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At least 613 records · Page 34Linked to original sources
PubMed1997

Syndesmotic screw placement: a biomechanical analysis.

At the present time, syndesmotic screw fixation is recommended when there is a tibiofibular diastasis, a Maisonneuve fracture, or syndesmotic instability after fixation of distal tibia-fibula fractures. The aim/purpose of this study was to demonstrate the optimal level of syndesmotic screw placement before creation of a Maisonneuve fracture. Legs of 17 embalmed cadavers underwent knee disarticulation. The legs were then dissected to expose the syndesmosis/interosseous membrane. The paired cadaver legs were tested in two groups. In group I (10 pairs), the left legs were tested without any syndesmotic fixation and the right legs were tested with the syndesmosis fixed at 2.0 cm above the tibiotalar joint. In group II (7 pairs), the syndesmosis in each left leg was fixed at 3.5 cm above the tibiotalar joint and the right leg syndesmosis was fixed at 2.0 cm above the tibiotalar joint. After ligament section and syndesmosis fixation, each leg was then jig mounted with transfixing wires through the proximal tibia and calcaneus. The ankle was placed in neutral with 15 degrees of pronation and a load of 150 pounds and a strain gauge anchored medially and laterally. The proximal tibia was internally rotated while the ankle was held fixed until syndesmotic, bony, or hardware failure occurred. Torsional force, the degree of rotation and the amount of syndesmotic widening were quantitated. Two-tailed t-test comparing no fixation with fixation at 2.0 cm indicated less syndesmotic widening with screw placed at 2.0 cm (P = 0.04). Two-tailed t-test comparing screw fixation at 2.0 cm and 3.5 cm indicated less syndesmotic widening with screw placed at 2.0 cm (P = 0.07). It would seem reasonable to place a syndesmotic screw at 2.0 cm above tibiotalar joint.

Ankle Injuries↗
PubMed1997

Charcot ankle fusion with a retrograde locked intramedullary nail.

Twenty patients with severe neuropathic (Charcot) ankle deformities underwent 21 attempted ankle fusions with a retrograde locked intramedullary nail as an alternative to amputation. All had insensate heel pads and had failed at nonoperative methods of accommodative ambulatory bracing. In 11, the talus was either absent, or the deformity was of sufficient magnitude to require talectomy to align the calcaneus under the tibia for plantigrade weightbearing. Ages ranged from 28 to -68 (average 56.3) years. Nineteen were diabetic, 12 being insulin-dependent. Their average body weight was 102 kg, with 11 greater than 90 kg at the time of surgery. Eight had chronic large full thickness ulcers overlying, but not involving bone of the medial malleolus, medial midfoot, or proximal fifth metatarsal, at the time of surgery. At a follow-up of 12 to 31 months, 19 achieved bony fusion. In the 10 patients where talectomy was not required, fusion was achieved at an average of 5.3 months without complications. In the patients who required talectomy, six of the patients required eight additional operations to achieve fusion. Three achieved fusion following removal of the nail and prolonged bracing. One opted for ankle disarticulation for chronic persistent infection, rather than attempt reoperation. One died of unrelated causes during the early postoperative period. Retrograde locked intramedullary ankle fusion is a reasonable alternative to amputation in the neuropathic (Charcot) ankle that cannot be controlled with standard bracing techniques. The potential for morbidity requiring reoperation is greatly increased when the deformity is of sufficient magnitude to require talectomy to achieve alignment of the calcaneus in a plantigrade weight-bearing position under the tibia or when there are large open ulcers.

Adult↗
PubMed2005

Analysis of the bite force and mechanical design of the feeding mechanism of the durophagous horn shark Heterodontus francisci.

Three-dimensional static equilibrium analysis of the forces generated by the jaw musculature of the horn shark Heterodontus francisci was used to theoretically estimate the maximum force distributions and loadings on its jaws and suspensorium during biting. Theoretical maximum bite force was then compared with bite forces measured (1) voluntarily in situ, (2) in restrained animals and (3) during electrical stimulation of the jaw adductor musculature of anesthetized sharks. Maximum theoretical bite force ranged from 128 N at the anteriormost cuspidate teeth to 338 N at the posteriormost molariform teeth. The hyomandibula, which connects the posterior margin of the jaws to the base of the chondrocranium, is loaded in tension during biting. Conversely, the ethmoidal articulation between the palatal region of the upper jaw and the chondrocranium is loaded in compression, even during upper jaw protrusion, because H. francisci's upper jaw does not disarticulate from the chondrocranium during prey capture. Maximum in situ bite force averaged 95 N for free-swimming H. francisci, with a maximum of 133 N. Time to maximum force averaged 322 ms and was significantly longer than time away from maximum force (212 ms). Bite force measurements from restrained individuals (187 N) were significantly greater than those from free-swimming individuals (95 N) but were equivalent to those from both theoretical (128 N) and electrically stimulated measurements (132 N). The mean mass-specific bite of H. francisci was greater than that of many other vertebrates and second highest of the cartilaginous fishes that have been studied. Measuring bite force on restrained sharks appears to be the best indicator of maximum bite force. The large bite forces and robust molariform dentition of H. francisci correspond to its consumption of hard prey.

Animals↗
PubMed2004

A kinematic method to calculate the workspace of the trapeziometacarpal joint.

The specific aim of this study was to develop a quantitative method and a kinematic method to evaluate the maximal workspace of the trapeziometacarpal (TM) joint. Six fresh-frozen human cadaver hands were disarticulated 4 cm proximal to the wrist joint and used in this experiment. The three-dimensional motion data of the TM joint was collected by an electromagnetic tracking device at 30 Hz. The workspace was reconstructed according to a complete set of motion data included circumduction, flexion-extension and abduction-adduction. A spherical fitting technique was used to obtain a sphere encompassing all the motion trajectories and estimating the centre of the sphere. The surface area of the maximal TM workspace, located on the one part of the sphere surface, was calculated by surface integration. The interclass correlation coefficient values for the reliability estimation of the repeated measurements of the radius and surface area of all specimens were 0.91 and 0.98 respectively. The mean coefficients of variance of the measured radius and the surface area were 2.04 per cent and 3.65 per cent respectively. The results also showed that using a spherical model to calculate the maximal workspace as an index for assessing TM joint impairment is practical.

Adolescent↗
PubMed1993

Three-dimensional analysis of knee joint movement with biplanar photography, with special reference to the analysis of 'dynamic' knee instabilities.

An apparatus was developed by means of which it was possible to move a cadaveric knee joint under a constant external force and to measure its movement in three dimensions using biplanar photography, to investigate mechanisms of 'dynamic' knee instabilities, such as the 'pivot shift' phenomenon. Two wire frameworks, one attached to the femur, the other to the tibia, defined a system of three mutually orthogonal axes. While the knee joint was moved under a given force, a series of biplanar photographs of the two frameworks were taken. This procedure was repeated after sectioning different ligaments simulating different injuries. The joint was finally fully disarticulated, but leaving the reference wire frameworks still attached to their respective bone. Another series of biplanar photographs of the femur and tibia were taken. From these two series of measurements, movements of the tibia with respect to the femur were calculated. With this two-step method, knee movements could be measured without damaging the knee structures before or during the actual measurement (which could change the knee movement itself). On validating the system, it was concluded that knee movement could be measured with sufficient accuracy for the analysis of knee instability.

Anterior Cruciate Ligament↗
PubMed1997

Does magnetic resonance imaging make a difference for patients with musculoskeletal sarcoma?

MR imaging has had an unparalleled impact on the treatment of patients with musculoskeletal sarcoma. Basically, the high accuracy of local staging has made the introduction of reconstructive and limb salvage procedures instead of amputation of disarticulation available to the majority of patients with musculoskeletal sarcoma. Pre-operative work-up with MRI is not only more accurate, but also much faster and cheaper than the conventional work-up. Staging is the single most important reason for performing MR imaging in patients with musculoskeletal tumours. The impact of MR specificity is less dramatic but the benefit to the patient is an increased safety margin. When diagnostic errors with devastating consequences are made nowadays, it is usually because the proper protocol has not been followed. A patient with a potentially malignant, or equivocal, musculoskeletal mass deserves to have a combined radiographic-MRI examination prior to invasive procedures. MRI does not currently have a major impact on chemotherapy decisions and colour Doppler ultrasound has a higher accuracy than MRI. However, selected cases, i.e. intraosseous tumours, dynamic Gd-enhanced MRI, can replace colour Doppler ultrasound.

Adult↗
PubMed1979

Hearing results following atticotomy.

Transmeatal atticotomy, a common otosurgical procedure near the turn of the century, has since enjoyed only sporadic periods of popularity. An earlier report illustrated the efficacy of the atticotomy operation in ablating cholesteatoma in 83% of cases. However, the ossicular chain usually suffers discontinuity either through erosion by cholesteatoma or surgical disarticulation. In ears with an intact chain, the incudostapedial joint is usually separated to avoid injury that may be transmitted to the inner ear if the rotating burr contacts the ossicles. The purpose of this paper is to portray the types of hearing restoration attempted and the results achieved in 55 patients who had an atticotomy procedure and had been followed for six months to eight years. The number of patients who attained serviceable hearing are compared to those that did not, with regard to such factors as the hearing level and state of the ossicles preoperatively as well as the extent of the surgery required for removal of the disease. The hearing results in these patients who underwent atticotomy compare favorably to those cited in the literature for tympanoplasties done with the modified radical mastoidectomy or the intact canal wall tympanomastoidectomy.

Auditory Threshold↗
PubMed1982

Proximal intratemporal facial nerve in Bell's palsy surgery. A study correlating anatomical and surgical findings.

This paper deals with the surgical approaches to that part of the intratemporal facial nerve lying proximal to the cochleariform process and focuses on two issues: the advisability of disarticulating the ossicular chain to reach this area and the accessibility of the labyrinthine segment via the transmastoid, extralabyrinthine, subtemporal route. Relevant anatomical features, which are based on 39 gross temporal bones, 47 histologic sections, and 10 cadaveric specimens are first considered. In the head specimens, it was possible to attempt exploration of the entire nerve with the transmastoid, extralabyrinthine, subtemporal operation and then remove the labyrinth to gauge the adequacy of this approach as an avenue to the labyrinthine segment. These anatomical findings, their bearing on the questions at hand, and the author's clinical experience are incorporated into descriptions of the operations currently in vogue for exploring the proximal nerve in patients with Bell's palsy.

Ear Ossicles↗
PubMed1982

Exploratory tympanotomy revisited.

The history of exploratory tympanotomy is somewhat obscure. Methods and findings of exploratory tympanotomy were described and assessed for unexplained conductive and occasional sensorineural hearing losses. Of 316 recent cases positive findings leading to diagnosis and therapy occurred in all 250 cases of conductive hearing losses and in 43 of 63 cases of sensorineural hearing losses. In decreasing order of occurrence findings were sequelae of otitis media, otosclerosis, oval and round window changes including perilymph leakage, congenital and traumatic fixation and disarticulation of ossicles. These observations and indications are discussed.

Ear Diseases↗
PubMed1994

Lesbian sightings: scoping for dykes in Boucher and Cosmo.

In Cosmopolitan magazine and in the work of the eighteenth-century French painter François Boucher, lesbians are visible, but nobody seems to notice. The operation of covert invisibility in such disparate cultural products suggests that the closet metaphor and the common idea that queer visibility generates queer empowerment must be retained but rethought. It also suggests that queer scholars and activists can benefit from occasionally working as historical-specificity outlaws, which here brings into focus the distinct ideological affects of each product, as well as some shared ones that demand our attention, including the disarticulation of female political activism, and the promotion rather than subversion of hetero-hegemony.

Female↗
PubMed1977

Joint surface incongruity and its maintenance: an experimental study.

The paper reports an experimental investigation into the mechanisms whereby the joints of living animals maintain their precise contours. The normal patter of joint incongruity in the rabbit's hip having first been established, three groups of experimental animals underwent operative procedures designed to reduce the joint pressure to a level unrealistic in normal life. In one group the hip was dislocated by manipulation; in a second group the muscles around the hip joint were divided; and in a third group the hind limb was disarticulated through the knee. When the animals were killed at intervals of a few weeks after the operations the experimental hip joint showed increased congruity in all cases. It is concluded that in immature animals there is a mechanism in joints to control the modelling of their shapes towards an ideal incongruity, and that that mechanisms is pressure sensitive.

Animals↗
PubMed1982

Diplopodia with double fibula and agenesis of tibia. A case report.

A 14-year-old girl with a congenitally deformed and shortened right leg and foot is described. The patient could not bear weight on the deformed limb and had to hop on the left leg. The deformed foot faced backwards and had nine toes. The right leg was shorter than the left by 26 centimetres. Radiologically, the lower end of the right femur was ill-developed and there was no knee joint. There were two fibulae and the tibia and the patella were absent. A through-knee disarticulation was done and a prosthesis fitted later. The amputated leg and foot were dissected. Many of the muscles in the leg and foot were duplicated. There were two calcanei, one talus, one navicular, two cuboids and four cuneiforms. Ther were nine metatarsals, and all the toes had three phalanges except for one which had two.

Adolescent↗
PubMed1982

The total femoral prosthesis. A preliminary report.

The use of a total femoral prosthesis can offer a realistic alternative to amputation or disarticulation. The limited indications for such a prosthesis in the surgical management of primary bone tumours and pathological fractures still exist. In this specialised clinic there is an increased need to replace the entire femur where repeated procedures have failed, from loss of bone stock with infection or because of non-union in the presence of a prosthesis. Over the past eight years, four basic models have been developed. The most recent designs allow for the preservation of non-involved bone or for stable support where there is complete acetabular destruction.

Adult↗
PubMed1984

Ruptured femoral vein. A complication of the use of gentamicin beads in an infected excision arthroplasty of the hip.

Despite widespread use of gentamicin beads in the treatment of chronic infections of bone and soft tissue, no serious complications have been reported. This report describes a rupture of the femoral vein which occurred during the attempted removal of a chain of beads after radical excision of a chronically discharging Girdlestone arthroplasty. The patient later had a disarticulation at the hip. In the light of our experience with this and other cases we offer some suggestions as to the positioning of gentamicin beads, as well as the timing and method of their extraction.

Aged↗
PubMed1998

Prognostic factors for major limb re-implantation at both immediate and long-term follow-up.

We performed a prospective study in 186 patients with a minimum follow-up of two years in order to attempt to predict successful major re-implantation of the upper limb. There were 137 men and 49 women with 24 amputations of the palm, 75 of the wrist, 50 of the forearm, 9 disarticulations through the elbow, and 28 amputations through the upper arm. The degree of injury to the amputated segment and the stump were good predictors of the rate of success and the final outcome. Adequate preservation, contraction of the muscle in the amputated part after stimulation, the level of injury and a smoking habit were fair indicators, but the serum potassium concentration in the amputated segment was the best objective predictor. When it is higher than 6.5 mmol/l 30 minutes after re-perfusion, re-implantation should be avoided. A high systemic venous serum potassium concentration was also found before clinical signs of the re-perfusion syndrome were seen.

Adult↗
PubMed2000

Lengthening of congenital below-elbow amputation stumps by the Ilizarov technique.

Patients with short congenital amputations below the elbow often function as if they have had a disarticulation of the elbow. We have reviewed the results in six patients who had lengthening of such stumps by the Ilizarov technique to improve the fitting of prostheses. The mean lengthening was 5.6 cm (3.4 to 8.4), and in two patients flexion contractures of the elbows were corrected simultaneously. Additional lateral distraction was used in one patient to provide a better surface on the stump. There were no major complications. All six patients were able to use their prosthesis at the latest follow-up after 39 to 78 months.

Adolescent↗
PubMed2000

Gait characteristics of patients after proximal femoral replacement for malignant bone tumour.

We analysed the gait characteristics of 15 patients with prosthetic reconstruction of the proximal femur after resection of a malignant bone tumour using stride analysis and measurement of oxygen consumption. Compared with normal volunteers their gait was slower, with less cadence and reduced stride length. The mean net energy cost of free walking was 141% of normal. The degree of asymmetry of the single-limb support time correlated with the free-walking velocity and the net energy cost. If they used a single cane the subjects walked with less cadence, longer stride length, and prolonged single-limb support times. The net energy cost of walking and asymmetry of the single-limb support time had a negative correlation with the strength of the hip abductor muscles. Their walking performance was better than that of six subjects who had hip disarticulation.

Adolescent↗
PubMed2004

The descent into suicide.

Suicidal breakdown requires attention both to attack upon the self (ego) as aggressive forces are unleashed against it by the superego, but also to the phases of self-breakup (ego regression) that follow. Less attention has been directed to ego-regression in suicide than to superego-directed assault on the ego in the psychoanalytic literature; this paper directs attention to the phenomena of ego failure and disarticulation of the self-representation. Clinical study of suicidal patients shows four aspects of suicidal collapse as ego loosens: affective flooding, desperate maneuvering to counter the resulting mental emergency, loss of control as the self begins to disintegrate, and grandiose magical scheming for mental survival as the self-representation splits up and body jettison becomes plausible. These phenomena are discussed theoretically in terms of failed affect regulation, ego helplessness, narcissistic surrender, breakdown of the representational world, and loss of reality testing.

Aggression↗