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1.
Acta Cir Bras ; 36(2): e360202, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33624719

RESUMO

PURPOSE: The biomechanical properties of the polyurethanes implant material derived from castor oil plant (Ricinus communis) were evaluated in a noncritical bone defect model in rat tibia. METHODS: After three weeks of the implant application, the tibias were tested by means of the biomechanical three-point flexion test and resistance, rigidity, energy at maximum load and maximum energy were evaluated. Nonparametric statistical analysis was performed. RESULTS: It was found that the group that received the implant behaved the same as the intact control group and also showed a significant increase in maximum load compared to the spontaneous repair group. CONCLUSIONS: Our results indicate that the tibias with the implant material in a noncritical bone defect recover normal biomechanical parameters in less time than spontaneously.


Assuntos
Próteses e Implantes , Ricinus , Animais , Poliuretanos , Ratos , Tíbia/cirurgia
2.
Acta Cir Bras ; 36(2): e360206, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33624723

RESUMO

PURPOSE: To evaluate clinical outcome following minimally invasive plate osteosynthesis (MIPO) associated with percutaneous transplantation of allogeneic adipose-derived mesenchymal stem cells (AD-MSC) at the tibial fracture site in dogs. METHODS: Thirty-six dogs presenting with nonarticular complete tibial fracture were included in this study. All fractures were treated by the same MIPO technique. The animals were divided in group 1 (n = 20) received a percutaneous application of 3 × 106 AD-MSC at the fracture site and group 2 (n = 16) did not receive any adjuvant treatment. Postoperative radiographic examinations were made at 15, 30, 60, 90 and 120 days. RESULTS: Fifty-eight percent of the patients were classified as skeletally immature. The median weight of the animals was 18.8 kg. The mean radiographic union time differed statistically between the AD-MSC group (28.5 days) and the control group (70.3 days). Sixty percent of dogs in group 1 and 56.25% of the group 2 were considered immature. CONCLUSIONS: The use of allogeneic AD-MSC cell therapy and MIPO is a safe, viable and effective technique for promoting bone healing in nonarticular tibial fractures in dogs.


Assuntos
Transplante de Células-Tronco Hematopoéticas , Células-Tronco Mesenquimais , Animais , Placas Ósseas , Cães , Fixação Interna de Fraturas , Humanos , Tíbia/cirurgia
3.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547128

RESUMO

Awareness of rare differential diagnoses of common clinical presentations helps promote early detection and prompt management of serious conditions. A 54-year-old man, with an infected non-union following a high tibial osteotomy, presented with an acutely discharging abscess to his proximal tibia. He was generally unwell with a Staphylococcus aureus bacteraemia. The tibia was debrided, CERAMENT G used as dead space management and a spanning external fixator applied. Postoperatively, pregabalin and tapentadol were commenced in addition to amitriptyline and sertraline, which the patient was taking regularly. Overnight, the patient developed hyperthermia, inducible clonus, hyperreflexia, agitation, confusion and rigors. Prompt recognition of the possibility of serotonin syndrome resulted in early cessation of serotonergic medications and a positive outcome. From this case an important message is that fever in a patient taking serotonergic medications should prompt a screening neurological examination. Clinicians should also be wary when patients are commenced on multimodal analgesia, including tapentadol.


Assuntos
Analgésicos Opioides/efeitos adversos , Osteomielite/microbiologia , Síndrome da Serotonina/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecção da Ferida Cirúrgica/microbiologia , Tapentadol/efeitos adversos , Bacteriemia/microbiologia , Desbridamento , Diagnóstico Diferencial , Febre , Humanos , Masculino , Pessoa de Meia-Idade , Osteomielite/cirurgia , Osteotomia , Infecções Estafilocócicas/cirurgia , Infecção da Ferida Cirúrgica/cirurgia , Tíbia/cirurgia
4.
Int J Oral Maxillofac Implants ; 36(1): 38-46, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33600521

RESUMO

PURPOSE: The aim of this work was to evaluate osseointegration of endosteal implants with two different surface treatments at early stages (~3 weeks) in the tibia of healthy and ovariectomized rabbits. MATERIALS AND METHODS: The study comprised 10 adult New Zealand female rabbits (Oryctolagus cuniculus; 6 months and 3.0 ± 0.5 kg). Five animals were subjected to bilateral ovariectomy to mimic osteoporotic-like conditions, and the remaining rabbits (n = 5) served as the healthy control group. After 3 months, specimens from the ovariectomized and control groups were subject to implant placement in both tibiae, using two different types of surface treatment. A total of 36 implants were placed, n = 18 acid-etched and n = 18 anodized. After 3 weeks, euthanasia of the animals was performed, and samples were obtained for processing. Bone-to-implant contact and bone area fraction occupancy were quantified to evaluate the osseointegration parameters around the implant surface and within the thread area, respectively, and nanoindentation tests were performed to determine elastic modulus and hardness of the new bone. Both analyses were performed on the entire implant (total), as well as individually within the cortical and bone marrow cavity area. RESULTS: All animals were evaluated with no signs of infection or postoperative complications. The total bone-to-implant contact and bone area fraction occupancy results, independent of surface treatment, yielded significant differences between the ovariectomized and control groups (P = .002 and P < .001, respectively). In the marrow cavity, analyzing the surface treatments independently as a function of bone condition, the only differences detected were in the anodized treatment (P = .04). Regarding the elastic modulus, differences were detected only with the anodized implants between the ovariectomized and control groups (P = .015). CONCLUSION: At 3 weeks after implant placement, there were better osseointegration values of the implants in the healthy control group compared with the ovariectomized group independent of surface treatment. Also, specifically in the medullary region of the rabbit tibia, the acid-etched implants had more uniform osseointegration values in conditions of low-quality bone in comparison to the anodized implants, histomorphometrically and biomechanically.


Assuntos
Implantes Dentários , Animais , Osso e Ossos , Feminino , Humanos , Osseointegração , Coelhos , Propriedades de Superfície , Tíbia/cirurgia , Titânio
5.
Arthroscopy ; 37(2): 645-646, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33546801

RESUMO

High tibial osteotomy is a widespread treatment option and has been performed in the treatment of osteoarthritis long before joint replacements started their triumphant era in the last third of the last century. However, osteotomies have again gained increased interest and popularity within the last 2 decades. Historically, osteotomies have mainly been recommended for early osteoarthritis and contraindicated for advanced osteoarthritis. However, over time, some historic but widespread dogmas have already been contradicted regarding high tibial osteotomy. Osteotomies are very well possible and can yield excellent outcomes, even in patients with severe osteoarthritis. Thus, another dogma from the past is contradicted.


Assuntos
Osteoartrite do Joelho , Osso e Ossos , Humanos , Osteoartrite do Joelho/cirurgia , Osteotomia , Tíbia/cirurgia
6.
Arthroscopy ; 37(2): 682-685, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33546804

RESUMO

The pivot shift and Lachman examinations are "teammates" with complementary but distinct roles in the successful diagnosis and treatment of anterior cruciate ligament rupture and injury to the surrounding soft-tissue envelope of the knee. The Lachman test measures anterior tibial translation in response to an applied anterior tibial load. This test assesses the integrity of the native or reconstructed anterior cruciate ligament and the secondary medial restraints including the medial meniscus and medial collateral ligament. In contrast, the pivot shift exam creates coupled tibiofemoral motions in response to a complex combination of multiplanar loads. This test assesses the stabilizing role of the native or reconstructed anterior cruciate ligament and the secondary lateral restraints including the lateral meniscus and anterolateral complex. The pivot shift grade depends not only on the soft the tissue stabilizers of the knee but also on the shape of the proximal tibia and the distal femur including lateral tibial slope and femoral condylar offset. Both examinations have unique strengths and weaknesses, but when combined as diagnostic tools, they achieve far more collectively than what each can achieve alone.


Assuntos
Lesões do Ligamento Cruzado Anterior , Instabilidade Articular , Ligamento Cruzado Anterior , Lesões do Ligamento Cruzado Anterior/diagnóstico , Fenômenos Biomecânicos , Cadáver , Humanos , Instabilidade Articular/diagnóstico , Articulação do Joelho , Amplitude de Movimento Articular , Rotação , Tíbia
8.
Medicine (Baltimore) ; 100(3): e23978, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545983

RESUMO

BACKGROUND AND PURPOSE: Medial compartment femoro-tibial osteoarthritis (OA) is a common disease and opening-wedge high tibial osteotomy (OWHTO) is the common surgical procedure carried out for these patients. While most researchers are focusing on the surgical techniques during operation, the aim of this study is to evaluate the pain control effect of femoral nerve block (FNB) for OWHTO patients. METHODS: In this prospective, single-center, randomized controlled trial (RCT) study, 41 patients were operated on by OWHTO for OA during 2017 to 2018. Twenty of them (group A) accepted epidural anesthesia with FNB and 21 patients (group B) only had their single epidural anesthesia. All blocks were successful and all the 41 patients recruited were included in the analysis and there was no loss to follow-up or withdrawal. Systematic records of visual analog scores (VAS), quadriceps strength, mean number of times of patient-controlled intravenous analgesia (PCIA), using of additional opioids or nonsteroidal anti-inflammatory drugs (NSAIDs), and complications were done after hospitalization. The Student t test and Chi-Squared test was used and all P values ≤.05 were considered statistically significant. RESULTS: VAS scores at rest (3.48 ±â€Š1.0 vs 4.68 ±â€Š1.1) and on movemment (4.51 ±â€Š0.6 vs 4.97 ±â€Š0.8) decreased more in group A than group B with significance at follow-up of 12 hours. The quadriceps strength, consumption of additional opioids or NSAID injections and mean number of times that the patients pushed the PCIA button didnot differ significantly within each group. CONCLUSION: This RCT study shows that FNB in patients undergoing OWHTO for unicompartmental osteoarthritis of the knee could result in significant reduction in VAS scores at 12 hours postoperatively.Research registry, Researchregistry4792. Registered April 7, 2019 - Retrospectively registered, http://www.researchregistry.com.


Assuntos
Nervo Femoral/efeitos dos fármacos , Bloqueio Nervoso/normas , Manejo da Dor/normas , Tíbia/cirurgia , Feminino , Nervo Femoral/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Bloqueio Nervoso/métodos , Bloqueio Nervoso/estatística & dados numéricos , Osteotomia/efeitos adversos , Osteotomia/métodos , Manejo da Dor/métodos , Manejo da Dor/estatística & dados numéricos , Estudos Prospectivos , Tíbia/efeitos dos fármacos
9.
Bone Joint J ; 103-B(2): 294-298, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517721

RESUMO

AIMS: The aim of this study was to determine the immediate post-fixation stability of a distal tibial fracture fixed with an intramedullary nail using a biomechanical model. This was used as a surrogate for immediate weight-bearing postoperatively. The goal was to help inform postoperative protocols. METHODS: A biomechanical model of distal metaphyseal tibial fractures was created using a fourth-generation composite bone model. Three fracture patterns were tested: spiral, oblique, and multifragmented. Each fracture extended to within 4 cm to 5 cm of the plafond. The models were nearly-anatomically reduced and stabilized with an intramedullary nail and three distal locking screws. Cyclic loading was performed to simulate normal gait. Loading was completed in compression at 3,000 N at 1 Hz for a total of 70,000 cycles. Displacement (shortening, coronal and sagittal angulation) was measured at regular intervals. RESULTS: The spiral and oblique fracture patterns withstood simulated weight-bearing with minimal displacement. The multifragmented model had early implant failure with breaking of the distal locking screws. The spiral fracture model shortened by a mean of 0.3 mm (SD 0.2), and developed a mean coronal angulation of 2.0° (SD 1.9°) and a mean sagittal angulation of 1.2° (SD 1.1°). On average, 88% of the shortening, 74% of the change in coronal alignment, and 75% of the change in sagittal alignment occurred in the first 2,500 cycles. No late acceleration of displacement was noted. The oblique fracture model shortened by a mean of 0.2 mm (SD 0.1) and developed a mean coronal angulation of 2.4° (SD 1.6°) and a mean sagittal angulation of 2.6° (SD 1.4°). On average, 44% of the shortening, 39% of the change in coronal alignment, and 79% of the change in sagittal alignment occurred in the first 2,500 cycles. No late acceleration of displacement was noted. CONCLUSION: For spiral and oblique fracture patterns, simulated weight-bearing resulted in a clinically acceptable degree of displacement. Most displacement occurred early in the test period, and the rate of displacement decreased over time. Based on this model, we offer evidence that early weight-bearing appears safe for well reduced oblique and spiral fractures, but not in multifragmented patterns that have poor bone contact. Cite this article: Bone Joint J 2021;103-B(2):294-298.


Assuntos
Deambulação Precoce , Fixação Intramedular de Fraturas/métodos , Cuidados Pós-Operatórios/métodos , Fraturas da Tíbia/cirurgia , Fenômenos Biomecânicos , Pinos Ortopédicos , Parafusos Ósseos , Fixação Intramedular de Fraturas/instrumentação , Fixação Intramedular de Fraturas/reabilitação , Humanos , Modelos Anatômicos , Tíbia/lesões , Tíbia/fisiologia , Tíbia/cirurgia , Fraturas da Tíbia/reabilitação , Suporte de Carga
10.
Bone Joint J ; 103-B(2): 338-346, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517724

RESUMO

AIMS: This study aimed to identify the tibial component and femoral component coronal angles (TCCAs and FCCAs), which concomitantly are associated with the best outcomes and survivorship in a cohort of fixed-bearing, cemented, medial unicompartmental knee arthroplasties (UKAs). We also investigated the potential two-way interactions between the TCCA and FCCA. METHODS: Prospectively collected registry data involving 264 UKAs from a single institution were analyzed. The TCCAs and FCCAs were measured on postoperative radiographs and absolute angles were analyzed. Clinical assessment at six months, two years, and ten years was undertaken using the Knee Society Knee score (KSKS) and Knee Society Function score (KSFS), the Oxford Knee Score (OKS), the 36-Item Short-Form Health Survey questionnaire (SF-36), and range of motion (ROM). Fulfilment of expectations and satisfaction was also recorded. Implant survivorship was reviewed at a mean follow-up of 14 years (12 to 16). Multivariate regression models included covariates, TCCA, FCCA, and two-way interactions between them. Partial residual graphs were generated to identify angles associated with the best outcomes. Kaplan-Meier analysis was used to compare implant survivorship between groups. RESULTS: Significant two-way interaction effects between TCCA and FCCA were identified. Adjusted for each other and their interaction, a TCCA of between 2° and 4° and a FCCA of between 0° and 2° were found to be associated with the greatest improvements in knee scores and the probability of fulfilling expectations and satisfaction at ten years. Patients in the optimal group whose TCCA and FCCA were between 2° and 4°, and 0° and 2°, respectively, had a significant survival benefit at 15 years compared with the non-optimal group (optimal: survival = 100% vs non-optimal: survival = 92%, 95% confidence interval (CI) 88% to 96%). CONCLUSION: Significant two-way interactions between the TCCA and FCCA demonstrate the importance of evaluating the alignment of the components concomitantly in future studies. By doing so, we found that patients who concomitantly had both a TCCA of between 2° and 4° and a FCCA of between 0° and 2° had the best patient-reported outcome measures at ten years and better survivorship at 15 years. Cite this article: Bone Joint J 2021;103-B(2):338-346.


Assuntos
Artroplastia do Joelho/métodos , Hemiartroplastia/métodos , Prótese do Joelho , Osteoartrite do Joelho/cirurgia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/instrumentação , Fenômenos Biomecânicos , Feminino , Fêmur/patologia , Fêmur/fisiologia , Fêmur/cirurgia , Seguimentos , Hemiartroplastia/instrumentação , Humanos , Articulação do Joelho/patologia , Articulação do Joelho/fisiologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Desenho de Prótese , Falha de Prótese , Sistema de Registros , Tíbia/patologia , Tíbia/fisiologia , Tíbia/cirurgia , Resultado do Tratamento
11.
Nat Commun ; 12(1): 723, 2021 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-33526787

RESUMO

Bone metastatic prostate cancer (PCa) promotes mesenchymal stem cell (MSC) recruitment and their differentiation into osteoblasts. However, the effects of bone-marrow derived MSCs on PCa cells are less explored. Here, we report MSC-derived interleukin-28 (IL-28) triggers prostate cancer cell apoptosis via IL-28 receptor alpha (IL-28Rα)-STAT1 signaling. However, chronic exposure to MSCs drives the selection of prostate cancer cells that are resistant to IL-28-induced apoptosis and therapeutics such as docetaxel. Further, MSC-selected/IL-28-resistant prostate cancer cells grow at accelerated rates in bone. Acquired resistance to apoptosis is PCa cell intrinsic, and is associated with a shift in IL-28Rα signaling via STAT1 to STAT3. Notably, STAT3 ablation or inhibition impairs MSC-selected prostate cancer cell growth and survival. Thus, bone marrow MSCs drive the emergence of therapy-resistant bone metastatic prostate cancer yet this can be disabled by targeting STAT3.


Assuntos
Adenocarcinoma/secundário , Neoplasias Ósseas/secundário , Células-Tronco Mesenquimais/patologia , Neoplasias da Próstata/patologia , Receptores de Interferon/metabolismo , Ácidos Aminossalicílicos/farmacologia , Ácidos Aminossalicílicos/uso terapêutico , Animais , Apoptose/efeitos dos fármacos , Benzenossulfonatos/farmacologia , Benzenossulfonatos/uso terapêutico , Neoplasias Ósseas/tratamento farmacológico , Diferenciação Celular/efeitos dos fármacos , Linhagem Celular Tumoral , Proliferação de Células , Meios de Cultivo Condicionados/metabolismo , Modelos Animais de Doenças , Docetaxel/farmacologia , Docetaxel/uso terapêutico , Humanos , Interferons/genética , Interferons/metabolismo , Masculino , Camundongos Knockout , Osteoblastos/patologia , Cultura Primária de Células , Neoplasias da Próstata/tratamento farmacológico , RNA Interferente Pequeno/metabolismo , Receptores de Interferon/genética , Proteínas Recombinantes/genética , Proteínas Recombinantes/metabolismo , Fator de Transcrição STAT1/metabolismo , Fator de Transcrição STAT3/antagonistas & inibidores , Fator de Transcrição STAT3/metabolismo , Tíbia/patologia
12.
Am J Sports Med ; 49(2): 404-409, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33411563

RESUMO

BACKGROUND: Bone contusions are commonly observed on magnetic resonance imaging (MRI) in individuals who have sustained a noncontact anterior cruciate ligament (ACL) injury. Time from injury to image acquisition affects the ability to visualize these bone contusions, as contusions resolve with time. PURPOSE: To quantify the number of bone contusions and their locations (lateral tibial plateau [LTP], lateral femoral condyle [LFC], medial tibial plateau [MTP], and medial femoral condyle [MFC]) observed on MRI scans of noncontact ACL-injured knees acquired within 6 weeks of injury. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: We retrospectively reviewed clinic notes, operative notes, and imaging of 136 patients undergoing ACL reconstruction. The following exclusion criteria were applied: MRI scans acquired beyond 6 weeks after injury, contact ACL injury, and previous knee trauma. Fat-suppressed fast spin-echo T2-weighted MRI scans were reviewed by a blinded musculoskeletal radiologist. The number of contusions and their locations (LTP, LFC, MTP, and MFC) were recorded. RESULTS: Contusions were observed in 135 of 136 patients. Eight patients (6%) had 1 contusion, 39 (29%) had 2, 41 (30%) had 3, and 47 (35%) had 4. The most common contusion patterns within each of these groups were 6 (75%) with LTP for 1 contusion, 29 (74%) with LTP/LFC for 2 contusions, 33 (80%) with LTP/LFC/MTP for 3 contusions, and 47 (100%) with LTP/LFC/MTP/MFC for 4 contusions. No sex differences were detected in contusion frequency in the 4 locations (P > .05). Among the participants, 50 (37%) had medial meniscal tears and 52 (38%) had lateral meniscal tears. CONCLUSION: The most common contusion patterns observed were 4 locations (LTP/LFC/MTP/MFC) and 3 locations (LTP/LFC/MTP).


Assuntos
Lesões do Ligamento Cruzado Anterior , Contusões , Fêmur/lesões , Tíbia/lesões , Lesões do Ligamento Cruzado Anterior/diagnóstico por imagem , Contusões/diagnóstico por imagem , Estudos Transversais , Humanos , Imagem por Ressonância Magnética , Estudos Retrospectivos
13.
Anticancer Res ; 41(2): 635-640, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33517267

RESUMO

BACKGROUND: A mouse model of metastatic osteosarcoma is imperative to identify effective agents for metastatic osteosarcoma, which is a recalcitrant disease. In the present study, we established osteosarcoma patient-derived cells (OS-PDCs) and transfected them with green fluorescent protein (GFP). MATERIALS AND METHODS: The OS-PDCs were transfected with GFP-lentivirus. GFP-expressing OS-PDCs (2.0×105) were then injected into the tibia of nude mice to establish the patient-derived orthotopic cell (PDOC) model (n=3). Six weeks after injection, the primary tumor and each organ were resected and imaged. RESULTS: Primary orthotopic tumors were established in two out of three mice. The GFP-expressing OS-PDCs in the PDOC model were visualized. Multiple GFP-expressing lung metastases were detected in one of the two mice with primary tumor. CONCLUSION: The present study proves the concept that a GFP-expressing PDOC model can mimic clinical lung-metastatic osteosarcoma. This model can serve as a paradigm to screen for effective drugs for osteosarcoma lung metastasis.


Assuntos
Neoplasias Ósseas/patologia , Proteínas de Fluorescência Verde/metabolismo , Neoplasias Pulmonares/secundário , Osteossarcoma/secundário , Tíbia/patologia , Adolescente , Animais , Neoplasias Ósseas/genética , Neoplasias Ósseas/metabolismo , Rastreamento de Células , Feminino , Proteínas de Fluorescência Verde/genética , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/metabolismo , Camundongos Nus , Transplante de Neoplasias , Osteossarcoma/genética , Osteossarcoma/metabolismo , Tíbia/metabolismo , Transfecção , Células Tumorais Cultivadas
14.
Mymensingh Med J ; 30(1): 148-153, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33397866

RESUMO

Distal tibial fractures are difficult to manage as the bone is subcutaneous with depleted muscular cover; the consequent decreased vascularity leads to complications. Minimal invasive plate osteosynthesis (MIPO) is a very good option for managing this type of fractures. This study was carried out to evaluate the outcome of patients treated with distal tibial locking plate by MIPO technique. Twenty patients with distal tibia fractures treated with distal tibial anatomical locking plate were prospectively studied from July 2013 to December 2016. The result was excellent in 18(90%) of patients i.e. 18 patients had an AOFAS score of 90 or greater out of a possible 100 points. The mean score was 94.28; the mean time for radiological union was 20.1 weeks with a range of 16 to 30 weeks. We encountered superficial infection in 02 (10%) of our patients which were managed with dressings and appropriate antibiotics. Two patients had union with valgus angulation of less than 5°. No malunion was detected. One patient had ankle stiffness requiring extensive physiotherapy to regain range of movement. Plate removal was done in 4 cases. MIPO technique is a good fixation method for fractures distal third of tibia, preserving blood supply & fracture hematoma.


Assuntos
Consolidação da Fratura , Tíbia , Placas Ósseas , Fixação Interna de Fraturas , Humanos , Procedimentos Cirúrgicos Minimamente Invasivos , Resultado do Tratamento
15.
West Afr J Med ; 38(1): 84-92, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33463713

RESUMO

Giant cell tumours of bone are relatively uncommon, accounting for about 5% of all primary bone tumours. They are generally classified as benign bone tumours. However, some of them might be locally aggressive. The peak incidence is between second and fourth decades of life. They are commonly found at the epiphyseal and, occasionally, metaphyseal zones of long bones such as radius, femur and tibia. They most often present as painless swellings; however, pain may be experienced as a result of pressure on the surrounding soft tissues. The relevant diagnostic investigations that help in establishing the diagnosis include plain x-rays, Magnetic resonance imaging (MRI), CT and tissue biopsy for histological confirmation. Traditionally, surgery is the mainstay of treatment of the disease. Other modalities include radiation, tumour embolization and injectable drugs for surgically inaccessible or recurrent cases.


Assuntos
Neoplasias Ósseas , Tumor de Células Gigantes do Osso , Tíbia , Biópsia , Neoplasias Ósseas/diagnóstico por imagem , Neoplasias Ósseas/terapia , Tumor de Células Gigantes do Osso/diagnóstico por imagem , Tumor de Células Gigantes do Osso/terapia , Humanos , Imagem por Ressonância Magnética , Tíbia/diagnóstico por imagem , Tíbia/patologia , Tomografia Computadorizada por Raios X
17.
Arthroscopy ; 37(1): 206-208, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33384083

RESUMO

Understanding the etiology behind anterior cruciate ligament (ACL) reconstruction failure is a complex topic still being investigated heavily. The 3 classes of failure are technical, traumatic, and biologic. Technical errors are most common and most frequently reflect tunnel malposition. In addition, tibial slope has long been understood to be a risk factor for failed ACL reconstruction. Although not routinely performed at time of primary ACL reconstruction, osteotomy may be considered in the setting of failed ACL reconstruction. Relative quadriceps weakness is a risk factor, and we recommend sport-specific return-to-play testing as well as benchmarks for relative quadriceps strength before full return to activity. Revision ACL reconstruction is associated with both increased costs and worse patient outcomes, so every effort should be made to give patients the best chance of success after the index surgery. Whereas this begins with understanding the patient's history and risk factors for failure, it crescendos with careful attention to the individually variable factors that make each case unique, tailoring one's management to ensure that each patient receives an anatomic, individualized, and value-based ACL reconstruction.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Humanos , Estudos Retrospectivos , Fatores de Risco , Tíbia/cirurgia
18.
Arthroscopy ; 37(1): 250-251, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33384085

RESUMO

The posterior tibial slope (PTS) plays an immensely important role in almost every orthopaedic operation on the knee joint. The PTS is a decisive factor in the reconstruction of a torn anterior or posterior cruciate ligament, in high tibial osteotomy and, of course, in total knee arthroplasty. It is therefore all the more surprising that in current clinical practice relatively little emphasis is placed on the exact measurement of PTS. If the true value is not known, the influence of the same is pure coincidence. In the coronal plane, it is clinically valid practice to determine the hip-knee-ankle angle and thus to be able to determine the mechanical and anatomical axes at the tibia and femur. In the sagittal plane, however, an in-depth analysis is often dispensed with and only a short lateral knee radiograph is used. Different axes are described to determine the PTS. In addition, it is often overlooked that a determination of the PTS on lateral radiographs can only represent an average, since the medial and lateral tibial plateau shows considerable differences purely anatomically. In the future, we should place more emphasis on an analysis of the sagittal plane in the knee joint including PTS at least as profound as the analysis of the frontal plane. Here, radiographs of the entire lateral tibia must be requested to determine the true axis and thus the true PTS.


Assuntos
Artroplastia do Joelho , Articulação do Joelho , Fêmur , Humanos , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/cirurgia , Osteotomia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
19.
Arthroscopy ; 37(1): 338-339, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33384091

RESUMO

Optimal femoral anterior cruciate ligament graft placement has been extensively studied. The champions of transtibial reconstruction debate the backers of anteromedial portal and outside-in drilling. The holy grail is footprint restoration and how we best to get there. To me, creating the femur independently provides the best chance of finding that footprint by being unconstrained by the tibia. Anterior cruciate ligament surgery is challenging enough; decrease intraoperative stress and increase your likelihood of femoral footprint restoration by drilling it though the anteromedial portal.


Assuntos
Lesões do Ligamento Cruzado Anterior , Reconstrução do Ligamento Cruzado Anterior , Ligamento Cruzado Anterior/cirurgia , Lesões do Ligamento Cruzado Anterior/cirurgia , Fêmur/cirurgia , Humanos , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto , Tíbia/cirurgia
20.
Instr Course Lect ; 70: 289-308, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33438917

RESUMO

Chondral lesions of the patellofemoral joint are common, and when symptomatic they can be difficult to manage. Not only are there various degrees of injury with multiple etiologies, but patellofemoral anatomy is complex and the patient's lower extremity alignment may contribute to the pathology. Treatment depends on the location, size, and depth of the lesion and may require realignment or concomitant stabilizing procedures. Tibial tubercle osteotomy can be performed in isolation or combined with various cartilage-based treatments, including marrow stimulation techniques, autologous chondrocyte implantation, osteochondral autograft, and osteochondral allograft. End-stage lesions, failed primary patellofemoral cartilage restoration with diffuse involvement, or isolated primary patellofemoral arthritis may be amenable to treatment with patellofemoral arthroplasty. Recent investigations in properly indicated patients using advanced techniques have shown that management of patellofemoral cartilage disease is now more effective and predictable than in the past.


Assuntos
Doenças das Cartilagens , Cartilagem Articular , Artropatias , Articulação Patelofemoral , Cartilagem Articular/cirurgia , Humanos , Osteotomia , Articulação Patelofemoral/diagnóstico por imagem , Articulação Patelofemoral/cirurgia , Tíbia
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