Juvenile Psammomatoid Ossifying Fibroma (JPOF) of Proximal Radius: A Rare Entity.

BACKGROUND: Juvenile psammomatoid ossifying fibroma (JPOF) is a rare fibro-osseous lesion that usually occurs in the facial bones. The pathognomonic histopathologic feature is the presence of spherical ossicles, which are similar to psammoma bodies. It is considered to be a unique lesion because of its reported tendency to occur in children and adolescents and its tendency for locally aggressive growth. Because this lesion is aggressive in nature with high recurrence rate, early detection and complete surgical excision are essential. CASE REPORT: Herein, we present a case of 11 year old girl, who presented to our clinic with history of gradual onset pain around right elbow associated with limitation of right forearm rotation for 3 months. After getting informed consent, we performed needle biopsy and histopathologically it was diagnosed as Psammomatoid type juvenile ossifying fibroma (JPOF) of proximal radius. We performed extensive debridement, curettage of entire cystic lesion involving the proximal radius and filled the cavity with allograft bone granules and intramedullary titanium elastic nail through fibular strut graft, bridging the cystic lesion. CONCLUSION: As far as our knowledge there is no reported case of psammomatoid type of juvenile ossifying fibroma of proximal radius. We believe that such tumors in long bones are aggressive and have tendency for recurrence. Definitive diagnosis is utmost important for proper planning, surgical excision and reconstruction of long bones and need regular follow up to look for any recurrence or malignant transformation.

Angulating-Distraction Ulnar Osteotomy and Interpositional Phosphocalcic Ceramic Wedge Graft for a Chronic Monteggia Lesion.

BACKGROUND: Various types of osteotomies have been used to facilitate reduction of the radial head and to prevent recurrent subluxation. The Bouyala technique - open reduction of radial head associated with open wedge ulnar osteotomy with or without annular ligament reconstruction, is presently the most widely used treatment for long- standing traumatic dislocation of the radial head, independently of age, in the absence of osteoarthritis remodeling, and should preferably be performed within 1 year of trauma. METHOD: In this article, we present a similar case operated by same technique, but we used synthetic phosphocalcic ceramic wedge graft instead of auto bone graft as described in many other studies. We believe that, this will limit the donor site morbidity and also aid in achieving better stability at osteotomy site, which in turn help in proceeding with early active mobilization protocol. RESULT: We achieved union of the osteotomy by three months. Clinically, there was no deformity and she achieved full pain-free range of motion of elbow joint. CONCLUSION: We believe that, use of synthetic phosphocalcic ceramic wedge graft allow rigid fixation of osteotomy, provides additional stability, decrease the risk of secondary displacement and allow early mobilization, which may minimize contracture and we could achieve fairly good clinical outcome.

Modified Open Suprapectoral EndoButton Tension Slide Tenodesis Technique of Long Head of Biceps with Restored Tendon Tension-Length.

BACKGROUND: The vast majority of biceps tendon ruptures occurs at the proximal insertion and almost always involves the long head. There are several options for long head of biceps (LHB) tenodesis with advantage and disadvantages of each technique. We believe that the suprapectoral LHB tenodesis described in this article enables the restoration of the anatomic length-tension relation in a technically reproducible manner, when following the guidelines set forth in this article, and restores biceps contour and function adequately with a low risk of complications. METHOD: We present a case of a young man who had a sudden jerk of his flexed right elbow, while involved in water skiing sports and sustained complete rupture of proximal end of long head of biceps tendon. In this article, we describe a modified surgical technique of open supra-pectoral long head of biceps tenodesis using an EndoButton tension slide technique, reproducing an anatomic length-tension relationship. RESULTS: By the end of one year, patient regained symmetrical muscle bulk, shape and contour of biceps compared to other side. There were no signs of dislodgement or loosening of the EndoButton on follow-up radiographs. He regained full muscle power in the biceps without any possible complications, such as humeral fracture, infection, or nerve injury, associated with this technique. CONCLUSION: This technique is a safe, easy to reproduce, cost-effective, less time consuming and an effective method that uses a small drill hole, conserving bone, minimizing trauma to the tendon, and decreasing postoperative complications. It does not need any special instrumentation and is suitable especially for use in centers where arthroscopy facility or training is not available.

Repair of Double Head Pectoralis Major Tendon Avulsion into its Native Footprint Using Bi-cortical EndoButtons and Tendon Sliding Technique.

Injuries to the pectoralis major muscle are relatively infrequent. The mechanism of injury is usually an eccentric shortening of the pectoralis major under heavy load, such as when performing a bench press exercise. We report a case that presented to us with a history of sudden pain in the left pectoral region while doing heavy bench press exercise. The patient sustained a type III D pectoralis muscle -tendon avulsion. Surgical repair was done through a bi-cortical tendon sliding technique using two cortical buttons. In this article we describe our modifications to the previously described surgical technique for the pectoralis major tendon repair using the EndoButton and tension - slide technique, aiming to overcome the possible complications.

Modified Tension - Slide Technique for Anatomical Distal Biceps Tenodesis using a Bicortical EndoButton and a Tenodesis Screw.

INTRODUCTION: Many surgical techniques have been described in the literature. In this article, we describe surgical technical details along with tips and tricks of distal biceps tendon tenodesis using the EndoButton and tension - slide technique, a modification of the suspensory cortical button technique, which allows the surgeon to tension and repairs the biceps tendon through the single longitudinal anterior incision. This modification in surgical technique of using dual implants, i.e., EndoButton and interference screw as fixation tools and concept of tendon sliding principle made this procedure unique. In this article, we describe surgical technique along with tips and tricks of distal biceps tendon tenodesis using the EndoButton and tension - slide technique and also discussed about modification of EndoButton technique reported in many other articles to overcome the possible complications. CASE REPORT: We report six consecutive patients, presented with distal biceps tendon rupture (4 acute; 2 chronic cases) between June 2013 and March 2015, who underwent single-incision, anatomical distal biceps tenodesis procedure with bicortical EndoButton and tenodesis screw using tension slide technique. Radiographs were taken immediate post-operative to document for displacement or loosening of EndoButton if any. CONCLUSION: The use of an EndoButton and an interference screw for repairing distal biceps tendons have been previously described. We describe a modification of originally described technique which is worth considering, as it provides two levels of fixation, whilst avoiding possible complications of such procedures. It is ideal for repairing both acute and chronic ruptures, without the need for allograft or autograft augmentation and describes detailed technical steps to avoid possible iatrogenic complications.

Do we need primer for orthodontic bonding? A randomized controlled trial.

OBJECTIVE: To evaluate the clinical performance of APC™II Victory Series™ (3M Unitek) brackets in direct orthodontic bonding with and without the use of primer. DESIGN: A single-operator, two-centre prospective, non-inferiority randomized controlled clinical trial. SETTING: The Orthodontic departments at the Leeds Dental Institute and St Luke's Hospital, Bradford, UK. ETHICAL APPROVAL: Ethical approval was granted by Leeds (East) Research Ethics Committee on 18th of December 2009 (Reference 09/H1306/102). PROTOCOL: The protocol was not published prior to trial commencement. SUBJECTS AND METHODS: Ninety-two patients requiring orthodontic treatment with fixed appliances were randomly allocated to the control (bonded with primer) or test groups (bonded without primer). Patients were randomly allocated to either the control or experimental group. This was performed by preparing opaque numbered sealed envelopes in advance using a random numbers table generated by a computer by an independent third party . Once the envelopes were opened, blinding of the operator and the patient was no longer possible due to the nature of the intervention. Patients were approached for inclusion in the trial if they qualified for NHS orthodontic treatment requiring fixed appliances and had no previous orthodontic treatment. MAIN OUTCOME MEASURES: Number of bracket failures, time to bond-up appliances, and the adhesive remnant index (ARI) when bracket failure occurred, over a 12-month period RESULTS: Failure rate with primer was 11.1 per cent and without primer was 15.8 per cent. Bonding without primer was shown statistically to be non-inferior to bonding with primer odds ratio 0.95-2.25 (P = 0.08). Mean difference in bond-up time per bracket was 0.068 minutes (4 seconds), which was not statistically significant (P = 0.402). There was a statistically significant difference in the Adhesive Remnant Index - ARI 0 with primer 49.4 per cent, no primer 76.5 per cent, (P < 0.0001). LIMITATIONS: As the study was only performed by one operator, the results can therefore only be truly be applied to their practice. Also this study was powered to ascertain if there was no difference between the 2 groups up to 5%, however orthodontists may consider a change in the bracket failure rate of 2% to be clinically significant. CONCLUSION: When bonding with APC™II Victory Series™ brackets without primer was shown statistically to be non-inferior to bonding with primer (P =0.08). There was no significant difference in bond-up times. Bond failure was more likely to happen at the composite-enamel interface when bonded without a primer. CONFLICT OF INTEREST: No conflict of interest for all authors. FUNDING: No funding sources were used. REGISTRATION: Study was not registered on external databases.

Odontoid fractures: A retrospective analysis of 53 cases.

BACKGROUND: The management of odontoid fracture has evolved but controversy persists as to the best method for Type II odontoid fractures with or without atlantoaxial (AA) instability. The anterior odontoid screw fixation can be associated with significant morbidity while delayed odontoid screw fixation has shown to be associated with reasonable good fusion rates. We conducted a retrospective analysis to evaluate the outcome of a trial of conservative management in type II odontoid fractures without atlantoaxial instability (Group A) followed by delayed odontoid screw fixation in cases in which fusion was not achieved by conservative treatment. The outcome of type II odontoid fracture with AA subluxation (Group B) was also analysed where closed reduction on traction could be achieved and in those atlantoaxial subluxations that were irreducible an intraoperative reduction was done. MATERIALS AND METHODS: A retrospective evaluation of 53 cases of odontoid fractures treated over a 9-year period is being reported. All odontoid fractures without AA instability (n=29) were initially managed conservatively. Three patients who did not achieve union with conservative management were treated with delayed anterior screw fixation. Twenty-four cases of odontoid fractures were associated with AA instability; 17 of them could be reduced with skeletal traction and were managed with posterior fusion and fixation. Of the seven cases that were irreducible, the initial three cases were treated by odontoid excision followed by posterior fusion and fixation; however, in the later four cases, intra operative reduction was achieved by a manipulation procedure, and posterior fusion and fixation was performed. RESULTS: Twenty-six of 29 cases of odontoid fracture without AA instability achieved fracture union with conservative management whereas the remaining three patients achieved union following delayed anterior odontoid screw fixation. 17 out of 24 odontoid fracture with atlantoaxial dislocation could be reduced on traction and these patients underwent posterior fusion and fixation. Optimal or near optimal reduction was achieved by on table manipulation in four cases which were irreducible with skeletal traction. Atlantoaxial stability was achieved in all cases. All cases were noted to be stable on evaluation with x-rays at six months. CONCLUSIONS: The initial conservative management and use of odontoid screw fixation only in cases where conservative management for 6-12 weeks has failed to provide fracture union have shown good outcome in type II odontoid fracture without AA instability rates. Intraoperative manipulation and reduction in patients where AA subluxation failed to reduce on skeletal traction followed by posterior fusion obviates the need for transoral odontoid excision.

Current products and practice: bone anchorage devices in orthodontics.

Bone anchorage is a promising new field in orthodontics and already a wide variety of bone anchorage devices (BADs) are available commercially. This review aims to assist clinicians by outlining the principles of bone anchorage and the salient features of the available systems, especially those that may influence the choice of a specific BAD for anchorage reinforcement.