Effects of laryngoscope handle light source on the light intensity from disposable laryngoscope blades.

A bench-top study was performed to assess the effects of different laryngoscope handles on the light intensity delivered from disposable metal or plastic laryngoscope blades. The light intensity from both the handle light sources themselves and the combined handle and laryngoscope blade sets was measured using a custom-designed testing system and light meter. Five samples of each disposable blade type were tested and compared with a standard re-usable stainless steel blade using three different handle/light sources (Vital Signs LED, Heine 2.5 V Xenon and 3.5 V Xenon). The light intensity delivered by the disposable blades ranged from 790 to 3846 lux for the different handle types. Overall, the 3.5 V Heine handle delivered the highest light output (p < 0.007) in comparison with the other handles. For the disposable blades, the overall light output was significantly higher from the plastic than the metal blades (p < 0.001).

The effect of sterilisation on the light intensity of the reusable Trachlight™.

We examined the light intensity delivered by the Trachlight™ reusable lightwand and the effect of repeated sterilisation on this light intensity. Using a light meter and test chamber, the light intensity of 12 new Trachlights and 31 Trachlights available in operating theatres was measured. In addition, five new devices underwent 30 repeated sterilisations with light intensity measurement after each cleaning. There was no difference between the light intensity of new Trachlights (median (IQR [range]) 2282 (2202-2780 [1970-4400])) lux and the devices currently in service (2295 (2018-2796 [1649-3280]) lux (p = 0.27)). The median (range) number of uses for devices currently in service was only 3 (0-9). There was, however, significant light intensity loss after 10, 20 and 30 cleanings (p = 0.001). After 10 cleanings, the mean light intensity was 75% of initial output, and after 30 cycles, light intensity was 59% of initial output.

The effect of flexor tendon repair bulk on tendon gliding during simulated active motion: an in vitro comparison of two-strand and six-strand techniques.

The gliding function of 2-strand (Tajima) and 6-strand (Savage) techniques of flexor tendon repair were compared in an in vitro biomechanical model. Stainless steel beads were inserted directly into the metacarpals, phalanges, and flexor digitorum profundus tendons of 22 human cadaver specimens. The FDP tendons were loaded from 5 to 25 N using a pneumatic actuator. The angular rotation and tendon excursion of the cadaver specimens were measured radiographically. The gliding function of the repairs was compared with core suture only, core suture plus epitenon repair, and sheath repair. There was no significant difference in angular rotation or linear excursion between the 2-strand and 6-strand techniques of flexor tendon repair. The addition of the epitendinous suture to the core suture improved the angular rotation and linear excursion for the 2-strand technique. Although the 6-strand repair tended to increase the repair site bulk more than the conventional 2-strand technique, the gliding function of the repair techniques was equivalent.

Design and validation of an unconstrained loading system to measure the envelope of motion in the rabbit knee joint.

An unconstrained loading system was developed to measure the passive envelope of joint motion in an animal model commonly used to study ligament healing and joint arthritis. The design of the five-degree-of-freedom system allowed for unconstrained knee joint loading throughout flexion with repeated removal and reapplication of the device to a specimen. Seven New Zealand White rabbit knees were subjected to varus, valgus, internal and external loads, and the resulting envelopes of motion were recorded using an electromagnetic tracking device. Intra-specimen reproducibility was excellent when measured in one specimen, with maximal rotational differences of 0.6 and 0.3 deg between the fourth and fifth testing cycles for the varus (VR) and valgus (VL) envelopes, respectively. Similarly, the maximal internal (INT) and external (EXT) envelope differences were 0.5 and 0.4 deg, respectively, between the fourth and fifth cycles. Good inter-animal envelope reproducibility was also observed with consistent motion pathways for each loading condition. A maximal VR-VL laxity of 17.9 +/- 2.3 deg was recorded at 95 deg flexion for the seven knees tested. The maximal INT-EXT laxity of 75.2 +/- 4.8 deg occurred at 50 deg flexion. Studies on measurement reproducibility of re-applying individual testing components demonstrated a maximal error of 1.2 +/- 0.7 deg. Serial removal and re-application (test-retest) of the complete measuring system to one cadaveric knee demonstrated maximal envelope differences of less than 0.7 deg for VR-VL rotation and 2.1 deg for INT-EXT rotation. Our results demonstrate that the measuring system is reproducible and capable of accurate evaluation of knee joint motion. Baseline in vitro data were generated on normal joint kinematics for future in-vivo studies with this system, evaluating ligament healing and disease progression in arthritis models.

In vitro assessment of the mechanical properties of latex and non-latex orthodontic elastics.

The increased incidence of latex allergies has led to the development of non-latex orthodontic products. The purpose of this study was to compare the mechanical properties of latex and non-latex orthodontic elastics. The elastics tested were from 2 manufacturers (GAC and Masel) and made of 2 materials (latex and non-latex). The properties tested included cross-sectional area, breaking force, peak load, peak stress, stiffness, modulus, hysteresis, and 24-hour load relaxation. The data were analyzed with 1-sample t tests, an analysis of variance, and the Fisher PLSD test. Between GAC and Masel, the GAC non-latex elastics had greater breaking forces than did the Masel non-latex elastics. The Masel latex elastics had greater breaking forces than did the Masel non-latex elastics. The GAC non-latex elastics showed more viscoelastic properties than both the GAC latex elastics and the Masel non-latex elastics; however, the Masel elastics were more viscoelastic than the GAC elastics. Forces generated by the elastics decreased over 24 hours to an average load approximating 75% of the manufacturers' values (GAC latex, Masel latex, and Masel non-latex elastics) and to 60% for the GAC non-latex elastics. The mechanical properties of the non-latex elastics were not comparable to those of the latex elastics. Therefore, the clinical choice of elastics should be based on the patient's medical history and the specific mechanical properties of the type of elastic.

Reconstruction of the proximal interphalangeal joint collateral ligaments using the Mitek Micro Arc Anchor: an in vitro biomechanical assessment.

Proximal interphalangeal joint (PIP) collateral ligament injuries are common and sometimes result in painful, stiff fingers. A number of techniques have been utilized in the past to reconstruct complete collateral ligament injuries. Recently, bone anchor systems have been described that allow collateral ligament reconstruction without the necessity of pull-out wires and other more cumbersome methods to reconstruct these ligaments. The Mitek bone anchor system has been used successfully in a variety of anatomic locations throughout the body to reattach soft tissues to bone. The current study was conducted to evaluate the biomechanical effects of the use of the Mitek Micro Arc Anchor in collateral ligament injuries of the PIP joint. In cadaveric PIP joints, the collateral ligament was isolated and then transsected in its mid substance. The authors compared suturing the ligament alone in standard fashion to repair of the ligament using a bone anchor inserted in the base of the middle phalanx. The joints were stressed to failure, with a lateral load applied at the distal end of the middle phalanx on a materials testing machine. The mean tensile failure loads of the two groups were the following: Mitek anchor, 16.4 +/- 3.7 N; suture repair, 19.3 +/- 7.6 N. The authors found no significant difference in the force required for failure of the repair or in the pattern of failure in the two groups. The Mitek Micro Arc Anchor appears to be adequate biomechanically to reconstruct the collateral ligaments of the finger PIP joint.

Error analysis of a direct current electromagnetic tracking system in digitizing 3-dimensional surface geometries.

The direct current electromagnetic tracking device has seen increasing use in biomechanics studies of joint kinematics and anatomical surface geometry. In these applications, a stylus is attached to a sensor to measure the spatial location of three-dimensional landmarks. Stylus calibration is performed by rotating the stylus about a fixed point in space and using regression analysis to determine the tip offset vector. Measurement errors can be induced via several pathways, including; intrinsic system errors in sensor position or angle and tip offset calibration errors. A detailed study was performed to determine the errors introduced in digitizing small surfaces with different stylus lengths (35, 55, and 65 mm) and approach angles (30 and 45 degrees) using a plastic calibration board and hemispherical models. Two-point discrimination errors increased to an average of 1.93 mm for a 254 mm step size. Rotation about a single point produced mean errors of 0.44 to 1.18 mm. Statistically significant differences in error were observed with increasing approach angles (p < 0.001). Errors of less than 6% were observed in determining the curvature of a 19 mm hemisphere. This study demonstrates that the "Flock of Birds" can be used as a digitizing tool with accuracy better than 0.76% over 254 mm step sizes.

Repair of central slip avulsions using Mitek Micro Arc bone anchors. An in vitro biomechanical assessment.

In this study we evaluated the pullout strength of the Mitek Micro Arc anchor for the reconstruction of central slip avulsions at the proximal interphalangeal joint of the finger. Forty paired fresh frozen cadaver fingers were randomized into treatment (anchor) and control groups (horizontal mattress repair) and subjected to tensile loading to failure. The mean (SD) failure loads of the repairs were: Mitek repair group 22.3 (4.7) N, and control group 24.7 (5.5) N. There were no statistically significant differences between the failure loads or the failure mechanisms of the two repairs. The pullout strength of the isolated anchor-bone complex was evaluated by refitting five anchors with stainless steel wire. The mean failure load of the isolated anchor was 400% higher than the tendon-suture-anchor complex, indicating that the weakest link of the system is not the bone-anchor interface.

A biomechanical analysis of intrascaphoid compression using the Herbert scaphoid screw system. An in vitro cadaveric study.

The purpose of this study was to evaluate the compressive capabilities of the Herbert scaphoid screw system. A transverse osteotomy was performed at the waist of eight scaphoids removing a 3 mm wafer of bone. A custom-designed load washer was inserted within this defect to measure intrascaphoid compression during Huene guide application, during screw insertion, after screw insertion and after guide release. The intrascaphoid compression was noted to peak during screw insertion; however it dramatically decreased without any clinical subjective evidence of decreased insertional torque by the surgeon. The average final compression as a percentage of maximal compression was 38 (SD 26) %.

Distal biceps brachii tendon repair. An in vitro biomechanical study of tendon reattachment.

Clinical reports suggest that suture anchors can simplify repair of distal biceps tendon avulsions. In this study, fixation strengths of Mitek and Statak suture anchors were compared with strength of reattachment using transosseous suture tunnels in eight cadaveric radii. Cyclic loading and load-to-failure testing were performed: No specimen failed during testing to 50 N for 3600 cycles: however, four of the Mitek anchors and one of the Statak anchors protruded out of the medullary canal. The mean load to failure of the Mitek suture anchor complexes was 220 +/- 54 N, that of the Statak suture anchor complexes was 187 +/- 64 N, and that of the transosseous sutures was 307 +/- 142 N. There was no significant difference in the failure load or mechanism of failure between the Statak and Mitek anchors. Transosseous sutures failed at significantly greater loads on static testing than the suture anchors. Cyclic loading results suggest that the bony fixation achieved using these three techniques should be sufficient to allow immediate passive mobilization of the elbow after surgery. Protrusion of the suture anchors out of the tuberosity during cyclic loading is a concern because of potential development of a gap at the repair site and interference with forearm rotation.

Advanced cement technique improves fixation in elbow arthroplasty.

An in vitro study was conducted to assess the efficacy of advanced cementing techniques in the fixation of the humeral stem in elbow arthroplasty. Sixteen fresh frozen cadaveric distal humeri were prepared to accept an acrylic sham humeral stem. Conventional cementing technique using doughy cement manually inserted and packed was performed in 8 specimens. The advanced cementing technique, consisting of canal irrigation, brushing and drying with gauze, canal plugging, and low viscosity cement pressurization with a delivery system was performed in the other specimens. All humeri subsequently were sectioned into 10 mm thick sections, photographed, and digitized to quantify the perimeter and area of the stem, cement mantle, corticocancellous junction, and cement voids. The degree of cement filling, determined from the area fraction of cement to the total available area within the corticocancellous junction, was significantly greater in the advanced group compared with the conventional group. Mechanical assessment of the specimens consisted of a push out load to failure test of the cement mantle from bone. For all locations in the distal humerus, the failure load and failure stress in the advanced group was significantly greater than the conventional group. It is concluded that development of an effective cement restrictor and application of advanced cement techniques in vivo should improve the initial fixation of the humeral component and may decrease the incidence of aseptic loosening associated with elbow arthroplasty.

Cyclic testing of flexor tendon repairs: an in vitro biomechanical study.

Forty cadaveric flexor digitorum profundus tendons were repaired using the Tajima, Halsted, Silfverskiold, or Savage techniques. The tendons were cyclically loaded in sets of 4,000 cycles beginning at 25 N and increasing by 10-N increments until failure occurred. Gap formation was continuously monitored with an extensiometer. Only the Savage repair group consistently withstood 4,000 cycles of 25-N loading, with respect to 2-mm gap formation and repair rupture. Tendon repairs subjected to cyclic loading demonstrated gap formation and repair rupture at lower loads than with static testing. Of the methods of flexor tendon repair tested, only the Savage technique could withstand simulated early active motion.

Plate fixation of comminuted olecranon fractures: an in vitro biomechanical study.

The stiffness, cyclic stability, and failure strength of posterior and lateral plating were compared in an in vitro model of a comminuted olecranon fracture. Loading was applied to the brachialis and triceps while displacements of the olecranon were measured with an electromagnetic tracking device in six degrees of freedom. No statistical difference was seen in the cyclic or static stability of either plating method. The triceps tendon suture attachment failed during destructive testing in each case between 300 and 500 N of applied loading. No gross failure of the bony fixation of the implant occurred before suture failure. These results suggest that both plating methods are likely to afford adequate stability to permit early protected postoperative range of motion.

Accuracy of an electromagnetic tracking device: a study of the optimal range and metal interference.

The positional and rotational accuracy of a direct-current magnetic tracking device commonly used in biomechanical investigations was evaluated. The effect of different metals was also studied to determine the possibility of interference induced by experimental test fixtures or orthopaedic implants within the working field. Positional and rotational data were evaluated for accuracy and resolution by comparing the device output to known motions as derived from a calibrated grid board or materials testing machine. The effect of different metals was evaluated by placing cylindrical metal samples at set locations throughout the working field and comparing the device readings before and after introducing each metal sample. Positional testing revealed an optimal operational range with the transmitter and receiver separation between 22.5 and 64.0 cm. Within this range the mean positional error was found to be 1.8 percent of the step size, and resolution was determined to be 0.25 mm. The mean rotational error over a 1-20 degree range was found to be 1.6% of the rotational increment with a rotational resolution of 0.1 degrees. Of the metal alloys tested only mild steel produced significant interference, which was maximum when the sample was placed adjacent to the receiver. At this location the mild steel induced a positional difference of 5.26 cm and an angular difference of 9.75 degrees. The device was found to be insensitive to commonly used orthopaedic alloys. In this study, the electromagnetic tracking device was found to have positional and rotational errors of less than 2 percent, when utilized within its optimal operating range. This accuracy combined with its insensitivity to orthopaedic alloys should make it suitable for a variety of musculoskeletal research investigations.

In-vitro strength of flexor-tendon repairs.

OBJECTIVE: To compare the standard Tajima technique for flexor-tendon repair of the hand with three new techniques with respect to strength and technical ease of the repair and bulk at the repair site. DESIGN: A randomized analysis of human cadaver flexor digitorum superficialis tendon repairs. SETTING: A musculoskeletal research laboratory at a university-affiliated health centre. MATERIAL: Thirty-nine fresh-frozen cadaveric flexor digitorum superficialis tendons from index, long and ring fingers harvested and divided transversely. The tendons were randomly allocated for repair by the current standard technique or one of three new techniques. INTERVENTIONS: The standard Tajima (modified Kessler) technique, and the Halsted, Savage or Silfverskiold technique. MAIN OUTCOME MEASURES: The time to perform each repair, the cross-sectional dimension and the load to failure of the tendon repairs. RESULTS: The Savage repair tolerated the highest loads, followed by the Halsted, Silfverskiold and Tajima repairs. The Silfverskiold technique was the least time-consuming to perform, followed by the Tajima, Halsted and Savage repairs. All of the techniques increased the cross-sectional dimensions of the tendon: the Silfverskiold repair by at least 50% and the Savage repair by over 100%. Although none of the techniques tested performed ideally, all three new techniques provided greater initial static strength than the standard Tajima method. CONCLUSION: Further in-vitro and in-vivo studies of these new techniques of flexor-tendon repair of the hand are necessary to optimize the treatment of these injuries.

Compression forces generated by the Huene alignment guide alone.

To enhance the fixation of scaphoid fractures by providing precise alignment and compression at the fracture site, the Huene alignment guide has been used in conjunction with bone screws. In an effort to predict the compressive force generated by the Huene guide alone, these forces were measured with a calibrated, strain-gauge, instrumented device. Three orthopedic surgeons each tested the guide 10 times on one cadaver scaphoid bone specimen. The magnitude of the compressive forces generated ranged from 9.0 to 67.0 N (mean 36.0 +/- 15.0 N). Comparisons of the force measurements among the individuals revealed no significant differences. This wide range of measurements could be attributed to the variability of the ratchet mechanism on the device. Because the Huene alignment guide is used to generate transcaphoid compressive forces, these results demonstrate that it does not yield consistent compression.

Characterisation of a bis(5'-nucleosidyl) triphosphate pyrophosphohydrolase from encysted embryos of the brine shrimp Artemia.

1. A P1,P3-bis(5'-nucleosidyl)triphosphate pyrophosphohydrolase (Np3 Nase) has been partially purified from Artemia embryos. 2. The Np3 Nase has a native Mr of 115,000 and preferentially hydrolyses substrates of the form Np3 N. Relative rates of hydrolysis are Ap3A (Vrel = 1.0), Gp3G (Vrel = 0.71), Ap4A (Vrel = 0.08), Ap5A (Vrel = 0.09), Gp4G (Vrel = 0.3) and Gp5G (Vrel = 0.33). An NMP is always one of the products. 3. The Km values for Ap3A and Gp3G are 15 and 10 microM respectively. 4. Mg2+, Mn2+ and Ca2+ ions all stimulate the activity, while Zn2+, Co2+ and Ni2+ ions are inhibitory. 5. The activity of the Np3 Nase remains constant during pre-emergence development of encysted embryos but decreases slightly after hatching.

Characterization of the bis(5'-nucleosidyl) tetraphosphate pyrophosphohydrolase from encysted embryos of the brine shrimp Artemia.

The P1P4-bis(5'-nucleosidyl) tetraphosphate asymmetrical-pyrophosphohydrolase from encysted embryos of the brine shrimp Artemia has been purified over 11,000-fold to homogeneity. Anion-exchange chromatography resolves two major species with very similar properties. The enzyme is a single polypeptide of Mr 17,600 and is maximally active at pH 8.4 and 2 mM-Mg2+. It is inhibited by Ca2+ (IC50 = 0.9 mM with 2 mM-Mg2+) but not by Zn2+ ions. It preferentially hydrolyses P1P4-bis(5'-nucleosidyl) tetraphosphates, e.g. P1P4-bis(5'-adenosyl) tetraphosphate (Ap4A) (kcat. = 12.7 s-1; Km = 33 microM) and P1P4-bis(5'-guanosyl) tetraphosphate (Gp4G) (kcat. = 6.2 s-1; Km = 5 microM). With adenosine 5'-P1-tetraphospho-P4-5"'-guanosine (Ap4G) as substrate, there is a 4.5-fold preference for AMP and GTP as products and biphasic reaction kinetics are observed giving Km values of 4.7 microM and 34 microM, and corresponding rate constants of 6.5 s-1 and 11.9 s-1. The net rate constant for Ap4G hydrolysis is 7.6 s-1. The enzyme will also hydrolyse nucleotides with more than four phosphate groups, e.g. Ap5G, Ap6A and Gp5G are hydrolysed at 25%, 18% and 10% of the rate of Ap4A respectively. An NTP is always one of the products. Ap2A and Gp2G are not hydrolysed, while Ap3A and Gp3G are very poor substrates. When the enzyme is partially purified from embryos and larvae at different stages of development by sedimentation through a sucrose density gradient, its activity increases 3-fold during the first 12 h of pre-emergence development. This is followed by a slow decline during subsequent larval development. The similarity of this enzyme to other asymmetrical-pyrophosphohydrolases suggests that it did not evolve specifically to degrade the large yolk platelet store of Gp4G which is found in Artemia embryos, but that it probably serves the same general function in bis(5'-nucleosidyl) oligophosphate metabolism as in other cells.