Proximal ulna comminuted fractures: Fixation using a double-plating technique

SummaryIntroductionComminuted fractures of the proximal ulna are severe injuries often associated with bone and ligament injuries of the elbow joint (Monteggia lesion, radial head fractures, dislocation of the elbow). The treatment of these fractures is very demanding and the functional results often fairly mediocre due to associated injuries. Based on a single-center retrospective study, we report the results of the treatment of these fractures fixed using a double-plate technique. The aim was to evaluate the feasibility and reliability of this fixation mode and to compare it with other fractures series using a single plate fixation (in terms of bone union, elbow joint function, and complications stemming from the plates).Patients and methodsEighteen patients sustained a comminuted proximal ulna fracture between 2002 and 2006. The fractures were associated in five cases with a Monteggia type lesion, in two cases with elbow dislocation, and in four cases with a Mason 3 radial head fracture. Four patients had an open fracture. These comminuted ulna fractures included nine Mayo Clinic IIIB fractures. Bone fixation was performed with two third-cylinder tubular plates, one plate on each side of the proximal ulna. This allows more versatile solutions for screw insertion. Functional assessment (according to Broberg and Morrey) and radiological evaluation (bone healing) were provided at 6 months and at the longest follow-up by an independent surgeon.ResultsSixteen of 18 patients achieved bone union. No septic complications occurred and no hardware removal was required on patient request. In 67% of the cases, the Morrey score indicated excellent or good results with a mean score of 82.DiscussionThere are no reports in the literature on the technical point of fixation concerning complex fractures of the ulna. Two plates mean the possibility of twice the number of screw insertions for epiphyseal reconstruction . This fixation remains easy to perform and provides stable anatomic reconstruction of the ulna.Level of evidenceLevel IV. Retrospective study

Determining ‘Age at Death’ for Forensic Purposes using Human Bone by a Laboratory-based Analytical Method

Determination of age-at-death (AAD) is an important and frequent requirement in contemporary forensic science and in the reconstruction of past populations and societies from their remains. Its estimation is relatively straightforward and accurate (±3 years) for immature skeletons by using morphological features and reference tables within the context of forensic anthropology. However, after skeletal maturity (>35 yrs) estimates become inaccurate, particularly in the legal context. In line with the general migration of all the forensic sciences from reliance upon empirical criteria to those which are more evidence-based, AAD determination should rely more-and-more upon more quantitative methods. We explore here whether well-known changes in the biomechanical properties of bone and the properties of bone matrix, which have been seen to change with age even after skeletal maturity in a traceable manner, can be used to provide a reliable estimate of AAD. This method charts a combination of physical characteristics some of which are measured at a macroscopic level (wet & dry apparent density, porosity, organic/mineral/water fractions, collagen thermal degradation properties, ash content) and others at the microscopic level (Ca/P ratios, osteonal and matrix microhardness, image analysis of sections). This method produced successful age estimates on a cohort of 12 donors of age 53–85 yr (7 male, 5 female), where the age of the individual could be approximated within less than ±1 yr. This represents a vastly improved level of accuracy than currently extant age estimation techniques. It also presents: (1) a greater level of reliability and objectivity as the results are not dependent on the experience and expertise of the observer, as is so often the case in forensic skeletal age estimation methods; (2) it is purely laboratory-based analytical technique which can be carried out by someone with technical skills and not the specialised forensic anthropology experience; (3) it can be applied worldwide following stringent laboratory protocols. As such, this technique contributes significantly to improving age estimation and therefore identification methods for forensic and other purposes

Longitudinal investigation of training status and cardiopulmonary responses in pre- and early-pubertal children

PurposeThe presence of a maturational threshold that modulates children’s physiological responses to exercise training continues to be debated, not least due to a lack of longitudinal evidence to address this question. The purpose of this study was to investigate the interaction between swim-training status and maturity in nineteen trained (T, 10 ± 1 years, −2.4 ± 1.9 years pre-peak height velocity, 8 boys) and fifteen untrained (UT, 10 ± 1 years, −2.3 ± 0.9 years pre-peak height velocity, 5 boys) children, at three annual measurements.MethodsIn addition to pulmonary gas exchange measurements, stroke volume (SV) and cardiac output ( Q˙) were estimated by thoracic bioelectrical impedance during incremental ramp exercise.ResultsAt baseline and both subsequent measurement points, trained children had significantly (P < 0.05) higher peak oxygen uptake (year 1 T 1.75 ± 0.34 vs. UT 1.49 ± 0.22; year 2 T 2.01 ± 0.31 vs. UT 1.65 ± 0.08; year 3 T 2.07 ± 0.30 vs. UT 1.77 ± 0.16 l min−1) and Q˙ (year 1 T 15.0 ± 2.9 vs. UT 13.2 ± 2.2; year 2 T 16.1 ± 2.8 vs. UT 13.8 ± 2.9; year 3 T 19.3 ± 4.4 vs. UT 16.0 ± 2.7 l min−1). Furthermore, the SV response pattern differed significantly with training status, demonstrating the conventional plateau in UT but a progressive increase in T. Multilevel modelling revealed that none of the measured pulmonary or cardiovascular parameters interacted with maturational status, and the magnitude of the difference between T and UT was similar, irrespective of maturational status.ConclusionThe results of this novel longitudinal study challenge the notion that differences in training status in young people are only evident once a maturational threshold has been exceeded

Influenza in Migratory Birds and Evidence of Limited Intercontinental Virus Exchange

Migratory waterfowl of the world are the natural reservoirs of influenza viruses of all known subtypes. However, it is unknown whether these waterfowl perpetuate highly pathogenic (HP) H5 and H7 avian influenza viruses. Here we report influenza virus surveillance from 2001 to 2006 in wild ducks in Alberta, Canada, and in shorebirds and gulls at Delaware Bay (New Jersey), United States, and examine the frequency of exchange of influenza viruses between the Eurasian and American virus clades, or superfamilies. Influenza viruses belonging to each of the subtypes H1 through H13 and N1 through N9 were detected in these waterfowl, but H14 and H15 were not found. Viruses of the HP Asian H5N1 subtypes were not detected, and serologic studies in adult mallard ducks provided no evidence of their circulation. The recently described H16 subtype of influenza viruses was detected in American shorebirds and gulls but not in ducks. We also found an unusual cluster of H7N3 influenza viruses in shorebirds and gulls that was able to replicate well in chickens and kill chicken embryos. Genetic analysis of 6,767 avian influenza gene segments and 248 complete avian influenza viruses supported the notion that the exchange of entire influenza viruses between the Eurasian and American clades does not occur frequently. Overall, the available evidence does not support the perpetuation of HP H5N1 influenza in migratory birds and suggests that the introduction of HP Asian H5N1 to the Americas by migratory birds is likely to be a rare event

Deformation change in light iridium nuclei from laser spectroscopy

Laser spectroscopy measurements have been performed on neutron-deficient and stable Ir isotopes using the COMPLIS experimental setup installed at ISOLDE-CERN. The radioactive Ir atoms were obtained from successive decays of a mass-separated Hg beam deposited onto a carbon substrate after deceleration to 1kV and subsequently laser desorbed. A three-color, two-step resonant scheme was used to selectively ionize the desorbed Ir atoms. The hyperfine structure (HFS) and isotope shift (IS) of the first transition of the ionization path 5d^{7}6s ^{2}^{4}F_{9/2} \to 5d^{7}6s6p ^{6}F_{11/2} at 351.5nm were measured for $^{182-189}$Ir, $^{186}Ir^{m}$ and the stable $^{191,193}$Ir. The nuclear magnetic moments μI and the spectroscopic quadrupole moments Qs were obtained from the HFS spectra and the change of the mean square charge radii from the IS measurements. The sign of μI was experimentally determined for the first time for the masses 182≤A≤189 and the isomeric state $^{186}Ir^ m$ . The spectroscopic quadrupole moments of $^{182}$Ir and $^{183}$Ir were measured also for the first time. A large mean square charge radius change between $^{187}$Ir and $^{186}Ir^g$ and between $^{186}Ir^m$ and $^{186}Ir ^g$ was observed corresponding to a sudden increase in deformation: from β2 ≃ + 0.16 for the heavier group A = 193, 191, 189, 187 and 186m to β2 ≥ + 0.2 for the lighter group A = 186g, 185, 184, 183 and 182. These results were analyzed in the framework of a microscopic treatment of an axial rotor plus one or two quasiparticle(s). This sudden deformation change is associated with a change in the proton state that describes the odd-nuclei ground state or that participates in the coupling with the neutron in the odd-odd nuclei. This state is identified with the π3/2+[402] orbital for the heavier group and with the π1/2-[541] orbital stemming from the 1h _9/2 spherical subshell for the lighter group. That last state seems to affect strongly the observed values of the nuclear moments

Charge-radius change and nuclear moments in the heavy tin isotopes from laser spectroscopy: Charge radius of 132^{132}Sn

NESTER ACCLaser spectroscopy measurements have been carried out on the neutron-rich tin isotopes with the COMPLIS experimental setup. Using the $5s^25p^2$ $^3P_0 \rightarrow 5s^25_p6s$ $^3P_1$ optical transition, hyperfine spectra of $^{126-132}$Sn and $^{125,127,129-131}Sn^m$ were recorded for the first time. The nuclear moments and the mean square charge radius variation ($\delta) were extracted. From the quadrupole moment values, these nuclei appear to be spherical. The magnetic moments measured are thus compared with those predicted by spherical basis approaches. From the measured$\delta, the absolute charge radii of these isotopes were deduced in particular that of the doubly magic $^{132}$Sn nucleus. The comparison of the results with several mean-field-type calculations have shown that dynamical effects play an important role in the tin isotopes