RESUMEN
PURPOSE: To review the subjective and functional results of basal thumb metacarpal osteotomy for the treatment of trapeziometacarpal osteoarthritis. METHODS: Between July 1993 and November 1998, 35 thumb osteotomies without internal fixation were performed on 33 patients in the Christchurch Hospital, New Zealand. Records of 28 thumbs (13 right and 15 left) of 26 patients (17 women and 9 men) were available for review. Patients were reviewed using strength testing and the Michigan Hand Outcomes Questionnaire. RESULTS: The mean age of the 26 patients was 54 years (range, 30-69 years). Of the 28 thumbs, 22 (21 patients) had good or excellent results, 2 fair, one poor. The remaining 3 thumbs (3 patients) required further revision and were classified as failures. The mean follow-up period of the 25 thumbs (24 patients) not requiring revision was 34 months (range, 12-73 months). Good thumb motion was present in all hands with no trapeziometacarpal instability seen. Compared with the normative data, the strengths of key pinch, pulp pinch, and tripod pinch of our patients were significantly lower (22-32% lower), but not the grip strength. Michigan Hand Outcomes Questionnaire scores increased 28 (range, 1-56) points after surgery, with significant improvement especially in pain (+44 points), activities of daily living (one-handed tasks, +41 points), and satisfaction (+35 points). CONCLUSION: Basal thumb metacarpal osteotomy is a straightforward, conservative procedure that should be considered for grades II and III trapeziometacarpal osteoarthritis.
Asunto(s)
Huesos del Metacarpo/cirugía , Articulación Metacarpofalángica , Osteoartritis/cirugía , Osteotomía , Pulgar , Actividades Cotidianas , Adulto , Anciano , Femenino , Fuerza de la Mano , Humanos , Masculino , Huesos del Metacarpo/diagnóstico por imagen , Articulación Metacarpofalángica/diagnóstico por imagen , Articulación Metacarpofalángica/cirugía , Persona de Mediana Edad , Osteoartritis/diagnóstico por imagen , Dimensión del Dolor , Satisfacción del Paciente , Complicaciones Posoperatorias , Radiografía , Reoperación , Encuestas y Cuestionarios , Pulgar/diagnóstico por imagenRESUMEN
We report a long-term follow-up of a female patient with a multifocal extremity desmoid tumour. She had 3 local recurrences after excision and developed a second unresectable pelvic tumour that has remained unchanged in size for 14 years since starting tamoxifen treatment.
Asunto(s)
Fibromatosis Agresiva/cirugía , Recurrencia Local de Neoplasia/tratamiento farmacológico , Neoplasias de los Tejidos Blandos/cirugía , Tamoxifeno/administración & dosificación , Adulto , Biopsia con Aguja , Relación Dosis-Respuesta a Droga , Esquema de Medicación , Femenino , Fibromatosis Agresiva/patología , Estudios de Seguimiento , Humanos , Inmunohistoquímica , Articulación de la Rodilla , Imagen por Resonancia Magnética/métodos , Recurrencia Local de Neoplasia/patología , Estadificación de Neoplasias , Procedimientos Ortopédicos/métodos , Medición de Riesgo , Neoplasias de los Tejidos Blandos/patología , Factores de Tiempo , Tomografía Computarizada por Rayos X/métodos , Resultado del TratamientoRESUMEN
Bilateral, uncemented hip replacements were performed on a 45-year-old woman with autosomal dominant osteopetrosis. The hips showed degenerative changes and protrusio acetabuli. Difficulties were encountered especially during preparation of the femoral canal. At ten-year follow-up she has an excellent clinical and radiological result with no sign of osteolysis. Uncemented hip replacement, while technically demanding, can be successful in the intermediate term for patients with this condition.
Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Osteopetrosis/cirugía , Femenino , Estudios de Seguimiento , Humanos , Persona de Mediana Edad , Osteopetrosis/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodosRESUMEN
Whether an occupation can cause carpal tunnel syndrome requiring carpal tunnel decompression (CTD) is contentious. We compared the demographics and incidence rates in lamb-freezing workers with the general population who had CTD. In the general population there were 1002 (63%) females and 583 (37%) males, mean age 48 years, and the rate of CTD was 1.36/1000 per annum. In lamb-freezing workers there were 225 males (mean age 38.4 years) and 60 females (mean age 44.6 years); most workers required CTD in their first three seasons. Compared with the general population, the incidence rate ratios in all freezing workers was 16.8; boners, 51.6; meat packers, 22.8; and slaughtermen, 5.4. All groups had a greater rate of CTD than the general population. This study suggests that carpal tunnel syndrome can be directly caused by an occupation.
Asunto(s)
Mataderos , Síndrome del Túnel Carpiano/epidemiología , Congelación/efectos adversos , Enfermedades Profesionales/epidemiología , Exposición Profesional/efectos adversos , Adulto , Factores de Edad , Anciano , Síndrome del Túnel Carpiano/diagnóstico , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Nueva Zelanda , Enfermedades Profesionales/diagnóstico , Factores de Riesgo , Factores Sexuales , Adulto JovenRESUMEN
We reviewed the results at nine to 13 years of 125 total hip replacements in 113 patients using the monoblock uncemented Morscher press-fit acetabular component. The mean age at the time of operation was 56.9 years (36 to 74). The mean clinical follow-up was 11 years (9.7 to 13.5) and the mean radiological follow-up was 9.4 years (7.7 to 13.1). Three hips were revised, one immediately for instability, one for excessive wear and one for deep infection. No revisions were required for aseptic loosening. A total of eight hips (7.0%) had osteolytic lesions greater than 1 cm, in four around the acetabular component (3.5%). One required bone grafting behind a well-fixed implant. The mean wear rate was 0.11 mm/year (0.06 to 0.78) and was significantly higher in components with a steeper abduction angle. Kaplan-Meier survival curves at 13 years showed survival of 96.8% (95% confidence interval 90.2 to 99.0) for revision for any cause and of 95.7% (95% confidence interval 88.6 to 98.4) for any acetabular re-operation.
Asunto(s)
Acetábulo/cirugía , Artroplastia de Reemplazo de Cadera/métodos , Articulación de la Cadera/cirugía , Infecciones Relacionadas con Prótesis/cirugía , Acetábulo/diagnóstico por imagen , Adulto , Anciano , Análisis de Falla de Equipo , Femenino , Estudios de Seguimiento , Articulación de la Cadera/diagnóstico por imagen , Prótesis de Cadera , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Diseño de Prótesis , Infecciones Relacionadas con Prótesis/diagnóstico por imagen , Radiografía , Reoperación/estadística & datos numéricosRESUMEN
Between August 1996 and August 1997, 130 children were admitted to our pediatric orthopaedic unit with Staphylococcus aureus musculoskeletal infection. Twenty-six of the 130 staphylococcal isolates were resistant to methicillin, an incidence of 20%. All but one of the infections, a femoral fixator-pin infection, were community-acquired. Twenty-two of the infections were superficial; however, there were four cases of deep musculoskeletal sepsis due to methicillin-resistant S. aureus. In areas where methicillin-resistant S. aureus is prevalent in the community, methicillin resistance should be considered in any overwhelming staphylococcal infection not responding to conventional antibiotics despite adequate surgical debridement.
Asunto(s)
Resistencia a la Meticilina , Enfermedades Musculoesqueléticas/microbiología , Sepsis/microbiología , Infecciones Estafilocócicas/tratamiento farmacológico , Niño , Preescolar , Infecciones Comunitarias Adquiridas , Femenino , Humanos , Masculino , Enfermedades Musculoesqueléticas/tratamiento farmacológico , Osteomielitis/tratamiento farmacológico , Osteomielitis/microbiologíaRESUMEN
Acute compartment syndrome has multiple causes: fractures, crush injury, vascular trauma and burns. Exertional compartment syndrome may be acute (progressive) or chronic (usually reversible). The acute form usually occurs after intensive exercise. Closed muscle rupture is an uncommon cause with few reports. We report two cases, in the peroneal compartment of the leg and the flexor compartment of the forearm, to show that a high index of suspicion, allowing prompt diagnosis and fasciotomy, will enable a full recovery without complications.