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Investigations of the development of the dentition and skeletal patterns in 14 pairs of monozygotic twins for approximately 10 years are the basis of a pair comparison. Following the measurements of the plaster casts and the cephalometric radiographs we can state, that in this group of identical twins there are small intra-pair variations.
The aim of this study was to identify the molar occlusal features in 73 subjects with the Turner's syndrome (TS) and compared to a control group (CG) of 322 healthy females. The occlusal features were scored on dental plaster casts using the Scoring Procedures for Key Morphological Traits of the Permanent Dentition: The Arizona State University Dental Anthropology System (ASU). The results were analyzed through frequency, percentage and chi 2-test. TS subjects have more frequent reduction of cusp number, distolingual cusp on the upper molars and distal cusp on the lower molar, with the consequent reduction of the occlusal surface. Reduced size of occlusal surface and number cusps on upper molars resulted in the transformation of rhomboid occlusal shape into triangular, with the consequent loss of H-shaped groove system (in the upper right first molars H-shaped groove system was significantly less frequently found in TS (p < 0.05); in the upper left second molars H-shaped groove system was significantly less frequently found in TS (p < 0.01). The X-chromosome aneuploidy can cause a decrease in developmental homeostasis, which results in the alteration of apposition of the enamel and in consequently substantial changes of the molar occlusal morphological features.
The results of treatment using a locally-designed external fixator in 20 patients are presented. Open fractures were the main indications for external fixation. Pin tract infection occurred in 8 patients. Only 2 patients had unstable fixation which required removal of the device. One third of patients developed malunion exceeding 15 degrees and two thirds had joint stiffness after conversion to plaster cast. This external fixator is adequate in the treatment of most open fractures of the tibia. However, improved techniques of pin insertion and cast application upon removal of the external fixator may help to reduce the incidence of pin tract infections and malunion.
Traditional conservative and surgical methods of treatment of melorheostosis, such as manipulations, plaster casts, soft-tissue releases, capsulotomies, and osteotomies cause a high recurrence rate. In a 12-year-old girl, flexion contracture of a knee with limb inequality caused by melorheostosis was corrected successfully with the Ilizarov distraction apparatus.
OBJECTIVE: To test the validation of the 3D measuring technique. METHODS: A life-size plaster cast of human head was used as the anthropomorphic model. Fifteen experimental conditions were studied. Nine linear distances between landmarks and Nasion were measured each time. These were compared to the standard anthropometric measurements using the same landmarks. RESULTS: The mean difference was 1.21mm (2.09%). Among the 8 conditions imitating different head posture,only the one turning 10 degrees to the left had a significant difference from the normal position. CONCLUSION: In accordance with the requirements of " human measurement handbook", the system error is acceptable.
Orthodontists use several diagnostic aids for treatment planning and evaluation of treatment results. Most common are plaster casts, panoramic as well as cephalometric x-rays and often also intraoral and facial photographs. Nowadays digital alternatives are available for these diagnostic tools. Also many software programmes have been developed on subjects such as practice management and patient education. In the near future the 'paperless office' appears to become reality. In this article developments up to now are presented.
A 19-year-old boy presented to the Accident and Emergency Department after sustaining trauma to his left ankle and foot while playing soccer. The radiograph of his left ankle showed a well-corticated triangular fragment of bone posterior to the left talus, typical of an os trigonum. This accessory bone was initially mistaken for a fracture fragment and a plaster cast was applied. The term, do not touch lesion, has been coined to describe this group of benign bony entities which may be classified into three broad categories, namely: normal variants, lesions that are real but obviously benign, and lesions that are related to degenerative disease. The importance of recognising the characteristic radiographical appearances of these entities is emphasised, as the need for further imaging or diagnostic tests can usually be avoided.
A retrospective review of 50 cases treated over a 12-month period with 95 tendon injuries was carried out. Post-operative management utilising a modified Kleinert method was used for cases over eight years of age, while those under eight were immobilised in plaster cast. Our results after a mean follow up period of 14 weeks compared well with other series using the Kleinert method. Zone II injuries gave an unexpected better results than those in other zones.
The authors have treated 31 fresh ruptures of the lateral ligament and 104 cases of chronic instability of the lateral side of the knee. In recent ruptures the results obtained after surgical repair were not as gratifying as those obtained after injuries of the medial ligament. The cases operated upon were tears of the lateral ligament associated with ruptures of one or both cruciate ligaments. The frequency of rupture of the popliteus tendon is emphasized. The authors recommend, when necessary, a double surgical approach both laterally and posteriorly and plaster cast immobilization for more than 6 weeks. Tendon transfer in recent lesions have been done when suture of a cruciate ligament was impossible. The results of several procedures for chronic instability were analysed; transposition of the patellar ligament, transposition of the head of the fibula, or tightening of the lateral structures of the knee (capsule, ligament, popliteus tendon). Associated lesions of the cruciate ligament were treated by tendon transfer. Poor results were obtained in those presenting with fixed varus deformities. The authors conclude that such deformities should be corrected by osteotomy.
PURPOSE OF THE STUDY: Total arthrodesis of the carpal joint is a complex operative procedure that results in the restoration of joint stability in frontal and sagittal planes and improvement in function of the tendons of digits' extensors and flexors. We developed our own method based on the use of a special implant; in this study we report our long-term results. MATERIAL: Since 1992 we have carried out 54 total carpal arthrodeses, using our method, on 51 patients; three patients were treated bilaterally. Both wrists were treated in. This group comprised 34 women and 19 men, with the average age of 47.6 years. We used the modified method mainly in patients with stage IV rheumatic carpal destruction (Larsen classification) or in those with wrist destruction due to arthritis or psoriasis. In two patients, this method was indicated because of a non-reparable lesion of the nervus radialis. It was also used in two patients who had their wrist replacements removed due to failure. METHODS: The procedure was carried out, with a tourniquet applied to the upper arm, from the dorsal approach to the carpal joint. After opening the capsule, using an oscillating saw, we resected the facies articularis radii, the carpal bones, which were freed from cartilage and turned into a cancellous in situ filling, and the distal ulna. This procedure prepared the operation field for the application of our plate. This L-shaped plate, only 2 mm thick, with its concave curve fitting the palm, allows for three-point fixation of the metacarpal region and also maintains slight compression. RESULTS: In all the patients, we achieved osseous fusion detectable by radiography and clinical examination on average at 12 weeks postoperatively. The grasping function of the hand improved in all patients because the carpal axis was adjusted to a functionally convenient position. The resection of the distal ulna, which is a part of our method, removed pain caused by supination or pronation. The patients reported the absence of pain, instability and edema of the wrist. DISCUSSION: The aim of any method for total wrist arthrodesis is the firm fixation of resection-treated articular surfaces of the radius, carpal bones and metacarpal bases for a period long enough to allow for their complete fusion. These techniques involve intraosseous procedures, the use of plates, osteorrhaphy and external fixation. Most of these methods use massive corticocancellous grafts collected from the hipbone crest. The critical point of all methods is fixation of the metacarpal region. CONCLUSIONS: The method described here is based on an original implant in the form of an L-shaped plate that permits sufficient fixation without using grafts taken from the pelvis. In patients with rheumatic arthritis, if needed, it facilitates peritenosynovectomy or reconstruction of spontaneous tendon ruptures in one operation. It does not require long-term immobilization in plaster cast and permits early rehabilitation of finger joints.
A short cut review was carried out to establish whether an above elbow plaster cast was better than a collar and cuff sling after reduction of a dislocated elbow. No papers addressing this question were found using the reported search.
From 1982 to 1986, a total of 106 children with supracondylar fractures of the humerus were treated at the trauma surgery clinic in Braunschweig. Undisplaced or slightly displaced fractures were treated with plaster casts. More severely displaced fractures were initially treated by closed reduction under general anesthesia and percutaneous Kirschner wiring. In 72 cases (= 85.7%) a follow-up examination revealed a very good or good result. In 9 cases (= 10.7%) satisfactory results were found and in 3 cases (= 3.6%) unsatisfactory results. The most common complication prejudicing the result was cubitus varus. It was found in 27 cases (= 32.1%), most often with a varus under 10 degrees (19 of the 27 cases). A retrospective study of the 12 cases in which the results were classified as satisfactory or unsatisfactory showed 8 insufficient reductions in fractures with severe instability.
Factors that affect the duration of orthodontic treatment in children were studied from treatment records, dental and cephalic radiographs, and dental plaster casts of a random sample of 93 orthodontic patients who were treated during the period 1983-1994 and were aged 7 to 13 years at the start of treatment. The duration of treatment and 15 variables describing the patients' age at the start of treatment, the gender distribution of the patients, the progress of treatment, the occlusal status, skeletal deviations, malocclusion classes (Angle), and patients' age at the start of treatment, were recorded. The data were analysed by means of analysis of variance, chi-square test, and multiple regression analysis. The mean treatment time was 2.9 years. The regression analysis revealed that the variations in sex variables, malocclusion class, patients' age at the start of treatment, type of appliances used, number of appliances used, number of missed appointments, and main additional diagnosis explained about 41% of variation in treatment time. Treatment of Class I and Class II/1 patients with combinations of fixed and removable appliances, early start, high number of appliances used, and high number of missed appointments prolonged the duration of treatment. Treatment of Class I patients with frontal crossbite was relatively short.
The authors have observed forty-two cases of fractures and dislocations of the spine in children. In twenty-eight cases there was a complete spinal cord lesion and in four cases a partial cord lesion with some recovery. Ten children had no neurological lesion. Fifteen progressive kyphoses and twenty-two progressive scolioses were noted and analysed. The kyphotic deformities were more severe at cervical levels and seem to be aggravated by laminectomies. They were stabilised at the time of bone maturity. To prevent this deformity, the authors recommend long-term plaster cast immobilisation associated with posterior fusion. In scoliotic deformities, the authors distinguish those due to neurological involvement and those arising at the level of the fracture due to disturbance of vertebral growth. Indications for treatment are discussed in relation to the age of the patient and the level of the fracture.
This study compared the tensile properties of the atrophied gastrocnemius unit after immobilization in a shortened position (SP) and lengthened position (LP). The left hind legs of 52 male Wistar rats were fixed with plaster casts either with the knee in flexion and the ankle in extension, or vice versa. After seven to 21 days of immobilization the load-deformation curves and the weights of both gastrocnemius muscle-tendon units from each rat were evaluated. The initial length increased about 4% in the LP immobilized muscles and decreased about 5% in the SP immobilized muscles when compared to the contralateral controls. The decrease in force to failure averaged 21% in the LP and 31% in the SP immobilized muscles after one week and continued to about 26% and 48%, respectively, in three weeks. The corresponding elongation decreased 13% and 21% in one week and 17% and 36% at the end of the third week when immobilized in the LP and SP, respectively. The decrease in elastic stiffness was similar in both groups, but the loss of energy absorption capacity before failure was more prominent in SP fixed muscles (64%) than in LP fixed muscles (49%). The loss of weight of the muscle-tendon units due to the immobilization was greater in the SP (36%) than in the LP (12%). We conclude that immobilization of the rat gastrocnemius muscle-tendon unit in an SP is followed by a more marked muscle atrophy and a greater decrease in tensile properties than immobilization in an LP.
PURPOSE OF THE STUDY: Fractures of a tibial pylon are serious problems in traumatology. The methods of their therapy have not been unified yet and treatment outcomes are not satisfactory. This is often due to extensive comminution of the distal tibia, bone defects or a thin coverage of soft tissue. The objective of this study is to compare the literature data and, on the basis of this and our own experience, to present guidelines for the treatment of fractures of tibial pylons. MATERIAL: In the period from 1998 to June 2002, 60 patients (average age, 42 years) underwent surgery for a fracture of the tibial pylon in the Department of Orthopedics, IPVZ, and in the hospital Na Bulovce, First Faculty of Medicine, Charles University in Prague. In most of the patients, the injury was caused by falling from a height. Thirteen patients failed to turn up for follow-up. METHODS: Plate osteosynthesis or MIO, usually combined with plaster cast, were used in 42 patients. External fixation, with individual screws or Kirschner's wires in some cases, was employed in 18 patients. External fixation was applied in open fractures and in serious comminutions of the distal tibia. RESULTS: A total of 47 patients were followed up for a period of 6 months to 5 years. Infectious complications occurred in 12 patients (20%), of whom five had to undergo repeat surgery. Twenty-five patients (53%) reported good results of treatment, with no or only very minor restriction of motion in the ankle joint. In 13 patients, the outcome was satisfactory and nine patients were not satisfied because of serious restriction of motion or ankylosis of the ankle joint. Three patients underwent a delayed arthrodesis of the ankle joint. The fractures healed completely in all patients. DISCUSSION: The results achieved in our patients were comparable with those described in the international literature. The very good and satisfactory outcomes in 53% and 28% of the patients, respectively, are in agreement with the studies reporting good rates of success. Also the number of infectious complications (20%; 8% serious) was in the range generally reported. The initial method of treating fractures of the tibial pylon by plate osteosynthesis has gradually been abandoned. The major prognostic factors for the outcome of treatment are the extent of injury to soft tissues and the kind of surgical procedure used. Therefore, it appears that external fixation, usually in combination with semi-closed reduction and fixation of fragments with screws and Ki-wires, has a better prognosis not only in open fractures but also in closed comminuted fractures with seriously injured soft tissues. CONCLUSIONS: Fractures of the tibial pylon are serious injuries and their therapy requires good experience in the field and appropriate technical facilities. The method of treatment should be chosen according to not only fracture type but also soft tissue involvement and the patient's overall state.
PURPOSE: The purpose of this study is to investigate the effect of premolar extractions on Bolton index. METHODS: 213 plaster casts were divided into Bolton big, normal and small groups according to Bolton normal value and one standard deviation. Bolton overall ratios and number of patients in each group were measured and compared between parameters before and after hypothetical premolar extractions. RESULTS: The Bolton overall ratios in each group were smaller after premolar extractions than those before extractions. Part of patients in the Bolton normal group and big group were changed into Bolton small group and normal group after premolar extractions, respectively. CONCLUSION: The Bolton overall ratios decreased after premolar extractions.
AIM: The study evaluates the repair of residual alveolar cleft through secondary bone graft, consisting in the transplantation of autologous bone to restore the continuity of the maxillary arch and achieve normal functioning and esthetics. METHODS: During 2001-2002, 15 patients (age range 9-26 years; 7 males, 8 females) were submitted to secondary bone graft at the Maxillo-facial Surgery Operative Unit, University Hospital, Sassari. Eleven patients had complete unilateral cleft, 4 had complete bilateral cleft. All patients were operated upon by the same surgeon; they received a graft of autologous bone from the iliac crest. For preoperative and postoperative evaluation at 1 year, the following were utilised: plaster casts of the tooth arches, OPT, photographs and complete clinical documentation. RESULTS: Postoperative results were: 100% formation of a bone bridge between the maxillary segments; 70% closure of oro-nasal fistula; 100% maxillary stability; 80% spontaneous eruption of the canine within the graft; 70% height of alveolar ridge level I, 25% level II, 5% level III; 70% orthodontic closure; 80% optimal periodontal condition and 20% presence of gingival recession. In 1 subject the graft site became infected, in 4 cases an oro-nasal fistula remained. CONCLUSION: This method was found to be the most valid one at present. The best period to intervene is during late childhood (9 years). Results and functional and esthetic recovery were satisfactory and encouraging to continue utilising this technique.