RESUMO
Arthrograms are commonly done in conjunction with an examination under anaesthesia (EUA), before any surgical intervention in Perthes disease. This usually is done as an independent day case procedure in the radiology department. The aim of this study is to confirm that the affected hip meets the prerequisites of a containment procedure. This study was carried out to investigate whether arthrogram findings ever altered the preoperative clinical decision of proposed osteotomy. One hundred and seven cases were reviewed retrospectively. Forty patients were excluded. Decision was not changed in 62 out of 67 hips, after the procedure. Five patients required different management following arthrogram and this was based mainly on EUA findings. EUA under image intensification helps the surgeon to decide the angle of varus osteotomy, required to contain the femoral head in the acetabulum and confirms an adequate range of abduction to undertake the procedure. This quick assessment can be done at the time of surgery under the same anaesthesia without the need for arthrography. Our findings question the role of arthrography as a routine before surgical intervention in Perthes disease and suggest that it may represent an unnecessary cost. We now reserve arthrography for cases of late Perthes disease where valgus osteotomy may be appropriate or for those unusual or questionable cases where clinical findings are inconclusive and therefore the type or appropriateness of treatment is uncertain.
Assuntos
Artrografia , Doença de Legg-Calve-Perthes/diagnóstico por imagem , Criança , Técnicas de Apoio para a Decisão , Humanos , Doença de Legg-Calve-Perthes/cirurgia , Osteotomia , Cuidados Pré-Operatórios , Estudos RetrospectivosRESUMO
The availability and usage of portable image intensifiers has revolutionised routine orthopaedic practice. Extensive use of fluoroscopy however may result into significant radiation exposure to operating staff. An accumulated dose of 65 microSv per procedure over long exposure has been reported to increase the risk of thyroid cancer. The present prospective study aimed at measuring the scattered dose to the thyroid using an Unfors EDD dosimeter during DHS/IMHS for fractures of the neck of the femur and IM nailing for long bone fractures. In 32 procedures, the dose of 65 microSv was exceeded 13 times; 8 times during DHS/IMHS and 5 times during IMN. The average thyroid dose was 142 microSv during IMN and 55 microSv during DHS. Only 9 of the total 223 (4%) theatre personnel were using a thyroid shield in spite of its availability. These results suggest that the thyroid is frequently exposed to potentially harmful radiation during these procedures. Strict inclusion of a thyroid shield as a part of routine radiation protection is recommended.
Assuntos
Exposição Ocupacional , Procedimentos Ortopédicos , Ortopedia , Glândula Tireoide/efeitos da radiação , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Doses de RadiaçãoRESUMO
BACKGROUND: The purpose of this study was to evaluate the clinical outcome of a two staged approach of subtalar arthrodesis followed by TAR for patients with ankle arthritis and AVN talus. METHODS: Out of total 210 TARs performed at our institute; 7 patients underwent a two staged procedure between 2006 and 2010. All patients had over 3 years of follow up (except one). The clinical results were assessed using AOFAS, WOMAC, SF-36 and patient satisfaction scores. RESULTS: The mean follow up was 3 years. There was significant improvement in AOFAS and WOMAC (pain and stiffness) from pre-op to 3 years post-op (P<0.05). SF 36 scores improved from pre-op to 3 years post-op for 6/8 domains. 5 patients were satisfied at 3 years for overall surgical outcomes, 4 were satisfied with pain relief. Radiological signs of talar subsidence were noted in 2 patients at year 1. This did not progress at 3 years and did not deteriorate clinical outcome. CONCLUSION: We recommend our two staged approach to deal with this difficult clinical problem. We believe this approach is safe for TAR surgery where talar vascularity and bone quality is questionable leading to reduced talar subsidence, ischaemic pain and improvement in longevity of TAR. LEVEL OF EVIDENCE: Evidence IV (Retrospective case series).
Assuntos
Tornozelo/cirurgia , Artroplastia de Substituição do Tornozelo , Osteonecrose/cirurgia , Cuidados Pré-Operatórios/métodos , Tálus/cirurgia , Idoso , Artrodese/métodos , Feminino , Seguimentos , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Osteonecrose/diagnóstico , Estudos Retrospectivos , Fatores de TempoRESUMO
The need for a screening programme for spinal stenosis in children with achondroplasia undergoing limb lengthening was identified in a tertiary limb reconstruction service. The aim of this study was to evaluate whether screening would identify the 'at risk' group. A total of 26 achondroplastic patients underwent our screening programme. Canal diameters were measured by MRI. Neurosurgical interventions were recorded. Of the patients, 13 had severe foramen magnum narrowing. Six patients required single or multiple surgical decompressions. We identified female sex, delayed milestones and a tight cervicomedullary junction as high risks. We stress upon the importance of developing a nationalized screening programme with guidelines to identify a high-risk group.
Assuntos
Alongamento Ósseo , Desigualdade de Membros Inferiores/cirurgia , Programas de Rastreamento/métodos , Estenose Espinal/diagnóstico , Adolescente , Criança , Feminino , Humanos , Incidência , Desigualdade de Membros Inferiores/diagnóstico , Desigualdade de Membros Inferiores/etiologia , Masculino , Osteocondrodisplasias/complicações , Osteocondrodisplasias/diagnóstico , Osteocondrodisplasias/cirurgia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/epidemiologia , Reino Unido/epidemiologiaRESUMO
The aim of this study was to assess the usefulness of currently available indices for casting in distal radius fractures in children and to identify risk factors associated with displacement. A cohort of 14 patients with redisplacement was compared with a cohort of 41 patients with maintenance of reduction. A significant difference (<0.008) was observed in the three-point index, the degree of comminution (<0.01) and the quality of the initial reduction (<0.003). We recommend careful identification of high-risk factors and appropriate stabilization for potentially unstable fractures at first treatment. Assessment of the three-point index is recommended for judging the moulding technique.
Assuntos
Fraturas Cominutivas/cirurgia , Fraturas do Rádio/cirurgia , Adolescente , Moldes Cirúrgicos , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Recidiva , Fatores de Risco , Resultado do TratamentoRESUMO
We retrospectively reviewed the results of joint distraction and reconstruction in complex knee contractures in 6 patients with 9 knees. The circular Ilizarov fixator was used in all cases. Extensor mechanism alignment with frame in situ was performed in 4 cases and alignment of mechanical axis of the lower limb was done in 2. All patients had a mean total arc of movement of 79 degrees before operation; however, this was nonfunctional because of the degree of flexion contracture. Three of the 6 patients were nonambulant before surgery. After joint distraction and reconstruction, mean total arc of movement remained unchanged, but this was more functional with improvement in the mobility status. At an average follow-up of 53 months, the mean flexion contracture was 100 degrees (range, 0-70 degrees), with further flexion possible up to 90 degrees (range, 60-120 degrees). Four patients had no recurrence. All 6 patients were ambulant with or without orthosis. Rebound phenomenon with loss of achieved correction was observed in 2 patients. Four patients were quite satisfied with results of surgery. Realignment of the extensor mechanism and mechanical axis is an important part that needs to be addressed in flexion contractures of the knee. Proper preoperative planning and staged procedures reduce the risk of recurrence. A treatment protocol is proposed to help in planning and further management.