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PubMed2003

Bodily distalization of molars with absolute anchorage.

Palatal implants have been used over the last two decades to eliminate headgear wear and to establish stationary anchorage. In this case report, the stability of a palatal implant for distalization of molars bodily and for anchorage maintenance was assessed. The implant was a stepped screw titanium (4.5 mm diameter x 8 mm length), and it was placed in the palatal region for orthodontic purposes. A surgical template containing a metal drill housing was prepared. Angulation of the drill housing was controlled according to the radiologic tracing of the maxilla transferred to a plaster cast section in the paramedian plane. The implant was placed using a noninvasive technique (incision, flap, and suture elimination) and left transmucosally to facilitate the surgical procedure and to reduce the number of operations. The paramedian region was selected (1) to avoid the connective tissues of the palatine suture and (2) because it is considered to be a suitable host site for implant placement. After three months of healing, the implant was osseointegrated and orthodontic treatment was initiated. For molar distalization, the Keles Slider appliance was modified and, instead of a Nance button, a palatal implant was used for anchorage. The results showed that the molars were distalized bodily at five months, and no anchorage loss was observed. At the end of the treatment, the smile was improved, and an ideal Class I molar and canine relationship, an ideal overbite, and an ideal overjet were all achieved. In conclusion, palatal implants can be used effectively for anchorage maintenance and in space-gaining procedures. Use of a three-dimensional surgical template eliminated implant placement errors, reduced chair time, minimized trauma to the tissues, and enhanced osseointegration. This method can be used effectively to achieve distalization of molars bodily without anchorage loss.

Adolescent↗
PubMed2004

The effect of premolar extractions on tooth size discrepancies.

The purpose of this study is to investigate the effect of premolar extractions on tooth size discrepancy. A total of 213 plaster casts were divided into a Bolton big (BB), a Bolton normal (BN) and a Bolton small (BS) group according to the Bolton normal value plus or minus one standard deviation. The Bolton overall ratio of each group was measured and compared before and after hypothetical premolar extractions. The Bolton overall ratios after premolar extractions were smaller than those before extraction in each group. Some of the patients in the BN group and BB group were moved into the BS group and BN group after premolar extractions. A tooth size discrepancy occurred in some patients with normal overall ratios after premolar extractions, but a tooth size discrepancy might be corrected in some patients with big overall ratios after premolar extraction.

Adolescent↗
PubMed1999

Associations between dental occlusion and misarticulations of Finnish dental consonants in cleft lip/palate children.

The purpose of this study was to examine whether malocclusions in terms of crossbites, large maxillary overjet, and deep bite are related to the articulatory problems with the Finnish dental consonants /r/, /s/ and /l/ in different cleft types and gender. The subjects were 260 (108 girls, 152 boys) 6-yr-old Finnish-speaking non-syndromic children with isolated cleft palate (CP, n = 79), cleft lip/alveolus (CL(A), n = 76), unilateral (UCLP, n = 78), and bilateral (BCLP, n = 27) cleft lip and palate. Occlusal anomalies were evaluated from dental plaster casts, and speech was analyzed by two speech pathologists with a high reliability. Altogether, 43% of patients misarticulated at least one of the studied sounds, and had crossbites significantly more often (73%) than subjects with correct /r/, /s/ and /l/ production (45%). Posterior crossbites were significantly associated with defective articulation, whereas anterior crossbite alone, large maxillary overjet, or deep bite were not. It was concluded that occlusal abnormalities in terms of posterior crossbites should be considered as a risk factor for correct dental consonant articulation in cleft-affected subjects.

Articulation Disorders↗
PubMed1999

An overview of distal radial fractures.

Fractures of the distal radius include a wide spectrum of fracture patterns. As well as involving the distal radius, these injuries can involve the wrist, the distal radio-ulnar joint and the distal ulna. The management of these injuries is consequently diverse, ranging from a plaster cast to advanced surgery. The principles of treatment are to reduce and maintain the reduction by restoring the radial height, volar tilt and intra-articular step. The acceptable reduction is to have radial height to within 2 mm of the ulnar, volar tilt greater than 0 degree and intra-articular step less than 1 mm. The present paper reviews the current concepts in the diagnosis, management and complications of distal radial fractures.

Emergency Medical Services↗
PubMed1998

Anatomical correction of the exstrophy-epispadias complex: analysis of 34 patients.

OBJECTIVE: To evaluate the surgical procedures required for anatomical reconstruction of the bladder and penis in the exstrophy-epispadias complex. PATIENTS AND METHODS: All primary exstrophy-epispadias repairs carried out by one surgeon between 1987 and 1997 were reviewed. Bladder closure consisted of full extraperitoneal mobilization, transpositional omphaloplasty, drainage with ureteric and urethral catheters and immobilization with a 'frog-leg' plaster-cast or 'mermaid' dressings. Osteotomies were always performed when bladder closure was attempted after 37 h of age. Before 1990 the osteotomies were posterior vertical iliac (one patient) and subsequently anterior oblique iliac (10 patients). Pre-peritoneal herniotomies, in the absence of a clinical hernia, were included in the primary procedure after 1992. A modified Cantwell technique was used for epispadias repair and this was undertaken at a median of 16 months after bladder closure (range 6-30). RESULTS: Thirty-four patients (27 male) were reviewed; one patient had a chromosomal abnormality, a deletion in the short arm of chromosome 4. The male infants required a median of four procedures (range 2-5) for bladder closure, epispadias reconstruction and herniotomies, while the females needed a median of two (range 2-5). Complete bladder dehiscence, requiring re-closure with osteotomies, occurred in three cases (9%, two male). There were no dehiscences in the primary osteotomy group. Fistulae after epispadias repair occurred in four patients (17%). The bladder capacity increased to > 60 mL in 10 of 15 males by 36 months after epispadias repair. Only two of seven female infants attained a capacity of > 60 mL. Of the 15 infants who did not undergo herniotomy at primary closure, 13 subsequently developed inguinal hernias (one uni- and 11 bilateral) with incarceration occurring in two. Twelve infants underwent herniotomy at primary closure and six developed subsequent hernias (two uni- and four bilateral; P = 0.05) with documented incarceration in two. CONCLUSIONS: Anatomical correction of the exstrophy-epispadias complex remains challenging, but can be achieved with complication rates of < 20% for each stage. Bladder volumes large enough to permit adequate bladder neck reconstruction can be anticipated after epispadias repair in a large proportion of male infants, but remains small in female infants with low outlet resistance. Inguinal herniotomy at the time of bladder closure significantly reduces the incidence of subsequent herniation, which nevertheless remains high.

Bladder Exstrophy↗
PubMed1997

Changes in muscle fibre type, muscle mass and IGF-I gene expression in rabbit skeletal muscle subjected to stretch.

The relationship between IGF-1 and changes in muscle fibre phenotype in response to 6 d of stretch or disuse of the lower limb muscles of the rabbit was studied by combining in situ hybridisation and immunohistochemistry procedures. Passive stretch by plaster cast immobilisation of the muscle in its lengthened position not only induced an increase in IGF-I mRNA expression within the individual muscle fibres but also an increase in the percentage of fibres expressing neonatal and slow myosin. This change in phenotype was also found to be accompanied by a rapid and marked increase of muscle mass, total RNA content as well as IGF-I gene expression. In contrast, IGF-I appears not to be involved in muscle atrophy induced by immobilisation in the shortened position and the inactivity which results from this procedure. The level of increase in expression of IGF-I mRNA varied from fibre to fibre. By using adjacent serial sections, the fibres which expressed IGF-I mRNA at the highest levels were identified as expressing neonatal and the slow type 1 myosin. These data suggest that the expression of IGF-I within individual muscle fibres is correlated not only with hypertrophy but also with the muscle phenotypic adaptation that results from stretch and overload.

Adaptation, Physiological↗
PubMedDate not supplied

Peritalar dislocations: a retrospective study of 18 cases.

The purpose of this study is to retrospectively evaluate 18 consecutive cases of peritalar dislocations referred to our department during a period of 25 years and to delineate the factors influencing long-term prognosis. There were 13 (73%) medial and 5 (27%) lateral dislocations. Six patients (33%) suffered an open injury, including 2 of 13 (15%) medial and 4 of 5 (80%) lateral dislocations. Associated fractures involving the hindfoot or forefoot were noted in 7 feet, including 3 of 5 lateral dislocation cases. Reduction was accomplished under general anesthesia; in no case was open reduction necessary. In 4 of 6 open injuries with associated fractures, temporary fixation with Kirschner wires was performed. Patients were immobilized in a plaster cast for 4 weeks, or for 6 weeks in the presence of fracture, followed by weightbearing as tolerated. At a mean follow-up of 10.2 years (range, 4 to 26 years), 10 patients (56%) showed excellent results; all had sustained a closed medial low-energy dislocation. There were 3 cases (17%) with fair results and 5 cases (28%) with poor results. Forty-five percent of patients showed a restriction of activity, a reduction of subtalar range of motion, and moderate or severe radiographic signs of hindfoot degenerative arthritis. There were no cases of talar avascular necrosis, and in no case was secondary surgery necessary. Lateral dislocation and open medial dislocations with concomitant fractures showed a greater potential for poor prognosis. The results were independent from period of cast immobilization, suggesting that 4 to 6 weeks of immobilization provides acceptable long-term results.

Adolescent↗
PubMedDate not supplied

Cerclage wire and lag screw fixation of the lateral malleolus in supination and external rotation fractures of the ankle.

Wound dehiscence and exposed lateral hardware can occur after open reduction internal fixation of lateral malleolus. The bulk of a lateral plate and the minimum soft tissue over the lateral malleolus may contribute to this situation. The objective of this study was to evaluate a series of patients with lateral malleolar fractures treated with operative reduction using minimal hardware. We wanted to observe whether there was any loss of reduction and whether there were any incidences of soft tissue disruption. Fifty-two patients with long spiral fracture of the lateral malleolus in a supination-external rotation injury were treated with two or three 3.5-mm lag screws inserted 1 cm apart and 1 or 2 circlage wires. Less rigid fixation was supplemented with a below-the-knee plaster cast. All patients were followed up until clinical and radiological evidence of fracture healing at 6, 10, and 14 weeks postoperatively. By 10 weeks, all patients were full weight bearing, although most patients still limped. At 14 weeks' follow-up, there were no infections or wound dehiscences. All patients were able to return to their activities of daily living. All the fractures had united without loss of original position. Two fractures of the posterior bone spikes seen during surgery united uneventfully. Long spiral fractures of the lateral malleolus of the ankle can be treated successfully with 2 or 3 lag screws and circlage wires without compromising the outcome of the fracture healing.

Adult↗
PubMedDate not supplied

Limb sparing using a double bone-transport technique for treatment of a distal tibial osteosarcoma in a dog.

OBJECTIVE: To evaluate the treatment of a spontaneously occurring osteosarcoma in a dog by means of tumor resection and bone regeneration of a 12-cm defect using double bone transport. STUDY DESIGN: Case report. ANIMALS OR SAMPLE POPULATION: An 11 year-old client-owned German shepherd. METHODS: After tumor resection, a preassambled Ilizarov frame was secured to the proximal tibia and to the tarso-metatarsal region. Two osteotomies were performed in the proximal metaphysis. The two bone segments were transfixed with 1.5-mm-diameter wires, each secured to a ring, and bone transport was performed until the distal segment reached the talar surface. Cisplatin was administered 14, 35, and 59 days after surgery. RESULTS: Bone regenerate was first visible radiographically 4 weeks after surgery. The frame was removed 162 days after surgery. The hock was protected with a plaster cast because the tarsal arthrodesis was not complete. The dog underwent tibiotarsal arthrodesis 201 days after osteosarcoma resection. The dog died of metastatic disease 239 days after the initial surgery. CONCLUSIONS: Even though this dog died of systemic metastases, local recurrence did not develop. Cisplatin chemotherapy did not appear to negatively affect bone regeneration. CLINICAL RELEVANCE: To our knowledge, the double transport technique has not been previously described in the veterinary literature. In this dog, this technique decreased the duration of treatment compared with a conventional single-segment transport technique.

Animals↗
PubMed2001

Tissue expansion of the lower limb: complications in a cohort of 103 cases.

Over 10 years we performed 103 skin-expansion procedures and placed 207 prostheses on lower limbs, using the same surgical protocol. In 83 cases (80.6%) the expansion was achieved without complications. We recorded 20 complications in all (19.4%). Major complications included sepsis, damage due to undermining, exposure of the prosthesis and necrosis of the flap in 16 cases (15.5%), resulting in complete failure of the method in five cases (4.9%). In all, nine patients had septic complications (8.7% of the patients and 45% of the complications), five had exposure of the prosthesis and two had skin necrosis after expansion. Infection and skin necrosis, which are the main causes of failure of this method, can be prevented by a strict surgical protocolcovering all stages of the procedure. Atraumatic undermining, remote and external valves, suction drains in the cavities, advancement flaps and plaster casts after surgery can help to prevent skin necrosis. A separate and remote approach for each prosthesis can prevent infection of all the prostheses and complete failure of the expansion procedure.

Adolescent↗
PubMed1999

The prognostic value and reproducibility of the radiological features of the fractured scaphoid.

We investigated whether the radiological features of the fractured scaphoid could be reproducibly measured and used to predict the likelihood of union with conservative plaster cast immobilization. We found that the inter- and intra-observer reproducibility of the Compson, Herbert and Russe classification systems were only fair and that none predicted fracture union. Assessments of fracture level, comminution and displacement showed moderate inter- and intra-observer reproducibility but did not predict the likelihood of fracture union. We conclude that the radiological features of acute scaphoid fractures cannot be used to predict the likelihood of fracture union.

Carpal Bones↗
PubMed1999

[Results of therapy after primary conservative management of distal radius fractures in patients over 65 years of age].

BACKGROUND: In the clinical routine of our City Hospital Triemli, Zürich, Switzerland, we prefer to treat old patients with fractures of the distal radius conservatively. It was our aim to examine the long-term effects of this treatment on anatomical position, mobility, strength, and patient satisfaction. PATIENTS AND METHODS: We reviewed the data of 102 consecutive patients over 65 years of age. 95 were treated with a plaster cast and controlled weekly in our outpatient department, finally discharged after 50 days. After an average time of eight months, 79 patients could be controlled clinically and radiologically. RESULTS: Although a significant (p < 0.001) reduction of joint mobility and grip strength was found in all cases, we documented no loss of independence in every-day life. Radiological malalignment of the distal radius with a dorsal or palmar angle of more than 20 degrees in the lateral view or a radio-ulnar angle of less than 15 degrees in the dorsopalmar view was associated with increased complaints and patients dissatisfaction. CONCLUSION: In old-aged patients with distal radius fractures, the indication for surgical treatment should be made very carefully, since certain degrees of radiological malalignment are tolerated well.

Aged↗
PubMed2002

An in vitro study to evaluate the accuracy of stereotactic localization using magnetic resonance imaging by means of the Leksell stereotactic system.

The advantages of using magnetic resonance imaging (MRI) as opposed to computed tomographic (CT) scans or ventriculography in stereotactic surgery include the increased tissue contrast of the lesion or target, direct non-reformatted multiplanar imaging and target coordinate determination as well as reduced imaging artefacts produced by the stereotactic frame. One disadvantage of MR stereotaxis, however, is the potential for anatomic inaccuracy due to equipment-induced inhomogeneities of the magnetic field. The authors present an experimental study on an in vitro model to examine the accuracy of target localization using the Leksell stereotactic frame and MR imaging. Ten formalin-fixed brains taken from patients who had died of non-neurological diseases were sealed in a properly modelled plaster-cast shell simulating the skull bone. These models were fixed in the Leksell stereotactic frame and high-field MR images were performed (Siemens Magnetom SP 1.5 Tesla, T1-weighted spin echo sequences, TR/TE 600/15 ms, slice thickness 2 mm, FOV 300 mm). Following electrocoagulation of different targets on both lentiforme nuclei, the localization and extension of the lesions were controlled by MRI. A gross-/histopathological verification was performed. This model allows a good representation of the anatomic structures without any artefacts. The postoperative MRI control and the pathological examination of the lesions matched well with the preoperatively defined targets. The correlation of coordinates and measurements obtained with the pathological studies were within a +/- 2 mm range in all cases.

Brain↗
PubMedDate not supplied

[Functional postoperative treatment of internally fixed ankle fractures with a flexible arthrodesis boot (Variostabil)].

AIM: Postoperative treatment following osteosynthesis of ankle fractures in a flexible arthrodesis boot (Variostabil) aims at fast restoration of the function of the injured extremity while allowing early full weight bearing. This treatment regimen was validated in a clinical and experimental study. METHODS: (1) In the clinical study part, 56 patients with internally fixed ankle fractures received after treatment with the arthrodesis boot for 6 weeks. (2) In the experimental study part, the intravascular pressure was recorded in a foot vein of 8 healthy volunteers during knee bends. RESULTS: (1) No implant failure or secondary dislocation was seen due to the after treatment. All patients rated subjective comfort and mobility as excellent. 90.5 % had a good to excellent functional result with the Philips Score. (2) Wearing the arthrodesis boot effected significantly faster venous outflow (25.8 +/- 15.2 vs. 11.3 +/- 6.0 mmHg/sec, p < 0.05) and higher pressure amplitude (53.6 +/- 12.0 vs. 26.5 +/- 9.6 mmHg) during knee bends, compared to a below-the-knee plaster cast. CONCLUSIONS: The flexible arthrodesis boot offers safe protection of ankle fractures combined with superior functional performance (undisturbed gait, training of the ankle joint, high patient comfort and mobility, accelerated venous outflow) as compared to cast immobilization.

Adolescent↗
PubMedDate not supplied

[Shoulder arthrodesis with plate fixation. Special features in cases of resection and defects].

AIM: Shoulder arthrodesis following prosthesis explantation or resection of the acromion has not often been described in the literature. The presented article analyses the special features and problems of these preoperative circumstances in 4 cases and discusses them within the entire group. PATIENTS AND METHOD: Between 06/1987 and 02/2001, a total of 30 shoulder arthrodeses using plate fixation were performed in our clinic and then analysed after an average of 2.7 (0.5 - 8.7) years. Surgery was carried out on 5 (17 %) females and 25 (83 %) males with a mean age of 37 (17 - 82) years. Two patients underwent shoulder arthrodesis as a salvage operation following unsatisfactory arthroplasty, or after trapezius transfer with corresponding reduced bony conditions, respectively. RESULTS: The active extent of movement following arthrodesis was 56 degrees (20 degrees - 90 degrees ) abduction, and 60 degrees (20 degrees - 105 degrees ) anteversion. The most frequent complications following arthrodesis included pseudarthroses (3/10 %), infections (4/13 %), and fractures of the humerus (4/13 %). The rate of complications was especially high in the cases after explantation of a shoulder prosthesis and resection of the acromion. In two of the four patients, three or five revision operations, respectively, were necessary. Two of the three pseudarthroses of the entire group occurred in these two cases. CONCLUSION: Complications of shoulder arthrodesis after resection of the acromion or the proximal humerus are especially frequent. To avoid pseudarthrosis in such cases, primary spongioplasty is advantageous. A fixation with plates is superior to a simple screw arthrodesis. For postoperative immobilization a plaster cast instead of an orthotic device should be taken into consideration.

Adolescent↗
PubMed2004

[Individual silicon applicator for nasopharyngeal brachytherapy].

BACKGROUND: Beyond surgery, conventional radiation therapy, and chemotherapy brachytherapy may enrich treatment of primary, residual, or recurrent head and neck cancer. Nasopharyngeal cancer is a proper indication for intracavitary brachytherapy which can be performed using a commercial applicator system or an individual applicator. METHODS AND PATIENTS: Technique for manufacturing an individual nasopharyngeal silicon applicator and its experiences in 3 patients (2 times brachytherapy in treatment regime of primary nasopharyngeal cancer, 1 time for nasopharyngeal lymphoma treatment) are presented. RESULTS: Under general anaesthesia in all 3 patients nasopharyngeal imprinting after placement of two suction tubes was performed with shore 12 silicon and followed by manufacturing the individual silicon applicator with two included tubes after plaster cast of the imprinting form has been performed. This silicon applicator enabled safe endocavitary brachytherapy using the high-dose-rate-afterloading-method. Tumor control was achieved in all 3 patients. CONCLUSIONS: The presented individual silicon applicator is suited for intracavitary brachytherapy of the nasopharynx being an valuable contribution in the primary treatment regime of nasopharyngeal cancer.

Adult↗
PubMed2005

[Bilateral carpal tunnel syndrome with familial accumulation].

We report on a six-year-old girl with bilateral carpal tunnel syndrome with familial accumulation. Parents and one grandmother had positive history for CTS, treated by surgical decompression. Following neurologic and radiologic evaluation and after failed conservative treatment in a plaster cast, open carpal tunnel release was performed in a two-stage procedure. Postoperatively symptoms diminished and now six months after surgery, all complaints disappeared completely.

Carpal Tunnel Syndrome↗
PubMed2005

[Results of operative therapy of idiopathic clubfoot using a dorsomedial approach with soft tissue preparation "à la carte"].

INTRODUCTION: Several concepts have been published for therapy of idiopathic clubfoot. Actually the Cincinnati approach is the "gold-standard" in operative treatment of idiopathic clubfoot. Using this approach delayed wound healing and overcorrection are wellknown complications. During the last 30 years a dorsomedial approach is used in operative treatment of idiopathic clubfoot in our clinic. Using this approach a dorsal, medial and/or lateral release can be performed. Postoperatively a plaster cast is used. The following years a rigid therapy with orthosis and support is requested. PATIENTS AND METHOD: Between June 1986 and December 2000 130 clubfoot operations with soft tissue release were performed. 119/130 (91 %) patients could be clinically and radiologically followed-up after a mean of 4.5 years (min: 2, max: 17) including 65.5 % male and 34.5 % female patients. Average age at time of operation was 7.6 months. The findings were classified according to Dimeglio. To evaluate the clinical results the score according to Laaveg and Ponseti was used. X-rays with load (a. p. and lateral view) were evaluated preoperatively and at follow-up for a. p. and lateral talocalcaneal angle, talometatarsal-I-angle, calcaneometatarsal-V-angle and the angle of the first ray. Additionally complications and recurrences were documented. RESULTS: 21.8 % of the feet were classified IV degrees , 39.5 % III degrees and 38.7 % II degrees according to Dimeglio. Recurrent clubfoot was found in 7.6 % of all cases. All angles showed a significant improve. At latest follow-up 95.6 +/- 9.2 points according to the score of Laaveg and Ponseti were achieved. Flat top talus was found in 37 cases. CONCLUSION: The dorsomedial approach allows an excellent correction of clubfeet with a low rate of complications and recurrences in comparison to other studies.

Achilles Tendon↗