Class III malocclusions in deciduous or early mixed dentition: an early orthopaedic treatment.

BACKGROUND: An early approach to Class III malocclusions is crucial. From diagnosis to treatment, the aim is be to correct and harmonise maxillary and mandibular growth as quickly as possible. CASE REPORT: A new treatment protocol for the early treatment of Class III malocclusions to be used in children in deciduous teething and/or early mixed teething was proposed. Ten children, 6 females and 4 males, with an overall average age of 6.5 years (6 years and 6 months) at time T0 were included in this experimental study. Twelve months orthopaedic interceptive therapy using two protraction facemasks (Delaire and Petit mask) and two types of extraoral elastic bands (8 and 16 oz) were given. Parents/guardians were involved as much as possible to increase compliance with the treatment. CONCLUSION: The orthopaedic-interceptive treatment for Class III malocclusion intends to provide a potential improvement of the growth response so that significant results can be achieved quickly. The motivational role of the parent can positively influence the child's treatment cooperation. The clinician should then try to make parents understand the importance of early treatment of Class III malocclusion thus obtaining a full cooperation with the parent/ guardian and a good compliance from the child.

Prevalence of Early Childhood Caries (ECC) in a paediatric italian population: An epidemiological study.

AIM: The present work aims to evaluate, through an epidemiological study, the prevalence of Early Childhood Caries in an Italian paediatric population, aged up to 71 months, evaluating some determinants that will be illustrated in this study in order to adopt preventive care and intervene as early as possible to limit the development of this disease. METHODS: The sample consisted of 76 children aged up to 71 months who were examined at the PAediatric Dentistry Clinic of the University of l'Aquila. Parents were informed of the research that was taking place. All read the information sheet explaining the study and signed the informed consent where it was emphasised that the data collected would be treated and stored in a strictly confidential manner, pursuant to the Legislative Decree 196/2003 in force in Italy since June 30, 2003, regarding the protection of individuals with regard to the processing of personal data. At the end of this study, a standardised questionnaire administered. The questionnaire, divided into two parts, made it possible to acquire information regarding the characteristics of the population. First part: General data of the child and the medical history of the mother and father; Second part: The age and gender of the child, the type and duration of breastfeeding, the use of sugary pacifiers, oral hygiene and frequency of consumption of sugars drinks and food, identifying the starting age. RESULTS: Evaluating the dmft of each child, 40.79% of our sample population is affected by ECC; 57.89% of the children used the pacifier and 13,16% of them have or have used it with honey with a p value of 0.001, therefore this parameter was statistically significant, together with the intake of candies, chocolates and sugar drinks. The data was collected for a period of about 12 months, consequently a descriptive statistical analysis was conducted in which the characteristics of the population under consideration were outlined. Discrete and nominal variables have been described with frequencies and percentages. The percentage differences were evaluated using the chi-square test and the Fisher test. Quantitative variables were expressed in terms of mean and standard deviation and significance was assessed by the Mann-Whitney test. The level of significance was established as p <0.05. A Logistic Regression was conducted to evaluate the risk factors associated with a dmft>0 setting, dmft=0/dmft>0 as the dependent variable and the variables investigated as explanatory variables. The evaluation of the association was reported as the Odds Ratio with the 95% confidence interval. The statistical analysis was carried out using the Stata 12/1C statistical package. CONCLUSION: ECC is a multifactorial disease in which eating habits play a very important role. A diet that from childhood is characterised by a high consumption of sugar-rich food and drinks is highly associated with the incidence of ECC in later years.

Recurrent dislocation of patella: three kinds of surgical treatment.

The authors compare three surgical techniques for treatment of recurrent dislocation of patella. The best results, even in the correction of lateral patellar displacement, were achieved with proximal realignment, while the worst results occurred when lateral retinacular release was used alone. In distal realignment, the degree of correction necessary must be ascertained by thorough preoperative assessment of both patellar height and malalignment between femoral groove and tibial tubercle. If the medial retinacular structures are weakened, it may be necessary to perform proximal realignment. We believe that a single surgical option is insufficient, and that the best solution for each individual case should be chosen according to precise indications. The choices include proximal realignment, distal realignment, or a combination of both, while lateral release should always be used in combination with another technique.

Reconstruction of the chronically lax anterior cruciate ligament using the middle third of the patellar tendon. A 3-9 year follow-up.

After an average of 5 years, the authors reviewed 76 cases of anterior cruciate ligament reconstruction in which the middle third of the patellar tendon had been used as a free autogenous graft. A lateral Lemaire operation had been used in 85% of the cases and postoperative cast immobilization in 72%. Functional knee instability was eliminated in 96% of the patients. Pain was present at the follow-up in 14.5% of the patients and correlated with both meniscectomy (p = 0.03) and the presence of degenerative changes on the radiographs (p = 0.002). The pivot-shift was eliminated in 93% of the cases and the maximum manual test performed with the KT-1000 arthrometer was less than or equal to 5 mm in 83%. Lateral compartment laxity which was not corrected at operation was frequently associated with graft failure (p = 0.01). Seven patients had difficulty in rehabilitation, and in 6 of these the final result was unsatisfactory. Pain and swelling in the femoropatellar joint were present in 8% of the cases. Slight and moderate degenerative changes were shown on the radiographs in 48% and 10% of the patients, respectively, at follow-up; these findings correlated with meniscectomy (p less than 0.001) and rehabilitation problems (p = 0.03). This procedure achieved lasting, satisfactory results in 70% of the cases. Additional advances include greater care in positioning the graft, use of arthroscopy, and early mobilization. Further studies are needed to verify the advantages of these new techniques.

[Scanning electron microscopy study of the meniscus of the knee in patients with anterior cruciate ligament lesions]. / Studio al microscopio elettronico a scansione del menisco del ginocchio in soggetti affetti da lesione del ligamento crociato anteriore.

In the aim of bringing a contribution to role of the knee menisci and the functional connection between meniscal lesions and knee joint instability, four patients have been studied, who underwent arthroscopy for sub-acute tear of anterior cruciate ligament without clinical or morphological evidence of meniscal pathology. In these patients biopsies have been taken from one of the menisci and processed for the examination by the SEM. As control, meniscal fragments from two healthy knees have been studied from patients who underwent amputation at thigh for accidental trauma with irreparable lesion of femoral artery. In patients affected by ligamentous tear, on the meniscal surface a lot of deposited material appears, as well as many microlesions as clefts or cracking and distortion of superficial collagenous fibers. All described alteration are more evident in the central portion of menisci than in the anterior or posterior horns. The above mentioned patterns suggest a strong correlation of the knee instability due to ligamentous lesions and meniscal degenerative process which would onset before its clinical or macroscopical evidence.

[Osteoid osteoma of the olecranon fossa. Presentation of a clinical case]. / Osteoma osteoide della fossa olecranica. Presentazione di un caso clinico.

We report one case of osteoid osteoma of olecranon fossa in a female with pain and functional limitation of the elbow. The articular variety of osteoid osteoma is relatively uncommon and its diagnosis is very difficult. Conventional radiology, tomography and scintigraphy are employed for diagnosis, however computed axial tomography is particularly useful for diagnosis and correct treatment of osteoid osteoma of olecranon fossa.

Arthroscopic lateral release for patellar pain or instability.

Forty-five arthroscopic lateral releases were reviewed with a follow-up from 2 to 6 years (average 4 years). Satisfactory results were obtained in 60% of the patellar pain group (20 knees) and 68.5% of the instability group (19 knees). The results in osteoarthrosis (6 knees) were unsatisfactory. Postoperative hemarthrosis was infrequent (2.2%). Unfavorable prognostic factors are an incomplete release with an insufficient postoperative passive patellar tilt in the pain group and more than five preoperative dislocations in the instability group. After failure of conservative treatment, a lateral release can be reasonably used in pain syndromes with a tight lateral retinaculum and lateral patellar tracking and in milder cases of instability.

Correction of valgus knee deformity with a supracondylar V osteotomy.

Valgus deformities at the knee can be successfully corrected with V-shaped supracondylar osteotomy. The advantages of this relatively simple technique are low morbidity, good stability with early weight-bearing, no need for internal fixation, and ability to adjust alignment with postoperative cast. Healing is relatively rapid (two months), and the range of motion returns (two months after cast removal) to preoperative values. This technique proved useful for deformities in both young and old patients with osteoarthritis. This is a preliminary report of the surgical technique, postoperative management, and short-term results of a prospectively evaluated series of 14 consecutive cases.

Results of arthroscopic meniscectomy.

The results of 100 arthroscopic partial meniscectomies are reported. Hospitalisation was on average 1.5 days; return to work 3 weeks and to sports activities 7 weeks. This is particularly rewarding for the patient. The results were excellent or good in 87% of cases. In 10 of the 13 unsatisfactory results there was associated chronic anterior laxity. Its prior evaluation by dynamic tests is therefore particularly important. The duration of symptoms and site and type of lesion had no bearing on the final result. Less satisfactory results were recorded in subjects with quadriceps wasting exceeding 2 On the basis of this and other reported series arthroscopic partial meniscectomy has proved effective in the mid-term assessment. It is still too early to draw definitive conclusions on the long-term results, but the conservative nature of this technique leads us to predict better long-term results than those obtained with traditional total meniscectomy.

Total condylar knee prosthesis with posterior stability. A mid-term follow-up of 74 cases with severe deformity.

The midterm results of 74 posterior stability total condylar prostheses were studied (average follow-up 3 1/2 years). The average age of the patients was 65 years with a predilection for females (73%). The most frequent diagnosis was osteoarthritis (70%) followed by rheumatoid arthritis (28%): in 20% of the cases previous operations had been performed. Most of the patients had severe deformity which was not susceptible to other surgical treatment. The most frequent deformity was varus (average 13 degrees), followed by valgus (average 25 degrees), and flexion contracture (average 37 degrees). Bone defect in the tibia requiring surgical treatment were present in 18% of the cases. The most frequent general complication was pulmonary embolism (5%), which was never fatal; minor complications related to wound healing were observed in 17.5% of the cases. The results, evaluated with a numerical recording form devised by the Hospital for Special Surgery (New York) were: excellent 72%, good 21%, fair 4%, poor 3%. Of the 4 fair results, one had lateral laxity following lysis for valgus knee, one had loosening of the tibial component, and one had painful patellar clicks. Painless, small patellar clicks were observed in 4 other patients. The two poor results were due to low-grade infection and detachment of both components. Seventy per cent of the knees had normal or almost normal function with maximum flexion averaging 100 degrees. In 78% of the cases a study of the cement-bone interface revealed either no radiotranslucent line or present in only one area of the tibia. Radiotranslucent lines around the femoral or patellar component was rare and of no clinical significance.

The results of arthroscopic partial meniscectomy.

Partial arthroscopic meniscectomy has been performed in the First Orthopedic Clinic of the University of Florence since 1981. We have reviewed the first 100 cases with an average follow-up of 18 months. The results were graded according to a numerical rating system and were satisfactory in 85% of the cases. The main advantage of this difficult technique is the fast recovery rate. Other advantages are the low morbidity and short hospital stay. When meniscectomy was performed in the ACL unstable knee, the results were inferior but still acceptable in terms of reduction of the mechanical symptoms. The influence of age, sex, medial or lateral meniscectomy, and type of tear was not statistically significant. Thigh atrophy or chondromalacia significantly decreased the knee score. We believe that the single most important technical factor is to make sure that a stable, well balanced and healthy rim is left in the knee.