RESUMEN
Based on the authors' clinical experience and a review of the literature, the methods used for the diagnosis of loosening in hip arthroprostheses are considered. Clinical and radiographic monitoring are essential but the authors believe that in suspected loosening it is particularly important to perform bone scintigraphy using Tc 99 M.D.P., Ga 67, and Indium 111. Arthrography is advised only in selected cases. The criteria of evaluation in the various tests are reported and a procedure for diagnosis is proposed.
Asunto(s)
Prótesis de Cadera , Radioisótopos de Galio , Articulación de la Cadera/diagnóstico por imagen , Humanos , Falla de Prótesis , Radiografía , Cintigrafía , Medronato de Tecnecio Tc 99mRESUMEN
Revision surgery for loosening of the components in total hip prostheses is still a problem and not only from the purely technical aspects. According to our experience, the use of cement is contraindicated, at least in Schneider grades 2 and 3 of aseptic loosening, because of the biological damage it can cause to the bone grafts used in such cases. The stability of non-cemented reimplants is dependant on good biological anchorage through endosteal osteogenesis. The cardinal points of technique are: complete removal of all cement, necrotic bone, and interposed fibrous membrane; the use of autoplastic bone grafts in the form of chips to replace the lost "bone stock"; the use of prostheses designed for optimum load distribution (long stem, large acetabulum). In the case of ruptured stems, diaphyseal osteotomy is necessary for complete removal of the cement and prosthesis; this can be stabilised by using a Lord prosthesis with a long stem.
Asunto(s)
Falla de Equipo , Prótesis de Cadera , Falla de Prótesis , Anciano , Cadera/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Radiografía , ReoperaciónRESUMEN
During a period of 10 years we treated 855 children aged from 1 to 13 years suffering from diaphyseal fractures of the femur or tibia. From this material we were able to compile statistics regarding age, type and level of fracture, quality of reduction and duration of traction. From this material we were able to follow-up 357 fractures at a minimum of 3 and a maximum of 12 years with a view to evaluating the incidence of dysmetria in relation to age, level of fracture, and the presence of compensatory scoliosis. Our survey showed that lengthening due to growth disturbance following fractures is more frequent in fractures of the middle third of the bone in children in the 5-9 years age group. It also showed that spontaneous correction of axial deformities during growth is more likely to occur in the sagittal plane than in the frontal plane. The radiographic survey showed constant thickening of the fractured diaphysis with sclerosis of the load bearing cortex and thinning where the cortex is under tension.
Asunto(s)
Fracturas del Fémur/complicaciones , Trastornos del Crecimiento/etiología , Fracturas de la Tibia/complicaciones , Adolescente , Niño , Preescolar , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/terapia , Estudios de Seguimiento , Humanos , Lactante , Diferencia de Longitud de las Piernas/etiología , Radiografía , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/terapiaRESUMEN
Thirty patients with articular pain had been treated with proglumetacin during average 12 days. Twenty-three (77%) responded well to very well to the treatment. Total symptom score decreased by 49%, and each tested symptom (painful, inflammatory and functional) significantly improved, in spite of the short observation period. Tolerance was defined good to excellent in 26 patients (87%). Overall, 10 patients complained of mild to moderate accessory symptoms, mainly heartburn and epigastric pain. No C.N.S. symptoms were observed, nor variations of the laboratory tests, carried out in 16 patients. Proglumetacin, therefore, showed to be a suitable drug for the fast and safe management of articular pain of orthopedic interest.