RESUMEN
PURPOSE: Develop a spectroscopic method to assess cartilage thickness during the arthroscopic examination. METHODS: Currently, arthroscopy assesses cartilage damage visually; outcomes are based on the surgeon's subjective experience. Light reflection spectroscopy is a promising method for measuring cartilage thickness based on the absorption of light by the subchondral bone. In the presented study, in vivo diffuse optical back reflection spectroscopic measurements were acquired by gently placing an optical fibre probe on different locations of the articular cartilage of 50 patients during complete knee replacement surgery. The optical fibre probe consists of two optical fibers with a diameter of 1 mm to deliver the light and detect back-reflected light from the cartilage. Centre to centre distance between the source and the detector fibers was 2.4 mm. Actual thicknesses of the articular cartilage samples were measured under microscopy using histopathological staining. RESULTS: Using half of the samples in the patient data, a linear regression model was formed to estimate cartilage thicknesses from the spectroscopic measurements. The regression model was then used to predict the cartilage thickness in the second half of the data. The cartilage thickness was predicted with a mean error of 8.7% if the actual thickness was less than 2.5 mm (R2 = 0.97). CONCLUSION: The outer diameter of the optical fibre probe was 3 mm, which can fit into the arthroscopy channel and can be used to measure the cartilage thickness in real-time during the arthroscopic examination of the articular cartilage.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Cartílago Articular , Humanos , Cartílago Articular/diagnóstico por imagen , Cartílago Articular/patología , Análisis Espectral/métodos , Artroscopía/métodos , Modelos LinealesRESUMEN
The quality of care provided for the management of postoperative pain and patient outcomes are key criteria for healthcare institutions. This study aimed to determine the relationship between the quality of care provided for the alleviation of postoperative pain experienced among patients undergoing major orthopedic surgery and the patient care outcomes. The study was designed as an analytical and cross-sectional study. The rates of pain severity and sleep interference, activity interference, affective experiences, and adverse effects due to postoperative pain were higher in female patients than in male patients. A significant positive correlation was identified between the quality of postoperative pain care and the perception of care (p < .05). Implementing nursing interventions to improve pain management and increase the quality of care appears to be vital elements for reducing adverse effects caused by pain and increasing the satisfaction with postoperative pain care.
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Procedimientos Ortopédicos , Dolor Postoperatorio , Estudios Transversales , Femenino , Humanos , Masculino , Procedimientos Ortopédicos/efectos adversos , Manejo del Dolor , Dolor Postoperatorio/psicología , Dolor Postoperatorio/terapia , Atención al Paciente/efectos adversosRESUMEN
OBJECTIVES: This study aims to investigate the effects of associated factors like age, fracture level, accompanying fibular fractures and wound condition on healing by determining and comparing union scores of pediatric tibial fractures (PTFs). PATIENTS AND METHODS: Forty-five patients with 46 PTFs (32 males, 13 females; mean age 9.5 years; range 2 to 16 years) who were treated by closed reduction and casting or operated between January 2016 and January 2019 were retrospectively evaluated. The union scores were evaluated at the end of fourth, sixth and eighth weeks and compared to each other. Effects of the age, associated fibular fractures, wound condition, fracture level and treatment type to union score were analyzed. RESULTS: Twenty-eight (60.9%) out of 46 PTFs had associated fibular fractures and 18 (39.1%) did not. Motor vehicle accident was the most frequent etiologic factor (47.8%). Thirty-four out of 46 fractures were closed tibial fractures (73.9%) and 12 had open wound (26.1%). There was a negative correlation between age and the union scores (p<0.001 for each week). No significant difference was observed between the union score of diaphyseal and metaphyseal fractures at the fourth, sixth, and eighth weeks. The union scores of each week were higher in the conservative group compared to operative group (p<0.001 for each week). Associated fibular fracture group had lower union scores compared to isolated tibial fracture group at fourth, sixth and eighth weeks. Likewise, the union scores of the open fracture group were lower than the closed fracture group (p<0.05 for each week). CONCLUSION: Associated fibular fractures, open fractures and aging negatively affect union scores of PTFs. Attention should be paid, particularly in these conditions, during the selection of the operation type and the follow-up period of PTFs.
Asunto(s)
Tratamiento Conservador/métodos , Procedimientos Ortopédicos/métodos , Selección de Paciente , Tibia , Fracturas de la Tibia , Factores de Edad , Niño , Femenino , Fracturas Cerradas/diagnóstico , Fracturas Cerradas/epidemiología , Fracturas Cerradas/etiología , Fracturas Abiertas/diagnóstico , Fracturas Abiertas/epidemiología , Fracturas Abiertas/etiología , Humanos , Masculino , Radiografía/métodos , Estudios Retrospectivos , Tibia/diagnóstico por imagen , Tibia/lesiones , Fracturas de la Tibia/clasificación , Fracturas de la Tibia/epidemiología , Fracturas de la Tibia/etiología , Fracturas de la Tibia/terapia , Índices de Gravedad del Trauma , Turquía/epidemiologíaRESUMEN
Osteoporosis (OP) is a major health problem characterized by compromised bone strength. Osteoarthritis (OA) is a joint disease that progresses slowly and is characterized by breakdown of the cartilage matrix. Alendronate (ALN), a nitrogen-containing bisphosphonate (BIS), inhibits bone loss and increases bone mineralization, and has been used clinically for the treatment of OP. It is still controversial whether BIS is effective in inhibiting the progression of OA. Chondrocyte apoptosis has been described in both human and experimentally induced OA models. In our study we aimed to detect whether ALN could protect articular cartilage from degeneration and reduce apoptosis rates in experimentally OA induced rats. For this rats were ovariectomized (ovex), nine weeks after operation rats were injected 30 µg/kg/week ALN subcutaneously for six weeks. After six weeks articular cartilages were obtained. We did Safranin O staining and Mankin and Pritzker scorings to evaluate degeneration and investigated the expressions of p53, cleaved caspase 3, Poly ADP-ribose (PAR), Poly ADP-ribose polymerase 1 (PARP 1), and applied TUNEL technique to determine apoptotis rates. We found a significant decrease in glycosaminoglycan (GAG) amount and increased apoptosis which indicates damage on articular cartilages of ovex rats. GAG amount was higher and apoptosis rate was lower on articular cartilages of ALN treated ovex rats compared to the ovex group. In contrary to studies showing that early ALN treatment has a protective effect, our study shows late ALN treatment has a chondroprotective effect on articular cartilage since we treated rats nine weeks after ovariectomy.
Asunto(s)
Alendronato/farmacología , Apoptosis/efectos de los fármacos , Conservadores de la Densidad Ósea/farmacología , Cartílago Articular/efectos de los fármacos , Cartílago Articular/patología , Osteoartritis/patología , Animales , Modelos Animales de Enfermedad , Femenino , Inmunohistoquímica , Etiquetado Corte-Fin in Situ , Osteoporosis/patología , Ovariectomía , Distribución Aleatoria , Ratas , Ratas WistarRESUMEN
Conventional procedures can usually prevent cerebrospinal fluid (CSF) leakages, but they may not work for complicated cases. In this case presentation, we demonstrated the effectiveness of combined omental and latissimus dorsi musculocutaneous flaps for management of difficult CSF fistula. A reverse turnover latissimus dorsi musculocutaneous flap and omental flap were transferred for reconstruction of the posterior wound and CSF leakage. The omental flap component was used for CSF absorption, and the latissimus dorsi muscle component was used for obliteration of the dead space, covering of the exposed bone, and tension-free closure of the wound. The wound healed dramatically, with no observed severe donor site morbidity. The patient has been followed for 30 months with no evidence of CSF leakage and no pseudomeningocele formation, which was confirmed by magnetic resonance imaging (MRI). Although this is a case presentation, we can say that the combination of the omental and musculocutaneous flaps allow effective treatment and prevention of CSF fistulas in selected high-risk patients and provide durable coverage of complex spinal wounds.
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Pérdida de Líquido Cefalorraquídeo/cirugía , Fístula Cutánea/cirugía , Colgajo Miocutáneo/cirugía , Epiplón/cirugía , Complicaciones Posoperatorias , Músculos Superficiales de la Espalda/cirugía , Anciano , Humanos , Imagen por Resonancia Magnética , Masculino , Procedimientos de Cirugía Plástica/métodos , Resultado del TratamientoRESUMEN
OBJECTIVES: In this experimental study the effect of alendronate (Aln) sodium on spinal fusion, that was given preoperatively or postoperatively, was compared both mechanically and histologically in ovariectomized rats. The research question was "Does application time of alendronate sodium effect the spinal fusion in ovariectomized rats?''. MATERIALS AND METHODS: Fifty female Wistar rats with a mean weight of 200 g and an average age of 12 weeks were ovariectomized according to the standard procedure. The rats were randomized into three groups nine weeks after ovariectomy. Group 1: spinal arthrodesis and saline weekly for six weeks postoperatively; group 2: spinal arthrodesis and Aln sodium 1 µgr/kg/week for six weeks postoperatively; group 3: Aln sodium 1 µgr/kg/week for six weeks preoperatively, then one week later spinal arthrodesis was done. The rats were sacrificed six weeks after fusion surgery and their vertebrae were evaluated by manual palpation, mechanical testing machine and histomorphometric analysis. RESULTS: Fusion rates obtained by manual palpation were 50%, 17.6% and 55.5% in group 1, 2 and 3, respectively (p>0.05). Mean values of fusion tissues in mechanical evaluation were 498±20.7, 481±23.7 and 480±26.2 (MPa) accordingly (p>0.05). Compared with group 1, delayed endochondral ossification and more cartilage matrix among bone grafts were seen in group 2 and 3 in histological evaluation. CONCLUSION: Application time of the Aln sodium didn't significantly affect the lumbar spinal fusion rates in ovariectomized rats. In histological evaluation, delayed endochondral ossification was seen in Aln sodium-treated groups.
Asunto(s)
Alendronato/farmacología , Conservadores de la Densidad Ósea/farmacología , Osteogénesis/efectos de los fármacos , Fusión Vertebral , Animales , Esquema de Medicación , Femenino , Vértebras Lumbares/efectos de los fármacos , Ovariectomía , Periodo Posoperatorio , Periodo Preoperatorio , Ratas , Ratas WistarRESUMEN
Traumatic separation of the distal humeral epiphysis during delivery is an uncommon injury in neonates and usually mimics elbow dislocation. Emergency medicine physicians and orthopedic surgeons must have a high index of suspicion for distal humeral epiphysis separation when evaluating elbow trauma in neonates. Magnetic resonance imaging (MRI) scan is an important diagnostic tool for this purpose. We report a case in which fracture-separation of the distal humeral epiphysis in a newborn was diagnosed with the help of ultrasonography and MRI scan, which provided a clear delineation of the injury.
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Traumatismos del Nacimiento/diagnóstico por imagen , Lesiones de Codo , Epífisis/lesiones , Fracturas del Húmero/diagnóstico por imagen , Luxaciones Articulares/diagnóstico por imagen , Traumatismos del Nacimiento/diagnóstico , Traumatismos del Nacimiento/cirugía , Articulación del Codo/diagnóstico por imagen , Articulación del Codo/cirugía , Epífisis/diagnóstico por imagen , Epífisis/cirugía , Humanos , Fracturas del Húmero/diagnóstico , Fracturas del Húmero/etiología , Fracturas del Húmero/cirugía , Recién Nacido , Luxaciones Articulares/diagnóstico , Luxaciones Articulares/etiología , Luxaciones Articulares/cirugía , Imagen por Resonancia Magnética , Masculino , Resultado del Tratamiento , UltrasonografíaRESUMEN
The aim of the present study was to investigate the detailed histological characteristics of membranous and cord-like anterior intermeniscal ligaments (AIMLs) by transmission electron microscopy (TEM) and light microscopy. Ten biopsies of AIMLs were sampled from 10 knees during total knee arthroplasty procedures. Three of them were membranous and 7 of them were cord-like. They were processed for light and TEM evaluations. Histologically, the findings in the membranous and cord-like ligaments were similar. They consisted of parallel bundles of collagen fibrils and their posterior surfaces were covered by a layer of loose well-vascularized synovial tissue. The subsynovial region consisted of loose connective tissue and was rich in blood vessels and nerve endings. Fibroblasts embedded between parallel-oriented collagen fibrils were the major cell type that we observed. Free nerve endings were squeezed between bundles of collagen fibers. Electron microscopic observations revealed the presence of Ruffini corpuscles. The presence of neural mechanoreceptors in the membranous and cord-like intermeniscal ligaments may contribute to structural and proprioceptional function of the knee. Protection of those ligaments may be valuable in planning and performing meniscal surgeries.
Asunto(s)
Artroplastia de Reemplazo de Rodilla , Ligamentos/anatomía & histología , Anciano , Anciano de 80 o más Años , Biopsia , Colágeno/análisis , Humanos , Ligamentos/inervación , Ligamentos/patología , Ligamentos/ultraestructura , Microscopía Electrónica , Terminaciones Nerviosas/ultraestructuraRESUMEN
The aim of this study is to search if there is any proprioceptive difference between auto and allograft anterior cruciate ligament (ACL) reconstructions, and also to determine if there is any relationship between instrumented anterior knee laxity and proprioception after an ACL reconstruction. The following four groups were constituted for this purpose: group I, control group; group II, autograft reconstructions; group III, allograft reconstructions and group IV, people with injured ACLs. Each group consisted of 20 patients/volunteers. Two subgroups were constituted according to the findings of KT-1,000 laxity testing in group II and III; patients/volunteers found to have a laxity of 3 mm or less were enrolled in the normal subgroup and those with a laxity of more than 3 mm were enrolled in the lax subgroup. Two proprioceptive tests were used: threshold to detect passive motion (TDPM) and joint position sense (JPS) by using Cybex Norm dynamometer. Patients underwent ten tests and the discrepancy in degrees was averaged for ten trials. Comparisons were made to evaluate the proprioceptive differences between groups/subgroups; ANOVA and t test was used for comparisons where appropriate, and the significance was set at P < 0.05. There was a significant difference in degrees between patients with injured ACLs and the other three groups in TDPM evaluations (injured: 1.93 degrees vs. control: 1.03 degrees , autograft: 1.01 degrees , allograft: 0.96 degrees ; P < 0.001). Auto and allograft reconstructions were not different from each other and controls. Allo and autograft ACL reconstructions are not different from each other according to proprioceptive measurements. Also, proprioception is not correlated to postoperative anterior knee laxity; many variables involve joint proprioception and mostly the anterior knee laxity may not be the sole determining element, and a lax ACL still may fulfill some of its afferent arc functions as long as it bridges the femur and tibia.
Asunto(s)
Ligamento Cruzado Anterior/fisiopatología , Ligamento Cruzado Anterior/cirugía , Articulación de la Rodilla/fisiopatología , Propiocepción/fisiología , Adulto , Lesiones del Ligamento Cruzado Anterior , Plastía con Hueso-Tendón Rotuliano-Hueso , Estudios de Casos y Controles , Femenino , Humanos , Inestabilidad de la Articulación/fisiopatología , Masculino , Dinamómetro de Fuerza Muscular , Estudios Retrospectivos , Trasplante Autólogo , Trasplante HomólogoRESUMEN
OBJECTIVE: Complications after vertebroplasty are rare. There are few reported infectious complications requiring surgical management such as corpectomy with anterior reconstruction and posterior stabilization, although we have not seen any reports about epidural abscess in the literature. We present a patient in whom posterior epidural abscess developed after vertebroplasty in which drainage and antibiotherapy were required for treatment. METHODS: A 70-year-old female with a painful T12 osteoporotic compression fracture underwent percutaneous vertebroplasty using polymethylmethacrylate without complication. One week after vertebroplasty, however, she had fever and increased back pain. On clinical examination, soft tissue abscess formation was determined at the vertebroplasty site. This was drained surgically and antibiotic treatment was started. At follow-up, she had progressive neurological deterioration (paraparetic) on the 18th day after abscess drainage. MRI of the thoracolombar spine revealed posterior spinal epidural abscess at the T11/12 level. Partial laminectomy and drainage were performed. She had complete neurological recovery in the follow-up period. CONCLUSION: An epidural abscess, which is an unusual complication of vertebroplasty, represents a medical and surgical emergency. Treatment is generally urgent surgical drainage combined with antibiotics. The patient should be evaluated in detail for systemic infectious disease and comorbid conditions before the vertebroplasty procedure.
Asunto(s)
Absceso Epidural/etiología , Complicaciones Posoperatorias/microbiología , Fracturas de la Columna Vertebral/cirugía , Fusión Vertebral , Infecciones Estafilocócicas/cirugía , Anciano , Drenaje , Femenino , Fracturas por Compresión/etiología , Fracturas por Compresión/cirugía , Humanos , Laminectomía , Osteoporosis/complicaciones , Complicaciones Posoperatorias/cirugía , Fracturas de la Columna Vertebral/etiología , Infecciones Estafilocócicas/terapiaRESUMEN
Effective joint distraction is crucial in arthroscopic ankle surgery. We describe an effective and controlled intra-articular ankle distraction technique that we have studied by means of a fresh-frozen cadaver model. Using a kyphoplasty balloon, which is currently used in spine surgery, we tried to achieve a controlled distraction. After the fixation of the cadaver model, standard anteromedial and anterolateral portals were used for ankle arthroscopy. From the same portals, the kyphoplasty balloon was inserted and placed in an appropriate position intra-articularly. The necessary amount of distraction was achieved by inflating the kyphoplasty balloon with a pressure regulation pump. All anatomic sites of the ankle joint were easily visualized with the arthroscope during surgery by changing the pressure and the intra-articular position of the kyphoplasty balloon. Ankle distraction was clearly seen on the arthroscopic and image intensifier view. The kyphoplasty balloon is simple to place through the standard portals and the advantage is that it allows easy manipulation of the arthroscopic instruments from the same portal.
Asunto(s)
Articulación del Tobillo/cirugía , Artroscopía , Cadáver , HumanosRESUMEN
This is a case report of two children with congenital dislocation of the knee. They have been treated surgically with Z-lengthening of the quadriceps tendon and additional reconstruction of the quadriceps tendon with Achilles tendon allograft to fill in the remaining average 6 cm gap of the tendon. The patients were two girls, 6 and 9 years old. One of them had an operative treatment previously with a tendon lengthening procedure and it was failed and the other patient was untreated before. Preoperatively, untreated case was unable to walk. The other patient was limping. None of them was able to flex their knees beyond the neutral extension position. Postoperatively, both patients were able to walk and the knees were reduced to a range of motion of 0 degrees -95 degrees of flexion. The mean follow-up time was 20 months.
Asunto(s)
Tendón Calcáneo/trasplante , Luxación de la Rodilla/congénito , Procedimientos Ortopédicos/métodos , Músculo Cuádriceps/anomalías , Factores de Edad , Niño , Femenino , Estudios de Seguimiento , Humanos , Luxación de la Rodilla/cirugía , Músculo Cuádriceps/cirugía , Resultado del TratamientoRESUMEN
OBJECTIVE: Transpedicular spinal fixation has recently been the focus of increased attention in several institutions throughout the world, but its safety and efficacy are still important questions for orthopedic surgeons. Accurate screwing through the pedicle will avoid neurologic complications and increase the stability of the instrumentation. In this study, it was aimed to analyze the anatomic relations quantitatively between the lumbar pedicle and the adjacent dural sac and nerve roots, to determine the risky areas for neural injury during transpedicular screw placement. METHODS: Ten adult cadavers were used for observation of the lumbar pedicle and its relations. After removal of the laminas and facets, the lumbar pedicles, dural sac, and nerve roots were exposed. Interpedicular distance (IPD), pedicle-inferior nerve root distance (PIRD), pedicle-superior nerve root distance (PSRD), and pedicle-dural sac distance (PDSD) were measured. RESULTS: Average distance from the lumbar pedicle to the dural sac medially and to the adjacent nerve roots superiorly and inferiorly through the cranial to caudal lumbar levels ranged from 1.29 to 1.56, from 4.12 to 5.52, and from 1.10 to 1.06 mm, respectively. The mean IPD ranged from 32.77 to 41.24 mm. There were statistically significant differences between the L5 level and other lumbar levels for IPD, PSRD, and PDSD measurements. CONCLUSIONS: These results indicate that although L5 is safer than other lumbar levels for pedicle screw insertion, an improper medial and caudal placement of a pedicular screw will carry a great risk of injury to the dural sac and inferior nerve root.
Asunto(s)
Duramadre/anatomía & histología , Vértebras Lumbares/anatomía & histología , Raíces Nerviosas Espinales/anatomía & histología , Tornillos Óseos , Humanos , Vértebras Lumbares/cirugía , Persona de Mediana EdadRESUMEN
PURPOSE: To evaluate the results for patients treated arthroscopically for anterolateral soft tissue impingement syndrome, to determine the factors affecting the outcome, and to report on a synovial shelf. TYPE OF STUDY: Retrospective clinical review. METHODS: Forty-one patients underwent operative arthroscopy for anterolateral impingement of the ankle between 1990 and 2001; the mean follow-up was 83.7 months (range, 21 to 152 months). There were 25 men and 16 women with an average age of 33.2 years (range, 15 to 63 years). All patients reported a history of inversion injury to the ankle. The most frequent preoperative complaints were tenderness localized to the anterolateral aspect of the ankle, swelling, crepitation, and pain at weight-bearing. All patients had failed to respond to at least 3 months of conservative treatment. The results were assessed according to Meislin's criteria and the American Orthopaedics Foot and Ankle Society (AOFAS) scoring table. For statistical analysis, the Mann-Whitney U test was used where appropriate and the significance was set at P < .005. RESULTS: According to Meislin's criteria, there were excellent results in 21 patients, good in 16, fair in 2, and poor in 2. The mean AOFAS score was 89.6 points (range, 60-100) at follow-up. Four different soft tissue pathologies causing impingement were described. It has been statistically shown that cartilage damage located at the anterolateral region of the ankle and not advanced to the subchondral bone, and repeated inversion injuries had negative effects on clinical results at long-term follow-up. CONCLUSIONS: The arthroscopic diagnosis and treatment of anterolateral soft tissue impingement is a safe and effective method. Any combination of associated intra-articular pathologies, such as a chondral lesion or a new inversion injury of the ankle, after the arthroscopic procedure resulted in a poor outcome. LEVEL OF EVIDENCE: Level IV, Therapeutic Study.
Asunto(s)
Traumatismos del Tobillo/complicaciones , Articulación del Tobillo/cirugía , Artroscopía/métodos , Artropatías/cirugía , Ligamentos Articulares/lesiones , Adolescente , Adulto , Articulación del Tobillo/diagnóstico por imagen , Artralgia/etiología , Artralgia/prevención & control , Enfermedades de los Cartílagos/diagnóstico , Enfermedades de los Cartílagos/etiología , Enfermedades de los Cartílagos/cirugía , Enfermedad Crónica , Femenino , Estudios de Seguimiento , Humanos , Artropatías/diagnóstico , Artropatías/etiología , Inestabilidad de la Articulación/diagnóstico , Inestabilidad de la Articulación/etiología , Inestabilidad de la Articulación/cirugía , Masculino , Persona de Mediana Edad , Radiografía , Rango del Movimiento Articular , Estudios Retrospectivos , Esguinces y Distensiones/complicaciones , Sinovitis/diagnóstico , Sinovitis/etiología , Sinovitis/prevención & control , Resultado del TratamientoRESUMEN
Metastatic malignancies of the hand are rare and they usually develop from lung, breast, and kidney tumors. Metastases to the bones of the hand can cause pain, swelling, soft tissue ulceration, and osteolytic destruction. We presented three patients with metastatic tumors of the hand, whose ages were 58 (male), 42 (female), and 40 (male) years. Metastases developed in the thumb and the big toe, metacarpal bone, and the nail bed following treatment for primary tumors of the bladder, colon, and chondrosarcoma of the proximal femur, respectively. One patient underwent amputation of the thumb and the big toe followed by systemic chemotherapy, one patient with metacarpal involvement was treated with Ray amputation, and the latter underwent a biopsy. Histopathological diagnoses were consistent with primary tumors.
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Adenocarcinoma/diagnóstico , Neoplasias Óseas/diagnóstico , Mano , Adenocarcinoma/diagnóstico por imagen , Adenocarcinoma/tratamiento farmacológico , Adenocarcinoma/secundario , Adenocarcinoma/cirugía , Adulto , Neoplasias Óseas/diagnóstico por imagen , Neoplasias Óseas/tratamiento farmacológico , Neoplasias Óseas/secundario , Neoplasias Óseas/cirugía , Neoplasias del Colon/diagnóstico , Neoplasias del Colon/patología , Terapia Combinada , Diagnóstico Diferencial , Femenino , Humanos , Masculino , Persona de Mediana Edad , Metástasis de la Neoplasia , Radiografía , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
Avulsion fractures of the apophyses of the pelvis are common in adolescent athletes. They usually occur as a result of trauma or overuse, involving especially the anterior inferior iliac spine, anterior superior iliac spine, anterior third of the iliac crest, tuber ischiadicum, and the symphysis pubis. The majority of these injuries occur during vigorous sports, with a male preponderance. They are often mistaken for muscle or tendon injuries. History, physical examination, and radiologic modalities are often helpful in diagnosis. Treatment may vary depending on the localization of the injury and the extent of fragment dislocation, but mainly remains conservative including bed rest, medications, and rehabilitation. Some patients may require surgical treatment, though.
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Traumatismos en Atletas/diagnóstico , Traumatismos en Atletas/terapia , Huesos Pélvicos/lesiones , Adolescente , Servicios de Salud del Adolescente , Traumatismos en Atletas/diagnóstico por imagen , Traumatismos en Atletas/patología , Traumatismos en Atletas/prevención & control , Fracturas Óseas/diagnóstico , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/patología , Fracturas Óseas/prevención & control , Fracturas Óseas/terapia , Humanos , Luxaciones Articulares/diagnóstico , Luxaciones Articulares/diagnóstico por imagen , Luxaciones Articulares/patología , Luxaciones Articulares/prevención & control , Luxaciones Articulares/terapia , Huesos Pélvicos/diagnóstico por imagen , Huesos Pélvicos/patología , Radiografía , TurquíaRESUMEN
The heel fat pad has a unique structure that is important for its shock-absorbing function. Loss of elasticity and changes in the thickness of the heel pad have been suggested as causes of heel pain. The present study of a population with heel pain shows the relationship between the thickness and elasticity of the heel fat pad and age, sex, obesity, duration of symptoms, subcalcaneal spurs, and noninvasive conservative treatment. Of 182 patients with heel pain who visited an outpatient clinic during a 3-year period, 50 (67 heels) fulfilling specific criteria were treated with a combination of nonsteroidal anti-inflammatory drugs, contrast baths, stretching exercises, and change of footwear habits. Patients were followed up for 1 year. Delayed healing, increased thickness, and decreased elasticity of the heel fat pad were found in patients who were older than 40 years, who had symptoms for longer than 12 months before treatment, and who had a large subcalcaneal spur. An increase in heel fat pad thickness with aging and increased body weight reduce the elasticity of the heel fat pad. In addition, subcalcaneal spurs diminish the elasticity of the heel fat pad and play a role in the formation of heel pain.
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Tejido Adiposo/fisiopatología , Talón , Dolor/fisiopatología , Tejido Adiposo/patología , Adulto , Anciano , Envejecimiento , Elasticidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Obesidad/complicaciones , Dolor/etiologíaRESUMEN
Between 1989 and 2000, 16 patients underwent surgery for tarsal tunnel syndrome; 12 patients (13 feet) were available for follow-up at a mean of 83 (12-143) months. The symptoms had resolved in six feet, were improved in four, were unchanged in two and recurred after five years in one. Better results are obtained in patients who have space occupying lesions than in those in whom the aetiology is idiopathic or post-traumatic or those with foot deformities.
Asunto(s)
Síndrome del Túnel Tarsiano/cirugía , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Síndrome del Túnel Tarsiano/etiología , Resultado del TratamientoRESUMEN
OBJECTIVES: We assessed the long-term functional results of surgical treatment of distal intra-articular humeral fractures, together with the factors having influence on the outcome. METHODS: Thirty-four patients (25 males, 9 females; mean age 38 years; range 20 to 78 years) who were treated by open reduction and plate osteosynthesis were retrospectively evaluated. All fractures were type C according to the AO classification. Five patients had open fractures. Thirty-three patients had surgery within the first two days after trauma. Posterior (n=19), lateral (n=13), and lateral and medial (n=2) incisions were used. Intra-articular olecranon osteotomy was performed in 11 patients in whom a posterior incision was used. The mean follow-up period was 81.5 months (range 24 to 141 months). Functional evaluation was made according to the criteria described by Jupiter et al. RESULTS: Postoperative complications included infection in four patients, nerve lesion in four patients, nonunion of the olecranon in one patient, and fixation failure in one patient. The mean elbow flexion was 115.1 degrees, and the mean extension loss was 26.3 degrees. Four patients had severe pain and deformities. According to the criteria by Jupiter et al., the results were excellent in six (17.7%), good in 15 (44.1%), fair in nine (26.4%), and poor in four (11.8%) patients. The rate of excellent and good results were higher in closed fractures, in males, in patients at 20 to 40 years of age, in those undergoing posterior incisions and intra-articular olecranon osteotomy, and in patients in whom double-plate osteosynthesis was used. CONCLUSION: Our results suggest that age, gender, infection, preservation of neural function, successful rigid fixation, an anatomic restoration of the joint surface, and early rehabilitation are effective factors on the functional outcome.