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Secondary corrective osteotomy of malunited craniofacial fractures can be a challenging proposition. The exposure, extrusion, and palpability of the titanium implants used become a genuine concern especially in areas of relatively thin skin, such as the periorbital region. Restoring a satisfactory contour to the midface is another major task for the plastic surgeon. Bone cement used to reconstruct craniofacial defects has existed for many years. However, most applications have been as a substitute for autogenous bone grafts for defects less than 25 cm 2 . In this article, we present two cases of malunited facial fractures that underwent corrective osteotomy, during which we felt that despite the conventional osteotomy and reduction techniques, there was still either a small remnant step deformity or suboptimal contour smoothness due to prominence of the implants used. We thus used bone cement as a resurfacing medium over titanium implants to restore good malar contour and reduce the palpability and exposure rate of the titanium implants. We report good patient satisfaction with contour correction with no increase in wound infection rates or any delay in wound healing. There was initial chemosis associated with the use of the bone cement, which resolved in both patients within 3 to 4 weeks. Postoperative computed tomography showed some degree of osteointegration but no fraction of the bone cement. Calcium phosphate bone cement thus presents an attractive adjunctive method for midfacial contour resurfacing, when used in conjunction with conventional osteotomy procedures and as an onlay over prominent titanium implants.

Chest injuries are common-rib fractures are present in approximately 21% of patients with blunt chest trauma. 1 Rib fractures are associated with significant morbidity. Patients require admission to the intensive care unit (ICU) and mortality rates are reported to be as high as 33%. 2,3 Acute problems associated with rib fractures include prolonged mechanical ventilation and length of stay (LOS), higher incidence of tracheostomy, pneumonia and mortality. 4 Postinjury, the mean number of days lost from work or usual activity per patient was 70 ± 41 days. 5 In the long-term, rib fractures are associated with chronic problems such as pain, chest wall deformity, reduced quality of life (QOL), functional loss and socioeconomic costs. 4 Increasingly, studies have shown that there might be a role for surgical fixation of rib fractures. Surgical stabilisation of ribs leads to earlier weaning from ventilator support, reduces acute complications and prevents chronic pain, which may be associated with permanent chest wall deformities. 6 Despite the reported clinical benefits, rib fracture fixation remains an underutilised procedure in Singapore. The aim of this study was to describe the results and long-term functional outcomes of our experience with rib fracture fixation.

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