Arthroscopic biceps tendon tenodesis: the anchorage technical note

Treatment of long head biceps (LHB) tendon pathology has become an area of renewed interest and debate among orthopaedic surgeons in recent years. The background of this manuscript is a description of biceps tenodesis which ensure continual dynamic action of the tendon which depresses the head and impedes lateral translation. A new technique has been developed in order to treat LHB tendon irreversible structural abnormalities associated with cuff rotator lesions. This technique entails the construction of a biological anchor between the LHB and supraspinatus and/or infraspinatus tendons according to arthroscopic findings. The rationale, although not supported by biomechanical studies is to obtain a triple, biomechanical effect. The first of these biomechanical effects which we try to promote through the procedure of transposition is the elimination of the deviation and oblique angle which occurs as the LHB completes its intra-articular course prior to reaching the bicipital groove. Furthermore, we have found this technique extremely useful in the presence of large ruptures of the rotator cuff with muscle retraction. The most common complication associated to this particular method, observed in less than 3%, is failed biological fixation which manifests as subsidence of the tenodesis and consequent descent of the tendon with evident aesthetic deformit

Trapping of magnetic flux by the plunge region of a black hole accretion disk

The existence of the radius of marginal stability means that accretion flows around black holes invariably undergo a transition from a MHD turbulent disk-like flow to an inward plunging flow. We argue that the plunging inflow can greatly enhance the trapping of large scale magnetic field on the black hole, and therefore may increase the importance of the Blandford-Znajek (BZ) effect relative to previous estimates that ignore the plunge region. We support this hypothesis by constructing and analyzing a toy-model of the dragging and trapping of a large scale field by a black hole disk, revealing a strong dependence of this effect on the effective magnetic Prandtl number of the MHD turbulent disk. Furthermore, we show that the enhancement of the BZ effect depends on the geometric thickness of the accretion disk. This may be, at least in part, the physical underpinnings of the empirical relation between the inferred geometric thickness of a black hole disk and the presence of a radio jet.Comment: 18 pages, 3 figures, accepted for publication in the Astrophysical Journal. See http://www.astro.umd.edu/~chris/publications/movies/flux_trapping.html for animation

Post-traumatic overload or acute syndrome of the os trigonum: a possible cause of posterior ankle impingement

The purpose of this paper is to discuss the post-traumatic overload syndrome of the os trigonum as a possible cause of posterior ankle impingement and hindfoot pain. We have reviewed 19 athletes who were referred to our foot unit between 1995 and 2001 because of posterior ankle pain, and in whom a post-traumatic overload syndrome of os trigonum was diagnosed. All these patients were followed up over a period of 2 years. In 11 cases a chronic repetitive movements in forced plantar flexion was found. In the other eight cases the pain appeared to persist after a standard treatment of an ankle sprain in inversion plantar flexion. The diagnosis was based on clinical history, physical examination and X-rays that revealed a non-fused os trigonum. The confirmation of diagnosis was carried-out injecting local anaesthetic under fluoroscopic control. In all cases a corticosteroid injection as first line treatment was performed. In 6 cases a second injection was necessary to alleviate pain because incomplete recovery with the first injection. Three cases (16%) were recalcitrant to this treatment and in these three cases a surgical excision of the os trigonum was carried out. Our conclusion is that after some chronic athletic activity or an acute ankle sprain the os trigonum, if present, may undergo mechanical overload, remain undisrupted and become painful. Treatment by corticosteroid injection often resolves the proble

Local behavior of p-harmonic Green's functions in metric spaces

We describe the behavior of p-harmonic Green's functions near a singularity in metric measure spaces equipped with a doubling measure and supporting a Poincar\'e inequality

On the factor structure of the Dissociative Experiences Scale:ontribution with an Italian version of the DES-II

Aim of the study: Notwithstanding its clinical and empirical relevance, there is no consensus on how to conceptualize dissociation. This may be partly due to the conflicting results yielded on the factor structure of the gold-standard selfreport measure of dissociation (the Dissociative Experiences Scale-Revised; DES-II, Carlson and Putnam, 1993). In an attempt to advance research on this topic, we sought to explore the factorial structure of an Italian version of the DES-II. Material and methods: A sample of 320 subjects (122 inmates and 198 community participants) was administered the Italian version of the DES-II. Results: The Italian version of the DES-II showed good psychometric properties and replicated a two-factor structure. Items content seemed to support the distinction into two qualitatively different forms of dissociative experiences, described as detachment and compartmentalization phenomena. In line with the expectations, participants in the inmate sample reported higher rates of dissociative experiences than community participants, on both dimensions. Conclusions: This study provides further support for the validity of the Italian version of the DES-II for use with community and inmate samples. Furthermore, we corroborated previous evidence on a two-factor structure of the DES-II, which is consistent with theoretical assumptions describing two distinct, albeit overlapping, dissociative dimensions (i.e., detachment and compartmentalization)

Anatomic anterior cruciate ligament reconstruction: the two-incision technique

This article describes the anatomical two-incision reconstruction of anterior cruciate ligament (ACL) of knee. The major part of currently single incision tibial endoscopic techniques attempts to reproduce the most isometric anteromedial bundle of ACL. Often a relatively vertical femoral tunnel, respect to the notch, is drilled, which is not really efficacious in providing rotatory stability. The single incision technique was developed to obviate the necessity of the lateral femoral incision and dissection. This technical note describes a two-incision ACL reconstruction using an instrumentation, which avoids a large lateral femoral soft tissue dissection, and discusses the rational use of the two-incision ACL reconstruction technique

Modified triangular posterior osteosynthesis of unstable sacrum fracture

We report preliminary results for unstable sacral fractures treated with a modified posterior triangular osteosynthesis. Seven patients were admitted to our trauma center with an unstable sacral fracture. The average age was 31years (22-41). There were four vertical shear lesions of the pelvis and three transverse fracture of the upper sacrum. The vertical shear injuries were initially treated with an anterior external fixator inserted at the time of admission. Definitive surgery was performed at a mean time of 9days after trauma. The operation consisted in a posterior fixation combining a vertebropelvic distraction osteosynthesis with pedicle screws and a rod system, whereby the transverse fixation was obtained using a 6mm rod as a cross-link between the two main rods. Late displacement of the posterior pelvis or fracture was measured on X-ray films according to the criteria of Henderson. The patients were followed-up for a minimum time of 12months. Four patients who presented with a pre-operative perineal neurological impairment made a complete recovery. No iatrogenic nerve injury was reported. One case of deep infection was managed successfully with surgical debridement and local antibiotics. All patients complained of symptoms related to the prominence of the iliac screws. The metalwork was removed in all cases after healing of the fracture, at a mean time of 4.3months after surgery. No loss of reduction of fracture was seen at final radiological follow-up. The preliminary results are promising. The fixation is sufficiently stable to allow an immediate progressive weight-bearing, and safe nursing care in polytrauma cases. The only problem seems to be related to prominent heads of the distal screw