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@#Introduction: Tibial bicondylar fractures are difficult fractures to treat and are usually associated with complications. Materials and methods: Thirty-five patients with Schatzker type V and VI fractures were managed from June 2016 to July 2018 with Ilizarov technique. The mean age of the patients was 46.5 ± 8.9 years, with 28 male and seven female patients. Sixteen patients had Schatzker type V fracture and the remaining had type VI. The functional outcome was assessed by using Modified functional evaluation system by Karlstrom - Olerud and the radiological outcome by Rasmussen's Radiological Score (RRS). Results: All patients achieved radiological union at a mean duration of 16 weeks for type 5 and 17 weeks for type 6 however, full weight-bearing was allowed at a mean of 18 weeks (14 - 22 weeks). Functional results were excellent in 24 cases, good in 10 and poor in one. Most patients achieved functional range of motion at the knee joint (average flexion 1280 ) except one, who had a flexion of less than 1100 . One patient with a delayed union united after bone marrow injection. Other complications included pin tract infections in 9 cases, axial malalignment of less than 100 in 4 cases and a prominent screw in one. Conclusion: Percutaneous restoration of articular anatomy and a ring external fixation with or without minimal internal fixation is an excellent method of treatment in this group of fractures caused by high energy trauma and with a usual association of severe comminution and a poor soft tissue envelope.
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SUMMARY: The temporomandibular joint (TMJ) is the joint between the mandibular condyles, the mandibular fossa and the articular tubercle of the temporal bone. TMJ has been described as a "bicondylar" joint, a term that in current literature is used in multiple and dissimilar contexts. We present a scoping review of the term "bicondylar" as a descriptive term for TMJ in the scientific literature of the last 5 years. After selection according to the inclusion/exclusion criteria, 24 articles were selected for further analysis. The countries with the most publications were Brazil, India and Turkey with 3 articles each. Seven articles (29.17 %) were published by Spanish- speaking authors, six of these written in Spanish. Regarding the use of the term "bicondylar", 50 % of the articles referred to this term but did not explain it; 25 % cited this term to refer to the location in the left and right mandibular condyles; and 25 % the articles use the term and explain it according to the morphology of the articular surfaces. Discrepancies were also detected regarding as to how to consider TMJ: 54.17 % considered that TMJ is a single joint between a single bone (the jaw) and two bones of the cranium, while 45.83 % considered that TMJ are actually two different TMJs that work at the same time. We suggest discussing the appropriate use of the term "bicondylar" to avoid confusion and to be able to adapt and satisfy the needs of both anatomists and clinicians.
RESUMEN: La articulación temporomandibular (ATM) es la articulación entre los cóndilos mandibulares con la fosa mandibular y el tubérculo articular del hueso temporal. La ATM ha sido descrita como una articulación "bicondílea", término que en la literatura actual se utiliza en múltiples y disímiles contextos. Presentamos una revisión con búsqueda sistemática del término "bicondíleo" como término descriptivo de la ATM en la literatura científica de los últimos 5 años. Siguiendo criterios de inclusión/exclusión, se seleccionaron 24 artículos para su posterior análisis. Los países con más publicaciones fueron Brasil, India y Turquía con 3 artículos cada uno. Siete artículos (29,17 %) fueron publicados por autores de habla hispana, seis de ellos escritos en español. En cuanto al uso del término "bicondilar", el 50 % de los artículos se refieren a él, pero no lo explican; un 25 % citó este término para referirse a la ubicación en los cóndilos mandibulares izquierdo y derecho; y el 25 % de los artículos utilizan el término y lo explican según la morfología de las superficies articulares. También se detectaron discrepancias en cuanto a cómo considerar la ATM: el 54,17 % consideró que la ATM es una única articulación entre un solo hueso (la mandíbula) y dos huesos del cráneo, mientras que el 45,83 % consideró que la ATM son en realidad dos ATM diferentes que funcionan al mismo tiempo. Se sugiere discutir el uso adecuado del término "bicondilar" para evitar confusiones y poder adaptar y satisfacer las necesidades tanto de anatomistas como de clínicos.
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Humans , Temporomandibular Joint/anatomy & histology , Terminology as Topic , Mandibular CondyleABSTRACT
@#Introduction: Bicondylar tibial plateau fractures account for 10-30% of tibial plateau fractures. Despite recent advancements in the management of unstable bicondylar tibial plateau fractures, the outcomes are often poor. The present study aimed to evaluate the functional outcomes and complications of internal fixation of bicondylar tibial plateau fractures with the dual plating using two incisions. Materials and methods: The present study included 30 patients (26 males; 4 females, mean age 35.6 years; range, 19 to 65 years) with bicondylar tibial plateau fractures who were treated with dual plating between January 2017 to August 2019. Out of 30 patients, 5 patients had Schatzker type (V) and 25 patients had Schatzker type (VI) bicondylar tibial plateau fracture. All patients were treated with dual plating using two incisions. In all patient’s similar standard physical rehabilitation therapy was followed. All complications including intra and post-operative were assessed and recorded. The patients were followed-up for over 24 months. Functional outcomes were assessed with Rasmussen’s functional grading system, Oxford knee score, and range of motion of knee joint. Radiological outcomes were evaluated using Rasmussen’s radiological scoring system. Result: All fractures united with a mean time of 18 weeks. The average knee range of motion was 1.5° - 130° (range: 0° - 10° for extension lag, range: 100° -135° for flexion). Mean Rasmussen's functional grading score at the final follow-up was 26.75. All patients showed excellent or good radiographic results according to Rasmussen’s radiological scoring with a mean score of 8.5 (range 6-10). The postoperative radiographs showed mean MPTA was 84.3° and the mean PPTA was 6.2°. In the present study, complications were encountered in five patients. However, there were no cases of secondary loss of reduction, failure of the implant, malunion, or non-union. Conclusion: The surgical treatment of bicondylar tibial plateau fractures with dual locking represents a significant treatment option and provides rigid fixation in these fractures with good functional and radiological outcomes.
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Background: Human body consists of 206 bones; among which femur. The thigh bone is considered as the biggest and strongest bone of the body. The bone contains a femoral bicondylar angle which helps in maintaining the balance and certain movements of the body. Those movements are essential to stand upright and erect; therefore, helps in balancing the posture of the body. Bicondylar angle shows various gestures and characteristics essential for describing the necessary ailments of the human skeleton. Thus, the present study is designed with an aim to measure and compare the bicondylar angle of femur both in males and females in Udaipur, Rajasthan, India zone.Methods: Totally, 96 bones were studied- 48 males and 48 females’ bones in 2 years duration. The study was carried out in the Department of Anatomy of Geetanjali Medical College and Hospital and R.N.T. Medical College. The bicondylar angle was measured with a suitable apparatus comprising of compass, Digital Vernier Calliper, scale and protector (Figure 1) along with osteometric board. Bicondylar angle of male and female bone was calculated using SPSS software.Results: The study shows that the bicondylar angle of left femur was greater than right femur in both the genders, but their side differences was statistically insignificant (p>0.05).Conclusions: Hence, the bicondylar angle of female is larger than in comparison to males and these results can put emphasis/light on the orthopaedic clinicians and surgeons to know the etiology of osteometric diseases.
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Objective: In this study our main goal is to evaluatetheoutcome of double tension band wiring and reconstructionplate and screws for the treatment of displaced bicondylar intraarticular fractures of the distal humerus.Methodology: This perspective and randomized study wasconducted at the National Institute of Traumatology andOrthopaedic Rehabilitation (NITOR), Dhaka from July 2003 to2005. Where out of 24 patients 12 were selected for operativetreatment by reconstruction plate and screws (Group –I), and12 were selected for operative treatment by double tensionband wiring (Group-II) as on random basis.Results: During the study, in group-1 and group-2 most of thepatients belongs to 18-30 age group., 75% patients’ injury inleft limb whereas, 35% had injury in left limb in group-2.33.33% patients with reconstruction Plate and Screw, hadexcellent recovery after treatment where as 25% had excellentrecovery when they had double Tension Band Wiring.Conclusion: From our study we can conclude that, operativetreatment of displaced bicondylar intra-articular fractures of thedistal humerus by reconstruction plate and screws gives amore rigid fixation with better functional outcome than bydouble tension band wiring.
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Background: The knowledge of different measurements of mandible is important to the dental surgeons in maxillofacial surgeries, reconstructive surgery of mandible, and plastic surgeries of face. The study of mandible is also important for individual identity such as age, sex, race, and stature. Objective: The objective of this study was as follows: Determination of sex, identification of individual for medicolegal purpose, and craniofacial reconstruction. Materials and Methods: In the present study, 140 cadaver mandibles including 100 male and 40 female mandibles of Wardha regions were studied. I have measured the bicondylar width, bigonial diameter, and mandibular symphyseal height of the left ramus with the help of spreading caliper (Vernier). Results: The calculated range for 100% accuracy is measured by mean ± 3.5 standards deviation. Conclusion: On the basis of percentage beyond demarking point, these parameters are found to be very useful in sex determination.
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@#This is the first report of a long-term follow-up of an open bicondylar Hoffa with patella fracture. It is interesting to note the radiological changes of osteoarthritis 15 years after global intra-articular injury of the distal femur. The good clinical outcome is possibly due to the integrity of the knee ligaments and reconstruction of the extensor mechanism in addition to stable anatomical reduction and fixation.
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PURPOSE: This study is to investigate clinical and radiological results of staged treatment using a temporary external fixator in bicondylar tibial plateau fractures (TPFs) and to evaluate correlation between prognostic factors and postoperative clinical outcomes. MATERIALS AND METHODS: Twenty-four bicondylar TPF patients were selected. All patients were operated by a temporary external fixator first and then open reduction and internal fixation with dual plating. Clinical and radiological outcomes were evaluated. RESULTS: The mean American Knee Society score (AKSS) was 85.3. The mean Western Ontario and McMaster Universities Osteoarthritis index was 11.2. The mean range of motion (ROM) was 123.4°. The mean medial tibial plateau angle (mTPA) was 88.3°, and the mean proximal posterior tibial angle (PPTA) was 8.4°. Compared with the uninjured limb, the mean difference of mTPA was 1.5° and that of PPTA was 4.0°. The difference of PPTA and the AKSS demonstrated negative correlation (p=0.007). Patients with normal mTPA showed better ROM than those with abnormal mTPA (p=0.041). CONCLUSIONS: Staged treatment using a temporary external fixator in bicondylar TPFs showed good clinical and radiological outcomes. Surgeons should evaluate the reduction status intraoperatively by fluoroscopy and also refer to the uninjured limb radiologically.
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Humans , External Fixators , Extremities , Fluoroscopy , Knee , Ontario , Osteoarthritis , Range of Motion, Articular , Surgeons , TibiaABSTRACT
Introduction: The femoral bicondylar angle of femur is an angle between the axis of shaft of the femur and a line perpendicular to the infracondylar plane. The bicondylar angle was studied from earliest known bipedal human ancestors: australopithecines from about 4.2 million years ago. The bicondylar angle of the femur of australopithecines is often used as a marker of bipedality and is therefore an indicator of human lineage. Objectives: The main objective was to study the femoral bicondylar angle by osteological and radiological method as to show their relation between different measured parameters as well as the angle under respective method. Methods: A total sample of 200 (100 dried femurs-for osteological method and 100 radiological films-for radiological method) from Medical colleges of Nepal were included in this study. Femoral bicondylar angle was measured by using osteometric board, goniometer, vernier caliper and accessories. Collected data were analyzed statistically and presented in the form of tables and graph. The mean of femoral bicondylar angle was calculated and correlated with other parameters using the Pearson’s correlation. Result: The mean value of femoral bicondylar angle obtained were 9.31⁰±2.13 and 9.37⁰±2.25 for right and left femurs respectively by the osteological method. The mean value calculated from radiological method were 8.96⁰±2.24 for right and 9.40⁰±2.44 for left in males whereas in females 8.70⁰±2.48 for right and 9.31⁰±2.58 for left. Apart from the average value and standard deviation, the mean angle correlation with height and side, showed statistically insignificant (P>0.005). Conclusion: The finding of the study showed the femoral bicondylar angle was greater in left femur than right in osteological method whereas it was greater in both right and left femur of male when compared to female as per radiological method. Overall, the bicondylar angle was found to be greater in left femur than right. Thus, obtained observation of the bicondylar angle could be useful in forensic discipline to ascertain the age and sex of the dried femur in controversial situation.
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The outcome of bicondylar tibial plateau fractures treated with either external fixation (35 patients) or internal fixation (24 patients) was reviewed. Outcome measures included the Rasmussen score, clinical complications, development of osteoarthritis and the requirement for total knee replacement (TKR). Twenty-two (92%) anatomical reductions were achieved in the internal fixation group compared to 27 (77%) in the external fixation group. Infective complications were more common in the external fixation group (9 patients, 26%) due to pin tract infection. There were no deep infections in the internal fixation group. The mean Rasmussen score was not significantly different (mean score 32 in external fixation and 29 in internal fixation) between the two groups and the incidence of osteoarthritis was the same in both groups. Four patients in the external fixation group underwent a TKR compared to 5 patients in the internal fixation group. Bicondylar tibial plateau fractures have similar outcomes following external or internal fixation.
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Background: Sexual identification from the skeletal parts is very important medicllegaly as well as anthropologicaly. Present study aims to ascertain values of femoral bicondylar width and to evaluate its possible efficacy in determining correct sexual identification.Methods: Study sample consisted of 184 dry, normal, adult, human femora (136 male & 48 female) from skeletal collections of Anatomy department, M. P. Shah Medical College, Jamnagar, Gujarat. Bicondylar width was considered as maximum distance between medial and lateral femoral condyle, measured with the Vernier caliper. Results: Mean Values obtained were, 76.84 and 72.34 for right male and female, and 76.64 and 72.84 for left male and female respectively. Higher value in male was statistically highly significant (P< 0.001) on both sides. Demarking point (D.P.) analysis of the data showed that right femora with bicondylar width more than 80.20 were definitely male and less than 65.50 were definitely female; while for left bones, femora with bicondylar width more than 80.76 were definitely male and less than 66.53 were definitely female. Conclusions: Bicondylar width identified 22.40% of right male femora and 14.49% of left male femora; it was not useful for female bone.
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Fractures involving both tibial plataeus result form high energy trauma such as a traffic accidents or falls, and it is frequently accompanied by soft tissue injuries. Thus it is very difficult to treat these fractures satisfactorily and severe complications can be caused. The purpose of study is to analyze the clinical results, complication and factors influencing the results after open reduction and internal fixation of tibial bicondylar fractures. Twenty cases(19 patients) of tibial bicondylar fractures which had been treated by open reduction and internal fixation from January 1989 to December 1994 were analyzed after 1 to 5 years follow-up. The results were as follows. 1. By AO classification, the most common type was C3(13 cases). 2. According to Blokker's criteria, 5 cases was unsatisfactory and all of these cases were C3. 3. Unsatisfactory results were 3 cases of reduction loss(angular deformity), one case of deep infection and one case of unresolved peroneal nerve palsy. 4. Tibial tubercle osteotomy, bone graft and medial buttress plate were important for anatomical reduction and maintenance.