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1.
Acta Radiol ; 65(10): 1252-1256, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39295291

RESUMO

BACKGROUND: Rotational abnormalities of the hip have been implicated in the etiology of diseases, such as hip dysplasia, osteoarthritis, and femoroacetabular impingement. Despite the extensive literature on hip morphology, there is a gap in knowledge regarding variations in the Hispanic population. PURPOSE: To describe the bony anatomy variations of the acetabulum in a Hispanic population. MATERIAL AND METHODS: This is a cross-sectional study. We studied 182 computed tomography (CT) images in patients aged older than 21 years, who had undergone pelvic CT for any condition, except hip fracture. Measurements of acetabular version, anterior and posterior acetabular sector angles (AASA/PASA) and horizontal acetabular sector angles (HASA) were made. Acetabular variations were then compared to weight and sex data. RESULTS: The mean acetabular anteversion was greater in women (P < 0.001). Women exhibited a greater PASA (P < 0.05); however, men had a greater AASA (P < 0.05). Underweight individuals had a smaller PASA (P < 0.01) and HASA (P < 0.05) than individuals with a normal weight. CONCLUSION: The Hispanic hip is morphologically similar to other populations previously reported in the literature; however, Hispanic men have less coverage of the femoral head by the posterior acetabular wall when compared to women of the same ethnicity. These abnormalities have a direct impact on management and surgical approach in patients treated for femoroacetabular impingement and hip dysplasia.


Assuntos
Acetábulo , Hispânico ou Latino , Tomografia Computadorizada por Raios X , Humanos , Feminino , Masculino , Acetábulo/diagnóstico por imagem , Acetábulo/anatomia & histologia , Estudos Transversais , Adulto , Tomografia Computadorizada por Raios X/métodos , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Idoso de 80 Anos ou mais
2.
J Pediatr Orthop ; 44(4): 232-235, 2024 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-38269603

RESUMO

BACKGROUND: Back pain, as a clinical marker in scoliosis, has been associated with underlying pathology for many years, warranting further magnetic resonance imaging (MRI). Failures of segmentation, mixed defects, female gender, rib anomalies, congenital thoracic anomalies, and neurocutaneous markers are known risk factors for abnormal MRI pathology findings in patients with congenital early-onset scoliosis (Congenital-EOS). Yet, back pain has not been evaluated as a risk factor for underlying MRI pathology in patients with Congenital-EOS. This study aimed to assess back pain as a risk factor for underlying pathology in Congenital-EOS using MRI as a diagnostic tool. METHODS: A retrospective database review from the Pediatric Spine Study Group (PSSG) of all patients with Congenital-EOS who reported a back pain complaint, and underwent a spinal MRI study before surgical intervention was performed. Patients were divided into those with an underlying MRI pathology and those without. Demographics were compared between groups. RESULTS: From a total of 2355 patients with Congenital-EOS registered in PSSG, 107 patients reported a back pain complaint, with only 42 patients fulfilling the inclusion criteria (being evaluated with an MRI study). Overall group mean age was 8.1±4.5 years, with 25 of the 42 patients (60%) being females. Twenty-four of 42 patients (57%) had a comorbidity reported such as cardiac problems, musculoskeletal complaints, neurological deficits/myelopathy, gastrointestinal symptoms, developmental delay, respiratory problems, craniofacial abnormalities, and chromosomal conditions. An underlying MRI pathology was found in 21 of 42 patients with Congenital-EOS (50%) with back pain. The underlying MRI pathologies found were tethered spinal cord, spinal canal stenosis, syringomyelia, Arnold-Chiari malformation, and arachnoid cyst. CONCLUSIONS: Abnormal MRI findings are common in patients with Congenital-EOS who report back pain. Gender, age, major coronal curve angle, thoracic or lumbar predominance deformity, and comorbidities type or amount were not associated with abnormal MRI findings. LEVEL OF EVIDENCE: Level II-Prognostic study.


Assuntos
Escoliose , Siringomielia , Humanos , Feminino , Criança , Pré-Escolar , Masculino , Escoliose/diagnóstico por imagem , Escoliose/epidemiologia , Escoliose/complicações , Estudos Retrospectivos , Relevância Clínica , Imageamento por Ressonância Magnética/métodos , Siringomielia/cirurgia , Dor nas Costas/diagnóstico por imagem , Dor nas Costas/etiologia
3.
Arthroplast Today ; 25: 101286, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38292146

RESUMO

Background: Robotic-assisted orthopaedic surgery has become popular and widely available, mainly for total joint arthroplasty. However, there has been a persistent concern regarding access to robotic-assisted surgery and the utilization rate of total joint arthroplasty among minority groups. As an imperative effort to close the gap regarding health inequalities, we assessed the knowledge and perspective of Hispanics regarding robotic-assisted orthopaedic surgery. Methods: A 28-item questionnaire was established to evaluate Hispanics' perceptions of robotic-assisted orthopaedic surgery. Participants answered questions about demographic features, knowledge about robotic-assisted orthopaedic surgery, and preferences regarding manual vs robotic-assisted procedures. Results: A total of 580 questionnaires were analyzed in our study, with an average age of participants of 49.1 years. Only 44.2% of the participants were familiar with robotic-assisted orthopaedic surgery. Fifty-three percent of the respondents preferred robotic-assisted surgery over conventional procedures, with many participants believing that robotic-assisted surgery leads to better outcomes (54.7%) and faster recovery (53.1%). Conclusions: Knowledge about specific factors such as clinical outcomes and costs may influence the perception and preference of Hispanics toward robotic-assisted orthopaedic surgery. Therefore, patient education may play a crucial role in the informed decision-making process in Hispanics when opting between robotic-assisted or traditional orthopaedic surgery.

4.
J Am Acad Orthop Surg ; 32(12): e596-e604, 2024 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-38579315

RESUMO

INTRODUCTION: Nonsteroidal anti-inflammatory drugs (NSAIDs) are effective analgesics commonly used in fracture management. Although previously associated with delayed fracture healing, multiple studies have demonstrated their safety, with minimal risks of fracture healing. Given the current opioid crisis in the United States, alternate pain control modalities are essential to reduce opioid consumption. This study aims to determine whether the combination of oral acetaminophen and intravenous ketorolac is a viable alternative to opioid-based pain management in closed tibial shaft fractures treated with intramedullary nailing. METHODS: We conducted a randomized controlled trial evaluating postoperative pain control and opioid consumption in patients with closed tibial shaft fractures who underwent intramedullary nailing. Patients were randomized into an NSAID-based pain control group (52 patients) and an opioid-based pain control group (44 patients). Visual analog scale (VAS) scores and morphine milligram equivalents (MMEs) were evaluated at 12-hour postoperative intervals during the first 48 hours after surgery. Nonunion and delayed healing rates were recorded for both groups. RESULTS: A statistically significant decrease in MMEs was noted at every measured interval (12, 24, 36, and 48 hours) in the NSAID group compared with the opioid group ( P -value 0.001, 0.001, 0.040, 0.024, respectively). No significant change in visual analog scale scores was observed at 12, 36, and 48 hours between both groups ( P -value 0.215, 0.12, and 0.083, respectively). A significant decrease in VAS scores was observed at the 24-hour interval in the NSAID group compared with the opioid group ( P -value 0.041). No significant differences in union rates were observed between groups ( P -value 0.820). DISCUSSION: Using an NSAID-based postoperative pain protocol led to a decrease in opioid consumption without affecting pain scores or union rates. Owing to the minimal risk of short-term NSAID use, their role in the perioperative management of tibia shaft fractures is justified, especially when they reduce opioid consumption markedly. LEVEL OF EVIDENCE: Therapeutic Level I.


Assuntos
Acetaminofen , Analgésicos Opioides , Anti-Inflamatórios não Esteroides , Fixação Intramedular de Fraturas , Consolidação da Fratura , Cetorolaco , Medição da Dor , Dor Pós-Operatória , Fraturas da Tíbia , Humanos , Fraturas da Tíbia/cirurgia , Fixação Intramedular de Fraturas/métodos , Anti-Inflamatórios não Esteroides/administração & dosagem , Anti-Inflamatórios não Esteroides/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Analgésicos Opioides/administração & dosagem , Masculino , Feminino , Adulto , Cetorolaco/administração & dosagem , Cetorolaco/uso terapêutico , Acetaminofen/administração & dosagem , Acetaminofen/uso terapêutico , Pessoa de Meia-Idade , Consolidação da Fratura/efeitos dos fármacos , Quimioterapia Combinada , Manejo da Dor/métodos , Adulto Jovem , Administração Oral
5.
J Hand Surg Glob Online ; 5(3): 382-385, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-37323981

RESUMO

Diffuse pigmented villonodular synovitis is characterized by synovial inflammation and hemosiderin deposition. It mainly occurs in adults, with the hip and knees being the most common sites of involvement. It is associated with high recurrence rates, with open synovectomy being the most common treatment method to avoid recurrences. Few cases of diffuse pigmented villonodular synovitis have been reported in pediatric patients, especially in uncommon locations such as the hand. This case presents pathology-confirmed diffuse pigmented villonodular synovitis in the hand of a pediatric patient with multiple recurrences despite adequate surgical margins. The patient underwent mass excision with adjuvant radiation treatment after his last recurrence, with excellent functional outcomes and no recurrence at the five-year follow-up.

6.
Int J Surg Case Rep ; 110: 108746, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37689019

RESUMO

INTRODUCTION AND IMPORTANCE: Wide Awake Local Anesthesia No Tourniquet (WALANT) is a surgical technique used in hand surgery that allows for active patient participation during surgery while avoiding the pain and discomfort associated with general anesthesia and tourniquets. Using this technique for tenolysis enables a surgeon to assess the repair intraoperatively. However, this technique is more commonly used in adults than in pediatric patients. We aimed to present a case that may contribute to the use of the WALANT technique on the pediatric population. CASE PRESENTATION: This case presents the successful use of the WALANT technique multiple times in a 7-year-old Hispanic male patient to repair recurrent tendon adhesions and joint contracture due to a prior gunshot wound that caused a comminuted, displaced fracture with intra-articular extension of the third finger. CLINICAL DISCUSSION: To the best of our knowledge, few reports and case series of WALANT hand surgery in children are available within the literature. The presented case is rare in terms of the mechanism of injury, the age of the patient, and the fact that multiple WALANT interventions were successfully performed on the same patient. CONCLUSION: Our findings showcase the potential of the WALANT technique on pediatric patients as an alternative to traditional techniques. Due to the scarcity of pediatric WALANT cases in the literature, and the benefits provided by the technique, this case report may be of clinical relevance.

7.
JSES Int ; 7(5): 786-792, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37719808

RESUMO

Background: Adhesive capsulitis of the shoulder is a painful and debilitating condition. While the majority of patients improve with conservative treatment, those who do not improve require surgery such as arthroscopic capsular release (ACR) for symptom relief. However, there is limited literature regarding the optimal timeframe to proceed with surgery. Methods: This retrospective cohort evaluated 134 Hispanic patients who underwent ACR for the treatment of adhesive capsulitis. Patients were divided into an early and a delayed treatment group that included all patients. Patients were then divided into diabetic and idiopathic subgroups. Early vs. delayed treatment outcomes (forward flexion, external rotation, Visual Analog Scale pain scores, and recurrence requiring reoperation) were assessed in all patients and in each subgroup. Results: No statistically significant differences were found between the early and delayed release groups in postoperative forward flexion, external rotation, pain intensity scores, and recurrence requiring reoperation at 1 month, 3 months, and 6 months of follow-up in the all-patient group. In the idiopathic frozen shoulder subgroup, no significant differences were observed in postoperative forward flexion, external rotation, pain intensity scores, and recurrence requiring reoperation at 1 month, 3 months, and 6 months of follow-up. In the diabetic frozen shoulder subgroup, no significant differences were observed in postoperative forward flexion, external rotation, pain intensity scores, and recurrence requiring reoperation at 1 month and 6 months of follow-up visits. Conclusions: There was no difference in outcomes following ACR for adhesive capsulitis between patients who underwent early release vs. delayed release. There were no significant differences in outcomes between early and delayed arthroscopic release in patients with a history of diabetes mellitus.

8.
Am J Infect Control ; 51(3): 349-350, 2023 03.
Artigo em Inglês | MEDLINE | ID: mdl-35944743

RESUMO

Evaluating the impact of surgical masks' conservation practices during the Coronavirus Disease pandemic in the bioburden of the operating room seems imperative, as they play a critical role against this pandemic. We demonstrate that surgeons' masks tend to be contaminated due to the conservation techniques to maximize protection equipment during the pandemic. Health institutions should highlight the importance of surgical mask exchange to avoid increments in surgical mask contamination.


Assuntos
COVID-19 , Cirurgiões , Humanos , Máscaras , COVID-19/prevenção & controle , SARS-CoV-2 , Pandemias/prevenção & controle
9.
JBJS Case Connect ; 13(1)2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-36821405

RESUMO

CASE: A 29-year-old man presented nontraumatic diffuse thoracic pain. Magnetic resonance imaging of the spine showed a cortical lesion with peripheral hyperintensity, a central sclerotic hypointense nidus, and surrounding paraspinal inflammatory changes at the T3 vertebral body. Clinical and radiologic findings were consistent with an osteoid osteoma. The patient successfully underwent an endoscopic partial corpectomy and mass resection. At the 6-month follow-up, radiographs showed complete tumor resolution. CONCLUSION: Endoscopic resection is an adequate and minimally invasive technique for the complete resection of osteoid osteomas.


Assuntos
Osteoma Osteoide , Neoplasias da Coluna Vertebral , Masculino , Humanos , Adulto , Osteoma Osteoide/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Neoplasias da Coluna Vertebral/cirurgia , Vértebras Torácicas/patologia , Radiografia
10.
J Hand Microsurg ; 15(4): 284-288, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37701311

RESUMO

Background Spastic joint contractures remain a complex and challenging condition. For patients with upper extremity spastic dysfunction, improving the muscle balance is essential to maximize their hand function. Multiple procedures, including proximal row carpectomy (PRC) and wrist arthrodesis (WA), are considered among the different surgical alternatives. However, the biomechanical consequences of these two procedures have not been well described in current literature. Hence, the objective of our study is to assess the change in the extrinsic digit flexor tendon resting length after proximal row carpectomy and wrist arthrodesis. Methods Six fresh-frozen cadaver upper extremities (four females and two males) with no obvious deformity underwent dissection, PRC, and WA. All the flexor digitorum profundus (FDP), flexor digitorum superficialis (FDS), and flexor pollicis longus (FPL) tendons were marked proximally 1-cm distal to their respective myotendinous junction and cut distally at the marked point. The overlapping segment of each distal flexor tendon from its proximal mark was considered the amount of flexor tendon resting length change after PRC and WA. A descriptive evaluation was performed to assess the increment in tendon resting length. Additionally, a regression analysis was performed to evaluate the relation between the tendon resting length and the proximal carpal row height. Results Following PRC and WA, the mean digit flexor tendon resting length increment achieved across all tendons was 1.88 cm (standard deviation [SD] = 0.45; range: 1.00-3.00 cm). A weak direct relationship ( R = 0.0334) between the increment in tendon resting length and proximal carpal row height was initially suggested, although no statistical significance was demonstrated ( p = 0.811). Conclusion This study provides an anatomic description of the increased extrinsic digit flexor tendon resting length after PRC and WA in cadaveric specimens. Findings provide a useful framework to estimate the amount of extrinsic digit flexor resting length increment achieved after wrist fusion and the proximal carpal row removal.

11.
J Am Acad Orthop Surg ; 31(17): 931-937, 2023 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-37192425

RESUMO

INTRODUCTION: Posterior lumbar fusion surgery has become more common amid an aging population, with degenerative disease as its most common indication. Historically, postoperative pain control for spine surgery has relied on opioids. However, opioid use is associated with adverse effects such as dependence, respiratory depression, and altered cognition. Our study aimed to determine whether an opioid-sparing multimodal analgesia regimen (ketorolac, orphenadrine, and gabapentin) could be a viable alternative to diminish opioid use compared with a standard opioid-based regimen in Hispanic patients undergoing posterior lumbar spinal fusion. METHODS: This was a randomized controlled trial of Hispanic patients scheduled to undergo elective posterior spinal fusion. Inclusion criteria included age 30 to 85 years, Hispanic ethnicity, lumbar stenosis between L1 and S1, elective posterior spinal fusion with instrumentation, American Society of Anesthesiologists Score <2, and consent to participate in the study. Patients were randomized into two groups, an experimental multimodal analgesia and control (opioid-based) treatment groups, and outcomes such as morphine milligram equivalents used, visual analog scale score, and length of hospital stay were compared between the groups. RESULTS: The MMA experimental group used significantly lower amounts of opioid (measured with morphine milligram equivalent) than the opioid-based group during the 12-hour and 24-hour postoperative periods ( P -value = 0.023 and P -value = 0.033, respectively). No statistically significant difference was observed in opioid use in the 48-hour postoperative period between both groups ( P -value = 0.066). The MMA group had significantly lower VAS scores reported at the 12-hour, 24-hour, and 48-hour postoperative periods compared with the opioid-based group ( P -values = 0.016, 0.020, and 0.020, respectively). No difference was observed in the length of hospital stay between groups ( P -value = 0.169). DISCUSSION: Implementing an MMA protocol in Hispanic patients undergoing posterior lumbar fusion resulted in decreased overall opioid use and decreased pain intensity compared with the opioid-based group. MMA is an effective alternative for pain control in patients who want to avoid opioid use. CLINICAL TRIAL REGISTRATION: Identifier: NCT05413902.


Assuntos
Analgesia , Fusão Vertebral , Adulto , Idoso , Idoso de 80 Anos ou mais , Humanos , Pessoa de Meia-Idade , Analgesia/métodos , Analgésicos Opioides/uso terapêutico , Hispânico ou Latino , Derivados da Morfina/uso terapêutico , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/prevenção & controle , Dor Pós-Operatória/etiologia , Fusão Vertebral/efeitos adversos
12.
J Child Orthop ; 16(6): 461-465, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36483650

RESUMO

Introduction: Pediatric back pain evaluation nowadays relies on patient history, physical examination, and plain radiographs to identify underlying pathologies. Constant pain, night pain, radicular pain, and abnormal neurological examination were previously recommended as clinical markers to assess the need for magnetic resonance imaging evaluation. Recent studies have challenged the use of these clinical markers, recommending further studies. This study aimed to assess pain intensity as a predictor of underlying magnetic resonance imaging pathology in children with back pain. Methods: An observational cross-sectional study of pediatric patients between 8 and 17 years with back pain for more than 4 weeks from 2009 to 2021 was conducted. A whole spine magnetic resonance imaging was performed on patients with back pain without an identifiable cause and no prior spine treatment. The numerical rating scale questionnaire was administered to each patient, and answers were divided into three groups: mild (1-3), moderate (4-6), and severe (7-10) numerical rating scale score. Student's t-test and chi-square analysis were used to correlate differences between continuous and categorical values, respectively. Results: Of 590 patients (70% female and a mean age of 15.25 years), there were 35.1% of patients had a magnetic resonance imaging underlying pathology. No association was found between severe numerical rating scale score and the presence of underlying MRI pathology (p = 0.666). Patients with low or moderate numerical rating scale scores had similar associations to an underlying magnetic resonance imaging pathology as patients with a severe numerical rating scale score (p = 0.256; p = 0.357, respectively). Conclusions: Back pain intensity was not found to be an effective clinical marker for predicting underlying magnetic resonance imaging pathology in pediatric patients with back pain.

13.
Arthroplast Today ; 18: 7-10, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36267393

RESUMO

Bilateral acetabular fractures after seizure activity are rare, as most of these injuries are associated with high-energy trauma. It is hypothesized that rapid forceful contracture of hip musculature during a seizure can lead to the femoral head fracturing the medial wall and driving in proximal and medial directions. Absence of standardized surgical treatment algorithms and literature-reported outcomes makes this fracture pattern challenging to orthopedic surgeons. To the best of our knowledge, no published data describe delayed simultaneous total hip arthroplasty for treating seizure-induced bilateral acetabular fractures with protrusio. We present a patient that sustained bilateral acetabular fractures after an alcohol-withdrawal seizure. The patient underwent delayed simultaneous total hip arthroplasty 3 months later with excellent functional outcomes at the 6-month follow-up.

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