Fracture in an arthrodesed Charcot’s knee joint

Charcot’s joint is a type of neuro-arthropathy, where asymmetrical damage of the involved joint happens haphazardly, without following any described pattern. We present a rare case of Charcot’s joint involving the knee joint in an adult male following spina bifida. His knee joint was successfully fused after two surgeries. Later, he sustained a fracture through the arthrodesis after a fall, which we managed surgically. The fracture through the knee arthrodesis was managed surgically by an open reduction and internal fixation, using a 14-hole broad low contact dynamic compression locking plate with bone grafting. Union was achieved at the knee arthrodesis site in 6 months. Fracture through a fused knee requires surgical management. Re-arthrodesis was done using a stable fixation. Postoperative rehabilitation should include protected weight bearing with braces and splints until a sound bony union is achieved.

Contemporary Management of Zygomaticomaxillary Complex Fractures

Zygomaticomaxillary complex fracture is one of the most commonly treated facial fractures. Accurate reduction and stable fixation of the zygoma are required to restore facial symmetry and projection and avoid functional sequalae from changes in orbital volume. Achieving optimal outcome is challenging due to the complex three-dimensional anatomy and limited visualization of all affected articulations of the zygoma. This article provides an updated overview of the evaluation and management of zygomaticomaxillary complex fractures based on available evidence and clinical experience at our center. The importance of soft tissue management is emphasized, and approaches to internal orbital reconstruction are discussed. While evidence remain limited, intraoperative imaging and navigation may prove to be useful adjuncts in the treatment of zygomaticomaxillary fractures.

Fractures of the mandible

The mandible forms the lower face and supports the teeth, the diaphragm of the floor of mouth, and the mobile tongue. It articulates with the skull base via the temporomandibular joints and is controlled by the muscles of mastication. Fractures of the mandible are common and require accurate reduction and stable fixation, particularly in the dentate patient. The anatomy, pathology, and management of mandible fractures are described in this chapter.

3D modeling in the planning of treatment of femoral tumors

Background. The outcome of surgical treatment of fe-moral tumors (FT) depends on the knowledge of the real picture of the extent of bone and soft tissue damage. The objective picture of the lesion can be significantly supplemented by virtual modeling in the framework of MRI, CT, and 3D modeling of the process, which is practically not studied in Ukraine. Real solid modeling of a skeletal segment with a tumor can produce the most optimal volume of resection and structure formation for stable fixation of bone fragments. The purpose of the work is to improve the technique of 3D modeling of hip tumors for preoperative planning of surgical intervention and the development of the most optimal design of the device. Materials and methods. The available literature data were analyzed; the radiographs, case histories of 15 patients with FT were studied. Good results of treatment of the last are possible at thorough preoperative planning. Results. We use technologies of 3D modeling and 3D printing of solid models of FT. This allows planning the line of the proposed bone resection, to properly form a graft from bioactive ceramics, tutoplast or own bones. 3D modeling helps to create the most optimal design of the device, which provides stable fixation of these grafts to the femoral fragments. The length of resection of the tumor segment with the tumor was calculated using multidetector compu-ted tomography (MDC) perfusion. This makes it possible to conduct preoperative training to establish the structures of the formed fixators on the segment of bone fragments — graft (BFG), to determine its bearing capacity. Based on planning and preoperative training, 5 ope-rations were performed on the hip. To stabilize the BFG segment, optimized constructions based on a DHS-type clamp, LCP-plates, or a clamp for low-contact multiplane osteosynthesis were used. Conclusions. Application of the technology of 3D modeling and 3D printing of solid models of specific SC and tumors allow planning the line of the proposed bone resection. Based on this, you can form the size of the graft, create a fixator structure that provides stability in the BFG. The preoperative training facilitates surgery. All this helps to choose the most optimal treatment tactics.

The state of the problem of fractures of the distal metepiphysis of the humerus in children and adolescents

Annotation. One of the most frequent injuries of the distal end of the humerus is the trans-condylar and supracondylar fractures of the humerus, which make up 47.5-80% of all intraarticular fractures of the elbow joint in children. Among the injuries of the distal humerus, the supracondylar and supracondylar fractures occur with the greatest frequency and is one of the most common domestic injuries in children aged 3 to 12 years. Our work is based on a retrospective analysis of the treatment of 255 patients treated in the Lviv City Children's Hospital for the period 2013-2017. 83.1% of patients were diagnosed with flexion fracture, 16.9% – flexion fracture. Transvertebral fractures of the shoulder were diagnosed in 85.5% of cases of the study array, supragingival – in 14.5%. The treatment of patients with the consequences of injuries of the elbow joint presents great difficulties and remains one of the most difficult problems in pediatric traumatology. Depending on the presence of rotational displacement and the severity of the fracture, the following types of treatment are most often used: conservative, osteosynthesis with spokes or Ilizarov apparatus. An ideal reposition and stable fixation of fragments during these injuries is necessary not only to ensure timely consolidation of the fracture, restoration of the anatomical integrity and shape of the distal humerus, but also to prevent the development of deformation in the elbow joint. Deformations of the elbow joint during supracondylar and supracondylar fractures of the shoulder, unlike deformation of another localization, cannot be adjusted and subsequently only increase and as a result can lead to impaired function of the elbow joint, and often to disability already in childhood. Thus, complicated anatomical localization of supracondylar and supracondylar fractures of the humerus in children, great technical difficulties in comparing and fixing fragments, there is a high probability of neurological and vascular disorders, both at the time of injury and during the provision of medical care, impaired function of the elbow joint determine the need for further study of this problem.

Fixation stability after surgical treatment of strabismus and biofeedback fixation training in amblyopic eyes

Background Visual fixation may be affected in amblyopic patients and, moreover, its stability may be associated with the effects of amblyopic treatments on visual performance in patients with strabismus. Therefore, fixation stability is a relevant biomarker that might predict the recurrence of amblyopia after a therapeutic intervention. Microperimetric biofeedback fixation training (BFT) can stabilize visual fixation in adult patients with central vision loss. It was the purpose of the present study to evaluate the effects of BFT on fixation stability in adult amblyopic patients after surgical intervention to treat strabismus. Methods Participants were 12 patients with strabismus (mean age = 29.6 ± 8.5 years; 6 females) and 12 healthy volunteers (mean age = 23.8 ± 1.5 years; 9 females). The protocol included ophthalmological and microperimetric follow-ups to measure fixation stability and macular sensitivity. BFT was applied monocularly to four amblyopic eyes either on the spontaneous preferential retinal locus or to a fixation area closer to the anatomical fovea after surgical treatment of strabismus. Results Baseline measurements showed significantly altered microperimetric average threshold in amblyopic eyes compared to fellow eyes (p = 0.024) and compared to control eyes (p < 0.001). Fixation was unstable in amblyopic eyes compared to control eyes (p < 0.001). Fixation stability did not significantly change after surgical alignment of strabismus (p = 0.805). BFT applied to operated eyes resulted in a more stable fixation with improvements of about 50% after three months of training. Conclusions Fixation stability improvements following BFT highlight its potential use in adult amblyopic eyes after the surgical alignment of the strabismus. Future investigations may also consider applying this method in combination with standard treatments to improve vision in amblyopic patients.

Cartilage Conduction Hearing and Its Clinical Application

Cartilage conduction (CC) is a form of conduction that allows a relatively loud sound to be audible when a transducer is placed on the aural cartilage. The CC transmission mechanism has gradually been elucidated, allowing for the development of CC hearing aids (CC-HAs), which are clinically available in Japan. However, CC is still not fully understood. This review summarizes previous CC reports to facilitate its understanding. Concerning the transmission mechanism, the sound pressure level in the ear canal was found to increase when the transducer was attached to the aural cartilage, compared to an unattached condition. Further, inserting an earplug and injecting water into the ear canal shifted the CC threshold, indicating the considerable influence of cartilage–air conduction on the transmission. In CC, the aural cartilage resembles the movable plate of a vibration speaker. This unique transduction mechanism is responsible for the CC characteristics. In terms of clinical applications, CC-HAs are a good option for patients with aural atresia, despite inferior signal transmission compared to bone conduction in bony atretic ears. The advantages of CC, namely comfort, stable fixation, esthetics, and non-invasiveness, facilitate its clinical use.

MODERN OSTEOSYNTHESIS TECHNIQUES IN SHOULDER BONE PROXIMAL FRACTURES

This article discusses the issues of choosing a treatment method for proximal humerus fractures and how the proposed minimally invasive method of osteosynthesis for fractures of the proximal humerus allows less traumatic repositioning of bone fragments andmore stable fixation of bone fragments. A less invasive osteosynthesis method for fractures of the proximal humerus allows less traumatic repositioning of bone fragments and more stable fixation of bone fragments. Improve treatment results by developing aminimally invasive method of extramedullary treatment for fractures of the proximal humerus.. This research work was carried out in clinical bases of RITOIAM and RSHTYoIM Bukhara branch in patients with multiple fragment fractures of the proximal part of the shoulder bone with 40, 15 of which were found to be moved in the varus state of the bone fragments. Patients were divided according to gender and 15 were male and 25 were female. The duration of the trip was an average of 5,8±1,8 days (3 –7 days). In order to assess the status of bone fragments in multi –fragment fractures in patients, the classification of Neer (1970) was used: single –fragment, 10 (25%) –two-fragment, 12 (30%) -three-fragment and the remaining 12 (30%) -multiple-fragment fractures in 6 (15 %) patients. In shoulder bone proximal fractures, osteosynthesis was performed with a less invasive blocking plate through an external distraction apparatus developed in the clinic and a small-sized wound incision.

Temporal Changes in Reverse Torque of Locking-Head Screws Used in the Locking Plate in Segmental Tibial Defect in Goat Model

The objective of this study was to evaluate changes in peak reverse torque (PRT) of the locking head screws that occur over time. A locking plate construct, consisting of an 8-hole locking plate and 8 locking screws, was used to stabilize a tibia segmental bone defect in a goat model. PRT was measured after periods of 3, 6, 9, and 12 months of ambulation. PRT for each screw was determined during plate removal. Statistical analysis revealed that after 6 months of loading, locking screws placed in position no. 4 had significantly less PRT as compared with screws placed in position no. 5 (p &lt; 0.05). There were no statistically significant differences in PRT between groups as a factor of time (p &gt; 0.05). Intracortical fractures occurred during the placement of 151 out of 664 screws (22.7%) and were significantly more common in the screw positions closest to the osteotomy (positions 4 and 5, p &lt; 0.05). Periosteal and endosteal bone reactions and locking screw backout occurred significantly more often in the proximal bone segments (p &lt; 0.05). Screw backout significantly, negatively influenced the PRT of the screws placed in positions no. 3, 4, and 5 (p &lt; 0.05). The locking plate-screw constructs provided stable fixation of 2.5-cm segmental tibia defects in a goat animal model for up to 12 months.

Basic principles of odontopreparation for non-removable orthopedic structures (literature review)

Introduction. The actual problem of dentists-orthopedists at the present time is a violation of the odontopreparation protocol and, as a result, poor-quality fixation of various non-removable orthopedic structures. For a strong and reliable fixation of non-removable orthopedic structures, special requirements must be imposed on them in terms of the shape and surface of the support of the processed tooth. These requirements include: parallelism of the walls of the prepared tooth (must be cylindrical); parallelism of the vertical walls of the stumps of the teeth, high-quality gingival ledge [1], [2]. Qualitatively prepared teeth for orthopedic structures, observance of parallelism of the walls create optimal conditions for stable fixation of orthopedic structures. Correctly executed gingival ledge promotes durable fixation of the crown and eliminates the likelihood of infection under it. After analyzing a large volume of domestic and foreign literature, it can be concluded that the creation of various methods of odontopreparation with the task of creating the most favorable supragingival part of the tooth for further fixation of the orthopedic structure is a significant problem in modern dentistry. The creation and clinical testing of DNT (dental navigation technologies) allows for accurate quality control of the performed odontopreparation. The purpose of this article was to analyze the existing methods of odontopreparation and identify the most effective ones among them.