RESUMEN
PURPOSE OF THE STUDY: Recurrent anterior dislocations associated with full thickness rotator cuff tear (RCT) carry a difficult therapeutic problem: should we treat instability and rotator cuff tear at the same time or only one of both pathologies? The goal of this study was to analyse a retrospective series of patients operated on to try to answer this question. MATERIAL AND METHODS: Twenty-eight shoulders (27 patients) were operated on between 1988 and 2002. The mean age at first dislocation was 47 years (16-65), the average delay between first dislocation and operation was 6.1 years. Twenty-four shoulders presented with recurrent dislocations and four shoulders with recurrent subluxations; the average number of dislocations was 2.6 (1-20). Preoperatively, Hill-Sachs lesion was present in 96%, anterior glenoid rim fracture in 53.5% and glenohumeral osteoarthritis was observed in 37.5%. All the cases had full thickness rotator cuff tears: isolated supraspinatus in 43%,, Supra- plus infraspinatus in 35%, supraspinatus plus subscapularis in 4% and rupture of the three tendons in 18%. An isolated open stabilization with the technique of Trillat was performed in 19 cases when the cuff was not repairable or when the patient was not willing to accept rotator cuff (RC) repair (age and motivation); the mean age of the patients was 59.3 years in this group. Whereas an open anterior stabilization (Latarjet procedure) associated with RC repair was done in nine cases (average age at operation: 40 years). All the patients were followed up and had clinical-radiographic examinations more than two years after the operation. RESULTS: With a mean follow-up of 73.5 months (24-178), the average Constant score progressed from 63.1 to 78.1 points (p<0.05). Three patients who had isolated anterior stabilization had recurrence of instability (16%) whereas none of the patients with both anterior stabilization and RC repair had recurrence. Subjectively, 96% of the patients were satisfied with their operation. Postoperatively, the rate of osteoarthritis progressed to 64.3%. DISCUSSION: The decision not to repair the RCT in 19 cases was justified by the size of the tear, the muscular fatty infiltration of the RC muscles and the age-motivation of the patients. This decision lead to a greater rate of recurrence (16%) and less satisfactory functional results but the age at FU was 20 years higher in this group than in the group with cuff repair. No patient had an isolated RC repair because 92.5% of the patients in this series had either a bony Bankart (53.5%) or a Bankart type lesion (39%). The recurrent instability in this series was clearly under the dependence of the "anterior mechanism" and not under the dependence of the "posterior mechanism". Therefore, isolated repair of the cuff has never been performed because of the fear of higher rate of postoperative instability leading to RC re-tear. CONCLUSION: In case of recurrent dislocations associated with rotator cuff tear, treatment of instability should be proposed whereas the concomitant repair of the cuff depends upon the possibility to perform it: size of the rupture, fatty infiltration, age and motivation of the patients.
Asunto(s)
Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/cirugía , Lesiones del Manguito de los Rotadores , Articulación del Hombro , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Recurrencia , Estudios Retrospectivos , Adulto JovenRESUMEN
We present here the preliminary results obtained with arthroscopic tightening of the anterior cruciate ligament. Six patients underwent the technique. Four had had prior ligamentoplasty, two had sequelae of tibial spine fractures. Laxity persisted in all cases. The transplant or the ligament were continuous and insertion points were well-positioned. The procedure consisted in using a trephine to bore the tibial bone at the "foot" of the ligament or transplant in order to tighten the ligament. There was no evidence of instability after the arthroscopic tightening procedure. Mean pre- and postoperative differential anterior drawer values were successively 9.2 and 3.9 mm. For native or reconstructed anterior cruciate ligaments, which are continuous and well-positioned but not loose, arthroscopic tightening spares the need for ligament transplant and appears to be free of specific morbidity.
Asunto(s)
Ligamento Cruzado Anterior/cirugía , Artroscopía , Inestabilidad de la Articulación/cirugía , Articulación de la Rodilla/cirugía , Adolescente , Adulto , Femenino , Humanos , MasculinoRESUMEN
A 26-year-old woman presented a rare double localization of an osteoid osteoma of the ankle. The first focus was situated in the tibial metaphysic, bordering the distal tibiofibular joint. The second focus was also superficial, located in the neck of the homolateral talus. Percutaneous drilling was performed for both localizations under computed tomographic (CT) guidance. The postoperative period was uneventful and the patient has remained symptom-free at four years follow-up. Compared with disphyseal localizations, it is often more difficult to recognize an osteoid osteoma located in the foot or ankle. Scintigraphy and CT are necessary and sufficient for diagnosis. Progress in imaging techniques has greatly facilitated the treatment of osteoid osteomas, allowing excellent outcome with limited morbidity.
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Articulación del Tobillo , Neoplasias Óseas , Neoplasias Primarias Múltiples , Osteoma Osteoide , Astrágalo , Tibia , Adulto , Neoplasias Óseas/diagnóstico , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Neoplasias Primarias Múltiples/diagnóstico , Neoplasias Primarias Múltiples/diagnóstico por imagen , Neoplasias Primarias Múltiples/cirugía , Osteoma Osteoide/diagnóstico , Osteoma Osteoide/diagnóstico por imagen , Osteoma Osteoide/cirugía , Cintigrafía , Astrágalo/diagnóstico por imagen , Astrágalo/cirugía , Tibia/diagnóstico por imagen , Tibia/cirugía , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del TratamientoAsunto(s)
Ligamento Cruzado Anterior/cirugía , Artroscopía , Meniscos Tibiales/cirugía , Adolescente , Adulto , Lesiones del Ligamento Cruzado Anterior , Trasplante Óseo , Niño , Estudios de Seguimiento , Humanos , Inestabilidad de la Articulación/etiología , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Osteotomía , Ligamento Rotuliano/trasplante , Selección de Paciente , Complicaciones Posoperatorias , Estudios Prospectivos , Procedimientos de Cirugía Plástica , Reoperación , Estudios Retrospectivos , Factores de Riesgo , Tendones/trasplante , Factores de Tiempo , Trasplante Autólogo , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
The patient we report here underwent a total knee arthroplasty (TKA) which got infected with P. multocida after her dog had licked a small wound at the third toe of the same foot. Despite a correct treatment comprising synovectomy and cleansing, and an active antibiotic treatment for 3 months, the patient was readmitted for persistent infection of the same knee 2 weeks after the end of the antibiotic treatment. Sampling during surgery allowed for the growth of a P. multocida isolate proven by a molecular method to be identical to the previously isolated strain. This recurrent P. multocida infection was treated by a two-step change of the TKA comprising a 2-month period of antibiotic treatment between the two surgical interventions.
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Artroplastia de Reemplazo de Rodilla , Perros/microbiología , Prótesis de la Rodilla/efectos adversos , Infecciones por Pasteurella/terapia , Pasteurella multocida/aislamiento & purificación , Infecciones Relacionadas con Prótesis/microbiología , Anciano , Amoxicilina/uso terapéutico , Animales , Antibacterianos/uso terapéutico , Ciprofloxacina/uso terapéutico , Doxiciclina/uso terapéutico , Quimioterapia Combinada , Femenino , Humanos , Infecciones por Pasteurella/diagnóstico , Infecciones Relacionadas con Prótesis/terapia , Recurrencia , Reoperación , Rifampin/uso terapéutico , SinovectomíaRESUMEN
We describe an endoscopic method for resection of the superomedial comer of the scapula in cases of painful snapping scapula. A preoperative computed tomography may be useful to show narrowing between the superomedial comer and the chest wall. Endoscopic technique gives the same goods results than open surgery with in cosmetic advantage and early rehabilitation. Avoided neurological lesion need to perform a precise portal placement.
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Artroscopía , Artropatías/cirugía , Escápula/cirugía , HumanosRESUMEN
We describe an endoscopic method for resection of the superomedial corner of the scapula in cases of painful snapping scapula. A preoperative computed tomography may be useful to show narrowing between the superomedial corner and the chest wall. Endoscopic technique gives the same goods results than open surgery with in cosmetic advantage and early rehabilitation. Avoided neurological lesion need to perform a precise portal placement.
RESUMEN
PURPOSE OF THE STUDY: We report our experience with the medial and medioposterior approaches to the humeral diaphysis for plate fixation of the proximal humerus. MATERIAL AND METHODS: Fifteen patients were treated for shaft fracture (n=13) or nonunion (n=2) of the distal third of the humerus without radial nerve involvement. The medial approach was performed in the supine position and the medioposterior approach in the prone position. Bone healing was achieved in all cases. Three patients experienced sensorial irritation in the territory of the median nerve after the medial approach; one case did not regress. There were no complications with the medioposterior approach. DISCUSSION: Dissection of the radial nerve can be avoided with these two approaches which also have a cosmetic advantage. The medioposterior approach appears to be preferable because of the comfortable operative position and the absence of risk for the median nerve. Both approaches are however contraindicated if there is preoperative involvement of the radial nerve.
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Fijación Interna de Fracturas/métodos , Fracturas del Húmero/cirugía , Adolescente , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios RetrospectivosRESUMEN
BACKGROUND: The development of refractive corneal surgery involves numerous attempts to isolate the effect of individual factors on surgical outcome. Computer simulation of refractive keratotomy allows the surgeon to alter variables of the technique and to isolate the effect of specific factors independent of other factors, something that cannot easily be done in any of the currently available experimental models. METHODS: We used the finite element numerical method to construct a mathematical model of the eye. The model analyzed stress-strain relationships in the normal corneoscleral shell and after astigmatic surgery. The model made the following assumptions: an axisymmetric eye, an idealized aspheric anterior corneal surface, transversal isotropy of the cornea, nonlinear strain tensor for large displacements, and near incompressibility of the corneoscleral shell. The eye was assumed to be fixed at the level of the optic nerve. The model described the acute elastic response of the eye to corneal surgery. RESULTS: We analyzed the effect of paired transverse arcuate corneal incisions for the correction of astigmatism. We evaluated the following incision variables and their effect on change in curvature of the incised and unincised meridians: length (longer, more steepening of unincised meridian), distance from the center of the cornea (farther, less flattening of incised meridian), depth (deeper, more effect), and the initial amount of astigmatism (small effect). CONCLUSIONS: Our finite element computer model gives reasonably accurate information about the relative effects of different surgical variables, and demonstrates the feasibility of using nonlinear, anisotropic assumptions in the construction of such a computer model. Comparison of these computer-generated results to clinically achieved results may help refine the computer model.
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Astigmatismo/cirugía , Simulación por Computador , Queratotomía Radial , Animales , Fenómenos Biomecánicos , Colágeno/fisiología , Córnea/fisiología , Sustancia Propia/fisiología , Elasticidad , Humanos , Presión Intraocular/fisiología , Matemática , Ratas , Esclerótica/fisiologíaRESUMEN
We created a computerized mathematical model of the eye for the simulation of refractive surgery. This model used a slightly prolate shape for a moderately myopic eye and an idealized aspheric profile for the cornea. The finite element method and the nonlinear Mooney-Rivelin law were used to analyze stress-strain relationships. Radial keratotomy changes stress distribution in the cornea and the anterior sclera, with major changes at the paracentral and peripheral ends of the incisions. The model predicted that there would be a flattening of the central cornea with a posterior displacement, which increased with an increase in intraocular pressure. A change in the length of the incision of 0.5 mm produced a significant change in correction. For small clear zones (3 to 4 mm), incisions of equal length produced comparable changes in refraction. We found that the effect of the corneal radius of curvature on the amount of refractive change was negligible. We studied the effect of elasticity coefficients and corneal anisotropia.
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Simulación por Computador , Queratotomía Radial , Fenómenos Biomecánicos , Córnea/patología , Córnea/fisiopatología , Córnea/cirugía , Elasticidad , Humanos , Presión Intraocular , Queratotomía Radial/métodos , Cómputos Matemáticos , Modelos Biológicos , Miopía/fisiopatología , Miopía/cirugía , Refracción Ocular , Esclerótica/fisiopatología , Estrés MecánicoRESUMEN
We have created a computer model of the eye that improves upon previous models with two assumptions: (1) the cornea is considered anisotropic, and (2) the strain tensor is non-linear for large displacements. Values used include those for Young's modulus, Poisson's ratio, and three coefficients of anisotropia. A finite element computer program was used to stimulate the behaviour of the eye. Four simulations were done: (1) a full thickness arcuate limbal cataract incision, (2) a partial thickness arcuate corneal relaxing incision, (3) a partial thickness radial incision extending across the limbus, (4) a partial thickness radial incision confined to the cornea. A full thickness corneal arcuate incision for cataract induced more change in corneal shape than a limbal incision. However, the gaping is more important in the limbal incision. Partial thickness arcuate corneal relaxing incisions were found to be more effective with a clear zone 3-5 mm in diameter. Radial incision simulation demonstrated little enhancement of the effect of the incisions when across the limbus.