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1.
J Bodyw Mov Ther ; 38: 506-513, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38763600

RESUMO

INTRODUCTION: The Balance Error Scoring System (BESS) assesses the ability to control postural stability by performing 3 different stances on two-type surfaces during closed eyes. Virtual reality technology combined with the BESS test (VR-BESS) may be used to disrupt visual inputs instead of closing the eyes, which may improve the sensitivity of diagnosing patients with chronic ankle instability (CAI). OBJECTIVE: This study aimed to evaluate the accuracy to identify individuals with CAI of the VR-BESS test comparing with the original BESS test. METHODS: The BESS and VR-BESS tests were administered to 68 young adults (34 participants with CAI and 34 without CAI). Frontal and lateral video views were used to measure the participant's performance errors. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was computed to determine the diagnostic test's overall accuracy. RESULTS: The total score of the BESS test and the VR-BESS test were statistically significant in comparison to the AUC of no discrimination at 0.5, with AUC values of 0.63 and 0.64, respectively. The cut-off scores for the BESS and VR-BESS tests were 12 and 15, respectively. There was no significant difference between the ROC curves of the BESS and the VR-BESS test for identifying individuals with CAI. CONCLUSION: The BESS and VR-BESS tests may be utilized interchangeably to identify individuals with CAI.


Assuntos
Articulação do Tornozelo , Instabilidade Articular , Equilíbrio Postural , Realidade Virtual , Humanos , Instabilidade Articular/diagnóstico , Instabilidade Articular/fisiopatologia , Equilíbrio Postural/fisiologia , Estudos Transversais , Masculino , Feminino , Adulto Jovem , Articulação do Tornozelo/fisiopatologia , Adulto , Curva ROC , Doença Crônica
2.
BMC Musculoskelet Disord ; 25(1): 347, 2024 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-38693507

RESUMO

BACKGROUND: Benign Joint Hypermobility Syndrome (BJHS) is a most common hereditary connective tissue disorders in children and adolescents. This study aimed to investigate the prevalence and subtypes of headache in children with BJHS. METHODS: This observational-analytical study was conducted in a case-control setting on school children aged 7 to 16 years in 2021-2023 in Isfahan, Iran. Students were examined for BJHS using Beighton criteria by a pediatric rheumatologist. Headache disorder was diagnosed according to the Child Headache-Attributed Restriction, Disability, and Social Handicap and Impaired Participation (HARDSHIP) questionnaires for child and adolescent and International Classification of Headache Disorders (ICHD-III). RESULTS: A total of 4,832 student (mean age 10.3 ± 3.1 years), 798 patients with BJHS and 912 healthy children were evaluated. The probability of headache in children aged 7-11 with hypermobility was 3.7 times lower than in children aged 12-16 with hypermobility (P = 0.001). The occurrence of headache in children with BJHS was more than the control group (P = 0.001), and the probability of headache in children with BJHS was 3.7 times higher than in healthy children (P = 0.001). Migraine was the most common headache type reported of total cases. The probability of migraine in children with BJHS was 4.5 times higher than healthy children ( P = 0.001). CONCLUSION: This study showed a significant correlation between BJHS and headache (especially migraine) in children and adolescents.


Assuntos
Cefaleia , Instabilidade Articular , Instabilidade Articular/congênito , Humanos , Adolescente , Criança , Masculino , Feminino , Estudos de Casos e Controles , Irã (Geográfico)/epidemiologia , Instabilidade Articular/epidemiologia , Instabilidade Articular/diagnóstico , Instabilidade Articular/complicações , Prevalência , Cefaleia/epidemiologia , Cefaleia/diagnóstico , Síndrome de Ehlers-Danlos/epidemiologia , Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/complicações
3.
Injury ; 55(6): 111583, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38692209

RESUMO

INTRODUCTION: Bone grafts for scaphoid nonunion with deformity include cortcicocancellous or pure cancellous bone grafts. This study compared the outcomes between two types of bone grafts when employing a volar locking-plate in patients with scaphoid nonunion with dorsal intercalated segmental instability (DISI). PATIENTS AND METHODS: This retrospective study included 34 patients with scaphoid nonunion and DISI due to humpback deformity treated between March 2017 and January 2022. Two types of bone grafts were obtained from iliac crest. Twenty of the corticocancellous (CC) group underwent a wedge-shaped graft, while 14 patients of the pure cancellous (C-only) group received graft chips. In both groups, a 1.5-mm anatomically pre-contoured locking plate was used for fixation. Radiographic evaluations included the union rate and carpal alignment including scapholunate angle (SLA), radiolunate angle (RLA), intrascaphoid angle (ISA) and scaphoid height to length ratio (HLR). Clinical assessments encompassed wrist range-of-motion, grip strength, and patient-reported outcomes. RESULTS: Nineteen of the 20 patients in the CC group and 12 of the 14 patients in the C-only group respectively, achieving osseous union. The mean follow-up period in CC group was 14.7 (range, 12 ∼ 24) months and that in C-only group was 12.6 (range, 12 ∼ 15) months. Postoperatively, there were no significant intergroup differences of radiographic parameters including SLA (CC; 49.9° ± 6.7° vs. C-only; 48.9° ± 3.5°, P = 0.676), RLA (1.7° ± 6.4° vs. 2.4° ± 3.3°, P = 0.74), ISA (36° ± 7.5° vs. 36.6° ± 12.2°, P = 0.881), and HLR (0.54 ± 0.09 vs. 0.53 ± 0.05, P = 0.587). Clinical outcomes, including the flexion-extension arc (137° ± 30° vs. 158° ± 33°, P = 0.122), grip strength (93.4 % ± 15.4% vs. 99.5 % ± 16.7 %, P = 0.39), Quick Disabilities of the Arm, Shoulder, and Hand scores (11.2 ± 8.3 vs. 12.5 ± 7.7, P = 0.74) and Mayo Wrist Scores (81.2 ± 13.1 vs. 89 ± 11.4, P = 0.242) also showed no significant intergroup differences. CONCLUSIONS: Volar locking-plate fixation with pure cancellous bone grafts achieved outcomes comparable to those achieved with corticocancellous bone grafts in scaphoid nonunion with deformity, possibly due to the biomechanical advantages of the volar plate to provide structural supports.


Assuntos
Placas Ósseas , Transplante Ósseo , Osso Esponjoso , Fixação Interna de Fraturas , Fraturas não Consolidadas , Instabilidade Articular , Amplitude de Movimento Articular , Osso Escafoide , Humanos , Osso Escafoide/cirurgia , Osso Escafoide/lesões , Osso Escafoide/diagnóstico por imagem , Masculino , Feminino , Fraturas não Consolidadas/cirurgia , Fraturas não Consolidadas/fisiopatologia , Estudos Retrospectivos , Adulto , Transplante Ósseo/métodos , Osso Esponjoso/transplante , Fixação Interna de Fraturas/métodos , Instabilidade Articular/cirurgia , Instabilidade Articular/fisiopatologia , Resultado do Tratamento , Adulto Jovem , Articulação do Punho/cirurgia , Articulação do Punho/fisiopatologia , Articulação do Punho/diagnóstico por imagem , Força da Mão , Ílio/transplante , Radiografia , Consolidação da Fratura/fisiologia , Adolescente , Pessoa de Meia-Idade
4.
Sci Rep ; 14(1): 11318, 2024 05 17.
Artigo em Inglês | MEDLINE | ID: mdl-38760396

RESUMO

The effect of arterial tortuosity on intracranial atherosclerosis (ICAS) is not well understood. This study aimed to evaluate the effect of global intracranial arterial tortuosity on intracranial atherosclerotic burden in patients with ischemic stroke. We included patients with acute ischemic stroke who underwent magnetic resonance angiography (MRA) and classified them into three groups according to the ICAS burden. Global tortuosity index (GTI) was defined as the standardized mean curvature of the entire intracranial arteries, measured by in-house vessel analysis software. Of the 516 patients included, 274 patients had no ICAS, 140 patients had a low ICAS burden, and 102 patients had a high ICAS burden. GTI increased with higher ICAS burden. After adjustment for age, sex, vascular risk factors, and standardized mean arterial area, GTI was independently associated with ICAS burden (adjusted odds ratio [adjusted OR] 1.33; 95% confidence interval [CI] 1.09-1.62). The degree of association increased when the arterial tortuosity was analyzed limited to the basal arteries (adjusted OR 1.48; 95% CI 1.22-1.81). We demonstrated that GTI is associated with ICAS burden in patients with ischemic stroke, suggesting a role for global arterial tortuosity in ICAS.


Assuntos
Arteriosclerose Intracraniana , Angiografia por Ressonância Magnética , Humanos , Feminino , Masculino , Arteriosclerose Intracraniana/diagnóstico por imagem , Arteriosclerose Intracraniana/patologia , Arteriosclerose Intracraniana/complicações , Idoso , Pessoa de Meia-Idade , AVC Isquêmico/diagnóstico por imagem , AVC Isquêmico/patologia , Fatores de Risco , Artérias Cerebrais/diagnóstico por imagem , Artérias Cerebrais/patologia , Artérias/anormalidades , Instabilidade Articular , Dermatopatias Genéticas , Malformações Vasculares
5.
Clin Podiatr Med Surg ; 41(3): 491-502, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38789166

RESUMO

Syndesmotic ankle injuries, though rare in isolation, are complex destabilizing injuries often accompanied by fractures. Misdiagnoses, particularly overlooking posterior malleolus fractures, are common in ankle sprains. Thorough physical examinations, emphasizing high fibular pain and anterior tibia palpation, aid in accurate diagnosis. Grading helps assess injury severity and guiding treatment. Initial imaging involves three ankle views, with stress radiographs enhancing accuracy. If conservative care fails, MRI reveals ligament and tendon damage. Physical therapy may suffice for functional instability; surgical intervention addresses mechanical instability. Syndesmotic fixation debates center on cortices, screw size, reduction methods, and optimal positioning.


Assuntos
Traumatismos do Tornozelo , Humanos , Traumatismos do Tornozelo/cirurgia , Traumatismos do Tornozelo/diagnóstico , Fixação Interna de Fraturas/métodos , Imageamento por Ressonância Magnética , Masculino , Fraturas do Tornozelo/cirurgia , Fraturas do Tornozelo/diagnóstico por imagem , Feminino , Instabilidade Articular/cirurgia , Instabilidade Articular/etiologia , Instabilidade Articular/diagnóstico
6.
PLoS One ; 19(5): e0302401, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38748660

RESUMO

OBJECTIVE: To co-create expert guidelines for the management of pregnancy, birth, and postpartum recovery in the context of hypermobile Ehlers-Danlos syndrome (hEDS) and hypermobility spectrum disorders (HSD). DESIGN: Scoping Review and Expert Co-creation. SETTING: United Kingdom, United States of America, Canada, France, Sweden, Luxembourg, Germany, Italy, and the Netherlands. SAMPLE: Co-creators (n = 15) included expertise from patients and clinicians from the International Consortium on the Ehlers-Danlos syndromes and Hypermobility Spectrum Disorders, facilitated by the Ehlers-Danlos Society. METHODS: A scoping review using Embase, Medline, the Cochrane Central Register of Controlled Trials and CINHAL was conducted from May 2022 to September 2023. Articles were included if they reported primary research findings in relation to childbearing with hEDS/HSD, including case reports. No language limitations were placed on our search, and our team had the ability to translate and screen articles retrieved in English, French, Spanish, Italian, Russian, Swedish, Norwegian, Dutch, Danish, German, and Portuguese. The Mixed Methods Appraisal Tool was used to assess bias and quality appraise articles selected. The co-creation of guidelines was based on descriptive evidence synthesis along with practical and clinical experience supported by patient and public involvement activities. RESULTS: Primary research studies (n = 14) and case studies (n = 21) including a total of 1,260,317 participants informed the co-creation of guidelines in four overarching categories: 1) Preconceptual: conception and screening, 2) Antenatal: risk assessment, management of miscarriage and termination of pregnancy, gastrointestinal issues and mobility, 3) Intrapartum: risk assessment, birth choices (mode of birth and intended place of birth), mobility in labor and anesthesia, and 4) Postpartum: wound healing, pelvic health, care of the newborn and infant feeding. Guidelines were also included in relation to pain management, mental health, nutrition and the common co-morbidities of postural orthostatic tachycardia syndrome, other forms of dysautonomia, and mast cell diseases. CONCLUSIONS: There is limited high quality evidence available. Individualized strategies are proposed for the management of childbearing people with hEDS/HSD throughout pregnancy, birth, and the postpartum period. A multidisciplinary approach is advised to address frequently seen issues in this population such as tissue fragility, joint hypermobility, and pain, as well as common comorbidities, including dysautonomia and mast cell diseases.


Assuntos
Síndrome de Ehlers-Danlos , Humanos , Síndrome de Ehlers-Danlos/terapia , Gravidez , Feminino , Instabilidade Articular , Guias de Prática Clínica como Assunto , Complicações na Gravidez , Medicina Baseada em Evidências
7.
Ned Tijdschr Tandheelkd ; 131(5): 191-200, 2024 May.
Artigo em Holandês | MEDLINE | ID: mdl-38715531

RESUMO

An internal derangement of the temporomandibular joint is described as a deviation in the position or shape of the joint tissues. Such a change is only functionally manifest if it interferes with smooth movements of the jaw joint. There are a number of internal derangements associated with jaw movements in which popping jaw joint sounds can occur. Examples are an anteriorly or posteriorly displaced disc and hypermobility of the condylar head. Although most internal derangements are harmless and only cause minor discomfort to patients, disc displacements can in some cases develop into a clinical problem, for example when there is a limitation of mouth opening (so-called closed lock) or an inability to close the mouth (so-called open lock). Most patients with these conditions do not require any or only conservative treatment.


Assuntos
Transtornos da Articulação Temporomandibular , Humanos , Articulação Temporomandibular/fisiologia , Articulação Temporomandibular/fisiopatologia , Amplitude de Movimento Articular/fisiologia , Instabilidade Articular/diagnóstico , Luxações Articulares/etiologia , Luxações Articulares/terapia , Luxações Articulares/diagnóstico
8.
Acta Chir Orthop Traumatol Cech ; 91(2): 96-102, 2024.
Artigo em Tcheco | MEDLINE | ID: mdl-38801665

RESUMO

PURPOSE OF THE STUDY: This manuscript aims to identify an indication algorithm for the surgical treatment of radial head fractures associated with elbow dislocation. The study compares the mid-term functional outcomes of patients with multifragment radial head fracture treated by resection with the outcomes of patients treated with radial head replacement. MATERIAL AND METHODS: The cohort of 34 patients who sustained a radial head fracture at the mean age of 42.5 years (age range 20-81 years) was broken down into two groups by type of surgery. The EXT group consists of 20 patients with the radial head fracture treated by radial head resection. The END group includes 14 patients treated with the radial head replacement. In all patients, the radial head fracture was associated with elbow dislocation (type IV fracture according to the Mason-Johnston classification). The modified Kocher's surgical approach was used in all patients of both the groups. In the EXT group, resection of the fragmented radial head was performed. In the END group, the ExploR® Modular Radial Head System (Zimmer, Biomet, USA) was used, consisting of a CoCr (cobalt chromium) alloy head and a titanium stem. The pain and the range of motion of the elbow and forearm were evaluated after the completion of the outpatient rehabilitation (the mean follow-up period was 2.4 years). Simultaneously, the elbow joint stability was assessed. Radiographs were taken to detect heterotopic ossifications, proximalization of the radius, and any signs of prosthesis loosening. The frequency of reoperations was followed-up. The MEPS (Mayo Elbow Performance Score) was calculated. RESULTS: In the EXT group, the mean elbow flexion was 117.5° and the mean pronation/supination was 166.9°. In 50% of patients, the MEPS obtained was greater than 90 points, which means an excellent functional outcome. In 1 patient (5%), recurrent elbow dislocation occurred which was the reason for revision surgery (elbow transfixation with the Kirschner wires and medial collateral ligament suture). Revision surgery was also performed in 2 patients (10%) in whom not all the radial head fragments were removed. Moreover, also observed was elbow joint instability (2 patients) and temporary radial nerve paralysis (1 patient). In 1 case discrete proximalization of the radius developed. The patients in the END group showed the mean elbow flexion of 112° and the mean pronation/supination of 135°. The MEPS obtained from 69% of patients was greater than 90 points, which means an excellent outcome. The pain under load was reported by 3 patients (21%). In 5 patients (35%), the X-rays showed radiolucent zone around the stem of the prosthesis. Neither revision surgery, nor prosthesis removal has been performed yet in any patient. No instability, neurological complications or infections have been reported. In both EXT and END group heterotopic ossifications have developed in 4 patients. CONCLUSIONS: Radial head replacement compared to the radial head resection in the management of multifragment fractures associated with elbow dislocations increase the elbow and forearm stability. The group of patients with an implanted radial head prosthesis shows a higher percentage of patients achieving excellent functional outcome than the group of patients with radial head resection. KEY WORDS: radial head, elbow, fracture, dislocation, resection, prosthesis.


Assuntos
Articulação do Cotovelo , Fraturas Cominutivas , Luxações Articulares , Instabilidade Articular , Fraturas do Rádio , Humanos , Fraturas do Rádio/cirurgia , Adulto , Luxações Articulares/cirurgia , Articulação do Cotovelo/cirurgia , Articulação do Cotovelo/fisiopatologia , Pessoa de Meia-Idade , Masculino , Fraturas Cominutivas/cirurgia , Idoso , Feminino , Instabilidade Articular/cirurgia , Instabilidade Articular/etiologia , Lesões no Cotovelo , Idoso de 80 Anos ou mais , Amplitude de Movimento Articular , Resultado do Tratamento , Adulto Jovem , Fraturas da Cabeça e do Colo do Rádio
9.
Sci Rep ; 14(1): 11390, 2024 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-38762569

RESUMO

This study performed three-dimensional (3D) magnetic resonance imaging (MRI)-based statistical shape analysis (SSA) by comparing patellofemoral instability (PFI) and normal femur models, and developed a machine learning (ML)-based prediction model. Twenty (19 patients) and 31 MRI scans (30 patients) of femurs with PFI and normal femurs, respectively, were used. Bone and cartilage segmentation of the distal femurs was performed and subsequently converted into 3D reconstructed models. The pointwise distance map showed anterior elevation of the trochlea, particularly at the central floor of the proximal trochlea, in the PFI models compared with the normal models. Principal component analysis examined shape variations in the PFI group, and several principal components exhibited shape variations in the trochlear floor and intercondylar width. Multivariate analysis showed that these shape components were significantly correlated with the PFI/non-PFI distinction after adjusting for age and sex. Our ML-based prediction model for PFI achieved a strong predictive performance with an accuracy of 0.909 ± 0.015, and an area under the curve of 0.939 ± 0.009 when using a support vector machine with a linear kernel. This study demonstrated that 3D MRI-based SSA can realistically visualize statistical results on surface models and may facilitate the understanding of complex shape features.


Assuntos
Imageamento Tridimensional , Instabilidade Articular , Aprendizado de Máquina , Imageamento por Ressonância Magnética , Articulação Patelofemoral , Humanos , Imageamento por Ressonância Magnética/métodos , Feminino , Masculino , Imageamento Tridimensional/métodos , Instabilidade Articular/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/patologia , Adulto , Adulto Jovem , Fêmur/diagnóstico por imagem , Fêmur/patologia , Adolescente
10.
Semin Musculoskelet Radiol ; 28(3): 257-266, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38768591

RESUMO

Patellofemoral instability results from impaired engagement of the patella in the trochlear groove at the start of flexion and may lead to pain and lateral patellar dislocation. It occurs most frequently in adolescents and young adults during sporting activities. Trochlear dysplasia, patella alta, and excessive lateralization of the tibial tuberosity are the most common risk factors for patellar instability. The main role of imaging is to depict and assess these anatomical factors and highlight features indicating previous lateral dislocation of the patella.


Assuntos
Instabilidade Articular , Articulação Patelofemoral , Humanos , Instabilidade Articular/diagnóstico por imagem , Articulação Patelofemoral/diagnóstico por imagem , Patela/diagnóstico por imagem , Patela/anormalidades , Luxação Patelar/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Fatores de Risco
11.
Semin Musculoskelet Radiol ; 28(3): 305-317, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38768595

RESUMO

The posterolateral corner (PLC) of the knee is a complex anatomical-functional unit that includes ligamentous and tendinous structures that are crucial for joint stability. This review discusses the intricate anatomy, biomechanics, and imaging modalities, as well as the current challenges in diagnosing PLC injuries, with an emphasis on magnetic resonance imaging (MRI). Recognizing the normal MRI anatomy is critical in identifying abnormalities and guiding effective treatment strategies. Identification of the smaller structures of the PLC, traditionally difficult to depict on imaging, may not be necessary to diagnose a clinically significant PLC injury. Injuries to the PLC, often associated with cruciate ligament tears, should be promptly identified because failure to recognize them may result in persistent instability, secondary osteoarthritis, and cruciate graft failure.


Assuntos
Traumatismos do Joelho , Articulação do Joelho , Imageamento por Ressonância Magnética , Humanos , Articulação do Joelho/diagnóstico por imagem , Traumatismos do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética/métodos , Fenômenos Biomecânicos , Ligamentos Articulares/diagnóstico por imagem , Ligamentos Articulares/lesões , Instabilidade Articular/diagnóstico por imagem
12.
J Orthop Surg (Hong Kong) ; 32(2): 10225536241257169, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38769768

RESUMO

Background: The purpose of this study was to investigate the effect of 3D-printed technology to repair glenoid bone defect on shoulder joint stability. Methods: The shoulder joints of 25 male cadavers were tested. The 3D-printed glenoid pad was designed and fabricated. The specimens were divided into 5 groups. Group A: no bone defect and the structure of the glenoid labrum and joint capsule was intact; Group B: Anterior inferior bone defect of the shoulder glenoid; Group C: a pad with a width of 2 mm was installed; Group D: a pad with a width of 4 mm was installed; Group E: a pad with a width of 6 mm was installed. This study measured the distance the humeral head moved forward at the time of glenohumeral dislocation and the maximum load required to dislocate the shoulder. Results: The shoulder joint stability and humerus displacement was significantly lower in groups B and C compared with group A (p < .05). Compared with group A, the stability of the shoulder joint of group D was significantly improved (p < .05). However, there was no significant difference in humerus displacement between groups D and A (p > .05). In addition, compared with group A, shoulder joint stability was significantly increased and humerus displacement was significantly decreased in group E (p < .05). Conclusion: The 3D-printed technology can be used to make the shoulder glenoid pad to perfectly restore the geometric shape of the shoulder glenoid articular surface. Moreover, the 3D-printed pad is 2 mm larger than the normal glenoid width to restore the initial stability of the shoulder joint.


Assuntos
Ligas , Cadáver , Impressão Tridimensional , Articulação do Ombro , Titânio , Humanos , Masculino , Articulação do Ombro/cirurgia , Articulação do Ombro/fisiopatologia , Fenômenos Biomecânicos , Instabilidade Articular/cirurgia , Instabilidade Articular/fisiopatologia , Cavidade Glenoide/cirurgia , Desenho de Prótese
13.
J Orthop Surg (Hong Kong) ; 32(2): 10225536241257760, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38773724

RESUMO

Purpose: There are various surgical interventions available for the management of Chronic lateral ankle instability (CLAI). The Broström-Gould procedure has gained widespread recognition among foot and ankle specialists for its favorable surgical outcomes. However, with advancements in anatomical understanding and medical technology, further enhancements to the effectiveness of the Gould procedure are warranted. This study introduces a all-inside modified "outside-in" Broström -Gould procedure as an alternative approach for addressing lateral ankle instability. Methods: From August 2020 to October 2022, 40 patients with lateral ankle instability who underwent arthroscopic repair of the modified "outside-in" Broström-Gould procedure were retrospectively analyzed. All patients received standard non-surgical treatment before surgery for more than 6 months without symptom relief. Visual Analogue Scale (VAS) and American Orthopaedic Foot and Ankle Society (AOFAS) and Karlsson-Peterson score were used to evaluate the postoperative effect. Results: All patients were followed up for (14.62 ± 2.04) months. One year after operation, all patients could walk normally, ankle instability sensation disappeared, varus stress test and anterior drawer test were negative. The VAS , AOFAS and Karlsson-Peterson scores of all patients were significantly better compared with those before operation, and the difference between before and after operation was statistically significant. Conclusions: The modified "outside-in" Broström-Gould procedure can effectively treat CLAI, which can obtain satisfactory results. The procedure is straightforward, the impact is minimal, and the aesthetics are pleasing.


Assuntos
Instabilidade Articular , Humanos , Instabilidade Articular/cirurgia , Estudos Retrospectivos , Feminino , Masculino , Adulto , Seguimentos , Articulação do Tornozelo/cirurgia , Artroscopia/métodos , Doença Crônica , Ligamentos Laterais do Tornozelo/cirurgia , Adulto Jovem , Resultado do Tratamento , Pessoa de Meia-Idade
14.
Khirurgiia (Mosk) ; (5): 95-100, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38785244

RESUMO

A personalized approach with attention to anamnesis and specific symptoms is necessary in patients with internal carotid artery tortuosity. Neuroimaging (especially before elective surgery) or functional stress tests following ultrasound of supra-aortic vessels may be necessary depending on medical history and complaints. In addition to standard Doppler ultrasound, these patients should undergo rotational and orthostatic transformation tests. We analyze changes in shape and hemodynamic parameters within the tortuosity area in various body positions. This is especially valuable for patients with concomitant carotid artery stenosis. The article presents a clinical case illustrating the importance of such approach.


Assuntos
Artéria Carótida Interna , Estenose das Carótidas , Humanos , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/anormalidades , Artéria Carótida Interna/fisiopatologia , Estenose das Carótidas/fisiopatologia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Estenose das Carótidas/cirurgia , Masculino , Feminino , Pessoa de Meia-Idade , Ultrassonografia Doppler/métodos , Hemodinâmica/fisiologia , Aterosclerose/complicações , Aterosclerose/diagnóstico , Aterosclerose/fisiopatologia , Malformações Vasculares/diagnóstico , Malformações Vasculares/complicações , Malformações Vasculares/fisiopatologia , Idoso , Artérias/anormalidades , Instabilidade Articular , Dermatopatias Genéticas
15.
Khirurgiia (Mosk) ; (5): 146-151, 2024.
Artigo em Russo | MEDLINE | ID: mdl-38785251

RESUMO

The review is devoted to diagnosis and treatment of internal carotid artery tortuosity. The authors consider modern classification, epidemiology and diagnostic options using neuroimaging or ultrasound-assisted functional stress tests depending on medical history and complaints. In addition to standard Doppler ultrasound, rotational and orthostatic tests are advisable due to possible changes of local shape and hemodynamic parameters following body position changes, especially in patients with concomitant atherosclerotic stenosis. Thus, a personalized approach is especially important for treatment and diagnostics of internal carotid artery tortuosity.


Assuntos
Artéria Carótida Interna , Humanos , Artéria Carótida Interna/diagnóstico por imagem , Artéria Carótida Interna/anormalidades , Artéria Carótida Interna/fisiopatologia , Aterosclerose/diagnóstico , Aterosclerose/complicações , Aterosclerose/fisiopatologia , Estenose das Carótidas/fisiopatologia , Estenose das Carótidas/complicações , Estenose das Carótidas/diagnóstico , Ultrassonografia Doppler/métodos , Malformações Vasculares/diagnóstico , Malformações Vasculares/fisiopatologia , Malformações Vasculares/complicações , Artérias/anormalidades , Instabilidade Articular , Dermatopatias Genéticas
16.
J Orthop Surg Res ; 19(1): 312, 2024 May 28.
Artigo em Inglês | MEDLINE | ID: mdl-38802920

RESUMO

BACKGROUND: Chronic Lateral Ankle Instability (CLAI) is a common condition treated using either Anterior Talofibular and Calcaneofibular Ligament (ATFL and CFL) reconstruction or Modified Brostrom Procedure (MBP). However, the comparative efficacy of these approaches is not well-studied. METHODS: In this study, clinical data were retrospectively collected from 101 patients diagnosed with CLAI who underwent either ATFL and CFL reconstruction (n = 51) or the MBP (n = 50). Patients were comparable in terms of age, sex, Body Mass Index (BMI), post-injury duration, preoperative American Orthopedic Foot and Ankle Society (AOFAS) score, Karlsson score, Visual Analog Score (VAS), Anterior Talar Translation, and Talar Tilt Angle. RESULTS: The post-operative measures showed no significant differences in AOFAS Score, Karlsson Score, and VAS between both treatment groups. However, patients who underwent ATFL and CFL reconstruction showed significantly lower follow-up Anterior Talar Translation (mean = 4.1667 ± 1.3991 mm) and Talar Tilt Angle (mean = 5.0549 ± 1.6173°) compared to those who underwent MBP. Further, patients treated with ATFL and CFL reconstruction experienced a significantly longer postoperative recovery time (median = 6 weeks) compared to MBP (median = 3 weeks). CONCLUSIONS: Although both therapeutic techniques were generally effective in treating CLAI, the ATFL and CFL reconstruction approach delivered superior control of Anterior Talar Translation and Talar Tilt Angle. However, its longer recovery time merits further study to optimize the balance between therapeutic efficacy and recovery speed.


Assuntos
Articulação do Tornozelo , Artroscopia , Instabilidade Articular , Ligamentos Laterais do Tornozelo , Procedimentos de Cirurgia Plástica , Humanos , Instabilidade Articular/cirurgia , Instabilidade Articular/diagnóstico por imagem , Feminino , Masculino , Adulto , Ligamentos Laterais do Tornozelo/cirurgia , Ligamentos Laterais do Tornozelo/diagnóstico por imagem , Estudos Retrospectivos , Artroscopia/métodos , Articulação do Tornozelo/cirurgia , Articulação do Tornozelo/diagnóstico por imagem , Procedimentos de Cirurgia Plástica/métodos , Doença Crônica , Resultado do Tratamento , Adulto Jovem , Pessoa de Meia-Idade , Seguimentos
17.
Eur Rev Med Pharmacol Sci ; 28(8): 3202-3207, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38708478

RESUMO

OBJECTIVE: The palmaris longus (PL) contributes to the palmar fascia, wrist flexion, hand muscle balance, and pinch strength. Also, PL is used as a graft source. So, PL's presence is helpful for joint stability and grafting. On the other hand, joint hypermobility (JH) is associated with many complaints and disorders. Considering the adverse effects of JH and benefit-based evolution, the genesis rather than agenesis of PL can be expected in JH. Herein, it was hypothesized that PL might be together with JH, and individuals with PL may have higher scores of JH than those without. PATIENTS AND METHODS: Between June 2023 and October 2023, 200 participants (F/M: 1/1) were included in the study. The Schaeffer's test and the Beighton scores were used to assess PL and JH, respectively. The participants were divided into two bilateral groups according to the presence or absence of PL. Then, the groups were compared for demographics and Beighton scores. Subgroup analyses were also done by considering gender. RESULTS: No significant differences were found between PL (+) and PL (-) groups considering females+males in age (p=0.559), gender (p=0.517), weight (p=0.375), height (p=0.061), work status (p=0.229), Beighton score (p=0.893), and JH (p=1.0). No significant differences were found between PL (+) and PL (-) groups considering females only in age (p=0.871), weight (p=0.189), height (p=0.127), work status (p=0.200), Beighton score (p=0.727), and JH (p=1.0). No significant differences were found between PL (+) and PL (-) groups considering males only in age (p=0.370), weight (p=0.981), height (p=0.400), BMI (p=0.601), work status (p=0.145), Beighton score (p=0.757), and JH (p=1.0). CONCLUSIONS: According to the results of this study, no relationship was found between PL and JH. However, this is the first study on the topic and has some limitations.


Assuntos
Instabilidade Articular , Humanos , Instabilidade Articular/fisiopatologia , Feminino , Masculino , Adulto , Pessoa de Meia-Idade , Adulto Jovem , Articulação do Punho , Amplitude de Movimento Articular , Músculo Esquelético
20.
Injury ; 55(6): 111537, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38657283

RESUMO

INTRODUCTION: The indications for reduction and fixation of the posterior malleolus component of rotational ankle fractures have been controversial for nearly a century. This study aims to identify the historical basis for surgical intervention and trace trends in management strategies over time. METHODS: In March 2023, a systematic review of full-text, English-language articles providing indications for surgical fixation of the posterior malleolus component of rotational ankle fractures was performed. Articles underwent title and abstract screening before undergoing full-text review. RESULTS: Historical indications for surgical fixation were size-dependent, with fractures comprising 25 % to 33 % of the plafond recommended for internal fixation. Modern studies suggest that nonoperative management of posterior malleolus fractures below this threshold results in residual malreduction of the articular surface, syndesmotic instability, and an increased need for independent fixation of the syndesmosis. CONCLUSIONS: Size-based indications for posterior malleolus fracture fixation are based on Level V evidence from small retrospective case series published nearly one century ago and should be retired. While the size of the posterior malleolus component cannot be ignored, additional factors like fracture morphology and location within the plafond should guide modern surgical indications. Contemporary studies indicate that reduction and fixation of small posterior malleolus fractures (comprising less than 25 % of the articular surface) are associated with improved articular reductions, tibiotalar contact pressures, syndesmotic stability with decreased need for independent fixation of the syndesmosis, and superior postoperative outcomes.


Assuntos
Fraturas do Tornozelo , Fixação Interna de Fraturas , Humanos , Fraturas do Tornozelo/cirurgia , Fixação Interna de Fraturas/métodos , Articulação do Tornozelo/cirurgia , Instabilidade Articular/cirurgia , Resultado do Tratamento
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