RESUMEN
BACKGROUND: We aimed to evaluate radiologic and clinical outcomes of ankle fractures involving posterior fragments that were fixed with a posterior plate by the posterolateral approach. METHODS: Sixty-five patients who were followed for at least 12 months and were older than 18 years were included. The posterior malleolus fractures were classified according to the Haraguchi classification system with computed tomography (CT). The posterior malleolus fragments were fixed with a plate through a posterolateral approach. Intra-articular step-off, reduction of the posterior malleolar fragment, and fibular position in the incisura were evaluated by early postoperative CT. American Orthopaedic Foot and Ankle Society (AOFAS) score and visual analog scale pain score were used for clinical assessment. RESULTS: The posterior malleolus fractures were classified as Haraguchi type 1 in 45 patients (69.2%), Haraguchi type 2 in 12 patients (18.5%), and Haraguchi type 3 in eight patients (12.3%). No patients showed signs of instability or loss of reduction on direct radiographs during follow-up. Postoperative CT showed no loss of reduction in the posterior malleolus and tibiofibular alignment. On evaluation, there was no intra-articular step-off (<1) in any of the patients. The mean AOFAS score was calculated to be 91.6. The mean visual analog scale score was 1.2. CONCLUSIONS: We conclude that direct posterior fixation with the posterolateral approach can be a good option for ankle fractures involving posterior malleolar fragments.
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Fracturas de Tobillo , Huesos Tarsianos , Fracturas de Tobillo/diagnóstico por imagen , Fracturas de Tobillo/cirugía , Placas Óseas , Fijación Interna de Fracturas , Humanos , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
INTRODUCTION: We report the short-term outcomes of total hip arthroplasty(THA) in patients previously treated with Schanz osteotomy (SO). MATERIALS AND METHODS: Eighteen patients [2 male, 16 female; mean age, 55.4 (range, 50-66) years] who had undergone THA after SO were retrospectively evaluated. Clinical evaluation was performed based on the Harris hip score. Radiological evaluation was performed using full-length radiographs of the lower extremities, pelvis, and hip. RESULTS: The mean follow-up period was 30.8 (range, 18-56) months. Mean femoral shortening was 3.7 (range, 2-5) cm. Perioperative complications occurred in 4 (22.2%) patients. Nonunion was not found at the osteotomy sites. No dislocation was observed. The Trendelenburg sign was positive for five (27.7%) patients, postoperatively. The mean Harris hip score improved from 42.7 to 78.7 (p < 0.05). CONCLUSION: THA for hips previously treated with SO is technically demanding. If careful preoperative planning is performed, successful treatment can be achieved.
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Artroplastia de Reemplazo de Cadera/métodos , Luxación de la Cadera/cirugía , Osteotomía/métodos , Anciano , Femenino , Fémur/diagnóstico por imagen , Fémur/cirugía , Humanos , Masculino , Persona de Mediana Edad , Osteotomía/efectos adversos , Estudios RetrospectivosRESUMEN
PURPOSE: The aim of this study is to evaluate clinical and radiological results of simultaneous bilateral correction of genu varum with Smart frame. METHODS: Between 2011 and 2015, a total of 25 patients (10 females, 15 males) who had bilateral genu varum deformity were operated bilaterally with tibial and fibular osteotomy in the same session, using Smart frame. The mean follow-up period was 28.7 (range, 13-45) months. All patients had bilateral tibial varus deformity. Femoral deformity was corrected in an earlier session in nine patients. Mechanical axis deviation (MAD), mechanical lateral distal femoral angle, mechanical medial proximal tibial angle (mMPTA) and posterior proximal tibial angle (PPTA) were measured preoperatively and postoperatively. Short Form-36 questionnaire was filled by the patients preoperatively and during the last follow-up. RESULTS: The mean preoperative MAD was 37.6 mm (range, 9-98 mm), which improved to 8.4 mm (range, 3-44 mm) postoperatively ( p < 0.05). The mean preoperative mMPTA was 76°, which improved to 89° ( p < 0.05). The mean preoperative PPTA was 75.5°, which improved to 80.3 ( p < 0.05). Ten problems (20%), two obstacles (4%) and no sequelae occurred in 50 legs of 25 patients. CONCLUSIONS: In conclusion, Smart frame is an accurate and reliable method for performing bilateral simultaneous deformity correction in patients with bilateral genu varum deformity. It can be applied for various childhood-induced severe tibial deformities such as achondroplasia, rickets, skeletal dysplasia and Blount's disease.
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Genu Varum/cirugía , Fijadores Internos , Osteotomía , Adolescente , Adulto , Enfermedades del Desarrollo Óseo , Femenino , Peroné/cirugía , Genu Varum/diagnóstico , Genu Varum/etiología , Humanos , Masculino , Osteocondrosis/congénito , Radiografía , Raquitismo , Tibia/cirugía , Adulto JovenRESUMEN
PURPOSE: To evaluate the outcome of percutaneous radiofrequency ablation under guidance of 3-dimensional fluoroscopy in 17 patients with osteoid osteoma. METHODS: Records of 11 male and 6 female consecutive patients aged 4 to 28 (mean, 13.8) years who underwent radiofrequency ablation under guidance of 3-dimensional fluoroscopy for osteoid osteoma and were followed up for a mean of 15.8 (range, 12-28) months were reviewed. All patients had been treated with analgesics but failed to achieve lasting pain relief. Visual analogue score (VAS) for pain was assessed pre- and post-operatively. Absence of pain was considered recovery. RESULTS: The mean operating time was 55 (range, 20-95) minutes, and the mean length of hospital stay was 2.8 (range, 2-7) days. The mean amount of radiation was 390.2 (range, 330.5-423.6) mGy/cm. Relief of pain occurred within the first 24 hours in 11 patients and by the end of the first week in 3 patients. Pain persisted in 3 patients at one month; they underwent revision surgery and achieved complete recovery. The mean VAS for pain was 7.2 (range, 6-9) in 17 patients preoperatively and decreased to 0.64 (range, 0-2) in the 14 patients with pain relief and 0.66 (range, 0-1) in the 3 patients after revision surgery. Two patients had severe discharge from the wound secondary to fat necrosis, which resolved within a week with antibiotics and local dressings. No patient had cellulitis, vasomotor instability, neurovascular injury, fracture, or deep infection. CONCLUSION: Percutaneous radiofrequency ablation under guidance of 3-dimensional fluoroscopy is a viable treatment option for osteoid osteoma.
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Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Ablación por Catéter , Osteoma Osteoide/diagnóstico por imagen , Osteoma Osteoide/cirugía , Cirugía Asistida por Computador , Adolescente , Adulto , Neoplasias Óseas/complicaciones , Dolor en Cáncer/diagnóstico , Dolor en Cáncer/etiología , Dolor en Cáncer/prevención & control , Niño , Preescolar , Estudios de Cohortes , Femenino , Fluoroscopía , Humanos , Imagenología Tridimensional , Masculino , Tempo Operativo , Osteoma Osteoide/complicaciones , Reoperación , Tomografía Computarizada por Rayos X , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: The aim of the present study was to evaluate the effect of locking compression plate (LCP) and autografting application in patients with nonunion of forearm fractures on radiologic and clinical outcome. METHODS: A total of 26 patients (16 males, 10 females; mean age: 45.7 years) with nonunion after surgical treatment of forearm fractures were included. Nonunion was located in the ulna in 14 patients, in the radius in 5 patients, and in both in 7 patients (21 ulna, 12 radius).Infection markers were checked prior to surgery. Samples for microbiologic cultures were peroperatively obtained in 7 patients with a history of open fractures. Autografting from the iliac crest and 3.5-mm LCP were applied. Type of nonunion, time to unification, range of motion in the wrist and elbow joints, and complications were analyzed. Functional evaluation was performedusing the scoring system described by Anderson et al. RESULTS: Mean follow-up period was 49.3 months (range 24-73 months). Unification was achieved in a mean 5.7 months (range 3-14 months). Additional surgical process was not required. No bacterial proliferation was observed in cultures. Superficial infection was observed in 3 patients and deep infection in 1. Results were scored as excellent in 10 (38.4%) patients, satisfactory in 13 (50%), and unsatisfactory in 3 (11.6%). CONCLUSION: Treatment of aseptic forearm nonunion in adults with autografting from the iliac crest and 3.5-mmLCP fixation increases unification rate and aids in function recovery.
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Placas Óseas , Evaluación de Resultado en la Atención de Salud , Fracturas del Radio/cirugía , Fracturas del Cúbito/cirugía , Adolescente , Adulto , Anciano , Autoinjertos , Femenino , Fijación Interna de Fracturas , Humanos , Masculino , Persona de Mediana Edad , Fracturas del Radio/diagnóstico por imagen , Fracturas del Radio/epidemiología , Fracturas del Radio/patología , Rango del Movimiento Articular , Recuperación de la Función , Infección de la Herida Quirúrgica/epidemiología , Turquía/epidemiología , Fracturas del Cúbito/diagnóstico por imagen , Fracturas del Cúbito/epidemiología , Fracturas del Cúbito/patología , Adulto JovenRESUMEN
The purpose of this paper is to describe a biologic reconstruction strategy for defects after resection of malignant tibia tumors. Limb-sparing surgery was used for 4 patients with malignant tibia tumors. All patients were male, with an average age of 39.5 years (range: 34-46 years). Mean length of the resected tibia segment was 135 mm (range: 120-150 mm). The defects were primarily reconstructed with bone cement and locked plate until completion of the medical treatment of the tumor. The bone transport was made through locked plate, and the docking site was grafted at the final stage. Mean follow-up period was 49.75 months (range: 71-22 months). Mean distraction index was 1148 mm/days (range: 1130-1175 mm/days), and mean external fixation time was 167 days (range: 152-187 days). According to Paley, functional results were excellent in 2 cases and good in the other 2 cases. Radiological results were excellent in all cases. Two major and 2 minor complications were observed. In this method, stable internal fixation and active usage of extremities are provided until biological reconstruction, and possible wound problems can be completely eliminated during the duration of medical treatment of the tumor.
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Neoplasias Óseas/cirugía , Osteogénesis por Distracción/métodos , Osteotomía/métodos , Tibia/cirugía , Fracturas de la Tibia/cirugía , Adulto , Neoplasias Óseas/diagnóstico por imagen , Placas Óseas , Trasplante Óseo/métodos , Fijadores Externos , Estudios de Seguimiento , Fijación de Fractura/métodos , Humanos , Masculino , Persona de Mediana Edad , Procedimientos de Cirugía Plástica/métodos , Tibia/diagnóstico por imagen , Fracturas de la Tibia/diagnóstico por imagen , Resultado del TratamientoRESUMEN
OBJECTIVE: The aim of the present study was to evaluate intermediate-term outcomes of Chevron osteotomy for treatment of osteochondral lesions of the talus with mosaicplasty and to assess its effect on surgery and whether it reduces complications that might occur intraoperatively. METHODS: The present study included a total of 42 patients (31 men, 11 women) who underwent Chevron osteotomy of the medial malleolus and who had been followed for more than 2 years. Mean age of the patients was 34 years (range: 18-54 years). Preoperatively, size of the lesions was measured in millimeters in the coronal and sagittal planes using magnetic resonance imaging (MRI). The angle between the osteotomy with the long axis of the tibia was measured on the coronal plane, the angle between the arms and the angle for the screws to be directed to the osteotomy line were measured on the sagittal plane on the postoperative images. Nonunion, malunion, and complications from the screws were evaluated from X-ray images taken at the final follow-up. RESULTS: Mean duration for follow-up was 31.4 years (range: 24-46). On the X-ray images taken at the final follow-up, no distraction, migration of the distal part, or rotation was observed. Only 1 patient experienced radiological non-union. Mean duration to union was 5.8 weeks (range: 4-14 weeks). Screws of 8 patients were removed at an average of 7.4 months (range: 5-11 months). The angle between the osteotomy line and long axis of the tibia was 29.0°±6.5°, the angel between the osteotomy arms on the sagittal plane was 74.7°±8.3°, and the direction angle of the screws on the coronal plane was 85.7°±5.9°. CONCLUSION: Chevron osteotomy is an assistive surgical method used for treatment of osteochondral lesions located in the medial talar joint surface (TOL) which provides fast anatomical healing because it allows efficient fixation due to its geometry.
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Placa de Crecimiento/cirugía , Osteotomía/métodos , Tibia/cirugía , Adolescente , Adulto , Articulación del Tobillo , Femenino , Humanos , Masculino , Persona de Mediana Edad , Astrágalo/cirugía , Adulto JovenRESUMEN
PURPOSE: The aim of this retrospective clinical study is to evaluate the effect of growing rod lengthening technique on sagittal balance in relationship with the spinopelvic parameters, in early onset scoliosis (EOS). METHODS: Twenty-three patients (18 female, 5 male), with a mean age of 8.3 years during the operation (range 3.2-12.2), with EOS due to various etiologies were operated using growing rod (8 single, 15 dual) technique, between the years 2007 and 2011. The patients were operated in two different institutions and were evaluated retrospectively via the parameters on the radiographic charts including the mean curve angle, T1-S1 distance, cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal and coronal balance, pelvic tilt, sacral slope and pelvic incidence. The parameters were measured in the preoperative and the early postoperative periods and during the last follow-up. The data obtained from the measurements were evaluated statistically. Complications were also noted. RESULTS: The mean follow-up period was 34.2 months (range 24-57.6). The mean thoracic kyphosis angle was 53.6° (range 25°-119°) preoperatively, 39.6° (range 20°-61°) early postoperatively (p < 0.05) and 39.9° (range 21°-65°) during the last follow-up (p < 0.05). The mean lumbar lordosis angle was -46.1° (range -67° to -13°) preoperatively, -41° (range -64° to -11°) early postoperatively (p > 0.05) and -39.7° (range -62° to -16°) during the last follow-up (p > 0.05). Average sagittal balance was measured as 0.2 cm (range -7 to 24.7 cm) preoperatively, -0.1 cm (range -6.6 to 8.5 cm) initial postoperatively (p > 0.05) and -0.2 cm (range -7.3 to 13.5 cm) during the last follow-up (p > 0.05). The average pelvic incidence was found as 46.4° (range 27°-83°) preoperatively, 45.2° (range 28°-78°) (p > 0.05) early postoperatively and 45.7° (range 28°-82°) during the last follow-up (p > 0.05). We have encountered complications in 14 patients. These consisted of eight rod fractures, seven screw pull-outs, four hook dislodgements, three proximal junctional kyphosis, two screw nut loosening, one lamina fracture, one skin slough, one superficial wound infection and one deep wound infection. CONCLUSION: Significant improvement was found in the global thoracic kyphosis angle, by comparing the preoperative, the early postoperative and the last follow-up parameters statistically (p < 0.05). There was no statistically significant improvement in the spinopelvic parameters (p > 0.05). We claim that growing rod technique doesn't provide statistically significant improvement, in the sagittal spinal and the spinopelvic parameters, except for the kyphosis, in the treatment of EOS patients.
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Prótesis e Implantes , Escoliosis/cirugía , Niño , Femenino , Estudios de Seguimiento , Humanos , Cifosis/diagnóstico por imagen , Lordosis/diagnóstico por imagen , Masculino , Osteogénesis por Distracción , Pelvis/diagnóstico por imagen , Radiografía , Estudios Retrospectivos , Escoliosis/diagnóstico por imagenRESUMEN
OBJECTIVE: The aim of this study was to determine the differences, if any, between application parameters for the Taylor Spatial Frame (TSF) system obtained during surgery under fluoroscopy and after surgery from digital radiography. METHODS: This retrospective study included 17 extremities of 15 patients (8 male, 7 female; mean age: 21.9 years, range: 10 to 55 years) who underwent TSF after deformity and fracture. Application parameters measured by fluoroscopy at the end of surgery after mounting the fixator were compared with parameters obtained from anteroposterior and lateral digital radiographs taken 1 day after surgery. RESULTS: Fixator was applied to the femur in 8 patients, tibia in 6 and radius in 3. Mean time to removal of the frame was 3.5 (range: 3 to 7) months. Mean perioperative anteroposterior, lateral and axial frame offsets of patients were 9.1 (range: 3 to 20) mm, 18.1 (range: 5 to 37) mm and 95.3 (range: 25 to 155) mm, respectively. Mean postoperative anteroposterior, lateral and axial frame offset radiographs were 11.8 (range: 2 to 30) mm, 18 (range: 6 to 47) mm and 109.5 (range: 28 to 195) mm, respectively. There was no statistically significant difference between the groups (p>0.05). CONCLUSION: While measurements taken during operation may lengthen the duration in the operation room, fluoroscopy may provide better images and is easier to perform than digital radiography. On the other hand, there is no difference between measurements taken during perioperative fluoroscopy and postoperative digital radiography.
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Fijadores Externos , Fluoroscopía/métodos , Fijación de Fractura/métodos , Intensificación de Imagen Radiográfica/métodos , Adolescente , Adulto , Niño , Estudios de Cohortes , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/cirugía , Estudios de Seguimiento , Fijación de Fractura/instrumentación , Humanos , Cuidados Intraoperatorios/métodos , Masculino , Persona de Mediana Edad , Tempo Operativo , Atención Perioperativa/métodos , Cuidados Posoperatorios/métodos , Estudios Retrospectivos , Medición de Riesgo , Estadísticas no Paramétricas , Fracturas de la Tibia/diagnóstico por imagen , Fracturas de la Tibia/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: The objective of this study was to evaluate the radiological and clinical outcomes of treatment of subtalar arthrodesis in patients developing talocalcaneal arthrosis secondary to intra-articular calcaneal fractures. METHODS: The study included 20 patients (21 feet) who underwent subtalar arthrodesis due to symptomatic subtalar arthrosis following conservative treatment for intra-articular calcaneal fracture between 2005 and 2011. Autograft or allograft was used in 11 patients. Patients were evaluated clinically using the American Orthopedic Foot and Ankle Society (AOFAS) ankle hindfoot score. Hindfoot alignment, quality of subtalar fusion and arthritis occurring in other joints were used for the radiological evaluations. RESULTS: Mean duration of follow-up was 43 (range: 21 to 83) months. Mean preoperative AOFAS score was 61.7 (range: 40 to 67) and mean postoperative AOFAS score was 84.2 (range: 65 to 94). The difference between scores was statistically significant (p=0.001). Six patients had excellent, 8 good and 6 fair results. Complete fusion was achieved in 19 patients (20 feet). In 2 patients, arthritic changes were radiologically observed in the midtarsal joints. These changes were not symptomatic. There were no statistically significant differences between pre- and postoperative radiological measurements. No patients experienced malunion. CONCLUSION: While subtalar arthrodesis appears to provide radiological and clinical benefits, it may cause moderate and asymptomatic osteoarthritis in the midtarsal joints.
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Artrodesis/métodos , Calcáneo/lesiones , Fracturas Intraarticulares/terapia , Enfermedades Desatendidas/cirugía , Osteoartritis/cirugía , Articulación Talocalcánea/cirugía , Adulto , Análisis de Varianza , Autoinjertos , Trasplante Óseo/métodos , Calcáneo/diagnóstico por imagen , Moldes Quirúrgicos , Distribución de Chi-Cuadrado , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Curación de Fractura/fisiología , Humanos , Fracturas Intraarticulares/complicaciones , Fracturas Intraarticulares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Enfermedades Desatendidas/complicaciones , Enfermedades Desatendidas/diagnóstico , Osteoartritis/diagnóstico por imagen , Osteoartritis/etiología , Radiografía , Rango del Movimiento Articular/fisiología , Estudios Retrospectivos , Medición de Riesgo , Articulación Talocalcánea/diagnóstico por imagen , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: In this study, we aimed to compare the functional and radiological results of intramedullary nailing and plate fixation techniques in the surgical treatment of distal tibia diaphyseal fractures close to the ankle joint. METHODS: Between 2005 and 2011, 55 patients (32 males, 23 females; mean age 42 years; range 15 to 72 years) who were treated with intramedullary nailing (21 patients) or plate fixation (34 patients) due to distal tibia diaphyseal fracture were included in the study. The average follow-up period was 27.6 months (range, 12-82 months). The patients were evaluated with regard to nonunion, malunion, infection, and implant irritation. The AOFAS (American Orthopaedic Foot and Ankle Society) scale was used for the clinical evaluation. RESULTS: No statistically significant difference was found between the two surgical methods with respect to unification time, AOFAS score, accompanying fibula fracture, material irritation, and malunion. Nine patients had open fractures, and these patients were treated with plate fixation (p=0.100). Nonunion developed in three patients who were treated with plates. Infection occurred in one patient. Anterior knee pain was significantly higher in patients who were treated with intramedullary nails. There was no malunion in any patient. CONCLUSION: As the distal fragment is not long enough, plate fixation technique is usually preferred in the treatment of distal tibia diaphyseal fractures. In this study, we observed that if the surgical guidelines are followed carefully, intramedullary nailing is an appropriate technique in this kind of fracture. The malunion rates are not significantly increased, and it also has the advantages of being a minimally invasive surgery with fewer wound problems.
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Clavos Ortopédicos , Placas Óseas , Fijación Intramedular de Fracturas/efectos adversos , Fijación Intramedular de Fracturas/métodos , Fracturas de la Tibia/cirugía , Adolescente , Adulto , Anciano , Fracturas de Tobillo/cirugía , Niño , Femenino , Curación de Fractura , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
OBJECTIVE: The aim of this prospective study was to assess the effectiveness of the flexion-adduction-external rotation method in the reduction of acute anterior shoulder dislocations. METHODS: The study included 128 patients (98 male, 30 female; mean age: 33, range: 19 to 81) with a history of acute anterior shoulder dislocation treated with the flexion-adduction-external rotation method. Neurovascular examination was performed before and after reduction. Reduction duration and patient responses regarding the reduction method were recorded. RESULTS: First-time dislocation occurred in 92 patients and recurrent dislocation in 36. 111 patients had subcoracoid dislocations and 17 subglenoid dislocations. Fracture of the greater tubercle was present in 13 patients. Reduction was achieved in the first attempt in 104 patients and in the second in 12 patients. Mean reduction time was under 1.5 (range: 0 to 5) minutes. Reduction was unsuccessful in 12 patients and reduction under general anesthesia was performed. No patients experienced neurovascular injury after reduction. CONCLUSION: The forward flexion-adduction-external rotation method is an effective and comfortable reduction method for the treatment of shoulder dislocation or fracture-dislocation.
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Manipulación Ortopédica , Luxación del Hombro , Fracturas del Hombro , Adulto , Femenino , Humanos , Masculino , Manipulación Ortopédica/efectos adversos , Manipulación Ortopédica/métodos , Radiografía , Recuperación de la Función , Recurrencia , Reproducibilidad de los Resultados , Luxación del Hombro/complicaciones , Luxación del Hombro/terapia , Fracturas del Hombro/complicaciones , Fracturas del Hombro/terapia , Articulación del Hombro/diagnóstico por imagen , Resultado del TratamientoRESUMEN
PURPOSE: The aim of this study was to evaluate the clinical and radiological results of patients presenting older than eight years and treated with Salter osteotomy for Perthes disease. METHOD: Seventeen patients (18 hips) with late presentation of Perthes disease treated with Salter osteotomy. Sixteen males were identified. The average age of patients was 8.8 years (range 8-12). Preoperation radiographs were analysed for lateral pillar staging, centre-periphery (CP) angle, Sharp acetabular index, acetabular depth index, acetabular covering percentage and Cross-over sign. Final follow-up radiograph were classified using modified Stulberg grade. RESULTS: The average follow-up of the patients was 78 months (range 40-104). During the surgery, seven hips were found to be lateral pillar grade B, three hips grade B/C and 8 hips grade C. In the final examination, 10 hips were evaluated as good (Stulberg 1 or 2), seven as medium (Stulberg 3) and one as bad (Stulberg 4). There was shortening in four patients who were all either Stulberg stage 3 or 4. A meaningful difference was detected between the pre-operation and post-operation radiographic values, regardless of the surgical staging. However, no statistical difference was found between the patients in Stulberg stage 3 or 4 and stage 1 or 2 for radiographic variables. CONCLUSION: Salter osteotomy can be used to treat older patients with lateral pillar stage B, B/C and C at presentation.
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Enfermedad de Legg-Calve-Perthes/cirugía , Osteotomía/métodos , Huesos Pélvicos/cirugía , Niño , Femenino , Estudios de Seguimiento , Humanos , Enfermedad de Legg-Calve-Perthes/diagnóstico por imagen , Masculino , Huesos Pélvicos/diagnóstico por imagen , Radiografía , Estudios Retrospectivos , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: The purpose of this study is to present and validate a hinge-fixator technique for the treatment of open tibial fractures, which has advantages in application and the follow up period. METHODS: The technique was used in open tibia fractures of 14 adult patients. Using this method, initial anatomic reduction was achieved and temporary stability was obtained on the hinge-fixator after applications were completed. Patients' radiological and clinical results were analyzed using the Paley's criteria at the time of the last follow-up. RESULTS: Patients were brought in for followed up analysis over a 5.4 year period. According to Paley, two patients had 'good' and 12 patients had 'excellent' radiological results, while the functional result were excellent (n=13) and good (n=1), respectively. CONCLUSION: The hinge-fixator technique is a fast and easy method that contributes to shorter operation times, reduced radiation exposure, and more comfortable treatment periods.
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Fijadores Externos , Fracturas Abiertas/cirugía , Fracturas de la Tibia/cirugía , Adulto , Diseño de Equipo , Femenino , Fijación de Fractura/métodos , Humanos , Masculino , Persona de Mediana Edad , Tempo Operativo , Rango del Movimiento Articular , Recuperación de la Función , Adulto JovenRESUMEN
We report a 45-year-old male archer with stress fracture in his left ulna on the background of adult type of hypophosphatasia. The patient presented to several medical centers for pain around the left elbow and received medical treatment upon diagnosis of tenosynovitis. History of the patient revealed that he had had diagnosis of hypophosphatasia ten years ago and underwent percutaneous screwing for stress fracture on both of his femoral necks. Upon finding nondisplaced stress fracture on proximal metaphysis of the ulna on X-ray, the patient underwent magnetic resonance imaging (MRI) in order to exclude pathological causes. No additional pathology was observed in MRI scanning. The patient's sportive activities were restricted for 6 weeks and he received conservative management with arm slings. Adult type of hypophosphatasia is a disease manifesting with widespread osteoporosis and presenting with low serum level of alkali phosphatase (ALP). Stress fracture should definitely be considered in the patients with history of hypophosphatasia and refractory extremity pain.
RESUMEN
The authors studied the plain radiographs and medical records of 5000 military recruits, mean age 19.1 years (range: 18 to 22), screened in a Turkish Military Hospital in the period November 2008-October 2009. They focused on the incidence of congenital lumbosacral malformations, such as spina bifida occulta and transitional vertebra, trying to find a correlation with subsequent low back complaints. Only 80 out of 748 subjects (10.7%) with low back complaints had one or more malformations, versus 744 out of 4252 subjects (17.5%) without low back complaints. This pleaded against a correlation between malformations and low back disorders. Also the literature is completely divided as to this problem, which means that there is probably no correlation at all. Interestingly, the 80 subjects with low back complaints and malformation estimated their pain level at +/- 4.6 on a Visual Analog Scale for pain, while the 668 with low back complaints but without malformation estimated their pain level at only +/- 2.2 (p = 0.007). At least two other studies led to the same conclusion. This paradox might be due to the fact that congenital malformations concentrate all external stress on the adjacent levels.
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Dolor de la Región Lumbar/epidemiología , Vértebras Lumbares/anomalías , Sacro/anomalías , Disrafia Espinal/epidemiología , Adolescente , Adulto , Humanos , Dolor de la Región Lumbar/etiología , Masculino , Dimensión del Dolor , Disrafia Espinal/complicaciones , Adulto JovenRESUMEN
Osteoarthritis is a chronic disease that causes serious pain and limitations in activities. Intraarticular corticosteroid injections combined with pharmacological treatment and physiotherapy have been used for years to control the local inflammation and relieve pain in the patients with osteoarthritis. There are several animal experiments which suggested that the intraarticular corticosteroid injections impair cartilage protein synthesis. However, there are no serious evidences suggesting the increase of cartilage impairment. The aim of our study was to compare the efficacy of placebo and intraarticular corticosteroid agents in the patients with symptomatic knee osteoarthritis. One hundred and twenty patients with painful knee osteoarthritis were included in the prospective, randomized, controlled study. The patients were randomized into four groups. Each group consisted of thirty patients. Intraarticular single dose of methylprednisolone acetate (40 mg, 1 ml), Betametazone disodium phosphate (3 mg, 1 ml), Triamsinolon acetonate (40 mg, 1 ml), and serum physiological (0.09% NaCl, 1 ml) were administrated to the groups, respectively. The patients were evaluated by Visual Analog Scale (0-10 cm [VAS]) for the pain severity, and by Lequesne Functional Index for functional state before treatment, and at the 1st, 3rd, 6th, and 12th weeks. Our results showed that single doses of three agents provided symptomatic and functional relief and their effects reduced at the 12th week. However, methylprednisolone acetate was a statistically more effective analgesic as compared to the other agents until the sixth week.
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Betametasona/uso terapéutico , Glucocorticoides/uso terapéutico , Metilprednisolona/uso terapéutico , Osteoartritis de la Rodilla/tratamiento farmacológico , Dolor/tratamiento farmacológico , Anciano , Betametasona/administración & dosificación , Femenino , Glucocorticoides/administración & dosificación , Humanos , Inyecciones Intraarticulares , Articulación de la Rodilla/efectos de los fármacos , Articulación de la Rodilla/fisiopatología , Masculino , Metilprednisolona/administración & dosificación , Persona de Mediana Edad , Osteoartritis de la Rodilla/fisiopatología , Dolor/fisiopatología , Dimensión del Dolor , Resultado del TratamientoRESUMEN
Open calcaneal fractures are high morbidity injuries and the risk of complications depends on the concomitant injuries, on the size and the position of the traumatic wound. A 53-year-old male patient with bilateral open calcaneal fractures and associated concomitant lower extremity injuries such as subtalar dislocation, talonavicular dislocation and open distal tibial metaphyseal fracture was immediately operated by percutaneous Kirschner wire fixation combined with external fixators. He was able to walk with full weight bearing without any assistance at the end of the first postoperative year. Early aggressive debridement and irrigation followed by fixation with percutaneous Kirschner wires and external fixator can supply bony alignment in open comminuted calcaneal fractures associated with concomitant lower extremity injuries and should be considered for the healthy and active patients before primary arthrodesis.
RESUMEN
OBJECTIVES: We evaluated the results of conservative and surgical treatment of pediatric Monteggia equivalent lesions. METHODS: The study included 13 children (3 females, 10 males; mean age 8 years; range 4 to 13 years) who underwent treatment for Monteggia equivalent lesions. Seven patients (53.9%) had Bado type 1 and six patients (46.2%) had type 3 equivalent lesions. Two patients with type 3 equivalent lesions also had a lateral humeral condyle fracture. On presentation, one patient (7.7%) had radial nerve palsy. Primarily, closed reduction was attempted in all the patients except for one patient who underwent urgent debridement and irrigation for an open fracture-dislocation. Reduction was successful in eight patients (61.5%). Upon failure of closed reduction, four patients (30.8%) underwent surgery within the first 24 hours of injury. Functional assessment was made according to the Reckling's criteria. The mean follow-up period was 4.1 years (range 2 to 7 years). RESULTS: None of the patients had nonunion. Conservative treatment did not result in loss of reduction of the radius head or limitation in the range of motion of the elbow joint. Except for the patient with an open fracture-dislocation leading to a poor functional result, the results were good in all the patients receiving conservative or surgical treatment. One patient (7.7%) treated conservatively developed cubitus varus (5 degrees ) and posterior angulation (20 degrees ) of the ulnar fracture line. One patient treated surgically had limitation of supination (10 degrees ) without limitation of flexion or extension of the elbow joint. Accompanying radial nerve palsy in this patient disappeared in the postoperative third month. CONCLUSION: Closed reduction is the first choice of treatment in pediatric Monteggia equivalent lesions. Surgical treatment becomes necessary if closed reduction fails.