No abstract

No abstract

Major problems in closed reduction of isolated, minimally displaced, and depressed zygomatic arch fractures are blind nature of the technique, reliability on digital palpation, reduction click, and step deformity between fragments. The purpose of this study was to objectively confirm the adequacy of closed reduction intraoperatively and the usefulness of the "C"-arm image intensifier. A total of 12 patients with 1- to 8-day-old unilateral isolated and depressed zygomatic arch fracture underwent closed reduction under "C"-arm image intensifier. Of these patients, 9 were men and 3 were women, with age ranging from 18 to 32 years. Intraoperative prereduction and postreduction images were obtained using the "C"-arm image intensifier. Criteria for adequate reduction were the following: intrafragmentary gap less than 0.5 mm, no overriding of fragments, no depression of fragments, and no step deformity. After being clinically satisfied about the reduction, images on "C"-arm showed no intrafragmentary gap. In 3 patients, there were residual overriding and minimal rotation around the anteroposterior axis of the posterior fragment. In 1 patient, rotation and step deformity remained. In this patient, additional stabilization was provided. The "C"-arm image intensifier shows some poorly reduced or unstable isolated depressed zygomatic arch fractures that remain unidentified even after careful palpation. Thus, it plays a recognizable role to avoid the trouble of second intervention.

It has been the desire and a great challenge to clinicians treating maxillofacial deformities to bring about symmetry in asymmetric faces. As one understands, it is very difficult to reproduce nature, that is, the normal side out of abnormal side, and it is easier to manage bilateral symmetrical deformities. Temporomandibular joint (TMJ) ankylosis, when it occurs in early childhood, will have devastating effects on the future growth and development of the jaws and teeth with obvious facial deformity including the chin, which worsens with advancing age and the time elapsed between the onset of ankylosis and the treatment instituted. We have been treating these chin deformities in adult unilateral TMJ ankylosis cases for over more than a decade with horizontal flip pedicled genioplasty, which has a mathematical basis of turning a scalene triangle to an isosceles triangle and thereby achieving symmetry. Fixation of the genial segment in an overriding position not only adds to the length of mandible but also overcomes the obstructive sleep apnea many times associated with TMJ ankylosis. We have successfully treated 15 patients using horizontal flip pedicled genioplasty during last 14 years. This instantaneous corrective and unique technique requiring minimal patient compliance is put forward with refinements developed during a period of years.

Introduction: The Ilizarov method and fixation is a well established treatment in lower limb reconstruction, but little has been reported about the outcome of its use in the treatment of segmental tibial fractures. Aim: To review a single unit's experience of the Ilizarov method in segmental tibial fractures. Materials and methods: 33 patients, aged 18-75 years, were reviewed retrospectively after the completion of treatment. 24 patients were male, 20 patients had open fractures; these were all graded as Gustilo-Anderson IIIb. Demographic data, type of fracture, period spent in the fixator, incidence of secondary operations and complications were recorded. The patients were asked to complete a Lysholm knee scale and Tegner activity level scale to assess knee function, an Olander and Moldeavia Ankle score to assess ankle function and a SF-36 health questionnaire. Results: All fractures were united at the end of treatment; the mean time spent in frame was 181 days. In three cases of non-union occurred at one fracture site these were corrected with the application of a second frame. Malunion was reported in one case, this was corrected with reapplication of a frame and satisfactory union was achieved soon after.Complications were few in number, one patient required excision of a ring sequestrum and one case of DVT was reported. There was no incidence of compartment syndrome.The mean Lysholm knee score dropped from 91 to 58, the mean Tegner activity score dropped from 6 to 2, and the mean Olander and Moldeavia ankle score dropped from 95 to 55 before and after the fracture. The SF-36 scoring gave a mean PCS of 39 and MCS of 51. Conclusion: The Ilizarov treatment of segmental tibial fractures can lead to relatively fast union rates, with an acceptably low incidence of complication. Due to the high velocity mechanism of injury the residual impairment of the limb is still significant.