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We developed and compared deep learning models to detect hip osteoarthritis on clinical CT. The CT-based summation images, CT-AP, that resemble X-ray radiographs can detect radiographic hip osteoarthritis and in the absence of large training data, a reliable deep learning model can be optimized by combining CT-AP and X-ray images. INTRODUCTION: In this study, we aimed to investigate the applicability of deep learning (DL) to assess radiographic hip osteoarthritis (rHOA) on computed tomography (CT). METHODS: The study data consisted of 94 abdominopelvic clinical CTs and 5659 hip X-ray images collected from Cohort Hip and Cohort Knee (CHECK). The CT slices were sequentially summed to create radiograph-like 2-D images named CT-AP. X-ray and CT-AP images were classified as rHOA if they had osteoarthritic changes corresponding to Kellgren-Lawrence grade 2 or higher. The study data was split into 55% training, 30% validation, and 15% test sets. A pretrained ResNet18 was optimized for a classification task of rHOA vs. no-rHOA. Five models were trained using (1) X-rays, (2) downsampled X-rays, (3) combination of CT-AP and X-ray images, (4) combination of CT-AP and downsampled X-ray images, and (5) CT-AP images. RESULTS: Amongst the five models, Model-3 and Model-5 performed best in detecting rHOA from the CT-AP images. Model-3 detected rHOA on the test set of CT-AP images with a balanced accuracy of 82.2% and was able to discriminate rHOA from no-rHOA with an area under the receiver operating characteristic curve (ROC AUC) of 0.93 [0.75-0.99]. Model-5 detected rHOA on the test set at a balanced accuracy of 82.2% and classified rHOA from no-rHOA with an ROC AUC of 0.89 [0.67-0.97]. CONCLUSION: CT-based summation images that resemble radiographs can be used to detect rHOA. In addition, in the absence of large training data, a reliable DL model can be optimized by combining CT-AP and X-ray images.
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Aprendizaje Profundo , Osteoartritis de la Cadera , Humanos , Osteoartritis de la Cadera/diagnóstico por imagen , Curva ROC , Radiografía , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Studies comparing recovery of men and women after hip fracture have reported conflicting results, some reporting worse recovery in male patients, while others found no differences between genders. METHODS: Recovery was compared in 105 male and 433 female patients with hip fractures and in age-matched groups of patients 50 years or older, who were home-dwelling and received similar rehabilitation. Residential status, walking ability, hip pain and activities of daily living function were recorded at admission and 4 and 12 months postoperatively, along with mortality and re-operations. RESULTS: No differences were observed between men and women 4 and 12 months postoperatively regarding residential status (p = 0.181 vs p = 0.883), mortality rates (p = 0.232 vs p = 0.880) or total activities of daily living scores (p = 0.546 vs p = 0.435). Walking ability was better among male patients prefracture (p < 0.001) and 4 and 12 months after fracture (p < 0.001, p = 0.031, respectively). In age-matched pair analysis, no differences were found regarding mortality, residential status, walking ability, or ADL score. Cox regression analysis identified mortality risk factors as being age, prefracture ADL score, American Society of Anesthesiologists score 4-5 and place of rehabilitation. Sex was not mortality risk factor. INTERPRETATION: Home-dwelling male and female patients had similar courses of recovery from hip fracture, although there were singular differences in specific activities of daily living functions and postoperative pain. There were no differences in mortality, even when prefracture characteristics were considered. Mortality was higher among older patients and who had high American Society of Anesthesiologists scores and low prefracture activities of daily living scores.
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Actividades Cotidianas , Fracturas de Cadera/rehabilitación , Vida Independiente , Recuperación de la Función , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Fijación de Fractura/rehabilitación , Fracturas de Cadera/mortalidad , Fracturas de Cadera/fisiopatología , Fracturas de Cadera/cirugía , Humanos , Masculino , Persona de Mediana Edad , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Factores Sexuales , Resultado del TratamientoRESUMEN
PURPOSE: We report 3- to 8-year follow-up results for the first tarsometatarsal joint derotational arthrodesis. METHODS: A total of 70 patients (88 feet) with symptomatic flexible hallux valgus were operated between 2003 and 2009. In all, 66 patients (94.3%) with 84 (95.5%) feet were enrolled in retrospective analysis; of those, 58 (87.9%) patients with 76 (90.5%) feet were followed for a mean of 5.1 (range: 3.0-8.3) years. Preoperative, 6 week postoperative, and late follow-up weightbearing radiographs were evaluated along with clinical examination and questionnaires. RESULTS: The mean hallux valgus angle improved 13.4° (95% confidence interval: 11.6-15.1, p < .001) at the latest follow-up, while the mean intermetatarsal angle correction was 4.5° (95% confidence interval: 3.7-5.2, p < .001). There were three (4.0%) nonunions, and seven (9.2%) feet needed reoperation during follow-up. CONCLUSION: First tarsometatarsal joint derotational arthrodesis is an effective procedure for correcting flexible hallux valgus deformity and provides a satisfactory long-term outcome.
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Artrodesis/métodos , Hallux Valgus/cirugía , Huesos Metatarsianos/cirugía , Huesos Tarsianos/cirugía , Articulaciones Tarsianas/cirugía , Adulto , Anciano , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
OBJECTIVE: To evaluate costs and cost-effectiveness of physical and geriatric rehabilitation after hip fracture. DESIGN: Prospective randomised study (mean age 78 years, 105 male, 433 female) in different rehabilitation settings: physically oriented (187 patients), geriatrically oriented (171 patients), and healthcare centre hospital (control, 180 patients). MAIN MEASURES: At 12 months post-fracture, we collected data regarding days in rehabilitation, post-rehabilitation hospital treatment, other healthcare service use, number of re-operations, taxi use by patient or relative, and help from relatives. RESULTS: Control rehabilitation (4945,2) was significantly less expensive than physical (6609.0, p=0.002) and geriatric rehabilitation (7034.7 p<0.001). Total institutional care costs (primary treatment, rehabilitation, and post-rehabilitation hospital care) were lower for control (13,438.4) than geriatric rehabilitation (17,201.7, p<0.001), but did not differ between control and physical rehabilitation (15659.1, p=0.055) or between physical and geriatric rehabilitation ( p=0.252). Costs of help from relatives (estimated as 30%, 50% and 100% of a home aid's salary) with physical rehabilitation were lower than control ( p=0.016) but higher than geriatric rehabilitation ( p=0.041). Total hip fracture treatment costs were lower with physical (36,356, 51,018) than control rehabilitation (38,018, 57,031) at 50% and 100% of salary ( p=0.032, p=0.014, respectively). At one year post-fracture, 15D-score was significantly higher in physical rehabilitation group (0.697) than geriatric rehabilitation group (0.586, p=0.008) and control group (0.594, p=0.009). CONCLUSIONS: Considering total costs one year after hip fracture the treatment including physical rehabilitation is significantly more cost-effective than routine treatment. This effect could not be seen between routine treatment and treatment including geriatric rehabilitation.
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Servicios de Salud para Ancianos/economía , Servicios de Salud/economía , Fracturas de Cadera/economía , Servicios de Atención de Salud a Domicilio/economía , Evaluación de Procesos y Resultados en Atención de Salud/economía , Modalidades de Fisioterapia/economía , Rehabilitación/economía , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , Femenino , Servicios de Salud/estadística & datos numéricos , Servicios de Salud para Ancianos/estadística & datos numéricos , Fracturas de Cadera/rehabilitación , Humanos , Vida Independiente , Masculino , Persona de Mediana Edad , Evaluación de Procesos y Resultados en Atención de Salud/estadística & datos numéricos , Estudios Prospectivos , Rehabilitación/métodos , Centros de Rehabilitación/economía , Estadísticas no ParamétricasRESUMEN
We investigated the epidemiology of total Achilles tendon ruptures and complication rates after operative and nonoperative treatments over a 33-year period in Oulu, Finland. Patients with Achilles tendon ruptures from 1979 to 2011 in Oulu were identified from hospital patient records. Demographic data, treatment method, and complications were collected retrospectively from medical records. Overall and sex- and age-specific incidence rates were calculated with 95% confidence intervals (CIs). The overall incidence per 100,000 person-years increased from 2.1 (95% CI 0.3-7.7) in 1979 to 21.5 (95% CI 14.6-30.6) in 2011. The incidence increased in all age groups. The mean annual increase in incidence was 2.4% (95% CI 1.3-4.7) higher for non-sports-related ruptures than for sports-related ruptures (P = 0.036). The incidence of sports-related ruptures increased during the second 11-year period whereas the incidence of non-sports-related ruptures increased steadily over the entire study period. Infection was four times more common after operative treatment compared with nonoperative treatment, re-rupture rates were similar. The incidence of Achilles tendon ruptures increased in all age groups over a 33-year period. Increases were mainly due to sports-related injuries in the second 11-year period and non-sports-related injuries in the last 11-year period.
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Tendón Calcáneo/lesiones , Traumatismos en Atletas/epidemiología , Complicaciones Posoperatorias/epidemiología , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Traumatismos en Atletas/terapia , Moldes Quirúrgicos , Femenino , Finlandia/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica , Recurrencia , Estudios Retrospectivos , Rotura/epidemiología , Rotura/terapia , Infección de la Herida Quirúrgica/epidemiología , Adulto JovenRESUMEN
Previous studies from single centres or single-surgeon series report good early and mid-term results for high tibial osteotomy (HTO) in the treatment of osteoarthritis of the knee. However, the survivorship of HTO at a national level is unknown. This registry-based study included 3195 high HTOs performed between 1987 and 2008. Kaplan-Meier analysis revealed an overall survivorship of 89% (95% confidence interval (CI) 88 to 90) at five years and 73% (95% CI 72 to 75) at ten years, when conversion to total knee replacement was taken as the endpoint. Females and patients aged > 50 years had worse survivorship than males or patients aged ≤ 50 years (hazard ratio (HR) 1.26 (95% CI 1.11 to 1.43) and HR 1.41 (95% CI 1.23 to 1.64), respectively). The survivorship of HTOs performed between 1998 to 2008 was worse than for those performed between 1987 and 1997.
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Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/mortalidad , Osteoartritis de la Rodilla/cirugía , Osteotomía/métodos , Tibia/cirugía , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Estimación de Kaplan-Meier , Articulación de la Rodilla/patología , Masculino , Persona de Mediana Edad , Sistema de Registros , Tasa de Supervivencia , Resultado del Tratamiento , Adulto JovenRESUMEN
We assessed the short- to mid-term survival of metallic press-fit radial head prostheses in patients with radial head fractures and acute traumatic instability of the elbow. The medical records of 42 patients (16 males, 26 females) with a mean age of 56 years (23 to 85) with acute unstable elbow injuries, including a fracture of the radial head requiring metallic replacement of the radial head, were reviewed retrospectively. Survival of the prosthesis was assessed from the radiographs of 37 patients after a mean follow-up of 50 months (12 to 107). The functional results of 31 patients were assessed using range-of-movement, Mayo elbow performance score (MEPS), Disabilities of the Arm, Shoulder and Hand (DASH) score and the RAND 36-item health survey. At the most recent follow-up 25 prostheses were still well fixed, nine had been removed because of loosening, and three remained implanted but were loose. The mean time from implantation to loosening was 11 months (2 to 24). Radiolucent lines that developed around the prosthesis before removal were mild in three patients, moderate in one and severe in five. Range of movement parameters and mass grip strength were significantly lower in the affected elbow than in the unaffected side. The mean MEPS score was 86 (40 to 100) and the mean DASH score was 23 (0 to 81). According to RAND-36 scores, patients had more pain and lower physical function scores than normal population values. Loosening of press-fit radial head prostheses is common, occurs early, often leads to severe osteolysis of the proximal radius, and commonly requires removal of the prosthesis.
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Artroplastia de Reemplazo/métodos , Lesiones de Codo , Inestabilidad de la Articulación/cirugía , Prótesis Articulares , Fracturas del Radio/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Artroplastia de Reemplazo/efectos adversos , Artroplastia de Reemplazo/instrumentación , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/fisiopatología , Articulación del Codo/cirugía , Femenino , Fracturas Conminutas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Osteólisis/diagnóstico por imagen , Osteólisis/etiología , Diseño de Prótesis , Falla de Prótesis , Radiografía , Rango del Movimiento Articular , Reoperación , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: To determine whether oral rinse matrix metalloproteinase (MMP)-8 levels, measured by three different methods, tissue inhibitor of matrix metalloprotease-1 (TIMP-1) levels and elastase activity differentiate subjects with different periodontal condition; and second, to find out if MMP-8 levels were comparable among the methods used. METHODS: MMP-8 levels were analysed with an immunofluorometric method (IFMA), dentoELISA and commercial ELISA. Also TIMP-1 levels and elastase activity were measured. For statistical analysis 214 study subjects were categorized into four groups, specified by the presence and number of moderate (4-5mm) and deep (≥6mm) periodontal pockets, and bleeding on probing percentage. RESULTS: MMP-8 levels especially measured by dentoELISA and adjusted to the number of teeth per subject differentiated the study group with strong periodontal inflammatory burden from groups with lower levels. This was also verified with receiver operating characteristic (ROC) analysis. Elastase activity associated with higher IFMA and dentoELISA MMP-8 levels. IFMA MMP-8/TIMP and dentoELISA MMP-8/TIMP-1 tended to be higher with the increasing level of periodontal inflammatory burden. TIMP-1 levels decreased with increasing age. CONCLUSIONS: Oral rinse MMP-8 together with TIMP-1 analysis may have potential in complementary periodontal diagnostics. dentoELISA can be applied in quantitative oral rinse chair side biomarker diagnostics.
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Líquido del Surco Gingival/metabolismo , Metaloproteinasa 8 de la Matriz/metabolismo , Bolsa Periodontal/enzimología , Periodontitis/enzimología , Inhibidor Tisular de Metaloproteinasa-1/metabolismo , Adulto , Anciano , Biomarcadores/análisis , Biomarcadores/metabolismo , Estudios de Casos y Controles , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , Femenino , Técnica del Anticuerpo Fluorescente , Líquido del Surco Gingival/química , Humanos , Masculino , Metaloproteinasa 8 de la Matriz/análisis , Persona de Mediana Edad , Elastasa Pancreática/análisis , Elastasa Pancreática/metabolismo , Bolsa Periodontal/inmunología , Periodontitis/inmunología , Sistemas de Atención de Punto , Valores de Referencia , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Manejo de Especímenes/métodos , Estadísticas no Paramétricas , Inhibidor Tisular de Metaloproteinasa-1/análisisRESUMEN
UNLABELLED: The purpose of this study was to assess changes in epidemiology and reasons for wintertime excess of distal radius fractures in Oulu, Finland. Our results showed that age-specific incidence of distal radius fractures in elderly women in Finland has increased compared with a previous study. Slippery pavement surfaces assessed by a new meteorological model partly explained wintertime excess of fractures, but factors beyond weather are contributing to seasonality. INTRODUCTION: In this report, we describe the epidemiology and seasonal variation of distal radius fractures in Oulu, Finland, with a focus on the effect of weather and slippery pavement conditions. METHODS: Records of patients aged ≥16 years living in Oulu with a distal radius fracture during the year 2008 were reviewed. Demographic data and details of the injury were assessed from medical records, and fractures were classified according to AO classification. Population data for Oulu during the year 2008 were used to calculate crude incidence as well as sex- and age-specific incidence rates. The number of wintertime fractures was compared with those related to pavement surface slipperiness using a unique weather and pavement condition model of the Finnish Meteorological Institute. RESULTS: The crude incidence was 258/100,000 person-years. Sex- and age-specific incidence rates rose to 1,107/100,000 person-years for females and 466/100,000 person-years for males aged ≥80 years. Poisson regression analysis showed that the number of fractures was 2.5 (95% confidence interval (CI), 1.6 to 4.0; P < 0.001) times greater on slippery winter days compared with non-winter days whereas on normal winter days fractures were 1.4 (95% CI, 1.1 to 1.9; P = 0.01) times greater. Both low- and high-energy injuries resulted in similar fracture patterns by AO classification. CONCLUSIONS: Our results suggest that the epidemiology of distal radius fractures in elderly women in Finland has changed compared with a previous study. Weather analysis showed that the slipperiness of the pavement could partly explain the wintertime excess of distal radius fractures.
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Fracturas del Radio/epidemiología , Estaciones del Año , Traumatismos de la Muñeca/epidemiología , Accidentes por Caídas/estadística & datos numéricos , Adolescente , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Femenino , Finlandia/epidemiología , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Fracturas del Radio/etiología , Factores de Riesgo , Distribución por Sexo , Tiempo (Meteorología) , Traumatismos de la Muñeca/etiología , Adulto JovenRESUMEN
OBJECTIVE: The aim of the study was to compare four methods for gingival crevicular fluid (GCF) matrix metalloproteinase (MMP)-8 detection. METHODS: Matrix metalloproteinase-8 levels from 20 GCF samples from two periodontally healthy subjects, 18 samples from two patients with gingivitis and 45 samples from six patients with moderate to severe periodontitis, altogether 83 samples, were analysed using (1) a time-resolved immunofluorometric assay (IFMA), (2) an MMP-8 specific chair-side dip-stick test, (3) a dentoAnalyzer device and (4) the Amersham ELISA kit. Western immunoblot using same monoclonal anti-MMP-8 as in IFMA and dentoAnalyzer was used to identify molecular forms of MMP-8 in GCFs. RESULTS: Correlation between IFMA and dentoAnalyzer results calculated with Spearman's correlation coefficient was 0.95 (P = 0.01). The chair-side dip-stick test results were well in line with these assays. Periodontitis sites with unstable characteristics were differentiated with these methods. The Amersham ELISA results were not in line with the findings by other methods. CONCLUSIONS: Immunofluorometric assay and dentoAnalyzer can detect MMP-8 from GCF samples and these methods are comparable. Using Western immunoblot, it was confirmed that IFMA and dentoAnalyzer can detect activated 55 kDa MMP-8 species especially in periodontitis-affected GCF. dentoAnalyzer is among the first quantitative MMP-8 chair-side testing devices in periodontal and peri-implant diagnostics and research.
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Pruebas de Enzimas/métodos , Líquido del Surco Gingival/enzimología , Metaloproteinasa 8 de la Matriz/análisis , Estudios de Casos y Controles , Gingivitis/enzimología , Humanos , Periodontitis/enzimologíaRESUMEN
The aim of this prospective matched-pair (age, sex, fracture type, residential status, and walking ability at fracture) study was to analyse the short-term outcome after Gamma nail (GN) and dynamic hip screw (DHS) fixation, focusing especially on functional aspects (Standardised Audit of Hip Fractures in Europe [SAHFE] hip fracture follow-up forms), reoperations, and mortality. Both groups consisted of 134 patients. DHS and GN groups did not differ significantly with respect to location of residence at 4 months or returning to the prefracture dwelling (78% vs. 73%, P = 0.224). The change in walking ability at 4 months compared to prefracture situation was better in the DHS group (p = 0.042), although there was no difference in the change of use of walking aids. The frequency of reoperations during the first year was somewhat lower in the DHS group (8.2% vs. 12.7%, p = 0.318). Mortality was lower in the DHS group both at 4 months (6.0% vs. 13.4%, p = 0.061) and 12 months (14.9% vs. 23.9%, p = 0.044). Although walking ability was better and mortality lower in the DHS group, both methods are useful in the treatment of trochanteric femoral fractures.
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Clavos Ortopédicos , Tornillos Óseos , Fijación Interna de Fracturas/métodos , Fracturas de Cadera/cirugía , Actividades Cotidianas , Anciano , Anciano de 80 o más Años , Femenino , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/instrumentación , Humanos , Tiempo de Internación , Masculino , Análisis por Apareamiento , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Estudios Prospectivos , Resultado del Tratamiento , CaminataRESUMEN
BACKGROUND: Common Achilles tendon ruptures are not usually fixed by bioabsorbable sutures due to limitations in their strength retention properties. Modern technology has made it possible to develop bioabsorbable sutures with prolonged strength retention. AIMS: To evaluate histologically tissue reactions of poly-L/D-lactide (PLDLA) sutures implanted in Achilles tendon of rabbits. MATERIAL AND METHODS: Fifteen rabbits were evaluated at 2, 6 and 12 weeks postoperatively, with five rabbits in each follow-up group. PLDLA monofilament sutures were implanted into the medial gastrocnemius tendon. Polyglyconate monofilament sutures with similar diameter (Maxon 4-0, Cyanamid of Great Britain Ltd., Gosport, UK) were implanted in the contralateral gastrocnemius tendon. The histology was studied in hard-resin embedded samples. The thickness of the formed fibrous tissue capsule was determined histomorphometrically. RESULTS: PLDLA led to formation of significantly thinner fibrous tissue capsule than Maxon sutures of the same diameter. Median thickness (PLDLA vs. Maxon) at two weeks was 5.26 vs.13.22 microm, at six weeks 11.66 vs. 80.97 microm, and at 12 weeks 10.63 vs. 17.59 microm (p<0.01). CONCLUSIONS: During the 12 week follow-up period, PLDLA sutures implanted intratendineously formed thinner fibrous capsule than Maxon sutures of the same diameter. The suture materials were not totally absorbed by 12 weeks.
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Poliésteres , Suturas , Tendones/cirugía , Animales , ConejosRESUMEN
The purpose of this study was to compare the incidence of radiographic osteolysis following insertion of 89 Swanson and 126 Sutter metacarpophalangeal implants in rheumatoid arthritis patients. The mean follow-up time in the two groups of patients was 57 (40-80) and 55 (36-79) months, respectively. This paper proposes a new method of classifying radiographic osteolysis. The remarkable number of osteolytic changes seen in the bones adjacent to MCP prostheses in this study would suggest that silastic prostheses should only be used when other surgical alternatives cannot be used and that long-term control by radiography be maintained after implantation of silicone prostheses into the MCP joint. In all grades of our classification, osteolysis was more frequent in the Sutter than in the Swanson group in this study, suggesting that use of the Sutter rather than the Swanson implant is questionable.
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Artroplastia de Reemplazo , Articulación Metacarpofalángica/cirugía , Osteólisis/diagnóstico por imagen , Anciano , Artritis Reumatoide/cirugía , Dimetilpolisiloxanos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Radiografía , SiliconasRESUMEN
We present a case report of acute bilateral excercise-induced compartment syndrome in the adductor longus muscles, which was treated with bilateral medial fasciotomies. Postoperatively, the healing process of the adductor muscles was followed up by repeated MR imagings over six months. Myonecrosis was found in peroperative muscle biopsies. Pain and muscle swelling subsided soon after the fasciotomy, correlating with the early postoperative MR findings. Four months postoperatively, the signal intensity of the adductor muscles was normal in T1- and T2-weighted images, but the normal fibre structure of the adductor muscles could only be seen 6 months postoperatively. At six month's control checkup there was no subjective weakness of the adductors, and hyperesthesia had disappeared and the patient was capable of normal activities.
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Traumatismos en Atletas/diagnóstico , Síndromes Compartimentales/diagnóstico , Imagen por Resonancia Magnética/métodos , Muslo/lesiones , Adulto , Traumatismos en Atletas/cirugía , Síndromes Compartimentales/etiología , Síndromes Compartimentales/cirugía , Estudios de Seguimiento , Humanos , Masculino , Músculo Esquelético/lesiones , Resultado del TratamientoRESUMEN
In a retrospective clinical study we evaluated the outcome of arthroscopic repair of osteochondritis dissecans (OCD) of the femoral condyles with metal stable fixation. Twenty-eight knees of 26 patients (mean age 20 years) with OCD of the knee were treated by fixation of the fragments with Hoffmann's dynamic metal staples arthroscopically and by additional arthrotomy in 7 knees. At follow-up (mean 4 years, 1-7) patients were interviewed for any residual symptoms and underwent a routine clinical and radiographic examination. The clinical results were based on the grading scale of Lysholm. The 17 knees which did not require further surgery showed 13 instances of complete healing, 3 of partial healing, and 1 of nonhealing. The 11 knees which had reoperations showed 2 instances of complete healing, 5 of partial healing, and 4 nonhealing. There was no significant difference between early or late surgery, and results were not related significantly to site of the lesion, handling of the fragment and the crater, percutaneous drilling, or type of fragmentation. Clinical grading of 13 knees was as excellent, 11 good, and 4 fair. Broken stables were observed in 9 knees, and they were removed from 5 knees. Complete healing was thus achieved in one-half and partial healing in one-third of cases. The metal staples used here fit for use in the arthroscopic fixation of the OCD of the knee, although the staples had a marked liability to break.
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Artroscopía/métodos , Fémur/cirugía , Articulación de la Rodilla/cirugía , Osteocondritis Disecante/cirugía , Grapado Quirúrgico , Adolescente , Adulto , Falla de Equipo , Femenino , Estudios de Seguimiento , Humanos , Masculino , Estudios Retrospectivos , Grapado Quirúrgico/instrumentación , Resultado del Tratamiento , Cicatrización de Heridas/fisiologíaRESUMEN
BACKGROUND AND AIMS: To evaluate the outcome in a prospective 2-year follow-up study of a non-constrained titanium-polyethylene total endoprosthesis (ReFlexion) in the treatment of hallux rigidus. MATERIAL AND METHODS: Ten patients with painful hallux rigidus were treated with a non-constrained titanium-polyethylene total endoprosthesis (ReFlexion). The American Orthopaedic Foot and Ankle Society (AOFAS) scoring was used preoperatively and at follow-up. RESULTS: At 2-year follow-up, the AOFAS scoring shbwed 5 instances of excellent, 1 of good, 2 of fair, and 2 of poor outcome. Eight patient were subjectively satisfied and 2 dissatisfied. Five of the patients were painless, 4 had mild, occasional pain, and 1 had moderate, daily pain in the first metatarsophalangeal joint. The mean VAS was 7.6 (SD 2.0) preoperatively and 1.1 (SD 1.4) at 2-year follow-up (p < 0.001). Extension increased by a mean of 25 (13-38) degrees and flexion by a mean of 15 (2-35) degrees (p < 0.001). Eight patients had no activity limitations, while 1 had mild and 1 moderate limitations. Alignment of the metatarsophalangeal joint was good in 7 cases, but some degree of valgus malalignment was seen in 2 and symptomatic malalignment in 1. Complications included one subluxation of a prosthesis, one recurrence of severe valgus alignment and one superficial wound infection. Radiological loosening of one cementless phalangeal component was seen at follow-up. CONCLUSION: The non-constrained titanium-polyethylene total arthroplasty gave satisfactory 2-year outcome in 60% of the patients. It is an alternative treatment for hallux rigidus in low demand patients. We do not recommended it for athletes and young people, because high forces acting on the prosthesis may cause a failure.
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Hallux Rigidus/fisiopatología , Hallux Rigidus/cirugía , Prótesis e Implantes , Adulto , Anciano , Distribución de Chi-Cuadrado , Femenino , Estudios de Seguimiento , Hallux Rigidus/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Polietilenos , Complicaciones Posoperatorias , Estudios Prospectivos , Radiografía , Rango del Movimiento Articular , Titanio , Resultado del TratamientoRESUMEN
PURPOSE: To compare supraspinatus outlet view (SOV) findings at different stages of the impingement syndrome (IS) with findings in asymptomatic age- and sex-matched controls. MATERIAL AND METHODS: Pre-operative SOVs were obtained of 37 shoulders of patients scheduled for unilateral open repair of a full-thickness rotator cuff tear (stage III IS) and 74 shoulders of patients scheduled for open (n=46) or arthroscopic (n=28) acromioplasty for tendinitis (stage II IS). Each view of a patient's shoulder was paired with a control view obtained from an age- and sex-matched person with no shoulder problems (n=111). RESULTS: There were no significant differences in acromial morphology as evaluated on the scale devised by BIGLIANI et al. or in the tilt, slope or length of the acromion between the study groups and their controls. However, hooked acromion seemed to be more common in the patients. The thickness of the anterior part of the acromion at the tendinitis stage and the acromial angle at the tear stage of IS were the only parameters that showed significant differences between patients and controls. CONCLUSION: Variation of the morphology of the acromion as evaluated on a basis of the SOV is associated with IS, but the association is weak and its value in the diagnosis of IS is therefore only as an adjunctive to other diagnostic modalities.
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Acromion/diagnóstico por imagen , Síndrome de Abducción Dolorosa del Hombro/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Síndrome de Abducción Dolorosa del Hombro/cirugía , Tendinopatía/diagnóstico por imagenRESUMEN
We compared decompression of the posterior interosseous nerve (PIN) and lengthening of the distal tendon of the extensor carpi radialis brevis (ECRB) for treatment of tennis elbow in a randomised trial of 28 patients. Fourteen underwent decompression of PIN and 14, lengthening of ERCB. The groups did not differ significantly with regard to age, sex and work activities. The average duration of preoperative symptoms was 23 months. The PIN was exposed in the groove between the brachioradialis and brachialis muscles and decompressed at the arcade of Frohse by means of a 1-2 cm incision through the supinator muscle. The ECRB tendon was lengthened by Z-plasty at the dorsilateral aspect of the forearm. No postoperative complications occurred. The outcome after the primary operation was successful in 50% of the PIN group and in 43% of the ECRB group. Four of the 5 patients with a poor outcome were reoperated in the former group and 3 in the latter. The overall outcome after a mean follow-up of 31 months after the primary operation was successful in 60% of the cases.
Asunto(s)
Descompresión Quirúrgica , Tendones/cirugía , Codo de Tenista/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
BACKGROUND: The purpose of this study was to examine some motor performance aspects of the unloaded lower extremity after Achilles tendon rupture repair. The measured motor performance aspects were simple reaction time, choice reaction time, speed of movement, foot tapping speed, and coordination. METHODS: Ninety patients (76 men and 14 women) with total closed Achilles tendon rupture had been operated on a mean of 3.1 years before the measurements. Ninety age and gender-matched control subjects were drawn from a larger reference group from the local population. Age and gender-matched pairs were set up, and the results were compared. The measurements were made with the HPM/BEP-system, which is a multifunctional system designed to measure different motor aspects of the feet, including reaction time, movement speed, tapping speed, and coordination. RESULTS: There were no statistically significant differences in the results between the operated and non-operated lower extremities in the patient group a mean of 3.1 years after the operation. When the results were compared between the patient and control groups, no statistically significant differences were found. CONCLUSION: Based on the results, it seems that the measured motor performance functions of the unloaded lower extremity had fully recovered after the Achilles tendon rupture repair in the above mentioned aspects, and the operated patients do not have an increased risk to get reinjury of Achilles tendon because of the lower performance of these motor functions of the lower extremity.