ALS, but there is no evidence that they are the primary cause of the syndrome.
Alfahad, Tariq; Nath, Avindra
Retroviruses and amyotrophic lateral sclerosis.
Amyotrophic lateral sclerosis (ALS) is a progressive, invariably fatal neurologic disorder resulting from upper and lower motor neuron degeneration, which typically develops during the sixth or seventh decade of life, and is diagnosed based on standard clinical criteria. Its underlying cause remains undetermined. The disease may occur with increased frequency within certain families, often in association with specific genomic mutations, while some sporadic cases have been linked to environmental toxins or trauma. Another possibility, first proposed in the 1970s, is that retroviruses play a role in pathogenesis. In this paper, we review the published literature for evidence that ALS is associated either with infection by an exogenous retrovirus or with the expression of human endogenous retroviral (HERV) sequences in cells of the central nervous system. A small percentage of persons infected with the human immunodeficiency virus-1 (HIV-1) or human T cell leukemia virus-1 (HTLV-1) develop ALS-like syndromes. While HTLV-1 associated ALS-like syndrome has several features that may distinguish it from classical ALS, HIV-infected patients may develop neurological manifestations that resemble classical ALS although it occurs at a younger age and they may show a dramatic improvement following the initiation of antiretroviral therapy. However, most patients with probable or definite ALS show no evidence of HIV-1 or HTLV-1 infection. In contrast, recent reports have shown a stronger association with HERV, as analysis of serum samples, and postmortem brain tissue from a number of patients with a classical ALS has revealed significantly increased expression of HERV-K, compared to controls. These findings suggest that endogenous retroviral elements are involved in the pathophysiology of ALS, but there is no evidence that they are the primary cause of the syndrome. PMID:23707220
Alfahad, Tariq; Nath, Avindra
Chondrolysis after partial lateral meniscectomy in athletes
Rapid chondrolysis after partial arthroscopic lateral meniscectomy has been seldom reported in literature. Considering the\\u000a relatively high number of partial lateral meniscectomy performed, we cannot understand why this complication is so rare. The\\u000a purpose of this paper is to report a series of athletes developing a chondrolysis associated with posterolateral corner laxity\\u000a after a partial lateral meniscectomy and attempt to
Pier Paolo Mariani; Raffaele Garofalo; Fabrizio Margheritini
Reliability of subsea pipelines against lateral instability
An approach for the reliability assessment of subsea pipelines against on-bottom lateral instability is presented in this work. Combined stresses\\/lateral displacement acting on offshore pipelines due to combined hydrodynamic loads including wave\\/current effects are computed using a non-linear finite element model. The model takes into account the effect of pipe–soil interaction. The resulting combined pipe stresses\\/lateral displacement are used as
T. Elsayed; H. Leheta; A. Yehya
Reliability of subsea pipelines against lateral instability
An approach for the reliability assessment of subsea pipelines against on-bottom lateral instability is presented in this work. Combined stresses\\/lateral displacement acting on offshore pipelines due to combined hydrodynamic loads including wave\\/current effects are computed using a non-linear finite element model. The model takes into account the effect of pipe–soil interaction. The resulting combined pipe stresses\\/lateral displacement are used as
T. Elsayed; H. Leheta; A. Yehya
Human olfactory lateralization requires trigeminal activation.
Rats are able to lateralize odors. This ability involves specialized neurons in the orbitofrontal cortex which are able to process the left, right and bilateral presentation of stimuli. However, it is not clear whether this function is preserved in humans. Humans are in general not able to differentiate whether a selective olfactory stimulant has been applied to the left or right nostril; however exceptions have been reported. Following a screening of 152 individuals with an olfactory lateralization test, we identified 19 who could lateralize odors above chance level. 15 of these "lateralizers" underwent olfactory fMRI scanning in a block design and were compared to 15 controls matched for age and sex distribution. As a result, both groups showed comparable activation of olfactory eloquent brain areas. However, subjects with lateralization ability had a significantly enhanced activation of cerebral trigeminal processing areas (somatosensory cortex, intraparietal sulcus). In contrast to controls, lateralizers furthermore exhibited no suppression in the area of the trigeminal principal sensory nucleus. An exploratory study with an olfactory change detection paradigm furthermore showed that lateralizers oriented faster towards changes in the olfactory environment. Taken together, our study suggests that the trigeminal system is activated to a higher degree by the odorous stimuli in the group of "lateralizers". We conclude that humans are not able to lateralize odors based on the olfactory input alone, but vary in the degree to which the trigeminal system is recruited. PMID:24825502
Croy, Ilona; Schulz, Max; Blumrich, Anna; Hummel, Cornelia; Gerber, Johannes; Hummel, Thomas
Artificial lateral line canal for hydrodynamic detection
NASA Astrophysics Data System (ADS)
Fish use their lateral line system to detect minute water motions. The lateral line consists of superficial neuromasts and canal neuromasts. The response properties of canal neuromasts differ from those of superficial ones. Here, we report the design, fabrication, and characterization of an artificial lateral line canal system. The characterization was done under various fluid conditions, including dipolar excitation and turbulent flow. The experimental results with dipole excitation match well with a mathematical model. Canal sensors also demonstrate significantly better noise immunity compared with superficial ones. Canal-type artificial lateral lines may become important for underwater flow sensing.
Yang, Yingchen; Klein, Adrian; Bleckmann, Horst; Liu, Chang
Simultaneous Medial and Lateral Patellofemoral Ligament Reconstruction for Combined Medial and Lateral Patellar Subluxation
Medial patellar subluxation (MPS) is a disabling, often iatrogenic patellar instability due to previous lateral release for patellar instability. Lateral release destabilizes the patella on the lateral side, worsening the initial lateral instability and causing MPS. MPS is poorly recognized and may range from subluxation to true dislocation. This report describes a technique developed in response to episodes of medial and lateral patellar subluxation after failed lateral release for patellar instability. The technique uses a graft that extends from the medial patellofemoral ligament origin through the quadriceps tendon to the lateral epicondyle, thereby reconstructing both the medial and lateral patellofemoral ligaments, as well as providing simultaneous stability to both the medial and lateral sides of the patella.
Saper, Michael G.; Shneider, David A.
Connections of the rat lateral septal complex.
The organization of lateral septal connections has been re-examined with respect to its newly defined subdivisions, using anterograde (PHAL) and retrograde (fluorogold) axonal tracer methods. The results confirm that progressively more ventral transverse bands in the hippocampus (defined by the orientation of the trisynaptic circuit) innervate progressively more ventral, transversely oriented sheets in the lateral septum. In addition, hippocampal field CA3 projects selectively to the caudal part of the lateral septal nucleus, which occupies topologically lateral regions of the transverse sheets, whereas field CA1 and the subiculum project selectively to the rostral and ventral parts of the lateral septal nucleus, which occupy topologically medial regions of the transverse sheets. Finally, the evidence suggests that progressively more ventral hippocampal bands innervate progressively thicker lateral septal sheets. In contrast, ascending inputs to the lateral septum appear to define at least 20 vertically oriented bands or subdivisions arranged orthogonal to the hippocampal input (Risold, P.Y. and Swanson, L.W., Chemoarchitecture of the rat lateral septal nucleus, Brain Res. Rev., 24 (1997) 91-113). Hypothalamic nuclei forming parts of behavior-specific subsystems share bidirectional connections with specific subdivisions of the lateral septal nucleus (especially the rostral part), suggesting that specific domains in the hippocampus may influence specific hypothalamic behavioral systems. In contrast, the caudal part of the lateral septal nucleus projects to the lateral hypothalamus and to the supramammillary nucleus, which projects back to the hippocampus and receives its major inputs from brainstem cell groups thought to regulate behavioral state. The neural system mediating defensive behavior shows these features rather clearly, and what is known about its organization is discussed in some detail. PMID:9385454
Risold, P Y; Swanson, L W
Vehicle Lateral Control for Highway Automation
The objectives of lateral control for highway automation are to let vehicles track the center of a lane with small error and to maintain good ride quality under different vehicle speeds, loads, wind gust disturbances, and road conditions. In this paper, the lateral feedback and feedforward controllers are designed to satisfy these objectives by utilizing the frequency-shaped linear quadratic (FSLQ)
Huei Peng; Masayoshi Tomizuka
Lateral buckling of overhanging crane trolley monorails
Lateral torsional buckling should be taken into account during the design of overhanging steel beams. One special type of overhanging beam is the crane trolley monorail. Lateral buckling of overhanging monorails under idealized loading and boundary conditions has been studied in the past using classical mathematical procedures. This paper aims to present a detailed investigation of overhanging monorails using finite
Kerem Murat Özdemir; Cem Topkaya
The lateral triangle of the groin
Summary The lateral triangle (LT) of the groin is an area that includes the deep inguinal ring (DIR), and the tissues immediately lateral to it. It is vulnerable to develop recurrent indirect inguinal and interstitial hernias. An interstitial hernia is one in which the sac burrows through or between muscular layers. One typically presents as a palpable bulge at the
A. I. Gilbert; M. F. Graham; W. J. Voigt
ERIC Educational Resources Information Center
In this article, an emerging framework for investigating and interpreting the experiences of learning in later life is presented. This framework is contextualized by a study in which the lived experiences of later-life computer learners were investigated. Significant ontological and existential interpretations from the study provided insights into…
Russell, Helen
Lateral epicondylitis: review of injection therapies.
Lateral epicondylitis has several different treatment methods, with no single agreed upon therapy. This article summarizes the current literature on injection therapies for lateral epicondylitis. Glucocorticoid, botulinum toxin, autologous blood, platelet-rich plasma, hyaluronic acid, polidocanol, glycosaminoglycan, and prolotherapy injections are discussed. PMID:24095076
Judson, Christopher H; Wolf, Jennifer Moriatis
Does lateral gas diffusion in leaves matter?
Photosynthesis depends on the diffusion of gaseous CO2 inside the leaf spaces from the stomatal entry point to the mesophyll cell walls. Although most research considers only the vertical diffusion from stomata on upper and\\/or leaf lower surfaces, some of the gas will diffuse in the lateral (paradermal) direction. The importance of lateral CO2 dif- fusion is reviewed, and the
Later Life Social Engagement and Health
The topic of later life social engagement is of growing importance worldwide given the confluence of large demographic, economic, and sociocultural trends. However, empirical research in this area faces some serious theoretical and methodological limitations. The purpose of this study was to address these limitations by: (1) examining the later life mental and physical health effects of five social roles,
Manacy Pai
Arthroscopic Thermal Shrinkage for Hypermobile Lateral Meniscus
Background: The posterior segment of the lateral meniscus is relatively mobile as compared with that of the medial meniscus; that is because of its characteristic anatomy. Abnormal mobility of the lateral meniscus with no obvious rupture can be an unusual cause of knee pain and locking during deep knee flexion.Purpose: To evaluate results for a small series of patients with
Kenichi Ohtoshi; Masashi Kimura; Yasukazu Kobayashi; Hiroshi Higuchi; Shinichi Kikuchi
Reappraisal of partial lateral internal sphincterotomy
PURPOSE: The aim of this study was to delineate the results, mortality, and morbidity of partial lateral internal sphincterotomy for the treatment of chronic anal fissure. METHOD: A retrospective review of 500 patients undergoing partial lateral internal sphincterotomy for chronic anal fissure between 1980 and 1990 was performed. Patients were identified by a review of an office surgical ledger and
B. J. Pernikoff; T. E. Eisenstat; R. J. Rubin; G. C. Oliver; E. P. Salvati
Tailored lateral sphincterotomy for anal fissure
PURPOSE: Most surgical texts describe the length of division of the internal sphincter during closed lateral sphincterotomy as "to just above the dentate line," resulting in significant rates of incontinence. This study reviews our experience using a "tailored" lateral sphincterotomy by selecting the height of sphincter to be divided with the aim of preserving more sphincter. METHODS: From 1976 to
David R. G. Littlejohn; Graham L. Newstead
Arthroscopic Centralization of an Extruded Lateral Meniscus
Extrusion of the lateral meniscus has been reported after posterior root tear or radial tear, partial meniscectomy, and meniscoplasty of discoid meniscus. It has also been shown to be associated with the development of osteoarthritis. This technical note describes a new arthroscopic technique to centralize and stabilize the mid body of the lateral meniscus to restore and maintain the lateral meniscus function by repairing/preventing extrusion of the meniscus. A JuggerKnot Soft Anchor (Biomet, Warsaw, IN), loaded with a MaxBraid suture (Biomet), was placed on the lateral edge of the lateral tibial plateau, just anterior to the popliteal hiatus, through a midlateral portal. A Micro Suture Lasso Small Curve with Nitinol Wire Loop (Arthrex, Naples, FL) was used to pass 2 limbs of the MaxBraid suture through the meniscus at the margin between the meniscus and the capsule. Another anchor was inserted on the lateral edge of the lateral tibial plateau, 1 cm anterior to the first anchor, and the same procedure was repeated. The sutures were then tied by use of a self-locking sliding knot, achieving centralization and secure stabilization of the lateral meniscus.
Koga, Hideyuki; Muneta, Takeshi; Yagishita, Kazuyoshi; Watanabe, Toshifumi; Mochizuki, Tomoyuki; Horie, Masafumi; Nakamura, Tomomasa; Okawa, Atsushi; Sekiya, Ichiro
Monitoring System Design for Lateral Vehicle Motion
Monitoring of lateral vehicle motion is very useful in many active safety applications such as yaw stability control and rollover prevention. Lateral velocity and sideslip angle are regarded as the most important motion variables. However, it is not feasible during vehicle operation to directly measure them due to the high cost of sensors, limitations to sensor technology, etc. Therefore, the
Sangoh Han; Kunsoo Huh
Orbital Fracture: Significance of lateral wall
The lateral orbital wall is the strongest among other orbital walls. However, it is commonly fractured in the setting of severe facial trauma. The fracture usually occurs at the sphenozygomatic suture line. In general, patients with lateral wall fractures are commonly young male who may present with mid facial swelling and some degree of deformity. In some cases, lateral orbital wall fracture may be associated with visual loss or change in mental status due to associated intracranial injury. Imaging studies with computed tomography is important in the proper diagnosis and planning of the surgical intervention. Management of intracranial or eye injuries should be undertaken on emergent basis. Thereafter, significantly displaced lateral wall fractures need to be repaired on timely basis. Proper realignment of the plane of the lateral orbital wall at the sphenozygomatic suture along with the other complex articulations of the zygomatic bone is necessary for proper functional and aesthetic outcome.
Alsuhaibani, Adel H.
Successful implementation of policies addressing lateral violence.
Lateral violence is a problem in nursing despite policies addressing the issue, which suggests that implementation of these policies may be ineffective. We used an evidence-based approach to locate and appraise evidence about effectively implementing lateral violence policies. Our search strategy emphasized preappraised evidence, and we found 12 sources that met our inclusion criteria. Most evidence was from low-level sources, which is not surprising due to the subjective and sensitive nature of this topic. The evidence did not indicate that there is consistent, effective implementation of lateral violence policies. The appraised evidence suggests the importance of collaboratively prepared implementation strategies. Administrator involvement and relationships with staff members and the presence of a commitment to positive behavior change before lateral violence incidents occur are factors that can lead to successful implementation of lateral violence policies. PMID:23265652
Coursey, Joy H; Rodriguez, Ricardo E; Dieckmann, Loraine S; Austin, Paul N
Model to Design Drip Hose Lateral Line
NASA Astrophysics Data System (ADS)
Introduction The design criterion for non-pressure compensating drip hose is normally to have 10% of flow variation (?q) in the lateral line, corresponding to 20% of head pressure variation (?H). Longer lateral lines in drip irrigation systems using conventional drippers provide cost reduction, but it is necessary to obtain to the uniformity of irrigation [1]. The use of ?q higher levels can provide longer lateral lines. [4] proposes the use of a 30% ?q and he found that this value resulted in distribution uniformity over 80%. [1] considered it is possible to extend the lateral line length using two emitters spacing in different section. He assumed that the spacing changing point would be at 40% of the total length, because this is approximately the location of the average flow according with [2]. [3] found that, for practical purposes, the average pressure is located at 40% of the length of the lateral line and that until this point it has already consumed 75% of total pressure head loss (hf ). In this case, the challenge for designers is getting longer lateral lines with high values of uniformity. Objective The objective of this study was to develop a model to design longer lateral lines using non-pressure compensating drip hose. Using the developed model, the hypotheses to be evaluated were: a) the use of two different spacing between emitters in the same lateral line allows longer length; b) it is possible to get longer lateral lines using high values of pressure variation in the lateral lines since the distribution uniformity stays below allowable limits. Methodology A computer program was developed in Delphi® based on the model developed and it is able to design lateral lines in level using non-pressure compensating drip hose. The input data are: desired distribution uniformity (DU); initial and final pressure in the lateral line; coefficients of relationship between emitter discharge and pressure head; hose internal diameter; pipe cross-sectional area with the dripper; and roughness coefficient for the Hazen-Williams equation. The program allows calculate the lateral line length with three possibilities: selecting two spacing between emitters and defining the exchange point; using two pre-established spacing between emitters and calculating the length of each section with different spacing; using one emitter spacing. Results Results showed that the use of two sections with different spacing between drippers in the lateral line didn't allow longer length but got better uniformity when compared with lateral line with one spacing between emitters. The adoption of two spacing increased the flow rate per meter in the final section which represented approximately 80% of the lateral line total length and this justifies their use. The software allowed DU above 90% with pressure head variation of 40% and the use of two spacing between emitters. Conclusions The developed model/software showed to be accurate, easy to handle and useful for lateral line design using non-pressure compensating drip hose. References [1] ANDRADE, L. A. D. Estudo de uniformidade de emissăo de água utilizando diferentes espaçamentos entre gotejadores na linha lateral. 2009. 87 f. Tese (Doutorado em Agronomia/Irigaçăo e Drenagem) - Faculdade de Cięncias Agronômicas, Universidade Estadual Paulista 'Julio de Mesquita Filho', Botucatu, (2009). [2] KELLER, J.; BLIESNER, R. D. Sprinkle and trickle irrigation. Caldwell: Blackburn Press, (1990). 652 p. [3] TALENS, J. A. M. Riego localizado y fertirrigacion. Madrid: Mundi-Prensa, (2002). 533 p. [4] WU, I. P. An assessment of hydraulic design of micro-irrigation systems. Agricultural Water Management, Amsterdan, v. 32, n. 3
Ludwig, Rafael; Cury Saad, Joăo Carlos
Lateral femoral cutaneous neuralgia: an anatomical insight.
A detailed anatomic study was carried out on the lateral femoral cutaneous nerve to better understand the etiology and treatment of lateral femoral cutaneous neuralgia. As it passed from the pelvis into the thigh, the lateral femoral cutaneous nerve ran through an "aponeuroticofascial tunnel," beginning at the iliopubic tract and ending at the inguinal ligament; as it passed through the tunnel, an enlargement in its side-to-side diameter was observed, suggesting that the fascial structures proximal to the inguinal ligament may be implicated in the genesis of lateral femoral cutaneous neuralgia. The finding of pseudoneuromas at this location, distant from the inguinal ligament, supports this hypothesis. The anterior superior iliac spine is located approximately 0.7 cm from the lateral femoral cutaneous nerve and serves as the bony landmark for nerve localization. Within the first 3 cm of leaving the pelvis, the lateral femoral cutaneous nerve was observed deep to the fascia lata; therefore, surgical dissection within the subcutaneous fascia may be conducted with relative impunity near the anterior superior iliac spine just inferior to the inguinal ligament. In 36% of cases there was no posterior branch of the nerve, which is correlated to lateral femoral cutaneous neuralgia symptoms often being limited to the anterior branch region. An accessory nerve was found in 30% of cases. PMID:12794914
Dias Filho, L C; Valença, M M; Guimarăes Filho, F A V; Medeiros, R C; Silva, R A M; Morais, M G V; Valente, F P; França, S M L
Olfactory coding in the honeybee lateral horn.
Olfactory systems dynamically encode odor information in the nervous system. Insects constitute a well-established model for the study of the neural processes underlying olfactory perception. In insects, odors are detected by sensory neurons located in the antennae, whose axons project to a primary processing center, the antennal lobe. There, the olfactory message is reshaped and further conveyed to higher-order centers, the mushroom bodies and the lateral horn. Previous work has intensively analyzed the principles of olfactory processing in the antennal lobe and in the mushroom bodies. However, how the lateral horn participates in olfactory coding remains comparatively more enigmatic. We studied odor representation at the input to the lateral horn of the honeybee, a social insect that relies on both floral odors for foraging and pheromones for social communication. Using in vivo calcium imaging, we show consistent neural activity in the honeybee lateral horn upon stimulation with both floral volatiles and social pheromones. Recordings reveal odor-specific maps in this brain region as stimulations with the same odorant elicit more similar spatial activity patterns than stimulations with different odorants. Odor-similarity relationships are mostly conserved between antennal lobe and lateral horn, so that odor maps recorded in the lateral horn allow predicting bees' behavioral responses to floral odorants. In addition, a clear segregation of odorants based on pheromone type is found in both structures. The lateral horn thus contains an odor-specific map with distinct representations for the different bee pheromones, a prerequisite for eliciting specific behaviors. PMID:24560579
Roussel, Edith; Carcaud, Julie; Combe, Maud; Giurfa, Martin; Sandoz, Jean-Christophe
[Slowly progressive dysarthria in primary lateral sclerosis].
Slowly progressive dysarthria over many years may be the only sign of primary lateral sclerosis (PLS). Clinically it presents as pseudobulbar palsy which can be differentiated from amyotrophic lateral sclerosis (ALS) by the longer disease duration (> or =4 years), central pathological magnetic-evoked potentials to the tongue and lack of denervation in EMG. In contrast, hereditary spastic paraplegia (HSP) is characterized by a primary spasticity of the lower limbs, mostly later onset, the fact that other family members are affected and in isolated cases by positive genetic testing for mutations. PMID:20532474
Urban, P P; Wellach, I; Pohlmann, C
Rapid prototyping of lateral flow assays.
Principles and characteristics of lateral flow strip assays are reviewed. Recent technology developments permit the use of inexpensive electronic readers for interrogating lateral flow strip test results, thus avoiding the inevitable variation and subjectivity of visual inspection to assess the capture of reporter-labeled analyte on test lines of the strip. Protocols for developing lateral flow assays are described, including two specific case studies for assaying cotinine (a small-molecule metabolite of nicotine) in a competitive format, and assaying HIV antibodies in a sandwich-type assay format. PMID:19159100
Volkov, Alexander; Mauk, Michael; Corstjens, Paul; Niedbala, R Sam
Individualized optimal surgical extent of the lateral neck in papillary thyroid cancer with lateral cervical metastasis.
Despite an excellent prognosis, cervical lymph node (LN) metastases are common in patients with papillary thyroid cancer (PTC). The presence of metastasis is associated with an increased risk of locoregional recurrence, which significantly impairs quality of life and may decrease survival. Therefore, it has been an important determinant of the extent of lateral LN dissection in the initial treatment of PTC patients with lateral cervical metastasis. However, the optimal extent of therapeutic lateral neck dissection (ND) remains controversial. Optimizing the surgical extent of LN dissection is fundamental for balancing the surgical morbidity and oncological benefits of ND in PTC patients with lateral neck metastasis. We reviewed the currently available literature regarding the optimal extent of lateral LN dissection in PTC patients with lateral neck metastasis. Even in cases with suspicion of metastatic LN at the single lateral level or isolated metastatic lateral LN, the application of ND including all sublevels from IIa and IIb to Va and Vb may be overtreatment, due to the surgical morbidity. When there is no suspicion of LN metastasis at levels II and V, or when multilevel aggressive neck metastasis is not found, sublevel IIb and Va dissection may not be necessary in PTC patients with lateral neck metastasis. Thus consideration of the individualized optimal surgical extent of lateral ND is important when treating PTC patients with lateral cervical metastasis. PMID:23857026
Park, Jae-Yong; Koo, Bon Seok
Septum formation of the lateral ventricles.
In an MRI study examining anomalies of the septum pellucidum in 505 cases, we detected bilateral septum formation of the lateral ventricles in a 17-month-old baby. In this study, we evaluate 505 (242 males and 263 females) patients referred to the Emaray Imaging Center, Ankara, Turkey with various prediagnoses. We specially selected all the cases from a non-psychotic population. We obtained MRI scans on a 1-Tesla imager (Picker International, Highland Heights, Ohio, USA), with slices of 5 and 6 mm thickness. In axial and coronal sections, we observed septum formation laterally between the anterior horn and the ventricular body of the lateral ventricles. Radio opaque septum formations started from the caudate nucleus and stretched to the genu of the corpus callosum. There was a second septum formation between the posterior horn and the ventricular body of the right lateral ventricle. It started from the caudate nucleus and stretched to the cavum vergae. PMID:16127534
Celik, Hakam H; Aldur, Mustafa M; Tatar, Ilkan; Ozkul, Emine; Tascioglu, Ayse B
Symplastic intercellular connectivity regulates lateral root patterning.
Cell-to-cell communication coordinates the behavior of individual cells to establish organ patterning and development. Although mobile signals are known to be important in lateral root development, the role of plasmodesmata (PD)-mediated transport in this process has not been investigated. Here, we show that changes in symplastic connectivity accompany and regulate lateral root organogenesis in Arabidopsis. This connectivity is dependent upon callose deposition around PD affecting molecular flux through the channel. Two plasmodesmal-localized ?-1,3 glucanases (PdBGs) were identified that regulate callose accumulation and the number and distribution of lateral roots. The fundamental role of PD-associated callose in this process was illustrated by the induction of similar phenotypes in lines with altered callose turnover. Our results show that regulation of callose and cell-to-cell connectivity is critical in determining the pattern of lateral root formation, which influences root architecture and optimal plant performance. PMID:23850190
Benitez-Alfonso, Yoselin; Faulkner, Christine; Pendle, Ali; Miyashima, Shunsuke; Helariutta, Ykä; Maule, Andrew
Lateral Force Device for Underwater Towed Array.
National Technical Information Service (NTIS)
A lateral force device for displacing a towed underwater acoustic cable providing displacement in the horizontal and vertical directions having a spool and a rotationally mounted winged fuselage. The hollow spool is mounted on a cable with cable elements ...
N. Owsley J. F. Law R. Vanasse S. Ebner R. Knutson
Lateral Transpsoas Fusion: Indications and Outcomes
Spinal fusion historically has been used extensively, and, recently, the lateral transpsoas approach to the thoracic and lumbar spine has become an increasingly common method to achieve fusion. Recent literature on this approach has elucidated its advantage over more traditional anterior and posterior approaches, which include a smaller tissue dissection, potentially lower blood loss, no need for an access surgeon, and a shorter hospital stay. Indications for the procedure have now expanded to include degenerative disc disease, spinal stenosis, degenerative scoliosis, nonunion, trauma, infection, and low-grade spondylolisthesis. Lateral interbody fusion has a similar if not lower rate of complications compared to traditional anterior and posterior approaches to interbody fusion. However, lateral interbody fusion has unique complications that include transient neurologic symptoms, motor deficits, and neural injuries that range from 1 to 60% in the literature. Additional studies are required to further evaluate and monitor the short- and long-term safety, efficacy, outcomes, and complications of lateral transpsoas procedures.
Patel, Vishal C.; Park, Daniel K.; Herkowitz, Harry N.
Lateral Inflow into High-Velocity Channels.
National Technical Information Service (NTIS)
This Coastal and Hydraulics Engineering Technical Note (CHETN) investigates lateral flow discharging into a high-velocity channel. The results of a series of laboratory and numerical model experiments are presented. Various geometric and hydraulic conditi...
R. L. Stockstill
Dynamic Lateral Earth Pressure on Underground Structures.
National Technical Information Service (NTIS)
The dynamic lateral earth pressures resulting from underground detonation can cause severe damage to underground structures. The shock exerted on an underground structure caused by an underground explosion will vary with the detonation depth, the intensit...
S. M. Helwany A. Chowdhury
Lateral Hip Pain in an Athletic Population
Context: Historically, the term greater trochanteric pain syndrome has been used to describe a spectrum of conditions that cause lateral-sided hip pain, including greater trochanteric bursitis, snapping iliotibial band, and/or strains or tendinopathy of the abductor mechanism. Diagnosis of these conditions may be difficult because clinical presentations are variable and sometimes inconclusive. Especially difficult is differentiating intrinsic pain from pain referred to the greater trochanteric region. The purposes of this article are to review the relevant anatomy and pathophysiology of the lateral hip. Evidence Acquisition: Data were collected through a thorough review of the literature conducted through a MEDLINE search of all relevant papers between 1980 and January 2010. Results: Recent advances in imaging and an improved understanding of pathomechanics have helped to guide the evaluation, diagnosis, and appropriate treatment for patients presenting with lateral hip pain. Conclusion: Various diagnostic tools and treatment modalities can be used to effectively manage the athletic patient presenting with lateral hip pain.
Grumet, Robert C.; Frank, Rachel M.; Slabaugh, Mark A.; Virkus, Walter W.; Bush-Joseph, Charles A.; Nho, Shane J.
Lateral releases of the subscapularis tendon
The technique of arthroscopic subscapularis repair continues to evolve. A three-sided subscapularis release (e.g. anterior, posterior, superior) is commonly advocated for improving tendon excursion to bone. However, a lateral release is commonly required as well, particularly for full thickness, upper subscapularis tears and full thickness, complete subscapularis tears. We describe the techniques to identify and release the lateral subscapularis border, which aids in the completion of other releases.
Lo, Ian K.Y.; Nelson, Atiba A.; Burkhart, Stephen S
Lateral displacement estimation using tissue incompressibility
Using the incompressibility property of soft tissue, lateral displacements can be reconstructed from axial strain measurements. Results of simulations and experiments on gelatin-based tissue equivalent phantoms are compared with theoretical displacements, as well as estimates derived from traditional speckle tracking. Incompressibility processing greatly improves the accuracy and signal-to-noise ratio (SNR) of lateral displacement measurements compared with more traditional speckle tracking
Mark A. Lubinski; Stanislav Y. Emelianov; K. R. Raghavan; Andrew E. Yagle; Andrei R. Skovoroda; Matthew O'Donnell
Coherent turbulence structures in lateral separation eddies
NASA Astrophysics Data System (ADS)
An abrupt expansion in channel width generally produces lateral flow separation. A zone of recirculating flow is produced downstream of the point of separation that is termed a lateral separation eddy. Often the abrupt expansion is preceded upstream by a rapid constriction of the channel width. Lateral separation eddies are common in the Colorado River in Grand Canyon downstream of tributary debris fans. They are also produced by spur dikes, which are engineering structures designed to promote lateral sedimentation and eliminate lateral channel migration. Accurate prediction of the sediment transport field in a lateral separation eddy is difficult because of the presence of large and energetic turbulence structures. We have produced a three-dimensional numerical model of turbulence employing the large eddy simulation (LES) technique, in which large scale turbulence is directly calculated by integration of the spatially-filtered Navier-Stokes equations. Our model employs a moving boundary-fitted coordinate system to capture the irregular geometry of the channel and the moving free water surface. The model was used to simulate the flow and large-scale turbulence structures downstream of a single spur dike and in the Thirty Mile lateral separation eddy in Grand Canyon. The lambda-2 technique was used to extract and visualize the large-scale vortices. In both simulations, the upstream channel constriction produces strong secondary circulation resulting in a large vortex core in the main channel flow that is oriented downstream. Past the point of separation, vertical Kelvin-Helmholtz vortex cores are periodically produced along the free shear layer in both simulations. In the spur-dike simulation, the vertical Kelvin-Helmholtz vortex cores interact with the downstream-directed vortex core to produce regularly-shaped vortex cores which periodically give rise to strong, near-bed, cross-stream velocities directed toward the zone of flow reattachment. In the Grand Canyon simulation, the vertical cores and downstream core interact to produce highly irregularly- shaped vortex cores and episodic strong near-bed velocities directed into the lateral separation zone. Presumably, these periodic and episodic, near-bed, cross-stream velocities are important for the flux of sediment into a lateral separation eddy.
Schmeeckle, M. W.; Akahori, R.
Lateral restraint assembly for reactor core
A restraint assembly for use in restraining lateral movement of a reactor core relative to a reactor vessel wherein a plurality of restraint assemblies are interposed between the reactor core and the reactor vessel in circumferentially spaced relation about the core. Each lateral restraint assembly includes a face plate urged against the outer periphery of the core by a plurality of compression springs which enable radial preloading of outer reflector blocks about the core and resist low-level lateral motion of the core. A fixed radial key member cooperates with each face plate in a manner enabling vertical movement of the face plate relative to the key member but restraining movement of the face plate transverse to the key member in a plane transverse to the center axis of the core. In this manner, the key members which have their axes transverse to or subtending acute angles with the direction of a high energy force tending to move the core laterally relative to the reactor vessel restrain such lateral movement.
Gorholt, Wilhelm (San Diego, CA); Luci, Raymond K. (Del Mar, CA)
Relationship between childhood growth and later outcomes.
Many studies in different settings and times provided us with enough evidence of the association between environmental exposures (mainly nutrition) during pregnancy/infancy and later health outcomes, such as adult non-communicable diseases (NCDs). An individual with a given susceptibility will continue to experience new environmental challenges (e.g. growth), and these later experiences will modulate the early ones. Children that are thin in infancy and then become larger are at greater risk for later NCD. Studies demonstrated that rapid weight gain is a strong predictor of later NCD, independently of the birthweight. But which periods imply a greater risk for developing NCD? Two periods in the first years of life have been linked to the early obesity onset: the first 6 months and between 2 and 5 years of age. And when do these later health outcomes appear? The literature suggests that they start long before adulthood. Children with rapid weight gain have greater risk for hypertension and cardiovascular disease in the first years of life. These lines of evidence suggest that future research should be committed with educational programs and preventive actions focusing on better life behavior in childhood, adolescence and pregnancy. PMID:23502154
Ferraro, Alexandre Archanjo; Bechere Fernandes, Maria Teresa
Transforaminal arthroscopic decompression of lateral recess stenosis.
The purpose of this study was to evaluate the feasibility and efficacy of arthroscopic decompression of lateral recess stenosis, determine potential associated complications, and present an alternative method to access the lateral recess of the lumbar spine. Forty patients were selected in whom the authors found clinical and computerized tomography evidence of lateral recess stenosis and sequestered foraminal herniations. All 40 were treated with a posterolateral arthroscopic technique, and 38 were available for this follow-up evaluation. A satisfactory result was obtained in 31 patients (82%). No neurovascular complications were encountered; however, other complications included an infection of the disc space in one patient and a causalgic-type pain in the involved extremity in four patients. The associated postoperative morbidity in this group of patients was minimal and resulted in rapid rehabilitation and return of patients to preoperative functioning level. PMID:8609559
Kambin, P; Casey, K; O'Brien, E; Zhou, L
Measurement of lateral straggling using a microbeam
NASA Astrophysics Data System (ADS)
An original method has been developed to measure the lateral straggling of sub-micron proton and alpha beams after passing through polymer foils of different thickness. For this purpose, the microbeam line at CENBG has been used in scanning transmission ion microscopy (STIM) configuration to deliver the ions in normal incidence on foils. The lateral spreading of the beam was measured using a collimated charged particle detector centred on the beam axis and placed 6.3 mm behind the foil. When the beam was horizontally scanned in front of the collimator, its lateral distribution was measured step by step detecting particles passing trough the small aperture. Regular gaussian shapes were obtained and data were compared to the result of simulations carried out using the SRIM Monte-Carlo code for 2.5 MeV protons and alphas in Mylar and Formvar thin films.
Michelet, C.; Moretto, Ph; Laurent, G.; Przybylowicz, W. J.; Prozesky, V. M.; Pineda, C. A.; Barberet, Ph; Lhoste, F.; Kennedy, J.
Recovery of Dysphagia in Lateral Medullary Stroke
Lateral medullary stroke is typically associated with increased likelihood of occurrence of dysphagia and exhibits the most severe and persistent form. Worldwide little research exists on dysphagia in brainstem stroke. An estimated 15% of all patients admitted to stroke rehabilitation units experience a brainstem stroke out of which about 47% suffer from dysphagia. In India, a study showed that 22.3% of posterior circulation stroke patients develop dysphagia. Dearth of literature on dysphagia and its outcome in brainstem stroke particularly lateral medullary stroke motivated the author to present an actual case study of a patient who had dysphagia following a lateral medullary infarct. This paper documents the severity and management approach of dysphagia in brainstem stroke, with traditional dysphagia therapy and VitalStim therapy. Despite being diagnosed with a severe form of dysphagia followed by late treatment intervention, the patient had complete recovery of the swallowing function.
Gupta, Hitesh; Banerjee, Alakananda
Knee ligament injury during lateral impact.
A volunteer woman subject incurred injury to her right knee consisting of a torn anterior cruciate ligament and stretched medial collateral ligament during a lateral (+Gy) impact test. Similar injury has not been reported in the English-language literature an accidental sideward automotive crashes or lateral impact experimentation involving humans. The primary mechanism which produced this injury was external tibial rotation on the femur with the knee flexed. The factors contributing to the injury included extraordinarily forceful leg bracing by the subject, her knee joint laxity or hypermobility, and the absence of side supports to limit lower extremity flailing during the impact response. In future lateral impact tests, women subjects should be used with caution and any subject with abnormal joint mobility should be excluded from participation. PMID:3977801
Hearon, B F; Brinkley, J W; Raddin, J H; Fleming, B W
Lateral flow immunoassay using magnetoresistive sensors
NASA Astrophysics Data System (ADS)
Magnetic particles have been adapted for use as labels in biochemical lateral flow strip tests. Standard gold particle lateral flow assays are generally qualitative; however, with magnetic particles, quantitative results can be obtained by using electronic detection systems with giant magnetoresistive (GMR) sensors. As described here, these small integrated sensor chips can detect the presence of magnetic labels in capture spots whose volume is approximately 150 ?m×150 ?m×150 ?m. The range of linear detection is better than two orders of magnitude; the total range is up to four orders of magnitude. The system was demonstrated with both indirect and sandwich enzyme-linked immunosorbent assays (ELISAs) for protein detection of rabbit IgG and interferon-?, respectively, achieving detection of 12 pg/ml protein. Ultimately, the goal is for the detector to be fully integrated into the lateral flow strip backing to form a single consumable item that is interrogated by a handheld electronic reader.
Taton, Kristin; Johnson, Diane; Guire, Patrick; Lange, Erik; Tondra, Mark
Lateral jet injection into swirling combustor flowfields
NASA Technical Reports Server (NTRS)
An experimental program has been conducted to ascertain the effects of the number of lateral jets, the jet velocity ratio, and the crossflow swirl strength, on the isothermal flowfield patterns in jets injected normally to a round-section crossflow. Attention has been given to the trajectory, penetration, and mixing efficiency of the lateral injection, using flow visualization, pitot-probe and hot-wire methods. In addition, such predictive techniques as a simple, explicit, fully three-dimensional turbulent computer code have been employed.
Lilley, David G.
Dermatomal sensory manifestations in lateral medullary infarction.
A 61-year-old man who experienced a sudden onset of unstable gait followed by nuchal pain was admitted to our department. The neurologic examination revealed right-sided limb ataxia, right partial ptosis, and decreased sensation to 50% of the normal side to pinprick and temperature stimuli on the left side below the level of the T-6 dermatome. A lateral medullary infarction caused by spontaneous vertebral artery dissection was diagnosed by magnetic resonance imaging and computed tomography angiography. In conclusion, lateral medullary infarction is an important entity to consider in the differential diagnosis of dermatomal sensory manifestations. PMID:23099044
Hongo, Hiroki; Tanaka, Yasutaka; Shimada, Yoshiaki; Tanaka, Ryota; Hattori, Nobutaka; Urabe, Takao
Oxidative Pathology in Amyotrophic Lateral Sclerosis
1. CLINICAL INTRODUCTION Amyotrophic lateral sclerosis (ALS) is a devastating neurological disease caused by death of motor neurons in the brain and spinal cord. Its essential clinical aspect is unrelenting paralysis that usually begins focally and then spreads. Most cases of ALS reveal evidence of concurrent corticospinal (upper) and spinal (lower) motor neuron death. The mean age of onset in
Robert H. Brown
The lateral approach to laparoscopic splenectomy
BackgroundLaparoscopic splenectomy has been shown to result in shorter hospital stays and a quicker return to work than conventional splenectomy. Having tried the anterior 5 trocar approach, we developed a 4 trocar lateral approach and now present our experience with 22 cases.
Adrian Park; Michel Gagner; Alfons Pomp
Bacterial Sex: Playing Voyeurs 50 Years Later
The concept of chromosomes with a ring structure was born during the early studies of bacterial sexuality, and the discovery of fertility factors-episomes or plasmids-provided much later the key tools for gene cloning and biotechnology. But the plasmid-mediated transfer of antibiotic and other resistances, as well as pathogenicity, has served bacteria well in their own adaptive evolution.
Masamichi Kohiyama; Sota Hiraga; Ivan Matic; Miroslav Radman
Proportioning the airplane for lateral stability
NASA Technical Reports Server (NTRS)
Proportioning for lateral aircraft control included: (1) directional stability (slope of curve of yawing moment coefficient against sideslip), and (2) effective dihedral factor (slope of curve of rolling moment coefficient against sideslip). Basic forces influencing the directional stability of aircraft are indicated. Propeller side force, basic fuselage yaw, and vertical tail side force contributed to yaw moment about center of gravity.
Donlan, C. J.
Monozygous Twins Discordant for Amyotrophic Lateral Sclerosis
A pair of identical female twins were discordant for amyotrophic lateral sclerosis. The affected twin was not breast-fed; was bitten by a poisonous snake, and was operated on for struma. She had more infections than her sister but no fractures. Her plasma insulin response to glucose loading was also higher. The twins lived separated in their early childhood.Copyright © 1978
M. Jokelainen; J. Palo; J. Lokki
Electroencephalographic laterality changes during human sexual orgasm
Left and right parietal EEGs were recorded while seven subjects experienced sexual climax through self-stimulation. EEG data were quantified by continuous cumulated measurements of the integrated areas of EEG recording during successive 1-sec epochs. In eight out of 12 experiments, this measure revealed a statistically significant change in laterality. Controlled replications with two of the original subjects obviated the possibility
Harvey D. Cohen; Raymond C. Rosen; Leonide Goldstein
Laterality, Implicit Memory, and Attention Disorder.
ERIC Educational Resources Information Center
Presents study showing children with behaviors characteristic of attention disorder/hyperactivity deficit and high intelligence have more mixed laterality and allergies. Finds these children gather and use more diverse nonverbal and poorly focused information. Concludes such children use uncommon information when exhibiting novelty in nonverbal…
Shaw, Geraldine A.; Brown, Geoffrey
Childhood Victimization; Early Adversity, Later Psychopathology.
National Technical Information Service (NTIS)
Childhood physical abuse, sexual abuse, and neglect have both immediate and long-term effects. Different types of abuse have a range of consequences for a childs later physical and psychological well-being, cognitive development, and behavior. But there i...
C. S. Widom
Salvage Surgery for Lateral Tennis Elbow
We undertook a retrospective analysis of 34 patients (35 elbows) who had prior failed surgical intervention for lateral tennis elbow. Revision surgeries were per formed between 1979 and 1994. Each patient's non operative and operative history was recorded before our salvage revision surgery. At revision surgery, find ings included residual tendinosis of the extensor carpi radialis brevis tendon in 34
Scott W. Organ; Robert P. Nirschl; Barry S. Kraushaar; Eric J. Guidi
Lateral capacity of helical piles in clays
Helical piles, also known as screw anchors, consist of one or more helical-shaped circular plates welded to a central steel shaft at a specified spacing. Currently, helical piles are being used as tower foundations on land and in offshore areas to secure moorings, cables, and sea-bed pipelines to the sea bed. In this paper, the behavior of helical piles under lateral loads in clayey soils is examined through an experimental investigation on model piles. Tests were conducted on rigid helical piles with different numbers of plates. Model anchors were made of 13.8 mm diameter mild steel shafts to which mild steel plates of 33 mm diameter were welded. For comparison, a single straight shaft with a diameter of 13.8 mm was also tested. Test results revealed that the lateral capacity of helical piles is greater than that of straight shaft piles. A simple theoretical model is suggested to estimate the lateral capacity of rigid helical piles. The theoretical model suggested incorporates lateral resistance of the soil on the shaft, bearing resistance on the bottom of the helical plate, uplift resistance on the top of the helical plate, and frictional resistance on the surface of the helical plate. The validity of this model is examined.
Prasad, Y.V.S.N. [Memorial Univ. of Newfoundland, St. John`s, Newfoundland (Canada). Faculty of Engineering and Applied Science] [Memorial Univ. of Newfoundland, St. John`s, Newfoundland (Canada). Faculty of Engineering and Applied Science
New lateral stabilizing device for airplanes
NASA Technical Reports Server (NTRS)
The proposed device tends to render the lateral stabilization of airplanes easier and more efficacious. The proposed solution is to mount the ailerons independently, in such a manner that they can turn freely, under the action of the relative wind, about an axis located in front of the extreme position of the center of the lift.
Constantin, Louis
Atretic cephalocele communicating with lateral ventricles
Atretic cephaloceles are thought to be involuted true meningoceles or encephaloceles. They are located at the midline of the parietal or occipital region and usually joined to the subarachnoidal space. We present a 6-month-old girl with atretic cephalocele communicating with the lateral ventricles.
M. D. Aydin
Lateral Jet Control for Tactical Missiles.
National Technical Information Service (NTIS)
The aim of this paper is to give a survey of lateral jets as control system of tactical missiles. The paper is divided into four parts. The first part gives a brief analysis of new control requirements pertaining to tactical missiles, presents the advanta...
P. Champigny R. G. Lacau
Lateralized Anomalous Perceptual Experiences in Schizophrenia
Four cases of schizophrenia are described, in which subjects reported anomalous perceptual experiences confined to one visual field, in all cases the left visual field. The pattern, content and laterality of such anomalous perceptions point to the presence of right hemisphere dysfunction in schizophrenia. Further evidence to this effect comes from examining the type of anomalous perceptual experiences reported by
R. Persaud; J. Cutting
Lateralization of Norepinephrine in Human Thalamus
Norepinephrine has a strongly lateralized distribution in the human thalamus. In the pulvinar region the left hemisphere is rich in norepinephrine, whereas in the somatosensory input area the right hemisphere has a higher concentration of this catecholamine. Such naturally occurring left-right differences in concentration of a neurotransmitter represent a new aspect of hemispheric specialization.
Arvin Oke; Richard Keller; Ivan Mefford; Ralph N. Adams
Profiling 1366 Technologies: One Year Later
Last January, we took a look at how ARPA-E performer, 1366 Technologies is working to dramatically reduce the cost of solar energy. A year later, we revisited their headquarters in Lexington, MA to see the progress they've made.
Van Mierlo, Frank; Sachs, Ely
Motor laterality in 4 breeds of dog
The aim of the current study was designed to explore possible breed differences in a basic behavioral phenotype in dogs. It measured paw use during food-retrieval from a cylindrical, hollow, rubber toy to assess motor laterality (pawedness) in 4 breeds of dogs selected for their morphological differences: 45 greyhounds (males n = 23\\/females n = 22), 47 whippets (15\\/32), 46
Paul D. McGreevy; Alex Brueckner; Peter C. Thomson; Nicholas J. Branson
Biphasic cell responses on laterally mobile films
NASA Astrophysics Data System (ADS)
The engineering of polymer surfaces or matrices that are capable of controlling cell adhesion has been widely explored. In nearly all of these works, the polymer chains (and ligands) are chemically attached to the underlying substrate, and therefore these systems are inherently static. By contrast, cellular environments such as the extracellular matrix (ECM) are dynamic and remodeled by biochemical reactions and biophysical forces. Borrowing this concept from Nature, we created polymer films by an interfacial self-assembly process, whereby individual chains can exhibit lateral mobility (in-plane diffusive motion). NIH 3T3 fibroblasts seeded on such RGD-presenting polymer films show biphasic responses in spreading and adhesion strength to lateral mobility, with a minimal response for intermediate mobility values. Futhermore, preliminary immuno-staining experiments reveal that the total area of focal adhesions demonstrates a similar biphasic trend to the cellular-scale behaviors. In contrast, actin filaments or stress fibers appear to be unaffected by the substrate lateral mobility. These results show that lateral mobility is an important, although not fully explored aspect of mechano-sensing by cells, and can potentially give new perspectives on cell-ECM interactions.
Kourouklis, Andreas; Lerum, Ronald; Bermudez, Harry
Skin involvement in amyotrophic lateral sclerosis
SummaryBackground Patients with sporadic amyotrophic lateral sclerosis (ALS) show disorganised collagen and elastin of the dermis. We looked for inflammatory alterations to cutaneous blood vessels.Patients and findings Seven patients with sporadic ALS were investigated; five were confined to bed, but none had bedsores. Light and electron microscopy of skin showed an oedematous dermis with collagen fibrils of irregular diameter. Small
G Kolde; R Bachus; A. C Ludolph
Later life, inequality and sociological theory
A central concern of many theorists of later life has been to elucidate the processes which shape the marginalisation and relative disadvantage of older people in contemporary society. This concern parallels a current argument within sociological theorising: that life course stage and generational location constitute increasingly important dimensions of social dierence and inequality. It is an argument of the paper
Root segments of Convolvulus arvensis, the field bindweed, were examined with the electron microscope to make possible a description of the fine structural correlates of lateral root protrusion through cortical parenchyma. Particular attention was directed to the outermost primordium cells, derived by meristematic activity from the endodermis, and to the con- tiguous cortical parenchyma cells. By following the fate of
The Columbine Tragedy Ten Years Later
ERIC Educational Resources Information Center
Some tragedies are so emblazoned in people's minds that years later they can recall where they were when they first heard the news. The assassinations of John F. Kennedy and Martin Luther King Jr., the Challenger explosion, and the Sept. 11 terrorist attacks are among these events. So also is the Columbine High School tragedy of April 20, 1999.…
Hammond, Jane
Profiling 1366 Technologies: One Year Later
Last January, we took a look at how ARPA-E performer, 1366 Technologies is working to dramatically reduce the cost of solar energy. A year later, we revisited their headquarters in Lexington, MA to see the progress they've made.
Van Mierlo, Frank; Sachs, Ely;
Cooling Therapy Helps Newborns Years Later
... Helps Newborns Years Later High Blood Pressure in Children Featured Website: Impact of NIH Research Links Labor and Birth (HHS) Cold Treatment Protects Against Infant Disability and Death From Oxygen Loss Cerebral Palsy CONTACT US NIH Office of Communications and Public ...
Focus on Spacetime 100 Years Later
Among the remarkable new ideas that Einstein introduced into physics in 1905 was the revision of our concept of space and time. His special theory of relativity quickly became incorporated into all of physics. This cannot be said of his later general relativity, the ultimate outgrowth of his original insight 100 years ago. In the general theory, curvature of Einsteinian
Richard Price; Jorge Pullin
F35% Revisited Ten Years Later
This paper reviews the original derivation of the F35% (later F40%) harvest strategy, which consists of fishing at a rate that reduces spawning biomass per recruit to 35% (or 40%) of the unfished value, and investigates its applicability to long-lived stocks with low resiliency, such as some of the Pacific Coast rockfishes Sebastes spp. The life history parameters are unimportant
William G. Clark
Risk factors for suicide in later life
Suicide rates are higher in later life than in any other age group. The design of effective suicide prevention strategies hinges on the identification of specific, quantifiable risk factors. Methodological challenges include the lack of systematically applied terminology in suicide and risk factor research, the low base rate of suicide, and its complex, multidetermined nature.Although variables in mental, physical, and
Yeates Conwell; Paul R. Duberstein; Eric D. Caine
Profiling 1366 Technologies: One Year Later
Last January, we took a look at how ARPA-E performer, 1366 Technologies is working to dramatically reduce the cost of solar energy. A year later, we revisited their headquarters in Lexington, MA to see the progress they've made.
Thrust Vectoring for Lateral-Directional Stability.
National Technical Information Service (NTIS)
The advantages and disadvantages of using thrust vectoring for lateral-directional control and the effects of reducing the tail size of a single-engine aircraft were investigated. The aerodynamic characteristics of the F-16 aircraft were generated by usin...
L. R. Peron T. Carpenter
Preparing Future Faculty: Ten Years Later
ERIC Educational Resources Information Center
When Sean Murphy designed the Graduate Student Internship Program at the College of Lake County (CLC), his 2001 TETYC article about the then two-year-old program detailed his programmatic response to the job market. Ten years later, the CLC-DePaul University partnership remains the strongest of the original dozen cross-sector relationships CLC…
Murphy, Sean P.; Aiossa, Elizabeth; Winter, Mary Mugica
Lateral Load Behavior of Drilled Shafts.
National Technical Information Service (NTIS)
Drilled shaft foundations, used extensively to support highway structures, are often subjected to both axial and lateral loads. To obtain a safe and economical design, the response of the soil to the applied loads must be known. In this study, currently a...
L. C. Reese R. C. Welch
Modeling lateral attenuation of aircraft flight noise
NASA Astrophysics Data System (ADS)
To calculate the airbase and/or airport noise exposure at any specified ground position located to the side of a flight path, a variety of noise attenuation mechanisms must be accounted for if the model is to predict levels that are in reasonable agreement with field noise measurements. For civil aircraft the lateral attenuation model developed by the Society of Automotive Engineers, Inc. A-21 Committee on Aircraft Noise is commonly used. Since it was derived mainly from measured lateral attenuation data on civil aircraft, the predicted results generally show good agreement when compared with actual measurements. However, the frequency spectra of the noise from most military aircraft is often quite different from that associated with civil transports. A series of field experiments was conducted to develop a data base of sufficient size (853 points at elevation angles aranging from 1.9 to 90 degrees) to accurately model the lateral attenuation associated with military flights near airbases and especially along Military Training Routes where the aircraft fly at low altitude (150 m or less) and at high subsonic airspeeds. Those tests confirmed the need for a different model of lateral attenuation for typical United States military versus civil aircraft flight operations. A companion paper, A Prediction Model for Noise From Low-Altitude Military Aircraft, describes recent tests performed in the United Kingdom. Two of the aircraft (F-15 and F-16) were common to the tests performed in the United States and the United Kingdom. This paper merges the 182 data points at very low elevation angles (1.3 to 6.8 degrees) from the UK tests, adds 154 more USAF data points at low to moderate elevation angles (3 to 45 degrees) and derives an improved model for lateral attenuation associated with military aircraft.
Speakman, J. D.; Berry, B. F.
Visual lateralization and homing in pigeons.
The aim of our study was to analyse the components of visual lateralization in pigeon homing, a large-scale spatial task. In a series of 13 releases, birds were tested as binocular controls or monocularly with the right or left-eye covered. Occlusion of either eye had a significant effect on initial orientation and homing performance. Vanishing bearings were deflected to the side of the open eye, vanishing intervals were longer, and homing speed was reduced. These parameters were affected to a different degree. Initial orientation was markedly lateralized, with birds using their right-eye deviating less from the mean of control birds and showing significantly less variance. One minute after release, the deviation and variance were similarly large in both monocular groups. However, while the right-eyed birds improved their performance until leaving the release site, the left-eyed birds failed to do so. Vanishing intervals were similar in both monocular groups, but homing speed was reduced to a lesser extent in pigeons using the right-eye. The degree of lateralization varied across different releases, but superiority of the right-eye/left hemisphere prevailed. Lateralization did not depend on familiarity with the release site. This suggests that the crucial processes involved the eyes, but did not depend on visual memory of landscape features at the release site. Results reveal, for the first time, asymmetries of directional orientation as an essential component of lateralized homing performance. As likely mechanisms we suggest hemispheric differences in magnetic compass orientation and in the adjustment to optic flow. PMID:15313017
Prior, Helmut; Wiltschko, Roswitha; Stapput, Katrin; Güntürkün, Onur; Wiltschko, Wolfgang
Lateral root development in the maize (Zea mays) lateral rootless1 mutant
Background and Aims The maize lrt1 (lateral rootless1) mutant is impaired in its development of lateral roots during early post-embryonic development. The aim of this study was to characterize, in detail, the influences that the mutation exerts on lateral root initiation and the subsequent developments, as well as to describe the behaviour of the entire plant under variable environmental conditions. Methods Mutant lrt1 plants were cultivated under different conditions of hydroponics, and in between sheets of moist paper. Cleared whole mounts and anatomical sections were used in combination with both selected staining procedures and histochemical tests to follow root development. Root surface permeability tests and the biochemical quantification of lignin were performed to complement the structural data. Key Results The data presented suggest a redefinition of lrt1 function in lateral roots as a promoter of later development; however, neither the complete absence of lateral roots nor the frequency of their initiation is linked to lrt1 function. The developmental effects of lrt1 are under strong environmental influences. Mutant primordia are affected in structure, growth and emergence; and the majority of primordia terminate their growth during this last step, or shortly thereafter. The lateral roots are impaired in the maintenance of the root apical meristem. The primary root shows disturbances in the organization of both epidermal and subepidermal layers. The lrt1-related cell-wall modifications include: lignification in peripheral layers, the deposition of polyphenolic substances and a higher activity of peroxidase. Conclusions The present study provides novel insights into the function of the lrt1 gene in root system development. The lrt1 gene participates in the spatial distribution of initiation, but not in its frequency. Later, the development of lateral roots is strongly affected. The effect of the lrt1 mutation is not as obvious in the primary root, with no influences observed on the root apical meristem structure and maintenance; however, development of the epidermis and cortex are impaired.
Husakova, Eva; Hochholdinger, Frank; Soukup, Ales
The treatment of lateral clavicle fractures.
This study assesses the results of surgical treatment of 15 displaced Neer type II fractures of the lateral clavicle in 15 patients, which occurred between November 1988 and March 1995 and which were followed up for a mean period of 4.6 years (range 2-9 years). The patients fell into two groups, one 'acute group' and one 'non-union' group. Patients treated initially by a non-operative approach had suffered prolonged morbidity and time off work prior to and after surgery. The ultimate result was good. The fixation used was a Dacron arterial graft as a sling around the clavicle and coracoid process. Delayed (non-union) cases were augmented with bone graft and inter-fragmentary screw fixation. All fractures eventually united. We question the place of prolonged non-operative management in the treatment of displaced Neer type II fractures of the lateral clavicle. PMID:10704582
Webber, M C; Haines, J F
High performance silicon lateral PIN photodiode
NASA Astrophysics Data System (ADS)
Start Photodetectors with high responsivity in Si-related processes are required for high speed optoelectronic applications such as fiber optic data communication systems. In this paper, the performance of a virtual lateral PIN photodiode with intensity response in the 200-1000 nm wavelength range was demonstrated. The results obtained for responsivity, total quantum efficiency and frequency response were 0.62 A/W and 13.1 GHz respectively for design parameters of intrinsic region length of 6 ?m, photoabsorption layer thickness of 50 ?m, incident optical power of 1 mW/cm2 and bias voltage of 3 V. As a conclusion, the decrease in device size enabled the realization of a high performance lateral p-i-n photodiode.
Kalthom Tasirin, S.; Susthitha Menon, P.; Ahmad, Ibrahim; Fazlili Abdullah, S.
Thrust vectoring for lateral-directional stability
NASA Technical Reports Server (NTRS)
The advantages and disadvantages of using thrust vectoring for lateral-directional control and the effects of reducing the tail size of a single-engine aircraft were investigated. The aerodynamic characteristics of the F-16 aircraft were generated by using the Aerodynamic Preliminary Analysis System II panel code. The resulting lateral-directional linear perturbation analysis of a modified F-16 aircraft with various tail sizes and yaw vectoring was performed at several speeds and altitudes to determine the stability and control trends for the aircraft compared to these trends for a baseline aircraft. A study of the paddle-type turning vane thrust vectoring control system as used on the National Aeronautics and Space Administration F/A-18 High Alpha Research Vehicle is also presented.
Peron, Lee R.; Carpenter, Thomas
Polarization phase shifting lateral shearing interferometer
NASA Astrophysics Data System (ADS)
A polarization phase shifting lateral shearing interferometer based on a polarization beam splitting plate(PBSP) is proposed. The front surface of the PBSP is coated with polarization beam splitting film and its back surface is coated with total reflection film. The beam to be tested is split by the PBSP with an incidence angle of 45° and divided into two mutually perpendicular linearly polarization beams. Phase shifting can be introduced to the interferometer when the PBSP is combined with a polarzation temporal or spatial phase shifter. A polarizaiton temporal phase shifting lateral shearing interferometer system is built up both with the ASAP software and the experiments. The usefulness of the interferometer is verified.
Liu, Lei; Zeng, Aijun; Zhu, Linglin; Song, Qiang; Huang, Huijie
Season of birth in amyotrophic lateral sclerosis.
While studying birth cohort issues, the authors focused also on the seasons of birth in amyotrophic lateral sclerosis (ALS). The analyses were based on computerized death records of Swiss mortality statistics 1969-1993. The results confirm an excess of births in spring months. They suggest that risk factors in ALS can be acquired very early in life, thus introducing a long latency period. PMID:9690754
Ajdacic-Gross, V; Wang, J; Gutzwiller, F
Lateral dampers for thrust bearings. Final Report
The development of lateral damping schemes for thrust bearings was examined, ranking their applicability to various engine classes, selecting the best concept for each engine class and performing an in-depth evaluation. Five major engine classes were considered: large transport, military, small general aviation, turboshaft, and non-manrated. Damper concepts developed for evaluation were: curved beam, constrained and unconstrained elastomer, hybrid boost bearing, hydraulic thrust piston, conical squeeze film, and rolling element thrust face.
Hibner, D.H.; Szafir, D.R.
Lateral–distortional buckling of monorails
This paper is concerned with the elastic lateral–distortional (LD) buckling of single span steel monorail I-beams and its influence on their design strengths. The distortion of a slender web reduces the elastic buckling resistance of an intermediate length beam below its flexural–torsional (FT) resistance. A finite element computer program was used to study the elastic LD buckling of single span
N. S. Trahair
Paraoxonase Gene Mutations in Amyotrophic Lateral Sclerosis
Three clustered, homologous paraoxonase genes (PON1, PON2 and PON3) have roles in preventing lipid oxidation and detoxifying organophosphates. Recent reports describe a genetic association between the PON genes and sporadic amyotrophic lateral sclerosis (ALS). We now report that in genomic DNA from individuals with familial and sporadic ALS we have identified at least seven PON gene mutations that are predicted to alter PON function.
Ticozzi, Nicola; LeClerc, Ashley Lyn; Keagle, Pamela; Glass, Jonathan D.; Wills, Anne-Marie; van Blitterswijk, Marka; Bosco, Daryl A.; Rodriguez-Leyva, Ildefonso; Gellera, Cinzia; Ratti, Antonia; Taroni, Franco; McKenna-Yasek, Diane M.; Sapp, Peter C.; Silani, Vincenzo; Furlong, Clement E.; Brown, Robert H.; Landers, John E.
This paper reports a simple lateral lamination scheme for the fabrication of multilayer piezoelectric actuators. The fabrication scheme consists of dicing of a high-d 33 piezoelectric coefficient lead zirconate titanate (PZT) material, photolithographic high- aspect-ratio SU-8 definition of electrical isolation, and micromolding of conductive polymer electrodes. Backside and inclined UV exposure has been exploited to secure the 1mm-thick SU-8 pillar
Xiaosong Wu; Guang Yuan; Seong-O Choi; Yanzhu Zhao; Seong-Hyok Kim; Yong-Kyu Yoon; Mark G. Allen
Lateral situated sinus pericranii. Case report.
We hereby report a case of a laterally situated sinus pericranii, which is rare. According to the articles regarding this kind of lesion, carotid angiograms revealed no pathological findings, and venograms taken with direct injection of contrast medium into the mass were useful. It should be stressed that the lesion could be demonstrated in the late phase of carotid angiograms, and digital subtraction angiography was especially useful for diagnosis. The literature is also reviewed. PMID:2814792
Nishio, A; Sakaguchi, M; Murata, K; Nishikawa, M; Nishimura, S
Giant lateral sinus pericranii. Case report.
A case of giant lateral sinus pericranii, which presented in a patient during early childhood as a soft, collapsible mass and gradually grew until it reached 13 x 9 cm when the patient was 36 years of age, is reported. The patient underwent successful surgery and the lesion was totally excised. The results of diagnostic tests (computerized tomography scanning, magnetic resonance imaging, cerebral angiography, and sinusography) and surgery-related problems are presented and discussed. PMID:9420089
Spektor, S; Weinberger, G; Constantini, S; Gomori, J M; Beni-Adani, L
Symptomatic torn discoid lateral meniscus in adults
The purposes of this study were to report degenerative changes that coexist with a symptomatic torn discoid lateral meniscus\\u000a in adults and to analyze the factors associated with the accompanied degenerative changes. From 1997 to 2008, 329 knees in\\u000a the 305 patients were included. Associations between the status of the meniscus and the coexisting degenerative changes on\\u000a the images and
Jin Hwan Ahn; Sang-Hee Choi; Yong Seuk Lee; Jae Chul Yoo; Moon Jong Chang; Sooho Bae; Young Ryeol Bae
F 35% Revisited Ten Years Later
This paper reviews the original derivation of the F35% (later F40%) harvest strategy, which consists of fishing at a rate that reduces spawning biomass per recruit to 35% (or 40%) of the unfished value, and investigates its applicability to long-lived stocks with low resiliency, such as some of the Pacific Coast rockfishesSebastes spp. The life history parameters are unimportant (at
William G. Clark
Total lateral sphincterotomy for anal fissure
Background and aimsInitial experience with the posterior sphincterotomy for treating anal fissures was unsatisfactory, with a significant rate of recurrences and anal incontinence. This report describes the lateral approach to complete section of the internal sphincter.Patients and methodsBetween 1997 and 2001 we surgically treated 164 patients for anal fissure. Preoperative and postoperative anal manometries were recorded. Postoperative course and early
Adriano Tocchi; Gianluca Mazzoni; Michelangelo Miccini; Diletta Cassini; Elia Bettelli; Stefania Brozzetti
Quantifiable Lateral Flow Assay Test Strips
NASA Technical Reports Server (NTRS)
As easy to read as a home pregnancy test, three Quantifiable Lateral Flow Assay (QLFA) strips used to test water for E. coli show different results. The brightly glowing control line on the far right of each strip indicates that all three tests ran successfully. But the glowing test line on the middle left and bottom strips reveal their samples were contaminated with E. coli bacteria at two different concentrations. The color intensity correlates with concentration of contamination.
A post-CMOS micromachined lateral accelerometer
In a post-complementary metal-oxide-semiconductor (CMOS) micromachining technology, the process flow enables the integration of micromechanical structures with conventional CMOS circuits which are low-cost and readily available. This paper presents a lateral capacitive sensing accelerometer fabricated in the post-CMOS process. Design advantages include electrically isolated multimetal routing on microstructures to create full-bridge capacitive sensors, and integration to increase transducer sensitivity by
Hao Luo; Gang Zhang; L. Richard Carley; Gary K. Fedder
Regulation of AMPA receptor lateral movements
NASA Astrophysics Data System (ADS)
An essential feature in the modulation of the efficacy of synaptic transmission is rapid changes in the number of AMPA (?-amino-3-hydroxy-5-methyl-4-isoxazole propionic acid) receptors at post-synaptic sites on neurons. Regulation of receptor endo- and exocytosis has been shown to be involved in this process. Whether regulated lateral diffusion of receptors in the plasma membrane also participates in receptor exchange to and from post-synaptic sites remains unknown. We analysed the lateral mobility of native AMPA receptors containing the glutamate receptor subunit GluR2 in rat cultured hippocampal neurons, using single-particle tracking and video microscopy. Here we show that AMPA receptors alternate within seconds between rapid diffusive and stationary behaviour. During maturation of neurons, stationary periods increase in frequency and length, often in spatial correlation with synaptic sites. Raising intracellular calcium, a central element in synaptic plasticity, triggers rapid receptor immobilization and local accumulation on the neuronal surface. We suggest that calcium influx prevents AMPA receptors from diffusing, and that lateral receptor diffusion to and from synaptic sites acts in the rapid and controlled regulation of receptor numbers at synapses.
Borgdorff, Aren J.; Choquet, Daniel
Laterally-biased quantum dot infrared photodetector
NASA Astrophysics Data System (ADS)
At the Air Force Research Laboratory, Space Vehicles Directorate, we are interested in improving the performance of or modifying the capabilities of infrared detectors in order to locate and identify dim and/or distant objects in space. One characteristic we are very interested in is multicolor detection. To this end, we have turned to a novel detector design that we have come to call a Lateral Quantum Dot Infrared Photodetector (LQDIP). In this design, InAs quantum dots are buried in a GaAs quantum well, which in turn is tunnel-coupled to another GaAs quantum well. Photoexcited electrons from the quantum dots tunnel over to the second well and are then swept out via a lateral (perpendicular to the growth direction) bias voltage. This architecture should exhibit the ability to tune to select infrared frequencies with reduced dark current and unity gain. The lateral photocurrent is directed by a vertical (parallel to the growth direction) gate voltage. We will discuss this detector architecture and the LQDIP operating principles and conditions, and we will present some preliminary results of current-voltage, photocurrent, differential conductance, and spectral measurements.
Cardimona, D. A.; Morath, C. P.; Guidry, D. H.; Cowan, V. M.
Lateralization of magnetic compass orientation in pigeons
The aim of our study was to test for lateralization of magnetic compass orientation in pigeons. Having shown that pigeons are capable of learning magnetic compass directions in an operant task, we wanted to know whether the brain hemispheres contribute differently and how the lateralization pattern relates to findings in other avian species. Birds that had learnt to locate food in an operant chamber by means of magnetic directions were tested for lateralization of magnetic compass orientation by temporarily covering one eye. Successful orientation occurred under all conditions of viewing. Thus, pigeons can perceive and process magnetic compass directions with the right eye and left brain hemisphere as well as the left eye and right brain hemisphere. However, while the right brain hemisphere tended to confuse the learned direction with its opposite (axial response), the left brain hemisphere specifically preferred the correct direction. Our findings demonstrate bilateral processing of magnetic information, but also suggest qualitative differences in how the left and the right brain deal with magnetic cues.
Wilzeck, Christiane; Wiltschko, Wolfgang; Gunturkun, Onur; Wiltschko, Roswitha; Prior, Helmut
Lateral jet injection into typical combustor flowfields
NASA Technical Reports Server (NTRS)
The experimental problem of lateral jet injection into typical flow fields in the absence of combustion was studied. All flow fields being investigated have no expansion of the crossflow (the test section to swirler diameter ratio D/d = 1), after its passage through an optional swirler (with swirl vane angle phi = 0 (swirler removed), 45, and 70 degree). The lateral jet(s) is(are) located one test-section diameter downstream of the test-section inlet (x/D = 1). The lateral jets have round-sectioned nozzles, each of which has an area of 1/100th of the cross sectional area of the crossflow (A sub j/A sub c = 1/100). Jet-to-crossflow velocity ratios of R = v sub j/u sub o = 2, 4, and 6 were investigated. Helium-bubble low visualization, five-hole pitot probe time-mean velocity measurements, and single-wire time-mean velocity and normal and shear stress turbulence data were obtained in the research program.
Lilley, D. G.
Lateral hypothalamus and sympathetic firing rate.
Measurements of sympathetic firing rate have been made after the acute microinjection of glucose or insulin into the lateral hypothalamic area as well as after ablation of this area with locally injected gold thioglucose. Injection of glucose into the lateral hypothalamus (LH) produced a small but significant and dose-dependent reduction in the firing rate of efferent sympathetic nerves to interscapular brown adipose tissue. Injection of insulin into the same region produced a very short-lived increase in efferent sympathetic firing rate. Bilateral lesions in the lateral hypothalamus produced by microinjection and gold thioglucose lowered body weight more than sham injections into the LH of control animals. There was an increase in basal sympathetic firing rate at 3, 9, and 24 h after LH lesions. There was also an increase in firing rate at 1 and 3 days, but by 7 days firing rate had returned to control levels. The data support the hypothesis that LH lesions enhance sympathetic activity but show only very limited modulation by glucose or insulin. PMID:3137829
Sakaguchi, T; Takahashi, M; Bray, G A
The governance of lateral relations between and within organisations
Recent years have witnessed various changes in organisational structures and seen the increasing importance of lateral relations. The objective of this paper is to explore the nature of lateral relations and to develop a framework for conceptualising the elements of a 'governance package' for lateral relationships. Drawing on two illustrations – one of lateral relations between organisations and the other
Jeltje van der Meer-Kooistra; Robert W. Scapens
Glomus tumor of the lateral aspect of the knee joint
Background We report a rare case of glomus tumor that occurred in the lateral joint of the knee. A 54?year?old man was referred to us with a 3?year history of lateral pain in the left knee and the diagnosis of lateral meniscus injury. Physical examination revealed a small trigger point localized just on the lateral joint space. Magnetic resonance imaging
Kohjirou Okahashi; Kazuya Sugimoto; Makoto Iwai; Kouji Kaneko; Masayuki Samma; Yoshiyuki Fujisawa; Yoshinori Takakura
An In Vitro Model to Investigate Filling of Lateral Canals
Aims of this work were to examine lateral canals in extracted teeth, to propose a new technique to produce artificial lateral canals, and to compare two obturation techniques. Cleared roots were examined to record measure and shape of lateral canals. Artificial lateral canals were prepared on human demineralized teeth before final clearing. Specimens were divided in two groups: canals of
Mauro Venturi; Carlo Prati; Lorenzo Breschi
AXR1 Acts after Lateral Bud Formation to Inhibit Lateral Bud Growth in Arabidopsis1
The AXR1 gene of Arabidopsis is required for many auxin re- sponses. The highly branched shoot phenotype of mature axr1 mutant plants has been taken as genetic evidence for a role of auxin in the control of shoot branching. We compared the development of lateral shoots in wild-type Columbia and axr1-12 plants. In the wild type, the pattern of lateral
Petra Stirnberg; Steven P. Chatfield; H. M. Ottoline Leyser
Motor neuron disease (amyotrophic lateral sclerosis) arising from longstanding primary lateral sclerosis.
Three men were initially diagnosed as having primary lateral sclerosis (PLS), but eventually developed amyotrophic lateral sclerosis (ALS) after 7.5, 9, and at least 27 years. Non-familial ALS and PLS might be different manifestations of a single disease or constitute completely distinct entities. The clinical diagnosis of PLS predicts a median survival that is four to five times longer than in ALS. Images
Bruyn, R P; Koelman, J H; Troost, D; de Jong, J M
Genetic factors and breast cancer laterality
Background Women are more likely to develop cancer in the left breast than the right. Such laterality may influence subsequent management, especially in elderly patients with heart disease who may require radiation therapy. The purpose of this study was to explore possible factors for such cancer laterality. Methods In this work, clinical data for consecutive patients with histologically confirmed breast cancer were reviewed, with emphasis on clinical presentation and family history. Results Between 2005 and 2012, 687 patients with breast cancer were seen. Two women with incomplete data and eleven men were excluded. In total, 343 (50.9%) patients presented with left breast cancer, 311 (46.1%) with right breast cancer, and 20 (3.0%) with simultaneous bilateral malignancy. There were no significant differences between the three groups, especially in regards to clinical presentation and tumor characteristics. A total of 622 (92.3%) patients had unilateral primary, 20 (3.0%) had simultaneous bilateral, and 32 (4.7%) had metachronous primary breast cancer with subsequent contralateral breast cancer after 7.5–236 months. The worst 10-year survival was for bilateral simultaneous (18%) compared with unilateral (28%) and metachronous primaries (90%). There were no differences in survival in relation to breast cancer laterality, handedness, and presence or absence of a family history of cancer. There were significant similarities between patients and first-degree relatives in regards to breast cancer laterality, namely same breast (30/66, 45.5%), opposite breast (9/66, 13.6%), and bilateral cancer (27/66, 40.9, P=0.01163). This was more evident among patients and their sisters (17/32, 53.1%) or mothers (11/27, 40.7%, P=0.0689). There were also close similarities in relation to age at initial diagnosis of cancer for patients and their first-degree relatives for age differences of ?5 years (48/166, 28.9%), 6–10 years (34/166, 20.5%), and >11 years (84/166, 50.6%, P=0.12065). Conclusion High similarities between patients and their first-degree relatives in regards to cancer laterality and possibly age at initial diagnosis of cancer may suggest an underlying inherited genetic predisposition.
Amer, Magid H
Involvements of the lateral hypothalamic area in gastric motility and its regulation by the lateral septum.
Ghrelin is an endogenous ligand for the growth hormone secretagogue receptor (GHS-R) pre-dominantly produced in the stomach. Recent studies have shown that it may promote food intake and gastric motility. We aim to explore effects of ghrelin on the gastric distension (GD) sensitive neurons and gastric motility in the lateral hypothalamic area (LHA), and the possible regulation by the lateral septum. Extracellular single unit discharges were recorded and the gastric motility was monitored by administration of ghrelin into LHA and electrical stimulation of lateral septum. Expression of GHS-R was determined by polymerase chain reaction (PCR), western blot and immunohistochemistry staining. Projection of nerve fiber and expression of ghrelin were observed by retrograde tracer and fluo-immunohistochemistry staining. Results revealed that there were GD neurons in the LHA, and administration of ghrelin could excite both GD-excitatory (GD-E) and GD-inhibited (GD-I) neurons in the LHA. The gastric motility was significantly promoted by administration of ghrelin into LHA with a dose dependent manner, which could be completely abolished by treatment with ghrelin receptor antagonist [D-Lys-3]-GHRP-6 or BIM-28163. c-Fos expression was significantly increased after ghrelin administration to the LHA. Electrical stimulation of the lateral septum could significantly excite GD neurons responsive to ghrelin in the LHA as well as promote gastric motility. However, those effects could be absorbed by pre-treatment of [D-Lys-3]-GHRP-6. GHSR-1a expression in the LHA had no change after ghrelin administration to the LHA or electrical stimulating lateral septum. Electrical lesion of the LHA resulted in the decrease of gastric motility. GHS-R and Ghrelin/FG-double labeled neurons were observed in the LHA and lateral septum, respectively. It is suggested that the LHA may involve in promoting gastric motility via ghrelin. The Lateral septum projects to the LHA and exerts some regulating function on the LHA. PMID:24100167
Gong, Yanling; Xu, Luo; Wang, Hongbo; Guo, Feifei; Sun, Xiangrong; Gao, Shengli
Lateral Mode Control of Semiconductor Lasers
NASA Astrophysics Data System (ADS)
This thesis deals with several topics related to the lateral modes of edge-emitting semiconductor lasers. The first topic is the improvement of lateral beam quality for high power operation. A thermally controlled antiguiding unstable-resonator semiconductor laser with cleaved facets is proposed. With temperature controlled by monolithically integrated micro-heaters, the beam propagation factor is improved by 8 times at 300 mW and by 6 time at 600 mW. The second issue is monolithic semiconductor laser beam steering. Two new mechanisms, thermally controlled offset gain and index guiding lasers and fan laser arrays, have been proposed and demonstrated. They both have single-lobed Gaussian intensity distributions. The fan laser array has shown a total steering angle of 80^circ with eleven resolvable spots, which surpasses the previous results by a factor of three. The third issue is the nonlinear interaction between the semiconductor gain medium and optical waves. The filamentation effect is studied with perturbation theory. Analytical spatial solitary waves have been obtained. The fourth issue is the complex Hermite-Gaussian functions and their applications. An analytical integral expression has been obtained. The generalized complex Gaussian duct is discussed. It is found that the biorthogonal mode expansion and adjoint mode coupling theory in unstable resonators need to be improved. The fifth issue is the lateral modes of stable resonator and stadium resonator semiconductor lasers which have been designed, fabricated and tested. For the stable cavity semiconductor lasers, three distinct operation regions are identified as the stable cavity region, the transition region, and the geometrically unstable region. Preliminary results on stadium resonator semiconductor lasers have also been obtained.
Sun, Yan
Lateral Flagellar Gene System of Vibrio parahaemolyticus
Vibrio parahaemolyticus possesses dual flagellar systems adapted for movement under different circumstances. A single polar flagellum propels the bacterium in liquid (i.e., swimming) with a motor that is powered by the sodium motive force. Multiple proton-driven lateral flagella enable translocation over surfaces (i.e., swarming). The polar flagellum is produced continuously, while production of lateral flagella is induced when the organism is grown on surfaces. This work describes the isolation of mutants with insertions in the structural and regulatory laf genes. A Tn5-based lux transcriptional reporter transposon was constructed and used for mutagenesis and subsequent transcriptional analysis of the laf regulon. Twenty-nine independent insertions were distributed within 16 laf genes. DNA sequence analysis identified 38 laf genes in two loci. Among the mutants isolated, 11 contained surface-induced lux fusions. A hierarchy of laf gene expression was established following characterization of the laf::lux transcriptional fusion strains and by mutational and primer extension analyses of the laf regulon. The laf system is like many enteric systems in that it is a proton-driven, peritrichous flagellar system; however, laf regulation was different from the Salmonella-Escherichia coli paradigm. There is no apparent flhDC counterpart that encodes master regulators known to control flagellar biosynthesis and swarming in many enteric bacteria. A potential ?54-dependent regulator, LafK, was demonstrated to control expression of early genes, and a lateral-specific ?28 factor controls late flagellar gene expression. Another notable feature was the discovery of a gene encoding a MotY-like product, which previously had been associated only with the architecture of sodium-type polar flagellar motors.
Stewart, Bonnie J.; McCarter, Linda L.
Lateral tunneling through voltage-controlled barriers
NASA Technical Reports Server (NTRS)
The paper reports on a detailed experimental investigation of lateral tunneling between electrodes of a two-dimensional electron gas separated by the voltage-controlled barrier of a nanometer Schottky gate. The experimental data are modeled using the WKB method to calculate the tunneling probability of electrons through a barrier whose shape is determined from a solution of the two-dimensional Poisson equation. This model is in excellent agreement with the experimental data over a two order of magnitude range of current.
Manion, S. J.; Bell, L. D.; Kaiser, W. J.; Maker, P. D.; Muller, R. E.
Lateral Interactions in Monolayer Thick Mercury Films
NASA Astrophysics Data System (ADS)
An understanding of lateral adatom-adatom interactions is often an important part of understanding electronic structure and adsorption energetics in monolayer thick films. In this dissertation I use angle-resolved photoemission and thermal desorption spectroscopies to explore the relationship between the adatom-adatom interaction and other characteristics of the adlayer, such as electronic structure, defects, or coexistent structural phases in the adlayer. Since Hg binds weakly to many substrates, the lateral interactions are often a major contribution to the dynamics of the overlayer. Hg adlayer systems are thus ideal for probing lateral interactions. The electronic structures of Hg adlayers on Ag(100), Cu(100), and Cu_3Au(100) are studied with angle-resolved ultraviolet photoemission. The Hg atomic 5d_{5/2} electronic band is observed to split into two levels following adsorption onto some surfaces. The energetic splitting of the Hg 5d_{5/2} level is found to be directly correlated to the adlayer homogeneous strain energy. The existence of the split off level also depends on the order or disorder of the Hg adlayer. The energetics of Hg adsorption on Cu(100) are probed using thermal desorption spectroscopy. Two different ordered adlayer structures are observed for Hg adsorption on Cu(100) at 200 K. Under some adsorption conditions and over a range of exposures, the two phases are seen to coexist on the surface prior to the thermal desorption process. A phase transition from the more dense to the less dense phase is observed to occur during the thermal desorption process. Inherent differences in defect densities are responsible for the observed differences between lateral interactions measured previously with equilibrium (atom beam scattering) and as measured by the non-equilibrium (thermal desorption) technique reported here. Theoretical and experimental evidence for an indirect through-metal interaction between adatoms is also discussed. Although through-metal interactions may play a role in some adsorption systems, there is little compelling evidence that this effect is significant in many experimental reports where the through metal bond is invoked.
Kime, Yolanda Jan
Responsiveness-to-Intervention: A Decade Later
In this introduction to this special issue, "A Decade Later," we provide an overview of the accomplishments as well as the persistent questions surrounding RTI. We organize this discussion within 3 categories: assessment, instruction, and policy. Within each of these sections, we also highlight how the articles in the present special issue expand upon the key issues. Developed initially for the early grades (kindergarten through third grade) and primarily in the area of reading, many-although not all-of these issues speak to the expansion of RTI to address a broader set of academic content areas and the full range of grade levels.
Fuchs, Lynn S.; Vaughn, Sharon
Lateral stress evolution in Chromium Sulfide
NASA Astrophysics Data System (ADS)
In this paper the shock response of CrS, a cermet of potential interest as a matrix material for ballistic applications, has been investigated. Compacts with a Chromium: Sulfur ratio of 1.15:1 were investigated via the plate-impact technique. These experiments allowed the material to be loaded under a one-dimensional state of strain. Embedded manganin stress gauges were employed to monitor the temporal evolution of longitudinal and lateral components of stress. Comparison of these two components has allowed assessment of the variation of material shear strength both with impact pressure/strain-rate and time.
Petel, O. E.; Appleby-Thomas, G. J.; Hameed, A.; Capozzi, A.; Goroshin, S.; Frost, D. L.; Hazell, P. J.
FUS mutations in sporadic amyotrophic lateral sclerosis.
Mutations in the FUS gene have recently been described as a cause of familial amyotrophic lateral sclerosis (ALS), but their role in the pathogenesis of sporadic ALS is unclear. We undertook mutational screening of all coding exons of FUS in 228 sporadic ALS cases, and, as previous reports suggest that exon 15 represents a mutational hotspot, we sequenced this exon in an additional 1295 sporadic cases. Six variants in six different cases were found, indicating that FUS mutations can underlie apparently sporadic ALS, but account for less than 1% of this form of disease. PMID:20138404
Lai, Shiao-Lin; Abramzon, Yevgeniya; Schymick, Jennifer C; Stephan, Dietrich A; Dunckley, Travis; Dillman, Allissa; Cookson, Mark; Calvo, Andrea; Battistini, Stefania; Giannini, Fabio; Caponnetto, Claudia; Mancardi, Giovanni Luigi; Spataro, Rossella; Monsurro, Maria Rosaria; Tedeschi, Gioacchino; Marinou, Kalliopi; Sabatelli, Mario; Conte, Amelia; Mandrioli, Jessica; Sola, Patrizia; Salvi, Fabrizio; Bartolomei, Ilaria; Lombardo, Federica; Mora, Gabriele; Restagno, Gabriella; Chiň, Adriano; Traynor, Bryan J
Correcting lateral chromatic aberrations by image processing
NASA Astrophysics Data System (ADS)
We have developed an image processing algorithm that reduces lateral chromatic aberration. It has been implemented in Nikon digital single-lens-reflex cameras and application software. We have developed the aberration detection method which analyzes capture images and detect the aberrations of the image without lens information. Moreover, we have developed the aberration correction method optimized for raw images, which are mosaic images with Bayer color filter array. We also have developed the correction method optimized for in-camera processed images, whose color shift structures are distorted by in-camera processing.
Utsugi, Akihiko; Ishiga, Kenichi
Blepharoplasty lateral internal suspension suture: BLISS technique.
The lower blepharoplasty procedure has had numerous surgical variations described and remains a challenge to those performing the operation. Disappointments with the technique revolve around complications such as lateral third scleral show, hollow sunken eyelids, rounding of the eye and overall long-term, tired, drawn appearance of the lower lids. Multiple adjuncts to the blepharoplasty procedure have been described. These vary in their difficulty of execution and associated complications. The concept of internal muscle suspension has been accepted as a successful adjunct by many authors but often the technique chosen has been a complicated one, adding time and complexity to the procedure. PMID:9502846
Widgerow, A D
AXR1 acts after lateral bud formation to inhibit lateral bud growth in Arabidopsis.
The AXR1 gene of Arabidopsis is required for many auxin responses. The highly branched shoot phenotype of mature axr1 mutant plants has been taken as genetic evidence for a role of auxin in the control of shoot branching. We compared the development of lateral shoots in wild-type Columbia and axr1-12 plants. In the wild type, the pattern of lateral shoot development depends on the developmental stage of the plant. During prolonged vegetative growth, axillary shoots arise and develop in a basal-apical sequence. After floral transition, axillary shoots arise rapidly along the primary shoot axis and grow out to form lateral inflorescences in an apical-basal sequence. For both patterns, the axr1 mutation does not affect the timing of axillary meristem formation; however, subsequent lateral shoot development proceeds more rapidly in axr1 plants. The outgrowth of lateral inflorescences from excised cauline nodes of wild-type plants is inhibited by apical auxin. axr1-12 nodes are resistant to this inhibition. These results provide evidence for common control of axillary growth in both patterns, and suggest a role for auxin during the late stages of axillary shoot development following the formation of the axillary bud and several axillary leaf primordia. PMID:10557232
Stirnberg, P; Chatfield, S P; Leyser, H M
Amyotrophic lateral sclerosis: one or multiple causes?
The Amyotrophic lateral sclerosis (ALS) is the most common form of motor neuron disease in the adulthood, and it is characterized by rapid and progressive compromise of the upper and lower motor neurons. The majority of the cases of ALS are classified as sporadic and, until now, a specific cause for these cases still is unknown. To present the different hypotheses on the etiology of ALS. It was carried out a search in the databases: Bireme, Scielo and Pubmed, in the period of 1987 to 2011, using the following keywords: Amyotrophic lateral sclerosis, motor neuron disease, etiology, causes and epidemiology and its similar in Portuguese and Spanish. It did not have consensus as regards the etiology of ALS. Researches demonstrates evidences as regards intoxication by heavy metals, environmental and occupational causes, genetic mutations (superoxide dismutase 1), certain viral infections and the accomplishment of vigorous physical activity for the development of the disease. There is still no consensus regarding the involved factors in the etiology of ALS. In this way, new research about these etiologies are necessary, for a better approach of the patients, promoting preventive programs for the disease and improving the quality of life of the patients.
Bastos, Aline Furtado; Orsini, Marco; Machado, Dionis; Mello, Mariana Pimentel; Nader, Sergio; Silva, Julio Guilherme; da Silva Catharino, Antonio M.; de Freitas, Marcos R.G.; Pereira, Alessandra; Pessoa, Luciane Lacerda; Sztajnbok, Flavio R.; Leite, Marco Araujo; Nascimento, Osvaldo J.M.; Bastos, Victor Hugo
Prototype cantilevers for quantitative lateral force microscopy.
Prototype cantilevers are presented that enable quantitative surface force measurements using contact-mode atomic force microscopy (AFM). The "hammerhead" cantilevers facilitate precise optical lever system calibrations for cantilever flexure and torsion, enabling quantifiable adhesion measurements and friction measurements by lateral force microscopy (LFM). Critically, a single hammerhead cantilever of known flexural stiffness and probe length dimension can be used to perform both a system calibration as well as surface force measurements in situ, which greatly increases force measurement precision and accuracy. During LFM calibration mode, a hammerhead cantilever allows an optical lever "torque sensitivity" to be generated for the quantification of LFM friction forces. Precise calibrations were performed on two different AFM instruments, in which torque sensitivity values were specified with sub-percent relative uncertainty. To examine the potential for accurate lateral force measurements using the prototype cantilevers, finite element analysis predicted measurement errors of a few percent or less, which could be reduced via refinement of calibration methodology or cantilever design. The cantilevers are compatible with commercial AFM instrumentation and can be used for other AFM techniques such as contact imaging and dynamic mode measurements. PMID:21974593
Reitsma, Mark G; Gates, Richard S; Friedman, Lawrence H; Cook, Robert F
Lateral epicondylalgia: midlife crisis of a tendon.
The pathogenesis and management of lateral epicondylalgia, or tennis elbow, a common ailment affecting middle-aged subjects of both genders continue to provoke controversy. Currently it is thought to be due to local tendon pathology, pain system changes, and motor system impairment. Its diagnosis is usually clinical, based on a classical history, as well as symptoms and signs. In selected cases, additional imaging (X-rays, ultrasound, and magnetic resonance imaging) can help to confirm the diagnosis. Different treatment modalities have been described, including the use of orthotics, non-steroidal anti-inflammatory drugs, steroid injections, topical glyceryl trinitrate, exercise therapy, manual therapy, ultrasound therapy, laser therapy, extracorporeal shockwave therapy, acupuncture, taping, platelet-rich plasma injections, hyaluronan gel injections, botulinum toxin injections, and surgery. Nevertheless, evidence to select the best treatment is lacking and the choice of therapy depends on the experience of the management team, availability of the equipment and expertise, and patient response. This article provides a snapshot of current medical practice for lateral epicondylalgia management. PMID:24584568
Luk, James K H; Tsang, Raymond C C; Leung, H B
Nappe emplacement under lateral pressure gradient
NASA Astrophysics Data System (ADS)
New thin viscous approximation is under development specifically targeted to model spontaneous initiation and tens of kilometers horizontal displacement of tectonic nappes. Nappes are few kilometers thing and tens of kilometers long rock units trusted towards foreland often preserving internal lithological consistency and laying at near horizontal position at the end of the emplacement. Significant shear stresses and deviation of principal stresses from vertical is required to explain this very peculiar strain localization style from mechanical point of view. There is also a need for the explanation of their common appearances in most collisional settings. Both pure shear thin sheet and flexural models kinematically eliminate nappes formation. Spreading viscous sheet models, such as used to model glaciers, are also not applicable as the direction of motion is upward, against gravity. The reason for this discrepancy is the hydrostatic pressure approximation of the gravity-driven spreading models. Actually, the thin sheet approximation is not sensitive to the assumptions made on pressure profile. Lateral non-lithostatic pressure gradient-driven viscous sheet model is appropriate for modeling of nappes. In turn, significant non-lithostatic pressure must be supported by flexural rigidity of overlying and underlying units. Lateral gradients of this non-lithostatic pressure are responsible for the significant shear stress and, therefore, deviation of principal stress from vertical.
Podladchikov, Yury; Schmalholz, Stefan
Confronting the Material Convoy in Later Life
We adapt a metaphor from life course studies to designate the whole of one's possessions, across time, as a convoy of material support. This dynamic collection of things supports daily life and the self, but it can also present difficulty in later life. To alleviate the purported burdens of the material convoy, a discourse has arisen that urges elders and their family members to reduce the volume of possessions. An analysis of 11 such possession management texts shows authors addressing two distinct audiences about elders' need to downsize: family members and elders themselves. Authors who speak to family members do so with an urgent, unsentimental tone that echoes mainstream clutter-control advice about disorderly, overfull households. In texts for elders, the standard critique about consumption and unruly lives is gentler, more sensitive to the meaning of things, and underplays the emotions of divestment. There is stress on the responsibility to spare the next generation and control one's legacy. These latter texts seem to respect that downsizing in later life symbolizes a narrowing of the life world.
Smith, Gabriella V.; Ekerdt, David J.
Lateral interactions in the outer retina
Lateral interactions in the outer retina, particularly negative feedback from horizontal cells to cones and direct feed-forward input from horizontal cells to bipolar cells, play a number of important roles in early visual processing, such as generating center-surround receptive fields that enhance spatial discrimination. These circuits may also contribute to post-receptoral light adaptation and the generation of color opponency. In this review, we examine the contributions of horizontal cell feedback and feed-forward pathways to early visual processing. We begin by reviewing the properties of bipolar cell receptive fields, especially with respect to modulation of the bipolar receptive field surround by the ambient light level and to the contribution of horizontal cells to the surround. We then review evidence for and against three proposed mechanisms for negative feedback from horizontal cells to cones: 1) GABA release by horizontal cells, 2) ephaptic modulation of the cone pedicle membrane potential generated by currents flowing through hemigap junctions in horizontal cell dendrites, and 3) modulation of cone calcium currents (ICa) by changes in synaptic cleft proton levels. We also consider evidence for the presence of direct horizontal cell feed-forward input to bipolar cells and discuss a possible role for GABA at this synapse. We summarize proposed functions of horizontal cell feedback and feed-forward pathways. Finally, we examine the mechanisms and functions of two other forms of lateral interaction in the outer retina: negative feedback from horizontal cells to rods and positive feedback from horizontal cells to cones.
Thoreson, Wallace B.; Mangel, Stuart C.
Lateral force transmission between human tendon fascicles.
Whether adjacent collagen fascicles transmit force in parallel is unknown. The purpose of the present study was to examine the magnitude of lateral force transmission between adjacent collagen fascicles from the human patellar and Achilles tendon. From each sample two adjacent strands of fascicles (phi 300-530 mum) enclosed in a fascicular membrane were dissected. The specimen was deformed to approximately 3% strain in three independent load-displacement cycles in a small-scale tensile testing device. Cycle 1: the fascicles and the fascicular membrane were intact. Cycle 2: one fascicle was transversally cut while the other fascicle and the fascicular membrane were kept intact. Cycle 3: both fascicles were cut in opposite ends while the fascicular membrane was left intact. A decline in peak force of 45% and 55% from cycle 1 to cycle 2, and 93% and 92% from cycle 2 to cycle 3 was observed in the patellar and Achilles tendon fascicles, respectively. A decline in stiffness of 39% and 60% from cycle 1 to cycle 2, and of 93% and 100% from cycle 2 to cycle 3 was observed in the patellar and Achilles tendon fascicles, respectively. The present data demonstrate that lateral force transmission between adjacent collagen fascicles in human tendons is small or negligible, suggesting that tendon fascicles largely act as independent structures and that force transmission principally takes place within the individual fascicles. PMID:17931846
Haraldsson, Bjarki T; Aagaard, Per; Qvortrup, Klaus; Bojsen-Moller, Jens; Krogsgaard, Michael; Koskinen, Satu; Kjaer, Michael; Magnusson, S Peter
Summary of Methods for Calculating Dynamic Lateral Stability and Response and for Estimating Lateral Stability Derivatives
NASA Technical Reports Server (NTRS)
A summary of methods for making dynamic lateral stability and response calculations and for estimating the aerodynamic stability derivatives required for use in these calculations is presented. The processes of performing calculations of the time histories of lateral motions, of the period and damping of these motions, and of the lateral stability boundaries are presented as a series of simple straightforward steps. Existing methods for estimating the stability derivatives are summarized and, in some cases, simple new empirical formulas are presented. Reference is also made to reports presenting experimental data that should be useful in making estimates of the derivatives. Detailed estimating methods are presented for low-subsonic-speed conditions but only a brief discussion and a list of references are given for transonic- and supersonic-speed conditions.
Campbell, John P; Mckinney, Marion O
Medial patellar subluxation without previous lateral release: a case report.
Medial patellar subluxation (MPS) is normally described following a lateral release. We report on a 14-year-old girl with MPS without previous lateral release. Arthroscopic examination demonstrated MPS at 0 and 30° of flexion, and the patella was tight in flexion on the lateral side. A low lateral release with a tibial tubercle transfer was performed, followed by repair of the lateral release with an iliotibial band flap, and lateral patellofemoral ligament reconstruction. Excellent functional outcome was achieved. This type of patellar instability is often overlooked and a high index of suspicion is needed for appropriate diagnosis and treatment. PMID:24755851
Saper, Michael G; Shneider, David A
Macroscopic lateral heterogeneity observed in a laterally mobile immiscible mixed polyelectrolyte-neutral polymer brush.
We studied mixed poly(ethylene oxide) (PEO) and poly(2-(dimethylamino)ethyl methacrylate) (PDMAEMA) brushes. The question we attempted to answer was: when the chain grafting points are laterally mobile, how will this lateral mobility influence the structure and phase behavior of the mixed brush? Three different model mixed PEO/PDMAEMA brush systems were prepared: (1) a laterally mobile mixed brush by spreading onto the air-water interface a mixture of poly(ethylene oxide)-poly(n-butyl acrylate) (PEO-PnBA) and poly(2-(dimethylamino)ethyl methacrylate)-poly(n-butyl acrylate) (PDMAEMA-PnBA) diblock copolymers (the specific diblock copolymers used will be denoted as PEO113-PnBA100 and PDMAEMA118-PnBA100, where the subscripts refer to the number-average degrees of polymerization of the individual blocks), (2) a mobility-restricted (inseparable) version of the above mixed brush prepared using a PEO-PnBA-PDMAEMA triblock copolymer (denoted as PEO113-PnBA89-PDMAEMA120) having respective brush molecular weights matched with those of the diblock copolymers, and (3) a different laterally mobile mixed PEO and PDMAEMA brush prepared from a PEO113-PnBA100 and PDMAEMA200-PnBA103 diblock copolymer combination, which represents a further more height-mismatched mixed brush situation than described in (1). These three mixed brush systems were investigated by surface pressure-area isotherm and X-ray (XR) reflectivity measurements. These experimental data were analyzed within the theoretical framework of a continuum self-consistent field (SCF) polymer brush model. The combined experimental and theoretical results suggest that the mobile mixed brush derived using the PEO113-PnBA100 and PDMAEMA118-PnBA100 combination (i.e., mixed brush System #1) undergoes a lateral macroscopic phase separation at high chain grafting densities, whereas the more height-mismatched system (System #3) is only microscopically phase separated under comparable brush density conditions even though the lateral mobility of the grafted chains is unrestricted. The macroscopic phase separation observed in the laterally mobile mixed brush system is in contrast with the microphase separation behavior commonly observed in two-dimensional laterally mobile charged small molecule mixtures. Further study is needed to determine the detailed morphologies of the macro- and microphase-separated mixed PEO/PDMAEMA brushes. PMID:24695635
Lee, Hoyoung; Tsouris, Vasilios; Lim, Yunho; Mustafa, Rafid; Choi, Je; Choi, Yun Hwa; Park, Hae-Woong; Meron, Mati; Lin, Binhua; Won, You-Yeon