Hybrid external fixation for tibial plateau fractures: clinical and biomechanical correlation.

The biomechanical data support the use of tensioned wire fixation to stabilize complex fractures of the proximal tibia. The authors will show that the stability of a four-wire construct is comparable to the gold standard of dual plating internal fixation techniques. Using these techniques, many recent investigators have demonstrated improved clinical results, with average knee scores for most patients ranging from 85 to 90.

Silicone gel breast implant rupture rates: research issues.

Documenting the rate of rupture of silicone breast implants appears to be deceptively easy. Largely because of the phenomenon of "silent rupture," it isn't. The authors explore the various technical biases (selection, misclassification, and confounding) and methodological problems that have plagued much of the research conducted to date.

Breast implants and cancer: causation, delayed detection, and survival.

Concern for many women with breast implants has been focused on three topics: cancer (both breast and other cancers), delayed detection of breast cancer, and increased breast cancer recurrence or decreased length of survival. In this study, a qualitative review of the literature on these subjects was conducted, coupled with a meta-analysis of the risk for breast cancer or other cancers (excluding that of the breast). Researchers have consistently found no persuasive evidence of a causal association between breast implants and any type of cancer.

Shear stress distribution in the trabeculae of human vertebral bone.

The statistical distribution of von Mises stress in the trabeculae of human vertebral cancellous bone was estimated using large-scale finite element models. The goal was to test the hypothesis that average trabecular von Mises stress is correlated to the maximum trabecular level von Mises stress. The hypothesis was proposed to explain the close experimental correlation between apparent strength and stiffness of human cancellous bone tissue.

Human vertebral body apparent and hard tissue stiffness.

Cancellous bone apparent stiffness and strength are dependent upon material properties at the tissue level and trabecular architecture. Microstructurally accurate, large-scale finite element (LS-FE) models were used to predict the experimental apparent stiffness of human vertebral cancellous bone and to estimate the trabecular hard tissue stiffness. Twenty-eight LS-FE models of cylindrical human vertebral cancellous bone specimens (8 mm in diameter, 9.

Effect of cane use on tibial strain and strain rates.

The effect of cane ambulation on hip biomechanics has been well studied, but its effect on tibial strains and strain rates is not known. To test the hypothesis that cane use may lower tibial strain and strain rates during walking, percutaneous axial extensometers were mounted on the right medial cortex of the midtibial diaphysis in seven male volunteers. In vivo peak-to-peak axial tibial strains and strain rates were measured for ipsilateral and contralateral cane usage and compared with a no cane control.

Effect of fatiguing exercise on longitudinal bone strain as related to stress fracture in humans.

Muscular fatigue in the training athlete or military recruit has been hypothesized to cause increased bone strain that may contribute to the development of a stress fracture. Under normal circumstances, muscles exert a protective effect by contracting to reduce bending strains on cortical bone surfaces. In vivo strain studies in dogs show that muscle fatigue following strenuous exercise elevates bone strain and changes strain distribution.

A comparison of the effect of shoes on human tibial axial strains recorded during dynamic loading.

Percutaneous axial extensometers were mounted on the medial cortex of the midtibial diaphysis in seven male volunteers and the effect of three different shoes on in vivo peak-to-peak axial compression-tension strains measured during dynamic loading. Zohar shoes had lower axial strains and strain rates during treadmill walking than Nike Air Max running shoes or Israeli infantry boots. During running on a running track, there was no statistically significant difference between the axial strains or strain rates between the shoes tested.

The interosseous membrane affects load distribution in the forearm.

The role of the interosseous membrane in load sharing was defined by simultaneously quantitating loads in the distal radius and ulna and in the proximal radius and ulna with an axial load to the wrist, before and after transecting the interosseous membrane. With the interosseous membrane intact, the load at the proximal ulna was greater than at the distal ulna and the load at the proximal radius was less than at the distal radius, suggesting that force was transferred from the radius distally to the ulna proximally. The average percentage of the total load in each bone in supination was as follows: distal radius, 68%; distal ulna, 32%; proximal radius, 51%; proximal ulna, 49%.

A method suitable for in vivo measurement of bone strain in humans.

Strain gages are the gold-standard for measurement of bone strains in vivo. The use of strain gages in humans, however, is limited by the need for surgery to implant them and by the use of cyanoacrylate adhesives to bond them to bone. Cyanoacrylate adhesives are not FDA approved for implantation in humans, making it difficult to justify their use in experimental procedures.

Decrease in canine proximal femoral ultimate strength and stiffness due to fatigue damage.

Fractures of the proximal femur represent a significant health concern especially in the elderly. Fatigue damage and microfractures have been implicated in the etiology of hip fractures; however, the extent to which these factors are sufficient to bring about significant reductions in proximal femur strength and stiffness is unknown. This study examined the hypothesis that fatigue loading of the proximal femur results in highly correlated decreases in bone stiffness and strength through the accumulation of bone microdamage.

In vivo measurement of human tibial strains during vigorous activity.

Our understanding of mechanical controls on bone remodeling comes from studies of animals with surgically implanted strain gages, but in vivo strain measurements have been made in a single human only once. That study showed that strains in the human tibia during walking and running are well below the fracture threshold. However, strains have never been monitored in vivo during vigorous activity in people, even though prolonged strenuous activity may be responsible for the occurrence of stress fractures.

Human vertebral cancellous bone surface distribution.

The three-dimensional distribution of bone surface and the bone volume fraction (BV/TV) of 110 human vertebral cancellous bone specimens from seven individuals were measured using a three-dimensional radiographic method (microcomputed tomography). The ratios of the three principal projections of bone surface per total volume were found to be relatively constant for specimens examined in this study. The constancy of the projected surface ratios means that the fraction of the total bone surface oriented in any direction does not change markedly with BV/TV.

TDT with covariates and genomic screens with mod scores: their behavior on simulated data.

We describe an extension to the TDT (transmission/disequilibrium test) which allows for more than two marker alleles and for covariates measured on the parent or offspring. We also describe a systematic genomic search where the mod score (maximized lod score) is computed for each marker under constraints on the population prevalence or penetrances of a single locus.