Dissimilar Sequelae Caused by Single Dental Trauma: A Case Report with Long-Term Follow-up.

Immediate care and accurate diagnosis are essential for treating dental trauma. This report presents a 7-year-old boy suffered a bicycle accident with direct trauma to the mouth and extrusive luxation of teeth #11 and #21. The emergency treatment was performed within the first hour. Clinical examinations showed that both teeth exhibited 3 mm extrusion from comparing their incisal edges to their neighboring teeth, had edematous gingiva, showed grade 3 mobility and were painful to percussion. Radiographic exams showed incomplete root formation, widened periodontal spaces along their entire lengths and absence of bone or root fractures. The treatment consisted of immediate repositioning and semi-rigid splinting. After 15 days, tooth #11 exhibited no clinical signor symptom and tooth #21 was diagnosed with pulp necrosis, with an acute dentoalveolar abscess and intraoral edema. Immediate endodontic treatment was initiated (intracanal dressing with calcium hydroxide paste). At 30 days, another pulp sensibility test was performed on tooth #11, which had a negative response. In the same visit, the intracanal dressing of tooth #21 was replaced. The Ca(OH)2 medication was replaced every 6 months until the formation of an apical barrier. The final dressing consisted of gutta-percha and Grossman's sealer and was placed two and a half years after the first dressing appointment. The extrusive luxation resulted in two different sequelae: complete root obliteration in tooth #11 and anomalous root development after the formation of an apical barrier in tooth #21. The patient received orthodontic treatment after 6 years from the initial treatment with no negative outcome. After 18 years follow-up, both teeth were stabilized with no symptom or sign. It's important to follow the evolution of every trauma case continuously because the sequelae can be unpredictable.

Orthodontic extrusion with fixed appliances for treatment of intrusive luxation injuries: A prospective study of 28 permanent maxillary incisors.

BACKGROUND: Limited evidence exists on the treatment options of tooth repositioning after intrusive luxation. AIM: The study aimed to investigate the outcomes and complications of orthodontic extrusion in treating intruded maxillary permanent incisors. DESIGN: A prospective study was conducted involving 28 intruded maxillary permanent incisors treated with orthodontic extrusion, compared with a retrospective control group of 29 teeth that underwent spontaneous re-eruption. The success rate of tooth repositioning, as well as pulp condition, periodontal healing, and root development were assessed and compared. RESULTS: The success rate of orthodontic extrusion was 96.4%, excluding one tooth that was ankylosed before treatment. There were no significant differences in pulp condition between the orthodontic extrusion and control groups for teeth with immature root development. Teeth with mature root development in the orthodontic group, however, showed a significantly higher rate of pulp necrosis (100%, p < .05). Periodontal healing outcomes were similar across both groups, regardless of the maturity of root development. The root length continued increasing during orthodontic extrusion treatment. CONCLUSIONS: Orthodontic extrusion treatment could effectively reposition moderately to severely intrusive permanent incisors, without increasing the risk of complications compared with spontaneous re-eruption.

The Management of an Unusual Combination of Anomalies Following Primary Tooth Trauma: A Case Report.

The prognosis of luxation injuries of primary teeth is often unpredictable. A two-year-old girl presented with a displaced left primary maxillary anterior tooth diagnosed as severe intrusive luxation. On radiographic examination, it was noticed to be impinging on the underlying permanent tooth bud. The tooth was extracted, and periodic follow-ups were emphasized until the successor tooth erupted. However, after eight years, the patient followed up with a chief complaint of an unerupted permanent maxillary anterior tooth. Cone-beam computed tomography (CBCT) revealed a combination of anomalies in the crown and root of the maxillary anterior tooth. After a wait-and-observe regime for six months, the incisal third of the crown erupted. At eight years and eight months, the tooth developed a periapical abscess which was treated endodontically and restored. At nine years and three months, the tooth is asymptomatic till date. The present case report highlights the consequences of intrusive luxation injuries to the primary teeth and the need for a multidisciplinary team approach in the management of complications of dental trauma along with meticulous long-term follow-ups.

Isolated volar dislocation of the distal radioulnar joint: Current concepts review and case report.

Isolated volar distal radioulnar joint (DRUJ) dislocation is a rare condition with only a few cases reported in the literature. Its diagnosis is often overlooked in the acute phase, and there is no consensus in its management. We present the case of a 20-year-old male patient with an isolated volar radioulnar dislocation, together with a review of the literature. The aim is to present and summarize the acute management of this condition and propose a therapeutic algorithm.

Assessing the Effectiveness of Modified Tibial Plateau Leveling Osteotomy Plates for Treating Cranial Cruciate Ligament Rupture and Medial Patellar Luxation in Small-Breed Dogs.

In small-breed dogs with concurrent cranial cruciate ligament rupture (CCLR) and medial patellar luxation (MPL), correcting both disorders is are essential for restoring normal gait. However, the previously described surgical treatment, using two osteotomy technique, poses a high risk of fracture and instability. Addressing CCLR and MPL with a single osteotomy and implant was considered superior to the conventional method. Therefore, a pre-contoured modified tibial plateau leveling osteotomy (PCM-TPLO) plate facilitating medial shifting of the proximal tibia was developed. We compared postoperative alignment and strength between this novel plate group and a conventional tibial plateau leveling osteotomy (TPLO) plate group using eight small-breed dog cadavers each. Additionally, we investigated the potential of the novel plate as an alternative to tibial tuberosity transposition. Postoperative alignment and strength were assessed through radiographs and mechanical testing. Measurements including tibial plateau angle, mechanical medial proximal tibial angle, and number of screws within the joint were also analyzed. There were no significant differences in all measured parameters. For the novel plate, the medial displacement ratio of the proximal tibia was confirmed to be approximately 30%, and the result was thought to be appropriate. These findings suggest that the PCM-TPLO plate could be a promising alternative for treating concurrent CCLR and MPL in small-breed dogs.

A retrospective study of Monteggia fractures in 8 dogs and 1 cat.

Monteggia fractures (MFs) are proximal ulnar fractures with concurrent dislocation of the radial head. This retrospective study aims to report the clinical findings and discuss the treatments and outcomes in MFs cases of 9 cases. Previous medical records of the animals were reviewed for history, clinical features, radiographic findings and choice of treatment. Treatment follow-up was evaluated over the telephone by discussion with the owners. Six animals included in the study were presented 2 days after the initial trauma. Five dogs were presented after common road traffic accidents and two after unknown traumas. All dogs had type I MFs, while the cat had a type III MF. Radiographical findings showed that six animals had extra-articular ulnar fractures, while three animals had intra-articular ulnar fractures. All animals were treated with open reduction of the ulna and internal fixation surgical methods. Six ulnar fractures were stabilized with intramedullary pin(s) with cerclage wire. The clinical outcome was assessed by the owners as full function in 3 dogs, acceptable function in 2 dogs and unacceptable function in 2 dogs with intraarticular ulnar fractures. The cat case was rated as full function. One dog died from a pulmonary fat embolism. The findings presented here provide some support that cerclage wire placement could be a satisfactory method for annular ligament reconstruction as a simple and economical treatment option. Also, to the authors' knowledge, this is the third report of MFs with intraarticular ulnar fractures. In this series, comminuted, intraarticular fractures were related to major postoperative complications.

Posterior sternoclavicular joint dislocation in a young male: a case report.

The traumatic dislocation of the posterior sternoclavicular joint is a serious injury with possibly severe complications and therefore has to be managed with the greatest caution. We report the case of a young male with a posterior dislocation of the medial clavicle with compression of the brachiocephalic artery as well as the esophagus. Open reduction and placement of a wire cerclage were performed with a good postoperative outcome.

Management of luxation injuries in line with International Association of Dental Traumatology guidelines - Two case reports.

Luxation injuries represent significant traumatic events for permanent teeth. This article presents the management of intrusive and extrusive luxation injuries, following the International Association of Dental Traumatology (IADT) guidelines, through two case reports. The first case involves a 30-year-old female with an intruded maxillary left central incisor, managed through surgical extrusion, stabilization, and endodontic treatment. The second case features a 15-year-old female with an extruded maxillary left central incisor, repositioned and splinted. Follow-up examinations revealed the resolution of symptoms in both cases. These cases highlight the efficacy of IADT guidelines in diagnosing and treating luxation injuries, resulting in favorable outcomes.

Combination of TPLO, medial and lateral augmentation techniques for the treatment of traumatic stifle luxation in a cat.

Case summary: An 11-year-old female neutered domestic shorthair cat was referred for surgical management of a traumatic right stifle luxation. Orthopaedic examination of the affected stifle under general anaesthesia revealed joint effusion and craniocaudal and rotational instability. Cranial displacement of the tibia with respect to the femur and infrapatellar pad sign were identified on radiography. Intraoperatively, complete rupture of both cruciate ligaments and marked disruption of the mid and caudal poles of the medial and lateral menisci were observed. Both collateral ligaments appeared intact. The remnants of the injured cruciate ligaments were removed, and medial and lateral caudal hemimeniscectomies were performed. A tibial plateau levelling osteotomy (TPLO) was performed to address the craniocaudal stifle instability. Intraoperative assessment of the stifle revealed persistent instability with cranial tibial translation, internal and external rotation, and a positive caudal draw test. A lateral augmentation suture was employed to address the persistent cranial tibial translation and internal rotation. To successfully neutralise caudocranial and external rotational instability secondary to the caudal cruciate ligament deficiency, a medial augmentation suture was placed with the aid of three interference screws. Stifle stability was achieved. A modified Robert-Jones bandage was kept on for 24 h postoperatively. An excellent outcome was achieved, with successful limb function restoration. Relevance and novel information: This case report represents the first documented instance of feline traumatic stifle luxation repair by combining a corrective tibial osteotomy and extra-articular augmentation. Notably, it introduces the novel technique of implementing a TPLO with medial and lateral augmentation sutures to address multidirectional stifle instability.

Stabilizing effect of total ankle arthroplasty by distal translation and lateralization of talus in varus ankle deformity.

BACKGROUND: In end-stage arthritis indicated for total ankle arthroplasty (TAA), full-thickness cartilage damage, subchondral bone defect/shaving, and fluttering of the talar dome occur, shortening the distance between the tibial and talar insertions of ligaments and leading to laxity of ligaments surrounding the ankle joint. Under such conditions, medial ligaments (including the deltoid ligament) would not be expected to function properly. To stabilize the ankle joint during the stance phase, medial ligament function under tension is important. This study therefore examined whether TAA contributes to lengthening of the medial tibio-talar joint as evaluated radiographically, as a preferable method for achieving tensile effects on medial ligaments. MATERIALS AND METHODS: Twenty-four feet with end-stage varus deformity of the ankle joint that underwent TAA were retrospectively investigated, excluding cases with any malleolar osteotomy or fracture. Distance between proximal and distal insertions of medial ligaments, lateralization of the talus, and talar tilt angle under valgus/varus stress condition were evaluated pre- and postoperatively. RESULTS: Distance between proximal and distal insertions of medial ligaments was significantly elongated after TAA. At the same time, the talus showed significant lateralization. Furthermore, talar tilt under valgus/varus stress conditions was also significantly reduced after TAA. CONCLUSION: TAA affects distal translation and lateralization of the talus in cases of varus ankle deformity. These effects might contribute to re-providing tensile force on lax medial ligaments, improving ligament function.

Biomechanical evaluation of a fixation technique with a modified hemicerclage for tibial tuberosity transposition: an ex vivo cadaveric study.

Objectives: (1) To determine stiffness, load at failure, and mode of failure of a novel fixation method with a tension modified-hemicerclage (MH) for tibial tuberosity transposition, and (2) to compare the biomechanical properties of this novel fixation technique to 2 pins (2Pins) and 2 pins and tension band wire fixation (2Pins + TBW). Study design: Thirty cadaveric stifles from dogs between 5.2 and 13.1 kg were assigned to 3 treatment groups: Group 1: fixation technique with MH; Group 2: 2Pins; Group 3: 2Pins + TBW. Biomechanical testing was performed with the tibia positioned at an angle of 135° relative to vertical position. Tensile force was applied to the patellar ligament until catastrophic failure was observed. The mode of failure, the load at failure, and the stiffness were compared among treatment groups. Results: The mean stiffness of the novel fixation (38.1 N/mm ± 7.1) and the 2Pins + TBW (40.2 N/mm ± 9.3) were greater than the 2Pins (26.7 N/mm ± 6.7). There was no significant difference between the novel fixation technique and 2Pins + TBW in stiffness and maximum load to failure. The 2Pins (284.3 N ± 70.5) failed at a significantly lower load than the tension modified-hemicerclage (555.7 N ± 225.9 N) and 2Pins + TBW (715.3 N ± 339.8 N). Conclusion: A fixation technique using a modified hemicerclage had the same strength and stiffness as the 2Pins + TBW and was stronger and stiffer than the 2 Pins technique in a cadaveric model.

Management of medial luxation of the shoulder joint in toy-breed dogs using an antiluxation pin placed lateral to the supraspinatus muscle tendon: 20 limbs (2017-2022).

OBJECTIVE: To describe the clinical and diagnostic findings, surgical procedures, and clinical course of dogs with medial shoulder luxation (MSL) treated with a novel method using an antiluxation pin. ANIMALS: 18 client-owned toy-breed dogs (20 treated limbs). CLINICAL PRESENTATION: Toy-breed dogs with MSL were treated with the antiluxation pin (2017 to 2022). The collected data included signalment, cause of luxation, preoperative and follow-up clinical evaluations with lameness scores (LMS), and radiographic and/or CT findings. RESULTS: Toy Poodle was the most represented breed (17 of 18 dogs [94.4%]). The median age was 10 years. One of 18 dogs had a history of trauma. Medial luxation was confirmed in all limbs using radiography or palpation under general anesthesia. Reluxation occurred in 3 limbs at 1, 4, and 30 days after surgery, respectively. Of these 3 limbs, 1 limb underwent revision to replace the original pin and the other 2 limbs underwent no further treatment. One limb with persistent pain underwent 2 revision surgeries to adjust the pin orientation 30 and 72 days after the initial surgery. Eighteen limbs remained unluxated after the initial or revision surgery until the final follow-up (median, 18.5 months; range, 1 to 63 months). The LMS at the final follow-up for the 18 unluxated limbs (mean, 0.5) was significantly lower than the preoperative LMS (mean, 4.5) (P < .01). CLINICAL RELEVANCE: A novel method of the antiluxation pin provides an alternative surgical treatment for MSL in toy-breed dogs that is minimally invasive and technically simple.

Equine Talocalcaneal subluxation.

A Quarter horse filly was evaluated for a two-week old wound of the right hind cannon bone after the mare stepped on her. A sequestrum was noted radiographically and was surgically debrided. After continued follow-up a left hind varus deformity was noted and was corrected with a lateral transphyseal screw in the distal left tibia. After the varus deformity was improved, a lateromedial radiograph was taken of the distal left tibia and tarsus and talocalcaneal subluxation was seen. The same view was taken of the right tarsus and the same deformity was noted. After finding no case reports on the condition with information on treatment or surgical correction, humane euthanasia was elected. A few months later, the same owner brought a two-month-old colt out of the same mare to the hospital for an elective procedure. Tarsal radiographs were taken due to the owner's previous experience, although the colt had no clinical history or any traumatic incidents. A lateromedial view of the right tarsus revealed talocalcaneal subluxation.

Management of traumatic dental injuries in a hemophiliac patient: A challenge! Case report with nine years follow-up.

Traumatic dental injuries (TDIs) are frequently associated with an injury pattern that requires accurate diagnosis for developing the appropriate treatment plan. When children with special healthcare needs, i.e., Hemophilia experience TDIs, managing the situation becomes a challenging task for pediatric dentists due to the requirement of a multidisciplinary approach in their care. This case report highlights the successful management of extrusive luxation injury of a young permanent tooth with an open apex in an eight-year-old male child with severe Hemophilia A. After a follow-up of nine years, the pulp showed significant healing with physiological closure of the apical foramen. The study further emphasizes that timely management of such injuries can lead to improved tooth prognosis.

Comparative analysis of post-operative rehabilitation approaches for medial patellar luxation in small-breed dogs.

Background and Aim: Electrical stimulation (ES) and light amplification by stimulated emission of radiation (LASER) therapy are frequently used in post-operative rehabilitation; however, there is currently insufficient research comparing their effectiveness. This study aimed to assess the effectiveness of post-operative rehabilitation following medial patellar luxation (MPL) surgical correction by comparing ES and LASER therapy when combined with exercise. This was compared with a control group that consisted solely of post-operative home exercise implemented by the owner. Materials and Methods: We conducted a prospective clinical trial on dogs that had undergone surgical treatment for MPL. The dogs were categorized into the following three groups: The control group, which did not participate in any post-operative rehabilitation program; the ES group, which received post-operative rehabilitation involving ES therapy; and the LASER group, which underwent post-operative rehabilitation featuring LASER therapy. Results: There were no significant differences among the groups regarding the evaluation parameters, including lameness score, pain score, thigh muscle circumference, and range of motion. Although there may have been a difference in pain score in some groups, it could be attributed to the pre-operative condition of patients. These results aligned with the owner questionnaires' canine brief pain inventory assessments, showing no significant differences between treatment groups. Conclusion: Post-operative rehabilitation for MPL correction may enhance limb usage, joint function, muscle mass, and pain relief. However, the duration and level of post-operative pain may influence the necessity for rehabilitation. In addition, ES and LASER therapy offer similar pain-relieving effects after MPL surgery; therefore, the choice between these methods depends on the availability of equipment and veterinarian preferences.

Fracture Dislocation of the Pisiform Bone in 14-Year-Old Boy-A Case Report.

We present the case of a 14-year-old patient who suffered fracture dislocation of the pisiform bone (PB) along with fractures of the scaphoid, proximal radius, and proximal phalanx of the thumb due to high-energy trauma directly to the extended wrist. This combination of fractures has not been previously reported in the literature. Currently, there is no consensus in the literature regarding the optimal treatment approach for such cases. In our management, initial attempts at closed and open reduction were unsuccessful, leading to the decision for primary pisiformectomy. Our report includes a follow-up of 3.5 years, demonstrating a very good outcome. Based on this case and a few similar published cases, primary pisiformectomy appears to be a viable and well-accepted option, particularly among young patients. Additionally, we conducted a review of radiographic criteria and management strategies for this specific injury and related conditions.

Epidemiological profile of luxations injuries with or without dental fractures in permanent teeth: A 10-years retrospective study.

BACKGROUND/AIM: This study assessed the epidemiology of luxation injuries with or without dental fractures in patients attending the outpatient clinic of a Brazilian dental school over the past decade. MATERIAL AND METHODS: We reviewed clinical records from a specialized center for dental trauma care in Brazil, focusing on patients who experienced at least one traumatic dental injury (TDI) in a permanent tooth between 2012 and 2022. The extracted data included sex, age, etiology, time between trauma occurrence and the search for initial care, TDI classification, and the need for endodontic treatment. The statistical analysis involved Pearson's chi-squared and Fisher's exact tests at a 5% significance level. RESULTS: The 366 analyzed clinical records included 166 patients (350 teeth) with luxation injuries. Men (n = 102) showed a higher prevalence of luxation injuries than women (n = 64). Extrusive luxation prevailed (n = 99 patients and 208 teeth). Patients with luxation injuries sought care promptly after dental trauma incidents (p = .02) and demonstrated a higher incidence of endodontic treatment (p < .0001) than those without luxation injuries. Lateral luxation was notably associated with traffic accidents (p < .0001). The combination of luxation injuries and tooth fractures did not correlate with a higher need for endodontic treatment (p > .05). CONCLUSIONS: Age and trauma etiology seemed to have influenced the epidemiological profile of luxation injuries. Additionally, these injuries affected the time to seek initial care and the need for endodontic treatment.

Risk of pulp necrosis and related complications in the permanent anterior teeth with lateral luxation: A systematic review and meta-analysis.

This systematic review aimed to evaluate the evidence related to the occurrence of pulp necrosis and related complications in permanent anterior teeth with lateral luxation. It was envisaged to address the ambiguity related to the recommendation for pulp extirpation in teeth with mature root apex. An a priori protocol was formulated as per the best practices of evidence-based medicine and registered in PROSPERO. A comprehensive search was performed electronically in PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane on July 10,2023 without any restriction of language or year of publication. The screening of titles and abstracts and later the full-text articles were performed. Later, the data extraction was performed by using a self-designed sheet, risk of bias (ROB) assessment was done, meta-analysis was performed, and the GRADE approach was used to assess the quality of evidence. The qualitative synthesis was performed on 13 studies done from 1985 to 2020 in hospital settings. There was variability in the minimum and total observation periods, sample sizes, and characteristics of the sample population. The overall pooled prevalence of pulp necrosis was found to be 57% (95% CI: 42, 72%). It was 12% (95% CI: 8%, 18%, I2 = 0%) in immature teeth, and 58% (95% CI: 42, 73%, I2 = 86%) in mature teeth. The pooled prevalence of EIRR was found to be 11% (95% CI: 4, 27%, I2 = 95%) with greater risk in teeth with mature root apex (RR: 1.26, 95% CI: 1.12, 1.42, I2 = 0%). The ROB was moderate or high in nine studies and the GRADE of evidence was very low in 14 of 15 outcomes. There are greater chances of pulp necrosis in teeth with lateral luxation, especially with mature apex. However, it can still be less than 60% in most cases with the prevalence of EIRR less than 20%. Hence, an absolute recommendation for endodontic intervention in mature teeth with lateral luxation must be interpreted with slight caution.

The Successful Use of an Ultrasound-Guided Mid-Femur Sciatic Nerve Block in a Juvenile Emu (Dromaius novaehollandiae) under General Anaesthesia.

The current case report describes a successful ultrasound-guided mid-femur sciatic nerve block in an emu. A 2-month-old emu suffering from acute-onset lameness was referred to the University Clinic of Liège, where he was diagnosed with a lateral luxation of the Achilles tendon on both hind limbs. Two surgical procedures were performed for treatment. Both surgical procedures were performed under general anaesthesia with butorphanol, ketamine, midazolam and isoflurane in oxygen. The anaesthesia was continuously monitored. An ultrasound-guided sciatic nerve block was performed to prevent and treat surgically induced nociception. The technique was adapted from what is already described in other species. Levobupivacaine was injected perineurally under ultrasound-guidance. Intraoperative nociception was assessed based on the heart rate and mean arterial pressure changes. The recovery was uneventful and with no clinical signs of postoperative pain.

Surgical Repair of Psittacine Femorotibial Luxation: A Case Series.

Luxation of the psittacine femorotibial joint most commonly occurs following trauma or as a development abnormality. Historically, this injury is considered to have a poor prognosis in birds; however, surgical management may result in acceptable and functional outcomes. This case series describes the surgical techniques, complications, and outcomes of 7 cases of femorotibial luxation in psittacine birds. Of the 7 cases, 6 were chronic injuries. Surgical repair methods included conjoined intramedullary pinning, transarticular pinning with an external skeletal fixator (ESF), a combination of extracapsular stabilization and ESF, ESF alone, and a combination of conjoined intramedullary pins with an ESF. An acceptable outcome was achieved in 75% (6/8) of luxated femorotibial joints managed with surgical methods. All cases were female birds of various species, suggesting a possible sex predisposition for stifle luxation.