Transosseous Wiring Research Articles

Surgical versus nonsurgical treatment of unilateral dislocated low subcondylar fractures: A clinical study of 52 cases

To compare open versus closed reduction of unilaterally dislocated low subcondylar fractures in adults, 101 consecutive dentulous patients were treated either by closed reduction with a median of 4 weeks of maxillomandibular fixation, or with a median of 6 weeks of maxillomandibular fixation after surgical repositioning and transosseous wiring of the dislocated condylar fragment. No selection of patients was done for either treatment. Fifty-two patients were seen at a median of 2 years postoperatively. Complications such as malocclusion, mandibular asymmetry, impaired masticatory function, and pain located to the affected joint or masticatory muscles were seen significantly more frequent in patients treated with closed reduction compared with those treated surgically ( P = .005). Neither the degree of dislocation of the proximal fragment, concomitant mandibular fractures, nor the absence of posterior occlusal support seemed to influence the results.

下顎骨骨折の治療成績

Twelve patients with mandibular fractures were treated with open reduction. Four patients with condylar fracture were treated by excision of the fractured segments which disturbed jaw movement. Patients without the condylar fracture were treated by transosseous wire and/or miniplate fixation. Intermaxillary fixation with an arch bar was also employed to obtain better postoperative occlusion in 8 patients with multiple fractures. However, for monofractures, the wire and miniplate fixation provides firm interosseous fixation and stable occlusion, so intermaxillary fixation with an arch bar is not necessary. In all 12 patients, good postoperative occlusion was acquired within 3 months after surgery.

Nerve supply to the anterior cruciate ligament and cruciate ligament allograft

To confirm the innervation of the anterior cruciate ligament and anterior cruciate allograft the anterior cruciate ligament was grafted allogenic and deep-freeze preserved, in 12 white New Zealand rabbits. After removal from the donor animal the ligaments and pertaining bone tissue were placed in deep freeze at -90 degrees C for 72 hours. The grafts were fixed in the receiving animal by means of transosseous wire sutures. The non-operated contralateral anterior cruciate ligament served as control. Follow-up examinations were performed after 3, 6, 12, 24, 36 and 52 weeks. Immunohistochemical methods were employed to examine newly ingrown nerve fibres. Monoclonal antibodies against neurofilaments (to identify rapid conducting mechanoreceptive afferent A fibres) were used, as well as substance P (to identify slow conducting nociceptive afferent C fibres) and thyrosine hydroxylase (for the identification of vasomotor efferent C fibres). In the control ligaments we found an abundant amount of nerve fibres of all three kinds, each of these having its own typical distribution pattern. The fibres were mainly subsynovial, in some cases however also localised in the interfascicular connective tissue septae. At specialised end organs we could only identify Ruffini's corpuscles. No nerve fibres were found in the cruciate ligament allografts after 3 weeks, but an initial few fibres showed up after 6 weeks. After 12 weeks individual nerve fibres of all 3 kinds became noticeable, and after 24 weeks all three kinds of fibres were abundantly represented. No specialised end organs were found in the allografts.(ABSTRACT TRUNCATED AT 250 WORDS)

Severe bone resorption and osteoarthrosis after miniplate fixation of high condylar fractures: A clinical and radiologic study of thirteen patients

Thirteen cases of high condylar fracture treated by open reduction and fixation with miniplates were monitored for an average of 18 months postoperatively. Satisfactory functional results were achieved clinically in all but one patient. Radiologically, however, signs of condylar resorption and osteoarthrosis were diagnosed in all patients. In four patients with associated multiple fractures of the facial bones, rapid complete resorption of the condyle was observed. These changes were markedly more severe than those observed in our previous study, in which osteosynthesis was performed by transosseous wiring and subsequent intermaxillary fixation for 3 to 7 weeks. Indications for rigid and nonrigid fixation in the surgical treatment of condylar fractures are discussed.

Local Bone Transportation for Treatment of Intercalary Defects by the Ilizarov Technique

Ilizarov applied revolutionary methods for salvaging limbs with severe congenital, posttraumatic, or other acquired deformities. His methods, which use a universal system of ring external fixators with tensioned transosseous wires, were developed over the past 35 years at his institute in Kurgan, USSR. These noninvasive techniques have proved successful in over 300,000 patients (adults and children) treated for bone shortening and intercalary deficiency, angulatory and rotational malalignment, active infection, ischemia, joint contractures, and nonunions. Bone transportation involves moving a free segment of living bone to fill intercalary bone defects with vital bone. The trailing end of the transport bone segment maintains continuity with the host bone surface by distraction osteogenesis. The leading end of the transport bone segment fuses to the target bone surface by transformational osteogenesis. The small diameter of the transosseous wires contributes to better patient tolerance over the prolonged treatment times required for gradual distraction at 1 mm per day.

Postsurgical maxillary movement: A comparison study of bone plate and screw versus wire osseous fixation

This study was designed to examine amounts of postoperative maxillary movement in patients who received Lefort I osteotomies, comparing bone plate and screw fixation with conventional transosseous wire fixation. Cephalograms of 17 patients whose maxillae were fixated with wire osseous fixation and 13 patients whose maxillae were fixated with bone plates and screws were compared at four different time periods throughout the first postoperative year. Millimeters of movement of five maxillary assessment points were assessed in the horizontal and vertical planes of space by use of a line constructed 7° to sella-nasion at nasion as the horizontal reference. Results indicate that the amount of maxillary movement was similar for the two groups during the two time periods subsequent to the surgical procedure. However, it appears that the maxillae fixated with bone plates and screws were more stable than those with wire osteosynthesis during the last postoperative period (6 months to 1 year) and during the overall postoperative time interval (2 days to 1 year).

Stability following combined maxillary and mandibular osteotomies treated with rigid internal fixation

Skeletal stability was examined in 16 patients following combined maxillary and mandibular osteotomies using rigid internal fixation. Postoperative changes (T2 to T3) were generally less than 1.0 mm for linear measurements and less than 2.0 degrees for angular measurements. The removal of maxillomandibular fixation (MMF) splints accounted for 85% to 95% of the counterclockwise rotation in the proximal and distal mandibular segments from T2 to T3. Maxillary inferior repositioning and large mandibular advancements exhibited the greatest tendency for relapse; however, the changes were less than with comparable procedures using nonrigid methods for stabilization. Except for large mandibular advancements, relapse was essentially unrelated to the magnitude of the surgical repositioning. Although the use of skeletal, maxillomandibular, and transosseous wire fixation have traditionally provided satisfactory clinical results, the use of rigid internal fixation in combined osteotomy procedures provides better stabilization of dentosseous segments when compared with these nonrigid methods, and may be particularly indicated in complex surgical procedures.

A method to facilitate placement of screws for sagittal ramus osteotomy

This article describes a method of placing screws for bilateral sagittal ramus osteotomies. The technique, a slight modification of previous methods, eliminates the need for use of a clamp, aids in proximal segment control, and employs a single transosseous wire and two transcortical screws. This method has been used in more than 50 cases and has been proved to be adaptable and stable, even without intermaxillary fixation.

Paraesthesia of the infraorbital nerve following fracture of the zygomatic complex

68 patients with fractures of the zygomatic complex were studied. Of these, 56 had sensory disturbances of the infraorbital nerve. 50 patients were operated on and in 42% (21) some degree of persisting hypesthesia was found. No significant difference in outcome was found between the different methods of indirect reduction used. However, in 10 out of 12 patients in which direct fixation with transosseous wiring of the infraorbital margin was performed, persisting hypesthesia was encountered. In 3 out of 4 patients where the nerve was also explored primarily, the sensation returned totally. A secondary nerve deliberation was also found to be beneficial in 4 out of 5 patients with persisting total loss of sensation.

Dynamic traction and early passive movement for fractures of the proximal interphalangeal joint

Unstable intra-articular fractures that involve the proximal and middle phalanges often lead to joint stiffness and loss of function. Ten patients with comminuted intra-articular fractures of the proximal interphalangeal (PIP) joint were treated by dynamic traction splinting and early mobilizations. Distal traction, with a force of 300 g, was provided by a rubber band connecting a transosseous wire to a movable component on an arcuate splint made of thermoplastic material. Intermittent passive movement was carried out on a timed schedule. Follow-up at 16 months (5 months to 51/2 years) showed a pain-free final range of motion (ROM) of 87 degrees (5 degrees to 92 degrees), with preservation of articular symmetry and space. this is the first report of treatment of intraarticular fractures in the hand by a combination of dynamic traction and passive movement.

Oblique zygomatic maxillary Kirschner wire in the treatment of malar fractures

INTRODUCTION FRACTURE of the zygomatico-maxillary complex is the most common bony injury diagnosed and treated in our unit. An average of 100 fractures of the zygomaticomaxillary complex are seen in our hospital each year. According to a recent review (Pospisil and Fernado, 1984), approximately 65 per cent of these fractures require surgical intervention to correct the deformity. Simple elevation via a Gillies (temporal) approach or transoral route is usually sufficient in approximately 60 per cent of these cases. However, a reduced malar complex which is unstable requires some means of fixation. Traditionally, internal fixation is best accomplished with intraosseous wiring of the fractured bone at the zygomatico-frontal suture and/or the infra-orbital rim. Zygomatico-maxillary buttress transosseous wires can also be added for the fixation of very unstable malar bones. Combination of any of these may be required to avoid partial collapse of the malar prominence. Insertion of an antral pack through the Caldwell-Luc approach may also achieve stability of corrected malars. In the hands of a less experienced surgeon, there is a risk of the antral pack being inserted into the inferior orbital fissure or into the orbit via the fracture in the orbital floor. Fixation with external pins is another form of fixation that is available. Though less timeconsuming than the previous methods, the external apparatus is usually embarrassing to the patient and contraindicated in certain circumstances (see Discussion). The first comprehensive report of the use of transmaxillary Kirschner wire to provide stability after the reduction of zygomatic fractures was by Brown et al. (1952). More recently, Vero (1968), Larsen and Thomsen (1978) and Larabee et al. (1979) have also shown the usefulness and effectiveness of this method of fixation in which the Kirschner wire is inserted into the contralateral (stable) malar. This technique could lead to serious Complications if the wire was directed in a cranial direction. Thus in our unit we prefer to use an oblique Kirschner wire, which is a less well-known technique.

Stability associated with mandibular advancement treated by rigid osseous fixation

Relapse after a mandibular sagittal ramus split osteotomy (SSO) fixed by transosseous wire has been shown to occur. Authors who use rigid screw fixation claim a lesser incidence of such relapse. Nine subjects with horizontal mandibular deficiency treated by an SSO and fixed with bone screws were prospectively studied. Serial cephalometric radiographs were traced and superimposed on the sella-nasion line and anterior cranial base structures. A markedly reduced horizontal movement during the first six weeks at both points B and Pg, followed by a slight advancement at six months, was observed. Concomitantly, the surgically increased facial height was shown to subsequently decrease during both those time intervals. The stability of this procedure warrants further investigation.

Reconstruction of the midfacial vertical dimension following Le Fort fractures.

Fracture dislocations of the middle third of the face usually involve a complex combination of Le Fort's three great weak lines of the facial skeleton. The fracture lines transverse the vertical buttresses of the middle third of the face at near right angles and strong impact forces can cause displacement and malalignment of the buttresses. The vertical dimension of the midfacial skeleton may be shortened or lengthened and the maxilla may be rotated. Direct realignment and stabilization of the zygomaticomaxillary buttresses with rigid fragment-to-fragment fixation gives precise reconstruction of the vertical dimension and excellent mechanical stability without craniofacial suspension or external fixation. The principles were first demonstrated in a cadaver study and then applied to a prospective group of 20 patients with Le Fort midfacial fractures. These findings fully justify the increased operative time required to place the transosseous wires.

Clinical and experimental studies with a resorbable transosseous ligature

Transosseous wire ligatures are used to oppose bone fragments during healing. Thereafter, such ligatures serve no function, and either remain permanently in the tissues or are removed by a second surgical procedure. This paper reports clinical and experimental studies with polydioxanone (PDS ®—Ethicon Ltd.), on the basis of which it is introduced as an alternative to stainless steel wire in some cases of transosseous fixation.

Biomechanical analysis of the knee after rupture of the anterior cruciate ligament and its primary repair. An instant-centre analysis of function.

Sixty-five knees were subjected to a kinematic analysis using the instant-centre technique in order to determine the effect of deficiency of the anterior cruciate ligament on the biomechanics of active movement in the knee. The instant-centre pathway in acute ruptures of the anterior cruciate ligament was found to have a specific abnormality. This corresponded with a positive pivot-shift sign, but was present even when that sign was not clinically detectable. Primary repair using a transosseous wire suture did not usually abolish the biomechanical abnormality. The data provide a possible explanation for the doubtful prognosis of primary repair of this ligament and encourage clinical and biomechanical evaluation of alternative procedures such as primary augmented repair.

Treatment of Fractures of the Edentulous Mandible

The reduction and fixation techniques for treatment of fractures of the edentulous mandible are varied, although all the operative techniques are based on the fundamental principles of adequate bone fragment apposition and immobilization. The techniques include the following: (1) analgesia and soft diet, (2) closed reduction with splint fixation, (3) open reduction (intraoral or extraoral) with transosseous wire ligation, (4) percutaneous intramedullary pinning, (5) intraoral open reduction with bone graft and maxillomandibular fixation, (6) external splint fixation appliance, (7) extraoral open reduction and fixation with malleable mesh, and (8) extraoral open reduction and fixation with bone plating (metacarpal, lateral compression, and eccentric dynamic compression plate [EDCP]). We review the various modalities of therapy for this challenging problem, with the strengths and weaknesses of each technique. In addition, we discuss a relatively new method of fracture fixation in North America, the EDCP, and our experience using it to treat 17 fractures of the edentulous or nearly edentulous mandible, with a 94% bony healing rate.

Surgical Management of Depression Fractures of the Equine Skull

Three cases of depression fractures of the equine facial bones are described. Treatment consisted of operative exposure using large skin flaps and elevation of the fragments with and without transosseous wiring. In all cases, cosmetic and functional results were considered excellent.

Zygomatic fractures. II. A follow-up study of 137 patients.

Out of a total of 137 patients with zygomatic fractures, 87 with post-reductively stable fractures were treated solely with Gillies' procedure. Twenty-eight patients with unstable fractures were treated with transosseous wiring. In 22 patients, in whom the fracture was considered undisplaced, no fracture treatment was given. At the follow-up only 2 of the patients treated by Gillies' procedure presented malunited fractures, and these only minor ones,this reductive method thus being satisfactory in 64% of all cases. Malunion was seen in one-third of the patients treated with transosseous wiring, this treatment thus appearing frequently insufficient. Consequently, accomplishment with Kirschner-pin fixation is proposed. Finally, a schedule for treatment of zygomatic fractures is given.

Bones and Joints: Transosseous wiring in the treatment of condylar fractures of the mandible

Bones and Joints: Transosseous wiring in the treatment of condylar fractures of the mandible

Effects of metal salts in prolonging antibacterial activity of teeth treated with 8-hydroxyquinoline.

METHODOLOGY AND CRITERIA IN THE EVALUATION OF DENTAL IMPLANTS Neuman, G . , Spangberg, L . , and Langeland, K . J Endodont 1: 193, June, 1975. Thirty-six guinea pigs were used to test the reaction of hard and soft tissue to three different endosseous implant materials, Teflon, Titanium 6A1-4V, and Vitall ium. Observations were made at 2 and 12 weeks. Implants were of two types: those exposed to the oral environment and those unexposed. Findings indicate inflammatory response significantly greater in exposed implants regardless of the implant material used. In exposed implants, epithelium, continuous with the oral mucosa, was found in the lumen around the implant. The findings suggested that bacterial access along the exposed implant was an important factor in the bio-acceptability of the implant. The study indicated that implant materials which prevent deposition of plaque should be sought, especially where the implant will be exposed to the oral environment. Department of Endodontics, University of Connecticut, School of Dental Medicine, Farmington, Connecticut 06032 Dr . J . Leary DENTAL PLAQUE REDUCTION WITH AN ANTIBACTERIAL MOUTHRINSE. ULTRASTRUCTURAL, MICROBIOLOGICAL, AND BIOCHEMICAL CHANGES Brady, J . M . , Gross, A . , Grower, M . F . , Carter, H . G . , and Barnes, G . P. J Prevent Dent 2: 10, July-August, 1975. A n ultrastructural biochemical and microbiological analysis of plaque was done 5 days after treatment with alexidine (QR-711) used as a mouthrinse for 1 minute daily on 17 males. Plaque prior to treatment, plaque which was allowed to grow after a prophylaxis, and plaque where no prophylaxis had been done (control) was examined. Results showed a marked decrease in plaque wet weight, plaque dry weight, protein content and alkali-extractable protein. There was also a change in the types of colonies of organisms with an increase of dense, small coccal forms. U.S. Army Institute of Dental Research, Walter Reed Army Medical Center, Washington, DC 20012 Dr . H . Israelson TEMPOROMANDIBULAR ANKYLOSIS SECONDARY TO RHEUMATOID ARTHRITIS. REPORT OF A CASE Seymour, R . L . , Crouse, V . L . , and Irby, W . B. Oral Surg 40: 584, November, 1975. About 50% of all cases of rheumatoid arthritis show involvement of the temporamandibular joint ( T M J ) . Ankylosis may occur when the T M J is involved by rheumatoid arthritis during childhood. A 16-year- old Negro boy was admitted because of restricted mandibular opening, and diagnosed as juvenile rheumatoid arthritis with partial ankylosis of the right T M J , which showed bony union of the right mandibular condyle and glenoid fossa. A silicone rubber block was placed between the proximal and distal segments of the ascending ramus and was held in place with a transosseous wire, resulting in a mandibular opening of 20 mm. A n exercise appliance was constructed but failed in use. Three years later the patient returned with a mandibular opening of about 2 mm. The ankylosis occurred anterior and medial to the implant and another rubber implant was placed, resulting in the intraoperative mandibular opening of 18 mm. Another exercise appliance was made and there was a 23-mm opening 4 months postoperatively. With the surgical treatment and postoperative regime (appliance and motiva- tion), an adequate oral opening may be maintained. Department of Oral Surgery, College of Dental Medicine, Medical University of South Carolina, 80 Barre Street, Charleston, SC 29401