Appropriate hinge position for prevention of unstable lateral hinge fracture in open wedge high tibial osteotomy

AIMS

Open wedge high tibial osteotomy (OWHTO) for medial-compartment osteoarthritis of the knee can be complicated by intra-operative lateral hinge fracture (LHF). We aimed to establish the relationship between hinge position and fracture types, and suggest an appropriate hinge position to reduce the risk of this complication.

PATIENTS AND METHODS

Consecutive patients undergoing OWHTO were evaluated on coronal multiplanar reconstruction CT images. Hinge positions were divided into five zones in our new classification, by their relationship to the proximal tibiofibular joint (PTFJ). Fractures were classified into types I, II, and III according to the Takeuchi classification.

RESULTS

Among 111 patients undergoing OWHTOs, 22 sustained lateral hinge fractures. Of the 89 patients without fractures, 70 had hinges in the zone within the PTFJ and lateral to the medial margin of the PTFJ (zone WL), just above the PTFJ. Among the five zones, the relative risk of unstable fracture was significantly lower in zone WL (relative risk 0.24, confidence interval 0.17 to 0.34).

CONCLUSION

Zone WL appears to offer the safest position for the placement of the osteotomy hinge when trying to avoid a fracture at the osteotomy site. Cite this article: Bone Joint J 2017;99B10:1313-18.

Structure, force balance, and topology of Earth's magnetopause

The magnetopause deflects the solar wind plasma and confines Earth's magnetic field. We combine measurements made by the four spacecraft of the Magnetospheric Multiscale mission to demonstrate how the plasma and magnetic forces at the boundary affect the interaction between the shocked solar wind and Earth's magnetosphere. We compare these forces with the plasma pressure and examine the electron distribution function. We find that the magnetopause has sublayers with thickness comparable to the ion scale. Small pockets of low magnetic field strength, small radius of curvature, and high electric current mark the electron diffusion region. The flow of electrons, parallel and antiparallel to the magnetic field, reveals a complex topology with the creation of magnetic ropes at the boundary.

Global observations of magnetospheric high-m poloidal waves during the 22 June 2015 magnetic storm

We report global observations of high-m poloidal waves during the recovery phase of the 22 June 2015 magnetic storm from a constellation of widely spaced satellites of five missions including Magnetospheric Multiscale (MMS), Van Allen Probes, Time History of Events and Macroscale Interactions during Substorm (THEMIS), Cluster, and Geostationary Operational Environmental Satellites (GOES). The combined observations demonstrate the global spatial extent of storm time poloidal waves. MMS observations confirm high azimuthal wave numbers (m ~ 100). Mode identification indicates the waves are associated with the second harmonic of field line resonances. The wave frequencies exhibit a decreasing trend as L increases, distinguishing them from the single-frequency global poloidal modes normally observed during quiet times. Detailed examination of the instantaneous frequency reveals discrete spatial structures with step-like frequency changes along L. Each discrete L shell has a steady wave frequency and spans about 1 R_E , suggesting that there exist a discrete number of drift-bounce resonance regions across L shells during storm times.

Magnetotail energy dissipation during an auroral substorm

Violent releases of space plasma energy from the Earth's magnetotail during substorms produce strong electric currents and bright aurora. But what modulates these currents and aurora and controls dissipation of the energy released in the ionosphere? Using data from the THEMIS fleet of satellites and ground-based imagers and magnetometers, we show that plasma energy dissipation is controlled by field-aligned currents (FACs) produced and modulated during magnetotail topology change and oscillatory braking of fast plasma jets at 10-14 Earth radii in the nightside magnetosphere. FACs appear in regions where plasma sheet pressure and flux tube volume gradients are non-collinear. Faster tailward expansion of magnetotail dipolarization and subsequent slower inner plasma sheet restretching during substorm expansion and recovery phases cause faster poleward then slower equatorward movement of the substorm aurora. Anharmonic radial plasma oscillations build up displaced current filaments and are responsible for discrete longitudinal auroral arcs that move equatorward at a velocity of about 1km/s. This observed auroral activity appears sufficient to dissipate the released energy.

Induction of Calcification in MC3T3-E1 Cells by Inorganic Polyphosphate

Relatively large amounts of inorganic polyphosphate [poly(P)] (400 μM) have been found in normal osteoblasts. The effect of poly(P) with an average chain length of 65 phosphate residues on cell calcification was therefore investigated with the use of MC3T3-E1 cells. Expression of both osteopontin and osteocalcin was induced by poly(P) (0.1 ~ 1 mM), and cells treated with poly(P) were strongly stained by alizarin red. In addition, the level of alkaline phosphatase activity induced in poly(P)-treated cells was two-fold higher than that in either orthophosphate-treated or control cells but not higher than that in cells treated with β-glycerophosphate and ascorbic acid. In contrast, however, polyphosphatase activities were activated by poly(P) treatment to levels up to six-fold greater than that in controls. MC3T3-E1 cells may utilize poly(P) as a phosphate source for calcification rather than phosphate sources that are mainly produced by ALPase. Poly(P)-dependent induction of polyphosphatase activities may therefore promote calcification in MC3T3-E1 cells.

Movement Patterns as an Output Variable in Reaction Time

Effects of two experimental variables, movement pattern and signal selection, on EMG-reaction time (RT) of the biceps brachii were investigated in 17 subjects. Analysis showed that (a) interaction of two variables was not significant in the analysis of variance, (b) RT-difference between the movement patterns was not affected by the signal selection, and (c) the degree of EMG-RT slowing due to the process of signal selection did not vary with movement patterns. The movement pattern was regarded as an output variable.

Preferred Hand and Reaction Time in Different Movement Patterns

The difference in RT for right and left biceps, acting on the forearm in two different movement patterns, flexion and supination, was examined for 14 normal Ss, seven right-handed and seven left-handed. The task was to flex or supinate both forearms simultaneously in response to a sound stimulus. Median RTs of each S were computed for each movement task. The analysis indicated that RT of supination is faster than that of flexion. Concerning left-right difference of RT, the flexion of the non-preferred hand is faster than that of the preferred hand and the supination of the preferred hand is faster than that of the non-preferred hand. Even in a simple movement there are differences in RTs for the right and left hands which do not depend on the muscles but on the movement patterns. Hemispheric dominance is not established by comparing the rapid initiation of movement.