1/47. Non-free osteoplasty of the mandible in maxillofacial gunshot wounds: mandibular reconstruction by compression-osteodistraction.We have treated 33 young men with medium to large (3-8 cm) bony and soft tissue defects of the lower third of the face caused by gunshot wounds. After debridement, collapsing the proximal segments for primary approximation of soft and hard tissues and a closed osteotomy of a small fragment of mandible, we used an original compression-distraction device, designed in 1982 and tested during 1983 (analogous devices were absent at that time) to reposition the mandible and cause callus to form (during distraction) between the fragment and to use the remaining stumps of bone to fill in the defect. The soft tissues were repaired at the same time. Twenty-eight of the patients presented within a few hours of injury, and the remaining five had old injuries. The only complications were in the group with old injuries where four patients developed abscesses that required drainage, but these did not interfere with the process of osteogenesis. All 33 patients had good functional and aesthetic results within 3-4.5 months. The method allows a bloodless minimally traumatic procedure which can be carried out in one stage. The results compare very favourably with the classic methods of the treatment of mandibular gunshot injuries.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
2/47. An open fracture of the ulna with bone loss, treated by bone transport.We report a Gustilo and Anderson IIIc fracture of the ulna with 8 cm of bone loss which was reconstructed primarily by the technique of external fixation and bone transport. Five operations were performed over a period of 14 months (treatment index = 52.5 days/cm). A satisfactory functional result was achieved, demonstrating the efficacy of this technique for difficult forearm reconstructions and comparing favourably with other methods of managing large bone and soft tissue defects.- - - - - - - - - - ranking = 11keywords = bone (Clic here for more details about this article) |
3/47. New technique for treatment of unstable distal femur fractures by locked double-plating: case report and biomechanical evaluation.BACKGROUND: A comminuted, intra-articular distal femur fracture was surgically treated by the authors with a locked, double-plating technique because fixation stability could not be initially achieved by using a standard double-plating technique. The purpose of this study was to determine biomechanically whether a locked double-plate construct would enhance fixation stability compared with a nonlocked double-plate construct. methods: Six matched pairs of mildly osteopenic femurs were selected and all had a reproducible intra-articular fracture pattern created. Each pair underwent fixation with either a double-plating construct or a locked, double-plating construct that was randomly assigned. The instrumented femurs were then mechanically tested in several loading modes to determine fixation stability. After initial testing, specimens were cyclically loaded and retested for stability. RESULTS: The locked, double-plating construct provided significantly greater fixation stability than the standard double-plating construct in precycling and postcycling biomechanical testing. CONCLUSION: The technique described is particularly applicable for severely comminuted fractures of the distal femur and fractures in osteopenic bone with poor screw purchase. It offers a simple alternative for enhancing fixation stability, which avoids the potential complications of methylmethacrylate-enhanced screw fixation.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
4/47. Centralization of ulna for infected nonunion of radius with extensive bone loss. A modified Hey-Groves procedure.We describe a case of infected nonunion of the radius with extensive bone loss in an 11-year-old boy treated by centralization of the ulna. The technique used differs from the original Hey Groves procedure in that it preserves the distal end of the ulna with its important triangular fibrocartilage complex, thereby retaining stability and contour of the wrist joint. Our patient obtained a functionally and cosmetically satisfactory, stable forearm and wrist. We present the technique as a useful armament in the management of extensive bony defect of the radius arising from trauma or infection.- - - - - - - - - - ranking = 5keywords = bone (Clic here for more details about this article) |
5/47. achilles tendon rupture associated with ankle fracture.The case of a 40-year-old man who sustained a medial malleolar fracture with extension of the fracture into the tibial plafond is discussed. Before surgery, the physical examination revealed an achilles tendon rupture. Surgical treatment to repair the bone and tendon injury was performed. achilles tendon rupture is not an uncommon injury, but it is rarely associated with a fracture. When a fracture is present, the achilles tendon injury can be overlooked, which may result in a delay of treatment or residual morbidity.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
6/47. Treatment of traumatic mandibular nonunion.BACKGROUND AND OBJECTIVES: Nonunion is a complication in mandibular fractures. The causative factors include delay in treatment, infection, inadequate immobilization, and improper internal fixation; concomitant infection may be present. pain, mobility of the fracture segments, and radiographic evidence of radiolucency did in diagnosis. methods AND MATERIALS: Three clinical cases are used to present the methods of treatment to manage nonunion following a gunshot wound, assault with a blunt object, and a fall. Treatment included antimicrobial therapy, fracture site debridement, segment immobilization, and bone grafting. Maxillomandibular fixation, debridement, and placement of a reconstruction plate were used in the first case; reconstruction plate, autogenous bone graft in a polyglactin resorbable mesh, and screw buttons in the second; and custom reconstruction plate and iliac crest bone graft in the third. RESULTS AND/OR CONCLUSIONS: All cases healed uneventfully. Due to rapid revascularization, use of autogenous cancellous bone grafts is preferred to cortical bone. Custom-molded polyglactin mesh provides control of the loose cancellous bone graft.- - - - - - - - - - ranking = 6keywords = bone (Clic here for more details about this article) |
7/47. Midface reconstruction with titanium mesh and hydroxyapatite cement: a case report.Reconstruction of the midface following trauma generally involves the simple assemblage of the existing bony fragments with the usage of miniplate osteosynthesis. Fractures of the maxilla are of significant functional as well as aesthetic importance. Occasionally, reestablishment of the bony structure is not possible without the concomitant use of bone grafts to replace areas where bone loss is present due to extensive comminution. Calvarial bone grafts are often used; however, they are not ideal, due to donor site morbidity, resorption, and difficulty in contouring the grafts to the curves of the face. This article will review a case of severe midfacial trauma in which a significant portion of the comminuted midface was successfully reconstructed with titanium mesh and hydroxyapatite cement.- - - - - - - - - - ranking = 3keywords = bone (Clic here for more details about this article) |
8/47. Orbitocraniofacial gunshot wounds: craniofacial reconstruction and preparation of the anophthalmic socket.This article is a retrospective clinical and radiographic analysis of four patients who survived high caliber orbitocraniofacial gunshot injuries. Early multidisciplinary craniofacial reconstruction included repair of comminuted orbital fractures with multiple autogenous bone grafts and/or porous polyethylene implants, enucleation, and insertion of a hollow silicone sphere as an anophthalmic socket implant. Migration of the silicone implant occurred in one case, requiring replacement with an autogenous dermis fat graft. There were no cases of extrusion or infection. Socket motility remained limited in all cases, despite reapposition of the extraocular muscles. In two cases with autogenous bone grafts along the orbital roof, there was no radiographic evidence of graft resorption after three years. Soft tissue volume deficiency and superior sulcus deformity developed in the three cases which were followed for more than six months. Despite these limitations, all four patients are wearing comfortable ocular prostheses. The postoperative results support immediate preparation of the anophthalmic socket after craniofacial reconstruction of these injuries.- - - - - - - - - - ranking = 2keywords = bone (Clic here for more details about this article) |
9/47. Management of frontal sinus fractures.frontal sinus fractures have been reported in 2 to 12 percent of all cranial fractures and, according to one study, in 8 percent of all facial fractures. Although immediate frontal bone reconstruction is not universally accepted, it is rapidly becoming the standard of care in treating cranial facial fractures, even in the face of gross contamination. This article presents a historical overview of fracture management, a review of the relevant anatomy, and a discussion of appropriate management principles. Three case studies are presented to demonstrate appropriate techniques for the management of frontal sinus fractures.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
10/47. Endoscopic repair of frontal sinus fracture: case report.Although the benefits of endoscopic techniques including direct visualization as well as minimization of scars and morbidity have been employed in general, gynecological, and thoracic cases, only recently have plastic surgeons begun to champion endoscopic procedures in their practices. The authors describe an endoscopic procedure that reduces an anterior wall frontal sinus fracture through two 1.0 cm paramedian stab incisions located less than 1.0 cm behind the hairline of a 13-year-old female patient. The repair, performed in the bloodless subperiosteal plane, was executed with a 30 degrees endoscope and endoscopic instrumentation. The patient had restoration of her cosmetic deformity and no postoperative morbidity. To the authors' knowledge, this represents the first description of endoscopic repair of a traumatic frontal bone defect.- - - - - - - - - - ranking = 1keywords = bone (Clic here for more details about this article) |
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