Effect of exercise on cardiovascular parameters in search and rescue-trained dogs / Efeito do exercício sobre parâmetros cardiovasculares em cães em treinamento de busca, resgate e salvamento

Physical activity alters the cardiovascular system of dogs, depending on the exercise characteristics and the animal's physical conditioning. Little is known about the cardiovascular changes in rescue-trained dogs. This study evaluated the cardiovascular responses to a search and rescue exercise session to differentiate these alterations from cases of exhaustion or some possible pathology. Nine healthy rescue-trained dogs that trained for at least one year were used. Seven German Shepherds and two Belgian Shepherd Malinois were evaluated twice, immediately before exercise (M0) and immediately after a 20-minute training (M1). Electrocardiographic, echocardiographic, and systemic blood pressure (SBP) measurements were performed at each evaluation. Heart rate was evaluated in three moments, M0, M1 and five minutes after the end of the physical activity (M2). The results indicated that training increased oxygen demand and significantly increased cardiac output, left ventricular volume in diastole and aortic artery diameter, and the contraction force with the increased mitral annular motion without impairing systolic and diastolic cardiac functions. Heart rate values immediately and five minutes after exercise were similar to baseline values. Training did not alter SBP and the electrocardiographic parameters. The present study indicated good cardiac performance to the physical effort of rescue-trained dogs and reduced the chances of poor performance and the occurrence of sudden death caused by exercise in response to the pattern of activity performed.(AU)

A atividade física acarreta diversas mudanças no sistema cardiovascular dos cães, dependendo das características do exercício realizado e do condicionamento físico do animal. Pouco se sabe sobre as alterações cardiovasculares causadas pelo treinamento de busca, resgate e salvamento. Objetivou-se, com este estudo, avaliar as respostas cardiovasculares após uma sessão desse tipo de treino, a fim de diferenciar essas alterações de casos de exaustão ou de alguma possível patologia. Foram utilizados nove cães saudáveis em treinamento de busca, resgate e salvamento há pelo menos um ano, sendo sete da raça Pastor Alemão e dois da raça Pastor Belga Malinois. Os cães foram submetidos a dois momentos de avaliação: M0 imediatamente antes do exercício e M1 imediatamente após um treinamento de 20 minutos. Em cada avaliação, foram realizados os exames eletrocardiográfico e ecocardiográfico e a aferição da pressão arterial sistólica sistêmica. Apenas a frequência cardíaca foi avaliada em três momentos, em M0, M1 e após cinco minutos do término da atividade física (M2). Os resultados obtidos indicam que o treinamento causa um aumento na demanda de oxigênio, provocando um aumento significativo no débito cardíaco, no volume ventricular esquerdo em diástole e no diâmetro da artéria aorta, assim como um aumento em um dos parâmetros de contratilidade cardíaca (movimento anular de mitral), sem causar prejuízo às funções cardíacas sistólicas e diastólicas. Os valores da FC imediatamente após e cinco minutos após o exercício foram similares aos valores basais. A PASS e os parâmetros eletrocardiográficos não se alteraram após o treinamento. Os achados encontrados indicam um bom desempenho cardíaco ao esforço físico dos cães de busca, resgate e salvamento, reduzindo-se as chances de má performance e de ocorrência de morte súbita causada pelo exercício, em resposta ao padrão da atividade realizada.(AU)

Echocardiographic parameters in dogs treated with acepromazine and fentanyl / Parâmetros ecocardiográficos em cães tratados com acepromazina e fentanil

Considering that the use of tranquillizers could optimize the performance of the echocardiogram, this study aimed to evaluate the effect of protocols with acepromazine and fentanyl on the echocardiographic parameters of healthy dogs, besides their effect in systolic blood pressure (SBP), respiratory rate (RR), heart rate (HR), time spent for examination and sedation scale. Ten adult dogs were submitted to different tranquilizing protocols 20 minutes before the echocardiographic examination, totalling five treatments for each pair, performed at seven-day intervals between evaluations. The treatments were CT (control treatment), IAT (intramuscular acepromazine), OAT (oral acepromazine), FT (fentanyl) and AFT (acepromazine associated with fentanyl). In addition to the echocardiographic evaluation, SBP, degree of reassurance, duration of the exam, HR and RR in the different protocols were evaluated. There was a significant decrease of SBP in OAT. There was a significant reduction in left ventricular diameter during systole and diastole and mitral annular movement in IAT, OAT and AFT, compared with CT. There was a decrease in tricuspid annular plane systolic excursion and increase in mitral E/mitral A ratio in IAT and OAT when compared with CT. All the tranquillizer protocols studied were found to significantly reduce HR, that facilitated the echocardiographic examination.(AU)

Considerando que o uso de tranquilizantes poderia otimizar a realização do ecocardiograma, objetivou-se com este estudo avaliar o efeito da tranquilização com acepromazina e fentanil sobre os parâmetros ecocardiográficos em cães saudáveis, bem como o efeito na pressão arterial sistólica (PAS), na frequência respiratória (FR), na frequência cardíaca (FC), no tempo gasto para a realização do exame e na escala de sedação. Dez cães adultos foram submetidos a diferentes protocolos tranquilizantes, 20 minutos antes da avaliação ecocardiográfica, totalizando cinco tratamentos para cada dupla, realizados com intervalos de sete dias entre as avaliações. Os tratamentos foram: TC (tratamento controle), TAI (acepromazina intramuscular), TAO (acepromazina oral), TF (fentanil) e TAF (acepromazina associada ao fentanil). Além dos parâmetros ecocardiográficos, foram avaliados a PAS, o grau de tranquilização, o tempo de duração do exame e a FC e a FR nos diferentes protocolos. Houve diminuição significativa da PAS no TAO. Observou-se redução significativa do diâmetro do ventrículo esquerdo em sístole e diástole e do movimento anular de mitral nos protocolos TAI, TAO e TAF, comparados com o TC. Observou-se também uma redução da excursão sistólica do plano anular tricúspide e aumento da relação mitral E/mitral A nos protocolos TAI e TAO quando comparados ao TC. Todos os protocolos de tranquilização reduziram significativamente a FC, o que facilitou a realização do exame.(AU)

Clinical outcome of increased flexion gap after total knee arthroplasty. Can controlled gap imbalance improve knee flexion?

PURPOSE: Increased range of motion (ROM) while maintaining joint stability is the goal of modern total knee arthroplasty (TKA). A biomechanical study has shown that small increases in flexion gap result in decreased tibiofemoral force beyond 90° flexion. The purpose of this paper was to investigate clinical implications of controlled increased flexion gap. METHODS: Four hundred and four TKAs were allocated into one of two groups and analysed retrospectively. In the first group (n = 352), flexion gap exceeded extension gap by 2.5 mm, while in the second group (n = 52) flexion gap was equal to the extension gap. The procedures were performed from 2008 to 2012. The patients were reviewed 12 months postoperatively. Objective clinical results were assessed for ROM, mediolateral and sagittal stability. Patient-reported outcome measures were the WOMAC score and the Forgotten Joint Score (FJS-12). RESULTS: After categorizing postoperative flexion into three groups (poor < 90°, satisfactory 91°-119°, good ≥ 120°) significantly more patients in group 1 achieved satisfactory or good ROM (p = 0.006). Group 1 also showed a significantly higher mean FJS-12 (group 1: 73, group 2: 61, p = 0.02). The mean WOMAC score was 11 in the first and 14 in the second group (n.s.). Increase in flexion gap did not influence knee stability. CONCLUSIONS: The clinical relevance of this study is that a controlled flexion gap increase of 2.5 mm may have a positive effect on postoperative flexion and patient satisfaction after TKA. Neither knee stability in the coronal and sagittal planes nor complications were influenced by a controlled increase in flexion gap. LEVEL OF EVIDENCE: III.

A newly discovered muscle: The tensor of the vastus intermedius.

The quadriceps femoris is traditionally described as a muscle group composed of the rectus femoris and the three vasti. However, clinical experience and investigations of anatomical specimens are not consistent with the textbook description. We have found a second tensor-like muscle between the vastus lateralis (VL) and the vastus intermedius (VI), hereafter named the tensor VI (TVI). The aim of this study was to clarify whether this intervening muscle was a variation of the VL or the VI, or a separate head of the extensor apparatus. Twenty-six cadaveric lower limbs were investigated. The architecture of the quadriceps femoris was examined with special attention to innervation and vascularization patterns. All muscle components were traced from origin to insertion and their affiliations were determined. A TVI was found in all dissections. It was supplied by independent muscular and vascular branches of the femoral nerve and lateral circumflex femoral artery. Further distally, the TVI combined with an aponeurosis merging separately into the quadriceps tendon and inserting on the medial aspect of the patella. Four morphological types of TVI were distinguished: Independent-type (11/26), VI-type (6/26), VL-type (5/26), and Common-type (4/26). This study demonstrated that the quadriceps femoris is architecturally different from previous descriptions: there is an additional muscle belly between the VI and VL, which cannot be clearly assigned to the former or the latter. Distal exposure shows that this muscle belly becomes its own aponeurosis, which continues distally as part of the quadriceps tendon.

Effects of ligation of lateral intermuscular septum perforating vessels on blood supply to the femur.

INTRODUCTION: With a subvastus approach to the femur, the vessels that perforate the lateral intermuscular septum (LISP-vessels) must be ligated. The effect on the blood supply to the femur remains unclear. The purpose of the current study was to investigate the effect of ligation of the LISP-Vessels on the blood supply and to examine the anatomy of the LISP-vessels and the anastomoses around the femur. MATERIALS: In six human cadavers the LISP vessels were ligated by a lateral subvastus approach on one side. The contralateral side served as control group. After bilateral injection of different coloured silicon dyes into the lateral and medial circumflex femoral artery (green), deep femoral artery (red) and the superficial femoral artery (blue) dissection was performed bilaterally. The arterial perfusion on both sides was compared and the anatomy of the LISP vessels studied. RESULTS: The medullary perfusion of the femur was not altered by the ligation of the LISP vessels. It did also not lead to a decrease in periosteal vessel filling. The LISP vessels were shown to be a part of a complex and rich anastomotic network and play an important role in the perfusion of the femur and quadriceps muscle group. The ligature could be compensated for by this anastomotic network. Branches to the periosteum separate from the LISP vessels immediately after perforating the lateral intermuscular septum. The linea aspera turned out to be an important area for the femoral blood supply. DISCUSSION AND CONCLUSIONS: Exposure of the femur through a lateral subvastus approach with ligation of LISP vessels causes a certain degree of soft tissue trauma. However, by using a gentle surgical technique the periostal perfusion of the femur can be preserved by a potent anastomotic network after ligation of the LISP vessels if they are not ligated to close to the lateral intermuscular septum and the linea aspera is not unnecessarily exposed.

Search for solar axions by the CERN axion solar telescope with 3He buffer gas: closing the hot dark matter gap.

The CERN Axion Solar Telescope has finished its search for solar axions with (3)He buffer gas, covering the search range 0.64 eV ≲ ma ≲ 1.17 eV. This closes the gap to the cosmological hot dark matter limit and actually overlaps with it. From the absence of excess x rays when the magnet was pointing to the Sun we set a typical upper limit on the axion-photon coupling of gaγ ≲ 3.3 × 10(-10) GeV(-1) at 95% C.L., with the exact value depending on the pressure setting. Future direct solar axion searches will focus on increasing the sensitivity to smaller values of gaγ, for example by the currently discussed next generation helioscope International AXion Observatory.

Distal tibiofibular radiological overlap: Does it always exist?

OBJECTIVES: Overlap between the distal tibia and fibula has always been quoted to be positive. If the value is not positive then an injury to the syndesmosis is thought to exist. Our null hypothesis is that it is a normal variant in the adult population. METHODS: We looked at axial CT scans of the ankle in 325 patients for the presence of overlap between the distal tibia and fibula. Where we thought this was possible we reconstructed the images to represent a plain film radiograph which we were able to rotate and view in multiple planes to confirm the assessment. RESULTS: The scans were taken for reasons other than pathology of the ankle. We found there was no overlap in four patients. These patients were then questioned about previous injury, trauma, surgery or pain, in order to exclude underlying pathology. CONCLUSION: We concluded that no overlap between the tibia and fibula may exist in the population, albeit in a very small proportion.

Clinical outcome using a ligament referencing technique in CAS versus conventional technique.

PURPOSE: Computer-assisted surgery (CAS) for total knee arthroplasty (TKA) has become increasingly common over the last decade. There are several reports including meta-analyses that show improved alignment, but the clinical results do not differ. Most of these studies have used a bone referencing technique to size and position the prosthesis. The question arises whether CAS has a more pronounced effect on strict ligamentous referencing TKAs. METHODS: We performed a prospective cohort study comparing clinical outcome of navigated TKA (43 patients) with that of conventional TKA (122 patients). Patients were assessed preoperatively, and 2 and 12 months postoperatively by an independent study nurse using validated patient-reported outcome tools as well as clinical examination. RESULTS: At 2 months, there was no difference between the two groups. However, after 12 months, CAS was associated with significantly less pain and stiffness, both at rest and during activities of daily living, as well as greater overall patient satisfaction. CONCLUSION: The present study demonstrated that computer-navigated TKA significantly improves patient outcome scores such as WOMAC score (P=0.002) and Knee Society score (P=0.040) 1 year after surgery in using a ligament referencing technique. Furthermore, 91% were extremely or very satisfied in the CAS TKA group versus 70% after conventional TKA (P=0.007).

Search for sub-eV mass solar axions by the CERN Axion Solar Telescope with 3He buffer gas.

The CERN Axion Solar Telescope (CAST) has extended its search for solar axions by using (3)He as a buffer gas. At T=1.8 K this allows for larger pressure settings and hence sensitivity to higher axion masses than our previous measurements with (4)He. With about 1 h of data taking at each of 252 different pressure settings we have scanned the axion mass range 0.39 eV≲m(a)≲0.64 eV. From the absence of excess x rays when the magnet was pointing to the Sun we set a typical upper limit on the axion-photon coupling of g(aγ)≲2.3×10(-10) GeV(-1) at 95% C.L., the exact value depending on the pressure setting. Kim-Shifman-Vainshtein-Zakharov axions are excluded at the upper end of our mass range, the first time ever for any solar axion search. In the future we will extend our search to m(a)≲1.15 eV, comfortably overlapping with cosmological hot dark matter bounds.

Evaluation of two aquatic passive sampling configurations for their suitability in the analysis of estrogens in water.

The presence of estrogens in the aquatic environment has been the target of several studies in the last decade. Newly developed passive sampling techniques for polar organic chemicals show great promise for the assessment of long-time exposure of aquatic organisms to emerging contaminants. In the present work, two configurations of the Chemcatcher(®) passive sampler have been tested for their applicability to the analysis of seven estrogens in water. Accumulation experiments in the laboratory, to calculate the uptake rates, and a field trial show that the polar configuration of this device may be used for the efficient sampling and determination of estrogens in water. Time weighted average concentrations were determined in the field trial and compared with spot sampling concentrations. The detection of estriol using passive sampling, although not found with spot sampling, clearly demonstrates the value of this technique in assessing relevant concentrations of estrogens in the aquatic media.

Lateral subvastus approach with osteotomy of the tibial tubercle for total knee replacement: a two-year prospective, randomised, blinded controlled trial.

The lateral subvastus approach combined with an osteotomy of the tibial tubercle is a recognised, but rarely used approach for total knee replacement (TKR). A total of 32 patients undergoing primary TKR was randomised into two groups, in one of which the lateral subvastus approach combined with a tibial tubercle osteotomy and in the other the medial parapatellar approach were used. The patients were assessed radiologically and clinically using measurement of the range of movement, a visual analogue patient satisfaction score, the Western Ontario McMasters University Osteoarthritis Index and the American Knee Society score. Four patients were lost to the complete follow-up at two years. At two years there were no significant differences between the groups in any of the parameters for clinical outcome. In the lateral approach group there was one complication due to displacement of the tibial tubercle osteotomy and two osteotomies took more than six months to unite. In the medial approach group, one patient had a partial tear of the quadriceps. There was a significantly greater incidence of lateral patellar subluxation in the medial approach group (3 of 12) compared with the lateral approach group (0 of 16) (p = 0.034), but without any apparent clinical detriment. We conclude that the lateral approach with tibial tubercle osteotomy is a safe technique with an outcome comparable with that of the medial parapatellar approach for TKR, but the increased surgical time and its specific complications do not support its routine use. It would seem to be more appropriate to reserve this technique for patients in whom problems with patellar tracking are anticipated.

[Periprosthetic fractures of the knee joint]. / Periprothetische Frakturen am Kniegelenk.

The demographic developments and an increasing number of total knee replacements will lead to more periprosthetic fractures in the future. These fractures can be classified into intraoperative and postoperative. Revisions in particular are associated with a higher incidence of intra-operative fractures, specifically for the tibia and patella. Most fractures occur in the postoperative period with an average of 2-4 years after the primary procedure. Most commonly the femur is involved. The history and clinical examination as well as imaging are crucial for the treatment as loose components would significantly alter the treatment strategy. In this case a revision has to be carefully planned. In the majority of the cases the prosthesis is well fixed especially at the femur. An open reduction internal fixation (ORIF) can then be carried out. A stable situation must be achieved to provide early post-operative mobilization. Also an anatomic reduction should be achieved with correct alignment especially with respect to varus/valgus and rotation. Modern locked implants can provide this with good success also with the possibility of minimally invasive techniques and polyaxial screw positioning. Retrograde intramedullary devices can be a feasible alternative. Similar principles can be used for the tibia whereas the patella can be stabilized with tension band wiring in the case of good bone stock but still remains a problem in case of bad bone stock.

Early results in the treatment of proximal humeral fractures with a polyaxial locking plate.

OBJECTIVES: We report early results using a second generation locking plate, non-contact bridging plate (NCB PH((R)), Zimmer Inc. Warsaw, IN, USA), for the treatment of proximal humeral fractures. The NCB PH combines conventional plating technique with polyaxial screw placement and angular stability. DESIGN: Prospective case series. SETTING: A single level-1 trauma center. PATIENTS: A total of 50 patients with proximal humeral fractures were treated from May 2004 to December 2005. INTERVENTION: Surgery was performed in open technique in all cases. MAIN OUTCOME MEASURES: Implant-related complications, clinical parameters (duration of surgery, range of motion, Constant-Murley Score, subjective patient satisfaction, complications) and radiographic evaluation [union, implant loosening, implant-related complications and avascular necrosis (AVN) of the humeral head] at 6, 12 and 24 weeks. RESULTS: All fractures available to follow-up (48 of 50) went to union within the follow-up period of 6 months. One patient was lost to follow-up, one patient died of a cause unrelated to the trauma, four patients developed AVN with cutout, one patient had implant loosening, three patients experienced cutout and one patient had an axillary nerve lesion (onset unknown). The average age- and gender-related Constant Score (n = 35) was 76. CONCLUSIONS: The NCB PH combines conventional plating technique with polyaxial screw placement and angular stability. Although the complication rate was 19%, with a reoperation rate of 12%, the early results show that the NCB PH is a safe implant for the treatment of proximal humeral fractures.

Analysis of phytoestrogens, progestogens and estrogens in environmental waters from Rio de Janeiro (Brazil).

The environment is currently exposed to a large variety of man-made chemicals (e.g. for industrial, medicinal use) which have potential adverse effects to its ecological status. In addition, the densely populated areas represent local high emissions of those chemicals leading to more aggravating consequences. Estrogenic compounds that end-up in environmental water directly affect living organisms by interfering with their endocrine metabolism. The assessment of their presence in the environment requires sensitive and selective analytical methods. Nineteen estrogenic compounds belonging to different classes (5 free estrogens, 6 conjugated estrogens, 3 progestogens and 5 phytoestrogens) have been studied. The analytical methodology developed is based on solid phase extraction followed by liquid chromatography tandem mass spectrometry and has been applied to study the occurrence of the above mentioned analytes in environmental waters from the state of Rio de Janeiro (Brazil). Due to insufficient infra-structure in this region, waste waters are released onto the environment without or with incomplete previous treatment. The results show that high levels of the phytoestrogens daidzein, coumestrol and genistein of up to 366 ng/L and progesterone of up to 47 ng/L could be found in river water. Estrogens and their conjugated derivatives were detected in the lower ng/L range up to 7 ng/L. The main estrogens estrone, estradiol and the synthetic ethinyl estradiol could not be detected. The developed method showed overall good performance with recoveries above 80% (with one exception), limits of detection < or =2 ng/L, good linearity and reproducibility.

Risk assessment of representative and priority pesticides, in surface water of the Alqueva reservoir (South of Portugal) using on-line solid phase extraction-liquid chromatography-tandem mass spectrometry.

Surface waters located in intensive agricultural areas are more vulnerable to the pesticides contamination, which is a major concern if the water is intended to be used for human consumption. The aim of this study was to evaluate the presence and the distribution of pesticides in the Alqueva reservoir, an important source of water supply (South of Portugal), considering their representativeness in the agricultural practice of the area. For the analysis of pesticides risk impact we used the environmental quality standards in the field of water policy proposed recently by the European Commission. The pesticides belonging to the classes of phenylureas, triazines, chloroacetanilides, organophosphorous and thiocarbamates were analysed by on-line solid phase extraction-liquid chromatography-tandem mass spectrometry. The pesticides more frequently detected were atrazine, simazine, diuron and terbuthylazine. The highest levels of these pesticides were registered in spring, after pesticides treatment, namely in olive-tree and vine crops. The priority pesticides atrazine and diuron reached values above the annual average proposed in the European Union Legislation. The herbicide atrazine reached values that surpassed the proposed maximum allowable concentration (2,000 ng L(-1)). The sampling stations most affected by these pesticides were Sra. Ajuda, Lucefecit and Alcarrache, located in the northern part of the reservoir, closer to Spain where the agricultural activity is more intensive.

Evaluation of the aquatic passive sampler Chemcatcher for the monitoring of highly hydrophobic compounds in water.

The Chemcatcher passive sampler was primarily developed for the detection and quantification of priority organic pollutants (e.g., polycyclic aromatic hydrocarbons) in water. In the present study, this prototype was evaluated for highly hydrophobic compounds such as the tetrabrominated diphenyl ether BDE-47, the hexabrominated diphenyl ether BDE-153, and the historic pesticide DDT with its main metabolites (DDE and DDD). The sampling device consists basically of a receiving phase with high affinity for organic chemicals which is separated from the environment by a diffusion limiting membrane, both placed in a rigid PTFE body. C18 Empore disks were evaluated as receiving phase, obtaining a better accumulation when impregnated until saturation with n-octanol. As diffusion membrane, low density polyethylene was chosen over polyethersulphone. Once optimized its accumulation capacity for the target compounds, the linear behaviour of this accumulation was investigated and shown to be satisfactory in a period of 15 days. Preliminary uptake rates calculated from that accumulation anticipate the utility of this device for the detection of DDXs and the PBDEs, as calculated limits of detection are lower than usually reported environmental concentrations.

Function, osteoarthritis and activity after ACL-rupture: 11 years follow-up results of conservative versus reconstructive treatment.

ACL-reconstruction aims to restore joint stability and prevent osteoarthritis; however, malfunction and osteoarthritis are often the sequelae. Our study asks whether ACL-reconstruction or conservative treatment lead to better long-term results. In this retrospective cohort study, 136 patients with isolated ACL-rupture who had been treated by bone-ligament-bone transplant or conservatively were identified. Twenty-seven of these were excluded because of a revision operation in the 11.1 years follow-up period, leaving 109 patients (60 reconstructions and 49 conservatively treated) for evaluation based on clinical, radiological and internationally accepted knee-scores (Tegner, IKDC, Kellgren and Lawrence). An individual cohort study is classified as EBM level 2b according to the Oxford Centre of EBM. We observed significantly better knee-stability (P = 0.008) but more osteoarthritis (Grade II or higher) after ACL-reconstruction (42% vs. 25%). Physical activity levels were similar in both groups during the follow-up period (P = 0.16). Eleven years after ACL-rupture the physical activity levels are similar for both groups. After ACL-reconstruction, stability is higher as is osteoarthritis, whereby the result is not necessarily perceived as better subjectively. Specifically, this retrospective study yielded a 24% incidence of oseoarthrits 11 years after conservative management of ACL-rupture in patients not needing secondary surgery. The risk of secondary meniscal tears is reduced after ACL reconstruction, which reduces the negative effects of OA after surgery. The ultimate objective would be to achieve a good subjective outcome by conservative treatment followed by a rehabilitation program designed to keep secondary meniscus tears at a low level.

Treatment of periprosthetic femur fractures with the non-contact bridging plate: a new angular stable implant.

OBJECTIVES: We report the application of a new fixed angle plate (NCB DF, Zimmer inc. USA, Warsaw, IN) in the treatment of periprosthetic femur fractures. The NCB DF combines conventional plating technique with polyaxial screw placement and angular stability. DESIGN: Prospective cohort study. SETTING: A single level-1 trauma center. PATIENTS: From May 2003 to December 2005, a total of 24 patients with periprosthetic femur fractures were treated. The NCB DF femur plate was used in all cases. The average follow-up period was 12 months (3-31 months). Twelve patients had a periprosthetic fracture after total knee replacement (TKA) and 12 patients after total hip replacement (THA). The mean period from primary joint replacement to periprosthetic fracture was 8.2 years for the THA group and 7.2 years for the TKA group. INTERVENTION: A combined conventional/locking surgical technique was performed in all the cases. MAIN OUTCOME MEASURES: Union, non-union, mal-union, duration of surgery, range of motion, postoperative mobility, subjective patient satisfaction and complications. RESULTS: The union rate was 90%, the mal-union rate 5% and the re-operation rate 15%. Postoperative mobility reached the preoperative level in all but for two patients. Three complications occurred relating to the implant or the procedure: one fatigue failure of the plate (non-union), one screw breakage, and one wound infection. CONCLUSIONS: The NCB DF combines conventional plating technique with polyaxial screw placement and angular stability. This combination technique shows promising results regarding union and mal-union rates in periprosthetic fractures in elderly and osteoporotic patients.

The variation in medial and lateral collateral ligament strain and tibiofemoral forces following changes in the flexion and extension gaps in total knee replacement. A laboratory experiment using cadaver knees.

Achieving deep flexion after total knee replacement remains a challenge. In this study we compared the soft-tissue tension and tibiofemoral force in a mobile-bearing posterior cruciate ligament-sacrificing total knee replacement, using equal flexion and extension gaps, and with the gaps increased by 2 mm each. The tests were conducted during passive movement in five cadaver knees, and measurements of strain were made simultaneously in the collateral ligaments. The tibiofemoral force was measured using a customised mini-force plate in the tibial tray. Measurements of collateral ligament strain were not very sensitive to changes in the gap ratio, but tibiofemoral force measurements were. Tibiofemoral force was decreased by a mean of 40% (SD 10.7) after 90 degrees of knee flexion when the flexion gap was increased by 2 mm. Increasing the extension gap by 2 mm affected the force only in full extension. Because increasing the range of flexion after total knee replacement beyond 110 degrees is a widely-held goal, small increases in the flexion gap warrant further investigation.

[Knee ligament injuries]. / Ligamentäre Knieverletzungen in der Praxis.

Like no other joint of the human body the knee depends on intact ligaments. Knee instability due to ligament injuries will cause abnormal joint kinematics, and thereby is made responsible for secondary damage to other important knee joint structures. Diagnosis of knee ligament injuries is based on the detailed history with often typical injury patterns, as well as on the physical examination with specific knee ligament tests. In addition radiological evaluation is used. The range of knee ligament injuries is wide. Beginning with an isolated medial collateral ligament rupture which will heal with conservative treatment, they range to knee dislocation, a serious injury which needs emediate care and is associated with a high incidence of complications. Surgical procedures aim to reconstruct knee ligaments as anatomical as possible to provide for a long term stable knee joint.