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1.
J Bone Joint Surg Am ; 82(10): 1373-8, 2000 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-11057464

RESUMO

BACKGROUND: The chevron osteotomy, an accepted method for the correction of mild and moderate hallux valgus, is generally advocated for patients younger than the age of fifty years. The purposes of this prospective study were to compare the short-term (two-year) and intermediate-term (five-year) results of this operation with respect to patient satisfaction, flexion and extension of the metatarsophalangeal joint, maintenance of correction, and development of arthrosis and to determine whether the effectiveness of the procedure was limited by age. METHODS: Between April 1991 and September 1992, the chevron osteotomy was performed for the treatment of mild-to-moderate hallux valgus deformity in sixty-six consecutive feet. Forty-three patients (fifty-seven feet) were available for follow-up at both two and five years postoperatively. The two-year and five-year clinical assessments were based on the American Orthopaedic Foot and Ankle Society's hallux-metatarsophalangeal-interphalangeal scale. RESULTS: Between the two-year and five-year follow-up evaluations, there was only a minimal change in overall patient satisfaction, and the average score on the hallux-metatarsophalangeal-interphalangeal scale was unchanged. The passive range of motion of the first metatarsophalangeal joint decreased between the preoperative assessment and the two-year follow-up evaluation and was unchanged at the five-year follow-up evaluation. Radiographic evaluation showed no changes in the hallux valgus or intermetatarsal angle between the two-year and five-year evaluations, although the number of feet with arthrosis of the metatarsophalangeal joint increased slightly, from eight to eleven. Patients aged fifty years or older did as well as younger patients. CONCLUSIONS: At these two follow-up periods, the chevron osteotomy was found to be a reliable procedure for the correction of mild and moderate hallux valgus deformity, and outcome did not differ on the basis of age.


Assuntos
Hallux Valgus/cirurgia , Osteotomia/métodos , Estudos de Casos e Controles , Feminino , Seguimentos , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/fisiopatologia , Humanos , Masculino , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/fisiopatologia , Pessoa de Meia-Idade , Satisfação do Paciente , Estudos Prospectivos , Radiografia , Amplitude de Movimento Articular , Fatores de Tempo
2.
Magn Reson Imaging ; 17(4): 577-83, 1999 May.
Artigo em Inglês | MEDLINE | ID: mdl-10231184

RESUMO

The effect of intravenous administration of gadolinium diethylenetriamine-pentaacetic acid (Gd-DTPA) on MR images was studied in vitro, using pathologic osteochondral specimens removed during surgery for total endoprosthesis, and in vivo, on a group of volunteers. In ex vivo specimens, lesions of different shape having lower T1 were detected which corresponded to areas with depleted proteoglycans found histologically. In vivo experiments on young volunteers showed that the time course of cartilage enhancement was different for different anatomies. The time for maximum enhancement ranged from 45 min for the ventral femoral condyle to 270 min for patellar cartilage.


Assuntos
Cartilagem Articular/metabolismo , Meios de Contraste , Gadolínio DTPA , Imageamento por Ressonância Magnética , Osteoartrite do Joelho/metabolismo , Proteoglicanas/metabolismo , Adulto , Idoso , Cartilagem Articular/patologia , Meios de Contraste/administração & dosagem , Feminino , Gadolínio DTPA/administração & dosagem , Humanos , Injeções Intravenosas , Articulação do Joelho/anatomia & histologia , Masculino , Osteoartrite do Joelho/patologia , Fatores de Tempo
3.
Foot Ankle Int ; 18(3): 119-27, 1997 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-9116890

RESUMO

The Austin osteotomy is a widely accepted method for correction of mild and moderate hallux valgus. In view of publications by Kitaoka et al. in 1991 and by Mann and colleagues, a more radical lateral soft tissue procedure was added to the originally described procedure. From September 1992 to January 1994, 85 patients underwent an Austin osteotomy combined with a lateral soft tissue procedure to correct their hallux valgus deformities. Seventy-nine patients (94 feet) were available for follow-up. The average patient age at the time of the operation was 47.1 years, and the average follow-up was 16.2 months. The average preoperative intermetatarsal angle was 13.9 degrees, and the average hallux valgus angle was 29.7 degrees. After surgery, the feet were corrected to an average intermetatarsal angle of 5.8 degrees and an average hallux valgus angle of 11.9 degrees. Sesamoid position was corrected from 2.1 before surgery to 0.5 after surgery. The results were also graded according to the Hallux Metatarsophalangeal Interphalangeal Score, and the functional and cosmetic outcomes were graded by the patient. Dissection of the plantar transverse ligament and release of the lateral capsule repositioned the tibial sesamoid and restored the biomechanics around the first metatarsophalangeal joint. There was no increased incidence of avascular necrosis of the first metatarsal head compared with the original technique.


Assuntos
Hallux Valgus/cirurgia , Osteotomia/métodos , Adolescente , Adulto , Idoso , Terapia Combinada , Feminino , Seguimentos , Hallux Valgus/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia
4.
Foot Ankle Int ; 20(3): 171-7, 1999 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-10195295

RESUMO

Between 1974 and 1985, 59 patients (83 feet) underwent basal closing wedge osteotomy in combination with a bunionectomy and a lateral soft tissue release for correction of hallux valgus and metatarsus primus varus at this institution. Of the original 59 patients, 42 patients (60 feet) with at least 10 years of follow-up (average, 194 months; range, 144-266 months) were available for this study. Results were analyzed by review of the medical records and plain radiographs, a standardized clinical questionnaire, and physical examination. Of the 60 feet, patients rated outcomes as excellent or good in 51 feet (85%) and rated cosmesis as excellent or good in 44 feet (73%). Radiographically at final follow-up, hallux valgus and intermetatarsal angles averaged 19.9 degrees (range, 0-40 degrees) and 6.7 degrees (range, 0-18 degrees), respectively. The sesamoid position was corrected from an average preoperative grade of 2.6 to a grade of 0.9 at final follow-up. The average shortening of the first metatarsal was 5 mm. The disadvantages of the closing wedge osteotomy are that it is technically demanding and it entails the risk of shortening, dorsal malalignment, and metatarsalgia. In the current study, long-term complications included hallux varus deformity (16 feet), dorsal malalignment (15 feet), and metatarsalgia (14 feet). Despite good correction of the intermetatarsal angle and sesamoid position, the clinical results and the incidence of complications after basal closing wedge osteotomy were not as favorable as those reported for other procedures in the literature. Therefore, alternative procedures, such as the basal crescentic osteotomy or the basal chevron osteotomy, should be used.


Assuntos
Hallux Valgus/cirurgia , Ossos do Metatarso/cirurgia , Osteotomia/métodos , Adolescente , Adulto , Seguimentos , Hallux Valgus/diagnóstico por imagem , Humanos , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/patologia , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Dor/etiologia , Satisfação do Paciente , Radiografia , Estudos Retrospectivos
5.
Arch Orthop Trauma Surg ; 119(7/8): 456-460, 1999 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-10591985

RESUMO

We included in a prospective study of a standardized indomethacin protocol 134 consecutive patients undergoing primary cementless endoprosthetic hip replacement between January and June 1990. Periarticular heterotopic ossification (HO) was graded according to the Arcq classification (grades 0 to III). At final follow-up, all patients were analyzed clinically and radiographically for HO and aseptic loosening. A similar group of 44 patients (mean age of 64 years, range 38-82 years) undergoing total hip replacement (THR) with the same prosthesis and technique in 1987 did not receive HO prophylaxis and served as a control group. The average age of the 134 prophylaxis patients was 66.5 years (range 32-85 years), and the average follow-up was 65 months (range 60-71 months). Thirty patients (25%) were lost to final follow-up (19 died, 10 unknown, 1 amputation). In the study group, 77% had HO grade 0, while none had HO grade III, compared with 18% HO grade 0 and 16% HO grade III in the control goup. These differences were statistically significant (P = < 0.001). At a minimum of 60 months follow-up, clinical and radiographic evaluation revealed no aseptic loosening in the study group: 4 cases of prosthesis subsidence during the first year did not progress. In the control group, there was a higher incidence of radiolucency around the femoral component, and one patient met all criteria for radiographic evidence of aseptic loosening. Statistical analysis revealed no significant difference between the two groups (P = 0.104). Based on our clinical and radiological results, indomethacin does not inhibit stable bony integration of the femoral component.

6.
Z Orthop Ihre Grenzgeb ; 134(6): 517-9, 1996.
Artigo em Alemão | MEDLINE | ID: mdl-9027121

RESUMO

The concept of surgical amputation and the problems of prosthetic management in a girl with congenital fibrosarcoma of left distal thigh, knee and shank is described. After failed polychemotherapy (EICESS 92) and expansion of the tumor a radical knee disarticulation and intended marginal resection of the tumorous soft tissue area of the distal thigh was performed at the age of eleven months and two weeks. The femur was shortened by osteotomy of the diaphysis and removing a fragment in order to protect the distal femoral epiphyseal growth plate and to be able to close the soft tissue of the stump primarily. Prosthetic fitting and rehabilitation started at the beginning of statomotorical development at the point when four feet standing changed into two feet standing. In present, at the age of two years and six months, this girl is independent mobile and well fitted with a knee disarticulation prosthesis.


Assuntos
Amputação Cirúrgica , Neoplasias Ósseas/cirurgia , Fibrossarcoma/cirurgia , Neoplasias de Tecidos Moles/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Membros Artificiais , Neoplasias Ósseas/congênito , Neoplasias Ósseas/patologia , Pré-Escolar , Terapia Combinada , Feminino , Fibrossarcoma/congênito , Fibrossarcoma/patologia , Humanos , Perna (Membro)/cirurgia , Neoplasias de Tecidos Moles/congênito , Neoplasias de Tecidos Moles/patologia
7.
Z Orthop Ihre Grenzgeb ; 137(2): 181-8, 1999.
Artigo em Alemão | MEDLINE | ID: mdl-10408064

RESUMO

PURPOSE: Aim of this retrospective study was to analyse the long term results (10-16 years) after Keller-Brandes' operation for correction of hallux valgus in the younger patient. METHODS: From 1980 to 1986 fifty-one patients (77 feet) at the age of 40 years or younger at the time of surgery (19-40 years, [symbol: see text] 34 years), were operated according to a resection-arthroplasty at our institution. 24 patients (37 feet) were evaluated retrospectively after 10 to 16 years (median: 13 years) in respect to their clinical outcome. Radiological evaluation was performed preoperatively in 23 feet and in 34 feet at follow up. Analysis was performed using a standardized questionnaire based on the HMIS-Score of the American Foot and Ankle Society, an additional clinical score, weight-bearing radiographs, the patient's record and clinical investigation inclusive pedobarographic analysis. RESULTS: Seventy-six % of the patients revealed very good or good subjective overall results. The HMIS-Score revealed excellent or good results in only 57%. Cosmetic was rated very good or good in 64%, 70% of the patients were painfree. Average ROM of the MTP I-joint ranged from 25 degrees flexion to 45 degrees extension. Radiological analysis at follow up: hallux valgus angle-correction: 28 degrees to 19 degrees, no change of the intermetatarsal angle (11 degrees), proximal shift of sesamoids: 9.4 mm to 14.4 mm, neoarticulation gap: 0-2 mm in 23 feet and 3-5 mm in 11 feet, arthritis of IP-joint: 82%: none; 18%: moderate; correction of sesamoid position: 1.7 to 1.4. Metatarsalgia was observed in 27% (10 feet). CONCLUSION: Lateral weight transfer to the lesser metatarsal heads is caused by defunction of the great toe postoperatively which may lead to metatarsalgia (transfer-metatarsalgia). Besides pain relief younger patients require satisfying functional and cosmetic long-term results. To be capable of meeting these requirements, adequate joint preserving procedures like basal or distal metatarsal osteotomies conjuncted with soft tissue procedures should be preferred in respect to the grade of the deformity.


Assuntos
Hallux Valgus/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , Feminino , Seguimentos , Hallux Valgus/fisiopatologia , Humanos , Masculino , Complicações Pós-Operatórias/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos , Suporte de Carga/fisiologia
8.
Z Orthop Ihre Grenzgeb ; 139(5): 435-9, 2001.
Artigo em Alemão | MEDLINE | ID: mdl-11605296

RESUMO

AIM: A Chevron osteotomy with lateral soft-tissue release was performed at our department in 1993. In 1994 a prospective study to evaluate the temporary Kirschner wire fixation was started. Aim of this prospective study was to analyse the short-term clinical and radiological results with special attention to stability, necroses, and luxation of the first metatarsal head. METHOD: Between February 1994 and October 1995 45 patients (55 feet) were treated with a Chevron osteotomy combined with a lateral soft-tissue release and temporary Kirschner wire fixation. The average follow-up was 33.9 months. All patients were seen and evaluated preoperatively and at a minimum follow-up of 24 months using a standardized questionnaire based on the Hallux metatarsophalangeal interphalangeal Scale (HMIS) of the American Foot and Ankle Society. RESULTS: Results of the survey of patient satisfaction revealed excellent and good results in 83%, fair in 8%, and poor in 9%. The median HMIS at final follow-up was 86.9 pints of 100 points. The average hallux valgus angle correction was 19.8 (from 28.7 to 8.9) and the average first intermetatarsal angel correction was, 8.2 (from 14.4 to 6.2). No avascular necrosis of the first metatarsal head and no loss of correction were noted. In one case a luxation of the metatarsal head was observed. CONCLUSION: Combining the Chevron osteotomy with an excessive lateral soft-tissue release increases the likelihood of instability of the metatarsal head and consecutive loss of correction. The temporary Kirschner wire fixation increases the stability of the Chevron osteotomy and prevents the loss of correction. The disadvantage of this method is, that the wire has to be removed after 6 weeks.


Assuntos
Fios Ortopédicos , Hallux Valgus/cirurgia , Osteotomia/métodos , Adulto , Feminino , Seguimentos , Hallux Valgus/diagnóstico por imagem , Humanos , Masculino , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Pessoa de Meia-Idade , Radiografia , Resultado do Tratamento
9.
Clin Orthop Relat Res ; (376): 183-94, 2000 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10906874

RESUMO

The long-term retrospective results (followup range, 10-22 years) of an uncontrolled series of basal metatarsal closing wedge osteotomies and Keller's excision arthroplasties performed in patients 14 to 40 years of age are analyzed. In the osteotomy group, 34 patients (50 feet) were available for clinical review and 26 patients (37 feet) were available for radiologic review. In the Keller group, 24 patients (37 feet) were reviewed clinically and 23 patients (34 feet) were reviewed radiologically. Patients were assessed using the Hallux Metatarsophalangeal Interphalangeal Scale of the American Foot and Ankle Society, an additional clinical score, weightbearing radiographs, the patient's record, and clinical investigation. Statistical analysis revealed significantly better results of the clinical and radiologic outcomes after osteotomy. In the osteotomy group, the first metatarsal was elevated dorsally in 14 feet (38%). The incidence of varus deformities was higher with basal osteotomy (18% versus 5.4%). Metatarsalgia occurred similarly in both groups (28% versus 27%). It is known that these techniques should be applied to different patient populations. However, they formerly were used for the same indication. This long-term analysis shows that the Keller arthroplasty should be abandoned for the treatment of hallux valgus in young and active patients. The basal metatarsal closing wedge osteotomy is conceptually the correct treatment for hallux valgus deformity for the younger patient; nevertheless, it is technically demanding and is associated with a higher risk of failure. The long-term results of both procedures are unacceptable for the patient and the surgeon. The short and middle-term results of the newer basal type osteotomies, such as the proximal crescentic osteotomy, the proximal chevron osteotomy, or the proximal oblique osteotomy combined with distal soft tissue releases, suggest a more satisfying long-term outcome.


Assuntos
Hallux Valgus/cirurgia , Prótese Articular , Ossos do Metatarso/cirurgia , Osteotomia , Adulto , Feminino , Humanos , Masculino , Resultado do Tratamento
10.
Z Orthop Ihre Grenzgeb ; 137(5): 452-6, 1999.
Artigo em Alemão | MEDLINE | ID: mdl-10549125

RESUMO

INTRODUCTION: The aim of this retrospective study was to analyse the short term results after the Weil-procedure for the treatment for metatarsalgia in 30 consecutive patients. METHODS: 30 patients (69 osteotomies) after the Weil-procedure with an average age of 60 years (range 25 to 78 years) were analysed by clinical and radiological evaluation. The average follow up was 15 months (range 12 to 26 months). Analysis was performed using the patients' records, weight-bearing radiographs and a standardized questionnaire. RESULTS: Subjective evaluation revealed 23 very satisfied and satisfied patients. Based on the Lesser-Metatarsal-Interphalangeal-Scale the objective results showed 77.1 points on average. The results were excellent in 17 cases, good in 4, fair in 3 and unsatisfactory in 6 cases respectively. Recurrent metatarsalgia was noted in 5 cases, whereas no transfermetatarsalgia was observed. The average shortening was 4.4 mm. Subluxation of the metatarsophalangeal joint was corrected in 18 out of 22 cases. A restricted plantar flexion of the metatarsophalangeal joint was noted in 14 cases. 2 patients showed loss of movement. CONCLUSION: Our short-term results reveal that the Weil-osteotomy is a sufficient treatment for metatarsalgia. This technique is able to reestablish the alignment of the metatarsals and to correct luxation and subluxation of the metatarsophalangeal joint. Restricted plantarflexion of the metatarsophalangeal joint is a drawback, which may be avoided by intensive physiotherapy.


Assuntos
Articulação Metatarsofalângica/cirurgia , Osteotomia/métodos , Adulto , Idoso , Parafusos Ósseos , Feminino , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Masculino , Articulação Metatarsofalângica/diagnóstico por imagem , Articulação Metatarsofalângica/lesões , Pessoa de Meia-Idade , Medição da Dor , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/etiologia , Radiografia , Recidiva , Resultado do Tratamento
11.
Z Orthop Ihre Grenzgeb ; 135(2): 150-6, 1997.
Artigo em Alemão | MEDLINE | ID: mdl-9214174

RESUMO

INTRODUCTION: Aim of this study was to analyze if, using the Austin technique for correction of hallux valgus deformity, the additional soft tissue procedure is capable to achieve better correction of the sesamoid subluxation, the hallux valgus angle and the intermetatarsal angle. PATIENTS AND METHODS: 19 patients with 20 feet operated according to the original Austin technique and 26 patients with 28 feet operated according to a modified technique with lateral soft tissue release both with a preoperative sesamoid subluxation grade 3 were compared with the help of a standardized questionnaire in respect to clinical and radiological results. RESULTS: Analyzing the clinical outcome of the two procedures, there was no statistical difference. Comparison of the radiological results revealed a significantly better correction of the sesamoid position and a better correction of hallux valgus and intermetatarsal angle by using the additional soft tissue procedure. DISCUSSION: The lateral soft tissue procedure with release of the adductor hallucis, dissection of the deep transverse plantar ligament and mobilisation of the sesamoids is capable of a significantly better correction of the sesamoid position. Only a combination of osseus and soft tissue correction is capable to correct the pathomechanism and to guarantee long lasting results.


Assuntos
Hallux Valgus/complicações , Luxações Articulares/cirurgia , Articulação Metatarsofalângica/cirurgia , Ossos Sesamoides , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Humanos , Cápsula Articular/cirurgia , Ligamentos Articulares/cirurgia , Masculino , Articulação Metatarsofalângica/patologia , Pessoa de Meia-Idade , Ortopedia/métodos , Satisfação do Paciente , Radiografia , Ossos Sesamoides/lesões , Ossos Sesamoides/cirurgia
12.
J Comput Assist Tomogr ; 24(2): 288-92, 2000.
Artigo em Inglês | MEDLINE | ID: mdl-10752895

RESUMO

Three patients with histologically proven elastofibroma dorsi underwent MRI, using T1-weighted, T2-weighted, STIR (short inversion time inversion recovery), and contrast-enhanced SE sequences. All lesions typically displayed low signal intensity masses interspersed with areas of high signal intensity on T1- and T2-weighted SE images. Contrary to prior reports, two patients showed marked enhancement of the mass after administration of Gd-DTPA. Although the characteristic signal intensity on conventional T1- and T2-weighted images may lead to the early diagnosis of this rare tumor, radiologists should be aware that marked contrast enhancement may be representative in elastofibroma dorsi.


Assuntos
Fibroma/diagnóstico , Aumento da Imagem/métodos , Escápula/patologia , Ombro/patologia , Feminino , Fibroma/cirurgia , Gadolínio DTPA , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Ombro/cirurgia
13.
Z Orthop Ihre Grenzgeb ; 136(3): 243-9, 1998.
Artigo em Alemão | MEDLINE | ID: mdl-9736986

RESUMO

INTRODUCTION: Aim of this retrospective study was to analyse the long term results after basal closing wedge osteotomy for correction of metatarsus primus varus and hallux valgus in the younger patient. PATIENT AND METHODS: 49 patients (70 feet) were operated according to a basal closing wedge osteotomy from 1974 to 1985 at our institution. Age was under 40 years in all patients at the time of surgery. 34 patients (50 feet) were evaluated in respect to their clinical and 26 patients (37 feet) to their radiological outcome. The average age was 26 years (14-39 years). The follow-up was 12 to 22 years (Median: 18 years). Analysis was performed using the patient's record, weight-bearing X-rays, a standardized questionnaire and clinical investigation. RESULTS: 82% of the patients had very good and good subjective results. Cosmetics was rated very good and good in 78%, 88% of the patients were painfree. Radiological analysis at follow-up: Hallux valgus-angle 19,3 degrees, intermetatarsal I/II-angle 6 degrees, shortening of first metatarsale 5 mm, at average; dorsal elevation of first metatarsale 38%, degenerative arthritis of the metatarsocuneiforme joint 19%, congruency of first metatarsophalangeal joint 54%,sesamoid subluxation: 46% grade 0, 30% grade I, 14% grade II and 10% grade III. In 14 feet (28%) metatarsalgia was found. DISCUSSION: The basal closing wedge osteotomy is rather a technically demanding procedure conjuncted with a higher risk of failure. Satisfactory long term results can be obtained by an ideal operating technique. As undesirable side effects shortening of the first ray and dorsal malangulation of the first metatarsale may occur consecutively leading to metatarsalgia. Lower risk procedures like the crescentic osteotomy according to Mann or chevron osteotomy should be preferred.


Assuntos
Hallux Valgus/cirurgia , Metatarso/cirurgia , Osteotomia/métodos , Adolescente , Adulto , Feminino , Hallux Valgus/diagnóstico por imagem , Humanos , Masculino , Metatarso/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia , Resultado do Tratamento , Suporte de Carga/fisiologia
14.
Clin Orthop Relat Res ; (364): 213-9, 1999 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-10416411

RESUMO

Two cases of elastofibroma dorsi (one bilateral, one unilateral) in the periscapular and infrascapular region of two male patients are described. Magnetic resonance imaging revealed a tumorous mass of typical low signal intensity with interspersed areas of high signal intensity on T1 and T2 weighted spin echo sequences. In contrast to previous studies that reported mild enhancement within elastofibromas after administration of intravenous contrast agent, marked enhancement in one of two elastofibromas was found. This is considered to be atypical for benign lesions. After biopsy and histopathologic examination, an intended marginal resection was performed in both cases. Laboratory values, radiographs, and computed tomography may not be helpful in differentiating elastofibroma from malignant tumors. In addition to careful clinical investigation, magnetic resonance imaging is the method of choice leading to a presumptive diagnosis. Because marked enhancement on contrast agent images was observed, which is characteristic for malignant tumors, one should be aware that this feature does not exclude the presence of elastofibroma. Accurate diagnosis should be made preferably by biopsy and histopathologic evaluation before additional treatment is administered. Marginal resection is curative in patients with symptoms. Despite its low incidence, this pseudotumoral lesion should be known generally to differentiate it from malignant tumors and to avoid unnecessary wide or radical surgery.


Assuntos
Dorso , Fibroma/diagnóstico , Imageamento por Ressonância Magnética , Escápula , Neoplasias de Tecidos Moles/diagnóstico , Biópsia , Diagnóstico Diferencial , Fibroma/etiologia , Fibroma/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias de Tecidos Moles/etiologia , Neoplasias de Tecidos Moles/cirurgia , Tomografia Computadorizada por Raios X
15.
Arch Orthop Trauma Surg ; 119(7-8): 456-60, 1999.
Artigo em Inglês | MEDLINE | ID: mdl-10613239

RESUMO

We included in a prospective study of a standardized indomethacin protocol 134 consecutive patients undergoing primary cementless endoprosthetic hip replacement between January and June 1990. Periarticular heterotopic ossification (HO) was graded according to the Arcq classification (grades 0 to III). At final follow-up, all patients were analyzed clinically and radiographically for HO and aseptic loosening. A similar group of 44 patients (mean age of 64 years, range 38-82 years) undergoing total hip replacement (THR) with the same prosthesis and technique in 1987 did not receive HO prophylaxis and served as a control group. The average age of the 134 prophylaxis patients was 66.5 years (range 32-85 years), and the average follow-up was 65 months (range 60-71 months). Thirty patients (25%) were lost to final follow-up (19 died, 10 unknown, 1 amputation). In the study group, 77% had HO grade 0, while none had HO grade III, compared with 18% HO grade 0 and 16% HO grade III in the control group. These differences were statistically significant (P = < 0.001). At a minimum of 60 months follow-up, clinical and radiographic evaluation revealed no aseptic loosening in the study group: 4 cases of prosthesis subsidence during the first year did not progress. In the control group, there was a higher incidence of radiolucency around the femoral component, and one patient met all criteria for radiographic evidence of aseptic loosening. Statistical analysis revealed no significant difference between the two groups (P = 0.104). Based on our clinical and radiological results, indomethacin does not inhibit stable bony integration of the femoral component.


Assuntos
Anti-Inflamatórios não Esteroides/uso terapêutico , Artroplastia de Quadril , Indometacina/uso terapêutico , Ossificação Heterotópica/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese
16.
J Magn Reson Imaging ; 10(4): 497-502, 1999 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-10508315

RESUMO

Various proton relaxation times (T2, T1rho, and gadolinium-diethylene triamine pentaacetic acid [Gd-DTPA]-enhanced T1) were measured in articular cartilage in vitro at 3 T to assess their role in visualizing proteoglycan depletion. Cartilage-bone specimens were obtained from patients who underwent total joint replacement and got a double dose of Gd-DTPA 2 hours prior surgery. In these specimens, regions of mechanically undamaged cartilage having a decreased content of proteoglycans showed about 15% lower T1 values compared with apparently normal cartilaginous tissue. The expected increase of the T2 relaxation time was not observed in these regions. On the other hand, the T2 and, to a lower degree, T1 relaxation times were found to be increased in regions of cartilage fibrillation. The T1rho relaxation times obtained were slightly longer than the corresponding T2 values, but both parameters showed almost identical spatial distributions. J. Magn. Reson. Imaging 1999;10:497-502.


Assuntos
Cartilagem Articular/metabolismo , Imageamento por Ressonância Magnética , Proteoglicanas/análise , Meios de Contraste , Gadolínio DTPA , Articulação do Quadril , Humanos , Técnicas In Vitro , Articulação do Joelho , Osteoartrite/metabolismo
17.
Z Orthop Ihre Grenzgeb ; 137(6): 521-7, 1999.
Artigo em Alemão | MEDLINE | ID: mdl-10666861

RESUMO

INTRODUCTION: Aim of this study is to present the treatment concept and the results of hallux valgus surgery of our department. PATIENTS AND METHODS: The criteria for decision making are 1st intermetatarsal angle, congruency of the first metatarsophalangeal joint and sesamoid position. According to our concept we performed between 1993 and 1996 42 Chevron osteotomies for mild, 138 Chevron with lateral soft tissue release (Chevron + LSR) for moderate and 93 basal crescentic (Mann) osteotomies with lateral soft tissue release for severe hallux valgus deformities. RESULTS: 31 Chevron, 118 Chevron with lateral soft tissue release and 80 basal crescentic osteotomies (Mann) were seen at an average follow up of 19 months (12-29) after a Chevron, respectively. 16 months (12-43) after Chevron with lateral soft tissue release and 18 months (12-32) after a basal crescentic osteotomy. 83% of all patients classified the results of the surgery as "very satisfactory" and "satisfactory". The average hallux valgus angle was corrected from preoperatively. 25.3 degrees (Chevron), 29.9 degrees (Chevron + LSR) and 41.8 degrees (Mann) to 16.5 degrees (Chevron), 12.1 degrees (Chevron + LSR) and 14.1 degrees (Mann) at final follow up, the average first intermetatarsal angle was corrected from preoperatively 12.1 degrees (Chevron), 14.0 degrees (Chevron + LSR) and 17.4 degrees (Mann) to 7.9 degrees (Chevron), 5.8 degrees (Chevron + LSR) and 7.8 degrees (Mann) at final follow up. CONCLUSION: Our analysis of the three osteotomies revealed that with this differentiated concept we were able to achieve excellent and good results in more than 80% of our patients. Only with a treatment plan that includes different procedures to address the various stages of hallux valgus can one achieve the optimum result for the patient.


Assuntos
Hallux Valgus/cirurgia , Complicações Pós-Operatórias/etiologia , Adulto , Idoso , Feminino , Seguimentos , Hallux Valgus/diagnóstico por imagem , Humanos , Ligamentos Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Radiografia , Tendões/cirurgia , Resultado do Tratamento
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