High failure rate of trochanteric fracture osteosynthesis with proximal femoral locking compression plate

INTRODUCTION Stable reconstruction of proximal femoral (PF) fractures is especially challenging due to the peculiarity of the injury patterns and the high load-bearing requirement. Since its introduction in 2007, the PF-locking compression plate (LCP) 4.5/5.0 has improved osteosynthesis for intertrochanteric and subtrochanteric fractures of the femur. This study reports our early results with this implant. METHODS Between January 2008 and June 2010, 19 of 52 patients (12 males, 7 females; mean age 59 years, range 19-96 years) presenting with fractures of the trochanteric region were treated at the authors' level 1 trauma centre with open reduction and internal fixation using PF-LCP. Postoperatively, partial weight bearing was allowed for all 19 patients. Follow-up included a thorough clinical and radiological evaluation at 1.5, 3, 6, 12, 24, 36 and 48 months. Failure analysis was based on conventional radiological and clinical assessment regarding the type of fracture, postoperative repositioning, secondary fracture dislocation in relation to the fracture constellation and postoperative clinical function (Merle d'Aubigné score). RESULTS In 18 patients surgery achieved adequate reduction and stable fixation without intra-operative complications. In one patient an ad latus displacement was observed on postoperative X-rays. At the third month follow-up four patients presented with secondary varus collapse and at the sixth month follow-up two patients had 'cut-outs' of the proximal fragment, with one patient having implant failure due to a broken proximal screw. Revision surgeries were performed in eight patients, one patient receiving a change of one screw, three patients undergoing reosteosynthesis with implantation of a condylar plate and one patient undergoing hardware removal with secondary implantation of a total hip prosthesis. Eight patients suffered from persistent trochanteric pain and three patients underwent hardware removal. CONCLUSIONS Early results for PF-LCP osteosynthesis show major complications in 7 of 19 patients requiring reosteosynthesis or prosthesis implantation due to secondary loss of reduction or hardware removal. Further studies are required to evaluate the limitations of this device.

Combining Monte Carlo methods with coherent wave optics for the simulation of phase-sensitive X-ray imaging

Phase-sensitive X-ray imaging shows a high sensitivity towards electron density variations, making it well suited for imaging of soft tissue matter. However, there are still open questions about the details of the image formation process. Here, a framework for numerical simulations of phase-sensitive X-ray imaging is presented, which takes both particle- and wave-like properties of X-rays into consideration. A split approach is presented where we combine a Monte Carlo method (MC) based sample part with a wave optics simulation based propagation part, leading to a framework that takes both particle- and wave-like properties into account. The framework can be adapted to different phase-sensitive imaging methods and has been validated through comparisons with experiments for grating interferometry and propagation-based imaging. The validation of the framework shows that the combination of wave optics and MC has been successfully implemented and yields good agreement between measurements and simulations. This demonstrates that the physical processes relevant for developing a deeper understanding of scattering in the context of phase-sensitive imaging are modelled in a sufficiently accurate manner. The framework can be used for the simulation of phase-sensitive X-ray imaging, for instance for the simulation of grating interferometry or propagation-based imaging.

The influence of different osteosynthesis configurations with locking compression plates (LCP) on stability and fracture healing after an oblique 45° angle osteotomy

Background Locking compression plates are used in various configurations with lack of detailed information on consequent bone healing. Study design In this in vivo study in sheep 5 different applications of locking compression plate (LCP) were tested using a 45° oblique osteotomy simulating simple fracture pattern. 60 Swiss Alpine sheep where assigned to 5 different groups with 12 sheep each (Group 1: interfragmentary lag screw and an LCP fixed with standard cortex screws as neutralisation plate; Group 2: interfragmentary lag screw and LCP with locking head screws; Group 3: compression plate technique (hybrid construct); Group 4: internal fixator without fracture gap; Group 5: internal fixator with 3 mm gap at the osteotomy site). One half of each group (6 sheep) was monitored for 6 weeks, and the other half (6 sheep) where followed for 12 weeks. Methods X-rays at 3, 6, 9 and 12 weeks were performed to monitor the healing process. After sacrifice operated tibiae were tested biomechanically for nondestructive torsion and compared to the tibia of the healthy opposite side. After testing specimens were processed for microradiography, histology, histomorphometry and assessment of calcium deposition by fluorescence microscopy. Results In all groups bone healing occurred without complications. Stiffness in biomechanical testing showed a tendency for higher values in G2 but results were not statistically significant. Values for G5 were significantly lower after 6 weeks, but after 12 weeks values had improved to comparable results. For all groups, except G3, stiffness values improved between 6 and 12 weeks. Histomorphometrical data demonstrate endosteal callus to be more marked in G2 at 6 weeks. Discussion and conclusion All five configurations resulted in undisturbed bone healing and are considered safe for clinical application.

Preoperative Planning of Periacetabular Osteotomy (PAO)

Pelvic osteotomies improve containment of the femoral head in cases of developmental dysplasia of the hip or in femoroacetabular impingement due to acetabular retroversion. In the evolution of osteotomies, the Ganz Periacetabular Osteotomy (PAO) is among the complex reorientation osteotomies and allows for complete mobilization of the acetabulum without compromising the integrity of the pelvic ring. For the complex reorientation osteotomies, preoperative planning of the required acetabular correction is an important step, due to the need to comprehend the three-dimensional (3D) relationship between acetabulum and femur. Traditionally, planning was performed using conventional radiographs in different projections, reducing the 3D problem to a two-dimensional one. Known disturbance variables, mainly tilt and rotation of the pelvis make assessment by these means approximate at the most. The advent of modern enhanced computation skills and new imaging techniques gave room for more sophisticated means of preoperative planning. Apart from analysis of acetabular geometry on conventional x-rays by sophisticated software applications, more accurate assessment of coverage and congruency and thus amount of correction necessary can be performed on multiplanar CT images. With further evolution of computer-assisted orthopaedic surgery, especially the ability to generate 3D models from the CT data, examiners were enabled to simulate the in vivo situation in a virtual in vitro setting. Based on this ability, different techniques have been described. They basically all employ virtual definition of an acetabular fragment. Subsequently reorientation can be simulated using either 3D calculation of standard parameters of femoroacetabular morphology, or joint contact pressures, or a combination of both. Other techniques employ patient specific implants, templates or cutting guides to achieve the goal of safe periacetabular osteotomies. This chapter will give an overview of the available techniques for planning of periacetabular osteotomy.

The incidence of necrotizing changes in adults with pneumococcal pneumonia

Background. Necrotizing pneumonia is generally considered a rare complication of pneumococcal pneumonia in adults. We systematically studied the incidence of necrotizing changes in adult patients with pneumococcal pneumonia, and examined the severity of infection, the role of causative serotype and the association with bacteremia. ^ Methods. We used a data base of all pneumococcal infections identified at our medical center between 2000 and 2010. Original readings of chest X-rays (CXR) and computerized tomography (CT) were noted. All images were then reread independently by 2 radiologists. The severity of disease was assessed using the SMART-COP scoring system. ^ Results. There were 351 cases of pneumococcal pneumonia. Necrosis was reported in no original CXR readings and 6 of 136 (4.4%) CTs. With re-reading, 8 of 351 (2.3%) CXR and 15 of 136 (11.0%) CT had necrotizing changes. Overall, these changes were found in 23 of 351 (6.6%, 95% CI 4.0 - 9.1) patients. The incidence of bacteremia and the admitting SMART-COP scores were similar in patients with and without necrosis (P=1.00 and P=0.32, respectively). Type 3 pneumococcus was more commonly isolated from patients with than from patients without necrotizing pneumonia (P=0.05), but a total of 10 serotypes were identified among 16 cases in which the organism was available for typing. ^ Conclusions. Necrotizing changes in the lungs were seen in 6.6% (95% CI 4.0 - 9.1) of a large series of adults with pneumococcal pneumonia. Patients with necrosis were not more likely to have bacteremia or more severe disease. Type 3 pneumococcus was commonly implicated, but 9 other serotypes were also identified.^

Radiochemistry at DSDP Leg 54 and 70 Holes

Use of the hydraulic piston corer during DSDP Leg 70 in the Galapagos mounds area allowed recovery of an undisturbed sedimentary sequence down to the basement. It thus became possible to establish the chronology of different events. Several holes on and off the mounds were studied, using uranium series disequilibrium methods of age determination and oxygen isotope stratigraphy. The following sequence was thereby established: 1) From 600,000 to 300,000 years ago there was normal pelagic sedimentation, with an injection of uranium-rich solution, probably of hydrothermal origin, between 400,000 and 300,000 years ago. 2) From 300,000 to 90,000 years ago, nontronitic clay formed, replacing a pre-existing sediment. 3) From 60,000 to 20,000 years ago, manganese oxide deposits formed, probably also replacing pre-existing sediments. 4) About 19,000 years ago there occurred a uranium injection from seawater, attributed to the end of the hydrothermal circulation. In some holes, especially Hole 424, Leg 54, younger manganese oxides have been found, indicating that some mounds may be presently active.

Geochemical analysis of minerals from sediment core CRP-2 in the Ross Sea, Antarctica

Distribution patterns, petrography, whole-rock and mineral chemistry, and shape and fabric data are described for the most representative basement lithologies occurring as clasts (granule to bolder grain-size class) from the 625 m deep CRP-2/2A drillcore. A major change in the distribution pattern of the clast types occurs at c. 310 mbsf., with granitoid-dominated clasts above and mainly dolerite clasts below; moreover, compositional and modal data suggest a further division into seven main detrital assemblages or petrofacies. In spite of this variability, most granitoid pebbles consist of either pink or grey biotite±hornblende monzogranites. Other less common and ubiquitous lithologies include biotite syenogranite, biotite-hornblende granodiorite, tonalite, monzogranitic porphyries (very common below 310 mbsf), microgranite, and subordinately, monzogabbro, Ca-silicate rocks, biotite-clinozoisite schist and biotite orthogneiss (restricted to the pre-Pliocene strata). The ubiquitous occurrence of biotite±hornblende monzogranite pebbles in both the Quaternary-Pliocene and Miocene-Oligocene sections, apparently reflects the dominance of these lithologies in the onshore basement, and particularly in the Cambro-Ordovician Granite Harbour Igneous Complex which forms the most extensive outcrop in southern Victoria Land. The petrographical features of the other CRP-2/2A pebble lithologies are consistent with a supply dominantly from areas of the Transantarctic Mountains facing the CRP-2/2A site, and they thus provide further evidence of a local provenance for the supply of basement clasts to the CRP-2/2A sedimentary strata.

Chemical composition of volcanic glass of some tephra layers in Northeastern Pacific Ocean

Five widespread upper Cenozoic tephra layers that are found within continental sediments of the western United States have been correlated with tephra layers in marine sediments in the Humboldt and Ventura basins of coastal California by similarities in major-and trace-element abundances; four of these layers have also been identified in deep-ocean sediments at DSDP sites 34, 36, 173, and 470 in the northeastern Pacific Ocean. These layers, erupted from vents in the Yellowstone National Park area of Wyoming and Idaho (Y), the Cascade Range of the Pacific Northwest (C), and the Long Valley area, California (L), are the Huckleberry Ridge ash bed (2.0 Ma, Y), Rio Dell ash bed (ca. 1.5 Ma, C), Bishop ash bed (0.74 Ma, L), Lava Creek B ash bed (0.62 Ma, Y), and Loleta ash bed (ca. 0.4 Ma, C). The isochronous nature of these beds allows direct comparison of chronologic and climatic data in a variety of depositional environments. For example, the widespread Bishop ash bed is correlated from proximal localities near Bishop in east-central California, where it is interbedded with volcanic and glacial deposits, to lacustrine beds near Tecopa, southeastern California, to deformed on-shore marine strata near Ventura, southwestern California, to deep-ocean sediments at site 470 in the eastern Pacific Ocean west of northern Mexico. The correlations allow us to compare isotopic ages determined for the tephra layers with ages of continental and marine biostratigraphic zones determined by magnetostratigraphy and other numerical age control and also provide iterative checks for available age control. Relative age variations of as much as 0.5 m.y. exist between marine biostratigraphic datums [for example, highest occurrence level of Discoaster brouweri and Calcidiscus tropicus (= C. macintyrei)], as determined from sedimentation rate curves derived from other age control available at each of several sites. These discrepancies may be due to several factors, among which are (1) diachronism of the lowest and highest occurrence levels of marine faunal and floral species with latitude because of ecologic thresholds, (2) upward reworking of older forms in hemipelagic sections adjacent to the tectonically active coast of the western United States and other similar analytical problems in identification of biostratigraphic and magnetostratigraphic datums, (3) dissolution of microfossils or selective diagenesis of some taxa, (4) lack of precision in isotopic age calibration of these datums, (5) errors in isotopic ages of tephra beds, and (6) large variations in sedimentation rates or hiatuses in stratigraphic sections that result in age errors of interpolated datums. Correlation of tephra layers between on-land marine and deep-ocean deposits indicates that some biostratigraphic datums (diatom and calcareous nannofossil) may be truly time transgressive because at some sites, they are found above and, at other sites, below the same tephra layers.

Partial melting experiments on oceanic cumulated gabbros

We performed hydrous partial melting experiments at shallow pressures (0.2 GPa) under slightly oxidizing conditions (NNO oxygen buffer) on oceanic cumulate gabbros drilled by ODP (Ocean Drilling Program) cruises to evaluate whether the partial melting of oceanic gabbro can generate SiO2-rich melts with compositions typical of oceanic plagiogranites. The experimental melts of the low-temperature runs broadly overlap those of natural plagiogranites. At 940 °C, the normalized SiO2 contents of the experimental melts of all systems range between 60 and 61 wt%, and at 900 °C between 63 and 68 wt%. These liquids are characterized by low TiO2 and FeOtot contents, similar to those of natural plagiogranites from the plutonic section of the oceanic crust, but in contrast to Fe and Ti-rich low-temperature experimental melts obtained in MORB systems at ~950 °C. The ~1,500-m-long drilled gabbroic section of ODP Hole 735B (Legs 118 and 176) at the Southwest Indian Ridge contains numerous small plagiogranitic veins often associated with zones which are characterized by high-temperature shearing. The compositions of the experimental melts obtained at low temperatures match those of the natural plagiogranitic veins, while the compositions of the crystals of low-temperature runs correspond to those of minerals from high-temperature microscopic veins occurring in the gabbroic section of the Hole 735B. This suggests that the observed plagiogranitic veins are products of a partial melting process triggered by a water-rich fluid phase. If the temperature estimations for hightemperature shear zones are correct (up to 1,000 °C), and a water-rich fluid phase is present, the formation of plagiogranites by partial melting of gabbros is probably a widespread phenomenon in the genesis of the ocean crust.

(Table 1) Heavy minerals in silt and sand samples of IODP Site 301-U1301

The northwestern Cascadia Basin of western North America accumulated high-sedimentation-rate sequences during the Pleistocene sea-level low-stands. The continental shelf was largely exposed at that time, and rivers and estuaries delivered large sediment fluxes directly to the deep ocean. The IODP EXP1301 core, which was taken from the middle portion of the Cascadia Basin, is well preserved and exhibits the deeper and - more distal sedimentary facies. The lithology in this location is composed of two units, 1) hemipelagic mud with a thin sand layer and 2) thick, coarsening upward silt-sand turbidites with a small proportion of granules at the top. We will focus on the detailed sand-grain proportions in order to understand the origin of these sediments. We determined the modal proportions of the heavy minerals, and the chemical composition of olivine and orthopyroxene in fourteen samples. These are characterized by an abundance of amphibole, pyroxenes and epidote, and the presence of minerals derived from peridotite. There is no drastic change in the modal and mineral compositions of the sands and silts between the turbidite and hemipelagic sequences. There were two probable drainage systems on the continent, the Frazer and Columbia rivers, which shed turbidites into the Cascadia Basin after 1.6 Ma, especially at 0.46-0.76 Ma. Based on a comparison of the modal and mineral compositions, the Northern Cascadia Basin has been supplied with sediments, mainly from the Frazer River, through the Straits of Juan de Fuca, by Pleistocene to Holocene turbidites.