RESUMO
Bothrops lanceolatus is an endemic Crotalidae species in Martinique, where approximately 30 cases of envenoming are managed yearly. Envenoming characteristics from Bothrops species include local tissue damage, systemic bleeding, and hemodynamic alterations. We hereby report a case of severe envenomation following B. lanceolatus snakebite to the right calf. Severe local manifestations developed progressively up to the lower limb despite adequate antivenom therapy. Systemic manifestations of venom also occurred, resulting in intensive care therapy. Surgery exploration revealed soft tissue necrosis, friability of the deep fascia, and myonecrosis. The patient needed multiple debridement procedures and fasciotomy of all leg compartments and anterior compartment of the thigh. Diagnosis of necrotizing fasciitis was confirmed by positive Aeromonas hydrophila blood cultures. This clinical case illustrates that major soft tissue infection, including necrotizing fasciitis may occur after snakebite. Abnormal coagulation tests should not delay surgical management, as severe envenoming is a life-threatening condition.
Assuntos
Bothrops , Gerenciamento Clínico , Fasciite Necrosante/etiologia , Fasciotomia , Mordeduras de Serpentes/cirurgia , Adulto , Aeromonas hydrophila/isolamento & purificação , Animais , Venenos de Crotalídeos/efeitos adversos , Desbridamento , Fasciite Necrosante/diagnóstico , Fasciite Necrosante/microbiologia , Feminino , Infecções por Bactérias Gram-Negativas/sangue , Humanos , Martinica , Coxa da Perna/patologia , Coxa da Perna/cirurgiaRESUMO
UNLABELLED: Gossypiboma imaging features are not well known and are often confused with soft tissue tumours. Publications on this topic mainly consist of case reports and small cohorts. Its appearance on various imaging modalities is not well defined. This led us to carry out a review of literature to determine specifically: (1) which imaging modalities should be used in cases of suspected gossypiboma, (2) what are the most common imaging findings that contribute to the diagnosis of gossypiboma. An exhaustive review of literature was carried out in June 2015 in the Medline, PubMed and Cochrane databases using the keywords "gossypiboma/textiloma/foreign body". We found 205 articles describing one or multiple cases of gossypiboma in various locations. Of these, the 32 articles that had imaging data were chosen - 16 for the limbs and 16 for other locations. The type of imaging carried out, description of the gossypiboma and circumstances of the discovery and occurrence were recorded. Descriptive statistics were generated to define the type of imaging used and the various findings. Imaging consisted of X-rays in 21/32 cases (66%), computed tomography (CT) in 14/32 cases (43%), magnetic resonance imaging (MRI) in 21/32 cases (65%) and ultrasonography in 14/32 cases (43%). On X-rays, bone involvement was found in 9/15 cases (60%); there was peripheral contrast product uptake on the CT scans in 9/14 cases (64%), a hypointense signal on T1-weighted sequences on MRI in 6/13 cases (46%) and lack of vascularisation in 8/13 cases (62%) and a acoustic shadow on ultrasonography in 9/14 cases (64%). In a patient presenting with a soft tissue lump and history of surgery, an imaging work-up including X-rays, ultrasonography and MRI must be performed. Bone involvement on X-rays, acoustic shadowing on ultrasonography and hypointense signal on T1-weighted MRI sequences with lack of vascularisation in combination with a history of surgery can bring up the possibility of gossypiboma. If there is a possibility of soft tissue tumour, the case should be discussed in a multidisciplinary meeting and a biopsy should be performed first. LEVEL OF EVIDENCE: IV - systematic analysis of published retrospective studies.
Assuntos
Diagnóstico por Imagem/métodos , Extremidades/diagnóstico por imagem , Corpos Estranhos/diagnóstico por imagem , Diagnóstico Diferencial , HumanosRESUMO
BACKGROUND: Although fractures of the proximal femur (FPF) are supposedly less frequent in Black populations (studies of incidence are rare) the life expectancy in Africa is low, which could partially explain this notion. There is only one retrospective study on the incidence of FPF in the islands of the Caribbean, thus we performed an incidence study in the insular, circumscribed, 90% Afro-Caribbean population of Martinique. The goals of this study were: (1) to estimate the incidence of FPF; (2) and to prospectively describe the main characteristics. HYPOTHESIS: The incidence of fractures of the proximal femur in Martinique is lower than in Western countries. PATIENTS AND METHODS: The raw and standardized incidence ratio of FPF in relation to the world population was estimated based on data from the Medical Information System Program (Programme de médicalisation des systèmes d'information [PMSI]) for all of Martinique for a period of 4 years (January 1, 2010 to December 31, 2013). Characteristics were based on all patients over the age of 60 who presented to the Fort-de-France University Hospital (CHU) for a FPF between December 1, 2011 and April 31, 2012. Patients with light-skin phenotype, high-energy fractures and secondary fractures were excluded from the study. RESULTS: The standardized incidence ratio in relation to the world population was estimated (n=794) as 22.5/100,000 patient-years [20.6-24.4]: 22.6 and 22.4/100,000 in men and women respectively. The characteristics of eighty-seven patients (including 56 women), mean age 85.3 (±7.2) (62-100) years old were evaluated: 52 femoral neck fractures (60%) and 33 fractures of the greater trochanter (38%). The 2-month mortality rate was 21%, and 1/3 of the surviving patients could function independently. The risk of death increased in relation to the initial risk of moderate to severe dementia. DISCUSSION: The incidence of FPF in Martinique is lower than in Western countries and includes, as expected, an elderly, female population. Unlike a previous study performed in Guadeloupe, there was a majority of femoral neck fractures. A Caribbean multi-insular study is needed to confirm these results and to obtain precise data on bone density. LEVEL OF EVIDENCE: IV; descriptive prospective epidemiological study.
Assuntos
Fraturas do Colo Femoral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , População Negra , Doenças Ósseas Metabólicas/epidemiologia , Demência/epidemiologia , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Martinica/epidemiologia , Pessoa de Meia-Idade , Fraturas por Osteoporose/epidemiologia , Autonomia Pessoal , Estudos ProspectivosRESUMO
OBJECTIVES: We conducted a retrospective study to examine the optimal regimen of transfusion and whether preoperative transfusion is needed in patients with Sickle cell anaemia (SCA) undergoing a Total hip arthroplasty (THA). Then, we assessed the incidence of perioperative complications rates among patients assigned to different transfusion regimens to propose finally the safety transfusion protocol. BACKGROUND: Preoperative transfusions are usually given to reduce or prevent perioperative complications to SCA patients undergoing THA. There is no consensus however on the best regimen of transfusion. STUDY DESIGN AND METHODS: During the period of 2000 to 2010, 14 patients with SCA (sex-ratio 0.4) with a mean age of 36 years underwent 16 THA (primary or revision). Three groups were differentiated according preoperatively protocol transfusion. Group 1: exchange transfusion (EXT), group 2: simple transfusion (ST), group 3: no transfusion (NT). RESULTS: Overall, preoperative transfusion was performed in 43.7% of cases and complications rate was 50%. In the group 1 (EXT) including five patients (31%), severe complications occurred in four patients (80%). in the group 2, including two patients (12.5%), no complications were observed. In the group 3, including nine patients (56%), complications occurred in four procedures (44.5%), the half of them were haemolytic complications. CONCLUSION: Our results support the decision to transfuse, ST, preoperatively only if the patient is significantly below their steady-state haemoglobin (Hb) level. Transfusion can be used intraoperatively according Hb level and/or the blood loss volume. Exchange transfusion appeared mostly to be related to postoperative morbidity rates.
Assuntos
Anemia Falciforme/terapia , Artroplastia de Quadril/efeitos adversos , Transfusão de Eritrócitos/métodos , Transfusão Total/métodos , Complicações Intraoperatórias/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Adulto , Anemia Falciforme/complicações , Anemia Falciforme/cirurgia , Transfusão de Eritrócitos/efeitos adversos , Feminino , França , Humanos , Incidência , Complicações Intraoperatórias/prevenção & controle , Masculino , Pessoa de Meia-Idade , Período Perioperatório , Complicações Pós-Operatórias/prevenção & controle , Estudos Retrospectivos , Adulto JovemRESUMO
We report on a case of isolated lesser trochanter fracture, without associated trauma, secondary to pulmonary adenocarcinoma metastasis. Treatment consisted in resection-reconstruction by megaprosthesis. This form of isolated fracture is rare, and results from infiltration of the trochanteric area by a malignant tumoral process, which is usually metastatic.
Assuntos
Adenocarcinoma/secundário , Neoplasias Ósseas/secundário , Fraturas do Quadril/diagnóstico , Fraturas do Quadril/etiologia , Fraturas do Quadril/cirurgia , Adenocarcinoma/terapia , Neoplasias Ósseas/terapia , Terapia Combinada , Diagnóstico Diferencial , Prótese de Quadril , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tomografia Computadorizada por Raios XRESUMO
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.
Assuntos
Cabeça do Fêmur/lesões , Fixação Interna de Fraturas/métodos , Luxação do Quadril/cirurgia , Fraturas do Quadril/cirurgia , Adulto , Artroplastia de Quadril , Nádegas/cirurgia , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/etiologia , Necrose da Cabeça do Fêmur/cirurgia , Seguimentos , Consolidação da Fratura/fisiologia , Luxação do Quadril/diagnóstico por imagem , Fraturas do Quadril/diagnóstico por imagem , Humanos , Masculino , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/etiologia , Osteoartrite do Quadril/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Radiografia , ReoperaçãoRESUMO
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
OBJECTIVE: No studies have been performed on cruising sailors who spend most of the year on offshore cruising sailboats. To gain a better understanding of this population, traumatic events occurring in this group of sailors were studied to define appropriate means of prevention. DESIGN, SETTING AND PATIENTS: Primary care data were collected prospectively using a questionnaire during in-depth interviews by one of the authors (FM) of 100 cruising sailboat crews that called at Martinique between December 2001 and May 2002. MAIN OUTCOME MEASUREMENTS: In total, 56 injuries were reported: 20 involved the upper limb, 20 the lower limb, and 7 the head and neck. There were also 19 burns, 11 of which were photoinduced and 8 accidental. There were 16 skin infections, 3 of which were complicated by arthritis. RESULTS: After analysis, we found that most of these injuries could be prevented if the following recommendations were applied. Wearing shoes would avoid foot injuries. A hatch cover would effectively protect from cranial trauma caused by the boom. To protect from the sun, a bimini top (cover to shield the cockpit) would be most effective. A windlass would avoid hand injuries and acute lower back pain. Lastly, meticulous wound care until complete healing would prevent the common complications of skin superinfections. CONCLUSIONS: Injuries to professional seafarers and ocean racers are well described, but the increasingly growing cruising sailor population has not been well studied. Development of easy and inexpensive worldwide network connection will allow better follow-up of this mobile population.
Assuntos
Traumatismos em Atletas/prevenção & controle , Navios , Esportes , Adulto , Traumatismos em Atletas/etiologia , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , TelemedicinaRESUMO
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.
RESUMO
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.
Assuntos
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: 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.
Assuntos
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
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.
Assuntos
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
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)
Assuntos
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.
Assuntos
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.
Assuntos
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
Three different exoskeletons of coral species Porites asteroides (P), Montastrea annularis (M), and Dichocoenia stokesi (D) were implanted for 2-20 weeks in rabbits. At 2, 4, 8, or 20 weeks, the exoskeletons presented variations in their resorptions depending on the species. To understand the variations in the decreasing speed of the implants despite their similar chemical composition, a study of the surface and architecture of the coral was carried out using scanning electronic microscopy, porosity was evaluated, and growth and differentiation of osteogenic cells cultured in vitro were observed for more than 1 month. At the cellular level, the surface of the implants was identical. Three-dimensional structures of the implants were variable, but the porosity values [P = 42.7%, M = 40.7%, and D = 17.4%] could not completely account for the differences in the resorbing process of the species. Standard histologic studies performed at 2, 4, 8, and 20 weeks after implantation produced the same pattern with P or M, showing aspects of rapid resorption; however, with D there were images resembling those of a foreign-body reaction. It seems that when resorption is not quick enough, a foreign body reaction develops which further slows down the process. This work focuses on the importance of porosity when using coral as bone substitute.
Assuntos
Reabsorção Óssea/fisiopatologia , Cnidários , Reação Enxerto-Hospedeiro/fisiologia , Próteses e Implantes , Animais , Células Cultivadas , Reação a Corpo Estranho/fisiopatologia , Humanos , Imuno-Histoquímica , Masculino , Microscopia Eletrônica de Varredura , Porosidade , Coelhos , Especificidade da Espécie , Células-Tronco/fisiologiaRESUMO
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.