In vitro mechanical evaluation of a limited contact dynamic compression plate and hybrid carpal arthrodesis plate for canine pancarpal arthrodesis.

OBJECTIVE: To compare the mechanical properties of pancarpal arthrodesis (PCA) constructs stabilized at 20° of extension using either a 3.5 mm limited contact dynamic compression plate (LC-DCP) or a 3.5/2.7 mm hybrid plate (HP). METHODS: Seven forelimb pairs were used from dogs of similar size. All soft tissues were removed except for supporting structures of the carpus and proximal metacarpal region. All plates were accurately bent to 20°, and then instrumented with two, 350Ω strain gauges applied at the level of the bend. Constructs were embedded in epoxy moulds then mounted onto a servo-hydraulic testing machine. Specimens were loaded for 10 cycles at 100N, 200N and 300N. Tenth cycle construct compliance (CC), maximum angular deformation (MAD), and peak plate strain (PPS) were compared using two-factor analysis of variance (ANOVA) and Student-Newman-Keuls post-hoc tests (p <0.05). RESULTS: Regardless of load, CC was 29% to 33% smaller in the HP than the LC-DCP group (p <0.03). In each group, the CC significantly increased with increasing loads (p <0.02). Mean MAD was 19% to 22% less in HP than LC-DCP constructs, with significant differences seen at 200N and 300N loads. In both groups, MAD was significantly greater with increasing loads (p <0.02). In addition, PPS was 37% to 43% smaller for HP than LC-DCP. CLINICAL SIGNIFICANCE: The mechanical advantages of the HP over the LC-DCP make it a viable alternative for PCA. Smaller CC, MAD and PSS of the HP may reduce the risk of implant failure and postoperative morbidity following PCA.

Low intraovarian vascular resistance: a marker for severe ovarian hyperstimulation syndrome.

OBJECTIVE: To assess intraovarian blood flow in relation to the severity of ovarian hyperstimulation syndrome (OHSS) after controlled ovarian hyperstimulation. DESIGN: A prospective study. SETTING: Monash IVF, Clayton, Victoria, Australia. PATIENT(S): Thirty patients with OHSS after embryo or gamete transfer who also had sonographic evidence of ascites. MAIN OUTCOME MEASURE(S): The resistance to blood flow within the ovaries of 11 patients with severe OHSS and 19 patients with mild OHSS was measured by using transabdominal ultrasonography with color flow and pulsed Doppler imaging. RESULT(S): The pulsatility index (PI), resistance index (RI), and the S-D ratio, all measures of downstream vascular impedance, were significantly lower in those patients with severe OHSS. In cases with RI < 0.48, more than two thirds of the patients had a pleural effusion, whereas patients with either PI < 0.75 or S-D < 1.92 had pleural effusion in over one half of the cases. It was notable that blood flow velocity did not differ significantly between the two groups despite the changes in vascular impedance. CONCLUSION(S): There appears to be a close correlation between the severity of OHSS and the resistance to blood flow within the stimulated ovaries. Measurement of intraovarian vascular resistance before gamete transfer or ET in patients undergoing controlled ovarian hyperstimulation may help in predicting those patients at particular risk of developing severe OHSS.