Clinical and radiological results of calcium phosphate cement-assisted balloon osteoplasty for Colles' fractures in osteoporotic senile female patients.

BACKGROUND: Distal radius fractures in osteoporotic senile female patients often used to be complicated with residual deformity, stiffness, and pain. Recently, however, adequate usage of a palmar locking plate or external fixation has led to fewer subsequent complications. The method proposed here deserves consideration because it is less invasive and more cost-effective. METHODS: A total of 11 Colles' type fractures (AO type A2) in 11 patients (all female; mean age 78 years) were treated. After a closed reduction, the fractures were fixed by percutaneous pinning, as Kapandji previously described. Through a 5-mm longitudinal skin incision on the dorsoulnar aspect of the fracture site, the barrel of a disposable 1-ml syringe was inserted into the fracture site as a port. Next, a pediatric uromatic balloon was introduced into the fracture site and inflated by contrast medium. The balloon inflation enlarged the void of the fracture site. A compression bandage around the fracture site was applied before calcium phosphate cement injection with a cement gun through the port under an image intensifier. The functional and radiological results were evaluated. The mean follow-up period was 16 months (range 12-25 months). RESULTS: All results were graded as good or excellent within 3 months, and all were graded as excellent at the final follow-up. The average duration of immobilization was 4 weeks with a short forearm cast. The overall postoperative correction loss in ulnar variance was 1.7 mm. Radial inclination and volar tilt showed no postoperative correction loss. The final volar tilt, radial inclination, and ulnar variance were comparable to those of the nonaffected side. CONCLUSIONS: Calcium phosphate cement-assisted balloon osteoplasty is a less invasive procedure and can be clinically justified as a therapeutic option for a Colles' fracture in osteoporotic senile female patients.

[Ictal electroencephalography (EEG) activity and cerebral blood flow dynamics as potential pathological indicators: a case of anti-leucine-rich glioma-inactivated 1 protein (LGI1) encephalitis].

A 29 year-old, right-handed woman was admitted to our hospital due to her headache with fever elevation lasting for two months followed by a prolonged loss of awareness with an involuntary movement in her left hand and mouth. This movement appeared very frequently, and the duration was very short, so called "faciobrachial dystonic seizures (FBDS)". Some of FBDS were followed by prolonged loss of awareness. Brain MRI fluid attenuated inversion recovery (FLAIR) image revealed high intensity lesion in the left mesial temporal lobe. Arterial spin labeling (ASL) image indicated hyper perfusion in this lesion and also the lateral temporal region. No ictal electroencephalography (EEG) change was observed before the onset of FBDS. FBDS was often followed by focal impaired awareness seizure (FIAS) in which ictal EEG showed rhythmic alpha activity arising from left mid-temporal region. This EEG seizure pattern was clearly visible in the time-frequency analysis. Given these clinical findings, along with an evidence of serum anti-leucine-rich glioma-inactivated 1 (LGI1) antibody positive, she was diagnosed with anti-LGI1 encephalitis. Immunotherapy (methylpredonisolone and intravenous immunoglobulin) with a multiple anti-epileptic drugs therapy (lacosamide, perampanel, and lamotrigine) was highly responsible to her symptoms. Although the high intensity lesion in FLAIR image still remained after the treatment, findings of ASL and EEG showed clear correlation to her cognitive function and seizures, respectively. Temporal change in ASL imaging suggested that the hyper perfusion in ASL during the acute stage could be provided by inflammation of the encephalitis its self and also the seizures activities (FBDS and FIAS). The pathophysiological indication of anti-LGI1 encephalitis was limited in terms of the therapeutic strategy, however, our findings collectively suggested that the combination analysis of EEG activity and cerebral blood flow dynamics (ASL) could be the potential candidate.

Interfacial gaps following ceramic inlay cementation vs direct composites.

This study compared the interfacial integrity of Class II ceramic inlay restorations and direct resin composite restorations. The influence of a flowable resin composite liner was also evaluated. Class II DO cavities were prepared in 40 recently extracted mandibular molars and assigned to four treatment groups. Group A: direct composite restoration; Group B: Cerec inlays fabricated and cemented with a resin cement; Group C: adhesive lining with a flowable resin composite used prior to resin composite restoration; Group D: lining with a flowable resin composite prior to cementation of Cerec inlays. After finishing, polishing and thermocycling (4 degrees C and 60 degrees C x 500), the samples were cross-sectioned in a mesio-distal direction along the center of the fillings or inlays. The cross-sectioned surface was polished, and the adhesive interfaces between resin and enamel or dentin were observed under a scanning laser measurement microscope. Ceramic inlay restorations showed no interfacial gaps in enamel, but direct resin composite restorations showed a significantly higher incidence of gaps at the interface or cracks in the interfacial enamel (p=0.0002). No differences were found in the resin-dentin interfaces for both the inlay and direct resin composite restorations. The use of a flowable resin composite as an adhesive liner produced a significantly greater gap-free resin-dentin interface in Cerec inlay and direct resin composite restorations (p=0.0233 & 0.0009), but it did not reduce gap formation at the resin-enamel interface.

Percutaneous vertebroplasty for osteoporotic compression fractures using calcium phosphate cement.

PURPOSE: To compare percutaneous transpedicular vertebroplasty using calcium phosphate cement (CPC) versus conservative treatment for osteoporotic vertebral fractures. METHODS: Eight men and 28 women aged 61 to 99 (mean, 80) years with osteoporotic vertebral fractures underwent percutaneous transpedicular vertebroplasty using CPC. During the same period, 6 men and 32 women aged 53 to 93 (mean, 77) years underwent conservative treatment. The indication for vertebroplasty was a painful unstable fracture, with mobility of the vertebral body shown on flexion and extension lateral radiographs. Fractures without mobility despite deformity were treated conservatively. RESULTS: In the vertebroplasty group, all patients benefited from reduced back pain immediately after surgery, and pain relief was maintained at the latest follow-up. However, correction loss continued until one month after the operation. The mean visual analogue score for pain decreased significantly from preoperation to one day after surgery (9.3 vs. 6.2, p=0.02), and further decreased to 2.8 (p = 0.04) on day 3 or 4 when ambulation began, and to 1.5 at the one month follow-up and 1.4 at the final follow-up (mean, 14 months). The mean duration of analgesic treatment was significantly shorter in the vertebroplasty than conservatively treated group (10.2 vs. 63.5 days). All patients in the vertebroplasty group achieved bone union, with no adjacent vertebral fractures. However, in patients having conservative treatment, there were 2 adjacent vertebral fractures and 4 pseudarthroses, and the collapse continued for several months. CONCLUSION: Percutaneous transpedicular vertebroplasty using CPC achieves immediate pain relief and reduces the risk of vertebral body collapse and pseudarthrosis among elderly patients with osteoporotic vertebral compression fractures.