RESUMEN
The purpose of the study is to improve the results of complex restorative treatment of patients with pain syndrome in osteochondrosis of the thoracic spine. The study was conducted on the basis of the Rehabilitation Department of the State Institution "ITO NAMSU" in Kiev (from 2020 to 2022). The study involved 150 patients with pain in the thoracic spine, who were treated in the rehabilitation department. The mean age of the patients was 44.7±1.5 years. The average duration of the disease was 10.2±0.3 years, treatment - 13.5±1.0 days. Evaluation of treatment results using the Visual Analogue Scale of pain (Visual Analogue Scale) and electromyography on DIGITAL M - TEST was carried out 14 days after the program of physiotherapy interventions. The developed program of rehabilitation interventions included the use of myofascial release of the thoracic spine, physical exercises, breathing exercises during the myofascial release of the thoracic spine. The analysis of the obtained results showed that after the rehabilitation measures with the use of myofascial release, there was a statistically significant decrease in the level of pain in the group of examined patients (before PT - 4.87±0.47 cm, after PT - 1.17±0.26*) * (x±S), (p<0.01), which allows us to conclude that the program of physiotherapy interventions is effective. The use of myofascial release in the complex of physiotherapeutic interventions improves the quality of life and saves patients from thoracic paÑn caused by degenerative changes in the spine in the short term.
Asunto(s)
Osteocondrosis , Calidad de Vida , Humanos , Adulto , Persona de Mediana Edad , Resultado del Tratamiento , Dolor , Vértebras Lumbares , Osteocondrosis/terapiaRESUMEN
RATIONALE: The purpose of this case study was to identify factors of bilateral etiopathogenesis of Osgood-Schlatter disease (OSD) and those supporting the effectiveness of the therapeutic process in a 12-year-old elite female Olympic karateka. PATIENT CONCERNS: The present case study concerns OSD female karateka who started her sport-specific training at the age of 4âyears. DIAGNOSES: The results of subjective palpation by the orthopedic surgeon and objective medical examination using ultrasonography, wall slide test, magnetic resonance imaging, and body height and weight measurements were collected. INTERVENTIONS: The therapeutic intervention for the athlete's knee joints lasted 20âmonths (5 stages). Physical therapy, kinesiotherapy, and pharmacological treatment were administered, and physical activity was gradually introduced. OUTCOMES: The developmental trajectory was uniform for body height and labile for body weight. OSD was diagnosed after the second growth spurt, and significant progression was reported during the subsequent height and weight gains and increased volume and intensity of sports training. The rate and dynamics of changes in the distance from the patellar ligament to the tibial apophysis were irregular, with dominance in the right knee with the highest rate of change (-3.3âmm) and twice the regression of the rate of change (-2.5âmm). The analyzed distance never exceeded the baseline value (5.5âmm), which was the case in the left knee. Return to sports competition was possible from the second month of therapy, in which kinesiotherapy and static stretching were the most effective. A relatively correct distance of the patellar ligament from the tibial apophysis was recorded at the time of stabilization of the body height and weight gain. No pathological changes were observed following OSD, and full recovery was observed. LESSONS: In the case discussed in this study, growth spurt, the specificity of the sport practiced, and early specialization including high-volume and high-intensity training should be considered as factors causing OSD and its progression. Kinesiotherapeutic management and static stretching are crucial for the treatment of OSD. Quick return to sports competition was possible due to early therapeutic intervention, which could also lead to the absence of pathological changes in the tibial tubercle and the absence of recurrence of OSD.
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Tratamiento Conservador , Terapia por Ejercicio , Osteocondrosis/terapia , Traumatismos en Atletas/complicaciones , Niño , Manejo de la Enfermedad , Femenino , Humanos , Traumatismos de la Rodilla/complicaciones , Articulación de la Rodilla/diagnóstico por imagen , Osteocondrosis/diagnóstico por imagen , Ligamento Rotuliano , Tibia/diagnóstico por imagen , UltrasonografíaRESUMEN
OBJECTIVES: Osgood-Schlatter disease (OSD) is a sport- and growth-associated knee pathology with locally painful alterations around the tibial tuberosity apophysis. Up to 10% of adolescents are affected by OSD. Treatment is predominantly conservative. The aims of this systematic review are to comprehensively identify conservative treatment options for OSD, compare their effectiveness in selected outcomes, and describe potential research gaps. METHODS: A systematic literature search was conducted using CENTRAL, CINAHL, EMBASE, MEDLINE, and PEDro databases. In addition, ongoing and unpublished clinical studies, dissertations, and other grey literature on OSD were searched. We also systematically retrieved review articles for extraction of treatment recommendations. RESULTS: Of 767 identified studies, thirteen were included, comprising only two randomised controlled trials (RCTs). The included studies were published from 1948 to 2019 and included 747 patients with 937 affected knees. Study quality was poor to moderate. In addition to the studies, 15 review articles were included, among which the most prevalent treatment recommendations were compiled. CONCLUSION: Certain therapeutic approaches, such as stretching, have apparent efficacy, but no RCT comparing specific exercises with sham or usual-care treatment exists. Carefully controlled studies on well-described treatment approaches are needed to establish which conservative treatment options are most effective for patients with OSD.
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Tratamiento Conservador/métodos , Osteocondrosis/terapia , Adolescente , Adulto , Niño , Ejercicio Físico , Terapia por Ejercicio/métodos , Femenino , Humanos , Rodilla/patología , Articulación de la Rodilla/patología , Masculino , Ejercicios de Estiramiento Muscular , Osteocondrosis/patología , Dolor/patología , Ensayos Clínicos Controlados Aleatorios como Asunto , Literatura de Revisión como Asunto , Deportes , Tibia/patología , Resultado del Tratamiento , Adulto JovenRESUMEN
Background and purpose - Van Neck-Odelberg disease (VND) is a self-limiting skeletal phenomenon characterized by a symptomatic or asymptomatic uni- or bilateral overgrowth of the pre-pubescent ischiopubic synchondrosis. It is frequently misinterpreted as a neoplastic, traumatic, or infectious process, often resulting in excessive diagnostic and therapeutic measures. This study assessed the demographic, clinical, and radiographic features of the condition and analyzed diagnostic and therapeutic pathways in a large single-center cohort.Patients and methods - We retrospectively analyzed 21 consecutive patients (13 male) with a median age of 10 years (IQR 8-13) and a median follow-up of 5 years (IQR 42-94 months), who were diagnosed at our department between 1995 and 2019.Results - VND was unilateral in 17 cases and bilateral in 4 cases. Initial referral diagnoses included suspected primary bone tumor (n = 9), fracture (n = 3), osteomyelitis (n = 2), and metastasis (n = 1). The referral diagnosis was more likely to be VND in asymptomatic than symptomatic patients (4/6 vs. 2/15). More MRI scans were performed in unilateral than bilateral VND (median 2 vs. 0). All 15 symptomatic patients underwent nonoperative treatment and reported a resolution of symptoms and return to physical activity after a median time of 5 months (IQR 0-6).Interpretation - By understanding the physiological course of VND during skeletal maturation, unnecessary diagnostic and therapeutic measures can be avoided and uncertainty and anxiety amongst affected patients, their families, and treating physicians can be minimized.
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Isquion , Osteocondrosis/diagnóstico por imagen , Osteocondrosis/terapia , Hueso Púbico , Adolescente , Niño , Femenino , Estudios de Seguimiento , Humanos , Imagen por Resonancia Magnética , Masculino , Osteocondrosis/complicaciones , Evaluación de Resultado en la Atención de Salud , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
Phosphatidylcholine-specific phospholipase Cγ1 (PLCγ1) is involved in regulating cell metabolism. However, little is known how PLCγ1 directs BMSC differentiation. Here, we investigated the role of PLCγ1 in rat BMSC differentiation into osteoblasts and chondrocytes. The results of Alizarin red and Alcian blue staining showed that PLCγ1 inhibitor U73122 significantly enhanced the mineralization capacity and proteoglycan deposition of BMSCs. The results of qPCR technique and Western blot analysis showed that long-term treatment of U73122 enhanced COL1A1 and OPG mRNA levels and Collagen 1A1, BMP2, and p-Smad1/5/9 protein levels and that short-term treatment of U73122 enhanced COL2A1 and SOX9 mRNA levels and Collagen 2, SOX9, Aggrecan, TGF-ß3, and p-Smad2/3 protein levels. Decreased p-mTOR and p-P38 contributed to enhanced osteogenic potentials of BMSCs and increased p-P38 contributed to enhanced chondrogenic potentials of BMSCs. The scaffold transplantation with U73122+BMSC was more efficacious than BMSC alone for osteochondral defect repair in a rat model. Therefore, suppressing PLCγ1 could improve the capacity to effectively use BMSCs for cell therapy of osteochondral defect.
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Condrogénesis/fisiología , Células Madre Mesenquimatosas/citología , Osteogénesis/fisiología , Fosfolipasa C gamma/antagonistas & inhibidores , Alginatos , Animales , Diferenciación Celular , Células Cultivadas , Condrogénesis/efectos de los fármacos , Estrenos/farmacología , Hidrogeles/administración & dosificación , Hidrogeles/química , Masculino , Trasplante de Células Madre Mesenquimatosas/métodos , Células Madre Mesenquimatosas/efectos de los fármacos , Osteocondrosis/fisiopatología , Osteocondrosis/terapia , Osteogénesis/efectos de los fármacos , Rótula/diagnóstico por imagen , Rótula/patología , Rótula/cirugía , Fosfolipasa C gamma/genética , Fosfolipasa C gamma/metabolismo , Pirrolidinonas/farmacología , Ratas Sprague-Dawley , Serina-Treonina Quinasas TOR/metabolismo , Proteínas Quinasas p38 Activadas por Mitógenos/metabolismoRESUMEN
Functional articular cartilage regeneration remains challenging, and it is essential to restore focal osteochondral defects and prevent secondary osteoarthritis. Combining autologous stem cells with therapeutic medical device, we developed a bi-compartmented implant that could promote both articular cartilage and subchondral bone regeneration. The first compartment based on therapeutic collagen associated with bone morphogenetic protein 2, provides structural support and promotes subchondral bone regeneration. The second compartment contains bone marrow-derived mesenchymal stem cell spheroids to support the regeneration of the articular cartilage. Six-month post-implantation, the regenerated articular cartilage surface was 3 times larger than that of untreated animals, and the regeneration of the osteochondral tissue occurred during the formation of hyaline-like cartilage. Our results demonstrate the positive impact of this combined advanced therapy medicinal product, meeting the needs of promising osteochondral regeneration in critical size articular defects in a large animal model combining not only therapeutic implant but also stem cells.
Asunto(s)
Cartílago Articular/crecimiento & desarrollo , Trasplante de Células Madre Mesenquimatosas , Osteocondrosis/terapia , Prótesis e Implantes , Regeneración/genética , Animales , Proteína Morfogenética Ósea 2/genética , Regeneración Ósea/genética , Regeneración Ósea/fisiología , Cartílago Articular/patología , Colágeno/genética , Colágeno/farmacología , Modelos Animales de Enfermedad , Humanos , Osteocondrosis/genética , Osteocondrosis/patología , Ovinos/genética , Ovinos/fisiología , Esferoides Celulares/citología , Esferoides Celulares/trasplante , Ingeniería de Tejidos/métodosRESUMEN
BACKGROUND: Osgood Schlatter disease (OSD) is the most common knee condition in adolescent athletes aged 9-16. Without evidence to guide clinical practice, it is unclear how OSD is managed. The aim of this study was to investigate how international healthcare professionals (general practitioners, physiotherapists, rheumatologists, sports and exercise medicine doctors, and orthopedic surgeons) diagnose and manage OSD. METHODS: This mixed-method study used a convergent parallel design. A quantitative questionnaire and semi-structured interview covered prognosis, diagnosis, treatment, and return to play of adolescents with OSD. For quantitative data, those who reported likely/very likely considered "for" and unlikely/very unlikely "against" (for specific diagnostic/management strategy). Qualitative data analysis used a phenomenological approach. RESULTS: Two hundred and fifty-one healthcare professionals completed the questionnaire. The most common diagnostic criterion was pain at the tibial tuberosity (97% for). The most common treatments were patient education (99%) and exercise therapy (92%). Other treatment options were more heterogeneous, for example, pain medication (31% for and 34% against). Managing training load (97%), pain intensity (87%), and psychological factors (86%) were considered the most important factors influencing the return to activities. Several themes emerged from the interviews (on N = 20) including imaging, pain management, family, and psychosocial factors influencing prognosis. CONCLUSION: Diagnosis criteria of OSD were relatively well agreed upon, whereas the triangulation of qualitative and quantitative data showed heterogeneity of treatments. Psychosocial factors including family were highlighted as critical in the management of OSD.
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Articulación de la Rodilla , Osteocondrosis/diagnóstico , Osteocondrosis/terapia , Adolescente , Analgésicos/uso terapéutico , Artralgia/diagnóstico , Artralgia/psicología , Artralgia/terapia , Estudios Transversales , Terapia por Ejercicio/estadística & datos numéricos , Familia , Encuestas de Atención de la Salud/estadística & datos numéricos , Humanos , Internacionalidad , Osteocondrosis/psicología , Dimensión del Dolor/métodos , Educación del Paciente como Asunto/estadística & datos numéricos , Pronóstico , Investigación Cualitativa , Volver al Deporte/psicologíaRESUMEN
BACKGROUND: The present-day conservative treatment algorithms of Osgood-Shlatter Disease (OSD) are often inadequate for young athletes because they require extremity immobilization and avoidance of sports, and hence the longer duration of rehabilitation. Therefore, the development of safe and efficacious treatment protocols for young athletes is of great practical importance. THE AIM OF THE STUDY: The aim of the study was to assess the efficacy and safety of the conservative treatment of Osgood-Schlatter disease in young professional soccer players. MATERIALS AND METHODS: Medical records of young soccer players from two different Russian soccer-academies from the period January 2016-July 2019 were analyzed in a retrospective cohort study. Trauma records of young soccer players aged 11-15 years were included in the analysis. Statistical analysis was performed using IBM SPSS Statistics software, 23.0. Descriptive statistics tools were applied for the analysis. RESULTS: A total of 280 soccer players were included in the study. The aged ranged between 11 and 15 years. Ten percent of players (n = 28, mean age 12.9 ± 1.3) were diagnosed with OSD during the observation period. The mean OSD treatment duration was 27.3 ± 13.9 days. Bilateral symptoms were observed in 42.9% of cases, and unilateral symptoms in 57.1%. In 53.6% of players, the first manifestation of OSD symptoms was observed during wintertime. All players were training on artificial turf playing fields. Conservative treatment without immobilization was applied to all patients. It included kinesiotherapy for quadriceps muscle lengthening and physiotherapy as well as gradual increase of physical activity. A total of 35.7% of players reported having discomfort upon resuming regular training, which caused some restrictions in exercise. However, the symptoms resolved spontaneously with time. Surgical treatment or complete avoidance of exercise was not used in any of the patients. CONCLUSION: High incidence of OSD was revealed among young soccer players of the leading Russian soccer academies. The OSD most commonly occurred during wintertime. Conservative treatment of OSD-i.e., physiotherapy and kinesiotherapy-enabled disease-free resuming of sports activity for the majority of patients.
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Osteocondrosis , Fútbol , Adolescente , Niño , Tratamiento Conservador , Humanos , Osteocondrosis/epidemiología , Osteocondrosis/terapia , Estudios Retrospectivos , Federación de RusiaRESUMEN
The aim of this study was to investigate the modification of gait kinematics before and after orthotic treatment in patients with ITV. Vicon instrumented gait analysis was performed on three patients with ITV, pre and post treatment. Orthoses were applied a total of eighteen participants with ITV who were 25-38 months. 34 extremities were treated and radiographic evidence evaluated before and after orthotic treatment. Treatment duration for orthotic treatment ranged between 11 and 41 (25.9 ± 10.0) months. Only three patients were evaluated in gait analysis due to application difficulties. Three patients kinematic and kinetic instrumented gait analysis were found flatfoot, varus and internal rotation of the foot, hip flexion and external rotation. Study were reported an improvement in gait kinematics after orthotic treatment, in patients with ITV.
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Enfermedades del Desarrollo Óseo/fisiopatología , Enfermedades del Desarrollo Óseo/terapia , Marcha/fisiología , Aparatos Ortopédicos , Osteocondrosis/congénito , Adulto , Fenómenos Biomecánicos , Enfermedades del Desarrollo Óseo/diagnóstico por imagen , Niño , Preescolar , Humanos , Lactante , Cinética , Osteocondrosis/diagnóstico por imagen , Osteocondrosis/fisiopatología , Osteocondrosis/terapia , Pelvis/fisiopatologíaRESUMEN
PURPOSE OF REVIEW: Osgood-Schlatter disease (OSD) is one of the most common causes for anterior knee pain in children and adolescents resulting from a traction apophysitis of the tibial tubercle. While a peak in boys aged 12-15 years old was well documented, there seems to be no difference in sex distribution nowadays. This may result from increased participation of young females in high-impact sports. This review provides an up-to-date account on contemporary prophylaxis as well as diagnostic and therapeutic approaches. RECENT FINDINGS: Numerous studies have examined risk factors for OSD. These include body weight, muscle tightness, muscle weakness during knee extension and flexibility of hamstring muscles. In particular, shortening of the rectus femoris may substantially alter biomechanical functions of the knee. Conservative management remains successful in over 90% of patients. However, if disabling symptoms and pain persistent after physeal closure, operative treatment may be necessary. SUMMARY: OSD is a mostly self-limiting apophysitis of the tibial tubercle and the adjacent patella tendon in young active patients with open physis. Prevention strategies include quadriceps and hamstring stretching and therefore should be implemented in everyday practice routines for children who partake in regular sports activities.
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Osteocondrosis/diagnóstico , Osteocondrosis/terapia , Adolescente , Artralgia/etiología , Artralgia/prevención & control , Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/epidemiología , Traumatismos en Atletas/fisiopatología , Traumatismos en Atletas/terapia , Niño , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Ejercicios de Estiramiento Muscular/métodos , Osteocondrosis/epidemiología , Osteocondrosis/fisiopatología , Medición de Riesgo , Factores de Riesgo , Tibia/diagnóstico por imagen , Tibia/cirugíaRESUMEN
Introducción: La enfermedad de Osgood-Schlatter afecta la tuberosidad anterior tibial. Ocasiona dolor e inflamación de la rodilla y un paulatino crecimiento de esta tuberosidad. En los exámenes radiológicos se observó el crecimiento y desprendimiento de la tuberosidad anterior tibial. Objetivo: Valorar la evolución radiológica de la enfermedad de Osgood-Schlatter junto a su evolución clínica desde su aparición en un niño. Caso clínico: Paciente masculino, de 11 años de edad, que acudió al Hospital Nacional Dr. Mario Catarino Rivas por presentar dolor moderado a intenso e inflamación leve en su rodilla izquierda, de varias semanas de evolución, luego de realizar moderada actividad física. En el Rayos X (postero-anterior y lateral) de la rodilla izquierda se observó una leve avulsión de la tuberosidad. Se diagnosticó Osgood-Schlatter. Se prescribió antiinflamatorios no esteroideos y reposo. Actualmente, a sus 14 años, el paciente presenta tumoración prominente de ambas tuberosidades, refiere dolor moderado al ejercitarse y al arrodillarse. Se realizaron Rayos X (vista postero-anterior y lateral) en ambas rodillas con el fin de comparar la evolución de su enfermedad después de tres años del diagnóstico. Se observó mayor avulsión de ambas tuberosidades anteriores tibiales. No hubo modificaciones en su tratamiento, ya que no refirió empeoramiento de los síntomas. Conclusiones: Con un diagnóstico clínico y radiológico se puede observar el progreso y severidad de la enfermedad de Osgood-Schlatter. Esta es benigna y su manejo, principalmente, es conservador(AU)
Introduction: Osgood-Schlatter disease affects the tibial anterior tuberosity. It causes pain and inflammation of the knee and gradual growth of this tuberosity. Radiological examinations showed the growth and detachment of the tibial anterior tuberosity. Objective: To assess the radiological evolution of Osgood-Schlatter disease along with the clinical evolution since the appearance in a child. Case report: An 11 year-old male patient came to Dr. Mario Catarino Rivas National Hospital due to moderate to intense pain and mild inflammation in his left knee, after his moderate physical activity for several weeks. X-rays (postero-anterior and lateral) of his left knee showed a slight avulsion of the tuberosity. Osgood-Schlatter was diagnosed. Nonsteroidal anti-inflammatory and rest was prescribed. Currently, at 14, the patient has prominent tumor of both tuberosities, refering moderate pain when exercising and kneeling. X-rays (postero-anterior and lateral view) were performed on both knees in order to compare the evolution of the disease after three years of diagnosis. Greater avulsion of both tibial anterior tuberosities was observed. There were no modifications in the treatment, since he did not report worsening of symptoms. Conclusions: The progress and severity of Osgood-Schlatter disease can be observed with a clinical and radiological diagnosis. This disease is benign and its management is mainly conservative(AU)
Introduction: La maladie d'Osgood-Schlatter affecte la tubérosité tibiale antérieure (TTA). Cette affection provoque la douleur et l'inflammation du genou, et une croissance progressive de cette tubérosité. Les examens radiologiques ont permis de visualiser la croissance et l'arrachement de la tubérosité tibiale antérieure. Objectif: Évaluer l'évolution clinique et radiologique de la maladie d'Osgood-Schlatter depuis sa survenue chez un enfant. Cas clinique: Il s'agit d'un patient âgé de 11 ans qui s'est rendu à l'Hôpital National Dr Mario Catarino Rivas due à une douleur modérée à intense et une légère inflammation au niveau du genou gauche, d'une durée de quelques semaines, après activité physique modérée. Une légère avulsion de la tubérosité a été observée sur les clichés du genou gauche (vue antéro-postérieure et vue latérale). Il a été diagnostiqué de la maladie d'Osgood-Schlatter, et on lui a prescrit des anti-inflammatoires non stéroïdiens (AINS) et du repos. Aujourd'hui, à l'âgé de 14 ans, le patient est atteint d'une tumeur proéminente au niveau de toutes les deux tubérosités; il se plaint d'une douleur modérée lorsqu'il fait des sports ou se met à genoux. Tous les deux genoux sont examinés au moyen des rayons X (vue antéro-postérieure et vue latérale), afin de comparer l'évolution de sa maladie trois ans après le diagnostic. On a trouvé une avulsion beaucoup plus grande au niveau de toutes les deux tubérosités. Le traitement n'a pas été modifié, car il n'y a pas eu d'aggravation des symptômes. Conclusions: Grâce aux diagnostics clinique et radiographique, on peut observer le progrès et la sévérité de la maladie d'Osgood-Schlatter. Cette affection est bénigne, et son traitement est essentiellement conservateur(AU)
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Humanos , Masculino , Niño , Osteocondrosis/terapia , Osteocondrosis/diagnóstico por imagen , Tratamiento Conservador , HondurasRESUMEN
Blount disease is an asymmetrical disorder of proximal tibial growth that produces a three-dimensional deformity. Tibia vara is the main component of the deformity. Blount disease exists as two clinical variants, infantile or early-onset, and adolescent or late-onset, defined based on whether the first manifestations develop before or after 10 years of age. The pathophysiological mechanisms are unclear. In the Americas and Caribbean, Blount disease chiefly affects black obese children. Without treatment, the prognosis is often severe, particularly in the infantile form due to the development of medial tibial epiphysiodesis at about 6 to 8 years of age. In other parts of the world, the associations with black ethnicity and obesity are less obvious and the prognosis is often less severe. A consensus exists about the optimal treatment in two situations: before 4 years of age, progressive Blount disease should be corrected, preferably by a simple osteotomy; and once medial tibial epiphysiodesis has developed, both a complementary epiphysiodesis and gradual external fixator correction of the other alignment abnormalities, rotational deformity, and limb length are required. After 4 years of age, the outcome in the individual patient is difficult to predict. Magnetic resonance imaging supplies information on the morphology and vascularisation of the growth regions, thereby helping to guide treatment decisions. In the adolescent form, morbid obesity limits the treatment options. Untreated Blount disease in adults is rarely encountered. A more common occurrence is the presence of residual abnormalities at skeletal maturity in patients treated for Blount disease in childhood. Premature osteoarthritis may develop. In this situation, osteotomy may delay the need for total knee arthroplasty.
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Enfermedades del Desarrollo Óseo/diagnóstico , Enfermedades del Desarrollo Óseo/terapia , Osteocondrosis/congénito , Edad de Inicio , Enfermedades del Desarrollo Óseo/clasificación , Niño , Progresión de la Enfermedad , Fijadores Externos , Peroné/cirugía , Humanos , Osteocondrosis/clasificación , Osteocondrosis/diagnóstico , Osteocondrosis/terapia , Osteotomía , Obesidad Infantil/complicaciones , Pronóstico , Remisión Espontánea , Factores de Riesgo , Tibia/diagnóstico por imagen , Tibia/cirugíaAsunto(s)
Enfermedades de los Caballos , Osteocondrosis/veterinaria , Publicaciones Periódicas como Asunto/historia , Animales , Historia del Siglo XX , Historia del Siglo XXI , Enfermedades de los Caballos/etiología , Enfermedades de los Caballos/terapia , Caballos , Osteocondrosis/etiología , Osteocondrosis/terapiaRESUMEN
PURPOSE OF REVIEW: Treatments available to correct adolescent Blount disease deformities differ in terms of features, advantages, and disadvantages. Each is indicated, therefore, for different scenarios of severity, physeal condition, and maturity. The purpose of this review is to update basic concepts, surgical treatments, and controversies concerning this disorder. RECENT FINDINGS: The cause of Blount disease is unknown although etiologic factors as morbid obesity and hypovitaminosis D are thought to be associated with it. Recently, semiinvasive techniques (guided growth) have been proposed for mild deformities but remain controversial. Osteotomies with external fixation (hexapodes) are still the most recommended corrective treatment in this condition. SUMMARY: Little is known about the origin and natural history of Blount disease. Treatment is always surgical and, given their complexity, should be preceded by a thorough analysis and planning regarding all deformities. Treatment principles are to correct the three-dimensional deformity and avoid recurrence. The choice of technique mainly depends on patient maturity and severity. Guided growth is a good choice for more immature patients with moderate deformities. Progressive correction using osteotomy or physeal distraction is indicated for patients with severe deformities and low remaining growth. The Taylor spatial frame is currently the most popular progressive correction device.
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Enfermedades del Desarrollo Óseo/terapia , Procedimientos Ortopédicos/métodos , Osteocondrosis/congénito , Adolescente , Enfermedades del Desarrollo Óseo/etiología , Enfermedades del Desarrollo Óseo/fisiopatología , Progresión de la Enfermedad , Humanos , Osteocondrosis/etiología , Osteocondrosis/fisiopatología , Osteocondrosis/terapia , Resultado del TratamientoRESUMEN
Growing children are susceptible to a number of disorders to their lower extremities of varying degrees of severity. The diagnosis and management of these conditions can be challenging. With musculoskeletal symptoms being one of the leading reasons for visits to general practitioners, a working knowledge of the basics of these disorders can help in the appropriate diagnosis, treatment, counselling, and specialist referral. This review covers common disorders affecting the hip, the knee and the foot. The aim is to assist general practitioners in recognising developmental norms and differentiating physiological from pathological conditions and to identify when a specialist referral is necessary.
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Deformidades Congénitas de las Extremidades Inferiores/diagnóstico , Niño , Deformidades Congénitas del Pie/diagnóstico , Deformidades Congénitas del Pie/terapia , Genu Valgum , Genu Varum , Luxación Congénita de la Cadera/diagnóstico , Luxación Congénita de la Cadera/terapia , Humanos , Enfermedad de Legg-Calve-Perthes/diagnóstico , Enfermedad de Legg-Calve-Perthes/terapia , Deformidades Congénitas de las Extremidades Inferiores/terapia , Osteocondritis Disecante/diagnóstico , Osteocondritis Disecante/terapia , Osteocondrosis/diagnóstico , Osteocondrosis/terapia , Epífisis Desprendida de Cabeza Femoral/diagnóstico , Epífisis Desprendida de Cabeza Femoral/terapiaRESUMEN
Foals are susceptible to many of the same types of fractures as adult horses, often secondary to external sources of trauma. In addition, some types of fractures are specific to foals and occur routinely in horses under 1 year of age. These foal-specific fractures may be due to the unique musculoskeletal properties of the developing animal and may present with distinct clinical signs. Treatment plans and prognoses are tailored specifically to young animals. Common fractures not affecting the long bones in foals are discussed in this article, including osteochondral fragmentation, proximal sesamoid bone fractures/sesamoiditis, and distal phalanx fractures.
Asunto(s)
Fracturas Óseas/veterinaria , Enfermedades de los Caballos , Caballos/lesiones , Osteocondrosis/veterinaria , Huesos Sesamoideos/lesiones , Falanges de los Dedos del Pie/lesiones , Animales , Animales Recién Nacidos/lesiones , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/terapia , Enfermedades de los Caballos/diagnóstico por imagen , Enfermedades de los Caballos/terapia , Osteocondrosis/complicaciones , Osteocondrosis/terapia , Huesos Sesamoideos/diagnóstico por imagen , Huesos Sesamoideos/patología , Falanges de los Dedos del Pie/diagnóstico por imagenRESUMEN
BACKGROUND: Osgood-Schlatter disease (OSD) is a self-limiting condition which occurs commonly in adolescence. PURPOSE: The objective of this article is to review published literature regarding pathophysiology, diagnosis and treatment of OSD. METHODS: A search of the literature was performed on the electronic databases PubMed, Cochrane and SCOPUS databases between 1962 and 2016 for pathophysiology, diagnosis and treatment of Osgood-Schlatter disease. RESULTS: OSD, also known as apophysitis of the tibial tubercle, is a common disease with most cases resolving spontaneously with skeletal maturity. In pathophysiology, the most accepted theory is repetitive knee extensor mechanism contraction. The pain is localized to the anterior aspect of the proximal tibia over the tibial tuberosity. They may describe a dull ache exacerbated by jumping or stair climbing. Radiological evaluation may indicate superficial ossicle in the patellar tendon. Osgood-Schlatter is a self-limited disease and generally ceases with skeletal maturity. Treatment is usually symptomatic. Adults with continued symptoms may need surgical treatment if they fail to respond to conservative treatment. Surgical procedures include open, bursoscopic and arthroscopic technique. Arthroscopic surgery is beneficial over an open procedure due to early postoperative recovery, no incisional scar in front of the tuberosity that usually causes discomfort in kneeling with a better cosmetic result and the ability to address concomitant intra-articular pathology. CONCLUSION: Osgood-Schlatter syndrome runs a self-limiting course, and usually complete recovery is expected with closure of the tibial growth plate. Overall prognosis for Osgood-Schlatter syndrome is good, except for some discomfort in kneeling and activity restriction in a few cases. Arthroscopic techniques seem to be the best choice of treatment of unresolved Osgood-Schlatter lesions.
Asunto(s)
Osteocondrosis/terapia , Adolescente , Adulto , Edad de Inicio , Artroscopía/métodos , Traumatismos en Atletas/complicaciones , Niño , Tratamiento Conservador , Manejo de la Enfermedad , Femenino , Humanos , Traumatismos de la Rodilla/complicaciones , Masculino , Osteocondrosis/diagnóstico por imagen , Osteocondrosis/fisiopatología , Osteocondrosis/cirugía , Ligamento Rotuliano/patología , Remisión Espontánea , Tibia/diagnóstico por imagen , Tibia/crecimiento & desarrollo , Tibia/cirugíaRESUMEN
Multiple treatment strategies have been developed for osteochondral lesions (OCLs) of the talus. The purpose of this retrospective study was to assess retrograde autologous bone marrow cell (BMC) transplantation via core drilling (CD) combined with focused extracorporeal shock wave treatment (ESWT) in undisplaced OCL of the talus. A total of 69 patients with unilateral osteochondral lesions of the talus (Hepple grade I-III) were divided into two groups: 41 patients received combined therapy of ESWT and BMC transplantation (group A), while 28 were administered BMC transplantation alone (group B). The patients were followed up clinically and radiographically for a minimum of 2 years. Mean follow-up was 4.1 ± 2.8 years. AOFAS scores increased more significantly while pain intensity levels decreased in group A after treatment, compared with group B values (P < 0.001). In MRI follow-up, a more remarkable improvement of OCLs of the talus was observed in group A compared with group B (P = 0.040). Therefore, the combined technique reported here is a highly effective therapeutic option in OCLs of the talus with intact cartilage. It promotes patient recovery with pain control, and improves clinical outcome for more than 2 years after surgery.