 different than what we’ve seen. Paul Dano is so good that you hardly realize that it’s Paul Dano playing Sweat. But Arquette is the real star of Dannemora, even if Del Toro is first in the credits. There are times she plays Tillie as the dumpy, whiny, not-that-bright person she seems to be at first. But in other scenes, she projects a sweaty sexuality that belies her humdrum life with Lyle. In still others, her manner with Lyle and others is cutting to the point of ruthless.
What we know about Tillie is that there is an aspect of her life that’s not only deeply troubled, but makes her deeply restless. And in the first episode, Arquette shows all of that, even if we don’t know for sure why she is the way she is.
Stiller does a fantastic job of pacing the first episode; while others may think he’s stretching the story, he’s trying to create a vibe where we contrast the small-town, almost Fargo-esque life of Tillie and Lyle with Tillie’s voraciousness inside Clinton’s walls. He also does a great job of integrating classic rock with current pop to indicate that this story isn’t from 30 years ago, it happened just over 3 years back and is still very fresh.
Sex and Skin: At least three scenes where Tillie and Sweat have clumsy sex, one where she demands he look her in the face. No nudity other than butts, though.
Parting Shot: After lights out, Matt asks Sweat if the COs moved his bed during their inspection. Sweat says “I don’t think so… why?” Matt: “Nothing.”
Most Pilot-y Line: “It’s not crap! It’s Nick Jonas and I like it!” That line from Tillie gave us chills, and not good ones.
Our Call: STREAM IT. A fine directorial job by Stiller and an Emmy-worthy performance by Arquette make Escape At Dannemora a Escape At Dannemora on ShowtimeI left the group at the campsite and went for a walk to the river.
As I near the water I smell the river.
by the smell of the river.
home to the days of childhood.
I am a little girl sitting on the bank of the river, fishing with my dad.
Lovely photos and memories! Thanks for sharing them.
Beautiful! Can't wait to hear more when we get together.
It kind of takes you away to dear,sweet memories doesnt it?
I love your photos and the beauty of Gods creation here...looks so peaceful..
green. green. green. wonderful. green. delightful. green. green.
I love this green post!
- Research article
- Open Access
- Published:
Treatment of distal humeral fractures using conventional implants. Biomechanical evaluation of a new implant configuration
BMC Musculoskeletal Disorders volume 11, Article number: 172 (2010)
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19 Citations
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Abstract.
Background
Fractures involving the distal humerus continue to challenge orthopedic surgery. Distal humeral fractures comprise approximately 2% of all fractures and one-third of all humeral fractures [1–3]. The risk of functional impairment following non-operative treatment is high [4–6]. On the other hand, establishing stability by internal fixation may be technically demanding in the face of complex fracture patterns and rising incidence of osteoporosis [2, 7, 8]. However, with respect to anatomic reduction, reconstitution of joint congruity, restoration of the functional bone axis, fixation stability and remobilization, it is generally accepted that internal fixation provides the most favorable outcome for distal humeral fractures [2, 4–6, 9, 10]. Particularly in reduced bone quality, promising biomechanical and biological performance have been demonstrated when using angular stable Locking Compression Plates (LCP) with anatomical shape [11]. Disadvantages of LCP osteosynthesis are high costs and unavailability on some markets, especially in second and third world countries [2, 8]. The LCP double plate osteosynthesis in 90° configuration has become one of the most popular treatment options mainly because of a less demanding surgical approach [9, 12]. Besides plating in 90° fashion, alternative concepts involve parallel plate configurations, either locked or non-locked [13, 14]. According to the theory of McKee and Jupiter [15], who figuratively compared distal humerus fixation to clamping a spool between thumb and index finger, the biomechanical benefit of interconnecting the two humeral columns is frequently emphasized in the literature [13, 16]. Self et al. [17] proposed the use of an interconnection bolt linking two parallel plates together. O'Driscoll et al. [18] aimed to increase the stability of the repair construct by interdigitation of screws. In this study another method is proposed to join the humeral columns with cost-efficient conventional implants. The technique involves a conventional reconstruction plate in combination with a 1/3 tubular plate in a parallel mediolateral configuration. A transverse connecting screw is inserted from lateral to medial through the most distal hole of the tubular plate. Medially, the screw interlocks with the reconstruction plate to establish a solid connection. The proposed osteosynthesis in a "U-Frame" configuration decreases the implant costs markedly compared to an LCP based solution. Drawbacks of conventional fixation hardware, such as damage to the periosteal blood supply or the necessity for accurate plate contouring to avoid shortcomings in reduction, need to be weighed against the benefits. This study investigates the biomechanical performance of the proposed "Frame"-technique in a human cadaveric model and compares it to the 90° LCP osteosynthesis considered as one of today's predominant fixation techniques [12]. Our hypothesis was that the Frame construct would perform at least as well as the established LCP osteosynthesis under static and cyclic loading.
Methods
Eight pairs of human cadaveric humeri (4 male, 4 female donors; mean age 88 years; range 79 - 96 years) were obtained from the department of Pathology, Kantonsspital Basel, Switzerland, where they had been harvested post mortem with appropriate consent of the relatives. Provision of the specimens was approved by the ethical commission of Kantonsspital Basel. The specimens were stored fresh frozen at -20°C. Bone mineral density (BMD) was measured for all samples in the cancellous bone of the distal condyles by means of peripheral quantitative computed-tomography using an Xtreme-CT (SCANCO Medical AG, Bassersdorf, Switzerland, resolution 82 μm). Left and right bones of each pair were randomly assigned to two study groups: 1) Frame-group; 2) LCP-group. Equal numbers of left and right specimens were assured in each group.
Specimen preparation
All bones were thawed at room temperature and stripped of soft tissue. Before performing the operations, an intra-articular distal humerus fracture with metaphyseal comminution (AO type 13-C2.3) [19] was simulated. A 5 mm transverse gap was created 28 mm proximal to the most distal aspect of the joint surface. Additionally, an intra-articular fracture line was sawed proximally from the Trochlea notch splitting the condylar block. The osteotomy was then reduced by temporarily affixing the distal fragments with a reduction forceps and a transverse Kirschner (K-) wire. For anatomical reconstruction of the bone the transverse gap was temporarily filled with a 5 mm spacer while securing distal and proximal parts with additional K-wires. The spacer was removed after completing the osteosyntheses. All implants used in the study were manufactured by Synthes GmbH (Bettlach, Switzerland). Implant material was Titanium.
Frame constructs
All Frame constructs were operated by a single experienced surgeon (E. R.). A 7-hole 3.5 mm 1/3 tubular plate was contoured to the lateral aspect of the reduced and temporarily stabilized bone. A conventional 7-hole, 3.5 mm reconstruction plate was contoured to the medial surface. Both plates were temporarily clamped to the bone. A 2.5 mm drill bit was placed into the most distal hole of the reconstruction plate. A drill channel was created parallel to the joint surface from medial to lateral, aiming at the most distal hole of the tubular plate in a free-hand manner. The plates were removed and the channel was then over-drilled from medial to lateral using a 5 mm drill bit in order to prevent screw to bone anchorage. A 4.5 mm cortex screw (self-tapping) was then inserted opposite to the drilling direction (from lateral to medial) through the most distal hole of the tubular plate into the transverse drill channel. Medially, the screw engaged with the most distal hole of the reconstruction plate similarly to a screw-nut connection. The diameter of the plate hole was 4.0 mm while the outer diameter of the screw thread was 4.5 mm. These dimensions allow insertion of the screw with moderate torque for stable connection of both elements. A slightly oblique orientation of the reconstruction plate with respect to the screw axis might further contribute to a rigid coupling at the screw-plate interface (Fig. 1). Plastic deformation of thread and plate hole is likely to occur. Since the components used were not engineered for this purpose, the assembly was a special object of our investigation. Careful compression was generated in the condylar block when tightening the interconnection screw. The screw length was determined such that the screw protruded approximately 5 mm from the medial cortex. The plates were further fixed to the condyl