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1.
J Surg Res ; 196(2): 388-94, 2015 Jun 15.
Artículo en Inglés | MEDLINE | ID: mdl-25881786

RESUMEN

BACKGROUND: The pathophysiology of acute lung injury is multifactorial, and the mechanisms are difficult to prove. We have devised a study of two known and standardized animal models (hemorrhagic shock [HS] and oleic acid [OA]) to more closely reproduce the pathophysiology of posttraumatic acute lung injury. MATERIAL AND METHODS: Pressure-controlled HS (group HS) was performed by withdrawing blood over 15-min until mean arterial pressure reached 35 mm Hg for 90 min. In an additional group, HS and standardized lung injury induced by OA were combined (group lung injury [HS + OA]). After the shock period, both groups were resuscitated over 15 min by transfusion of the removed blood and an equal volume of lactate Ringer solution. The end point was 6 h. Plasma interleukin (IL)-6, keratinocyte chemoattractant (KC), IL-10, monocyte chemoattractant protein-1 (MCP-1), and lung histology were carried out. RESULTS: The posttraumatic lung injury group demonstrated significantly higher IL-6 levels when compared with HS group (744.8 ± 104 versus 297.7 ± 134 pg/mL; P = 0.004). Histologic analysis confirmed diffuse alveolar congestion and moderate-to-severe lung edema in animals with HS + OA. Lung injury was mild in mice with isolated HS or OA injection. CONCLUSIONS: We established a posttraumatic lung injury model combining two different standardized protocols (HS and OA). This model leads to pronounced inflammation and lung injury. This model allows the analysis of the dynamics of sterile lung injury and associated organ dysfunction.


Asunto(s)
Lesión Pulmonar Aguda/etiología , Modelos Animales de Enfermedad , Síndrome de Dificultad Respiratoria/etiología , Choque Hemorrágico/complicaciones , Lesión Pulmonar Aguda/sangre , Animales , Citocinas/sangre , Masculino , Ratones Endogámicos C57BL , Ácidos Oléicos , Síndrome de Dificultad Respiratoria/sangre , Choque Hemorrágico/sangre
2.
Knee Surg Sports Traumatol Arthrosc ; 22(10): 2513-7, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24770348

RESUMEN

PURPOSE: The suture anchor technique for medial capsular plication has been previously described. We present our technique and its medium-term results. METHODS: A single surgeon's experience (senior author) of the suture anchor technique for medial capsular plication was reviewed in 14 knees in 14 patients. All patients underwent arthroscopic stabilisation for patello-femoral instability. The method used was the suture anchor technique for medial capsular plication (full technique described in paper). The primary outcome measure used was further dislocation or instability. The validated Kujala score was used pre- and post-op to assess functional outcome. RESULTS: There were nine male and five female patients (M:F, 64%:34%). Median age was 25 (range 16-65). Mean follow-up was 52 months (95% CI 44-56 range 24-72). The mean pre-op Kujala score was 54.6 (SD 24.4). The mean post-op Kujala score was 78.2 (SD 20.5). The mean increase in Kujala score was 23.6 (95% CI 7.9-39.4). There was a statistically significant increase in Kujala score, P=0.006. Only 1 of 14 patients had a further dislocation (7%), and there were no further episodes of instability. CONCLUSION: This is the first paper to describe the results of this technique in the literature. There was a statistically significant improvement in the patients' functional outcome and 13/14 patients did not re-dislocate or experience instability. It was concluded that this technique is a successful mode of treatment for patello-femoral instability. LEVEL OF EVIDENCE: Case series, Level IV.


Asunto(s)
Artroscopía/métodos , Inestabilidad de la Articulación/cirugía , Articulación Patelofemoral/cirugía , Adolescente , Adulto , Anciano , Artroscopía/estadística & datos numéricos , Femenino , Fémur/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Anclas para Sutura , Técnicas de Sutura , Adulto Joven
3.
J Foot Ankle Surg ; 53(1): 8-11, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24239427

RESUMEN

We have reviewed a single surgeon's (M.S.) experience of talonavicular arthrodesis in 7 feet in 7 patients with isolated talonavicular arthritis. A standard dorsomedial approach was used to the talonavicular joint. Fixation was performed with 5.5-mm, partially threaded, cancellous screws. The visual analog scale for the foot and ankle (VASFA) was used to measure the preoperative and postoperative results in the categories of pain, function, other complaints, and total score. The follow-up period was 17 to 90 months (mean 48). The overall VASFA score ranged from +19.2 to +57.6 (mean +33.2, p < .01). The VASFA score for pain ranged from +19 to +74.8 (mean +51.3, p < .01). The VASFA score for function ranged from +12.5 to +68.2 (mean +28.3, p < .01). The VASFA score for other problems ranged from +12 to +45.8 (mean +25.5, p < .01). None of the 7 feet required revision, and all 7 patients were satisfied with the outcome and would have the operation again. We have concluded that, taking into account the small power of the present study, talonavicular arthrodesis is a successful treatment for isolated talonavicular arthritis.


Asunto(s)
Artrodesis , Osteoartritis/cirugía , Astrágalo/cirugía , Huesos Tarsianos/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad
4.
Orthop J Sports Med ; 12(3): 23259671231214766, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38524891

RESUMEN

Background: Changes in knee loading have been reported after meniscectomy. Knee loading has previously been assessed during jogging and treadmill running rather than overground running, which could give altered results. Purpose/Hypothesis: The purpose of this study was to evaluate knee function during overground running and walking after meniscectomy. It was hypothesized that the affected limb would demonstrate higher external knee adduction moment, lower knee flexion moment (KFM), and lower knee rotation moment (KRM) compared with the contralateral limb and with healthy individuals. Study Design: Controlled laboratory study. Methods: Kinematic and kinetic data were collected during running and walking in individuals after a meniscectomy and healthy individuals. Total knee joint moments (TKJM) were calculated from the sagittal, frontal, and transverse knee moments. Isometric quadriceps strength, perceived knee function, and kinesiophobia were also assessed. A mixed linear model compared differences between the affected leg, the contralateral leg, and the healthy leg. Results: Data were collected on 20 healthy individuals and 30 individuals after a meniscectomy (mean ± SD, 5.7 ± 2.9 months postsurgery), with 12, 16, and 2 individuals who had medial, lateral, and both medial and lateral meniscectomy, respectively. The affected limb demonstrated lower TKJM (P < .001), KFM (P = .004), and KRM (P < .001) during late stance of walking compared with the healthy group. Lower TKJM and KFM were observed during running in the affected limb compared with the contralateral limb and healthy group. No significant differences were observed between contralateral and healthy limbs except for KRM during late stance of walking. Lower quadriceps strength was observed in the affected (P < .001) and contralateral limbs (P = .001) compared with the healthy group. Individuals after a meniscectomy also reported greater kinesiophobia (P = .006) and lower perceived knee function (31.1%; P < .001) compared with the healthy group. Conclusion: After meniscectomy, individuals who sustained a traumatic meniscal injury showed lower TKJM in the affected limb compared with the contralateral limb and healthy individuals. This decrease in TKJM can be attributed to altered knee-loading strategies in the sagittal and transverse planes. Clinical Relevance: Improving movement strategies, quadriceps strength, and kinesiophobia through rehabilitation approaches will allow individuals to load their knee appropriately when returning to sport. Registration: NCT03379415 (ClinicalTrials.gov identifier).

5.
Acta Orthop Belg ; 79(4): 463-9, 2013 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-24205779

RESUMEN

This study aimed at assessing the prevalence of MRSA colonisation in Trauma and Orthopaedics. Risk factors, decolonisation, and subsequent infection rates were investigated. Cost-analysis of the MRSA screening program was performed. The validity and effectiveness of the MRSA screening program was reviewed. A prospective analysis was made of all orthopaedic admissions in East Lancashire Hospital Trust. A total number of 13,155 swabs were taken in 8,867 patients in 2010. This MRSA screening program was compared to the ideal screening criteria set out by Wilson and Junger (WHO 1968). The MRSA prevalence in Trauma and Orthopaedics in 2010 was 0.47%. The decolonisation rate was 55%. There was no correlation between MRSA colonisation and subsequent infection. The total cost of MRSA screening at ELHT was calculated as a minimum of 184,170 Pounds. This could extrapolate to a national expense of around 16 million pounds in England and Wales in Orthopaedics alone. The MRSA screening program did not meet 4 out of 9 screening criteria of Wilson and Junger. The vast majority of Trauma and Orthopaedic patients are not at risk of MRSA colonisation or infection and therefore should not be screened. MRSA infection is a risk in certain high risk groups which should be screened. The MRSA screening program is ineffective when assessed to WHO standards. The program should be considered to be surveillance of MRSA, not an effective screening program for pathological MRSA infection.


Asunto(s)
Tamizaje Masivo/estadística & datos numéricos , Staphylococcus aureus Resistente a Meticilina , Procedimientos Ortopédicos , Infecciones Estafilocócicas/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Tamizaje Masivo/economía , Persona de Mediana Edad , Enfermedades Musculoesqueléticas/epidemiología , Prevalencia , Estudios Prospectivos , Infecciones Estafilocócicas/economía , Infecciones Estafilocócicas/epidemiología , Infección de la Herida Quirúrgica/microbiología
6.
Cureus ; 15(2): e34533, 2023 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-36751575

RESUMEN

BACKGROUND: Recent evidence suggests a benefit in platelet-rich plasma injections (PRP) for the knee in the management of mild to moderate osteoarthritis (OA). There is a reported reduction in pain, stiffness, and improved function. However, there is very little level-one literature available that supports this practice and conclusively proves a benefit gained throughout the course. Three main randomized control trials (RCTs) conducted in North America are often referenced and cited to prove their efficacy. This study aimed to look at the outcomes of patients having undergone this treatment to determine if there was any benefit. AIMS: This study aimed to determine if PRP injections administered in patients with knee OA over a six to eight-week time period demonstrated any benefit. METHODS: The Western Ontario and McMaster Universities arthritis index (WOMAC) tool was used before each of the three PRP injections over the six to eight-week period, and six weeks after the final injection in 31 patients. Each injection was given spaced two to three weeks apart. The outcomes observed were pain, stiffness, and physical function, and the total WOMAC score was calculated. RESULTS: The third injection showed a reduction in total WOMAC score, pain, stiffness, and physical function by 16.36%, 16.37%, 5.12%, and 18.03%, respectively. However, all scores returned close to baseline at the sixth-week follow-up post treatment. CONCLUSION: Results showed a trend of reduction in the WOMAC score. However, they are overall indicative of a placebo effect from the injections. Further studies are needed to explore whether the grade of OA and patients' weight have a significant impact on the results.

7.
Knee ; 42: 304-311, 2023 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-37141797

RESUMEN

BACKGROUND: Arthroscopic partial meniscectomy is a frequently undertaken procedure for traumatic meniscal injuries. The location of knee joint degeneration and long-term prognosis differs between knees who have had a medial or lateral meniscectomy. However, there is no evidence comparing knee loading following a medial or lateral meniscectomy during sporting tasks. This study compared knee loading during walking and running between individuals who either had a medial or lateral meniscectomy. METHODS: Knee kinematic and kinetic data were collected during walking and running in individuals three to twelve months post-surgery. Participants were grouped according to the location of surgery (medial, n = 12, and lateral, n = 16). An independent t-test compared knee biomechanics between the groups and Hedge's g effects sizes were also conducted. RESULTS: External knee adduction and knee flexion moments were similar between groups for walking and running with negligible to small effect sizes (effect size, 0.08-0.30). Kinematic (effect size, 0.03-0.22) and spatiotemporal (effect size, 0.02-0.59) outcomes were also similar between the groups. CONCLUSIONS: The lack of differences in surrogate knee loading variables between medial and lateral meniscectomy groups was unexpected. These findings suggest that combining groups in the short-term period following surgery is applicable. However, the data presented in this study cannot explain the differences in long-term prognosis between medial and lateral meniscectomies.


Asunto(s)
Meniscectomía , Carrera , Humanos , Meniscectomía/métodos , Meniscos Tibiales/cirugía , Articulación de la Rodilla/cirugía , Rodilla , Fenómenos Biomecánicos
8.
EFORT Open Rev ; 6(4): 225-235, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-34040800

RESUMEN

The aim of this article was to synopsize platelet-rich plasma (PRP) use in musculoskeletal pathologies through evidence-based assessment of the preparation, classification, mechanism of action and applications of PRP, thereby answering which PRP type is best for each clinical indication.The literature search was performed using Medline, EMBASE and Cochrane Reviews databases for papers containing the key terms "platelet-rich plasma" AND "orthopaedics" AND ("classification" OR "mechanism of action" OR "preparation" OR "clinical application"). Generated papers were evaluated for pertinence in following areas: preparation, classification, mechanism of action, clinical application within orthopaedics. Non-English papers were excluded. Included studies were evaluated for quality.Sixty studies were included in our review. There are many commercial PRP preparation kits with differing component concentrations. There is no consensus on optimal component concentrations. Multiple PRP classifications exist but none have been validated. Platelet-rich plasma acts via growth factors (GFs) released from α-granules within platelets. Growth factors have been shown to be beneficial in healing. Grossly elevated concentrations of GFs may have inhibitory effects on healing. Multiple systematic reviews show efficacy of PRP in tendinopathies, early osteoarthritis, acute muscle injuries and in combination with rotator cuff repair and anterior cruciate ligament reconstruction.The literature suggests leukocyte-rich PRP (L-PRP) is more beneficial in tendinopathies and pure PRP (P-PRP) is more beneficial in cartilage pathology. However, different PRP preparations have not been directly compared in any pathology. Classification of PRP type is frequently not stated in research. Standardization of PRP research parameters is needed to streamline findings and generate clear indications for PRP types to yield maximum clinical benefit. Cite this article: EFORT Open Rev 2021;6:225-235. DOI: 10.1302/2058-5241.6.200017.

9.
Hip Int ; 28(1): 53-58, 2018 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-29192734

RESUMEN

INTRODUCTION: The moderately cross-linked Depuy Marathon® cemented acetabular component was introduced into the UK in 2007. The wear rate for the previously introduced Marathon® uncemented acetabular component has been reported to range from 0.06 to 0.01 mm/year. The aim of this study was to present the medium-term results and wear rate of the Marathon® cemented prosthesis used in primary total hip arthroplasty. METHODS: 103 Marathon® cemented acetabular components were implanted between 2008 and 2009 in primary arthroplasty, who were eligible for this study. All patients received a metal 28-mm head. Mean age was 68 years (range 27-87). Mean clinical follow-up was 55 months (range 50-61). Mean radiological follow-up was 46 months (range 24-57). Wear was calculated on AP radiographs using computer-assisted uni-radiographic technique. RESULTS: The mean wear was 0.37 mm (range 0.0-0.78 mm). The wear rate was calculated as 0.03 mm/year (95% confidence interval 0.02-0.06). Postoperative complications included deep vein thrombosis (2%) and dislocation (0.8%); there were no deep infections. There were no revisions for failure of the Marathon® cemented acetabular component. CONCLUSIONS: The Marathon® cemented acetabular component demonstrates satisfactory wear rates and survivorship at medium-term follow-up.


Asunto(s)
Artroplastia de Reemplazo de Cadera/instrumentación , Articulación de la Cadera , Prótesis de Cadera , Artropatías/cirugía , Falla de Prótesis , Acetábulo/cirugía , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Estudios de Seguimiento , Humanos , Artropatías/diagnóstico por imagen , Artropatías/etiología , Masculino , Persona de Mediana Edad , Polietilenos , Diseño de Prótesis , Radiografía
10.
Med Eng Phys ; 47: 159-166, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28684212

RESUMEN

A new 2-D radiographic wear measurement system has been developed which enables the low wear of highly cross-linked polyethylene acetabular cups to be accurately and precisely measured from standard, pelvis radiographs. The software was validated using radiographic images of a measurement jig which could vary the cup orientation and simulate the effect of pelvic tilt/rotation. Wear was simulated using accurately measured plastic shims to vary the position of the femoral head relative to the cup. The effects of varying "wear" penetration, "wear" direction, cup orientation and X-ray focus position were assessed. Further direct comparison tests were also carried out using radiostereometric analysis. Inter/intra-observer repeatability of the new system was assessed using clinical radiographs. The mean (SD) "wear" penetration error was -0.002mm (0.028mm). The "wear" penetration precision was 0.055mm. Changing the position of the X-ray focus point made no difference to the measurement error. Inter/intra-observer repeatability and limits of agreement had similar low values. Comparison tests with RSA showed the accuracy was similar.


Asunto(s)
Acetábulo/diagnóstico por imagen , Análisis de Falla de Equipo/métodos , Prótesis de Cadera , Polietileno/química , Falla de Prótesis , Interpretación de Imagen Radiográfica Asistida por Computador/métodos , Programas Informáticos , Acetábulo/cirugía , Algoritmos , Cementación , Reactivos de Enlaces Cruzados/química , Articulación de la Cadera/diagnóstico por imagen , Articulación de la Cadera/cirugía , Humanos , Fantasmas de Imagen , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
11.
J Pediatr Orthop B ; 25(6): 489-92, 2016 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-27135219

RESUMEN

Following surgical reduction of an irreducible hip in developmental dysplasia of the hip, imaging is required to ascertain successful reduction. Recent studies have compared MRI versus computed tomography (CT) in terms of cost, time, sensitivity and specificity. This is the first study to compare intraobserver and interobserver reliability for both modalities. Nineteen CT scans of 38 hips in 10 patients and nine MRI scans of 18 hips in six patients were reviewed on two separate occasions by three clinicians. Image clarity, confidence of diagnosis, time taken to perform the scan as well as radiation dose for CT were recorded. Intraobserver and interobserver reliability κ values were calculated. There were 14 female patients and one male patient. The mean age at the time of the scan was 12 months (range 3-25 months). Intraobserver reliability was greater than 0.8 (both CT and MRI). Interobserver reliability was greater than 0.8 (both CT and MRI). Image clarity was higher for CT for two out of the three clinicians (9.47 vs. 6.33 P<0.05; 9.89 vs. 8.11, P<0.05). All clinicians were equally confident in the diagnosis when using CT or MRI. The time taken to perform the investigation was not significantly different (3.32 vs. 4.88 min, P>0.05). The mean radiation dose for CT was 91.75 DLP (dose length product, mGy×cm) (95% confidence interval±26.95). Our results show that MRI is equal to CT as an imaging modality in the assessment of postreduction hips in developmental dysplasia of the hip. Intraobserver and interobserver reliability was excellent for both. The image clarity was higher for CT, but this method of imaging carries a significant risk of radiation exposure. We recommend that MRI should supersede CT as an imaging modality for this clinical situation.


Asunto(s)
Luxación Congénita de la Cadera/diagnóstico por imagen , Imagen por Resonancia Magnética , Tomografía Computarizada por Rayos X , Preescolar , Diagnóstico por Imagen , Femenino , Cadera/diagnóstico por imagen , Luxación Congénita de la Cadera/diagnóstico , Humanos , Lactante , Masculino , Variaciones Dependientes del Observador , Complicaciones Posoperatorias , Reproducibilidad de los Resultados , Sensibilidad y Especificidad
12.
PLoS One ; 11(2): e0148844, 2016.
Artículo en Inglés | MEDLINE | ID: mdl-26871937

RESUMEN

PURPOSE: A high percentage (50%-60%) of trauma patients die due to their injuries prior to arrival at the hospital. Studies on preclinical mortality including post-mortem examinations are rare. In this review, we summarized the literature focusing on clinical and preclinical mortality and studies included post-mortem examinations. METHODS: A literature search was conducted using PubMed/Medline database for relevant medical literature in English or German language published within the last four decades (1980-2015). The following MeSH search terms were used in different combinations: "multiple trauma", "epidemiology", "mortality ", "cause of death", and "autopsy". References from available studies were searched as well. RESULTS: Marked differences in demographic parameters and injury severity between studies were identified. Moreover, the incidence of penetrating injuries has shown a wide range (between 4% and 38%). Both unimodal and bimodal concepts of trauma mortality have been favored. Studies have shown a wide variation in time intervals used to analyze the distribution of death. Thus, it is difficult to say which distribution is correct. CONCLUSIONS: We have identified variable results indicating bimodal or unimodal death distribution. Further more stundardized studies in this field are needed. We would like to encourage investigators to choose the inclusion criteria more critically and to consider factors affecting the pattern of mortality.


Asunto(s)
Lesiones Encefálicas/mortalidad , Traumatismo Múltiple/mortalidad , Autopsia , Causas de Muerte , Humanos , Análisis de Supervivencia
14.
Injury ; 46 Suppl 4: S93-8, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26542873

RESUMEN

BACKGROUND: The impact of conventional laboratory data to identify polytrauma patients at risk of complications is established. However, it has not been assessed in terms of prognostic accuracy for systemic complications (ARDS, organ failure). We therefore assessed the most predictive parameters for systemic complications and developed a scoring system for early grading of polytrauma patients. METHODS: A population based trauma registry was used. INCLUSION CRITERIA: age >16 years, Abbreviated Injury Score (AIS) of the abdomen or chest ≥ 3 points and treatment in an intensive care unit, or Injury Severity Score (ISS) ≥ 16 points. The primary endpoint was hospital mortality. Patients were graded according their risk of death: low risk of death (5-14% mortality), intermediate risk patients (15-39% mortality) and high risk (>40%). Routine clinical and laboratory parameters on admission were assessed to determine their specific relevance to describe the risk profile of the patient. Based on these data, a scoring system for the description of the clinical status was developed. Statistical analysis included uniand multivariate analysis. RESULTS: 11.436 patients were included, the mean ISS was 22.7 ± 11.2 points, 73% were male, and 95.6% had blunt injuries. The most sensitive parameters were found to be the following ones: systolic blood pressure, INR, thrombocytes, base deficit, NISS, packed red blood cells administered. The multivariate analysis revealed the following threshold levels: BP 76-90 mmHg: r = 0.249, OR 1.283: Base deficit 8-10 r = 0.474, OR 1.606; INR 1.4-2 r = 0.160, OR 1.174; NISS 35-39 r = 0.9, OR 2.46; pBRC 3-14: r = 0.671, OR 1.957. The following ranges of score values were found to be associated with different patient status: <6 points: stable patients; 6-11 points: borderline condition; >11 points: unstable patients. When using this score, 80.6% were stable, 14.6% in a borderline condition and 4.8% unstable. CONCLUSION: We developed a scoring system to discriminate polytrauma patients on admission that are at risk of systemic complications. Systolic blood pressure, INR, thrombocytes, base deficit, NISS, packed red blood cells administered are able to provide a prognosis of patients at risk of posttraumatic complications. Further prospective studies should be performed to verify this new scoring system.


Asunto(s)
Sistemas de Apoyo a Decisiones Clínicas , Traumatismo Múltiple/diagnóstico , Femenino , Alemania , Mortalidad Hospitalaria , Humanos , Puntaje de Gravedad del Traumatismo , Unidades de Cuidados Intensivos/estadística & datos numéricos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Traumatismo Múltiple/mortalidad , Admisión del Paciente , Pronóstico , Estudios Prospectivos , Reproducibilidad de los Resultados , Medición de Riesgo
15.
Hip Int ; 24(4): 417-20, 2014.
Artículo en Inglés | MEDLINE | ID: mdl-24817402

RESUMEN

INTRODUCTION: This case describes a case of an osteochondral lesion in the femoral head and its treatment by partial resurfacing of the femoral head using the HemiCAP (Contoured Articular Prosthetic) hip resurfacing system. CASE HISTORY: A 19-year-old patient who complained of 15 months of worsening left hip pain. X-rays and MR scan revealed a large osteochondral lesion. SURGERY: A Ganz approach to the hip in the lateral position was used. The osteochondral lesion was identified, lying superiorly and centrally on the head, in the weight bearing zone. The osteochondral fragment was removed and HemiCAP prosthesis applied. OUTCOME: At six-year follow-up the patient remains pain free clinically. And radiographic follow-up shows no evidence of loosening. CONCLUSION: There are multiple methods of treatment described in the literature for osteochondral lesions; but treatments for defects of the femoral head are few. We conclude that partial hip resurfacing using the HemiCAP prosthesis is an effective treatment for osteochondral defects of the femoral head.


Asunto(s)
Artroplastia de Reemplazo de Cadera/métodos , Cabeza Femoral/cirugía , Prótesis de Cadera , Osteocondritis/cirugía , Estudios de Seguimiento , Humanos , Masculino , Osteocondritis/diagnóstico , Osteocondritis/fisiopatología , Rango del Movimiento Articular , Factores de Tiempo , Adulto Joven
16.
J Trauma Acute Care Surg ; 76(6): 1495-506, 2014 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-24854321

RESUMEN

BACKGROUND: Numerous experimental studies have been performed to investigate the adverse effects of reamed versus unreamed nailing in isolated or combined trauma models. However, the translational relevance is still discussed controversially. METHODS AND RESULTS: A systemic review of the literature was performed. An increase of intramedullary pressure with liberation of emboli to the venous and systemic circulation associated with reamed and unreamed nailing has been well described. Reamed nailing, however, seems to have superior clinical results in terms of fracture healing. CONCLUSION: The pathophysiologic effects, optimal timing, and technique of reamed nailing particularly in patients with multiple injuries continue to be controversial topics. Therefore, further experimental studies should focus on these topics as well as on the interaction of local and systemic processes particularly in the context of different surgical treatment strategies (Early Total Care vs. Damage Control Orthopaedics) to improve our understanding and approach to intramedullary nailing.


Asunto(s)
Investigación Biomédica/tendencias , Fijación Intramedular de Fracturas , Fracturas Óseas/cirugía , Animales , Modelos Animales de Enfermedad , Curación de Fractura , Factores de Tiempo
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