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2.
Hematol Oncol Clin North Am ; 36(6): 1201-1215, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36400539

RESUMO

Microvascular occlusions caused by sickle cell disease (SCD) can affect all ocular and orbital structures. Sickle cell retinopathy (SCR) is the most common ophthalmic manifestation of SCD. Fortunately, most individuals with SCR are visually asymptomatic. Vision loss in SCD most commonly occurs as a consequence of proliferative sickle cell retinopathy (PSR), in which pathologic retinal neovascularization occurs. To prevent significant vision loss and blindness, which can occur from complications of PSR, regular retinopathy surveillance screening examinations and consistent follow-up with a retina specialist are recommended. Scatter laser photocoagulation is the current gold-standard treatment to prevent vision threatening progression of PSR. Patients with sickle cell disease should have regular checkups with their dental care provider. Patients should be educated on the importance of proper dental care, a healthy diet, and the need for early intervention if they suspect any dental problems or are having dental pain. If any dental procedures that involve surgery or sedation are planned, it is critical to consult with the hematologist before the procedure is started. Prophylactic antibiotics may have to be prescribed before invasive dental procedures, such as extractions or periodontal surgery but is best determined by discussions between the dental care provider and the hematologist. Osteonecrosis is a highly prevalent skeletal complication of sickle cell disease that affects all genotypes. Risk factors for osteonecrosis include older age, HbSS genotype with concomitant alpha-thalassemia trait, frequent vaso-occlusive episodes, history of acute chest syndrome, elevated body mass index, and low white blood cell counts. Osteonecrosis causes progressive joint damage and associates with chronic pain, frequent acute care visits, and overall poor health-related quality of life. Current consensus guidelines recommend analgesics, physical therapy, and early consideration of joint arthroplasty in sickle cell-related osteonecrosis, although surgery may be deferred until late adolescence after growth plates have fused.


Assuntos
Anemia Falciforme , Osteonecrose , Doenças Retinianas , Humanos , Adolescente , Qualidade de Vida , Doenças Retinianas/etiologia , Doenças Retinianas/patologia , Doenças Retinianas/cirurgia , Anemia Falciforme/complicações , Anemia Falciforme/diagnóstico , Anemia Falciforme/genética , Neovascularização Patológica , Osteonecrose/terapia , Osteonecrose/complicações
3.
Jt Dis Relat Surg ; 33(3): 599-608, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36345188

RESUMO

OBJECTIVES: This study aims to evaluate the efficacy of an alternative method by comparing an old established method with a new less invasive method in the surgical treatment of Stage 3A Kienböck's disease. PATIENTS AND METHODS: Between January 2014 and July 2018, a total of 35 patients (28 males, 7 females; mean age: 22.8±3.3 years; range, 17 to 29 years) who underwent surgery due to Kienböck's disease were retrospectively analyzed. The patients were divided into two groups according to the procedure applied as the capitate forage procedure (CFP) group (Group 1, n=16) and the radial shortening osteotomy (RSO) group (Group 2, n=19). Patients with a minimum follow-up period of 18 months were examined according to the MAYO wrist scores pre- and postoperatively. RESULTS: The postoperative MAYO scores were statistically significantly higher in both groups (CFP, p=0.001; RSO, p=0.000). However, the osteotomy group showed statistically significantly higher results than the forage group in terms of not only postoperative scores, but also pre- and postoperative score difference (p=0.004). CONCLUSION: Our study results confirm that both CFP and RSO are effective in the treatment of Stage 3A Kienböck's disease. However, RSO should be the first choice in Stage 3A patients with high success rates. Supported by long-term follow-up results, CFP may be considered a minimally invasive alternative only in selected patients who avoid major surgery or expect a rapid return to work.


Assuntos
Capitato , Osteonecrose , Masculino , Feminino , Humanos , Adulto Jovem , Adulto , Estudos Retrospectivos , Capitato/cirurgia , Osteonecrose/diagnóstico por imagem , Osteonecrose/cirurgia , Osteotomia/métodos , Articulação do Punho/cirurgia
4.
Nucl Med Commun ; 43(12): 1188-1194, 2022 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-36345763

RESUMO

OBJECTIVES: To investigate the comparison of maximum and mean standardized uptake values (SUVs) of jaw pathologies with bone Single-photon emission computed tomography/computed tomography (SPECT/CT), and a special focus on medication-related osteonecrosis of the jaw (MRONJ). METHODS: Eighty-nine patients with jaw pathologies (63 MRONJ, 13 chronic osteomyelitis, 11 osteoradionecrosis and 2 primary intraosseous carcinoma) underwent bone SPECT/CT scans acquisition at 4 h after intravenous injection of Tc-99m hydroxymethylene diphosphonate in this prospective study. The evaluation of mean and maximum SUVs of jaw pathologies were performed using Q. Metrix and Xeleris workstation and defined the data automatically. Statistical analyses were performed by Pearson's correlation coefficient for comparison of maximum and mean SUVs and Mann-Whitney U-test for SUVs of MRONJ. A P value lower than 0.05 was considered to indicate statistical significance. RESULTS: Maximum SUVs of MRONJ, chronic osteomyelitis, osteoradionecrosis and primary intraosseous carcinoma were 17.6 ± 8.4, 21.7 ± 7.1, 11.9 ± 4.8 and 26.6 ± 7.0, respectively. Mean SUVs of MRONJ, chronic osteomyelitis, osteoradionecrosis and primary intraosseous carcinoma were 10.1 ± 4.9, 11.9 ± 3.3, 7.0 ± 2.8 and 10.1 ± 4.5, respectively. The maximum SUV of jaw pathologies was significantly correlated with the mean SUV (Y = 0.494X + 1.228; R2 = 0.786; P < 0.001). Furthermore, maximum and mean SUVs of MRONJ had significant differences in underlying diseases, medication and staging. CONCLUSION: The maximum and mean SUVs with bone SPECT/CT can be an effective tool for the quantitative evaluation of jaw pathologies, especially MRONJ.


Assuntos
Carcinoma , Osteomielite , Osteonecrose , Osteorradionecrose , Humanos , Osteorradionecrose/diagnóstico por imagem , Osteorradionecrose/patologia , Estudos Prospectivos , Osteonecrose/diagnóstico por imagem , Osteonecrose/patologia , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único , Osteomielite/diagnóstico por imagem
5.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(11): 1428-1433, 2022 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-36382463

RESUMO

Objective: To summarize the characteristics of the occurrence and development of osteonecrosis of the femoral head (ONFH), and to review the important regulatory role of immune cells in the progression of ONFH. Methods: The domestic and foreign literature on the immune regulation of ONFH was reviewed, and the relationship between immune cells and the occurrence and development of ONFH was analyzed. Results: The ONFH region has a chronic inflammatory reaction and an imbalance between osteoblast and osteoclast, while innate immune cells such as macrophages, neutrophils, dendritic cells, and immune effector cells such as T cells and B cells are closely related to the maintenance of bone homeostasis. Conclusion: Immunotherapy targeting the immune cells in the ONFH region and the key factors and proteins in their regulatory pathways may be a feasible method to delay the occurrence, development, and even reverse the pathology of ONFH.


Assuntos
Necrose da Cabeça do Fêmur , Células-Tronco Mesenquimais , Osteonecrose , Humanos , Cabeça do Fêmur/patologia , Necrose da Cabeça do Fêmur/etiologia , Necrose da Cabeça do Fêmur/patologia , Células-Tronco Mesenquimais/metabolismo , Osteoblastos/metabolismo , Osteoclastos/metabolismo
6.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(11): 1420-1427, 2022 Nov 15.
Artigo em Chinês | MEDLINE | ID: mdl-36382462

RESUMO

Objective: To review the research progress of pathogenesis and genetics of alcohol-induced osteonecrosis of the femoral head (AIONFH). Methods: The relevant domestic and foreign literature in recent years was extensively reviewed. The pathogenesis, the relationship between gene polymorphism and susceptibility, the related factors of disease progression, and the potential therapeutic targets of AIONFH were summarized. Results: AIONFH is a refractory orthopedic disease caused by excessive drinking, seriously affecting the daily life of patients due to its high disability rate. The pathogenesis of AIONFH includes lipid metabolism disorder, endothelial dysfunction, bone homeostasis imbalance, and et al. Gene polymorphism and non-coding RNA are also involved. The hematological and molecular changes involved in AIONFH may be used as early diagnostic markers and potential therapeutic targets of the disease. Conclusion: The pathogenesis of AIONFH has not been fully elucidated. Research based on genetics, including gene polymorphism and non-coding RNA, combined with next-generation sequencing technology, may provide directions for future research on the mechanism and discovery of potential therapeutic targets.


Assuntos
Necrose da Cabeça do Fêmur , Osteonecrose , Humanos , Cabeça do Fêmur/patologia , Necrose da Cabeça do Fêmur/genética , Necrose da Cabeça do Fêmur/induzido quimicamente , Etanol/efeitos adversos , RNA não Traduzido
7.
Biomed Res Int ; 2022: 4501186, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36193326

RESUMO

Background: Osteonecrosis of the femoral head (ONFH) is a disabling orthopedic disease, which is impacted by infiltration of immune cells. Thus, the aim of the current research was to determine the inflammation-related biomarkers in ONFH. Methods: GSE123568 dataset with control and steroid-induced osteonecrosis of the femoral head (SONFH) samples were downloaded from Gene Expression Omnibus (GEO) database. The differentially expressed genes (DEGs) were detected by limma R package and weighted gene co-expression network analysis (WGCNA) was used to explore the co-expression genes and modules. We obtained inflammation-related genes (IRGs) from the Molecular Signatures Database (MSigDB). Then, the IRGs associated with SONFH (IRGs-SONFH) were screened out and analyzed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis. A protein-protein interaction (PPI) network was established using the Search Tool for the Retrieval of Interacting Genes/Proteins (STRING) database, and hub genes were identified by the MCODE algorithm. Based on the hub genes, we constructed a lncRNA-miRNA-mRNA network. Results: We identified 535 DEGs between control and SONFH samples. The WGCNA clearly indicated that the brown module was most significantly associated with SONFH. We identified 25 IRGs-SONFH through WGCNA module genes, DEGs and IRGs. A total of 4 hub genes (CD14, CYBB, NOD2, and TLR1) were identified by Cytoscape. Receiver operating characteristic (ROC) curve analysis determined that the expressions of the four genes could distinguish SONFH from controls as evidenced by the area under the curve (AUC) greater than 0.7. Finally, we constructed a competitive endogenous RNA (ceRNA) network which included 67 lncRNAs, 1 miRNA (hsa-miR-320a), and 1 mRNA (NOD2). Conclusions: Our study identified 4 hub genes as potential inflammation-related biomarkers of SONFH. Moreover, we proposed a ceRNA network of lncRNAs targeting hsa-miR-320a, hsa-miR-320a, and NOD2 as a potential RNA regulatory pathway that controls disease progression in ONFH.


Assuntos
MicroRNAs , Osteonecrose , RNA Longo não Codificante , Biomarcadores/metabolismo , Cabeça do Fêmur/metabolismo , Redes Reguladoras de Genes , Humanos , Inflamação/genética , Inflamação/metabolismo , MicroRNAs/genética , Osteonecrose/induzido quimicamente , RNA Longo não Codificante/metabolismo , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , Esteroides/efeitos adversos , Receptor 1 Toll-Like/genética , Receptor 1 Toll-Like/metabolismo
8.
Orthop Clin North Am ; 53(4): 377-392, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36208881

RESUMO

Knee pain is among the most common complaints that an orthopedic surgeon may see in practice. It is often worked up with X-rays and MRI, leading to a myriad of potential diagnoses ranging from minimal edema patterns to various types of osteonecrosis. Similarities in certain causes can pose diagnostic challenges. The purpose of this review was to present the 3 types of osteonecrosis observed in the knee as well as additional causes to consider to help aid in the diagnosis and treatment..


Assuntos
Joelho , Osteonecrose , Osso e Ossos , Edema/diagnóstico , Edema/etiologia , Humanos , Articulação do Joelho/diagnóstico por imagem , Imageamento por Ressonância Magnética , Osteonecrose/diagnóstico por imagem , Osteonecrose/etiologia
9.
Orthop Clin North Am ; 53(4): 421-430, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36208885

RESUMO

Sickle cell disease (SCD) is a hemoglobinopathy that commonly has musculoskeletal effects including osteonecrosis of major joints (most often the hip) and medullary infarcts with resultant pain, functional limitations, and decreased quality of life. Patients with SCD may require surgical intervention, including total hip arthroplasty, frequently at a young age. The underlying pathologic process of SCD creates unique medical and surgical challenges that place these patients at increased risk of complications. This necessitates a multidisciplinary approach for providing surgical care to patients with SCD.


Assuntos
Anemia Falciforme , Artroplastia de Quadril , Osteonecrose , Anemia Falciforme/complicações , Anemia Falciforme/cirurgia , Artroplastia de Quadril/efeitos adversos , Humanos , Osteonecrose/cirurgia , Dor/etiologia , Qualidade de Vida
10.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 36(10): 1277-1287, 2022 Oct 15.
Artigo em Chinês | MEDLINE | ID: mdl-36310467

RESUMO

Objective: To explore the effect of Kaempferol on bone microvascular endothelial cells (BMECs) in glucocorticoid induced osteonecrosis of the femoral head (GIONFH) in vitro. Methods: BMECs were isolated from cancellous bone of femoral head or femoral neck donated voluntarily by patients with femoral neck fracture. BMECs were identified by von Willebrand factor and CD31 immunofluorescence staining and tube formation assay. The cell counting kit 8 (CCK-8) assay was used to screen the optimal concentration and the time point of dexamethasone (Dex) to inhibit the cell activity and the optimal concentration of Kaempferol to improve the inhibition of Dex. Then the BMECs were divided into 4 groups, namely, the cell group (group A), the cells treated with optimal concentration of Dex group (group B), the cells treated with optimal concentration of Dex+1 µmol/L Kaempferol group (group C), and the cells treated with optimal concentration of Dex+5 µmol/L Kaempferol group (group D). EdU assay, in vitro tube formation assay, TUNEL staining assay, Annexin Ⅴ/propidium iodide (PI) staining assay, Transwell migration assay, scratch healing assay, and Western blot assay were used to detect the effect of Kaempferol on the proliferation, tube formation, apoptosis, migration, and protein expression of BMECs treated with Dex. Results: The cultured cells were identified as BMECs. CCK-8 assay showed that the optimal concentration and the time point of Dex to inhibit cell activity was 300 µmol/L for 24 hours, and the optimal concentration of Kaempferol to improve the inhibitory activity of Dex was 1 µmol/L. EdU and tube formation assays showed that the cell proliferation rate, tube length, and number of branch points were significantly lower in groups B-D than in group A, and in groups B and D than in group C ( P<0.05). TUNEL and Annexin V/PI staining assays showed that the rates of TUNEL positive cells and apoptotic cells were significantly higher in groups B-D than in group A, and in groups B and D than in group C ( P<0.05). Scratch healing assay and Transwell migration assay showed that the scratch healing rate and the number of migration cells were significantly lower in groups B-D than in group A, and in groups B and D than in group C ( P<0.05). Western blot assay demonstrated that the relative expressions of Cleaved Caspase-3 and Bax proteins were significantly higher in groups B-D than in group A, and in groups B and D than in group C ( P<0.05); the relative expressions of matrix metalloproteinase 2, Cyclin D1, Cyclin E1, VEGFA, and Bcl2 proteins were significantly lower in groups B-D than in group A, and in groups B and D than in group C ( P<0.05). Conclusion: Kaempferol can alleviate the damage and dysfunction of BMECs in GIONFH.


Assuntos
Glucocorticoides , Osteonecrose , Humanos , Glucocorticoides/efeitos adversos , Células Endoteliais , Cabeça do Fêmur , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 2 da Matriz/farmacologia , Quempferóis/farmacologia , Quempferóis/metabolismo , Anexina A5/metabolismo , Anexina A5/farmacologia , Sincalida/metabolismo , Sincalida/farmacologia , Apoptose , Osteonecrose/induzido quimicamente , Osteonecrose/prevenção & controle
11.
Oxid Med Cell Longev ; 2022: 6360133, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36275897

RESUMO

Objective: Glucocorticoid-induced osteonecrosis of the femoral head is one of the most common causes of nontraumatic osteonecrosis of the femoral head, but its exact pathogenesis remains unclear. The aim of this study was to investigate the role of SIRT6 in the maintenance of bone tissue morphology and structure, intravascular lipid metabolism, and its potential molecular mechanism in glucocorticoid-induced osteonecrosis of the femoral head. Methods: SIRT6 adenovirus was transfected into GIONFH in rats. The microstructure of rat bone was observed by micro-CT and histological staining, and the expression of bone formation-related proteins and angiogenesis-related factors was determined through western blot and immunohistochemistry. Alkaline phosphatase activity, alizarin red staining, and the expression levels of Runx2 and osteocalcin were used to evaluate the osteogenic potential. And in vitro tube formation assay and immunofluorescence were used to detect the ability of endothelial cell angiogenesis. Results: Dexamethasone significantly inhibited osteoblast differentiation, affected bone formation, and destroyed microvessel formation, increased the intracellular Fe2+ and ROS levels and induced the occurrence of ferroptosis. SIRT6 can inhibit ferroptosis and restore the ability of bone formation and angiogenesis. Conclusion: SIRT6 can inhibit the occurrence of ferroptosis, reduce the damage of vascular endothelium, and promote osteogenic differentiation, so as to prevent the occurrence of osteonecrosis of the femoral head.


Assuntos
Osteonecrose , Sirtuínas , Animais , Ratos , Fosfatase Alcalina/metabolismo , Subunidade alfa 1 de Fator de Ligação ao Core/metabolismo , Dexametasona , Cabeça do Fêmur/metabolismo , Glucocorticoides/farmacologia , Osteocalcina/metabolismo , Osteogênese , Osteonecrose/induzido quimicamente , Osteonecrose/metabolismo , Espécies Reativas de Oxigênio/metabolismo , Sirtuínas/metabolismo
12.
Front Endocrinol (Lausanne) ; 13: 1016687, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36277691

RESUMO

Glucocorticoids (GCs) are widely used in various autoimmune diseases. Side effects may occur in patients with long-term or high-dose GC usage. Among them, steroid myopathy and osteonecrosis are two severe forms. We report a patient with pemphigus vulgaris on GC-treatment who developed muscle weakness when a cumulative dose of methylprednisolone reached about 20g (14-80mg/d for 2.5 years). Laboratory tests showed slightly elevated lactate dehydrogenase and hydroxybutyrate dehydrogenase. MRI revealed osteonecrosis in the femoral head, distal femur, and proximal tibia of both legs. The biopsy of the right quadriceps revealed atrophy of type II myofiber without leukocyte infiltration, which was suggestive of steroid myopathy. Genotyping of the patient showed 5G/5G genotype of the PAI-1 gene and CC genotype of the ABCB1 gene (C3435T), suggesting she was sensitive to GCs. The patient's lesions were considered to be GC-induced adverse events, which were improved with tapering GC. Therefore, it is important to recognize steroid-induced musculoskeletal side effects and genotyping favors personalized medication.


Assuntos
Doenças Musculares , Osteonecrose , Feminino , Humanos , Glucocorticoides/efeitos adversos , Inibidor 1 de Ativador de Plasminogênio/efeitos adversos , Inibidor 1 de Ativador de Plasminogênio/genética , Hidroxibutirato Desidrogenase/genética , Osteonecrose/induzido quimicamente , Osteonecrose/genética , Osteonecrose/patologia , Polimorfismo Genético , Metilprednisolona , Esteroides , Doenças Musculares/induzido quimicamente , Doenças Musculares/genética , Lactato Desidrogenases/genética , Subfamília B de Transportador de Cassetes de Ligação de ATP/genética , Subfamília B de Transportador de Cassetes de Ligação de ATP/efeitos adversos
13.
Pan Afr Med J ; 42: 244, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36303824

RESUMO

Osteonecrosis of the metaphysis is often rare as it is a highly vascular region. Here we report an unusual case of non-traumatic osteonecrosis of the humerus predominantly involving the metaphysis in a post covid elderly female. The patient had a pathological fracture of humerus during the post-operative period of intertrochanteric femur fracture surgery. She was evaluated for the causes of pathological fracture and the fracture was managed with hemi replacement of the shoulder because of the extensive bone loss. The pathology here could only be explained as some sequelae of hyper inflammatory state associated with COVID-19 infection. The possible differentials are also discussed here. This case report will help clinicians to consider COVID-19 infection as a cause for non-traumatic osteonecrosis among other reported causes of osteonecrosis.


Assuntos
COVID-19 , Fraturas Espontâneas , Osteonecrose , Feminino , Humanos , Idoso , Fraturas Espontâneas/patologia , COVID-19/complicações , Úmero/patologia , Osteonecrose/etiologia , Osteonecrose/cirurgia , Ombro/patologia
14.
Eur Rev Med Pharmacol Sci ; 26(20): 7404-7412, 2022 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-36314310

RESUMO

OBJECTIVE: Glucocorticoid-induced osteonecrosis is a serious debilitating health problem. In the present study, we investigated the effects of alpha-lipoic acid on glucocorticoid-induced osteonecrosis in rats. MATERIALS AND METHODS: A total of 40 male Wistar albino rats were equally assigned to 4 groups as control, methylprednisolone acetate (MPA), alpha-lipoic acid (ALA), and methylprednisolone acetate with alpha-lipoic acid (MPA+ALA). The animals in MPA group subcutaneously received 15 mg/kg/week for 2 weeks, whereas 100 mg/kg/day alpha-lipoic acid was intraperitoneal administered for 4 weeks to ALA group. The MPA+ALA group was subjected to both treatments in same doses. Osteonecrosis was confirmed and graded histologically. The serum concentrations of glucose, total cholesterol, low- and high-density lipoprotein, triglyceride, as well as the total oxidant and antioxidant status, oxidative stress index, prothrombin time and activated partial thromboplastin time were evaluated. Also, lipid peroxidation and DNA damage were immunohistochemically assessed in the bone. RESULTS: Osteonecrotic lesions were narrower in the MPA+ALA group than in the MPA group (p<0.05). As compared to the controls, the biochemical parameters in MPA and MPA+ALA groups were significantly increased (p<0.001). The oxidative stress index was significantly higher in the groups with MPA than the controls (p=0.002), but the animals treated with ALA alongside MPA displayed lesser scores than the ones injected with solely MPA (p=0.03). The administration of MPA elevated lipid peroxidation and DNA damage, which were successfully alleviated by ALA. CONCLUSIONS: Alpha-lipoic acid may be suggested to be a protective supplement in glucocorticoid-induced osteonecrosis in rats. The antioxidant capacity of alpha-lipoic acid may involve its beneficial effects.


Assuntos
Osteonecrose , Ácido Tióctico , Animais , Ratos , Masculino , Ácido Tióctico/farmacologia , Ácido Tióctico/uso terapêutico , Antioxidantes/uso terapêutico , Acetato de Metilprednisolona/farmacologia , Glucocorticoides/farmacologia , Ratos Wistar , Estresse Oxidativo , Osteonecrose/induzido quimicamente , Osteonecrose/tratamento farmacológico
16.
Hand Clin ; 38(4): 367-376, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36244704

RESUMO

Avascular necrosis is a complicated, multifactorial disease with potentially devastating consequences. Although the underlying root cause is a lack of appropriate vascular perfusion to affected bone, there are often varying patient-specific, anatomic-specific, and injury-specific predispositions. These factors generally fall into 3 categories: direct vascular disruption, intravascular obliteration, or extravascular compression. The initial stages of disease can be insidiously symptomatic because edematous bone marrow progresses to subchondral collapse and subsequent degenerative arthritis. Although much of the current literature focuses on the femoral head, other common areas of occurrence include the proximal humerus, knee, and the carpus. The low-incidence rate of carpal avascular necrosis poses a challenge in establishing adequately powered, control-based validated treatment options, and therefore, optimal surgical management remains a continued debate among hand surgeons. Appreciation for expectant fracture healing physiology may help guide future investigation into carpal-specific causes of avascular necrosis.


Assuntos
Ossos do Carpo , Osteonecrose , Ossos do Carpo/cirurgia , Consolidação da Fratura , Humanos , Úmero , Osteonecrose/cirurgia
17.
Hand Clin ; 38(4): 435-446, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36244711

RESUMO

Of the many treatments for Kienböck disease, only lunate revascularization procedures provide a direct mechanism for reversing the process of osteonecrosis. Owing to the redundant blood supply of the distal radius and carpus, pedicled flaps are versatile solutions for patients with bone loss but intact cartilage. With the advent of free vascularized flaps, the indications for lunate revascularization procedures are expanding. These flaps can be used when the articular cartilage has been compromised and are suitable options to restore native anatomy in patients previously thought to have unreconstructible disease.


Assuntos
Cartilagem Articular , Osso Semilunar , Osteonecrose , Transplante Ósseo/métodos , Humanos , Osso Semilunar/cirurgia , Osteonecrose/cirurgia , Rádio (Anatomia)/irrigação sanguínea , Rádio (Anatomia)/cirurgia
18.
Hand Clin ; 38(4): 393-403, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36244707

RESUMO

Kienböck disease (KD) involves osseous, vascular, and chondral aspects of the lunate and wrist. We present our theories on the etiology and pathogenesis of the condition based on basic science models, seminal literature, personal case experience, and kinematic observations of the Kienböck wrist. Three phenotypes of Kienböck disease occur, and each tends to have different morphology, rates of progression, and disease pattern. The lunate fracture in KD is well-recognized but different fracture types can occur. Dynamic assessment of the Kienböck wrist allows assessment of the complex kinematics of KD. Disease onset and progression require a "perfect storm" of risk factors.


Assuntos
Osso Semilunar , Osteonecrose , Fenômenos Biomecânicos , Humanos , Punho , Articulação do Punho
19.
Hand Clin ; 38(4): 417-424, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36244709

RESUMO

The algorithm and rationale described is a reflection of our own surgical experience for this challenging disorder and can be compared with other publications. Our algorithm has evolved from treatment of a large volume of patients with Kienböck disease in a referral practice. However, it is limited to the management that we have found logical, effective, and within our scope of experience. The treatment guidelines for our specialty as a whole will evolve as our understanding of the etiology and our ability to quantify efficacy improves.


Assuntos
Osso Semilunar , Osteonecrose , Algoritmos , Humanos , Osso Semilunar/cirurgia , Osteonecrose/cirurgia
20.
Hand Clin ; 38(4): 405-415, 2022 11.
Artigo em Inglês | MEDLINE | ID: mdl-36244708

RESUMO

Robert Kienböck described radiographic changes associated with idiopathic lunate osteonecrosis in 1910. The radiographic progression of this eponymous condition has been well-described to progress from normal radiographs, to lunate sclerosis, lunate collapse, proximal capitate migration, scaphoid flexion, and pancarpal arthritis. Diagnosing early stages of the disease without radiographic changes presented a challenge. As imaging modalities have evolved, diagnosis has become possible with MRI. Although numerous classification systems exist, the Lichtman classification and the Bain arthroscopic grading system have become widely used. This article outlines the available classification systems and aims to highlight when each may be useful in patient management.


Assuntos
Osso Semilunar , Osteonecrose , Osso Escafoide , Humanos , Osso Semilunar/diagnóstico por imagem , Osso Semilunar/cirurgia , Imageamento por Ressonância Magnética , Osteonecrose/cirurgia , Amplitude de Movimento Articular , Osso Escafoide/cirurgia
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