Ligamento cruzado anterior mucoide: serie de casos y revisión bibliográfica / Mucoid degeneration of the anterior cruciate ligament. Case series and literature review

Introducción: Actualizar el cuadro de ligamento cruzado anterior mucoide y describir nuestra experiencia en el diagnóstico y el tratamiento quirúrgico. Materiales y métodos: Se analizan los aspectos clínicos y fisiopatológicos, los hallazgos por imágenes y el tratamiento quirúrgico, según las series publicadas. Además, se presenta un estudio retrospectivo con 27 pacientes (promedio de edad, 55 años ; rango 34-68 años), llevado a cabo entre 2004 y 2011. Para la evaluación de los pacientesse consideró el dolor, el rango de movilidad y la estabilidad. Se emplearon maniobras clínicas y el artrómetro KT-1000 para evaluar la estabilidad posoperatoria. Se realizaron radiografías y resonancia magnética preoperatorias y posoperatorias. Los resultados funcionales posoperatorios fueron evaluados con las escalas de Lysholm, IKDC, y la evaluación subjetiva del dolor. Se tomaron muestras para biopsia. Resultados: La escala de evaluación analógica del dolor mejoró un promedio de 6 puntos y el rango de movilidad, un promedio de 26°. La estabilidad de la rodilla no estaba comprometida. Las escalas de evaluación funcional arrojaron un IKDC de A en el 50 por ciento de los pacientes, de B en el 33 por ciento y de C en el 17 por ciento. El puntaje de Lysholm fue de 95. El resultado en la escala de evaluación subjetiva osciló entre muy bueno y excelente en la mayoría de los casos. No hubo complicaciones posoperatorias. Conclusiones: La resonancia magnética es el estudio por imágenes para el diagnóstico preoperatorio; los hallazgos son característicos y no deben confundirse con desgarros del ligamento cruzado anterior. El diagnóstico definitivo es histológico. Creemos que el tratamiento artroscópico es eficaz, reproducible y tiene una baja tasa de complicaciones.

Osteocondrose bilateral de côndilos femorais laterais: relato de caso e revisão da literatura / Bilateral osteochondrosis of lateral femoral condyles: case report and literature review

A osteocondrose é uma falha na ossificação subcondral com predileção pelo esqueleto imaturo e cuja etiologia permanece indefinida. Pode afetar os côndilos femorais (geralmente o medial), e o acometimento é, na maioria, unilateral. Os autores chamam a atenção desse diagnóstico, geralmente tardio por sua ocorrência infrequente, e relatam o caso raro de uma criança com osteocondrose bilateral de côndilos femorais laterais, ressaltando que, até o presente momento, apenas um caso semelhante foi descrito na literatura.

Osteochondrosis is an injury on subchondral ossification with predominance of immature skeleton and whose etiology remains unknown. It may affect the femoral condyles (usually the medial condyle) and the involvement is mostly unilateral. The authors draw the attention to this usually late diagnosis due to its infrequent occurrence and report a child's rare case of bilateral osteochondrosis on lateral femoral condyles, stressing that just one similar case has been described in the orthopaedic literature up to the present time.

Medial Unicompartmental Knee Arthroplasty in Patients with Spontaneous Osteonecrosis of the Knee

BACKGROUND: We analyzed the clinical and radiologic results of patients with spontaneous osteonecrosis of the knee treated by minimally invasive medial unicompartmental arthroplasty using Oxford Uni. METHODS: We reviewed 22 knees in 21 patients which were treated for spontaneous osteonecrosis between 2002 and 2006. Patients included one male and 20 females. The mean age was 70.8 years (range, 53 to 82 years). The mean follow-up period was 70.3 months (range, 48 to 93 months). The clinical results were evaluated using the Hospital for Special Surgery (HSS) knee score and the range of motion of the knee preoperatively and at the final follow-up. Preoperative plain radiographs and magnetic resonance images were analyzed to determine the size and stage of osteonecrotic lesions. RESULTS: The mean HSS knee score was 64.3 (range, 54 to 75) preoperatively and 92.0 (range, 71 to 100) at the final follow-up. The mean preoperative flexion contracture was 8.9degrees (range, 0 to 15degrees) and 0.2degrees (range, 0 to 5degrees) at the final follow-up. The mean further flexion increased from 138.6degrees (range, 100 to 145degrees) preoperatively to 145.6degrees (range, 140 to 150degrees) at the final follow-up. Active full flexion was possible within 2 months of the operation. The squatting position was possible in 16 patients (84.2%) out of 19, except one case of bronchiectasis and one case of spine fracture. The cross-leg posture was possible in 19 patients (90.5%) out of 21. The mean tibiofemoral angle was improved from varus 0.98degrees to valgus 3.22degrees. Meniscal bearing dislocation occurred in 2 cases and femoral component loosening occurred in 1 case. CONCLUSIONS: Unicompartmental knee arthroplasty using Oxford Uni could be an alternative treatment option in spontaneous osteonecrosis of the knee.

Comparison of four imaging examinations of shoulder joint injury in forensic expertise / 法医学杂志

OBJECTIVE@#To compare the value of four imaging examinations, including the X-ray, CT, MRI and gas-iodine double contrast CT analyses, in the forensic expertise of shoulder joint injury.@*METHODS@#Imaging data of shoulder joint injury, by the X-ray, CT, MRI and gas-iodine double contrast CT were retrieved and analyzed.@*RESULTS@#The correct diagnosis rates of fracture and soft tissue injury by X-ray, CT and MRI were 52.8%, 72.0% and 63.2%, as well as 0.0%, 32.9% and 82.5%, respectively. The correct diagnosis rate of soft tissue injury by gas-iodine double contrast CT was 100%.@*CONCLUSION@#X-ray is a useful screening method, CT is better for diagnosis of fracture, and MRI is fit for diagnosis of soft tissue injury. Gas-iodine double contrast CT can reflect not only the soft tissue injury but also its severity. Thus, combined application of X-ray, CT, MRI and gas-iodine double contrast CT can provide important imaging information for forensic expertise in shoulder joint injury.

Enxerto estruturado no tratamento das perdas ósseas femorais em artroplastias de quadril infectadas / Structural allograft in the treatment of femoral bone loss in infected hip arthroplasty

Foram submetidos ao tratamento em dois tempos cirúrgicos 17 pacientes com infecções crônicas em próteses de quadril e perda óssea circunferencial do fêmur proximal, consistindo da realização, no primeiro tempo, da retirada dos componentes e materiais infectados e colocação de espaçador de cimento com vancomicina e, no segundo tempo, da reconstrução do estoque ósseo com enxerto maciço da região proximal do fêmur e fixação da prótese através de hastes longas cimentadas ao enxerto e cimentas (dez hastes) ou não (sete hastes) no fêmur hospedeiro. Após nove anos de seguimento, em média (mínimo de sete anos), apenas um caso evoluiu com recidiva infecciosa. Todos os enxertos apresentaram sinais de consolidação radiográfica com o osso hospedeiro. Não houve solturas dos componentes femorais. Funcionalmente os pacientes melhoraram, embora a maioria deambule com marcha de Trendelemburg. O enxerto maciço de fêmur proximal se apresentou como uma técnica segura e reprodutível para o tratamento das falhas ósseas após artroplastia infectada de quadril.

Cytomorphology of tumoral calcinosis: a case report.

This paper describes the clinical, radiological and cytomorphological findings of tumoral calcinosis in a twelve-year old boy with normal serum calcium levels and simultaneous involvement of the right shoulder and the left hip. The aim of presentation is to highlights the fact that clinicoradiological correlation and correct interpretation of cytologic findings can alleviate patients' anxiety and avoid unnecessary mutilating surgery in this uncommon but completely benign condition.

Artropatía de Charcot secundaria a tabes dorsal: reporte de un caso: Servicio de Traumatología y Ortopedia del Hospital Central Luis Ortega Estado Nueva Esparta / Artropatía of secondary Charcot to dorsal tabes: report of a case: Servicio de Traumatología y Ortopedia del Hospital Central Luis Ortega estado Nueva Esparta

El Tabes dorsal (TD) es una enfermedad tóxica degenerativa, muy rara en nuestro medio, donde hay afectación de la médula espinal por la espiroqueta de la sífilis, como manifestación tardía de la enfermedad. El 5 a 10 por ciento de los pacientes presentan una Osteoartropatía Neuropática o Artropatía de Charcot (AC), que afecta predominantemente a las articulaciones de las extremidades inferiores. Se presenta el caso de un paciente masculino de 29 años, con diagnóstico clínico y de laboratorio, de sífilis, quien inicia su enfermedad actual en 2003 con trastornos de marcha, artralgias y espasticidad en miembros inferiores. Al ingreso presenta aumento de la base de sustentación, Romberg positivo, arreflexia rotuliana y aquílea y pupilas de Argyll Robertson. Los estudios radiológicos muestran signos de afectación importante de ambas rodillas. Se realizó una artroplastia total izquierda para luego realizar el mismo procedimiento en la derecha. La artropatía total de rodilla se puede ofrecer a pacientes con AC en estadios finales.

A Case of Hypertrophic Osteoarthropathy Associated with Nasopharyngeal Carcinoma in a Child

Hypertrophic osteoarthropathy is characterized by clubbing of the digital tips and periosteal reaction of long bones. Most of the cases are associated with malignancy or other conditions such as congenital heart disease, liver cirrhosis, pulmonary fibrosis, biliary atresia, and gastrointestinal polyps. Hypertrophic osteoarthropathy associated with malignancy is rare in children. A few cases of hypertrophic osteoarthropathy in children with nasopharyngeal carcinoma have been reported, however, there has been no report of such case in Korea. We present a case of hypertrophic osteoarthropathy associated with nasopharyngeal carcinoma with lung metastasis in a 14-yr-old boy. In this case, hypertrophic osteoarthropathy regressed after intensive chemotherapy, but subsequently the patient died of progressive lung metastasis.

Evolución clínico radiológica de la pseudoartrosis congénita de tibia tipo I tratada según la técnica de Mc Farland / Evolution clinic radiology of the pseudarthrosis congenital of the tibia type I: with the Mc Farland techique

Se trata de un estudio de tipo descriptivo en el que se realizó una revisión retrospectiva de cinco niños con diagnóstico de Pseudoartrosis Congénita de Tibia tipo I de Crawford operados en el Hospital San Juan de Dios de Caracas, Venezuela entre los años 1975 y 1993 con la técnica de Mc Farland la edad promedio en el momento de la cirugía fue de seis años y cuatro meses. El período de seguimiento promedio fué de 10.8 años. La evolución fué satisfactoria en 3 de los 5 pacientes tratados, modificandose la historia natural de la enfermedad. Es importante destacar el hecho de que a pesar de haber estudiado una serie de tan solo 5 pacientes, está cantidad es significativa ya que los trabajos previos realizados reportan un número similar o incluso menor de casos

Prevalencia de enfermedades articulares en la CNS de Cochabamba / Prevalence of joint diseases of the CNS of Cochabamba

El trabajo de investigación, consiste en una revisión por muestreo aleatorio (10 por ciento) de las carpetas familiares de los policonsultorios de Medicina Familiar de la C.N.S., en el Departamento de Cochabamba, eligidos a la zar de los policonsultorios: Central 32, Cala Cala, Villa Galindo, Quillacollo, Sacaba y Punata de las cuales se ha determinado la prevalencia de las enfermedades articulares de familias aseguradas que asistieron en forma regular a la consulta médica durante el periodo de 1980 a 1990. Durante el proceso de investigación se utilizo el método de la encuesta comparativa retrospectiva institucional no experimental: tomando en cuenta las variables: sexo, edad, ocupación, procedencia, diagnóstico, tratamiento, estado socioeconómico y nivel cultural. De acuerdo a los resultos finales, se ha demostrado la alta prevalencia de estas patologías en cada area, policonsultorio y grupo familiar asegurada a la C.N.S. de Cochabamba, de las 580 carpetas familiares revisadas se han registrado 1.338 historias clínicas y de las cuales 174 pacientes padecen de enfermedad articular, lo cual representa el 13 por ciento del total de revisados. Las patologías mas prevalentes, en forma decreciente, son la Artritis Reumatoide con 51 por ciento, Osteoartritis con 25 por ciento, gota con el 15 por ciento y la Fiebre Reumática con 9 por ciento del total de afecciones. Ademas se aha averificado alta prevalencia de estas patologías en sexo femenino, en grupo etareo de 30 a 60 años de edad y en pacientes de ocupación en labores de casa, rentistas y del magisterio.

Joint restriction in adult non-insulin-dependent diabetes mellitus

100 patients suffering from adult non insulin dependent diabetes mellitus for a duration varying between one year and 15 years were included study. 35 age and sex matched controls not suffering from diabetes were also included in the study. The mobility score recommended by Campbell et al. [1985] was used to assess joint restriction in both groups. The diabetics were divided into 2 groups; group A [patients with joint restriction] and group B [patients without joint restriction]. 48% [48/109] of the diabetics had joint restriction while 8.57% [3/35] of the control group had joint restriction. The mobility score was significantly poorer in the diabetics than in patients of control group [P < 0.05]. The mobility score was poorer in patients who had diabetes for more than 10 years [P < 0.0001], 25% [12/48] of diabetics with joint restriction and all of them had diabetes for more than 10 years. The incidence of intake of insulin in group A patients [diabetics with joint restriction] was 87, 80% while its incidence in group B patients [diabetics without joint restriction] was 61.5% while is statistically significant [P < 0.001]. The incidence of micro-vascular disease of eyes and kidneys in group A was 43.75% while its incidence in group B was 22% which is statistically significant [P < 0.02]. The incidence of neuropathy in group A was 33.33% while its incidence in group B was 11.53% which is statistically significant [P < 0.001]. The incidence of tight waxy skin over proximal phalanges was 60.4% in group A while its incidence in group B was 1r90.2% which is statistically significant [P < 0.0001]