Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.288
Filtrar
1.
J Pediatr Orthop B ; 31(1): 31-42, 2022 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-34848665

RESUMO

The term cubitus varus describes the inward inclination of the supinated forearm on the extended elbow. The deformity manifests clinically as a decreased carrying angle, decreased range of motion (ROM) along with a cosmetically unsightly appearance. The aim of the present study was to evaluate the technique of compression-distraction osteogenesis using the Ilizarov apparatus in the management of patients with post-traumatic cubitus varus deformity. The objectives were to study the impact of this method on the ROM, the Humerus Elbow Wrist (HEW) angle as well as the Lateral Prominence Index. A total of 32 patients who presented with a cubitus varus deformity of ≥10° at the elbow were retrospectively analyzed using data retrieved from a computerized hospital database. All patients had undergone a mini-incision subperiosteal osteotomy followed by application of an Ilizarov frame. Cinico-radiological follow-up was carried out at regular intervals until union was achieved and yearly thereafter. The mean time to union was 11 weeks. The mean follow-up period ranged from 2 to 12 years (mean 4.0 years). Results were graded as excellent in 25 cases (78.1%), good in 2 (6.3%) and poor in 5 case (15.6%) using the grading system of Oppenheim. The mean HEW angle at final follow-up improved from 20° of varus to 6° of valgus. The mean flexion/extension improved from 121°/-3° preoperatively to 125°/-4° at final follow-up. The Mayo Elbow Performance scores at final follow-up were excellent in 23 cases, good in 7 and fair in 2. Complications encountered included superficial pintract infections in three cases, lateral condylar prominence in one case, loss of terminal flexion in three cases and valgus over-correction in one case.


Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Técnica de Ilizarov , Deformidades Articulares Adquiridas , Osteogênese por Distração , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Seguimentos , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Deformidades Articulares Adquiridas/diagnóstico por imagem , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Osteotomia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
2.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 35(7): 836-840, 2021 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-34308590

RESUMO

Objective: To investigate effectiveness of picture archiving and communication systems (PACS) in lateral wedge osteotomy for cubitus varus deformity in teenagers. Methods: A clinical data of 16 teenagers with cubitus varus deformity between July 2014 and July 2016 was retrospectively analyzed. All patients were treated with lateral wedge osteotomy and fixed with plate. Before operation, the osteotomy design (the osteotomy angle and length) was done in the PACS, including the carrying angle of healthy limb and the varus angle of affected side. There were 10 males and 6 females, with an average age of 11.4 years (range, 10-17 years). The disease duration ranged from 2 to 10 years (mean, 5.6 years). The preoperative X-ray film showed that the supracondylar fractures of the humerus had all healed, and 9 cases had internal rotation deformity; the varus angle of the affected side was 19.5°-33.5°. After operation, the fracture healing and cubitus varus deformity correction were observed by X-ray films, the elbow function was evaluated by Mayo scoring, and the elbow range of motion was detected. Results: There was no significant difference between the actual intraoperative osteotomy angle and length and the preoperative design ( P>0.05). The hospital stay was 2-8 days, with an average of 4.5 days. No complication such as incision infection or ulnar nerve injury occurred. All 16 cases were followed up 12-18 months, with an average of 14 months. X-ray films showed that the osteotomy healed at 2-7 months after operation, with an average of 2.5 months. The internal fixators were removed within 8-14 months after operation (mean, 12.0 months). X-ray films measurement showed that the carrying angle of the affected side recovered to (10.3±2.0)° at 1 day after operation, which was not significantly different from that of the healthy side [(10.6±1.5)°] before operation ( t=0.480, P=0.637). The carrying angle of the affected side was (9.8±2.6)° at 1 year after operation, which was not significantly different from that of the healthy side [(10.4±1.6)°] at the same time point ( t=0.789, P=0.438). At 1 year after operation, the ranges of flexion and extension of affected side were (131.6±8.4)° and (6.4±2.6)°, respectively; and the ranges of flexion and extension of healthy side were (134.2±6.3)° and (5.9±2.2)°, respectively. There was no significant difference between the healthy and affected sides ( t=1.143, P=0.262; t=0.587, P=0.561). The elbow joint function at 1 year after operation evaluated by Mayo scoring standard rated as excellent in 9 cases, good in 6 cases, and fair in 1 case, and the excellent and good rate was 93.7%. Conclusion: Before lateral wedge osteotomy, the PACS is used to design the osteotomy angle and length, which can guide the operation and make the osteotomy more accurate and simple.


Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Sistemas de Informação em Radiologia , Adolescente , Placas Ósseas , Criança , Cotovelo , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Fraturas do Úmero/cirurgia , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Masculino , Osteotomia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
3.
Medicine (Baltimore) ; 100(23): e26124, 2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34114995

RESUMO

ABSTRACT: Various osteotomy methods have been proposed in the treatment of cubitus varus. We designed an improved stepped osteotomy to achieve improved deformity correction. We refer to this new approach as double-closed wedge broken-line osteotomy and report a series of clinical and imaging results (deformity correction, range of motion [ROM], function, osteotomy healing, and complications) of patients with cubitus varus treated with this technique.Between July 2014 and July 2019, we treated 9 cases of cubitus varus using the new technique. The study was conducted in accordance with the principles of the Declaration of Helsinki, and the study protocol was approved by the ethics committee of Shenzhen Children's Hospital. We obtained written parental consent for the minors before the study was begun. We compared preoperative and postoperative clinical and imaging parameters (humeral elbow-wrist angle, elbow ROM) in all patients. Postoperative evaluation was performed by telephone interview and outpatient review. The median follow-up was 23.2 months (range, 3-63 months).The median humeral elbow-wrist angle modified from -14.27 to 15.15. The median clinical and imaging parameters after correction of deformity were not different from that of the normal side. Using our rehabilitation program, all patients recovered preoperative elbow ROM at the last follow-up.Our double-closed wedge broken-line osteotomy has a larger cancellous bone contact surface. The deformity correction is satisfactory, the osteotomy healing is reliable, and the incidence of complications is low.Level of Evidence: Level IV.


Assuntos
Articulação do Cotovelo , Fraturas do Úmero/complicações , Deformidades Articulares Adquiridas , Osteotomia/métodos , Criança , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Deformidades Articulares Adquiridas/diagnóstico por imagem , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Masculino , Período Pós-Operatório , Radiografia/métodos , Amplitude de Movimento Articular , Resultado do Tratamento
4.
Acta Orthop Traumatol Turc ; 55(2): 177-180, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33847582

RESUMO

OBJECTIVE: The aim of this study was to determine the intraoperative corrective effect of the aponeurotic release of semimembranosus (SM) as a single procedure or an adjunct procedure to distal myotendinous release of semitendinosus (ST) and myofascial release of SM lengthening in the correction of knee flexion deformity in cerebral palsy (CP). METHODS: In this prospective study, 46 knees of 23 consecutive ambulatory patients (15 boys and 8 girls; mean age=8.33 years; age range=5-12 years) with spastic diplegic CP with a gross motor function classification system level (GMFCS) II or III were included. The patients were then divided into 2 groups. In group I, there were 10 patients (4 boys, 6 girls; mean age=8.6±2), and combined release of ST in the myotendinous junction and SM in the myofascial junction, followed by aponeurotic release of SM were carried out. In group II, there were 13 patients (2 girls, 11 boys; mean age=8±2.35), and aponeurotic release of SM was done first and followed by the combined release of ST in the distal myotendinous junction and the myofascial release of SM. Intraoperative popliteal angle (PA) measurements were recorded in each group. RESULTS: PA was reduced from 58.1°±7.6° (range=46°-75°) to 41.2°±8.8° (range=20°-54°) in group 1 and from 59.1°±11.3° (range=40°-87°) to 42.7°±10.8° (range=24°-64°) in group 2. No significant difference was observed between the groups in terms of reduction in PA (p=0.867). In group 1, adding the aponeurotic release of SM further reduced the PA to 31.7°± 8.5° (range=14°-47°) (p=0.002). In group 2, adding the myotendinous release of ST and myofascial release of SM further reduced the PA to 32.9°±7.2° (range=16°-44°) (p=0.004). There was no significant difference between the final PA values in the 2 groups (p=0.662). There was no difference in terms of early complications. CONCLUSION: Aponeurotic release of SM is equally effective to reduce the intraoperative PA with combined myotendinous release of ST and myofascial release of SM. Combining all the 3 procedures provides a better correction without forceful manipulation or lengthening of the lateral hamstrings during the correction of knee flexion deformity in CP.


Assuntos
Paralisia Cerebral , Músculos Isquiossurais , Deformidades Articulares Adquiridas/cirurgia , Articulação do Joelho , Tenotomia , Paralisia Cerebral/complicações , Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/cirurgia , Criança , Contratura/etiologia , Contratura/cirurgia , Feminino , Músculos Isquiossurais/patologia , Músculos Isquiossurais/fisiopatologia , Humanos , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/fisiopatologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Prospectivos , Estudos Retrospectivos , Tenotomia/efeitos adversos , Tenotomia/métodos , Resultado do Tratamento
5.
J Hand Surg Asian Pac Vol ; 26(2): 218-222, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33928862

RESUMO

Background: Lateral humeral condylar fractures often heal with some residual elbow deformity. However, details of angulation or tilting angle of the lateral condyle after the fracture have not been evaluated so far. Methods: Between 2008 and 2016, we followed up 80 mild fractures of the lateral humeral condyle for more than a year. Thirty fractures were treated by open reduction and internal fixation (ORIF) with Kirschner wires. Fifty cases were treated with a long arm splint for 3 weeks (Fig. 1). The average age of the patients at the time of the injury was 5.5 years. The humerus-elbow-wrist angle (HEWA), Baumann's angle (BA), and tilting angle (TA) were measured on the radiographs. The active range of motion (ROM) was clinically assessed at unaffected and affected sides at the final follow-up. Results: No significant differences were detected between the sides about TA or ROM at the final follow-up. However, HEWA/ BA showed more significant loss of correction. There were significant differences in BA at the affected side between the ORIF and splint groups. Conclusions: Cubitus varus deformity after lateral humeral condylar fracture is not accompanied by a change in TA or ROM, unlike the deformity after supracondylar or distal epiphyseal fracture of the humerus (Fig. 2). Operative treatment to precisely correct and fix the lateral condylar fracture still retained some cubitus varus deformity, although it might lessen or prevent the deformity when compared to conservative treatment with a splint.


Assuntos
Articulação do Cotovelo/fisiopatologia , Fraturas do Úmero/fisiopatologia , Fraturas do Úmero/terapia , Deformidades Articulares Adquiridas/fisiopatologia , Criança , Pré-Escolar , Articulação do Cotovelo/diagnóstico por imagem , Feminino , Seguimentos , Fixação Interna de Fraturas , Humanos , Lactente , Masculino , Redução Aberta , Radiografia , Amplitude de Movimento Articular/fisiologia , Contenções , Articulação do Punho/diagnóstico por imagem
6.
Knee ; 29: 411-417, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33714928

RESUMO

BACKGROUND: The purpose of this study was to examine the status of cartilage repair by second-look arthroscopy following double-level osteotomy (DLO) performed for osteoarthritic knees with severe varus deformity. METHODS: Forty-seven consecutive knees in 33 patients who underwent DLO were included in the study. The surgical technique used was a minimally invasive DLO procedure combining lateral closed-wedge distal femoral and medial open-wedge high tibial osteotomies. In the second-look arthroscopic evaluation, the following grading system proposed by Koshino was adopted: Stage A, no repair; stage B, pink fibrous tissue with or without partial coverage with white fibrocartilage; and stage C, total coverage with cartilage. The findings corresponding to stage B or C were considered as repaired. Arthroscopic assessment was performed for each compartment. Clinical outcomes were evaluated using the validated outcome measures. RESULTS: The mean age at surgery was 62.8 ± 6.2 years (range: 45-75 years), and the mean time period from DLO to second-look arthroscopy was 17.1 ± 5.0 months (range: 12-33 months). Cartilage repair to some extent was identified in over 90% of the medial femoral and tibial condyles, and 12.8% of the patellar facet. As for clinical scores, both Knee Injury and Osteoarthritis Outcome Score (KOOS) and the International Knee Documentation Committee Subjective Knee Form (IKDC) subjective scores significantly improved after surgery (P < 0.01). CONCLUSIONS: Evaluation of the present study subjects showed that DLO could induce cartilage repair in the majority of the affected femoral and tibial articular surfaces with significant clinical improvement. In the patellar facet, however, cartilage repair could be identified in only 12.8% of cases.


Assuntos
Artroscopia , Cartilagem Articular/patologia , Cartilagem Articular/cirurgia , Osteoartrite do Joelho/cirurgia , Cirurgia de Second-Look , Idoso , Feminino , Humanos , Deformidades Articulares Adquiridas/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/métodos
7.
J Orthop Surg (Hong Kong) ; 29(1): 23094990211002002, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33787403

RESUMO

PURPOSE: To evaluate the integrity of lateral soft tissue in varus osteoarthritis knee by comparing the mechanical axis under varus stress during navigation-assisted total knee arthroplasty before and after compensating for a bone defect with the implant. METHODS: Sixty-six knees that underwent total knee arthroplasty were investigated. The mechanical axis of the operated knee was evaluated under manual varus stress immediately after knee exposure and after navigation-assisted implantation. The correlation between each value of the mechanical axis and degree of preoperative varus deformity was compared by regression analysis. RESULTS: The maximum mechanical axis under varus stress immediately after knee exposure increased in proportion to the degree of preoperative varus deformity. Moreover, the maximum mechanical axis under varus stress after implantation increased in proportion to the degree of preoperative varus deformity. Therefore, the severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, regression coefficients after implantation were much smaller than those measured immediately after knee exposure (0.99 vs 0.20). Based on the results of the regression formula, the postoperative laxity of the lateral soft tissue was negligible, provided that an appropriate thickness of the implant was compensated for the bone and cartilage defect in the medial compartment without changing the joint line. CONCLUSION: The severity of varus knee deformity leads to a progressive laxity of the lateral soft tissue. However, even if the degree of preoperative varus deformity is severe, most cases may not require additional procedures to address the residual lateral laxity.


Assuntos
Artroplastia do Joelho , Articulação do Joelho/fisiologia , Osteoartrite do Joelho/cirurgia , Amplitude de Movimento Articular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Artroplastia do Joelho/reabilitação , Feminino , Humanos , Deformidades Articulares Adquiridas/patologia , Deformidades Articulares Adquiridas/fisiopatologia , Deformidades Articulares Adquiridas/cirurgia , Joelho/fisiologia , Joelho/cirurgia , Articulação do Joelho/cirurgia , Masculino , Fenômenos Mecânicos , Pessoa de Meia-Idade , Osteoartrite do Joelho/fisiopatologia , Período Pós-Operatório
8.
J Orthop Surg Res ; 16(1): 107, 2021 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-33541393

RESUMO

INTRODUCTION: This study aimed to determine the effects of denosumab treatment on the joint destruction of Japanese females with rheumatoid arthritis (RA) and anti-cyclic citrullinated peptide (CCP) antibodies. MATERIALS AND METHODS: This retrospective longitudinal study included 56 patients treated with denosumab and 50 patients treated with bisphosphonate. All participants were positive for anti-CCP antibodies. All patients also had a history of osteoporosis treatment with bisphosphonate, which was either continued or switched to 60 mg of subcutaneous denosumab injection every 6 months. To assess the progression of joint destruction, hand and foot radiographs were taken, and changes in modified total Sharp score (mTSS), erosion score (ERO), and joint space narrowing score (JSN) were evaluated at 12 months and 24 months. The changes in BMD of the lumbar spine and hip were also assessed at 12 months. RESULTS: At 12 months, there were significant differences in the change of ERO (p = 0.015) and mTSS (p = 0.01). Similarly, there were significant differences in the change of ERO (p = 0.013) and mTSS (p = 0.003) at 24 months. In contrast, no significant difference was observed in the changes of JSN and clinical parameters. There were significant differences in the changes in BMD in the femoral neck (p = 0.011) and total hip (p = 0.012). CONCLUSION: Denosumab treatment might be effective for the inhibition of bone erosion progression in the patients with RA, and it potentially contributes to the treatment of osteoporosis and prevention of destructive arthritis in patients with switching treatment from bisphosphonate.


Assuntos
Anticorpos Anti-Proteína Citrulinada , Artrite Reumatoide/tratamento farmacológico , Artrite Reumatoide/imunologia , Denosumab/administração & dosagem , Difosfonatos/administração & dosagem , Substituição de Medicamentos , Deformidades Articulares Adquiridas/prevenção & controle , Pós-Menopausa , Idoso , Artrite Reumatoide/complicações , Densidade Óssea , Conservadores da Densidade Óssea/administração & dosagem , Progressão da Doença , Feminino , Humanos , Deformidades Articulares Adquiridas/etiologia , Estudos Longitudinais , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/complicações , Osteoporose Pós-Menopausa/tratamento farmacológico , Estudos Retrospectivos
9.
J Orthop Surg Res ; 16(1): 149, 2021 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-33610184

RESUMO

BACKGROUND: Knee osteoarthritis associated with extra-articular deformity (EAD) can confront the arthroplasty surgeons with challenges of bone resection and soft tissue balancing. The aim of this study was to describe a single-stage procedure associating corrective osteotomy with total knee arthroplasty (TKA), and to determine the outcome at mid- to long-term follow-up. METHODS: A total of seven patients (seven knees) with knee osteoarthritis and supracondylar deformity were included in this study. Six patients were female, and one was male, with the median age of 62 years (range, 37-76 years). All patients were treated with single-stage TKA and femoral osteotomy. Osteotomy was fixed with long cemented stem. Hospital of Special Surgery (HSS) scores, collateral ligament laxity, and range of motion (ROM) were clinically evaluated preoperatively and at each follow-up. Radiographic parameters including the mechanical axis deviation (MAD), mechanical lateral distal femoral angle (mLDFA), mechanical proximal tibial angle (mMPTA), and joint line congruence angle (JLCA) were also measured. The occurrence of perioperative complications was recorded. RESULTS: The median follow-up time was 91 months (range, 38-104 months). At the last follow-up, all components were stable and no patients required revision. Nonunion of the osteotomy occurred in one patient. In all patients, the lower limb mechanical alignment improved greatly. The mean angle of MAD was restored from 10.49±6.05 cm preoperatively to 1.11±4.97 cm postoperatively. The 90° mLDFA was almost acquired in all cases, with the postoperative value of 90.79±2.40°. After operation, the mMPTA improved from 84.18±6.13° to 91.33±3.13°. The JLCA changed from 2.94±1.61° to -0.71±3.50°. The median HSS score improved from 45 (range, 34-56) preoperatively to 90 (range, 82-97) postoperatively, with the outcome of all patients rated good to excellent. The median ROM improved from 70° (range 0-110°) preoperatively to 105° (range 90-125°) postoperatively. No instability of knee joint was observed. Complications included an intraoperative split fracture of distal femur and one case of wound exudation resulting from fat liquefaction. CONCLUSIONS: For knee osteoarthritis with femoral supracondylar deformity, single-stage TKA and corrective osteotomy was feasible but technically demanding. The use of long cemented stem for osteotomy fixation can provide reliable rotational control of the bone segments.


Assuntos
Artroplastia do Joelho/métodos , Fêmur/cirurgia , Deformidades Articulares Adquiridas/cirurgia , Osteoartrite do Joelho/cirurgia , Osteotomia/métodos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
10.
Rheumatology (Oxford) ; 60(4): 1755-1762, 2021 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-33097960

RESUMO

OBJECTIVES: Our aim is to understand clinical characteristics, real-life treatment strategies, outcomes of early PsA patients and determine the differences between the inception and established PsA cohorts. METHODS: PsArt-ID (Psoriatic Arthritis- International Database) is a multicentre registry. From that registry, patients with a diagnosis of PsA up to 6 months were classified as the inception cohort (n==388). Two periods were identified for the established cohort: Patients with PsA diagnosis within 5-10 years (n = 328), ≥10 years (n = 326). Demographic, clinical characteristics, treatment strategies, outcomes were determined for the inception cohort and compared with the established cohorts. RESULTS: The mean (s.d.) age of the inception cohort was 44.7 (13.3) and 167/388 (43.0%) of the patients were male. Polyarticular and mono-oligoarticular presentations were comparable in the inception and established cohorts. Axial involvement rate was higher in the cohort of patients with PsA ≥10 years compared with the inception cohort (34.8% vs 27.7%). As well as dactylitis and nail involvement (P = 0.004, P = 0.001 respectively). Both enthesitis, deformity rates were lower in the inception cohort. Overall, 13% of patients in the inception group had a deformity. MTX was the most commonly prescribed treatment for all cohorts with 10.7% of the early PsA patients were given anti-TNF agents after 16 months. CONCLUSION: The real-life experience in PsA patients showed no significant differences in the disease pattern rates except for the axial involvement. The dactylitis, nail involvement rates had increased significantly after 10 years from the diagnosis and the enthesitis, deformity had an increasing trend over time.


Assuntos
Artrite Psoriásica/tratamento farmacológico , Artrite Psoriásica/fisiopatologia , Adulto , Antirreumáticos/uso terapêutico , Estudos de Coortes , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Articulações dos Dedos/fisiopatologia , Glucocorticoides/uso terapêutico , Humanos , Deformidades Articulares Adquiridas/fisiopatologia , Masculino , Metotrexato/uso terapêutico , Pessoa de Meia-Idade , Doenças da Unha/tratamento farmacológico , Doenças da Unha/fisiopatologia , Medidas de Resultados Relatados pelo Paciente , Sistema de Registros , Sulfassalazina/uso terapêutico , Inibidores do Fator de Necrose Tumoral/uso terapêutico
12.
Mod Rheumatol ; 31(1): 114-118, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32017657

RESUMO

OBJECTIVE: Digital joints affected by rheumatoid arthritis often have severe deformity and/or dislocation, and arthrodesis in a functional position is required. METHODS: Arthrodesis was performed using intraosseous wiring (modified Lister's method) from January 2011 to December 2015, and we investigated the union rate, postoperative complications, and patient satisfaction with the operation at the final follow-up. The DASH score, grip power, and pinch power were also investigated before the operation and at the final follow-up. RESULTS: Arthrodesis was performed for 90 digital joints in 56 patients. Bone union was obtained in 85 of 89 joints (96%). Wire removal was needed due to subcutaneous protrusion in 20 joints and superficial infection in five joints. The mean preoperative DASH score of 50.5 improved to 45.2 at the final follow-up. The pulp pinch power of the index fingers through the little fingers changed significantly. In the questionnaire regarding the operated digit using a visual analogue scale (VAS, 0 [worst] to 100 [best]), the overall satisfaction was 70. CONCLUSION: With this approach, we achieved painless stability as well as deformity correction. A restored prehensile pattern and improvement in the activities of daily life can thus be expected after surgery.


Assuntos
Artralgia , Artrite Reumatoide , Artrodese , Articulações dos Dedos , Deformidades Articulares Adquiridas , Idoso , Artralgia/etiologia , Artralgia/terapia , Artrite Reumatoide/complicações , Artrite Reumatoide/fisiopatologia , Artrite Reumatoide/cirurgia , Artrodese/efeitos adversos , Artrodese/instrumentação , Artrodese/métodos , Fios Ortopédicos , Feminino , Articulações dos Dedos/patologia , Articulações dos Dedos/cirurgia , Humanos , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Masculino , Avaliação de Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/diagnóstico , Estudos Retrospectivos
13.
BMJ Case Rep ; 13(12)2020 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-33328209

RESUMO

Pachydermodactyly (PDD) is a rare, benign disease associated with progressive swelling of the periarticular soft tissue of phalangeal hand joints typically treated with local steroid injections. We present a case of a 37-year-old man with PDD treated with local steroid injections. He later developed heterotopic ossification and para-articular calcifications in the injection sites. Heterotopic ossification is not associated with PDD nor is it a recognised complication of local steroid injections. This is the first case in literature of heterotopic ossification occurring after local steroid injection and brings to attention a new potential complication of a widely performed procedure.


Assuntos
Articulações dos Dedos/patologia , Deformidades Articulares Adquiridas/tratamento farmacológico , Ossificação Heterotópica/induzido quimicamente , Esteroides/efeitos adversos , Adulto , Humanos , Injeções Intra-Articulares , Masculino , Ilustração Médica , Esteroides/administração & dosagem
14.
BMC Musculoskelet Disord ; 21(1): 820, 2020 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-33287786

RESUMO

BACKGROUND: Cubitus varus is a complex three-dimensional deformity. Various osteotomies have been introduced to correct this complex deformity. The objective of the present study was to evaluate clinical and functional outcomes of adult cubitus varus deformity treated with translation step-cut osteotomy. METHODS: Seventeen consecutive patients with a mean age of 25 years (range, 19-50 years) who underwent translation step-cut osteotomy were enrolled in this study. Their average follow-up period was 28.2 months. Radiographic measurements preoperatively, 3-month postoperatively, and at the last follow-up were compared. Functional outcomes were assessed using Disabilities of the Arm, Shoulder and Hand (DASH), Mayo Elbow Performance Score (MEPS), and Oppenheim criteria. RESULTS: The mean humerus-elbow-wrist angle improved from 14.7° ± 6.4° (range, 6°-23°) varus preoperatively to 12.1° ± 6.6° (range, 5°-20°) valgus postoperatively (p <  0.001). The lateral prominence index improved 9.6% from its preoperative value, showing no significant difference from that of a normal elbow. Osseous union was radiographically demonstrated in 16 patients (except one out of 17 patients) within a mean of 12.7 weeks (range, 8-18 weeks). The motion arc of the elbow at the last follow-up was not significantly (p > 0.05) different from that at the initial presentation. Based on Oppenheim criteria, results were excellent for 7, good for 8, and poor for 2 patients. Mean final DASH value and MEPS were 2.5 ± 3.8 points (range, 0-15 points) and 97.0 ± 5.8 points (range, 85-100 points), respectively. With regard to complications, one case had delayed union and one case had transient radial nerve injury. CONCLUSION: Translation step-cut osteotomy using Y plate is an efficient procedure to correct varus alignment and flexion-extension deformities so that they are within normal limits of adults with post-traumatic cubitus varus deformity. TRIAL REGISTRATION: Institutional Review Board of Jeonbuk National University Hospital (IRB No. 2020-01-020 ).


Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Adulto , Braço , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Deformidades Articulares Adquiridas/diagnóstico por imagem , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Pessoa de Meia-Idade , Osteotomia , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
15.
Tech Hand Up Extrem Surg ; 25(2): 123-126, 2020 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-33017348

RESUMO

Despite surgical advances in fracture management, it is not uncommon to find pediatric or adolescent patients with elbow deformities. Correction of severe deformities, often leaves the ingenuity of the treating surgeon asking for more. Various osteotomy techniques have been described in the literature for the correction of elbow deformities. Although, the concept of dome osteotomy did address certain inadequacies of the existing osteotomy techniques for distal humerus, but correction of complex deformities associated with deformation of trochlea and olecranon fossa still remain a surgical challenge which has not been adequately addressed in the literature so far. Our experience with the existing osteotomies for distal humerus led to the development of a new surgical technique of shortening dome osteotomy for correction of such complex multiplanar elbow deformities. Surgical steps, indications, and expected outcome is described.


Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Adolescente , Criança , Cotovelo , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Úmero/diagnóstico por imagem , Úmero/cirurgia , Deformidades Articulares Adquiridas/cirurgia , Osteotomia , Resultado do Tratamento
16.
Injury ; 51(11): 2574-2580, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32843147

RESUMO

INTRODUCTION: Supracondylar fracture malunion usually results in cubitus varus deformity. The long-standing unsightly deformity causes psychological stress to the child and his/her parents in addition to biomechanical disturbances and functional disorders in the affected elbow. The optimal timing of corrective osteotomy is not well-established in the literature. The present study aimed to report the results of early correction of cubitus varus deformity using a simple technique and to focus on the timing of early correction after supracondylar fracture malunion. PATIENTS AND METHODS: Thirty consecutive patients treated for recent cubitus varus deformity after malunited supracondylar fractures, in the period between January 2012 and August 2017, were retrospectively reviewed. All patients had early surgical correction of the deformity within one year after the initial injury. In patients who presented with maluniting supracondylar fracture, the fracture was splinted until union was achieved, then active exercises were encouraged until elbow ROM was regained. The deformity was then corrected with a lateral closing wedge (LCW) osteotomy and fixed with two lateral and one medial wire. RESULTS: All the osteotomies united. All the deformities were corrected. The humerus-elbow-wrist (HEW) angle significantly improved compared to the pre-operative values (p<0.001). All patients achieved satisfactory results at the final evaluation. Twenty-six patients (86.7%) achieved excellent results while four patients (13.3%) achieved good results. CONCLUSION: Early correction of cubitus varus deformity avoids the psychological stress of the long-standing unsightly deformity to the young child and his/her family. It also avoids the delayed biomechanical and functional disturbances to the affected elbow. The LCW osteotomy and the three-wires fixation technique are simple and effective to correct the deformity and maintain the correction.


Assuntos
Articulação do Cotovelo , Fraturas Mal-Unidas , Fraturas do Úmero , Deformidades Articulares Adquiridas , Criança , Pré-Escolar , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Feminino , Fraturas Mal-Unidas/diagnóstico por imagem , Fraturas Mal-Unidas/cirurgia , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Úmero , Deformidades Articulares Adquiridas/diagnóstico por imagem , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
17.
J Pediatr Orthop ; 40(7): e547-e553, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32658393

RESUMO

INTRODUCTION: The incidence of residual deformity in the sagittal plane of the humerus (RDSPH) after nonoperative management of type II supracondylar humerus fractures (SCHFs), and the effects of such deformity on the overall arc of motion (AOM) of the elbow, are unknown. Our purpose was to analyze data collected prospectively on a large cohort of type II SCHF's to establish the incidence and extent of RDSPH, and the effects of the deformity on the elbow function, to further support our previously published recommendations on the treatment of type II SCHF. METHODS: The clinical data and radiographs of 1107 pediatric type II SCHFs enrolled in a prospective registry, and followed for a minimum of 8 weeks, were retrospectively reviewed. The radiographs obtained during the latest follow-up appointment were examined for the presence of RDSPH, as demonstrated by the anterior humeral line falling anterior or posterior relative to the center of the capitellum. The amount of RDSPH in the sagittal plane was then calculated. We compared the treatment outcome of elbows with and without RDSPH by assessing the patients' AOM, the arc of flexion (AOF), and relative arcs of motion (R-AOM) and relative arcs of flexion (R-AOF) (as compared with the unaffected, contralateral elbow). RESULTS: Overall, 799 (72.2%) fractures were treated nonsurgically, and 308 (27.8%) fractures were treated surgically. The overall incidence of RDSPH was 10.2%. None of the fractures managed operatively demonstrated residual deformity. The RDSPH was classified as mild in 35 fractures (3.2%), moderate in 64 fractures (5.7%) and severe in 14 fractures (1.3%). Therefore, the incidence of RDSPH in fractures treated nonoperatively was 14.1%. In fractures treated nonoperatively, the difference in AOM between those without (n=686) and with (n=113) RDSPH was <4 degrees (149.1 vs. 145.8 degrees, P=0.02). Those with and without RDSPH had a clinically similar AOF, with a mean difference of<4 degrees (134.5 vs. 137.9 degrees, P<0.0001). The differences in R-AOM and R-AOF between those with and without RDSPH were minimal (97.3% vs. 95.6% and 96.6% vs. 95.3%, respectively). A satisfactory outcome, defined as an R-AOM of at least 85% when compared with the unaffected, contralateral side at the latest follow-up, was achieved in 91% of fractures with RDSPH, and 93% of fractures without RDSPH. DISCUSSION AND CONCLUSION: The incidence of RDSPH in type II SCHF treated nonoperatively was 14%. In our cohort, nearly 99% of all RDSPH were mild to moderate. On the basis of the data presented in the current study, nonsurgical treatment of type II SCHF can provide a satisfactory recovery of AOM, AOF, R-AOM, and R-AOF, and a high rate of satisfactory outcomes, even in the presence of RDSPH.


Assuntos
Articulação do Cotovelo/diagnóstico por imagem , Fraturas do Úmero/terapia , Deformidades Articulares Adquiridas/epidemiologia , Adolescente , Algoritmos , Criança , Pré-Escolar , Estudos de Coortes , Progressão da Doença , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Incidência , Lactente , Masculino , Radiografia , Amplitude de Movimento Articular , Sistema de Registros , Estudos Retrospectivos , Resultado do Tratamento
18.
J Pediatr Orthop ; 40(9): e873-e879, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32658158

RESUMO

BACKGROUND: In children with cerebral palsy who demonstrate hamstring tightness, increasing attention is being paid to less invasive methods of correcting knee flexion contractures. Guided growth principles represent one such approach, and in tandem with a serial extension casting protocol, may provide a less invasive method of addressing these contractures. To date, no evidence is available on this combination of procedures. The purpose of this study was to investigate the effectiveness of a combined lengthening/guided growth procedure (hamstring lengthening, percutaneous anterior screw hemiepiphysiodesis, and serial extension casting) in addressing knee flexion contracture, and to compare this approach to hamstring lengthening and serial extension casting alone. METHODS: Measures from preoperative and postoperative gait analyses were reviewed retrospectively for 10 patients with cerebral palsy who underwent anterior screw hemiepiphysiodesis and hamstring lengthening followed by serial extension casting [anterior epiphysiodesis (AE) group]. These findings were compared with measures from 19 patients with cerebral palsy who underwent hamstring lengthening followed by serial extension casting [no anterior epiphysiodesis (NAE) group]. Postoperative changes in clinical, functional, and kinematic parameters were assessed. Radiographic parameters were also assessed for the AE group. RESULTS: In the AE group, improvements were measured in knee contracture, popliteal angle, peak stance phase knee extension, knee range of motion, and Gait Deviation Index. Similar results were observed in the NAE group. In the AE group, the lateral distal femoral angle increased into extension by 20.9 degrees at an average of 26-month follow-up. Both groups showed an increase in pelvic tilt postoperatively. There were no surgical complications associated with the screw anterior hemiepiphysiodesis. Four patients did have complaints of knee pain, but the pain was attributable to the implants in only one patient. DISCUSSION: The AE group demonstrated statistically greater postoperative improvement in popliteal angle, knee flexion contracture, and peak knee extension during stance than the NAE group. Both procedures led to improvements in clinical and functional measures, indicating the validity of this approach as a means of correcting flexion contracture that is less invasive and allows immediate weight bearing. LEVEL OF EVIDENCE: Level III-therapeutic study.


Assuntos
Artrodese , Paralisia Cerebral/complicações , Contratura , Músculos Isquiossurais/cirurgia , Deformidades Articulares Adquiridas , Articulação do Joelho , Tenotomia/métodos , Artrodese/instrumentação , Artrodese/métodos , Parafusos Ósseos , Criança , Contratura/etiologia , Contratura/cirurgia , Feminino , Análise da Marcha , Humanos , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Articulação do Joelho/patologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
19.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(7): 831-835, 2020 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-32666724

RESUMO

Objective: To investigate the effectiveness of three-dimensional (3D) navigation template in the adult cubitus varus osteotomy. Methods: Between April 2013 and September 2015, 17 patients with cubitus varus were admitted. There were 6 males and 11 females, aged from 19 to 38 years, with an average age of 26.9 years. There were 10 cases of left elbow joints and 7 cases of right elbow joints. The disease duration was 9-30 years (mean, 18 years). Based on the preoperative X-ray film, the humerus-elbow-wrist (HEW) angle was (-13.2 ±3.3)°, the anteversion angle was (-10.5±2.3)°. The preoperative range of motion (ROM) of flexion was (127.3±7.3)° and ROM of extension was (-10.0±2.5)°. Based on the CT 3D reconstruction, the osteotomy navigation template was designed and printed by 3D printing technique. The cubitus varus osteotomy was assisted by 3D navigation template. The postoperative HEW angle, anteversion angle, and ROMs of the elbow joints of both sides were measured. The elbow function was evaluated based on the Oppenheim elbow function score at 1 year after operation. Results: All cubitus varus osteotomies succeeded with the assist of 3D navigation template. All incisions healed by first intention. All patients were followed up 12-15 months (mean, 13 months). X-ray films showed that all osteotomies healed after 9-12 weeks (mean, 11 weeks). At 1 year after operation, the HEW angle was (9.7±1.9)°, the anteversion angle was (20.7±4.3)°, the ROM was (2.6±3.5)° in extension and (139.2±4.8)° in flexion of affected side. The HEW angle, anteversion angle, and ROMs significantly increased compared with preoperative values ( P<0.05). And there was no significant difference between affected and normal elbow joints ( P>0.05). The elbow functions were excellent in 13 cases and good in 4 cases based on the Oppenheim elbow function score at 1 year after operation. There was no complication such as the nerve injury or osteomyositis of elbow joint during follow-up. Conclusion: The 3D navigation template can provide a personalized and precise osteotomy treatment for adult cubitus varus deformity and obtain a satisfactory effectiveness.


Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Adulto , Feminino , Humanos , Úmero , Masculino , Osteotomia , Amplitude de Movimento Articular , Resultado do Tratamento , Adulto Jovem
20.
Int Orthop ; 44(7): 1417-1426, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32458036

RESUMO

PURPOSE: Cubitus varus deformity occurs in children as a late consequence of supracondylar fracture of the distal humerus. Different types of corrective osteotomies have been described, but a gold standard has not yet been established. The aim of this study is to report the clinical, radiological, and cosmetic outcome of the modified reverse step-cut osteotomy technique. METHODS: This study was conducted on 15 cases, which were operated during the period between July 2015 and June 2016. We used the technique modified reverse step-cut osteotomy with the calculated medial translation of the distal fragment to correct varus and sagittal plane deformity and to achieve anatomical alignment of the forearm axis with the axis of the humerus. Follow-up was done for two years. Pre-operative and post-operative clinical and radiological parameters were compared, and patient satisfaction was assessed. RESULTS: The mean pre-operative humerus-elbow-wrist (HEW) angle was - 22.4°; it improved to + 9.4° post-operatively. The pre-operative mean range of motion was 131.6°, and the post-operative mean was 132°. The clinico-radiological outcome was assessed according to Oppenheim criteria. There was an excellent result in nine patients (60%), a good result in five patients (33.3%), and poor results in one patient (6.6%). Cosmetic outcome was assessed as per Barrett's criteria, excellent result in thirteen patients (86.6%) and poor results in two patients (13.3%). Post-operative lateral condylar prominence index (LCPI) was compared with the normal side, and there was no significant difference. CONCLUSION: We have achieved satisfactory results with acceptable cosmetic appearance and functional outcomes with minimal complications. We recommend this technique as a safe, reliable, reproducible, technically easy procedure for correction of cubitus varus deformity.


Assuntos
Articulação do Cotovelo , Fraturas do Úmero , Deformidades Articulares Adquiridas , Criança , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/cirurgia , Humanos , Fraturas do Úmero/complicações , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/cirurgia , Úmero/diagnóstico por imagem , Úmero/cirurgia , Deformidades Articulares Adquiridas/diagnóstico por imagem , Deformidades Articulares Adquiridas/etiologia , Deformidades Articulares Adquiridas/cirurgia , Osteotomia , Amplitude de Movimento Articular , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...