Percutaneous screw fixation of the iliosacral joint: optimal screw pathways are frequently not completely intraosseous

INTRODUCTION In iliosacral screw fixation, the dimensions of solely intraosseous (secure) pathways, perpendicular to the ilio-sacral articulation (optimal) with corresponding entry (EP) and aiming points (AP) on lateral fluoroscopic projections, and the factors (demographic, anatomic) influencing these have not yet been described. METHODS In 100 CTs of normal pelvises, the height and width of the secure and optimal pathways were measured on axial and coronal views bilaterally (total measurements: n=200). Corresponding EP and AP were defined as either the location of the screw head or tip at the crossing of lateral innominate bones' cortices (EP) and sacral midlines (AP) within the centre of the pathway, respectively. EP and AP were transferred to the sagittal pelvic view using a coordinate system with the zero-point in the centre of the posterior cortex of the S1 vertebral body (x-axis parallel to upper S1 endplate). Distances are expressed in relation to the anteroposterior distance of the S1 upper endplate (in %). The influence of demographic (age, gender, side) and/or anatomic (PIA=pelvic incidence angle; TCA=transversal curvature angle, PID-Index=pelvic incidence distance-index; USW=unilateral sacral width-index) parameters on pathway dimensions and positions of EP and AP were assessed (multivariate analysis). RESULTS The width, height or both factors of the pathways were at least 7mm or more in 32% and 53% or 20%, respectively. The EP was on average 14±24% behind the centre of the posterior S1 cortex and 41±14% below it. The AP was on average 53±7% in the front of the centre of the posterior S1 cortex and 11±7% above it. PIA influenced the width, TCA, PID-Index the height of the pathways. PIA, PID-Index, and USW-Index significantly influenced EP and AP. Age, gender, and TCA significantly influenced EP. CONCLUSION Secure and optimal placement of screws of at least 7mm in diameter will be unfeasible in the majority of patients. Thoughtful preoperative planning of screw placement on CT scans is advisable to identify secure pathways with an optimal direction. For this purpose, the presented methodology of determining and transferring EPs and APs of corresponding pathways to the sagittal pelvic view using a coordinate system may be useful.

Temporary Internal Fixation for Ligamentous and Osseous Lisfranc Injuries: Outcome and Technical Tip

BACKGROUND Open rather than closed reduction and internal fixation as well as primary definitive arthrodesis are well accepted for ligamentous and osseous Lisfranc injuries. For ligamentous injuries, a better outcome after primary definitive partial arthrodesis has been published. METHODS Of 135 Lisfranc injuries that were treated from 1998 to 2012 with open reduction, temporary internal fixation by screws and plates, and restricted weight bearing in a lower leg cast for 3 months followed by an arch support for another 4 to 6 weeks, 29 ligamentous Lisfranc injuries were available for follow-up. They were compared with 29 osseous Lisfranc injuries matched in age and gender. RESULTS Between the groups, there were no significant differences in average age (39.9 vs 38 years) or in average follow-up time (8.3 vs 9.1 years). Also, no significant differences were seen in the AOFAS midfoot score (84 vs 85.3 points), the FFI pain scale (9.9 vs 14.9 points), SF 36 physical component (56.2 vs 53.9 points), SF 36 mental component (57 vs 56.4 points), or VAS for pain (1.6 vs 1.5 points). The FFI function scale was significantly lower in the ligamentous group (11.6 vs 19.5 points). Radiographically, loss of reduction was recorded 3 times in the ligamentous injuries and 4 times in the osseous injuries. Arthritis was mild/moderate/severe in 5/3/0 ligamentous injuries and in 7/2/1 osseous injuries, requiring 1 definitive secondary Lisfranc arthrodesis in each group. CONCLUSION With longer and conservative postoperative management, open reduction and temporary internal fixation in ligamentous and osseous Lisfranc injuries led to equal medium-term outcome. Inferior outcome in ligamentous injuries was not found. LEVEL OF EVIDENCE Level III, retrospective comparative cohort study.

Stability of Le Fort I maxillary inferior repositioning surgery with rigid internal fixation: a systematic review

The aim of this study was to evaluate the stability of Le Fort I maxillary inferior repositioning surgery in patients with a vertical maxillary deficiency at least 6 months after surgery. The electronic databases were searched to identify all articles reporting the long-term effects of one-piece maxillary inferior repositioning with rigid fixation. Methodological quality was evaluated according to 15 criteria related to study design, measurements, and statistical analysis. Two articles were identified, with a total of 22 patients. The maxilla was repositioned inferiorly from a mean 3.2 to 4.5mm in the anterior part and from a mean 0.1 to 1.8mm in the posterior part. At 6 months post-treatment, absolute relapse of a mean 1.6mm was measured for the anterior part of the maxilla and 0.3mm for the posterior part of the maxilla. The stability of maxillary inferior repositioning surgery could not be confirmed due to the small sample size, unclear diagnosis, and potential confounding factors.

Effect of an intervertebral disk spacer on stiffness after monocortical screw/polymethylmethacrylate fixation in simulated and cadaveric canine cervical vertebral columns.

OBJECTIVE To determine the biomechanical effect of an intervertebral spacer on construct stiffness in a PVC model and cadaveric canine cervical vertebral columns stabilized with monocortical screws/polymethylmethacrylate (PMMA). STUDY DESIGN Biomechanical study. SAMPLE POPULATION PVC pipe; cadaveric canine vertebral columns. METHODS PVC model-PVC pipe was used to create a gap model mimicking vertebral endplate orientation and disk space width of large-breed canine cervical vertebrae; 6 models had a 4-mm gap with no spacer (PVC group 1); 6 had a PVC pipe ring spacer filling the gap (PCV group 2). Animals-large breed cadaveric canine cervical vertebral columns (C2-C7) from skeletally mature dogs without (cadaveric group 1, n = 6, historical data) and with an intervertebral disk spacer (cadaveric group 2, n = 6) were used. All PVC models and cadaver specimens were instrumented with monocortical titanium screws/PMMA. Stiffness of the 2 PVC groups was compared in extension, flexion, and lateral bending using non-destructive 4-point bend testing. Stiffness testing in all 3 directions was performed of the unaltered C4-C5 vertebral motion unit in cadaveric spines and repeated after placement of an intervertebral cortical allograft ring and instrumentation. Data were compared using a linear mixed model approach that also incorporated data from previously tested spines with the same screw/PMMA construct but without disk spacer (cadaveric group 1). RESULTS Addition of a spacer increased construct stiffness in both the PVC model (P < .001) and cadaveric vertebral columns (P < .001) compared to fixation without a spacer. CONCLUSIONS Addition of an intervertebral spacer significantly increased construct stiffness of monocortical screw/PMMA fixation.

Enhancing Yield and Biological Nitrogen Fixation of Common Beans

Two studies were conducted at the ISU Horticulture Station to evaluate potential limitations on yield and atmospheric nitrogen fixation by common bean (Phaseolus vulgaris L.). This legume is a food staple for small landholder farm families worldwide. But it has a limited capacity for nitrogen fixation and often yields only a fraction of its genetic potential. In these studies, we examined the dependence of pod filling on current assimilate supply, as well as the potential to improve nitrogen fixation using an inoculant shown to enhance biological nitrogen fixation under stressful conditions.

Seawater carbonate chemistry, chlorophyll a and photosynthetic carbon fixation rate under different light and pCO2 conditions during experiments, 2010

We carried out short term pCO2/pH perturbation experiments in the coastal waters of the South China Sea to evaluate the combined effects of seawater acidification (low pH/high pCO2) and solar UV radiation (UVR, 280-400 nm) on photosynthetic carbon fixation of phytoplankton assemblages. Under photosynthetically active radiation (PAR) alone treatments, reduced pCO2 (190 ppmv) with increased pH resulted in a significant decrease in the photosynthetic carbon fixation rate (about 23%), while enriched pCO2 (700 ppmv) with lowered pH had no significant effect on the photosynthetic performance compared to the ambient level. The apparent photosynthetic efficiency decreased under the reduced pCO2 level, probably due to C-limitation as well as energy being diverged for up-regulation of carbon concentrating mechanisms (CCMs). In the presence of UVR, both UV-A and UV-B caused photosynthetic inhibition, though UV-A appeared to enhance the photosynthetic efficiency under lower PAR levels. UV-B caused less inhibition of photosynthesis under the reduced pCO2 level, probably because of its contribution to the inorganic carbon (Ci)-acquisition processes. Under the seawater acidification conditions (enriched pCO2), both UV-A and UV-B reduced the photosynthetic carbon fixation to higher extents compared to the ambient pCO2 conditions. We conclude that solar UV and seawater acidification could synergistically inhibit photosynthesis.

Depth integrated nitrogen fixation from the northern Benguela upwelling system during Maria S. Merain cruise MSM18/5

Nitrogen fixation data from the cruise number MSM18/5 with research vessel "Maria S. Merian" from 22.08.-20.09.2011 (from Walvis Bay to Walvis Bay) in front of Angola and northern Namibia. Samples taken by CTD- rosette sampler from different depths and incubated in glass bottles (535 ml) at light intensities that resemble the in situ light intensities of the sampling depth after 15N2 gas was injected to the sample. After the incubation time of 6 hours, the complete bottle content was filtered onto a pre-combusted Whatman GF/F filter. Filters were frozen, transported to the institute on dry ice and measured in a mass spectrometer for Delta 15N. The principle of the method was described by Montoya et al. (1996) and calculation was done according to their spread sheet. From the data of the single depths, the nitrogen fixation per square meter within the upper 40 m of the water column was calculated. The methods are described in detail in a paper submitted by Wasmund et al. in 2014 to be printed in 2015. Some results are surprisingly below zero. This occurs if the Delta 15N of the blank is higher than the measurement after incubation. It indicates that no nitrogen fixation occurred. Due to natural variability, the variability of the nitrogen fixation data is high. In an overall estimate, also over several cruises, negative and positive values compensate more or less, suggesting that nitrogen fixation is insignificant in the waters in front of northern Namibia and southern Angola.

Phototrophic carbon fixation rates measured in water samples from the Porcupine Abyssal Plains during James Cook cruise JC087

Water samples were collected from pre-dawn CTD casts at 5 depths corresponding to 55%, 20%, 7%, 5% and 1% of surface irradiance. 1 litre water samples wrapped with optical filters to replicate light levels. Spiked with 200 µL of 13C labelled sodium bicarbonate. After 24 hourse filtered through ashed 25mm GF/F (Whatman) filters, rinsed with HCl solution (1-2%) and stored at -20oC. On shore encapsulated in tin capsules and analysed for 13C isotopic enrichment. Carbon uptake rates calculated using the equations of Fernandez et al. (2005).

Depth integrated nitrogen fixation from the northern Benguela upwelling system during Maria S. Merain cruise MSM17/3

Nitrogen fixation data from the cruise number MSM17/3 with research vessel "Maria S. Merian" from 30.01.-10.02.2011 (= "leg a" from Walvis Bay to Walvis Bay) in front of Namibia. Samples taken by CTD- rosette sampler from different depths and incubated in glass bottles (535 ml) at light intensities that resemble the in situ light intensities of the sampling depth after 15N2 gas was injected to the sample. After the incubation time of 6-8 hours, the complete bottle content was filtered onto a pre-combusted Whatman GF/F filter. Filters were frozen, transported to the institute on dry ice and measured in a mass spectrometer for Delta 15N. The principle of the method was described by Montoya et al. (1996) and calculation was done according to their spread sheet. From the data of the single depths, the nitrogen fixation per square meter within the upper 40 m of the water column was calculated. The methods are described in detail in a paper submitted by Wasmund et al. in 2014 to be printed in 2015. Some results are surprisingly below zero. This occurs if the Delta 15N of the blank is higher than the measurement after incubation. It indicates that no nitrogen fixation occurred. Due to natural variability, the variability of the nitrogen fixation data is high. In an overall estimate, also over several cruises, negative and positive values compensate more or less, suggesting that nitrogen fixation is insignificant in the waters in front of northern Namibia and southern Angola.