Impact of refrigeration of different Resin composite restorative materials on the marginal adaptation in class II restorations.

BACKGROUND: The pre-polymerization temperature of resin composite restorative materials could influence their adaptation to cavity details. As a current debate is existing about the refrigeration of resin composite restorative materials, this study was designed to assess the effect of refrigeration of 3 types of resin composite restorative materials with different matrix systems on their marginal adaptation in Class II restorations. METHODS: Forty-two sound maxillary molars, each with two separated Class II cavities, were used in this study. The teeth were assigned into 3 main groups (n = 14) according to the restorative /adhesive system used; an Ormocer-based composite (Admira Fusion/Futurabond M+, Voco GmbH, Cuxhaven, Germany), a methacrylate modified Ormocer-based (Ceram.X SphereTEC One/Prime&Bond Universal, Dentsply Sirona GmbH Konstanz, Germany), and a methacrylate-based (Tetric N-Ceram/Tetric N-Bond Universal, Ivoclar Vivadent AG, Schaan, Liechtenstein). Each group was then divided into 2 subgroups (n = 14) according to the gingival margin location; 1 mm above and 1 mm below the cemento-enamel junction (C.E.J). Each subgroup was further divided into 2 categories (n = 7) according to the storage temperature; stored at room temperature or stored in refrigerator at 4°- 5° C. Epoxy resin replicas were observed under scanning electron microscope (SEM) to examine the marginal gaps. A gab scoring system was used to assess the marginal adaptation of each restoration by giving scores on the basis of measurements of the maximum marginal gaps. The data obtained were statistically analyzed using the Chi-square test at a significance level of p < 0.05. RESULTS: None of the tested groups exhibited 100% gap-free margins irrespective of margin location or storage temperature. For both storage temperatures, no statistically significant difference was observed among all tested groups either with margins located above or below C.E.J (p > 0.05). As well, there was no statistically significant difference when comparing both marginal locations for each material (p > 0.05). Regarding the effect of storage temperature, statistically significant difference was only observed between the room-temperature stored groups with margins located above C.E.J and their corresponding groups stored in refrigerator (p < 0.05). CONCLUSION: The refrigeration of resin composite restorative materials prior to the restorative procedures revealed a deleterious effect on marginal adaptation of the restorations with margins located in enamel regardless the type of material used.

Lower limb coronal malalignment correction by percutaneous osteotomy and schanz screws fixation.

Pediatric knee deformities are common, and the classic treatment is corrective osteotomy. The aim of this study to assess the safety and efficacy of percutaneous low-energy osteotomy and casting with shanz screws fixation in treatment of Genu varum in children equal or younger than 7 years. This is a prospective nonrandomized case series study was conducted. A total of 38 patients (total of 60 limbs: 36 varus and 24 valgus) were treated by percutaneous low-energy osteotomy and casting with shanz screws fixation and observed over 2-5 years. Clinical and radiological outcomes were evaluated at the end of follow-up period by standing scanogram which enabled tibiofemoral angles and the mechanical axis to be measured and the rate of complications. There was a statistically significant improvement of the radiographic parameters in the form of tibiofemoral angle and MAD. Clinically, all the cases were completely corrected just one patient (two limbs) complicated by over-correction but statically non-significant and. pin tract infection in shanz screws fixation was noticed in one Patient. Percutaneous low-energy osteotomy and casting with shanz screws fixation is a simple, safe, and effective method in dealing with 7 years and younger children with pathological knee deformities. Level of evidence: Therapeutic level IV.

3-year randomized clinical trial to evaluate the performance of posterior composite restorations lined with ion-releasing materials.

To evaluate the impact of using ion-releasing liners on the 3-year clinical performance of posterior resin composite restorations after selective caries excavation with polymer burs. 20 patients were enrolled in this trial. Each patient had two deep carious lesions, one on each side of the mouth. After selective caries removal using polymer bur (PolyBur P1, Komet, Brasseler GmbH Co. KG, Lemgo, Germany), cavities were lined with bioactive ionic resin composite (Activa Bioactive Base/Liner, Pulpdent, Watertown, MA, USA) or resin-modified glass ionomer liner (Riva Light Cure, SDI, Bayswater, Victoria, Australia). All cavities were then restored with nanofilled resin composite (Filtek Z350XT, 3M Oral Care, St. Paul, MN, USA). All the tested materials were placed according to the manufacturers' instructions. Clinical evaluation was accomplished using World Dental Federation (FDI) criteria at baseline and after 6 months, 1, 2, and 3 years. Data were analyzed using Mann-whitney U and Friedman tests (p < 0.05). The success rates were 100% for all resin composite restorations either lined with ion-releasing resin composite or resin-modified glass ionomer liner. Mann-whitney U test revealed that there were no statistically significant differences between both ion-releasing lining material groups for all criteria during the follow-up periods (p > 0.05). Resin composite restorations showed acceptable clinical performance over 3 years either lined with bioactive ionic or resin-modified glass ionomer liners after selective caries excavation preserving pulp vitality. After the 3-year follow-up period, Activa Bioactive and Riva Light Cure liners were clinically effective and they exhibited with the overlying composite restorations successful clinical performance.Trial registration number: NCT05470959. Date of registration: 22/7/2022. Retrospectively registered.

Correction of cubitus valgus and reconstruction of lateral humerus condylar defect using tricortical iliac graft in pediatric patients.

BACKGROUND: Neglected non-united lateral humeral condyle fractures in pediatrics are a probable cause of cubitus valgus deformity which is a disabling complication. The ideal management for this condition is still debatable. This study aimed to evaluate the reconstruction of a non-united lateral humerus condylar fracture complicated by cubitus valgus using a tricortical iliac crest graft in pediatric patients. PATIENTS AND METHODS: Twenty children suffering from cubitus valgus as a complication after a non-united fracture of the lateral humeral condyle were included in this study. They were managed by open reduction, screw fixation, and reconstruction by an autologous tricortical iliac bone graft. We compared the preoperative and postoperative range of motion of the elbow, alignment, and elbow function using the Mayo elbow performance index. RESULTS: There was a statistically significant improvement in the elbow range of motion postoperatively, and there was a highly significant improvement regarding the elbow alignment and function. CONCLUSION: Open reduction, screw fixation, and reconstruction by the autologous tricortical iliac bone graft is an effective technique for the management of cubitus valgus due to neglected non-united lateral humeral condyle fractures in pediatrics.

Mid-term results of sub-trochanteric valgus osteotomy for symptomatic late stages Legg-Calvé-Perthes disease.

BACKGROUND: The treatment of late stages of Legg-Calvé-Perthes disease (LCPD) is controversial. Although the concept of femoral head containment is a well-established technique of treatment, its use remains debatable in the late stages of the disease, as it does not improve symptoms in terms of limb length discrepancy and gait. AIM: To assess the results of subtrochanteric valgus osteotomy in symptomatic patients with late-stage Perthes disease. METHODS: From 2000 to 2007, 36 symptomatic patients with late stage of Perthes disease were surgically treated with subtrochanteric valgus osteotomy and followed-up for 8 to 11 years using the IOWA score and range of motion (ROM) variables. The Mose classification was also assessed at the last follow-up to reflect possible remodeling. The patients were 8 years old or older at the time of surgery, in the post-fragmentation stage, and complaining of pain, limited ROM, Trendelenburg gait, and/or abductor weakness. RESULTS: The preoperative IOWA score (average: 53.3) markedly improved at the 1-year post follow-up period (average: 85.41) and then slightly improved at the last follow-up (average: 89.4) (P value < 0.05). ROM improved, with internal rotation increased on average by 22° (from 10° preoperatively to 32° postoperatively) and abduction increased on average by 15.9° (from 25° preoperatively to 41° postoperatively). The mean Mose deviation of femoral heads was 4.1 mm at the end of the follow-up period. The tests used were the paired t-test and Pearson correlation test, where the level of significance was a P value less than 0.05. CONCLUSION: Subtrochanteric valgus osteotomy can be a good option for symptomatic relief in patients with late-stage of LCPD.

Effect of shelf-storage temperature on degree of conversion and microhardness of composite restorative materials.

BACKGROUND: The pre-cure temperature is considered an important parameter that affects the polymerization kinetics and the properties of composite restoration. As dissension exists about the effect of storing composite restorative materials in refrigerator, this study aimed to assess the effect of shelf-storage temperature on degree of conversion (DC) and microhardness of three composite restorative materials with different matrix systems. METHODS: Three commercially-available composite restorative materials were used in this study; an Ormocer-based composite (Admira Fusion, Voco GmbH), a nanoceramic composite, (Ceram.X SphereTEC One, Dentsply Sirona GmbH), and a nanohybrid composite (Tetric N-Ceram, Ivoclar Vivadent AG). Regarding DC and microhardness tests, 60 disc-shaped composite specimens for each test were randomly divided into 3 groups (n = 20) according to the restorative material used. Each group was divided into 2 subgroups (n = 10) according to the composite storage temperature; stored at room temperature or stored in the refrigerator at 4°-5 °C. DC was evaluated using a Fourier-transform infrared spectrometer coupled to an attenuated total reflectance accessory. Microhardness was evaluated using micro-Vickers hardness tester under a load of 50 g with a dwell time of 10 s. The results were analyzed by ANOVA, post-hoc LSD, and independent t-tests at a significance level of p < 0.05. RESULTS: Regarding DC test all groups showed statistically significant differences at both storage temperature. The Ormocer-based composite had the highest mean values. There was a statistically significant difference between all room-stored groups and their corresponding groups stored at refrigerator (p < 0.05). For microhardness test, all groups exhibited also statistically significant differences at both storage temperatures with the Ormocer-based composite having the highest mean values. A statistically significant difference between both room-stored and refrigerator-stored groups has been observed also (p < 0.05). CONCLUSIONS: Refrigeration of resin-composite might have a deleterious effect on DC and microhardness of the tested composite restorative materials with different matrix systems. Moreover, the differences in the formulations of composite matrix have a potential impact on DC and microhardness.

Five-year randomized clinical trial to evaluate the clinical performance of high-viscosity glass ionomer restorative systems in small class II restorations.

OBJECTIVE: Evaluate and compare the 5-year clinical performance of three high-viscosity glass ionomer restorative materials in small class II restorations. MATERIALS AND METHODS: Forty patients, each with four class II restorations, were enrolled in this trial. A total of 160 restorations were placed, 25% for each material, as follows: three high-viscosity conventional glass ionomer restorative systems (Ketac Universal Aplicap, EQUIA Forte and Riva Self Cure HV) and a microhybrid resin composite system (Filtek Z250). Clinical evaluation was performed at baseline and after 1, 3, and 5 years by two independent examiners using FDI criteria. Epoxy resin replicas were observed under scanning electron microscope (SEM) to examine surface characteristics. Data were analyzed with Kruskal-Wallis, Mann-Whitney U, Friedman, and Wilcoxon signed-rank tests (p < 0.05). RESULTS: The success rates were 100% for resin composite, 97.4% for Ketac Universal, and 94.9% for both EQUIA Forte and Riva HV restorations. Statistically significant differences were observed between all groups in terms of surface luster and color match criteria (p < 0.05). Statistically significant changes were found over time for all criteria except for fracture of material, postoperative hypersensitivity, recurrence of caries, tooth integrity, periodontal response, adjacent mucosa, and oral health criteria (p > 0.05). SEM evaluations were in accordance with the clinical findings. CONCLUSIONS: Although drawbacks in surface luster and color match appeared over the 5-year evaluation period, the three high-viscosity glass ionomer restorative materials provided successful clinical performance in small to medium sized class II cavities compared to microhybrid resin composite. CLINICAL SIGNIFICANCE: Glass ionomer restorations exhibited clinical performance similar to that of microhybrid resin composite restorations in small class II cavities subsequent to 5-year evaluation.

Styloid Ulna Window Approach for Repair of Avulsed Foveal Attachment of Triangular Fibrocartilage Complex.

PURPOSE: To describe a surgical approach for open repair of the triangular fibrocartilage complex foveal avulsion via ulnar styloid osteotomy, and to assess its clinical results. METHODS: We reviewed 12 patients with distal radioulnar joint (DRUJ) instability due to isolated foveal avulsion of DRUJ ligaments. Wrist arthroscopy was conducted for all patients to exclude the presence of concomitant tear of the superficial part of the triangular fibrocartilage complex and to corroborate the diagnosis with a positive hook test. Through an ulnar approach between flexor and extensor carpi ulnaris, an ulnar styloid osteotomy was performed under image intensifier control just ulnar to the fovea of the head of the ulna. The avulsed foveal attachment was anchored through transosseous sutures passing from the fovea to the neck of the ulna. The ulnar styloid was fixed by means of screws or tension band wires. Outcome measures included clinical assessment of pain (visual analog scale), grip strength, DRUJ instability, range of motion of the wrist, and modified Mayo wrist score. Radiographic assessment was done to determine union of the ulnar styloid osteotomy, DRUJ subluxation, and any hardware-related problems. RESULTS: Outcome measures were evaluated after a mean follow-up of 21 months. Healing of the osteotomy was obtained in all cases by 11 weeks. The DRUJ laxity, visual analog scale, and modified Mayo wrist score improved, while grip strength and range of motion remained unchanged. One patient had prominent hardware necessitating removal after union of the osteotomy. There were no reported cases of injury or neuropraxia of the dorsal cutaneous branch of the ulnar nerve. CONCLUSIONS: Open repair of an avulsed foveal attachment of the triangular fibrocartilage complex using an ulnar styloid osteotomy is an alternative to either open or arthroscopic repair approaches. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

Immunohistochemical expression of FOXP3 in gastric carcinoma; its relation to Ki-67 proliferation marker, HER2/neu expression, and other clinicopathological parameters.

Gastric cancer is common cancer in the world. Contradictory results regarding FOXP3 expression in gastric carcinoma were detected and the role of Ki-67 in prognosis is not completely understood. Furthermore, due to increasing use of anti-HER2 drug trastuzumab for gastric cancer, assessment of HER2 expression becomes important. This study tried to assess the FOXP3 expression in gastric carcinoma and to study the relation between its expression and Ki-67 and HER2/neu expression and relation between their expression and other clinicopathological variables. This retrospective study was carried out on 60 gastric adenocarcinoma cases. Tissue microarrays and immunohistochemical staining for FOXP3, Ki-67 and HER2/neu were done and then assessed and scored. HER2/neu expression showed significant relation to Lauren histological type and lymph node status. High Ki-67 index was related significantly to patients' age, lympho-vascular tumor emboli, peri-neural invasion, tumor grade, lymph node status, and cancer stage. There was significant relation between high FOXP3 expression and patients' age, lympho-vascular tumor emboli, peri-neural invasion, tumor grade, lymph node status, and cancer stage. Direct positive significant relationships between HER2/neu, Ki-67, and FOXP3 expression were noticed. Finally, high FOXP3 expression, positive HER2/neu, and high Ki-67 nuclear proliferation index may be an indication of the aggressiveness of gastric carcinoma.

Functional outcome and health-related quality of life following ipsilateral femoral and acetabular fractures: a retrospective analysis.

INTRODUCTION: The combination of ipsilateral femoral and acetabular fractures is known in the literature as the "Floating hip injury". The primary aim of this study is to assess both generic and specific patient-reported outcomes and the factors affecting the quality of life in patients sustaining this injury, while the secondary aim was to assess the injury patterns and the associated complications. METHODS: A retrospective study including 27 patients according to specific inclusion and exclusion criteria. EQ5D5L and Oxford hip score (OHS) were used. The mean age was 28 years (±10.1 SD) and 21 patients (77.8%) were males. The mean follow-up was 7 years (± 3.1 years SD). RESULTS: Median OHS was 46.5 (IQR: 31.5-48). The median EQ5D score was 0.919 (95% CI: 0.601-1). The mean EQ5D index value was 0.679 ± 0.442 (95% CI: 0.492-0.865). In this young cohort of patients, this drop in the mean EQ5D index value has led to a loss of a mean of 2.2 Quality-adjusted Life Years (QALYs). Through multivariate analysis, we found that the quality of life was mainly affected by the occurrence of end-stage arthritis, the presence of non-recovered traumatic sciatic nerve injury, and the occurrence of infection. CONCLUSIONS: Our findings show that the quality of life of those patients was significantly affected. These findings can be beneficial in counselling patients sustaining this complex injury and could be helpful in the discussion of the prognosis and in planning postoperative rehabilitation and support.

Virtual orthopedic assessment: Main principles and specific regions.

Telemedicine was originally created as a way to treat patients who were located in remote places far away from local health facilities or in areas with shortages of medical professionals. Telemedicine is still used today to address those problems, and is increasingly becoming a tool for convenient medical care. With the emergence of pandemics, telemedicine became almost a mandatory and valuable option for continuing to provide medical care in various specialties. As the threat of pandemic progress has continued for months and may continue for years, it is essential to validate existing tools to maintain clinical assessment and patient treatment to avoid negative consequences of the lack of medical follow-up. Therefore, the establishment of a virtual assessment technique that can be conducted effectively is of outmost importance as a way of adapting to the current situation. This study evaluated the role of telemedicine in the assessment of various orthopedic pathologies by means of a systematic virtual evaluation.

Gastrointestinal and hepatic diseases during the COVID-19 pandemic: Manifestations, mechanism and management.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is considered the causative pathogen of coronavirus disease 2019 (COVID-19) and has become an international danger to human health. Although respiratory transmission and symptoms are still the essential manifestations of COVID-19, the digestive system could be an unconventional or supplementary route for COVID-19 to be transmitted and manifested, most likely due to the presence of angiotensin-converting enzyme 2 (ACE2) in the gastrointestinal tract. In addition, SARS-CoV-2 can trigger hepatic injury via direct binding to the ACE2 receptor in cholangiocytes, antibody-dependent enhancement of infection, systemic inflammatory response syndrome, inflammatory cytokine storms, ischemia/reperfusion injury, and adverse events of treatment drugs. Gastrointestinal symptoms, including anorexia, nausea, vomiting, and diarrhea, which are unusual in patients with COVID-19, and some digestive signs may occur without other respiratory symptoms. Furthermore, SARS-CoV-2 can be found in infected patients' stool, demonstrating the likelihood of transmission through the fecal-oral route. In addition, liver function should be monitored during COVID-19, particularly in more severe cases. This review summarizes the evidence for extra-pulmonary manifestations, mechanisms, and management of COVID-19, particularly those related to the gastrointestinal tract and liver.

Clinical utility of fetal echocardiography: an Egyptian center experience.

BACKGROUND: The impact of early diagnosis of fetal cardiac abnormalities on the postnatal outcome has been controversial in literature. We aimed to evaluate the role of fetal echocardiography (FE) as a diagnostic tool for early detection and proper management of fetal cardiac abnormalities, study the indications of referral and detect the perinatal outcome in our institution. RESULTS: This is a cross-sectional observational and descriptive study that included one hundred and one singleton pregnant women (101 fetuses) who were referred for FE over a period of one year. Indications for referral and perinatal risk factors were documented. FE and postnatal transthoracic echocardiography were done. Fetal cardiac abnormalities were detected in 46.5% of cases. Congenital heart defects (CHDs) in 34.6%, fetal arrythmias in 9.9%, cardiomyopathy in 2.9% and cardiac mass (Rhabdomyoma) in 1% (combined structural and rhythm abnormalities were observed in two fetuses). Of the CHDs, complex heart lesions were diagnosed in 57.1%, common atrioventricular canal in 28.6% and conotrunchal anomalies in 14.3%. Of the ten cases with fetal arrythmias, five fetuses had tachyarrhythmias, four had ectopics and one fetus had congenital heart block in association with maternal lupus. The indications for referral were abnormal obstetric ultrasound (52.5%), maternal medical illnesses (23.8%), multiple neonatal deaths (13.9%) and positive family history of CHD (10.9%). The number of fetuses with cardiac abnormalities was significantly higher than those without cardiac abnormalities in mothers not exposed to perinatal risk factors (p = 0.009) and was statistically lower in mothers exposed to perinatal risk factors (p = 0.005). FE showed 100% accuracy in diagnosing complex lesions, common atrio-ventricular canals, cono-truncal anomalies, cardiac masses and fetal arrhythmias. It missed two cases of tiny muscular ventricular septal defects and one case of aortic coarctation. Cases of fetal supraventricular tachycardia were successfully treated in-utero. CONCLUSIONS: CHDs exist in fetuses with no underlying perinatal risk factors. FE can accurately diagnose most of the cardiac anomalies though few errors remain challenging (aortic coarctation). It also offers a good chance for successful early life-saving management of some types of fetal arrhythmia.

Single-strand repair of EWAS 1 lesion of triangular fibrocartilage complex.

PURPOSE: To report the results of our modified technique for repair of the EWAS 1 lesion of triangular fibrocartilage complex (TFCC). METHODS: This retrospective case series reviewed 22 consecutive patients with EWAS 1 TFCC tear. Arthroscopic repair was done using our modified double-loop arthroscopic outside-in technique which is originally described by Mathoulin and Del Piñal. The repair was performed using single-strand suture and 18-gauge cannula, having three passes through the tear. Follow-ups ranged from 24 to 33 months with an average of 29.3 months. The results were evaluated by the Modified Mayo Wrist Score (MMWS), Visual Analog Score (VAS). In addition, range of motion (ROM) and power grip were compared with the contralateral side. RESULTS: The mean age was 23 years. The dominant side was affected in 16 wrists. There was postoperative improvement of the all functional outcome measures (MMWS, VAS, ROM, and power grip). All the patients returned to their previous activities with no reported intra- or postoperative complications. CONCLUSIONS: The described outside-in technique is safe and effective technique for repair of EWAS 1 TFCC tear. LEVEL OF EVIDENCE: Therapeutic, case series, level IV.

Reliability of propeller flaps in post-traumatic reconstruction of wrist and hand defects.

PURPOSE: This is a purely observational study with a literature comparison to assess the effectiveness of radial and ulnar arteries propeller perforator-based flaps in post-traumatic soft tissue reconstruction and identify the risk factors for complications. METHODS: Sixteen patients were involved with post-traumatic wrist and hand soft tissue defects not exceeding 5 × 20 cm. Defects were covered with propeller radial and ulnar arteries perforator-based flaps. Patient demographics, soft tissue defects, complications and clinical outcomes were recorded. Assessment of patients' satisfaction for donor site morbidity and aesthetic outcome of the flap were performed. RESULTS: Radial artery propeller perforator flap was performed in seven cases, and ulnar artery propeller perforator flap was done in nine cases. The size of the skin paddle ranged from 2.5 × 5 cm to 4.5 × 10.5 cm. Primary closure of the donor site was performed in all cases. One flap was lost, while superficial epidermolysis occurred in seven cases (45%). Edge necrosis ranging between 3 and 7 mm occurred in nine cases (60%). Patients' factors, mode of injury, associated injuries and interval between trauma and coverage were all correlated with complication incidence. The patients' satisfaction for donor site morbidity was very good and good in 80% of patients, while satisfaction for aesthetic outcome of the flap was very good and good in only 40%. CONCLUSION: Radial and ulnar arteries have reliable perforators for flap elevation, which produce reliable outcome for small- and medium-sized soft tissue reconstruction. Effectiveness decreases in post-traumatic reconstructions. Complications are more frequent in crushing injuries especially if associated with bony fractures. Most complications in trauma cases were attributed to venous congestion, for which supercharging with a vein if accessible to the surgeon is recommended.

Is dual mobility cup total hip replacement associated with increased incidence of heterotopic ossification compared to conventional total hip replacements in fracture neck of femur patients?

INTRODUCTION: The incidence of heterotopic ossification after total hip replacement is variable in the literature. If symptomatic, it may cause pain and reduced range of motion. Dual mobility total hip replacements have been considered a valuable option for the treatment of femoral neck fractures in the active patients, achieving good range of motion with reduced risk of dislocation. The occurrence of HO may have detrimental effect on this type of articulation and may accelerate polyethylene wear and predispose to intra-prosthetic dislocation. We compared the incidence of HO in DMC versus conventional THR in femoral neck fracture patients across 3 large trauma institutes PATIENTS AND METHODS: This is a retrospective cohort study which included 334 patients, 223 received DMC replacements, 111 received conventional total hip replacement (THR). Mean age for the DMC group was 72.3 ± 9.9 years and was 72.1 ± 6.8 years for the THR group. Patients were stratified according to specific inclusion and exclusion criteria, and the 1-year follow up X rays were evaluated for the presence of heterotopic ossification by 3 assessors. RESULTS: The incidence of HO in the DMC group was 27.1% compared to 12.2% in the THR group (χ2 p value = 0.0001, Relative Risk = 2.22, 95% CI 1.22-4.03, p value = 0.0091). There was no significant effect of gender or age on the incidence of HO in both groups CONCLUSIONS: Patients receiving DMC hip replacements are more likely to develop HO as compared to patients receiving conventional THR for femoral neck fractures. Further prospective studies are required to confirm our findings and to assess the indication of HO prophylaxis in patients receiving DMC hip replacements, and the long-term outcomes in these patients.

Partial Capitate with/without Hamate Osteotomy in the Treatment of Kienböck's Disease: Influence of the Stage of the Disease on the Midterm Outcome.

Objective Moritomo et al introduced partial capitate osteotomy as a treatment modality for early stages of Kienböck's disease. This technique maintains articular contact between the capitate and the scaphoid. We added hamate-shortening osteotomy in addition to partial capitate shortening in cases of lunate type II. The purpose of this study was to evaluate intermediate-term results of partial capitate shortening, investigate the influence of the stage of the disease on the outcome, and assess the clinical and radiological outcomes of adding hamate osteotomy in cases of type II lunate. Patients and Methods A total of 17 consecutive patients (3 women, 14 men) with early stages of Kienböck's disease were prospectively reviewed using the aforementioned technique. Eight patients were in stage II and nine patients were in stage IIIA according to the Lichtman classification system. Clinical outcome measures included pain visual analog score, grip strength and range of motion as a percentage of the unaffected side, and assessment using the Patient-Rated Hand and Wrist Evaluation (PRHWE) and the modified Wrightington Hospital Wrist Score (MWHWS). Radiological outcome measures included healing of the osteotomy site, Stahl index, radioscaphoid angle, and progression of the disease. Results Follow-up period averaged 72 months. All cases of isolated capitate osteotomy and combined capitate and hamate osteotomies united fully. Clinical results revealed significant improvement in pain, grip strength and extension, and PRHWE and MWHWS values. Wrist flexion did not change postoperatively. Patients with stage II showed better overall results and significant MWHWS improvement. Conclusion At the intermediate term, partial capitate with/without hamate shortening is an effective modality for the treatment of patients with early stage Kienböck's disease. Stage II patients showed better results than stage IIIA patients in terms of pain, flexion, grip, PRHWE, and MWHWS. Adding hamate osteotomy may improve the functional results for type II lunate; however, a larger sample is needed to elicit statistical significance. Level of Evidence This is a Level IV, therapeutic study.

Comparison Between Supercharged Ulnar Nerve Repair by Anterior Interosseous Nerve Transfer and Isolated Ulnar Nerve Repair in Proximal Ulnar Nerve Injuries.

PURPOSE: To compare combined ulnar nerve repair with supercharged end-to-side anterior interosseous nerve to ulnar motor nerve transfer (UR+SETS) with conventional isolated ulnar repair techniques in proximal ulnar nerve transection, with respect to intrinsic muscle power recovery and claw hand deformity correction. METHODS: We conducted a comparative matched-paired series prospectively on 21 patients with proximal ulnar nerve transection injury. Eleven patients were managed by UR+SETS and 10 by isolated ulnar repair. The outcome was reported at 3, 6, 12, and 18 months using the score of Birch and Raji and Brand's criteria. RESULTS: A total of 21 patients with acute proximal ulnar nerve transection injury had completed 18 months' follow-up. We observed better results in the UR+SETS group regarding the return of intrinsic function and reduction of deformity with earlier improvement in the score of Birch and Raji and Brand's criteria. CONCLUSIONS: In the short term, UR+SETS transfer appears to result in better intrinsic muscle reinnervation and clawing deformity correction after proximal ulnar nerve transection injury. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic II.

Fracture resistance of prepared premolars restored with bonded new lab composite and all-ceramic inlay/onlay restorations: Laboratory study.

OBJECTIVES: To assess the influence of new light curing lab composite, lithium-disilicate glass-ceramic and yttrium-stabilized zirconia-based ceramic on the fracture resistance of maxillary premolars with class II inlay and onlay preparations. METHODS: Seventy sound maxillary premolars were divided randomly into seven main groups. The first group was left intact (control group). The remaining six groups were prepared with inlay and onlay cavities and restored with lab composite (SR Nexco), lithium-disilicate glass-ceramic (IPS e.max Press) and yttrium-stabilized zirconia-based ceramic (ICE Zirkon). The restorations were cemented with luting resin composite (Variolink N). All specimens were thermocycled 5000 cycles between 5°C ± 2°C and 55°C ± 2°C and were then cyclic loaded for 500 000 cycles. The specimens were subjected to a compressive load in a universal testing machine using a metal sphere until fracture occurred. The results were analyzed by 2-way ANOVA and Tukey HSD post hoc tests. The level of significance was set at P < .05. RESULTS: There were no statistically significant differences among the means of control group and the groups restored with zirconia ceramic inlays and onlays (P > .05). However, statistically significant differences were found among the means of control group and the groups restored with lab composite inlays, lab composite onlays, pressable glass ceramic inlays and pressable glass ceramic onlays (P < .05). CONCLUSIONS: The fracture resistance of prepared teeth for inlay and onlay restorations is inferior to the intact teeth when lab composite is used. Conversely, when a ceramic material being used, the prepared teeth for inlay and onlay restorations showed a comparable strength to the intact teeth especially zirconia ceramic. CLINICAL SIGNIFICANCE: Premolar teeth restored with zirconia ceramic inlays and onlays exhibited fracture resistance comparable to intact teeth.