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1.
BMC Med Genet ; 21(1): 21, 2020 01 31.
Artigo em Inglês | MEDLINE | ID: mdl-32005172

RESUMO

BACKGROUND: More than 95% of individuals with RTT have mutations in methyl-CpG-binding protein 2 (MECP2), whose protein product modulates gene transcription. The disorder is caused by mutations in a single gene and the disease severity in affected individuals can be quite variable. Specific MECP2 mutations may lead phenotypic variability and different degrees of disease severity. It is known that low bone mass is a frequent and early complication of subjects with Rett syndrome. As a consequence of the low bone mass Rett girls are at an increased risk of fragility fractures. This study aimed to investigate if specific MECP2 mutations may affects the degree of involvement of the bone status in Rett subjects. METHODS: In 232 women with Rett syndrome (mean age 13.8 ± 8.3 yrs) we measured bone mineral density at whole body and at femur (BMD-FN and BMD-TH) by using a DXA machine (Hologic QDR 4500). QUS parameters were assessed at phalanxes by Bone Profiler-IGEA (amplitude dependent speed of sound: AD-SoS and bone transmission time: BTT). Moreover, ambulation capacity (independent or assisted), fracture history and presence of scoliosis were assessed. We divided the subjects with the most common point mutations in two group based on genotype-phenotype severity; in particular, there has been consensus in recognising that the mutations R106T, R168X, R255X, R270X are considered more severe. RESULTS: As aspect, BMD-WB, BMD-FN and BMD-TH were lower in subjects with Rett syndrome that present the most severe mutations with respect to subjects with Rett syndrome with less severe mutations, but the difference was statistically significant only for BMD-FN and BMD-TH (p < 0.05). Also both AD-SoS and BTT values were lower in subjects that present the most severe mutations with respect to less severe mutations but the difference was not statistically significant. Moreover, subjects with Rett syndrome with more severe mutations present a higher prevalence of scoliosis (p < 0.05) and of inability to walk (p < 0.05). CONCLUSION: This study confirms that MECP2 mutation type is a strong predictor of disease severity in subjects with Rett syndrome. In particular, the subjects with more severe mutation present a greater deterioration of bone status, and a higher prevalence of scoliosis and inability to walk.


Assuntos
Doenças Ósseas/genética , Proteína 2 de Ligação a Metil-CpG/genética , Osteoporose/genética , Síndrome de Rett/genética , Adolescente , Adulto , Densidade Óssea/genética , Doenças Ósseas/diagnóstico por imagem , Doenças Ósseas/fisiopatologia , Criança , Pré-Escolar , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/genética , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Mutação , Osteoporose/diagnóstico por imagem , Osteoporose/fisiopatologia , Síndrome de Rett/diagnóstico por imagem , Síndrome de Rett/fisiopatologia , Escoliose/diagnóstico por imagem , Escoliose/genética , Escoliose/fisiopatologia , Índice de Gravidade de Doença , Adulto Jovem
2.
Ultraschall Med ; 41(1): 12-28, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32023628

RESUMO

Fracture ultrasound has increasingly come into the focus of international research. A growing number of original articles and a meta-analysis show that wrist fractures can be diagnosed without X-ray in children up to 12 years. Further original publications state that elbow fractures can be ruled out by exclusion of intraarticular effusion and in proximal humerus fractures the number of X-rays is reduced by about 50 %, while the quality of diagnosis is improved. Screening for occult fractures is another good indication. Clavicle fractures, and ac-joint sprains can be diagnosed better with US than with X-rays. A number of research groups have contributed valuable research about the different indications. The aim of this paper is to give an overview of the basics and actual fields of application for fracture ultrasound of the extremities.


Assuntos
Fraturas Ósseas , Fraturas da Ulna , Criança , Fraturas Ósseas/diagnóstico por imagem , Humanos , Radiografia , Fraturas da Ulna/diagnóstico por imagem , Ultrassonografia
3.
Sports Health ; 12(1): 88-93, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31689146

RESUMO

BACKGROUND: There are approximately 2.1 million recreational surfers in the United States. However, little has been reported on surfing-related injuries and, to date, no study has utilized magnetic resonance imaging (MRI) to characterize injury patterns. OBJECTIVE: To use MRI to perform a descriptive analysis of surfing injuries in patients who presented to an urban tertiary care musculoskeletal hospital. This was not a hypothesis-driven study. STUDY DESIGN: Case series. LEVEL OF EVIDENCE: Level 4. METHODS: A retrospective review of the picture archiving and communication system as well as the electronic medical record was performed to identify patients with surfing-related injuries who presented to a tertiary care musculoskeletal hospital for treatment. The search included participants over a 10-year period who presented between January 1, 2009, and August 1, 2018. Descriptive data analyses were performed to determine frequency of body part injured, diagnosis, and operative versus nonoperative treatment. RESULTS: The search yielded 109 patients with surfing-related injuries and MRIs. A total of 90 patients presented within 6 months of their surfing injury and were included in the final analysis. The median age was 36 years (range, 12-66 years). A majority of the patients included were male (74%; n = 67). Acute surfing injuries were diagnosed via imaging in 72% (n = 65) of patients. The joints injured most commonly were the shoulder (46%; n = 30) and the knee (28%; n = 18). Only 17% (n = 11) of acute surfing injuries required surgery, while 83% (n = 54) were treated nonoperatively. CONCLUSION: The most common surfing-related injuries occurred in the shoulder and knee. CLINICAL RELEVANCE: This study helps characterize the risk of injury for surfers and informs healthcare providers on common surfing injuries.


Assuntos
Traumatismos em Atletas/diagnóstico por imagem , Esportes Aquáticos/lesões , Adolescente , Adulto , Idoso , Criança , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Lacerações/diagnóstico por imagem , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Lesões do Ombro/diagnóstico por imagem , Adulto Jovem
4.
Int J Radiat Oncol Biol Phys ; 106(3): 475-484, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31580930

RESUMO

PURPOSE: To estimate the overall rate, symptomatic proportion, and most common sites of pelvic insufficiency fracture (PIF) after external beam radiation therapy for gynecologic cancers based on posttreatment computed tomography, magnetic resonance imaging, positron emission tomography, or bone scintigraphy. METHODS AND MATERIALS: A systematic search of databases (PubMed and EMBASE) was performed (CRD42019125679). The pooled summary of overall PIF and the proportion of symptomatic cases were calculated using the random-effects model weighted by the inverse variance. A multivariate meta-regression was performed to evaluate potential sources of heterogeneity regarding PIF fractures. RESULTS: Twenty-one studies met the inclusion criteria (total 3929 patients). Five hundred four patients developed PIF, translating to an overall rate of 14% (95% confidence interval, 10%-18%, based on 21 studies). Among these cases with PIF, the proportion of symptomatic patients was 61% (95% confidence interval, 52%-69%, based on 14 studies). The total number of PIFs was 704 (mean, 1.72 PIFs per each patient to develop PIF, based on 14 studies). More recent series (P = .0074) and the use of intensity modulated radiation therapy (P = .0299) were associated with lower fracture rates. The most common fracture sites were sacroiliac joint (39.7%), body of the sacrum (33.9%), pubis (13%), lumbar vertebra (7%), iliac bone (2.8%), acetabulum (2.1%), and femoral head/neck (1.5%). The median time to fracture was 7.1 to 19 months after radiation therapy. CONCLUSIONS: The incidence of PIF after radiation therapy for gynecologic cancers is high (14%), with the majority affecting the sacral bone or joint (73.6%), although this risk appears to be lower with intensity modulated radiation therapy. Posttreatment bone surveillance is warranted in this population because nearly 40% of patients were asymptomatic at the time of PIF diagnosis.


Assuntos
Fraturas Ósseas/epidemiologia , Fraturas Espontâneas/epidemiologia , Neoplasias dos Genitais Femininos/radioterapia , Ossos Pélvicos/lesões , Intervalos de Confiança , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Neoplasias dos Genitais Femininos/diagnóstico por imagem , Humanos , Ossos Pélvicos/efeitos da radiação , Radioterapia de Intensidade Modulada , Análise de Regressão
6.
Br J Radiol ; 93(1105): 20180989, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31742428

RESUMO

OBJECTIVE: To assess the rates of fractures and ligament injuries in patients with an acute ankle injury and a normal radiographic examination, and to consider the most appropriate examination protocol. METHODS: Patients with an acute ankle injury who presented to the John Radcliffe Hospital Emergency Department with a normal radiographic examination were eligible for the study. They were invited to receive a cone beam CT and ultrasound examination at a local radiology department within 5 days of their ankle injury. RESULTS: Of the 100 patients recruited to the study, 19 patients were found to have major fractures and 42 patients had small avulsion fractures. Additionally, 42 patients had ankle effusions and there were a large number of soft tissue injuries. There were 83 acute injuries of the anterior talofibular ligament, 19 of the anterior tibiofibular ligaments, 26 of the calcaneofibular ligament, 39 of the deltoid ligament complex, 21 of the talonavicular ligament, 14 of the spring ligament and 3 of the calcaneocuboid ligament. CONCLUSION: Conventional radiographic examination misses significant fractures of the foot and ankle and the presence of an ankle effusion does not relate to the severity of injury. Ultrasound is a useful imaging technique that can supplement clinical practice, but it is unlikely to replace current protocols alone. Cone beam CT is an appropriate alternative to plain radiography, being more sensitive in detecting fractures and delivering a similar dose of radiation. However, neither CT or ultrasound examination can detect all avulsion fractures. Simple anterior process fractures of the calcaneus are associated with talonavicular ligament injuries and the medial ligaments are injured in almost 50% of cases when there is a lateral ligament injury. ADVANCES IN KNOWLEDGE: Fractures in the foot and ankle are detected more precisely with cone beam CT compared to radiographs. Cone beam CT delivers similar doses of to conventional radiographs which is around 10% of that resulting from conventional CT. Ultrasound examination is an effective assessment tool to detect ligamentous injuries. The absence of an ankle effusion does not exclude a major fracture.


Assuntos
Traumatismos do Tornozelo/diagnóstico por imagem , Tomografia Computadorizada de Feixe Cônico/métodos , Fraturas Ósseas/diagnóstico por imagem , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Lesões dos Tecidos Moles/diagnóstico por imagem , Ultrassonografia/métodos , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
8.
Medicine (Baltimore) ; 98(44): e17823, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689869

RESUMO

BACKGROUNDS: Hand fractures are the second most common upper-extremity fractures. The standard X-ray has shortcomings, such as exposure to radiation. Ultrasound has been reported as an alternative method of detecting hand fractures. In this study, we used meta-analysis to assess the diagnostic value of ultrasound for hand fractures. METHODS: Web of Science, PubMed, Embase, and Cochrane Library databases were searched for relative citations up to June 2019. The pooled sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), area under the summary receiver operating characteristic curve (AUC), and summary receiver operating characteristic (SROC) curve were estimated. RESULTS: Seven studies including 842 participants (845 examined hands) met our inclusion criteria. The pooled sensitivity, specificity, PLR, and NLR of ultrasound for detecting hand fractures were 91%, 96%, 20.66, and 0.09, respectively. The pooled DOR was 231.17, indicating a very powerful diagnostic ability of ultrasound. Meta-regression showed that there was no heterogeneity with respect to age, cut-off, the performer of the ultrasound, and the types of hand fractures. CONCLUSIONS: Our results showed that ultrasound had an excellent diagnostic value for hand fractures. In clinic, we proposed using ultrasound as a first-line and radiation-free modality in detecting hand fractures, including phalanx and metacarpal fractures.


Assuntos
Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/lesões , Fraturas Ósseas/diagnóstico por imagem , Ossos Metacarpais/diagnóstico por imagem , Ossos Metacarpais/lesões , Humanos , Ultrassonografia
9.
J S Afr Vet Assoc ; 90(0): e1-e7, 2019 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-31588759

RESUMO

A definitive diagnosis of extensive suture line exostoses affecting the nasofrontal, nasolacrimal, nasomaxillary, frontolacrimal, lacrimozygomatic and lacrimomaxillary suture lines in a 7-year-old Thoroughbred mare with chronic bilateral epiphora and facial deformation was achieved using standing computed tomography (CT) examinations. Positive contrast dacryocystorhinography using CT revealed partial bilateral obstruction of the nasolacrimal ducts. Minimally displaced depression fractures of the right nasal bone, the right maxillary bone and right frontal bone were also demonstrated. The cosmetic appearance of the periosteal reaction associated with the suture line exostosis and epiphora significantly improved within 3 months of diagnosis and treatment.


Assuntos
Exostose/veterinária , Fraturas Ósseas/veterinária , Traumatismos Cranianos Fechados/veterinária , Doenças dos Cavalos/etiologia , Cavalos/lesões , Obstrução dos Ductos Lacrimais/veterinária , Animais , Exostose/etiologia , Exostose/terapia , Feminino , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Traumatismos Cranianos Fechados/complicações , Doenças dos Cavalos/diagnóstico por imagem , Doenças dos Cavalos/terapia , Obstrução dos Ductos Lacrimais/complicações , Obstrução dos Ductos Lacrimais/diagnóstico por imagem , Ducto Nasolacrimal/lesões , África do Sul , Resultado do Tratamento
10.
Eur J Radiol ; 120: 108694, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31593844

RESUMO

PURPOSE: To evaluate the clinical, radiological and periprocedural features associated with the occurrence or worsening of acetabular fracture (OWAF) following percutaneous cementoplasty of the acetabulum (PCA) in cancer patients. METHOD: All patients who underwent PCA in our comprehensive cancer center for an acetabular metastasis between January 2008 and December 2015 were included. Clinical features, characteristics of the metastasis on computed tomography (CT-scan) (location [roof, quadrilateral surface, anterior and posterior columns], number of locations, matrix, extra/intra-articular fractures, extra-osseous or subchondral extensions) and of the procedure (extra- or intra-articular cement leakage (IACL), percentage of filling of each location, complications) were reported as well as prior, concomitant or post-PCA treatments. The endpoint was OWAF on CT-scan during post-PCA follow-up. Log-rank tests and Cox models were used to identify prognostic factors. RESULTS: 140 PCA were identified in 129 patients (11 bilateral procedures, median age: 66.6). Eighteen (18/140, 12.9%) had an initial articular fracture. IACL was seen in 12/140 (8.6%) PCA. The only feature associated with IACL was a pre-existing articular fracture (p = 0.009). Of the 111 patients with imaging follow-ups, 18 (16.2%) showed OWAF. In multivariate analysis, the presence of cement filling (even partial) of all acetabular metastatic locations was the only feature predictive of OWAF-free survival (hazard ratio = 3.8, p = 0.031). CONCLUSIONS: Injecting cement in all areas affected by acetabular metastases could prevent OWAF. Because survival following PCA is not negligible, completing an insufficient first PCA could help preserve patients' quality of life.


Assuntos
Acetábulo/lesões , Neoplasias Ósseas/complicações , Neoplasias Ósseas/terapia , Cementoplastia/efeitos adversos , Fraturas Ósseas/etiologia , Fraturas Ósseas/terapia , Acetábulo/diagnóstico por imagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Ósseas/diagnóstico por imagem , Cementoplastia/métodos , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Tomografia Computadorizada por Raios X , Resultado do Tratamento
11.
Med Sci Monit ; 25: 7591-7596, 2019 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-31596837

RESUMO

BACKGROUND The purpose of this study was to evaluate clinical efficacy of the medial-end clavicle fractures with a reversed lateral locking clavicle plate. MATERIAL AND METHODS Eleven male patients age 28 to 66 years old with medial-end clavicle fractures were included in the present study from October 2014 and October 2017. All the patients received operation of fixed with reversed lateral locking clavicle plates. In the operation, a curved incision approximately 8 to 10 cm in length was made, and after the reduction, the fracture was fixed by a reversed lateral locking clavicle plate. Postoperative follow-up was performed in order to evaluate the efficacy of the treatment. Disabilities of the Arm, Shoulder and Hand (DASH) score was used in evaluation the shoulder function post-operation. The functional assessment was performed by using the DASH score. RESULTS No intraoperative complications were found during the operation. All patients' incisions achieved healing after operations. Eleven cases were scored by DASH scoring after the operation; Of these, 9 patients were rated excellent, and 2 patients were rated good. There were no neurovascular injuries, nor were there any hemopneumothorax or internal fixation failures. CONCLUSIONS The fixation of with reversed lateral locking clavicle plates is effective safe patients with medial-end clavicle fractures.


Assuntos
Placas Ósseas , Clavícula/cirurgia , Fixação Interna de Fraturas , Fraturas Ósseas/cirurgia , Adulto , Idoso , Clavícula/diagnóstico por imagem , Seguimentos , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade
12.
Acta Cir Bras ; 34(7): e201900702, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31531537

RESUMO

PURPOSE: To investigate the effect of intermittent vibration at different intervals on bone fracture healing and optimize the vibration interval. METHODS: Ninety sheep were randomized to receive no treatment (the control group), incision only (the sham control group), internal fixation with or without metatarsal fracture (the internal fixation group), and continuous vibration in addition to internal fixation of metatarsal fracture, or intermittent vibration at 1, 2, 3, 5, 7 and 17-day interval in addition to internal fixation of metatarsal fracture (the vibration group). Vibration was done at frequency F=35 Hz, acceleration a=0.25g, 15 min each time 2 weeks after bone fracture. Bone healing was evaluated by micro-CT scan, bone microstructure and mechanical compression of finite element simulation. RESULTS: Intermittent vibration at 7-day interval significantly improved bone fracture healing grade. However, no significant changes on microstructure parameters and mechanical properties were observed among sheep receiving vibration at different intervals. CONCLUSIONS: Clinical healing effects should be the top concern. Quantitative analyses of bone microstructure and of finite element mechanics on the process of fracture healing need to be further investigated.


Assuntos
Consolidação da Fratura/fisiologia , Fraturas Ósseas/diagnóstico por imagem , Ossos do Metatarso/lesões , Vibração/uso terapêutico , Animais , Análise de Elementos Finitos , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/normas , Fraturas Ósseas/cirurgia , Fraturas Ósseas/terapia , Ossos do Metatarso/diagnóstico por imagem , Ossos do Metatarso/cirurgia , Distribuição Aleatória , Ovinos , Microtomografia por Raio-X
13.
Acta Chir Orthop Traumatol Cech ; 86(4): 299-303, 2019.
Artigo em Tcheco | MEDLINE | ID: mdl-31524594

RESUMO

Superior Shoulder Suspensory Complex (SSSC) is a bone and soft-tissue ring securing the connection of the upper extremity to the axial skeleton via the clavicle and sternoclavicular joint. An isolated injury to one component of SSSC is usually stable. An injury to 2 of its components is a potential source of shoulder girdle instability and requires surgical stabilisation. An injury affecting 3 and more components is extremely rare and surgical stabilisation should be indicated. Our study presents the case of a 50-year-old man who fell off the bicycle and sustained a direct blow to his left shoulder resulting in an ipsilateral fracture of the coracoid and acromion process combined with the fracture of the distal end of the clavicle. Following a standard clinical examination and a subsequent X-ray and a CT scan with three-dimensional shoulder reconstruction, an open reduction and stabilisation of all the injured SSSC components was performed. Later, early and gradual rehabilitation of the shoulder girdle was commenced. At 48 weeks after the surgery, almost full range of motion of the shoulder joint was achieved and the muscle strength of the operated upper extremity was comparable to that of the healthy one. Key words:Superior Shoulder Suspensory Complex, fracture, acromion, coracoid process, clavicle.


Assuntos
Clavícula/lesões , Fraturas Ósseas/cirurgia , Escápula/lesões , Lesões do Ombro/cirurgia , Acrômio/diagnóstico por imagem , Acrômio/lesões , Clavícula/diagnóstico por imagem , Processo Coracoide/diagnóstico por imagem , Processo Coracoide/lesões , Fixação Interna de Fraturas , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/reabilitação , Humanos , Masculino , Pessoa de Meia-Idade , Escápula/diagnóstico por imagem , Lesões do Ombro/diagnóstico por imagem , Lesões do Ombro/reabilitação
14.
Medicina (Kaunas) ; 55(10)2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31547588

RESUMO

Background and objectives: The aim of the study was to compare the accuracy of X-ray (XR) imaging according to computed tomography (CT) scanning in the diagnosis of knee bone fractures, and in the determination of fracture characteristics, and to identify CT scan indications in patients with knee trauma. Materials and methods: The patients who presented to the emergency department (ED) due to knee trauma between January 2017 and December 2018 and who underwent XR imaging and CT scans were included in the study. XR images were reinterpreted by an emergency physician. The official reports, which had been interpreted by a radiologist in the hospital automation system for CT images, were considered valid. Results: Five hundred and forty-eight patients were included in the study. Of the patients, 200 (36.5%) had fractures in XR imaging and 208 (38.0%) had fractures in CT scans. Compared to CT scanning, XR imaging was found to have 89% sensitivity, 95% specificity, 92% positive predictive value, and 92% negative predictive value in identifying the fracture. The sensitivity of XR imaging in identifying growth plate fracture, angulation, stepping off, and extension of the fracture into the joint space was determined as 78% and less. According to the kappa value, there was determined a perfect concordance between the XR imaging and CT scans in angulation, stepping off, and extension of the fracture into the joint space. This concordance was moderate in growth plate fractures. Conclusions: XR imaging has a low sensitivity in identifying knee fractures. There is a moderate concordance between XR imaging and CT scanning in identifying growth plate fractures. Therefore, CT scanning should be performed in patients whose fracture type and fracture characteristics are not able to be determined exactly with XR imaging in knee injury.


Assuntos
Fraturas Ósseas/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Radiografia , Tomografia Computadorizada por Raios X , Adulto , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Curva ROC , Estudos Retrospectivos , Sensibilidade e Especificidade
16.
J Orthop Surg Res ; 14(1): 310, 2019 Sep 12.
Artigo em Inglês | MEDLINE | ID: mdl-31514742

RESUMO

BACKGROUND: Quadrilateral plate fractures are a challenging group of acetabular fractures to manage. However, there is little literature that describes the fracture lines of the quadrilateral plate. The aim of this study was to explore the fracture lines of the quadrilateral plate and relevant clinical significance. METHODS: CT data from a series of acetabular fractures were retrospectively analyzed. According to the X-ray, CT, and operative records of the patients, Judet-Letournel classification was carried out for acetabular fractures involving quadrilateral plate. Then, the fracture maps of different types of acetabular fractures in the quadrilateral plate were drawn. To facilitate the characterization of fracture maps, we defined six basic fracture lines. RESULTS: The fracture lines of the three types of acetabular fractures (double-column fracture, T-type fracture, and anterior column with posterior hemitransverse fracture) mainly included upper transverse lines and upper oblique lines. Although the fracture lines of posterior wall fracture and anterior column fracture were mainly upper transverse lines, the fracture lines of the former were in a low position. The fracture lines of transverse fracture and transverse with posterior wall fracture were similar, both of which were mainly upper oblique lines. The fracture lines of posterior column fractures mainly included posterior vertical lines. CONCLUSIONS: The fracture lines of different types of acetabular fractures have certain regularity respectively. Observation of the fracture lines of the quadrilateral plate based on fracture mapping can help orthopedic surgeons to enhance the understanding of the Judet-Letournel classification, which may have some significant guidance on the choice of operation approach and the design of internal fixation devices.


Assuntos
Acetábulo/lesões , Fraturas Ósseas/patologia , Acetábulo/patologia , Acetábulo/cirurgia , Adolescente , Adulto , Idoso , Feminino , Fixação de Fratura/métodos , Fraturas Ósseas/classificação , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Radiografia , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
17.
J Orthop Surg Res ; 14(1): 249, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31387615

RESUMO

OBJECTIVE: This study aimed to investigate the effectiveness of a three-dimensional strapping reduction in the treatment of patellar fractures. METHODS: Between January 2015 and June 2017, a total of 56 patients were randomly allocated to the three-dimensional strapping reduction group (trial group) and towel clamp reduction group (control group). There were no significant differences in age, gender, injury side, the interval time from injury to surgery, fracture pattern, and cause of injury (P > 0.05). The operation time, fluoroscopy time, bone union time, postoperative Hospital for Special Surgery (HSS) scores, and complications were recorded and analyzed. RESULTS: All incisions achieved primary union. All patients in both groups completed a follow-up with an average of 12.5 months (range 11-15 months). Both operation time and fluoroscopy time in the trial group were significantly shorter than those in the control group (P < 0.001). All patellar fractures achieved bone union, and there was no significant difference in bone union time between the two groups (P > 0.05). Bone nonunion, infection, and fixation failure were not found in both groups. HSS scores of the trial group (90.9 ± 4.2) were higher than those of the control group (86.6 ± 5.2) (P < 0.01). CONCLUSION: Compared with towel clamp reduction, the three-dimensional strapping reduction in the treatment of patellar fractures has advantages of shorter operation time and fluoroscopy time, better knee function after surgery, and satisfactory fracture healing.


Assuntos
Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Patela/diagnóstico por imagem , Patela/cirurgia , Técnicas de Sutura , Adulto , Idoso , Feminino , Seguimentos , Humanos , Traumatismos do Joelho/diagnóstico por imagem , Traumatismos do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Patela/lesões , Resultado do Tratamento , Adulto Jovem
18.
J Med Ultrason (2001) ; 46(4): 377-388, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31377938

RESUMO

PURPOSE: Low-intensity pulsed ultrasound (LIPUS) is effective in promoting bone healing, and a myostatin deficiency also has a positive effect on bone formation. In this study, we evaluated the effects of LIPUS on bone healing in rats in vivo and investigated the mechanisms in vitro, aiming to explore whether LIPUS promotes bone healing through inhibition of the myostatin signaling pathway. METHODS: Rats with both drill-hole defects and MC3T3-E1 cells were randomly assigned to a LIPUS group and a control group. The LIPUS group received LIPUS treatment (1.5 MHz, 30 mW/cm2) for 20 min/day. RESULTS: After 21 days, the myostatin expression in quadriceps was significantly inhibited in the LIPUS group, and remodeling of the newly formed bone in the drill-hole site was significantly better in the LIPUS group than that in the control group, which was confirmed by micro-CT analysis. After 3 days, LIPUS significantly promoted osteoblast proliferation; inhibited the expression of AcvrIIB (the myostatin receptor), Smad3, p-Smad3, and GSK-3ß; and increased Wnt1 and ß-catenin expression. Moreover, translocation of ß-catenin from the cytolemma to the nucleus was observed in the LIPUS group. However, these effects were blocked by treatment with myostatin recombinant protein. CONCLUSIONS: The results indicate that LIPUS may promote bone healing through inhibition of the myostatin signal pathway.


Assuntos
Consolidação da Fratura/fisiologia , Fraturas Ósseas/terapia , Miostatina/metabolismo , Transdução de Sinais/fisiologia , Terapia por Ultrassom/métodos , Animais , Western Blotting , Técnicas de Cultura de Células , Modelos Animais de Doenças , Feminino , Fraturas Ósseas/diagnóstico por imagem , Reação em Cadeia da Polimerase , Ratos , Ratos Sprague-Dawley , Tomografia Computadorizada por Raios X , Ondas Ultrassônicas
19.
Elife ; 82019 08 16.
Artigo em Inglês | MEDLINE | ID: mdl-31418688

RESUMO

Modern humans have more fragile skeletons than other hominins, which may result from physical inactivity. Here, we test whether reproductive effort also compromises bone strength, by measuring using computed tomography thoracic vertebral bone mineral density (BMD) and fracture prevalence among physically active Tsimane forager-horticulturalists. Earlier onset of reproduction and shorter interbirth intervals are associated with reduced BMD for women. Tsimane BMD is lower versus Americans, but only for women, contrary to simple predictions relying on inactivity to explain skeletal fragility. Minimal BMD differences exist between Tsimane and American men, suggesting that systemic factors other than fertility (e.g. diet) do not easily explain Tsimane women's lower BMD. Tsimane fracture prevalence is also higher versus Americans. Lower BMD increases Tsimane fracture risk, but only for women, suggesting a role of weak bone in women's fracture etiology. Our results highlight the role of sex-specific mechanisms underlying skeletal fragility that operate long before menopause.


Assuntos
Densidade Óssea , Grupos Étnicos , Comportamento Alimentar , Fraturas Ósseas/epidemiologia , Comportamento Reprodutivo , Adulto , Idoso , Idoso de 80 Anos ou mais , Bolívia , Feminino , Fraturas Ósseas/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores Sexuais , Tomografia Computadorizada por Raios X , Estados Unidos
20.
Iowa Orthop J ; 39(1): 167-172, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413690

RESUMO

Yablon originally described that late posttraumatic degenerative ankle arthritis was due to ongoing tibio-talar joint incongruity, and more importantly that anatomic reduction of the lateral malleolus was key to anatomic reduction of the ankle joint, as the talus "faithfully followed that of the lateral malleolus." Ankle fractures involving the lateral malleolus, left unreduced, can lead to malunion and posttraumatic degenerative arthritis. Treatment of this often includes a fibular osteotomy to restore length and rotation. We revisit Yablon's original principles and present a review of the literature pertaining to techniques and outcomes of lateral malleolus malunions treated with distal fibular osteotomies as well as a case report highlighting the challenges and considerations when facing this problem.


Assuntos
Fraturas do Tornozelo/cirurgia , Artroscopia/métodos , Fíbula/lesões , Fixação Interna de Fraturas/efeitos adversos , Fraturas Mal-Unidas/cirurgia , Osteotomia/métodos , Fraturas do Tornozelo/diagnóstico por imagem , Feminino , Fíbula/cirurgia , Fluoroscopia/métodos , Seguimentos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/diagnóstico por imagem , Fraturas Ósseas/cirurgia , Fraturas Mal-Unidas/diagnóstico por imagem , Humanos , Escala de Gravidade do Ferimento , Pessoa de Meia-Idade , Reoperação/métodos , Resultado do Tratamento
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