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Comminuted olecranon fracture fixation with pre-contoured plate:Comparison of composite and cadaver bones

World Journal of Orthopedics 2015年第9期6卷 705-711页

作者： David A Hamilton Jr Danielle Reilly Felix Wipf srinath kamineni Elbow Shoulder Research Centre Department of Orthopaedic Surgery and Sports MedicineUniversity of Kentucky Stryker Trauma AG CH-2545 SelzachSwitzerland

AIM: To determine whether use of a precontoured olecranon plate provides adequate fixation to withstand supraphysiologic force in a comminuted olecranon fracture ***: Five samples of fourth generation composite bones and five samples of fresh frozen human cadaveric left ulnae were utilized for this study. The cadaveric specimens underwent dual-energy X-ray absorptiometry(DEXA) scanning to quantify the bone quality. The composite and cadaveric bones were prepared by creating a comminuted olecranon fracture and fixed with a pre-contoured olecranon plate with locking screws. Construct stiffness and failure load were measured by subjecting specimens to cantilever bending moments until failure. Fracture site motion was measured with differential variable resistance transducer spanning the fracture. Statistical analysis was performed with two-tailed Mann-Whitney-U test with Monte Carlo Exact ***: There was a significant difference in fixation stiffness and strength between the composite bones and human cadaver bones. Failure modes differed in cadaveric and composite specimens. The load to failure for the composite bones(n = 5) and human cadaver bones(n = 5) specimens were 10.67 nm(range 9.40-11.91 nm) and 13.05 nm(range 12.59-15.38 nm) respectively. This difference was statistically significant(P ? 0.007, 97% power). Median stiffness for composite bones and human cadaver bones specimens were 5.69 nm/mm(range 4.69-6.80 nm/mm) and 7.55 nm/mm(range 6.31-7.72 nm/mm). There was a significant difference for stiffness(P ? 0.033, 79% power) between composite bones and cadaveric bones. No correlation was found between the DEXA results and stiffness. All cadaveric specimens withstood the physiologic load anticipated postoperatively. Catastrophic failure occurred in all composite specimens. All failures resulted from composite bone failure at the distal screw site and not hardware failure. There were no catastrophic fracture failures in the cadaveric specimens. Fa

关键词： Composite bone Fracture Biomechanic Cadaveric Olecranon Precontoured plate

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Posterior interosseous nerve localization within the proximal forearm-a patient normalized parameter

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World Journal of Orthopedics 2017年第4期8卷 310-316页

作者： srinath kamineni Crystal R Norgren Evan M Davidson Ellora P kamineni Andrew S Deane Elbow Shoulder Research Centre Depart-ment of Orthopaedics and Sports MedicineUniversity of Kentucky University of Kentucky College of Medicine Paul Laurence Dunbar High School Department of Anatomy and Cell Biology Indiana University School of Medicine

AIM To provide a "patient-normalized" parameter in the proximal forearm. METHODS Sixty-three cadaveric upper extremities from thirty-five cadavers were studied. A muscle splitting approach was utilized to locate the posterior interosseous nerve(PIN) at the point where it emerges from beneath the supinator. The supinator was carefully incised to expose the midpoint length of the nerve as it passes into the forearm while preserving the associated fascial connections, thereby preserving the relationship of the nerve with the muscle. We measured the transepicondylar distance(TED), PIN distance in the forearm's neutral rotation position, pronation position, supination position, and the nerve width. Two individuals performed measurements using a digital caliper with inter-observer and intraobserver blinding. The results were analyzed with the Wilcoxon-Mann-Whitney test for paired samples. RESULTS In pronation, the PIN was within two confidence intervals of 1.0 TED in 95% of cases(range 0.7-1.3 TED); in neutral, within two confidence intervals of 0.84 TED in 95% of cases(range 0.5-1.1 TED); in supination,within two confidence intervals of 0.72 TED in 95% of cases(range 0.5-0.9 TED). The mean PIN distance from the lateral epicondyle was 100% of TED in a pronated forearm, 84% in neutral, and 72% in supination. Predictive accuracy was highest in supination; in all cases the majority of specimens(90.47%-95.23%) are within 2 cm of the forearm position-specific percentage of TED. When comparing right to left sides for TEDs with the signed Wilcoxon-Mann-Whitney test for paired samples as well as a significance test(with normal distribution), the P-value was 0.0357(significance-0.05) indicating a significant difference between the two *** This "patient normalized" parameter localizes the PIN crossing a line drawn between the lateral epicondyle and the radial styloid. Accurate PIN localization will aid in diagnosis, injections, and surgical approaches.

关键词： Posterior interosseous nerve Radial nerve Transepicondylar distance Radial tunnel syndrome Supinator syndrome

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