ABSTRACT
PURPOSE: Three-dimensional (3D) capacity for remodelling in cubitus varus deformity (CVD) after paediatric supracondylar humeral fractures (PSHFs) remains unelucidated. This study investigated remodelling patterns after PSHFs by examining 3D deformity distribution over time after injury. METHODS: Computed tomography (CT) data of 86 patients with CVD after PSHFs were analysed. The 3D deformity angles in the sagittal, coronal, and axial directions were assessed and correlated with the duration between the age at injury and CT evaluation. For the subgroup analysis, we performed the same correlation analysis in a younger (< 8 years old) and an older group (≥ 8 years old); we categorized the duration into early (< 2 years), middle (≥ 2 to < 5 years), and late periods (≥ 5 years) and compared the deformity angles of each direction among the three groups. RESULTS: Sagittal deformity showed a moderate correlation with the duration of deformity (r = -0.54; P < 0.001), while coronal and axial deformities showed a negligible correlation. Sagittal deformity showed moderate correlations with the duration in the younger group (r = -0.62; P < 0.001) and weak correlations in the older group (r = -0.37; P = 0.091). In the sagittal direction, the deformity angle in the early period was significantly larger than those in the mid and late periods (P < 0.001). However, there were no significant differences among the three groups in the coronal and axial directions. CONCLUSION: Sagittal deformities in CVDs are capable of remodelling, especially in the early period and at a younger age, whereas coronal and axial deformities are less likely to undergo remodelling.
Subject(s)
Bone Remodeling , Humeral Fractures , Imaging, Three-Dimensional , Joint Deformities, Acquired , Tomography, X-Ray Computed , Humans , Child , Humeral Fractures/surgery , Humeral Fractures/complications , Male , Female , Child, Preschool , Bone Remodeling/physiology , Adolescent , Joint Deformities, Acquired/etiology , Joint Deformities, Acquired/physiopathology , Elbow Joint/physiopathology , Retrospective Studies , Elbow InjuriesABSTRACT
Con la osteotomía en un solo nivel, se puede lograr la corrección del eje de la extremidad en pacientes con deformidades combinadas femoral y tibial, pero de forma simultánea generará una alteración patológica de oblicuidad de la interlínea articular, lo que conducirá a elongación ligamentaria, inestabilidad, degeneración condral y, en última instancia, comprometerá su sobrevida y los resultados funcionales. En virtud del análisis de la literatura más reciente, podemos concluir que existe un número significativo de pacientes que requieren de un procedimiento combinado para lograr un objetivo biomecánico óptimo. La finalidad de una osteotomía en doble nivel alrededor de la rodilla consiste en restablecer la anatomía normal, descargar el compartimiento afectado, normalizar los ángulos mecánicos y la orientación de la interlínea articular. Los ejes fisiológicos pueden restablecerse a través de un análisis preoperatorio exhaustivo, respetando principios biomecánicos y fijación estable con placas bloqueadas. Es un procedimiento demandante y con indicaciones en evolución, que progresivamente se ha instaurado como una alternativa de tratamiento justificada en estudios clínicos y biomecánicos para el manejo de deformidades severas alrededor de la rodilla.
With single-level osteotomy, correction of the limb axis in patients with combined femoral and tibial deformities can be achieved. This correction, however, will generate a pathological alteration in the joint line oblicuity, leading to ligament elongation, instability, joint degeneration and, ultimately, it will compromise the longevity and functional results of the correction. By analyzing the most recent literature, we can conclude that there is a significant number of patients who require a combined procedure to achieve an optimal biomechanical goal. The purpose of a double-level osteotomy around the knee is to restore normal anatomy, unload the affected compartment, normalize the mechanical angles and the orientation of the joint line. Physiological axes can be reestablished by means of a thorough preoperative analysis, observing the biomechanical principles and stable fixation with locked plates. It is a demanding procedure with increasing indications, which has progressively been established in clinical and biomechanical studies as a justified treatment alternative for the management of severe deformities around the knee.
Subject(s)
Humans , Osteotomy/methods , Joint Deformities, Acquired/surgery , Knee Joint/physiopathology , Tibia/surgery , Biomechanical Phenomena , Joint Deformities, Acquired/physiopathology , Femur/surgerySubject(s)
Hip Fractures/surgery , Joint Deformities, Acquired/prevention & control , Patient Positioning/methods , Postoperative Complications/prevention & control , Traction/methods , Hip Fractures/complications , Hip Fractures/physiopathology , Hip Joint/physiopathology , Humans , Joint Deformities, Acquired/etiology , Joint Deformities, Acquired/physiopathology , Knee Joint/physiology , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Range of Motion, Articular , Traction/instrumentationABSTRACT
Background: Lateral humeral condylar fractures often heal with some residual elbow deformity. However, details of angulation or tilting angle of the lateral condyle after the fracture have not been evaluated so far. Methods: Between 2008 and 2016, we followed up 80 mild fractures of the lateral humeral condyle for more than a year. Thirty fractures were treated by open reduction and internal fixation (ORIF) with Kirschner wires. Fifty cases were treated with a long arm splint for 3 weeks (Fig. 1). The average age of the patients at the time of the injury was 5.5 years. The humerus-elbow-wrist angle (HEWA), Baumann's angle (BA), and tilting angle (TA) were measured on the radiographs. The active range of motion (ROM) was clinically assessed at unaffected and affected sides at the final follow-up. Results: No significant differences were detected between the sides about TA or ROM at the final follow-up. However, HEWA/ BA showed more significant loss of correction. There were significant differences in BA at the affected side between the ORIF and splint groups. Conclusions: Cubitus varus deformity after lateral humeral condylar fracture is not accompanied by a change in TA or ROM, unlike the deformity after supracondylar or distal epiphyseal fracture of the humerus (Fig. 2). Operative treatment to precisely correct and fix the lateral condylar fracture still retained some cubitus varus deformity, although it might lessen or prevent the deformity when compared to conservative treatment with a splint.
Subject(s)
Elbow Joint/physiopathology , Humeral Fractures/physiopathology , Humeral Fractures/therapy , Joint Deformities, Acquired/physiopathology , Child , Child, Preschool , Elbow Joint/diagnostic imaging , Female , Follow-Up Studies , Fracture Fixation, Internal , Humans , Infant , Male , Open Fracture Reduction , Radiography , Range of Motion, Articular/physiology , Splints , Wrist Joint/diagnostic imagingABSTRACT
OBJECTIVE: The aim of this study was to determine the intraoperative corrective effect of the aponeurotic release of semimembranosus (SM) as a single procedure or an adjunct procedure to distal myotendinous release of semitendinosus (ST) and myofascial release of SM lengthening in the correction of knee flexion deformity in cerebral palsy (CP). METHODS: In this prospective study, 46 knees of 23 consecutive ambulatory patients (15 boys and 8 girls; mean age=8.33 years; age range=5-12 years) with spastic diplegic CP with a gross motor function classification system level (GMFCS) II or III were included. The patients were then divided into 2 groups. In group I, there were 10 patients (4 boys, 6 girls; mean age=8.6±2), and combined release of ST in the myotendinous junction and SM in the myofascial junction, followed by aponeurotic release of SM were carried out. In group II, there were 13 patients (2 girls, 11 boys; mean age=8±2.35), and aponeurotic release of SM was done first and followed by the combined release of ST in the distal myotendinous junction and the myofascial release of SM. Intraoperative popliteal angle (PA) measurements were recorded in each group. RESULTS: PA was reduced from 58.1°±7.6° (range=46°-75°) to 41.2°±8.8° (range=20°-54°) in group 1 and from 59.1°±11.3° (range=40°-87°) to 42.7°±10.8° (range=24°-64°) in group 2. No significant difference was observed between the groups in terms of reduction in PA (p=0.867). In group 1, adding the aponeurotic release of SM further reduced the PA to 31.7°± 8.5° (range=14°-47°) (p=0.002). In group 2, adding the myotendinous release of ST and myofascial release of SM further reduced the PA to 32.9°±7.2° (range=16°-44°) (p=0.004). There was no significant difference between the final PA values in the 2 groups (p=0.662). There was no difference in terms of early complications. CONCLUSION: Aponeurotic release of SM is equally effective to reduce the intraoperative PA with combined myotendinous release of ST and myofascial release of SM. Combining all the 3 procedures provides a better correction without forceful manipulation or lengthening of the lateral hamstrings during the correction of knee flexion deformity in CP.
Subject(s)
Cerebral Palsy , Hamstring Muscles , Joint Deformities, Acquired/surgery , Knee Joint , Tenotomy , Cerebral Palsy/complications , Cerebral Palsy/physiopathology , Cerebral Palsy/surgery , Child , Contracture/etiology , Contracture/surgery , Female , Hamstring Muscles/pathology , Hamstring Muscles/physiopathology , Humans , Joint Deformities, Acquired/etiology , Joint Deformities, Acquired/physiopathology , Knee Joint/physiopathology , Knee Joint/surgery , Male , Outcome and Process Assessment, Health Care , Prospective Studies , Retrospective Studies , Tenotomy/adverse effects , Tenotomy/methods , Treatment OutcomeABSTRACT
PURPOSE: To evaluate the integrity of lateral soft tissue in varus osteoarthritis knee by comparing the mechanical axis under varus stress during navigation-assisted total knee arthroplasty before and after compensating for a bone defect with the implant. METHODS: Sixty-six knees that underwent total knee arthroplasty were investigated. The mechanical axis of the operated knee was evaluated under manual varus stress immediately after knee exposure and after navigation-assisted implantation. The correlation between each value of the mechanical axis and degree of preoperative varus deformity was compared by regression analysis. RESULTS: The maximum mechanical axis under varus stress immediately after knee exposure increased in proportion to the degree of preoperative varus deformity. Moreover, the maximum mechanical axis under varus stress after implantation increased in proportion to the degree of preoperative varus deformity. Therefore, the severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, regression coefficients after implantation were much smaller than those measured immediately after knee exposure (0.99 vs 0.20). Based on the results of the regression formula, the postoperative laxity of the lateral soft tissue was negligible, provided that an appropriate thickness of the implant was compensated for the bone and cartilage defect in the medial compartment without changing the joint line. CONCLUSION: The severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, even if the degree of preoperative varus deformity is severe, most cases may not require additional procedures to address the residual lateral laxity.
Subject(s)
Arthroplasty, Replacement, Knee , Knee Joint/physiology , Osteoarthritis, Knee/surgery , Range of Motion, Articular/physiology , Aged , Aged, 80 and over , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/methods , Arthroplasty, Replacement, Knee/rehabilitation , Female , Humans , Joint Deformities, Acquired/pathology , Joint Deformities, Acquired/physiopathology , Joint Deformities, Acquired/surgery , Knee/physiology , Knee/surgery , Knee Joint/surgery , Male , Mechanical Phenomena , Middle Aged , Osteoarthritis, Knee/physiopathology , Postoperative PeriodABSTRACT
OBJECTIVES: Our aim is to understand clinical characteristics, real-life treatment strategies, outcomes of early PsA patients and determine the differences between the inception and established PsA cohorts. METHODS: PsArt-ID (Psoriatic Arthritis- International Database) is a multicentre registry. From that registry, patients with a diagnosis of PsA up to 6 months were classified as the inception cohort (n==388). Two periods were identified for the established cohort: Patients with PsA diagnosis within 5-10 years (n = 328), ≥10 years (n = 326). Demographic, clinical characteristics, treatment strategies, outcomes were determined for the inception cohort and compared with the established cohorts. RESULTS: The mean (s.d.) age of the inception cohort was 44.7 (13.3) and 167/388 (43.0%) of the patients were male. Polyarticular and mono-oligoarticular presentations were comparable in the inception and established cohorts. Axial involvement rate was higher in the cohort of patients with PsA ≥10 years compared with the inception cohort (34.8% vs 27.7%). As well as dactylitis and nail involvement (P = 0.004, P = 0.001 respectively). Both enthesitis, deformity rates were lower in the inception cohort. Overall, 13% of patients in the inception group had a deformity. MTX was the most commonly prescribed treatment for all cohorts with 10.7% of the early PsA patients were given anti-TNF agents after 16 months. CONCLUSION: The real-life experience in PsA patients showed no significant differences in the disease pattern rates except for the axial involvement. The dactylitis, nail involvement rates had increased significantly after 10 years from the diagnosis and the enthesitis, deformity had an increasing trend over time.
Subject(s)
Arthritis, Psoriatic/drug therapy , Arthritis, Psoriatic/physiopathology , Adult , Antirheumatic Agents/therapeutic use , Cohort Studies , Drug Prescriptions/statistics & numerical data , Female , Finger Joint/physiopathology , Glucocorticoids/therapeutic use , Humans , Joint Deformities, Acquired/physiopathology , Male , Methotrexate/therapeutic use , Middle Aged , Nail Diseases/drug therapy , Nail Diseases/physiopathology , Patient Reported Outcome Measures , Registries , Sulfasalazine/therapeutic use , Tumor Necrosis Factor Inhibitors/therapeutic useABSTRACT
BACKGROUND: Increased genu recurvatum (GR) angle is a risk factor for knee injury. Identification of factors causing GR is important for the prevention and rehabilitation of GR. Few studies have investigated the association between muscle strength and GR. OBJECTIVE: To examine the association between GR angle and hip and knee muscle strength in standing workersMETHODS:The participants in this study were 110 healthy volunteers (59 male, 51 female) who performed standing work in a theme park. The GR angle, muscle strength, and strength ratio of the lower extremities were measured to determine their associations with GR. The GR angle was measured using a Smart KEMA motion sensor, and muscle strength was assessed using a Smart KEMA strength sensor. Stepwise multiple regression models were used to investigate which muscles contributed most to the extent of the GR angle. RESULTS: Stepwise multiple regression analysis showed that the decreased hip external rotator to hip internal rotator ratio, increased knee extensor to knee flexor ratio, and young age were associated with an increased GR angle. CONCLUSIONS: Many factors are known to increase the GR angle. However, this study investigated the roles of only hip and knee muscle strength. The results suggest that muscle strength ratios are more important than the weakness of any muscle.
Subject(s)
Joint Deformities, Acquired/physiopathology , Muscle Strength , Muscle, Skeletal/physiology , Standing Position , Adult , Biomechanical Phenomena , Female , Hip Joint , Humans , Knee Joint , Lower Extremity , Male , Middle Aged , Occupational InjuriesABSTRACT
Wrist treatment in spastic cerebral palsy includes splints, botulinum toxin, tendon transfers, tendon lengthening, capsular liberations, and arthrodesis. A well-indicated wrist arthrodesis corrects deformity improving function and cosmetic appearance in patients with fixed deformities. It is indicated in patients with cerebral palsy, older than 12 years with a fixed deformity in wrist flexion. We report 11 clinical cases with the wrist arthrodesis with a plate of 3.5 with 2.7 mm by dorsal approach and technical resources to minimize the complications of tendon irritation and dorsal discomfort. We present an illustrative clinical case. It is a known procedure, its execution must be careful to avoid complications.
Subject(s)
Arthrodesis/methods , Cerebral Palsy/physiopathology , Joint Deformities, Acquired/surgery , Wrist Joint/surgery , Adolescent , Bone Plates , Child , Female , Humans , Joint Deformities, Acquired/physiopathology , Male , Wrist Joint/physiopathologyABSTRACT
OBJECTIVE: Wrist deformity in older people is common following treatment for a wrist fracture, particularly after non-surgical treatment. A cohort of older wrist fracture patients were surveyed by telephone regarding perceived deformity, bother with deformity and patient-reported wrist function. The objectives were to: (1) determine whether older patients with wrist fractures perceived a deformity of their wrist and if they were bothered by it; (2) test if there were associations between deformity and treatment-type and between deformity and function; (3) test for associations between bother and treatment-type and between bother and function; (4) measure the test-retest reliability of the 'bother' question. RESULTS: Of 98 eligible patients who were invited to participate, 41 responded. Out of 41, 14 (34%) believed they had a deformity and 4 (10%) reported that they were bothered by the appearance of their wrist. Deformity was associated with non-surgical treatment (RR = 3.85, p = 0.006) but was not significantly associated with functional outcomes (p = 0.15). All those who were bothered belonged to the non-surgical treatment group. Bother was significantly associated with poorer functional outcomes (p = 0.006) and this association was clinically significant (MD = 35 points). The deformity and bother questions were found to have excellent test-retest reliability; κ = 1.00 and κ = 0.92, respectively.
Subject(s)
Aging , Fractures, Bone , Hand Deformities, Acquired , Joint Deformities, Acquired , Wrist Injuries , Wrist , Aged , Aged, 80 and over , Aging/pathology , Female , Fractures, Bone/pathology , Fractures, Bone/physiopathology , Fractures, Bone/therapy , Hand Deformities, Acquired/pathology , Hand Deformities, Acquired/physiopathology , Humans , Joint Deformities, Acquired/pathology , Joint Deformities, Acquired/physiopathology , Male , Wrist/pathology , Wrist/physiopathology , Wrist Injuries/pathology , Wrist Injuries/physiopathologySubject(s)
Elbow Joint/diagnostic imaging , Elbow Joint/surgery , Humeral Fractures/complications , Joint Deformities, Acquired/diagnostic imaging , Joint Deformities, Acquired/surgery , Osteotomy/methods , Adolescent , Computer Simulation , Elbow Joint/physiopathology , Humans , Imaging, Three-Dimensional , Joint Deformities, Acquired/etiology , Joint Deformities, Acquired/physiopathology , Male , Models, Anatomic , Printing, Three-Dimensional , Surgery, Computer-AssistedABSTRACT
Objective: The aim of this study was to clarify the association of scoliosis and windswept hips with immobility, lying position, and time in lying, in adults with cerebral palsy (CP).Methods: This cross-sectional study included 830 adults (469 males and 361 females) with a diagnosis of CP, 16-73 years, and classified at levels I-V according to the Gross Motor Function Classification System (GMFCS). Subjects' Gross motor function classification system level, presence and severity of scoliosis, hip and knee joint range of movement, lying position, postural ability in lying, and time in lying were used to identify connections between them.Results: Adults who are immobile in the lying position have higher odds of both scoliosis and windswept hips. Spending more than 8 h daily in the same lying position, increased the odds of having scoliosis, while lying solely in a supine position, resulted in higher odds of windswept hips.Conclusions: The "preferred" habitual posture frequently observed in immobile adults with CP, leads to established distortion of their body shape. The results indicate the need for early introduction of appropriate posture control, in immobile individuals with CP, from a young age.Implications for rehabilitationThe preferred posture, observed in immobile adults with cerebral palsy, leads to a distortion of their body shape.One in four adults with cerebral palsy use only one position when in bed.The results indicate the need for early introduction of appropriate posture control in individuals unable to change position.
Subject(s)
Cerebral Palsy/physiopathology , Hip Joint/physiopathology , Joint Deformities, Acquired/physiopathology , Scoliosis/physiopathology , Supine Position/physiology , Adolescent , Adult , Aged , Cross-Sectional Studies , Female , Humans , Immobilization , Male , Middle Aged , Range of Motion, Articular/physiology , Severity of Illness Index , Young AdultABSTRACT
To evaluate the clinical outcomes of an anterolateral approach for lateral humeral condylar fractures in children. The patients aged < 15 years undergoing surgery with an anterolateral approach for humeral lateral condylar fractures between April 2005 and March 2014 were investigated. Medical records and radiographs from 15 patients were reviewed. Average patient age at surgery was 6.0 years (range, 3-10 years). Based on Jakob's classification, 12 patients had type II fractures, and 3 patients had type III fractures. Based on Milch classification, 1 elbow was type I, and 14 elbows were type II. The average postoperative follow-up duration was 16.4 months (range, 6-58 months). Postoperative complications, and radiographic and clinical findings, including range of motion and Flynn criteria were evaluated. To evaluate humeral deformity, Baumann angle (BA) and the carrying angle (CA) were calculated on anteroposterior radiographs. There were no postoperative complications, including secondary displacement, deep infection, nonunion, avascular necrosis, or cubitus varus or valgus deformity. In the injured elbow, follow-up radiographs revealed an average BA of 69.1° (range, 57-84°), versus 70.9° (range, 61-83°) on the contralateral side. The average CA on the injured side was 10.3° (range, 4-20°) versus 12.3° (range, 6-24°) on the contralateral side. BA gain and CA loss (affected- compared with contralateral sides) averaged -1.4° (range, -17° to 9°) and 2.3° (range, -2° to 6°), respectively. The mean range of motion in the affected elbow averaged 4.7° (range, 0-15°) in extension and 139.7° (range, 135-140°) in flexion. Over 5° loss of range of motion in the affected elbow compared with the contralateral side was not observed. However, 2 patients experienced over 5° loss of CA in the affected elbow versus the contralateral side. Based on Flynn criteria, clinical results for both cosmetics and function were excellent in 13 patients, and good in 2. The advantages of the anterolateral approach are combining an optimal view of the anterior articular surface of the trochlea and capitellum and a limited risk of devascularization injury. We strongly recommend an anterolateral approach for these fractures in children to prevent postoperative deformity and to achieve anatomical reduction and reliable fixation.
Subject(s)
Elbow Injuries , Elbow Joint , Fracture Fixation, Internal , Humeral Fractures , Joint Deformities, Acquired , Postoperative Complications , Child , Child, Preschool , Elbow Joint/diagnostic imaging , Elbow Joint/physiopathology , Elbow Joint/surgery , Female , Fracture Fixation, Internal/adverse effects , Fracture Fixation, Internal/methods , Humans , Humeral Fractures/diagnosis , Humeral Fractures/diagnostic imaging , Humeral Fractures/surgery , Japan/epidemiology , Joint Deformities, Acquired/diagnosis , Joint Deformities, Acquired/etiology , Joint Deformities, Acquired/physiopathology , Joint Deformities, Acquired/prevention & control , Male , Postoperative Complications/diagnosis , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Postoperative Complications/prevention & control , Radiography/methods , Range of Motion, Articular , Recovery of Function , Retrospective Studies , Treatment OutcomeABSTRACT
Surgical correction of multiapical deformities of the lower limb requires careful preoperative planning. Surgeons must account for the potential creation of secondary deformity, such as knee joint line obliquity, and the risks associated with accepting these changes in limb alignment. In this study, we evaluate the effect of knee joint obliquity on tibial plateau contact pressures and knee instability. Three cadaveric knees were dissected and put through biomechanical testing to simulate loading of an oblique knee joint. We observed < 1 mm femoral displacement (proxy measure of instability) between 15 degrees of varus tilt and 10 degrees of valgus tilt, and greater increases in tibial plateau contact pressures with valgus tilt than with varus tilt. Our results suggest that, if the creation of a secondary coronal plane deformity at the knee joint cannot be avoided, up to 15 degrees of varus or 10 degrees of valgus alignment can be tolerated by an otherwise structurally normal knee.
Subject(s)
Joint Deformities, Acquired/physiopathology , Joint Deformities, Acquired/surgery , Joint Instability/physiopathology , Knee Joint/pathology , Knee Joint/physiopathology , Aged , Cadaver , Femur/physiopathology , Humans , Joint Deformities, Acquired/etiology , Joint Instability/etiology , Joint Instability/surgery , Knee Joint/surgery , Middle Aged , Range of Motion, Articular , Tibia/physiopathology , Weight-BearingABSTRACT
OBJECTIVE: To quantify the bone density and stress distribution patterns in long-standing cubitus varus and clarify the effects of the deformity on bone density. DESIGN: We created three-dimensional computed tomography (CT) elbow models from 21 patients with long-standing cubitus varus deformities without advanced osteoarthritis (OA) and assessed the deformity by superimposing the affected humerus onto a mirror-image of the contralateral normal. Elbows were divided into 13 regions before measuring the bone density of each region and comparing the percentage of high-density volume (%HDV) between affected and normal sides. We constructed finite element models and quantitatively analyzed stress distribution. RESULTS: Average degrees of deformities were 20.1° of varus, 6.4° of extension, and 12.7° of internal rotation. The medial side of the affected humerus and ulna, Anteromedial trochlea (P < 0.001), Medial coronoid (P = 0.004), and Medial olecranon (P = 0.049) had significantly higher %HDVs than their normal counterparts. Conversely, %HDVs on the affected lateral side, Capitellum (P < 0.001), Anterolateral trochlea (P = 0.010), Posterolateral trochlea (P < 0.001), Lateral coronoid (P = 0.007), and Lateral olecranon (P < 0.001) were significantly lower than the normal side. The affected radial head %HDVs at Anterolateral and Posteromedial quadrants were high (P = 0.007) and low (P = 0.007), respectively. The bone density distribution coincided with stress distribution patterns revealed by finite element analysis (FEA), except in the lateral region influenced by forearm rotation. CONCLUSIONS: Repetitive stress on the medial elbow may alter bone density distribution patterns, probably presenting from early stage of OA.
Subject(s)
Bone Density/physiology , Joint Deformities, Acquired/physiopathology , Osteoarthritis/physiopathology , Stress, Physiological/physiology , Adolescent , Adult , Elbow Joint/physiology , Female , Humans , Humerus/physiology , Imaging, Three-Dimensional , Male , Middle Aged , Range of Motion, Articular/physiology , Retrospective Studies , Tomography, X-Ray Computed , Young AdultABSTRACT
BACKGROUND: Various deformities can occur in the forearm bones when the traumatically dislocated radial head is untreated for a long period. Without correction of all deformities, reduction of the dislocated radial head is difficult to maintain, and forearm and elbow motion will deteriorate after reduction. We evaluated radiographic parameters of forearms with traumatically dislocated radial heads (and of the normal sides) to understand the resulting deformities and the effectiveness of surgical treatment. METHODS: We analyzed pre- and postoperative anteroposterior and lateral radiographs of 22 forearms (22 patients) with traumatic radial head dislocation. We divided the forearm into three equal parts and measured various morphological parameters. All patients underwent surgical treatment and evaluation of radial head reduction and range of motion pre- and postoperatively. RESULTS: Before treatment, the middle of the ulna was significantly different from the unaffected side in both anteroposterior and lateral views. After surgery, the proximal ulna was significantly different from the unaffected side and the abnormal proximal radial neck angle persisted. The radial head was successfully reduced in 20 of 22 cases. Overall, the mean range of motion decreased after surgery, except for increased flexion-extension. CONCLUSIONS: Complicated deformities developing during long-term remodeling after injury indicate that stable reduction is difficult to achieve with conventional one-bone osteotomy. Even after successful reduction, secondary deformity in the proximal ulna and/or remaining deformity in the proximal radius can hinder forearm rotation.
Subject(s)
Elbow Injuries , Elbow Joint/diagnostic imaging , Joint Deformities, Acquired/diagnostic imaging , Joint Dislocations/diagnostic imaging , Radius/diagnostic imaging , Adolescent , Child , Child, Preschool , Elbow Joint/physiopathology , Female , Forearm/physiopathology , Humans , Joint Deformities, Acquired/etiology , Joint Deformities, Acquired/physiopathology , Joint Deformities, Acquired/surgery , Joint Dislocations/complications , Joint Dislocations/surgery , Male , Postoperative Period , Preoperative Period , Pronation , Radiography , Radius/surgery , Range of Motion, Articular , Retrospective Studies , Supination , Ulna/diagnostic imagingABSTRACT
BACKGROUND: The purpose of this study was to evaluate the relationship between the preoperative knee deformity/kinematic pattern and the postoperative knee kinematic pattern in posterior cruciate ligament substituting (PS)-total knee arthroplasty (TKA). METHODS: This study involved 39 patients with medial osteoarthritis who underwent a primary PS-TKA using a computed-tomography-based navigation system. All the operations were performed by a single surgeon using a subvastus approach, modified gap technique and the same PS type of prosthesis (Genesis II™ total knee system, Smith & Nephew, Memphis, TN, USA). Knee deformity, kinematic pattern after capsule incision (preoperative knee kinematics), and kinematic pattern after implantation (postoperative knee kinematics) in PS-TKA were measured. Kinematic patterns were divided into two groups: a medial pivot group and a non-medial pivot group. RESULTS: Preoperative varus knee deformity was significantly larger in the non-medial pivot group than in the medial pivot group (femorotibial angle: 184.7±6.4° vs. 180.8±3.9°, P<0.05). In addition, preoperative knee kinematics were conserved postoperatively, at a rate of 82% (P<0.01). CONCLUSIONS: The severity of varus knee deformity and the preoperative knee kinematic pattern might have affected the postoperative knee kinematics in PS-TKA. This must be confirmed with a randomized controlled trial on a large population study. LEVEL OF EVIDENCE: case control study, Level III.
Subject(s)
Arthroplasty, Replacement, Knee/methods , Joint Deformities, Acquired/surgery , Knee Joint/physiopathology , Osteoarthritis, Knee/surgery , Aged , Aged, 80 and over , Biomechanical Phenomena , Case-Control Studies , Female , Humans , Joint Deformities, Acquired/physiopathology , Knee Joint/diagnostic imaging , Knee Joint/surgery , Male , Middle Aged , Osteoarthritis, Knee/physiopathology , Posterior Cruciate Ligament/surgery , Postoperative Period , Range of Motion, Articular , Surgery, Computer-Assisted/methods , Tomography, X-Ray Computed/methodsABSTRACT
OBJECTIVE: In our retrospective study, we aimed to investigate the differences between the adductor ratio (AR) in knees with and without osteoarthritis, and its validity in determining the articular level. METHODS: Data from 80 knees of 80 patients were retrospectively evaluated. Anteroposterior weight-bearing knee radiographs of the patients with and without osteoarthritis (40 knees in each group) were obtained. The adductor ratio was determined using the following formula: ATJL/FW (adductor tubercle-joint line distance/femoral width). All radiographs were evaluated at the baseline and at one-month intervals afterwards. Intraobserver reliability of the two measurements was assessed using interclass correlations (ICC). Pearson's correlation test was used to evaluate the correlation between the ATJL and the FW. The differences between the adductor ratios of the two groups were evaluated by the independent samples two-tailed t-test. RESULTS: Most of the ICC values were well above 0.95, indicating a very high intraobserver reliability. The adductor ratio was significantly greater in Group 2 in comparison to Group 1 (Mean AR in Group 2: 0.522 ± 0.031 and Mean AR in Group 1: 0.502 ± 0.032; p = 0.005). There was a significant correlation between the ATJL and FW in the groups when assessed both separately and combined. CONCLUSION: In conclusion, we can assert that if the AR is used to determine the articular level in revision arthroplasty cases, it may be sensible to measure the FW intraoperatively rather than measuring it on primary or contralateral radiographs of arthritic patients. LEVEL OF EVIDENCE: Level III, Diagnostic study.
Subject(s)
Arthroplasty, Replacement, Knee , Femur , Joint Deformities, Acquired , Knee Joint , Osteoarthritis, Knee , Range of Motion, Articular , Reoperation/methods , Aged , Arthroplasty, Replacement, Knee/adverse effects , Arthroplasty, Replacement, Knee/methods , Female , Femur/diagnostic imaging , Femur/pathology , Femur/surgery , Humans , Joint Deformities, Acquired/etiology , Joint Deformities, Acquired/physiopathology , Joint Deformities, Acquired/surgery , Knee Joint/diagnostic imaging , Knee Joint/physiopathology , Knee Joint/surgery , Male , Middle Aged , Osteoarthritis, Knee/complications , Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/physiopathology , Osteoarthritis, Knee/surgery , Preoperative Care/methods , Radiography/methods , Reproducibility of Results , Retrospective Studies , Turkey , Weight-BearingABSTRACT
The ball and socket ankle joint is a morphologically abnormal joint characterized by rounding of the articular surface of the talus. Other than anecdotal observation, little evidence has been presented to describe the development of this deformity. The purpose of the present study was to review ankle and subtalar joint mechanics and to kinematically examine the functional combination of these joints as a mechanism of the ball and socket ankle deformity. We reviewed functional representations of the ankle joint, subtalar joint, and ball and socket ankle deformity. A computational study of joint kinematics was then performed using a 3-dimensional model derived from a computed tomography scan of a ball and socket deformity. The joint kinematics were captured by creating a "virtual map" of the combined kinematics of the ankle and subtalar joints in the respective models. The ball and socket ankle deformity produces functionally similar kinematics to a combination of the ankle and subtalar joints. The findings of the present study support the notion that a possible cause of the ball and socket deformity is bony adaptation that compensates for a functional deficit of the ankle and subtalar joints.
Subject(s)
Ankle Joint/physiopathology , Joint Deformities, Acquired/etiology , Subtalar Joint/physiopathology , Ankle Joint/diagnostic imaging , Biomechanical Phenomena , Computer Simulation , Humans , Image Processing, Computer-Assisted , Joint Deformities, Acquired/diagnostic imaging , Joint Deformities, Acquired/physiopathology , Range of Motion, Articular , Subtalar Joint/diagnostic imaging , Tomography, X-Ray Computed , Weight-BearingABSTRACT
OBJECTIVE: To describe the social status and health-related quality of life of patients with psoriatic arthritis mutilans (PAM) in the Nordic countries. METHOD: Patients with at least one mutilated joint confirmed by radiology were studied. Disease activity involving joints and skin, physician-assessed disease activity, and patient's education and work status were recorded. Data from the 36-item Short Form Health Survey, Health Assessment Questionnaire and Dermatology Life Quality Index questionnaire were gathered and correlated with disease duration, pain, and general well-being (visual analogue scale). The controls were 58 Swedish patients with long-standing psoriatic arthritis sine PAM. RESULTS: Sixty-seven patients were included. Patients with PAM had a protracted disease history (33 ± 14 years) and disease onset at a relatively early age (30 ± 12 years). Overall inflammatory activity at inclusion was mild to moderate. The mean number of mutilated joints was 8.2 and gross deformity was found in 16% of patients. Forty per cent were treated with biological and 32% with conventional synthetic disease-modifying anti-rheumatic drugs. Forty-two per cent had retired early or were on sick leave. Impaired functional capacity with little or no ability to perform self-care or everyday tasks was reported by 21% of the patients. Patients between 45 and 60 years of age reported the most impaired quality of life in comparison to the control group. CONCLUSION: PAM seriously affects social functioning. Whether early recognition of PAM and new forms of therapy can improve disease outcome and quality of life remains to be studied.