Surgical treatment of an old avulsion fracture of the ischial tuberosity and ischial ramus: A case report

BACKGROUND Avulsion fracture of the ischial tuberosity is a relatively clinically rare type of trauma that is mainly incurred by adolescents during competitive sports activities.According to previous literature,the most commonly involved sports are soccer,sprinting,and gymnastics,in descending order.Dance-induced avulsion fracture of the ischial tuberosity and ischial ramus is extremely clinically rare.CASE SUMMARY A case of a neglected avulsion fracture of the ischial tuberosity and ischial ramus was diagnosed in a young female dancer who complained of pain and restricted movement of her right hip.She stated that she had suffered the injury while performing a split leap during a dance performance 9 mo prior.Eventually,she underwent surgery and obtained satisfactory treatment results.CONCLUSION Early diagnosis of these fractures is important to ensuring early proper treatment towards a quicker recovery.For old fractures with nonunion and chronic buttock pain,surgery is a preferred therapeutic choice with good treatment outcomes.

The Anatomy of Dorsal Ramus Nerves and Its Implications in Lower Back Pain

This article reviews the relationship between the spinal dorsal ramus system and low back pain, including the anatomy, clinical findings, pathogenesis and treatment of low back pain mediated by spinal dorsal ramus and zygapophysial (facet) joint syndrome. Each spinal dorsal ramus arises from the spinal nerve and then divides into a medial and lateral branch. The medial branch supplies the tissues from the midline to the zygapophysial joint line and innervates two to three adjacent zygapophysial joints and their related soft tissues. The lateral branch innervates the tissues lateral to the zygapophysial joint line. The clinical pain presentations follow these anatomic distributions, which can be used for localizing the involved dorsal ramus. The diagnosis can be confirmed by performing a single dorsal ramus block that results in relief of pain and muscle spasm. Etiologically, any factor that stimulates the spinal dorsal ramus can cause low back pain, which is distinct from zygapophysial joint syndrome. Clinically, L1 and L2 are the most common sites of dorsal rami involvement. Treatment includes spinal dorsal ramus injection therapy and percutaneous neurotomy. Summarily, irritation of the spinal dorsal ramus system is a potential source of low back pain. Based on the anatomy and clinical presentation, the involved spinal dorsal ramus can be localized and treated.

A guiding oblique osteotomy cut to prevent bad split in sagittal split ramus osteotomy:a technical note

Aim:To present a simple technical modification of a medial osteotomy cut which prevents its misdirection and overcomes various anatomical variations as well as technical problems.Methods:The medial osteotomy cut is modified in the posterior half at an angle of 15°-20°following novel landmarks.Results:The proposed cut exclusively directs the splitting forces downwards to create a favorable lingual fracture,preventing the possibility of an upwards split which would cause a coronoid or condylar fracture.Conclusion:This modification has proven to be successful to date without encountering the complications of a bad split or nerve damage.

Changes of Transverse Mandibular Width in Set-Back Mandibular Surgery: Sagittal Split versus Intraoral Verticosagittal Osteotomy

Aim: This study was performed to evaluate the movement of the proximal segment following different methods of ramus osteotomy that is one of the side effects of orthognathic surgery. Theoretically, with intraoral verticosagittal ramus osteotomy, it can minimize the movement of the proximal segment. The changes in the intergonal distance of mandible and the angle of the ramus flaring in two methods of osteotomy have been compared in this study. Materials and Methods: In this randomized clinical trial, included 60 patients (32 males) with mandibular prognathism and without any asymmetry were selected and divided into two groups (n = 30). One group underwent bilateral sagittal split ramus osteotomy technique to achieve mandibular setback and the other by the intraoral verticosagittal ramus osteotomy technique. Intergonial width and inner-ramal angle in the transverse plane were measured on radiographs preoperatively and 1 and 12 weeks postoperatively. Data were analyzed using covariance test with the significance level set at P 0.1). Conclusion: Considering our findings, there was no significant difference between two ramus osteotomy techniques regarding changes in mandibular width and inter-ramal flaring angle.

大胆的新艺术——建筑盛世的三个表演艺术中心

达拉斯艺术区是美国德克萨斯州达拉斯城著名的艺术中心区。在这里，有达拉斯艺术博物馆（Dallas Museum of Art）、有SOM设计的市立表演厅（City Performance Half）、有贝聿铭设计的交响乐中心（Meyerson Symphony cester）等等重要文化建筑。如今，由Foster、Ramus和Koolhaas等著名建筑师设计的文化建筑又为这一区域带来两位新邻居。

A retrospective study of unfavorable fractures during sagittal split osteotomy:A single surgeon’s experience

Background:Unfavorable fractures are among the most common complications of bilateral sagittal split ramus osteotomy(BSSRO).This study aimed to evaluate unfavorable fracture patterns during BSSRO and assess the related risk factors and treatment measures.Methods:The clinical records and radiographs of 679 patients(1358 sides)who underwent BSSRO at Shanghai Ninth People’s Hospital between September 2013 and December 2021 were examined.Results:Patients with unfavorable fractures who underwent surgical restoration were studied.The incidence of unfavorable fractures was 0.8%(n¼11),with the highest rate in the third year.The unfavorable fractures were divided into three types by location and clinical treatment:(1)SSRO could still be completed after buccal/lingual plate unfavorable fracture(0.6%,n=8);(2)condylar/coronoid process fractures/intermaxillary fixation needed(0.1%,n=2);(3)additional osteotomy required(0.07%,n=1).Conclusion:These results suggest that as a surgeon’s experience increases,the rate of unfavorable fractures may decrease.The novel classification of unfavorable fractures for SSRO might be useful for surgeons to make appropriate treatment choices during orthognathic surgery.

选择什么样的内存才适合你

SDRAM之实用主义篇 也许你会问:现在不已经是“后SDRAM时代”了吗?

高压酸浸法从镍红土矿中回收镍钴

采用高压酸浸法从Ramu镍红土矿中回收镍钴。详细介绍了矿浆处理、高压酸浸、循环浸出及矿浆中和、CCD逆流洗涤、中和除铁铝、氢氧化镍钴沉淀、深海填埋工艺(DSTP)等流程,并分析了工艺出现的问题及改进措施。全流程镍回收率～96%,钴回收率～94%。

Ramu红土镍矿湿法冶炼过程中钪的富集回收

分析了Ramu红土镍矿中金属钪的矿物赋存特性。跟踪考察了钪在Ramu红土镍矿湿法冶炼过程中的走向和分布。在此基础之上,结合工业生产实际,研究了中和除铁铝过程pH值、石灰石乳浆加入速度和搅拌强度对钪富集的影响,给出了合理化建议。结果表明,在Ramu红土镍矿湿法冶炼过程中,大于60%的钪可在中和除铁铝过程的铁铝渣中进行富集。在一段中和除铁铝pH值为3.9,二段中和除铁铝pH值为4.9,匀速加入石灰乳浆且搅拌强度均匀时,钪的富集情况最佳,可得到钪含量为1300g/t粗钪中间体,且此条件下的浸出液铁铝去除率高,镍钴损失小。

Management of multiple and displaced mandibular fractures in a pediatric patient sans mandibular immobilization,sans open reduction and internal fixation

Maxillofacial fractures in the pediatric population are generally managed by conservative approaches such as soft diet and medication or semi-invasive procedures namely inter-maxillary fixation or circummandibular wiring.These approaches are preferred over any invasive treatment to minimize injury to the growing skeleton and tooth germs.Displaced fractures that cause functional problems such as restricted mouth opening,malocclusion or impaired breathing,mandate open reduction and internal fixation.However,surgical management is associated with morbidity related to general anesthesia,risk of injury to vital structures,and potential,skeletal or dental growth disturbances.This case report describes a non-invasive method of managing displaced,multiple fractures of the mandible in a pediatric patient,with the use of low intensity pulsed ultrasound to achieve favorable clinical outcomes and nil complications.Neither immobilization of the mandible with inter-maxillary fixation nor open reduction and internal fixation was used.Low intensity pulsed ultrasound therapy is painless and patient-friendly.