Management of Mandibular Fractures: Report of Three Cases

The mandibular bone is an important component of the facial bone, which has a unique role in digestive system, speech, and facial esthetics. For these important functions of mandibular bone, it is vital that surgeons should not only treat function but also consider the esthetics together. Mandibular fractures are among the most common traumatic injuries of the maxillofacial, and it is in facial region, the second most frequently fractured adult facial bone is the mandible due to its vulnerable position and projected onto the face. The objective of this study is to show in detail all the specific aspects, the management and the efficacy of the use of treatments by means of closed reduction and open reduction+stable internal fixation in patients with mandibular fractures. Special emphasis was placed on the potential impact of socioeconomic standards on the mechanism and pattern of jaw fractures.

Fixação cirúrgica de fratura oblíqua de mandíbula utilizando lag screw: relato de caso

A mandíbula se configura como um dos ossos mais acometidos por trauma no esqueleto maxilofacial em virtude de sua projeção anteriorizada. Sua localização está associada a direção e força do impacto, ocorrendo mais frequentemente na região de ângulo mandibular seguidas de sínfise e corpo. O tratamento de qualquer tipo de fratura consiste na redução e fixação dos fragmentos ósseos, o mais precoce possível, assim que as condições gerais do paciente permita. Este trabalho tem como objetivo descrever uma das técnicas de fixação interna rígida mandibular, utilizando parafusos na técnica lag screw. Relato de caso: Paciente, 37 anos, gênero feminino, compareceu ao pronto atendimento do Hospital Maria Aparecida Pedrossian com histórico de agressão física cursando com dificuldades de mastigação, apresentando ao exame tomográfico fratura de corpo mandibular com moderado deslocamento e em posição oblíqua. Diante do exame clinico e tomográfico, optou-se como conduta terapêutica o tratamento cirúrgico sob anestesia geral por meio da técnica lag screw que se mostrou uma técnica com resultado satisfatório até o momento e menos oneroso para o sistema publico de saúde. Descritores: Mandíbula; Fixação de Fratura; Cirurgia Bucal. Referências Flandes MP, Dias LBGM, Paulesini Junior W. Fratura de mandíbula – relato de caso. Rev Odontol Univ Cid São Paulo. 2019; 31(2):205-12. Zamboni RA, Wagner JCB, Volkweis MR, Gerhardt EL, Buchmann EM, Bavaresco CS. Levantamento epidemiológico das fraturas de face do Serviço de Cirurgia e Traumatologia Bucomaxilofacial da Santa Casa de Misericórdia de Porto Alegre – RS. Rev Col Bras Cir. 2017; 44(5):491-97. Dantas BPSS, Fialho PV, Fernandes ACF, Silva DT, Queiroz CS. Fratura complexa de mandíbula: relato de caso. Rev Odontol Araçatuba. 2017; 38(3):43-8. Hupp JR, Ellis III E, Tucker MR. Cirurgia Oral e Maxilofacial. 5.ed. Rio de Janeiro: Elsevier; 2009. Wang R, Liu Y, Wang JH, Baur DA. Effect of interfragmentary gap on the mechanical behavior of mandibular angle fracture with three fixation designs: A finite element analysis. J Plast Reconstr Aesthet Surg. 2017;70(3):360-69. Brons R, Boering G. Fractures of the mandibular body treated by stable internal fixation: a preliminary report. J Oral Surg. 1970;28(6):407-15. Campolongo GD, Barros TP, Amantéa DV. Fixação das fraturas mandibulares, utilizando a técnica lag screw associada à sedação: relado de caso. Rev Cir Traumatol Buco-Maxilo-Fac. 2005, 5(1):39-44. Fonseca RJ, Walker RV, Barber HD, Powers MP, Frost DE. Trauma Bucomaxilofacial. 4.ed. Rio de Janeiro: Elsevier; 2015. Miloro M, Ghali GE, Larsen PE, Waite PD. Princípios de cirurgia bucomaxilofacial de Peterson. 3.ed. São Paulo: Santos; 2016. El-Anwar MW, Sweed AH, Abdulmonaem G. Mental Foramen Relation to Mandibular Fracture. J Craniofac Surg. 2016;27(8):e743-e745. Mendonça JCG, Gaetti Jardim EG, Manrique GR, Freitas GP. Acesso cirúrgico para tratamento de fraturas mandibulares: Revisão de literatura. Arch Heath Invest. 2013;2(2):19-23. Ramalho RA, Araújo FAC, Santos FSM, Caubi AF, Sobreira T. Tratamento de fratura de mandibula: miniplacas e parafusos x lag screws - relato de caso. Rev Cir Traumatol Buco-Maxilo-Fac. 2011;11(1):9-12. Pereira ICS, Galdino AS, Palitó APPG, Santos TL, Barros F, Sobreira T. Redução cirúrgica de fratura mandibular oblíqua: parafusos transcorticais x placas de titânio - relatos de caso. Rev Cir Traumatol Buco-Maxilo-Fac. 2011;11(3):69-76.

A Study of Functional Outcome of Bimalleolar Fracture

The results of bimalleolar ankle fractures are better with emphasis on anatomical reduction of fracture, stable internal fixation, regaining full fibular length and early active pain free mobilization, since the advent of A.O principles of management. This study analyzes the functional outcome of Ankle joint after Internal Fixation of bimalleolar fracture. This study was done to evaluate the functional outcome of ankle joint after internal fixation of bimalleolar fracture, those which were operated with different modalities. Classifications used were Lauge-Hansen Classification and Danis-Weber Classification. Road traffic accident, Twisting injury and Fall from height were major mode of injury. Cannulated cancellous screw, Malleolar Screw and TBW used for medial malleolus and semi tubular plate, cannulated cancellous screw and Rush Nail used for fibula are common mode of fixation. According to Baird and Jackson scoring system out of 40 cases, 92.5% were excellent and good, 5% were fair and 2.5% were poor. Anatomical correlations suggest reduction and stable internal fixation restore the articular congruity of ankle joint results in high percentage of excellent and good results.

Fractures of the surgical neck of the scapula with separation of the coracoid base

Fractures of the surgical neck of the scapula combined with a fracture of the coracoid base constitute a specific and rare type of a fracture pattern. When displaced, they present a severe, completely unstable type of surgical neck fracture, requiring a precise CT diagnosis, open reduction and stable internal fixation of the fracture via the Judet approach. The aim of this study is to describe our four cases and discuss three others reported to date.

Refracture of the Mandibular Condyle in Epilepsy

Refracture of the mandible following stable internal fixation would be rare. A 28-years-old male patient was transferred to our emergency center due to fall caused by epilepsy seizure. Computed tomography (CT) showed left condylar base fracture with medial displacement and dislocation, and symphysis fracture. The fracture of condyle and symphysis were performed osteosynthesis with 2 mini-plates on ideal lines of osteosynthesis. The proximal segment of the condyle was placed totally three 7-mm-screws and 2 mini-plates. Six days after surgery, the patient transferred to our emergency center again due to fall by epileptic seizure. The patient drunk a lot of alcohol on the day before. CT indicated that left side fracture of condylar neck with medial displacement above the fixation plates, and no fracture of symphysis. The fracture line run on upper screw of posterior plate. The proximal segment of condyle could not be repositioned in the secondary surgery. The epilepsy patient following mandibular fracture might cause further epilepsy seizures. The risk factors of recurrence seizures should be evaluated including alcohol intake, less sleep and a history of noncompliance to anti-epileptic drugs.

Slipped capital femoral epiphysis after treatment of femoral neck fracture

Slipped capital femoral epiphysis (SCFE) in children after treatment of femoral neck fracture is a very rare condition. This complication should be recognized promptly and treated urgently. The risk of development of this complication can be minimized by anatomical reduction of the fracture and stable internal fixation of the fracture. Five years old male child sustained right sided femur neck fracture and was treated with closed reduction and Hip spica cast application. The fracture healed with a varus deformity. After 7 months, he developed slip of femoral epiphysis with a coxa vara deformity of proximal femur, which was treated with in situ fixation with Cannulated screws. His subsequent course remained uneventful up to five months.Slipped capital femoral epiphysis (SCFE) after treatment of femoral neck fracture in children is a rare complication that should be recognized and treated promptly. The onset of SCFE may show inadequate reduction or fixation of the fracture. Anatomic reduction and stable internal fixation for femoral neck fracture in children provides best outcomes. Postoperative care and delayed weight bearing are also equally important to avoid complications. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1725 How to cite this:Chinoy MA, Pal S, Khan MA. Slipped capital femoral epiphysis after treatment of femoral neck fracture. Pak J Med Sci. Special Supplement ICON 2020. 2020;36(1):S94-S97. doi: https://doi.org/10.12669/pjms.36.ICON-Suppl.1725 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Effect of early protected weight bearing in fractures of shaft of femur

<p class="abstract"><strong>Background: </strong>Fracture shaft of femur is a common and major musculoskeletal injury and in most of the cases the patients are immediately brought to hospitals for specialist orthopaedic management. The purpose of this study was to evaluate the effectiveness of early protected weight bearing in fractures of shaft of femur.</p><p class="abstract"><strong>Methods: </strong>This was observational study conducted on 35 patient’s hospital with transverse fracture mid-shaft of femur, between March 2007 and July 2011. Patients with high velocity trauma, with transverse fracture of mid shaft of femur amenable to closed reduction and interlocking intramedullary nailing and otherwise healthy individuals were included in this study. The preoperative parameters were recorded included age, gender, side of the fracture and medical history. All patients were operated on second day of admission.</p><p class="abstract"><strong>Results: </strong>A total of 35 consecutive cases were included, 34 patients were males and 1 was female. In 74% cases closed intramedullary nailing given excellent healing of fracture, in 14% cases healing was good, in 6% cases it was average and 6% cases poor healing was observed.</p><p class="abstract"><strong>Conclusions: </strong>Our study demonstrate that this method provides anatomical reduction and maintenance of femur length and early ambulation which promotes fracture healing by a stable internal fixation allowing micro motion at fracture site enhancing callous formation.</p>