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The Orthopaedic Forum  |  March 05, 2014

Current Concepts Review  |  March 19, 2014
Scientific Articles  |  March 05, 2014
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    Schema summarizing the approaches that have been evaluated for augmentation of tendon-to-bone healing, including the use of osteoinductive growth factors, platelet-rich plasma, gene therapy, enveloping the grafts with periosteum, osteoconductive materials, cell-based therapies, biodegradable scaffolds, and biomimetic patches. Low-intensity pulsed ultrasound and extracorporeal shockwave treatment may affect tendon-to-bone healing by means of mechanical forces that stimulate biological cascades at the insertion site. Application of various loading methods and immobilization times influences the stress forces acting on the recently repaired tendon-to-bone attachment, which eventually may change the biological dynamics of the interface. Other approaches such as the use of coated sutures and interference screws aim to deliver biological factors while achieving mechanical stability by means of various fixators.

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    Schematic representation of the Transwell system used in the experiments.

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    Schematic workflow for a microarray GWAS. (1) When identifying study populations, note that a GWAS has greater power to detect significant associations when large populations are included in the analysis. (2) DNA from each sample is analyzed on microarrays that test millions of genome-wide SNPs. SNP genotypes are determined by the fluorescent color of the microarray during signal detection. (3) SNP alleles are counted in the case and control populations. Each sample has two possible alleles for each SNP site (shown in red), one allele inherited from each parent. Sites without SNP mutations are shown in black. (4) Statistical analysis in this GWAS uses case-control chi-square contingency tables. SNP1 is significantly associated with the disease (p < 0.05). (5) Association results are plotted genome-wide, from the first SNP of chromosome 1 to the last SNP of chromosome X; this is called a Manhattan plot. The negative of the logarithm of the p value, –log(p), for each SNP is plotted on the y axis. Peaks in the plot represent highly significant p values near candidate genes. The horizontal dashed line marks the –log(p) value representing Bonferroni-corrected genome-wide significance. Chromosomes are represented with alternating colors.

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    Figs. 1-A through 1-H Graphs showing the bactericidal effect of the antiseptics on three strains of bacteria. The dashed vertical line in each panel indicates the MBC. Fig. 1-A Polyhexanide was not sufficiently bactericidal even at the undiluted concentration. Fig. 1-B Peroxide was sufficiently bactericidal (99.9% reduction of the most resistant strain) at a minimal concentration far above the concentration that was compatible with cell viability as shown in Figure 2. Figs. 1-C, 1-D, and 1-E Graphs showing the bactericidal effect of octenidine, povidone-iodine, and chlorhexidine. The rectangles indicate the area of interest that was analyzed in more detail. Figs. 1-F, 1-G, and 1-H Graphs of the more detailed analyses. The error bars indicate the standard deviation (n = 6 replicates).

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    Immediately postoperative anteroposterior (Fig. 1-A) and lateral (Fig. 1-B) radiographs and a lateral radiograph made at the completion of the follow-up period (Fig. 1-C). As the distal aspect of the femur grew, the plates rotated and became more parallel to the femoral axis, resulting in a change in the posterior angle between the plates (inter-plate angle), as marked on the lateral radiographs.

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    Bar graphs showing a group comparison of the compound muscle action potential (CMAP), isometric tetanic force, and wet muscle weight. The results are expressed as a percentage of the values on the normal, contralateral side and are given as the mean and standard deviation. The asterisks indicate no significant difference (p ≥ 0.05), with all other comparisons being significant.

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    Representative histological sections from the two groups (toluidine blue, ×10). The sections are from two implants inserted in the same animal. The bone allograft (G) appears as lightly stained lamellar structures with empty lacunae. New bone (N) appears as a dense, dark purple, disorganized substance with embedded cells. Bone marrow (MAR) appears as a less dense, cell-rich, disorganized conglomerate with empty areas representing dissolved fat. Fibrous tissue (not evident) would appear as well-organized bundles of fibers with spindle-shaped cells. The control specimen (shown on top) has a sparse amount of bone allograft (11%, similar to the group mean of 9%) and some new bone formation in the defect between the implant and the surrounding bone (22%, similar to the group mean of 23%). Compared with the control specimen, the zoledronate-treated specimen (shown on the bottom) has a greater amount of retained bone allograft (29%, similar to the group mean of 27%) and a comparable amount of new bone formation (26%, similar to the group mean of 25%).

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    Oblique radiograph of a nondisplaced transverse fracture of the proximal fifth metatarsal (arrow) in a premenopausal subject with non-low BMD.

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    Osteolysis (expansile type) can be seen around an uncemented acetabular component as indicated by the black outline.

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    Influence of fracture location on POSNA and AAOS abstract treatment recommendations for pediatric upper extremity fractures.

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