An extensive posterior approach of the elbow with osteotomy of the medial epicondyle

Item does not contain fulltextBACKGROUND: This study describes a posterior approach to the elbow for placement of a total elbow prosthesis. METHODS: Release of the medial collateral ligament is achieved by performing an osteotomy of the medial epicondyle. This allows anatomic refixation of the origin of the medial collateral ligament. A description of the posterior approach is given. Standard radiographs were used to analyze the bone-to-bone refixation of the osteotomy of the medial epicondyle in 13 elbows. RESULTS: Radiographs showed proper bone healing in all elbows, with restoration of the anatomic origin of the medial collateral ligament. DISCUSSION: The described approach provides a good exposure of the elbow necessary for the placement of modern total elbow prostheses, without compromising the stability of the elbow. Refixation of stabilizing structures is relatively easy and results in an anatomic position of the ligaments

Biomechanical evaluation of three different fixation methods of the Chevron osteotomy of the olecranon: an analysis with Roentgen Stereophotogrammatic Analysis

Item does not contain fulltextBACKGROUND: In this study three different methods for fixating the Chevron osteotomy of the olecranon are evaluated. Transcortical fixed Kirschner wires with a tension band, a large cancellous screw with a tension band, and a large cancellous screw alone are compared using Roentgen Stereophotogrammatic Analysis (RSA). METHODS: The different fixation methods were tested in 17 cadaver specimens by applying increasing repetitive force to the triceps tendon. Forces applied were 200N, 350N, and 500N. Translation and rotation of the osteotomy were recorded using Roentgen Stereophotogrammatic Analysis. FINDINGS: Both the fixations with a cancellous screw with tension band and with bi-cortical placed Kirschner wires with a tension band provide enough stability to withstand the forces of normal daily use. INTERPRETATION: Since fixation with a cancellous screw with tension band is a fast and easy method and is related to minimal soft tissue damage this method can preferably be used for fixation of a Chevron osteotomy of the olecranon.5 p

Linking of total elbow prosthesis during surgery; a biomechanical analysis

Item does not contain fulltextBACKGROUND: Presently, 2 types of elbow prostheses are used: unlinked and linked. The Latitude total elbow prosthesis allows the surgeon to decide during the implantation whether the prosthesis is placed unlinked or linked, and whether the native radial head is retained, resected, or replaced. The purpose of this study is to assess and to compare the varus and valgus laxity of the unlinked and linked version of the latitude total elbow prosthesis with: (1) the native radial head preserved, (2) the native radial head excised, and (3) the native radial head replaced by a radial head component. METHODS: Biomechanical testing was performed on 14 fresh-frozen upper limb specimens. RESULTS: Linking the prosthesis predominantly influences the valgus laxity of the elbow. DISCUSSION/CONCLUSION: Linking the Latitude total elbow prosthesis results in increased valgus stability. In the linked version of the total elbow prosthesis, the radial head only plays a small part in both valgus and varus stability. An unlinked situation is not advised in absence of a native radial head or in case of inability to replace the radial head

Stability of the unlinked Latitude total elbow prosthesis: A biomechanical in vitro analysis.

Item does not contain fulltextBACKGROUND: The purpose of this study is to assess the valgus and varus laxity of the unlinked version of the Latitude total elbow prosthesis and the effects of radial head preservation or replacement. METHODS: Biomechanical analysis of the valgus and varus laxity of the unlinked Latitude was performed in fourteen upper limb specimens in the following conditions: (1) native elbow, (2) native elbow after the surgical approach and closing all layers again, (3) elbow with humeral and ulnar component implanted, unlinked, with the native radial head preserved, (4) elbow with humeral and ulnar component implanted, unlinked, with the native radial excised, (5) elbow with humeral, ulnar, and radial head component implanted. FINDINGS: After implantation of the Latitude total elbow prosthesis both the valgus and varus laxity slightly increase from mid to maximal flexion when compared to the native elbow after surgical approach. The unlinked Latitude total elbow prosthesis provides both valgus and varus stability in elbows with intact ligamentous constraints. With intact ligamentous constraints the radial head component only slightly contributes to the stability of the elbow after implantation of the unlinked Latitude total elbow prosthesis. INTERPRETATION: The unlinked Latitude total elbow prosthesis provides both valgus and varus stability in elbows with intact ligamentous constraints. The radial head component contributes only slightly to the stability.1 juni 201

Het 'zuggurtung'-principe bij olecranonfracturen en de Chevronoesteotomie van het olecranon

Bij ongeveer 20% van de fracturen van de onderarm is sprake van een fractuur van het olecranon. Simpele, niet-comminutieve fracturen van het olecranon kunnen, biomechanisch gezien, worden vergeleken met een Chevron-osteotomie van het olecranon. Beide worden frequent gefixeerd met twee bicorticaal geplaatste Kirschner-draden en een cerclagedraad (de klassieke ‘zuggurtung’ of trekgording). Een algemeen aanvaard principe bij deze fixatie is dat tractie van de triceps op het olecranon omgezet wordt in compressiekrachten ter hoogte van de fractuur, dan wel ter hoogte van de osteotomie van het olecranon. In dit artikel wordt met de röntgen stereofotogrammetrische analyse (RSA) techniek aangetoond dat fixatie van kadaverarmen met twee bicorticaal geplaatste Kirschner-draden en een cerclagedraad in een achtvormige configuratie resulteert in een stabiele situatie, waarbij direct postoperatieve mobilisatie mogelijk is. De resultaten lieten echter ook zien dat tractie van de triceps niet resulteert in compressie over het fractuurvlak

Handball : vers le démarquage

Apprentissage d'une compétence spécifique : le démarquage en handball. Objectif : amener les élèves à se rendre disponibles pour faire évoluer le jeu vers le but adverse

Evaluation of a shared decision-making strategy with online decision aids in surgical and orthopaedic practice: study protocol for the E-valuAID, a multicentre study with a stepped-wedge design

Contains fulltext : 232427.pdf (Publisher’s version ) (Open Access)BACKGROUND: Inguinal hernia repair, gallbladder removal, and knee- and hip replacements are the most commonly performed surgical procedures, but all are subject to practice variation and variable patient-reported outcomes. Shared decision-making (SDM) has the potential to reduce surgery rates and increase patient satisfaction. This study aims to evaluate the effectiveness of an SDM strategy with online decision aids for surgical and orthopaedic practice in terms of impact on surgery rates, patient-reported outcomes, and cost-effectiveness. METHODS: The E-valuAID-study is designed as a multicentre, non-randomized stepped-wedge study in patients with an inguinal hernia, gallstones, knee or hip osteoarthritis in six surgical and six orthopaedic departments. The primary outcome is the surgery rate before and after implementation of the SDM strategy. Secondary outcomes are patient-reported outcomes and cost-effectiveness. Patients in the usual care cluster prior to implementation of the SDM strategy will be treated in accordance with the best available clinical evidence, physician's knowledge and preference and the patient's preference. The intervention consists of the implementation of the SDM strategy and provision of disease-specific online decision aids. Decision aids will be provided to the patients before the consultation in which treatment decision is made. During this consultation, treatment preferences are discussed, and the final treatment decision is confirmed. Surgery rates will be extracted from hospital files. Secondary outcomes will be evaluated using questionnaires, at baseline, 3 and 6 months. DISCUSSION: The E-valuAID-study will examine the cost-effectiveness of an SDM strategy with online decision aids in patients with an inguinal hernia, gallstones, knee or hip osteoarthritis. This study will show whether decision aids reduce operation rates while improving patient-reported outcomes. We hypothesize that the SDM strategy will lead to lower surgery rates, better patient-reported outcomes, and be cost-effective. TRIAL REGISTRATION: The Netherlands Trial Register, Trial NL8318, registered 22 January 2020. URL: https://www.trialregister.nl/trial/8318

Binding of von Willebrand factor and plasma proteins to the eggshell of Schistosoma mansoni

Proteomic

Specificity and affinity of monoclonal antibodies against carcinoembryonic antigen.

The binding specificities of 52 well-characterized monoclonal antibodies (Mabs) against carcinoembryonic antigen (CEA) from 12 different research groups were studied by immunohistochemistry and immuno flow cytometry. In addition, the binding constant for the interaction between Mab and CEA was determined by a solution-phase assay. Cryostat sections of colon carcinoma and normal colon, stomach, liver, pancreas, and spleen were studied by immunohistochemistry. Peripheral blood granulocytes, monocytes, and lymphocytes were assayed by immuno flow cytometry. The Mabs used here have previously been classified into five essentially nonoverlapping epitope groups (GOLD 1-5) (Cancer Res., 49: 4852-4858, 1989). Most Mabs cross-reacted with different normal tissues, ranging from highly cross-reactive Mabs (positive reaction with 8 of 9 discriminating tissues) to relatively specific Mabs (positive reaction with 1 of 9 discriminating tissues). Five Mabs (10%) were specific, reacting only with colon carcinoma, normal colon mucosa, and normal gastric foveola. There was a correlation between epitope group and binding specificity. Mabs with a high degree of CEA specificity almost exclusively belonged to epitope groups 1, 2, and 3, while highly cross-reactive Mabs belonged to epitope groups 4 and 5. There was no correlation between antibody specificity and affinity for CEA. Specific Mabs with high as well as low affinity were found