RESUMEN
BACKGROUND: Maximum stresses show critical points on an object because failure may start from the area close to maximum stress points. However, there appears no study on maximum loading points of carpal bones. PURPOSE: To clarify the loading pattern of each carpal bone during wrist movements. METHODS: A finite element wrist model was designed using a three-dimensional reconstruction of computed tomographic images from the distal end of radius and ulna to the proximal third of metacarpals. Loading was performed in neutral, 45° of flexion and extension, 5° of radial and 25° of ulnar deviation, and maximum loading points were plotted. RESULTS: In each position except for extension, minimum loads were carried by triquetrum, while minimum loads were carried by capitatum in extension. Maximum loads were carried by trapezium in neutral and ulnar deviation and flexion but by scaphoideum in radial deviation and extension. CONCLUSION: Studies on maximum loading of each bone are a new approach and may help to improve the knowledge on wrist mechanics.
Asunto(s)
Huesos del Carpo/diagnóstico por imagen , Huesos del Carpo/fisiología , Muñeca/fisiología , Adulto , Fenómenos Biomecánicos , Análisis de Elementos Finitos , Humanos , Imagenología Tridimensional , Masculino , Huesos del Metacarpo/diagnóstico por imagen , Movimiento , Postura , Estrés Mecánico , Tomografía Computarizada por Rayos XRESUMEN
Although limited carpal fusion is a choice of treatment in several wrist disorders, little is known about the biomechanics of these procedures, especially the loads carried by the ligaments. In a finite element study, four types of limited carpal fusions (scaphotrapeziotrapezoid, capitohamate, four corner fusion with and without scaphoid excision) were simulated and the loads carried by the ligaments were recorded. Measurements were repeated with and without implantation. The load transmission through the ligaments varied by the type of the fusion but, radioscaphoid and long radiolunate ligaments carried significantly more loads if not excised during the operation. Implantation did not affect the results in most cases. The model of the present study may be useful in preoperative planning.
Asunto(s)
Fenómenos Biomecánicos/fisiología , Simulación por Computador , Análisis de Elementos Finitos , Ligamentos Articulares/fisiopatología , Articulación de la Muñeca/fisiopatología , Artrodesis/métodos , Huesos del Carpo/cirugía , Humanos , Masculino , Radiografía , Radio (Anatomía)/fisiopatología , Cúbito/fisiopatología , Articulación de la Muñeca/diagnóstico por imagen , Articulación de la Muñeca/cirugía , Adulto JovenRESUMEN
The management of nonunion following high tibial osteotomy by total knee replacement (TKR) has been reported previously. We have extended the treatment to embrace cases with an infected high tibial osteotomy by performing an initial debridement with a period of antibiotic treatment followed by TKR. We have reviewed the results of seven knees in six patients with a mean follow-up of 40.5 months (20 to 57) after the staged TKR. At the latest follow-up, all the pseudarthroses had healed and there had been no recurrence of infection. The mean Hospital for Special Surgery knee score improved from 51.2 (35 to 73) to a mean of 91.7 (84 to 98) at final review. Management of nonunion following high tibial osteotomy with a TKR can be extended to infected cases when treated in two stages with a debridement and antibiotic therapy prior to TKR.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Osteoartritis de la Rodilla/cirugía , Osteotomía/efectos adversos , Infección de la Herida Quirúrgica/terapia , Tibia/cirugía , Anciano , Antibacterianos/uso terapéutico , Terapia Combinada , Desbridamiento/métodos , Femenino , Estudios de Seguimiento , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Osteotomía/métodos , Radiografía , Reoperación/métodosRESUMEN
Avascular necrosis of the scaphoid following a fracture in children is rare and there is no established treatment protocol in the literature. We present two boys with nonunion and avascular necrosis of the scaphoid treated by simple immobilisation. Both cases healed with painless wrists and full movements. Our cases confirm that an ununited scaphoid fracture in children may heal with conservative treatment, even when an MRI scan suggests avascular necrosis. Unlike in adults, operative treatment need only be considered in children when conservative treatment fails.
Asunto(s)
Fracturas no Consolidadas/terapia , Osteonecrosis/terapia , Hueso Escafoides/lesiones , Férulas (Fijadores) , Adolescente , Niño , Fracturas no Consolidadas/complicaciones , Fracturas no Consolidadas/diagnóstico por imagen , Humanos , Inmovilización/métodos , Imagen por Resonancia Magnética , Masculino , Osteonecrosis/diagnóstico , Osteonecrosis/etiología , Radiografía , Hueso Escafoides/diagnóstico por imagen , Hueso Escafoides/patologíaRESUMEN
We have studied the biomechanical stability in vitro of three different Kirschner (K) wire configurations in three types of simulated scaphoid waist fractures. The fractures were created with a saw in Sawbones models. There were three fracture patterns: perpendicular to the long axis of the scaphoid model; and 30° and 20° oblique to that. Two 1.2 mm. K-wires were used in each scaphoid. The three configurations were: parallel; 20° oblique; and crossing. The oblique or crossing configurations of K-wires were the most stable depending on the fracture pattern.
Asunto(s)
Sustitutos de Huesos , Hilos Ortopédicos , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Hueso Escafoides/lesiones , Traumatismos de la Muñeca/cirugía , Fenómenos Biomecánicos , Tornillos Óseos , Humanos , Técnicas In VitroRESUMEN
OBJECTIVE: The goal of this study has been to determine whether hyaluronic acid (HA) or exercise therapy can improve functional parameters in patients with osteoarthritis (OA) of the ankle. METHODS: In a prospective clinical trial, 43 ankles (30 patients) with radiographic Kellgren Lawrence grade III OA were randomized to receive three intra-articular HA injections, with one-week interval of or exercise therapy for six weeks. Patients were evaluated by the American Orthopaedic Foot and Ankle Society (AOFAS) Ankle-Hindfoot Scale and followed-up after 12 months. RESULTS: Total AOFAS Ankle-Hindfoot score of OA patients has improved in both groups, varying from 61.6+/-16.8 to 90.1+/-9.7 with HA treatment and from 72.1+/-16.6 to 87.5+/-17.5 using exercise therapy at the end of the trial (p<0.01). There were no statistically significant differences between the groups. CONCLUSION: This prospective randomized trial confirmed that, both HA injections and exercise therapy provide functional improvement. However, larger trials with longer follow-up are necessary for more definite conclusions.
Asunto(s)
Adyuvantes Inmunológicos/administración & dosificación , Articulación del Tobillo/fisiopatología , Terapia por Ejercicio , Ácido Hialurónico/administración & dosificación , Osteoartritis/tratamiento farmacológico , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Inyecciones Intraarticulares , Masculino , Persona de Mediana Edad , Osteoartritis/fisiopatología , Dolor/tratamiento farmacológico , Dolor/fisiopatología , Estudios Prospectivos , Resultado del TratamientoRESUMEN
The clinical, radiologic, histopathologic, and genetic features of a sclerosing bone dysplasia found in three members of a family are described. The bone disorder affected all metaphyseal-diaphyseal regions of all long bones, the skull, and three metacarpals. All affected members also had ichthyosis vulgaris and premature ovarian failure. These features have not been reported before, indicating a new syndrome.
Asunto(s)
Enfermedades del Desarrollo Óseo/patología , Huesos/patología , Ictiosis Vulgar/patología , Insuficiencia Ovárica Primaria/patología , Esclerosis/patología , Adulto , Enfermedades del Desarrollo Óseo/genética , Femenino , Humanos , Ictiosis Vulgar/genética , Persona de Mediana Edad , Insuficiencia Ovárica Primaria/genética , Esclerosis/genética , Hermanos , SíndromeRESUMEN
This cadaveric study used 200 scaphoid bones (100 left and 100 right) to assess 24 morphological and 11 morphometric parameters. At least one morphometric feature was absent in all scaphoids, though the tubercle and the dorsal sulcus were present in all instances. There were significant differences in the circumferences of the waist and the base of the tubercle, the width of the main sulcus and the secondary height of the tubercle between left and right scaphoids. Detailed knowledge of anatomy and correlations between the anatomical features may help better understanding of clinical problems.
Asunto(s)
Hueso Escafoides/anatomía & histología , Cadáver , HumanosRESUMEN
We aimed to determine the normal ranges of radial and ulnar deviation of the wrist in relation to the ulnar variance. A total of 102 healthy subjects (204 wrists) were included in the study. The ranges of radial and ulnar deviation of the wrists were measured using a universal goniometer. Ulnar variance was assessed manually or radiographically, and recorded as ulna minus, ulna plus or ulna minus/plus. When the ranges of radial and ulnar deviation were compared with ulnar variance, ulnar deviation was greater in ulna minus subjects and radial deviation was greater in ulna minus/plus subjects. There was no significant difference in the total range of radio-ulnar deviation. The results of this study indicate that ulnar deviation is greater in ulna minus wrists, and we suggest that ulnar variance should be recorded alongside measurements of radial and ulnar deviation.
Asunto(s)
Radio (Anatomía)/anatomía & histología , Cúbito/anatomía & histología , Articulación de la Muñeca/anatomía & histología , Adolescente , Adulto , Fenómenos Biomecánicos , Femenino , Humanos , Masculino , Rango del Movimiento Articular , Articulación de la Muñeca/metabolismoRESUMEN
A postoperative immobilisation orthosis was developed at the School of Physical Therapy and Rehabilitation, Department of Orthotics and Prosthetics, and applied from the first postoperative day as an alternative device for ambulation of patients who have undergone hallux valgus surgery while maintaining the corrected position. The orthosis is constructed with polyethylene thermoplastic sheet of 3mm thickness and Velcro. During the ambulation period, there was no complication or complaint due to its application and the position of the great toe was maintained. The time of the orthotic application was six weeks. The orthosis has allowed patients to walk with full weight bearing from the postoperative first day without any complication or recurrence.
Asunto(s)
Hallux Valgus/cirugía , Inmovilización/instrumentación , Cuidados Posoperatorios , Férulas (Fijadores) , Femenino , Humanos , Persona de Mediana Edad , PolietilenoRESUMEN
We report a case with an unusual manifestation of autoerythrocyte sensitization syndrome (Gardner-Diamond syndrome). The patient had the clinical signs of compartment syndrome of the forearm requiring fasciotomy. Dermatological signs identical to Gardner-Diamond syndrome should alert the physician to avoid unnecessary fasciotomy, as these patients respond well to psychiatric treatment as in the present case.
Asunto(s)
Enfermedades Autoinmunes/diagnóstico , Síndromes Compartimentales/diagnóstico , Eritrocitos/inmunología , Adulto , Enfermedades Autoinmunes/psicología , Humanos , Masculino , Púrpura/inmunología , Púrpura/psicología , Estrés Psicológico , SíndromeRESUMEN
BACKGROUND: In the hierarchy of research designs, randomized controlled trials and meta-analyses are considered to be evidence of the highest grade, and scientific journals are the main source of scientific information. METHODS: Using the National Library of Medicine Medline database, all randomized controlled trials and meta-analyses from 1966 to 1999 were retrieved from the journals indexed in the core list of the Science Citation Index in 1999, dedicated primarily to orthopaedics. The abstracts of the articles were reviewed independently by each author and classified by the year, journal name and subject. RESULTS: The total number of articles was 36,293, of which only 671 were randomized controlled trials (1.85%) and 12 were meta-analyses (0.03%). Although there was a progressively increasing trend for randomized controlled trials, more than half of them (81.9%) were published in four journals. Of the randomized controlled trials, 66% was about arthroplasty, and hip and knee arthroplasties covered 90.7%. CONCLUSION: Although the number of randomized controlled trials and meta-analyses is tending to increase, the conclusion of this study is that the high-quality evidence provided by the major orthopaedic journals is quite low, and more randomized controlled trials and meta-analyses are needed for evidence-based orthopaedic practice.
Asunto(s)
Medicina Basada en la Evidencia , Ortopedia , Publicaciones Periódicas como Asunto/estadística & datos numéricos , MEDLINE/estadística & datos numéricos , Metaanálisis como Asunto , Publicaciones Periódicas como Asunto/normas , Ensayos Clínicos Controlados Aleatorios como AsuntoRESUMEN
We treated 36 scaphoid fractures in 34 patients with trapezio-lunate external fixation. According to the Herbert and Fisher classification, there were 16 type B1, 14 type B2, four type B3 and two type B4 fractures. Trapezial and lunate pins broke in three patients and these were rated as failures. The remaining 33 fractures were followed-up for 3 years and all had excellent outcomes, without signs of arthritis, avascularity or instability.
Asunto(s)
Huesos del Carpo/cirugía , Fijadores Externos , Fijación de Fractura/métodos , Hueso Semilunar/cirugía , Hueso Escafoides/lesiones , Adolescente , Adulto , Clavos Ortopédicos , Femenino , Fracturas Óseas/cirugía , Humanos , Masculino , Complicaciones Posoperatorias , Falla de Prótesis , Infecciones Relacionadas con Prótesis/etiología , Resultado del TratamientoRESUMEN
In a prospective randomized study of lateral epicondylitis, 120 patients were treated with 2 mL lidocaine (Group A, n=60) or 1 mL lidocaine combined with 1 mL triamcinolone (Group B, n=60). All injections were done using the peppering technique: after inserting the needle the tender area was peppered with 40 to 50 injections by injecting, withdrawing, redirecting, and reinserting without emerging from the skin. All patients were followed up for 1 year. Fifty-six patients in Group A and 57 patients in Group B had excellent results. There was statistically no difference between the groups. Both groups had excellent results and because the injection of local anesthetics is known to have no long-term effect in the treatment of lateral epicondylitis, the peppering technique seems to be a reliable method of treatment.
Asunto(s)
Anestésicos Locales/uso terapéutico , Antiinflamatorios/uso terapéutico , Lidocaína/uso terapéutico , Codo de Tenista/tratamiento farmacológico , Triamcinolona/uso terapéutico , Adulto , Femenino , Humanos , Inyecciones/métodos , Masculino , Estudios Prospectivos , Resultado del TratamientoRESUMEN
The scapular elevation (shoulder shrug), depression, and total elevation-depression motion in 30 healthy subjects were measured by goniometer under standardized conditions. Mean values were 37.74, 8.39, and 44.60 deg, respectively. The intraobserver variation was calculated as 1.3 deg, and the interobserver variation was 1.8 deg. There was no difference between the sides. This previously unreported values may be used in the evaluation of shoulder and neck disorders.
Asunto(s)
Rango del Movimiento Articular/fisiología , Escápula/fisiología , Articulación del Hombro/fisiología , Adolescente , Adulto , Femenino , Humanos , Masculino , Variaciones Dependientes del Observador , Ortopedia/métodos , Estudios Prospectivos , Radiografía , Valores de Referencia , Sensibilidad y Especificidad , Articulación del Hombro/diagnóstico por imagenRESUMEN
We did a prospective consecutive study of prophylaxis for heterotopic ossification (HO) comparing indomethacin (100 mg/day) and salmon calcitonin (3 MRC-U/kg/day) for 14 days. Each group consisted of 30 patients. 19 patients in the indomethacin group and 2 in the calcitonin group developed HO. We conclude that use of calcitonin in the prophylaxis of HO after total hip replacement is more effective than indomethacin.
Asunto(s)
Artroplastia de Reemplazo de Cadera/efectos adversos , Densidad Ósea/efectos de los fármacos , Calcitonina/uso terapéutico , Indometacina/uso terapéutico , Osificación Heterotópica/prevención & control , Anciano , Antiinflamatorios no Esteroideos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
A case of osteonecrosis of the accessory navicular bone is reported. This entity should be kept in mind in the differential diagnosis of painful accessory navicular.
Asunto(s)
Osteonecrosis/patología , Huesos Tarsianos/anomalías , Femenino , Humanos , Persona de Mediana Edad , Radiografía , Huesos Tarsianos/diagnóstico por imagenRESUMEN
The authors did percutaneous, arthroscopic-assisted osteosynthesis of patellar fractures associated with skin abrasions and lacerations in 11 patients. Skin problems did not delay the operation and the rehabilitation. The average followup was 2.8 years. All fractures healed without complications and good results were obtained in all patients using the criteria of Levack et al. This technique avoids the problems of patellar fractures with skin abrasions and may be adapted to other fractures of the patella.
Asunto(s)
Artroscopía , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Rótula/lesiones , Rótula/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Patellectomy is a relatively old procedure and its effect on knee function has been a matter of controversy. Although indications for a patellectomy have been narrowed, patellectomy still is indicated as the last choice of treatment in certain situations including comminuted fractures, advanced chondromalacia or osteoarthritis, dislocations, infections, and tumoral conditions. Excision of the patella results in a decrease in the moment arm of the extensor mechanism, alteration of the forces acting on the tibiofemoral joint and instant center of motion, limitation of range of motion, anterior instability, loss of protection of the trochlea from injury, and poor cosmesis. A good technique of patellectomy should overcome all or at least some of these problems. Although comparison of various techniques of patellectomy is impossible because of the lack of prospective randomized trials, reinforcement techniques seem more logical than simple repair procedures.
Asunto(s)
Rótula/cirugía , Humanos , Procedimientos Ortopédicos , Procedimientos de Cirugía PlásticaRESUMEN
Droopy shoulder syndrome (DSS) is characterized by a depression of the shoulders that stretches the brachial plexus, thus causing pain without any signs of neurological impairment. We describe ten patients with DSS; all had been treated for different diagnoses before. Contrary to previous reports, three patients had unilateral involvement, and five had accompanying disease of the cervical-shoulder region. All patients responded well to conservative treatment in 2-10 weeks. DSS must be kept in mind in the differential diagnosis of pain in the cervical-shoulder region, to prevent unnecessary medication.