RESUMEN
OBJECTIVE: To report the evaluation, surgical planning, and outcome for correction of a complex limb deformity in the tibia of a donkey using computed tomographic (CT) imaging and a 3D bone model. STUDY DESIGN: Case report. ANIMALS: A 1.5-year-old, 110 kg donkey colt with an angular and torsional deformity of the right pelvic limb. METHODS: Findings on physical examimation included a severe, complex deformity of the right pelvic limb that substantially impeded ambulation. Both hind limbs were imaged via CT, and imaging software was used to characterize the bone deformity. A custom stereolithographic bone model was printed for preoperative planning and rehersal of the surgery. A closing wedge ostectomy with de-rotation of the tibia was stabilized with 2 precontoured 3.5-mm locking compression plates. Clinical follow-up was available for 3.5 years postoperatively. RESULTS: CT allowed characterization of the angular and torsional bone deformity of the right tibia. A custom bone model facilitated surgical planning and rehearsal of the procedure. Tibial corrective ostectomy was performed without complication. Postoperative management included physical rehabilitation to help restore muscular function and pelvic limb mechanics. Short-term and long-term follow-up confirmed bone healing and excellent clinical function. CONCLUSION: CT imaging and stereolithography facilitated the evaluation and surgical planning of a complex limb deformity. This combination of techniques may improve the accuracy of the surgeons' evaluation of complex bone deformities in large animals, shorten operating times, and improve outcomes.
Asunto(s)
Traumatismos de la Pierna/veterinaria , Estereolitografía , Tibia/cirugía , Tomografía Computarizada por Rayos X/veterinaria , Anomalía Torsional/veterinaria , Animales , Equidae , Traumatismos de la Pierna/rehabilitación , Traumatismos de la Pierna/cirugía , Masculino , Tibia/lesiones , Anomalía Torsional/rehabilitación , Anomalía Torsional/cirugíaRESUMEN
Diastolic dysfunction is common in coronary artery disease (CAD). Exercise-based cardiac rehabilitation (CR) improves survival and quality of life but its effect on diastolic function is unclear. We sought to determine the impact of CR on diastolic function. We conducted a prospective study of CAD patients referred for 3-month outpatient CR, with pre-CR and post-CR echocardiograms. Twenty-five outpatients (age [mean ± SD], 66 ± 11 ! years; 7 [28 %] women; 22 [88 %] with recent acute coronary syndrome) were recruited upon beginning CR; one patient lacking follow-up was excluded from analysis. Before CR, patients' mean ejection fraction was 61 ± 7 %; regional wall motion score index was 1.18 ± 0.28; and left ventricular diastolic dysfunction existed in 21 (88 %). Of the 24 (96 %) patients with post-CR follow-up, 12 (50 %) had improved diastolic function, 2 of the 24 (8 %) had normal diastolic function throughout, nine (38 %) remained at the same grade, and one (4 %) had worsened diastolic function. The E/e' ratio improved significantly after CR (11.9 ± 4.5 vs. 10.7 ± 4.5; P = .048). Fourteen patients with normal or improved diastolic function had a greater decrease in left atrial volume index (-4.2 ± 6.3 vs. 1.6 ± 6.3 mL/m(2); P = .04) and a greater increase in peak untwisting rate (20 ± 36 vs. -42 ± 45 °/s; P = .003) than did patients with no diastolic improvement. Three-month, exercise-based CR was associated with improved left ventricular diastolic function in half of our patients. Further large studies are needed to clarify the effect of CR on diastolic dysfunction in patients with CAD.
Asunto(s)
Enfermedad de la Arteria Coronaria/rehabilitación , Diástole , Terapia por Ejercicio , Anomalía Torsional/rehabilitación , Disfunción Ventricular Izquierda/rehabilitación , Función Ventricular Izquierda , Anciano , Atención Ambulatoria , Enfermedad de la Arteria Coronaria/diagnóstico , Enfermedad de la Arteria Coronaria/fisiopatología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos Piloto , Estudios Prospectivos , Recuperación de la Función , Volumen Sistólico , Factores de Tiempo , Anomalía Torsional/diagnóstico , Anomalía Torsional/fisiopatología , Resultado del Tratamiento , Disfunción Ventricular Izquierda/diagnóstico , Disfunción Ventricular Izquierda/fisiopatologíaRESUMEN
BACKGROUND: Tibial malrotation is a complication that is seen in approximately 30% of patients following locked intramedullary nailing. In this cohort study, we evaluated the hypothesis that tibial malrotation would lead to impaired functional outcomes. METHODS: Patients with a unilateral tibial shaft fracture who were managed with intramedullary nailing between 2003 and 2007 were identified with use of ICD-10 (International Classification of Diseases, 10th Revision) codes. After institutional review board approval and written informed consent had been obtained, specific assessment of eligible patients was achieved with use of computed tomography, functional measures (Lower Extremity Functional Scale, Olerud-Molander Score, six-minute walk test), and physical examination. Measures were compared between patients with and without tibial malrotation (defined as tibial rotation of ≥ 10°) on imaging studies. RESULTS: Of the 288 patients who were identified, 100 were eligible for the study and seventy consented to participate. The mean duration of follow-up (and standard deviation) for these seventy patients was 58 ± 11 months. Twenty-nine patients (41%) had tibial malrotation. Lower Extremity Functional Scale scores were similar between the groups with and without malrotation (mean, 70.8 ± 8.6 points compared with 72.6 ± 8.7 points; p = 0.41). The results for the other functional tests were also similar. CONCLUSIONS: Despite high rates of tibial malrotation following locked intramedullary nailing of isolated tibial diaphyseal fractures, this finding does not have a significant intermediate-term functional impact.
Asunto(s)
Desviación Ósea/diagnóstico por imagen , Desviación Ósea/etiología , Fijación Intramedular de Fracturas/efectos adversos , Fracturas de la Tibia/cirugía , Anomalía Torsional/diagnóstico por imagen , Anomalía Torsional/etiología , Adolescente , Adulto , Anciano , Desviación Ósea/epidemiología , Desviación Ósea/rehabilitación , Clavos Ortopédicos , Estudios de Cohortes , Intervalos de Confianza , Femenino , Estudios de Seguimiento , Fijación Intramedular de Fracturas/métodos , Fijación Intramedular de Fracturas/estadística & datos numéricos , Humanos , Incidencia , Puntaje de Gravedad del Traumatismo , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Rotación , Fracturas de la Tibia/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Anomalía Torsional/epidemiología , Anomalía Torsional/rehabilitación , Torsión Mecánica , Centros Traumatológicos , Resultado del Tratamiento , Adulto JovenRESUMEN
A clear understanding of the pathophysiology of anterior knee pain is inhibited by the use of imprecise, poorly defined, and often interchanged words, such as malalignment, patellar alignment, maltracking, subluxation, dislocation, and congruence. The literature is filled with articles regarding the diagnosis, "malalignment of the patella," most of which give no precise diagnosis. This article presents a definition of malalignment and a plea for rational descriptive and scientific analysis. Much of what is described is based on theory, not facts. These ideas are supported by clinical experience and logical analysis, but very little in the way of scientific data. Most of the data involve radiographic images, which present only one piece of the puzzle.