RESUMEN
BACKGROUND: Currently Minimally Invasive Plate Osteosynthesis (MIPO) technique for tibial shaft fracture management has gained wide attention. However, an increased intracompartmental pressure after the plate insertion may result in postoperative acute compartment syndrome. We reported the difference of immediate effect of percutaneous plate insertion using 2 approaches of MIPO technique on anterior compartment pressure of the legs. MATERIALS AND METHODS: Eight soft cadaveric legs (one female and three males) without previous history of skeletal trauma or surgery were infused with normal saline to create the sustained intracompartmental pressure of 20mm Hg in all four compartments. The Synthes® 4.5mm 11-hole Narrow Locking Compression Plate was inserted via anteromedial and anterolateral approach. Anterior compartment pressure was measured by portable digital monitoring device through side-port needle (Stryker® Intracompartmental Monitoring Device) before and after plate insertion for each approach. RESULTS: By using anteromedial approach, a mean of anterior compartment pressure was increased by 0.375mm Hg after plate insertion (5 of 8 legs had no change in pressure and the remaining 3 resulted in 1mm Hg pressure elevation). For anterolateral plate insertion, all of the 8 legs had an elevation of anterior compartment pressure with a mean of 3.5mmHg (ranged from 2 to 6mm Hg). CONCLUSIONS: When both approaches were compared to each other, the anterolateral plate insertion resulted in higher intracompartmental pressure elevation of the anterior compartment than the anteromedial approach. Surgeon should be more aware of acute compartment syndrome when considering the anterolateral approach in treating close tibial fracture. However, in patients with suspected acute compartment syndrome, close observation and continuous monitoring of the intracompartmental pressure is still imperative for all healthcare provider.
Asunto(s)
Placas Óseas , Síndromes Compartimentales/prevención & control , Síndromes Compartimentales/cirugía , Fijación Interna de Fracturas , Pierna/cirugía , Fracturas de la Tibia/cirugía , Anciano , Anciano de 80 o más Años , Fenómenos Biomecánicos , Cadáver , Femenino , Fijación Interna de Fracturas/instrumentación , Fijación Interna de Fracturas/métodos , Humanos , Pierna/patología , Masculino , Estudios Prospectivos , Fracturas de la Tibia/patologíaRESUMEN
Zoledronic acid has been used for prevention of osteolytic and osteoblastic bone metastasis. This case report illustrates an undesirable consequence from prolonged usage of zoledronic acid in bone metastasis prevention. Periprosthetic acetabular fracture in a patient treated with zoledronic acid for 7 years was reported. The clinical presentation, radiographic and pathological results were described. This is a rare complication after total hip arthroplasty which should not be ignored especially in patients who received long term bisphosphonate.
Asunto(s)
Acetábulo/lesiones , Artroplastia de Reemplazo de Cadera/efectos adversos , Conservadores de la Densidad Ósea/efectos adversos , Difosfonatos/efectos adversos , Imidazoles/efectos adversos , Osteoartritis de la Cadera/cirugía , Fracturas Periprotésicas/inducido químicamente , Acetábulo/patología , Acetábulo/cirugía , Anciano , Conservadores de la Densidad Ósea/farmacología , Neoplasias Óseas/prevención & control , Neoplasias Óseas/secundario , Remodelación Ósea/efectos de los fármacos , Neoplasias de la Mama/patología , Difosfonatos/farmacología , Femenino , Fracturas Espontáneas/inducido químicamente , Fracturas Espontáneas/etiología , Prótesis de Cadera , Humanos , Imidazoles/farmacología , Fracturas Periprotésicas/etiología , Falla de Prótesis , Reoperación , Ácido ZoledrónicoRESUMEN
STUDY DESIGN: An experimental study. OBJECTIVE: To analyze the effects of a modified U-shape interspinous distraction device (IDD) on the stability of a destabilized lumbar spine model. SUMMARY OF BACKGROUND DATA: The use of IDD for treatment of lumbar spine pathology remains a subject of debate. A modified design of an IDD consisted of a titanium (Ti) U-shape dynamic stabilizer and a Ti tensioning wire loop was biomechanically tested. MATERIALS AND METHODS: Six sets of cadaveric lumbar vertebrae levels 1-5 (L1-L5) were subjected to loads in flexion, extension, and lateral bending in the 4 following sequences: intact specimen, unilateral facetectomy and discectomy at L3-L4, insertion of the modified U-shape IDD at L3-L4, and pedicle screw fixation at L3-L4. The range of motion (ROM) of L3-L4 following modified U-shape IDD insertion was compared with that of the intact specimen. The ROM of the adjacent vertebrae (L2-L3 and L4-L5) following modified U-shape IDD insertion was compared with that after pedicle screw fixation. Statistical analysis was performed using the Wilcoxon signed-rank test. RESULTS: The modified U-shape IDD decreased the ROM of a destabilized L3-L4 in all testing load (P<0.05). The stability of L3-L4 following the modified U-shape IDD insertion was restored to that of the intact specimen (P>0.05). The ROM at adjacent vertebrae after the modified U-shape IDD placement was similar to the ROM obtained after pedicle screw fixation at L3-L4. CONCLUSIONS: The modified version of a U-shape IDD is effective in stabilizing an unstable segment of the lumbar spine. The device does not create deleterious effects on the adjacent vertebrae.
Asunto(s)
Degeneración del Disco Intervertebral/cirugía , Inestabilidad de la Articulación/cirugía , Vértebras Lumbares/fisiología , Vértebras Lumbares/cirugía , Rango del Movimiento Articular/fisiología , Fusión Vertebral/instrumentación , Fenómenos Biomecánicos/fisiología , Tornillos Óseos , Cadáver , Discectomía/instrumentación , Femenino , Humanos , Fijadores Internos , Masculino , Persona de Mediana Edad , Postura/fisiología , Fusión Vertebral/métodos , TitanioRESUMEN
OBJECTIVE: To compare the accuracy of postoperative mechanical alignment in computer-assisted total knee arthroplasties (CAS-TKA) related to various degrees of extra-articular tibial deformity. METHODS: We performed CAS-TKA on 30 knee models in which extra-articular proximal tibial deformities were preset to have malalignments ranging from 30° of varus to 30° of valgus. The knees were assigned to two groups, designated Group A (knees with ≤ 15° preoperative malalignment) and Group B (knees with > 15° preoperative malalignment), and the postoperative mechanical alignment in the two groups was compared using a computer-assisted surgery (CAS) system. Resected bone pieces from the distal femurs and proximal tibias were measured with a digital Vernier caliper and the results compared with the CAS calculations to evaluate the execution accuracy of the bone resection. RESULTS: There was no outlier in either group when a ± 3° deviation from neutral mechanical alignment was set as the acceptance criterion. Interestingly, Group B showed significantly more outliers when the acceptance criterion was a deviation of ± 2° (26.67%, p = 0.0317) or ± 1° (6.67%, p = 0.0007) from neutral alignment. There was no statistical difference between the groups in terms of the execution accuracy of the bone resection. DISCUSSION: The CAS-TKA approach provided significantly less alignment accuracy in tibia with greater preoperative frontal deformity, despite there being no outliers beyond ± 3°.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Desviación Ósea/patología , Desviación Ósea/cirugía , Articulación de la Rodilla/patología , Cirugía Asistida por Computador , Tibia/patología , Desviación Ósea/fisiopatología , Humanos , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Modelos Biológicos , Rango del Movimiento Articular , Reproducibilidad de los Resultados , Tibia/fisiopatología , Tibia/cirugíaRESUMEN
Popliteus-tendon injury during total knee arthroplasty (TKA) may result in imbalanced soft-tissue tension; however, it is unclear whether complete popliteus-tendon resection is a factor which contributes to knee instability following TKA. We performed an isolated complete resection of the popliteus tendon during a standard posterior stabilised TKA (PS-TKA) in 14 normal knees of Thai female cadavers and measured gap differences in both knee flexion and extension. In addition, we measured the distance from the femoral attachment of the popliteus tendon to the femoral condyles including the distance from the most distal femoral attachment of the popliteus tendon to the distal lateral femoral condyle (DFa-DLFC), and the distance from the most posterior femoral attachment of the popliteus tendon to the posterior lateral femoral condyle (PFa-PLFC). After completion of bone cuts, static flexion and extension gaps were measured with a tension of 98 N under intact and complete tendon resection, respectively. The mean DFa-DLFC and PFa-PLFC distances were 8.9 mm (range, 6.4-10.5mm) and 11.5mm (range, 9.5-14.0mm), respectively. Of 14 cadaveric knees, 35.7% had a DFa-DLFC distance <9 mm. Flexion and extension gaps significantly increased in both medial and lateral sides after complete popliteus resection with a similar mean increased value of 1.85 mm. The clinical evaluation of gap changes after popliteus resection on knee stability should be further investigated. A routine 9-mm distal femoral bone cut may injure the popliteus tendon during TKA conducted on small knees.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Inestabilidad de la Articulación/diagnóstico , Articulación de la Rodilla/patología , Músculo Esquelético/cirugía , Tendones/cirugía , Anciano , Anciano de 80 o más Años , Cadáver , Femenino , Humanos , Inestabilidad de la Articulación/fisiopatología , Articulación de la Rodilla/fisiopatología , Articulación de la Rodilla/cirugía , Persona de Mediana Edad , Rango del Movimiento Articular , TailandiaRESUMEN
BACKGROUND: Glucosamine sulfate has been recommended for treatment of knee osteoarthritis in several published guidelines. However, there are various preparations of glucosamine that may result in different pharmacokinetic and clinical outcomes. OBJECTIVES: Comparison of clinical outcomes of two different preparations of glucosamine sulfate (Sodium chloride salt and Potassium chloride salt) in patients with mild and moderate degree knee osteoarthritis. Laboratory tests to monitor drug safety were also studied. MATERIAL AND METHOD: Patients with symptomatic mild and moderate degree knee osteoarthritis were randomly assigned to receive treatment with either glucosamine sulfate with potassium salt (GS-K) 1500 mg daily or glucosamine sulfate with sodium salt (GS-Na) 1500 mg daily. Types of treatments were blinded to both patients and evaluators. Clinical assessments were done two weeks prior to initiation of treatment and then every four weeks until the sixteen week of treatment. Standing knee radiographs were taken at the initial visit. Patients with Ahlback stage 1 to 4 were included in the current study. Clinical data included range of motion, presence or absence of joint effusion, WOMAC and SF36. Laboratory studies were also done to evaluate drug safety, including BUN, creatinine, electrolytes, and liver function test. Adverse drug reactions were also recorded. RESULTS: Ninety patients with mild and moderate knee osteoarthritis (Ahlback grade 1-4) were randomized to two treatment groups, forty-five patients each. Demographic data and initial clinical assessment were similar in both groups. Both groups demonstrated improvement of WOMAC score and SF-36 at final follow-up but this did not reach statistical significance. Differences of WOMAC score and SF-36 between the two groups were not significant at any follow-up visit. Serum potassium level increased more significantly in the GS-K group but did not exceed normal value. CONCLUSION: In this short-term randomized comparison, glucosamine sulfate with potassium salt (GS-K) is as effective in pain relief and as safe as glucosamine sulfate with sodium salt (GS-Na) for treatment of mild and moderate degree knee osteoarthritis.
Asunto(s)
Glucosamina/uso terapéutico , Osteoartritis de la Rodilla/tratamiento farmacológico , Cloruro de Potasio/uso terapéutico , Cloruro de Sodio/uso terapéutico , Administración Oral , Adulto , Anciano , Anciano de 80 o más Años , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Dimensión del Dolor , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
BACKGROUND: Postoperative tibiofemoral alignment of the lower extremity is one of the most important factors that will assure a successful long-term outcome of a total knee arthroplasty. In this regard, most surgeons prefer to use an intramedullary guide than an extramedullary one for the femoral cut. However the entry point for the guiding rod is crucial for an appropriate femoral cut and femoral component positioning. The ideal entry point of the guiding rod should be the central axis of the distal femur in both coronal (anterior view) and sagittal planes (lateral view). OBJECTIVE: The authors studied the proper entry point for the femoral intramedullary guiding rod in total knee arthroplasty by using the top of the femoral intercondylar notch as the referenced point. MATERIAL AND METHOD: A series of radiographs for twenty-nine femurs from thirty-one cadavers, both anterior-posterior and lateral views, were evaluated in this study. RESULTS: 75.8 percent of the entry points in the coronal plane were at least 1 mm medial to the top ofthefemoral intercondylar notch. 82.7 percent of the entry points in the sagittal plane were superior to the top of the femoral intercondylar notch more than 10 mm. The proper entry point at the distal femur should be 1.5 +/- 2.01 mm medial and 12 +/- 2.72 mm superior to the top of the femoral intercondylar notch. CONCLUSION: The result of this study could be useful for surgeons who prefer intramedullary guide system in total knee arthroplasty.