Determining optimal length of coracoid graft in the modified Bristow procedure for anterior shoulder instability: A three-dimensional finite element analysis.

BACKGROUND: There is a lack of consensus concerning the coracoid graft length in the modified Bristow procedure. OBJECTIVE: We attempted to determine the optimal graft length using the three-dimensional finite element method. METHODS: In a shoulder model with a 25% anterior glenoid defect, a coracoid graft of varying lengths (5, 10, 15, and 20 mm) was fixed using a half-threaded screw. First, a compressive load of 500 N was applied to the screw head to determine the graft failure load during screw tightening. Next, a tensile load (200 N) was applied to the graft to determine the failure load due to biceps muscle traction. RESULTS: In the screw compression, the failure loads in the 5-, 10-, 15-, and 20-mm models were 252, 370, 377, and 331 N, respectively. In the tensile load applied to the coracoid graft, the failure load exceeded 200 N for both the 5- and 10-mm models. CONCLUSION: The 5-mm graft had a high risk of fracture during intraoperative screw tightening. As for the biceps muscle traction, the 5- and 10-mm-grafts had a lower failure risk than the 15- and 20-mm-grafts. Therefore, we believe that the optimal length of the coracoid graft is 10 mm in the modified Bristow procedure.

Intra-articular biomechanical environment following modified Bristow and Latarjet procedures in shoulders with large glenoid defects: relationship with postoperative complications.

BACKGROUND: Although coracoid transfers including the modified Bristow and Latarjet procedures are widely used to treat anterior shoulder instability, the influence of the choice of procedure on the biomechanical outcomes is not well characterized. We aimed to clarify the intra-articular stress distribution following these 2 procedures using 3-dimensional finite-element analysis and to investigate the role of stress distribution in the pathophysiology of postoperative complications. METHODS: Overall, 6 male patients aged 17-47 years with unilateral anterior shoulder instability were recruited. Computed tomographic digital imaging and communications in medicine (CT-DICOM) data of the contralateral (healthy) shoulder of each patient was obtained and used for developing the 3-dimensional normal glenohumeral joint model. A 25% bony defect was created in the anterior glenoid rim where the coracoid process was transferred in the standing and lying-down positions to create the Bristow and Latarjet models, respectively. The arm position was set as 0° or 90° abduction. The Young moduli of the humerus and scapula were calculated using CT data, and set as 35.0 MPa and 113.8 GPa for the articular cartilage and inserted screw, respectively. A compressive load (50 N) was applied to the greater tuberosity toward the center of the glenoid, and a tensile load (20 N) was applied to the tip of the coracoid in the direction of conjoint tendon. Elastic analysis was used to determine the equivalent stress distribution. RESULTS: A significant reduction in mean equivalent stress was observed within the glenoid cartilage for both models (P = .031); however, a new stress concentration appeared within the grafted coracoid-facing region of the humeral-head cartilage in both models. The proximal half of the coracoid graft exhibited lower equivalent stress than the distal half in 5 of the 6 Latarjet models, whereas the proximal half showed higher equivalent stress than the distal half in all 6 Bristow models. High stress concentration was identified at the midpoint of the inserted screw in Bristow models. DISCUSSION AND CONCLUSIONS: Intra-articular stress distribution may explain the different rates of postoperative complications associated with the modified Bristow and Latarjet procedures. New stress concentration within the humeral-head cartilage might contribute to the development of glenohumeral osteoarthritis following both procedures. Stress shielding in the proximal part of the coracoid graft might contribute to osteolysis following the Latarjet procedure. Surgeons should be aware of the risk of breakage of the inserted screw following the modified Bristow procedure.

Proximal-medial part in the coracoid graft demonstrates the most evident stress shielding following the Latarjet procedure: a simulation study using the 3-dimensional finite element method.

BACKGROUND: Although the osteolysis of the coracoid graft is frequently observed after the Latarjet procedure particularly in its proximal part, its pathomechanism is not well understood. METHODS: Three-dimensional finite element glenohumeral joint models were developed using CT-DICOM data of 10 normal shoulders. A 25% bony defect was created on the anterior glenoid rim, and the coracoid process was transferred flush with the glenoid cartilage using 2 half-threaded screws. In the hanging arm as well as in the 90° abducted positions, a compressive load (50 N) was applied to the greater tuberosity toward the center of the glenoid and a tensile force (20 N) was applied to the coracoid tip along the direction of the conjoint tendon. Next, elastic analysis was performed, and the distribution patterns of the equivalent stress as well as the maximum principal stress were compared among 4 parts (proximal/distal and medial/lateral) of the coracoid graft. RESULTS: Both the equivalent stress and the maximum principal stress were reduced in the proximal half of the coracoid graft. A high stress concentration was observed in the lateral aspect of the coracoid graft particularly in the 90° abducted position. The proximal-medial part demonstrated the lowest equivalent stress as well as the maximum principal stress for both arm positions, which were significantly lower than those in the distal 2 parts. CONCLUSION: In the Latarjet procedure, the proximal-medial part of the coracoid graft demonstrated the most evident stress shielding, which may play an important role in postoperative osteolysis.

Reaction of Hypercoordinate Dichlorosilanes Bearing 8-(Dimethylamino)-1-naphthyl Group(s) with Magnesium: Formation of the 1,2-Disilaacenaphthene Skeleton.

Migration of NMe(2) from C(naphthyl) to Si and Si-Si and Si-C bond formation to give a 1,2-disilaacenaphthene skeleton occurred in the reaction of hypercoordinate dichlorosilanes bearing the 8-(dimethylamino)-1-naphthyl group with two equivalents of magnesium [e.g., Eq. (a)]. The intermediate was isolated as the 1-isopropoxy derivative after quenching the reaction mixture with isopropyl alcohol.

Evaluation of the ACR-NEMA standard for communications in digital radiology.

An implementation and evaluation of a prototype multivendor communications system which complies with the American College of Radiology (ACR) and the National Electrical Manufacturers Association (NEMA) standard for communications in digital radiology is discussed. The system allows communications between interfaces from different manufacturers within a networked environment. The implementation includes network software compatible with the International Standards Organization's Open Systems Interconnect standard. The experience of the implementation effort and the evaluation of the system provide the basis for a critique of the ACR-NEMA standard. It is concluded that the ACR-NEMA standard is not well suited for application to the networked environment of picture archiving and communications systems. Two possible solutions are recommended for this problem. The first is a major revision of the existing standard. The second is the development of a family of network communications standards for digital radiology.

Optical measurement of dental cast profile and application to analysis of three-dimensional tooth movement in orthodontics.

Dental casts are frequently used for measuring the size, shape and position of a tooth. We have developed an optical apparatus for measuring a three-dimensional profile of a dental cast. The measurement is based on the triangular method which detects a laser spot on a cast by an image sensor. The apparatus is computer-controlled and designed to achieve a total measuring depth of 40 mm, a data acquisition time of 25 ms per point and a minimum scanning pitch of 0.1 mm. The depth and lateral resolutions are 0.05 and 0.1 mm, respectively, within a depth range of 25 mm. As a particular application of the apparatus, three-dimensional movement of teeth, including rotational movement, during orthodontic treatment, has been quantified by means of the superimposition of tooth profiles using a computer.