Bone Repositioning Research Articles

The Expertise of Traditional Healers in Using Coconut Oil as a Traditional Treatment for Bone Fracture Recovery in Aliantan Village

This research aims to explore more deeply the skills of traditional healers in using coconut oil as a traditional treatment for fracture recovery in Aliantan Village. The research method used is a qualitative approach with a case study method, which involves interviews with traditional healers and patients who have undergone treatment, as well as observations to strengthen the data. The research results show that traditional medicine with coconut oil is still relevant and appreciated by the people of Aliantan Village, even though there is a shift towards modern medicine. Broken healers use coconut oil with massage and bone repositioning techniques to speed up the healing process. The conclusion of this research is that the skills of traditional healers and the use of coconut oil remain an important part of cultural heritage and local knowledge that continues to be preserved. Keyword: Shaman, Bones, Oil, Coconut, Treatment

Bone Flap Resorption After Cranioplasty: Risk Factors and Proposal of the Flap Integrity Score

BackgroundBone flap resorption is a known complication of post-decompressive autologous cranioplasty. Although several potential etiopathogenetic factors have been investigated, their role is still under discussion. To further complicate things, resorption is not an all-or-nothing event, patients frequently presenting with different degrees of flap remodeling. Focus of this paper was to describe the elaboration of a score quantifying bone resorption according to a set of clinical and radiological criteria, hopefully allowing prompt identification of patients needing re-surgery before the development of adverse events. MethodsIn a 10-years-time, 281 autologous cranioplasties were performed at our Institution following decompressive craniectomy. Pertinent clinical and radiological information was registered. A set of 3 clinical and 3 radiological parameters was established to score the degree of resorption, identified under the acronym FIS (Flap Integrity Score). Three groups of patients emerged, respectively showing no (208), partial (32) and advanced (41) resorption. ResultsAn overall 14.6% incidence of advanced bone resorption was found in our series. Younger age, bone multifragmentation, higher post-cranioplasty GOS scores, < 2 cm distance of medial craniectomy border from the midline, and cause leading to decompressive craniectomy were associated to a statistically significant higher risk of developing a relevant bone flap resorption. The first three variables confirmed as risk factors at multivariate analysis. FIS well discriminated the 3 different groups. ConclusionsAutologous bone repositioning is still a valuable, low-cost, cosmetically and functionally satisfactory procedure. Nonetheless, although resorption affects a minor percentage of patients, its early identification and treatment can improve long term results.

Average Three-Dimensional Skeletofacial Model as a Template for Bone Repositioning during Virtual Orthognathic Surgery.

Virtual planning has revolutionized orthognathic surgery. This study presents a computer-assisted method for constructing average three-dimensional skeletofacial models that can be applied as templates for surgical planning for maxillomandibular repositioning. The authors used the images of 60 individuals (30 women and 30 men) who had never undergone orthognathic surgery to construct an average three-dimensional skeletofacial model for male participants and one for female participants. The authors validated the accuracy of the newly developed skeletofacial models by comparing their images with 30 surgical simulation images (ie, skulls) that had been created using three-dimensional cephalometric normative data. The comparison was conducted by superimposing surgical simulation images created using the authors' models with the previously created images to analyze their differences, particularly differences in the jawbone position. For all participants, the authors compared the jaw position in the surgical simulation images created using the authors' average three-dimensional skeletofacial models with that in the images created using three-dimensional cephalometric normative data. The results revealed that the planned maxillary and mandibular positions were similar in both images and that the differences between all facial landmarks were less than 1 mm, except for one dental position. Most studies have reported less than 2 mm to be the success criterion for the distance difference between planned and outcome images; thus, the authors' data indicate high consistency between the images in terms of jawbone position. The authors' average three-dimensional skeletofacial models provide an innovative template-assisted orthognathic surgery planning modality that can enhance the fully digital workflow for virtual orthognathic surgical planning. Therapeutic, V.

Virtual Surgical Reduction in Atrophic Edentulous Mandible Fractures: A Novel Approach Based on “in House” Digital Work-Flow

Atrophic edentulous mandible fractures are a challenge for maxillo-facial surgeons because of low vascularization, low bone regeneration, and lack of occlusion. Whereas occlusion is the main guide in the reduction of mandibular fractures, the aim of our study is to show the advantages of using virtual surgical planning (VSP) in surgery when the occlusal guide is absent. This work is a prospective study that shows the in-house digital workflow for the management of these fractures in the Maxillo-Facial Surgery Unit of Federico II University Hospital of Naples. Four patients who satisfied the criteria were included in the study. For each patient, the same defined CAD/CAM-based was applied. The workflow followed four steps: (1) bone segmentation and virtual reduction of fracture fragments; (2) three-dimensional printing of virtually reduced mandible and modelling of 2.4 reconstruction plate on printed resin model; (3) surgery aided by the pre-formed plate; (4) digital and clinical outcomes analysis. In the last step, a distance colour map was conducted to compare the virtual planning and postoperative CT outcome. In all cases, the discrepancies values between the two images were lower than 1.5 mm, and good clinical outcomes in terms of facial symmetry, absence of sensory disturbance, and possibility of prosthetic rehabilitation were obtained. In conclusion, the VSP, with our in-house workflow brings benefits in the management of atrophic edentulous mandible fractures in terms of the high accuracy of bone repositioning.

Role of surgical hyoid bone repositioning in modifying upper airway collapsibility.

Background: Surgical hyoid bone repositioning procedures are being performed to treat obstructive sleep apnea (OSA), though outcomes are highly variable. This is likely due to lack of knowledge regarding the precise influence of hyoid bone position on upper airway patency. The aim of this study is to determine the effect of surgical hyoid bone repositioning on upper airway collapsibility. Methods: Seven anaesthetized, male, New Zealand White rabbits were positioned supine with head/neck position controlled. The rabbit's upper airway was surgically isolated and hyoid bone exposed to allow manipulation of its position using a custom-made device. A sealed facemask was fitted over the rabbit's snout, and mask/upper airway pressures were monitored. Collapsibility was quantified using upper airway closing pressure (Pclose). The hyoid bone was repositioned within the mid-sagittal plane from 0 to 5mm (1mm increments) in anterior, cranial, caudal, anterior-cranial (45°) and anterior-caudal (45°) directions. Results: Anterior displacement of the hyoid bone resulted in the greatest decrease in Pclose amongst all directions (p = 0.002). Pclose decreased progressively with each increment of anterior hyoid bone displacement, and down by -4.0 ± 1.3cmH2O at 5mm. Cranial and caudal hyoid bone displacement did not alter Pclose (p > 0.35). Anterior-cranial and anterior-caudal hyoid bone displacements decreased Pclose significantly (p < 0.004) and at similar magnitudes to the anterior direction (p > 0.68). Conclusion: Changes in upper airway collapsibility following hyoid bone repositioning are both direction and magnitude dependent. Anterior-based repositioning directions have the greatest impact on reducing upper airway collapsibility, with no effect on collapsibility by cranial and caudal directions. Findings may have implications for guiding and improving the outcomes of surgical hyoid interventions for the treatment of OSA.

Contemporary management of complex craniofacial trauma: virtual planning, navigation and the novel thermoformed cage splints in a strategic, sequential, computer-guided protocol

IntroductionIt was the aim of the study to assess if computerized simulation and the use of thermoformed cage splints are useful to plan cases of complex craniofacial trauma. Materials and methodspatients with fractures in any of the thirds of the craniofacial skeleton and occlusion impairment. Virtual surgical planning with digital reduction of fractures, navigated planning, thermoformed cage splints were used in all cases. Surgical outcomes were evaluated by computing the surface deviation and occlusograms between planned and postoperative models. Results13 patients were enrolled in this study. Accuracy of bone repositioning was evaluated compared with the surgical planning. For the mandible, mean Root Mean Square Error (RMSE) was of 1.67 with a standard deviation (SD) of ±0.75 mm (p < 0.001); for the maxilla, average RMSE was of 0.88 with SD of ±0.52 mm (p < 0.001); and for midfacial and upper third bone segments, average RMSE was of 0.59 with SD of ±0.47 mm (p < 0.001) ConclusionsWithin the limitations of the study it seems that thermoformed cage splints might be a promising alternative to other well-established approaches for accurate occlusal restoration and can be fully integrated within the digital workflow.

The Accuracy of Computer-Assisted Surgical Planning in Predicting Soft Tissue Responses After Le Fort I Osteotomy: Retrospective Analysis.

Mismatch between preoperative planning and surgical outcome in maxillofacial surgery relate to on-table replication of presurgical planning and predictive algorithm inaccuracy: software error was hereby decoupled from planning inaccuracy to assess a commercial software. The hypothesis was that soft tissue prediction error would be minimized if the surgical procedure was replicated precisely as planned and is independent of the extent of bone repositioning. Cone-beam computed tomography scans of 16 Le Fort I osteotomy patients were collected at Boston Children's Hospital. Preoperative and postoperative models of bone and soft tissue were constructed and the maxilla repositioning was replicated. Each model was subdivided into 6 regions: mouth, nose, eyes, and cheeks. Soft tissue prediction (performed using Proplan CMF-Materialise) for each patient was compared with the relative postoperative reconstruction and error was determined. P <0.05 was considered significant. Le Fort I segment repositioning was replicated within 0.70±0.18mm. The highest prediction error was found in the mouth (1.49±0.77mm) followed by the cheeks (0.98±0.34mm), nose (0.86±0.23mm), and eyes (0.76±0.32). Prediction error on cheeks correlated significantly with mouth ( r =0.63, P < 0.01) and nose ( r =0.67, P < 0.01). Mouth prediction error correlated with total advancement ( r =0.52, P =0.04). ProPlan CMF is a useful outcome prediction tool; however, accuracy decreases with the extent of maxillary advancement even when errors in surgical replication are minimized.

Multi‐ligamentous injury of the carpus with dislocation of the ulnar styloid in a dog

AbstractA 3‐year‐old mixed‐breed dog was presented with acute onset of non‐weight bearing right thoracic limb lameness. Radiographs revealed dislocation of the ulnar styloid and a small slab fracture of the medial cortex of the distal ulna. Moderate medial and mild lateral instability without hyperextension were detected, and carpal bone fractures were excluded on stress radiographs and computed tomography. The surgical repositioning of the ulnar bone revealed multiple torn ligaments. To reinforce primary repair, the collateral ligaments were augmented medially and laterally using screws, washers and synthetic suture material. Postoperatively, external coaptation, followed by a soft neoprene brace, was used for further rehabilitation. Seven months postoperatively, the dog exhibited pre‐traumatic function. There is no proper classification for multi‐ligamentous injuries, and little is known regarding the long‐term outcomes and limitations of primary carpal ligament repair. In this case, medial and lateral ligament prostheses provided a feasible treatment option with excellent outcomes.

Descriptive Analysis of Idarucizumab (Praxbind®) Use in a National Hospital Database

Study Objectives:Based on clinical data including the REVERSE AD study, idarucizumab (Praxbind®), the first reversal agent specific for dabigatran (Pradaxa®) users, received approval for indications of life threatening bleeding and emergency surgery/urgent procedures in patients treated with dabigatran when reversal of the anticoagulant effects of dabigatran is needed. The objectives of this analysis were to identify the number of idarucizumab encounters in a large national hospital database; describe indications and patient characteristics of those encounters; and, extrapolate the number of national uses.Methods:This is a retrospective analysis of the Premier Healthcare Database (PHD) among adult patients (age >18 years) with a hospital encounter between October 16, 2015 and September 30, 2016 and a billing charge for idarucizumab. For this analysis, idarucizumab indication was defined using ICD 9 and 10 diagnosis and procedures codes and Admission Type from the CMS UB04 Billing Form. Life threatening bleed was defined as intracranial hemorrhage or gastrointestinal bleed with admission type of emergent, urgent, or trauma; Emergency Surgery/Urgent Procedure was defined as procedure on the day of or day after admission with admission type of emergent, urgent, or trauma. Categorical variables were presented as counts and percentages (N, %) and continuous variables were summarized as means (standard deviations), medians and interquartiles. National volume projections were estimated using Premier's proprietary methodology that includes weighting according to hospital characteristics.Results:During the identification period, there were 558 encounters requiring idarucizumab. The mean patient age at encounter was 76 years (± 12), 53% were male, 88% were white, and the mean Charlson Comorbidity Index score was 2.4 (± 2.2). Among 494 patients, 60% were admitted with a life threatening bleed, 36% with an emergency surgery/urgent procedure and 4% fit both indication definitions; 64 (12%) could not be categorized. Among those admitted with life threatening bleeds, 61% were gastrointestinal and 36% were intracranial. The most common emergency surgery/urgent procedures were gastrointestinal surgeries for inspection, resection, excision, and/or repair (21%), bone repositioning (8%), drainage/repair of anatomical site (7%), joint replacement (7%) and hepatobiliary system/pancreas resection (6%). Overall, ninety-six percent of the initial dose administered was according to the label (5g/100mL). The estimated number of idarucizumab administrations nationally over the 1-year period was 2,225.Conclusion:This is the first real world descriptive analysis to characterize the utilization of idarucizumab in U.S. hospitals. From this analysis, withstanding the limitation of a retrospective analysis, the pattern of use for idarucizumb is consistent with what was observed in the REVERSE AD clinical trial. Further study is required to understand the implications of use on clinical and economic outcomes in a real-world setting. DisclosuresNo relevant conflicts of interest to declare.

Comparative assessment of changes in pharyngeal airway space in cases of obstructive sleep apnoea with a customized mandibular repositioning appliance - a clinical study

ObjectivesThe present study aims at evaluating the effects of a customized mandibular repositioning appliance on the pharyngeal airway, nocturnal sleep patterns, daytime discomfort and occlusal changes in established cases of adult obstructive sleep apnoea.Material and MethodsTen consecutive patients with a complaint of snoring and disturbed sleep were included in the study. The primary diagnosis was established by the Epworth sleepiness scale, clinical examination, history and subsequently the diagnosis was substantiated through assessment of the pharyngeal airway space on a lateral cephalogram and polysomnography. A customized mandibular repositioning appliance was used to advance the mandible sequentially every 6 months, using 4 sets of the appliance. Pre and post-treatment evaluations were performed to establish, effects and changes in the outcome of obstructive sleep apnoea.ResultsThe study revealed significant increase in the mean pharyngeal widths of upper airway and velum dimension with antero-superior repositioning of hyoid bone. Epworth sleepiness scale score improved significantly from baseline with clinically evident change in daytime discomforts. Significant decline in the mean apnoea/hypopnea index, oxygen desaturation index, respiratory disturbance index, heart rate, snoring and a significant increase in mean oxygen saturation of arterial blood was observed. No evident change noticed in occlusion except lower incisor inclination.ConclusionThe customized mandibular repositioning appliances are effective in the management of adult obstructive sleep apnoea with a significant improvement observed in the airway patency and polysomnography parameters with clinically non-significant effects on dental occlusion..

Patient-specific plate for navigation and fixation of the distal radius: a case series

PurposeCorrective osteotomy of a malunited distal radius conventionally relies on 2D imaging techniques for alignment planning and evaluation. However, this approach results in suboptimal bone repositioning, which is associated with poor patient outcomes. In this case series, we evaluate the use of novel patient-specific plates (PSPs), which feature navigation and fixation of bone segments as preoperatively planned in 3D.MethodsTen participants with distal radius malunion underwent CT scans for preoperative alignment planning. Patient-specific guides and plates were designed, 3D-printed, and sterilized for use in corrective surgery of the distal radius. Pre- and postoperative results were compared in regard to clinical, functional, and radiographic outcomes.ResultsThe application of a PSP was successful in 7 of the 10 cases. After treatment, the residual alignment error was reduced by approximately 50% compared with conventional treatment. The use of PSPs reduced pain significantly. Pre- and postoperative results were pooled and demonstrated significant correlations between: (1) pain and malpositioning, (2) the range of pro- and supination motion, the MHOQ score, the EQ-5D-5L score and dorsovolar angulation, and (3) MHOQ score and proximodistal translation.ConclusionThe correlation between malalignment and MHOQ score, EQ-5D-5L score, pain, and range of motion shows that alignment should be restored as well as possible. Compared to the conventional approach, which relies on 2D imaging techniques, corrective osteotomy based on 3D preoperative planning and intraoperative fixation with a PSP has been shown to improve bone alignment and reduce pain.Level of evidenceIV.

The importance of reestablishing orbitary architecture for rehabilitation with an ocular prosthesis: a case report

Anophthalmia is mainly caused by two etiological groups, trauma and medical conditions. In addition, anophthalmia creates difficulties in social, professional, and family adaptation due to psychological, and functional disorders related to eye loss. Studies show a positive influence on the personal relationship of patients with anophthalmia after being rehabilitated with ocular prostheses. However, in order to achieve a good aesthetic result in prosthetic eye rehabilitation, it is essential that the size and positioning of the orbital skeleton are adequate. Facial trauma can also cause defects associated with bone loss, and in these cases, reconstructive techniques aim to restore the appropriate bone contour. The aim of this work is to report a case where reconstructive treatment was performed on a patient victim of a long-term traffic accident sequel, using an alloplastic implant in polymethylmethacrylate (PMMA) and bone repositioning, so that an ocular prosthesis could be made. At the end of the treatment, after reconstruction of the frontal-nasal region in PMMA and repositioning of the left zygoma, the aesthetic objectives were achieved and the patient improved his self-esteem and social life.

Use of the developed bone holder for open reposition of small tubular bones

The disadvantages and traumatic injury of using traditional traumatological instrumentation for open reduction of metacarpal fractures prompted the development of a modified bone holder. The clinical experience of using the developed instrument is presented, the advantages of its use are displayed.

A preoperative planning method for long tubular bone osteosynthesis

Objectives the development of a preoperative planning method for long tubular bone osteosynthesis using the contralateral healthy bone.&#x0D; Material and methods.To justify the usage of the opposite limbs intact segment model in order to reconstruct the damaged one, their matching in shape and size was analyzed. We built three-dimensional models of the right and left segments of the upper limbs of 20 people and compared them using the Hausdorff distance calculation algorithm. For treatment of a 24-year-old patient with a closed humerus fracture, an individual stereolithographic surgical template with fracture lines was created with the help of computed tomography data of the healthy humerus bone processed by AUTOPLAN EXPERT software. This template was used for pre-bending the plate for osteosynthesis. The plate positioning on the template defined the surgical approach, taking into account the anatomical structures located in the projection of the fracture line and the plate. The technique of "reverse bone reposition" on the prepared plate was applied.&#x0D; Results.With the help of the created 3D models we revealed the size differences of the symmetrical segments of upper limbs. The greatest difference in the limits was registered in the area of the epiphyses (heads of the humeri) up to 6.8 mm, and the smallest throughout the entire diaphysis, less than 1.5 mm. Due to preoperative planning there were no intraoperative and postoperative complications, the installation of the plate and osteosynthesis was convenient. The fracture consolidation took place in 3 months.&#x0D; Conclusion.The proposed method has a number of advantages. It is possible to make a stereolithographic template even for a seriously damaged bone with a copied fracture line. This allows the surgeon to plan the details of osteosynthesis, to model the plate according to the template, to determine the required length and shape of the surgical approach, thus reducing the surgical risks and injury for the patient.

A Robot Arm and Image-Guided Navigation Assisted Surgical System for Maxillary Repositioning in Orthognathic Surgery: A Phantom Skull-Based Trial

This study aimed to present a simplified and safe method to reposition the bone segment with easy identification and removing bone interference using a robot arm and image-guided navigation and to assess the accuracy for maxillary orthognathic surgery on phantom skulls. A surgical system consists of a robot arm with specialized end-effector, and image-guided navigation including the optical tracking system. The end-effector was designed to reflect the surgical procedures including identification and removal of bone interference and repositioning of the bone segment. To evaluate the handling and accuracy of this system, 10 phantom-based experiments were conducted according to four surgical plans. Mean absolute deviations at the upper central incisor were 0.10 ± 0.15 mm medio-laterally, 0.05 ± 0.07 mm antero-posteriorly, and 0.12 ± 0.15 mm supero-inferiorly. There was no significant difference in deviations between anterior and posterior regions of the maxilla. The mean root mean square deviation was 0.18 ± 0.16 mm, and ranged from 0.05 mm to 0.54 mm. The robot arm and image-guided navigation assisted surgical system would be helpful to manage bone interferences and reposition bone segments with improved accuracy. Though further technological advances are necessary, this study may provide a basis for developing clinically applicable robot assisted system for orthognathic surgery.

Особливості діагностики та лікування нестабільності крижово-клубового суглобу у собак

Trauma of sacroiliac joint in dogs is often caused by consequences of pelvis and pelvic limb injuries. As a result, this case can go unnoticed while pet is being treated from more oblivious pathologies. According to the results of the study, it can be concluded that sacroiliac instability may appear as outcome of big specter of different etiological factors and have different clinical manifestations. Diagnosis of this pathology should be prioritized because of its significant extend in dogs and major decline of the animal's quality of life. Diagnosis of the specified pathology has to be approached complexly taking into account history data and manual research of the pathological site. With the help of X-ray diagnostics it is possible to determine normal and pathological mobility in the sacroiliac joint, which allows to combine radiological and biomechanical studies. There are also specialized ways to perform X-ray studies of this pathology, such as radiogrammetry of the pelvis. In addition, computer tomography is an informative method of research and gives a detailed analysis of ​​the tissue damage. Treatment has to be applied depending on combination of pelvic injuries, displacement direction of iliac bone, determination of the degree of instability, breed features, etc. Treatment can be made by surgical intervention or conservatively. Most effective treatment of sacro-iliac instability proves to be surgical fixation, but it is not always mandatory and sometimes impossible to execute. When a surgical treatment is planned, it is necessary to take into account the direction of the displacement of the ilium in relation to the sacral. The manual exposure of the bone reposition with their subsequent fixation will depend on it. Particular immobilization of the animal, analgesic and anti-inflammatory therapy can be used as methods of instability sacroilial joint treatment. The prospect of research into this pathological condition is the development of a comprehensive method of treatment using pathogenetic methods.

PO 18236 - Assessment of hallux valgus reduction using a modified version of the McBride test

Introduction: The McBride test was created to assess hallux valgus reduction and is also used to assess capsular and lateral soft-tissue tension indicating the need for lateral capsular release after the bone procedure in the first metatarsal bone. The flowcharts for lateral soft-tissue release remain unclear and lack consensus among surgeons. Objective: To propose a modified version of the test for the complementary preoperative assessment of hallux valgus reduction. Methods: We describe a method in which the examiner supinates the first metatarsal head medially to manually correct the pronation of the first metatarsal and then applies varus force to the hallux to test the lateral capsular tension of the metatarsophalangeal joint. Results: A significant reduction in lateral capsular tension was observed in the metatarsal head lifting and rotating maneuver compared with the conventional McBride test. Discussion: Hallux valgus reduction is greater with manual correction of the deformity than with the classic McBride test, most likely because of the resulting rotational bone repositioning and soft-tissue balancing. These changes seem to decrease the lateral tension that limits the correction of the deformity in the metatarsophalangeal angular plane. Conclusion: We believe that this modified version of the McBride test can be used as a more reliable predictor of the need for lateral metatarsophalangeal release after the metatarsal position is corrected through osteotomy or cuneometatarsal arthrodesis.&#x0D;

Virtual 3D planning of osteotomies for craniosynostoses and complex craniofacial malformations

Introduction and objectivesComputer-assisted surgery has been more and more widely used in craniofacial surgery in recent years. It is useful in many situations: stereolithographic models, surgical simulations of osteotomies and bone repositioning, and cutting guides and customized implants. The present paper argues that computer-assisted surgery is particularly useful in complex cases such as rare malformations, or to address the sequelae of previous surgeries. The various advantages of the technique are emphasized from a surgical and from a teaching standpoint. Materials and methodsForty cases of various computer-assisted surgeries were analyzed, allowing a comprehensive review of outcomes in cases such as craniosynostosis, complex craniosynostosis, hypertelorism, craniosynostosis sequelae and cranio-facial and orbital trauma. ResultsResults were promising in all of the cases reviewed, except in a few cases for which computer-assisted surgery with cutting guides may not be necessary. In these specific cases, the pedagogical input is nevertheless interesting for residents and students. ConclusionComputer-assisted surgery is revolutionizing the surgical approach to complex craniofacial malformations, as well as easing management of less complex ones. It is likely that in the years to come this technique will supersede previous ones. However, using this technique implies being willing to rely on a non-human device. We need to consider computer-assisted surgery as a tool that can change surgical practices. The surgeon can rely on it, yet nothing will replace his/her eye and experience. It is the combination of both this experience and the appropriate use of computer-assisted surgery that, ultimately, leads to successful surgery.

Efficacy evaluation of closed reduction of fifth metacarpal neck fractures in children

This article covers the retrospective analysis of the results of treatment of 47 children aged 9 to 17 years with V metacarpal neck fractures, based on the data of radiation studies. The treatment of fifth metacarpal neck fractures, without reduction, does not have a reliable positive result. At large angles of deformity of the V neck of the metacarpal (&gt;45°), the use of closed reduction leads to a significant positive therapeutic effect in the immediate observation period. However, from our point of view, the persistence of the displacement V metacarpal bone with sufficiently large degree in certain cases and the presence of posttraumatic changes in the structure of the heads, subcapital and growth zones in the observed patients cannot satisfy specialists from the standpoint of modern children’s traumatology. Thus, changes in the structure of the heads and subcapital zones in the long-term radiological control of the group were found in 11. 1% of patients who were treated without reduction with a stabilizing plaster cast and in 55% of patients who underwent closed reduction of the metacarpal fractures. The predominance of the narrowing of the growth zone of the injured V metacarpal bone occurs in patients who undergo a closed manual reduction, which may be due to the traumatic effect on the physical zone of the primary force or reduction manipulations. All this indicates the feasibility of further scientific research of this problem with the prospect of developing therapeutic technologies that allow to achieve a complete anatomical reposition of the metacarpal bones in pediatric patients.

An average three-dimensional virtual human skull for a template-assisted maxillofacial surgery.

Although many advances have been made in three-dimensional virtual planning in maxillofacial surgery, facial harmony is still difficult to achieve and is heavily dependent on the surgeon's experience. The aim of the study is to present a method to build up an average three-dimensional virtual human skull to be used as a reference template for bone repositioning and reconstruction during maxillofacial surgical interventions. A total of 20 patients (10 females and 10 males) were selected for the optimal outcome after orthognathic surgery. Postoperative cone-beam computed tomography scans were collected and processed in order to obtain three-dimensional digital models of each skull. For male and female subgroups, the three-dimensional skull models were registered and an average three-dimensional virtual skull model was computed. Deviation color maps were calculated to show differences between each postoperative skull model in the population and the obtained average three-dimensional skull. A clinical use case of genioplasty treatment assisted by the provided average three-dimensional skull template was presented. The overall mean deviation from the average three-dimensional skull model was 1.3 ± 0.6 and 1.6 ± 0.5 mm in male and female subgroups, respectively. For both groups, the greatest deviations were at the area of the mandible, while almost no deviation was found at the zygomatic and orbital areas. In the presented use case, the female average three-dimensional skull model was effectively used for guiding surgical planning. The presented method of obtaining an average three-dimensional virtual human skull may offer the interesting perspective of performing an innovative template-assisted maxillofacial surgery.