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1.
Pediatr Radiol ; 48(3): 350-358, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29181581

RESUMEN

BACKGROUND: Evaluating postoperative patients with hardware is challenging following surgical intervention for hip maladies such as femoral neck fractures and slipped capital femoral epiphysis (SCFE). These children are at increased risk of developing avascular necrosis, and imaging may be requested to confirm or exclude this diagnosis. Children with Legg-Calvé-Perthes disease can be monitored for restoration of blood flow to the capital femoral epiphysis to guide management and help with prognosis. Although MRI is sensitive for detecting early avascular necrosis, the presence of hardware degrades image quality. OBJECTIVE: This report examines the utility of bone scans for evaluating femoral head perfusion in children who have undergone surgery for femoral neck fractures, SCFE or Legg-Calvé-Perthes disease. MATERIALS AND METHODS: A retrospective review of 20 patients (22 scans) after fixation for femoral neck fracture, SCFE or Legg-Calvé-Perthes disease from 2012 to 2015 was performed. The bone scan findings were correlated with the intraoperative findings or clinical follow-up. RESULTS: Twenty-one of the 22 (95%) bone scans in 19 of the 20 (95%) patients demonstrated findings consistent with clinical outcomes and/or the intraoperative appearance of the femoral head. Four of 20 patients (20%) had bone scan features of avascular necrosis, defined as "absent" or "moderately diminished" femoral head activity, which were confirmed intraoperatively and resulted in poor outcomes. CONCLUSION: Radionuclide imaging of hips in the postoperative setting is a valuable modality for assessing the risk of avascular necrosis, a complication of femoral neck fractures and SCFE and for evaluating the restoration of flow to the capital femoral epiphyses of children with Legg-Calvé-Perthes disease.


Asunto(s)
Fracturas del Cuello Femoral/cirugía , Necrosis de la Cabeza Femoral/diagnóstico por imagen , Enfermedad de Legg-Calve-Perthes/cirugía , Complicaciones Posoperatorias/diagnóstico por imagen , Cintigrafía , Epífisis Desprendida de Cabeza Femoral/cirugía , Adolescente , Niño , Preescolar , Femenino , Cabeza Femoral , Humanos , Masculino , Estudios Retrospectivos
2.
Clin Imaging ; 69: 233-237, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32977195

RESUMEN

Bizarre parosteal osteochondromatous proliferation (BPOP) or Nora's lesion, is a rare benign surface-based bone lesion most commonly involving the tubular bones of hands and feet. We report an unusual case of BPOP affecting the distal ulna in a 22-year-old man who presented with a painless wrist mass following injury and was successfully treated with surgical resection. We focus on multi-modality imaging, histopathology, and differential diagnosis (including osteochondroma, florid reactive periostitis, myositis ossificans, and surface-type osteosarcoma), as well as a review of the literature regarding recent concepts on etiology and evolution, spectrum of imaging characteristics and diagnostic overlap, histopathology, as well as treatment options.


Asunto(s)
Neoplasias Óseas , Osteocondroma , Adulto , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/cirugía , Proliferación Celular , Humanos , Masculino , Osteocondroma/diagnóstico por imagen , Osteocondroma/cirugía , Cúbito/diagnóstico por imagen , Cúbito/cirugía , Articulación de la Muñeca , Adulto Joven
3.
J Orthop ; 16(6): 596-602, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31708608

RESUMEN

BACKGROUND: There are different treatments as well as controversies surrounding the adequate treatment for Distal Radius Fractures (DRF). In the absence of enough evidence[HYPHEN]base data regarding clinical effectiveness of available treatments, cost should be considered as an essential factor in selecting the surgical technique for DRF treatment. The goal of this study is introducing an improved and modified pin[HYPHEN]and[HYPHEN]plaster (MP&P) technique as an affordable alternative for treatment of DRF. This study also assesses and compares the outcomes of DRF treatment by using the introduced method versus external fixation (EF) technique. METHODS: In this clinical cohort study, 98 patients presenting with closed DRF Types III or IV, randomly were classified into two modified P&P (50 patients) and EF (48 patients) groups and assessed for functional, clinical, radiographic and overall outcome at the time, 2, 10 and 22 months after surgery. They were also followed[HYPHEN]up for up to 3 years to determine the rate of complications. RESULTS: Eighty one percent of EF and 86% of MP&P group were female. The average ages in the EF and MP&P groups were 44.9 ± 12.4 and 46.1 ± 5.4, respectively. Around 70% of the patients in each group had a Type III fracture, and 30% had Type IV. The rate of complications was higher among EF group patients (seven major and seven minor complications) compared to the MP&P (only 4 minor complications), however the difference between two groups regarding the complications and treatment outcome were insignificant, except in extension ROM and the quick[HYPHEN]dash score (only in two and four months follow up visits) and also returning to work (only in two month follow up visit). CONCLUSION: This study introduces a modified P&P technique that protects the transverse palmar curvature, prevents the collapse of the distal radius, and simplifies casting, thereby obviating a full arm cast and mitigating elbow stiffness in patient outcomes. This modified technique could be considered as a more cost[HYPHEN]conscious alternative to external fixation for patients with distal radius fractures.

4.
J Am Coll Radiol ; 16(7): 983-991, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30745038

RESUMEN

RATIONALE AND OBJECTIVES: Diagnostic radiology training programs are less diverse than graduating US medical school classes and the patient populations they serve. Inclusion of physicians who are underrepresented minorities in medicine (URMM) can strengthen the profession and help to meet the needs of an increasingly diverse population. Our Department of Radiology developed and implemented a plan to increase the number of URMMs in our residency applicant pool and residency training program. MATERIALS AND METHODS: We designed a recruitment strategy to diversify the radiology residency applicant pool. This included website development, advertising, early exposure opportunities, travel to predominantly minority institutions and national meetings, and mentoring URMM medical students. We implemented parallel activities to increase the number of URMMs in our residency program. These included holistic screening tools for residency application review, a diverse residency recruitment committee, a welcome environment for visiting candidates, and "Second Look Weekend" visits for talented candidates. Primary outcomes measured include change in percentages of URMM applicants in our applicant pool and URMM residents in our residency program. RESULTS: The percentage of URMM radiology residency applicants increased from 7.5% (42 of 556) of the total applicant pool in the 2012 to 2013 recruitment year to 12.6% (98 of 777) in the 2017 to 2018 recruitment year (P = .001). URMM radiology residency representation increased from 0% (0 of 32) in the 2013 to 2014 academic year to 20% (6 of 30) in the 2018 to 2019 academic year (P = .01). CONCLUSION: An intentional, strategic diversity program can diversify an institution's residency applicant pool and increase representation of URMMs in a diagnostic radiology residency program.


Asunto(s)
Educación de Postgrado en Medicina/organización & administración , Educación de Pregrado en Medicina/organización & administración , Grupos Minoritarios/educación , Radiología/organización & administración , Criterios de Admisión Escolar , Selección de Profesión , Femenino , Humanos , Masculino , Evaluación de Necesidades , Evaluación de Programas y Proyectos de Salud , Facultades de Medicina/organización & administración , Sesgo de Selección , Estudiantes de Medicina/estadística & datos numéricos , Estados Unidos
5.
Perm J ; 22: 17-120, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-29702056

RESUMEN

CONTEXT: Psychiatric comorbidity is common in orthopedic injury, but the effects on hospital care outcomes have been identified only generally. OBJECTIVE: To quantify psychiatric comorbidity and its outcome effects in a large, multicenter population of inpatients with orthopedic injuries. DESIGN: Retrospective analysis of patient discharge data from 507 California hospitals from 2001 to 2010. Study sample included orthopedic diagnoses using International Classification of Diseases codes for major pelvic and lower extremity injuries in patients older than age 17 years. From the injury data, we extracted psychiatric diagnoses, alcoholism, substance abuse, and sociodemographic characteristics. MAIN OUTCOME MEASURES: Length of stay, surgical complications, and inpatient deaths. RESULTS: The entire injury admissions represented about 1.9% of all hospital admissions and were predominantly older than age 64 years, white, and women with conventional health care insurance. The most common comorbidity in the patients with injury was psychiatric illness (24.7%). The most common psychiatric diagnoses in orthopedic injury admissions were dementia (14.3%) and depression (6.9%) without association. Compared with the injury admissions with no psychiatric diagnosis, admissions with psychiatric diagnosis had higher odds of a hospital stay of 7 or more days, surgical treatment complications, and inhospital death. CONCLUSION: Psychiatric comorbidity adversely affects several hospital outcomes in patients with orthopedic injuries: Length of stay, surgical complications, and inpatient mortality. In low-income populations, the adverse psychiatric effects are incrementally worse. The adverse effects of psychiatric comorbidity, particularly dementia and depression, on hospital outcomes should stimulate improved psychiatric care of many patients at risk of poor clinical outcomes.


Asunto(s)
Tiempo de Internación/estadística & datos numéricos , Trastornos Mentales/epidemiología , Heridas y Lesiones/epidemiología , Heridas y Lesiones/cirugía , Adulto , Factores de Edad , Anciano , California , Comorbilidad , Estudios Transversales , Femenino , Fracturas Óseas/epidemiología , Gastos en Salud/estadística & datos numéricos , Mortalidad Hospitalaria/tendencias , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Grupos Raciales/estadística & datos numéricos , Estudios Retrospectivos , Factores Sexuales , Factores Socioeconómicos , Trastornos Relacionados con Sustancias/epidemiología
6.
Clin Orthop Surg ; 8(1): 19-28, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26929795

RESUMEN

BACKGROUND: It is debatable whether a managed care model would affect the quality of care and length of hospital stay in the treatment of hip fractures in elderly patients. METHODS: This prospective study was undertaken to determine whether or not a managed care critical pathway tool shortened hospital stay in a group of 102 senior patients with fractures of the hip during follow-up. We compared our study findings with two equivalent populations of senior hip fracture patients not treated using a critical care pathway concerning specific markers of quality. RESULTS: The managed care group had a 9% mortality rate, 95% return to prefracture living and 63% return to ambulatory status. The rates compared favorably with previous studies. The quality of care provided before and after the critical pathway was equivalent, while the post-pathway length of stay dropped 30%. CONCLUSIONS: The proposed care protocol is recommended to shorten hospital stay in elderly patients with hip fractures.


Asunto(s)
Fracturas de Cadera/epidemiología , Fracturas de Cadera/terapia , Tiempo de Internación/estadística & datos numéricos , Programas Controlados de Atención en Salud/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Femenino , Fracturas de Cadera/mortalidad , Humanos , Los Angeles/epidemiología , Masculino , Persona de Mediana Edad , Readmisión del Paciente , Complicaciones Posoperatorias , Estudios Prospectivos , Calidad de la Atención de Salud
7.
J Orthop ; 13(1): 43-7, 2016 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-26955223

RESUMEN

BACKGROUND: Computerized tomography (CT) is the gold standard technique for tibial torsion assessment. This study compared two methods of tibial torsion assessment and proposed a new method, which could be of value in cases of abnormal fibular changes. METHODS: The CT-scanograms of 60 participants were assessed by using two different techniques, differed in determination of the distal tibial axis. RESULTS: The interobserver reliability was 0.861 and 0.863 in the first and second methods, respectively. The intraobserver reliability in both measurement methods was 0.868. CONCLUSIONS: We proposed a reliable method, independent of the fibular midpoint, in assessment of tibial torsion by CT.

8.
J Hand Microsurg ; 8(3): 127-133, 2016 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-28018057

RESUMEN

Background The outcomes of treating severe wrist injuries are not well understood and despite their complexity and prevalence, particularly among young adults, spaghetti wrist is rarely investigated. The aim of this study is to evaluate the postsurgery, functional outcome of spaghetti wrist injuries. Material and Methods In this prospective cross-sectional study, 153 patients with spaghetti wrist injuries were followed up for approximately 20 months and were assessed regarding returning to work and postsurgical functional outcomes that included tendon functionality, opposition, intrinsic function, deformity, sensation, and grip strength. Results The mean age was 28.3 ± 5 years. The most common cause of injury was glass window panes and bottles. Moreover, the most commonly involved structures were the tendons of flexor digitorum superficialis 3, 4, and 5. During the follow-up, the tendon functionality in 120 (78%), opposition in 115 (75.1%), and intrinsic function in 62 (40.5%) were "excellent." Hand sensation was "fair" in 75 patients (49.1%), "good" in 46 patients (30%), and "excellent" in 28 patients (18.3%). The average return time to activities of daily living was 10 months. Conclusion In this study, worse outcomes were seen in older patients and those with higher number of damaged structures (especially nerves).

9.
J Orthop ; 12(4): 179-83, 2015 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26566316

RESUMEN

BACKGROUND: Bone-Patellar Tendon-Bone Graft is one of the most acceptable methods of treatment for Anterior Cruciate Ligament rupture (ACL). This study evaluates the recovery process of the graft donor site. METHODS: This study evaluates the graft donor site recovery in 23 patients with ACL reconstruction, 6 and 12 months after the patellar tendon graft surgery. RESULTS: In 70 percent of the cases, the healing process was completed after 6 months and the remaining 30 percent recovered after 12 months. CONCLUSION: Time is an important factor in the recovery process of the patellar tendon for reconstruction of the ACL.

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