RESUMO
INTRODUCCIÓN: La epifisiólisis de la cabeza femoral es el desplazamiento de la epífisis con respecto a la metáfisis, en dirección anterosuperior; su etiología es desconocida, frecuente en adolescentes, periodo peripuberal, y con índice de masa corporal elevado, edad promedio entre 12 y 18 años. Su incidencia es variable, 0.2 (Japón) a 10 (Estados Unidos) por 100 000 habitantes. Se caracteriza por dolor progresivo en cadera, con irradiación a la ingle o rodilla, se asocia a cojera; con la detección precoz se puede instaurar un tratamiento adecuado, el más aceptado es la fijación in situ con tornillos centrales. CASO CLÍNICO: Paciente de sexo femenino 14 años de edad sin antecedentes patológicos, acudió al servicio de ortopedia infantil por presentar dolor lancinante crónico de cadera derecha de nueve meses de evolución que aumenta con la deambulación, diagnosticada por clínica y exámenes complementarios de imagen de epifisiólisis de cabeza femoral. Se realizó luxación quirúrgica de la cadera y reducción abierta anatómica con colocación de tornillos esponjosos. EVOLUCIÓN: Al tercer día de la cirugía, se decide alta hospitalaria; deambulación con muletas y sin apoyo durante un mes posquirúrgico. La osteosíntesis permaneció durante un año con controles mensuales y fisioterapia correspondiente; se ha evidenciado evolución favorable; arcos de movilidad de cadera conservados, deambulación normal, sin complicaciones. CONCLUSIÓN: El tratamiento inicial de un paciente con epifisiólisis de cabeza femoral estable depende del tiempo de evolución y se realiza fijando con tornillos o agujas mediante la luxación anatómica de la cadera y osteoplastia de remodelación del cuello femoral. La mayoría de los pacientes no desarrollan necrosis ni condrolisis y los resultados a largo plazo con la fijación in situ suelen ser excelentes, a diferencia de los pacientes con diagnóstico tardío.
BACKGROUND: The epiphysiolysis of the femoral head is the displacement of the epiphysis with respect to the metaphysis, in anterosuperior direction; it is etiology is unknown, frequent in adolescents, peripubertal period, and with high body mass index, average age between 12 and 18 years. It is incidence is variable, 0.2 (Japan) to 10 (United States) per 100 000 inhabitants. It is characterized by progressive pain in the hip, with irradiation to the groin or knee, is associated with lameness; with the early detection, an adequate treatment can be established, the most accepted one is the in situ fixation with central screws. CASE REPORT: A 14-year-old female patient with no pathological history attended the Children's Orthopedic Service due to the chronic lancinating pain of the right hip, which increases with walking, it is diagnosed by clinical examination and complementary exams of femoral head epiphysiolysis. Surgical dislocation of the hip and anatomical open reduction with placement of spongy screws was performed. EVOLUTION: On the third day of surgery, hospital discharge is decided; walking with crutches and without support during a postoperative month. The osteosynthesis remained for a year with monthly controls and corresponding physiotherapy; it has been evidenced favorable evolution; hip mobility arches preserved, normal ambulation, without complications CONCLUSIONS: The initial treatment of a patient with epiphysiolysis of stable femoral head depends on the evolution time and is done by fixing with screws or needles with of anatomical dislocation of the hip and osteoplasty of femoral neck remodeling. Most patients do not develop necrosis or chondro- lysis and long-term results with in situ fixation are usually excellent, unlike patients with late diagnosis.
Assuntos
Humanos , Feminino , Administração de Caso , Epifise Deslocada/cirurgia , Impacto Femoroacetabular/diagnóstico , Quadril/patologiaRESUMO
There are few studies about the treatment options for cranial cruciate ligament rupture in growing dogs, especially with epiphysiodesis techniques. The aim of this study was to evaluate the electrocautery technique for proximal tibial epiphysiodesis in Labrador retriever puppies. The novel electrocautery technique was compared with the screw technique regarding the efficacy for tibial plateau leveling in growing dogs. Six healthy Labrador retriever puppies were divided into two groups. The screw technique was used in one group and the electrocautery technique was used in the other group. Both proximal tibial epiphysiodesis techniques for tibial plateau leveling were effective in achieving reduced tibial plateau angle and did not cause significant joint changes. The screw technique was more invasive and caused slightly greater morbidity than the electrocautery technique. The electrocautery technique seems to be a good alternative for proximal tibial epiphysiodesis in young dogs.(AU)
São descritos poucos estudos sobre as opções de tratamento para a ruptura do ligamento cruzado cranial em cães na fase de crescimento, especialmente em relação às técnicas de epifisiodese. O objetivo deste estudo foi avaliar a técnica de eletrocauterização para epifisiodese proximal da tíbia em cães filhotes da raça Labrador Retriever. A nova técnica de eletrocauterização foi comparada com a do parafuso em relação à eficácia para nivelamento do platô tibial em cães na fase de crescimento. Seis filhotes saudáveis da raça Labrador foram selecionados e divididos aleatoriamente em dois grupos. A técnica do parafuso foi usada em um grupo, enquanto no outro foi usada a da eletrocauterização. Ambas as técnicas de epifisiodese proximal da tíbia para nivelamento do platô tibial foram eficazes na redução do ângulo do platô tibial e não causaram alterações articulares importantes. A técnica do parafuso foi considerada mais invasiva e causou morbidade um pouco mais acentuada do que a da eletrocauterização. Assim, a técnica da eletrocauterização parece ser uma boa alternativa para a epifisiodese proximal da tíbia em cães jovens.(AU)
Assuntos
Animais , Cães , Eletrocoagulação/métodos , Epifise Deslocada/cirurgia , Articulação do Joelho/cirurgia , Tíbia/lesões , Eletrocoagulação/veterináriaRESUMO
There are few studies about the treatment options for cranial cruciate ligament rupture in growing dogs, especially with epiphysiodesis techniques. The aim of this study was to evaluate the electrocautery technique for proximal tibial epiphysiodesis in Labrador retriever puppies. The novel electrocautery technique was compared with the screw technique regarding the efficacy for tibial plateau leveling in growing dogs. Six healthy Labrador retriever puppies were divided into two groups. The screw technique was used in one group and the electrocautery technique was used in the other group. Both proximal tibial epiphysiodesis techniques for tibial plateau leveling were effective in achieving reduced tibial plateau angle and did not cause significant joint changes. The screw technique was more invasive and caused slightly greater morbidity than the electrocautery technique. The electrocautery technique seems to be a good alternative for proximal tibial epiphysiodesis in young dogs.(AU)
São descritos poucos estudos sobre as opções de tratamento para a ruptura do ligamento cruzado cranial em cães na fase de crescimento, especialmente em relação às técnicas de epifisiodese. O objetivo deste estudo foi avaliar a técnica de eletrocauterização para epifisiodese proximal da tíbia em cães filhotes da raça Labrador Retriever. A nova técnica de eletrocauterização foi comparada com a do parafuso em relação à eficácia para nivelamento do platô tibial em cães na fase de crescimento. Seis filhotes saudáveis da raça Labrador foram selecionados e divididos aleatoriamente em dois grupos. A técnica do parafuso foi usada em um grupo, enquanto no outro foi usada a da eletrocauterização. Ambas as técnicas de epifisiodese proximal da tíbia para nivelamento do platô tibial foram eficazes na redução do ângulo do platô tibial e não causaram alterações articulares importantes. A técnica do parafuso foi considerada mais invasiva e causou morbidade um pouco mais acentuada do que a da eletrocauterização. Assim, a técnica da eletrocauterização parece ser uma boa alternativa para a epifisiodese proximal da tíbia em cães jovens.(AU)
Assuntos
Animais , Cães , Eletrocoagulação/métodos , Epifise Deslocada/cirurgia , Tíbia/lesões , Articulação do Joelho/cirurgia , Eletrocoagulação/veterináriaRESUMO
Objetivo: Determinar a aplicacão do escore de Oxford modificado em pacientes com escorre gamento epifisário femoral proximal (EEFP) no auxílio da indicacão do tratamento cirúrgico profilático dos quadris contralaterais. Métodos: Análise retrospectiva dos prontuários dos pacientes atendidos na instituicão na qual os autores trabalham. Foram selecionados aqueles com um tempo de seguimento mínimo de dois anos, atendidos de 2008 até 2011, que apresentaram EEPF unilateral. Os cri térios de exclusão foram pacientes com doenca endócrina ou metabólica, síndrome de Down e aqueles com radiografias inadequadas para determinar a pontuacão no escore de Oxford modificado. As radiografias iniciais receberam uma pontuacão que varia de 16 a 26. A aná lise estatística foi usada para determinar se a pontuacão foi preditiva do desenvolvimento futuro de deslizamento contralateral. Resultados: Dos 15 pacientes selecionados com EEFP unilateral, cinco (33,3%) evoluíram para o escorregamento contralateral. Os pacientes foram divididos em dois grupos, qua tro pacientes foram considerados de risco e desses três desenvolveram o escorregamento contralateral. No grupo sem risco havia 11 pacientes, dois evoluíram para o escorregamento contralateral. Nota-se assim uma tendência de que pacientes do grupo que desenvolveu a doenca difiram do grupo que não desenvolveu em relacão à classificacão de risco. Conclusão: Apesar de na nossa amostra a aplicacão do escore de Oxford modificado não ter sido estatisticamente significativa, notamos uma tendência para o escorregamento contra lateral nos quadris com escore baixo.
OBJECTIVE: To determine the application of the modified Oxford score among patients with proximal femoral epiphyseal slippage (PFES) as an aid to indicating prophylactic surgical treatment on the contralateral hip. METHODS: Retrospective analysis on the medical files of patients attended at the institution where the authors work. From these, patients attended between 2008 and 2011 who presented unilateral PFES and were followed up for a minimum of two years were selected. Patients were excluded if they presented endocrine disease, metabolic disease, Down syndrome or radiographs that were inadequate for determining the modified Oxford score. The initial radiographs received scores ranging from 16 to 26. Statistical analysis was used to determine whether the scoring was predictive of future development of contralateral slippage. RESULTS: Among the 15 patients with unilateral PFES that were selected, five (33.3%) evolved with contralateral slippage. The patients were divided into two groups. Four patients were considered to present risk and three of them developed contralateral slippage. In the group that was considered not to present risk, there were 11 patients and two of these evolved with contralateral slippage. Thus, there was a tendency for the patients in the group that developed the disease to differ from the group that did not develop it, in relation to the risk classification. CONCLUSION: Although application of the modified Oxford score was not statistically significant in our sample, we noted a tendency toward contralateral slippage among hips with low scores.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Epifise Deslocada/cirurgia , Epifise Deslocada/patologia , Epifise Deslocada/radioterapiaRESUMO
Introducción: La deformidad residual resultante de un deslizamiento epifisario femoral proximal moderado o grave conduce a osteoartritis prematura debida al choque femoroacetabular. Los objetivos del trabajo fueron evaluar la mejoría de la anatomía del fémur proximal y evaluar la función de la cadera en pacientes con deslizamiento epifisario femoral proximal >30 grados tratados con el procedimiento de Dunn modificado, a corto plazo. Materiales y Métodos: Cohorte retrospectiva de pacientes con deslizamiento epifisario femoral proximal >30 grados, tratados con luxación controlada de cadera y el procedimiento de Dunn modificado. Se evaluaron mediciones clínicas y radiológicas preoperatorias y posoperatorias, hallazgos intraoperatorios y funcionalidad con los puntajes de Harris y de D'Aubigne-Postel. Resultados: Trece casos, mediana de edad 12 años y mediana de seguimiento 14 meses. El ángulo de deslizamiento de Southwick preoperatorio (75 grados, RI 67-85) y posoperatorio (10 grados, RI 5-17) mostró una disminución estadísticamente significativa (p <0,001). El offset radio cabeza-cuello preoperatorio (-0,13) versus el posoperatorio (0,12) obtuvo una mejoría significativa (p 0,002). El 69,2 por ciento de los pacientes presentó daño de alguna estructura intraarticular. Los puntajes promedio de funcionalidad fueron 14,6 (muy buena mejoría) y 83,4 (bueno). Complicaciones: necrosis avascular 15,3 por ciento y condrólisis 15,3 por ciento. Conclusiones: Esta técnica restaura la anatomía del fémur proximal y la funcionalidad de la cadera a corto plazo. Aunque no disponemos de resultados a largo plazo, al menos en teoría, serían buenos. Sin embargo, la luxación controlada con Dunn modificado no está exenta de complicaciones y el riesgo de necrosis avascular y condrólisis persiste. Nivel de evidencia: Estudios terapéuticos - III.
Background: The residual deformity resulting from a moderate and/or severe proximal femoral epiphysis slipping (SCFE) leads to premature osteoarthritis due to impingement. The objectives were to assess improvement in the anatomy of the proximal femur and to evaluate hip function in patients with SCFE >30° treated with the modified Dunn procedure. Methods: A retrospective cohort of patients with SCFE >30° treated with hip dislocation control and modified Dunn procedure. Preoperative and postoperative clinical and radiographic measurements, intra-operative findings and functionality using Harris and D'Aubigne & Postel scores were evaluated. Results: Thirteen cases, median age 12 years, median follow-up 14 months. Southwick slip angle showed a statistically significant decrease (preoperative: 75, IR 67-85; postoperative: 10, IR 5-17) (p <0.001). The head-neck offset radius obtained a significant improvement (preoperative -0.13; postoperative: 0.12) (p 0.002). The 69.2% of patients presented intraarticular damage. The average scores for functionality were 14.6 (excellent improvement) and 83.4 (good). Complications: avascular necrosis 15.3% and chondrolysis 15.3%. Conclusions: This technique restores the anatomy of the proximal femur and hip functionality in the short term. Although we do not have long-term results, at least in theory they would be good. However, the dislocation controlled with modified Dunn procedure is not free of complications and the risk of avascular necrosis and chondrolysis persists. Level of evidence: Therapeutic studies - III.
Assuntos
Criança , Articulação do Quadril/cirurgia , Epifise Deslocada/cirurgia , Fêmur/cirurgia , Osteotomia/métodos , Articulação do Quadril , Estudos de Coortes , Seguimentos , Estudos RetrospectivosRESUMO
Introducción: La deformidad residual resultante de un deslizamiento epifisario femoral proximal moderado o grave conduce a osteoartritis prematura debida al choque femoroacetabular. Los objetivos del trabajo fueron evaluar la mejoría de la anatomía del fémur proximal y evaluar la función de la cadera en pacientes con deslizamiento epifisario femoral proximal >30 grados tratados con el procedimiento de Dunn modificado, a corto plazo. Materiales y Métodos: Cohorte retrospectiva de pacientes con deslizamiento epifisario femoral proximal >30 grados, tratados con luxación controlada de cadera y el procedimiento de Dunn modificado. Se evaluaron mediciones clínicas y radiológicas preoperatorias y posoperatorias, hallazgos intraoperatorios y funcionalidad con los puntajes de Harris y de DAubigne-Postel. Resultados: Trece casos, mediana de edad 12 años y mediana de seguimiento 14 meses. El ángulo de deslizamiento de Southwick preoperatorio (75 grados, RI 67-85) y posoperatorio (10 grados, RI 5-17) mostró una disminución estadísticamente significativa (p <0,001). El offset radio cabeza-cuello preoperatorio (-0,13) versus el posoperatorio (0,12) obtuvo una mejoría significativa (p 0,002). El 69,2 por ciento de los pacientes presentó daño de alguna estructura intraarticular. Los puntajes promedio de funcionalidad fueron 14,6 (muy buena mejoría) y 83,4 (bueno). Complicaciones: necrosis avascular 15,3 por ciento y condrólisis 15,3 por ciento. Conclusiones: Esta técnica restaura la anatomía del fémur proximal y la funcionalidad de la cadera a corto plazo. Aunque no disponemos de resultados a largo plazo, al menos en teoría, serían buenos. Sin embargo, la luxación controlada con Dunn modificado no está exenta de complicaciones y el riesgo de necrosis avascular y condrólisis persiste. Nivel de evidencia: Estudios terapéuticos - III.(AU)
Background: The residual deformity resulting from a moderate and/or severe proximal femoral epiphysis slipping (SCFE) leads to premature osteoarthritis due to impingement. The objectives were to assess improvement in the anatomy of the proximal femur and to evaluate hip function in patients with SCFE >30° treated with the modified Dunn procedure. Methods: A retrospective cohort of patients with SCFE >30° treated with hip dislocation control and modified Dunn procedure. Preoperative and postoperative clinical and radiographic measurements, intra-operative findings and functionality using Harris and DAubigne & Postel scores were evaluated. Results: Thirteen cases, median age 12 years, median follow-up 14 months. Southwick slip angle showed a statistically significant decrease (preoperative: 75, IR 67-85; postoperative: 10, IR 5-17) (p <0.001). The head-neck offset radius obtained a significant improvement (preoperative -0.13; postoperative: 0.12) (p 0.002). The 69.2% of patients presented intraarticular damage. The average scores for functionality were 14.6 (excellent improvement) and 83.4 (good). Complications: avascular necrosis 15.3% and chondrolysis 15.3%. Conclusions: This technique restores the anatomy of the proximal femur and hip functionality in the short term. Although we do not have long-term results, at least in theory they would be good. However, the dislocation controlled with modified Dunn procedure is not free of complications and the risk of avascular necrosis and chondrolysis persists. Level of evidence: Therapeutic studies - III.(AU)
Assuntos
Criança , Epifise Deslocada/cirurgia , Articulação do Quadril/cirurgia , Fêmur/cirurgia , Osteotomia/métodos , Articulação do Quadril/diagnóstico por imagem , Seguimentos , Estudos de Coortes , Estudos RetrospectivosRESUMO
Analizar los resultados clínicos y radiológicos postquirúrgicosen pacientes con epifisiolistesis femoral proximal. Estudio prospectivo con seguimiento de 4 años, se valoró la clínica, estabilidad, el ángulo de Southwick, y cadera afectada. Se reportaron a 14 pacientes,15 caderas (1 caso bilateral), edad promedio de 11,28 años, el ángulo de Southwick promedio fue de 30,6°. Todos los casos fueron tratados con fijación in situ con un tornillo canulado bajo técnica de FrancisYoung-In Lee, y 3 ameritaron osteotomía triplanar con sistema de fijación externa multiplanar tipo Ilizarov. No se reportaron casos de deslizamiento contralateral. Como complicaciones dismetría asociada a coxa brevay marcha extrarrotada. Los resultados clínicos fueronuniformemente buenos en este grupo de pacientes que típicamente se han considerado de difícil de tratamiento,radiológicamente se observó una anatomía relativamentenormal y sólo se presentó un caso bilateral asociado a trastornos endocrinos.
Analyze the postoperative clinical and radiographic resultsin patients with slipped proximal femoral epiphysis.Retrospective follow up of 4 years, we have evaluatedclinics, stability, the Southwicks angle, and most affected hip. We reported 14 patients, 15 hips (1 bilateralcase), average age of 11.28 years; the Southwicks angle averaged 30.6°. All cases were treated with in situ fixation with a cannulated screw, Francis Young-In Lees technique, and 3 merited triplane osteotomy with multiplanar external fixation system of Ilizarov type.There were no cases of contralateral slip. The most common complications were associated with coxa brevadysmetria and extrarotated walk. The clinical results were uniformly good in this group of patients who have typically been considered difficult to treat; radiographicallythere was a relatively normal anatomy and only one case the presentation was bilateral associated with endocrine disorders.
Assuntos
Humanos , Masculino , Feminino , Dispositivos de Fixação Ortopédica , Epifise Deslocada/cirurgia , Epifise Deslocada/diagnóstico , Fraturas do Quadril/cirurgia , Fraturas do Fêmur/cirurgiaRESUMO
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.
Assuntos
Artroscopia/métodos , Epifise Deslocada/cirurgia , Colo do Fêmur/cirurgia , Osteotomia/métodos , Amplitude de Movimento Articular/fisiologia , Doença Aguda , Adolescente , Pinos Ortopédicos , Criança , Progressão da Doença , Epifise Deslocada/diagnóstico por imagem , Feminino , Cabeça do Fêmur/diagnóstico por imagem , Cabeça do Fêmur/cirurgia , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/terapia , Colo do Fêmur/diagnóstico por imagem , Seguimentos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Articulação do Quadril/cirurgia , Humanos , Masculino , Osteotomia/instrumentação , Complicações Pós-Operatórias/fisiopatologia , Cuidados Pré-Operatórios/métodos , Estudos Prospectivos , Recuperação de Função Fisiológica , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Trapezoide/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: To examine associations of major complications after surgical treatment of slipped upper femoral epiphysis (SUFE) with condition- and treatment-related risk factors. STUDY DESIGN: This systematic review and meta-analysis of observational studies used an electronic literature search of Embase and Medline supplemented by a manual search of bibliographies. The studies enrolled children and adolescents with SUFE, defined stable and unstable disease, and reported at least 3 primary endpoints: avascular necrosis (AVN), chondrolysis, and reoperation. Random-effects meta-regression analysis was performed when possible. RESULTS: The weighted risk for AVN, derived from intercept-only meta-regression, was estimated as 5.3% (95% confidence interval [CI], 3.4%-7.2%). Patients with unstable slips had a 9.4-fold greater risk of developing AVN. Instability proved to be an independent predictor for AVN. The weighted risk of chondrolysis was 0.8% (95% CI, 0.2%-1.4%), associated with unstable slips and osteotomies. The risk of reoperation was estimated at 5.5% (95% CI, 1.7%-9.3%). Loss of fixation was the primary reason for reoperation. CONCLUSIONS: Current evidence indicates that unstable slips are at a significantly higher risk for AVN than stable slips, regardless of the attempted surgical approach. Little clinical information is available regarding chondrolysis and reoperation in relation to the stability of the physis.
Assuntos
Epifise Deslocada/complicações , Epifise Deslocada/cirurgia , Instabilidade Articular/complicações , Adolescente , Criança , Epifise Deslocada/epidemiologia , Fêmur , Articulação do Quadril , Humanos , Procedimentos Ortopédicos/métodos , Osteonecrose/epidemiologia , Osteonecrose/cirurgia , Prognóstico , Reoperação , Fatores de RiscoRESUMO
Introducción: el deslizamiento epifisario femoral (DEF) ocurre usualmente en el adolescente, predominantemente en hombres. Se caracteriza por pérdida de la relación de la epífisis femoral con su cuello generando un cuadro clínico de dolor en la región inguinal o en la rodilla, asociado a acortamiento con rotación externa del miembro afetado. El tratamiento quirúrgico busca la reducción anatómica y estable de la cabeza femoral, así como la disminución del riesgo de necrosis avascular de la cabeza femoral, reducción incompleta de la epífisis femoral y artrosis de la cadera. Materiales y métodos: se describe la técnica quirúrgica y los resultados radiológicos posquirúrgicos inmediatos de 5 casos de pacientes con DEF operados por el mismo cirujano ortopedista infantil mediante luxación quirúrgica de la cadera y reducción abierta anatómica. Resultados: se evaluaron cuatro hombres y una mujer con edad promedio de 14,2 y 2,6 años, diagnosticados con DEF moderada a severa según la clasificación radiológica. De acuerdo al criterio clínico 2 pacientes presentaron DEF moderada a crónico. La cadera derecha se encontraba afectada en 3 pacientes . En la evaluación radiológica, todos los pacientes presentaron reducción anatómica de la epífisis femoral. Discusión: el seguimiento de largo plazo en este grupo de pacientes es mandatorio, pero de acuerdo a los resultados rediológicos posquirúrgicos inmediatos aquí reportados y el cuidado en la preservación de la vascularización esta técnica podría ser una alternativa para el tratamiento de DEF dado que restituye la anatomía y protege el aporte vascular a la epífisis.
Assuntos
Adolescente , Criança , Quadril/cirurgia , Epifise Deslocada/cirurgia , Resultado do TratamentoRESUMO
OBJECTIVE: Analyze the postoperative clinical and radiographic results of children under 10 years of age with slipped proximal femoral epiphysis and determine the differences compared to other age groups. MATERIAL AND METHODS: Retrospective study with a minimum follow-up of 2 years; Southwick's angle, treatment, and the rate of contralateral slip were all assessed. The Iowa scale was used for assessment purposes. RESULTS: A total of 18 patients and 23 hips were reported (5 cases were bilateral), mean age was 8.53 years, and Southwick's angle was 43 degrees. All cases were treated with in situ fixation, with a single screw in 19 hips, Kirschner's nails in 2 hips, and one screw and one nail in one hip; prophylactic fixation was used in one hip. Mean follow-up was 6.9 years. Three cases had contralateral slip occurring 6-13 months after the initial slip. The mean Iowa score was 85.69. A neck-shaft angle of 115 degrees was seen in the final X-ray; there were 3 complications: two cases of avascular necrosis and one chondrolysis. DISCUSSION: The clinical results were similarly good in this group of patients, who have typically been considered as very difficult to treat. Radiographically, a relatively normal anatomy was seen and only one case showed early arthrosis. The contralateral slip rate was not higher than in older patients.
Assuntos
Epifise Deslocada/diagnóstico por imagem , Epifise Deslocada/cirurgia , Cabeça do Fêmur , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Radiografia , Estudos RetrospectivosRESUMO
BACKGROUND: We sought to determine the functional outcome of patients with grade 3 slipped capital femoral epiphysis who had been treated with in situ pinning at a mid-term follow-up. METHODS: One hundred and five patients with 129 slips (24 bilateral) were reviewed. Minimum follow-up was 5 years and mean follow-up was 66 months. Slips over 60 degrees were considered grade 3. All of the patients underwent in situ pinning with a single cannulated screw; the placement of the screw was evaluated with the criteria of Stambough. The final evaluation was performed using the Iowa Hip Score and results were analyzed by sex, age at time of diagnosis, and body mass index. Statistical analysis was carried out using the Mann-Whitney U-test considering a P value of less than 0.005 to be statistically significant. RESULTS: The mean Iowa Hip Score was 84.73. Fifty-two patients were considered to have an excellent result, 28 a good result, 16 a fair result, and 9 a bad result. The pin placement was considered adequate in 89 patients and inadequate in 16 patients. Forty-three patients were girls and 62 were boys and no statistical difference was found in function by sex. The mean Iowa Hip Score for patients under 12 years of age (n=20) was 85.8, for those between 12 and 15 years of age (n=69) it was 82.8 and for those over 15 years of age (n=16) it was 82.5 (P=0.003). There were 10 complications, all in the group in which the pin placement was considered inadequate, and all of these were considered fair or poor results. CONCLUSIONS: The functional results in the mid-term for patients with grade 3 slips treated with in situ pinning were generally good or excellent; a better result was found in patients below 12 years of age. A good or excellent result can be expected when pin placement is adequate and no complications arise.
Assuntos
Parafusos Ósseos , Epifise Deslocada/cirurgia , Fêmur/patologia , Adolescente , Fatores Etários , Criança , Feminino , Seguimentos , Humanos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do TratamentoRESUMO
A case report of an 8 years old patient with Osteopetrosis and a Slipped Capital Femoral Epiphysis is presented. Along with a literature review (where there are only two reports of this pathology) the diagnosis methods and treatment are displayed. Clinical results, x-rays and MRI are exhibited.
Se presenta un caso de Epifisiolisis en un paciente de 8 años con el diagnóstico de Osteopetrosis. Junto con una revisión de la literatura, en que solamente se encuentran dos publicaciones con casos similares, se exhiben los métodos diagnósticos y el tratamiento realizado, así como sus resultados clínicos e imagenológicos.
Assuntos
Humanos , Masculino , Criança , Epifise Deslocada/cirurgia , Epifise Deslocada/complicações , Osteopetrose/complicações , Parafusos Ósseos , Epifise Deslocada/diagnóstico , Resultado do TratamentoRESUMO
OBJETIVO: Avaliar clínica e radiograficamente os resultados da osteotomia triplanar intertrocantérica no tratamento dos pacientes com escorregamento epifisário proximal do fêmur crônico. MÉTODOS: Foram avaliados retrospectivamente 25 quadris, de 23 pacientes submetidos à osteotomia triplanar intertrocantérica no período de 1987 a 2003, que apresentavam escorregamento epifisário proximal do fêmur crônico (EEPF). Dezesseis pacientes eram do sexo masculino e sete do feminino, com média de idade de 14 anos e um mês, que tiveram seguimento clínico e radiológico médio de nove anos e três meses. A cirurgia foi realizada em pacientes com escorregamento moderado ou grave segundo a escala de Southwick (média de 57º). RESULTADOS: A classificação clínica e radiológica de Southwick foi utilizada na avaliação dos resultados e obtiveram-se 84 por cento de resultados excelentes e bons nos critérios clínicos dor e função e 72 por cento de resultados excelentes e bons no critério radiológico, com avaliação final de 76 por cento de resultados excelentes e bons. Dos quatro resultados ruins verificados, dois apresentaram condrólise e dois evoluíram com degeneração articular. Não foi observado qualquer caso de necrose avascular. CONCLUSÃO: A osteotomia tridimensional intertrocantérica é boa opção de tratamento para os casos de EEPF com deslizamento maior de 30º, com resultados clínicos e radiográficos bons e excelentes em 76 por cento dos pacientes.
OBJECTIVE: To make a clinical and radiographic evaluation of intertrochanteric triplane osteotomy in the treatment of patients with chronic slipped capital femoral epiphysis. METHOD: 25 hips of 23 patients with chronic slipped capital femoral epiphysis (EEPF) submitted to intertrochanteric triplane osteotomy from 1987 to 2003 were evaluated retrospectively. Sixteen of the patients were male, and seven, female, with a mean age of 14 years and one month, who had a mean clinical and radiological follow-up of nine years and three months. Surgery was performed in patients with moderate or severe slip according to the Sothwick scale (mean of 57º). RESULTS: The Southwick clinical and radiological classification was used to evaluate the results and results were 84 percent of excellent and good according to the clinical criteria of pain and function, and 72 percent of excellent and good results according to the radiological criteria, with a final evaluation of 76 percent of excellent and good results. Out of the four bad results achieved, two presented chondrolysis, and two developed joint degeneration. No case of avascular necrosis was seen. CONCLUSION: Intertrochanteric triplane osteotomy is a good treatment option for the cases of EEPF with a slip greater than 30º, yielding good and excellent clinical and radiographic results in 76 percent of the patients.
Assuntos
Humanos , Masculino , Feminino , Adolescente , Epifise Deslocada/cirurgia , Osteotomia , Resultado do TratamentoRESUMO
The use of cannulated screws for internal fixation of slipped capital femoral epiphysis (SCFE) is recognized as the standard method of treatment and has fewer complications compared with previous methods such as pins or tri-flanged nails. Some complications related to guidewires have been reported in the treatment SCFE. The most dangerous complication is inadvertent advance of the guidewire into the pelvic cavity. Guidewire breakage is frequent and maybe under-reported. Articular migration of a guidewire fragment has potentially devastating effects and implies a second surgical procedure. Open arthrotomy is the traditional method for fragment removal from the hip joint. We report the case of a 12-year-old-girl with bilateral SCFE. Both hips were fixed with cannulated screws. A guidewire broke inside her right hip, leaving an articular fragment located at the inferior-posterior acetabular notch. Hip arthroscopy was performed 6 weeks after the index procedure; the fragment was located and removed from the joint. No evidence of cartilage damage other than the perforation created by the guidewire was found. Hip arthroscopy is an attractive option for articular foreign body removal; it has the potential for less morbidity and is adequate for evaluating and treating articular cartilage lesions.
Assuntos
Artroscopia , Parafusos Ósseos , Epifise Deslocada/cirurgia , Corpos Estranhos/cirurgia , Criança , Feminino , Corpos Estranhos/etiologia , Articulação do Quadril , Humanos , Procedimentos Ortopédicos/efeitos adversos , Procedimentos Ortopédicos/instrumentaçãoRESUMO
El objetivo del trabajo fue el de presentar 2 jugadores de basket que tuvieron epifisiolisis de la tibia proximal con el antecedente de osteocondritis de la tuberosidad anterior de la tibia. Ambos pacientes refirieron dolor previo en la región anterior de la rodilla atribuida a patología de Osgood-Schlatter y se lesionaron durante la práctica de basket, con un mecanismo de extensión forzada durante el salto sin traumatismo directo ni contacto con otro jugador. Un paciente de 16 años presentó una lesión tipo II de Salter y Harris sin desplazamiento. Se realizó inmovilización con férula en extensión por 4 semanas. El segundo paciente, de 13 años se diagnóstico epifisiolisis tipo IV de Salter y Harris, realizándose reducción a cielo abierto y osteosíntesis con dos tornillos canulados. Los 2 pacientes evolucionaron favorablemente volviendo a su actividad deportiva a los 6 meses postoperatorio. El cierre asimétrico de la físis, de posterior a anterior y la enfermedad de OsgoodSchlatter alteran la respuesta biomecánica de los tejidos fisarios haciéndolos susceptibles a fracturas en especial con la exigencia repetida en hiperextensión. A pesar de ser una patología infrecuente es importante conocer la relación entre osteocondritis de la tuberosidad anterior de la tibia y epifisiolisis de la tibia proximal en especial en los deportes que generan una rodilla de saltador como en el basket.
Assuntos
Adolescente , Basquetebol/lesões , Epifise Deslocada/cirurgia , Epifise Deslocada , Epifise Deslocada/terapia , Osteocondrite , Tíbia , Traumatismos em Atletas , Epífises/lesões , Fixação Interna de Fraturas , Traumatismos do JoelhoRESUMO
El objetivo del trabajo fue el de presentar 2 jugadores de basket que tuvieron epifisiolisis de la tibia proximal con el antecedente de osteocondritis de la tuberosidad anterior de la tibia. Ambos pacientes refirieron dolor previo en la región anterior de la rodilla atribuida a patología de Osgood-Schlatter y se lesionaron durante la práctica de basket, con un mecanismo de extensión forzada durante el salto sin traumatismo directo ni contacto con otro jugador. Un paciente de 16 años presentó una lesión tipo II de Salter y Harris sin desplazamiento. Se realizó inmovilización con férula en extensión por 4 semanas. El segundo paciente, de 13 años se diagnóstico epifisiolisis tipo IV de Salter y Harris, realizándose reducción a cielo abierto y osteosíntesis con dos tornillos canulados. Los 2 pacientes evolucionaron favorablemente volviendo a su actividad deportiva a los 6 meses postoperatorio. El cierre asimétrico de la físis, de posterior a anterior y la enfermedad de Osgood¹Schlatter alteran la respuesta biomecánica de los tejidos fisarios haciéndolos susceptibles a fracturas en especial con la exigencia repetida en hiperextensión. A pesar de ser una patología infrecuente es importante conocer la relación entre osteocondritis de la tuberosidad anterior de la tibia y epifisiolisis de la tibia proximal en especial en los deportes que generan una rodilla de saltador como en el basket.(AU)
Assuntos
Adolescente , Epifise Deslocada/terapia , Epifise Deslocada/cirurgia , Epifise Deslocada/diagnóstico por imagem , Tíbia , Osteocondrite , Basquetebol/lesões , Traumatismos em Atletas , Traumatismos do Joelho , Fixação Interna de Fraturas , Epífises/lesõesRESUMO
El objetivo del trabajo fue el de presentar 2 jugadores de basket que tuvieron epifisiolisis de la tibia proximal con el antecedente de osteocondritis de la tuberosidad anterior de la tibia. Ambos pacientes refirieron dolor previo en la región anterior de la rodilla atribuida a patología de Osgood-Schlatter y se lesionaron durante la práctica de basket, con un mecanismo de extensión forzada durante el salto sin traumatismo directo ni contacto con otro jugador. Un paciente de 16 años presentó una lesión tipo II de Salter y Harris sin desplazamiento. Se realizó inmovilización con férula en extensión por 4 semanas. El segundo paciente, de 13 años se diagnóstico epifisiolisis tipo IV de Salter y Harris, realizándose reducción a cielo abierto y osteosíntesis con dos tornillos canulados. Los 2 pacientes evolucionaron favorablemente volviendo a su actividad deportiva a los 6 meses postoperatorio. El cierre asimétrico de la físis, de posterior a anterior y la enfermedad de OsgoodûSchlatter alteran la respuesta biomecánica de los tejidos fisarios haciéndolos susceptibles a fracturas en especial con la exigencia repetida en hiperextensión. A pesar de ser una patología infrecuente es importante conocer la relación entre osteocondritis de la tuberosidad anterior de la tibia y epifisiolisis de la tibia proximal en especial en los deportes que generan una rodilla de saltador como en el basket
Assuntos
Adolescente , Epifise Deslocada/terapia , Epifise Deslocada/cirurgia , Epifise Deslocada , Tíbia , Osteocondrite , Basquetebol/lesões , Traumatismos em Atletas , Traumatismos do Joelho , Fixação Interna de Fraturas , Epífises/lesõesRESUMO
From May 1990 to November 1997, 24 cases of severe slipped capital femoral epiphysis were treated by an osteotomy that is a modification of the Hungria-Kramer intertrochanteric osteotomy proposed by Sugioka (Hungria-Kramer-Sugioka osteotomy or HKS osteotomy). The degree of displacement as seen on the frog-leg lateral radiograph of the proximal femur was measured according to the deviation of the longitudinal axis of the epiphysis from the center line of the neck (Fish classification). All hips were considered as grade III and underwent HKS osteotomy. Sugioka's radiographic study (true AP view with the limb internally rotated until the patella is perpendicular to the x-ray beam, and lateral view with the hip in 90 degrees flexion and 45 degrees abduction) was performed before surgery to show that the real direction of the slip was posterior in relation to the neck. Clinical results were assessed according to Merle-D'Aubigné and Postel system modified by Charnley (hip score system that takes into consideration pain, gait, and joint motion). Roentgenographic results were considered good if none of the following was present: joint space decreased by more than 2 mm (chondrolysis), avascular necrosis of the femoral head, neck-shaft angle of less than 120 degrees, nonunion at the osteotomy site, and a epiphyseal plate still open. Follow-up varied from 31 to 120 months (average 65.1 months).