Deep lateral wall combined with medial wall orbital decompression for thyroid associated ophthalmopathy / 国际眼科杂志(Guoji Yanke Zazhi)

@#AIM: To explore the clinical effect and safety of deep lateral wall combined with medial wall orbital decompression in the treatment of thyroid associated ophthalmopathy(TAO).<p>METHODS: Totally 17 patients with TAO in our department from January 2019 to May 2020 were included. All patients underwent deep lateral wall combined with medial wall orbital decompression under general anesthesia, the visual acuity, recovery of exposure keratitis, exophthalmos, intraocular pressure and complications were compared before and after operation.<p>RESULTS: Eight patients(9 eyes)with TAO and dysthyroid optic neuropathy(DON)were included in the study. The best corrected visual acuity averaged 0.78±0.15 preoperatively and 0.36±0.12 1mo postoperatively, which was statistically significant(<i>P</i><0.01)compared with the preoperative visual acuity, 0.38±0.12 at 6mo after surgery, which was not statistically different from that at 1mo after surgery(<i>P</i>=0.594). The mean preoperative proptosis was 23.75±2.55mm and the mean postoperative proptosis was 14.85±1.53mm at 1mo, which was statistically significant compared with the preoperative proptosis(<i>P</i><0.01), proptosis was on average 14.60±1.64mm at 6mo after surgery and remained generally stable(<i>P</i>=0.658)from 1mo before surgery. The intraocular pressure of the patients was 25.56±3.23mmHg preoperatively and 18.42±2.35mmHg 1mo postoperatively, which was statistically significant compared with the preoperative value(<i>P</i><0.01), and the intraocular pressure of the patients was reduced to 15.82±2.57mmHg at the 6mo postoperative follow-up, which was statistically significant compared with the intraocular pressure of the patients 1mo postoperatively(<i>P</i><0.01). There were 6 eyes of 6 patients with exposure keratitis preoperatively, 4 eyes improved and 2 eyes were cured in the 1mo postoperative, and all 6 eyes were cured 6mo postoperatively. Postoperatively, the diplopia of the patients all decreased to various degrees, and there were some patients whose diplopia symptoms continued to improve 6mo thereafter without other serious complications.<p>CONCLUSION: Deep lateral wall combined with medial wall orbital decompression can effectively improve the proptosis and also have a good effect on severe complications such as DON and exposure keratitis with few complications, so deep lateral wall combined with medial wall orbital decompression is an effective surgical procedure in the treatment of severe TAO.

Finite element analysis of medial wall fixation of proximal femur / 中华创伤骨科杂志

Objective To explore the significance of proximal femoral medial wall plating by finite element analysis of the stability after medial wall fixation of the proximal femur in all types of 6-part classification of femoral intertrochanteric fractures.Methods Finite element method was used to establish models of 7 types of 6-part classification of femoral intertrochanteric fractures which were fixated with proximal femoral nail anti-rotation (PFNA),medial wall plating (bi-cortex),PFNA + medial wall plating (uni-cortex).The boundary conditions and material properties were defined according to the data published in literature.A load of the peak hip stress was applied in simulation of a normal adult of 70 kg in weight walking.The conditions above produced the Von Mises stress diagrams and Min Principal stress distributions of the normal femur for 21 groups of internal fixation models.The stability of the model was assessed by analyzing the peak stress value of the key part and fragmental displacements in each group.Results In 7 types of fractures fixated with PFNA,the changes in stress and fragmental displacement were small for all major femoral parts while the fragmental displacement increased in the greater trochanter.In the medial wall plating,the stress increased obviously with the increase in bone fragments,especially the lateral ones,for the significant femoral parts and internal fixation,and the fragmental displacements increased greatly but the displacement was always limited for the medial fragments.In the fixation with PFNA + medial wall plating,the stress changes and fragmental displacements for significant femoral parts were the smallest of the 3 fixation methods.Conclusions Proximal femoral plating can effectively reduce stress concentration at the proximal femur and provide better support for the medial wall of the proximal femur.For unstable fractures,PFNA plus medial plating may provide rigid fixation because it better reduces stress on the femur than simple PFNA,does not increase fragmental displacements and leads to no significant abnormal changes in internal fixation structure.

Locking plate in the treatment of proximal humeral fractures involving humeral calcar: Effective support, complications and functional recovery / 中国组织工程研究

BACKGROUND: Saving the humeral head is a challenge when the proximal humerus is fracture in orthopedic trauma, and how to obtain medial column support is a hot topic in recent years. OBJECTIVE: To summarize the general concept, clinical significance and function, the common injury mechanism of humeral calcar, and the progress using locking plate so as to improve the clinicians' understanding for the humeral calcar and to reduce the occurrence of surgical complications. METHODS: From 2004 to 2019, Wanfang, CNKI, VIP, PubMed, Web of Science, and Springer Link about the treatment and research progress of proximal medial wall of the humerus were searched by the first author. The key words were "proximal humeral fracture, Philos, intermedial screw, calcar screw, fibular allograft, middle support" in English, and "proximal humeral fracture, humeral spur, medial column, plate, fibular allograft" in Chinese. The references were retrieved by hand. Finally, 51 studies were used for review according to the inclusion and exclusion criteria. RESULTS AND CONCLUSION: (1) The range of the humeral calcar region is still unclear. There is no uniform classification standard for fractures involving the humeral calcar region. X-ray films show that calcar fracture patterns are often inconsistent with the actual fracture situation, which is often a complex fracture. Lack of understanding and paying litter attention to the humeral calcar region is the main reason of iatrogenic injury and the failure to get a good repair. (2) Treatment using the locking plate is still the preferred method for proximal humerus fracture. Meanwhile, it is a feasible method that using the screw, the allogeneic iliac bone graft, the bone cement or the medial plate to reconstruct the medial column if there is a "repairable medial wall". Getting anatomical reduction of the internal wall and effective support of the medial column during operation can help to reduce postoperative complications. However, the use of the medial buttress plate requires further research to verify. It is critical important to repair the rotator cuff for the medial column support. (3) The range of the humeral calcar region needs to be unified. Understanding the humerus calcar is essential for the treatment of proximal humeral fracture. Only by mastering the fracture mode of the humerus calcar and choosing the most appropriate surgical procedure before surgery, meanwhile, achieving anatomical reduction of the medial wall and the effective support of the medial column during operation can reduce the postoperative complications of the fracture. Repairing of the rotator cuff carefully during operation is indispensable for patients to obtain better shoulder function.

3D CT map of the femoral intertrochanteric fracture involving the posteromedial wall / 中华创伤骨科杂志

Objective@#To investigate the distribution characteristics of the fracture lines on the posteromedial wall by mapping the femoral intertrochanteric fractures involving the posteromedial wall on 3D CT.@*Methods@#A retrospective study was conducted of the 136 patients with femoral intertrochanteric fracture who had been treated at Department of Orthopaedics, Affiliated Hospital to Chengdu University from January 2009 to October 2018. They were 57 men and 79 women with an average age of 64 years (from 48 to 81 years). By the AO classification, 101 cases were type 31-A2 and 35 type 31-A3. Their CT data were collected for 3D reconstruction. By comparing the specific markers on the femoral shaft and lesser trochanter, the 3D CT reconstruction images were superimposed and orientated to the standard models of intertrochanteric posteromedial wall to create a map of the fracture. The width, height, area, and fracture deviation angle of the fracture of posteromedial wall were measured to characterize the distribution of the fracture lines.@*Results@#In the 136 femoral intertrochanteric fractures involving the posteromedial wall, the height of the posteromedial wall fracture was 48.76±4.11 mm, the width 29.78±3.29 mm, the area 1,468.47±75.26 mm2, and the fracture deviation angle 49.93°±13.05°. The fracture area ratio (fracture area/posteromedial wall area) was 38.34%±16.58%. On the map of the posteromedial wall fracture, the fracture lines were densely distributed in the lesser trochanter and in front of it. In the fractures of type 31-A2, the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and below it, going obliquely from anterosuperior to posteroinferior to affect the lower calcar femorale. In the fractures of type 31-A3, the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and above it, going obliquely from anteroinferior to posterosuperior to affect the upper calcar femorale.@*Conclusion@#The fracture map can help visual understanding of the intertrochanteric fracture involving the posteromedial wall, and provide further characterization of the posteromedial wall fracture in the fractures of AO types 31-A2 and 31-A3.

3D CT map of the femoral intertrochanteric fracture involving the posteromedial wall / 中华创伤骨科杂志

Objective To investigate the distribution characteristics of the fracture lines on the posteromedial wall by mapping the femoral intertrochanteric fractures involving the posteromedial wall on 3D CT.Methods A retrospective study was conducted of the 136 patients with femoral intertrochanteric fracture who had been treated at Department of Orthopaedics,Affiliated Hospital to Chengdu University from January 2009 to October 2018.They were 57 men and 79 women with an average age of 64 years (from 48 to 81 years).By the AO classification,101 cases were type 31-A2 and 35 type 31-A3.Their CT data were collected for 3D reconstruction.By comparing the specific markers on the femoral shaft and lesser trochanter,the 3D CT reconstruction images were superimposed and orientated to the standard models of intertrochanteric posteromedial wall to create a map of the fracture.The width,height,area,and fracture deviation angle of the fracture of posteromedial wall were measured to characterize the distribution of the fracture lines.Results In the 136 femoral intertrochanteric fractures involving the posteromedial wall,the height of the posteromedial wall fracture was 48.76 ± 4.11 mm,the width 29.78 ± 3.29 mm,the area 1,468.47 ± 75.26 mm2,and the fracture deviation angle 49.93° ± 13.05°.The fracture area ratio (fracture area/posteromedial wall area) was 38.34％ ± 16.58％.On the map of the posteromedial wall fracture,the fracture lines were densely distributed in the lesser trochanter and in front of it.In the fractures of type 31-A2,the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and below it,going obliquely from anterosuperior to posteroinferior to affect the lower calcar femorale.In the fractures of type 31-A3,the lines of the posteromedial wall fracture were mostly distributed in the lesser trochanter and above it,going obliquely from anteroinferior to posterosuperior to affect the upper calcar femorale.Conclusion The fracture map can help visual understanding of the inteetrochanteric fracture involving the posteromedial wall,and provide further characterization ofthe posteromedial wall fracture in the fractures of AO types 31-A2 and 31-A3.

CT classification and significance of lamina papyracea ingression in orbital medial wall / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the CT classification of the lamina papyracea ingression and its significance. METHODS Data of computed tomography(CT) were analyzed retrospectively in 928 patients with nasal symptoms in out-patient department of Huairou Hospital from April 2017 to September 2017. All data were analyzed predicatively to observe the prevalence of lamina papyracea ingression. RESULTS The probability of lamina papyracea ingression in this group was 6.03％(112/1856). The lamina papyracea ingression were divided into four types on the basis of the coronal CT: upper medial rectus type, medial rectus type, under medial rectus type and generalized type. There was no difference in the incidence between the under medial rectus type and the extensive type(P=1.00), there were significant differences in the incidence of the remaining types(P=0.00). CONCLUSION In this study, the classification of the lamina papyracea ingression on coronal CT is helpful to understand lamina papyracea ingression better and reduce the intraorbital complicatians of endoscopic sinus surgery.

Study on the Relationship of Carotid Intimal-Medial Wall Thickness and the Expression of IL-6 and Fetuin-A in the Serum of Two Type Diabetes / 现代检验医学杂志

Objective To investigate the relationship of carotid intimal-medial wall thickness(IMT) and the expression of IL-6 and Fetuin-A in two type diabetes.Methods 80 patients with two type diabetes were chosen,and 60 cases healthypeople of examination for the control group.The levels of IL-6 and Fetuin-A were measured,and measured the intimal-medial thickness (IMT) of internal carotid artery by carotid duplex ultrasonography scanning simultaneously.Results The level of IL-6 was significantly higher in two type diabetes than those in control group,and the level of Fetuin-A was declind (t=8.34 ～15.65,all P＜0.05).IL-6 level in normal IMT (A group,20 cases) was 2.24±0.21 pg/L,Fetuin level was 5.41±0.32 ng/ ml.IL-6 level in abnormal IMT (B group,18 cases) was 3.44±0.18 mm,and Fetuin level was 3.86±0.42 ng/ml.Relatively,IL-6 level in IMT with plaque (C group,22 cases) was 4.95-±-0.31 ng/ml,Fetuin-A level was 2.41±0.32 ng/ml.IL-6 level in lumen narrow (D group,20 cases) was 5.35±0.31 ng/ml,and Fetuin-A level was 2.02 ± 0.08 ng/ml.There were obvious differences for four groups to detect IL-6 was Fetuin-A levels (F=8.69 ～ 11.02,all P＜ 0.05).The level of IL-6 were rised little by little from A group to D group.There were obvious differences for comparison among groups (t=5.32～9.01,all P＜0.05).The level of Fetuin-A were declined little by little from A group to D group,there were obvious differnce for comparison among groups (t=6.14～11.53,all P＜0.05).Conclusion There was a close correlation between IL-6,Fetuin-A level and carotid intimal-medial wall thickness(IMT) in two type diabetes.To detection IL-6 and Fetuin-A levels is a target to distinguish two type diabetes whether or not with atherosclerosis.

A Case of Pediatric Medial-Orbital Wall Fracture with Extraocular Muscle Entrapment

PURPOSE: To report a case of pediatric medial wall blowout fracture with entrapment of medial rectus muscle which can be easily misdiagnosed as a cerebral lesion. CASE SUMMARY: A 16-year-old male visited our clinic with headache, severe restriction of his right eye movement, and diplopia after a head injury due to falling occurring 1 day before evaluation. The patient was inebriated at the time of the accident and could not recall the event but occipital hematoma was palpable. Periorbital ecchymosis or edema was not observed with minimal soft tissue injury except mild conjunctival injection on slit-lamp examination. The patient had an 18 prism diopter exodeviation at primary position and severe medial and mild lateral gaze limitation in his right eye. Brain magnetic resonance imaging (MRI) showed no specific cerebral findings although trapdoor orbital medial wall fracture with incarceration of soft tissue and medial rectus muscle at the medial wall fracture site of his right eye was observed. Within 48 hours from the first evaluation, the blowout fracture was repaired and 50 days postoperatively, right eye gaze limitation and diplopia were nearly recovered. CONCLUSIONS: A case of pediatric blowout fracture with uncertain injury location, periocular ecchymosis, or edema absent could be misdiagnosed as a cerebral lesion. If a pediatric patient is experiencing gaze limitation, diplopia, nausea, or vomiting after trauma, neurological examination as well as evaluation for blowout fracture should be performed.

Reconstruction of Orbital Medial Wall Fracture with Absorbable and Non-Absorbable Orbital Implant: Comparative Study

PURPOSE: To compare the surgical results and complications of medial wall fracture reconstruction using non-absorbable porous polyethylene implants (Medpor(R), Stryker Instruments, Kalamazoo, Michigan, USA) and an absorbable polymer of polyglycolic acid (PGA) and polylactic acid (PLA) (Mesh plate(R), Inion Ltd, Tampere, Finland). METHODS: We retrospectively reviewed the data of patients who underwent reconstruction of medial wall fracture between January 2007 and June 2012 and divided them into 2 groups according to orbital implant type (Medpor(R), Mesh plate(R)). RESULTS: Among the 86 patients, 37 were treated with Medpor(R) and 49 with Mesh plate(R). There was no statistically significant difference in limitation of motion or diplopia score between the 2 groups at postoperative 6 months (Fisher's exact test, p = 0.192, p = 0.128, respectively). Mean postoperative exophthalmometry differences between the eyes were 0.49 +/- 1.04 mm and 0.37 +/- 0.62 mm in Medpor(R) and Mesh plate(R) groups, respectively, showing no statistically significant difference (independent t-test, p = 0.512). Postoperative complications such as inflammation or implant malposition were observed only in 3 patients in the Medpor(R) group. CONCLUSIONS: No difference was observed between Medpor(R) and Mesh plate(R) in terms of surgical results during the postoperative 6 month period after reconstruction of orbital medial wall fracture. However, postoperative complications were observed in 3 patients in the Medpor(R) group.

Reconstruction of Orbital Medial Wall Fracture with Absorbable and Non-Absorbable Orbital Implant: Comparative Study

PURPOSE: To compare the surgical results and complications of medial wall fracture reconstruction using non-absorbable porous polyethylene implants (Medpor(R), Stryker Instruments, Kalamazoo, Michigan, USA) and an absorbable polymer of polyglycolic acid (PGA) and polylactic acid (PLA) (Mesh plate(R), Inion Ltd, Tampere, Finland). METHODS: We retrospectively reviewed the data of patients who underwent reconstruction of medial wall fracture between January 2007 and June 2012 and divided them into 2 groups according to orbital implant type (Medpor(R), Mesh plate(R)). RESULTS: Among the 86 patients, 37 were treated with Medpor(R) and 49 with Mesh plate(R). There was no statistically significant difference in limitation of motion or diplopia score between the 2 groups at postoperative 6 months (Fisher's exact test, p = 0.192, p = 0.128, respectively). Mean postoperative exophthalmometry differences between the eyes were 0.49 +/- 1.04 mm and 0.37 +/- 0.62 mm in Medpor(R) and Mesh plate(R) groups, respectively, showing no statistically significant difference (independent t-test, p = 0.512). Postoperative complications such as inflammation or implant malposition were observed only in 3 patients in the Medpor(R) group. CONCLUSIONS: No difference was observed between Medpor(R) and Mesh plate(R) in terms of surgical results during the postoperative 6 month period after reconstruction of orbital medial wall fracture. However, postoperative complications were observed in 3 patients in the Medpor(R) group.

Temporary Severe Neurogenic Blepharoptosis after Reconstruction of Orbital Medial Wall Fracture

PURPOSE: To report two cases of temporary severe neurogenic blepharoptosis after successful reconstruction of orbital medial wall fracture. CASE SUMMARY: A 36-year-old woman and a 52-year-old man received orbital medial wall reconstruction with Medpor(R) for large fractures. Before the operation, the patients had only moderate swelling of the lid and periorbital ecchymosis. There were no limitations of extraocular muscles or ptosis. The operations were successful, although the patients developed unilateral complete ptosis with totally impaired levetor muscle function immediately after recovering from anesthesia. There were no anisocoria or limitations of the extraocular muscles. After oral steroid therapy, the patients began to improve on postoperative day 4 and after one month, respectively, and recovered to normal lid height and levator function after two months. CONCLUSIONS: Blepharoptosis after orbital medial wall reconstruction may result from ischemic damage at the end of the superior branch of the oculomotor nerve in the orbit due to compressive and tractional manipulation. Although very rare and temporary, this complication should be considered important because the occurrence can be unpredictable and may cause dissatisfaction to the surgeon and the patient after a successful operation.

Acetabular Medial Wall Displacement Osteotomy in Total Hip Arthroplasty for Dysplastic Hips

PURPOSE: This study evaluated the results of acetabular medial wall osteotomy to reconstruct the acetabulum in dysplastic hip during total hip arthroplasty. MATERIALS AND METHODS: We clinically and radiologically evaluated 30 hips of 30 patients with secondary hip osteoarthritis caused by congenital hip dislocation or acetabular dysplasia who underwent total hip arthroplasty (THA) between March 1999 and October 2002. The average age of subjects was 46.5 years(17 to 73 years), and the mean follow-up period was 5 years(5.3 to 8.7 years). In 26 cases, a cementless hemispherical acetabular cup was inserted in the true acetabulum; in 4 cases a reinforced ring was inserted. Only 2 hips needed structural bone grafting. RESULTS: The average Harris hip score improved from 56.3 points preoperatively to 93.2 points at the last follow up. Radiographic analysis revealed no aseptic loosening or radiolucent line, and showed stable bony fixation at the true acetabulum. The mean thickness of the medial acetabular wall postoperative was 20.5 mm(10 to 36 mm). Bone union of the medial wall was observed at a mean of four months postoperatively. CONCLUSION: Acetabular medial wall osteotomy can maintain the integrity of the acetabular medial wall while achieving enhanced acetabular coverage and more normal hip biomechanics.

Cementless Total Hip Arthroplasty with Medial Wall Osteotomy for the Sequelae of Septic Arthritis of the Hip

BACKGROUND: We performed a retrospective study to evaluate the results of acetabular circumferential medial wall osteotomy, a procedure designed to provide secure fixation of a cementless hemispherical acetabular cup for the sequelae of septic arthritis of the hip. METHODS: We assessed 38 total hip arthroplasties (THAs) with circumferential acetabular medial wall osteotomies performed on patients with sequelae of septic arthritis of the hip between 1993 and 2000, who were followed up for > or = 3 years. The average follow-up period was 8.3 years (range, 3 to 12 years). The indication for this technique was poor acetabular cup coverage of < or = 70% on preoperative templating. In all cases, cementless hemispherical acetabular cups were fixed to the true acetabulum. Additional procedures included soft tissue release in 16 hips and femoral derotational and shortening osteotomies in 12 hips. We evaluated both clinical and radiological results. RESULTS: The Harris hip scores improved from 57 points preoperatively to 91 points postoperatively. Radiological analysis revealed no aseptic loosening or radiolucent lines around the acetabular cup. Stable bony fixation of the acetabular cup in the true acetabulum was seen in all cases. Acetabular osteolysis was demonstrated in 12 hips. Revision surgery was performed in 6 hips, but there were no complications related to acetabular circumferential medial wall osteotomy. CONCLUSIONS: Circumferential acetabular medial wall osteotomy can provide appropriate positioning and sufficient coverage of the acetabular cup and thus preserve the medial wall thickness in cementless THA without the need for additional bone grafting for the sequelae of septic arthritis of the hip.

Reconstruction of Isolated Medial Orbital Wall Fracture Using a Transcaruncular Approach

PURPOSE: We present our results in the reconstruction of medial orbital wall fractures using a transcaruncular approach. METHODS: Forty-five patients with isolated medial orbital wall fractures underwent reconstruction by transcaruncular approach in our clinic between May 2003 and October 2007, and were followed up for 6 months or more. RESULTS: Thirty-three males and 12 females were included in this study, with a mean age of 34.9 years. The most common indication for reconstruction were large sized fractures more than 50%. Operations were performed at a mean 11.9 days after trauma. Among 18 patients who had diplopia before the operation, 16 (89%) patients had symptom relief or improvement, and in the 2 patients where diplopia persisted, it did not in primary and down gaze and offered no difficulties in daily activities. Among 34 patients who had enophthalmos before the operation, most (n=30) of the patients had minimal enophthalmos not more than 2 mm, 4 patients had enophthalmos that exceeded 2 mm. CONCLUSIONS: Transcaruncular approach in reconstruction of isolated medial orbital wall fracture shows more satisfying functional and cosmetic results and can be preferred to isolated medial orbital wall fracture.

A Case of Orbital Medial Wall Fracture in a Pilot

Incidences of blowout fractures have increased due to rapid industrialization and rise in violent crimes. However, there have been few studies on the proper follow-up guidelines or protocol after reduction of the orbital wall for patients working in a high atmospheric pressure environment. We have experienced a pilot with an orbital medial wall fracture who underwent reduction through an endoscopic approach. The patient underwent the Valsalva maneuver and scan of paranasal sinuses 8 weeks after reduction. Emphysema did not occur in the orbit even after the Valsalva maneuver and he was able to return to his workplace without any complications. We report this case with a brief review of the literature.

Cementless Acetabular Component Fixation with Circumferential Medial Wall Osteotomy in Severely Hypoplastic Acetabulum / 대한정형외과학회잡지

PURPOSE: To evaluate the results of the acetabular circumferential medial wall osteotomy in obtaining secure fixation of cementless hemispherical acetabular cup to the hypoplastic acetabulum. MATERIALS AND METHODS: Seventy-nine THAs with a circumferential acetabular medial wall osteotomy in the dysplastic acetabulum performed between 1987 to 1997 and followed up for more than 6 years were assessed. The indication of this technique was acetabular coverage that could not achieve more than 70% after cup fixation. In all cases, a cementless hemispherical acetabular cup was fixed in the true acetabulum. Additional procedures included soft tissue releases in 23 hips, a derotational femoral osteotomy in 10 hips, a structural bone graft in 7 hips and femoral shortening in 8 hips. Both clinical and radiographic parameters were evaluated. RESULTS: The Harris hip scores were improved from 68.4 to 92.2 postoperatively. Radiographic analysis revealed no aseptic loosening or radioluacent line, and showed stable bony fixation at the true acetabulum in all cases. 7 hips showed acetabular osteolysis. Two acetabular components were revised due to dissociation of the polyethylene liner and 4 polyethylene liners were exchanged because of severe wear or osteolysis. CONCLUSION: The circumferential acetabular medial wall osteotomy can provide appropriate positioning, sufficient coverage of the acetabular cup with a preservation of the medial wall thickness in cementless THA without additional bone grafting in the dysplastic acetabulum.

Transcaruncular Approach for Reconstruction of Old Medial Orbital wall Fracture

PURPOSE: The purpose of this study was to identify the therapeutic effect of orbital reconstruction by transcaruncular approach on old medial orbital wall fracture. METHODS: We performed retrospective study on 23 eyes of 23 patients, who underwent orbital reconstruction with transcaruncular approach over six weeks after injury from July 1999 to August 2001. RESULTS: Nineteen cases had enophthalmos, preoperatively; five cases; 2 mm, seven cases; 3 mm, six cases; 4 mm, and one case; 5 mm, respectively. Postoperatively, we obtained enophthalmos less than 1 mm in 17 cases(89%). The exophthalmometry revealed that enophthalmos improved from 3.2+/-0.9 mm, preoperatively to 0.9+/-0.7 mm, postoperatively. Twelve cases had diplopia on the primary and downgaze, preoperatively. However, ten cases of them(83%) disappeared diplopia, postoperatively. Of the remaining two cases, one had persistent diplopia on the downgaze and the other had paralytic strabismus. CONCLUSIONS: We believe that the medial orbital wall repair through transcaruncular approach was a good way to correct enophthalmos and diplopia on old medial orbital wall fracture.

Endoscopic Intranasal Reconstruction of Medial Orbital Wall Fracture with Muco-periosteal Flap

Surgical method for blow out fracture of medial orbital wall is performed by medial canthotomy and subciliary incision or transconjunctival incision. However, these approaches can leave cosmetic problem due to skin incision and have a risk of infection and absorption of prosthetic implant for a large medial wall fracture. The authors performed endoscopic intranasal reconstruction of the isolated medial wall fracture in a case with significant functional impairment of extraocular muscle. After the incision of the middle turbinate, medial wall fracture was reconstructed with muco-periosteal flap under endoscopic control. We had a good result without intraoperative or postoperative complications caused by prosthetic implant. There was no disadvantage seen with the traditional approaches by medial canthotomy. Endoscopic intranasal reconstruction with muco-periosteal flap appears to be a new safe method for especially large defect.

Treatment of Medial Orbital Wall Fracture Using Endoscopic Intranasal Ethmoidectomy

An isolated blow out fracture of the medial orbital wall is uncommon, where as the incidence of conjugation with an orbital floor fracture is high. Clinically, they are suspected when periorbital trauma is associated with epistaxis, orbital hematoma, subcutaneous emphysema and horizontal diplopia. Surgical intervention is indicated if the fracture cause impairment of ocular motility, diplopia and enophthalmos due to incarceration of medial rectus muscle and soft tissue. Recently, endoscopic surgery in the treatment of orbital wall fracture instead of external approach has been introduced. The authors performed endoscopic intranasal ethmoidectomy with release of the rectus muscle in two patients with medial orbital wall fracture on the first post-traumatic day in one and the thirteenth day in the other and have good result.

Orbital Fractures Evaluated by Computed Tomography

Orbital fractures are increasing in frequency with the rise in number of automobile accidents and the development of industries. It may be difficult to detect fractures with plain X-rarys of the orbit, because of the superimposition of the shadow by bony structures. Even minor alterations in head position can cause a significant change of shadow. Computed tomography is extremely accurate and can be diagnostic with respect to the location and size of the fractures, because it provides detailed visualization of both the bones and soft tissues of the orbits. We studied 89 patients with orbital fractures proven by computed tomography and the results are as follows: 1. Orbital fractures occurred most frequently between the ages of 11 and 40 years. 2. The causes of orbital fractures were traffic accidents(46.1%), contact with human bodies(24.7%), fall-down injuries(14.6%) and others(14.6%). 3. There was no significant difference in the incidence of orbital fracture between the right and left eyes. 4. In single wall fractures, medial wall fractures were most common, followed by factures of inferior, superior and lateral walls in order. 5. In combined wall fractures, medial and inferior wall fractures were most common.