Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 3.461
Filtrar
1.
JBJS Case Connect ; 14(1)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38484087

RESUMO

CASE: We will present the case of a 6-year-old girl who presented with a 3-cm limb length discrepancy after intraosseous line placement at age 14 months without other known history of trauma or infection to account for the growth arrest. Imaging revealed a left proximal tibial physeal bar amenable to surgical resection with autologous lipotransfer. At 10 months postoperatively, physical examination and imaging demonstrated a stable 3-cm leg length discrepancy with an interval increase in the length of the left tibia in proportion to the growth of the right side with an increase in valgus alignment that will continue to be monitored and addressed as indicated. CONCLUSION: Pediatric intraosseous line placement presents unique challenges and can ultimately lead to physeal injury and growth arrest in the case of malpositioning.


Assuntos
Lâmina de Crescimento , Tíbia , Criança , Feminino , Humanos , Lâmina de Crescimento/cirurgia , Desigualdade de Membros Inferiores/etiologia , Desigualdade de Membros Inferiores/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia
2.
Sci Prog ; 107(1): 368504241236345, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38490169

RESUMO

The accurate identification of dynamic change of limb length discrepancy (LLD) in non-clinical settings is of great significance for monitoring gait function change in people's everyday lives. How to search for advanced techniques to measure LLD changes in non-clinical settings has always been a challenging endeavor in recent related research. In this study, we have proposed a novel approach to accurately measure the dynamic change of LLD outdoors by using deep learning and wearable sensors. The basic idea is that the measurement of dynamic change of LLD was considered as a multiple gait classification task based on LLD change that is clearly associated with its gait pattern. A hybrid deep learning model of convolutional neural network and long short-term memory (CNN-LSTM) was developed to precisely classify LLD gait patterns by discovering the most representative spatial-temporal LLD dynamic change features. Twenty-three healthy subjects were recruited to simulate four levels of LLD by wearing a shoe lift with different heights. The Delsys TrignoTM system was implemented to simultaneously acquire gait data from six sensors positioned on the hip, knee and ankle joint of two lower limbs respectively. The experimental results showed that the developed CNN-LSTM model could reach a higher accuracy of 93.24% and F1-score of 93.48% to classify four different LLD gait patterns when compared with CNN, LSTM, and CNN-gated recurrent unit(CNN-GRU), and gain better recall and precision (more than 92%) to detect each LLD gait pattern accurately. Our model could achieve excellent learning ability to discover the most representative LLD dynamic change features for classifying LLD gait patterns accurately. Our technical solution would help not only to accurately measure LLD dynamic change in non-clinical settings, but also to potentially find out lower limb joints with more abnormal compensatory change caused by LLD.


Assuntos
Aprendizado Profundo , Dispositivos Eletrônicos Vestíveis , Humanos , Desigualdade de Membros Inferiores/diagnóstico , Desigualdade de Membros Inferiores/etiologia , Marcha , Articulação do Joelho
3.
Gait Posture ; 109: 311-317, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-38412684

RESUMO

BACKGROUND: Leg length discrepancy (LLD) is common in youth and is cause by several conditions. Long leg X-rays is the gold standard technique of measuring LLD. It is highly accurate and reliable compared to clinical method, but expose the subject to radiation. Instrumented Gait Analysis (IGA) serves not only as a means to measure joint kinematics during gait but also as a valuable tool for assessing Leg Length Discrepancy (LLD) while standing. RESEARCH QUESTION: The purpose of this study was to compare different methods of determining the LLD in paediatric population. We hypothesize that IGA using joint centres is more accurate and precise than the tape measurement. METHODS: Thirty-one patients with mean age 12.3 (SD=2.4) years were retrospectively included in the study. Their LLD varied between 0 and 36 mm. Three methods for determining LLD were compared to radiography using Bland-Altman analysis: 1. Tape measurement, 2. IGA, summarizing the distance from the spina iliaca anterior superior to the medial malleolus marker via the medial knee condyle marker. 3. IGA, summarizing distances between ankle, knee, and hip joints centres where the latter is calculated with different equations. RESULTS: The IGA joints method performed better than the tape measurement or IGA markers method. The equations of Davis calculating the hip joint centre had the highest accuracy with mean difference to radiography of 0.7 mm (SD=6.3). The simple Harrington method resulted in a slightly reduced accuracy but higher precision 0.9 mm (SD=6.2). The Harrington method with leg length as input was less accurate 1.0 mm (SD=6.7), but was still considerably better than the tape measurement 1.8 mm (SD=7.0) or IGA markers method 1.1 mm (SD=11.5). SIGNIFICANCE: Determining LLD with IGA using the distances between ankle, knee and hip joints centres is a feasible method that can be applied in clinical practice to calculate LLD.


Assuntos
Artroplastia de Quadril , Perna (Membro) , Criança , Adolescente , Humanos , Estudos Retrospectivos , Desigualdade de Membros Inferiores/diagnóstico , Desigualdade de Membros Inferiores/etiologia , Marcha , Imunoglobulina A , Artroplastia de Quadril/efeitos adversos
4.
Arch Orthop Trauma Surg ; 144(4): 1503-1509, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38353685

RESUMO

INTRODUCTION: The use of magnetic resonance imaging (MRI) with a magnetic intramedullary lengthening nail in place is contraindicated per the manufacturer due to the concern of implant activation and migration. A prior in vitro study did not confirm these complications only noting that a 3.0 T MRI weakened the internal magnet. Therefore, a retrospective analysis of patients who underwent an MRI with a magnetic nail in place was performed to determine if any adverse effects occurred in the clinical setting. MATERIALS AND METHODS: A retrospective review of all patients who underwent an MRI with a magnetic lengthening nail in place was performed. The time spent being imaged in the MRI, number of times the patient entered the MRI suite, and the images obtained were recorded. Radiographs were performed before and after the MRI to determine if any hardware complications occurred. The patients were monitored for any adverse symptoms while they were in the suite. RESULTS: A total of 12 patients with 13 nails were identified. Two patients underwent imaging with a 3.0 T MRI while the remaining 10 underwent imaging with a 1.5 T MRI. Each patient entered the MRI suite 2.1 times and spent an average of 84.7 min being imaged in the MRI (range 21-494). No patients noted any adverse symptoms related to the nail while in the suite and no hardware complications were identified. CONCLUSION: MRI appears to be safe with a magnetic nail in place and did not result in any complications. Given the manufacturer's recommendations, informed consent should be obtained prior to an MRI being performed and a 3.0 T MRI should be avoided when possible if further activation of the nail is required.


Assuntos
Alongamento Ósseo , Fixação Intramedular de Fraturas , Humanos , Alongamento Ósseo/métodos , Fêmur/cirurgia , Desigualdade de Membros Inferiores/cirurgia , Fixação Intramedular de Fraturas/métodos , Estudos Retrospectivos , Estudos de Viabilidade , Pinos Ortopédicos , Resultado do Tratamento , Imageamento por Ressonância Magnética
5.
J Orthop Traumatol ; 25(1): 9, 2024 Feb 21.
Artigo em Inglês | MEDLINE | ID: mdl-38381320

RESUMO

BACKGROUND: The purpose of this study is to compare peri-operative and short-term outcomes in patients who underwent elective total hip replacement (THA) for primary osteoarthritis (OA) with direct anterior approach (DAA) versus a pair-matched cohort of patients who underwent robotic-assisted THA with posterolateral approach. MATERIALS AND METHODS: Data from consecutive patients who underwent elective hip replacement from 2021 to 2023 for primary OA were retrospectively retrieved and divided into two groups: the DAA group, who underwent THA with the DAA approach using conventional instruments, and the robotic posterolateral (R-PL group), who underwent robot arm-assisted THA with the posterolateral approach. Comparative assessed outcomes were: operative time, radiographical implant positioning, intake of rescue analgesics, blood loss, transfusion rate, leg length discrepancy and functional outcomes (Harris hip score and forgotten joint score). RESULTS: A total of 100 pair-matched patients were retrieved with a mean age of 66.7 ± 10.7 (range: 32-85) years and a mean follow-up of 12.8 ± 3.6 (range: 7-24) months. No differences in patients' characteristics were detected. Patients in the R-PL group required less rescue tramadol (p > 0.001), ketorolac (p = 0.028) and acetaminophen (p < 0.001). There was no significant difference in the operative time between (MD = 5.0 min; p = 0.071). Patients in the DAA group had significantly lower Hb levels at day 1 (p = 0.002) without significant differences in transfusion rate (p = 0.283). Patients in the R-PL group had shorter length of stay (LOS) with a mean difference of 1.8 days [p < 0.001; 95% confidence interval (CI) 1.4-2.3]. No difference in clinical outcomes was found [leg length discrepancy (LLD), p = 0.572; HHS, p = 0.558; forgotten joint score (FJS), p = 0.629]. No radiographical differences were measured in cup inclination (MD = 2.0°, p = 0.069), malpositioning [odd ratio (OR) = 0.2; p = 0.141], stem alignment (OR = 0.3; p = 0.485) and stem sizing (OR = 1.5; p = 1.000). There was no difference in complication rate except for lateral femoral cutaneous nerve damage, which was higher in DAA group (p < 0.001). CONCLUSIONS: R-PL and DAA THA had comparable short-term clinical and radiological outcomes along with similar complication rates. The R-PL group showed significantly lower Hb drop, rescue analgesic consumption and shorter LOS. This is a preliminary study and no strong recommendation can be provided. Further prospective randomized trials are requested to further investigate the cost-effectiveness of robotic surgery in THA. LEVEL OF EVIDENCE: Level IV, case-control study.


Assuntos
Artroplastia de Quadril , Osteoartrite , Procedimentos Cirúrgicos Robóticos , Robótica , Humanos , Pessoa de Meia-Idade , Idoso , Estudos de Casos e Controles , Estudos Retrospectivos , Desigualdade de Membros Inferiores
6.
Arch Orthop Trauma Surg ; 144(4): 1485-1490, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38285221

RESUMO

PURPOSE: Plantar fasciitis (PF) is a main source of heel pain, and only about one-third of patients have bilateral symptomatic involvement, although age, body mass index (BMI), and physical activities are known risk factors. The high prevalence of unilateral involvement is poorly understood. We aimed to assess the potential association between PF and the leg length discrepancy (LLD) in unilateral PF. METHODS: A transversal case-control study was conducted from January 2019 to December 2020, including 120 participants allocated to two groups matched by BMI and sex: cases (with a diagnosis of PF; 50 ± 13 years) and control (without foot pain; 40 ± 15 years). For both groups, a difference greater than 0.64 cm in the scanometry determined the criteria for the presence of LLD. RESULTS: The multivariate logistic regression analysis showed an independent association of PF only with age (p < 0.001), and no association with LLD. We did not observe differences in the mean discrepancy (1.37 ± 0.83 cm in the PF group in comparison with 1.13 ± 0.37 cm in the control group, [p > 0.05]) or in the prevalence of LLD between groups (48% [n = 29] in the PF group compared with 42% [n = 25] in the control group, [p > 0.05]). In the PF group, 80% of the participants reported unilateral pain. We observed a higher prevalence of pain in the shorter limb (p < 0.05). CONCLUSION: Age was the only factor associated with the diagnosis of PF when groups were matched by sex and BMI. LLD was not an independent factor associated with the diagnosis of PF. However, when PF is unilateral, the shorter limb is more affected with 70% of prevalence. LEVEL OF EVIDENCE: Level III, case-control.


Assuntos
Fasciíte Plantar , Humanos , Fasciíte Plantar/diagnóstico , Fasciíte Plantar/epidemiologia , Fasciíte Plantar/etiologia , Estudos de Casos e Controles , Perna (Membro) , Dor , Desigualdade de Membros Inferiores/epidemiologia , Desigualdade de Membros Inferiores/etiologia , Fatores de Risco
7.
Acta Orthop ; 95: 47-54, 2024 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-38287909

RESUMO

BACKGROUND AND PURPOSE: Bilateral femoral distraction osteogenesis in patients with achondroplasia is insufficiently reported. We aimed to perform the first study that exclusively analyzed simultaneous bilateral femoral distraction osteogenesis with motorized intramedullary lengthening nails via an antegrade approach in patients with achondroplasia focused on reliability, accuracy, precision, and the evolving complications. PATIENTS AND METHODS: In this retrospective singlecenter study we analyzed patients with achondroplasia who underwent simultaneous bilateral femoral lengthening with antegrade intramedullary lengthening nails between October 2014 and April 2019. 15 patients (30 femoral segments) of median age 14 years (interquartile range [IQR] 12-15) were available for analysis. The median follow-up was 29 months (IQR 27-37) after nail implantation. RESULTS: The median distraction length per segment was 49 mm (IQR 47-51) with a median distraction index of 1.0 mm/day (IQR 0.9-1.0), and a median consolidation index of 20 days/cm (IQR 17-23). Reliability of the lengthening nails was 97% and their calculated accuracy and precision were 96% and 95%, respectively. The most common complication was temporary restriction of knee range of motion during distraction in 10 of 30 of the lengthened segments. 1 patient was treated with 2 unplanned additional surgeries due to premature consolidation. CONCLUSION: The method is reliable and accurate with few complications.


Assuntos
Acondroplasia , Alongamento Ósseo , Fixação Intramedular de Fraturas , Osteogênese por Distração , Humanos , Adolescente , Osteogênese por Distração/efeitos adversos , Osteogênese por Distração/métodos , Estudos Retrospectivos , Fixação Intramedular de Fraturas/métodos , Seguimentos , Unhas , Reprodutibilidade dos Testes , Fêmur/cirurgia , Alongamento Ósseo/métodos , Acondroplasia/complicações , Acondroplasia/cirurgia , Pinos Ortopédicos/efeitos adversos , Resultado do Tratamento , Desigualdade de Membros Inferiores/cirurgia
8.
Sci Rep ; 14(1): 717, 2024 01 06.
Artigo em Inglês | MEDLINE | ID: mdl-38184715

RESUMO

Correction of leg length discrepancy (LLD) in skeletally mature patients with osteosarcoma was rarely reported and quite challenging. This study aimed to propose a treatment strategy of staged lengthening and reconstruction with a standard static prosthesis to address LLD and restore limb function. It also evaluated the effectiveness of the strategy in terms of leg lengthening, functional outcomes, and complications. The strategy for lengthening included three stages. In stage 1, the previous prosthesis was removed and an external fixator with a temporary rod-cement spacer was placed. In this stage, the external fixator was used to lengthen the limb to the appropriate length. In stage 2, the external fixator was removed and the old rod-cement spacer was replaced with a new one. In stage 3, the rod-cement spacer was removed and the standard static prosthesis was planted. Nine skeletally mature distal femoral osteosarcoma patients with unacceptable LLD were treated in our institution from 2019 to 2021. We performed a chart review on nine patients for the clinical and radiographic assessment of functional outcomes, LLD, and complications. The mean (range) leg lengthening was 7.3 cm (3.6-15.6). The mean (range) LLD of the lower limbs decreased from 7.6 cm (4.1-14.2) before the lengthening to 0.3 cm (- 0.3 to 2.1) at the final follow-up with statistical significance (P = 0.000). The mean (range) Musculoskeletal Tumor Society score improved from 30.3% (16.7%-53.3%) before the lengthening to 96.3% (86.7%-100%) at the final follow-up with statistical significance (P = 0.000). Three patients (33.3%) had a minor complication; none needed additional surgical intervention. In the short term, the current staged lengthening and reconstruction with standard static prosthesis provided satisfactory functional outcomes and LLD correction with few complications. The long-term effects of this method need further exploration.


Assuntos
Neoplasias Ósseas , Osteossarcoma , Humanos , Perna (Membro)/cirurgia , Extremidade Inferior , Desigualdade de Membros Inferiores/cirurgia , Osteossarcoma/cirurgia , Neoplasias Ósseas/cirurgia
9.
Hip Int ; 34(1): 134-143, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37128124

RESUMO

PURPOSE: The aim of the study was to determine the restoration of hip biomechanics through lateral offset, leg length, and acetabular component position when comparing non-arthroplasty surgeons (NAS) to elective arthroplasty surgeons (EAS). METHODS: 131 patients, with a femoral neck fracture treated with a THA by 7 EAS and 20 NAS, were retrospectively reviewed. 2 blinded observers measured leg-length discrepancy, femoral offset, and acetabular component position. Multivariate logistic regression models examined the association between the surgeon groups and restoration of lateral femoral, acetabular offset, leg length discrepancy, acetabular anteversion, acetabular position, and component size, while adjusting for surgical approach and spinal pathology. RESULTS: NAS under-restored 4.8 mm of lateral femoral offset (43.9 ± 8.7 mm) after THA when compared to the uninjured side (48.7 ± 7.1 mm, p = 0.044). NAS were at risk for under-restoring lateral femoral offset when compared to EAS (p = 0.040). There was no association between lateral acetabular offset, leg length, acetabular position, or component size and surgeon type. CONCLUSIONS: Lateral femoral offset is at risk for under-restoration after THA for femoral neck fractures, when performed by surgeons that do not regularly perform elective THA. This indicates that lateral femoral offset is an under-appreciated contributor to hip instability when performing THA for a femoral neck fracture. Lateral femoral offset deserves as much attention and awareness as acetabular component position since a secondary analysis of our data reveal that preoperative templating and intraoperative imaging did not prevent under-restoration.


Assuntos
Artroplastia de Quadril , Fraturas do Colo Femoral , Prótese de Quadril , Humanos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Estudos Retrospectivos , Fêmur , Desigualdade de Membros Inferiores/etiologia , Desigualdade de Membros Inferiores/cirurgia , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/cirurgia
10.
J Bone Joint Surg Am ; 106(2): 145-150, 2024 Jan 17.
Artigo em Inglês | MEDLINE | ID: mdl-37972990

RESUMO

BACKGROUND: The Modified Fels (mFels) and Abbreviated Modified Fels (abFels) knee systems have been recently developed as options for grading skeletal maturity without the need for a separate hand radiograph. We sought to determine the interobserver reliability of these systems and to compare their prediction accuracy with that of the Greulich and Pyle (G-P) atlas in a cohort managed with epiphysiodesis for leg-length discrepancy (LLD). METHODS: Three reviewers scored 20 knee radiographs using the mFels system, which includes 5 qualitative and 2 quantitative measures as well as a quantitative output. Short leg length (SL), long leg length (LL), and LLD prediction errors at maturity using the White-Menelaus (W-M) method and G-P, mFels, or abFels skeletal age were compared in a cohort of 60 patients managed with epiphysiodesis for LLD. RESULTS: Intraclass correlation coefficients for the 2 quantitative variables and the quantitative output of the mFels system using 20 knee radiographs ranged from 0.55 to 0.98, and kappa coefficients for the 5 qualitative variables ranged from 0.56 to 1, indicating a reliability range from moderate to excellent. In the epiphysiodesis cohort, G-P skeletal age was on average 0.25 year older than mFels and abFels skeletal ages, most notably in females. The majority of average prediction errors between G-P, mFels, and abFels were <0.5 cm, with the greatest error being for the SL prediction in females, which approached 1 cm. Skeletal-age estimates with the mFels and abFels systems were statistically comparable. CONCLUSIONS: The mFels skeletal-age system is a reproducible method of determining skeletal age. Prediction errors in mFels and abFels skeletal ages were clinically comparable with those in G-P skeletal ages in this epiphysiodesis cohort. Further work is warranted to optimize and validate the accuracy of mFels and abFels skeletal ages to predict LLD and the impact of epiphysiodesis, particularly in females. Both the mFels and abFels systems are promising means of estimating skeletal age, avoiding additional radiation and health-care expenditure. LEVEL OF EVIDENCE: Prognostic Level II . See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Desigualdade de Membros Inferiores , Perna (Membro) , Feminino , Humanos , Reprodutibilidade dos Testes , Desigualdade de Membros Inferiores/diagnóstico por imagem , Desigualdade de Membros Inferiores/cirurgia , Extremidade Inferior , Fêmur , Determinação da Idade pelo Esqueleto/métodos
11.
Int Orthop ; 48(3): 773-783, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37964157

RESUMO

PURPOSE: The objective of this study was to investigate the efficacy of an artificial intelligence-assisted 3D planning system (AIHIP) in total hip arthroplasty by direct anterior approach and assess the reliability of the AIHIP preoperative program in terms of both interobserver and intraobserver agreement. METHODS: A retrospective analysis was conducted on patients who underwent unilateral primary THA via direct anterior approach from June 2019 to March 2022. Participants were randomly assigned to receive either the AIHIP system (n = 220) or the 2D template (control group) (n = 220) for preoperative planning. The primary outcome aimed to evaluate the correspondence between the prosthesis selected intro-operation and the one planned preoperatively, as well as to calculate the intraclass correlation coefficient (ICC). Secondary outcomes included operation time, intraoperative blood loss, fluoroscopy times, Harris hip score (HHS), lower limb length difference (LLD), femoral offset (FO), and bilateral femoral offset difference. RESULTS: No significant differences were observed in gender, age, body mass index (BMI), aetiology, and American Society of Anesthesiologists (ASA) score between the two groups. Both planning methods exhibited good intraobserver agreement for component planning (ICC: 0.941-0.976). Interobserver agreement for component planning was comparable between the two methods (ICC: 0.882-0.929). In the AIHIP group, the accuracy of acetabular cup and femoral stem prosthetics planning significantly improved, with accuracies within the size range of ± 0 and ± 1 being 76.8% and 90.5% and 79.5% and 95.5%, respectively. All differences between two groups were statistically significant (p < 0.05). Patients receiving AIHIP preoperative planning experienced shorter operation times, reduced intraoperative blood loss, fewer fluoroscopy times, and lower leg length discrepancy (LLD) (p < 0.05). Moreover, they demonstrated a higher Harris hip score (HHS) at three days post-surgery (p < 0.05). However, no significant differences were found in femoral offset (FO), difference of bilateral femoral offsets, and HHS at 1 month after the operation. CONCLUSION: Utilizing AIHIP for preoperative planning of direct anterior approach THA can significantly enhance the accuracy of prosthetic sizing with good reliability, decrease operation time, reduce intraoperative blood loss, and more effectively restore the length of both lower limbs. This approach has greater clinical application value.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Humanos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Inteligência Artificial , Estudos Retrospectivos , Reprodutibilidade dos Testes , Perda Sanguínea Cirúrgica , Desigualdade de Membros Inferiores , Resultado do Tratamento
12.
Int Orthop ; 48(2): 473-479, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-37715062

RESUMO

PURPOSE: Operative approach in total hip arthroplasty (THA) has long been a topic of debate with each approach having unique benefits and disadvantages. One purported benefit of an anterior approach to THA is that it allows for intraoperative positioning using fluoroscopy rather than manual positioning. Proper positioning allows for improved outcomes including leg length discrepancy and acetabular component angle. This study aims to examine if operative approach and use of imaging in intraoperative positioning impact LLD and cup angle post-operatively. METHODS: A total of 300 hips were enrolled in the study with 100 hips per approach (anterior with fluoroscopy, lateral, and posterior). Retrospective chart review was conducted to assess patient demographics and radiographic analysis used to determine LLD and acetabular cup angle. RESULTS: Of the three groups, those receiving anterior approach THAs were on average older than those in the posterior group. Analysis comparing the LLD and acetabular angle across the three groups showed no statistically significant difference in LLD (p=0.091); this was also reflected when comparing hips that received fluoroscopy with those that did not (p=0.91). For acetabular angle, while no difference existed when comparing hips that received imaging versus those that did not, statistically significant differences were observed when comparing the three intraoperative approaches (p<0.0001). CONCLUSIONS: Neither intraoperative approach nor the use of intraoperative imaging in THA has a statistically significant effect on LLD post-operatively. However, approach did impact the acetabular cup angle across all three distinct approaches.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Humanos , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Estudos Retrospectivos , Perna (Membro) , Posicionamento do Paciente , Acetábulo/diagnóstico por imagem , Acetábulo/cirurgia , Desigualdade de Membros Inferiores/diagnóstico por imagem , Desigualdade de Membros Inferiores/cirurgia
13.
Explore (NY) ; 20(1): 70-78, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-37344335

RESUMO

CONTEXT: Trigeminal neuralgia is a debilitating facial pain condition. Upper cervical chiropractic care has been mentioned as a possible solution OBJECTIVE: To determine the effects of Atlas Orthogonal upper cervical chiropractic technique adjustments on trigeminal neuralgia sufferers DESIGN: Case series SETTING: A private chiropractic practice PARTICIPANTS: Five persons with chronic, severe, daily trigeminal neuralgia pain, radiological findings of significant head tilt, pain upon upper cervical palpation, and supine leg length inequality INTERVENTIONS: Up to two consultations and/or Atlas Orthogonal adjustments a week for eight weeks OUTCOME MEASURES: Self-reported reduction in trigeminal neuralgia pain and changes in radiological findings, sensitivity to upper cervical palpation, and leg length inequality RESULTS: Four participants reported reduced trigeminal neuralgia pain, including two with complete cessation of pain. Three participants reduced medication dosages. One reported no change.


Assuntos
Quiroprática , Dor Crônica , Manipulação Quiroprática , Neuralgia do Trigêmeo , Humanos , Neuralgia do Trigêmeo/terapia , Desigualdade de Membros Inferiores/complicações , Resultado do Tratamento
14.
Instr Course Lect ; 73: 369-385, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38090910

RESUMO

Motorized intramedullary lengthening nails allow for transport of a bone segment for limb lengthening, deformity correction, healing of nonunion, and intercalary distraction osteogenesis. Resection of tumors involving the bone can result in substantial defects that require reconstruction. Use of these nails allows for a biologic reconstruction with the incorporation of allograft or by distraction osteogenesis. Limb lengthening after an internal hemipelvectomy where the hip joint is resected can be performed to improve gait, decrease pain, and prevent the need for a custom shoe or shoe lift. Using these nails in compression aids the incorporation of intercalary allografts and prevents stress shielding and stress risers within the graft when compared with plating. It also allows for a subsequent lengthening of the limb using the same implant. Plate-assisted bone segment transport or the use of a bone transport nail allows for a true biologic reconstruction of an intercalary defect using distraction osteogenesis. These implants provide the orthopaedic oncologist with more options for reconstruction and the potential to improve the function and outcomes of their patients.


Assuntos
Produtos Biológicos , Fixação Intramedular de Fraturas , Osteogênese por Distração , Humanos , Desigualdade de Membros Inferiores/cirurgia , Resultado do Tratamento , Pinos Ortopédicos , Fêmur/cirurgia
15.
J Pediatr Orthop ; 44(1): e57-e60, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-37867312

RESUMO

BACKGROUND: Few studies address frequency or magnitude of healthy lower-extremity segment response to ipsilateral companion segment shortening. We sought to document and quantify this occurrence in a variety of pediatric etiologies. METHODS: We reviewed the medical record and radiographs of patients undergoing epiphysiodesis to manage leg length discrepancy. Inclusion criteria for this study were leg length discrepancy of a single lower-extremity segment by identifiable cause and adequate scanograms to allow accurate measurement of all 4 lower-extremity segments before any surgical treatment for the discrepancy. We recorded the etiology of shortening, age of onset of disorder, the length of the lower-extremity segments on scanograms, and age at the time of radiographs. We considered ipsilateral healthy-segment difference from the contralateral ≥ 0.5 cm. as clinically significant. RESULTS: Two hundred nine patients met inclusion criteria (126 boys, 83 girls). The average age was 12.5 years. 16/60 patients with avascular necrosis of the hip demonstrated ipsilateral tibial shortening averaging 1.2 cm whereas 6/60 demonstrated ipsilateral tibial overgrowth averaging 0.6 cm. 11/30 Legg-Perthés patients demonstrated ipsilateral tibial shortening averaging 0.7 cm; none had ipsilateral tibial overgrowth. 10/42 posteromedial bow patients had ipsilateral femoral shortening averaging 0.8 cm, whereas 6/42 had ipsilateral overgrowth averaging 0.8 cm. 13/48 with distal femoral physeal injury demonstrated ipsilateral tibial shortening averaging 1.2 cm, whereas 6/48 demonstrated ipsilateral tibial overgrowth averaging 0.8 cm. 8/29 tibial physeal injuries (proximal or distal) demonstrated ipsilateral femoral shortening averaging 1.1 cm. whereas 7/29 demonstrated ipsilateral femoral overgrowth averaging 0.7 cm. CONCLUSIONS: Although there are individual exceptions, the ipsilateral healthy segment does not grow appreciably more than the contralateral in patients with avascular necrosis of the hip, Legg-Perthés disease, or physeal trauma. The femur is not a significant component of shortening in patients with posteromedial bow. LEVEL OF EVIDENCE: Level III, retrospective review.


Assuntos
Perna (Membro) , Osteonecrose , Masculino , Feminino , Humanos , Criança , Fêmur/diagnóstico por imagem , Fêmur/cirurgia , Tíbia/diagnóstico por imagem , Tíbia/cirurgia , Extremidade Inferior , Desigualdade de Membros Inferiores/diagnóstico por imagem , Desigualdade de Membros Inferiores/etiologia , Desigualdade de Membros Inferiores/cirurgia , Estudos Retrospectivos
16.
Artigo em Inglês | MEDLINE | ID: mdl-38082685

RESUMO

Leg length measurement is relevant for the early diagnostic and treatment of discrepancies as they are related with orthopedic and biomechanical changes. Simple radiology constitutes the gold standard on which radiologists perform manual lower limb measurements. It is a simple task but represents an inefficient use of their time, expertise and knowledge that could be spent in more complex labors. In this study, a pipeline for semantic bone segmentation in lower extremities radiographs is proposed. It uses a deep learning U-net model and performs an automatic measurement without consuming physicians' time. A total of 20 radiographs were used to test the methodology proposed obtaining a high overlap between manual and automatic masks with a Dice coefficient value of 0.963. The obtained Spearman's rank correlation coefficient between manual and automatic leg length measurements is statistically different from cero except for the angle of the left mechanical axis. Furthermore, there is no case in which the proposed automatic method makes an absolute error greater than 2 cm in the quantification of leg length discrepancies, being this value the degree of discrepancy from which medical treatment is required.Clinical Relevance- Leg length discrepancy measurements from X-ray images is of vital importance for proper treatment planning. This is a laborious task for radiologists that can be accelerated using deep learning techniques.


Assuntos
Aprendizado Profundo , Perna (Membro) , Humanos , Perna (Membro)/diagnóstico por imagem , Radiografia , Extremidade Inferior/diagnóstico por imagem , Desigualdade de Membros Inferiores/diagnóstico por imagem
17.
BMC Musculoskelet Disord ; 24(1): 954, 2023 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-38066461

RESUMO

BACKGROUND: Leg length discrepancy (LLD) is one of the troublesome complications of total hip arthroplasty (THA). Previously, several risk factors have been suggested, but they were subjected to their inherent limitations. By controlling confounding variables, we hypothesized that known risk factors be re-evaluated and novel ones be discovered. This study aimed to analyze the independent risk factors for LLD after primary THA in patients with non-traumatic osteonecrosis of the femoral head (ONFH). METHODS: We retrospectively reviewed patients with non-traumatic ONFH who underwent unilateral THA between 2014 and 2021. All patients were operated by one senior surgeon using a single implant. Demographic data, surgical parameters, and radiological findings (pre-operative LLD, Dorr classification, and femoral neck resection) were analyzed to identify the risk factors of ≥ 5 mm post-operative LLD based on radiological measurement and to calculate odds ratios by logistic regression analysis. Post hoc power analysis demonstrated that the number of analyzed patients was sufficient with 80% power. RESULTS: One hundred and eighty-six patients were analyzed, including 96 females, with a mean age of 58.8 years at the time of initial THA. The average post-operative LLD was 1.2 ± 2.9 mm in the control group and 9.7 ± 3.2 mm in the LLD group, respectively. The LLD group tended to have minimal pre-operative LLD than the control group (-3.2 ± 5.1 mm vs. -7.9 ± 5.8 mm p = 2.38 × 10- 8). No significant difference was found between the groups in age, gender, body mass index, femoral cortical index, and implant size. CONCLUSION: Mild pre-operative LLD is associated with an increased risk of post-operative LLD after primary THA in patients with ONFH. Thus, surgeons should recognize pre-operative LLD to achieve an optimal outcome and must inform patients about the risk of developing LLD.


Assuntos
Artroplastia de Quadril , Osteonecrose , Feminino , Humanos , Pessoa de Meia-Idade , Artroplastia de Quadril/efeitos adversos , Estudos Retrospectivos , Cabeça do Fêmur/cirurgia , Perna (Membro) , Fatores de Risco , Desigualdade de Membros Inferiores/diagnóstico por imagem , Desigualdade de Membros Inferiores/epidemiologia , Desigualdade de Membros Inferiores/etiologia , Osteonecrose/complicações
18.
Injury ; 54 Suppl 6: 110838, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38143138

RESUMO

BACKGROUND: To evaluate the clinical outcomes using the PRECICE magnetic limb lengthening intramedullary nail for the correction of lower limb length discrepancies (LLD) in adults with posttraumatic nonunion or malunion defects in a Latin American center. METHODS: A retrospective review of 25 adult patients with LLD associated with posttraumatic nonunion or malunion defects of femur or tibia treated with the PRECICE nail between January 2018 and December 2020. The primary outcomes considered were lengthening length achieved in mm, incidence of complications and quality of life (EQ-5D-3 L questionnaire). RESULTS: Twenty-five cases (20 femoral and 5 tibial nails) were performed, with a median follow-up of 27 months (Interquartile range-IQR: 17.5 to 34.5). The average age was 36.5 ± 12.9 years; 10 cases were women. Fifteen cases had an LLD secondary to a malunion defect and 10 cases had an LLD secondary to a nonunion. PRECICE nails were inserted for the treatment of a median LLD of 40.0 mm (IQR: 30.2 to 74.2) in the femur and 30.0 mm (28.5 to 50.0) in the tibia. An accuracy of 100% was reported in 18 cases (Femur: 14 and tibia: 4) and consolidation was achieved in 22/25 cases with the PRECICE nail in situ. Complications were recorded in 9 (36%) cases (6/20 femur, 3/5 tibia), mainly related to the consolidation process (5/9). The median EQ-5D and EQ-VAS were 0.79 (IQR: 0.63 to 0.79) and 80.0 (IQR: 50.0 to 90.0), respectively. CONCLUSIONS: The results of this study demonstrated that the PRECICE nail is an effective device for the management of posttraumatic LLD during the treatment of nonunion or malunion bone defects of femur and tibia, offering a reasonable quality of life, despite its postoperative complication risk.


Assuntos
Alongamento Ósseo , Adulto , Humanos , Feminino , Adulto Jovem , Pessoa de Meia-Idade , Masculino , Desigualdade de Membros Inferiores/cirurgia , América Latina , Qualidade de Vida , Resultado do Tratamento , Pinos Ortopédicos/efeitos adversos , Fêmur/cirurgia , Extremidade Inferior , Estudos Retrospectivos
19.
Sensors (Basel) ; 23(24)2023 Dec 08.
Artigo em Inglês | MEDLINE | ID: mdl-38139541

RESUMO

Leg length discrepancy (LLD) is a common postural deviation of musculoskeletal origin, which causes compensatory reactions and often leads to injury. The aim of the study was to investigate the effect of artificially induced LLD on gait symmetry by means of the spatiotemporal gait parameters and ground reaction forces (GRFs) using a treadmill equipped with capacitive sensors (instrumented) as well as the EMG activity of trunk and hip muscles during walking and running. Twenty-six healthy male and female college students were required to perform two sets of four 2.5-min walking and running trials on an instrumented treadmill at 5.6 and 8.1 km·h-1, respectively, without (0) and with 1, 2, and 3 cm LLD implemented by wearing a special rubber shoe. Statistical analysis was performed using one-way repeated measures or a mixed-design ANOVA. Most spatiotemporal gait parameters and GRFs demonstrated an increase or decrease as LLD increased either on the short-limb or the long-limb side, with changes becoming more apparent at ≥1 cm LLD during walking and ≥2 cm LLD during running. The EMG activity of trunk and hip muscles was not affected by LLD. Our findings showed that gait symmetry in terms of treadmill-based spatiotemporal parameters of gait and GRFs is affected by LLD, the magnitude of which depends on the speed of locomotion.


Assuntos
Perna (Membro) , Corrida , Humanos , Masculino , Feminino , Fenômenos Biomecânicos , Caminhada/fisiologia , Marcha/fisiologia , Corrida/fisiologia , Desigualdade de Membros Inferiores/etiologia , Estudantes
20.
Can Vet J ; 64(11): 1002-1008, 2023 11.
Artigo em Inglês | MEDLINE | ID: mdl-37915782

RESUMO

Our objective was to report the use of distraction osteogenesis at the site of angular limb deformity correction using external skeletal fixation for treatment of 1 femoral and 1 tibial angular limb deformity in 2 large-breed puppies. Medical records were reviewed from 2 dogs (a 7-month-old intact male golden retriever and a 4-month-old intact female German shepherd mixed breed) diagnosed with angular limb deformities and truncation of a pelvic limb. Surgical treatment consisted of neutral wedge ostectomy and distraction osteogenesis at the site of bone deformity with an external skeletal fixator (ESF). The surgical technique and postoperative period of distraction osteogenesis were reviewed along with postoperative complications and clinical outcomes after complete bone healing was evident radiographically. Both dogs had adequate bone formation during distraction osteogenesis and the ESFs remained intact and structurally stable. At ESF removal, femoral length had increased 2.6 cm for Dog 1 and tibial length increased 3.88 cm for Dog 2, distal femoral valgus improved 16.3 degrees for Dog 1, and tibial procurvatum improved 19.5 degrees and distal tibial valgus improved 6.2 degrees for Dog 2. At the last follow-up examinations, 5 mo (Dog 1) and 3 mo (Dog 2) postoperatively, both dogs were ambulating without any visible lameness. Key clinical message: Acute angular correction and subsequent distraction osteogenesis at the site of bone deformity and corrective ostectomy using an ESF enabled successful treatment of femoral (Dog 1) and tibial (Dog 2) truncation and angulation in 2 large-breed puppies. Optimal deformity correction and lengthening were achieved through distraction osteogenesis at the site of neutral wedge ostectomy, minimizing soft tissue dissection and risk for potential complications that can occur with bifocal deformity correction (i.e., correction of the deformity at 1 osteotomy/ostectomy and correction of bone length at another, remote osteotomy).


Ostéogenèse par distraction au site d'ostectomie en coin neutre pour déformation angulaire du membre postérieur chez 2 jeunes chiens. Notre objectif était de rapporter l'utilisation de l'ostéogenèse par distraction au niveau du site de correction de la déformation angulaire du membre par fixation squelettique externe pour le traitement d'une déformation angulaire fémorale et d'une déformation angulaire tibiale chez 2 chiots de grande race. Les dossiers médicaux ont été examinés concernant 2 chiens (un golden retriever mâle intact âgé de 7 mois et une femelle berger allemand intacte de race mixte âgée de 4 mois) diagnostiqués avec des déformations angulaires des membres et une troncature d'un membre pelvien. Le traitement chirurgical consistait en une ostéogenèse en coin neutre et une ostéogenèse par distraction au niveau du site de déformation osseuse avec un fixateur squelettique externe (FSE). La technique chirurgicale et la période postopératoire d'ostéogenèse par distraction ont été examinées ainsi que les complications postopératoires et les résultats cliniques après une guérison osseuse complète évidente radiographiquement.Les deux chiens présentaient une formation osseuse adéquate pendant l'ostéogenèse par distraction et les FSE restaient intacts et structurellement stables. Lors du retrait de le FSE, la longueur fémorale avait augmenté de 2,6 cm pour le chien 1 et la longueur tibiale de 3,88 cm pour le chien 2, le valgus fémoral distal s'était amélioré de 16,3 degrés pour le chien 1, le procurvatum tibial s'était amélioré de 19,5 degrés et le valgus tibial distal s'était amélioré de 6,2 degrés pour le chien 2. Lors des derniers examens de suivi, 5 mois (chien 1) et 3 mois (chien 2) postopératoires, les deux chiens marchaient sans aucune boiterie visible.Message clinique clé :La correction angulaire aiguë et l'ostéogenèse de distraction ultérieure au site de déformation osseuse et l'ostectomie corrective à l'aide d'un FSE ont permis un traitement réussi de la troncature et de l'angulation fémorale (chien 1) et tibiale (chien 2) chez 2 chiots de grande race. La correction et l'allongement optimaux de la déformation ont été obtenus grâce à l'ostéogenèse par distraction au site de l'ostectomie en coin neutre, minimisant la dissection des tissus mous et le risque de complications potentielles pouvant survenir avec la correction de la déformation bifocale (c'est-à-dire la correction de la déformation à 1 ostéotomie/ostectomie et la correction de la longueur de l'os à une autre ostéotomie distante).(Traduit par Dr Serge Messier).


Assuntos
Osteogênese por Distração , Cães , Masculino , Animais , Feminino , Osteogênese por Distração/veterinária , Osteogênese por Distração/métodos , Desigualdade de Membros Inferiores/cirurgia , Desigualdade de Membros Inferiores/veterinária , Fixadores Externos/veterinária , Extremidade Inferior , Fêmur/cirurgia , Tíbia/cirurgia , Resultado do Tratamento
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...