How plate positioning impacts the biomechanics of the open wedge tibial osteotomy; A finite element analysis

A numerical model of the medial open wedge tibial osteotomy based on the finite element method was developed. Two plate positions were tested numerically. In a configuration, (a), the plate was fixed in a medial position and (b) in an anteromedial position. The simulation took into account soft tissues preload, muscular tonus and maximal gait load.

The maximal stresses observed in the four structural elements (bone, plate, wedge, screws) of an osteotomy with plate in medial position were substantially higher (1.13–2.8 times more) than those observed in osteotomy with an anteromedial plate configuration. An important increase (1.71 times more) of the relative micromotions between the wedge and the bone was also observed. In order to avoid formation of fibrous tissue at the bone wedge interface, the osteotomy should be loaded under 18.8% (～50 kg) of the normal gait load until the osteotomy interfaces union is achieved.     

How plate positioning impacts the biomechanics of the open wedge tibial osteotomy; a finite element analysis

A numerical model of the medial open wedge tibial osteotomy based on the finite element method was developed. Two plate positions were tested numerically. In a configuration, (a), the plate was fixed in a medial position and (b) in an anteromedial position. The simulation took into account soft tissues preload, muscular tonus and maximal gait load.The maximal stresses observed in the four structural elements (bone, plate, wedge, screws) of an osteotomy with plate in medial position were substantially higher (1.13-2.8 times more) than those observed in osteotomy with an anteromedial plate configuration. An important increase (1.71 times more) of the relative micromotions between the wedge and the bone was also observed. In order to avoid formation of fibrous tissue at the bone wedge interface, the osteotomy should be loaded under 18.8% (approximately 50 kg) of the normal gait load until the osteotomy interfaces union is achieved.     

Effects of medial collateral ligament release,limb correction,and soft tissue laxity on knee joint contact force distribution after medial opening wedge high tibial osteotomy: a computational study

In this study, the effects of medial collateral ligament (MCL) release and the limb correction strategies with pre-existing MCL laxity on tibiofemoral contact force distribution after high tibial osteotomy (HTO) were investigated. The medial and lateral contact forces of the knee were quantified during simulated standing using computational modeling techniques. MCL slackness had a primary influence on contact force distribution of the knee, while there was little effect of simulated limb correction. Anterior and middle bundle release, which involved the partial release of two-thirds of the superficial MCL, was shown to be an optimal surgical method in HTO, achieving balanced contact distribution in simulated weight-bearing standing.     

腓骨近端截骨术与胫骨高位截骨术治疗内侧间室性膝关节骨关节炎的比较研究

目的:对比内侧间室性膝关节骨关节炎(KOA)患者应用腓骨近端截骨术与胫骨高位截骨术治疗的疗效。方法:选取2016年11月到2017年12月在我院接受治疗的内侧间室性KOA患者32例,采用随机数字表法将所有患者分为腓骨近端截骨组与胫骨高位截骨组各16例,比较两组患者的手术时间、住院时间、术中出血量和住院费用,比较两组患者术前、术后3个月、术后6个月的美国特种外科医院膝关节评分(HSS)、美国膝关节协会评分(KSS)、视觉模拟疼痛评分(VAS)和股胫角(FTA),比较两组患者术后出现的并发症的发生率。结果:腓骨近端截骨组患者的手术时间、住院时间短于胫骨高位截骨组,术中出血量和住院费用均显著少于胫骨高位截骨组(P0.05);术后3个月、术后6个月两组患者的HSS评分、KSS评分均明显高于术前,VAS评分、FTA均明显低于术前(P0.05);术前、术后3个月、术后6个月两组患者的HSS评分、KSS评分、VAS评分、FTA比较均无统计学差异(P0.05);两组患者的并发症发生率比较无统计学差异(P0.05)。结论:腓骨近端截骨术和胫骨高位截骨术均可有效治疗内侧间室性KOA,改善患者的膝关节功能和疼痛感,纠正内翻畸形,但腓骨近端截骨术手术时间和住院时间更短,术中出血量和住院费用更少。     

Testing amniote models of prey transport kinematics: a quantitative analysis of mouth opening patterns in lizards

Two models have been proposed to describe the prey transport kinematics of terrestrial vertebrates (Bramble and Wake, 1985; Reilly and Lauder, 1990). The critical difference between the models is the presence or absence of a slow open-II phase (SO-II) in the gape profile during mouth opening. Each of these models has been applied to lizards, however to date, lizard feeding kinematics have not been adequately quantified to assess the utility of these models for this clade. Neither model has been sufficiently tested due to the lack of a methodology to assess the specific differences between the models. We describe a method that uses explicit mathematical criteria to define the kinematic phases in tetrapod feeding. This "slope analysis& is used to precisely quantify and compare the transport kinematics of seven lizard species. Lizard transport kinematics were highly variable both within and across taxa. However, several common gape cycle patterns were identified. The predominant patterns were slow-fast opening (37.3%), fast opening only (22.9%) and slow opening only (21.2%). The most common pattern explicitly fits the prediction of the Reilly and Lauder model while the other two are similar to patterns observed in salamanders. Thus, lizards possess both the slow opening-fast opening pattern predicted for amniotes and the more primitive, simple opening pattern characteristic of more basal tetrapods. Plateau phases were found in only 12.8% of the profiles and only a fourth of these (3.4% of the total) explicitly fit the Bramble and Wake model (slow opening, plateau, fast opening) and two species never exhibited plateaus in their gape cycles. Thus, it is clear that the Bramble and Wake model is not supported as a generalized model for lizards or generalized tetrapods.     

Does screw–bone interface modelling matter in finite element analyses?

The effect of screw-bone interface modelling strategies was evaluated in the setting of a tibial mid-shaft fracture stabilised using locking plates. Three interface models were examined: fully bonded interface; screw with sliding contact with bone; and screw with sliding contact with bone in an undersized pilot hole. For the simulation of the last interface condition we used a novel thermal expansion approach to generate the pre-stress that the bone would be exposed to during screw insertion. The study finds that the global load-deformation response is not influenced by the interface modelling approach employed; the deformation varied by less than 1% between different interaction models. However, interface modelling is found to have a considerable impact on the local stress-strain environment within the bone in the vicinity of the screws. Frictional and tied representations did not have significantly different peak strain values (<5% difference); the frictional interface had higher peak compressive strains while the tied interface had higher tensile strains. The undersized pilot hole simulation produced the largest strains. The peak minimum principal strains for the frictional interface were 26% of those for the undersized pilot hole simulation at a load of 770 N. It is concluded that the commonly used tie constraint can be used effectively when the only interest is the global load-deformation behaviour. Different contact interface models, however, alter the mechanical response around screw holes leading to different predictions for screw loosening, bone damage and stress shielding.     

关节镜手术联合胫骨高位截骨治疗内侧膝关节骨关节炎的临床研究

目的:观察关节镜手术联合胫骨高位截骨(HTO)治疗内侧膝关节骨关节炎(KOA)的临床疗效。方法:本研究为回顾性研究,将2018年2月~2020年9月间在我院接受治疗的内侧KOA患者63根据手术方式的不同分为A组和B组,分别为30例和33例。A组进行HTO手术,B组进行关节镜手术联合HTO治疗。术前、术后6周、术后12周采用美国纽约特种外科医院(HSS)评分、视觉模拟量表(VAS)评分评价两组患者膝关节功能、疼痛情况。采用36项简明健康状况调查表(SF-36)评价两组患者术前与术后12周的生活质量变化情况。记录两组术后并发症发生情况。术前、术后12周采用MB-Ruler软件测量两组患者机械胫骨近端内侧角(mMPTA)、解剖股胫角(aFTA)。结果:术后6周、术后12周,B组HSS评分高于A组,VAS评分低于A组(P<0.05)。术后12周,B组SF-36量表各维度评分高于A组(P<0.05)。术后3周,B组mMPTA、aFTA小于A组(P<0.05)。两组术后并发症发生率组间对比无差异(P>0.05)。结论:相对于单纯的HTO手术,关节镜手术联合HTO治疗内侧KOA患者,可有效促进膝关节功能改善,减轻疼痛症状,调整下肢力线,近期疗效肯定。     

Using digital image correlation to determine bone surface strains during loading and after adaptation of the mouse tibia

Previous models of cortical bone adaptation, in which loading is imposed on the bone, have estimated the strains in the tissue using strain gauges, analytical beam theory, or finite element analysis. We used digital image correlation (DIC), tracing a speckle pattern on the surface of the bone during loading, to determine surface strains in a murine tibia during compressive loading through the knee joint. We examined whether these surface strains in the mouse tibia are modified following two weeks of load-induced adaptation by comparison with contralateral controls. Results indicated non-uniform strain patterns with isolated areas of high strain (0.5%), particularly on the medial side. Strain measurements were reproducible (standard deviation of the error 0.03%), similar between specimens, and in agreement with strain gauge measurements (between 0.1 and 0.2% strain). After structural adaptation, strains were more uniform across the tibial surface, particularly on the medial side where peak strains were reduced from 0.5% to 0.3%. Because DIC determines local strains over the entire surface, it will provide a better understanding of how strain stimulus influences the bone response during adaptation.     

Rate of opening of a population of Na channels in frog skeletal muscle fibers

Linear Systems convolution analysis of muscle sodium currents was used to predict the opening rate of sodium channels as a function of time during voltage clamp pulses. If open sodium channel lifetimes are exponentially distributed, the channel opening rate corresponding to a sodium current obtained at any particular voltage, can be analytically obtained using a simple equation, given single channel information about the mean open-channel lifetime and current.Predictions of channel opening rate during voltage clamp pulses show that sodium channel inactivation arises coincident with a decline in channel opening rate.Sodium currents pharmacologically modified with Chloramine-T treatment so that they do not inactivate, show a predicted sustained channel opening rate.Large depolarizing voltage clamp pulses produce channel opening rate functions that resemble gating currents.The predicted channel opening rate functions are best described by kinetic models for Na channels which confer most of the charge movement to transitions between closed states.Comparisons of channel opening rate functions with gating currents suggests that there may be subtypes of Na channel with some contributing more charge movement per channel opening than others.Na channels open on average, only once during the transient period of Na activation and inactivation.After transiently opening during the activation period and then closing by entering the inactivated state, Na channels reopen if the voltage pulse is long enough and contribute to steady-state currents.The convolution model overestimates the opening rate of channels contributing to the steady-state currents that remain after the transient early Na current has subsided.     

Reconstruction of the hand in Apert syndrome: a simplified approach

Children born with Apert acrocephalosyndactyly pose great challenges to the pediatric hand surgeon. Reconstructive dilemmas consist of shortened, deviated phalanges and extensive skin deficits following syndactyly release. We present a 10-year review of patients with Apert acrocephalosyndactyly who were treated with a simplified surgical approach. Between 1986 and 1996, 10 patients with Apert syndrome underwent reconstructive surgery of their hands. The overall strategy involved early bilateral separation of syndactylous border digits at 1 year of age, followed by sequential unilateral middle syndactyly mass separation with thumb osteotomy and bone grafting as needed. In these 10 patients, a total of 53 web spaces were released, 49 of which involved osteotomies for complex syndactyly. Only local flaps and full-thickness skin grafts from the groin were used in all cases to achieve soft-tissue coverage. To date, seven of the 53 web spaces have needed revision (revision rate, 13 percent). Eleven thumb osteotomies (nine opening wedge and two closing wedge) were performed. Bone grafts from the proximal ulna or from other digits were used in all cases. To date, none of these thumb osteotomies have needed revision. This early, simplified approach to the complex hand anomalies of Apert acrocephalosyndactyly has been successful in achieving low revision rates and excellent functional outcomes as measured by gross grasp and pinch and by patient and parent satisfaction.     

Method for comparative studies of the revascularisation processes in the bone tissue, using 85Sr

85SR was used for the local blood flow measurements in bones. A method for dynamic analysis of the magnitude of local blood flow based on 7-min analysis of the area under the logarithmic curve was presented. The radioactivity of the tibial diaphysis was followed by a gamma-scintillation dectector focused on the area of approximately 10 mm 0. The revascularisation process during bone repair after the osteotomy of the tibial diaphysis fixed intramarrowally was observed on 14 rabbits, two and four weeks after the osteotomy. In the first two weeks following the osteotomy the process of revascularisation was significantly enhanced in a comparison to the second two weeks.     

Quantification of soft tissue balance in total knee arthroplasty using finite element analysis

Unbalanced contact force on the tibial component has been considered a factor leading to loosening of the implant and increased wear of the bearing surface in total knee arthroplasty. Because it has been reported that good alignment cannot guarantee successful clinical outcomes, the soft tissue balance should be checked together with the alignment. Finite element models of patients' lower extremities were developed to analyse the medial and lateral contact force distribution on the tibial insert. The distributions for four out of five patients were not balanced equally, even though the alignment angles were within a clinically acceptable range. Moreover, the distribution was improved by changing soft tissue release and ligament tightening for the specific case. Integration of the biomechanical modelling, image matching and finite element analysis techniques with the patient-specific properties and various dynamic loading would suggest a clinically relevant pre-operative planning for soft tissue balancing.     

In vivo tibiofemoral contact analysis using 3D MRI-based knee models

This paper quantified the motion of the tibiofemoral contact points during in vivo weight bearing flexion using MRI- based 3D knee models and two orthogonal fluoroscopic images. The contact points on the medial and lateral tibial plateau were calculated by finding the centroid of the intersection of the tibial and femoral cartilage layers and by using the bony geometry alone. Our results indicate that the medial femoral condyle remains in the central portion of the tibial plateau and the lateral condyle translates posteriorly with increasing flexion. Using the bony contact model increased the total translation of the medial and lateral condyles by 250 and 55%, respectively, compared to the cartilage contact model. These results suggest that using the bony geometry alone may not accurately represent the articular surfaces of the knee. Articular cartilage geometry may have to be used to accurately quantify tibiofemoral contact.     

Outline of a theory for the ontogenesis of iso-orientation domains in visual cortex

The following statements are assumed as experimental facts: The majority of cells in visual cortex is selectively sensitive to stimuli in the form of lines or edges of a certain orientation. Optimal orientation varies smoothly from cell to cell over the cortical surface. This structure is present, in immature form, at the time of eye opening. The problem is to find a plausible mechanism for the ontogenesis of this structure. Published theories are reviewed and found to be insufficient in one or more respects. A new theory is proposed. It distinguishes two processes: A) In the previsual period, intracortical connections re-organize themselves such that they restrict activity to an appropriate family of patterns (e.g. stripes of different phases). B) Later, a one-to-one mapping is developed that couples each stimulus orientation to one of the cortical patterns. The coupling may take place in two stages: a) Still before eye opening, two sets of afferent pilot fibres serve to fix the mapping in two points. (The pilot fibres can be assigned to these two sets on the basis of correlated or anticorrelated spike activity. They have genetically programmed orientation preferences which fall into two groups. A fibre sorting mechanism analogous to the one producing ocularity domains concentrates the sets of fibres into complementary activity patterns.) b) After eye opening, a more precise mapping of orientations to cortical patterns develops with the help of visual stimulation and synaptic plasticity according to a well-known mechanism. Experimental evidence for the theory is discussed. The theory can be evaluated in terms of general principles of brain organization.Supported in part by NATO grant No. 1791     

The determinants of change in tibial plateau bone area in osteoarthritic knees: a cohort study

Bone is integral to the pathogenesis of osteoarthritis (OA). Whether the bone area of the tibial plateau changes over time in subjects with knee OA is unknown. We performed a cohort study to describe this and identify factors that might influence the change. One hundred and twenty-six subjects with knee OA underwent baseline knee radiography and magnetic resonance imaging on their symptomatic knee. They were followed up with a repeatmagnetic resonance image of the same knee approximately 2 years later. The bone area of the tibial plateau was measured at baseline and follow-up. Risk factors assessed at baseline were tested for their association with change in tibial plateau bone area over time. One hundred and seventeen subjects completed the study. The medial and lateral tibial plateau bone areas increased by 2.2 ± 6.9% and 1.5 ± 4.3% per year, respectively. Being male (P = 0.001), having a higher body mass index (P = 0.002), and having a higher baseline grade of medial joint-space narrowing (P = 0.01) were all independently and positively associated with an increased rate of enlargement of bone area of the medial tibial plateau. A larger baseline bone area of the medial tibial plateau was inversely associated with the rate of increase of that area (P < 0.001). No factor examined affected the rate of increase of the bone area of the lateral tibial plateau. In subjects with established knee OA, tibial plateau bone area increases over time. The role of subchondral bone change in the pathogenesis of knee OA will need to be determined but may be one explanation for the mechanism of action of risk factors such as body mass index on knee OA.     

Internal kinetic changes in the knee due to high tibial osteotomy are well-correlated with change in external adduction moment: An osteoarthritic knee model

In-vivo quantification of loads in the constitutive structures of the osteoarthritic knee can provide clinical insight, particularly when planning a surgery like the opening-wedge high tibial osteotomy (HTO). A computational knee model was created to estimate internal kinetics during walking gait. An optimization approach partitioned loads between the muscles, ligaments, medial and lateral contact surfaces of the tibial–femoral joint. Three kinetic measures were examined in 30 HTO patients: external knee adduction moment (EKAM), medial compartment load (ML) and the medial-to-lateral compartment loads ratio (MLR). Three time points were compared: immediately pre-HTO, 6 and 12 months post-HTO. Three hypotheses were tested: (1) HTO reduces an EKAM, an ML and an MLR, (2) these measures are not significantly different at 6 and 12 months post-HTO, and (3) the change in the impulse of EKAM due to a HTO is well-correlated with the impulse of an MLR.The three hypotheses were confirmed. First peak of an EKAM during stance phase was reduced significantly by 1.70% BW-ht. ML and MLR at the same instance were reduced significantly by 0.56%BW and 1.0, respectively. These measures were not significantly different between 6 and 12 months post-HTO. Changes in impulse of an EKAM and an MLR were moderately well-correlated between the pre-HTO and 6 months post-HTO time points (R²=0.5485). Therefore, the external measure EKAM-impulse is a good proxy of the internal kinetic measure of an MLR-impulse, explaining about 55% of the variance in the change due to a HTO intervention.     

The Mechanical Benefit of Medial Support Screws in Locking Plating of Proximal Humerus Fractures

Background

The purpose of this study was to evaluate the biomechanical advantages of medial support screws (MSSs) in the locking proximal humeral plate for treating proximal humerus fractures.

Methods

Thirty synthetic left humeri were randomly divided into 3 subgroups to establish two-part surgical neck fracture models of proximal humerus. All fractures were fixed with a locking proximal humerus plate. Group A was fixed with medial cortical support and no MSSs; Group B was fixed with 3 MSSs but without medial cortical support; Group C was fixed with neither medial cortical support nor MSSs. Axial compression, torsional stiffness, shear stiffness, and failure tests were performed.

Results

Constructs with medial support from cortical bone showed statistically higher axial and shear stiffness than other subgroups examined (P<0.0001). When the proximal humerus was not supported by medial cortical bone, locking plating with medial support screws exhibited higher axial and torsional stiffness than locking plating without medial support screws (P≤0.0207). Specimens with medial cortical bone failed primarily by fracture of the humeral shaft or humeral head. Specimens without medial cortical bone support failed primarily by significant plate bending at the fracture site followed by humeral head collapse or humeral head fracture.

Conclusions

Anatomic reduction with medial cortical support was the stiffest construct after a simulated two-part fracture. Significant biomechanical benefits of MSSs in locking plating of proximal humerus fractures were identified. The reconstruction of the medial column support for proximal humerus fractures helps to enhance mechanical stability of the humeral head and prevent implant failure.     

Distribution of acetylcholinesterase and monoamine oxidase in the amygdala of the guinea pig

Summary A study of the amygdala of the guinea pig was carried out on material stained by the Nissl, acetylcholinesterase (AChE) and monoamine oxidase (MAO) methods. The material stained for Nissl substance was used primarily as a reference in determining the distribution of the two enzymes. Regional differences in cell size and/or distribution were noted within the lateral, basal, medial and cortical nuclei. In the AChE preparations, it was observed that the large-celled part of the basal nucleus stained very intensely, the small-celled part of the basal nucleus and ventromedial part of the lateral nucleus more moderately, and the dorsolateral part of the lateral nucleus and cortical nucleus lightly. The central and medial nuclei showed almost no reaction. With the MAO method, the greatest staining reaction was seen in the medial nucleus, the medial part of the cortical nucleus, the anterior amygdaloid area and the ventromedial wedge of the putamen adjacent to the central nucleus. In addition, fibres of the stria terminalis stained very darkly.These findings are discussed in relation to the observations of previous authors employing the same methods.Supported in part by the Canadian Medical Research Council Grant No. M.T. 870 and U.S. Public Health Service Grant No. NS-07998. This aid is gratefully acknowledged. We are indebted to Dr. Gorm Danscher for additional material and to Mr. A. Meier, Mrs. L. Munkøe, Mrs. K. Sørensen, Miss M. Sørensen, Miss D. Valgaard, and Miss B. Ørum for skillful assistance.     

Flower opening and closure: a review

Flower opening and closure are traits of a reproductive syndrome, as it allows pollen removal and/or pollination. Various types of opening can be distinguished such as nocturnal and diurnal and single or repetitive. Opening is generally due to cell expansion. Osmotic solute levels increase by the conversion of polysaccharides (starch or fructan) to monosaccharides, and/or the uptake of sugars from the apoplast. Repeated opening and closure movements are often brought about by differential elongation. In tulip petals, for example, the upper and lower sides of the mesophyll exhibit a 10 degrees C difference in optimum temperature for elongation growth, resulting in opening in the morning and closure in the evening. Opening and closure in several other species is regulated by changes in light intensity and, in some species with nocturnal opening, by an increase in relative humidity. A minimum duration of darkness and light are usually required for opening and closure, respectively, in flowers that open during the day. Both phytochrome and a blue light receptor seem involved in light perception. In some species, opening and closure are regulated by an endogenous rhythm, which, in all cases investigated, can be reset by changes from dark to light and/or light to dark. So far, Arabidopsis mutants have not been used to investigate the timing of flower opening and closure. As its flowers open and close in a circadian fashion, several mutants that are involved in the circadian clock and its light input may help to provide an insight into this type of flower opening. The co-ordination of processes culminating in synchronized flower opening is, in many species, highly intricate. The complex control by endogenous and exogenous factors sets flower opening and closure apart from most other growth processes.