Short Term Analysis of various uses of Cancellous Femoral Head and Cortical Allografts and their functional outcome in Orthopaedic Surgery

INTRODUCTION: Autografting has many disadvantages such as additional blood loss, increased operative time and cutaneous nerve damage, persistent pain at the donor site, vascular injury, and iliac bone fracture, herniation into the defect and in additional morbidity. Also the amount of morbidity is in direct proportion to the quality of graft retried. When the graft requirement is larger as in children where risk of damage to growth plate is high, revision hip surgeries, traumatic bone defects, spiral fusion and decompression surgeries, allograft comes into play. Although technique for allograft bone storage was described in the late 1940s and whole segmental grafts were used for tumor surgery in 1960s, the use of femoral head allografts as structural bone grafts was started in 1976 for revision hip surgeries. Initially, bone grafting was performed most commonly during complex primary hip arthroplasties such as for dysplasia, Protrusio acetebuli etc; currently for revision hip arthroplasty, foot and ankle surgeries, tumors and fracture non unions. The technique and practice of bone allografting in India is yet to take a firm footing. The facility for proper processing of the harvested bone allografts, its storage and strict donor screening is available only at few tertiary heath centers in India. The bone bank in government General Hospital started in the year 2005 is one such place aimed at maximal utilization of the allografts. AIM: 1. To analyze various the uses cancellous and cortical allografts in orthopaedic surgery. 2. The functional outcome of the allografts in these conditions. MATERIALS AND METHODS: Between February 2003-October 2006, 38 cases of cortical and cancellous allografting has been carried out at the department of orthopaedics, Govt. General Hospital, Chennai. This was a prospective study conducted in 38 patients, 22 of which were males and 16 were females. The Age groups of these patients were ranging from 6-55 years. Benign bone tumors were 21 cases of which the histopathological diagnosis was Fibrous dysplasia in 7 cases, Giant cell tumor in 4 cases, ABC in 2 cases, Chondroblastoma in 2 cases, Chondromyxoid fibroma in 1 case, Simple bone cyst in 2 cases, Osteochondroma with fracture in 2 cases and Chondroma 1 case. RESULTS: None of the patients developed systemic infection this highlights the fact that a through donor screening, proper allograft processing and storage was as essential as operative planning and technique for successful outcome of the procedure. Although the short term results were encouraging, it is required to study these cases for longer periods to reach a conclusion about the state of incorporation of structural bone allografts and need for re – surgery at a longer follow up. CONCLUSION: 1. Bone allograft is a safe and reliable adjuvant in the management of bone defect in the setting of tumors and traumatic bone loss, and revision hip surgeries and spine surgeries. 2. Better results are observed with use of both morsellized and structural bone allografts clinically as well as radiologically. 3. Allograft procured and processed in sterile condition and stringent donor screening are very important safe guards for prevention of disease transmission. 4. Autoclaving though weakens the graft, reduces the immunological as well as reduces further, the risk of disease transmission without much comparative on bony union. 5. Cancellous femoral heads are an excellent method in the management of bone tumor defects. 6. Femoral head allografts are available options in traumatic bone defects and in children. 7. Cortical allografts and autografts add additional sterility to the defect. 8. The clinical results are good and support recommendations for continued use the grafts and development of the technique

A kinematic analysis of the spine during rugby scrummaging on natural and synthetic turfs

Artificial surfaces are now an established alternative to grass (natural) surfaces in rugby union. Little is known, however, about their potential to reduce injury. This study characterises the spinal kinematics of rugby union hookers during scrummaging on third-generation synthetic (3G) and natural pitches. The spine was sectioned into five segments, with inertial sensors providing three-dimensional kinematic data sampled at 40 Hz/sensor. Twenty-two adult, male community club and university-level hookers were recruited. An equal number were analysed whilst scrummaging on natural or synthetic turf. Players scrummaging on synthetic turf demonstrated less angular velocity in the lower thoracic spine for right and left lateral bending and right rotation. The general reduction in the range of motion and velocities, extrapolated over a prolonged playing career, may mean that the synthetic turf could result in fewer degenerative injuries. It should be noted, however, that this conclusion considers only the scrummaging scenario

Segment-specific association between cervical pillar hyperplasia (CPH) and degenerative joint disease (DJD)

BACKGROUND: Cervical pillar hyperplasia (CPH) is a recently described phenomenon of unknown etiology and clinical significance. Global assessment of pillar hyperplasia of the cervical spine as a unit has not shown a relationship with degenerative joint disease, but a more sensible explanation of the architectural influence of CPH on cervical spine biomechanics may be segment-specific. OBJECTIVE: The objective of this study was to determine the level of association between degenerative joint disease (DJD) and cervical pillar hyperplasia (CPH) in an age- and gender-matched sample on a [cervical spine] by-level basis. RESEARCH METHODS: Two-hundred and forty radiographs were collected from subjects ranging in age between 40 and 69 years. The two primary outcome measures used in the study were the segmental presence/absence of cervical pillar hyperplasia from C3 to C6, and segment-specific presence/absence of degenerative joint disease from C1 to C7. Contingency Coefficients, at the 5% level of significance, at each level, were used to determine the strength of the association between CPH and DJD. Odds Ratios (OR) with their 95% Confidence Intervals (95% CI) were also calculated at each level to assess the strength of the association. RESULTS: Our study suggests that an approximately two-to-one odds, or a weak-to-moderate correlation, exists at C4 and C5 CPH and adjacent level degenerative disc disease (DDD); with the strongest (overall) associations demonstrated between C4 CPH and C4–5 DDD and between C5 CPH and C5–6 DDD. Age-stratified results demonstrated a similar pattern of association, even reaching the initially hypothesized OR ≥ 5.0 (95% CI > 1.0) or "moderately-strong correlation of C ≥ .4 (p ≤ .05)" in some age categories, including the 40–44, 50–59, and 60–64 years of age subgroups; these ORs were as follows: OR = 5.5 (95% CI 1.39–21.59); OR = 6.7 (95% CI 1.65–27.34); and OR = 5.3 (95% CI 1.35–21.14), respectively. CONCLUSION: Our results suggest that CPH has around two-to-one odds, that is, only a weak-to-moderate association with the presence of DJD (DDD component) at specific cervical spine levels; therefore, CPH may be but one of several factors that contributes (to a clinically important degree) to the development of DJD at specific levels in the cervical spine

Inter-examiner reliability of the diagnosis of cervical pillar hyperplasia (CPH) and the correlation between CPH and spinal degenerative joint disease (DJD)

BACKGROUND: Cervical pillar hyperplasia (CPH) is a recently described phenomenon of unknown aetiology. Its clinical importance is poorly understood at the present time; therefore, the objective of this study was to determine (1) the inter-examiner reliability of detecting CPH and (2) if there is a clinically important correlation (r > 0.4) between the number of cervical spine levels showing signs of degenerative joint disease (DJD) and CPH. METHODS: The sample consisted of 320 radiographs of human male and female subjects who ranged from 40 to 79 years of age. The inter-examiner reliability of assessing the presence/absence of pillar hyperplasia was evaluated on 50 neutral lateral radiographs by two examiners using line drawings and it was quantified using the kappa coefficient of concordance. To determine the presence/absence of hyperplastic pillars as well as the presence/absence of DJD at each intervertebral disc and zygapophysial joint, 320 AP open mouth, AP lower cervical and neutral lateral radiographs were then examined. The unpaired t-test at the 5% level of significance was performed to test for a statistically significant difference between the number of levels affected by DJD in patients with and without hyperplasia. The Spearman's rho at the 5% level of significance was performed to quantify the correlation between DJD and age. RESULTS: The inter-examiner reliability of detecting cervical pillar hyperplasia was moderate with a kappa coefficient of 0.51. The unpaired t-test indicated that there was no statistically significant difference (p > 0.05) between the presence/absence of cervical pillar hyperplasia and the number of levels affected by DJD in an age-matched population, regardless of whether all elements were considered together, or the discs and facets were analyzed separately. A Spearman correlation rank of 0.67 (p < 0.05) suggested a moderately strong correlation between the number of elements (i.e. discs/facets) affected, and the age of the individual. CONCLUSION: Cervical pillar hyperplasia is a reasonable concept that requires further research. Its evaluation is easy to learn and acceptably reliable. Previous research has suggested that CPH may affect the cervical lordosis, and therefore, alter biomechanics which may result in premature DJD. This current study, however, indicates that, globally, CPH does not appear to be related to the development of DJD

A comparative study of cranial, blunt trauma fractures as seen at medicolegal autopsy and by Computed Tomography

<p>Abstract</p> <p>Background</p> <p>Computed Tomography (CT) has become a widely used supplement to medico legal autopsies at several forensic institutes. Amongst other things, it has proven to be very valuable in visualising fractures of the cranium. Also CT scan data are being used to create head models for biomechanical trauma analysis by Finite Element Analysis. If CT scan data are to be used for creating individual head models for retrograde trauma analysis in the future we need to ascertain how well cranial fractures are captured by CT scan. The purpose of this study was to compare the diagnostic agreement between CT and autopsy regarding cranial fractures and especially the precision with which cranial fractures are recorded.</p> <p>Methods</p> <p>The autopsy fracture diagnosis was compared to the diagnosis of two CT readings (reconstructed with Multiplanar and Maximum Intensity Projection reconstructions) by registering the fractures on schematic drawings. The extent of the fractures was quantified by merging 3-dimensional datasets from both the autopsy as input by 3D digitizer tracing and CT scan.</p> <p>Results</p> <p>The results showed a good diagnostic agreement regarding fractures localised in the posterior fossa, while the fracture diagnosis in the medial and anterior fossa was difficult at the first CT scan reading. The fracture diagnosis improved during the second CT scan reading. Thus using two different CT reconstructions improved diagnosis in the medial fossa and at the impact points in the cranial vault. However, fracture diagnosis in the anterior and medial fossa and of hairline fractures in general still remained difficult.</p> <p>Conclusion</p> <p>The study showed that the forensically important fracture systems to a large extent were diagnosed on CT images using Multiplanar and Maximum Intensity Projection reconstructions. Difficulties remained in the minute diagnosis of hairline fractures. These inconsistencies need to be resolved in order to use CT scan data of victims for individual head modelling and trauma analysis.</p

Does facial soft tissue protect against zygomatic fractures?: results of a finite element analysis

Introduction: Zygomatic fractures form a major entity in craniomaxillofacial traumatology. Few studies have dealt with biomechanical basics and none with the role of the facial soft tissues. Therefore this study should investigate, whether facial soft tissue plays a protecting role in lateral midfacial trauma

Diversity of Recent Benthic Foraminifera and its Environmental Condition of Selected Estuaries in Tamil Nadu, India

Micropaleontological investigation has been carried out, for the first time to study the systematic of recent Benthic Foraminifera from the southeast coast flowing river estuaries Cauvery, Athankarai and Thamirabarani, Tamil Nadu, India. Totally 16 sediment samples were collected during December 2018. Benthic foraminiferal species, belonging to 14 species, 7 families and 5 Sub-orders are identified. Among this Miliolida (>75%) occupies the dominant place followed by Rotaliida (<25%). The higher species are observed in the rivermouth area particularly in the Cauvery estuary sample (365 species of Ammonia beccarii). The following species are abundantly distributed in this region namely Ammonia beccarii, Quinqueloculina and Miliolinella subrotunda. The abundance of species in the river mouth may be due to the mixing of marine and nearshore environment