ABSTRACT
Diversos fatores determinam o sucesso na obtenção dos objetivos funcionais e estéticos com restaurações implantossuportadas. O trabalho em equipe é essencial desde o momento do diagnóstico, bem como o compromisso de todos os membros envolvidos com a resolução das diversas situações que surgem diariamente na prática odontológica. Um planejamento abrangente mostra-se a chave para alcançar os resultados propostos, respeitando uma prática interdisciplinar e utilizando protocolos aceitos clinicamente e cientificamente, baseados em evidências científicas. Assim, o presente artigo apresentará a integração paciente-dentista-TPD, na busca por resultados sustentáveis em longo prazo...
Several factors determine the success of functional and esthetic outcomes with implant-supported prosthetic replacement. Team work is essential as from the time of diagnosis, along with commitment of all members involved in solving different situations daily arising in dental practice. Meticulous planning is the key to achieve the desired result, respecting an interdisciplinary practice and using clinically scientifically acceptable evidence-based protocols. Thus, this article presents a case of patient-dentist-dental hygiene technician integration in the quest for sustainable results in the long run...
Subject(s)
Humans , Male , Young Adult , Jaw, Edentulous, Partially/rehabilitation , Dental Implants , Incisor/injuries , Dental Prosthesis, Implant-Supported/methods , Clinical Protocols , Dentist-Patient Relations , Esthetics, Dental , Treatment OutcomeABSTRACT
Se presentó un paciente de 66 años ingresado en el Servicio de Cuidados Intensivos del Hospital Princesa Margarita de la ciudad de Roseau, Dominica, con un diagnóstico de osteoartritis; fue remitido a la unidad luego de la intervención quirúrgica con remplazo protésico total de rodilla izquierda. Llegó somnoliento, aunque consciente, orientado, cooperativo, con respuesta al llamado, con pupilas isocóricas y reactivas a la luz, ventilando espontáneamente. Presentó, además, herida quirúrgica cubierta con apósito estéril en la rodilla izquierda con drenaje quirúrgico, hidratado a través de vena periférica permeable en la región del antebrazo izquierdo. Desde las primeras 24 h el paciente se mantuvo estable, con parámetros vitales normales, recuperó gradualmente la motilidad y el funcionamiento de la articulación de la rodilla intervenida. Luego de cinco días de estadía en el servicio el paciente logró caminar y continuo su evolución favorablemente, por lo que se decidió su egreso hospitalario.
A 66 year old patient admitted to the Intensive Care Unit of the Princesa Margarita Hospital in Roseau, Dominica, with a diagnosis of osteoarthritis was presented. The patient was referred to the unit after surgery with complete prosthetic left knee replacement. He arrived sleepy, though conscious, oriented, cooperative, responsive to the call, with isochoric and reactive to light pupils, spontaneously breathing. He also presented wound covered with sterile dressing on the left knee with surgical drainage, hydrated through permeable peripheral vein in the region of the left forearm. Since the first 24 h the patient was stable, with normal vital parameters, gradually recovered motility and joint function of the operated knee. After five days of stay in the service the patient started to walk and continued a favorably evolution, so the doctors decided to discharge him.
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PURPOSE: To compare clinical outcomes of the tumor prosthetic replacement and osteosynthetic fixation for pathologic fracture of skeletal metastatic lesion of the proximal femur. MATERIALS AND METHODS: From 1994 May to 2009 May, medical records of 22 patients who underwent tumor prosthetic replacement with tumor resection (group 1) and 15 others (16 hips) who underwent osteosynthetic fixation without tumor resection (group 2) were reviewed. The mean age of overall patients were 59 (group 1) and 60 (group 2). Mean follow up periods were 23 and 11 months. The oncological and functional results were evaluated with Kaplan-Meier methods and Musculoskeletal Tumor Society (MSTS) scoring system, 1993. The statistical evaluation was assessed with Log rank test and t-test. RESULTS: The mean survival periods were 24 months in group 1 and 11months in group 2. The 1 year survival rates were 86% in group 1 and 50 % in group 2, and 2 year survival rates were 29.7% in group 1 and 9.4% in group 2. The mean MSTS functional score were 26.4 (19-30), 87.9% in group 1 and 15.3 (10-23), 51.0% in group 2. CONCLUSION: The results of tumor resection and prosthetic replacement in selected cases was better than osteosynthetic fixation without tumor resection for metastatic bone tumors around proximal femur in oncological and functional aspects.
Subject(s)
Humans , Femur , Follow-Up Studies , Fractures, Spontaneous , Joints , Medical Records , Survival RateABSTRACT
Objective To evaluate the therapeutic effects of the integration of impaction bone grafting reconstructing femur trochanter and femoral head arthropalsty in the treatment of unstable intertrochanteric fractures in aged patients. Methods From January 2006 to December 2008,21 cases unstable intertrohanteric fractures with serious osteoporosis were treated with impaction bone grafting reconstructing the femur trochanter and femoral head arthropalsty. Results Functional assessment based on the Harris score ,great in 14 cases, good in 5 cases, medium in 2 cases. The excellent and good rate was 90. 4%. Conclusion The integration of impaction bone grafting reconstructing femur trochanter and femoral head arthropalsty is convenient to treat unstable intertrochanteric fractures in aged patients.
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PURPOSE: To assess the effectiveness of a prosthetic replacement of the humeral head in rotator cuff tear arthropathy patients. MATERIALS AND METHODS: 11 patients underwent a prosthetic replacement of the humeral head for rotator cuff tear arthropathy between 1997 and 2003. The average age was 69 years and 9 out of the 11 patients were women. The average follow-up was 44 months. The level of pain, daily activities, range of motion and patient's satisfaction were assessed both preoperatively and postoperatively. RESULTS: The mean pain score decreased from 9.0 preoperatively to 2.2 postoperatively. The mean active forward elevation increased from 40o to 82o and the mean external rotation increased from 8.2o to 30o. The mean ASES score improved from 22 to 72. Nine patients were satisfied with the surgical outcome, particularly in terms of pain relief and the improvement in their daily activities. CONCLUSION: A prosthetic replacement of the humeral head is an effective treatment option for pain relief as well as for improving the functional activity in rotator cuff tear arthropathy.
Subject(s)
Female , Humans , Follow-Up Studies , Humeral Head , Range of Motion, Articular , Rotator Cuff , ShoulderABSTRACT
Objective To evaluate the clinical application and significance of lengthen-stem bipolar-femur prosthetic replacement for the treatment of old-age patients with intertrochanteric fracture osteoporosis.Methods 28 cases of patients aging from 75 to 99 years old of intertrochanteric fracture osteoporosis treated with lengthen- stem cemented bipolar prosthesis were studicd from March 2000 to December 2006.After taking the blank margin, the bones of different sizes were replaced and the steel wire was fixed.After determining the depth of the front an- gle,the artificial bone was placed.Results After 28 examples attaining the following-up examination for 7 months to 3 years,with an average of 1.5 years,its function according to Harris standard was evaluated 3 months after the operation,8 examples were excellent,13 examples good,5 examples pass,2 examples inferior.The excellent or good rate reached 75% ,with no abnormal cases,no joint dislocation during the followed-up period.1 example had the phantom phenomenon 1 year after the operation.2 examples among the inferior had got more serious internal medicine disease which affected the restoring function.1 example died of the internal medicine disease 1 year after the operation.Conclusion By using the lengthen-stem bipolar-femur prosthetic replacement for the treatment of old patients with inrertrochanteric fracture osteoporosis,the patients will restore quickly after the operation and can carry a heavy load at an early time.The illness complication and the mortality rate will be redaced.But its related disease must be strictly dealt with and the surgery operating skill must be grasped.
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Objective To explore the selection of prostheses for the elderly patients with severe displaced fracture of the femoral neck through retrospective comparison of the long term clinical results between bipolar hemiarthroplasty and total hip replacement. Methods From January 1986 to December 2002, 101 cases of Garden Ⅲand Ⅳtypes of the femoral neck fracture were treated with either bipolar hemiarthroplasty (Group A: 55 cases) or total hip replacement (Group B: 46 cases). The age of the patients at the time of operation ranged from 55 to 94 years old (mean: 70.4 years old) in Group A, and from 57 to 75 years old (mean 69.5 years old) in Group B. The average period of follow up was 4.9 years (1 to 10 years) in Group A and 3.5 years (1.5 to 5 years) in Group B. The clinical results were evaluated according to Harris and Merle d'Aubigue criteria. The perioperative complications were compared. Results The excellent and good clinical results were 78.12 %in Groups A and 95.65 %in Group B respectively. The rate of groin and thigh pains was higher in Group A (36.36 %) than in Group B (6.52 %). The flexion of the hip in Group A was more limited (mean 85 degrees) than in Group B (mean 110 degrees). There were more cases of sunken femoral stem in Group A. The perioperative complications were similar in both groups. Conclusions The total hip arthroplasty is the first choice for the elderly patients with severe displaced femoral neck fracture if the conditions of the patient and the skills of the surgeon permit. The bipolar hemiarthroplasty is suitable for patients of more than 75 years old, or for those with severe diseases.
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Objective To report the preliminary clinical results of treatment of severely comminuted radial head fractures by replacement with floating cup radial head prosthesis. Methods In the period from August 2002 to June 2005, replacement with floating cup radial head prosthesis was performed to treat 10 cases of Mason Ⅲ , Ⅳ radial head fractures, of whom 9 were acute fractures and 1 old. Results All the patients were followed up for 6 to 40 months (mean 14.9 months). The mean flexion/extension of the elbow was 133.5? /9.0? , while the mean pronation/supination of the forearm was 78.5? /84.0? . There were 3 cases of mild pain, 1 case of mild valgus instability in the elbow and 3 cases of mild weakness. The Broberg and Morrey elbow scores averaged 93. The result was excellent in 6 cases, good in 3 and fair in 1, the excellent and good rates were 90% . Conclusion The replacement with floating cup prosthesis shows satisfying preliminary clinical outcome in the treatment of radial head fractures unable to be reduced, while its long- term result needs further follow- up
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The authors have reviewed 11 cases of prosthetic replacement for severe proximal humeral fractures which were treated from March 1989 to December 1993, paying particular attention to the range of motion attained after surgery and the factors which influence the limitation of shoulder motion. The results of this study were as follows: l. Among the 11 cases, 10 cases showed sttisfactory pain relief. 2. Active motion of the shoulder averaged 91° of forward flexion, 72.8° of abduction and 35° of external rotation. 3. The humeral offset averaged 30.9mm in normal shoulder and 18.9mm in affected shoulder. 4. In 6 cases which the humeral offset measured over 20mm, active motion averaged 104° of forward flexion and 83° of abduction and 5 cases showed satisfactory results. 5. In 5 cases which the humeral offset measured under 20mm, active motion averaged 104° of forward flexion and 83 of abduction and 5 cases showed unsatisfactory results. 6. Prosthetic replacements were performed within 1 week after injury in 7 cases and among these 5 cases showed satisfactory results. The range of motion after prosthetic replacement for severe proximal humeral fracture was disappointing. We concluded that limited range of motion is mainly due to reduced humeral offset and restoration of humeral offset by appropriate reattachment of greater tuberosity will allow better clinical result.
Subject(s)
Range of Motion, Articular , Shoulder , Shoulder FracturesABSTRACT
We treated three cases of bone tumors-giant cell tumor, chondroblastoma and malignant fibrous histiocytoma-with a custom-made prosthetic replacement. The patients were followed from 10 months to 18 months, postoperatively. The results of these study are as follows: 1. Satisfactory anatomic restoration 2. Early ambulation 3. Good function 4. Biomechanically sound reconstruction
Subject(s)
Humans , Chondroblastoma , Early AmbulationABSTRACT
The displaced femoral neck fractures remain a major challenge to orthopaedic surgeons as the elderly population is increasing. Successful union by internal fixation after adequate reduction without avascular necrosis is primary goal since the functional results having own femoral head are much superior to those having prosthetic femoral head, but prosthetic replacement is indicated for some patients with fresh fractures who need early ambulation as well as neglected fractures and failed internal fixations. The early result after prosthetic replacement was known to be very satisfactory but the late complications are becomming the major problem. Authors reviewed 21 cases of the prosthetic replacements for the femoral neck fractures which were followed for more than one year and managed at Fatima Hospital during the years between 1975-1984 and the following results were obtained. 1. The cases were 8 males and 13 females having ages from 42 to 87 years with average 69 years old. 2. The cases were 11 elderly fresh fractures, 6 neglected fractures, 2 failed osteosynthesis and 2 others. 3. Moore and Thompson prosthesis were used and 13 of them were fixed with bone cement. 4. The early result evaluated at 3 months after surgery revealed satisfactory in 90% but the final result at average 3 years and 5 months ranging from 1 year to 6 years and 2 months revealed satisfactory results in 58% 5. There was no significant early post-operative complications. 6. The late complications were 8 cases of acetabular erosions and these were combined with stem loosening in 2, subsidence in 2 and deep infection in 1 case. 7. The late complications started to reveal at about 3 years after surgery and occurred in younger and active patient. 8. The prosthetic replacement for femoral neck fracture is recommended for the inactive patient or the patient with expected activity less than 3 years.
Subject(s)
Aged , Female , Humans , Male , Acetabulum , Early Ambulation , Femoral Neck Fractures , Femur Neck , Head , Necrosis , Prostheses and Implants , SurgeonsABSTRACT
Prosthetic replacement was performed in 31 patients (32 cases) with femoral neck fractures at National Medical Center from 1968 to 1981. We reviewed the records of 28 patients having Austin-Moore prosthetic arthroplasty in 29 cases, and of 3 patients having Thompson prosthetic arthroplasty; then obtained following results. l. Of the 31 patients, 23 were female and 8 were male. The left hip was involved in 20 patients, right in 10, and the both sides in one. 2. The age range was between 35 and 84 years, with the average age of 61.2 years. 74.2% of patients were older than 51 years of age. 3. The most common cause of fracture was slipping or fall (65.6%), and the fracture sites were subcapital in 11 (34.4%), transcervical in 12 (37.4%), and basilar in 3 (9.4%). 4. Three cases (9.4%) were operated within a week, and 21 cases (65.6%) more than 3 weeks after injury. Good results were obtained in fresh fracture which was operated within a week. 5. In comparing the blood loss in Moores and modified Gibson's surgical approaches, the average total loss by the former was 1,290 ml and 1,720 ml by the latter. 6. In complications, one case of fracture of the posterior rim of acetabulum with subsequent subluxation and two cases of fracture of the greater trochanter were notable as operative complicatiens. 7. In a follow-up study averaging 13.1 months, good to excellent results were obtained in 8 cases, fair in 6, poor or bad in 5, respectively.