Acceptable Restoration Research Articles

Comparison of the clinical parameters of restorations performed with total-etch and self-etch adhesive techniques

AIM. To conduct a systematic review to evaluate the differences between the clinical performance of restorations made with total-etch and self-etch techniques.MATERIALS AND METHODS. A literature search was conducted in the Pubmed, Google Scholar and Cyberleninka databases. The research was done according to the PICO strategy. Articles from the last 10 years (2013–2023) were included in the review.RESULTS. After screening 1005 articles, 52 studies were subjected to data extraction. There were no statistically significant differences in any study regarding recurrence of caries. In 9 of 14 articles, retention was higher with the total-etch technique. Total-etch groups showed better marginal adaptation in 11 of 19 studies. 11 of 17 studies recorded the least marginal staining using the total-etch technique. None of the studies found statistically significant results for the presence of post-operative sensitivity at the end of the follow-up period. However, three studies reported statistically significant evidence of post-operative sensitivity at baseline, and after 12 months (1/2 follow-up) in the total-etch groups only.CONCLUSIONS. Both methods show effective and clinically acceptable restoration performance.

Identifying the critical lakeshore zone to optimize landscape factors for improved lake water quality in a semi-arid region of Northeastern China

The degradation of water quality and decline in purification capacity of lakeshore zones due to anthropogenic activities and climate change is a growing concern in China. The identification of the critical width of the lakeshore zone remains a challenge due to natural geographic features and pollutant types, that is why a general identification approach has yet to be developed. To facilitate the planning of lakeshore restoration plans, it becomes necessary to conduct studies focusing on the development of relationships between water quality and landscape factors within the lakeshore zone in different regions. In this study, spatio-temporal patterns of water quality of 49 lakes in Western Jilin Province, China, were determined through field monitoring from 2015 to 2019. Multivariate statistical methods were applied to quantitatively identify the relationships between lakes water quality and landscape factors within lakeshore zones of different widths. The results indicated that nitrogen (N) contributed more to eutrophication, while fluoride concentrations were found to be abnormally high. Furthermore, the width of the lakeshore zone was found to have a significant impact on water quality, with a critical width of 150 m having the greatest effect. Cropland and saline land explained almost 50% of the water quality variability throughout different seasons. The results also revealed that dual control of N and phosphorus (P) will be required to prevent eutrophication in the study area. Agricultural activities and severe soil salinization were identified as the main causes of diffuse pollution. The establishment of a width threshold identification framework for lakeshore zones is not only of great significance for development of scientific and acceptable restoration plans for lakeshore vegetation filters in ecologically vulnerable areas of western Jilin, but should also provide an effective and user-friendly tool for implementing diffuse pollution control.

Computational design of custom therapeutic cells to correct failing human cardiomyocytes.

Myocardial delivery of non-excitable cells-namely human mesenchymal stem cells (hMSCs) and c-kit+ cardiac interstitial cells (hCICs)-remains a promising approach for treating the failing heart. Recent empirical studies attempt to improve such therapies by genetically engineering cells to express specific ion channels, or by creating hybrid cells with combined channel expression. This study uses a computational modeling approach to test the hypothesis that custom hypothetical cells can be rationally designed to restore a healthy phenotype when coupled to human heart failure (HF) cardiomyocytes. Candidate custom cells were simulated with a combination of ion channels from non-excitable cells and healthy human cardiomyocytes (hCMs). Using a genetic algorithm-based optimization approach, candidate cells were accepted if a root mean square error (RMSE) of less than 50% relative to healthy hCM was achieved for both action potential and calcium transient waveforms for the cell-treated HF cardiomyocyte, normalized to the untreated HF cardiomyocyte. Custom cells expressing only non-excitable ion channels were inadequate to restore a healthy cardiac phenotype when coupled to either fibrotic or non-fibrotic HF cardiomyocytes. In contrast, custom cells also expressing cardiac ion channels led to acceptable restoration of a healthy cardiomyocyte phenotype when coupled to fibrotic, but not non-fibrotic, HF cardiomyocytes. Incorporating the cardiomyocyte inward rectifier K+ channel was critical to accomplishing this phenotypic rescue while also improving single-cell action potential metrics associated with arrhythmias, namely resting membrane potential and action potential duration. The computational approach also provided insight into the rescue mechanisms, whereby heterocellular coupling enhanced cardiomyocyte L-type calcium current and promoted calcium-induced calcium release. Finally, as a therapeutically translatable strategy, we simulated delivery of hMSCs and hCICs genetically engineered to express the cardiomyocyte inward rectifier K+ channel, which decreased action potential and calcium transient RMSEs by at least 24% relative to control hMSCs and hCICs, with more favorable single-cell arrhythmia metrics. Computational modeling facilitates exploration of customizable engineered cell therapies. Optimized cells expressing cardiac ion channels restored healthy action potential and calcium handling phenotypes in fibrotic HF cardiomyocytes and improved single-cell arrhythmia metrics, warranting further experimental validation studies of the proposed custom therapeutic cells.

Latarjet coracoid transfer vs. distal clavicle autograft for anterior shoulder instability with glenoid bone loss: A biomechanical comparison of two graft reconstructions in various medial to lateral positions

While the consensus of optimal positioning of the transferred coracoid, no biomechanical study has established if the position differs for other bone block types. To compare the effect of distal clavicle autograft and coracoid autograft alignment and medialization on glenohumeral stability. Eight Fresh-frozen cadaver shoulders comprised of the scapula and proximal humerus were tested. The cadavers were tested while positioning both grafts, the distal clavicle autograft and coracoid graft, consecutively at 0 mm, 4 mm and 8 mm medially. Each experiment comprised of maximum external rotation and glenohumeral abduction of 60° while applying a constant, 50 N medial compressive force via a pneumatic actuator to the humerus under all conditions. The starting position was determined by the humeral head being seated at its most medial position on the glenoid surface. The conjoint tendon was routed through a split in subscapularis and loaded with a 5N weight using a pulley system for all Latarjet trials to simulate the sling effect. Clavicle grafts at all offsets showed a statistically significant decrease in the stability ratio versus the intact condition. Within the clavicle graft conditions, the 4 mm clavicle offset had a significantly lower stability ratio versus the 0 mm clavicle offset and a significantly higher stability ratio than the 8 mm offset. The clavicle 8 mm offset graft had a significantly lower stability ratio than the 0 mm offset position. The Latarjet graft with 0 mm of medial offset showed no statistically significant difference in stability ratio when normalized at 10 mm of anterior displacement relative to the intact glenoid condition, while the 4 mm and 8 mm medial offset Latarjet conditions had significantly lower stability ratios versus the intact condition. Within the Latarjet graft positions, the stability ratio of the 4 mm medial offset had no statistically significant difference than the 0 mm offset. In shoulders with anterior glenoid bone loss, the Latarjet procedure and transfer of an osteoarticular distal clavicle autograft seem to be biomechanically sound if placed flush with the glenoid. Medialization of 4 mm provides acceptable restoration of shoulder stability when a Latarjet procedure is used but not for a distal clavicle autograft.

Restoration of the native humeral anatomy during stemless anatomic total shoulder arthroplasty: a radiographic comparison of intramedullary versus freehand resection.

During anatomic total shoulder arthroplasty (aTSA), the humeral head can be resected with or without the use of an intramedullary cutting guide, the former referred to as intramedullary (IM) resection and the latter referred to as freehand (FH) resection. Outcomes following aTSA are predicated upon the restoration of the native humeral anatomy, which can be more challenging with stemless implants. To date, no studies have determined which method of humeral head resection is superior in restoring native anatomy. Our purpose was to determine whether FH or IM resection was superior in restoring native anatomy during aTSA with stemless implants. A review of all patients who underwent aTSA using the stemless Tornier Simpliciti Shoulder System at two academic institutions by two separate surgeons between January 2017 and June 2020 was performed. One surgeon at one institution performed stemless aTSA using the IM resection technique, while the second surgeon utilized the FH resection technique. Patients were excluded if they underwent surgery for an indication other than glenohumeral osteoarthritis, if they received a short-stem or standard-stem implant, or if they lacked adequate preoperative and postoperative Grashey radiographs. One hundred eleven patients across both institutions (51 IM, 60 FH) were included for the final radiographic assessment. The humeral head height (HH) and neck-shaft angle (NSA) were measured on preoperative and postoperative Grashey radiographs. The centers of rotation (CORs) were measured on postoperative Grashey radiographs. Patients were classified as having acceptable restoration of their native anatomy if the change (Δ) in COR or HH was ≤3mm and ≤ 5mm, respectively, or if the postoperative NSA was ≥130°. IM resection had the greatest acceptable restoration of COR (90.2% IM versus 70% FH, P=.009), HH (96.1% IM vs. 63.3% FH, P<.001), and NSA (96.1% IM vs. 78.3% FH, P=.006) relative to FH resection. The mean postoperative NSAs for the IM and FH cohorts were 134.4° (±2.1°) and 133.8° (±5.4°), respectively (P=.208). The mean ΔCORs for the IM and FH groups were 1.2 (±1.5) and 2.3 (±1.2) mm, respectively (P<.001). Finally, the mean ΔHHs for the IM and FH cohorts were 1.7 (±1.4) and 4.4 (±2.9) mm, respectively (P<.001). Restoration of the native humeral anatomy following stemless aTSA occurred at a significantly higher rate when using IM vs. FH resection.

Outcomes of root canal treatment of first permanent molars among children in Jeddah, Saudi Arabia: A retrospective cohort study

ObjectivesThe first permanent molar (FPM) is considered the tooth most susceptible to caries, as it is the first permanent tooth to erupt in the oral cavity, making it susceptible to environmental conditions that may appear as caries, hypoplasia, or hypomineralization. Several treatment options are available for managing deep caries, including root canal treatment (RCT). However, there is a lack of data on the success and failure rates of RCT in FPM among children. This study aimed to determine the success and failure rates of RCT in FPM among children and related factors. MethodsThis retrospective cohort study was conducted at three major centers in Jeddah, Saudi Arabia. Children aged 9–18 years who underwent an RCT between 2010 and 2019 were included. Clinical and radiographic examinations were also performed. ResultsBased on the loose criteria, most of the evaluated teeth (79.6%) were successfully treated. The treatment failed in only 20.4% of participants. Older patients and teeth with acceptable restoration quality had an increased success rate compared to younger patients and teeth with unacceptable restoration quality. A shorter time lapse between treatment and assessment resulted in a lower success rate compared to a longer time lapse. Based on strict criteria, 72.9% of the patients were successfully treated. The use of a microscope and teeth with acceptable restoration quality resulted in an increased success rate compared to teeth treated without the microscope and with unacceptable restoration quality. ConclusionsThe success rate of this procedure was high. Several factors, including older age, acceptable restoration quality, and the use of a microscope, increase the probability of success.

Resilience-based approach to maintenance asset and operational cost planning

Reliability-based and risk-based methods for directing maintenance activities play a critical role in ensuring system safety and reducing unnecessary downtime. Those methods focus on preventive maintenance to avoid component failures and are applicable before unexpected disruptions occur. However, when disruptions are unavoidable, more attention should be paid to systems’ recovery from unwanted changes. As a remedy of preventive maintenance, improving system restoration capacity of resilience through optimizing the system's maintenance asset and operational cost is an efficient way to help system restore from disruption conditions within an optimal cost. In this paper, a resilience-based approach is proposed to optimize maintenance asset and operational cost. A novel resilience metric is developed and utilized to quantify system resilience under various restoration capacities. The minimal acceptable resilience level (MARL) and maximal acceptable restoration time (MART) are proposed to determine the optimal maintenance cost. The proposed approach is applied to the Chevron Richmond refinery crude unit and its upstream process. The results show that it can help practitioners identify the optimal cost to ensure a system is resilient to respond to uncertain disruptions and provide a dynamic resilience profile to support decision-making.

Assessment of Seismic Load Capacity of a Slender Masonry Clock Tower

The paper presents the seismic vulnerability assessment of a historical masonry clock tower by means of the finite element method. The mechanical behavior and failure mechanism of these structures must be well understood in order to evaluate their performance and select an appropriate retrofit approach when needed. Stone towers, which sometimes have complex geometries and irregularities and are often designed for vertical loads, are vulnerable to lateral loads, especially earthquake loads, due to the slenderness of the tower and the limited ductility of the stone. This study aims to determine the horizontal load capacity of a magnificent clock tower by investigating its structural behavior using the finite element method. The analyzes carried out considering the seismicity of the region showed that the clock tower would be severely damaged or completely collapsed in case of an earthquake with an exceedance probability of 10% in 50 years. In non-linear time history analyses, the maximum base shear force to weight ratio was calculated as 0.27. The maximum drift ratio at the top of the clock tower reveals that the tower exceeds the collapse prevention performance level. The residual displacements obtained from non-linear time history analysis prove that plastic deformations occur on the tower body. In the light of this data, it is considered that the clock tower needs to be retrofitted with acceptable restoration procedures against possible earthquakes in the region.

Clinical Outcome of Class II direct composite restorations using total-Cetch versus selective etch adhesives

Background: The composite restoration of anterior is always a challenging job. Aim: To compare the clinical outcome of class 2 direct composite restorations using total-etch and selective etch adhesives, according to USPHS criteria. Methods: One hundred patients were included in this randomized controlled clinical trial study at Operative Dentistry department of LMDC, Lahore. They were divided in two groups. Group 1 for total etch technique, group 2 for selective etch technique enamel was etched with 37% phosphoric acid for 20 second and then washed thoroughly with water for 5-10 seconds and was dried with air for 5 seconds till frosty white and bond with self etch. Results: The majority of patients were in the age range of 25-31 years, 25 (50%) patients used total etch technique and 22 (44%) patients used selected etch technique. When compare the overall rating for restorations, 38 patients (76%) have acceptable restoration in total etch technique and 46 patients (92%) in selected etch technique. Statistically the difference was significant (P&lt;0.05). Conclusion: Selected etch technique presented a successful clinical performance over total etch technique for Class II restorations. Keywords: Class II direct composition restoration, Total etch technique, Selected etch technique.

Damage Assessment and Guidelines for Restoration Methods of Ancient Brick Structures at Sambor Prei Kuk, Cambodia

ABSTRACT Many ancient brick structures have been recorded in the archaeological site of Sambor Prei Kuk. Most of these structures were considered to be built in the 7th century as religious facilities of royal city Isanapura and abandoned in the 15th century. Since then, the brick structures in this site had been covered by dense forest and suffered severe damage due to the tropical climate. This archaeological site was inscribed on the World Heritage List in 2017, and proper intervention is needed to preserve the remaining brick structures. The Sambor Prei Kuk Conservation Project carried out comprehensive research on the state of conservation for all 286 brick structures in this site. This project has developed a risk map, and carried out the survey of structural deformation and diagnosis of deterioration. Based on these surveys, the main causes of damage were identified: outward deformation of the base and foundation; thrust caused by the roof of the corbel arch; structural weakness at the door opening; fragmentation of brickwork by invasive vegetation; and impact of fallen tree. Finally, appropriate and acceptable restoration methods which can effectively stabilize and consolidate the brick structures to prevent further destruction while not negatively affecting the authenticity were discussed.

Investigation of Ecosystem Restoration at Sites of Spent Coal Deposits in the Regions of the Urals Using Remote Sensing Resources

The results of assessing the ecological state of lands disturbed during the open-cut mining of four coal deposits in the Sverdlovsk and Chelyabinsk regions are presented. In the course of the studies carried out using the results of remote monitoring, it was found that ecologically acceptable restoration of vegetation cover on the territory of disturbed lands occurs as a result of reclamation work and natural processes of its self-restoration.

Evaluation of patient outcomes after operative treatment of intra-articular calcaneus fractures.

Background: Percutaneous reduction with fixation and open reduction internal fixation are often used to treat intra-articular calcaneus fractures with no consensus on the preferred method. Open techniques have been associated with an increased risk of wound complications, while percutaneous techniques may result in inferior reduction capabilities. These injuries pose a challenge to patients as they often result in poor patient outcomes. We retrospectively analyzed patient outcomes of a single surgeon’s experience in treating these injuries at a busy urban Level 1 trauma center. Methods: Patients with intra-articular calcaneus fractures managed operatively over 10 years with a minimum six-month follow-up were included. Patients were divided into two cohorts based on operative technique: closed reduction and percutaneous fixation (CRPF) or open reduction internal fixation (ORIF). Descriptive analysis of each cohort included postoperative infection, the need for repeat operations, development of post-traumatic subtalar arthritis, and reduction capabilities as assessed by Bohler’s angle. Results: Sixty-two patients were included in this study, with 33 patients in the CRPF group and 29 patients in the ORIF group. Infection requiring a return to the operating room occurred in 1 (3%) CRPF and 7 (24%) ORIF patients. Instrumentation was removed in 23 (70%) CRPF and 9 (31%) ORIF patients. Clinical subtalar arthritis developed in 10 (30%) CRPF and 7 (24%) ORIF patients, requiring arthrodesis in 2 (6%) and 5 (17%) patients, respectively. Both techniques had acceptable restoration of Bohler’s angle immediately postoperatively and at final follow-up. Conclusions: Percutaneous reduction with fixation and open reduction internal fixation may both be considered for the surgical treatment of intra-articular calcaneal fractures. Indications for each technique may vary between surgeons, and each has its own set of risk factors and complications, however, both have been shown to result in an acceptable reduction. Level of Evidence: Level IV.

First human facial retransplantation: 30-month follow-up

Since the first successful facial transplantation in 2005, the benefits of this procedure in terms of aesthetics, functionality, and quality of life have been firmly established. However, despite immunosuppressive treatment, long-term survival of the allograft might be compromised by chronic antibody-mediated rejection (CAMR), leading to irreversible necrosis of the tissue. In the absence of therapeutic options, this complication is inevitably life-threatening. We report facial retransplantation in a man, 8 years after his first facial transplantation because of extensive disfigurement from type 1 neurofibromatosis and 6 weeks after complete loss of his allograft due to severe CAMR. We describe the chronology of immune-related problems that culminated in allograft necrosis and the eventual loss of the facial transplant, the desensitisation protocol used for this highly immunosensitised recipient, the surgical technicalities of the procedure, the specific psychological management of this patient, and the results from follow-up at 30 months. Although the patient had a complicated postoperative course with numerous immunological, infectious, cardiorespiratory, and psychological events, he was discharged after a hospital stay of almost 1 year. He has since been able to re-integrate into his community with acceptable restoration of his quality of life. This clinical report of the first documented human facial retransplantation is proof-of-concept that the loss of a facial transplant after CAMR can be mitigated successfully by retransplantation combined with an aggressive desensitisation process. Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris.

Clinical and morphological aspects of structures based on fiberglass posts use

The aimof this review article is to determine the positive and negative qualities and properties of restoration structures based on fiber posts. After endodontic treatment, it is necessary to strengthen the remaining tissues, since there is an irreversible decrease in the strength characteristics of the tooth.Materials and methods.Produced a systematic review of the literature in the electronic databases Google Scholar and Pubmed. Articles based on the method of using fiberglass posts in clinical practice, analysis of methods for modifying the adhesive preparation of the dentin surface and the post itself, as well as publications related to the discussion of factors that led to the success/failure of the treatment are considered were included.Results.45 articles were reviewed in the course of information collection. As a result of the submitted articles analysis according to the exclusion criteria, the number of included studies has become 39.Conclusions. Based on the literature studied, the use of structures based on fiber posts is an acceptable method ofpost-endodontic restoration of teeth. But, like any medical manipulation, it has its limitations and side effects.

Outcome of tendon transfer for radial nerve palsy using Flexor Carpi Radialis combination (Brands transfer)

Introduction–Loss of radial nerve function leads to severe weakness of grip and tendon transfer is considered the standard treatment. However; there is continuing debate as to the best combination of tendon transfers in such patients. The aim of this study is to present the results of Flexor carpi radialis (FCR) combination of triple tendon transfer for radial nerve palsy. Material and methodsIt is a retrospective study conducted over 15 years. 58 patients of with irreversible radial nerve paralysis were included. Brands transfer was performed in all cases. The ranges of movement of the wrist, fingers and thumb were evaluated pre-operatively and postoperatively using Bincaz scale. ResultsTotal 58 patients were included in the study, 47 were male and 11 female patients with mean age of 35.27 years. Causes of radial nerve palsy were comminuted open humeral fracture (n = 42), penetrating injuries (n = 13) and brachial plexus palsy (n = 3). Mean duration of palsy was 9.37 months (range = 9–12 months). The mean post-operative follow-up was 10 (range = 2–15) years. On evaluation with the Bincaz score, 6 patients had excellent results, 49 patients had good results, and 3 patients had poor results. There were 3 complications in 5 patients, including radial deviation of wrist, inadequate abduction of thumb and restricted wrist flexion. 55 patients (94.82%) were able to return to their normal daily work after ∼8 weeks. Conclusions - Tendon transfer is a standard procedure for radial nerve palsy but potential advantage of one method over the other has not been demonstrated. Brand’s transfer results in an acceptable restoration of hand function.

Six-year results of a randomized controlled clinical trial of two glass ionomer cements in class II cavities

ObjectivesLong-term survival of two highly viscous glass ionomer cements (Fuji IX GP Fast and Equia Fil) over a period of 6 years in vivo. MethodsA total of 85 two- or three-surface class II restorations, comprising 43 Equia Fil / Equia Coat and 42 Fuji IX GP Fast / Fuji Coat LC, were placed in 34 patients. The restorations were re-evaluated after 6 years using the FDI criteria. The statistical analysis was performed with Fisher’s exact test, the Wilcoxon signed-rank test, the Mann-Whitney U test and the Kaplan-Meier method. ResultsForty-four restorations (22 Equia Fil and 22 Fuji IX GP Fast) could be assessed at the 6-year follow-up. During the whole study period, eight failures, four for each material, were observed. The main reasons for failure were material fractures and retention loss, which were partly combined with poor marginal adaptation or poor proximal anatomical form. Two failures may be attributed to insufficient application of the materials, as suspected according to the radiographs. The Kaplan-Meier survival proportion for Equia Fil restorations at 6 years was 86.5% and that for Fuji IX GP Fast at 6 years was 86.8% (log-rank p = 0.907). During the period from 3 to 6 years, only one filling in each group failed. ConclusionBoth materials showed acceptable and comparable survival rates after 6 years. Clinical significanceHighly viscous glass ionomer cement can be an acceptable restoration material for smaller class II cavities.

Clinical Performance of Glass Ionomer in Class V Restorations: One-Year Follow-Up of Pilot Study

This study’s purpose is to evaluate the clinical performance of Class V restorations in non-carious cervical lesions (NCCL’s) using conventional glass ionomer Riva Self Cure (SDI) materials in a teaching institute for one-year follow-up. Participants with Class V restorations were recruited from the e-clinical database and reviewed after one-year. Two independent calibrated examiners were assigned to the clinical assessment with high inter-examiner reliability (? =0.82). Modified Ryge / USPHS criteria was used for direct evaluation of the clinical performance of restorations. The criteria assessed were anatomical form, the presence of secondary caries, retention, marginal adaptation, surface staining, soft tissue health and post-operative sensitivity. Class V restoration restored with glass ionomer showed 80.9% retention rate. Secondary caries, retention, surface staining and soft tissue health showed high scoring of A (clinically excellent restoration) (&gt;90%). The highest acceptable restoration percentage (A- clinically excellent restoration + B-clinically acceptable) was surface staining while the lowest scoring categories was post-operative sensitivity. There was significant difference between gender and post-operative sensitivity (p&lt;0.05). Spearman Correlation test showed that the gender was significantly correlated with post-operative sensitivity (r=0.48) while marginal adaptation was significantly associated with anatomical form (r=0.36) and secondary caries (r=0.39). In summary, after one-year follow, conventional glass ionomers are still clinically acceptable material to restore Class V and come with minimal complications. Clinical Significance: Class V restorations restored with conventional glass ionomer is still relevant as a material of choice to restore NCCL’s despite the advancement of resin based materials.

Maxillary segmental osteoperiosteal flap with simultaneous placement of dental implants: case report of a novel technique

Dental restorative space from the opposing dentition requires adequate distance for restorative material for an acceptable restoration. Typically, long-standing edentulous alveolar ridges will have vertical and or horizontal defects that require alveolar ridge augmentation for ideal dental implant restorations. Along with these defects, one will see the opposing dentition supra erupt which can obliterate the restorative space. Multiple surgical techniques have been described to address these dilemmas. The use of osteoperiosteal flaps has been described to address vertical height deficiencies. The purpose of this paper is to document and introduce a maxillary segmental osteoperiosteal flap intrusion to increase the restorative space with simultaneous dental implant placement. As with most dilemmas in treatment planning dental implants, multiple acceptable treatment options are available to the practitioner. This technique is another of many that can be added to the available options. When appropriately planned in select cases, this technique will result with ideal dental implant restorations without compromising the esthetic and functional harmony of the native dentition.

Surgical Results of 135 Thoraco-Lumbar Fractures Treated with Open Posterior Multi-Level Segmental Fixation: A Single Center Experience

Introduction Surgical treatment strategies for thoraco-lumbar spine fractures differ widely around the world. Choice of operative approach varies depending on many factors including fracture classification, presence of spinal cord injury and whether subluxation or dislocation is present. Combinations of anterior and posterior approaches vary depending on surgeon choice, available resources and fracture morphology. We reviewed our experience of thoraco-lumbar vertebral fractures treated at our institution from Jan 14 – May 2015 to determine if our policy of posterior multi- level segmental fixation produced acceptable restoration of spinal alignment and reduction of kyphosis. Materials and Methods A retrospective cohort review was performed using the hospital electronic medical records system (Cerner, USA). All surgical cases were identified from the operating theater records. Only fractures from T1 to L5 were included. Imaging was reviewed using the hospital PACS system and classified according to the AO thoraco -lumbar classification system. Spinal cord injury was classified according to the ASIA scale. Post-operative images were reviewed and levels of fixation recorded. Accuracy of screw placement was assessed. Neurological status at discharge was recorded. Results 135 cases of TL fracture underwent surgery via an open posterior approach. Screw placement was performed using C-arm fluoroscopy.Data on the extent of kyphosis reduction is presented. Post-operative results in cases of vertebral subluxation and dislocation are presented. Early surgical outcome in cases with spinal cord injury are presented. Due to the high level of loss to follow up in our region we were unable to carry out longitudinal outcome studies. Conclusion The majority of thoraco -lumbar fractures can be managed by posterior approaches alone with good surgical outcomes. Type C fractures and fractures with dural tears and nerve damage can be adequately dealt with via this approach. The majority of cases had pedicle screw fixation two levels above and one level below the affected level. This strategy allowed good reduction of deformity, especially for fractures at L1, where fixation only to T12 can be associated with late onset of adjacent segment degeneration.The inability to carry out longitudinal outcome measures is an acknowledged weakness of our study, but the short-term surgical results are comparable to those in the literature using other surgical strategies. This retrospective cohort review supports our continuing use of the posterior multi-level segmental approach for T-L fractures irrespective of fracture type.

Periprosthetic knee fractures

The cumulative incidence of periprosthetic fractures around the knee is increasing further because of an extended indication for knee replacement, previous revision arthroplasty, rising life expectancy and comorbidities. The relevance of local parameters such as malalignment, osseous defects, neighbouring implants, aseptic loosening and low-grade infections may sometimes be hidden behind the manifestation of a traumatic fracture. A differentiated diagnostic approach before the treatment of a periprosthetic fracture is of paramount importance, while the physician in-charge should also have particular expertise in fracture treatment and in advanced techniques of revision endoprosthetics. The following work gives an overview of this topic. Valid classifications are available for categorising periprosthetic fractures of the femur, the tibia and the patella respectively, which are helpful for the selection of treatment. With the wide-ranging modern treatment portfolio bearing in mind the substantial rate of complications and the heterogeneous functional outcome, the adequate analysis of fracture aetiology and the corresponding transformation into an individualised treatment concept offer the chance of an acceptable functional restoration of the patient at early full weight-bearing and prolonged implant survival. The management of complications is crucial to the final outcome.