Traumatic Deformities Research Articles

General Surgeon’s Challenge: Primary Reconstruction of High-Velocity Facial Trauma

Background: Facial wounds are often seen in the emergency department. Whether isolated or associated with cranial injuries or poly-trauma, they can have a significant impact on the patient’s facial aesthetics and consequently, their eminent psychological states.Case presentation: A 63-year-old man was referred to our emergency department with an extensive facial injury, which occurred when a grinder disc for working with metal broke, while he was working at home and hit him with high velocity in the face. The patient was hemodynamically stable with a disfiguring, profusely bleeding wound of the maxilla and mandible. One tooth in the lower jaw had been broken and one was missing. The wound was closed with synthetic, resorbable, interrupted sutures in two layers (the inner layer was buccal mucosa, and the other layer was only the skin).Discussion and conclusion: The extent of damage to soft tissue depends on the type and velocity of the object. Proper wound treatment is necessary, including thorough irrigation, removal of foreign bodies, tension-free closure, reconstruction of anatomical landmarks and correct follow-up. Wound healing starts shortly after the initial tissue trauma, and can take up to several months to complete. Disorder in hemostasis and uncontrolled inflammation can lead to an unfavorable outcome. Facial injuries are treated by general surgeons in only 0.5% of cases, with plastic surgeons, oral and maxillofacial surgeons, and otolaryngologists/head and neck surgeons being the most common specialties. Anatomic, diagnostic, and handling considerations should be analyzed to achieve the best results and minimize late post traumatic deformities. Complex facial reconstruction is possible when treated by an experienced general surgeon.

A 56-Year-Old Man with an Unusual Projectile Trajectory of Gunshot Wound at Head and Neck Region: A Rare Case Report

Background: Gunshot injuries to the neck are linked to a substantial risk of high mortality and morbidity due to the presence of critical vascular and vital structures. However, there are rare instances where a bullet trajectory through the neck region avoids damaging these vital structures. In this context, we report a specific case involving a 56-year-old male who presented to the emergency department with a gunshot wound to the right maxilla through the left anterior neck region.
 Case presentation: During the examination, a hematoma was observed in the left neck without an apparent entrance wound. The occurrence of a bullet injury to the neck without affecting any vital structures is exceptionally uncommon. Effectively managing patients with high-velocity penetrating injuries to the head and neck entails prioritizing tasks such as securing the airway, controlling hemorrhage, and promptly addressing any residual traumatic deformities for optimal outcomes. The presented case involves a gunshot injury to the head and neck, and a comprehensive review of the literature is provided.
 Conclusion: Gunshot injuries to the head and neck are complex and serious, demanding swift and thorough medical attention. The case emphasizes the significance of post-surgery monitoring for potential complications, contributing valuable insights to the ongoing discourse on managing such injuries.

Management of blowout fracture with iliac bone graft

Introduction: Blowout fracture is a traumatic deformity of the orbital wall and the repair is indicated when enophthalmos is troublesome to the patient, or when diplopia interferes patient’s activities. Iliac bone has been reported in the immediate and secondary repair of orbital wall deformities following blowout fracture. This case is to report blowout fracture management using iliac bone graft. Case Illustration: A 35 years old man complains pain on his left eye when moving his eye and diplopia in upgazed since 4 months after fell down from stairs. Eye position is orthophoria, visual acuity 6/6 on both eye, anterior and posterior segments are normal, restricted movement to superior on left eye, Hertel exophthalmometry examination on right eye 15 mm and left eye 10 mm (base 90). On CT-scan examination, it was found that an orbital floor fracture was characterized by herniation of the orbital tissue. The patient was diagnosed with left eye enophthalmos, suspect inferior rectus muscle and adnexal entrapment and neglected blow out fracture. LE Repair Orbital Floor Fracture, Release Muscle Rectus Inferior, Exploration (join op with Plastic Reconstructive and Aesthetic Surgery Department) is done to this patient. Conclusion: Iliac bone graft can be used as an alternative in orbital floor reconstruction, since it easy to harvest, low risk to rejected or extruded and can be used in large defect. Optimal outcome of blowout fracture repair can be achieved if the surgical management is done before two weeks after the incidence.

Transnasal tension suture of external nasal splints: A reliable, novel technique

BackgroundWe routinely apply external nasal splints after closed nasal reduction or rhinoplasty and secure the splint by transnasal suturing. We seek to describe our technique and review our experience. MethodsA retrospective chart review was performed to review patients who had an external nasal splint secured by transnasal suturing. The technique consists of steristrips applied across the dorsum and nasal bones. The Aquaplast is molded to the nose and a 2-0 polypropylene suture on a straightened tapered needle or a Keith needle is passed through the splint, the nasal sidewalls and septum, through the splint on the contralateral side, and back again in a horizontal mattress fashion. The suture is tied down to maintain the desired shape of the splint. The splint is removed in the first postoperative followup (10–14 days). ResultsMean patient age was 31.5 years, 82 male and 18 female patients were reviewed, 67 % of splints were placed for closed reduction of acute nasal trauma, and 33 % placed after elective rhinoplasty for late correction of functional and cosmetic traumatic deformity. No splints were inadvertently removed by patients prior to followup. Splints were removed an average of 12 days postoperatively, and mean followup was 27 weeks. There were no complications related to transnasal suturing of the splint, such as skin ulceration, pressure necrosis, identifiable scarring related to the suture entry points or breathing difficulty attributable to internal nasal valve narrowing. ConclusionTransnasal suturing is a safe and reliable method for fixation of an external nasal splint.

Treatment outcome of tardy ulnar nerve palsy associated with traumatic cubitus valgus by supracondylar shortening wedge rotary osteotomy and ulnar nerve in situ tension release

BackgroundTardy ulnar nerve palsy is a common late complication of traumatic cubitus valgus. At present, the treatment of tardy ulnar nerve palsy associated with traumatic cubitus valgus is still controversial, whether these two problems can be corrected safely and effectively in one operation is still unclear. To investigate the supracondylar shortening wedge rotary osteotomy combined with in situ tension release of the ulnar nerve in the treatment of tardy ulnar nerve palsy associated with traumatic cubitus valgus.MethodsBetween 2012 and 2019, 16 patients who had traumatic cubitus valgus deformities with tardy ulnar nerve palsy were treated with simultaneous supracondylar shortening wedge rotary osteotomy and ulnar nerve in situ tension release. we compared a series of indicators of preoperative and postoperative follow-up for at least 24 months, (1) elbow range of motion; (2) the radiographic correction of the preoperative and postoperative humerus-elbow-wrist angles; (3) the static two-point discrimination and grip strength; and (4) the preoperative and postoperative DASH scores of upper limb function. The minimum follow-up was 24 months postoperative (mean, 33 months; range, 24 ~ 44 months).ResultsThe mean ROM was improved from 107 ° preoperatively to 122 ° postoperatively (P = 0.001). The mean preoperative elbow wrist angle was 24.6 °, and the mean postoperative humerus-elbow wrist angle was 12.1 ° (P < 0.001). The average grip strength and static two-point discrimination improved from 21 kgf and 8 mm to 28 kgf and 4.0 mm (P < 0.001 and P < 0.001, respectively). The ulnar nerve symptoms were improved in all patients except one. The mean HASH score improved from 29 to 16 (P < 0.001).ConclusionSupracondylar shortening wedge rotary osteotomy combined with in situ tension release of ulnar nerve is an effective method for the treatment of traumatic cubitus valgus with tardy ulnar nerve palsy, which restored the normal biomechanical characteristics of the affected limb and improved the elbow joint function.

The behaviour and treatment outcomes of paediatric hemangiomas

Aim: Infantile hemangiomas are the most common vascular tumours of infancy, affecting up to 12% of infants by the first year of life. The main aim of this study is to present the best treatment modality based on the behaviour of hemangiomas in paediatric population and their pattern of progression or regression with age and in response to intralesional steroids and sclerosing agents administered, along with the rate of recurrence in cases where surgical intervention was done. Materials and methods: A total of 25 patients were in- cluded in this study based on inclusion and exclusion cri- teria. The injections (Kenacort /Kenalog, as intralesional injection) were administered at monthly intervals and patients were reviewed. Based on the response elicited to this minimally invasive procedure the patients were divided into the following three groups: A-Responders, B-incomplete responders, C-Non-responders. Surgical intervention was taken up in incomplete responders and Non responders with significant aesthetic and functional compromise. Results: Of all lesions only 16% of the cases responded to non-surgical treatment methods, and were further sub- categorised into: Group A (Responders) which comprised of 2 (8%) of the cases, Group B (Incomplete responders) n= 2(8%) and Group C (Non-Responders) n=21 [84%. All patients belonging to group B and C were treated surgically and fairly good prognosis was documented, as amongst 8% (n=2) + 84% (n=21), 87% (n=20) of the patients were completely cured and re- currence due to the presence of residual tumour was noted in only 13% (n=3) of the cases. Conclusion: As the psychological impact of the congeni- tal deformity on patients is generally more detrimental than it is measurable, except for the post-surgical or traumatic deformities in the treatment of medium size tumours the surgical excision seems to be a worthwhile procedure.

3D-print in the planning of surgical treatment in the case of extraarticular deformity of lower limbs

An adequate planning of the curative measures is an important factor providing good functional results in the treatment of consequences of long bones injuries, in particular, malunions (post traumatic deformities). 3D-modeling in the preoperative planing gives an opportunity to assess both deformity itself and joint status. Visua­lization of injured segment with three-dimensional model manufactured using 3D-print in actual size (1:1 scale) provides additional capacities. Objective. To analyze the capacity provided by the usage of three-dimensional models of damaged segments in scale 1:1 while the planning of corrective surgery. Methods. Practicability of the usage of 3D-models, that was worked out on the base of CT-scanning, was studied in the treatment of 52 patients with different post traumatic extraarticular deformities of femur and tibia, after the fractures with intraarticular extension. Clinical results were evaluated using SF-36 and AOFAS scales. Results. Calculation for 3D-modeling was performed mostly virtually using standard computer programs with 3D-reconstruction, but 3D-print technology was used for 5 patients with the most severe and sophisticated deformities of the lower extremities. Changes in functional outcomes, according to SF-36 and AOFAS, for the patients undergone opera- tive treatment, were positive at 12 month of follow-up. Fore­ign colleagues expose analogous results of the investigations and suggest that the modeling with 3D-print provides mostly more safe, reliable and standardized clinical decisions for every particular patient. Conclusions. Preoperative usage of 3D-print on the stage of preoperative planing allows the surgeons to simulate different stages of operative intervention on the physical model, thus, help him to realize possible technical problems, choose adequate fixation device and proper instrumentation. It facilitates the shortening of surgery time, elimination of possible complications rate and achievement, in sum, good functional results in the treatment of this kind of patients.

On The Features of Changes In Hearing And Cerebral Hemodynamics In Patients With Nasal Obstruction Curvature

This article presents the characteristics of changes in the hearing and cerebral hemadynamics of patients with deviation of the nasal septum. The deviation of the nasal septum occurs in the cartilaginous and bone regions, both separately and in both at the same time. Deformations can be of a different nature (bend, crest, spike) and localization. They are one and two-sided. Spines and ridges are more often localized at the junction of the quadrangular cartilage and the perpendicular plate, ploughshare, and the crest of the upper jaw (“growth zone”). Less often, the upper sections of the perpendicular plate and the rear section of the ploughshare are deformed. For traumatic deformities, characteristic bends with sharp angles. Often, after injury, the anterior edge of the quadrilateral cartilage is displaced in the form of its subluxation. The deformation of the cartilaginous part of the external nose in the patients under our supervision was due to the deviation of the nasal septum. There were no patients with deformity of the nose, who would have been indicated for surgical intervention on the cartilage of the external nose, in our group.

PECULIARITIES OF THE STATE OF HEARING AND CEREBRAL HEMODYNAMICS IN PATIENTS WITH DEVIATION OF THE NASAL SEPTUM

This article presents the characteristics of changes in the hearingand cerebral hemadynamics of patients with deviationof the nasal septum. The deviationof the nasal septum occurs in the cartilaginous and bone regions, both separately and in both at the same time. Deformations can be of a different nature (bend, crest, spike) and localization. They are one and two-sided. Spines and ridges are more often localized at the junction of the quadrangular cartilage and the perpendicular plate, ploughshare, and the crest of the upper jaw (“growth zone”). Less often, the upper sections of the perpendicular plate and the rear section of the ploughshare are deformed. For traumatic deformities, characteristic bends with sharp angles. Often, after injury, the anterior edge of the quadrilateral cartilage is displaced in the form of its subluxation. The deformation of the cartilaginous part of the external nose in the patients under our supervision was due to the deviationof the nasal septum. There were no patients with deformity of the nose, who would have been indicated for surgical intervention on the cartilage of the external nose, in our group.Keywords:cerebral hemadynamics, deviationof the nasal septum, quadrangular cartilage, septoplasty

Comparative Characteristics Of Surgical Treatment Methods For Patients With Nasal Septum Deviation

The methodological recommendation presents a comparative characteristic of surgical methods of treatment of deviation of the nasal septum. Deviation of the nasal septum occurs in the cartilaginous and bone regions, both separately and in both simultaneously. Deformations can be of different nature (bend, crest, spike) and localization. They are one and two-sided. Spines and ridges are more often localized at the junction of the quadrangular cartilage and the perpendicular plate, ploughshare, and the crest of the upper jaw (“growth zone”). Less often, the upper sections of the perpendicular plate and the rear section of the ploughshare are deformed. For traumatic deformities, characteristic bends with acute angles. Often, after injury, there is a displacement of the anterior edge of the quadrangular cartilage in the form of its subluxation. The deformation of the cartilaginous part of the external nose in patients under our supervision was caused by the deviation of the nasal septum. There were no patients with deformity of the nose who would have been indicated for surgical intervention on the cartilage of the external nose. When correcting the deformity of the external nose in patients, we used an exclusively closed technique of intervention with a transseptal access, and, if necessary, access under the upper lip, which allowed us to obtain a good cosmetic effect and minimize traumatic complications after surgery.

Novel in vivo depiction of optic nerves hemorrhages in child abuse: a 3D-SWI pilot study

PurposeUntil now, the diagnosis of optic nerves hemorrhages in abusive head trauma (AHT) has been obtained only in the postmortem setting. The aim of the IRB-approved study was to assess the presence of optic nerves hemorrhages in AHT patients using 3D-SWI.MethodsThirteen children with a final confirmed multidisciplinary diagnosis of AHT underwent coronal and axial 3D-SWI imaging of the orbits. The presence of optic nerve sheath (ONS) hemorrhages was defined by thickening and marked 3D-SWI hypointensity of the ONS, resulting in mass effect upon the CSF space. Optic nerve (ON) hemorrhages were defined by areas of susceptibility artifacts in the ON parenchyma. Superficial siderosis was defined by susceptibility artifact coating the ON. Furthermore, data about post-traumatic deformity of the ONS at the head of the optic nerve were collected.ResultsThe average age of the population was 7.9 ± 5.9 months old. The average GCS was 11.8 ± 4.5. The male to female ratio was 7:6. ONS hemorrhages were identified in 69.2% of cases. Superficial siderosis and ON hemorrhages were identified in 38.5 and 76.9% of cases, respectively. 3D-SWI also depicted traumatic deformity of the ONS at the level of the optic nerve head in 10 cases (76.9%). No statistical correlations were identified between RetCam findings and 3D-SWI findings or GCS and ON hemorrhages.ConclusionThis research shows that dedicated MRI with volumetric SWI of the orbits can depict hemorrhages in the ON, ONS, and ONS injury, in AHT victims.

Advanced Biomaterials and Techniques for Oral Tissue Engineering and Regeneration-A Review.

The reconstruction or repair of oral and maxillofacial functionalities and aesthetics is a priority for patients affected by tooth loss, congenital defects, trauma deformities, or various dental diseases. Therefore, in dental medicine, tissue reconstruction represents a major interest in oral and maxillofacial surgery, periodontics, orthodontics, endodontics, and even daily clinical practice. The current clinical approaches involve a vast array of techniques ranging from the traditional use of tissue grafts to the most innovative regenerative procedures, such as tissue engineering. In recent decades, a wide range of both artificial and natural biomaterials and scaffolds, genes, stem cells isolated from the mouth area (dental follicle, deciduous teeth, periodontal ligament, dental pulp, salivary glands, and adipose tissue), and various growth factors have been tested in tissue engineering approaches in dentistry, with many being proven successful. However, to fully eliminate the problems of traditional bone and tissue reconstruction in dentistry, continuous research is needed. Based on a recent literature review, this paper creates a picture of current innovative strategies applying dental stem cells for tissue regeneration in different dental fields and maxillofacial surgery, and offers detailed information regarding the available scientific data and practical applications.

Familiar occurrence of facial asymmetry: a pilot study

The point at which "normal" asymmetry becomes "abnormal" can be defined by an aesthetic limit and a functional limit. The underlying causes are still not fully discovered; the etiology includes congenital disorders, acquired diseases, and traumatic and developmental deformities. Our purpose was to investigate the possible genetic liability in the transmissibility of the asymmetric traits, through an analysis developed by twofold approach: 1) exploring and recording the family history through the use of a specific questionnaire; and 2) examining differences in laterality between the patients and their corresponding parent by a facial analysis. A total of 52 Italian subjects (57% females, 43% males; mean age: 11.7 years), showing a clinically detectable asymmetry, were selected. Individuals in the sample were selected according to the diagnosis of facial asymmetry, non-syndromic patients, participation by informed consent, and negative medical history of the maxillo-facial complex. A specifically designed questionnaire was used to investigate the presence of the asymmetric trait in the family. Differences in length between distance from the anthropometric points to the facial midline and to horizontal reference were measured on a frontal facial photograph. For all the subjects recruited the same analysis was performed on the frontal facial photographs of both the parents. A descriptive and interferential statistical analysis was performed on the data. Concerning the linear measurement, in a high percentage of parent-child pairs there is a correspondence of laterality of asymmetry traits, with a more common relation with the maternal trait. Sixty-five percent of parents with correspondence of laterality reported a positive family history of asymmetry. The analysis of the obtained data shows that the mother is the parent most involved in the correspondence of laterality. Further analysis would be appropriate to investigate this result.

Management of Gunshot Injuries of Mandible with Open Reduction and Internal Fixation versus Closed Reduction and Maxillo-mandibular Fixation.

Background/objectivesGunshot injuries are known to cause severe morbidity and mortality when facial regions are involved. Management of the gunshot wounds of the face comprises of securing an airway, controlling hemorrhage, identifying other injuries and definite repair of the traumatic facial deformities. The objective of the present study was to compare the clinical outcome (infection and nonunion) of open reduction and internal fixation versus closed reduction and maxillo-mandibular fixation (CR-MMF) in the treatment of gunshot injuries of the mandible.Materials & methodsThis study was conducted at Oral and Maxillofacial Surgery Department of Shaheed Zulfiqar Ali Bhutto Medical University/Pakistan Institute of Medical Sciences Islamabad, Pakistan. Ninety gunshot mandibular fractures were randomly allocated in two equal groups. In group-A, 45 patients were treated by open reduction and internal fixation while in group-B, 45 patients were also managed by closed reduction and maxillo-mandibular fixation. Post-operative complications (infection, non-union) were evaluated clinically and radiographically in both groups.ResultsPatients treated by open reduction and internal fixation were having more complications in terms of infection (17.8%) as compared to closed reduction (4.4%) with a p-value 0.044. Whereas non-union was more in closed reduction (15.6%) as compared to open reduction and internal fixation group (2.2%) with a significant p-value 0.026.ConclusionBoth the treatment modalities can be used in the management of gunshot injuries of mandible and there is need for further studies to have clear guideline in this regard in best interest of patients, community and health care providers.

Functional rhinoplasty for nasal traumatic deformity

功能性鼻整形是通过调整鼻部的解剖结构来改善鼻通气功能，同步改善外鼻的面部表情及美观功能的手术技术。本文围绕"鼻外伤畸形"这一专病，结合大量的国内外文献，阐述了功能性鼻整形术的各种要点，详细叙述了鼻骨骨折、鼻眶筛骨折、鼻中隔骨折和偏曲、外伤后鼻畸形和鼻瓣区畸形5种疾病，同时介绍了在行功能性鼻整形术前后的主观性和客观性评估方法。.

Neglected lumbar traumatic spine injury after falling from a tree

This 48-year-old man, previously healthy, presented with a six-month history of progressive low back pain and bilateral pseudo-sciatica of the lower extremities without sphincter disturbances. Physical examination revealed fixed kyphotic posture of the lumbar spine. Straight leg test and tendon reflexes were normal without any neurologic deficits. He reported sustaining a traumatic injury two years earlier secondary to a fall from a tree. At that time, he did not seek medical treatment. Plain radiograph (A) demonstrated regional lumbar kyphosis from L1 to L3 as well as a healed burst fracture of L2 vertebra (star). Spinal lumbar computed tomography scan (B-C) confirmed traumatic kyphotic deformity at L1-L2-L3 and moderate central stenosis at L2. There was also a new joint surface formation and vacuum phenomenon between the anterior vertebral bodies of L1 and L3. The patient was counseled on the need for surgery, but he refused any surgical intervention and insisted on conservative management. Neglected lumbar spinal injuries are rare but serious clinical situations. Their etiologies vary from missed injuries, delayed presentation for treatment, and wrong initial management. The clinical symptoms include spinal and/or radicular pain, scoliotic and/or kyphotic deformity, and neurological deficits. Management of these neglected injuries is difficult with respect to intraoperative difficulties, higher incidence of surgical complications, and subsequent rehabilitation.

Treatment of Patients with Ankle Fractures (Literature Review)

The consequences of ankle fractures are a leading cause of disability among injuries of the musculoskeletal system. The problems of treating patients with this pathology have been of interest to researchers throughout the entire period of development of ankle joint surgery. However, numerous attempts to define terminology and classify chronic ankle joint injuries were unsuccessful. It can be argued that the consequences of ankle fractures are a symptom complex that includes traumatic deformity and pseudoarthrosis of the ankles, subluxation of the foot, contracture and arthrosis of the ankle joint. Today, for the surgical treatment of chronic injuries of the ankle joint, a number of surgical techniques are used, the indications and contraindications for each of them are not completely determined. In addition, longterm results are also the subject of a debate. There is a need to develop an improved approach to the treatment of the pathology under consideration, to create a decision-making algorithm in each specific clinical case. There is no doubt that preference should be given to organ-preserving operations. Based on a review of world literature, data were obtained on the epidemiology, medical and social significance of the effects of ankle fractures, and the evolution of researchers' views on the treatment of patients with this pathology and their development prospects were examined.

A Study of Septorhinoplasty by Open Technique

Background: This study aimed to assess the reasons for which patients seek rhinoplasty, viz aesthetic, functional and psychosocial reasons. The study included 20 patients with traumatic, infective and congenital nasal deformities and were taken up for open septorhinoplasty. Methods: This study was carried out in the Department of Surgery at Hamdard Institute of Medical Sciences and Research, Jamia Hamdard, New Delhi. The duration of study was from April 2017 to May 2018. It was a prospective study. All the patients who underwent open septorhinoplasty were assessed for outcome using Alsarraf questionnaire. Other patient data including demographic data, comorbid conditions etc were considered. Results: After completion of surgeries patients were subjected to the questions of the questionnaire and final results were noted. Results were also assessed on the basis of comparative photographs, both taken pre and post operatively. Conclusions: Based on the conducted studies and after analysis of available literature, it may be concluded that functional and aesthetic results after open septorhinoplasty have an influence on quality of life of the patients. This study includes all the three aspects ie, aesthetic, functional and psychosocial, for which most of the patients seek rhinoplasty and the results of our study is comparable to various other studies.

Prevalence of Leptoprosopic type of Face among Dental Students

Facial index is useful for anatomists, forensic scientists and plastic surgeons during treatment of congenital and traumatic deformities, identification of individuals in medico-legal cases and identifying craniofacial deformities and they help us in distinguishing one person from another. Very few researchers from Nepal have worked on these facial features with respect to population and environment. The study aims to find the prevalence of leptoprosopic type of face among dental students of Kantipur Dental College, Kathmandu, Nepal. The descriptive cross-sectional study was conducted among 173 dental students of age group 17-25 years in the Department of Anatomy, Kantipur Dental College Teaching Hospital and Research Center, Basundhara, Kathmandu from September to December 2018. Ethical clearance was obtained from Institutional Review Committee of the institution and convenience sampling was done. The facial parameters include facial height, facial width which was measured using Digital Vernier Caliper and Sliding Caliper respectively. The face was classified into three different types based on the value of facial index, according to Bannister Classification. Data was analyzed using SPSS 20. Prevalence of leptoprosopic type of face was 70 (40.46%) [40.39-40.53 at 95%CI]. Among these, 37 (21.39%) were males and 33 (19.07%) were females. Leptoprosopic was most common which was followed by hyperleptoprosopic in 64 (36.99%), mesoprosopic in 26 (15.03%), euryprosopic in 12 (6.94%) and hypereuryprosopic facial types in 1 (0.58%). All three facial parameters including facial height, facial width and facial index were greater in male than in female. This study concludes that the leptoprosopic face was most common followed by hyperleptoprosopic, mesoprosopic, europrosopic and hypereuroprosopic type of face.

Cubitus varus deformity in young adults, Correction by rigidly fixed lateral closing wedge osteotomy

Neglected or poorly managed elbow trauma in developing countries often present as complex deformities of elbow in adolescents and young adults. Mostly deformities are being corrected for functional and/or cosmetic reasons. Same is the case with neglected post-traumatic cubitus varus deformity in young adults both male and female. Often these deformities are being corrected before the skeletal maturity even in developing countries now a day’s except few underprivileged whose deformities are left unaddressed till skeletal maturity. This is a retrospective study which was conducted on 14 young adults with post-traumatic cubitus varus deformity who underwent corrective surgery in our hospital during last three years. The mean age of patients was 24.4 years and mean time since injury to correction of deformity was 18 years. The male and female ratio was equal. Our mean follow up was 21.42 months. The mean cubitus varus deformity of -15.420 was corrected to a mean of cubitus valgus of 11.710 and our mean valgus angle on normal side was 130. The lateral condyle prominence was reduced from mean of 5.56 to mean of -13.14 percent. Neglected traumatic deformity like cubitus varus must be dealt early to avoid complications. Lateral closing wedge osteotomy with rigid fixation of lateral column of distal humerus for correction of cubitus varus in young skeletally mature adults has promising results in achieving the correction of deformity, timely union and preserving the elbow arc of motion. Keywords: Cubitus varus, Young adults, Lateral closing wedge osteotomy.