ABSTRACT
Objetivo. Evaluar la relación entre el Notching y los resultados clínico-funcionales y radiológicos tras el tratamiento de las fracturas de húmero proximal con prótesis invertida de hombro (PTHi). Material y métodos. Estudio retrospectivo de 37 pacientes con fracturas de húmero proximal tratadas mediante PTHi con seguimiento medio de 24 meses. Se evaluó: tipo de fractura, rango de movilidad postoperatoria (antepulsión [AP], abducción [ABD], rotación externa [RE] y rotación interna [RI]), complicaciones y grado de satisfacción del paciente mediante la escala de Constant (CS). Se constató desarrollo de Notching según la clasificación de Nerot. Análisis estadístico de la relación Notching-posición de la glenosfera y resultados funcionales. Resultados. Los rangos medios de movilidad fueron AP 106,22°, ABD 104,46°, RE 46,08° y RI 40,27°. Se produjo Notching en el 29% de los pacientes al año de seguimiento. El valor medio del CS fue de 63 a los 18 meses post-IQ. Fueron estadísticamente no significativas las relaciones: Notching - balance articular final, Notching - CS, Notching - ángulo del cuello de la escápula, Notching - ángulo de la glena, Notching - distancia del bulón al borde inferior de la glena. Se encontró significación estadística entre la edad y el desarrollo de Notching y el Notching y el Tilt glenoideo. Conclusiones. La PTHi es una opción en pacientes con osteoporosis y artropatía del manguito rotador que presentan fractura humeral proximal. Permite alivio rápido del dolor y una funcionalidad aceptable. No está exenta de complicaciones: son necesarios estudios a largo plazo para determinar la relevancia del Notching (AU)
Objective. An analysis was made on relationship between Notching and functional and radiographic parameters after treatment of acute proximal humeral fractures with reverse total shoulder arthroplasty. Methods. A retrospective evaluation was performed on 37 patients with acute proximal humeral fracture treated by reversed shoulder arthroplasty. The mean follow-up was 24 months. Range of motion, intraoperative and postoperative complications were recorded. Nerot's classification was used to evaluate Notching. Patient satisfaction was evaluated with the Constant Score (CS). Statistical analysis was performed to evaluate the relationship between Notching and glenosphere position, or functional outcomes. Results. Mean range of elevation, abduction, external and internal rotation were 106.22°, 104.46°, 46.08° and 40.27°, respectively. Mean CS was 63. Notching was present at 12 months in 29% of patients. Statistical analysis showed significance differences between age and CS, age and notching development, and tilt with notching. No statistical significance differences were found between elevation, abduction, internal and external rotation and CS either with scapular or glenosphere-neck angle. Conclusion. Reverse shoulder arthroplasty is a valuable option for acute humeral fractures in patients with osteoporosis and cuff-tear arthropathy. It leads to early pain relief and shoulder motion. Nevertheless, it is not exempt from complications, and long-term studies are needed to determine the importance of notching (AU)
Subject(s)
Aged , Female , Humans , Male , Humeral Fractures/surgery , Arthroplasty/methods , Shoulder Fractures/surgery , Shoulder Fractures , Osteoporosis/complications , Osteoporosis/diagnosis , Retrospective Studies , Shoulder/surgery , Clinical Protocols , Fluoroscopy/instrumentation , Fluoroscopy/methods , Fluoroscopy , Scapula/injuries , ScapulaABSTRACT
OBJECTIVE: An analysis was made on relationship between Notching and functional and radiographic parameters after treatment of acute proximal humeral fractures with reverse total shoulder arthroplasty. METHODS: A retrospective evaluation was performed on 37 patients with acute proximal humeral fracture treated by reversed shoulder arthroplasty. The mean follow-up was 24 months. Range of motion, intraoperative and postoperative complications were recorded. Nerot's classification was used to evaluate Notching. Patient satisfaction was evaluated with the Constant Score (CS). Statistical analysis was performed to evaluate the relationship between Notching and glenosphere position, or functional outcomes. RESULTS: Mean range of elevation, abduction, external and internal rotation were 106.22°, 104.46°, 46.08° and 40.27°, respectively. Mean CS was 63. Notching was present at 12 months in 29% of patients. Statistical analysis showed significance differences between age and CS, age and notching development, and tilt with notching. No statistical significance differences were found between elevation, abduction, internal and external rotation and CS either with scapular or glenosphere-neck angle. CONCLUSION: Reverse shoulder arthroplasty is a valuable option for acute humeral fractures in patients with osteoporosis and cuff-tear arthropathy. It leads to early pain relief and shoulder motion. Nevertheless, it is not exempt from complications, and long-term studies are needed to determine the importance of notching.
Subject(s)
Arthroplasty, Replacement, Shoulder/methods , Osteoporotic Fractures/surgery , Shoulder Fractures/surgery , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Male , Osteoporotic Fractures/diagnostic imaging , Osteoporotic Fractures/physiopathology , Postoperative Complications/diagnosis , Radiography , Retrospective Studies , Shoulder Fractures/diagnostic imaging , Shoulder Fractures/physiopathology , Treatment OutcomeABSTRACT
UNLABELLED: In comparison with hip fractures, increased expression of genes in the Wnt pathway and increased Wnt activity were found in bone samples and osteoblast cultures from patients with osteoarthritis, suggesting the involvement of this pathway in subchondral bone changes. No consistent differences were found in the genetic association study. INTRODUCTION: This study aims to explore the allelic variations and expression of Wnt pathway genes in patients with osteoporosis and osteoarthritis. METHODS: The expression of 86 genes was studied in bone samples and osteoblast primary cultures from patients with hip fractures and hip or knee osteoarthritis. The Wnt-related activity was assessed by measuring AXIN2 and in transfection experiments. Fifty-five SNPs of the LRP5, LRP6, FRZB, and SOST genes were analyzed in 1,128 patients. RESULTS: Several genes were differentially expressed in bone tissue, with the lowest values usually found in hip fracture and the highest in knee osteoarthritis. Overall, seven genes were consistently upregulated both in tissue samples and in cell cultures from patients with knee osteoarthritis (BCL9, FZD5, DVL2, EP300, FRZB, LRP5, and TCF7L1). The increased expression of AXIN2 and experiments of transient transfection of osteoblasts with the TOP-Flash construct confirmed the activation of Wnt signaling. Three SNPs of the LRP5 gene and one in the LRP6 gene showed marginally significant differences in allelic frequencies across the patient groups, but they did not resist multiple-test adjustment. CONCLUSIONS: Genes in the Wnt pathway are upregulated in the osteoarthritic bone, suggesting their involvement not only in cartilage distortion but also in subchondral bone changes.
Subject(s)
Osteoarthritis/genetics , Osteoporosis/genetics , Wnt Proteins/genetics , Aged , Aged, 80 and over , Cells, Cultured , Female , Gene Frequency , Genetic Association Studies/methods , Genetic Predisposition to Disease , Genotype , Hip Fractures/genetics , Hip Fractures/metabolism , Humans , Male , Osteoarthritis/metabolism , Osteoarthritis, Hip/genetics , Osteoarthritis, Hip/metabolism , Osteoarthritis, Knee/genetics , Osteoarthritis, Knee/metabolism , Osteoblasts/metabolism , Osteoporosis/metabolism , Polymorphism, Single Nucleotide , Signal Transduction/genetics , Up-Regulation , Wnt Proteins/metabolismABSTRACT
El propósito de este trabajo es estudiar las complicaciones del uso del arnés de Pavlik en la luxación congénita de cadera.Se revisaron restrospectivamente 60 pacientes con luxación congénita de cadera que fueron tratados con el arnés de Pavlik. El seguimiento fue de nueve años y ocho meses. La serie se compuso de nueve niños y 51 niñas. La cadera derecha estaba afectada en 20 ocasiones, la izquierda en 16 y en 24 casos la lesión era bilateral, por lo tanto el número total de caderas fue de 84. Todos los niños revisados presentaban un signo de Ortolani, de Barlow o telescopaje positivo.Las complicaciones se observaron en ocho casos, distribuidas de la forma siguiente: necrosis avascular, cuatro casos; insuficiente desarrollo acetabular, tres casos; y fallo al realizar reducción, un caso. Se analizan las causas de estas complicaciones, fundamentalmente la edad al inicio del tratamiento, la bilateralidad, la adecuación en la colocación del arnés y si la conducción de la cadera era: luxable, luxada reductible o irreductible (AU)
