RESUMEN
Bernese periacetabular osteotomy (PAO) developed by Ganz is currently the treatment of choice for skeletally mature symptomatic patients with developmental dysplasia of the hip (DDH) without osteoarthritis. However, the steep learning curve and considerable number of severe complications lead surgeons to seek for alternatives to promote greater reproducibility and safety of this procedure. This is a report of a DDH case surgically treated with the aid of a digital three-dimensional (3D) planning and rapidly prototyped sterile ABS plastic osteotomy guide, developed in Brazil. We present details regarding the planning, guide production, and surgical technique and report the early results of this treatment approach in a single patient. Digital 3D planning and rapidly prototyped surgical guides are applicable and helpful in PAO surgery as shown in this case. We noted no safety issues, good accuracy, and low production costs with this approach.
RESUMEN
OBJECTIVE: To compare clinical, functional, and quality of life outcomes between patients with tibial plateau fractures operated with locked or conventional plates, and to compare the costs of these implants. METHODS: This was a comparative cross-sectional study of a consecutive series of patients with tibial plateau fractures treated surgically from August 2015 to June 2016. Patients < 18 years old, those unable to answer the questionnaires or to attend the outpatient reassessment, polytrauma patients, those with associated injuries on the ipsilateral limb, and patients who had not undergone treatment with bone plates were excluded. The present study compared the costs of the implants for the hospital, quality of life (with the 12-Item Short Form Health Survey [SF-12]), Lysholm score, pain scale, and clinical and radiological parameters. RESULTS: A total of 45 patients with tibial plateau fractures were admitted, and 11 cases were excluded. Two cases were lost to follow-up; therefore, 32 remained for the analysis (94%). The mean follow-up time was of 15.1 months (standard deviation [SD] = 4.8 months). In group A (locked plates), there were 22 patients (69%), at an average hospital cost of BRL 4,125.39/patient (SD = 1,634.79/patient) for the implants. In group B (conventional plates) there were 10 patients (31%), at an average cost of BRL 438.53 (SD = 161.8/patient) ( p < 0.00001). For the other parameters, no differences were observed, except for a greater articular depression in group A (2.7 mm ± 3.3 mm versus 0.5 mm ± 1.6 mm; p = 0.02; TE = 0.90). CONCLUSION: The costs of locked implants for the treatment of tibial plateau fractures are signiï¬cantly higher than those of conventional implants, without any clinical, quality of life, radiological, or functional advantages of the locked implants demonstrated in the present series.
RESUMEN
Este artigo objetiva fornecer os subsídios para a compreensão e reconhecimento da síndrome do impacto femoroacetabular (SIFA) aos médicos que fazem primeiros atendimentos de pacientes com queixas de dor na região inguinal. Foi realizada uma revisão bibliográfica na base de dados Medline com artigos de 1990 até 2018, utilizando a palavra-chave "femoroacetabular impingement" e suas variações. A SIFA é uma condição frequentemente negligenciada que afeta pessoas jovens e ativas, mas que pode ser identificada com conhecimento adequado da história clínica e dos achados no exame físico. Ela se caracteriza por um conflito anormal entre o rebordo do acetábulo e o colo do fêmur, sendo causa frequente de dor inguinal e fator precipitante de coxartrose. Os sintomas podem ser evitados ou reduzidos com intervenção cirúrgica precoce. A expectativa é que, no futuro, possamos impedir ou atrasar o começo das mudanças degenerativas na articulação do quadril. Concluímos que pacientes com suspeita de síndrome do impacto femoroacetabular podem ser identificados por médicos não especialistas em ortopedia, colaborando com o encaminhamento precoce desses pacientes para tratamento adequado.
This article aims to provide the subsidies for the understanding and recognition of the femoroacetabular impingement syndrome (FAIS) to physicians who provide primary care for patients with complaints of pain in the inguinal region. A literature review was conducted in the Medline database with papers from 1990 to 2016, using the keyword "femoroacetabular impingement" and its variations. The FAIS is an often-neglected condition that affects young and active people but can be identified with adequate knowledge of clinical history and physical examination findings. It is characterized by an abnormal conflict between the acetabulum and the femoral neck, being a frequent cause of inguinal pain and a precipitating factor of coxarthrosis. The symptoms can be avoided or reduced with early surgical intervention. The expectation is that, in the future, we can prevent or delay the appearance of degenerative changes in the hip joint. We conclude that patients with suspected femoroacetabular impingement syndrome can be identified by non-specialist in orthopedics physicians, collaborating with the early referral of these patients to appropriate treatment.