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We report clinical, radiological and histological findings following high tibial valgisation osteotomy (HTVO) using micro-macroporous biphasic calcium phosphate wedges fixed with a plate and locking screws. From 1999 to 2002, 43 knees were operated on and studied prospectively. All underwent clinical and radiological follow-up at days 1, 90, and 365 to evaluate consolidation and bone substitute interfaces. Additionally, biopsies were taken for histology at least 1 year after implantation from 10 patients who requested plate removal. Radiologically, consolidation was observed in 98% of cases. At 1 year, correction was unchanged in 95% of cases. Histological analysis revealed considerable MBCP resorption and bone ingrowth, both into the pores and replacing the bioceramic material. Polarised light microscopy confirmed normal bony architecture with trabecular and/or dense lamellar bone growth at the expense of the wedge implants. X-ray and micro-CT scan revealed a well organised and mineralised structure in the newly-formed bone. This study shows that using MBCP wedges in combination with orientable locking screws and a plate is a simple, safe and fast surgical technique for HTVO. The is the first study to examine the results by histological analysis, which confirmed good outcomes.
Assuntos
Substitutos Ósseos , Cerâmica , Articulação do Joelho/cirurgia , Osteotomia/instrumentação , Tíbia/cirurgia , Adolescente , Adulto , Idoso , Placas Ósseas , Parafusos Ósseos , Fosfatos de Cálcio/análise , Feminino , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Osseointegração , Osteotomia/métodos , Estudos Prospectivos , Radiografia , Tíbia/diagnóstico por imagem , Tíbia/ultraestruturaRESUMO
The authors report a case of a patient with paraparesis secondary to T5-T6 spondylodiscitis accompanied by a closely lying, well-formed pleural abscess. This rare association has previously been reported only twice in the literature. The technical difficulty of surgery for both the abscess and the compressive spondylodiscitis was resolved by the use of an enlarged posterior approach. This approach enabled evacuation of the pleural lesion, curettage of the disc space, interbody grafting, and spinal osteosynthesis in one stage.
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PURPOSE OF THE STUDY: The aim of this radiological study was to evaluate the use of a biphasic ceramic wedge combined with plate fixation with locked adjustable screws for open wedge tibial osteotomy. MATERIAL AND METHODS: Twenty-six consecutive patients (27 knees) underwent surgery between December 1999 and March 2002 to establish a normal lower-limb axis. The series included 6 women and 20 men, mean age 50 years (16 right knees and 11 left knees). Partial weight-bearing with crutches was allowed on day 1. A standard radiological assessment was performed on day 1, 90, and 360 (plain AP and lateral stance films of the knee). A pangonogram was performed before surgery and at day 360. Presence of a lateral metaphyseal space, development of peripheral cortical bridges, and osteointegration of the bone substitute-bone interface were evaluated used to assess bone healing. The medial tibial angle between the line tangent to the tibial plateau and the anatomic axis of the tibia (beta) was evaluated to assess preservation of postoperative correction. The HKA angle was determined. RESULTS: Three patients were lost to follow-up and 23 patients (24 knees) were retained for analysis. At last follow-up, presence of peripheral cortical bridges and complete filling of the lateral metaphyseal space demonstrated bone healing in all patients. Good quality osteointegration was achieved since 21 knees did not present an interface between the bone substitute and native bone (homogeneous transition zone). The beta angle was unchanged for 23 knees. A normal axis was observed in patients (16 knees) postoperatively. DISCUSSION: Use of a biphasic ceramic wedge in combination with plate fixation with locked adjustable screws is a reliable option for open wedge tibial osteotomy. The bone substitute fills the gap well. Tolerance and integration are optimal. Bone healing is achieved. Plate fixation with protected weight bearing appears to be a solid assembly, maintaining these corrections.
Assuntos
Placas Ósseas , Parafusos Ósseos , Cerâmica , Osteotomia/instrumentação , Osteotomia/métodos , Tíbia/cirurgia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
PURPOSE OF THE STUDY: Developmental lumbar stenosis is a rare entity, exceptionally described in the literature. No study has been directly devoted to this condition. The purpose of the present study was to examine specific features, particularly clinical and anatomic expression, observed in a series of operated patients. MATERIAL AND METHODS: Eleven patients from the French Antilles were treated for developmental lumbar stenosis between 1996 and 2000. The Verbiest criteria were used to define canal narrowness. Signs of degeneration and presence of discal herniation were exclusion criteria. Epidemiological and clinical data were collected for the 11 patients. The degree of sagittal stenosis (fixed diameter at the bone level and mobile diameter at the discal level) was measured on computed tomography images. Transverse stenosis was determined by measuring the interpedicular and interapophyseal distances. Lateral stenosis was determined by measuring the depth of the recessus. RESULTS: These patients were young (mean age 42.4 years). Most of the clinical signs were monoradicular. Discal level stenosis predominated, generally at level L4-L5. It was generally central and lateral, sagittal and transverse. The interpedicular distance was the only diameter that remained within normal limits. Soft tissues (yellow ligaments and joint capsules) played an important role in the stenosis. DISCUSSION: The rare reports of developmental lumbar stenosis describe decompensated stenosis due to discal herniation in the adolescent. Developmental lumbar stenosis is considered to be a genetic disease and its particular high frequency in the French Antilles favors this hypothesis. The stenosis results from bony (short pedicles, hypertrophic lateral masses) and ligament (hypertrophy of the yellow ligament and joint capsules) structures. CONCLUSION: Developmental lumbar stenosis produces a global (sagittal, transverse, central, lateral) narrowing of the lumbar canal where soft tissue structures apparently play a greater role than usually thought. A prospective study examining the impact of ethnic origin is required to analyze the genetic hypothesis.
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Doenças do Desenvolvimento Ósseo , Estenose Espinal , Adulto , Distribuição por Idade , Antropometria , Doenças do Desenvolvimento Ósseo/diagnóstico , Doenças do Desenvolvimento Ósseo/epidemiologia , Doenças do Desenvolvimento Ósseo/etiologia , Doenças do Desenvolvimento Ósseo/cirurgia , Feminino , Predisposição Genética para Doença/genética , Humanos , Incidência , Laminectomia , Dor Lombar/etiologia , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Fusão Vertebral , Estenose Espinal/diagnóstico , Estenose Espinal/epidemiologia , Estenose Espinal/etiologia , Estenose Espinal/cirurgia , Tomografia Computadorizada por Raios XRESUMO
PURPOSE OF THE STUDY: Fracture of lateral process of the talus is an uncommon injury, fracture of the posteromedial tubercle of the talus is quite rare, and association of the two lesions is not reported previously. We report a case of an associated fracture of posteromedial tubercle an lateral process of the talus. PATIENT AND METHODS: The mechanism of injury was forced ankle dorsiflexion and pronation, this mechanism was responsible of an avulsion of the posteromedial tubercle by the postero talotibial ligament and a fracture of lateral process by compression between the lateral malleolus and the calcaneus. RESULTS: Conventional radiographs permitted the diagnosis of the lateral process fracture but the fracture of the posteromedial tubercle was showed only on CT scans. DISCUSSION: The fracture of the posteromedial tubercle was treated by internal fixation, through a posteromedial approach. At 12 months follow-up the patient was able to walk without pain and radiographic result was excellent (no avascular necrosis of the tubercle and no Arthrosis of subtalar joint).
Assuntos
Fraturas Ósseas/diagnóstico por imagem , Tálus/diagnóstico por imagem , Tálus/lesões , Tomografia Computadorizada por Raios X , Adulto , Humanos , MasculinoRESUMO
PURPOSE OF THE STUDY: To quantify the modifications occurring on the femoral side, after Total Knee Arthroplasty, we describe a method of measurements in the sagittal plane on standardized X-rays. MATERIAL AND METHODS: We report the clinical and radiologic results of a prospective study of 80 cases of Total Knee Arthroplasty performed with the same prosthesis. We eliminated twenty cases with incorrect X-rays. Measurements were done on 60 preoperative X-rays and 60 postoperative X-rays. The aim of the measure was to quantify the modifications induced by the prosthesis on the trochlear groove and on the tibio-femoral joint line in full extension and in flexion, to eliminate individual femoral diameter was used as a reference in order to cancel variations in X-rays magnification. We first validated the two perpendicular reference axis on which we based all the measurements. RESULTS: No significative difference was found on the position of the tibio-femoral joint line in flexion. The tibio-femoral joint line in extension was significantly moved distally. The prosthesis was placed too distally, therefore we changed the operative procedure. No significative difference was found on the position of the anterior trochlear groove. DISCUSSION: With this method, the anatomic variations of the femoral profiles can be quantified, therefore, further prosthesis shapes can be improved. Radiological follow-up of knee prosthesis and comparison of the influence of different prosthesis can be made by these measures.
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Artroplastia do Joelho , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/normas , Interpretação Estatística de Dados , Seguimentos , Humanos , Articulação do Joelho/diagnóstico por imagem , Pessoa de Meia-Idade , Modelos Teóricos , Estudos Prospectivos , Desenho de Prótese , Radiografia , Fatores de TempoRESUMO
PURPOSE OF THE STUDY: The purpose of this study was to analyse the results of tibial intramedullary nailing using an unreamed "Universal Elastic Bundle Nail". MATERIAL AND METHODS: Forty-three intramedullary nailing of tibial shaft were done in 43 patients with recents fractures, from May 1993 and May 1996. There were 36 males and 7 females. The average age was 31.5 years (range 17-68 years). Thirty-three were injured in a traffic accident (20 motorcycles, 5 pedestrians and 8 car passengers), seven were injured in a home accident (fall) and three had a sport injury. There were 13 open fractures according to Gustilo: 5 grade I, 7 grade II and one grade III B. Eight fractures involved the proximal metaphyseal part of the tibia, 16 the distal metaphyseal part and 14 the tibial shaft; in five cases there were segmental fractures. According to AO classification there were: 10 fractures type A, 24 fractures type B and 9 fractures type C (5 segmental fractures). In 5 cases there were associated femoral fractures: three ipsilaterals and two controlaterals. All were treated in the same time: four by UEBN device and one by AO's nail. All the patients with type B and C fractures were positioned on a Maquet table with a boot traction or transcalcaneal pin traction (in the distal fractures). The nail was introduced after closed reduction through a vertical transpatellar tendon incision, without reaming procedure. RESULTS: Forty one fractures healed after an average time of 96 days (60-120). In 11 open fractures bone union occurred after 98 days (85-120). The distal fractures healed after a mean time of 86 days (60-120), proximal fractures in 123 days and mid shaft fractures in 98 days. In type A fractures bone union occurred after an average time of 68 days, while bone union occurred after a mean time of 100 days in type B and C fractures. Two patients with an open proximal type B fracture, had a delayed union: both healed after proximal screws removal. Two fractures healed with a valgus angulaton 5 degrees and 10 degrees. No infection, no loss of reduction and no bundle migration has been noted. DISCUSSION: The Marchetti-Vicenzi's nail (UEBN) permitted a stable fixation in tibial fractures. The use of this unreamed nailing coupled with an automatic distal locking in the metaphyseal cancellous bone, reduced operative time and shortened X Ray's radiation exposure. At the follow-up fracture healing occurred in 41 cases 95.3 p. 100 at four months. Two delayed union occurred after four months, the two cases were open fractures grade II. All the two cases healed after secondary procedure without any loss of function. Malunion occurred in two patients (in only one case there was a major valgus angulation 10 degrees), the two cases were related to technical error. We had no cases of infection or leg shortening or bundle migration in the ankle joint. CONCLUSION: We believe that Universal Elastic Bundle Nail allows a stable and safety fixation in open or closed tibial fractures without pseudarthrosis and without infection (in our series).
Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas/instrumentação , Fraturas da Tíbia/cirurgia , Acidentes , Adolescente , Adulto , Idoso , Traumatismos em Atletas/complicações , Fenômenos Biomecânicos , Elasticidade , Desenho de Equipamento , Feminino , Seguimentos , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Fraturas da Tíbia/classificação , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/etiologia , Fatores de Tempo , Resultado do TratamentoRESUMO
Two cases of cervical myelopathy due to calcification of the ligamenta flava (CLF) are described for the first time in black patients from the French West Indies. A pre-operative CT scan differentiated the diagnosis from one of ossification of the ligamenta flava. Microanalysis on the operatively excised specimen in one patient revealed a mixture of calcium pyrophosphate dihydrate crystals and hydroxypatite crystals. Poor outcome in one patient contrasting with excellent recovery in the other one, who had undergone posterior decompressive laminectomy, emphasizes the importance of surgery in the management of CLF.
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Ligamento Amarelo/patologia , Doenças da Medula Espinal/etiologia , Idoso , População Negra , Calcinose , Pirofosfato de Cálcio/análise , Cristalização , Durapatita/análise , Feminino , Humanos , Ligamento Amarelo/cirurgia , Pessoa de Meia-Idade , Índias OcidentaisRESUMO
PURPOSE OF THE STUDY: We report four cases of bilateral recurrent dislocation of the patella with major trochlear dysplasia, in the same family. MATERIAL AND METHODS: Details of clinical examination of all members of this family and measurements on knee radiographs are reported. RESULTS: In all cases a severe proximal dysplasia of the trochlea was described on lateral views. The patella and the trochlea had a normal shape on the axial view. DISCUSSION: In some recurrent dislocation, with no associated disease, possibility of a genetic transmission have been suggested in some publications. Cases involving the same family have never been reported to confirm a genetic transmission of a bilateral and major trochlear dysplasia. CONCLUSION: This report points out a genetic origin of severe trochlear dysplasia. To know more about transmission and chromosomic localisation, careful investigations on others families of bilateral dislocations with trochlear dysplasia must be done.
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Fêmur/anormalidades , Luxações Articulares/genética , Patela/lesões , Adolescente , Adulto , Criança , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Instabilidade Articular/genética , Articulação do Joelho , Masculino , Patela/diagnóstico por imagem , Linhagem , Radiografia , RecidivaRESUMO
STUDY DESIGN: A case of symptomatic ossification of ligamenta flava in a black man from Martinique (French West Indies) is reported. OBJECTIVES: To show that ossification of ligamenta flava may be observed in racial groups other than Japanese people and that the postoperative prognosis of symptomatic ossification of ligamenta flava is not always excellent. SUMMARY OF BACKGROUND DATA: Ossification of ligamenta flava causing slowly progressive myelopathy or radiculopathy is rare. It usually occurs in the lower thoracic spine. Ossification of ligamenta flava has mainly been described as occurring in Japanese people and very rarely in Caucasians. Diagnosis is based on a computed tomographic scan or magnetic resonance imaging, and postoperative prognosis is usually good. METHODS: Low thoracic ossification of ligamenta flava was diagnosed in a black man from Martinique, based on the computed tomographic scan data and on the histopathologic examination of the removed tissue. The patient was clinically evaluated before and 1 year after the operation. A postoperative computed tomographic scan was performed. A magnetic resonance image was not available in this case. RESULTS: The patient exhibited severe subacute myelopathy. After decompression, the neurologic recovery was incomplete. A postoperative computed tomographic scan showed complete excision of ossification of ligamenta flava and decompression of the spinal cord. CONCLUSIONS: Ossification of ligamenta flava may occur in black people. An incomplete postoperative recovery may be observed in such cases of unusual subacute compressive myelopathy.
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Ligamento Amarelo , Ossificação Heterotópica/diagnóstico , Compressão da Medula Espinal/etiologia , Idoso , População Negra , Humanos , Ligamento Amarelo/diagnóstico por imagem , Ligamento Amarelo/patologia , Masculino , Martinica/etnologia , Ossificação Heterotópica/complicações , Tomografia Computadorizada por Raios XRESUMO
Grade III open tibial fractures often require long hospitialized and many operations. They always leave unsightly scars and functional results are sometimes very poor. We wanted to establish a predictive score for use in all cases to help us to decide if amputation would give a better result or not. We devised a "PLD" scoring system with a maximum of twenty points, comprising data that concern the patient (0 to 4), the lesions (0 to 14) and the delay of bone coverage(0 to 2). Patient outcome was quantitatively scored by assessing the function (15 points) and the quality of life (professional, sport and leisure, social and psychologic, 15 points). Twenty-seven cases of grade III open tibial fracture were reviewed for this study. Traffic accidents (23 cases) were very frequent. For each case, the total hospital stay and the type and the number of interventions were noted. PLD scores were calculated at emergency and after one month. Final outcome was evaluated at the latest patients follow-up. Results showed that if the PLD score in emergency or at one month was < 5, the final resut was good or excellent (>25) for more than 80 percent of patients. If the score at one month was < 5, the result was judged poor (<20) in more than half the cases. If the PLD score in emergency or at one month was o 20, all such cases required an amputation in emergency or at a later stage. (AU)
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Humanos , Qualidade de Vida , Fraturas da Tíbia/cirurgiaRESUMO
PURPOSE OF THE STUDY: Chondromyxoid fibroma (CMF) is a very rare tumor. CMF represents less than 1p. 100 of all benign osseous tumors. The upper part of the tibia is the most frequent localization. We report the second case of talus tumor published in the world literature. MATERIAL AND METHODS: A 20 years old man presented a lytic tumor of the talus. The histology diagnosed a Chondromyxoid fibroma. A complete excision was made. An autologous bone graft associated with blocks of coral were used for reconstruction. RESULTS: After six months sport activities were authorized. After 10 years follow-up, there is no recurrence, the coral has progressively disappeared, replaced by host bone. DISCUSSION: Only one case of talus tumor has been published in world literature. Feldman has collected 189 cases of CMF published before 1970. After 1970, 297 new cases published. Analysis of these 486 cases pointed out the frequency of differents localizations. CONCLUSION: This very rare tumor frequent between 10 and 30 years of age. The foot is the second localization after the tibia. A surgical conservative treatment with complete excision is recommended even in case of recurrence. Radiotherapy must be avoided in any case because of the risk of malignant degeneration.
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Neoplasias Ósseas/diagnóstico , Condroblastoma/diagnóstico , Doenças do Pé/diagnóstico , Tálus , Adulto , Neoplasias Ósseas/cirurgia , Condroblastoma/cirurgia , Doenças do Pé/cirurgia , Humanos , MasculinoRESUMO
In advanced cases of wrist osteoarthritis with lesions of the radio-scaphoid and mediocarpal joints, and when a proximal row carpectomy is not possible because of lesions of the head of the capitate, we suggest a new technique: The hamate-capitate-lunate shortening arthrodesis with a scaphoid-triquetral resection. The good results observed with proximal row carpectomies, and particularly their long-term reliability, have encouraged us on this new path. Effectively, this operation takes the concept of proximal row carpectomy one step further by reconstructing the head of the capitate with the lunate whose proximal articular surface is often not deteriorated even in very advanced cases of radio and mediocarpal osteoarthritis. The two theoretical concepts of this operation are the shortening of the carpus and respect of the physiological congruence of the radio-lunate joint, the goal being obtain similar results those with proximal row carpectomy, particularly concerning mobility. We present our first two cases with this technique. This new procedure is an alternative to the four bone arthrodesis, particularly in SLAC wrist sequellae when they have evolved to the stage of radio and mediocarpal osteoarthritis.
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Artrodese/métodos , Ossos do Carpo/cirurgia , Osteoartrite/cirurgia , Osteotomia/métodos , Articulação do Punho , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Osteoartrite/fisiopatologia , Radiografia , Amplitude de Movimento Articular , Grampeamento CirúrgicoRESUMO
INTRODUCTION: The authors report one case of overriding impacted symphysis by lateral compression injury of the pelvis. MATERIAL AND METHODS: A 30 year old male presented a disruption of the symphysis pubis following a motor vehicle accident with lateral injury. Radiographs of the pelvis revealed a displacement of the right part of the symphysis behind the left one and a protrusion of the left pubic body through the right obturator foramen. CT scan did not show any sacro-iliac disruption but a fracture of the lateral part of the sacrum. An urethral injury with a complete urethral disruption was associated. Open reduction and internal fixation was necessary to reduce displacement. Urethral disruption was treated after retrograde urethrogram, four months after injury. RESULTS: Two years after injury, there was no pain in the pelvis and urinal function was normal. A sexual dysfunction remained. DISCUSSION: This lesion is secondary to lateral compression injury with internal rotation of the right part of the pelvis. It can be classified in type B2 of Tile's classification. It is a rare condition because this mechanism very often leeds to a fracture of the pelvic ring.
Assuntos
Acidentes de Trânsito , Fixação Interna de Fraturas/métodos , Traumatismo Múltiplo/complicações , Ossos Pélvicos/lesões , Adulto , Placas Ósseas , Parafusos Ósseos , Seguimentos , Humanos , Masculino , Ossos Pélvicos/diagnóstico por imagem , Ossos Pélvicos/cirurgia , Radiografia , Amplitude de Movimento Articular , Uretra/lesõesRESUMO
For more than 20 years, orthopaedic surgery has been using mostly artificial biomaterials which are known to develop problems of intolerance in the long run. More recent biomaterials (coral, hydroxyapatite...) are too fragile to bear heavy mechanical strain. The disadvantages of bone autografts are their availability and the after effects that can appear at the donor site. The disadvantage of bone allografts is that they are vulnerable to virus contamination. The nacre of the big oyster, Pinctada maxima, possesses a three-dimensional structure and physical characteristics similar to bone. The authors present an experimental study already done in vitro and study being done in vivo on sheep. The in vitro work demonstrated the capacity of the nacre to induce bone formation by human osteoblasts. The aim of the animal experimentation (done at the CHRU of Forte de France) is to study the nacre as a bone substitute for the spongy and cortical zones of bone. It has also been used as an articular and intramedullary implant and as an osteosynthesis screw. An X-ray and histological study of bone restoration and the integration of the nacre implant has been done. The first results confirm the biocompatibility and the bioactivity of the nacre biomaterial (osteoconduction and osteogenesis). In conclusion, the nacre seems to possess the required qualities to constitute a biomaterial for future use (AU)
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21003 , Substitutos Ósseos , Ortopedia , FrançaRESUMO
PURPOSE OF THE STUDY: Rupture of the distal tendon of the biceps is an uncommon occurrence. 43 cases were analyzed in a multicentric study in order to define etiological factors and treatment of this lesion. MATERIAL AND METHODS: 43 cases were reviewed from Fort de France, Paris, Marseille, Lyon and Suresnes. There were only male patients with an average age of 50 years. The mechanism of injury, the clinical and radiographic features, the anatomical findings and the results of surgical treatment were analyzed. 4 patients were treated conservatively and 39 surgically. In 28 cases, anatomical reattachment of the tendon was performed. In 11 cases the tendon was simply attached to the brachialis anterior muscle. RESULTS: The mechanism of injury in all patients was passive extension against active flexion 17 patients had sustained injury while engaged in sports activities and 17 during domestic activities. Most of the patients were diagnosed clinically. Ultrasound and CT scan was useful in cases seen a long time after injury. In 34 cases avulsion of the bicipital tuberosity was found. Subjective results were good in 28 cases and poor in 5 cases. Objective testing was performed one year after injury using the criteria described by Baker: flexion and suppination force (maximum force) and endurance (ability to perform repeated contractions). Following attachment to the brachialis anterior, there was an average loss of 33 per cent of flexion strength and 52 per cent of supination strength. Following anatomical reattachment, the loss was 5 per cent for flexion and 15 per cent for supination. There were two cases of radial nerve palsies and 1 case of radio-ulnar synostosis. DISCUSSION: Attachment of the biceps brachialis tendon to the brachialis anterior muscle is unable to restore supination force. Complications only occur following anatomical reattachment. Radial nerve palsies can be avoided by using two separate incisions as described by Boyd. CONCLUSION: Surgical reinsertion onto the radial tuberosity restore more strength. Attachment to the brachialis muscle can be sued in cases seen a long time after injury.
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Traumatismos do Braço/cirurgia , Traumatismos dos Tendões/cirurgia , Adulto , Traumatismos do Braço/diagnóstico por imagem , Traumatismos em Atletas/complicações , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Ruptura/diagnóstico por imagem , Ruptura/cirurgia , Técnicas de Sutura , Traumatismos dos Tendões/diagnóstico por imagem , Tomografia Computadorizada por Raios X , UltrassonografiaRESUMO
If idiopathic bowleg is common, rachitic bowleg must be recognized and cured with vitamin D therapy. Apart from these two conditions, there occurs very frequently another condition known as Blount's disease in the black population in the Caribbean. There is partial dystrophy of the medial part of the upper growth-plate of the tibia. Seventy-five cases were treated in 12 years and the different stages in the pathology of the condition are shown. Young children with this condition are treated with a small tibial osteotomy which prevents bowing of the legs (AU)
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Criança , Perna (Organismo)/anormalidades , Ossos da Perna/anormalidades , Vitamina D/uso terapêutico , Índias OcidentaisRESUMO
Infantile coxa-vara is an infrequent lesion and two etiologic factors have been recognised: mechanical and genetic. As in Blount's disease, the same populations (black and scandinavian people) are usually affected. Twenty eight patients with 42 infantile coxa vara were reviewed. The diagnosis was often late. The radiographs showed the decrease of the neck-shaft angle and the signs of cervical dystrophy. The aggravation of the coxa vara is usual and pseudarthrosis or osteo-arthritis can be observed. Thirty six femoral valgus sub-trochanteric osteotomies were done. The results were best when the surgery was done before the age of 9 years. When the surgery was done later, an epiphysiodesis of the greater trochanter was associated to the femoral osteotomy if the epiphyseal cartilage was fused. Langenskiold's osteotomy was used only when the neck-shaft angle was lower than 80 degrees. The results were evaluated according to the neck shaft angle and the morphology of the femoral head: 22 very good and good, 11 fair and 3 bad results were noted.
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Luxação do Quadril/diagnóstico por imagem , Osteotomia/métodos , Adolescente , Fatores Etários , Criança , Pré-Escolar , Feminino , Luxação do Quadril/etiologia , Luxação do Quadril/cirurgia , Humanos , Masculino , RadiografiaRESUMO
The Caribbean coral Porites astreoides was selected for use as a bone substitute in humans after several animal experiments. Coral was used as a bone substitute in 47 cases comprising 23 tibial plateau fractures, 4 benign osseous tumours, 4 cases of cortical defects of the femur and tibia following fractures, 2 cases of tibial osteotomy, in 8 patients undergoing total hip arthroplasty and in 6 other orthopaedic patients. In follow up 6 months to 4 years, X-rays revealed resorption and new bone formation in place of the coral which behaved very similar to bone grafts. The indications for using coral as a bone substitute, the complications and detailed results are described (AU)
Assuntos
Humanos , Masculino , Feminino , Substitutos Ósseos , Transplante ÓsseoRESUMO
Blount's disease is associated with agenesis of the medial tibial plateau leading to tibia vara. It appears to be more frequent in Scandinavian countries and in black populations. Twenty-six cases had been seen in Martinique (Antilles) of whom twenty were children. A classification into six stages was described. Stage IV is a critical one. Before it, corrective osteotomy will often lead to complete healing. After stage IV, lateral epiphysiodesis must be added to avoid recurrence of deformity. The technique of osteotomy was variable according to the age of the child and the obliquity of the joint line. In young children, a subtraction closing wedge osteotomy is suitable. In older children a "V" shaped osteotomy is recommended to lessen the amount of shortening. At the end of the growth period, a medial opening wedge osteotomy is advisable. In adults (six cases) whose deformity can reach as much as 50 degrees with considerable ligamentous laxity, reefing of the ligament must be added to the osteotomy. The problem of the opposite knee is discussed. Even when the disease is not bilateral, it can tend to develop towards arthrosis.