• Hip & pelvis
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• v.30 no.4
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• pp.260-268
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• 2018

Purpose: This study was performed to assess the clinical and radiological outcomes following one-stage hip reconstruction, consisting of open reduction femoral shortening and pelvic osteotomy, for neglected developmental dislocation of the hip (DDH). Materials and Methods: This is a retrospective analysis of 77 hips in 65 patients (46 females and 19 males; 12 had bilateral dislocations), operated at a Ghurki Trust Teaching Hospital in Pakistan between 2013 and 2015. The average age at surgery was $11.02{\pm}3.43$ years. According to the Tonnis classification, there were 10, 14, 22, and 31 patients in grades 1, 2, 3, and 4, respectively. The pelvic procedure utilized in this study was triple osteotomy (47 hips) followed by double and Salter osteotomy (18 and 12 hips, respectively). Postoperative evaluations were conducted using the modified MacKay's scoring system (functional outcomes) and Severin's scoring method (radiological assessment). Results: Postoperatively, there were 38 (49.4%), 19 (24.7%), 14 (18.2%), and 6 (7.8%) hips in Severin grade I, II, III and IV, respectively. According to the modified McKay criteria, there were 22 hips (28.6%) in excellent condition, 44 (57.1%) in good condition, 9 (11.7%) in fair condition and 2 (2.6%) in poor condition. Both patients with poor outcomes had an unstable, painful hip with evidence of avascular necrosis of the femoral head. Conclusion: Based on the results presented here, we recommend the single stage procedure of open reduction, femoral shortening and pelvic osteotomy for treatment of DDH in older children with good to excellent functional and radiological outcomes.

• Metals and materials international
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• v.24 no.6
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• pp.1359-1368
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• 2018

The mechanical properties and microstructure evolution of Mg-8Li-3Al-1Y alloy undergoing different rolling processes were systematically investigated. X-ray diffraction, optical microscope, scanning electron microscopy, transmission electron microscopy as well as electron backscattered diffraction were used for tracking the microstructure evolution. Tensile testing was employed to characterize the mechanical properties. After hot rolling, the $MgLi_2Al$ precipitated in ${\beta}-Li$ matrix due to the transformation reaction: ${\beta}-Li{\rightarrow}{\beta}-Li+MgLi_2Al+{\alpha}-Mg$. As for the alloy subjected to annealed hot rolling, ${\beta}-Li$ phase was clearly recrystallized while recrystallization rarely occurred in ${\alpha}-Mg$ phase. With regard to the microstructure undergoing cold rolling, plenty of dislocations and dislocation walls were easily observed. In addition, the microstructure of alloys subjected to annealed cold rolling revealed the formation of new fresh ${\alpha}-Mg$ grains in ${\beta}-Li$ phase due to the precipitation reaction. The mechanical properties and fracture modes of Mg-8Li-3Al-1Y alloys can be effectively tuned by different rolling processes.

• Corrosion Science and Technology
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• v.20 no.3
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• pp.158-168
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• 2021

Austenitic 316 stainless steel was irradiated with protons accelerated by an energy of 2 MeV at 360 ℃, the various defects induced by this proton irradiation were characterized with microscopic equipment. In our observations irradiation defects such as dislocations and micro-voids were clearly revealed. The typical irradiation defects observed differed according to depth, indicating the evolution of irradiation defects follows the characteristics of radiation damage profiles that depend on depth. Surface oxidation tests were conducted under the simulated primary water conditions of a pressurized water reactor (PWR) to understand the role irradiation defects play in surface oxidation behavior and also to investigate the resultant irradiation assisted stress corrosion cracking (IASCC) susceptibility that occurs after exposure to PWR primary water. We found that Cr and Fe became depleted while Ni was enriched at the grain boundary beneath the surface oxidation layer both in the non-irradiated and proton-irradiated specimens. However, the degree of Cr/Fe depletion and Ni enrichment was much higher in the proton-irradiated sample than in the non-irradiated one owing to radiation-induced segregation and the irradiation defects. The microstructural and microchemical changes induced by proton irradiation all appear to significantly increase the susceptibility of austenitic 316 stainless steel to IASCC.

• Nuclear Engineering and Technology
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• v.54 no.7
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• pp.2376-2385
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• 2022

Two groups of oxide dispersion-strengthened reduced-activation ferritic/martensitic steels (A and B) were prepared by adding Y, Ti, and Zr into steels through vacuum induction melting to investigate the inclusions, microstructures, mechanical properties of the alloys. Results showed that particles with Y, Ti, and Zr easily formed. Massive, Zr-rich inclusions were found in B steel. Density of micron inclusions in A steel was 1.42 × 10¹⁴ m^-3, and density of nanoparticles was 3.61 × 10¹⁶ m^-3. More and finer MX carbides were found in steel tempered at 650 ℃, and yield strengths (YS) of A and B steel were 714±2 and 664±3.5 MPa. Thermomechanical processing (TMP) retained many dislocations, which improved the mechanical properties. YSs of A and B treated by TMP were 725±3 and 683±4 MPa. The existence of massive Zr-rich inclusions in B steels interrupted the continuity of the matrix and produced microcracks (fracture), which caused a reduction in mechanical properties. The presence of fine prior austenite grain size and inclusions was attributed to the low DBTTs of the A steels; DBTTs of A650 and A700 alloy were -79 and -65 ℃. Tempering temperature reduction and TMP are simple, readily useable methods that can lead to a superior balance of strength and impact toughness in industry applications.

• Journal of Trauma and Injury
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• v.35 no.3
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• pp.209-214
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• 2022

We describe a case of hyperbaric oxygen therapy (HBOt) as an adjunct to treatment of a crush injury to the hand. A 34-year-old male paramedic was involved in a motor vehicle accident and admitted for diagnosis and surgical treatment. He sustained a crush injury to his right hand and presented with significant muscle damage, including multiple fractures and dislocations, an avulsion injury of the flexor tendons, and amputation of the distal phalanx of the little finger. He underwent reconstructive surgery and received HBOt over the following days. In the following 2 months, he lost the distal and middle phalanges of the little finger and recovered hand function. Posttraumatic compartment syndrome responds well to HBOt, which reduces edema and contributes to angiogenesis, as well as promoting the cascade of healing events. High-energy trauma causes massive cell destruction, and the blood supply is usually not sufficient to meet the oxygen demands of viable tissues. Hyperbaric oxygenation by diffusion through interstitial and cellular fluids increases tissue oxygenation to levels sufficient for the host's responses to injury to work and helps control the delayed inflammatory reaction. HBOt used as an adjunct to surgical treatment resulted in early healing and rehabilitation, accelerating functional recovery. The results suggest that adjunctive HBOt can be beneficial for the treatment of crush injuries of the hand, resulting in better functional outcomes and helping to avoid unnecessary amputations.

• Clinics in Shoulder and Elbow
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• v.25 no.3
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• pp.224-229
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• 2022

Background: Most acromioclavicular joint (ACJ) injuries are caused by direct trauma to the shoulders, and various methods and techniques are used to treat them; however, none of the options can be considered the gold standard. This study examines the horizontal stability of the ACJ after a complete dislocation was repaired using one of two Ethibond suture techniques, the loop technique and the two holes in the clavicle technique. Methods: In this single-blind, randomized clinical trial, 104 patients diagnosed with complete ACJ dislocation type V were treated using Ethibond sutures with either the loop technique or the two holes in the clavicle technique. Horizontal changes in the ACJ were radiographically assessed in the lateral axial view, and shoulder function was evaluated by the Constant (CS) and Taft (TS) scores at intervals of 3, 6, and 12 months after surgery. Results: The horizontal stability of the ACJ was better with the two-hole technique than the loop technique at all measurement times. CS and TS changes showed a significant upward trend over time with both techniques. The mean CS and TS at the final visit were 95.2 and 11.6 with the loop technique and 94.0 and 11.9 with the two-hole technique, respectively. The incidence of superficial infections caused by the subcutaneous pins was the same in the two groups. Conclusions: Due to the improved ACJ stability with the two-hole technique, it appears to be a more suitable option than the loop technique for AC joint reduction.

• Journal of the Korean Orthopaedic Association
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• v.55 no.1
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• pp.95-100
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• 2020

In general, most knee dislocations are reduced easily by simple traction. In rare cases, closed reduction of the knee dislocation is attempted, but ruptured ligaments or muscles are stuck in the joints and cannot be reduced. The cases of this irreducible knee dislocation have sometimes been reported. The authors encountered a case of irreducible knee posterolateral rotational dislocation that was not reduced by simple traction and report it along with a review of the literature. This case provides an opportunity for clinicians to examine the clinical considerations when experiencing an irreducible knee dislocation.

• Clinics in Shoulder and Elbow
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• v.26 no.2
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• pp.156-161
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• 2023

Background: We analyzed association between viewing two-dimensional computed tomography (2D CT) images in addition to radiographs with radial head treatment recommendations after accounting for patient and surgeon factors in a survey-based experiment. Methods: One hundred and fifty-four surgeons reviewed 15 patient scenarios with terrible triad fracture dislocations of the elbow. Surgeons were randomized to view either radiographs only or radiographs and 2D CT images. The scenarios randomized patient age, hand dominance, and occupation. For each scenario, surgeons were asked if they would recommend fixation or arthroplasty of the radial head. Multi-level logistic regression analysis identified variables associated with radial head treatment recommendations. Results: Reviewing 2D CT images in addition to radiographs had no statistical association with treatment recommendations. A higher likelihood of recommending prosthetic arthroplasty was associated with older patient age, patient occupation not requiring manual labor, surgeon practice location in the United States, practicing for five years or less, and the subspecialties "trauma" and "shoulder and elbow." Conclusions: The results of this study suggest that in terrible triad injuries, the imaging appearance of radial head fractures has no measurable influence on treatment recommendations. Personal surgeon factors and patient demographic characteristics may have a larger role in surgical decision making. Level of evidence: Level III, therapeutic case-control study.

• Nuclear Engineering and Technology
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• v.8 no.4
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• pp.203-207
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• 1976

Strain rate dependence of the flow stress of cold-worked and annealed Zircaloy-4 was studied by stress relaxation test in temperature range of 20$0^{\circ}C$ to 45$0^{\circ}C$. The In $\sigma$-ln i curves for various temperatures were straight in the eirange of 10$^{-5}$ to 10$^{-3}$ sec$^{-1}$ . From the slope of a curve strain rate sensitivity m was obtained. The m in cold-worked Zircaloy-4 had a minimum value at 30$0^{\circ}C$, while m in annealed Zircaloy-4 had two minimum values, one at 30$0^{\circ}C$ and the other at 45$0^{\circ}C$. It was found that the temperatures of the minimum m are consistent with the temperatures of strain ageing peaks. The minimum m at 30$0^{\circ}C$ is considered to be due to strain ageing owing to the pinning of glide dislocations by oxygen atoms, while the minimum m at 45$0^{\circ}C$ for annealed specimen is attributed to iron atoms.

• Journal of Oral Medicine and Pain
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• v.47 no.1
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• pp.27-37
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• 2022

Purpose: This study aimed to broaden our understanding of the predisposing factor and treatment of dislocation by analyzing and evaluating the morphology of the articular eminence (AE) in subjects with temporomandibular joint (TMJ) dislocation using cone beam computed tomography (CBCT). Methods: The subjects were divided into two groups: dislocation (31 subjects) and control (32 subjects). CBCT was used to examine 126 TMJs in 63 subjects (26 males, 37 females). The height, width, and posterior slope of the AE were measured in the parasagittal plane. The posterior slope was measured using the "top-roof line angle (TR angle)" method and the "best-fit line angle (BF angle)" method. The AE on the left side (AEL) and the AE on the right side (AER) of the subjects in the dislocation group were separately analyzed and compared with the control group after taking measurements. The average value of both sides was used when comparing with subjects with bilateral dislocation. Results: Dislocations were more frequent in females (67.7%) than in males (32.3%). The dislocation group showed a gentler TR angle than the control group in the AER and in the average of AE on the both sides (AEB). The same group also showed a wider AE in the AEL and the AER (p<0.05). In subjects with unilateral dislocation, the width of the AE with dislocation was narrower and the TR angle and BF angle was steeper than the other side without dislocation (p<0.05). Conclusions: In subjects with unilateral TMJ dislocation, the posterior slope of the AE is steeper, and the width is narrower at the site of dislocation compared to the site without dislocation. However, in subjects with bilateral TMJ dislocation, AEB were wider, and the mean value of the posterior slope of AEB was gentler than that of the control group.