text:
Between the pines, the tombs, throbs visibly.
Impartial noon patterns the sea in flame --
That sea forever starting and re-starting.
Our voices are snatched up and swallowed by the wind as it reaches in through the open windows, the drumming noise barely allowing the music to be heard. We've succeeded in escaping once again, just the two of us, and we revel in the escapade as we laughingly watch the paysage, the scenery flow by, the world a blur around us. We feel all alone, together here in the car as we roll south towards sunnier skies and warmer climes, singing loudly to the songs that flutter and sputter out of the radio, and we are never happier than when we are together by ourselves. My hand steals across the space between the seats that separates us and my fingertips brush against the back of his hand, feeling the warmth of his skin and his smile as he glances my way and gives me that special wink he has just for me. The road slips behind us as we try and leave our worries and concerns behind us as well.
We head south, first stop Bordeaux, that majestic, monumental city. Hand in hand, we stroll through this beautiful city the color of pewter and pearls and wonder at the fact that it is, in fact, smaller than Nantes. The wide turbulent river and stunning palaces lining the spacious squares in the guise of government buildings and apartment houses give this city the feel of one so much larger and of greater importance. We stood in awe at the beauty as the cars sped past and we dodged tramway cars as they trundled down the rails. As night fell and the darkness began to envelope us, the restaurants, bars and clubs lit up one by one, strung together by the laughter and babble of clients and passers by. The city comes alive at dusk as Nantes shuts down, Bordeaux bubbles and simmers with life as Nantes slumbers. Yet we stayed only one night as the itch to move, to widen the space between ourselves and home pulled us back out onto the road, our restlessness energized by the sun.
Next stop was Sète. Husband had a conference to attend in Montpellier yet we decided to stay in the seaside "Venice of the Langudoc", Sète, a bustling port town peninsula on the Mediterranean Sea. Heavily influenced by both the Italians and Moroccans, their languages, cultures and gastronomies, the tiny center is dotted with both Halal butchers and pizza parlors while the main thoroughfares, narrow and packed with cars and people, line and weave along the waterways which themselves are studded with boats and fishing trawlers. A true fishing village in all its connotations, the buildings, now distorted with time, their elegantly decorative balconies rusted in the salty air, the once-bright yellows, pinks, blues and greens of the façades faded with sun and heat, lean towards the water as if searching for their fishermen. The ground level restaurants spill out into the street offering platters of seafood, stuffed mussels and other treasures from the sea, much to our delight! This is a predominantly poor town of immigration and fishing, the doorway to Morocco and back again, and her people's struggles are shadowed wherever we roam, from the crowded, dingy streets to the faded beauty of her buildings, yet there is something so alive in the noise and activity, a vitality that comes from the water and gathers in the cafés and bars, a vibrancy warmed and nourished by the bright sun and brisk breeze off the water that gives Sète a certain intrigue and fascination.
Thursday, my man leaves me halfheartedly, nay, sadly as he stalks out of the hotel room, leaving his heart with me for the day. I gather my forces (I hate sightseeing on my own) and head to the Musée International des Arts Modestes, The International Museum of Modest Arts, art created from everyday objects, the ordinary infused with emotion, nostalgia and meaning. I then wander over to the town's covered market which is much more impressive than I had imagined. I purchase the local gastronomic treasure, une Tielle, a very traditional tomato and octopus pie, poor man's food to be carried to work on the boats to be eaten at lunch. Along with a cold drink and an apple, I wend my way up, up, up to the top of the city and the Fisherman Cemetery, awash in white, brilliant in the blazing sunlight. Tombs old and older, many cracked and askew, each one telling a story of a loved one lost, words engraved in stone, photos of the beloved staring at me from happier times. I wind my way up and up, climbing worn stone steps, letting the sun heat my skin and push away the memories, the thoughts of my own deceased and I come across a beautiful bench of elegant chocolate-hued wood stuck in the middle of all this crude white stone and it welcomes me as the land welcomes her sailors home. I settled in ready to lunch on my Tielle when I lifted my eyes and saw that I was sharing my meager meal with Sète's own son, Paul Valéry. Poet and writer, his words, though chiseled into the tomb for safekeeping, flew out to me, touched my face, my heart than drifted out to sea.
Are the long vistas of celestial calm!
(poem Le Cimetière Marin by Paul Valéry, translation by C. Day Lewis)
Our trip ended with a stop to see his sister and mother, two sleepy days in the country, then the long drive home. Back to the daily grind, the last days of his job, a son happier to greet us than we usually expect and a Boston Terrier with a cartoon grin spread across his tiny face.
Before leaving on holiday, I created this Baked Custard Tart. Leftover egg yolks on my hands, I knew that I had to do something fast and this was it. Infused with the delicate, subtle flavor of vanilla and Amaretto and the sprinkling of almonds adding a slightly nutty hint, this creamy, rich filling bakes up light and elegant, perfectly nestled in my own tender Sweet Pastry Crust. This is the perfect dessert to serve with spring and summer's own fresh, fruity, sweet berries as I have with our own local strawberries. I decorated the cooled tart with a fine dusting of finely grated chocolate and topped it with strawberries drizzled with Verlaque's Wild Flower Honey-Infused Balsamic Reduction (a goodie bag gift from South African Food & Wine Indaba). Fabulous! And while we were basking in the glory days of vacation, this wonderful tart kept Clem excellent company, a reward for his staying behind on Marty Duty, and he finished before I had even phoned home (to check up on Marty) the first time.
I am sharing this with Jeanne of Cook Sister! who is hosting this month's Monthly Mingle (created by our lovely sister Meeta of What's For Lunch Honey?). Count on Jeanne to Spice it up with a provocative theme: Topless Tarts! And it is!
1 10-inch (23 cm) partially pre-baked Sweet Pastry Crust (recipe follows)
For the custard:
3 whole large eggs + 2 or 3 egg yolks (save the whites for macarons)
½ cup (100 g) sugar
2 cups (500 ml) whole milk or half and half (I used 1 cup heavy cream + 1 cup lowfat milk)
1/8 tsp salt
Dash ground nutmeg
½ tsp vanilla extract
1 tsp Amaretto (or replace with an extra ½ tsp vanilla extract)
1 to 2 Tbs slivered blanched almonds, optional
Fresh fruit, berries or strawberries to serve
Prepare the Sweet Pastry Pie Crust:
1 ¼ cup (175 g) flour
1/4 cup (50 g) sugar
7 Tbs (100 grams) unsalted butter, cubed
1 egg, lightly beaten
Combine flour and sugar in a mixing bowl or on a work surface. Using only your thumbs and fingertips, rub the butter into the flour until the consistency of damp sand and there are no more large chunks of butter.
Using a fork, vigorously stir in the lightly beaten egg until all the dry ingredients are moistened and a dough starts to pull together
Gather the dough together into a ball and scrape onto a floured surface. Using the heel of one hand, smear the dough little by little away from you in quick, hard strokes in order to make sure that all of the butter is blended in well.
Scrape up the dough together, re-flour the surface lightly and work very briefly and quickly until you have a smooth, homogenous dough. Wrap the ball of dough in plastic wrap and refrigerate for 15 to 30 minutes until it can be easily rolled out without sticking to your rolling pin.
Lightly butter a 10-inch x 1 ½-inch (23 cm) pie plate or dish (a 9-inch dish will work perfectly and give you a slightly deeper tart, just adjust baking time accordingly if needed).
On a lightly floured surface, roll out the dough into a disc, dusting the surface of the dough as needed to keep the dough from sticking to the rolling pin. Lift and turn the dough as you roll into a disc, keeping the table underneath the dough floured. When the disc is just larger than the pie plate, gently and lightly roll the dough around the rolling pin, lift the dough and unroll it on top of the prepared pie plate. Gently lift and press the edges of the dough into the pie plate, pressing together to "mend" any rips or holes. Trim the overhanging dough. Cover with plastic and refrigerate for 30 minutes before baking.
Preheat the oven to 400°F (200°C).
Remove the chilled Sweet Pastry Crust from the refrigerator and remove and discard the plastic wrap. Prick all over with a fork then line with a square of parchment paper and fill with pastry weights or dried beans. Bake in the preheated oven for 8 minutes, remove from the oven and, without burning yourself, remove the paper and beans and return the crust to the oven for an additional 5 minutes until set and matte and just beginning to turn golden around the edges.
Reduce the oven temperature to 325°F (165°C).
Prepare the Custard Filling while the Sweet Pastry Shell chills and bakes:
In a medium heatproof mixing bowl, whisk the whole eggs, the yolks and the sugar until blended and smooth. Heat the milk or milk and cream over medium-low heat until it just reaches the boil (you will see tiny bubbles around the edges). Very gradually pour/whisk the hot milk into the eggs and sugar, whisking continuously so the eggs don't cook, until all the hot liquid is blended in. Whisk in the salt, nutmeg, vanilla and Amaretto.
Pour the custard liquid into the hot/warm pastry shell and bake in the 325°F (165°C) oven – or better yet, place the pastry shell on the oven shelf/rack then pour the custard into the shell. This will help you avoid sloshing the custard as you lift and carry the pie dish to the oven.
Bake for 15 minutes then carefully sprinkle the slivered almonds – if using – over the top of the tart. Continue baking for an additional 15 minutes (bake for a total of 30 minutes) until the custard is set all the way to the center and just slightly puffed. If using a clear glass pie dish, you will see that the bottom of the crust is golden brown.
Remove the Baked Custard Tart from the oven and place on a wire cooling rack. Allow to cool to room temperature before chilling. You can serve the Baked Custard Tart at room temperature or chilled, but store any uneaten Tart in the refrigerator. Serve with fresh fruit salad or berries.


text:
The SPL rivals have been paired together in the draw for the quarter-finals, which will take place across the first weekend in March.
Elsewhere Celtic must overcome their League Cup semi-final conquerors St Mirren on away territory for a last-four spot.
And the semi-finals will definitely include a team from the First Division after the two remaining non-SPL sides - Hamilton and Falkirk - were drawn to meet at New Douglas Park.
Kilmarnock will host Hibernian in the last of the quarter-finals.
Hamilton v Falkirk
Dundee v Dundee United
Kilmarnock v Hibernian
St Mirren v Celtic
Ties are to be played on the weekend of March 2-3.

subset: commoncrawl


text:
By a GenomeWeb staff reporter
NEW YORK (GenomeWeb News) – AltheaDx today said that it will collaborate with the Nicholas Conor Institute for Pediatric Cancer Research on developing molecular diagnostic tests for pediatric cancer.
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In Science this week: caution urged in use of gene drives, and more.
NIH's Sally Rockey examines the tapped and untapped potential of the NIH peer reviewer pool.
PLOS Biology has asked researchers how they envision the future of genetics and genomics.
Representative Lamar Smith brings back a provision to require the National Science Foundation to certify that each study it funds is "in the national interest."
This online seminar will provide examples of how commercial and hospital-affiliated clinical labs are successfully developing and deploying high-throughput next-generation sequencing-based testing services for genetic diseases.
This webinar will discuss the benefits of a rapid targeted next-generation sequencing (TNGS) panel, using dried blood spots, for second-tier newborn metabolic and hearing loss screening and its immediate utility for high-risk diagnostic testing in the neonatal intensive care unit.
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May 11, 2013, 11:00am
The Ridgefield Playhouse
80 East Ridge Road, Ridgefield CT 06877
May 11, 2013, 6:30am-12:00pm
Walnut Hill Park
Lindwood Street, New Britain CT 06052
May 11, 2013, 12:00pm
Compo Beach
Westport CT
May 11, 2013, 2:00pm
May 11, 2013, 10:00am-2:00pm
Merwin Meadows Park
Wilton CT
May 11, 2013, 12:00pm-2:00pm
Chelsea Piers Connecticut
1 Blachley Road, Stamford CT 06902
May 11, 2013, 12:00pm-3:00pm
Black Bear Saloon
80 Washington st, Norwalk CT 06854
May 11, 2013, 7:00pm
Quick Center for The Arts at Fairfield University
1073 North Benson Road, Fairfield CT 06824
May 11, 2013, 8:00pm
Ridgefield Playhouse
Voices Cafe at the Unitarian Church in Westport
10 Lyons Plains Road, Westport CT 06880
May 11, 2013, 7:30pm-9:30pm
Norwalk City Hall-Concert Hall
125 East Avenue, Norwalk CT 06851
May 11, 2013, 12:00am
Every 3 weeks on Sun, Mon, Tue, Wed, Thu, Fri, Sat until May 18, 2013 at 10:00am
Knights of Columbus Hall
333 Unquowa Road, Fairfield CT 06824
Every day at 4:30pm-7:30pm
Sono Field House
365 Dr Martin Luther King Dr, Norwalk CT 06854
Every Thursday, Friday, Saturday at 4:00pm
Bottlerocket Westport
1790 Post Rd. East, Westport CT 06880
Every day until Jun 24, 2013 at 7:00am
INTENSITY Fitness . Tennis . Dance
490 Westport Ave, Norwalk CT 06851
Every Sun, Wed, Thu, Fri, Sat until May 12, 2013 at 12:00pm-4:00pm
Ridgefield Guild Of Artists
34 Halpin Lane , Ridgefield CT 06877
Every day until Jun 30, 2013 at 12:00am-11:30pm
Ridgefield Guild Of Artists
34 Halpin Lane , Ridgefield CT 06877
Every day at 10:45am-11:45am
staple High School
70 North Avenue, Westport CT 06880
Every Saturday at 9:00am-12:00pm
The Onion Barn
Rt. 57, Weston CT 06883
Every day at 6:30pm
Redding Roadhouse
405 Redding Road, Redding CT
Every day at 12:00pm
Anywhere (Online)
Every Saturday at 10:00am
Cranbury park
norwalk, ct
Every day at 3:00pm
Lumberyard Pub
2 main st, Redding CT 06896
The Weston Public Library
Every day at 10:30am-11:00am
Mark Twain Library
Children's Story Time Room, CT
Every day at 9:00am
All About You Medical Spa
1891 post rd Suite B, Fairfield 06824
Every Sun, Wed, Thu, Fri, Sat at 12:00pm-4:00pm
Ridgefield Guild of Artists
Every Saturday at 9:00am-6:00pm
Dog Gone Smart Canine Center
15 Cross Street, Norwalk CT 06851
Every day at 12:00am
Fairfield University
1073 North Benson Road, CT 06824
Aug 5, 2015, 12:00am-4:00pm (until Jul 21, 2013)
Fairfield Musuem and History Center
370 Beach Road, Fairfield CT 06824
Every day at 11:00am
263 Riverside Avenue, Westport CT 06880
Every day at 1:00pm
Every day at 1:00pm-2:00pm
Joy2Crafts Studio
Connecticut's Beardsley Zoo
1875 Noble Avenue, Bridgeport CT 06610
Every day at 12:30pm-1:30pm
mystical parlors
17 washington avenue, norwalk, ct CT
Every day until May 21, 2013 at 9:00am-7:00pm
Cassio Pet Resort and Training Center
173 Mount Pleasant Rd, Newtown CT 06470
Every day until May 31, 2013 at 11:00am-5:00pm
Westchester Sandbox Theatre
931c E. Boston Post Rd, Mamaroneck NY 10543
Every Wed, Thu, Fri, Sat until May 31, 2013 at 9:30am-5:00pm
Geary Gallery
576 Boston Post Road, Darien CT 06820
Every day until Jun 2, 2013 at 9:00am-4:00pm
Cherry Lane Park
Wilton CT
Every day at 10:30am
Westport Weston Family Y
59 Post Road East, Westport. CT, CT
Every day at 3:00pm-2:00pm
COLLEGE nannies + tutors | wilton
396 Danbury Rd #B6, Wilton CT 06897
Gaelic American Club
74 Beach Road, Fairfield CT 06824
Every day at 1:00pm-11:00pm
238 Danbury Rd, Wilton CT 06897
Every day at 5:30pm-8:00pm
Greenwich Woods Healthcare Center
1165 King Street, Greenwich CT 06831
Every day at 10:00am
Downtown Westport
Parker Harding Plaza & Gorham Island, Westport CT 06880
Sacred Heart University
5151 Park Avenue, Fairfield, CT 06825 CT
Every Friday, Saturday at 9:00pm-12:00am
2 Main St, Redding CT 06896
FAIRFIELD COUNTY, Conn. -- Put down your beer or mixed drink ...
WESTPORT, Conn. -- Matthew Morrison will be among the Broadway talents ...
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text:
Ricky will make his first Sprint Cup career start at Phoenix this weekend in the Subway Fresh Fit 500. Ricky has six Nationwide career starts, earning three top-five and six top-10 finishes. Ricky has completed 100% of the laps ran at PIR in the Nationwide Series and has never finished out of the top-10 at PIR! Be sure to check out all of Ricky's statistics and thoughts on racing at Phoenix International Raceway in the full preview!
NASCAR Sprint Cup Series:
Sunday March 3rd, 2013
Subway Fresh Fit 500
Phoenix International Raceway
3:00 pm ET on FOX
Click here to download the full preview (PDF format)


text:
|264 posts found
Originally posted by Acidon
fact of the matter is - now there's about a 1300 sub base constantly online, if you're an Irc buff then u can arrange 8v8 scrambles, if you play to enjoy there are pug slots 24/7, and most (most) of the a-holes stay out of general chat and just squable on the VN boards.
that solved : Dicks in trade chat, No room for new players, Too small of a player base.
I found there is a competent competitive 21+ population. Nice to get away from the over-compensatingly competitive 12+ population I run into w/ WoW and eq2
That being said, I'm as biased as any other person here.
If it aint broke - dont fix it. ~ but you can certainly polish it!
a new graphics engine would probably double the subs which isn't saying a lot.
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Originally posted by Vulturnus
doesn't matter what game you play or log into - min/max'rs are everywhere. ML's you flat out get when you ding 50. The game has literally funneled an overwhelming amount of "Help a Buddy Out" buttons. Bounty points will min max you'r gear with BP items, buy your MLs, and i think CL's too now (definitely not certain on that though).
IMO DAoC is much more of a community than eq2 w/ eq2flames . com , wow w/ the official blizz forums etc. And it's a sub 5k subscription platform who's main web forum is through VN....
Make the game into what you want. The champion quests / Epic lines are absolutely great. sure i don't want to run to lyonesse to bop a goblin and run back to CS to hand in it's eye, but the epic lines literally forced you into the content. much more-so than EQ's epic lines from Kunark, Their 1.5's and the 2.0's. (not knocking EQ's epic quests)
Player's make the community.
If you want casual/daily ease play WoW.
If you REALLY want competitive PvE load eq2
If you want a unique PvP or RvR experience load DAoC.
And If you want to succeed in school, you have to uninstall all 3 for your senior semester. :( FML
Novice Member
Joined: 8/12/03
I dream of a 3 faction RvR game without guilds and Teamspeak disabled.
Guilds, especially pre-made Guilds are the Death of any "Realmpride".
Stop thinking about A vs B
Advanced Member
Joined: 4/22/06
Originally posted by Deleted User
Upgrade DAoC graphics engine and I am resubbing right now!!
I would also buy and play a DAoC 2... But after reading this reply, I think A new enigine for DAoC would be better than a part 2
Side note / Plug : Mythic offers a free 10 day Come Back and Play period. your toons your account entire game no limits etc.
Novice Member
Joined: 7/13/10
I want an mmorpg where pvp matters, my enemies are not my race or class, and community matters.
Originally posted by Stradden
Twenty-five pages on this topic, and yet DAoC will remain gagged in a basement while the Warhammer employees try to keep Warhammer from drowning - all for the sake of their investor's interests. What a damned shame. I just wish some wealthy gamer (Robin Williams?) who loved DAoC, would buy the rights to it and let it grow. Damn how I wish that.
1. New engine
2. 30 mins to 1 hour on a realm timer (if even allowed)
3. A complete deletion of ToA, Master Levels, etc (even if they are "easy to achieve" they are still not part of what made the game great).
The Warhammer folks know their struggling Games Workshop title would die if DAoC was freed from her shackles. But, since these people are all about the money and could care less about what the fans want (at least an Origions server??!!), then it is arguably possible that a wealthy investor could buy the rights out from under their noses.
Am I just dreaming?
/My 2 cents - Robin Williams, where are thou good sir? =D
Apprentice Member
Joined: 1/06/08
Originally posted by Comaf
I'm right there with you. I'm so disgusted with the way current MMOs are going, I'm thinking about re-subscribing to DAoC. Downloading the trial now.
Novice Member
Joined: 9/17/04
EQ1 was my first that opened my eyes to the world of MMOs, DAoC was my second and was the MMO I called home for years.
Going go D/L the trial and give it a spin.
Novice Member
Joined: 7/13/10
I want an mmorpg where pvp matters, my enemies are not my race or class, and community matters.
Originally posted by Stradden
Massively multiplayer game launches have pretty much become a joke lately. After the chaos at the EverQuest launch and the clumsy launches of both WWII Online and Anarchy Online, most people just decided that any MMORPG wouldn't be worth playing until it has been out for a month or so.
Dark Age of Camelot from Mythic Entertainment takes that perception and shatters it. From day one, the game has been stable with only a few minor bugs to cause players grief. Instead of logging on to find the servers down on day one, each was up and I was able to get right into the game with no problems.
The above were two reviews from 2001. Note how the second review sounds like a lot of things have not changed in 10 years. Massively multiplayer game launches have pretty much become a joke lately
So, here we have two references from 2001 - one month after Dark Age of Camelot released. The game broke barriers, raised the bar, and blew away the competition. They saw EQ's endless quest grinds and made a mistake in 2003 or so with Trials of Atlantis - but even with that - the game was still far more pvp depth than anyone has yet to experience (eat your heart out Warhammer).
But, DAoC is dead if you discount the 3k players on Ywain server. The game lost its luster for me when they allowed you to transfer to an enemy realm on the same server in under 6 minutes. What happened was the pvp' die hards that needed daoc until a new sandbox came out (Darkfall, Mortal Online), ended up just logging on whatever realm that was "pwning" the most at any given moment. Twenty-five players of Faction A would log and twenty-five players of faction C would log in - in about 6 minutes. Realm pride died, and the sense of Us vs Them vs The other guys died.
Mythic was bought up by EA/Bioware and DAoC, a game that with a little investment could had destroyed any concept of Warhammer, was instead swept under a carpet with a lot of her staff including Mark Jacobs (president) were fired/layed off. It was a buy out and delete move and very corporate. Good for Warhammer since they created a propoganda team that lied non stop about game imbalancing and endless boredom what they referred to as RvR IN THE FACE - myself and all my daoc buddies referred to as "oh god, seriously?."
DAoC 2 had a great start. Made a mistake a few years down the road, then WoW came out and every developer since has tried to create their own capture the flag battleground game with 2 factions and generic lore.
What a shame.
Apprentice Member
Joined: 4/09/11
The biggest draw back to bringing back DAoC community in this day in age is almost impossible. You think now about all the Vet. DAoC players and think of how much they've aged. Most people who truly played within the first 4-5 years of the game have a completely different mindset to the players of today. WoW was the breeding ground for trolls, and since it's inception has only increased by 1000x fold. The same courtesy you'd see in DAoC today isnt the same you'd see in most MMO's of today. It suck b/c DAoC had an amazing array of revolutionary ideas, even though some like to say it was the bane of the game. CC and an exorbinant amount of classes, RVR, Guild houses, unique grinds, world bosses that werent as bad as EQs, etc. I mean the things it brought to the table are limitless but, I think bringing back DAoC would be a terrible call. It would be like putting two warring tribes together in the same house without any restrictions. Not only would you alienate an older crowd, you'd cause an outcry to a company that kinda has a track record after Warhammer of not being able to keep up with its customers.
Novice Member
Joined: 12/20/05
new frontiers and toa killed daoc, the game was soo much fun and you never had to look far for people to kill. just get to a mile gate, or past a mile gate and find some lowbies to kill, always made the big boys come out in force
Novice Member
Joined: 5/20/07
DAoC was the best pvp mmo ever made, simple. Mythic's warhammer made me sick... how could they have fallen so far from what they first created. DAoC 2 would challenge and beat WoW IMO.
Made History
Joined: 7/11/11
Pink, it's like red but not quite.
Honestly, if I were Mythic, I wouldn't touch it with a ten foot pole.
No matter what you create as "2nd Edition", it will not live up to the rose-colored memories from years past. See: EQ2.
Self-pity imprisons us in the walls of our own self-absorption. The whole world shrinks down to the size of our problem, and the more we dwell on it, the smaller we are and the larger the problem seems to grow.
Novice Member
Joined: 1/09/12
I agree with pretty much most of the article, however there is one part i strongly disagree on.
Limiting servers.
Although there is a valid point there, stating that it would create a closer comunity, limiting server population in this day and age just not advisable. We now live in an age where people are measuring and comparing the health of mmo's and the amount of people seen online at once factors heavily in that comparison.
As an example head over to the EVE online forums, you will on a daily basis see posts complaining that EVE is dying and losing players, heck they have 40k people playing on one server at a time.
Age of Conan is another one, thye usually have roughly 1.5k to 2k people playing on each server at one time in peek hours, a similar number to what is proposed. Look at their forums . "the game is dying" is a common theme.
Simply put nowdays people compare player numbers with other high population games such as WoW and EVE, if they don't see at least a 10% figure they will say the game is dead and move on.
Add into that people who play and invite their friends to play only to find the server is cap'd and their friends can't play on the same realm/server as them, the new player might say screw it i'll play something else, leaving the existing player with a decision .. to stay and lose a friend or to fidn another game to play with that friend .. i knwo what my choice would be.
Apprentice Member
Joined: 1/11/12
Wow... DAoC. I tried a couple of other games a couple of years post DAoC... nothing ever challenged, thrilled, or inspired like DAoC. I haven't played a MMO for 5 or 6 years, and not interested in playing one again... A DAoC 2.. I'd play.
Like most people here, and those I am still in contact with, I think Mythic lost its customer base, or began to with ToA... I was okay with the idea of expansions, new races, new classes, but what truly aggravated me, along with so many others I know is that it forced a person to recreate their characters. I began DAoC 1 month after launch... I grinded to 50... and oh what a grind it was in early DAoC, all of that so that I could RvR...
I loved the realm pride, and guild pride that was in DAoC... I'm kind of gettng to be an old guy, but I'd play DAoC released in its early form again in a heartbeat, or a sequal that emulated the early edition....
Garrock "The Hand of Uruz"
Arsham Applefinder rr11 shaman
Hard Core Member
Joined: 1/02/08
"Always borrow money from a pessimist. They won't expect it back."
Originally posted by flibodob
Those two things killed the game for me too.
What happens when you log off your characters????.....
Apprentice Member
Joined: 7/15/08
WAR was supposed to be the successor to DAoC but failed......ALot of people would like to see DAoC remade with todays graphics though......Like a previous post said, the CC in both WAR and DAoC made both games a nightmare.....
Apprentice Member
Joined: 7/08/12
If Dark Age of Camelot updated and released a new version of the same game, I'd be fighting for a chance to be on the list of playtesters. DAoC was the first MMORPG I ever played and the only one I still miss. My friends and I still talk about it. I still chat occassionally with friends of mine who I met through DAoC. We always mention that if DAOC ever released a DAOC: 2 that we'd get the guild back together and own RVR again! We all stopped because it wasn't being updated well enough. There weren't enough CSRs to handle issues quickly and it started to die. It just needed a CGI makeover and more CSRs and it would have been set up. It truly was the best MMORPG ever. It was...EPIC. And I agree wholly with what was stated about how keeping the realms small made it more personal. Our guild knew what guilds to watch out for in RVR. We knew to avoid certain areas because they were "camping" areas for certain guilds and we knew the guilds (and lots of times the names of the characters and/or people). It was amazing and I challenge Mythic to bring it back. I think they'd be overwhelmed with the positive response. Just gotta update the graphics, races, etc. and you'll be all ready to roll. The premise and the setup of the game were the best. 3 realm RVR was epic. BGs were perfect. Yeah...I'm 31 years old and it makes me giddy like a school boy. I miss this game.
Joshua Manning
TPO Giankarlo-Guinevere
Advanced Member
Joined: 9/18/04
Killer 73.33%
After WAR and TOR... I definitely do not want a sequel. DAOC2 would end up being some frankenstein monstrosity. I have no faith in either development group after those products. Things can change, but they will have to earn my respect again. Until then I am more than happy to let DAOC2 sit on a back burner.
- Never underestimate the predictability of stupidity.
Novice Member
Joined: 9/12/12
DAoC 2!!!!!!!!! Make it happen people. I can't beleive we've waiting this long and still nothing.


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Mesh Inset Racerback Bodysuit
Style # 207770
With sheer back mesh panel and a soft lightweight stretch, this bebe bodysuit is sure to lend your weekend wardrobe a sportif-chic punch. Try it with a circle skirt and a leather jacket for a flirty day look.
- 92% nylon, 8% spandex
- Center back to hem: 18" (46 cm)
- Hand wash
- Imported
- Model is 5'9" and is wearing a US size S
Rated 5 out of 5�by 1 reviewer.
Rated 5 out of 5�by NikkieGiovanni Great go to bodysuit I got this bodysuit on sale a couple of weeks ago to wear with one of my trumpet skirts and I really like it. It can be dressed up or down and can also be edgy due to the mesh detailing. I normally get a Small in my body suits but I got this in an Xsmall so that I could avoid wearing a bra with it. It worked out geat for me February 9, 2013
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The tenor Giuseppe di Stefano was born in 1921 near Catania, in Sicily. He studied with Adriano Torchi and Luigi Montesanto in Milan. After three years in the Italian army he escaped to Switzerland in 1943 and was interned. He later appeared in Swiss broadcasts and concerts that aroused considerable interest.
His official début was as Des Grieux in Massenet's Manon in 1946 in Florence, repeating the part for his first appearance at La Scala in Milan the following year. His American début was as Gounod's Faust in February 1948 at the Metropolitan, where he would regularly appear until 1952. He returned there in 1955-56 and 1965. He also sang in Mexico City (1948-52), often opposite Maria Callas. He appeared regularly at La Scala between 1952 and 1961, the latter year being the occasion of his début at Covent Garden in London. He also sang in Paris, Vienna, Berlin and Buenos Aires. Originally a lyric tenor, his first rôles included Nemorino, Rodolfo, Alfredo, Fenton and Pinkerton.
Di Stefano moved into heavier parts such as Don José, Canio, Turridu, Radames, Alvaro and, most unwisely, Otello. His voice in his early years with its smooth and liquid golden tone was considered the finest since Gigli but, regrettably, he later chose parts for which his voice was really unsuited, in addition to suffering from respiratory problems. He recorded extensively, often with Callas and Gobbi, in a whole series made by the Scala Company. Di Stefano died on 3rd March 2008 at his home in Santa Maria Hoè, north of Milan, from injuries sustained in a November 2004 attack at his family's villa in Kenya.


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Beans & Cornbread, and optical LANDecember 24, 2013 1:18 pm | by Editor | Comments
Optical local area networking has some clear advantages. It is roughly comparable in price, and can last for 50 years or more. Fiber requires vastly less infrastructure to support, and significantly less maintenance. It is far more difficult to tap, and is impervious to EMP (electro-magnetic pulse) disruption.
Born freeDecember 13, 2013 12:17 pm | by Brian Santo | Comments
Two bills were introduced to fix the video market, one from Rep. Steve Scalise, one from Rep. Anna Eshoo. You have to wonder if Scalise was even trying. Just look at that acronym: NGTMA. What are we supposed to do with that? Pronouncing it is a nightmare: N-n-ngitma? Ingateema? Nagtama?
In the media: Cox also sets its sights on TWCNovember 27, 2013 12:29 pm | by Editor | Comments
The landscape for the sell-off of Time Warner Cable continues to shift with Cox Communications reportedly joining Comcast and Charter/Liberty Media as a potential suitor. Citing un-named sources, The Wall Street Journal reported that privately held Cox was considering whether it wanted to join in on the bidding for Time Warner Cable.
Does anyone have a real reason to buy TWC?November 25, 2013 2:08 pm | by Brian Santo | Comments
Late Friday, those agitating for consolidation in the cable industry floated the notion of Charter Communications and Comcast bidding on Time Warner Cable together, then breaking it up into pieces, with each claiming chunks. The news was well received by Wall Street merger-and-acquisition (M&A) experts and investors, who bid up the values of the stock of any MSO rumored to be party to any such deal.
Last call for BrittOctober 31, 2013 12:59 pm | by Mike Robuck | Comments
After 41 years in the cable industry, Time Warner Cable CEO and Chairman Glenn Britt took part in his last quarterly earnings conference call this morning. Britt spent about the first 20 minutes of the call with analysts speaking about the state of the cable industry in general while providing his own views and experiences.
Technology is the impetus for a Comcast-Netflix dealOctober 30, 2013 12:04 pm | by Brian Santo | Comments
There is no shortage of speculation about whether Comcast doing a deal with Netflix makes business sense – some say yes, some say no – but there are few evaluations of whether a Comcast-Netflix deal makes technological sense, which is key to why a Comcast-Netflix agreement is far more likely than not.
The politics of Cox's FlareWatchOctober 3, 2013 12:50 pm | by Brian Santo | Comments
The margins on the low-cost, IP-based TV package might have been half what they were on Cox's comparable standard video package, but was that why the MSO pulled the plug on the service after only three months? Even after announcing FlareWatch was only an experiment?
Divergent paths to TV everywhereSeptember 19, 2013 12:15 pm | by Brian Santo | Comments
That service providers will have to deliver TV everywhere is a foregone conclusion, but a couple of recent announcements – one from Sling and another from TiVo – provided an interesting juxtaposition of alternatives of how to accomplish the feat.
TWC's Britt 'It's not a free market'September 9, 2013 12:59 pm | by Mike Robuck | Comments
With today marking the one-week anniversary of CBS and Time Warner Cable ending their month-long stare down over retransmission fees, and with another dustup looming between Disney/ESPN and Dish Network, Time Warner Cable CEO and Chairman Glenn Britt has some advice for pundits covering programming fee dustups: Go read the Cable Television Consumer Protection and Competition Act of 1992.
Transparent caching catching onAugust 29, 2013 4:18 pm | by Brian Santo | Comments
Transparent caching is essentially edge caching, ultimately on behalf of OTT providers. Several companies have solutions in which they cut deals with either the MVPDs or with the CDNs to do transparent caching. The amount of equipment that needs to be added can be minimized, and the improvement in quality of service (QoS) ultimately benefits everyone all up and down the value chain.
Wait a sec...August 20, 2013 1:31 pm | by Brian Santo | Comments
The cloud is being sold as the greatest innovation since the food industry started building zip-lock technology into the packages of everything from hot dogs to shredded cheese, but there have been concerns: can cloud computing scale to cover hundreds of thousands of subscribers, and aren't you just courting trouble by automatically building in too much delay? But the world is safe for the cloud, according to ActiveVideo.
RDK Management a good move by TWC, ComcastAugust 15, 2013 3:14 pm | by Mike Robuck | Comments
With the formation of RDK Management, Comcast and Time Warner Cable not only reaffirmed their own commitment in regards to developing new boxes on the Comcast RDK, but also signaled to the rest of the cable industry that the RDK was truly an open community.
OTT: an entree with a side of IPDRJuly 31, 2013 1:26 pm | by Brian Santo | Comments
Incognito Software just released data that pretty much settles the "over-the-top: friend or foe?" debate, at least in North America. OTT is has widely come to be seen as an opportunity, and MVPDs are actively preparing for it. Part of that preparation is learning how to deliberately collect, store, and analyze IPDR data.
UPC offering separate neighborhood SSID Wi-Fi accessJuly 2, 2013 11:53 am | by Mike Robuck | Comments
While Comcast announced last month that it would open up a separate, public Wi-Fi network on customers' home gateways, Liberty Global's UPC Netherlands also has second SSIDs enabled. Since most of UPC's cable plant is underground, it needed to find another way to turn on more Wi-Fi hotspots.
Charter ♥s Time Warner Cable!June 28, 2013 12:32 pm | by Brian Santo | Comments
The merger & acquisition boys are bored and frustrated, and that can spell trouble. The way these guys work is that stuff has to happen and it doesn't much matter what it is. So now the rumor mill is churning that Charter Communications, prompted by new investor Liberty Media, might buy Time Warner Cable. Or Cablevision. Or both!


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A renovation. A move. An election. I have been wrapped up in all of the nerve-wracking, nail-biting excitement, bogged down with so much frustrating, passionate activity. It has taken me away, dragged me body and soul from my work, my writing, even my cooking and baking. Lunches were more often than not sandwiches bought at the corner bakery washed down with cans of cola; dinners were more often than not pizza or kabobs. Evenings found us blottis, slumped on the sofa, cocooned deeply in layers of blankets and pillows, too exhausted both physically and mentally to do anything other than zone out in front of a movie. Nothing outside of those three activities got done in any way, shape or form. Now, I tell you one thing, I could always drag this on and on as we are still surrounded by cartons and suitcases, there are still walls to be finished and lighting fixtures to be hung. I could use this as an excuse, the excuse of the lazy, to procrastinate further, to put off until tomorrow what I should do today. But as much as I truly think that I needed that break, needed to step away for a few weeks from the expectations and deadlines, I am actually anxious to get back to work.
Focus is necessary. A clean kitchen and an orderly workspace are crucial. The head must be perfectly clear of worry, the body free from stress, the marriage in perfect working order, the children…well at their age nothing is guaranteed. A place for everything, as the old saying goes, and everything in its place. We need to create a Zen environment, Feng Shui for the soul. Bottles of wine lined up on the countertop, grumps kept at arm's length and if all goes well I might just get a little writing done.
Although toolboxes still clutter the entryway and odds and ends litter the floors, our kitchen is in good working order, the oven a dream, the stovetop burning and spluttering away non-stop as our pleasure in cooking is renewed. Husband and I have taken turns preparing homey, warming, comforting meals while the other sits perched on a stool on the other side of the island, chattering, typing or just keeping company. Sausages with lentils, a traditional Potée Limousin, chicken and mushrooms even cheese fondue and the scents and warmth pervade our new apartment turning a house into a home. Marty slips and slides across the new parquet flooring, hoping, waiting for some tasty tidbit to flip up and plop onto the floor.
I have now also set up shop in the kitchen, my laptop no longer teetering atop a pile of cookbooks and magazines on the edge of a small stand in front of our dusty, crumb-spewing toaster nor sitting on the rickety, rocking table collecting flour and sugar in between the keys, getting butter smeared across the screen and losing internet if I close the door for privacy. I can now keep one eye on the cake in the oven, jump up and give a stir to whatever is simmering on the fire and keep typing, keep writing, keep chatting to my heart's content. And, yes, I can now get back to my regularly scheduled program…
But just wait a minute there…. Not the regular regularly scheduled programming! You see, with the new home and the new workspace and the new outlook, I have decided to embrace my lovely city of Nantes and begin a journey of discovery… my own and yours. I recently attended a soirée dedicated to Le Guide Les Tables de Nantes and connected with Nantes Tourisme and Voyages à Nantes, organizations devoted to everything cultural and gastronomic about my city so I will be sharing more with you. I have also been schlepping around… oh no, sorry, strolling the streets of Nantes armed with an iphone and seeing the world through other eyes, noting the beautiful, the comic, the historic, excited at the multitude of layers and cultures surrounding me, in hidden view for all the world to see if only the world would stop and look. And these I will continue to share with you.
And Ilva, Jeanne, Meeta and I are now well ensconced in the organization of our next From Plate to Page workshop. How does Dublin, Ireland in the lovely month of May sound to you? We are tightening up the program, readying our famous post-it note challenges and have even dusted off our old website and shined it all up spiffy new…. And to kick it all off, we are offering all of our readers a very creative challenge with the chance to win one of our Somerset Plate to Page goodie bags…just read all about it here!
And in between, I have been baking. After my comforting Apple Almond Bundt Cake I craved something rich and chocolate. I returned to a favorite recipe, the Heavenly Chocolate Cupcakes, and turned it into a Bundt cake. Although, I will admit here, that the most-distinctive Bundt bumps stuck to the non-stick pan when turning it out, yet the cake came out perfect despite this gentle glitch! As I wrote in the Cupcake post:
I decided to delve into Abigail Serves, the community cookbook put together, under the watchful and formidable eye of my mother's aunt, Great Aunt Mae in 1956. Abigail Serves is the collected recipes of The United Order of True Sisters of Albany, New York. Perusing the yellowed, faded pages of this self-published cookbook, I couldn't help myself when I came across Heavenly Chocolate Cake; with such a name, who could resist? Before the days when adding a box of pudding mix to cake batter was all the rage, this recipe is based upon this very idea to create a dense, moist cake. A chocolate pudding-like cream or custard is prepared with sugar, milk, cocoa powder and an egg then added to the cake batter to create a luxuriously thick and creamy mixture. Once baked, the cake is a deep, dark chocolate, the sweetness perfectly balanced, the texture extra moist without being overly gooey and dense. Light, fluffy yet moist and tender, full-flavored, the chocolate kissed by the barest hint of espresso as I decided to replace some of the water in the batter with prepared coffee. Add to that chocolate's best friend, cinnamon, and pour it all into a Bundt pan and you have the ideal cake. No frosting needed, although lightly sweetened whipped cream never hurt anyone.
I love Bundt cakes and want to share this with Lora and Anuradha for their #BundtAMonth challenge Spicy November! Go to either of their blogs on the posts that I have linked to and see all this months fabulous entries!
And looking for even more fantastic Bundt cake recipes? How about
Grand Marnier Bundt with Chocolate Ganache Glaze
Chestnut Fondant Bundlets
Chocolate Chip Yeast Kuchen Bundt
Glazed Lemon Bundt
Apple Almond Bundt
Chocolate One-Bowl Emergency Bundlets
For the chocolate cream:
¾ cup (150 g) sugar
¾ cup (75 g) unsweetened cocoa powder
¾ cup (185 ml) milk
1 large egg
For the batter:
2/3 cup (150 g) unsalted butter
1 ¼ cups (250 g) sugar
3 large eggs
2 ¼ cup (260 g) sifted flour (sifted BEFORE measuring, not measured then sifted)
1 tsp salt
½ tsp baking powder
1 tsp ground cinnamon
2/3 cup (165 ml) cold water (replace half or all of the water with prepared coffee)
1 tsp vanilla
1 ¾ tsp baking soda
¼ cup (62 ml) warm water
Prepare the Chocolate Custard:
Whisk the sugar, cocoa powder, milk and egg together in a medium saucepan until thick, creamy and very smooth. Place the saucepan over low heat and very gently bring to a low boil. Whisking constantly, continue to cook for 2 to 3 minutes longer until it becomes a thick sauce or custard. (Once the mixture is heated, the sauce thins and then re-thickens as it cooks.) Remove from the heat, set aside and allow to cool. As I use Le Creuset, which continue to heat even after the pan is removed from the flame, I immediately scraped the custard into a heatproof Pyrex bowl to cool.
Prepare the cake:
Preheat the oven to 350°F (180°C). Generously butter one classic Bundt pan or a smaller 8 ½- or 9-inch in diameter (22-cm) and about 3 ½-inch high (9-cm) fluted pan.
In a large mixing bowl, cream the butter and sugar until blended and light. Beat in the eggs one at a time just until blended. Beat or stir in the chocolate custard in a few additions, blending thoroughly. Stir the sifted flour, baking powder, salt and cinnamon together; beat the flour mixture into the batter in three additions alternating with the cold water in two, beginning and ending with the dry ingredients. Add the vanilla.
Dissolve the baking soda in the warm water then stir quickly into the cake batter until very well blended. Pour into the prepared Bundt pan and bake in the preheated oven for 40 minutes to 1 hour, depending upon both your oven and the size of the Bundt pan being used until risen, the cake is set and a tester inserted in the center comes out dry.
Allow to cool on a rack for at least 10 or 15 minutes before running a sharp knife around the cake or loosening and turning out onto the rack to cool completely.


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SOUTH WHITLEY — Whitko's baseball team lost its second game in a row to a Three Rivers Conference opponent Wednesday.
The Wildcats fell to visiting Wabash, 9-2. The Apaches have now won four in a row.
In the defeat, Whitko is now 15-7 for the season and 2-3 overall in conference play.
Wabash built up a 5-1 lead after three, then added two more in the fourth inning and two more in the sixth. Whitko got its second run in the bottom of the sixth frame.
Ethan Nicodemus was tagged with the loss for the Wildcats on the mound.
Whitko, ranked seventh in the state in Class 3A, has a county-rivalry match-up tomorrow at home against Columbia City.
[1] mailto:email@example.com


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Apparatus for bone reinforcement, fixation and treatment of diseased or fractured bones including a supporting structure optionally coated with therapeutic agent is provided. The supporting structure or device may be collapsible upon deployment at the surgical site, and include fixation features such as anchors to securely position in place once deployed. Bone cement or other material may be provided to alternatively secure the positioned supporting structure for treatment. A lockable bone fixation device is described that comprises: a sleeve adapted to be positioned in a space formed in a bone; a guidewire adapted to guide movement of the sleeve; and an actuable lock adapted to secure the sleeve within the space of the bone from an end of the device.
1. A method for treatment of an elongate bone, an intermedullary space extending along an axis of the bone, the bone having a fracture, the method comprising;
forming an access opening traversing the intermedullary space at a placement angle to the axis of the bone;
inserting a first end of a bone fixation device into the access opening, the bone fixation device having a flexible sleeve extending between the first end and a second end along a sleeve axis;
advancing the bone fixation device from the access opening into the intermedullary space by flexing the sleeve in a plane along the sleeve axis;
rigidly affixing a section of the bone fixation device to the bone adjacent the access opening, wherein the section spans the placement angle and rigidly supports the sleeve within the intramedullary space;
locking the bone fixation device within the intramedullary space by rotating an actuator of the bone fixation device, the actuator oriented along the access opening and coupled with the second end of the sleeve by the section so that the actuator rotates about an axis of the access opening disposed at the placement angle to the axis of the bone wherein an elongate structure extends from the actuator and around the placement angle, the elongate structure having sufficient flexibility to transfer movement from the actuator to the sleeve when the placement angle is at least within a range of at least 30 to 45 degrees,
and wherein the locking of the bone fixation device imposes an axial load on bearing surfaces disposed along the sleeve so as to stiffens the bone fixation device;
deploying a plurality of teeth, with the elongate element and in response to rotating of the actuator, from an un-deployed configuration to a deployed configuration, the teeth in the un-deployed configuration disposed within an outer surface of the sleeve, the teeth in the deployed configuration extending radially outwardly from the outer surface of the sleeve through apertures in the sleeve and securing the sleeve within the intermedullary space of the bone.
2. The method of
3. The method of
wherein the bone fixation device is advanced axially while the guidewire is disposed within the guidewire lumen so that the guidewire axially guides the sleeve of the bone fixation device from the access opening, around the placement angle, and into the intermedullary space.
4. The method of
5. The method of
6. The method of
7. The method of
8. The method of
9. The method of
10. The method of
This application is a continuation application of Ser. No. 11/383,269, filed May 15, 2006 by Nelson entitled Minimally Invasive Actuable Bone Fixation Devices, to which application priority under 35 USC §120 is claimed, and which claims the benefit of U.S. Provisional Application No. 60/682,652, filed May 18, 2005 entitled Method and System for Providing Reinforcement of Bones, each of which are incorporated herein by reference in their entirety.
The present invention relates to method and system for providing reinforcement of bones. More specifically, the present invention relates to method and system for providing reconstructive surgical procedures and devices for reconstruction and reinforcement bones, including diseased, osteoporotic and fractured bones.
Bone fractures are a common medical condition both in the young and old segments of the population. However, with an increasingly aging population, osteoporosis has become more of a significant medical concern in part due to the risk of osteoporotic fractures. Osteoporosis and osteoarthritis are among the most common conditions to affect the musculoskeletal system, as well as frequent causes of locomotor pain and disability. Osteoporosis can occur in both human and animal subjects (e.g. horses). Osteoporosis (OP) and osteoarthritis (OA) occur in a substantial portion of the human population over the age of fifty. The National Osteoporosis Foundation estimates that as many as 44 million Americans are affected by osteoporosis and low bone mass, leading to fractures in more than 300,000 people over the age of 65. In 1997 the estimated cost for osteoporosis related fractures was $13 billion. That figure increased to $17 billion in 2002 and is projected to increase to $210-240 billion by 2040. Currently it is expected that one in two women, and one in four men, over the age of 50 will suffer an osteoporosis-related fracture. Osteoporosis is the most important underlying cause of fracture in the elderly.
One current treatment of bone fractures includes surgically resetting the fractured bone. After the surgical procedure, the fractured area of the body (i.e., where the fractured bone is located) is often placed in an external cast for an extended period of time to ensure that the fractured bone heals properly. This can take several months for the bone to heal and for the patient to remove the cast before resuming normal activities.
In some instances, an intramedullary (IM) rod or nail is used to align and stabilize the fracture. In that instance, a metal rod is placed inside a canal of a bone and fixed in place, typically at both ends. See, for example, Fixion™ IM (Nail), www.disc-o-tech.com. This approach requires incision, access to the canal, and placement of the IM nail. The nail can be subsequently removed or left in place. A conventional IM nail procedure requires a similar, but possibly larger, opening to the space, a long metallic nail being placed across the fracture, and either subsequent removal, and or when the nail is not removed, a long term implant of the IM nail. The outer diameter of the IM nail must be selected for the minimum inside diameter of the space. Therefore, portions of the IM nail may not be in contact with the canal. Further, micro-motion between the bone and the IM nail may cause pain or necrosis of the bone. In still other cases, infection can occur. The IM nail may be removed after the fracture has healed. This requires a subsequent surgery with all of the complications and risks of a later intrusive procedure.
External fixation is another technique employed to repair fractures. In this approach, a rod may traverse the fracture site outside of the epidermis. The rod is attached to the bone with trans-dermal screws. If external fixation is used, the patient will have multiple incisions, screws, and trans-dermal infection paths. Furthermore, the external fixation is cosmetically intrusive, bulky, and prone to painful inadvertent manipulation by environmental conditions such as, for example, bumping into objects and laying on the device.
Other concepts relating to bone repair are disclosed in, for example, U.S. Pat. No. 5,108,404 to Scholten for Surgical Protocol for Fixation of Bone Using Inflatable Device; U.S. Pat. No. 4,453,539 to Raftopoulos et al. for Expandable Intramedullary Nail for the Fixation of Bone Fractures; U.S. Pat. No. 4,854,312 to Raftopolous for Expanding Nail; U.S. Pat. No. 4,932,969 to Frey et al. for Joint Endoprosthesis; U.S. Pat. No. 5,571,189 to Kuslich for Expandable Fabric Implant for Stabilizing the Spinal Motion Segment; U.S. Pat. No. 4,522,200 to Stednitz for Adjustable Rod; U.S. Pat. No. 4,204,531 to Aginsky for Nail with Expanding Mechanism; U.S. Pat. No. 5,480,400 to Berger for Method and Device for Internal Fixation of Bone Fractures; U.S. Pat. No. 5,102,413 to Poddar for Inflatable Bone Fixation Device; U.S. Pat. No. 5,303,718 to Krajicek for Method and Device for the Osteosynthesis of Bones; U.S. Pat. No. 6,358,283 to Hogfors et al. for Implantable Device for Lengthening and Correcting Malpositions of Skeletal Bones; U.S. Pat. No. 6,127,597 to Beyar et al. for Systems for Percutaneous Bone and Spinal Stabilization, Fixation and Repair; U.S. Pat. No. 6,527,775 to Warburton for Interlocking Fixation Device for the Distal Radius; U.S. Patent Publication US2006/0084998 A1 to Levy et al. for Expandable Orthopedic Device; and PCT Publication WO 2005/112804 A1 to Myers Surgical Solutions, LLC for Fracture Fixation and Site Stabilization System.
In view of the foregoing, it would be desirable to have a device, system and method for providing effective and minimally invasive bone reinforcement to treat fractured or diseased bones.
One embodiment of the present invention provides a low weight to volume mechanical support for fixation, reinforcement and reconstruction of bone or other regions of the musculo-skeletal system. The method of delivery of the device is another aspect of the invention. The method of delivery of the device in accordance with the various embodiments of the invention reduces the trauma created during surgery, decreasing the risks associated with infection and thereby decreasing the recuperation time of the patient. The framework may in one embodiment include an expandable and contractable structure to permit re-placement and removal of the reinforcement structure or framework.
In accordance with the various embodiments of the present invention, the mechanical supporting framework or device may be made from a variety of materials such as metal, composite, plastic or amorphous materials, which include, but are not limited to, steel, stainless steel, cobalt chromium plated steel, titanium, nickel titanium alloy (nitinol), super elastic alloy, and polymethylmethacrylate (PMMA). The supporting framework or device may also include other polymeric materials that are biocompatible and provide mechanical strength, that include polymeric material with ability to carry and delivery therapeutic agents, that include bioabsorbable properties, as well as composite materials and composite materials of titanium and polyetheretherketone (PEEK™), composite materials of polymers and minerals, composite materials of polymers and glass fibers, composite materials of metal, polymer, and minerals.
Within the scope of the present invention, each of the aforementioned types of device may further be coated with proteins from synthetic or animal source, or include collagen coated structures, and radioactive or brachytherapy materials. Furthermore, the construction of the supporting framework or device may include radio-opaque markers or components that assist in their location during and after placement in the bone or other region of the musculo-skeletal systems.
Further, the reinforcement device may, in one embodiment, be osteo incorporating, such that the reinforcement device may be integrated into the bone.
In a further embodiment, there is provided a low weight to volume mechanical supporting framework or device deployed in conjunction with other suitable materials to form a composite structure in-situ. Examples of such suitable materials may include, but are not limited to, bone cement, high density polyethylene, Kapton®, polyetheretherketone (PEEK™), and other engineering polymers.
Once deployed, the supporting framework or device may be electrically, thermally, or mechanically passive or active at the deployed site within the body. Thus, for example, where the supporting framework or device includes nitinol, the shape of the device may be dynamically modified using thermal, electrical or mechanical manipulation. For example, the nitinol device or supporting framework may be expanded or contracted once deployed, to move the bone or other region of the musculo-skeletal system or area of the anatomy by using one or more of thermal, electrical or mechanical approaches.
An embodiment of the invention includes a lockable bone fixation device comprising: a sleeve adapted to be positioned in a space formed in a bone; a guidewire adapted to guide movement of the sleeve; and an actuable lock adapted to secure the sleeve within the space of the bone from an end of the device. The sleeve can be configured to be flexible, have apertures, be expandable and/or be bioabsorbable. Further, the sleeve can be removable from the space within the bone, if desired. The device is adapted and configured to access the space within the bone through an access aperture formed in a bony protuberance of the bone. In a further embodiment, a second sleeve can be provided that is adapted to fit within the first sleeve. Where a second sleeve is provided, the second sleeve can be used to control a retractable interdigitation process or teeth. The sleeve can accomplish this control by being configured with slots or apertures along its length through which the teeth extend when the slots are positioned over the teeth. Once the teeth are exposed through the second sleeve, the teeth or interdigitation process are adapted to engage bone. In still another embodiment of the invention, a cantilever adapted to retain the lockable bone fixation device within the space. Another embodiment of the invention includes adapting the sleeve to be expanded and collapsed within the space by a user. In still another embodiment, the device is adapted to be delivered by a catheter. In yet another embodiment, the distal end of the device is adapted to provide a blunt obdurator surface. In still another embodiment of the device, the distal end of the device is configured to provide a guiding tip. In yet another embodiment of the device, the device is adapted to receive external stimulation to provide therapy to the bone. In still another embodiment of the device, the device is adapted to receive composite material when the device is disposed within a lumen or opening within the body or bone.
In another embodiment of the invention, a bone fixation device is provided that comprises: a first sleeve having a retractable interdigitation process at a location along its length adapted to engage a bone; and a second sleeve sized adapted to activate the interdigitation process of the first sleeve. The bone fixation device can be configured to provide a flexible first or second sleeve. In another embodiment, the first or second sleeve can be provided with apertures, can be expandable and/or can be fashioned from bioabsorbable materials. In still other embodiments, either of the first or second sleeve can be removable. In yet another embodiment of the invention, the first and second sleeve are adapted to access a space of the bone through an access aperture formed in a bony protuberance of the bone. In still other embodiments, the second sleeve can be configured to provide a retractable interdigitation process or teeth. Apertures can also be provided in some embodiments, along the length of the device through which the retractable interdigitation process engages the bone. The apertures can, in some embodiments, be on the second sleeve. In some embodiments, the retractable interdigitation process can be adapted to engage bone when actuated by the second sleeve. In still other embodiments, a cantilever retains the bone fixation device within a space of the bone. Further, a first or second sleeve is adapted in some embodiments to be expanded and collapsed within the bone by a user. In still other embodiments, the device is adapted to be delivered by a catheter or catheter-like device. The catheter may be a single or multilumen tube. The catheter may employ methods or apparatus that power or shape the device for introduction and placement. The distal end of the device in some embodiments is adapted to provide a blunt obdurator surface. Additionally, the distal end of the device can have a guiding tip. In still other embodiments, the device is adapted to deliver therapeutic stimulation to the bone. In other embodiments the device is adapted to deliver therapeutic stimulation to the biological processes within bone. These processes are cellular in nature and provide therapeutic remedies to the health of the patient not related to bone. One such therapeutic application is anemia or hemophilia. In yet other embodiments, the device is adapted to receive composite material when the device is disposed within a lumen.
In still another embodiment of the invention, a method of repairing a bone fracture is disclosed that comprises: accessing a fracture along a length of a bone through a bony protuberance at an access point at an end of a bone; advancing a bone fixation device into a space through the access point at the end of the bone; bending a portion of the bone fixation device along its length to traverse the fracture; and locking the bone fixation device into place within the space of the bone. The method can also include the step of advancing an obdurator through the bony protuberance and across the fracture prior to advancing the bone fixation device into the space. In yet another embodiment of the method, the step of anchoring the bone fixation device within the space can be included. In still another embodiment of the method, a first sleeve and a second sleeve of the bone fixation device can be engaged to expand an interdigitation process into the bone.
An aspect of the invention discloses a removable bone fixation device that has a single end of introduction, deployment, and remote actuation wherein a bone fixation device stabilizes bone. The bone fixation device is adapted to provide a single end in one area or location where the device initiates interaction with bone. The device can be deployed such that the device interacts with bone. Remote actuation activates, deactivates, reduces bone, displaces bone, locks, places, removes, grips, stiffens device, compresses, adjusts, axially adjusts, torsionally adjusts, angularly adjusts, and releases the devices during its interaction with bone. A removable extractor can be provided in some embodiments of the device to enable the device to be placed and extracted by deployment and remote actuation from a single end. The device of the invention can be adapted and configured to provide at least one sleeve. Further the sleeve can be configured to be flexible in all angles and directions. The flexibility provided is in selective planes and angles in the Cartesian, polar, or cylindrical coordinate systems. Further, in some embodiments, the sleeve is configured to have a remote actuation at a single end. Additionally, the sleeve can be configured to have apertures. In still further embodiments, the sleeve is configured to minimize boney in-growth. Another aspect of the invention includes a bone fixation device in that has mechanical geometry that interacts with bone by a change in the size of at least one dimension of a Cartesian, polar, or spherical coordinate system. Further, in some embodiments, bioabsorbable materials can be used in conjunction with the devices, for example by providing specific subcomponents of the device configured from bioabsorbable materials. A second sleeve can be provided in some embodiments where the second sleeve is removable, has deployment, remote actuation, and a single end. Where a second sleeve is employed, the second sleeve can be adapted to provide a deployable interdigitation process or to provide an aperture along its length through which the deployable interdigitation process is adapted to engage bone. In some embodiments, the deployable interdigitation process is further adapted to engage bone when actuated by the sleeve. In some embodiments, the bone fixation device further comprises a cantilever adapted to retain the deployable bone fixation device within the space. The sleeve can further be adapted to be expanded and collapsed within the space by a user. One end of the device can be configured to provide a blunt obdurator surface adapted to advance into the bone. A guiding tip may also be provided that facilitates guiding the device through the bone. Further, the deployable bone fixation device can be adapted to receive external stimulation to provide therapy to the bone. The device can further be adapted to provide an integral stimulator which provides therapy to the bone. In still other embodiments, the device can be adapted to receive deliver therapeutic stimulation to the bone.
The invention also includes a method for repairing a bone fracture comprising: accessing a fracture along a length of bone through a bony protuberance at an entry portal; introducing the bone fixation device into the medullary canal through the entry portal; bending the bone fixation device along its length to advance into the medullary space in the bone; bending the bone fixation device along its length to traverse the fracture site; placing a flexible elbow in the medullary canal at the fracture site; stiffening the bone fixation device; locking the bone fixation device to the bone; reducing the fracture with the bone fixation device in place in the medullary canal; locking the flexible elbow to achieve intramedullary reduction of the fracture. The method can further include the step of introducing a guide wire into the medullary space through a bony protuberance at an entry portal. Additionally, the guidewire can be reamed through the bony protuberance at an entry portal. The location of the reamed boney canal can be determined by the fracture anatomy and bone anatomy. In some embodiments of the method, a sleeve can be advanced along the bone fixation device. In such embodiments, the sleeve can function to unlock the spikes from the fixation device. Once the spikes are unlocked from the fixation device, the spikes then fix the device to the bone. Locking butterfly rings can also be employed to lock the device to the bone. The butterfly rings can be locked to the fixation device in some embodiments. Additionally, the rings can be threaded over the device. In other embodiments, a guide jig guides screws through the butterfly rings. Further self tapping screws lock the butterfly rings to the bone and bone fixation device. A set screw can also be used to lock the device at the fracture site. The device can also be stiffened. In performing the method of the invention, fracture fragments can be reduced.
Yet another aspect of the invention includes a barb-screw comprising a sleeve, one or more teeth deployable at a distal end of the sleeve, and an actuable lock adapted to secure the sleeve within the space of the bone from an end of the device.
These and other features and advantages of the present invention will be understood upon consideration of the following detailed description of the invention and the accompanying drawings.
All publications, patents and patent applications mentioned in this specification are herein incorporated by reference in their entirety to the same extent as if each individual publication, patent or patent application was specifically and individually indicated to be incorporated by reference.
The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative embodiments, in which the principles of the invention are utilized, and the accompanying drawings of which:
By way of background and to provide context for the invention, it may be useful to understand that bone is often described as a specialized connective tissue that serves three major functions anatomically. First, bone provides a mechanical function by providing structure and muscular attachment for movement. Second, bone provides a metabolic function by providing a reserve for calcium and phosphate. Finally, bone provides a protective function by enclosing bone marrow and vital organs. Bones can be categorized as long bones (e.g. radius, femur, tibia and humerus) and flat bones (e.g. skull, scapula and mandible). Each bone type has a different embryological template. Further each bone type contains cortical and trabecular bone in varying proportions.
Cortical bone (compact) forms the shaft, or diaphysis, of long bones and the outer shell of flat bones. The cortical bone provides the main mechanical and protective function. The trabecular bone (cancellous) is found at the end of the long bones, or the epiphysis, and inside the cortex of flat bones. The trabecular bone consists of a network of interconnecting trabecular plates and rods and is the major site of bone remodeling and resorption for mineral homeostasis. During development, the zone of growth between the epiphysis and diaphysis is the metaphysis. Finally, woven bone, which lacks the organized structure of cortical or cancellous bone, is the first bone laid down during fracture repair. Once a bone is fractured, the bone segments are positioned in proximity to each other in a manner that enables woven bone to be laid down on the surface of the fracture. This description of anatomy and physiology is provided in order to facilitate an understanding of the invention. Persons of skill in the art, will appreciate that the scope and nature of the invention is not limited by the anatomy discussion provided. Further, it will be appreciated there can be variations in anatomical characteristics of an individual, as a result of a variety of factors, which are not described herein.
The bone fixation device is suitable for reinforcing and/or repairing a bone. Further, the bone fixation device is adapted to be anatomically conformable. Still further, the bone fixation device is adapted to cross a fracture. Once actuated, the device anchors into a portion of the bone and then draws the bone segments effected by the fracture together. Kirshner or K-wires can also be used where there are additional fracture fragments.
The bone fixation device 100 has an actuator 110 at a proximal end 102. The actuator 110 enables a user to control the movement, insertion, deployment, removal, and operation of the device. The actuator 110 has internal threads (not shown) that engage threads 112 formed on a shaft or guidewire 120. The shaft 120 extends through a proximal bearing segment 132, intermediate bearing segments 134 and terminates in a distal bearing segment 136. Interposed between the bearing segments on shaft 120 are anchoring segments 140. The bearing segments control translation and bending of the device 100. In some embodiments, the bearing segments can withstand, for example, up to 800 lb of axial loading force. The anchoring segments 140 have radially extending teeth or grippers 142 that deploy upon actuation of the device 100 to interlock the device with the bone, as explained below.
The outer sheath 150 is a component of the device 100. The outer sheath surrounds a portion of the exposed length of the device 100. Slots 152 are provided along its length that enable the teeth 142 of the anchoring segment 140 to extend radially away from the external surface of the device 100 and into the bone when the device is actuated. The slots 152 can also be adapted to promote or control bending of the device, as will be appreciated below. In
Turning now to
513 or adapted to provide an indicator to facilitate deploying the teeth by providing an indication to the user of the relative position of the teeth relative to the slots on the sheath and relative to the plane within the bone. Thereby establishing the direction of flexibility of the device while in bone. Additionally, a central aperture 519 which forms a keyway can be provided for engaging an additional tool or device to control the deployment of the bone fixation device. For example, the central aperture 519 can be in the shape of a slit to accept, for example, the head of a flat head screw driver.
Turning now to
A challenge in bone fixation across the diaphysis to the metaphysis has been securing the cancellous bone in the metaphysis. This bone is sponge-like and can be brittle or vacuous, particularly in osteoporotic patients. A physician must choose between rigid to rigid surface fixation and rigid to porous surface fixation. One embodiment of a system capable of achieving rigid to porous fixation in skeletal bone is described here.
The actuable barb screw is adapted to provide a small diameter with great amount of surface area upon deployment; a combination of screw and barb capture modalities; locking threads to the device 3601; and an activation by removal of external force or by imparting energy to the device by thermal, electrical, optical, or mechanical means. Any frequency of the spectrum of electromechanical radiation may be used to impart such energy to the system.
As will be appreciated by those skilled in the art, the actuable barb screw can be configured to provide superior holding force and capture by employing rigid materials that change their radius of capture area after undergoing a change. Further, the barbs may be configured to be displaced as threads to aid insertion of the barb-screw.
Additional embodiments, methods, and uses are envisioned in accordance with the inventive attributes. Thus, for example, the drill can be used to bore an access opening into the trabecular (cancellous) bone at a bony protrusion located at a proximal 4401 or distal 4402 end of
In accordance with one embodiment of the method, an incision 4501 as shown in
A drill bit may be operated 4502 by the surgeon to bore an opening to create a space within a central portion of the fractured bone. See, U.S. Pat. No. 6,699,253 to McDowell et al. for Self-Centering Bone Drill. Although, as will be appreciated by those skilled in the art, any tool capable of boring through the layer of tissue and into the fractured bone may be used without departing from the scope of the invention. One example of such a device includes, but is not limited to, a coring reamer 4601 as shown in
The drill or reamer can be operated along the length of the bone in order to reach the location of the bone fracture. As would be appreciated by those skilled in the art, the use of a flexible reamer may require distal guidance 4602 to prevent inadvertent injury or damage to the surrounding bone. In order to provide such guidance, a wire, or other thin resilient, flexible entity of minimal cross sectional size, can be provided to provide such guidance. The guide wire is placed subsequent to creation of the access site and exposure of the space. A secondary access hole 4603 can be created distal to the initial access. The guide wire is then deployed using standard technique into the bone space, across the bone from the proximal access hole to the secondary access hole. Further, the device can use its distal end as an obdurator to create a path through the bone, through the intramedullary space, and/or across a fracture, is desired.
A centering entity 4604, may be used to "float" the guide wire away from the extremities of the inside feature of the space and bone. The guide wire and centering entity may be left in place throughout the procedure and may be present considerable advantages for subsequent cleaning, and placement of the reinforcement device. The second distal access may be optional. The centering entity, or visualization under fluoroscopy, may obviate the need for the distal access. In this embodiment of the use of the guide wire, the centering entity can be used independently of the distal access. Another embodiment eliminates both the distal access and the centering device. In that embodiment, only the guide wire is used to center the reaming tool. In another embodiment the guide wire is not used. The reaming tool is centered by technique of visualization under fluoroscopy or other means.
Thereafter, a channel within the bone, such as within the intramedullary space, is created and is cleaned to remove the bone and fat debris prior to the deployment of the reinforcement device through the space within the fractured bone. Irrigation and cleaning of the channel created in the bone would be accomplished using techniques known in the art. For example, irrigation can be accomplished using water, saline or ringers solution. Solutions that include other solutes may also be beneficial; for example, solutions of having functional or therapeutic advantage, as well as growth stimulation and anti-infection agents such as antibiotic, including gentomiacin.
A lavage system can also be used, such as a lavage system 4701 shown in
The coring reamer or drill can be used to create a space within the fractured bone, as well as past the location of the fracture itself The lavage system can be similarly configured to clean the debris within the space including at the location of the fracture. The reamer or drill may traverse the fracture site independently or in conjunction with a protective sheath across the fracture site. As will be appreciated by those skilled in the art, the space may be reamed from both ends, from a proximal opening and a distal opening up to the fracture site.
As discussed above, in accordance with one embodiment of the present invention, the physical trauma to the patient is substantially minimized in treating the bone fracture by limiting the incision to a relatively small location corresponding to the proximal end of the fractured bone, allowing faster patient recovery and wound healing.
This procedure can use a smaller opening than the procedure used for an intramedullary nail. Further, the device and its operation, minimizes or eliminates the risk of pain or necrosis of the bone.
Candidate materials for the devices and components would be known by persons skilled in the art and include, for example, suitable biocompatible materials such as metals (e.g. stainless steel, shape memory alloys, such a nickel titanium alloy nitinol) and engineering plastics (e.g. polycarbonate). See, for example U.S. Pat. No. 5,190,546 to Jervis for Medical Devices Incorporating SIM Memory Alloy Elements and U.S. Pat. No. 5,964,770 to Flomenblit for High Strength Medical Devices of Shape Memory Alloy. In one embodiment, the outer exoskeleton or sheath may be made of materials such as titanium, cobalt chrome stainless steel. Alternatively, the sheath can be made of biocompatible polymers such as polyetheretherketone (PEEK), polyarylamide, polyethylene, and polysulphone.
As will be appreciated by those skilled in the art, the polymer or thermoplastic used to make any of the components of the device, such can comprise virtually any non-radiopaque polymer well known to those skilled in the art including, but not limited to, polyether-etherketone (PEEK), polyphenylsolfone (Radel®), or polyetherimide resin (Ultem®). If desired, the polymer may also comprise a translucent or transparent material, or a combination of materials where a first material has a first radiopacity and the second material has a second radiopacity. Suitable PEEK can include an unfilled PEEK approved for medical implantation. The devices and components can be formed by extrusion, injection, compression molding and/or machining techniques, as would be appreciated by those skilled in the art.
Other polymers that may be suitable for use in some embodiments, for example other grades of PEEK, such as 30% glass-filled or 30% carbon filled, provided such materials are cleared for use in implantable devices by the FDA, or other regulatory body. The use of glass filled PEEK would be desirable where there was a need to reduce the expansion rate and increase the flexural modulus of PEEK for the instrument. Glass-filled PEEK is known to be ideal for improved strength, stiffness, or stability while carbon filled PEEK is known to enhance the compressive strength and stiffness of PEEK and lower its expansion rate. Still other suitable biocompatible thermoplastic or thermoplastic polycondensate materials may be suitable, including materials that have good memory, are flexible, and/or deflectable have very low moisture absorption, and good wear and/or abrasion resistance, can be used without departing from the scope of the invention. These include polyetherketoneketone (PEKK), polyetherketone (PEK), polyetherketoneetherketoneketone (PEKEKK), and polyetheretherketoneketone (PEEKK), and generally a polyaryletheretherketone. Further other polyketones can be used as well as other thermoplastics. Reference to appropriate polymers that can be used in the tools or tool components can be made to the following documents, all of which are incorporated herein by reference. These documents include: PCT Publication WO 02/02158 A1, to Victrex Manufacturing Ltd. entitled Bio-Compatible Polymeric Materials; PCT Publication WO 02/00275 A1, to Victrex Manufacturing Ltd. entitled Bio-Compatible Polymeric Materials; and PCT Publication WO 02/00270 A1, to Victrex Manufacturing Ltd. entitled Bio-Compatible Polymeric Materials. Still other materials such as Bionate®, polycarbonate urethane, available from the Polymer Technology Group, Berkeley, Calif., may also be appropriate because of the good oxidative stability, biocompatibility, mechanical strength and abrasion resistance. Other thermoplastic materials and other high molecular weight polymers can be used as well for portions of the instrument that are desired to be radiolucent.
Moreover, the outer exoskeleton structure, or sheath, may be a hybrid of metal components to accommodate the interdigitation features or die tubular part of the exoskeleton.
In still other embodiments, the device or components can be coated with therapeutic agents or can be configured from polymers with therapeutic agents incorporated therein.
The device may be of a variety of lengths and diameters. The length and diameter of the device may be determined by the fracture site and patient anatomy and physiology considerations. The length must traverse the fracture across its angularity to the internal diameter. The diameter ranges from the minimum to the maximum internal diameter for the space. Though not restricted to these values, the length may vary from 1000 mm to 1 mm and the diameter may range from 0.1 mm to 100 mm. These interdigitation features are designed to penetrate 25 to 75% of the cortical bone at the site of the fracture. The designs of the device allow for a multiple lengths of interdigitation in different devices and within the same device.
The interdigitation features, upon full deployment, may be configured to open out and into the surrounding bone to hold in place the fragments of the fractured bone. This can be achieved with the use of an inner sleeve 4901 as shown in
As will be appreciated by those skilled in the art, the device can be configured such that an outer sleeve is removable upon deployment of the interdigitation feature (e.g. expansion of the teeth away from the central axis). In another embodiment, the inner sleeve 5001 as shown in
While the description above relates to cross bone deployment, this stabilization device is suitable to communicate anatomical forces across any areas of weakened bone. The location of the weakened bone is identified by suitable diagnosis. The cross bone stabilization device 5101 as shown in
After positioning the reinforcement device at the desired location within the space so as to substantially be in contact, with the bone fracture, using a K-wire driver 5201 as shown in
More specifically, upon complete removal of the introducer described above from the central aperture, the bone fragments can be attached to the device by K-wires deployed using a K-wire driver so that the fragments are substantially and properly aligned with the bone structure guided by the reinforcement device during the recuperation process. Furthermore, optionally, bone cement, allographic bone, harvested bone, cadaver bone or other suitable bony matrices maybe introduced into the space after removing the introducer to substantially fill the space from the incision site to the reinforcement device. Moreover, prior to closing the incision site, a bone plug may be deployed at the opening of the space of the bone to substantially seal the bony matrix and/or to seal the space.
After the device has been implanted according to any of the techniques described herein, the incision site is closed with stitches, for example, to allow the fracture, and the fragments to heal.
In another embodiment of the device includes a plurality of independent structural members with inner or outer position across weakened or fractured bone. Though each independent structural member is placed uniquely in bone additional wires, threads, sutures may tie these together across bone so that the plurality of structural members are linked and form a rigid construction that resists anatomical and typical patient loading and forces. In
In similar construction an expandable device 5401 as shown in
In another example, the upper trochanteric region of the bone or other region of the musculo-skeletal system may be exposed and a hole may be cored out of the femoral neck 5501 as shown in
A corollary embodiment of the previously described art include axial translation from distal to proximal ends of the device thereby drawing bone and tissue together through shortening the axial distance distal to proximal. These embodiments have specific applications in fracture non-unions, joint fusions and certain fractures.
The devices disclosed herein can be deployed in a variety of suitable ways, as would be appreciated by those skilled in the art. For example, a provisional closed reduction of the fracture can be performed wherein a 1.5 to 2 inch incision is made overlying the metaphyseal prominence of the bone. Blunt dissection is then carried to the fascia whereupon the fascia is incised. The surgical approach to the central aspect (anterior-posterior) proceeds by either splitting the tendon or ligament or muscle longitudinally or by elevating structures of the bone in a subperiosteal fashion. The choice of the particular approach varies with respect to the fractured bone that is being treated. A specialized soft tissue retractor is placed onto the bone retracting the soft tissues away from the entry point of the bone.
A guide wire can then be drilled at an angle into the insertion point along the metaphyseal prominence. The angle of placement of the guide wire along the longitudinal axis of the bone depends on the fracture anatomy and particular bone being treated. The guide wire can then be placed under fluoroscopic guidance. An optimally chosen reamer is introduced over the guide wire opening the metaphyseal entry point. Both devices are then removed.
A curved guide wire is introduced across the open channel of the metaphysis and is advanced across the fracture site into the diaphysis of the bone. Sequential reaming appropriate for the particular device is performed to prepare the diaphysis. The distance from the fracture site to the entry point is estimated under fluoroscopy and the appropriate device is selected. The reamer is withdrawn and the device is introduced across the guide wire into the metaphysis and across the fracture into the diaphysis. Fluoroscopy confirms the location of the universal joint at the metaphyseal/diaphyseal fracture site.
The diaphyseal teeth of the device are deployed and the device is rigidly fixed to the diaphysis of the fractured bone distal to the fracture site. Any extension of the fracture into the joint can now be reduced in a closed fashion and held with K wires or in an open fashion via a dorsal approach to the intra-articular portion of the fracture. Metaphyseal locking flanges with targeting outriggers attached are now advanced (in to the metaphyseal bone) across the metaphyseal shaft. Using the attached targeting outrigger, guidewires are now placed through the metaphyseal locking flanges. The guidewires are directed fluoroscopically to stabilize the intra-articular portion of the fracture and/or to stabilize the metaphyseal fracture securely. Holes are drilled over the guidewires with a cannulated drill bit. Then, self tapping screws are advanced over the guidewires to lock the bone to the shaft and metaphyseal locking flange. The device is now locked within the proximal and distal bone fragments (metaphyseal or diaphyseal) and distal (diaphyseal) bone. This provides for rigid fixation of the comminuted intra-articular fragments to each other, and the fixation between these screws interlocking in to the metaphyseal flange component provides rigid fixation of these intra-articular fragments in the metaphyseal region to the diaphyseal shaft as well. The extremity and fracture is now manipulated until a satisfactory reduction is achieved as visualized under fluoroscopy. Thereafter, the fracture is manipulated under fluoroscopic guidance in order to achieve anatomic alignment of the bone fragments. Once optimal intramedullary reduction is achieved, the universal joint is locked. The fracture is now fixed securely. The guide wire is removed and the wound is closed repairing the periosteum over the metaphyseal entry point and repairing the fascia and closing the skin. A splint maybe applied.
While preferred embodiments of the present invention have been shown and described herein, it will be obvious to those skilled in the art that such embodiments are provided by way of example only. Numerous variations, changes, and substitutions will now occur to those skilled in the art without departing from the invention. It should be understood that various alternatives to the embodiments of the invention described herein may be employed in practicing the invention. It is intended that the following claims define the scope of the invention and that methods and structures within the scope of these claims and their equivalents be covered thereby.
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Good morning ladies!
Could any of you PM me your experiences with any MFMs in the area? I tried to get a referral to one during my last pregnancy since I was hypertensive at 8 weeks (after having pre-e during my first pregnancy) and had placenta previa; the first one I contacted said I wasn't high risk enough to warrant seeing a specialist. I think my OB/GYN gave me good care, but I'm not convince that she or my GP are up-to-date on problem pregnancies. I'd like to see someone before we start actively trying again to discuss anything I should be doing beforehand, especially given that surprises happen. If anyone can recommend an MFM who's not snobby about seeing someone for a pre-pregnancy consult, that would be very helpful.


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I'll take a shot at him or D-cord
I'll take a shot at him or D-cord
He's a positional coach for the Patriots at the moment right? Anything's better than Bill Sheridan at DC lol
"They come to the line of scrimmage and the first thing they do is start looking for me....I know, and they know. When theyd find me theyd start screaming: 56 left ! 56 left!....So theres this thing I did. After the play was over Id come up behind them and whisper: dont worry where I am. Ill tell you when I get there."
- Lawrence Taylor
Has he ever been a coordinator?
What makes you think that he would be a good HC?


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|My First Storytime
Event Type: Children's Storytime
Date: 9/11/2013
Start Time: 10:30 AM
End Time: 11:00 AM
For babies and 1's, with a caregiver. Boost your baby's brain power with simple board books, engaging props, fun rhymes, singing and socializing. This class develops enriched language skills, builds and early love of reading, and connects you with your little one. After the storytime, stay for Baby Playgroup, with hands-on age-appropriate pre-literacy activities! OPPL card required.Library: Oak Park Public Library Main Branch
Location: First Floor - Storytime Room
Contact: Children's Department
Contact Number: 708.452.3420