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Orthopaedics
Published in Kelvin Yan, Surgical and Anaesthetic Instruments for OSCEs, 2021
This is a dynamic hip screw (DHS) (Figure 8.4). It consists of a large cancellous lag screw, a metal sleeve attached to a plate and associated screws that fix the plate to the cortex of the femur. The lag screw slides freely into the metal sleeve thereby offering dynamic compression of the fracture through transferring weight-bearing forces to the femoral metaphysis. Bone healing and remodelling occur with the maintained reduction of the fracture.
Bone Healing and Revascularisation after Total Maxillary Osteotomy
Published in Niall MH McLeod, Peter A Brennan, 50 Landmark Papers every Oral & Maxillofacial Surgeon Should Know, 2020
The study showed that blood supply for the maxilla during total osteotomy can be reliable via the buccal and palatal soft tissue flaps. In addition, it showed that ligation of the greater palatine artery had no effect on the survival of the maxilla. Evidence of bone healing is seen as early as six weeks after surgery.
Dentin-Pulp Complex Regeneration
Published in Vincenzo Guarino, Marco Antonio Alvarez-Pérez, Current Advances in Oral and Craniofacial Tissue Engineering, 2020
Amaury Pozos-Guillén, Héctor Flores
The European Society of Endodontology and the American Association for Endodontists have released position statements and clinical considerations for regenerative endodontics. In general, they consider that the degree of success of regenerative endodontics depends on three factors: (i) resolution of clinical signs and symptoms and bone healing; (ii) further root maturation; and (iii) return of neurogenesis, positive response to vitality testing. The results are variable for these objectives, and a true regeneration of the pulp/dentine complex is not reached (Feigin and Shope 2017; Kim et al. 2018).
Interosseous wiring for fragmented proximal phalangeal fractures
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Hidetoshi Teraura, Hideki Sakanaka, Hiroyuki Gotani
No patient complained of pain. Bone healing was achieved in all cases, and the mean healing time was 13.6 (range, 11–19) weeks. No rotational or flexion/extension deformities were observed. No postoperative complications, such as infection, CRPS type one, re-displacement of the fractured bone, and implant breakage, were reported. The mean extension lag of the PIP joint was 3° (range, 0°–10°), and an extension lag was observed in two cases, one with 5° and another with 10°. The mean TAM was 237° (range, 210°–260°), mean %TAM was 94% (range, 86–100), and the outcome of all five cases was determined to be excellent based on the ASSH criteria (Table 1). The implants were removed after a mean postoperative period of 29 (range, 22–36) weeks in four of the five patients. The remaining patient did not wish for the implant to be removed and was thus left in place. Tenolysis of extensor tendon was not performed during implant removal in any of these cases, and the TAM before and after implant removal was similar.
The evolution of radiological measurements and the association with clinician and patient reported outcome following distal radius fractures in non-osteoporotic patients: what is clinically relevant?
Published in Disability and Rehabilitation, 2021
Charlotte M. Lameijer, Henk Jan ten Duis, Charlotte M. S. C. Haag, Mostafa El Moumni, Corry K. van der Sluis
Surprisingly, our results showed that step-off and gap diminished significantly between 6 weeks and follow-up, although these differences were within earlier mentioned magnitude error [10]. Conflicting results regarding reliability of measuring gaps and step-offs following distal radius fractures have been reported. It has been reported that observers, independent of skill level, may measure step-off and gaps accurately to 0.62 ± 53 mm (95% CI 0.59–0.65) [67]. Intraclass correlation coefficient scores showed “substantial” (0.78) to “almost perfect” (0.81) inter- and intraobserver agreement [67]. In contrast, other studies reported low intra- and inter-reliability ICC values [10,18]. Watson et al. showed that measurement error lies within 1–2 mm, indicating that clinicians cannot measure differences ≤1 mm [10]. They therefore questioned the reliability of using these radiographic measurements to guide treatment decisions regarding conservative or operative management. To our knowledge, no literature on the decrease of articular incongruence over time in adult patients is available. Bone healing is a complex event that involves coordination of two complex forces: anabolism or tissue formation and catabolism or remodelling under influence of axial, translational and rotational forces [68,69]. Possibly remodelling processes have diminished the articular incongruence.
Recent Advances in Biomaterials for the Treatment of Bone Defects
Published in Organogenesis, 2020
Le-Yi Zhang, Qing Bi, Chen Zhao, Jin-Yang Chen, Mao-Hua Cai, Xiao-Yi Chen
Bone defects produced by large bone tumor resections, trauma-induced nonunion fractures, biochemical disorders, infections, or abnormal skeletal development due to genetic disorders, are a major cause of disability and a loss of quality of life globally.6 The treatment of bone defects to recover normal bone morphology and function represents an important and unmet clinical challenge, particularly when bone healing is impaired.7 There are several reasons for bone healing defects, including bone loss due to injury, impaired vascularization, dysregulated immune responses, infection and osteomyelitis.8 Surgical techniques, including the implantation of synthetic bone substitutes and bone graft implants, have been developed to aid bone recovery.9 Bone grafting replaces the missing bone during surgery, and as a procedure, its demand is widespread, second only to blood transplants in terms of treatment frequency.7, 10 Autographs remain the front line therapy but their attainability is complex and their effectiveness is limited by the associated morbidity during harvesting and poor clinical performance, particularly in osteoporosis patients.11 Therefore, the development of new, effective and safer alternatives is urgently required in the field of bone regenerative therapy.