A 60-year-old male crane-driver slipped at work and fell onto his anterior chest against a concrete bar. This caused a transverse fracture of the body of his sternum. The pain in his anterior chest wall and sternum caused him such severe pain that, 4 months after the injury he was still taking daily morphine derivatives and was unable to work. On examination, he had a very painful and tender area at the site of the fracture, with mobility and crepitus. Sternal radiographs showed a transverse, posteriorly displaced fracture of the body of the sternum with fibrous non-union of the fracture plane ( Fig. 1). He was therefore referred to a thoracic surgeon for advice regarding surgical management of his sternum.The fracture was exposed through a paramedian skin incision, so that the wound would not be directly over the plate. The chest wall muscles were elevated from their insertion onto the sternum. The transverse sternal fracture, which was located towards the upper half of the body of the sternum, was exposed and the fibrous non-union carefully taken down by a combination of sharp dissection with a No. 15 blade and a Volkmann's spoon. Despite this it was not possible to safely mobilise the bone ends enough to allow end-to-end apposition without damage to the soft bone. Approximately 3-4 mm of the distal fragment was therefore excised. This allowed for satisfactory reduction of the fracture with a bone clamp (Fig. 2).Using an aluminium template, a seven-hole reconstruction plate was chosen and contoured. This allowed for three holes above and three holes below the fracture line. The three proximal holes for 4 mm cancellous screws were pre-drilled, measured and partially tapped using the definitive plate as a guide. A bone lever was placed posteriorly to the bone to protect the deep structures during this procedure. The plate was then fixed to the proximal fragment and then the fracture reduced and held with a bone clamp. The distal screws were then inserted. Iliac crest cancellous bone autograft chips were laid alongside the plate. A lateral sternal radiograph confirmed the correct position of the plate, appropriate length of the screws, and a complete reduction of the fracture. The soft tissues were closed over a redivac drain and the skin closed with a subcuticular undyed 3-0 Vicryl 1 . The skin was closed with clips. The patient was not Injury Extra (2005) 36, 214-216

Newer diagnostic methods have become widespread in medicine nowadays as a result of extraordinary advancements in the field of electronics. On computers, various orthodontic programs are available as software. When it comes to orthodontics, diagnosis is critical, with the radiographic study being the most important phase. The goal of this research was to assess the level of liability of direct digital radiograph tracing using CephX and compare with hand tracing digital printouts and evaluate the two techniques concerning measurement reproducibility of individual methods. The material consisted of 25 digital lateral cephalometric images, fourteen linear and angular parameters were measured by a single operator digitally and manually. The intraclass correlation coefficient and confidence interval were used to compare the difference of the measurements obtained from manual and digital tracings, and intra-examiner error was evaluated by the coefficient of variation. A comparison of hand and CephX tracing showed a low level of agreement in the anterior facial height, anterior and posterior cranial base length. Only of (LI to A-Pog) line for both manual and digital methods showed poor intra-examiner duplicability. Thus, it can be concluded that digital tracing with CephX is adequate for clinical uses and similar to manual cephalometric tracings.

Background and Objectives: The success of root canal therapy is depending on cleaning and shaping of the root canals. The root canals have complex morphology and wide individual variations. The purpose of this study was to investigate the prevalence of second mesiobuccal canal (MB2) of maxillary first molars in Erbil population using cone beam computed tomography (CBCT). Materials and Methods: A total of 101 permanent maxillary first molars were randomly se-lected from Erbil citizens. All teeth were examined for the number of root canals and the pres-ence of second mesiobuccal canal by Cone Beam Computed Tomography (CBCT). Result: The MB2 canal was found in 80.2% (the 95% CI is 72.3% to 87.1%) of the analyzed cas-es (81/101). Conclusion: The second mesiobuccal canal was found in a high percentage of the samples. And it is within normal magnitude in comparison with the common findings in the literature. These results indicate that CBCT is an effective, high-precision diagnostic tool for detecting canals. Keywords: Maxillary first molars, second mesiobuccal canal, cone beam computed tomography, Erbil Citizens.