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1.
Medicine (Baltimore) ; 99(1): e18613, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895814

RESUMO

Postoperative fever in pediatric patients following reconstructive hip surgery is of unknown significance. This study identifies the prevalence of postoperative fever after corrective hip surgery, its relationship to infection, and whether preventative use of anti-pyretics affects patient outcomes.Overall, 222 patients who underwent a varus derotational osteotomy (VDRO) between 11/1/2004 to 8/1/2014 with minimum 6 months follow up were retrospectively identified. Variables included diagnosis, inpatient stay, daily maximum temperature, duration of fever, fever workup, and administration of scheduled anti-pyretics. Fever was defined as temperature ≥38°C.In total, 123/222 (55.4%) and 70/222 (31.5%) had postoperative fevers of ≥38°C and ≥38.5°C, respectively. Average inpatient stay was 2.7 days postoperatively. Temperature (mean = 38.0°C) was greatest on postoperative day 1 (POD1), and 43.7% of patients had T ≥38°C on POD1. Anti-pyretics did not influence the duration of fever. Anti-pyretics on the day of surgery (POD0) did not influence the incidence of fever. Acetaminophen on POD0 significantly reduced likelihood of fever on POD1 (P = .02). Average length of fevers ≥38°C and 38.5°C were 8.4 and 4.2 hours, respectively. 3/18 (16.7%) fever workups administered were positive. Postoperative fever did not predict infection. 9/222 (4/1%) patients had postoperative infection - 5/123 (4.1%) with fever ≥38°C and 4/70 (5.7%) with fever ≥38.5°C. Rates of infection in patients with and without fevers were not significantly different (P = .97 for T ≥38°C and P = .38, for T ≥38.5°C).Though common, postoperative fever does not increase risk of infection. The low prevalence of positive cultures indicates routine fever workups can safely be avoided in most patients.Level of Evidence: III, retrospective comparative study.


Assuntos
Coxa Vara/cirurgia , Febre/etiologia , Osteotomia/efeitos adversos , Complicações Pós-Operatórias/etiologia , Criança , Febre/epidemiologia , Humanos , Los Angeles/epidemiologia , Osteotomia/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Fatores de Risco
2.
J Pediatr Orthop ; 39(6): 282-288, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31169747

RESUMO

BACKGROUND: Coxa vara has been frequently reported in spondyloepiphyseal dysplasia congenita (SEDC), and proximal femoral osteotomy has been described as a useful treatment. The aim of this study was to discuss the clinical, radiographic, and gait outcomes after valgus extension osteotomy of the proximal femur. Changes of lumbar lordosis, associated with coxa vara correction, are reported as well as the outcome differences between different ages. METHODS: Records of children with SEDC, who were followed at our institution between 2004 and 2014, were reviewed; and children had hip surgery were identified. Hip pain and passive range of motion, radiographic neck shaft angle (NSA), and Hilgenreiner trochanteric (H-T) angle, sagittal spinopelvic parameters, and gait data were recorded. Preoperative and last follow-up data were compared. Outcomes were also compared between 3 age groups. RESULTS: Of the 79 children with SEDC, 26 children (12 boys and 14 girls) had hip osteotomy in 48 hips. Mean age at surgery was 9.6 years and the mean follow-up was 5 years. Preoperative hip pain was noted in 30 hips. At the last follow-up, 3 hips were painful at the extreme range of motion. Passive range of motion, NSA, and H-T improved postoperatively. Although NSA was maintained over the follow-up, H-T deterioration was noted. Spinopelvic measurements changed significantly and gait data remained stable except pelvic tilt that reduced significantly after surgery. The changes of radiographic measurements in each age group were similar to the total group of patients. CONCLUSIONS: In children with SEDC, surgical correction of coxa vara, by proximal femoral valgus osteotomy, is an effective treatment that improves hip pain and range of motion in addition to the radiographic alignment of the proximal femur and the sagittal spinopelvic alignment. Children are expected to maintain their level of function after surgery and to have good results over the midterm regardless of their age at surgery. LEVEL OF EVIDENCE: Level IV-therapeutic study.


Assuntos
Osteocondrodisplasias/congênito , Osteotomia/métodos , Adolescente , Criança , Pré-Escolar , Coxa Vara/cirurgia , Feminino , Fêmur/cirurgia , Seguimentos , Marcha/fisiologia , Articulação do Quadril/cirurgia , Humanos , Masculino , Osteocondrodisplasias/diagnóstico por imagem , Osteocondrodisplasias/fisiopatologia , Osteocondrodisplasias/cirurgia , Radiografia , Amplitude de Movimento Articular/fisiologia , Estudos Retrospectivos
3.
J Orthop Traumatol ; 18(4): 365-378, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28702703

RESUMO

BACKGROUND: Coxa vara is a radiological term describing a decrease in the neck-shaft angle to 120° or less. Coxa vara is associated with pathomechanical changes that can manifest clinically. If left untreated, coxa vara can affect the normal development of the pediatric hip. Valgus osteotomy is the standard surgical treatment for coxa vara, but there is no consensus regarding the optimal osteotomy technique and fixation method. The work reported here aimed to highlight transfixing wires as a fixation method for valgus osteotomy applied as treatment for various types of pediatric coxa vara. MATERIALS AND METHODS: This study included 16 cases of pediatric coxa vara with different etiologies in 9 patients with a mean age of 39.9 ± 15.2 months. Radiological and clinical evaluations and scoring of the condition of each patient according to the Iowa Hip Score were performed pre- and postoperatively. Transfixing wires and a protective spica were used for the fixation of a V-shaped, laterally based, closing-wedge valgus osteotomy in all cases. The postoperative follow-up period ranged from 14 to 102 months, with a mean duration of 33.3 ± 27.7 months. RESULTS: The mean Hilgenreiner epiphyseal angle (HEA) was corrected from 81.7 ± 2.2° to 24.3 ± 3.5° and the mean femoral neck-shaft angle (FNSA) was improved from 86.9 ± 4.2° to 138.6 ± 3.5°. No recurrence of the deformity was observed during the follow-up periods considered here. The osteotomy site united after an average of 11.7 ± 2.2 weeks with no secondary displacement, and in cases of developmental coxa vara there was progressive ossification of the neck defect with no surgery-related complications. Clinical results were markedly improved by the osteotomy, with a mean postoperative Iowa Hip Score at last follow-up of 95.06 ± 2.6, compared to a mean preoperative score of 57.4 ± 3.6. CONCLUSIONS: Transfixing wires protected in a hip spica cast represent a simple, easy, and reliable fixation method for valgus osteotomies performed to correct pediatic coxa vara. It assures stable fixation and rapid healing of the osteotomy without loss of the achieved correction, it completely avoids the femoral neck affording marked protection to the growth plate. LEVEL OF EVIDENCE: IV.


Assuntos
Fios Ortopédicos , Coxa Vara/cirurgia , Fêmur/cirurgia , Osteotomia/instrumentação , Moldes Cirúrgicos , Pré-Escolar , Coxa Vara/etiologia , Feminino , Humanos , Lactente , Masculino , Osteotomia/métodos
4.
Am J Case Rep ; 18: 440-443, 2017 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-28434011

RESUMO

BACKGROUND Coxa vara and pseudoarthrosis of the femoral neck after septic hip arthritis is a very rare disease. The aim of this study was to present a case with pseudoarthrosis of the femoral neck, with coxa vara after neonatal septic arthritis of the right hip, and treatment of the pseudarthrosis with proximal femoral valgus osteotomy. CASE REPORT A 12-month-old female, who had suffered neonatal septic arthritis with a five-day history of fever and painful right hip now demonstrated painless limping to the right hip, pelvic obliquity, Trendelenburg-Duchenne gait, limitation of hip abduction, lower-extremity length discrepancy with 3.0 cm of shortening of right femur, and walking on her tiptoes. In addition, a viable femoral head, coxa vara, and pseudoarthrosis of the femoral neck were observed. At the age of 26-months, the patient had a realignment valgus osteotomy of the proximal femur and adductor tenotomy was performed. At the last follow-up postoperative evaluation, at the age of four and a half years, the patient showed successful consolidation of pseudoarthrosis, correction of Trendelenburg gait, restored right lower extremity alignment, and corrected lower-extremity length discrepancy. CONCLUSIONS In the case of coxa vara and pseudoarthrosis of the femoral neck, realignment of the proximal femoral valgus osteotomy and bone grafting of the pseudoarthrosis resulted in ossification of the femoral neck as the epiphyseal plate was placed at right angle to the compressive forces.


Assuntos
Coxa Vara/cirurgia , Colo do Fêmur/diagnóstico por imagem , Osteotomia , Pseudoartrose/cirurgia , Tenotomia , Artrite Infecciosa/complicações , Coxa Vara/diagnóstico por imagem , Coxa Vara/etiologia , Feminino , Fêmur/cirurgia , Humanos , Lactente , Desigualdade de Membros Inferiores/etiologia , Desigualdade de Membros Inferiores/cirurgia , Pseudoartrose/diagnóstico por imagem , Pseudoartrose/etiologia
5.
J Arthroplasty ; 32(7): 2199-2203, 2017 07.
Artigo em Inglês | MEDLINE | ID: mdl-28262457

RESUMO

BACKGROUND: In total hip arthroplasty (THA) of hips with coxa vara, the femoral stems might be inserted in a varus alignment. To avoid varus insertion, we designed a technique, which we termed "trochantoplasty." In this procedure, the medial half of the greater trochanter was removed during THA. METHODS: We evaluated 30 patients (31 hips) who had coxa vara deformity and underwent THA using trochantoplasty at the mean follow-up of 5 years (range, 3-9 years). RESULTS: All stems were inserted in the neutral position. One Vancouver type 1 periprosthetic femoral fracture occurred after a fall at postoperative 2 months. At the latest follow-up, the mean power of abductor was 4.3 (range, 3-5). Four patients had moderate limp whereas 26 patients had slight limp. The abduction at 90° flexion ranged from 15° to 45° (mean, 35°). There was no revision. All prostheses had bone-ingrown stability without any detectable wear or osteolysis. The mean Harris hip score was improved from 66.9 to 89.4 points. CONCLUSION: Trochantoplasty can be used to avoid varus insertion of the femoral stem while performing THA in patients with coxa vara deformity without compromising the abductor mechanism.


Assuntos
Artroplastia de Quadril/métodos , Coxa Vara/cirurgia , Adulto , Idoso , Artroplastia de Quadril/estatística & dados numéricos , Feminino , Fêmur/cirurgia , Quadril/cirurgia , Luxação Congênita de Quadril/cirurgia , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos , Fraturas Periprotéticas , Período Pós-Operatório , Amplitude de Movimento Articular , Adulto Jovem
6.
J Pediatr Orthop B ; 26(4): 313-319, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28151779

RESUMO

The behavior and treatment of coxa vara and pseudarthrosis of the proximal femur secondary to sepsis is not well described. The aim of this study is to describe the pathoanatomy for coxa vara and pseudarthrosis in postseptic hips, evaluate progression of neck shaft angle (NSA), and discuss treatment. This is a retrospective case series of 20 patients (21 hips). There were 11 hips with predominant avascular necrosis of the capital femoral epiphysis without pseudarthrosis (type 1) and 10 with pseudarthrosis (type 2). The interobserver κ value was 0.79. There was a decrease in NSA from 110.3° to 99.3° during an average follow-up duration of 5.2 years (range: 2-14 years). The average change in NSA between the initial presentation and the final follow-up was 5.5° in type 1 and 17.1° in type 2. Nine patients underwent a surgical intervention. In cases where subtrochanteric valgus osteotomy was performed, the mean preoperative NSA was 94° and the mean NSA at the final follow-up was 128°; all operated pseudarthroses healed without bone grafting. Acetabuloplasty is not necessary in most cases.


Assuntos
Artrite Infecciosa/complicações , Coxa Vara/cirurgia , Necrose da Cabeça do Fêmur/cirurgia , Articulação do Quadril/cirurgia , Pseudoartrose/fisiopatologia , Adolescente , Criança , Pré-Escolar , Coxa Vara/diagnóstico por imagem , Coxa Vara/etiologia , Progressão da Doença , Epifise Deslocada/cirurgia , Feminino , Necrose da Cabeça do Fêmur/patologia , Fraturas do Quadril/cirurgia , Articulação do Quadril/patologia , Humanos , Estudos Longitudinais , Masculino , Pseudoartrose/complicações , Estudos Retrospectivos
7.
J Pediatr Orthop B ; 26(4): 320-328, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27748677

RESUMO

Developmental coxa vara (DCV) develops during early childhood between the age of independent walking and 6 years. The deformity includes a decrease in the neck-shaft angle and femoral retroversion. Recently, good results have been reported using external fixator systems for the correction of proximal femoral deformities secondary to slipped capital femoral epiphysis, Perthes' disease in children, and percutaneous proximal femoral osteotomy for coxa vara. This preliminary study was performed to evaluate the results of percutaneous subtrochanteric osteotomy in restoring the normal alignment and orientation (radiographic outcome), thereby restoring the normal mechanics of the hip joint, overcoming shortening of the limb, and re-establishing the length-tension relationship of the abductor muscles (functional outcome). During the period between January 2009 and January 2012, a prospective study was conducted involving 30 (33 hips) patients with DCV and a preoperative Hilgenreiner's epiphyseal angle of 60° or greater on coronal radiographs. Clinical and radiological (anteroposterior radiograph of the pelvis) evaluation of patients was carried out preoperatively and postoperatively until union was achieved and fixator removal was carried out, and then at 6 months and at the final follow-up, with a minimum of 12 and a maximum of 33 months after surgery and an average of 20.8 months. We used the technique described by Sabharwal and colleagues (2005) to perform an acute, opened wedge subtrochanteric valgus-flexion-derotation femoral osteotomy using a percutaneous multiple drill hole technique. A low-profile Ilizarov external fixator was applied in each case. The average operative time (including anesthesia time) was 74 (range 60-130) min. The average time spent in the external fixator until union was 11 (range 7-15) weeks. The average intraoperative blood loss was 35 (range 10-150) ml, and no patient developed hemodynamic instability or required any postoperative blood transfusion. The hospital stay averaged 1.2 (range 1-2) days. Hilgenreiner's epiphyseal angle preoperatively averaged 70.6° (ranging from 55° to 90°). At 6 months it averaged 40.6° (ranging from 15° to 60°). At final follow-up it averaged 41.16° (ranging from 15° to 60°). Percutaneous subtrochanteric osteotomy with external fixation appears safe and effective in treating multiplanar proximal femoral deformities associated with DCV in children. LEVEL OF EVIDENCE: Level IV.


Assuntos
Coxa Vara/cirurgia , Fixadores Externos , Colo do Fêmur/cirurgia , Osteotomia/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Colo do Fêmur/diagnóstico por imagem , Articulação do Quadril/anormalidades , Articulação do Quadril/diagnóstico por imagem , Humanos , Tempo de Internação , Estudos Longitudinais , Masculino , Duração da Cirurgia , Estudos Prospectivos , Radiografia , Resultado do Tratamento
8.
Hip Int ; 26(6): 554-560, 2016 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-27768218

RESUMO

BACKGROUND: Varus inclination of the uncemented stem is not necessarily a technical error. The proximal femoral anatomy of hips with a coxa vara deformity frequently predisposes varus inclination. METHODS: We reviewed a series of 200 patients undergoing primary uncemented THA with the Corail® hip system. Preoperative data were based on patient demographics, diagnosis, and radiographic information (preoperative templating-CT measurements), and compared postoperative alignment for each stem and type of stem used. Proximal femoral traits which can alert surgeons, when templating preoperatively, to potential varus alignment were noted. RESULTS: All stems were inserted either in neutral or varus alignments. Low neck shaft angle is strongly predictive of increased varus stem alignment (p<0.001). Stems inserted with higher varus alignment were associated with the preoperative morphological traits associated with coxa vara hip deformities - increased femoral offset (p<0.001), greater trochanteric overhang (p<0.001), greater trochanteric height (p<0.046), and a lower canal flare index (p<0.046). CONCLUSIONS: Varus stem alignment is neither unexpected nor necessarily a technical failure when using this particular uncemented stem system. Coxa vara deformities, due to a combination of morphological traits, are more likely to be inserted with higher varus alignment than hips with normal or higher neck shaft angles. Surgeons need to be aware of this when carrying out preoperative templating and intraoperative assessment, in order to prevent over-compensation for offset, length or stability.


Assuntos
Artroplastia de Quadril , Coxa Vara/diagnóstico por imagem , Coxa Vara/cirurgia , Prótese de Quadril , Artropatias/diagnóstico por imagem , Artropatias/cirurgia , Idoso , Cimentação , Coxa Vara/etiologia , Feminino , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Humanos , Artropatias/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do Tratamento
9.
Clin Orthop Surg ; 8(3): 310-5, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27583115

RESUMO

BACKGROUND: Although the valgus subtrochanteric osteotomy is considered as a standard surgical treatment for coxa vara, there is no consensus on the optimal method of fixation and osteotomy technique. Fixation of the osteotomy has been achieved by various methods including external fixation and internal fixation with pins and cerclage and a variety of plates. The aim of this study is the evaluation of the results of developmental coxa treated by Y intertrochanteric valgus osteotomy fixed with a T-buttress plate compared with other methods of fixation in the literature. METHODS: Eighteen corrective valgus intertrochanteric femoral osteotomies were performed in 18 patients (18 hips) for treatment of unilateral developmental coxa vara deformity and fixed with a T plate. There were 12 males and 6 females. The right hip was affected in 10 patients and the left hip in 8 patients. Clinically, patients were evaluated by Larson hip score. Radiographically, anteroposterior view of the pelvis and frog leg lateral views of the affected hip were taken preoperatively and compared with the findings at the final follow-up. RESULTS: The average follow-up was 29 months (range, 24 to 36 months). Clinical results showed improvement of the mean Larson hip score from 57.8 to 97.0 (p < 0.001). Radiological results showed that all osteotomies were completely united in 2.4 months (range, 2 to 3 months) with the achievement of the planned correction angle. The average correction of Hilgenreiner's epiphyseal angle improved from 78.2° to 27.8° (p < 0.001) at the final follow-up. The femoral neck shaft angle was improved from 93.7° to 129.9° (p < 0.001) at the final follow-up. Shortening of the affected limb was corrected from 2.8 cm to 1.3 cm (p < 0.001) at the last follow-up. No major serious complications were recorded in the present study. CONCLUSIONS: Intertrochanteric valgus osteotomy of the proximal femur fixed with a T plate may be efficient for treatment of developmental coxa vara. With careful planning, it can result in a low complication rate and insignificant or minimal recurrence rate.


Assuntos
Placas Ósseas , Coxa Vara/cirurgia , Colo do Fêmur/cirurgia , Fixação Interna de Fraturas , Osteotomia , Criança , Pré-Escolar , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/estatística & dados numéricos , Humanos , Masculino , Osteotomia/métodos , Osteotomia/estatística & dados numéricos
10.
Rev Med Chir Soc Med Nat Iasi ; 120(1): 137-41, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27125086

RESUMO

AIM: To monitor the effect of tranexamic acid use (Exacyl) on postoperative bleeding (aspiration), autologous blood transfusion (autotransfusion), allogeneic blood transfusion and postoperative anemia (difference between preoperative and immediate postoperative hemoglobin levels) in total knee arthroplasty. MATERIALS AND METHODS: This retrospective observational study was conducted on a sample of 457 patients who underwent endoprosthetic knee arthroplasty in the interval January 1, 2008-July 3O, 2014 at the Traumatology-Orthopedics Clinic of the Iasi Rehabilitation Hospital. The mean age of the study group was 66 years (range 32-84 years), 74.4% were female, 39.8% presented varus and 6.1% valgus malalignment. The study group was subdivided into two groups: Group 1 served as controls and underwent surgery without the administration of tranexamic acid and Group 2 received tranexamic acid. RESULTS: In group 1 the average amount of blood lost was significantly higher than in group 2, 1168.94 ml vs. 452.9 ml (p < 0.001). The use of a cell saver was required in 70% of group 1 patients with an average amount of auto transfused blood of 480.70 ml, significantly more frequent and in greater amounts than in group 2 (below 10%) with an average of 15.05 ml (p < 0.001). In this study tranexamic acid had not a statistically significant favorable effect on blood transfusion requirements and anemia syndrome. CONCLUSION: Tranexamic acid has a favorable effect on postoperative blood loss and its associated complications, with a favorable impact on both early clinical and functional recovery.


Assuntos
Antifibrinolíticos/administração & dosagem , Artroplastia do Joelho , Hemorragia Pós-Operatória/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Coxa Valga/cirurgia , Coxa Vara/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
11.
Clin Orthop Relat Res ; 473(10): 3315-20, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-26242281

RESUMO

BACKGROUND: Spinal cord injury is a rare complication after lower extremity surgery in children with skeletal dysplasia and thoracic kyphosis. We encountered two patients who had this complication, from among 51 (39 from Nemours/Alfred I. duPont Hospital for Children and 12 from Seattle Children's Hospital) who underwent lower extremity surgery during an 8.5-year period (June 2004 to December 2012). Because spinal cord injury is a devastating complication likely not known to most physicians treating patients with skeletal dysplasias, we sought to examine factors that may contribute to this rare complication. CASE DESCRIPTION: We performed a retrospective review of two patients with skeletal dysplasia who had paraplegia develop after extremity surgery. Outcome measures included operative time, vital signs, and postsurgery recovery of neurologic deficit. MR images were reviewed. Two patients were found-an 8.5-year-old boy with spondyloepiphyseal dysplasia congenita with a 76°-thoracic kyphosis apex at T4 and a 6.5-year-old boy with mucopolysaccharidosis type 1-H with an 80°-thoracic kyphosis apex at T2. Bilateral proximal femoral osteotomies or bilateral innominate and proximal femoral osteotomies had been performed. The spinal cord injuries occurred at the apex of the kyphosis as determined by clinical examination and MRI assessment. In both patients, the mean arterial blood pressure decreased below 50 mm Hg and might be a factor in the etiology of the paralysis. The first patient recovered motor function in 5 months; the second had no recovery. LITERATURE REVIEW: Paraplegia is extremely rare after nonspine operations. Many factors contribute to the risk for a spinal cord event: low mean arterial pressure, duration of the surgery, position on the operating table, the kyphotic spine deformity, or unappreciated vascular disease. Motor-evoked potentials and somatosensory-evoked potentials together potentially provide high sensitivity and specificity for predicting a postoperative neurologic deficit. CLINICAL RELEVANCE: Based on our two patients with skeletal dysplasia and a literature review of patients with hyperkyphosis undergoing extremity surgery, the surgeon must be aware of the risk of spinal cord injury. Careful preoperative assessment possibly including MRI of the spine is recommended. Mean arterial pressure should be maintained at a safe level; neuromonitoring should be considered.


Assuntos
Coxa Vara/complicações , Coxa Vara/cirurgia , Cifose/complicações , Osteotomia , Complicações Pós-Operatórias/etiologia , Traumatismos da Medula Espinal/etiologia , Criança , Humanos , Masculino , Estudos Retrospectivos
12.
J Bone Joint Surg Am ; 97(2): 119-25, 2015 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-25609438

RESUMO

BACKGROUND: In patients with polyostotic fibrous dysplasia with extensive femoral involvement, severe coxa vara may cause complex femoral deformities that are difficult to treat with a single-stage surgical procedure. We evaluated the results of treatment of such patients with a two-stage procedure. METHODS: Eleven patients with polyostotic fibrous dysplasia and severe coxa vara (including one who required bilateral treatment and one who required repeat treatment) were treated surgically at a mean age of fourteen years and four months. A two-stage surgical procedure was planned to correct the deformity. The first stage involved correction of the coxa vara and fixation with a hip plate. The second stage involved correction of a shepherd's crook deformity if present and definitive fixation with an interlocking cervicodiaphyseal nail. All patients were evaluated clinically and radiographically at a mean of four years and seven months after the second-stage procedure. RESULTS: The femoral neck-shaft angle averaged 83° before surgery and was corrected to a mean of 130° after the first-stage procedure. In two patients, cutout of the hip screw-plate caused acute postoperative loss of correction (by 40° in one patient and 20° in the other). After the second-stage procedure, the neck-shaft angle was either fully corrected or improved and the shepherd's crook deformity was fully corrected in all patients. At the time of the latest follow-up, the mean neck-shaft angle was 124°, with a mean loss of correction of 5° relative to the angle measured at the end of the second-stage procedure. The mean estimated blood loss was 625 mL in the first stage and 979 mL in the second. CONCLUSIONS: The two-stage surgical procedure designed to treat patients with polyostotic fibrous dysplasia with complex femoral deformity and severe coxa vara restored a nearly normal femoral alignment that was maintained at a mean of four years and seven months of follow-up. The clinical benefits were pain relief in all of the patients and gait normalization or improvement in most. The estimated blood loss was substantial in both stages. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Coxa Vara/cirurgia , Fêmur/cirurgia , Displasia Fibrosa Poliostótica/cirurgia , Adolescente , Coxa Vara/diagnóstico por imagem , Feminino , Fêmur/diagnóstico por imagem , Displasia Fibrosa Poliostótica/diagnóstico por imagem , Fixação Intramedular de Fraturas , Humanos , Masculino , Osteotomia , Radiografia
13.
J Med Assoc Thai ; 97 Suppl 9: S78-82, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25365895

RESUMO

BACKGROUND: Coxa vara is a rare condition. Surgical correction of coxa vara has been challenging. A few reports present correction coxa vara in multiple causes. In this retrospective study, the authors reported the results of surgical treatment of coxa vara by valgus osteotomy with angle blade plate fixation in 11 children with 12 hips. MATERIAL AND METHOD: Since 2002-2011, 11 children with 12 hips with coxa vara were reviewed retrospectively by medical chart and radiographic data after surgical treatment. All of them were operated by valgus osteotomy and fixation with angle blade plate. All of them had been hip spica cast between 8-12 weeks after surgery. Neck-shaft angle, Hilgenreiner-epiphyseal angle, leg-length discrepancy and Harris hip score were evaluated at preoperative, postoperative, and final follow-up. RESULTS: Twelve coxa vara; 4 malunion femeral neck fracture, 4 congenital coxa vara, 2 spondyloepiphyseal dysplasia and 1 multiple epiphyseal dysplasia were operated on in 11 patients. One spondyloepiphyseal dysplasia had bilateral coxa vara. The average age at surgery was 9.5 years (range, 7-12 years). The average time of follow-up was 4.2 years (range, 3-7years). The average neck-shaft angle was changed significantly from 79.8 to 123.7 degrees, the Hilgenreiner-epiphyseal angle was changed significantly from 70 to 39.3 degrees and leg-length discrepancy was changed significantly from 2.2 to 1.7 centimeters at final follow-up. The average Harris Hip score was improved significantly from 68 at preoperative to 96 atfinalfollow-up. No complication or recurrence was found. CONCLUSION: Surgical treatment of coxa vara is uncommon treatment. The aims of treatment were to change the stress in the neck femur from shearing force to compression force and also improving shortening that could reduce incidence of further fracture and osteoarthritis. The Hilgenreiner-epiphyseal angle should be closed to 38-40 degree or less after surgery.


Assuntos
Placas Ósseas , Coxa Vara/cirurgia , Osteotomia/métodos , Criança , Feminino , Fraturas do Colo Femoral/cirurgia , Seguimentos , Fraturas Mal-Unidas/cirurgia , Humanos , Desigualdade de Membros Inferiores/etiologia , Desigualdade de Membros Inferiores/cirurgia , Masculino , Osteocondrodisplasias/congênito , Osteocondrodisplasias/cirurgia , Estudos Retrospectivos
14.
Ger Med Sci ; 12: Doc13, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25276115

RESUMO

We report on a 42-year-old woman who presented with persistent pain in her left knee with no history of trauma. Sagittal T1-weighted MRI of the left knee showed discontinuity between the anterior and posterior horns of the left medial meniscus, causing effectively the development of degenerative lesion of the posterior horn. The latter was correlated to varus deformity of the left lower extremity associated with subsequent narrowing of the medial knee joint. The unusual craniofacial contour of the patient, the skeletal survey and the elevated serum alkaline phosphatase were compatible with the diagnosis of Paget's disease of the bone. To alleviate the adverse effect of the mal-alignment of the left femur onto the left knee, corrective osteotomy of the left femoral diaphysis by means of fixators was performed. To the best of our knowledge this is the first clinical report describing the management and the pathological correlation of a unilateral varus deformity of the femoral shaft and degenerative lesions of the left knee in a patient with Paget's disease of the bone.


Assuntos
Coxa Vara/etiologia , Meniscos Tibiais/patologia , Osteíte Deformante/complicações , Adulto , Coxa Vara/patologia , Coxa Vara/cirurgia , Feminino , Fêmur/patologia , Fêmur/cirurgia , Humanos , Articulação do Joelho/patologia , Imagem por Ressonância Magnética , Osteíte Deformante/patologia , Osteíte Deformante/cirurgia , Osteotomia
15.
J Pediatr Orthop ; 34(6): 585-90, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24705347

RESUMO

INTRODUCTION: Majewski osteodysplastic primordial dwarfism type II (MOPDII) is characterized by severe prenatal and postnatal growth failure with microcephaly, characteristic skeletal dysplasia, an increased risk for cerebrovascular disease, and insulin resistance. MOPDII is caused by mutations in the pericentrin (PCNT) gene and is inherited in an autosomal-recessive manner. This study aimed to determine the incidence of hip pathology in patients with molecularly confirmed MOPDII and to describe the functional outcomes of surgical treatment. METHODS: Thirty-three enrolled patients had a clinical diagnosis of MOPDII. Biallelic PCNT mutations or absent pericentrin protein was confirmed in 25 of these patients. Twelve patients (7 female) had appropriate clinical and radiographic records at this institution and were included in this study. The data collected included age at presentation, age at surgery, sex, body weight and height, weight-bearing status at diagnosis, and the clinical examination. RESULTS: Four patients (31%) had coxa vara: 3 unilateral and 1 bilateral. Three unilateral patients had in situ pinning at a mean age 4 years. The patient with bilateral coxa vara had valgus osteotomy at the age of 5 years. Two children had bilateral hip dysplasia and subluxation with no surgery. One patient had bilateral developmental hip dislocations. The patient was treated by open reduction-spica cast and 2 years after surgery, coxa valga was noted. Another patient was diagnosed at an age of 12 years with bilateral avascular necrosis of the hips. Four patients did not have hip pathology. CONCLUSIONS: Hip pathology is common among children with MOPDII; coxa vara is the most frequent diagnosis. Routine clinical and radiographic hip evaluation is important. The capital femoral epiphysis appears to slip down along the shaft, giving the appearance of a proximal femoral epiphysiolysis. A hip diagnosed with slipped capital femoral epiphysis in early life may progress to severe coxa vara. LEVEL OF EVIDENCE: Level IV.


Assuntos
Coxa Vara/cirurgia , Nanismo/patologia , Retardo do Crescimento Fetal/patologia , Microcefalia/patologia , Osteocondrodisplasias/patologia , Adolescente , Antígenos/genética , Criança , Pré-Escolar , Nanismo/genética , Nanismo/cirurgia , Feminino , Retardo do Crescimento Fetal/genética , Retardo do Crescimento Fetal/cirurgia , Luxação Congênita de Quadril/cirurgia , Articulação do Quadril/cirurgia , Humanos , Masculino , Microcefalia/genética , Microcefalia/cirurgia , Mutação , Osteocondrodisplasias/genética , Osteocondrodisplasias/cirurgia , Osteotomia , Adulto Jovem
16.
Musculoskelet Surg ; 98(1): 71-5, 2014 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22528854

RESUMO

Valgus subtrochanteric osteotomies and hemiepiphyseodesis around the knees have been performed to correct severe coxa vara and genua valga in a girl patient who manifested extreme dwarfism associated with spondylometaepiphyseal dysplasia consistent with anauxetic dysplasia. To the best of our knowledge, this is the first description of the combined orthopaedic intervention in a girl with anauxetic dysplasia.


Assuntos
Coxa Vara/cirurgia , Nanismo/cirurgia , Fêmur/cirurgia , Genu Varum/cirurgia , Osteocondrodisplasias/cirurgia , Osteotomia , Tíbia/cirurgia , Anormalidades Múltiplas/genética , Placas Ósseas , Moldes Cirúrgicos , Terapia Combinada , Coxa Vara/genética , Progressão da Doença , Nanismo/diagnóstico por imagem , Nanismo/patologia , Epífises/cirurgia , Feminino , Genu Varum/congênito , Genu Varum/genética , Humanos , Osteocondrodisplasias/diagnóstico por imagem , Osteocondrodisplasias/patologia , Radiografia , Restrição Física
18.
Acta Chir Orthop Traumatol Cech ; 80(4): 273-7, 2013.
Artigo em Tcheco | MEDLINE | ID: mdl-24119475

RESUMO

PURPOSE OF THE STUDY: The aim of the study was to evaluate, in comparison with the pre-operative planning, the accuracy of proximal femur correction achieved with the use of locking compression paediatric hip plates (LCP) in children and adolescents and to assess pre- and post-operative complications. MATERIAL AND METHODS: A group of 52 patients in whom proximal femoral osteotomy using the LCP was performed on a total of 55 hips between September 2009 and February 2013 were retrospectively evaluated. The following diagnoses were treated: unstable hip in cerebral palsy, 18 operations; Legg-Calvé-Perthes disease, 10 operations; coxa vara of aetiology other than coxa vara adolescentium (CVA), eight operations; true CVA, six operations; femoral shortening by the Wagner method, six procedures; proximal femoral derotation osteotomy, four procedures; and post-traumatic pseudoarthrosis of the proximal femur, three operations. RESULTS: Compared with the pre-operative plan, the average deviation of the colodiaphyseal angle was 5.2° (1° to 11°) in 18 unstable hips; 4.7° (1° to 10°) in 10 cases of Legg-Calvé-Perthes disease; 4.5° (3° to 6°) in eight hips with coxa vara of aetiology other than CVA; 6.5° (2° to 13°) in six CVA hips; 4.5° (1° to 10°) in six cases of femoral shortening; 3.5° (1° to 5°) in four derotation osteotomies; and 3.7° (0° to 6°) in three corrections of pseudoarthrosis. In one patient, osteosynthesis failed due to screws being pulled out from the proximal fragment; re-osteosynthesis was carried out using a conventional angled blade plate. DISCUSSION: As in other international studies, our results confirmed a high accuracy of proximal femur correction with use of the LCP instrumentation. The reported higher time requirement for this technique seems to be related to the learning curve and, with more frequent use, will probably be comparable to the time needed for application of conventional hip angled plates. CONCLUSIONS: The up-to-date LCP fixation system using the principle of angular stability for correction of the proximal femur in children is a clear advancement and its higher costs are certain to be outweighed by its higher accuracy and thus better results.


Assuntos
Placas Ósseas , Coxa Vara/cirurgia , Fêmur/cirurgia , Articulação do Quadril/cirurgia , Instabilidade Articular/cirurgia , Osteotomia/métodos , Pseudoartrose/cirurgia , Adolescente , Paralisia Cerebral/complicações , Criança , Coxa Vara/etiologia , Feminino , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Instabilidade Articular/etiologia , Doença de Legg-Calve-Perthes/complicações , Masculino , Osteotomia/instrumentação , Estudos Retrospectivos , Resultado do Tratamento
20.
J Pediatr Orthop ; 33(4): 353-60, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23653021

RESUMO

BACKGROUND: For the treatment of the severe infantile coxa vara it is mandatory for the orthopaedic surgeon to observe the mechanobiology of the growing hip before and after the surgical intervention. We hereby would like to present our experiences with the subtrochanteric end-to-side valgization osteotomy and to compare the procedure with the alternatively used Y-shaped osteotomy as described by Pauwels. METHODS: Thirteen patients (20 hips) who had undergone subtrochanteric end-to-side valgization were followed for a mean 6.2 years (range, 0.8 to 12.8 y). At the time of surgery the mean age was 7.1 years (range, 2.0 to 13.3 y), last follow-up examination was performed at a mean of 13.4 years of age (range, 5.1 to 18.3 y). The deformities were etiologically based on 5 entities: congenital coxa vara (n=1), osteochondrodysplasias (n=12), postosteomyelitic coxa vara (n=5), and avascular femoral head necrosis in the course of congenital dysplasia of the hip (n=2). The follow-up rate was 100%.In addition, we analyzed a total of 93 pelvic radiographies with a total of 139 hip joints. Thirty angles and distances were assessed according to parameters described in the literature. RESULTS: Although preoperatively 12 patients presented with a positive Trendelenburg's sign, it was only present postoperatively in 2 patients. Duchenne's limp reduced from 10 to 1. All of the 15 preoperatively apparent nonunions could be healed by means of surgery. Two hips redeveloped pathologically lowered collodiaphyseal angles postoperatively, one of which had to undergo revision surgery. Preoperatively 15 out of 20 patients (75%) showed nonunions all of which healed after surgery. No recurrence could be seen at the time of the last follow-up.The following angles were assessed on plain radiographies of the pelvis preoperatively and directly postoperatively as well as on the last follow-up at a mean of 85 months: CCD-angle 98 degrees/156 degrees/144 degrees, EY-angle 55 degrees/5 degrees/15.7 degrees, AY-angle 32 degrees/75 degrees/66 degrees, CE-angle 20 degrees/25 degrees/18 degrees, AC-angle 20 degrees/18 degrees/20 degrees. The articulotrochanteric distance was 5 mm/26 mm/14 mm. CONCLUSIONS: The subtrochanteric end-to-side valgization osteotomy showed to be highly effective in the management of the infantile coxa vara, improving the clinical impairment of the patients postoperatively. All of the preoperatively present nonunions showed osseous consolidation at follow-up examination. Only minor revarization tendencies could be found. The procedure is technically less demanding, safer and more efficient regarding the lengthening of the affected limb in comparison to the Y-shaped intertrochanteric osteotomy as described by Pauwels. LEVEL OF EVIDENCE: Case-control study (EBM-level III).


Assuntos
Coxa Vara/cirurgia , Articulação do Quadril/cirurgia , Osteotomia/métodos , Adolescente , Criança , Pré-Escolar , Coxa Vara/diagnóstico por imagem , Coxa Vara/patologia , Feminino , Necrose da Cabeça do Fêmur/patologia , Necrose da Cabeça do Fêmur/cirurgia , Seguimentos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/patologia , Humanos , Masculino , Osteocondrodisplasias/patologia , Osteocondrodisplasias/cirurgia , Osteotomia/efeitos adversos , Radiografia , Índice de Gravidade de Doença , Resultado do Tratamento
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