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1.
PLoS One ; 18(1): e0280687, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36662878

RESUMO

Open-wedge high tibial osteotomy (OWHTO) is effective in treating medial compartment osteoarthritis. The association between body mass index (BMI) and outcomes following OWHTO is being debated. This study compared radiographic and clinical outcomes between patients with preoperative overweight, obesity, and normal BMI following OWHTO for medial compartment osteoarthritis. In total, 123 patients (123 knees) who underwent OWHTO for medial compartment osteoarthritis were enrolled and were divided into normal-BMI (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (>30 kg/m2) groups based on body mass index. The numeric rating scale for pain, mechanical tibiofemoral angle (mTFA), tibia tilting angle (TTA), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for function were evaluated preoperatively and at postoperative follow-ups. The improvements of clinical and radiological outcomes in normal-BMI, overweight, and obese groups were not significantly different. The incidence of soft tissue irritation, wound infection, nonunion, and conversion to total knee arthroplasty were not significantly different between groups.The clinical and radiological outcomes in patients with preoperative overweight, obesity, and normal-BMI were not significantly different. Preoperative overweight and obesity thus has no effect on outcomes following OWHTO during the two years follow-up period. These findings cannot be generalized to patients with morbid obesity.


Assuntos
Articulação do Joelho , Osteoartrite do Joelho , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Estudos Retrospectivos , Sobrepeso/complicações , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Osteotomia/efeitos adversos , Obesidade/complicações , Obesidade/cirurgia
2.
Neurosurg Focus ; 54(1): E11, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36587408

RESUMO

OBJECTIVE: The Global Alignment and Proportion (GAP) score was developed to serve as a tool to predict mechanical complication probability in patients undergoing surgery for adult spinal deformity (ASD), serving as an aid for setting surgical goals to decrease the prevalence of mechanical complications in ASD surgery. However, it was developed using ASD patients for whom open surgical techniques were used for correction. Therefore, the purpose of this study was to assess the applicability of the score for patients undergoing circumferential minimally invasive surgery (cMIS) for correction of ASD. METHODS: Study participants were patients undergoing cMIS ASD surgery without the use of osteotomies with a minimum of four levels fused and 2 years of follow-up. Postoperative GAP scores were calculated for all patients, and the association with mechanical failure was analyzed. RESULTS: The authors identified 182 patients who underwent cMIS correction of ASD. Mechanical complications were found in 11.1% of patients with proportioned spinopelvic states, 20.5% of patients with moderately disproportioned spinopelvic states, and 18.8% of patients with severely disproportioned spinopelvic states. Analysis with a chi-square test showed a significant difference between the cMIS and original GAP study cohorts in the moderately disproportioned and severely disproportioned spinopelvic states, but not in the proportioned spinopelvic states. CONCLUSIONS: For patients stratified into proportioned, moderately disproportioned, and severely disproportioned spinopelvic states, the GAP score predicted 6%, 47%, and 95% mechanical complication rates, respectively. The mechanical complication rate in patients undergoing cMIS ASD correction did not correlate with the calculated GAP spinopelvic state.


Assuntos
Fusão Vertebral , Humanos , Adulto , Estudos Retrospectivos , Fusão Vertebral/efeitos adversos , Fusão Vertebral/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Osteotomia , Período Pós-Operatório , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia
3.
Medicina (Kaunas) ; 59(1)2023 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-36676772

RESUMO

Background and Objectives: Although the effects of cartilage repair in patients who are undergoing high tibial osteotomy (HTO) remains controversial, cartilage repair may be required for the full-thickness cartilage defect because of a concern of lower clinical outcome. The purpose of this study was to investigate clinical outcome and cartilage repair following implantation of allogeneic umbilical cord-blood-derived MSCs (UCB-MSCs)-hyaluronate composite in patients who received HTO for medial knee osteoarthritis (OA) with full-thickness cartilage defect. Materials and Methods: Inclusion criteria were patients with a medial knee OA, a full-thickness cartilage defect (International Cartilage Repair Society (ICRS) grade IV) ≥ 3 cm2 of the medial femoral condyle, and a varus deformity ≥ 5°. The full-thickness cartilage defect was treated with implantation of an allogeneic UCB-MSCs-hyaluronate composite following medial open-wedge HTO. Visual analogue scale for pain and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score were assessed at each follow-up. Cartilage repair was assessed by the ICRS cartilage repair assessment system at second-look arthroscopy when the plate was removed. Results: Twelve patients (mean age 56.1 years; mean defect size: 4.5 cm2) were included, and 10 patients underwent second-look arthroscopy during plate removal after a minimum of 1 year after the HTO. At the final follow-up of mean 2.9 years (range; 1-6 years), all clinical outcomes had improved. At second-look arthroscopy, repaired tissue was observed in all cases. One case (10%) showed grade I, seven (70%) cases showed grade II, and two (20%) cases showed grade III according to ICRS cartilage repair assessment system, which meant that 80% showed an overall repair assessment of "normal" or "nearly normal". Conclusion: Allogeneic UCB-MSCs-HA composite implantation combined with HTO resulted in favorable clinical outcome and cartilage repair in all cases. These findings suggest that UCB-MSCs-HA composite implantation combined with HTO would be a good therapeutic option for patients with knee OA and full-thickness cartilage defects.


Assuntos
Cartilagem Articular , Transplante de Células-Tronco Hematopoéticas , Células-Tronco Mesenquimais , Osteoartrite do Joelho , Humanos , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Tíbia/cirurgia , Cartilagem Articular/cirurgia , Articulação do Joelho/cirurgia , Osteotomia/métodos , Cordão Umbilical , Estudos Retrospectivos , Resultado do Tratamento
4.
J Am Acad Orthop Surg ; 31(3): 122-131, 2023 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-36656273

RESUMO

There is rapidly growing interest in minimally invasive surgery (MIS) of the foot and ankle. Technological advances, specifically with the advent of low-speed high-torque burrs, have enabled the expansion of MIS techniques. Accordingly, there is growing literature reporting excellent outcomes of MIS surgery to address many different pathologies of the foot and ankle. MIS techniques are particularly useful for conducting percutaneous osteotomies and bony débridement. These can be used to address bunion deformity, hammertoes, metatarsalgia, bunionette deformity, bone spurs, and hindfoot deformity. A detailed understanding of the technology, equipment, and techniques is crucial to safely conduct MIS of the foot and ankle. When done safely, MIS provides favorable outcomes with an expedited recovery and limited complications.


Assuntos
Joanete do Alfaiate , Cirurgiões Ortopédicos , Humanos , Tornozelo/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Osteotomia/métodos , Joanete do Alfaiate/cirurgia , Resultado do Tratamento
5.
BMC Musculoskelet Disord ; 24(1): 56, 2023 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-36683021

RESUMO

BACKGROUND: In literature, studies evaluating the factors associated the postoperative progression of patellofemoral (PF) osteoarthritis (OA) following patellar stabilization surgery are limited. This study aimed to compare the clinical outcomes after medial patellofemoral ligament reconstruction (MPFLR) as an isolated procedure (iMPFLR) and in combination with anteromedialization (AMZ) of the tibial tubercle osteotomy (TTO) and investigate the factors related to the postoperative progression of PFOA after patellar stabilization surgery. METHODS: Between 2009 and 2020, 30 knees of 23 consecutive patients underwent MPFLR with or without AMZ, using an autologous semitendinosus tendon graft; they were followed up for more than 2 years in the retrospective nature of the study. iMPFLR was performed in cases of recurrent patellar dislocation with normal tibial tubercle-trochlear groove (TT-TG) distance and no PFOA, and MPFLR+AMZ was performed for cases of excessive TT-TG distance, preoperative PFOA of recurrent patellar dislocation, or habitual patellar dislocation. Clinical findings and radiographs of the PF joint were evaluated pre- and postoperatively with PF alignment parameters and PFOA and were compared between surgical procedures. Factors for the postoperative progression of PFOA were compared between the OA progression and non-progression groups. RESULTS: Postoperative clinical score, radiographic parameters except for sulcus angle, TT-TG distance, and progression of PFOA were not significantly different between the iMPFLR and MPFLR+AMZ groups. Postoperative lateral patellar displacement (p = 0.001) and congruence angle (p = 0.017) were significantly different between the OA progression and non-progression groups. CONCLUSION: Similar to MPFLR for recurrent cases, MPFLR with AMZ can improve the clinical and radiographic outcomes in severe cases. The remaining parameters of patellar instability could be affected in the postoperative progression of PFOA after MPFL reconstruction with or without AMZ of TTO for patellar instability.


Assuntos
Doenças Ósseas , Luxações Articulares , Instabilidade Articular , Osteoartrite do Joelho , Luxação Patelar , Articulação Patelofemoral , Humanos , Luxação Patelar/diagnóstico por imagem , Luxação Patelar/cirurgia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Estudos Retrospectivos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Recidiva , Ligamentos Articulares/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Osteotomia/métodos , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia
6.
BMC Musculoskelet Disord ; 24(1): 14, 2023 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-36611141

RESUMO

BACKGROUND: During medial opening wedge high tibial osteotomy (MOWHTO), sometimes the plate tends to be positioned anteromedially. The plate position can affect the length of the proximal screw, which significantly affects stability after osteotomy. Therefore, research on the correlation among plate position, screw length, and clinical outcomes is needed. METHODS: This retrospective review examines 196 knees in 175 patients who underwent MOWHTO from May 2012 to December 2018, for symptomatic medial compartment osteoarthritis with a varus alignment of > 5°. We evaluated the anteroposterior plate position, length of proximal screw, and postoperative computed tomography (CT). We reviewed patients' clinical outcome scores, presence of lateral hinge fracture, neurovascular complications, and infection. The correlation among proximal plate position, proximal screw length, and clinical outcomes was evaluated using Pearson's correlation analysis. A subgroup analysis by screw angle (> 48 ° or < 48 °) was also performed using chi-square test and Student t-test. RESULTS: The mean proximal plate position was 16.28% (range, 5.17-44.74) of the proximal tibia's anterior-to-posterior distance ratio, and the proximal screw length averaged 63.8 mm (range, 44-80 mm). Proximal posteromedial plate position and proximal screw length were significantly correlated (r2 = 0.667, P < .001), as were screw angle and length (r2 = 0.746, P < .001). Medial plating (< 48°) can use a longer proximal screw; nevertheless, no significant difference occurred in clinical outcomes between the two groups. Also, no differences occurred in complication rate, including hinge fracture. CONCLUSION: With more medially positioned plating during MOWHTO, we can use longer proximal screws. However, there was no significant difference in clinical outcomes and the incidence of lateral hinge fractures regardless of plate position and screw length.


Assuntos
Fraturas Ósseas , Osteoartrite do Joelho , Humanos , Placas Ósseas , Parafusos Ósseos/efeitos adversos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/diagnóstico por imagem , Osteoartrite do Joelho/cirurgia , Osteotomia/efeitos adversos , Osteotomia/métodos , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
7.
Arthroscopy ; 39(2): 335-336, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36604000

RESUMO

The most common adverse event during opening-wedge high tibial osteotomy is lateral hinge fracture. It may be caused by a variety of factors, including an insufficient osteotomy, a large opening gap, an inappropriate hinge position, and early weight bearing with compromised fixation. In addition, particularly in men, posterolateral protrusion of the proximal tibial condyle often results in an insufficient posterior cortical osteotomy owing to surgical overprotection in an effort to avoid popliteal vessel injury. An insufficient posterolateral osteotomy shifts the hinge point posteriorly, resulting in an unstable hinge fracture during opening of the osteotomy wedge, as well as undesirable changes in the mechanical axis. A solution in patients with a large posterolateral proximal tibial condyle could be to shift the osteotomy slightly distally. Surgeons should be mindful of individual proximal tibial morphology in the area of the lateral hinge.


Assuntos
Osteoartrite do Joelho , Fraturas da Tíbia , Lesões do Sistema Vascular , Masculino , Humanos , Tíbia/cirurgia , Fraturas da Tíbia/cirurgia , Fraturas da Tíbia/etiologia , Osteotomia/efeitos adversos , Osteotomia/métodos , Próteses e Implantes/efeitos adversos , Lesões do Sistema Vascular/etiologia , Osteoartrite do Joelho/cirurgia
8.
Arthroscopy ; 39(2): 283-284, 2023 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-36603997

RESUMO

Borderline hip dysplasia (BHD) is often defined based on the lateral center edge angle. While patients with frank hip dysplasia often require bony realignment with periacetabular osteotomy and/or derotational femoral osteotomy, patients with BHD represent an "in-between" group of patients. While many, perhaps even most, patients with BHD will have successful outcomes after hip arthroscopy alone, some will be unresponsive to an arthroscopic-only approach and require the same surgical treatments as those with frank dysplasia. A variety of radiographic and arthroscopic parameters can be used to assess the degree of instability in patients with BHD. It may be that patients with "borderline" hip dysplasia combined with hip instability are more likely to fail an arthroscopic-only approach but to date we still do not have a great algorithm for determining which patients with BHD should undergo bony treatment with periacetabular osteotomy. It is important for future studies to continue to seek out characteristics of BHD patients that predict failure of an arthroscopic-only approach. This will not only allow for optimal initial surgical treatment in "at-risk" patients with BHD but will also improve success rates in BHD patients selected for hip arthroscopy as initial surgical treatment.


Assuntos
Luxação Congênita de Quadril , Luxação do Quadril , Humanos , Luxação do Quadril/cirurgia , Artroscopia , Luxação Congênita de Quadril/cirurgia , Reoperação , Osteotomia , Resultado do Tratamento , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Estudos Retrospectivos
9.
Can J Vet Res ; 87(1): 67-73, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36606042

RESUMO

The objective of this retrospective case series was to report overall peri-operative complications, short- to mid-term outcome, and owner satisfaction of closing tibial wedge osteotomy (CTWO) using locking compression plates, in dogs weighing ≤ 20 kg, for the treatment of cranial cruciate ligament disease. Medical records from 2015 to 2020 were reviewed for surgical technique, intraoperative findings, and complications. Pre- and postoperative radiographs were evaluated for healing, complications, and tibial plateau angles (TPAs). A follow-up telephone questionnaire was used to evaluate patient outcome and owner satisfaction. Eighty-one client-owned dogs (12.0 kg ± 3.0 kg; 95% CI: 8.4 to 15.5) (N = 89 stifles) were included in the study. Mean tibial plateau angles at preoperative, postoperative, and 8-week follow-up were 29.7° ± 4.1° (95% CI: 25.5 to 33.8), 6.7° ± 2.6° (95% CI: 4.2 to 9.2), and 7.8° ± 2.4° (95% CI: 4.9 to 10.6), respectively. Tibial plateau angles had significantly increased at the 8-week follow-up assessment by 1.04° ± 1.8°; 95% CI: -0.8 to -2.8) compared to immediately postoperative. The postoperative complication rate was 4.49% (4 cases). Overall satisfaction was excellent with good return to limb function. Closing tibial wedge osteotomy can be performed in dogs ≤ 20 kg, using locking compression plates, achieving excellent overall owner satisfaction and return to function.


L'objectif de cette série de cas rétrospectifs était de rapporter les complications peropératoires globales, les résultats à court et à moyen terme et la satisfaction du propriétaire de l'ostéotomie de fermeture du coin tibial (CTWO) à l'aide de plaques de compression verrouillables, chez les chiens pesant ≤ 20 kg, pour le traitement de pathologie du ligament croisé crânien.Les dossiers médicaux de 2015 à 2020 ont été examinés pour la technique chirurgicale, les résultats peropératoires et les complications. Les radiographies pré- et postopératoires ont été évaluées pour la guérison, les complications et les angles du plateau tibial (TPA). Un questionnaire téléphonique de suivi a été utilisé pour évaluer les résultats des patients et la satisfaction des propriétaires.Quatre-vingt-un chiens de clients (12,0 kg ± 3,0 kg; IC à 95 % : 8,4 à 15,5) (N = 89 grassets) ont été inclus dans l'étude. Les angles moyens du plateau tibial en préopératoire, postopératoire et à 8 semaines de suivi étaient de 29,7° ± 4,1° (IC à 95 % : 25,5 à 33,8), 6,7° ± 2,6° (IC à 95 % : 4,2 à 9,2) et 7,8° ± 2,4° (IC à 95 % : 4,9 à 10,6), respectivement. Les angles du plateau tibial avaient significativement augmenté lors de l'évaluation de suivi à 8 semaines de 1,04° ± 1,8°; IC à 95 % : −0,8 à −2,8) par rapport à immédiatement postopératoire. Le taux de complications postopératoires était de 4,49 % (quatre cas). La satisfaction globale était excellente avec un bon retour à la fonction des membres.L'ostéotomie de fermeture du coin tibial peut être réalisée chez les chiens ≤ 20 kg, à l'aide de plaques de compression verrouillables, ce qui permet d'obtenir une excellente satisfaction globale du propriétaire et un retour à la fonction.(Traduit par Docteur Serge Messier).


Assuntos
Ligamento Cruzado Anterior , Doenças do Cão , Cães , Animais , Estudos Retrospectivos , Ligamento Cruzado Anterior/cirurgia , Osteotomia/efeitos adversos , Osteotomia/veterinária , Osteotomia/métodos , Complicações Pós-Operatórias/veterinária , Tíbia/cirurgia , Doenças do Cão/cirurgia
10.
Zhonghua Yi Xue Za Zhi ; 103(1): 25-31, 2023 Jan 07.
Artigo em Chinês | MEDLINE | ID: mdl-36594134

RESUMO

Objective: To investigate the correlation between the first tarsometatarsal joint (TMT1) sagittal mobility and hallux valgus (HV) combined with transfer metatarsalgia (TM). Methods: The weight-bearing CT (WBCT) imaging data of 111 HV patients (167 feet) who were treated at the Foot and Ankle Surgery Center, Beijing Tongren Hospital Affiliated to Capital Medical University from January 2018 to January 2020 were retrospectively analyzed. The patients underwent PedCAT WBCT scans of both feet, and the hallux valgus angle (HVA), intermetatarsal angle (IMA), plantar distance (PD), medial cuneiform-first metatarsal angle (CMA) and metatarsal protrusion distance (MPD) were measured using CubeVue software. PD and CMA were signs of TMT1 instability. Visual analogue scale (VAS) and foot and ankle ability measures (FAAM) scores were obtained. The patients were divided into TM group and non-TM group according to the presence of metatarsalgia. The TM group and the non-TM group were compared in terms of HVA, IMA, PD, CMA, MPD, VAS and FAAM. Correlations between PD, CMA and HVA, IMA, VAS, FAAM were analyzed using Spearman correlation. Results: Total of 111 cases were included in this study, there were 35 males and 76 females with a mean age of (57.7±14.1) years. The average values of HVA (37.9°±8.6°), IMA (17.9°±2.6°), CMA (2.1°±0.3°) and PD [(1.8±0.4) mm] in TM group were all significantly higher than those in the non-TM group [HVA (32.5°±9.1°), IMA (15.1°±3.4°), CMA (1.7°±0.3°) and PD (1.6±0.2) mm] (All P<0.001). There was no significant difference in MPD between the two groups (P=0.580). The TM group demonstrated a higher VAS score when compared with the non-TM group (P<0.001). The FAAM score of the TM group (54.1±11.8) was significantly lower than that in the non-TM group (66.2±11.4) (P<0.001). The results of Spearman correlation analysis showed that there was no correlation between PD and HVA, IMA and VAS score. There was a negative correlation between PD, CMA and FAAM score, and the difference was statistically significant (rs=-0.637, -0.254, both P<0.001); CMA was positively correlated with HVA, IMA, and VAS score (rs=0.603, 0.971, 0.269, all P<0.001). Conclusions: WBCT is helpful for the diagnosis of TMT1 sagittal instability. The severity of TMT1 sagittal instability is positively correlated with hallux valgus and TM. The TMT1 instability may play an important role in the pathogenesis of hallux valgus.


Assuntos
Hallux Valgus , Ossos do Metatarso , Metatarsalgia , Masculino , Feminino , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Hallux Valgus/diagnóstico por imagem , Hallux Valgus/cirurgia , Estudos Retrospectivos , Radiografia , Osteotomia/métodos , Ossos do Metatarso/cirurgia , Resultado do Tratamento
11.
Eur Rev Med Pharmacol Sci ; 27(1): 144-150, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36647862

RESUMO

OBJECTIVE: This study aims to investigate the incidence of adductor tubercle tendinitis (ATT) and demonstrate the effects of intraoperative steroid injections on clinical outcomes in patients undergoing high tibial osteotomy (HTO) due to genu varum (GV). PATIENTS AND METHODS: Of 738 patients who underwent HTO due to GV between 2014-2021, 454 patients had accompanying preoperative ATT. Of these patients, 324 patients who presented to follow-ups and had adequate medical records were evaluated. Mean patient age was 52.6 years. Patients who received steroid injections to the adductor tubercle during HTO (Group I, n=182) and patients who did not receive injections (Group II, n=142) were compared. Univariate and multivariate logistic regression analyses were performed by evaluating preoperative and postoperative VAS scores and presence of ATT. RESULTS: Preoperative ATT sensitivity was present in 61% of the patients. ATT findings were significantly less in Group I compared to Group II in the early-term (1-3 months) (p=0.0001), while there was no significant difference in the late-term (6-12 months) (p=0.880). There was no statistically significant difference between the preoperative and postoperative VAS scores of the groups (p=0.0001). CONCLUSIONS: Stress and tendinitis often develop in the adductor muscle groups due to increased adductor moment in GV. We believe that tendinitis contributes to increased knee pain. HTO reduces the symptoms of tendinitis in the long term by decreasing the adductor moment, while intra-operative steroid injections contribute to relieving complaints related to tendinitis in the early term.


Assuntos
Genu Varum , Osteoartrite do Joelho , Tendinopatia , Humanos , Pessoa de Meia-Idade , Genu Varum/complicações , Incidência , Osteoartrite do Joelho/cirurgia , Tíbia/cirurgia , Articulação do Joelho/cirurgia , Osteotomia/efeitos adversos , Osteotomia/métodos , Tendinopatia/epidemiologia , Tendinopatia/cirurgia , Tendinopatia/complicações , Esteroides , Resultado do Tratamento
12.
Ugeskr Laeger ; 185(2)2023 Jan 09.
Artigo em Dinamarquês | MEDLINE | ID: mdl-36636936

RESUMO

Pes planovalgus (PV) in early childhood is a common physiological state, and usually resolves throughout childhood. Parental concern often leads to seeking medical advice. This review summarises the current knowledge of the different types of PV. Asymptomatic PV does not need treatment, but corrective footwear can be utilised for painful PV. Orthopaedic referral is needed if conservative treatment is not sufficient. It is important to distinguish between flexible and rigid PV, since rigid PV can be a sign of underlying pathologies and needs referral to orthopaedic surgeons. Further studies are needed to investigate for predictive factors to develop painful PV.


Assuntos
Pé Chato , Humanos , Criança , Pré-Escolar , Pé Chato/diagnóstico , Pé Chato/cirurgia , Dor , Osteotomia , Imagem de Difusão por Ressonância Magnética , Tratamento Conservador
13.
BMC Oral Health ; 23(1): 13, 2023 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-36627621

RESUMO

PURPOSE: To explore the outcomes of bone augmentation in the aesthetic zone of the anterior teeth using computer-aided design and a 3D-printed template. METHODS: Ten patients with severe bone defects in the aesthetic zone of anterior teeth were included in the study; CT data were collected before surgery. The design of the osteotomy line in the bone defect area was determined under computer simulation. The position parameters and osteotomy line of the free bone were determined via virtual surgery. A 3D-printed template was prepared to guide the accurate placement of the bone graft. Reexamination was conducted to evaluate the position of the bone graft immediately after the operation and the resorbed capacity of the bone graft before implant restoration. RESULTS: The position of the bone graft was consistent with the preoperative design. The amount of bone graft resorbed was within the acceptable range three months after the operation, and the effect of implant restoration was satisfactory. CLINICAL SIGNIFICANCE: Use of computer-aided design and a 3D-printed template can be an effective approach for accurate bone augmentation in the aesthetic zone of the anterior teeth.


Assuntos
Desenho Assistido por Computador , Estética Dentária , Impressão Tridimensional , Humanos , Simulação por Computador , Osteotomia
14.
BMC Musculoskelet Disord ; 24(1): 10, 2023 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-36609310

RESUMO

BACKGROUND: Ulnar shortening osteotomy (USO) is a common surgical procedure for the treatment of ulnar impaction syndrome (UIS). The purpose of this study was to compare the results of metaphyseal and diaphyseal USO.  METHODS: This retrospective study compared the clinical outcomes and complications of 32 patients who underwent diaphyseal step-cut USO (n = 10), diaphyseal oblique USO (n = 12), or metaphyseal USO (n = 10). RESULTS: Patient characteristics, ulnar variance, wrist range of motion, preoperative pain, grip strength, and functional scores (quick disability of the arm, shoulder, and hand and patient-rated wrist evaluation) were comparable. Both operation time (79.5 vs. 138/139 min) and incision length (7.80 vs. 9.67/13.00 cm) were shorter in the metaphyseal USO than in the diaphyseal oblique/step-cut USO. Compared with diaphyseal oblique/step-cut USO, metaphyseal osteotomies were associated with greater improvement in the pain on postoperative day 3 and shorter bone healing time. The requirements for implant removal were the same among the three groups. No complications were observed in any group. CONCLUSION: Compared with diaphyseal USO, metaphyseal USO has advantages for operation time and incision length, early postoperative pain, bone healing in UIS management. The results suggested that metaphyseal USO could be widely applied to the surgical treatment of UIS. However, the long-term outcomes of these techniques still require further evaluation using more large-scale, randomized clinical trials.


Assuntos
Artropatias , Ulna , Humanos , Estudos Retrospectivos , Ulna/diagnóstico por imagem , Ulna/cirurgia , Artropatias/cirurgia , Osteotomia/métodos , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/cirurgia , Artralgia/cirurgia , Resultado do Tratamento , Amplitude de Movimento Articular
15.
BMJ Case Rep ; 16(1)2023 Jan 12.
Artigo em Inglês | MEDLINE | ID: mdl-36634991

RESUMO

A woman in her late 70s with bilateral total hip arthroplasty (THA) presented with left hip pain arising immediately after the last THA procedure, progressively worsening. Clinically, a severe abductor insufficiency with Trendelenburg limp was observed. Moreover, symptomatic leg length discrepancy required a contralateral heel lift of 0.5 cm. She was previously managed conservatively without any clinical benefit. Radiographs showed a well-fixed uncemented straight, sitting proud stem. MRI showed a large abductor tear. A minimally invasive proximal advancement of the greater trochanter was planned to allow direct surgical repair of the abductor lesion. The patient made a good recovery, and 12 months after surgery, wire removal was performed. The patient gained significant improvements in hip function (Harris Hip Score from 52 to 89), full limp recovery and complete pain relief at 13 months follow-up from primary surgery.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Feminino , Humanos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Postura Sentada , Resultado do Tratamento , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Dor/cirurgia , Osteotomia/métodos , Estudos Retrospectivos
16.
J Bone Joint Surg Am ; 105(2): 137-144, 2023 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-36651889

RESUMO

BACKGROUND: The optimal surgical treatment (hip arthroscopy compared with periacetabular osteotomy [PAO]) for borderline acetabular dysplasia (lateral center-edge angle [LCEA], 18° to 25°) remains a topic of debate. To date, the literature has focused primarily on arthroscopy outcomes, with only a few small reports on PAO outcomes. The purpose of this study was to define PAO outcomes in a large cohort of borderline hips. In a secondary analysis, we assessed the effect of prior failed arthroscopy, concurrent hip arthroscopy, and concurrent femoral osteoplasty on PAO outcomes in this cohort. METHODS: A prospective database was retrospectively reviewed for patients who underwent PAO for symptomatic instability in the setting of borderline dysplasia (LCEA, 18° to 25°). Of the 232 identified hips, 186 (80.2%) were assessed at a mean follow-up of 3.3 ± 2.0 years postoperatively. The mean patient age was 25.2 ± 8.5 years (range, 14 to 45 years), and 88.2% were female. Thirty hips (16.1%) had undergone a failed prior arthroscopy. Arthroscopy was performed concurrently with the PAO in 130 hips (69.9%), and femoral osteoplasty was performed concurrently in 120 hips (64.5%). The modified Harris hip score (mHHS) was assessed relative to the minimal clinically important difference (MCID) of 8 and patient acceptable symptom state (PASS) of 74. Clinical failure was defined as a reoperation for persistent symptoms or a failure to achieve either the mHHS MCID or PASS. RESULTS: Of the 156 hips undergoing a primary surgical procedure, clinical success was achieved in 148 hips (94.9% [95% confidence interval (CI), 90.2% to 97.4%]). Two hips (1.3% [95% CI, 0.4% to 4.6%]) underwent reoperation (hip arthroscopy) for persistent symptoms and an additional 6 hips (3.8% [95% CI, 1.8% to 8.1%]) failed to achieve the mHHS MCID or PASS, for a clinical failure rate of 5.1% (95% CI, 2.6% to 9.8%); 8.8% reported dissatisfaction with the surgical procedure. Clinical failure was more frequent among the 30 hips (23.3% [95% CI, 11.8% to 40.9%]; p = 0.001) that had undergone a prior failed arthroscopy. There were no outcome differences between hips that had or had not undergone concurrent hip arthroscopy or femoral osteoplasty. CONCLUSIONS: This study demonstrates excellent early outcomes of PAO for borderline acetabular dysplasia, with significant clinical improvement in 94.9% of patients undergoing a primary surgical procedure; 91.2% were satisfied with the surgical procedure. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Luxação Congênita de Quadril , Luxação do Quadril , Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Luxação do Quadril/cirurgia , Luxação Congênita de Quadril/cirurgia , Osteotomia/métodos , Artroscopia/métodos , Articulação do Quadril/cirurgia , Acetábulo/cirurgia
19.
J Plast Reconstr Aesthet Surg ; 76: 34-43, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36513002

RESUMO

PURPOSE: Despite maxillo-malar osteotomies having been discarded in the most recent literature, in the setting of orthognathic surgery they provide several advantages for middle third augmentation. This paper reintroduces maxillo-malar osteotomies as an effective method to increase volume of midfacial region in combination with contemporary technology, including piezosurgery, virtual surgical planning, and navigation. MATERIAL AND METHODS: Eighteen patients with midface hypoplasia were included in this study and underwent orthognathic surgery with maxillo-malar osteotomies. All patients underwent the same workflow: virtual design of maxillo-malar osteotomies, surgery with navigation-assisted piezoelectric osteotomies, and computerized morphometric analysis. RESULTS: Simulated maxillo-malar osteotomies were successfully replicated in the operating room, as shown by accuracy evaluation performed using three-dimensional analysis. In long-term follow-up period, no permanent complications were assessed. Superimposition between postoperative and preoperative CBCTs revealed that the soft tissue area influenced by the underlying skeletal movement was comparable for all cases. CONCLUSIONS: Virtual surgical planning, navigation, and piezosurgery are today indispensable tools to perform maxillo-malar osteotomies safely and accurately. We suggest incorporating such osteotomies in the surgeon's armamentarium for patients with severe midfacial hypoplasia as they offer an integrated solution to restore functionality and aesthetics.


Assuntos
Ossos Faciais , Osteotomia , Humanos , Ossos Faciais/cirurgia , Osteotomia/métodos , Zigoma/cirurgia , Face , Computadores
20.
J Pediatr Orthop ; 43(1): e17-e24, 2023 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-36509455

RESUMO

BACKGROUND: Fractures around the elbow are common in children. Their management remains challenging. Inadequate treatment often leads to malunion, causing growth disturbance or avascular necrosis. This can develop into cubital axis deformities. This study evaluated our modified supracondylar dome osteotomy technique for acute correction of posttraumatic cubital axis deformities in adolescent patients. METHODS: Eighteen cases of posttraumatic cubital axis deformity that underwent acute correction through supracondylar dome osteotomy in our department between 2012 and 2019 were retrospectively evaluated. The radiologic results were measured through the carrying angle. The clinical functional outcomes were assessed using the Mayo Elbow Performance Index. RESULTS: No neurovascular injuries occurred and there was no notable loss of muscular strength or functional deficiencies in any of the patients. Symmetrical cubital axes were achieved in all cases. All cases were consolidated in a timely matter and no malunion was observed upon consolidation. Besides 1 case of hardware damage caused by a severe fall due to heavy alcohol intoxication, there was no correction loss, no secondary displacement, and no implant-related discomfort. None of the patients were left with a limited range of motion or reduced weight-bearing capacity. An excellent level of elbow functionality was achieved in all cases, with an average Mayo Elbow Performance Index of 97.8. CONCLUSIONS: The supracondylar dome osteotomy technique showed promising results in both radiologic outcomes and clinical performance, with a low complication rate. The dome-shaped osteotomy allows simultaneous multiplanar correction of not only varus or valgus deformities but also additional extension or flexion deformities. This technique also enables translation of the distal fragment in the frontal plane, which contributes to a more balanced anatomic geometry of the distal humerus. We consider the posterior triceps-splitting approach to be a safe technique that preserves muscle strength and improves the cosmetic appearance of the surgical scar. We recommend a cast-free plate fixation to allow early movement after surgery. We believe any residual deformities that present 18 months after the initial trauma should be addressed through surgical correction before clinical symptoms become apparent to avoid the chronic manifestation of functional deficiencies. LEVEL OF EVIDENCE: Level IV, therapeutic study, case series.


Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Criança , Humanos , Adolescente , Deformidades Articulares Adquiridas/cirurgia , Fraturas do Úmero/cirurgia , Fraturas do Úmero/complicações , Estudos Retrospectivos , Osteotomia/métodos , Articulação do Cotovelo/cirurgia , Amplitude de Movimento Articular/fisiologia , Resultado do Tratamento
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