Outcomes of Using Different Generations of Telescopic Intramedullary Nails in Lower Limbs in Management of Osteogenesis Imperfecta Patients. A Systematic Review

Background Osteogenesis imperfecta is a group of heterogeneous disorders with a common characteristic of congenital bone fragility caused by mutations in genes encoding procollagen type I. (COL1A1 and COL1A2). Objectives This study aims to review the outcomes of the use of different generations of telescopic intramedullary nails in lower limbs for management of children with osteogenesis imperfecta (OI) and evaluate the functional outcomes of them. Patients and Methods Methodology: Criteria for considering studies for this review, types of studies: we will include: case series studies, retrospective cohort studies and we will exclude: case reports, cross sectional studies, non English studies. Search results will be conducted to systematic review management software and manually screened for eligibility to be included. PRISMA flowchart will be produced based on the search results and the inclusion/ exclusion criteria. Results One of the highest complications that have been very challenging for the orthopedic surgeons is migration and displacement of the telescopic intramedullary nails and FassierDuval nail has showed to have the lowest migration and displacement incidence rate (10.3%) which was clinically significant according to our statistics which supports the previous literature. On the other hand according to our statistics we found that there is no statistical significance in the cortical perforation of the telescopic nails between the different generations despite it might have been thought before that Bailey-Dubow nail has higher cortical perforation rate as the P value = 0.413. Post operative fractures and telescopic nail bending have shown no statistical significance according to our statistics which differ from each study when taken separately with P value = 0.252 and P value = 0.059 respectively. For the bending results we think that more studies are needed to increase the number of patients as it might show statistical significance according to its P value. Conclusion Fassier-Duval telescopic nail has good outcomes with the least complication rates and a promising generation of telescopic nail but needs a multicenter randomized control trials to conduct a level I evidence based on meta-analysis.

Biomechanical Consequences of Nail Insertion Point and Anterior Cortical Perforation for Antegrade Femoral Nailing

This biomechanical study assessed the influence of changing antegrade cephalomedullary nail insertion point from anterior to neutral to posterior locations relative to the tip of the greater trochanter with or without anterior cortical perforation in the distal femur. Artificial osteoporotic femurs and cephalomedullary nails were used to create 5 test groups each with 8 specimens: intact femur without a nail or perforation, anterior nail insertion point without perforation, neutral nail insertion point without perforation, posterior nail insertion point without perforation, and posterior nail insertion point with perforation. Nondestructive biomechanical tests were done at 250 N in axial, coronal 3-point bending, sagittal 3-point bending, and torsional loading in order to measure overall stiffness and bone stress. The intact femur group vs. all femur/nail groups had lower stiffness in all loading modes ( p ≤ 0.018 ), as well as higher bone stress in the proximal femur ( p ≤ 0.027 ) but not in the distal femur above the perforation ( p = 0.096 ). Compared to each other, femur/nail groups only showed differences in sagittal 3-point bending stiffness for anterior and neutral vs. posterior nail insertion points without ( p ≤ 0.025 ) and with perforation ( p ≤ 0.047 ). Although it did not achieve statistical significance ( p ≥ 0.096 ), moving the nail insertion point from anterior to neutral to posterior to posterior with perforation did gradually increase bone stress by 45% (proximal femur) and 46% (distal femur). No femur or hardware failures occurred. Moving the nail insertion point and the presence of a perforation had little effect on stiffness, but the increased bone stress may be important as a predictor of fracture. Based on current bone stress results, surgeons should use anterior or neutral nail insertion points to reduce the risk of anterior cortical perforation.

Analisis ameloblastoma unilokuler menggunakan radiograf cone beam computed tomography (CBCT) 3D sebagai penunjang diagnosis

Objectives: This purpose of this case report is to explain the imaging characteristics of unilocular ameloblastoma in CBCT 3D radiograph. Case Report: A 32-year-old male patient came to the dentist complaining his painful right lower jaw over the past few days. Clinical examination showed extensive swelling in the posterior region of the right mandible to cause asymmetry at the inferior border of the mandibular corpus. Panoramic radiography showed radiolucent area in periapical mesial root of 46 tooth, extending to the right angular mandibular with a clearly demarcated shape, and there was a root resorption of 47 tooth. CBCT 3D examination showed the presence of unilocular radiolucent lesion in a regular shape and a clear borderline, extending to the inferior border of the mandible and causing buccal-lingual cortical perforation accompanied with the resorption of adjacent 47 tooth. Conclusion: CBCT is a supporting radiography that may act as a more accurate diagnostic tool for the diagnosis of unique ameloblastoma lesions.