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1.
Acta Biomater ; 141: 233-243, 2022 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-34999261

RESUMO

Skeletal adaptation is substantially influenced by mechanical loads. Osteocytes and their lacuno-canalicular network have been identified as a key player in load sensation and bone quality regulation. In the femoral neck, one of the most common fracture sites, a complex loading pattern with lower habitual loading in the superolateral neck and higher compressive stresses in the inferomedial neck is present. Variations in the femoral neck-shaft angle (NSA), i.e., coxa vara or coxa valga, provide the opportunity to examine the influence of loading patterns on bone quality. We obtained femoral neck specimens of 28 osteoarthritic human subjects with coxa vara, coxa norma and coxa valga during total hip arthroplasty. Bone mineral density (BMD) was assessed preoperatively by dual energy X-ray absorptiometry (DXA). Cortical and trabecular microstructure and three-dimensional osteocyte lacunar characteristics were assessed in the superolateral and inferomedial neck using ex vivo high resolution micro-computed tomography. Additionally, BMD distribution and osteocyte lacunar characteristics were analyzed by quantitative backscattered electron imaging (qBEI). All groups presented thicker inferomedial than superolateral cortices. Furthermore, the superolateral site exhibited a lower osteocyte lacunar density along with lower lacunar sphericity than the inferomedial site, independent of NSA. Importantly, BMD and corresponding T-scores correlated with microstructural parameters at the inferomedial but not superolateral neck. In conclusion, we provide micromorphological evidence for fracture vulnerability of the superolateral neck, which is independent of NSA and BMD. The presented bone qualitative data provide an explanation why DXA may be insufficient to predict a substantial proportion of femoral neck fractures. STATEMENT OF SIGNIFICANCE: The femoral neck, one of the most common fracture sites, is subject to a complex loading pattern. Site-specific differences (i.e., superolateral vs. inferomedial) in bone quality influence fracture risk, but it is unclear how this relates to hip geometry and bone mineral density (BMD) measurements in vivo. Here, we examine femoral neck specimens using a variety of high-resolution imaging techniques and demonstrate impaired bone quality in the superolateral compared to the inferomedial neck. Specifically, we found impaired cortical and trabecular microarchitecture, mineralization, and osteocyte properties, regardless of neck-shaft angle. Since BMD correlated with bone quality of the inferomedial but not the superolateral neck, our results illustrate why bone densitometry may not predict a substantial proportion of femoral neck fractures.


Assuntos
Coxa Valga , Coxa Vara , Fraturas do Colo Femoral , Densidade Óssea/fisiologia , Colo do Fêmur/diagnóstico por imagem , Quadril , Humanos , Microtomografia por Raio-X
2.
BMC Musculoskelet Disord ; 22(1): 561, 2021 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-34147092

RESUMO

BACKGROUND: Gluteal muscle contracture (GMC) is a disease characterized by the limited function of the hip joint, knee pain, and abnormal gait. There is a lack of research on the effect of GMC on the hip joint structure to date. This study aims to analyze the association between GMC and the deformity of the hip and pelvis. METHODS: Standing anteroposterior pelvic radiographs of 214 patients (152 with gluteal muscle contracture and 62 without gluteal muscle contracture) were retrospectively collected. Neck-shaft angle, lateral center edge angle, Tönnis angle, femoral head coverage index, acetabular depth, Sacro-femoral-pubic angle, and obturator foramen ratio were respectively measured and included in the following statistical analysis. The collected data were analyzed using logistical regression and multiple linear regression to explore the factors influencing coxa valga and SFP angle. RESULTS: GMC was identified as a common factor significantly associated with coxa valga and increased SFP angle. There is a difference of risk factors in logistic regression for coxa valga between the left and right sides. CONCLUSION: GMC is a significant risk factor for coxa valga and increased SFP angle. Given that GMC can cause coxa valga and likely alter the pelvis's position, GMC should be paid attention to and treated early.


Assuntos
Contratura , Coxa Valga , Contratura/diagnóstico por imagem , Humanos , Análise Multivariada , Músculos , Estudos Retrospectivos
3.
Bone Joint J ; 102-B(9): 1242-1247, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862682

RESUMO

AIMS: Guided growth has been used to treat coxa valga for cerebral palsy (CP) children. However, there has been no study on the optimal position of screw application. In this paper we have investigated the influence of screw position on the outcomes of guided growth. METHODS: We retrospectively analyzed 61 hips in 32 CP children who underwent proximal femoral hemi epiphysiodesis between July 2012 and September 2017. The hips were divided into two groups according to the transphyseal position of the screw in the coronal plane: across medial quarter (Group 1) or middle quarter (Group 2) of the medial half of the physis. We compared pre- and postoperative radiographs in head-shaft angle (HSA), Reimer's migration percentage (MP), acetabular index (AI), and femoral anteversion angle (FAVA), as well as incidences of the physis growing-off the screw within two years. Linear and Cox regression analysis were conducted to identify factors related to HSA correction and risk of the physis growing-off the screw. RESULTS: A total of 37 hips in Group 1 and 24 hips in Group 2 were compared. Group 1 showed a more substantial decrease in the HSA (p = 0.003) and the MP (p = 0.032). Both groups had significant and similar improvements in the AI (p = 0.809) and the FAVA (p = 0.304). Group 1 presented a higher incidence of the physis growing-off the screw (p = 0.038). Results of the regression analysis indicated that the eccentricity of screw position correlated with HSA correction and increases the risk of the physis growing-off the screw. CONCLUSION: Guided growth is effective in improving coxa valga and excessive femoral anteversion in CP children. For younger children, despite compromised efficacy of varus correction, we recommend a more centered screw position, at least across the middle quarter of the medial physis, to avoid early revision. Cite this article: Bone Joint J 2020;102-B(9):1242-1247.


Assuntos
Parafusos Ósseos , Coxa Valga/cirurgia , Lâmina de Crescimento/cirurgia , Paralisia Cerebral/complicações , Criança , Coxa Valga/etiologia , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Resultado do Tratamento
4.
BMC Musculoskelet Disord ; 21(1): 124, 2020 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-32093714

RESUMO

BACKGROUND: Trochanter valgus deformity (TVD) is a rare condition of total hip arthroplasty (THA). Femoral osteotomy could be required in correcting the deformity to implant femoral stem in severe TVD. In this study, we described one unpublished technique of reverse sleeve of S-ROM to get through the complex situation. This study aimed to summarize and evaluate its technical challenges, safety and effectiveness. METHODS: From January 2006 to December 2014, we enrolled patients whose sleeves were implanted towards the great trochanter in THA with TVD. Their demographics, perioperative and postoperative information were recorded. To explore its indication, we measured and analyzed the ratio of greater trochanter/lesser trochanter (G/L ratio) and trochanter valgus angle (TVA). RESULTS: Twelve patients (1 male and 11 female, average age 42.30 ± 10.23) had mean follow-up of 6 years. Among them, only two patients had intraoperative femoral fracture. The survivorship of femoral prosthesis was 100%. The Harris hip score (HHS) increased from preoperative 34.31 ± 14.43 to postoperative 84.12 ± 11.33. All patients' G/L ratio were larger than 1.50. CONCLUSIONS: The reverse sleeve of S-ROM was a reliable method for the patients with severe TVD, which brought satisfying clinical outcomes in mid-term follow-up.


Assuntos
Artroplastia de Quadril/métodos , Coxa Valga/cirurgia , Fêmur/anormalidades , Fêmur/cirurgia , Prótese de Quadril , Desenho de Prótese/métodos , Adulto , Artroplastia de Quadril/instrumentação , Coxa Valga/diagnóstico por imagem , Feminino , Fêmur/diagnóstico por imagem , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
5.
Injury ; 51(2): 357-360, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31679832

RESUMO

PURPOSE: This study evaluated a series of geriatric femoral neck fracture treated with closed reduction percutaneous pinning (CRPP) at a single level-1 trauma center to determine if there are any simple, reliable, radiographic characteristics that can be used to predict increased risk of post-operative failure in nondisplaced and valgus impacted fracture patterns. METHODS: We conducted a retrospective cohort study of all patients with femoral neck fractures (AO/OTA 31B) who underwent CRPP over a 12-year period at a single Level 1 trauma center. Failure was defined as radiographic failure within the first year after the index operation requiring revision surgery. Common patterns identified on initial review were the presence of a visible medial transcervical line (MTL) felt to indicate a tension-sided failure, a straight inferior calcar (SIC) indicating severe valgus impaction, and quality of intra-operative screw positioning. X-rays of patients were then reviewed for these characteristics in a blinded manner by three different trauma-fellowship trained orthopedic surgeons. Inter-rater reliability was calculated using Fleiss' Kappa Coefficient. Comparisons of failure rates between groups were made using a Fisher's Exact test. RESULTS: 139 patients who underwent CRPP for a femoral neck fracture and follow-up for at least 90 days were identified and reviewed. There were a total of 19 failures (13.6%) within one year. The patients with a varus fracture had a failure rate of 9/24 (37.5%). Of the valgus/nondisplaced fractures, MTL was identified in 42/115 (36%) patients. Inter-rater agreement was high for the presence of an MTL (84%, Kappa 0.69). Patients with an MTL had a fourfold increase in risk of failure (7/42=17% with an MTL vs. 3/73=4% without, p  0.03). The presence of a SIC and quality of screw placement were not predictive of failure. CONCLUSION: Varus femoral neck fractures fixed with CRPP have a high rate of failure (37.5%). Nondisplaced or valgus impacted fractures with the presence of a visible medial transcervical line on pre-operative radiographic imaging resulted in a fourfold increase in the risk of failure after CRPP. Identification of the MTL will help treating surgeons better council patients when making pre-operative decisions between arthroplasty and CRPP.


Assuntos
Redução Fechada/efeitos adversos , Fraturas do Colo Femoral/cirurgia , Fixação de Fratura/métodos , Reoperação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Parafusos Ósseos , Estudos de Casos e Controles , Redução Fechada/instrumentação , Coxa Valga/diagnóstico por imagem , Coxa Valga/etiologia , Coxa Vara/diagnóstico por imagem , Coxa Vara/etiologia , Feminino , Fraturas do Colo Femoral/classificação , Fraturas do Colo Femoral/diagnóstico por imagem , Seguimentos , Fixação de Fratura/estatística & dados numéricos , Humanos , Masculino , Radiografia/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Falha de Tratamento
7.
Clin Orthop Relat Res ; 477(11): 2568-2576, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31425278

RESUMO

BACKGROUND: Spastic hip subluxation or dislocation that is associated with an excessive coxa valga deformity is a common pathologic condition in children with cerebral palsy (CP) that is often treated with large bone reconstructive procedures. Guided growth techniques (such as stapling, plate, or transphyseal screw) have been widely used to alter the growth axis in patients with a lower-limb deformity but only a few reports have described their use in patients with coxa valga deformities. QUESTIONS/PURPOSES: (1) Does guided growth surgery using a transphyseal screw combined with adductor tenotomy prevent progressive coxa valga deformity and lateral hip subluxation in children with CP? (2) What factors influence the correction of coxa valga deformity and the success of hip stabilization? (3) What complications were associated with this operation and how often did children treated with it undergo reoperation? METHODS: From 2012 to 2016, at our institution, three authors (H-CH, KNK, K-WW) retrospectively studied data on children with CP who underwent guided growth of the hip for progressive bilateral hip subluxation associated with coxa valga deformities. A single percutaneous screw was inserted across the inferomedial portion of proximal femoral physis in an AP view and centered along femoral neck in lateral view under fluoroscopy guidance. During the period, we treated 25 consecutive children with CP who had progressive hip subluxation with coxa valga deformities. The indications for surgery were migration percentage > 30% and head-shaft angle > 155° with at least 2 years growth remaining. Of those, 13 patients underwent guided growth alone, and 48% (12) underwent a combination of guided growth and adductor tenotomy. Of the 25 patients treated with this approach, 96% (24) were available for follow-up with complete data at a minimum of 2 years follow-up (mean 50 months; range 25 to 72). All children (17 boys and seven girls; 48 hips) underwent surgery at a mean age of 8 years (range 5 to 12). With regard to the gross motor function classification system, three patients were Level 1, four patients were Level II, seven patients were Level III, seven were Level IV, and three were Level V. Radiographic parameters including the head-shaft angle, Hilgenreiner's epiphyseal angle, acetabular index, and Reimer's migration percentage were assessed before surgery and at the latest follow-up examination by one author (H-CH). Complications and reoperations were assessed by chart review. During the period in question, we generally offered secondary reconstructive surgery to patients who underwent a guided growth procedure once their subluxation progressed. RESULTS: With the data available, the coxa valga and lateral hip subluxation improved in terms of the reduction of head-shaft angle by a mean of 13° ± 7° (95% CI 11 to 15; p < 0.001) and the reduction of the migration percentage by 10% ± 11% (95% CI 7 to 13; p < 0.001). After controlling for potentially confounding variables like gender, gross motor function classification system, Hilgenreiner's epiphyseal angle and acetabular index, we found that longer follow-up duration (r = 0.234; p < 0.001) and a smaller preoperative migration percentage (r = -0.258; p = 0.004) were associated with larger changes in the head-shaft angle. In terms of complications, we found that the proximal femoral physis grew off the screw tip in 44% (21 of 48 hips) at a mean of 28 months. Among these, 31% of hips (15 of 48) in 33% of patients (eight of 24) underwent replacement with a longer screw. Among the 17% of hips (eight of 48) in 21% of patients (five of 24) who had progressive lateral subluxation and underwent secondary reconstructive surgery, we found that their preoperative acetabular index was higher (mean 29° versus 21°; p < 0.001), as was their head-shaft angle (mean 166° versus 162°; p = 0.045), and migration percentage (mean 54% versus 36 %; p < 0.001). CONCLUSIONS: Although guided growth with single transphyseal screw did not create as large a degree of varus as proximal femoral osteotomy, it did stabilize the hip in children with cerebral palsy with migration percentage less than 50% in our series. It is a simple procedure that can be of benefit to children with cerebral palsy with unstable hip. Reoperation in patients where the physis has grown off the screw tip can be a problem; fortunately, it is a rather minor procedure to replace with a longer screw. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Parafusos Ósseos , Paralisia Cerebral/complicações , Coxa Valga/cirurgia , Fêmur/crescimento & desenvolvimento , Fêmur/cirurgia , Luxação do Quadril/prevenção & controle , Paralisia Cerebral/diagnóstico por imagem , Paralisia Cerebral/cirurgia , Criança , Pré-Escolar , Coxa Valga/diagnóstico por imagem , Epífises/diagnóstico por imagem , Epífises/cirurgia , Feminino , Fêmur/diagnóstico por imagem , Seguimentos , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/etiologia , Humanos , Masculino , Estudos Retrospectivos , Resultado do Tratamento
8.
Medicine (Baltimore) ; 98(30): e16485, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348255

RESUMO

RATIONALE: Spondylometaphyseal dysplasia (SMD) is an extremely rare disorder of irregular development of spine and metaphyses of long tubular bones. Mutations in the collagen type X alpha 1 gene were found to underlie this condition. Previously reported mutations in the N-terminal non-collagenous NC2 domain and C-terminal non-collagenous NC1 domain failed to be identified in some specific patients. PATIENT CONCERNS: A 23-year-old male was referred to us for fixed, angular thoracolumbar kyphosis with semi-paralysis, numbness, and tremor on his left lower limb. Marked hypoplasia of thoracolumbar vertebra and spinal canal stenosis were observed on radiology. DIAGNOSES: He was diagnosed with spondylometaphyseal dysplasia (Type A4). Gene sequencing was performed using normalized targeted regions sequencing (TRS). A novel heterozygous missense variant p.Gly139Cys in the triple-helical region. Multiple lines of evidence imply this mutation to be pathogenic. INTERVENTIONS: Posterior instrumentation and vertebral column resection were given to correct his fixed, angular thoracolumbar kyphosis. OUTCOMES: The correction was satisfying and the functional outcomes were good. LESSONS SUBSECTIONS AS PER STYLE: The findings corroborated that type X collagen plays a critical role in the formation of the human spine as well as the long bones, and further expanded the range of type X collagenopathy. Surgical procedure could be considered for patients with severe malformation and neurological impairments.


Assuntos
Colágeno Tipo X/genética , Coxa Valga/complicações , Osteocondrodisplasias/complicações , Osteocondrodisplasias/genética , Coxa Valga/cirurgia , Humanos , Cifose/etiologia , Cifose/cirurgia , Masculino , Osteocondrodisplasias/cirurgia , Análise de Sequência de DNA , Adulto Jovem
9.
Acta Orthop Traumatol Turc ; 53(2): 100-105, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30554836

RESUMO

OBJECTIVE: The aim of this study was to evaluate the results of fixator assisted correction of the distal femoral valgus deformities and the precision of the correction. METHODS: Seventeen extremities of 13 patients (7 women and 6 men; mean age: 16 ± 5.4 years) who had fixator assisted plating of the distal femur for genu valgum deformity were evaluated. Mechanical axis deviation (MAD) and mechanical lateral distal femoral angles (mLDFA) were measured pre-operatively and post-operatively. mLDFA was graded as perfect if it is between 85° and 90°(85° ≤ x ≤ 90°); overcorrection if it is between 91° and 95° (91° ≤ x ≤ 95°) and undercorrection if it is between 80° and 85° (80° ≤ x < 85°). Measurements beyond those limits were graded as a poor result. The position of the mechanical axis line with respect to center of the knee was graded from zone 1 to zone 4 pre-operatively and post-operatively. RESULTS: The mean follow-up period was 12.8 ± 3.7 months. The pre-operative and post-operative mLDFA was 70.5°±9.4° (range, 57°-82°) and 87.7° ± 3.5° (range, 80°-94°), respectively (p < 0.001). Based on post-operative standing radiographs, the correction was graded perfect in 12 femurs. The correction in three femurs were graded as overcorrection and graded as undercorrection in two femurs. Sagittal plane correction was also achieved in two femurs. Peroneal nerve decompression was done in three patients (5 extremities) with valgus deformity over 30°. The mechanical axes in all lower extremities were passing through zone 2 or more, pre-operatively, whereas the mechanical axes were in zone 2 or more in five extremities post-operatively. CONCLUSION: Fixator assisted plating is an effective treatment modality in patients with distal femoral valgus deformity. Although the technique enables to obtain significant correction in coronal plane it has the disadvantages of over- and undercorrection. Thus, we advise intraoperative confirmation of the correction under fluoroscopic control. LEVEL OF EVIDENCE: Level IV Therapeutic Study.


Assuntos
Coxa Valga/cirurgia , Fêmur , Fluoroscopia/métodos , Cuidados Intraoperatórios/métodos , Osteotomia , Complicações Pós-Operatórias , Adolescente , Criança , Coxa Valga/diagnóstico , Feminino , Fêmur/diagnóstico por imagem , Fêmur/patologia , Fêmur/cirurgia , Humanos , Masculino , Osteotomia/efeitos adversos , Osteotomia/métodos , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/prevenção & controle , Resultado do Tratamento , Adulto Jovem
10.
Eur J Orthop Surg Traumatol ; 27(5): 643-651, 2017 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-28391517

RESUMO

INTRODUCTION: Modern total hip arthroplasty is largely dependent on the successful preservation of hip geometry. Thus, a successful implementation of the preoperative planning is of great importance. The present study evaluates the accuracy of anatomic hip reconstruction predicted by 2D digital planning using a calcar-guided short stem of the newest generation. METHODS: A calcar-guided short stem was implanted in 109 patients in combination with a cementless cup using the modified anterolateral approach. Preoperative digital planning was performed including implant size, caput-collum-diaphyseal angle, offset, and leg length using mediCAD II software. A coordinate system and individual scale factors were implemented. Postoperative outcome was evaluated accordingly and was compared to the planning. RESULTS: Intraoperatively used stem sizes were within one unit of the planned stem sizes. The postoperative stem alignment showed a minor and insignificant (p = 0.159) mean valgization of 0.5° (SD 3.79°) compared to the planned caput-collum-diaphyseal angles. Compared to the planning, mean femoral offset gained 2.18 (SD 4.24) mm, while acetabular offset was reduced by 0.78 (SD 4.36) mm during implantation resulting in an increased global offset of 1.40 (SD 5.51) mm (p = 0.0094). Postoperative femoroacetabular height increased by a mean of 5.00 (SD 5.98) mm (p < 0.0001) compared to preoperative measures. DISCUSSION: Two-dimensional digital preoperative planning in calcar-guided short-stem total hip arthroplasty assures a satisfying implementation of the intended anatomy. Valgization, which has been frequently observed in previous short-stem designs, negatively affecting offset, can be avoided. However, surgeons have to be aware of a possible leg lengthening.


Assuntos
Artroplastia de Quadril/instrumentação , Articulação do Quadril/diagnóstico por imagem , Prótese de Quadril , Cirurgia Assistida por Computador , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Coxa Valga/etiologia , Coxa Valga/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Planejamento de Assistência ao Paciente , Período Pré-Operatório , Resultado do Tratamento
11.
Arch Orthop Trauma Surg ; 137(3): 431-439, 2017 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28154993

RESUMO

INTRODUCTION: The principle of implanting a calcar-guided short stem consists of an individual alignment alongside the medial calcar providing the ability of reconstructing varus and valgus anatomy in a great variety. However, still, there are broad concerns about the safety of extensive varus and valgus positioning in regard to stability, bony alterations, and periprosthetic fractures. MATERIALS AND METHODS: 216 total hip arthroplasties using a calcar-guided short stem (optimys, Mathys Ltd.) in 162 patients were included. Depending on postoperative CCD angle, hips were divided into five groups (A-E). Varus- and valgus tilt and axial subsidence were assessed by "Einzel-Bild-Roentgen-Analyse"(EBRA-FCA, femoral component analysis) over a 2-year follow-up. The incidence of stress-shielding and cortical hypertrophy as well as clinical outcome [Harris Hip Score (HHS)] were reported. RESULTS: Postoperative CCD angles ranged from 117.9° to 145.6° and mean postoperative CCD angles in group A-E were 123.3°, 128.0°, 132.4°, 137.5°, and 142.5°, respectively. After 2 years, the mean varus/valgus tilt was -0.16°, 0.37°, 0.48°, 0.01°, and 0.86°, respectively (p = 0.502). Axial subsidence after 2 years was 1.20, 1.02, 1.44, 1.50, and 2.62 mm, respectively (p = 0.043). No periprosthetic fractures occurred and none of the stems had to be revised. Rates of stress-shielding and cortical hypertrophy as well as HHS showed no significant difference between the groups. CONCLUSIONS: Valgus alignment results in increased subsidence but does not affect the clinical outcome. There is no difference in stress shielding and cortical hypertrophy between the groups. The authors recommend long term monitoring of valgus aligned stems.


Assuntos
Artroplastia de Quadril/métodos , Coxa Valga/epidemiologia , Coxa Vara/epidemiologia , Prótese de Quadril , Osteoartrite do Quadril/cirurgia , Complicações Pós-Operatórias/epidemiologia , Idoso , Coxa Valga/diagnóstico por imagem , Coxa Valga/fisiopatologia , Coxa Vara/diagnóstico por imagem , Coxa Vara/fisiopatologia , Feminino , Necrose da Cabeça do Fêmur/cirurgia , Quadril/cirurgia , Luxação Congênita de Quadril/cirurgia , Articulação do Quadril/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite/cirurgia , Fraturas Periprotéticas/epidemiologia , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/fisiopatologia , Período Pós-Operatório , Desenho de Prótese , Radiografia , Radiologistas , Estudos Retrospectivos , Resultado do Tratamento
12.
Osteoarthritis Cartilage ; 25(4): 438-447, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-27836678

RESUMO

Developmental dysplasia of the hip (DDH) is a common condition predisposing to osteoarthritis (OA). Especially since DDH is best identified and treated in infancy before bones ossify, there is surprisingly a near-complete absence of literature examining mechanical behavior of infant dysplastic hips. We sought to identify current practice in finite element modeling (FEM) of DDH, to inform future modeling of infant dysplastic hips. We performed multi-database systematic review using PRISMA criteria. Abstracts (n = 126) fulfilling inclusion criteria were screened for methodological quality, and results were analyzed and summarized for eligible articles (n = 12). The majority of the studies modeled human adult dysplastic hips. Two studies focused on etiology of DDH through simulating mechanobiological growth of prenatal hips; we found no FEM-based studies in infants or children. Finite element models used either patient-specific geometry or idealized average geometry. Diversities in choice of material properties, boundary conditions, and loading scenarios were found in the finite-element models. FEM of adult dysplastic hips demonstrated generally smaller cartilage contact area in dysplastic hips than in normal joints. Contact pressure (CP) may be higher or lower in dysplastic hips depending on joint geometry and mechanical contribution of labrum (Lb). FEM of mechanobiological growth of prenatal hip joints revealed evidence for effects of the joint mechanical environment on formation of coxa valga, asymmetrically shallow acetabulum and malformed femoral head associated with DDH. Future modeling informed by the results of this review may yield valuable insights into optimal treatment of DDH, and into how and why OA develops early in DDH.


Assuntos
Luxação Congênita de Quadril/fisiopatologia , Articulação do Quadril/fisiopatologia , Fenômenos Biomecânicos , Coxa Valga , Análise de Elementos Finitos , Luxação Congênita de Quadril/embriologia , Articulação do Quadril/embriologia , Humanos , Recém-Nascido
13.
Injury ; 47(12): 2743-2748, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27793326

RESUMO

INTRODUCTION: The aim of our study was to identify the risk factors for avascular necrosis of the femoral head (AVN) and fixation failure (FF) after screw osteosynthesis in patients with valgus angulated femoral neck fractures. PATIENTS AND METHODS: We conducted a retrospective study of 308 patients (mean age, 72.5 years, range, 50-97 years), with a mean follow-up of 21.4 months (range, 12-64 months). The risk for failure in treatment (FIT) associated with patient- and fracture-related factors was evaluated by logistic regression analyses. RESULTS: FIT was identified in 32 cases (10.3%): 22 cases (7.1%) of AVN and 10 cases (3.2%) of FF. Initial valgus tilt>15° (p=0.023), posterior tilt>15° (p=0.012), and screw sliding distance (p=0.037) were significantly associated with FIT. FIT occurred in 7 patients (5.2%) with B1.2.1 fractures and 17 patients (48.6%) with B1.1.2 fractures (p<0.001). The odds of FIT were 17-fold higher in patients with initial valgus and posterior tilts>15° (B1.1.2) compared to patients with <15° of tilt in both planes (B1.2.1). CONCLUSION: The severity of initial deformity predicts AVN and FF in patients with valgus angulated femoral neck fractures. Patients with an initial valgus and posterior tilt>15° are reasonable candidates for primary arthroplasty due to high risk of FIT.


Assuntos
Coxa Valga/patologia , Fraturas do Colo Femoral/cirurgia , Necrose da Cabeça do Fêmur/patologia , Fixação Interna de Fraturas , Fraturas por Osteoporose/cirurgia , Idoso , Idoso de 80 Anos ou mais , Parafusos Ósseos , Coxa Valga/diagnóstico por imagem , Coxa Valga/cirurgia , Feminino , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/fisiopatologia , Necrose da Cabeça do Fêmur/diagnóstico por imagem , Necrose da Cabeça do Fêmur/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Fraturas por Osteoporose/fisiopatologia , Radiografia , Estudos Retrospectivos , Falha de Tratamento , Resultado do Tratamento
14.
eNeuro ; 3(3)2016.
Artigo em Inglês | MEDLINE | ID: mdl-27257630

RESUMO

The growth of research on adult neurogenesis and the development of new models and tools have greatly advanced our understanding of the function of newborn neurons in recent years. However, there are still significant limitations in the ability to identify the functions of adult neurogenesis in available models. Here we report a transgenic rat (TK rat) that expresses herpes simplex virus thymidine kinase in GFAP+ cells. Upon treating TK rats with the antiviral drug valganciclovir, granule cell neurogenesis can be completely inhibited in adulthood, in both the hippocampus and olfactory bulb. Interestingly, neurogenesis in the glomerular and external plexiform layers of the olfactory bulb was only partially inhibited, suggesting that some adult-born neurons in these regions derive from a distinct precursor population that does not express GFAP. Within the hippocampus, blockade of neurogenesis was rapid and nearly complete within 1 week of starting treatment. Preliminary behavioral analyses indicate that general anxiety levels and patterns of exploration are generally unaffected in neurogenesis-deficient rats. However, neurogenesis-deficient TK rats showed reduced sucrose preference, suggesting deficits in reward-related behaviors. We expect that TK rats will facilitate structural, physiological, and behavioral studies that complement those possible in existing models, broadly enhancing understanding of the function of adult neurogenesis.


Assuntos
Células-Tronco Adultas/fisiologia , Modelos Animais , Neurogênese/fisiologia , Ratos Transgênicos , Células-Tronco Adultas/patologia , Animais , Ansiedade/fisiopatologia , Coxa Valga , Sacarose na Dieta , Comportamento Exploratório/fisiologia , Preferências Alimentares/fisiologia , Proteína Glial Fibrilar Ácida/metabolismo , Hipocampo/crescimento & desenvolvimento , Hipocampo/patologia , Hipocampo/fisiologia , Humanos , Masculino , Bulbo Olfatório/crescimento & desenvolvimento , Bulbo Olfatório/patologia , Bulbo Olfatório/fisiologia , Recompensa , Simplexvirus , Timidina Quinase/genética , Timidina Quinase/metabolismo , Proteínas Virais/genética , Proteínas Virais/metabolismo
15.
Rev Med Chir Soc Med Nat Iasi ; 120(1): 137-41, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27125086

RESUMO

AIM: To monitor the effect of tranexamic acid use (Exacyl) on postoperative bleeding (aspiration), autologous blood transfusion (autotransfusion), allogeneic blood transfusion and postoperative anemia (difference between preoperative and immediate postoperative hemoglobin levels) in total knee arthroplasty. MATERIALS AND METHODS: This retrospective observational study was conducted on a sample of 457 patients who underwent endoprosthetic knee arthroplasty in the interval January 1, 2008-July 3O, 2014 at the Traumatology-Orthopedics Clinic of the Iasi Rehabilitation Hospital. The mean age of the study group was 66 years (range 32-84 years), 74.4% were female, 39.8% presented varus and 6.1% valgus malalignment. The study group was subdivided into two groups: Group 1 served as controls and underwent surgery without the administration of tranexamic acid and Group 2 received tranexamic acid. RESULTS: In group 1 the average amount of blood lost was significantly higher than in group 2, 1168.94 ml vs. 452.9 ml (p < 0.001). The use of a cell saver was required in 70% of group 1 patients with an average amount of auto transfused blood of 480.70 ml, significantly more frequent and in greater amounts than in group 2 (below 10%) with an average of 15.05 ml (p < 0.001). In this study tranexamic acid had not a statistically significant favorable effect on blood transfusion requirements and anemia syndrome. CONCLUSION: Tranexamic acid has a favorable effect on postoperative blood loss and its associated complications, with a favorable impact on both early clinical and functional recovery.


Assuntos
Antifibrinolíticos/administração & dosagem , Artroplastia do Joelho , Hemorragia Pós-Operatória/prevenção & controle , Ácido Tranexâmico/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Coxa Valga/cirurgia , Coxa Vara/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
16.
J Orthop Sci ; 21(3): 323-6, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26951643

RESUMO

BACKGROUND: Various deformities appear in hereditary multiple exostoses (HMEs). Deformities around the knee or ankle joints are easy to detect in this disease because such deformities are visible in appearance. However, deformities in the hip joints of skeletally mature patients are not well understood because their tumors are invisible. METHODS: To understand deformities around the hip joint in HMEs, we investigated 36 hip joints in 19 skeletally mature patients (12 males, 7 females). The mean age at last X-ray imaging investigation was 29.2 years (14.5-66.5 years). We evaluated the lesions of exostoses around the acetabulum and proximal femur, Wiberg's center-edge angle (CEA), neck-shaft angle (NSA), acetabular depth-width ratio (ADR), and Sharp's acetabular angle. RESULTS: No exostoses were present in four hips of three cases. Thirty-one hip joints had exostoses on the medial side of the femoral neck. Exostoses existed on the lateral side of the femoral neck in 16 hips. None of the patients had acetabuluar tumors. One patient experienced pain because of impingement between the acetabular rim and medial tumors of the femoral neck. The increase in NSA, which is an index of proximal femoral deformity, was common with a mean NSA of 147.3 °. Two indices of acetabular deformity, Sharp's angle and ADR, were within normal limits with a mean Sharp's angle of 41.3 ° and mean ADR of 269. The average CEA was 29.9 °. CONCLUSIONS: Hip dysplasia is not necessarily common in skeletally mature patients with HMEs. To determine the possibility of hip dysplasia in skeletally immature patients with HMEs, ADR may be a useful reference index.


Assuntos
Coxa Valga/diagnóstico por imagem , Coxa Valga/epidemiologia , Exostose Múltipla Hereditária/diagnóstico por imagem , Exostose Múltipla Hereditária/epidemiologia , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Estudos de Coortes , Comorbidade , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Radiografia/métodos , Índice de Gravidade de Doença , Distribuição por Sexo , Tomografia Computadorizada por Raios X/métodos , Adulto Jovem
18.
Clin Orthop Relat Res ; 474(5): 1283-91, 2016 May.
Artigo em Inglês | MEDLINE | ID: mdl-26825816

RESUMO

BACKGROUND: During tibial lengthening, the soft tissues of the posterolateral compartment produce distraction-resisting forces causing valgus angulation. Although this occurs with the classic Ilizarov method, whether a valgus deformity develops with the lengthening over nail (LON) technique is questioned, because the intramedullary nail is thought to resist deforming forces and adequately maintain alignment of the distracted bone. QUESTIONS/PURPOSES: The purposes of this study were to (1) determine the amount of valgus deviation during tibial lengthening with the LON technique; and (2) analyze the factors that may be associated with valgus deviation with the LON technique. METHODS: Between June 2009 and September 2013, we performed 346 tibial lengthenings using the LON technique, lengthening and then nail technique, or lengthening with an intramedullary lengthening device. Sixty patients (120 tibias) who underwent bilateral lower leg lengthening with the LON technique were enrolled in this retrospective study. To limit the number of variables, we analyzed only the right tibia in all patients (60 tibias). The mean followup was 42 months (range, 26-71 months). The mean age of the patients was 25 years (range, 18-40 years). There were 36 male and 24 female patients. The mean final length gain was 67 ± 9 mm. The mean time for distraction was 100 ± 25 days. The overall valgus deviation was assessed by measuring the change in the medial proximal tibial angle and mechanical femorotibial angle on radiographs obtained before and after surgery and after completion of lengthening. Several demographic, surgical, and distraction-related variables were considered possible factors to prevent valgus deviation: proximal fixation method; presence of a blocking screw; diameter and length of the intramedullary nail; degree of nail insertion; length of the nail in the distal segment after completion of distraction; final length gain; and patient's BMI. During the period studied, the blocking screw was to maintain the mechanical axis in patients who had neutral or valgus alignment preoperatively, or to prevent more valgus change in patients who underwent acute correction of varus deformity intraoperatively. Uni- and multivariate analyses were conducted. RESULTS: Valgus deviation occurred during the tibial LON. The medial proximal tibial angle increased from 86° (95% CI, 85°-86°) to 90° (95% CI, 89°-91°) (p < 0.001). The mechanical femorotibial angle changed from 2.2° varus (95% CI, 3°-1.4° varus) to 2.6° valgus (95% CI, 1.8°-3.4° valgus) (p < 0.001). Valgus deviation was evident in proximal and distal segments. In the multivariate regression model, use of a blocking screw was the only factor that was associated with decreased valgus deviation, and its effect size, although detectable, was small (-2.62; 95% CI, -4.65 to -0.59; p = 0.013). CONCLUSIONS: We found that valgus deviation does occur during tibial lengthening using the LON technique, but that blocking screw placement may help to minimize the likelihood that severe valgus deviation will occur. Future prospective studies should be conducted to confirm this preliminary finding. LEVEL OF EVIDENCE: Level III, therapeutic study.


Assuntos
Pinos Ortopédicos , Remodelação Óssea , Coxa Valga/etiologia , Osteogênese por Distração , Tíbia/cirurgia , Adolescente , Adulto , Fenômenos Biomecânicos , Coxa Valga/diagnóstico , Coxa Valga/fisiopatologia , Feminino , Humanos , Modelos Lineares , Masculino , Análise Multivariada , Osteogênese por Distração/efeitos adversos , Osteogênese por Distração/instrumentação , Osteogênese por Distração/métodos , Radiografia , Estudos Retrospectivos , Fatores de Risco , Tíbia/diagnóstico por imagem , Tíbia/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
19.
J Pediatr Orthop ; 36(5): 511-5, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-25887815

RESUMO

BACKGROUND: Guided growth by 1 eccentric transphyseal screw has been used to correct lower limb deformities. Pilot animal studies showed encouraging results in producing varus deformity in the proximal femur. The purpose of this study was to report the preliminary results of guided growth surgery to treat spastic hip displacement. METHODS: This case series study included consecutive patients who received soft-tissue release and guided growth at the proximal femur from January 2004 to May 2012 with minimal 2-year follow-up. Surgical indications were children with spastic cerebral palsy aged 4 to 10 years, a gross motor function classification system level IV or V, and hip displacement on 1 or both sides. Study outcomes were Reimer's migration percentage (MP) and the head-shaft angle (HSA). RESULTS: Nine children with 13 spastic displaced hips received surgery at the age of 6.2 years and were followed up for a mean of 45.6 months. The mean MP improved significantly from 52.2% preoperatively to 45.8% at 3 months, 40.3% at 1 year, and 37.1% at 2 years after operation. HSA was unchanged in the first 3 months, and deceased from 173.3 to 166.4 degrees at 1 year (P<0.01) and to 162.7 degrees at 2 years postoperatively. The screw was usually backed out from the femoral epiphysis in the second postoperative year, and no radiologic bony bar or other surgical complications occurred. CONCLUSIONS: The immediate postoperative improvement of MP was the result of soft-tissue release. From postoperative 3 months to 2 years, the HSA was reduced by 10.6 degrees and the MP further improved by 8.7%. Less surgical dissection, faster recovery of motion, and less comorbidity than varus osteotomy make guided growth surgery a treatment option for coxa valga in spastic hip displacement in nonambulant cerebral palsy children. LEVEL OF EVIDENCE: Level IV-therapeutic, case series.


Assuntos
Parafusos Ósseos , Paralisia Cerebral/cirurgia , Coxa Valga/cirurgia , Epífises/cirurgia , Fêmur/cirurgia , Luxação do Quadril/cirurgia , Paralisia Cerebral/complicações , Criança , Pré-Escolar , Coxa Valga/diagnóstico por imagem , Coxa Valga/etiologia , Feminino , Fêmur/diagnóstico por imagem , Fêmur/crescimento & desenvolvimento , Seguimentos , Luxação do Quadril/diagnóstico por imagem , Luxação do Quadril/etiologia , Humanos , Masculino , Osteotomia/métodos , Radiografia , Estudos Retrospectivos
20.
Biomed Res Int ; 2015: 971216, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26693491

RESUMO

There is a growing concern about elderly valgus impacted proximal humeral fractures. The aim of this study was to evaluate the treatment and clinical outcomes following minimal invasive percutaneous plate osteosynthesis (MIPPO) with the proximal humeral internal locking system (PHILOS) for the treatment of elderly valgus impacted proximal humeral fracture. Between May 2008 and May 2012, 27 patients (average age 67.3, range 61-74) with valgus impacted proximal humeral fractures were enrolled in the study. The patients were treated with MIPPO using PHILOS-plate through the anterolateral delta-splitting approach. Rehabilitation exercises were done gradually. The NEER score and Constant-Murley score were used to evaluate shoulder function. All the patients were followed up by routine radiological imaging and clinical examination. There were 15 cases of II-part greater tuberosity fractures, 10 cases of III-part greater tuberosity fractures, and 2 cases of IV-part fractures according to the NEER classification. The surgery was successful in all patients with an average follow-up of 20.8 (range: 11-34) months. The fractures united in an average of 7.2 (6-14) weeks without implant loosening. According to NEER score, there were 17 excellent, 7 satisfactory, 2 unsatisfactory, and 1 poor. The mean Constant-Murley score was 89.4 ± 4.35. No complication including axillary nerve damage, postoperative nerve or vessel damage, infections, DVT, or death was observed. In conclusion, the MIPPO technique with the PHILOS through the anterolateral delta-splitting approach seems to be a safe and easy treatment for elderly valgus impacted proximal humeral fractures. A case-control study and longer follow-up time are needed.


Assuntos
Coxa Valga/cirurgia , Fixação Interna de Fraturas/métodos , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Fraturas do Ombro/cirurgia , Idoso , Coxa Valga/diagnóstico por imagem , Coxa Valga/patologia , Epífises/patologia , Epífises/cirurgia , Feminino , Fixação Interna de Fraturas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Radiografia , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/patologia , Resultado do Tratamento
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