Immediate Post-Operative Reconstruction of Calvarial Bone by Cranioplasty Prosthesis in Calvarial Bone Fibrous Dysplasia

Objectives: Immediate post-operative reconstruction of calvarial bone by cranioplasty prosthesis in calvarial bone fibrous dysplasia. An easy and economical method for reconstruction of the defect. Methods: Surgical excision of right parietal cranial space occupied lesion was performed followed by fabrication of immediate postoperative period cranioplasty prosthesis by using clear heat polymerized polymethylmethacrylate. Results: The cranial defect created during excision of calvarial bone fibrous dysplasia was immediately replaced by cranioplasty prosthesis which was fabricated in the immediate post-operative period using heat polymethylmethacrylate. Conclusions: Polymethylmethacrylate is a very reliable thermoplastic material that can be prefabricated or even placed immediately after post-operative period to produce a suitable prosthesis. Polymethylmethacrylate implants have been outmoded by computer-aided design and computer-aided manufacturing and newer 3-dimensional printed implants, but these newer methods are accompanied by higher expenses and timing issues.

Improvement in Quality of Life Following Operative Correction of Midtarsal Charcot Foot Deformity

Background: Patients with Charcot foot arthropathy report a poor quality of life following the development of deformity. Their quality of life is often not improved with “successful” historic accommodative treatment. There is increased current interest in operative correction of the acquired deformity with the stated goals of achieving both the traditional goals of resolution of infection and limb salvage as well as the desire to improve quality of life. The Short Musculoskeletal Functional Assessment (SMFA) outcomes instrument appears to be a valid tool for evaluating this complex patient population. Methods: Twenty-five consecutive patients undergoing operative reconstruction for nonplantigrade midtarsal Charcot foot arthropathy completed the SMFA patient-reported outcomes instrument prior to surgery, with 24 completing it at 1 year following the surgery. One patient died during the year following surgery from unrelated causes. Results: There was an 11.5-point (95% confidence interval [CI]: –19.7 to −3.2) decrease in the standardized functional index ( P = .01). Similarly, there was a 12.4-point (95% CI: –22.5 to −2.3) decrease in the standardized bother index ( P = .02). The standardized daily activity index demonstrated a 19.6-point decrease (95% CI: –30.5 to −8.6, P = .002), and there was a 14.7-point (95% CI: –24.1 to −5.3) decrease in the standardized emotion index ( P = .004). There was no meaningful change in the standardized arm/hand index ( P = .81). Conclusion: The results of this investigation demonstrate that successful operative reconstruction of midtarsal Charcot foot arthropathy improved quality of life. This supports the modern paradigm shift from immobilization during the active phase of the disease process followed by simple accommodation of the acquired deformity to the modern interest in operative correction to allow the use of commercially available therapeutic footwear. Level of Evidence: Level IV, case series.

Trigonocephaly – Our Experience and Treatment in the Republic of Macedonia

Introduction: Prematurely fused metopic suture results in developmental anomaly named trigonocephaly. The treatment of trigonocephaly is a surgical reconstruction, starting from the simple suturectomy toward the complicated cranial vault reconstructions with aim to obtain enough endocranial space for normal development of the brain and aesthetic correction as well. The aim: The aim of our paper is to present our experience on this pathology in the Republic of Macedonia, stressing the trigonocephaly as one of the rare forms of craniosynostosis. Our material: During a period of 20 years (from 1996 to 2015) at the Pediatric department of the Clinic for Neurosurgery in Skopje, we observed 18 babies with trigonocephaly, including one with Carpenter syndrome and trigonocephaly, 14 males and 4 females. All children had simple trigonocephaly, one had syndromic trigonocephaly (Carpenter’s syndrome). According to Oi and Matsumoto classification done in 19865 severe trigonocephaly is observed in 11 cases and, moderate trigonocephaly in 7 cases. Our method: Our treatment consisted of slightly modified Di Rocco’s3 surgical procedure named “shell” operation, adding transposition of the “bone flap”. Results: The postoperative period was uneventful except for the expected forehead swelling. The babies were discharged from the hospital on average at the 8th postoperative day. At the three months control after the surgery, the head had excellent aesthetic appearance, with regular psychomotor development according to the age of the patient (Fig 3а and 3b). We had no serious complications except the expected postoperative swelling of the forehead. All operated children had excellent “long term” aesthetic effect and normal psychomotor development. Conclusion: The early recognition of these anomalies including all craniosynostoses, the deformities of the newborn and infant’s head and the preventive operative reconstruction would prevent abnormal disturbance of the psychomotor development during the child’s growth. The multidisciplinary approach can prevent new disabled individuals in the society. Our technique allows shortening the entire surgical procedure, especially in the departments where blood saving devices are not available.

The quadriga syndrome: a rarely recognized alteration in hand surgery

The tendons of flexor digitorum profundus are most often interconnected and making them less able to move independently than the superfical tendons. The reason for this is the cross connective tissue-ligamentous connection between the tendons of the profundus. The recognition of this so called quadriga phenomenon is important in the clinical practice, when the presence of this syndrome hinders the strength and the movement of the tendons after the operative reconstruction. In his work the author describes the anatomical bases, the biomechanical relations and the clinical importance of the quadriga syndrome in the mirror of literature data. Orv. Hetil., 2014, 155(20), 778–782.