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Ulnar Club Hand
Published in Benjamin Joseph, Selvadurai Nayagam, Randall T Loder, Anjali Benjamin Daniel, Essential Paediatric Orthopaedic Decision Making, 2022
Christopher Prior, Nicholas Peterson, Selvadurai Nayagam
Using percutaneous access, small drill holes were created at the levels of the planned osteotomies in the distal radius and ulna. The osteotomies were completed using an osteotome. Acute correction of the ulnar angulation of both radius and ulna was performed by manipulating the rings. The fixator was stabilised once the desired correction was obtained (Figures 35.5a – d).
Dorsum Surgery
Published in Suleyman Tas, Rhinoplasty in Practice, 2022
The surgery used to cut bone is known as an osteotomy. Performing this type of surgery smoothly and without creating additional fractures requires great skills, patience, and good equipment. Osteotomies used to be performed with hand saws in the 1900s; however, due to emerging bone defects through their use, they were then performed with a chisel, then with 4 mm guarded osteotomies, and then with 2 mm guarded osteotomies. Today, power tools facilitate this stage and two specific ones come to mind: ultrasonic devices and micromotors (Videos 3.1–3.2).
Instruments and Implants in Hand Surgery
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
Anil K Bhat, Ashwath M Acharya, Mithun Pai G
Fine osteotomes of varying size: These are used for performing osteotomies and smoothening the bone surface. A selection of sharp osteotomies of varying width is necessary to avoid injury to surrounding soft tissue when performing osteotomies of phalanges/metacarpals (Figure 15.17).
Patient-specific pre-operative simulation of the surgically assisted rapid maxillary expansion using finite element method and Latin hypercube sampling: workflow and first clinical results
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
L. Bonitz, A. Volf, S. Hassfeld, A. Pugachev, B. Ludwig, S. Chhatwani, A. Bicsák
The use of FEA in SARME has also been described by Jiang et al. (2009). Three different types of osteotomies were compared. Osteotomy of the pterygomaxillary bone connection is recommended because considerable forces are derived from the base of the skull counteracting the transversal distraction force. As presented by Bonitz et al. in the book of Döessel and Schlegel the FEA is also used to analyze and calculate the forces during the distraction and the resulting mechanical stresses (Dössel and Schlegel 2010). The paranasal bone region, lateral wall of the maxillary sinus and pterygomaxillary bone junction were identified as important resistance centers during distraction. The selective weakening of these bony units enables more control over the distraction vector. Esen et al. also confirmed that osteotomy of the pterygomaxillary connection resulted in a significant reduction in forces detected in the skull base area (Esen et al. 2018). A more extensive osteotomy technique can significantly reduce this tension. However, this also increases the risk of complications, like severe bleeding or neurologic complications, as shown by Gautam et al. (2011a, 2011b). In addition, other negative effects of an osteotomy in the Le Fort I plane can also be avoided, including injury to the root tips or damage to the infraorbital nerves.
Correction of 4th and 5th metacarpal synostosis in a skeletally mature hand using de-rotational osteotomies
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Christopher D. Liao, Feras Yamin, Roger L. Simpson
Preoperatively, we combined several radiographic images to estimate the appropriate degree of angulation and rotation with precise virtual measurements. The procedure was performed under general anesthesia and fluoroscopic guidance. Total operative time was 2 h, during which a right arm tourniquet was applied. A 6-cm incision was created on the dorsal aspect of the ulnar side of the right hand. A surgical plane was dissected between the heads of the 4th and 5th metacarpals. Wedge osteotomies were created using an oscillating saw. A 2-mm closing wedge osteotomy was made on the ulnar side of the neck of the 4th metacarpal at the exact location and orientation dictated by the preoperative diagrams. The head of the 4th metacarpal and ring finger were then de-rotated and realigned in the appropriate position. This was followed by fixation of the osteotomy site with a 1.6-mm mini-plate and 8-mm non-locking screws spanning the osteotomy. Another 2-mm closing wedge osteotomy was created on the radial aspect of the neck of the 5th metacarpal, again adhering to the preoperative diagrams. The small finger was de-rotated and realigned into a more acceptable position anatomically and functionally. The normal cascade of the right hand was restored intraoperatively. The wedge osteotomy bone fragments were placed as grafts to lengthen the 5th metacarpal head, followed by fixation with a 1.6-mm mini-plate and 8-mm non-locking screws to stabilize the construct.
Three-dimensional morphological and biomechanical analysis of temporomandibular joint in mandibular and bi-maxillary osteotomies
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2022
Bingmei Shao, Annan Li, Jingheng Shu, Hedi Ma, Shiming Dong, Zhan Liu
The study protocol was reviewed and approved by the Affiliated Hospital of Stomatology of Chongqing Medical University Institutional Review Board (CQHS-IRB-2014-01). Each participant signed an informed consent form. Ten asymptomatic subjects were recruited and identified by an oral surgeon in the Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Stomatology, and named the control group. The inclusion criteria were as follows: no TMD symptoms, no degenerative joint disease, and no prior TMJ-related procedures. Twenty-three patients with mandibular or bi-maxillary deformities were selected and operated by an oral surgeon. Eleven patients with mandibular protrusion and asymmetry underwent mono-maxillary (mandible) osteotomy (bilateral SSRO), designated as the mono-pre (preoperative) and mono-post (postoperative) groups. The osteotomies were performed within 2.5–4 h. The occlusion was aligned using an occlusal splint. Each split mandibular ramus was fixed using a straight titanium plate. The intermaxillary elastics lasted for 4–5 weeks. The remaining 12 patients underwent bi-maxillary osteotomy (SSRO and Le Fort I osteotomy), designated as the bi-pre (preoperative) and bi-post (postoperative) groups. The osteotomies were performed within 3–5.7 h. The SSROs were similar to those in the mono group. Each maxilla was fixed using four ‘L’ titanium plates after Le Fort I osteotomy. Four and five patients in the mono-pre and bi-pre groups, respectively, exhibited preoperative TMD.