Traumatic spondylolisthesis of the axis: 42 cases

Fourty-two patients (34 males and 8 female) with traumatic spondylolisthesis of the axis were studied in a retrospective review There were 20 stable and 22 unstable fractures. The 22 unstable fractures were treated surgically: 16 anterior interbody fusion (10 non-plated and 6 plated), 4 pedicle screw fixation for osteosynthesis of the fractured pedicles, and 2 posterior wire fixation for flexion and axial load injury. For all non-surgical cases, head halter tractions for 1 to 8 weeks was prescribed and a cervical orthosis was worn for an additional 6 to 18 weeks. The surgical cases underwent 5 to 7 days of preoperative and 1 to 4 weeks of post-operative head halter traction. In all cases pedicle fractures united after 13 weeks on average in group treated conservatively, 12 weeks (11 to 13 weeks) in the posterior wiring group, 8 weeks (7 to 9 weeks) in the group in which pedicle screws were used, and 11 weeks (9 to 15 weeks) in the anterior fusion group (13 weeks in non-plated, and 8 weeks in plated). There were no differences in patterns of anterior fusion between those in the non-plated and plated groups. There were no non-unions of fractured pedicles and there was no late instability of the C2-C3 or neurological complications. In 2 cases in the posterior surgery group, there was mild nuchal discomfort and some rigidity for a short while postoperatively. Final outcomes were good in all cases.     

Functional results of unilateral mandibular condylar process fractures after open and closed treatment

BACKGROUND: This retrospective study compared the functional results of unilateral mandibular condylar process fractures treated either by open reduction or by closed treatment. METHODS: Sixty-six patients with unilateral mandibular condylar process fractures were reviewed. Thirty-six patients received open reduction, and the other 30 underwent closed treatment (intermaxillary fixation only). Each group was further divided into condylar and subcondylar subgroups according to fracture level. The functional outcome was evaluated by posttreatment occlusion status, maximal mouth opening, facial symmetry, chin deviation, and temporomandibular joint symptoms. RESULTS: Patients undergoing closed treatment exhibited more condylar motility than those treated by open reduction. Patients in the condylar subgroup with open reduction presented less chin deviation (21.43%) compared with those with closed treatment (56.25%; p = 0.072). Although a greater severity of subcondylar fractures existed in patients treated with open reduction, patients treated with open reduction or closed treatment did not reveal a significantly functional difference. CONCLUSION: The present study revealed that patients with condylar neck or head fractures gained more benefits from open reduction in terms of chin deviation and temporomandibular joint pain. For subcondylar fractures, open reduction provides satisfactory functional results in patients with severely displaced fractures.     

Monocortical non-compression miniplate osteosynthesis of mandibular angle fractures

The technique of monocortical non-compression miniplate fixation of mandibular angle fractures is reviewed. A study of our first 50 patients treated using this technique reveals that consistent reduction and stabilization of these mandibular fractures can be achieved without the requirement for intermaxillary fixation. Such results were produced with minimal postoperative morbidity.     

Bone-screw mandible fixation: An intraoperative alternative to arch bars

OBJECTIVES: Bone-screw mandible fixation (BSMF) is evaluated as an alternative to intraoperative arch-bar maxillomandibular fixation before plating of mandibular fractures. BSMF is achieved by wire ligation of opposing bone-screws placed in the maxilla and mandible. METHODS: A retrospective evaluation of 23 patients with 40 mandibular fractures who underwent mandibular fracture repairs. BSMF was used instead of arch bars to ensure proper dental occlusion. All fractures were then plated, after which BSMF was removed before termination of anesthesia. RESULTS: Normal occlusion was observed in 21 patients (91.3%), Class II malocclusion was noted in 1 patient (4. 3%), and 1 patient was edentulous. No complications related to the use of BSMF were observed. CONCLUSION: BSMF can serve as a viable alternative to arch-bar maxillomandibular fixation for obtaining temporary intraoperative occlusion. BSMF produces acceptable malocclusion rates and offers the advantages of decreased intraoperative time, lower risk for percutaneous and mucosal wire punctures, and ease of use.     

小型钛板内固定治疗下颌骨骨折

目的：评估小型钛板内固定治疗下颌骨骨折的临床疗效.方法：对52例下颌骨骨折的患者行切开复位术，使用小型钛板内固定，保留骨折线上的牙齿.结果：52例患者创口均Ⅰ期愈合，骨折愈合良好，51例恢复到术前咬合关系，有1例固定后出现咬合关系不良，经颌间牵引后恢复正常咬合关系，所有患者钛板均未取出.结论：小型钛板内固定具有良好的稳定性，缩短了颌间固定的时间，可早期恢复张口运动，对骨折线上牙齿可以保留，是一种较好的下颌骨骨折内固定方法。     

Management of Mandibular Fractures in a Developing Country: A Review of 314 Cases from Two Urban Centers in Nigeria

BACKGROUND: This study was designed to establish the current demographic and treatment patterns of mandibular fractures in two urban centers (Lagos University Teaching Hospital, Lagos, and National Hospital, Abuja) in Nigeria. METHODS: All cases of mandibular fractures diagnosed and treated at the Department of Oral and Maxillofacial Surgery, Lagos University Teaching Hospital, Lagos (1998-2007) and Department of Oral and Maxillofacial Surgery, National Hospital, Abuja, Nigeria (2001-2007) were reviewed. Data collected included age, sex, etiology of fracture, anatomic site of fracture, associated maxillofacial fracture, types of treatment, and postoperative complications. RESULTS: The highest incidence of mandibular fractures (49.3%) occurred in the age group 21-30 years and the lowest in the age group 0-10 years, with male preponderance in nearly all age groups. Road traffic crashes (RTC) were the leading cause (67.5%), followed by assault (18.8%), and gunshot. Of the RTC cases, 85 (40%) were sustained from motorcycle-related crashes. The commonest site of fracture was the body of the mandible (n = 137), followed by the angle (n = 114). The majority (83.1%) were treated by closed reduction using intermaxillary fixation, 13.1% by open reduction and internal fixation, and 3.8% had conservative treatment. CONCLUSIONS: Mandibular fractures are commonest during the third decade of life and in men, with almost half of the cases due to of road traffic crashes. RTC was the leading cause of mandibular fractures in all age groups. Motorcycle-related mandibular fractures seem to be increasing in Nigeria. There is a need to enforce legislation designed to prevent RTC to reduce maxillofacial fractures in Nigeria.     

Mandibular fractures in an urban trauma center

The hospital records of 307 patients sustaining mandibular fractures between 1980 and 1984 were reviewed. The patient population consisted of 79% males, with precipitating events usually being fist fights (47%) and assaults with a blunt object (18%). The most common fracture involved the body (30%), followed by the angle (21%) and the condyles (19%). Intermaxillary fixation (IMF) was the preferred method of treatment (42%); however, a large number of patients were treated by internal fixation (31%) or external stabilization (11%). Despite the large number with internal fixation procedures, the complication rate was relatively low (18%). This review suggests changing trends in mandibular fractures. Motor vehicle accidents no longer comprise the most common etiology, so that condylar fractures are no longer the most common, and fractures of the body and angle are more common. Although most patients still are initially treated by intermaxillary fixation, the number of open reductions appears to be increasing. Despite this trend, the complication rate has remained relatively low.     

Internal fixation vs. conventional therapy in midface fractures

The purpose of this review is to evaluate internal fixation by means of AO miniplates compared to conventional therapy for the treatment of complicated midface fractures. A more precise division of midface fractures into functional units than that afforded by the Le Fort classification was employed to categorize the complexity of injury. The criteria of evaluation were ease of functional rehabilitation, incidence of complications, and results of surgery. The classification system was helpful in surgical planning and in subsequent analysis of results. Forty-nine of the 92 midface fractures treated by open repair between July 1980 and January 1986 were malar fractures, and 41 of these had associated orbital fractures. The remaining 43 had Le Fort II or more complicated midface fractures, only 15 of which could be adequately categorized by the Le Fort classification. Twenty-two of the 43 patients with complicated midface fractures were surgically treated with internal fixation utilizing 67 AO miniplates. The remaining 21 patients were treated with conventional therapy utilizing a combination of intermaxillary fixation (IMF), and/or interosseous wiring, and/or primary bone grafting. Among the problems encountered were a nonunion of the midface in a delayed repair of a severely comminuted midface fracture, which required secondary split rib grafting. Three plates were removed because of intraoral extrusion. There were no plate-related infections. One of the advantages of internal fixation is that the need for primary bone grafting and external fixation is eliminated. Another is that intermaxillary fixation is needed less frequently, allowing immediate access to the oral cavity for control of airway, care of intraoral wounds, and rapid return to normal alimentation with full mandibular function. Most patients with no associated GI problems tolerated a soft diet within 6 days. Tracheostomy tubes were removed within 3 days if no pulmonary failure was present. We can conclude that internal fixation provides excellent stabilization and repair of complicated midface injuries with minimal complications and rapid return to function for most patients.     

Plate and screw fixation of selected condylar fractures of the mandible.

The majority of condylar fractures can be treated with closed reduction and intermaxillary fixation. In this study, we examine the use of open reduction with plate and screw fixation for the treatment of condylar fractures. Fourteen patients with 18 subcondylar fractures underwent open reduction and fixation using miniplates (12 patients) and lag screws (two patients). Thirteen patients and 16 condylar fractures had adequate follow-up for analysis of results. The follow-up period ranged from 7 to 46 months with a mean of 24 months. Bony union was obtained in all fractures with no permanent facial nerve injuries and good mandibular opening (average of 45 mm). We conclude that condylar fractures can be opened and fixed with plates and screws with good results without the use of intermaxillary fixation. This technique can be an effective approach for the treatment of selected condylar fractures.     

Noncompression unicortical miniplate osteosynthesis of mandibular fractures.

The use of transoral noncompression unicortical miniplates in treating 42 consecutive patients with 64 displaced mandibular fractures (excluding subcondylar) was reviewed. Titanium miniplates (Wurzburg) were used for fixation. The principles set forth by Champy and colleagues, with two plates for body and symphyseal fracture fixation and one plate superiorly along the oblique ridge for angle fractures, were performed. Intermaxillary fixation was not used postoperatively. Results compared favorably with other forms of treatment with no evidence of postoperative malocclusion, with an overall complication rate of 3%. The advantage of no external incision, avoidance of intermaxillary fixation, and normal postoperative incisal opening and occlusion make this technique our treatment of choice.     

小型钢板固定治疗下颌骨多发性骨折

对34例下颌骨多发性骨折采用小型钢板经口内进路按 Champy 理想线固定,辅助短期颌间固定,本组病例术后经 X 线摄片检查和临床随诊观察,全部达到良好复位固定和1期愈合,2例出现切口处软组织感染;未发现咬合错乱、骨折延迟愈合和手术造成神经或牙齿损伤等并发症。提示用小型钢板单层骨皮质固定治疗下颌骨多发性骨折,方法简便,效果可靠。     

Intracapsular hip fractures in end-stage renal failure

Patients with end-stage renal failure (ESRF) have metabolic bone disease. This increases the risk of femoral neck fracture and increases the risk of complications associated with fracture fixation such as non-union and avascular necrosis (AVN). We report the results of treatment in a consecutive series of 15 intracapsular fractures of the hip occurring in 13 patients with ESRF over a 5-year period. Six intracapsular hip fractures (of which five were undisplaced) were treated by internal fixation. Five out of these six (mean=83.3%) required conversion to total hip arthroplasty because of non-union or AVN. In all six of these patients, internal fixation was considered adequate post operatively. Of the remaining nine intracapsular hip fractures treated by hemiarthroplasty, only one required conversion to total hip arthroplasty because of stem subsidence (mean=11%). The difference in the revision rate for the two groups i.e. primary fixation versus primary hemiarthroplasty was statistically significant (p-value=0.01). The six patients with undisplaced intracapsular fractures treated by internal fixation required a total of 14 major operations, at an average rate (including initial fracture fixation and revision surgery) of 2.3 per patient. The 9 displaced fractures treated by hemiarthroplasty required just 10 operations in total, at an average rate of 1.1 per patient. (The difference was significant; p-value=0.006.) The 1-year mortality in the whole group (13 patients with 15 fractures) was 44.4%. We suggest that patients with ESRF with an intracapsular fracture of the neck of femur should be treated by replacement arthroplasty irrespective of femoral head displacement because of the high risk of revision surgery associated with internal fixation.     

Fractures of the mandible

An overview of the various methods available for treatment of mandibular fractures is presented; these range from the application of arch bars and intermaxillary fixation alone to open reduction with compression plating. Whenever possible, particularly in young patients, mandibular fractures requiring open reduction are approached transorally.     

Operative treatment of humeral shaft fractures. Comparison of plating and intramedullary nailing

Plate and screw fixation (PSF) has always been the more common surgical treatment of humeral shaft fractures. However, intramedullary nailing (IMN) of the humerus has gained in popularity over the last two decades. The purpose of this retrospective study was to evaluate the clinical outcome of plate fixation versus intramedullary nailing of midshaft humeral fractures. The study included 91 patients treated at the department of Trauma Surgery of the University hospital of Leuven; 42 fractures had been treated by plate fixation and 49 by IM nailing. Union, functional outcome, possible complications and the need for additional surgery were compared between the IMN and PSF group. No significant difference in terms of fracture union and functional recovery was noted between the two groups. There were four cases of postoperative radial nerve palsy in the PSF group, versus two in the IMN group (non significant difference). A significantly larger number of patients with restrictive pain and/or functional hindrance in the shoulder or elbow was noted in the IMN group (p = 0.0053). Problems with osteosynthesis material occurred as often in the PSF group as in the IMN group. One patient developed wound infection at the shoulder after antegrade nailing. A significantly larger number of complications was seen in the IMN group than in the PSF group (p = 0.05). A reoperation was necessary in 143% of the PSF patients and 163% of the IMN patients (non significant difference). In this retrospective study, IMN did not achieve better results than PSF of humeral midshaft fractures and was associated with more postoperative complications. Based on these findings, we suggest that plating of humeral shaft fractures should be considered as the primary treatment for all surgical indications, except for some open fractures requiring temporary external fixation, pathological fractures, humeral shaft fractures in morbidly obese and osteopenic patients, and large segmental fractures of the humerus.     

冲洗引流对预防跟骨骨折术后切口并发症的作用

目的 通过比较冲洗引流与单纯引流在跟骨骨折内固定术后预防切口并发症方面的价值,探讨切口冲洗引流在跟骨骨折钢板内固定围手术期的意义.方法 对2003年6月至2006年12月间采用外侧入路切开复位钢板内固定治疗的92例107侧跟骨骨折患者进行回顾性分析,其中术后冲洗引流(A组)63侧,术后单纯引流(B组)44侧,A、B两组经两独立样本t检验排除年龄、坠落高度、开放伤、术前时间、止血带及抗生素使用时间等干扰冈素.从切口感染、皮下血肿形成、表皮水疱、切口裂开、皮缘坏死、钢板外露等方面比较两组的结果,并对两组切口并发症发生率进行χ2检验.结果 A组63侧跟骨手术后4侧(4次)发生切口相关并发症,发牛率为6.3%;其中1侧为可疑伤口感染,3侧发生表皮水疱.B组44侧跟骨手术后11侧(15次)发牛切口相关并发症,发生率为25.0%;其中1侧出现皮下血肿、切口裂开,最终导致钢板外露,表皮水疱与皮下血肿单独发生各1侧,同时发生2侧,可疑切口感染3侧.确诊切口感染1侧,皮缘坏死2侧.两组切口并发症发生率比较差异有统计学意义(χ2=7.476,P＜0.05).结论 冲洗引流可以有效地减少跟骨骨折术后切口并发症的发生.     

A comparison of fixation methods in adolescent patients with diaphyseal forearm fractures

IntroductionThe purpose of this study was to compare both bone diaphyseal forearm fractures in adolescent patients treated with plate fixation to patients treated with intramedullary fixation to identify differences in complications and outcomes.Materials & methodsA retrospective study was performed on all adolescent patients with age between 10 and16 year and treated with intramedullary fixation or plate fixation for a diaphyseal both bone forearm fracture between 2005 and 2014. Demographic information and clinical data was collected. Radiographs were reviewed to evaluate post-operative radial bow magnitude and location, time to union, and residual angulation. Complications were graded using the modified Clavien-Dindo Classification system.ResultsA total of 102 patients met the inclusion criteria. Of these, 32 were treated with plate fixation and 70 with intramedullary fixation. The intramedullary nail group had 55% of complications classified as major. There were no major complications in the plate fixation group (P = 0.1). The radial bow was significantly more distal and smaller in magnitude in the intramedullary fixation group (P < 0.01). Of the patients who underwent intramedullary fixation, 76% required an open reduction of at least one forearm bone. There was increased time to radiographic union in patients treated with intramedullary fixation when compared to those treated with plates, 68 days versus 58 days (P = 0.03). A second operation was necessary for 91% of patients treated with intramedullary fixation compared to only 3% of patients treated with a plate (P < 0.01).ConclusionDiaphyseal forearm fractures in adolescent patients remain challenging injuries to treat. Forearm bony anatomy is not completely restored with intramedullary fixation. Results suggested an association towards increased complication rates and complication severity with intramedullary fixation.Level of evidenceLevel 3 retrospective comparative study     

Fixation versus hemiarthroplasty for undisplaced intracapsular hip fractures

The conventional treatment for an undisplaced intracapsular hip fracture is internal fixation. A possible alternative treatment is replacement hemiarthroplasty. We have compared the outcomes of an age, sex and co-morbidity matched cohort of 346 patients who have had their undisplaced intracapsular hip fracture treated using cannulated screws with a group of 346 patients who have had a displaced intracapsular fracture treated using a hemiarthroplasty. Patients treated by internal fixation had a shorter operation time (43 versus 67 min), reduced orthopaedic ward stay (11 versus 15 days), lower incidence of peri-operative complications (24 versus 81), and a lower 1-year mortality (19% versus 26%). Additional benefits for the fixation group were less pain at 1 year, less reduction in mobility and lower dependence on walking aids. All these differences were statistically significant. Hemiarthroplasty had a lower re-admission rate (43 versus 14 cases) and re-operation rate (59 versus 22 cases). These results support the use of internal fixation for undisplaced intracapsular fractures and confirm that the final outcome for an undisplaced intracapsular hip fracture is significantly better than for a displaced intracapsular fracture, despite a higher re-operation rate after internal fixation.     

Efficacy of open reduction and internal fixation in achieving bony union of comminuted mandibular fractures caused by civilian gunshot injuries

IntroductionComminuted fractures of the mandible caused by gunshot injuries were traditionally treated with closed reduction using maxillo-mandibular fixation (MMF).^2,3 Open reduction and internal fixation (ORIF) has become a valuable treatment modality in the management of comminuted mandibular fractures due to low rate of complications and predictable healing ^{4, 5}.ObjectiveTo compare the efficacy of ORIF compared with MMF in achieving bony union of comminuted mandibular fractures in gunshot injury patients.Methodology: Randomized controlled trial conducted at the department of Oral & Maxillofacial Surgery, Abbasi Shaheed Hospital for a period of 3 years; total of 40 patients divided equally into two groups. Group A were treated with ORIF and group B were treated with MMF. Callus formation radiographically was confirmed by 8th week post operatively. Data was collected using proforma, entered on a statistical software SPSS version 20. Frequency percentages were computed for age and gender. Chi square and Fisher's exact tests were applied. P value ≤ 0.05 considered significant.ResultA total of 40 patients of gunshot injuries were included in this study. 37 (92.5%) were males and 3 (7.5%) were Females with mean age of 36.35 ± 12.9 years SD. 19 (47.5%) patients showed callus formation, whereas, 21 (52.5%) did not. Out of 19 patients, 14 (70%) belonged to group A, and 5 (25%) from group B. The final healing considered by 8th week was in 16 (80%) of ORIF group A, and 8 (40%) group B (MMF) after calculating the clinical and radiographic evidences.ConclusionComparative clinical trials have proven that ORIF is superior to MMF in the management of comminuted mandibular fractures. Early primary repair and internal fixation provides predictable and cost effective results.     

微小切口进路坚固内固定术治疗口腔颌面部骨折的临床效果

探究对口腔颌面部骨折患者应用微小切口进路坚固内固定术治疗的效果。方法 选择2021年 6月-2022年6月青岛大学附属威海市中心医院收治的80例口腔颌面部骨折患者为研究对象,依据随机数字 表法分为对照组（n =41）和研究组（n =39）。对照组应用颌间结扎固定术治疗,研究组应用微小切口进 路坚固内固定术治疗,比较两组骨折愈合率、生活质量、不良反应发生率及恢复满意度。结果 研究组 骨折总愈合率为94.87%,高于对照组的78.05%（P ＜0.05）;研究组治疗后生活质量各项评分均高于对照 组（P ＜0.05）;研究组不良反应发生率为5.13%,低于对照组的24.39%（P ＜0.05）;研究组恢复满意度为 97.44%,高于对照组的82.93%（P＜0.05）。结论 微小切口进路坚固内固定术治疗口腔颌面部骨折效果良 好,可有效提高患者骨折愈合率和生活质量,且不良反应较少,患者整体满意度较高,值得临床应用。     

微小切口进路坚固内固定治疗口腔颌面部骨折的临床效果

目的 探讨微小切口进路坚固内固定治疗口腔颌面部骨折临床效果。方法 选取我院2020年 2月-2022年3月收治的70例口腔颌面部骨折患者为研究对象，按照随机数字表法将其分为观察组与对 照组，每组35例。对照组采用传统方式治疗，观察组采用微小切口进路坚固内固定治疗，比较两组临 床疗效、术后恢复情况、并发症发生情况、语言功能、咀嚼功能及固定功能、美观度、舒适满意度 评分。结果 观察组治疗总有效率为94.29%，高于对照组的71.43%（P＜0.05）；观察组外形恢复满意、 张口度完全恢复、螺钉未松动、固定未移位情况均优于对照组（P＜0.05）；观察组并发症总发生率为 5.71%，低于对照组的25.71%（P＜0.05）；观察组术后语言功能、咀嚼功能及固定功能、美观度、舒适 满意度评分均高于对照组（P＜0.05）。结论 对口腔颌面部骨折患者采用微小切口进路坚固内固定进行 治疗可改善患者的口腔及颌面部的生理功能，满足患者对外形恢复的要求，提高其生活质量，且术后并 发症较少，值得临床应用。