We retrospectively analyzed 63 patients with internal rotation contracture of the shoulder secondary to brachial plexus birth palsy treated with subscapularis sliding combined with either latissimus dorsi transfer (group A: n = 18) or latissimus dorsi and teres major transfer (group B: n = 45) to the rotator cuff. The mean age at time of surgery was 43 months (SD 21 months; range 8 months to 9 years). We used a modification of the Gilbert shoulder grading system for assessment. All patients showed statistically significant improvement of active shoulder abduction and external rotation without significant differences between the two groups. Significant external rotation contracture of the shoulder (inability to touch the abdomen with the wrist extended) occurred in 42 of 63 patients, and there was a greater incidence of external rotation contracture in group B. We conclude that surgery should be restricted to latissimus dorsi transfer without teres major transfer to avoid external rotation contractures. Our modification of the Gilbert grading system appears to be valid and applicable.

objective: This study was conducted to assess the shear bond strength of orthodontic brackets bonded with total etch adhesive systems containing silver nanoparticles (AgNPs) and interfacial analysis using Environmental Scanning Electron Microscope (ESEM). materials and methods:The AgNPs was synthesized and characterized by (UV-Vis) spectroscopy and Transmission Electron Microscope (TEM). Adper Single Bond 2 was used as the total etch (TE) adhesive. 48 teeth were divided into 40 teeth for shear bond strength test and 8 teeth for ultra-morphologic examination. For shear bond strength test 40 teeth were randomly divided into two equal groups according to the addition of silver nanoparticles, (TE) teeth were bonded with adhesive not containing silver nanoparticles and (TES) teeth were bonded with adhesive containing silver nanoparticles. Each group was subdivided into 2 subgroups: C 1 (10 specimens): 24 hours aging period. C 2 (10 specimens): 3months aging period. Finally two representative samples of each group were analyzed using an (ESEM) for interfacial analysis. result: After 24 hours aging, there was non-significant difference between mean shear bond strength values of the adhesive contain silver nanoparticles (5.09± 1.69) and the nanoparticles free adhesive (4.69± 1.42). Also after 3 months aging there was non-significant difference between both adhesives with (6.31±1.12) and without (5.14± 1.16) addition of silver nanoparticles. conclusions:The addition silver nanoparticles to total-etch adhesive systems did not hinder bonding of resin composite to enamel. Silver nanoparticles didn't antagonize penetration of resin tags into enamel. Bonding of brackets with resin composite using total etch adhesive system containing and non-containing Silver nanoparticles doesn't deteriorate with time.