Anatomical studies and a correlative management of facial skeleton and skull base injuries with bone plate fixation

Abstract Background Metacarpal shaft fractures are a common hand trauma. The current surgical fixation options for such fractures include percutaneous Kirschner wire pinning and nonlocking and locking plate fixation. Although bone plate fixation, compared with Kirschner wire pinning, has superior fixation ability, a consensus has not been reached on whether the bone plate is better placed on the dorsal or lateral side. Objective The purpose of this study was to evaluate the fixation of locking and regular bone plates on the dorsal and lateral sides of a metacarpal shaft fracture. Materials and methods Thirty-five artificial metacarpal bones were used in the experiment. Metacarpal shaft fractures were created using a saw blade, which were then treated with four types of fixation as follows: (1) a locking plate with four locking bicortical screws on the dorsal side (LP_D); (2) a locking plate with four locking bicortical screws on the lateral side (LP_L); (3) a regular plate with four regular bicortical screws on the dorsal side (RP_D); (4) a regular plate with four regular bicortical screws on the lateral side (RP_D); and (5) two K-wires (KWs). All specimens were tested through cantilever bending tests on a material testing system. The maximum fracture force and stiffness of the five fixation types were determined based on the force–displacement data. The maximum fracture force and stiffness of the specimens with metacarpal shaft fractures were first analyzed using one-way analysis of variance and Tukey’s test. Results The maximum fracture force results of the five types of metacarpal shaft fracture were as follows: LP_D group (230.1 ± 22.8 N, mean ± SD) ≅ RP_D group (228.2 ± 13.4 N) > KW group (94.0 ± 17.4 N) > LP_L group (59.0 ± 7.9 N) ≅ RP_L group (44.5 ± 3.4 N). In addition, the stiffness results of the five types of metacarpal shaft fracture were as follows: LP_D group (68.7 ± 14.0 N/mm) > RP_D group (54.9 ± 3.2 N/mm) > KW group (20.7 ± 5.8 N/mm) ≅ LP_L group (10.6 ± 1.7 N/mm) ≅ RP_L group (9.4 ± 1.2 N/mm). Conclusion According to our results, the mechanical strength offered by lateral plate fixation of a metacarpal shaft fracture is so low that even KW fixation can offer relatively superior mechanical strength; this is regardless of whether a locking or nonlocking plate is used for lateral plate fixation. Such fixation can reduce the probability of extensor tendon adhesion. Nevertheless, our results indicated that when lateral plate fixation is used for fixating a metacarpal shaft fracture in a clinical setting, whether the mechanical strength offered by such fixation would be strong enough to support bone union remains questionable.

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Atypical Form of Cervicofacial Actinomycosis Involving the Skull Base and Temporal Bone

Annals of Otology Rhinology & Laryngology ◽

10.1177/0003489418808541 ◽

2018 ◽

Vol 128 (2) ◽

pp. 152-156 ◽

Cited By ~ 2

Author(s):

Adam McCann ◽

Sameer A. Alvi ◽

Jessica Newman ◽

Kiran Kakarala ◽

Hinrich Staecker ◽

...

Keyword(s):

Soft Tissue ◽

Skull Base ◽

Temporal Bone ◽

Soft Tissues ◽

Trauma Surgery ◽

Oral Antibiotic ◽

Facial Skeleton ◽

Atypical Form ◽

Unsuccessful Treatment ◽

The Right

Background: Cervicofacial actinomycosis is an uncommon indolent infection caused by Actinomyces spp that typically affects individuals with innate or adaptive immunodeficiencies. Soft tissues of the face and neck are most commonly involved. Actinomyces osteomyelitis is uncommon; involvement of the skull base and temporal bone is exceedingly rare. The authors present a unique case of refractory cervicofacial actinomycosis with development of skull base and temporal bone osteomyelitis in an otherwise healthy individual. Methods: Case report with literature review. Results: A 69-year-old man presented with a soft tissue infection, culture positive for Actinomyces, over the right maxilla. Previous unsuccessful treatment included local debridement and 6 weeks of intravenous ceftriaxone. He was subsequently treated with conservative debridement and a prolonged course of intravenous followed by oral antibiotic. However, he eventually required multiple procedures, including maxillectomy, pterygopalatine fossa debridement, and a radical mastoidectomy to clear his disease. Postoperatively he was gradually transitioned off intravenous antibiotics. Conclusions: Cervicofacial actinomycosis involves soft tissue surrounding the facial skeleton and oral cavity and is typically associated with a history of mucosal trauma, surgery, or immunodeficiency. The patient was appropriately treated but experienced disease progression and escalation of therapy. Although actinomycosis is typically not an aggressive bacterial infection, this case illustrates the need for prompt recognition of persistent disease and earlier surgical intervention in cases of recalcitrant cervicofacial actinomycosis. Chronic actinomycosis has the potential for significant morbidity.

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From rigid bone plate fixation to stable dynamic osteosynthesis in mandibular and craniomaxillo-facial surgery: Historical evolution of concepts and technical developments

Journal of Stomatology Oral and Maxillofacial Surgery ◽

10.1016/j.jormas.2019.01.011 ◽

2019 ◽

Vol 120 (3) ◽

pp. 229-233 ◽

Cited By ~ 1

Author(s):

N. Pham Dang ◽

I. Barthélémy ◽

F. Bekara

Keyword(s):

Plate Fixation ◽

Bone Plate ◽

Historical Evolution ◽

Technical Developments ◽

Facial Surgery

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Correlations between the abnormal development of the skull base and facial skeleton growth in anterior synostotic plagiocephaly: the predictive value of a classification based on CT scan examination

Child s Nervous System ◽

10.1007/s00381-011-1514-x ◽

2011 ◽

Vol 27 (9) ◽

pp. 1431-1443 ◽

Cited By ~ 20

Author(s):

Sandro Pelo ◽

Giampiero Tamburrini ◽

Tito Matteo Marianetti ◽

Gianmarco Saponaro ◽

Alessandro Moro ◽

...

Keyword(s):

Ct Scan ◽

Skull Base ◽

Predictive Value ◽

Abnormal Development ◽

Facial Skeleton

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Conventional bone plate fixation of distal radius and ulna fractures in toy breed dogs

Australian Veterinary Journal ◽

10.1111/avj.12408 ◽

2016 ◽

Vol 94 (3) ◽

pp. 76-80 ◽

Cited By ~ 3

Author(s):

JM Ramírez ◽

C Macías

Keyword(s):

Distal Radius ◽

Plate Fixation ◽

Bone Plate ◽

Ulna Fractures

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Augmentation of diaphyseal fractures of the radius and ulna in toy breed dogs using a free autogenous omental graft and bone plating

Veterinary and Comparative Orthopaedics and Traumatology ◽

10.3415/vcot-14-02-0020 ◽

2015 ◽

Vol 28 (02) ◽

pp. 131-139 ◽

Cited By ~ 8

Author(s):

S. Cooley ◽

J. J. Warnock ◽

S. Nemanic ◽

S. M. Stieger-Vanegas ◽

W. I. Baltzer

Keyword(s):

Plate Fixation ◽

Fracture Site ◽

Implant Removal ◽

Bone Plate ◽

Term Outcome ◽

Post Surgery ◽

Retrospective Clinical Study ◽

Diaphyseal Fractures ◽

Omental Graft

SummaryObjectives: Evaluation of the short-term outcome, duration of bone healing, and complications following bone plate fixation in dogs weighing [uni2264]6 kg, with and without the use of a free autogenous greater omental graft (OG).Materials and methods: A retrospective clinical study reviewed the medical records of 25 dogs of body weight <6 kg with mid to distal diaphyseal fractures of the radius and ulna (29 fractures) treated with open reduction bone plate fixation. Thirteen out of 29 fractures were implanted with an additional 2–3 cm3 OG lateral, cranial, and medial to the fracture site, adjacent to the bone plate.Results: Median time to radiographic healing in OG fractures (n = 11) was 70 days (range 28–98) compared to 106 days (range: 56–144) in non-OG grafted fractures (n = 14). The OG dogs had no major complications; minor complications included oedema, erythema, and mild osteopenia. Six of the eight non-OG dogs for which follow-up could be obtained developed osteopenia necessitating implant removal, four of which re-fractured the radius one to five months after implant removal, with one dog re-fracturing the limb a second time and resulting in amputation. Telephone follow-up of owners of OG dogs (n = 11) three to 15 months (median 10) post-surgery did not identify any signs of lameness or other complications. Owners of the non-OG dogs (n = 8) reported that there were not any signs of lameness six to 48 months (median 36) post-surgery.Clinical relevance: Free autogenous omen-tal grafting of diaphyseal fractures of the radius and ulna was associated with radial and ulnar healing with minimal complications in dogs weighing less than 6 kg.

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Experimental Fracture Model versus Osteotomy Model in Metacarpal Bone Plate Fixation

The Scientific World JOURNAL ◽

10.1100/2011/465371 ◽

2011 ◽

Vol 11 ◽

pp. 1692-1698 ◽

Cited By ~ 5

Author(s):

S. Ochman ◽

T. Vordemvenne ◽

J. Paletta ◽

M. J. Raschke ◽

R. H. Meffert ◽

...

Keyword(s):

Mechanical Properties ◽

Plate Fixation ◽

Maximum Load ◽

Fracture Model ◽

Bone Plate ◽

Bending Test ◽

Group I ◽

Metacarpal Bones ◽

Fixation Techniques ◽

Fracture Models

Introduction. Osteotomy or fracture models can be used to evaluate mechanical properties of fixation techniques of the hand skeletonin vitro. Although many studies make use of osteotomy models, fracture models simulate the clinical situation more realistically. This study investigates monocortical and bicortical plate fixation on metacarpal bones considering both aforementioned models to decide which method is best suited to test fixation techniques.Methods. Porcine metacarpal bones () were randomized into 4 groups. In groups I and II bones were fractured with a modified 3-point bending test. The intact bones represented a further control group to which the other groups after fixation were compared. In groups III and IV a standard osteotomy was carried out. Bones were fixated with plates monocortically (group I, III) and bicortically (group II, IV) and tested for failure.Results. Bones fractured at a mean maximum load of 482.8 N 104.8 N with a relative standard deviation (RSD) of 21.7%, mean stiffness was 122.3 35 N/mm. In the fracture model, there was a significant difference () for maximum load of monocortically and bicortically fixed bones in contrast to the osteotomy model ().Discussion. In the fracture model, because one can use the same bone for both measurements in the intact state and the bone-plate construct states, the impact of inter-individual differences is reduced. In contrast to the osteotomy model there are differences between monocortical and bicortical fixations in the fracture model. Thus simulation of thein vivosituation is better and seems to be suitable for the evaluation of mechanical properties of fixation techniques on metacarpals.

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