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|Número de publicación
|Tipo de publicación
|Número de solicitud
|Fecha de publicación
|10 May 2005
|Fecha de presentación
|13 Nov 2001
|Fecha de prioridad
|30 Mar 2001
|También publicado como
|Número de publicación
|Gerard von Hoffmann, Victor V. Cachia, Brad S. Culbert
|Cesionario original
|Triage Medical, Inc.
|Exportar cita
|BiBTeX, EndNote, RefMan
|Citas de patentes (103), Otras citas (1), Citada por (67), Clasificaciones (18), Eventos legales (5)
|Enlaces externos: USPTO, Cesión de USPTO, Espacenet
This invention is a continuation-in-part of U.S. patent application Ser. No. 09/822,803, filed Mar. 30, 2001 now U.S. Pat. No. 6,511,481, the entire contents of which are hereby expressly incorporated herein by reference.
1. Field of the Invention
The present invention relates to internal bone fracture fixation devices. In one application, the present invention relates to bone fracture fixation devices and methods adapted for fixation, among other fractures, of femoral neck and other proximal femoral fractures.
2. Description of the Related Art
The femur, otherwise known as the thigh bone, generally comprises an elongate shaft extending from the hip to the knee. The proximal end of the shaft includes a head, a neck, a greater trochanter and a lesser trochanter. The head of the femur fits into the acetabular cup of the hip bone to form a ball and socket joint at the hip. The distal end of the femur includes a medial condyle and a lateral condyle. The condyles engage an upper end of the tibia to form the knee joint. Overall, the femur is the longest and strongest bone in the skeleton. However, portions of the femur are extremely susceptible to fracturing.
Pertrochanteric fractures among geriatric patients are the most frequent in connection with those of the region of the neck of the bone. The advanced age and the pathologies which are encountered in these patients make a timely stabilization of skeletal injuries necessary in order to reduce to a minimum the bed confinement and the rehabilitation times. Preferably, devices and procedures are utilized which minimize complications brought about by the so-called immobilization syndrome, which may be lethal for patients in delicate metabolical circumstances. It is also preferable to reduce to a minimum blood losses related to surgical intervention. At the same time, the syntheses means utilized must be stable in order to allow the patient to very timely assume a seated position and, two or three days following the intervention, to reassume an erect posture with progressive bearing of weight.
Internal fixation of femoral fractures in general is one of the most common orthopedic surgical procedures. Fractures of the femur occur in both the proximal portion of the femur and the distal portion of the femur. Fractures of the proximal portion of the femur (hip fractures) are generally classified as femoral neck fractures, intertrochanteric fractures and subtrochanteric fractures. Fractures of the distal portion of the femur (knee fractures) are referred to as supracondylar fractures. Supracondylar fractures generally extend vertically between the condyles at the lower end of the femur to separate the distal portion of the femur into two main bone fragments. A fracture line may be further comminuted to create a plurality of smaller bone fragments. Fractures of the femur which extend into the neck of the bone are generally more difficult to treat than fractures restricted to the shaft of the femur.
Operative treatment of the fractures requires that the fractures be internally fixed and possibly compressed. Fractures of the neck, head or trochanters of the femur have been treated with a variety of compression screw assemblies which include generally a compression plate having a barrel member, a lag screw and a compressing screw. The compression plate is secured to the exterior of the femur and the barrel member is inserted into a predrilled hole in the direction of the femoral head. The lag screw which has a threaded end and a smooth portion is inserted through the barrel member so that it extends across the break and into the femoral head. The threaded portion engages the femoral head. The compressing screw connects the lag screw to the plate. By adjusting the tension of the compressing screw the compression (reduction) of the fracture can be adjusted.
A variety of elongated implants (nail, screw, pin, etc.) have been developed, which are adapted to be positioned along the longitudinal axis of the femoral neck with a leading (distal) end portion in the femoral head so as to stabilize a fracture of the femoral neck. The elongated implant may be implanted by itself or connected to another implant such as a side plate or intramedullary rod. The leading end portion of the implant typically includes means to positively grip the femoral head bone (external threads, expanding arms, etc.), but the inclusion of such gripping means can introduce several significant problems. First, implants with sharp edges on the leading end portion, such as the externally threaded implants, exhibit a tendency to migrate proximally towards the hip joint weight bearing surface after implantation. This can occur when the proximal cortical bone has insufficient integrity to resist distal movement of the screw head. Such proximal migration under physiological loading, which is also referred to as femoral head cut-out, can lead to significant damage to the adjacent hip joint. Also, the externally threaded implants can generate large stress concentrations in the bone during implantation which can lead to stripping of the threads formed in the bone and thus a weakened grip. The movable arms of known expanding arm devices are usually free at one end and attached at the other end to the main body of the leading end portion of the implant. As a result, all fatigue loading is concentrated at the attached ends of the arms and undesirably large bending moments are realized at the points of attachment. In addition, conventional threaded implants generally exhibit insufficient holding power under tension, such that the threads can be stripped out of the femoral head either by overtightening during the implantation procedure or during post operative loading by the patient's weight.
Thus, notwithstanding the variety of efforts in the prior art, there remains a need for an orthopedic fixation device with improved locking force such as within the femoral head in a femoral neck application, which resists migration and rotation, and which can be easily and rapidly deployed within the bone.
There is provided in accordance with one aspect of the present invention, a method of securing a first bone fragment to a second bone fragment. The method comprises the steps of drilling a bore through the first bone fragment in the direction of the second bone fragment, and advancing through the bore a fixation device comprising a first portion and a second portion that are coupled to each other. A distal anchor of the fixation device is rotated to secure the fixation device to the second fragment, and the proximal anchor is axially advanced to engage the first fragment.
In one application of the method, the second bone fragment comprises the head of a femur. Alternatively, the second bone fragment comprises a tibia, a fibula, a femur, a humurus, a radius, or an ulna. The first bone fragment may comprise a condyle.
The method may additionally comprise the step of uncoupling the first portion from the second portion.
In accordance with another aspect of the present invention, there is provided a femoral neck fracture fixation device. The device comprises an elongated body, having a proximal end and a distal end and comprising a first portion and a second portion detachably coupled to each other at a junction. The first portion includes an anti-rotational structure. A helical distal anchor is provided on the distal end. A first retention structure is provided on the body, proximal to the distal anchor, and a proximal anchor surface is moveably carried by the body. The proximal anchor includes a tubular sleeve that in a first position extends distally past the junction between the first portion and the second portion. The proximal anchor surface is moveable in the distal direction with respect to the body. The retention structure resists proximal movement of the proximal anchor surface with respect to the body, and the anti-rotational structure prevents rotational movement of the first portion with respect to the proximal anchor.
In one embodiment, the first retention structure comprises a series of ridges or grooves. A second retention structure is preferably provided on the interior of the tubular sleeve for cooperating with the first retention structure on the body.
In accordance with a further aspect of the present invention, there is provided a bone fracture fixation device. The fixation device comprises an elongate body having a proximal end and a distal end and comprising a first portion and a second portion that are detachably coupled to each other at a junction. A cancellous bone anchor and/or a cortical bone anchor is carried by the distal end. A proximal anchor is axially moveably carried on the body and includes a tubular portion that extends distally past the junction. Complementary surface structures are provided in between the first portion of the body and the proximal anchor to permit advancing the proximal anchor in the distal direction to tighten the fixation device but resist axial proximal movement of the proximal anchor and to prevent rotational movement between the first portion and the proximal anchor.
In accordance with another aspect of the present invention, there is provided a method of treating a femoral fracture. The method comprises the steps of drilling at least one and preferably two or three bores distally into the femur in the direction of a fracture, and advancing into each bore a fixation device that comprises a body having a first portion that forms a distal bone anchor and a second portion that forms a proximal end. A proximal component is rotated to engage the distal anchor with the bone distal to the fracture, and a proximal anchor is advanced distally along the fixation device to compress the fracture.
Preferably, the drilling step comprises drilling the bore along an axis which extends through the femoral neck and in the direction of the head of the femur. In one embodiment, the advancing a proximal anchor step comprises axially advancing the proximal anchor without rotating the proximal anchor with respect to the fixation device. The femoral fracture may be a femoral neck fracture (e.g., capital or subcapital), an intertrochanteric fracture or a subtrochanteric fracture.
Further features and advantages of the present invention will become apparent to those of skill in the art in view of the detailed description of preferred embodiments which follows, when considered together with the attached drawings and claims.
Although the fixation devices of the present invention will be disclosed primarily in the context of fractures of the proximal femur, the methods and structures disclosed herein are intended for application in any of a wide variety of bones and fractures, as will be apparent to those of skill in the art in view of the disclosure herein. For example, the bone fixation device of the present invention is applicable in a wide variety of fractures and osteotomies in the hand, such as interphalangeal and metacarpophalangeal arthrodesis, transverse phalangeal and metacarpal fracture fixation, spiral phalangeal and metacarpal fracture fixation, oblique phalangeal and metacarpal fracture fixation, intercondylar phalangeal and metacarpal fracture fixation, phalangeal and metacarpal osteotomy fixation as well as others known in the art. A wide variety of phalangeal and metatarsal osteotomies and fractures of the foot may also be stabilized using the bone fixation device of the present invention. These include, among others, distal metaphyseal osteotomies such as those described by Austin and Reverdin-Laird, base wedge osteotomies, oblique diaphyseal, digital arthrodesis as well as a wide variety of others that will be known to those of skill in the art. The bone fixation device may be used with or without plate(s) or washer(s), all of which can be either permanent, absorbable, or combinations.
Fractures of the fibular and tibial malleoli, pilon fractures and other fractures of the bones of the leg may be fixated and stabilized with the present invention with or without the use of plates, both absorbable or non-absorbing types, and with alternate embodiments of the current invention. Fractures and osteotomies of the mid and hind foot, tarsal arthrodesis and osteotomy, or others as are known to those with skill in the art. One example is the fixation of the medial malleolar avulsion fragment.
The fixation device of the present invention may also be used to attach tissue or structure to the bone, such as in ligament reattachment and other soft tissue attachment procedures. Plates and washers, with or without tissue spikes for soft tissue attachment, and other implants may also be attached to bone, using either resorbable or nonresorbable fixation devices depending upon the implant and procedure. The fixation device may also be used to attach sutures to the bone, such as in any of a variety of tissue suspension procedures.
For example, peripheral applications for the fixation devices include utilization of the device for fastening soft tissue such as capsule, tendon or ligament to bone. It may also be used to attach a synthetic material such as marlex mesh, to bone or allograft material such as tensor fascia lata, to bone. In the process of doing so, retention of the material to bone may be accomplished with the collar as shown, or the pin and or collar may be modified to accept a suture or other material for facilitation of this attachment.
Specific examples include attachment of the posterior tibial tendon to the navicular bone in the Kidner operation. This application may be accomplished using an appropriately sized implant of the present invention along with a washer with distally extending soft tissue spikes. Navicular-cuneiform arthrodesis may be performed utilizing the device and concurrent attachment of the tendon may be accomplished. Attachment of the tendon may be accomplished in the absence of arthrodesis by altering the placement of the implant in the adjacent bone.
Ligament or capsule reattachment after rupture, avulsion or detachment, such as in the ankle, shoulder or knee can also be accomplished using the devices disclosed herein.
The fixation devices may be used in combination with semi tubular, one-third tubular and dynamic compression plates, both of metallic and absorbable composition, if the collar is modified to match the opening on the plate.
The canulated design disclosed below can be fashioned to accept an antibiotic impregnated rod for the slow adsorption of medication locally. This may be beneficial for prophylaxis, especially in open wounds, or when osteomyelitis is present and stabilization of fracture fragments is indicated.
A kit may be assembled for field use by military or sport medical or paramedical personnel. This kit contains an implanting tool, and a variety of implant device size and types. The kit may include additional components such as sterilization or disinfectant materials, a skin stapler, bandages, gloves, and basic tools for emergent wound and fracture treatment. Antibiotic rods may be included for wound prophylaxis during transport.
Referring to
The greater trochanter 18 extends outwardly above the junction of the neck 16 and the body 17 of the femur 10. On the medial side of the greater trochanter 18 is the trochanteric fossa 20. This depression accommodates the insertion of the obturator externux muscle. The lesser trochanter 21 is located posteromedially at the junction of the neck 16 and the body 17 of the femur 10. Both the greater trochanter 18 and the lesser trochanter 21 serve for the attachment of muscles. On the posterior surface of the femur 10 at about the same axial level as the lesser trochanter 21 is the gluteal tuberosity 22, for the insertion of the gluteus maximus muscle. Additional details of the femur are well understood in the art and not discussed in further detail herein.
Referring to
In one embodiment, the body 28 comprises titanium. However, as will be described in more detail below, other metals or bioabsorbable or nonabsorbable polymeric materials may be utilized, depending upon the dimensions and desired structural integrity of the finished fixation device 12.
The distal end 32 of the body 28 is provided with a cancellous bone anchor or distal cortical bone anchor 34. Additional details of the distal bone anchor are described below. In general, in a femoral neck application, distal bone anchor 34 is adapted to be rotationally inserted into the cancellous bone within the head 14 of the femur 10, to retain the fixation device 12 within the femoral head.
Referring to
In a modified arrangement, the second portion 38 can comprise any of a variety of tensioning elements for permitting proximal tension to be placed on the distal anchor 34 while the proximal anchor is advanced distally to compress the fracture. For example, any of a variety of tubes or wires can be removably attached to the first portion 36 and extend proximally to the proximal handpiece. In one such arrangement, the first portion 36 can include a releasable connector in the form of a latching element, such as an eye or hook. The second portion 38 can include a complementary releasable connector (e.g., a complementary hook) for engaging the first portion 36. In this manner, the second portion 38 can be detachably coupled to the first portion 36 such proximal traction can be applied to the first portion 36 through the second portion as will be explained below. Alternatively, the second portion 48 may be provided with an eye or hook, or transverse bar, around which or through which a suture or wire may be advanced, both ends of which are retained at the proximal end of the device. Following proximal tension on the tensioning element during the compression step, one end of the suture or wire is released, and the other end may be pulled free of the device. Alternate releasable proximal tensioning structures may be devised by those of skill in the art in view of the disclosure herein.
The proximal end 30 of the fixation device is provided with a proximal anchor 50. Proximal anchor 50 is axially distally moveable along the body 28, to permit compression of the fracture 24 as will be apparent from FIG. 1 and the description below. As will be explained below, complimentary locking structures such as threads or ratchet like structures between the proximal anchor 50 and the body 28 resist proximal movement of the anchor 50 with respect to the body 28 under normal use conditions. The proximal anchor 50 preferably can be axially advanced along the body 28 without rotation as will be apparent from the disclosure herein.
In the illustrated embodiment, proximal anchor 50 comprises a housing 52 such as a tubular body, for coaxial movement along the body 28. As best seen in
For example, as best seen in
Retention structures 58 are spaced axially apart along the body 28, between a proximal limit 62 and a distal limit 64. The axial distance between proximal limit 62 and distal limit 64 is related to the desired axial working range of the proximal anchor 50, and thus the range of functional sizes of the fixation device 12. Thus, the present invention provides a bone fixation device which can provide compression across a fracture throughout a range of motion following the placement of the distal anchor. The distal anchor may be positioned within the cancellous and/or distal cortical bone, and the proximal anchor may be distally advanced throughout a range to provide compression across the fracture without needing to relocate the distal anchor and without needing to initially locate the distal anchor in a precise position with respect to the proximal side of the bone. Providing a working range throughout which tensioning of the proximal anchor is independent from setting the distal anchor allows a single device to be useful for a wide variety of fractures, as well as eliminates the need for accurate device measurement and accurate placement of the distal anchor. In many applications, the working range is at least about 10% of the overall length of the device, and may be as much as 20% or 30% or more of the overall device length. In the context of a femoral application, working ranges of up to about 10 mm or more may be provided, since estimates within that range can normally be readily accomplished within the clinical setting. In other applications, such as a metatarsal fracture, a working range in the area of from about 1 mm to about 2 mm may be all that is necessary. The embodiments disclosed herein can be scaled to have a greater or a lesser working range, as will be apparent to those of skill in the art in view of the disclosure herein.
The proximal anchor 50 includes a flange 66 that seats against the outer surface of the femur or tissue adjacent the femur. The flange 66 is preferably an annular flange, to optimize the footprint or contact surface area between the flange 66 and the femur. Circular or polygonal shaped flanges for use in femoral head fixation will generally have a diameter of at least about 4 mm greater than the adjacent body 28 and often within the range of from about 4 mm to about 20 mm or more greater than the adjacent body 28.
In the illustrated embodiment, the bone contacting surface 68 of the flange 44 is tapered and generally faces the shaft 17 of the femur 10. In other embodiments, the bone contacting surface 69 can resides in or approximately on a plane, which is perpendicular with respect to the longitudinal axis of the body 28. In other embodiments, other angular relationships between the bone contacting surface 68 of the flange 66 and the longitudinal axis of the body 28 and housing 52 may be utilized, depending upon the anticipated entrance angle of the body 28 and associated entrance point surface of the femur 10. In general, the longitudinal axis extending through the head 14 and neck 16 of the human femur is inclined at an angle of approximately 126° from the longitudinal axis of the long body 17 of the femur 10. Angles between the longitudinal axis of body 28 and tissue contacting surface 68 within the range of from about 90° to about 140° will generally be utilized.
In a modified embodiment, the housing 52 of the proximal anchor 50 can include one or more one or more barbs that extend radially outwardly from the tubular housing 52. Such barbs provide for self tightening after the device has been implanted in the patient as described in a co-pending U.S. Patent Application entitled DISTAL BONE FOR BONE FIXATION WITH SECONDARY COMPRESSION", filed Nov. 13, 2001, which is hereby expressly incorporated by reference herein. The barbs may be radially symmetrically distributed about the longitudinal axis of the housing 52. Each barb is provided with a transverse engagement surface, for anchoring the proximal anchor 50 in the bone. The transverse engagement surface may lie on a plane which is transverse to the longitudinal axis of the housing 50 or may be inclined with respect to the longitudinal axis of the tubular 50. In either arrangement, the transverse engagement surface 43 generally faces the bone contacting surface 68 of the flange 44. As such, the transverse engagement surface inhibits proximal movement of the proximal anchor with respect to the bone.
The clinician can be provided an array of proximal anchors 50 of varying angular relationships between the bone contacting surface 68 and the longitudinal axis of the body 28 and housing 52 (e.g., 90°, 100°, 110°, 120°, and 130°). A single body 28 can be associated with the array such as in a single sterile package. The clinician upon identifying the entrance angle of the body 28 and the associated entrance point surface orientation of the femur 10 can choose the anchor 50 from the array with the best fit angular relationship, for use with the body 28.
With particular reference to
In one embodiment, the rotational coupling 70 comprises a proximal projection of the body 28 having an axial recess with a polygonal cross section, such as a hexagonal cross section. The rotational coupling 70 is illustrated as a female component, machined or milled or attached to the proximal end 30 of the body 28. However, the rotational coupling may also be in the form of a male element, such as a hexagonal or other noncircular cross sectioned projection.
As illustrated, the body 28 is cannulated to accommodate installation over a placement wire as is understood in the art. The cross section of the illustrated central cannulation is circular but in other embodiments may be non circular, e.g., hexagonal, to accommodate a corresponding male tool for installation or removal of the second portion 38 of the body 28 as will be explained below. In other embodiments, the body 28 may partially or wholly solid.
In all of the embodiments illustrated herein, the distal anchor 34 comprises a helical locking structure 72 for engaging cancellous and/or distal cortical bone. In the illustrated embodiment, the locking structure 72 comprises a flange that is wrapped around the axial lumen. The flange extends through at least one and generally from about two to about 50 or more full revolutions depending upon the axial length of the distal anchor and intended application. For most femoral neck fixation devices, the flange will generally complete from about 2 to about 20 revolutions. The helical flange 72 is preferably provided with a pitch and an axial spacing to optimize the retention force within cancellous bone, to optimize compression of the fracture.
The helical flange 72 of the illustrated embodiment has a generally triangular cross-sectional shape (see FIG. 4). However, it should be appreciated that the helical flange 72 can have any of a variety of cross sectional shapes, such as rectangular, oval or other as deemed desirable for a particular application through routine experimentation in view of the disclosure herein. The outer edge of the helical flange 72 defines an outer boundary. The ratio of the diameter of the outer boundary to the diameter of the central lumen can be optimized with respect to the desired retention force within the cancellous bone and giving due consideration to the structural integrity and strength of the distal anchor 34. Another aspect of the distal anchor 34 that can be optimized is the shape of the outer boundary and the central core, which in the illustrated embodiment are generally cylindrical.
The distal end 32 and/or the outer edges of the helical flange 72 may be atraumatic (e.g., blunt or soft). This inhibits the tendency of the fixation device 12 to migrate anatomically proximally towards the hip joint bearing surface after implantation (i.e., femoral head cut-out). Distal migration is also inhibited by the dimensions and presence of the proximal anchor 50, which has a larger footprint than conventional screws.
A variety of other arrangements for the distal anchor 32 can also be used. For example, the various distal anchors described in U.S. patent application Ser. No. 09/822,803, filed Mar. 30, 2001, and co-pending U.S. Patent Application entitled "DISTAL BONE FOR BONE FIXATION WITH SECONDARY COMPRESSION", filed Nov. 13, 2001 can be incorporated into the fixation device 12 described herein. The entire contents these applications are hereby expressly incorporated by reference. In particular, the distal anchor may comprise a single helical thread surrounding a central core, much as in a conventional screw, which has been cannulated to facilitate placement over a wire. Alternatively, a double helical thread may be utilized, with the distal end of the first thread rotationally offset from the distal end of the second thread. The use of a double helical thread can enable a greater axial travel for a given degree of rotation and greater retention force than a corresponding single helical thread. Specific distal anchor designs can be optimized for the intended use, taking into account desired performance characteristics, the integrity of the distal bone, and whether the distal anchor is intended to engage exclusively cancellous bone or will also engage cortical bone.
With particular reference to
To rotate the proximal collar, the flange 66 is preferably provided with a gripping structure to permit an insertion tool to rotate the flange 66. Any of a variety of gripping structures may be provided, such as one or more slots, flats, bores or the like. In one embodiment, the flange 44 is provided with a polygonal, and, in particular, a pentagonal or hexagonal recess 84. See FIG. 4.
In use, the clinician first identifies a patient having a fracture to be treated, such as a femoral neck fracture, which is fixable by an internal fixation device. The clinician accesses the proximal femur, reduces the fracture if necessary and selects a bone drill and drills a hole 90 (see
A fixation device 12 having an axial length and outside diameter suitable for the hole 90 is selected. The distal end 32 of the fixation device 12 is advanced distally into the hole 90 until the distal anchor 34 reaches the distal end of the hole 90. The proximal anchor 50 may be carried by the fixation device 12 prior to advancing the body 28 into the hole 90, or may be attached following placement of the body 28 within the hole 90. Once the body 28 and proximal anchor 50 are in place, the clinician may use any of a variety of driving devices, such as electric drills or hand tools to rotate the proximal anchor 50 and thus cancellous bone anchor 34 into the head of the femur.
Once the anchor 34 is in the desired location, proximal traction is applied to the proximal end 30 of body 28, such as by conventional hemostats, pliers or a calibrated loading device, while distal force is applied to the proximal anchor 50. In this manner, the proximal anchor 50 is advanced distally until the anchor 50 fits snugly against the outer surface of the femur or tissue adjacent the femur and the fracture 24 is completely reduced as shown in FIG. 6B. Appropriate tensioning of the fixation device 12 is accomplished by tactile feedback or through the use of a calibration device for applying a predetermined load on the implantation device. One advantage of the structure of the present invention is the ability to adjust compression independently of the setting of the distal anchor 34.
Following appropriate tensioning of the proximal anchor 50, the second portion 38 of the body 28 is preferably detached from the first portion 36 and removed. See FIG. 6C. In the illustrated embodiment, this involves rotating the second portion 38 with respect to the first portion via the coupling 70. In connection with many of the fractures identified previously herein, a single fixation device 12 may be all that is clinically indicated. However, two or three or more fixation devices 12 may be utilized to reduce a single fracture, depending upon the location and physical requirements of the fractured portion of the bone. For example, in the case of proximal femoral fractures of the type illustrated herein, typically at least two and preferably three fixation devices 12 will be implanted to span the femoral neck. The use of three fixation devices 12 desirably provides sufficient compression across the fracture, as well as minimizes the risk of rotation of the head of the femur around the axis of a single fixation device 12. The proximal end of the fixation devices may be connected together such as through a three-holed plate or rod, or may be independent of each other.
Following removal of the second portion 38 of each body 28, the access site may be closed and dressed in accordance with conventional wound closure techniques.
In a modified arrangement, the second portion 38 may form part of the driving device, which is used to rotate the proximal anchor 50 and thus cancellous bone anchor 34 into the head of the femur. The second portion 38 is used to apply proximal traction so as to compress the fracture. After appropriate tensioning, the second portion 38 can be de-coupled from the first portion 36 and removed with the driving device.
In the foregoing variation, the second portion 38 may be connected to a rotatable control such as a thumb wheel on the deployment device. A container may be opened at the clinical site exposing the proximal end of the implant, such that the distal end of the second portion 38 may be removably coupled thereto. Proximal retraction of the hand tool will pull the implant out of its packaging. The implant may then be positioned within the aperture in the bone, rotated to set the distal anchor, and the hand piece may be manipulated to place proximal traction on the second portion 38 while simultaneously distally advancing the proximal anchor. Following appropriate tensioning across the fracture, the second portion 38 may be disengaged from the implant, and removed from the patient. In the example of a threaded engagement, the second portion 38 may be disengaged from the implant by rotating a thumb wheel or other rotational control on the hand piece. In an alternate embodiment, such as where the second portion 38 comprises a pull wire, following appropriate tensioning across the fracture, a first end of the pull wire is released such that the pull wire may be removed from the implant by proximal retraction of the second end which may be attached to the hand piece.
Preferably, the clinician will have access to an array of fixation devices 12, having, for example, different diameters, axial lengths and, if applicable, angular relationships. These may be packaged one per package in sterile envelopes or peelable pouches, or in dispensing cartridges which may each hold a plurality of devices 12. Upon encountering a fracture for which the use of a fixation device is deemed appropriate, the clinician will assess the dimensions and load requirements, and select a fixation device from the array, which meets the desired specifications.
In some instances, a clinician may want to introduce two or more fixation devices 12 into the femoral head 14 to secure the fracture 24. This may be desirable if the clinician determines that, based upon the nature of the fracture 24, there is a possibility that the head 14 of the femur 10 could rotate about a single fixation device 12. Even minor rotation can inhibit the healing of the fracture. Significant rotation can result in failure of the fixation device or necrosis of the femoral head. Two or more fixation devices 12 may also be desirable where the direction of the fracture is generally parallel to the axis of implantation as is understood in the art.
The fixation device 12 of the present invention may also be used in combination with intramedullary nails or rods, as will be understood by those of skill in the art.
The fixation device 12 of the present invention may be used in any of a wide variety of anatomical settings beside the proximal femur, as has been discussed. For example, lateral and medial malleolar fractures can be readily fixed using the device of the present invention. Referring to
A fixation device 12 in accordance with the present invention is illustrated in
The fixation devices of the present invention may be made from either conventional bioabsorbable materials or conventional non-absorbable materials, combinations thereof and equivalents thereof. In addition, natural materials such as allografts may be used. Examples of absorbable materials include homopolymers and copolymers of lactide, glycolide, trimethylene carbonate, caprolactone, and p-dioxanone and blends thereof. The following two blends may be useful: 1) the blend of poly(p-dioxanone) and a lactide/glycolide copolymer, as disclosed in U.S. Pat. No. 4,646,741 which is incorporated by reference and (2) the glycolide-rich blend of two or more polymers, one polymer being a high lactide content polymer, and the other being a high glycolide content disclosed in U.S. Pat. No. 4,889,119 which is incorporated by reference. Additional bioabsorbable materials are disclosed in copending application Ser. No. 09/558,057 filed Apr. 26, 2000, the disclosure of which is incorporated in its entirety herein by reference.
The fixation devices may also be made from conventional non-absorbable, biocompatible materials including stainless steel, titanium, alloys thereof, polymers, composites and the like and equivalents thereof. In one embodiment, the distal anchor comprises a metal helix, while the body and the proximal anchor comprise a bioabsorbable material. Alternatively, the distal anchor comprises a bioabsorbable material, and the body and proximal anchor comprise either a bioabsorbable material or a non-absorbable material. As a further alternative, each of the distal anchor and the body comprise a non-absorbable material, connected by an absorbable link. This may be accomplished by providing a concentric fit between the distal anchor and the body, with a transverse absorbable pin extending therethrough. This embodiment will enable removal of the body following dissipation of the pin, while leaving the distal anchor within the bone.
The components of the invention (or a bioabsorbable polymeric coating layer on part or all of the anchor surface), may contain one or more bioactive substances, such as antibiotics, chemotherapeutic substances, angiogenic growth factors, substances for accelerating the healing of the wound, growth hormones, antithrombogenic agents, bone growth accelerators or agents, and the like. Such bioactive implants may be desirable because they contribute to the healing of the injury in addition to providing mechanical support.
In addition, the components may be provided with any of a variety of structural modifications to accomplish various objectives, such as osteoincorporation, or more rapid or uniform absorption into the body. For example, osteoincorporation may be enhanced by providing a micropitted or otherwise textured surface on the components. Alternatively, capillary pathways may be provided throughout the body and collar, such as by manufacturing the anchor and body from an open cell foam material, which produces tortuous pathways through the device. This construction increases the surface area of the device which is exposed to body fluids, thereby generally increasing the absorption rate. Capillary pathways may alternatively be provided by laser drilling or other technique, which will be understood by those of skill in the art in view of the disclosure herein. In general, the extent to which the anchor can be permeated by capillary pathways or open cell foam passageways may be determined by balancing the desired structural integrity of the device with the desired reabsorption time, taking into account the particular strength and absorption characteristics of the desired polymer.
One open cell bioabsorbable material is described in U.S. Pat. No. 6,005,161 as a poly(hydroxy) acid in the form of an interconnecting, open-cell meshwork which duplicates the architecture of human cancellous bone from the iliac crest and possesses physical property (strength) values in excess of those demonstrated by human (mammalian) iliac crest cancellous bone. The gross structure is said to maintain physical property values at least equal to those of human, iliac crest, cancellous bone for a minimum of 90 days following implantation. The disclosure of U.S. Pat. No. 6,005,161 is incorporated by reference in its entirety herein.
The components of the present invention may be sterilized by any of the well known sterilization techniques, depending on the type of material. Suitable sterilization techniques include heat sterilization, radiation sterilization, such as cobalt 60 irradiation or electron beams, ethylene oxide sterilization, and the like.
The specific dimensions of any of the bone fixation devices of the present invention can be readily varied depending upon the intended application, as will be apparent to those of skill in the art in view of the disclosure herein. Moreover, although the present invention has been described in terms of certain preferred embodiments, other embodiments of the invention including variations in dimensions, configuration and materials will be apparent to those of skill in the art in view of the disclosure herein. In addition, all features discussed in connection with any one embodiment herein can be readily adapted for use in other embodiments herein. The use of different terms or reference numerals for similar features in different embodiments does not imply differences other than those which may be expressly set forth. Accordingly, the present invention is intended to be described solely by reference to the appended claims, and not limited to the preferred embodiments disclosed herein.
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|Clasificación de EE.UU.
|Clasificación internacional
|Clasificación cooperativa
|Clasificación europea
|28 Ene 2002
Owner name: TRIAGE MEDICAL INC., CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:VON HOFFMANN, GERARD;CACHIA, VICTOR V.;CULBERT, BRAD S.;REEL/FRAME:012496/0240;SIGNING DATES FROM 20020102 TO 20020122
|23 Oct 2007
|Certificate of correction
|4 Dic 2007
Owner name: INTERVENTIONAL SPINE, INC.,CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:TRIAGE MEDICAL INC.;REEL/FRAME:020206/0327
Effective date: 20061128
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text:
Rebecca Kimitch
Recent articles
Does the race of your child's teacher matter?
When children in California walked into their classrooms at the start of the school year, odds are they saw a white person at the head of the room. And odds are, when they looked around at their classmates, they saw a lot of Latino, Asian and black students. Despite efforts to increase the diversity of the state's teaching ranks, minority teachers remain almost as underrepresented in public schools as they were 10 years ago, according to an assessment of California Department...
Centinela Valley district bills piling up for Jose Fernandez investigation
Bills stemming from the ouster of former Superintendent Jose Fernandez keep mounting for the Centinela Valley school district. In the latest financial hit, the district's refusal to release public documents related to its investigation into Fernandez will cost nearly $80,000.The sum is part of an agreement Centinela Valley struck to settle
Effort to recall Centinela Valley board President Hugo Rojas fails
Supporters of a campaign to oust Centinela Valley school board President Hugo Rojas for his role in approving a lavish compensation package for the former district superintendent have failed to qualify a recall election for the ballot.A group of parents, teachers and community members fell nearly 4,000 signatures short on petitions to force the recall...
Daily newspaper publishing
The San Gabriel Valley Tribune is moving offices to Monrovia
WEST COVINA>>The lack of windows, the train thundering by right outside, the warehouse-like environment: for some who walk into the offices of the San Gabriel Valley Tribune, the building leaves something to be desired. But when the office at 1210 N. Azusa Canyon opened on March 25, 1974, each of those elements served a function. As those functions have grown obsolete in a changing news environment, the Tribune is saying goodbye to its long-time home this weekend.
Thai community remembers shocking case of modern slavery at sweatshop
EL MONTE>> Twenty years ago, a loud wake-up call for the nation came screaming out of an indistinct apartment complex in El Monte: Slavery in the United States is not over. On the morning of Aug. 2, 1995, state and federal agents raided the complex and found 72 Thai men and women imprisoned in a sweatshop, confined behind barbed wire and boarded up windows, with 24-hour guards keeping watch. The victims had been locked up for up to seven years, prohibited from...
Ousted Centinela Superintendent Jose Fernandez fights for bigger pension
Since his official retirement earlier this year, disgraced Centinela Valley Superintendent Jose Fernandez has been pulling in $7,316 a month through his pension.While some parents and teachers insist this is far more than he deserves after bilking taxpayers out of hundreds of thousands of dollars through his extraordinary compensation package, it is a fraction of what Fernandez, 55, expected to take home in...
Why Centinela Valley Superintendent Jose Fernandez was fired
When then-Superintendent Jose Fernandez was on a cruise in the Mediterranean Sea in 2013, he called the finance department of the Centinela Valley school district with an important question: When was he going to get paid for his unused vacation days?Though Fernandez was on vacation at that moment, he didn't use a single vacation day that year, nor the year before that, nor the year before that.Every year from 2010 to 2013, Fernandez managed to collect $34,000 to $41,000...
How ousted Superintendent Jose Fernandez turned short work calendar into cash
For most people, the work year is 260 days: five days a week, 52 weeks a year. But discredited Superintendent Jose Fernandez had it better. His work year for the Centinela Valley school district was defined under his contract as only 215 days. That meant Fernandez was able to enjoy Mediterranean and other destinations without touching the 30 days of vacation also provided under his contract. In turn, he could cash out the unused vacation hours at the end of each...
School boards
Centinela Valley activists confident recall of school board President Hugo Rojas will make ballot
School board President Hugo Rojas could be the next Centinela Valley school district leader on the chopping block in the wake of the uproar surrounding the former superintendent's excessive pay. Supporters of a bid to oust Rojas said Tuesday they are confident they have collected enough valid signatures to place his recall on the November...
Centinela Valley school board recall backers scramble for signatures
The effort to recall three members of the Centinela Valley school board is coming down to the wire. Supporters have until Monday to submit just under 9,000 valid signatures to qualify the recall for the November ballot. As of Friday morning, it's far from certain they'll succeed."It's going to be close. I think it will come down to whether the signatures we have are valid," said Kevin Schaaf, a parent and educator who is leading the effort.

subset: commoncrawl


text:
Beastie Boys
The Beastie Boys are an American hip-hop trio from New York City, United States: Brooklyn and Manhattan. The members are Mike D (real name Michael Diamond), MCA (Adam Yauch), and Adrock (Adam Horovitz). The Beastie Boys were the first successful white rap group and one of the few acts from the early days of hip-hop that still enjoy major success. Their rock and punk -influenced rap has had a significant impact on artists both in and outside the hip-hop scene, and they were the first rap group to gain a substantial following with alternative rock fans.
No stations playing Beastie Boys now
No albums found
Don't Play No Game That I Can't Win
Ch-Check it out


text:
Icy-Veins interviewed Tom Chilton and Ion Hazzikostas about Legion. In that interview, it was revealed that all three Hunter specs will have their own unique flavor
Star Wars: The Old Republic
All Aboard the KotFE Hype Train
On September 30, BioWare held a live stream for Knights of the Fallen Empire. When Eric Musco opened up with 45-minutes of Chapter One gameplay,
Share this:
The Hunting Party Podcast
Episode 226: Welcome Cliperol and Niix!
This week we welcome special guests Cliperol and Niix to the show. Both are raiding Hunters from Midwinter. They take us inside the world of
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Star Wars
My Cantina Cast Debut
I'm officially blogging over at the Cantina Cast now. On May the Fourth I published my first blog post – Broken Heroes. In the article,


text:
Kids' Craft: Candy Necklace Valentines
Kids will love making these fun and easy edible valentines for their friends using licorice laces and gummy ring candy.
DIY Candy Necklace Valentines 01:53
Marianne and Lulu make candy necklace valentines for Lulu's classmates.
Materials Needed:
- scissors
- strawberry licorice laces
- gummy ring candy (any flavor)
- cellophane treat bags
Create Necklaces
String gummy rings on a licorice lace. Each necklace should have 7 to 8 gummy rings.
Prepare Cards
Download and print cards (Image 1). Cut a half-inch slit on each side of a card. Thread the finished necklace through the slits, leaving the excess licorice on the back of the card (Image 2). Tie excess licorice into a loose bow (Image 3).
Package Cards
Carefully put the finished cards (one at a time) into a cellophane treat bag (Image 1). Fold over the top and seal with a piece of washi tape. Add a sticker for extra embellishment (Image 2).
Now, the candy necklace valentines are ready to be given away to your child's dearest friends.
Next Up
Kids' Craft: Biggest Fan Valentine
Nothing sends a heartwarming message to loved ones like a handmade valentine. This year, show the object of your affection that you're their "biggest fan" with this clever, easy-to-make card.
Kids' Craft: Handmade Turtle Valentine
Let that special someone know exactly how you feel with this sweet turtle card that reads, "You really bring me out of my shell."
Valentine's Day Kids' Craft: White-Chocolate-Dipped Fortune Cookies
Delight your valentine with white-chocolate-dipped fortune cookies in a crafty (and cute!) Chinese takeout box. Basic cooking skills and craft supplies are all you need, making this a great Valentine's Day craft project for kids.
Make Homemade Play Dough Valentines
Ditch the store-bought valentines and try something new this year. The kids will love helping you make homemade, heart-shaped play dough to hand out to friends and classmates.
Kids' Craft: Easy Doily Treat Cups
Get the kids crafting to turn inexpensive paper doilies into cute treat cups perfect for filling with candy, cookies, small toys or a cupcake. They're a sweet surprise for Valentine's Day or Easter and make a great party favor.
How to Make a Valentine's Day Phrase Pillow
Show your significant other just how much you care with a colorful, one-of-a-kind pillow that can be showcased all year round.
Easy Hand-Knit Kids' Scarf and Heart Pin
New to knitting? This is just the project for you! Keep your little one bundled up this winter with a hand-knit scarf that's a snap to make. Finish it off with a plush, embroidered heart pin that's the sweetest embellishment.
Valentine's Day Project: Cupid's Arrow Hot Chocolate
Surprise your Valentine with a cup of hot chocolate dressed up with a paper straw "arrow" and a heart-shaped marshmallow. Kids and adults alike will love this new twist on a classic winter treat.
Etched Heart Wineglasses
Surprise your sweetheart with a home-cooked meal and custom-made wineglasses this Valentine's Day. A few simple steps are all it takes to turn basic stemware into heart-accented pieces you'll use for every romantic occasion.
How to Make Glitter Champagne Flutes
Bring some sparkle to your Valentine's Day table with easy-to-make glitter champagne flutes.
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text:
CAI was born in 1957 in Quanzhou, located on the southeastern coast of Fujian Province.
CAI says 170; my own tiny random sample and the 60 Minutes investigation indicate that there are probably a lot less.
Mortenson will have to pay "restitution" to CAI of at least $1 million—though it will likely end up being more than that.
Problem is, several of the Dirty Dozen harnessed their "untapped resourcefulness" to loot a mountain of money from CAI.
But this statement is contradicted by the way CAI actually conducts its business.
Does you aim to say dat I CAIn't conversation in privut wid my frien's?
They CAIn't no man lay a hand on my mother and live long after it.
I CAIn't tell yer dat, but I knows I 'members seein' 'em in de big road.
It's a cinch we CAIn't find the divide if Carlson couldn't—he know'd the country.
Ye got me down, and I CAIn't help myself, ef so be ye mean to do hit; but better let me off this time.


text:
|Reviews for Karmic Balance
| Guest chapter 3 . 6/18
I love that phrase. "Unfortunately, all of the gods must have been either deaf, on vacation, or just plain rude," LOVED IT! SO FUNNY! I am personally rooting for "plain rude" as the gods never answered to any of my prayers. *pouts* I mean, they can't be on vacation every single time, and I'm pretty sure if they're deaf they can use hearing aids... so...I have jumped to the option of "plain rude". But I am still endeavoring for that day when the gods will let me have a hundred chocolate bars without having a sugar rush and let me read fanfiction for over twenty-four hours without having to stop for homework. :D LOVE YOUR STORY! Seriously, the AR fandom needs more Ian/Alex fics out there. SO LITTLE and even littler[that is not a word in the English language and I know it and I am apologizing profusely to Ms. Turner.(My English teacher that is obsessed with correct usage of grammar)] are as good as this one! YAY!
| musicalgirl4474 chapter 7 . 6/7
Well, Ian made it to Italian. (the swearing thing) and yes, Yassin, everything is karmic balance. (Lovely term, by the way. You should coin that phrase if no one else did yet.)
| jaylene.olebar.3 chapter 2 . 4/16
lol jack isn't IAN! lol i laughed and my friends in school gave a 'WTF' face ! funny
| jaylene.olebar.3 chapter 1 . 4/16
love it i am so late for a review uh?
| New and Old chapter 7 . 9/5/2014
O gosh. Oh gosh. i noted that you said that this was for you to add to the Alex rider fandom, and OMG great job!
Thank you thankyou thankyou for not doing a slash... geez I mean, slash is okay to a degree, but almost everything Alex Rider on FFnet is slash! It was sooo frustrating!
So thank you sooooo much for writing this! Oh geez this one was awesome! Loved it...
| thebeautifulbicky chapter 7 . 12/4/2013
Omg I love the ending. I love the Ian-Yassen dynamic so much - YOU KILLED ME, YOU BASTARD.
Herp derp.
| Toadmiffle chapter 7 . 10/29/2013
Type your review for this chapter here...
| CHiKa-RoXy chapter 7 . 8/11/2011
why on earth do people write 'El Fin' after a story?
do you even know on what lenguage that is? it's in Spanish, and it's writte like 'Final' not 'Fin'
anyways, loved the story, i liked it :)
i hope you can do a sequel outta this
| doomedpassion chapter 7 . 2/1/2011
This was so awesome! and the end...wow...back full circle with the books ) yay! alex doesn't remember...
| guepard54 chapter 1 . 9/26/2010
genious story
| writertron chapter 7 . 6/11/2010
karmic balance... how convenient for yassen to end up with all these excuses for saving alex's life P good story!
| hypercell chapter 7 . 3/21/2010
wow, I love how you tied it in with the books in that last scene! Great story!
| Anonymous is a pretty bad name chapter 7 . 3/17/2010
Oh wow. I adore the last paragraph, it completes the whole story brilliantly.
Yassen sounds a bit like a psychopath XD
| HurogWalker chapter 7 . 12/27/2009
*gasp* Thats it? No more? Awesome plot line though. Loved it.
| iRiot.Light chapter 7 . 11/11/2009
O yess! I absolutely loved it! Oh dear me how wonderful! I've recently been bored on FF and knew you were a wonderful author so I decided to check out your stories! Wonderful this one was. However I do wish for you to continue the Unlikely soon? I've been waiting eagerly for an update, but am understanding for a hectic schedule. Good luck and keep on writing. :)
Without Wax
Contact R.


text:
Dare2b On Your Bike Cycle Short
The Dare2b On Your Bike Cycle Shorts, are stretch fabric cycle shorts that come with molded double density inserts for extra comfort. With an elasticated waistband and lightweight construction, these shorts are quick drying and ideal for hitting the roads in comfort and sophistication.
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text: Rappler raised as good example by UP student Written by marichulambino " 'You wouldn't like it when I'm angry…' " written by Mumster " I think Rappler's report on the peace talks deadlock between the Philippine government and the Moro International Liberation Front (www.rappler.com/nation/special-coverage/peacetalks/31452-ph-milf-peace-talks-) covered both sides fairly. It made sure that both parties had their say in every issue that it raised about the delay on the peace pact. "Although when I first saw the title of the article (MILF on stalled talks: 'Frustrated, angry') I expected another "demonization" of our Muslim brothers and sisters, I was quite relieved when I found this wasn't so. I know coming up with an attention-grabbing title for a news article is tricky. But I was glad Rappler clearly stated the context of the MILF leadership's frustration and anger on the progress (or should I say lack of it?) of the peace talks. "Fair airing of the government and MILF's accounts regarding the draft annexes for wealth and power-sharing and other related issues is a welcome change. For once, it didn't seem like I was a reading a script of a telenovela where the government is the good guy and the rebels are the bad guys."Posted by Mumster YOU CAN REPOST W/ CREDITS PLS, TNXTwitterFacebookEmailPrintLinkedInRedditTumblrLike this:Like Loading... comments are welcome anytime Cancel reply Enter your comment here... Fill in your details below or click an icon to log in: Email (required) (Address never made public) Name (required) Website You are commenting using your WordPress.com account. ( Log Out / Change ) You are commenting using your Twitter account. ( Log Out / Change ) You are commenting using your Facebook account. ( Log Out / Change ) You are commenting using your Google+ account. ( Log Out / Change ) Cancel Connecting to %s


text:
Hellyeah's Tom Maxwell Talks 'Blood for Blood' Album, 'Moth' + Upcoming Tour
Hellyeah's Tom Maxwell reflects on the band's big year and looks forward to their tour with Devour the Day and Like a Storm.
Hellyeah's Tom Maxwell reflects on the band's big year and looks forward to their tour with Devour the Day and Like a Storm.
Slipknot have unleashed a fiery live video of 'The Devil in I,' which was recorded at Knotfest 2014.
The 2015 Rock on the Range lineup has been unveiled, and Linkin Park, Judas Priest and Slipknot will headline the festival.
Even bands are getting in on the Black Friday action! Starting Friday (November 28th) and ending Monday (December 1st) at 11:59 p.m. you can score a 4-pack of Volbeat/Anthrax tickets for $99...
Good work Missoula, the Flogging Molly show scheduled for Friday, December 12th is completely sold out. Thank you for supporting live music!
Getcha pull at the 8th annual Dimestock!
In a video posted by Nerdist, the entire process of turning Scott Ian into a cannibalistic member of the bitten is documented.
Here is your pre-sale information so you can be the first to get your tickets for the Volbeat show on April 28th at the Adams Center.
Can't make it to San Bernardino, but want to catch this year's Knotfest? Watch the action via this webcast on Saturday and Sunday.
'Moth' is one of the standout cuts on Hellyeah's 'Blood for Blood' album, and we asked them all about the tune when they recently stopped by our studio.
Slipknot were planning on keeping their new bassist's identity a mystery, and the band was succeeding until the video for 'The Devil in I' was released.


text:
October 8, 2015
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Michael Frey, left, Stephanie Wilson, center, and Al Mancini at the Viva Max! benefit dinner for Max Jacobson hosted at Luxor's Tacos & Tequila restaurant Thursday, March 13, 2014. All proceeds went toward the recovery of Max Jacobson.
© Las Vegas Sun, 2015, All Rights Reserved


text:
Latest Weather Blog
Fire: Arson in Baton Rouge Saturday morning
Topics : Arson Brusly fire baton rouge fire department Billups
BATON ROUGE - Arson is believed to be the cause of an early morning house fire in Baton Rouge Saturday morning, according to the Baton Rouge Fire Department.
It happened on the 3900 block of Billops street off 39th street just before 6 a.m. Fire officials say there were four spots around the house where the arsonist attempted to start a fire.
Officials say the fire was put out in about five minutes, before much damage was done.
The fire is still under investigation.
More News
Desktop NewsClick to open Continuous News in a sidebar that updates in real-time.
News Video
Daycare owner indicted on negligent homicide charge in child's death
Slow start to ticket sales for Saturday's LSU, USC game
La. VA secretary out amid patient care scandal
LSU general admission tickets go on sale Thursday
West Feliciana deputy accused of using 'n' word, multiple complaints filed


text:
The Leading eBooks Store Online
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Barrel of a GunCasemate 2010; US$ 20.95
Anybody who says that the pen is mightier than the sword hasnt spent time in Somalia, or in Beirut during its bloody heyday. So begins this fascinating memoir of a journalist, filmmaker, and just plain raconteur who has made a career of examining warfareon the ground and as the bullets are flying. While the average citizen is... more...
Principles of American JournalismTaylor and Francis 2013; US$ 49.95
In a rapidly changing media landscape, what becomes of journalism? Designed to engage, inspire and challenge students while laying out the fundamental principles of the craft, Principles of American Journalism introduces students to the core values of journalism and its singularly important role in a democracy. From the First Amendment to Facebook,... more...
Ginger-SnapsThe Floating Press 2012; US$ 3.99
An influential critic, commentator, and journalist, New England-based writer Fanny Fern (born Sara Willis) ascended to the very highest levels of literary acclaim in the late nineteenth century, even at one time commanding the title of the best-paid woman writer in the United States. The collection Ginger-Snaps brings together many of Fern's most... more...
Memories and StudiesThe Floating Press 2012; US$ 4.99
William James was a towering intellectual figure with a vast knowledge base that transcended typical disciplinary boundaries. In this collection of essays, William James explores the topics of memory and cognition through the lenses of philosophy, psychology, and his own personal life experiences, all recounted in his uniquely engaging writing style. more...
HieroglyphicsThe Floating Press 2014; US$ 3.99
Welsh writer Arthur Machen achieved literary acclaim with his groundbreaking tales of the supernatural, some of which modern-day horror luminary Stephen King ranks among the best in the English language. In the engaging nonfiction volume Hieroglyphics, Machen turns his focus to literary criticism, opining on the role of the ecstatic in literature. more...
Liebe, Lust und LeidenschaftKomplett Media GmbH 2011; US$ 5.60
Die Liebe - wir alle glauben, sie zu kennen. Und doch scheint jeder anders zu lieben: die Leidenschaft der Sappho l�sst sie ergl�hend erzittern und raubt ihr das Bewusstsein. Didos rasende Liebe zu ihrem Ein und Alles Aeneas f�hrt nach dem Liebesverrat zum Selbstmord. Der vom Eros begeisterte Platoniker vervollkommnet sein Ich und steigt durch die... more...
Washington Merry-Go-RoundPotomac Books 2015; US$ 39.95
For most of three decades, Drew Pearson was the most well-known journalist in the United States. In his daily newspaper column?the most widely syndicated in the nation?and on radio and television broadcasts, he chronicled the political and public policy news of the nation. At the same time, he worked his way into the inner circles of policy makers... more...
Ending the AffairUniversity of NSW Press 2005; US$ 32.95
Examines the state of current affairs television in Australia today by pondering its future, while drawing lessons from the past. The book questions the social and political value of what we now think of as current affairs journalism. Underpinning this approach is the conviction that TV current affairs serves functions which are important to a civilised... more...
Tabloid BritainTaylor & Francis 2005; US$ 41.95
Tabloid Britain examines four popular tabloid newspapers and uncovers the variety of linguistic strategies they use to depict contemporary Britain. Martin Conboy considers how this imaginary community of the British nation is drawn through themes such as 'outsiders' and 'insiders', women, celebrity, history and politics. more...
GonzoLittle, Brown and Company 2007; US$ 9.99
Few American lives are stranger, more action-packed, or wilder than that of Hunter S. Thompson. Born a rebel in Louisville , Kentucky , Thompson spent a lifetime channeling his energy and insight into such landmark works as Fear and Loathing in Las Vegas - and his singular and provocative style challenged and revolutionized writing. Now, for... more...


text:
occupational health Companies in Georgia (US)
Certification Europe
based in Dublin, IRELAND
Certification Europe is an accredited certification body which provides International Organization for Standardization (ISO) management system certification and inspection services to organisations globally. ISO Standards provide a recognised framework to achieve best practice management. Certification Europe can certify your organisation to Quality (ISO 9001), ...
Environmental Compliance Systems, Inc.
based in Lake Mills, WISCONSIN (USA)
Environmental Compliance Systems Inc. specializes in risk management and performance improvement. ECSI provides auditing, consulting, and training services which improve overall business function while increasing profit margins.
3E Company
based in Carlsbad, CALIFORNIA (USA)
3E Company's comprehensive suite of data products and information services enable improved compliance with global Environmental Health & Safety (EH&S) requirements related to the safe manufacturing, distribution, transportation, usage and disposal of chemicals and hazardous products. This full chemical lifecycle approach enables in-house EH&S staff to reduce cost, risk ...
Enhesa - Global EHS & Product Compliance Assurance
based in Brussels, BELGIUM
Enhesa is a global environmental, health and safety consulting firm, providing EHS regulatory compliance assurance support to businesses worldwide. Over the past 20 years, Enhesa has built a knowledgebase of EHS regulations which includes the "What" of business requirements, the "How" to develop cost-effective solutions and the "When" of enforcement activities in over 200 ...
T3 EH&S Planning and Implementation Services
based in Dallas, TEXAS (USA)
T3, a division of Trinity Consultants, helps businesses operate more efficiently and cost-effectively, while improving environmental, health, and safety (EH&S) performance. With a unique mix of extensive experience in EH&S consulting, software development, system support, and training, T3 harnesses the power of technology to help streamline your EH&S information ...
Alliant Corporation
based in Knoxville, TENNESSEE (USA)
Alliant's success is built upon the four cornerstones of integrity, competency, dependablility, and flexibility. The best measure of our success is to solve clients' problems, within their budget or schedule constraints. Our objective is to allow our clients to focus on their primary business by calling upon Alliant's capabilities in: Occupational Safety and Health, ...
Intelex Technologies Inc.
based in Toronto, ONTARIO (CANADA)
(Intelex Technologies, Inc.) Trusted since 1992, Intelex is a global leader in EHS, Quality and Business Performance Management software. We enable organizations to ensure the highest standard of health, safety and environmental conditions as well as superior product and service quality by streamlining and integrating business data for our more than 1,000 clients and ...
Bonza Training Solutions
based in Stratford, ONTARIO (CANADA)
We are an experienced training organization, working to help companies meet their training needs and achieve their goals.Bonza Training Solutions offers public training courses in the ISO, Manufacturing, Management Development and Occupational Health & Safety (OH&S) fields, as well as customized courses for companies requiring on-site training. For those wanting the ...
Riebdon Group
based in Marco Island, FLORIDA (USA)
Headquartered in Florida, Riebdon Group is a global provider in Quality Environmental Health and Safety Consulting, Engineering and Project/ Program management delivering high quality services to help clients meet the growing challenges of quality, safety, environmental protection and social responsibility. As a trusted partner, Riebdon Group offers innovative solutions ...
OMI Industries
based in Long Grove, ILLINOIS (USA)
OMI Industries (OMI) specializes in controlling malodors and emissions with our patented Ecosorb(R) technology. OMI has extensive experience engineering solutions to solve a variety of odor-related problems from industries that experience year-round odor problems due to their production process, to seasonal odor problems due to temperature, to occasional odor problems ...
Related Terms for occupational health
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text:
This Workshop is part of EHRO-N/ECVET project aiming at the implementation of ECVET system in the nuclear energy sector. ECVET is the European initiative on education and training to promote transparent and transferable qualifications.
This Workshop is part of EHRO-N/ECVET project aiming at the implementation of ECVET system in the nuclear energy sector. ECVET is the European initiative on education and training to promote transparent and transferable qualifications.
At this one-day Conference in the EU Pavillion of the EXPO site, the JRC will give an overview of its activities in agricultural and agro-environmental monitoring, yield forecasting and early warning, deforestation and land use/land cover monitoring.
The training course focuses on showing methods and tools for the implementation of Regulation 994/2010 on security of gas supply. The aim is to provide potentially interested organisations (Regulators, Competent Authorities, etc.) and persons the methods needed to implement correctly the Regulation 994/2010.
Reference & description
In conjunction with the EU Code Week 2015, the JRC is organising the Happy Onlife laboratory for children between 8 and 12 and teachers from local schools.
They will validate innovative methods (Happy Onlife & Coding with Scratch) of developing formal and informal education for a better use of digital technologies, thus contributing to JRC research in this field.
A two-day festival 'Resonances', where the JRC will experiment with the building blocks of science, politics and the arts.
The EU Expo Taskforce of the JRC has organised an international conference to close the scientific programme of activities at Expo Milano 2015. Taking place just one day before World Food Day, it will offer a platform where international actors from politics, the scientific community, industry, and civil society can discuss the recommendations for a "European Research and Innovation Agenda for Global Food and Nutrition Security" that have been produced by the EU scientific steering committee for Expo 2015.
with discussants:
Jerome Ravetz, Oxford
Silvio Funtowicz, Univ. of Bergen, NO
JRC- ITU is organising in cooperation with the Ministry of Environment, Climate Protection and the Energy Sector of Baden- Württemberg, a public information event about the infrastructure development at the Karlsruhe site, as a follow-up of the mediation process of the last years. The event will take place on 16th of October 2015 at the Karlsruhe Institute of Technology premises.
This two-day conference brings together soil scientists and specialists in the areas of communication and education in order to understand how best to raise awareness among an increasingly urbanised public and policy makers of the life-critical ecosystems services that are provided by soil.
Shortly after the adoption of the Sustainable Development Goals and just ahead of the 21st Conference of the Parties to the UNFCCC in Paris (COP21), the JRC organises a joint event together with the Berlin-Brandenburg Academy of Sciences and Humanities (BBAW) to discuss the inequality dimension of climate change. The event will be opened by JRC Director-General Vladimír Šucha and Chair of the JRC Board of Governors Walter Mönig as well as Annette Grüters-Kieslich, Vice-President, Berlin-Brandenburg Academy of Sciences and Humanities, and include a keynote by Apollonia Miola, JRC Institute for Environment and Sustainability.


text:
Illinois Public Media News
In-depth reporting from WILL, NPR, the Associated Press, and other sources
Contact WILL News at email@example.com
(Indiana University Jacobs School of Music)
April 29, 2013
(Scott Boehm/AP Images for Olive Garden)
April 29, 2013
As Health Law Changes Loom, A Shift to Part-Time Workers
(Andrew Harnik /The Washington Times /Landov)
April 29, 2013
Sen. Manchin Says Background Checks Bill Will Pass Next Time
Page 468 of 950 pages ‹ First < 466 467 468 469 470 > Last ›
WILL Newscast audio
NPR News
Mother Teresa's Missionaries Of Charity Says No More Adoptions In India
Why Is The Sky Blue? (On Pluto, That Is)
California Approves A Sweeping Digital Privacy Law
U.S. Says It Will Overhaul Program Intended To Train Syrian Rebels
Shooting At Northern Arizona University Campus: 1 Dead, 3 Injured
'We Did It Together,' Says Tunisian Co-Winner Of 2015 Nobel Peace Prize
North Charleston Will Pay Walter Scott's Family $6.5 Million
SS United States, Once a Marvel Of Technology, May Soon Be Reduced To Scraps
Partisan Divide Widens Over Immigration Policy
NASA Rover Finds Evidence That Mars Once Had Lakes
More NPR News
WILL Highlights
Vintage Vinyl is coming!
The Vintage Vinyl Sale to benefit Illinois Radio Reader returns on October 3. Click for the latest info.
WILL News wins PRNDI Award for "Unmet Needs" Radio Doc
The 2014 radio documentary, produced by former WILL staff and hosted by Scott Cameron, won second place in the Long Form Documentary category among medium-sized stations.
WILL Ag Director Dave Dickey retires
He carried on the farm broadcasting tradition, while innovating on the Internet.


text:
2012 Gear & Apparel on Sale2012 Gear & Apparel is now on SALE! Choose from the best brands in outdoor and winter sports! The 2012 Gear includes the latest in snowboard and ski technologies at lowest prices on the web. With a huge selection of 1200+ 2012 items in stock, you'll find exactly what you're looking for.
4 Results for 2012 Gear & Apparel on Sale
- Brand: Sessions
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Size: X-Small, Small, Medium, Large, X-Large
Reg: $71.95 On Sale: $39.95
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Reg: $149.95 On Sale: $82.95
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Reg: $139.95 On Sale: $76.95


text: I booked this hotel for a high school robotics trip and was extremely disappointing. Here are the list of room issues that I had, and this doesn't even cover the students rooms. Tub had a slow clog in it Hairdryer had no heat Box spring on the bed was dirty. Had hairs and other gross human artifacts. The room smelled... More


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Autopsy of a Debt Collection LawsuitRecently I read an article that said nearly 98% of debt collection lawsuits ended up in a default judgment. A default judgment is entered with the person getting sued doesn't respond to...more
I don't know how much more I can take. Day in and day out I meet with people that have been sued by Midland Funding, Equable Ascent, LVNV, LLC, Portfolio Recovery – and a long list of the other debt buyers. And many – too...more
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Street Fighter Alpha Anthology
Great game but no online....By Justin Nelson Score:
Jun 05, 2007 1:18AM PST
Of course these games include the original battle modes like the popular 2-on-1 battles, training, survival, etc. Curiously, Street Fighter Alpha 3 doesn't feature the World Tour Mode, which may break the hearts of hardcore Alpha purists.. There's also no multiplayer mode, save two-player battle. While most of these Capcom collections don't offer that to begin with, it still would have been nice to be able to slug it out online and maybe have the option of a leaderboard ranking system. Sure that's asking too much for a classic collection, and it wasn't something they promised but still it would have been cool...finally it's worth mentioning that if you have a Hard Drive for your PS2 this game supports it. Using this optional loading feature, players won't have to wait as long for the game to load, which makes it an almost immediate transition from menu-to-game. It's a nice feature, but if you don't own the PS2 Hard Drive, you'll only be subjected to a minimal load time anyway. In the end, Capcom's Street Fighter Alpha Anthology is a good deal and certainly a tribute to arguably the best 2D beat 'em series for its time. There's a lot of hidden extras in this game, and despite a few slight omissions, this collection delivers what it promises on the box. If you're still in love with the Street Fighter Alpha series then this collection is a required purchase.
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