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The two-stage induced-membrane technique for treatment of large bone defects has become popular among orthopedic surgeons. In the first operation, the bone defect is filled with poly(methyl methacrylate) (PMMA), which is intended to produce a membrane around the implant. In the second operation, PMMA is replaced with autograft or allograft bone. Bioactive glasses (BAGs) are bone substitutes with bone-stimulating and angiogenetic properties. The aim of our study was to evaluate the inductive vascular capacity of BAG-S53P4 and poly(lactide-co-glycolide) (PLGA)-coated BAG-S53P4 for potential use as bone substitutes in a single-stage induced-membrane technique. Sintered porous rods of BAG-S53P4, PLGA-coated BAG-S53P4 and PMMA were implanted in the femur of 36 rabbits for 2, 4 and 8 weeks. The expression of vascular endothelial growth factor (VEGF) and tumor necrosis factor alpha (TNF) in the induced membranes of implanted materials was analyzed with real-time quantitative polymerase chain reaction and compared with histology. Both uncoated BAG-S53P4 and PLGA-coated BAG-S53P4 increase expression of VEGF and TNF, resulting in higher amounts of capillary beds, compared with the lower expression of VEGF and less capillary beads observed for negative control and PMMA samples. A significantly higher expression of VEGF was observed for PLGA-coated BAG-S53P4 than for PMMA at 8 weeks ( p < 0.036). VEGF and TNF expression in the induced membrane of BAG-S53P4 and PLGA-coated BAG-S53P4 is equal or superior to PMMA, the 'gold standard' material used in the induced-membrane technique. Furthermore, the VEGF and TNF expression for PLGA-coated BAG-S53P4 increased during follow-up. [ABSTRACT FROM AUTHOR]

Purpose: This study investigated the impact of the field of view (FOV), voxel size, and exposure parameters on the contrast-to-noise ratio (CNR) in cone-beam computed tomography (CBCT)., Materials and Methods: A SedentexCT phantom was scanned using 3D Accuitomo 170 across 3 FOVs (40×40 mm, 60×60 mm, 80×80 mm). Each FOV had 4 settings for kVp and 3 for mA. Volumes were reconstructed with voxel sizes from 80 to 250 µm. The CNR was calculated using ImageJ (ver. 1.41, National Institutes of Health, Bethesda). Statistical analyses included Pearson correlation coefficients and regression (R 2 )., Results: Positive correlations were observed in the 40×40 FOV between voxel size, kVp, mA, rotation degree, and CNR. The 60×60 FOV showed positive correlations between mA, kVp, and CNR, while the 80×80 FOV exhibited correlations for voxel size, kVp, and mA. In the 40×40 (R 2 =0.551) and 80×80 (R 2 =0.550) FOVs, mA, kVp, and voxel size influenced CNR. For the 60×60 FOV, mA and kVp were significant contributors (R 2 =0.389). Using a constant 80-µm voxel size, both mA and kVp significantly influenced CNR (R 2 =0.467); neither FOV nor rotation degree had substantial impacts., Conclusion: CNR increased with higher mA, kVp, and larger voxel sizes for 40×40 and 80×80 FOVs. mA was the most influential factor across all FOVs. Regression models showed significant effects of mA and kVp on CNR with 80-µm voxels, while FOV had no effect., Competing Interests: Conflicts of Interest: None, (Copyright © 2024 by Korean Academy of Oral and Maxillofacial Radiology.)

Objectives: Poor oral health and dental infections can jeopardize medical treatment and be life-threatening. Due to this, patients with head and neck malignancies, generalized tumor spread, organ transplant, or severe infection are referred for a clinical oral and radiographic examination. The aim of this study was to compare the diagnostic agreement of three radiographic modalities: intraoral radiographs (IO), panoramic radiographs (PX), and cone beam computed tomography (CBCT) for diagnosis of dental diseases., Materials and Methods: Three hundred patients were examined with IO, PX, and CBCT. Periapical lesions, marginal bone level, and caries lesions were diagnosed separately by four oral radiologists. All observers also assessed six teeth in 30 randomly selected patients at two different occasions. Kappa values and percent agreement were calculated., Results: The highest Kappa value and percent agreement were for diagnosing periapical lesions (0.76, 97.7%), and for the assessment of marginal bone level, it varied between 0.58 and 0.60 (87.8-89.3%). In CBCT, only 44.4% of all teeth were assessable for caries (Kappa 0.68, 93.4%). The intra-observer agreement, for all modalities and diagnoses, showed Kappa values between 0.5 and 0.93 and inter-observer agreement varied from 0.51 to 0.87., Conclusions: CBCT was an alternative to IO in diagnosing periapical lesions. Both modalities found the same healthy teeth in 93.8%. All modalities were performed equally regarding marginal bone level. In caries diagnosis, artifacts were the major cause of fallout for CBCT., Clinical Relevance: Intraoral radiography is the first-hand choice for diagnosing dental disease. For some rare cases where intraoral imaging is not possible, a dedicated panoramic image and/or CBCT examination is an alternative., (© 2024. The Author(s).)

Background/Aim Enchondroma is the most common primary bone tumour of the hand. When surgery is indicated, curettage with or without void augmentation has been described. However, only few comparative studies exist. The aim of this study was to compare the outcomes of hand enchondromas treated with autologous bone graft (AG) and bioactive glass S53P4 (BAG)., Patients and Methods: A retrospective comparative analysis was conducted among patients surgically treated for hand enchondromas at a tertiary referral centre during a 17-year period., Results: A total of 190 patients (116 AG vs. 74 BAG) with 205 enchondromas were included. No statistically significant differences in outcome measures were observed. A reoperation was performed in five patients in the autologous bone-graft group; one patient presented a rare malignant transformation from enchondroma to chondrosarcoma after the primary operation. No reoperations were performed in the BAG group., Conclusion: Although AG is the gold standard for filling bony cavities, bone-graft retrieval can cause complications and postoperative pain. Our results suggest that S53P4 BAG is a safe and effective bone-graft material alternative for filling of enchondroma-evacuated cavities., (Copyright © 2022, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

This study evaluates the usefulness of ultrasonography in diagnosing carpal tunnel syndrome (CTS). The cross-sectional area of the median nerve was measured at the forearm and its entry into the carpal tunnel and compared with clinical symptoms and electroneuromyography. A total of 124 patients were examined, 77 patients with clinically confirmed CTS and 47 controls. A significant correlation was found between the ultrasonography cross-sectional area values at entry points into the carpal tunnel and electroneuromyography. The highest sensitivity (87%) and specificity (91%) for different cut-off values (8.5-12.5 mm 2 ) of the cross-sectional area was for 11.5 mm 2 . The use of ultrasonography may provide a quick and reliable differential diagnostic tool for the primary diagnosis of CTS in patients with classical symptoms. Level of evidence : II.

Critical-sized diaphysis defects are complicated by inherent sub-optimal healing conditions. The two-staged induced membrane technique has been used to treat these challenging defects since the 1980's. It involves temporary implantation of a membrane-inducing spacer and subsequent bone graft defect filling. A single-staged, graft-independent technique would reduce both socio-economic costs and patient morbidity. Our aim was to enable such single-staged approach through development of a strong bioactive glass scaffold that could replace both the spacer and the graft filling. We constructed amorphous porous scaffolds of the clinically used bioactive glass S53P4 and evaluated them in vivo using a critical-sized defect model in the weight-bearing femur diaphysis of New Zealand White rabbits. S53P4 scaffolds and standard polymethylmethacrylate spacers were implanted for 2, 4, and 8 weeks. Induced membranes were confirmed histologically, and their osteostimulative activity was evaluated through RT-qPCR of bone morphogenic protein 2, 4, and 7 (BMPs). Bone formation and osseointegration were examined using histology, scanning electron microscopy, energy-dispersive X-ray analysis, and micro-computed tomography imaging. Scaffold integration, defect union and osteosynthesis were assessed manually and with X-ray projections. We demonstrated that S53P4 scaffolds induce osteostimulative membranes and produce osseointegrative new bone formation throughout the scaffolds. We also demonstrated successful stable scaffold integration with early defect union at 8 weeks postoperative in critical-sized segmental diaphyseal defects with implanted sintered amorphous S53P4 scaffolds. This study presents important considerations for future research and the potential of the S53P4 bioactive glass as a bone substitute in large diaphyseal defects. STATEMENT OF SIGNIFICANCE: Surgical management of critical-sized diaphyseal defects involves multiple challenges, and up to 10% result in delayed or non-union. The two-staged induced membrane technique is successfully used to treat these defects, but it is limited by the need of several procedures and bone graft. Repeated procedures increase costs and morbidity, while grafts are subject to donor-site complications and scarce availability. To transform this two-staged technique into one graft-independent procedure, we developed amorphous porous scaffolds sintered from the clinically used bioactive glass S53P4. This work constitutes the first evaluation of such scaffolds in vivo in a critical-sized diaphyseal defect in the weight-bearing rabbit femur. We provide important knowledge and prospects for future development of sintered S53P4 scaffolds as a bone substitute., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021. Published by Elsevier Ltd.)

Introduction: This study applied mathematical modeling to examine the anatomy of the distal radius; to define the radiographic parameters in a 3D imaging modality; and to report their normal ranges in the uninjured radius., Materials and Methods: A series of 50 cone-beam computed tomography (CBCT) scans of uninjured radii were analyzed using computer-aided image processing. The radius shape model was used to determine the optimal location for measuring the longitudinal axis. With the axis determined, the volar tilt and radial inclination angles and the areas of the articular facets and their reference points were analyzed., Results: The optimal location for determining the longitudinal axis was between 28.8 and 53.3 mm proximally from the articular surface. The mean radial inclination angle was 21.8°. The mean volar tilt angle via the most distal tips of the volar and dorsal rims was 13.0°; along the lunate and scaphoid facets it was 9.1° and 11.2°, respectively. The scaphoid facet was larger than the lunate facet and 25% of it was convex., Conclusions: Computer-aided CBCT image processing offers an advanced tool to record 3D geometry and the radiographic parameters of the osseous structures of the wrist. Analysis of the distal radius' anatomy showed that the longitudinal axis was affected by its measurement location and subsequently also affected the determination of the angular parameters. We also report the variation of the volar tilt along the articular surface and the shapes and sizes of the articular facets., (© 2020 The Authors. Clinical Anatomy published by Wiley Periodicals, Inc. on behalf of American Association of Clinical Anatomists.)

We examined the reliability of a computer-aided cone-beam CT analysis of radiographic parameters of 50 normal distal radii and compared it with interobserver agreement of measurements made by three groups of physicians on two-dimensional plain radiographs. The intra-rater reliability of the computer-aided analysis was evaluated on 33 wrists imaged twice by cone-beam CT. The longitudinal axis, anterior tilt, radial inclination and ulnar variance were measured. The reliability of computer-aided analysis was excellent (intraclass correlation coefficient (ICC) 0.94-0.96) while the interobserver agreement of two-dimensional radiograph interpretation was good (ulnar variance, ICC 0.80-0.84) to poor (anterior tilt and radial inclination, ICC 0.20-0.42). We conclude that computer-aided cone-beam CT analysis was a reliable tool for radiographic parameter determination, whereas physicians demonstrated substantial variability especially in interpreting the angular parameters.

Bioactive glasses (BAG) are used as bone-graft substitutes in orthopaedic surgery. A specific BAG scaffold was developed by sintering BAG-S53P4 granules. It is hypothesised that this scaffold can be used as a bone substitute to fill bone defects and induce a bioactive membrane (IM) around the defect site. Beyond providing the scaffold increased mechanical strength, that the initial inflammatory reaction and subsequent IM formation can be enhanced by coating the scaffolds with poly(DL-lactide-co-glycolide) (PLGA) is also hypothesised. To study the immunomodulatory effects, BAG-S53P4 (± PLGA) scaffolds were placed on monolayers of primary human macrophage cultures and the production of various pro- and anti-inflammatory cytokines was assessed using reverse transcriptase quantitative polymerase chain reaction (RT-qPCR) and ELISA. To study the osteogenic effects, BAG-S53P4 (± PLGA) scaffolds were cultured with rabbit mesenchymal stem cells and osteogenic differentiation was evaluated by RT-qPCR and matrix mineralisation assays. The scaffold ion release was quantified and the BAG surface reactivity visualised. Furthermore, the pH of culture media was measured. BAG-S53P4 scaffolds had both anti-inflammatory and osteogenic properties that were likely attributable to alkalinisation of the media and ion release from the scaffold. pH change, ion release, and immunomodulatory properties of the scaffold could be modulated by the PLGA coating. Contrary to the hypothesis, the coating functioned by attenuating the BAG surface reactions and subsequent anti-inflammatory properties, rather than inducing an elevated inflammatory response compared to BAG-S53P4 alone. These results further validated the use of BAG-S53P4 (± PLGA) scaffolds as bone substitutes and indicate that scaffold properties can be tailored to a specific clinical need.

Objectives: The aim of this in vitro study was to evaluate how a deviation from the horizontal plane, affects the image quality in two different CBCT-devices., Methods: A phantom head SK150 (RANDO, The Phantom Laboratory, Salem, NY, USA) was examined in two CBCT-units: Accuitomo 80 and Veraviewepocs 3D R100 (J. Morita Mfg. Corp. Kyoto, Japan). The phantom head was placed with the hard palate parallel to the horizontal plane and tilted 20 ° backwards. Exposures were performed with different field of views (FOVs), voxel sizes, slice thicknesses and exposure settings. Effective dose was calculated using PCXMC 2.0 (STUK, Helsinki, Finland). Image quality was assessed using contrast-to-noise-ratio (CNR). Region of interest (ROI) was set at three different levels of the mandibular bone and soft tissue, uni- and bilaterally in small and large FOVs, respectively. CNR values were calculated by CT-value and standard deviation for each ROI. Factor analysis was used to analyze the material., Results: Tilting the phantom head backwards rendered significantly higher mean CNR values regardless of FOV. The effective dose was lower in small than in large FOVs and varied to a larger extent between CBCT-devices in large FOVs., Conclusions: Head position can affect the image quality. Tilting the head backward improved image quality in the mandibular region. However, if influenced by other variables e.g. motion artifacts in a clinical situation, remains to be further investigated., Advances in Knowledge: Image quality assessed using CNR values to investigate the influence of different patient positions and FOVs.

Osteomyelitis is an infectious process in bone that occasionally leads to bone destruction. Traditionally, the surgical treatment procedure is performed in combination with systemic and local antibiotics as a two-stage procedure that uses autograft or allograft bone for filling of the cavitary defect. Bioactive glass (BAG-S53P4) is a bone substitute with proven antibacterial and bone bonding properties.One hundred and sixteen patients who had verified chronic osteomyelitis was treated using BAG-S53P4 as part of the treatment. Most of the patients had previously undergone numerous procedures, sometimes for decades. A register of patient data obtained from 11 centers from Finland, Italy, the Netherlands, Germany, Azerbaijan and Poland was set-up and continuously maintained at Helsinki University Central Hospital.The location of the osteomyelitis was mainly in the tibia followed by the femur and then the calcaneus. The median age of the patients was 48 years (15-87). The patients were either treated according to a one-stage procedure without local antibiotics (85 %) or by a two-stage procedure using antibiotic beads in the first procedure (15 %). The minimum follow-up was 1 year (12-95 months, median 31).The cure rate was 104/116, the total success rate 90 % and most of the patients showed a rapid recovery.The study shows that (BAG-S53P4) can be used in a one-stage procedure in treatment of osteomyelitis with excellent results.

The aim of the this study was to present data on oral care habits and knowledge of oral health in 2013, and to compare these data with results from a series of four previous cross-sectional epidemiological studies. All these studies were carried out in the city of Jönköping, Sweden, in 1973, 1983, 1993, 2003, and 2013. The 1973 study constituted a random sample of 1,ooo individuals evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, and 70 years. The same age groups with addition of a group of 80-year-olds were included in the 1983, 1993, 2003, and 2013 studies, which comprised 1,104; 1,078; 987; and 1,010 individuals, respectively. A questionnaire about dental care habits and knowledge of oral health was used. The questionnaire contained the same questions in all the five studies, although some had to be slightly modernised during the 40-year period. During the period 1973-2013, a continous increase of individuals in the age group 20-60 years were treated by the Public Dental Service amounting to about 50%. Almost 70% of the 70- and 80-year-olds were treated by private practitioners. In 2013, 10-20% of the individuals in the age groups 30-40 years did not regularly visit neither Public Dental Service nor a private practitioner. The corresponding figures for the individuals 50-80 years old were 4-7%. Similar number of avoidance was reported in the previous studies. In the survey 2013, about 20-30% of the individuals in the age groups 20-50 felt frightened, sick, or ill at ease at the prospect of an appointment with the dentist. These findings were in agreement with the results from the surveys 1973-2003. Among the younger age groups, 0-15 years, a reduction in self-reported "ill at ease" was found in the surveys 2003 and 2013 compared to the previous surveys in this series. In 2013, the knowledge of the etiology of caries was known by about 60% of the individuals which was similar to that reported 1973-2003. Twenty per cent of the individuals stated that they did not know which etiological factors that causes caries. This percentage was equivalent during the period 1973-2013.About 85% of the individuals in all age groups brushed their teeth with fluoride tooth paste at least two times a day. These frequencies have gradually increased during the 40-year period. Around 40% in the age groups 50-80 years used toothpicks regularly in 2013. This is a about 1/3-1/2 less compared to 2003. In the age groups 20-40 years 3-14% used toothpicks for proximal cleaning in 2013. In 2013, about 35% of the individuals never consumed soft drinks, in comparison with 20% in 2003. In the age groups 3-20 years about 20% were consuming soft drinks every day or several times a week,which is a reduction by half compared to 2013.

The aim of this epidemiological study performed in 2013 was to analyze various clinical and radiographic data on oral health and compare the results to those of four cross-sectional studies carried out 1973-2003. In 1973, 1983, 1993, 2003, and 2013 random samples of 1,000; 1,104; 1,078; 987; and 1,010 individuals, respectively, were studied. The individuals were evenly distributed in the age groups 3, 5, 10, 15, 20, 30, 40, 50, 60, 70, and 80o years. Eighty-year-olds were not included in 1973. All subjects were inhabitants of the city of Jönköping, Sweden. The clinical and radiographic examination assessed edentulousness, removable dentures, implants, number of teeth, caries, restorations, oral hygiene, calculus, periodontal status, and endodontic treatment. The frequency of edentulous individuals aged 40-70 years was 16, 12, 8, 1, and 0.3% in 1973, 1983, 1993, 2003, and 2013, respectively. No complete denture weareryounger than 80-years old was found in 2013. During the 40-year period, the mean number of teeth in the age groups 30-80 years increased. In 2013, the 60-year-olds had nearly complete dentitions. Implants were found in all age groups from 30 years of age. The total number of individuals with implants was 36 in 2013. This was higher than earlier surveys, 4 in 1993, and 18 in 2003. The percentage of children and adults without caries and restorations increased during the 40-year period. It was found that the percentage of caries-free 3- and 5-year-olds were 79% and 69%, respectively, of the individuals in 2013. In the age groups 10-20 years, the percentage of caries-free individuals increased between 2003 and 2013. In 2013, 43% of the 15-year-olds were completely free from caries and restorations compared to 20% in 2003. In all age groups 5-60 years, DFS was lower in 2013 compared to the earlier examinations.There was no major change in DFS between 2003 and 2013 in the age groups 70 and 80 years. The most obvious change was the decrease in number of FS over the 40-year period of time. Regarding crowned teeth the most clear changes between 1973 to 2013 were the decrease in percentage of crowned teeth in the age groups 40 and 50-year-olds. The percentage of endodontically treated teeth decreased between 1973 and 2013 in all age groups. In age groups 10-30-year-olds a major reduction from about 30% to 15% in mean plaque score was seen between 1973-2003. Only a minor change in plaque score was seen during the last decade. For the age groups 40 years and older, a decrease in the percentage of surfaces with plaque was observed between 2003-2013. The percentage of tooth sites with gingivitis was for 20 years and older about 40% in 1973. In 2013, the percentage was about 15%. The frequency of sites with gingivitis was generally lower in 2013 compared with the otheryears,1973-1993. The percentage of individuals with probing pocket depths > 4mm increased with age. Between 2003-2013 a clear reduction was seen in all age groups in frequency of individuals with probing pocket depth > 4mm. Over the 40-year period an increase in the number of individuals with no marginal bone loss and a decrease in the number of subjects with moderate alveolar bone loss were seen. The continuous improvement in oral health and the reduced need of restorative treatment will seriously affect the provision of dental helath care and dental delivery system in the near future.

Background: Surgical reconstruction of peri-implant defects is challenging and unpredictable due to, for example, the extent of the bone defect or the osteogenic potential of adjunctive materials used., Purpose: To study the healing capacity of a new bone xenograft material in the treatment of peri-implant defects., Material and Methods: In three cases with advanced peri-implant defects, flap surgery was performed. After thorough debridement including cleaning of the exposed implant surface, prehydrated and collagenated porcine bone (PCPB) particles were placed into the defect. A bioresorbable collagen barrier was adapted and placed over the defect and the flaps were relocated. After 6 and 12 months of healing, clinical and radiographic examinations were done. In one case, the surgical procedure was repeated 6 months postoperatively. One year after the second surgery, a bone biopsy was harvested and analyzed with histology., Results: All defects healed uneventfully. At 6 months, probing depths were reduced by 3-4 mm with no bleeding on probing or pus formation. At 12 months, healthy peri-implant conditions were found. Intra-oral radiographs showed gain of the marginal bone level by 2-4 mm. In the case where reconstructive surgery was repeated, histology showed osteoconductive properties as bone formation with typical osteoblastic seams was observed directly on the surface of the grafted particles., Conclusion: The presented cases show that PCPB have favorable properties enhancing bone regeneration in peri-implant bone defects., (© 2011 Wiley Periodicals, Inc.)

We studied the epidemiology, incidence, and outcome among children and adolescents admitted for possible replantation or revascularisation of an injured upper extremity during the period 1998-2008. Twenty-nine patients with 38 finger injuries were admitted. Eight of the 29 had a severe amputation injury. The annual rate of all amputations in the referral area of 300,000 children was 0.42/100,000 children/year and total amputation injuries 0.18/100,000 children/year. Most injuries occurred in patients aged 12-15 years. The survival after total amputations was 6/14 and after subtotal amputations 13/15. Mean total active movement after replantation was 84° (n = 5) and after revascularisation 152° (n = 10). Four patients were re-examined in the outpatient department and nine answered a questionnaire. Cold intolerance was reported by most of the patients. Patients' satisfaction with outcome of treatment was good.

Objectives: To use pre- and post-operative diffusion tensor imaging (DTI) to monitor median nerve integrity in patients suffering from carpal tunnel syndrome (CTS)., Methods: Diffusivity and anisotropy images along the median nerve were compared among 12 patients, 12 age-matched and 12 young control subjects and correlated with electrophysiological neurography results. Slice-wise DTI parameter values were calculated to focus on local changes., Results: Results of pre-operative patients and age-matched control subjects differed only in the distal nerve. Moreover, pre-operative patients differed significantly from young controls and post-operative patients. The main abnormalities were increased diffusivity and decreased anisotropy in the carpal tunnel and distal median nerve. Post-operative clinical improvement was reflected in diffusivity, but not in anisotropy. Slice-wise analysis showed high pre-operative diffusivity at the distal nerve. All groups had relatively large inter-subject variation in both diffusivity and anisotropy., Conclusions: DTI can provide information complementary to clinical examination, electrophysiological recordings and anatomical MRI of diseases and injuries of peripheral nerves. However, similar age-related changes in diffusivity and anisotropy may weaken DTI specificity. Slice-wise analysis is necessary for detection of local changes in nerve integrity., Key Points: • Diffusion tensor magnetic resonance imaging provides information complementary to conventional diagnostic methods. • Age caused similar changes to diffusivity and anisotropy as carpal tunnel syndrome. • Post-operative clinical improvement was reflected in diffusivity, but not in anisotropy. • Inter-subject variation in diffusivity and anisotropy was considerable.

Purpose: To calculate the national incidence of upper limb deficiencies and associated infant mortality in children in Finland using the International Federation of Societies for Surgery of the Hand (IFSSH) classification. Radial ray deficiency, ulnar ray deficiency, central ray deficiency, transverse arrest, phocomelia, undergrowth, and constriction band syndrome with skeletal defects were evaluated., Methods: We reviewed upper limb deficiencies among all 753,342 births in Finland during 1993 to 2005 reported to the Finnish Register of Congenital Malformations. Classification of these upper limb deficiencies was done according to a modified IFSSH system. We calculated incidence, gender and side distributions, frequency of associated anomalies, and infant mortality rates in different subtypes of the deficiencies. Familial occurrence of congenital upper limb defects was recorded., Results: A total of 419 cases (234 male, 185 female) of upper limb deficiencies were identified. The national incidence of upper limb deficiencies was 5.56 per 10,000 births and 5.25 per 10,000 live births. The most common upper limb abnormality was radial ray deficiency (138), followed by subgroups of undergrowth (91), upper limb defects due to constriction band syndrome (51), central ray deficiency (41), and ulnar ray deficiency (33). Perinatal mortality was 14%. Infant mortality among children with upper limb deficiencies was 137 per 1,000 live births, compared with an overall infant mortality of 3.7 per 1,000 live births in Finland. Additional birth defects were found in 60% of these children. Prevalence of upper limb defects in relatives of the census population was 2% (11 of 419)., Conclusions: The national incidence of upper limb deficiencies is 5.25 per 10,000 live births. Congenital upper limb deficiencies are associated with additional birth defects in two thirds of cases. These children, especially children with radial ray deficiency, have a high perinatal mortality rate. When divided into subgroups using IFSSH classification, differences emerge in both associated anomalies and mortality., (Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.)

The clinical and radiological outcomes of bioactive glass (BAG)-S53P4 and autograft bone (AB) used as bone-graft substitutes in depressed tibial plateau fractures were evaluated in a prospective randomized 11-year follow-up study. All patients (n = 29) had sustained tibial plateau fractures with a joint-line depression of >3 mm. Fifteen patients (5 patients the BAG group, 10 patients in the AB group) participated in this long-term follow-up. X-rays were taken preoperatively, postoperatively, and at the long-term follow-up, and computed tomography (CT) scans were made at the long-term follow-up for evaluation of the bone substitute, osteoarthritis, the tibial-femoral angle, and deviation of mechanical axes. No material-dependent adverse effects were seen in any patient. The means of the articular surface depression on X-rays at the long-term follow-up were 1.4 mm (range: 0-2 mm) in the BAG group and 1.4 mm (range: 0-4 mm) in the AB group, and on CT scans the means were 2.2 mm (range: 2-3 mm), and 2.1 mm (range: 0-3), respectively. No significant difference in the tibial-femoral angle or deviation of mechanical axes was observed between the two groups. BAG-S53P4 can be used as a bone substitute in depressed lateral tibial plateau fractures with good functional and radiological long-term results.

Bioactive glass (BAG)-S53P4 is an osteoconductive bone substitute with proven antibacterial and bone bonding properties. In a multicentre study 11 patients with verified chronic osteomyelitis in the lower extremity and the spine were treated with BAG-S53P4 as a bone substitute. The cavitary bone defect and the surrounding of a spinal implant were filled with BAG-S53P4. The most common pathogen causing the infection was Staphylococcus aureus. The mean follow-up was 24 months (range 10-38). BAG-S53P4 was well tolerated. Nine patients healed without complications. One patient who achieved good bone formation sustained a superficial wound infection due to vascular problems in the muscle flap, and one patient had an infection due to a deep haematoma. This study shows that BAG-S53P4 is a good and well-tolerated bone substitute, and can be used in treatment of osteomyelitis with good primary results.

A retrospective study of drug abuse patients who developed arterial and venous complications in the upper extremity during 2002-2006 was performed. Twenty-two patients were admitted to hospital on 24 occasions over this period for treatment by our hand clinic. The drug most frequently causing complications was midazolam. The predominant clinical findings were increasing pain and loss of sensitivity in the hand, followed by oedema, cyanosis and marbling of the skin. Treatments included brachial block anaesthesia, low molecular weight heparin, embolectomy and fasciotomies. Despite these measures, amputations, mainly of the fingertips, were necessary in 15 patients. Complications in the upper extremity after self-injection by drug addicts are increasing; information and preventive procedures to minimize these complications are important and demanding tasks for health care bodies.

We retrospectively studied the epidemiology of adult patients admitted for possible replantation or revascularisation of an injured upper extremity during the period June 2003 to May 2008. A total of 121 patients were admitted (71 graded severe), mean 24 (14 graded severe), being admitted each year. The annual rate of amputation injuries in the referral area of 1.5 million was 1.5/100 000 and for severe amputation injuries 0.9/100 000. Most injuries occurred in patients aged 41-50. Fifty-eight patients had the accident during working hours (36 severe), and 62 during leisure time (34 severe). The survival rate for subtotal amputations was 77% and for total amputations 55%. Of 15 further vascularisation procedures, two succeeded at the metacarpal level. Most of the accidents occurred during wood-processing with circular saws or powered wood splitters. More efforts should focus on preventing such injuries.

A recurrent aneurysmal bone cyst of the proximal phalanx of the index finger of a three-year-old child, treated with bioactive glass, is presented. Over a two-year follow-up, the treated area appeared dense on X-rays. At two years, no cavity was observed and the homogenous region resembled normal trabecular bone. The phalanx had grown in length and remodelled to an almost normal shape.