RESUMEN
BACKGROUND: Femoroacetabular impingement (FAI) has been recognized as a common cause of hip pain as well as a cause of hip arthritis, yet despite this, little is known about the etiology of the cam morphology or possible risk factors associated with its development. QUESTIONS/PURPOSES: The purposes of our study were to determine when the cam morphology associated with FAI developed in a cross-sectional cohort study of pediatric patients pre- and postphyseal closure using MRI and whether increased activity level during the period of physeal closure is associated with an increased likelihood that the cam deformity will develop. METHODS: Alpha angles were measured at the 3 o'clock (anterior head-neck junction) and 1:30 (anterosuperior head-neck junction) positions in both hips with a cam deformity defined as an alpha angle ≥ 50.5° at the 3 o'clock position. Forty-four volunteers (88 hips) were studied: 23 with open physes (12 females, mean age 9.7 years; 11 males, age 11.7 years) and 21 with closed physes (five females, age 15.2 years; 16 males, age 16.2 years). Daily activity level using the validated Habitual Activity Estimation Scale was compared for patients in whom cam morphology did and did not develop. RESULTS: None of the 23 (0%) patients prephyseal closure had cam morphology, whereas three of 21 (14%, p = 0.02; all males) postclosure had at least one hip with cam morphology. Daily activity level was higher (p = 0.02) for patients with the cam morphology (7.1 hours versus 2.9 hours). Mean alpha angles at the 3 o'clock head-neck position were 38° (95% confidence interval [CI], 37.2°-39.1°) in the open physes group and 42° (95% CI, 40.16°-43.90°) in the closed physes group; at the 1:30 head-neck position, they were 45° (95% CI, 44.0°-46.4°) in the open physes group and 50° (47.9°-52.3°) in the closed physes group. CONCLUSIONS: The fact that cam morphology was present exclusively in the closed physeal group strongly supports its development during the period of physeal closure with increased activity level as a possible risk factor.
Asunto(s)
Pinzamiento Femoroacetabular/diagnóstico , Cabeza Femoral/patología , Cuello Femoral/patología , Articulación de la Cadera/patología , Imagen por Resonancia Magnética , Acetábulo/patología , Actividades Cotidianas , Adolescente , Factores de Edad , Análisis de Varianza , Fenómenos Biomecánicos , Distribución de Chi-Cuadrado , Niño , Estudios Transversales , Evaluación de la Discapacidad , Femenino , Pinzamiento Femoroacetabular/etiología , Pinzamiento Femoroacetabular/patología , Pinzamiento Femoroacetabular/fisiopatología , Pinzamiento Femoroacetabular/cirugía , Cabeza Femoral/cirugía , Cuello Femoral/cirugía , Articulación de la Cadera/fisiopatología , Articulación de la Cadera/cirugía , Humanos , Masculino , Examen Físico , Valor Predictivo de las Pruebas , Estudios Prospectivos , Rango del Movimiento Articular , Recuperación de la Función , Factores de Riesgo , Resultado del TratamientoRESUMEN
Pediatric patients who require orthopaedic surgical emergency care are often treated by orthopaedic surgeons who primarily treat adult patients. Essential information is needed to safely evaluate and treat the most common surgical emergencies in pediatric patients, including hip fractures; supracondylar humeral, femoral, and tibial conditions of the hip (such as slipped capital femoral epiphysis and septic arthritis); and limb- and life-threatening pathologies, including compartment syndrome, the dysvascular limb, cervical spine trauma, and the polytraumatized child. To provide optimal care to pediatric patients, it is important to be aware of the key points in patient evaluation and surgical care as well as expected complications.
Asunto(s)
Enfermedades Óseas/cirugía , Servicios Médicos de Urgencia , Enfermedades Musculoesqueléticas/diagnóstico , Enfermedades Musculoesqueléticas/terapia , Adulto , Artritis Infecciosa/tratamiento farmacológico , Niño , Competencia Clínica , Síndromes Compartimentales/diagnóstico , Síndromes Compartimentales/terapia , Diagnóstico Diferencial , Servicio de Urgencia en Hospital , Fascitis Necrotizante/diagnóstico , Fascitis Necrotizante/terapia , Luxación de la Cadera/cirugía , Fracturas de Cadera/complicaciones , Fracturas de Cadera/cirugía , Humanos , Enfermedades Musculoesqueléticas/cirugía , Osteonecrosis/etiología , Examen Físico , Epífisis Desprendida de Cabeza Femoral/cirugía , Traumatismos Vertebrales/diagnóstico , Traumatismos Vertebrales/terapia , Fracturas de la Tibia/cirugíaRESUMEN
UNLABELLED: In 1948, Professor Ignacio Ponseti began a nonoperative management form of treatment for severe talipes equinovarus. This method of manipulative treatment became attractive because long-term outcomes demonstrated the majority of feet were pain-free, plantigrade, and functioning at a high level of activity without evidence of degenerative arthrosis. We retrospectively reviewed the charts of 51 children (31 boys and 20 girls; 72 feet) with idiopathic clubfeet deformity treated with the Ponseti method from January 5, 2002, to January 5, 2007. The median age at treatment was 2 weeks (95% confidence limit, 1-2 weeks); there was no difference in age at presentation between boys and girls. The minimum followup was 4 months (mean, 19.8 months; range, 4-48 months). A total of 288 casts were applied (mean, 5.5; standard deviation, 0.92). Successful treatment was defined as a plantigrade foot with a normal hindfoot, midfoot, and forefoot on clinical examination. Correction was achieved and maintained in 90% (65 of 72) of the feet; 10% (seven of 72) of the treated feet did not improve and needed subsequent surgery. There was no difference in the proportion of children who had tenotomy or previous treatment among those who presented with residual deformity or recurrence or had surgery. However, patients who tolerated bracing had lower recurrence rates and underwent less surgery. LEVEL OF EVIDENCE: Level IV, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.
Asunto(s)
Tendón Calcáneo/cirugía , Tirantes , Moldes Quirúrgicos , Pie Equinovaro/terapia , Manipulaciones Musculoesqueléticas , Transferencia Tendinosa , Factores de Edad , Fenómenos Biomecánicos , Pie Equinovaro/fisiopatología , Pie Equinovaro/cirugía , Terapia Combinada , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Recurrencia , Reoperación , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores de Tiempo , Insuficiencia del Tratamiento , CaminataRESUMEN
UNLABELLED: Twenty-two patients (24 shoulders) had a scapulothoracic arthrodesis for various clinical disorders including facioscapulohumeral muscular dystrophy, scapular winging from serratus anterior palsy, painful scapular crepitation, and cleidocranial dysostosis. All patients were extremely disabled with pain and loss of function because of their symptomatic scapular winging, and many of the patients had multiple previous procedures on their shoulders before the scapulothoracic arthrodesis. The surgical indication was stabilization of painful scapulothoracic articulation to provide pain relief and allow functional use of the involved arm for activities of daily living. The surgical technique involved use of a semitubular plate and wire construct along the medial border of the scapula with the use of autograft (iliac crest) or allograft bone or both between the scapula and the rib cage. Patients were immobilized postoperatively for 12 weeks. Complications occurred in more than (1/2) of the patients and included pulmonary complications, hardware failure, pseudarthrosis, and persistent pain. Postoperatively, 20 of 22 (91%) patients thought that the pain in their shoulder complex was improved and were satisfied with their functional outcome. Scapulothoracic arthrodesis can improve function and reduce pain in the shoulder complex in patients with debilitating complex scapulothoracic dysfunction. However, the high incidence of complications with this procedure is a concern. LEVEL OF EVIDENCE: Therapeutic study, Level IV (case series--no, or historical control group). See the Guidelines for Authors for a complete description of levels of evidence.
Asunto(s)
Artrodesis/métodos , Displasia Cleidocraneal/cirugía , Distrofias Musculares/cirugía , Paresia/cirugía , Escápula/cirugía , Articulación del Hombro/cirugía , Adolescente , Adulto , Análisis de Varianza , Tirantes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Rango del Movimiento Articular , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
We recommend a treatment algorithm for tibial eminence fracture management (Fig.11). Displaced and irreducible fractures require arthroscopic or open treatment based on surgeon preference. Objective sagittal plane laxity does not translate into long-term clinical or subjective instability. Every effort should be made to obtain the best possible reduction with stable fixation, when needed, to maximize function.