Search

Surgical management of fractures has advanced with the incorporation of advanced technology, surgical techniques, and regenerative therapies, but delayed bone healing remains a clinical challenge and the prevalence of long bone nonunion ranges from 10 to 15% of surgically managed fractures. Delayed bone healing arises from a combination of mechanical, biological, and systemic factors acting on the site of tissue remodeling, and careful consideration of each case's injury-related, patient-dependent, surgical, and mechanical risk factors is key to successful bone union. In this review, we describe the biology and biomechanics of delayed bone healing, outline the known risk factors for nonunion development, and introduce modern preventative and corrective therapies targeting fracture nonunion. [ABSTRACT FROM AUTHOR]

Abstract Background Single limb support phase of the gait-cycle in patients who are treated for a pertrochanteric fracture is characterized by transversal loads acting on the lag screw, tending to block its dynamization. If the simultaneous axial force overcomes transversal loads of the sliding screw, the dynamization can still occur. Methods Biomechanical investigation was performed for three types of dynamic implants: Gamma Nail, and two types of Selfdynamizable Internal Fixators (SIF) – SIF-7 (containing two 7 mm non-cannulated sliding screws), and SIF-10 (containing one 10 mm cannulated sliding screw). Contact surface between the stem and the sliding screws is larger in SIF implants than in Gamma Nail, as the stem of Gamma Nail is hollow. A special testing device was designed for this study to provide simultaneous application of a controlled sliding screws bending moment and a controlled transversal load on sliding screws (Qt) without using of weights. Using each of the implants, axial forces required to initiate sliding screws dynamization (Qa) were applied and measured using a tensile testing machine, for several values of sliding screws bending moment. Standard least-squares method was used to present the results through the linear regression model. Results Positive correlation between Qt and Qa was confirmed (p

Background: Single limb support phase of the gait-cycle in patients who are treated for a pertrochanteric fracture is characterized by transversal loads acting on the lag screw, tending to block its dynamization. If the simultaneous axial force overcomes transversal loads of the sliding screw, the dynamization can still occur. Methods: Biomechanical investigation was performed for three types of dynamic implants: Gamma Nail, and two types of Selfdynamizable Internal Fixators (SIF) – SIF-7 (containing two 7 mm non-cannulated sliding screws), and SIF-10 (containing one 10 mm cannulated sliding screw). Contact surface between the stem and the sliding screws is larger in SIF implants than in Gamma Nail, as the stem of Gamma Nail is hollow. A special testing device was designed for this study to provide simultaneous application of a controlled sliding screws bending moment and a controlled transversal load on sliding screws (Qt) without using of weights. Using each of the implants, axial forces required to initiate sliding screws dynamization (Qa) were applied and measured using a tensile testing machine, for several values of sliding screws bending moment. Standard least-squares method was used to present the results through the linear regression model. Results: Positive correlation between Qt and Qa was confirmed (p < 0.05). While performing higher bending moments in all the tested implants, Qa was higher than it could be provided by the body weight. It was the highest in Gamma Nail, and the lowest in SIF-10. Conclusions: A larger contact surface between a sliding screw and stem results in lower forces required to initiate dynamization of a sliding screw. Patients treated for a pertrochanteric fracture by a sliding screw internal fixation who have longer femoral neck or higher body weight could have different programme of early postoperative rehabilitation than lighter patients or patients with shorter femoral neck. [ABSTRACT FROM AUTHOR]

Delayed union and non-union of fractures continue to be a major problem in trauma and orthopedic surgery. These cases are challenging for the surgeon. In addition, these patients suffer from multiple surgeries, pain and disability. Furthermore, these cases are a major burden on healthcare systems. The scientific community widely agrees that the stability of fixation plays a crucial role in determining the outcome of osteosynthesis. The extent of stabilization affects factors like fracture gap strain and fluid flow, which, in turn, influence the regenerative processes positively or negatively. Nonetheless, a growing body of literature suggests that during the fracture healing process, there exists a critical time frame where intervention can stimulate the bone's return to its original form and function. This article provides a summary of existing evidence in the literature regarding the impact of different levels of fixation stability on the strain experienced by newly forming tissues. We will also discuss the timing and nature of this “window of opportunity” and explore how current knowledge is driving the development of new technologies with design enhancements rooted in mechanobiological principles.

Copyright of Historia Regional is the property of Historia Regional and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Dynamization, that is, increasing interfragmentary movement (IFM) by reducing fixation stiffness from a rigid to a more flexible state, has been successfully used in clinical practice to promote fracture healing. However, it remains unclear how dynamization timing and degree affect bone healing of different fracture types. Finite element models of tibial fractures based on the OTA/AO classification (Simple: A1‐Spiral, A2‐Oblique, A3‐Transverse; Wedge: B2‐Spiral, B3‐Fragmented; Complex: C2‐Segment, C3‐Irregular), in combination with fuzzy logic‐based mechano‐regulatory tissue differentiation algorithms, were used to simulate the healing process when dynamization of varied degrees (dynamization coefficient or DC = 0‐0.9; 0.9 represents 90% reduction in the fixation stiffness relative to a rigid fixation) were applied at different time points after fracture. The fuzzy logic‐based algorithms have been validated with a preclinical animal model. The results showed that the healing responses of type A fractures were more sensitive to the changes in dynamization degree and timing comparing with type B or C fractures. Additionally, the optimal dynamization regime for each fracture type was different. For type A fractures, a moderate dynamization degree (e.g., DC = 0.5) applied after Week 1 promoted the recovery of biomechanical integrity. For type B and C fractures, the effective dynamization included a greater dynamization degree (DC = 0.7) applied after Week 2. Our results further demonstrated that the fracture morphology affected interfragmentary strain environments within the callus, leading to varied healing results for different fracture types. These results suggest that the effects of dynamization are highly dependent of the fracture types. Therefore, specific dynamization strategies should be chosen for different fracture types to achieve optimal healing outcomes. [ABSTRACT FROM AUTHOR]

Abstract The optimal balance between mechanical environment and biological factors is crucial for successful bone healing, as they synergistically affect bone development. Any imbalance between these factors can lead to impaired bone healing, resulting in delayed union or non-union. To address this bone healing disorder, clinicians have adopted a technique known as "dynamization" which involves modifying the stiffness properties of the fixator. This technique facilitates the establishment of a favorable mechanical and biological environment by changing a rigid fixator to a more flexible one that promotes bone healing. However, the dynamization of fixators is selective for certain types of non-union and can result in complications or failure to heal if applied to inappropriate non-unions. This review aims to summarize the indications for dynamization, as well as introduce a novel dynamic locking plate and various techniques for dynamization of fixators (intramedullary nails, steel plates, external fixators) in femur and tibial fractures. Additionally, Factors associated with the effectiveness of dynamization are explored in response to the variation in dynamization success rates seen in clinical studies.

Surgical management of fractures has advanced with the incorporation of advanced technology, surgical techniques, and regenerative therapies, but delayed bone healing remains a clinical challenge and the prevalence of long bone nonunion ranges from 10 to 15% of surgically managed fractures. Delayed bone healing arises from a combination of mechanical, biological, and systemic factors acting on the site of tissue remodeling, and careful consideration of each case’s injury-related, patient-dependent, surgical, and mechanical risk factors is key to successful bone union. In this review, we describe the biology and biomechanics of delayed bone healing, outline the known risk factors for nonunion development, and introduce modern preventative and corrective therapies targeting fracture nonunion.

Objective Dynamization of the external fixator, defined as gradually decreasing construct‐stability of the fixator, is widely accepted as a method for treatment during the late phase of the bone healing process. However, the dynamization is mostly based on the subjective experience of orthopaedists at present, without unified standards and a clear theoretical basis. The objective of the study is to investigate the influence of the dynamization operations on the tibial mechanical properties with a hexapod circular external fixator and standardize the dynamization process. Methods A 3D‐printed tibial defects model with Young's modulus of 10.5 GPa and Poisson's ratio of 0.32 simulated the clinically fractured bone. A 10 × ∅ 45 mm silicone sample with Young's modulus of 2.7 MPa and Poisson's ratio of 0.32 simulated the callus in the fracture site. Furthermore, a hexapod circular external fixator whose struts were coded from #1 to #6 was fixed on the model with six half‐pins (5 mm diameter). Corresponding to the action of removing and loosening the struts, 17 dynamization operations are designed. For each construct after different dynamization operations, the mechanical environment changes in the fracture site were recorded by a triaxle forces sensor under gradually increasing external load from 0 to 500 N. Results The results show that the bone axial load‐sharing ratio of each construct in the removal group was generally higher than that in the loosening group. The ratio increased from 92.51 ± 0.74% to 102.68 ± 0.27% with the number of operated struts rising from 2 to 6. Besides, the constructions with the same number of operated struts but with different strut codes such as constructions 3–5, had similar bone axial load‐sharing ratios. In addition, the proposed dynamization method of the hexapod circular external fixator can gradually increase the bone axial load‐sharing ratio from 90.73 ± 0.19% to 102.68 ± 0.27% and maintain the bone radial load‐sharing ratio below 8%. Conclusion The laboratory study verified the effects of the type of operations and the number of operated struts on the bone axial load‐sharing ratio, as well as the slight influence of the choice of the strut code. Besides, a dynamization method of the hexapod circular external fixator was proposed to increase the bone axial load‐sharing ratio gradually.

Background: Plate osteosynthesis for the tibial fracture is one of the alternative treatments with satisfactory outcomes. Appropriate surgical techniques, including an open or minimally invasive approach, absolute or relative stability regarding fracture characteristics, and construct stiffness, could lead to proper fracture healing. However, in some circumstances the nonunion might be a problem. The treatment of the healing disturbance is challenging as more complex procedures, such as compression plating, bone grafting, or conversion to nailing, are considered. Dynamization, which aims to optimize the rigidity of the construct, was an alternative to stimulate bone healing. Case: We present two cases of tibial nonunion following open reduction internal fixation (ORIF) with plating. The dynamization concept by percutaneously removing screws close to the fracture site to reduce fixation stiffness for appropriate relative stability, promote callus formation, and facilitate fracture healing without additional bone grafting. This simple procedure could be an alternative option in selected healing problem cases. Conclusion: These cases highlight the importance of considering fixation construct rigidity in fracture management. Too rigid fixation with a simple fracture gap or in comminuted fracture led to delayed healing. Dynamization of plating should be considered when delayed healing is related to the fixation construct's stiffness. Screw removal, as demonstrated in this case report, can be done under local anesthesia as a simple procedure to stimulate fracture healing before more complex surgical options. However, individualized analysis of nonunion causes is essential for successful bone healing.

The optimal balance between mechanical environment and biological factors is crucial for successful bone healing, as they synergistically affect bone development. Any imbalance between these factors can lead to impaired bone healing, resulting in delayed union or non-union. To address this bone healing disorder, clinicians have adopted a technique known as "dynamization" which involves modifying the stiffness properties of the fixator. This technique facilitates the establishment of a favorable mechanical and biological environment by changing a rigid fixator to a more flexible one that promotes bone healing. However, the dynamization of fixators is selective for certain types of non-union and can result in complications or failure to heal if applied to inappropriate non-unions. This review aims to summarize the indications for dynamization, as well as introduce a novel dynamic locking plate and various techniques for dynamization of fixators (intramedullary nails, steel plates, external fixators) in femur and tibial fractures. Additionally, Factors associated with the effectiveness of dynamization are explored in response to the variation in dynamization success rates seen in clinical studies. [ABSTRACT FROM AUTHOR]

Objective: Dynamization of the external fixator, defined as gradually decreasing construct‐stability of the fixator, is widely accepted as a method for treatment during the late phase of the bone healing process. However, the dynamization is mostly based on the subjective experience of orthopaedists at present, without unified standards and a clear theoretical basis. The objective of the study is to investigate the influence of the dynamization operations on the tibial mechanical properties with a hexapod circular external fixator and standardize the dynamization process. Methods: A 3D‐printed tibial defects model with Young's modulus of 10.5 GPa and Poisson's ratio of 0.32 simulated the clinically fractured bone. A 10 × ∅ 45 mm silicone sample with Young's modulus of 2.7 MPa and Poisson's ratio of 0.32 simulated the callus in the fracture site. Furthermore, a hexapod circular external fixator whose struts were coded from #1 to #6 was fixed on the model with six half‐pins (5 mm diameter). Corresponding to the action of removing and loosening the struts, 17 dynamization operations are designed. For each construct after different dynamization operations, the mechanical environment changes in the fracture site were recorded by a triaxle forces sensor under gradually increasing external load from 0 to 500 N. Results: The results show that the bone axial load‐sharing ratio of each construct in the removal group was generally higher than that in the loosening group. The ratio increased from 92.51 ± 0.74% to 102.68 ± 0.27% with the number of operated struts rising from 2 to 6. Besides, the constructions with the same number of operated struts but with different strut codes such as constructions 3–5, had similar bone axial load‐sharing ratios. In addition, the proposed dynamization method of the hexapod circular external fixator can gradually increase the bone axial load‐sharing ratio from 90.73 ± 0.19% to 102.68 ± 0.27% and maintain the bone radial load‐sharing ratio below 8%. Conclusion: The laboratory study verified the effects of the type of operations and the number of operated struts on the bone axial load‐sharing ratio, as well as the slight influence of the choice of the strut code. Besides, a dynamization method of the hexapod circular external fixator was proposed to increase the bone axial load‐sharing ratio gradually. [ABSTRACT FROM AUTHOR]

Background Compounds from vegetal matter have therapeutic potential to control highly prevalent microorganisms that are resistant to commonly used antimicrobial drugs. Dynamization of compounds can either maintain or improve their therapeutic effects, and make their use safer, especially those compounds whose therapeutic dose is close to the toxic limit. Aloysia polystachya (Griseb.) stands out among aromatic plants with antimicrobial potential. Objective The aim of this study was to evaluate the antimicrobial activity of dynamized and crude forms of A. polystachya essential oil against Candida albicans , Escherichia coli and Staphylococcus aureus. Methods Essential oil was extracted from A. polystachya dry leaves, solubilized, and dynamized at 1 cH potency as recommended by the Brazilian Homeopathic Pharmacopoeia. Antimicrobial activity against C. albicans , E. coli and S. aureus of the samples was assayed using the plate microdilution method. Results Dynamized A. polystachya essential oil at the concentration of 1 μg/mL inhibited the growth of all the microbial species analyzed. The minimum inhibitory concentration of dynamized essential oil was smaller than crude essential oil for S. aureus , E. coli and C. albicans. Conclusion It is reported for the first time that A. polystachya dynamized essential oil can effectively suppress microbial growth, and it is a promising adjuvant to treat infections with pathogenic S. aureus , E. coli and C. albicans. [ABSTRACT FROM AUTHOR]

The pertinence dative constitutes one of the peripheral uses of the dative phrase in German. As a combinatorial case in connection with an accusative or directive complement, it conveys a possessor-possessum relation. On the basis of peripheral verbs, the weather verbs, it will be shown that this combinatorial case, which is used to express motion towards a living being, is quite characteristic of this verb group, both in the inherent meaning of the lexeme and in the meaning caused by metaphorical reinterpretations of the lexeme. After a brief overview of descriptions of the PD in the relevant literature, its occurrence in constructions with weather verbs is subjected to a more detailed analysis. The metaphorical reinterpretations are related, among other things, to the interpretation of precipitation verbs and verbs of air movement as verbs of motion, and accordingly, the interpretation of thunderstorm verbs as verbs of noise.

El Centro de Recursos, Interpretación y Estudios de la Escuela (CRIEME) de Polanco, además de dedicarse a la recuperación y registro del patrimonio escolar de Cantabria, pone un especial énfasis en su divulgación y en el aprovechamiento de sus exposiciones y proyectos como herramienta didáctica. El centro está especialmente dirigido al alumnado de la Comunidad Autónoma de Cantabria y la mayor parte de las actividades están orientadas a este tipo de público. El CRIEME, además de desarrollar una labor didáctica en el propio centro, abre también sus puertas para colaborar en otros lugares, principalmente en centros educativos de la comunidad. Creemos que la labor de sensibilización y concienciación en el cuidado y respeto de nuestro patrimonio en los más pequeños será un aval para su conservación en el futuro y un valor en la formación de las siguientes generaciones.

Study Design Clinical case series. Purpose This study aimed to report dynamization–posterior lumbar interbody fusion (PLIF), our surgical treatment for hemodialysis-related spondyloarthropathy (HSA), and investigate patients’ postoperative course within 2 years. Overview of Literature HSA often requires lumbar fusion surgery. Conventional PLIF for HSA may cause progressive destructive changes in the vertebral endplate, leading to progressive cage subsidence, pedicle screw loosening, and pseudoarthrosis. A dynamic stabilization system might be effective in patients with a poor bone quality. Thus, we performed “dynamization–PLIF” in hemodialysis patients with destructive vertebral endplate changes. Methods We retrospectively examined patients with HSA who underwent dynamization–PLIF at our hospital between April 2010 and March 2018. The radiographic measurements included lumbar lordosis and local lordosis in the fused segment. The evaluation points were before surgery, immediately after surgery, 1 year after surgery, and 2 years after surgery. The preoperative and postoperative radiographic findings were compared using a paired t-test. A p-value of less than 0.05 was considered significant. Results We included 50 patients (28 males, 22 females). Lumbar lordosis and local lordosis were significantly improved through dynamization–PLIF (lumbar lordosis, 28.4°–35.5°; local lordosis, 2.7°–12.8°; p

Aims: The timing of when to remove a circular frame is crucial; early removal results in refracture or deformity, while late removal increases the patient morbidity and delay in return to work. This study was designed to assess the effectiveness of a staged reloading protocol. We report the incidence of mechanical failure following both single-stage and two stage reloading protocols and analyze the associated risk factors. Methods: We identified consecutive patients from our departmental database. Both trauma and elective cases were included, of all ages, frame types, and pathologies who underwent circular frame treatment. Our protocol is either a single-stage or two-stage process implemented by defunctioning the frame, in order to progressively increase the weightbearing load through the bone, and promote full loading prior to frame removal. Before progression, through the process we monitor patients for any increase in pain and assess radiographs for deformity or refracture. Results: There were 244 frames (230 patients) included in the analyses, of which 90 were Ilizarov type frames and 154 were hexapods. There were 149 frames which underwent single-stage reloading and 95 frames which underwent a two-stage reloading protocol. Mechanical failure occurred after frame removal in 13 frames (5%), which suffered refracture. There were no cases of change in alignment. There was no difference between refracture patients who underwent single-stage or two-stage reloading protocols (p = 0.772). In all, 14 patients had failure prevented through identification with the reloading protocol. Conclusion: Our reloading protocol is a simple and effective way to confirm the timing of frame removal and minimize the rate of mechanical failure. Similar failure rates occurred between patients undergoing single-stage and two-stage reloading protocols. If the surgeon is confident with clinical and radiological assessment, it may be possible to progress directly to stage two and decrease frame time and patient morbidity. Cite this article: Bone Jt Open 2022;3(5):359–366.

Background: Homeopathy is highly controversial. The main reason for this is its use of very highly dilute medicines (high homeopathic potencies, HHP), diluted beyond the Avogadro/Loschmidt limit. Research using Nano Tracking Analysis has demonstrated the presence of particles in HHPs. This study aims to verify the results of a previous publication that identified the ionic composition of these particles in all dilutions. Methods: We used Scanning Electron Microscopy & Energy Dispersive X-Ray Spectroscopy (SEM-EDX) to examine dilutions of a commonly used homeopathic medicine, an insoluble metal, Cuprum metallicum, for the presence of particles (NPs). The homeopathic medicines tested were specially prepared according to the European pharmacopoeia standards. We compared the homeopathic dilutions/dynamizations of copper with simple dilutions and dynamized lactose controls. Results: We observed an ionic diversity common to all preparations including HHPs but also significant differences in the relative quantity of each ion between manufacturing lines of homeopathic copper and lactose controls. The probability that the observed differences could have occurred chance alone (especially above Avogadro limit) can be rejected at p < 0.001. The essential component of these homeopathic medicines is sodium hydrogen carbonate, modulated by some other elements and by its quantity, size and shape. Conclusion: Homeopathic medicines made of Cuprum metallicum do contain material with a specific ionic composition even in HHPs diluted beyond the Avogadro/Loschmidt limit. This specificity can be attributed to the manufacturing process. This material demonstrates that the step-by-step process (dynamized or not) does not match the theoretical expectations of a dilution process. The starting material and dilution/dynamization method influences the nature of these NPs. Further measurements are needed on other raw materials using the same controls (solvent and simply diluted manufacturing lines) to support these findings. The role of sodium bicarbonate must be carefully studied in the future. [ABSTRACT FROM AUTHOR]

Copyright of Linguistische Treffen in Wrocław is the property of Oficyna Wydawnicza ATUT and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

to assess the small-scale 3D printing feasibility and cost estimation of a device for controlled dynamization. The two-part device previously developed by our research group was printed with a carbon fiber-reinforced nylon filament (Gen3 CarbonX™ PA6+CF, 3DXTECH Additive Manufacturing) by a professional 3D printer (FUNMAT HT, Intamsys). Electricity, material, and labor costs for production in a Brazilian city in the Santa Catarina state were calculated. The devices for controlled dynamization were successfully printed in accordance with the planned design and dimensions. Six out of 38 printed devices presented defects in the bolt hole and were discarded. The average printing time per device was 1.9 h. The average electricity, material, and labor costs per printed device were respectively US$0.71, US$13.55, and US$3.04. The total production cost per device reaches approximately US$20 by adding the average cost of defective devices (15 %). 3D printing of the controlled dynamization device is feasible and its cost seems affordable to most healthcare services, which could optimize the consolidation of diaphyseal fractures and reduce treatment time for patients. [ABSTRACT FROM AUTHOR]

Objective: Dynamization has already been described as a secondary intervention for delay unions of tibial shaft fractures treated with intramedullary nailing. Although it's a common procedure, it is not widely supported in the literature. The purpose of this study was to determine the union rate of nail dynamization in cases of delayed union of diaphyseal tibial fractures, and assess the effect of fracture morphology on union rates. Materials and methods: We retrospectively analyzed a series of 199 consecutive tibial shaft fractures. We recorded the dynamization rate, period from nailing to dynamization, nailing to the union, the fracture pattern (according to AO/ASIF and whether it was closed or open), the callus diameter before dynamization (fracture healing index; FHI) and union/failure rates. Results: Out of a total of 199 fractures treated during the study period, 41 (20.6%) were dynamized. After applying inclusion and exclusion criteria, 39 patients with 39 fractures were included in the study. The mean time from nailing to dynamization was 18.4 ± 7.2 weeks. The union rate was 92.3% (n = 36) over a mean time of 14.1 ± 5.6 weeks as from dynamization. The overall failure rate was 6.7% (n = 3). There was no significant association between failure and AO/ASIF classification (p > 0.05) or fracture exposure (X2 = 0.19; p = 0.66). The pre-dynamization FHI of ≥ 1.17 was significantly associated with consolidation (p < 0.05). Conclusion: In cases of delayed union of tibial fractures, dynamization offered a high union rate associated with pre-dynamization FHI, while fracture morphology did not affect the failure rate. [ABSTRACT FROM AUTHOR]

Dynamization, increasing the interfragmentary movement (IFM) by reducing the fixation stiffness from a rigid to a more flexible condition, is widely used clinically to promote fracture healing. However, it remains unknown how dynamization degree (relative change in fixation stiffness/IFM from a rigid to a flexible fixation) affects bone healing at various stages. To address this issue, we used a fuzzy logic‐based mechano‐regulated tissue differentiation algorithm on published experimental data from a sheep osteotomy healing model. We applied a varied degree of dynamization, from 0 (fully rigid fixation) to 0.9 (90% reduction in stiffness relative to the rigid fixation) after 1, 2, 3, and 4 weeks of osteotomy (R1wF, R2wF, R3wF, and R4wF) and computationally evaluated bone regeneration and biomechanical integrity over the healing process of 8 weeks. Compared with the constant rigid fixation, early dynamization (R1wF and R2wF) led to delays in bone bridging and biomechanical recovery of the osteotomized bone. However, the effect of early dynamization on healing was dependent of the degree of dynamization. Specifically, a higher dynamization degree (e.g., 0.9 for R1wF) led to a prolonged delay in bone bridging and largely unrecovered bending stiffness (48% relative to the intact bone), whereas a moderate degree of dynamization (e.g., 0.5 or 0.7) significantly enhanced bone formation and biomechanical properties of the osteotomized bone. These results suggest that dynamization degree and timing interactively affect the healing process. A combination of early dynamization with a moderate degree could enhance the ultimate biomechanical recovery of the fractured bone. [ABSTRACT FROM AUTHOR]

State-induced components constitute the major share of electricity prices for consumers and are generally charged at a fixed rate. We analyze the benefits of charging state-induced price components at time-varying rates instead, especially with regard to the integration of variable renewable energy (VRE) sources and to decarbonization. For this purpose, we apply a detailed power market model that puts particular emphasis on electricity demand and how it is sensitive to prices. For a quantitative case study, the model is parametrized to represent a German energy system with an 85% share of renewables in its power generation. We find that dynamization has a reducing effect on integration costs of VRE, ranging from 0.3 to 3.4 €/MWh. Furthermore, strong distributional effects in favor of flexible consumers can be observed. [ABSTRACT FROM AUTHOR]

Dynamization of fixation has long been used as a strategy to promote fracture healing. Which clinical scenarios would benefit from dynamization, how and when to introduce it and its effectiveness remains to be elucidated. A systematic review of the literature reporting on the use of dynamization in fracture healing using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis was conducted. The primary outcome was time to union and union rate of fractures across all anatomical sites, including adult and pediatric populations. A total of 19 studies fulfilled the inclusion criteria of which 14 studies evaluated the use of dynamization using intramedullary nails, while five studies evaluated external fixator dynamization. The diversity of dynamization strategies, variation in timing of dynamization and contradictory results precludes definitive conclusions. Further research is needed before recommendations for the use of dynamization to improve fracture healing can be considered.

Delayed union and non-union of fractures continue to be a major problem in trauma and orthopedic surgery. These cases are challenging for the surgeon. In addition, these patients suffer from multiple surgeries, pain and disability. Furthermore, these cases are a major burden on healthcare systems. The scientific community widely agrees that the stability of fixation plays a crucial role in determining the outcome of osteosynthesis. The extent of stabilization affects factors like fracture gap strain and fluid flow, which, in turn, influence the regenerative processes positively or negatively. Nonetheless, a growing body of literature suggests that during the fracture healing process, there exists a critical time frame where intervention can stimulate the bone's return to its original form and function. This article provides a summary of existing evidence in the literature regarding the impact of different levels of fixation stability on the strain experienced by newly forming tissues. We will also discuss the timing and nature of this "window of opportunity" and explore how current knowledge is driving the development of new technologies with design enhancements rooted in mechanobiological principles., Competing Interests: SB is employed and has shares of Biomech Innovations. DW and MP are part of the, non-financially compensated, Biomech Innovations scientific advisory board. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Wähnert, Miersbach, Colcuc, Brianza, Vordemvenne, Plecko and Schwarz.)

Background: Homeopathy is highly controversial. The main reason for this is the highly diluted medicines (high homeopathic potencies, HHP), diluted beyond the Avogadro/Loschmidt limit. Research using several different methods has demonstrated the presence of particles, including nanoparticles of source material, in HHPs. This study aims to verify the results of a previous publication that detected the presence of particles in all dilutions. Methods: We used the Nano Tracking Analyzer (NTA) to examine dilutions of a commonly used homeopathic medicine, an insoluble metal, Cuprum metallicum, for the presence of particles. The homeopathic medicines tested were specially prepared according to the European pharmacopeia standards. We compared the homeopathic dilutions/dynamizations with simple dilutions and controls, including a soluble medicine. Results: We observed the presence of solid material in all preparations, including HHPs (except for pure water). The measurements showed significant differences in particle sizes distribution between homeopathic manufacturing lines and controls. The probability that the observed differences could have occurred just by random chance can be rejected p < 0,001 (even above Avogadro limit p < 0,01). Conclusion: The homeopathic medicines Cuprum metallicum contain material with a specific size distribution even in HHPs diluted beyond the Avogadro/Loschmidt limit. This specificity can be attributed to the manufacturing and potentization process. This material demonstrates that the step-by-step process (dynamized or not) does not match the theoretical expectations in a dilution process. The starting material and dilution/dynamization method influence the nature and concentration of these NPs. Further measurements are needed on other raw materials using the same controls (solvent and simply diluted manufacturing lines) to support these findings. [ABSTRACT FROM AUTHOR]

Purpose: To summarize the evolution of intramedullary nailing, highlight important milestones, introduce the atmosphere of the era concerning the first uses and development of intramedullary nailing, and present the status of nailing in modern international orthopaedics and traumatology. Method: A thorough literature search was undertaken in PubMed and Google Scholar as well as in physical books in libraries to summarize the literature on the history and evolution of intramedullary nailing. Results: The first use of an intramedullary device was attested in ancient Egypt; however, the first use of intramedullary nailing was reported in 1524 in Mexico, and the first medical journals reported on intramedullary nailing around the mid-1800s. The evolutions of intramedullary nailing including approach, material, cross-section and shape, and reaming technique occurred in the twentieth century. During the 1960s, intramedullary nailing was abandoned in favour of plate and screws osteosynthesis; however, in the 1970s, 1980s, and 1990s, a surge of novelties including flexible reaming, interlocking, and use of image intensification and titanium nails led to the advent of the second-generation intramedullary nailing. Today, intramedullary nailing has become the standard treatment of long bone fractures with low infection rates, small scars, excellent stabilization of the fractures, and immediate mobilization of the patients. Conclusion: Intramedullary nailing has revolutionized the treatment of long bone fractures. However, with numerous nail designs, a lot of information on their efficacy is lacking. Considerably more work will need to be done to determine the optimal nail specifications. [ABSTRACT FROM AUTHOR]

Background  Nuclear magnetic resonance (NMR) proton relaxation is sensitive to the dynamics of the water molecule, H 2 O, through the interaction of the spin of the proton (1 H) with external magnetic and electromagnetic fields. NMR relaxation times describe how quickly the spin of 1 H, forced in a direction by an external electromagnetic field, returns to a normal resting position. As a result, such measurements allow us potentially to describe higher structuring of water in homeopathic medicines. Objective  The purpose of the present study was to verify whether specific NMR relaxation times could be measured in full lines of cH dynamizations of a metal (copper) and of a plant substance (Gelsemium sempervirens), compared with a solvent control, a potentized lactose control and a control prepared by simple dilution, in three production lines. It is aimed at verification of a previous publication (2017) on two new manufacturing lines of the same starting material and controls. Materials and Methods  To monitor dilution and potentization processes, measurements of 1 H spin-lattice T1 and spin-spin T2 relaxation times were used. T1 and T2 relaxation times were measured at 25°C with a spin analyser working at a frequency of 20 MHz. To account for its possible role as a confounding factor, free oxygen was also measured in all samples, using a MicroOptode meter. Results  When the values of the three production lines were pooled, a statistically significant discrimination of NMR relaxation times between the medicines and their controls was confirmed. We found for copper cH and Gelsemium sempervirens cH a highly significant influence of the starting material (p  = 0.008), a highly significant influence of level of dilution (p  < 0.001), and a significant influence of the O 2 concentration (p  = 0.04). Conclusions  We have evidence of an obvious retention of a specific magnetic resonance signal when a substance (lactose, copper, Gelsemium) is diluted/potentized in pure water. This means that homeopathic solutions cannot be considered to be pure water. O 2 is a covariant and not an explanatory variable: this factor itself is too weak to explain the NMR signal specificities in potentized samples. Homeopathic dilutions may thus have a specific material configuration governed not only by the potentized substance but also by the chemical nature of the containers, the chemical nature of dissolved gases and even by the electromagnetic environment. This sensitivity of homeopathically prepared medicines to electromagnetic fields may be amplified by the processes routinely applied during their preparation; because it occurs only when a dynamization has been performed, we may call this phenomenon "dynamic pharmacy". [ABSTRACT FROM AUTHOR]

Context: The field of deformity correction with external fixation has continued to advance since with the addition of half-pins, even though they can act to stiffen the construct and undermine healing. Dynamization increases axial motion at the fracture site and improves fracture and osteotomy healing in the experimental and clinical studies. No study compares the lateral and vertical displacements of bone segment in dynamized versus nondynamized frames. Aims: The purpose of this study was to compare the segmentary motion in the axial, coronal, and sagittal planes using nondynamized and dynamized circular external fixation frames. Subjects and Methods: Seven frame models were tested including classic Ilizarov three-wire construct and two frame configurations representing the most common modern half-pin and wire combinations. These models were either nondynamized or dynamized with two types of dynamization modules. Each model underwent axial loading up to 50 kg for 11 cycles. Statistical Analysis Used: One-way analysis of variance testing followed by post hoc Tukey's test. Results: The addition of each half pin sequentially decreased axial motion while increased sagittal motion. Dynamization had a limited effect on the sagittal motion but significantly improved axial motion. The sagittal to axial motion ratio increased with half pins in nondynamized frames but decreased equal to or beyond the Ilizarov three-wire fixation frame with dynamization. At the limit of the dynamizers' motion, there was change in the rate of displacement, suggesting that subsequent motion was strictly from the wires and half-pins. Overall, there was minimal coronal motion. Conclusions: While half pins decrease axial micromotion and increase detrimental sagittal motion, dynamization restores. [ABSTRACT FROM AUTHOR]

The article studies the problems associated with the functioning of traditional motifs in Mikhail Lermontov’s youthful poetry, which undergo changes gradually and persistently while being entirely consistent with the author’s personal task. The motifs of suffering, pilgrimage, fate, life and death, which are well-known in romantic poetry, when included in the associative area of the verbal context, become subject to the dynamism principle and acquire new meanings, which are understandable and productive only in the artistic world of a Russian poet. The article provides a structural-semantic analysis of “Azrail” and “The Angel of Death” poems built on the binary “life and death” opposition, which is creatively interpreted by Lermontov.

Openness is an expression of an enterprise’s ability to adapt to changing environment conditions and its ability to cooperate with different types of partners. A given company’s openness shows its readiness for the creation of dynamics of many business processes, including the creation of its competitive advantage. Due to the nature of today’s enterprises’ environment, mainly its “high velocity” & “complexity” attributes, openness of companies has to be multifaceted. Organization-customer relationships, called co-creation, are one of such facets. The capacity for effective co-creation gives a company the ability to gain a competitive advantage along with the chance for its permanent dynamization and sustainability. The main purpose of the paper is to present the framework and algorithm of co-creation as a method of reducing the complexity of the environment and dynamizing companies’ competitive advantages. A review of literature in the areas of open organization, open culture, partnership, co-creation, and competitive advantage provides a basis for understanding the process of co-creation. Collected data show that the activity of enterprises in this process is a key factor in the reduction of complexity of a company’s environment and an important stimulator of the dynamization of a company’s competitive advantage. The authors’ own CATI questionnaire survey research conducted in Poland showed the level of preparation Polish SMEs have to co-create.

Introduction/Objective. Subtrochanteric fractures are unstable, tending to a varus, antecurvatum, and shortening deformity. The aim of this paper was to compare operation time and fluoroscopy time between different internal fixation methods in the treatment of subtrochanteric fractures. Method. The prospective study of the group of 27 patients with a subtrochanteric fracture treated by the SIF (selfdynamisable internal fixator with a trochanteric unit) method had been done. Operation time and fluoroscopy time values from this group were compared to the same parameters data from the literature for intramedullary (IM) nails, proximal femur locking plates (PF-LCP), dynamic condylar screws (DCS), and the 95°-angled blade plate. Results. In the SIF group, operation time was 62.2 (25–140) minutes and fluoroscopy time was 43 (20–95) s. Average operation time from the literature data was: 102.1 (43–181) minutes for IM nail, 94.2 (75–129) minutes for PF-LCP, 105.3 (70–166) minutes for DCS and 221.5 (171–272) minutes for blade plate. Average fluoroscopy time from the literature data was: 109.6 (34–250) seconds for IM nail, 102.3 (47–180) seconds for PF-LCP, 238 seconds for DCS. Operation time and intraoperative fluoroscopy time were higher in IM nail, PF-LCP, DCS and blade plate comparing to SIF method (p < 0.05). Conclusion. The above mentioned difference could be explained by a degree of required accuracy in the initial operative technique maneuvers, by used number of screws and by the type of the fracture reduction performance in different fixation methods. Operation time during IM nailing of subtrochanteric fractures sometimes can be shorter than average operation time in SIF method, what could be explained by the skill of the surgeon to perform as fast closed reduction for insertion of guide wire. [Project of the Serbian Ministry of Education, Science and Technological Development, Grant no. III41017: Virtual human osteoarticular system and its application in preclinical and clinical practice]

Introduction: The objective of this study was to find the outcome of interlocking nail in fracture tibia. Methods: This study was conducted in the Department of Orthopaedic Surgery in SMS and R, Sharda University, from December 2010 to December 2015. Two hundred and seventy-eight patients were recruited from emergency and outpatient department having closed fracture of tibial shaft. The clinical results of our study were rated on the basis of the criteria of union, nonunion, delayed union, or malunion. All patients were operated under general or spinal anesthesia. All patients were followed for 9 months. Results: Nearly 86.33% (240/278) patients had union in 90–150 days with a mean of 110.68. Union was achieved in 10.07% (28/278) patients in 95–109 days with a mean of 103.38. About 9.35% (26/278) had delayed unions and 4.31% (12/278) had nonunion which were treated with dynamization and bone graft. The results were excellent in 86.33% (240/278) and good in 9.35% (26/278) patients. All of our patients had full range of motion of their knees and ankles. Conclusion: We concluded that this technique is advantageous because of early mobilization (early weight-bearing) and less complication with good results and is economical.

World views and forms of human interaction, which can be included in the modern globalism, pose challenges not only for scientific disciplines such as political science or sociology, but also for language and media studies. If one wants to do justice to the global perspective that has become increasingly necessary due to social and cultural developments in these disciplines, the first thing to do in linguistic and media studies is to redefine the subject of study and possibly to expand it. This study takes into consideration new perspectives that give fresh impulses to the debates on genre canon formation and genre canon revision, which have been virulent in diverse formats of public communication. Dynamization and hybridity of media genres as well as the genre spectrum of modern media are presented in the paper as a scalable model that supports systematic and nuanced distinctions between degrees of generic blending. Accordingly contemporary media offer rich text material for developing such a model. The media texts indicate a clear tendency towards mixing of diverse media strategies. It will be also emphasized that this tendency, based on a distinct genres awareness, has been numerously documented in media texts in the recent years. The current revival of genre oriented and media generated text styles, at one hand, represent forms that merge genre attributes and blur the lines between them. The other extreme covers the motley bulk of media texts and makes their distinctive generic elements clearly recognizable, e.g. allows to follow hypothetic text changes from one genre to another. In the conditions of dynamization and hybridization media texts are challenged for the reader as a very complex arrangement of levels, settings and formats. They all perform an overriding unity of mental activity and reflections containing complex and amalgamated generic elements. [ABSTRACT FROM AUTHOR]

Copyright of Revue Internationale PME is the property of Institue de Recherche sur les PME and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Libraries have played a fundamental role in the dissemination of knowledge for centuries, assuming conservation, dissemination and revitalization functions among society. The emergence of digital publishing technologies, caused a change of model in the patterns of reader consumption and raised the debate of the usefulness of libraries. Given this perspective, the Nubeteca project arises, sponsored by the Germán Sánchez Ruipérez Foundation and the Badajoz Provincial Council, as a model of the physical and digital integration system, to turn libraries into the meeting point of two converging ecosystems. The objective of this article is the description of this research project, articulating a proposal for future development. [ABSTRACT FROM AUTHOR]

One-dimensional range queries, as one of the most basic type of queries in databases, have been studied extensively in the literature. For large databases, the goal is to build an external index that is optimized for disk block accesses (or I/Os). The problem is well understood in the static case. Theoretically, there exists an index of linear size that can answer a range query in O( Due to image rights restrictions, multiple line equation(s) cannot be graphically displayed ) I/Os, where K is the output size and B is the disk block size, but it is highly impractical. In practice, the standard solution is the B-tree, which answers a query in O(log Due to image rights restrictions, multiple line equation(s) cannot be graphically displayed ) I/Os on a data set of size N, where M is the main memory size. For typical values of N,M, and B, log Due to image rights restrictions, multiple line equation(s) cannot be graphically displayed can be considered a constant. However, the problem is still wide open in the dynamic setting, when insertions and deletions of records are to be supported. With smart buffering, it is possible to speed up updates significantly to o(1) I/Os amortized. Indeed, several dynamic B-trees have been proposed, but they all cause certain levels of degradation in the query performance, with the most interesting tradeoff point at O(Due to image rights restrictions, multiple line equation(s) cannot be graphically displayed ) I/Os for updates and O(Due to image rights restrictions, multiple line equation(s) cannot be graphically displayed ) I/Os for queries. In this article, we prove that the query-update tradeoffs of all the known dynamic B-trees are optimal, when log Due to image rights restrictions, multiple line equation(s) cannot be graphically displayed is a constant. This implies that one should not hope for substantially better solutions for all practical values of the parameters. Our lower bounds hold in a dynamic version of the indexability model, which is of independent interests. Dynamic indexability is a clean yet powerful model for studying dynamic indexing problems, and can potentially lead to more interesting lower bound results. [ABSTRACT FROM AUTHOR]

• Lateral cortical notching was developed for blocked dynamization of proximalemoral nailing despite removal of distal interlocking. • Finite element analysis of lateral cortical notching in combination with distal dynamization in proximal femoral nailing. • Lateral cortical notching promotes gliding of intramedullary nails along the femoral shaft axis in inter-/subtrochanteric fractures. • Von Mises stress is reduced or unvaried at most sites of the bone/implant interface reducing the risk for implant failure/peri‑implant fractures. • Lateral cortical notching in combination with distal dynamization can be efficient to treat nonunions of inter-/subtrochanteric fractures. Dynamization of proximal femoral nailing by removal of distal interlocking is one of the recommended treatment options for nonunions of femur fractures. However, in certain inter-/subtrochanteric fractures, gliding of the nail along the femoral shaft is blocked by lateral femoral cortical support of the lag screw. For these cases, Biber et al. proposed lateral cortical notching (LCN), in which the supporting lateral bone is removed. This study investigates the biomechanical effect of LCN on gliding of proximal femoral nailing and stress distribution at the bone/implant interface. In this finite element analysis a three-dimensional model of an unstable intertrochanteric fracture with proximal femoral nailing without distal interlocking was simulated using the FebioStudio software suite. To simulate LCN, the lag screw hole was lengthened to 15.34 mm at the lateral cortex. Displacement of the nail along the femoral shaft axis and von Mises stress distribution were compared between LCN model and standard implantation model. Displacement of the nail along the femoral shaft axis was higher in the LCN model than in the standard implantation model (0.48 mm vs. 0.07 mm). Highest von Mises stresses of 176–178 MPa at the implant and of 52–81 MPa at the proximal femur were detected. Maximum von Mises stresses of the implant were comparable at all sides, except for a reduced von Mises stress at the lateral inferior side in the LCN model (80 vs. 102 MPa). At the inferior lateral screw hole and the anterior/posterior lateral screw hole maximum von Mises stress was reduced in the LCN model (2 vs. 49 MPa and 52 vs. 81 MPa), whereas the maximum von Mises stress at the inferior medial screw hole was higher in the LCN model than in the standard implantation model (53 vs. 27 MPa). Lateral cortical notching facilitates gliding of a distally dynamized proximal femoral nail along the femoral shaft axis in intertrochanteric fractures. Additionally, the lack of lateral cortical bone support at the lag screw reduces von Mises stress at the bone/implant interface and thus could lower the risk for implant breakage and peri‑implant fractures. [ABSTRACT FROM AUTHOR]