(i) Fractures of the talus

Despite its being a small bone, the whole body weight has to be transmitted through the bone at heel strike. Its unique anatomy and poor blood supply make it prone to a number of different injuries and complications which make it an area of particular disability due to its unique role. The various fractures around the talus are discussed as clinical entities regarding anatomy, diagnosis, classification, investigation and management options.     

(i) Clinical assessment of the shoulder

Clinical assessment of the shoulder involves an interview with the patient during which a history is taken relevant not only to the presenting complaint, but also to factors that might impact on treatment such as a past history of similar complaints and a review of the medical history of the patient which may impact on the management plan. This is followed by clinical examination which refines the differential diagnosis suggested by the history and is used to direct the choice of subsequent investigations. This article considers the salient components of the history and clinical examination of a patient presenting with shoulder problems. Subsequent articles in the mini-symposium will look at the imaging of shoulder problems as well as the capabilities of shoulder arthroscopy, which started as a technology to supplement available imaging modalities but now presents increasingly exciting prospects for minimally invasive treatment of many of the conditions detected by our clinical assessment.     

(i) Biomechanics of the knee joint

The knee joint has biomechanical roles in allowing gait, flexing and rotating yet remaining stable during the activities of daily life, and transmitting forces across it. Geometrical, anatomical and structural considerations allow the knee joint to accomplish these biomechanical roles. These are addressed and discussed in this article.     

Disorders of the sternoclavicular joint

The sternoclavicular joint is, in the main, a stable joint which relatively rarely becomes diseased. However, conditions of the sternoclavicular joint, when untreated, can have major life limiting consequences. They therefore merit serious consideration because they are rare and an individual clinicians' experience will inevitably be limited. This article covers the main conditions of the sternoclavicular joint: dislocations; periarticular fractures of the clavicle in children and adults; swellings, which may be arthritis, infection, or tumours, and rare conditions. The article focusses on how to diagnose and treat these disorders, what to watch out for in clinical practice and how to manage the late diagnosis.     

(i) Assessment of the acutely injured hand

An acutely injured hand presents a diagnostic challenge to the treating clinician. A comprehensive history with a detailed understanding of the mechanism of injury and a thorough knowledge of underlying patho-anatomy forms a keystone to the systematic assessment of the injured hand. This is followed by a logical sequence of physical examination which includes ‘look’, ‘feel’, ‘move’ and special tests.This article aims to present a system for assessment of an acutely injured hand to help the treating doctor plan further management.     

正畸治疗中磨牙的拔除与保留(八)——主动拔除第一磨牙的可行性探讨

目的：分析正畸治疗中拔除第一磨牙的临床意义,着重从功能上探讨主动拔除第一磨牙矫治部分错殆畸形病例的可行性。方法：本组34份病例来源于福州第八医院7例、林连桥齿科诊所27例,均涉及拔除第一磨牙进行矫治的错殆畸形患者,男13例,女21例。年龄11～28岁,平均15,4岁,其中AngleⅠ类13例,AngleⅡ类8例,AngleⅢ类13例。均采用方丝弓矫治器进行矫治。结果：矫治完成时间12～25个月,平均18.1月。矫治后牙齿排列整齐,无间隙,前牙覆黯,覆盖正常,后牙呈牙尖交错殆关系,面部侧貌协调,咬合功能良好。结论：本着健康、功能、稳定和美观的原则,正畸中对部分病例设计主动拔除第一磨牙矫治方案是可行的。     

(i) Investigation of the painful knee arthroplasty

Both total and unicompartmental knee arthroplasty are effective operations for the treatment of gonarthrosis. However, up to 20% of patients will return with pain and a suboptimal functional outcome. The investigation of such a patient is critical in determining an accurate diagnosis and establishing an effective management plan. Causes of pain can be broadly classified into extrinsic and intrinsic. The commonest intrinsic causes of pain are infection, component loosening, component mal-orientation and soft tissue impingement. Extrinsic causes, including hip and spinal pathology, may be responsible for the patient’s symptoms and must be considered. Accurate evaluation uses a four-step procedure involving a detailed history, thorough clinical examination and microbiological plus imaging analysis. This review article will focus on each of these key steps and highlight some of the latest modes of investigating the painful knee arthroplasty.     

(i) Initial resuscitation of the trauma victim

The initial management of the trauma victim has evolved over many years. Changes have occurred in both pre-hospital and hospital practice and in the overall approach to patient management. The focus of patient care is now aimed at maintaining the patient's physiological state whilst obtaining an early CT scan of the head, spine and trunk to identify all injuries. However, in the critically ill patient with active bleeding the immediate surgical control of haemorrhage is essential. Recent developments in trauma management, including damage control resuscitation, more rapid imaging, improved methods of haemorrhage control and the identification of patients who would benefit from either early total care or damage control orthopaedics have all led to improved outcomes in the trauma patient.     

双侧上颌第一前磨牙牙体对称性研究

目的：研究左右离体上颌第一前磨牙牙体的对称性。方法：筛选40位正畸患者新近拔除的双侧年轻上颌第一前磨牙共80颗作为研究对象。使用电子游标卡尺分别对牙体全长、冠长、根长、牙冠、牙颈及根中1/2的宽和厚等10个数据进行测量,测量结果使用SPSS 16.0软件进行统计分析。结果：所有40位患者左右上颌第一前磨牙在牙体外部形态上无统计学差异（P〉0.05）。结论：左右上颌第一前磨牙牙体外部形态存在一定的对称性,变异较小。     

Root morphology of the maxillary first premolar in Singaporeans

Extracted teeth were collected from clinical procedures performed in the Faculty of Dentistry, National University of Singapore. A selected sample of 957 maxillary first premolars were subjected to visual examination and digital radiography. There was a higher incidence of two-root form (50.6 per cent) than previously reported for the Singaporean dentition. In the two-root category, 307 teeth exhibited the fused-root form (two fused roots with two root canals) and 177 were distinctively of the two-root form (two separate roots with two root canals and two foramina). The fused-root form was emphasized as an entity in this study. The one-root form accounted for 49.4 per cent. No three-root form was detected.     

Root morphology of the maxillary first premolar in Singaporeans

Extracted teeth were collected from clinical procedures performed in the Faculty of Dentistry, National University of Singapore. A selected sample of 957 maxillary first premolars were subjected to visual examination and digital radiography. There was a higher incidence of two-root form (50.6 per cent) than previously reported for the Singaporean dentition. In the two-root category, 307 teeth exhibited the fused-root form (two fused roots with two root canals) and 177 were distinctively of the two-root form (two separate roots with two root canals and two foramina). The fused-root form was emphasized as an entity in this study. The one-root form accounted for 49.4 per cent. No three-root form was detected.     

Validation of an extended total joint replacement (eTJR) classification system for the temporomandibular joint (TMJ)

The aim of this paper was to validate a previously described classification system for extended total joint replacements (eTJRs) of the temporomandibular joint (TMJ). We engaged an expert panel to review 60 TMJ eTJR devices and classify them using the system, examining their responses for inter-rater agreement and concordance with the correct response as determined by the authors. Conger's kappa was 0.34 for the fossa (F) component sub-classification and 0.67 for the mandibular (M) component. A posthoc analysis showed improvements in inter-rater agreement for a modified three-tiered F sub-classification system which is suggested in a revised version of the TMJ eTJR classification system.     

关节冲洗术治疗颞下颌关节紊乱病的临床研究

目的　观察和评价关节冲洗术治疗颞下颌关节紊乱病 (TMD)的临床效果。方法　对 86例出现急性疼痛、开口受限的TMD患者采用关节冲洗疗法进行治疗 ,比较治疗前后患者张口度和疼痛程度的变化 ,并对两种冲洗方法的效果进行了比较。结果　关节冲洗对恢复张口度和缓解疼痛有显著的疗效 ,两种冲洗方法的疗效无显著差异。结论　关节冲洗对出现关节绞锁症状的TMD患者是一种简便、微创、有效的治疗方法。     

Reliability and validity of Axis I of the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) with proposed revisions*

Summary The research diagnostic criteria for temporomandibular disorders (RDC/TMD) have been employed internationally since 1992 for the study of temporomandibular muscle and joint disorders (TMD). This diagnostic protocol incorporates a dual system for assessment of TMD for Axis I physical diagnoses as well as Axis II psychological status and pain‐related disability. Because the reliability and criterion validity of RDC/TMD had not yet been comprehensively characterised, the National Institute of Dental and Craniofacial Research funded in 2001 the most definitive research to date on the RDC/TMD as a U01 project entitled, ‘Research Diagnostic Criteria: Reliability and Validity’. The results of this multi‐site collaboration involving the University of Minnesota, the University of Washington, and the University at Buffalo were first reported at a pre‐session workshop of the Toronto general session of the International Association of Dental Research on 2 July 2008. Summaries of five reports from this meeting are presented in this paper including: (i) reliability of RDC/TMD Axis I diagnoses based on clinical signs and symptoms; (ii) reliability of radiographic interpretations used for RDC/TMD Axis I diagnoses; (iii) reliability of self‐report data used for RDC/TMD Axis I diagnoses; (iv) validity of RDC/TMD Axis I diagnoses based on clinical signs and symptoms; and (v) proposed revisions of the RDC/TMD Axis I diagnostic algorithms.     

(iii) Biomechanics of the knee and TKR

The principal aim of a total knee replacement (TKR) is to restore painless movements of the knee joint. Osteoarthritis, along with other pathologies that damage the articular surface of the knee, results in painful limitation of knee movement and alteration of shape and alignment of the joint. Restoration of the functional anatomy of the knee, including alignment, soft tissue balancing and restoration of the joint line, are integral to improving function. Factors that ensure long-term survival of the replaced knee have to be addressed while performing this procedure. Biomechanics of the knee and its restoration are key to improving both function and survival of a total knee replacement. Screw home movement in terminal extension and femoral roll back in flexion are unique to the knee joint. The patella improves extensor function by increasing its lever arm. Implant designs available include femoral components of fixed or multiple radii, high flexion knee replacements, posterior cruciate retaining or substituting designs and fixed or mobile tibial inserts. Computer navigation has been used to achieve accurate bone alignment and soft tissue balancing. Further research on these advances is essential to define their role in improving the results of TKR.     

下颌第一恒磨牙根管弯曲度的研究

目的：确定下颌第一恒磨牙的根管弯曲程度的情况。方法；收集36个离体的下颌第一恒磨牙，在根管中分别插入15－^#25的根管扩大针，拍摄近远中向（临床）和颊舌向（邻面）的X线片，用Photoshop5.0软件分析根管的弯曲率，根管的构型采用Vertucci分类法。结果：大多数的近中根管在2个观察方向均显示有不同程度的弯曲，弯曲发生处多为根中1／3，近远中向的近中颊要管弯曲度最高（P＜0．05），颊舌向的近中颊，舌根管可在根尖1／3显示第二个弯曲度，弯曲程度均高于同一根管的第一个弯曲度，VertucciⅡ型占近中根的64％。大多数的远中根管无明显的弯曲，且多是单根单根管。结论：下颌第一恒磨牙的近中根管多有不同程度的弯曲，了解根管的弯曲对于成功的牙髓，尖周病治疗是必要的。     

上颌第一磨牙近中颊根的解剖形态研究

目的：研究上颌第一磨牙（16、26）近中颊根的解剖形态，为临床治疗提供参考。方法：使用透明标本法，将132个离体16、26制成透明牙，观察其近中颊根的牙根外形与根管形态，比较并分析两者间的关系。结果：16、26近中颊根的牙根外形按照融合角度和分叉情况的不同分为4型：Ⅰ～Ⅳ型牙根的百分比依次为40.91％、23．48％、23．48%和12．12％。根管形态按Weine法分为4型：1-1型、2—1型、1—2型、2—2型，发生率依次为32．58％、17．42％、12．12％和37．88％。并对根管的锥度和弯曲角度进行了探讨。结论：16、26近中颊根的牙根外形与根管形态间有着密切的关系，掌握其形态学规律具有重要的临床意义。     

上颌第一磨牙根管弯曲度的实验研究

目的:分析上颌第一磨牙根管弯曲位置、方向及弯曲度。方法:收集80个上颌第一磨牙,在根管中分别插入15#-20#扩大针,拍摄近远中向和颊舌向X线片,用Photoshop6.0软件测量根管弯曲位置、方向和弯曲度。结果:上颌第一磨牙腭侧根管通畅、较直。远中颊侧根管80%在近远中方向、45%在颊舌方向有>5°的明显弯曲,弯曲位置多位于根中1/3,且近远中向弯曲度明显大于颊舌向(P<0.05)。近中颊根颊侧根管在近远中方向、颊舌方向分别有82.5%、77.5%出现>5°的明显弯曲。两个方向上的弯曲度无明显差异(P>0.05)。35%的标本探通了近颊根舌侧根管,其在近远中向、颊舌向出现明显弯曲的比例达91%和83%。结论:上颌第一磨牙四个根管在近远中向、颊舌方向均有不同程度的弯曲,其第二弯曲出现的情况也各不相同。