RESUMO
ABSTRACT: Whether femoral varus derotational osteotomy (VDRO) alone or a combination of femoral and pelvic osteotomies should be performed for hip dislocation in nonambulatory children with cerebral palsy (CP) remains controversial. Few studies have reported radiographical results after the surgical treatment in nonambulatory children with CP. This study aimed to assess the results and determine predictors indicating progressive hip subluxation and redislocation after VDRO without pelvic osteotomy. We retrospectively analyzed 22 hips in 15 nonambulatory children with CP. All patients underwent VDRO without pelvic osteotomy and were followed up for at least 5âyears. The mean follow-up period was 7.3â±â1.9âyears. In radiological assessments, we investigated migration percentage (MP), center-edge angle, neck-shaft angle, teardrop distance, break in Shenton's line (SL), sharp's angle, acetabular ridge angle (ARA), and the change ratio of MP (Change MP). We classified patients with an MP of <40% at final follow-up in the Good group and those with an MP of ≥40% in the Poor group. The Good group included 10 children (14 hips), and the Poor group included 8 children (8 hips). No preoperative differences were found in the means of all the radiographical parameters. However, MP was significantly different between the groups from 1âyear postoperatively. ARA showed improvement 5âyears after surgery in the Good group. Change MP in the Good group was maintained from immediately after surgery to the final follow-up. Multivariate logistic regression analyses revealed that preoperative break in SL and Change MP immediately after surgery were parameters to predict MP at the final follow-up. In the receiver operating characteristic analysis, the cut-off values were estimated to be 19.2âmm for preoperative SL and 79.0% for Change MP immediately after surgery. Within 7.3âyears of follow-up, 63.6% of the patients who underwent VDRO without pelvic osteotomy had good results. Preoperative SL and postoperative Change MP can be considered as predictors of postoperative subluxation and/or dislocation.
Assuntos
Paralisia Cerebral/complicações , Luxação do Quadril/cirurgia , Luxações Articulares , Osteotomia/métodos , Criança , Feminino , Seguimentos , Luxação do Quadril/diagnóstico por imagem , Humanos , Masculino , Estudos Retrospectivos , Resultado do TratamentoRESUMO
CASE: A nonimmunocompromised 77-year-old man was bitten in the hand by his dog; redness, swelling, and exudate developed. Despite debridement and medications administered at another hospital, his symptoms did not improve. He was referred to us after 3 months. Debridement and negative-pressure wound therapy was performed. Cultures were positive for multiple bacterial organisms, including Mycobacterium chelonae. Polymicrobial extensor tenosynovitis including M. chelonae was diagnosed. Clarithromycin was given for 7 months based on drug sensitivity. His symptoms did not recur. CONCLUSION: Mycobacterium chelonae infections after dog bites are rare; however, mycobacterial culture tests are important, especially if tissue shows granulomatous inflammation.