Application of Far Cortical Locking Technology in Periprosthetic Femoral Fracture Fixation: A Biomechanical Study

© 2016 Elsevier Inc. Background Lack of fracture movement could be a potential cause of periprosthetic femoral fracture (PFF) fixation failures. This study aimed to test whether the use of distal far cortical locking screws reduces the overall stiffness of PFF fixations and allows an increase in fracture movement compared to standard locking screws while retaining the overall strength of the PFF fixations. Methods Twelve laboratory models of Vancouver type B1 PFFs were developed. In all specimens, the proximal screw fixations were similar, whereas in 6 specimens, distal locking screws were used, and in the other six specimens, far cortical locking screws. The overall stiffness, fracture movement, and pattern of strain distribution on the plate were measured in stable and unstable fractures under anatomic 1-legged stance. Specimens with unstable fracture were loaded to failure. Results No statistical difference was found between the stiffness and fracture movement of the two groups in stable fractures. In the unstable fractures, the overall stiffness and fracture movement of the locking group was significantly higher and lower than the far cortical group, respectively. Maximum principal strain on the plate was consistently lower in the far cortical group, and there was no significant difference between the failure loads of the 2 groups. Conclusion The results indicate that far cortical locking screws can reduce the overall effective stiffness of the locking plates and increase the fracture movement while maintaining the overall strength of the PFF fixation construct. However, in unstable fractures, alternative fixation methods, for example, long stem revision might be a better option

Cowden syndrome. Managing multiple skeletal metastases of different origin: a case report

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

Minimally invasive versus open transforaminal lumbar interbody fusion: evaluating initial experience

The aim of this study was to compare our experience with minimally invasive transforaminal lumbar interbody fusion (MITLIF) and open midline transforaminal lumbar interbody fusion (TLIF). A total of 36 patients suffering from isthmic spondylolisthesis or degenerative disc disease were operated with either a MITLIF (n = 18) or an open TLIF technique (n = 18) with an average follow-up of 22 and 24months, respectively. Clinical outcome was assessed using the visual analogue scale (VAS) and the Oswestry disability index (ODI). There was no difference in length of surgery between the two groups. The MITLIF group resulted in a significant reduction of blood loss and had a shorter length of hospital stay. No difference was observed in postoperative pain, initial analgesia consumption, VAS or ODI between the groups. Three pseudarthroses were observed in the MITLIF group although this was not statistically significant. A steeper learning effect was observed for the MITLIF grou

Η Ελληνική Κοινωνία Πολιτών στη Δικτατορία των Συνταγματαρχών. Τυπική και Άτυπη Αντιστασιακή Δράση

Η διατριβή εξετάζει το ρόλο της ελληνικής κοινωνίας πολιτών στα χρόνια της δικτατορίας των συνταγματαρχών. Ποια σχέση αναπτύσσεται ανάμεσα στις εκδηλώσεις της κοινωνίας πολιτών και σε ένα αυταρχικό καθεστώς; Υπήρξε η ελληνική κοινωνία πολιτών αποτελεσματική απέναντι στο δικτατορικό καθεστώς και σε συνάρτηση με τους στόχους που η ίδια έθετε; Εκτενής λόγος γίνεται για την έννοια της κοινωνίας πολιτών και τις άτυπες εκδηλώσεις της και υιοθετείται ένας ορισμός που τις περιλαμβάνει. Τονίζεται η αυξημένη σημασία που αυτές προσλαμβάνουν υπό αυταρχική διακυβέρνηση, καθώς οι άτυπες ομάδες απολαμβάνουν συνήθως, κατά τη διάρκεια δικτατορικών περιόδων, μια – από την άποψη της πολιτικής δράσης - πιο ελεύθερη πραγματικότητα σε σύγκριση με τις τυπικές ομάδες. Χάριν αποτελεσματικότητας, η κοινωνία πολιτών προχώρησε στη διάρκεια της επταετίας σε ένα μετασχηματισμό των χαρακτηριστικών της και των μέσων αντίστασης που μεταχειρίστηκε, αμφισβητώντας και υπονομεύοντας σταθερά την πολιτική νομιμοποίηση του καθεστώτος.The dissertation examines the Greek civil society's role during the Colonels’ dictatorial regime. What is the relationship that develops between civil society manifestations and an authoritarian regime? Was the Greek civil society effective against the dictatorial regime in relation to its own goals? The dissertation discusses the concept of civil society and its informal manifestations and adopts a definition that includes them. Emphasis is placed on the increased importance of the latter under authoritarian rule, as informal groups usually experience a more liberal reality in terms of political action than typical groups during dictatorial periods. Over the seven years period, for the sake of efficiency, civil society progressed into a transformation of its characteristics and means of resistance, challenging and gradually undermining the regime’s political legitimacy

Metastatic malignant melanoma of the conjunctiva: a case report

BACKGROUND: Malignant melanoma of the conjunctiva is an extremely rare non-cutaneous neoplasm with infrequent skeletal metastatic spread. CASE PRESENTATION: We present the case of a 54 year old female Caucasian patient with osseous metastases originating from a malignant melanoma of her right conjunctiva. Metastatic deposits were identified in the left humeral diaphysis and left tibial metaphysis. Clinical, radiological and scintigraphic evaluation necessitated prompt stabilisation of both long bones. Following reamed intramedullary nailing and post-operative radiotherapy she remains asymptomatic six months post-operatively. CONCLUSION: This unusual pattern of metastatic spread to the appendicular skeleton of an extremely rare melanomatous lesion requires diagnostic vigilance as well as a multidisciplinary approach for accurate diagnosis, staging and management. Due to the poor prognosis, treatment goals should be directed to palliation of symptoms and prolongation of the quality of life

Calcitonin delays the progress of early-stage mechanically induced osteoarthritis. In vivo, prospective study

SummaryBackground/rationaleIntroducing new or testing existing drugs in an attempt to modify the progress of osteoarthritis (OA) is of paramount importance.Questions/purposesThis study aims to determine the effect exerted by Calcitonin on the progress of early-stage osteoarthritic lesions.MethodsWe used 18, skeletally mature, white, female, New Zealand rabbits. OA was operatively induced in the right knee of each animal by the complete dissection of the anterior cruciate ligament, complete medial meniscectomy and partial dissection of the medial collateral ligament. Postoperatively, animals were divided into two groups. Starting on the ninth postoperative day and daily thereafter, group A animals (n = 9) received 10 IU oculus dexter (o.d.) of synthetic Calcitonin IntraMuscularly (I.M.); group B animals (n = 9) received equal volume of saline o.d. Three animals from each group were sacrificed at 1, 2 and 3 months following treatment's initiation. The extent and the grade of OA were assessed macroscopically, histologically and by radiographs, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI)-scans. The Osteoarthritis Research Society International (OARSI) score, incorporating histological and macroscopic information, was calculated for each knee.ResultsOsteoarthritic changes in group A animals were less severe and progressed less rapidly when compared with those of group B animals (sham). This difference was statistically significant in the first and second month (P = 0.05), but not in the third month (P = 0.513).ConclusionsI.M. administration of Calcitonin seems to delay the progress of early-stage osteoarthritic lesions induced by mechanical instability in a rabbit experimental model

Dementia and osteoporosis in a geriatric population: Is there a common link?

AIM To determine the existence of a common pathological link between dementia and osteoporosis through reviewing the current evidence base. METHODS This paper reviews the current literature on osteoporosis and dementia in order to ascertain evidence of a common predisposing aetiology. A literature search of Ovid MEDLINE (1950 to June 2016) was conducted. The keywords “osteoporosis”, “osteoporotic fracture”, “dementia” and “Alzheimer’s disease” (AD) were used to determine the theoretical links with the most significant evidence base behind them. The key links were found to be vitamins D and K, calcium, thyroid disease, statins, alcohol and sex steroids. These subjects were then searched in combination with the previous terms and the resulting papers manually examined. Theoretical, in vitro and in vivo research were all used to inform this review which focuses on the most well developed theoretical common causes for dementia (predominantly Alzheimer’s type) and osteoporosis. RESULTS Dementia and osteoporosis are multifaceted disease processes with similar epidemiology and a marked increase in prevalence in elderly populations. The existence of a common link between the two has been suggested despite a lack of clear pathological overlap in our current understanding. Research to date has tended to be fragmented and relatively weak in nature with multiple confounding factors reflecting the difficulties of in vivo experimentation in the population of interest. Despite exploration of various possible mechanisms in search for a link between the two pathologies, this paper found that it is possible that these associations are coincidental due to the nature of the evidence available. One finding in this review is that prior investigation into common aetiologies has found raised amyloid beta peptide levels in osteoporotic bone tissue, with a hypothesis that amyloid beta disorders are systemic disorders resulting in differing tissue manifestations. However, our findings were that the most compelling evidence of a common yet independent aetiology lies in the APOE4 allele, which is a well-established risk for AD but also carries an independent association with fracture risk. The mechanism behind this is thought to be the reduced plasma vitamin K levels in individuals exhibiting the APOE4 allele which may be amplified by the nutritional deficiencies associated with dementia, which are known to include vitamins K and D. The vitamin theory postulates that malnutrition and reduced exposure to sunlight in patients with AD leads to vitamin deficiencies. CONCLUSION Robust evidence remains to be produced regarding potential links and regarding the exact aetiology of these diseases and remains relevant given the burden of dementia and osteoporosis in our ageing population. Future research into amyloid beta, APOE4 and vitamins K and D as the most promising aetiological links should be welcomed