Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 17 de 17
Filtrar
Mais filtros











Base de dados
Intervalo de ano de publicação
1.
Hand Surg Rehabil ; 43(2): 101643, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38228245

RESUMO

This study investigated whether dorsoradial ligament repair with internal brace augmentation provided more immediate stability in the trapeziometacarpal joint than dorsoradial ligament repair alone. Seven matched pairs of cadaveric hands were used. One specimen from each pair was assigned to the repair-only group and the other to the repair + internal brace augmentation group. Trapeziometacarpal joint range of motion and translation were quantified under different conditions for both groups: (1) intact, (2) transected dorsoradial ligament, and (3) repaired dorsoradial ligament or repaired dorsoradial ligament plus internal brace augmentation. Load-to-failure tests were performed after repair. Range of motion and translation were increased by dorsoradial ligament transection and were decreased by dorsoradial ligament repair; however, compared to the intact condition, the repair-only group demonstrated greater flexion/extension range, while the repair + internal brace group showed no significant difference in range of motion. Mean loads at 2- and 3-mm displacements were greater in the repair + internal brace group than in the repair-only group (18.0 ± 1.8 N vs. 10.8 ± 1.3 N for 2 mm displacement and 35.3 ± 3.7 N vs. 23.1 ± 2.9 N for 3 mm displacement, respectively). Internal brace augmentation improved the load-to-failure characteristics of dorsoradial ligament repair without compromising range of motion. LEVEL OF EVIDENCE: IV.


Assuntos
Braquetes , Cadáver , Articulações Carpometacarpais , Ligamentos Articulares , Amplitude de Movimento Articular , Humanos , Ligamentos Articulares/cirurgia , Amplitude de Movimento Articular/fisiologia , Fenômenos Biomecânicos , Articulações Carpometacarpais/cirurgia , Articulações Carpometacarpais/fisiopatologia , Feminino , Masculino , Pessoa de Meia-Idade , Idoso
2.
J Hand Surg Glob Online ; 5(3): 349-357, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37323971

RESUMO

Purpose: The purpose of this systematic review was to summarize the available data on how surgical management of injuries to the thumb ulnar collateral ligament (UCL) complex affects athletes and their return-to-play (RTP) and postinjury performance metrics in addition to evaluating rehabilitation guidelines. Methods: A systematic search was performed on PubMed and Embase databases for articles on outcomes of surgical treatment of thumb UCL injuries in athletes. Articles with expert recommendations on postoperative management and RTP guidelines were also included separately. Study characteristics were recorded, including sport, RTP rates, and data on performance. Recommendations were summarized by sport. The Methodological Index for Non-Randomized Studies (MINORS) criteria was used to assess methodological quality. The authors also present their recommended return-to-sport algorithm. Results: Twenty-three articles were included, including 11 with reports on patients and 12 expert opinions on guiding RTP. The mean MINORS score for the applicable studies was 9.4. In the 311 patients included, RTP was 98.1% in aggregate. No performance detriments were noted in athletes after surgery. Thirty-two (10.3%) patients had postoperative complications. The recommendations on timing to RTP vary by sport and author, but all recommended initial thumb protection when returning to sport. Newer techniques, such as suture tape augmentation, suggest the permission for earlier motion. Conclusions: Return-to-play rates after surgical treatment of thumb UCL injuries are high, with reassuring return to preinjury level of play with few complications. Recommendations for surgical technique have trended toward suture anchors and, now, suture tape augmentation with earlier motion protocols, although rehabilitation guidelines vary by sport and author. Current information on thumb UCL surgery in athletes is limited by the low quality of evidence and expert recommendations. Type of study/level of evidence: Prognostic IV.

3.
Iowa Orthop J ; 42(1): 201-206, 2022 06.
Artigo em Inglês | MEDLINE | ID: mdl-35821949

RESUMO

Background: Traditional rehabilitation protocols for surgically treated metacarpal shaft fracture allow for return to play at 6-8 weeks post-operative. This may be devastating for the elite athlete. We outline a protocol that may allow for professional basketball players to successfully return to sport within four weeks following surgery. Methods: Professional basketball players who sustained non-thumb metacarpal shaft fractures were included. All athletes underwent open reduction and internal fixation of the injured metacarpal. Patients were subsequently enrolled into an accelerated rehabilitation protocol. Results: The five athletes in our case series successfully passed return to sport testing within four weeks of surgery. Conclusion: A plate and screw construct can potentially allow for professional basketball players to return to play in half the time. Future research studies should include a larger pool of athletes to further investigate accelerated rehabilitation following surgical fixation of metacarpal fractures. Level of Evidence: IV.


Assuntos
Basquetebol , Fraturas Ósseas , Traumatismos da Mão , Ossos Metacarpais , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Humanos , Ossos Metacarpais/lesões , Ossos Metacarpais/cirurgia , Volta ao Esporte
4.
Tech Hand Up Extrem Surg ; 26(4): 263-266, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-35698299

RESUMO

Basal joint arthritis is commonly associated with attenuation of the volar structures at the thumb metacarpophalangeal (MCP) joint, leading to an initially dynamic, and eventually passive hyperextension deformity. In surgical treatment of basilar thumb disease, intervention at the MCP joint should also be considered to correct deformity and prevent persistent dysfunction. We present a novel technique using suture tape augmentation of the thumb MCP joint volar plate advancement and capsulodesis, with the goal of preventing recurrent instability as a result of tissue attenuation and enabling early functional recovery. We also report a representative case of a 66-year-old woman with symptomatic thumb carpometacarpal osteoarthritis and 50 degrees of MCP passive hyperextension. She underwent trapeziectomy and MCP joint volar plate advancement and capsulodesis with suture tape augmentation. Postoperatively, the patient underwent early mobilization of the affected thumb and at final follow-up of 2 years postsurgery had a painless thumb with full opposition and without hyperextension at the MCP joint during pinch maneuvers.


Assuntos
Osteoartrite , Placa Palmar , Feminino , Humanos , Idoso , Polegar/cirurgia , Articulação Metacarpofalângica/cirurgia , Placa Palmar/cirurgia , Osteoartrite/cirurgia , Suturas
5.
Orthop J Sports Med ; 10(5): 23259671221096095, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35601731

RESUMO

Background: Thumb injuries are common in baseball players and can sometimes be challenging to effectively manage. A subset of patients experience failed nonoperative management yet do not have a clear indication for surgery. Cryoneurolysis or cryoanalgesia is a form of neuromodulation for pain that has been approved by the US Food and Drug Administration; it has been used safely and effectively on a variety of peripheral nerves. The mechanism of action involves percutaneous introduction of a small probe under local anesthetic to nerve tissue using ultrasound guidance. The probe is then cooled to -88°C using nitrous oxide, which results in secondary Wallerian degeneration. Axonal and myelin regeneration occurs completely in 3 to 6 months. Purpose: To describe a nonsurgical approach to refractory digital neuralgia using cryoneurolysis in a series of professional baseball players. Study Design: Case series; Level of evidence, 4. Methods: Included were 3 professional baseball players, each presenting with thumb pain in his top batting hand refractory to nonoperative modalities. Visualization of the superficial radial sensory and ulnar digital nerves was obtained using ultrasound. The skin was prepared in sterile fashion. A 22-gauge, 1.5-inch (3.8-cm) needle was then advanced using ultrasound guidance, and local anesthetic was applied. Both treatment sites were marked using a skin marker. Cryoneurolysis was performed using a 5-mm tip, and 60-second treatment cycles were performed at each site. Each of the cycles resulted in a roughly 5 × 7-mm lesion visible as hypoechoic signal. Results: All 3 players endorsed significant and prolonged relief and were able to return to an elite level of play. Conclusion: Study findings indicated marked efficacy and safety of using cryoneurolysis of the ulnar digital nerve and the superficial radial sensory nerve in a small group of elite baseball players with refractory digital neuralgia.

6.
J Am Acad Orthop Surg ; 29(22): 943-950, 2021 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-34271570

RESUMO

The basal joint complex of the thumb provides the framework necessary for function of the human hand. Although its unique saddle articulation allows for a wide range of motion necessary for routine function of the hand, it is rendered inherently unstable because of poor bony congruency and reliance on its capsuloligamentous support. Painful instability of this joint can stem from several causes including traumatic dislocation, various hypermobility conditions, and chronic overuse and microtrauma. A thorough history and examination as well adequate imaging is necessary for proper evaluation of instability. Treatment options range from nonoperative modalities to surgery, which entails closed, percutaneous, or open reduction with numerous ligament repair and reconstruction techniques. Arthroscopy can also serve to be a useful adjunct for assessment of the joint and stabilization of the critical capsuloligamentous structures. This review outlines the critical osseous and soft-tissue anatomy surrounding the thumb carpometacarpal joint, the key points in evaluating patients presenting with acute traumatic and chronic thumb carpometacarpal instability without fracture or arthritis, and reviews both nonoperative and operative treatments of this injury.


Assuntos
Articulações Carpometacarpais , Luxações Articulares , Artroscopia , Articulações Carpometacarpais/diagnóstico por imagem , Articulações Carpometacarpais/cirurgia , Humanos , Amplitude de Movimento Articular , Polegar/cirurgia
7.
J Orthop Surg (Hong Kong) ; 29(2): 23094990211025830, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34189986

RESUMO

PURPOSE: This study compares the kinematic changes after the procedures for scapholunate interosseous ligament (SLIL) reconstruction-the modified Brunelli technique (MBT) and Mark Henry's technique (MHT). METHODS: Ten cadaveric wrists were used. The scapholunate (SL) interval and angle and radiolunate (RL) angle were recorded using the MicroScribe system. The SL interval was measured by dividing the volar and dorsal portions. Four motions of the wrist were performed-neutral, flexion, extension, and clenched fist (CF) positions-and compared among five conditions: (1) intact wrist, (2) volar SLIL resection, (3) whole SLIL resection, (4) MBT reconstruction, and (5) MHT reconstruction. RESULTS: Under the whole SLIL resection condition, the dorsal SL intervals were widened in all positions. In all positions, the dorsal SL intervals were restored after MBT and MHT. The volar SL interval widened in the extension position after volar SLIL resection. The volar SL interval was not restored in the extension position after MBT and MHT. The SL angle increased in the neutral and CF positions under the whole SLIL resection condition. The SL angle was not restored in the neutral and CF positions after MBT and MHT. The RL angle increased in the neutral and CF positions under the whole SLIL resection condition. The RL angle was not restored in the neutral and CF positions after MBT and MHT. CONCLUSION: The MBT and MHT may restore the dorsal SL interval. No significant differences in restoration of the SL interval between MBT and MHT were found in the cadaveric models. CLINICAL RELEVANCE: No significant differences between MBT and MHT were found in the cadaveric models for SLIL reconstruction. When considering the complications due to volar incision and additional procedures in MHT, MBT may be a more efficient technique in terms of operative time and injury of the anterior structures during surgery, but further research is needed.


Assuntos
Osso Semilunar , Osso Escafoide , Fenômenos Biomecânicos , Humanos , Ligamentos Articulares/cirurgia , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/cirurgia , Osso Escafoide/diagnóstico por imagem , Osso Escafoide/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia
8.
Tech Hand Up Extrem Surg ; 26(1): 37-41, 2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-35179135

RESUMO

Claw hand deformity is characterized by hyperextension of the metacarpophalangeal joints and flexion of the proximal interphalangeal joints. Surgical treatment of claw hand deformities often involves soft tissue procedures such as tendon transfers or volar plate capsulodesis. However, tissue attenuation over time can lead to recurrence of the deformity. Augmentation with an internal brace may help to address this problem. This report presents a novel technique for the treatment of claw hand deformity involving augmentation of the traditional volar plate capsulodesis with internal brace. Two illustrative cases utilizing the described technique are presented.


Assuntos
Deformidades Adquiridas da Mão , Deformidades Congênitas dos Membros , Placas Ósseas , Articulações dos Dedos/cirurgia , Deformidades Adquiridas da Mão/cirurgia , Humanos , Articulação Metacarpofalângica/cirurgia , Amplitude de Movimento Articular , Transferência Tendinosa
9.
J Hand Surg Am ; 45(10): 985.e1-985.e9, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32434732

RESUMO

PURPOSE: Internal bracing (IB) is an augmentation method using high-strength nonabsorbable tape. This study compared scapholunate interosseous ligament (SLIL) repair alone, SLIL repair with IB augmentation (RIBA), and native intact SLIL (NIS) in a biomechanical cadaveric model. METHODS: We used 21 specimens of fresh-frozen wrists in this study (7 matched pairs, SLIL repair-only and SLIL RIBA groups; and 7 independent fresh-frozen wrists, NIS group). In the SLIL RIBA group, augmentation using IB was performed after the repair. The specimens were preloaded and cyclically loaded in tension. Maximum extension and hysteresis were measured in all specimens. The specimens were subsequently tested for load to failure. Failure load (yield point load, mean ultimate load, and load at clinical failure) and linear stiffness were calculated. RESULTS: In cyclic tensile testing, RIBA showed lower maximum extension and lower hysteresis than repair alone. In load to failure testing, the yield point load was statistically higher in the RIBA (59.3 N) group than in the repair-only (30.4 N) group but showed no significant difference compared with the NIS (90.7 N) groups. Moreover, the RIBA (98.5 N) group showed higher and lower mean ultimate loads than the repair-only (37.7 N) and NIS (211.8 N) groups, respectively. Load at clinical failure was higher with RIBA than with repair alone (3-mm extension: 70.0 vs 26.4 N; 4-mm extension: 84.1 vs 33.4 N). Repair alone and RIBA had comparable linear stiffness (38.2 vs 44.1 N/mm). CONCLUSIONS: Although SLIL RIBA did not recreate biomechanical properties equivalent to those of NIS, it demonstrated a significantly higher strength than repair alone. CLINICAL RELEVANCE: Repair with IB augmentation could serve as a novel surgical technique that enhances SLIL direct repair through biomechanical support.


Assuntos
Osso Semilunar , Osso Escafoide , Fenômenos Biomecânicos , Cadáver , Humanos , Ligamentos Articulares/cirurgia , Osso Escafoide/cirurgia , Articulação do Punho
10.
J Hand Surg Am ; 45(2): 117-122, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31727379

RESUMO

PURPOSE: Acute thumb ulnar collateral ligament (UCL) tears are common injuries of the thumb in athletes. Thumb UCL repair with suture tape augmentation is a novel procedure that may allow earlier return to play. The purpose of this study was to evaluate the biomechanical characteristics of the thumb after UCL repair with and without suture tape augmentation. METHODS: Eight cadaveric thumbs were tested in a custom hand testing system. Varus-valgus kinematics were measured at -10°, 0°, 15°, and 30° of thumb metacarpophalangeal flexion under the following conditions: (1) intact thumb UCL, (2) complete UCL tear (proper and accessory ligaments), (3) UCL repair, and (4) UCL repair with suture tape augmentation. Angular stiffness was also quantified after application of sequentially increasing valgus torque in the intact UCL repair and the UCL repair with suture tape augmentation conditions. RESULTS: Complete UCL tear increased total varus-valgus angulation at all degrees of thumb metacarpophalangeal flexion. Thumb UCL repair alone and repair with suture tape augmentation decreased total varus-valgus angulation relative to complete UCL tear at all flexion angles. Total varus-valgus angulation was not significantly different from intact results for either the repair alone or the repair with suture tape augmentation at all flexion angles. Repair with suture tape augmentation had significantly higher valgus angular stiffness compared with repair alone but not compared with intact. CONCLUSIONS: Thumb UCL repair with suture tape augmentation is able to restore varus-valgus kinematics after complete UCL tear without over-constraining the joint. In addition, the higher angular stiffness afforded by the suture tape augmentation may allow for earlier rehabilitation after surgery. CLINICAL RELEVANCE: Thumb UCL repair with suture tape augmentation may allow earlier return to sport in athletes than with repair alone.


Assuntos
Ligamento Colateral Ulnar , Ligamentos Colaterais , Fenômenos Biomecânicos , Cadáver , Ligamento Colateral Ulnar/cirurgia , Ligamentos Colaterais/cirurgia , Humanos , Amplitude de Movimento Articular , Suturas , Polegar/cirurgia
11.
J Hand Surg Am ; 43(9): 868.e1-868.e6, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-29551339

RESUMO

PURPOSE: This study aimed to evaluate and compare the biomechanical strength of repair of the thumb ulnar collateral ligament (UCL) alone and repair augmented with suture tape. METHODS: Twelve fresh-frozen cadaveric specimens (6 matched pairs) had the UCL divided at its attachment on the base of the proximal phalanx and repaired with or without suture tape augmentation. A material testing machine was used to provide valgus stress at a rate of 0.1 mm/s until failure. The maximum load, load at clinical failure, and mode of failure were recorded. RESULTS: In the specimens with UCL repair augmented with suture tape, the maximum load (46.6 N [SD, 25.6 N]) and load at clinical failure (25.3 N [SD, 18.3 N]) were significantly higher than in the repair-only group (8.02 N [SD, 2.24 N]) and (6.00 N [SD, 2.39 N], respectively). CONCLUSIONS: In this model, thumb UCL repair with suture tape augmentation demonstrated greater maximum and clinical failure loads compared with nonaugmented repair at time 0, that is, without any biological healing. CLINICAL RELEVANCE: Suture tape augmentation of UCL repair may be valuable in the setting of acute tears by decreasing the time of postoperative cast immobilization and, therefore, allowing for earlier thumb metacarpophalangeal joint motion and overall faster clinical recovery.


Assuntos
Ligamento Colateral Ulnar/lesões , Ligamento Colateral Ulnar/cirurgia , Teste de Materiais , Estresse Mecânico , Fita Cirúrgica , Fenômenos Biomecânicos , Cadáver , Humanos , Pessoa de Meia-Idade , Âncoras de Sutura , Suturas , Polegar/cirurgia
12.
Tech Hand Up Extrem Surg ; 21(4): 164-166, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28902098

RESUMO

One of the most commonly injured structures of the thumb metacarpophalangeal (MCP) joint is the ulnar collateral ligament (UCL). An acute injury of this ligament is often amenable to primary repair. Despite the favorable outcomes of primary repair, the thumb is often restricted during initial healing of the ligament with immobilization and delayed rehabilitation. We present a novel technique to augment the repair of the UCL with suture tape to provide immediate biomechanical support and strength during the critical time of ligament healing. We describe the surgical technique of suture tape augmentation for thumb UCL repair. At the ulnar aspect of the thumb MCP joint, a longitudinal midaxial incision is made. Subsequently, the adductor pollicis aponeurosis and extensor mechanism are identified, incised, and retracted. The UCL is exposed and usually torn off the volar-ulnar base of the proximal phalanx. A 2.5-mm PushLock anchor loaded with 1.3-mm SutureTape and 3-0 FiberWire suture, is placed into a hole at the volar-ulnar base of the proximal phalanx after preparation with a 1.8-mm drill bit. The 3-0 FiberWire is used for direct repair of the ligament. Both tails of the 1.3-mm SutureTape is then brought proximally over the ligament and loaded into a 3.5-mm SwiveLock anchor. A 3.2-mm drill bit is then used to make a hole at the ulnar aspect of the metacarpal head, just proximal to the attachment of the proximal UCL. With the thumb MCP joint held in at least 30 degrees of flexion, the tape-loaded 3.5-mm SwiveLock anchor is inserted into metacarpal head. Reinforcement of the repair is then carried out with fine absorbable suture to surrounding capsular tissue. We present a representative case of a professional basketball player treated with this novel procedure. After the surgical repair, the patient was placed in a plaster splint for 3 days to immobilize the thumb and wrist. At 3 days postsurgery, the splint was removed and therapy initiated. Practice drills were initiated at 1 week postsurgery with the use of a removable hand-based thumb spica custom splint. During the entire postoperative period, the left thumb MCP joint had excellent stability to radial stress at full extension and 30 degrees of flexion. In addition, at 3 weeks postsurgery, the patient was able to oppose the thumb tip to the palmar-digital crease of the small finger and MCP joint motion was 0 to 50 degrees. The patient began strengthening exercises at this time, along with the ability to participate in all position-specific drills. At 5 weeks postsurgery, the patient was cleared to return to full play, without use of a splint. At 37 days postsurgery, the patient returned to competitive play. During competitive play, the player completed the entire remaining season of 25 games as well as extended competition into the playoffs of 7 games without further incident or time missed. At the latest follow-up, the patient is 6 months postprocedure and continues to remain asymptomatic with full participation in playing sports. During the critical time of ligament healing, the UCL repair can be enhanced with synthetic material to obviate the need for prolonged postoperative immobilization. We offer a novel surgical technique that enhances primary repair of the thumb UCL through appended biomechanical support. Under these circumstances, with structural support augmentation, the recovery and rehabilitation process can be expedited for patients to allow an earlier return to activities.


Assuntos
Ligamento Colateral Ulnar/lesões , Ligamento Colateral Ulnar/cirurgia , Fita Cirúrgica , Âncoras de Sutura , Polegar/cirurgia , Adulto , Basquetebol/lesões , Humanos , Masculino , Volta ao Esporte , Suturas , Polegar/lesões
13.
Hand Clin ; 28(4): 511-8, 2012 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-23101601

RESUMO

Suture anchors are an important tool in the orthopedist's armamentarium. Their use is prevalent in surgery of the entire upper limb. Suture anchors have mostly obviated the need for multiple drill holes when striving for secure fixation of soft tissue to bone. As with most other orthopedic products, the designs of these anchors and the materials used to fabricate them have evolved as their use increased and their applications became more widespread. It is ultimately the surgeon's responsibility to be familiar with these rapidly evolving technologies and to use the most appropriate anchor for any given surgery.


Assuntos
Âncoras de Sutura , Suturas , Extremidade Superior/cirurgia , Ligamentos Colaterais/cirurgia , Desenho de Equipamento , Mãos/cirurgia , Humanos
15.
Bull Hosp Jt Dis ; 62(3-4): 134-6, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-16022228

RESUMO

The simultaneous diagnosis of ipsilateral patellar tendon rupture and anterior cruciate ligament tear is rare. Surgical repair is complicated by different rehabilitation regimens as well as anterior cruciate ligament graft choices. We present a case where at the same operative setting, the patellar tendon was repaired, and the anterior cruciate ligament reconstructed with autologous hamstring graft.


Assuntos
Lesões do Ligamento Cruzado Anterior , Traumatismos do Joelho/cirurgia , Procedimentos Ortopédicos , Traumatismos dos Tendões/cirurgia , Tendões/transplante , Adulto , Artroscopia , Humanos , Traumatismos do Joelho/fisiopatologia , Articulação do Joelho/fisiopatologia , Masculino , Patela , Amplitude de Movimento Articular , Ruptura
16.
J Hand Surg Am ; 29(5): 809-14, 2004 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-15465229

RESUMO

PURPOSE: Dupuytren's fibroblasts, or myofibroblasts, are the primary cell type in Dupuytren's disease. Growth factors play a role in the differentiation of fibroblasts to myofibroblasts. Myofibroblasts are specialized fibroblasts that display morphologic and biochemical features similar to smooth muscle cells. Cytokines, adhesion molecules, and extracellular matrix components are all thought to play a role in myofibroblast transdifferentiation. Recent research has shown that specific cytokines, such as transforming growth factor beta1 (TGF-beta1), can modulate myofibroblast expression. We hypothesize that bone morphogenetic proteins (BMPs) play a role in the modulation of Dupuytren's fibroblasts. METHODS: Dupuytren's fibroblasts and normal palmar fascia fibroblasts (control) were analyzed for messenger RNA expression of BMPs (BMP-1, -2, -3, -4, -5, -6, -7, -8, -9, -10 and -11), their receptors (BMPR-IA, BMPR-IB, and BMPR-II), and their antagonists (follistatin and noggin) by reverse-transcription polymerase chain reaction (PCR). Western blot analysis and immunostaining also were used to confirm the differential expression of BMP-4. RESULTS: With reverse-transcription PCR the expression profile for normal palmar fascia fibroblasts versus Dupuytren's fibroblasts was found to show similar expression of BMP-1 and -11; qualitatively decreased expression of BMP-6, BMP-8, BMPR-IA, BMPR-IB, and BMPR-II in Dupuytren's fibroblasts; and no expression of BMP-4 in Dupuytren's fibroblasts. There was no expression of BMP-2, -3, -5, -7, -9, and -10 in both the control fibroblasts and Dupuytren's fibroblasts. In line with the messenger RNA expression pattern BMP-4 was detected in only the control fibroblasts and not in the Dupuytren's fibroblasts, whereas BMP-8 (chosen for comparison purposes) was detectable in both cell populations. Immunostaining for BMP-8 and BMP-4 confirmed our findings with reverse-transcription PCR and Western blot analysis. CONCLUSIONS: This study reports on the expression of BMPs in Dupuytren's fibroblasts. We characterized the expression of BMPs in both normal palmar fascia fibroblasts and in Dupuytren's fibroblasts through reverse-transcription PCR, Western blot analysis, and immunostaining. The most significant difference in expression profiles was in the expression of BMP-4; that is, BMP-4 was expressed in the normal fibroblasts but not in the Dupuytren's fibroblasts. Whether BMP-4 is necessary and/or sufficient for maintaining a normal palmar fascia fibroblast phenotype is not yet known. Further studies are needed to elucidate the exact role of BMPs, and especially BMP-4, in Dupuytren's fibroblasts.


Assuntos
Proteínas Morfogenéticas Ósseas/biossíntese , Contratura de Dupuytren/metabolismo , Fibroblastos/metabolismo , Proteínas Morfogenéticas Ósseas/genética , Contratura de Dupuytren/patologia , Fáscia/patologia , Expressão Gênica , Humanos , Imuno-Histoquímica , RNA Mensageiro/biossíntese , Reação em Cadeia da Polimerase Via Transcriptase Reversa
17.
J Orthop Trauma ; 17(8): 549-54, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-14504575

RESUMO

OBJECTIVE: To determine the effectiveness of six-axis analysis deformity correction using the Taylor Spatial Frame for the treatment of posttraumatic tibial malunions and nonunions. DESIGN: Retrospectively reviewed, consecutive series. Mean duration of follow-up was 3.2 years (range 2-4.2 years). SETTING: Tertiary referral center for deformity correction. PATIENTS/PARTICIPANTS: Eighteen patients were included in the study (11 malunions and 7 nonunions). All deformities were posttraumatic in nature. The mean number of operations before the application of the spatial frame was 2.6 (range 1-6 operations). All patients completed the study. INTERVENTION: Six-axis analysis deformity correction using the Taylor Spatial Frame (Smith & Nephew, Memphis, TN) was used for correction of posttraumatic tibial malunion or nonunion. Nine patients had bone grafting at the time of frame application. One patient with a tibial plafond fracture simultaneously had deformity correction and an ankle fusion for a mobile atrophic nonunion. Two patients had infected tibial nonunions that were treated with multiple débridements, antibiotic beads, and bone grafting at the time of spatial frame application. A rotational gastrocnemius flap was used to cover a proximal third tibial defect in one patient. The average length of time the spatial frame was worn, time to healing, was 18.5 weeks (range 12-32 weeks). MAIN OUTCOME MEASUREMENTS: Assessment of deformity correction in six axes, knee and ankle range of motion, incidence of infection, and return to preinjury activities. RESULTS: Of the 18 patients treated with the Taylor Spatial Frame, with adjunctive bone graft as necessary, 17 achieved union and significant correction of their deformities in six axes (ie, coronal angulation and translation, sagittal angulation and translation, rotation, and shortening). Fifteen patients returned to their preinjury activities at last follow-up. CONCLUSION: Six-axis analysis deformity correction using the Taylor Spatial Frame is an effective technique to treat posttraumatic malunions and nonunions of the tibia, with several advantages over previously used devices.


Assuntos
Fraturas Mal-Unidas/patologia , Fraturas Mal-Unidas/cirurgia , Fraturas não Consolidadas/patologia , Fraturas não Consolidadas/cirurgia , Procedimentos Ortopédicos/métodos , Fraturas da Tíbia/patologia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Criança , Desenho de Equipamento , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/instrumentação , Estudos Retrospectivos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA