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At least 559 records · Page 31Linked to original sources
PubMed2004

Excision of heterotopic bone around the elbow.

Heterotopic ossification about the elbow is common and sometimes contributes to a disabling loss of motion. The traditional trepidation and pessimism regarding surgical excision of heterotopic bone is giving way to a realization that operative treatment is successful in most cases and dramatic functional improvements can be obtained. Familiarity with extensile exposure and operative technique will increase the safety and efficacy of the procedure.

Journal Article↗
PubMed2003

Oblique osteotomy for multiplanar correction of malunions of the femoral shaft.

Between 1990 and 1996, six patients had oblique femoral osteotomies for symptomatic posttraumatic femoral malunions. In each patient, an oblique osteotomy was done that allowed for correction in the coronal, transverse, and sagittal planes. Fixation was achieved with lag screws supplemented by a neutralization plate. The average followup was 49 months (range, 18-99 months). All osteotomies healed at an average of 2.9 months (range, 2.5-4.0 months). Postoperatively, all patients had full range of motion in the ipsilateral hip and knee and could bear full weight without pain. Radiographically, the average deformity measured on anteroposterior radiographs improved from 21.6 degrees to 4.2 degrees varus. The average deformity on lateral radiographs improved from 22.5 degrees to 7.0 degrees antecurvatum. In all patients, the leg lengths were within 0.5 cm of each other and axial alignment was within 10 degrees of the contralateral limb. The use of an oblique osteotomy is a simple and predictable method of correcting complex posttraumatic femoral malunions and provides excellent surgical and clinical results.

Adolescent↗
PubMed2003

Atrophic nonunions of the proximal ulna.

Ten consecutive patients were treated by one surgeon for an atrophic nonunion of the proximal ulna. There were six men and four women with an average age of 47 years. Nine of the initial injuries were fracture-dislocations (seven posterior Monteggia lesions and two transolecranon fracture-dislocations) and one was a fracture of the proximal ulnar and radial diaphysis. The nonunion was associated with failed operative fixation in nine patients and occurred after treatment in cast in one patient. Three patients had synovial pseudarthroses and eight had bony defects. Debridement of the nonunion, autogenous cancellous bone grafting, and contoured limited-contact plate fixation were done at an average of 36 months after the original injury. The patients were followed up for an average of 39 months. Union was achieved in all 10 patients. The average arc of ulnohumeral motion was 105 degrees and the average arc of forearm rotation was 130 degrees. According to the system of Broberg and Morrey five patients had an excellent result, four had a good result, and one had a fair result. The fair result was attributable to proximal radioulnar synostosis and severe ulnohumeral arthrosis. Atrophic nonunion of fractures of the proximal ulna usually follow a complex injury treated with inadequate fixation. Stable plate fixation and autogenous bone graft predictably lead to union, but the functional result may be limited by associated problems.

Adolescent↗
PubMed2004

Locking compression plates for osteoporotic nonunions of the diaphyseal humerus.

Poor bone quality increases the technical difficulty and complications of operative treatment of nonunions and delayed unions of the diaphyseal humerus in older patients. Plates with screws that lock to the plate (transforming each screw into a fixed blade) are intended to improve the fixation of poor quality bone. Twenty-four patients (20 women, four men) with an average age of 72 years (range, 52-86 years) were followed up for a minimum of 12 months after locking compression plate fixation of an osteopenic delayed union (nine patients) or nonunion (15 patients) of the diaphyseal humerus. Twelve patients had iliac crest cancellous bone grafts, two patients had local graft, and 13 patients had demineralized bone applied to the fracture site. All the fractures eventually healed; two healed after a second procedure for autogenous bone grafting in patients who initially received demineralized bone. Using a modification of the Constant and Murley shoulder score, the results were good or excellent in 22 patients, and fair in two patients. Locking compression plates provide stable fixation of poor quality bone in patients with delayed union or nonunion of the humerus. Successful union and restoration of function are achieved in most patients. We no longer consider osteoporosis a contraindication to operative fixation of an ununited fracture of the humeral diaphysis.

Aged↗
PubMed2004

Effective treatment of fracture-dislocations of the olecranon requires a stable trochlear notch.

Our goal with this study was to better define and characterize fracture-dislocations of the olecranon and to provide additional data regarding complications and elbow function after operative treatment. Twenty-six patients with fracture-dislocations of the elbow were reviewed retrospectively. Ten had anterior and 16 had posterior fracture-dislocations. Five of 10 patients with anterior injuries and all of the patients with posterior injuries had an associated fracture of the coronoid process of the ulna. One of 10 patients with anterior and 13 of 16 patients with posterior injuries had fracture of the radial head. Only one patient had a true dislocation of the ulnohumeral joint. In the other 25 patients the articular surfaces remained apposed. All 26 patients were treated operatively and followed up for at least 3 years (average, 6 years). The results were good or excellent in 21 of 26 patients according to the system of Broberg and Morrey. The five unsatisfactory results were related to inadequate fixation of the coronoid with subsequent arthrosis (three patients), proximal radioulnar synostosis (three patients), and a subsequent fracture of the distal humerus (one patient). Fracture-dislocations of the olecranon occur in anterior and posterior patterns with specific injury characteristics and pitfalls. The key to effective treatment is stable restoration of the trochlear notch.

Adult↗
PubMed2006

Plate and screw design in fractures of the hand and wrist.

UNLABELLED: As internal fixation of fractures of the hand and wrist has evolved, so too have the implants used for the same purpose. Implants used for the first (1/2) of the 20th century were modeled on implants used to fix long bone fractures. Consequently, they were often bulky. In addition, they often were made of materials which were ill suited to the unique functional and biomechanical requirements of the hand and wrist. As a result, outcomes of internal fixation frequently were suboptimal and complication rates were high. In the past 40 years there has been an evolution in metallurgy, biomechanics, and implant design for fracture fixation in the hand and wrist, quite unlike any other anatomic location in the body. The principal purpose of this review is to highlight these very advances. Implants now are made of highly bio-compatible materials, have a low profile, can be contoured to suit individual anatomy, and provide considerably reduced rates of soft tissue irritation. These features afford surgeons the ability to fix complex injuries in a stable manner so as to institute early rehabilitation in an effort to maximize individual outcomes. LEVEL OF EVIDENCE: Level V (expert opinion).

Biocompatible Materials↗
PubMed2006

Operative treatment of osteochondral nonunion of the distal humerus.

Three patients with ununited osteochondral fracture fragments of the distal humerus (2 anterior capitellum and trochlea; 1 posterior trochlea) who had debridement and realignment of the nonunion, autogenous cancellous bone graft, and internal fixation an average of 6 (range, 5-8) months after injury were studied. The preoperative arc of elbow flexion was 80 degrees, 35 degrees, and 25 degrees. All 3 fractures healed without implant related complications or osteonecrosis. At 28, 27, and 46 months after the index procedure for nonunion, the patients had 95 degrees, 90 degrees, and 115 degrees arcs of elbow flexion. The scores on the Mayo Elbow Performance Index were 80, 80, and 95 (2 good, 1 excellent). Based on this limited experience, it seems that operative treatment of ununited osteochondral fracture fragments can achieve union without osteonecrosis. Attempts to improve the function of the native elbow rather than salvage the situation with interpositional or prosthetic arthroplasty are worthwhile.

Adult↗
PubMed2005

Life-long learning.

Explore the source record for details and available documents.

Education, Medical, Continuing↗
PubMed2006

Mini external fixation in the hand.

External fixation is an effective means of addressing several pathologies of the hand. The advantages of its use include the ability to achieve stable fixation, minimize soft tissue trauma at the site of injury, and allow wound care and mobilization of adjacent joints. External fixators can be constructed from material readily available in the operating room or obtained from a commercial source. Sufficient rigidity can be achieved by any of these means. Improper placement, although achieving rigid fixation, may compromise motion and overall function if basic principles of external fixation are not followed or if the anatomy of the hand is not taken into consideration. The objective of this article is to describe the technique of application of mini external fixation, emphasizing the basic principles of external fixation as they relate to the specific anatomy of the hand. In addition to fracture fixation, various other uses are described including distraction lengthening, arthrodesis, treatment of nonunion, and infection.

Arthrodesis↗
PubMed2005

Comminuted diaphyseal fractures of the radius and ulna: does bone grafting affect nonunion rate?

BACKGROUND: The recommendation of Anderson and colleagues to bone graft even relatively minor amounts of comminution (a third of the bone diameter) in the treatment of diaphyseal forearm fractures with plate-and-screw fixation has been questioned. This study examines factors related to nonunion in adult patients with comminuted diaphyseal fractures of both the radius and the ulna to determine the relative influence of bone grafting. METHODS: Over a 15-year period at two hospitals, 41 patients with diaphyseal fractures of both forearm bones satisfied the following criteria: comminution (Orthopaedic Trauma Association grade IV or higher) of at least one fracture; treatment with 3.5- or 4.5-mm dynamic compression plates at least six holes in length; and minimum 12-month follow-up. Multiple logistic regression was used to determine the contribution of the following factors to the risk of nonunion: multiple injuries; ipsilateral upper extremity injury; open wound; and the application of cancellous bone graft at the fracture site. RESULTS: Five patients had nonunion of one or both bones (12%). According to the multiple logistic regression model, none of the factors studied had a statistically significant association with nonunion (p > 0.40 for all). The odds ratios were as follows: multiple injuries, 2.1 (95% confidence interval [CI], 0.34-12.9); ipsilateral injury, 0.68 (95% CI, 0.058-7.84); open fracture, 1.46 (95% CI, 0.21-9.89); and bone graft, 0.98 (95% CI, 0.15-6.42). CONCLUSION: Nonunion occurred in 12% of comminuted, diaphyseal fractures of both bones of the forearm treated with dynamic compression plates. No single factor was associated with nonunion. In particular, the use of bone graft was not associated with a higher rate of union.

Adolescent↗
PubMed2025

L1 insertion intermediates recombine with one another or with DNA breaks to form genome rearrangements.

LINE-1 retrotransposition is common in human cancers and rearrangements at insertion sites can contribute to cancer-driving oncogene amplifications and promote genome instability. However, the mechanisms underlying rearrangements of L1 retrotransposition intermediates are poorly understood. To address this gap, we developed GFP-based recombination reporter assays to study the formation of L1 retrotransposition-mediated rearrangements. Using these reporters combined with long-read sequencing approaches, we find that L1 retrotransposition intermediates can recombine with distal DNA breaks to generate chromosomal rearrangements. We also find that two distinct L1 insertion intermediates can recombine with each other to generate chromosomal rearrangements. Both types of rearrangements depend on L1-encoded ORF2p endonuclease and reverse transcriptase activities. Using these reporters, we discover that L1 retrotransposition-mediated rearrangements are robustly induced when the recombining sequences share homology and that their formation requires the homologous recombination factor BRCA1. Given the repetitive nature of our genome, these findings highlight the risk of L1 insertion intermediates becoming substrates for aberrant recombination and promoting genome instability.

L1 retrotransposons↗
PubMed1995

Melatonin modulation of estrogen-regulated proteins, growth factors, and proto-oncogenes in human breast cancer.

The growth-inhibitory actions of the pineal hormone, melatonin, on human breast tumor cells and the possible association between this inhibition and melatonin's down-regulation of the estrogen receptor (ER) expression were examined in the ER-positive, estrogen-responsive MCF-7 human breast tumor cell line. As previously reported, melatonin dramatically inhibits the growth of these breast tumor cells and down-regulates ER levels in these cells, suggesting that the modulation of ER may be an important mechanism by which melatonin inhibits breast cancer cell growth. In the present studies, Northern blot analysis was used to examine the expression of estrogen-regulated transcripts known to be involved in estrogen's mitogenic actions. Melatonin, at a physiologic concentration (10(-9) M), rapidly, significantly, and, in some cases, transiently elevated the steady-state mRNA levels of growth stimulatory products such as TGF alpha, c-myc, and pS2, which are normally up-regulated in response to estrogen. Conversely, melatonin decreased the expression of other factors normally up-regulated by estrogen, such as progesterone receptor and c-fos. Significant stimulation of the expression of the growth-inhibitory factor TGF beta was seen with melatonin treatment, potentially supporting the concept that melatonin's growth-inhibitory activity is mediated through the breast tumor cells' estrogen-response pathway. The early regulation of many of these products by melatonin suggests that mechanisms more rapid than the down-regulation of ER are important in melatonin's modulation of their expression. However, the long-term modulation of these transcripts (12-48 hr) may be heavily influenced by melatonin's down-regulation of ER expression. These results clearly define the need for additional in depth studies to dissect the cellular events leading to melatonin-induced growth inhibition in breast tumor cells.

Blotting, Northern↗
PubMed2002

Formation of giant planets by fragmentation of protoplanetary disks.

The evolution of gravitationally unstable protoplanetary gaseous disks has been studied with the use of three-dimensional smoothed particle hydrodynamics simulations with unprecedented resolution. We have considered disks with initial masses and temperature profiles consistent with those inferred for the protosolar nebula and for other protoplanetary disks. We show that long-lasting, self-gravitating protoplanets arise after a few disk orbital periods if cooling is efficient enough to maintain the temperature close to 50 K. The resulting bodies have masses and orbital eccentricities similar to those of detected extrasolar planets.

Computer Simulation↗
PubMed2005

Deep Impact: excavating comet Tempel 1.

Deep Impact collided with comet Tempel 1, excavating a crater controlled by gravity. The comet's outer layer is composed of 1- to 100-micrometer fine particles with negligible strength (<65 pascals). Local gravitational field and average nucleus density (600 kilograms per cubic meter) are estimated from ejecta fallback. Initial ejecta were hot (>1000 kelvins). A large increase in organic material occurred during and after the event, with smaller changes in carbon dioxide relative to water. On approach, the spacecraft observed frequent natural outbursts, a mean radius of 3.0 +/- 0.1 kilometers, smooth and rough terrain, scarps, and impact craters. A thermal map indicates a surface in equilibrium with sunlight.

Jupiter↗