Craniofacial trauma, including management of frontal sinus and nasoethmoidal injuries
John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan in Operative Oral and Maxillofacial Surgery, 2017
The selection of osteosynthesis material requires maintenance of the reduced fractures and bone grafts in a stable position. Usually, titanium plates with a low profile utilizing screws 1–1.3 mm in diameter are used. This is sufficient as the bone is not load-bearing other than to withstand the pulsation of the dura or in the case of the orbital roof the weight of the frontal lobes. Bone grafts must take into account the original anatomy of the defect and nowhere is this more important than in restoring the upward curving nature of the orbital roof, failure to realize this important point may result in vertical hypoglobus and potentially exophthalmos. Bone grafting within the orbital roof is important to separate the pulsation of the brain from the orbital contents which may result in very unsightly pulsation of the eye. Having restored the orbital roof, the anterior fossa floor and if necessary cranialization of the frontal sinus, then vascularized peri-cranial grafts may now be introduced. If an anterior flap is raised, this may be fed in beneath the frontal lobes and be secured with a few sutures and supplemented with fibrin glue to try and obtain a watertight seal and close off the nasopharynx from the anterior fossa. If damage to the pericranium anteriorly has necessitated a laterally based flap, then this may be introduced from the region of the lateral craniotomy cut and burr hole. Finally, the craniotomy segment may be repositioned taking care not to compress the peri-cranial graft and trying to position any subsequent space in the bone cuts to give the most cosmetically acceptable result.
History of osteotomies around the hip joint and their classification
K. Mohan Iyer in Hip Preservation Techniques, 2019
Of all these listed complications, the most commonly seen is trochanteric bursitis, and routine removal of the implants usually avoids this problem. An adequate radiographic workup and skillful preoperative tracing or computer templating for many osteotomies. Rigid internal fixation is critically important for stability by osteosynthesis. A preoperative Trendelenberg limp can be improved after osteotomy or possibly by greater trochanter advancement, which improves the abductor mechanics. Osteotomy can make subsequent THR surgery more difficult on both the pelvic and femoral sides. In some cases, a revision osteotomy of the femur may be necessary prior to proceeding with a THR. Simultaneous implant removal and THR surgery results in slightly increased operative time and possibly an increased infection rate for the THR. One of the more dreaded complications is AVN. Myositis ossificans can appear after an otherwise uncomplicated osteotomy, more commonly on the pelvic side. It is usually an incidental finding but can cause symptomatic stiffness.
Polytrauma
Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor in Essentials of Anesthesia for Neurotrauma, 2018
A window of opportunity in polytrauma management refers to the time period when definitive surgical repair achieves the desired outcome with the least impact on the patient’s physiological status. Following DCS, further surgical interventions are often needed for definitive anatomical repair during the stabilization period in the ICU. The impact of surgery on the patient’s physiologic reserve depends on its type and timing. For orthopedic procedures, the window was set between the fifth and tenth days. Earlier interventions between the second to the fourth days after an injury has been reported to be unsuitable for performing definitive osteosynthesis.102 The balance between the early surgical intervention with its impact on the patient’s ongoing immune disturbance (as a second hit) vs. the delayed one with the risk of contamination or function loss is the rationale behind this concept.
Interosseous wiring for fragmented proximal phalangeal fractures
Published in Case Reports in Plastic Surgery and Hand Surgery, 2022
Hidetoshi Teraura, Hideki Sakanaka, Hiroyuki Gotani
In conclusion, the present study describes cases of proximal phalangeal fractures involving more than three fragments that were challenging to treat with percutaneous pinning or screw fixation and were treated with IOW. Plate and screw can be used as an osteosynthesis in suitable cases. However, although IOW certainly requires proficiency in the procedure, it is possible to fix small bone fragments that are difficult to fix with plate and screw, and so I think that it is a good option for fragmented proximal phalangeal fractures. The treatment outcomes were positive without deformity or the patient complaining of pain, with a mean TAM of 237° and mean %TAM of 94%; all five cases were assessed as having excellent outcomes, based on the ASSH criteria. A good range of TAM was achieved by starting ROM training for the DIP and PIP joints immediately after surgery and fixing the MP joints in the flexion position.
Prediction of interfragmentary movement in fracture fixation constructs using a combination of finite element modeling and rigid body assumptions
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2021
M. Mühling, M. Winkler, P. Augat
An artificial tibia bone model (SKU 3402, 4th Gen. large left, Sawbones Europe AB, Malmö, Sweden) was scanned by computed tomography (140 kV, 96 mA, slice thickness 0.75 mm, SOMATOM 86 AS+, Siemens AG, Erlangen, Germany) and segmented using Amira (6.0.0, Zuse Institute Berlin, Berlin, Germany & Thermo Fisher Scientific, Waltham, USA). The scan was then separated into a cortical and a cancellous bone model. For fracture fixation a 3 D scanned (accuracy 0.06 mm (0.05%), HP Pro S3 with 3 D Scan Software Pro v5, HP Inc., Palo Alto, USA) large fragment locking compression plate (LCP 4.5/5.0 broad 10 holes, Synthes GmbH, Oberdorf, Switzerland) and 6 locking screws (5 mm x 40 mm), modelled as cylinders via Solidworks (2015 × 64, Dassault Systmes, Vlizy-Villacoublay, France), were placed on the distal and proximal end of the LCP. The model was created as a locked construct with 2 mm of space between tibia and LCP. Each model was processed using Geomagic Studio (12.1.0 64-Bit, Geomagic, North Carolina, USA) to achieve volume type models out of surface type ones. A 20 mm transverse fracture gap (AO/OTA type 42-A3) was virtually induced to achieve a fracture without touching fragments in the middle of the shaft. The osteosynthesis was configured and placed according to the expertise of an experienced surgeon using Solidworks. The experimental setup of the mechanical test (Figure 1) was transferred into a digital model by including the distal embedding resin block into the model.
The design of the cemented stem influences the risk of Vancouver type B fractures, but not of type C: an analysis of 82,837 Lubinus SPII and Exeter Polished stems
Published in Acta Orthopaedica, 2019
Georgios Chatziagorou, Hans Lindahl, Johan Kärrholm
Several previous studies have demonstrated an increased risk for periprosthetic fracture of the Exeter when compared with the Lubinus stem (Lindahl et al. 2005, Thien et al. 2014). To our knowledge, this is the first study that distinguished between Vancouver type B and type C fractures, based on extensive research to include all reoperations. Earlier studies have either looked at the overall risk for periprosthetic fracture (Lindahl et al. 2005, Palan et al. 2016), or the risk for revision due to fracture (Cook et al. 2008, Thien et al. 2014) (mainly Vancouver type B2 and type B3 fractures), for one or both of these stems. Our main finding is that the Lubinus SPII did not have a higher risk for type C fractures, despite the fact that almost 3 out of 4 fractures around this stem were located distal to it (see Table 4). The finding that the Exeter Polished stem had a higher risk for fracture (type B and overall), confirms earlier publications (Lindahl et al. 2005, Thien et al. 2014). The commonest fracture type in this material was, however, type C (see Table 4). This observation results from an almost complete registration of fractures treated with osteosynthesis only, and without any stem revision (Chatziagorou et al. 2018). In Sweden, type B fractures are more common in uncemented stems, and type C fractures in cemented stems (Chatziagorou et al. 2018), in contrast to a previous study from the Mayo Clinic (Abdel et al. 2016).
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