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BACKGROUND: The authors modified the anterolateral approach for Holstein-Lewis humeral shaft fractures using a plating technique to achieve sufficient distal fixation by minimal splitting of the brachioradialis muscle to fix the most distal screws. The purpose of this retrospective study was to evaluate the efficacy of our modified anterolateral approach for Holstein-Lewis humeral fractures and document clinical and functional results. MATERIALS AND METHODS: Between 2008 and 2014, 18 patients (mean age 35.4 years) with a Holstein-Lewis humeral shaft fracture who underwent open reduction and internal fixation with a plate and screws using the modified anterolateral approach and followed for a minimum of 12 months were included. Radiologic fracture configurations, number of distal cortical fixations, union rate, and time to union were analyzed. Clinical outcomes were evaluated using the Mayo elbow performance index system, range of elbow motion, and postoperative complications. RESULTS: Mean fracture length was 60.2 ± 10.2 mm (range 49.2-77.2) and mean distal cortical length was 41.4 ± 7.04 mm (range 22.8-59.6). Distal fragments were fixed at a minimum of six cortical points (range 6-8) in all cases using the modified anterolateral approach. Average time to union was 10.5 weeks (range 8-12 weeks). All cases of radial nerve palsy completely recovered within 3 months. Mean elbow range of motion at final follow-up was 3.2 degrees of flexion contracture (range 0-10) and 135.4 degrees of further flexion (range 120-140), and the average Mayo elbow performance score was 96.3 points (range 90-100). There were no non-union or metal failures. CONCLUSIONS: The results obtained indicate that the modified anterolateral approach is a safe and easy accessible method that provides sufficient distal osseous fixation for Holstein-Lewis humeral shaft fractures without serious complications. The modified anterolateral approach for plate osteosynthesis appears to be one of the most available options for the treatment of Holstein-Lewis humeral fractures. LEVEL OF EVIDENCE: Level IV, retrospective case series.
Assuntos
Placas Ósseas , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Adulto , Idoso , Estudos de Coortes , Feminino , Fluoroscopia/métodos , Seguimentos , Fixação Interna de Fraturas/instrumentação , Consolidação da Fratura/fisiologia , Humanos , Fraturas do Úmero/diagnóstico por imagem , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Radiografia/métodos , Estudos Retrospectivos , Medição de RiscoRESUMO
Knee dislocation following total knee replacement arthroplasty is a rare but serious complication. The incidence of dislocation following primary total knee arthroplasty with posterior stabilized implants ranges from 0.15 to 0.5%, and posterior dislocation after revision total knee arthroplasty is even rarer. Here, we report the case of a 76-year-old male who presented with posterior dislocation after posterior stabilized revision total knee arthroplasty.
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Artroplastia do Joelho , Luxação do Joelho , Osteólise , Complicações Pós-Operatórias , Reoperação/métodos , Idoso , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Humanos , Luxação do Joelho/diagnóstico , Luxação do Joelho/etiologia , Luxação do Joelho/cirurgia , Prótese do Joelho/efeitos adversos , Masculino , Osteólise/diagnóstico , Osteólise/etiologia , Osteólise/cirurgia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Resultado do TratamentoRESUMO
Fatigue stress fractures of the talus are rare and usually involve the head of the talus in military recruits. We report an uncommon cause of ankle pain due to a fatigue stress fracture of the body of the talus in a 32-year-old male social soccer player. Healing was achieved after weightbearing suppression for 6 weeks. Although rare, a stress fracture of the body of the talus should be considered in an athlete with a gradual onset of chronic ankle pain. Magnetic resonance imaging and bone scan are useful tools for early diagnosis.
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Fraturas de Estresse/diagnóstico por imagem , Fraturas de Estresse/terapia , Imagem Multimodal , Tálus/diagnóstico por imagem , Tálus/lesões , Adulto , Tornozelo/fisiopatologia , Tratamento Conservador/métodos , Seguimentos , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Dor/diagnóstico , Dor/etiologia , Medição da Dor , Tomografia por Emissão de Pósitrons/métodos , Radiografia/métodos , Recuperação de Função Fisiológica , Futebol/lesõesRESUMO
Water supply systems are mainly classified into branched and looped network systems. The main difference between these two systems is that, in a branched network system, the flow within each pipe is a known value, whereas in a looped network system, the flow in each pipe is considered an unknown value. Therefore, an analysis of a looped network system is a more complex task. This study aims to develop a technique for estimating the optimal pipe diameter for a looped agricultural irrigation water supply system using a harmony search algorithm, which is an optimization technique. This study mainly serves two purposes. The first is to develop an algorithm and a program for estimating a cost-effective pipe diameter for agricultural irrigation water supply systems using optimization techniques. The second is to validate the developed program by applying the proposed optimized cost-effective pipe diameter to an actual study region (Saemangeum project area, zone 6). The results suggest that the optimal design program, which applies an optimization theory and enhances user convenience, can be effectively applied for the real systems of a looped agricultural irrigation water supply.
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Atypical femoral fractures have unique radiologic and clinical feature. Most commonly used fixation method for atypical femoral fracture is interlocking intramedullary (IM) nailing. The aim of this paper is to document a rare case of a 76-year-old female who sustained bilateral proximal femoral insufficiency fractures after conventional interlocking IM nailing for bilateral atypical femoral shaft fractures without taking history of bisphosphonates. We recommend the routine use of full-length reconstruction or cephalomedullary-type interlocking IM nail for atypical femoral fractures.
Assuntos
Fraturas do Fêmur/etiologia , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/efeitos adversos , Fraturas de Estresse/etiologia , Idoso , Parafusos Ósseos , Feminino , Consolidação da Fratura , Fraturas de Estresse/cirurgia , HumanosRESUMO
Orbital fractures are frequently observed in maxillofacial trauma and can cause a wide range of functional impairments and esthetic deformities. Many approaches have been used for the repair of medial orbital wall fractures. It has been necessary to use grafts or splints in these approaches. We introduced a new technique to treat our patient with diplopia that resulted from a medial orbital fracture. In this new method that involves rotational repositioning of the fractured segment, there is no need for a graft from another location or synthetic material. This technique has several advantages compared with using synthetic materials or other types of autogenous grafts. However, the limitation of this method is that our technique cannot be applied to all cases of medial orbital wall fracture.
Assuntos
Endoscopia , Cavidade Nasal/cirurgia , Fraturas Orbitárias/cirurgia , Adolescente , Diplopia/etiologia , Humanos , Masculino , Rotação , Resultado do TratamentoRESUMO
Background: To investigate the doctor shopping trend of patients with rotator cuff tear (RCT) before undergoing surgery and the relevance of the results to the public. Methods: A survey was conducted of 326 patients from 10 hospitals (male, 176; female, 150) who underwent arthroscopic rotator cuff repair (ARCR) for symptomatic RCT between September 2019 and February 2020. A questionnaire was used to obtain data regarding the type of medical care service, medical institutions visited before surgery, number of treatments received, and cost of treatment. Results: A total of 326 patients (87%) received treatment at least once at another medical institution before visiting the hospital where the surgery was performed. Patients visited an average of 9.4 health providers or physicians for shoulder pain before visiting the hospital where surgery was performed. Among the 326 patients, 148 (45%) visited more than two medical institutions and spent an average of 641,983 Korean won (KRW; $466, 50,000-5,000,000 KRW) before surgery. Medical expenses before surgery were proportional to the number of medical institutions visited (P=0.002), symptom duration (P=0.002), and initial visual analog scale (VAS) pain score (P=0.007) but were not associated with gender, age, VAS pain score immediately before surgery, or RCT size. Conclusions: Medical expense before ARCR was associated with the severity of preoperative pain and duration of symptoms. After onset of shoulder symptoms, patients should visit as soon as possible a hospital that has surgeons who specialize in shoulder repair to prevent unnecessary medical expense and proper treatment.
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Hanging is a common method of suicide. We present a case of vallecular rupture and cervical spine fracture without an external wound after a failed hanging suicide attempt. Surgical treatment involved posterior fusion of C2 to 3, followed by repair of the vallecular rupture via an external approach. The patient recovered with no residual physical or mental sequelae.
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Vértebras Cervicais/lesões , Lesões do Pescoço/complicações , Fraturas da Coluna Vertebral/etiologia , Tentativa de Suicídio , Língua/lesões , Adulto , Vértebras Cervicais/cirurgia , Fraturas Ósseas/etiologia , Fraturas Ósseas/cirurgia , Humanos , Osso Hioide/lesões , Osso Hioide/cirurgia , Imageamento Tridimensional , Masculino , Ruptura , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral , Enfisema Subcutâneo/etiologia , Tomografia Computadorizada por Raios X , Língua/cirurgiaRESUMO
Bifocal disruption of the knee extensor mechanism is a rare injury. Bifocal proximal and distal avulsion fracture of the patella tendon is extremely rare in adults. Here, the authors report the case of an 84-year-old male patient who developed simultaneous avulsion fracture of the patella tendon from the inferior pole of the patella and the tibial tuberosity. Open reduction and internal fixation were performed, and at 12 months postoperatively, an excellent functional result was obtained.
Assuntos
Traumatismos do Joelho/cirurgia , Ligamento Patelar/lesões , Traumatismos dos Tendões/cirurgia , Idoso de 80 Anos ou mais , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Masculino , Ligamento Patelar/diagnóstico por imagem , Radiografia , Traumatismos dos Tendões/diagnóstico por imagemRESUMO
Acute calcific tendinitis of the shoulder is a well-known condition, but it is rare in the rectus femoris origin. Mostly reported cases were occurred in the reflected head of the rectus femoris, and only few cases were in the direct head of the rectus femoris. Intraosseous marrow involvement of calcific tendinitis is a more rare condition; it often goes misdiagnosed as an infection or a neoplasm. We report a rare, unusual case of acute calcific tendinitis of the direct head of the rectus femoris associated with intraosseous marrow involvement of calcification in anterior inferior iliac spine with serial CT and MRI findings. Aggressive osseous change may occur in acute calcific tendinitis of the rectus femoris as in this case which should be made an appropriate diagnosis to avoid unnecessary investigation and overtreatment like a surgery.
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Doenças da Medula Óssea/diagnóstico , Calcinose/diagnóstico , Tendinopatia/diagnóstico , Doença Aguda , Adulto , Anti-Inflamatórios/uso terapêutico , Biópsia por Agulha , Medula Óssea/patologia , Calcinose/tratamento farmacológico , Humanos , Ílio , Imageamento por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Músculo Quadríceps , Tendinopatia/tratamento farmacológico , Tomografia Computadorizada por Raios XRESUMO
Scaphocapitate fracture syndrome is rare, complex injury. We report an unusual presentation of scaphocapitate fracture syndrome, involving fracture of the scaphoid and capitate associated with volar dislocation of the lunate and scaphoid and the proximal fragment of the capitate in a 30-year-old male after a motor vehicle accident. Computed tomography was found to be helpful for achieving the correct diagnosis. Open reduction and internal fixation was performed. The scaphoid fracture was fixed using a headless compression screw, and the volar displaced proximal fragment of the capitate was reduced to its original position, but could not be fixed because of severe comminution. This case cautions that the capitate fragment should not be excised even when it cannot be fixed due to comminution.
Assuntos
Capitato/lesões , Fraturas Ósseas/cirurgia , Luxações Articulares/cirurgia , Osso Escafoide/lesões , Traumatismos do Punho/cirurgia , Adulto , Capitato/diagnóstico por imagem , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Humanos , Luxações Articulares/diagnóstico por imagem , Osso Semilunar/diagnóstico por imagem , Masculino , Osso Escafoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Traumatismos do Punho/diagnóstico por imagemAssuntos
Lipoma/complicações , Síndromes de Compressão do Nervo Ulnar/etiologia , Diagnóstico Diferencial , Dissecação/métodos , Mãos , Humanos , Lipoma/diagnóstico , Lipoma/cirurgia , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão do Nervo Ulnar/diagnóstico , Síndromes de Compressão do Nervo Ulnar/cirurgiaRESUMO
An intraarticular osteoid osteoma of the knee is uncommon, and its treatment is challenging. The authors present a case of arthroscopic excision of an intraarticular osteoid osteoma in the distal femur, which was accessible through the knee joint. After confirming the nidus of the osteoid osteoma by computed tomography, the lesion was completely removed arthroscopically. The patient reported complete pain relief immediately after surgery. This case demonstrates that intraarticular osteoid osteomas in the knee joint can be treated by arthroscopic excision and that good results can be obtained.
Assuntos
Artroscopia , Fêmur , Osteoma Osteoide , Adulto , Feminino , Fêmur/diagnóstico por imagem , Fêmur/patologia , Fêmur/cirurgia , Humanos , Osteoma Osteoide/diagnóstico por imagem , Osteoma Osteoide/patologia , Osteoma Osteoide/cirurgia , Cirurgia Assistida por Computador , Adulto JovemRESUMO
Verrucous carcinoma of the foot is a rare malignancy, and proper diagnosis can be delayed. Furthermore, misdiagnosis often results in delayed appropriate treatment. Herein, we present an unusual case of verrucous carcinoma of the fifth toe with bone invasion in a 63-year-old woman that was mistaken for a plantar wart for 3 years. The condition was treated by ray amputation. We emphasize the need for appropriate biopsy to achieve an accurate diagnosis.
Assuntos
Neoplasias Ósseas/patologia , Carcinoma Verrucoso/patologia , Doenças do Pé/diagnóstico , Neoplasias Cutâneas/patologia , Verrugas/patologia , Amputação Cirúrgica/métodos , Biópsia por Agulha , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Carcinoma Verrucoso/diagnóstico , Carcinoma Verrucoso/cirurgia , Diagnóstico Diferencial , Erros de Diagnóstico , Feminino , Doenças do Pé/patologia , Doenças do Pé/cirurgia , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Invasividade Neoplásica/patologia , Medição de Risco , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/cirurgia , Dedos do Pé/patologia , Dedos do Pé/cirurgia , Resultado do Tratamento , Verrugas/diagnósticoRESUMO
PURPOSE: Occult intertrochanteric fractures are misdiagnosed as isolated greater trochanteric fractures in some cases. We investigated the utility of three-dimensional computed tomography (3D-CT) and magnetic resonance imaging (MRI) in the diagnosis and outcome management of occult intertrochanteric fractures. MATERIALS AND METHODS: This study involved 23 cases of greater trochanteric fractures as diagnosed using plain radiographs from January 2004 to July 2013. Until January 2008, 9 cases were examined with 3D-CT only, while 14 cases were screened with both 3D-CT and MRI scans. We analyzed diagnostic accuracy and treatment results following 3D-CT and MRI scanning. RESULTS: Nine cases that underwent 3D-CT only were diagnosed with isolated greater trochanteric fractures without occult intertrochanteric fractures. Of these, a patient with displacement received surgical treatment. Of the 14 patients screened using both CT and MRI, 13 were diagnosed with occult intertrochanteric fractures. Of these, 11 were treated with surgical intervention and 2 with conservative management. CONCLUSION: Three-dimensional CT has very low diagnostic accuracy in diagnosing occult intertrochanteric fractures. For this reason, MRI is recommended to confirm a suspected occult intertrochanteric fracture and to determine the most appropriate mode of treatment.
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BACKGROUND: As there is substantial variation in the classification and diagnosis of lateral clavicle fractures, proper management can be challenging. Although the Neer classification system modified by Craig has been widely used, no study has assessed its validity through inter- and intrarater agreement. PURPOSE: To determine the inter- and intrarater agreement of the modified Neer classification system and associated treatment choice for lateral clavicle fractures and to assess whether 3-dimensional computed tomography (3D CT) improves the level of agreement. STUDY DESIGN: Cohort study (diagnosis); Level of evidence, 3. METHODS: Nine experienced shoulder specialists and 9 orthopaedic fellows evaluated 52 patients with lateral clavicle fractures, completing fracture typing according to the modified Neer classification system and selecting a treatment choice for each case. Web-based assessment was performed using plain radiographs only, followed by the addition of 3D CT images 2 weeks later. This procedure was repeated 4 weeks later. Fleiss κ values were calculated to estimate the inter- and intrarater agreement. RESULTS: Based on plain radiographs only, the inter- and intrarater agreement of the modified Neer classification system was regarded as fair (κ = 0.344) and moderate (κ = 0.496), respectively; the inter- and intrarater agreement of treatment choice was both regarded as moderate (κ = 0.465 and 0.555, respectively). Based on the plain radiographs and 3D CT images, the inter- and intrarater agreement of the classification system was regarded as fair (κ = 0.317) and moderate (κ = 0.508), respectively; the inter- and intrarater agreement of treatment choice was regarded as moderate (κ = 0.463) and substantial (κ = 0.623), respectively. There were no significant differences in the level of agreement between the plain radiographs only and plain radiographs plus 3D CT images for any κ values (all P > .05). CONCLUSION: The level of interrater agreement of the modified Neer classification system for lateral clavicle fractures was fair. Additional 3D CT did not improve the overall level of interrater or intrarater agreement of the modified Neer classification system or associated treatment choice. To eliminate a common source of disagreement among surgeons, a new classification system to focus on unclassifiable fracture types is needed.
Assuntos
Clavícula/lesões , Fixação de Fratura , Fraturas Ósseas/classificação , Imageamento Tridimensional , Tomografia Computadorizada por Raios X/métodos , Adolescente , Adulto , Idoso , Clavícula/diagnóstico por imagem , Clavícula/cirurgia , Feminino , Seguimentos , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Reprodutibilidade dos Testes , Adulto JovemRESUMO
Percutaneous iliosacral screw fixation is commonly practiced to treat unstable posterior pelvic ring injuries. The number of reported cases of iatrogenic complications is increasing. We present a case of superior gluteal artery injury during bilateral percutaneous iliosacral screw fixation in a patient with sacral fracture of spino-pelvic dissociation. This complication was managed by arterial embolization. We discussed the cause, prevention and treatment of arterial injury along with a review of literature.
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Dislocation of the rotating platform is a significant early complication of mobile-bearing total knee arthroplasty. The authors report an unusual case of acute 180° rotatory dislocation of the rotating platform after closed reduction of a posterior dislocation of a posterior-stabilized mobile-bearing total knee prosthesis. A 71-year-old male with knee osteoarthritis underwent TKRA using a posterior-stabilized mobile-bearing prosthesis. Posterior dislocation of the prosthesis occurred at 5 weeks postoperatively, and closed reduction of the posterior dislocation resulted in complete 180° rotatory dislocation of the rotating platform. The patient was treated by open exploration and polyethylene exchange for a larger component. This case illustrates that dislocation of a posterior-stabilized mobile-bearing total knee prosthesis can occur given valgus laxity and causes a 90° spin-out of the polyethylene insert, and that closed reduction attempts may contribute to complete 180° rotatory dislocation of the rotating platform. Special attention should be given to both AP and lateral views to ensure that the platform is truly reduced and not rotated by 180°. Plain digital radiography, which enhances the density of polyethylene, or arthrography is helpful for diagnosing this complication.
Assuntos
Luxação do Joelho/etiologia , Luxação do Joelho/terapia , Prótese do Joelho/efeitos adversos , Manipulação Ortopédica/efeitos adversos , Falha de Prótese , Idoso , Artroplastia do Joelho , Humanos , Luxação do Joelho/diagnóstico por imagem , Masculino , Desenho de Prótese , Radiografia , ReoperaçãoRESUMO
The authors describe a case of simultaneous anterior dislocation of the radial head with plastic deformation of the ulna and an ipsilateral medial humeral condyle fracture in a 6-year-old boy after a fall on an outstretched hand. This rare combination of injuries has not been described previously in the literature. Closed reduction of the dislocated radial head and percutaneous K-wire fixation of the medial humeral condyle fracture achieved an excellent result with full function. This rare combination of injuries is considered to be an unusual subtype of the Bado type I Monteggia equivalent lesion. The case emphasizes that when a fracture is detected around an elbow, other injuries in the region should be suspected.
Assuntos
Lesões no Cotovelo , Fraturas do Úmero/complicações , Luxações Articulares/complicações , Fratura de Monteggia/complicações , Rádio (Anatomia)/lesões , Criança , Humanos , Fraturas do Úmero/diagnóstico , Fraturas do Úmero/terapia , Luxações Articulares/diagnóstico , Luxações Articulares/terapia , Masculino , Fratura de Monteggia/diagnóstico , Fratura de Monteggia/terapiaRESUMO
OBJECTIVES: Glucocorticoids, such as dexamethasone (DEX), increase apoptosis in a variety of white cells in nasal polyps and apoptosis is an important factor in the resolution of inflammation. However, the mechanism of glucocorticoids induced apoptosis in nasal polyp remains unclear. In this study the authors evaluated which pathways were engaged in apoptosis induced by DEX in an ex vivo model of nasal polyps. METHODS: Nasal polyp tissues were cultured using an air-liquid interface method. Cultures were maintained in the absence or presence of DEX (10 or 100 µM) for 24 hours. To investigate the involvement of the apoptotic signaling pathways in nasal polyp, such as caspase cascades, Fas-FasL signaling pathway, mitochondrial pathway and p38 mitogen-activated protein kinase (MAPK)/JNK pathway, the authors performed reverse transcription-polymerase chain reaction and Western blotting. RESULTS: The expression ratios of FasL, activated form of caspase-8, caspase-9, and caspase-3 were significantly higher in DEX-treated polyps (P<0.01). In the Bcl-2 family expression, the anti-apoptotic molecules, Bcl-2 and Bcl-XL decreased, but pro-apoptotic molecules, Bax increased, and Bid and Bad were activated. In the conventional MAPKs, JNK, and the phospho-p38 MAPK were significantly higher, but phospho-extracellular signal-regulated kinase (ERK)1/2 was significantly lower in DEX-treated polyps (P<0.01). CONCLUSION: DEX induces apoptosis of nasal polyp via caspase cascades, Fas-FasL signaling pathway, mitochondrial pathway and p38 MAPK/JNK pathway.