Transverse Bone Research Articles

Application of a customized 3D-printed osteotomy guide plate for tibial transverse transport

Enhance the efficiency of tibial transverse transport by employing customized 3D-printed osteotomy guide plates and striving to improve precision through CT evaluation for enhanced guide design. 17 diabetic foot patients were treated with the plate for tibial transverse transport. Preoperatively, we collected DICOM data from the affected tibia’s CT and designed the geometric parameters of the tibial cortical bone window. A customized 3D-printed osteotomy guide plate was then fabricated using 3D printing technology. Postoperative X-ray and CT evaluations, conducted at two and five weeks post-surgery, assessed five crucial geometric parameters of the bone window. Measurements included the distance from the upper edge of the tibial cortical bone window to the tibial plateau, the distance from the anterior edge of the tibial cortical bone window to the bone ridge, the height of the tibial cortical bone window, the center-to-center distance between the 4.0 mm diameter Schanz pin and the osteotomy Kirschner pin, and the center-to-center distance of the 4.0 mm diameter Schanz pin. These measured parameters were subsequently compared to the preoperative design parameters. The Clinical trial registration number is ChiCTR2400087174. CT measurements showed no significant differences (P > 0.05) from preoperative design parameters across the five evaluated aspects. The average osteotomy duration was 35 ± 15 min with no bone window fractures. The bone window aligned effectively with the tibial shaft, achieving complete incorporation after distraction. A 4 to 8-month postoperative follow-up confirmed full healing of the tibial surgical wound and diabetic foot wounds. Utilizing customized 3D-printed osteotomy guide plates in tibial transverse bone transport surgery enables accurate translation of preoperative virtual designs into real-time procedures, enhancing surgical efficiency and quality.

Relationship between the heterogeneity in mechanical properties, bone density and composition parameters of cortical bone to design and develop bone scaffolds and implants: Analysis of bone microstructure

Bone is heterogeneous and anisotropic because its mechanical characteristics vary by anatomic location and loading direction. Previous research established a correlation between bone density, mineral, organic content, and porosity and mechanical qualities. Medical and bioengineering researchers can learn about bone heterogeneity and anisotropy by analysing bone density and later composition parameters across the bone diaphysis in both longitudinal and transverse orientations. This research examines bone density and composition parameters in bovine femoral cortical bone from higher, middle, and lower diaphysis regions and longitudinal and transverse orientations. At three homogeneous diaphysis sites, these properties did not alter in longitudinal or transverse orientations. At the upper and lower diaphysis locations, mineral and organic content were statistically different in both longitudinal and transverse orientations, contributing to anisotropy. At the middle location, all measured parameters were not statistically different. Transverse bone density and water heterogeneity were greater, while longitudinal values were higher for the other metrics. Upper and lower sites had increased bone variability due to %water, although mineral content was more homogenous. The longitudinal and transverse organic content and apparent density heterogeneity was greater at the middle position. At the later site, bone density and mineral content were more homogenous longitudinally and transversely. Lamellar bone microstructure with canalicular/vascular network, cavities, and holes contributed to bone materials' %water content. Collagen fibres contributed to bone material's organic composition, whereas intrafibrillar and extra fibrillar minerals contributed to its mineral content.

Craniomandibular transverse tomographic evaluation after anterior open bite orthodontic treatment with miniplates anchorage

BackgroundSkeletal anterior open bite (SAOB) represents one of the most complex and challenging malocclusions in orthodontics. Orthodontic treatment supported by miniplates enable to reduce the need for orthognathic surgery. Transverse dimension may be affected by intrusion biomechanics. This study aims to assess transverse bone alterations in patients with SAOB who underwent orthodontic treatment with absolute anchorage using four miniplates.MethodsA total of 32 patients of both sexes, with an average age of 33.8 years, diagnosed with SAOB and treated orthodontically with four miniplates (one in each hemiarch), were selected for this study. Tomographic examinations were performed before (T1) and after (T2) orthodontic treatment. Linear measurements (width of the maxillary base, maxillary alveolar, maxillary root, maxillary dental cusp, mandibular alveolar) and angular measurements (maxillary intermolar angle) were assessed in these images. The Shapiro-Wilks normality tests were applied to verify data distribution, and the paired t-test was used to compare the initial and final measures obtained.ResultsAmong the evaluated parameters, the maxillary alveolar width, maxillary dental cusp width, mandibular alveolar cusp width, and intermolar angle showed statistically significant differences between T1 and T2 (p < 0.05). However, maxillary base and maxillary root widths showed no significant difference (p > 0.05).ConclusionsIntrusion and distalization with miniplates in SAOB therapy may lead to significant expansive changes, due to molars cusps width and buccal inclination increase restricted at the alveolar level.

Computational evaluation of wire position using separate vertical wire technique and candy box technique for the fixation of inferior pole patellar fractures: a finite element analysis.

The separate vertical wire (SVW) technique and the improved candy box (CB) technique have been proposed for treating inferior pole patellar fractures. However, there is still a lack of clear explanation regarding the location of the wire passing through the patella. Five models of SVW techniques were established in different positions. Finite element analysis was then conducted to determine the optimal bone tunnel position for the SVW technique. Based on these findings, six groups of finite element models were created for CB techniques. The maximum displacement and stress on both the patella and steel wire were compared among these groups under 100-N, 200-N, 300-N, 400-N, and 500-N force loads. The results indicated that, in the SVW technique, the steel wire group near the fracture end of the longitudinal bone tunnel showed minimal displacement and stress on the patella when subjected to different forces. On the other hand, in the CB technique, both the patella and wire experienced minimal stress when a transverse bone tunnel wire was placed near the upper posterior aspect of patella. In conclusion, the SVW technique may require the bone tunnel wire to be positioned near the fractured end of the lower pole of the patella. On the other hand, in CB technique, the transverse bone tunnel wire passing through the patella may be close to its upper posterior aspect. However, further validation is necessary through comprehensive finite element analysis and additional biomechanical experiments.

Soft- and Hard-Tissue Thicknesses in Patients with Different Vertical Facial Patterns and the Transverse Deficiencies, An Integrated CBCT-3D Digital Model Analysis

Different vertical facial patterns may present different bone and gingival thicknesses at the molar level and can be influenced by the dental compensations that manifest in the presence of transverse bone discrepancies. A retrospective analysis was made of 120 patients divided into three groups according to their vertical facial patterns (mesofacial, dolichofacial or brachyfacial). Each group in turn was divided into two subgroups according to the presence or absence of transverse discrepancies assessed by cone-beam computed tomography (CBCT). The bone and gingival measurements were made integrating a CBCT-3D digital model of the patient dentition. In the brachyfacial patients, the distance from the palatine root to the cortical bone corresponding to the right upper first molar was significantly greater (1.27 mm) than in the dolichofacial (1.06 mm) and mesofacial (1.03 mm) (p < 0.05) patients. The brachyfacial and mesofacial patients with transverse discrepancies presented a greater distance from the mesiobuccal root of the left upper first molar and from the palatine root to the cortical bone, while in the dolichofacial individuals the distances were shorter (p < 0.05); The presence of transverse bone discrepancies in brachyfacial and mesofacial patients without posterior cross-bite implies a better dentoalveolar expansion prognosis than in dolichofacial individuals.

Effectiveness analysis of modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering in treatment of diabetic foot

To investigate the effectiveness of modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering in the treatment of diabetic foot (DF). The clinical data of 22 DF patients treated with modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering between October 2019 and December 2021 were retrospectively analyzed. There were 13 males and 9 females with an average age of 61.3 years (range, 41-74 years). The duration of diabetes mellitus was 8-30 years, with an average of 12.5 years, and the duration of DF was 10-42 days, with an average of 28.2 days. There were 2 cases of grade 3 and 20 cases of grade 4 according to Wagner classification. CT angiography was performed on both lower extremities of the patients, and the blood vessels of the affected extremities were narrowed to varying degrees and the blood supply was poor. The preoperative skin temperature of affected foot was (28.27±0.91)°C, the ankle brachial index (ABI) was 0.42±0.11, and the visual analogue scale (VAS) score was 7.7±0.6. Preoperative size of DF ulcer ranged from 2.5 cm×2.0 cm to 3.5 cm×3.0 cm. The skin temperature of affected foot, ABI, VAS score, and skin wound healing of the affected foot were recorded and compared between before operation and at 3 months after operation. All patients were followed up 3-18 months, with an average of 10.5 months. The infection of 1 patient with Wagner grade 4 did not improve significantly after operation, and there was a trend of further deterioration, and the amputation of the left leg was finally performed at 22 days after operation.The remaining 21 patients recovered well after operation, the external fixator was removed at 1 month after operation, the wound healed at 3 months after operation, and there was no recurrence of ulcer in situ or other sites during follow-up. At 3 months after operation, the skin temperature of affected foot was (31.76±0.34)°C, the ABI was 0.94±0.08, and the VAS score was 2.1±0.3, which significantly improved when compared with those before operation ( t=25.060, P<0.001; t=32.412, P<0.001; t=-51.746, P<0.001). Modified tibial transverse bone transport technique combined with vancomycin calcium phosphate bone cement local filling and covering for DF patients can effectively improve the blood supply of the affected limb, promote wound healing, and improve effectiveness.

X-ray Radiography of Bone Fractures Associated With Road Traffic Accidents RTA

One of the leading causes of bone fractures are Road Traffice Accidents (RTAs), they are perhaps the most prevalent causes of mortality in individuals. Objective: To investigate the prevalence and types of bone fractures in patients who have been involved in a road traffic collisions in the city of Gujranwala, Pakistan. Methods: It was a cross-sectional analysis at the orthopedic department of the DHQ/Teaching Hospital in Gujranwala, all patients with RTA-related fractures who underwent x-rays were included after written informed consent. The study included a total of 100 patients, all of which had suffered fractures as a result of traffic incidents from January 13th, 2022 to April 13th, 2022, the research was completed in three months. The obtained data were entered and analyzed by utilizing IBM SPSS Statistics 26.0. Results: There were 35 females and 65 males in the study, and according to the age distribution, 34% of those aged 26 to 35 years had a higher risk of fracture. Femur 37.7%, tibia 21.3%, fibula 16.4%, radius 2.5%, ankle joint 1.6%, humerus 6.6%, knee joint 2.5%, elbow joint 4.9%, and thumb and spine 0.8% are among the bones that have been fractured. Moreover, no incidents of skull fractures were recorded. Conclusion: Bone fractures are much more common in men than in women. In road traffic accidents, the most common bone fracture is the femur, which occurs most frequently in people who ride motorbikes or cycles, whereas, the transverse bone fracture is the most prevalent type of bone fracture.

Cleft Hand-Our Experience of Five Cases.

Introduction Hand helps us perform our work and express ourselves. Cleft hand is an aesthetic deformity rather than functional. We document our experience in five such cases from the ages of 3 to 5 years who underwent reconstruction under general anesthesia. Materials and Methods Three patients underwent Snow-Littler procedure, one underwent osteotomy for angled metacarpal and transverse metacarpal ligament reconstruction, and one underwent removal of transverse bone and transverse metacarpal ligament reconstruction. Splintage was done for 6 to 8 weeks and physiotherapy started. Function was assessed at 6 months. Results The operating time ranged from 2 to 3 hours. No major postoperative complications were noted. The parents' satisfaction was excellent at 6 months. None of the patients needed revision surgery for recurrence or first web space widening. Conclusion Cleft hand needs to be analyzed for the adequacy of first web space. The reconstruction is aimed at functional first web space and cleft closure for providing better aesthetic results.

Estimation of Thickness and Speed of Sound for Transverse Cortical Bone Imaging Using Phase Aberration Correction Methods: An In Silico and Ex Vivo Validation Study

Delay-and-sum (DAS) beamforming of backscattered echoes is used for conventional ultrasound imaging. Although DAS beamforming is well suited for imaging in soft tissues, refraction, scattering, and absorption, porous mineralized tissues cause phase aberrations of reflected echoes and subsequent image degradation. The recently developed refraction corrected multi-focus technique uses subsequent focusing of waves at variable depths, the tracking of travel times of waves reflected from outer and inner cortical bone interfaces, the estimation of the shift needed to focus from one interface to another to determine cortical thickness (Ct.Th), and the speed of sound propagating in a radial bone direction (Ct.ν11). The method was validated previously in silico and ex vivo on plate shaped samples. The aim of this study was to correct phase aberration caused by bone geometry (i.e., curvature and tilt with respect to the transducer array) and intracortical pores for the multi-focus approach. The phase aberration correction methods are based on time delay estimation via bone geometry differences to flat bone plates and via the autocorrelation and cross correlation of the reflected ultrasound waves from the endosteal bone interface. We evaluate the multi-focus approach by incorporating the phase aberration correction methods by numerical simulation and one experiment on a human tibia bone, and analyze the precision and accuracy of measuring Ct.Th and Ct.ν11. Site-matched reference values of the cortical thickness of the human tibia bone were obtained from high-resolution peripheral computed tomography. The phase aberration correction methods resulted in a more precise (coefficient of variation of 5.7%) and accurate (root mean square error of 6.3%) estimation of Ct.Th, and a more precise (9.8%) and accurate (3.4%) Ct.ν11 estimation, than without any phase aberration correction. The developed multi-focus method including phase aberration corrections provides local estimations of both cortical thickness and sound velocity and is proposed as a biomarker of cortical bone quality with high clinical potential for the prevention of osteoporotic fractures.

Revision Amputation with Press-Fit Osseointegration for Transfemoral Amputees.

We demonstrate the fundamentals of a single-stage procedure involving an impacted press-fit porous-coated titanium osseointegration implant. The preoperative evaluation is summarized and the specific surgical steps are described: exposure, osteotomy, canal preparation, implant insertion, (optional) targeted muscle reinnervation, muscle closure, soft-tissue contouring and stoma creation, and abutment insertion. Amputees who are dissatisfied with their quality of life or mobility when using a socket prosthesis can attempt to modify their socket or activity level or accept their situation. Non-osseointegration surgical options to try to improve socket fit include bone lengthening and/or soft-tissue contouring. An alternative design is a screw-type osseointegration implant1. Press-fit osseointegration can be provided for amputees having difficulty with socket wear5. Press-fit osseointegration usually provides superior mobility and quality of life compared with nonoperative and other operative options for patients expressing dissatisfaction for reasons such as those mentioned above, including poor fit, compromised energy transfer, skin pinching, compression, and abrasions. Review articles describing the clinical outcomes of osseointegration consistently suggest that patients have improved prosthesis wear time, mobility, and quality of life compared with patients with a socket prosthesis3,4. In a recent study2 of 18 femoral and 13 tibial amputees who had osseointegration, Reif et al. showed significant improvements in prosthesis wear time, mobility, and multiple quality-of-life surveys at a mean follow-up of nearly 2 years. The most common postoperative complication for this procedure is low-grade soft-tissue infection, which is usually managed by a short course of oral antibiotics. Much less often, soft-tissue debridement or implant removal may be needed to manage infection. Periprosthetic fractures can nearly always be managed with familiar fracture fixation techniques and implant retention6. Template and choose an implant with an optimal diameter that encroaches the inner cortex at the narrowest bone diameter; an implant that is too wide may not fit without causing a large fracture, and an implant that is too narrow may fall out. Do not cement the implant7.Ideally, the abutment of the implant should rest against a flat transverse bone end with cortical contact and leave the correct amount of room for the prosthetic knee so that it matches the height of the contralateral knee; avoid inserting an implant too distally or in too wide a metaphyseal flare.Gentle impaction pressure is necessary and small contained distal fractures are acceptable, but avoid causing a propagating fracture. Do not place cerclage cables or loose bone graft at these small fracture sites.Avoid the use of a tourniquet during intramedullary reaming to prevent potential heat-induced osteonecrosis.Nerve surgery such as targeted muscle reinnervation, if indicated, can be performed in the same surgical episode as the osseointegration.The muscles should be closed at the bone-implant interface with use of a tight purse string in order to provide a vascularized tissue barrier against bacterial ingress8.The skin surrounding the stoma should have unnecessary fat removed, but not excess removal leading to skin necrosis. The skin fascia should be sutured to the muscle surrounding the stoma to stabilize the peri-stomal skin.Soft-tissue contouring is needed to achieve the optimal soft-tissue tension around the stoma and abutment. Single-stage surgery has a distinct advantage in this regard. MVA = motor vehicle accidentAP = anteroposteriorCT = computed tomographyTMR = targeted muscle reinnervationQTFA = Questionnaire for Persons with a Transfemoral AmputationEQ-5D = EuroQol 5 DimensionsLD-SRS = Limb Deformity-Scoliosis Research Society (questionnaire)PROMIS = Patient-Reported Outcomes Measurement Information System.

A review of biomechanical studies for mandibular angle fracture internal fixation

Mandible fractures correspond to 19-40% of all facial fractures. Among all mandible fractures, 12-30% are fractures of the mandibular angle. These fractures are mainly caused by sports activities, interpersonal violence and car accidents. The presence of the third molar and the thin transverse bone area seem to be responsible for the frequent involvement of the mandibular angle in facial fractures. Before the advent of antibiotics, a high frequency of infection was always associated after an open reduction in mandibular angle fractures. Wired osteosynthesis and maxillomandibular fixation (MMF) were traditional methods for fixing mandibular angle fractures. The limitation of both methods has influenced the development of new approaches for the treatment of mandibular angle fractures. Currently, osteosynthesis of mandibular angle fractures with plates and screws has become an effective treatment option. Several forms are described in the literature as: fixation of bone segments with a miniplate on the upper edge of the mandible, fixation with two miniplates, lag screw or by a single rigid plate on the lower edge of the mandible. The purpose of this study was to summarize the main characteristics of biomechanical studies such as the type of mandible source used, the plating techniques employed, the plate material, and the loading protocols used to evaluate the stability of the fixation methods. The Medline (PubMed) database was searched combining relevant terms and pertinent articles in English were included. Articles had to meet the following inclusion criteria: be in vitro biomechanical studies evaluating fixation methods for mandibular angle fractures. A total of 27 articles fulfilled the inclusion criteria. Synthetic mandibles (n=12), animal mandibles (n=9), and human cadaveric mandibles (n=5) were used as the sample source to perform the biomechanical analysis. One article used both synthetic and human cadaveric mandibles. Also, a variety of fixation techniques was described such as mini-plates, lag-screws, reconstruction plates, and three-dimensional plates. The materials of the bone plates used were: stainless steel, commercially pure titanium, titanium alloy or bioresorbable. However, there was inconsistency in reporting the materials and not all studies clearly stated the material of the bone plates. For the biomechanical analysis, there was a high variation among all studies regarding the loading protocols used. The same side of fixation, the anterior part of the mandible (central incisors) or the contralateral side were reported as the dentate regions in which the force was applied. For more than 2 decades, in vitro biomechanical studies have been used to help researchers and clinicians in the field of Oral and Maxillofacial Surgery to properly evaluate and compare the different devices and techniques available for the treatment of mandibular angle fractures. Also, biomechanical studies are important to answer questions on fatigue performance and fracture strength on the gross level.

FREQUENCY OF BONE FRACTURES DETECTED BY PLAIN RADIOGRAPHY AND KEEPING CT AS GOLD STANDARD

Background: The main cause of bone fracture is traffic accidents are (72.2%), falls (11.6%), blunt injuries are (7.7%) and others (5.8 %) ). About 84 patients were included in our studies. Out of which 21 (25.0%) were females and 63(75.0%) were males. Objective: The objective of this study is to evaluate the frequency of bone fractures detected by plain radiography and keeping CT as gold standard. Methodology: In our cross-sectional study all the patients with fracture undergoing CT and X-Ray were included. Patients with bone surgery were excluded as well as patients who declined to give consent and those who were uncooperative were all excluded. X-ray performed for all the fractures and the complex one sent to CT. The consent form was obtained by patients in this study. We reviewed our data of patients who underwent CT and X-ray. CT (Toshiba 64) was performed from the exact area of fracture and images reconstructed at 3mm and for reporting 5mm for filming. X-ray performed according to the appropriate range of kVp and mAs. All findings of CT were considered by the advice of consultant radiologist. Data was represented with means of standard deviation of frequency and percentage where appropriate. Chi square testing was used to compare CT and X-ray qualitative data. Data was entered into IBM SPSS Statistics 24.0. P-value &lt;0.05 considered the significant. Results: In our study 84 patients were included. Out of which 21 (25.0%) were females and 63 (75.0%) were males and the standard deviation was 0.436. There causes of fracture were 18(21.4%) injury, 8(9.5%) were compression fractures, 54(64.3%) RTA, 2(2.4%) pathologic fractures and 1(1.2%) was sports injury fracture and the standard deviation was .997. Conclusion: Our study concluded that the bone fractures are more common in males than females. The most common cause of bone fractures is RTA (Road Traffic Accidents). Study also concludes that most common type of bone fracture is Transverse bone fracture. CT was more efficient in detecting bone fractures than plain radiography because more fractures were detected on CT than plain radiography. Keywords: Non-enhanced CT, X- ray, Bone fracture, Road Traffic Accidents DOI: 10.7176/JHMN/93-09 Publication date: September 30 th 2021

Biomechanical approach to the choice of the type of intramedullary fixator in a simulated femoral fracture

Intramedullary osteosynthesis is currently one of the main methods of treating fractures of long tubular bones. There is a large selection of both the fixators themselves and the manufacturers of these implants. The aim of this study was to conduct biomechanical testing of three types of intramedular rods – ChM, BNB (three-bladed), SarNIITO rod and Fixion (Israel) in femoral fractures of types A1, A2, A3 and B1. According to the results of the study of the displacement of fragments in different types of fractures, affecting the “bone– fixator” system with three types of loads (axial, transverse and rotational) – the stability is not the same. The most commonly used cross-blocking rod (or perhaps the entire type of such rods) showed fairly good indicators of the stability of fragments that can lead to the desired result – bone fusion. The use of different types of intramedullary fixators based on a different method of locking in the bone (transversely inserted screws, by expanding in the bone marrow canal, embedding the blades into the bone from the inside and with a spoke) allows a more rational approach to increasing the stability of a fixed fracture by using their positive sides. So, for a fracture of type A1 and A2, it is better to use Fixion rod. With a transverse bone fracture line (type A3), it is better to give preference to the three-bladed BNB rod, since it holds the transverse and rotational load better, and when exposed to the axial one, the fracture is autodynamized (compression), stimulating regeneration. Fractures of type B2 (comminuted, with a small contact line between the fragments) require the maximum possible stability. For this purpose, Fixion rod is better suited, which is blocked throughout the entire bone marrow canal. But when it is used, it is possible for the fragment to move away from the mother bed when the rod is stabilized by its expansion.

Modified transverse tibial bone transplantation and microcirculation reconstruction for the treatment of end-stage diabetic foot

To explore clinical effect of modified transverse tibial bone transfer microcirculation reconstruction in treating end-stage diabetic foot. From August 2016 to June 2018, 87 patients with diabetic foot treated with modified tibial transverse bone removal and microcirculation reconstruction, inclduing 54 males and 33 females;aged from 39 to 95 years old with an average of (68.9±11.3) years old;2 patients were grade 2, 37 patients were grade 3 and 50 patients were grade 4 according to Wagner's classification;the courses of diabetic were for 10 to 16 years with an average of (13.0±2.2) years;the courses of diabetic feet were for 21 to 48 days with an avergae of (34.2±8.6) days. Postoperative comlications were observed. Skin temperature, visual analogue scale(VAS) and ankle brachial index(ABI) and wound healing were recorded before and 3 months after operation. All patients were followed up for 4 to 19 months with an average of (12.6±2.8) months. Two patients occurred subcutaneous tissue liquefaction and seepage under needle passage during bone transfer, and scabed without special treatment. One patient was performed amputation above 5 cm of ankle joint because of severe infection, and 1 patient occurred re-ulceration at 1 year after wound healing, bone transfer was performed again at the same site, and was completely healed at 8 weeks after operation. The healing time of wound ranged from 3 to 24 weeks with an average of (11.9± 3.8) weeks. Foot skin temperature before operation was (28.9±0.91) ℃, and increased to (31.70±0.32)℃ at 3 months after operation(t=5.72 P=0.006);VAS score before opertaion was (7.80±0.72), and improved to (2.20±0.13) at 3 months after operation (t=25.38, P=0.000);ABI beforeoperation was(0.48±0.30), increased to(0.98±0.24) at 3 months after oeprtaion(t= 14.68, P=0.000). Modified lateral tibial bone transfer could effectively reconstruct microvascular network under lower leg, promote recovery of peripheral blood vessels, and promote wound healing of foot, reduce or avoid amputation. At the same time, the improved osteotomy is one of the effective methods for the treatment of diabetic foot which has advantags of less trauma, simple opertaion.

Tracking Occupational Intensity Using Archaeo-faunal Data: Case Studies from the Late Pleistocene in the Southern Cape of South Africa

Occupational intensity is a common theme in current research and has been linked to significant demographic trends in the past. The Late Pleistocene in the southern Cape may be especially important in understanding the impacts of socio-demographic change given its association with developments in ‘modern’ human behaviour. The ubiquity of archaeo-faunal remains at Middle Stone Age (MSA) sites makes these convenient datasets for documenting site-specific occupational patterns. In this paper, zooarchaeological and taphonomic data are evaluated as proxies for occupational intensity, and occupational trends are explored in the southern Cape. Zooarchaeological and taphonomic data from three southern Cape MSA sites—Klipdrift Shelter, Blombos Cave and Pinnacle Point—are compared with previously determined higher and lower occupational levels within each site to assess the value of these proxies in tracking temporal changes in settlement intensity. The results show that, while frequencies of small mammals and larger ungulates often covary with occupational levels, these are problematic indicators because of the impact of carnivores. Similarly, faunal diversity generally corresponds well with increasing human occupations but is a problematic proxy because of the effects of animal activity. Anthropogenic bone surface modifications appear to be effective in tracking occupational patterns, with trampling a particularly useful indicator. Faunal and shellfish density, and transverse bone fracture patterns, are valuable proxies of occupational intensity at all sites. Generally, the data suggests close links between occupational intensity at these sites and marine transgressions. Evidence of increased exploitation of small game in the later MSA may imply periods of subsistence intensification possibly linked to increased demographic pressure during Marine Isotope Stage 4.

A computed tomographic graphical approach to guide correction of femoral torsion.

To report geometric methods to assess femoral transverse bone morphology and develop a virtual method to guide the surgical correction of femoral torsional deformities. Observational study. Sixteen client-owned dogs comprising 14 normal femurs and 14 femurs with angulation-rotation bone deformities. Femoral torsion angle was measured with computed tomographic (CT) three-dimensional (3D) multiplanar reconstruction. Distal femoral transverse morphology was estimated with geometric methods and compared to direct measurements to span a target 20° angle on 3D reconstructions. A virtual correction of 20° was performed, and 3D-printed bone models were created. Femoral torsion of corrected bone models was compared to precorrection. Geometric estimates with an arc and chord of the metaphyseal area and chord of a best fit circle did not differ from direct measurement of femoral cortical length along the cranial cortex. Femoral torsion differed between normal femurs (25.8° ± 6°) and those with deformity (36.9° ± 8.4°, P < .001). Torsion that was measured on corrected 3D bone models did not differ from the expected torsion (preoperative +20°). Geometric methods provided an accurate estimate of distal femoral transverse bone morphology. Rotation of the distal femur based on geometric methods resulted in an accurate correction of torsion. Femoral bone diameter can be measured on a CT cross-section, and rotation distance can be calculated to achieve a desired correction of torsion. This approach provides a simple and accurate method to guide the correction of femoral torsion.

Changes of the upper airway and bone in microimplant-assisted rapid palatal expansion: A cone-beam computed tomography (CBCT) study.

To evaluate the changes of maxillary expansion and upper airway structure after microimplant assisted rapid palatal expansion (MARPE) using cone-beam computed tomography (CBCT). This retrospective study included 19 subjects (15 females and 4 males) aged 15-29 years old (mean, 19.95±4.39 years) with maxillary transverse deficiency treated with MARPE. CBCT was performed at the initial diagnosis and 3 months after MARPE treatment. Measurements were taken to evaluate the amount of total expansion, skeletal expansion, and dental expansion at the maxillary first premolar (P1), second premolar (P2), first molar (M1), second molar (M2) regions and upper airway changes. After MARPE treatment, the maxillary skeletal base expansion, skeletal expansion, alveolar expansion and dental expansion were achieved at the P1, P2, M1, M2 region. The nasopharyngeal volume significantly increased 8.48% after MARPE treatment compared with that before the treatment (P < 0.05). The change of nasal lateral width (NLW) was also significantly different before and after MARPE (P < 0.05). However, there were no statistically significant change in the oropharyngeal, palatopharyngeal, glossopharyngeal and airway total volume (all P > 0.05). MARPE can produce more transverse bone expansion, relieve maxillary transverse deficiency and improve upper airway ventilation.

Effects of surgically assisted rapid maxillary expansion on the modification of the pharynx and hard palate and on obstructive sleep apnea, and their correlations

PurposeTo investigate the changes induced by surgically assisted rapid maxillary expansion (SARME) on palate and pharynx morphology as well as the correlation of these changes with the improvement of obstructive sleep apnea (OSA). Materials and methodsThe study was conducted in 16 patients, seven women and nine men, aged on average 40.23 ± 10.23 years, all of them with OSA confirmed by polysomnography (PSG) and with posterior crossbite. All participants underwent computed tomography (CT) and PSG before and after SARME. The CT scans were used to determine the dimensions of the palate and pharynx before and after surgery. Data were analyzed statistically by the paired t-test, Wilcoxon test and Pearson correlation, with the level of significance set at P < 0.05. ResultsA 56.24% reduction in apnea and hypopnea index was detected (from 33.23 ± 39.54 to 14.54 ± 19.48: P = 0.001). The total airway area increased on average by 23.99% (P = 0.016), although in a more expressive manner in its lower half (28.63%, P = 0.008). A 24% transverse bone increase was observed in the palate in the region of the first premolars and an 18% increase in the region of the first molars (from 2.42 ± 0.31 to 2.99 ± 0.26. P < 0.001, and from 3.11 ± 0.32 to 3.70 ± 0.41, P < 0.001, respectively), and a mean 15% reduction of its depth (from 1.07 ± 0.33 to 0.89 ± 0.18, P = 0.014). A moderate correlation was detected between palate depth and width and OSA severity, as well as a correlation of the reduction of palate depth and its transverse increase with the improvement of OSA, especially among patients with severe OSA. ConclusionIt appears that narrowing of the palate, especially in the premolar region, and its greater depth may be related to the severity of OSA. SARME promotes transverse maxillary widening and lowering of palate depth, thus reducing OSA among adults and expanding the airway, especially in its lower half.

Caso clínico: paladar fisurado y su influencia en las funciones del aparato estomatognático

El paladar fisurado se presenta cuando el paladar no se cierra completamente, sino que deja una abertura que se extiende hasta la cavidad nasal. La hendidura puede extenderse desde la parte anterior de la boca (paladar duro) hasta la garganta (paladar blando). Según la Fundación Operación Sonrisa cada 3 minutos, nace un niño con labio hendido y/o paladar hendido. El caso se presenta en paciente masculino de ocho años labio fisurado unilateral derecho y fistula en el paladar duro a nivel del tercio medio y es portador de aparatología ortopédica (placa Hairax) para expansión ósea transversal, se han realizado dos palatoplastias y una queiloplastia. El nivel de articulación fonética del lenguaje fue diagnosticado por medio de los instrumentos Evaluación del Lenguaje Oral y El Algoritmo de Habla. Una vez hecho el diagnóstico odontológico y lingüístico se determinó los procedimientos de intervención, el individuo fue rehabilitado odontológicamente y participó de 18 sesiones ordinarias y 10 de sesiones de refuerzo (fonemas /t/, /s/, /f/ y /č/) de ejercicios para mejorar las praxias bucofonatorias en la pronunciación de los fonemas en los que se evidencian problemas. Después de la intervención, el paciente obtuvo un rango medio alto en las pruebas mencionadas anteriormente, confirmándose que el ejercitar la respiración y músculos articulatorios de la cavidad oral ayuda a mejorar la función del habla del paciente. Se concluye que para rehabilitar integralmente a una persona con malformaciones congénitas se debe tener un correcto diagnóstico y tratamiento tanto odontológico como lingüístico antes y después de la intervención quirúrgica.

Comparative analysis of the efficacy of a transverse process bone graft with other bone grafts in the treatment of single-segment thoracic spinal tuberculosis

BackgroundThere was a controversy about bone grafting of spinal tuberculosis treatment. The aim of this study was to compare the clinical efficacy of a new bone grafting method—transverse bone grafting (TBG)—with iliac bone grafting (IBG) and titanium mesh grafting (TMG) in the treatment of single-segment thoracic spinal tuberculosis.Material and methodsTBG was undertaken in 30 patients (group A), IBG was carried out in 28 patients (group B), and TMG was performed in 36 patients (group C). The operative time, intraoperative blood loss, postoperative drainage amount, postoperative complications, length of hospital stay, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, visual analog scale (VAS) score for back pain, Oswestry dysfunction index (ODI), intervertebral height, and time to bone graft fusion were compared. Changes in the Cobb angle of kyphosis, intervertebral height, and loss to the final follow-up were measured. Neurological function recovery was evaluated according to the criteria of the American Spinal Injury Association (ASIA).ResultsThe operative times in group A was significantly shorter than those in groups B and C (PAB = 0.036, PAC = 0.005, PBC = 0.901). The hospital stay in group A was significantly shorter than that in groups B and C (PAB = 0.022, PAC = 0.031, PBC = 0.424). The intraoperative blood loss in group A was significantly less than that in groups B and C (PAB = 0.045, PAC = 0.004, PBC = 0.586). The VAS score, ODI, ESR level, CRP level, Cobb angle of kyphosis, and intervertebral height of the affected segment were significantly improved compared with those before surgery (P < 0.05).ConclusionFor the treatment of single-segment thoracic spinal tuberculosis, the new interbody fusion technique using transverse process bone grafting is a safe, reliable, effective, and ideal bone grafting method.