RESUMEN
Patellar instability is usually diagnosed on the basis of the clinical presentation without radiographic confirmation. In the present report, we describe a new radiographic method to demonstrate patellar instability. Axial radiographs were made of the patellofemoral joint of ninety individuals (180 knees) and were then repeated while a medial or lateral force was applied to the patella. The applied force was kept constant with use of a specially designed instrument. The ninety individuals were divided into four groups on the basis of the clinical findings: normal, lateral instability, medial instability, and multidirectional instability. Stress radiographs differentiated the four groups and confirmed the clinical diagnosis in all patients who had unilateral symptoms. A four-millimeter increase in medial or lateral excursion of the patella excursion of the asymptomatic knee was significant (p < 0.0001). Stress radiographs offer a simple method for the measurement of force-displacement relationships in the patellofemoral joint and for the demonstration of patellofemoral instability.
Asunto(s)
Inestabilidad de la Articulación/diagnóstico por imagen , Articulación de la Rodilla/diagnóstico por imagen , Adulto , Humanos , Articulación de la Rodilla/fisiopatología , Radiografía/métodos , Estrés MecánicoRESUMEN
Seven patients, with an average age of 53 years, were treated for bone loss or recalcitrant nonunions of the femur. The average duration from initial injury to presentation was 37 months (range 4-92 months). The patients had undergone one to eight (mean, 3.9) previous surgical attempts at achieving union. The nonunion involved the diaphysis in three patients, the diaphyseal-supracondylar junction in three patients, and the pertrochanteric region in one patient. All patients were treated using a standard lateral plate in combination with an endosteal plate and primary iliac crest bone grafting. The mean surgical time was 6.3 h, and the average blood loss was 1.7 L. There were three complications, including one superficial wound infection, one nonfatal pulmonary embolism, and one wound hematoma. At a mean follow-up of 12.6 months (range 4-24 months), all fractures had healed with an average time to union of 19.2 weeks (range 15-36 weeks). Knee flexion averaged 118 degrees (range 100-135 degrees), and all patients were satisfied with the operative procedure. Endosteal plating, in combination with a standard lateral plate and iliac crest bone-grafting, can successfully treat difficult nonunions of the femur.
Asunto(s)
Placas Óseas , Trasplante Óseo/métodos , Fracturas del Fémur/cirugía , Fijación Interna de Fracturas/métodos , Curación de Fractura , Fracturas no Consolidadas/cirugía , Adulto , Anciano , Pérdida de Sangre Quirúrgica , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/fisiopatología , Estudios de Seguimiento , Fracturas no Consolidadas/diagnóstico por imagen , Fracturas no Consolidadas/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Radiografía , Rango del Movimiento Articular , Factores de TiempoRESUMEN
The purpose of this study was to determine the cause of acute hemarthrosis of the knee in a prospective pediatric patient population. Between December 1988 and August 1991, 21 consecutive children who were seen with an acute traumatic hemarthrosis of the knee had an arthroscopic evaluation. The average age of the children at the time of injury was 14 years, 3 months (range, 10 to 17 years). The mechanism of injury was a torsional strain to the knee in 12 (71%) of the 17 patients who could accurately remember the injury. The initial evaluation included a history, physical examination, and anteroposterior, lateral, sunrise, and comparison radiographs. The arthroscopic procedure was performed under general anesthesia, and the arthroscopic findings were compared with preoperative findings. During arthroscopic examination, an osteochondral fracture of the lateral femoral condyle or patella was identified in 14 (67%) of the 21 patients. Preoperative radiographs failed to identify the fracture in 5 (36%) of the 14 patients who had an osteochondral fracture. The anterior cruciate ligament was visualized and probed; an injury was found in only two cases (10%). We concluded that in children an acute traumatic hemarthrosis reflects a major injury to the knee. The children in this study had a high frequency of osteochondral fractures; ACL injuries were found in only two patients. Because of the unreliable nature of radiographic evaluation, arthroscopic evaluation is a valuable tool in differential diagnosis and treatment of acute hemarthrosis of the knee.
Asunto(s)
Hemartrosis/etiología , Traumatismos de la Rodilla/complicaciones , Articulación de la Rodilla , Enfermedad Aguda , Adolescente , Lesiones del Ligamento Cruzado Anterior , Artroscopía , Niño , Diagnóstico Diferencial , Endoscopía , Femenino , Fracturas del Fémur/complicaciones , Fracturas del Fémur/diagnóstico por imagen , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico por imagen , Hemartrosis/diagnóstico por imagen , Hemartrosis/cirugía , Humanos , Traumatismos de la Rodilla/diagnóstico por imagen , Traumatismos de la Rodilla/cirugía , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Masculino , Rótula/diagnóstico por imagen , Rótula/lesiones , Examen Físico , Estudios Prospectivos , Radiografía , Rotación , Esguinces y Distensiones/complicaciones , Esguinces y Distensiones/diagnóstico por imagenRESUMEN
Closed degloving injuries of the toes are rare due to their short length, protection in shoes, and general lack of adornment. When these injuries occur, neurovascular compromise can lead to a loss of viability of the toe. Prompt recognition and successful reduction are necessary to maintain normal structure and function.