The presented Master’s Thesis aims at determining stress and strain distribution in proximal femur with applied PCCP and DHS systems. The DHS system has been widely and successfully used for treating intertrochanteric fractures of proximal femur; in some cases, however, complications concerning implant cut-out and excessive fracture collapse occur. To minimize the risk of stabilization failure, the PCCP system was designed. In the Thesis, the process of creating the numerical model is described and the results obtained by employing Finite Element Method are presented. The 3D models of implants’ geometry were created based on the real objects. The model of proximal femur geometry was built by utilizing a series of CT scans and divided into two bodies with respect to the AO classification afterwards. The loading was obtained by solving the static equilibrium equations for the loose lower extremity. The computation was run in Ansys Workbench v13 software. In the hip screws of the PCCP system, lower values of equivalent stress can be found when compared to the DHS system. However, the equivalent strain generated in the proximal fragment is 3-times higher when the PCCP system is employed than in case of DHS system which may be due to the self-cutting design of PCCP screws. By employing PCCP system, the risk of implant failure is decreased. On the other hand, the bone tissue of the proximal fragment in close vicinity of the implant screws seems to be overloaded and prone to collapse.

Introduction: Congenital short femur, or proximal femoral focal deficiency (PFFD), is a rare complex deformity of the lower extremity with femoral dominance. The clinical findings cover wide range of variety, from femoral absence till inconspicuous shortening of the femur. Aim of the study: 1. Molecular analysis of pseudoarthrosis tissue in congenital short femur with focusing on osteogenic and angiogenic gene expression in comparison with physiological bone. The differences in gene expression were expected. 2. Retrospective analysis of femoral healing after prolongation calculating the severity of affection, age, distance of elongation and complication. The extended healing according to severity type and age was expected compared to control group. Material and methods: The RNA from piece of one was isolated and transcription profile of possible 113 genes of osteogenesis and angiogenesis was detected by biochip technology (SuperArray Bioscience Corporation). 10 samples analyses were performed (7 of PFFD, 3 controls). The data of 57 PFFD patients indicated for elongation of the femur with the types Pappas III, IV, VII, VIII and IX and 12 patients in control group were evaluated retrospectively and statistically by GLS method. Results: The expected differences in gene expression in PFFD tissue...

Ökomorphologische Konvergenz tritt auf, wenn Arten mit demselben Lebensstil unabhängig voneinander ähnliche morphologische Merkmale evolvieren. Neue Fallstudien können dabei helfen, die diesem Prozess zugrunde liegenden Mechanismen aufzuklären. Diese Arbeit befasst sich mit einigen konvergent evolvierten, langsamen, baumbewohnenden Säugetieren, d. h. zwei Linien baumlebender Faultieren, dem Zwergameisenbär, den Lorisiden, zwei Kladen ausgestorbener Lemuren, d. h. Paläopropithekiden und Megaladapis, und dem Koala. Es werden funktionsmorphologische Konvergenzen in diesen Taxa erforscht, indem ihr Humerus und ihr Femur sowie jene ihrer nah verwandten, aber ökologisch unterschiedlichen Taxa untersucht werden. Erstmals werden Knochen mittels phylogenetisch vergleichender Methoden auf vier anatomischen Ebenen, d.h. äußere Form, diaphysäre Mikrostruktur und Anatomie sowie epiphysäre Trabekelarchitektur, analysiert. Viele langsame, baumbewohnende Säugetiere teilen eine geringe kortikale Kompaktheit, was wahrscheinlich mit ihrer extrem niedrigen Stoffwechselrate und ihren biomechanischen Anforderungen zusammenhängt. Langsame, arboreale Xenarthra, d. h. baumbewohnende Faultiere und der Zwergameisenbär, weisen ein Muster unvollständiger Konvergenz für eine Reihe äußerer und innerer anatomischer Merkmale auf, was möglicherweise durch die relativ unterschiedliche Ökologie des Zwergameisenbären erklärt wird. Auf einer breiteren Säugetierskala konvergieren andere Merkmale, die möglicherweise mit der Ökologie der langsamen baumbewohnenden Lebensweise in einigen der untersuchten Taxa zusammenhängen, obwohl komplexe Muster auch durch andere evolutionäre Prozesse erklärt werden können. Nur suspensorisch lebende Taxa tragen signifikant zur Konvergenz bei. Diese Arbeit hebt die stärkere Konvergenz hervor, die sich in der inneren Struktur des Knochens widerspiegelt. / Ecomorphological convergence occurs when similar morphological traits are independently evolved by species with the same lifestyle. Novel case studies can help to elucidate the underlying mechanisms of this process. This work addresses some convergent slow arboreal mammals, i.e. two lineages of ‘tree sloths’, the silky anteater, ‘Lorisidae’, two clades of extinct lemurs, i.e. palaeopropithecids and Megaladapis, and the koala. Functional morphological convergences are searched in these taxa, studying their humerus and femur as well as those of their closely related ecologically distinct taxa. For the first time, bones are analyzed at four anatomical levels, i.e. external shape, diaphyseal microstructure and anatomy and epiphyseal trabecular architecture, through phylogenetic comparative methods. Many slow arboreal mammals share a low cortical compactness, probably related to their extremely low metabolic rate and biomechanical demands. Slow arboreal xenarthrans, i.e. ‘tree sloths’ and the silky anteater, exhibit a pattern of incomplete convergence for a set of external and internal anatomical features, possibly explained by the relatively distinct ecology of the silky anteater. On a wider mammalian scale, other traits possibly related to slow arboreal ecology converge in some of the studied taxa, although with complex patterns also explained by other evolutionary processes. Only suspensory taxa significantly contribute to convergence. This thesis highlights the stronger convergence reflected by bone internal structure. By providing potential explanations for convergence in slow arboreal mammals, the inherent complexity of this process is here emphasized.

For many decades the Boston University School of Medicine Department of Anatomy and Neurobiology has housed an unprovenienced collection of fetal specimens. At least ten percent of the 137 fetal specimens were lost due to drying out and other damage. The specimens were stored for many decades in individual fluid filled containers. There is no reliable information regarding the medical or curation histories of the human fetal specimens. Furthermore, there is concern that the fixative may have led some internal structures to shrink more than others. At issue was to determine whether the specimens had maintained or lost their relationships, and size amongst internal structures. In normal fetal development the cerebellum, the femur, and the foot all follow mostly positive linear growth with age. Therefore, the purpose of the present study was to assess whether these specimens demonstrate anatomical correlations that one might find within in utero fetuses. This prospective correlation study used MRI images of the cerebellum and femur as well as anthropometric measurements of each foot and mass to seek to answer this question. A blind, random sample of twenty-five specimens was selected from forty-eight specimens roughly grouped by size. The Boston University Institutional Review Board was notified and, assigned waiver status to the application because the specimens were unprovenienced fixed tissue. All specimens were magnetic resonance scanned at the Center for Biomedical Imaging at the Boston University School of Medicine using a 3.0T whole body scanner (Achieva, Philips Healthcare, Best, The Netherlands). All scans were acquired using the 8-channel high-resolution head coil made by Invivo for the Achieva 3T scanner. This study found that the measurements taken from the images, and the feet had good intra-rater reliability because paired t-tests did not show significant differences between the measurements (alpha (α) < 0.05, all p-values were > 0.17, t-values were less than t-critical, and R2 < 0.02). Pearson's correlation coefficient testing revealed strong positive correlation between all the mean measures comparing these three structures: transverse cerebellar diameter (TCD), femur length, and foot length (α < 0.05, r - values were > 0.91, p < 0.001, and R2 > 0.82). Leading us to conclude that the dimensions of the soft tissues - TCD; and bone tissues - femur and foot of the lower extremities were unlikely to have changed significantly in decades of storage.

Thesis (MMed (Surgical Sciences. Orthopaedic Surgery))--University of Stellenbosch, 2010. / No abstract available

Background: Previous research suggests that vitamin D deficiency during pregnancy may be associated with suboptimal fetal growth, but direct evidence is lacking. Our objectives were 1) to develop a method for measurement of the fetal sphenoidal fontanelle area (FA) and femur volume (FV) using 3D ultrasound; 2) to create normal charts for FA and FV; and 3) to correlate FA and FV with maternal vitamin D concentration. Methods: FA measurement in 3D was evaluated in vitro and in vivo. Different segmentation methods for FV measurement were explored. A novel FV method was described which consists of three linear measurements and a volume equation; this was validated in vitro and also by comparing FV measured sonographically to the true volume assessed by computed tomography (CT), in 6 cases following pregnancy termination. A cohort of 868 uncomplicated pregnancies was selected on the basis of strict inclusion criteria; participants underwent serial ultrasound scans for FV and multilevel modeling was used for the creation of a “prescriptive” FV chart. Finally, a different cohort of 357 healthy pregnant women had serum vitamin D levels and FV ultrasound at 34 weeks gestation and dual emission x-ray absorptiometry (DEXA) of their neonates in order to investigate the prenatal determinants of fetal bone mass. Results: FA measurement was accurate in vitro, but unreliable in vivo and was therefore abandoned. A novel FV method had excellent agreement with CT and superior repeatability compared with segmentation-based methods. A normal FV chart was created and the regression equations for the median and percentile values were presented. Vitamin D demonstrated a significant correlation with FV. Conclusions: FV is a reliable sonographic marker of skeletal growth. Maternal vitamin D deficiency is associated with reduced FV. This finding has public health implications as reduced bone mass may increase the lifetime risk of osteoporosis, through fetal programming.

Due to the demographic development osteopoorosis is an increasing serious medical and economical problem today in developed industrial countries including Czech republic. Fractures of the proximal femur in the elderly are one of the manifestations of the illness. Within the context of the pharmacological prevention we must consider carefully its contribution in comparison with costs of the fracture treatment in the hospital. This graduation theses deals with evaluation of expenses on the surgical treatment of these fractures and expenses on the pharmacological prevention using Fosamax. This comparison is made in economic situation in Czech republic in the end of the first decade of 21. century

As fraturas do fêmur proximal são frequentes em idosos, consideradas uma devastadora consequência da osteoporose, acometem mais o sexo feminino, estão comumente associadas a traumas de pequena energia e, embora apresentem poucas complicações referentes a consolidação no caso das fraturas extracapsulares, estão relacionadas a déficits funcionais, a elevadas taxas de morbidade e mortalidade, além dos altos custos aos serviços de saúde. Representam importante problema de saúde pública mundial devido a sua alta incidência. Trata-se de um estudo retrospectivo com base em um levantamento de prontuários, objetivando caracterizar os pacientes com fraturas do fêmur proximal atendidos na Santa Casa de Misericórdia de Batatais SP. Foram analisados 258 prontuários, de 258 pacientes, correspondendo a 260 fraturas do fêmur proximal (duas fraturas bilaterais) de indivíduos atendidos na Santa Casa de Misericórdia de Batatais no período de janeiro de 2007 a dezembro de 2010 com idade média de 74,8 anos, com predomínio de fraturas na faixa etária entre 80 e 89 anos (35,8%), mulheres (64,6%) e que se declaravam brancos (73%). As fraturas trocantéricas foram as mais incidentes com 60% dos casos, o mecanismo de trauma mais comum foi a queda da própria altura com 91,1% e o lado mais acometido foi o direito com 51,9%. O tratamento cirúrgico foi aplicado a 95,7% das fraturas do fêmur proximal. Dos 258 pacientes incluídos no estudo, 50 foram a óbito, sendo frequente entre as mulheres (61,6%) e o período mais incidente foi com três meses após a fratura. / Proximal femur fractures (PFFs) are common among the elderly. Rendered as a devastating consequence of osteoporosis, women are the most affected. PFFs are commonly associated with low-energy traumas, and, although they have few complications related to consolidation in the case of extracapsular fractures, they are related to functional deficits, high morbidity and mortality rates, besides being costly to health services. Due to the high incidence, PFFs are considered a relevant global public health issue. This is a retrospective study based on a survey of patient records with the objective to characterize the patients with proximal femur fractures seen at the Santa Casa de Misericórdia de Batatais Hospital São Paulo. A total of 258 patient records were analyzed, corresponding to 260 proximal femur fractures (two bilateral fractures) of individuals seen at Santa Casa de Misericórdia de Batatais between January of 2007 and December 2010. Most subjects were women (64.6%) with a mean age of 74.8 years, most in the age group between 80 and 89 years (35.8%), and self-declared being white (73%). Trochanteric fractures were the most common, with 60% of cases. The most common trauma mechanism was falling from ones own height with 91.1%, and the most affected side was the right side with 51.9%. Surgery was the chosen treatment in 95.7% of the proximal femur fractures. Of all the 258 study patients, 50 died, mostly women (61.6%), and the most incident time was at three months after the fracture.

Neste estudo padronizamos modelo de dor óssea induzida pela administração de células do tumor de Walker 256 em fêmur de ratos e avaliamos o efeito analgésico da crotalfina, um peptídeo com atividade analgésica. Análises radiográficas, tomográficas e cintilográficas demonstraram a presença de processos osteolíticos difusos, destruição do tecido cortical ósseo e intensa atividade osteogênica. Foi detectado aumento de partes moles adjacentes ao osso, fenômeno observado em pacientes com câncer ósseo. Análises histopatológicas mostraram a presença de células tumorais no pulmão, baço e fígado dos animais, indicando disseminação das células tumorais. Foi detectada a presença de hiperalgesia, alodinia e dor manifesta, a partir do 1º dia após a inoculação das células, persistindo por pelo menos 14 dias. Crotalfina (8 <font face=\"Symbol\">mg/kg, p.o) administrada no 14º dia, bloqueou estes fenômenos. Esse efeito antinociceptivo é de longa duração (48 h) e mediado por receptores opióides do tipo <font face=\"Symbol\">k e <font face=\"Symbol\">d. Não foi observado desenvolvimento de tolerância após o tratamento prolongado com crotalfina. / The aim of the present work was to standardize a new rat model of bone pain induced by the injection of Walker 256 carcinoma cells into the femoral cavity of rats, and to evaluate the analgesic effect of crotalphine, an analgesic peptide. Radiographic, tomographic and scintigraphic analysis showed the presence of diffuse osteolytic processes, destruction of cortical bone tissue and intense osteogenic activity. Increase of soft tissue adjacent to the bone was also detected, being this phenomenon observed in patients with bone cancer. Hystopathological analysis showed the presence of tumor cells in lungs, spleen and liver, indicating the occurrence of metastasis. Tumor cell inoculation induced the presence of hyperalgesia, allodynia and spontaneous pain. Crotalphine (8 <font face=\"Symbol\">mg/kg, p.o.), administered on day 14, blocked these phenomena. This antinociceptive effect is long-lasting effect (2 days) and mediated by peripheral <font face=\"Symbol\">k and <font face=\"Symbol\">d- opioid receptors. Prolonged treatment with crotalphine (14 days) did not cause the development of tolerance to its antinociceptive effect.

A osteonecrose dos maxilares associada ao uso dos Bisfosfonatos é uma exposição óssea que persiste por mais de 8 semanas na cavidade oral em pacientes sob tratamento com bisfosfonatos e que não foram submetidos a radioterapia de cabeça e pescoço. Explicar o motivo do desenvolvimento destas lesões ósseas principalmente nos maxilares e desvendar a sua patofisiologia ainda é necessário. Por isso, o reparo ósseo em um modelo animal de osteonecrose dos maxilares associada ao uso de bisfosfonatos em ratos Wistar (Rattus norvegicus, albinus) foi avaliado através de análise microscópica e molecular. A amostra foi composta por 48 ratos machos, com 12 semanas de vida e peso aproximado de 300 gramas, que foram submetidos a administração de Ácido Zoledrônico, 0,6 mg/kg a cada 28 dias com um total de 5 doses. Os animais foram dividos em quatro grupos, cada um composto por 12 animais; 2 grupos de tratamento AZ e AZ-experimental (AZ-exp) e 2 grupos controles CO e CO-experimental (CO-exp) com administração de cloreto de sódio 0,9% no mesmo volume e frequencia do Ácido Zoledrônico. As soluções foram administradas por via intraperitoneal. O grupo AZ-exp e o CO-exp foram submetidos a exodontias dos molares superiores direitos e a realização de defeito ósseo no fêmur esquerdo 45 dias após a primeira aplicação das soluções. A eutanásia dos animais ocorreu após 150 dias do início do experimento. A avaliação histológica foi realizada através de análises qualitativa e quantitativa, verificou a presença de sequestros ósseos, áreas de osteonecrose e áreas de osso total por meio de estudos de microscopia óptica pela coloração Hematoxilina e Eosina. Análise quantitativa da expressão do RNAm de proteínas envolvidas no processo de reparo ósseo pelo método de reação em cadeia da polimerase em tempo real (RealTimePCR) também foi realizada para avaliação dos osteoclastos (RANK, RANKL e OPG), osteoblastos (ALPL e OCN) osteócitos (DMP-1 e PHEX) e vascularização (VEGF). Apenas o grupo com administração de AZ e realização de exodontias apresentou sequestros ósseos e áreas significativamente maiores de osteonecrose em comparação aos animais com exodontia e sem a administração de AZ. Não foram encontradas áreas de osteonecrose na análise do fêmur. A avaliação do osso total apresentou maior quantidade de osso nos animais submetidos a procedimentos cirúrgicos e administração de AZ, porém não houve significância estatística. Na análise molecular, a administração de AZ e a realização das exodontias e do defeito ósseo, provocou alteração na expressão de marcadores para osteoclastos. A administração do AZ associada à realização dos procedimentos cirúrgicos aumentou a expressão de marcadores iniciais da osteoblastogênese e diminuiu a expressão tardia dos osteoblastos. A expressão de marcadores de osteócitos foi menor após a administração de AZ e exodontias na maxila, no entanto, no fêmur, houve aumento na expressão destes marcadores. A realização das exodontias e de defeitos ósseos no fêmur aumentou a expressão de VEGF nos grupos com e sem administração de AZ. Estes resultados evidenciam a interferência do Ácido Zoledrônico no reparo ósseo dos alvéolos e dos defeitos ósseos nos fêmures, causando incidência de osteonecrose na maxila, atraso na remodelação óssea, e ausência de lesões de osteonecrose no fêmur. A presença de lesões de osteonecrose na maxila pode ser consequência do atraso na remodelação óssea, evidenciado pela alteração na expressão de marcadores para osteclastos e osteoblastos, e as mesmas ocasionam a diminuição da expressão de proteínas pelos osteócitos. / Bisphosphonate-related osteonecrosis of the jaws is a bone exposure persisting for more than 8 weeks in the oral cavity in patients receiving bisphosphonates and who did not undergo radiation therapy for head and neck. Explain the reason for these development bone lesions mainly in the jaws and unveil its pathophysiology is still needed. Therefore, the bone repair in an animal model of Bisphosphonate-related osteonecrosis of the jaws in Wistar rats (Rattus norvegicus, Albinus) was evaluated by microscopic and molecular analysis. The sample was composed of 48 male rats, with 12 weeks old and weighing approximately of 300 grams, who underwent the administration of zoledronic acid, 0.6 mg / kg every 28 days with a total of 5 doses. The animals were divided into four groups, each consisting of 12 animals; 2 treatment groups AZ and AZ-experimental (AZ-exp) and 2 control groups CO and CO-experimental (CO-exp) with sodium chloride administration 0.9% in the same volume and frequency of zoledronic acid. All solutions were administered intraperitoneally. The AZ-exp group and the CO-exp group underwent extractions rights upper molars and the bone defect was performed in the left femur 45 days after the first application of the solutions. Euthanasia of animals occurred after 150 days from the beginning of the experiment. Histological evaluation was performed through quantitative and qualitative analysis checked the presence of bone sequestration, osteonecrosis area and whole bone areas by means of optical microscopy by hematoxylin-eosin staining. Quantitative analysis of mRNA expression of proteins involved in bone repair by polymerase chain reaction method in real time (RealTimePCR) was also performed: osteoclasts (RANK, RANKL and OPG), osteoblasts (ALPL and OCN) osteocytes (PMD-1 and PHEX) and vascularization (VEGF). Only the group with administration of AZ and performing tooth extractions presented bone sequestration and significantly larger areas of osteonecrosis when compared to animals with extraction and without AZ administration. There were no areas of osteonecrosis of the femoral analysis. The evaluation of the whole bone showed more bone in animals undergoing surgeries and AZ administration but there was no statistical significance. Molecular analysis, AZ administration and the performance of tooth extractions and bone defect changed the expression of markers for osteoclasts. The AZ administration associated with surgical procedures increased the expression of early markers of osteoblastogenesis and decreased the late expression of osteoblasts. The expression of osteocytes markers was lower after AZ administration and maxillary tooth extractions; however, there was an increase in the expression of these markers in the femur. The performance of tooth extractions and bone defects in the femur increased VEGF expression in animals with and without administration of AZ. These results show the interference of zoledronic acid on bone repair of the sockets and bone defects in the femurs, causing incidence of osteonecrosis of the upper jaw, delayed bone remodeling, and no femoral osteonecrosis injuries. The presence of osteonecrosis injuries in the upper jaw can be the consequence of the delay on bone remodeling, evidenced by the change in the markers expression for osteoclasts and osteoblasts, and they cause the decreased in protein expression by osteocytes.