Internal femoral osteosynthesis after external fixation in multiple-trauma patients

In this study the authors evaluate the results of internal synthesis of femoral fractures in polytraumatised patients initially treated by external fixation (EF). From January 2002 to December 2005, 39 femurs in 37 polytraumatised patients (average age 34.2 years, range 18-44) with closed fractures and an ISS>20 were initially treated with EF. There were three groups: Group A, 13 cases when conversion to internal osteosynthesis occurred after 4-7 days (average 5.6 days); Group B, 11 cases with a 4-6-month interval before internal osteosynthesis, and after investigation using MRI and scintigraphy with labelled leucocytes; Group C, the remaining cases treated definitively with EF. Time of healing, lower limb function, time of return to previous activities and short and long-term complications were evaluated at the follow-up. The average time of follow-up was 23 months. In Group A the time of bone healing was 123 days; there were no events of embolism but one case of pseudoarthrosis and one case of instrument failure. In Group B the time of bone healing was 274 days, with one case of pseudoarthrosis and one case of deep infection. In Group C the average healing time was 193 days, with 3 cases of screw (half-pin) osteolysis. Functional recovery was delayed by the presence of other fractures. EF is a simple, quick and safe procedure to stabilise fractures in polytraumatised patients. According to damage control orthopaedic (DCO) concepts, it is possible to replace EF with internal synthesis after an interval as this reduces the risks of internal osteosynthesis when performed in the emergency period. EF can also be maintained as definitive treatment but should a change to internal synthesis be needed, it is possible to do it safely after excluding bone infection

An oral hygiene instruction program for orthodontic patients

Introduction. Protocols which contribute to the long-term success of orthodontic treatment, in both adult and young patients, and which establish a proper routine for oral hygiene at home, must be personalized and followed strictly. Materials and methods. Our protocol includes the following steps: before orthodontic treatment (initial examination, initial preparation and reassessment); during orthodontic treatment (first session, treatment session in association with oral hygiene check-ups, recall, if oral hygiene is insufficient); after orthodontic treatment (postreatment support). The differences in treatment and approach necessary when dealing with adults or children and with removable appliance or fixed appliance are also highlighted