RESUMEN
Mineral bone density (MBD) in osteomyelitic focus and symmetric intact tubular bone was compared in 54 patients. Changes of MBD values were also measured after surgical treatment (bone trepanation or osteonecroectomy with bone plasty). Thus, MBD, and, therefore, bone strength, was mostly higher in pathologic focus then in the healthy bone. Operative treatment showed no negative influence on MBD.
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Densidad Ósea , Desbridamiento/efectos adversos , Huesos de la Mano/fisiopatología , Huesos de la Pierna/fisiopatología , Osteomielitis/cirugía , Absorciometría de Fotón , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Huesos de la Mano/diagnóstico por imagen , Huesos de la Mano/cirugía , Humanos , Huesos de la Pierna/diagnóstico por imagen , Huesos de la Pierna/cirugía , Masculino , Persona de Mediana Edad , Osteomielitis/fisiopatología , Pronóstico , Estudios Retrospectivos , Adulto JovenRESUMEN
Stress fractures of the foot and ankle are common in the athletic population. Because this population is especially eager to return to activity, such fractures can be challenging to treat. If the biomechanical faults are not addressed or gradual return to activity is not monitored appropriately, fractures occasionally recur. A retrospective analysis was conducted of 96 athletes who presented to a podiatric sports medicine practice over the course of 10 years with stress fractures confirmed by radiograph or bone scan. The most common type of fracture sustained by this population was tibial stress fracture, followed by second metatarsal fracture. Marathon training was the most common pre-injury activity overall, although fitness walking was the most common activity among those with metatarsal fractures. This study relates the most common types of stress fractures of the foot, ankle, and leg to certain athletic activities and correlates duration of symptoms before presentation with return-to-activity time.
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Traumatismos en Atletas/fisiopatología , Trastornos de Traumas Acumulados/fisiopatología , Huesos del Pie/lesiones , Fracturas por Estrés/fisiopatología , Huesos de la Pierna/lesiones , Huesos Tarsianos/lesiones , Adolescente , Adulto , Anciano , Traumatismos en Atletas/terapia , Trastornos de Traumas Acumulados/terapia , Femenino , Huesos del Pie/fisiopatología , Fracturas por Estrés/terapia , Humanos , Huesos de la Pierna/fisiopatología , Masculino , Persona de Mediana Edad , Recuperación de la Función , Estudios Retrospectivos , Huesos Tarsianos/fisiopatologíaRESUMEN
Total knee arthroplasty (TKA) changes the knee joint in both intentional and unintentional, known and unknown, ways. Patellofemoral and tibiofemoral kinematics play an important role in postoperative pain, function, satisfaction and revision, yet are largely unknown. Preoperative kinematics, postoperative kinematics or changes in kinematics may help identify causes of poor clinical outcome. Patellofemoral kinematics are challenging to record since the patella is obscured by the metal femoral component in X-ray and moves under the skin. The purpose of this study was to determine the kinematic degrees of freedom having significant changes and to evaluate the variability in individual changes to allow future study of patients with poor clinical outcomes. We prospectively studied the 6 degrees of freedom patellofemoral and tibiofemoral weightbearing kinematics, tibiofemoral contact points and helical axes of rotation of nine subjects before and at least 1 year after total knee arthroplasty using clinically available computed tomography and radiographic imaging systems. Normal kinematics for healthy individuals were identified from the literature. Significant differences existed between pre-TKA and post-TKA kinematics, with the post-TKA kinematics being closer to normal. While on average the pre-total knee arthroplasty knees in this group displayed no pivoting (only translation), individually only five knees displayed this behaviour (of these, two showed lateral pivoting, one showed medial pivoting and one showed central pivoting). There was considerable variability postoperatively as well (five central, two lateral and two medial pivoting). Both preop and postop, flexion behaviour was more hinge-like medially and more rolling laterally. Helical axes were more consistent postop for this group. An inclusive understanding of the pre-TKA and post-TKA kinematics and changes in kinematics due to total knee arthroplasty could improve implant design, patient diagnosis and surgical technique.
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Artroplastia de Reemplazo de Rodilla/efectos adversos , Fenómenos Biomecánicos/fisiología , Articulación de la Rodilla/fisiopatología , Huesos de la Pierna/fisiopatología , Rango del Movimiento Articular/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Articulación de la Rodilla/cirugía , Huesos de la Pierna/cirugía , Masculino , Persona de Mediana EdadRESUMEN
Bone mineral density (BMD) and mechanical strength generally show strong positive correlations. However, osteopetrosis is a metabolic bone disease with increased skeletal density radiographically and increased risk of fracture. We have evaluated mechanical strength and mineral density in three osteopetrotic mutations in the rat (incisors-absent [ia/ia], osteopetrosis [op/op], and toothless [tl/tl]) to test the hypothesis that reduced bone resorption in one or more of these mutations results in weaker bones in the presence of greater mineral density and skeletal mass. Peripheral quantitative computed tomography (pQCT) was used to analyze BMD and cross-sectional geometry in the tibial diaphysis and metaphysis as well as the femoral diaphysis and femoral neck. The bending breaking force of tibial and femoral midshafts was obtained using the three-point bending test and femoral neck strength was tested by axial loading. Osteopetrotic mutants were significantly smaller than their normal littermates (NLMs) in each stock. The pQCT analysis showed that BMD and bone mineral content (BMC) were higher than or equal to NLMs in all skeletal sites measured in the osteopetrotic mutants. However, the mechanical breaking force was equal to or lower than their NLMs in all sites. The cross-sectional structure of long bone shafts was markedly different in osteopetrotic mutants, having a thin cortex and a medullary area filled with primary trabecular bone. These results indicate that osteopetrotic mutations in the rat increase bone density and decrease bone strength. The tibial diaphysis was significantly weaker in tl/tl and ia/ia mutants and the tibial metaphysis showed the greatest increase in BMD in all mutants. These data are another illustration that an increased BMD does not necessarily lead to stronger bones.
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Densidad Ósea/fisiología , Huesos de la Pierna/fisiopatología , Mutación/genética , Osteopetrosis/genética , Osteopetrosis/fisiopatología , Resistencia a la Tracción/fisiología , Animales , Peso Corporal , Resorción Ósea/complicaciones , Resorción Ósea/diagnóstico por imagen , Resorción Ósea/genética , Resorción Ósea/fisiopatología , Diáfisis/diagnóstico por imagen , Diáfisis/fisiopatología , Fémur/diagnóstico por imagen , Fémur/fisiopatología , Fracturas Óseas/complicaciones , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/genética , Fracturas Óseas/fisiopatología , Histocitoquímica , Huesos de la Pierna/diagnóstico por imagen , Osteopetrosis/complicaciones , Osteopetrosis/diagnóstico por imagen , Fenotipo , Ratas , Ratas Mutantes , Estrés Mecánico , Tibia/diagnóstico por imagen , Tibia/fisiopatología , Tomografía Computarizada por Rayos XRESUMEN
A 3D finite element (FE) model of an implanted pelvis was developed as part of a project investigating an all-polymer hip resurfacing design. The model was used to compare this novel design with a metal-on-metal design in current use and a metal-on-polymer design typical of early resurfacing implants. The model included forces representing the actions of 22 muscles as well as variable cancellous bone stiffness and variable cortical shell thickness. The hip joint reaction force was applied via contact modelled between the femoral and acetabular components of the resurfacing prosthesis. Five load cases representing time points through the gait cycle were analysed. The effect of varying fixation conditions was also investigated. The highest cancellous bone strain levels were found at mid-stance, not heel-strike. Remote from the acetabulum there was little effect of prosthesis material and fixation upon the von Mises stresses and maximum principal strains. Implant material appeared to have little effect upon cancellous bone strain failure with both bended and unbonded bone-implant interfaces. The unbonded implants increased stresses in the subchondral bone at the centre of the acetabulum and increased cancellous bone loading, resembling behaviour obtained previously for the intact acetabulum.
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Análisis de Falla de Equipo/métodos , Prótesis de Cadera , Cadera/fisiopatología , Huesos de la Pierna/fisiopatología , Polietilenos/química , Acetábulo/fisiopatología , Materiales Biocompatibles Revestidos/química , Simulación por Computador , Fémur/fisiopatología , Análisis de Elementos Finitos , Marcha/fisiología , Humanos , Músculo Esquelético/fisiología , Diseño de Prótesis/métodos , Reproducibilidad de los Resultados , Sensibilidad y Especificidad , Estrés Mecánico , Propiedades de Superficie , Soporte de PesoRESUMEN
The fracture toughness at crack initiation was determined for bovine cortical bone under tension (mode I), shear (mode II), and tear (mode III). A total of 130 compact tension specimens, compact shear specimens and triple pantleg specimens were used for the measurement of fracture toughness under tension, shear, and tear, respectively. Multiple-sample compliance method was utilized to measure the critical strain energy release rate (Gc) at the a/W = 0.55 (crack length, a, to specimen width, W, ratio). The critical stress intensity factor (Kc) was also calculated from the critical loading (PQ) of the specimens at the a/W = 0.55. The effect of the anisotropy of bone on its resistance to crack initiation under shear and tear loading was investigated as well. The fracture toughness of bone with precrack orientations parallel(designed as longitudinal fracture) to and that with precrack orientations normal (designed as transverse fracture) to the longitudinal axis of bone were compared. In longitudinal fracture, the critical strain energy release rates(Gc) of cortical bone under tension, shear, and tear were 644 +/- 102, 2430 +/- 836, and 1723 +/- 486 N/m, respectively. In transverse fracture, the critical strain energy release rates(Gc) of cortical bone under tesion, shear, and tear were 1374 +/- 183, 4710 +/- 1284, and 4016 +/- 948 N/m, respectively. An analysis of variance demonstrated that the crack initiation fracture toughness of bone under shear and tear loading is significantly greater than that under tensile loading in both longitudinal and transverse fracture. Our results also suggest that cortical bone has been "designed" to prevent crack initiation in transverse fracture under tension, shear, and tesar.
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Fracturas Óseas/fisiopatología , Huesos de la Pierna/fisiopatología , Animales , Bovinos , Huesos de la Pierna/lesiones , Estrés Mecánico , Resistencia a la TracciónRESUMEN
PURPOSE: Most of the patients who died of breast cancer have developed bone metastases. To understand the pathogenesis of bone metastases and to analyze treatment response of different bone remodeling therapies, preclinical animal models are examined. In breast cancer, bone metastases are often bone destructive. To assess treatment response of bone remodeling therapies, the volumes of these lesions have to be determined during the therapy process. The manual delineation of missing structures, especially if large parts are missing, is very time-consuming and not reproducible. Reproducibility is highly important to have comparable results during the therapy process. Therefore, a computerized approach is needed. Also for the preclinical research, a reproducible measurement of the lesions is essential. Here, the authors present an automated segmentation method for the measurement of missing bone mass in a preclinical rat model with bone metastases in the hind leg bones based on 3D CT scans. METHODS: The affected bone structure is compared to a healthy model. Since in this preclinical rat trial the metastasis only occurs on the right hind legs, which is assured by using vessel clips, the authors use the left body side as a healthy model. The left femur is segmented with a statistical shape model which is initialised using the automatically segmented medullary cavity. The left tibia and fibula are segmented using volume growing starting at the tibia medullary cavity and stopping at the femur boundary. Masked images of both segmentations are mirrored along the median plane and transferred manually to the position of the affected bone by rigid registration. Affected bone and healthy model are compared based on their gray values. If the gray value of a voxel indicates bone mass in the healthy model and no bone in the affected bone, this voxel is considered to be osteolytic. RESULTS: The lesion segmentations complete the missing bone structures in a reasonable way. The mean ratio vr∕vm of the reconstructed bone volume vr and the healthy model bone volume vm is 1.07, which indicates a good reconstruction of the modified bone. CONCLUSIONS: The qualitative and quantitative comparison of manual and semi-automated segmentation results have shown that comparing a modified bone structure with a healthy model can be used to identify and measure missing bone mass in a reproducible way.
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Procesamiento de Imagen Asistido por Computador/métodos , Huesos de la Pierna/diagnóstico por imagen , Huesos de la Pierna/fisiopatología , Osteólisis/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Animales , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/fisiopatología , Neoplasias Óseas/secundario , RatasRESUMEN
PURPOSE: Nonunions of the upper and lower extremity have been associated with pain and functional deficits. Recent studies have demonstrated that healing of these nonunions is associated with pain relief and both subjective and objective functional improvement. The purpose of this study was to determine which patient and surgical factors correlated with successful healing of a nonunion following surgical intervention. METHODS: Between September 2004 and February 2008, all patients with a "long bone nonunion" presenting to our academic trauma service were enrolled in a prospective data base. Baseline functional, demographic and pain status was obtained. Follow-up was obtained at 3, 6, and 12 months following surgical intervention, with longer follow-up as possible. One hundred and thirty-four patients with a variety of fracture nonunions were operated on by four different fellowship trained trauma surgeons with experience ranging from 2 to 15 years and variable nonunion surgery loads. Patients were stratified into one of three groups: 1. Patients who healed following one surgical intervention, 2. those who healed following multiple surgical intervention, and 3. those who failed to heal (remain ununited or underwent amputation). Healing was determined radiographically and clinically. Complications were recorded. Logistic regression analysis was performed to assess the cor-relation between specific baseline and surgical characteristics and healing. RESULTS: A minimum of 1 year follow-up was available for all 134 patients. One hundred and one patients (76%) with a mean age of 50 years healed at a mean of 6 months (range, 3 to 16) after one surgery. Twenty-two patients (16%) with a mean age of 47 years, who required more than one intervention, healed their nonunions at a mean of 11 months (range, 4 to 23). Eleven patients (8%) with a mean age of 50 years failed to heal at an average of 12 months follow-up. Complication rates were 11%, 68%, and 100% respectively for those who healed following one procedure, multiple procedures, and those who never healed. Higher surgeon volume (greater than 10 cases per year) was associated with 85% increased healing rates (OR = 0.15, 0.05-0.47 CI). The presence of a postoperative complication was associated with a 9 times lower likelihood of successful union as well (OR = 9.0, 2.6-31.7 CI). Patient age, sex, BMI, initial injury mechanism, tobacco use, and initial injury characteristics did not correlate with failure to heal. CONCLUSION: Our data is similar to other studies assessing outcomes following other complex reconstructive procedures. It appears that more experienced (higher volume) reconstructive surgeons and the development of fewer postoperative complications is associated with greater success following repair of a long bone nonunion. Infection at any point during treatment is associated with failure to achieve successful union.
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Huesos del Brazo/cirugía , Fijación Interna de Fracturas , Curación de Fractura , Fracturas no Consolidadas/cirugía , Huesos de la Pierna/cirugía , Adolescente , Adulto , Amputación Quirúrgica , Huesos del Brazo/diagnóstico por imagen , Huesos del Brazo/lesiones , Huesos del Brazo/fisiopatología , Niño , Preescolar , Femenino , Fijación Interna de Fracturas/efectos adversos , Fracturas no Consolidadas/diagnóstico por imagen , Fracturas no Consolidadas/fisiopatología , Humanos , Huesos de la Pierna/diagnóstico por imagen , Huesos de la Pierna/lesiones , Huesos de la Pierna/fisiopatología , Modelos Lineales , Modelos Logísticos , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Dolor Postoperatorio/etiología , Radiografía , Recuperación de la Función , Reoperación , Factores de Riesgo , Factores de Tiempo , Resultado del Tratamiento , Adulto JovenRESUMEN
AIM: Our aim was to detect the status of bone mineral density (BMD) in children with NF1, and thus to help the management of the skeletal complications of NF1. METHODS: Dual-energy X-ray absorptiometry (DEXA) was performed in lumbar spine, total body, proximal femur and forearm in 31 children (3.1-18 years) with NF1. Correlations among the BMD values of four regions were calculated statistically. Z-scores of lumbar- and total body-BMD were also evaluated in 24 patients at and older than 5 years. RESULTS: Eleven children had skeletal findings, including mild scoliosis in 5 patients. No case with total body-Z score <-2 was detected. Lumbar-Z score was lower than -2 in 3 out of 24 cases. Patients with any skeletal involvement of NF1 were likely to have a lumbar-BMD lower than -2 in comparison with patients with no skeletal finding (odds ratio 4; 95% CI 0.01-4.62). Proximal femur-BMD values (g/cm(2)), yet forearm-BMDs, were correlated with both lumbar- and total body-BMD, regardless of skeletal involvements of NF1. CONCLUSIONS: Our findings suggest that lumbar- or proximal femur-DEXA, rather than forearm- or total body-DEXA, could reveal significantly decreased BMD in children with NF1, especially in those with skeletal involvement of NF1.
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Densidad Ósea/fisiología , Neurofibromatosis 1/fisiopatología , Absorciometría de Fotón , Adolescente , Composición Corporal/fisiología , Enfermedades Óseas Metabólicas/fisiopatología , Niño , Preescolar , Ejercicio Físico/fisiología , Femenino , Humanos , Huesos de la Pierna/diagnóstico por imagen , Huesos de la Pierna/fisiopatología , Masculino , Neurofibromatosis 1/complicaciones , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/fisiopatologíaRESUMEN
OBJECTIVE: Little is known about the interactions of sports-related demands and human body, in particular on musculoskeletal features, during growth. Focusing on the relationship between soccer and lower limb alignment, we examined the hypothesis that varus knee deviation is more prevalent among high-performance pediatric and adolescent soccer players. DESIGN: Cross-sectional study with focused sampling. SETTING: First league sports clubs. PARTICIPANTS: 106 male child/adolescent soccer players aged 10 to 21 years and 68 age-matched tennis players. INTERVENTIONS: All athletes completed a demographic questionnaire and underwent physical examinations, which included height, weight, generalized laxity, knee, ankle, foot and spine axis, hip range of motion, tibial torsion, Q angle, foot navicular height, and progression angle. MAIN OUTCOME MEASUREMENT: Varus/valgus axis was determined by the intercondylar intermalleolar distance while standing. Soccer and tennis players were compared on knee axis and other outcome variables by analysis of covariance, adjusting for age and by t-tests within age groups. RESULTS: A significantly higher prevalence of knee varus was found among the soccer players compared to that among the tennis players. The difference in intracondylar distance was statistically significant after the age of 13 years (P < 0.001). In addition, compared to tennis players, soccer players had higher foot arches, decreased hip external rotation and increased external tibial torsion. CONCLUSIONS: Varus knee axis deviation was more common among children and adolescent soccer players than among tennis players. The prevalence was more pronounced among players aged 13 years or older. Further research is needed to explore the rationale of this phenomenon.
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Traumatismos en Atletas/fisiopatología , Enfermedades del Desarrollo Óseo/epidemiología , Huesos de la Pierna/crecimiento & desarrollo , Fútbol/fisiología , Tenis/fisiología , Adolescente , Adulto , Factores de Edad , Enfermedades del Desarrollo Óseo/etiología , Desviación Ósea/diagnóstico , Desviación Ósea/epidemiología , Niño , Femenino , Encuestas Epidemiológicas , Humanos , Israel/epidemiología , Articulación de la Rodilla/fisiopatología , Huesos de la Pierna/fisiopatología , Masculino , Osteocondritis/diagnóstico , Osteocondritis/epidemiología , Examen Físico , Prevalencia , Medición de Riesgo , Factores de Riesgo , Fútbol/lesiones , Encuestas y Cuestionarios , Tenis/lesionesRESUMEN
Neurofibromatosis type 1 (NF1) is a dominantly inherited disease. Skeletal ailments such as short stature, kyphoscoliosis, tibial bowing and pseudarthrosis are common osseous manifestations of NF1. Previously, a correlation with scoliosis and decreased bone mineral density (BMD) of the lumbar spine has been reported in 12 NF1 patients. A total of 35 NF1 patients and 26 healthy controls were included in the present study. Of the participants over 20 years of age (26 NF1 patients and all controls) 14 were male and 12 were female, seven of whom were premenopausal. The controls were matched for age, sex and body mass index (BMI). Physical activity and medical history of NF1 patients were evaluated to screen the fractures and osseous manifestations of the disease and to rule out the factors that effect BMD. BMD and bone mineral content (BMC) were measured with DXA, using a total body program. The present study detected a lowered bone mineral density (p =0.028) and content (p <0.001) in NF1 patients of both sexes. The results of the present study also show that NF1 patients have an increased risk for osteoporosis. Among NF1 patients seven cases of osteoporosis and 13 cases of osteopenia were detected. In controls, one case of osteoporosis and 13 cases of osteopenia were detected. The location of the lowest local BMD was clustered to the load-carrying parts of the body in NF1 patients. Physical activity and the medical history of the NF1 patients did not explain the decreased BMD and BMC. The findings of the present and previous studies suggest that the pathogenesis of the osseous manifestations in NF1 may involve impaired development of the skeletal system and impaired maintenance of bone structure.
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Densidad Ósea/fisiología , Neurofibromatosis 1/fisiopatología , Osteoporosis/fisiopatología , Absorciometría de Fotón , Adulto , Anciano , Huesos del Brazo/fisiopatología , Composición Corporal/fisiología , Enfermedades Óseas Metabólicas/fisiopatología , Estudios de Casos y Controles , Ejercicio Físico/fisiología , Femenino , Humanos , Huesos de la Pierna/fisiopatología , Masculino , Persona de Mediana Edad , Escoliosis/fisiopatologíaRESUMEN
We have shown previously that the hypomineralization defects of the calvarium and vertebrae of tissue nonspecific alkaline phosphatase (TNAP)-deficient (Akp2-/-) hypophosphatasia mice are rescued by simultaneous deletion of the Enpp1 gene, which encodes nucleotide pyrophosphatase phosphodiesterase 1 (NPP1). Conversely, the hyperossification in the vertebral apophyses typical of Enpp1-/- mice is corrected in [Akp2-/-; Enpp1-/-] double-knockout mice. Here we have examined the appendicular skeletons of Akp2-/-, Enpp1-/-, and [Akp2-/-; Enpp1-/-] mice to ascertain the degree of rescue afforded at these skeletal sites. Alizarin red and Alcian blue whole mount analysis of the skeletons from wild-type, Akp2-/-, and [Akp2-/-; Enpp1-/-] mice revealed that although calvarium and vertebrae of double-knockout mice were normalized with respect to mineral deposition, the femur and tibia were not. Using several different methodologies, we found reduced mineralization not only in Akp2-/- but also in Enpp1-/- and [Akp2-/-; Enpp1-/-] femurs and tibias. Analysis of calvarial- and bone marrow-derived osteoblasts for mineralized nodule formation in vitro showed increased mineral deposition by Enpp1-/- calvarial osteoblasts but decreased mineral deposition by Enpp1-/- long bone marrow-derived osteoblasts in comparison to wild-type cells. Thus, the osteomalacia of Akp2-/- mice and the hypomineralized phenotype of the long bones of Enpp1-/- mice are not rescued by simultaneous deletion of TNAP and NPP1 functions.
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Fosfatasa Alcalina/deficiencia , Calcificación Fisiológica/fisiología , Hipofosfatasia/fisiopatología , Huesos de la Pierna/fisiopatología , Osteomalacia/fisiopatología , Hidrolasas Diéster Fosfóricas/deficiencia , Pirofosfatasas/deficiencia , Animales , Western Blotting , Modelos Animales de Enfermedad , Fémur/fisiopatología , Fémur/ultraestructura , Hipofosfatasia/complicaciones , Inmunohistoquímica , Huesos de la Pierna/ultraestructura , Ratones , Ratones Noqueados , Osteoblastos/metabolismo , Osteomalacia/etiología , Cráneo/patología , Espectroscopía Infrarroja por Transformada de Fourier , Tibia/fisiopatología , Tibia/ultraestructura , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: One out of every 8 women will be diagnosed with breast cancer and 1 in 28 will succumb to the disease. Skeletal metastasis occurs in 16% to 73% of breast cancer patients. OBJECTIVE: To present a comprehensive look at the pathophysiology, clinical presentation, and treatment options for skeletal metastasis secondary to breast carcinoma by discussing the case of an 80-year-old female patient with bilateral distal lower extremity metastasis following a previous diagnosis of breast cancer. CLINICAL FEATURES: The patient had severe pain in both lower extremities, which caused her to have difficulty when ambulating. She also complained of fatigue and anorexia, with an 8-lb weight loss. Chest examination revealed widespread rales without change. Her left calcaneus was tender to palpation and both feet and ankles were hot and swollen. Laboratory CA 27.29 values were 1131 on October 16, 2001, which was elevated compared with the 454 value obtained previously. Plain films of the lower extremities revealed destructive lesions of the distal left and right tibia and fibula with involvement of the left calcaneus. These findings were most consistent with metastasis. INTERVENTION AND OUTCOME: The patient refused further care and sought a hospice referral. CONCLUSION: There is no cure for acrometastasis and prognosis is poor. Treatment focuses on symptomatic relief, extended survival, and maintaining quality of life. Clinicians should consider metastasis in a patient with distal lower extremity osteolytic lesions with a previous history of breast malignancy.
Asunto(s)
Neoplasias Óseas/secundario , Neoplasias de la Mama/patología , Calcáneo/fisiopatología , Huesos de la Pierna/fisiopatología , Pierna/fisiopatología , Dolor/etiología , Anciano , Anciano de 80 o más Años , Neoplasias Óseas/complicaciones , Femenino , Peroné/fisiopatología , Humanos , Factores de Riesgo , Tibia/fisiopatología , Factores de TiempoRESUMEN
To assess osteoarthritic changes in knee joints a radiography rig for acquisition of standardized radiographs of trabecular bone has been developed. The rig contains a steel frame on castors, a turntable, a cassette holder frame, calibration Plexiglas sheets, body supports and points. It is used to lock the patient in a standardized position. A film cassette holder frame was also developed to reduce scattering of X-rays, and consequently the amount of noise in the radiographs. Calibration Plexiglas sheets were mounted on ball bearing slides to obtain radiographs without a calibration pattern (suitable for the analysis of trabecular bone texture) and radiographs containing a calibration pattern (suitable for the measurement of leg alignment).
Asunto(s)
Articulación de la Rodilla/diagnóstico por imagen , Huesos de la Pierna/diagnóstico por imagen , Osteoartritis de la Rodilla/diagnóstico por imagen , Interpretación de Imagen Radiográfica Asistida por Computador/instrumentación , Progresión de la Enfermedad , Diseño de Equipo , Humanos , Articulación de la Rodilla/fisiopatología , Huesos de la Pierna/fisiopatología , Osteoartritis de la Rodilla/fisiopatologíaRESUMEN
Multimodal, limb-saving therapy is the treatment of choice in children with osteosarcoma. However, few data are available on long-term functional problems and disabilities in surviving patients. Seventy-eight children treated for Stage II-B osteosarcoma who were treated between 1970 and 1997 were evaluated. Beyond the clinical examination, functional results were assessed using the scoring system of the Musculoskeletal Tumor Society. Patients reported their physical disabilities when completing the Toronto Extremity Salvage Score. The most recent cohort of patients who had tumor resection combined with preoperative and postoperative chemotherapy had the best 10-year survival rate at 70%. Thirty-four children (44%) were treated by limb-sparing therapy with 25 children requiring an endoprosthesis. Ten of these 25 children (40%) required one or in some cases several replacements of the endoprostheses because of complications. The original prostheses were in place for a median of 4.9 years before the first exchange (range, 2.0-12.0 years). Evaluations with rating scales showed that the subjective estimation of disabilities by the Toronto Extremity Salvage Score was significantly higher than a rating of limb functions by a doctor using the Musculoskeletal Tumor Society score. Best results were observed in children with an endoprosthesis of the distal femur who achieved as much as 90% ability to do their daily life routine. Limb-saving therapy in children with osteosarcoma enables a return to activities of daily living in long-term survivors with a minimum of remaining disability.
Asunto(s)
Neoplasias Óseas/cirugía , Osteosarcoma/cirugía , Recuperación de la Función/fisiología , Actividades Cotidianas , Adolescente , Neoplasias Óseas/tratamiento farmacológico , Quimioterapia Adyuvante , Niño , Evaluación de la Discapacidad , Femenino , Estudios de Seguimiento , Humanos , Húmero/patología , Húmero/fisiopatología , Huesos de la Pierna/patología , Huesos de la Pierna/fisiopatología , Recuperación del Miembro , Masculino , Osteosarcoma/tratamiento farmacológico , Estudios Retrospectivos , Factores de TiempoRESUMEN
STUDY DESIGN: Cross-sectional study comparing a group of active spinal cord injured (SCI) males carefully matched for age, height, and weight with active able-bodied male controls. OBJECTIVES: To compare bone mass of the total body, upper and lower limbs, hip, and spine regions in active SCI and able-bodied individuals. SETTING: Outpatient study undertaken in two centres in New Zealand. METHODS: Dual energy X-ray absorptiometry (DEXA) scanning was used to determine bone mass. Questionnaires were used to ascertain total time spent in weekly physical activity for each individual. The criterion for entry into the study was regular participation in physical activity of more than 60 min per week, over and above that required for rehabilitation. RESULTS: Seventeen SCI and their able-bodied controls met our required activity criterion. Bone mineral density (BMD) values of the total body and hip regions were significantly lower in the SCI group than in their controls (P=0.0001). Leg BMD and bone mineral content (BMC) were also significantly lower in the SCI group (P=0.0001). By contrast, lumbar spine BMD and arm BMD and BMC did not differ between the SCI and control groups. Arm BMD and BMC were greater (not significant) than the reference norms (LUNAR database) for both groups. CONCLUSION: Intensive exercise regimens may contribute to preservation of arm bone mass in SCI males, but does not prevent demineralisation in the lower body.
Asunto(s)
Densidad Ósea/fisiología , Huesos de la Extremidad Superior/fisiopatología , Ejercicio Físico/fisiología , Huesos de la Pierna/fisiopatología , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/rehabilitación , Absorciometría de Fotón , Adolescente , Adulto , Huesos de la Extremidad Superior/diagnóstico por imagen , Terapia por Ejercicio , Humanos , Huesos de la Pierna/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Osteoporosis/etiología , Osteoporosis/prevención & control , Traumatismos de la Médula Espinal/complicaciones , Encuestas y CuestionariosRESUMEN
Fitting children and infants who have osteogenesis imperfecta (OI) with braces has posed substantial problems of implementation and patient management For the past twelve years bracing has been an important component of a patient research and management program conducted at the National Institutes of Health. By using the smallest manufactured parts and developing a wealth of experience, functional and well-fitting braces have been provided to a number of tiny and small children. Bracing allows these children to stand and walk earlier than would have otherwise been possible. Braces are used in conjunction with standing frames and parapodiums to increase a child's mobility. Less involved children have become good household and short distance ambulators with the use of braces.
Asunto(s)
Aparatos Ortopédicos/normas , Aparatos Ortopédicos/tendencias , Osteogénesis Imperfecta/rehabilitación , Niño , Preescolar , Terapia por Ejercicio/normas , Terapia por Ejercicio/tendencias , Trastornos Neurológicos de la Marcha/etiología , Trastornos Neurológicos de la Marcha/fisiopatología , Trastornos Neurológicos de la Marcha/rehabilitación , Humanos , Lactante , Recién Nacido , Huesos de la Pierna/patología , Huesos de la Pierna/fisiopatología , Osteogénesis Imperfecta/fisiopatología , Selección de Paciente , Postura/fisiología , Resultado del TratamientoRESUMEN
La estabilidad de la cintura pélvica depende en gran medida de dos factores determinantes. Por un lado la coherencia articular entre la sínfisis del pubis, la articulación de la cadera y las vértebras lumbo-sacras, y por otro la correcta mecánica entre la cintura pélvica y las extremidades inferiores (EE.II.).El pie como último eslabón de la cadena cinética colabora en el desplazamiento del (CGO.) trasmitiendo los momentos cinéticos y las cargas en las mejores condiciones mecánicas, cualquier alteración en la adaptabilidad de los pies sobre el suelo condiciona sin duda el reajuste de toda la estructura corporal. Siguiendo este principio se plantea la hipótesis de la relación existente entre las disfunciones mecánicas en EE.II. en general y en el tarso, mediopié y antepié en particular, y las alteraciones en las articulaciones de la cintura pélvica, como causas determinantes de gran parte de los síndromes dolorosos en la cintura pélvica (AU)