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1.
JBJS Case Connect ; 14(2)2024 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-38758928

RESUMEN

CASE: A 17-year-old adolescent boy with Gross Motor Function Classification System 5 cerebral palsy and neuromuscular scoliosis underwent posterior spinal fusion and segmental spinal instrumentation from T3 to the pelvis. He developed a right ischial pressure injury a few months postoperatively, which persisted despite nonoperative measures. He subsequently underwent an ipsilateral transiliac-shortening osteotomy 16 months after spinal surgery to treat his residual pelvic obliquity and the ischial pressure injury, which healed completely. At the 1-year follow-up visit, there were no further signs of pressure injury. CONCLUSION: This case report describes transiliac-shortening osteotomy as a viable treatment option for non-healing ischial pressure injuries secondary to fixed pelvic obliquity.


Asunto(s)
Isquion , Osteotomía , Úlcera por Presión , Humanos , Masculino , Adolescente , Osteotomía/métodos , Isquion/lesiones , Isquion/cirugía , Úlcera por Presión/cirugía , Úlcera por Presión/etiología , Fusión Vertebral/métodos , Parálisis Cerebral/cirugía , Parálisis Cerebral/complicaciones , Escoliosis/cirugía , Ilion/cirugía
2.
J Pediatr Orthop B ; 32(3): 278-286, 2023 May 01.
Artículo en Inglés | MEDLINE | ID: mdl-35412512

RESUMEN

Apophyseal proximal hamstring bone avulsion is uncommon, occurring in adolescents following sudden forceful contraction of the musculotendinous unit. It can be severely disabling, preventing return to sport. This study assessed outcome following avulsed bone excision and direct hamstring tendon-ischial tuberosity reattachment using bone anchors. Validated hamstring-specific Sydney hamstring orthopaedic research evaluation PROMs were prospectively collected from consecutively treated athletes (7 elite and 11 recreational) by a single surgeon over 13 years. Outcomes at 1-year and final follow-up for primary acute surgery at less than 3 months after injury (group 1), primary chronic surgery at more than 3 months after established nonunion (group 2) and revision following failed screw fixation (group 3) were analyzed with sport participation and level at 1 year. Sixteen primary and two revision procedures were analyzed. Mean injury age was 14.6 years (SD, 1.8). Combined primary mean injury scores improved from 11.89 (SD, 7.32) to 33.31 (SD, 2.30) and showed mean 1 year and final follow-up scores within 0.3-6.1% of preinjury values. Pronounced improvement occurred from injured scores for groups 1 versus 2, respectively at 1 year by 247.7% versus 59.0% and at final follow-up by 251.0% versus 64.1%, for groups 1 versus 2, respectively. Final outcome scores of group 3 were high. All cases returned to preinjury sport level by 1 year and indicated satisfaction to repeat treatment. No significant complications occurred. As the largest series to assess outcomes following this surgical technique, success is highlighted by high score improvements close to preinjury values and return to preinjury sport level.


Asunto(s)
Músculos Isquiosurales , Tendones Isquiotibiales , Deportes , Humanos , Adolescente , Isquion/lesiones , Atletas , Tendones Isquiotibiales/cirugía
3.
Clin J Sport Med ; 32(4): 368-374, 2022 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-35762861

RESUMEN

OBJECTIVE: To evaluate whether delay in the diagnosis of pelvic avulsion fractures in young athletes leads to prolonged treatment and prolonged return toward sport activities, whether fractures at certain locations are associated with a greater risk of diagnostic delay, and what reasons may exist for delay in diagnosis. DESIGN: Retrospective chart review of young patients who presented with pelvic region avulsion fracture to a community-based sports medicine clinic over a 19-year period. SETTING: Private practice, primary care sports medicine clinic. PATIENTS: Patients younger than 20 years diagnosed with pelvic region avulsion fracture. INTERVENTIONS: None, this was a retrospective study. MAIN OUTCOME MEASURES: Clearance for return toward sport activities. RESULTS: Two hundred twenty-five cases were reviewed for reasons for delay in diagnosis; 208 cases met criteria for the duration of treatment and return to play activities portions of the study. The mean time from date of injury diagnosis was 19.59 days, and the mean duration from date of injury to clearance for return to play advancement was 67.20 days. Duration of treatment varied slightly depending on timing of diagnosis, whereas duration from date of injury to clearance for return to play advancement varied greatly depending on diagnostic delay. Those who did not sense a "pop" at the time of injury were more likely to experience diagnostic delay, as were athletes with ischial tuberosity fractures. The most common cause of diagnostic delay was patient/family decision on when to seek care; misdiagnosis as a muscle strain was also common. CONCLUSIONS: Diagnostic delay of adolescent pelvic avulsion fractures may unnecessarily prevent athletes from returning to play within an optimal time frame. Our observations highlight a need for educating athletes and their families on when to seek initial or follow-up medical care as well as educating medical providers regarding the diagnosis of pelvic avulsion fractures.


Asunto(s)
Traumatismos en Atletas , Fracturas por Avulsión , Fracturas Óseas , Adolescente , Atletas , Traumatismos en Atletas/complicaciones , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/terapia , Diagnóstico Tardío/efectos adversos , Fracturas por Avulsión/complicaciones , Fracturas por Avulsión/diagnóstico , Fracturas por Avulsión/terapia , Fracturas Óseas/diagnóstico , Fracturas Óseas/terapia , Humanos , Isquion/lesiones , Pelvis , Estudios Retrospectivos
4.
J Pediatr Orthop B ; 31(5): 508-516, 2022 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-35258027

RESUMEN

Apophyseal avulsion fractures of the ischial tuberosity (AFIT) in pediatric athletes are relatively uncommon injuries with treatment and return to sport (RTS) outcomes being largely unknown. The purpose of this review is to perform a systematic review analyzing RTS and predictors of successful RTS for pediatric athletes sustaining AFIT. Studies reporting on athletes strictly under the age of 18 years sustaining an AFIT with reported RTS status were included. RTS was analyzed based on injury acuity, mechanism, and management, whereas the incidence of any complications was recorded. A total of 33 studies comprising 90 cases of AFIT were identified. The mean age of athletes sustaining injuries was 14.7 + 1.4 years (range, 9-17 years), most commonly participating in soccer ( n = 25), sprinting ( n = 21), and gymnastics ( n = 7). Acute trauma during sporting activities was responsible for 74.4% ( n = 77/90) of injuries. A total of 82% ( n = 74/90) of athletes reported successful RTS at an average of 7.0 + 5.0 months. Athletes undergoing surgery had a significantly higher RTS rate ( n = 36/38, 94.7%) compared with athletes treated nonoperatively (n = 38/52, 73.08%; P = 0.008). When reported, a high rate of misdiagnosis was reported (39.4%, n = 28/71). Complications were reported in 15.8% ( n = 7/38) and 32.7% ( n = 17/52) of athletes managed surgically and conservatively, respectively. As such, the high rate of misdiagnosis and subsequent high rate of complications and poor rate of RTS highlight the importance of accurate diagnosis and treatment. Future prospective studies evaluating patient outcomes based on fracture displacement, sporting activity, and management strategies are warranted to better treat pediatric athletes. Study design: Level IV, systematic review.


Asunto(s)
Traumatismos en Atletas , Fracturas por Avulsión , Isquion , Volver al Deporte , Adolescente , Traumatismos en Atletas/cirugía , Traumatismos en Atletas/terapia , Niño , Fracturas por Avulsión/cirugía , Fracturas por Avulsión/terapia , Humanos , Isquion/lesiones , Isquion/cirugía , Volver al Deporte/estadística & datos numéricos , Resultado del Tratamiento
5.
Unfallchirurg ; 124(7): 519-525, 2021 Jul.
Artículo en Alemán | MEDLINE | ID: mdl-33938973

RESUMEN

BACKGROUND: The importance of the apophyseal plates during growth is often underestimated. They act as a muscular insertion and influence the joint mechanics by the load-dependent change in shape. PATHOMECHANISMS: An anatomically functional adaptation occurs as protection from overloading. In special kinds of sports with highly dynamic movements, sudden changes of direction and eccentric/concentric muscle activities the resulting stress may exceed the strength of the apophyseal plate. In adolescence this results in a total or partial tearing of the apophysis in the sense of an avulsion injury. In the pelvic region the ischial tuberosity, the anterior superior and inferior iliac spine are mainly affected. DIAGNOSTICS: The medical history and clinical diagnostics are supplemented by conventional radiographic imaging. Sectional imaging diagnostics are usually unnecessary. TREATMENT: Conservative management by reduced (partial) weight bearing and physiotherapy represents the gold standard in treatment. In cases with a fragment displacement >1.5-2.0 cm and in competitive athletes an open reduction should be considered.


Asunto(s)
Traumatismos en Atletas , Fracturas por Avulsión , Fracturas Óseas , Adolescente , Traumatismos en Atletas/diagnóstico por imagen , Traumatismos en Atletas/terapia , Fracturas por Avulsión/diagnóstico por imagen , Fracturas por Avulsión/cirugía , Humanos , Isquion/lesiones , Pelvis
6.
J Bone Joint Surg Am ; 103(12): 1083-1092, 2021 06 16.
Artículo en Inglés | MEDLINE | ID: mdl-33724973

RESUMEN

BACKGROUND: We propose a new classification system for ischial tuberosity fractures in adolescents that is based on the ossification pattern of the apophysis. METHODS: We performed a retrospective review of patients who were diagnosed with ischial tuberosity avulsion fractures at a single institution from 2008 to 2018. Skeletal maturity and fracture location, size, and displacement were recorded based on initial injury radiographs. The fractures were classified by location as being lateral (type 1) or complete (type 2). Pelvic computed tomography (CT) review demonstrated 5 stages of ossification. We then reviewed pelvic CT and magnetic resonance imaging scans to assess the tendinous insertions at the ischial tuberosity apophysis. Reliability analysis was performed. RESULTS: We identified 45 ischial tuberosity fractures. The mean patient age was 14.4 years (range, 10.3 to 18.0 years). Boys accounted for 82% of the cohort. Forty-seven percent of the fractures were classified as type 1, and 53% were classified as type 2. Type-1 fractures were associated with younger age (p = 0.001), lower Risser score (p = 0.002), lower modified Oxford score (p = 0.002), less displacement (p = 0.001), and smaller size (p < 0.001) when compared with type-2 fractures. Of the 45 patients, 18 had follow-up of >6 months, with 56% going on to nonunion. Nonunion was associated with greater displacement (p = 0.016) and size (p = 0.027). When comparing union rates by fracture type, 33% of type-1 fractures progressed to nonunion, while 78% percent of type-2 fractures progressed to nonunion; however, this difference was not significant (p = 0.153). A review of the advanced imaging indicated that type-1 fractures involved the semimembranosus and conjoined tendons, whereas type-2 fractures also involved the adductor magnus tendon. CONCLUSIONS: We propose a new classification system based on the ossification pattern of the ischial tuberosity apophysis that reflects the skeletal maturity of the patient, the size and location of the fracture, and the amount of displacement, and likely predicts the probability of subsequent nonunion. The ischial tuberosity ossifies in a pattern similar to the iliac crest as described by Risser, and this pattern of ossification dictates the size of the ischial tuberosity avulsion fracture fragments and the involved tendons.


Asunto(s)
Fracturas por Avulsión/clasificación , Fracturas por Avulsión/patología , Isquion/lesiones , Osteogénesis/fisiología , Tendones/diagnóstico por imagen , Adolescente , Niño , Femenino , Fracturas por Avulsión/diagnóstico por imagen , Humanos , Imagen por Resonancia Magnética , Masculino , Estudios Retrospectivos , Tendones/patología , Tomografía Computarizada por Rayos X
7.
Clin Sports Med ; 40(2): 375-384, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33673893

RESUMEN

Pelvic avulsion fractures are common in youth athletes; many of these injuries can be treated conservatively. This article reviews the etiology, presentation, and management of the more common pelvic avulsion fractures, including anterior superior iliac spine, anterior inferior iliac spine, ischial tuberosity, and iliac crest avulsions. Adolescent pelvic avulsion fractures rely on the amount of fracture displacement to guide treatment. Conservative management includes rest and avoiding use of the muscle(s) that attach to the avulsed fragment. Operative treatment is reserved for widely displaced fractures or symptomatic nonunions. With appropriate treatment, young athletes frequently return to their same level of sport.


Asunto(s)
Traumatismos en Atletas/diagnóstico , Fracturas por Avulsión/diagnóstico , Pelvis/lesiones , Adolescente , Atletas , Traumatismos en Atletas/terapia , Tratamiento Conservador/efectos adversos , Fijación Interna de Fracturas/efectos adversos , Fracturas Óseas/terapia , Humanos , Ilion/lesiones , Ilion/cirugía , Isquion/lesiones , Isquion/cirugía
8.
Sports Health ; 13(4): 387-389, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33541258

RESUMEN

We present the case of a 11-year-old White female patient with a traumatic quadratus femoris and obturator internus tear after a sprint while at school. She felt immediate pain, swelling, and point tenderness in her posterosuperior thigh with a severely antalgic gait. Magnetic resonance imaging demonstrated a quadratus femoris tear, obturator internus tear, and ischial spine avulsion fracture. Although a less common etiology for acute hip pain in the pediatric population, traumatic injury to the short external rotators should not be excluded. The prognosis is favorable with a full return to previous activities expected using an appropriate rehabilitation program.


Asunto(s)
Fracturas Óseas/diagnóstico por imagen , Cadera/diagnóstico por imagen , Isquion/lesiones , Músculo Esquelético/lesiones , Carrera/lesiones , Niño , Tratamiento Conservador , Femenino , Fracturas Óseas/terapia , Humanos , Imagen por Resonancia Magnética , Traumatismos de los Tendones/diagnóstico por imagen , Traumatismos de los Tendones/terapia
9.
Jt Dis Relat Surg ; 31(2): 184-192, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32584713

RESUMEN

OBJECTIVES: This study aims to investigate the characterization, treatment approaches, and follow-up results of tumors and tumor-like lesions located in the pelvic ramus. PATIENTS AND METHODS: Thirty-one patients (9 males, 22 females; mean age 48.9 years; range, 7 to 79 years) with benign and malignant tumors or tumor-like lesions in the pelvic ramus region treated and followed-up in our clinic between January 2005 and January 2019 were evaluated retrospectively. Surgical procedures were performed with anterior approach or inner-thigh approach. Twelve patients were diagnosed with malignant tumors, 12 patients with benign tumors, and seven patients with tumor-like lesions. RESULTS: Seventeen patients who underwent surgical treatment were followed-up for a mean period of 61.7 months. The diameters of benign and malignant tumors were similar (p=0.425). Of all lesions, 64.5% were located in the pubis. Ischium location was significantly higher in patients with malignant lesions than tumor-like lesions. The most common complication was diffuse subcutaneous edema in the inguinal region and thigh (8.3%). CONCLUSION: There are many different tumoral lesions in the pelvic ramus. Pelvic ramus tumors tend to settle more frequently in pubic ramus, whereas ramus ischium tumors are more likely to be malignant. In addition, the diagnosis of insufficiency fracture should be considered primarily in pathologic fractures of pubic ramus in females over 50 years of age. In the postoperative follow-up of pelvic ramus tumors, diffuse edema may occur even if there is no intraoperative vascular damage.


Asunto(s)
Neoplasias Óseas/patología , Neoplasias Óseas/cirugía , Edema/etiología , Fracturas Espontáneas/etiología , Isquion/lesiones , Hueso Púbico/lesiones , Adolescente , Adulto , Anciano , Neoplasias Óseas/complicaciones , Niño , Femenino , Fracturas por Estrés/etiología , Humanos , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Adulto Joven
10.
Ned Tijdschr Geneeskd ; 1642020 04 30.
Artículo en Holandés | MEDLINE | ID: mdl-32395953

RESUMEN

A 14-year-old boy presented to the emergency department with pain in his right buttock after a breakdance move. He got injured while simultaneously hyperflexing his hip and extending his knee. Upon physical examination he had tenderness over his right ischial tuberosity and an inability to perform combined hip extension and knee flexion. Radiography and CT-imaging showed an avulsion fracture of the ischial tuberosity.


Asunto(s)
Nalgas , Baile/lesiones , Fracturas Óseas , Isquion , Dolor Musculoesquelético/diagnóstico , Tomografía Computarizada por Rayos X/métodos , Dolor Agudo , Adolescente , Diagnóstico Diferencial , Fracturas Óseas/diagnóstico , Fracturas Óseas/etiología , Fracturas Óseas/fisiopatología , Humanos , Isquion/diagnóstico por imagen , Isquion/lesiones , Masculino , Dolor Musculoesquelético/etiología
11.
Clin J Sport Med ; 30(5): e163-e165, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-30908326

RESUMEN

Pelvic stress fractures are rare and present unique challenges for medical personnel. Delayed healing can lead to increased physical, psychological, and social stress for athletes. Recent literature suggests effective use of a synthetic derivative of parathyroid hormone, teriparatide, to augment healing of delayed-union stress fractures. We present a case of a female National Collegiate Athletic Association Division I gymnast successfully returned to play after a 12-week course of teriparatide injections for an ischioacetabular stress fracture.


Asunto(s)
Acetábulo/lesiones , Conservadores de la Densidad Ósea/uso terapéutico , Hormonas y Agentes Reguladores de Calcio/uso terapéutico , Curación de Fractura/efectos de los fármacos , Fracturas por Estrés/tratamiento farmacológico , Gimnasia/lesiones , Teriparatido/uso terapéutico , Acetábulo/diagnóstico por imagen , Adolescente , Femenino , Fracturas por Estrés/diagnóstico por imagen , Humanos , Isquion/diagnóstico por imagen , Isquion/lesiones , Volver al Deporte
12.
Regen Med ; 14(5): 353-358, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-31070520

RESUMEN

We present a case of an 18-year-old with a 2-year history of buttock pain who failed extensive treatment for a perceived hamstring strain. Upon evaluation, he was diagnosed with an ischial tuberosity nonunion avulsion fracture. The patient underwent bone grafting via an ultrasound guided leukocyte rich platelet-rich plasma injection followed by the use of a bone stimulator to enhance the bone healing. At 3 months, he was asymptomatic and had radiographic evidence of excellent bone healing. He remained asymptomatic at 1 year and had resumed full activities. This case report is the first in the literature to describe the treatment of a chronic ischial tuberosity nonunion avulsion fracture with the use of platelet-rich plasma as a bone graft.


Asunto(s)
Trasplante Óseo , Fracturas Óseas/terapia , Isquion/lesiones , Plasma Rico en Plaquetas , Adolescente , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/patología , Humanos , Masculino
13.
J Orthop Surg (Hong Kong) ; 27(2): 2309499019839022, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30939995

RESUMEN

Various surgical techniques exist to approach an ischial tuberosity avulsion fracture, including open reduction and internal fixation with screws and suture anchors, augmentation with allograft tendon, and excision of the fragment. However, the majority of these techniques approached acute fractures, and nonunions were not addressed nor studied. This case series describes two adolescent patients treated for ischial tuberosity nonunions with a posterior column screw through a subgluteal approach. Both patients demonstrated radiographic healing of their nonunion sites at 6 months' follow-up. Each patient reported no pain during activity, had symmetric hamstring strength, and were able to return to pre-injury level of activity by final follow-up. In conclusion, the authors utilized a muscle-sparing approach to the ischial tuberosity nonunion site through a cosmetically appealing incision and introduced a novel approach to nonunion fixation without the use of bone graft, resulting in excellent clinical outcomes.


Asunto(s)
Tornillos Óseos , Fijación Interna de Fracturas/métodos , Fracturas no Consolidadas/cirugía , Isquion/lesiones , Adolescente , Femenino , Fijación Interna de Fracturas/instrumentación , Humanos , Masculino , Anclas para Sutura , Resultado del Tratamiento
14.
Medicine (Baltimore) ; 98(14): e15040, 2019 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-30946345

RESUMEN

RATIONALE: Ischial tuberosity avulsion fracture (ITAF) is a very rare sports injury, and there is currently no consensus on its diagnosis and treatment. Although conservative treatment is adequate for most patients, those with large displacement of the fracture need surgical management. PATIENT CONCERNS: A 13-year-old male athlete experienced tearing pain in the right hip during a sprint. Radiographic examination showed an avulsion fracture of the right ischial tuberosity. DIAGNOSIS: Right ITAF. INTERVENTIONS: On the 3rd day of injury, the patient was treated with open reduction and internal fixation of ITAF under general anesthesia. OUTCOMES: The patient received a systematic postoperative exercise in 2 weeks, and the fracture healed 4 weeks later. After 8 months, the patient returned to the field to participate in the competition. LESSONS: Early surgical treatment can bring about good results in the treatment of ITAF with large displacement. The longitudinal incision and subgluteal approach is an ideal choice for the operative procedure.


Asunto(s)
Fijación Interna de Fracturas/métodos , Fracturas por Avulsión/cirugía , Isquion/lesiones , Reducción Abierta/métodos , Carrera/lesiones , Adolescente , Humanos , Isquion/cirugía , Masculino
15.
BMC Musculoskelet Disord ; 20(1): 9, 2019 Jan 05.
Artículo en Inglés | MEDLINE | ID: mdl-30611250

RESUMEN

BACKGROUND: In cases of avulsion fracture of the ischial tuberosity in which the bone fragments are substantially displaced, nonunion may cause pain in the ischial area. Various surgical procedures have been reported, but achieving sufficient fixation strength is difficult. CASE PRESENTATION: We treated a 12-year-old male track-and-field athlete with avulsion fracture of the ischial tuberosity by suture anchor fixation using the suture bridge technique. The boy felt pain in the left gluteal area while running. Radiography showed a left avulsion fracture of the ischial tuberosity with approximately 20-mm displacement. Union was not achieved by conservative non-weight-bearing therapy, and muscle weakness persisted; therefore, surgery was performed. A subgluteal approach was taken via a longitudinal incision in the buttocks, and the avulsed fragment was fixed with five biodegradable suture anchors using the suture bridge technique. CONCLUSIONS: Although the majority of avulsion fractures of the ischial tuberosity can be treated conservatively, patients with excessive displacement require surgical treatment. The suture bridge technique provided secure fixation and enabled an early return to sports activities.


Asunto(s)
Fijación Interna de Fracturas/métodos , Fracturas por Avulsión/cirugía , Isquion/lesiones , Técnicas de Sutura , Atletismo/lesiones , Niño , Fijación Interna de Fracturas/instrumentación , Curación de Fractura , Fracturas por Avulsión/diagnóstico por imagen , Fracturas por Avulsión/fisiopatología , Humanos , Isquion/diagnóstico por imagen , Isquion/fisiopatología , Imagen por Resonancia Magnética , Masculino , Recuperación de la Función , Volver al Deporte , Anclas para Sutura , Técnicas de Sutura/instrumentación , Factores de Tiempo , Tomografía Computarizada por Rayos X , Resultado del Tratamiento
16.
Med Sci Monit ; 24: 9406-9412, 2018 Dec 27.
Artículo en Inglés | MEDLINE | ID: mdl-30589058

RESUMEN

Avulsion fracture of the ischial tuberosity (AFIT) is a rare adolescent sports injury. At present, there is no consensus on its therapeutic paradigm, but conservative treatment appears to be the predominate choice. Furthermore, the degree of fracture displacement (DFD) remains as an important factor in determining whether AFIT needs internal fixation. The aim of the present study was to review and update the injury mechanism, clinical manifestations, imaging examination, diagnosis and differential diagnosis, and treatment of AFIT. A literature search was performed on a variety of databases using text words, and the results were limited to the English language. This review provides an important reference for the diagnosis and treatment of AFIT. AFIT can be easily misdiagnosed. Therefore, a detailed medical history and imaging examination are crucial for a correct diagnosis and differential diagnosis. For the choice of treatment of AFIT, it is necessary to consider not only the size of the fracture and DFD, but also the long-term functional needs of the patient.


Asunto(s)
Fijación Interna de Fracturas/métodos , Isquion/lesiones , Isquion/cirugía , Adolescente , Traumatismos en Atletas/diagnóstico , Diagnóstico Diferencial , Femenino , Fracturas Óseas/cirugía , Humanos , Masculino
17.
J Dance Med Sci ; 22(4): 233-237, 2018 Dec 01.
Artículo en Inglés | MEDLINE | ID: mdl-30477613

RESUMEN

A 14-year-old female ballet dancer sustained an injury during a routine ballet movement that was diagnosed as an ischial tuberosity avulsion fracture. This diagnosis was complicated by extensive soft tissue injury to the hamstrings, adductors, and external rotator musculature. Although uncommon, the potential for this injury should be uniformly considered in adolescent dancers due to the unique stresses in ballet training and the added risk of growth spurts during this stage of development. Prevention targeting individual deficiencies in flexibility and strength is essential to avoid similar devastating injuries. In most cases that are diagnosed early, avulsions heal with conservative treatment. Early imaging and correct diagnosis can serve to guide clinical management and prevent unnecessary surgery in the young dancer.


Asunto(s)
Traumatismos en Atletas/diagnóstico por imagen , Baile/lesiones , Fracturas Óseas/diagnóstico por imagen , Isquion/lesiones , Adolescente , Traumatismos en Atletas/terapia , Femenino , Fracturas Óseas/terapia , Humanos , Isquion/diagnóstico por imagen , Muslo
18.
Adv Emerg Nurs J ; 40(4): 278-284, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30365442

RESUMEN

The Research to Practice column is intended to improve the research critique skills of the advanced practice registered nurse and the emergency nurse, and to assist with the translation of research into practice. For each column, a topic and a research study are selected. The stage is set with a case presentation. The research article is then reviewed and critiqued, and the findings are discussed in relation to the case presented. In the current column, we examine the findings of A. from their article titled "An Iceberg Phenomenon in Dementia: Pain."


Asunto(s)
Trastornos del Conocimiento/complicaciones , Servicio de Urgencia en Hospital , Dimensión del Dolor/métodos , Dolor/etiología , Accidentes por Caídas , Anciano , Anciano de 80 o más Años , Trastornos del Conocimiento/enfermería , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico por imagen , Humanos , Isquion/lesiones , Masculino , Dolor/enfermería
19.
Eur J Orthop Surg Traumatol ; 28(3): 423-429, 2018 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-29159479

RESUMEN

INTRODUCTION: Pelvic apophyseal avulsion can limit young athletes' performance for months and may result in permanent disability. Nonoperative treatment is most commonly preferred, while surgical management with reduction and fixation is reserved for selected cases. Our aim was to evaluate outcomes of operative management of pelvic apophyseal avulsions in a series of adolescents and young adult athletes. MATERIALS AND METHODS: Operative room registries and medical records were reviewed to identify patients who received surgical treatment for pelvic apophyseal avulsions who were younger than 24 years and with a minimum of 12 month follow-up. RESULTS: Thirty-two patients (16.8 years ± 2.6) were identified. The most common avulsion sites were anterior inferior iliac spine (34.4%, N = 11) and ischial tuberosity (34.4%, N = 11). Other avulsions were five cases (15.6%) of the pubic apophysis, four cases (12.5%) of the anterior superior iliac spine apophysis and one case of the iliac crest apophysis. Seventeen cases (53.1%) underwent surgery early, i.e., during the first 3 months after the acute injury. Twenty-two cases (68.8%) involved reduction with internal fixation, and six cases (18.8%) involved resection of the fragment. Twenty-six athletes (81.3%, N = 26) reported good outcomes and were able to return to preinjury sports level. Six patients (18.8%) had moderate outcome and reported activity limitations during high-level sports. Large displacement (> 20 mm) or delayed (> 3 months) surgery was not associated with inferior outcomes (P = 0.690 and P = 0.392, respectively). Injury side (P = 0.61) or gender (P = 0.345) did not affect outcomes. CONCLUSIONS: Operative management of pelvic apophyseal avulsion results in return to the preinjury sports level in more than 80% of the cases. However, while both acute surgery for large displacement and delayed intervention for failed nonoperative treatment are generally successful in improving sports function in these cases, comparative studies are required to refine criteria for surgery. LEVEL OF EVIDENCE: Case series, IV.


Asunto(s)
Traumatismos en Atletas/cirugía , Fracturas Óseas/cirugía , Huesos Pélvicos/lesiones , Adolescente , Niño , Femenino , Estudios de Seguimiento , Fijación Interna de Fracturas/métodos , Humanos , Ilion/lesiones , Ilion/cirugía , Isquion/lesiones , Isquion/cirugía , Masculino , Huesos Pélvicos/cirugía , Volver al Deporte , Resultado del Tratamiento , Adulto Joven
20.
J Am Acad Orthop Surg ; 25(5): 330-338, 2017 May.
Artículo en Inglés | MEDLINE | ID: mdl-28350548

RESUMEN

Pelvic discontinuity is a challenging complication encountered during revision total hip arthroplasty. Pelvic discontinuity is defined as a separation of the ilium superiorly from the ischiopubic segment inferiorly and is typically a chronic condition in failed total hip arthroplasties in the setting of bone loss. After a history and a physical examination have been completed and infection has been ruled out, appropriate imaging must be obtained, including plain hip radiographs, oblique Judet radiographs, and often a CT scan. The main management options are a hemispheric acetabular component with posterior column plating, a cup-cage construct, pelvic distraction, and a custom triflange construct. The techniques have unique pros and cons, but the goals are to obtain stable and durable acetabular component fixation and a healed or unitized pelvis while minimizing complications.


Asunto(s)
Artroplastia de Reemplazo de Cadera , Enfermedades Óseas/cirugía , Ilion , Isquion , Hueso Púbico , Acetábulo , Enfermedades Óseas/diagnóstico , Placas Óseas , Prótesis de Cadera , Humanos , Ilion/diagnóstico por imagen , Ilion/lesiones , Isquion/diagnóstico por imagen , Isquion/lesiones , Osteogénesis por Distracción , Complicaciones Posoperatorias , Diseño de Prótesis , Falla de Prótesis , Hueso Púbico/diagnóstico por imagen , Hueso Púbico/lesiones , Reoperación
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