Treatment of condylar fractures with an intraoral approach using an angulated screwdriver: Results of a multicentre study

Background This multicentre study aimed to investigate long-term radiographic and functional results following the treatment of condylar fractures using an angulated screwdriver system and open rigid internal fixation with an intraoral surgical approach. Methods Twenty-nine patients with a total of 32 condylar fractures were evaluated. The patients were investigated prospectively based on the following variables: age, sex, aetiology, side, location and classification of the fracture, degree of displacement, associated fractures, surgical approach, oral health status, type of osteosynthesis plate, duration of surgery, mouth-opening, complications, and duration of follow-up. Results The fractures were classified as subcondylar (n = 25) or condylar neck (n = 7). Mean patient age was 36.38 ± 16.60 years. The median duration of postoperative follow-up was 24.39 ± 13.94 months. No joint noise, weakness of the facial nerve, joint pain, or muscle pain was observed. An additional retromandibular approach was necessary to enable the treatment of one subcondylar fracture with medial displacement. Conclusion Subcondylar or condylar neck fractures with medial or lateral displacement can be treated using an intraoral approach with satisfactory results with the advantages of the absence of visible scarring, the avoidance of facial nerve injury, and the ability to obtain rapid access to the fracture.

Implant-supported rehabilitation after treatment of atrophic mandibular fractures: report of two cases

Objective The objective of this article is to present options of rehabilitation with dental implants in two cases of severely atrophic mandibles (<10 mm) after rigid internal fixation of fractures. Patients and method Two patients who sustained fractures in severely atrophic mandibles with less than 10 mm of bone height were treated by open reduction and internal fixation through a transcervical access. Internal fixation was obtained with 2.4-mm locking reconstruction plates. The first patient presented satisfactory bone height at the area between the mental foramens and after 2 years, received flapless guided implants in the anterior mandible and an immediate protocol prosthesis. The second patient received a tent pole iliac crest autogenous graft after 2 years of fracture treatment and immediate implants. After 5 months, a protocol prosthesis was installed in the second patient. Results In both cases, the internal fixation followed AO principles for load-bearing osteosynthesis. Both prosthetic devices were Branemark protocol prosthesis. The mandibular reconstruction plates were not removed. Both patients are rehabilitated without complications and satisfied with esthetic and functional results. Conclusion With the current techniques of internal fixation, grafting, and guided implants, the treatment of atrophic mandible fractures can achieve very good results, which were previously not possible.

Avaliação da espessura da mandíbula com relação à fixação interna rígida em osteotomia sagital: estudo anatômico

Purpose: Trying to provide more anatomical data to the oral and maxillofacial surgeons regarding to orthognathic surgery, specifically about sagittal split osteotomy, the authors accomplished an anatomical study in dry human jaws, measuring the thickness in four previously established points of the body and mandibular ramus, at the usual spots used for the internal fixation by screws. Material and Methods: The authors also use the data collected to evaluate if there are significant differences between the group I (human dry mandibles with teeth) and group II (edentulous human dry mandibles). Results: For the group I the authors found the following results: x1 = 14,48, x2 = 14,94, x3=12,82 and x4 = 9,41, being the x2 the thickest point, and the least thick the x4. However in the group II, the found medium values were: x1 = 13,38, x2 = 13,08, x3 = 11,63 and x4 = 12,18, being the thickest point in that group the x1 and the least thick x3. The coefficient of simple correlation between the variables (group I and II) revealed a value of 0,6194, being this difference no significant at the meaning level of 95%.

Pinos transcorticais e gesso associados à aplicação local de plasma rico em plaquetas no tratamento de fratura do III metatarsiano em potro

In horses less than one year of age fractures of the third metacarpal bone (McIII) or metatarsal bone III (MtIII) are mainly attributed to trauma. Open reduction and internal fixation are the most common treatment method. A Quarter Horse filly with three months of age, which weighed 150kg presented a diaphyseal multifragmentar wedge fracture of right MtIII which was treated with transcortical pins and cast, associated with intralesional application of platelet rich plasma (PRP). After two years of surgery, the animal initiated a training program for racing, and six months later, the patient ran its first official match. The choice of therapeutic methods for treating fractures in horses should be one that provides an earlier repair and minor possibility of complications. Thus, the therapy association which was adopted was considered favorable, since allowed full reestablishment of locomotion of the patient and made possible its return to race.

Treatment of condylar fractures with an intraoral approach using an angulated screwdriver: Results of a multicentre study

Background: This multicentre study aimed to investigate long-term radiographic and functional results following the treatment of condylar fractures using an angulated screwdriver system and open rigid internal fixation with an intraoral surgical approach.Methods: Twenty-nine patients with a total of 32 condylar fractures were evaluated. The patients were investigated prospectively based on the following variables: age, sex, aetiology, side, location and classification of the fracture, degree of displacement, associated fractures, surgical approach, oral health status, type of osteosynthesis plate, duration of surgery, mouth-opening, complications, and duration of follow-up.Results: The fractures were classified as subcondylar (n = 25) or condylar neck (n = 7). Mean patient age was 36.38 +/- 16.60 years. The median duration of postoperative follow-up was 24.39 +/- 13.94 months. No joint noise, weakness of the facial nerve, joint pain, or muscle pain was observed. An additional retromandibular approach was necessary to enable the treatment of one subcondylar fracture with medial displacement.Conclusion: Subcondylar or condylar neck fractures with medial or lateral displacement can be treated using an intraoral approach with satisfactory results with the advantages of the absence of visible scarring, the avoidance of facial nerve injury, and the ability to obtain rapid access to the fracture. (C) 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

Radiographic and clinical evaluation of zygomatico-maxillary complex fractures treated by 2.0 miniplates system

The zygomaticomaxillary complex (ZMC) is the second highly incidental of facial fractures. According to the anatomical complexity, there are many reports in the literature about this trauma, mainly related to treatment for these fractures. With the purpose of evaluating clinically and radiographically the stability of unilateral zygomatic fractures treated by surgical reduction and fixed in two points by stable internal fixation, this research was proposed. Twenty patients with zygomatic fractures were evaluated and compared with twenty nonfractured patients. The results showed that there were no statistically significant differences among the obtained data, perimeter and area, of the treated and contra-lateral sides of the experimental group. When compared to the control group the differences were not statistically significant. We also performed a comparison of the distance between the nasal bone and zygomatic prominence in all groups the results were also satisfactory.

Controvérsias no tratamento das fraturas mandibulares em crianças: relato de caso clínico

Introduction: The treatment of mandibular fractures has undergone many changes, especially after the introduction of rigid internal fixation techniques. Currently, the use of resorbable materials presents some advantages over metallic devices, particularly when applied in children. Objective: The authors discuss the controversies involved in the treatment of mandibular fractures in children, mainly related to fixation of fractures. Case Report: In this paper, we present a case of a 5 years treatment patient with mandibular angle fracture treated by open reduction and internal fixation with plates and screws. Final Comments: Aiming to not interfere in the development of tooth germs and mandibular bone growth a second surgery for removal of the fixation devices is indicated.

Hip fracture in a developing country: a picture in need of change

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Mandibular Angle Fracture Treated With New Three-Dimensional Grid Miniplate

Fractures of the mandibular angle deserve particular attention because they represent the highest percentage of mandibular fractures and have the highest postsurgical complication rate, making them the most challenging and unpredictable mandibular fractures to treat. Despite the evolution in the treatment of maxillofacial trauma and fixation methods, no single treatment modality has been revealed to be ideal for mandibular angle fractures. Several methods of internal fixation have been studied with great variation in complications rates, especially postoperative infections. Recently, new studies have shown reduction of postsurgical complications rates using three-dimensional plates to treat mandibular angle fractures. Nevertheless, only few surgeons have used this type of plate for the treatment of mandibular angle fractures. The aim of this clinical report was to describe a case of a patient with a mandibular angle fracture treated by an intraoral approach and a three-dimensional rectangular grid miniplate with 4 holes, which was stabilized with monocortical screws. The authors show a follow-up of 8 months, without infection and with occlusal stability.

Soft tissue profile changes after bilateral sagittal split osteotomy for mandibular setback: a systematic review

PURPOSE: To evaluate the ratio of soft tissue to hard tissue in bilateral sagittal split setback osteotomy with rigid internal fixation or wire fixation. MATERIALS AND METHODS: A literature search was performed using PubMed, Medline, CINAHL, Web of Science, the Cochrane Library, and Google Scholar Beta. From the original 766 articles identified, 8 articles were included. Two articles were prospective and 6 retrospective. The follow-up period ranged from 1 year to 12.7 years for rigid internal fixation. Two articles on wire fixation were found to be appropriate for inclusion. RESULTS: The differences between short- and long-term ratios of the lower lip to lower incisors for bilateral sagittal split setback osteotomy with rigid internal fixation or wire fixation were quite small. The ratio was 1:1 in the long term and by trend slightly lower in the short term. No distinction was seen between the short- and long-term ratios for mentolabial fold. The ratio was found to be 1:1 for the mentolabial fold to point B. In the short term, the ratio of the soft tissue pogonion to the pogonion showed a 1:1 ratio, with a trend to be lower in the long term. The upper lip showed mainly protrusion, but the amount was highly variable. CONCLUSIONS: This systematic review shows that evidence-based conclusions on soft tissue changes are difficult to draw. This is mostly because of inherent problems of retrospective studies, inferior study designs, and the lack of standardized outcome measurements. Well-designed prospective studies with sufficient samples and excluding additional surgery, ie, genioplasty or maxillary surgery, are needed.

Soft tissue profile changes after bilateral sagittal split osteotomy for mandibular advancement: a systematic review

PURPOSE: The purpose of the present systematic review was to evaluate the soft tissue/hard tissue ratio in bilateral sagittal split advancement osteotomy (BSSO) with rigid internal fixation (RIF) or wire fixation (WF). MATERIALS AND METHODS: The databases PubMed, Medline, CINAHL, Web of Science, Cochrane Library, and Google Scholar Beta were searched. From the original 711 articles identified, 12 were finally included. Only 3 studies were prospective and 9 were retrospective. The postoperative follow-up ranged from 3 months to 12.7 years for RIF and 6 months to 5 years for WF. RESULTS: The short- and long-term ratios for the lower lip to lower incisor for BSSO with RIF or WF were 50%. No difference between the short- and long-term ratios for the mentolabial-fold to point B and soft tissue pogonion to pogonion could be observed. It was a 1:1 ratio. One exception was seen for the long-term results of the soft tissue pogonion to pogonion in BSSO with RIF; they tended to be greater than a 1:1 ratio. The upper lip mainly showed retrusion but with high variability. CONCLUSIONS: Despite a large number of studies on the short- and long-term effects of mandibular advancement by BSSO, the results of the present systematic review have shown that evidence-based conclusions on soft tissue changes are still unknown. This is mostly because of the inherent problems of retrospective studies, inferior study designs, and the lack of standardized outcome measures. Well-designed prospective studies with sufficient sample sizes that have excluded patients undergoing additional surgery (ie, genioplasty or maxillary surgery) are needed.

On-table reconstruction of comminuted fractures of the radial head

The most widely accepted treatment for comminuted fractures of the radial head is either the excision or open reduction and internal fixation. The purpose of the present study is to evaluate the value of an 'on-table' reconstruction technique in severely comminuted fractures of the radial head. In this study, two patients with a Mason type-III and four patients with a Mason type-IV radial-head fracture were treated with 'on-table' reconstruction and fixation using low-profile mini-plates. After a mean follow-up of 112 months (47-154 months), the mean elbow motion was 0-6-141 degrees extension flexion with 79 degrees of pronation and 70 degrees of supination. The mean Broberg and Morrey functional rating score was 97.0 points, the Mayo Elbow Performance Index was 99.2 points and the mean Disabilities of the Arm, Shoulder, and Hand (DASH) Outcome Measure score was 1.94 points. One patient had symptoms of degenerative changes, with a slight joint-space narrowing. There were no radiographic signs of devitalisation at final examination. Comminuted fractures of the radial head, which would otherwise require excision, can be successfully treated with an 'on-table' reconstruction technique.

Adult Proximal Humerus Locking Plate for the Treatment of a Pediatric Subtrochanteric Femoral Nonunion: A Case Report

Nonunions of pediatric subtrochanteric femur fractures are exceedingly rare and have to date not been reported in the literature. We present the case of an 11-year-old boy who developed such a nonunion after open reduction internal fixation using a pediatric locked proximal femur plate. Using an adult proximal humerus locking plate, adequate proximal fixation of the nonunion was obtained. Furthermore, previously placed distal screw holes were safely bridged and the biomechanical environment around the nonunion site improved. Uneventful healing was possible with the use of adjuvant bone grafting. No short- or midterm complications occurred. Although other implants can certainly be adapted to a use different than that of its original design, the present case suggests that adult proximal humerus locking plates may be a safe option for revision surgery of the proximal pediatric femur.

Two to twenty-year survivorship of the hip in 810 patients with operatively treated acetabular fractures

The aims of the study were (1) to determine the cumulative two to twenty-year survivorship of the hip after open reduction and internal fixation of displaced acetabular fractures, (2) to identify factors predicting conversion to total hip arthroplasty or hip arthrodesis, and (3) to create a predictive model that calculates an individual's probability of early need for total hip arthroplasty or hip arthrodesis.

Endovascular treatment of arterial injury as an uncommon complication after orthopedic surgery

PURPOSE: To evaluate selective and superselective catheter therapy of serious arterial damage associated with orthopedic surgery of the pelvis, hip joint, femur, and knee. MATERIALS AND METHODS: Between 1989 and 2005, 16 consecutive patients with arterial damage after orthopedic surgery (seven women, nine men; mean age, 62 years; age range, 21-82 y) underwent angiographic exploration. Seven patients were in hemodynamically unstable condition. Initial orthopedic procedures were iliac crest internal fixation (n = 1); total hip prosthesis (n = 3); revision of total hip prosthesis (n = 4); revision of acetabular cup prosthesis (n = 1); gamma-nailing, nail-plate fixation, or intramedullary nailing (n = 3); and total knee prosthesis (n = 4). RESULTS: Angiography showed pseudoaneurysms (n = 11), vascular lacerations with active extravasation (n = 3), and arteriovenous fistulas with extravasation (n = 2). After angiographic documentation of serious arterial injury, 14 patients were treated with a single or coaxial catheter technique in combination with coils alone, coils and polyvinyl alcohol particles, coils and Gelfoam pledgets, or Gelfoam pledgets; or balloon occlusion with isobutyl cyanoacrylate and coils. Two patients were treated with covered stents. In all, bleeding was effectively controlled in a single session in 16 patients, with immediate circulatory stabilization. Major complications included death, pulmonary embolism, and postprocedural hematoma. CONCLUSION: Selective and superselective catheter therapy may be used for effective, minimally invasive management of rare but potentially life-threatening vascular complications after orthopedic surgery.