Dissertations / Theses on the topic 'Orthopedie'

L’épaule est la plus mobile et la plus fragile des articulations. Elle est souvent touchée en traumatologie ou altérée à cause de dégénérescences. Afin d’étudier son fonctionnement et les diverses problématiques associées, un modèle éléments finis multidisciplinaire a été développé. Les différents composants anatomiques ont été reconstruits à partir d’images médicales ; puis un comportement mécanique et des propriétés spécifiques ont été paramétrés. Des propriétés contractiles ont été implémentées pour les principaux muscles. Différentes applications ont été étudiées :- En traumatologie, la chronologie lésionnelle a été expliquée et détaillée dans le cas d’un impact latéral.- En orthopédique, l’enclouage centromédullaire d’un humérus traumatique a permis de comprendre le fonctionnement et les conséquences de ce type d’implant.- En physiologie du mouvement, le concept de la prothèse inversée a été évalué mécaniquement à travers l’influence des muscles de la coiffe des rotateurs<br>The shoulder is the most mobile and the most fragile joint. It is often affected by trauma or impaired due to degenerations. In order to study its behaviour and various problems associated, a multidisciplinary finite element model was developed. The anatomical components have been reconstructed from medical data, and then mechanical behaviour and specific properties have been configured. Contractile properties were implemented for the main muscles. Different applications have been studied:- In trauma field, the injury timeline was explained and detailed in the case of a side impact.- In orthopaedic domain, the intramedullary nailing of a traumatic humerus has to understand the function and the consequences of this type of implant.- In the physiologic field, the concept of reverse prosthesis has been evaluated mechanically through the influence of the muscles of the rotator cuff

Une enquête prospective a permis la constitution en trois ans d'un échantillon orthodontique poly-régional ; l'interrogation de praticiens spécialistes a abouti à une liste de 270 variables concernant l'observation clinique. 435 patients ont ainsi été recrutés jusqu'à un fichier pur. Un descriptif de la population orthodontique française a pu ainsi pour la première fois ëtte dressé de façon complète. Une réduction des redondances a pu être réalisée par analyse de données permettant de ramener à 47 le nombre d'informations pertinentes pour décrire ceè patients dysmorphiques ; ainsi se trouvent posées les bases d'une observation clinique clarifiée. Les analyses en composantes principales et des correspondances multiples ont permis de traiter séparément, puis, après cette première réduction, simultanément, les variables quantitatives et qualitatives. La qualité discriminante des variables ainsi sélectionnées a été confirmée par une typologie fondée sur celles-ci, et qui au passage a confirmé l'importance du facteur régional. Une seconde typologie a permis de vérifier que ces 47 variables retenues étaient de nature à autoriser une aide au diagnostic ultérieure. Le fichier constitué initialement réalise une banque de données à partir de laquelle de nombreuses études pourront être entreprises.

L'os humain adulte est le résultat d'un processus de maturation multi échelle complexe et multifactoriel. Concernant la croissance de l'os de l'enfant, les données quantitatives issues de la littérature sont peu nombreuses et souvent discutables. Une caractérisation multimodale de ce matériau (acoustique, mécanique, histologique, biochimique et par l'imagerie) permet de traduire quantitativement les différences observées en pratique clinique avec l'os adulte. Cette étude propose de déterminer les paramètres biomécaniques de l'os cortical au cours de la croissance par une approche multimodale. Différents types d’échantillons ont été utilisés, os long (fibula), os plats (côtes issus de la cage thoracique des patients scoliotiques) en provenance de service de chirurgie orthopédique. Des résultats originaux ont été obtenus, avec des lois reliant les données à différentes échelles. Les résultats ont permis d’infirmer des hypothèses concernant la déminéralisation osseuse dans le cadre des études sur la scoliose idiopathique chez l’enfant, et l’obtention de nouvelles données concernant l’os cortical au cours de la croissance<br>Human bone is the result of a multiscale maturation process determined by several factors. Concerning the bone growth, few quantitative data are available in literature and their validity is questionable. A multimodal method (acoustical, mechanical, histological, biochemical and using imagery) characterizing the bone matrix leads to quantify the differences between adult and children based on clinical observations. The goal of this study is to quantify the biomechanical properties of cortical bone during growth by using a multimodal method. Several kinds of samples have been characterized, on one hand from long bone (fibula) and on the other hand from flat bone (extracted from the scoliotic rib hump). Original results have been found with law linking multiscale data. These results weak the hypothesis of bone demineralization in idiopathic adolescent scoliosis and provide new data concerning cortical bone during growth process

Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Chemical Engineering, 2001.<br>Includes bibliographical references.<br>Historically, using suitable mechanical replacements for bone has been a priority in designing permanent, load-bearing orthopedic implants. As a result, the biomaterials used in these implants have been largely limited to bioinert titanium-based alloys, as well as to polycrystalline alumina and zirconia ceramics. However, analysis of implants incorporating these traditional biomaterials indicated that most failures involved an unstable implant-tissue interface and/or a mismatch of the mechanical behavior of the implant with the surrounding tissues. As a result, up to 20% of patients receiving permanent, load-bearing implants may undergo a revision operation. The objective of this research was to develop an alternative biomaterial that combined both mechanical resilience and an osteoconductive surface to provide a stable interface with the surrounding connective tissue so that the need for revision operations may be significantly reduced. In the effort to address the issue of mechanical strength and bioactivity simultaneously, hydroxyapatite (HAP) has generated considerable interest. Though a commonly used bioceramic, HAP has been limited by its processability. This material is sensitive to non-stoichiometry and impurities during synthesis and processing due to its complex composition and crystal structure (Ca10(P04)6(OH)2, P63/m).<br>(cont.) Consequently, conventionally processed HAP materials lack phase purity and homogeneity. Densification of HAP requires high temperatures that result in grain growth and decomposition into undesired phases with poor mechanical and chemical stability. To circumvent densification at high temperatures, glassy additives have been introduced to promote liquid-phase sintering at a lower temperature. However, the presence of a secondary glassy phase gave rise to poor mechanical characteristics. Hence, clinical applications of HAP have been limited to powders, coatings, porous bodies, and non-load-bearing implants. To overcome the deficiencies of conventionally processed HAP, nanostructure processing was applied, which allowed for materials design from the molecular level. By using an aqueous chemical precipitation technique, a fully dense, transparent, nanostructured HAP-based bioceramic that exhibited superior mechanical properties and enhanced tissue bonding was obtained. Processing parameters affecting the molecular and structural development of HAP were used to tailor HAP stoichiometry, crystallite size, morphology and surface chemistry for optimal thermal stability and sinterability. Unlike conventionally processed HAP, the stoichiometric, equiaxed, nanocrystalline HAP powders demonstrated significantly enhanced sinterability by fully densifying at a remarkably low temperature of 900ʻC with pressure-assisted sintering.<br>(cont.) Furthermore, high-resolution electron micrographs illustrated that the sintered compact possessed a uniform and ultrafine microstructure with an average grain size of -100 nm, with no glassy or amorphous interfaces along the grain boundaries. The crystallinity of the HAP grains and grain boundaries and the minimal flaw sizes could be credited for the superior strength of nanostructured HAP compared to conventional HAP. Compared to polycrystalline HAP, nanocrystalline HAP also provided greater osteoblast function. In vitro experiments indicated that nanocrystalline HAP surfaces enhanced cell attachment, proliferation and mineralization. The larger grain boundary volume resulting from the ultrafine microstructure might have enhanced protein adsorption, ...<br>by Edward Sun Ahn.<br>Ph.D.

Over the last decade, biodegradable screws and plates have received wide acceptance over metallic fasteners for orthopedic fracture fixation. A biodegradable fastener would gradually "disappear" during healing of a fractured bone or tissues, therefore avoiding a secondary operation to remove that fastener. When using a metal fastener, the current approach requires manual threading on a large bone fragment for fixation. This technique is difficult when it is required to fixate a small bone fragment. This study puts forth the development of a threadless, polymer based orthopedic fastener for small fragment fixation which would provide stability and interfragmental compression to the fracture site. The fastener was designed with ratchets on its surface, which deflect during insertion into the drilled hole in the bone and subsequently stiffen to hold the bone fragments in place due to interference. The head of the fastener was developed analogous to a Belleville washer which deflects during insertion of the fastener and subjects the bone fragments to interfragmental compression. Finite element analysis (FEA) was conducted to design the fastener profile and assess its performance. The push-in and pull-out forces predicted by FEA were comparable to the experimental results for the prototype of the microfasteners. The push-in force was found to increase with increasing insertion depth and radial interference. The force required to initiate pull-out was maximum and was reduced with reducing fastener bone contact. An analytical model was proposed to explain the fastener bone interaction. It was found to be in good agreement with the FEA and experimental results at low levels of interference.

Mestrado em Materiais e Dispositivos Biomédicos<br>Zircónia e alumina são biocerâmicos bastante conhecidos, e são usados principalmente em aplicações ortopédicas. Estes materiais têm sido aplicados em implantes de anca e joelho graças à reduzida taxa de desgaste e à excelente biocompatibilidade que apresentam. No entanto, estes cerâmicos apresentam também algumas limitações: a fragilidade da alumina ao impacto e a sensibilidade da zircónia ao envelhecimento. Devido a estas limitações, o objectivo passou por desenvolver implantes mais resistentes e com uma resposta inflamatória menos intensa. Surgiram, então, estudos de compósitos de zircónia e alumina. Neste estudo, foram desenvolvidas três diferentes composições de Alumina reforçada com Zircónia (ZTA) com 80 wt% a 90 wt% de alumina, e três composições de Zircónia reforçada com Alumina (ATZ) com 80 wt% a 90 wt% de zircónia. Foram usados dois tipos diferentes de zircónia estabilizada: zircónia estabilizada com 3 mol% de yttria (3YSZ) que foi usada nos compósitos ATZ, e zircónia estabilizada com 2 mol% de yttria (2YSZ) aplicada nos compósitos ZTA. A composição ATZ com o melhor conjunto de propriedades foi também testada com a zircónia 2YSZ, de forma a produzir um compósito com melhores propriedades mecânicas e uma resistência à degradação semelhante à apresentada pelo compósito ATZ, com a zircónia 3YSZ. Foram seleccionados dois aditivos, óxido de lântanio e pentóxido de tântalo, que foram depois adicionados aos compósitos ATZ e ZTA com o melhor conjunto de propriedades (composição 80:20), com o objectivo de melhorar a resistência ao envelhecimento e as propriedades mecânicas dos materiais produzidos. Após uma etapa de moagem, os pós compósitos foram obtidos por atomização, a partir de suspensões estabilizadas, com uma distribuição de tamanho de partícula nanométrica controlada. Estes pós foram caracterizados através de várias técnicas tais como microscopia electrónica de varrimento, difracção de raios-X, fluorescência de raios-X, densidade real, e área superficial específica. De forma a aumentar a densidade dos corpos em verde, foram efectuadas duas diferentes prensagens, prensagem uniaxial e prensagem isostática a frio (CIP). Foram obtidos cerâmicos com uma elevada densidade (com densidade relativa entre 97% e 99%) a uma baixa temperatura de sinterização (1400ºC). O tamanho de grão das amostras sinterizadas foi observado por SEM e, de forma a verificar as fases cristalográficas presentes, foi realizada difracção de raios-X. Em todos os compósitos foi obtida uma microestrutura dispersa, com um tamanho de grão nanométrico (abaixo dos 500 nm). Este conjunto de etapas de produção aplicado levou à obtenção de compósitos com propriedades mecânicas melhoradas. Foram estudadas a dureza de Vickers, a tenacidade à fratura e resistência à flexão das amostras sinterizadas. Os compósitos ATZ atingiram os melhores valores de tenacidade à fractura e resistência à flexão (acima de 5 MPa.m1/2 e 1394 MPa respetivamente), enquanto os compósitos ZTA apresentaram os melhores valores de dureza (acima de 1846 HV). Como era esperado, o compósito ATZ com zircónia 2YSZ apresentou melhores propriedades mecânicas, tendo sido obtidos 7.94 MPa.m1/2 de tenacidade à fratura e 1498 MPa para a resistência à flexão. A aplicação dos dopantes nos compósitos ZTA e ATZ induziram alterações nas suas propriedades. A adição de Ta2O5 melhorou, com sucesso, as propriedades mecânicas dos dois tipos de compósitos. Foi verificado um aumento dos valores de dureza, tenacidade à fratura e resistência à flexão em relação às amostras sem dopantes. A adição de La2O3 não levou a melhorias nas propriedades mecânicas mas, no entanto, também não teve um efeito prejudicial, o que levou à sua preservação. Foram realizados testes de envelhecimento de acordo com a norma ISO13356 (2008) em todos os compósitos produzidos. A quantidade de zircónia monoclínica, indicador de degradação, foi determinada por difracção de raios-X após 5,12,24,48 e 96 horas de testes de envelhecimento. Foi determinado que os compósitos ZTA não dopados, não apresentaram zircónia monoclínica após 96 horas em ambiente agressivo. Para os compósitos ATZ, apesar de a quantidade de zircónia monoclínica aumentar proporcionalmente ao conteúdo de zircónia presente no compósito, foi verificado que a extensão da degradação foi mínima, e relegada apenas para a superfície do material. Esta evidência permitiu que as propriedades mecânicas se mantivessem durante todo o período dos testes de degradação. Como era esperado, o compósito com a zircónia menos estável, o ATZ com a zircónia 2YSZ, apresentou o conteúdo mais elevado de zircónia monoclínica. No entanto, o facto de as propriedades mecânicas se manterem ao longo dos testes de degradação, confirmou que a degradação, mais uma vez, não se expandiu para o interior do material. A adição dos dois dopantes levou a melhorias na resistência à degradação dos compósitos ATZ, que apresentaram um conteúdo de zircónica monoclínica menor em comparação com as amostras não dopadas, após 96 horas de testes de degradação. No entanto, a adição de Ta2O5 teve um efeito desestabilizador na zircónia 2YSZ presente no compósito ZTA, sendo que foi detectada 10% de zircónia monoclínica após as 96 horas de testes de degradação. De novo, foi confirmado que esta degradação esteve presente apenas à superfície do material, visto que as propriedades mecânicas se mantiveram após estes testes. Foi também testada a biocompatibilidade destes compósitos. Células MG63 foram cultivadas nas amostras sinterizadas e foram realizados ensaios MTT e ensaios de atividade da fosfatase alcalina. Para todos os compósitos produzidos foi verificado que a viabilidade/proliferação celular aumentou significativamente desde o dia 1 para o dia 4. Os compósitos ZTA, que possuíam um maior número de locais de adesão, apresentaram uma maior adesão e proliferação celular, em comparação com os compósitos ATZ. A adição de La2O3 e Ta2O5 não induziu diferenças significativas na viabilidade celular dos compósitos ATZ. No entanto, no compósito ZTA, a adição de Ta2O5 levou a um pior desempenho devido à sua verificada hidrofobicidade. O presente estudo mostra que podem ser obtidas composições óptimas destes compósitos, com excelentes propriedades mecânicas, resistência à degradação e biocompatibilidade satisfatória.<br>Zirconia and alumina are well known bioceramics, used in the field of orthopedics. These materials have been used as hip and knee bearings thanks to their reduced wear rate and excellent biocompatibility. However, these ceramics presented some limitations: the brittleness of alumina and the aging sensitivity of zirconia. The aim became to develop long-lasting hip implants, with less inflammatory response and better designs. Zirconia alumina composites were then studied. In this study, three different grades of alumina toughened zirconia composites (ATZ) from 80 wt% to 90 wt% of zirconia, and three grades of zirconia toughened alumina (ZTA) from 80 wt% to 90 wt% of alumina were developed. Two different types of stabilized zirconia were used: 3 mol% yttria stabilized zirconia (3YSZ) was applied on the ATZ samples, and a 2 mol% yttria stabilized zirconia (2YSZ) on the ZTA samples. The ATZ with the best set of properties (80Z20A) was also tested with the 2YSZ, in order to produce a composite with improved mechanical properties and similar aging resistance to the ATZ with 3YSZ. Two selected additives, lanthanum oxide and tantalum pentoxide were added to the best ATZ and ZTA composite (80:20 composition) with the aim of enhance the aging resistance and mechanical properties of the produced materials. After a wet milling stage, the composite powders were achieved by spray-drying, from stabilized suspensions with a controlled nanometric particle distribution. The obtained composite powders were characterized through several techniques, such as scanning electron microscopy, X-ray diffraction, X-ray fluorescence, true density and specific surface area. Two stages of pressing, uniaxial pressing and cold isostatic pressing, were performed in order to improve the density of the green pieces. High density ceramics (with a relative density between 97% and 99%) were achieved with a low sintering temperature (1400ºC). The grain size of the sintered pieces was determined by SEM, and X-ray diffraction was performed in order to verify the present crystallographic phases. A disperse microstructure was obtained for all composites, with a nanometric grain size (under 500 nm). This set of producing stages, lead to the obtention of composites with enhanced mechanical properties. The Vickers Hardness, fracture toughness and flexural strength of the sintered samples were evaluated. Higher values of fracture toughness and flexural strength were achieved for the ATZ samples (up to 5 MPa.m1/2 and 1394 MPa respectively), while ZTA samples presented higher values of hardness (up to 1846 HV). As expected, the ATZ with 2YSZ presented enhanced mechanical properties, with an outstanding fracture toughness of 7.94 MPa.m1/2, and 1498 MPa of flexural strength. The addition of the two dopants to both ZTA and ATZ composites induced changes in their properties. The addition of Ta2O5 successfully improved the mechanical properties of both composites. In comparison with the undoped ATZ and ZTA composites, improvements of the hardness, fracture toughness and flexural strength were verified. The addition of La2O3 did not lead to an enhancement of the mechanical properties; however, it did not led to a deleterious effect either, and these properties were maintained. Accelerated aging tests were made on all produced composites, accordingly to ISO13356 (2008). The amount of monoclinic zirconia, which is an indicator of degradation on these composites, was quantified by X-ray diffraction analysis for 5,12,24,48 and 96 hours of aging tests. It was determined that, the undoped ZTA samples did not present monoclinic zirconia after 96 hours on an aggressive environment. Regarding the ATZ composites, even though the monoclinic zirconia content increased proportionally to the zirconia content present in the composite, it was found that the extent of degradation was minimal, since it was relegated to the material surface. This fact allowed the maintaining of the mechanical properties of the material throughout all the duration of the aging tests. As expected, the less stable composite, the ATZ with 2YSZ, presented the highest content of monoclinic zirconia. Nonetheless, the mechanical properties tested on the aged composite confirmed that the degradation did not expand to the material bulk. The addition of both dopants, successfully improved the aging resistance of the ATZ composite, presenting a lower amount of monoclinic zirconia after 96 hours of aging tests in comparison with the undoped ones. However, the addition of Ta2O5 destabilized the 2YSZ present on the ZTA composites, and 10% of monoclinic zirconia was detected after 96 hours of aging tests. Still, the mechanical properties were maintained on all the doped composites, which again confirmed the presence of degradation only at the material surface. The biocompatibility of these composites was also tested. MG63 cells were seeded on the sintered samples and MTT and alkaline phosphatase activity (ALP) assays were performed. The cell viability/proliferation increased significantly from day 1 to day 4 for all the produced composites. The ZTA composites, with more anchorage sites, presented higher cell adhesion and proliferation in comparison with the ATZ composites. The addition of La2O3 and Ta2O5 did not induced significant changes on the cell viability of the ATZ composites. However, the addition of Ta2O5 on the ZTA composite led to a poor performance, due to its verified hydrophobicity. The present study shows that optimal compositions of these composites can be achieved, with improved mechanical properties, hydrothermal degradation resistance and satisfactory biocompatibility.

Mechanical Engineering<br>M.S.M.E.<br>In orthopedic surgery, fixation pins are used to provide stability of bone segments to ensure proper healing. The drilling process to implant these pins can generate a considerable amount of heat. Raising the temperature of bone tissue above 47°C for a prolonged amount of time can cause cell death in a process called thermal osteonecrosis. Should bone tissue surrounding implants like fixation pins die and begin to break-down, the stability of said implants becomes at risk for failure. The failure of a surgical implant can be costly, resulting in additional surgery for repairs and prolonged recovery time. Reducing the amount of heat generated during drilling can greatly lessen the potential for thermal injury. This study aims to evaluate the effect of varying drilling parameters on heat generation, namely examining if internal temperatures be reduced by varying the rotational velocity and feed rate in orthopedic drilling, and thus reduce the probability of thermal osteonecrosis. Experiments were performed comparing combinations of feed rates and spindle speeds for the drilling process parameters, specifically feed rates of 1.5, 3.0, 5.0, 9.0, and 12.0 mm⁄s and spindle speeds of 1000, 2000, and 3000 rpm. The tests used traditional smooth-shaft fixation pins, with trocar tips, that were drilled into 20 PCF synthetic bone. A Flir T440 infrared camera was used to record thermal video of the drilling process. Data acquired from the infrared camera shows that lower spindle speeds resulted in lower maximum temperatures while varying feed rates had only a moderate effect. With these results orthopedic drilling can be optimized for reduced heat generation and the prevention of thermal osteonecrosis.<br>Temple University--Theses

Orientador: William Dias Belangero<br>Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas<br>Made available in DSpace on 2018-08-19T13:05:04Z (GMT). No. of bitstreams: 1 Sawaia_RogerioNaim_D.pdf: 9806060 bytes, checksum: d75ddfca6472ebb85dbfad46a0daa1a4 (MD5) Previous issue date: 2011<br>Resumo: INTRODUÇÃO: O tratamento cirúrgico das fraturas intertrocanterianas do fêmur ainda é motivo de estudo e controvérsias. As vantagens da utilização de técnicas minimamente invasivas para essas fraturas já despontam na literatura. O objetivo deste estudo foi avaliar as complicações da técnica minimamente invasiva que utiliza um implante e um instrumental desenvolvidos especificamente (Sistema Minus) para o tratamento dessas fraturas. CASUÍSTICA E MÉTODO: Foram estudados 172 pacientes com fratura intertrocanteriana do fêmur, tratados com o Sistema Minus, dos quais 52 pacientes foram excluídos do estudo por não terem preenchido os critérios de inclusão. No protocolo inicial foram registrados o gênero, a idade, detalhes operatórios como tempo cirúrgico, tempo de uso da fluoroscopia, qualidade da redução e da fixação da fratura. Como parâmetros clínicos foram incluídos a capacidade de marcha, dor, classificação da fratura segundo os critérios de Tronzo e o risco anestésico segundo a classificação de ASA. Dividimos as complicações em dois grupos. As complicações gerais, subdivididas em infecção e mortalidade e as complicações específicas, subdivididas em migração do implante, a perda da redução e a falta de união. Embora a migração do pino deslizante não seja considerada na literatura como uma complicação do DHS (Hrubna e Skotak, 2010)1, no presente estudo ela foi incluída. Cabendo salientar que foi considerada como migração, a impacção lateral da fratura sem a ocorrência de perda de redução. RESULTADOS: O gênero feminino ocorreu em 93 casos e obteve percentual de 77,5%, foi prevalente em relação ao masculino com 27 casos e 22,5%. A idade variou de 52 a 95 anos, com a média de 80,06 anos e desvio padrão de 7,87 anos. A média de idade do gênero masculino foi de 76,19 anos e desvio padrão de 8,321. O gênero feminino obteve a média de 81,18 anos com desvio padrão de 7,407. O tempo cirúrgico médio foi de 39,35 minutos, variando de 25 a 65 minutos. O tempo médio de radioscopia foi 1min7s, variando de 0,6 a 2 minutos e 3s. A redução foi considerada adequada em 92 casos (76,6%), quando obteve-se o alinhamento do eixo de carga, como valgo em 20 casos (16,6%) e como varo em oito casos (6,6%). O somatório médio do TAD (Tip Apex Distance) na incidência Ântero-posterior (AP) foi de 1,19cm, variando de 0,2 a 2,8cm; e no Perfil (P), de 1,14cm, variando de 0,3 a 2,52cm. Dos pacientes, 112 (93,3%) voltaram a andar e a dor pós-operatória em uma escala de 0 a 10, teve a média de 4,44. Dos 120 pacientes, 11 foram classificados como Tronzo I (9,1%), 24 como Tronzo II (20%), 58 como Tronzo III (48,3%), sete Tronzo III variante (5,8%) e 20 Tronzo IV (16,7%). As fraturas instáveis ocorreram em 85 (70,8%) pacientes, os quais 74 (61,6%) tinham idade superior a 75 anos. Já as fraturas estáveis em 35 (29,1%) pacientes, os quais 17 (14,1%) possuíam idade superior a 75 anos. Em relação ao risco anestésico, oito (6,6%) foram classificados como ASA I, 33 (27,5%) ASA II, 74 (61,6%) ASA III e cinco ASA IV (4,16%). Houve um caso de infecção (0,83%). Ocorreram 13 óbitos (10,8%) dentro do primeiro ano de pós-operatório. Desses, um (0,83%) foi classificado como Asa II, cinco (4,16%) como Asa III e sete (5,83%) Asa IV. Dos 85 pacientes com fraturas instáveis, 36 (30%) apresentaram complicações, como perda de redução em 7(5,88%) e migração do pino deslizante em 29 (24,1%). No grupo das 35 fraturas estáveis, as complicações ocorreram em 4 casos (3,33 %), sendo que a perda de redução ocorreu em um caso (0,83%) e a migração em 3 casos (2,5%). No total, a migração ocorreu em 33 casos (27,6%), sendo que desses, todos evoluíram para consolidação. A perda de redução ocorreu em oito (6,7%) e a falta de união, em um caso (0,83%). CONCLUSÃO: Concluímos que a técnica minimamente invasiva, Sistema Minus, é uma técnica segura, que permite a realização da cirurgia com baixa incidência de complicações, quando comparada aos demais métodos existentes<br>Abstract: INTRODUCTION: The surgical treatment of intertrochanteric fractures is still controversial, resulting in further studies. Many papers have appeared in reference to the advantages of minimal invasive procedures for these fractures. The aim of this study was to evaluate the complications of a minimal invasive procedure using a specific implant and instruments developed for the treatment of intertrochanteric fractures (Minus System). MATERIAL AND METHOD: One hundred and seventy two patients with intertrochanteric fractures of the femur were studied, and submitted to treatment with the Minus System. Fifty two patients were excluded from the study as they did not fulfil all criteria for inclusion. The initial protocol registered gender, age, operative details such as length of operation, length of fluoroscopy use, quality of reduction and fixation of the fracture. The clinical parameters considered included deambulatory ability, pain, Tronzo fracture classification and anesthesia risk according to ASA classification. Complications were divided into two groups: general complications (infection and mortality rate) and specific complications (implant migration, loss of reduction and non-union). Although the migration of a sliding nail has not been considered in the literature as a DHS complication (Hrubna e Skotak, 2010)1 RESULTS: There were 93 feminine cases (77.5%) prevailing on 27 masculine cases (22.5%). Age span was 52 to 95 years, with an average of 80.06 years (standard deviation of 7.87 years). The average age for men was 76.19 years with a standard deviation of 8.321. The average age for women was 81.18 years with a standard deviation of 7.407. The average operative length of time was 39.35 minutes (25 to 65 minutes). The average time of fluoroscopy was 1min 7sec (0.6 to 2min 3sec). Fracture reduction was considered adequate in 92 cases (76.6%), , in the present study it was taken into account. It is important to mention that migration here is the lateral impaction of the fracture without loss of reduction. when alignment with weight-bearing axis was obtained, valgus in 20 cases (16.6%) and varus in eight cases (6.6%). The average Tip Apex Distance (TAD) on an anteroposterior view was 1.19cm (variation of 0.2 to 2.52 cm) and lateral view was 1.14cm (variaton of 0.3 to 2.52cm). One hundred and twelve patients (93,3%) were able to walk with postoperative pain (average of 4.4 on a pain scale of 0 to 10). The classification of the 120 patients is as follows: 11 patients with Tronzo I (9,1%), 24 cases of Tronzo II (20%), 58 Tronzo III (48.3%), seven Tronzo III variant (5.8%) and 20 Tronzo IV (16.7%). Unstable fractures occured in 85 (70.8%) patients, and 74 (61.6%) were over 75 years of age. There were 35 stable fractures (29.1%), with 17 patients (14.1%) over 75 years of age. As to the anesthesia risk eight (6.6%) were classified as ASA I, 33 (27.5%) ASA II, 74 (61.6%) ASA III and five patients as ASA IV (4.16%). There was one case of infection (0.83%). During the first postoperative year there were 13 deaths (10.8%). Of these, one patient (0.83%) had been classified as ASA II, five (4.16%) as ASA III and seven (5.83%) as ASA IV. There were 36 patients (30%) with complications out of 85 patients with unstable fractures, with loss of reduction in seven (5.88%) and migration of the sliding nail in 29 (24.1%). In the group of 35 stable fractures there were complications in four cases (3.3 %), with loss of reduction in one case (0.83%) and migration in three (2.5%). The total number of migrations was 33 (27.5%), but resulted in union in all patients. The loss in reduction occurred in eight patients (6.7%) and non-union in one case (0.83%). CONCLUSION: The minimal invasive procedure, the Minus System, is a safe procedure, that provides adequate surgery with a low incidence of complications, when compared to other existing techniques<br>Doutorado<br>Fisiopatologia Cirúrgica<br>Doutor em Ciências

Bioengineering<br>Ph.D.<br>Current degradable orthopedic fixation devices do not typically facilitate tissue integration during healing. Proposed here is a novel combination of processing methods to enhance the tissue integration capability of degradable thermoplastics used in temporary orthopedic fixation devices. The provision of open pores in devices used to affix reconstructed hard tissues would allow for local cells to infiltrate during the healing process. Any openly porous structure is inherently weakened in comparison to its monolithic peers (i.e. decreased relative bulk modulus), such that the matrix materials must be made more resilient in keep the device from becoming friable. These processing methods aim to improve degradable surgical fixation devices at multiple levels of design: both through the inclusion of porous morphology, processing changes, and additives to regain mechanical integrity. Biomimetic pores are added for cellular infiltration by dissolving a porogen’s interpenetrating polymer network. The addition of open pores significantly reduces the bulk stiffness. More uniform phase separation has led to better pores, but the objects still need more resilience. Carbon nanomaterials are used to improve on the mechanics and surface chemistry of the polymer matrix material, composites of polylactide/nanodiamond are produced through cryogenic milling and solid state polycondensation. The addition of minute amounts of functionalized nanodiamond has remedied the brittle failure of the material, by cryogenic milling and solid state polycondensation of poly((D,L)lactide-co-glycolide) and hydroxyl functionalized detonation nanodiamonds. This composite has also demonstrated increased cytocompatability with 7F2 osteoblasts, as analyzed by cellular adhesion through fluorescence microscopy and alamar blue assay.<br>Temple University--Theses

Thesis (M.S.)--University of Missouri-Columbia, 2006.<br>The entire dissertation/thesis text is included in the research.pdf file; the official abstract appears in the short.pdf file (which also appears in the research.pdf); a non-technical general description, or public abstract, appears in the public.pdf file. Title from title screen of research.pdf file (viewed on August 30, 1981) Includes bibliographical references.

Femoroacetabular impingement (FAI) has been increasingly recognized as a cause of early hip osteoarthritis. FAI is characterized by pathologic contact between the femur and acetabular rim during hip join movement, caused by morphological abnormalities. Arthroscopic technique has become increasingly popular for FAI surgical treatment because of its minimal invasiveness. However, it involves cumbersome procedures and over- or under-resection are likely to occur. To tackle this issue, robot-assisted FAI arthroscopy is a well suited approach because it results in high accuracy and reproducible surgical outcomes. This dissertation provides new approaches and methods for the current challenges in the development of robot-assisted FAI arthroscopy. The study has three objectives: 1) to develop a robust calibration method for the A-mode ultrasound probe used for noninvasive bone registration, 2) to develop a bone registration simulator for verifying the registration accuracy and consistency for any given registration point-pattern, and 3) to develop a hip range of motion simulation system that returns the virtual range of motion and determines the bone resection volume. Carefully designed calibration procedures and simulation experiments have been conducted during the study of this research. From the experimental results, the developed ultrasound calibration method successfully reduces the registration errors and is proved to be robust. The results from the registration simulator indicate that the pattern with widely distributed points lead to better registration accuracy and consistency. The hip range of motion simulation system results in acceptable accuracy and successfully generates the resection volume. With further modifications, the ultrasound probe can be successfully calibrated with the developed method, and will be applied for noninvasive bone registration. The registration simulator can also be served as a useful tool for determining the optimized registration point-pattern, which can lead to reduced surgical trauma and registration time. Finally, the developed range of motion simulation system can allow the surgeon to evaluate the surgical outcome and to determine the resection volume even before the surgery begins. To conclude, this dissertation provides useful approaches, methods, and software for developing robot-assisted FAI arthroscopy.

Hydroxyapatite (HA) has received wide attention in orthopedics, due to its biocompatibility and osseointegration ability. Despite these advantages, the brittle nature and low fracture toughness of HA often results in rapid wear and premature fracture of implant. Hence, there is a need to improve the fracture toughness and wear resistance of HA without compromising its biocompatibility. The aim of the current research is to explore the potential of nanotubes as reinforcement to HA for orthopedic implants. HA- 4 wt.% carbon nanotube (CNT) composites and coatings are synthesized by spark plasma sintering and plasma spraying respectively, and investigated for their mechanical, tribological and biological behavior. CNT reinforcement improves the fracture toughness (>90%) and wear resistance (>66%) of HA for coating and free standing composites. CNTs have demonstrated a positive influence on the proliferation, differentiation and matrix mineralization activities of osteoblasts, during in-vitro biocompatibility studies. In-vivo exposure of HA-CNT coated titanium implant in animal model (rat) shows excellent histocompatibility and neobone integration on the implant surface. The improved osseointegration due to presence of CNTs in HA is quantified by the adhesion strength measurement of single osteoblast using nano-scratch technique. Considering the ongoing debate about cytotoxicity of CNTs in the literature, the present study also suggests boron nitride nanotube (BNNT) as an alternative reinforcement. BNNT with the similar elastic modulus and strength as CNT, were added to HA. The resulting composite having 4 wt.% BNNTs improved the fracture toughness (~85%) and wear resistance (~75%) of HA in the similar range as HA-CNT composites. BNNTs were found to be non-cytotoxic for osteoblasts and macrophages. In-vitro evaluation shows positive role of BNNT in osteoblast proliferation and viability. Apatite formability of BNNT surface in ~4 days establishes its osseointegration ability.

Nacre from mollusc shells has a complex hierarchical structure composed of an organic-inorganic composite, and exhibits remarkable mechanical properties. In addition, nacre is biocompatible and bioactive making it an excellent candidate for biological coatings for orthopaedic applications. The bioprocessing of nacreous coatings on conventional orthopedic materials via biomineralization of abalone shells was examined in this thesis. The animal reaction to the materials was evaluated by the coating surface morphology, thickness and coating-implant interface, which were characterized using SEM, EDS, XRD and Raman spectroscopy. In the first test, poly(methyl methacrylate) (PMMA), high density polyethylene (HDPE), and titanium (Ti) substrates were implanted separately on the growth surface of abalone shells to examine the effect of different materials on mineral growth. The abalones were under restricted diet. PMMA and HDPE implants resulted in thicker coatings and were able to achieve the desired nacre structure (thickness of 38.1 ± 28.8 μm and 38.7 ± 22.2 μm, respectively). The titanium implants showed thin and sparse coating and were not able to achieve nacre (thickness of 5.3 ± 3.4μm). In the second test, the effect of Ti surface modification (micro-porous, nano-porous and smooth surface) was examined. The substrates were implant together on one location of the shell and were under normal feeding conditions. Thick nacreous coatings, 50 to 280 µm, were formed on the Ti surfaces. There was no apparent trend between the type of Ti surface and the coating formed; however, it appeared that coatings on the implants were similar within the same animal. Thus, this indicates that feeding conditions and location of implantation may play a role in coating mineralization. In addition, two new unique features were found in the implants that have not been reported in literature before: vaterite and alternating bands of nacre towers and aragonite grains across the coating surface. The findings in this thesis therefore suggest that nacreous coatings can be processed on both polymeric and metallic implant materials as long as proper abalone culturing conditions are maintained. The biofabrication techniques developed in this project can be applied to the development of new classes of surface coatings for biomedical implants.

The operating room (OR) at the project site was experiencing surgical delays for orthopedic surgical patients due to unavailable instruments, which led to a decrease in the efficiency of OR utilization. The purpose of this project was to decrease operating room delays for the orthopedic surgical patients. The practice-focused question explored whether a multidisciplinary approach to the procurement of instruments and supplies for the orthopedic surgical patient would help to ensure an on-time surgery start, resulting in increased efficiency in the utilization of the OR from 42% to 65% within a 9-month period. Lewin's change model was used to guide the project. Data analysis was conducted using a t test to compare the changes in the mean scores of the OR utilization rate before and after the involvement of a multidisciplinary team. An independent samples t test found no significant effect of the intervention, t (13) = 0.74, p > .05. Because the t test results were not significant at the α = .05 level, results showed no evidence that the multidisciplinary team affected the OR utilization rate. Decreasing surgical delays can have the potential implication for positive social change at the organization level, because delays hinder optimal patient flow, increase anxiety for patient and families, and have a significant negative economic impact on hospitals.

Le infezioni ortopediche sono una problematica devastante che colpisce il 2% dei pazienti che si sottopongono ad interventi di sostituzione articolari. Il lavoro di ricerca di questo dottorato ha come scopo l'individuazione di sistemi tecnologicamente innovativi per la profilassi e la cura di tali infezioni.

Etude clinique de 254 enfants de la naissance a 16 ans, hospitalises en chirurgie orthopedique infantile pour traumatisme, maladie ou malformation congenitale et acquise. Les hypotheses sont centrees sur l'angoisse de l'enfant devant la chirurgie : age sensible, manifestations de l'angoisse, signification de cette angoisse, role des parents et du chirurgien. Nous avons trouve que les pre-adolescents et les adolescents etaient particulierement vulnerables devant la chirurgie : ce sont eux qui montrent le plus de troubles du comportement, les plus importantes manifestations d'angoisse, les depressions les plus graves. Notre hypothese est etayee par une comparaison statistique qui est significative. Certains pre-adolescents et adolescents experimentent, en cas de stress aigu, une rupture de leur fonctionnement psychique. Il s'agit de crises d'allure psychotique survenant brusquement juste avant ou immediatement apres l'intervention. Ces crises d'angoisse ou de depression intense sont accompagnees de nombreux troubles somatiques, d'expression de fantasmes de mort, d'evisceration ou de mutilation, d'angoisses d'abandon et de craintes de persecution. Elles sont reversibles mais laissent des traces dans le fonctionnement de l'adolescent. Elles surviennent sur des personnalites fragiles ou perturbees. Nous avons souligne le poids d'une malformation congenitale sur l'enfant et ses parents : la depression est le corollaire de cette situation, en raison de la blessure narcissique eprouvee par les parents et vehiculee a l'enfant. Nous avons etudie le role du chirurgien comme moderateur de l'angoisse. L'intensite du transfert fait par l'enfant et ses parents sur le chirurgien<br>Study of 254 children from birth to 16, hospitalized for accident, orthopedic disease or congenital malformation. The hypotheses are focused on the anxiety of the child facing surgery : sensitive age, signs of anxiety, meaning of the anxiety, role of the parents and surgeon. Pre-adolescents and adolescents are most vulnerable to surgery : they show the most serious behavioural problems, the most important signs of anxiety, the deepest depression. These findings are based on a significant statistical study. In some cases of acute anxiety, they experiment a psychological breakdown. These crisis which look like a psychotic breakdown take place just before or immediately after surgery. Anxiety and depression are followed by many physical troubles and the expression of fantasies about death, mutilation, blood loosing, being abandonned or persecuted. The breakdown, which occur on vulnerable or upset personalities, leaves marks in the mental functionning of the adolescent. We have insisted on the impact of a congenital difformity on the child and his parents : depression goes along because of the narcissic wound felt by the parents and carried to the child. We have seen the surgeon as a moderator of the anxiety. The intensity of the transference established by the child and his parents on the surgeon shows the existence of the fantasies projected on him. His capacity to authorize the establishment of a transference link with him, helps the child to maintain his anxiety at a tolorable level

This report presents a master thesis on 3D visualization for pre-operation planning of orthopedic surgery done for Sectra Medical Systems AB. The focus is on visualizing clinically relevant data for planning a Total Hip Replacement (THR). The thesis includes a pre-study and the implementation of a prototype using the Sectra IDS7 workstation.