RESUMO
DIAGNOSTICS: Perthes disease remains a challenge for paediatric orthopedic surgeons. Xray imaging is still the method of choice for diagnostics and follow-up examination. A more detailed differentiation of Waldenström's classification, especially in early and late fragmentation stages, might be relevant to optimize timing of containment surgery. So-called "advanced MRI" imaging might help to detect patients at risk earlier than conventional xray imaging, which could lead to earlier surgical intervention. TREATMENT: Currently there is no treatment modality available which would improve the bone changes in Perthes disease. Non-operative treatment like improving hip range of motion as well as unloading is still the basic standard of care, with analgesic and/or anti-inflammatory medication, according to symptoms or findings. In the case of loss of containment, especially in children older than 6 years, surgery is indicated. Currently, there is a trend favoring acetabular reorientation techniques-especially the triple osteotomy, since the biomechanical relations would not be additionally impaired as in case of femoral varus osteotomy.
Assuntos
Acetábulo , Doença de Legg-Calve-Perthes/diagnóstico , Criança , Fêmur , Humanos , Doença de Legg-Calve-Perthes/terapia , Osteotomia , Radiografia , Resultado do TratamentoRESUMO
BACKGROUND: Slipped capital femoral epiphysis (SCFE) is a frequent chronic and often bilateral atraumatic slippage of the epiphysis relative to the femoral neck in adolescence. The success of the treatment depends on the extent of the slippage and possible complications. OBJECTIVES: Review on current trends in clinical examination and diagnostic imaging protocols. Commonly used imaging techniques, methods of measuring the slippage and treatment-relevant classification schemes are presented. MATERIALS AND METHODS: An overview on the clinical findings, the diagnostic procedures and the classification of SCFE based on relevant study results and experience gained in our daily clinical practice. RESULTS: Early diagnosis of SCFE is essential, as a delay in diagnosis regularly leads to an increase in slippage with an increased risk of subsequent damage to the blood vessels, which can lead to irreversible damage of the joint. Symptoms and findings are frequently subtle and nonspecific, often leading to delay in diagnosis and treatment and, consequently, to the manifestation of massive deformities. Xray imaging is the primary imaging modality, whereas MRI, computed tomography (CT) and ultrasound are helpful in surgical planning and prognostic evaluation. Postoperatively, they provide information on short and long-term complications. DISCUSSION: The delay in the diagnosis of SCFE is still present in the literature as well as in our own patient population, indicating that a repeated, consistent training on this topic is essential to prevent harm to patients. Whether patients benefit from advanced imaging techniques such as MRI or CT is questionable and should be screened case by case.
Assuntos
Escorregamento das Epífises Proximais do Fêmur , Adolescente , Epífises , Humanos , Imageamento por Ressonância Magnética , Radiografia , Tomografia Computadorizada por Raios XRESUMO
The purpose of this review is to present the pros and cons as well as the surgical techniques of conventional implants used for fixation of slipped capital femoral epiphysis (SCFE). Worth mentioning are Kwires, Hansson pins, transfixing screws, and gliding screws. We searched PubMed for "ECF" and "SCFE" in combination with "in situ fixation," "pin," "wire," "screw," and "nail." We considered Johansson nail, Knowles pin, and Nyström nail to be obsolete and of historical interest only. We noticed a trend from absolute stability towards some form of dynamic fixation over time, likely related to considerations of growth disturbance of the proximal femur and also the inherent potential for remodeling with time.
Assuntos
Escorregamento das Epífises Proximais do Fêmur , Pinos Ortopédicos , Parafusos Ósseos , Fios Ortopédicos , Humanos , RadiografiaRESUMO
Therapeutic options for the treatment of irreparable rotator cuff tears are fluent, are dependent on the patients' claims and demands and on the grade of the ongoing cuff tear arthropathy.A partial rotator cuff reconstruction with sufficient tenolysis combined with interval slide techniques to restore the anterior and posterior force couple may be indicated if there is no fatty degeneration > grade 3 of the rotator cuff muscles in a well-centered joint. The margin convergence technique with side-by-side adaptation of the tendon limbs may reduce the load on the reconstructed tendons.The role of the suprascapular nerve, which can probably be constricted by the retracted rotator cuff, and its therapy has not been completely clarified. When distinct symptoms are present neurolysis may be reasonable.Tendon transfers can be indicated in a cooperative patient < 65 years with a higher grade of muscular atrophy but without degenerative changes > grade II according to Hamada with the loss of active external rotation but performable active flexion. For posterosuperior tears the latissimus dorsi or recently the teres major tendon transfer to the rotator cuff footprint may be appropriate. For nonreconstructable anterosuperior tears a partial transfer of the pectoralis major tendon is possible.Careful subacromial debridement combined with biceps tenotomy and a cautious or reversed decompression may reduce the pain temporarily without having an influence on active motion until with the loss of active elevation the indication for a reversed shoulder arthroplasty is reached.In the mean time, absorbable subacromial spacers may re-center the humeral head, but the effectiveness of this therapy on clinical outcome should be analyzed in further studies.
Assuntos
Artroplastia do Ombro/métodos , Desbridamento/métodos , Procedimentos de Cirurgia Plástica/métodos , Transferência Tendinosa/métodos , Tenodese/métodos , Tenotomia/métodos , Artroplastia do Ombro/instrumentação , Terapia Combinada/métodos , Medicina Baseada em Evidências , Humanos , Falha de TratamentoRESUMO
BACKGROUND: Hereditary multiple exostosis (HME) is a hereditary autosomal dominant disease in which multiple exostoses occur. Typically, the exostoses are primarily located at the metaphysis and migrate with continued growth towards the diaphysis. Clinical problems are caused by local pain, impingement of muscle tendons and neurovascular structures, malformation - especially in the forearm - and malignant transformation - especially exostoses at the trunc and pelvic girdle. METHODS: A causal therapy is currently not available. Mechanical irritation is an indication for resection of the exostosis. Axial deviation of the lower extremity is treated according to the same principles as primary malalignments (temporary hemiepiphysiodesis/corrective osteotomy). RESULTS: The indication for correction of axial deviation at the upper extremity depends on age, extent as well as functional and cosmetic impairment. This should be discussed with the patient in detail. The patient has to be informed about the risk of malignant transformation after cessation of growth. Growing mass or new occurrence of symptoms after end of growth are suspicious and require further diagnostic examinations.
Assuntos
Alongamento Ósseo/métodos , Mau Alinhamento Ósseo/congênito , Mau Alinhamento Ósseo/cirurgia , Exostose Múltipla Hereditária/congênito , Exostose Múltipla Hereditária/cirurgia , Osteotomia/métodos , Procedimentos de Cirurgia Plástica/métodos , Adolescente , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
BACKGROUND: Infantile cerebral palsy is one of the most common diseases resulting in chronic disability and is mostly concomitant with impairment in the ability to walk. DISEASE PATTERN: Muscle contractions typically develop during the growth phase with subsequent joint contracture and instability as well as bone deformities to various extents. From a biomechanical viewpoint the gait impairment is due to a lever arm dysfunction. THERAPEUTIC STRATEGIES: The therapy concept is multimodal and involves conservative as well as operative measures. The objectives are to lower the muscle tonus, to avoid muscle and joint contractures and bone deformities and to correct already fixed malformations in order to achieve the best possible function for the patient. Complicated multilevel operations are often necessary to achieve this aim. CONCLUSION: Extensive knowledge on the biomechanics of gait and the pathobiomechanics of spastic bilateral cerebral palsy are necessary to carry out surgery. Using instrumental gait analyses the biomechanical relationships can be analyzed better and complicated operations can be planned with greater precision.
Assuntos
Paralisia Cerebral/fisiopatologia , Paralisia Cerebral/cirurgia , Comportamento Cooperativo , Avaliação da Deficiência , Comunicação Interdisciplinar , Caminhada/fisiologia , Fenômenos Biomecânicos/fisiologia , Paralisia Cerebral/classificação , Paralisia Cerebral/diagnóstico , Criança , Pré-Escolar , Terapia Combinada , Humanos , Lactente , Recém-Nascido , Força Muscular/fisiologia , Músculo Esquelético/fisiopatologia , Procedimentos Ortopédicos , Aparelhos Ortopédicos , Amplitude de Movimento Articular/fisiologiaRESUMO
AIM: Pigmented villonodular synovitis is rare. Thus, we initiated a retrospective multi-center study regarding symptoms, location, type of disease, type of surgery, number of recurrences, use of adjuvant therapies and functional outcome. RESULTS: Ten centers contributed. Data from 173 patients were sampled. The disease was seen predominantly in joints, less frequently in tendon sheaths and bursae. Patients with articular lesions suffered mainly from the diffuse type. In tendon sheaths, the relation "diffuse versus nodular" was nearly 50 % each, in bursae most often the nodular type was found. Anatomically, mostly the knee was affected. Institutions with more than 20 patients had a lower rate of recurrence than those with less than 20 cases. Regarding the knee, there were less recurrences in joints treated with open synovectomy than in those treated arthroscopically. CONCLUSIONS: Since the rate of recurrence has been rather high, the use of adjuvant treatments (radiosynoviorthesis or radiotherapy) is recommended. In our study, the rate of their application was quite low. Patients who received an adjuvant therapy after primary surgery did not show any recurrence. In 14 % of patients in whom an adjuvant therapy had been used, after at least one recurrence, further recurrences were observed. Functional results were excellent in 84 % of patients. LEVEL OF EVIDENCE: Prognostic multi-center study, Level III.
Assuntos
Sinovite Pigmentada Vilonodular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Feminino , Tumores de Células Gigantes , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sinovite Pigmentada Vilonodular/diagnóstico , Sinovite Pigmentada Vilonodular/terapia , Tendões , Adulto JovemRESUMO
Osteotomy of the lesser tuberosity for the surgical delto-pectoral approach to the glenohumeral joint results in good visualization and overview and sufficient anatomical refixation of the insertion of the subscapularis muscle. However, clinical and biomechanical studies have not shown clearly significantly better results for osteotomy concerning ultimate load to failure, displacement after cyclic loading and outcome in patients compared with tenotomy and tenodesis of the subscapularis tendon. One advantage of osteotomy, however, is the potential radiological evaluation of the refixation with healing of the bony fragment. In the context of refixation, securing of the sutures behind the stem during implantation can be beneficial because it prevents sutures cutting through the bone. This benefit is increased in cemented stems by means of better suture fixation. With respect to the choice of osteotomy or tenotomy, the bony substance and tendon quality of the insertion of the subscapularis muscle should be evaluated.
Assuntos
Artroplastia de Substituição/instrumentação , Artroplastia de Substituição/métodos , Osteotomia/instrumentação , Osteotomia/métodos , Luxação do Ombro/cirurgia , Fraturas do Ombro/cirurgia , Ombro/cirurgia , HumanosRESUMO
The long-term prognosis of Legg-Calvé-Perthes disease primarily depends on the spherical form of the femoral head and the congruency of the hip joint after healing. Of the many factors influencing the outcome only the range of mobility and containment can be addressed therapeutically. The mobility of the joint is maintained or restored through various conservative measures thus reducing joint deforming forces. If loss of containment becomes evident operative treatment is indicated, preferably in the early fragmentation stage. For biomechanical reasons correction of the acetabulum is preferred. For children less than 8.5 years old greater trochanteric apophyseodesis is warranted to prevent trochanteric overgrowth. The results of containment ameliorating surgery are promising. In older children with severe Legg-Calvé-Perthes disease the results are less promising.
Assuntos
Articulação do Quadril/cirurgia , Instabilidade Articular/terapia , Doença de Legg-Calve-Perthes/terapia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Osteotomia/métodos , Procedimentos de Cirurgia Plástica/métodos , Criança , Pré-Escolar , Terapia Combinada , Feminino , Humanos , Lactente , Recém-Nascido , Instabilidade Articular/diagnóstico , Instabilidade Articular/etiologia , Doença de Legg-Calve-Perthes/complicações , Doença de Legg-Calve-Perthes/diagnóstico , Masculino , Resultado do TratamentoRESUMO
Relapse and residual deformity after treatment of congenital clubfoot are common problems. Recurrences occur in up to 48 % of cases after successful initial treatment using Ponseti's technique. By casting and anterior tibial tendon transfer as recommended by Ponseti a flexible and well functioning foot can be achieved in most cases. Neglected clubfoot remains a demanding challenge. Depending on the severity of the deformity, the impairment of function and patient age, conservative and/or different operative treatment options can be considered. Manipulation and casting according to Ponseti is also recommended in toddlers with relapses even after peritalar joint release. Thus the need and extent of operative treatment can be reduced. Additional osteotomy may be indicated in more rigid feet and older children. An accurate evaluation of the existing deformity and functional impairment is mandatory for the individual choice of treatment. The number of previous operative procedures reduces the amount of improvement and mobility of the foot. Therefore, the best and most efficient treatment for recurrent clubfoot is prevention in the form of consistent primary treatment, consistently wearing braces and regular follow-up examinations.
Assuntos
Pé Torto Equinovaro/diagnóstico , Pé Torto Equinovaro/terapia , Manipulações Musculoesqueléticas/métodos , Osteotomia/métodos , Procedimentos de Cirurgia Plástica/métodos , Transferência Tendinosa/métodos , Moldes Cirúrgicos , Terapia Combinada/métodos , Humanos , Prevenção SecundáriaRESUMO
OBJECTIVE: To evaluate T2* values in various histological severities of osteoarthritis (OA). METHOD: Magnetic resonance imaging (MRI) and T2* mapping including a three-dimensional (3D) double-echo steady-state (DESS) sequence for morphological cartilage assessment and a 3D multiecho data image combination (MEDIC) sequence for T2* mapping were conducted in 21 human femoral head specimens with varying severities of OA. Subsequently, histological assessment was undertaken in all specimens to correlate the observations of T2* mapping with histological analyses. According to the Mankin score, four grades of histological changes were determined: grade 0 (Mankin scores of 0-4), grade I (scores of 5-8), grade II (scores of 9-10), and grade III (scores of 11-14). For reliability assessment, cartilage T2* measurements were repeated after 4 weeks in 10 randomly selected femoral head specimens. RESULTS: T2* values decreased significantly with increasing cartilage degeneration (total P-values <0.001) ranging from 36.3 ± 4.3 ms in grade 0 regions to 22.8 ± 4.3 ms in regions with grade III changes. Pearson correlation analysis proved a fair correlation between T2* values and Mankin score (correlation coefficient = -0.362) that was statistically significant (P-value <0.001). Intra-class correlation (ICC) analysis demonstrated high intra-observer reproducibility for the T2* measurement (ICC: 0.949, P < 0.001). CONCLUSIONS: Given the advantages of the T2* mapping technique with no need for contrast medium, high image resolution and ability to perform 3D biochemically sensitive imaging, T2* mapping may be a strong addition to the currently evolving era of cartilage biochemical imaging.
Assuntos
Cartilagem Articular/patologia , Articulação do Quadril/patologia , Osteoartrite do Quadril/patologia , Adulto , Idoso , Artroplastia de Quadril , Feminino , Cabeça do Fêmur/patologia , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/cirurgia , Reprodutibilidade dos Testes , Índice de Gravidade de DoençaRESUMO
Preoperative anaemia is common in patients undergoing orthopaedic and other major surgery. Anaemia is associated with increased risks of postoperative mortality and morbidity, infectious complications, prolonged hospitalization, and a greater likelihood of allogeneic red blood cell (RBC) transfusion. Evidence of the clinical and economic disadvantages of RBC transfusion in treating perioperative anaemia has prompted recommendations for its restriction and a growing interest in approaches that rely on patients' own (rather than donor) blood. These approaches are collectively termed 'patient blood management' (PBM). PBM involves the use of multidisciplinary, multimodal, individualized strategies to minimize RBC transfusion with the ultimate goal of improving patient outcomes. PBM relies on approaches (pillars) that detect and treat perioperative anaemia and reduce surgical blood loss and perioperative coagulopathy to harness and optimize physiological tolerance of anaemia. After the recent resolution 63.12 of the World Health Assembly, the implementation of PBM is encouraged in all WHO member states. This new standard of care is now established in some centres in the USA and Austria, in Western Australia, and nationally in the Netherlands. However, there is a pressing need for European healthcare providers to integrate PBM strategies into routine care for patients undergoing orthopaedic and other types of surgery in order to reduce the use of unnecessary transfusions and improve the quality of care. After reviewing current PBM practices in Europe, this article offers recommendations supporting its wider implementation, focusing on anaemia management, the first of the three pillars of PBM.
Assuntos
Anemia/terapia , Transfusão de Eritrócitos , Cuidados Pré-Operatórios , Lesão Pulmonar Aguda/etiologia , Transfusão de Eritrócitos/efeitos adversos , Europa (Continente) , HumanosRESUMO
The aim of this study was to evaluate the initial acetabular implant stability and late acetabular implant migration in press fit cups combined with screw fixation of the acetabular component in order to answer the question whether screws are necessary for the fixation of the acetabular component in cementless primary total hip arthroplasty. One hundred and seven hips were available for follow-up after primary THA using a cementless, porous-coated acetabular component. A total of 631 standardized radiographs were analyzed digitally by the "single-film-x-ray-analysis" method (EBRA). One hundred and one (94.4 %) acetabular components did not show significant migration of more than 1 mm. Six (5.6%) implants showed migration of more than 1 mm. Statistical analysis did not reveal preoperative patterns that would identify predictors for future migration. Our findings suggest that the use of screw fixation for cementless porous-coated acetabular components for primary THA does not prevent cup migration.
Assuntos
Artroplastia de Quadril , Parafusos Ósseos , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
In order to assess outcome and possible predictors of early good results, a prospective study on 22 patients who were treated with save surgical hip dislocation for symptomatic isolated cam-type femoroacetabular impingement (FAI) was performed. After a follow-up of 6 and 12 months, standard clinical and radiographic parameters were recorded. A statistically significant improvement of the clinical status according to the Harris hip score could be assessed at six months (p-value = 0.003) and 12 months (p-value = 0.001) post-surgery. By comparing standard clinical and radiographic preoperative parameters with various follow-up outcomes, we revealed no specific parameter with predictive value. These findings are important for centers that have just started to use this surgical technique and are still identifying their learning curve.
Assuntos
Impacto Femoroacetabular/cirurgia , Articulação do Quadril/cirurgia , Adulto , Desbridamento , Feminino , Impacto Femoroacetabular/patologia , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-IdadeRESUMO
BACKGROUND: Treatment of Juvenile Idiopathic Arthritis (JIA) has improved quality of life in children and adolescents with JIA. Standardisation of care offers the chance to improve the quality of care of those patients. New studies have been published after completion of our last treatment guideline (2007). An updated consensus process is mandatory. METHODS: A systematic literature analysis in PUBMED (key words: juvenile idiopathic (rheumatoid) arthritis, therapy; limits: humans, published in the last 3 years, all child 0-18 years, clinical trial) revealed 17 relevant studies. Studies relating to diagnosis of JIA, Uveitis, vaccination, transition were excluded. Representatives nominated by scientific societies and organisations were invited to consensus conferences which were hosted by a professional moderator. The following societies were invited: Berufsverband der Kinder- und Jugendärzte (BVKJ), Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Deutsche Gesellschaft für Rheumatologie (DGRh), Deutsche Ophthalmologische Gesellschaft (DOG), Deutsche Rheuma-Liga Bundesverband, Verein zur Förderung und Unterstützung rheumatologisch erkrankter Kinder und deren Eltern, Vereinigung für Kinderorthopädie, Zentraler Verband der Physiotherapeuten und Krankengymnasten (ZVK). Consensus conferences were each attended by more than 95% of the nominated representatives. Consensus statements were confirmed by nominal group technique and Delphi method. RESULTS AND CONCLUSION: Updated consensus statements regarding drug therapy, symptomatic and surgical management of JIA were compiled and judged strictly by the criteria of Evidence-Based Medicine (EBM).
Assuntos
Artrite Juvenil/terapia , Comportamento Cooperativo , Medicina Baseada em Evidências , Comunicação Interdisciplinar , Adolescente , Anti-Inflamatórios/uso terapêutico , Antirreumáticos/uso terapêutico , Artrite Juvenil/diagnóstico , Produtos Biológicos/uso terapêutico , Criança , Pré-Escolar , Terapia Combinada , Alemanha , Glucocorticoides/uso terapêutico , Humanos , Imunossupressores/uso terapêutico , Lactente , Terapia Ocupacional , Modalidades de FisioterapiaRESUMO
Pes equinus is the most common deformity in cerebral palsy. A primarily dynamic pes equinus without shortening of the calf muscle in many cases turns into a structural pes equinus. This is due to insufficient linear growth of the calf muscle compared to bone growth. Structural pes equinus has to be distinguished from marked, compensatory and forefoot pes equinus. Conservative as well as operative treatment options are often applied in combination or sequentially. In dynamic pes equinus botulinum toxin A is the therapy of choice. Only slight structural pes equinus may improve under botulinum toxin A injection with and without additional casting. Usually, structural pes equinus requires operative treatment or lengthening of the gastrocnemius and/or soleus muscle (operation according to Baumann). Because of its side effect of inducing loss of power of the calf muscle, lengthening of the Achilles tendon should only be performed with caution. Especially in bilateral spastic cerebral palsy, the increased risk of causing talipes calcaneovalgus and crouch gait has to be considered.
Assuntos
Paralisia Cerebral/cirurgia , Pé Equino/cirurgia , Tendão do Calcâneo/cirurgia , Toxinas Botulínicas Tipo A/administração & dosagem , Moldes Cirúrgicos , Paralisia Cerebral/diagnóstico , Criança , Pré-Escolar , Pé Equino/diagnóstico , Marcha/fisiologia , Humanos , Lactente , Injeções Intramusculares , Músculo Esquelético/cirurgia , Aparelhos Ortopédicos , Complicações Pós-Operatórias/etiologiaRESUMO
OBJECTIVE: The influence of cytomechanical forces in cellular migration, proliferation and differentiation of mesenchymal stem cells (MSCs) is still poorly understood in detail. METHODS: Human MSCs were isolated and cultivated onto the surface of a 3 x 3 mm porcine collagen I / III carrier. After incubation, cell cultures were transferred to the different cultures systems: regular static tissue flasks (group I), spinner flasks (group II) and rotating wall vessels (group III). Following standard protocols cells were stimulated lineage specific towards the osteogenic and chondrogenic lines. To evaluate the effects of applied cytomechanical forces towards cellular differentiation distinct parameters were measured (morphology, antigen and antigen expression) after a total cultivation period of 21 days in vitro. RESULTS: Depending on the cultivation technique we found significant differences in both gen and protein expression. CONCLUSION: Cytomechanical forces with rotational components strongly influence the osteogenic and chondrogenic differentiation.
Assuntos
Técnicas de Cultura de Células/métodos , Condrócitos/citologia , Células-Tronco Mesenquimais/citologia , Osteoblastos/citologia , Biomarcadores , Diferenciação Celular/fisiologia , Células Cultivadas , Condrócitos/fisiologia , Condrogênese/fisiologia , Meios de Cultura/farmacologia , Perfilação da Expressão Gênica , Humanos , Imuno-Histoquímica , Osteoblastos/fisiologia , Osteogênese/fisiologia , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Estresse MecânicoRESUMO
Congenital clubfoot is one of the most common congenital skeletal deformities with an incidence of 1-2/1000 newborns. The deformity is characterized by pathological changes of joints, bones (especially the talus), muscles, tendons and soft tissues which result in subtalar malpositions known as talipes equinus, varus adductus and cavus. Secondary clubfoot is always part of an underlying systemic or neurologic disease and can occur at birth or develop over time. The treatment of clubfoot should start early after birth and is primarily conservative, involving manipulation and serial casting. Among conservative techniques available today, the Ponseti method is the treatment of choice. Applying this treatment protocol surgical therapy can be reduced in amount and extent. Extensive surgical therapy is only necessary in exceptional cases.
Assuntos
Moldes Cirúrgicos , Pé Torto Equinovaro/diagnóstico , Pé Torto Equinovaro/cirurgia , Manipulações Musculoesqueléticas/métodos , HumanosRESUMO
Slipped capital femoral epiphysis (SCFE) is a common hip disorder in adolescence and should be diagnosed and treated surgically as soon as possible. The etiology, biomechanical, biochemical and hereditary factors are still under investigation. The classification of SCFE is based on the acuteness, clinical and radiomorphological findings. Avascular necrosis of the epiphysis (AVN) and chondrolysis occur more often in operated than in non-operated patients. Medium and long-term sequelae of SCFE are loss of function and degenerative joint disease due to femoroacetabular impingement (FAI) or consequences from complications such as AVN and chondrolysis. For mild slips the long-term prognosis is better than for moderate or severe slips. Higher grade unstable SCFE may benefit from reduction while in chronic slips corrective osteotomy may be indicated. Traditional osteotomy procedures, such as Imhäuser or Southwick intertrochanteric osteotomy are safe procedures but correct the deformity distant from the site of the deformity. The surgical dislocation with modified Dunn osteotomy according to Ganz allows the preparation of an extended retinacular soft tissue flap and offers an extensive subperiosteal exposure of the circumference of the femoral neck before reducing the slipped epiphysis anatomically. In cases of FAI due to mild deformities restoration of the head-neck offset via hip arthroscopy or surgical dislocation should be considered before higher grade cartilage damage occurs.