RESUMO
We present a case report of a novel salvage technique for a failed Keller's arthroplasty using nonvascularised phalanx transfer from the second toe to the hallux on the same foot. The technique restores length, function and relieves pain.
Assuntos
Artroplastia/efeitos adversos , Transplante Ósseo , Deformidades Adquiridas do Pé/cirurgia , Falanges dos Dedos do Pé/transplante , Feminino , Deformidades Adquiridas do Pé/etiologia , Humanos , Pessoa de Meia-IdadeRESUMO
This study looks at the difference between the macroscopic and microscopic appearances of the anterior cruciate ligament (ACL) in a sample of 55 consecutive patients admitted for routine total knee replacement for osteoarthritis. At the time of surgery the macroscopic appearance of the ACL was classified as normal, moderately damaged (fissured) or completely ruptured. The excised ACL was sent for histological examination and grading. The macroscopic appearance of the ACL at surgery was compared to the severity of disease on microscopic examination. At surgery, 31 ACLs were found to be macroscopically normal: 22 of these (71%) showed moderate to severe disease on microscopic assessment. Thus a macroscopically normal ACL does not necessarily imply histological integrity. This has clinical implications in other areas of knee surgery including Unicompartmental Knee Replacement which require a fully functional intact ACL.
Assuntos
Ligamento Cruzado Anterior/patologia , Osteoartrite do Joelho/patologia , Idoso , Idoso de 80 Anos ou mais , Lesões do Ligamento Cruzado Anterior , Estudos de Coortes , Feminino , Humanos , Instabilidade Articular/diagnóstico , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicaçõesAssuntos
Articulação do Quadril/patologia , Articulação do Joelho/patologia , Cuidados Pré-Operatórios/economia , Biópsia por Agulha , Análise Custo-Benefício , Feminino , Articulação do Quadril/cirurgia , Prótese de Quadril/economia , Humanos , Imuno-Histoquímica , Articulação do Joelho/cirurgia , Prótese do Joelho/economia , Masculino , Cuidados Pré-Operatórios/métodosRESUMO
We have investigated the ability to kneel after total knee replacement. We asked 75 patients (100 knees) at least six months after routine uncemented primary total knee replacement, to comment on and to demonstrate their ability to kneel. Differences between the perceived and actual ability to kneel were noted. In 32 knees patients stated that they could kneel without significant discomfort. In 54 knees patients avoided kneeling because of uncertainties or recommendations from third parties (doctors, nursing staff, friends, etc). A total of 64 patients was actually able to kneel without discomfort or with mild discomfort only and 12 of the remainder were unable to kneel because of problems which were not related to the knee. Twenty-four patients therefore were unable to kneel because of discomfort in the knee. There was no difference between the 'kneelers' and 'non-kneelers' with regard to overall knee score, range of movement and the presence of patellar resurfacing.
Assuntos
Artroplastia do Joelho , Movimento , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Pessoa de Meia-Idade , Período Pós-Operatório , Radiografia , Amplitude de Movimento ArticularRESUMO
Balanced and stable fixation in metaphyseal fractures and nonunion can be difficult because of osteoporosis, disuse osteopenia, comminution, joint proximity or malignant infiltration. Five patients with nonunion and four with comminuted or pathological acute fractures of metaphyseal areas of the tibia or humerus were treated with a 'customized' interlocked blade plate. The plates are standard AO dynamic compression plates of a suitable length that are bent to an acute angle in an industrial vice and 'interlocked'. The nine patients with a mean age of 62.2 years (range 30-91) were followed up for a mean of 7.2 months. At follow-up all fractures had healed with a single complication of subacromial impingement in a patient with a proximal humeral fracture.
Assuntos
Placas Ósseas , Fixação Interna de Fraturas/métodos , Fraturas Cominutivas/cirurgia , Fraturas não Consolidadas/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Fraturas Cominutivas/diagnóstico por imagem , Fraturas não Consolidadas/diagnóstico por imagem , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Pessoa de Meia-Idade , Radiografia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgiaRESUMO
We analysed the histological findings in 1146 osteoarthritic femoral heads which would have been considered suitable for bone-bank donation to determine whether pathological lesions, other than osteoarthritis, were present. We found that 91 femoral heads (8%) showed evidence of disease. The most common conditions noted were chondrocalcinosis (63 cases), avascular necrosis (13), osteomas (6) and malignant tumours (one case of low-grade chondrosarcoma and two of well-differentiated lymphocytic lymphoma). There were two with metabolic bone disease (Paget's disease and hyperparathyroid bone disease) and four with inflammatory (rheumatoid-like) arthritis. Our findings indicate that occult pathological conditions are common and it is recommended that histological examination of this regularly used source of bone allograft should be included as part of the screening protocol for bone-bank collection.
Assuntos
Bancos de Ossos/normas , Transplante Ósseo/normas , Cabeça do Fêmur/patologia , Cabeça do Fêmur/transplante , Humanos , Osteoartrite do Quadril/cirurgia , Estudos Retrospectivos , Transplante Homólogo/normasRESUMO
Concerns in clinical practice arose over the amount of ovarian irradiation received from X-ray examinations in females with scoliosis. This study was instigated to assess the adequacy of ovarian protection in this young and genetically vulnerable group of patients. A total of 283 plain films in 20 patients with scoliosis were reviewed. If the area immediately adjacent to the medial wall of the acetabulum was clearly seen, then this was taken as indicative of ovarian irradiation. In a separate study, the radiation dose in the centre of the X-ray field on the surface of a tissue-equivalent anthropomorphic phantom was measured using thermoluminescent dosimeters. Standard conditions for scoliosis X-ray examination were used. The average age of patients was 21.5 years. The mean number of single X-ray exposures per patient was 14.1 over a mean of 44 months. The mean measured entrance dose to the skin in the 20 patients was 0.08 mGy (equivalent dose = 0.08 mSv). The mean percentage of examinations without lead protection was 18% per patient (range 0-40%). This would have resulted in a mean equivalent dose to the surface of the abdomen of 0.1 mSv per year per patient from the unprotected examinations. The maximum dose received in 1 year was 0.6 mSv. The maximum dose to the unprotected ovary was estimated to be 0.05 mSv from a single examination. The mean total cumulative ovarian dose was calculated as 180 microSv per patient (range 45-355 microSv) over the time period studied. The findings of this study indicate that ovarian protection should be improved. Reasons for this and suggestions for improvement are discussed.
Assuntos
Ovário , Proteção Radiológica , Escoliose/diagnóstico por imagem , Adolescente , Adulto , Criança , Feminino , Humanos , Ovário/efeitos da radiação , Doses de Radiação , Radiografia , Pele/efeitos da radiaçãoRESUMO
Unicompartmental knee arthroplasty is an appropriate method of treating selected patients with osteoarthritis of the medial compartment of the knee. The common causes of failure are aseptic loosening, infection, patellofemoral pain, and deterioration in the opposite compartment. Seven cases of a cohort of 32 Robert Brigham unicondylar knee replacements that failed because of early catastrophic wear of the polyethylene tibial component are reported. Possible reasons suggested for failure include inadequate thickness of polyethylene, fusion defects in the polyethylene structure as a result of the sterilization process, increased rotational freedom, and reduced conformity in the design of the prosthesis.
Assuntos
Artroplastia do Joelho , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho , Masculino , Pessoa de Meia-Idade , Osteoartrite/cirurgia , Polietilenos , Desenho de Prótese , Falha de Prótese , TíbiaRESUMO
Classical anatomical teaching suggests that the deltoid muscle is the main abductor of the shoulder. We present three cases of proven complete paralysis of the deltoid with an almost full range of movement of the shoulder owing to the compensatory action of accessory muscles. The mechanisms by which this occurs are described.
Assuntos
Músculo Esquelético/inervação , Paralisia/fisiopatologia , Recuperação de Função Fisiológica , Articulação do Ombro/fisiopatologia , Adulto , Axila , Humanos , Masculino , Movimento , Manguito Rotador/inervação , Lesões do OmbroRESUMO
Tension pneumothorax in a large man was inadequately drained by needle thoracocentesis with a 4.5 cm cannula. Unsuccessful needle thoracocentesis of a clinical tension pneumothorax in a large patient should be followed immediately by chest drain insertion, without local anaesthetic, as dictated by clinical urgency. If the clinical situation is still not improved other diagnoses should be considered.
Assuntos
Tubos Torácicos , Pneumotórax/cirurgia , Toracostomia/instrumentação , Acidentes de Trabalho , Humanos , Masculino , Pessoa de Meia-Idade , Punções/métodos , Traumatismos Torácicos/cirurgia , Toracostomia/métodos , Falha de TratamentoRESUMO
Advanced Trauma Life Support guidelines recommend the use of a cannula 3 to 6 cm long to perform needle thoracocentesis for life-threatening tension pneumothorax. The chest wall thickness in the 2nd intercostal space, mid-clavicular line, was determined by ultrasound in 54 patients aged 18 to 55 years, and ranged from 1.3 to 5.2 cm (mean 3.2 cm). In thirty-one patients (57 per cent) the chest-wall thickness (CWT) was greater than 3 cm, the minimum recommended cannula length, although in only two (4 per cent) was it greater than 4.5 cm, the length of cannula commonly used in the UK. As a 3 cm cannula would fail to reach the pleural cavity in over half of patients, we suggest that the recommended shortest length be increased to 4.5 cm. Unsuccessful needle thoracocentesis using a 4.5 cm cannula should be followed immediately by insertion of a longer cannula or a definitive chest drain.
Assuntos
Tubos Torácicos , Pneumotórax/cirurgia , Toracostomia/instrumentação , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumotórax/patologia , Toracostomia/métodos , Falha de TratamentoRESUMO
The importance of visualizing the entire cervical spine on radiological examination in patients with cervical trauma is well known. A review of the cervical films of 98 patients attending an accident and emergency (A&E) department was undertaken in order to assess the adequacy of imaging. It was found that 33.7% of the films were not sufficient to exclude fracture or dislocation of the cervical spine. The number of patients with inadequate views was significantly reduced when an advanced trauma life support trained senior doctor was involved.
Assuntos
Vértebras Cervicais/diagnóstico por imagem , Traumatismos da Coluna Vertebral/diagnóstico por imagem , Adulto , Vértebras Cervicais/patologia , Medicina de Emergência , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Radiografia , Estudos Retrospectivos , Sensibilidade e Especificidade , Traumatismos da Coluna Vertebral/diagnósticoRESUMO
A case is described of a patient who developed rhabdomyolysis and acute renal failure after the use of an intraoperative tourniquet for elective orthopaedic surgery. A review of the literature revealed four similar cases in the last 20 years. The clinical features and management of such patients are discussed.