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Introduction The purpose of the current study is to present the outcome of closed reduction and stabilization using an Illizarov ring fixator in severe pilon fractures and to investigate the correlation between reduction quality and clinical and functional outcomes. Materials and methods Thirty-three type III tibial plafond fractures, which had been treated with this method, were retrospectively analysed. Quality of reduction was classified according to the Teeny & Wiss (TW) criteria. Clinical and functional assessment was carried out using the Ovadia & Beals (OB) and Olerud & Molander (OM) scores. Results All fractures were successfully united. The mean time in the fixator was 6.3 months, and the mean follow-up was 50 months after frame removal. There were no major infections. There was no significant relationship between TW and OM (r=-0.34, p=0.13), TW and OB (r=0.35, p=0.23), neither Delay (from injury until surgery) and OM (r=-0.03, p=0.28), and Delay and OB (r=0.30, p=0.31). Conclusions The present study demonstrates that the major problems of open reduction and internal fixation of pilon type III fractures can be avoided by a non-invasive approach to the treatment of these fractures. The articular surface can be reconstituted with olive-tip wires and small fragment washers, early ligamentotaxis and fracture stabilization with the Ilizarov ring fixator. These simple steps could lead safely to union and a good clinical and functional outcome.
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Measuring the spectral phase of a pulse is key for performing wavelength resolved ultrafast measurements in the few femtosecond regime. However, accurate measurements in real experimental conditions can be challenging. We show that the reflectivity change induced by coherent phonons in a quantum material can be used to infer the spectral phase of an optical probe pulse with few-femtosecond accuracy.
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BACKGROUND: Secondary patella resurfacing is often performed for dissatisfaction following primary knee arthroplasty where the native patella was retained. The purpose of this meta-analysis was to evaluate outcomes of secondary patella resurfacing. METHODS: The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Studies reporting on patients who underwent secondary patella resurfacing after previous primary knee arthroplasty with retention of the native patella were considered eligible. The risk of bias was assessed using the Methodological Index for Non-Randomized studies tool. A random-effects model and the inverse-variance weighting method was used for meta-analysis. There were sixteen retrospective studies including 604 knees (594 patients) with a mean follow up of 42 months (range, 2 to 197). RESULTS: An overall improvement in patient-reported outcomes (PROMs) was achieved in 53% of cases from pooled data available for 293 knees [95% Confidence Interval (CI) (0.44, 0.62), I2=68% - moderate heterogeneity]. The pooled proportion of patients satisfied with the procedure was 59% [95% CI (48, 68), I2 = 70% - moderate heterogeneity] in a sample size of 415. There was a minimal rate (2%) of complication incidence when performing secondary patella resurfacing and a pooled rate of revision surgery of 10%. CONCLUSIONS: An improvement in pain, satisfaction, and PROMs was achieved in slightly more than half of the patients following secondary patella resurfacing. However, studies lacked standardized objective selection criteria for the procedure and the available data was predominantly retrospective, with high heterogeneity and variation in outcome reporting.
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Artroplastia do Joelho , Prótese do Joelho , Osteoartrite do Joelho , Humanos , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Patela/cirurgia , Estudos Retrospectivos , Dor/cirurgia , Reoperação , Resultado do Tratamento , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/cirurgiaRESUMO
Spontaneous C4-symmetry breaking phases are ubiquitous in layered quantum materials, and often compete with other phases such as superconductivity. Preferential suppression of the symmetry broken phases by light has been used to explain non-equilibrium light induced superconductivity, metallicity, and the creation of metastable states. Key to understanding how these phases emerge is understanding how C4 symmetry is restored. A leading approach is based on time-dependent Ginzburg-Landau theory, which explains the coherence response seen in many systems. However, we show that, for the case of the single layered manganite La0.5Sr1.5MnO4, the theory fails. Instead, we find an ultrafast inhomogeneous disordering transition in which the mean-field order parameter no longer reflects the atomic-scale state of the system. Our results suggest that disorder may be common to light-induced phase transitions, and methods beyond the mean-field are necessary for understanding and manipulating photoinduced phases.
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In this work, we present an achromatic pump-probe setup covering the visible (VIS) to near-infrared (NIR) wavelength regions (500-3000 nm) for few-cycle pulses. Both the pump and probe arms can work either in the VIS or the NIR wavelength regions, making our setup suitable for multi-color, broadband pump-probe measurements. In particular, our setup minimizes time-smearing due to the phase front curvature, an aspect of ultrafast spectroscopy that has been missing from previous works and allowing us to achieve sub-20-fs temporal resolution. We demonstrate the capabilities of our setup by performing measurements on Pr0.5Ca1.5MnO4. We pump and probe in both wavelength regions with a range of pump fluences and demonstrate how the observed dynamics depend strongly on the probe wavelength. Furthermore, the observation of a 16.5 THz phonon demonstrates the high temporal resolution of the setup.
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Solid-state systems can host a variety of thermodynamic phases that can be controlled with magnetic fields, strain, or laser excitation. Many phases that are believed to exhibit exotic properties only exist on the nanoscale, coexisting with other phases that make them challenging to study, as measurements require both nanometer spatial resolution and spectroscopic information, which are not easily accessible with traditional x-ray spectromicroscopy techniques. Here, we use coherent diffractive imaging spectroscopy (CDIS) to acquire quantitative hyperspectral images of the prototypical quantum material vanadium oxide across the vanadium L 2,3 and oxygen K x-ray absorption edges with nanometer-scale resolution. We extract the full complex refractive indices of the monoclinic insulating and rutile conducting phases of VO2 from a single sample and find no evidence for correlation-driven phase transitions. CDIS will enable quantitative full-field x-ray spectromicroscopy for studying phase separation in time-resolved experiments and other extreme sample environments where other methods cannot operate.
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Although ultrafast manipulation of magnetism holds great promise for new physical phenomena and applications, targeting specific states is held back by our limited understanding of how magnetic correlations evolve on ultrafast timescales. Using ultrafast resonant inelastic X-ray scattering we demonstrate that femtosecond laser pulses can excite transient magnons at large wavevectors in gapped antiferromagnets and that they persist for several picoseconds, which is opposite to what is observed in nearly gapless magnets. Our work suggests that materials with isotropic magnetic interactions are preferred to achieve rapid manipulation of magnetism.
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Tuneable ultrafast laser pulses are a powerful tool for measuring difficult-to-access degrees of freedom in materials science. In general these experiments require the ability to address resonances and excitations both above and below the bandgap of materials, and to probe their response at the timescale of the fastest non-trivial internal dynamics. This drives the need for ultrafast sources capable of delivering 10-15 fs duration pulses tuneable across the entire visible (VIS) and near infrared (NIR) range, 500- 3000 nm, as well as the characterization of these sources. Here we present a single frequency-resolved optical gating (FROG) system capable of self-referenced characterization of pulses with 10 fs duration across the entire VIS-NIR spectral range. Our system does not require auxiliary beams and only minor reconfiguration for different wavelengths. We demonstrate the system with measurements of pulses across the entire tuning range.
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Many ultrafast solid phase transitions are treated as chemical reactions that transform the structures between two different unit cells along a reaction coordinate, but this neglects the role of disorder. Although ultrafast diffraction provides insights into atomic dynamics during such transformations, diffraction alone probes an averaged unit cell and is less sensitive to randomness in the transition pathway. Using total scattering of femtosecond x-ray pulses, we show that atomic disordering in photoexcited vanadium dioxide (VO2) is central to the transition mechanism and that, after photoexcitation, the system explores a large volume of phase space on a time scale comparable to that of a single phonon oscillation. These results overturn the current understanding of an archetypal ultrafast phase transition and provide new microscopic insights into rapid evolution toward equilibrium in photoexcited matter.
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We use resonant soft X-ray holography to image the insulator-metal phase transition in vanadium dioxide with element and polarization specificity and nanometer spatial resolution. We observe that nanoscale inhomogeneity in the film results in spatial-dependent transition pathways between the insulating and metallic states. Additional nanoscale phases form in the vicinity of defects which are not apparent in the initial or final states of the system, which would be missed in area-integrated X-ray absorption measurements. These intermediate phases are vital to understand the phase transition in VO2, and our results demonstrate how resonant imaging can be used to understand the electronic properties of phase-separated correlated materials obtained by X-ray absorption.
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Strain engineering is an emerging route for tuning the bandgap, carrier mobility, chemical reactivity and diffusivity of materials. Here we show how strain can be used to control atomic diffusion in van der Waals heterostructures of two-dimensional (2D) crystals. We use strain to increase the diffusivity of Ge and Te atoms that are confined to 5 Å thick 2D planes within an Sb2Te3-GeTe van der Waals superlattice. The number of quintuple Sb2Te3 2D crystal layers dictates the strain in the GeTe layers and consequently its diffusive atomic disordering. By identifying four critical rules for the superlattice configuration we lay the foundation for a generalizable approach to the design of switchable van der Waals heterostructures. As Sb2Te3-GeTe is a topological insulator, we envision these rules enabling methods to control spin and topological properties of materials in reversible and energy efficient ways.
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Phase-change materials based on Ge-Sb-Te alloys are widely used in industrial applications such as nonvolatile memories, but reaction pathways for crystalline-to-amorphous phase-change on picosecond timescales remain unknown. Femtosecond laser excitation and an ultrashort x-ray probe is used to show the temporal separation of electronic and thermal effects in a long-lived (>100 ps) transient metastable state of Ge2Sb2Te5 with muted interatomic interaction induced by a weakening of resonant bonding. Due to a specific electronic state, the lattice undergoes a reversible nondestructive modification over a nanoscale region, remaining cold for 4 ps. An independent time-resolved x-ray absorption fine structure experiment confirms the existence of an intermediate state with disordered bonds. This newly unveiled effect allows the utilization of non-thermal ultra-fast pathways enabling artificial manipulation of the switching process, ultimately leading to a redefined speed limit, and improved energy efficiency and reliability of phase-change memory technologies.
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In-plane anisotropic ground states are ubiquitous in correlated solids such as pnictides, cuprates and manganites. They can arise from doping Mott insulators and compete with phases such as superconductivity; however, their origins are debated. Strong coupling between lattice, charge, orbital and spin degrees of freedom results in simultaneous ordering of multiple parameters, masking the mechanism that drives the transition. Here we demonstrate that the orbital domains in a manganite can be oriented by the polarization of a pulsed THz light field. Through the application of a Hubbard model, we show that domain control can be achieved by enhancing the local Coulomb interactions, which drive domain reorientation. Our results highlight the key role played by the Coulomb interaction in the control and manipulation of orbital order in the manganites and demonstrate a new way to use THz to understand and manipulate anisotropic phases in a potentially broad range of correlated materials.
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The extreme electro-optical contrast between crystalline and amorphous states in phase-change materials is routinely exploited in optical data storage and future applications include universal memories, flexible displays, reconfigurable optical circuits, and logic devices. Optical contrast is believed to arise owing to a change in crystallinity. Here we show that the connection between optical properties and structure can be broken. Using a combination of single-shot femtosecond electron diffraction and optical spectroscopy, we simultaneously follow the lattice dynamics and dielectric function in the phase-change material Ge2Sb2Te5 during an irreversible state transformation. The dielectric function changes by 30% within 100 fs owing to a rapid depletion of electrons from resonantly bonded states. This occurs without perturbing the crystallinity of the lattice, which heats with a 2-ps time constant. The optical changes are an order of magnitude larger than those achievable with silicon and present new routes to manipulate light on an ultrafast timescale without structural changes.
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The non-equilibrium approach to correlated electron systems is often based on the paradigm that different degrees of freedom interact on different timescales. In this context, photo-excitation is treated as an impulsive injection of electronic energy that is transferred to other degrees of freedom only at later times. Here, by studying the ultrafast dynamics of quasi-particles in an archetypal strongly correlated charge-transfer insulator (La2CuO(4+δ)), we show that the interaction between electrons and bosons manifests itself directly in the photo-excitation processes of a correlated material. With the aid of a general theoretical framework (Hubbard-Holstein Hamiltonian), we reveal that sub-gap excitation pilots the formation of itinerant quasi-particles, which are suddenly dressed by an ultrafast reaction of the bosonic field.
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BACKGROUND: Compressive and quadriceps forces have been associated with noncontact anterior cruciate ligament (ACL) injury. The purpose of this study was to quantify the relative importance of each load component during noncontact ACL injury. HYPOTHESIS: We hypothesized that the introduction of a quadriceps force lowers the axial compressive force threshold to produce ACL injury. STUDY DESIGN: Controlled laboratory study. METHODS: Six pairs of fresh-frozen cadaveric knees, flexed to 15°, were loaded with axial compression (group A) or compression with a quadriceps force (group B) until failure. All specimens underwent axial compressive loading under displacement control with a time to peak load of 50 msec. The initial displacement of the MTS actuator was 8 mm and was increased in 2-mm increments with successive tests until catastrophic damage of the joint occurred. Failure was determined by a combination of clinical specimen examination and force-displacement data analysis and by dissection and direct visualization after failure was recognized. Differences in failure load between groups were examined using a paired t test (significance, P ≤ .05). RESULTS: In group A, there were 2 isolated ACL injuries, 2 ACL ruptures combined with a tibial plateau fracture, and 2 isolated tibial plateau fractures. In group B, there were 5 isolated ACL ruptures and 1 tibial plateau fracture. There was a significant difference in the average failure load between groups A and B: 10 832 N (95% confidence interval [CI], 9743-11,604 N) and 6119 N (95% CI, 4335-7903 N), respectively. CONCLUSION: Isolated compressive forces displayed an ability to produce an ACL injury in this cadaveric model, but the addition of a quadriceps load significantly reduced the compressive force required for ACL injury. CLINICAL RELEVANCE: Compressive and quadriceps forces contribute to noncontact ACL injury and should be taken into account when developing ACL injury prevention programs and rehabilitation after ACL reconstruction.
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Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho/etiologia , Cadáver , Humanos , Pessoa de Meia-Idade , Músculo Quadríceps , Fraturas da Tíbia/etiologiaRESUMO
BACKGROUND: Optimal alignment of the prosthesis in total knee arthroplasty results in improved patient outcomes. The goal of this study was to determine the most accurate technique for component alignment in total knee arthroplasty by comparing computer-assisted surgery with two conventional techniques involving use of an intramedullary guide for the femur and either an intramedullary or an extramedullary guide for the tibia. METHODS: One hundred and seven patients were randomized prior to surgery to one of three arms: computer-assisted surgery for both the femur and the tibia (the computer-assisted surgery group), intramedullary guides for both the femur and the tibia (the intramedullary guide group), and an intramedullary guide for the femur and an extramedullary guide for the tibia (the extramedullary guide group). Measurements of alignment on hip-to-ankle radiographs and computed tomography (CT) scans made three months after surgery were evaluated. The operative times and complications were compared among the three groups. RESULTS: The coronal tibiofemoral angle demonstrated, on average, less malalignment in the computer-assisted surgery group (1.91°) than in the extramedullary (3.22°) and intramedullary (2.59°) groups (p = 0.007). The coronal tibiofemoral angle was >3° of varus or valgus deviation in 19% (seven) of the thirty-six patients treated with computer-assisted surgery compared with 38% (thirteen) of the thirty-four in the extramedullary guide group and 36% (thirteen) of the thirty-six in the intramedullary guide group (p = 0.022). The increase in accuracy with computer-assisted surgery came at a cost of increased operative time. The operative time for the computer-assisted surgery group averaged 107 minutes compared with eighty-three and eighty minutes, respectively, for the surgery with the extramedullary and intramedullary guides (p < 0.0001). There was no significant difference in any of the outcomes between the intramedullary and extramedullary guide groups. CONCLUSIONS: This study provides evidence that the implant alignment with computer-assisted total knee arthroplasty, as measured with radiography and computed tomography, is significantly improved compared with that associated with conventional surgery with intramedullary or extramedullary guides. This finding adds to the body of evidence showing an improved radiographic outcome with computer-assisted surgery compared with that following conventional total knee arthroplasty.
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Artroplastia do Joelho/instrumentação , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Ajuste de Prótese/métodos , Cirurgia Assistida por Computador/métodos , Análise de Variância , Feminino , Fêmur/cirurgia , Humanos , Modelos Lineares , Modelos Logísticos , Masculino , Osteoartrite do Joelho/diagnóstico por imagem , Tíbia/cirurgia , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
We propose a method for improving the quality of cone-beam tomographic reconstruction done with a C-arm. C-arm scans frequently suffer from incomplete information due to image truncation, limited scan length, or other limitations. Our proposed "hybrid reconstruction" method injects information from a prior anatomical model, derived from a subject-specific computed tomography (CT) or from a statistical database (atlas), where the C-arm X-ray data is missing. This significantly reduces reconstruction artifacts with little loss of true information from the X-ray projections. The methods consist of constructing anatomical models, fast rendering of digitally reconstructed radiograph (DRR) projections of the models, rigid or deformable registration of the model and the X-ray images, and fusion of the DRR and X-ray projections, all prior to a conventional filtered back-projection algorithm. Our experiments, conducted with a mobile image intensifier C-arm, demonstrate visually and quantitatively the contribution of data fusion to image quality, which we assess through comparison to a "ground truth" CT. Importantly, we show that a significantly improved reconstruction can be obtained from a C-arm scan as short as 90° by complementing the observed projections with DRRs of two prior models, namely an atlas and a preoperative same-patient CT. The hybrid reconstruction principles are applicable to other types of C-arms as well.