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1.
J Am Geriatr Soc ; 69(9): 2556-2565, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34062611

RESUMO

BACKGROUND: Fractures in late life are highly consequential for health, services use, and spending. Little is known about trends in extremity fracture hospitalizations among older adults in the United States. DESIGN: Retrospective longitudinal cohort study. SETTING: The 2003-2017 National Inpatient Sample (NIS), a representative sample of U.S. community hospitals. PARTICIPANTS: Hospitalized adults aged 65 and older with a diagnosis of upper or lower extremity fracture. MEASUREMENTS: Incidence of extremity fracture hospitalization and mortality, using NIS discharge and trend weights, and population denominators derived from the U.S. Census Bureau. Incidence was reported separately for men and women by age, fracture diagnosis, and injury mechanism. Weighted linear regression was used to test for significant trends over time. RESULTS: Incidence of extremity fracture hospitalizations declined in both women (15.7%, p trend < 0.001) and men (3.2%, p trend < 0.001) between 2003 and 2017. This trend was primarily attributed to a decline in low energy femur fractures which accounted for 65% of all fracture hospitalizations. Among older adults with an extremity fracture hospitalization, mortality declined from 5.1% in 2003 to 3.3% in 2017 in men, and from 2.6% to 1.9% in women (p trend < 0.001). High energy fractures were due to falls (53%), motor vehicle accidents (34%), and other high impact injuries (13%). Overall, 12% of extremity fracture hospitalizations were attributed to high-energy injuries: increases were observed among men ages 65-74 (20%; p trend < 0.001) and 75-84 (10%; p trend = 0.013), but not among women of any age. CONCLUSION: Observed declines in the incidence of extremity fracture hospitalizations and related mortality are encouraging. However, increasing incidence of fracture hospitalization from high energy injuries among men suggests that older adults with complex injuries will be seen with more prevalence in the future.


Assuntos
Ossos do Braço/lesões , Fraturas Ósseas/epidemiologia , Hospitalização/tendências , Ossos da Perna/lesões , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Fatores de Tempo , Estados Unidos/epidemiologia
2.
Plast Reconstr Surg ; 148(2): 443-453, 2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34181596

RESUMO

BACKGROUND: Treating chronic osteomyelitis of the lower extremities is challenging. The treatment of acute lower limb trauma by orthoplastic teams has shown good results over the past few decades. This study aimed to characterize surgical outcomes of leg and heel chronic osteomyelitis by an orthoplastic team. METHODS: The cases of 113 consecutive leg and heel chronic osteomyelitis patients undergoing soft-tissue reconstruction with an orthopedic procedure were reviewed in this retrospective single-center observational study. The main objective was to assess surgical outcomes of skin healing and gait recovery at the 1-year follow-up. The secondary objective was to evaluate the global success rate at the last follow-up. RESULTS: The median follow-up was 19.7 months. A free flap was performed for 33 patients (29.2 percent) and a locoregional flap was used in 79 patients (69.9 percent). Seventy-two patients (63.7 percent) had chronic osteomyelitis on continuous bone. The others had a septic pseudarthrosis with a mean bone defect length of 42.9 mm. Forty-four patients (38.9 percent) underwent curettage only, eight (7.1 percent) underwent curettage and cement, 20 (17.7 percent) underwent curettage and bone fixation, and 39 (34.5 percent) underwent the Masquelet technique. At the 1-year follow-up, 72 patients (63.7 percent) had achieved skin healing and had recovered their gait. The success rate at all follow-up time points was 82.3 percent. The median time to achieve skin healing was 6.5 months and that to bone union in cases of septic pseudarthrosis was 7.9 months. CONCLUSION: Orthoplastic management of leg and heel chronic osteomyelitis patients with combined soft-tissue reconstruction using an orthopedic procedure was a viable strategy that offered good results even though the time to complete healing was long. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Curetagem/métodos , Osteomielite/cirurgia , Pseudoartrose/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Pele/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cimentos Ósseos/uso terapêutico , Criança , Pré-Escolar , Doença Crônica/terapia , Curetagem/estatística & dados numéricos , Feminino , Seguimentos , Ossos do Pé/microbiologia , Ossos do Pé/patologia , Ossos do Pé/cirurgia , Marcha/fisiologia , Calcanhar/patologia , Calcanhar/cirurgia , Hospitais Universitários/estatística & dados numéricos , Humanos , Perna (Membro)/patologia , Perna (Membro)/cirurgia , Ossos da Perna/microbiologia , Ossos da Perna/patologia , Ossos da Perna/cirurgia , Masculino , Pessoa de Meia-Idade , Osteomielite/complicações , Osteomielite/microbiologia , Osteomielite/patologia , Pseudoartrose/microbiologia , Pseudoartrose/fisiopatologia , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Recuperação de Função Fisiológica , Estudos Retrospectivos , Pele/microbiologia , Pele/patologia , Resultado do Tratamento , Cicatrização , Adulto Jovem
3.
J Orthop Surg Res ; 16(1): 193, 2021 Mar 16.
Artigo em Inglês | MEDLINE | ID: mdl-33726774

RESUMO

BACKGROUND: Leg length (LL) and offset (OS) are important factors in total hip arthroplasty (THA). Because most LL and OS callipers used in THA depend on fixed points on the pelvis and the femur, limb position could affect measurement error. This study was conducted on a THA simulator to clarify the effects of lower limb position and iliac pin position on LL and OS errors and to determine the permissible range of limb position for accurate LL and OS measurement. METHODS: An LL and OS measurement instrument was used. Two pin positions were tested: the iliac tubercle and the top of the iliac crest intersecting with the extension of the femoral axis. First, the limb was moved in one direction (flexion-extension, abduction-adduction, or internal-external rotation), and LL and OS were measured for each pin position. Next, the limb was moved in combinations of the three directions. Then, the permissible range of combined limb position, which resulted in LL and OS measurement error within ±2 mm, was determined for each pin position. RESULTS: Only 4° of abduction/adduction caused 5-7 mm error in LL and 2-4 mm error in OS, irrespective of pin position. The effects of flexion-extension and internal-external rotation on LL error were smaller for the top of the iliac crest than for the iliac tubercle, though OS error was similar for both pin positions. For LL, the permissible range of the combined limb position was wider for the top of the iliac crest than for the iliac tubercle. CONCLUSION: To minimize LL and OS measurement errors in THA, adduction-abduction must be maintained. The iliac pin position in the top of the iliac crest is preferred because it provides less LL measurement error and a wider permissible range of combined limb position for accurate LL measurement.


Assuntos
Artroplastia de Quadril/métodos , Pinos Ortopédicos , Ossos da Perna/anatomia & histologia , Extremidade Inferior , Pelve , Artroplastia de Quadril/efeitos adversos , Humanos , Desigualdade de Membros Inferiores/etiologia , Modelos Anatômicos
4.
J Therm Biol ; 93: 102726, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33077137

RESUMO

The present study evaluated whether broiler femoral and tibiotarsal characteristics (as assessed at slaughter age) could be improved if birds were reared under their preferred temperature and whether continuous high or low incubation temperature during the fetal period improves bone characteristics of broilers reared under heat stress or thermal preference. Broiler breeder eggs were incubated from day 13 until hatching under cold (36 °C), control (37.5 °C), or hot (39 °C) temperatures. Under these conditions, the eggshell temperatures were 37.4 ± 0.1°C, 37.8 ± 0.15°C, and 38.8 ± 0.3°C, respectively. Then, broiler chicks were reared under control, preferred (determined previously in thermal preference test), or high temperatures. At day 42 of age, the broilers were weighed and euthanized, and femora and tibiotarsi collected to measure weight, length, diaphysis perimeter, breaking strength, maximum flexion, rigidity, ash, phosphorus, and calcium. Rearing under the preferred temperature did not affect broiler body weight or femoral and tibiotarsal characteristics (P > 0.05). In contrast, high rearing temperature, decreased the body weight, mineral contents of both bones, femoral breaking strength, and tibiotarsal rigidity (P < 0.05). Regarding incubation temperature effects, egg exposure to cold and hot temperatures during the fetal period minimized or avoided a few effects of high rearing temperature, such as those on femoral and tibiotarsal morphological characteristics, mineral composition, and mechanical properties at slaughter age (P < 0.05), but not all. In conclusion, rearing under the preferred broiler temperature did not improve the bone characteristics, and the negative effects of high rearing temperature on bone development were minimized but not completely prevented by high or low temperature incubation during the fetal period.


Assuntos
Criação de Animais Domésticos/normas , Embrião de Galinha/fisiologia , Galinhas/fisiologia , Abrigo para Animais/normas , Ossos da Perna/crescimento & desenvolvimento , Temperatura , Animais , Embrião de Galinha/embriologia , Ossos da Perna/embriologia , Osteogênese
6.
Ann Chir Plast Esthet ; 65(5-6): 380-393, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32800464

RESUMO

Bone and joint infections (BJI) of the lower limb can cause functional sequelae and in some cases have an impact on patient's life prognostic. One of the main objectives of multidisciplinary consultation team meetings (MTM) in the treatment of bone and joint infections is to provide an appropriate medical-surgical care, pooling skills of different organ specialists: infectious disease physicians, microbiologists, orthopedic surgeons and plastic surgeons. Treatment is based on aggressive debridement, bone stabilization, adequate antibiotic therapy, long-term coverage of the loss of skin substance and close clinical monitoring. The authors present their multidisciplinary diagnostic and therapeutic approaches to BJI complicating an open fracture at a referent center in the management of complex bone and joint infections.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Bacterianas/terapia , Doenças Ósseas/diagnóstico , Doenças Ósseas/terapia , Fraturas Expostas/cirurgia , Artropatias/diagnóstico , Artropatias/terapia , Ossos da Perna/lesões , Ossos da Perna/cirurgia , Equipe de Assistência ao Paciente , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/terapia , Doenças Ósseas/microbiologia , Humanos , Artropatias/microbiologia , Complicações Pós-Operatórias/microbiologia
7.
Commun Biol ; 3(1): 283, 2020 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-32504030

RESUMO

Digits shape is sculpted by interdigital programmed cell death during limb development. Here, we show that DNA breakage in the periphery of 5-methylcytosine nuclei foci of interdigital precursors precedes cell death. These cells showed higher genome instability than the digit-forming precursors when exposed to X-ray irradiation or local bone morphogenetic protein (BMP) treatments. Regional but not global DNA methylation differences were found between both progenitors. DNA-Methyl-Transferases (DNMTs) including DNMT1, DNMT3B and, to a lesser extent, DNMT3A, exhibited well-defined expression patterns in regions destined to degenerate, as the interdigital tissue and the prospective joint regions. Dnmt3b functional experiments revealed an inverse regulation of cell death and cartilage differentiation, by transcriptional regulation of key genes including Sox9, Scleraxis, p21 and Bak1, via differential methylation of CpG islands across their promoters. Our findings point to a regulation of cell death versus chondrogenesis of limb skeletal precursors based on epigenetic mechanisms.


Assuntos
Embrião de Galinha/embriologia , Galinhas/genética , Condrogênese/genética , Metilação de DNA , Instabilidade Genômica , Membro Posterior/metabolismo , Ossos da Perna/embriologia , Animais , Proteínas Aviárias/genética , Proteínas Aviárias/metabolismo , Diferenciação Celular/genética , Expressão Gênica , Membro Posterior/embriologia
10.
J Musculoskelet Neuronal Interact ; 20(1): 27-52, 2020 03 03.
Artigo em Inglês | MEDLINE | ID: mdl-32131368

RESUMO

OBJECTIVES: To describe peripheral long bone material and structural differences in youth at risk of secondary osteoporosis across disease-specific profiles. METHODS: Upper- and lower limbs of children and adolescents were scanned at 4% distal and 66% mid-shaft sites using peripheral Quantitative Computed Tomography sub-categorised as (1) increased risk of secondary osteoporosis (neuromuscular disorders; chronic diseases; endocrine diseases; inborn errors of metabolism; iatrogenic conditions), (2) low motor competence and (3) non-affected controls. RESULTS: Children with disease-specific profiles showed a range of bone deficits compared to the control group with these predominantly indicated for neuromuscular disorders, chronic diseases and low motor competence. Deficits between upper arm and lower leg long bone parameters were different for disease-specific profiles compared to the control group. Endocortical radius, muscle area, and mid-cortical ring density were not significantly different for any disease-specific profile compared to the control group for any bone sites. CONCLUSIONS: Neuromuscular disorders, chronic diseases and low motor competence have a strong correlation to bone health for appendicular bone parameters in youth, suggesting a critical mechanical loading influence which may differ specific to disease profile. As mechanical loading effects are observed in regional bone analyses, targeted exercise interventions to improve bone strength should be implemented to examine if this is effective in reducing the risk of secondary osteoporosis in youth.


Assuntos
Ossos do Braço/diagnóstico por imagem , Densidade Óssea/fisiologia , Ossos da Perna/diagnóstico por imagem , Osteoporose/diagnóstico por imagem , Osteoporose/epidemiologia , Adolescente , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Fatores de Risco , Tomografia Computadorizada por Raios X/métodos , Austrália Ocidental/epidemiologia
11.
JAAPA ; 33(2): 33-37, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31990832

RESUMO

Point-of-care ultrasound may be an alternative to radiographs for diagnosing long bone fractures when medical resources are limited. Safe and timesaving, ultrasound also can be used in the ED as a screening tool for suspected long bone fractures and can detect associated musculoskeletal injuries. Ultrasound can be used in radiation-sensitive patients such as children and pregnant patients.Studies have found that clinicians using ultrasound can detect long bone fractures with an average 90% sensitivity and specificity after an average of 1 to 4 hours total of didactic and practical training. More research is needed to determine standards for ultrasound training, patient morbidity outcomes, cost effectiveness, and insurance benefits.


Assuntos
Ossos do Braço/diagnóstico por imagem , Ossos do Braço/lesões , Medicina de Emergência/métodos , Fraturas Ósseas/diagnóstico por imagem , Ossos da Perna/diagnóstico por imagem , Ossos da Perna/lesões , Ultrassonografia/métodos , Criança , Humanos , Segurança do Paciente , Satisfação do Paciente
12.
Rapid Commun Mass Spectrom ; 34(8): e8686, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31785028

RESUMO

RATIONALE: Although the analysis of skeletal remains dominates the study of ancient dietary stable isotopes, mummified bodies also allow short-term diet to be studied through the analysis of soft tissues. The application of resins, waxes and oils during mummification can affect the results obtained. This study assesses a range of methods for removing such substances from mummified tissue. METHODS: An experimental mummification model following ancient Egyptian methods was created using a modern pig leg. Sub-samples of skin, muscle and bone were removed and coated with a range of substances used in Egyptian mummification. Four methods were used to clean these samples before the measurement of the carbon and nitrogen stable isotope ratios of their gelatinised collagen content using a ThermoFinnigan Flash Elemental analyser coupled to a DeltaPlus XL isotope ratio mass spectrometer via a ConFlo III interface. RESULTS: The results showed that embalming materials can significantly affect dietary stable isotope ratios, and that these substances are most effectively removed using a mixture of polar and non-polar solvents. Results indicate that bone samples demineralised with HCl and skin samples produce more accurate results than bone samples demineralised with EDTA or muscle samples. CONCLUSIONS: The choice of tissue and the preparation methods used can have a significant effect on the accuracy of stable isotope data obtained from mummified tissue, particularly when embalming materials are also present. A mixture of solvents appears to be a more effective cleaning agent than a single solvent. Demineralisation with HCl is preferable for well-preserved bone, as used in this study, but whether this is the case for more fragile, less well-preserved bone requires further study. Skin samples produce more consistent data than muscle, but visually distinguishing between these tissues is not simple on ancient mummies.


Assuntos
Embalsamamento/métodos , Múmias , Animais , Isótopos de Carbono/análise , Egito , Embalsamamento/história , História Antiga , Humanos , Ossos da Perna/química , Espectrometria de Massas , Músculo Esquelético/química , Isótopos de Nitrogênio/análise , Pele/química , Solubilidade , Solventes/química , Suínos
13.
Pediatr Emerg Care ; 36(3): e115-e119, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30335686

RESUMO

OBJECTIVE: This study aimed to identify risk factors for compartment syndrome (CS) in pediatric trauma populations. METHODS: We included patients younger than 19 years treated at trauma centers contributing to the National Trauma Data Bank between 2009 and 2012. Multivariable logistic regression was used to examine the association between risk factors and the development of CS. The final model adjusted for age, sex, race, number of comorbidities, Glascow Coma Scale, Injury Severity Score, mechanism of injury, and fracture of the lower limb. RESULTS: A total of 341,238 patients were eligible for analysis, and 896 patients developed CS (0.3%). In adjusted regression models, older patients had significantly higher odds of CS compared with patients 1 years or younger (odds ratio [OR], 3.29 [95% confidence interval [CI], 1.29-8.37; 2-6 years]; OR, 7.55 [95% CI, 3.08-18.55 [7-12 years]; OR, 10.34 [95% CI, 4.26-25.09 [13-18 years]). Male patients had significantly increased odds of CS compared with female patients, as did patients with lower limb fractures compared with patients without lower limb fractures (OR, 1.93 [95% CI, 1.56-2.40]; OR, 7.61 [95% CI, 6.48-8.94]; respectively). Finally, patients with a firearm injury had higher odds of CS compared with other mechanisms of injury (OR, 3.51 [95% CI, 2.70-4.56]). CONCLUSIONS: Older pediatric trauma patients, male patients, and those with lower limb fractures and firearm injuries have increased odds of CS. Information on risk factors can be used to help identify patients most likely to develop CS, facilitating timely diagnosis and treatment.


Assuntos
Síndromes Compartimentais/epidemiologia , Fraturas Ósseas/epidemiologia , Ossos da Perna/lesões , Centros de Traumatologia/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Adolescente , Criança , Pré-Escolar , Comorbidade , Bases de Dados Factuais , Feminino , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Modelos Logísticos , Masculino , Razão de Chances , Estudos Retrospectivos , Fatores de Risco
14.
Med Sci Sports Exerc ; 52(2): 434-440, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31479005

RESUMO

PURPOSE: Obesity during adolescence has multisystem health consequences. The objective of this work was to determine whether preadolescent overweight/obese children's bones respond to a 9-month physical activity intervention by increasing bone density similar to healthy weight children. METHODS: Participants included overweight/obese (BMI > 85%) and healthy weight (15% < BMI < 85%) preadolescents (8-9 yr old). Participants in the physical activity group participated in a 9-month physical activity curriculum every day after school. The wait list control group received no intervention. Both groups had overweight/obese children and healthy weight controls. Whole-body bone mineral content, area, and bone mineral apparent density (BMAD) were assessed using dual x-ray absorptiometry) at the beginning and end of the 9-month trial in the physical activity and control group. RESULTS: Overweight/obese preadolescent children had higher BMAD than healthy weight children (P < 0.001 for spine, leg, and whole body). However, the density/weight (BMAD/lean mass) was lower in overweight/obese children than that in healthy weight children, indicating that the density of bones in overweight/obese children may not compensate sufficiently for the excessive load due to weight. The change in BMAD over 9 months was greater in healthy weight children than overweight/obese children in the whole body and leg, but not the lumbar spine. Physical activity caused a site-specific increase in bone density, affecting the legs more than the lumbar spine, but there was no significant difference in the effect of exercise between the healthy weight and the overweight/obese group. CONCLUSIONS: The smaller change in BMAD over the 9 months and lower BMAD per unit lean mass in overweight/obese compared with healthy weight children may indicate a slower rate of bone mass accrual, which may have implications for bone health during skeletal growth in obese/overweight children.


Assuntos
Peso Corporal/fisiologia , Densidade Óssea/fisiologia , Terapia por Exercício , Obesidade Pediátrica/fisiopatologia , Obesidade Pediátrica/terapia , Criança , Humanos , Ossos da Perna/fisiologia , Vértebras Lombares/fisiologia
15.
Nature ; 577(7790): 381-385, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31853068

RESUMO

Homo erectus is the founding early hominin species of Island Southeast Asia, and reached Java (Indonesia) more than 1.5 million years ago1,2. Twelve H. erectus calvaria (skull caps) and two tibiae (lower leg bones) were discovered from a bone bed located about 20 m above the Solo River at Ngandong (Central Java) between 1931 and 19333,4, and are of the youngest, most-advanced form of H. erectus5-8. Despite the importance of the Ngandong fossils, the relationship between the fossils, terrace fill and ages have been heavily debated9-14. Here, to resolve the age of the Ngandong evidence, we use Bayesian modelling of 52 radiometric age estimates to establish-to our knowledge-the first robust chronology at regional, valley and local scales. We used uranium-series dating of speleothems to constrain regional landscape evolution; luminescence, 40argon/39argon (40Ar/39Ar) and uranium-series dating to constrain the sequence of terrace evolution; and applied uranium-series and uranium series-electron-spin resonance (US-ESR) dating to non-human fossils to directly date our re-excavation of Ngandong5,15. We show that at least by 500 thousand years ago (ka) the Solo River was diverted into the Kendeng Hills, and that it formed the Solo terrace sequence between 316 and 31 ka and the Ngandong terrace between about 140 and 92 ka. Non-human fossils recovered during the re-excavation of Ngandong date to between 109 and 106 ka (uranium-series minimum)16 and 134 and 118 ka (US-ESR), with modelled ages of 117 to 108 thousand years (kyr) for the H. erectus bone bed, which accumulated during flood conditions3,17. These results negate the extreme ages that have been proposed for the site and solidify Ngandong as the last known occurrence of this long-lived species.


Assuntos
Hominidae , Animais , Evolução Biológica , Fósseis , Indonésia , Ossos da Perna , Crânio , Fatores de Tempo
16.
Rev. clín. med. fam ; 12(3): 155-159, oct. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-186807

RESUMO

El dolor óseo es un problema frecuente y constituye uno de los principales motivos de consulta, puede tratarse de un problema simple o puede ser el síntoma inicial de una patología más compleja y grave. En pacientes de edad avanzada con dolor óseo no asociado a traumatismo, que no mejora con tratamiento habitual, debemos realizar el diagnóstico diferencial con mieloma múltiple entre otros. Presentamos el caso de una mujer de 83 años que acude por dolor óseo en el miembro inferior izquierdo de meses de evolución que no mejora con tratamiento analgésico. Se realiza un estudio radiografico, en el que se objetiva una lesión lítica en el fémur izquierdo y ensanchamiento mediastínico en relación con plasmocitoma esternal que causaba compresión cardiaca. Se realizó estudio complementario que confirmó el diagnóstico de mieloma múltiple


Bone pain is one of the most common chief complaints. It can be a simple problem or an initial symptom of a more complex and serious disease. In older patients with non-traumatic bone pain that does not improve with conventional treatment, differential diagnosis with multiple myeloma, among others, is required. We present the case of an 83-year-old woman with bone pain in lower limb of several months' duration that does not improve with pain medications. X-ray reveal lytic lesion in her left femur and mediastinal widening related to sternal plasmacytoma causing cardiac compression. A complementary study confirmed the diagnosis of multiple myeloma


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Dor Musculoesquelética/etiologia , Mieloma Múltiplo/diagnóstico , Plasmocitoma/diagnóstico , Ossos da Perna , Diagnóstico Diferencial , Osteoporose/complicações
18.
Arch Orthop Trauma Surg ; 139(10): 1455-1460, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31414170

RESUMO

BACKGROUND: Anteroposterior (AP) whole leg radiographs (WLR) in the standing position for assessment of the mechanical leg axis are generally performed preoperatively for the planning of total knee replacement (TKR) and postoperatively to assess the leg axis. The objective of the present study was to investigate whether, if preoperative WLR are available, postoperative AP standard knee radiographs in the standing position are sufficient for calculating the mechanical leg axis. METHODS: In the present prospective study, the mechanical and the anatomical leg axes were determined on the basis of WLR from 104 patients prior to implantation of a TKR and the difference was calculated. Twelve weeks postoperatively, standing long AP radiographs and WLR were prepared. In addition, the mechanical axis was calculated by adding the preoperative difference between the anatomical and mechanical axis to the anatomical axis from the postoperative AP radiographs. Accuracy, bias and level of agreement for calculated relative to measured mechanical alignment were determined. RESULTS: Mean accuracy of calculated mechanical alignment was 0.5° ± 0.4°, and mean bias was 0.0° ± 0.6° (p = 1.00). Bland-Altman analysis revealed a 95% upper and lower level of agreement of - 1.3° and 1.3°, respectively. CONCLUSION: A preoperative WLR and a postoperative long AP knee standard radiograph are sufficient to determine the mechanical leg axis after TKR. If these are available, it is possible to do without WLR after TKR, particularly since they involve higher radiation exposure, are time-consuming, and are also prone to errors in the first postoperative weeks. LEVEL OF EVIDENCE: II diagnostic study.


Assuntos
Artroplastia do Joelho , Articulação do Joelho/diagnóstico por imagem , Ossos da Perna/diagnóstico por imagem , Radiografia , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos
19.
PLoS One ; 14(8): e0221083, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31415653

RESUMO

Providing a broiler chicken embryo with a lighting schedule during incubation may stimulate leg bone development. Bone development may be stimulated through melatonin, a hormone released in darkness that stimulates bone development, or increased activity in embryos exposed to a light-dark rhythm. Aim was to investigate lighting conditions during incubation and leg bone development in broiler embryos, and to reveal the involved mechanisms. Embryos were incubated under continuous cool white 500 lux LED light (24L), continuous darkness (24D), or 16h of light, followed by 8h of darkness (16L:8D) from the start of incubation until hatching. Embryonic bone development largely takes place through cartilage formation (of which collagen is an important component) and ossification. Expression of genes involved in cartilage formation (col1α2, col2α1, and col10α1) and ossification (spp1, sparc, bglap, and alpl) in the tibia on embryonic day (ED)13, ED17, and at hatching were measured through qPCR. Femur and tibia dimensions were determined at hatch. Plasma growth hormone and corticosterone and pineal melatonin concentrations were determined every 4h between ED18.75 and ED19.5. Embryonic heart rate was measured twice daily from ED12 till ED19 as a reflection of activity. No difference between lighting treatments on gene expression was found. 24D resulted in higher femur length and higher femur and tibia weight, width, and depth at hatch than 16L:8D. 24D furthermore resulted in higher femur length and width and tibia depth than 24L. Embryonic heart rate was higher for 24D and 16L:8D in both its light and dark period than for 24L, suggesting that 24L embryos may have been less active. Melatonin and growth hormone showed different release patterns between treatments, but the biological significance was hard to interpret. To conclude, 24D resulted in larger leg bones at hatch than light during incubation, but the underlying pathways were not clear from present data.


Assuntos
Desenvolvimento Ósseo , Escuridão , Ossos da Perna/embriologia , Iluminação , Animais , Embrião de Galinha , Galinhas , Corticosterona/metabolismo , Hormônio do Crescimento/metabolismo , Melatonina/metabolismo
20.
J Hum Evol ; 133: 167-197, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31358179

RESUMO

Due to its completeness, the A.L. 288-1 ('Lucy') skeleton has long served as the archetypal bipedal Australopithecus. However, there remains considerable debate about its limb proportions. There are three competing, but not necessarily mutually exclusive, explanations for the high humerofemoral index of A.L. 288-1: (1) a retention of proportions from an Ardipithecus-like chimp/human last common ancestor (CLCA); (2) indication of some degree of climbing ability; (3) allometry. Recent discoveries of other partial skeletons of Australopithecus, such as those of Australopithecus sediba (MH1 and MH2) and Australopithecus afarensis (KSD-VP-1/1 and DIK-1/1), have provided new opportunities to test hypotheses of early hominin body size and limb proportions. Yet, no early hominin is as complete (>90%), as is the ∼3.67 Ma 'Little Foot' (StW 573) skeleton from Sterkfontein Member 2. Here, we provide the first descriptions of its upper and lower long limb bones, as well as a comparative context of its limb proportions. We found that StW 573 possesses absolutely longer limb lengths than A.L. 288-1, but both skeletons show similar limb proportions. This finding seems to argue against a purely allometric explanation for A.L. 288-1 limb proportions. In fact, our multivariate allometric analysis suggests that limb lengths of Australopithecus, as represented by StW 573 and A.L. 288-1, exhibit a significantly different (p < 0.001) allometric pattern than that which typifies modern humans and African apes. Like some previous analyses, our results also suggest that hominin limb evolution occurred in two stages with: first, a modest increase in lower limb length and a concurrent shortening of the antebrachium between Ardipithecus and Australopithecus, followed by a considerable lengthening of the lower limb along with a decrease of both upper limb elements occurring between Australopithecus and Homo sapiens.


Assuntos
Ossos do Braço/anatomia & histologia , Fêmur/anatomia & histologia , Fósseis/anatomia & histologia , Hominidae/anatomia & histologia , Ossos da Perna/anatomia & histologia , Animais , Arqueologia , África do Sul
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