Comparisons of physical exposure between workers harvesting apples on mobile orchard platforms and ladders, part 2: Repetitive upper arm motions.

Farmworkers are exposed to physical risk factors including repetitive motions. Existing ergonomic assessment methods are primarily laboratory-based and, thus, inappropriate for use in the field. This study presents an approach to characterize the repetitive motions of the upper arms based on direct measurement using accelerometers. Repetition rates were derived from upper arm inclination data and with video recordings in the field. This method was used to investigate whether harvesting with mobile platforms (teams harvesting apples from the platform and the ground) increased the farmworkers' exposure to upper arm repetitive motions compared to traditional harvesting using ladders. The ladder workers had higher repetitive motions (13.7 cycles per minute) compared to the platform and ground workers (11.7 and 12.2 cycles per minutes). The higher repetitions in the ladder workers were likely due to their ability to work independently and the additional arm movements associated with ladder climbing and walking.

Comparisons of physical exposure between workers harvesting apples on mobile orchard platforms and ladders, part 1: Back and upper arm postures.

This study compared farmworkers' exposure to non-neutral postures using a new mobile platform apple harvesting method and the traditional method using ladders. Twenty-four workers were recruited and assigned into three groups: ladder workers (n = 8) picking apples from full trees using a ladder, mobile platform workers (n = 8) picking apples from upper part of the trees while standing on a moving platform, and ground-based mobile platform workers (n = 8) picking apples from lower part of the trees which the mobile platform workers left out. Upper arm and back inclinations were continuously monitored during harvesting using tri-axial accelerometers over full work shifts (~8 h). Upper arm posture was characterized as the percentage of time that upper arm flexion and abduction exceeded 30°, 60°, and 90°. Back posture was characterized as the percentage of time that torso angles (sagittal flexion or lateral bending) exceeded 10°, 20°, and 30°. The 10th, 50th, and 90th postural percentiles were also calculated. The platform workers had lower exposures to upper arm flexion and abduction than the ground and ladder workers. There were no differences in torso angles between the ladder and mobile platform workers; however, the ground workers were exposed to more and greater percentages of time in torso flexions.

Accuracy and Precision of a Surgical Navigation System: Effect of Camera and Patient Tracker Position and Number of Active Markers.

INTRODUCTION: Surgical navigation systems are increasingly used to aid resection and reconstruction of osseous malignancies. In the process of implementing image-based surgical navigation systems, there are numerous opportunities for error that may impact surgical outcome. This study aimed to examine modifiable sources of error in an idealized scenario, when using a bidirectional infrared surgical navigation system. MATERIALS AND METHODS: Accuracy and precision were assessed using a computerized-numerical-controlled (CNC) machined grid with known distances between indentations while varying: 1) the distance from the grid to the navigation camera (range 150 to 247cm), 2) the distance from the grid to the patient tracker device (range 20 to 40cm), and 3) whether the minimum or maximum number of bidirectional infrared markers were actively functioning. For each scenario, distances between grid points were measured at 10-mm increments between 10 and 120mm, with twelve measurements made at each distance. The accuracy outcome was the root mean square (RMS) error between the navigation system distance and the actual grid distance. To assess precision, four indentations were recorded six times for each scenario while also varying the angle of the navigation system pointer. The outcome for precision testing was the standard deviation of the distance between each measured point to the mean three-dimensional coordinate of the six points for each cluster. RESULTS: Univariate and multiple linear regression revealed that as the distance from the navigation camera to the grid increased, the RMS error increased (p<0.001). The RMS error also increased when not all infrared markers were actively tracking (p=0.03), and as the measured distance increased (p<0.001). In a multivariate model, these factors accounted for 58% of the overall variance in the RMS error. Standard deviations in repeated measures also increased when not all infrared markers were active (p<0.001), and as the distance between navigation camera and physical space increased (p=0.005). Location of the patient tracker did not affect accuracy (0.36) or precision (p=0.97). CONCLUSION: In our model laboratory test environment, the infrared bidirectional navigation system was more accurate and precise when the distance from the navigation camera to the physical (working) space was minimized and all bidirectional markers were active. These findings may require alterations in operating room setup and software changes to improve the performance of this system.

Performance of Alpine Touring Boots When Used in Alpine Ski Bindings.

Alpine touring (AT) equipment is designed for ascending mountains and snow skiing down backcountry terrain. Skiers have been observed using AT boots in alpine (not made for Alpine Touring) ski bindings. We tested the effect on the retention-release characteristics of AT boots used in alpine bindings. Ten AT ski boots and 5 alpine ski boots were tested in 8 models of alpine ski bindings using an ASTM F504-05 (2012) apparatus. Thirty-one percent of the AT boots released appropriately when used in alpine ski bindings. One alpine binding released appropriately for all alpine and AT boots tested; 2 alpine ski bindings did not release appropriately for any AT boots. Altering the visual indicator settings on the bindings (that control the release torque of an alpine system) had little or no effect on the release torque when using AT boots in alpine ski bindings. Many combinations released appropriately in ski shop tests, but did not release appropriately in the more complex loading cases that simulated forward and backward falls; the simple tests performed by ski shops could produce a "false-negative" test result. These results indicate that using AT boots with alpine ski bindings could increase the likelihood of lower leg injuries.

Head Impact Exposure During a Weekend Youth Soccer Tournament.

Concussion is a known risk in youth soccer, but little is known about subconcussive head impacts. The authors provided a prospective cohort study measuring frequency and magnitude of subconcussive head impacts using accelerometry in a middle school-age soccer tournament, and association between head impacts and changes in (1) symptoms, (2) cognitive testing, and (3) advanced neuroimaging. A total of 17 youth completed the study (41% female, mean 12.6 years). There were 73 head impacts >15g measured (45% headers) and only 2 had a maximum peak linear acceleration >50g No youth reported symptoms consistent with concussion. After correction for multiple comparisons and a sensitivity analysis excluding clear outliers, no significant associations were found between head impact exposure and neuropsychological testing or advanced neuroimaging. The authors conclude that head impacts were relatively uncommon and low in acceleration in youth playing a weekend soccer tournament. This study adds to the limited data regarding head impacts in youth soccer.

Articular congruency of the Salto Talaris total ankle prosthesis.

BACKGROUND: The Salto-Talaris polyethylene articulating surface was designed to allow, but limit accessory motion. This investigation examines surface characteristics between the polyethylene bearing and anatomic talar component in various positions of function. METHODS: A Salto Talaris talar prosthesis and matching polyethylene bearing were scanned to create digital solid body models and manipulated to assess surface contact during simulated gait. With computer micromanipulation of the component positions, the surface intersections were recorded for 15 different alignments. RESULTS: The Salto Talaris has limited contact congruity with four points of contact in dorsiflexion, neutral, and plantarflexion. Lateral and medial translations showed only 2-point contact. The radii of curvatures between the talar component and polyethylene surfaces do not match. There was no sulcus contact yet component separation distance was small, suggesting increased loads. CONCLUSION: Surface incongruency was measured based on computer model analysis which raises a concern of increased contact pressures.

Effect of simulated early weight bearing on micromotion and pullout strength of uncemented distal femoral stems.

The effect of simulated early weight bearing on both micromotion and pullout strength of uncemented distal femoral stems was evaluated in this study. The effect of stem endosteal contact and bone quality on implant pullout strength was also analyzed. A randomized matched-pair study was performed using 8 bilateral pairs of fresh human cadaveric femoral specimens. Each specimen pair was dual-energy x-ray absorptiometry scanned, uniformly implanted, fluoroscopically imaged, and randomly assigned to the cycled or uncycled group. The cycled group received 5000 cycles of axial compressive loading (to 700 N) and the contralateral side was not cycled. Micromotion was monitored during cycling and compared with a failure threshold (150 µm), and all implants underwent direct axial distraction (pullout) testing. During cycling, minimal micromotion was observed with an asymptotic decrease in differential motion between the first and last 50 cycles. Both cycled and uncycled groups demonstrated no statistical difference in average pullout force (4888±2124 N vs 4367±1154 N; P=.43). The percentage of cortical contact for each implant was determined from panoramic fluoroscopy images using digital image analysis software. Contact area for the distal third of the stem showed the highest correlation with pullout force and with predicting pullout force. Bone quality did not correlate with pullout force (r(2)=0.367) or stem contact area (r(2)=0.394). In sum, press-fit uncemented femoral stems did not loosen or demonstrate decreased pullout strength with early weight bearing simulated by cyclical axial compressive loading.

Biomechanical evaluation of metacarpal fracture fixation: application of a 90° internal fixation model.

PURPOSE: Complications in metacarpal fracture treatment increase in proportion to the severity of the initial injury and the invasiveness of the surgical fixation technique. This manuscript evaluates the feasibility of minimizing internal fixation construct size and soft tissue dissection, while preserving the advantages of stable internal fixation in a biomechanical model. We hypothesized that comparable construct stability could be achieved with mini-plates in an orthogonal (90/90) configuration compared with a standard dorsal plating technique. METHODS: This hypothesis was evaluated in a transverse metacarpal fracture model. Twelve metacarpals were subject to either placement of a 2.0-mm six-hole dorsal plate or two 1.5-mm four-hole mini-plates in a 90/90 configuration. These constructs were tested to failure in a three-point bending apparatus, attaining failure force, displacement, and stiffness. RESULTS: Mean failure force was 353.5 ± 121.1 N for the dorsal plating construct and 358.8 ± 77.1 N for the orthogonal construct. Mean failure displacement was 3.3 ± 1.2 mm for the dorsal plating construct and 4.1 ± 0.9 mm for the orthogonal construct. Mean stiffness was 161.3 ± 50.0 N/mm for the dorsal plating construct and 122.1 ± 46.6 N/mm for the orthogonal construct. Mean failure moment was 3.09 ± 1.06 Nm for the dorsal plating construct and 3.14 ± 0.67 Nm for the orthogonal construct. The dorsal plating group failed via screw pullout, whereas the orthogonal failed either by screw pullout or breakage of the plate. CONCLUSIONS: When subject to apex dorsal bending, the orthogonal construct and the standard dorsal plate construct behaved comparably. These data suggest that despite its shorter length, lower profile, and less substantial screws, the orthogonal construct provides sufficient rigidity. CLINICAL RELEVANCE: This study represents a "proof of concept" regarding the applicability of orthogonal plating in the metacarpal and provides the foundation for minimizing construct size and profile.

Whole-body Vibration Exposure Intervention among Professional Bus and Truck Drivers: A Laboratory Evaluation of Seat-suspension Designs.

Long-term exposure to seated whole-body vibration (WBV) is one of the leading risk factors for the development of low back disorders. Professional bus and truck drivers are regularly exposed to continuous WBV, since they spend the majority of their working hours driving heavy vehicles. This study measured WBV exposures among professional bus and truck drivers and evaluated the effects of seat-suspension designs using simulated field-collected data on a vibration table. WBV exposures were measured and compared across three different seat designs: an air-ride bus seat, an air-ride truck seat, and an electromagnetically active (EM-active) seat. Air-ride seats use a compressed-air bladder to attenuate vibrations, and they have been in operation throughout the transportation industry for many years. The EM-active seat is a relatively new design that incorporates a microprocessor-controlled actuator to dampen vibration. The vibration table simulated seven WBV exposure scenarios: four segments of vertical vibration and three scenarios that used field-collected driving data on different road surfaces-a city street, a freeway, and a section of rough roadway. The field scenarios used tri-axial WBV data that had been collected at the seat pan and at the driver's sternum, in accordance with ISO 2631-1 and 2631-5. This study found that WBV was significantly greater in the vertical direction (z-axis) than in the lateral directions (x-and y-axes) for each of the three road types and each of the three types of seats. Quantitative comparisons of the results showed that the floor-to-seat-pan transmissibility was significantly lower for the EM-active seat than for either the air-ride bus seat or the air-ride truck seat, across all three road types. This study also demonstrated that seat-suspension designs have a significant effect on the vibrations transmitted to vehicle operators, and the study's results may prove useful in designing future seat suspensions.

Assessment of registration accuracy during computer-aided oncologic limb-salvage surgery.

PURPOSE: Computer-aided surgery is used in musculoskeletal tumor procedures to improve the surgeon's orientation to local anatomy during tumor resection. For the navigation system to function correctly, preoperative imaging (e.g., CT, MR) must be registered to the patient in the operating room. The goals of this study were (1) to directly quantify registration accuracy in computer-aided tumor surgery and (2) to validate the "system reported error" (SRE) of the navigation system. METHODS: Registration accuracy was evaluated in eight bone sarcoma cases by determining the location of the anatomical paired-points used for registration following surface matching. Coordinates of specific intraoperative post-registration points were compared with the corresponding coordinates in preoperative CT scans to determine the measurement error (ME). RESULTS: The mean difference between post-registration points and planned registration points was 12.21±6.52 mm significantly higher than the mean SRE (0.68 ± 0.15 mm; p = 0.002; 95 % CI 6.11-16.96 mm). The SRE poorly correlated with the calculated ME (R(2) = 0.040). Anatomical paired-point registration with surface matching results in a substantial shift in the post-registration coordinates of the same paired-points used for registration, and this shift is not represented by the SRE. CONCLUSION: The SRE of a surgical navigation system was poorly correlated with direct measurements obtained in musculoskeletal tumor surgery. Improvement in registration accuracy is needed to better navigate tumor boundaries and ensure clear margins while maximally preserving the unaffected tissues and reducing operative morbidity.

The effect of hardhats on head and neck response to vertical impacts from large construction objects.

We evaluated the effectiveness of hardhats in attenuating head acceleration and neck force in vertical impacts from large construction objects. Two weight-matched objects (lead shot bag and concrete block) weighing 9.1 kg were dropped from three heights (0.91 m, 1.83 m and 2.74 m) onto the head of a 50th percentile male Hybrid III anthropomorphic test device (ATD). Two headgear conditions were tested: no head protection and an ANSI Type-I, Class-E hardhat. A third headgear condition (snow sport helmet) was tested at 1.83 m for comparison with the hardhat. Hardhats significantly reduced the resultant linear acceleration for the concrete block impacts by 70-95% when compared to the unprotected head condition. Upper neck compression was also significantly reduced by 26-60% with the use of a hardhat when compared to the unprotected head condition for the 0.91 and 1.83 m drop heights for both lead shot and concrete block drop objects. In this study we found that hardhats can be effective in reducing both head accelerations and compressive neck forces for large construction objects in vertical impacts.

Enhancing pedicle screw fixation in the lumbar spine using allograft bone plug interference fixation.

STUDY DESIGN: A within-subjects controlled laboratory study. OBJECTIVE: To examine a biological alternative to cement augmentation for pedicle screw fixation comparing bilateral axial pullout tests of augmented and nonaugmented (controls) pedicle screws. SUMMARY OF BACKGROUND DATA: Fixation in the osteoporotic spine remains a difficult challenge with failure by loosening or backout. Pedicle screw augmentation has been attempted using polymethylmethacrylate and bioabsorbable calcium cements; however, the potential for extravasation and embolization of cement are becoming increasingly concerning and merit the search for alternative methods to improve screw-anchoring strength. METHODS: Twenty-four (24) fresh human lumbar vertebrae were tested to compare the pullout strength of augmented and nonaugmented pedicle screws. Two different augmentation strategies were employed using allograft bone plugs (ABPs) and evaluated using 12 specimens per group. Bone mineral density of each specimen was obtained using dual-energy x-ray absorptiometry. The augmented versus nonaugmented pedicle was randomized for each vertebra, and bilateral testing enabled paired statistical analyses. Axial pullout tests were performed using an materials testing system servohydraulic test system, and peak force, failure displacement, and stiffness was obtained for each test and correlated with bone mineral density. RESULTS: Augmentation using 6-mm-diameter ABPs with 6.25-mm-diameter pedicle screws resulted in statistically weaker average pullout strength (775±455 N) than the nonaugmented controls (1233±826 N). When using smaller (5 mm diameter) AGPs with the same diameter screws, there was no statistical difference between average pullout strength for the augmented pedicle screws (1772±652 N) and the nonaugmented screws (1780±575 N). CONCLUSIONS: Preliminary study of pedicle screw augmentation using cannulated ABPs showed no improvement of fixation with pedicles in the spine. This was even true in osteoporotic specimens, where augmentation would seem to be of considerable benefit.

Burst fractures of the lumbar spine in frontal crashes.

BACKGROUND: In the United States, major compression and burst type fractures (>20% height loss) of the lumbar spine occur as a result of motor vehicle crashes, despite the improvements in restraint technologies. Lumbar burst fractures typically require an axial compressive load and have been known to occur during a non-horizontal crash event that involve high vertical components of loading. Recently these fracture patterns have also been observed in pure horizontal frontal crashes. This study sought to examine the contributing factors that would induce an axial compressive force to the lumbar spine in frontal motor vehicle crashes. METHODS: We searched the National Automotive Sampling System (NASS, 1993-2011) and Crash Injury Research and Engineering Network (CIREN, 1996-2012) databases to identify all patients with major compression lumbar spine (MCLS) fractures and then specifically examined those involved in frontal crashes. National trends were assessed based on weighted NASS estimates. Using a case-control study design, NASS and CIREN cases were utilized and a conditional logistic regression was performed to assess driver and vehicle characteristics. CIREN case studies and biomechanical data were used to illustrate the kinematics and define the mechanism of injury. RESULTS: During the study period 132 NASS cases involved major compression lumbar spine fractures for all crash directions. Nationally weighted, this accounted for 800 cases annually with 44% of these in horizontal frontal crashes. The proportion of frontal crashes resulting in MCLS fractures was 2.5 times greater in late model vehicles (since 2000) as compared to 1990s models. Belted occupants in frontal crashes had a 5 times greater odds of a MCLS fracture than those not belted, and an increase in age also greatly increased the odds. In CIREN, 19 cases were isolated as horizontal frontal crashes and 12 of these involved a major compression lumbar burst fracture primarily at L1. All were belted and almost all occurred in late model vehicles with belt pretensioners and buckets seats. CONCLUSION: Major compression burst fractures of the lumbar spine in frontal crashes were induced via a dynamic axial force transmitted to the pelvis/buttocks into the seat cushion/pan involving belted occupants in late model vehicles with increasing age as a significant factor.

Developmental biomechanics of the human cervical spine.

Head and neck injuries, the leading cause of death for children in the U.S., are difficult to diagnose, treat, and prevent because of a critical void in our understanding of the biomechanical response of the immature cervical spine. The objective of this study was to investigate the functional and failure biomechanics of the cervical spine across multiple axes of loading throughout maturation. A correlational study design was used to examine the relationships governing spinal maturation and biomechanical flexibility curves and tolerance data using a cadaver human in vitro model. Eleven human cadaver cervical spines from across the developmental spectrum (2-28 years) were dissected into segments (C1-C2, C3-C5, and C6-C7) for biomechanical testing. Non-destructive flexibility tests were performed in tension, compression, flexion, extension, lateral bending, and axial rotation. After measuring their intact biomechanical responses, each segment group was failed in different modes to measure the tissue tolerance in tension (C1-C2), compression (C3-C5), and extension (C5-C6). Classical injury patterns were observed in all of the specimens tested. Both the functional (p<0.014) and failure (p<0.0001) mechanics exhibited significant relationships with age. Nonlinear flexibility curves described the functional response of the cervical spine throughout maturation and elucidated age, spinal level, and mode of loading specificity. These data support our understanding of the child cervical spine from a developmental perspective and facilitate the generation of injury prevention or management schema for the mitigation of child spine injuries and their deleterious effects.

Coupling between the spinal cord and cervical vertebral column under tensile loading.

Current neck injury criteria are based on structural failure of the spinal (vertebral) column without consideration of injury to the spinal cord. Since one of the primary functions of the vertebral column is to protect the cord, it stands to reason that a more refined measure of neck injury threshold would be the onset of spinal cord injury (SCI). This study investigated the relationship between axial strains in the cervical vertebral column and the spinal cord using an in vitro primate model (n=10) under continuous tensile loading. Mean failure loads occurred at 1951.5±396N with failure strains in the vertebral column of 16±5% at the level of failure. Average tensile strains in the spinal cord at failure were 11±5% resulting in a mean coupling ratio of 0.54±0.17 between C1 and C7. The level of peak strain measured in the spinal cord did not always occur at the location of vertebral column failure. Spinal cord strains were less than spine strains and coupling ratios were not significantly different along the length of the spine. The largest coupling ratio was measured in the atlanto-occipital joint whereas the smallest coupling ratio occurred at the adjacent C1-C2 joint.

Developmental biomechanics of neck musculature.

Neck mechanics is central to head injury prevention since it is the musculoskeletal neck, which dictates the position and movement of the head. In the US, traumatic injury is the leading cause of death for children; however prevention is hampered by the lack of data concerning the mechanics of the immature head-and-neck. Thus, the objective of this study was to quantify neck muscle strength and endurance across the maturation spectrum and correlate these with head-and-neck anthropometry. A factorial study was performed on 91 human subjects measuring head-and-neck anthropometry and neck strength and endurance in three bending directions (flexion, extension, and lateral) as a function of age (6-23 years). Using a custom device, neck maximum voluntary contraction (MVC) force was measured in triplicate. Next, neck muscle endurance (sustained effort) was measured as the subjects' ability to maintain 70% of peak force over 30s. Linear regression of peak force and endurance as a function of age revealed each direction to significantly (p<0.0001) increase with age. The MVC force, averaged across all directions and normalized to the adult values, exhibits the following maturation curve: %MVC Force=-0.0879(age)(2)+6.018(age)+8.120. Neck muscle strength, similar between young males and females, becomes disparate in adolescence and adulthood with males exhibiting greater strength. Bending direction differences were also found with extension strength being the greatest regardless of age and sex. Furthermore, neck circumference appears predictive of neck strength and endurance in children. Together, these relationships may facilitate improved design of injury prevention interventions.

A comparison of the shock-absorbing properties of cervical disc prosthesis bearing materials.

BACKGROUND DATA: Cervical arthroplasty offers theoretical advantages over traditional spinal fusion, including elimination of adjacent segment disease and elimination of the risk of pseudoarthrosis formation. Initial studies of cervical arthroplasty have shown promising results, however, the ideal design characteristics for disc replacement constructs have not been determined. The current study seeks to quantify the differences in the shock absorption characteristics of three commonly used materials in cervical disc arthroplasty. METHODS: Three different nucleus materials, polyurethane (PU), polyethylene (PE) and a titanium-alloy (Ti) were tested in a humidity- and temperature-controlled chamber. Ten of each nucleus type underwent three separate mechanical testing protocols to measure 1) dynamic stiffness, 2) quasi-static stiffness, 3) energy absorption, and 4) energy dissipation. The results were compared using analysis of variance. RESULTS: PU had the lowest mean dynamic stiffness (435 ± 13 N/mm, P < .0001) and highest energy absorption (19.4 ± 0.1 N/mm, P < .0001) of all three nucleus materials tested. PU was found to have significantly higher energy dissipation (viscous damping ratio 0.017 ± 0,001, P < .0001) than the PE or TI nuclei. PU had the lowest quasi-static stiffness (598 ± 23 N/mm, P < .0001) of the nucleus materials tested. A biphasic response curve was observed for all of the PU nuclei tests. CONCLUSIONS: Polyurethane absorbs and dissipates more energy and is less stiff than either polyethylene or titanium. LEVEL OF EVIDENCE: Basic Science/Biomechanical Study. CLINICAL RELEVANCE: This study characterizes important differences in biomechanical properties of materials that are currently being used for different cervical disc prostheses.

The effect of bilateral laminotomy versus laminectomy on the motion and stiffness of the human lumbar spine: a biomechanical comparison.

STUDY DESIGN: A cadaveric simulation model of the lumbar spine was used to study the intervertebral motion characteristics of the lumbar spine after bilateral laminotomy and facet-sparing laminectomy. OBJECTIVE: To assess differences in motion patterns and lumbar spine stiffness after bilateral laminotomy versus laminectomy. SUMMARY OF BACKGROUND DATA: Spondylolisthesis after facet-sparing laminectomy has been reported with a frequency of 8% to 31%. Bilateral laminotomies have been shown to be effective in decompressing the spine, without resection of the posterior osteo-ligamentous complex. We hypothesize that bilateral laminotomies induce significantly less iatrogenic hypermobility and less stiffness reduction than a traditional facet-sparing laminectomy in the lumbar spine. METHODS: Six fresh frozen human cadaveric lumbar spines (L1-L5) were mounted into a spine motion simulator for testing. With physiologic follower preload, flexion/extension, lateral bending, and axial rotation moments were applied to the lumbar spine in 3 trials: (1) Intact lumbar spine-no surgery, (2) Lumbar spine after bilateral lumbar laminotomies at L2-L5, (3) Lumbar spine after full laminectomies at L2-L5. The lumbar spine kinematics were measured using a Vicon motion tracking system. Total and segmental range of motion and spine stiffness were recorded. RESULTS: In flexion/extension, bilateral laminotomies resulted in an average increase in L2-L5 range of flexion/extension motion of 14.3%, whereas a full laminectomy resulted in an increase of 32.0% (P<0.05). Analysis per level demonstrated roughly twofold increase in motion with laminectomy compared with bilateral laminotomies (P<0.05, at every treated level). Stiffness was decreased by an average of 11.8% after the 3-level-laminotomies and by 27.2% (P<0.05) after the 3-level-laminectomy. CONCLUSION: These data demonstrate that bilateral laminotomies induce significantly less hypermobility and less stiffness reduction compared with a full laminectomy. The preservation of the central posterior osteo-ligamentous structures may provide a stabilizing effect in preventing postdecompression spondylolisthesis.

The efficacy of using vibrometry to detect osteointegration of the Agility total ankle.

Arthritis is a chronic, debilitating disease affecting one in six people in the United States annually. One of the most promising surgical treatments is total joint replacement. After decades of development, some joint replacement (arthroplasty) systems such as the hip and knee enjoy high success rates while others, particularly newer ones for the ankle, have disappointing survival rates. The goal of this study was to investigate, develop, and test a methodology to assess implant osteointegration, specifically for the talar component of a total ankle prosthesis. A vibrometry technique using Doppler ultrasound was developed to non-invasively determine osteointegration clinically. This methodology was evaluated via preliminary experimentation, along with another validation methodology, to access whether design criteria have been met in order to initiate a clinical study of the technique. Bench-top and cadaveric testing demonstrated that the Doppler ultrasound technique could distinguish the level of osteointegration between loose and fixed implant components. The laser vibrometry technique, used for the validation of the ultrasound technique intraoperatively, was also shown to be functional and indicative of the ultrasound technique's testing results. This methodology can provide a much needed tool to determine the integration of implants non-invasively in the clinical and surgical setting, thus allowing each patient's rehabilitation program to be monitored and tailored to maximize the osteointegration and survival rate of their total joint replacement.

Helmet and shoulder pad removal in football players with unstable cervical spine injuries.

Football, one of the country's most popular team sports, is associated with the largest overall number of sports-related, catastrophic, cervical spine injuries in the United States (Mueller, 2007). Patient handling can be hindered by the protective sports equipment worn by the athlete. Improper stabilization of these patients can exacerbate neurologic injury. Because of the lack of consensus on the best method for equipment removal, a study was performed comparing three techniques: full body levitation, upper torso tilt, and log roll. These techniques were performed on an intact and lesioned cervical spine cadaveric model simulating conditions in the emergency department. The levitation technique was found to produce motion in the anterior and right lateral directions. The tilt technique resulted in motions in the posterior left lateral directions, and the log roll technique generated motions in the right lateral direction and had the largest amount of increased instability when comparing the intact and lesioned specimen. These findings suggest that each method of equipment removal displays unique weaknesses that the practitioner should take into account, possibly on a patient-by-patient basis.