Effect of the Glenosphere Position and Size on Reverse Shoulder Prostheses Mobility

Introduction: Several methods have already been proposed to improve the mobility of reversed prostheses (lateral or inferior displacement, increase of the glenosphere size). However, the effect of these design changes have only been evaluated on the maximal range of motion and were not related to activities of daily living (ADL). Our aim was thus to measure the effect of these design changes and to relate it to 4 typical ADL. Methods: CT data were used to reconstruct a accurate geometric model of the scapula and humerus. The Aequalis reversed prosthesis (Tornier) was used. The mobility of a healthy shoulder was compared to the mobility of 4 different reversed designs: 36 and 42 mm glenospheres diameters, inferior (4 mm) and lateral (3.2 mm) glenospheres displacements. The complete mobility map of the prosthesis was compared to kinematics measurement on healthy subjects for 4 ADL: 1) hand to contra lateral shoulder, 2) hand to mouth, 3) combing hair, 4) hand to back pocket. The results are presented as percentage of the allowed movement of the prosthestic shouder relative to the healthy shoulder, considered as the control group. Results: None of the tested designs allowed to recover a full mobility. The differences of allowed range of motion among each prosthetic designs appeared mainly in two of the 4 movements: hand to back pocket and hand to contra lateral shoulder. For the hand to back pocket, the 36 had the lowest mobility range, particularly for the last third of the movement. The 42 appeared to be a good compromise for all ADL activities. Conclusion: Reverse shoulder prostheses does not allow to recover a full range of motion compared to healthy shoulders, even for ADL. The present study allowed to obtain a complete 3D mobility map for several glenosphere positions and sizes, and to relate it to typical ADL. We mainly observed an improved mobility with inferior displacement and increased glenosphere size. We would suggest to use larger glenosphere, whenever it is possible.

Tectonic and metamorphic evolution of the Central Himalayan Domain in Southeast Zanskar (Kashmir, India)

La région du Zanskar, étudiée dans le cadre de ce travail, se situe au passage entre deux domaines himalayens fortement contrastés, la Séquence Cristalline du Haut Himalaya (HHCS), composée de roches métamorphiques et l'Himalaya Tethysien (TH), composé de séries sédimentaires. La transition entre ces deux domaines est marquée par une structure tectonique majeure, la Zone de Cisaillement du Zanskar (ZSZ), au sein de laquelle on observe une augmentation extrêmement rapide, mais néanmoins graduelle, du degré du métamorphisme entre le TH et le HHCS. Il a été établi que le HHCS n'est autre que l'équivalent métamorphique des séries sédimentaires de la base du TH. C'est principalement lors d'un épisode de mise en place de nappes à vergence sudouest, entre l'Eocène moyen et l'Oligocène, que les séries sédimentaires de la base du TH ont été entraînées en profondeur où elles ont subi un métamorphisme de type barrovien. Au début du Miocène, le HHCS à été exhumé en direction du sud-ouest sous forme d'une grande nappe, délimitée a sa base par le MCT (principal chevauchement central) et à son sommet par la Zone de Cisaillement du Zanskar. L'ensemble des zones barroviennes, de la zone à biotite jusqu'à la zone à disthène, a été cisaillée par les mouvements en faille normale au sommet du HHCS et se retrouve actuellement sur une épaisseur d'environ 1 kilomètre au sein de la ZSZ. La décompression associée à l'exhumation du HHCS a provoqué la fusion partielle d'une partie du HHCS et a donné naissance à des magmas de composition leucogranitiques. Grâce à la géothermobarometrie, et connaissant la géométrie de la ZSZ, il nous a été possible de déterminer que le rejet le long de cette structure d'extension est d'au moins 35?9 kilomètres. Une série d'arguments nous permet cependant de suggérer que ce rejet aurait pu être encore bien plus important (~100km). Les données géochronologiques nous permettent de contraindre la durée des mouvements d'extension le long de la ZSZ à 2.4?0.2 Ma entre 22.2?0.2 Ma et 19.8?0.1 Ma. Ce travail apporte de nouvelles données sur les processus métamorphiques, magmatiques et tectoniques liés aux phénomènes d'extension syn-orogeniques.<br/><br/>The southeastern part of Zanskar is located at the transition between two major Himalayan domains of contrasting metamorphic grade, the High Himalayan Crystalline Sequence (HHCS) and the Tethyan Himalaya (TH). The transition between the TH and the HHCS is marked by a very rapid, although perfectly gradual, decrease in metamorphic grade, which coincides with a major tectonic structure, the Zanskar Shear Zone (ZSZ). It is now an established fact that the relation between the HHCS and the TH is not one of basement-cover type, but that the metasedimentary series of the HHCS represent the metamorphic equivalent of the lowermost sedimentary series of the TH. This transformation of sedimentary series into metamorphic rocks, and hence the differentiation between the TH and the HHCS, is the consequence of crustal thickening associated to the formation of large scale southwest vergent nappes within the Tethyan Himalaya sedimentary series. This, Middle Eocene to Oligocene, episode of crustal thickening and associated Barrovian metamorphism is followed, shortly after, by the exhumation of the HHCS as a, large scale, south-west vergent, nappe. Foreword The exhumation of the HHCS nappe is marked by the activation of two contemporaneous structures, the Main Central Thrust at its base and the Zanskar Shear Zone at its top. Extensional movements along the ZSZ, caused the Barrovian biotite to the kyanite zones to be sheared and constricted within the ~1 km thick shear zone. Decompression associated with the exhumation of the HHCS induced the formation of leucogranitic magmas through vapour-absent partial melting of the highest-grade rocks. The combination of geothermobarometric data with a geometric model of the ZSZ allowed us to constrain the net slip at the top of the HHCS to be at least 35?9 kilometres. A set of arguments however suggests that these movements might have been much more important (~ 100 km). Geochronological data coupled with structural observations constrain the duration of ductile shearing along the ZSZ to 2.4?0.2 Ma between 22.2?0.2 Ma and 19.8?0.1 Ma. This study also addresses the consequences of synorogenic extension on the metamorphic, tectonic and magmatic evolution of the upper parts of the High Himalayan Crystalline Sequence.

Structural analysis of Turtle mountain (Alberta) using digital elevation model: Toward a progressive failure

In 1903, the eastern slope of Turtle Mountain (Alberta) was affected by a 30 M m3-rockslide named Frank Slide that resulted in more than 70 casualties. Assuming that the main discontinuity sets, including bedding, control part of the slope morphology, the structural features of Turtle Mountain were investigated using a digital elevation model (DEM). Using new landscape analysis techniques, we have identified three main joint and fault sets. These results are in agreement with those sets identified through field observations. Landscape analysis techniques, using a DEM, confirm and refine the most recent geology model of the Frank Slide. The rockslide was initiated along bedding and a fault at the base of the slope and propagated up slope by a regressive process following a surface composed of pre-existing discontinuities. The DEM analysis also permits the identification of important geological structures along the 1903 slide scar. Based on the so called Sloping Local Base Level (SLBL) an estimation was made of the present unstable volumes in the main scar delimited by the cracks, and around the south area of the scar (South Peak). The SLBL is a method permitting a geometric interpretation of the failure surface based on a DEM. Finally we propose a failure mechanism permitting the progressive failure of the rock mass that considers gentle dipping wedges (30°). The prisms or wedges defined by two discontinuity sets permit the creation of a failure surface by progressive failure. Such structures are more commonly observed in recent rockslides. This method is efficient and is recommended as a preliminary analysis prior to field investigation.

Cytostatic lung perfusion results in heterogeneous spatial regional blood flow and drug distribution: evaluation of different cytostatic lung perfusion techniques in a porcine model.

OBJECTIVES: Comparison of doxorubicin uptake, leakage and spatial regional blood flow, and drug distribution was made for antegrade, retrograde, combined antegrade and retrograde isolated lung perfusion, and pulmonary artery infusion by endovascular inflow occlusion (blood flow occlusion), as opposed to intravenous administration in a porcine model. METHODS: White pigs underwent single-pass lung perfusion with doxorubicin (320 mug/mL), labeled 99mTc-microspheres, and Indian ink. Visual assessment of the ink distribution and perfusion scintigraphy of the perfused lung was performed. 99mTc activity and doxorubicin levels were measured by gamma counting and high-performance liquid chromatography on 15 tissue samples from each perfused lung at predetermined localizations. RESULTS: Overall doxorubicin uptake in the perfused lung was significantly higher (P = .001) and the plasma concentration was significantly lower (P < .0001) after all isolated lung perfusion techniques, compared with intravenous administration, without differences between them. Pulmonary artery infusion (blood flow occlusion) showed an equally high doxorubicin uptake in the perfused lung but a higher systemic leakage than surgical isolated lung perfusion (P < .0001). The geometric coefficients of variation of the doxorubicin lung tissue levels were 175%, 279%, 226%, and 151% for antegrade, retrograde, combined antegrade and retrograde isolated lung perfusion, and pulmonary artery infusion by endovascular inflow occlusion (blood flow occlusion), respectively, compared with 51% for intravenous administration (P = .09). 99mTc activity measurements of the samples paralleled the doxorubicin level measurements, indicating a trend to a more heterogeneous spatial regional blood flow and drug distribution after isolated lung perfusion and blood flow occlusion compared with intravenous administration. CONCLUSIONS: Cytostatic lung perfusion results in a high overall doxorubicin uptake, which is, however, heterogeneously distributed within the perfused lung.

Improving anterior deltoid activity in a musculoskeletal shoulder model - an analysis of the torque-feasible space at the sternoclavicular joint.

Modelling the shoulder's musculature is challenging given its mechanical and geometric complexity. The use of the ideal fibre model to represent a muscle's line of action cannot always faithfully represent the mechanical effect of each muscle, leading to considerable differences between model-estimated and in vivo measured muscle activity. While the musculo-tendon force coordination problem has been extensively analysed in terms of the cost function, only few works have investigated the existence and sensitivity of solutions to fibre topology. The goal of this paper is to present an analysis of the solution set using the concepts of torque-feasible space (TFS) and wrench-feasible space (WFS) from cable-driven robotics. A shoulder model is presented and a simple musculo-tendon force coordination problem is defined. The ideal fibre model for representing muscles is reviewed and the TFS and WFS are defined, leading to the necessary and sufficient conditions for the existence of a solution. The shoulder model's TFS is analysed to explain the lack of anterior deltoid (DLTa) activity. Based on the analysis, a modification of the model's muscle fibre geometry is proposed. The performance with and without the modification is assessed by solving the musculo-tendon force coordination problem for quasi-static abduction in the scapular plane. After the proposed modification, the DLTa reaches 20% of activation.