Conservative Treatment of Comminuted Mandibular Fracture Involving Maxillomandibular Fixation With Miniplates

Bars and steel wires are the most commonly used methods to achieve maxillomandibular fixation, although there are numerous alternatives described for this same purpose. In cases of edentulous candidates for the conservative treatment of facial fractures, none of the conventional methods can be instituted for maxillomandibular fixation. Fixation in such cases is achieved with the aid of the total dentures of the patient or the confection of splints, but these methods lead to eating and oral hygiene problems. This article reports the case of an edentulous patient with a comminuted mandible fracture treated with a rarely described technique in which intermaxillary fixation was achieved with titanium miniplates.

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.

Comminuted fractures of the radial head and neck: is fixation to the shaft necessary?

Mason type III fractures of the radial head are treated by open reduction and internal fixation, resection or prosthetic joint replacement. When internal fixation is performed, fixation of the radial head to the shaft is difficult and implant-related complications are common. Furthermore, problems of devascularisation of the radial head can result from fixation of the plate to the radial neck. In a small retrospective study, the treatment of Mason type III fractures with fixation of the radial neck in 13 cases (group 2) was compared with 12 cases where no fixation was performed (group 1). The mean clinical and radiological follow-up was four years (1 to 9). The Broberg-Morrey index showed excellent results in both groups. Degenerative radiological changes were seen more frequently in group 2, and removal of the implant was necessary in seven of 13 cases. Post-operative evaluation of these two different techniques revealed similar ranges of movement and functional scores. We propose that anatomical reconstruction of the radial head without metalwork fixation to the neck is preferable, and the outcome is the same as that achieved with the conventional technique. In addition degenerative changes of the elbow joint may develop less frequently, and implant removal is not necessary.

Displaced Comminuted Patellar Fracture Associated with Post Anterior Cruciate Ligament Reconstruction in a Male Collegiate Basketball Player

We present a unique case of a collegiate athlete who suffered an anterior cruciate ligament (ACL) injury leading to a displaced patellar stress fracture. We identified an unusual potential association between ACL reconstruction and patellar fractures in order to avoid potential complications in the rehabilitation and return to activity process.

Terapêutica interdisciplinar para fratura cominutiva de côndilo por projétil de arma de fogo: enfoque miofuncional

TEMA: ferimentos causados por projéteis de arma de fogo apresentam alta incidência na região da cabeça e face. A articulação temporomandibular pode estar envolvida, além de estruturas anatômicas importantes como o nervo facial, necessitando de equipe multidisciplinar para efetuar tratamento adequado. PROCEDIMENTOS: apresentação de caso clínico de fratura condilar cominutiva causada por projétil de arma de fogo tratado de forma não-cirúrgica associado à terapia miofuncional orofacial. Paciente encaminhado para avaliação e procedimentos fonoaudiológicos após conduta da equipe de cirurgia bucomaxilofacial, sem remoção do projétil, alojado superficialmente, próximo da origem do músculo esternocleidomastóideo à direita, com fratura condilar cominutiva e lesão do nervo facial. Foram aspectos observados em avaliação: mordida aberta anterior, importante redução da amplitude dos movimentos mandibulares com desvios para o lado acometido, ausência de lateralidade contralateral, dor muscular, paralisia e parestesia em terço médio e superior da hemiface direita. Realizadas sessões de terapia miofuncional seguindo protocolo específico para traumas de face constando de: drenagem de edema; manipulações na musculatura levantadora da mandíbula ipsilateral; ampliação e correção dos movimentos mandibulares; procedimentos específicos referentes à paralisia facial e reorganização funcional direcionada. RESULTADOS: após oito semanas de terapia os resultados obtidos mostram restabelecimento de amplitude e da simetria dos movimentos mandibulares, reorganização da mastigação, adequação da deglutição e fala, remissão da sintomatologia dolorosa e remissão da paralisia do terço médio. CONCLUSÃO: o tratamento conservador da fratura por meio da terapia miofuncional orofacial resultou na reabilitação funcional da mandíbula e face dirigindo os movimentos e estimulando a adequação das funções estomatognáticas.

Effect of reducing and replacing pork fat on the physicochemical, instrumental and sensory characteristics throughout storage time of small caliber non-acid fermented sausages with reduced sodium content

The effect of pork fat reduction (from 44% to 20% final fat content) and its partial substitution by sunflower oil (3% addition) on the physicochemical, instrumental and sensory properties throughout storage time of small caliber non-acid fermented sausages (fuet type) with reduced sodium content (with partial substitution of NaCl by KCl and K-lactate) and without direct addition of nitrate and nitrite (natural nitrate source used instead), was studied. Results showed that sausages with reduced fat (10% initial fat content) and with acceptable sensory characteristics can be obtained by adding to the shoulder lean (8% fat content) during the grinding, either 3.3% backfat (3% fat content) or 3% sunflower oil, both previously finely comminuted with lean. Furthermore, sunflower oil showed to be suitable for partial pork backfat substitution in very lean fermented sausages, conferring desirable sensory properties similar to those of sausages with standard fat content. The sensory quality of the sausages was maintained after three-month cold storage in modified atmosphere.

Energiapuun haketuksen ja murskauksen kustannukset

Energiapuun tuotannossa puu on hienonnettava kuljettimille ja kattilaan sopivaan kokoon. Tämä tehdään Suomessa yleensä joko metsätien varressa välivarastolla, keskitetyssä terminaalissa tai voimalaitoksella. Puu hienonnetaan joko terävillä terillä hakettamalla tai tylpemmillä työkaluilla murskaamalla. Hakkeessa on vähemmän käsittelyä haittaavia pitkiä tikkuja ja sen valmistamiseen tarvittava energia on hiukan pienempi kuin murskaimilla. Viimeksi mainitulla on merkitystä lähinnä karsittua puuta haketettaessa. Murskain puolestaan sallii enemmän epäpuhtauksia raaka-aineessa, joten esimerkiksi kantoja käsitellään vain murskaimilla. Tässä tarkastellaan erityisesti pienpuun haketuksen ja murskauksen kustannuksia. Pienpuuta saadaan nuoren metsän kunnostuksista ja ensiharvennuksista. Se voi olla joko karsimatonta kokopuuta tai karsittua rankaa. Kokonaiskustannukset pienpuun haketukselle tai murskaukselle ovat tämän tutkimuksen mukaan välivarastolla noin 3,4 euroa/MWh ja terminaalilla tai voimalaitoksella noin 2 euroa/MWh. Pääomakustannukset ovat pienpuulla tavallisesti 1-1,2 euroa/MWh, keskitetyllä terminaalilla toimittaessa noin kolmanneksen vähemmän, jos pääomalle asetetaan 10% tuottovaatimus. Työvoimakustannukset ovat 30-80 snt/MWh varaston ja laitteen koosta riippuen, käyttöenergia dieselmoottoria käytettäessä noin 50 snt/MWh, sähkömoottorilla noin 30 snt/MWh. Muut kulut, mm. huolto, ovat yhteensä 40-80 snt/MWh. Energiapuun hankinnan kokonaiskustannuksista raaka-aineen hienontamisen osuus on 10-30% puutavaran lajista ja käytetystä työmenetelmästä riippuen. Terminaaleilla ja voimalaitoksilla toimittaessa on usein kiinnitettävä huomiota melun- ja pölyntorjuntaan. Muun muassa näistä syistä saattaa kiinteä, sähkökäyttöinen murska olla sopiva sellaisiin kohteisiin, joissa käsiteltävät määrät ovat suuria ja toiminta pysyvää. Melun ja pölyn kunnollinen torjunta vaatii suuria rakenteita, joita on vaikea yhdistää liikuteltaviin laitteisiin.

Evaluation of a novel transcortical pin-sleeve system in a calf model

Le desserrage des tiges est une complication fréquente des plâtres avec tiges transcorticales (TP) chez les grands animaux, nécessitant souvent leur retrait prématuré avant la guérison des fractures. Les charges excessives centrées sur le cortex à l’interface os-tige proximo-externe et disto-interne causent de l'ostéolyse. En utilisant un modèle de veau nouveau-né, ce projet a évalué un nouveau système de tige-manchon et anneau integré dans un plâtre (PS) optimisé pour réduire la contrainte péri-implant et le stress à l'interface os-implant. On a émis l'hypothèse que les PS se traduiraient par une ostéolyse péri-implant moindre par rapport aux TP. Dix veaux en bonne santé, de 3 semaines d'âge, ont été implantés avec les TP ou PS dans le métacarpe droit, à raison de 2 implants par veau. Les veaux ont été observés quotidiennement pour le confort et la boiterie et ont été euthanasiés à 28 jours. Les données recueillies comprenaient les radiographies à la chirurgie et à l'euthanasie et les mesures histomorphométriques de contact os-implant sur des échantillons non-décalcifiés avec les implants in situ. Les données ont été analysées en utilisant le test de Cochran-Mantel-Haenszel, une valeur de P <0,05 a été considérée comme significative. L'épaisseur corticale était plus importante pour les implants distaux que proximaux pour les deux groupes lors de la chirurgie (P = 0,03), mais était similaire entre les groupes (P > 0,3). Les veaux avec TP ont développé une boiterie plus tôt (au jour 21) que les veaux avec PS (P = 0,04). Histologiquement, il y avait plus de contact direct os-implant cortical pour les implants PS distaux que les implants TP (P = 0,04). La jonction métaphyso-diaphysaire osseuse où les implants proximaux étaient situés est impropre aux deux systèmes; chacun a un minimum de contact os-implant et de l'ostéolyse extensive. Le système PS n'ayant pas causé une ostéolyse importante lorsque implantés dans l'os diaphysaire et peut-être une alternative convenable aux TP pour des fractures comminutives des membres distaux.

Gesso sintético e pinos transcorticais na redução de fratura de tíbia em uma bezerra

Relata-se um caso de fratura de tíbia em uma bezerra de sete meses de idade, 200kg de peso, apresentando fratura fechada, cominutiva em diáfise. A fixação externa foi preferida como método de imobilização óssea, utilizando-se pinos transcorticais e gesso sintético. Obteve-se eficiente imobilização da fratura, com rápida recuperação do animal, dispendendo-se pouco tempo para o pós-operatório (52 dias). A técnica demonstrou ser de fácil realização e passível de ser executada a campo.

Immediate reconstruction of frontal sinus fractures: review of 26 cases

Purpose: the purpose of this study was to evaluate complications occurring after immediate reconstruction of severe frontal sinus fractures, including cases where the fracture was not limited to the anterior wall and also involved the posterior wall and/or sinus floor.Patients and Methods: the records of twenty-six patients presently undergoing follow-up for frontal sinus fracture reconstruction were reviewed. Information regarding demographics, fracture characteristics and causes, associated facial fractures, use of grafts or implants, type of fixation used, nasofrontal duct management, use of antibiotics, and complications were noted. Patients were asked to return for clinical and radiographic follow-up to access late complications.Results: the average age of patients with frontal fractures was 29.1 years and 92.3% were male. Mean follow-up was 3.6 years. The most common causes of fracture were motor vehicle accidents and physical aggression. All patients presented with comminuted and dislocated anterior wall fractures, 34.6% presented with posterior wall fractures, and 46% had sinus floor fractures. Complications occurred in 7 patients (26.92%) and included pneumoencephalus, frontal cutaneous fistula, frontal bone irregularity, and sinusitis.Conclusions: Frontal sinus reconstruction is a good procedure for immediate fracture treatment if there is not excessive comminution, dislocation, or instability of the posterior wall and if the frontonasal duct area is intact or can be repaired. Most complications result from incorrect indication for reconstruction. (C) 2004 American Association of Oral and Maxillofacial Surgeons.

Treatment of radius, ulna and humerus fractures with the aid of a bone morphogenetic protein in a giant anteater (Myrmecophaga tridactyla)

A giant anteater (Myrmecophaga tridactyla) was found with closed comminuted fractures on the fight radius and ulna and left humerus he duration of which was unknown. The animal was unable to use either of he thoracic limbs. The fractures were stabilized with 3.5-mm titanium plates and a commercially available mixture of micro lyophilized bovine cortical osseous and bovine BMP (Gen-tech(R), Baumer, Brazil) was implanted into the fractures sites. Postoperative radiographic evaluations were performed every 30 days and after four months. Bone healing was observed in all of he fractures. The animal was able to be reintroduced into its natural habitat. From his case we conclude that despite he low metabolic fate of the giant anteater, which is an inherent characteristic of this species, he treatment of radius, ulna and humerus fractures by means of plates and screws, associated with BMP on the Myrmecophaga tridactyla, was a success.

Hyolith-dominated shell beds from the Lampazar Formation in NW Argentina: patterns and processes of origin in the Late Cambrian (Furongian) seas of western Gondwana.

Late Cambrian (Furongian) shell beds in the Salta Province of NW Argentina are unique because of the presence of abundant hyolith skeletal remains within them. Hyolith shell beds are located in the mid-upper part of the Lampazar Formation at the Angosto de La Quesera locality, and are the first recorded accumulations of this type in the lower Palaeozoic of the South American Andean Basin. The shell beds are of the order of several mm thick, and are laterally persistent within outcrop scale, with a few metres of lateral development. Two types of hyolith shell beds are recognised: Type 1 is a storm-dominated, event concentration, represented by dispersed to densely packed accumulations of well preserved hyolith and gastropod shells (Strepsodiscus austrinus). Hyolith conchs are current oriented with the long axes parallel to unidirectional flow on the sandstones surfaces. Type 2 shell beds are background, composite concentrations, of poorly preserved, comminuted debris of hyolith shells with associated gastropod and trilobite sclerites (dominated by Parabolina, Beltella and Leiostegium). The genesis of both shell beds was controlled primarily by physical processes, such as storms and current and/or wave agitation. The thickness, simple internal fabric and geometry shown by both accumulations are typical of Cambrian-style shell-beds.

Vascular pericranial graft: A viable resource for frontal sinus obliteration

Inappropriate treatments of frontal sinus fractures may lead to serious complications, such as mucopyocele, meningitis, and brain abscess. Assessment of nasofrontal duct injury is crucial, and nasofrontal duct injury requires sinus obliteration, which is often accomplished by autologous grafts such as fat, muscle, or bone. These avascular grafts have an increased risk of resorption and infection, as well as donor site morbidity. For these reasons, pericranial flap, which is vascular, should be used for frontal sinus obliteration. The pericranial flap presented with less morbidity procedure and has decreased infection rates, which justifies its use in frontal sinus obliteration. This paper aims to report a case of a comminuted frontal sinus fracture in a 29-year-old man who was successfully treated by frontal sinus obliteration, using pericranial local flap. The patient was followed up postoperatively for 16 months without infection. Copyright © 2013 by Mutaz B. Habal, MD.