Biomedical subjects

Richard V Baratta

Publications and source records attributed to Richard V Baratta.

13 recordsLinked to original sources

PubMed2005

The memory properties of cold-worked titanium rods in scoliosis constructs.

STUDY DESIGN: Time series monitoring changes in titanium and stainless steel rod curvature kept at a constant temperature of 37 C as a function of time. OBJECTIVES: To assess the possibility of loss of curvature in titanium rods after scoliosis surgery. SUMMARY OF BACKGROUND DATA: Titanium rods have gained use in scoliosis surgery due to their excellent biocompatibility, while allowing medical personnel to obtain undistorted magnetic resonance imaging scans following surgery. However, the impression of several clinicians has been that when screw pullout and/or loss of sagittal balance occurs, it may be due to the rods losing some of their curvature. METHODS: Five 6-mm rods of differing compositions and lengths (titanium 300 and 100 mm, stainless steel 300 and 100 mm, prebent titanium 85 mm) were bent at room temperature with a 3-point rod bender, then placed in an incubator at 37 C. Digital photographs were taken every 2 weeks and analyzed to extract the radius of curvature of each rod. RESULTS: The Ti rods had a significantly decreasing curvature with time. The prebent Ti and stainless steel rods did not exhibit significant change in curvature. CONCLUSIONS: Titanium rods bent at room temperature and then exposed to body temperature over time tend to exhibit "metal memory"; they gradually revert to their original shape. This may result in loss of sagittal balance and/or proximal screw pullout.

Bone Nails↗

PubMed2005

Unilateral removal of pars interarticularis.

OBJECT: Lumbar radiculopathy secondary to foraminal entrapment can be treated by unilateral removal of the overlying pars interarticularis. The authors prospectively evaluated the outcome after this procedure. METHODS: Thirty-six consecutive patients underwent unilateral resection of the pars interarticularis between August 1999 and July 2002. In 18 patients acute foraminal disc herniations compressed the nerve root against the superior pedicle; in the other 18 foraminal stenosis was secondary to degenerative changes. All patients, at each visit, completed the following questionnaires: visual analog scale for overall, leg, and back pain; the Prolo Functional Economic Rating scale; and the Pain Rating Index (PRI) of the Short-Form McGill Pain Questionnaire. At 1 year, leg pain improved in 33 patients (91%). Low-back pain appeared or worsened in eight patients (22%; one in the acute herniation group and seven in the chronic degenerative group). Only one patient required lumbar fusion for pain. The Prolo economic and function scores improved in 21 (58%) and 27 (75%) patients, respectively. The PRI scores improved in 30 cases (83%). No spondylolisthesis was observed at any level at which resection had been performed. CONCLUSIONS: Unilateral removal of the pars interarticularis is effective in relieving lumbar radicular symptoms in patients with intraforaminal entrapment. The incidence of low-back pain in patients with acute foraminal disc herniations does not increase as a result of this procedure. In patients with degenerative foraminal stenosis, unilateral resection of the pars interarticularis may be a better alternative to facetectomy and segmental fusion. This procedure may be a useful tool in spine surgery.

Adult↗

PubMed2005

New tension band material for fixation of transverse olecranon fractures: a biomechanical study.

This study tested the use of braided polyethylene cable as an option for repairing transverse olecranon fractures. Six cadaveric elbows underwent a transverse olecranon osteotomy followed by fixation with tension band constructs using 18-gauge wire and Secure-Strand (U.S. Surgical, North Haven, Conn). Distraction forces up to 450 N were applied to the triceps tendon while measuring fracture displacement with an extensometer. The average maximal fracture gap with the standard AO tension band technique using stainless steel wire was 0.66 +/- 0.43 mm, as opposed to 0.68 +/- 0.45 mm with braided polyethylene cable. A paired t test indicated no significant difference between the two materials. These results support the feasibility of braided polyethylene cable as an alternative to the standard steel-wire tension band.

Biocompatible Materials↗

PubMed2004

Static load magnitude is a risk factor in the development of cumulative low back disorder.

Occupations requiring frequent periods of static lumbar flexion are known epidemiologically to be risk factors for the development of cumulative low back disorder. The impact of the load magnitude sustained during a series of short static lumbar flexions followed by an equally long rest period on the development of a cumulative low back disorder was addressed in an in vivo feline model. Static loads of 20, 40, and 60 N were applied over 10 min of flexion followed by 10-min rest sessions that were repeated six times (for a total of 2 h) while monitoring lumbar viscoelastic creep (laxity) and reflex electromyographic (EMG) activity from the multifidus muscles. Creep and EMG were also monitored over 7 h of rest following the six flexion-rest sessions. It was found that the creep developed in the 10-min flexion periods did not recover completely during the following 10 min of rest, giving rise to a large cumulative creep at the end of the work-rest session. Muscle activity demonstrated spasms during the static flexion periods as well as initial and delayed hyperexcitability during the 7-h rest period. Loads of 20 and 40 N did not result in delayed hyperexcitability, whereas loads of 60 N resulted in delayed hyperexcitability. Statistical analysis demonstrated that increased load significantly intensified the magnitude of the hyperexcitabilities (P < 0.05). Thus, repeated periods of static lumbar flexion were found to result in a transient neuromuscular disorder with an intensity directly related to the load magnitude, which should be considered a compounding risk factor.

Animals↗

PubMed2003

Biomechanics and electromyography of a common idiopathic low back disorder.

STUDY DESIGN: In vivo feline preparation groups loaded into lumbar flexion at different magnitudes and an unloaded control group. OBJECTIVE: To demonstrate that a static, constant load flexion of the lumbar spine results in a complex neuromuscular disorder. SUMMARY OF BACKGROUND DATA: Epidemiology suggests that static lumbar flexion is a cause of low back disorders. There is little direct experimental evidence describing the physiologic and biomechanical processes that elicit the disorder. Recent evidence shows that static flexion of the spine under constant displacement results in muscular spasms and a prolonged recovery period. The response of the spine to flexion under constant load of various magnitudes (as opposed to constant displacement) is not known. It was hypothesized that static lumbar flexion under constant load may elicit creep in spinal ligaments, discs, etc., causing microdamage and development of a neuromuscular disorder. METHODS: The lumbar spine of the feline was subjected to 20 minutes of constant load static flexion at physiologic load intensities from light to heavy while creep of lumbar viscoelastic tissues and EMG from the multifidus muscles of L3-L4 to L5-L6 were recorded. Recordings were continued over a 7-hour rest period after the static flexion was terminated. RESULTS: Spasms and decreasing reflexive EMG were evident during the loading period, and a transient surge of EMG activity occurred at the beginning of the rest period. A second surge of EMG activity was seen 3-4 hours later. The four components of the neuromuscular disorder were present regardless of the load magnitude. A model was developed to quantify the disorder. CONCLUSION: A four-component neuromuscular disorder was elicited by a 20-minute constant load static flexion even when very light loads were applied. The disorder was elicited by creep of the viscoelastic tissues, which resulted in spasms and muscular hyperexcitability lasting for >24 hours. Although the disorder was transient, the physiologic and biomechanical principles associated with its development could also explain cumulative trauma disorders.

Animals↗

PubMed2003

Transients of the force and surface mechanomyogram during cat gastrocnemius tetanic stimulation.

The aim of the study was to investigate the time relationship between force and muscle surface displacement, detected as the surface mechanomyogram (MMG) by a laser distance sensor, in the transient phases of a tetanic stimulation. For this purpose the motor nerve of the exposed medial gastrocnemius of four cats was supramaximally stimulated at 30, 40 and 50 Hz for 9 s. Force was detected by a transducer connected at the distal tendon while MMG was measured after pointing the laser beam at the muscle belly. We found that the MMG always anticipated and trailed the force changes during the on- and off-phase of the tetani, respectively. Independently of the stimulation rate, the half-times of the two signals were: on-phase, about 76 ms for force and 33 ms for MMG; off-phase, about 83 ms for force and 132 ms for MMG. There are two main comments to make about these results. First, during the on-phase the shortening of the contractile elements results at first in a muscle geometry change with low output force. After this, when the slack of the elastic-connective tissue has been taken up, the tension is efficiently transmitted to the tendon. Second, the different force and MMG dynamics in the on- and off-phases determine a counter-clockwise hysteresis with more force produced at a given muscle surface displacement during relaxation. To explain the results, the possible specific roles of some components of the muscle mechanical model, muscle mechanical properties and intra-muscular phenomena taking place during contraction have been discussed.

Animals↗

PubMed2003

Neuromuscular dysfunction elicited by cyclic lumbar flexion.

An attempt was made to develop an in vivo model that could explain the neurophysiological and biomechanical processes active in the development of the idiopathic low back disorder common in workers who perform repetitive lifting tasks in industry. Passive cyclic flexion of the feline lumbar spine at 0.1 HZ for 20 min resulted in creep of the supraspinous ligament and other lumbar viscoelastic tissues as well as spasms superimposed on a decreasing electromyogram (EMG) elicited reflexly from the multifidus muscles. Rest for 7 h did not allow full recovery of the viscoelastic creep; the multifidus EMG gradually increased with initial and delayed hyperexcitability. Increasing the peak load of the cyclic flexion resulted in larger creep in the passive tissues and required a longer time for recovery of reflex EMG activity and longer delayed hyperexcitability, but development of spasms and hyperexcitability was unaffected. It is conceivable that damage to the viscoelastic tissues elicits an inflammatory process that in turn triggers a transient neuromuscular disorder. The present findings provide a biomechanical and neurophysiological explanation for a common idiopathic low back disorder as well as for the development of a cumulative trauma disorder often seen in workers engaged in repetitive lumbar flexion.

Animals↗

PubMed2003

Neuromuscular disorder in response to anterior cruciate ligament creep.

OBJECTIVE: To determine the effect of creep developed in the anterior cruciate ligament and other viscoelastic knee structures on the function of the flexor and extensor muscles of males and females. DESIGN: Static load applied to the proximal tibia of young healthy male and female subjects in a laboratory setting with maximal voluntary knee flexion and extension performed before and after the load application. BACKGROUND: Static loads applied to various joints during occupational and sports activities are epidemiologically linked to higher than normal rates of disability reports. The physiological and biomechanical processes active in the development of such a neuromuscular disorder are not known. We hypothesize that creep developed in the anterior cruciate ligament due to prolonged static load will have pronounced impact on the reflexive activation of the associated musculature in a manner that may increase the risk of injury. Females are expected to be exposed to higher risk than males. METHODS: Male and female groups performed maximal voluntary knee flexion and extension before and after applying 200 and 150 N, respectively, to the proximal tibia for a 10 min period. Flexion and extension forces as well as electromyograph from agonist and antagonist muscles were measured at 35 degrees and 90 degrees knee flexion. Data was analyzed through repeated measures of analysis of variance. RESULTS: It was found that in extension, quadriceps electromyographic activity increased significantly after anterior cruciate ligament creep while hamstrings co-activation did not change. There was also a trend towards increased extension force after creep was developed, with significant effect of gender (larger increase in females). Similarly, significant increase in hamstrings electromyographic activity and a trend towards increased force during knee flexion was observed but with no effect of gender. Electromyographic spasms from the flexors and extensors were recorded in 30% of the subjects during the 10 min static loading period at 90 degrees angle and from the flexors only at 35 degrees. Creep in the ligament was marginally greater in females than in males with a significant effect of angle, being greater at 35 degrees than in 90 degrees knee flexion. CONCLUSIONS: The results suggest that ligament creep may develop a neuromuscular disorder consisting of spasms, increased electromyography and force in the agonist muscles without compensation from the antagonist. Static loading of a joint, therefore, may develop a neuromuscular disorder compounded with laxity of the ligaments and subject the individual to increased risk of injury. RELEVANCE: The data provides evidence that prolonged static loads applied to the anterior cruciate ligament and associated viscoelastic structures results in unbalanced muscular activation which puts individuals at increased exposure to injury. Work and sports activities should be scheduled while minimizing periods of static joint loading and emphasizing sufficient rest periods to allow recovery of creep and return to balanced muscular activation and co-activation.

Adaptation, Physiological↗

PubMed2003

Flexion-relaxation response to static lumbar flexion in males and females.

OBJECTIVE: To determine if creep developed in the lumbar viscoelastic tissues during a period of static flexion elicited changes in the muscular responses of the flexion-relaxation phenomenon. BACKGROUND: Static lumbar flexion is a risk factor in workers, yet the physiological biomechanical and histological processes active in the evolution of the consequent low back disorder were not demonstrated experimentally. Controlled animal studies show that static lumbar flexion develops creep in the associated viscoelastic tissues and elicits spasms and modification of muscle function. Such neuromuscular changes are to be investigated in this study while assessing normal human subjects via the flexion-relaxation phenomenon. METHODS: Male and female subject groups performed three bouts of lumbar flexion-extension before and after a 10 min period of static lumbar flexion. The surface electromyographic from the erector spinae muscles as well as flexion angle were recorded. The angle in which electromyographic diminished during flexion and initiated during extension was determined and subjected to ANOVA with repeated measures to determine any significant changes in the flexion-relaxation response. RESULTS: The erector spinae were active through a significantly larger angle during flexion and initiated activity significantly earlier during extension after static flexion. Females demonstrated more pronounced changes than males. EMG amplitude did not change significantly. Spasms were recorded in more than half of the subjects during the static flexion period. CONCLUSIONS: Creep developed during a short static lumbar flexion elicited significant changes in the muscular activity pattern of the flexion-relaxation phenomenon. The muscles seem to compensate for the loss of tension in the lumbar viscoelastic tissues, while spasms suggest that some micro-damage was incurred to the viscoelastic tissues. RELEVANCE: Static lumbar flexion is shown experimentally as an activity that constitutes an occupational risk factor for the development of low back disorder.

Adult↗

PubMed2003

The effect of divergent screw placement on the initial strength of plate-to-bone fixation.

BACKGROUND: Numerous implants exist that allow screws to be placed at varying angles for lag fixation or to fix additional fragments. This study determined how placing screws at different angles affects fixation strength. METHODS: Using a bone model, we first investigated the pullout strength of screws inserted at varying angles; then, we studied the strength of plate-bone constructs with end screws placed at divergent angles. RESULTS: Varying the screw angle from 0 to 10 to 20 degrees progressively weakened the screw pullout resistance. No additional decrease was found in varying the angle further. In contrast, the strength of fixation of plate to bone was higher for constructs with screws placed at 20 or 30 degrees off of perpendicular when tested in gap-open bending and axial compression (all p < 0.05). No such differences were found in torsion. CONCLUSION: The pullout strength with angled screws is reduced, but this does not translate into reduced strength of the bone-to-plate interface.

Analysis of Variance↗

PubMed2002

Early results of a reverse design prosthesis in the treatment of arthritis of the shoulder in elderly patients with a large rotator cuff tear.

Results of shoulder arthroplasty in patients with a deficient rotator cuff often are suboptimal with significant limitations in postoperative active mobility. Short-term results using a reverse design prosthesis in the treatment of the cuff-deficient arthritic shoulder are encouraging. This prosthesis compares favorably, particularly with regard to postoperative active anterior elevation, to other treatment options in this challenging patient population.

Aged↗

PubMedDate not supplied

Comparison of tensile strength of resorbable plating systems used in monocortical mandible angle osteotomy repair.

OBJECTIVE: To determine the usefulness of resorbable plating systems in load-bearing applications of the mandible and the location of critical failure. METHODS: An osteotomy was created in 24 fresh cadaveric mandibles at the angle and fixated by the Champy technique with similar resorbable craniofacial plating systems from 4 manufacturers. Each mandible was held rigid as a material test system applied a downward force anteriorly. The critical tolerance was measured and the type of failure was noted. RESULTS: Critical failure occurred at forces from 34.6 to 137.8 N. We found a statistically significant difference between the plating groups (P<.001 for all comparisons). The point of failure was almost uniformly at the plate. CONCLUSIONS: Critical failure was overwhelmingly due to rupture of the plate rather than to stripping or shearing of the screws as had been strongly expected. We found differences in plate strengths for this particular application and did not evaluate their respective long-term resorptive properties. We do not advocate that single resorbable plate fixation be the sole means of mandible angle fracture fixation, regardless of the plating system used.

Absorbable Implants↗

PubMedDate not supplied

Interobserver and intraobserver reliability of the measurement of shoulder internal rotation by vertebral level.

Internal rotation is commonly measured as the vertebral level reached by the fully extended thumb. The purpose of this study was to evaluate interobserver and intraobserver reliability with the use of this method. Three male subjects were used for internal rotation measurement. Eleven orthopaedic surgeons and 2 physical therapists served as examiners. Each subject had a radiographic marker placed at a random vertebral level, and the subject's extended thumb was placed at this marker. All examiners then independently measured internal rotation based on vertebral level. To assess intraobserver reliability, this process was repeated twice. After all measurements were completed, an anterior-posterior radiograph of each subject was obtained to define the vertebral level of the marker. This process was repeated 2 additional times with the marker and subject's thumb positioned at different levels than in the previous examination. Intraclass correlation coefficients were calculated to determine reliability. Results demonstrated poor interobserver reliability and reasonable intraobserver reliability. The mean clinical measurement deviated from the mean actual measurement by 1 vertebral level. Despite being the standard method in which shoulder internal rotation is measured, measurement of internal rotation by vertebral level is not readily reproducible between observers.

Adult↗