Background The proximal interphalangeal (PIP) joint plays an important role in both grasp and pinch. In terms of mobility and stability, an intact PIP joint plays an important role in isolated finger function as well as the function of the entire hand. Currently, there are only a few surgical management protocols: arthrodesis, arthroplasty without joint replacement and arthroplasty with prosthetic replacement. This study aims to evaluate the gap arthroplasty technique as an alternative method for PIP joint reconstruction and to identify its advantages and disadvantages. Methods This interventional prospective study was conducted in a university hospital setting. We performed PIP joint gap arthroplasty using a dynamic traction device system after resection of the ankylotic area. The assessed outcome parameters were pain relief and range of motion (ROM) at 6 months, post-operatively.
ResultsThe results showed a complete pain relief, excellent passive ROM (in mean 65°) and a good active ROM (in mean 41°). This allows the patient to move the four ulnar fingers together without interruption from the injured finger. Overall patient satisfaction was very good. Conclusions Gap arthroplasty is an easy and effective technique for the PIP joint, and it does not require expensive materials as do artificial joint procedures. However, further studies are needed to conduct a longterm functional evaluation. Level of Evidence: Level IV, therapeutic study.
Using traditional measures to assess mandibular stability after the surgery-first approach (SFA) may produce inaccurate results because unlike the conventional orthodonticfirst approach (OFA), the main dental movements occur after surgery in SFA, which produce unavoidable mandibular movements, especially in cases with postsurgical premature dental contact. As these movements are part of the surgicalorthodontic plan, they should not be considered an actual relapse. In this study, to avoid postsurgical dental movement effects, the authors used the relationship between proximal and distal mandibular segments to evaluate stability after SFA. Four easily located points on computerized tomography/conebeam computerized tomography reconstructed 3-dimensional images were used to calculate 4 measurements between proximal and distal mandibular segments across the osteotomy line in two matched groups of patients (SFA and OFA) at 3 different time points (before, immediately after, and 1 year after the surgery). A high level of skeletal stability was found in the SFA group, with changes 1 year after surgery not exceeding 0.5 mm. The SFA was as skeletally stable as OFA, and the mandibular counterclockwise rotation after surgery was related to the planned dental movements and not the instability of the surgery itself. To avoid the illusion of this preplanned relapse, stability should be measured as a relation between proximal and distal mandibular segments, across the osteotomy and fixation line, and not as a relation between maxillary and mandibular landmarks or between the mandible and facial planes as classically described.
Background: The 3-dimensional evaluation of skeletal stability after orthognathic surgery is time-consuming and complex procedure. The complexity increases further when evaluating the surgery-first orthognathic approach (SFOA). Herein, we propose and validate a simple time-saving method of 3D analysis using a single software, demonstrating high accuracy and repeatability.
Methods: This retrospective cohort study included 12 patients with skeletal class-3 malocclusion, who underwent bimaxillary surgery without any pre-surgical orthodontics. Computed tomography (CT) / cone beam CT images of each patient were obtained at three different time points (pre-operation (T0), immediately post-operation (T1) and one year after surgery (T2)) and reconstructed into 3D images. After automatic surface-based alignment of the 3 models based on the anterior cranial base, five easily located anatomical landmarks were defined to each model. A set of angular and linear measurements were automatically calculated and used to define the amount of movement (T1-T0) and the amount of relapse (T2-T1). To evaluate the reproducibility, two independent observers processed all the cases, One of them repeated the steps after two weeks to assess intra-observer variability. Intraclass correlation coefficients (ICC) were calculated at a 95% confidence interval. Time required for evaluating each case was recorded
Results: both the intra- and inter-observer variability showed high ICC values (more than 0.95) with low measurement variations (mean linear variations (0.18 mm), mean angular variations (0.25 degree). Time needed for the evaluation process ranged from 3-5 minutes.
Conclusions: This approach is time-saving, semi-automatic, easy to learn and can be used to effectively evaluate stability after SFOA.
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