Is Fibular Fracture Displacement Consistent with Tibiotalar Displacement?

We believed open reduction with internal fixation is required for supination-external rotation ankle fractures located at the level of the distal tibiofibular syndesmosis (Lauge-Hanssen SER II and Weber B) with 2 mm or more fibular fracture displacement. The rationale for surgery for these ankle fractures is based on the notion of elevated intraarticular contact pressures with lateral displacement. To diagnose these injuries, we presumed that in patients with a fibular fracture with at least 2 mm fracture displacement, the lateral malleolus and talus have moved at least 2 mm in a lateral direction without medial displacement of the proximal fibula. We reviewed 55 adult patients treated operatively for a supination-external rotation II ankle fracture (2 mm or more fibular fracture displacement) between 1990 and 1998. On standard radiographs, distance from the tibia to the proximal fibula, distance from the tibia to the distal fibula, and displacement at the level of the fibular fracture were measured. These distances were compared preoperatively and postoperatively. We concluded tibiotalar displacement cannot be reliably assessed at the level of the fracture. Based on this and other studies, we believe there is little evidence to perform open reduction and internal fixation of supination-external rotation II ankle fractures

Industrial heating using energy efficient induction technology

Abstract in UndeterminedThe demands for energy efficent heating solutions for the manufacturing industry can be met by a newinduction heating platform, presented in this article. A new concept and technology to design andmanufacture induction heating unit is presented, as well as a prototype induction heater, evaluated and testedin an industrial environment. Improvements compared to existing heating solutions can be clearly shown, e.g.higher heating efficiency, no requirement for advanced cooling, a higher geometrical flexibility and alsoenvironmental gains. The Greenheat platform is built on Litz wiring, SMC flux conductors, and a castingtechnology which is outlined in the article

Chronic instability of the anterior tibiofibular syndesmosis of the ankle. Arthroscopic findings and results of anatomical reconstruction

<p>Abstract</p> <p>Background</p> <p>The arthroscopic findings in patients with chronic anterior syndesmotic instability that need reconstructive surgery have never been described extensively.</p> <p>Methods</p> <p>In 12 patients the clinical suspicion of chronic instability of the syndesmosis was confirmed during arthroscopy of the ankle. All findings during the arthroscopy were scored. Anatomical reconstruction of the anterior tibiofibular syndesmosis was performed in all patients. The AOFAS score was assessed to evaluate the result of the reconstruction. At an average of 43 months after the reconstruction all patients were seen for follow-up.</p> <p>Results</p> <p>The syndesmosis being easily accessible for the 3 mm transverse end of probe which could be rotated around its longitudinal axis in all cases during arthroscopy of the ankle joint, confirmed the diagnosis. Cartilage damage was seen in 8 ankles, of which in 7 patients the damage was situated at the medial side of the ankle joint. The intraarticular part of anterior tibiofibular ligament was visibly damaged in 5 patients. Synovitis was seen in all but one ankle joint. After surgical reconstruction the AOFAS score improved from an average of 72 pre-operatively to 92 post-operatively.</p> <p>Conclusions</p> <p>To confirm the clinical suspicion, the final diagnosis of chronic instability of the anterior syndesmosis can be made during arthroscopy of the ankle. Cartilage damage to the medial side of the tibiotalar joint is often seen and might be the result of syndesmotic instability. Good results are achieved by anatomic reconstruction of the anterior syndesmosis, and all patients in this study would undergo the surgery again if necessary.</p

Tibiofibular syndesmosis in acute ankle fractures: additional value of an oblique MR image plane

Item does not contain fulltextOBJECTIVE: To evaluate the additional value of a 45� oblique MRI scan plane for assessing the anterior and posterior distal tibiofibular syndesmotic ligaments in patients with an acute ankle fracture. MATERIALS AND METHODS: Prospectively, data were collected for 44 consecutive patients with an acute ankle fracture who underwent a radiograph (AP, lateral, and mortise view) as well as an MRI in both the standard three orthogonal planes and in an additional 45� oblique plane. The fractures on the radiographs were classified according to Lauge-Hansen (LH). The anterior (ATIFL) and posterior (PTIFL) distal tibiofibular ligaments, as well as the presence of a bony avulsion in both the axial and oblique planes was evaluated on MRI. MRI findings regarding syndesmotic injury in the axial and oblique planes were compared to syndesmotic injury predicted by LH. Kappa and the agreement score were calculated to determine the interobserver agreement. The Wilcoxon signed rank test and McNemar's test were used to compare the two scan planes. RESULTS: The interobserver agreement (?) and agreement score [AS (\%)] regarding injury of the ATIFL and PTIFL and the presence of a fibular or tibial avulsion fracture were good to excellent in both the axial and oblique image planes (? 0.61-0.92, AS 84-95\%). For both ligaments the oblique image plane indicated significantly less injury than the axial plane (p?<?0.001). There was no significant difference in detection of an avulsion fracture in the axial or oblique plane, neither anteriorly (p?=?0.50) nor posteriorly (p?=?1.00). With syndesmotic injury as predicted by LH as comparison, the specificity in the oblique MR plane increased for both anterior (to 86\% from 7\%) and posterior (to 86\% from 48\%) syndesmotic injury when compared to the axial plane. CONCLUSION: Our results show the additional value of an 45� oblique MR image plane for detection of injury of the anterior and posterior distal tibiofibular syndesmoses in acute ankle fractures. Findings of syndesmotic injury in the oblique MRI plane were closer to the diagnosis as assumed by the Lauge-Hansen classification than in the axial plane. With more accurate information, the surgeon can better decide when to stabilize syndesmotic injury in acute ankle fractures

Effects of a training program after surgically treated ankle fracture: a prospective randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Despite conflicting results after surgically treated ankle fractures few studies have evaluated the effects of different types of training programs performed after plaster removal. The aim of this study was to evaluate the effects of a 12-week standardised but individually suited training program (training group) versus usual care (control group) after plaster removal in adults with surgically treated ankle fractures.</p> <p>Methods</p> <p>In total, 110 men and women, 18-64 years of age, with surgically treated ankle fracture were included and randomised to either a 12-week training program or to a control group. Six and twelve months after the injury the subjects were examined by the same physiotherapist who was blinded to the treatment group. The main outcome measure was the Olerud-Molander Ankle Score (OMAS) which rates symptoms and subjectively scored function. Secondary outcome measures were: quality of life (SF-36), timed walking tests, ankle mobility tests, muscle strength tests and radiological status.</p> <p>Results</p> <p>52 patients were randomised to the training group and 58 to the control group. Five patients dropped out before the six-month follow-up resulting in 50 patients in the training group and 55 in the control group. Nine patients dropped out between the six- and twelve-month follow-up resulting in 48 patients in both groups. When analysing the results in a mixed model analysis on repeated measures including interaction between age-group and treatment effect the training group demonstrated significantly improved results compared to the control group in subjects younger than 40 years of age regarding OMAS (p = 0.028), muscle strength in the plantar flexors (p = 0.029) and dorsiflexors (p = 0.030).</p> <p>Conclusion</p> <p>The results of this study suggest that when adjusting for interaction between age-group and treatment effect the training model employed in this study was superior to usual care in patients under the age of 40. However, as only three out of nine outcome measures showed a difference, the beneficial effect from an additional standardised individually suited training program can be expected to be limited. There is need for further studies to elucidate how a training program should be designed to increase and optimise function in patients middle-aged or older.</p> <p>Trial Registration</p> <p>Current Controlled Trials ACTRN12609000327280</p

Veiledende plan for det offentlige rom (VPOR)

Denne oppgaven beskriver prinsipplanen Veiledende Plan for det Offentlige Rom, også kjent som VPOR. Den er en del av det man i forvaltningen kaller Oslo-modellen og er nylig blitt vist også interesse fra andre områder i landet, som har hel- eller deladoptert verktøyet. Oppgaven tar for seg VPOR som forvaltningsverktøy og hvilke funksjoner og formål denne har i forvaltningen. Oppgaven tar kun for seg VPOR og Oslo-modellen som konsept sett i lys av erfaringer og bruk i forvaltningen i Oslo kommune. Det blir også prøvd beskrevet hvor denne planen kommer inn i kontekst i planteorien og hvilken retning den tar i forvaltningen. Oppgaven tar utgangspunkt i metode og datainnsamling gjort gjennom kvalitative forskningsintervjuer og praktisering gjennom planer, bakgrunnsmaterialer og lovverk. De seks kvalitative intervjuene består av tre store private aktører og tre aktuelle offentlige parter. Analysen av disse og gjennomgangen med drøfting viser at de tre forutsatte hypotesene til denne oppgaven ikke alle er like gjeldende

Supercooling Simulation of Latent Heat Based Storage : A simulation model built in COMSOL Multiphysics

The energy demand in the building sector makes up a large portion of our energy consumption. The industrial sector is also energy intense and oftentimes loses a great deal as surplus heat. To bridge this gap a Mobile Thermal Energy Storage unit could be applied to store industrial waste heat and make use of it in the building sector to produce sanitary hot water. The objective of this work will be to produce a numerical simulation model of the discharge process for the storage unit, including the supercooling phenomenon observed to be taking place during solidification of the phase change material (Erythritol). Previously acquired experimental performance measurements will be compared to the numerical results to confirm validity. COMSOL Multiphysics was used to simulate different sub-parts of the module, including fluid dynamics. The cut-down into sub-parts was done to reduce the amount of required elements. The results showed that the numerical model could produce similar thermal behavior as the experimental unit including the supercooling phenomenon. The model did however not include the natural convection that would take place in the Erythritol, which could have led to more accurate results.Energibehovet är stort i byggnadssektorn och utgör en stor del av konsumtionen. Industrisektorn är också energiintensiv och upplever ofta stora förluster i form av överskottsvärme. En lösning skulle kunna vara att applicera en Mobile Thermal Energy Storage unit som kan lagra restvärmen och sedan transportera den till byggnadssektorn för produktionen av sanitärt varmvatten. Målet med detta arbete kommer vara att tillverka en numerisk simuleringsmodell av modulens urladdningsprocess som inkluderar underkylnings-fenomenet som har observerats ta plats i fasändringsmaterialet (Erytritol) under stelningen. Tidigare församlade experimentella prestationsresultat kommer jämföras med den numeriska modellen för att bekräfta giltighet. COMSOL Multiphysics användes för att simulera modellen, en delkomponent i taget med vätskedynamiken inkluderat. Nedskärningen av modellen genomfördes för att reducera mängden nödvändiga element. Resultaten visade att den numeriska simuleringen kunde producera liknande termiskt beteende som den experimentella enheten, inkluderat underkylningsfasen. Modellen tog dock inte hänsyn till den naturliga konvektion som tar plats i Erytritolen, vilket skulle kunnat ha bidragit till mer exakta resultat.