Residual Bone Research Articles

PAPER 14: Excision of Hook of Hamate Fractures in Elite Baseball Players: Surgical Technique and Return to Play

Objectives:Hook of hamate fractures are relatively common in baseball players, but diagnosis and surgical technique can be challenging. Outcomes following surgical excision, as well as optimal surgical technique, in elite baseball players have not been clearly established. Our hypothesis was that excision of hook of hamate fractures in elite professional and collegiate baseball players with a tailored technique would lead to high rates of return to play within a short time.Methods:eview of a single academic hand surgery practice from 2006-2020 found 42 elite athletes competing at professional (20) or varsity collegiate (22) baseball levels who underwent surgical excision of 42 hook of hamate fractures with a standardized technique. The clinical history, timing of surgery, complications, and time to return to play were recorded for each patient.Results:All patients underwent an excision of their hook of hamate fracture at an average of 7.2 weeks (range 0.5 – 52 weeks) from the onset of symptoms. All patients but one were able to return to full pre-injury level of baseball participation within 6 weeks from the date of surgery, with a mean return to sport of 5.4 weeks (range 3-8 weeks). Two patients returned to the operating room – one for scar tissue formation causing ulnar nerve compression and one for residual bone fragment causing pain and ulnar nerve compression.Conclusions:Surgical excision of hook of hamate fractures in elite baseball players showed a very high rate of return to play within six weeks. Meticulous adherence to the described surgical technique tailored to athletes optimizes clinical outcomes and avoids complications.

Surgical Treatment of Clavicular Fractures, Refractures, Delayed and Non-Unions Using a Resorbable, Gentamicin-Eluting Calcium Sulphate/Hydroxyapatite Biocomposite.

ObjectiveThis study describes clinical and radiological outcomes following treatment of displaced primary fractures, refractures, delayed unions and non-unions of the clavicle with open reduction and internal fixation (ORIF) with a plate plus filling of the residual bone defect and/or implant augmentation with a gentamicin-loaded bone graft substitute (CERAMENT G, BONESUPPORT).Patients and MethodsPatients who underwent surgical treatment either for displaced clavicle fractures, refractures, delayed unions or non-unions between June 2018 and May 2021 were enrolled in this retrospective study. Bony consolidation, complication rate, and functional outcomes, including overall health, were assessed.ResultsA total of 26 clavicles in 25 patients with a mean age of 50.7 (16–85) years, 16 male and 9 female, were enrolled in the study. The mean follow-up was 14.9 (6–31) months. There were 18 cases of displaced clavicle fractures, four refractures, two delayed unions and two non-unions. The majority of the clavicle lesions were located at the middle third (17/26, 65.4%), seven at the lateral third (26.9%) and two at the medial third (7.7%) of the clavicle. A mean Goldberg score of 7 indicated complete bony union and remodeling of the bone graft substitute in all cases. No complications occurred. The mean University of California at Los Angeles Shoulder Score and the mean Quick Disability of the Arm, Shoulder and Hand Score were 34.6±0.8 (32–35) points and 0.6±1.6 (0–5.4) points, respectively, and revealed excellent functional results. The mean 12-item Short-Form Survey physical component questionnaire was 57.7±1.7 (54.1–58.9) points, and no patient experienced any pain at the last follow-up.ConclusionOur initial experience suggests that ORIF using a plate plus bone defect filling and/or implant augmentation with a gentamicin-eluting bone graft substitute may be useful not only for complication management after clavicle fractures but also in the initial treatment of challenging clavicular fractures.

Evaluation of Contour Augmentation in Immediate Single-Tooth Implants With and Without Flaps in the Anterior Maxilla: A 1-Year Prospective Study.

This prospective clinical study involved 20 patients in whom implants were immediately placed in extraction sockets. Residual bone defects were grafted, and the buccal bone plate was overcontoured with a xenogeneic bone substitute and covered by a collagen membrane. One year after implant placement, CBCT images were acquired to evaluate buccal bone, and implant stability was analyzed through resonance frequency analysis. Results showed that buccal bone covered the rough surface of all implants 1 year after implantation. Hard tissues responded more favorably in the flapless group. No correlation was found between initial bone defects and bone dimensions in the follow-up exam.

Influence of the height of the alveolar bone in the distal parts of the upper jaw on the odontogenic inflammatory processes in the maxillary sinus

Aim: To determine whether the height of the alveolar bone affects the transmission of inflammation from the periapex of the tooth to the maxillary sinus. Background: The maxillary sinus is the largest of all paranasal cavities and is located in the body of the upper jaw. The inflammatory process in the teeth can often ascend to the maxillary sinuses and thus can cause odontogenic maxillary sinusitis. Untreated periapical inflammatory processes of the teeth in the distal parts of the upper jaw are the most common cause of odontogenic sinusitis. Data in the literature show that there is a correlation between the thickness of the mucosa of the maxillary sinus and the proximity of some anatomical structures, such as the height of the alveolar bone between the distal teeth of the upper jaw and the floor of the maxillary sinus. Methods: To accomplish the task, we analyzed 109 CBCT images of patients with odontogenic cysts of the upper jaw, located in the area below the floor of the maxillary sinus. In 61 of them the residual alveolar bone was less than 3 mm. For the other 48 it was over 5 mm. The group of teeth, included in the study, consisted of premolars and molars. Above each tooth with an odontogenic cyst, the thickness of the mucosa of the maxillary cavity was measured. For normal mucosa we considered thickness of 0 – 2 mm, and for pathological – thickness of over 2 mm. Group I – In this group we included odontogenic cysts in which the measured distance between the cystic cavity and the floor of the maxillary sinus was less than 3 mm. Group II – In this group we included odontogenic cysts in which the measured distance between the cystic cavity and the floor of the maxillary sinus was over 5 mm. Results: The following results were obtained in group I. Of the 61 cases with an odontogenic cyst present and alveolar bone height below 3 mm, the mean measured value in mm of sinus membrane thickness was 5.7 mm. The maximum value was 13 mm and the minimum was 2 mm. In group II we obtained the following results: we had 47 cases of radicular cysts of the distal teeth of the upper jaw, and the height of the bone to the floor of the maxillary sinus was 5 mm and more. The average thickness of the maxillary sinus mucosa was 2.21 mm. For comparison, up to 2 mm in the scientific literature is considered a healthy clinical mucosa. The minimum measured value was 1 mm and the maximum value was 8 mm. Conclusions: Based on the results obtained, we can conclude that there is a clear relationship between the thickening of the maxillary sinus membrane and the present periapical pathology of the maxillary distal teeth when they are close to or in contact with the floor of the maxillary sinus. This dependence increases with decreasing the volume of the residual alveolar bone.

Radiographic Analysis of Graft Dimensional Changes after Lateral Maxillary Sinus Augmentation with Heterologous Materials and Simultaneous Implant Placement: A Retrospective Study in 18 Patients.

Background: This investigation aimed to radiographically assess the variations of graft dimension following maxillary sinus augmentation by the lateral approach. Methods: Eighteen patients (seven males), with a mean age at surgery of 66.5 ± 9.8 (range 52–82) years, were unilaterally treated. Thirty-five dental implants were positioned in the posterior maxilla simultaneously to grafting with heterologous biomaterials. Intraoral radiographs taken at the time of surgery, after six months, and at the longest follow-up (up to nine years after implant placement) were analyzed. The following distances were measured: mesio-distal width of the graft, vertical distance from implant apex to most coronal level of the graft, distance from the mesial aspect of the (mesial) implant to the mesial graft extension; distance from the distal aspect of the (distal) implant to the distal graft extension, and graft height along the implant axis. The dimensional changes with respect to baseline, after six months and at the longest follow-up were calculated. Results: The patient-based mean follow-up was 38.3 ± 30.1 months (range 12–108 months). The mean residual bone height at the mesial and distal aspect of the implants was 3.19 ± 2.05 mm and 2.65 ± 1.60 mm, respectively (p = 0.38). The mean graft width at baseline was 27.95 ± 5.23 mm, and the mean graft width reduction was 10.2 ± 12.7% (2.98 ± 3.62 mm) and 11.3 ± 14.4% (3.36 ± 4.08 mm) at six months and at the latest follow-up. The change was significant at six months (p = 0.005), but did not show significant further variation (p = 0.11). On the mesial and distal aspect, the mean graft extension decreased by 1.56 ± 2.67 mm and 0.84 ± 2.71 mm at the latest follow-up. No significant difference between mesial and distal changes was found (p = 0.24), suggesting that the biomaterial is resorbed homogeneously on both sides. The mean graft height was 11.92 ± 2.53 mm at baseline and decreased by 9.3 ± 9.05% (1.11 ± 1.09 mm) at six months (p < 0.001). Non-significant further changes were found at the latest follow-up (p = 0.10). Conclusions: after early remodeling, heterologous bone substitutes showed a good dimensional stability in the mid-term for maxillary sinus augmentation.

Guided implant surgery and sinus lift in severely resorbed maxillae: A retrospective clinical study with up to 10 years of follow-up

ObjectivesIn the posterior maxilla, due to the presence of maxillary sinus, residual bone height lower than 3mm is a critical factor that can affect implant stability and survival. The use of guided surgery may facilitate the surgical procedures and the implant insertion in case of severely resorbed maxillae. Moreover, it may have beneficial effects on the long-term survival and success of implant-supported restorations. This study aimed to evaluate implant supported restorations on severely resorbed maxilla (<3 mm) after sinus lift with collagenated xenograft and guided surgery. MethodsForty-three patients with need for implant rehabilitation and residual bone height between 1 and 3 mm were recruited. Surgical and prosthetical aspects were planned following digital approach with the use of Realguide 5.0 (3diemme, Varese, Italy). Lateral window sinus lift was performed and implants were placed simultaneously to the augmentation procedure with a tooth-supported pilot drill surgical template. A pre-hydrated collagenated porcine bone matrix was adopted as regenerative material. Computer-aided-design/computer-aided-manufacturing (CAD/CAM) restorations were delivered after six months of healing. Milled titanium chamfer abutments with CAD/CAM crowns were used. Bone height at implant site level was measured using an image software analysis applied to the pre- and post-surgical radiographs and at the follow-up. Biological and technical complications were recorded during all the follow-up periods. ResultsFifty-four sinus were treated. After a mean follow-up time of 5.11 years (SD: 2.47), no implants were lost nor showed signs of disease. The mean pristine bone height was 2.07 mm (SD: 075). At the final evaluation the augmented sinus height was 12.83 mm (SD: 1.23). Two cases experienced minor perforation of the membrane, while five patients developed minimal post-operative complications, completely resolved with pharmacologic therapy. No mid-term biological complications were experienced by the patients. No cases experienced peri-implant mucositis and peri-implantitis during the whole follow-up period. Four patients (7.4%) faced an unscrewing of the prosthesis. ConclusionsThe present study showed the efficacy in the mid-term of the digital planning and the guided surgery in restoring severely resorbed posterior maxilla with dental implants. Clinical SignificanceThis paper underlines the high potential of the digital approach in the mid-term to implant rehabilitation of severely resorbed maxilla simultaneously with sinus lift.

Within-subject effects of standardized prosthetic socket modifications on physical function and patient-reported outcomes

BackgroundAmong the challenges of living with lower limb loss is the increased risk of long-term health problems that can be either attributed directly to the amputation surgery and/or prosthetic rehabilitation or indirectly to a disability-induced sedentary lifestyle. These problems are exacerbated by poorly fit prosthetic sockets. There is a knowledge gap regarding how the socket design affects in-socket mechanics and how in-socket mechanics affect patient-reported comfort and function. The objectives of this study are (1) to gain a better understanding of how in-socket mechanics of the residual limb in transfemoral amputees are related to patient-reported comfort and function, (2) to identify clinical tests that can streamline the socket design process, and (3) to evaluate the efficacy and cost of a novel, quantitatively informed socket optimization process.MethodsUsers of transfemoral prostheses will be asked to walk on a treadmill wearing their current socket plus 8 different check sockets with designed changes in different structural measurements that are likely to induce changes in residual limb motion, skin strain, and pressure distribution within the socket. Dynamic biplane radiography and pressure sensors will be used to measure in-socket residual limb mechanics. Patient-reported outcomes will also be collected after wearing each socket. The effects of in-socket mechanics on both physical function and patient-reported outcomes (aim 1) will be assessed using a generalized linear model. Partial correlation analysis will be used to examine the association between research-grade measurements and readily available clinical measurements (aim 2). In order to compare the new quantitative design method to the standard of care, patient-reported outcomes and cost will be compared between the two methods, utilizing the Wilcoxon-Mann-Whitney non-parametric test (aim 3).DiscussionKnowledge on how prosthetic socket modifications affect residual bone and skin biomechanics itself can be applied to devise future socket designs, and the methodology can be used to investigate and improve such designs, past and present. Apart from saving time and costs, this may result in better prosthetic socket fit for a large patient population, thus increasing their mobility, participation, and overall health-related quality of life.Trial registrationClinicalTrials.gov NCT05041998. Date of registration: Sept 13, 2021.

AUTOLOGOUS BONE GRAFTS – INDICATIONS AND RESTRICTIONS

INTRODUCTION : Autologous bone grafts and especially intraoral autografts have been used with increasing success for centuries and remain in common use today. They involve the transport of bone from an intraoral donor site to a different intraoral site, in the same patient. AIM AND METHOD: The aim of this poster is to introduce the intraoral autogenous bone grafts and evaluate the indications and restrictions of these techniques. MATERIAL AND METHOD: Autografts are commonly obtained from intraoral sites such as: symphysis mandible, ramus mandible, anterior sinus wall and lateral zygomatic buttress. Autograft bone harvested from mandibular ramus is used when the requiring augmentation is less than 4mm in thickness and span a maximum of four teeth. Although this graft presents a risk of damage to the inferior alveolar nerve, it is associated with secondary complications compared to other intraoral sites. Generally, indications for bone augmentation procedures are determined by means of the following parameters: a)Presence of severe alveolar ridge atrophy rated classes IV and V according to the Cawood and Howell classification b)Residual maxillary bone less than 5 mm from the alveolar crest to the sinus floor. RESULTS: Even when major augmentation procedures with autografts had to be carried out for severely resorbed jaws, success rates exceeding 95% have been achieved. CONCLUSION: Although, autolografts occasionally have significant drawbacks, such as increased postoperative morbidity, the need of secondary surgical visit and the lack of sufficient bone mass at the donor site, it is still regarded as the gold standard in alveolar reconstruction, due to its osteoconduction, osteoinduction and osteogenesis-inducing characteristics.

Osteotome technique: literature review

OBJECTIVE: This focus literature review aimed to identify, in a clear and systematic way, the various factors (indications, influence of biomaterials and survival rates of the implants) that a clinician must take into account when addressing the maxillary sinus using trasncrestal maxillary sinus floor elevation techniques. MATERIALS AND METHODS: The papers to include in this focus review were obtained via automatic search and screening of articles published in scientific journals with peer review and indexed in the well-known sources of scientific information e.g. PubMed, ScienceDirect, LILACS, Web of Science, Scielo, Cochrane Library. RESULTS: After screening, 25 papers were included in this focus review. Overall literature results highlight that the osteotome technique is a valid alternative when the remaining bone is &gt;5mm. Also, the most frequent complication is the perforation of the Schneider membrane. Furthermore, different grafts, or no graft at all, can be used with different results, depending on the individual case. Summarizing the results, the average sinus floor elevation was 3,8 mm with variation between 2.6±1.2mm and 5,65±1.93mm. Analyzing the implant survival rate with 5 years follow-up periods, the overall survival rate was 94,3% (varying between 91,9% and 98,3%). The 10 years’ follow-up studies report an average survival rate of 97% (varying between 94% and 100%). CONCLUSIONS: The consensual minimum residual bone height for the indication of osteotome technique is &gt;5mm. Osteotome techniques are predictable, well documented and present a high success rate when correctly carried on.

A novel crestal protocol for the application of denatured Albumin in minimally invasive Implantology and Sinus Piezosurgery - Preliminary Results of a Pilot Study

Sinus-Floor-Elevation surgical procedure has been considered the dominant treatment protocol towards posterior maxillary atrophy and implant rehabilitation. Nevertheless, the high incidence of postoperative sinusitis and intra- and post-operative complications, such as Schneider’s membrane perforation in 10-55% of patients, constitute it an invasive approach of high morbidity (mainly adopted for open-lateral-window version). The innovative crestal approach termed PAC-Protocol (Piezo-Alb-CGF) comprises: a) Minimally invasive transcrestal-flapped or flapless-approach, b) Piezosurgery preparation by Sinus Intralift™ Technique (Satelec–France), c) Schneiderian membrane cavitation by hydrodynamic membrane detachment-elevation, d) CGF-matrix into the sinus, e) Denatured Albumin, mixed together with Autologous Concentrated Growth Factors (CGF), an Autologous-Osseoinductive-Slow-Absorption-Graft (of 6 to 8 weeks) placed (within the interspace between membrane &amp; sinus bone floor) as a scaffold, f) Bone grafting (optional), (g) Implantation, (h) Wound closure, evaluation for next 4-6 months postop. The clinical sample comprises five (5) patients (2 women – 3 men) with an average age of 55.6 years and an average residual-bone-height of 3.9 mm. A total of eight (8) implants were placed, showing sufficient to high primary stability without any complications. CBCT and panoramic x-rays also showed new bone formation and complete osseointegration. The Albumin-CGF regenerative properties promote new bone formation, eliminate sinus surgery's high-risk and postoperative patient morbidity, and reduce the healing period (4-6 months) compared to the current surgical procedures. PAC-Protocol provides uniform-safe-hydraulic membrane lift and bi-cortical implant fixation due to piezo-surgery under-preparation of only 2.8mm in diameter, even in cases with a residual bone height below 6mm to avoid an open lateral-window approach.

Is There a Correlation Between Benign Paroxysmal Positional Vertigo and Indirect Sinus Lifting?

Objective: The aim of this study is to inform surgeons regarding benign paroxysmal positional vertigo (BPPV) after indirect sinus liftingprocedures and to assess its relationship with age, gender, residual alveolar bone height (RAB), and cortical thickness of the sinus floor.Methods: This study included 138 patients presenting for evaluation and management of BPPV after indirect sinus lifting. Patients withRAB lengths of 5–8 mm had been taken for indirect sinus lifting. Preoperative RAB length and cortical thickness of the sinus floor had beendetermined by cone beam computed tomography (CBCT) in each patient. The patients diagnosed with BPPV were promptly treated by anotolaryngologist. Data were assessed by descriptive statistical methods (mean ± standard deviation). Results were evaluated at the p&amp;lt;0.05significance level, in 95% confidence interval (95% CI).Results: Totally 4 out of 138 of the patients showed BPPV. There was no statistically significant difference between the mean ages and genderratio between the patients with BPPV [BPPV(+)] and without BPPV [BPPV(-)] groups. It was found that BPPV is 2.48 times more prevalent inpatients with RAB criterion values &amp;lt;5.9 mm than in patients with criterion values &amp;gt;5.9 mm. BPPV is 4.54 times more prevalent in patients witha criterion cortical thickness value &amp;gt;0.8 mm than in patients with a criterion value &amp;lt;0.8 mm.Conclusion: Based on the results of this study, patients with cortical thickness values &amp;gt;0.8 mm should be informed before undergoing surgery,and patients exhibiting postoperative symptoms associated with vertigo should be treated promptly.

Sinus Lift Associated with Leucocyte-Platelet-Rich Fibrin (Second Generation) for Bone Gain: A Systematic Review.

The purpose of this systematic review was to analyze sinus lifting procedures and to compare the efficiency of this treatment associated with the second generation of platelet-rich fibrin related to its effects on bone gain and to clarify the regenerative efficacy in sinus lift procedure, whether alone or as a coadjutant to other bone graft materials. The PICOT question was, “In clinical studies with patients needing a maxillary sinus lift (P), does the use of PRF either alone (I) or in conjunction with other biomaterials (C) improve the clinical outcome associated with bone gain and density (O), with at least three months of follow-up (T)?” An electronic search was conducted in the MEDLINE (PubMed), Science Direct, and Scopus databases through a search strategy. A total of 443 articles were obtained from the electronic database search. Sixteen articles met all criteria and were included in this review. Within the limitation of this study and interpreting the results carefully, it was suggested that a higher risk for implant failure after a sinus elevation might be seen in patients with residual bone ≤4 mm, and PRF application was effective, suggesting reducing the time needed for new bone formation.

Epithelioid hemangioendothelioma of the spine: an analysis of imaging findings

BackgroundEpithelioid hemangioendothelioma (EHE) is a low-grade malignant vascular neoplasm with the potential to metastasize. Primary EHE of the spine is very rare and an accurate diagnosis is crucial to treatment planning. We aim to investigate the imaging and clinical data of spinal EHE to improve the understanding of the disease.MethodsWe retrospectively analyzed the imaging manifestations and clinical data of 12 cases with pathologically confirmed spinal EHE. The imaging features analyzed included number, locations, size, border, density, signal, majority of the lesions, expansile osteolysis, residual bone trabeculae, sclerotic rim, vertebral compression, enhancement.ResultsPatients included 5 female and 7 male patients (mean age: 43.0 ± 19.6 years; range 15–73 years). Multiple lesions were noted in 1 case and single lesion was noted in 11 cases. The lesions were located in the thoracic, cervical, lumbar, and sacral vertebrae in 7, 3, 1, and 1 cases, respectively. They were centered in the vertebral body and posterior elements in 9 and 3 cases, respectively. Residual bone trabeculae, no sclerotic margin, and surrounding soft-tissue mass were noted in 11 cases, each, and mild expansile osteolysis and vertebral compression were noted in 10 and 6 cases, respectively. MRI was performed for 11 patients, all of whom showed isointensity on T1WI, hyperintensity or slight hyperintensity on T2WI, and hyperintensity on fat-suppressed T2WI. A marked enhancement pattern was noted in 10 cases.ConclusionSpinal EHE tend to develop in the thoracic vertebrae. EHE should be considered when residual bone trabeculae can be seen in the bone destruction area, accompanied by pathological compression fracture, no sclerotic rim, and high signal intensity for a vascular tumor on T2WI.

Histological and dimensional changes of the alveolar ridge following tooth extraction when using collagen matrix and collagen-embedded xenogenic bone substitute: A randomized clinical trial.

AimTo assess the horizontal and vertical dimensional changes of the alveolar ridge when using a collagen matrix in combination with collagen embedded xenogenic bone substitute, in comparison with natural healing after tooth extraction.MethodsPatients that required extraction in non‐molars areas were included. Test group‐15 sockets were treated with deproteinized bovine bone mineral containing 10% collagen (DBBM‐C), covered by a procaine collagen membrane (CMXs). Control group‐15 sockets left for spontaneous healing. We used a custom‐made acrylic stent as a reference for alveolar ridge measurements. Six‐month postoperative, a single implant was placed in the experimental site. A core biopsy was taken from the site, using a trephine bur. Histomorphometric analysis assessed bone area, connective tissue, bone marrow, and residual bone graft.ResultsSix months later, horizontal ridge width at −3 mm showed a significant (p < 0.05) reduction in both groups albeit smaller in the test group 1.19 ± 1.55 mm, compared with the control 2.27 ± 1.52 (p = 0.087). At −5 mm sub‐crestally, statistically non‐significant reduction was noted in both groups, 1.61 ± 1.53 and 1.96 ± 1.52 mm for the test and control groups, respectively (p = 0.542). Vertical changes were smaller in the test group (0.14 ± 1.84 mm) compared with control (0.98 ± 1.49 mm). Keratinized tissue (KT) width was 7.3 ± 2.13 and 7.5 ± 3.49 mm in the test and control groups, respectively. Newly formed bone occupied 33.79 ± 17.37% and 51.14 ± 23.04% in the test and control groups, respectively, (p = 0.11). Connective tissue volume was 33.74 ± 13.81% and 30.12 ± 18.32% in the test and control groups, respectively (p = 0.65). Bone marrow occupied 19.57 ± 10.26% and 18.74 ± 17.15% in the test and control groups, respectively (p = 0.91). Residual graft occupied 12.9 ± 9.88% in the test group.ConclusionAlveolar ridge preservation using DBBM‐C resulted in reductions of the vertical and horizontal dimensions albeit not reaching statistical significance. The larger than anticipated standard deviation and smaller inter‐group differences might account for this phenomenon.

Excision of Hook of Hamate Fractures in Elite Baseball Players: Surgical Technique and Return to Play.

Background:Hook of hamate fractures are relatively common in baseball players, but the proper diagnosis and surgical technique can be challenging. Outcomes after surgical excision, as well as optimal surgical technique, in elite baseball players have not been clearly established.Hypothesis:Excision of hook of hamate fractures with a technique tailored to elite professional and collegiate baseball players will lead to high rates of return to play within a short time.Study Design:Case series; Level of evidence, 4.Methods:We reviewed the cases of 42 elite athletes who underwent surgical excision of 42 hook of hamate fractures at a single academic hand surgery practice from 2006 to 2020. The athletes competed at the professional (n = 20) or varsity collegiate (n = 22) baseball levels and were treated using the same surgical technique tailored toward the elite athlete. The clinical history, timing of surgery, complications, and time to return to play were recorded for each patient.Results:All 42 patients underwent an excision of their hook of hamate fracture at a mean of 7.2 weeks (range, 0.5-52 weeks) from the onset of symptoms. All but one patient were able to return to full preinjury level of baseball participation within 6 weeks from the date of surgery, with a mean return to sport of 5.4 weeks (range, 3-8 weeks). Two patients returned to the operating room—1 for scar tissue formation causing ulnar nerve compression and 1 for residual bone fragment causing pain and ulnar nerve compression.Conclusion:Surgical excision of hook of hamate fractures in elite baseball players showed a very high rate of return to play within 6 weeks. Meticulous adherence to the described surgical technique tailored to athletes optimizes clinical outcomes and avoids complications.

Feasibility of In-Line Raman Spectroscopy for Quality Assessment in Food Industry: How Fast Can We Go?

Raman spectroscopy is a viable tool within process analytical technologies due to recent technological advances. In this article, we evaluate the feasibility of Raman spectroscopy for in-line applications in the food industry by estimating the concentration of the fatty acids EPA + DHA in ground salmon samples (n = 63) and residual bone concentration in samples of mechanically recovered ground chicken (n = 66). The samples were measured under industry like conditions: They moved on a conveyor belt through a dark cabinet where they were scanned with a wide area illumination standoff Raman probe. Such a setup should be able to handle relevant industrial conveyor belt speeds, and it was studied how different speeds (i.e., exposure times) influenced the signal-to-noise ratio (SNR) of the Raman spectra as well as the corresponding model performance. For all samples we applied speeds that resulted in 1 s, 2 s, 4 s, and 10 s exposure times. Samples were scanned in both heterogenous and homogenous state. The slowest speed (10 s exposure) yielded prediction errors (RMSECV) of 0.41%EPA + DHA and 0.59% ash for the salmon and chicken data sets, respectively. The more in-line relevant exposure time of 1 s resulted in increased RMSECV values, 0.84% EPA + DHA and 0.84% ash, respectively. The increase in prediction error correlated closely with the decrease in SNR. Further improvements of model performance were possible through different noise reduction strategies. Model performance for homogenous and heterogenous samples was similar, suggesting that the presented Raman scanning approach has the potential to work well also on intact heterogenous foods. The estimation errors obtained at these high speeds are likely acceptable for industrial use, but successful strategies to increase SNR will be key for widespread in-line use in the food industry.

Treatment with Hyaluronic Acid Injections in a Patient with Craniosynostosis

A case of a 25-year-old White female left with residual bone deformity after surgical correction of craniosynostosis during childhood is presented here. The significant psychological discomfort from her deformity caused the patient to experience clinical depression and social phobia. Objectives: The use of soft tissue fillers has grown in popularity for minimally invasive cosmetic procedures. The authors discuss the use of hyaluronic acid (HA) as an available treatment option for the reconstructive volumisation of postsurgical bony deformities in patients with congenital craniosynostosis. Discussion: Although fat graft techniques have previously been described, to the best of the authors’ knowledge, this is the first report of HA fillers as an available treatment option for the reconstructive volumisation of residual bony deformities in patients with craniosynostosis. The negative emotional impact of facial deformities can be dramatically improved by these procedures, making HA a valuable option in providing patients with a highly acceptable cosmetic result. Conclusions: HA can be successfully used as a non-surgical alternative to correct bone deformities of any aetiology. It is a relatively simple and effective technique that leads to cosmetically acceptable results. The authors emphasise the importance of training to gain an in-depth knowledge of the facial anatomy. Intravascular injections in the forehead and temporal fossa can lead to skin necrosis or blindness, therefore it is imperative to perform safe and proper facial aesthetics injections and to manage possible complications before injections.

Insertion des vis au cours des différentes phases de prise du ciment acrylique : conséquences sur leur résistance à l’arrachage

BackgroundFor large bone defects, after curettage of aggressive bone tumors; such as giant-cell tumors, cementation with supplement internal fixation was used to prevent subsequent collapse of cement-bone constructs. The purpose of this study is to compare the pull-out strength of cement augmented screws between inserting screws in the working phase or hard phase of bone cement. HypothesisTiming at which completed screw insertion takes place affecting the pull-out strength of cement augmented screws. MethodsPull-out strength was compared between screws; inserted within the working phases of cement, and after the cement was hardened in high viscos cement blocks. Each group consists of 10 cortex screws, 10 cancellous screws and 10 locking screws. The pull-out strength test was followed using the instructions of ASTM F543–13e1 Standard Specification and Test Methods, for Metallic Medical Bone Screws. ResultsScrews that were inserted in the working phases of cement had significantly higher pull-out strength, than those inserted in hard cement (p=0.021). The pull-out strength was statistically significant in difference among the types of screws (p<0.001), with locking screws having the highest pull-out strength. Furthermore, the pull-out strength of locking screws revealed no significant difference when either; inserted during the working or hardened phases of bone cement. ConclusionInsertion of screws during the working periods of PMMA cement had higher pull out strength compared to the hard phase of cement. Hence, we recommend performing internal fixation before cementation after curettage of aggressive bone tumors. However, if the surgeon prefers to pack the cement first, for benefit of avoiding residual bone defects, we suggest using a locking plate system to achieve comparable pull-out strength. Level of evidenceIn-vitro study.

Pterygoid Implant-Based "VIV" Design for Rehabilitation of Extreme Maxillary Atrophy.

:Rehabilitation of severe maxillary atrophy using implant-supported fixed prostheses is challenging due to limited bone volume. Although the all-on-4 concept offers a potential treatment option, sufficient residual bone in the anterior region remains a prerequisite for these prostheses. Pterygoid implants have been used in conjunction with the all-on-4 technique to eliminate the cantilevered prosthetic design, with good long-term results reported. However, when the bone volume in the anterior region is limited or the bucco-palatal dimension is insufficient, use of the traditional all-on-4 approach is problematic. This article describes the clinical management and good short-term success achieved in the treatment of severe maxillary atrophy with a novel ‘‘VIV’’ design, using a combination of 3 anterior and 2 pterygoid implants.

Direct skeletal fixation: A new treatment option for Canadian war amputees

LAY SUMMARY Combat-related extremity amputations are common injuries during armed conflict. In recent years, improvised explosive devices have been responsible for massive trauma, including major amputations. Many war amputees have functional limitations that affect quality of life. Surgeons can now insert a metal implant directly in the residual bone to provide a stable anchor for an extremity prosthesis. This procedure improves the ability to walk but carries a high risk of infection. Veterans with serious functional limitations due to problems with socket fixation may consider this treatment option a?er consulting with a specialized team.