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@#Introduction: The current standard treatment for ankle syndesmosis injury is static screw fixation. Dynamic fixation was developed to restore the dynamic function of the syndesmosis. The purpose of this study was to determine that which of static screw fixation and dynamic fixation is better for treatment of ankle syndesmosis injury in pronationexternal rotation fractures. Materials and methods: Thirty patients were treated with dynamic fixation (DF group) and 28 patients with static screw fixation (SF group). The primary outcome was Olerud–Molander Ankle Outcome Score. The secondary outcome were Visual Analogue Scale score and American Orthopedic Foot and Ankle Society score, radiographic outcomes, complications and cost effectiveness. To evaluate the radiographic outcome, the tibiofibular clear space, tibiofibular overlap, and medial clear space were compared using the pre-operative and last follow-up plain radiographs. To evaluate the cost effectiveness, the total hospital cost was compared between the two groups Results: There was no significant difference in primary outcome. Moreover, there were no significant difference in secondary outcome including Visual Analogue Scale score and American Orthopedic Foot and Ankle Society score and radiographic outcome. Two cases of reduction loss and four cases of screw breakage were observed in the SF group. No complication in the DF group was observed. Dynamic fixation was more cost effective than static screw fixation with respect to the total hospital cost. Conclusion: Although dynamic fixation provided similar clinical and radiologic outcome, dynamic fixation is more cost effective with fewer complications than static screw fixation in ankle syndesmosis injury of pronation-external rotation fractures.
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Objective: To evaluate the clinical results of intermaxillary fixation screws used in the management of oral and maxillofacial bone fracture. Methods: The clinical and imaging data of 166 cases of oral and maxillofacial bone fractures treated by intermaxillary fixation screws were analyzed retrospectively with the implant location,numbers and the complications of the treatment. Results: 668 intermaxillary fixation screws were used in the 166 cases,at an average of 4 screws per case. The occlusal relationship of the patients was perfect after 1 week traction. Radiographs showed 105 screws (15. 7％) reached the superficial layer of dentin,middle or deep layer in 14 cases (2. 1％),and root canal injury in 2 cases(1. 2％). No intermaxillary fixation screw was broken,loosened or fallen off. Conclusion: Intermaxillary fixation screws can be effectively used in the management of oral and maxillofacial bone fracture. For the most cases,4-6 screws can meet the needs. Root injuries and other complications should be avoided.
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PURPOSE: After exposure of fracture site, the proximal segment must be reduced to their preinjury position for open reduction of fractured mandibular condyle. We examined the use of inter-maxillary fixation screws or titanium screws tied with stainless steel wire to assist in positioning of proximal segment. Since it enables to make a relatively small preauricular incision by not disturbing the operative field like Moule pin, we can reduce the danger of injury to the facial nerve. METHODS: A preauricular approach was used for exposure, reduction, and rigid fixation in 4 cases of mandibular condylar fractures. Inter-maxillary fixation screws or titanium screws tied with stainless steel wire were used to assist in aligning proximal segment. The joints were submitted to functional exercises and postoperative radiologic and clinical follow-ups were performed. RESULTS: No facial nerve lesions were found in all 4 cases. Radiologic follow-up showed correct reduction and fixation in all 4 cases. Clinical follow-up showed an initial limitation, but normal morbility of the condyle was achieved within 4 months after the operation, with a maximum mouth opening of 34.1+/-5.2 mm after 12 months. There found no occlusal disturbances, no trismus, no lateral deviations of the mandible. CONCLUSION: By using Inter-maxillary fixation screws tied with stainless steel wire, it was shown that reducing the proximal segment to their preinjury position is easy to perform and it enables us to make a minimal dissection below preauricular skin incision to avoid facial nerve injury.
Subject(s)
Exercise , Facial Nerve , Facial Nerve Injuries , Follow-Up Studies , Joints , Mandible , Mandibular Condyle , Mouth , Skin , Stainless Steel , Titanium , TrismusABSTRACT
Objective:To evaluate fixation effect of intermaxillary fixation screw.Methods:63 cases with mandibular fractures were treated with open reduction,and then internal fixation were managed with intermaxillary fixation using dental arch splint or intermaxillary fixation screw randomly.The operation time,postoperation periodontal index,mouth open degree,occluding relation and fracture healing were compared.Results:There was no significant difference upon occluding relation,fracture healing and mouth open degree under two treatment methods.Compared with dental arch splint fixation method,intermaxillary fixation screw had shorter operation time and better periodontal index.Conclusion:Intermaxillary fixation screw is a good intermaxillary fixation method because of short operation time.Furthermore,it can provide enough traction retention strength and easy to maintain oral hygiene.
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PURPOSE: This study was conducted to obtain anatomical data useful for transacetabular screw fixation in total hip arthroplasty. MATERIAL AND METHODS: Using 67 hemipelvises of Korean adults cadaver, the variations of external iliac vessels and obturator neurovascular bundle were observed. Forty-nine pelvises were used for the study of vulnerable structures to transacetabular screw inserted through 8 points and 25 pelvises for measuring the thickness of articular cartilage, cortical bone and cancellous bone at each screw penetration site. RESULT: The lengths of S-pin inserted at the inferior, posterior and posteroinferior portion of the acetabulum were more than 20mm. The length of entire bone and thickness of cortical bone measured at the mid point of the posterosuperior portion were longest. The external iliac vessels showed variations in their spatial relationship. At anterosuperior portion, the bone and muscle layer were very thin. The cortical bone of articular side became thicker from center to periphery. The thickness of cortical bone in the pelvic cavity showed different values at different sites. CONCLUSION: The authors suggest that the structural varieties can be injured when inserting the fixation screw of acetabular cup, and the thickness of cortical and cancellous bone may be useful in total hip replacement.