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1.
Int Orthop ; 2021 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-34415419

RESUMO

PURPOSE: An "unplanned excision" refers to soft tissue sarcomas excised without planning imaging studies and a diagnostic biopsy, resulting in the presence of residual disease and usually necessitating a re-excision procedure. We aimed to assess the impact of previous unplanned excisions on the intra-operative pathologic assessment at the time of re-excision, in terms of need to perform repeat assessments and the accuracy to predict margin status of the final pathologic specimen. METHODS: Data was collected for all patients with extremity soft tissue sarcoma who had undergone wide local excision limb salvage surgery or amputation between 2012 and 2017. Intra-operative pathologic assessment with frozen sections was performed in all cases and was classified as negative, negative but close (< 1 mm), and positive. RESULTS: A total of 173 patients with extremity soft tissue sarcoma were included, 54 in the unplanned excision group and 119 in the planned excision group. The accuracy of intra-operative pathologic assessment to predict the margin status on final pathology was similar between groups (87% unplanned vs. 90.7% planned excisions). However, the need for repeat intra-operative pathologic assessment and subsequent resection due to microscopically positive margins was found to be higher within the unplanned excision group ((p = 0.04), OR = 3.2 (95% CI: 1.1-9.1, p = 0.048)). CONCLUSIONS: Intra-operative pathologic assessment of resection margins had a similar accuracy in planned and unplanned excisions; however, unplanned excisions showed a higher risk of re-resection during the same surgical setting.

2.
Isr Med Assoc J ; 23(8): 521-525, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392627

RESUMO

BACKGROUND: Cervical spinal surgery is considered safe and effective. One of the few specific complications of this procedure is C5 nerve root palsy. Expressed primarily by deltoid muscle and biceps brachii weakness, it is rare and has been related to nerve root traction or to ischemic spinal cord damage. OBJECTIVES: To determine the clinical and epidemiological traits of C5 palsy. To determine whether C5 palsy occurs predominantly in one specific surgical approach compared to others. METHODS: A retrospective study of patients who underwent cervical spine surgery at our medical center during a consecutive 8-year period was conducted. The patient data were analyzed for demographics, diagnosis, and surgery type and approach, as well as for complications, with emphasis on the C5 nerve root palsy. RESULTS: The study group was comprised of 124 patients. Seven (5.6%) developed a C5 palsy following surgery. Interventions were either by anterior, by posterior or by a combined approach. Seven patients developed this complication. All of whom had myelopathy and were older males. A combined anteroposterior (5 patients) and posterior access (2 patients) were the only approaches that were associated with the C5 palsy. None of the patients who were operated via an anterior approach did develop this sequel. CONCLUSIONS: The incidence of the C5 root palsy in our cohort reached 5.6%. Interventions performed through a combined anterior-posterior access in older myelopathic males, may carry the highest risk for this complication.


Assuntos
Plexo Cervical/lesões , Descompressão Cirúrgica , Músculo Deltoide , Complicações Intraoperatórias , Paresia , Complicações Pós-Operatórias , Vértebras Cervicais/cirurgia , Descompressão Cirúrgica/efeitos adversos , Descompressão Cirúrgica/métodos , Músculo Deltoide/inervação , Músculo Deltoide/fisiopatologia , Feminino , Humanos , Complicações Intraoperatórias/diagnóstico , Complicações Intraoperatórias/fisiopatologia , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Debilidade Muscular/diagnóstico , Debilidade Muscular/etiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Paresia/diagnóstico , Paresia/etiologia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Isquemia do Cordão Espinal/etiologia , Isquemia do Cordão Espinal/fisiopatologia
3.
Isr Med Assoc J ; 23(8): 506-509, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392628

RESUMO

BACKGROUND: Flexible flatfoot (FF) is a common foot deformity that can often consist of foot pain. Surgical treatment is designed to lengthen the lateral column. OBJECTIVES: To resolve whether radiographic standing feet measurements of normo-plantigrade feet and FF, symptomatic or not, differ and to determine whether the lateral column is shorter. METHODS: The study comprised 72 patients (127 feet) consecutive patients, 18 years of age and older, who were divided into three groups: normal feet (56), asymptomatic FF (29), and symptomatic FF (42). All patients had a standing anterior posterior (AP) and lateral radiographs. AP images were used for the measurement of the talocalcaneal angle, talar-1st metatarsal angle, and talonavicular coverage. Lateral X-rays were used to estimate the talocalcaneal angle, talar-1st metatarsal angle, calcaneal pitch, naviculocuboid overlap, and column ratio. RESULTS: All three of the AP radiograph measurements differed among groups, and higher values were measured in the symptomatic FF group. Post hoc analysis found that the talonavicular coverage and the talocalcaneal angles also differed between symptomatic and asymptomatic FF patients. While some lateral measurements differed within groups, only the lateral talar-1st metatarsal angle distinguished between asymptomatic and symptomatic patients. The lateral column length was not found to be shorter among FF patients, weather symptomatic or not. CONCLUSIONS: Only the talonavicular coverage, the AP talocalcaneal, and the lateral talar-1st metatarsal angles were found to differ between asymptomatic and symptomatic FF patients. The lateral column was not found to be shorter.


Assuntos
Doenças Assintomáticas , Pé Chato , Dor , Radiografia/métodos , Adulto , Antropometria/métodos , Correlação de Dados , Feminino , Pé Chato/diagnóstico por imagem , Pé Chato/fisiopatologia , Pé Chato/cirurgia , Deformidades Congênitas do Pé/diagnóstico por imagem , Humanos , Masculino , Ossos do Metatarso/diagnóstico por imagem , Dor/diagnóstico , Dor/etiologia , Posicionamento do Paciente/métodos , Articulação Talocalcânea/diagnóstico por imagem , Avaliação de Sintomas/métodos , Tálus/anormalidades , Tálus/diagnóstico por imagem
4.
Isr Med Assoc J ; 23(8): 469-474, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34392619

RESUMO

BACKGROUND: Hip fractures in elderly patients are a major cause of morbidity and mortality. Variability in length of hospital stay (LOS) was evident in this population. The coronavirus disease-2019 (COVID-19) pandemic led to prompt discharge of effected patients in order to reduce contagion risk. LOS and discharge destination in COVID-19 negative patients has not been studied. OBJECTIVES: To evaluate the LOS and discharge destination during the COVID-19 outbreak and compare it with a similar cohort in preceding years. METHODS: A retrospective study was conducted comparing a total of 182 consecutive fragility hip fracture patients operated on during the first COVID-19 outbreak to patients operated on in 2 preceding years. Data regarding demographic, co-morbidities, surgical management, hospitalization, as well as surgical and medical complications were retrieved from electronic charts. RESULTS: During the pandemic 67 fragility hip fracture patients were admitted (COVID group); 55 and 60 patients were admitted during the same time periods in 2017 and 2018, respectively (control groups). All groups were of similar age and gender. Patients in the COVID group had significantly shorter LOS (7.2 ± 3.3 vs. 8.9 ± 4.9 days, P = 0.008) and waiting time for a rehabilitation facility (7.2 ± 3.1 vs. 9.3 ± 4.9 days, P = 0.003), but greater prevalence of delirium (17.9% vs. 7% of patients, P = 0.028). In hospital mortality did not differ among groups. CONCLUSIONS: LOS and time to rehabilitation were significantly shorter in the COVID group. Delirium was more common in this group, possibly due to negative effects of social distancing.


Assuntos
COVID-19 , Delírio , Fixação de Fratura , Fraturas do Quadril , Controle de Infecções , Tempo de Internação/estatística & dados numéricos , Complicações Pós-Operatórias , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Delírio/diagnóstico , Delírio/epidemiologia , Delírio/etiologia , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Fixação de Fratura/reabilitação , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Israel/epidemiologia , Masculino , Inovação Organizacional , Avaliação de Processos e Resultados em Cuidados de Saúde , Alta do Paciente/tendências , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Gestão de Riscos/organização & administração , SARS-CoV-2/isolamento & purificação
5.
Artigo em Inglês | MEDLINE | ID: mdl-34100140

RESUMO

INTRODUCTION: An increasing number of patients sustaining a fragility hip fracture (FHF) have either an active diagnosis or a history of cancer. However, little is known about the outcomes of non-malignant related FHF in this group of patients. We aimed to evaluate the mortality and complications rates during hospitalization, as well as at 1-year follow-up within this population. METHODS: A retrospective cohort study of patients 65 years of age and above, who underwent surgery for the treatment of proximal femoral fractures between January 2012 and June 2016 was conducted. Patients diagnosed with malignancies, both solid (Carcinomas) and a hematological neoplasias (Lymphomas, Multiple Myeloma) were included, along with consecutive controls without a diagnosis of cancer in the 5 years prior to the study period. Demographic, clinical and radiographic parameters were recorded and analyzed. RESULTS: Seven hundred and fifty-two patients with FHF were included, of whom 51 had a malignancy diagnosis within the 5-year period preceding the fracture (18% metastatic disease). The mean time from malignancy diagnosis to FHF was 4.3 ± 4.8 years. Time to surgery did not differ between groups, and the vast majority of patients from both groups (over 87%) were operated within the desirable 48 h from admission. Patients with malignancy had a higher probability of being admitted to an internal medicine department both pre and post-surgically (p < 0.001), and were more susceptible to pre-operative anemia (p = 0.034). In-hospital mortality did not differ between groups, yet 1-year mortality was higher for the malignancy group (41.2% vs 19.5%, p < 0.001). At 1-year post-operatively, orthopedic complications were similar between groups. CONCLUSION: Patients with a history of malignancy in the 5-years prior to a non-neoplastic FHF, showed similar mortality and complications rates during admission but increased 1 year mortality rate when compared to patients without cancer undergoing surgical treatment of a non-neoplastic proximal femoral fracture.

6.
Isr Med Assoc J ; 23(1): 33-37, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33443340

RESUMO

BACKGROUND: Injuries to the anterior cruciate ligament (ACL) are common and complete tears often fail to heal. ACL reconstruction is considered the surgical gold standard of care for ACL injuries in young active patients. OBJECTIVES: To determine the corresponding morphological and histological features of the torn ACL in different time periods after injury. METHODS: The study included 28 remnant specimens of torn ACLs from patients who had ACL reconstruction surgery of the knee. The remnant pathology was evaluated by its morphology during arthroscopy and by histopathologic measurements. RESULTS: At surgery there were three progressive and distinct morphological tear patterns. The first pattern was noticed within the first 3 months from injury and showed no scar tissue. The second pattern appeared later and was characterized by the appearance of scar tissue with adhesion to the femoral wall. The third pattern was characterized by adhesion of the ACL remnant to the posterior cruciate ligament. The histological changes of the first morphological pattern showed abundance of blood vessels and lymphocytes at the torn femoral end with few irregular collagen fibers. The second and third tear patterns showed decrement in the number of blood vessels and lymphocytes with longitudinally oriented collagen fibers. CONCLUSIONS: The morphological features of the ACL remnant in the first 3 months after injury showed no scar tissue and its histological features had the characteristics of a reparative phase. This phase was followed by a prolonged remodeling phase that ended with attachment of the remnant to the posterior cruciate ligament.


Assuntos
Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Cicatriz , Articulação do Joelho , Efeitos Adversos de Longa Duração , Aderências Teciduais , Adulto , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroscopia/métodos , Cicatriz/diagnóstico por imagem , Cicatriz/etiologia , Feminino , Tecido de Granulação/irrigação sanguínea , Tecido de Granulação/patologia , Humanos , Articulação do Joelho/irrigação sanguínea , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/patologia , Efeitos Adversos de Longa Duração/diagnóstico por imagem , Efeitos Adversos de Longa Duração/etiologia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Período Pós-Operatório , Fatores de Tempo , Aderências Teciduais/diagnóstico por imagem , Aderências Teciduais/etiologia
7.
Arch Orthop Trauma Surg ; 141(1): 39-44, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32361954

RESUMO

INTRODUCTION: Holocaust survivors (HS) were under an immense continues physical and mental stressors in their younger years, putting them at increased risk for both fragility hip fractures and worse medical and functional outcomes. We aimed to evaluate whether being a HS could affect the functional outcomes of fragility hip fractures in patients 80 years of age and older following surgery. MATERIALS AND METHODS: A retrospective study comparing consecutive patients, 80 years and older, who were operated for fragility hip fractures between 2011 and 2016. HS survival status was self-defined by survivors who were born in European and northern African countries that were later occupied by the Nazi regime during World War II and experienced incarceration in concentration camps, forced labor camps and mass transport. Primary outcomes were mortality either within hospital or in the post-operative year. Secondary outcomes were in-hospital complications, recurrent hospitalizations and orthopedic complications within the post-operative year. RESULTS: Two hundred thirty-one HS and 339 controls, ages 86.4 ± 4.4 years who were operated for fragility hip fracture between January 2011 to June of 2016 were included in the study. Patients from both groups were of similar age, Carlson's co-morbidity index score, leaving arrangement and pre-fracture mobility. Among HS there were more women (p = 0.029). HS did not have lower survival rates either within hospital or in the post- operative year. Both length of stay and in-hospital complication rates were similar between groups. In the post-operative year, HS were less likely to be hospitalized than controls (p = 0.021). The rate of orthopedic complications was also similar. CONCLUSIONS: Holocaust survivors patients do not achieve worse outcome following fragility hip fracture surgery and present distinctive resilience.


Assuntos
Fraturas do Quadril , Holocausto , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/mortalidade , Fraturas do Quadril/cirurgia , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Sobreviventes , Resultado do Tratamento
8.
J Knee Surg ; 34(7): 712-716, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31683349

RESUMO

Arthroscopic classification of the torn anterior cruciate ligament (ACL) morphology is fundamental for clinical studies on emerging techniques such as repair and preservation. At present, the most acknowledged classification is Crain description of four morphological patterns. The purpose of the study was to analyze the intra- and interobserver reliability of Crain classification in patients undergoing ACL reconstruction surgeries. The study included 101 patients who had ACL reconstruction surgery between the years 2014 and 2017. The morphological pattern of ACL remnant scar formation during surgery was observed and classified according to Crain by three orthopaedic surgeons. Inter- and intraobserver reliabilities were measured using kappa statistics. Intraobserver reliability for the Crain classification ranged from 0.63 to 0.83 (substantial to almost perfect agreement). Interobserver reliability was 0.51 (moderate agreement). In almost a third of the cases, observers reported on additional morphological pattern of scar formation that was not well defined by Crain. A modified classification of four patterns was suggested: (A) without scar tissue, (B) with adhesion to the femoral notch (wall or roof), (C) with adhesion to the notch and posterior cruciate ligament (PCL), and (D) with adhesion to the PCL. Reanalysis of these four morphological configurations resulted in interobserver reliability of 0.82 (almost perfect agreement). In conclusion, the Crain classification of torn ACL remnant morphology has moderate interobserver reliability; however, a suggested classification with modified and additional configurations has almost perfect reliability and may be useful for studies on ACL repair and preservation.

9.
J Spinal Cord Med ; 44(2): 204-211, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31050608

RESUMO

Context: There is no consensus on the preferred treatment for patients with spinal metastases. Little is known about the outcomes of surgery for this population. The objectives of this paper are to examine the outcomes of surgery among patients with spinal metastases suffering from cord compression (CC) or intractable pain (IP).Design: Retrospective, descriptive (level 4) case series.Setting: Rabin Medical Center, Israel.Participants: 61 patients undergoing surgery for spinal metastasis in a tertiary care hospital. Patients were divided into two groups: those with spinal CC and those with IP only.Interventions: Surgery due to CC or IP among patients with spinal metastases.Outcome measures: Frankel scale to assess neurological status, ambulatory and incontinence status, which were examined before surgery, at discharge and at last follow-up. Endpoints were death or latest follow-up visit. Survival and postoperative complications were documented.Results: There was no significant difference in Frankel score before and after surgery among patients with CC (mean score 3.5 and 3.4 respectively, P = 0.62). Complete incontinence rates significantly increased in patients with CC between preoperative and last follow-up examinations (13.6% vs. 20%, respectively, P = 0.05). Median survival of CC and IP groups was 201 and 402 days, respectively (P = 0.32). Complication rate was 41.4%.Conclusion: In our cohort, Frankel score and walking capability of patients with CC did not change postoperatively, but continence status deteriorated over time. Surgeons should advise patients on expected surgical outcomes, especially in non-ambulatory and incontinent patients.

10.
Arch Gerontol Geriatr ; 93: 104297, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33248319

RESUMO

AIMS: Diabetes mellitus (DM) and osteoporosis are both diseases of epidemic proportions with an increasing incidence worldwide. Fragility hip fractures (FHF) are associated with elevated morbidity, mortality, social burden and medical costs. The aim of this study was to determine whether patients with DM have worse medical and surgical outcomes following FHFs and whether the Diabetes Complications Severity Index (DCSI) can predict in-hospital complications and one-year mortality. METHODS: A single centre retrospective cohort study including 1343 patients older than 65 years who underwent surgery for FHFs was conducted. The data collected included length of hospital stay, time-to-surgery, blood loss, complications and mortality during the first post-operative year. RESULTS: 408 patients with a DM diagnosis were compared with 935 without DM. Pre-operatively, patients with DM had lower haemoglobin levels, higher platelet counts and worse renal function. Following surgery, patients with DM were more likely to be transferred to another department or intensive care. One-year mortality was significantly higher in the DM group [23.3% vs. 17.1%, odds ratio 1.36 (CI 1.029-1.799, p = 0.03)]. Higher DCSI scores were related with elevated one-year mortality rates in the DM group. Cerebrovascular events were found to be nearly five times more prevalent in the DM group. Patients with DM were more likely to continue treatment in a rehabilitation centre and had a higher probability to be re-hospitalized in the first post-operative year (p.<0.001). CONCLUSIONS: Our results emphasize the increased vulnerability of this patient population and the importance of specialized care during the peri-operative period of FHFs.


Assuntos
Complicações do Diabetes , Diabetes Mellitus , Fraturas do Quadril , Osteoporose , Idoso , Diabetes Mellitus/epidemiologia , Fraturas do Quadril/epidemiologia , Fraturas do Quadril/cirurgia , Humanos , Osteoporose/complicações , Osteoporose/epidemiologia , Estudos Retrospectivos
11.
J Knee Surg ; 2020 Nov 09.
Artigo em Inglês | MEDLINE | ID: mdl-33167053

RESUMO

For patients with advanced osteoarthritis of the knee, total knee arthroplasty (TKA) has been shown to provide significant pain relief and improved function with consistent, reproducible results. Post-operative physical therapy (PT) plays an important role is restoring muscle strength and range of motion (ROM). Yet, the impact of earlier physical therapy initiation after TKA has not been well defined. We assessed 205 patients that underwent primary TKA including 136 patients who started PT on the first post-operative day (POD1) and a second group that started PT 3 days after surgery (POD3), or later. Length of hospital stay (LOS), opioid use during hospital stay, complications, re-admissions, knee ROM and the need for subsequent hospitalized rehabilitation were recorded. LOS was not significantly shorter in the early PT group, compared with the delayed PT group (6.4 ± 2.2 days vs. 6.8 ± 2 days, respectively, P = .217). Patients in the delayed PT group consumed more opioids during their inpatient stay compared with the early PT group on both POD 3 (89% vs 82%, p = 0.013) and POD 4 (81% vs 66%, p = 0.005). There was no significant difference in the incidence of Immediate post-operative complications or final knee ROM between the two groups. While early postoperative PT did not impact hospital LOS or final knee ROM, it was associated with an earlier reduction in postoperative opioid consumption after primary TKA.

12.
Mar Drugs ; 18(8)2020 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-32796603

RESUMO

Scaffold material is essential in providing mechanical support to tissue, allowing stem cells to improve their function in the healing and repair of trauma sites and tissue regeneration. The scaffold aids cell organization in the damaged tissue. It serves and allows bio mimicking the mechanical and biological properties of the target tissue and facilitates cell proliferation and differentiation at the regeneration site. In this study, the developed and assayed bio-composite made of unique collagen fibers and alginate hydrogel supports the function of cells around the implanted material. We used an in vivo rat model to study the scaffold effects when transplanted subcutaneously and as an augment for tendon repair. Animals' well-being was measured by their weight and daily activity post scaffold transplantation during their recovery. At the end of the experiment, the bio-composite was histologically examined, and the surrounding tissues around the implant were evaluated for inflammation reaction and scarring tissue. In the histology, the formation of granulation tissue and fibroblasts that were part of the inclusion process of the implanted material were noted. At the transplanted sites, inflammatory cells, such as plasma cells, macrophages, and giant cells, were also observed as expected at this time point post transplantation. This study demonstrated not only the collagen-alginate device biocompatibility, with no cytotoxic effects on the analyzed rats, but also that the 3D structure enables cell migration and new blood vessel formation needed for tissue repair. Overall, the results of the current study proved for the first time that the implantable scaffold for long-term confirms the well-being of these rats and is correspondence to biocompatibility ISO standards and can be further developed for medical devices application.


Assuntos
Antozoários/química , Materiais Biocompatíveis , Colágenos Fibrilares/química , Implantes Experimentais , Procedimentos Ortopédicos/instrumentação , Lesões do Manguito Rotador/cirurgia , Manguito Rotador/cirurgia , Tecidos Suporte , Alginatos/química , Animais , Materiais Biocompatíveis/toxicidade , Modelos Animais de Doenças , Colágenos Fibrilares/isolamento & purificação , Colágenos Fibrilares/toxicidade , Reação a Corpo Estranho/etiologia , Reação a Corpo Estranho/patologia , Hidrogéis , Implantes Experimentais/efeitos adversos , Masculino , Procedimentos Ortopédicos/efeitos adversos , Desenho de Prótese , Ratos Wistar , Manguito Rotador/patologia , Lesões do Manguito Rotador/patologia , Fatores de Tempo , Tecidos Suporte/efeitos adversos , Cicatrização
13.
Hip Int ; : 1120700020918868, 2020 May 29.
Artigo em Inglês | MEDLINE | ID: mdl-32468868

RESUMO

INTRODUCTION: Traumatic anterior hip dislocations are subdivided to obturator (inferior) and pubic (superior) dislocations by Epstein's descriptive classification. This rare injury is thought to have favourable clinical outcomes. The incidence of associated femoral head and acetabular injuries has been low in past case series. We sought to revisit this injury and classification in the era of advanced imaging and contemporary surgical techniques. MATERIALS AND METHODS: A retrospective study of 15 patients treated for anterior hip dislocation was performed. Medical records were reviewed for demographic and surgical data. Imaging studies were revisited to determine direction of dislocation and associated fractures. Patients were assessed for pain, hip function using the modified Harris Hip Score (mHHS), hip range of motion and radiographic changes. Mean follow-up time was 3 years. RESULTS: Anterior dislocation occurred in an obturator (inferior), pubic (superior) or central direction. 9 patients had concomitant femoral head impaction and 7 patients suffered from acetabular fractures. 8 patients with an anterior hip dislocation underwent surgical treatment. This therapy, along with early range of motion and weight bearing, produced favourable clinical outcomes with 9 patients reporting no pain and an average mHHS of 83.8. 6 patients had heterotopic ossification at latest follow-up. CONCLUSIONS: Traumatic anterior hip dislocation is commonly associated with femoral head impaction and acetabular injuries which should be addressed operatively when appropriate to produce favourable results. In this paper, we propose a revision to the commonly used descriptive classification system.

14.
J Plast Surg Hand Surg ; 54(1): 14-18, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31453741

RESUMO

Pyogenic flexor tenosynovitis (PFT) of the hand is a common infection which is clinically diagnosed using Kanavel's signs. Delay in diagnosis and treatment may lead to devastating outcomes, including reduced range of motion (ROM), deformities, tendon impairment or even amputation. While the gold standard for treatment is irrigation and debridement of the flexor sheath, little is known about the outcomes of conservative treatment with intravenous (IV) antibiotics. Patients treated conservatively for PFT between 2000 and 2013 were included. Demographic information, co-morbidities and clinical features at presentation such as Kanavel's signs and inflammatory markers levels were gathered. Treatment course, length of stay (LOS), functional outcomes and complications were collected. Fifty-four (54) patients presented with PFT in the study period. Forty-six (46) patients, ages 19-84 years old, who were treated conservatively were included. Average time from symptoms onset to presentation was 4.6 ± 7.1 days. Fourteen (14) patients failed to improve with course of oral antibiotics prior to presentation. The average number of Kanavel's signs was 3 ± 0.7. Inflammatory markers were elevated in 82.2% of patients. The mean LOS was 4.7 ± 2 days. Forty-four (44) patients continued follow-up for 55 ± 45 months. Final flexion ROM was full or minimally limited in 69% of patients. Three patients were eventually operated. Complication rate for the entire cohort was 4.3% and no fingers were lost. This retrospective case series indicate that inpatient empirical IV antibiotic therapy can be considered for patients presenting with uncomplicated PFT, provided it is practiced under a hand specialist's surveillance.


Assuntos
Antibacterianos/uso terapêutico , Tratamento Conservador , Dedos , Tenossinovite/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Biomarcadores/sangue , Proteína C-Reativa/análise , Cefazolina/uso terapêutico , Diabetes Mellitus , Feminino , Dedos/cirurgia , Humanos , Tempo de Internação/estatística & dados numéricos , Leucocitose/etiologia , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Estudos Retrospectivos , Tenossinovite/cirurgia , Adulto Jovem
15.
Isr Med Assoc J ; 21(8): 532-537, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31474015

RESUMO

BACKGROUND: Implant-related spinal infections are a surgical complication associated with high morbidity. Due to infection, hardware removal may be necessary, which could lead to pseudarthrosis and the loss of stability and alignment. OBJECTIVES: To evaluate the accuracy and diagnostic value of 18F-fluorodeoxyglucose positron-emission tomography/computed tomography (18F-FDG PET/CT) in the workup of patients with suspected implant-related infections of the spine and to assess the clinical impact of PET/CT results on the management of these infections. METHODS: The study included nine consecutive patients with a history of spinal surgery who underwent PET/CT for evaluation of suspected spinal implant related infection. All imaging studies were performed between January 2011 and December 2013. All 18F-FDG PET/CT scans were performed on an 8 slice PET/CT following an 18F-FDG injection. Images were scored both visually and semi-quantitatively by a radiology expert. Results were compared to additional imaging studies when available, which were correlated to clinical and bacteriological findings allowing calculation of sensitivity, specificity and accuracy. RESULTS: Among the patients, five experienced hardware-related spinal infection. 18F-FDG PET/CT sensitivity was 80%, specificity 100%, and accuracy 88.9%. One scan produced a false negative; however, a second PET/CT scan revealed an infection. CONCLUSIONS: PET/CT was found to be valuable for the diagnosis of postoperative hardware-related spinal infection, especially when other imaging modalities were uninformative or inconclusive. As such, PET/CT could be useful for management of infection treatment.


Assuntos
Fluordesoxiglucose F18 , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada/métodos , Complicações Pós-Operatórias/diagnóstico por imagem , Infecções Relacionadas à Prótese/diagnóstico por imagem , Compostos Radiofarmacêuticos , Coluna Vertebral/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/patologia , Infecções Relacionadas à Prótese/patologia , Reprodutibilidade dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Coluna Vertebral/patologia
16.
Injury ; 50(7): 1347-1352, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31142435

RESUMO

INTRODUCTION: With the aging of the population the rate of fragility hip fractures increases. While medical recommendations are for hasten surgical treatment, for some older patients burdened with severe comorbidities, this might be risky. AIMS: To compare the outcomes of patients treated non-surgically to those of the most fragile patients treated surgically. PATIENTS AND METHODS: A retrospective cohort study, of individuals aged ≥65 years who presented with fragility hip fractures between 01.01.2011-30.06.2016, to a primary trauma center. Patients treated surgically were stratified according to their age-adjusted Charlsons' comorbidity index (ACCI) score. Patients in the upper third of ACCI score, representing the more fragile population, were compared to patients treated non-surgically. RESULTS: 847 patients presented with fragility fractures. 94 (11%) were treated non-surgically and 753 (89%) underwent surgery. Medical reasons were the leading cause for non-surgical treatment (61.7%). Surgically-treated patients were stratified according to their ACCI and 114 patients with ACCI > 9 were chosen for comparison. While both groups were comparable in terms of age, the non-surgical treatment group had more female patients (p. = 0.026) and a smaller proportion of independent walkers (p < 0.001). The ACCI was higher for the surgical treatment group (p < 0.001). In-hospital mortality was similar (14.9% and 18.1% for the operative and non-surgical groups respectively, P. = 0.575). However, one-year mortality was significantly higher for the non-surgical group (48.2% vs. 67.0%, P. = 0.005). The rates of in-hospital complications and 1-year readmissions were similar. CONCLUSIONS: Operative treatment for fragility hip fracture reduces long-term mortality rates even in the more fragile patients, compared to non-surgical treatment.


Assuntos
Tratamento Conservador , Idoso Fragilizado , Fraturas do Quadril/terapia , Fraturas por Osteoporose/terapia , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Feminino , Fraturas do Quadril/mortalidade , Fraturas do Quadril/fisiopatologia , Humanos , Masculino , Fraturas por Osteoporose/mortalidade , Fraturas por Osteoporose/fisiopatologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
17.
Arch Orthop Trauma Surg ; 139(12): 1659-1666, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31020410

RESUMO

BACKGROUND: The traditional treatment for chondrosarcoma is wide local excision (WLE), as these tumors are resistant to chemotherapy and radiation treatment. While achieving negative margins has traditionally been the goal of chondrosarcoma resection, multiple studies have demonstrated good short-term results after intralesional procedures for low-grade chondrosarcomas (LGCS) with curettage and adjuvant treatments (phenol application, cauterization or cryotherapy) followed by either cementation or bone grafting. Due to the rarity of this diagnosis and the recent application of this surgical treatment modality to chondrosarcoma, most of the information regarding treatment outcomes is retrospective, with short or intermediate-term follow-up. The aim of this study was to assess the long-term results of patients with LGCS of bone treated with intralesional curettage (IC) treatment versus WLE. This retrospective analysis aims to characterize the oncologic outcomes (local recurrence, metastases) and functional outcomes in these two treatment groups at a single institution. METHODS: Using an institutional musculoskeletal oncologic database, we retrospectively reviewed medical records of all patients with LGCS of the appendicular skeleton that underwent surgical treatment between 1985 and 2007. Thirty-two patients (33 tumors) were identified with LGCS; 17 treated with IC and 15 with WLE. RESULTS: Seventeen patients (18 tumors) with a minimum clinical and radiologic follow-up of 10 years were included. Nine patients were treated with IC (four with no adjuvant, three with additional phenol, one with liquid nitrogen and one with H2O2) with either bone graft or cement augmentation, and nine others were treated with WLE and reconstruction with intercalary/osteoarticular allograft or megaprosthesis. The mean age at surgery was 41 years (range 14-66 years) with no difference (p = 0.51) between treatment cohorts. There was a mean follow-up of 13.5 years in the intralesional cohort (range 10-19 years) and 15.9 years in the WLE cohort (range 10-28 years, p = 0.36). Tumor size varied significantly between groups and was larger in patients treated with WLE (8.2 ± 3.1 cm versus 5.4 ± 1.2 cm, at the greatest dimension, p = 0.021). There were two local recurrences (LR), one in the intralesional group and one in the wide local excision group, occurring at 3.5 months and 2.9 years, respectively, and both required revision. No further LR could be detected with long-term follow-up. The MSTS score at final follow-up was significantly higher for patients managed with intralesional procedures (28.7 ± 1.7 versus 25.7 ± 3.4, p = 0.033). There were less complications requiring reoperation in the intralesional group compared with the wide local excision group, although this difference was not found to be statistically significant (one versus four patients, respectively; p = 0.3). CONCLUSION: This series of low-grade chondrosarcoma, surgically treated with an intralesional procedures, with 10-year follow-up, demonstrates excellent local control (88.9%). Complications were infrequent and minor and MSTS functional scores were excellent. Wide resection of LGCS was associated with lower MSTS score and more complications. In our series, the LR in both groups were detected within the first 3.5 years following the index procedure, and none were detected in the late surveillance period.


Assuntos
Neoplasias Ósseas/cirurgia , Condrossarcoma/cirurgia , Extremidades/cirurgia , Adolescente , Adulto , Idoso , Cimentos Ósseos/uso terapêutico , Neoplasias Ósseas/fisiopatologia , Transplante Ósseo/métodos , Cimentação/métodos , Condrossarcoma/fisiopatologia , Terapia Combinada , Curetagem/métodos , Feminino , Humanos , Peróxido de Hidrogênio/uso terapêutico , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Osteotomia/métodos , Reoperação , Estudos Retrospectivos , Adulto Jovem
18.
J Cell Biochem ; 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30825230

RESUMO

Lumbar spinal canal stenosis (LSCS) is a degenerative disease observed by hypertrophy of the ligamentum flavum (LF) that cause compression of the lumbar neural content. Diabetes mellitus (DM) is a risk factor for the disease and we have shown previously that DM increases the fibrosis and elastic fiber loss in patients with LSCS. The purpose of this study was to find the proteins that play a role in the development of this clinical pathogenesis and the effect of DM on protein expression. LF tissue retrieved from patients diagnosed with LSCS, some were also diagnosed with DM, were compared with LF from patients diagnosed with herniated nucleus pulposus (HNP). The tissues were analyzed by mass spectrometry for proteins profile alteration. We found that LF of LSCS/DM patients exhibited significantly higher levels of proteoglycan proteins and latent transforming growth factor ß-binding protein (LTBP2 and LTBP4). Additionally, an increase of HTRA serine protease 1 and insulin-like growth factor binding protein-5 were noted. The higher fibrosis was also associated with proteins related to inflammation and slower tissue repair. Collagen 6 and transforming growth factor inhibitor are related to activation of the anti-inflammatory M2 pathway that is associated with tissue repair. The decrease of these proteins expression in LSCS/DM is associated with increased levels and activation of M1 pro-inflammatory pathways. Interestingly, C3 and C4b members of the complement complex and mannose receptor-like protein (CLEC18) paralogous proteins were detectable solely at the LSCS/DM patients' samples. Histology analysis shows that inflammatory was induced by the hyperglycemic conditions in diabetic patients involve in altering the matrix compositions. Thus, the protein profiles associated with inflammatory pathways affecting the LF suggested increasing susceptibility of developing the degeneration under hyperglycemic conditions.

19.
Arch Orthop Trauma Surg ; 139(10): 1339-1349, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30877429

RESUMO

BACKGROUND: Denosumab is a human monoclonal antibody (mAb) that specifically inhibits tumor-associated bone lysis through the RANKL pathway and has been used as neoadjuvant therapy for giant-cell tumor of bone (GCTB) in surgical as well as non-surgical cases. The purpose of this systematic review of the literature, therefore, is to investigate: (1) demographic characteristics of patients affected by GCTBs treated with denosumab and the clinical impact, as well as, possible complications associated with its use (2) oncological outcomes in terms of local recurrence rate (LRR) and development of lung metastasis, and (3) characteristics of its treatment effect in terms of clinical, radiological, and histological response. METHODS: A systematic review of the literature was conducted using PubMed, EMBASE, and COCHRANE search including the following terms and Boolean operators: "Denosumab" AND "primary bone tumor", "denosumab" AND "giant cell tumor", "denosumab" AND "treatment", and finally, "denosumab" AND "giant cell tumor" AND "treatment" since 2000. After applying inclusion and exclusion criteria, a total of 19 articles were included. The quality of the included studies was assessed using STROBE for the assessment of observational studies. RESULTS: A total of 1095 patients were included across all 19 studies. Across all the studies included, there were 615 females and 480 males. The mean patient age was 33.7 ± 8.3 years when starting the denosumab treatment. The pooled weighted local recurrence rate was 9% (95% CI 6-12%) and the pooled weighted metastases rate was 3% (95% CI 1-7%). The most common adverse event was fatigue and muscular pain. Radiologic response was estimated to occur in 66-100% of the patients. A significant reduction in pain under denosumab treatment was reported in seven studies and additional improvement in function and mobility was reported by several authors. Only two studies reported musculoskeletal tumor society (MSTS) scores which were better after denosumab treatment. CONCLUSIONS: The use of denosumab as an adjuvant treatment of GCTB has shown a positive but variable histological response with consistent radiological changes and several types of adverse effects. There is a positive clinical response in terms of pain relief with decrease on the morbidity of surgical procedures to be performed. Finally, oncological outcomes are disparate with neither effect on metastatic disease nor local recurrence rates. LEVEL OF EVIDENCE: IV.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Denosumab/uso terapêutico , Tumor de Células Gigantes do Osso/tratamento farmacológico , Neoplasias Ósseas/patologia , Humanos , Recidiva Local de Neoplasia
20.
Knee Surg Sports Traumatol Arthrosc ; 27(8): 2653-2658, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30430220

RESUMO

PURPOSE: To evaluate the progressive changes in the morphology of traumatic ruptures of the anterior cruciate ligament (ACL) over time. A secondary objective was evaluating their correlation with meniscal tears or chondral lesions. METHODS: The study included one hundred and one patients who underwent ACL reconstruction surgery of the knee after a definite date of injury. The torn ACL remnant morphological pattern was assessed and classified during arthroscopy. A correlation analysis was performed between the pathological features of the remnant and the time length from injury. In addition, correlation between ACL remnant subtypes and meniscal tears or chondral lesions was evaluated. RESULTS: At surgery there were four distinct ACL tear morphological patterns that were correlated to the time span from injury (r = 0.61, p < 0.001) and ended with scarring of the femoral remnant to the posterior cruciate ligament. The early pattern was noticed within median time of 2.6 months from injury and appeared as a separate stump with no scar tissue. The following two patterns appeared within 6 months from injury and were characterized by adhesion of scar tissue to different locations in the femoral notch. The last morphological pattern appeared as adherence of the ACL stump to the posterior cruciate ligament. This pattern was seen in some patients within 6 months from injury but was the dominant pattern later on and was also correlated with meniscal tears. CONCLUSIONS: During the first 3 months from injury the gross morphological features of the torn ACL remnant showed no scar. This phase was followed by scarring of the femoral remnant at first to the femoral notch, and eventually to the posterior cruciate ligament within 6 months from injury and later on. Therefore, further research on the healing potential of the human ACL stump and its biological environment should be focused on the first 3 months from injury. STUDY DESIGN: Case series; Level of evidence, 4.


Assuntos
Lesões do Ligamento Cruzado Anterior/patologia , Ligamento Cruzado Anterior/patologia , Fêmur/patologia , Ligamento Cruzado Posterior/patologia , Cicatrização , Adolescente , Adulto , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior , Artroscopia , Cicatriz , Feminino , Fêmur/cirurgia , Humanos , Traumatismos do Joelho/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Ruptura/patologia , Ruptura/cirurgia , Lesões do Menisco Tibial/cirurgia , Fatores de Tempo , Adulto Jovem
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