Vascularised fibula grafts for early tibia reconstruction in infants with congenital pseudarthrosis

Congenital pseudarthrosis of the tibia (CPT) is caused by an ill-defined, segmental disturbance of periosteal bone formation leading to spontaneous bowing, followed by fracture and subsequent pseudarthrosis in the first 2 years of life. The results of conventional treatment modalities (e.g., bracing, internal and external fixation and bone grafting) are associated with high failure rates in terms of persisting pseudarthrosis, malunion and impaired growth. As a more promising alternative, a more aggressive approach, including wide resection of the affected bone, reconstruction with free vascularised fibula grafts from the healthy contralateral leg and stable external fixation at a very early stage has been suggested. Between 1995 and 2007, 10 children (age 12-31 months, median 20 months) suffering from CPT were treated at our institutions according to this principle. Two patients were treated before a fracture had occurred. The length of the fibula graft was 7-9cm. End-to-end anastomoses were performed at the level of the distal tibia stump. The follow-up was 80 months (median, range 12 months to 12 years). Radiologic examination at 6 weeks postoperatively showed normal bone density and structure of the transplanted fibula in all cases and osseous consolidation at 19 of the 20 graft/tibia junctions. One nonunion was sucessfully treated with bone grafting and plate osteosynthesis. Pin-tract infection occurred in three patients. Five children sustained graft fractures that were successfully treated with internal or external fixation. Two patients developed diminished growth of the affected limb or foot; all others had equal limb length and shoe size. At long-term follow-up, tibialisation of the transplant had occurred, and normal gait and physical activities were possible in all children. We conclude that in spite of a relatively high complication rate and the reluctance to perform free flap surgery in infants at this young age, the present concept may successfully prevent the imminent severe sequelae associated with CPT.

Sciatic neuropathy after body contouring surgery in massive weight loss patients

To date, obesity affects a substantial population in industrialised countries. Due to the increased awareness of obesity-related morbidity, efficient dietary regimens and the recent successes with bariatric surgery, there is now a high demand for body contouring surgery to correct skin abundancies after massive weight loss. The known risks for this type of surgery are mainly wound-healing complications, and, more rarely, thromboembolic or respiratory complications. We present two female patients (23 and 39 years of age) who, in spite of standard positioning and precautions, developed sciatic neuropathy after combined body contouring procedures, including abdominoplasty and inner thigh lift. Complete functional loss of the sciatic nerve was found by clinical and electroneurographic examination on the left side in patient one and bilaterally in patient two. Full nerve conductance recovery was obtained after 6 months in both patients. Although the occurrence of spontaneous neuropathies after heavy weight loss is well documented, this is the first report describing the appearance of such a phenomenon following body contouring surgery. One theoretical explanation may be the compression of the nerve during the semirecumbent positioning combined with hip flexion and abduction, which was required for abdominal closure and simultaneous access to the inner thighs. We advise to avoid this positioning and to include the risk of sciatic neuropathy in the routine preoperative information of patients scheduled for body contouring surgery after heavy weight loss.

Influence of rhBMP-2 on bone formation and osseointegration in different implant systems after sinus-floor elevation. An in vivo study on sheep

Several studies have reported certain bone morphogenic proteins (BMPs) to have positive effects on bone generation. Although some investigators have studied the effects of human recombinant BMP (rhBMP-2) in sinus augmentation in sheep, none of these studies looked at the placement of implants at the time of sinus augmentation. Furthermore, no literature could be found to report on the impact that different implant systems, as well as the positioning of the implants had on bone formation if rhBMP-2 was utilized in sinus-lift procedures.

Ligament balancing in TKA: Evaluation of a force-sensing device and the influence of patellar eversion and ligament release

Ligament balancing in total knee arthroplasty may have an important influence on joint stability and prosthesis lifetime. In order to provide quantitative information and assistance during ligament balancing, a device that intraoperatively measures knee joint forces and moments was developed. Its performance and surgical advantages were evaluated on six cadaver specimens mounted on a knee joint loading apparatus allowing unconstrained knee motion as well as compression and varus-valgus loading. Four different experiments were performed on each specimen. (1) Knee joints were axially loaded. Comparison between applied and measured compressive forces demonstrated the accuracy and reliability of in situ measurements (1.8N). (2) Assessment of knee stability based on condyle contact forces or varus-valgus moments were compared to the current surgical method (difference of varus-valgus loads causing condyle lift-off). The force-based approach was equivalent to the surgical method while the moment-based, which is considered optimal, showed a tendency of lateral imbalance. (3) To estimate the importance of keeping the patella in its anatomical position during imbalance assessment, the effect of patellar eversion on the mediolateral distribution of tibiofemoral contact forces was measured. One fourth of the contact force induced by the patellar load was shifted to the lateral compartment. (4) The effect of minor and major medial collateral ligament releases was biomechanically quantified. On average, the medial contact force was reduced by 20% and 46%, respectively. Large variation among specimens reflected the difficulty of ligament release and the need for intraoperative force monitoring. This series of experiments thus demonstrated the device's potential to improve ligament balancing and survivorship of total knee arthroplasty.

Lesser tuberosity osteotomy for total shoulder arthroplasty. Surgical technique

BACKGROUND: Recent studies have suggested that tenotomy and repair of the subscapularis tendon carried out for anterior approaches to the shoulder can be followed by failure of the tendon repair and by changes resulting in permanent loss of subscapularis function. We hypothesized that release of the subscapularis with use of a superficial osteotomy of the lesser tuberosity followed by repair of the two opposing bone surfaces would lead to consistent bone-to-bone healing, which would be possible to monitor radiographically, and would lead to satisfactory clinical and structural outcomes. METHODS: Thirty-nine shoulders in thirty-six consecutive patients who, at an average age of fifty-seven years, had undergone total shoulder replacement through an anterior approach involving an osteotomy of the lesser tuberosity were evaluated at an average of thirty-nine months. Assessment included a standardized interview and physical examination, scoring according to the system described by Constant and Murley, and imaging with conventional radiography and computed tomography to assess healing of the osteotomy site and changes in the subscapularis. RESULTS: The osteotomized tuberosity fragment healed in an anatomical position in all shoulders, and no cuff tendon ruptures were observed. At the time of follow-up, thirty-three (89%) of thirty-seven shoulders evaluated with a belly-press test had a negative result and twenty-seven (75%) of thirty-six shoulders evaluated with a lift-off test had an unequivocally normal result. Fatty infiltration of the subscapularis muscle increased after the operation (p < 0.0001) and was at least stage two in eleven (32%) of thirty-four shoulders. The fatty infiltration had progressed by one stage in eight (24%) of the thirty-four shoulders, by two stages in five shoulders (15%), and by three stages in two shoulders (6%). CONCLUSIONS: Osteotomy of the lesser tuberosity provides an easy anterior approach for total shoulder replacement and is followed by consistent bone-to-bone healing, which can be monitored, and good subscapularis function. In the presence of documented anatomical healing of the osteotomy site, postoperative fatty infiltration of the subscapularis muscle remains unexplained and needs to be investigated further as it is associated with a poorer clinical outcome.

Dynamic modeling, simulation and control design of a parafoil-payload system for ship launched aerial delivery system (SLADS)

The objective of this research was to develop a high-fidelity dynamic model of a parafoilpayload system with respect to its application for the Ship Launched Aerial Delivery System (SLADS). SLADS is a concept in which cargo can be transfered from ship to shore using a parafoil-payload system. It is accomplished in two phases: An initial towing phase when the glider follows the towing vessel in a passive lift mode and an autonomous gliding phase when the system is guided to the desired point. While many previous researchers have analyzed the parafoil-payload system when it is released from another airborne vehicle, limited work has been done in the area of towing up the system from ground or sea. One of the main contributions of this research was the development of a nonlinear dynamic model of a towed parafoil-payload system. After performing an extensive literature review of the existing methods of modeling a parafoil-payload system, a five degree-of-freedom model was developed. The inertial and geometric properties of the system were investigated to predict accurate results in the simulation environment. Since extensive research has been done in determining the aerodynamic characteristics of a paraglider, an existing aerodynamic model was chosen to incorporate the effects of air flow around the flexible paraglider wing. During the towing phase, it is essential that the parafoil-payload system follow the line of the towing vessel path to prevent an unstable flight condition called ‘lockout’. A detailed study of the causes of lockout, its mathematical representation and the flight conditions and the parameters related to lockout, constitute another contribution of this work. A linearized model of the parafoil-payload system was developed and used to analyze the stability of the system about equilibrium conditions. The relationship between the control surface inputs and the stability was investigated. In addition to stability of flight, one more important objective of SLADS is to tow up the parafoil-payload system as fast as possible. The tension in the tow cable is directly proportional to the rate of ascent of the parafoil-payload system. Lockout instability is more favorable when tow tensions are large. Thus there is a tradeoff between susceptibility to lockout and rapid deployment. Control strategies were also developed for optimal tow up and to maintain stability in the event of disturbances.

Neuromuscular issues in cavovarus foot

Differential muscle weakness can cause a cavus foot deformity. Presenting complaints in the hindfoot may include ankle instability, secondary arthritis, or peroneal tendonitis. Presenting complaints in the forefoot may include stress fractures, callus formation over the lateral border of the foot, claw toes, first ray overload, and metatarsalgia. More general presenting complaints can include a drop-foot gait, decreased walking tolerance, and difficulty with shoe or orthotic fitting. To surgically correct the foot shape, soft tissue contractures need to be released, bone deformity corrected, and muscles balanced to optimize their strength and prevent recurrence of the deformity. This article reviews the diagnosis and management of the cavovarus foot secondary to longstanding muscle imbalance.

Decentralized or centralized production : impacts to the environment, industry, and the economy

Since product take-back is mandated in Europe, and has effects for producers worldwide including the U.S., designing efficient forward and reverse supply chain networks is becoming essential for business viability. Centralizing production facilities may reduce costs but perhaps not environmental impacts. Decentralizing a supply chain may reduce transportation environmental impacts but increase capital costs. Facility location strategies of centralization or decentralization are tested for companies with supply chains that both take back and manufacture products. Decentralized and centralized production systems have different effects on the environment, industry and the economy. Decentralized production systems cluster suppliers within the geographical market region that the system serves. Centralized production systems have many suppliers spread out that meet all market demand. The point of this research is to help further the understanding of company decision-makers about impacts to the environment and costs when choosing a decentralized or centralized supply chain organizational strategy. This research explores; what degree of centralization for a supply chain makes the most financial and environmental sense for siting facilities; and which factories are in the best location to handle the financial and environmental impacts of particular processing steps needed for product manufacture. This research considered two examples of facility location for supply chains when products are taken back; the theoretical case involved shoe resoling and a real world case study considered the location of operations for a company that reclaims multiple products for use as material inputs. For the theoretical example a centralized strategy to facility location was optimal: whereas for the case study a decentralized strategy to facility location was best. In conclusion, it is not possible to say that a centralized or decentralized strategy to facility location is in general best for a company that takes back products. Each company’s specific concerns, needs, and supply chain details will determine which degree of centralization creates the optimal strategy for siting their facilities.

Sustainability study of nanomaterials including societal and occupational implications

In recent years there has been a tremendous amount of research in the area of nanotechnology. History tells us that the commercialization of technologies will always be accompanied by both positive and negative effects for society and the environment. Products containing nanomaterials are already available in the market, and yet there is still not much information regarding the potential negative effects that these products may cause. The work presented in this dissertation describes a holistic approach to address different dimensions of nanotechnology sustainability. Life cycle analysis (LCA) was used to study the potential usage of polyethylene filled with nanomaterials to manufacture automobile body panels. Results showed that the nanocomposite does not provide an environmental benefit over traditional steel panels. A new methodology based on design of experiments (DOE) techniques, coupled with LCA, was implemented to investigate the impact of inventory uncertainties. Results showed that data variability does not have a significant effect on the prediction of the environmental impacts. Material profiles for input materials did have a highly significant effect on the overall impact. Energy consumption and material characterization were identified as two mainstreams where additional research is needed in order to predict the overall impact of nanomaterials more effectively. A study was undertaken to gain insights into the behavior of small particles in contact with a surface exposed to air flow to determine particle lift-off from the surface. A mapping strategy was implemented that allows for the identification of conditions for particle liftoff based on particle size and separation distance from the wall. Main results showed that particles smaller than 0:1mm will not become airborne under shear flow unless the separation distance is greater than 15 nm. Results may be used to minimize exposure to airborne materials. Societal implications that may occur in the workplace were researched. This research task explored different topics including health, ethics, and worker perception with the aim of identifying the base knowledge available in the literature. Recommendations are given for different scenarios to describe how workers and employers could minimize the unwanted effects of nanotechnology production.

Effects of Enhanced Oil Recovery on Production Engineers, Elm Coulee Field, Bakken Reservoir, Richland County, Montana

This presentation describes research at Montana Tech to improve oil recovery rates in the Elm Coulee Oil Field in the Bakken Reservoir, Richmond County, Montana. The slides display current recovery rate predictions, enhanced oil recovery methods, reservoir model building and history matching strategies. Recommended development strategies include implementing hydrocarbon gas injection operations to improve current oil recovery rates by more than 75%. The impact of increased production on Production Engineers is also described. The Principal Investigators include John Evans, Leo Heath, David Reichhardt and Burt Todd in the Petroleum Engineering Department.

Posterolateral approach to the displaced posterior malleolus: functional outcome and local morbidity

BACKGROUND: Stable anatomical reconstruction of the joint surface in ankle fractures is essential to successful recovery. However, the functional outcome of fractures involving the posterior tibial plafond is often poor. We describe the morbidity and functional outcome for plate fixation of the displaced posterior malleolus using a posterolateral approach. MATERIALS AND METHODS: The posterolateral approach was used for osteosynthesis of the posterior malleolus in 45 consecutive patients (median age 54 years) with AO/Muller-classification type 44-A3 (n = 1), 44-B3 (n = 35), 44-C1 (n = 7), and 44-C2 (n = 2) ankle fractures. Thirty-three of the patients suffered complete fracture dislocation. Functional outcome at followup was measured using the modified Weber protocol and the standardized AAOS foot and ankle questionnaire. Radiological evaluation employed standardized anterior-posterior and lateral views. RESULTS: The fragment comprised a median of 24% (range, 10% to 48%) of the articular surface. Postoperative soft tissue problems were encountered in five patients (11%), one of whom required revision surgery. Two patients (4%) developed Stage I complex regional pain syndrome. Clinical and radiological followup at 25 months disclosed no secondary displacement of the fixed fragment. The median foot and ankle score was 93 (range, 58 to 100), shoe comfort score was 77 (range, 0 to 100). A median score of 7 (range, 5 to 16) was documented using the modified Weber protocol. CONCLUSION: The posterolateral approach allowed good exposure and stable fixation of a displaced posterior malleolar fragment with few local complications. The anatomical repositioning and stable fixation led to good functional and subjective outcome.

The effectiveness and safety of proton radiation therapy for indications of the eye : a systematic review

BACKGROUND AND PURPOSE: : Proton radiation has been used for the treatment of uveal melanoma since 1975, but few studies have been conducted to assess its efficacy and safety. This paper aims to systematically review the effects and side effects of proton therapy for any indication of the eye. MATERIAL AND METHODS: : A range of databases were searched from inception to 2007. All studies that included at least ten patients and that assessed the efficacy or safety of proton therapy for any indication of the eye were included. RESULTS: : The search generated 2,385 references, of which 37 met the inclusion criteria. Five controlled trials, two comparative studies and 30 case series were found, most often reporting on uveal melanoma, choroidal melanoma and age-related macular degeneration (AMD). Methodological quality of these studies was poor. Studies were characterized by large differences in radiation techniques applied within the studies, and by variation in patient characteristics within and between studies. Results for uveal melanoma and choroidal melanoma suggest favorable survival, with, however, significant rates of side effects. Results for choroidal hemangioma and AMD did not reveal beneficial effects from proton radiation. CONCLUSION: : There is limited evidence on the effectiveness and safety of proton radiation due to the lack of well-designed and well-reported studies. There is a need to lift evidence on proton therapy to a higher level by performing dose-finding randomized controlled trials (RCTs), comparative studies of proton radiation versus standard given alternatives and prospective case studies enrolling only patients treated with up-to-date techniques, allowing extrapolation of results to similar patient groups.

Manner of Obtainment as a relative in a family of resultative constructions

The present paper examines the syntactic and semantic properties of a group of constructions which carry an idiomatic interpretation of obtainment. In Polish and German, the constructions under consideration consist of a verb with a directional particle followed by an object NP, as exemplified in (1a)-(1b). (1a) Adam wynurkował starego buta. (Polish) Adam wy- snorkeled old shoe. ‘Adam found an old shoe while snorkeling.’ (1b) Michael erboxte sich den Titel. (German) Michael er- boxed REFL the title. ‘Michael boxed his way to the (championship) title.’ Sentences containing these constructions will be assumed to have the same basic interpretation “Subject obtains/produces Object by V-ing”. A constructional analysis of the constructions will be proposed, as they pose licensing problems and their interpretation cannot be accounted for in terms of the individual conceptual structures of the lexical items composing the sentence. Unlike most accounts of verb particle constructions based on implicit or explicit assumptions of straightforward semantic composition, the present study proposes an analysis under which the semantic structure of verb particle combinations is not a compositional function of the verb and the particle/prefix alone. It is argued that the construction comes with its own subcategorization frame (separate from that carried by the verb) which is motivated by the meaning of the construction and its corresponding constructional subevent. Additionally, a crosslinguistic correlation will be shown to hold between a language’s ability to express event conflation (Talmy 1985, 2000) and the occurrence of some form of the construction in that language. This will be taken as an indication of the resultative nature of those types of directional phrases which involve the semantic interpretation of boundary crossing.

Der Einfluss kinematischer Parameter auf den Energiebedarf eines Regalbediengerätes

Bisher wurde noch nicht erforscht wie sich die Variation kinematischer Parameter konkret auf den Energiebedarf von Regalbediengeräten auswirkt. Dieser Beitrag untersucht daher die energetischen Folgen bei unterschiedlichen Geschwindigkeiten und Beschleunigungen der Antriebe eines Regalbediengerätes. Veränderte Geschwindigkeiten und Beschleunigungen beeinflussen jedoch auch die Fahr- und Hubzeiten des Regalbediengerätes. Daher wird ebenfalls eine Berechnungsmethode vorgestellt, mit der der optimale Startpunkt des Hubwerkes und die optimale Fahrgeschwindigkeit auf Basis der eingestellten kinematischen Parameter berechnet werden können.

Dynamische Standsicherheit von Portalstaplern

Der Artikel beschreibt die Untersuchung der dynamischen Standsicherheit von Portalstaplern. Dazu wurde ein aktueller repräsentativer Portalstapler analysiert und in ein Mehrkörper-Simulationsmodell abgebildet. Die Validierung des Modells erfolgte auf Basis von Messfahrten am realen System. Aus den durchgeführten Simulationsstudien wurden technische Verbesserungsmaßnahmen abgeleitet, welche die dynamische Standsicherheit von Portalstaplern erhöhen.