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PubMed2004

Locking compression plate loosening and plate breakage: a report of four cases.

The Locking Compression Plate (LCP) system offers a number of advantages in fracture fixation combining angular stability through the use of locking screws with traditional fixation techniques. This makes the implant particularly suitable for use in poor bone stock and complex joint fractures, especially in the epimetaphyseal area. However, the system is complex, requiring careful attention to biomechanical principles, and a number of potential pitfalls need to be considered. These pitfalls are illustrated in the 4 cases described herein, in which treatment was unsuccessful due to implant breakage or loosening. In each case, treatment failure could be attributed to the choice of an inappropriate plate and/or fixation technique, rather than to the features of the Locking Compression Plate system itself. Such experiences highlight the importance of detailed understanding of the biomechanical principles of plate fixation as well as careful preoperative planning for the successful use of the Locking Compression Plate system.

Aged↗

PubMed2005

The static stiffness index: a simple method to assess the elastic property of compression material in vivo.

BACKGROUND: The efficacy of compression therapy depends mainly on the exerted pressure and on the stiffness of the material. OBJECTIVE: To propose a simple method by which pressure and stiffness can be assessed in the individual patient. MATERIAL AND METHODS: Using a pressure transducer (Kikuhime small probe, MediTrade, Soro, Denmark) the sub-bandage pressure is measured on the medial aspect of the lower leg at the transition of the gastrocnemius muscle into the Achilles' tendon. The pressure difference between active standing and lying is defined as the static stiffness index (SSI). RESULTS: The accuracy and precision of the probe are good. Unna boot bandages (Lohmann-Rauscher, Vienna, Austria) and multilayer short-stretch bandages show a significantly higher SSI than long-stretch bandages and round-knitted class II stockings. The SSI values are lower than 10 mm Hg for elastic, long-stretch material and higher than 10 mm Hg for inelastic, short-stretch material. CONCLUSION: In future compression trials, pressure and stiffness measured in vivo should be declared.

Bandages↗

PubMed1989

[Elastic support in 1988].

After several remarks concerning physiology and physiopathology, we discuss the different physical aspects of compression and its use in therapy. We then consider, first, the choice of a bandage to reduce edema and secondly, that of an appropriate elastic stocking to maintain the therapeutic results.

Clothing↗

PubMed1994

[Growth factors and bone tissue. Implications in the formation of bone matrix].

Bone formation is highly dependent on the number of osteoblastic cells. Simulating factors which recruit osteoblastic cells play an essential role in regulating bone formation. Several growth factors produced locally by bone marrow cells and osteoblasts regulate cell growth and differentiation of osteoblastic cells. These growth factors may be systemic or local and can be stocked in the matrix. The factors secreted locally play a dominant role in regulation and are stocked in an active form in the bone matrix. Growth factors act through both autocrine and paracrine effects, or as local mediators of hormones and compression forces. The wide range of effects of the local growth factors and cytokines on bone cells, and the numerous interactions between these factors lead to precise regulation of the osteoblastic function. Thus these factors plan an extremely important role in local regulation and cell growth and osteoblastic differentiation, and are highly implicated in local control of bone formation.

Bone Matrix↗

PubMed2003

[Prophylactic strategies for perioperative pulmonary embolism].

BACKGROUND: Incidence of perioperative pulmonary embolism (PE) has increased in Japan probably due to the modernized life style. As the mortality rate of PE is very high, its prophylaxis is important. Therefore, prophylactic strategies for PE were instituted in the entire hospital. METHODS: Elastic stockings (ES) for preventing perioperative deep vein thrombosis in lower extremities were worn from the morning of the operation until the beginning of ambulation. Intermittent pneumatic compression (IPC) apparatuses were used in combination with ES. IPC apparatus was employed right after induction of anesthesia until leaving postanesthetic care unit (PACU). Seventy percent of patients stayed in PACU until the morning after the operation and the other patients for a few hours after the end of surgery. RESULTS: We managed 4,200 patients with this method. We experienced one symptomatic deep vein thrombosis but not severe or moderately severe PE. However, it is difficult to evaluate the incidence of mild PE because it is usual that symptom such as chest discomfort is thought as an indefinite complaint and its cause is not investigated further. CONCLUSIONS: Our preventive strategies seem to be useful to decrease the incidence and severity of perioperative PE.

Bandages↗

PubMed1996

[New technique for a hip arthrodesis using an anterior approach and a ventral plate].

The authors present a new technique for fusion of the hip joint through an anterior approach (Smith-Petersen) with the use of a ventral plate and a lateral compression screw. The indications for fusion of the hip joint are discussed and some cases are presented. The advantages of this technique are that strong bone stock for fixation is used on the pelvic side, that the abductor muscles and vascularization of the femoral head are left intact, and that no external fixation (cast) is routinely used for after-treatment.

Adult↗

PubMed1993

High-resolution mapping of a minor histocompatibility antigen gene on mouse chromosome 2.

Minor histocompatibility (H) loci are significant tissue transplantation barriers but are poorly understood at the genetic and molecular level. We describe the construction of a high-resolution genetic map that positions a class II MHC-restricted minor H antigen locus and orders 12 other genes and genetic markers within the we-un interval of mouse Chromosome (Chr) 2. An intersubspecific backcross between B10.UW/Sn-H-3b and CAST/Ei, an inbred stock of Mus musculus castaneus, was used for this purpose. A total of 1168 backcross mice were generated, and 71 we-un recombinants were identified. Significant compression of the genetic map in males versus females and transmission distortion of CAST-derived we, un, and Aw genes were observed. Monoclonal T cell lines specific for two minor H alloantigens, Hd-1a and Hd-2a, encoded by gene(s) that map to the we-un interval were used to antigen type the backcross mice. The results suggest the Hd-1a and Hd-2a antigens are most likely encoded by a single gene, now referred to as H-3b. The determined gene order is we-0.09 +/- 0.09-Itp-0.62 +/- 0.23-D2Mit77-0.26 +/- 0.15-[Evi-4, Pcna, Prn-p]-0.26 +/- 0.15-Scg-1-0.44 +/- 0.19-[Bmp2a, D2Mit70]-0.09 +/-. 0.09-[D2Mit19, D2Mit46]-1.59 +/- 0.36-D2Mit28-0.97 +/- 0.28-D2Ler1-1.50 +/- 0.35-H-3b-0.26 +/- 0.15-un (% recombination +/- 1 SE). Because the average resolution of the backcross is 0.09 cM, the backcross panel should facilitate the physical mapping and molecular identification of a number of genes in this chromosome region.

Animals↗

PubMed2006

Knee arthrodesis.

Arthrodesis is one of the last options available to obtain a stable, painless knee in a patient with a damaged knee joint that is not amenable to reconstructive measures. Common indications for knee arthrodesis include failed total knee arthroplasty, periarticular tumor, posttraumatic arthritis, and chronic sepsis. The primary contraindications to knee fusion are bilateral involvement or an ipsilateral hip arthrodesis. A variety of techniques has been described, including external fixation, internal fixation by compression plates, intramedullary fixation through the knee with a modular nail, and antegrade nailing through the piriformis fossa. Allograft or autograft may be necessary to restore lost bone stock or to augment fusion. For the carefully selected patient with realistic expectations, knee arthrodesis may relieve pain and obviate the need for additional surgery or extensive postoperative rehabilitation.

Arthrodesis↗

PubMed2006

[A case of rheumatoid factor-positive hypertrophic spinal pachymeningitis].

A 54-year-old female was admitted to our hospital with the complaint of progressive gait disturbance, starting with left abdominal pain 1 month previously. She developed acute paraparesis and stocking-anesthesia type sensory disturbance within a few days. MR imagings on admission, revealed an encircled subdural mass at the Th1-9 vertebral level, and her spinal cord was compressed at several places at the Th5-6. The subdural mass showed low intensity on T1 and T2 weighted image, and was homogenously enhanced after Gd-DTPA administration. Laboratory data revealed elevation of rheumatoid factor, CH50, C3, C4, and C-reactive protein. An emergency operation was performed by left hemilaminectomy from Th4 to Th6. The subdural mass was resected as far as possible, followed by dural plasty and initiation of steroid intraoperatively. Histopathologic examination of the resected lesion documented a hypertrophic pathymeningitis. Postoperatively, her neurological findings were improved immediately, followed by adjuvant therapy. Recurrence was not present on radiographic images 3 years after surgery. Laboratory data normalized within 4 months. Hypertrophic pachymeningitis is a rare case, and it is difficult to diagnose preoperatively. If there are subdural mass lesions at the multiple vertebral levels, we should suspect this disease. Treatment by immediate decompressive surgery and continuous adjuvant therapy was effective in our case.

Decompression, Surgical↗

PubMed1995

[Manual fragmentation of deep vein thrombosis].

To preserve the venous function after deep vein thrombosis, physical treatment combines elastic stockings, active exercises, lower limbs elevation, ventilatory exercises and manual lymph drainage. When this traditional treatment is not sufficient, we use a new technique. It aims at fragmenting thrombus by compressing it between the physiotherapist's fingers and the patient's bone. In order to define the fragmentation sites we use the Triplex ultrasonography. This technique has been tested on ten patients with serious thrombosis, whom the thromboembolic risk was first controlled. The evaluation was performed by the clinical examination, echography and occlusive impedance plethysmography rheography. The improvement of the subjective and objective signs leads to use our technique. It has to be validated on a larger scale to extend its use.

Female↗

PubMed1995

Prophylaxis against thromboembolism in neurosurgical patients: a survey of current practice in the United Kingdom.

Venous thromboembolism is a life threatening, but preventable complication of major surgery. Many neurosurgical patients are at high risk of developing thromboembolic disease. A postal survey was undertaken of 44 UK neurosurgical centres to assess the use of physical and pharmacological methods of prophylaxis against thromboembolism. Thirty-five replies were received from 31 centres. Seventy-seven per cent of units used antiembolism stockings (TEDs) for elective surgery and 37% for emergency surgery; in approximately two-thirds of these units TEDs constituted the sole method of prophylaxis used during both elective and emergency surgery. Intermittent pneumatic compression (IPC) was utilized in 37 and 11% of units for elective and emergency surgery, respectively. Subcutaneous heparin was used in 32% of units perioperatively including 6% of emergency cases. These findings suggest that neurosurgical patients, who are at moderate to high risk of developing thromboembolic complications, may not receive effective prophylaxis; those undergoing emergency neurosurgery are less likely to receive any form of prophylaxis.

Brain↗

PubMed1995

[Biomechanical study of the initial stability of various arthrodesis methods for the upper ankle joint].

Arthrodesis of the ankle joint is commonly, performed to treat severe arthritis. Three different techniques have been biomechanically evaluated for initial stability: fusion with three isolated tibio-talar lag screws (type I), which was inaugurated by Wagner; a second fusion technique with two isolated tibio-talar lag screws and an anterior tibio-talar three-hole 3.5 mm AO compression plate (type II); and type-II fusion with an additional lag screw through the center hole of the anterior plate (type III). Ten fresh cadaver ankles were used for biomechanical evaluation. Bone stock quality was compared before fusion by CT scan and osteodensitometry. Osteopenic ankle joints (bone density less than 80% of the median density) were excluded. Each ankle fusion was stressed with 15 Nm in a universal testing machine (UTS 10, Ulm, Germany) in antero-posterior and medio-lateral directions and in a rotational torque technique. The movements at the fusion gap were recorded by computer-assisted image analysis. A video camera recorded the displacement of four active markers on both sides of the fusion line during loading in real time. A computer-assisted calculation of the dislocation at the fusion gap was performed. This technique provides comparable results except for systemic failure induced by the fixation device of the testing machine. The results revealed comparable initial stability with types I (0.063 mm/Nm) and III (0.074 mm/Nm; P = 0.95) ankle fusion. Type-II fusion was significantly less favorable concerning initial stability (0.14 mm/Nm; P < 0.01, Duncan's test for multiple comparisons). Our biomechanical results advertise isolated lag screws for ankle fusion.

Ankle Joint↗

PubMed1991

Venous hypertensive microangiopathy in relation to clinical severity and effect of elastic compression.

Arterial inflow in mL/minute and perimalleolar skin blood flow were measured with venous occlusion air-plethysmography and laser-Doppler flowmetry in 20 normal limbs, 40 limbs with uncomplicated primary varicose veins, 32 limbs with primary varicose veins and skin changes, and 36 limbs with deep venous disease. Limbs with complicated varicose veins (skin changes) and deep venous disease showed a marked increase (2 to 4 times) in both arterial inflow and skin blood flow when compared with the normal controls and uncomplicated varicose veins. The measurements were repeated 30 minutes after the application of graduated elastic stockings. There was a 16% reduction in the mean arterial inflow (P less than .01) and a 45% decrease in skin blood flow (P less than .01). The results indicate that in limbs with chronic venous insufficiency and skin changes there is an increased blood flow which is mainly in the skin. This is irrespective of whether the venous problem is in the superficial or deep venous system. Elastic compression tends to reduce the hyperemia towards the normal range.

Adult↗

PubMed1996

Processing complete dentures.

When this procedure is followed carefully, a strip of 0.0005-inch shim stock meets resistance when an attempt is made to withdraw it from between the teeth in occlusion and the incisal pin and its table simultaneously. Therefore, it is possible to process complete dentures by using compression molding and external heat for polymerization. The procedure involves a precise step-by-step method with particular emphasis on (1) investing properly in dental stone, (2) packing only one denture at a time with only one mix of acrylic resin, (3) using minimum packing pressure with maximum flow time, (4) trial packing until no flash is evident, and (5) careful deflasking.

Acrylic Resins↗

PubMed1999

Superficial thrombophlebitis of the legs: a randomized, controlled, follow-up study.

The aim of the present study was to evaluate the effects of different treatment plans (compression only, early surgery, low-dose subcutaneous heparin [LDSH], low-molecular-weight heparin [LMWH], and oral anticoagulant [OC] treatment) in the management of superficial thrombophlebitis (STP), by considering efficacy and costs in a 6-month, randomized, follow-up trial. Patients with STP, with large varicose veins without any suspected/documented systemic disorder, were included. Criteria for inclusion were as follows: presence of varicose veins; venous incompetence (by duplex); a tender, indurated cord along a superficial vein; and redness and heat in the affected area. All patients were ambulatory. Exclusion criteria were obesity, cardiovascular or neoplastic diseases, bone/joint disease, problems requiring immobilization, and age > 70 years. Patients with superficial thrombophlebitis without varicose veins and patients under treatment with drugs at referral were also excluded. Color duplex (CD) was used to detect concomitant deep vein thrombosis (DVT) and to evaluate the extension or reduction of STP at 3 and 6 months. Venography was not used. Of 562 patients included, 3.5% had had a recent DVT in the same limb affected by SVT and 2.1% in the contralateral limb. In six patients DVT was present in both limbs. These patients were treated with anticoagulants and excluded from the follow-up. After 3 and 6 months the incidence of STP extension was higher in the elastic compression and in the saphenous ligation groups (p < 0.05). There was no significant difference in DVT incidence at 3 months among the treatment groups. Stripping of the affected veins was associated with the lowest incidence of thrombus extension. The cost for compression alone was the lowest and the cost including LMWH was the highest. The average cost was 1,383 US$. However the highest social cost (lost working days, inactivity) was observed in subjects treated only with stockings.

Absenteeism↗

PubMed2003

Proximal humeral fractures: how stiff should an implant be? A comparative mechanical study with new implants in human specimens.

BACKGROUND: The objective of this study was to determine the in vitro characteristics of the clinically used and newly developed implants for the stabilization of proximal humeral fractures under static and cyclic loading. The goal was to optimize implant stiffness for fracture stabilization even in weak bone stock. METHODS: In a laboratory study using 35 fresh human humeri, the specimens were randomized into 5 groups, which included the clinically used humerus T-plate (HTP), the cross-screw osteosynthesis (CSO), the unreamed proximal humerus nail with spiral blade (UHN), the recently developed Synclaw Proximal Humerus Nail (Synclaw PHN) and the angle-stable Locking Compression Plate Proximal Humerus (LCP-PH). The implant stiffness was determined for three clinically relevant load cases: axial compression, torsion and varus bending. In addition, a cyclic varus-bending test was performed to determine the implant properties under cyclic loading. RESULTS: In contrast to a rather elastic and minimally invasive implant(LCP-PH), the conventionally designed ones (Synclaw PHN, CSO, HTP, UHN) showed rather high stiffness values under static loading. In cyclic loading, a strong decrease in stiffness ( p<0.05) was found for the rigid implants HTP and UHN. In comparison with the other implants, only the elastic implant (LCP-PH) showed a significantly lower load reduction in a weak bone stock (17+/-6.2%). CONCLUSION: The high initial stiffness of rigid implants led to an early loosening and failure of the implant-bone interface under cyclic loading. Implants with low stiffness and elastic characteristics, however, appear to minimize the peak stresses at the bone-implant interface, making them particularly suitable for fracture fixation in osteoporotic bone.

Adult↗

PubMed2005

Video laparoscopic surgery: is out-of-hospital thromboprophylaxis necessary?

Despite widespread use of laparoscopic procedures, no adequate data are available to support specific recommendations for venous thromboprophylaxis in patients undergoing laparoscopic surgery. This prospective, randomized trial is the first to be designed to evaluate a regimen of out-of-hospital thromboprophylaxis after laparoscopic surgery. Consecutive patients admitted for laparoscopic surgery were considered for the study. The thromboprophylaxis regimen used for each patient was based on a risk score. Possible thromboprophylactic measures included elastic stockings and pre- and postoperative Dalteparin or early ambulation. At discharge, patients were randomly allocated either to continue Dalteparin for 1 week, or to receive no further prophylaxis. Patients judged to be at low risk were not randomized. Compression ultrasound of the leg veins was performed in all patients 4 weeks after hospital discharge. Fifty-three patients, all with acute appendicitis, were judged to be at low risk of deep vein thrombosis and were not included in the randomized study. The remaining 209 patients fell into two groups: 104 patients received postdischarge Dalteparin and 105 patients did not. The incidence of deep vein thrombosis was 0% (0 of 104) vs. 0.95% (one of 105), respectively (P = 1.00). The risk of postdischarge venous thromboembolism is low in patients undergoing laparoscopic surgery who receive in-hospital thromboprophylaxis. Given this low risk, a clinical trial powered to determine if extending prophylaxis in such patients reduces the risk of clinically apparent deep vein thrombosis would be unfeasibly large.

Adult↗

PubMed1987

Revision total hip arthroplasty. Current role of polymethylmethacrylate.

In 29 consecutive failed total hip arthroplasties revised during a 15-month period, cement fixation was used in 14 and cementless fixation in 11. A combination of the two techniques was used in four patients. Analysis of the indications for one or the other fixation type showed that the quality of bone stock and the location of bone deficiency were the most important criteria. The use of a fixation technique that suited the method of bone repair, i.e., autografts, allografts, or a combination of the two, was all-important. Cement technique alone was generally used when bone stock was intact and healthy. Cement was also used in combination with protrusio screens and allografts for gross acetabular deficiencies. Cementless, porous ingrowth technique, together with autografts, was preferred for femoral deficiencies or minor acetabular deficiencies. Bipolar prostheses with compressed, fragmented allografts were used as salvage procedures in gross acetabular deficiencies in older patients, especially when the femoral component did not need to be exchanged.

Age Factors↗