• Clinics in Shoulder and Elbow
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• v.19 no.4
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• pp.216-222
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• 2016

Background: We investigated the effectiveness of fibular strut allograft augmentation of proximal humerus fractures to prevent varus deformity in patients over the age of 65 years with insufficient medial support. Methods: We analyzed the clinical and radiological outcomes of locking plate fixation with adjunct fibular strut allograft augmentation in 21 patients with proximal humeral fractures. The inclusion criteria were age (65-year-old or older); presence of severe medial comminution; inadequate medial support; and those who could participate in at least a one year follow-up. The average age was 76.4 years. We analyzed each patient's Constant score, our indicator of clinical outcome. As radiological parameters, we analyzed time-to-bone union; restoration of the medial hinge; difference between the immediately postoperative and the last follow-up humeral neck-shaft angles;; and anatomical reduction status, which was assessed using the Paavolainen method. Results: A successful bone union was achieved in all patients at an average of 11.4 weeks. We found that the average Constant score was 74.2, showing a satisfactory outcome. The average difference in the humeral neck-shaft angles between the immediately postoperative time-point and at the final follow-up was $3.09^{\circ}$. According to the Paavolainen method, the anatomical reduction was rated excellent. The medial hinge was restored in 14 of 21 patients. Although we did not find evidence for osteonecrosis, we found that a single patient had a postoperative complication of screw cut-out. Conclusions: Fibular strut allografting as an adjunct treatment of proximal humeral fractures may reduce varus deformity in patients with severe medial comminution.

• Geomechanics and Engineering
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• v.29 no.4
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• pp.391-405
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• 2022

A newly proposed grouting simulation method, the sequential diffusion solidification method was introduced into the numerical simulation of combined bi-borehole grouting. The traditional, critical and difficult numerical problem for the temporal and spatial variation simulation of the slurry is solved. Thus, numerical simulation of grouting and blocking of flowing water in karst conduits is realized and the mechanism understanding of the combined bi-borehole technology is promoted. The sensitivity analysis of the influence factors of combined bi-borehole grouting was investigated. Through orthogonal experiment, the influences of proximal and distal slurry properties, the initial flow velocity of the conduit and the proximal and distal slurry injection rate on the blocking efficiency are compared. The velocity variation, pressure variation and slurry deposition phenomenon were monitored, and the flow field characteristics and slurry outflow behavior were analyzed. The interaction mechanism between the proximal and distal slurries in the combined bi-borehole grouting is revealed. The results show that, under the orthogonal experiment conditions, the slurry injection rate has the greatest impact on blocking. With a constant slurry injection rate, the blocking efficiency can be increased by more than 30% when using slurry with weak time-dependent viscosity behavior in the distal borehole and slurry with strong time-dependent viscosity behavior in the proximal borehole respectively. According to the results of numerical simulation, the grouting scheme of "intercept the flow from the proximal borehole by quick-setting slurry, and grout cement slurry from the distal borehole" is put forward and successfully applied to the water inflow treatment project of China Resources Cement (Pingnan) Limestone Mine.

• Korean Journal of Computational Design and Engineering
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• v.16 no.6
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• pp.458-466
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• 2011

The morphology of a bone is closely associated with its biomechanical response. Thus, much research has been focused on analyzing the effects of variation of bone morphology with subject-specific models. Subject-specific models, which are generally achieved from 3D imaging devices like CT and MRI, incorporate more of the detailed information that makes a model unique. Hence, it may predict individual responses more accurately. Despite these powerful characteristics, specific models are not easily parameterized to the extent possible with statistical models because of their morphologic complexities. Thus, it is still proven challenging to analyze morphologic variations of subject-specific models across changes due to aging or disease. The aim of this article is to propose a generic and robust parametric morphing method for a subject-specific bone structure. We demonstrate this by using the proposed method on a model of a human proximal femur. Automatic segmentation algorithms are also presented to parameterize the specific model efficiently. A total of 48 femur models were evaluated for defining morphing vector fields. Also, several anatomical and mechanical functions of femur were considered as morphing constraints, and the NURBS interpolating technique was applied in the method to guarantee the generality of our morphed results.

• Journal of Veterinary Clinics
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• v.11 no.1
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• pp.437-470
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• 1994

These studies were performed to establish more effective surgical method for correcting congenital atresia coli in calves. Distal colon fistulation, proximal colon fistulation and colon anastomosis which could be applied for surgical repair of intestinal obstruction were carried out in goatlings experimentally and in calves with atresia coli clinically. After treatment of the animals clinical signs, blood component values, body weight gain, survival and necropsy findings were observed. In goatlings, clinical signs after colon fistulation were diarrhea, anorexia and vitality loss, and those of proximal colon fistulation group were severer than those of distal colon fistulation group. Surviviability after operation was 9~16 weeks in distal colon fistulation group, 2~8 weeks in proximal colon fistulation group, and 2-3 days in colocolic anastomosis group, respectively. There were no alterations in blood component values among experimental groups. Weight gain rates were 54.6% in distal colon fistulation group and 42.9% in proximal colon fistulation group compared with those of control. Necropsy findings observed in experimental groups were distension of intestine and excessive fluid in abomasum and intestine. Two calves with atresia coli died 1 day and 6 days after operation but one with colon fistulation survived more than two months. Preoperative clinical signs in calves with atresia coli were abdominal distension, progressive anorexia, no defecation and postoperative clinical signs wert diarrhea and periodic abdominal distension. After operation there were no alterations in blood component values between the calf with atresia coli and control calf. Weight gain rate of calf with atresia coli was similar to that of control but revealed the tendency to decrease from the 2nd month after operation. Necropsy findings observed in two calves with atresia coli were intestinal distension. intraluminal excessive fluid, blind atretic sac and absence of intrarectal content. It was concluded that proximal or distal colon fistulation could be available for surgical correction of congenital atresla coli and prognosis of distal colon fistulation was better than of proximal colon fistulation, but that extensive colocolic anastomosis could not be compatible with life in ruminants.

• Journal of Trauma and Injury
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• v.36 no.4
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• pp.369-375
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• 2023

Purpose: The reconstruction of defects around the knee and the proximal third of the leg necessitates thin, pliable skin with a stable and sensate soft tissue cover. This study analyzed the use of a proximally based sural artery flap for the coverage of such defects. Methods: This prospective clinical interventional study involved 10 patients who had soft tissue defects over the knee and the proximal third of the leg. These patients underwent reconstruction with a proximally based sural artery flap. The study analyzed various factors including age, sex, etiology, location and presentation of the defect, defect dimensions, flap particulars, postoperative complications, and follow-up. Results: There were 10 cases, all of which involved men aged 20 to 65 years. The most common cause of injury was trauma resulting from road traffic accidents. The majority of defects were found in the proximal third of the leg, particularly on the anterolateral aspect. Defect dimensions varied from 6×3 to 15×13 cm², and extensive defects as large as 16 cm×14 cm could be covered using this flap. The size of the flaps ranged from 7×4 to 16×14 cm², and the pedicle length was 10 to 15 cm. In all cases, donor site closure was achieved with split skin grafting. This flap consistently provided a thin, pliable, stable, and durable soft tissue cover over the defect with no functional deficit and minimal donor site morbidity. Complications, including distal flap necrosis and donor site graft loss, were observed in two cases. Conclusions: The proximally based sural fasciocutaneous flap serves as the primary method for reconstructing medium to large soft tissue defects around the knee and the proximal third of the leg. This technique offers thin, reliable, sensate, and stable soft tissue coverage, and can cover larger defects with minimal complications.

• Journal of applied mathematics & informatics
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• v.28 no.5_6
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• pp.1249-1262
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• 2010

An approximate alternating linearization decomposition method, for minimizing the sum of two convex functions with some separable structures, is presented in this paper. It can be viewed as an extension of the method with exact solutions proposed by Kiwiel, Rosa and Ruszczynski(1999). In this paper we use inexact optimal solutions instead of the exact ones that are not easily computed to construct the linear models and get the inexact solutions of both subproblems, and also we prove that the inexact optimal solution tends to proximal point, i.e., the inexact optimal solution tends to optimal solution.

• Clinics in Shoulder and Elbow
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• v.12 no.1
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• pp.44-52
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• 2009

Purpose: We assessed the radiographic and clinical results of one surgeon's experience treating proximal humerus fractures with a locked proximal humeral plate. Materials and Methods: Twenty patients with unstable proximal humerus fractures were treated with a locking compression plate between February 2005 and September 2007. The average age of the patients was 60.6 years, and the average postoperative follow-up period was 22.3 months. The clinical results were evaluated using the Constant and DASH scores. The radiologic results were evaluated by the Paavolainen method, which measures the neck shaft angle and humeral head height. Results: At the last follow-up examination, the mean Constant score was 75.3 and 15 cases (75%) had excellent or good results; the mean DASH score was 16.4. The mean neck shaft angle was $137.1^{\circ}$, and 19 cases (95%) had good results by the Paavolainen method. There was one delayed union, malunion, and screw loosening. Conclusion: The patients treated with a locking compression plate had relatively good clinical and radiologic results, and a low complication rate. Moreover, the patients could exercise earlier due to good reduction and initial stability. Treatment of unstable proximal humerus fractures with a locking compression plate is a reliable method.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.92-96
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• 1999

Neuroma is formed by abnormal, incomplete nerve regeneration after nerve injury. A painful neuroma in the hand can be psychologically and physically disabling. The goal of treating painful neuroma is to relieve pain and to restore nerve function. A numerous treatment modality was reported for alleviating the problem. These treatments include crushing the neuroma, ligating it, burying in soft tissue, bone, and muscle, injecting it with alcohol, phenol, and steroid, capping it with silicone cuff. But, none of these methods has been uniformly successful, although each has its advocates. No one technique reliably prevents formation of a painful neuroma. However, the principles of treatment is resection of neuroma and proximal stump of the nerve is transposed to appropriate adjacent tissue. Our current technique was resection of neuroma with partial normal neural tissue, and then the nerve ending was transposed and sutured to the side of the proximal stump with 10-0 nylon, so end-to-side neurorrhaphy was made. The nerve ending had to be placed and fixed into the proximal nerve epineurium like as a figure of a loop. We believe this technique is another useful method for the treatment of painful neuroma.

• The Mathematical Education
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• v.44 no.1 s.108
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• pp.41-65
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• 2005

In this paper we make an experiment in order to test whether the teaching method with the Zone of Proximal Development (ZPD) developed by Vygotsky can be more effective and well applied in the middle school pratces. Based on this investigation, we conclude that ZPD help to efficiently enhance the study of students, in particular, the inferior student group. Moreover, if we divide the student by more precise stoups, the ZPD will be more effective on teaching and learning in middle school. Lastly, we arrive at the conclusion that a continuous teaching with ZPD will improve the student attitude positively in solving mathematical problem even it does not appeared apparently on this test.

• Archives of Reconstructive Microsurgery
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• v.11 no.2
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• pp.167-172
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• 2002

The only treatment method for crushed soft tissue injuries in the proximal leg involving the knee joint is the microsurgical free flap transplantation, especially latissimus dorsi myocutaneous free flap is useful to cover the extensive soft tissue defects, therefore prevents iatrogenic below knee amputation and facilitates early wound healing, early ambulation and shortens hospital stay. Authors have treated the open amputation with crushed soft tissue and bone injuries in the proximal leg, and the repeated abrasion and infectious wound with traumatic neuroma in the below knee with myocutaneous free flap and succeeded to wear below knee amputation prosthesis and return to normal activities of the daily living in the relatively shorter period than usual.