Long-term follow-up of flexor digitorum longus transfer and calcaneal osteotomy for stage II posterior tibial tendon dysfunction

Flexor digitorum longus transfer and medial displacement alcaneal osteotomy is a wellrecognised form of treatment or stage II posterior tibial tendon dysfunction. Although excellent short- and medium-term results have been reported, the long-term outcome is unknown. We reviewed the clinical outcome of 31 patients with a symptomatic flexible flatfoot deformity who underwent this procedure between 1994 and 1996. There were 21 women and ten men with a mean age of 54.3 years (42 to 70). The mean follow-up was 15.2 years (11.4 to 16.5). All scores improved significantly (p < 0.001). The mean American Orthopedic Foot and Ankle Society (AOFAS) score improved from 48.4 pre-operatively to 90.3 (54 to 100) at the final follow-up. The mean pain component improved from 12.3 to 35.2 (20 to 40). The mean function score improved from 35.2 to 45.6 (30 to 50). The mean visual analogue score for pain improved from 7.3 to 1.3 (0 to 6). The mean Short Form-36 physical component score was 40.6 (SD 8.9), and this showed a significant correlation with the mean AOFAS score (r = 0.68, p = 0.005). A total of 27 patients (87%) were pain free and functioning well at the final follow-up. We believe that flexor digitorum longus transfer and calcaneal osteotomy provides long-term pain relief and satisfactory function in the treatment of stage II posterior tibial tendon dysfunction.

Adjustable stiffness, external fixator for the rat femur osteotomy and segmental bone defect models

The mechanical environment around the healing of broken bone is very important as it determines the way the fracture will heal. Over the past decade there has been great clinical interest in improving bone healing by altering the mechanical environment through the fixation stability around the lesion. One constraint of preclinical animal research in this area is the lack of experimental control over the local mechanical environment within a large segmental defect as well as osteotomies as they heal. In this paper we report on the design and use of an external fixator to study the healing of large segmental bone defects or osteotomies. This device not only allows for controlled axial stiffness on the bone lesion as it heals, but it also enables the change of stiffness during the healing process in vivo. The conducted experiments have shown that the fixators were able to maintain a 5 mm femoral defect gap in rats in vivo during unrestricted cage activity for at least 8 weeks. Likewise, we observed no distortion or infections, including pin infections during the entire healing period. These results demonstrate that our newly developed external fixator was able to achieve reproducible and standardized stabilization, and the alteration of the mechanical environment of in vivo rat large bone defects and various size osteotomies. This confirms that the external fixation device is well suited for preclinical research investigations using a rat model in the field of bone regeneration and repair.

Customised osteotomy guides and endoprosthetic reconstruction for periacetabular tumours

Purpose We sought to analyse clinical and oncological outcomes of patients after guided resection of periacetabular tumours and endoprosthetic reconstruction of the remaining defect. Methods From 1988 to 2008, we treated 56 consecutive patients (mean age 52.5 years, 41.1 % women). Patients were followed up either until death or February 2011 (mean follow up 5.5 years, range 0.1–22.5, standard deviation ± 5.3). Kaplan–Meier analysis was used to estimate survival rates. Results Disease-specific survival was 59.9 % at five years and 49.7 % at ten and 20 years, respectively. Wide resection margins were achieved in 38 patients, whereas 11 patients underwent marginal and seven intralesional resection. Survival was significantly better in patients with wide or marginal resection than in patients with intralesional resection (p = 0.022). Survival for patients with secondary tumours was significantly worse than for patients with primary tumours (p = 0.003). In 29 patients (51.8 %), at least one reoperation was necessary, resulting in a revision-free survival of 50.5 % at five years, 41.1 % at ten years and 30.6 % at 20 years. Implant survival was 77.0 % at five years, 68.6 % at ten years and 51.8 % at 20 years. A total of 35 patients (62.5 %) experienced one or more complications after surgery. Ten of 56 patients (17.9 %) experienced local recurrence after a mean of 8.9 months. The mean postoperative Musculoskeletal Tumor Society (MSTS) score was 18.1 (60.1 %). Conclusion The surgical approach assessed in this study simplifies the process of tumour resection and prosthesis implantation and leads to acceptable clinical and oncological outcomes.

Potential role of intensity-modulated radiotherapy in the treatment of tumors of the maxillary sinus.

To assess 3-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) techniques to see whether doses to critical structures could be reduced while maintaining planning target volume (PTV) coverage in patients receiving conventional radiotherapy (RT) for carcinoma of the maxillary sinus because of the risk of radiation-induced complications, particularly visual loss. Six patients who had recently received conventional RT for carcinoma of the maxillary sinus were studied. Conventional RT, 3D-CRT, and step-and-shoot IMRT plans were prepared using the same 2-field arrangement. The effect of reducing the number of segments in the IMRT beams was investigated. 3D-CRT and IMRT reduced the brain and ipsilateral parotid gland doses compared with the conventional plans. IMRT reduced doses to both optic nerves; for the contralateral optic nerve, 15-segment IMRT plans delivered an average maximal dose of 56.4 Gy (range 53.9–59.3) compared with 65.7 Gy (range 65.3–65.9) and 64.2 Gy (range 61.4–65.6) for conventional RT and 3D-CRT, respectively. IMRT also gave improved PTV homogeneity and improved coverage, with an average of 8.5% (range 7.0–11.7%) of the volume receiving

Étude pilote des effets du Tandem Forsus Maxillary Corrector sur la croissance des maxillaires

Objectif : Récemment, un nouvel appareil issu de la technologie du Forsus™ et visant à corriger les malocclusions de classe III a été mis sur le marché et se popularise dans la pratique orthodontique : le Tandem Forsus Maxillary Corrector (TFMC). L’objectif de la présente étude est de mesurer les effets squelettiques, l’influence réelle sur la croissance, et les effets dento-alvéolaires du port du TFMC. Matériel et méthodes : 14 patients présentant une malocclusion de classe III (âge moyen de 9 ans 6 mois) traités par le même orthodontiste ont participé à cette étude prospective. Le groupe consiste en 10 garçons et 4 filles. Le Tandem Forsus Maxillary Corrector est porté de 12 à 14 heures par jour jusqu’à l’obtention d’une surcorrection du surplomb horizontal et une relation dentaire de classe I. Le traitement est généralement d’une durée de 8 à 9 mois. Des radiographies céphalométriques latérales prises avant (T1) et après (T2) le traitement ont été analysées afin de déterminer les changements dentaires et squelettiques. Les résultats ont été comparés à un groupe contrôle composé de 42 enfants provenant du Centre de croissance de l’Université de Montréal. Les radiographies ont été tracées et analysées de manière aveugle à l’aide du logiciel Dolphin Imaging (ver 11.0, Patterson Dental, Chatsworth, California). L’erreur sur la méthode a été évaluée avec la formule de Dahlberg, le coefficient de corrélation intra-classe et l’indice de Bland-Altman. L’effet du traitement a été évalué à l’aide du test t pour échantillons appariés. L’effet de la croissance pour le groupe contrôle a été calculé à l’aide d’un test t pour échantillons indépendants. Résultats : L’utilisation du TFMC produit un mouvement antérieur et une rotation antihoraire du maxillaire. De plus, il procline les incisives supérieures et rétrocline les incisives inférieures. Une rotation antihoraire du plan occlusal contribue aussi à la correction de la malocclusion de classe III. Par contre, le TFMC ne semble pas avoir pour effet de restreindre la croissance mandibulaire. Conclusion : La présente étude tend à démontrer que le port de l’appareil TFMC a un effet orthopédique et dento-alvéolaire significatif lors du traitement correctif des malocclusions modérées de classe III.

Maxillary complete denture movement during chewing in mandibular removable partial denture wearers

To evaluate the pattern of maxillary complete denture movement during chewing for free-end removable partial dentures (RPD) wearers, compared to maxillary and mandibular complete denture wearers. Eighteen edentulous participants (group I) and 10 volunteers with bilateral posterior edentulous mandibles (group II) comprised the sample. Measures of mean denture movement and its variability were obtained by a kinesiographic instrument K6-I Diagnostic System, during the mastication of bread and a polysulphide block. Data were analysed using two-way anova (alpha = 0.05). Upper movement during chewing was significantly lower for group II, regardless of the test food. The test food did not influence the vertical or lateral position of the denture bases, but more anterior dislocation was found when polysulphide blocks were chewed. Group II presented lower intra-individual variability for the vertical axis. Vertical displacement was also more precise with bread as a test food. It can be concluded that mandibular free-end RPD wearers show smaller and more precise movements than mandibular complete denture wearers.