Acute soft tissue injury to the temporomandibular joint and posttraumatic assessment after mandibular condyle fractures: a longitudinal prospective MRI study

Objective: Evaluation of acute soft tissue injury of the temporomandibular joint (TMJ) with type I-VI fractures immediately after trauma and investigation of the longitudinal evolution including response to conservative treatment using MRI. Methods: The joints of 24 patients with 33 condylar fractures (15 unilateral, nine bilateral) were imaged on a 1 Tesla MR system within the first 24 h post-trauma. 12 of these patients with 16 condylar fractures (eight unilateral, four bilateral) were clinically re-evaluated using MRI after 3 months of closed treatment. The position, morphology and signal intensities of the disc, capsule, retrodiscal tissue, and osseous structures were documented. Results: In the acute phase, disc displacements (DDs) were diagnosed in 8 out of 33 joints with fracture, including posterior DDs in two joints and tears of the inferior retrodiscal lamina in 11 joints. The follow-up MRI in 12 patients revealed new DD in four joints on the fractured side (FS) including a posterior DD and an increased degree of displacement, and new DDs in two joints in the non-fractured side (NFS). Conclusion: Preexisting and traumatic DD and soft tissue injuries are frequent findings in patients with condylar fracture. Independent of the degree of trauma, condylar fractures may determine the subsequent development of DD on both FS and NFS. Early MR imaging may help initiate well-directed specific measures for better outcomes in the acutely injured TMJ.

Clinico-radiological outcome of distal radius fractures managed with closed reduction during COVID-19 pandemic

<p><strong>Background:</strong> distal radius fractures are the most common fractures of the upper extremity and account for more than 1/6 of all fractures treated in emergency department the elderly population account for 18% of all distal end radius fractures and have a significant impact on health of young adults. An optimal outcome of closed treatment of a Colle’s fracture may depend on accurate reduction and adequate immobilization.</p><p class="abstract"><strong>Methods:</strong> A total 45 patients with displaced Colle’s-type fractures were subjected to treatment with closed reduction with manual manipulation. The fractures were assessed radiographically by measurement of the radial angle, dorsal tilt, and radial shortening before reduction, immediately after reduction, and at one and five weeks after reduction. Data was recorded and assessed.</p><p class="abstract"><strong>Results: </strong>Anatomical outcome as per Sarmiento criteria. 66.67% patients had excellent result with no residual Deformity, 17.77% patients had good result with mild residual deformity, 8.88% of them show fair results with moderate residual deformity and 6.66 % had poor outcome.</p><p class="abstract"><strong>Conclusions: </strong>Coronavirus disease 2019 (COVID-19) pandemic was burden on all including patients and medical fraternity, and considering looming threat of third wave and delta variant of virus, our study material can be used to make guidelines for optimal utilisation of orthopaedic fraternity, who have to work in COVID wards as well as trauma wards, our study shows that proper technique of fracture reduction with patient counselling and early physiotherapy can yield good results in fracture which can be managed conservatively.</p><p> </p>

Outcomes of 3-D corrective osteotomies for paediatric malunited both-bone forearm fractures

Closed treatment of paediatric diaphyseal forearm fractures carries the risk of re-displacement, which can lead to symptomatic malunions. This is because growth will not correct angulation deformity as it does in metaphyseal fractures. The purpose of this prospective cohort study was to evaluate the outcomes after 3-D-planned corrective osteotomy with patient-specific surgical guides for paediatric malunited forearm fractures causing impaired pro-supination. Our primary outcome measure was the gain in pro-supination at 12 months follow-up. Fifteen patients with a mean age at trauma of 9.6 years and time until osteotomy of 5.9 years were included. Preoperatively, patients displayed a mean pro-supination of 67° corresponding to 44% of the contralateral forearm. At final follow-up, this improved to 128°, achieving 85% of the contralateral side. Multivariate linear regression analysis revealed that predictors of greater functional gain after 3-D corrective osteotomy are severe preoperative impairment in pro-supination, shorter interval until 3-D corrective osteotomy and greater angulation of the radius. Level of evidence: III

Are Adaptive Chemotherapy Schedules Robust? A Three-Strategy Stochastic Evolutionary Game Theory Model

We investigate the robustness of adaptive chemotherapy schedules over repeated cycles and a wide range of tumor sizes. Using a non-stationary stochastic three-component fitness-dependent Moran process model (to track frequencies), we quantify the variance of the response to treatment associated with multidrug adaptive schedules that are designed to mitigate chemotherapeutic resistance in an idealized (well-mixed) setting. The finite cell (N tumor cells) stochastic process consists of populations of chemosensitive cells, chemoresistant cells to drug 1, and chemoresistant cells to drug 2, and the drug interactions can be synergistic, additive, or antagonistic. Tumor growth rates in this model are proportional to the average fitness of the tumor as measured by the three populations of cancer cells compared to a background microenvironment average value. An adaptive chemoschedule is determined by using the N→∞ limit of the finite-cell process (i.e., the adjusted replicator equations) which is constructed by finding closed treatment response loops (which we call evolutionary cycles) in the three component phase-space. The schedules that give rise to these cycles are designed to manage chemoresistance by avoiding competitive release of the resistant cell populations. To address the question of how these cycles perform in practice over large patient populations with tumors across a range of sizes, we consider the variances associated with the approximate stochastic cycles for finite N, repeating the idealized adaptive schedule over multiple periods. For finite cell populations, the distributions remain approximately multi-Gaussian in the principal component coordinates through the first three cycles, with variances increasing exponentially with each cycle. As the number of cycles increases, the multi-Gaussian nature of the distribution breaks down due to the fact that one of the three sub-populations typically saturates the tumor (competitive release) resulting in treatment failure. This suggests that to design an effective and repeatable adaptive chemoschedule in practice will require a highly accurate tumor model and accurate measurements of the sub-population frequencies or the errors will quickly (exponentially) degrade its effectiveness, particularly when the drug interactions are synergistic. Possible ways to extend the efficacy of the stochastic cycles in light of the computational simulations are discussed.

Are adaptive chemotherapy schedules robust? A three-strategy stochastic evolutionary game theory model

We investigate the robustness of adaptive chemotherapy schedules over repeated cycles and a wide range of tumor sizes. We introduce a non-stationary stochastic three-component fitness-dependent Moran process to quantify the variance of the response to treatment associated with multidrug adaptive schedules that are designed to mitigate chemotherapeutic resistance in an idealized (well-mixed) setting. The finite cell (N tumor cells) stochastic process consists of populations of chemosensitive cells, chemoresistant cells to drug 1, and chemoresistant cells to drug 2, and the drug interactions can be synergistic, additive, or antagonistic. First, the adaptive chemoschedule is determined by using the N → ∞ limit of the finite-cell process (i.e. the adjusted replicator equations) which is constructed by finding closed treatment response loops (which we call evolutionary cycles) in the three component phase-space. The schedules that give rise to these cycles are designed to manage chemoresistance by avoiding competitive release of the resistant cell populations. To address the question of how these cycles are likely to perform in practice over large patient populations with tumors across a range of sizes, we then consider the statistical variances associated with the approximate stochastic cycles for finite N, repeating the idealized adaptive schedule over multiple periods. For finite cell populations, the error distributions remain approximately multi-Gaussian in the principal component coordinates through the first three cycles, with variances increasing exponentially with each cycle. As the number of cycles increases, the multi-Gaussian nature of the distribution breaks down due to the fact that one of the three subpopulations typically saturates the tumor (competitive release) resulting in treatment failure. This suggests that to design an effective and repeatable adaptive chemoschedule in practice will require a highly accurate tumor model and accurate measurements of the subpopulation frequencies or the errors will quickly (exponentially) degrade its effectiveness, particularly when the drug interactions are synergistic. Possible ways to extend the efficacy of the stochastic cycles in light of the computational simulations are discussed.

A COMPARATIVE STUDY ON OPEN AND CLOSED TREATMENT OF EDENTULOUS MANDIBULAR FRACTURES.

Background And Objectives: The loss of bone mass and decreased vascularity decreases the strength of mandible and makes it vulnerable to fracture. Elderly persons with atrophic mandible have less osteogenic capability and reduced blood ow, and may have a complex medical history, so that management of a fracture of the mandible may require special considerations. An ideal treatment for these mostly geriatric patients is absolutely essential. In this context this particular study is being undertaken to compare with the two available treatment modalities open and closed reduction and to do an analysis to nd out which one will be a suitable technique for treatment. Method: This study involved 30 patients with edentulous mandibular fractures in which 15 patients for open reduction and 15 patients for closed reduction were selected. All the patients selected for the study were followed up postoperatively for a minimum period of 6 months. Postoperative assessment for pain, swelling, mobility of fracture segment, signs of Infections and radiographic assessment of fracture ends were done on the rst, third and sixth month respectively. Result: Postoperative assessment for pain, swelling, mobility of fracture segment, signs of Infections and radiographic assessment of fracture ends were done on the rst, third and sixth month showed no signicant differences. The results and observations from the study suggest us that there was no signicant difference between both methods on fracture healing.