ABSTRACT
For underwater adhesives with biocompatible and more flexible bonds using biomimetic adhesive groups, DOPA-like adhesive molecules were modified with cyanoacrylates to obtain different repeating units and chain length copolymers. The goal of this work is to copy the mechanisms of underwater bonding to create synthetic water-borne underwater medical adhesives through blending of the modified DOPA and a triblock copolymer (PEO-PPO-PEO) for practical application to repair wet living tissues and bones, and in turn, to use the synthetic adhesives to test mechanistic hypotheses about the natural adhesive. The highest values in stress and modulus of the biomimetic adhesives prepared in wet state were 165 kPa and 33 MPa, respectively.
Subject(s)
Acrylamides/chemistry , Adhesives/chemistry , Biomimetic Materials/chemistry , Bone and Bones/chemistry , Dopamine/chemistry , Polymers/chemistry , Humans , Materials Testing , Molecular Structure , Polyethylene Glycols/chemistry , Propylene Glycols/chemistry , Steel/chemistry , Surface PropertiesABSTRACT
Proximal humeral fractures account for 4% to 5% of all fractures, and most of these are minimally displaced and less prone to neurovascular injuries. This article presents a case of a 65-year-old man who injured the posterior circumflex humeral artery following a fracture dislocation of the proximal humerus leading to a life-threatening hemorrhagic complication during surgical fixation of the dislocated proximal humeral fracture. Preoperative vital signs were normal. Using the deltopectoral approach, the fracture site was exposed and the dislocated head was extracted. Blood pooled and overflowed the cavity at a brisk pace. Blood pressure dropped from 130/70 mm Hg to 90/45 mm Hg, and preoperative follow-up hemoglobin dropped to 4.8 g/dL. The axillary artery was explored and a ruptured posterior humeral circumflex artery was observed that was later ligated. In view of the damage to 1 of the circumflex humeral branches, primary hemiarthroplasty was performed. This article highlights the possibility of encountering life-threatening vascular injuries in highly displaced or dislocated 4-part proximal humeral fractures and the significance of obtaining the angiographic studies early in the course of management in such cases.
Subject(s)
Arteries/injuries , Shoulder Dislocation/complications , Shoulder Dislocation/surgery , Shoulder Fractures/complications , Shoulder Fractures/surgery , Vascular System Injuries/etiology , Vascular System Injuries/surgery , Aged , Arteries/surgery , Hemorrhage/etiology , Hemorrhage/prevention & control , Humans , Male , Multiple Trauma/diagnostic imaging , Multiple Trauma/surgery , Radiography , Shoulder Dislocation/diagnosis , Shoulder Fractures/diagnosis , Treatment Outcome , Vascular System Injuries/diagnostic imagingABSTRACT
INTRODUCTION: The treatment of tendinosis of elbow can be challenging, yet rewarding. Nevertheless, for the patients who failed conservative management and develop persistent recalcitrant symptoms, surgical intervention should be considered. The hypothesis of this study is iliac bone marrow plasma injection after arthroscopic debridement of degenerative tissue will bring along biological cure. Thus, it will not only reduce pain but also improve function in patients with resistant elbow tendonitis. MATERIALS AND METHODS: Twenty-four patients (26 elbows) with significant persistent pain for a mean of 15 months, despite of standard rehabilitation protocol and a variety of other nonsurgical modalities were treated arthroscopically. We applied autologous iliac bone marrow plasma injection following arthroscopic debridement. This material is produced by centrifugation of iliac bone marrow blood at 1,800 rpm for 20 to 30 minutes. Patients were allowed full range of motion (ROM) exercise after 2 to 3 days. Cytokine analyses for this injective material were done. Outcome was rated by postoperative sonography, visual analog pain scores (VAS) and Mayo elbow performance scores (MEPS) at 8 weeks and 6 months follow-up. Informed consent had been obtained from the subjects, and the study protocol was approved by the ethics committee of Chosun University Hospital, Korea. RESULTS: All patients in this study noted improvement both in their VAS and MEPS. No complication occurred in any patient. Evidence of tendon healing was observed in postoperative sonographic examination. Predominant cytokines of this study were interleukin-12 (IL-12), interferon-gamma-inducible protein-10 (IP-10) and RANTES. CONCLUSION: Biologic treatments in orthopaedics are just beginning to evolve. In the present investigation, the injection of iliac bone marrow plasma after arthroscopic debridement in severe elbow tendinosis demonstrated early recovery of daily activities and clear improvement.
