Biomechanical Analysis of Staples for Epiphysiodesis

Limb asymmetry can, and often does, cause various health problems. Blount bone staples (clips) are used to correct such uneven growth. This article analyzes the performance of a biomechanical staple during bone (tibia) growth arrest. The staples considered in this study were made of 1.4441 stainless steel, the model of tibia consisted of two materials representing corticalis and spongiosis. Hooke’s law was used for modeling materials’ behaviors for finite element analysis (FEA). The maxima of stress and total staple displacement were evaluated using the finite element method and verification of the results, along with the determination of the maximum loading (growing) force that the staples are capable of withstanding, was performed experimentally. The presented method can be used to determine the safety and usability of staples for bone growth arrest. According to our results, the design of Blount staples considered in this paper is safe and suitable for orthopedic treatment.

Digital mental health intervention for orthopedic patients with symptoms of depression and/or anxiety: Pilot feasibility study (Preprint)

BACKGROUND Depression and anxiety commonly coexist with chronic musculoskeletal pain, and when this occurs, standard orthopedic treatment is less effective. Nevertheless, addressing mental health is not yet a routine part of standard orthopedic treatment, in part due to access related barriers. Digital mental health intervention offers the potential to be a scalable resource that could feasibly be incorporated into orthopedic care. OBJECTIVE The primary purpose of this study was to assess the feasibility of introducing a digital mental health intervention (Wysa) within an outpatient orthopedic setting to patients who endorse coexisting symptoms of depression and/or anxiety. The secondary purpose was to perform a preliminary effectiveness analysis of the intervention. METHODS In this single-arm, prospective cohort study, participants included adult patients (18 years and older) who presented to a non-surgical orthopedic specialist at a single tertiary care academic center for evaluation of a musculoskeletal condition and who self-reported symptoms of depression and/or anxiety (Patient-Reported Outcomes Measurement Information System (PROMIS) Depression and/or Anxiety score ≥ 55). Enrollment was performed face-to-face by a research coordinator immediately after the participant’s encounter with an orthopedic clinician. Participants were provided two months of access to a mobile app called Wysa, which is an established, multi-component digital mental health intervention that uses chatbot technology and text-based access to human counselors to deliver cognitive behavioral therapy, mindfulness training, and sleep tools, among other features. For this study, Wysa access also included novel, behavioral activation based features specifically developed for users with chronic pain. Primary feasibility outcomes included the study recruitment rate, retention rate, and engagement rate with Wysa (defined as engaging with a therapeutic Wysa tool at least once during the study period). Secondary effectiveness outcomes were between-group differences in mean longitudinal PROMIS mental and physical health score changes at two-month follow-up between high Wysa users and low Wysa users, defined by a median split. RESULTS The recruitment rate was 61/208 (29%), retention rate was 51/61 (84%), and engagement rate was 44/61 (72%). Compared to low users, high Wysa users achieved greater improvement in PROMIS Anxiety (between-group difference -4.2 points [95% CI -8.1 to -0.2], P=.044) at two-month follow-up. Between-group differences in PROMIS Depression (-3.2 points [-7.5 to 1.2], P=.15) and Pain Interference (-2.3 points [-6.3 to 1.7], P=.26) favored high users but did not meet statistical significance. Improvements in PROMIS Physical Function were comparable between groups. CONCLUSIONS Delivery of a digital mental health intervention within the context of orthopedic care is feasible and demonstrates potential to improve mental health and pain-related impairment to a clinically meaningful degree. Participants’ engagement rates exceeded industry standards, and additional opportunities to improve recruitment and retention were identified. Further pilot study followed by a definitive, randomized controlled trial is warranted. CLINICALTRIAL ClinicalTrials.gov NCT202005219

SIS therapy in the treatment of distal radius epiphyseal fracture (Case report)

Introduction. Fractures of the distal radius epiphysis are the most common fractures of the upper limb, present both in the general population active following major trauma and in the elderly population in minimal trauma due to osteoporosis. Among the adjuvant therapies for orthopedic treatment of distal radius epiphyseal fracture we can list Super Inductive System (SIS), a therapy based on the interaction between the electric field and the human body with the improvement of the healing process by acting on the pathophysiological stages of bone callus. Material and method. A clinical case study was performed on a 28-year-old patient, hospitalized and treated in the neurosurgery department of the Constanta County and Emergency Hospital for a polytrauma by road accident (passenger) with amyelotic cervical vertebral trauma, thoracic trauma and trauma to the right upper limb, subsequently performing 12 SIS therapy sessions at the Balneal and Rehabilitation Sanatorium of Techirghiol. CT examination of the cervical spine reveals fractures of C4 vertebra (the blade and pedicle) and C5 vertebra (vertebral body, lamina and pedicle). Right forearm radiography reveals fracture of the right radial styloid. After conservative treatment of the cervical injury and orthopedic treatment of the upper limb injury, the clinical evolution is favorable, allowing the patient to be discharged and allowed to do 12 sessions of SIS therapy, 3 times a week, within 4 weeks. The subsequent clinical and paraclinical evolution was favorable for the outpatient orthopedic ambulatory reevaluation performed at 5 weeks. Results and discussions. Due to the type of fracture of the radial distal epiphysis (linear fracture without displacement), absence of comorbidities and young age, led to the indication of orthopedic treatment with immobilization in the antebrachio-palmarcast, which allowed subsequent physiotherapy. Keywords: radial fracture, callus, polytrauma, cervical spine, lamina, Super Inductive System,

Assessment of the bioelectric activity of the masticatory muscles in orthopedic treatment with partial removable plate prostheses

Relevance. According to a number of authors, it is known that full adaptation to complete removable dentures occurs within 3 months [3–5, 9]. The main criterion for patients getting used to removable dentures is the synchronization of the work of the masticatory muscles and, as a consequence, the normalization of the chewing function.The aim of the study was to evaluate the bioelectrical activity of the masticatory muscles in patients using the CSPP.Materials and methods. In patients of the control (n = 23) and main (n = 63) groups, electromyographic examination was performed using the electroneuromyographic system "Synapsis" (Neurotechnology, Russia). Registration of the bioelectric activity of the chewing muscles was carried out directly on the day of applying the prostheses, after 1 and 3 months, respectively.Results and discussion. The electromyographic indices of the masticatory muscles in the patients of the control group decreased within one month after the treatment and amounted to 231 ± 18.2 μV for the right and 229 ± 16.1 μV for the left proper chewing muscles. The values were also reduced for the right and left temporal muscles – 228 ± 15.2 μV and 225 ± 24.1 μV (p < 0.05). It should be noted that the electromyographic parameters in patients of the main group were comparable to the lower limit of the norm and amounted to 269 ± 16.5 μV and 256 ± 20.4 μV, respectively, after one month of treatment.Conclusions. In the treatment of dysfunction of the temporomandibular joint with the use of thermoplastic prostheses, an increase in the biopotentials of the masticatory muscles is observed. In the orthopedic treatment of patients with terminal dentition defects using thermoplastic prostheses, the electromyographic parameters of the masticatory muscles are most close to normal after 3 months of using these prostheses.

COMPUTER TECHNOLOGIES FOR DETERMINING INDEX ASSESSMENT OF THE DESTRUCTION OF DENTAL HARD TISSUES

The aim of the study was to compare the obtained data of hard dental tissues destruction indices with the corresponding indications for the choice of the method of treatment by means of mathematical analysis. Materials & methods. 120 patients aged 20 to 55 were examined and 358 teeth hard tissue defects were identified in them. The data of indices was obtained and compared with the indications for orthopedic treatment according two indices in the same clinical situation. Results. The study showed that the indices had different meanings and different indications for treatment in the same situations. Such discrepancies in indications for treatment indicate the subjective data of one of the indices, which does not take into account the depth of destruction and the volume of the remaining natural tissue of the teeth. Comparison of these indices showed different figures in the same clinical situation, identifying corresponding incorrect indications for the choice of the design of the first investigated index, as well as more accurate data of the proposed index. Conclusion. The index assessment of hard dental tissues destruction serves as the main guideline for the dentist when choosing a method for tooth restoration, and can be calculated using photographs, scans and computer software.

CONDITIONAL TISSUE CONDITION IN PATIENTS WITH PROSTHETIC DENTISTS IN THE PROCESS OF ORTHOPEDIC TREATMENT WITH PROSTHESES MODIFIED BY NANOMATER

The main cause of prosthetic stomatitis belongs to the chemical and toxic action of the residual monomer of the prosthesis base, which is a protoplasmic poison. Occurrence of prosthetic stomatitis depends not only on quality of production of prosthesis in laboratory though at non-observance of technology indicators of residual monomer can reach 2-5%, but also at individual intolerance at its minimum concentration in a prosthesis after polymerization - 0,2-0 .5%. The aim of our study was to increase the effectiveness of orthopedic treatment of patients with prosthetic stomatitis by coating the plastic of removable prostheses with nanoscale materials. Materials and methods. To solve this goal, we studied the condition of the tissues of the prosthetic place of patients with prosthetic stomatitis with prosthetic removable prostheses with modified plastic. Orthopedic dental treatment of 50 people was examined and performed, including 25 people (the second group, prostheses were not covered with nanoparticles) and 25 people (the third group, prostheses were covered with nanoparticles). The first control group consisted of 10 people without signs of pathology. Prior to treatment, all patients had removable acrylic plastic dentures. The reason for seeking orthopedic care was a violation of masticatory function and the inability to use previously made prostheses due to the development of pain in the soft tissues of the prosthetic place. Complaints of pain were observed in all patients of varying intensity, impaired fixation and stabilization of the prosthesis due to swelling of the mucous membrane of the soft tissues of the prosthetic place, heartburn and dryness were observed in 90% of patients. Complaints were also about speech and aesthetic defects. Patients of III group after two weeks of using prostheses were coated with the inner surface of the prosthesis, which is in direct contact with the mucous membrane of the prosthetic place with molecules of fullerene C60, by magnetron sputtering. For this purpose, the prostheses were removed from the patients for several days and returned after the coating with the nanomaterial, after which the observation was continued. The results. After coating the prostheses in patients of group III with Fullerene C60, we observed the disappearance of inflammation of the mucous membrane under the prosthesis and patients noted the absence of discomfort. Рatients in II group had a negative dynamics in 80% and had diffuse inflammation of the mucous membrane under the prosthesis. Within 3 months of use, 18 patients (72%) in II group reported that they stopped using removable dentures during the day, due to unpleasant pain under the prosthesis, and used only during meals and during conversations. In contrast to II group, patients in III group did not notice discomfort when using plate prostheses. Conclusions. Obtained in the course of the work convincingly prove the effectiveness of the use of removable plate prostheses with nanocoating for the treatment and prevention of prosthetic stomatitis in patients. This is evidenced by the data of objective examination and the disappearance of complaints from patients.