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1.
Rev. bras. ortop ; 58(1): 168-172, Jan.-Feb. 2023. graf
Article in English | LILACS | ID: biblio-1441338

ABSTRACT

Abstract Neglected elbow dislocation is an uncommon condition and its treatment remains challenging. We present a case of a middle-aged woman presenting with neglected elbow dislocation and multi-direction instability in whom open reduction of the elbow joint and circumferential ligamentous reconstruction with a gracilis tendon graft was done. The functional outcome assessed with the Mayo elbow performance index was excellent. This circumferential technique is undoubtedly a viable technique and the indications can be extended to even manage a neglected dislocation. This procedure reduces the need or diminishes the duration of external fixation requirement and thereby encourages early mobilization.


Resumo A luxação negligenciada do cotovelo é uma condição incomum e seu tratamento permanece desafiador. Apresentamos o caso de uma mulher de meia-idade que apresentou luxação negligenciada do cotovelo e instabilidade multidirecional, na qual foi realizada redução aberta da articulação do cotovelo e reconstrução ligamentar circunferencial com enxerto de tendão gracilis. O resultado funcional avaliado com o índice de desempenho do cotovelo de Mayo foi excelente. Essa técnica circunferencial é, sem dúvida, uma técnica viável e as indicações podem ser estendidas para gerenciar até mesmo um deslocamento negligenciado. Este procedimento reduz a necessidade ou diminui a duração da exigência de fixação externa e, assim, incentiva a mobilização precoce.


Subject(s)
Humans , Female , Adult , Joint Dislocations , Elbow Joint , Joint Instability , Ligaments, Articular
2.
Rev. bras. ortop ; 58(1): 164-167, Jan.-Feb. 2023. graf
Article in English | LILACS | ID: biblio-1441353

ABSTRACT

Abstract Congenital knee dislocation (CKD) is a rare malformation characterized by hyperextension deformity of the knee with anterior tibia displacement, present at birth. Rarely reported, CKD might occur as an isolated deformity or commonly associated with musculoskeletal abnormalities, with the most common ones being developmental dysplasia of the hip (DDH) and clubfoot. The etiology is unknown, but CKD has been associated with certain intrinsic and extrinsic factors. Treatment with conservative methods at an early stage is most likely to yield successful results. We report here a rare case of successful spontaneous reduction of CKD in an infant within 24 hours of life.


Resumo A luxação congênita do joelho (LCJ) é uma malformação rara caracterizada por deformidade de hiperextensão do joelho com deslocamento anterior da tíbia, presente ao nascimento. Raramente relatada, a LCJ pode ocorrer como uma deformidade isolada ou comumente associada a anormalidades musculoesqueléticas, sendo as mais comuns a displasia do desenvolvimento do quadril (DDQ) e o pé torto congênito (PTC). A etiologia é desconhecida, mas a LCJ foi associada a certos fatores intrínsecos e extrínsecos. O tratamento com métodos conservadores em um estágio inicial tem maior probabilidade de produzir resultados bem-sucedidos. Relatamos aqui um caso raro de redução espontânea bem-sucedida de LCJ em um bebê nas suas primeiras 24 horas de vida.


Subject(s)
Humans , Infant, Newborn , Remission, Spontaneous , Joint Dislocations/congenital , Joint Dislocations/therapy
3.
Chinese Journal of Stomatology ; (12): 569-574, 2023.
Article in Chinese | WPRIM | ID: wpr-986112

ABSTRACT

Objective: To explore the correlation between the attachment type of lateral pterygoid muscle (LPM) and the position of temporomandibular joint (TMJ) disc in patients with temporomandibular disorders (TMD) by using wireless amplified magnetic resonance imaging detector (WAND) coupled with conventional head and neck joint coil for high resolution imaging of TMJ. Methods: Eighty-five patients with TMD diagnosed by oral and maxillofacial surgeons of Guizhou Provincial People's Hospital from October 2019 to January 2022 were collected. A total of 160 TMJ were included. There were 16 males and 69 females, aged (32.7±14.2) years. All patients were scanned with open, closed oblique sagittal and coronal WAND coupled head and neck coils with bilateral TMJ. Based on TMJ and LPM high resolution imaging, to explore the correlation between LPM attachment types and the position of TMJ disc in TMD patients, and to evaluate the potential clinical value of LPM attachment types in TMD patients. χ2 test and Pearson correlation analysis were used to evaluate the correlation between LPM attachment type and TMJ disc location. Results: There were three types of LPM attachment: type Ⅰ in 51 cases [31.9% (51/160)], type Ⅱ in 77 cases [48.1% (77/160)] and type Ⅲ in 32 cases [20.0% (32/160)]. There was a significant correlation between the type of LPM attachment and the position of articular disc (χ2=28.20, P=0.002, r=0.776). There was no statistical significance between the type of LPM attachment and the reversible displacement of articular disc (χ2=0.24, P=0.887, r=0.825). Conclusions: There is a correlation between the attachment type of LPM and the position of the disc in TMD patients. WNAD coupled with conventional head and neck joint coil TMJ high resolution scan can provide reliable imaging evidence for TMD patients in evaluating the type of LPM attachment and the location of disc.


Subject(s)
Male , Female , Humans , Temporomandibular Joint Disc/pathology , Pterygoid Muscles/pathology , Joint Dislocations , Temporomandibular Joint Disorders/diagnostic imaging , Magnetic Resonance Imaging/methods , Temporomandibular Joint/pathology
4.
Article in Chinese | WPRIM | ID: wpr-981729

ABSTRACT

OBJECTIVE@#This study aims to examine the biomechanical effects of different reconstruction methods, including single-bundle, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of the coracoclavicular ligament on the acromioclavicular joint using finite element analysis, to provide a theoretical basis for the clinical application of truly anatomical coracoclavicular ligament reconstruction.@*METHODS@#One volunteer, aged 27 years old, with a height of 178 cm and a weight of 75 kg, was selected for CT scanning of the shoulder joint. Three-dimensional finite element models of single-bundle reconstruction, double-bundle anatomical reconstruction, and double-bundle truly anatomical reconstruction of coracoclavicular ligament were established by using Mimics17.0, Geomagic studio 2012, UG NX 10.0, HyperMesh 14.0 and ABAQUS 6.14 software. The maximum displacement of the middle point of the distal clavicle in the main loading direction and the maximum equivalent stress of the reconstruction device under different loading conditions were recorded and compared.@*RESULTS@#The maximum forward displacement and the maximum backward displacement of the middle point of the distal clavicle in the double-bundle truly anatomic reconstruction were the lowest, which were 7.76 mm and 7.27 mm respectively. When an upward load was applied, the maximum displacement of the distal clavicle midpoint in the double-beam anatomic reconstruction was the lowest, which was 5.12 mm. Applying three different loads forward, backward, and upward, the maximum equivalent stress of the reconstruction devices in the double-beam reconstruction was lower than that in the single-beam reconstruction. The maximum equivalent stress of the trapezoid ligament reconstruction device in the double-bundle truly anatomical reconstruction was lower than that in the double-bundle anatomical reconstruction, which was 73.29 MPa, but the maximum equivalent stress of the conoid ligament reconstruction device was higher than that of the double-bundle anatomical reconstruction.@*CONCLUSION@#The truly anatomical reconstruction of coracoclavicular ligament can improve the horizontal stability of acromioclavicular joint and reduce the stress of the trapezoid ligament reconstruction device. It can be a good method for the treatment of acromioclavicular joint dislocation.


Subject(s)
Humans , Adult , Acromioclavicular Joint/surgery , Finite Element Analysis , Ligaments, Articular/surgery , Shoulder Joint/surgery , Plastic Surgery Procedures , Joint Dislocations/surgery
5.
Article in Chinese | WPRIM | ID: wpr-981720

ABSTRACT

OBJECTIVE@#To investigate the clinical efficacy of posterior cervical pedicle screw short-segment internal fixation for the treatment of atlantoaxial fracture and dislocation.@*METHODS@#The clinical data of 60 patients with atlantoaxial vertebral fracture and dislocation underwent surgery between January 2015 and January 2018 were retrospectively analyzed. The patients were divided into study group and control group according to different surgical methods. There were 30 patients in study group, including 13 males and 17 females, with an average age of (39.32±2.85) years old, were underwent short-segment internal fixation with posterior cervical pedicle screws. There were 30 patients in control group, including 12 males and 18 females, with an average age of (39.57±2.90) years old, were underwent posterior lamina clip internal fixation of the atlas. The operation time, intraoperative blood loss, postoperative ambulation time, hospitalization time and complications between two groups were recorded and compared. The pain visual analogue scale(VAS), Japanese Orthopedic Association(JOA) score of neurological function, and fusion status were evaluated between two groups.@*RESULTS@#All patients were followed up for at least 12 months. The study group was better than control group in operation time, intraoperative blood loss, postoperative off-bed activity time, and hospital stay (P=0.000). One case of respiratory tract injury occurred in study group. In control group, 2 cases occurred incision infection, 3 cases occurred respiratory tract injury, and 3 cases occurred adjacent segmental joint degeneration. The incidence of complications in study group was lower than that in control group (χ2=4.705, P=0.030). At 1, 3, 7 days after operation, VAS of study group was lower than that of control group(P=0.000). At 1, 3 months after operation, JOA score of study group was higher than that of control group(P=0.000). At 12 months after operation, all the patients in the study group achieved bony fusion. In control group, there were 3 cases of poor bony fusion and 3 cases of internal fixation fracture, the incidence rate was 20.00%(6/30). The difference between two groups was statistically significant (χ2=4.629, P=0.031).@*CONCLUSION@#Posterior cervical short-segment pedicle screw fixation for atlantoaxial fracture and dislocation has the advantages of less trauma, shorter operation time, fewer complications, and less pain, and can promote the recovery of nerve function as soon as possible.


Subject(s)
Male , Female , Humans , Adult , Pedicle Screws , Retrospective Studies , Fractures, Bone , Fracture Fixation, Internal/methods , Joint Dislocations/surgery , Spinal Fractures/surgery , Treatment Outcome , Postoperative Hemorrhage
6.
Article in Chinese | WPRIM | ID: wpr-981624

ABSTRACT

The shoulder joint is the most prone to dislocation in the whole body, and more than 95% of them are anterior dislocation. Improper treatment after the initial dislocation is easy to lead to recurrent anterior dislocation or anterior shoulder instability, and the outcomes following conservative treatment is poor. Anterior shoulder instability can damage the soft tissue structure and bone structure that maintain the stability of shoulder joint, among which bone structure is the most important factor affecting the stability of shoulder joint. Diagnosis should be combined with medical history, physical examination, and auxiliary examination. Currently, three-dimensional CT is the most commonly used auxiliary examination means. However, various bone defect measurement and preoperative evaluation methods based on three-dimensional CT and the glenoid track theory have their own advantages and disadvantages, and there is still a lack of gold standard. Currently, the mainstream treatment methods mainly include Bankart procedure, coracoid process transposition, glenoid reconstruction with free bone graft, Bankart combined with Remplissage procedure, and subscapular tendon binding tamponade, etc. Each of these procedures has its own advantages and disadvantages. For the diagnosis and treatment of anterior shoulder instability, there are still too many unknown, further research and exploration need to be studied.


Subject(s)
Humans , Shoulder Joint/surgery , Shoulder Dislocation/surgery , Shoulder , Joint Instability/surgery , Scapula , Joint Dislocations , Recurrence , Arthroscopy/methods
7.
Article in Spanish | LILACS, BINACIS | ID: biblio-1512343

ABSTRACT

Objetivo: El objetivo de este estudio retrospectivo fue evaluar los resultados funcionales y la tasa de luxación en pacientes >65 años con fractura de cadera operados con prótesis de doble movilidad. materiales y métodos: Se analizó a los pacientes tratados por una fractura de cadera entre 2017 y 2021. Se incluyó a pacientes >65 años, tratados con copas de doble movilidad y un seguimiento mínimo de 24 meses. Se analizaron los datos demográficos, las comorbilidades, los resultados funcionales (Parker y puntaje de Harris), las complicaciones (infección, luxación, aflojamiento), las reoperaciones y revisiones. Resultados: Se trataron 102 fracturas de cadera (75 mediales y 27 intertrocantéricas) en 102 pacientes. El 72,5% eran mujeres (media de la edad 80.59 ± 6.92 años), el Índice de Comorbilidad de Charlson promedio fue de 4,71 y el puntaje ASA, 2,47. El 93,1% comenzó a caminar al segundo día de la cirugía. Según el puntaje de Harris, los resultados fueron excelentes o muy buenos en el 94,1%; los puntajes de Parker preoperatorio y posoperatorio no difirieron significativamente (p <0,05). El seguimiento promedio fue de 30 meses. Hubo 8 (7,84%) complicaciones: 2 (1,9%) casos de trombosis venosa profunda, 4 (3,9%) de tromboembolismo pulmonar, tres infecciones (2,9%) y una (0,9%) luxación. La tasa de reoperaciones fue del 2,9%. Conclusiones: Con el empleo de copas de doble movilidad se obtuvieron resultados funcionales aceptables y una tasa de luxación relativamente baja (0,9%). Esto sugiere que estos implantes representan una opción en el tratamiento de estas lesiones. Nivel de Evidencia: IV


Objective: This retrospective study aimed to assess the functional outcomes and dislocation rate in the treatment with dual mobility prostheses in patients older than 65 with hip fractures. materials and methods: We analyzed all patients treated between 2017 and 2021 for hip fractures in our service. We included patients older than 65 years, treated with dual mobility cups, and a minimum follow-up of 24 months. We analyzed demographic data, comorbidities, functional outcomes (Parker score and Harris Hip Score, HHS), complications (infection, dislocation, loosening), reoperations, and revisions. Results: We included 102 hip fractures (75 medial and 27 intertrochanteric) in 102 patients. Seventy-four (72.5%) were women, the mean age was 80.59 ± 6.92 years, the mean Charlson index was 4.71 (range 3-10), and ASA was 2.47 (1-4). 93.1% started walking on the second postoperative day. 94.1% presented excellent or very good outcomes according to the HHS, the postoperative Parker index did not show significant differences in comparison to the preoperative one (p < 0.05). The average follow-up was 30 months (range 24-60). There were 8 (7.84%) complications: 2 (1.9%) deep vein thrombosis, 4 (3.9%) pulmonary thromboembolism, 3 infections (2.9%), and 1 (0.9%) dislocation. The reoperation rate was 2.9%. Conclusions: We obtained acceptable functional outcomes using dual mobility cups with a relatively low dislocation rate (0.9%). This suggests that these implants are an option to consider in treating these lesions. Level of Evidence: IV


Subject(s)
Aged , Aged, 80 and over , Reoperation , Retrospective Studies , Treatment Outcome , Arthroplasty, Replacement, Hip , Joint Dislocations , Hip Fractures
8.
Article in Spanish | LILACS, BINACIS | ID: biblio-1415758

ABSTRACT

Las luxaciones del escafoides aisladas y sin fractura son poco frecuentes. Por lo general, se presentan asociadas a fracturas del escafoides o a diversos patrones de lesión de la columna lateral. Presentamos el caso de un paciente con luxación medial y plantar del hueso navicular y fractura conminuta del proceso anterior del calcáneo y subluxación calcaneocuboidea. En el Servicio de Urgencia, se procedió a la reducción cerrada y la estabilización con agujas de Kirschner y, como tratamiento diferido, se colocaron placas en puente astragalonaviculo-cuneiforme y calcaneocuboidea de 2,0 mm, en forma transitoria, y el material de osteosíntesis se retiró a los 5 meses. El puntaje de la escala de la AOFAS fue excelente al año de seguimiento. Conclusiones: Es necesario llegar a un diagnóstico adecuado descartando lesiones de la columna lateral y reducir esta lesión en la atención de urgencia. La estabilización con placas en puente es una opción válida que podría evitar la pérdida de la reducción que se observa al retirar los clavos de Kirschner y permite una carga precoz. Nivel de Evidencia: IV


Isolated navicular dislocations are unusual. They are frequently associated with navicular fractures or diverse patterns of lateral column injuries. We report a case of a patient with medial and plantar navicular dislocation with a comminuted intra-articular fracture of the anterior process of the calcaneus and associated subluxation at the calcaneocuboid joint. The patient underwent closed reduction and Kirschner wire stabilization in the Emergency Service. As part of the deferred treatment, talonavicular-cuneiform and calcaneocuboid 2.0 mm bridge plates were temporarily placed and osteosynthesis material was removed 5 months later. The AO-FAS score was excellent in the one-year follow-up. Conclusion: An accurate diagnosis, ruling out lateral column injuries, should be done in the Emergency Service. Bridge plate stabilization is a valid option to prevent loss of reduction, which is observed when removing Kirschner wires, allowing early weight-bearing. Level of Evidence: IV


Subject(s)
Calcaneus , Scaphoid Bone , Foot Joints , Joint Dislocations , Fractures, Bone
9.
Rev. bras. ciênc. vet ; 29(4): 169-174, out./dez. 2022. il.
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1427105

ABSTRACT

A estabilidade da articulação do ombro é garantida por ligamentos, cápsula articular, tendões e músculos, contudo traumas podem causar falência dos mecanismos estabilizadores, com consequente luxação ou instabilidade articular. Objetivou-se relatar o caso de instabilidade medial e lateral de ombro direito em felino sem raça definida, atendido com queixa de claudicação aguda de membro torácico secundária a trauma por confronto com outro animal. Inicialmente foi realizado tratamento clínico por meio de imobilização articular. Contudo, devido ao insucesso da técnica, procedeu-se para o tratamento cirúrgico de estabilização articular com prótese ligamentar sintética. No pós-operatório imediato, evidenciou-se ausência de crepitações e instabilidade articular. Após oito dias da cirurgia, o paciente apresentou retorno total às funções de apoio do membro e sem sinais de dor ou redução de movimentos. Concluiu-se que, embora de reduzida ocorrência, a instabilidade de origem traumática do ombro configura-se como um diferencial para claudicação aguda de membro torácico e que o tratamento cirúrgico pode ser necessário, mostrando-se eficiente na resolução de tais casos com o acesso e técnica de estabilização propostos.


The stability of the shoulder joint is granted by ligaments, joint capsule, tendons and muscles. However, traumatic injuries can cause failure of the stabilization mechanisms, which leads to articular luxation or instability. The aim of the paper is to report a case of medial and lateral right shoulder joint instability in a mixed-breed cat, presenting acute forelimb lameness after a fight trauma with another cat. Initially, it was recommended a conservative treatment through articular immobilization. However, the technique was unsuccessful, and the surgery treatment was performed, to stabilize the joint with synthetic ligament prosthetic. In the postoperative period, no crepitation or instability were identified. After eight days of surgery, the patient returned totally to the normal function of the forelimb, without movement restriction or pain. It was concluded that, although rare, the traumatic shoulder joint instability is a differential diagnosis for acute forelimb lameness and the surgical treatment can be necessary, showing a good result in the resolution of these injuries with the surgical approach and stabilization method proposed.


Subject(s)
Animals , Cats , Shoulder/surgery , Shoulder Joint/surgery , Cats/surgery , Joint Dislocations/veterinary , Shoulder Injuries/veterinary , Shoulder Prosthesis/veterinary , Intermittent Claudication/veterinary
10.
Rev. Odontol. Araçatuba (Impr.) ; 43(2): 29-34, maio-ago. 2022. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1362016

ABSTRACT

A articulação temporomandibular está vunerável a várias condições de anormalidades já bastante conhecidas, dentre elas, o deslocamento do disco articular sem redução, considerado pela literatura o mais comum das patologias desta região. A deterioração do quadro pode ser um indicativo da necessidade cirúrgica. Em específico, no deslocamento de disco sem redução, o reposicionamento definitivo pode ser adquirido através de discopexia e artrocentese. O presente trabalho tem como objetivo relatar um caso clínico de deslocamento de disco articular bilateral sem redução, apresentando a importância da fisioterapia associada à abordagem cirúrgia na recuperação da função mandibular, bem como, reforçar a importância de uma abordagem conjunta entre análise clínica e imaginológica para resolução de casos. Paciente feminino cursando com diversos sintomas em face e pescoço de forma progressiva ao longo de dois anos foi submetida a cirurgia na articulação temporo-mandibular, onde foi feita a discopexia através de ancoragem dos discos articulares com parafusos. A avaliação física, assim como, a imaginológica, ajudaram na confirmação do diagnóstico. A abordagem cirurgica adotada no tratamento deste caso foi descrita na literatura desde o final do século XIX. Conclui-se que, o método utilizado no tratamento do deslocamento de disco sem redução deve ser baseado nos sinais e sintomas do paciente, cuja abordagem deve ser readequada de acordo com as mudanças do quadro apresentado. Nesta análise, a abordagem cirúrgica associada à fisioterapia específica para as estruturas musculoesquelética da face trouxeram resultados positivos(AU)


The temporomandibular joint is responsible for several well-known conditions of abnormalities, among them, the joint disc displacement without reduction, considered by the literature the most common pathology of this region. Deterioration of the condition may be indicative of surgical need. Specifically, in displacement disc without reduction, definitive repositioning can be achieved through discopexy and arthrocentesis. The aim of the present study is to report a case of unilateral articular disc displacement without reduction, as well the importance of physiotherapy associated with the surgical approach in the recovery of mandibular function, as well as reinforcing the importance of a joint approach between clinical and imaging analysis for case resolution. Female patient with several symptoms in the face and neck progressively over two years, underwent surgery in the temporomandibular joint, where discopexy was performed by anchoring the articular discs with screws. The physical assessment, as well as the imaging, helped to confirm the diagnosis. The surgical approach adopted in the treatment of this case has been described in the literature since the end of the 19th century. In conclusion, the method used to treat articular disc displacement without reduction should be based on the patient's signs and symptoms, whose approach should be readjusted according to the changes in the presented picture. In this analysis, the surgical approach associated with specific physiotherapy for the musculoskeletal structures of the face brought positive results(AU)


Subject(s)
Humans , Female , Adult , Temporomandibular Joint Disc , Temporomandibular Joint Disc/injuries , Joint Dislocations , Temporomandibular Joint/injuries , Physical Therapy Modalities , Temporomandibular Joint Disc/surgery , Temporomandibular Joint Disc/diagnostic imaging , Arthrocentesis
11.
Rev.chil.ortop.traumatol. ; 63(2): 123-127, ago.2022. ilus
Article in Spanish | LILACS | ID: biblio-1436748

ABSTRACT

Es conocido que el codo se disloca con frecuencia, y corresponde a la primera causa de luxación en niños y a la segunda causa en adultos. Respecto a las fracturas distales, representan un tercio de todas las fracturas del húmero en población adulta. Por lo general, se presentan en una distribución bimodal que afecta a hombres jóvenes o a mujeres ancianas. En este artículo, reportamos un caso clínico poco frecuente de luxación de codo izquierdo complicada, producto de fractura del húmero distal, en una mujer de 64 años. La lesión comprende una luxación posterolateral de codo izquierdo complicada con fractura articular parcial (compromiso del cóndilo y de la tróclea humeral externa), sagital, multifragmentaria, de húmero distal que requirió tres intervenciones quirúrgicas y terapia de rehabilitación por seis meses que finalizaron en recuperación funcional de la estabilidad de la articulación del codo. El caso reportado es particular debido a la individualidad del paciente con sus comorbilidades, el mecanismo de producción de la luxofractura, el abordaje quirúrgico, y el éxito del tratamiento instaurado. Sin embargo, este éxito terapéutico debe ser confirmado en series de casos


It is known that the elbow is dislocated frequently, representing the first cause of dislocation in children and the second cause in adults. Regarding distal humerus fractures, they represent a third of all humerus fractures in the adult population. They generally occur in a bimodal distribution, affecting young men or elderly women. In the present article, we report a rare clinical case of a complicated left elbow dislocation due to a distal humerus fracture in a 64-year-old woman. The lesion includes a posterolateral dislocation of the left elbow complicated by a sagittal, multifragmentary, partial articular fracture (compromise of the condyle and external humeral trochlea) of the distal humerus which required three surgical interventions and rehabilitation therapy for six months and resulted in functional recovery of the stability of the elbow joint. The case herein reported is particular due to the individuality of the patient, with her comorbidities, the mechanism of production of the fracture-dislocation, the surgical approach, and the success of the established treatment. This therapeutic success must be confirmed in series of cases


Subject(s)
Humans , Female , Middle Aged , Joint Dislocations/surgery , Elbow Injuries/surgery , Humeral Fractures, Distal/surgery , Tomography, X-Ray Computed/methods , Joint Dislocations/diagnostic imaging , Fracture Fixation, Internal/methods , Elbow Injuries/diagnostic imaging , Humeral Fractures, Distal/diagnostic imaging
12.
Article in Spanish | LILACS, UY-BNMED, BNUY | ID: biblio-1383552

ABSTRACT

Introducción: El 25% de las luxaciones de codo corresponden a luxaciones complejas, que se definen como aquellas luxaciones que se acompañan de lesiones óseas, siendo las mismas más inestables que la luxaciones puras o simples. Estas lesiones han planteado un importante desafío terapéutico, ya que históricamente se han obtenido pobres resultados funcionales. El objetivo de este trabajo es revisar la bibliografía acerca del tratamiento de las luxaciones complejas de codo con inestabilidad posterolateral, y valorar los resultados de las múltiples opciones terapéuticas. Materiales y Métodos: Se realizó la búsqueda sistematizada utilizando el buscador PubMed, obteniéndose un total de 1450 artículos, de los cuales 32 cumplieron con los criterios de inclusión y exclusión establecidos. Resultados: Los estudios analizados fueron de bajo nivel de evidencia, III o IV, correspondiendo en su mayoría a series de casos retrospectivos. Destaca la gran cantidad de variantes terapúticas existentes, con diferentes protocolos terapéuticos, que arrojan resultados funcionales similares. Conclusiones: Las luxaciones complejas del codo corresponden a lesiones complejas, capaces de causar secuelas funcionales importantes en los pacientes. El establecimiento de protocolos terapéuticos es clave para obtener mejores resultados funcionales.


Introduction: 25% of elbow dislocations correspond to complex dislocations, which are defined as those dislocations that are accompanied by bone injuries, being more unstable than pure or simple dislocations. These lesions have set an important therapeutic challenge, since historically poor functional results have been obtained. The objective of this study is to review the literature on the treatment of complex elbow dislocations with posterolateral instability, and to assess the results of the multiple therapeutic options. Materials and Methods: The systematized search was carried out using the Pubmed search engine, obtaining a total of 1450 articles, of which 32 met the established inclusion and exclusion criteria. Results: The studies analyzed were of a low level of evidence, III or IV, corresponding mostly to retrospective case series. The large number of existing therapeutic variants stands out, with different therapeutic protocols, which yield similar functional results. Conclusions: Complex elbow dislocations correspond to complex injuries, capable of causing important functional sequelae in patients. The establishment of therapeutic protocols is key to obtaining better functional results.


Introdução: 25% das luxações do cotovelo correspondem a luxações complexas, que são definidas como aquelas luxações acompanhadas de lesões ósseas, sendo as mesmas mais instáveis ​​que as luxações puras ou simples. Essas lesões representam um importante desafio terapêutico, uma vez que resultados funcionais historicamente ruins têm sido obtidos. O objetivo deste trabalho é revisar a literatura sobre o tratamento das luxações complexas do cotovelo com instabilidade póstero-lateral e avaliar os resultados das múltiplas opções terapêuticas. Materiais e Métodos: Foi realizada uma busca sistematizada por meio do mecanismo de busca PubMed, obtendo-se um total de 1450 artigos, dos quais 32 atenderam aos critérios de inclusão e exclusão estabelecidos. Resultados: Os estudos analisados ​​foram de baixo nível de evidência, III ou IV, correspondendo em sua maioria a séries de casos retrospectivas. Destaca-se o grande número de variantes terapêuticas existentes, com diferentes protocolos terapêuticos, que apresentam resultados funcionais semelhantes. Conclusões: As luxações complexas do cotovelo correspondem a lesões complexas, capazes de causar sequelas funcionais importantes nos pacientes. O estabelecimento de protocolos terapêuticos é fundamental para obter melhores resultados funcionais.


Subject(s)
Humans , Orthopedic Procedures/methods , Joint Dislocations/therapy , Elbow Joint/injuries , Joint Instability/therapy , Clinical Protocols
13.
Rev. bras. ortop ; 57(2): 308-313, Mar.-Apr. 2022. tab, graf
Article in English | LILACS | ID: biblio-1387986

ABSTRACT

Abstract Objective To evaluate major complications after a minimum of 5 years of follow-up after acute or recurrent patellar dislocation treated with medial patellofemoral ligament (MPFL) reconstruction with the medial third of the patellar tendon, with or without associated medialization of the tibial anterior tuberosity (TAT). Methods A total of 50 patients were included, with a minimum follow-up of 5 years. The patients were evaluated regarding complications such as joint stiffness, recurrence of patellar dislocation, subjective instability reported by patients, and inability to return to the previous level of physical activity. Results The mean follow-up was of 8.9 2.6 years, with a minimum of 6 and maximum of 15 years; 64% of the patients were women, with a mean age of 27 11.2 years old; 24% were submitted to TAT osteotomy for simultaneous medialization; and 46% were acute cases. Only 9 poor results (18%) were found, all resulting from recurrence of dislocation (12%) and complaint of subjective instability (6%) at between 36 and 60 months of follow-up. No other complications occurred. Among the poor results, five occurred in cases of acute dislocation, and four in recurrent cases, and only one had undergone TAT osteotomy. Conclusion Reconstruction of the MPFL with the medial third of the patellar tendon, associated or not with TAT medialization osteotomy, is an alternative in the treatment of acute or chronic patellar instability, with a failure rate of only 18% in at least 5 years of follow-up. In addition, it is safe treatment, that does not present other complications.


Resumo Objetivo Avaliar complicações maiores após um mínimo de 5 anos de acompanhamento após luxação aguda ou recidivante da patela tratada com reconstrução do ligamento femoropatelar medial (LFPM) com terço medial do tendão patelar, com ou sem medialização da tuberosidade anterior da tíbia (TAT) associada. Métodos Um total de 50 pacientes foram incluídos, com acompanhamento mínimo de 5 anos. Os pacientes foram avaliados em relação à ocorrência de complicações como rigidez articular, recidiva de luxação patelar ou instabilidade subjetiva relatada pelos pacientes, e incapacidade de retorno ao nível prévio de atividades físicas. Resultados O acompanhamento médio foi de 8,9 2,6 anos, com mínimo de 6 e máximo de 15 anos; 64% dos pacientes eram mulheres, com média de idade de 27 11,2 anos; 24% dos pacientes foram submetidos a osteotomia da TAT para medialização concomitantemente; e 46% eram casos agudos. Foram constatados apenas 9 maus resultados (18%), todos decorrentes de recidiva da luxação (12%) e de queixa de instabilidade subjetiva (6%), ocorridos entre 36 e 60 meses de acompanhamento. Não ocorreram outras complicações. Dentre os maus resultados, cinco ocorreram em casos de luxação aguda, e quatro em casos recidivantes, e apenas um havia sido submetido a osteotomia da TAT. Conclusão AreconstruçãodoLFPMcomterçomedialdotendãopatelar,associadaounãoà osteotomia de medialização da TAT, é uma alternativa no tratamento da instabilidade patelar aguda ou crônica, com falha de apenas 18% em acompanhamento mínimo de 5 anos. Além disso, é um tratamento seguro, sem apresentar outras complicações.


Subject(s)
Humans , Recurrence , Patellar Ligament , Patellar Dislocation , Joint Dislocations , Joint Instability , Exercise
14.
Rev. bras. ortop ; 57(2): 341-344, Mar.-Apr. 2022. graf
Article in English | LILACS | ID: biblio-1387987

ABSTRACT

Abstract Isolated pisiform dislocation is a rare lesion with few cases described in the literature. This type of lesion is typically observed in young males and can be easily overlooked at first assessment. Isolated proximal dislocation is more common due to the action of the flexor carpi ulnaris (FCU) muscle. We present the case of a 19-year-old male patient with isolated distal pisiform dislocation after wrist trauma. He underwent open reduction and internal fixation with Kirschner wires with excellent functional outcomes. Although there is no consensual therapeutic method, closed reduction is a first-line treatment for acute presentations. Pisiform open reduction or excision may be performed alternatively or after a failed closed reduction.


Resumo A luxação isolada do pisiforme é uma lesão rara com poucos casos descritos na literatura. Esse tipo de lesão é observado tipicamente em adultos jovens do sexo masculino e pode ser facilmente negligenciada numa primeira avaliação. A luxação proximal isolada é mais comum devido à ação do flexor ulnar do carpo (FUC). Apresentamos o caso de um paciente do sexo masculino, com 19 anos de idade, com luxação distal isolada do pisiforme após traumatismo do punho. O paciente foi submetido a uma redução aberta e fixação interna com fios de Kirschner com excelente resultado funcional. Apesar de não existir um método de tratamento consensual, a redução fechada perfila-se como tratamento de primeira linha na apresentação aguda. Em caso de insucesso ou como método alternativo pode-se optar pela redução aberta ou a excisão do pisiforme.


Subject(s)
Humans , Male , Adult , Wrist Injuries , Carpal Bones/injuries , Joint Dislocations , Pisiform Bone
15.
Article in English | WPRIM | ID: wpr-974043

ABSTRACT

Objective@#This study aims to describe a new extraoral technique for reducing bilateral temporomandibular joint (TMJ) dislocations.@*Methods@# Design: Retrospective Preliminary Case Series Setting: Tertiary Government Training Hospital Participants: Ten (10) adults with bilateral TMJ dislocation@*Results@#Ten patients, 7 males and 3 females with median age of 35.50 (IQR:21.25 [23.50, 44.75]) years old were included in our series. Seven had more than one previous episode of TMJ dislocation, and the dislocation spontaneously occurred while yawning or eating in six patients. Our new technique resulted in complete bilateral reduction in three patients who had first-episode TMJ dislocations but only in four out of seven with previous dislocation. The three others (two partial, unilateral failure of reduction and one complete failure of reduction) needed conventional extraoral reduction (Hippocratic technique). @*Conclusion@#This new extraoral technique may show promising preliminary results in the management of temporomandibular joint dislocation, but a larger trial in comparison with other techniques is needed.


Subject(s)
Temporomandibular Joint , Temporomandibular Joint Disorders , Joint Dislocations , Therapeutics
16.
Article in Chinese | WPRIM | ID: wpr-970793

ABSTRACT

OBJECTIVE@#To investigate clinical outcomes of countertraction method in treating irreducible subcoracoid dislocation of shoulder joint combined with Hill-Sacks injury.@*METHODS@#A total of 56 patients with irreducible subcoracoid dislocation of the shoulder joint combined with Hill-Sacks injury admitted from December 2013 to June 2020 were retrospectively analyzed. Under the anesthesia of shoulder joint cavity injection, the reduction was performed by using anti-traction method (experimental group) and traditional Hippocrates method (control group), 28 cases in each group. There were 11 males and 17 females in experimental group, with an average age of (61.95±19.32) years old, 9 cases on the left side, and 19 cases on the right side. Twelve males and 16 females in control group, with an average age of (63.13±12.75) years old, 11 cases on the left side, 17 cases on the right side. The curative effects between two groups were evaluated before and after operation, including the success rate of reduction, the duration of reduction, the distance from successful reduction to injury, complications and functional rehabilitation(Constant score of shoulder joint).@*RESULTS@#The success rates of reduction in experimental group and control group were 92.86%(26/28) and 67.86% (19/28), respectively, and the difference was statistically significant (P<0.05). The duration of simple reduction was (4.25±2.13) min and ( 6.31±1.69) min, the difference was statistically significant (P<0.05);the time from successful reduction to injury was (9.16±0.94) h and (8.94±1.31) h, respectively, with no significant difference(P>0.05). There were no complications such as vascular nerve injury and fracture in experimental group, 2 cases of axillary nerve injury and 1 case of humeral head fracture in control group. Constant scores of shoulder joint between experimental group and control group were (92.34±5.62) points and (90.91±4.73) points, respectively, with no significant difference (P>0.05).@*CONCLUSION@#For patients with irreducible subcoracoid dislocation of the shoulder joint with Hill-Sacks injury, the countertraction method under anesthesia of the shoulder joint cavity achieved a higher success rate and few complications.


Subject(s)
Male , Female , Humans , Adult , Middle Aged , Aged , Aged, 80 and over , Shoulder Joint/surgery , Shoulder Dislocation/complications , Retrospective Studies , Shoulder Injuries , Joint Dislocations/complications , Joint Instability/surgery
17.
Acta odontol. Colomb. (En linea) ; 12(1): 58-71, 2022. tab Causas comunes de luxación de articulación temporomandibular, ilus 1 A: Fotografía extraoral del paciente B: Fotografía intraoral, ilus 2 A: Radiografía postero-anterior de cráneo B: Ortopantomografía, ilus 3 Tomografía computarizada de ATM derecha e izquierda con mala posición de cóndilos y ausencia de zonas hiperdensas compatibles con anquilosis de ATM, ilus 4 A: marcaje de abordaje preauricular con extensión temporal B: incisión inicial en piel y tejido subcutáneo, ilus 5 A: localización de eminencia articular B: eminectomía C: posición adecuada de cóndilo mandibular derecho D: posición adecuada de cóndilo mandibular izquierdo, ilus 6 A: fotografía frontal B: distancia interincisal máxima C: ortopantomografía en la que se observa la correcta posición de los cóndilos mandibulares
Article in Spanish | LILACS, COLNAL | ID: biblio-1353794

ABSTRACT

Introducción: la luxación de la articulación temporomandibular es un desplazamiento del cóndilo fuera de sus posiciones funcionales dentro de la fosa articular y la eminencia articular, la cual ocasiona una pérdida completa de la función articular. La luxación crónica es toda luxación aguda que progresa sin un tratamiento específico y que puede ser de carácter recurrente. La eminectomía es un tratamiento quirúrgico definitivo contra la luxación crónica de articulación temporomandibular. Objetivo: reportar el caso clínico de un paciente masculino, de la tercera década de su vida, con diagnóstico de luxación crónica de la articulación temporomandibular de cinco meses de evolución y presentar una revisión actualizada de la literatura sobre este procedimiento quirúrgico. Caso clínico: el paciente fue tratado quirúrgicamente con eminectomía bilateral. Discusión: la eminectomía es un procedimiento quirúrgico controversial; sin embargo, recientes investigaciones lo catalogan como seguro y efectivo. Conclusión: el caso clínico presentado muestra un buen resultado.


Background: Temporo-mandibular joint dislocation is a displacement of the condyle, out of its functional positions within the articular fossa and articular eminence, causing a complete loss of joint function. Chronic dislocation is any acute dislocation that progresses without specific treatment and that can be recurrent. Eminectomy is a definitive surgical treatment for chronic temporomandibular joint dislocation. Objective: To report the clinical case of a male patient in the third decade of his life with a diagnosis of chronic dislocation of the temporomandibular joint of 5 months of evolution and to carry out an updated review of the literature on this surgical procedure. Case Report: The patient was treated surgically with bilateral eminectomy. Discussion: Eminectomy is a controversial surgical procedure; recent research classifies it as safe and effective. Conclusion: The presented clinical case shows a good result.


Subject(s)
Humans , Male , Adult , Joint Dislocations , Temporomandibular Joint , Temporomandibular Joint Disorders
18.
Rev. odontopediatr. latinoam ; 12(1): 221504, 2022. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1419008

ABSTRACT

Las lesiones traumáticas en la dentición primaria constituyen uno de los principales motivos de consulta odontopediátrica. Las luxaciones intrusivas en la dentición primaria son injurias severas en las que el diente se desplaza de forma axial, hacia el alvéolo, ocasionando daño tisular que puede afectar gravemente a los tejidos de soporte y dientes sucesores, siendo recomendado el tratamiento conservador. Presentación de caso: Se trata de paciente masculino de 1 año y 10 meses de edad quien acude al área de emergencia pediátrica en El Centro Médico Docente la Trinidad por traumatismo dentofacial. Al momento de la exploración clínica, posterior a la evaluación pediátrica, se observa que presenta lesión lacerante en la encía del sector anterosuperior con ausencia del incisivo central superior primario (51). Al realizar examen radiográfico confirma el diagnóstico de luxación intrusiva completa con fractura de tabla vestibular en premaxila y fractura coronal no complicada esmalte-dentina del 51. Se realizó desinfección tópica de la zona, se recetó antibioticoterapia preventiva, antiinflamatorios, higiene bucal y dieta líquida y blanda. El tratamiento de elección fue conservador, esperando la reerupción espontánea para posterior restauración. Se realizaron controles periódicos presenciales y a través de la teleodontología, evidenciando evolución favorable. A los 12 meses posteriores al traumatismo el diente llegó al plano de oclusión, sin sintomatología. Se realizó la restauración estética con resina fotocurada. Conclusiones: El manejo conservador en casos de luxaciones intrusivas severas, acompañado de adecuado monitoreo, permite obtener resultados satisfactorios


Lesões traumáticas na dentição decídua são um dos principais motivos de consulta da odontopediatria. As luxações intrusivas na dentição decídua são lesões graves nas quais o dente se move axialmente em direção ao alvéolo,causando danos aos tecidos que podem afetar seriamente os tecidos de suporte e os dentes sucessores,e o tratamento conservador é recomendado. Objetivo: descrever a evolução do tratamento conservado causado por uma intrusão grave de um incisivo primário. Apresentação do caso: paciente do sexo masculino,com 1 ano e 10 meses de idade,que atende ao pronto-socorro pediátrico do El Centro Médico Docente la Trinidad para traumas dentofaciais. No momento do exame clínico,após da avaliação pediátrica, observou-se que apresentava lesão lacerante em gengiva do setor ântero-superior com ausência do incisivo central superior primário (51).O exame radiográfico confirmou o diagnóstico de luxação intrusiva completa com fratura da tábua vestibular no pré-maxilar e fratura coronal de esmalte-dentina não complicada de 51.Foi realizada desinfecção tópica da área, antibioticoterapia preventiva, anti-inflamatórios, higiene oral e dieta liquida foi prescrita. O tratamento de escolha foi conservador, aguardando re-erupção espontânea para posterior restauração. Os controles periódicos foram realizados pessoalmente e pela teleodontologia, apresentando evolução favorável. 12 meses após o trauma, o dente atingiu o plano de oclusão, sem sintomas. A restauração estética foi realizada com resina fotopolimerizável. Conclusões: o manejo conservador nos casos de luxações intrusivas graves,acompanhado de monitoramento adequado, permite a obtenção de resultados satisfatórios


Traumatic injuries in the primary dentition are one of the main reasons for pediatric dentistry consultation. Intrusive dislocations in the primary dentition are severe injuries in which the tooth moves axially towards the socket,causing tissue damage that can seriously affect the supporting tissues and successor teeth, and conservative treatment is recommended. Objective: to describe the outcome of conservative treatment for severe intrusion of a primary incisor. Case presentation: this is a 1 year and 10 month old male patient who attends the pediatric emergency area at El Centro Médico Docente la Trinidad for dentofacial trauma. At the time of the clinical examination,after the pediatric evaluation, it was observed that he presented a lacerating lesion in the gingiva of the anterosuperior sector with the absence of the primary upper central incisor (51). A radiographic examination confirmed the diagnosis of complete intrusive dislocation with a vestibular table fracture in the premaxilla and an uncomplicated enamel-dentin coronal fracture of 51. Topical disinfection of the area was performed,preventive antibiotic therapy, anti-inflammatories, oral hygiene and soft liquid diet were prescribed. The treatment of choice was conservative, waiting for spontaneous re-eruption for later restoration. Periodic controls were carried out in person and through teleodontology,showing favorable resolution. Twelve months after the trauma, the tooth reached the occlusion plane,with no symptoms. The aesthetic restoration was performed with light-cured resin. Conclusions: conservative management in cases of severe intrusive dislocations, accompanied by adequate monitoring,allows satisfactory results to be obtained


Subject(s)
Humans , Male , Infant , Joint Dislocations , Fractures, Bone , Teledentistry , Oral Hygiene , Tooth, Deciduous , Wounds and Injuries , Dental Occlusion , Incisor
19.
Rev. odontopediatr. latinoam ; 12(1): 2204521, 2022. graf
Article in Spanish | LILACS, COLNAL | ID: biblio-1419009

ABSTRACT

El objetivo de este trabajo es referir, a través de un reporte de caso clínico, a una paciente de sexo femenino de 9 años que sufrió una caída de su propia altura en el colegio. Inicialmente, la paciente acudió a urgencias en su ciudad natal, en la que al examen clínico se objetivó un traumatismo dentario en los dientes 11 y 21 y el diente 11 sufrió una luxación extrusiva leve, siendo reposicionada por el odontólogo que le brindó la primera atención. El examen radiográfico reveló una fractura radicular horizontal en el tercio medio de los dos incisivos centrales superiores. Los dientes fueron ferulizados con resina compuesta en los dientes proximales involucrados en el trauma. Posteriormente, la paciente fue remitida a la consulta de odontopediatría de la FOA-Unesp, donde recibió atención clínica y radiográfica por un período de diez años. No fue necesaria la intervención endodóntica en ambos dientes incisivos centrales, y los procesos de cicatrización se dieron de dos maneras diferentes. Cicatrización del diente 11 por interposición de hueso y tejido conectivo, y cicatrización del diente 21 por interposición de tejido conectivo. Después de diez años, los dientes se presentaban sin signos o síntomas significativos que requirieran una intervención invasiva. Se concluye que en un mismo paciente ocurren diferentes procesos de cicatrización en dientes muy próximos entre sí y que la cooperación del paciente en cuanto a cuidados, higiene bucal y asistencia a las citas de retorno, puede ser determinante para el éxito del tratamiento


The objective of this case report is to present a 9-year-old female patient who suffered horizontal root fracture in the middle third of the two upper central permanent incisors. The teeth were splinted with composite resin in the proximal teeth involved in the trauma. After, the patient was referred to the pediatric dentistry clinic, where she received clinical and radiographic care for a period of ten years. Endodontic intervention was not necessary on both central incisors teeth. Tooth 11 healing by interposition of bone and connective tissue, and teeth 21 healing by interposition of connective tissue. After ten years, the teeth presented without any significant signs or symptoms requiring an invasive intervention. It is concluded that the patient's cooperation regarding care, oral hygiene and attendance at the return appointments, can be decisive for the success of the treatment


O objetivo deste trabalho é referir-se, por meio de um relato de caso clínico, sobre um paciente de 9 anos de idade, sexo feminino, que sofreu queda da própria altura na escola. A paciente recebeu atendimento em sua cidade de origem, em que ao exame clínico foi observado traumatismo dentário sobre os dentes 11 e 21 e o dente 11 sofreu suave luxação extrusiva sendo reposicionado pelo cirurgião dentista que prestou os primeiros atendimentos. Ao exame radiográfico foi constatada fratura radicular horizontal de terço médio nos dois elementos dentários. Foi realizada a contenção dos dentes com resina composta nas proximais dos dentes envolvidos no trauma. A paciente foi encaminhada para a clínica de Odontopediatria da FOA-Unesp onde recebeu atendimento clínico e radiográfico por um período de dez anos, sem que a mesma apresentasse sinais ou sintomas significativos que necessitasse de uma intervenção invasiva. Dessa forma, infere-se que uma correta atuação no primeiro atendimento e a proservação do caso, pode ser determinante para o sucesso do tratamento, assim como a colaboração do paciente quanto aos cuidados, higienização bucal e comparecimento nas consultas de retorno


Subject(s)
Humans , Female , Child , Tooth Injuries , Attention , X-Rays , Patient Compliance , Joint Dislocations , Fractures, Bone
20.
Article in English | WPRIM | ID: wpr-928483

ABSTRACT

PURPOSE@#The main aim is to provide clinical reference for the application of mini suture anchor in the reduction and fixation of displaced temporomandibular joint (TMJ) disc with intracapsular condylar fracture.@*METHODS@#From October 2018 to October 2019, 21 patients (31 sides) with intracapsular condylar fractures and articular disc displacement from West China Hospital of Stomatology, Sichuan University were included. The selection criteria were: (1) mandibular condylar fractures accompanied by displacement of the TMJ disc, confirmed by clinical examination, CT scan and other auxiliary examinations; (2) indication for surgical treatment; (3) no surgical contraindications; (4) no previous history of surgery in the operative area; (5) no facial nerve injury before the surgery; (6) informed consent to participate in the research program and (7) complete data. Patients without surgical treatment were excluded. The employed patients were followed up at 1, 3, 6 and 12 months after operation. Outcomes were assessed by success rate of operation, TMJ function and radiological examination results at 3 months after operation. Data were expressed as number and percent and analyzed using SPSS 19.0.@*RESULTS@#All the surgical procedures were completed successfully and all the articular discs were firmly attached to the condyles. The articular disc sufficiently covered the condylar head after the fixation. The fixation remained stable when the mandible was moved in each direction by the surgeons. No complications occurred. The functions of the TMJ were well-recovered postoperatively in most cases. CT scan revealed that the screws were completely embedded in the bone without loosening or displacement.@*CONCLUSION@#Mini suture anchor can provide satisfactory stabilization for the reduced articular disc and also promote the recovery of TMJ functions.


Subject(s)
Humans , Joint Dislocations/surgery , Mandible , Mandibular Condyle , Mandibular Fractures/surgery , Suture Anchors , Temporomandibular Joint Disc/surgery
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