[Interscapulo-cleidothoracic disarticulation. Indications and technic].
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The aim of this study was the evaluation of spiral-CT examinations in preoperative planning of calcaneal fractures supported by 3D reconstructions after electronic disarticulation. We examined 45 patients with 47 calcaneal fractures with diagnostic spiral-CT examinations in a prospective study. In addition to the conventional axial slices and sagittal reconstructions, 3D reconstructions prior to and after electronic disarticulation were performed and rated by orthopaedic surgeons and radiologists. The following diagnostic criteria were rated: involvement of articular facets, number of fragments and hindfoot deformities. Axial slices were considered to be the gold standard, because not all patients underwent surgical treatment. Axial slices showed involvement of 90 articular facets (100 %). Three-dimensional reformations after electronic disarticulation depicted 82 fractures (82 of 90, 91 %), sagittal reconstructions 63 fractures (63 of 90, 70 %). Three-dimensional reconstructions without electronic disarticulation showed five fractures (5 of 90, 5.5 %). The number of fragments was demonstrated best on sagittal reconstructions (two, three or four fragments); five fragments were diagnosed best on axial slices, and 3D reconstruction without electronic disarticulation showed only a very small number of fragments, due to overlaying bones. Hindfoot deformities (lateralisation, varus deformation, shortening) were demonstrated best on axial slices, except in terms of showing height reduction, which was demonstrated better on sagittal and 3D reconstructions. Three-dimensional reconstructions after electronic disarticulation support a clear understanding of the 3D position of the fragments and of their displacement in comparison with 3D reconstruction without electronic disarticulation, which is essential for an effective surgical reduction. Due to the potential manipulation of surface-oriented 3D reconstructions, regardless of whether electronic disarticulation is used, this imaging technique should not be considered in an isolated framework. Three-dimensional images without electronic disarticulation are superfluous in any case.
PURPOSE: To evaluate the clinical value of sagittal 2D- and 3D-reformations of the talus with and without electronic disarticulation compared to axial slices. MATERIAL AND METHODS: 23 patients with suspected traumatic lesions of the talus underwent 26 diagnostic CT examinations. Axial slices, sagittal reformations, and 3D-reformations without and with electronic disarticulation were performed. The sagittal 2D- and both types of 3D-reformations were compared to the axial slices with regard to their diagnostic information. RESULTS: Axial slices showed involvement of articular facets in 25 cases. Sagittal and 3D-reformations after electronic disarticulation depicted 23 fractures (23/25), 3D-reformations without electronic disarticulation showed none (0/23). Subluxation of the talocalcaneal joint was only visualised on axial slices three times. One complete luxation of this joint was shown on axial slices, sagittal and 3D-reformations without disarticulation. It was not visualised on 3D-reformations after disarticulation. CONCLUSION: The diagnosis must be made based on the axial slices, supported by sagittal reconstructions. 3D-reformations after electronic disarticulation provide a graphic, detailed and readily recognised image of the anatomy of transchondral fractures, and are very helpful in preoperative planning.
The percentages of change in cross-sectional area and dorsoventral height of the rima glottidis were measured after seven types of laryngoplasty in 30 postmortem canine specimens. The mean increases in area after each procedure were, in decreasing order, bilateral cricoarytenoid disarticulation with interarytenoid sesamoid band transection before placement of arytenoid abduction sutures 350% +/- 42%, bilateral placement of arytenoid abduction sutures 318% +/- 40%, bilateral cricothyroid disarticulation before placement of arytenoid abduction sutures 255% +/- 51%, modified castellated laryngofissure 244% +/- 30%, unilateral cricoarytenoid disarticulation with interarytenoid sesamoid band transection before placement of an arytenoid abduction suture 161% +/- 25%, unilateral placement of an arytenoid abduction suture 151% +/- 24% and unilateral cricothyroid disarticulation before placement of an arytenoid abduction suture 108% +/- 25%. Bilateral cricoarytenoid disarticulation with interarytenoid sesamoid band transection before placement of arytenoid abduction sutures resulted in a significantly greater increase in rima glottidis area than modified castellated laryngofissure and all unilateral arytenoid abduction techniques. Modified castellated laryngofissure resulted in a significantly greater increase than unilateral placement of an arytenoid abduction suture and cricothyroid disarticulation before placement of an arytenoid abduction suture. Bilateral disarticulation of the cricothyroid joint before placement of arytenoid abduction sutures resulted in significant collapse of the dorsoventral height of the rima glottidis.
Shattering is an essential seed dispersal mechanism in wild species. It is believed that independent mutations at orthologous loci led to convergent domestication of cereal crops. To investigate genetic relationships of Triticeae shattering genes with those of other grasses, we mapped spike-, barrel- (B-type), and wedge-type (W-type) spikelet disarticulation genes in wheat and its wild relatives. The Br1 gene for W-type disarticulation was mapped to a region delimited by Xpsr598 and Xpsr1196 on the short arm of chromosomes 3A in Triticum timopheevii and 3S in Aegilops speltoides. The spike- and W-type disarticulation genes are allelic at Br1 in Ae. speltoides. The B-type disarticulation gene, designated as Br2, was mapped to an interval of 4.4 cM between Xmwg2013 and Xpsr170 on the long arm of chromosome 3D in Aegilops tauschii, the D-genome donor of common wheat. Therefore, B- and W-type disarticulations are governed by two different orthologous loci on group-3 chromosomes. Based on map position, orthologs of Br1 and Br2 were not detected in barley, maize, rice, and sorghum, indicating multiple genetic pathways for shattering in grasses. The implications of the mapping results are discussed with regard to the evolution of polyploid wheat and domestication of cereals.
OBJECTIVES: To evaluate the effect of abduction suture tension and cricothyroid (CT) joint disarticulation on the area, height, and width of the rima glottidis (RG) during unilateral arytenoid lateralization. STUDY DESIGN: Experimental study. ANIMALS: Nine canine cadaver larynges. METHODS: Left arytenoid lateralization was performed with high or low abduction suture tension. RG area, height, and width were measured by computerized planimetric analysis with the epiglottis in an open and closed position. The experiment was performed with the CT joint intact and disarticulated. The effects of suture tension, CT disarticulation, and their interaction on RG area with the epiglottis closed or open were evaluated by repeated measures analysis of variance (ANOVA). RESULTS: RG area increased by 82% and 129% (P <.0001) with low and high suture tension, respectively. The aperture not covered by the epiglottis in a closed position was 467% larger with high suture tension than with low tension (P <.0001). CT disarticulation had no significant effect on RG geometry with either low or high suture tension (P =.4970). CONCLUSIONS: Low suture tension increased RG area when the epiglottis was in an open position without increasing RG aperture when the epiglottis was closed. Suture tension had a significant effect on RG opening when the epiglottis was closed. CT disarticulation did not modify the geometry of the RG. CLINICAL RELEVANCE: Use of a low-suture tension should be considered during arytenoid lateralization because it has the potential to reduce the risk of aspiration pneumonia.
Between 1962 and 1983, fourteen patients (twenty knees) had centralization of the fibula for congenital longitudinal deficiency: tibial, complete. Eleven of the twenty index procedures were performed on patients who were one year old or less. A progressive flexion deformity of the knee developed after all twenty index procedures. Twenty-six secondary procedures were needed, including disarticulation at the knee, posterior release, extension osteotomy, femorofibular arthrodesis, and biceps-to-quadriceps transfer, and one patient had a second attempt at centralization of the fibula. The duration of follow-up after the initial centralization of the fibula ranged from four years to twenty-two years and seven months (average, twelve years and four months). Seven patients (eight limbs) in whom the index procedure resulted in failure had a satisfactory result after disarticulation at the knee. The patients who did not have secondary disarticulation at the knee are also considered to have had a failed index procedure because they had a flexion deformity at the latest follow-up. Attempts to reconstruct the knee joint by centralization of the fibula are not warranted for patients who have congenital longitudinal deficiency: tibial, complete. Early disarticulation at the knee and fitting with a prosthesis, with close follow-up, is the treatment of choice.