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Tibial Fractures:
 JoVE In-Press

A Rat Tibial Growth Plate Injury Model to Characterize Repair Mechanisms and Evaluate Growth Plate Regeneration Strategies

1Department of Bioengineering, Department of Orthopedics, University of Colorado Anschutz Medical Campus, 2Department of Orthopedics, University of Colorado Anschutz Medical Campus, 3Department of Chemical & Biological Engineering, Colorado School of Mines, 4Department of Orthopedics, Gates Center for Regenerative Medicine, University of Colorado Anschutz Medical Campus

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JoVE 55571

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 JoVE Medicine

Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling

1Orthopedic and Trauma Surgery, University Hospital Erlangen, 2Pediatric Surgery, University Hospital Erlangen, 3Orthopedic and Trauma Surgery, St.-Theresien Hospital, 4Institute of Anatomy I, University Erlangen-Nuremberg


JoVE 52124

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 Science Education: Essentials of Physical Examinations III

Knee Exam

JoVE Science Education

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The knee is a hinged joint that connects the femur with the tibia. It is the largest joint in the body, and due to its location in the middle of the lower leg, it is subjected to a variety of traumatic and degenerative forces. Examination of the knee can be quite complex, owing to the fact it is an inherently unstable joint held together by various ligaments and supported by menisci, which act as shock absorbers and increase the contact area of the joint. In addition, the patella lies in front of the knee, acting as a fulcrum to allow the forceful extension of the knee needed for running and kicking. As the largest sesamoid bone in the body, the knee is a common source of pain related to trauma or overuse. When examining the knee, it is important to remove enough clothing so that the entire thigh, knee, and lower leg are exposed. The exam begins with inspection and palpation of key anatomic landmarks, followed by an assessment of the patient's range of motion (ROM). The knee exam continues with tests for ligament or meniscus injury and special testing for patellofemoral dysfunction and dislocation of the patella. The opposite knee should be used as the standard to evaluate the injured knee, provided it has not been previousl

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 JoVE Medicine

Computerized Dynamic Posturography for Postural Control Assessment in Patients with Intermittent Claudication

1Discipline of Exercise and Sport Science, Faculty of Health Sciences, University of Sydney, 2Department of Sport, Health and Exercise Science, University of Hull, 3Academic Vascular Department, Hull Royal Infirmary, Hull and East Yorkshire Hospitals, 4Department of Vascular Surgery, Addenbrookes Hospital


JoVE 51077

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 JoVE Bioengineering

Training Persons with Spinal Cord Injury to Ambulate Using a Powered Exoskeleton

1Department of Veterans Affairs (VA) Rehabilitation Research and Development National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, 2Department of Veterans Affairs (VA) Spinal Cord Injury Service, James J. Peters VA Medical Center


JoVE 54071

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 Science Education: Essentials of Physical Examinations I

Peripheral Vascular Exam Using a Continuous Wave Doppler

JoVE Science Education

Source: Joseph Donroe, MD, Internal Medicine and Pediatrics, Yale School of Medicine, New Haven, CT

Peripheral vascular disease (PVD) is a common condition affecting older adults and includes disease of the peripheral arteries and veins. While the history and physical exam offer clues to its diagnosis, Doppler ultrasound has become a routine part of the bedside vascular examination. The video titled "The Peripheral Vascular Exam" gave a detailed review of the physical examination of the peripheral arterial and venous systems. This video specifically reviews the bedside assessment of peripheral arterial disease (PAD) and chronic venous insufficiency using a handheld continuous wave Doppler. The handheld Doppler (HHD) is a simple instrument that utilizes continuous transmission and reception of ultrasound (also referred to as continuous wave Doppler) to detect changes in blood velocity as it courses through a vessel. The Doppler probe contains a transmitting element that emits ultrasound and a receiving element that detects ultrasound waves (Figure 1). The emitted ultrasound is reflected off of moving blood and back to the probe at a frequency directly related to the velocity of blood flow. The reflected signal is detected and transduced to an audible sound with a frequen

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 JoVE Cancer Research

Intra-iliac Artery Injection for Efficient and Selective Modeling of Microscopic Bone Metastasis

1Lester and Sue Smith Breast Center, Baylor College of Medicine, 2Department of Molecular and Cellular Biology, Baylor College of Medicine, 3Graduate Program in Developmental Biology, Baylor College of Medicine, 4Department of Molecular and Human Genetics, Baylor College of Medicine, 5McNair Medical Institute, Baylor College of Medicine, 6Dan L. Duncan Cancer Center, Baylor College of Medicine


JoVE 53982

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 Science Education: Essentials of Emergency Medicine and Critical Care

Intraosseous Needle Placement

JoVE Science Education

Source: Julianna Jung, MD, FACEP, Associate Professor of Emergency Medicine, The Johns Hopkins University School of Medicine, Maryland, USA

For unstable patients requiring urgent administration of medications, fluids, or blood products, establishing vascular access quickly is essential. However, there are many factors that can complicate placement of a peripheral intravenous cannula (PIV), and it is extremely common for PIV attempts to fail. PIV placement may be technically challenging in small children, injection drug users, obese people, people with chronic illnesses necessitating frequent vascular access, and in those with burns and other skin conditions. Furthermore, for patients in shock, blood is shunted away from the periphery in order to compensate for impaired perfusion of vital organs, making peripheral vessels difficult to find and

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 JoVE Neuroscience

Kinematics and Ground Reaction Force Determination: A Demonstration Quantifying Locomotor Abilities of Young Adult, Middle-aged, and Geriatric Rats

1CullenWebb Animal Neurology & Ophthalmology Center, Riverview, NB, 2Department of Clinical Neurosciences, Faculty of Medicine, University of Calgary, 3Department of Comparative Biology and Experimental Medicine, University of Calgary, 4Department of Neuroscience, University of Calgary


JoVE 2138

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 JoVE Cancer Research

In Vivo Model for Testing Effect of Hypoxia on Tumor Metastasis

1Department of Biochemistry and Molecular & Cellular Biology, Georgetown University Medical Center, 2Department of Nursing, Georgetown University, School of Nursing and Health Studies, 3Department of Human Science, Georgetown University, School of Nursing and Health Studies, 4School of Medicine, Georgetown University Medical Center, 5Department of Pathology and Neuropathology, Medical University of Gdańsk, 6Department of Oncology, Georgetown University Medical Center, 7Department of Pathology, Georgetown University Medical Center


JoVE 54532

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 JoVE Medicine

Proximal Cadaveric Femur Preparation for Fracture Strength Testing and Quantitative CT-based Finite Element Analysis

1Department of Physiology and Biomedical Engineering, Mayo Clinic, 2Division of Engineering, Mayo Clinic, 3Department of Orthopedic Surgery, Mayo Clinic, 4Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign


JoVE 54925

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 Science Education: Essentials of Physical Examinations III

Motor Exam I

JoVE Science Education

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

Abnormalities in the motor function are associated with a wide range of diseases, from movement disorders and myopathies to strokes. The motor assessment starts with observation of the patient. When the patient enters the examination area, the clinician observes the patient's ability to walk unassisted and the speed and coordination while moving. Taking the patient's history provides an additional opportunity to observe for evidence of tremors or other abnormal movements, such as chorea or tardive dyskinesia. Such simple but important observations can yield valuable clues to the diagnosis and help to focus the rest of the examination. The motor assessment continues in a systematic fashion, including inspection for muscle atrophy and abnormal movements, assessment of muscle tone, muscle strength testing, and finally the examination of the muscle reflexes and coordination. The careful systematic testing of the motor system and the integration of all the findings provide insight to the level at which the motor pathway is affected, and also help the clinician to formulate the differential diagnosis and determine the course of the subsequent evaluation and treatment.

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 Science Education: Essentials of Physical Examinations III

Foot Exam

JoVE Science Education

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The foot is a complex structure composed of numerous bones and articulations. It provides flexibility, is the essential contact point needed for ambulation, and is uniquely suited to absorb shock. Because the foot must support the weight of the entire body, it is prone to injury and pain. When examining the foot, it is important to remove shoes and socks on both sides, so that the entire foot can be inspected and compared. It is important to closely compare the injured or painful foot to the uninvolved side. The essential parts of the evaluation of the foot include inspection, palpation (which should include vascular assessment), testing of the range of motion (ROM) and strength, and the neurological evaluation.

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 Science Education: Essentials of Physical Examinations III

Sensory Exam

JoVE Science Education

Source:Tracey A. Milligan, MD; Tamara B. Kaplan, MD; Neurology, Brigham and Women's/Massachusetts General Hospital, Boston, Massachusetts, USA

A complete sensory examination consists of testing primary sensory modalities as well as cortical sensory function. Primary sensory modalities include pain, temperature, light touch, vibration, and joint position sense. Sensation of the face is discussed in the videos Cranial Nerves Exam I and II, as are the special senses of smell, vision, taste, and hearing. The spinothalamic tract mediates pain and temperature information from skin to thalamus. The spinothalamic fibers decussate (cross over) 1-2 spinal nerve segments above the point of entry, then travel up to the brainstem until they synapse on various nuclei in thalamus. From the thalamus, information is then relayed to the cortical areas such as the postcentral gyrus (also known as the primary somatosensory cortex). Afferent fibers transmitting vibration and proprioception travel up to medulla in the ipsilateral posterior columns as fasciculus gracilis and fasciculus cuneatus, which carry information from the lower limbs and upper limbs, respectively. Subsequently, the afferent projections cross over and ascend to the thalamus, and from there to the primary somatosensory cortex. The pattern of a

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 JoVE Medicine

A Multicenter MRI Protocol for the Evaluation and Quantification of Deep Vein Thrombosis

1Department of Radiology, Translational and Molecular Imaging Institute, Icahn School of Medicine at Mount Sinai, 2Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, 3Daiichi Sankyo Pharma Development


JoVE 52761

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 JoVE Medicine

A Novel in vivo Gene Transfer Technique and in vitro Cell Based Assays for the Study of Bone Loss in Musculoskeletal Disorders

1Division of Rheumatology, Allergy and Clinical Immunology, University of California, Davis, 2Institute for Pediatric Regenerative Medicine, Shriners Hospitals for Children - Northern California, 3Department of Dermatology, University of California, Davis


JoVE 51810

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 Science Education: Essentials of Organic Chemistry

Degassing Liquids with Freeze-Pump-Thaw Cycling

JoVE Science Education

Source: Laboratory of Dr. Neil Branda — Simon Fraser University

Degassing refers to the process by which dissolved gases are removed from a liquid. The presence of dissolved gases such as oxygen or carbon dioxide can impede chemical reactions that utilize sensitive reagents, interfere with spectroscopic measurements, or can induce unwanted bubble formation. A number of different techniques are available for degassing liquids; some of these include heating, ultrasonic agitation, chemical removal of gases, substitution with inert gas by bubbling and freeze-pump-thaw cycling. Freeze-pump-thaw cycling is a common and effective method for small scale degassing, and will be demonstrated here in more detail.

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 Science Education: Essentials of Emergency Medicine and Critical Care

Pericardiocentesis

JoVE Science Education

Source: Rachel Liu, BAO, MBBCh, Emergency Medicine, Yale School of Medicine, New Haven, Connecticut, USA

The heart lies within the pericardium, a relatively inelastic fibrous sac. The pericardium has some compliance to stretch when fluid is slowly introduced into the pericardial space. However, rapid accumulation overwhelms pericardial ability to accommodate extra fluid. Once a critical volume is reached, intrapericardial pressure increases dramatically, compressing the right ventricle and eventually impeding the volume that enters the left ventricle. When these chambers cannot fill in diastole, stroke volume and cardiac output are diminished, leading to cardiac tamponade, a life-threatening compression of the cardiac chambers by a pericardial effusion. Unless the pressure is relieved by aspiration of pericardial fluid (pericardiocentesis), cardiac arrest is imminent. Cardiac tamponadeis a critical emergency that can carry high morbidity and mortality. Patients may present in extremis, without much time to make the diagnosis and perform life-saving treatments. Causes of this condition are broken into traumatic and non-traumatic categories, with different treatment algorithms. Stab and gunshot wounds are the primary cause of traumatic tamponade, but it may occur from blunt trauma associated with

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 JoVE Medicine

Models of Bone Metastasis

1Department of Pharmacology, Vanderbilt University, 2Vanderbilt Center for Bone Biology, Vanderbilt University, 3Department of Veterans Affairs, Tennessee Valley Healthcare System (VISN 9), 4Department of Medicine, Division of Clinical Pharmacology, Vanderbilt University, 5Department of Cancer Biology, Vanderbilt University


JoVE 4260

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 Science Education: Essentials of Physical Examinations III

Lower Back Exam

JoVE Science Education

Source: Robert E. Sallis, MD. Kaiser Permanente, Fontana, California, USA

The back is the most common source of pain in the body. Examination of the back can be a challenge due to its numerous structures, including the bones, discs, ligaments, nerves, and muscles-all of which can generate pain. Sometimes, the location of the pain can be suggestive of etiology. The essential components of the lower back exam include inspection and palpation for signs of deformity and inflammation, evaluation of the range of motion (ROM) of the back, testing the strength of the muscles innervated by the nerves exiting in the lumbar-sacral spine, neurological evaluation, and special tests (including the Stork test and Patrick's test).

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 Science Education: Essentials of Physical Examinations I

Cardiac Exam I: Inspection and Palpation

JoVE Science Education

Source: Suneel Dhand, MD, Attending Physician, Internal Medicine, Beth Israel Deaconess Medical Center

The cardiac assessment is one of the core examinations performed by almost every physician whenever encountering a patient. Disorders of the cardiac system are among the most common reasons for hospital admission, with conditions ranging from myocardial infarction to congestive heart failure. Learning a complete and thorough cardiac examination is therefore crucial for any practicing physician. If there is pathology in the heart or circulatory system, the consequences can also be manifested in other bodily areas, including the lungs, abdomen, and legs. Many physicians instinctively reach straight for their stethoscopes when performing cardiac exams. However, a large amount of information is gained before auscultation by going through the correct sequence of examination, starting with inspection and palpation.

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