Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 43
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
1.
JBJS Case Connect ; 10(1): e0289, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32044784

RESUMO

CASE: We present the unique case of deltoid and hand compartment syndrome in a young man after prolonged syncope because of polysubstance use. The patient was subsequently treated with urgent deltoid and hand compartment fasciotomies which resulted in full recovery of his shoulder function. CONCLUSIONS: Patients suspected of deltoid compartment syndrome should have a thorough physical examination, followed by repeat examinations. Invasive compartment monitoring should be used in equivocal cases, in patients with decreased level of consciousness, and in patients with distracting injury. Once diagnosed, deltoid compartment syndrome (± other compartments) should be taken for emergent fasciotomy, ensuring adequate decompression of all 3 deltoid compartments.

3.
Acta Neurochir (Wien) ; 160(12): 2479-2484, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30377830

RESUMO

Superficial radial intraneural ganglion cysts are rare. Only nine previous cases have been described. We provide two examples with a wrist joint connection and review the literature to provide further support for the unifying articular (synovial) theory for the pathogenesis and treatment of intraneural ganglia.


Assuntos
Cistos Glanglionares/cirurgia , Punho/cirurgia , Adulto , Feminino , Cistos Glanglionares/diagnóstico por imagem , Cistos Glanglionares/patologia , Humanos , Imagem por Ressonância Magnética , Masculino , Punho/diagnóstico por imagem , Punho/patologia
4.
J Bone Joint Surg Am ; 100(12): 1056-1063, 2018 Jun 20.
Artigo em Inglês | MEDLINE | ID: mdl-29916934

RESUMO

BACKGROUND: Redislocation of the native hip is rare. An anterior fulcrum between the proximal part of the femur and the pelvis must be present for a posterior dislocation to occur. The purpose of this study is to describe the cases of 9 patients with posterior redislocation or recurrent subluxation of the native hip that was treated with hip preservation surgery. METHODS: We retrospectively identified the cases of 9 patients, from 2 institutions, who had undergone hip preservation surgery for the management of posterior redislocation or recurrent subluxation of the native hip after a dislocation. The mean number of dislocations prior to surgery was 3.2 (range, 1 to 7). Pelvic radiographs were used to classify the acetabular morphology, sufficiency of acetabular containment, and structural anatomy of the proximal part of the femur. Radiographic identification of impinging structures was used to guide surgical treatment, which involved either femoral correction alone or the combination of femoral correction and an anteverting periacetabular osteotomy. RESULTS: At a mean follow-up of 73.8 months (range, 10 to 192 months), there had been no subsequent episodes of dislocation or subluxation in any of the hips treated with correction of the anatomic pivot point. An algorithmic approach is presented. CONCLUSIONS: In patients who have episodes of redislocation or recurrent subluxation of the native hip, the identification of anatomic abnormalities that create a fulcrum between the proximal part of the femur and the pelvis is critical for making appropriate treatment decisions. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Acetábulo , Fêmur , Luxação do Quadril/cirurgia , Acetábulo/anatomia & histologia , Acetábulo/cirurgia , Algoritmos , Fêmur/anatomia & histologia , Fêmur/cirurgia , Seguimentos , Luxação do Quadril/patologia , Articulação do Quadril/anatomia & histologia , Articulação do Quadril/cirurgia , Humanos , Recidiva , Estudos Retrospectivos
5.
J Hip Preserv Surg ; 4(3): 231-239, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28948035

RESUMO

Osteochondral defects of the femoral head are rare. Several treatment options have been described, though there is currently no consensus on the appropriate management of these lesions. Five patients underwent femoral head osteochondral autograft transfer for treatment of ipsilateral femoral head osteochondral defects via surgical hip dislocation between 2011 and 2014 at our institution. The mean age of the patients was 24.8 (16-37) years. There were four females and one male. Mean follow-up was 53.8 (30-64) months. Four patients reported complete resolution of preoperative pain, return to baseline activities and were satisfied with their results. Harris hip scores improved from a mean 60.8 (30-87) to 86.6 (44-100). There was no radiographic evidence of progression of the femoral head defects. There were no operative complications. Osteochondral autograft transfer from the ipsilateral femoral head using a surgical hip dislocation demonstrated good clinical and radiographic outcomes at midterm follow-up in our cohort and may be considered a suitable option for management of these lesions in select patients. Further research and follow-up is warranted to more clearly define the indications and outcomes of this procedure.

6.
J Arthroplasty ; 32(5): 1565-1570, 2017 05.
Artigo em Inglês | MEDLINE | ID: mdl-28109761

RESUMO

BACKGROUND: Metaphyseal fixation has promising early results in providing component stability and fixation in revision total knee arthroplasty (TKA). However, there are limited studies on midterm results of metaphyseal sleeves. We analyzed complications, rerevisions, and survivorship free of revision for aseptic loosening of metaphyseal sleeves in revision TKA. METHODS: Two hundred eighty patients with 393 metaphyseal sleeves (144 femoral, 249 tibial) implanted during revision TKA from 2006-2014 were reviewed. Sleeves were most commonly cemented (55% femoral, 72% tibial). Mean follow-up was 3 years, mean age was 66 years, and mean body mass index was 34 kg/m2. Indications for revision TKA included 2-stage reimplantation for deep infection (37%), aseptic loosening of the tibia (14%), femur (12%), or both components (9%), and instability (14%). RESULTS: There was a 12% rate of perioperative complications, most commonly intraoperative fracture (6.5%). Eight sleeves (2.5%) required removal: 6 (2%) during component resection for deep infection (all were well-fixed at removal) as well as 1 (0.8%) femoral sleeve and 1 (0.8%) tibial sleeve for aseptic loosening. Five-year survivorship free of revision for aseptic loosening was 96% and 99.5% for femoral and tibial sleeves, respectively. Level of constraint, bone loss, sleeve and/or stem fixation, and revision indication did not significantly affect outcomes. CONCLUSION: Metaphyseal sleeve fixation to enhance component stability during revision TKA has a 5-year survivorship free of revision for aseptic loosening of 96% and 99.5% in femoral and tibial sleeves, respectively. Both cemented and cementless sleeve fixation provides reliable durability at intermediate follow-up.


Assuntos
Artroplastia do Joelho/instrumentação , Prótese do Joelho , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fêmur/cirurgia , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese , Reoperação , Tíbia/cirurgia
7.
J Arthroplasty ; 32(2): 494-498, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-27600303

RESUMO

BACKGROUND: The Exeter cemented femoral stem has demonstrated excellent clinical and radiographic outcomes as well as long-term survivorship free from aseptic loosening. A shorter revision stem (125 mm) with a 44 offset became available for the purpose of cement-in-cement revision situations. In certain cases, this shorter revision stem may be used for various primary total hip arthroplasties (THAs) where the standard length stem would require distally reaming the femoral canal. We sought to report on the early to midterm results of this specific stem when used for primary THA regarding (1) clinical and radiographic outcomes, (2) complications, and (3) survivorship. METHODS: Twenty-nine patients (33 hips) underwent a hybrid THA using the smaller revision Exeter cemented femoral stem. Twenty-five patients (28 hips) had at least 2 years of follow-up and were assessed for clinical and radiographic outcomes. All 33 hips were included in the analysis of complications and survivorship. The Kaplan-Meier survivorship was performed using revision for all causes and for aseptic loosening as the end points. RESULTS: The average clinical follow-up was 4 years (range, 2-7). Harris Hip Scores improved from a mean preoperative value of 56 (range, 23-96) to 90 (range, 51-100) at the latest follow-up. All patients demonstrated superior cement mantles with no signs of loosening. One patient suffered a B2 periprosthetic fracture and 1 patient experienced 2 episodes of instability. The 5-year Kaplan-Meier survivorship was 96.7% for all causes of revision and was 100% using aseptic loosening as the end point. CONCLUSION: The shorter Exeter revision cemented femoral stem has favorable early to midterm clinical and radiographic outcomes when used for primary THA with a low complication rate and is a viable option in patients with narrow femoral canals where uncemented stem fixation is not desired.


Assuntos
Artroplastia de Quadril/instrumentação , Prótese de Quadril/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentos para Ossos , Feminino , Fêmur/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese , Reoperação/instrumentação , Estudos Retrospectivos , Resultado do Tratamento
8.
J Orthop Trauma ; 31(3): 146-150, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-27755337

RESUMO

OBJECTIVES: To define the incidence, risk factors, and anatomic location of articular malreductions in operatively treated lateral tibial plateau fractures. DESIGN: Prospective Cohort Study. SETTING: Academic Level 1 Trauma Centre. PATIENTS/PARTICIPANTS: Study subjects were patients entered into a prospective cohort study of tibial plateau fractures. INTERVENTIONS: Surgical fixation of tibial plateau fractures and postoperative computed tomographies (CTs). MAIN OUTCOME MEASURES: The primary outcome was incidence of articular malreduction. Secondary outcomes included risk factors for malreduction and a descriptive analysis of malreduction location. RESULTS: Sixty-five postoperative CTs were reviewed. Twenty-one reductions (32.3%) had a step or gap more than 2 mm. The frequency of malreductions in patients undergoing submeniscal arthrotomy or fluoroscopic-assisted reduction alone was 16.6% and 41.4%, respectively (P = 0.0021). Age, body mass index, OTA/AO fracture type, operative time, use of bone graft or bone graft substitute, and use of locking plates were not predictive of malreduction. Malreductions were heavily weighted to the posterior quadrants of the lateral tibial plateau. CONCLUSIONS: When examined using cross-sectional imaging the rate of articular malreductions was high at 32.3%. Fluoroscopic reduction alone was a predictor for articular malreduction. Most malreductions were located in the posterior quadrants of the lateral plateau. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Transplante Ósseo/estatística & dados numéricos , Fixação Interna de Fraturas/estatística & dados numéricos , Instabilidade Articular/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Fraturas da Tíbia/epidemiologia , Fraturas da Tíbia/cirurgia , Adulto , Distribuição por Idade , Idoso , Canadá/epidemiologia , Causalidade , Estudos de Coortes , Comorbidade , Feminino , Humanos , Incidência , Instabilidade Articular/diagnóstico , Instabilidade Articular/prevenção & controle , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/epidemiologia , Traumatismos do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Prognóstico , Fatores de Risco , Distribuição por Sexo , Resultado do Tratamento
10.
Acta Neurochir (Wien) ; 158(11): 2225-2229, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27562681

RESUMO

Intraneural ganglion cysts in the tarsal tunnel are rare. We present a patient who had an intraneural ganglion cyst involving the medial and lateral plantar and distal tibial nerves. Magnetic resonance imaging revealed evidence to support the joint-related (i.e., subtalar) origin of the cyst. Careful reinterpretation of the imaging supported a phasic mechanism (i.e., cross-over) to explain the interrelated pathogenesis of the intraneural cyst within the three nerves. This mechanism is analogous to that described for the prototypes-the peroneal, tibial and sciatic nerves in the knee region-and can be generalized to other nerves in the foot and ankle region. We believe that understanding the pathogenesis sheds light on the effective treatment.


Assuntos
Tornozelo/diagnóstico por imagem , Cistos Glanglionares/diagnóstico por imagem , Nervo Tibial/diagnóstico por imagem , Tornozelo/cirurgia , Cistos Glanglionares/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Adulto Jovem
14.
J Neurosurg ; 125(3): 615-30, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-26799306

RESUMO

OBJECTIVE The etiology of intraneural ganglion cysts has been controversial. In recent years, substantial evidence has been presented to support the articular (synovial) theory for their pathogenesis. The authors sought to 1) perform a systematic review of the world's literature on intraneural cysts, and 2) reinterpret available published MR images in articles by other authors to identify unrecognized joint connections. METHODS In Part 1, all cases were analyzed for demographic data, duration of symptoms, the presence of a history of trauma, whether electromyography or nerve conduction studies were performed, the type of imaging, surgical treatment, presence of a joint connection, intraneural cyst recurrence, and postoperative imaging. Two univariate analyses were completed: 1) to compare the proportion of intraneural ganglion cyst publications per decade and 2) to assess the number of recurrences from 1914 to 2003 compared with the years 2004-2015. Three multivariate regression models were used to identify risk factors for intraneural cyst recurrence. In Part 2, the authors analyzed all available published MR images and obtained MR images from selected cases in which joint connections were not identified by the original authors, specifically looking for unrecognized joint connections. Two univariate analyses were done: 1) to determine a possible association between the identification of a joint connection and obtaining an MRI and 2) to assess the number of joint connections reported from 1914 to 2003 compared with 2004 to 2015. RESULTS In Part 1, 417 articles (645 patients) were selected for analysis. Joint connections were identified in 313 intraneural cysts (48%). Both intraneural ganglion cyst cases and cyst recurrences were more frequently reported since 2004 (statistically significant difference for both). There was a statistically significant association between cyst recurrence and percutaneous aspiration as well as failure to disconnect the articular branch or address the joint. In Part 2, the authors identified 43 examples of joint connections that initially went unrecognized: 27 based on their retrospective MR image reinterpretation of published cases and 16 of 16 cases from their sampling of original MR images from published cases. Overall, joint connections were more commonly found in patients who received an MRI examination and were more frequently reported during the years 2004 to 2015 (statistically significant difference for both). CONCLUSIONS This comprehensive review of the world's literature and the MR images further supports the articular (synovial) theory and provides baseline data for future investigators.


Assuntos
Cistos Glanglionares , Doenças do Sistema Nervoso , Cistos Glanglionares/diagnóstico , Cistos Glanglionares/etiologia , Cistos Glanglionares/terapia , Humanos , Doenças do Sistema Nervoso/diagnóstico , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/terapia
16.
Clin Anat ; 29(4): 530-7, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26599204

RESUMO

Over the last decade, the mechanism of formation of intraneural ganglion cysts has been established through a meticulous review of clinical findings and correlation with patterns produced on magnetic resonance imaging (MRI). Pathognomonic imaging patterns distinguish these rare lesions from the more common extraneural variants in almost all cases. In this report, we present a new pattern of cyst occurrence in the subparaneurial compartment of the nerve and provide potential anatomic explanations for its pathogenesis. Using an anatomic framework of connective tissue compartments of the nerve, we reviewed 63 (56 fibular and seven tibial) intraneural ganglion cysts in the knee region evaluated at our institution and all reports with MRI in the world's literature for evidence of cyst occurrence in the subparaneurial compartment. We identified six cases (five in the common fibular nerve and one in the tibial nerve) at our institution that had MR evidence of cyst in the subparaneurial compartment with a new complex lobulated pattern. All cases had articular branch connections to the superior tibiofibular joint, which at operation were resected along with the joints. Follow-up revealed complete recovery in all instances and no clinical or radiological signs of recurrence. Three cases out of 80 in the literature exhibited the new complex lobulated MRI pattern. We present a new pattern of intraneural ganglion cyst occurrence in a potential space that surrounds peripheral nerves--the subparaneurial compartment. We believe that the unifying articular theory applies to the pathogenesis and management of these rare variants.


Assuntos
Tecido Conjuntivo/inervação , Cistos Glanglionares/patologia , Joelho/inervação , Adulto , Tecido Conjuntivo/diagnóstico por imagem , Feminino , Fíbula/patologia , Cistos Glanglionares/cirurgia , Humanos , Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Tíbia/patologia , Nervo Tibial/patologia
17.
Clin Anat ; 28(8): 1058-69, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26296291

RESUMO

The etiology of intraneural ganglion cysts has been poorly understood. This has resulted in the development of multiple surgical treatment strategies and a high recurrence rate. We sought to analyze these recurrences in order to provide a pathoanatomic explanation and staging classification for intraneural cyst recurrence. An expanded literature search was performed to identify frequencies and patterns in cases of intraneural ganglion cyst recurrences following primary surgery. Two univariate analyses were completed to identify associations between the type of revision surgery and repeat cyst recurrences. The expanded literature search found an 11% recurrence rate following primary surgery, including 64 recurrences following isolated cyst decompression (Group 1); six after articular branch resection (Group 2); and none following surgical procedures that addressed the joint (Group 3). Eight cases did not specify the type of primary surgery. In group 1, forty-eight of the recurrences (75%) were in the parent nerve, three involved only the articular branch, and one travelled along the articular branch in a different distal direction without involving the main parent nerve. In group 2, only one case (17%) recurred/persisted within the parent nerve, one recurred within a persistent articular branch, and one formed within a persistent articular branch and travelled in a different distal direction. Intraneural recurrences most commonly occur following surgical procedures that only target the main parent nerve. We provide proven or theoretical explanations for all identified cases of intraneural recurrences for an occult or persistent articular branch pathway.


Assuntos
Cistos Glanglionares/patologia , Cistos Glanglionares/cirurgia , Articulações/inervação , Nervos Periféricos/cirurgia , Descompressão Cirúrgica , Cistos Glanglionares/etiologia , Humanos , Articulações/cirurgia , Recidiva , Reoperação
19.
J Vasc Surg ; 60(1): 235-45, 245.e1-11, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24970659

RESUMO

BACKGROUND: Cystic adventitial disease (CAD) is a rare condition that affects arteries and veins. The etiology remains controversial and several treatment methods have been described. By understanding the pathogenesis of CAD, we can improve the surgical treatment, reduce recurrence rates, and improve patient outcomes. The objective of this study was to perform a systematic review of the world's literature. METHODS: We searched across multiple scientific databases and cross-referenced each article to collect the world's literature on CAD. Studies included were those that reported a case or case series of CAD. Each article was analyzed for site of CAD, patient demographic data, type of imaging, surgical management, presence of a joint connection on imaging or at surgery, and recurrences. A regression analysis was used to identify risk factors for cyst recurrence. RESULTS: We identified 503 reports (724 patients), which were included in our analysis. The most common vessel affected was the popliteal artery with 587 cysts. The mean age was 46 (range, 5-80) years with a male-to-female ratio of approximately 4:1. Magnetic resonance imaging (MRI) or angiography was performed for 182 cysts and conventional angiography was the most advanced imaging modality used in 355 patients who did not receive a MRI or computed tomography scan as part of their assessment. Multiple types of surgical interventions were reported with the most common being cyst resection and saphenous vein graft reconstruction (204 cases). There were 122 joint connections (17%) identified. Sixty-five patients (9%) developed at least one cyst recurrence or persistence. Percutaneous surgery (aspiration or angioplasty) was found to be a risk factor for cyst recurrence (odds ratio, 13.7; 95% confidence interval, 6.5-29.0; P < .0001). Because of the rarity of this condition, publications were limited to level IV evidence consisting of case series and case reports. Several reports had short or no follow-up and few patients had postoperative MRI. These limitations likely underestimate the true rate of cyst recurrence or persistence. CONCLUSIONS: This article provides a comprehensive review of the world's literature on CAD, which can serve as a baseline for future studies. When analyzed in the context of the literature, this systematic review supplies further evidence that CAD adheres to the articular (synovial) theory. We believe that knowledge of these joint connections can simplify treatment, reduce recurrence rates, and improve patient outcomes.


Assuntos
Cistos/etiologia , Doenças Vasculares Periféricas/etiologia , Artéria Poplítea , Adolescente , Adulto , Túnica Adventícia , Idoso , Idoso de 80 Anos ou mais , Angiografia , Criança , Pré-Escolar , Cistos/diagnóstico por imagem , Cistos/cirurgia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Doenças Vasculares Periféricas/diagnóstico por imagem , Doenças Vasculares Periféricas/cirurgia , Artéria Poplítea/diagnóstico por imagem , Artéria Poplítea/cirurgia , Recidiva , Adulto Jovem
20.
J Bone Joint Surg Am ; 95(19): e1421-6, 2013 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-24088977

RESUMO

BACKGROUND: The Orthopaedic Trauma Association (OTA) awarded over $3 million in research grants during 2000 through 2009. However, little is known regarding the outcomes of this funding program. Given the continued constraints in securing research dollars, we evaluated the research funding program of the OTA over this ten-year period. We studied the association of grant funding with (1) the publication rate, (2) the cost per publication, (3) the journal impact factor for published manuscripts, and (4) the dollar amount of extramural funding secured. METHODS: Grants from the target period were identified with use of the OTA online archive. The title of each grant and the name of the principal investigator were used to search across seven scientific databases for associated publications. RESULTS: Over the study period, $3,507,050 was awarded through 131 grants (thirty-three clinical, thirty-nine basic science, and fifty-nine resident). A total of 202 associated publications (seventy-three for the clinical grants, eighty-four for the basic science grants, and forty-five for the resident grants) were identified. Twenty-two (67%) of the clinical grants led to at least one publication compared with thirty-one (79%) of the basic science grants and twenty-four (41%) of the resident grants. The cost per publication was $26,892 for the clinical grants compared with $11,357 for the basic science grants and $13,111 for the resident grants. The mean impact factor of the journals containing the publications was 2.58. CONCLUSIONS: Over the study period, the publication output for the funded projects was substantial. Basic science grants had the highest publication rate. The three types of grants resulted in publication in peer-reviewed journals with similar impact factors.


Assuntos
Pesquisa Biomédica/economia , Organização do Financiamento/economia , Ortopedia/economia , Apoio à Pesquisa como Assunto/economia , Sociedades Médicas/economia , Traumatologia/economia , Organização do Financiamento/tendências , Fator de Impacto de Revistas , Ortopedia/tendências , Editoração , Apoio à Pesquisa como Assunto/tendências , Sociedades Médicas/tendências , Traumatologia/tendências , Estados Unidos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA