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1.
Bone Joint J ; 101-B(9): 1050-1057, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31474145

RESUMO

AIMS: To our knowledge, no study has compared the long-term results of cemented and hybrid total hip arthroplasty (THA) in patients with osteoarthritis (OA) secondary to congenital hip disease (CHD). This is a demanding procedure that may require special techniques and implants. Our aim was to compare the long-term outcome of cemented low-friction arthroplasty (LFA) and hybrid THA performed by one surgeon. PATIENTS AND METHODS: Between January 1989 and December 1997, 58 hips (44 patients; one man, 43 woman; mean age 56.6 years (25 to 77)) with OA secondary to CHD were treated with a cemented Charnley LFA (group A), and 55 hips (39 patients; two men, 37 women; mean age 49.1 years (27 to 70)) were treated with a hybrid THA (group B), by the senior author (GH). The clinical outcome and survivorship were compared. RESULTS: At all timepoints, group A hips had slightly better survivorship than those in group B without a statistically significant difference, except for the 24-year survival of acetabular components with revision for aseptic loosening as the endpoint, which was slightly worse. The survivorship was only significantly better in group A compared with group B when considering reoperation for any indication as the endpoint, 15 years postoperatively (74% vs 52%, p = 0.018). CONCLUSION: We concluded that there was not a substantial difference at almost any time in the outcome of cemented Charnley LFAs compared with hybrid THAs when treating patients with OA of the hip secondary to CHD. We believe, however, that after improvements in the design of components used in hybrid THA, this could be the method of choice, as it is technically easier with a shorter operating time. Cite this article: Bone Joint J 2019;101-B:1050-1057.


Assuntos
Artroplastia de Quadril/métodos , Luxação Congênita de Quadril/cirurgia , Prótese de Quadril , Osteoartrite do Quadril/cirurgia , Adulto , Idoso , Cimentos para Ossos/uso terapêutico , Cimentação , Feminino , Luxação Congênita de Quadril/complicações , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/etiologia , Desenho de Prótese , Sistema de Registros , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
2.
Hip Int ; : 1120700019839685, 2019 Apr 04.
Artigo em Inglês | MEDLINE | ID: mdl-30947550

RESUMO

INTRODUCTION:: The purpose of this study was to examine the ability of a surgeon to predict survival of a total hip replacement (THR) based on the patient's diagnosis, demographics, postoperative activity level and the surgical technique. METHODS:: 4 experienced hip surgeons were asked to predict the longevity of 131 Charnley THRs, performed by the senior author (GH) 22-35 years ago, by providing them with pre- and postoperative radiographs, and data concerning patient's diagnosis, demographics, postoperative activity level and the surgical technique. This process was repeated 3 months later. RESULTS:: There was only a slight agreement between the majority of the predictions and actual outcome. The inter-observer agreement was also slight and intra-observer agreement ranged from slight to moderate. CONCLUSION:: We confirmed that surgeons are unable to determine the life expectancy of the implants of a THR, based on the aforementioned data, because there are other non-identified factors that affect the survivorship of a THR. For this reason, regular follow-up remains the safest way to evaluate patients' clinical picture and the evolution of radiographic changes, if there are any, in order to accurately advise patients and decide on the appropriate time for revision.

3.
Artigo em Inglês | MEDLINE | ID: mdl-30221330

RESUMO

PURPOSE: To evaluate the efficacy of the combined intravenous and intra-articular administration of tranexamic acid (TXA) to control the collateral effects and complications of rivaroxaban (RIV) after total knee arthroplasty (TKA) and to compare thromboprophylaxis schemes with and without TXA, RIV and low molecular weight heparin (LMWH). MATERIALS AND METHODS: We prospectively studied 158 TKA patients from 2014 to 2018. The patients were randomly assigned into three groups. Group A (46 patients) was administered intravenous and intra-articular TXA and RIV postoperatively; group B (58 patients) was administered TXA as in group A and LMWH postoperatively; and group C (54 patients) was administered saline as in group A and RIV postoperatively. We evaluated blood loss, transfusion requirements and hemorrhagic complications. RESULTS: Hct and Hb values significantly decreased in group C compared to groups A and B, without any difference between groups A and B. Suction drain blood volume output was significantly higher in group C compared to group A and B, without any difference between group A and B. Hemorrhagic complications were more common in group C. No patient experienced clinical findings of VTE. CONCLUSION: Combined intravenous and intra-articular administration of TXA is safe and effective in TKA, with fewer hemorrhagic complications compared to placebo. Thromboprophylaxis with RIV and LMWH is similar.

4.
Hip Int ; 28(3): 246-253, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29192728

RESUMO

INTRODUCTION: The purpose of the present study was (i) to review the long-term outcome of cemented Charnley total hip replacements (THRs) performed by 1 surgeon (GH), 20 to 42 years ago, in patients ≥60 years, using both the Kaplan-Meier (KM) and the cumulative incidence (CI) methods, and (ii) to compare the estimations of the 2 statistical methods. METHODS: We evaluated the outcome of 306 consecutive primary cemented THRs that were performed in 265 patients. The final clinical, radiographic assessment and satisfaction of living patients were also included. The survivorship was estimated with the use of KM and CI methods and the relative difference between their estimations was calculated. RESULTS: Living patients' final clinical results were significantly improved in comparison with respective preoperative ones, and all the acetabular and 91% of femoral components considered as well fixed. 95% of these patients reported satisfaction. The risk of revision at 25 years, with revision for aseptic loosening for 1 or both components as the endpoint, with 21 hips at risk, assessed with KM analysis was 6.9% and with CI approach was 3.9%. The relative difference between KM and CI estimations was increasing during follow-up, reaching up to 76.8% at 25 years. CONCLUSIONS: We concluded that fixation of implants with cement in older patients had satisfactory long-term results and can serve as a benchmark with which to compare newer fixation methods (hybrid and uncemented) and materials. However, KM method, in studies that include older population with long-term follow-up, may significantly overestimate the risk of revision and clinicians could consider using besides the cumulative incidence of competing risk method.

5.
J Shoulder Elbow Surg ; 26(12): e369-e375, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28739299

RESUMO

BACKGROUND: Most acromioclavicular (AC) joint injuries occur in men in their third decade of life during high-speed or high-impact body contact sports. The management of acute complete AC joint dislocation is surgical. Current surgical techniques include anatomic reconstruction of the main restraints of the AC joint and aim to improve functional outcomes and to reduce the complication rate. METHODS: We present 10 cases of acute type V AC joint dislocation in professional athletes treated surgically with anatomic reconstruction of the coracoclavicular and AC ligaments and augmentation with the use of a synthetic polyester tape. The minimum follow-up of the patients was 2 years (mean, 48 months; range, 24-86 months). The postoperative functional outcome was assessed at 1 year and 2 years using the Constant-Murley, American Shoulder and Elbow Surgeons, and modified University of California-Los Angeles scoring systems. RESULTS: In all cases, the postoperative scores were significantly improved (P < .005 in all comparisons with the preoperative scores), and all patients returned to their preinjury high level of activity 6 months postoperatively. Radiographs at 1 month and 6 months revealed the maintenance of reduction. There were no complications. CONCLUSION: According to the results of our series of patients, demanding cases of acute AC joint dislocation Rockwood type V, in professional athletes, require anatomic fixation of both coracoclavicular and AC ligaments for return to sports as soon as possible and at the preinjury level of performance.


Assuntos
Articulação Acromioclavicular/lesões , Traumatismos em Atletas/cirurgia , Luxações Articulares/cirurgia , Ligamentos Articulares/cirurgia , Traumatismos Ocupacionais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/fisiopatologia , Adulto , Traumatismos em Atletas/fisiopatologia , Seguimentos , Humanos , Luxações Articulares/fisiopatologia , Masculino , Pessoa de Meia-Idade , Traumatismos Ocupacionais/fisiopatologia , Próteses e Implantes , Radiografia , Volta ao Esporte , Adulto Jovem
6.
Hip Int ; 27(3): 211-214, 2017 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-28497452

RESUMO

The terminology of the wide spectrum of hip deformities seen during the neonatal, infantile and adult life period remains controversial, mainly due to the indiscriminate use of the terms dysplasia, subluxation, congenital hip disease, developmental hip disease, congenital dislocation, etc. This has a serious implication on the anticipation of clinical outcomes, complications and comparison of different reconstructive techniques when these patients are treated with total hip arthroplasty in adulthood. Journals, specialising in this field, should publish homogeneous series (type of the disease, reconstruction technique, implants) in order to clarify arguments and anticipate clinical outcomes.


Assuntos
Artroplastia de Quadril/métodos , Luxação Congênita de Quadril/cirurgia , Terminologia como Assunto , Luxação Congênita de Quadril/diagnóstico , Humanos , Radiografia , Resultado do Tratamento
7.
World J Orthop ; 7(12): 785-792, 2016 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-28032030

RESUMO

Orthopaedic surgeons specialising in adult hip reconstruction surgery often face the problem of osteoarthritis secondary to congenital hip disease (CHD). To achieve better communication among physicians, better treatment planning and evaluation of the results of various treatment options, an agreed terminology is needed to describe the entire pathology. Furthermore, a generally accepted classification of the deformities is necessary. Herein, the authors propose the use of the term "congenital hip disease" and its classification as dysplasia, low dislocation and high dislocation. Knowledge of the CHD natural history facilitates comprehension of the potential development and progression of the disease, which differs among the aforementioned types. This can lead to better understanding of the anatomical abnormalities found in the different CHD types and thus facilitate preoperative planning and choice of the most appropriate management for adult patients. The basic principles for improved results of total hip replacement in patients with CHD, especially those with low and high dislocation, are: Wide exposure, restoration of the normal centre of rotation and the use of special techniques and implants for the reconstruction of the acetabulum and femur. Application of these principles during total hip replacement in young female patients born with severe deformities of the hip joint has led to radical improvement of their quality of life.

8.
J Arthroplasty ; 31(10): 2252-5, 2016 10.
Artigo em Inglês | MEDLINE | ID: mdl-27181492

RESUMO

BACKGROUND: There is a lack of long-term data on cement-in-cement technique in revision of failed hip femoral stem. METHODS: We present the outcome of 69 consecutive recemented femoral prostheses, performed by one surgeon (GH) 22-40 years ago. Four patients (4 hips) were lost to follow-up. Sixty-three patients (65 hips) were followed for their lifetime or until the time of the preparation of the study. The study population consisted of 18 failed hemiarthroplasties and 47 failed total hip arthroplasties. RESULTS: The 23-year probability of survival for the recemented femoral components, with re-revision for any reason and resection arthroplasty as the end point, was 73.6% (61.8%-85.4%) and, with re-revision for aseptic loosening as the end point, was 82.2% (71.4%-93%). CONCLUSION: Our follow-up study at 22-40 years, after recemented hip femoral prostheses, shows that recementing works well in selected cases.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Cimentos para Ossos/uso terapêutico , Prótese de Quadril , Falha de Prótese , Reoperação/estatística & dados numéricos , Adulto , Idoso , Artroplastia de Quadril/métodos , Feminino , Fêmur/cirurgia , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Probabilidade , Cirurgiões , Resultado do Tratamento
9.
Clin Orthop Surg ; 7(3): 406-9, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26330967

RESUMO

Butterfly vertebra is a rare congenital malformation of the spine, which is usually reported in the literature as an isolated finding. We describe a 40-year-old woman that presented to our emergency department with back pain and sciatica. Initial radiological evaluation revealed an incidental finding of a L4 butterfly vertebra in the anteroposterior and lateral view radiographs. The patient presented with no neurological deficit. This rare congenital anomaly is usually asymptomatic, and awareness of its non-traumatic nature is critical in order to establish a correct diagnosis. Further evaluation of the patient is necessary to exclude pathologic fracture, infection, or associated vertebral anomalies and syndromes, such as Alagille, Jarcho-Levin, Crouzon, and Pfeiffer syndromes. Furthermore, in the emergency setting, awareness of this entity is needed so that a correct diagnosis can be established.


Assuntos
Vértebras Lombares/anormalidades , Acidentes por Quedas , Adulto , Feminino , Humanos , Dor Lombar , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Tomografia Computadorizada por Raios X
10.
Injury ; 46 Suppl 5: S18-24, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26343298

RESUMO

The objective of this study was to report on the safety, efficacy and clinical outcomes of the Polyax Locked Plating System (Biomet, Warsaw, IN, USA) in the management of acute (non-implant related and periprosthetic) distal femoral fractures. We retrospectively reviewed 71 patients with 73 distal femoral fractures. Thirty-three of the included fractures occurred around previously placed implants. The average patients' age was 67 years (range 18-98). There were 7 early postoperative complications (9.5%) including one deep surgical site infection, 2 pulmonary embolisms and 4 urinary or respiratory infections. At final follow-up (mean 12, range 9-55 months) all fractures progressed to clinical and radiological union. However, major revision surgery for healing problems was required in 5 cases (6.8%) and minor in 3 cases (4.1%). The average time to healing was 6 (range 3-23) months. Angulation less than 5 degrees in any plane was observed in 66 cases (89.7%), within 5-10 degrees in 5 cases (7.3%) and within 10-15 degrees in 2 cases (2.9%). The mean pre-injury and final follow-up values of Glasgow Outcome Scale were 1.5(1-3) and 1.7(1-3) respectively. Overall 61 patients (83.53%) retained their pre-injury activity status. The Polyax Locked Plating System offers a safe and efficient fixation in distal femoral fractures.


Assuntos
Fraturas do Fêmur/cirurgia , Fixação Interna de Fraturas , Fraturas Periprotéticas/cirurgia , Infecção da Ferida Cirúrgica/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas , Feminino , Fraturas do Fêmur/epidemiologia , Fraturas do Fêmur/fisiopatologia , Seguimentos , Consolidação da Fratura , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas Periprotéticas/epidemiologia , Fraturas Periprotéticas/fisiopatologia , Estudos Retrospectivos , Resultado do Tratamento
11.
J Orthop Trauma ; 2015 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-26087454

RESUMO

Long antegrade cephalomedullary nailing is the standard of surgical care of atypical subtrochanteric fractures of the femur. Long nailing of such fractures is a technically demanding procedure. Our case report discusses the management of sequential bilateral atypical subtrochanteric fractures in an elderly female patient and the technical issues pertaining to nailing of such fractures. During the nailing procedure of the second fracture, an intraoperative distal peri-implant fracture occurred and it was addressed with the application of a distal femoral locking plate. At 2 years postoperative follow-up, the patient was ambulating independently and had sufficient range of motion in both hips and knees.

12.
J Arthroplasty ; 30(10): 1767-71, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25956524

RESUMO

We present the outcome of 241 consecutive low friction arthroplasties (LFAs) performed by one surgeon (GH) 30 to 40 years ago. The overall survival rate at 30 years with revision for any reason or removal of the components as the end point was 53% (43.2-62.8%) when 40 hips remained in the study. Cox regression analysis for the possible risk factors of age, gender and diagnosis revealed higher risk of the overall failure in younger patients, and higher risk of failure due to loosening in younger patients and in those with congenital hip disease. Our follow-up study at 30 to 40 years following Charnley LFA can be used as a benchmark for comparison with the newer methods of total hip arthroplasty.


Assuntos
Artroplastia de Quadril/estatística & dados numéricos , Prótese de Quadril/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/métodos , Feminino , Seguimentos , Fricção , Humanos , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Análise de Regressão , Reoperação , Cirurgiões , Taxa de Sobrevida
13.
Hip Int ; 25(2): 138-41, 2015 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25362873

RESUMO

The purpose of this study was to compare the long-term survivorship of total hip replacement in unilaterally and bilaterally operated patients and try to answer the question whether analyses of combined unilateral and bilateral cases could result in erroneous interpretations. The material consisted of 266 Charnley's low-friction arthroplasties performed on 193 patients with osteoarthritis of the hip, followed for a minimum of 15 years. The 25-year survivorship of unilaterally operated hips was 69.2% (95% CI 57%-81.4%) and of bilaterally 66.4% (95% CI 57.6%-75.2%), respectively (p = 0.324). Cox regression analysis of unilateral and bilateral cases for confounding factors of gender, age and primary diagnosis confirmed that there was no significant relationship between survival of THR and whether the patient is unilaterally or bilaterally operated. Only age had a significant relationship with the survival of THR. In bilateral cases, Cox analysis for possible predictive factors found that the primary diagnosis, time interval between the two operations and sequence of the operation were not significantly correlated with the survivorship of bilateral THRs. We thus concluded that in analysing a combination of unilateral and bilateral cases, and presenting the long-term THR results, the bilateral character does not change the overall survival.


Assuntos
Artroplastia de Quadril/métodos , Prótese de Quadril/normas , Osteoartrite do Quadril/diagnóstico por imagem , Osteoartrite do Quadril/cirurgia , Falha de Prótese/tendências , Sistema de Registros , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Distribuição de Qui-Quadrado , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Masculino , Modelos de Riscos Proporcionais , Reoperação/métodos , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Estatísticas não Paramétricas , Fatores de Tempo , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento
14.
Clin Podiatr Med Surg ; 31(4): 577-84, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25281517

RESUMO

Management of posttraumatic segmental bone loss as a result of severe open injuries of the lower extremity, high-energy closed injuries, and following failed initial treatment of complex fractures that develop pseudarthrosis continues to challenge reconstructive surgeons. There are numerous strategies for dealing with such injuries but the outcome is unpredictable. The procedure is rarely only one stage and complications frequently arise. In most cases the reconstruction process is long and difficult and amputation must be part of the decision-making process. All traditional treatment strategies have advantages and major drawbacks. To overcome some limitations, biologic treatments have been developed based on specific pathways of bone physiology and healing.


Assuntos
Transplante Ósseo/métodos , Traumatismos do Pé/cirurgia , Fixação de Fratura/métodos , Fraturas Expostas/cirurgia , Traumatismos da Perna/cirurgia , Osteogênese por Distração/métodos , Traumatismos do Pé/diagnóstico , Fraturas Expostas/diagnóstico , Humanos , Traumatismos da Perna/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/cirurgia , Reoperação
15.
J Orthop Res ; 32(12): 1646-51, 2014 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25125266

RESUMO

To address the need to impact the subchondral bone-articular cartilage interaction for the treatment of degenerative osteoarthritis (OA), bisphosphonates may be used as a means to inhibit the subchondral bone resorption. The purpose of the present study is to evaluate the chondroprotective effect of zoledronic acid (ZOL) in a model of OA. Eighteen adult male rabbits underwent an anterior cruciate ligament transection and were separated into two groups: ZOL group (n=10) received 0.6 mg/kg intravenous injection of ZOL on day 1, 15, and 29 and placebo group (n=8) received saline. The animals were euthanized at 8 weeks. Macroscopically, the ZOL group had significantly milder ulcerations, cartilage softening and fibrillation compared to the placebo group. Microscopically, morphology of the articular cartilage was better in the ZOL treated group compared with the placebo group, without complete disorganization in any section of the ZOL group. Furthermore, the chondrocytes in the ZOL treated group were mainly cloning, indicating cartilage repairing and regeneration process, while in the placebo group hypocellularity predominated. Additionally, subchondral necrosis was evident in some specimens of the placebo group. Zoledronic acid, in a high-dose regimen, proved to be chondroprotective in a well-established animal model of OA.


Assuntos
Conservadores da Densidade Óssea/farmacologia , Condrócitos/efeitos dos fármacos , Difosfonatos/farmacologia , Imidazóis/farmacologia , Osteoartrite/tratamento farmacológico , Animais , Modelos Animais de Doenças , Masculino , Coelhos , Ácido Zoledrônico
16.
J Arthroplasty ; 29(10): 2007-12, 2014 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-24939637

RESUMO

The purpose of the present study was to evaluate the long-term outcome of the unrevised part in one-component total hip arthroplasty revision (index operation). Forty-four patients (46 hips) with a mean age of 58years at the time of the index operation were included. At the final follow-up, 4 of the 19 (21%) unrevised acetabular components and 6 of the 27 (22%) unrevised femoral components were subsequently revised at a mean time of 14 and 11years from the index operation, and 22 and 24years from the primary operation, respectively. We concluded that revision of a stable component is not justifiable on the basis of its long duration in use or non-ideal position or possible loosening on radiographs.


Assuntos
Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Articulação do Quadril/cirurgia , Prótese de Quadril , Artropatias/cirurgia , Falha de Prótese , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/instrumentação , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Seguimentos , Articulação do Quadril/diagnóstico por imagem , Humanos , Artropatias/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Radiografia , Reoperação
18.
Eur J Orthop Surg Traumatol ; 24(4): 607-13, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-24190345

RESUMO

BACKGROUND: Controversy exists regarding the optimal treatment for acute Achilles tendon ruptures. Conservative and surgical treatments have been reported with variable results and complications rates. The purpose of this study is to compare the postoperative clinical and functional results of percutaneous versus open repair of acute Achilles tendon ruptures. MATERIALS AND METHODS: We present 34 patients with acute Achilles tendon ruptures treated with open and percutaneous surgical repair. There were 15 patients who had open surgical repair and 19 patients who had percutaneous repair. The mean follow-up was 22 months (range 10-24 months) for the open repair group and 20 months (range 9-24 months) for the percutaneous repair group; no patient was lost to follow-up. Postoperative rehabilitation was the same for both groups. Wound healing, complications, ankle range of motion, and patients' return to work, activity level, weight-bearing, and subjective assessment of their treatment were recorded. RESULTS: No significant difference was observed with respect to any of the examined variables between the open and percutaneous repair groups. Tendon healing was observed in all patients of both groups by 7-9 weeks. The mean time of patients' return to work was 7 weeks for the open repair group and 9 weeks for the percutaneous repair group. All patients were capable of full weight bearing by the 8th postoperative week time; the time to return to previous activities including non-contact sports was 5 months for both groups. All patients expressed satisfaction and graded their treatment as good. As expected, cosmetic appearance was significantly better in the percutaneous repair group. One patient who had open repair experienced skin incision pain and dysesthesia and graded his operation as fair. No patient experienced other complications such as re-rupture, infection, sural neuroma, or Achilles tendinitis within the period of this study. CONCLUSIONS: The present study showed similarly successful clinical and functional results after both open and percutaneous repair of acute Achilles tendon ruptures are similar. Cosmetic appearance is superior in the group of patients who had a percutaneous treatment.


Assuntos
Tendão do Calcâneo/lesões , Tendão do Calcâneo/cirurgia , Traumatismos do Tornozelo/cirurgia , Artroscopia/métodos , Procedimentos Ortopédicos/métodos , Traumatismos dos Tendões/cirurgia , Tendão do Calcâneo/patologia , Adulto , Traumatismos do Tornozelo/patologia , Traumatismos em Atletas/patologia , Traumatismos em Atletas/cirurgia , Feminino , Seguimentos , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Ruptura , Nervo Sural/cirurgia , Traumatismos dos Tendões/patologia
19.
Eur J Orthop Surg Traumatol ; 24(4): 427-33, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-23543044

RESUMO

Osteoporotic fractures are becoming more prevalent with ageing of populations worldwide. Inadequate fixation or prolonged immobilization after non-surgical care leads to serious life-threatening events, poor functional results and lifelong disability. Thus, a stable internal fixation and rapid initiation of rehabilitation are required for faster return of function. Conventional internal fixation attempts to achieve the exact anatomy, often with extended soft-tissue stripping and compression of the periosteum, causing disturbance of the metaphyseal and comminuted fracture's bone blood supply. This technique relies on frictional forces between bone and plate. Osteoporotic bone might not be able to generate enough torque with the screw to securely fix the plate to bone. Thus, this surgical management have resulted in increased incidence of poor results in elderly, osteoporotic patients. The newly developed locked internal fixators, locking compression plates and less invasive stabilization system, consist of plate and screw systems where the screws are locked in the plate, minimizing the compressive forces exerted between plate and bone. Thus, the plate does not need to compress the bone nor requires precise anatomical contouring of a plate disturbing the periosteal blood supply. These fixators allowed the development of the minimal invasive percutaneous osteosynthesis. Nowadays, locking plates are the fixation method of choice for osteoporotic, diaphyseal or metaphyseal, severely comminuted fractures.


Assuntos
Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fraturas Espontâneas/etiologia , Fraturas Espontâneas/cirurgia , Osteoporose/complicações , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Placas Ósseas , Feminino , Fraturas Espontâneas/fisiopatologia , Humanos
20.
Eur J Orthop Surg Traumatol ; 24(3): 263-71, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23508348

RESUMO

Osteoarthritis (OA) is a major cause of suffering for millions of people. Investigating the disease directly on humans may be challenging. The aim of the present study is to investigate the advantages and limitations of the animal models currently used in OA research. The animal models are divided into induced and spontaneous. Induced models are further subdivided into surgical and chemical models, according to the procedure used to induce OA. Surgical induction of OA is the most commonly used procedure, which alters the exerted strain on the joint and/or alter load bearing leading to instability of the joint and induction of OA. Chemical models are generated by intra-articular injection of modifying factors or by systemically administering noxious agents, such as quinolones. Spontaneous models include naturally occurring and genetic models. Naturally occurring OA is described in certain species, while genetic models are developed by gene manipulation. Overall, there is no single animal model that is ideal for studying degenerative OA. However, in the present review, an attempt is made to clarify the most appropriate use of each model.


Assuntos
Modelos Animais de Doenças , Osteoartrite/etiologia , Animais , Ligamento Cruzado Anterior/cirurgia , Colagenases , Humanos , Injeções Intra-Articulares , Articulações/cirurgia , Meniscos Tibiais/cirurgia , Osteoartrite/induzido quimicamente , Osteoartrite/genética , Papaína , Quinolonas , Lesões do Menisco Tibial
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