Cemented monoblock hemiarthroplasty: a dependable option in femoral neck fracture in elderly

Background: Femoral neck fracture in elderly continues to pose a treatment dilemma. Associated co-morbidities and high mortality (1-year mortality of 25–30% and only 25% survivorship at 10 years) often skews the surgical decision. The underlying treatment goal is minimum revision and maximum functional outcome. Lack of clear guidelines is reflected by the continued debates regarding their management namely osteosynthesis vs arthroplasty; hemiarthroplasty vs total hip arthroplasty, unipolar vs bipolar and cemented vs uncemented. A review of joint registries, uniformly suggest that cemented fixation in elderly patient results in early mobilization, less residual pain and the lowest risk of revision. We analyzed clinical outcome of cemented monoblock hemi-arthroplasty (modified design) in femoral neck fracture in elderly.Methods: Total 94 cemented hemiarthroplasty, performed since January 2009, with a minimum follow up of 3 years are included in the study. Mean modified Haris Hip score at 2 years, 3 years and in the last follow up was 88 (72-91), 84 (70-89) and 81 (65-86) respectively. Acetabular erosion was noted in three patients (3.19%) (one was symptomatic) and aseptic loosening in another two patients (2.12%). Major complications such as deep wound infection, dislocation or peri-prosthetic fracture were not noted in any patient.Results: Result of the present study is consistent to marginally superior when compared to cemented Thompson monoblock and the cemented bipolar prostheses. We attribute this to routine use of cement in the elderly osteoporotic bone along with design modification of the monoblock stem. Long term result of THA is marginally (not statistically significant) better compared to hemiarthroplasty. However, it is associated with prolonged surgery, more blood loss and higher dislocation rate. The rates of dislocation following THA, bipolar and unipolar arthroplasty were 11%, 3%, and 2% respectively.Conclusions: Cemented monoblock hemiarthroplasty is effective and viable option in displaced femoral neck fracture in elderly in terms of excellent functional outcome, low reoperation without adversely affecting morbidity and mortality. Being cost effective procedure this may be considered as first line surgical option especially in socio-economically disadvantaged section of the society.

Stress distribution and failure load of multilayer and monolayer glass ceramic / Distribuição de tensão e carga para fratura de cerâmica vítrea em multicamada e em monocamada

This short report evaluated the differences in stress concentration and the load to fracture of multilayered and monolayer glass ceramic discs. Using a simulated static structural analysis, the 3D model of the samples received a load of 150 N and results in maximum principal stress were obtained. For the in vitro analysis, the samples (ø 12 mm) were submitted to a compressive test (100 kgf, 1 mm/min). The data was analyzed using one-way analysis of variance and Tukey test (α = 5%). The monolayer group showed a lower stress peak (129.24 MPa) and higher load to fracture (118.38 N) than the multilayered group with 211.04MPa and 48.34N, respectively. All samples presented catastrophic failure with its origin on the tensile surface. Therefore, the monolayer ceramic group showed superior mechanical behavior than the multilayered group. (AU)

Este relato avaliou a diferença na concentração de tensão e a carga para fratura de discos de cerâmica vítrea em multicamada e monocamada. Usando uma análise estática estrutural simulada, o modelo 3D das amostras recebeu uma carga de 150 N e resultados de tensão máxima principal foram obtidos. Para a análise in vitro, as amostras (ø 12 mm) foram submetidas a um teste de compressão (100 kgf, 1 mm / min). Os dados foram analisados por análise de variância e teste de Tukey (α = 5%). O grupo em monocamada mostrou um menor pico de tensão (129,24 MPa) e maior carga para fratura (118,38N) do que o grupo multicamada com 211,04 MPa e 48,34 N, respectivamente. Todas as amostras apresentaram falha catastrófica com sua origem na superfície de tração. Portanto, o grupo em monocamada apresentou comportamento mecânico superior ao grupo multicamadas. (AU)

Push-out bond strength and dentinal tubule penetration of different root canal sealers used with coated core materials

OBJECTIVES: The aim of this study was to compare the push-out bond strength and dentinal tubule penetration of root canal sealers used with coated core materials and conventional gutta-percha. MATERIALS AND METHODS: A total of 72 single-rooted human mandibular incisors were instrumented with NiTi rotary files with irrigation of 2.5% NaOCl. The smear layer was removed with 17% ethylenediaminetetraacetic acid (EDTA). Specimens were assigned into four groups according to the obturation system: Group 1, EndoRez (Ultradent Product Inc.); Group 2, Activ GP (Brasseler); Group 3, SmartSeal (DFRP Ltd. Villa Farm); Group 4, AH 26 (Dentsply de Trey)/gutta-percha (GP). For push-out bond strength measurement, two horizontal slices were obtained from each specimen (n = 20). To compare dentinal tubule penetration, remaining 32 roots assigned to 4 groups as above were obturated with 0.1% Rhodamine B labeled sealers. One horizontal slice was obtained from the middle third of each specimen (n = 8) and scanned under confocal laser scanning electron microscope. Tubule penetration area, depth, and percentage were measured. Kruskall-Wallis test was used for statistical analysis. RESULTS: EndoRez showed significantly lower push-out bond strength than the others (p < 0.05). No significant difference was found amongst the groups in terms of percentage of sealer penetration. SmartSeal showed the least penetration than the others (p < 0.05). CONCLUSIONS: The bond strength and sealer penetration of resin-and glass ionomer-based sealers used with coated core was not superior to resin-based sealer used with conventional GP. Dentinal tubule penetration has limited effect on bond strength. The use of conventional GP with sealer seems to be sufficient in terms of push-out bond strength.

Biological Post: A Reconstructive Approach to Achieve Aesthetics.

Traumatic injuries lead to fracture of anterior teeth, frequently occurs in dentistry and the prevalence rate of fractured anterior teeth, as a result of traumatic injuries, occurs 8.1 in 1000. The fracture of a tooth is itself a traumatic incident for young patients which leads to functional, aesthetic, psychological problems and reduces patient's quality of life. Various materials are available to restore these types of traumatic injuries, but till date there is no material that has been proved to be as effective as natural structure considering mechanical and biological properties. This case report represents the management of traumatized fractured mandibular anterior teeth with biological posts and coronal restorations with composite.

Comparison of Monoblock and Modular Femoral Stem on Isolated Acetabular Revision with Use of Uncemented Cup

Purpose: The purpose of our study was to assess the clinical and radiological results of isolated acetabular revision and the differences in the results between monoblock and modular femoral stems. Materials and Methods: Between October 1991 and June 2002, 39 patients (39 hips) underwent isolated acetabular revisions with use of uncemented cups and bone grafts. The mean period of follow-up was 5 years 3 months (range, 2 years 1 month to 9 years 8 months). The mean age of the patients at the time of the surgery was 51 years old (range, 26 to 75 years old). The monoblock femoral stems were used in 19 hips and the modular femoral stems were used in 20 hips. The monoblock stems were retained without exchange provided that there was no gross scratch on the femoral head and the femoral stem was confirmed to be stable and fixed intraoperatively. In the modular stems, the femoral heads were always exchanged with new ones. Results: The mean Harris hip score improved from 57 to 87 points. Radiologically, all the stems retained at surgery remained well osseointegrated without osteolysis. Re-revisions of the acetabular components were performed in 5 hips using monoblock stems due to periacetabular osteolysis caused by excessive wear of polyethylene and subsequent loosening of the cups in 3 hips and mechanically unstable acetabular cups without osteolysis in 2 hips. The mean wear rate of polyethylene coupled with the monoblock stem was 0.27 mm/year which was greater than the 0.11 mm/year in the cases with modular stems. Conclusion: To prevent failure of acetabular cups that may occur later by excessive wear of polyethylene, we recommend revision of the well-fixed monoblock femoral stems even though there is no gross scratch on the femoral heads of the monoblock stems.