Management of Non-Prosthetic Peri-Implant Fracture in a Case of Broken Intramedullary Locking Nail - A Rare Case Report and Review of Literature

A non-prosthetic peri-implant fracture (NPPIF) can be defined as a fracture in a bone with an existing non-prosthetic implant such as an extramedullary plate and screws or an intramedullary nail, NPPIFs are mostly reported together with peri-prosthetic fractures (PPFs) that occur around joint replacement implants, but they represent a separate clinical entity with different conceptual and practical considerations1. Our case is a 72-year male with a broken humerus intramedullary Nail in right upper limb who was managed with implant removal and bridge plating with locking plate. The favourable outcome in our case sheds a light in a grey region of non-prosthetic peri implant fractures of upper limbs where no definite management protocol is available. Our patient had very good outcome which was noted by 0/100 on dash scores and complete pain-free range of movement elbow and shoulder. Our case stands as a manifest for NPPIFs of humerus, which can be managed with similar protocol which was used in our case.

Custom-Made Alloplastic Prosthetic Implant to Treat Temporomandibular Joint Ankylosis in Pediatric Patients: A Case Study

Temporomandibular Joint (TMJ) ankylosis represents a fairly common condition which surgeons need to face. According to Rowe, it can be defined as a restricted functional capacity of the jaw with limited movements owing to bony or fibrous adhesions between the condyle and either glenoid fossa, disc or eminence (or both). It can become a disease which impacts patients’ daily life, who suffer from limited mandibular excursion with reduced intercisal opening, anterior open bite, inability to swallow, sleep disorders, and speech problems. In children this may also result in abnormal mandibular and facial growth. In this paper, we deal with the case of a child with an important momolateral ankylosis, previously treated surgically with Costochondral Grafting arthroplasty without success and subsequently treated with a custom-made prosthesis.

Comparison of Mechanical Resistance to Maximal Torsion Stress in Original and Nonoriginal or Compatible Prosthetic Implant Screws: An In Vitro Study

Micromovements of the implant-abutment connection influence peri-implant bone preservation. The maximal torque after a cycle of implant prosthetic screw tightening using original components of different manufacturers and replicas produced by other companies is evaluated and quantified in this study. A total of 30 Mis Seven® standard platform implants and 30 interfaces were used, and 30 standard platform screws were tested, 10 Mis®, 10 Iconekt®, and 10 Exaktus®. The screws were tightened with an MIS® torquemeter until their respective fracture, and the fracture point was measured through the equipment’s load cell, CS-Dental Testing Machine®. The screws were analyzed under an Olympus® SZ61 microscope. The fracture points were recorded and compared among all samples. To compare the mean values of the fracture torques, t-tests were performed using the reference values associated with each brand and the sample results. The variable “Place of Fracture” between the original Mis® brand and the Exaktus® replica compared to the Iconekt® replica presented a statistically significant difference (p < 0.001). When analyzing the variable “Fracture Torque,” although it was verified that the replica screws (Iconekt® and Exaktus®) had a lower maximum torque, 65.11 Nm and 62.89 Nm, respectively, compared to the original Mis® brand (70 Nm and 69 Nm), there were no statistically significant differences p > 0.05. Nonoriginal screws did not present different fracture resistances compared to the original Mis® brand screws. The fracture site of Iconekt® screws showed a different pattern compared to the other brands.

In vitro microtomography evaluation of the implant-abutment interface - Gap microtomography evaluation/ Avaliação da microtomografia in vitro da interface implante-pilar - Avaliação da microtomografia de Gap

Objectives: To evaluate in vitro the micromorphological differences of the prosthetic implant-abutment interface in two screw implant systems and a friction one.Materials and methods: Two screw implants (Group 1- Crossfit Internal Connection, Group 2- Tapered Internal Connection), a compressed friction implant (Group 3 - Frictional Connection), and their corresponding prosthetic components were used. The implants were individually fixed in an acrylic resin cylinder and the abutments were positioned with the torque recommended by the manufacturer and taken into a SkyScan 1173 microtomograph. In each implant-abutment image, the regions of interest evaluated were cervical area, abutment area, screw area, and abutment and screw area (G1-G2). In group 3, the cervical and abutment areas were measured. Statistical analysis was performed with ANOVA, Robust ANOVA, and Post Hoc Tukey’s test.Results: In the cervical region, only the samples from group 2 presented maladaptation (12.5 ± 7.0 µm). In the abutment area, the samples from groups 1 (159.6 ± 6.2 µm) and 2 (149.9 ± 9.1 µm) were statistically similar. In the screw area and the abutment and screw area, group 1 had a larger contact surface compared to group 2 but they were statistically similar.Conclusion: The samples from groups 1 and 3 did not present micro-spaces in the cervical third. Nevertheless, the samples from group 2 presented a mismatch in this region but within the acceptable limits found in the literature.

The woman and the penile prosthetic implant. Primary or secondary role? Personal experiences on 355 implanted patients

In a group of 355 pts submitted to Penile Prosthesis Implant (PPI) we recorded data on their relationships with the woman (wife, partner, girlfriend, lover); the aspects of their sexual life; if they were married, divorced or widowed; if they had a lover; if they frequented brothels; if they were satisfied of their actual couple’s life; after operation we recorded data concerning if they had some difficulties utilizing the PPI and their level of satisfaction. After operation most pts (93%) confirmed their satisfaction. Relational aspects: Unmarried pts: 6 pts (21-30 years old) who weren’t able to penetrate their girlfriends managed to have regular sex with PPI and could marry. 42/46 unmarried pts after PPI decided to marry. In the group of married pts 3 pts weren’t able to penetrate their wives; after PPI they managed to have regular intercourses and pregnancies. 15 widowers and 23 divorced pts decided to have a PPI for possible sexual encounters or stable relationships. 96/271 (28,2%) married pts declared a stable extramarital relation that could represent the main reason for having a PPI. The results of PPI are commonly accepted. Until now PPI may re-establish penile rigidity and maintenance. In our opinion the simple act of penetrate and ejaculate in vagina, without considering the importance of personal, relational, emotional factors often well linked to the specific woman, cannot be considered the ideal target of PPI.

Color and cellular selectivity of retinal ganglion cell subtypes through frequency modulation of electrical stimulation

Epiretinal prostheses aim at electrically stimulating the inner most surviving retinal cells—retinal ganglion cells (RGCs)—to restore partial sight to the blind. Recent tests in patients with epiretinal implants have revealed that electrical stimulation of the retina results in the percept of color of the elicited phosphenes, which depends on the frequency of stimulation. This paper presents computational results that are predictive of this finding and further support our understanding of the mechanisms of color encoding in electrical stimulation of retina, which could prove pivotal for the design of advanced retinal prosthetics that elicit both percept and color. This provides, for the first time, a directly applicable “amplitude-frequency” stimulation strategy to “encode color” in future retinal prosthetics through a predictive computational tool to selectively target small bistratified cells, which have been shown to contribute to “blue-yellow” color opponency in the retinal circuitry. The presented results are validated with experimental data reported in the literature and correlated with findings in blind patients with a retinal prosthetic implant collected by our group.

Breast prosthetic implant-associated Squamous Cell Carcinoma: A case report and Literature Review

BackgroundBreast reconstruction is widely used for women undergoing mastectomy. Prosthetic implants have become a common technique performed for these women because of their safety, flexibility and adjustable size. There are few reports of implant-associated squamous cell carcinoma. In addition to this report, only 8 reports including 11 cases have been reported in the English literature.Case presentationWe report the case of a patient with breast prosthetic implant-associated squamous cell carcinoma who received mastectomy and prosthetic implants 10 years ago. She was recently hospitalized with unilateral breast enlargement. Surgical pathology showed squamous cell carcinoma around the breast implant. There was no evidence of primary squamous cell carcinoma at any other anatomic site. We analysed all 11 patients with breast implant-derived squamous cell carcinoma (SCC) from a thorough literature search to identify studies. The median age of patients at SCC diagnosis was 56.8 years old. The average time from initial breast augmentation until SCC diagnosis was 21.9 years. The prognosis was poor; 4 of the 11 patients eventually progressed or died within 1 year, 3 of the 11 patients were disease free during the follow-up period, and 4 of the 11 patients were lost to follow-up. The most widespread opinion is that chronic inflammation from breast implants plays a substantial role in the disease progression of SCC.ConclusionsWe reported the rare complications associated with breast prosthetic implants and reviewed the literature. This malignancy should be taken into account in patients with breast prosthetic implants who have acute breast pain and enlargement.

Current Reconstruction Options in Periprosthetic Fractures Around the Knee

Background: Periprosthetic fractures are a rare complication after total knee arthroplasty (TKA). However, the incidence of these fractures is growing after the increasing number of TKAs performed every year and the progressive aging of the population. In addition, the surgical treatment and peri-operative management of these complications are demanding, representing a challenge for the orthopedic surgeon. Significance: A thorough understanding of these fractures and a correct classification are necessary in order to select the most suitable surgical treatment. The aim of this review was to analyze the epidemiology, classification, diagnosis, surgical treatment, and outcomes of periprosthetic knee fractures in order to give an exhaustive overview. Results: Reduction and internal fixation with locking plates or intramedullary nails represents the preferred option in case of a stable prosthetic implant. Conversely, in case of loose tibial and/or femoral component, implant revision is mandatory. Conservative treatment is rarely indicated. Conclusion: A deep understanding of the characteristics and patterns of periprosthetic knee fractures, and the determination of the stability of the prosthetic implant are necessary in order to establish the correct treatment.