Staged Rehabilitation of Posttraumatic Dentoalveolar Defect with Distraction Osteogenesis and Dental Implants

Rehabilitation of posttraumatic composite defects of anterior mandible following comminution type high-energy injury often presents a reconstructive challenge. Obtaining ideal osseous and soft tissue contours in these cases is a demanding task. We discuss a case of a young man, involved in a road-side accident leading to multiple fractures in his mandible with comminution of anterior alveolar ridge. We were able to achieve excellent results by planning and treating him in five sequential stages. First, the need for rigid internal fixation was addressed followed by bone augmentation with the dynamic osteodistraction method, dental implants, and prosthesis delivery. Satisfactory aesthetics and functions were noted at a 7-year follow-up evaluation of the patient justifying the multistaged rehabilitation treatment rendered.

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Piezosurgery in Bone Augmentation Procedures Previous to Dental Implant Surgery: A Review of the Literature

The Open Dentistry Journal ◽

10.2174/1874210601509010426 ◽

2015 ◽

Vol 9 (1) ◽

pp. 426-430 ◽

Cited By ~ 7

Author(s):

Gabriel Leonardo Magrin ◽

Eder Alberto Sigua-Rodriguez ◽

Douglas Rangel Goulart ◽

Luciana Asprino

Keyword(s):

Soft Tissue ◽

Dental Implants ◽

Health Professionals ◽

Oral Surgery ◽

Inferior Alveolar Nerve ◽

Alveolar Ridge ◽

Bone Augmentation ◽

Review Of The Literature ◽

Sinus Lifting ◽

Dental Implant Surgery

The piezosurgery has been used with increasing frequency and applicability by health professionals, especially those who deal with dental implants. The concept of piezoelectricity has emerged in the nineteenth century, but it was applied in oral surgery from 1988 by Tomaso Vercellotti. It consists of an ultrasonic device able to cut mineralized bone tissue, without injuring the adjacent soft tissue. It also has several advantages when compared to conventional techniques with drills and saws, such as the production of a precise, clean and low bleed bone cut that shows positive biological results. In dental implants surgery, it has been used for maxillary sinus lifting, removal of bone blocks, distraction osteogenesis, lateralization of the inferior alveolar nerve, split crest of alveolar ridge and even for dental implants placement. The purpose of this paper is to discuss the use of piezosurgery in bone augmentation procedures used previously to dental implants placement.

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Staged Management of Severely Displaced Calcaneal Fractures With Transarticular Pinning: A Damage Control Strategy

Foot & Ankle International ◽

10.1177/10711007211013012 ◽

2021 ◽

pp. 107110072110130

Author(s):

Kyeong-Hyeon Park ◽

Chang-Wug Oh ◽

Joon-Woo Kim ◽

Hee-June Kim ◽

Dong-Hyun Kim ◽

...

Keyword(s):

Soft Tissue ◽

Internal Fixation ◽

Kirschner Wire ◽

Wound Complications ◽

Calcaneal Fractures ◽

Simple Method ◽

Wire Fixation ◽

The Mean ◽

Radiographic Union

Background: Severely displaced calcaneal fractures can result in considerable morphology derangement and may be accompanied by soft tissue compromise. Delayed operative restoration of the calcaneal morphology may result in acute retensioning of the damaged soft tissue with associated wound-related complications. In this study, we describe a staged treatment of displaced intra-articular calcaneal fractures that uses temporary transarticular Kirschner wire (K-wire) fixation and staged conversion to definite fixation. Methods: We identified all of the patients who were treated at our institution for calcaneal fractures between 2015 and 2019. A total of 17 patients with 20 calcaneal fractures were selectively treated with 2-stage management. Temporary transarticular K-wire fixation was performed 24 hours after the injury to restore calcaneal morphology and the surrounding soft tissue. After the soft tissue was considered safe, delayed open reduction and internal fixation was performed. The time to definite surgery, radiographic alignment, wound complications, time to radiographic union, and hindfoot American Orthopaedic Foot & Ankle Society (AOFAS) scores were recorded. Results: The average follow-up period was 17 months (range, 12-43). The average Böhler angle increased from a mean of −22 degrees (range, −109 to 25) to 25 degrees (range, 0 to 47) after temporary transarticular K-wire fixation. The mean time from temporary pinning to conversion to definite internal fixation was 20 (range, 10-32) days. There were no immediate postoperative complications. The average time to radiographic union was 13.7 (range, 10-16) weeks. The mean AOFAS score was 87 (range, 55-100). No infections or wound complications were reported during the follow-up period. Conclusion: Temporary transarticular pinning for staged calcaneal fracture treatment is safe and effective in restoring the calcaneal morphology. This novel and relatively simple method may facilitate delayed operation and decrease wound-related complications. Level of Evidence: Level IV, retrospective case series.

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Autogenous bone augmentation for vertical defects in a severely resorbed mandible: case report of five year follow-up with dental implants

International Journal of Oral and Maxillofacial Surgery ◽

10.1016/j.ijom.2011.07.383 ◽

2011 ◽

Vol 40 (10) ◽

pp. 1139

Author(s):

L.E. Morais ◽

S.A. Raskin ◽

R.D.L. Pocztaruk ◽

T.A. Lico ◽

E. Kolodny ◽

...

Keyword(s):

Case Report ◽

Dental Implants ◽

Autogenous Bone ◽

Bone Augmentation

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Acute Compartment Syndrome of Upper Extremities with Tendon Ruptures

The Journal of Hand Surgery (Asian-Pacific Volume) ◽

10.1142/s0218810417500423 ◽

2017 ◽

Vol 22 (04) ◽

pp. 411-415

Author(s):

Taku Suzuki ◽

Eiko Yamabe ◽

Takuji Iwamoto ◽

Katsuji Suzuki ◽

Harumoto Yamada ◽

...

Keyword(s):

Soft Tissue ◽

Compartment Syndrome ◽

Tissue Injury ◽

Soft Tissue Injury ◽

Skin Grafting ◽

High Energy ◽

Acute Compartment Syndrome ◽

Mechanism Of Injury ◽

Sensory Disturbances

Background: It is well known that acute compartment syndrome is associated with fracture of the forearm, while involvement of soft tissue injury including musculotendinous injury remains unclear. The purpose of this study was to evaluate the soft tissue involvement, including musculotendinous ruptures, in acute compartment syndrome of the upper limb. Methods: We retrospectively enrolled 16 patients who underwent surgical treatment for acute compartment syndrome of the upper extremity. The average age of the patients was 47 years (range, 14 to 79) and the mean follow-up period after the surgery was 15 months (range, 12 to 29). Complications included at least one presentation at the final follow up of sensory disturbances or motor disturbances. We examined the presence of musculotendinous injury mechanism of injury, presence of fracture, the performance of skin grafting, and complications. Results: Mechanism of injury of “caught in a machine” was found in six cases. Three of these patients had musculotendinous ruptures and all muscle tears were revealed by intraoperative findings. No patients had muscle ruptures with other injury mechanisms. Seven out of 16 patients (44%) developed complications at final follow-up. Skin grafting was performed in six patients, and five of these patients developed complications. Only one of the nine patients without complications underwent skin grafting. Conclusions: In cases of high-energy injuries, the surgeon should suspect the presence of a musculotendinous injury prior to surgery.

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Open Reduction Internal Fixation versus External Fixation with Limited Internal Fixation for Displaced Comminuted Closed Pilon Fractures: A Randomised Prospective Study

Journal of Orthopaedics Trauma and Rehabilitation ◽

10.1016/j.jotr.2017.08.001 ◽

2018 ◽

Vol 24 (1) ◽

pp. 84-89

Author(s):

Rayan Ahmed ◽

Kotb Ahmed ◽

M. Elmoatasem Elhussein ◽

Samir Shady ◽

Tamer A. El-Sobky ◽

...

Keyword(s):

Soft Tissue ◽

Prospective Study ◽

Internal Fixation ◽

External Fixation ◽

Functional Outcomes ◽

Open Reduction ◽

Articular Surface ◽

High Energy ◽

Complication Rates ◽

Pilon Fractures

Background Pilon fractures involve the dome of the distal tibial articular surface. The optimal treatment for high-energy pilon fractures remains controversial. Some authors advocate the use of open reduction and internal fixation (ORIF) to avoid articular incongruence. Others advocate the use of bridging external fixation with limited internal fixation (EFLIF) to reduce soft tissue complications. Literature reports of prospective studies comparing the radioclinical outcomes of ORIF and EFLIF in high-energy fractures are scarce. Retrospective studies have their limitations because of insufficient randomisation. The objective of this randomised prospective study is to compare the clinical, radiologic and functional outcomes of displaced and comminuted closed pilon fractures, Rüedi and Allgöwer type II and III, treated by either ORIF or EFLIF. Materials and Methods Forty-two patients were selected for the study. Twenty-two patients were subjected to ORIF and 20 patients were subjected to EFLIF. We used the American Orthopaedic Foot and Ankle Society score as a standard method of reporting clinical status of the ankle. Patients were followed-up clinically and radiologically for over 2 years after the surgical treatment. Results The results of ORIF and EFLIF in treatment of high-energy pilon fractures are equally effective in terms of functional outcomes and complication rates on the short term. Conclusion Soft tissue integrity and fracture comminution seem to have a significant influence on outcomes of intervention. A prospective multicentre study with a larger sample size that controls for other associated variables and comorbidities is warranted. Level of evidence Level II.

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Combination of Fine Wire Fixation and Limited Internal Fixation for High-Energy Tibial Plateau Fractures: Functional Results at Minimum 5-Year Follow-up

Yearbook of Orthopedics ◽

10.1016/s0276-1092(09)79634-8 ◽

2010 ◽

Vol 2010 ◽

pp. 61-62

Author(s):

M.F. Swiontkowski

Keyword(s):

Internal Fixation ◽

Tibial Plateau ◽

Functional Results ◽

High Energy ◽

Tibial Plateau Fractures ◽

Fine Wire ◽

Wire Fixation

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Staged distraction osteogenesis followed by arthrodesis using internal fixation as a form of surgical treatment for complex conditions of the ankle

The Bone & Joint Journal ◽

10.1302/0301-620x.100b6.bjj-2017-1188.r1 ◽

2018 ◽

Vol 100-B (6) ◽

pp. 755-760 ◽

Cited By ~ 2

Author(s):

T-F. Lou ◽

M. Hamushan ◽

H. Li ◽

C-Y. Wang ◽

Y. Chai ◽

...

Keyword(s):

Tract Infection ◽

Internal Fixation ◽

Distraction Osteogenesis ◽

Wound Dehiscence ◽

High Rate ◽

Fixation Index ◽

Major Complications ◽

The Mean ◽

Pin Tract Infection

AimsThe aim of this study was to describe the technique of distraction osteogenesis followed by arthrodesis using internal fixation to manage complex conditions of the ankle, and to present the results of this technique.Patients and MethodsBetween 2008 and 2014, distraction osteogenesis followed by arthrodesis using internal fixation was performed in 12 patients with complex conditions of the ankle due to trauma or infection. There were eight men and four women: their mean age was 35 years (23 to 51) at the time of surgery. Bone healing and functional recovery were evaluated according to the criteria described by Paley. Function was assessed using the ankle-hindfoot scale of the American Orthopedic Foot and Ankle Society (AOFAS).ResultsA solid fusion of the ankle and eradication of infection was achieved in all patients. A mean lengthening of 6.1 cm (2.5 to 14) was achieved at a mean follow-up of 25.2 months (14 to 37). The mean external fixation index (EFI) was 42 days/cm (33.3 to 58). The function was judged to be excellent in six patients and good in six patients. Bone results were graded as excellent in ten patients and good in two patients. The mean AOFAS score was 37.3 (5 to 77) preoperatively and 75.3 (61 to 82) at the final follow-up. Minor complications, which were treated conservatively, included pain, pin-tract infection, loosening of wires, and midfoot stiffness. Major complications, which were treated surgically included grade V pin-tract infection with inflammation and osteolysis, poor consolidation of the regenerate bone, and soft-tissue invagination. The reoperations required to treat the major complications included the exchange of pins and wires, bone grafting and invagination split surgery.ConclusionThe technique of distraction osteogenesis followed by arthrodesis using internal fixation is an effective form of treatment for the management of complex conditions of the ankle. It offers a high rate of union, an opportunity to remove the frame early, and a reduced EFI without infection or wound dehiscence. Cite this article: Bone Joint J 2018;100-B:755–60.

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Ankle spanning external fixator with limited internal fixation for distal tibial extra-articular fractures

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20174557 ◽

2017 ◽

Vol 5 (10) ◽

pp. 4355

Author(s):

Siddharth Goel ◽

Abhay Elhence

Keyword(s):

Soft Tissue ◽

Internal Fixation ◽

External Fixation ◽

External Fixator ◽

Tibial Fractures ◽

Fixation Method ◽

Ankle Pain ◽

Distal Tibial Fractures ◽

Tract Infections

Background: Fractures of the distal tibia are among the most difficult fractures to treat. The short distal segment presents difficulty in choosing the appropriate fixation method. The greatest challenge lies in the relatively tight soft tissue around the ankle. As a result, it has been a recent interest in treating these fractures with external fixation and limited internal fixation. The external stable fixation methods used are tubular or ring fixators, with or without immobilising the ankle. This minimally invasive nature of the surgery can avoid catastrophic wound complications like dehiscence, implant exposure and infection.Methods: 18 patients with extra-articular distal tibial fractures (AO Type 43A) were treated with the technique of ankle spanning external fixation. Lag screws or K-wires were supplemented for limited internal fixation when required. Fibula was stabilised in all cases. Intra- articular and Compound fractures were excluded. In addition to union at fracture site, ankle pain and motion was noted in each follow-up.Results: The mean follow-up was 25 months. Of the 18 patients included all but one fractures united with an average healing time of 16 to 18 weeks. Ankle pain and motion was graded according to Mazur modified by Teeny and Wiss clinical scoring system. 15 of them had excellent or good results, 2 had fair results. One patient had poor result. Five pin tract infections occurred. 17 patients had no evidence of osteoarthritis after completing follow up of at least 2 years.Conclusions: Distal tibial fractures are complex injuries, not only regarding the bony component, but also in terms of the management of the soft tissue problem. Ankle Spanning External Fixator with Limited Internal fixation is a relatively simple and cost-effective method for treating these fractures, achieving union and also maintaining ankle function.

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Treatment of a Maxillary Dento-Alveolar Defect Using an Immediately Loaded Definitive Zygoma Implant-Retained Prosthesis With 11-Month Follow-Up: A Clinical Report

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-09-00062 ◽

2010 ◽

Vol 36 (1) ◽

pp. 31-35 ◽

Cited By ~ 2

Author(s):

Mirza Rustum Baig ◽

Gunaseelan Rajan

Keyword(s):

Soft Tissue ◽

Dental Implants ◽

Dental Implant ◽

The Other ◽

Clinical Report ◽

Edentulous Patient ◽

Implant Prosthesis

Abstract This article describes the dental implant-based rehabilitation of a partially edentulous patient with a unilateral maxillary dento-alveolar defect. A screw-retained prosthesis with a modified design was fabricated on zygomatic and regular dental implants. One section of the implant prosthesis has cemented crowns and the other section is conventional screw-retained. The design of the prosthesis overcame the hard and soft tissue deficit and provided the desired esthetics.

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Functional outcome after open reduction and internal fixation for traumatic diastasis of the pubic symphysis a one year follow-up study

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20163548 ◽

2016 ◽

Vol 2 (4) ◽

pp. 256

Author(s):

B. L. S. Kumar Babu ◽

Biju Ravindran

Keyword(s):

Internal Fixation ◽

Functional Outcome ◽

Open Reduction ◽

High Energy ◽

Walking Distance ◽

Early Weight Bearing ◽

Dual Plating ◽

Pubic Diastasis ◽

One Year

Background: Pubic diastasis often results in anteroposterior compression (APC) injuries based on Young and Burgess classification. It is caused due to high-energy trauma and of much clinical importance is given when coexists with urogenital and neurological complications with hemodynamic instability. Open reduction and internal fixation with plating facilitates early mobilisation with better results and is the preferable mode of stabilisation. We evaluated the clinical and functional outcome of such patients in a one-year follow-up period.Methods: In our study, we included 20 patients with APC II injuries who underwent an open reduction by single or dual plating technique by the Pfannenstiel approach, were followed for one year.Results: Among 20 patients, 14 patients (70%) were operated with single superior plating, six patients (30%) were performed with dual plating, i.e., both superior and anterior plating. Among 20 patients, two patients (10%) were operated for primary arthrodesis with double plating. Only one among 20 (5%) had implant failure due to early weight bearing and were re-operated with primary arthrodesis with plating. Results were analysed based on a scoring system which includes five criteria such as anterior pelvic pain, dyspareunia and sexual dysfunction, ability to sit, gait abnormalities and walking distance. Among 20 patients ten patients (50%) had excellent results, six patients (30%) had good results, two patients (10%) had fair results, two patients (10%) had poor results.Conclusions: Open reduction and internal fixation of traumatic pubic diastasis in type II APC injuries with single or dual plating had given better results and early functional recovery.

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