Thesis (MMed)--Stellenbosch University, 2014 / ENGLISH ABSTRACT: Background With recent literature indicating certain clavicle shaft fracture types are best treated surgically; there is renewed interest in the anatomy of the clavicle. lntramedullary fixation of clavicle shaft fractures requires an adequate medullary canal to accommodate the fixation device used. This computer tomography anatomical study of the clavicle and its medullary canal describes its general anatomy and determines the suitability of its medullary canal to intramedullary fixation. Description of methods Four hundred and eighteen clavicles in 209 patients were examined using computer tomography imaging. The length and curvatures as well as the height and width of the clavicle and its canal at various pre-determined points were measured. ln addition the start and end of the medullary canal from the sternal and acromial ends of the clavicle were determined. The data was grouped according to age, gender and lateralization. Summary of results The average length of the clavicle was 151.15 mm with the average stemal and acromial curvature being 146 and 133 respectively. The medullary canal starts on average 6.59 mm from the sternal end and ends 19.56 mm from the acromial end with the average height and width of the canal at the middle third being 5.61 mm and 6.63 mm respectively. Conclusion The medullary canal of the clavicle is large enough to accommodate commonly used intramedullary devices in the nraprity of cases. The medullary canal extends far enough medially and laterally for an intramedullary device to adequatet'y bridge most middte third clavicle fractures. An alternative surgical option should be avalable in theatre when treating females as the medullary canal is too small to pass an intranedullary device past the fracture site on rare occasions.

Age estimation is a critical component of the biological profile in forensic and bioarchaeological contexts. The majority of age estimation methods are most accurate for individuals of younger age cohorts, typically those under 40 years of age. Skeletal degeneration can vary greatly between individuals, making age estimation less accurate for adult individuals. While there are some methods that attempt to age older individuals accurately and precisely, more research must be conducted to expand the range of methods available. Falys and Prangle (2014) developed a method for estimating age in individuals over the age of 40 using three degenerative characteristics of the sternal end of the clavicle: (1) surface topography, (2) porosity, and (3) osteophyte formation. In order to test their method, a sample of 1,510 individuals of known sex and age, ranging from 20 to 101 years of age (males: n = 1112, mean = 50.57, SD = 18.015; females: n = 398, mean = 53.065, SD = 20.358), were drawn from the McCormick Collection and the William M. Bass Donated Skeletal Collection at the University of Tennessee. Due to the paucity of remains of other ancestries, only individuals of reported White ancestry were used in this study. The two estimation methods proposed in Falys and Prangle (2014), regression equation and composite score, were tested to see how well they perform when applied to a different sample population than the populations used to develop the method. When applied to the collected data, the regression equation produced age estimations that fell within the 95% confidence interval in 47.6% of the male sample and 57.4% of the female sample. Composite scores were calculated and compared to the corresponding age ranges provided in Falys and Prangle (2014). The composite scores of the male sample estimated the age of an individual more accurately than the composite scores of the female sample (male = 65.9%; female = 58.8%). The lowest estimation accuracy for both males and females was between 70-79 years of age (male = 46.0%; female = 51.4%). From 80-89 years of age, the accuracy increased for males (76.4%) and females (69.4%). The sample also included individuals under the age of 40 in order to test whether the inclusion of clavicles with recent epiphyseal union would affect the applicability of the Falys and Prangle (2014) method. Multiple regression equations were generated: (1) individuals over 20 years of age, (2) individuals over 30 years of age, and (3) individuals over 40 years of age. The results from the multiple regression analyses show comparable Pearson’s coefficients for the above mentioned equations (r = 0.690, r = 0.632, and r = 0.611, respectively). Spearman’s rank correlation coefficients indicated a correlation significant at the 0.01 level for all three components individually, as well as the composite score. Of the three components, surface topography was most strongly correlated with age for both males (r = 0.643) and females (r = 0.590). Unlike the findings of Falys and Prangle (2014), porosity was found to be the least correlated with age for both males (r = 0.474) and females (r = 0.514). In addition, when broken down into ten year intervals (40-49, 50-59, etc.), the correlation coefficients increase with advancing age. This suggests that the method becomes more accurate as the age of an individual increases. The inter-observer and intra-observer agreement tests produced very low agreement values. The low observer agreement indicates that the current scoring method is not a reliable, repeatable technique. However, when examined further, the observed trait values that differed between the tests primarily differed by one score. These results suggest that condensing the scores in order to account for more variation would likely increase the observer agreement. However, condensing the scores would result in larger age intervals, which nullifies the purpose of this method. The findings in the present study indicate that the sternal end of the clavicle has potential for use in age estimation in older individuals. Although the present study produced lower correlation coefficients than proposed by the original study in 2014, the correlations and age-at-transition test results suggest that the sternal end of the clavicle deteriorates in a predictable manner that, with more observation and understanding, could be used to accurately age older individuals more precisely than the large age intervals currently in use. Despite the correlations between the degeneration of the sternal end of the clavicle and the age-at-death, the error rates suggest it is not a reliable alternative to the current methods used.

AN ABSTRACT OF THE THESIS OF MEGAN K. CLEARY, for the Master of Arts degree in ANTHROPOLOGY, presented on MARCH 28th at 8am, at Southern Illinois University Carbondale TITLE: SEX ESTIMATION FROM THE CLAVICLE: A DISCRIMINANT FUNCTION ANALYSIS MAJOR PROFESSOR: Dr. Gretchen R. Dabbs The development of methods for sex estimation using postcranial remains other than the os coxa is imperative for physical anthropology to improve the reliability of biological profile estimates in cases of incomplete and/or fragmentary skeletal remains. As the last skeletal element to complete fusion, the clavicle has the longest period of time to develop sexually dimorphic features, making it an ideal skeletal element for use in sex estimation. Sexual dimorphism in the clavicle was assessed using 18 measurements of the left clavicle of 265 (129 females; 136 males) individuals from the Hamann-Todd Collection. Independent samples t-tests with Bonferroni correction show males and females differ at a statistically significant level for all 18 variables with a significance level of 0.0028. Discriminate function analyses using the stepwise method (0.05 to enter, 0.10 to exit) produced a four variable model with cross-validated accuracy of 89.8%. A holdout sample from the Hamann-Todd Collection (n=30) similar in demographic character to the calibration sample was tested using the four variable model. The accuracy of the four variable model on the holdout sample was 90.0%. Additionally, four single variable models developed to accommodate fragmentary remains also have high predictive power (75.1-82.3% cross-validated calibration sample; 60.0-86.7% hold-out sample).

No description available.

<p>During a three-year period (1989-91), all patients living in the county of Uppsala, Sweden, with a radiographically verified fracture of the clavicle were prospectively, consecutively followed (n=245). </p><p>The epidemiological study (I) was restricted to the two first years with 187 fractures in185 patients. The short term study (II) with 6 months follow-up included 222 patients. The long term study (III) with 10 years follow-up included 208 patients. The malunion study (IV) included eight patients and the nonunion study (V) 24 patients all of whom were consecutively operated between 1988-2000.</p><p>Displacement, especially with no bony contact in the initial radiographs, was a statistically significant risk factor for sequelae.</p><p>Comminute fractures, especially if including transversally placed fragments, were associated with a significantly increased risk of remaining symptoms. An increasing number of fragments was also associated with an increased risk of sequelae.</p><p>Patients with remainig symptoms after 6 months were on average older at the time of injury as compared to patients without remaining symptoms. Advancing age was also a significant risk factor for sequelae – specifically pain at rest – still after 10 years.</p><p>There was no difference between gender with respect to the risk of sequelae, except for nonunion.</p><p>Fracture location did not predict outcome, except for more cosmetic defects (middle part).</p><p>Shortening defined as overlapping at the fracture site was a significant risk factor for cosmetic defects after 10 years.</p><p>Patients who experience pain at rest and/or cosmetic defects more than twelve weeks after the fracture have a higher risk for sequelae.</p><p>The radiographic examination should always consist of two projections: the AP (0°) view and the 45° tilted view. Transversally placed fragments are not seen in the 0° view.</p><p>Removal of excessive callus in patients with persistent symptoms even several years after the fracture showed a good outcome. One does not have to stabilize the clavicle when excising the hypertrophic callus.</p><p>Symptomatic clavicular nonunions should be treated with surgery. Reconstruction plate combined with cancellous bone gives a faster and more reliable healing rate than external fixation.</p>

During a three-year period (1989-91), all patients living in the county of Uppsala, Sweden, with a radiographically verified fracture of the clavicle were prospectively, consecutively followed (n=245). The epidemiological study (I) was restricted to the two first years with 187 fractures in185 patients. The short term study (II) with 6 months follow-up included 222 patients. The long term study (III) with 10 years follow-up included 208 patients. The malunion study (IV) included eight patients and the nonunion study (V) 24 patients all of whom were consecutively operated between 1988-2000. Displacement, especially with no bony contact in the initial radiographs, was a statistically significant risk factor for sequelae. Comminute fractures, especially if including transversally placed fragments, were associated with a significantly increased risk of remaining symptoms. An increasing number of fragments was also associated with an increased risk of sequelae. Patients with remainig symptoms after 6 months were on average older at the time of injury as compared to patients without remaining symptoms. Advancing age was also a significant risk factor for sequelae – specifically pain at rest – still after 10 years. There was no difference between gender with respect to the risk of sequelae, except for nonunion. Fracture location did not predict outcome, except for more cosmetic defects (middle part). Shortening defined as overlapping at the fracture site was a significant risk factor for cosmetic defects after 10 years. Patients who experience pain at rest and/or cosmetic defects more than twelve weeks after the fracture have a higher risk for sequelae. The radiographic examination should always consist of two projections: the AP (0°) view and the 45° tilted view. Transversally placed fragments are not seen in the 0° view. Removal of excessive callus in patients with persistent symptoms even several years after the fracture showed a good outcome. One does not have to stabilize the clavicle when excising the hypertrophic callus. Symptomatic clavicular nonunions should be treated with surgery. Reconstruction plate combined with cancellous bone gives a faster and more reliable healing rate than external fixation.

The study of the human motion as a discipline is ancient almost like the man. Early theories and observations on these topics can be found in Hyppocrates' and Galeno's work. More recently Duchenne de Boulogne (1867), Marey (1885), Braune and Fisher (1888), Sherrington (1933), Luria and finally Haken (1996) applied new techniques to the study of movement trying to understand and localise also the main areas of the brain involved during motion. Despite the richness of the literature produced, "man in motion" still represents a fascinating and partially unknown theme to deal with, particularly in the dynamic behaviour of the arms during the execution of specific tasks. Such movement, indeed individual expression of the complex interaction of biological subsystems (brain, muscles, skeleton, etc. ) against the surrounding environment, hides nowadays its features and very few data are available on its kinematic and dynamic response. This gap is largely due to the lack of knowledge on the dynamic movement of the "shoulder complex" and of the related muscles involved during motion. In fact, the large number of degrees of freedom to be measured and the high deformability of skin and soft tissues prevent the direct measurement of skeletal movements and contribute to increment the above described indetermination. Against this complex background, the rehabilitationist faces the pragmatic difficulties to decide which joints require attention as a priority or, in the case of biological damage, to assess the degree of impairment and subsequent recovery. As a result, clinical assessmentis performed by the use of relatively elementary test tasks, which can be monitored either by timing or by some indirect measurement of the success of the execution. The aim of the present research is then to provide new means of measurements to be used for gaining objective information on the motion particularly of "non visible" joints like the shoulder complex in order to characterise properly their motion and, in turn, the workspace of the arm.

Histological methods to estimate skeletal age at death, in forensic cases, are an alternative to the more traditional gross morphological methods. Most histological methods utilize counts of bone type within a given field for their estimation. The method presented in this paper uses the percentage area occupied by unremodeled bone to estimate age. The percentage area occupied by unremodeled bone is used in a linear regression model to predict skeletal age at death. Additionally, this method uses digital software to measure area rather than the traditional technique in which a gridded microscope is used to estimate area. The clavicle was chosen as a sample site since it is not a weight bearing bone and has little muscular insertion. These factors reduce the variation seen as a result of differences in lifestyle or activity pattern.

The National Highway Traffic Safety Administration (NHTSA) reported that in 2008 there were a total of 37,261 automotive related fatalities, 26,689 of which were vehicle occupants. It has been reported that in automotive collisions chest injuries rank second only to head injuries in overall number of fatalities and serious injuries. In frontal collisions, chest injuries constitute 37.6% of all AIS 3+ injuries, 46.3% of all AIS 4+ injuries, and 43.3% of all AIS 5+ injuries. In side impact collisions, it has been reported that thoracic injuries are the most common type of serious injury (AIS≥3) to vehicle occupants in both near side and far side crashes which do not involve a rollover. In addition, rib fractures are the most frequent type of thoracic injury observed in both frontal and side impact automotive collisions. Anthropomorphic test devices (ATDs), i.e. crash test dummies, and finite element models (FEMs) have proved to be integral tools in the assessment and mitigation of thoracic injury risk. However, the validation of both of these tools is contingent on the availability of relevant biomechanical data. In order to develop and validate FEMs and ATDs with improved thoracic injury risk assessment capabilities, it is necessary to generate biomechanical data currently not presented in the literature. Therefore, the purpose of this dissertation is to present novel material, structural, and global thoracic skeletal response data as well as quantify thoracic injury timing in both frontal belt loading and side impact tests using cadaveric specimens. / Ph. D.

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