RESUMO
OBJECTIVE: In this study, eighteen patients who have had perilunate injury with dislocation or fracture, were evaluated and the patho-mechanics and surgical treatment were studied. SUBJECTS AND METHODS: According to the Green and O'Brien's classification, type 1 injury occurred in one patient, type 2 in nine, type 4A in five, type 4C in one and type 4D in one. The other one case could not be classified using the Green and O'Brien's criteria. RESULTS: According to the Evans scoring system, good results were achieved in thirteen patients, fair results, in four, poor results in one and very poor results in none. When the patho-mechanics was estimated based on the Mayfield's criteria, seventeen patients were classified as stage 3. However only one case was extremely unusual and should be classified as a subtype of stage 2. CONCLUSION: The results were good in the majority of patients who had repair of perilunate injury.
Assuntos
Fraturas Ósseas/cirurgia , Luxações Articulares/cirurgia , Osso Semilunar/lesões , Traumatismos do Punho/cirurgia , Adulto , Idoso , Feminino , Fraturas Ósseas/classificação , Fraturas Ósseas/diagnóstico por imagem , Humanos , Luxações Articulares/classificação , Luxações Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Resultado do Tratamento , Traumatismos do Punho/classificação , Traumatismos do Punho/diagnóstico por imagemRESUMO
AIM AND BACKGROUND: The surgical treatment for acromioclavicular joint dislocations is recommended for Rockwood's classification types 4, 5 and 6. In this study, we evaluate the therapeutic results of the modified Cadenat procedure on type 5 acromioclavicular joint dislocation, and report on a comparative study of the modified Dewar procedure also on type 5 acromioclavicular joint dislocation. SUBJECTS AND METHODS: The modified Cadenat procedure was performed on 73 patients (66 males and 7 females, group C). The mean age at the time of the surgery was 35.4 years. On the other hand, the modified Dewar procedure was performed on 55 patients (51 males and 4 females, group D). The mean age at the time of the surgery was 34.5 years. RESULTS: The mean therapeutic results were 28.2 points in group C and 27.3 in group D according to the UCLA scoring system. In group C, the subluxation that represented less than 5 mm superior translation of the clavicle, occurred only in 18 of 73 patients. Meanwhile, in group D, the subluxation that represented less than 5 mm, occurred only in 14; that which represented 5 to 10 mm was in seven patients, and the complete dislocation occurred in three patients. Also, the occurrence ofosteoarthritic changes in the acromioclavicular joint was nine patients in group C and 20 in group D, respectively. CONCLUSION: The modified Cadenat procedure could provide satisfactory therapeutic results and avoid postoperative failure of reduction compared to the modified Dewar procedure. However, the modified Cadenat procedure does not aim to restore the anatomical coracoclavicular ligaments. It is believed that anatomic restoration ofboth coracoclavicular ligaments could best restore the function ofthe acromioclavicular joint.
OBJETIVO Y ANTECEDENTES: El tratamiento quirúrgico para las dislocaciones de la articulación acromioclavicular se recomienda para los tipos 4, 5, y 6 de la clasificación de Rookwood. En este estudio, se evalúan los resultados terapéuticos del procedimiento de Cadenat modificado en dislocación de la articulación acromioclavicular de tipo 5, y también se informa sobre el estudio comparativo con el procedimiento de Dewar modificado practicado sobre el tipo 5 de dislocación de la articulación acromioclavicular. SUJETOS Y MÉTODOS: El procedimiento de Cadenat modificado se realizó en 73 pacientes (66 varones y 7 hembras, grupo C). La edad promedio en el momento de la cirugía era 35.4 años. Por otro lado, el procedimiento de Dewar modificado se realizó en 55 pacientes (51 varones y 4 hembras, grupo D). La edad promedio en el momento de la cirugía era 34.5 años. RESULTADOS: Los resultados terapéuticos promedio fueron 28.2 puntos en el grupo C y 27.3 en el grupo D de acuerdo con el sistema de puntuación UCLA. En el grupo C, la subluxación que representó menos de 5 mm de traslación superior de la clavícula, sólo ocurrió en 18 de 73 pacientes. Entretanto, en el grupo D, la subluxación que representó menos de 5 mm, sólo ocurrió en 14; la subluxación que representó de 5 a 10 mm ocurrió en siete pacientes; yla dislocación completa ocurrió en tres pacientes. También, la ocurrencia de cambios osteoartríticos en la articulación acromioclavicular fue de nueve pacientes en el grupo C y 20 en el grupo D, respectivamente. CONCLUSIÓN: El procedimiento de Cadenat modificado podría proporcionar resultados terapéuticos satisfactorios, y podría evitar el fracaso postoperatorio de la reducción en comparación con el procedimiento de Dewar modificado. Sin embargo, el procedimiento de Cadenat modificado no esta dirigido a restaurar los ligamentos coracoclaviculares anatómicas. Se entiende que la restauración anatómica de ambos ligamentos coracoclaviculares pudiera restaurar mejor la función de la articulación acromioclavicular.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Articulação Acromioclavicular , Luxações Articulares/cirurgia , Procedimentos Ortopédicos/métodos , Articulação Acromioclavicular , Luxações Articulares , Resultado do TratamentoRESUMO
OBJECTIVES: In this study, eighteen patients who have had perilunate injury with dislocation or fracture, were evaluated and the patho-mechanics and surgical treatment were studied. SUBJECTS AND METHODS: According to the Green and O 'Brien's classification, type 1 injury occurred in one patient, type 2 in nine, type 4A in five, type 4C in one and type 4D in one. The other one case could not be classified using the Green and O 'Brien's criteria. RESULTS: According to the Evans scoring system, good results were achieved in thirteen patients, fair results, in four, poor results in one and very poor results in none. When the patho-mechanics was esti mated based on the Mayfield's criteria, seventeen patients were classified as stage 3. However, only one case was extremely unusual and should be classified as a subtype of stage 2. CONCLUSION: The results were good in the majority ofpatients who had repair ofperilunate injury.
OBJETIVO: En este estudio, se evaluaron dieciocho pacientes que tuvieron lesión perisemilunar con dislocación o fractura, y se estudiaron la patomecánica y el tratamiento quirúrgico. SUJETOS Y MÉTODO: Sobre la base de la clasificación de Green y O'Brien, se concluye que ocurrieron las siguientes lesiones: lesión de tipo 1 en un paciente, de tipo 2 en nueve, tipo 4A en cinco, tipo 4C en uno y tipo 4D en uno. El otro caso no se pudo clasificar usando criterios de Green y O'Brien. RESULTADOS: El sistema de puntuación de Evans, indica que se lograron buenos resultados en trece pacientes; resultados satisfactorios en cuatro; resultados pobres en uno; resultados muy pobres en ninguno. Cuando se estimó la patomecánica sobre la base de los criterios Mayfield, diecisiete pacientes fueron clasificados como fase 3. Sin embargo, sólo un caso fue sumamente raro y debe ser clasificado como subtipo de fase 2. CONCLUSIÓN: Los resultados fueron buenos en la mayoría de los pacientes que tuvieron reparación de lesión perisemilunar.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Luxações Articulares/cirurgia , Fraturas Ósseas/cirurgia , Osso Semilunar/lesões , Traumatismos do Punho/cirurgia , Luxações Articulares/classificação , Luxações Articulares , Fraturas Ósseas/classificação , Fraturas Ósseas , Resultado do Tratamento , Traumatismos do Punho/classificação , Traumatismos do PunhoRESUMO
AIM AND BACKGROUND: The surgical treatment for acromioclavicular joint dislocations is recommended for Rockwood's classification types 4, 5 and 6. In this study we evaluate the therapeutic results of the modified Cadenat procedure on type 5 acromioclavicular joint dislocation, and report on a comparative study of the modified Dewar procedure also on type 5 acromioclavicular joint dislocation. SUBJECTS AND METHODS: The modified Cadenat procedure was performed on 73 patients (66 males and 7 females, group C). The mean age at the time of the surgery was 35.4 years. On the other hand, the modified Dewar procedure was performed on 55 patients (51 males and 4 females, group D). The mean age at the time of the surgery was 34.5 years. RESULTS: The mean therapeutic results were 28.2 points in group C and 27.3 in group D according to the UCLA scoring system. In group C, the subluxation that represented less than 5 mm superior translation of the clavicle, occurred only in 18 of 73 patients. Meanwhile, in group D, the subluxation that represented less than 5 mm, occurred only in 14; that which represented 5 to 10 mm was in seven patients, and the complete dislocation occurred in three patients. Also, the occurrence of osteoarthritic changes in the acromioclavicular joint was nine patients in group C and 20 in group D, respectively. CONCLUSION: The modified Cadenat procedure could provide satisfactory therapeutic results and avoid postoperative failure of reduction compared to the modified Dewar procedure. However the modified Cadenat procedure does not aim to restore the anatomical coracoclavicular ligaments. It is believed that anatomic restoration of both coracoclavicular ligaments could best restore the function of the acromioclavicular joint.
Assuntos
Articulação Acromioclavicular , Luxações Articulares/cirurgia , Procedimentos Ortopédicos/métodos , Articulação Acromioclavicular/diagnóstico por imagem , Adolescente , Adulto , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Resultado do Tratamento , Adulto JovemRESUMO
BACKGROUND: Since frozen shoulder is characterized by spontaneous recovery, no precise treatment strategy exists. Both conservative therapy and arthroscopic surgery is available, but the time required for recovery varies considerably. This study looks at the possible early symptom relief with oral steroid therapy. SUBJECTS AND METHODS: The subjects were 76 patients aged 33 to 73 years at the beginning of the study. The duration of the frozen shoulder was one to 15 months (mean 5.7 months) and hypertension was noted in 13 patients as a complicated disorder. A single course of steroid therapy consisted of a total dose of 105 mg of prednisolone over approximately a three-week period by the dose-tapering method. The number of courses varied with the degree of symptom relief, but the rest period between courses was always approximately four weeks. The results were assessed on the basis of the Japanese Orthopaedic Association (JOA) score, but the principal evaluations were pain and range of motion. RESULTS: The average ranges of motion before treatment were 102.8º of forward flexion 11.3º of external rotation and internal, rotation was at the buttocks. However, after one course of treatment, forward flexion was 136º, external rotation was 33.7º, and internal rotation was limited to the buttocks in only six cases. CONCLUSION: The results of oral steroid therapy for frozen shoulder were highly satisfactory. However, sufficient care is required in explaining the method of administration and the adverse effects such as the osteonecrosis of the femoral head or osteoporosis.
ANTECEDENTES: Como que el hombro congelado se caracteriza por la recuperación espontánea, no existe una estrategia de tratamiento precisa. Tanto la terapia conservadora como la cirugía artroscópica se hallan a disposición, pero el tiempo requerido para la recuperación varía considerablemente. Este estudio echa una ojeada al posible alivio de los síntomas tempranos por medio de la terapia de esteroides orales. SUJETOS Y MÉTODO: Los sujetos fueron 76pacientes en edades de 33 a 73 años al comienzo del estudio. La duración del hombro congelado fue de 1 a 15 meses (promedio 5.7 meses), y se observó hipertensión en 13 pacientes como una condición co-mórbida. Un solo tratamiento con esteroides consistía en una dosis total de 105 mg de prednisolona por un período de aproximadamente tres semanas mediante el método de reducción gradual de la dosis. El número de tratamientos varió de acuerdo con el grado de alivio del síntoma, pero el período de descanso entre tratamientos fue aproximadamente de cuatro semanas. Los resultados fueron evaluados sobre la base de la puntuación establecida por la Asociación Ortopédica del Japón (JOA), y las evaluaciones principales fueron el dolor y el alcance del movimiento. RESULTADOS: El rango promedio del movimiento antes del tratamiento fue 102.8º deflexión delantera, y 11.3º de rotación externa y la rotación interna fue en las nalgas. Sin embargo, luego de un tratamiento, la flexión delantera fue 136º, la rotación externa fue 33.7º, y la rotación interna estuvo limitada a las nalgas en sólo seis casos. CONCLUSIÓN: Los resultados de la terapia de esteroides orales para el hombro congelado, fueron altamente satisfactorias. Sin embargo, se requiere suficiente cuidado al explicar el método de administración y los efectos adversos, tales como la osteonecrosis de la cabeza del fémur o la osteoporosis.
Assuntos
Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Artropatias/tratamento farmacológico , Articulação do Ombro , Esteroides/administração & dosagem , Administração Oral , Radioisótopos de Gálio , Artropatias/fisiopatologia , Artropatias , Medição da Dor , Amplitude de Movimento Articular , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
This study evaluated the pathology and therapeutic results of seven patients with intraosseous ganglia of the carpal bone. The mean age at the time of surgery was 27.6 years. The lesions were localized in the proximal carpal row in six patients and in the distal carpal row in only one. Surgical treatment was performed in all patients with good bone union. None had pain during activity or at rest and no recurrence had occurred. The intraosseous ganglia in four patients was of the idiopathic type, and in the other three patients was of the penetrating type. Although intraosseous ganglia of the carpal bone is reported as a rare disease, there were 159 cases in the literature. The pathology was intra- or extraosseous development, showing variation, but most cases were localized in the proximal carpal row.
Assuntos
Cistos Ósseos/cirurgia , Ossos do Carpo/cirurgia , Adolescente , Adulto , Cistos Ósseos/diagnóstico , Cistos Ósseos/patologia , Ossos do Carpo/patologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Resultado do TratamentoRESUMO
Malignant fibrous histiocytoma (MFH) is a type of highly malignant soft tissue sarcoma with a predilection for the extremities of adults. We report a patient with MFH in the infraspinatus muscle for which wide resection including total resection of the infraspinatus muscle was performed, followed by transfer of the latissimus dorsi muscle for shoulder reconstruction in a one-stage operation with good postoperative function.
Assuntos
Histiocitoma Fibroso Maligno/cirurgia , Músculo Esquelético/patologia , Músculo Esquelético/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Ombro/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Adulto , Biópsia , Meios de Contraste , Feminino , Gadolínio DTPA , Histiocitoma Fibroso Maligno/diagnóstico , Humanos , Imageamento por Ressonância Magnética , Neoplasias de Tecidos Moles/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
This study evaluated the pathology and therapeutic results of seven patients with intraosseous ganglia of the carpal bone. The mean age at the time of surgery was 27.6 years. The lesions were localized in the proximal carpal row in six patients and in the distal carpal row in only one. Surgical treatment was performed in all patients with good bone union. None had pain during activity or at rest and no recurrence had occurred. The intraosseous ganglia in four patients was of the idiopathic type, and in the other three patients was of the penetrating type. Although intraosseous ganglia of the carpal bone is reported as a rare disease, there were 159 cases in the literature. The pathology was intra- or extraosseous development, showing variation, but most cases were localized in the proximal carpal row.
Este estudio evaluó la patología y resultados terapéuticos de siete pacientes con ganglión intraóseo del hueso carpiano. La edad promedio en el momento de la cirugía fue 27.6 años. Las lesiones se localizaban en la fila proximal del carpo en seis pacientes y en la fila distal carpiana solamente en uno. El tratamiento quirúrgico se realizó en todos los pacientes con buena unión ósea. Ninguno tuvo dolor durante la actividad o el reposo, y no había tenido lugar recurrencia alguna. El ganglión intraóseo en cuatro pacientes fue de tipo idiopático, y en los otros tres pacientes fue de tipo penetrante. Aunque el ganglión intraóseo del hueso carpiano se informa como una enfermedad rara, se reportaban 159 casos en la literatura. La patología consistía en un desarrollo intra- o extraóseo, con variación, pero la mayoría de los casos se localizaban en la fila proximal carpiana.
Assuntos
Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Cistos Ósseos/cirurgia , Ossos do Carpo/cirurgia , Cistos Ósseos/diagnóstico , Cistos Ósseos/patologia , Ossos do Carpo/patologia , Imageamento por Ressonância Magnética , Resultado do TratamentoRESUMO
Malignant fibrous histiocytoma (MFH) is a type of highly malignant soft tissue sarcoma with a predilection for the extremities of adults. We report a patient with MFH in the infraspinatus muscle for which wide resection including total resection of the infraspinatus muscle was performed, followed by transfer of the latissimus dorsi muscle for shoulder reconstruction in a onestage operation with good postoperative function.
El histiocitoma fibroso maligno (HFM) es un tipo de sarcoma del tejido suave, altamente maligno, con predilección por las extremidades de los adultos. Reportamos el caso de un paciente con HFM en el músculo infraespinoso, al cual se le hizo una amplia resección que incluyó la resección total del músculo infraespinoso, seguida de una transferencia del músculo latissimus dorsi para la reconstrucción del hombro, en una operación de una sola etapa con buena función postoperatoria.
Assuntos
Adulto , Feminino , Humanos , Histiocitoma Fibroso Maligno/cirurgia , Músculo Esquelético/patologia , Músculo Esquelético/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Ombro/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Retalhos Cirúrgicos , Biópsia , Meios de Contraste , Gadolínio DTPA , Histiocitoma Fibroso Maligno/diagnóstico , Imageamento por Ressonância Magnética , Neoplasias de Tecidos Moles/diagnóstico , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: Since frozen shoulder is characterized by spontaneous recovery, no precise treatment strategy exists. Both conservative therapy and arthroscopic surgery is available, but the time required for recovery varies considerably. This study looks at the possible early symptom relief with oral steroid therapy. SUBJECTS AND METHODS: The subjects were 76 patients aged 33 to 73 years at the beginning of the study. The duration of the frozen shoulder was one to 15 months (mean 5.7 months) and hypertension was noted in 13 patients as a complicated disorder. A single course of steroid therapy consisted of a total dose of 105 mg of prednisolone over approximately a three-week period by the dose-tapering method. The number of courses varied with the degree of symptom relief but the rest period between courses was always approximately four weeks. The results were assessed on the basis of the Japanese Orthopaedic Association (JOA) score, but the principal evaluations were pain and range of motion. RESULTS: The average ranges of motion before treatment were 102.8 degrees of forward flexion 11.3 degrees of external rotation and internal, rotation was at the buttocks. However, after one course of treatment, forward flexion was 136 degrees, external rotation was 33.7 degrees, and internal rotation was limited to the buttocks in only six cases. CONCLUSION: The results of oral steroid therapy for frozen shoulder were highly satisfactory. However, sufficient care is required in explaining the method of administration and the adverse effects such as the osteonecrosis of the femoral head or osteoporosis.