RESUMO
Bilateral asymmetric hip fracture dislocation is an extremely rare entity. The injury is caused by a high velocity mechanism. We reported a case of bilateral hip fracture dislocation and its management. A 30-year-old man with no previous medical or surgical history was involved in a road accident involving a high-speed collision between two trucks. X-rays of the pelvis revealed asymmetrical bilateral fracture-luxation of the hips. The reduction of the hips was done under general anesthesia. Asymmetrical bilateral traumatic dislocation fracture of the hip is a rare serious injury. Reduction must be performed within 6 hours. Short- and long-term monitoring of the patient is essential.
Assuntos
Acidentes de Trânsito , Luxação do Quadril , Fraturas do Quadril , Humanos , Masculino , Adulto , Fraturas do Quadril/cirurgia , Fraturas do Quadril/etiologia , Luxação do Quadril/etiologia , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/cirurgia , Fratura-Luxação/diagnóstico por imagem , Anestesia Geral/métodosRESUMO
Background: Costovertebral hydatidosis is a rarely reported clinical and radiological entity, estimated at less than 1% of thoracic hydatid locations. Its management is still not codified. Objective: The aim of our study was to specify the management peculiarities of costovertebral hydatidosis. Methods: Between January 2000 and December 2018, 14 patients were managed for costovertebral hydatidosis in a thoracic surgery department. Results: The mean age of our patients was 48 years. The history of a prior hydatid disease was found in 7 patients. Imaging features were suggestive in 13 cases. They showed: involvement of the spinal canal (6 cases), of the soft tissues (5 cases) and spinal cord compression (3 cases). Costovertebral resection of the hydatid lesions was complete in 12 cases. Four patients presented postoperative complications. Conclusion: Costovertebral hydatid involvement, may threaten the functional and vital prognosis. Therefore, early diagnosis and management are mandatory, before the occurrence of irreversible neurological impairment. Surgical resection remains the treatment of choice and must be complete whenever possible. Relapse is frequent, hence the importance of a regular follow-up.
Assuntos
Equinococose , Doenças da Coluna Vertebral , Humanos , Pessoa de Meia-Idade , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/cirurgia , Equinococose/diagnóstico por imagem , Equinococose/cirurgia , Recidiva , Complicações Pós-Operatórias , PrognósticoRESUMO
Tuberculosis of the cervical spine is a rare extra-pulmonary localization. We reported the case of a 59-year-old woman with no medical history. She consulted for a 9 weeks history of painful cervical stiffness. Neurological examination was normal. Plain radiography revealed an osteolytic lesion of the C3 body, with infiltration of adjacent soft tissues. MRI showed a compression fracture of the C3 body with a signal anomaly extending to the anterior epidural space and pre-vertebral soft tissues. First, tumoral extension assessment was done and was normal. BK's research into sputum was negative. Histological examination of a CT biopsy revealed typical granulomatous inflammation. The diagnosis of tuberculosis was retained and antituberculous treatment was started with immobilization for 12 months. The patient had a total functional recovery at 18 months follow-up, with complete radiographic bone reconstruction of C3 after 12 months.
Assuntos
Vértebras Cervicais/patologia , Tuberculose da Coluna Vertebral/diagnóstico , Antituberculosos/uso terapêutico , Vértebras Cervicais/microbiologia , Diagnóstico Diferencial , Feminino , Fixação de Fratura , Fraturas por Compressão/diagnóstico , Fraturas por Compressão/etiologia , Fraturas por Compressão/terapia , Humanos , Imobilização , Pessoa de Meia-Idade , Cervicalgia/diagnóstico , Fraturas da Coluna Vertebral/diagnóstico , Fraturas da Coluna Vertebral/etiologia , Fraturas da Coluna Vertebral/terapia , Tuberculose da Coluna Vertebral/complicações , Tuberculose da Coluna Vertebral/terapiaRESUMO
BACKGROUND: Total knee arthroplasty on excessive genu varum is a more demanding technique and gives worst results than procedures on moderate deformations. It remains a subject of controversies due to the lack of consensus. The purpose of our study is to evaluate the results of total knee arthroplasty (TKA) on excessive genu varum (superior to 20°) by analyzing pre and post operative clinical and radiological parameters. METHODS: We reviewed retrospectively 40 TKA in 33 patients (seven patients operated bilaterally) performed for genu varum superior to 20° between 2004 and 2011. Pre and post operative evaluation of patients were done according to the International Knee Society score. RESULTS: The mean age of our patients was 67 years with a female predominance. Tricompartmental arthritis was the etiology in all cases. Pre operative IKS score and HKA angle were respectively 52,36 /200 points and 155,7°. The mean follow up was 4 years. Our results were generally satisfactory. The post operative IKS score was 155,36 points (mean joint score of 85.85 points and mean functional score of 69.26 Points) and the post operative HKA angle was 176,17°. Only 60° of patients had normal HKA angle. We noted aseptic loosening of the tibial component in 3 cases. CONCLUSION: TKA on excessive genu varum is more demanding technique. Pre operative planning after analyzing different clinical and radiological parameters is necessary to obtain a good functional outcome while minimizing the rate of complications.
Assuntos
Artroplastia do Joelho/efeitos adversos , Genu Varum/etiologia , Distribuição por Idade , Idoso , Artroplastia do Joelho/estatística & dados numéricos , Feminino , Genu Varum/diagnóstico por imagem , Genu Varum/patologia , Humanos , Articulação do Joelho/diagnóstico por imagem , Masculino , Radiografia , Estudos Retrospectivos , Índice de Gravidade de Doença , Distribuição por SexoRESUMO
Authors describe the case of a patient with breast cancer and multiple myeloma as the second metachronous disease responsible for spinal cord compression. Synchronous occurrence of bone marrow breast cancer disease and multiple myeloma has not been described in the literature, as in this case. By presenting this case, we point to possible association between both diseases and the possible factors involved in the development of second malignant disease.
Assuntos
Neoplasias da Mama/patologia , Mieloma Múltiplo/patologia , Compressão da Medula Espinal/etiologia , Neoplasias da Coluna Vertebral/patologia , Neoplasias da Mama/diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Mieloma Múltiplo/diagnóstico , Segunda Neoplasia Primária/diagnóstico , Segunda Neoplasia Primária/patologia , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/patologia , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/secundárioRESUMO
Hydatidosis is a parasitic disease due to Echinococcus granulosus. Spinal hytatidosis is the most common form, characterized by high morbidity and mortality. It is often diagnosed only when neurological complications occur, due to the long clinical latency and the non specific nature of symptoms. Standard radiography may show lacunar, areolar abnormalities separated by irregular walls without clear boundaries. Magnetic resonance imagery can reveal hydatic abcess presenting typical liquid abcess and locoregional extension. Laboratory methods are of little assistance to the diagnosis. Complete surgical excision of the lesions remains the only curative treatment, in the same way as for malignant tumors. Surgical eradication of hydatic lesions is difficult, however. Indeed, the surgeon is guided by the macroscopic aspect, but the bone may be infiltrated by microvesicles without clear boundaries. It is now recommended to accompany surgery by medical treatment based on albendazole. Rapid diagnosis and treatment of spinal hyatidosis may yield long-term remission or even cure, especially in localized forms.
Assuntos
Equinococose/diagnóstico , Equinococose/terapia , Doenças da Coluna Vertebral/diagnóstico , Doenças da Coluna Vertebral/terapia , Anti-Helmínticos/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Procedimentos NeurocirúrgicosRESUMO
BACKGROUND: The first metatarsophalangeal joint arthrodesis is a fusion with optimal alignment of the first metatarsal and first phalanx which conferring indolence, strength and stability. AIM: The goal of this study was to evaluate the place of arthrodesis of the first metatarsophalangeal joint in surgery of the fore foot. METHODS: This work is based on analysis of records of 35 patients between 1995 and 2006. 39 first metatarsophalangeal joint arthrodesis were practice (3 were bilateral). They had a follow up of from three to ten years. All patients were called for a complete exploration radiographic and clinical evaluation according to the criteria of KITAOKA. The average age of patients was 54 years. RESULTS: They were 28 women and 7 men. The indications were hallux rigidus in 51% cases and rheumatoid arthritis in 41% cases. The procedure used mostly a stable fixation with a compressive screw. The dorsal flexion recommended is between 20 and 30°. Ankylosis of the ankle or the inter-phalangeal joint was an against indication for the first metatarsophalangeal joint arthrodesis. The study found a patient subjective satisfaction rate of 92 per cent, there was no pain for 89 per cent of cases. It was noted 4 non-fusion cases paradoxically with satisfactory functional result. There was no pain of inter-phalangeal joint in all cases when X-rays showed arthritis in 4 cases. CONCLUSION: The first metatarsophalangeal joint arthrodesis, provided we respect a few simple principles, restores painless and satisfying function of foot.
Assuntos
Artrodese , Articulação Metatarsofalângica/cirurgia , Artrite Reumatoide/cirurgia , Feminino , Hallux Rigidus/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
Three different tumour-like lesions within the infrapatellar fat pad, an osteochondroma, a localised pigmented villonodular synovitis and a synovial cyst are reported. The osteochondroma and the pigmented villonodular synovitis were treated by marginal excision, and the synovial cyst was resected using arthroscopy.
Assuntos
Tecido Adiposo/patologia , Neoplasias Ósseas/patologia , Cistos Glanglionares/patologia , Osteocondroma/patologia , Patela/patologia , Sinovite Pigmentada Vilonodular/patologia , Tecido Adiposo/cirurgia , Adulto , Artroscopia/métodos , Biópsia por Agulha , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Diagnóstico Diferencial , Feminino , Cistos Glanglionares/diagnóstico , Cistos Glanglionares/cirurgia , Humanos , Imuno-Histoquímica , Articulação do Joelho/patologia , Articulação do Joelho/cirurgia , Imageamento por Ressonância Magnética/métodos , Masculino , Procedimentos Ortopédicos/métodos , Osteocondroma/diagnóstico , Osteocondroma/cirurgia , Patela/cirurgia , Estudos de Amostragem , Sinovite Pigmentada Vilonodular/diagnóstico , Sinovite Pigmentada Vilonodular/cirurgiaRESUMO
The authors report a case of Fielding type II acute atlanto-axial rotatory fixation (AARF). The CT scan with coronal reconstruction showed an avulsion of the apical and right alar ligament. These findings are exceptionally reported in the literature, especially concerning the apical ligament which might be a stabiliser in flexion and extension of the occipitocervical joint.
Assuntos
Articulação Atlantoaxial/lesões , Luxações Articulares/reabilitação , Tração , Articulação Atlantoaxial/fisiopatologia , Vértebras Cervicais/lesões , Traumatismos Craniocerebrais/diagnóstico por imagem , Traumatismos Craniocerebrais/terapia , Seguimentos , Humanos , Escala de Gravidade do Ferimento , Luxações Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Radiografia , Amplitude de Movimento Articular/fisiologia , Medição de Risco , Recusa do Paciente ao TratamentoRESUMO
On the basis of a retrospective study comprising 91 cases of femoral neck fracture treated by DHS, unrecognized screw articular penetration was observed in 9 cases (9.9%). The coxa valga (Garden I) fractures are the most interested by this complication (7 cases out of 9). With a practical purpose and to avoid remarking each time complex measurements again we found that the distance "d" separating the end of the implant from subchondral bone calculated on antero posterior and lateral views and so the angle measured on the lateral view were two criteria significantly predictive of this technical error with respectively P: 0.005 and P: 0.0005. Thus during the surgical procedure taking these two measurements after the installation of the pin guide would allow attention on the risk incurred. In case of doubt, we have changed the way of this pin before resorting to drilling and tapping.