Fixation-based surgery: a new technique for distal radius osteotomy.

OBJECTIVE: The objective was to develop a fixation-based three-dimensional presurgical planner and an intraoperative guidance system for distal radius osteotomy. Fixation-based surgery is a technique premised on using a fixation device, such as a fracture-fixation plate, during the alignment and distraction phases of an osteotomy. MATERIALS AND METHODS: The planning system and guidance system were coded using OpenGL on UNIX workstations. In vitro tests were performed to compare the reproducibility of the computer-enhanced technique to that of the traditional technique, and an in vivo pilot study was initiated. RESULTS: In vitro, the computer-enhanced technique produced a significant reduction by more than one half in both the maximum error of correction and the standard deviation of the correction error. Preliminary in vivo results on six patients suggest that similar error diminution will occur during regular clinical application of the technique. CONCLUSIONS: Both studies showed that the computer system is simple to use. The planning system allowed the surgeon to perform multiple simulations of the surgical procedure preoperatively, which were used to optimize the plan and identify potential problems during realignment. The use of a fixation-based technique avoided the complexity of attempting to guide the surgeon to realign a bone fragment in six degrees of freedom of correction, and eliminated the use of X-ray fluoroscopy for achieving the alignment.

Three-dimensional metacarpophalangeal joint kinematics using two markers on the phalanx.

A protocol for analysing three-dimensional metacarpophalangeal (MCP) joint motion in vivo using two markers on the proximal phalanx is described. The analysis uses an assumption that the rotation of the phalanx about its own long axis is zero. In an experimental study 24 volunteers had surface markers applied to the dorsal surfaces of their hands and index and long finger proximal phalanges, with three-dimensional marker positions recorded in two hand and finger postures in an incomplete box design using a test-retest protocol. Kinematic parameters from the optoelectronic system were compared with those obtained from three-dimensional reconstruction of bone landmarks and of the marker positions identified on stereoradiographs. Pronation/supination angles obtained from bone landmarks showed high test-retest variability, reflecting the difficulty in obtaining reliable pronation/supination data in small bones without the use of implanted markers. Changes in MCP joint extension and deviation angles determined using two surface markers agree with those obtained from bone landmarks. The results indicate a reproducible protocol for tracking MCP joint motion using only two phalangeal markers, suggesting that the 'no-rotation assumption' can be applied without affecting measures of extension and deviation motion in the normal joint.

In situ compressive properties of the glenoid labrum.

The purpose of this study was to measure the structural stiffness (load/displacement response) and elastic modulus (stress-strain response) of the glenoid labrum at different locations throughout the tissue. It was intended that the results of this work would serve to define the properties of the labrum. This in turn may permit a better understanding of labral function and of the mechanics of injury or degeneration and may ultimately contribute to improving the design of future labral reconstruction procedures. In addition, these data may allow incorporation of labral properties into a glenoid arthroplasty component. The testing procedure consisted of rapid compression of the labrum using a flat indentor. Stiffness and modulus results demonstrated differences between the superior and inferior portions of the labrum. The elastic moduli findings for the labrum were 0.18 +/- 0.17, 0.11 +/- 0.16, and 0.23 +/- 0.20 MPa for the inferior anterior, inferior, and inferior posterior sections, respectively. The superior anterior, superior, and superior posterior sections were respectively 0.19 +/- 0.09, 0. 32 +/- 0.22, and 0.41 +/- 0.32 MPa. These results are similar to those of knee menisci. The modulus findings for the substrate cartilage were 1.92 +/- 0.78, 1.99 +/- 0.70, and 2.00 +/- 1.33 MPa for the inferior anterior, inferior, and inferior posterior sections, respectively. The superior anterior, superior, and superior posterior sections were respectively 1.60 +/- 0.79, 1.29 +/- 0.75, and 1.42 +/- 0.54 MPa, which are comparable to previous cartilage findings.

In vitro analysis of colour Doppler flow with the use of proximal isovelocity surface area: improved flow estimates using a nonhemispherical model.

OBJECTIVE: To examine the geometry of the proximal isovelocity surface area (PISA) envelope and its associated isotach, and to evaluate the accuracy of two models of calculating volumetric flow by using the PISA technique. DESIGN: A new model for determining isotach geometry from the PISA envelope was developed and tested in an in vitro simulation. SETTING: Echocardiography Laboratory, Hotel Dieu Hospital, Kingston, Ontario. MATERIALS AND METHODS: PISA envelopes were visualized using an in vitro flow simulator with a series of sharp-edged orifices (2.5 to 16 mm diameter) at a range of flow rates (10 to 110 mL/s). INTERVENTIONS: Flow calculations based on the traditional hemispherical geometric assumption for the isotach and the new model were made and compared with measured flow rates. MAIN RESULTS: The hemispherical model systematically and significantly underestimated flow. The nonhemispherical model, which requires measurement of both the height (a) and lateral width (2d) of the PISA envelope, provided improved estimates of flow. CONCLUSIONS: The nonhemispherical model provides a better estimate of flow through an orifice. Flow rate Q can be calculated directly from the size of the PISA envelope and the aliasing velocity (VA) by using the relationship Q = (3.14d2 + 5.97da + 1.37a2)VA or can be read from a nomogram.

Mechanical properties of wrist extensor tendons are altered by the presence of rheumatoid arthritis.

The in vitro mechanical properties of 14 wrist extensor tendons salvaged at surgery from patients with inflammatory (rheumatoid) arthritis and noninflammatory arthrosis were measured in uniaxial tension and compared. The rheumatoid tendons had higher extensibility at low stresses, lower stiffness in the linear portion of the stress-strain curve, greater rates of stress relaxation, and lower ultimate strengths than did the nonrheumatoid tendons. Differences in tangent modulus, stress remaining at 100 seconds, and ultimate tensile strength were significant at the 95% confidence level. In vivo, mechanically impaired tendons may play an important role in destabilization of the wrist in patients with rheumatoid arthritis.

Load dependence in carpal kinematics during wrist flexion in vivo.

OBJECTIVE: The hypothesis tested was that generation of torque at the wrist affects joint kinematics. DESIGN: An in vivo study of normal wrist kinematics during plantar flexion motion against a constant load was undertaken, using a custom-designed instrumented apparatus to track the motion of the hand during the task. BACKGROUND: Despite clinical observations of a relationship between motion-loading and pain in wrists affected by rheumatoid arthritis, there is little published literature on thein vivo kinematics of the normal human wrist under load. METHODS: Ten volunteers with no wrist pathology were tested while generating torques of zero, 1.1 and 2.2 N m in a planar, unidirectional flexion motion. Hand kinematics were computed using the Planar Rigid Body Method algorithm and an 8 degrees angular step size. The finite radius of motion and the range and standard deviation of the residuals to a fitted second-order curve were used as indices of changes in the kinematics. RESULTS: The magnitude of both the range and standard deviation of the residuals were found to increase significantly with torque at the 95% confidence level. CONCLUSIONS: The wrist does not behave like a smooth mechanism when generating torque. Load affects carpal kinematics. RELEVANCE: We propose that fluctuations in the finite radius of motion are the natural kinematic consequence of intercarpal motion known to occur during wrist flexion. Wrist kinematics may be particularly sensitive to load and joint integrity because orchestrated intercarpal motion depends on the soundness of articular and ligamentous structures, the first to be affected in joint degenerating conditions such as rheumatoid arthritis. Thus, wrist kinematics under load may be a key to characterizing joint integrity. In wrist pathologies, simple planar testing of carpal kinematics under reproducible and controlled joint torque conditions may be a useful way to assess joint involvement before the onset of gross dysfunction, and to evaluate treatment outcomes.

Validation of a 3D optoelectronic motion analysis system for the wrist joint.

OBJECTIVE: A study was undertaken to determine the experimental accuracy of a non-invasive optoelectonic 3-dimensional tracking system in assessing wrist joint motion. DESIGN: This was an in vivo experimental study involving volunteer subjects performing prescribed wrist motions. BACKGROUND: Current clinical practice does not include routine kinematic analysis for evaluating arthritic disease state, although motion disorders are common. METHODS: Surface markers were applied to 24 subjects assigned two hand postures in a test-retest factorial design for the expected range of motion. The marker positions were measured optoelectronically and using calibrated stereoradiography, to determine the positions of the surface markers and of key bone landmarks. Alignment and motion were compared for the three measurement techniques. Standard kinematic analyses were performed to extract Euler angles and equivalent screw displacement axes for paired postures. RESULTS: The three measurement techniques were highly correlated for wrist flexion-extension. Uncertainties were less than 6 degrees, similar to uncertainties from bone landmark identification errors when implanted markers cannot be used. Measures of motion exhibited higher correlations than those for alignment. Equivalent screw displacement axis orientations had poor intraclass correlations, reflecting sensitivity to coordinate system definitions. CONCLUSIONS: For motion analysis in the wrist in vivo, a non-invasive optoelectronic measurement system is as accurate as stereoradiographic analysis of bone segments.

Biomedical engineering education in Canada, 1996.

This paper updates the information contained in a previously published paper, ¿Bioengineering Education in Canada, 1988,¿ which appeared in the Journal of Clinical Engineering (Volume 13, No. 5). It describes the current biomedical engineering and biomedical engineering technology programs available in Canada, but does not attempt to evaluate them. There are no undergraduate degree programs specifically in biomedical engineering, although three universities have created options in biomedical engineering in undergraduate programs. Also, the clinical engineering program at the University of British Columbia has been discontinued.

Survey of automated noninvasive blood pressure monitors.

Automated noninvasive blood pressure (NIBP) monitors, or automated sphygmomanometers, have been increasingly used both inside and outside clinical environments. An extensive survey of such monitors was carried out over the past five years. This survey covers a broad spectrum of monitors including ambulatory monitors, bedside and transport monitors, stress-test monitors, and monitors that are intended for self-measurement. It includes more than 400 models from suppliers in the United States and many other countries. A review of NIBP measurement methods that have been used in automated NIBP monitors is presented in this paper, along with statistical distributions of their use in the surveyed monitors and a list of the suppliers and monitors.

Update on methods & simulators for evaluation of noninvasive blood pressure monitors.

The development of methods and simulators for evaluating noninvasive blood pressure (NIBP) monitors has been dynamic during the past few years. As a complement to a previous review paper in this journal, several additional developments are reported in this paper. These include evaluation methods developed in Australia, the United States and Europe, as well as NIBP simulators developed in Germany and the United States.

Precision and accuracy of bone landmarks in characterizing hand and wrist position.

Characterization of the motion of the hand and wrist requires reference to the underlying bones which, for three-dimensional analyses, are assumed to be rigid bodies. Stereoradiogrammetric techniques involving the identification of prominent bone landmarks have been used as the standard against which surface markers used for in vivo testing have been evaluated. The precision and accuracy with which the 3D positions of bone landmarks in the hand and wrist could be determined was evaluated in a small inter-observer and inter-cadaver study and compared to the precision and accuracy with which implanted lead markers could be located. A subset of landmarks suitable for evaluating wrist and metacarpal-phalangeal joint motion was identified; the mean precision for identifying these points was better than 1.1 mm in all hand positions with a mean inter-observer accuracy of 2.3 mm. These values show that the average uncertainty in locating bone landmarks is at best roughly twice that for implanted markers.

Changes in oscillometric pulse amplitude envelope with cuff size: implications for blood pressure measurement criteria and cuff size selection.

Oscillometric blood pressures are derived from the amplitude envelope of oscillometric pulses generated in an occlusive cuff during cuff inflation or deflation; one factor which will affect the characteristics of these pulses is the size of the cuff bladder. Because limiting values are stipulated in recommendations and standards for bladder sizes, there is a wide variety of acceptable cuff sizes for any particular application. An experimental and theoretical study was undertaken to show the dependence of oscillometric blood pressures on bladder size. Actual cuff-arm compliance data were obtained from two subjects for two cuffs of different bladder size. Theoretical analysis was then applied to the data to predict the effects of different bladder sizes on the characteristics of the pulses. The results show that cuff-arm compliance and bladder size interact to affect the pulse amplitude and hence oscillometric blood pressure determination. These results suggest that blood pressures obtained using the oscillometric method may vary depending on cuff size, and in particular that replacement cuffs for oscillometric non-invasive blood pressure monitors should be chosen carefully.

Optimized 3D coordinate reconstruction from paired stereographs using a calibrated phantom.

A refinement to a previously described three-dimensional reconstruction algorithm based on point identification in calibrated non-orthogonal radiograms (stereo-pairs) is described. The modification involves a computation of the focal point magnitude of the point in three dimensions, analogous to focusing in two dimensions, as well as the most likely location of the target point in 3-space; the focal point magnitude may be thought of as the precision of the point identification. Multiple observer studies of the same stereopair can be used to estimate three-dimensional reconstruction accuracy by providing an average location and a mean distance from average. Both measures are useful parameters for initial selection of bone landmark references and for error propagation studies.

Stereoradiogrammetric technique for estimating alignment of the joints in the hand and wrist.

A method and apparatus for quantitative measurement of the alignment and motion of the joints of the hand in three dimensions has been developed using stereoradiogrammetric principles. Alignment in planes of flexion-extension and radial-ulnar deviation can be determined to within 2.5 degrees; rotation about the long axis of the metacarpals or phalanges is more difficult to determine, and can be measured to within 7 degrees. Stereo views subtending angles in the range of 40 degrees were found to optimize the total system accuracy.

A kinematic technique for describing wrist joint motion: analysis of configuration space plots.

This paper describes an experimental method for determining the minimum number of degrees of freedom of a human joint. Application of this technique to the wrist suggests that the normal, intact wrist joint uses only two degrees of freedom to move in a plane that is not aligned with the anatomic planes. The technique may be useful in identifying emerging joint pathologies and in simplifying kinematic models of joint function.

Review of methods & simulators for evaluation of noninvasive blood pressure monitors.

Automated noninvasive blood pressure (NIBP) monitors have found widespread use both inside and outside clinical environments in recent years. Present methods for evaluating the measurement accuracy of this class of devices involve population studies that are meticulous, time-consuming and costly. These methods are also impractical for routine evaluation. NIBP simulators offer an alternative approach to evaluating automated NIBP monitors without directly using human subjects. They enable evaluation to be carried out on demand with little training, providing a safe and convenient way for manufacturers and hospitals to validate the performance of both new and existing monitors.

Rationalization of kinematic descriptors for three-dimensional hand and finger motion.

Modelling joint motion in three dimensions is often based on techniques taken from classical dynamics, each analysis resulting in a set of six parameters describing the relative motion between two body segments. The literature on joint kinematics has been difficult to compare due to use of different anatomical landmarks, axis nomenclature, and analytical methods. It is here shown that with care in sequence definition, the three alignment-based systems (Euler, Cardan, floating axis) give identical results for angular parameters. While the equivalent screw displacement axis system can be related simply to the other methods only if the functional axis of motion is aligned with a coordinate axis, the basic matrix for relating rigid body positions before and after a motion can always be reconstructed. Therefore the changes in alignment angles may be obtained from screw displacement parameters, permitting the results of different analyses to be compared. Translation parameters are most difficult to interpret in any system. Examples of the way in which simple planar motions are characterized by the various analytical methods are given.

Detection of interruptions in the breathing gas of ventilated anaesthetized patients.

Interruption of the breathing gas to a ventilated anaesthetized patient due to accidental disconnection or anaesthesia system malfunction may have serious consequences if not detected quickly. A series of tests which covers the range of foreseeable mechanical problems was developed and used to test the performance of three breathing gas interruption monitors, two commercially available and one developed at Vancouver General Hospital. The tests were designed to evaluate the performance of monitors as installed on anaesthesia systems under a variety of failure conditions, including endotracheal tube disconnection with and without occlusion of the opening, kinks in the inspiratory and fresh gas hoses, disconnection of the fresh gas hose, leaks in the breathing circuit, excessive high or low pressure in the scavenging circuit, continuing high breathing circuit pressure, and kinks in the circuit pressure sensing hose. Ability to detect both significant changes in ventilation variables and faults existing at initiation of ventilation were also tested over a representative range of ventilator and patient variables using circle, coaxial and paediatric circuits. Only complete endotracheal tube disconnections with no obstruction of the opening were reliably detected by all three monitors. A commercial monitor with a single fixed-threshold alarm level also detected fresh gas interruptions in circle and adult coaxial circuits, but failed to alarm in response to any other fault condition. A monitor with selectable pressure thresholds and high, low, and continuing pressure limits detected just under half of the fault conditions. A microprocessor-based monitor developed at Vancouver General Hospital detected and correctly identified roughly 80 per cent of the faults. The series of tests forms the basis for a Canadian Standards Association Preliminary Standard (Z168.10) and will allow hospitals to test the performance of breathing gas interruption monitors in use in their institutions. Comments on the test series are solicited.

Bioengineering education in Canada, 1988.

As a companion article to the Journal of Clinical Engineering's series on Bioengineering Education in the United States, this paper describes the biomedical engineering and biomedical engineering technology programs in Canada. The purpose of the article is not to evaluate each program, but to illustrate the breadth of bioengineering and related programs available today in this country. While biomedical engineering technology programs are offered at the college level, the Canadian philosophy toward biomedical engineering is slightly different from that found in the United States: in Canada, biomedical engineering is offered only at the graduate level to qualified applicants with a previous degree in engineering, science, medicine, or dentistry.