SHS vs. Gamma Nail Using FE analysis, the behaviour of the Gamma nail and the SHS was compared in an osteoporotic bone model for the fixation of three- and fourpart trochanteric fractures (31-A2 in the AO classification, types IV and V in Evans’ classification). The size of the medial fragment was varied based on clinical data and the case of a fractured greater trochanter was also considered. Results show that for Evans’ type V stabilized with a Gamma nail and for Evans’ types IV and V with the SHS, cancellous bone around the lag screw is susceptible to yielding, thus indicating a risk of cut-out. The volume of bone susceptible to yielding increases with an increase in size of the medial fragment. On the other hand, Evans’ type IV with a Gamma nail is not predicted to cut out. These findings suggest that future clinical trials investigating fixation of unstable proximal fractures should include the size of the medial fragment and the integrity of the greater trochanter as covariables and be powered to evaluate whether intramedullary devices are superior to SHSs for Evans’ type IV fractures and inferior/equivalent for type V. PFNA Because of the contradictory body of evidence related to the potential benefits of helical blades in trochanteric fracture fixation, the e↵ect of bone compaction resulting from the insertion of a PFNA was evaluated. A subject-specific computational model of a trochanteric fracture (31-A2 in the AO classification) was developed with lack of medial support and bone density was varied to account for variability in bone properties amongst hip fracture patients. Results show that for a bone density corresponding to 100% of the bone density of the cadaveric femur, there does not seem to be any advantage in using a PFNA with respect to the risk of blade cut-out. On the other hand, in a more osteoporotic femoral head characterized by a density corresponding to 75% of the initial bone density, local bone compaction around the helical blade provides additional bone purchase, thereby decreasing the risk of cut-out, as quantified by the volume of bone susceptible to yielding. These findings indicate benefits of using a PFNA over an intramedullary nail with a conventional lag screw and suggest that any clinical trial reporting surgical outcomes regarding the use of helical blades should include a measure of the femoral head bone density as a covariable. TAD and Screw Position Using a simple mathematical formulation, the relationship between the position of the lag screw tip (relevant to both intramedullary and extramedullary devices) and the concept of tip-apex distance (TAD) was derived. TAD is widely used in operating theaters as a surgical guideline in relation to the fixation of trochanteric fractures and in clinical studies as a predictor of lag screw cut-out. In order to visualize better this concept, the locus of points having the same TAD was plotted and TAD variations as the location of the lag screw tip was varied were described. Findings show that TAD should be adjusted for the size of the femoral head (a variable which varies a lot according to the sex of the patient) and that no correlation exists between TAD and bone morphometry indices obtained from μCT data (BV/TV and Tb.Th). Therefore, these results seem to suggest that TAD lacks mechanical justification and that predictors which are based on mechanical properties, such as bone density, should be investigated further. Cut-out and Screw Position The biomechanical performance of a CT scan-based three-part trochanteric fracture model (31-A2 in the AO classification) stabilized with a SHS was compared for nine di↵erent positions of the lag screw (3 x 3 arrangement, from anterior to posterior and from inferior to superior). Results show that the volume of bone susceptible to yielding in the head and neck region is the lowest for inferior positions and increases as the lag screw is moved superiorly. Overall, for this specific subject, the models less likely to lead to cut-out are the ones corresponding to inferior middle and inferior posterior positions of the lag screw. In this study, TAD was anti-correlated with the risk of cut-out, as quantified by the volume of bone susceptible to yielding, which suggests that a TAD > 25 mm cannot be considered to be an accurate predictor of lag screw cut-out. Further clinical studies investigating lag screw cut-out should attempt to find more reliable predictors of cut-out that should better reflect the biomechanics and subject-specificity of the femoral head. Plasticity Formulations Using an FE model of unstable trochanteric fracture stabilized with a SHS, the benefits of two plasticity-based formulations, Drucker-Prager and crushable foam, were evaluated and compared to the commonly used linear elastic model of trabecular bone in order to predict relative risk of lag screw cut-out for five distinct load cases. The crushable foam plasticity formulation leads to a much greater strain localization, in comparison to the other two models, with large plastic strains in a localized region. The plastic zone predicted with Drucker-Prager is relatively more di↵use. Linear elasticity associated with a minimum principal strain criterion provides the smallest volume of elements susceptible to yielding for all loading modes. The region likely to undergo plastic deformation, as predicted by the linear elastic model, is similar to that obtained from plasticity-based formulations, which indicates that this simple criterion provides an adequate estimate of the risk of cut-out.

The hip joint center (HJC) is needed for calculation of hip kinematics in various applications. In the functional method, the center is determined by moving femur with respect to acetabulum. A popular way for measuring this movement is through an optical motion capture system. This method is fast and economical for most applications where we require an instant HJC even though the reconstruction error in bone position calculation exists due to skin artifact. This error is caused by movement of markers placed on skin rather than on actual bone. Here we introduce ultrasound imaging as an additional modality to measure the change in soft tissue thickness above bone while hip is flexed. We use this information on the tissue thickness change to recalculate position of markers placed on skin to match the movement of bone. A good advantage of using ultrasound machine is its non-invasiveness. We calculated HJC using a symmetric center of rotation estimation (SCoRE) algorithm, which uses the concept of coordinate transformation on 3D marker position data. The algorithm gives the 3D position of two centers, one for each hip bone. The distance between these two centers (SCoRE residual) gives us a hint on the accuracy of the HJC calculation and has been proved to be proportional to the error with respect to actual center in previous studies. These two centers should ideally coincide as they collectively form a spherical joint. Our new algorithm for HJC calculation with tissue thickness compensation, measured using ultrasound imaging shows the error has been reduced from 9.13 mm to 4.87 mm

M.Tech. (Chiropractic) / Purpose: A kinematic chain consists of a succession of joints linking several fixed components (Levangie and Norkin, 2005). Any tension or restriction within a component of this chain increases the load placed on the remaining components (Commorford and Mottram, 2001). Pathomechanics of the hip may have an effect on the areas of pressure exerted by the plantar surface of the foot during gait through the kinematic chain (Levangie and Norkin, 2005). Chiropractic manipulative therapy restores the correct biomechanical function to a joint (Gatterman, 2005). No previous research to determine the effect of hip manipulation on lower limb biomechanics and gait patterns has been identified. The purpose of this study was to determine the effect of chiropractic manipulative therapy of the hip on gait patterns, particularly the degrees of foot rotation and the pathway of the centre of pressure of the foot. Method: Sixty participants matching the inclusion and exclusion criteria for this study were recruited. The procedure, risks and benefits were explained to each of them and they were required to sign an information and consent form. The participants then underwent a full case history accompanied by a physical and hip regional examination, including motion palpation of the hip. This ensured that none of the participants matched the exclusion criteria consisting of serious gait abnormalities, contraindications to manipulation and the receipt of simultaneous forms of treatment. Individual gait analysis by the Zebris FDM-System was performed for each participant before they received a hip manipulation. A second gait analysis was then conducted to determine a change. Procedure: Each participant was required to walk barefoot over the Zebris platform for approximately 2 minutes while 3 – 5 gait cycles were recorded for gait analysis. The participant then received manipulative therapy of the restricted hip. A second gait analysis was performed just as the first. The Zebris software calculated the average results from before and after the hip manipulation and displayed the changes of foot rotation and the parameters of the pathway of the centre of pressure in a report for each participant. The focus of this study was the manipulated hip. Changes of the non-manipulated hip were mentioned only where applicable. The Zebris FDM-System allows for accurate gait analysis due to its “capacitive force sensors,” each of which possesses its own calibration curve (Zebris Medical GmbH, 2006). Results: Statistically significant changes were found for certain gait parameters representing the pathway of the centre of pressure. These included anterior/posterior variability, lateral symmetry and lateral symmetry variability. Conclusion: This study demonstrates that chiropractic manipulative therapy of the hip has an effect on certain centre of pressure parameters and chiropractors, therefore, should be consulted for the treatment of gait abnormalities. The study trial involved only a single treatment per participant. Further studies should be conducted to determine whether multiple treatments and manipulation of other kinematic chain components have an effect.

No description available.

Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Background: In 2001 an assessment tool for predicting fracture risk in postmenopausal women was developed. An index based on a small number of risk factors that are easily assessed was developed called the Fracture Index. The value of this index ranges from 0-13 with higher number associated with higher five year probability of fracture. The magnitude of the morbidity and mortality associated with osteoporosis makes it valuable for health care professionals to know if a treatment to prevent fractures is cost effective or not. Objective: To investigate at what Fracture Index value it becomes cost effective to treat postmenopausal women with alendronate to prevent hip fractures. The focus is on Icelandic women. Design: A Markov model was developed to model the disease progression for women 65 years of age to 85 years of age which is the average life expectancy for women in Iceland. Cost effectiveness of alendronate vs. no treatment was assessed by transitioning women in the model every six months between different health states. In the base-case five year treatment with alendronate was assumed. Results: At Fracture Index 1-2 the incremental cost effectiveness ratio (ICER) was 27,467,073 ISK (238,844$) which is not considered to be cost effective. At Fracture Index 3-4 the ICER was 4,349,2511SK (37,820$) which has a 59% probability of being cost effective if the per capita GOP (4,800,000 ISK) for Iceland is used as a threshold for cost effectiveness. However cost effectiveness for Fracture Index 3-4 depends largely on the assumptions made in the model, some of which are uncertain such as drug cost, drug efficacy and appropriate discount rate. Treatment with Alendronate is cost effective for Fracture Index 5 and variation in the model's assumptions does not change that result. Conclusions: The results of this study indicate that treating osteoporotic women with alendronate to prevent hip fractures becomes cost effective at Fracture Index 5 with a 1.9% five year probability of hip fracture. / 2999-01-01

When mainstream institutions fail to provide adequate avenues for black Americans to develop humanizing understandings of their identities and exclude them from full citizenship, how do black Americans develop identity, belonging, and community within structures of oppression? Through ethnography and archival research this study documents how the aesthetic realm historically and contemporarily serves as a site of articulation where rural black Americans recast notions of black subjectivity and local belonging. To understand the process of rural black Americans using the aesthetic realm to reposition the importance of mainstream institutions, this research uses a 'socio-diasporic' framework to view the ways those socially positioned as black come to understand that positioning via the way institutions structure their day-to-day reality; and how through the forging of diasporic connections black people have been able to construct knowledge within, alongside, and independently of those institutions. Specifically, this ethnography situates the criminal justice system as a primary institutional apparatus in defining the societal significance of blackness in northeast North Carolina. Hip-hop has served as a performative avenue to engage negotiations of identity, and through this search for identity black centered epistemological and ontological understandings of black subjectivity have been created. To appreciate black Americans' unique understandings of the world that I argue they construct, I advance the notion of "vibe" as a methodological tool to conceptualize the way specific aesthetic and cultural sensibilities are used to construct understandings of blackness, gendered identity, and local belonging. / Doctor of Philosophy / When America fails to provide black Americans spaces to develop dignity and excludes them from full citizenship, how do black Americans develop identity, belonging, and community living in an oppressive society? Through living with rural black Americans and exploring how they understand their lived experience this study documents how the aesthetic realm historically and contemporarily serves as a space where rural black Americans reshape notions of black identity and local belonging. To understand the process of rural black Americans using the aesthetic realm to challenge the taken-for-granted structure of American society, this research views the ways those socially positioned as black forge community with each other and develop new ways of understanding their selves and society in ways that don’t squarely align with mainstream assumptions. Specifically, this ethnography situates the criminal justice system as a primary structure in America that shapes the significance of blackness in northeast North Carolina, linking what it means to be black to criminal. Hip-hop has served as a performative avenue to engage negotiations of identity, and through this search for identity black centered ways of understanding the world has been created that challenge American assumptions about humanity.

Many people across the world suffer from joint pain with age. The degeneration of the space between bones, osteoarthritis, is an extremely common disease, known to affect around 7% of the global population. Two of the most common risk factors to the development of osteoarthritis is body weight and inactivity. These factors are usually the first target of lifestyle changes that are recommended when a patient presents to an orthopedic clinic with joint pain, specifically knee or hip. This is because the weight of the body puts pressure on the joints and leads to breakdown of the joint spaces, causing arthritis to develop and progress. Many treatment options are available for people that suffer from joint pain -- medications, injections, physical therapy, and lifestyle changes. However, the gold standard treatment option for the gradual degeneration of joint spaces is a total or partial joint replacement depending on the severity of the disease and how compromised the patient’s day to day life is at that time. Many orthopedic surgeons prefer to exhaust more conservative treatment options prior to approving surgery, however, many patients eventually require a joint replacement due to disease relentlessness. There are two main approaches to hip replacement surgeries, anterior and posterior approach. The posterior approach has been used in practice for the longest amount of time and was the initial surgical option. However, more recently, the anterior approach has been introduced and is on the rise due to several factors that make it favorable to many providers and patients over the long-standing posterior approach. Given that many patients who eventually require joint replacement are overweight or lead a lifestyle that is very sedentary, this study will investigate whether a patient’s body mass index should influence whether the anterior approach should be used based on patient outcomes and success from the two approaches.

Twelve normal mixed-breed dogs were selected and assigned to acetabular rotation or sham-operated groups. Rotation group dogs had pelvic osteotomies followed by application of an ilial bone plate, causing rotation of the acetabulum to reduce dorsal coverage of the femoral head. Sham group dogs received identical osteotomies but were plated in normal orientation. All dogs had force plate and subjective lameness evaluations pre-operatively and post-operatively. Pelvic radiographs were evaluated pre-operatively and at four-week intervals post-operatively. The dogs were killed at the conclusion of the study, and samples were taken for evaluation. Analysis of vertical ground reaction forces indicated a significant difference between treatment groups, however no difference was noted based on subjective scores. No difference was observed between groups based on radiographic estimations of degenerative changes or Norberg angle, however the coverage of the femoral head was less in rotated dogs. Mild inflammatory changes were discernible in the joint capsule of some dogs in both groups. A trend toward more severe change was present in the left hip of the treatment group, but statistically significant difference was noted only when comparing the right and left legs of the acetabular rotation group. Although evidence of osteoarthritis was noted histologically, only minor differences were detected in the dogs by other means. Because of the minimal changes noted over the duration of the study, we conclude that the model does result in histopathologic change consistent with osteoarthritis, but that force plate analysis, radiographic evaluation, and clinical lameness evaluation are insensitive measures of this change. / Master of Science

Yes / This literature review aims to conduct an extensive systematic literature review of the nursing interventions on discharge planning among geriatric patients with hip fractures. Design: The review applied multiple research designs, and the literature search was based on PRISMA’s publication standard. Data Sources: The articles were selected from three primary online databases: Scopus, Science Direct and Web of Science and one supporting database, Google Scholar. Review Method: After searching the eligible articles, 15 articles were selected for thematic analysis. Results: The systematic review came out with five central themes 1) assessments of the patient’s and family member’s needs: 2) diagnosis of an individual discharge planning: 3) prescription of the appropriate nursing interventions; 4) implementation of the nursing interventions and 5) follow -up after the patients have been discharged from hospital. Conclusion: The review’s findings explained the nursing intervention implemented and its effectiveness on elderly patients with hip fractures. Apart from that, this review also highlighted the methodology approach and health outcomes measured, which will help the scholars better understand the study area. Impact: The review contributes needed information for future nursing research and practice of the elderly with hip fractures.

A longitudinal content analysis of top-chart hip-hop songs’ lyrics produced between 1980 and 2013 was conducted to investigate the degree and progression of the paradoxical juxtaposition, or postmodern hybridity, of oppositional modernist identities in terms of race/ethnicity, gender, sexual orientation, sexuality, and economic lifestyle, in addition to the longitudinal diversification of artist’s race and gender demographics. Demographically, the percentage of non-African-American artists increased as the percentage of African-American artists decreased. Additionally, the percentage of songs featuring either all male or all female artists decreased, while the percentage of collaboration between male and female artists increased over time. Although hybrid oppositional identities related to race/ethnicity and gender did not increase over time, those of sexual orientation, sexuality, and economic lifestyle increased over time. In addition, materialist identities were related to the hybridity of sexual orientation and sexuality, but not to that of gender and race/ethnicity. Overall, the research found increasing postmodern hybridity within the sexualization of hip-hop songs along with intensified materialism.