ABSTRACT
Objective@#To generate a new classification for adult temporomandibular joint ankylosis (TMJA), which could effectively guide treatment strategies for adult TMJA patients with various clinical features. @* Methods@# We developed a new "CD" classification system according to the preservation of the condyle (C) and the severity of dentofacial bone deformity (D). From January 2016 to April 2020, 56 TMJ patients (with 73 ankylosed joints) in our department were classified into 4 subgroups by ‘CD’ classification: condylar head preservation but no dentofacial deformities (C+D-), no condylar head preservation and no dentofacial deformities (C-D-), condylar head preservation and dentofacial deformities (C+ D+), and no condylar head preservation but dentofacial deformities (C-D+). Different strategies were used according to the clinical features of each subgroup. The clinical outcomes of these patients were analyzed. Different treatment strategies of temporomandibular joint reconstruction were adopted for different subclasses of patients and were followed. "C +": lateral arthroplasty (LAP) was used to remove the rigidity and preserve the medial residual condyle. "C-": if the ankylosing bone ball is small and the loss of ascending branch height is not obvious, arthroplasty should be performed to relieve ankylosis; however, if the ankylosing bone ball is large and the ascending branch height decreases significantly, joint reconstruction should be carried out after the ankylosis is relieved. "D +": surgical treatment of secondary dental and maxillofacial malformations at the same time or over stages. "D-": orthodontic treatment after operation to improve occlusal relationship and symptomatic treatment of oral diseases. @*Results@#After treatment, all 73 ankylosed joints were completely released, and the average maximal interincisal opening increased from (3.6±3.2 )to (32.8 ± 5.4) mm (P<0.001), with no recurrence of ankylosis found during the 12-48 month follow-up period.@*Conclusion @#The generation and elaboration of a ‘CD’ classification system is intended to help as a TMJA reconstruction guide for adult TMJA treatment and be widely used in more hospitals.
ABSTRACT
Objective: To evaluate the effectiveness of total scapular arthroplasty after total scapulectomy for scapular tumors. Methods: A clinical data of 17 patients with scapular tumors treated with total scapulectomy and total scapular arthroplasty between January 2010 and December 2017 were retrospectively reviewed. There were 9 males and 8 females with an average age of 34.4 years (range, 13-64 years). Seven patients were diagnosed with chondrosarcoma, 3 with osteosarcoma, 2 with Ewing's sarcoma, 1 with high-grade sarcoma, 1 with polymorphic dedifferentiated sarcoma, 1 with fibrosarcoma, 1 with plasmacytoma, and 1 with bone giant cell tumor. According to the surgical staging system described by Enneking et al, 1 patient was rated as stage 3, 8 as stageⅠB, 8 as stageⅡB. According to the classifications of shoulder girdle resections of Malawer et al, 11 patients were type ⅢB, 5 were type ⅣB, 1 was type ⅥB. The disease duration ranged from 0.5 to 8.0 months (mean, 3.2 months) and tumor size ranged from 11.0 cm×7.5 cm×6.0 cm to 18.5 cm×18.0 cm×12.5 cm. The 1993 Musculoskeletal Tumor Society (MSTS) upper limb function scoring system and shoulder mobility were used to evaluate postoperative shoulder joint function. Tumor recurrence and metastases were monitored by radiograph. Results: Poor superficial incision healing occurred in 1 patient, the rest incisions achieved healing by first intention. All patients were followed up 20-72 months (mean, 45.4 months). Two of the 17 patients died of multiple organ dysfunction syndrome caused by tumor metastases; 3 patients suffered from pulmonary metastases and were alive with disease. No local recurrence occurred in all patients. The overall survival rate was 88.2% (15/17) and the disease-free survival rate was 70.6% (12/17). Rib fracture after trauma, aseptic loosening, and atrophy of the deltoid muscle occurred in 1, 1, and 1 case, respectively. The other related complication was not observed. At last follow-up, the MSTS score was 26.1±1.4, and the flexion, extension, and abduction range of motion of shoulder joint were (70.0±7.5), (31.2±11.3), and (54.4 ±12.5) °, respectively. Conclusion: Reconstruction with total scapular arthroplasty after total scapulectomy can obtain a satisfactory shoulder contour and an acceptable functional outcomes in patients with scapular tumors.
ABSTRACT
BACKGROUND: For patients with Crowe II and III developmental dysplasia of hip combined with severe hip osteoarthritis, total hip arthroplasty is still controversial whether to choose acetabular anatomical reconstruction or high hip rotation center reconstruction. OBJECTIVE: To compare the differences in gait characteristics between the reconstruction technique of the high hip center and the anatomical hip center during total hip arthroplasty. METHODS: Forty patients with Crowe II-III developmental dysplasia of hip with unilateral hip disease from January 2014 to July 2017 were selected. All patients received total hip arthroplasty, of which 20 cases underwent acetabular anatomical reconstruction, and another 20 patients underwent high hip center reconstruction. The patients were followed up for more than 2 years after arthroplasty for gait analysis. The study was approved by Ethics Committee of Affiliated Hospital of Xuzhou Medical University. RESULTS AND CONCLUSION: (1) Spatiotemporal parameters: The pace, stride frequency, step length, single leg support time, single leg swing time, and double leg support time of the two groups of surgical side and non-surgical side were similar. There was no significant difference in pace, stride frequency, step length, one-leg support time, one-leg swing time, and two-leg support time between the two groups (P > 0.05). (2) Kinematic parameters: The maximum extension of the hip joint on the surgical side of the high reconstruction group was lower than that on the non-surgical side (P 0.05). (3) Kinetic parameters: The longitudinal peak of the plantar reaction force on the surgical side of the high reconstruction group was higher than that of the anatomical reconstruction group (P 0.05). (4) The results show that in patients with developmental dysplasia of hip, total hip arthroplasty using high hip center reconstruction can obtain gait parameters similar to anatomical hip center reconstruction. However, compared with patients undergoing anatomical hip rotation center reconstruction, patients with high hip center reconstruction had limited hip flexion and extension range movement and greater longitudinal force on the hip.
ABSTRACT
Acromioclavicular joint (ACJ) injury is a common shoulder injury. There are various techniques of ACJ reconstruction. Superficial infection after ACJ reconstruction is not an uncommon complication. However, osteomyelitis post ACJ reconstruction has never been highlighted as a possible complication. Our patient is a 31-year-old male who sustained a Rockwood 5 ACJ dislocation and had anatomical ACJ reconstruction with autogenous gracilis and semitendinosus graft. Our technique involved the anatomical reconstruction of the ACJ and the coracoclavicular ligament with the usage of two bioscrews and the temporary stabilisation of the ACJ with two k-wires. As in any orthopaedic surgery, infection is often disastrous especially when the surgery involves implants. It can be disastrous with high morbidity to the patient as well as a costly complication to treat. Therefore, we wish to highlight this case as despite its rarity, osteomyelitis can be devastating to the patient and should be prevented if possible.
Subject(s)
Adult , Humans , Male , Acromioclavicular Joint , Wounds and Injuries , General Surgery , Anti-Bacterial Agents , Bone Screws , Bone Wires , Gracilis Muscle , Transplantation , Hamstring Muscles , Transplantation , Joint Dislocations , General Surgery , Orthopedic Procedures , Methods , Osteomyelitis , Therapeutics , Postoperative Complications , Therapeutics , Prognosis , Plastic Surgery Procedures , MethodsABSTRACT
@#Treatment of chronic Rockwood’s type V Acromioclavicular (AC) joint dislocation remains controversial. We describe a surgical technique to reduce and maintain AC joint using a combination of gracilis autograft with GraftMax™ button (Conmed Inc, Utica, NY). Graft was prepared using running whip stitch technique with No. 5 Hi-Fi high strength suture (ConMed Linvatec, Largo, FL). Our technique reduces intraoperative clavicular and coracoid tunnel fracture and restores anatomical coracoclavicular ligament. At sixth week and third month postoperatively, the patient demonstrated good clinical and radiographic outcome.
ABSTRACT
Since Swanson designed the silicone small joint prosthesis, the material and design of the small joint prosthesis have been constantly innovating. The number of small joint reconstruction and arthroplasty has gradually increased in the past decade. The numerous studies have focused on design and application of new material prosthesis and its long-term effectiveness analysis, in order to overcome prosthesis loosening, shift, dislocation, and poor function problem, at the same time to challenge the difficulty of the small joints revision procedures. Although the small joint prosthesis which has got the overall performance of the Swanson joints and been mature and stable like a knee joints prosthesis has not been obtained, but the small joint development has made revolutionary changes in the treatment of joint diseases, and the prosthesis selection criterion and surgical technique tendency solution have been established. In the future, digital three-dimensional printing, regenerative medicine, and translational medicine will contribute to the development of small joint reconstruction and replacement.
ABSTRACT
The treatment of open, traumatic intraarticular injuries to the metatarsophalangeal joint with severe articular comminution and cartilage defect of metatarsal head is a challenge to the foot surgeon. We report the joint reconstruction treating the injured joint by autogenic costal osteochondral graft with satisfactory outcome.