RESUMEN
BACKGROUND: No consensus is available regarding which radiographic measurement most accurately correlates with anterior coverage of the femoral head. PURPOSE: (1) To determine the correlation between 2 measurements of anterior wall coverage: total anterior coverage (TAC) calculated from radiographs and equatorial anterior acetabular sector angle (eAASA) calculated from computed tomography (CT) scans; (2) to define the correlation between anterior center-edge angle (ACEA) and anterior wall index (AWI) with TAC and eAASA; and (3) to investigate what other radiographic metrics may help predict anterior coverage. STUDY DESIGN: Cohort study (Diagnosis); Level of evidence, 3. METHODS: The authors retrospectively reviewed 77 hips (48 patients) for which radiographs and CT scans were obtained for reasons other than hip-related pain. Mean age of the population was 62 ± 22 years; 48 (62%) hips were from female patients. Two observers measured lateral center-edge angle (LCEA), AWI, Tönnis angle, ACEA, CT-based pelvic tilt, and CT-based acetabular version, with all Bland-Altman plots within 95% agreement. Correlation between intermethod measurements was estimated with a Pearson coefficient. Linear regression was used to test the ability of baseline radiographic measurements to predict both TAC and eAASA. RESULTS: Pearson coefficients were r = 0.164 (ACEA vs TAC; P = .155), r = 0.170 (ACEA vs eAASA; P = .140), r = 0.58 (AWI vs TAC; P = .0001), and r = 0.693 (AWI vs eAASA; P < .0001). Multiple linear regression model 1 showed that AWI (ß = 17.8; 95% CI, 5.7 to 29.9; P = .004), CT acetabular version (ß = -0.45; 95% CI, -0.71 to -0.22; P = .001), and LCEA (ß = 0.33; 95% CI, 0.19 to 0.47; P = .001) were useful to predict TAC. Multiple linear regression model 2 revealed that AWI (ß = 25; 95% CI, 15.67 to 34.4; P = .001), CT acetabular version (ß = -0.48; 95% CI, -0.67 to -0.29; P = .001), CT pelvic tilt (ß = 0.26; 95% CI, 0.12 to 0.4; P = .001), and LCEA (ß = 0.21; 95% CI, 0.1 to 0.3; P = .001) accurately predicted eAASA. Model-based estimates and 95% CIs using 2000 bootstrap samples from the original data were 6.16 to 28.6 for AWI in model 1 and 15.1 to 34.26 for AWI in model 2. CONCLUSION: There was a moderate to strong correlation between AWI and both TAC and eAASA, whereas ACEA correlated weakly with the former measurements, thus not being useful to quantify anterior acetabular coverage. Other variables such as LCEA, acetabular version, and pelvic tilt may also help predict anterior coverage in asymptomatic hips.
Asunto(s)
Acetábulo , Cabeza Femoral , Humanos , Femenino , Adulto , Persona de Mediana Edad , Anciano , Anciano de 80 o más Años , Estudios Retrospectivos , Cabeza Femoral/diagnóstico por imagen , Estudios de Cohortes , Acetábulo/diagnóstico por imagen , Articulación de la Cadera , ArtralgiaRESUMEN
BACKGROUND: Early containment surgery has become increasingly popular in Legg-Calvé-Perthes Disease (LCPD), especially for older children. These procedures treat the proximal femur, the acetabulum, or both, and most surgeons endorse the same surgical option regardless of an individual patient's anatomy. This "one-surgery-fits-all" approach fails to consider potential variations in baseline anatomy that may make one option more sensible than another. We sought to describe hip morphology in a large series of children with newly diagnosed LCPD, hypothesizing that variation in anatomy may support the concept of anatomic-specific containment. METHODS: A retrospective review of a prospectively collected multicenter database was conducted for patients aged 6 to 11 at diagnosis. To assess anatomy before significant morphologic changes secondary to the disease itself, only patients in Waldenström stages IA/IB were included. Standard hip radiographic measurements including acetabular index, lateral center-edge angle, proximal femoral neck-shaft angle (NSA), articulotrochanteric quartiles, and extrusion index (EI) were made on printed anteroposterior pelvis radiographs. Age-specific percentiles were calculated for these measures using published norms. Significant outliers (≤10th/≥90th percentile) were reported where applicable. RESULTS: A total of 168 patients with mean age at diagnosis of 8.0±1.3 years met inclusion criteria (81.5% male). Mean acetabular index for the entire cohort was 16.8±4.1 degrees; 58 hips (34.5%) were significantly dysplastic compared with normative data. Mean lateral center-edge angle was 15.9±5.2 degrees at diagnosis; 110 (65.5%) were ≤10th percentile indicating dysplasia (by this metric). Mean NSA overall was 136.5±7.0 degrees. Fifty-one (30.4%) and 20 (11.9%) hips were significantly varus (≤10th percentile) or valgus (≥90th percentile), respectively. Thirty-five hips (20.8%) were the third articulo-trochanteric quartiles or higher suggesting a higher-riding trochanter at baseline. Mean EI was 15.5%±9.0%, while 63 patients (37.5%) had an EI ≥20%. CONCLUSIONS: The present study finds significant variation in baseline anatomy in children with early-stage LCPD, including a high prevalence of coexisting acetabular dysplasia as well as high/low NSAs. These variations suggest that the "one-surgery-fits-all" approach may lack specificity for a particular patient; a potentially wiser option may be an anatomic-specific containment operation (eg, acetabular-sided osteotomy for coexisting dysplasia, varus femoral osteotomy for valgus NSA). LEVEL OF EVIDENCE: Level IV.
Asunto(s)
Acetábulo/patología , Cabeza Femoral/patología , Enfermedad de Legg-Calve-Perthes/patología , Enfermedad de Legg-Calve-Perthes/cirugía , Acetábulo/diagnóstico por imagen , Acetábulo/cirugía , Variación Anatómica , Niño , Bases de Datos Factuales , Epífisis/diagnóstico por imagen , Epífisis/patología , Epífisis/cirugía , Femenino , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/cirugía , Luxación de la Cadera/complicaciones , Luxación de la Cadera/diagnóstico por imagen , Luxación de la Cadera/cirugía , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/patología , Articulación de la Cadera/cirugía , Humanos , Enfermedad de Legg-Calve-Perthes/complicaciones , Enfermedad de Legg-Calve-Perthes/diagnóstico por imagen , Masculino , Radiografía , Estudios RetrospectivosRESUMEN
BACKGROUND: Following successful treatment of developmental hip dysplasia with a Pavlik harness, controversy exists over the benefit of continued harness use for an additional "weaning" period beyond ultrasonographic normalization versus simply terminating treatment. Although practitioners are often dogmatic in their beliefs, there is little literature to support the superiority of 1 protocol over the other. The purpose of this study was to compare the radiographic outcomes of 2 cohorts of infants with developmental hip dysplasia treated with Pavlik harness, 1 with a weaning protocol and 1 without. METHODS: This was a comparative review of patients with dislocated/reducible hips and stable dysplasia from 2 centers. All patients had pretreatment ultrasounds, and all started harness treatment before 3 months of age. On the basis of power analysis, a sufficient cohort of hips were matched based on clinical examination, age at initiation, initial α angle, and initial percent femoral head coverage. Patients from institution W (weaned) were weaned following ultrasonographic normalization, whereas those from institution NW (not weaned) immediately ceased treatment. The primary outcome was the acetabular index at 1 year of age. RESULTS: In total, 16 dislocated/reducible and 16 stable dysplastic hips were matched at each center (64 total hips in 53 patients). Initial α angle and initial femoral head coverage were not different between cohorts for either stable dysplasia (P=0.59, 0.81) or dislocated/reducible hips (P=0.67, 0.70), respectively. As expected, weaned hips were treated for significantly longer in both the stable dysplasia (1540.4 vs. 1066.3 h, P<0.01), and dislocated/reducible cohorts (1596.6 vs. 1362.5 h, P=0.01). Despite this, we found no significant difference in the acetabular index at 1 year in either cohort (22.8 vs. 23.1 degrees, P=0.84 for stable dysplasia; 23.9 vs. 24.8 degrees, P=0.32 for Ortolani positive). CONCLUSIONS: Despite greater total harness time, infants treated with additional Pavlik weaning did not demonstrate significantly different radiographic results at 1 year of age compared with those who were not weaned. However, differences in follow-up protocols between centers support the need for a more rigorous randomized controlled trial. LEVEL OF EVIDENCE: Level III.
Asunto(s)
Luxación Congénita de la Cadera/terapia , Aparatos Ortopédicos/estadística & datos numéricos , Acetábulo/diagnóstico por imagen , Tirantes , Estudios de Cohortes , Femenino , Cabeza Femoral/diagnóstico por imagen , Luxación Congénita de la Cadera/diagnóstico por imagen , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Factores de Tiempo , Resultado del Tratamiento , UltrasonografíaRESUMEN
Valgus slipped capital femoral epiphysis (SCFE), is rare. This study describes the diagnosis, treatment and outcome of valgus SCFE in Uruguay. The medical records and radiographs were reviewed in eight consecutive children [mean age 11.9 years (range 9-13; six female)] with valgus SCFE between 1997-2017. In 2018-2019, all patients were reexamined clinically, new radiographs obtained, and patient-reported outcomes completed using the international tool of hip results (iHOT-12). The prevalence of clinical femoroacetabular impingement (FAI), avascular necrosis, and surgical complications were also studied. There were 11 valgus SCFEs in eight patients; two had primary bilateral SCFEs, and one child later developed a valgus SCFE in the contralateral hip. Seven out of eight patients were overweight. All were stable idiopathic SCFEs. The mean femoral head shaft angle on the anteroposterior radiographs for the 11 SCFEs was 145° (range 140-168) and 141° (range 139-145) for the six healthy contralateral hips. Slip severity measured on the Lauenstein projection was mild (<30°) in eight hips and moderate (30°-60°) in three hips. At a mean follow-up of 87 months (range 24-252), there were no cases of avascular necrosis. The mean iHOT12 was 74 (range 13-97). Significant remodeling was detected in both head shaft angle (8°) and alpha angle (10°) in the affected hips. Nine hips (81%) demonstrated clinical signs of FAI. Our study is the first to describe long-term results using both clinical and patient outcome measures (iHOT-12). A majority of patients have residual symptoms, likely associated with FAI.
Asunto(s)
Pinzamiento Femoroacetabular , Epífisis Desprendida de Cabeza Femoral , Adolescente , Niño , Femenino , Pinzamiento Femoroacetabular/diagnóstico por imagen , Pinzamiento Femoroacetabular/cirugía , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/cirugía , Humanos , Medición de Resultados Informados por el Paciente , Estudios Retrospectivos , Epífisis Desprendida de Cabeza Femoral/diagnóstico por imagen , Epífisis Desprendida de Cabeza Femoral/cirugíaRESUMEN
CASE: We report the case of a patient who suffered traumatic avulsion of the gluteus medius and minimus tendons associated with posterior fracture-dislocation of the femoral head. The patient was treated with open reduction and internal fixation, followed by gluteus tenodesis with intraosseous anchors. CONCLUSION: Although in isolation, gluteus medius or gluteus minimus tendons tear, hip dislocation, and head fractures are relatively common injuries; the concurrence of these lesions is noteworthy for its rarity. This patient had an uneventful postoperative evolution, with a complete functional recovery, healing of the femoral head fracture and the tendons, and absence of signs of avascular necrosis.
Asunto(s)
Cabeza Femoral/lesiones , Fijación Interna de Fracturas/métodos , Luxación de la Cadera/complicaciones , Fracturas de Cadera/complicaciones , Traumatismos de los Tendones/etiología , Accidentes de Tránsito , Adulto , Nalgas/lesiones , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/cirugía , Fijación Interna de Fracturas/instrumentación , Luxación de la Cadera/diagnóstico por imagen , Luxación de la Cadera/cirugía , Fracturas de Cadera/diagnóstico por imagen , Fracturas de Cadera/cirugía , Humanos , Masculino , Traumatismos de los Tendones/cirugía , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Although ultrasound (US) is frequently used in diagnosis and management of infantile developmental dysplasia of the hip, precise ultrasonographic parameters of what constitutes a dislocation, subluxation etc remain poorly defined. The purpose of this study was (1) to describe the ultrasonographic characteristics of a large cohort of clinically dislocated but reducible hips and (2) to begin to develop ultrasonographic definitions for what constitutes a hip dislocation. METHODS: A retrospective review of prospectively collected data from an international multicenter study group on developmental dysplasia of the hip was conducted on all patients under 6 months of age with hip(s) that were dislocated at rest but reducible based on initial physical examination (ie, Ortolani positive). Femoral head coverage (FHC), alpha angle (α), and beta angle (ß) were measured on pretreatment US by the individual treating surgeon, and were recorded directly into the database. RESULTS: Based on 325 Ortolani positive hips, the median FHC on presentation was 10% with an interquartile range of 0% to 23%. A total of 126 of the 327 hips (39%) demonstrated 0% FHC. The 90th percentile was found to be at 33% FHC. Of 264 hips with sufficient α data, the median α was 43 degrees with an interquartile range from 37 to 49 degrees. The 90th percentile for α was at 54 degrees. A total of 164 hips had documented ß with a median of 66 degrees and an interquartile range of 57 to 79 degrees; the 90th percentile was at 94 degrees. CONCLUSIONS: Analysis of a large cohort of patients with dislocated but reducible hips reveals a median percent FHC of 10%, a median α of 43 degrees, and a median ß of 66 degrees on initial US. Using a threshold at the 90th percentile, a sensible ultrasonographic definition of a dislocated hip seems to be FHC≤33%, implying that FHC between 34% and 50% may be reasonably termed a subluxation. Although these findings are consistent with previous, smaller reports, further prospective research is necessary to validate these thresholds. LEVEL OF EVIDENCE: Level IV-diagnostic study.
Asunto(s)
Cabeza Femoral/diagnóstico por imagen , Luxación Congénita de la Cadera/diagnóstico por imagen , Ultrasonografía , Femenino , Luxación Congénita de la Cadera/terapia , Humanos , Lactante , Masculino , Examen Físico , Estudios RetrospectivosRESUMEN
Developmental dysplasia of the hip (DDH) is a developmental defect that prevents normal articulation between the acetabulum and the femoral head. This is an unusual condition, with a prevalence of 1-2 per thousand, and with only two poorly described skeletons documented in South American paleopathological literature. In this work we report an individual with such a condition, from the archeological site Tres Cruces I (Quebrada del Toro, Salta, Argentina). Several radiocarbon dates and associated materials date it to the Superior Formative (400-1000 AD). The remains are of an adult female, who also has tabular oblique cranial modification. Through detection of abnormalities in the morphology of the femora and ossa coxae, a differential diagnosis was carried out. On the left hip joint the formation of a well-defined false acetabulum, without connection with the true one, was observed. The latter was shallow, triangular, with an irregular base. The left os coxae showed a wider greater sciatic notch angle. The right os coxae exhibited a false acetabulum connected with the true one. Both femora presented a small femoral head, flat and mushroom-shaped, with shortening of the neck. These features were more pronounced on the right-side elements. On the basis of the aforementioned, a presumptive diagnosis of bilateral developmental dysplasia of the hip with complete dislocation on both sides was established.
Asunto(s)
Arqueología , Luxación Congénita de la Cadera/historia , Paleopatología , Acetábulo/diagnóstico por imagen , Acetábulo/patología , Adulto , Argentina , Diagnóstico Diferencial , Femenino , Fémur/diagnóstico por imagen , Fémur/patología , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/patología , Luxación Congénita de la Cadera/diagnóstico por imagen , Luxación Congénita de la Cadera/patología , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/patología , Historia Antigua , Historia Medieval , Humanos , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: Current dogma contends that prolonged treatment of a dislocated hip in Pavlik harness beyond 3 weeks will cause "Pavlik harness disease." To our knowledge, however, no previous studies have documented objective morphologic changes to the acetabulum from continued treatment of a persistently dislocated hip. METHODS: We retrospectively reviewed a consecutive series of infants with developmental dysplasia of the hip, below 6 months old, who failed Pavlik treatment from a single, tertiary-care pediatric hospital and a multicenter, international study group. Inclusion criteria were dislocated hips confirmed by ultrasound (both initially and at Pavlik termination) and a minimum of 2 ultrasounds during harness treatment at least 3 weeks apart. As a global measure of acetabular morphology, α angle (AA) was compared between initial and final ultrasound. The final means of obtaining successful hip reduction was recorded from the medical records. RESULTS: Forty-nine hips in 38 patients were identified. Median age at Pavlik initiation was 4 weeks (range, 0 to 18 wk); median time in harness was 6 weeks (range, 3 to 14 wk). Surprisingly, a mean of 4 degrees improvement in AA (95% CI, 2-6 degrees; P=0.001) was observed between first and final ultrasound. We found no difference in AA change between those in harness 3 to 5 weeks and those with prolonged wear >5 weeks (P=0.817). There was no significant association between change in AA and time in harness (P=0.545), age at Pavlik initiation (P=0.199), clinical reducibility of the hip (P=0.202), or initial percent femoral head coverage (P=0.956). Following harness failure, 22/49 hips (45%) were successfully treated with rigid abduction bracing, 16 (33%) by closed reduction/spica casting, and 10 (20%) by open reduction; 1 hip (2%) spontaneously reduced and required no further treatment. CONCLUSIONS: On the basis of the lengths of harness treatment in our series, most hips did not exhibit negative changes in the acetabular AA in response to prolonged treatment of a dislocated hip in harness. Furthermore, 80% of hips failing Pavlik treatment were successfully reduced through closed means, indicating that subsequent treatment was not compromised. LEVEL OF EVIDENCE: Level IV-retrospective case series.
Asunto(s)
Luxación Congénita de la Cadera/terapia , Aparatos Ortopédicos , Acetábulo/diagnóstico por imagen , Tirantes , Femenino , Cabeza Femoral/diagnóstico por imagen , Luxación Congénita de la Cadera/diagnóstico por imagen , Humanos , Lactante , Recién Nacido , Masculino , Estudios Retrospectivos , Factores de Tiempo , Insuficiencia del Tratamiento , Resultado del Tratamiento , UltrasonografíaRESUMEN
Summary Gaucher's disease is characterized by glucocerebroside accumulation in the cells of the reticuloendothelial system. There are three subtypes. The most common is type 1, known as the non-neuropathic form. Pancytopenia, hepatosplenomegaly and bone lesions occur as a result of glucocerebroside accumulation in the liver, lung, spleen and bone marrow in these patients. Findings associated with liver, spleen or bone involvement may be seen at radiological analysis. Improvement in extraskeletal system findings is seen with enzyme replacement therapy. Support therapy is added in patients developing infection, anemia or pain. We describe a case of hepatosplenomegaly, splenic infarction, splenic nodules and femur fracture determined at radiological imaging in a patient under monitoring due to Gaucher's disease.
Asunto(s)
Humanos , Femenino , Dolor/diagnóstico por imagen , Cabeza Femoral/diagnóstico por imagen , Enfermedad de Gaucher/diagnóstico por imagen , Esplenomegalia/diagnóstico por imagen , Médula Ósea/patología , Médula Ósea/diagnóstico por imagen , Radiografía , Dolor Abdominal/etiología , Cabeza Femoral/lesiones , Enfermedad de Gaucher/patología , Hepatomegalia/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
BACKGROUND: The etiology of hip instability in Down syndrome is not completely understood. We investigated the morphology of the acetabulum and femur in patients with Down syndrome and compared measurements of the hips with those of matched controls. METHODS: Computed tomography (CT) images of the pelvis of 42 patients with Down syndrome and hip symptoms were compared with those of 42 age and sex-matched subjects without Down syndrome or history of hip disease who had undergone CT for abdominal pain. Each of the cohorts had 23 male and 19 female subjects. The mean age (and standard deviation) in each cohort was 11.3 ± 5.3 years. The lateral center-edge angle (LCEA), acetabular inclination angle (IA), acetabular depth-width ratio (ADR), acetabular version, and anterior and posterior acetabular sector angles (AASA and PASA) were compared. The neck-shaft angle and femoral version were measured in the patients with Down syndrome only. The hips of the patients with Down syndrome were further categorized as stable (n = 21) or unstable (n = 63) for secondary analysis. RESULTS: The hips in the Down syndrome group had a smaller LCEA (mean, 10.8° ± 12.6° compared with 25.6° ± 4.6°; p < 0.0001), a larger IA (mean, 17.4° ± 10.3° compared with 10.9° ± 4.8°; p < 0.0001), a lower ADR (mean, 231.9 ± 56.2 compared with 306.8 ± 31.0; p < 0.0001), a more retroverted acetabulum (mean acetabular version as measured at the level of the centers of the femoral heads [AVC], 7.8° ± 5.1° compared with 14.0° ± 4.5°; p < 0.0001), a smaller AASA (mean, 55.0° ± 9.9° compared with 59.7° ± 7.8°; p = 0.005), and a smaller PASA (mean, 67.1° ± 10.4° compared with 85.2° ± 6.8°; p < 0.0001). Within the Down syndrome cohort, the unstable hips showed greater femoral anteversion (mean, 32.7° ± 14.6° compared with 23.6° ± 10.6°; p = 0.002) and worse global acetabular insufficiency compared with the stable hips. No differences between the unstable and stable hips were found with respect to acetabular version (mean AVC, 7.8° ± 5.5° compared with 7.6° ± 3.8°; p = 0.93) and the neck-shaft angle (mean, 133.7° ± 6.7° compared with 133.2° ± 6.4°; p = 0.81). CONCLUSIONS: Patients with Down syndrome and hip-related symptoms had more retroverted and shallower acetabula with globally reduced coverage of the femoral head compared with age and sex-matched subjects. Hip instability among those with Down syndrome was associated with worse global acetabular insufficiency and increased femoral anteversion, but not with more severe acetabular retroversion. No difference in the mean femoral neck-shaft angle was observed between the stable and unstable hips in the Down syndrome cohort. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Asunto(s)
Acetábulo/patología , Síndrome de Down/complicaciones , Cabeza Femoral/patología , Articulación de la Cadera/patología , Inestabilidad de la Articulación/etiología , Tomografía Computarizada por Rayos X , Acetábulo/diagnóstico por imagen , Acetábulo/fisiopatología , Adolescente , Adulto , Anteversión Ósea/diagnóstico por imagen , Anteversión Ósea/etiología , Anteversión Ósea/patología , Anteversión Ósea/fisiopatología , Retroversión Ósea/diagnóstico por imagen , Retroversión Ósea/etiología , Retroversión Ósea/patología , Retroversión Ósea/fisiopatología , Estudios de Casos y Controles , Niño , Preescolar , Síndrome de Down/patología , Síndrome de Down/fisiopatología , Femenino , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/fisiopatología , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiopatología , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Inestabilidad de la Articulación/patología , Masculino , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the evolution of the ultrasonographic pubo-femoral distance (PFD) before and after Pavlik harness treatment for developmental dysplasia of the hip (DDH) in newborns. PATIENTS AND METHODS: Twenty-five patients (16.7 ± 10.4 days; 19 females, six males) diagnosed with DDH and treated using the Pavlik harness were included. Eighteen patients had bilateral, and seven unilateral DDH, with a total of 43 dysplastic hips. The seven non-dysplastic hips in unilateral cases were used for comparison. The PFD was measured in the coronal and axial planes with the hip flexed to approximately 90°, before and after an average of 93 days of treatment. The femoral head coverage was assessed in the coronal plane, and correlated with PFD values. RESULTS: In dysplastic hips, the mean PFD decreased from 6.1 ± 1.8 mm to 3.0 ± 0.7 mm in the axial (adjusted difference, 2.9 mm; p < 0.01), and from 5.9 ± 2.0 to 3.0 ± 0.6 mm in the coronal plane (adjusted difference 2.7 mm; p < 0.01). The femoral head coverage increased from 30.8 to 62.1%, and the mean differences of femoral head coverage and PFD were significantly correlated (p < 0.001). There was no difference between treated dysplastic and non-dysplastic hips. There was high intra- and inter-observer agreement for PFD measurements. CONCLUSION: The PFD decreased significantly after DDH treatment using the Pavlik harness in newborns, and showed significant correlation with the femoral head coverage improvement. PFD might be a reliable tool for monitoring DDH treatment in newborns treated using the Pavlik harness.
Asunto(s)
Cabeza Femoral/diagnóstico por imagen , Luxación Congénita de la Cadera/diagnóstico por imagen , Luxación Congénita de la Cadera/terapia , Aparatos Ortopédicos , Hueso Púbico/diagnóstico por imagen , Ultrasonografía/métodos , Femenino , Humanos , Recién Nacido , Estudios Longitudinales , Masculino , Estudios Retrospectivos , Resultado del TratamientoRESUMEN
Gaucher's disease is characterized by glucocerebroside accumulation in the cells of the reticuloendothelial system. There are three subtypes. The most common is type 1, known as the non-neuropathic form. Pancytopenia, hepatosplenomegaly and bone lesions occur as a result of glucocerebroside accumulation in the liver, lung, spleen and bone marrow in these patients. Findings associated with liver, spleen or bone involvement may be seen at radiological analysis. Improvement in extraskeletal system findings is seen with enzyme replacement therapy. Support therapy is added in patients developing infection, anemia or pain. We describe a case of hepatosplenomegaly, splenic infarction, splenic nodules and femur fracture determined at radiological imaging in a patient under monitoring due to Gaucher's disease.
Asunto(s)
Cabeza Femoral/diagnóstico por imagen , Enfermedad de Gaucher/diagnóstico por imagen , Dolor/diagnóstico por imagen , Dolor Abdominal/etiología , Médula Ósea/diagnóstico por imagen , Médula Ósea/patología , Femenino , Cabeza Femoral/lesiones , Enfermedad de Gaucher/patología , Hepatomegalia/diagnóstico por imagen , Humanos , Persona de Mediana Edad , Radiografía , Esplenomegalia/diagnóstico por imagenRESUMEN
BACKGROUND: Traumatic posterior hip dislocation in children is a rare injury that typically is treated with closed reduction. Surgical treatment is typically recommended for nonconcentric reduction with joint space asymmetry with entrapped labrum or an osteochondral fragment. The surgical hip dislocation (SHD) approach allows for full assessment of the acetabulum and femoral head and has been our preferred surgical strategy. The purpose of this study was to (1) describe the intra-articular pathologic findings seen at the time of SHD; and (2) to investigate hip pain, function, and activity level of a cohort of children and adolescents after open treatment of a posterior hip dislocation using the SHD approach. METHODS: Following IRB approval, 23 patients who sustained a traumatic posterior hip dislocation between January 2009 and December 2013 were identified. In 8/23 (34.8%) patients there was evidence of nonconcentric reduction after closed treatment and surgical treatment was performed using the SHD approach. Seven male and 1 female (mean age, 11.2 y; range, 6 to 14.6 y) were followed for an average of 28 months (range, 13 to 67 mo). The modified Harris Hip Score (mHHS) and the University of California Los Angeles activity score assessed clinical hip outcome and activity level at minimum of 1 year after surgery. RESULTS: Six patients were treated after an acute trauma, whereas 2 were treated after recurrent dislocations. Five patients were involved in motor vehicle accidents and 3 in sports-related injuries. Intraoperative findings include posterior labral avulsion in all patients, fracture of the cartilaginous posterior wall (n=3), and femoral head chondral injuries (n=5) and fracture (n=1). The labral root was repaired using suture anchor technique in 7/8 patients and resected in 1. In 2 patients, labral repair was complemented by screw fixation of the posterior wall. All but one patient (mHHS=94) reported maximum mHHS. The University of California Los Angeles activity score was 10 for 5/8 patients and 7 in 3 patients. No case of femoral head osteonecrosis was noted. One patient developed an asymptomatic heterotopic ossification. CONCLUSIONS: When open reduction is recommended for the treatment of intra-articular pathologies and hip instability following traumatic dislocation of the hip in children and adolescents, the SHD is an excellent approach that allows surgical correction of the damaged bony and soft-tissue structures including repair of the capsule-labral complex, and reduction and internal fixation of the cartilaginous posterior wall and femoral head fractures. LEVEL OF EVIDENCE: Level IV.
Asunto(s)
Acetábulo/diagnóstico por imagen , Tratamiento Conservador , Cabeza Femoral/diagnóstico por imagen , Luxación de la Cadera , Articulación de la Cadera , Inestabilidad de la Articulación , Procedimientos Ortopédicos , Adolescente , Niño , Tratamiento Conservador/efectos adversos , Tratamiento Conservador/métodos , Femenino , Fracturas Óseas/cirugía , Luxación de la Cadera/diagnóstico , Luxación de la Cadera/cirugía , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiopatología , Humanos , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/etiología , Efectos Adversos a Largo Plazo/diagnóstico , Efectos Adversos a Largo Plazo/etiología , Masculino , Procedimientos Ortopédicos/efectos adversos , Procedimientos Ortopédicos/instrumentación , Procedimientos Ortopédicos/métodos , Osificación Heterotópica/diagnóstico , Osificación Heterotópica/etiología , Resultado del TratamientoRESUMEN
For proximal varus osteotomy of the femur in children, a stable fixation, is a concern regarding the safety and the protection of the surgery. The methods of fixation are mostly represented by plating systems; however, the tension band wiring is a simple and eligible option for fixation of proximal femur osteotomy. The purpose of this retrospective case series study is to evaluate outcomes and bone remodelation after using the tension band wiring technique to fixate proximal femoral varus osteotomies in children.The study enrolled 20 patients who underwent femoral varus osteotomy to treat Legg-Calvé-Perthes disease and other causes of necrosis of the femoral head. The mean patient age at the time of surgery was 7.4 ± 2.3 years (range, 4.3-13.8 y), and the follow-up period averaged 10 ± 4.3 years (range, 4.7-20.8 y). To assess the effects of the osteotomy at the neck-shaft angle and its evolution over time, radiographs obtained preoperatively and during the follow-up were analyzed. The neck-shaft angle was measured independently by 2 observers, and intraclass correlation coefficients (ICCs) were assessed for reliability.The ICC analysis showed good reliability. There was a significant reduction in the neck-shaft angle (P < 0.001) between the preoperative and the immediate postoperative periods, with an estimated difference of 14.3°. Between the immediate and the early postoperative periods, the estimated difference was 2.1°, which indicated a significant increase in the neck-shaft angle (P = 0.003). Between the early postoperative period and the final evaluation, there was a significant increase (P < 0.001), with an estimated difference of 7.0°. No implant failures or other complications were observed, but 1 case of peri-implant femoral fracture occurred >17 years postsurgery.The tension band wiring technique proved to be a simple and effective method for fixating proximal femoral varus osteotomy in children.The level IV is appropriated for our study (case series, retrospective).
Asunto(s)
Cabeza Femoral/patología , Cabeza Femoral/cirugía , Enfermedad de Legg-Calve-Perthes/cirugía , Osteotomía , Adolescente , Hilos Ortopédicos , Niño , Preescolar , Femenino , Cabeza Femoral/diagnóstico por imagen , Estudios de Seguimiento , Humanos , Enfermedad de Legg-Calve-Perthes/complicaciones , Masculino , Necrosis/etiología , Variaciones Dependientes del Observador , Radiografía , Estudios RetrospectivosRESUMEN
BACKGROUND: Closed reduction (CR) and spica casting is performed using arthrography to assess the adequacy of reduction based in part on the width of medial dye pool (MDP); however, the amount of MDP that is acceptable and its correlation to the actual anatomic position of the femoral head within the acetabulum has been poorly delineated. The purpose of this study was to determine this correlation and to explore the potential limits of acceptable MDP measurements. METHODS: We retrospectively reviewed a consecutive series of patients with DDH treated at our institution by CR and immediate postoperative magnetic resonance imaging (MRI) and found 20 patients (23 hips) meeting inclusion criteria. We measured the MDP and femoral head area on the best reduced arthrographic image, the immediate postoperative mid-coronal MRI, and on 3 planes (neutral, 30-degree anterior, and 30-degree posterior) of the mid-axial MRI and compared MDP values from both imaging modalities using the Pearson correlation coefficient (R). To provide useful data for establishing intraoperative thresholds, MDP was also expressed as a percentage of femoral head width to control for fluoroscopic magnification. RESULTS: Twenty-two of the 23 hips were reduced on postoperative MRI; the one persistently dislocated hip was excluded from our analysis. The Pearson correlation coefficient was R = 0.73 comparing arthrography and coronal MRI, indicating excellent correlation. Correlation was even stronger between arthrography and axial MRI (neutral R = 0.73; 30-degree anterior, R = 0.81; 30-degree posterior, R = 0.81). The mean fluoroscopic MDP in the successful, fully concentric, CRs was 4.2% of the femoral head width (range, 0.6% to 15.8%). CONCLUSIONS: There is very strong correlation between MDP measurements on arthrography and immediate postoperative MRI in both the axial and coronal planes. On the basis of our data, an arthrographic MDP between 0.6% and 15.8% of the femoral head width always resulted in an excellent reduction, suggesting that an MDP of ≤ 16% of femoral head width may be a useful intraoperative criterion for determining the adequacy of CR. LEVEL OF EVIDENCE: Level I Diagnostic Study.
Asunto(s)
Artrografía , Medios de Contraste , Luxación Congénita de la Cadera/diagnóstico por imagen , Luxación Congénita de la Cadera/terapia , Imagen por Resonancia Magnética , Acetábulo/diagnóstico por imagen , Moldes Quirúrgicos , Femenino , Cabeza Femoral/diagnóstico por imagen , Fluoroscopía , Humanos , Inmovilización , Lactante , Cuidados Intraoperatorios , Masculino , Cuidados Posoperatorios , Estudios RetrospectivosRESUMEN
OBJECTIVE: The present study assessed the correlation between maxillomandibular alveolar bone density and systemic bone mineral density (BMD). METHODS: Dual-energy X-ray absorptiometry of the anterior and posterior maxillomandibular alveolar bone, of the standard sites for the measurement of BMD (lumbar spine and femur) and the third cervical vertebra was performed on 23 middle-aged women. Periapical radiographs were also obtained, with an aluminum step-wedge as reference for the digital reading of apical bone density of the upper incisors. RESULTS: Spearman's correlations coefficients revealed that density in the apical region was correlated with that of the femoral neck (r = 0.433; p < 0.05); BMDs of the posterior regions of the mandible and maxilla were significantly correlated with that of the cervical vertebra (r = 0.554, p ≤ 0.01 and r = 0.423, p ≤ 0.05, respectively); and the anterior maxilla was correlated with the posterior mandible (r = 0.488, p ≤ 0.05). CONCLUSION: Bone density of the maxillary alveolar bone was significantly correlated with that of the femoral neck. Among the bone densities of the alveolar regions, only the anterior maxilla and the posterior mandible were significantly correlated. The findings suggested that bone densitometry might be individually and locally evaluated.
Asunto(s)
Proceso Alveolar/fisiología , Densidad Ósea , Vértebras Cervicales/fisiología , Cuello Femoral/fisiología , Vértebras Lumbares/fisiología , Absorciometría de Fotón , Adulto , Proceso Alveolar/diagnóstico por imagen , Vértebras Cervicales/diagnóstico por imagen , Densitometría , Femenino , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/fisiología , Cuello Femoral/diagnóstico por imagen , Humanos , Vértebras Lumbares/diagnóstico por imagen , Mandíbula/diagnóstico por imagen , Maxilar/diagnóstico por imagen , Persona de Mediana Edad , Estadísticas no ParamétricasRESUMEN
PURPOSE: Legg-Calvé-Perthes (LCP) disease is currently managed by mechanical containment of the femoral head in the hip socket. As evidence suggests that hip distraction may offer a new treatment strategy, we used arthrodistraction as a primary treatment for active forms of LCP disease and prospectively compared the results with the Salter innominate osteotomy. METHODS: A total of 54 children, six years or older of both genders with severe forms of LCP disease in the stages of necrosis or revascularisation, were enrolled. Patients were submitted to either Salter innominate osteotomy (n = 28) or hip arthrodistraction (n = 26). Final radiographs were used to evaluate the Mose index, Wiberg angle, extrusion index and the Stulberg et al. classification. RESULTS: There were no significant differences in gender, age, lateral pillar classification and average follow-up time between the two groups. The osteotomy group progressed without major complications, but children in the joint distraction group experienced episodes of pin tract pain and infection, leading to the early removal of the external device in one case. Two patients developed joint stiffness, treated by physiotherapy or manipulation, and one child developed subluxation of the femoral head. The average time in distraction was 4.44 months (2.53-7.23 months). In the final evaluation the osteotomy group showed better containment of the femoral head. The Mose index and the Stulberg et al. classification were statistically similar between the two groups. CONCLUSIONS: Despite similar final radiological results, arthrodistraction was associated with a higher morbidity. Consequently, we do not recommend hip distraction as a primary treatment for the early stages of LCP disease.
Asunto(s)
Cabeza Femoral/cirugía , Articulación de la Cadera/cirugía , Enfermedad de Legg-Calve-Perthes/cirugía , Osteogénesis por Distracción/métodos , Osteotomía/métodos , Niño , Preescolar , Femenino , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/patología , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/patología , Hospitales Universitarios , Humanos , Enfermedad de Legg-Calve-Perthes/diagnóstico , Enfermedad de Legg-Calve-Perthes/diagnóstico por imagen , Masculino , Osteogénesis por Distracción/efectos adversos , Complicaciones Posoperatorias/etiología , Estudios Prospectivos , Radiografía , Centros de Atención Terciaria , Atención Terciaria de SaludRESUMEN
OBJECTIVE: To compare the existence of radiographic abnormalities in two groups of patients, those with and without hip pain. METHODS: A total 222 patients were evaluated between March 2007 and April 2009; 122 complained of groin pain, and 100 had no symptoms. The individuals in both groups underwent radiographic examinations of the hip using the following views: anteroposterior, Lequesne false profile, Dunn, Dunn 45º, and Ducroquet. RESULTS: A total of 1110 radiographs were evaluated. Female patients were prevalent in both groups (52% symptomatic, 58% asymptomatic). There were statistically significant differences between the groups in age (p<0.0001), weight (p = 0.002) and BMI (p = 0.006). The positive findings in the group with groin pain consisted of the presence of a bump on the femoral head in the anteroposterior view (p<0.0001) or in the Dunn 45º view (p = 0.008). The difference in the a angle in the anteroposterior, Dunn, Dunn 45º, and Ducroquet views for all of the cases studied was p,0.0001. The joint space measurement differed significantly between groups in the Lequesne view (p = 0.007). The Lequesne anteversion angle (ρ) and the femoral offset measurement also differed significantly (p = 0.005 and p = 0.0001, respectively). CONCLUSIONS: We conclude that the best views for diagnosing a femoroacetabular impingement are the anteroposterior pelvic orthostatic, the Dunn 45º, and the Ducroquet views. The following findings correlated with hip pain: a decrease in the femoral offset, an increase in the α angle, an increase in the Lequesne ρ angle, a decrease in the CE angle of Wiberg, a thinner articular space and the presence of a bump on the femoral head-neck transition.
Asunto(s)
Artralgia/diagnóstico por imagen , Pinzamiento Femoroacetabular/diagnóstico por imagen , Cabeza Femoral/diagnóstico por imagen , Articulación de la Cadera/diagnóstico por imagen , Osteoartritis de la Cadera/diagnóstico por imagen , Adulto , Estudios de Casos y Controles , Femenino , Cuello Femoral/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Osteoartritis de la Cadera/etiología , Radiografía , Estadísticas no Paramétricas , Adulto JovenRESUMEN
PURPOSE: To present the first technical description of a modified surgical technique for trapezoidal bony correction of the femoral neck in the treatment of slipped capital femoral epiphysis (SCFE), performed entirely by arthroscopy. METHODS: From December 2005 to January 2008, 5 patients with severe SCFE underwent trapezoidal femoral neck bone correction through arthroscopy. Their mean age at the time of surgery was 13.2 years. The time for postoperative follow-up ranged from a minimum of 12 months to a maximum of 39 months (mean, 26 months). The study analyzed data regarding the type of slip, degree of correction obtained, clinical and functional outcomes, and complications. RESULTS: Analysis with the modified Harris Hip Score criteria showed a mean of 17.2 points preoperatively and 86.6 points at the last assessment. The mean epiphyseal deviation ranged from 82° at the initial presentation to 14° postoperatively. There were no intraoperative complications, and there was 1 case of avascular necrosis. CONCLUSIONS: Arthroscopic treatment of SCFE resulted in correction of the angles of epiphyseal slip (from a mean epiphyseal-diaphyseal angle of 82° before surgery to 14° after surgery), with no immediate complications and 1 case of a late complication (avascular necrosis) in this 5-patient series. Clinical improvement was shown by a mean 69.4-point increase in the modified Harris Hip Score. LEVEL OF EVIDENCE: Level IV, therapeutic case series.
Asunto(s)
Artroscopía/métodos , Epífisis Desprendida/cirugía , Cuello Femoral/cirugía , Osteotomía/métodos , Rango del Movimiento Articular/fisiología , Enfermedad Aguda , Adolescente , Clavos Ortopédicos , Niño , Progresión de la Enfermedad , Epífisis Desprendida/diagnóstico por imagen , Femenino , Cabeza Femoral/diagnóstico por imagen , Cabeza Femoral/cirugía , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Necrosis de la Cabeza Femoral/terapia , Cuello Femoral/diagnóstico por imagen , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/fisiopatología , Articulación de la Cadera/cirugía , Humanos , Masculino , Osteotomía/instrumentación , Complicaciones Posoperatorias/fisiopatología , Cuidados Preoperatorios/métodos , Estudios Prospectivos , Recuperación de la Función , Índice de Severidad de la Enfermedad , Tomografía Computarizada por Rayos X , Hueso Trapezoide/cirugía , Resultado del TratamientoRESUMEN
UNLABELLED: Femoral head fracture-dislocations (FHFD) are rare, while irreducible cases are even less frequent. Truly irreducible fractures such as the two cases in this report must be differentiated from incomplete reduction due to incarcerated bone or soft tissue interposition. Opinions vary on the surgical approach to be used once the hip is reduced and the fragment of the femoral head yet remains to be stabilized. Reports in the literature do not usually take into account the specificity of irreducible lesions, which in our opinion should be treated by the transgluteal approach (TGA) while reducible forms can be treated by the Hueter approach. The transgluteal approach with the patient in the lateral decubitus position provides a direct anterior view of the antero-infero-medial fracture site as well as dorsal access via the injuries occasioned to dorsal soft tissues by the posterolateral dislocation. A lag screw can be used with this approach, which is the only way to stabilize the ligament teres femoris attachment. LEVEL OF EVIDENCE: Level IV retrospective historical study.