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PubMed1984

Reduction of hypertonicity by early casting in a comatose head-injured individual. A case report.

The patient in this report sustained a closed-head injury. Within six days of the injury, he demonstrated generalized hypertonicity accompanied by alternating strong decerebrate and decorticate posturing. By Day 10 after injury, normal passive ROM could no longer be maintained using neurophysiological therapeutic techniques. Therefore, we applied plaster casts to both ankles. Within 24 hours of cast application, the patient's general hypertonus had decreased, and by 72 hours after casting, the patient demonstrated seemingly purposeful movements of the left extremities. Although casts have been used previously to maintain ROM or decrease contractures and to improve balance of muscle function of the joint that was immobilized, we believe that the marked, generalized reduction in tone in body segments far removed from the ankles was an important clinical observation. We explored several possible mechanisms for these observations. Because the usual casting conditions for reflex inhibition were not obtained with this patient, other factors were suggested to be important: total even pressure and neutral warmth. Research is currently in progress at the Medical Center Hospital of Vermont to study further the effects of plaster casting and to understand the mechanisms underlying the effects.

Accidents, Home↗

PubMed2005

Effect of combined movement and heart rate monitor placement on physical activity estimates during treadmill locomotion and free-living.

A placement effect on activity measures from movement sensors has been reported during treadmill and free-living activity. Positioning of electrodes may impact on movement artifact susceptibility as well as surface ECG waveform amplitudes and thus potentially on the precision by which heart rate (HR) is ascertained from such ECG traces. The purpose of this study was to examine the extent to which placement of the combined HR and movement sensor, Actiheart, influences measurement of HR and movement, and estimates of energy expenditure. A total of 24 participants (20-39 years, 45-109 kg, 1.54-2.05 m, 19-29 kg m(-2)) were recruited. Whilst wearing two monitors, one placed at the level of the third intercostal space (upper position) and one just below the apex of the sternum (lower position), study participants performed level walking, incline walking, and level running on treadmill, and completed at least one day of free-living monitoring. Placement differences in HR data quality, movement counts, and energy expenditure (estimated from combined HR and movement) were analyzed with regression techniques. Quality of HR data was generally higher when monitors were placed in the lower position. This effect was more pronounced in men during both treadmill activity (relative risk, RR [95% CI] of noisy HR data in upper vs. lower position, RR=1.3[0.3; 5.6] in women, RR=174[14; 2,156] in men) and during free-living (RR=1.2[0.4; 3.3] in women, RR=25[9.6; 67] in men). There were minor placement differences (< or =8%) in movement counts only in women during incline walking and running. During free-living, no placement effect on counts was observed. In all test scenarios, estimates of energy expenditure from the two positions were not significantly different. Positioning the Actiheart at the level below the sternum may yield cleaner HR data. Regardless of which position is used, this has little or no effect on movement counts and energy expenditure estimates, which is encouraging for studies where research participants may have to position the monitors themselves.

Adult↗

PubMed1997

On the management of extraction sites.

Extraction sites may be needed to achieve specific orthodontic goals of positioning the dentition within the craniofacial complex. The fundamental reality that determines the final position of the dentition, however, is the control exercised by the clinician in closure of the extraction sites. A specific treatment objective may require the posterior teeth to remain in a constant position anteroposteriorly as well as vertically, while the anterior teeth occupy the entire extraction site. Another treatment objective may require the reverse, or any number of purposeful alternatives of extraction site closure. An appliance system developed over time, which provides this control, is described. The system takes advantage of aspects of continuous arch therapy that provides constant, positive orientation of the anterior and posterior groups of teeth to each other in three-dimensional space across an extraction site, combined with aspects of the segmented arch technique that permit definable and predictable force systems to be applied to these teeth. Consequently, the clinician has the ability to forecast treatment outcomes with confidence.

Bicuspid↗

PubMed2005

Heading in football. Part 1: development of biomechanical methods to investigate head response.

OBJECTIVES: There has been growing controversy regarding long term effects of repeated low severity head impacts such as when heading a football. However, there are few scientific data substantiating these concerns in terms of the biomechanical head response to impact. The present study aimed to develop a research methodology to investigate the biomechanical response of human subjects during intentional heading and identify strategies for reducing head impact severity. METHODS: A controlled laboratory study was carried out with seven active football players, aged 20-23 and of average stature and weight. The subjects were fitted with photographic targets for kinematic analysis and instrumented to measure head linear/angular accelerations and neck muscle activity. Balls were delivered at two speeds (6 m/s and 8 m/s) as the subjects executed several specific forward heading manoeuvres in the standing position. Heading speeds up to 11 m/s were seen when the head closing speed was considered. One subject demonstrating averaged flexion-extension muscle activity phased with head acceleration data and upper torso kinematics was used to validate a biofidelic 50th percentile human model with a detailed head and neck. The model was exercised under ball incoming speeds of 6-7 m/s with parameter variations including torso/head alignment, neck muscle tensing, and follow through. The model output was subsequently compared with additional laboratory tests with football players (n = 3). Additional heading scenarios were investigated including follow through, non-active ball impact, and non-contact events. Subject and model head responses were evaluated with peak linear and rotational accelerations and maximum incremental head impact power. RESULTS: Modelling of neck muscle tensing predicted lower head accelerations and higher neck loads whereas volunteer head acceleration reductions were not consistent. Modelling of head-torso alignment predicted a modest reduction in volunteer head accelerations. Exaggerated follow through while heading reduced volunteer head accelerations modestly. CONCLUSION: Biomechanical methods were developed to measure head impact response. Changing the biomechanics of currently accepted heading techniques will have inconsistent benefits towards the reduction of head loading. Furthermore, mathematical modelling suggested an increased risk of neck loads with one alternative technique. No consistent recommendations can be made on the basis of the current study for altering heading techniques to reduce impact severity.

Acceleration↗

PubMed1979

[Study of muscle hemodynamics during exercise: Physiological and pathological variations in Xe 133 elimination: A new method of interpretation (author's transl)].

Muscle blood flow measurements are of physiological (and pathological) significance only during effort. For this reason, the authors used Xe 133, which has been known since 1964, to measure regional muscle blood flow after its injection into the muscle, to quantify results during effort (pedalling). Effort is controlled by two measurable parameters: the weight lifted by the pedal and the frequency of movements. Curves showing the reduction in intramuscular Xe 133 levels cannot be mathematically formulated. It is easy, however, to measure their areas and thus define a mean elimination time (Tm) between times T1 and T2, beginning and end of effort, corresponding to activities A1 and A2 such that: formula: (see text). Normal Tm value, measured in 58 normal subjects with variable frequencies and weights lifted is: Tm = 1.70 +/- 0.38 min. The values in 70 patients with arteritis were significantly longer and can be greater than 3.5 min. This objective test could be of value in quintifying the effects of so-called vasodilators, both in patients with arteritis and venous insufficiency.

Humans↗

PubMed1991

The use of high-speed treadmills for lameness and hoof balance evaluations in the horse.

Examination for lameness remains the most important component of the clinical evaluation for poor performance. Although conventional examinations can be used to diagnose many causes of lameness, treadmill video gait analysis and dynamic hoof balance evaluations have proved to be useful not only for evaluating lameness but also for maintenance of long-term soundness. Treadmill lameness evaluations offer a major advantage compared to conventional evaluations because of the stationary position of the exercising horse relative to the people performing the examination. Lameness is suspected if asymmetric motion is observed or asymmetric sounds of the feet contacting the tread surface are heard during the treadmill evaluation. Localization of lameness to the front or hind legs is the first step in the treadmill gait analysis protocol. In trotting and pacing horses, asymmetric movements associated with foreleg lameness generally are confined to the front end. In contrast to the pacing gait, asymmetric movements associated with hindlimb lameness can involve both the front and rear of the horse at the trot. The evaluation is continued to determine which side of the horse is abnormal. Viewed from the front, horses with primary forelimb lameness appear to have an asymmetric downward rotation of the torso, head, and neck away from the stiffer lame front leg toward the flexed normal leg as it contacts the tread surface. The lame hind leg can appear to be stiff relative to the opposite normal leg. This results in uneven side-to-side oscillations of the pelvis rotating away from the abnormal stiff-appearing hind leg toward the normal, flexed hind leg as it contacts the tread surface. Both front- and hind-leg lamenesses cause dissociation of the normal foot-fall sequence, resulting in the alteration of the normal two beat gait at the trot or the pace to a three-beat gait. The final step of the lameness examination involves the use of diagnostic regional anesthesia to determine the anatomic location of the lameness. Treadmill video gait analysis can be used to evaluate differences in the horse's gait before and after each anesthetic block. Optimal foot balance during exercise is critical for long-term maintenance of musculoskeletal soundness. Combining slow-motion video gait analysis with treadmill exercise provides an excellent method for evaluating hoof balance at a variety of speeds. Optimal hoof balance can be achieved by using the technique of successive trimming and re-evaluation. The principles of hoof balancing include establishing dorsopalmar or dorsoplantar hoof balance.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

PubMed2001

[Arytenoid subluxation. Experience with a new voice therapy].

The systematic use of video-fibro-endoscopy techniques has made it possible to precisely define an uncommon laryngeal pathology of traumatic origin: arytenoid subluxation. This pathology general arises after anesthesiological intubation and is characterized by a pathological anteromedial shift of one arytenoid resulting in cord immobility. The symptoms of this disorder are dysphonia similar to recurrent nerve palsy. Differential diagnosis is not always easy. The treatment of choice indicated in the literature is based on invasive approaches (reduction under direct laryngoscopy or, less frequently, even more aggressive surgery) while voice treatment plays a marginal role. The authors offer an overall picture of arytenoid subluxation in view of the anatomophysiological aspects of the crico-arytenoid articulation and describe a new approach to voice rehabilitation. While watching himself in the video-fibroscopy monitor (visual feedback), the patient performs a particular exercise enabling him to raise the larynx, lifting the arytenoids and causing hyperadduction and vibration of the arytenoid hood. After having learned the exercise the patient continues with regular speech therapy sessions and voice therapy at home. Periodically the patient undergoes video-endoscopy and phoniatric-speech therapy check-ups until vocal function and cord motility have been restored. This type of approach was applied in 4 patients, all of whom responded relatively quickly with reactivation of the articulation and recovery of the voice. The authors conclude that voice therapy can achieve full healing in patients with arytenoid subluxation and should be given priority over other forms of treatment. The excellent results are explained asserting that particular movement of the larynx can achieve a reduction in subluxation by rearranging the articulatory surface.

Adult↗

PubMed2006

Arthroscopic technique of interposition arthroplasty of the glenohumeral joint.

Arthroscopic glenohumeral interposition arthroplasty is performed with the patient placed in the lateral decubitus position. Standard posterior, anterior, and anterosuperior portals are created, a routine diagnostic arthroscopy is performed, and the joint is débrided with the use of an arthroscopic shaver. An arthroscopic burr is used to resect prominent osteophytes, to alter the version of the glenoid if necessary, and to create microfractures on the glenoid surface. Next, 3 absorbable sutures are passed percutaneously with a 30 degrees angled suture grasper from 3 different sites posteriorly through the posterior capsular-labral tissue and into the anterior portal cannula, where they are isolated by means of the suture saver kit. The prepared interposition membrane/tissue (GRAFTJACKET Regenerative Tissue Matrix, Wright Medical Technology, Inc., Arlington, TN) is tagged with the 3 sutures in the anterior cannula before it is introduced into the joint. Three additional sutures are attached to the membrane anteriorly at 1, 3, and 5 o'clock positions and are isolated with suture savers. The membrane is next introduced into the joint through the anterior cannula and is aligned with the glenoid rim. The anterior sutures are rerouted through the anterior capsular-labral tissue with a 70 degrees angled suture grasper, and they are retrieved through the anterior cannula. Intra-articular nonsliding knots are used anteriorly to anchor the interposition tissue to the anterior glenoid labrum and capsule. The posterior sutures are knotted intra-articularly, or they may be tied extra-articularly; the proximal and distal posterior sutures are retrieved subcutaneously out through the skin tract of the posterior portal and are knotted with the suture present in this portal, with the use of nonsliding knots. Stability of the interposition tissue is assessed by movement of the glenohumeral joint through its entire range of motion. The postoperative protocol consists of early passive exercises, active exercises after 3 weeks, and muscle-strengthening exercises after 6 weeks.

Arthritis↗

PubMed1998

Exercise intensity and metabolic response in singles tennis.

The aim of this study was to determine exercise intensity and metabolic response during singles tennis play. Techniques for assessment of exercise intensity were studied on-court and in the laboratory. The on-court study required eight State-level tennis players to complete a competitive singles tennis match. During the laboratory study, a separate group of seven male subjects performed an intermittent and a continuous treadmill run. During tennis play, heart rate (HR) and relative exercise intensity (72 +/- 1.9% VO2max; estimated from measurement of heart rate) remained constant (83.4 +/- 0.9% HRmax; mean +/- s(x)) after the second change of end. The peak value for estimated play intensity (1.25 +/- 0.11 steps x s(-1); from video analysis) occurred after the fourth change of end (P< 0.005). Plasma lactate concentration, measured at rest and at the change of ends, increased 175% from 2.13 +/- 0.32 mmol x l(-1) at rest to a peak 5.86 +/- 1.33 mmol x l(-1) after the sixth change of end (P < 0.001). A linear regression model, which included significant terms for %HRmax (P< 0.001), estimated play intensity (P < 0.001) and subject (P < 0.00), as well as a %HRmax subject interaction (P < 0.05), accounted for 82% of the variation in plasma lactate concentration. During intermittent laboratory treadmill running, % VO2peak estimated from heart rate was 17% higher than the value derived from the measured VO2 (79.7 +/- 2.2% and 69.0 +/- 2.5% VO2peak respectively; P< 0.001). The %VO2peak was estimated with reasonable accuracy during continuous treadmill running (5% error). We conclude that changes in exercise intensity based on measurements of heart rate and a time-motion analysis of court movement patterns explain the variation in lactate concentration observed during singles tennis, and that measuring heart rate during play, in association with preliminary fitness tests to estimate VO2, will overestimate the aerobic response.

Adult↗

PubMed1993

Rheological characteristics of horse blood: significance during exercise.

When horses maximally exercise, splenic contraction and fluid movement out of the vascular compartment greatly increase the hematocrit (up to 0.70). We studied the in vitro rheological characteristics of blood from Thoroughbreds and Quarter Horses to determine the interaction of hematocrit and shear rate on apparent viscosity. We also compared the rheological characteristics of the blood before and after horses received furosemide, a drug commonly used to prevent exercise-induced pulmonary hemorrhage. Although the apparent viscosity of blood with a high hematocrit was high at low shear rates, it rapidly decreased as the shear rate increased and appeared to continue to decrease at shear rates above 450 sec-1, which was the limit of our measurement capability. Furosemide had no detectable influence on the measured in vitro rheological characteristics of the blood at any hematocrit or shear rate studied. We postulate that during exercise, when shear rates in the circulation are high, apparent viscosity at high hematocrit may approach values similar to those that occur during rest when both hematocrit and shear rates are lower. Consequently, the shear-dependent properties of blood may create a homeostasis of viscosity in vivo during exercise so that high viscosity is not a major factor contributing to vascular resistance.

Animals↗

PubMedDate not supplied

Real-time continuous visual biofeedback in the treatment of speech breathing disorders following childhood traumatic brain injury: report of one case.

The efficacy of traditional and physiological biofeedback methods for modifying abnormal speech breathing patterns was investigated in a child with persistent dysarthria following severe traumatic brain injury (TBI). An A-B-A-B single-subject experimental research design was utilized to provide the subject with two exclusive periods of therapy for speech breathing, based on traditional therapy techniques and physiological biofeedback methods, respectively. Traditional therapy techniques included establishing optimal posture for speech breathing, explanation of the movement of the respiratory muscles, and a hierarchy of non-speech and speech tasks focusing on establishing an appropriate level of sub-glottal air pressure, and improving the subject's control of inhalation and exhalation. The biofeedback phase of therapy utilized variable inductance plethysmography (or Respitrace) to provide real-time, continuous visual biofeedback of ribcage circumference during breathing. As in traditional therapy, a hierarchy of non-speech and speech tasks were devised to improve the subject's control of his respiratory pattern. Throughout the project, the subject's respiratory support for speech was assessed both instrumentally and perceptually. Instrumental assessment included kinematic and spirometric measures, and perceptual assessment included the Frenchay Dysarthria Assessment, Assessment of Intelligibility of Dysarthric Speech, and analysis of a speech sample. The results of the study demonstrated that real-time continuous visual biofeedback techniques for modifying speech breathing patterns were not only effective, but superior to the traditional therapy techniques for modifying abnormal speech breathing patterns in a child with persistent dysarthria following severe TBI. These results show that physiological biofeedback techniques are potentially useful clinical tools for the remediation of speech breathing impairment in the paediatric dysarthric population.

Biofeedback, Psychology↗

PubMed2006

Psychophysiological training of operators in adaptive biofeedback cardiorhythm control.

A new individual computerized technique for psychophysiological training of operators before performing psychomotor activity on a computer model (psychomotor concentration and spatial orientation test) was developed. Qualitative criteria for the prediction of safe operator activity were formulated. Preliminary testing of operators' activity quality showed great dispersion of individual results: The amount of errors ranged from 0 to 56 and the rate of information processing varied from 1.01 up 3.56 bit/s. Subjects with initially identified respiratory sinus arrhythmia or synchronization caused by respiratory movements committed minimal recognition errors in initial stages at a high rate of information processing. The number of errors remained unchanged after the biofeedback cardio-training cycle, with the rate of information processing increasing noticeably. Subjects without inherent harmonics developed harmonics after sessions of cardiorhythm biofeedback control, and their operator activity quality improved significantly, making fewer mistakes and increasing the rate of information processing. Biofeedback control led not only to the restoration of respiratory sinus arrhythmia, a favorable diagnostic sign, as revealed by cardiorhythmograms, but also resulted in improvement of the quality of operator activity.

Adolescent↗

PubMed2006

Techniques and considerations for determining isoinertial upper-body power.

Power is an integral aspect of many sports. Although power output of the lower body is often measured during jumping and cycling movements, much less is known about power as pertains to the upper body musculature. Recently, isoinertial methods--with constant gravitational load--of power testing have become common, but little is known of the reliability and criterion validity of these tests as they pertain to sport performance. In addition, the varied methodology makes a lucid model more evasive. The aims of this review are to examine the various methods of assessing upper body power, to establish its role in predicting athletic performance, and to assess the body of literature that has assessed power output of the upper extremities by isoinertial methods. To our knowledge, only two studies on isoinertial upper-body power have shown a direct correlation to sporting ability (Baker, 2001; Baker et al., 2001); therefore, many unanswered questions exist as to the efficacy of these tests as predictors of athletic ability or as a method to track athletes' training over time. From this review we hope to allow the sport coach to assess the overall utility of these tests in terms of availability, safety and external validity.

Arm↗

PubMed2003

Hand rim configuration: effects on physical strain and technique in unimpaired subjects?

OBJECTIVE: Hand rim wheelchair propulsion is inefficient and physically straining. To evaluate the possibly advantageous role in this respect of three different prototype hand rim configurations (a rubber foam-coated cylindrical (II) hand rim and two profiled rubber foam-coated hand rims (wide and narrow: III, IV)), a group of 10 unimpaired subjects conducted four submaximal discontinuous wheelchair exercise tests on a computer-controlled wheelchair ergometer, thus allowing a comparison with a standard hand rim (chromium-plated round hand rim (I)). METHODS: Apart from physiological measures (oxygen uptake, heart rate (HR), ventilation, mechanical efficiency (ME)), a subjective score for the rating of each of the hand rims was determined, as well as characteristics of the force application in the propulsion phase during each test condition. Timing parameters of the push and recovery phase were determined. Each exercise test was conducted with one of the four hand rim configurations in a counter-balanced order. RESULTS: Analysis of variance with repeated measures (hand rim configuration, power output) revealed no significant effects (P>0.05) on any of the physiological parameters and force application characteristics for the main factor 'hand rim configuration'. Only the subjective score (scale 0-10) for rating of the hand rims proved significantly different between the round rubber (7.5+/-0.53) coated hand rim-receiving the highest score-versus the narrow rubber-coated flat profiled hand rim (5.5+/-1.72). DISCUSSION: In this subject group and under the selected tasks and submaximal conditions of wheelchair propulsion, the studied hand rim configurations did not introduce critical shifts in the technique of (de-)coupling and power production in the push phase. As a consequence, no systematic shifts in ME are found among the different hand rim configurations. It is suggested that the biological constraints of the task overrule the possible effects of small design variations of the different hand rim configurations within the studied subject group and under the limited test conditions. The hand rim design characteristics may however be much more critical in (1) experienced wheelchair users, (2) especially those subjects with a limited hand-arm and/or trunk function and/or (3) under much more extreme conditions of daily wheelchair ambulation (i.e. turning, stopping/starting, negotiating a slope) or during peak performance. These issues clearly require continued future research. As such, the current results can be viewed as preliminary results only.

Adult↗

PubMed2003

Minocycline and doxycycline are not beneficial in a model of Huntington's disease.

Huntington's Disease (HD) is an inherited neurological disorder causing movement impairment, personality changes, dementia, and premature death, for which there is currently no effective therapy. The modified tetracycline antibiotic, minocycline, has been reported to ameliorate the disease phenotype in the R6/2 mouse model of HD. Because the tetracyclines have also been reported to inhibit aggregation in other amyloid disorders, we have investigated their ability to inhibit huntingtin aggregation and further explored their efficacy in preclinical mouse trials. We show that tetracyclines are potent inhibitors of huntingtin aggregation in a hippocampal slice culture model of HD at an effective concentration of 30 microM. However, despite achieving tissue levels approaching this concentration by oral treatment of R6/2 mice with minocycline, we observed no clear difference in their behavioral abnormalities, or in aggregate load postmortem. In the light of these new data, we would advise that caution be exercised in proceeding into human clinical trials of minocycline.

Animals↗

PubMed2005

Robotics and other devices in the treatment of patients recovering from stroke.

Stroke is the leading cause of permanent disability in the United States despite advances in prevention and novel interventional treatments. Randomized controlled studies have demonstrated the effectiveness of specialized post-stroke rehabilitation units, but administrative orders have severely limited the length of stay, so novel approaches to the treatment of recovery need to be tested in outpatients. Although the mechanisms of stroke recovery depend on multiple factors, a number of techniques that concentrate on enhanced exercise of the paralyzed limb have demonstrated effectiveness in reducing the motor impairment. For example, interactive robotic devices are new tools for therapists to deliver enhanced sensorimotor training for the paralyzed upper limb, which can potentially improve patient outcome and increase patient productivity. New data support the idea that for some post-stroke patients and for some aspects of training-induced recovery, timing of the training may be less important than the quality and intensity of the training. The positive outcome that resulted in the interactive robotic trials contrasts with the failure to find a beneficial result in trials that used a noninteractive device that delivered continuous passive motion only. New pilot data from novel devices to move the wrist demonstrate benefit and suggest that successive improvement of the function of the arm progressing to the distal muscles may eventually lead to significant disability reduction. These data from robotic trials continue to contribute to the emerging scientific basis of neuro-rehabilitation.

Clinical Trials as Topic↗

PubMed1983

[Reliability of digital subtraction angiocardiography for the evaluation of left ventricular function and physical stress].

The reliability of determinations of left ventricular dimensions from digital subtraction angiocardiographies during exercise using intravenous injection of contrast material was proved in 20 patients. All angiocardiograms could be analyzed qualitatively and quantitatively only by means of the time-interval-difference (TID-) mode. Compared with other mask modes the superiority of the TID-mode results from the close temporal relationship between mask and contrasted frame. Thus, changes in position and brightness of the background structures are small, and left ventricular contours can be determined accurately despite intense respiratory movements. The intra-observer variability of determinations of end-diastolic and end-systolic volumes was +/- 12 ml (i.e. 7.5% of the mean value), corresponding inter-observer variability was +/- 24 ml (i.e. 17% of the mean value), respectively. Intra-observer deviation in determining ejection fraction was 2.8% (i.e. 4.5% of the mean value). The intra-observer variability in determining left ventricular axes was basal +/- 0.40 cm (i.e. 7% of the mean value), equatorial +/- 0.73 cm (i.e. 13% of the mean value) and apical +/- 0.34 cm (i.e. 8% of the mean value). Deviations of corresponding circumferential fiber shortening rates were basal +/- 0.22 s-1 (i.e. 14% of the mean value), equatorial +/- 0.32 s-1 (i.e. 22% of the mean value), and apical +/- 0.18 s-1 (i.e. 13% of the mean value). The results show that left ventricular dimensions can be determined accurately from intravenous angiocardiograms during exercise using digital subtraction angiocardiography.

Adult↗

PubMed1992

Axial 'anchor' screw (lag screw with biconcave washer) or 'slanted-screw' plate for osteosynthesis of fractures of the mandibular condylar process.

Almost a quarter of all mandibular fractures are located in the condylar neck region and generally lead to disturbances of occlusion. Because they still possess active growth centres, children and adolescents can take advantage of the joint's remodelling capacity following conservative treatment of these fractures. Fractures with displacement of the condylar head in adults can interfere with function if they are not surgically reduced (Krenkel and Strobl, 1989). In addition, a compensatory overloading of the non-fractured side, which originally goes unnoticed, can bring about disc pathology and chronic pain years later. For this reason, a surgical technique was developed for the management of mandibular condylar neck fractures. A new axial/oblique-axial lag screw (anchor screw) with biconcave washers (anchor washer) makes it possible to carry out standardized osteosynthesis in the region of the thin mandibular condyle neck. Functional exercises can be initiated immediately after the operation. There are three operative procedures using an extraoral approach (1-3) and two using an intraoral approach (4-5), depending on the type and severity of the fracture: 1. Direct anchor screw osteosynthesis with closed gliding hole. 2. Indirect anchor screw osteosynthesis with open gliding groove and safety plates. 3. Osteosynthesis with a 'slanted-screw' plate for longer oblique fractures. 4. Intraoral anchor screw method. 5. Intraoral anchor screw method with intraoral 'slanted-screw' plate. The functional long-term results of conservatively and surgically treated mandibular condylar neck fractures were objectively documented by means of mechanical and electronic axiography. The functional long-term results of the condylar neck fractures treated surgically were significantly better than those treated conservatively.(ABSTRACT TRUNCATED AT 250 WORDS)

Bone Plates↗