scholarly journals Nutrient Foramen of Fibula in Relation to Distal end, Potential Implications for Vascularised Done Graft Surgery

2019 ◽  
Vol 1 (4) ◽  
pp. 29-32
Author(s):  
Amjad N Bhatti ◽  
C Smith
Keyword(s):  
Bone Grafting ◽  
Human Beings ◽  
Bony Landmark ◽  
Nutrient Foramen ◽  
Total Length ◽  
Nutrient Foramina ◽  
The Mean ◽  
Topographical Analysis ◽  
Transfer Procedures

Background Free vascularised fibular bone grafting has gained popularity in various Orthopaedic and Oral & maxillofacial reconstructive surgeries. The objective of the present study was to identify the morphology and topography of nutrient foramina of fibula and to determine the foraminal index (FI) of the fibula using a more surgeon friendly bony landmark. Methods The study comprised examination of 100 fibulae specimens. Each bone was divided into 03 parts and topographical analysis was performed on each section. The nutrient foramina were identified macroscopically using size 24-gauge needle. Modified Hughes formula was used to calculate the foraminal index using distance of foramen (DF) from distal end which is easier to palpate in living human beings, total length of fibula (TL); and the formula was DF/TL x100. Results With respect to fibulae, 98% had single foramen and foramen was absent in 2%. The mean foraminal index (FI) was 56% for fibulae using modified Hughes’ formula. The majority of the fibulae showed nutrient foramen in the middle 3rd in relation to distal end of fibula. Conclusion The study provides information on the morphology of nutrient foramina in relation to easily palpable landmark on living human beings, which can provide guidance to surgeon while performing microvascular bone transfer procedures.

scholarly journals NUTRIENT FORAMEN;

2018 ◽  
Vol 25 (08) ◽  
pp. 1252-1255
Author(s):  
Anwaar Hussain ◽  
Jawaria Khalid ◽  
Abdul Rauf
Keyword(s):  
Blood Supply ◽  
Bone Grafting ◽  
Posterior Surface ◽  
Anterior Surface ◽  
Cross Sectional ◽  
Nutrient Foramen ◽  
Nutrient Foramina ◽  
Clinical Interest ◽  
The Mean ◽  
Medical University

Objectives: To study the nutrient foramina of the dried human clavicle with respectto their position, number and direction for clinical interest. Study Design: Cross sectional study.Setting: Anatomy Department Faisalabad Medical University Faisalabad. Period: Six monthsfrom July to December 2017. Material and Methods: 60 dried human clavicles taken frombone bank of Anatomy Department Faisalabad Medical University Faisalabad. The foraminawere studied according to their location, and number and direction. The foramina index wascalculated using Hughes Formula by measuring the average total length and average lengthof foramina from sternal end of the clavicle. Results: The nutrient foramen was observed in all60(100%) of the clavicle. Single foramen was present in 22 (36.6%) clavicle and double foramenin 30(50%) clavicle. Triple and quadruple foramen in 6(10%) and 2(3.3%) clavicles respectively.The 34 left clavicles posses single foramen 12 (41.1%), double foramen 14(35.2%) while tripleand quadruple are 6(17.6%) and 2(5.8%) respectively. Total 26 right clavicles had 10 (38.4%)single foramen and 16(61.5%) double foramen. Total number of foramen in all 60 clavicleswere 108 of which 61.1% are located on posterior surface of the clavicle, 27% were found oninferior surface and rest 11.1% were on anterior surface. The clavicle having more than oneforamina are 28 out of which 64.2% was having both inferior and posterior foramina, 21.4 % wasanterior and posterior while 14.28% was located on triple sites anterior, inferior and posterior.We also found 90% of foramina were present on middle 1/3 and 10% on lateral 1/3. 98.3% ofthe foramina were directed to acromial end while rest 1.7 % to sternal end. The mean length offoramina from sternal end is 7.46 cm and mean maximum length of the clavicle was 14.51cm.The mean foramina index was 51.41. Conclusion: It is concluded from the study that most ofthe foramina are located on middle 3rd of the clavicle the commonest site of the fractures of thebone. Most of the foramina are located on the posterior surface denoting its blood supply fromthe neighboring blood supply. The knowledge of the foramina and its blood supply is importantfor fracture healing and bone grafting.

scholarly journals Topography of diaphyseal nutrient foramina of femora and their implications in bone grafting

2016 ◽  
Vol 05 (03) ◽  
pp. 127-132
Author(s):  
Venkatesh Kamath ◽  
Shivarama Bhat ◽  
Muhammed Asif ◽  
Ramakrishna Avadhani
Keyword(s):  
Bone Grafting ◽  
Success Rates ◽  
Orthopedic Surgeon ◽  
Nutrient Artery ◽  
Nutrient Foramina ◽  
Vascular Compromise ◽  
Rapid Healing ◽  
The Mean ◽  
Linea Aspera ◽  
Upper Third

Abstract Background : Long bones derive their nutrition through a nutrient artery that enters the bone through a foramen in its diaphysis. An orthopedic surgeon must be familiar with the topography of the nutrient foramina to avoid vascular compromise during surgery. Aim :This study attempts to analyze the topography of primary nutrient foramina of femora. Materials and method : One hundred dry adult femora were used for this study. The primary diaphyseal nutrient foramina were identified macroscopically using hand lens. The number of foramina and their position were noted and the foramina! index was calculated. Results : It was observed that 79% of femora had single primary nutrient foramen, 20% had double foramina and I% had three foramina. All the foramina were located between 30.8%-89.6% of total length of femur. 11.47 % of foramina were in the upper third, 1.64% in the lower third and the majority 86.88% of foramina were in the middle third of femur. The mean foramina!index was 46.01. 82.78% of foramina were located on the linea aspera, 14.75% on the medial surface and2.46% on the lateral surface. Conclusion : An orthopedic surgeon operating on femur must be careful in the middle 1/3rd, especially over the linea aspera as majority of primary diaphyseal foramina were observed in this region. A cogent knowledge of vascular topography ensures preservation of vasculature of the bone during surgeries. This enables rapid healing of surgical wound increasing the success rates of fracture fixation, bone grafting, vascularized microscopic surgeries and hip and knee replacement procedures.

scholarly journals DIAPHYSEAL NUTRIENT FORAMINA OF ADULT HUMAN TIBIA - ITS POSITIONAL ANATOMY AND CLINICAL IMPLICATIONS. Foramen nutricio diafisario de la tibia humana adulta – Su anatomía posicional y las implicancias clínicas

2016 ◽  
Vol 5 (3) ◽  
pp. 222-228
Author(s):  
Swati Gandhi ◽  
Rajan K Singla ◽  
Rajesh K Suri ◽  
Vandana Mehta
Keyword(s):  
Fracture Repair ◽  
Orthopedic Procedures ◽  
Long Bones ◽  
Tibial Shaft ◽  
Nutrient Foramen ◽  
Medical College ◽  
Adult Human ◽  
Nutrient Foramina ◽  
The Mean ◽  
The Right

El conocimiento del número y posición de los forámenes nutricios en los huesos largos es importante en los procedimientos ortopédicos, tales como la terapia de reemplazo de articulaciones, reparación de fracturas, injertos de hueso y micro-cirugía de hueso vascularizado. El presente estudio se llevó a cabo en el departamento de Anatomía, Colegio Médico Gubernamental de Amritsar. El estudio comprendió 100 tibias de humanos adultos obtenidas de 50 cadáveres masculinos y 50 femeninos. Todos los huesos del presente estudio presentaban el foramen nutricio situado en el tercio superior del eje y se dirigían hacia abajo. En la mayoría de los huesos, se encuentró lateral a la línea vertical en la superficie posterior de la diáfisis tibial. Las distancias medias de foramen nutricio de los extremos superior e inferior de la tibia eran mayores en los hombres en ambos lados. Además, estas mediciones mostraron valores más altos en los huesos de la mitad derecha. El conocimiento preciso de la ubicación de la forámenes nutricios en los huesos largos es útil en la prevención de las lesiones intra-operatorias en cirugía ortopédica, así como en cirugía plástica y reconstructiva y también es relevante en la práctica médico-legal. An understanding of the number and position of nutrient foramina in long bones is important in orthopedic procedures such as joint replacement therapy, fracture repair, bone grafts and vascularized bone microsurgery. The present study was conducted in the department of Anatomy, Govt. Medical College Amritsar. The study group comprised of 100 adult human tibiae obtained from 50 male and 50 female cadavers. All the bones of the present study depicted single nutrient foramen situated in the upper one third of the shaft and were directed downwards. In majority of the bones, it was located lateral to the vertical line on the posterior surface of tibial shaft. The mean distances of nutrient foramen from the upper and lower ends of tibia were found to be greater in males on both the sides. Also, these measurements showed higher values in the right sided bones.Precise knowledge of the location of the nutrient foramina in long bones is helpful in preventing intra-operative injuries in orthopedic as well as in plastic and reconstructive surgery and is also relevant in medicolegal practice.

Biomechanical Evaluation of Glenoid Reconstruction With an Implant-Free J-Bone Graft for Anterior Glenoid Bone Loss

2017 ◽  
Vol 45 (12) ◽  
pp. 2849-2857 ◽  
Author(s):  
Leo Pauzenberger ◽  
Felix Dyrna ◽  
Elifho Obopilwe ◽  
Philipp R. Heuberer ◽  
Robert A. Arciero ◽  
...  
Keyword(s):  
Bone Graft ◽  
Bone Grafting ◽  
Humeral Head ◽  
External Rotation ◽  
Glenoid Defect ◽  
Contact Patterns ◽  
Grafting Technique ◽  
The Mean ◽  
The Creation ◽  
Glenoid Reconstruction

Background: The anatomic restoration of glenoid morphology with an implant-free J-shaped iliac crest bone graft offers an alternative to currently widely used glenoid reconstruction techniques. No biomechanical data on the J-bone grafting technique are currently available. Purpose: To evaluate (1) glenohumeral contact patterns, (2) graft fixation under cyclic loading, and (3) the initial stabilizing effect of anatomic glenoid reconstruction with the implant-free J-bone grafting technique. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric shoulders and J-shaped iliac crest bone grafts were used for this study. J-bone grafts were harvested, prepared, and implanted according to a previously described, clinically used technique. Glenohumeral contact patterns were measured using dynamic pressure-sensitive sensors under a compressive load of 440 N with the humerus in (a) 30° of abduction, (b) 30° of abduction and 60° of external rotation, (c) 60° of abduction, and (d) 60° of abduction and 60° of external rotation. Using a custom shoulder-testing system allowing positioning with 6 degrees of freedom, a compressive load of 50 N was applied, and the peak force needed to translate the humeral head 10 mm anteriorly at a rate of 2.0 mm/s was recorded. All tests were performed (1) for the intact glenoid, (2) after the creation of a 30% anterior osseous glenoid defect parallel to the longitudinal axis of the glenoid, and (3) after anatomic glenoid reconstruction with an implant-free J-bone graft. Furthermore, after glenoid reconstruction, each specimen was translated anteriorly for 5 mm at a rate of 4.0 mm/s for a total of 3000 cycles while logging graft protrusion and mediolateral bending motions. Graft micromovements were recorded using 2 high-resolution, linear differential variable reluctance transducer strain gauges placed in line with the long leg of the graft and the mediolateral direction, respectively. Results: The creation of a 30% glenoid defect significantly decreased glenohumeral contact areas ( P < .05) but significantly increased contact pressures at all abduction and rotation positions ( P < .05). Glenoid reconstruction restored the contact area and contact pressure back to levels of the native glenohumeral joint in all tested positions. The mean (±SD) force to translate the humeral head anteriorly for 10 mm (60° of abduction: 31.7 ± 12.6 N; 60° of abduction and 60° of external rotation: 28.6 ± 7.6 N) was significantly reduced after the creation of a 30% anterior bone glenoid defect (60° of abduction: 12.2 ± 6.8 N; 60° of abduction and 60° of external rotation: 11.4 ± 5.4 N; P < .001). After glenoid reconstruction with a J-bone graft, the mean peak translational force significantly increased (60° of abduction: 85.0 ± 8.2 N; 60° of abduction and 60° of external rotation: 73.6 ± 4.5 N; P < .001) compared with the defect state and baseline. The mean total graft protrusion under cyclical translation of the humeral head over 3000 cycles was 138.3 ± 169.8 µm, whereas the mean maximal mediolateral graft deflection was 320.1 ± 475.7 µm. Conclusion: Implant-free anatomic glenoid reconstruction with the J-bone grafting technique restored near-native glenohumeral contact areas and pressures, provided secure initial graft fixation, and demonstrated excellent osseous glenohumeral stability at time zero. Clinical Relevance: The implant-free J-bone graft is a viable alternative to commonly used glenoid reconstruction techniques, providing excellent graft fixation and glenohumeral stability immediately postoperatively. The normalization of glenohumeral contact patterns after reconstruction could potentially avoid the progression of dislocation arthropathy.

scholarly journals Optimization of the balance between effort and yield in unilateral surgical transfer of mouse embryos

2017 ◽  
Vol 51 (6) ◽  
pp. 622-628 ◽  
Author(s):  
Pablo González-Jara ◽  
Tomás Fontela ◽  
Esther López-Mimbela ◽  
Marta Cereceda ◽  
Daniel Del Olmo ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Mouse Embryos ◽  
Mouse Strains ◽  
Optimization Approach ◽  
Use Of Resources ◽  
Heterogeneous Nature ◽  
Laboratory Manuals ◽  
The Mean ◽  
Transfer Procedures

Surgical transfer of embryos is carried out daily in animal facilities worldwide for the rederivation of mouse strains/lines, among other purposes. Current protocols described in laboratory manuals recommend using a high number of embryos during transfer, typically in the range of 15 up to 25. To optimize the use of resources it is necessary to estimate and relate the effort required and the yield obtained. Here, we analyse the balance between the number of embryos transferred (the effort), and the yield as the number of born pups obtained from surgical embryo transfer. To accomplish this, we have analyzed data obtained during rederivation of nearly one hundred lines of mice to a new animal facility. Our results confirm that the use of increasing numbers of embryos per transfer increases the yields of born pups, as has been described previously in the literature, but they also highlight the disproportionate effort required, i.e. in the number of embryos that needed to be transferred. An estimate of the mean expected yields of surgical transfers and their comparison with the actual observed yields indicated that the balance between effort and yield is optimized when using lower numbers of embryos than in currently used protocols, in the range of 8 to 12. Given the heterogeneous nature of the data presented and analyzed here, which is from a population of mice that may be considered as representative of any animal facility, our optimization approach should help save resources in similar facilities and improve the yields of embryo transfer procedures.

scholarly journals THE ASSAY OF HYPERTENSIN FROM THE ARTERIAL BLOOD OF NORMOTENSIVE AND HYPERTENSIVE HUMAN BEINGS

1952 ◽  
Vol 95 (6) ◽  
pp. 523-529 ◽  
Author(s):  
Joseph R. Kahn ◽  
Leonard T. Skeggs ◽  
Norman P. Shumway ◽  
Paul E. Wisenbaugh
Keyword(s):  
Blood Pressure ◽  
Essential Hypertension ◽  
Normal Blood ◽  
Moderate Degree ◽  
Human Beings ◽  
Normal Blood Pressure ◽  
Arterial Blood ◽  
The Mean ◽  
Mean Concentration ◽  
Benign Group

Hypertensin has been assayed in the blood of patients with normal blood pressure and in those with essential hypertension in both the benign and malignant phases. 250 ml. samples of arterial blood were obtained, chemically purified, and concentrated to a volume of 1 ml. These extracts were then assayed in anesthetized rats. The concentrations of hypertensin in the blood of patients with the malignant phase of essential hypertension were found to be greatly increased. The concentrations of hypertensin found in patients with benign hypertension had a moderate degree of overlapping with those found in the normotensive group, but the mean concentration of hypertensin in the former group was twice that of the controls. Although these results are statistically significant, the amounts of hypertensin recovered in the benign group are so small that no conclusions can be drawn as to its effectiveness in producing vasoconstriction in these patients.

scholarly journals Cost of coils for intracranial aneurysms: clinical decision analysis for implementation of a capitation model

2018 ◽  
Vol 128 (6) ◽  
pp. 1792-1798 ◽  
Author(s):  
Gurpreet S. Gandhoke ◽  
Yash K. Pandya ◽  
Ashutosh P. Jadhav ◽  
Tudor Jovin ◽  
Robert M. Friedlander ◽  
...  
Keyword(s):  
Sensitivity Analysis ◽  
Probabilistic Sensitivity Analysis ◽  
Cost Savings ◽  
Clinical Decision ◽  
Sensitivity Analyses ◽  
List Price ◽  
Maximum Dimension ◽  
Total Length ◽  
The Mean ◽  
Mean Cost

OBJECTIVEThe price of coils used for intracranial aneurysm embolization has continued to rise despite an increase in competition in the marketplace. Coils on the US market range in list price from $500 to $3000. The purpose of this study was to investigate potential cost savings with the use of a price capitation model.METHODSThe authors built a clinical decision analytical tree and compared their institution’s current expenditure on endovascular coils to the costs if a capped-price model were implemented. They retrospectively reviewed coil and cost data for 148 patients who underwent coil embolization from January 2015 through September 2016. Data on the length and number of coils used in all patients were collected and analyzed. The probabilities of a treated aneurysm being ≤/> 10 mm in maximum dimension, the total number of coils used for a case being ≤/> 5, and the total length of coils used for a case being ≤/> 50 cm were calculated, as was the mean cost of the currently used coils for all possible combinations of events with these probabilities. Using the same probabilities, the authors calculated the expected value of the capped-price strategy in comparison with the current one. They also conducted multiple 1-way sensitivity analyses by applying plausible ranges to the probabilities and cost variables. The robustness of the results was confirmed by applying individual distributions to all studied variables and conducting probabilistic sensitivity analysis.RESULTSNinety-five (64%) of 148 patients presented with a rupture, and 53 (36%) were treated on an elective basis. The mean aneurysm size was 6.7 mm. A total of 1061 coils were used from a total of 4 different providers. Companies A (72%) and B (16%) accounted for the major share of coil consumption. The mean number of coils per case was 7.3. The mean cost per case (for all coils) was $10,434. The median total length of coils used, for all coils, was 42 cm. The calculated probability of treating an aneurysm less than 10 mm in maximum dimension was 0.83, for using 5 coils or fewer per case it was 0.42, and for coil length of 50 cm or less it was 0.89. The expected cost per case with the capped policy was calculated to be $4000, a cost savings of $6564 in comparison with using the price of Company A. Multiple 1-way sensitivity analyses revealed that the capped policy was cost saving if its cost was less than $10,500. In probabilistic sensitivity analyses, the lowest cost difference between current and capped policies was $2750.CONCLUSIONSIn comparison with the cost of coils from the authors’ current provider, their decision model and probabilistic sensitivity analysis predicted a minimum $407,000 to a maximum $1,799,976 cost savings in 148 cases by adapting the capped-price policy for coils.

scholarly journals An evaluation of the efficacy of the locked plate with bone grafting in Sanders type III and IV intra-articular calcaneus fractures

2021 ◽  
Vol 9 ◽  
pp. 205031212110409
Author(s):  
Ali Varol ◽  
Yunus Oc ◽  
Bekir Eray Kilinc
Keyword(s):  
Bone Grafting ◽  
Plate Osteosynthesis ◽  
Locking Plates ◽  
Foot And Ankle ◽  
Calcaneal Fractures ◽  
Type Iii ◽  
Heel Height ◽  
The Mean ◽  
American Orthopaedic

Objective: To demonstrate the efficacy of locking plate osteosynthesis performed by an L-shaped lateral approach in patients with Sanders type III and IV intra-articular calcaneal fractures with posterior facet displacement. Methods: Fifty-three patients with Sanders type III or IV unilateral calcaneal fractures treated with locking plates and additional bone grafting were included in the study. Böhler and Gissane angles, and heel height values were measured on the radiological examinations. Clinical results of the patients were evaluated using the American Orthopaedic Foot and Ankle Society and Maryland evaluation criteria. The presence of arthrosis was investigated with Broden’s view. Preoperative and postoperative values were evaluated. Results: The mean Gissane angle was 119.32°, the mean Böhler angle was 9.47° and the mean heel height was 40.82 mm on radiographs at initial presentation of the patients. The mean Gissane angle was 114.63°, the mean Böhler angle was 23.33° and the mean heel height was 47.84 mm on the early postoperative radiographs of the patients. In patients, a mean 4.69° recovery was achieved in the Gissane angle, 13.86° in Böhler angle and 7.02 mm in heel height. On the most recent follow-up, Böhler angle was 21.49°, Gissane was 114.88° and the mean heel height was 46.95 mm. The mean American Orthopaedic Foot and Ankle Society score and Maryland score were 86.91 and 86.53, respectively, on the last follow-up. Conclusion: Internal fixation and grephonage using low-profile locking plates provides good functional results to patients since it facilitates anatomic restoration of the subtalar joint and correction of calcaneal height, width and varus/valgus heel.

scholarly journals Locking compression plate in humeral shaft nonunion: a retrospective study of 18 cases

2016 ◽  
Vol 2 (3) ◽  
pp. 86
Author(s):  
Rajesh Govindasamy ◽  
Ramkumar Gnanasundaram ◽  
Saravanan Kasirajan ◽  
Fawas Thonikadavath ◽  
Jeff Walter Rajadurai
Keyword(s):  
Bone Grafting ◽  
Locking Compression Plate ◽  
Humeral Shaft ◽  
Radial Nerve Palsy ◽  
Functional Evaluation ◽  
Postoperative Function ◽  
Non Union ◽  
Humeral Shaft Nonunion ◽  
Compression Plate ◽  
The Mean

<p class="abstract"><strong>Background:</strong> Humeral shaft nonunions are frequently seen in Orthopaedic practice. Osteosynthesis with bone grafting is the treatment of choice. Locking compression plate (LCP) is the latest implant used in treating them. We retrospectively evaluated the outcome of use of LCP in humeral shaft non-union resulted by both conservative management and following failed internal fixations.</p><p class="abstract"><strong>Methods:</strong> Eighteen patients with nonunion of humeral shaft in which ten were treated by traditional bone setters and eight followed by failed internal fixation were included in these study. The mean duration of nonunion was 18.3 months (range 8-22).  The mean follow up period was 18 months (range 12-26). The mean age of patients was 44.4 years (range 22-60). All patients underwent osteosynthesis with LCP and autologoous cortico-cancellous iliac crest graft. The outcome measures include radiographic assessment of fracture union and preoperative and postoperative function using modified constant and murley scoring system.<strong></strong></p><p class="abstract"><strong>Results:</strong> All fractures united following osteosyntesis average time for union was15 weeks (range 10-24). We did not have any delayed union or non-union. The complications were superficial infection (n=1) and wound haematoma (n=1).Three patients with preoperative radial nerve palsy recovered at the end of four months. Functional evaluation using constant-murley score showed excellent result in 14, good in 3 and fair in 1. We did not have any poor results.</p><strong>Conclusions:</strong> LCP with cancellous bone grafting is a safe reliable option for all forms of humeral shaft nonunion. We recommend it.

scholarly journals Early development and allometric growth in Nannacara anomala Regan, 1905 (Perciformes: Cichlidae) under laboratory conditions

2014 ◽  
Vol 12 (3) ◽  
pp. 659-665 ◽  
Author(s):  
Krzysztof Kupren ◽  
Maja Prusińska ◽  
Daniel Żarski ◽  
Sławomir Krejszeff ◽  
Dariusz Kucharczyk
Keyword(s):  
Early Development ◽  
Morphological Development ◽  
Allometric Growth ◽  
Laboratory Conditions ◽  
Total Length ◽  
Larvae And Juveniles ◽  
The Mean ◽  
Accelerated Growth

Morphological development and allometric growth of laboratory reared Nannacara anomala were studied from hatching to the loss of larval characters and beginning of squamation (18 days post-hatching) at 26°C. The mean total length (TL) of larvae and juveniles increased from 3.74 mm at hatching to 9.60 mm at metamorphosis. Morphogenesis and differentiation were most intense during the first week of development. During this period (TL interval = 3.74 - 4.84 mm) there was an evident priority to enhance the feeding and swimming capabilities by promoting accelerated growth in the head and tail regions. Following this period, there was a major decrease in growth coefficients, indicating a change in growth priorities. Observations on the early development of Nannacara anomala confirmed the basic uniformity development of a substrate brooding cichlid.

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