Purpose: To analyze the outcome of distal tibia fracture treated with the Distal Tibia LCP with combination of interfragmentary screw. Materials and Methods: Between January 2008 and March 2012, data of 34 patients with fracture of distal tibia treated with the Distal Tibia LCP with or without combination of interfragmentary screws were reviewed. There were 17 males and 17 females with an average age of 51.8 years (range, 18~77 years). Radiographic union time and time from surgery until ability to full weight bearing were measured and compared. Callus index was measured as quotient of callus thickness and diameter of corticalis both in AP and sagittal direction. Results: 12 fractures were treated with interfragmentary screws and 22 fractures were treated with bridging plate alone. In interfragmentary fixation group, time to full weight bearing was 14 weeks versus 15.75 weeks without screw. Callus index at bearing was not significantly lesser in patients with screw compated with those without, but callus index difference at posterative 4weeks was sigficant. Radiologic union time was 11.3 weeks in interfragmentary fixation group and 12.58 weeks without screw. Conclusion: The osteosynthesis with the Distal tibia LCP with combination of interfragmentary screw seems to be more stable in postoperative 4weeks than Distal tibia LCP alone, expecting to earlier ROM exercise and rehabilitation.
Purpose: Despite the high success rates of endosseous dental implants, their placement is restricted according to the height and volume of bone available. The use of short or mini dental implants could be one way to overcome this limitation. Thus, this study aimed to compare standard, short, and mini dental implants with regard to associated clinical parameters and peri-implant crevicular fluid (PICF) levels of cathepsin-K (CTSK), RANK ligand (RANKL), and osteoprotegerin (OPG), after prosthodontic loading. Methods: A total of 78 non-submerged implants (Euroteknika, $Aesthetica^{+2}$, Sallanches, France) were installed in 30 subjects (13 male, 17 female; range, 26-62 years) who visited the clinic of the Periodontology Department, Faculty of Dentistry, Selcuk University. Sampling and measurements were performed on the loading date (baseline) and 2, 14, and 90 days after loading. Assessment of the peri-implant status for the implant sites was performed using the pocket probing depth (PPD), modified plaque index, modified gingival index, modified sulcular bleeding index, and radiographic signs of bone loss. PICF samples collected from each implant were evaluated for CTSK, RANKL, and OPG levels using the ELISA method. Keratinized tissue and marginal bone loss (MBL) were also noted. Results: Clinical parameters statistically significantly increased in each group but did not show statistical differences between groups without PPD. Although implant groups showed a higher MBL in the upper jaw, only the standard dental group demonstrated a statistically significant difference. At 90 days, the OPG:sRANKL ratio and total amounts of CTSK for each group did not differ from baseline. Conclusions: Within the limitations of this study, both short and mini dental implants were achieving the same outcomes as the standard dental implants in the early period after loading.
Background: The combined use of biomaterials for regeneration may have great biological relevance. This study aimed to compare the regenerative potential of biphasic calcium phosphate (BCP) alone and with growth factor enamel matrix derivatives (EMDs) for the regeneration of intrabony defects at 1 year. Methods: This randomized controlled trial included 40 sites in 29 patients with stage II/III periodontitis and 2/3 wall intrabony defects that were treated with BCP alone (control group) or a combination of BCP and EMD (test group). BCP alloplastic bone grafts provide better bio-absorbability and accelerate bone formation. EMDs are commercially available amelogenins. Mean values and standard deviations were calculated for the following parameters: plaque index (PI), papillary bleeding index (PBI), vertical probing pocket depth (V-PPD), vertical clinical attachment level (V-CAL), and radiographic defect depth (RDD). Student paired and unpaired t-tests were used to compare the data from baseline to 12 months for each group and between the groups, respectively. The results were considered statistically significant at p<0.05. Results: At 12 months, the PI and PBI scores of the control and test groups were not significantly different (p>0.05). The mean V-PPD difference, V-CAL gain, and RDD difference were statistically significant in both groups at 12 months (p<0.001 for all parameters). Intergroup comparisons showed that the mean V-PPD reduction (2.13±1.35 mm), V-CAL gain (2.53±1.2 mm), and RDD fill (1.33±1.0 mm) were statistically significant between the groups at 12 months (p<0.001 for all parameters). Conclusion: BCP and EMDs combination is a promising modality for the regeneration of intrabony defects.
Objective : Lateral interbody fusion (LIF) is attractive as a less invasive technique to address anterior spinal pathology in the treatment of adult spinal deformity. Its own uses and benefits in treatment of adult degenerative scoliosis are undefined. To investigate the radiographic and clinical outcomes of LIF, and staged LIF and posterior spinal fusion (PSF) for the treatment of adult degenerative scoliosis patients, we analyzed radiographic and clinical outcomes of adult degenerative scoliosis patients who underwent LIF and posterior spinal fusion. Methods : Forty consecutive adult degenerative scoliosis patients who underwent LIF followed by staged PSF at a single institution were retrospectively reviewed. Long-standing 36" anterior-posterior and lateral radiographs were taken preoperatively, at inter-stage, 3 months, 1 year, and 2 years after surgery were reviewed. Outcomes were assessed through the visual analogue scale (VAS), 36-Item Short Form Health Survey (SF-36), and Oswestry Disability Index (ODI). Results : Forty patients with a mean age of 66.3 (range, 49-79) met inclusion criteria. A mean of 3.8 levels (range, 2-5) were fused using LIF, while a mean of 9.0 levels (range, 3-16) were fused during the posterior approach. The mean time between stages was 1.4 days (range, 1-6). The mean follow-up was 19.6 months. Lumbar lordosis was significantly restored from $36.4^{\circ}$ preoperatively up to $48.9^{\circ}$ (71.4% of total correction) after LIF and $53.9^{\circ}$ after PSF. Lumbar coronal Cobb was prominently improved from $38.6^{\circ}$ preoperatively to $24.1^{\circ}$ (55.8% of total correction) after LIF, $12.6^{\circ}$ after PSF respectively. The mean pelvic incidence-lumbar lordosis mismatch was markedly improved from $22.2^{\circ}$ preoperatively to $8.1^{\circ}$ (86.5% of total correction) after LIF, $5.9^{\circ}$ after PSF. Correction of coronal imbalance and sagittal vertebral axis did not reach significance. The rate of perioperative complication was 37.5%. Five patients underwent revision surgery due to wound infection. No major perioperative medical complications occurred. At last follow-up, there were significant improvements in VAS, SF-36 Physical Component Summary and ODI scores. Conclusion : LIF provides significant corrections in the coronal and sagittal plane in the patients with adult degenerative scoliosis. However, LIF combined with staged PSF provides more excellent radiographic and clinical outcomes, with reduced perioperative risk in the treatment of adult degenerative scoliosis.
Purpose: The aim of this study was to determine whether the panoramic mandibular index (PMI) is useful for assessing bone mineral density. We also analyzed the potential correlations between PMI parameters and patient age. Materials and Methods: Four observers measured the PMI of both sides of the mental foramen using a picture archiving and communication system and images in the Digital Imaging and Communications in Medicine format. They studied 300 panoramic radiographic images of patients belonging to the following age groups: 40-49 years, 50-59 years, 60-69 years, 70-79 years, and 80-89 years. The observers were allowed to zoom in or out and to adjust the contrast of the images. Further, they were instructed to record the reasons for any measurements that could not be made. Then, we conducted a reliability analysis of the measured PMI and assessed the correlations between different patient age groups and the 3 parameters used for determining the PMI from the available data. Results: Among the 600 data items collected, 23 items were considered unmeasurable by at least 1 observer for the following 4 reasons: postoperative state, lesion, unidentified mental foramen, and alveolar bone loss. The intraobserver reproducibility of the measurable data was 0.611-0.752. The mandibular cortical width (MCW) decreased significantly as patient age increased. Conclusion: PMI had limited usability when the margin of the mental foramen was not clear. In contrast, MCW, a parameter used for determining the PMI, had fewer drawbacks than the PMI with respect to bone mineral density measurements and exhibited a significant correlation with patient age.
Lee, Keun-Bae;Kim, Byung-Soo;Park, Yu-Bok;Moon, Eun-Sun;Choi, Jin
Journal of Korean Foot and Ankle Society
/
v.9
no.2
/
pp.140-145
/
2005
Purpose: To analyze the outcome of metatarsal lengthening of first brachymetatarsia by callotasis using an external fixator. Materials and Methods: Between January 1998 and February 2004, 10 patients (17 cases) were reviewed. The mean age at operation was 17.3 years. Seven patients had bilateral first brachymetatarsia and eight patients had combined 4th brachymetatarsia. The operations were performed with a monoexternal fixator, and distraction was started at a rate of 0.75 mm/day after 7 days. The radiographic results were evaluated by lengthening amount and percentage, fixation time, and healing index. Complications and AOFAS score were evaluated. Results: The average lengthening amount was 17.7 mm and the average lengthening percentage was 43.4%. The external fixation time was 107 days and average healing index was 69.8 days/cm. The evaluation according to AOFAS score was excellent in 12 cases and good in 5 cases. Complications were 4 cases of hallux valgus, 4 of metatarsophalangeal joint stiffness, 3 of medial angular deformity, 3 of pes cavus, 2 of pin breakage, 2 of pin site infection, and 1 of skin hyperpigmentation. Conclusion: Callotasis for 1st brachymetatarsia is a very useful treatment method with high patient satisfaction, excellent healing rate and early ambulation without bone graft. Nevertheless, great care must be taken to minimize the various possible complications.
Objective : The current literature implies that the use of short-segment pedicle screw fixation for spinal fractures is dangerous and inappropriate because of its high failure rate, but favorable results have been reported. The purpose of this study is to report the short term results of thoracolumbar burst and compression fractures treated with short-segment pedicle instrumentation. Methods : A retrospective review of all surgically managed thoracolumbar fractures during six years were performed. The 19 surgically managed patients were instrumented by the short-segment technique. Patients' charts, operation notes, preoperative and postoperative radiographs (sagittal index, sagittal plane kyphosis, anterior body compression, vertebral kyphosis, regional kyphosis), computed tomography scans, neurological findings (Frankel functional classification), and follow-up records up to 12-month follow-up were reviewed. Results : No patients showed an increase in neurological deficit. A statistically significant difference existed between the patients preoperative, postoperative and follow-up sagittal index, sagittal plane kyphosis, anterior body compression, vertebral kyphosis and regional kyphosis. One screw pullout resulted in kyphotic angulation, one screw was misplaced and one patient suffered angulation of the proximal segment on follow-up, but these findings were not related to the radiographic findings. Significant bending of screws or hardware breakage were not encountered. Conclusion : Although long term follow-up evaluation needs to verified, the short term follow-up results suggest a favorable outcome for short-segment instrumentation. When applied to patients with isolated spinal fractures who were cooperative with 3-4 months of spinal bracing, short-segment pedicle screw fixation using the posterior approach seems to provide satisfactory result.
Purpose: The aim of this study was to compare the clinical outcome of open flap debridement (OFD) with a biphasic calcium phosphate (BCP) graft to that of OFD without BCP graft for the treatment of intrabony periodontal defects (IBDs). Methods: The study included 25 subjects that had at least one intrabony defect of 2- or 3-wall morphology and an intrabony component ${\geq}4$ mm as detected radiographically. Subjects were randomly assigned to treatment with (BCP group, n=14) or without BCP (OFD group, n=11). Clinical parameters were recorded at baseline and 6 months after surgery and included the plaque index, gingival index, probing depth (PD), clinical attachment level (CAL), and gingival recession (REC). A stringent plaque control regimen was enforced for all of the patients during the 6-month observation period. Results: In all of the treatment groups, significant PD reductions and CAL gains occurred during the study period (P<0.01). At 6 months, patients in the BCP group exhibited a mean PD reduction of $3.7{\pm}1.2$ mm and a mean CAL gain of $3.0{\pm}1.1$ mm compared to the baseline. Corresponding values for the patients treated with OFD were $2.5{\pm}0.8$ mm and $1.4{\pm}1.0$ mm, respectively. Compared to OFD group, the additional CAL gain was significantly greater in the patients in BCP group (P=0.028). The additional PD reduction was significant for the BCP group (P=0.048). The REC showed a significant increase in both groups, and the amount of recession was significantly smaller in the BCP group than OFD group (P=0.023). In radiographic evaluation, the height of the bone fill in the BCP group was significantly greater than OFD group. Conclusions: The clinical benefits of BCP found in this study indicate that BCP may be an appropriate alternative to conventional graft materials.
Lim, Ji Seok;Yoon, Kang Hyun;Lee, Seungmin;Cho, Ye Eun;Park, Ji Min;Lee, Sang Hoon;Kim, Yong Suk
Journal of Acupuncture Research
/
v.32
no.3
/
pp.107-115
/
2015
Objectives : The aim of this study is to investigate the state of cervical disc herniation according to the degree of cervical lordosis and age. Methods : 67 records of inpatients who were diagnosed with herniated intervertebral disc(HIVD) of the cervical spine were analyzed. Cobb's method, Jochumsen method and the Ishihara index were used to measure the degree of cervical lordosis. The state of the cervical disc was identified using magnetic resonance imaging(MRI) of the cervical spine. Then correlations among cervical lordosis, age and cervical disc herniation were analyzed. Results : Disc bulging was associated with hypolordosis and disc protrusion was associated with hyperlordosis and age. Disc extrusion was not associated with either cervical lordosis or age. The number of disc herniations in the cervical spine was correlated with age significantly, but not with cervical lordosis. Conclusions : Cervical disc herniation had a tendency to correlate with age and cervical lordosis, although this is not definite. Future studies that analyze more radiographic images of patients with HIVD of the cervical spine might be necessary to identify the influence of cervical lordosis on cervical disc herniation.
Purpose: The purpose of this study was to observe and quantify the expression of interleukin-4 (IL-4), interferon-$\gamma$ (IFN-$\gamma$), and tissue inhibitor of matrix metalloproteinase-2 (TIMP-2) in the gingival tissue of patients with type 2 diabetes mellitus (DM) and healthy adults with chronic periodontitis. Methods: Twelve patients with type 2 DM and chronic periodontitis (Group 3), twelve patients with chronic periodontitis (Group 2), and twelve healthy individuals (Group 1) were included in the study. Clinical criteria of gingival (sulcus bleeding index value, probing depths) and radiographic evidences of bone resorption were divided into three groups. The concentrations of cytokines were determined by a western blot analysis and compared using one-way ANOVA followed by Tukey's test. Results: The expression levels of IFN-$\gamma$ and TIMP-2 showed an increasing tendency in Groups 2 and 3 when compared to Group 1. On the other hand, the expression of IL-4 was highest in Group 1. Conclusions: The findings suggest that IFN-$\gamma$ and TIMP-2 may be involved in the periodontal inflammation associated with type 2 DM. IL-4 may be involved in the retrogression of the periodontal inflammation associated with type 2 DM.
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