Arthroplastie totale semicontrainte pour ankylose sévère post-traumatique du coude : à propos d'un cas

Costochondral Graft as Interpositional material for TMJ Ankylosis in Children: A Clinical Study

ABSTRACT

TMJ ankylosis is one of the most disruptive anomaly that affects the masticatory system. The inability to move the mandible has significant functional ramification, such as the inability to eat a normal diet. Additionally, speech is affected, making it difficult for some individuals to communicate and express themselves to others. As there are several biologic and anatomic similarities to the mandibular condyles, autogenous costochondral grafts have been considered to be the most acceptable tissue for temporomandibular joint reconstruction. In addition donor site complications are infrequent and regeneration of the rib usually occurs within a year post operatively in children.

AIM

The aim of this study was to evaluate the function of costochondral grafts to replace the mandibular condyles and to assess the position, growth, overgrowth, function, success, failure and resorption of costochondral grafts.

MATERIALS AND METHODS

Ten TMJ ankylosis patients were operated in the Department of Oral and Maxillofacial Surgery at Institute of Dental Sciences, Bareilly. Out of the 10 cases 6 were male patients and 4 female patients in age group of ≤14 years; of which 8 patients were of unilateral TMJ ankylosis and 2 were of bilateral TMJ ankylosis. All ten patients underwent interpositional gap arthroplasty with reconstruction of the condyle by costochondral graft.

RESULTS

All patients with costochondral grafts had improved mandibular symmetry and growth with adequate mouth opening.

CONCLUSION

This study indicates that using costochondral grafts to reconstruct TMJ ankylosis in children provides a good result.

Ulnar component surface finish influenced the outcome of primary Coonrad-Morrey total elbow arthroplasty

BACKGROUND

Controversy remains regarding the mechanisms leading to ulnar loosening after elbow replacement. We therefore assessed the loosening rate of the ulnar component as a function of the surface finish of a commonly used implant design.

MATERIALS AND METHODS

This study included 3 groups who received implants with 3 different surface finishes: sintered beads (278 components), polymethylmethacrylate precoating (219 components), and plasma-sprayed beads (205 components).

RESULTS

The 3 groups who received the implants did not differ statistically in age, sex, or underlying diagnosis. The rates of mechanical failure for the sintered, precoated, and plasma-sprayed ulnar components were 6.8%, 12.8%, and 0%, respectively. The 7-year Kaplan-Meier survival rates free of mechanical failure were 93.1% for the sintered-beads group, 83.1% for the precoated group, and 100% for the plasma-sprayed group. Failed precoated ulnar components often failed early and exhibited typical features, including proximal debonding and severe focal or global osteolysis, sometimes leading to periprosthetic insufficiency fractures.

CONCLUSION

Precoating the ulnar component with polymethylmethacrylate can lead to an increased rate of loosening and severe osteolysis. A plasma-sprayed ulnar component is associated with a very low mechanical failure rate with surveillance of less than 10 years.

[Functional outcome of posttraumatic elbow contractures]

INTRODUCTION

Posttraumatic elbow contractures can cause functional limitations and impairment of activities of daily living in children and adults. The aim of this study was to investigate the outcome and differences between posttraumatic elbow contractures in children and adults during rehabilitation.

MATERIAL AND METHODS

We analyzed 68 patients with posttraumatic elbow contractures, who had been admitted to the regional rehabilitation center and managed by procedures of physical therapy. All patients were divided into two groups: group A (34 children) and group B (34 adults). Mayo Clinic Performance Index for Elbow (MCPI) was measured at the beginning and at the end of the physical treatment for each patient.

RESULTS

Out of the study sample, 76.47% of children and 47.06% of adult patients had excellent score at the end of the therapy. The median of Performance index increased for both groups after the physical therapy and the differences were significantly high for both groups, children (t = 5.66, p < 0.001) and adults (t = 2.47, p < 0.001). MCPI at the discharge was significantly higher in the children than in the adults (t = 2.85, p < 0.05).

CONCLUSION

The results of our investigation have shown that the elbow function assessment in patients with posttraumatic elbow contractures (in regard to pain, motion, stability and sum of daily function) was better in children than in adults at discharge, after approximately 3 weeks of rehabilitation.