Search Results (92)

Introduction: Ocular complications associated with dental procedures are diverse but have been primarily reported through case reports and series, with no comprehensive reviews to date. The underlying mechanisms of these complications are often poorly understood by medical professionals, partly due to limited interdisciplinary education. This review aims to bridge this gap by summarizing the relevant anatomical connections between the oral and ocular regions, exploring the mechanisms through which dental procedures may lead to ophthalmic complications, and detailing their clinical presentations, progression, and potential management and preventive strategies. Methods: Published case reports and case series from 1950 to October 2024 that described ophthalmic complications in human patients following dental procedures were included in this scoping review. Results: Dental procedures can give rise to a variety of ophthalmological complications, whether neuro–ophthalmic (e.g., diplopia, ptosis, or vision loss), vascular (e.g., retrobulbar hemorrhage or cervical artery dissection), infectious (e.g., orbital cellulitis or abscess), mechanical (e.g., orbital trauma or fractures), or air-related (e.g., orbital and subcutaneous emphysema). Conclusions: Most of the ophthalmological complications following dental procedures are often reversible, but some can be vision-threatening or lead to permanent sequelae if not promptly recognized and managed. Prevention through precise technique and anatomical awareness, early identification of symptoms, and timely multidisciplinary collaboration are crucial to minimizing risks and ensuring better patient outcomes. Full article

Background: Traumatic fractures of the cervical spine pose significant challenges in management, particularly in young patients, where preserving mobility is crucial. Patient Characteristics: A 30-year-old woman presented with a C3 lateral mass and pedicle fracture following a motor vehicle collision. Initial conservative management with a rigid cervical collar for three months failed to reduce the diastasis, and the debilitating neck pain worsened. Preoperative imaging confirmed fracture instability without spinal cord compression. Intervention and Outcome: Preoperative screw trajectory planning was conducted with the My Spine MC system (Medacta), and fine-tuning was achieved on a 3D-printed model of the vertebra. A posterior midline approach was employed to expose the C3 vertebra, and a Herbert screw was inserted under fluoroscopic guidance. Imaging at three months demonstrated significant fracture reduction and early bone fusion. The patient achieved substantial improvement in functional mobility without complications. Conclusion: Herbert screw fixation holds potential as a less-invasive alternative to conventional posterior stabilization for selected cervical fractures. This technical note provides the reader with the required information to support surgical planning and execution. Full article

Background/Objectives: Equestrian activities can result in spine injuries. Most studies are from single centers, and none use a national database. It was the purpose of this study to describe the demographics, injury mechanisms, and types of equestrian-associated spinal injuries using a US national ED database. Methods: The National Electronic Injury Surveillance System database was queried for equestrian-related spine injuries from 2000–2023. ED disposition was categorized as discharged or not discharged. Statistical analyses accounted for the weighted, stratified nature of the data to obtain national estimates. Results: There were an estimated 54,830 patients, having an average age of 42 years. Most were female (73.6%) and White (93.7%); one-half (51.1%) were not discharged from the ED. The spine level was the lumbar (49.1%), thoracic (24.4%), sacrococcygeal (15.5%), and cervical (11.0%) spine. Multiple spine fractures occurred in 4.0%. A simple fall off a horse occurred in 53.6% of the injuries, and the patient was bucked/thrown/kicked off the horse in 39.7%. Neurologic injury was rare (1.8%). Hospital admission was highest in the cervical group (74.3%) and lowest in the sacrococcygeal group (33.5%). The cervical group had the highest percentage of males (43.7%) compared to the thoracic, lumbar, and sacrococcygeal groups (22.8%, 27.3%, 16.8%, respectively). There were proportionally fewer females in those over 50 years of age, where the male percentage was 11.7%, 25.6%, and 31.6% for those <18 years, 18–50 years, and >50 years old, respectively. Conclusions: This large study can be used as baseline data to evaluate further changes in equestrian injuries, especially the impact of further prevention strategies, education protocols, and legislative/governmental regulations of public equestrian localities. Full article

Objective: This in vitro study aimed to evaluate the influence of cervical margin design—tangential versus chamfer—on the fracture resistance of monolithic crowns fabricated from lithium disilicate and zirconia ceramics. Materials and Methods: Forty extracted human molars were randomly assigned to two preparation types: chamfer and tangential. Each group was restored with CAD/CAM-fabricated crowns made from either zirconia (IPS e.max^® ZirCAD Prime) or lithium disilicate (IPS e.max^® CAD), resulting in four subgroups (n = 10). Standardized adhesive cementation protocols were applied. After 24 h storage in distilled water, the specimens underwent static load-to-failure testing using a ZwickRoell ProLine Z005 universal testing machine. Results: Zirconia crowns with chamfer margins exhibited the highest mean fracture resistance (2658 N), while lithium disilicate crowns with tangential margins showed the lowest (1862 N). Chamfer preparation significantly increased the fracture resistance of lithium disilicate crowns (p < 0.01), whereas margin design had no significant effect on zirconia. All restorations exceeded physiological masticatory forces, confirming their clinical viability. Conclusions: Cervical margin design significantly affected the fracture performance of lithium disilicate crowns but not zirconia. Chamfer preparations are recommended when using lithium disilicate to optimize mechanical strength. These findings underscore the importance of preparation geometry in guiding material selection for CAD/CAM ceramic restorations. Full article

Introduction: Intertrochanteric femoral fractures (IFFs) are the most common traumatic injuries in elderly people and significantly impact the patient’s health status. The current evidence indicates that short intramedullary nails may be a better choice than dynamic hip screws in IFF management, being less invasive and biomechanically superior, providing a buttress to limit fracture collapse. On the other hand, an unstable fracture may collapse even after adequate reduction and fixation. This paper aims to describe the surgical complexity of the nail-to-total hip arthroplasty (THA) conversion, focusing on the restoration of normal hip geometry. Material and Methods: Patients referred to our level I trauma center with failed cephalomedullary nailing following IFFs and managed with the nail-to-THA conversion were retrospectively recruited. The anteroposterior postoperative pelvis radiographs were analyzed to establish whether the normal biomechanics of the involved hip were restored. The following radiographic parameters were recorded and compared to the contralateral unaffected side: hip offset, cervical–diaphyseal angle, and limb length discrepancy. Clinical assessment was performed using the following scores: the Harris hip score (HHS) and the visual analog scale for pain (VAS). The independent samples t-test and the Pearson correlation test were performed. The tests were two-tailed; a p < 0.05 was considered significant. Results: A total of 31 patients met the inclusion and exclusion criteria (10 males and 21 females; mean age: 76.2 years; range: 66–90 years) and were included in this study. The modes of trochanteric nail failure included the following: cut-out in 22 cases (70.97%), non-union in 4 cases (12.9%), peri-implant fracture in 1 case (3.23%), cut-through in 2 cases (6.45%), and femoral head avascular necrosis (HAN) in 2 cases (6.45%). Long stems were used in 21 patients out of 31 (67.74%), while dual-mobility cups were implanted in 24 patients out of 31 (77.41%). A significant mean neck shaft angle (NSA) increase (p < 0.001) and a significant mean femoral offset reduction (FO, p 0.001) compared to the contralateral hip were recorded; a mean limb length discrepancy (LLD) of 8.35 mm was observed. A significant correlation between HHS and ∆NSA (p = 0.01) and ∆FO (p = 0.003) was recorded. Conclusions: Conversion from a cephalomedullary nail to THA is a complex procedure that should be considered a revision surgery, rather than a primary surgery. Surgeons must be aware that normal hip geometry may not be obtained during this surgical procedure; thus, a patient undergoing the nail-to-THA conversion for intertrochanteric fixation failure may have an increased risk of implant-related complications. Full article

Minimal facet and lateral mass fractures of the subaxial cervical spine (C3–C7) are a distinct subset of spinal injuries that present diagnostic and therapeutic challenges. These fractures often result from low-energy trauma or hyperextension mechanisms. They are frequently stable. However, subtle fracture instability and associated soft tissue injuries may lead to delayed instability, neurological compromise, and/or chronic severe pain if not properly identified. Accurate diagnosis relies on a combination of plain radiography, high-resolution computed tomography (CT), and magnetic resonance imaging (MRI) to assess bony and ligamentous integrity. Treatment strategy is determined based on fracture stability, neurological status, and radiographic findings. Most stable fractures can be effectively treated with conservative treatment, allowing for natural healing while minimizing complications. However, when instability is suspected—such as those with significant disc and ligamentous injuries, progressive deformity, or neurological deficits—surgical stabilization may be considered. The presence of vertebral artery injury (VAI) can further complicate management. To mitigate the risk of stroke, a multidisciplinary approach that includes neurosurgery, vascular surgery, and interventional radiology is needed. Surgical treatment aims to restore spinal alignment, maintain stability, and prevent further neurological deterioration with approaches tailored to individual fracture patterns and patient-specific factors. Advances in surgical techniques, perioperative management, and endovascular interventions for VAI continue refining treatment options to improve clinical outcomes while minimizing complications. Despite increasing knowledge of these fractures and associated vascular injuries, optimal treatment strategies remain unclear due to limited high-quality evidence. This review provides a comprehensive analysis of the anatomy, biomechanics, classification, imaging modalities, and treatment strategies for minimal facet and lateral mass fractures in the subaxial cervical spine, highlighting recent advancements in diagnostic tools, therapeutic approaches, and managing vertebral artery injuries. A more precise understanding of the natural history and optimal management of these injuries will help spine specialists refine clinical decision-making and improve patient outcomes. Full article

Vertebral fracture (VF) may induce spinal cord injury that can lead to serious consequences which eventually may paralyze the entire or some parts of the body depending on the location and severity of the injury. Diagnosis of VFs is crucial at the initial stage, which may be challenging because of the subtle features, noise, and homogeneity present in the computed tomography (CT) images. In this study, Wide ResNet-40, DenseNet-121, and EfficientNet-B7 are chosen, fine-tuned, and used as base models, and a Bayesian-based probabilistic ensemble learning method is proposed for fracture detection in cervical spine CT images. The proposed method considers the prediction’s uncertainty of the base models and combines the predictions obtained from them, to improve the overall performance significantly. This method assigns weights to the base learners, based on their performance and confidence about the prediction. To increase the robustness of the proposed model, custom data augmentation techniques are performed in the preprocessing step. This work utilizes 15,123 CT images from the RSNA-2022 C-spine fracture detection challenge and demonstrates superior performance compared to the individual base learners, and the other existing conventional ensemble methods. The proposed model also outperforms the best state-of-the-art (SOTA) model by 1.62%, 0.51%, and 1.29% in terms of accuracy, specificity, and sensitivity, respectively; furthermore, the AUC score of the best SOTA model is lagging by 5%. The overall accuracy, specificity, sensitivity, and F1-score of the proposed model are 94.62%, 93.51%, 95.29%, and 93.16%, respectively. Full article

Background/Objectives: This report details a rare instance of an infant with achondroplasia developing acute tetraparesis after a cervical whiplash injury, highlighting key multidisciplinary management considerations and specific anesthetic strategies to mitigate potential risks. Case presentation: A 1-year-old boy with achondroplasia presented with acute tetraparesis after a whiplash injury. Initial craniocervical computed tomography demonstrated a reduced volume of the posterior fossa, foramen magnum stenosis, and ventriculomegaly, without any fractures or dislocations. Moreover, magnetic resonance imaging (MRI) revealed pathological signal changes in the medulla oblongata, cervical spinal cord in segments C1 and C2, and the posterior atlantoaxial ligament. After initial conservative therapy and head immobilization using a soft cervical collar, partial remission of the tetraparesis was achieved. Two weeks post-injury, microsurgical posterior fossa decompression extending to the foramen magnum and C1 laminectomy was performed under general anesthesia with intraoperative neuromonitoring. Following an unsuccessful intubation attempt using a fiberoptic bronchoscope, successful airway management was achieved using a combined technique incorporating video laryngoscopy. Venous access was secured under ultrasound guidance. The patient exhibited complete remission of neurological symptoms by the third postoperative month during follow-up. Conclusions: This case report underscores the crucial need for a multidisciplinary approach in managing children with achondroplasia, especially with foramen magnum stenosis and complex cervical spine injuries. Anesthetic management required meticulously planned airway strategies using advanced techniques like video laryngoscopy and fiberoptic bronchoscopy to reduce airway risks. It also highlights the importance of conservative therapy paired with timely neurosurgical intervention, resulting in the patient’s full recovery. Full article

Background/Objectives: Occipital condyle fractures (OCFs) can be seen in around 4–19% of patients who suffer from cervical spine trauma. Anderson and Montesano system type III OCFs, which are avulsion fractures, are potentially unstable and operative. This study evaluates the management of type III OCFs at our institution over a 22-year period. Methods: This retrospective study reviewed all cases of type III OCFs at our institution from July 2001 to March 2023, identified via imaging reports. Using the in-house radiology imaging informatics system “Doris” (Dig Our Radiology Information System), reports containing the terms subluxation, avulsion, unstable, or type 3/III with occipital condyle, occipital condylar, occipital fx, or occipital fracture were collected. We also searched for Montesano type III/3 fracture. Electronic medical records were used to collect clinical and demographic data. Patients evaluated by the neurosurgical team with at least 1 month of follow-up were included in the analysis. Results: A total of 563 patients were identified with type III OCFs. A total of 56 patients met the inclusion criteria. The majority (91%, 51/56) were treated conservatively with cervical orthosis. A small subset (8.9%, 5/56) underwent occipito-cervical fusion. Three had concomitant unstable C1 fractures, while the other two had significant coronal deformity associated with their type III OCF. Conclusions: At our institution, type III OCFs are predominantly managed with cervical orthosis. Only those with an associated malalignment of the occipito-cervical joint underwent fusion. These findings suggest that most type III OCFs can be treated conservatively with orthosis once stability is confirmed with an upright radiograph. Full article

This study aimed to assess the quality of YouTube (YT) videos providing medical information on cervical spine fractures; secondly, a comparison of two timeframes has been conducted. Using Google Chrome with privacy settings to minimize personalization, two searches were conducted on 20 July 2021 and the second one on 10 April 2024 using various terms related to cervical spine injuries. Videos were evaluated using the DISCERN (Quality Criteria for Consumer Health Information), GQS (Global Quality Score), and JAMA scoring systems. In total, 91 videos were included. Mechanisms of injury were the most frequent video content (n = 66), and postoperative pain occurred the least (n = 6). The mean DISCERN score of 43.26 (std = 11.25), mean GQS of 2.67 (std = 0.74), and mean JAMA score was 2.2 (std = 0.68). Inclusion of treatment options had an odd ratio of 21.72 for a better-quality video. The largest number of videos was provided by physicians (n = 24). In DISCERN, risks of treatment were graded lowest = 1.9. Newer videos achieved higher scores in the DISCERN, GQS, and JAMA scoring systems reaching 52.5, 3, and 2.75, respectively. These scores suggest inadequate information provision in the videos, hindering patients’ understanding of their condition. Due to insufficient information presented in current videos, patients are not fully informed. Full article

Pycnodysostosis (PD) is a rare autosomal recessive skeletal dysplasia from impaired bone resorption due to osteoclastic dysfunction. The features of PD are deformity of the skull, maxilla, and phalanges; osteosclerosis; and bone fragility. We describe the case of a patient with complaints of multiple fractures of the lower extremities in the anamnesis and pain in the lower extremities, cervical spine, and shoulder girdle during physical exertion. Genetic testing revealed a novel homozygous variant c.704T>C (p.Leu235Pro) in the CTSK gene. Biallelic pathogenic variants in this gene lead to PD. Thus, the diagnosis in the patient was established by finding a novel likely pathogenic variant in the CTSK gene. Full article

Neck pain can be associated with specific conditions, such as neurological disorders, vascular or inflammatory diseases, fractures, herniated discs, etc. However, the majority of neck pain cases cannot be attributed to a specific cause. The objective of this review is to describe the muscle dysfunctions associated with neck pain, as measured by electromyography, and to determine the effectiveness of dry needling in improving these muscular dysfunctions. The research was conducted using the following databases: PubMed, Alcorze, and Google Scholar. The next conclusions have been extracted after the revision of the 65 selected manuscripts. The current scientific evidence supports electromyographic pathological findings in individuals with chronic neck pain, especially during general upper limb movement, repetitive work, violin playing, cervical force, and cervical movement tasks. Dry needling applied to an active myofascial trigger point in the upper trapezius can be suggested as an intervention to enhance the performance in the cranio-cervical flexion. Dry needling applied to latent myofascial trigger points in the upper trapezius after typing tasks in healthy subjects resulted in decreased upper trapezius activity and fatigue in the short term. In women with trapezius myalgia, dry needling applied to the upper trapezius led to a lower increase in electromyography activity compared to no intervention. Full article

The integration of three-dimensional (3D) printed resin denture teeth represents a significant advancement in digital dentistry. This study aims to assess the ability of 3D-printed denture teeth to withstand chipping and indirect tensile fractures, comparing them with conventionally manufactured resin denture teeth. Four groups, each comprising 30 specimens, were examined: Group 1 featured 3D-printed denture teeth (NextDent, 3D Systems, Soesterberg, The Netherlands), while the others included commercially obtained Ivostar Shade, SpofaDent Plus, and Major Super Lux teeth. Stereolithography 3D printing was utilized to produce methacrylate-based photopolymerized resin teeth models for Group 1, while the remaining groups were commercially sourced. Chipping and indirect tensile fracture tests were performed at a rate of 0.8 mm/min until material failure, offering valuable insights into the mechanical properties of the tested denture teeth. Statistical analysis was carried out using one-way analysis of variance (ANOVA), coupled with Tukey’s honestly significant difference test to compare multiple groups, with a significance threshold of p < 0.05. The findings showed that 3D-printed resin denture teeth exhibited greater indirect tensile fracture resistance than Major Super Lux and Ivostar Shade, though they were surpassed by SpofaDent Plus. In the chipping test, the 3D-printed teeth experienced buccal chipping without distortion, indicating their structural stability under localized force. Fractures during the indirect tensile test originated near the loading point and extended cervically along the inner slopes of both cusps, displaying consistent fracture patterns. These results demonstrate that 3D-printed denture teeth made from resin materials provide adequate fracture resistance for clinical use, although further refinement of materials could enhance their performance relative to conventional alternatives. Full article

The zygomatic bone, a fundamental structure in facial anatomy, is exposed to fractures in impact situations, such as traffic accidents or contact sports. The installation of zygomatic implants can also alter the distribution of forces in this region, increasing the risk of fractures. To evaluate this situation, the first step is to develop a complex anatomical model from the stomatognathic point of view so that simulations in this sense can be validated. This study uses numerical simulation using a finite-element method (FEM) to analyze the behavior of the zygomatic bone under impacts of different velocities, offering a more realistic approach than previous studies by including the mandible, cervical spine, and masticatory muscles. Methods: An FEM model was developed based on 3D scans of actual bones, and simulations were performed using Abaqus Explicit 2023 software (Dassault Systemes, Vélizy-Villacoublay, France). The impact was evaluated using a steel cylinder (200 mm length, 40 mm diameter, 2 kg weight) impacted at speeds of 5, 10, 15, and 20 km/h. Zygomatic, maxillary, and mandibular bone properties were based on dynamic stiffness parameters, and bone damage was analyzed using ductile fracture and fracture energy criteria. Results: The results show that at impact velocities of 15 and 20 km/h, the zygomatic bone suffered crush fractures, with impact forces up to 400 kg. At 10 km/h, a combination of crushing and bending was observed, while at 5 km/h, only local damage without complete fracture was detected. The maximum stresses were concentrated at the zygoma–jaw junction, with values above 100 MPa at some critical points. Conclusion: The FEM model developed offers a detailed representation of the mechanical behavior, integrating the main structures of the stomatognathic apparatus of the zygomatic bone under impact, providing valuable information to, for example, advance injury prevention and zygomatic implant design. Higher impact velocities result in severe fractures, underscoring the need for protective measures in clinical and sports settings. Full article

Introduction: Biomechanical analysis of spinal structures is crucial in the evaluation of injuries, the risk of fracture, and age-related changes. Osteoporotic vertebrae are very fragile and therefore constitute a serious risk, especially in the elderly. Methods: At present, clinically relevant decision making in fracture risk assessment is predicated upon finite element analysis (FEA), which utilizes high-resolution computed tomography (CT) scans from clinical practice alongside micro-CT scans from laboratory settings. Of particular interest is the utilization of cortical vertebral body thicknesses, as meticulously measured via micro-CT. The data from a body donation over 80 years old with diffuse idiopathic skeletal hyperostosis (DISH) and osteoporosis (OP) were utilized through FEA to evaluate stresses in cortical and trabecular bone and to predict the stiffness and deformability of the examined vertebral bodies. Results: The investigation revealed a higher density of cortical and cancellous bone in vertebrae affected by DISH. Cortical density was highest in the thoracic section (median 188 µm), while cancellous bone density was 222 HU in the cervical vertebrae. The load on cortical bone increased as we progressed towards the lumbar spine; however, it remained quite constant in cancellous bone. Despite a low bone density, we registered no fractures in vertebrae. Conclusions: The data showed that DISH increased the thickness of the cortical bone and the density of the cancellous bone. The combination of increased cortical and cancellous bone density might reduce the risk of fracture in patients with low bone density. These conclusions emphasize the significance of biomechanical properties in the assessment of fracture risk and have important implications for clinical practice, particularly in relation to the prevention of vertebral fractures in osteoporotic patients with DISH. Full article