Classification of Joints

Int. J. Med. Sci. 2009, 6 http://www.medsci.org 227IInntteerrnnaattiioonnaall JJoouurrnnaall ooff MMeeddiiccaall SScciieenncceess 2009; 6(5):227-233 © Ivyspring International Publisher. All rights reserved Review Classification of hip joint infections Konstantinos Anagnostakos 1 , Nora Verena Schmid 1, Jens Kelm 1,2, Ulrich Grün 1, Jochen Jung 1 1. Klinik für Orthopädie und Orthopädische Chirurgie, Universitätskliniken des Saarlandes, Homburg/Saar, Germany 2. Chirurgisch-Orthopädisches Zentrum Illingen/Saar, Germany  Correspondence to: Dr. Konstantinos Anagnostakos, Klinik für Orthopädie und Orthopädische Chirurgie, Univer-sitätskliniken des Saarlandes, Kirrbergerstr. 1, D-66421, Homburg/Saar, Germany. Tel.: 0049-6841-1624520; Fax: 0049-6841-1624516; e-mail: k.anagnostakos@web.de Received: 2009.07.01; Accepted: 2009.08.28; Published: 2009.09.01 Abstract Infections still remain one of the most devastating complications in hip joint surgery. Classi-fication of these infections help the orthopaedic surgeon to identify the acuteness or chronicity of the infection, predict the complexity of the treatment procedure and ensure that all necessary device are available at the time of the revision surgery. The present article reviews the actual literature and provides an overview of clinical, arthroscopic, microbi-ological and radiological staging systems. Key words: hip joint infection, early infection, late infection, low-grade infection Introduction Approximately 170,000 primary total hip ar-throplasties are performed in Germany annually [10]. Despite numerous prophylactic measures infections still occur in 1-2 % of these cases, whereas this rate may increase after revision surgery [1]. This means that between 1000 and 2500 patients per year will be-come infected. Similar figures are reported in the United States [16]. Moreover, the overall infection rate is likely to increase as the life expectancy of the im-plants is increased and patients are followed up longer. Depending on the time of infection manifesta-tion, presence of any hardware, virulence and antibi-otic profile of the pathogen organism, and the general medical condition of the patient, several treatment options are available including both one- and two-stage procedures. These infections require often demanding man-agement procedures which can be associated with prolonged and complicated treatment courses. Clas-sification of hip joint infections allows the orthopaedic surgeon not only to define the actual status of the in-fected joint, but also choose the most adequate treat-ment option, plan the prosthesis reimplantation in case of a hardware explantation and make any state-ments regarding the prognosis. In this review article, the current status about classification of hip joint infections is presented. Classification of hip joint infections The major aim of a classification system for hip joint infections is to help the orthopaedic surgeon identify the acuteness or chronicity of the infection, predict the complexity of the treatment procedure and ensure that all necessary devices are available at the time of the first revision surgery as well as of further surgical interventions, if necessary. Moreover, a clas-sification system should also permit a valid and reli-able comparison of results from similar case mixes. However, due to a variety of different classification systems, there is currently no consensus as to which system is the most appropriate in reflecting the actual severity of the infection, determining the femoral or acetabular bone defects or choosing the ideal treat-ment procedure. Generally, hip joint infections can be divided into primary (e.g. Classification of Joints Classification of Joints Bởi: OpenStaxCollege A joint, also called an articulation, is any place where adjacent bones or bone and cartilage come together (articulate with each other) to form a connection Joints are classified both structurally and functionally Structural classifications of joints take into account whether the adjacent bones are strongly anchored to each other by fibrous connective tissue or cartilage, or whether the adjacent bones articulate with each other within a fluid-filled space called a joint cavity Functional classifications describe the degree of movement available between the bones, ranging from immobile, to slightly mobile, to freely moveable joints The amount of movement available at a particular joint of the body is related to the functional requirements for that joint Thus immobile or slightly moveable joints serve to protect internal organs, give stability to the body, and allow for limited body movement In contrast, freely moveable joints allow for much more extensive movements of the body and limbs Structural Classification of Joints The structural classification of joints is based on whether the articulating surfaces of the adjacent bones are directly connected by fibrous connective tissue or cartilage, or whether the articulating surfaces contact each other within a fluid-filled joint cavity These differences serve to divide the joints of the body into three structural classifications A fibrous joint is where the adjacent bones are united by fibrous connective tissue At a cartilaginous joint, the bones are joined by hyaline cartilage or fibrocartilage At a synovial joint, the articulating surfaces of the bones are not directly connected, but instead come into contact with each other within a joint cavity that is filled with a lubricating fluid Synovial joints allow for free movement between the bones and are the most common joints of the body Functional Classification of Joints The functional classification of joints is determined by the amount of mobility found between the adjacent bones Joints are thus functionally classified as a synarthrosis or immobile joint, an amphiarthrosis or slightly moveable joint, or as a diarthrosis, which is a freely moveable joint (arthroun = “to fasten by a joint”) Depending on their location, fibrous joints may be functionally classified as a synarthrosis (immobile joint) 1/6 Classification of Joints or an amphiarthrosis (slightly mobile joint) Cartilaginous joints are also functionally classified as either a synarthrosis or an amphiarthrosis joint All synovial joints are functionally classified as a diarthrosis joint Synarthrosis An immobile or nearly immobile joint is called a synarthrosis The immobile nature of these joints provide for a strong union between the articulating bones This is important at locations where the bones provide protection for internal organs Examples include sutures, the fibrous joints between the bones of the skull that surround and protect the brain ([link]), and the manubriosternal joint, the cartilaginous joint that unites the manubrium and body of the sternum for protection of the heart Suture Joints of Skull The suture joints of the skull are an example of a synarthrosis, an immobile or essentially immobile joint Amphiarthrosis An amphiarthrosis is a joint that has limited mobility An example of this type of joint is the cartilaginous joint that unites the bodies of adjacent vertebrae Filling the gap between the vertebrae is a thick pad of fibrocartilage called an intervertebral disc ([link]) Each intervertebral disc strongly unites the vertebrae but still allows for a limited amount of movement between them However, the small movements available between adjacent vertebrae can sum together along the length of the vertebral column to provide for large ranges of body movements Another example of an amphiarthrosis is the pubic symphysis of the pelvis This is a cartilaginous joint in which the pubic regions of the right and left hip bones are strongly 2/6 Classification of Joints anchored to each other by fibrocartilage This joint normally has very little mobility The strength of the pubic symphysis is important in conferring weight-bearing stability to the pelvis Intervertebral Disc An intervertebral disc unites the bodies of adjacent vertebrae within the vertebral column Each disc allows for limited movement between the vertebrae and thus functionally forms an amphiarthrosis type of joint Intervertebral discs are made of fibrocartilage and thereby structurally form a symphysis type of cartilaginous joint Diarthrosis A freely mobile joint is classified as a diarthrosis These types of joints include all synovial joints of the body, which provide the majority of body movements Most diarthrotic joints are found in the appendicular skeleton and thus give the limbs a wide range of motion These joints are divided into three categories, based on the number of axes of motion provided by each ... NORME INTERNATIONALE CEI IEC INTERNATIONAL STANDARD 60079-10 Quatrième édition Fourth edition 2002-06 Matériel électrique pour atmosphères explosives gazeuses – Partie 10: Classement des emplacements dangereux Electrical apparatus for explosive gas atmospheres – Part 10: Classification of hazardous areas Numéro de référence Reference number CEI/IEC 60079-10:2002 Copyright International Electrotechnical Commission Provided by IHS under license with IEC Licensee=Technip Abu Dabhi/5931917101 Not for Resale, 02/12/2006 05:14:25 MSTNo reproduction or networking permitted without license from IHS --``,`,`,,,,`,,,,`,```,``````,`-`-`,,`,,`,`,,`--- Numérotation des publications Depuis le 1er janvier 1997, les publications de la CEI sont numérotées à partir de 60000. Ainsi, la CEI 34-1 devient la CEI 60034-1. Editions consolidées Les versions consolidées de certaines publications de la CEI incorporant les amendements sont disponibles. Par exemple, les numéros d’édition 1.0, 1.1 et 1.2 indiquent respectivement la publication de base, la publication de base incorporant l’amendement 1, et la publication de base incorporant les amendements 1 et 2. Informations supplémentaires sur les publications de la CEI Le contenu technique des publications de la CEI est constamment revu par la CEI afin qu'il reflète l'état actuel de la technique. Des renseignements relatifs à cette publication, y compris sa validité, sont dispo- nibles dans le Catalogue des publications de la CEI (voir ci-dessous) en plus des nouvelles éditions, amendements et corrigenda. Des informations sur les sujets à l’étude et l’avancement des travaux entrepris par le comité d’études qui a élaboré cette publication, ainsi que la liste des publications parues, sont également disponibles par l’intermédiaire de: • Site web de la CEI (www.iec.ch) • Catalogue des publications de la CEI Le catalogue en ligne sur le site web de la CEI (www.iec.ch/catlg-f.htm) vous permet de faire des recherches en utilisant de nombreux critères, comprenant des recherches textuelles, par comité d’études ou date de publication. Des informations en ligne sont également disponibles sur les nouvelles publications, les publications rempla- cées ou retirées, ainsi que sur les corrigenda. • IEC Just Published Ce résumé des dernières publications parues (www.iec.ch/JP.htm) est aussi disponible par courrier électronique. Veuillez prendre contact avec le Service client (voir ci-dessous) pour plus d’informations. • Service clients Si vous avez des questions au sujet de cette publication ou avez besoin de renseignements supplémentaires, prenez contact avec le Service clients: Email: custserv@iec.ch Tél: +41 22 919 02 11 Fax: +41 22 919 03 00 Publication numbering As from 1 January 1997 all IEC publications are issued with a designation in the 60000 series. For example, IEC 34-1 is now referred to as IEC 60034-1. Consolidated editions The IEC is now publishing consolidated versions of its publications. For example, edition numbers 1.0, 1.1 and 1.2 refer, respectively, to the base publication, the base publication incorporating amendment 1 and the base publication incorporating amendments 1 and 2. Further information on IEC publications The technical content of IEC publications is kept under constant review by the IEC, thus ensuring that the content reflects current technology. Information relating to this publication, including its validity, is available in the IEC Catalogue of publications (see below) in addition to new editions, amendments and corrigenda. Information on the subjects under consideration and work in progress undertaken by the technical committee which has prepared this publication, as well as the list of publications issued, is also available from the following: • IEC Web Site VNU JOURNAL OF SCIENCE, Earth sciences, T.xxIII, N 0 1, 2007 38 DETERMINING FLOW ENERGY AND EROSION COEFFICIENT FOR CLASSIFICATION OF POTENTIAL EROSION IN BINH DINH PROVINCE Luong Thi Van Faculty of Geography, Quy Nhon University ABSTRACT. The mountainous area occupies three fourth of the total area of Binh Dinh Province. The potential of landuse is very large. However, under the influence of irrational exploitation and natural disasters in the past, the land resource has declined, thus leading to the decline of forest resource. Furthermore, the increase of unused land and bare hills along with the decrease in the cultivated area seriously influenced on the ecological environment as well as the socio-economic development. Therefore, the classification of erosion potential and the identification of highly assuming erosive areas (regardless of the role of the forest cover) are of a great significance in protecting the cultivated land and reducing soil erosion, improving ecological environment, thus gradually eradicating hunger and reducing poverty and improving living standard of people. The author has used a method for classification of erosion potential (M), which is based on the identification of numerical values of flow energy (Y) and erodability factor (K). K is determined by the quantity of grain force of various types of soil in mountainous areas, and the numerical values of Y are calculated on each 1ha pixel on four main rive basins in Binh Dinh as: Y = I 0.75 × ∆ h 0.5 ×P 1.5 , where: I is the slope; ∆h is the height difference (absolute height subtracts height of base erosion at the valleys); P is the average annual rainfall. The result has identified three groups of cultivated land (convertible land) equivalent to three levels of the erosion potential (low, normal, high), that is needed for protecting measures at different levels. Furthermore, we classified 100 out of 155 communes of different erosion potentials at province-wide scale. 1. Introduction The mountainous area occupies three fourth of the total area of Binh Dinh Province. The potential of landuse is very large. However, under the influence of irrational exploitation and natural disasters in the past, the land resource has declined, thus leading to the decline of forest resource. Furthermore, the increase of unused land and bare hills along with the decrease in the cultivated area seriously influenced on the ecological environment as well as the socio-economic development. Therefore, the classification of erosion potential (CEP) and the identification of highly assuming erosive areas (regardless of the role of the forest cover) are of a great significance in protecting the cultivated land and reducing soil erosion, improving the ecological environment, thus gradually eradicating hunger and reducing poverty and improving living standard of people. Determining flow energy and erosion coefficient VNU. Journal of Science, Earth Sciences, T.XXIII, N 0 1, 2007 39 2. The method of erosion potential classification in Binh Dinh Province The classification of erosion potential M in Binh Dinh Province is based on the Annals of Mathematics Classification of local conformal nets. Case c < 1 By Yasuyuki Kawahigashi and Roberto Longo Annals of Mathematics, 160 (2004), 493–522 Classification of local conformal nets. Case c<1 By Yasuyuki Kawahigashi and Roberto Longo* Dedicated to Masamichi Takesaki on the occasion of his seventieth birthday Abstract We completely classify diffeomorphism covariant local nets of von Neu- mann algebras on the circle with central charge c less than 1. The irreducible ones are in bijective correspondence with the pairs of A-D 2n -E 6,8 Dynkin dia- grams such that the difference of their Coxeter numbers is equal to 1. We first identify the nets generated by irreducible representations of the Virasoro algebra for c<1 with certain coset nets. Then, by using the clas- sification of modular invariants for the minimal models by Cappelli-Itzykson- Zuber and the method of α-induction in subfactor theory, we classify all local irreducible extensions of the Virasoro nets for c<1 and infer our main classi- fication result. As an application, we identify in our classification list certain concrete coset nets studied in the literature. 1. Introduction Conformal field theory on S 1 has been extensively studied in recent years by different methods with important motivation coming from various branches of theoretical physics (two-dimensional critical phenomena, holography, ) and mathematics (quantum groups, subfactors, topological invariants in three dimensions, ). In various approaches to the subject, it is unclear whether different models are to be regarded as equivalent or to contain the same physical information. This becomes clearer by considering the operator algebra generated by smeared fields localized in a given interval I of S 1 and taking its closure A(I) in the weak operator topology. The relative positions of the various von Neumann *The first author was supported in part by the Grants-in-Aid for Scientific Research, JSPS. The second author was supported in part by the Italian MIUR and GNAMPA-INDAM. 494 YASUYUKI KAWAHIGASHI AND ROBERTO LONGO algebras A(I), namely the net I →A(I), essentially encode all the structural information, in particular the fields can be constructed out of a net [18]. One can describe local conformal nets by a natural set of axioms. The classification of such nets is certainly a well-posed problem and obviously one of the basic ones of the subject. Note that the isomorphism class of a given net corresponds to the Borchers’ class for the generating field. Our aim in this paper is to give a first general and complete classification of local conformal nets on S 1 when the central charge c is less than 1, where the central charge is the one associated with the representation of the Vira- soro algebra (or, in physical terms, with the stress-energy tensor) canonically associated with the irreducible local conformal net, as we will explain. Haag-Kastler nets of operator algebras have been studied in algebraic quantum field theory for a long time (see [29], for example). More recently, (irreducible, local) conformal nets of von Neumann algebras on S 1 have been studied; see [8], [12], [13], [18], [19], [21], [26], [27], [66], [67], [68], [69], [70]. Although a complete classification seems to be still out of reach, we will take a first step by classifying the discrete series. In general, it is not clear what kinds of axioms we should impose on con- formal nets, beside the general ones, in order to obtain an interesting math- ematical structure or classification theory. A set of conditions studied by us in [40], called complete rationality, selects a basic class of nets. Complete rationality consists ... unites the manubrium and body of the sternum for protection of the heart Suture Joints of Skull The suture joints of the skull are an example of a synarthrosis, an immobile or essentially immobile... example of an amphiarthrosis is the pubic symphysis of the pelvis This is a cartilaginous joint in which the pubic regions of the right and left hip bones are strongly 2/6 Classification of Joints. .. classified as a diarthrosis These types of joints include all synovial joints of the body, which provide the majority of body movements Most diarthrotic joints are found in the appendicular skeleton