1/10. Orthodontic-surgical treatment after posttraumatic bilateral condylectomy of the mandible in an adult patient.A posttraumatic open bite associated with a bird face is reported. Condylectomy was indicated in relation to the plurifragmentary fracture of the condyles with limitation of mandibular movement. Condylectomies were mandatory as a result of delayed maxillofacial surgical treatment, which was related to the poor general condition of the patient after trauma. Functional disorder recovery and aesthetic deformity correction were planned by a team approach between orthodontists and maxillofacial surgeons with the support of a logopedist for the postural-related muscle problems. The main practical and theoretical problems presented by the clinical case were a result of the need to restore the occlusal relations and to avoid recurrence of open bite in this patient. The patient presented a wide alteration of muscular function and a strength fibrotic retraction with alteration in the relationship between upper and lower jaws and retrusion of the mandible associated to open bite. Orthodontic treatment was carried with no impact on the upper and lower axis, avoiding orthodontic correction of the open bite. Surgery corrected both the open bite and the bird face by means of bilateral sagittal split osteotomies. Wiring of the mandibular osteotomies and intermaxillary fixation allowed positioning of the mandibular ramus bilaterally because of the fibrosis and muscular action-related forces without resulting in a similar rotation of the mandible with the risk of recurrence. Myotherapy and logopedic support minimized the risk of recurrence, improved reduction of muscular tension with the resolution of the lip incompetence, and allowed functional recovery of mandibular movements.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/10. Fatal steamer accident; blunt force injuries and drowning in post-mortem MSCT and MRI.Steamer accidents, through contact with the bucket wheel, are very seldom today. No publication of such a kind of fatal accident could be found in literature. We present the case of a fatal steamer accident, in which the findings of a blunt traumatization of a person by the ship was completely documented by post-mortem combined multi-slice computed tomography (MSCT) and magnetic resonance imaging (MRI) examinations. A rupture of the aorta was detected using both radiological methods without use of radiopaque material. Radiological examination revealed a comminuted fracture of the thorax vertebrae at the same level as the aortic rupture. Injuries of the soft tissues of the back, caused by the bucket wheel of the steamer, were also diagnosed. In addition to the signs of blunt force trauma the findings of drowning such as an over inflation of the lungs, fluid in the stomach and duodenum were revealed. Furthermore, algological analysis detected diatoms in the lung tissue and blood from the left heart. Therefore, the cause of death was considered being a combination of fatal hemorrhage, caused by the aortic rupture, and drowning. We conclude that virtual autopsy using combined post-mortem MSCT and MRI is a useful tool for documentation, visualisation and analysis of the findings of blunt force trauma and drowning with a large potential in forensic medicine.- - - - - - - - - - ranking = 0.23232565978542keywords = back (Clic here for more details about this article) |
3/10. Split flexor carpi ulnaris transfer: a new functioning free muscle transfer with independent dual function.BACKGROUND: A functioning free muscle transfer is a well-established modality of restoring upper limb function in patients with significant functional deficits. Splitting the neuromuscular compartments of the free muscle based on its intramuscular neural anatomy and using each compartment for a different function would allow for restoration of two functions instead of one at the new distant site. methods: The authors previously reported on the clinical use of a pedicled split flexor carpi ulnaris muscle transfer. They now report the use of this muscle as a functioning free split muscle transfer to restore independent thumb and finger extension in a patient with total extensor compartment muscle loss in the forearm and a concomitant high radial nerve avulsion injury. RESULTS: Nine months postoperatively, the patient was able to extend his thumb and fingers independent of each other. CONCLUSION: This is the first report of a functioning free split muscle transfer demonstrating two independent functions in the upper limb.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
4/10. Early salvage reconstruction of severe distal radius fractures.During an 8-year period from 1980 through 1988, 9 distal radius fractures could not be restored because of bone loss or extensive comminution and were, therefore, salvaged by early arthrodesis in 7 patients and Swanson silicone wrist arthroplasty in 2. At a mean of 3.7 years, 4 patients rated good, 2 satisfactory, and 3 poor according to a 100-point scoring system based on residual pain, motion, grip strength, and occupational recovery. Irreparable distal radial fractures with damage largely confined to the skeleton achieved satisfactory or good results. Poor results occurred when there was severe soft tissue damage, especially neurovascular injury, despite a successful skeletal reconstruction. When articular restoration could not be accomplished, early arthrodesis or arthroplasty resulted in wrist alignment, stability, and pain control, and optimized the opportunity for digital and upper extremity functional recovery.- - - - - - - - - - ranking = 0.5keywords = upper (Clic here for more details about this article) |
5/10. Multifocal malignant fibrous histiocytoma of the spine.A 40-year-old patient was seen because of a three-month history of low back pain unresponsive to standard therapy. Crush fractures of T12 and L2 were seen on plain radiographs. A magnetic resonance imaging study disclosed lesions of all the vertebral bodies from T12 to the sacrum sparing the disks and epidural space. Histologic features of a vertebral biopsy specimen was consistent with malignant fibrous histiocytoma of the bone. The multifocal distribution caused some reluctance to accept this diagnosis, which was, however, confirmed by detailed immunohistochemical studies and reevaluation of the histologic slides by independent observers who were unaware of the initial diagnosis. Chemotherapy with doxorubicin and cisplatin was started but the patient died 15 months after the diagnosis. Malignant fibrous histiocytoma mainly affects the metaphyses of the long tubular bones. The spine is a very uncommon site of localization of this tumor. The multifocal spinal lesions in our patient may have been produced by metastases from an unidentified primary or by direct spread via the perivertebral soft tissues of a primary located in a vertebral body. The management of malignant fibrous histiocytoma relies on a combination of surgery and chemotherapy. Although complete excision of the tumor can be followed by prolonged survival, the prognosis is bleak in unresectable forms.- - - - - - - - - - ranking = 0.23232565978542keywords = back (Clic here for more details about this article) |
6/10. Case report: sequential vascular connection of free flaps in the upper extremity.Devastating hand injuries often require multiple microvascular reconstructions. We report a patient in whom two flaps were used for late reconstruction of a devastating hand injury involving devascularization of the right hand, severely comminuted fractures of the hand and forearm, and multiple tendon avulsions. We believe the sequential vascular connection of free flaps offers the best method of reconstruction in this severe case, allowing composite tissue transfer, monitoring of the osseous flap, and optimal positioning of the two free tissue transfers.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
7/10. titanium screw implants for intermaxillary fixation of partially edentulous jaw.Establishment of the best possible relationship between upper and lower teeth is very important when treating jaw fractures and orthognathic deformities in partially edentulous patients. Many surgeons use arch bars and acrylic splints for intermaxillary fixation (IMF) to obtain the best occlusal relationships after the operation. In patients with sufficient teeth, IMF is not so difficult to realize. However, in partially edentulous patients, the available teeth may not be sufficient to apply arch bars or splints. This paper describes a system for IMF of a partially edentulous jaw. Screws made of medical-grade titanium are implanted into the alveolar ridges where two or more teeth are missing. Arch bars or acrylic splints secured on these implants and available teeth can be used safely for IMF. in vitro axial pull-out tests demonstrated that these implants can withstand the traction forces generated by elastics. Five partially edentulous patients, three with mandibular fractures and two with orthognathic problems, were treated with these implants. All patients healed without any complications and with the best possible occlusal relationships.- - - - - - - - - - ranking = 0.5keywords = upper (Clic here for more details about this article) |
8/10. A simple means of demonstrating skull fractures using radiographic altered image geometry.Multiple comminuted fractures distributed around a skull and resulting from repeated weapon impacts were poorly demonstrated on conventional lateral and upper frontal radiographs. This was due to superimposition of contralateral fractures, normal anatomy and tangential projection angles. Simple modification of a standard dental x-ray generator and manipulation of projection geometry allowed isolation of individual fractures with improved image quality. The above technique lends itself to cases in which soft tissue remains to obscure the detail of multiple fractures during clinical observation.- - - - - - - - - - ranking = 0.5keywords = upper (Clic here for more details about this article) |
9/10. Use of a hybrid external fixator for a severely comminuted juxta-articular fracture of the distal humerus.Severely comminuted, juxta-articular fractures present a difficult management dilemma for orthopaedic surgeons. Recently, hybrid external fixators have been used for treatment of such fractures in the lower extremity, particularly in the tibial plateau and the tibial plafond. The same technique may be applied to the upper extremity with gratifying results. This technique has the advantage of minimal dissection while restoring limb alignment and permitting immediate joint motion. The proximity of neurovascular structures to the humerus requires careful attention to anatomic detail when placing such a fixator.- - - - - - - - - - ranking = 0.5keywords = upper (Clic here for more details about this article) |
10/10. Traumatic forearm amputation with avulsions of the ulnar and median nerves from the brachial plexus.A case of a traumatic forearm amputation and associated complete avulsions of the ulnar and median nerves from the brachial plexus due to a crush-traction injury of the distal part of the right forearm is reported. The patient also suffered a traumatic head injury. The injury of the upper limb and the general condition of the patient were so serious that an amputation at the 1/3 middle part of the forearm had to be performed.- - - - - - - - - - ranking = 0.5keywords = upper (Clic here for more details about this article) |
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