Journal of Aesthetic & Reconstructive Surgery

Description

According to Peterson with the exception of mandibular condyle fractures judicious use of ORIF is preferable to the closed reduction and immobilization techniques with splints when treating fractures in the deciduous and mixed dentition. Also, resorbable materials have been made available as a fixation option for pediatric craniomaxillofacial fracture management.

Extended periods of maxilla mandibular fixation can lead to alkalosis in children and should be avoided. In cases of condylar fractures, non-operative management is overwhelmingly popular, because minimal complications occur and the outcomes are good in both adults and children. Moreover, in older children, the bone has less capacity to adapt and remodel, and the ramus height may not be regained.

Previous research has shown the use of arch-bar fixation restricts normal dietary intake in children, resulting in significant weight and protein loss. Here in the present case series, maxilla mandibular fixation was performed using light-training elastics so that an active exercise program could be started as soon as the child could cooperate. Before inserting the arch bar, occlusion was checked to confirm full interdigitation of the teeth with regular contact.

Ecto-Mesenchyme

The bar was adapted closely to the dental arch and placed between the dental equator and gingiva. The arch bar was extended to the last tooth on both sides in the oral cavity. The hooks were positioned symmetrically in the upper and lower jaws to achieve calculable tension forces on both the bars for functional training with elastics. Once the wire was secured to the awl, it was withdrawn until the tip of the awl reached the lower border of the mandible and then the wire was carefully passed on to the buckle sulcus along the body of the mandible, with care taken to prevent soft-tissue injury. One wire was passed on each side, taking precaution to avoid injury to the mental neurovascular bundle. To fix the arch bar in place, a ligature in the premolar region was prepared on each side. The arch bar was positioned and fixed using the wire twister.

It is more difficult to make use of the teeth in children for fixation, because deciduous teeth may be either insufficient in number or their roots may be resorbed and permanent teeth may be incompletely erupted. The wire was cut with a cutter, and the ends were turned away from the gingiva to prevent damage. Maxilla mandibular fixation was performed with elastics for intraoperative management of the occlusion Management of mandibular fractures in children differs somewhat from that in adults because of several considerations, including anatomic variation, rapidity of healing, degree of patient cooperation, and the potential for changes in mandibular growth.

Ankylosis of the temporomandibular joint causing impairment of function is more common in children and damage to the condylar growth center can result in facial deformity. This paper focuses on the assessment, evaluation, and treatment of mandibular fracture in young children by ORIF.

Since the initial work by Julliard's group, we have demonstrated that a computer-assisted navigation system (CANS) improves accuracy in positioning the femoral and tibial graft insertion sites. We therefore hypothesised that using a CANS significantly decreased the failure rate of ACL reconstruction. To assess this hypothesis, we prospectively compared two groups of patients, an intervention group managed with CANS and a control group managed with conventional surgery. The primary evaluation criteria were the objective and subjective IKDC scores 1 year after surgery. A grade of A or B based on the IKDC scores was taken to indicate successful reconstruction and a grade of C or D failed reconstruction. Secondary evaluation criteria included the subjective IKDC score increase after 6 months and 1 year versus baseline, to determine whether the time to functional recovery was shorter in the CANS group; feasibility (percentage of patients actually managed with CANS in the CANS group); learning curve parameters (ligament positioning and operating time); and hospital stay characteristics (stay length, need for ICU admission, operating time, and immediate postoperative complications including reoperation). In addition, any complications after hospital discharge were recorded during three patient visits, 3 months, 6 months, and 1 year after the procedure. Finally, the time to resumption of physical activities was recorded, as well as the number and specific modalities of the rehabilitation sessions.

We used a prospective, observational, multicentre, comparative, non-randomised, open study design. The study was sponsored by the French Ministry of Health. We included patients older than 18 years of age who were scheduled for a primary ACL reconstruction procedure using either the autologous semitendinosus and gracilis tendons (four-strand hamstring graft, FSHG) or an autologous bone-patellar tendonbone graft (BPBG). All study data were handled confidentially and entered into an electronic case-report form. Each patient was given an information sheet explaining how the data would be used and specifying the patient's right to refuse the study and to access and modify the data. The primary evaluation criterion was assessed 1 year after ACL reconstruction.

Anterior Cruciate Ligament

Surgical reconstruction of the Anterior Cruciate Ligament (ACL) is a very commonly performed procedure (about 40,000 cases per year in France). The goal is recovery of full knee function. Therefore, ligament reconstruction must be both anatomically and functionally optimal. Good or very good overall objective and subjective outcomes have been reported in 85% of cases. Failed reconstruction in the remaining 15% of cases is associated with an IKDC grade of C or D, an inability to resume previous occupation-related or sporting activities, and/or tunnel malposition. The result is loss of chance for the patient and additional healthcare costs related not only to the need for further surgery, but also to the well-documented meniscal and cartilaginous complications that characterise the natural history of ACL rupture.

The evaluation criteria were the objective and subjective IKDC scores, knee laxity measured using Telos radiography, and measurements of graft position. Few studies have compared clinical outcomes after ACL reconstruction with versus without computer-assisted navigation. Plaweski et al. used the ACL Logics system in 30 patients, who were compared to 30 patients managed by conventional surgery. The additional operating time was 26 minutes. After a mean follow-up of 2 years, differential laxity was lower in the navigation group: Laxity was less than 2 mm in 96.7% of knees in this group compared to 83% in the conventional-surgery group. In addition, tibial tunnel positioning was significantly better in the navigation group. No statistically significant differences were found between the two groups for the functional scores or the resumption of sporting activities. Picard et al. assessed tunnel placement with and without navigation in a prospective randomised trial. Two surgeons experienced in ACL reconstruction but inexperienced in computer-assisted navigation drilled tibial tunnels in 20 artificial knees. Accuracy in tunnel placement was significantly better with the navigation system.

When used for ACL reconstruction, a computer-assisted navigation system seems beneficial as a learning tool for junior surgeons and in difficult cases (tunnel positioning). Use of a navigation system increases the operating time but has no effect on the complication rate. Nevertheless, we found no evidence that the navigation system significantly improved the clinical outcomes. Thus, our results disprove our working hypothesis. Conceivably, given the young age of our patients, a longerfollow- up may be necessary to detect clinical benefits of improved anatomical reconstruction accuracy via the use of navigation.