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1.
Bone Joint J ; 103-B(4): 659-664, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789480

RESUMEN

AIMS: Injury to the lateral femoral cutaneous nerve (LFCN) is one of the known complications after periacetabular osteotomy (PAO) performed using the anterior approach, reported to occur in between 1.5% and 65% of cases. In this study, we performed a prospective study on the incidence of LFCN injury as well as its clinical outcomes based on the Harris Hip Score (HHS), Short-Form 36 Health Survey (SF-36), and Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ). METHODS: The study included 42 consecutive hips in 42 patients (three male and 39 female) who underwent PAO from May 2016 to July 2018. We prospectively evaluated the incidence of LFCN injury at ten days, three months, six months, and one year postoperatively. We also evaluated the clinical scores, including the HHS, SF-36, and JHEQ scores, at one year postoperatively. RESULTS: LFCN injury was observed in 31 of 42 (74%) patients at ten days, of which 11 resolved completely by one year. Incidence decreased gradually, to 25 of 42 (60%) patients at three months, 24 of 42 patients (57%) at six months, and 20 of 42 (48%) patients at one year postoperatively. There was no significant difference in the HHS between patients with and without LFCN injury at one year postoperatively. Regarding the SF-36 and JHEQ, a significant difference in the mental score was recognized between patients with and without LFCN injury, but there were no significant differences in the other clinical scores. CONCLUSION: The incidence of LFCN injury was 74% at ten days after PAO, and subsequently decreased to 48% at one year. LFCN injury did not influence the hip function as assessed by the HHS, but had a negative impact on mental health at one year. Cite this article: Bone Joint J 2021;103-B(4):659-664.


Asunto(s)
Acetábulo/cirugía , Nervio Femoral/lesiones , Osteotomía , Complicaciones Posoperatorias/epidemiología , Adolescente , Adulto , Femenino , Humanos , Japón/epidemiología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de Riesgo , Encuestas y Cuestionarios
2.
Bone Joint J ; 103-B(4): 665-671, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33789486

RESUMEN

AIMS: We compared the clinical outcomes of curved intertrochanteric varus osteotomy (CVO) with bone impaction grafting (BIG) with CVO alone for the treatment of osteonecrosis of the femoral head (ONFH). METHODS: This retrospective comparative study included 81 patients with ONFH; 37 patients (40 hips) underwent CVO with BIG (BIG group) and 44 patients (47 hips) underwent CVO alone (CVO group). Patients in the BIG group were followed-up for a mean of 12.2 years (10.0 to 16.5). Patients in the CVO group were followed-up for a mean of 14.5 years (10.0 to 21.0). Assessment parameters included the Harris Hip Score (HHS), Oxford Hip Score (OHS), Japanese Orthopaedic Association Hip-Disease Evaluation Questionnaire (JHEQ), complication rates, and survival rates, with conversion to total hip arthroplasty (THA) and radiological failure as the endpoints. RESULTS: There were no significant differences in preoperative and postoperative HHS or postoperative OHS and JHEQ between the BIG group and the CVO group. Complication rates were comparable between groups. Ten-year survival rates with conversion to THA and radiological failure as the endpoints were not significantly different between groups. Successful CVO (postoperative coverage ratio of more than one-third) exhibited better ten-year survival rates with radiological failure as the endpoint in the BIG group (91.4%) than in the CVO group (77.7%), but this difference was not significant (p = 0.079). CONCLUSION: Long-term outcomes of CVO with BIG were favourable when proper patient selection and accurate surgery are performed. However, this study did not show improvements in treatment results with the concomitant use of BIG. Cite this article: Bone Joint J 2021;103-B(4):665-671.


Asunto(s)
Trasplante Óseo/métodos , Necrosis de la Cabeza Femoral/cirugía , Osteotomía/métodos , Adolescente , Adulto , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Estudios Retrospectivos
3.
Stomatologiia (Mosk) ; 100(2): 90-96, 2021.
Artículo en Ruso | MEDLINE | ID: mdl-33874668

RESUMEN

Correction of disorders during transformation into one of the most difficult tasks, both in orthodontics and in maxillofacial (orthognathic) surgery. This article presents two clinical cases of median osteotomy/ostectomy. The stages of operations are described. Surgical technique of transversal correction by osteotomy/ ostectomy is presented. Operation is combined with bilateral retromolar osteotomy. Three dimensional fragments moving helps to change lower jaw shape. Indications for this surgical manipulation: one or two side cross-bite, discrepancies between size of teeth and length of alveolar bone (lower macrognathia, microdentia, extra-teeth, huge diastema), asymmetry of mandible.


Asunto(s)
Maloclusión , Procedimientos Quirúrgicos Reconstructivos , Cefalometría , Humanos , Maloclusión/cirugía , Mandíbula/cirugía , Osteotomía
4.
Orthopade ; 50(5): 378-386, 2021 May.
Artículo en Alemán | MEDLINE | ID: mdl-33844033

RESUMEN

A cornerstone in the treatment of osteoarthritis in young patients is the evaluation and correction of the leg axis. The combination of a joint injury (meniscus, cartilage, ligament) and an axis deviation inevitably, depending on its extent and the patient's comorbidities such as obesity, leads to progressive osteoarthritis of the knee after a few years. In addition to the precise deformity analysis for osteotomy planning, it is important to know the normal ranges of the corresponding angles and to define a target value for axis correction. Reflecting the repertoire of different osteotomy options around the knee (open vs. closed, tibial vs. femoral, medial vs. lateral), the side effects in relation to patellofemoral maltracking, ligamentary balancing and leg length should then be assessed. Especially with regard to possible (and probable) prosthetic operations at some time in the future of young patients, new bony deformities or ligamentous insufficiencies, which potentially arise from overcorrection, must be avoided.


Asunto(s)
Osteoartritis de la Rodilla , Tibia , Fémur , Humanos , Articulación de la Rodilla/diagnóstico por imagen , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/cirugía , Osteotomía , Radiografía
5.
Orthopade ; 50(5): 387-394, 2021 May.
Artículo en Alemán | MEDLINE | ID: mdl-33847791

RESUMEN

Unicompartmental knee arthroplasty, especially for both femorotibial compartments of the knee, is an established partly joint-saving treatment option for osteoarthritis of the knee if the disease is limited to one compartment. Even smaller implants or resurfacing of the patellofemoral joint have been shown-in smaller patient collectives-to have the potential to yield good clinical results.


Asunto(s)
Artroplastia de Reemplazo de Rodilla , Prótesis de la Rodilla , Osteoartritis de la Rodilla , Humanos , Articulación de la Rodilla/cirugía , Osteoartritis de la Rodilla/diagnóstico por imagen , Osteoartritis de la Rodilla/cirugía , Osteotomía , Resultado del Tratamiento
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(3): 343-348, 2021 Mar 15.
Artículo en Chino | MEDLINE | ID: mdl-33719244

RESUMEN

Objective: To investigate the short-term effectiveness of derotational distal femoral osteotomy (DDFO) combined with medial patellofemoral ligament (MPFL) reconstruction in treatment of recurrent patellar dislocation with excessive femoral anteversion angle (FAA≥30°). Methods: Between June 2017 and August 2019, 17 patients with recurrent patellar dislocation with FAA≥30° were treated with DDFO and MPFL reconstruction. There were 5 males and 12 females, aged 14-22 years, with an average of 17.7 years. The patella dislocated for 2 to 8 times (mean, 3.6 times). The disease duration was 2-7 years (mean, 4.6 years). The patellar apprehension tests were positive. Preoperative pain visual analogue scale (VAS) score, Lysholm score, Tegner score, and Kujala score were 4.2±1.1, 47.8±8.1, 3.6±1.1, and 56.8±5.7, respectively. FAA, mechanical lateral distal femoral angle (mLDFA), lateral patella displacement (LPD), tibial tuberosity-trochlear groove distance (TT-TG) were (34.9±3.4)°, (85.8±3.0)°, (13.7±3.8) mm, and (23.1±2.1) mm, respectively. Results: All incisions healed by first intention, and there was no complications such as knee stiffness, infection, and re-dislocation of the patella. All patients were followed up 13-25 months, with an average of 17.7 months. The imaging review showed that 1 case of osteotomy did not union, and achieved satisfactory results after the secondary revision and strengthening fixation; the osteotomies of other patients healed completely after 3 to 4 months of operation. The patellar apprehension tests were negative. At last follow-up, the FAA, mLDFA, LPD, and TT-TG were (15.6±2.7)°, (83.0±2.1)°, (5.0±2.6) mm, and (20.5±2.5) mm, respectively; the VAS score, Lysholm score, Tegner score, and Kujala score were 2.4±1.4, 93.4±7.8, 6.8±1.5, and 89.0±8.0, respectively. There were significant differences in the above indicators between pre- and post-operation ( P<0.05). Conclusion: DDFO combined with MPFL reconstruction for the recurrent patellar dislocation with excessive FAA (≥30°) can achieve good short-term effectiveness, significantly reduce knee pain, and improve function.


Asunto(s)
Luxación de la Rótula , Ligamento Rotuliano , Articulación Patelofemoral , Adolescente , Adulto , Femenino , Humanos , Articulación de la Rodilla , Ligamentos Articulares/cirugía , Masculino , Osteotomía , Rótula , Luxación de la Rótula/cirugía , Articulación Patelofemoral/cirugía , Adulto Joven
7.
Facial Plast Surg ; 37(1): 45-52, 2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33715148

RESUMEN

Nasal dorsal preservation surgery was described more than 100 years ago, but recently has gained prominence. Our objective is to show the surgical technique, the main indications and counterindications, and the complications. It is a technique that does not cause the detachment of the upper lateral cartilage (ULC) from the nasal septum, and has the main following sequence: preparation of the septum and its resection can be at different levels (high or low, i.e., SPAR [septum pyramidal adjustment and repositioning] A or B); preparation of the pyramid; transversal osteotomy; lateral osteotomy(s); and septopyramidal adjustment. The result is a nose with a lower radix than the original, a deprojection of the nasal dorsum tending to maintain its original shape; an increase in the interalar distance (IAD) and enlargement of the nasal middle ⅓; and loss of projection of the nasal tip and roundness of the nostrils. Thus, the ideal candidate is the one who benefits from such side effects, that is: tension nose, that is, high radix with projected dorsum, projected anterior nasal septal angle (ANSA), narrow middle ⅓, narrow IAD, thin nostrils and straight perpendicular plate of the ethmoid (PPE), and, depending on the characteristics, the deviated nose. The counterindications are low radix, irregularities in the nasal dorsum, ANSA lower than rhinion, and a wide middle ⅓. And the main stigmas are: a nose with a very low radix, middle ⅓ enlarged, residual hump, and saddling of the supratip area. Other issues of this technique are: the shape of the radix; the need or not to remove PPE; wide dorsum; irregular dorsum; ANSA lower than rhinion; weak cartilages; long nasal bone; deviated PPE; and obsessive patient. We conclude that this is a great technique for noses with characteristics suitable to it; care must be taken with the stigmas it can cause.


Asunto(s)
Rinoplastia , Humanos , Hueso Nasal , Cavidad Nasal , Tabique Nasal/cirugía , Nariz/cirugía , Osteotomía , Rinoplastia/efectos adversos
8.
Zhongguo Gu Shang ; 34(1): 57-62, 2021 Jan 25.
Artículo en Chino | MEDLINE | ID: mdl-33666021

RESUMEN

OBJECTIVE: To investigate the clinical effect of high tibial osteotomy combined with arthroscopic lateral retinacular release in the treatment of knee varus osteoarthritis. METHODS: From October 2017 to April 2019, a retrospective analysis was performed on 43 patients with knee varus osteoarthritis and lateral patellar compression syndrome treated by high tibial osteotomy combined with arthroscopic lateral retinacular release. There were 15 males and 28 females, aged 53 to 72(62.05±5.17) years. The visual analogue scale(VAS), Lysholm, and the knee range of motion were used to evaluate knee pain and functional recovery before operation, 2 weeks, 3 months and 12 months after operation. And the congruence angle (CA), patellar tilt angle (PTA), and femala-tibial angle (FTA) were measured respectively before and 12 months after operation to evaluate the congruence of patellar joint, and the improvement of line of gravity of lower limb. RESULTS: All 43 patients were followed up for more than 12 months, with a follow-up time of 14 to 28 (19.60±4.50) months. The VAS scores decreased from 6.65±0.65 before operation to 2.16±0.95, 0.51±0.77 and 0.33±0.64 at 2 weeks, 3 months and 12 months after operation, and the difference was statistically significant (P<0.001). Lysholm score increased from 43.02±8.54 before operation to 46.84±2.81, 72.42±5.30, and 93.40±5.44 at 2 weeks, 3 months and 12 months after operation, and the difference was statistically significant (P<0.001). The knee range of motion increased from (86.97±5.02)° before operation to (99.38±3.27)°, (110.13±4.13)°, and (113.03±4.85)° at 2 weeks, 3 months and 12 months after operation, the difference was statistically significant (P<0.001). The CA decreased from (7.81±1.21)° before operation to (5.82±4.10)° at 12 months after operation, the PTA decreased from (15.87±2.89)° before operation to (13.79±4.26)° at 12 months after operation, and the FTA decreased from(182.61±2.07)° before operation to(170.89±0.89)° at 12 months after operation, and the differences were statistically significant (P<0.05). One case received proper braking and anticoagulation after operation, and was improved after 1 week. The swelling was observed in 14 patients after operation, and subsided about 2 weeks later. CONCLUSION: High tibial osteotomy combined with arthroscopic lateral retinacular release can relieve weight-bearing pain in frontal axis and improve the function of knee in sagittal axis.


Asunto(s)
Osteoartritis de la Rodilla , Rótula , Anciano , Femenino , Humanos , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Osteoartritis de la Rodilla/cirugía , Osteotomía , Estudios Retrospectivos , Tibia/cirugía , Resultado del Tratamiento
9.
Ann R Coll Surg Engl ; 103(4): 272-277, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33682473

RESUMEN

INTRODUCTION: Aesthetic rhinoplasty remains a challenging procedure with high expectations and narrow tolerance for errors. Considerable training is required to achieve controlled and reliable results. Use of the Piezotome is gaining popularity for performing the nasal osteotomies, a key step in rhinoplasty, where it is reported to improve precision and predictability and to keep tissue damage to a minimum. We compare the outcomes of conventional osteotomy techniques to piezosurgery in human cadavers as undertaken by surgical trainees. MATERIALS AND METHODS: Seven human cadavers were used and a total of 14 osteotomies were performed. Conventional osteotomies and piezosurgery were carried out each on one side of the cadaver. A number of fragments and a blinded assessment of the accuracy of the osteotomy compared with the preprocedure skin markings were carried out by two experienced rhinoplasty surgeons. The Mann-Whitney test for statistical analysis was used. RESULTS: The mean number of fragments was 1.57 in the piezosurgery osteotomy and 2.14 using conventional osteotomies. Four of seven piezosurgery osteotomies achieved an accuracy within 1mm. The conventional osteotomies as performed by the trainees showed a significant mismatch of more than 3mm in three of seven of cases. Accuracy within 1mm was achieved in one of seven cases. DISCUSSION: Piezosurgery offers a safe, reliable and precise method of performing lateral nasal osteotomies. This human cadaver study shows a high accuracy of osteotomy and fewer comminuted fractures using this technique compared with conventional osteotomy techniques.


Asunto(s)
Hueso Nasal/cirugía , Osteotomía/métodos , Piezocirugía/métodos , Rinoplastia/métodos , Humanos , Osteotomía/efectos adversos , Osteotomía/instrumentación , Evaluación de Resultado en la Atención de Salud , Piezocirugía/efectos adversos , Piezocirugía/instrumentación , Rinoplastia/efectos adversos , Rinoplastia/instrumentación
10.
Medicine (Baltimore) ; 100(10): e25129, 2021 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-33725914

RESUMEN

ABSTRACT: A neglected Monteggia fracture is defined as the fracture of the proximal ulna associated with radial head dislocation (RHD) without undergoing any treatment for 4 weeks or more after injury. One-stage operation of ulnar corrective osteotomy and open reduction of RHD might result in many complications. Therefore, a two-stage strategy, including ulnar osteotomy (UO) with or without annular ligament reconstruction (ALR), was adopted at our institute since 2010.We performed a retrospective review of 51 patients with neglected Monteggia fracture between January 2010 and January 2018. Patients with bilateral problems or concomitant injuries in the ipsilateral extremity were excluded. Radiological and clinical data were collected from Hospital Database and clinical visits. All patients were divided into 2 groups based on the status of the ALR: the UO alone (UO) group and the ALR group.There were 15 patients in the UO group and 36 patients in the ALR group. The age in the UO group (6.1 ±â€Š2.3, year) was significantly younger than the ALR group (9.8 ±â€Š2.8, year) (P < .001). Concerning the duration from initial injury to surgery, there was a significant difference between the UO group (8.6 ±â€Š3.2 months) and the ALR group (23.3 ±â€Š12.6 months, P < .001). Concerning the preoperative elbow function, there was no significant difference between the UO group (67.6 ±â€Š5.0) and the ALR group (66.6 ±â€Š4.4) according to the Mayo elbow performance score (MEPS) (P = .51). Concerning the postoperative parameters, including postoperative ROM of the joint, removal of external fixator (6.7 ±â€Š0.8, 6.9 ±â€Š0.9 weeks) (P = .55), lengthening (8.9 ±â€Š2.5, 10.3 ±â€Š2.5 mm) (P = .10) and MEPS (92.7 ±â€Š2.1, 91.6 ±â€Š2.1) (P = .08), there was no significant difference between the UO group and ALR group.Two-stage strategy is a reasonable choice for selected patients with long-lasting RHD with ulnar deformity.


Asunto(s)
Articulación del Codo/cirugía , Ligamentos Articulares/cirugía , Fractura de Monteggia/cirugía , Reducción Abierta/métodos , Cúbito/cirugía , Niño , Preescolar , Articulación del Codo/lesiones , Fijadores Externos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Reducción Abierta/instrumentación , Osteotomía , Rango del Movimiento Articular , Estudios Retrospectivos , Factores de Tiempo , Tiempo de Tratamiento , Resultado del Tratamiento
11.
Medicine (Baltimore) ; 100(12): e24330, 2021 Mar 26.
Artículo en Inglés | MEDLINE | ID: mdl-33761633

RESUMEN

ABSTRACT: This study aimed to investigate the therapeutic effects of osteotomy combined with lateral ligament reconstruction on the osteochondral lesion of patients with talar injuries and varus ankles.Seventy five patients with talar injuries and varus ankles who received osteotomy combined with lateral ligament reconstruction for the osteochondral lesions from June 2008 to December 2014 were retrospectively reviewed. Patients were followed up for 32.4 ±â€Š15.3 months after surgeries, and the AOFAS-AH score, VAS score and SF36 score were determined preoperatively and postoperatively. The iconographic data were compared preoperatively and postoperatively, including tibial anterior surface angle (TAS), TTS, TT, and tibial lateral surface angle (TLS) angles.After surgeries, the AOFAS-AF score increased from 43.2 ±â€Š8.1 to 82.1 ±â€Š5.6, the VAS score decreased from 6.9 ±â€Š2.3 to 1.8 ±â€Š1.5, and the SF36 score increased from 48.7 ±â€Š9.4 to 83.5 ±â€Š6.2. TAS increased from 83.3 ±â€Š5.1 to 90.3 ±â€Š6.1, TTS increased from 70.3 ±â€Š6.1 to 82.5 ±â€Š5.4, TT decreased from 12.9 ±â€Š6.1 to 6.9 ±â€Š5.7, and TLS increased from 76.5 ±â€Š4.1 to 81.2 ±â€Š3.3 (P < .05).Osteotomy combined with lateral ligament reconstruction is effective for the treatment of talar osteochondral lesion with varus ankle, which could relieve the arthritic symptoms induced by cartilage lesions. By correcting the force line on lower limbs and metapedes with osteotomy completely, the treatments on talar osteochondral lesion and lateral ligament reconstruction are the critical factors with better results.


Asunto(s)
Articulación del Tobillo/anomalías , Ligamentos Colaterales/cirugía , Osteotomía/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Astrágalo/lesiones , Articulación del Tobillo/cirugía , Cartílago Articular/lesiones , Cartílago Articular/cirugía , Terapia Combinada/efectos adversos , Terapia Combinada/métodos , Desbridamiento/efectos adversos , Desbridamiento/métodos , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteotomía/efectos adversos , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Estudios Retrospectivos , Astrágalo/cirugía , Resultado del Tratamiento
12.
Am J Sports Med ; 49(5): 1209-1219, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33661717

RESUMEN

BACKGROUND: Gaining a better understanding of the underlying pattern of acetabular dysplasia 3-dimensionally can help better guide treatment and optimize clinical outcomes after periacetabular osteotomy (PAO). PURPOSE: (1) To examine the relationship between femoral head coverage before and after PAO for dysplasia and patient-reported outcome measure (PROM) scores and (2) to assess if the direction/orientation of correction of the acetabulum can be predicted based on the Ottawa classification. STUDY DESIGN: Cohort study; Level of evidence, 3. METHODS: A retrospective analysis of a prospectively collected database from a single-center institutional registry of PAO was conducted, and PROM scores at a minimum of 2 years were analyzed. A total of 79 hips (67 patients [56 female]; mean age at surgery, 27.5 years [range, 15.8-53.7 years]) were available for inclusion. According to the Ottawa classification, 54 hips (68.4%) had global deficiency, 15 hips (18.9%) had posterior deficiency, and 10 hips (12.7%) had anterior deficiency. Hip2Norm software was used to analyze the 3-dimensional coverage of the femoral head. Statistical analysis was conducted to look at significant predictors of improvements in PROMs using the minimal clinically important difference (MCID) for the Hip disability and Osteoarthritis Outcome Score (HOOS) Activities of Daily Living subscale. RESULTS: At a mean follow-up of 3.1 years (range, 2.0-7.4 years), all functional outcome scores improved significantly. A postoperative total femoral coverage <75.7%, posterior coverage (PC) <45.2%, and femoral head extrusion index >15.5% were all associated with not reaching the MCID for the HOOS Activities of Daily Living subscale. Multivariate analysis showed that PC was the single most important significant modifier influencing functional outcomes after PAO for the treatment of acetabular dysplasia, with an odds ratio of 6.0 (95% CI, 1.8-20.4; P = .004). One-way analysis of variance showed a significant difference comparing the mean change in radiographic measurements, that is, anterior coverage, PC, and total femoral coverage, per the Ottawa classification (P < .001). CONCLUSION: Our study demonstrated that postoperative femoral head coverage and acetabular orientation were significant predictors of PROM scores. Classifying acetabular dysplasia into 3 groups based on the plane of instability could optimize the planning of PAO by giving a better understanding of the 3-dimensional deformity.


Asunto(s)
Acetábulo , Luxación de la Cadera , Acetábulo/cirugía , Actividades Cotidianas , Estudios de Cohortes , Femenino , Cabeza Femoral/cirugía , Luxación de la Cadera/cirugía , Humanos , Osteotomía , Medición de Resultados Informados por el Paciente , Estudios Retrospectivos , Resultado del Tratamiento
13.
Am J Sports Med ; 49(4): 1031-1039, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33719608

RESUMEN

BACKGROUND: Internal fixation of an osteochondral lesion of the talus (OLT) can restore the congruency of the talus and maintain the subchondral bone and innate hyaline cartilage. However, OLT that is indicated for fixation is rarely encountered; hence, not many studies report on the results after the procedure. PURPOSE: To evaluate the clinical and radiological outcomes after internal fixation of chronic OLT involving a large bone fragment of at least 10 mm in diameter and 3 mm in depth on computed tomography (CT). STUDY DESIGN: Case series; Level of evidence, 4. METHODS: We retrospectively reviewed the data of 26 patients with OLT treated with internal fixation between August 2014 and April 2018. Of the patients, 15 were male and 11 were female, with a mean age of 16 years (range, 11-29 years). The primary radiological outcome measurement was bone union assessed on the 6-month postoperative CT scan. Clinical outcomes were assessed at a mean of 27.7 months postoperatively. RESULTS: Twenty patients (77%) achieved bone union on postoperative CT scan. The mean 100-mm visual analog scale (VAS) improved from 30.5 ± 8.5 preoperatively to 13.4 ± 9.7 postoperatively (P < .001). The mean Foot Function Index (FFI) improved from 30.5 ± 6.7 preoperatively to 13.7 ± 9.8 postoperatively (P < .001). A malleolar osteotomy was not necessary to approach the lesion in 88% of patients. A bone fragment with an irregular margin and low density on the preoperative CT scan was significantly associated with nonunion (odds ratio: 7.67, 95% confidence interval: 2.67 to 22.02, P = .008). The difference in clinical outcomes between patients with skeletally immature ankles and those with skeletally mature ankles was not statistically significant. Patient age did not correlate with postoperative 100-mm VAS (Pearson correlation coefficient, r = -0.07, P = 0.72) or the postoperative FFI (Pearson correlation coefficient, r = -0.05, P = .80). CONCLUSION: Internal fixation of an OLT involving a large bone fragment resulted in satisfactory clinical and radiologic outcomes. We found that patients with skeletally immature and mature ankles attained healing at comparable rates after the internal fixation of OLT.


Asunto(s)
Fracturas Intraarticulares , Astrágalo , Adolescente , Adulto , Niño , Femenino , Fijación Interna de Fracturas , Humanos , Masculino , Osteotomía , Estudios Retrospectivos , Astrágalo/diagnóstico por imagen , Astrágalo/cirugía , Resultado del Tratamiento , Adulto Joven
14.
Clin Sports Med ; 40(2): 271-288, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33673886

RESUMEN

Acetabular dysplasia represents a structural pathomorphology associated with hip pain, instability, and osteoarthritis. The wide spectrum of dysplasia anatomically refers to a 3-dimensional volumetric- and surface area-based insufficiency in coverage and is classified based on the magnitude and location of undercoverage. Borderline dysplasia has been variably defined and leads to management challenges. In symptomatic dysplasia, treatment addresses coverage with periacetabular osteotomy. Concomitant simultaneous or staged hip arthroscopy has significant advantages to address intra-articular pathology. In nonarthritic individuals, there is evidence PAO alters the natural history of dysplasia and decreases the risk of hip arthritis and total hip arthroplasty.


Asunto(s)
Luxación de la Cadera/cirugía , Acetábulo/cirugía , Adulto , Artralgia , Artroscopía , Femenino , Humanos , Masculino , Osteotomía , Resultado del Tratamiento
15.
Orthod Fr ; 92(1): 115-128, 2021 Mar 01.
Artículo en Francés | MEDLINE | ID: mdl-33772507

RESUMEN

Different surgical and non-surgical techniques have been developed in order to reduce the duration of orthodontic treatment. Regarding surgical techniques, corticotomies are widely used. The micro-osteoperforation technique (MOP), in addition to the piezocision technique, have been developed to provide minimally invasive surgery as an alternative to conventional corticotomies, without the elevation of a mucoperiosteal flap. Regarding non-surgical techniques, the approach is radically different in terms of physical stimuli or chemical techniques. Corticotomy and piezocision techniques have been found to be effective in accelerating orthodontic tooth movement, although the corticotomy technique presents a significant risk of postoperative treatment. These two techniques also offer the possibility of adding a bone graft using a tunneling surgical approach. Regarding non-surgical techniques, physical stimuli techniques such as with a laser are easy to perform, non-invasive and seem to be promising. However, their effectiveness has not yet been demonstrated, as is the case for chemical techniques. While at first glance these techniques are reassuringly non-invasive, do they not give the sensation of playing the sorcerer's apprentice ? Although surgical techniques seem to have demonstrated their significant efficacy in accelerating orthodontic tooth movement, non-surgical techniques do not yet provide a sufficient level of evidence and / or safety to be performed in our routine clinical practice as orthodontists. As these topics are innovative, new and future scientific evidence should be able to lead to the development of all these concepts.


Asunto(s)
Piezocirugía , Técnicas de Movimiento Dental , Aceleración , Humanos , Procedimientos Quirúrgicos Mínimamente Invasivos , Osteotomía
16.
J Clin Neurosci ; 85: 64-66, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33581792

RESUMEN

The surgical management of sacro-iliac chondrosarcomas is challenging given their intimate relationship to the nerves and vessels of the pelvis. Osteotomies for en bloc excision can be challenging because of lack of visualization and high risk of injury to pelvic structures. The use of three-dimensional (3D) printed models helps conceptualize the tumor relative to the patient's anatomy. Coupled with stereotactic navigation, safe osteotomy planning and execution can be performed with avoidance of vital nerves and vessels. Very few cases have been reported demonstrating the successful use of these 2 modern technologies for en bloc excision of difficult tumors. We present our technique of using a 3D printed model and navigation for en bloc excision of a large sacro-iliac chondrosarcoma, supplemented with an intraoperative video.


Asunto(s)
Neoplasias Óseas/cirugía , Condrosarcoma/cirugía , Imagenología Tridimensional/métodos , Neuronavegación/métodos , Osteotomía/métodos , Impresión Tridimensional , Humanos , Rayos Láser , Masculino , Persona de Mediana Edad , Articulación Sacroiliaca/patología , Articulación Sacroiliaca/cirugía , Resultado del Tratamiento
17.
J Hand Surg Asian Pac Vol ; 26(1): 118-125, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33559562

RESUMEN

Congenital radioulnar synostosis with posterior dislocation of the radial head remains challenging to treat. We describe a three-step treatment method that combines radial shaft osteotomy with a custom-made device, ulnar shaft osteotomy, and local adipofascial flap elevation procedures. For posterior radial head dislocation treatment, osteotomy near the proximal radius cannot recover physiological rotation of the radial head. Thus, we chose a precise radial shaft osteotomy with a custom-made device according to preoperative planning based on three-dimensional evaluation of the bone deformation. Performing radial shaft osteotomy alone, however, may not be enough to achieve sufficient supination range of motion. We, therefore, also performed ulnar shaft osteotomy. Finally, we elevated the local adipofascial flap to prevent re-adhesion. In three patients, the range of motion of the elbow improved postoperatively. In conclusion, our three-step method does not require a microsurgical technique and is easy to perform.


Asunto(s)
Articulación del Codo/cirugía , Luxaciones Articulares/cirugía , Radio (Anatomía)/anomalías , Sinostosis/cirugía , Cúbito/anomalías , Placas Óseas , Niño , Preescolar , Simulación por Computador , Humanos , Imagenología Tridimensional , Masculino , Osteotomía , Cuidados Preoperatorios , Radio (Anatomía)/diagnóstico por imagen , Radio (Anatomía)/cirugía , Cirugía Asistida por Computador/instrumentación , Sinostosis/diagnóstico por imagen , Transferencia Tendinosa , Tomografía Computarizada por Rayos X , Cúbito/diagnóstico por imagen , Cúbito/cirugía
18.
Spine (Phila Pa 1976) ; 46(6): E374-E383, 2021 Mar 15.
Artículo en Inglés | MEDLINE | ID: mdl-33620182

RESUMEN

STUDY DESIGN: A retrospective study. OBJECTIVE: The aim of this study was to make a thorough comparison of clinical and radiographic outcomes between ankylosing spondylitis (AS) patients with severe kyphosis who underwent one- or two-level pedicle subtraction osteotomy (PSO) and to determine the indications of one-level PSO. SUMMARY OF BACKGROUND DATA: Traditionally, one-level PSO was considered being able to obtain 35° to 40° correction. However, in our practice, one-level PSO might achieve satisfied clinical and radiographic outcomes in AS patients with severe thoracolumbar kyphosis defined as global kyphosis (GK) ≥80°. METHODS: Fifty-five AS-related severe thoracolumbar kyphosis patients undergoing one- or two-level PSO from January 2007 to November 2016 were reviewed. The radiographic parameters included thoracic kyphosis (TK), lumbar lordosis (LL), GK, pelvic tilt (PT), sacral slope (SS), pelvic incidence (PI), sagittal vertical axis (SVA), and femoral obliquity angle (FOA). Clinical outcomes were evaluated by Oswestry Disability Index (ODI) and Visual Analogue Scale (VAS). RESULTS: The mean follow-up period was 39.7 ±â€Š20.2 months (range, 24-120 months). Patients who underwent one-level PSO have significantly smaller preoperative GK, SVA, FOA, and larger preoperative LL and SS compared to those who underwent two-level PSO (P < 0.05). The optimal cutoff points of preoperative radiographic parameters for selecting one-level PSO were: GK <94°, SVA <18.0 cm, and LL <18°. No significant difference was observed between the two groups with regard to preoperative ODI and VAS (P > 0.05), and the improvement of ODI and VAS (P > 0.05). Significantly more operative time, blood loss, and fusion levels were found in two-level PSO group (P < 0.05). CONCLUSION: One-level PSO might be appropriate for selected severe AS-related kyphosis patients with GK <94°, SVA <18.0 cm, and LL <18°. This finding might be beneficial for surgical decision-making in performing one-level PSO, a relatively less risky procedure, to reconstruct the ideal sagittal alignment in AS patients with severe thoracolumbar kyphosis.Level of Evidence: 2.


Asunto(s)
Cifosis/cirugía , Vértebras Lumbares/cirugía , Osteotomía/métodos , Satisfacción del Paciente , Espondilitis Anquilosante/cirugía , Vértebras Torácicas/cirugía , Adolescente , Adulto , Femenino , Estudios de Seguimiento , Humanos , Cifosis/diagnóstico por imagen , Vértebras Lumbares/diagnóstico por imagen , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Espondilitis Anquilosante/diagnóstico por imagen , Vértebras Torácicas/diagnóstico por imagen , Resultado del Tratamiento , Adulto Joven
19.
Medicine (Baltimore) ; 100(7): e24693, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607809

RESUMEN

RATIONALE: Crouzon syndrome is a craniofacial malformation caused by premature fusion of fibrous sutures in infants. It is one of the most common craniosynostosis syndromes, and surgery is the only effective treatment for correcting it. Postoperative complications such as encephalocele, infections, hematoma have been reported. We herein report a case of a 62-month-old boy with Crouzon syndrome who underwent fronto-orbital advancing osteotomy, cranial vault remolding, and extensive osteotomy and subsequently developed left proptosis and severe chemosis, these complications are rare and we believe it will be of use to clinicians, physicians, and researchers alike. PATIENT CONCERNS: The patient's skull had been malformed since birth, and he had been experiencing paroxysmal headaches coupled with vomiting for 4 months. Having never received prior treatment, he underwent fronto-orbital advancement at our clinic; afterward, left proptosis and severe chemosis occurred. DIAGNOSIS: The patient was diagnosed with Crouzon syndrome, and the complications included left proptosis and severe chemosis, confirmed by the clinical manifestations, physical examination, and computed tomography (CT). INTERVENTION: We carried out cranial vault remodeling and fronto-orbital advancement. We applied ophthalmic chlortetracycline ointment on the conjunctivae, elevated the patient's head, evacuated the hematoma, and carried out a left blepharorrhaphy. OUTCOMES: The proptosis and chemosis resolved with no recurrence. No other complications occurred during the follow-up period (12 months), and CT scans revealed that the hematoma had disappeared. The calvarial vault reshaping was satisfactorily performed, and the patient's vision was not impaired. LESSONS: Severe proptosis and chemosis are rare complications that can occur after fronto-orbital advancement for Crouzon syndrome. A detailed preoperative examination (including magnetic resonance imaging and CT) is essential for diagnosis. Complete hemostasis, evacuation of hematoma, and placement of a periorbital drainage tube during surgery all contribute to an effective treatment plan. An ophthalmic ointment should be administered, and the patient's head should be elevated during the procedure. Evacuation of retrobulbar epidural hematoma and blepharorrhaphy could also help relieve proptosis and chemosis. Our report describes 2 rare complications associated with the treatment for Crouzon syndrome, and we believe it will be of use to clinicians, physicians, and researchers alike.


Asunto(s)
Disostosis Craneofacial/cirugía , Exoftalmia/etiología , Hueso Frontal/cirugía , Procedimientos Quirúrgicos Oftalmológicos/efectos adversos , Órbita/cirugía , Procedimientos Quirúrgicos Reconstructivos/efectos adversos , Preescolar , Disostosis Craneofacial/diagnóstico , Disostosis Craneofacial/patología , Enfermedades de los Párpados/patología , Enfermedades de los Párpados/cirugía , Hueso Frontal/anomalías , Humanos , Masculino , Procedimientos Quirúrgicos Oftalmológicos/métodos , Órbita/anomalías , Osteotomía/métodos , Procedimientos Quirúrgicos Reconstructivos/métodos , Hemorragia Retrobulbar/diagnóstico por imagen , Hemorragia Retrobulbar/cirugía , Cráneo/cirugía , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento , Trastornos de la Visión/cirugía
20.
BMJ Case Rep ; 14(2)2021 Feb 04.
Artículo en Inglés | MEDLINE | ID: mdl-33541981

RESUMEN

Hoffa fractures are unstable intra-articular fractures of the femoral condyle that occur in the coronal plane.Insufficient anatomical reduction and internal fixation may lead to non-union or malunion. A 39-year-old man was involved in a traffic accident while riding a motorcycle and was diagnosed with left Hoffa fracture and avulsion fracture of the femoral attachment of the medial collateral ligament. Open reduction and internal fixation were performed 5 days after injury. The patient experienced intermittent knee pain, joint contracture and deformity, and attended our hospital for further treatment 18 months after surgery. CT revealed depression and malunion of the posterior aspect of the lateral femoral condyle, and weight-bearing X-ray showed valgus deformity due to malunion. Distal femoral osteotomy (DFO) was performed and good functional and radiographic results were obtained. This report suggests that DFO is a reasonable treatment for young patients suffering from malalignment due to malunited Hoffa fracture.


Asunto(s)
Fijación Interna de Fracturas , Fracturas Mal Unidas/diagnóstico por imagen , Genu Valgum/diagnóstico por imagen , Articulación de la Rodilla/fisiopatología , Osteotomía , Adulto , Femenino , Genu Valgum/diagnóstico , Humanos , Fracturas Intraarticulares/diagnóstico por imagen , Masculino , Reducción Abierta , Radiografía , Tomografía Computarizada por Rayos X
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