RESUMO
In osteoporosis it is postulated that while the amount of bone is diminished, the quality of the bone is unaltered. Recently relatively novel methods of analysis have shown that, at the fracture site of osteoporotic subcapital fractures, there is a marked change in the molecular orientation of components of the non-collagenous bone matrix. These procedures, now applied to iliac crest biopsies, confirm earlier findings of altered orientation of the proteoglycans at the subcapital fracture site but show that very similar changes occur even in the iliac crests from patients with both types of osteoporotic proximal femoral fracture. Thus, whereas the amount of these acidic moieties of the non-collagenous bone matrix was unchanged, the molecular orientation was markedly altered, albeit not to the same extent as that found at the fracture site. These results imply that the quality of the bone, as well as the quantity, may be generally affected in osteoporosis.
Assuntos
Matriz Óssea/metabolismo , Osteoporose/metabolismo , Adulto , Idoso , Idoso de 80 Anos ou mais , Birrefringência , Matriz Óssea/patologia , Colágeno/metabolismo , Feminino , Fraturas do Quadril/metabolismo , Humanos , Ílio/metabolismo , Ílio/patologia , Masculino , Pessoa de Meia-Idade , Osteoporose/patologia , Proteoglicanas/metabolismoRESUMO
We describe a rare form of congenital snapping knee. In six knees in four children, the tibia subluxed anteriorly on the femur when the knee was extended and reduced spontaneously on flexion. The abnormal movements were seen and felt as sudden snaps or clunks at about 30 degrees of flexion. All six knees showed similar dysplastic features, although the patients had different clinical syndromes. The mechanism of the subluxation and its management are discussed.
Assuntos
Luxações Articulares/etiologia , Articulação do Joelho/anormalidades , Criança , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Articulação do Joelho/diagnóstico por imagem , Ligamentos Articulares/cirurgia , Radiografia , Recidiva , Síndrome , Transferência Tendinosa/métodosRESUMO
We enrolled 34 normal volunteers to test the hypothesis that there were two types of movement of the wrist. On lateral radiographs two distinct patterns of movement emerged. Some volunteers showed extensive rotation of the lunate with a mean range of dorsiflexion of 65 degrees, while others had a mean range of 50 degrees. The extensive rotators were associated with a greater excursion of the centre of articulation of the wrist. It is suggested that dynamic external fixation of a fracture of the distal radius carries with it the risk of stretching the ligaments or causing volar displacement at the site of the fracture.
Assuntos
Amplitude de Movimento Articular/fisiologia , Articulação do Punho/fisiopatologia , Adulto , Idoso , Ossos do Carpo/diagnóstico por imagem , Ossos do Carpo/fisiopatologia , Feminino , Humanos , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/fisiopatologia , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Radiografia , Valores de Referência , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/fisiopatologia , Articulação do Punho/diagnóstico por imagemRESUMO
We studied the morphology of the contralateral femur in 10 patients with subcapital fractures, 10 with trochanteric fractures and 10 with unilateral osteoarthritis. We found that the patients with trochanteric fractures had a significantly shorter femoral neck (4.5 +/- 0.5 cm) than patients with subcapital fractures or osteoarthritis (5.4 +/- 0.4 cm). It may be that this difference in femoral neck length is related to the site at which a proximal femoral fracture occurs.
Assuntos
Fêmur/patologia , Fraturas do Quadril/patologia , Idoso , Idoso de 80 Anos ou mais , Biometria/métodos , Feminino , Fêmur/diagnóstico por imagem , Colo do Fêmur/patologia , Fraturas do Quadril/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/patologia , RadiografiaRESUMO
A relationship between scapho-trapezio-trapezoid (STT) osteoarthritis and static dorsal intercalated segment instability (DISI) was suspected. The radiographs of 697 wrists in patients over 50 years were surveyed. In 63 wrists STT osteoarthritis was found in isolation, and isolated DISI was found in four wrists. A combination was found in 16 wrists. This was statistically significant (0.02 < P < 0.05). It is likely that the static DISI occurs as a consequence the STT osteoarthritis.
Assuntos
Ossos do Carpo/patologia , Instabilidade Articular/complicações , Osteoartrite/complicações , Articulação do Punho/patologia , Ossos do Carpo/diagnóstico por imagem , Humanos , Instabilidade Articular/diagnóstico por imagem , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/patologia , Pessoa de Meia-Idade , Osteoartrite/diagnóstico por imagem , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/patologia , Articulação do Punho/diagnóstico por imagemRESUMO
Some 1000 postcard questionnaires were sent to Fellows of the British Orthopaedic Association (BOA) to establish current follow-up practice of primary total hip replacement (THR) patients. For cemented THRs, 50% of surgeons saw their patients for under 1 year, 78% under 5 years with indefinite follow-up being performed by 14%. There was significantly more follow-up of uncemented and hybrid prostheses with the proportions being 25%, 56% and 30% respectively (chi 2, P < 0.0001). This study has revealed a wide variation in practice between individual surgeons and has shown over one-third of surgeons feel they are prevented from performing as much follow-up as they would wish by the availability of clinic resources. Higher follow-up rates of uncemented components may reflect a lack of confidence in their long-term performance.
Assuntos
Artroplastia de Quadril , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Artroplastia de Quadril/métodos , Atitude do Pessoal de Saúde , Cimentos Ósseos , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Humanos , Ortopedia/estatística & dados numéricos , Fatores de Tempo , Reino UnidoRESUMO
A total of 22 patients having hip replacements were studied to determine biochemically whether or not fat stitches cause fat necrosis. We found that fat necrosis, as measured by the triglyceride concentration of the drainage fluid, occurred in all wounds. The use of a fat stitch did not increase the amount of fat necrosis, but significantly reduced the amount of fluid drained (P less than 0.001; Student's t test). This retention of triglycerides is probably undesirable as they can act as a substrate for prostaglandin synthesis.
Assuntos
Tecido Adiposo/cirurgia , Necrose Gordurosa/etiologia , Necrose/etiologia , Técnicas de Sutura , Tecido Adiposo/metabolismo , Drenagem , Prótese de Quadril , Humanos , Pessoa de Meia-Idade , Osteoartrite do Quadril , Triglicerídeos/metabolismoAssuntos
Fraturas do Fêmur/sangue , Vitamina K 1/sangue , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
An attempt has been made to refine the quantitative evaluation of the tissue response to a prosthesis using the goat hip as an experimental model. Total joint replacement was performed in six goats; in three the cup was made of conventional ultrahigh molecular weight polyethylene and in three a new silane cross-linked ultrahigh molecular weight polyethylene was used. The pseudocapsule of the hips was examined histologically at 15, 19 and 24 months following surgery. Small and large polyethylene debris were visualized using semi-crossed polars and were counted. Giant cells were counted after staining with toluidine blue as were macrophages which were identified by dense staining after the acid phosphatase reaction. The amount of small birefringent debris was closely related to the number of macrophages in the pseudocapsule. This method of assessment may be helpful in comparing the tissue reaction of different polymers.
Assuntos
Artrite/etiologia , Articulação do Quadril/patologia , Prótese de Quadril/efeitos adversos , Polietilenos/efeitos adversos , Animais , Artrite/patologia , Contagem de Células , Feminino , Células Gigantes , Cabras , Macrófagos , Índice de Gravidade de DoençaRESUMO
Congenital abnormalities of the medial meniscus are extremely rare. We present two cases of hypoplasia and demonstrate the arthroscopic and radiological features.
Assuntos
Meniscos Tibiais/anormalidades , Adulto , Artrografia , Artroscopia , Criança , Feminino , Humanos , Articulação do Joelho/patologia , MasculinoRESUMO
8 subjects with a variety of orthopedic implants were examined by the security staff at an international airport using arch and hand-held metal detectors. None of the subjects caused activation of the alarm on the arch, although the presence of metal was registered in 2 at a level below the alarm threshold. The hand-held detectors alarmed over the larger superficial implants. A substantial tissue screening effect was noted.
Assuntos
Metais , Próteses e Implantes , Medidas de Segurança , Ligas , Aviação , Ligas de Cromo , Humanos , Aço Inoxidável , Titânio , ViagemRESUMO
The radiographs of 25 patients who presented to the Whittington Hospital with Colles' fractures were studied. Measurements of dorsal angulation and radial shortening were made on radiographs taken at presentation, following reduction (where performed) and 5 weeks after injury. The presence, and degree, of osteoporosis was assessed using the metacarpal index. There was a strong correlation between the degree of osteoporosis and age. There was no correlation between the degree of osteoporosis, as determined by the metacarpal index, and either the severity of the injury or the final result. Thus, the metacarpal index is not a useful prognostic indicator as to the radiological outcome of Colles' fractures. The single most important factor influencing the radiological result was the quality of the initial reduction.
Assuntos
Fratura de Colles/diagnóstico por imagem , Metacarpo/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Fratura de Colles/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/complicações , Osteoporose/diagnóstico por imagem , Prognóstico , RadiografiaRESUMO
We reviewed the results of 22 operations performed on 21 patients for the relief of de Quervain's disease over the last six years. At a mean follow-up of 34 months (range 4-78 months), 18 of 22 wrists had complete relief of their original symptoms. One patient required reoperation because of inadequate decompression, and two others await further surgery. Most operations (14 out of 22) were performed under local anaesthesia, and 17 out of 22 used a longitudinal incision. The use of a longitudinal incision was associated with a significant risk of complications: four patients had a poor cosmetic result, and six showed evidence of superficial radial nerve injury. Two patients had a wound infection, and one developed reflex sympathetic dystrophy. Although surgical decompression for de Quervain's disease is effective in curing the symptoms in most patients, using a longitudinal incision is associated with poor wound healing and damage to the terminal branches of the radial nerve.
Assuntos
Complicações Pós-Operatórias/prevenção & controle , Tenossinovite/cirurgia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Nervo Radial/lesõesRESUMO
Two deaths following the insertion of a Küntscher nail and cement fixation of distal femoral fractures of the femur are described and the possible aetiology is discussed.
Assuntos
Cimentos Ósseos/efeitos adversos , Pinos Ortopédicos/efeitos adversos , Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Idoso , Feminino , HumanosRESUMO
Two cases of false aneurysm of the axillary artery occurred after closed shoulder injuries. One was a dislocation of the shoulder, and the other was a fracture of the lesser tuberosity. In both cases the diagnosis was delayed, and only became apparent after excessive bruising was seen.
Assuntos
Aneurisma/etiologia , Artéria Axilar , Lesões do Ombro , Idoso , Idoso de 80 Anos ou mais , Aneurisma/diagnóstico por imagem , Artéria Axilar/diagnóstico por imagem , Artéria Axilar/lesões , Humanos , Masculino , Radiografia , Luxação do Ombro/complicaçõesRESUMO
Peripheral neuropathy, following total hip arthroplasty, has a reported incidence of 0.7%. However, delayed sciatic nerve palsy has only been reported twice in the literature. We report on two further cases, both of whom developed clinical sciatic nerve palsy at 72 hours after surgery.
Assuntos
Articulação do Quadril/cirurgia , Prótese de Quadril , Paralisia/etiologia , Complicações Pós-Operatórias/etiologia , Nervo Isquiático , Idoso , Humanos , Masculino , Pessoa de Meia-Idade , Doenças do Sistema Nervoso Periférico/etiologia , Período Pós-OperatórioRESUMO
Thirteen patients are presented who developed tuberculosis at the site of injury. They were all immigrants from areas where tuberculosis is endemic. The presence of injury caused a delay in diagnosis and therefore appropriate treatment. In an immigrant with an injury that pursues an unusual or protracted course, tuberculous infection should be considered.
Assuntos
Infecções Oportunistas/complicações , Tuberculose/complicações , Ferimentos não Penetrantes/complicações , Adolescente , Adulto , Artrite Infecciosa/etiologia , Ásia/etnologia , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/etiologia , Portugal/etnologia , Tuberculose/etnologia , Tuberculose OsteoarticularRESUMO
Hydatid disease affecting the cervical spine occurred in a 31-year-old man. Because bone grafting is associated with a high failure rate, treatment included filling the excised defect with a high-density polyethylene implant and fusing the cervical spine to stabilize it.