Posttraumatic severe infection of the ankle joint - long term results of the treatment with resection arthrodesis in 133 cases

Although there is a clear trend toward internal fixation for ankle arthrodesis, there is general consensus that external fixation is required for cases of posttraumatic infection. We retrospectively evaluated the technique and clinical long term results of external fixation in a triangular frame for cases of posttraumatic infection of the ankle. From 1993 to 2006 a consecutive series of 155 patients with an infection of the ankle was included in our study. 133 cases of the advanced "Gächter" stage III and IV were treated with arthrodesis. We treated the patients with a two step treatment plan. After radical debridement and sequestrectomy the malleoli and the joint surfaces were resected. An AO fixator was applied with two Steinmann-nails inserted in the tibia and in the calcaneus and the gap was temporary filled with gentamicin beads as the first step. In the second step we performed an autologous bone graft after a period of four weeks. The case notes were evaluated regarding trauma history, medical complaints, further injuries and illnesses, walking and pain status and occupational issues. Mean age at the index procedure was 49.7 years (18-82), 104 patients were male (67,1%). Follow up examination after mean 4.5 years included a standardised questionnaire and a clinical examination including the criteria of the AO-FAS-Score and radiographs. 92,7% of the cases lead to a stable arthrodesis. In 5 patients the arthrodesis was found partly-stable. In six patients (4,5%) the infection was not controllable during the treatment process. These patients had to be treated with a below knee amputation. The mean AOFAS score at follow up was 63,7 (53-92). Overall there is a high degree of remaining disability. The complication rate and the reduced patient comfort reserve this method mainly for infection. Joint salvage is possible in the majority of cases with an earlier stage I and II infection

Mid-term results after operative treatment of rockwood grade III-V Acromioclavicular joint dislocations with an AC-hook-plate

Acromioclavicular joint dislocations often occur in athletic, young patients after blunt force to the shoulder. Several static and dynamic operative procedures with or without primary ligament replacement have been described. Between February 2003 and March 2009 we treated 313 patients suffering from Rockwood III-V lesions of the AC joint with an AC-hook plate. 225 (72%) of these patients could be followed up. Mean operation time was 42 minutes in the conventional group and 47 minutes in the minimal invasive group. The postoperative pain on a scale from 1 to 10 (VAS-scale) was rated 2.7 in the conventional group and 2.2 in the minimal invasive group. Taft score showed very good and good results in 189 patients (84%). Constant score showed an average of 92.4 of 100 possible points with 89% excellent and good results and 11% satisfying results. All patients had some degree of pain or discomfort with the hookplate in place. These symptoms were relieved after removal of the plate. The overall complication rate was 10.6%. There were 6 superficial soft tissue infections, 1 fracture of the acromion, 7 redislocations after removal of the hook-plate. We observed 4 broken hooks which could be removed at the time of plate removal, 4 seromas and 2 cases of lateral clavicle bone infection, which required early removal of the plate. We can conclude that clavicle hook plate is a convenient device for the surgical treatment of Rockwood Grade III-V dislocations, giving good mid-term results with a low overall complication rate compared to the literature. Early functional therapy is possible and can avoid limitations in postoperative shoulder function

Advanced visual rendering, gesture-based interaction and distributed delivery for immersive and interactive media services

The media industry is currently being pulled in the often-opposing directions of increased realism (high resolution, stereoscopic, large screen) and personalisation (selection and control of content, availability on many devices). A capture, production, delivery and rendering system capable of supporting both these trends is being developed by a consortium of European organisations including partners from the broadcast, film, telecoms and academic sectors, in the EU-funded FascinatE project. This paper reports on the latest project developments in the delivery network and end-user device domains, including advanced audiovisual rendering, computer analysis and scripting, content-aware distributed delivery and gesture-based interaction. The paper includes an overview of existing immersive media services and concludes with initial service concept descriptions and their market potential.Peer ReviewedPreprin

Atlantic water inflow to Labrador Sea and its interaction with ice sheet dynamics during the Holocene

The hydrodynamics of the Labrador Sea, controlled by the complex interplay of oceanographic, atmospheric and ice-sheet processes, play a crucial role for the Atlantic Meridional Overturning Circulation (AMOC). An improved understanding of the hydrodynamics and its forcing in the past could therefore hold a key to understanding its future behaviour. At present, there is a remarkable temporal mismatch, in that the largely microfossil-based reconstructions of Holocene Atlantic-water inflow/influence in the Labrador Sea and Baffin Bay appear to lag grain size-based current strength reconstructions from the adjacent North Atlantic by > 2ka. Here, we present the first current strength record from the West Greenland shelf off Nuuk to reconstruct Atlantic Water (AW)-inflow to the Labrador Sea via the West Greenland Current. Our data show that the Holocene AW-inflow into Labrador Sea is well aligned with the Holocene Speed Maximum documented in the North Atlantic (McCave and Andrews, 2019; Quat. Sci. Rev. 223), suggesting a close coupling with the AMOC. The observed lag between the microfossil-based records and the Holocene Speed Maximum can be explained when considering the presence of an extended meltwater lens that prevented the shoaling of the inflowing Atlantic waters. Once the meltwater discharge waned after the cessation of large-scale melting of the surrounding ice sheets, the AW could influence the surface waters, independently of the strength of its inflow. Only then was an effective ocean-atmosphere heat transfer enabled, triggering the comparably late onset of the regional Holocene Thermal Maximum. Furthermore, sediment geochemical analyses show that short term cooling events, such as the 8.2 ka event related to the final drainage of glacial Lake Agassiz, lead to glacier advances of the Greenland Ice Sheet. Since the grain size data show that these events had no influence on the AW-inflow to the north eastern Labrador Sea, these advances must have been caused by atmospheric cooling. Consequently, we argue that (i) in this region, surface water-based proxies register AW influence rather than inflow (ii) the AW inflow into the Labrador Sea is controlled by the AMOC, but (iii) its impact on an effective ocean-atmosphere heat transfer was hindered by a prevailing meltwater lens in the early Holocene, i.e. until the cessation of large-scale melting of the surrounding ice sheets

Extensive hydrogen supersaturations in the western South Atlantic Ocean suggest substantial underestimation of nitrogen fixation

The nitrogen cycle is fundamental to Earth's biogeochemistry. Yet major uncertainties of quantification remain, particularly regarding the global oceanic nitrogen fixation rate. Hydrogen is produced during nitrogen fixation and will become supersaturated in surface waters if there is net release from diazotrophs. Ocean surveys of hydrogen supersaturation thus have the potential to illustrate the spatial and temporal distribution of nitrogen fixation, and to guide the far more onerous but quantitative methods for measuring it. Here we present the first transect of high resolution measurements of hydrogen supersaturations in surface waters along a meridional 10,000 km cruise track through the Atlantic. We compare measured saturations with published measurements of nitrogen fixation rates and also with model-derived values. If the primary source of excess hydrogen is nitrogen fixation and has a hydrogen release ratio similar to Trichodesmium, our hydrogen measurements would point to similar rates of fixation in the North and South Atlantic, roughly consistent with modelled fixation rates but not with measured rates, which are lower in the south. Possible explanations would include any substantial nitrogen fixation by newly discovered diazotrophs, particularly any having a hydrogen release ratio similar to or exceeding that of Trichodesmium; under-sampling of nitrogen fixation south of the equator related to excessive focus on Trichodesmium; and methodological shortcomings of nitrogen fixation techniques that cause a bias towards colonial diazotrophs relative to unicellular forms. Alternatively our data are affected by an unknown hydrogen source that is greater in the southern half of the cruise track than the northern

Salinity control on Na incorporation into calcite tests of the planktonic foraminifera Trilobatus sacculifer – Evidence from culture experiments and surface sediments

The quantitative reconstruction of past seawater salinity has yet to be achieved and the search for a direct and independent salinity proxy is ongoing. Recent culture and field studies show a significant positive correlation of Na/Ca with salinity in benthic and planktonic foraminiferal calcite. For accurate paleoceanographic reconstructions, consistent and reliable calibrations are necessary, which are still missing. In order to assess the reliability of foraminiferal Na/Ca as a direct proxy for seawater salinity, this study presents electron microprobe Na/Ca data, measured on cultured specimens of Trilobatus sacculifer. The culture experiments were conducted over a wide salinity range of 26 to 45, while temperature was kept constant. To further understand potential controlling factors of Na incorporation, measurements were also performed on foraminifera cultured at various temperatures in the range of 19.5 °C to 29.5 °C under constant salinity conditions. Foraminiferal Na/Ca ratios positively correlate with seawater salinity (Na/Caforam = 0.97 + 0.115 ⋅ Salinity, R = 0.97, p < 0.005). Temperature on the other hand exhibits no statistically significant relationship with Na/Ca ratios indicating salinity to be the dominant factor controlling Na incorporation. The culturing results are corroborated by measurements on T. sacculifer from Caribbean and Gulf of Guinea surface sediments. In conclusion, planktonic foraminiferal Na/Ca can be applied as a reliable proxy for reconstructing sea surface salinities, albeit species-specific calibrations might be necessary

Synchronous changes in sediment transport and provenance at the Iceland‐Faroe Ridge linked to millennial climate variability from 55 to 6 ka BP

Unique marine sediment cores retrieved from the southwestern slope of the Iceland‐Faroe Ridge (IFR), close to the main axis of the Iceland‐Scotland Overflow Water (ISOW) revealed prominent sedimentary cycles reflecting near‐bottom current dynamics, sediment transport and deposition, coincident with Dansgaard‐Oeschger cycles and deglacial perturbations of the Atlantic Meridional Overturning Circulation (AMOC). The transition between Greenland Stadials (GSs) and Greenland Interstadials (GIs) follows a distinct, recurring sedimentation pattern. Basaltic (Ti‐rich) silts were transported from local volcanic sources by strong bottom currents and deposited during GIs comparable to modern ocean circulation. Finer‐grained felsic (K‐rich) sediments were deposited during GSs, when ISOW was weak. Possible felsic source areas include British‐Ireland and/or Fennoscandian shelf areas. A cyclic saw‐tooth pattern of bottom current strength is characterized by gradual intensification during GIs followed by a sharp decline towards GSs as is documented at core sites along the flank of Reykjanes Ridge. The cores north of Faroe Channel instead document the opposite pattern. This suggests that the near‐bottom currents along the Reykjanes Ridge are strongly controlled by the flow cascading over the IFR. Heinrich (like) Stadials (HSs) especially HS‐1 and HS‐2 are characterized by the deposition of very fine felsic sediments pointing to weakened bottom currents. Distinct coarse‐grained intervals of ice rafted debris (IRD) are absent from the sediment records, although pebble and gravel sized IRD is irregularly distributed throughout the fine sediment matrix. Near bottom currents are considered to have a major control on the lithogenic sediment deposition southwest of the Iceland‐Faroe Ridge and further down‐stream

Biomechanical analysis of a synthetic femoral spiral fracture model: Do end caps improve retrograde flexible intramedullary nail fixation?

<p>Abstract</p> <p>Background</p> <p>Elastic Stable intramedullary Nailing (ESIN) of dislocated diaphyseal femur fractures has become an accepted method for the treatment in children and adolescents with open physis. Studies focused on complications of this technique showed problems regarding stability, usually in complex fracture types such as spiral fractures and in older children weighing > 40 kg. Biomechanical in vitro testing was performed to evaluate the stability of simulated spiral femoral fractures after retrograde flexible titanium intramedullary nail fixation with and without End caps.</p> <p>Methods</p> <p>Eight synthetic adolescent-size femoral bone models (Sawbones^®with a medullar canal of 10 mm and a spiral fracture of 100 mm length identically sawn by the manufacturer) were used for each group. Both groups underwent retrograde fixation with two 3.5 mm Titanium C-shaped nails inserted from medial and lateral entry portals. In the End Cap group the ends of the nails of the eight specimens were covered with End Caps (Synthes Company, Oberdorf, Switzerland) at the distal entry.</p> <p>Results</p> <p>Beside posterior-anterior stress (4.11 Nm/mm vs. 1.78 Nm/mm, p < 0.001), the use of End Caps demonstrated no higher stability in 4-point bending compared to the group without End Caps (anterior-posterior bending 0.27 Nm/mm vs. 0.77 Nm/mm, p < 0.001; medial-lateral bending 0.8 Nm/mm vs. 1.10 Nm/mm, p < 0.01; lateral-medial bending 0.53 Nm/mm vs. 0.86 Nm/mm, p < 0.001) as well as during internal rotation (0.11 Nm/° vs. 0.14 Nm/°, p < 0.05). During compression in 9°- position and external rotation there was no statistical significant difference (0.37 Nm/° vs. 0.32 Nm/°, p = 0.13 and 1.29 mm vs. 2.18 mm, p = 0.20, respectively) compared to the "classic" 2-C-shaped osteosynthesis without End Caps.</p> <p>Conclusion</p> <p>In this biomechanical study the use of End Caps did not improve the stability of the intramedullary flexible nail osteosynthesis.</p