Diagnosing Maxillary Occlusal Cant with average 3D Skeletofacial Model Template.

BACKGROUND: Diagnosing maxillary occlusal cant involves varied methods, yet classification remains incomplete. This includes determining if the cant results from equal faults on both sides or if one side exhibits overdevelopment while the other underdevelops. This study introduces an innovative average 3D skull template for classifying maxillary occlusal cant instances. METHODS: Sixty adult patients were divided into two groups: 30 with a mesoprosopic facial type and 30 with a leptoprosopic facial type. Using seven pairs of anatomical landmarks (N, Or (L, R), Lo (L, R), Zy (L, R)), the average skull models were aligned and superimposed onto the patients' skull models. Image resizing facilitated optimal registration area fitting. Vertical distances from the U6 mesial buccal cusp tip to the FH plane were measured to analyze occlusal cant, classified into three classes: overdevelopment (Class A), underdevelopment (Class B) and equal fault on both sides (Class C). RESULTS: In the mesoprosopic group, Class B t was most common (40%), followed by Class A (27%) and Class C (33%). In the leptoprosopic facial type group, Class B remained prevalent (50%), followed by Class A (43%) and Class C (7%). Statistical analysis revealed a significant association between facial types and the three classes. CONCLUSIONS: Contrary to expectations, equal fault patterns were not predominant; instead, underdevelopment of the maxilla constituted the majority of occlusal cant cases. Utilizing average 3D skeletofacial models as templates emerges as an effective tool and alternative for diagnosing the instance of maxillary occlusal cant. RISK STUDIES/LEVEL OF EVIDENCE: Therapeutic, II.

Effects of decompression on behavioral, electrophysiologic, and histomorphologic recovery in a chronic sciatic nerve compression model of streptozotocin-induced diabetic rats.

PURPOSE: To determine susceptibility to decompression surgery in diabetic and nondiabetic peripheral neuropathy using a chronic compression neuropathy model. MATERIALS AND METHODS: Twenty-four streptozotocin-induced diabetic rats were randomly divided into three groups: group I, chronic compression of the left sciatic nerve for 4 weeks with decompression; group II, similar without decompression; and group III, sham exposing the sciatic nerve only. The other 24 nondiabetic rats were assigned to groups IV-VI, which received compression-decompression, compression, and the sham operation, respectively. Mixed-nerve-elicited somatosensory evoked potentials (M-SSEPs) and compound muscle action potentials (CMAPs) were measured to verify the compression neuropathy in the posttreatment follow-up. Behavioral observations in thermal hyperalgesia tests were quantified before electrophysiologic examinations. Treated and contralateral nerves were harvested for histomorphologic analysis. RESULTS: Chronic compression of sciatic nerve induced significant reduction of amplitude and increment of latency of M-SSEP and CMAP in both diabetic and nondiabetic rats. Diabetic group changes were more susceptible. Decompression surgery significantly improved both sensory and motor conduction, thermal hyperalgesia, and the mean myelin diameter of the rat sciatic nerve in both diabetic and nondiabetic groups. Near full recovery of motor and sensory function occurred in the nondiabetic rats, but not in the diabetic rats 8 weeks postdecompression. CONCLUSION: Behavioral, electrophysiologic, and histomorphologic findings indicate that decompression surgery is effective in both diabetic and nondiabetic peripheral neuropathy.

High Prevalence of Methicillin-Resistant Staphylococcus aureus among Patients with Septic Arthritis Caused by Staphylococcus aureus.

BACKGROUND: This study investigated the clinical characteristics of patients with septic arthritis caused by Staphylococcus aureus and tried to identify the risk factors for methicillin-resistant S. aureus (MRSA) arthritis. METHODS: Between January 2008 and December 2011, patients with septic arthritis caused by S. aureus were identified from the computerized databases of a regional hospital and a medical center in southern Taiwan. The medical records of these patients were retrospectively reviewed. RESULTS: A total of 93 patients with S. aureus arthritis were identified, and MRSA arthritis was found in 38 (40.9%) cases. The mean age of the patients was 58 years, and 86 (92.5%) episodes were classified as community-acquired infections. Diabetes mellitus (n = 41, 44.1%) was the most common underlying disease, followed by chronic kidney disease and liver cirrhosis. Patients with MRSA arthritis were more frequently elderly and found in the setting of healthcare-associated infection than patients with methicillin-susceptible S. aureus (MSSA) infections. No other significant differences in clinical manifestations and outcomes were noted between these two groups of patients. Overall, the in-hospital mortality rate was 5.4%, and diabetes mellitus was the only risk factor for mortality. CONCLUSIONS: MRSA is emerging in the setting of community-acquired septic arthritis. MRSA septic arthritis is more likely to develop in the elderly and in healthcare-associated infections than MSSA septic arthritis.

Distraction arthroplasty of the trapeziometacarpal joint without trapeziectomy.

BACKGROUND: Thumb carpometacarpal joint (CMC) arthrosis leads to pain and joint instability. Therefore, pain relief and functional restoration of the CMC joint are primary goals of surgical treatment, after failure of conservative treatment. Several options for surgical treatment were listed, ranging from simple debridement of the joint, reconstruction with tendon graft, arthroplasty, to arthrodesis. Distraction arthroplasty is a good choice for mild to moderate CMC arthrosis or instability. METHODS: Ten patients with persistent basal joint pain who failed conservative treatment and having basal joint instability with significant poterolateral translation were included. They were treated by distraction arthroplasty without trapeziectomy. The functional outcome was evaluated by Patient-Rated Wrist Evaluation (PRWE) questionnaire. The Wilcoxon signed-rank test was used for analysis. RESULTS: The mean follow up period is 37 months (minimum 15 months). All patients achieved total or near total pain relief. Significant improvement of functional outcome was gained. The PRWE functional score showed an average improvement of 41.5 (p = 0.005). No loss of reduction or CMC joint instability was noted. CONCLUSION: Our technique (distraction arthroplasty without trapeziectomy) preserves bony and adjacent structures. It is easier and quicker than traditional arthroplasties. It serves as another effective and stable method of tendon reconstruction with a less invasive approach. A larger series is needed for further observation of validity of the procedure.

The effect of normal saline irrigation at different temperatures on the surface of articular cartilage: an experimental study in the rat.

PURPOSE: To determine, with an electron microscope, the effects of irrigation fluid at different temperatures on the surface of articular cartilage. TYPE OD STUDY: Experimental in vivo study. METHODS: With a scanning electron microscope, we investigated the effect of 2 hours of irrigation with normal saline at 3 different temperatures (4 degrees C, 25 degrees C, and 37 degrees C) on articular hyaline cartilage in an in vivo rat knee model study. The contralateral knees were used as controls. We then compared the results. RESULTS: Specimens irrigated with cold (4 degrees C) fluid seemed to show the most uneven surface and apparent fibril exposure. Those irrigated with fluid close to body temperature (37 degrees C) showed the most even surface without fibril exposure. CONCLUSIONS: Although further work is needed to evaluate the long-term effects, using warm irrigation fluid to maintain the intra-articular environment at a more physiologically normal temperature may help reduce damage to cartilage during irrigation.

Sonography for monitoring closed reduction of displaced extra-articular distal radial fractures.

BACKGROUND: Closed reduction and cast immobilization are employed in the primary treatment of most distal radial fractures, and conventional radiographic techniques have been essential and effective in monitoring these reductions. Radiation-free ultrasonography, however, can provide both real-time and dynamic multiple-plane images with a small and simple-to-use transducer that can be operated with only one hand. We therefore wanted to see if the real-time and dynamic multiple-plane observation capabilities of ultrasonography would allow an orthopaedic surgeon to perform a closed reduction without multiple attempts, as are frequently required when only conventional radiographic techniques are used. METHODS: Sonographically guided closed reduction was performed in twenty-seven consecutive wrists with an acute distal radial fracture. The efficacy of this method was evaluated and compared with that of conventional radiographic techniques. RESULTS: The sonographic images delineated the fractures as accurately as did the conventional radiographs. All parameters measured on the sonograms and radiographs showed substantial restoration of anatomic alignment after reduction, and all measurements were similar on the two types of images. CONCLUSIONS: Sonographically guided monitoring compared well with conventional radiographic techniques during closed reduction of extra-articular distal radial fractures. Sonography is an accurate, simple, and radiation-free tool that provides the substantial benefits of dynamic multiple-plane and real-time observation.