ABSTRACT
Introduction: Retrocalcaneal pain in late adulthood and athletes has been attributed to insertional Achilles tendinosis (IAT). Another presentation of IAT is a degenerative Achilles tear, which can be partial or complete. Symptomatic patients with failed conservative management are treated by debridement and repair of the Achilles tendon. Often, they need augmentation with a tendon transfer. The flexor hallucis longus (FHL) is the most commonly used tendon for augmentation. The Speed Bridge technique to repair the degenerated tendoachilles tear gives better pullout strength and provides a larger surface area of contact between the bone and tendon. Case Report: We included 12 patients with symptomatic degenerative Achilles tears repaired with the Speed Bridge technique and FHL augmentation. Post-operatively, all patients were allowed active ankle mobilization on day 1 and were allowed weight bearing as tolerated in an airwalker shoe. All patients went through an accelerated rehabilitation protocol. Pre-operative and post-operative American Orthopedic Foot and Ankle Hindfoot Score (AOFAS) and Visual Analog Scale (VAS) scores were compared for all the patients. Conclusion: The mean age was 58.1 (range 50-68) years. The mean follow-up period was 13.1 (range 12-15) months. The mean pre- and post-operative AOFAS score at 12 months was 59.5 (range 58-71) and 90.2 (range 87-100), respectively. The mean pre-operative VAS for pain was 6.8 (range 6-8), and the mean post-operative VAS score was 0.5 (range 0-2). The mean interval to weight bearing was 8.4 days (range 7-10) days. Our study indicates that accelerated early rehabilitation and an early return to active life are possible with the Speed Bridge technique and FHL augmentation in degenerative Achilles tears. The mean post-operative AOFAS scores were comparable to other studies, but early return to activity, minimal need for immobilization, and accelerated rehabilitation were the advantages of the Speed Bridge technique in the repair of degenerative Achilles tears.
ABSTRACT
CONTEXT: Determining the amount of cortical and cancellous bone present in the mandible is an important criterion for the selection of proper implant size and reduction of post implant placement complications. It becomes difficult to manage the presence of lingual undercuts when there is perforation of either the buccal or lingual cortical plates. Computed tomography (CT) images of the mandible can reduce the risk of complications by evaluating the thickness of cortical and cancellous bone in the mandible. AIMS: Evaluate thickness of the buccal and lingual cortical plates and cancellous bone. Gender variation in the cancellous bone and cortical bone thickness. Determine the shape of the mandible. SETTINGS AND DESIGN: A retrospective study was conducted using the CT scan images of pathologies pertaining to the Head and Neck region. METHODS AND MATERIAL: CT scan images of 30 patients, comprising of 22 males and 8 females. The mental foramen was considered as the anatomical landmark and the vertical marking was considered at a height of 20 mm from basal bone. The thickness of both cortical and cancellous bone was noted 6 mm anterior to it and 18 mm posterior. The shape of the buccal and lingual cortical bone was also considered. STATISTICAL ANALYSIS: Statistical analysis was done using Student's t-test or Chi-square test. RESULTS: The mean thickness of cortical bone was more in anterior mandible than posterior mandible and cortical bone density was thickest at height of 20 mm, whereas for cancellous bone, it was highest at 5 mm from the basal bone, thickness. Buccal concavity, type A (68.2%), was the most common in the anterior region for males, followed by round shape, type C (56-58%) in the posterior region. For females, type C (25-31%) in the posterior region and lingual concavity, type B (18-30%) were the most common types in the anterior region. CONCLUSIONS: Lingual concavity may pose serious problems in cases of perforations during implant placement. Lingual cortical plates were thicker than the buccal cortical plates and it is concave anterior mandible. Thus, CT imaging can help in characterizing the quantity and morphology of the mandible.
Subject(s)
Cone-Beam Computed Tomography , Mandible , Bone Density , Female , Humans , Male , Mandible/diagnostic imaging , Retrospective StudiesABSTRACT
Background The proximal femoral nail anti-rotation Asia (PFNA 2) is an implant designed for unstable osteoporotic intertrochanteric fractures in Asians as the PFNA was designed for Caucasians and had various complications when applied to the Asian population due to the femoral geometrical mismatch. This study observes the functional outcomes and complications associated with PFNA 2 in unstable intertrochanteric fractures in the elderly Indian population. Methods Sixty-one above 60 years old patients with an unstable intertrochanteric fracture who were operated with PFNA 2 were included in this prospective observational study. They were followed up for one year. The functional and radiographic evaluations were done at 6, 12, 20 weeks, and the functional outcome was evaluated at the end of one year. Association of age, American Society of Anaesthesiologists (ASA) grade, AO Foundation classification, osteoporosis to the functional outcome of modified Harris hip score (MHHS) was evaluated. Results Type A2 fractures demonstrated a statistically higher-good reduction than Type A3 (Student t-test, P < 0.05). The difference in mean surgical duration in Type A3 (45.47 minutes) and Type A2 (40.30 minutes) was statistically significant (Student t-test, P < 0.05). Mean blood loss was 110.66 ml (SD = 48.40 ml). MHHS at 6, 12, 20 weeks, and one year were 40.37, 63.93, 79.03, and 82.34, respectively. At the end of the year, 46 (82.1%) patients achieved good scores, eight (14.3%) achieved fair scores, and two (3.5%) achieved poor scores. There was one case of nonunion and medial migration of the helical blade. The mortality rate was 6.55% at the end of one year. Conclusion A good reduction was associated with a better functional outcome. PFNA 2 is an efficient implant in managing unstable intertrochanteric fractures in elderly Indian patients with good outcomes, low morbidity rates, and mortality. Implant mismatch was not a problem in the Indian population. However, large multi-centric studies with a larger sample size are required. Moreover, achieving a good reduction cannot be over-emphasized in unstable intertrochanteric fractures, especially in the elderly, to achieve a good functional outcome.
ABSTRACT
INTRODUCTION: The dentist must be aware of this drug use in their individual patients to: (1) avoid possible contraindications during dental treatment, (2) be aware of the many oral and craniofacial manifestations of such drug use, (3) be able to provide necessary dental treatment to combat the dental/oral ravages of drug use, and (4) be able to refer such patients, if so desired by the patient. AIMS AND OBJECTIVES: The aim of the study is (1) To determine the knowledge of abusive drugs among dentists and (2) To determine the attitude and role of dentists in identifying patients with abusive drugs. SUBJECTS AND METHODS: A modified 27-item questionnaire was formulated and distributed among the study. The participants were to return the filled questionnaire to the investigators within a week. A total of 203 validated entries were collected. Data were entered into Microsoft Excel 2007 and analyzed in SPSS V20. Associations between categorical variables were determined using Chi-square or Fisher's exact test. P < 0.05 was considered statistically significant. RESULTS: Irrespective of the educational qualification drugs are perceived harmful with definite oral manifestations, and dentists should be concerned with identifying individuals with drugs. It is believed that trying drugs once could lead to possible addiction and that dental practitioners should have their skills developed to handle cases and referred to deaddiction centers with modification of treatment plans. CONCLUSIONS: Educating dental graduates and postgraduates about the oral implications of drugs intake and making it a part of the dental curriculum may help us dealing with the global issues of drugs. Even making dental students a part in counseling and part of the behavioral therapies advocated in treating drug addicts.
