On-table reconstruction of comminuted fractures of the radial head

The most widely accepted treatment for comminuted fractures of the radial head is either the excision or open reduction and internal fixation. The purpose of the present study is to evaluate the value of an 'on-table' reconstruction technique in severely comminuted fractures of the radial head. In this study, two patients with a Mason type-III and four patients with a Mason type-IV radial-head fracture were treated with 'on-table' reconstruction and fixation using low-profile mini-plates. After a mean follow-up of 112 months (47-154 months), the mean elbow motion was 0-6-141 degrees extension flexion with 79 degrees of pronation and 70 degrees of supination. The mean Broberg and Morrey functional rating score was 97.0 points, the Mayo Elbow Performance Index was 99.2 points and the mean Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure score was 1.94 points. One patient had symptoms of degenerative changes, with a slight joint-space narrowing. There were no radiographic signs of devitalisation at final examination. Comminuted fractures of the radial head, which would otherwise require excision, can be successfully treated with an 'on-table' reconstruction technique.

Comminuted fractures of the radial head and neck: is fixation to the shaft necessary?

Mason type III fractures of the radial head are treated by open reduction and internal fixation, resection or prosthetic joint replacement. When internal fixation is performed, fixation of the radial head to the shaft is difficult and implant-related complications are common. Furthermore, problems of devascularisation of the radial head can result from fixation of the plate to the radial neck. In a small retrospective study, the treatment of Mason type III fractures with fixation of the radial neck in 13 cases (group 2) was compared with 12 cases where no fixation was performed (group 1). The mean clinical and radiological follow-up was four years (1 to 9). The Broberg-Morrey index showed excellent results in both groups. Degenerative radiological changes were seen more frequently in group 2, and removal of the implant was necessary in seven of 13 cases. Post-operative evaluation of these two different techniques revealed similar ranges of movement and functional scores. We propose that anatomical reconstruction of the radial head without metalwork fixation to the neck is preferable, and the outcome is the same as that achieved with the conventional technique. In addition degenerative changes of the elbow joint may develop less frequently, and implant removal is not necessary.

Subluxation de la tête radiale suite au malalignement du cubitus proximal : une étude biomécanique

Le cubitus proximal détient une courbe sagittale unique pour chaque individu, nommée « Proximal Ulna Dorsal Angulation (PUDA) ». Une reconstruction non-anatomique du cubitus proximal, suite à une fracture complexe peut engendrer une malunion, de l’arthrose et de l’instabilité. L’objectif de cette étude était d’évaluer la magnitude de malalignement au niveau de l’angulation proximale dorsale du cubitus qui causerait un malalignement radio-capitellaire, avec et sans un ligament annulaire intact. Afin d’atteindre cet objectif, une étude biomécanique fut conduite sur six spécimens frais congelés avec un simulateur de mouvement du coude. Des fractures simulées au niveau du PUDA, furent stabilisées avec une fixation interne dans cinq configurations différentes. Des images fluoroscopiques furent prises dans différentes positions du coude et de l’avant-bras, avec le ligament annulaire intact, puis relâché. Le déplacement de la tête radiale fut quantifié avec le ratio radio-capitellaire. Une interaction significative fut découverte entre les positions du coude, les angles de malalignement et l’intégrité du ligament annulaire. La subluxation de la tête radiale fut accentuée lors de la déchirure du ligament annulaire. Une augmentation de la subluxation antérieure de la tête radiale fut observée lorsque le malalignement était fixé en extension et lors de mouvements de flexion progressive du coude. D’autre part, un malalignement en flexion et une extension graduelle du coude occasionnait une subluxation postérieure. En conclusion, les résultats ont démontré l’importance d’une reconstruction anatomique du cubitus proximal, car un malalignement de 5 degrés engendre une subluxation de la tête radiale, surtout lors d’une déchirure du ligament annulaire.

Open elbow arthrolysis for posttraumatic elbow stiffness.

OBJECTIVES: The elbow joint is vulnerable to stiffness, especially after trauma. The aim of this study was to evaluate the results of open arthrolysis for posttraumatic elbow stiffness. DESIGN: Cohort retrospective study. PATIENTS: Eighteen consecutive patients were evaluated by an independent observer at an average of 16 months (6 to 43) after open elbow arthrolysis was performed for posttraumatic stiffness. Initial traumas were: isolated fractures (11) or dislocation (1) and complex fracture-dislocations (6). Initial treatments were: nonoperative (3), radial head resection (1), and ORIF (14). Patients presented predominantly with mixed contractures (combined extrinsic and intrinsic contractures). INTERVENTION: Open elbow arthrolysis. MAIN OUTCOME MEASUREMENTS: Elbow function and patient satisfaction were the principal outcome measures. At follow-up European Society for Shoulder and Elbow Surgery (SECEC) elbow scores were calculated. RESULTS AND CONCLUSIONS: Three patients had minor postoperative complications: 1 partial wound dehiscence, 1 subcutaneous infection, and one seroma. None of these complications influenced the final result clinically. The mean total increase in range of motion was 40 degrees (13 to 112 degrees), with a mean gain in flexion of 14 degrees (0 to 45 degrees) and 26 degrees in extension (5 to 67 degrees). No patient showed signs of elbow instability. There was no radiographic evidence of osteoarthritis progression at follow-up. We did not find any correlations between the type of stiffness, the approaches used, and the results. However, patients with the greatest preoperative stiffness had significantly better improvement of mobility (P<0.001). The best results were obtained in patients who had arthrolysis done within 1 year after the initial trauma (P=0.008). The mean SECEC scores were 88 (52 to 100) for the injured elbows, and 96 (88 to 100) for the contralateral elbows. CONCLUSION: Open elbow arthrolysis for patients with posttraumatic stiffness improves joint function and provides patient satisfaction. The best results, in terms of gain of motion and patient satisfaction, were obtained in patients with severe stiffness who had operations within the first year after initial trauma.

Concordancia interobservador entre ortopedistas de urgencias y cirujanos de codo en fracturas de cúpula radial

El trauma de codo y la fractura de cúpula radial resultan ser un motivo de consulta frecuente en nuestro medio. Es común en nuestro medio que a pesar de tener radiografías de codo en las que se evidencia fractura de cúpula radial se solicite un TAC de codo. Consideramos que el TAC es una herramienta útil en algunos casos de fracturas de la cúpula radial, es decir, no se debe tomar de forma rutinaria el TAC de codo en los pacientes con fracturas de cúpula radial como es usual en nuestro medio. Existen pocos estudios que comparan la concordancia inter observador de las clasificaciones utilizadas para las fracturas de cúpula radial, pero, no existe en la literatura mundial un estudio que evalué las diferencias entre la clasificación de la fractura en base a radiografías y tomografía entre un grupo ortopedistas traumatólogos y sub-especialistas de miembro superior. La realización de este estudio permite elaborar guías de manejo de pacientes con fractura de cúpula radial en la que se racionalizara el uso del TAC de codo.

¿La tomografía de codo cambia la conducta tomada previamente con radiografía en fracturas de cúpula radial? un estudio de concordancia

Las fracturas de la cúpula radial corresponden a un tercio de todas las fracturas del codo en adultos (1), por lo que se toman radiografías o tomografías, sin embargo no existe literatura que soporte la realización de la tomografía como estudio complementario, por lo que preguntamos ¿La tomografía de codo cambia la conducta tomada previamente con radiografía en fracturas de cúpula radial? Se propone un estudio de concordancia, donde se evalúan las radiografías y tomografías por parte de dos cirujanos de codo, de pacientes con diagnóstico de fractura de cúpula radial valorados en urgencias de dos hospitales de tercer nivel de Bogotá desde enero 2011 a enero 2013. Se revisaron 116 historias, 99 cumplieron los criterios, las radiografías fueron revisadas por dos ortopedistas de codo quienes realizaron clasificación de Mason obteniendo un κ 1 (p˂ 0,00), propuesta de tratamiento postradiografía κ 0,934 (p˂ 0,000 IC95% 0.85, 1). Tratamiento post-tomografía de codo κ 0.949 (p˂ 0,00 IC95% 0.867,1). Concordancia intra-ortopedista de la conducta pre y post-tomografía hay cambio en la conducta del ortopedista 1 en 32.6% (κ 0.674 p˂ 0,00 IC95% 0.52, 0.818) y del ortopedista 2 en 36% (κ 0.64 p˂ 0,00 IC95% 0.452, 0.792). Se dividieron los pacientes en Mason I, II, III con concordancia considerable en los pacientes Mason I y III, mientras que en Mason II fue una concordancia aceptable lo que significa que el uso de tomografía de codo cambia la conducta en general pero sobretodo en pacientes clasificados Masson II.

the human hand. I. Movements of the index ANALYSE ELECTROMYOGRAPHIQUE DU PREMIER MUSCLE INTEROSSEUX DORSAL DE LA MAIN HUMAINE

An electromyographic study of the musculus interosseus dorsalis was performed on the right hand of 25 young adult male right-handed volunteers. The electrodes, simple coaxial needles, were implanted one at the ulnar head and the other at the radial head of the muscle. The muscles were analyzed during free movements of the index and against resistance. The same movements were done in four different positions of the fore-arm and hand, without variation in the results for each one of the movements. There was no significant difference between the activities of the ulnar head and radial head. During freely performed movements, muscle activity was recorded only during abduction. During movements against resistance, muscle activity was completely nil only during adduction; during the remaining movements, however, moderate (2+), strong (3+) and very strong activity (4+) was recorded.

Fractures in Children and Adolescents

Fractures of the growing bone require fixation techniques, which preclude any injury to the growth plate regions. This requirement is met by Elastic Stable Intramedullary Nails (ESIN) which are positioned between both metaphyseal regions. Pronounced malposition and/or shortening, open fractures and fractures with impending skin perforation are indications for clavicle nailing in adolescents. Retrograde nailing with two elastic nails, inserted from lateral, is the method of choice for stabilization of humerus fractures. In radial neck fractures with severe tilting of the radial head, a retrograde nail may reduce and fix the head. In Monteggia lesions, the ulna fracture is reduced and fixed with an antegrade nail. Forearm fractures with unacceptable axial deviation are reduced and fixed with one antegrade nail in the ulna and a retrograde nail in the radius. Ascending elastic nailing is done for femur shaft and proximal femur fractures. The medial and lateral entry sites are located above the distal physis. End caps are used to prevent shortening in spiral and multiple segment fractures. Fractures of the distal third of the femur are nailed in a descending technique. The entry sites of two nails are located on the lateral cortex below the greater trochanter. Combined tibia and fibula fractures, open fractures and unstable fracture types such as spiral and multifragmental tibia fractures are good indications for ESIN. Descending nailing is the method of choice. The nail entry points are medially and laterally distal to the apophysis of the proximal tibia. Thorough knowledge of each fracture type, fracture location and age specific healing pattern is necessary for safe and effective treatment of pediatric fractures

Monteggia lesion in an Asian small-clawed otter (Aonyx cinerea).

A 10-yr-old female Asian small-clawed otter (Aonyx cinerea) presented with a history of right forelimb lameness. Antebrachial radiographs revealed a Monteggia lesion, classified by cranial radial head luxation and distal diaphyseal ulnar fracture. Open reduction with placement of an ulnar-radial positional screw was performed. The lateral collateral ligament was reconstructed using suture anchored by a condylar screw and bone tunnel in the radius. Reduction and proper implant placement was confirmed on postoperative radiographs. The ulnar-radial positional screw was removed 6 wk postoperatively to allow proper supination and pronation. Limb function was greatly improved at this time; however, a mild lameness was still observed. At 7 mo postoperatively, the otter was ambulating lameness-free. Radiographs documented proper joint reduction and stable condylar screw. At 32 mo postoperatively, the otter continued to exhibit normal ambulation.

Changes in joint stability with muscle contraction measured from transmission of mechanical vibration

A non-invasive in vivo technique was developed to evaluate changes in wrist joint stability properties induced by increased co-activation of the forearm muscles in a gripping task. Mechanical vibration at 45, 50 and 55 Hz was applied to the radial head in ten healthy volunteers. Vibrations of the styloid process of the radius and the distal end of the metacarpal bone of the index finger were measured with triaxial accelerometers. Joint stability properties were quantified by the transfer function gain between accelerations on either side of the wrist-joint. Gain was calculated with the muscles at rest and at five force levels ranging from 5% to 25% of maximum grip force (%MF). During contraction the gain was significantly greater than in control trial (0%MF) for all contractions levels at 45 and 50 Hz and a trend for 15%MF and higher at 55 Hz. Group means of contraction force and gain were significantly correlated at 45 (R-2 = 0.98) and 50 Hz (R-2 = 0.72), but not at 55 Hz (R-2 = 0.10). In conclusion, vibration transmission gain may provide a method to evaluate changes in joint stability properties. (c) 2005 Published by Elsevier Ltd.

Electromagnetic Instability Studies in Fusion Plasmas Edge

Este trabajo esta dedicado al estudio de las estructuras macroscópicas conocidas en la literatura como filamentos o blobs que han sido observadas de manera universal en el borde de todo tipo de dispositivos de fusión por confinamiento magnético. Estos filamentos, celdas convectivas elongadas a lo largo de las líneas de campo que surgen en el plasma fuertemente turbulento que existe en este tipo de dispositivos, parecen dominar el transporte radial de partículas y energía en la región conocida como Scrape-off Layer, en la que las líneas de campo dejan de estar cerradas y el plasma es dirigido hacia la pared sólida que forma la cámara de vacío. Aunque el comportamiento y las leyes de escala de estas estructuras son relativamente bien conocidos, no existe aún una teoría generalmente aceptada acerca del mecanismo físico responsable de su formación, que constituye una de las principales incógnitas de la teoría de transporte del borde en plasmas de fusión y una cuestión de gran importancia práctica en el desarrollo de la siguiente generación de reactores de fusión (incluyendo dispositivos como ITER y DEMO), puesto que la eficiencia del confinamiento y la cantidad de energía depositadas en la pared dependen directamente de las características del transporte en el borde. El trabajo ha sido realizado desde una perspectiva eminentemente experimental, incluyendo la observación y el análisis de este tipo de estructuras en el stellarator tipo heliotrón LHD (un dispositivo de gran tamaño, capaz de generar plasmas de características cercanas a las necesarias en un reactor de fusión) y en el stellarator tipo heliac TJ-II (un dispositivo de medio tamaño, capaz de generar plasmas relativamente más fríos pero con una accesibilidad y disponibilidad de diagnósticos mayor). En particular, en LHD se observó la generación de filamentos durante las descargas realizadas en configuración de alta _ (alta presión cinética frente a magnética) mediante una cámara visible ultrarrápida, se caracterizó su comportamiento y se investigó, mediante el análisis estadístico y la comparación con modelos teóricos, el posible papel de la Criticalidad Autoorganizada en la formación de este tipo de estructuras. En TJ-II se diseñó y construyó una cabeza de sonda capaz de medir simultáneamente las fluctuaciones electrostáticas y electromagnéticas del plasma. Gracias a este nuevo diagnóstico se pudieron realizar experimentos con el fin de determinar la presencia de corriente paralela a través de los filamentos (un parámetro de gran importancia en su modelización) y relacionar los dos tipos de fluctuaciones por primera vez en un stellarator. Así mismo, también por primera vez en este tipo de dispositivo, fue posible realizar mediciones simultáneas de los tensores viscoso y magnético (Reynolds y Maxwell) de transporte de cantidad de movimiento. ABSTRACT This work has been devoted to the study of the macroscopic structures known in the literature as filaments or blobs, which have been observed universally in the edge of all kind of magnetic confinement fusion devices. These filaments, convective cells stretching along the magnetic field lines, arise from the highly turbulent plasma present in this kind of machines and seem to dominate radial transport of particles and energy in the region known as Scrapeoff Layer, in which field lines become open and plasma is directed towards the solid wall of the vacuum vessel. Although the behavior and scale laws of these structures are relatively well known, there is no generally accepted theory about the physical mechanism involved in their formation yet, which remains one of the main unsolved questions in the fusion plasmas edge transport theory and a matter of great practical importance for the development of the next generation of fusion reactors (including ITER and DEMO), since efficiency of confinement and the energy deposition levels on the wall are directly dependent of the characteristics of edge transport. This work has been realized mainly from an experimental perspective, including the observation and analysis of this kind of structures in the heliotron stellarator LHD (a large device capable of generating reactor-relevant plasma conditions) and in the heliac stellarator TJ-II (a medium-sized device, capable of relatively colder plasmas, but with greater ease of access and diagnostics availability). In particular, in LHD, the generation of filaments during high _ discharges (with high kinetic to magnetic pressure ratio) was observed by means of an ultrafast visible camera, and the behavior of this structures was characterized. Finally, the potential role of Self-Organized Criticality in the generation of filaments was investigated. In TJ-II, a probe head capable of measuring simultaneously electrostatic and electromagnetic fluctuations in the plasma was designed and built. Thanks to this new diagnostic, experiments were carried out in order to determine the presence of parallel current through filaments (one of the most important parameters in their modelization) and to related electromagnetic (EM) and electrostatic (ES) fluctuations for the first time in an stellarator. As well, also for the first time in this kind of device, measurements of the viscous and magnetic momentum transfer tensors (Reynolds and Maxwell) were performed.

Molecular Cloning and Characterization of a Radial Spoke Head Protein of Sea Urchin Sperm Axonemes: Involvement of the Protein in the Regulation of Sperm Motility

Monoclonal antibodies raised against axonemal proteins of sea urchin spermatozoa have been used to study regulatory mechanisms involved in flagellar motility. Here, we report that one of these antibodies, monoclonal antibody D-316, has an unusual perturbating effect on the motility of sea urchin sperm models; it does not affect the beat frequency, the amplitude of beating or the percentage of motile sperm models, but instead promotes a marked transformation of the flagellar beating pattern which changes from a two-dimensional to a three-dimensional type of movement. On immunoblots of axonemal proteins separated by SDS-PAGE, D-316 recognized a single polypeptide of 90 kDa. This protein was purified following its extraction by exposure of axonemes to a brief heat treatment at 40°C. The protein copurified and coimmunoprecipitated with proteins of 43 and 34 kDa, suggesting that it exists as a complex in its native form. Using D-316 as a probe, a full-length cDNA clone encoding the 90-kDa protein was obtained from a sea urchin cDNA library. The sequence predicts a highly acidic (pI = 4.0) protein of 552 amino acids with a mass of 62,720 Da (p63). Comparison with protein sequences in databases indicated that the protein is related to radial spoke proteins 4 and 6 (RSP4 and RSP6) of Chlamydomonas reinhardtii, which share 37% and 25% similarity, respectively, with p63. However, the sea urchin protein possesses structural features distinct from RSP4 and RSP6, such as the presence of three major acidic stretches which contains 25, 17, and 12 aspartate and glutamate residues of 34-, 22-, and 14-amino acid long stretches, respectively, that are predicted to form α-helical coiled-coil secondary structures. These results suggest a major role for p63 in the maintenance of a planar form of sperm flagellar beating and provide new tools to study the function of radial spoke heads in more evolved species.

Nonaxisymmetric magnetorotational instability in ideal and viscous plasmas

The excitation of magnetorotational instability (MRI) in rotating laboratory plasmas is investigated. In contrast to astrophysical plasmas, in which gravitation plays an important role, in laboratory plasmas it can be neglected and the plasma rotation is equilibrated by the pressure gradient. The analysis is restricted to the simple model of a magnetic confinement configuration with cylindrical symmetry, in which nonaxisymmetric perturbations are investigated using the local approximation. Starting from the simplest case of an ideal plasma, the corresponding dispersion relations are derived for more complicated models including the physical effects of parallel and perpendicular viscosities. The Friemann-Rotenberg approach used for ideal plasmas is generalized for the viscous model and an analytical expression for the instability boundary is obtained. It is shown that, in addition to the standard effect of radial derivative of the rotation frequency (the Velikhov effect), which can be destabilizing or stabilizing depending on the sign of this derivative in the ideal plasma, there is a destabilizing effect proportional to the fourth power of the rotation frequency, or, what is the same, to the square of the plasma pressure gradient, and to the square of the azimuthal mode number of the perturbations. It is shown that the instability boundary also depends on the product of the plasma pressure and density gradients, which has a destabilizing effect when it is negative. In the case of parallel viscosity, the MRI looks like an ideal instability independent of viscosity, while, in the case of strong perpendicular viscosity, it is a dissipative instability with the growth rate inversely proportional to the characteristic viscous decay rate. We point out, however, that the modes of the continuous range of the magnetohydrodynamics spectrum are not taken into account in this paper, and they can be more dangerous than those that are considered. (c) 2008 American Institute of Physics.

Dust-induced instability in a rotating plasma

The effect of immobile dust on stability of a magnetized rotating plasma is analyzed. In the presence of dust, a term containing an electric field appears in the one-fluid equation of plasma motion. This electric field leads to an instability of the magnetized rotating plasma called the dust-induced rotational instability (DRI). The DRI is related to the charge imbalance between plasma ions and electrons introduced by the presence of charged dust. In contrast to the well-known magnetorotational instability requiring the decreasing radial profile of the plasma rotation frequency, the DRI can appear for an increasing rotation frequency profile. (c) 2008 American Institute of Physics.

Biomechanical characterization and in vitro mechanical injury of elderly human femoral head cartilage: comparison to adult bovine humeral head cartilage.

OBJECTIVES: In vitro mechanical injury of articular cartilage is useful to identify events associated with development of post-traumatic osteoarthritis (OA). To date, many in vitro injury models have used animal cartilage despite the greater clinical relevance of human cartilage. We aimed to characterize a new in vitro injury model using elderly human femoral head cartilage and compare its behavior to that of an existing model with adult bovine humeral head cartilage. DESIGN: Mechanical properties of human and bovine cartilage disks were characterized by elastic modulus and hydraulic permeability in radially confined axial compression, and by Young's modulus, Poisson's ratio, and direction-dependent radial strain in unconfined compression. Biochemical composition was assessed in terms of tissue water, solid, and glycosaminoglycan (GAG) contents. Responses to mechanical injury were assessed by observation of macroscopic superficial tissue cracks and histological measurements of cell viability following single injurious ramp loads at 7 or 70%/s strain rate to 3 or 14 MPa peak stress. RESULTS: Confined compression moduli and Young's moduli were greater in elderly human femoral cartilage vs adult bovine humeral cartilage whereas hydraulic permeability was less. Radial deformations of axially compressed explant disks were more anisotropic (direction-dependent) for the human cartilage. In both cartilage sources, tissue cracking and associated cell death during injurious loading was common for 14 MPa peak stress at both strain rates. CONCLUSION: Despite differences in mechanical properties, acute damage induced by injurious loading was similar in both elderly human femoral cartilage and adult bovine humeral cartilage, supporting the clinical relevance of animal-based cartilage injury models. However, inherent structural differences such as cell density may influence subsequent cell-mediated responses to injurious loading and affect the development of OA.