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At least 109 records · Page 6Linked to original sources
PubMed2002

A mechanical comparison of bone-ligament-bone autografts from the wrist for replacement of the scapholunate ligament.

A study was performed to compare the mechanical properties of two intracarpal ligaments with those of the dorsal component of the scapholunate interosseous ligament (SLIL). Trapezoid-to-second metacarpal, capitate-to-trapezoid ligaments, and the dorsal part of the SLIL were obtained as bone-ligament-bone grafts from fresh frozen cadavers. Their respective load to failure and stiffness were measured under uniaxial load on a servohydraulic machine and compared. The capitate-to-trapezoid ligament closely approximated the load to failure and stiffness of the dorsal SLIL, whereas the trapezoid-to-second metacarpal ligament was significantly stronger and stiffer than the dorsal SLIL. These 2 intracarpal bone-ligament-bone grafts share similar mechanical properties with the dorsal component of the scapholunate ligament and might be used clinically to replace it.

Aged↗
PubMed1980

Limited wrist arthrodesis.

Limited wrist arthrodesis is the surgical fusion of selected bones of the wrist. In each case the extent of the fusion is determined by the extent of the disease process. Limited wrist arthrodesis is an alternative to complete wrist fusion when there is a localized area of degenerative change or instability in the carpus. It relieves pain yet still allows a good range of motion. Since 1968, 36 patients have had 38 limited wrist arthrodeses. Twenty-four cases have involved carpal bones only. Fourteen of these were "triskaphe" arthrodeses: scaphoid-trapezium-trapezoid arthrodeses. Eleven cases have included the radius, and 3 have included the index metacarpal.

Arthrodesis↗
PubMed2005

Relationship between dorsal ganglion cysts of the wrist and intraosseous ganglion cysts of the carpal bones.

Soft tissue ganglion cysts are the most common benign tumours of the wrist; their pathogenesis remains controversial. We prospectively screened the radiographic appearance of the wrists of 51 patients presenting to a single surgeon with dorsal wrist ganglions during a one-year period. Postero-anterior and lateral radiographs were systematically performed looking for possible associated intraosseous ganglion cysts. There were 51 dorsal soft tissue ganglion cysts in 51 patients. We detected 29 associated intraosseous ganglia in 24 patients (47%): 16 ganglia in the lunate bone (55%), 5 in the capitate bone, 7 in the scaphoid and 1 in the trapezoid. Mean size of the intraosseous ganglia was 3 mm (range, 2 to 5 mm). This high prevalence of intraosseous ganglia in association with soft tissue ganglia has to our knowledge never been reported previously. A common aetiology for these two types of ganglion cysts may explain this high association rate.

Bone Cysts↗
PubMedDate not supplied

In vitro measurement of bone-acrylic interface pressure during femoral component insertion.

Bone-acrylic interface pressure measurements were recorded at the medial interior rasped surfaces of fresh cadaver femurs during digital packing of acrylic bone cement and during insertion and seating of a Trapezoidal-28 femoral total hip component. Plugging of the femoral canal below the tip of the prosthesis stem was an effective means for increasing pressure in the distal femoral canal when the stem was inserted in the early stages of acrylic polymerization (i.e. immediately after dough time). At surgery, this can be accomplished by inserting a small bolus of acrylic down the canal to a depth below the tip of the seated stem and allowing it to polymerize in place. This forms an effective seal which prevents distal extrusion of the acrylic when the cavity is then packed prior to prosthesis insertion. Elimination of cement in the distal canal also avoids any future difficulty of acrylic removal should revision become necessary due to loosening or infection. No significant pressure differences were observed between one and two millimeter thicknesses of acrylic between the metal and bone. Interface pressures developed during finger packing were of the same order of magnitude as those achieved during seating of the femoral component. Use of a rubber diaphragm stretched tightly over the margins of the rasped femoral cavity helped to contain the acrylic and prevent extrusion during finger packing but was ineffective in increasing interface pressure. When this method is used, the acrylic can be poured or injected into the canal and packed before dough stage and thus facilitate increased cancellous penetration when the acrylic is in a state of low viscosity.

Arthroplasty↗
PubMed1995

[A new surgical technique for carpal instability with scapho-lunar dislocation. (Eleven cases)].

A new operation for correcting carpal instability with scapholunate dissociation is presented. Rupture of the volar scaphoid-trapezium-trapezoid ligament (i.e. the fibrous sheath of the F.C.R.) is recognized to play a prominent role in the etiology of this instability. The scar formed in between the scaphoid and lunate bones is removed as well as that formed between scaphoid, trapezium and trapezoid. A slip of F.C.R. is passed throughout a tunnel pierced in the distal pole of the scaphoid. The slip is then sutured to the dorsolunar ridge of the distal radius with correction of both the dissociation and the scaphoid flexion. The operation is easy and quick. Eleven cases are presented with satisfactory results.

Follow-Up Studies↗
PubMed2001

Bone anchored sling for the treatment of post-prostatectomy incontinence.

PURPOSE: This ongoing study evaluates the safety and efficacy of a new minimally invasive sling procedure for treating post-prostatectomy incontinence. MATERIALS AND METHODS: A total of 16 men 56 to 74 years old (mean age 67) underwent the procedure using the Straight-In bone anchoring system. Time after prostatectomy was 1.5 to 5 years (mean 2.5). Of the 16 patients 14 had urodynamically confirmed stress urinary incontinence, while 2 had mixed incontinence with stress incontinence and detrusor instability. The procedure is performed with the patient in the lithotomy position using a perineal approach. Four miniature bone screws with pre-attached pairs of No. 1 polypropylene sutures are placed directly into the medial aspect of the inferior rami of the pubic bone. A pair of bone anchors is placed just below the symphysis on each side, and the second pair is inserted 3 to 4 cm. lower. To support the bulbar urethra a gelatin coated polyethylene terephthalate trapezoid shaped sling or cadaveric fascia lata is tied to the pubic bone using the 4 pairs of sutures attached to the bone anchors. Urethral resistance is increased to 30 to 50 cm. water above baseline pressure. RESULTS: Followup was 4 to 20 months (mean 12.2). Of the 14 men with the preoperative urodynamic diagnosis of genuine stress incontinence 12 were cured of incontinence, defined as subjectively dry with no or only 1 pad used daily for security without any episode of leakage, while 2 were improved subjectively with a decrease of 50% or more in pads daily. Two other patients with the preoperative diagnosis of mixed urinary incontinence were improved. Postoperatively urodynamic study in these patients revealed resolved stress incontinence but persistent urge urinary incontinence. They responded to anticholinergics and are completely dry. Intraoperative and postoperative complications were minimal with no erosion, infection or osseous complications. CONCLUSIONS: This new minimally invasive male sling procedure is safe and efficacious. Adjusting sling tension by measuring urethral resistance results in a low rate of over correction and failure. Further experience is needed to establish this procedure as treatment for post-prostatectomy incontinence.

Aged↗
PubMed1982

The three-dimensional rotational behaviors of the carpal bones.

The rotational behaviors of the carpal bones of ten fresh cadaver forearms were determined using a three-dimensional sonic digitizer, as the hands were passively moved through planar constrained motions. Changing forearm orientation from supination to pronation results in an increase in the magnitudes of extension of the proximal and distal carpal row bones and a reduction in the magnitudes of flexion of the distal carpal row bones. The included angles between each carpal bone screw displacement axis (SDA) and third metacarpal SDA for corresponding intervals of motion are significantly greater than zero, regardless of forearm orientation. The included angles of the proximal carpal row bones are significantly greater than those of the distal carpal row bones during third metacarpal radial-ulnar deviation. The carpal bone rotation magnitudes are significantly attenuated relative to the prescribed rotation magnitudes of the third metacarpal, with the exception of the trapezoid during third metacarpal extension. The rotational attenuation is greatest in the proximal carpal row bones and is most pronounced during third metacarpal flexion-extension motion and ulnar deviation. Evidence from this investigation favors a carpal row concept of wrist motion, as opposed to a carpal column model.

Carpal Bones↗
PubMed1989

Acute scaphoid fracture with scapholunate gap.

Disruptive forces from wrist trauma are thought to fracture bone or disrupt ligaments. Two cases are presented to demonstrate the simultaneous occurrence of acute scaphoid fracture and scapholunate gap. Recommended treatment in acute cases is open reduction and internal fixation of the fracture and open stabilization of the scaphoid. In chronic cases, we recommend open reduction and internal fixation with bone graft to the scaphoid nonunion combined with fusion of the scaphoid-trapezium-trapezoid joint.

Adolescent↗
PubMed2005

Trapezoidal titanium cage in anterior cervical interbody fusion: a clinical experience.

BACKGROUND: Use of autogenous bone grafting taken from anterior iliac crest for anterior cervical interbody fusion has been the "gold-standard" for decades. Substitutes for autogenous bone graft continue to be sought to avoid potential donor site morbidity. A titanium-alloy square-shaped hollow cage was applied to facilitate the process of fusion as a bone graft substitute, then assessed in this retrospective clinical study. METHODS: From July 2000 to July 2001, sixty-three discs from fifty-four patients were selected to receive this cage for one or two segments of the cervical spine for anterior cervical interbody fusion. The Japanese Orthopedic Association (JOA) score and Odom's criteria were used to measure the clinical outcome. Postoperative radiographs were analyzed for graft dislodgement, loss of anterior and posterior disc heights, maintenance of lordosis correction, and status of fusion between the cage and endplates to assess their suitability as a grafting substitute. RESULTS: Eighty-seven percent of patients exhibited satisfactory clinical outcome. Successful fusion was obtained in ninety point five percent of operated discs. Partial cage dislodgement was observed in four point eight percent of discs and caused no adverse symptoms. The mean collapse of the anterior and posterior disc heights were 1.73 mm and 0.91 mm, respectively. Moreover, the mean loss of lordosis correction was 2.75 degrees. CONCLUSIONS: Based on this primary clinical experience, the trapezoid-design, titanium-alloy cage provided adequate mechanical support and stability in the disc space and an excellent fusion result without significant subsidence of disc height or any other complications.

Bone Transplantation↗
PubMed1988

Knife wounds into the airspaces of the laryngeal trapezium.

The trapezoidal-shaped area of the neck bounded by the hyoid bone, cricoid cartilage, and medial borders of the sternocleidomastoid muscles is widely exposed to knife slash and stab injuries. Suicidal or homicidal throat slashes involving this area may produce serious horizontal laryngeal injuries, whereas homicidal stab wounds may produce serious vertical laryngeal or hypopharyngeal injuries. The extent of such injuries often cannot be predicted from the entrance wounds and presenting symptoms. Therefore special guidelines should be followed to insure the safety of selective exploration of knife wounds penetrating into the airspaces within this trapezium. In addition, repair of serious laryngeal injuries may require use of laryngoplasty or partial laryngectomy techniques rather than simple repair.

Female↗
PubMed2000

Cross-sectional and longitudinal assessment of pre- and postmenopausal bone loss with a portable forearm X-ray device: the Ofely study.

The aim of our study was to describe cross-sectional and longitudinal bone mineral decrease in pre-, peri-, and postmenopausal healthy women using a monoenergy X-ray densitometer specifically designed for forearm assessement. Measurements were performed on the most distal part of the radius (ultradistal, 55% of trabecular bone and 45% of trabecular bone), and on the distal part (distal, 13% of trabecular bone and 87% of cortical bone). A specific trabecular-rich region of interest (nROI) comprising two trapezoids regions of interest located proximally to the endplates of the radius and ulna was also investigated. From a large prospective study (OFELY study), 455 women were measured once a year for 2 years (three measurements). The proportion of postmenopausal women classified as having osteoporosis (i.e., a T score <-2.5) was 33% for the distal region, 44% for the ultradistal region, and 45% for the nROI. No significant bone mineral decrease was found over the 2-year period in premenopausal women (n = 138). In perimenopausal (n = 48) women, a bone loss of 1% was found at the distal site. In the 269 postmenopausal women, a significant decrease was observed at all sites, ranging from 2.14% for the nROI to 2.68% for the ultradistal part. Bone loss was greater in the first 5 years after menopause in trabecular sites and decreased thereafter. For the distal site, bone loss remained stable during the postmenopausal period. We conclude that this small and portable forearm densitometer is suitable for the diagnosis of osteoporosis, and provides information on the rate of bone loss in peri- and postmenopausal women in trabecular and cortical compartments of bone.

Absorptiometry, Photon↗
PubMedDate not supplied

[Flat crossleg flaps in the repair of large skin, muscle and bone defect of the leg. Present indications, new techniques (author's transl)].

This is a report on a patient who suffered a large skin, muscle and bone defect of the leg following a Volkmann's ischemia. The author's indications for a flat crossleg flap are explained : extended skin defect at the anterior and inner aspect of the broken tibia or a skin defect associated to a tibial defect making a secondary bone graft necessary. Finally the authors describe an original technique of crossleg flap : this consists in a trapezoidal flap with the large side being the implantation basis.

Adolescent↗
PubMed1989

Wrist kinematics after limited intercarpal arthrodesis.

Two limited intercarpal fusions, scapho-trapezial-trapezoidal and scapho-capitate, were simulated in six fresh human cadaver wrists by means of two Herbert screws. By use of a biplanar radiographic measurement system, the relative kinematic behavior of selected carpal bones, before and after the simulated limited fusions could be analyzed. Both scapho-trapezial-trapezoidal and scapho-capitate fusions produced a similar reduction in global range of motion and comparable effects on the relative intracarpal motion. In both fusions, a significant reduction in relative motion at the lunocapitate joint was recorded. The scaphoid, being fused to the distal carpal row, was shown to lose its role in the adaptative mechanism that allows preservation of articular congruency to the always changing space between the distal carpal row and the radius. After both types of fusion, increased sliding motion of the lunate on the radius was found. These kinematic changes are likely to enhance shear stresses on the lunate and tension on the surrounding ligaments, potentially diminishing long-term functional results.

Arthrodesis↗
PubMed1988

Lateral orbitotomy without removal of the lateral orbital rim.

Lateral orbitotomy is used for the removal of orbital tumors and for orbital decompression. Most surgeons make saw cuts through the lateral orbital rim and remove and rewire the bone. This procedure is time-consuming and requires repair of the lateral canthal structures. We describe a technique using an air-driven "acorn-tipped" bur that removes the posterolateral lip of the frontal process of the zygomatic bone and effectively straightens the external surface of the lateral orbital wall. This permits removal of the bone without serious injury to the periorbita. The technique creates a trapezoidal orbitotomy measuring approximately 20 mm anteroposterior, 25 mm at the anterior vertical base, and 6 mm at the posterior base. The orbital soft tissues can thus be safely exposed without removal of the lateral rim. We operated on one patient with cavernous hemangioma (27 X 21 X 19 mm) and three patients with bilateral Graves' ophthalmopathy. We discuss anatomic considerations for the prevention of complications, including injury to the frontotemporal branches of the facial nerve, injury to the superior head of the lateral pterygoid muscle, and inadvertent penetration of the dura.

Dissection↗
PubMedDate not supplied

[Patellar fracture after reconstruction of the anterior cruciate ligament--case report].

INTRODUCTION: The most frequent procedure in treatment of acute or chronic anterior cruciate ligament (ACL) rupture is the so called bone-tendon-bone reconstruction. A transverse dislocated patella fracture is a rare complication of this procedure with an incidence of 0.23%-2.3%. In a five year period, (1998-2002), 407 arthroscopic reconstructions of the anterior cruciate ligaments were done at our Clinic, and there was only one case of patella fracture. CASE REPORT: An 18-year-old female patient, a handball player, suffered an acute rupture of anterior cruciate ligament of the left knee, so arthroscopic bone-tendon-bone reconstruction of the anterior cruciate ligament was performed. After adequate skin incision, a bone graft was taken from the patella and upper part of trapezoid tibia, which was 25 mm long, 10 mm wide and 5 mm thick, together with a part of patellar ligament. After the remains of the anterior cruciate ligament had been arthroscopically removed, tunnels were made in tibia and femur and a graft was inserted and fixed with two metal interference screws. Knee stability was tested, and drainage was put in the knee joint. The wound was closed by layers. The quadriceps exercises and passive knee movements started immediately. Full range of movements was accomplished six weeks later when the patient started to walk with full weight-bearing on her operated leg. Three weeks later, (nine weeks after the operation), the patient has accidentally lost her balance and fell. A transverse, dislocated fracture of the left patella was diagnosed and osteosynthesis of the fractured patella with two Kirschner wires and a metallic loop was performed. Postoperatively, full range of movement was allowed. Six months later, the patient felt no pain, there was no swelling, full range of knee movement was achieved, while the Lachman Test was identical in both knees and the pivot shift test was negative. DISCUSSION: Fracture of patella after ACL reconstruction is due to several reasons: size and shape of the graft, technique of its taking, disturbed patellar blood supply, incomplete filling of patella defect after graft taking, and inappropriate postoperative rehabilitation. If a patellar fracture occurs after anterior cruciate ligament reconstruction, the best treatment is firm osteosynthesis, which enables bone healing and immediate continuation of the previously resumed rehabilitation program. However, this complication prolongs the rehabilitation period and slows down return to sports.

Adolescent↗