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Graphene physics and plasmonics are two fields which, once combined, promise a variety of exciting applications. One of those applications is the integration of active nano-optoelectronic devices in electronic systems, using the fact that plasmons in graphene are tunable, highly confined and weakly damped. A crucial challenge remains before achieving these active devices: finding a platform enabling a high propagation of Graphene Plasmons Polaritons (GPPs). Suspended graphene presenting ultrahigh electron mobility has given rise to increasing interest. We numerically studied the plasmonic properties of suspended graphene. We propose a hybrid configuration and a set of conditions to launch graphene plasmons via an in-plane gold nanoantenna, for micrometric propagation of surface plasmons in suspended graphene. Finally, we propose a realistic optoelectronic device based on the use of suspended graphene.
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Bamboo-shaped carbon nanotubes (CNTs) had been successfully fabricated by a plasma enhanced chemical vapor deposition method, in which nanocluster-assembled ZnO:Co thin film was used as catalyst. It was found that bamboo-shaped CNTs were generally grown in a direction perpendicularly to the substrate surface with the tops of CNTs dominated by the droplet-like catalyst covered by the carbon layer. The diameter of CNTs was ranged from 20-50 nm. High resolution of TEM image showed that the typical CNT had a multi-walled structure with an inner core presented. The ordered graphite layers were inclined to an axis of CNT about 18 degrees and the interlayer space of a CNT was about 0.35 nm. Two peaks in Raman spectrum at 1586 cm(-1) and 1372 cm(-1) were identified as G-band and D-band for graphite, respectively. The results showed that catalyst based on ZnO:Co thin films could be used for the growth of CNTs with bamboo-shaped structure.
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Formation of nanocrystals with preferred orientation within the amorphous carbon matrix has attracted lots of theoretical and experimental attentions recently. Interesting properties of this films, easy fabrication methods and practical problems associated with the growth of other carbon nanomaterials such as carbon nanotubes (CNTs) and graphene gives this new class of carbon nanostructure a potential to be considered as a replacement for some applications such as thermal management at nanoscale and interconnects. In this short review paper, the fabrication techniques and associated formation mechanisms of these nanostructured films have been discussed. Besides, electrical and thermal properties of these nanostructured films have been compared with CNTs and graphene.
Subject(s)
Carbon/chemistry , Nanotechnology/methods , Electricity , Graphite/chemistry , TemperatureABSTRACT
INTRODUCTION: Bisphosphonates have been shown to be effective in reducing the risk of fragility fractures in several landmark clinical trials conducted in Western populations. However, limited studies on bone mineral densitometry (BMD) trends have been conducted in Asian women. We conducted a retrospective review of electronic records to determine the actual BMD trends in a local population of postmenopausal women on bisphosphonate treatment. METHODS: The electronic records of all women over 50 years of age who had undergone BMD at Singapore General Hospital in 2004 were examined. Patients who were later started on bisphosphonates and continued the treatment for at least two years were selected for the study. Their subsequent BMD results were recorded, and longitudinal analysis was applied to determine the BMD trends as a cohort. RESULTS: A total of 254 postmenopausal women were included for analysis. Their mean BMD T-score was -2.70 before treatment, and improved to -2.56 and -2.27 one and two years after treatment, respectively. However, the score deteriorated to -2.50 and -2.62 three and four years after treatment, respectively. The difference between each year's results and those of the baseline was statistically significant. CONCLUSION: In our study, the BMD scores in our local population showed improvement in the first two years of bisphosphonate treatment but declined subsequently. Our findings contrasted with those of studies conducted in Western populations. Further prospective studies are suggested so as to elucidate the actual BMD trends and fracture risk reduction in Asian women on bisphosphonate treatment.
Subject(s)
Densitometry/methods , Diphosphonates/therapeutic use , Osteoporosis, Postmenopausal/prevention & control , Aged , Aged, 80 and over , Bone Density/drug effects , Electronic Health Records , Female , Humans , Middle Aged , Postmenopause , Retrospective Studies , Singapore , Treatment OutcomeABSTRACT
We report dewetting of thermodynamically stable, thick (approximately 100 nm) polystyrene films by titanium ion implantation. The dynamic dewetting patterns in time evolution are recorded. The dewetting mechanism is determined to be heterogeneous nucleation, where the defects and Ti nanoparticles formed by ion implantation serve as the nuclei. In addition, we observe abundant rims with regular polygonal shapes in dewetting patterns. This is attributed to fingering instability, which results from the balance between the driving force arisen from thermally induced surface tension gradient and the resistive forces from the combination of friction force, Laplace pressure and long-range van der Waals interactions. Finally, a model based on mass conservation is used to qualitatively describe the transition from circular to polygonal shaped rims at a critical diameter for holes.
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We demonstrate that when, and only when, the biaxial stress is increased above a critical value of 6+/-1 GPa during the growth of a carbon film at room temperature, tetrahedral amorphous carbon is formed. This confirms that the stress present during the formation of an amorphous carbon film determines its sp;{3} bonding fraction. In the vicinity of the critical stress, a highly oriented graphitelike material is formed which exhibits low electrical resistance and provides Ohmic contacts to silicon. Atomistic simulations reveal that the structural transitions are thermodynamically driven and not the result of dynamical effects.
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ZnO:Co nanoclusters were synthesized by nanocluster-beam deposition with averaged particle size of 5 nm and porous structure, which were for the first time adopted to construct a novel amperometric glucose biosensor. Glucose oxidase was immobilized into the ZnO:Co nanocluster-assembled thin film through Nafion-assisted cross-linking technique. Due to the high specific active sites and high electrocatalytic activity of the ZnO:Co nanoclusters, the constructed glucose biosensor showed a high sensitivity of 13.3 microA/mA cm2. The low detection limit was estimated to be 20 microM (S/N=3) and the apparent Michaelis-Menten constant was found to be 21 mM, indicating the high affinity of the enzyme on ZnO:Co nanoclusters to glucose. The results show that the ZnO:Co nanocluster-assembled thin films with nanoporous structure and nanocrystallites have potential applications as platforms to immobilize enzyme in biosensors.
Subject(s)
Biosensing Techniques/instrumentation , Cobalt/chemistry , Electrochemistry/instrumentation , Glucose/analysis , Nanostructures/chemistry , Zinc Oxide/chemistry , Biosensing Techniques/methods , Electrochemistry/methods , Equipment Design , Equipment Failure Analysis , Reproducibility of Results , Sensitivity and SpecificityABSTRACT
Injector-like zinc oxide (ZnO) nanostructures have been synthesized on Si substrate by the vapour phase transport method. Samples with different areal densities were obtained by controlling the temperature. The field emission properties of the injector-like ZnO nanostructures showed a clear dependence on the areal density of the nanostructures, which is due to the screening effect. The samples with a needle length of 850 nm and an areal density of 1 × 10(8) cm(-2) showed the lowest field emission turn-on field of 1.85 V µm(-1) at a current density of 10 µA cm(-2), and the current density reaches 1 mA cm(-2) at an applied field of 4.7 V µm(-1).
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OBJECTIVE: The number of hip fractures is expected to double in the next 20 years, with current estimates that Asia will account for 37% of these cases. As bone mineral density (BMD) may be used as a measure of fracture risk, we sought to compare the effects of teriparatide with salmon calcitonin treatment on changes in BMD, biochemical bone markers, and safety in postmenopausal Asian women with osteoporosis. METHODOLOGY: A total of 104 patients (n = 47 teriparatide [20 g/day subcutaneously] and n = 57 calcitonin [100 IU/day subcutaneously]) were enrolled in Hong Kong, Singapore, Philippines, Malaysia, and Thailand. Calcium (> or = 500 mg/day) and vitamin D (200-400 IU/day) supplements were taken throughout the 6-month controlled, randomized study. RESULTS: Teriparatide was associated with a 5.03 +/- 4.77% increase in lumbar spine BMD (p < 0.0001, mean +/- SD change from baseline), whereas changes in lumbar spine BMD for patients on calcitonin were not statistically significant (mean change of 0.36 +/- 4.12%, p = 0.16). Comparison of the two groups indicated that teriparatide treatment improved lumbar spine BMD statistically significantly more than calcitonin (p < 0.0001). No statistically significant changes were observed for total hip or femoral neck BMD. Serum bone-specific alkaline phosphatase (BSAP) increased by 55.9% (median change from baseline, p < 0.0001) in the teriparatide group, and remained stable with calcitonin (5.0% change, p = 0.24); osteocalcin increased by 156.15% (median change from baseline, p < 0.0001) with teriparatide, and decreased with calcitonin (-15.25%, p = 0.03). Similar rates of adverse events were observed, with nausea and dizziness the most commonly reported for both groups (teriparatide versus calcitonin, 13.0% versus 23.2% p = 0.21, 10.9% versus 21.4% p = 0.19, respectively). There were no clinically relevant changes observed in laboratory parameters. CONCLUSIONS: Both treatments were similarly tolerated, however teriparatide was associated with greater increases in lumbar spine BMD and bone formation markers, demonstrating the unique mechanism of action and safety of this treatment for osteoporosis in these Asian women.
Subject(s)
Asian People , Bone Density Conservation Agents/therapeutic use , Calcitonin/therapeutic use , Fractures, Bone/prevention & control , Osteoporosis, Postmenopausal/drug therapy , Teriparatide/therapeutic use , Age Factors , Aged , Aged, 80 and over , Asia, Southeastern , Bone Density/drug effects , Bone Density Conservation Agents/pharmacology , Calcitonin/pharmacology , China , Female , Fractures, Bone/etiology , Humans , Middle Aged , Osteoporosis, Postmenopausal/physiopathology , Risk Assessment , Risk Factors , Teriparatide/pharmacology , Treatment OutcomeABSTRACT
PURPOSE: To compare the results of anterior cruciate ligament (ACL) reconstructions using either a patella-tendon autograft or a semitendinosus-tendon autograft. METHODS: Based on surgeon experience and preference, 68 patients underwent ACL reconstruction using either a quadruple-strand semitendinosus autograft (n = 34) or a central one-third bone-patella tendon-bone autograft (n = 34). Each patient was assessed preoperatively and postoperatively at 3, 6, and 24 months using the International Knee Documentation Committee (IKDC) knee score, Biodex muscle strength and endurance testing, and the KT1000 instrumented arthrometer test of knee laxity to anterior translation. All assessments at the 2-year follow-up were performed by the same physician and physiotherapist. RESULTS: While ACL reconstruction improved knee stability and IKDC knee scores significantly, there was no statistically significant difference between semitendinosus- and patella-tendon autograft reconstructions in terms of long-term knee score or laxity to anterior translation. Semitendinosus graft reconstruction was associated with less donor-site morbidity and hamstring weakness. Meniscectomy was associated with poorer long-term knee scores. CONCLUSION: ACL reconstruction is associated with a significantly better IKDC knee score and laxity measurement at 2-year follow-up. However, we were unable to demonstrate a significantly better long-term outcome in knee score or laxity to anterior translation with either a patella-tendon autograft or a semitendinosus-tendon autograft.
Subject(s)
Anterior Cruciate Ligament/surgery , Plastic Surgery Procedures/methods , Tendons/transplantation , Adolescent , Adult , Anterior Cruciate Ligament Injuries , Female , Follow-Up Studies , Humans , Injury Severity Score , Knee Injuries/diagnosis , Knee Injuries/surgery , Male , Muscle, Skeletal/physiology , Pain Measurement , Patella/transplantation , Postoperative Complications , Prospective Studies , Range of Motion, Articular/physiology , Recovery of Function , Risk Assessment , Time Factors , Transplantation, Autologous , Treatment OutcomeABSTRACT
PURPOSE: To investigate the harmful effects of a single episode of intra-articular bleeding on articular cartilage of rabbit knees using scanning electron microscopy. METHODS: Autologous blood was injected into the right knee joints of 18 New Zealand white rabbits. Surface and cellular damages were examined by the scanning electron microscope (n=9) and light microscope (n=34), respectively. The injected right knees were then compared with the corresponding control left knees at one, 3, and 6 weeks after the blood injection. RESULTS: The articular surface of the injected knees turned uniformly rough with multiple pits after one week. Maximal changes with elevations and depressions were observed at 3 weeks. These changes reversed at 6 weeks with the irregularities smoothing out. A similar pattern of transient cartilage damage was noted histologically. CONCLUSION: Both scanning electron microscopic and light microscopic findings suggest that a single episode of intra-articular bleeding leads to articular cartilage damage but this appears to be reversible. Our findings of transient damage to the articular cartilage suggest that there is no need for intra-articular evacuation and washout following an acute episode of haemarthrosis.
Subject(s)
Cartilage Diseases/etiology , Cartilage, Articular/pathology , Hemarthrosis/complications , Knee Joint , Animals , Cartilage Diseases/pathology , Female , Hemarthrosis/pathology , Male , Microscopy, Electron, Scanning , RabbitsABSTRACT
A 30-year-old Thai woman with piriformis pyomyositis presented with sciatica. Computed tomography showed swelling and enhancement of the right gluteus medius and piriformis muscles. She made a complete recovery after a course of intravenous antibiotics. This condition has only been reported three other times and is often diagnosed with difficulty. It could be erroneously dismissed as a lumbar disc prolapse. If untreated, it could lead to prolonged hospital stay and death. A high index of suspicion, early diagnosis and appropriate antibiotic or surgical treatment leads to full recovery.
Subject(s)
Abscess/complications , Myositis/complications , Myositis/diagnosis , Sciatica/etiology , Abscess/diagnosis , Adult , Diagnosis, Differential , Female , Humans , Muscle, Skeletal , PelvisABSTRACT
INTRODUCTION: As anterior cruciate ligament (ACL) reconstruction becomes more frequently performed, the expectation of earlier return to activities becomes higher; hence graft selection becomes more important. The use of hamstring tendon autograft is perceived to have less postoperative morbidities. We evaluate the early postoperative complications in this prospective study. MATERIALS AND METHODS: Seventy-six patients operated by the same surgeon were assessed preoperatively, and 3 and 6 months after surgery. The hamstring and quadriceps strength were measured with Biodex machine and the side-to-side laxity measured using KT-1000 instrument. The patients were also assessed for their subjective complaints using IKDC (International Knee Documentation Committee) Knee Scoring System. RESULTS: The strength and endurance index of the quadriceps and hamstrings recovered and improved by the sixth month after surgery. The recovery by the quadriceps muscle is more marked and by the sixth month, it has recovered to more than the preoperative level. As for laxity, the average side-to-side difference at 30 pounds was 2.75 mm by 6 months. Of these patients, the side-to-side difference was less than 5 mm in 66 patients (5 mm as taken to be acceptable for graft success). As for IKDC rating, at the sixth month, 71 patients had normal or near normal knee by their own assessment. No patients had anterior knee pain at rest. Sensory deficits were only present in 3 patients with complaints of numbness over the distribution of the saphenous nerve or its infrapatellar branch. CONCLUSION: Most morbidities are temporal in nature and do not significantly affect the patient's activities.
Subject(s)
Anterior Cruciate Ligament/surgery , Arthralgia/etiology , Arthroplasty/adverse effects , Hypesthesia/etiology , Joint Instability/etiology , Tendons/transplantation , Adolescent , Adult , Female , Follow-Up Studies , Humans , Knee Joint/physiopathology , Knee Joint/surgery , Male , Middle Aged , Muscle, Skeletal/physiopathology , Thigh/physiopathology , Transplantation, AutologousABSTRACT
INTRODUCTION: A prospective trial was carried out in simultaneous bilateral total knee replacement to compare the outcome of resurfaced versus non-surfaced patella. METHODS: Thirty-five patients between 1997 and 2002 had simultaneous bilateral total knee replacement with resurfaced patella on the left and non-resurfaced patella on the right knee using the same implant in both. RESULTS: There were 29 females and six males with a mean age of 65.3 years. Mean follow-up was 3.18 years. There was no significant difference between the resurfaced and non-resurfaced knees with respect to the overall Knee Society clinical score (p = 0.093 preoperative, 0.310 postoperative) or the pain (p = 0.715 preoperative, 0.395 postoperative) or function subscores (p = 0.126 preoperative, 0.317 postoperative). The postoperative range of motion was 109 and 110 degrees for the resurfaced patella and non-resurfaced patella respectively (p = 0.894). The post-operative knee scores between patients with or without pre-operative anterior knee pain (p = 0.238) and between those who were obese and non-obese (p = 0.387) were not significantly different. 82.9% of patients felt that the resurfaced knee and 80% felt that the non-resurfaced knee were much better than before. There was no major preference for either knee for climbing stairs and getting out of chair. CONCLUSION: The functional and symptomatic outcome of total knee replacement with or without patella resurfacing is the same in the local population. Also, the present study demonstrated no evidence that the weight of the patient or the presence of preoperative anterior knee pain should be considered as factors in the decision to resurface the patella.
Subject(s)
Arthroplasty, Replacement, Knee/methods , Aged , Aged, 80 and over , Female , Humans , Knee Joint/physiopathology , Male , Middle Aged , Patella/surgery , Prospective Studies , Range of Motion, Articular , Treatment OutcomeABSTRACT
Donor site morbidity, which occurs in 15% to 20% with the use of autografts for anterior cervical fusion, is eliminated with the use of allografts. While allografts from the iliac crest, ribs, fibula, femoral head and skull have been used in anterior cervical fusion, the use of patellar allografts has not been previously reported. Twenty-two patients underwent Cloward anterior cervical decompression and fusion using bicortical patellar allografts from 1993 to 1997. Fifteen patients, with a follow-up period of at least two years, were reviewed. Eleven patients (73.4%) had good or excellent results at an average of 42.8 months after surgery. Fourteen patients (93.4%) achieved union. Two patients (13.3%) developed collapse of the graft with extrusion, one of whom still achieved union. These results are comparable to those reported of anterior cervical fusion using autografts or other types of allografts.
Subject(s)
Cervical Vertebrae/surgery , Patella/transplantation , Spinal Fusion/methods , Adult , Aged , Female , Humans , Male , Middle Aged , Transplantation, Homologous , Treatment OutcomeABSTRACT
INTRODUCTION: Quantitative data regarding the dimensions of the posterior cruciate ligament (PCL) and its insertions have not been studied in Asians, and concerns have been raised regarding the danger of vascular injury when the bony tunnels are created during arthroscopically-assisted reconstruction. MATERIALS AND METHODS: Ten male cadavers were used in this study, incorporating dissection and procedural arms. In the procedural arm, the path of the drill bit was tracked fluoroscopically as the tibial and femoral tunnels were created during simulated reconstructive surgery, and the effect of varying knee flexion angles was studied. Fluoroscopic images were analysed using specialised image processing software. RESULTS: The mean length of the PCL at full extension was 37.7 +/- 1.9 mm, and the mean mid-substance width was 13.7 +/- 1.7 mm. The mean sagittal distance between the exit point of the tibial tunnel and the anterior surface of the popliteal artery, across all knee flexion positions, was merely 6.0 mm (range, 2.8 to 10.2 mm). This distance tended to increase with increasing knee flexion, but this was not statistically significant. The mean distance between the exit point of the femoral tunnel and the femoral artery was 51.1 mm (range, 42.1 to 59.0 mm). CONCLUSIONS: The dimensions of the PCL and its insertions in Asians do not vary greatly from those reported for Western subjects. The distance from the exit point of the tibial tunnel to the popliteal artery is very small and, although this distance increases with increasing knee flexion, the improvement in the safety margin may neither be clinically nor statistically significant. The margin of safety for drilling of the femoral tunnel is much greater.
Subject(s)
Asian People , Posterior Cruciate Ligament/anatomy & histology , Anthropometry , Arthroscopy , Humans , Image Processing, Computer-Assisted , Knee Joint/surgery , Male , Posterior Cruciate Ligament/surgery , Plastic Surgery ProceduresABSTRACT
The lack of data on in-vivo material properties of soft tissues has been a significant impediment in the development of virtual reality based surgical simulators that can provide the user with realistic visual and haptic feedback. As a first step towards characterizing the mechanical behavior of organs, this work presents in-vivo force response of the liver and lower esophagus of pigs when subjected to ramp and hold, and sinusoidal indentations delivered using a haptic feedback device, Phantom, employed as a mechanical stimulator. The results show that pulse significantly affects the reaction forces and that the lower esophagus is 2 to 2.5 times stiffer than the liver.
Subject(s)
Abdomen/surgery , Computer Simulation , Connective Tissue/surgery , Feedback , Models, Anatomic , Surgery, Computer-Assisted/education , Touch , User-Computer Interface , Animals , Biomechanical Phenomena , Computer-Assisted Instruction , Esophagus/surgery , Humans , Liver/surgery , SwineABSTRACT
Bone graft substitutes may be broadly classified as mineralized and demineralized preparations. This article reviews the basic science and biology underlying each preparation. A review of the clinical and experimental applications of each preparation follows. The text concludes with a review of growth factors as biological supplements.
Subject(s)
Biocompatible Materials/therapeutic use , Bone Matrix/transplantation , Growth Substances/therapeutic use , Spinal Fusion/methods , Spine/surgery , Animals , Bone Demineralization Technique , Ceramics , Humans , Prostheses and Implants , Transplantation, HomologousABSTRACT
BACKGROUND: Whether or not to remove bullets or bullet fragments from the spinal column of a neurologically intact patient has been a subject of continual debate. The controversy is due in part to a lack of information about the long-term effects of bullet fragments on spinal cord tissue. Although many studies have demonstrated the toxic effects of metal fragments on brain tissue, to our knowledge no one has evaluated the effects of the metals contained in commercially available bullets on spinal cord tissue. METHODS: Copper, aluminum, and lead fragments from three commercially available bullet cartridges were implanted in intradural and extradural locations in seventeen New Zealand White rabbits. At an average of 9.8 months, the metal content of specimens of blood, cerebrospinal fluid, and liver were determined. The spinal cords were harvested and examined histologically. RESULTS: There was a significant increase in the copper level of blood from the rabbits with an implanted copper fragment compared with that of the control animals (p = 0.007). Concentrations of copper and lead were not elevated, compared with the control values, in the serum or liver. Histological examination of the spinal cords revealed major destruction of both the axons and the myelin of the dorsal column adjacent to the intradural copper fragments. Intradural fragments of lead caused similar destruction of myelin and axons in the dorsal column, but to a lesser degree. Minimal spinal cord or meningeal histological changes were noted around the aluminum intradural fragments, and no pathological changes were found near any fragments placed in an extradural location. CONCLUSIONS: The results of this study show that certain metals contained in commercially available bullets can cause varying degrees of neural destruction independent of the initial mechanical injury caused by implantation. Of the three metals tested, copper fragments consistently caused a substantial localized area of neural injury within the spinal cord. CLINICAL RELEVANCE: In our study, copper fragments caused local neural toxicity involving as much as 10% of the spinal cord area, suggesting that there may be a scientific basis for removal of copper fragments lodged in the spinal cord, even in the absence of a neurological deficit.
Subject(s)
Foreign Bodies/pathology , Metals/toxicity , Spinal Canal , Spinal Cord Injuries/pathology , Spinal Cord/pathology , Wounds, Gunshot/surgery , Aluminum/pharmacokinetics , Aluminum/toxicity , Animals , Copper/pharmacokinetics , Copper/toxicity , Epidural Space , Foreign Bodies/surgery , Lead/pharmacokinetics , Lead/toxicity , Metals/pharmacokinetics , Rabbits , Spinal Cord/drug effects , Spinal Cord Injuries/chemically inducedABSTRACT
The aim of this study is to firstly ascertain the survival of autogenously grafted morselised cartilage for full thickness osteochondral defects in knee joints of pigs. Secondly, it is to determine the quality of the grafted cartilage that survives and to score to it based on a recognised and tested system of indices and thirdly, to recognise, if any, the potential for reconstitution of the osteochondral junction. Two groups of five pigs were followed up for six and 12 weeks. Similar osteochondral defects were created in the medial condyles of both knees with the right medial femoral condyle defect filled with graft and the left used as control and filled with gel foam. At the end of the study period, an independent pathologist assessed the defects macroscopically and microscopically with an accepted and comparable histological scoring system. Macroscopically, there was better filling of the defect and restoration of bony contour in the grafted group compared to the control. Microscopically, at six weeks, filling of the defect, nature of predominant tissue, matrix staining and nature of cells all showed significantly better histological score than the control using the Mann-Whitney U test at the level of significance of p<0.05. At 12 weeks, in addition to the above, the reconstitution of osteochondral junction also showed a significantly better score. Comparing the test groups at six and 12 weeks, the reconstitution of the osteochondral junction was significantly better at 12 weeks. In conclusion, the autogenous osteochondral morselised graft persisted as mature hyaline cartilage with good histological score at six weeks with significantly better reconstitution of osteochondral junction occurring at 12 weeks. The use of morselised graft allows for the inclusion of bone graft which possibly allows for larger amounts of donor tissue and thus the possibility of treating larger defects. In the human model the donor site would be the non-weight bearing surfaces of the knee such as the intercondylar notch as described by Walgenbach A and Stone KR at the 1997 Annual Meeting of the American Academy of Orthopaedic Surgeons in San Francisco.