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1.
Endocr Pract ; 27(5): 408-412, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33934751

RESUMO

OBJECTIVE: To investigate the added value of 1/3 radius (1/3R) for the diagnosis of osteoporosis by spine and hip sites and its correlation with prevalent fractures and predicted fracture risk. METHODS: Fracture Risk Assessment Tool (FRAX) scores for hip and major osteoporotic fractures (MOF) with/without trabecular bone score were considered proxy for fracture risk. The contribution of 1/3R to risk prediction was depicted via linear regression models with FRAX score as the dependent variable-first only with central and then with radius T-score as an additional covariate. Significance of change in the explained variance was compared by F-test. RESULTS: The study included 1453 patients, 86% women, aged 66 ± 10 years. A total of 32% (n = 471) were osteoporotic by spine/hip and 8% (n = 115) by radius only, constituting a 24.4% increase in the number of subjects defined as osteoporotic (n = 586, 40%). Prior fracture prevalence was similar among patients with osteoporosis by spine/hip (17.4%) and radius only (19.1%) (P = .77). FRAX prediction by a regression model using spine/hip T-score yielded explained variance of 51.8% and 49.9% for MOF and 39.8% and 36.4% for hip (with/without trabecular bone score adjustment, respectively). The contribution of 1/3R was statistically significant (P < .001) and slightly increased the explained variance to 52.3% and 50.4% for MOF and 40.9% and 37.4% for hip, respectively. CONCLUSION: Reclassification of BMD results according to radius measurements results in higher diagnostic output. Prior fractures were equally prevalent among patients with radius-only and classic-site osteoporosis. FRAX tool performance slightly improved by incorporating radius BMD. Whether this approach may lead to a better fracture prediction warrants further prospective evaluation.


Assuntos
Fraturas do Quadril , Osteoporose , Fraturas por Osteoporose , Absorciometria de Fóton , Idoso , Densidade Óssea , Feminino , Fraturas do Quadril/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Fraturas por Osteoporose/epidemiologia , Rádio (Anatomia)/diagnóstico por imagem , Medição de Risco , Fatores de Risco
2.
Artigo em Inglês | MEDLINE | ID: mdl-33803781

RESUMO

This study examines the functional model of bone development in peri-pubertal boys and girls. Specifically, we implemented a mixed-longitudinal design and hierarchical structural models to provide experimental evidence in support of the conceptual functional model of bone development, postulating that the primary mechanical stimulus of bone strength development is muscle force. To this end, we measured radial and tibial bone properties (speed of sound, SOS), isometric grip and knee extensors strength, bone resorption (urinary NTX concentration), body mass index (BMI), somatic maturity (years from peak height velocity) and skeletal maturity (bone age) in 180 children aged 8-16 years. Measurements were repeated 2-4 times over a period of 3 years. The multilevel structural equation modeling of 406 participant-session observations revealed similar results for radial and tibial SOS. Muscle strength (i.e., grip strength for the radial and knee extension for tibial model) and NTX have a significant direct effect on bone SOS (ß = 0.29 and -0.18, respectively). Somatic maturity had a direct impact on muscle strength (ß = 0.24) and both a direct and indirect effect on bone SOS (total effect, ß = 0.30). Physical activity and BMI also had a significant direct impact on bone properties, (ß = 0.06 and -0.18, respectively), and an additional significant indirect effect through muscle strength (ß = 0.01 and 0.05, respectively) with small differences per bone site and sex. Muscle strength fully mediated the impact of bone age (ß = 0.14) while there was no significant effect of energy intake on either muscle strength or bone SOS. In conclusion, our results support the functional model of bone development in that muscle strength and bone metabolism directly affect bone development while the contribution of maturity, physical activity, and other modulators such as BMI, on bone development is additionally modulated through their effect on muscle strength.


Assuntos
Osso e Ossos , Força Muscular , Adolescente , Densidade Óssea , Desenvolvimento Ósseo , Criança , Feminino , Humanos , Masculino , Rádio (Anatomia)/diagnóstico por imagem , Tíbia , Ultrassonografia
3.
Medicine (Baltimore) ; 100(12): e24324, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761632

RESUMO

ABSTRACT: To evaluate the feasibility of utilizing ultrasonography to monitor the fracture reduction and elastic intramedullary nail fixation processes in treating children with double forearm fractures. A retrospective analysis of 30 children with double forearm fractures treated at our hospital between January 2016 and July 2018. The children were aged 3 to 10 years. All patients were treated with closed reduction and internal fixation with elastic intramedullary nails using intraoperative ultrasound monitoring and intermittent radiographic imaging. The closed reduction and fixation were successful in all patients. The operation times ranged from 16 to 30 minutes, averaging 21 minutes. No neurovascular injuries occurred during closed reduction and nail insertion. Moreover, closed reduction was successful in the first attempt in 86.7% of patients. All patient outcomes were optimal, lacking serious complications during follow-ups. Intraoperative ultrasound monitoring can clearly show the shape and changes in fracture ends, distal growth plates, and surrounding soft tissues, and fracture reduction and passage of elastic nail processes at fracture ends during closed reduction; therefore, visualizing closed reductions can be achieved. The combination of intraoperative ultrasound and radiographic imaging can ensure operative effects and significantly reduce radiation exposure for both doctors and patients. An adequately powered prospective randomized trial is required to confirm our findings.


Assuntos
Antebraço/diagnóstico por imagem , Fixação Intramedular de Fraturas/instrumentação , Monitorização Intraoperatória/métodos , Fraturas do Rádio/cirurgia , Fraturas da Ulna/cirurgia , Pinos Ortopédicos , Criança , Pré-Escolar , Redução Fechada , Estudos de Viabilidade , Feminino , Humanos , Masculino , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/lesões , Rádio (Anatomia)/cirurgia , Fraturas do Rádio/complicações , Fraturas do Rádio/diagnóstico , Estudos Retrospectivos , Resultado do Tratamento , Ulna/diagnóstico por imagem , Ulna/lesões , Ulna/cirurgia , Fraturas da Ulna/complicações , Fraturas da Ulna/diagnóstico , Ultrassonografia
4.
Bone Joint J ; 103-B(3): 530-535, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33641422

RESUMO

AIMS: It has been hypothesized that proximal radial neck resorption (PRNR) following press-fit radial head arthroplasty (RHA) is due to stress-shielding. We compared two different press-fit stems by means of radiographs to investigate whether the shape and size of the stems are correlated with the degree of PRNR. METHODS: The radiographs of 52 RHAs were analyzed both at 14 days postoperatively and after two years. A cylindrical stem and a conical stem were implanted in 22 patients (group 1) and 30 patients (group 2), respectively. The PRNR was measured in the four quadrants of the radial neck and the degree of stem filling was calculated by analyzing the ratio between the prosthetic stem diameter (PSD) and the medullary canal diameter (MCD) at the proximal portion of the stem (level A), halfway along the stem length (level B), and distally at the stem tip (level C). RESULTS: Overall, 50 of the 52 patients displayed PRNR. The mean PRNR observed was 3.9 mm (0 to 7.4). The degree of endomedullary stem filling at levels A, B, and C was 96%, 90%, and 68% in group 1, and 96%, 72%, and 57%, in group 2, with differences being significant at levels B (p < 0.001) and C (p < 0.001). No significant correlations emerged between the severity of PRNR and the three stem/canal ratios either within each group or between the groups. CONCLUSION: PRNR in press-fit RHA appears to be independent of the shape and size of the stems. Other causes besides stem design should be investigated to explain completely this phenomenon. Cite this article: Bone Joint J 2021;103-B(3):530-535.


Assuntos
Artroplastia de Substituição do Cotovelo , Prótese de Cotovelo , Desenho de Prótese , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estresse Mecânico
5.
Zhongguo Gu Shang ; 34(2): 153-6, 2021 Feb 25.
Artigo em Chinês | MEDLINE | ID: mdl-33666003

RESUMO

OBJECTIVE: To investigate specific technique and clinical effects of closed folding top consolidation maneuver combined with splint fixation maneuver for consolidation and cedar bark external fixation splint for the treatment of double fractures of distal ulna and radius in children. METHODS: From January 2017 to December 2019, 17 children with double fractures of distal ulna and radius were treated with closed folded apex consolidation maneuver, including 13 males and 4 females, aged from 4 to 11 years old with an average of (7.29±2.34) years old. The fractures were fixed with cedar bark splint and followed up for 6 months, and alignment of fracture was evaluated according to the latest X-rays by follow up, and function of the affected limbs was evaluated by Anderson forearm function evaluation criteria. RESULTS: Fifteen of 17 children were successfully reset immediately, and 2 children were successfully reset again. The average fixed time was (25.00±3.35) days. At 6 months of follow up, 12 patients got excellent results, 3 good, 2 fair, and 0 poor according to Anderson forearm function evaluation criteria. The position of all children were larger than 3/4, and 10 children were received anatomical reduction, alignment of 4 children was less than 10°, 3 children was less than 15°. No complications such as fracture displacement, nonunion, compartment syndrome, and forearm rotation dysfunction occurred. CONCLUSION: Restoration of distal radius double fracture in children with the combination of the closed folding and top fixation maneuver and splint fixation maneuver has advantages of higher success rate, lower complications, which could reduce operating difficultyand pain of patients.


Assuntos
Fraturas do Rádio , Fraturas da Ulna , Idoso , Criança , Pré-Escolar , Feminino , Fixação de Fratura , Fixação Interna de Fraturas , Humanos , Masculino , Rádio (Anatomia) , Fraturas do Rádio/terapia , Contenções , Resultado do Tratamento , Ulna
6.
Am J Sports Med ; 49(5): 1152-1159, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33635730

RESUMO

BACKGROUND: The proximity of the posterior interosseous nerve (PIN) to the bicipital tuberosity is clinically important in the increasingly popular anterior single-incision technique for distal biceps tendon repair. Maximal forearm supination is recommended during tendon reinsertion from the anterior approach to ensure the maximum protective distance of the PIN from the bicipital tuberosity. PURPOSE: To compare the location of the PIN on magnetic resonance imaging (MRI) relative to bicortical drill pin instrumentation for suspensory button fixation via the anterior single-incision approach in varying positions of forearm rotation. STUDY DESIGN: Descriptive laboratory study. METHODS: Axial, non-fat suppressed, T1-weighted MRI scans of the elbow were obtained in positions of maximal supination, neutral, and maximal pronation in 13 skeletally mature individuals. Distances were measured from the PIN to (1) the simulated path of an entering guidewire (GWE-PIN) and (2) the cortical starting point of the guidewire on the bicipital tuberosity (CSP-PIN) achievable from the single-incision approach. To radiographically define the location of the nerve relative to constant landmarks, measurements were also made from the PIN to (3) the prominent-most point on the bicipital tuberosity (BTP-PIN) and (4) a perpendicular plane trajectory from the bicipital tuberosity exiting the opposing radial cortex (PPT-PIN). All measurements were subsequently compared between positions of pronation, neutral, and supination. In supination only, BTP-PIN and PPT-PIN measurements were made and compared at 3 sequential axial levels to evaluate the longitudinal course of the nerve relative to the bicipital tuberosity. RESULTS: Of the 13 study participants, mean age was 38.77 years, and mean body mass index was 25.58. Five participants were female, and 5 left and 8 right elbow MRI scans were reviewed. The GWE-PIN was significantly greater in supination (mean ± SD, 16.01 ± 2.9 mm) compared with pronation (13.66 ± 2.5 mm) (P < .005). The mean CSP-PIN was significantly greater in supination (16.20 ± 2.8 mm) compared with pronation (14.18 ± 2.4 mm) (P < .013).The mean PPT-PIN was significantly greater in supination (9.00 ± 3.0 mm) compared with both pronation (1.96 ± 1.2 mm; P < .001) and neutral (4.73 ± 2.6 mm; P < .001). The mean BTP-PIN was 20.54 ± 3.0, 20.81 ± 2.7, and 20.35 ± 2.9 mm in pronation, neutral, and supination, respectively, which did not significantly differ between positions. In supination, the proximal, midportion, and distal measurements of BTP-PIN did not significantly differ. The proximal PPT-PIN distance (9.08 ± 2.9 mm) was significantly greater than midportion PPT-PIN (5.85 ± 2.4 mm; P < .001) and distal BTP-PIN (2.27 ± 1.8 mm; P < .001). CONCLUSION: This MRI study supports existing evidence that supination protects the PIN from the entering guidewire instrumentation during anterior, single-incision biceps tendon repair using cortical button fixation. The distances between the entering guidewire trajectory and PIN show that guidewire-inflicted injury to the nerve is unlikely during the anterior single-incision approach. CLINICAL RELEVANCE: When a safe technique is used, PIN injuries during anterior repair are likely the result of aberrant retractor placement, and we recommend against the use of retractors deep to the radial neck. Guidewire placement as close as possible to the anatomic footprint of the biceps tendon is safe from the anterior approach. MRI evaluation confirms that ulnar and proximal guidewire trajectory is the safest technique when using single-incision bicortical suspensory button fixation.


Assuntos
Antebraço , Rádio (Anatomia) , Adulto , Cadáver , Feminino , Antebraço/diagnóstico por imagem , Antebraço/cirurgia , Humanos , Imagem por Ressonância Magnética , Masculino , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Rotação , Supinação
7.
J Hand Surg Asian Pac Vol ; 26(1): 118-125, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33559562

RESUMO

Congenital radioulnar synostosis with posterior dislocation of the radial head remains challenging to treat. We describe a three-step treatment method that combines radial shaft osteotomy with a custom-made device, ulnar shaft osteotomy, and local adipofascial flap elevation procedures. For posterior radial head dislocation treatment, osteotomy near the proximal radius cannot recover physiological rotation of the radial head. Thus, we chose a precise radial shaft osteotomy with a custom-made device according to preoperative planning based on three-dimensional evaluation of the bone deformation. Performing radial shaft osteotomy alone, however, may not be enough to achieve sufficient supination range of motion. We, therefore, also performed ulnar shaft osteotomy. Finally, we elevated the local adipofascial flap to prevent re-adhesion. In three patients, the range of motion of the elbow improved postoperatively. In conclusion, our three-step method does not require a microsurgical technique and is easy to perform.


Assuntos
Articulação do Cotovelo/cirurgia , Luxações Articulares/cirurgia , Rádio (Anatomia)/anormalidades , Sinostose/cirurgia , Ulna/anormalidades , Placas Ósseas , Criança , Pré-Escolar , Simulação por Computador , Humanos , Imageamento Tridimensional , Masculino , Osteotomia , Cuidados Pré-Operatórios , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Cirurgia Assistida por Computador/instrumentação , Sinostose/diagnóstico por imagem , Transferência Tendinosa , Tomografia Computadorizada por Raios X , Ulna/diagnóstico por imagem , Ulna/cirurgia
8.
J Hand Surg Asian Pac Vol ; 26(1): 77-83, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33559579

RESUMO

Background: Literature has limited evidence concerning the morphology of volar surface of distal radius. A mismatch between the plate-contour and contour of the actual volar bony surface can result in malreduction. The purpose of this study is to analyze the normal curvature morphology of volar surface of distal radius and related parameters that can help in designing of the volar plates for fixation of distal radial fractures. Methods: We retrospectively analyzed CT scans of uninjured healthy distal radii performed during a one year period (2018-2019). The mediolateral extent of the pronator quadratus line, the mediolateral curve of the pronator quadratus line, the mediolateral surface angle between intermediate column and radial column of distal radius, the curvatures and locations of their vertices for radial and intermediate columns were measured. Results: A total of 84 CT-based studies were analyzed. The mediolateral extent of the pronator quadratus line, the mediolateral curve of the pronator quadratus line, and the mediolateral surface angle between intermediate column and radial column of the distal radius were 24.27 mm, 144.8 degrees and 163.1 degrees, respectively. The mean volar curvatures of the radial and intermediate columns were 156.5 and 151.4 degrees, respectively and distances of their vertices from the pronator-quadratus line were 10.96 mm and 14.13 mm, respectively. Conclusions: Considerable variations occur in curvature morphology of distal radial volar surface. A best fit rather than an anatomical fit can be considered during implant selection owing to these variations. Besides volar curvature of radial and ulnar columns, location of their vertices, mediolateral angulation and surface curvature between these columns at the level of watershed line should also be considered in plate selection. A combination of a few serial increments of the described parameters in the designs of volar fixation plates would be helpful for surgeons in the best implant selection.


Assuntos
Placas Ósseas , Desenho de Prótese , Fraturas do Rádio/cirurgia , Rádio (Anatomia)/anatomia & histologia , Rádio (Anatomia)/diagnóstico por imagem , Adolescente , Adulto , Feminino , Fixação Interna de Fraturas/instrumentação , Voluntários Saudáveis , Humanos , Imageamento Tridimensional , Masculino , Ajuste de Prótese , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Adulto Jovem
9.
BMC Musculoskelet Disord ; 22(1): 147, 2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33546669

RESUMO

BACKGROUND: There are disputes about which reduction technique should be adopted in treatment of distal radius-ulna fractures in older children who failed to achieve manual reduction. This study compared clinical effects between prying reduction with mosquito forceps (PRMF) and limited open reduction (LOR) of treating irreducible distal radius-ulna fractures in older children. METHODS: One hundred ten children with irreducible distal radius-ulna fractures were selected from January 2015 to December 2017 in Xi'an Hong Hui hospital. Retrospective analysis was performed. According to different reduction techniques, these children were divided into PRMF group (59 cases) and LOR group (51 cases). All children were treated with percutaneous Kirschner wire fixation and external fixation with plaster. Operation indexes, complications and wrist joint functions were compared between the two groups. RESULTS: Operation time of PRMF group was shorter than that of LOR group (P < 0.05). Incision length in PRMF group was less than that in LOR group (P < 0.05). Bleeding volume of PRMF group was less than that of LOR group (P < 0.05). Incidence of complications in PRMF group was lower than that in LOR group. CONCLUSIONS: Compared with limited open reduction, it has better clinical effects of prying reduction with mosquito forceps in treatment of irreducible distal radius-ulna fractures in older children. This technique has the advantages of simple operation, less trauma, less bleeding and fewer complications, which is worthy of clinical promotion.


Assuntos
Culicidae , Fraturas do Rádio , Fraturas da Ulna , Animais , Criança , Fixação Interna de Fraturas , Humanos , Rádio (Anatomia) , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Estudos Retrospectivos , Instrumentos Cirúrgicos , Resultado do Tratamento
10.
J Surg Oncol ; 123(5): 1304-1315, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33559165

RESUMO

BACKGROUND: The aims of this study are to evaluate the rate of wrist joint preservation, allograft retention, factors associated with reoperation and to report the patient reported outcomes after osteoarticular allograft reconstruction of the distal radius. METHODS: Retrospective chart review identified 33 patients who underwent distal radius resection followed by osteoarticular allograft reconstruction, including 27 giant cell tumors and 6 primary malignancies. Ten patients with a preserved wrist joint completed the QuickDASH, PROMIS-CA physical function, and Toronto extremity salvage score (TESS) at a median of 13 years postoperatively. RESULTS: The allograft retention rate was 89%, and an allograft fracture predisposed to conversion to wrist arthrodesis. The reoperation rate was 55% and 36% underwent wrist arthrodesis at a median of 4.2 years following index surgery. The use of locking plate fixation was associated with lower reoperation and allograft fracture rates. Patients reported a median QuickDASH of 10.2 (range: 0-52.3), a mean PROMIS physical function of 57.8 (range: 38.9-64.5) and the median TESS was 95.5 (range: 67.0-98.4). CONCLUSION: Osteoarticular allograft reconstruction results in acceptable long-term patient reported outcomes, despite a high revision rate. Allograft fixation with locking plates seems to reduce the number of reoperations and allograft fractures, along with reduction in wrist arthrodesis rates.


Assuntos
Neoplasias Ósseas/cirurgia , Tumor de Células Gigantes do Osso/cirurgia , Medidas de Resultados Relatados pelo Paciente , Rádio (Anatomia)/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reoperação/métodos , Articulação do Punho/cirurgia , Adulto , Aloenxertos , Artroplastia , Neoplasias Ósseas/patologia , Feminino , Seguimentos , Tumor de Células Gigantes do Osso/patologia , Humanos , Masculino , Rádio (Anatomia)/transplante , Estudos Retrospectivos , Articulação do Punho/patologia , Adulto Jovem
11.
J Vis Exp ; (168)2021 02 04.
Artigo em Inglês | MEDLINE | ID: mdl-33616093

RESUMO

Accurate measurement of skeletal kinematics in vivo is essential for understanding normal joint function, the influence of pathology, disease progression, and the effects of treatments. Measurement systems that use skin surface markers to infer skeletal motion have provided important insight into normal and pathological kinematics, however, accurate arthrokinematics cannot be attained using these systems, especially during dynamic activities. In the past two decades, biplanar videoradiography (BVR) systems have enabled many researchers to directly study the skeletal kinematics of the joints during activities of daily living. To implement BVR systems for the distal upper extremity, videoradiographs of the distal radius and the hand are acquired from two calibrated X-ray sources while a subject performs a designated task. Three-dimensional (3D) rigid-body positions are computed from the videoradiographs via a best-fit registrations of 3D model projections onto to each BVR view. The 3D models are density-based image volumes of the specific bone derived from independently acquired computed-tomography data. Utilizing graphics processor units and high-performance computing systems, this model-based tracking approach is shown to be fast and accurate in evaluating the wrist and distal radioulnar joint biomechanics. In this study, we first summarized the previous studies that have established the submillimeter and subdegree agreement of BVR with an in vitro optical motion capture system in evaluating the wrist and distal radioulnar joint kinematics. Furthermore, we used BVR to compute the center of rotation behavior of the wrist joint, to evaluate the articulation pattern of the components of the implant upon one another, and to assess the dynamic change of ulnar variance during pronosupination of the forearm. In the future, carpal bones may be captured in greater detail with the addition of flat panel X-ray detectors, more X-ray sources (i.e., multiplanar videoradiography), or advanced computer vision algorithms.


Assuntos
Artroplastia/métodos , Rádio (Anatomia)/diagnóstico por imagem , Tomografia Computadorizada por Raios X/métodos , Gravação de Videoteipe , Articulação do Punho/diagnóstico por imagem , Punho/diagnóstico por imagem , Atividades Cotidianas , Idoso , Algoritmos , Fenômenos Biomecânicos , Cadáver , Feminino , Voluntários Saudáveis , Humanos , Pessoa de Meia-Idade , Rádio (Anatomia)/cirurgia , Amplitude de Movimento Articular , Tomografia Computadorizada por Raios X/instrumentação , Tomografia Computadorizada por Raios X/normas , Punho/cirurgia , Articulação do Punho/cirurgia
13.
Zhonghua Kou Qiang Yi Xue Za Zhi ; 56(2): 196-199, 2021 Feb 09.
Artigo em Chinês | MEDLINE | ID: mdl-33557505

RESUMO

Objective: To measure and analyze the spherical radius of Monson of normal young people in Guangdong province using cone-beam CT (CBCT), and to establish a personalized measurement method of the spherical radius of Monson to provide a reference for clinical application of Monson spherical radius in occlusal reconstruction. Methods: Sixty healthy young adults from physical examination population at Stomatology Hospital of Guangzhou Medical University [30 males and 30 females, aged (22.1±2.0) years 18-26 years) were recruited, and their CBCT were taken. Three-dimensional reconstruction of CBCT data was carried out, and the reconstructed models were fixed, traced and measured. The difference of Monson spherical radius between male and female was compared by using a single sample t-test. Results: The Monson spherical radius was (100.72±4.89) mm. The Monson spherical radius of male and female were (103.48±4.19) mm and (97.97±3.93) mm respectively. The difference between male and female was statistically significant (P<0.01). Conclusions: CBCT can be used to accurately measure the spherical radius of Monson and can be used as a reference for reconstruction of occlusal plane.


Assuntos
Processamento de Imagem Assistida por Computador , Rádio (Anatomia) , Adolescente , Adulto , Tomografia Computadorizada de Feixe Cônico , Oclusão Dentária , Feminino , Humanos , Masculino , Adulto Jovem
14.
Medicine (Baltimore) ; 100(3): e24036, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546002

RESUMO

RATIONALE: Distal radius fracture with simultaneous ipsilateral radial head fracture is a very rare pattern of injury. This type of injury is referred to as 'radius bipolar fracture'. Treatments for this injury pattern can be challenging because both the wrist and elbow need to be considered. There are currently no guidelines for the treatment of this specific type of injury. We report two cases of this unusual pattern of injury treated in our hospital. PATIENT CONCERNS: Case 1 was a 78-year-old female patient and case 2 was a 19-year-old female patient who visited our emergency department with left elbow and wrist pain after slipping and falling. DIAGNOSIS: Plain radiography and computed tomography revealed radius bipolar fracture. Case 1 had an AO type C3 distal radius fracture, a Mason type III radial head fracture. Case 2 had an AO type B2 undisplaced distal radius fracture and a Mason type III radial head fracture. INTERVENTIONS: In case 1, open reduction and internal fixation (ORIF) was performed for the distal radius fracture and radial head replacement arthroplasty for the radial head fracture. In case 2, distal radius fracture was treated conservatively and ORIF was performed for the radial head fracture. OUTCOMES: Bony union as achieved in both cases. At 1-year follow-up, case 1 showed slight limited range of motion of the wrist. Case 2 showed no radius shortening and full range of motion of the wrist and elbow. The Quick disabilities of the arm, shoulder and hand score was 18 and 16, respectively. LESSONS: After this type of injury, the radius length can be changed, and as a result, ulnar variance can be affected. When radial head replaced is considered, it would be better to operate on the wrist first, and then perform radial head replacement. In this way, radiocapitellar overstuffing or instability can be prevented. However, if ORIF is planned for proximal radius fracture, either the proximal or distal radius can be fixed first. Surgeons should try to preserve radial length during treatment to optimize patient outcomes.


Assuntos
Artroplastia/métodos , Fraturas Múltiplas/cirurgia , Redução Aberta/métodos , Fraturas do Rádio/cirurgia , Idoso , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Feminino , Fraturas Múltiplas/fisiopatologia , Humanos , Rádio (Anatomia)/fisiopatologia , Rádio (Anatomia)/cirurgia , Fraturas do Rádio/fisiopatologia , Amplitude de Movimento Articular , Articulação do Punho/fisiopatologia , Articulação do Punho/cirurgia , Adulto Jovem
15.
Aust Vet J ; 99(5): 172-177, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-33501661

RESUMO

Pulmonary actinomycosis is described in 17 South Australian koalas necropsied between 2016 and 2019. From these cases, four koalas had secondary hypertrophic osteopathy. Plain radiographical and computed tomography images demonstrated periosteal reaction on multiple appendicular skeletal bones in all cases, including scapula, humerus, ulna, radius, ilium, femur, tibia, fibula, metacarpus, metatarsus and phalanx. Grossly, periosteal surfaces of the metaphyses and diaphyses of long bones were thickened and roughened; microscopically, this was characterised by bi-layered proliferation of well-differentiated trabecular bony spicules oriented perpendicular to the cortex (pseudocortices) and separated by vascular connective tissue, typical for hypertrophic osteopathy. Well characterised in domestic species and rarely reported in marsupials, this is the first radiographical and pathological characterisation of hypertrophic osteopathy in koalas, associated with pulmonary actinomycosis in all cases.


Assuntos
Actinomicose , Phascolarctidae , Actinomicose/diagnóstico por imagem , Actinomicose/veterinária , Animais , Austrália , Rádio (Anatomia) , Austrália do Sul
16.
Unfallchirurg ; 124(2): 153-162, 2021 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-33443629

RESUMO

Radial head fractures account for the majority of bony injuries to the elbow. The usual clinical signs include hemarthrosis, pain and limitations in movement. The standard diagnostic tool is radiological imaging using X­rays and for more complex fractures, computed tomography (CT). Concomitant ligamentous injuries occur more frequently than expected and must be reliably excluded. The classification is based on the modified Mason classification. Mason type I fractures are usually treated conservatively with immobilization and early functional aftercare. Mason type II fractures can be well-addressed by screw osteosynthesis but higher grade fractures (Mason types III-IV) can necessitate a prosthetic radial head replacement. In this case, prosthesis implantation is to be preferred to a radial head resection. The outcome after treatment of radial head fractures can be described as good to very good if all accompanying injuries are adequately addressed.


Assuntos
Articulação do Cotovelo , Fraturas do Rádio , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Fixação Interna de Fraturas , Humanos , Rádio (Anatomia) , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/epidemiologia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
17.
BMJ Case Rep ; 14(1)2021 Jan 11.
Artigo em Inglês | MEDLINE | ID: mdl-33431528

RESUMO

A 13-year-old girl presented to the clinic with a midshaft refracture of both forearm bones adjacent to the site of a prior forearm fracture that had been treated with plating. She was treated with hardware removal and placement of elastic intramedullary nails. Flexible intramedullary nailing can be successful for a skeletally mature adolescent in treatment of refracture surrounding plate fixation of a midshaft forearm fracture. This technique allows for additional protection of the entire length of the affected bones, while avoiding the extensive dissection needed for extended plating.


Assuntos
Pinos Ortopédicos , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Rádio/cirurgia , Prevenção Secundária/instrumentação , Fraturas da Ulna/cirurgia , Adolescente , Placas Ósseas/efeitos adversos , Feminino , Consolidação da Fratura , Humanos , Radiografia , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/lesões , Fraturas do Rádio/diagnóstico , Recidiva , Reoperação/instrumentação , Resultado do Tratamento , Ulna/diagnóstico por imagem , Ulna/lesões
18.
Nature ; 589(7843): 518-519, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33505031
19.
J Periodontal Res ; 56(2): 314-329, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33314132

RESUMO

BACKGROUND AND OBJECTIVE: There is a close relationship between inflammation and bone remodeling in the periodontium. However, previous studies have not delineated the alterations in calcium (Ca) metabolism during periodontitis progression. The aim of this current investigation was to examine Ca dynamics in alveolar bone of rats during progression of ligature-induced periodontal inflammation by using 45 Ca, which is an index of hard tissue neogenesis. MATERIAL AND METHODS: To induce periodontitis, the maxillary right first molar (M1) of 8-week-old male rats was ligated with a silk suture for 1, 3, 7, and 28 days. The left M1 was not ligated as a control. To evaluate resultant changes in bone neogenesis, 45 CaCl2 was injected intraperitoneally 24 hours before euthanasia. The left-and-right palatal mucosa, molar teeth (M1 and M2), and alveolar bone were harvested for evaluation of 45 Ca radioactivity using a liquid scintillation counter. The distribution of 45 Ca in maxillary tissues was evaluated using autoradiography (ARG). In addition, we analyzed the bone volume fraction (BV/TV) and bone mineral density (BMD) of the alveolar bone by micro-computed tomography. To investigate the number of osteoclasts and osteoblasts, tartrate-resistant acid phosphatase (TRAP) and bone-specific alkaline phosphatase (BAP) were measured by an enzymatic assay and immunohistochemistry, respectively. RESULTS: 45 Ca radioactivity in the alveolar bone of the ligature side decreased by 8% compared to the unligated control-side on day 1, whereas on day 7, it markedly increased by 33%. The 45 Ca levels in the gingival tissue and molar teeth were slightly but significantly lower than the control-side on day 1 and higher from day 3 to 28. The variation in 45 Ca levels for the alveolar bone was greater and specific compared with other tissues. Furthermore, on day 7, ARG data revealed that 45 Ca on the control side was primarily localized to the periodontal ligament (PDL) space and alveolar bone crest and barely detected in the gingival tissues and deeper parts of the alveolar bone. On the ligature side, 45 Ca disappeared from the PDL and alveolar crest, but instead was broadly and significantly increased within the deeper zones of the alveolar bone and furcation areas and distant from the site of ligature placement and periodontal inflammation. In the shallow zone of the alveolar bone, these changes in 45 Ca levels on day 7 were consistent with decreases in the bone structural parameters (BV/TV and BMD), enhanced osteoclast presence, and suppressed levels of BAP expression in osteoblasts. In contrast, the deep zone and furcation area showed that TRAP-positive cells increased, but BAP expression was maintained in the resorption lacunae of the alveolar bone. CONCLUSION: During periodontitis progression in rats, 45 Ca levels in the alveolar bone exhibited biphasic alterations, namely decreases and increases. These data indicate that periodontitis induces a wide range of site-specific Ca metabolism alterations within the alveolar bone.


Assuntos
Perda do Osso Alveolar , Perda do Osso Alveolar/diagnóstico por imagem , Animais , Cálcio , Modelos Animais de Doenças , Inflamação , Masculino , Osteoclastos , Rádio (Anatomia) , Ratos , Ratos Wistar , Microtomografia por Raio-X
20.
J Pediatr Orthop ; 41(1): 17-22, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33044259

RESUMO

BACKGROUND: The purpose of this study is to examine pediatric patients with a radial neck fracture and determine the factors associated with a failed closed reduction (CR) in the emergency department (ED). METHODS: A total of 70 patients with acute radial neck fractures were retrospectively reviewed. Inclusion criteria were: age 18 years or younger at time of injury, diagnosis of radial neck fracture without other associated elbow fractures, an attempt at CR with manipulation in the ED or immediate surgery, open proximal radial physis, and appropriate imaging to categorize the injury. Charts were reviewed and demographic data was obtained. Initial injury films were reviewed and the Judet classification was used to define fracture types/categories. RESULTS: CR was attempted on 41 patients. Twenty-nine patients went straight to surgery without a CR attempt. Compared with patients that had an attempted CR in the ED, patients that went straight to surgery had longer mean time from injury to ED presentation (5.6 d; P=0.0001), greater mean fracture angulation (55.0 degrees; P=0.001), and greater fracture translation (46.2%; P=0.001). When analyzing the patients that had a CR attempted in the ED, univariate statistical analysis demonstrated that ≥Judet 4 classification (P=0.03), greater amounts of fracture angulation (P=0.003), and a treatment delayed >24 hours from injury (P=0.007) were significant risk factors for failure of CR in the ED. Zero (0/10) patients with fracture angulation ≥60 degrees had a successful CR. Only 1/14 patients presenting >24 hours after injury had a successful CR in the ED. CONCLUSIONS: Circumventing sedation in the ED, and instead splinting for a planned surgical intervention may be a more efficient treatment method for pediatric radial neck fractures that present to the ED>24 hours after injury and/or have angulations ≥60 degrees. Adopting this new strategy may save time, reduce costs, and avoid possible harm/complications associated with sedation in the ED. LEVEL OF EVIDENCE: Level III-prognostic.


Assuntos
Redução Fechada , Fraturas Fechadas , Complicações Pós-Operatórias/prevenção & controle , Fraturas do Rádio , Rádio (Anatomia) , Adolescente , Criança , Redução Fechada/efeitos adversos , Redução Fechada/métodos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Fraturas Fechadas/complicações , Fraturas Fechadas/terapia , Lâmina de Crescimento , Humanos , Masculino , Seleção de Pacientes , Rádio (Anatomia)/lesões , Rádio (Anatomia)/cirurgia , Fraturas do Rádio/diagnóstico , Fraturas do Rádio/terapia , Estudos Retrospectivos , Tempo para o Tratamento , Resultado do Tratamento
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