Functional state of the mandible and rolling-gliding characteristics in the TMJ.

For the physiological intact stomatognathic system, the three main functional states (occlusat articular functions, free mandibular movements, and ideal bolus function) were biomechanically discussed concerning the structure of movement, rolling-gliding characteristics, and force transfer in the temporomandibular joint (TMJ). In all three cases, rolling is not possible in the TMJ since the instantaneous rotational axis is positioned outside of the joint-rolling is not necessary because the TMJ is not loaded by appreciable forces. In the aged stomatognathic system with a lost discus and considerable Loads in the TMJ, however, the attrition of the joint is eased by rolling movement at the articulating surfaces. The destruction of the discus can be seen as a physiological adaptation which brings back the joint to an original odontogen condition.     

Compartment Syndrome of the Foot: An Evidence-Based Review

Compartment syndrome of the foot (CSF) is a surgical emergency, with high risk of morbidity and poor outcome, including persistent neurologic deficits or amputation. Uncertainty remains regarding surgical approaches, pressure monitoring values, and the extent of surgical treatment. This review provides a summary of the current knowledge and reports evidence-based diagnostic and therapeutic management options for CSF. Articles describing CSF were identified from MEDLINE, PubMed, and Cochrane databases up until February 2018. Experimental and original articles, systematic and nonsystematic reviews, case reports, and book chapters, independent of their level of evidence, were included. Crush injuries are the leading cause of CSF, but CSF can present after fractures of the tarsal or metatarsal bones and dislocations of the Lisfranc or Chopart joints. CSF is often associated with persistent neurologic deficits, claw toes, amputations, and skin healing problems. Diagnosis is made after accurate clinical evaluation combined with intracompartmental pressure monitoring. A threshold value of <20 mmHg difference between the diastolic blood pressure and the intracompartmental pressure is considered diagnostic. Management consists of surgery, whereby 2 dorsal incisions are combined with a medioplantar incision to the calcaneal compartment. The calcaneal compartment can serve as an “indicator compartment,” as the highest-pressure values can regularly be measured within this compartment. Appropriately powered studies of CSF are necessary to further evaluate and compare diagnostic and therapeutic options.     

Cigarette smoking, road traffic accidents andseat belt usage

The association between cigarette smoking and certain diseases found in the populationof England and Wales has been documented¹, but the possible association between smoking and road traffic accidents has not previously received much serious attention. In a recent case control study during the period February–September 1980 an association was found between the smoking habits of drivers of vehicles involved in injury-producing road traffic accidents and the hours of darkness (χ²=9·76, d.f.=1, P<0·01), indicating an increased risk of an injury accident during the hours of darkness for drivers who smoke compared to drivers who did not smoke but were also involved in an injury accident. The study also showed a statistically significant association between people who smoked cigarettes and their use of seat belts, (χ²=21·86, d.f.=1, P<0·001), with smokers less likely to wear seat belts than non-smokers.     

Modified Valenti Arthroplasty in Running and Jumping Athletes With Hallux Limitus/Rigidus: Analysis of One Hundred Procedures

Despite hallux limitus/rigidus being a common condition, results of surgical procedures specifically pertaining to athletes are scarce. The results of 100 modified Valenti procedures, prospectively studied from January 2000 to June 2016 with an average 49.17 months of follow-up, are presented evaluating demographics, sport, time and ability to return to activity (RTA), decreased desired activity level, and need for additional surgery. Inclusion criteria included athletes who have exhausted conservative care without relief of daily pain, dorsiflexion <20°, and grade ≥2. Seventeen had grade 2, 79 had grade 3, and 4 had grade 4 disease. RTA for the 89 procedures where exact time could be determined was 9.25 weeks; however, 100% were confirmed to RTA to some degree. The RTA of dancers and runners (the largest portion of the cohort at 76) was around 8 weeks, whereas soccer players were the slowest at >16 weeks, which was significant. There was no other significant difference in RTA between sport, sex, or grade of hallux limitus/rigidus except for between runners and soccer players. Six patients (6%) stated a decreased desire to activity, although this was not a significant finding. The modified Valenti procedure is a safe and highly effective treatment for running and jumping athletes limited by hallux limitus/rigidus because 94% of patients were able to return to their desired level of activity.