Skeletal deformities and mortality in grey herons (Ardea cinerea) at Besthorpe heronry, Nottinghamshire.

Dead and sick grey heron chicks with multiple fractures of the leg and wing bones and/or bone deformities have been reported at Besthorpe Nature Reserve heronry in north Nottinghamshire since 1996. Forty-five grey heron carcases were examined, 35 from the Besthorpe colony and 10 from other colonies where bone disease was not known to occur. On the basis of the results of radiological studies, postmortem examinations, peripheral quantitative computed tomography scanning and four-point bending tests, it was concluded that the skeletal abnormalities were probably due to metabolic bone disease.

Subsurface probing in diffusely scattering media using spatially offset Raman spectroscopy.

We describe a simple methodology for the effective retrieval of Raman spectra of subsurface layers in diffusely scattering media. The technique is based on the collection of Raman scattered light from surface regions that are laterally offset away from the excitation laser spot on the sample. The Raman spectra obtained in this way exhibit a variation in relative spectral intensities of the surface and subsurface layers of the sample being investigated. The data set is processed using a multivariate data analysis to yield pure Raman spectra of the individual sample layers, providing a method for the effective elimination of surface Raman scatter. The methodology is applicable to the retrieval of pure Raman spectra from depths well in excess of those accessible with conventional confocal microscopy. In this first feasibility study we have differentiated between surface and subsurface Raman signals within a diffusely scattering sample composed of two layers: trans-stilbene powder beneath a 1 mm thick over-layer of PMMA (poly(methyl methacrylate)) powder. The improvement in contrast of the subsurface trans-stilbene layer without numerical processing was 19 times. The potential applications include biomedical subsurface probing of specific tissues through different overlying tissues such as assessment of bone quality through skin, providing an effective noninvasive means of screening for bone degeneration, other skeletal disease diagnosis, and dermatology studies, as well as materials and catalyst research.

Instantaneous center of rotation and instability of the cervical spine. A clinical study.

STUDY DESIGN: This study was designed to investigate flexion and extension of the cervical spine in patients with "instability" of the cervical spine. OBJECTIVES: To establish a new method of calculating the instantaneous center of rotation (ICR) of the skull relative to the thorax and to compare the differences in the ICR between normal volunteers and patients. SUMMARY OF BACKGROUND DATA: "Instability" of the cervical spine commonly is investigated using functional radiographs, which is an unreliable method. Although the ICR was suggested as an objective parameter in measuring spinal "instability," the ICR of the skull relative to the thorax has not been studied before. METHOD: Three groups of subjects (27 normal volunteers, 28 patients with chronic cervical spondylosis, and 17 patients undergoing fusion for cervical disc degeneration) were measured with a CA-6000 system (OSI, CA). The ICR then were calculated and compared at various angles of flexion and extension. RESULTS: The horizontal component of the ICR in the preoperative group was found to have shifted anteriorly from 5 degrees to 25 degrees of flexion (P < 0.05) and at 5 degrees of extension (P < 0.05), compared with that of the healthy subjects. There also was a significant difference in the vertical component of the ICR at 15 degrees of flexion (P < 0.05). However, there were no significant differences in the horizontal and the vertical components of the ICR between the normal and nonoperative groups. CONCLUSION: The ICR in patients with "instability" of the cervical spine was found to have shifted anteriorly; the method described in this study might be useful for identifying patients who suffer from this condition.

The effect of Luque segmental sublaminar instrumentation on the rib hump in idiopathic scoliosis.

The change in back shape after Luque segmental sublaminar instrumentation was assessed in the frontal, sagittal, and transverse planes in 61 patients with adolescent idiopathic scoliosis using the Integrated Shape Investigation System (ISIS) and standard radiographic techniques. Luque instrumentation was found to be an effective method of correcting thoracic and thoracolumbar curves in the frontal plane with a 59% and 63% respective reduction in the size of the preoperative Cobb angle. Despite the frontal plane correction, however, the ISIS scan showed that of the 40 single thoracic curves, the rib hump was reduced in only 6 patients, was unchanged in 27 patients, and was worsened slightly in 7 patients. By contrast, thoracolumbar and lumbar curves were corrected in all three planes with a significant cosmetic improvement.

The effect of devascularisation upon early bone healing in dynamic external fixation.

We examined the effect of periosteal devascularisation upon the early healing of osteotomies of sheep tibiae held in an instrumented external fixation system with an axial stiffness of 240 N/mm. At 14 days, cortical blood flow measured by the microsphere technique was 19.3 ml/min/100g in the well-vascularised osteotomies, but only 1.7 ml/min/100g in the devascularised osteotomies, despite an increase in medullary flow (p less than 0.0005). Delay in healing of the devascularised osteotomies was suggested by an in vivo monitoring system and confirmed by post-mortem mechanical testing. We suggest that the osteogenic stimulus of dynamic external fixation is dependent on the early restoration of cortical blood flow in devascularised fractures.

Improvement in function after valgus bracing of the knee. An analysis of gait symmetry.

The use of a valgus brace can effectively relieve the symptoms of unicompartmental osteoarthritis of the knee. This study provides an objective measurement of function by analysis of gait symmetry. This was measured in 30 patients on four separate occasions: immediately before and after initial fitting and then again at three months with the brace on and off. All patients reported immediate symptomatic improvement with less pain on walking. After fitting the brace, symmetry indices of stance and the swing phase of gait showed a consistent and immediate improvement at 0 and 3 months, respectively, of 3.92% (p = 0.030) and 3.40% (p = 0.025) in the stance phase and 11.78% (p = 0.020) and 9.58% (p = 0.005) in the swing phase. This was confirmed by a significant improvement at three months in the mean Hospital for Special Surgery (HSS) knee score from 69.9 to 82.0 (p < 0.001). Thus, wearing a valgus brace gives a significant and immediate improvement in the function of patients with unicompartmental osteoarthritis of the knee, as measured by analysis of gait symmetry.

A treadmill-based system for measuring symmetry of gait.

It has been recognised for centuries that various conditions will lead to asymmetries in gait and several researchers have analysed symmetry of gait. However, in general such analyses are based on five steps or fewer. A new system has been designed and manufactured that is based on a motorised treadmill with forceplates (errors +3. 2% and -4.3%) that quickly gathers information on larger numbers of steps. It automatically records the data and then performs a semi automatic analysis to calculate various parameters from each of the measured steps, including: heel strike, toe off, stance phase, swing phase, peak forces and loading and unloading rates. Other parameters can also be easily incorporated into the analysis such as double support time. Student's t tests are performed comparing the means of these parameters. The ratios of the parameters, left to right (or uninvolved to involved limbs), are then quoted as Symmetry Indices. It has been found to be quick and easy to use and produces results that are both readily understood and clinically relevant.

The design and performance of an experimental external fixator with variable axial stiffness and a compressive force transducer.

A unilateral external fixator has been designed for controlled experiments into the effects of micromovement on fracture healing. The experimental model used is based on a diaphyseal osteotomy of the right tibia of the sheep. The main bar has linear bearings, which allows free axial movement. This is then controlled by a spring whose stiffness can be varied. The resulting axial micromovement can be calculated from the measured compressive force and the known axial stiffness of the fixator. The transducer has limits of error of +13.3 N and -44.5 N. Preliminary measurements showed maximum micromovement at the fracture site of 0.48 mm during slow walking.

The design and performance of an experimental external fixation device with load transducers.

It is becoming increasingly common that fracture healing is modelled in the laboratory with an osteotomy in the diaphysis of the ovine tibia. External fixation is often used to hold the bones in these models, presenting the problem that the loads on such devices are poorly understood. To help investigate this, a unilateral device has been developed which is capable of measuring the two components of load considered to be the most important, that of axial compression and bending in the plane of the fixator. The device was found to be a rigid system and easy to apply, with the in-vivo measurements being straightforward. The estimated limits of error of the compression transducer are +37.9 N and -21.4 N and those of the bending transducer are +3.6 Nm and -4.2 Nm. Preliminary measurements showed the maximum load during normal walking to 345 N compression and 28 Nm in-plane bending.

The influence of the mechanical environment on remodelling of the patellar tendon.

An understanding of the remodelling of tendon is crucial for the development of scientific methods of treatment and rehabilitation. This study tested the hypothesis that tendon adapts structurally in response to changes in functional loading. A novel model allowed manipulation of the mechanical environment of the patellar tendon in the presence of normal joint movement via the application of an adjustable external fixator mechanism between the patella and the tibia in sheep, while avoiding exposure of the patellar tendon itself. Stress shielding caused a significant reduction in the structural and material properties of stiffness (79%), ultimate load (69%), energy absorbed (61%), elastic modulus (76%) and ultimate stress (72%) of the tendon compared with controls. Compared with the material properties the structural properties exhibited better recovery after re-stressing with stiffness 97%, ultimate load 92%, energy absorbed 96%, elastic modulus 79% and ultimate stress 80%. The cross-sectional area of the re-stressed tendons was significantly greater than that of stress-shielded tendons. The remodelling phenomena exhibited in this study are consistent with a putative feedback mechanism under strain control. This study provides a basis from which to explore the interactions of tendon remodelling and mechanical environment.

The vascular response to fracture micromovement.

Micromovement has been shown to promote the healing of experimental fractures, but its role in the clinical management of fractures with soft-tissue injury is less certain. In a 2-mm transverse osteotomy of the ovine tibia held in an instrumented external fixator, axial interfragmentary displacement was quantified in vivo for six weeks after osteotomy. Group I (n = 11) had an axial fixation stiffness of 460 N/mm and Group II (n = 12) had a stiffness of 238 N/mm. With a 25% difference in micromovement, a fourfold change in corticomedullary blood flow was observed at two weeks after osteotomy (p < 0.01). Although by six weeks mechanical properties in torsion were similar, there were marked differences in the periosteal cross-sectional perimeter, area, and intracortical porosity that complemented the hemodynamic changes. The early vascular response is very sensitive to the initial mechanical environment, and appears to precede and determine the organization of osteogenesis. Further understanding of this relationship may prove to be of direct clinical relevance in the augmentation of healing of devascularized diaphyseal fractures.