Alexander Views Research Articles

Arthroscopically assisted stabilization of acute high-grade acromioclavicular joint separations in a coracoclavicular Double-TightRope technique: V-shaped versus parallel drill hole orientation

The arthroscopically assisted Double-TightRope technique has recently been reported to yield good to excellent clinical results in the treatment of acute, high-grade acromioclavicular dislocation. However, the orientation of the transclavicular-transcoracoidal drill holes remains a matter of debate. A V-shaped drill hole orientation leads to better clinical and radiologic results and provides a higher vertical and horizontal stability compared to parallel drill hole placement. This was a cohort study; level of evidence, 2b. Two groups of patients with acute high-grade acromioclavicular joint instability (Rockwood type V) were included in this prospective, non-randomized cohort study. 15 patients (1 female/14 male) with a mean age of 37.7 (18-66) years were treated with aDouble-TightRope technique using a V-shaped orientation of the drill holes (group 1). 13 patients (1 female/12 male) with a mean age of 40.9 (21-59) years were treated with a Double-TightRope technique with a parallel drill hole placement (group 2). After 2 years, the final evaluation consisted of a complete physical examination of both shoulders, evaluation of the Subjective Shoulder Value (SSV), Constant Score (CS), Taft Score (TF) and Acromioclavicular Joint Instability Score (ACJI) as well as a radiologic examination including bilateral anteroposterior stress views and bilateral Alexander views. After a mean follow-up of 2 years, all patients were free of shoulder pain at rest and during daily activities. Range of motion did not differ significantly between both groups (p>0.05). Patients in group 1 reached on average 92.4 points in the CS, 96.2% in the SSV, 10.5 points in the TF and 75.9 points in the ACJI. Patients in group 2 scored 90.5 points in the CS, 93.9% in the SSV, 10.5 points in the TF and 84.5 points in the ACJI (p>0.05). Radiographically, the coracoclavicular distance was found to be 13.9mm (group 1) and 13.4mm (group 2) on the affected side and 9.3mm (group 1) and 9.4mm (group 2) on the contralateral side. The distance of neither the affected side nor the contralateral side differed significantly between both groups (p>0.05). In group 1, eight patients (53%) and in group 2 four patients (31%) revealed signs of dynamic posterior instability (p>0.05). Clavicular drill hole enlargement was found to be equally distributed in group 1, whereas group 2 displayed a cone-shaped form. The Double-TightRope technique yields good to excellent clinical results in both V-shaped and parallel drill hole placement. Partial recurrent vertical and horizontal instability represents a problem in both techniques. So far, no significant differences regarding clinical or radiologic results have been found. Long-term results are needed to reveal possible advantages in terms of clinical and radiologic acromioclavicular stability.

Management of acute acromioclavicular joint dislocations: current concepts

Acromioclavicular joint (ACJ) injuries represent a common injury to the shoulder girdle. In the management algorithm of acute ACJ injuries complete radiological evaluation represents the key to a successful therapy. According to the classification of Rockwood the presence of a horizontal component in addition to vertical instability has to be detected. Using axillary functional views or Alexander views dynamic horizontal ACJ instability can be diagnosed in a simple, efficient and cost-effective manner reducing the number of mis-/underdiagnosed ACJ injuries. MRI should not be the imaging modality of first choice. The treatment of ACJ dislocations must consider two aspects. In addition to the correct type of injury therapy strategies should be adapted to patient's demands and compliance. Low grade AC injuries types I and II are treated non-operatively in terms of "skilful-neglect". High-grade injuries types IV-VI should be treated operatively within a time frame of 2-3 weeks after injury. A certain debate is still ongoing regarding type III injuries. Out from the literature, non-operative treatment of type III injuries results to provide at least equal functional outcomes as compared to surgical treatment associated with less complications and earlier return to professional and sports activities. If surgical treatment is indicated, open surgical procedures using pins, PDS-slings or hook plates are still widely used concurring with recently raising minimally invasive, arthroscopic techniques using new implants designed to remain in situ. Combined coracoclavicular and acromioclavicular repair are gaining in importance to restore horizontal as well as vertical ACJ stability.

Arthroscopically Assisted Stabilization of Acute High-Grade Acromioclavicular Joint Separations

Background: The purpose of this study was to evaluate the clinical and radiological results after arthroscopically assisted and image intensifier–controlled stabilization of high-grade acromioclavicular (AC) joint separations using the double TightRope technique with the first-generation implant. Hypothesis: The double TightRope technique using the first-generation implant leads to good clinical and radiological results by re-creating the anatomy of the AC joint. Study Design: Case series; Level of evidence, 4. Methods: Thirty-seven consecutive patients (4 women and 33 men; mean age, 38.6 years) who sustained an acute AC joint dislocation grade V according to Rockwood were included in this prospective study. The Subjective Shoulder Value (SSV), the Constant Score (CS), the Taft Score (TS), and a newly developed Acromioclavicular Joint Instability Score (ACJI) were used for final follow-up. Bilateral stress views and bilateral Alexander views were taken to evaluate radiographic signs of recurrent vertical and horizontal AC joint instability. Results: Twenty-eight patients (2 women and 26 men; mean age, 38.8 years [range, 18-66 years]) could be evaluated after a mean follow-up of 26.5 months (range, 20.1-32.8 months). The interval from trauma to surgery averaged 7.3 days (range, 0-18 days). The mean SSV reached 95.1% (range, 85%-100%), the mean CS was 91.5 points (range, 84-100) (contralateral side: mean, 92.6 points), the mean TS was 10.5 points (range, 7-12), and the ACJI averaged 79.9 points (range, 45-100). The final coracoclavicular distance was 13.6 mm (range, 5-27 mm) on the operated versus 9.4 mm (range, 4-15 mm) on the contralateral side (P < .05). Radiographic signs of posterior instability were noted in 42.9% of cases. Patients with evidence of posterior instability had significantly inferior results in the TS and the ACJI (P < .05). Neither coracoid fractures nor early (within 6 weeks postoperatively) loss of reduction due to tunnel malpositioning or implant loosening was observed. Conclusion: The combined arthroscopically assisted and image intensifier–controlled double TightRope technique using implants of the first-generation represents a safe technique and yields good to excellent early clinical results despite the presence of partial recurrent vertical and horizontal AC joint instability.

Adventures in the Spirit: God, World, Divine Action (review)

Reviewed by: Adventures in the Spirit: God, World, Divine Action Donald Wayne Viney Adventures in the Spirit: God, World, Divine Action. Philip Clayton. Edited by Zachary Simpson. Minneapolis: Fortress Press, 2008. 310 pp. $25.00 paper. Philip Clayton, Ingraham Professor of Theology at Claremont School of Theology, is widely recognized both as a major contributor to contemporary discussions of the relations between science and religion and as a philosopher-theologian of great originality. Although Clayton invariably couches his arguments and conclusions in fallibilist terms, this is, by any measure, an ambitious book. It is the closest thing yet to his magnum opus. Included are revisions of fifteen previously published articles that appeared between 1997 and 2008 and revisions of two lectures delivered at Claremont in 2004. Following the editor's introduction, the book is divided into five parts. Part 1 could be read as a commentary on Whitehead's statement in Science and the Modern World that "Religion will not regain its old power until it can face change in the same spirit as does science." The rise in the prestige of science since the seventeenth century and the whittling away of the metaphysical certainties of religion have jeopardized the very possibility of theology. Richard Dawkins, as is well known, claims that theology has no more content than the study of leprechauns. Clayton banks that Dawkins is wrong. He advocates a method for theology that "builds the controversial nature of religious belief into theology itself" (26). This is implicit in his concept of the "secular believer," one who participates in the life of a religious community while entertaining doubts about its truth claims (47, 58). Clayton refuses to insulate theology from scientific or philosophic critique. This is not to say that he opts for treating the activity of God as a scientific hypothesis, after the manner of the new atheists and the intelligent design creationists. Rather, Clayton seeks what he calls maximum traction (54f) between science and theology. He argues that when the rubber hits the road, so to speak, the frontiers of science point beyond themselves to theological questions and that theology, attentive to science, can be enriched by its discoveries. Clayton's rapprochement between science and theology begins in earnest in part 2, on emergence. Philosophers have long recognized that proponents of reducing mental processes to brain processes can offer only promissory notes, but the so-called "hard problems" of consciousness remain—first person ascriptions, [End Page 161] intentionality, and qualia. Clayton notes that the reductionist program is not only in trouble at the level of mind but also at every intersection where one scientific inquiry meets another. Following Harold Morowitz, Clayton thinks there may be as many as twenty-eight distinct levels of emergence (68, 191). Emergence theory does not posit properties that can exist independently of a physical substrate and the laws that govern it, as in Descartes' res cogitans ; rather, emergent properties exhibit dynamics that go beyond the substrate and its laws without contradicting them. For example, cells, unlike the atoms of which they are composed, reproduce themselves, and there is a science of how this is done that introduces ideas (like information) that are not part of atomic theory. Clayton's subtle but rich suggestion, inspired by Kant, is that preconscious biological systems exhibit "purposiveness without purpose" (79). The "strong emergence" that Clayton defends holds that emergent qualities bring with them emergent causal powers. At the highest levels available to our inspection, the emergent qualities are mental and perhaps even spiritual—although Clayton never says precisely what he means by spiritual qualities and powers (cf. 95). The book's third and fourth parts leave empirical science and ascend into more rarified speculation. The trajectory of emergentism, if it leads to spiritual properties, suggests that a divine being, if such exists, is the end product of the evolutionary ladder of complexification. This was Samuel Alexander's view. Clayton accepts that it is best to conceive the deity as in some respects dependent on creatures, even as the one "in whom we live, move, and have our being," but he denies that God is a product of the universe's processes. This puts him in the...

A Critique of R.D. Alexander's Views on Group Selection

Group selection is increasingly being viewed as an important force in human evolution. This paper examines the views of R.D. Alexander, one of the most influential thinkers about human behavior from an evolutionary perspective, on the subject of group selection. Alexander's general conception of evolution is based on the gene-centered approach of G.C. Williams, but he has also emphasized a potential role for group selection in the evolution of individual genomes and in human evolution. Alexander's views are internally inconsistent and underestimate the importance of group selection. Specific themes that Alexander has developed in his account of human evolution are important but are best understood within the framework of multilevel selection theory. From this perspective, Alexander's views on moral systems are not the radical departure from conventional views that he claims, but remain radical in another way more compatible with conventional views.

Alexander and the East: the tragedy of triumph

In this study Brian Bosworth looks at the critical period between 329 and 325 BC, when Alexander the Great was active in Central Asia and what is now Pakistan. He documents Alexander's relations with the peoples he conquered, and addresses the question of what it meant to be on the receiving end of the conquest, drawing a bleak picture of massacre and repression. At the same time Alexander's views of empire are investigated, his attitude to his subjects, and the development of his concepts of personal divinity and universal monarchy. Analogies are thus drawn with the Spanish conquest of Mexico, which has a comparable historiographical tradition and parallels many of Alexander's dealings with his subjects. Although of concern to the specialist, this book is equally directed at the general reader interested in the history of Alexander and the morality of empire.

Comment: Pensions and Passivity

Professor Alexander is justifiably critical of the pension-fund thesis.' The notion that, because pension plans have become the owners of a major portion of U.S. corporate equity and debt, there is some form of unseen socialist revolution is nonsensical. If life insurance companies owned these same assets, there would be no talk of socialism, yet the effect would be similar. The mere fact that one is the beneficiary of an annuity, life insurance policy, or a pension plan does not make one the owner of the underlying assets that generate the wealth necessary to make the payments thereunder. Socialism is a deeper concept than mere ownership. Even if all the pension plans and financial intermediaries were eliminated, and all corporate stock were somehow nationalized and distributed equally to every citizen, the present system would change little. The separation of ownership from control, in the Berle and Means sense,2 would remain. Such diffuse ownership would leave corporate managers even more unfettered than they are today, when at least some financial intermediaries, especially public pension funds, have become more active in reviewing management.3 This is a widely recognized contemporary problem, but it has little to do with pensions. Classical socialism is the utopian Marxist vision of direct worker ownership of the means of production. The workers control the factory in which they work or, certainly, at least the company that employs them. Professor Alexander sees some type of workplace democracy as a means whereby workers can protect themselves against plant closings, job relocations, wage reductions, and the like. One can certainly be skeptical about worker ownership providing enhanced protection against the general insecurities of the modern global marketplace, but the main problem with focusing on workplace democracy is that it is fundamentally unrelated to the issue of pension policy. Professor Alexander views pension plans as a device for achieving workplace democracy. The plan can simply buy the company, or at least enough of it to obtain a strong in corporate affairs. This voice would then be passed to the plan participants, who would steer the plan fiduciary in some democratic

Alexander of Aphrodisias' Views on Universals

Alexander's views on universals are, it seems, quite important in the history of western philosophy. When Boethius gives in his second commentary on Porphyry's Isagogel his solution to the problem of universals as he conceived it, he claims to be adopting Alexander's approach. If true, this means that the locus classicus for all western medieval thinkers on this topic is really a rendering of Alexander's teaching. Furthermore, as I shall point out later, there is good reason to think his views were influential in Arabic circles from about 900 on. In particular, Avicenna may have drawn on them. If this is the case, then later western medieval thought received a second dose of Aphrodisian doctrine, albeit indirectly from the great Persian doctor, when his writings, particularly his Metaphysics or Prima Philosophia became known in Europe from about 1160.2 However, it is not at all straightforward to determine what Alexander's theory of universals or common items exactly was, and this for several reasons. First of all, the view as we find it in Greek texts attributed to Alexander seems not entirely coherent, and the interpreter naturally feels unsure whether he has understood it properly. Secondly, doubt has been cast on the authentiticity of some of the more important of these texts. Finally, commentators, both ancient and modern, have ascribed an extreme anti-realist view to Alexander that, as we shall see, is not borne out

The Sources of Plutarch's Alexander

At the outset of the parallel lives of Alexander and Caesar, Plutarch warns his readers that what he offers them is biography, not history, and that consequently he will attend more to details which reveal character than to the great events. These he will either treat summarily or even omit entirely. Both the plan and the matter of the Life of Alexander are in harmony with this preface. The first ten chapters, which bring the story down to Alexander's accession, teem with anecdote and characterisation; then, after a rapid sketch of the wars in Illyria and Greece, the main narrative begins in ch. 15, with the crossing of the Hellespont. From thence to the end the biography is a historical sketch with digressions at intervals to illustrate various sides of Alexander's character. Thus the appointment of Aristotle as tutor to Alexander is followed by a disquisition on his attitude to learning and philosophy in general (7–8); the treatment of the captive women at Issus provokes a discussion (21, 5–23) on Alexander's continence, and subsequently on his temperance and habits of life. The journey to Siwah is followed by a general discussion of Alexander's views on his own deification (28), while the longest of such digressions, occasioned by the burning of the palace at Persepolis, deals with Alexander's generosity and his attention and loyalty to friends (39–42, 4). The common characteristics of these digressions are their disregard of chronology, their anecdotic content, and the prominence of the Letters of Alexander among the sources named in them; indeed, the only other sources appearing by name are Onesicritus (8, 2), Aristobulus (21, 9) and the official diaries (23, 4), each once.