Cambios Degenerativos y Evaluación Funcional de Fracturas Intraarticulares de Tobillo en Pacientes Pediatricos / Degenerative Changes and Functional Evaluation of Intraarticular Ankle Fractures in Pediatric Patients

Introducción Las fracturas de tobillo representan el 12% de las fracturas en la edad pediátrica. Planteamos la hipótesis que los pacientes con fracturas intraarticulares de tobillo tendrán un excelente resultado funcional y no presentarán cambios degenerativos articulares a los 6 meses post cirugía. El objetivo del estudio es realizar un analisis del resultado funcional, así como la presencia de cambios radiologicos degenerativos precoces en el seguimiento de pacientes con fracturas intra-articulares de tobillo tratadas en nuestro centro. Materiales y Métodos Estudio de Cohorte retrospectivo, se recolectaron datos de pacientes con fracturas intra-articulares de tobillo entre 2012 y 2016. Se clasificaron y evaluaron mediante score AOFAS y radiografías para clasificar según Van Dijk. Resultados La diferencia promedio de edad entre las fracturas triplanares y tillaux es de 17 meses (p: 0.038). La media de Score AOFAS fue de 85,2%. El 88.8% refiere dolor en relación a actividades cotidianas, a pesar de tener excelentes o buenos resultados funcionales. No hay correlación significativa entre los resultados de AOFAS en pacientes con fracturas transicionales y no transicionales., 43,4% presentaron estadio 0, 43,4% estadio I y 13% estadio II de Van Dijk. Ningún caso presento estadio III. Discusión En base a los hallazgos de este estudio, y al contrario de lo hipotetizado, la mayoría de los pacientes tienen un buen resultado funcional tras el manejo de las fracturas intraarticulares de tobillo y no excelente como se pensaba. Existe un grupo de pacientes que mostró cambios degenerativos precoces demostrables por radiografía.

Background Ankle fractures represent 12% of fractures in pediatric age. We hypothesized that patients with intra-articular ankle fractures will have an excellent functional result and will not present degenerative joint changes 6 months after surgery. The objective of the study is to carry out an analysis of the functional result, as well as the presence of early degenerative radiological changes in the follow-up of patients with intra-articular ankle fractures treated in our center. Methods Retrospective cohort study, data were collected from patients with intra-articular ankle fractures between 2012 and 2016. They were classified and evaluated using AOFAS score and radiographs to classify according to Van Dijk. Results The average age difference between triplanar and tillaux fractures is 17 months (p: 0.038). The mean AOFAS Score was 85.2%. 88.8% reported pain in relation to daily activities, despite having excellent or good functional results. There is no significant correlation between the AOFAS results in patients with transitional and non-transitional fractures. 43.4% had stage 0, 43.4% stage I, and 13% stage II Van Dijk. No case presented stage III. Discussion Based on the findings of this study, and contrary to the hypothesized, most patients have a good functional result after the management of intra-articular ankle fractures and not excellent as previously thought. There is a group of patients who showed early degenerative changes demonstrable by radiography.

Role of Magnetic Resonance Imaging in Evaluation of Low Back Pain of Non-Traumatic Causes

Low back pain (LBP) is a commonly encountered complaint in clinical practice with a significant economic burden to the society. The objective of study was to evaluate the changes seen on MRI in patients with low back pain due to various non-traumatic causes and to distinguish various causes of low back pain with level of spinal involvement. Methods: This descriptive observational study was carried from October 2015 to October 2017 in 106 patients with low back pain who underwent MRI of the lower spine at Department of Radio-Diagnosis, Chalmeda AnandRao institute of Medical sciences. Patients who met the inclusion/exclusion criteria were included in the study. Results: More than 40% of patients (n=43; 40.57%) were in the age group of 41 to 60 years (Figure 24). There were 29 patients in the age group of 21 to 40 years (27.36%), followed by age group of > 60 years (n =21; 19.8%) and least patients were in the age group of <20 years (n =13; 12.26%. Conclusions: We concluded that 106 patients, degenerative changes were the commonest cause for low back pain followed by infective and neoplastic etiologies. The ability of MRI to detect morphological abnormalities, extent of lesion and nerve root compression all help in complete evaluation of low back pain.

Determination of the Impact of Functional Instability of Parathyroid Hormone and the Calcium-Phosphorus Ratio as Risk Factors during Osteoarthritic Disorders using Receiver Operating Characteristic Curves

Backgrounds: The disease risk factor prediction with calcium-phosphorus ratio (CPR) and/or parathyroid hormone (PTH) levels are suitable biomarkers. The aim of the present study was to investigate the functional instability of these biomarkers in the blood on the risk of osteoarthritic disorder (OAD) by using receiver operating characteristic (ROC) curves. Methods: Separate evaluations were performed for subjects 132 with OAD and 109 without OAD symptoms using questionnaires, standardized physical and radiographic examinations, and risk factor identification (hypoparathyroidism, hypocalcaemia and hyperphosphatemia diseases). The blood levels of PTH, calcium, and phosphorus were measured by using appropriate kits. ROC curve and logistic regression analyses were performed for the PTH and CPR levels. Results: The area under the ROC curve (AUC), 95% CI for the AUC, for the OAD compared with the non-OAD cohorts were 0.985, 0.969-1.000, and P<0.001 for the PTH analysis and 0.579, 0.506-0.652, and P<0.05 for the CPR analysis. In the OAD cohort, the AUC and the PTH risk were higher for men than for women; AUC=1.000 for men, and AUC=0.977 for women, with both AUC values highly significant (P<0.001). The CPR risk was higher for men (AUC=0.614, 95% CI=0.483-0.746, P=0.079) than for women (AUC=0.516, 95% CI=0.419-0.613, P=0.736) but was not statistically significant in either sex. Conclusion: A functional instability risk that is higher in male than female OAD cohorts causes lower PTH and CPR levels during OADs, which can be considered one of the OAD diagnostic protocols besides radiological images.

Degenerative Changes of Spine in Helicopter Pilots

OBJECTIVE: To determine the relationship between whole body vibration (WBV) induced helicopter flights and degenerative changes of the cervical and lumbar spine. METHODS: We examined 186 helicopter pilots who were exposed to WBV and 94 military clerical workers at a military hospital. Questionnaires and interviews were completed for 164 of the 186 pilots (response rate, 88.2%) and 88 of the 94 clerical workers (response rate, 93.6%). Radiographic examinations of the cervical and the lumbar spines were performed after obtaining informed consent in both groups. Degenerative changes of the cervical and lumbar spines were determined using four radiographs per subject, and diagnosed by two independent, blinded radiologists. RESULTS: There was no significant difference in general and work-related characteristics except for flight hours and frequency between helicopter pilots and clerical workers. Degenerative changes in the cervical spine were significantly more prevalent in the helicopter pilots compared with control group. In the cervical spine multivariate model, accumulated flight hours (per 100 hours) was associated with degenerative changes. And in the lumbar spine multivariate model, accumulated flight hours (per 100 hours) and age were associated with degenerative changes. CONCLUSION: Accumulated flight hours were associated with degenerative changes of the cervical and lumbar spines in helicopter pilots.

Effects of Growth Hormone on the Degenerative Changes in the Intervertebral Disc of Rabbits / 고신대학교의과대학학술지

OBJECTIVES: Growth hormone is expected to delay the degenerative changes of the intervertebral disc and affect the initial recovery process of cartilage injury, but these effects are still open to disputes. METHODS: This researcher injected growth hormone to the intervertebral disc and subcutaneous tissue of rabbits whose degenerative change were induced artificially, and evaluated the treatment effects of growth hormone through a comparison between the injected and control groups of rabbits. The intervertebral discs between the 3th and 4th vertebrae were extracted 4 weeks after the administration of growth hormone and then histologically graded in a quantitative method. Changes in the height of the intervertebral discs were measured after the induction of degenerative changes. After four weeks of the treatment, then, the height changes were measured. RESULTS: In the subcutaneous-growth hormone injected group, any consistent, sequential, and progressive degeneration of the annular fibrosus was not observed through histopathological studies. The disc height also sequentially did not decrease from that at the time of the injury set in this study. CONCLUSIONS: Considering the histopathological findings of the study, the researcher suggests that subcutaneous injection of growth hormone will be a therapeutic model of disc degeneration. But further biochemical or electromicroscopic studies are necessary to clarify the mechanism of delay degenerative disc changes by growth hormone.

Microstructural observations on nissl substances in the cerebellar cortex of adult wistar rats following quinine administration

Purpose: This study assessed some microstructural effects of quinine; commonly used in malaria chemotherapy; especially in chloroquine-resistant and cerebral malaria; on the Nissl substance in the cerebellar cortex of adult Wistar rats using microanatomical studies. Methods: Twenty seven adult male Wistar rats; weighing between 150g and 190g; were randomly separated into groups A; B and C (n=9). The rats in group A served as the control and received intramuscular injection of physiological saline. Group B rats were injected intramuscularly with liquid quinine; 16mg/kg body weight as a start dose; followed by 8mg/kg body weight 8 hourly for seven days. Group C rats received the same treatment as group B but were subjected to a withdrawal period of one week. Groups A and B rats were sacrificed at the end of the treatment while group C rats were sacrificed at the end of one week. The cerebellum of each rat was removed and fixed in 10formol saline for histological analysis. Results: The findings showed that the Nissl substances in the cerebellar cortex in control rats stained more intensely and distinctly compared with the less intense stain and degenerated Nissl substances in the treated rats.Conclusion: The observed degenerative changes in the Nissl substances in the cerebellar cortex of the treated rats may affect the synthesis of proteins in correlation with neuronal functions

Surgical Treatment of Adjacent Segment Degeneration after Spinal Fusion in Degenerative Lumbar Disc Disease

OBJECTIVE: We experienced some cases of adjacent segment degeneration after spinal fusion and treated them by various reoperation methods. The authors report an evaluation of causes of adjacent segment degeneration after spinal fusion and treatment methods. METHODS: Sixteen patients was admitted to our hospital due to adjacent segment degeneration after spinal fusion from November 1997 to May 2001 and we operated 11 patients among 16 patients with various surgical methods. We analyzed clinical diagnosea, surgical methods, and disc degeneration status of adjacent segment following spinal fusion on 1st operation and 2nd operation, and also evaluated the clinical symptoms, type of adjacent segment degeneration, and time interval between the 1st operation and the 2nd operation. RESULTS: Clinical diagnoses on 1st operation were degenerative spondylolisthesis of four cases, chronic degenerative disc disease with spinal stenosis of six cases, and recurred herniated lumbar disc disease of one case. We treated eight cases by posterior lumbar interbody fusion, one case by 360degrees fusion, and two cases by pedicle screw fixation only. Disc degeneration on adjacent segment to spinal fusion existed already in nine among 11 patients before spinal fusion. Types of adjacent segment degeneration after spinal fusion were disc degeneration of two cases, lumbar instability of three cases, lumbar stenosis of four cases, and lumbar instability and stenosis of two cases. Most patients complained of low back pain due to disc degeneration and instability, and some patients complained of leg and buttock pain due to stenosis. Time interval from 1st operation to reoperation was 20 months through 99 months, mean time interval was 57 months. CONCLUSION: Inevitable compensatory mechanism occurs at adjacent segment after fusion, because of stress concentration and alteration of biomechanics after fusion. But, we achieve excellent or good results of reoperation surgical treatment for adjacent segment degeneration after spinal fusion.

Surgical Treatment of Adjacent Degenerative Segment after Lumbar Fusion: Preliminary report / 대한척추외과학회지

STUDY DESIGN: A retrospective study OBJECTIVES: To demonstrate the early experience of operative treatment about adjacent segments degeneration after lumbar fusion. SUMMARY OF LITERATURE REVIEW: The treatment of degenerative changes at adjacent segment after lumbar spinal fusion have not been well described in literature. MATERIALS AND METHODS: A retrospective reviews of radiographs, medical records and follow up study were undertaken in eight patients who had been treated surgically due to degenerative changes at adjacent segment after lumbar fusion. Average follow up duration was 25 months. Causes of secondary operation were 3 cases of segmental instability, 2 cases of degenerative spondylolisthesis, 2 cases of degenerative spinal stenosis, 2 cases of cauda equina syndrome, 1 case of disc degeneration. Clinical results were evaluated by using of author's criteria. For the radiographic evaluation, plain roentgenogram(AP, Lat. flextion/extension Lat.), CT, MRI were checked. RESULTS: The mean time interval to secondary operation from first operation was seven years nine months. At the preoperative CT or MRI film review, there were initial adjacent segment degenerative changes in half of the cases preoperatively. The level developing degenerative changes were upper segment in 5 cases, lower segment in 2 cases and both segment in 1 case. Most common segment was L3,4 in 5 cases. The second operations were mainly PLIF in 7 cases and PL fusion in 1 case. All cases showed solid fusion. Clinical results were excellent in 3 cases, good in 4 cases, fair in 1 case and poor in no case. CONCLUSION: The early clinical and radiographic results of surgical treatment was satisfactory. If the degenerative changes of adjacent segments are detected preoperatively, there are some needs to consider the extension of surgery according to the severity of the lesions. We think that the results of secondary operation was better in case of PLIF than posterolateral fusion because PLIF provided more rigid stability which enabled early walking stability and better corrective power. But long term results of that should be followed up.

Autografted and Allogrfted Meniscal Transplantation in the Knee Joint / 대한정형외과학회잡지

The degenerative arthritis following total menisectomy has led to consideration of the need for meniscal transplantation, this study evaluates the morphologic and histologic changes fol lowing fresh meniscal autograft and allograft in therabbits. Transplantation of the medial meniscus was carried out in two groups of 32 rabbits(autograft group=16 rabbits, allograft group=16 rabbits). The morphological and histological changes of the transplanted auto-and allografted menisci and the articular cartilage of the medial femoral and tibial condyle were observed at 2,4,6,8,10,12,22,28 weeks postoperatively. There were no significant differences between auto and allograft groups in gross appearance. Histologically, the fibrous adhesion was noted between grafted meniscus and joint capsule 2 weeks after operation, but complete healing was seen at the suture sites without rejection phenomenon at 6 weeks in both groups. There were prominent inflammatory reactions such as lymphocytes and inflammatory cells infiltration during early postoperative stages(2,4 weeks) only in the allograft group, and more prominent fibrotic reactions in the allograft group than auto-graft group. The results of this study suggest that meniscal allografts are able to adapt to the host tissues, survive within the joint environment, and provide a functional replacement for the removed meniscus, but further studies for graft-host immune response and a method to take the maintenance and deposits of graft must be needed to perform the meniscal allograft in human.

Histologic change of the posterior attachment in anterior disc displacement of the temporomandibular joint - a new model of internal derangement in rabbits / 대한치과교정학회지

This paper describes a new method to create an animal model for TMJ internal derangement in the New Zealand white rabbits and the light and electron microscopical changes of posterior attachment of them. Twenty six rabbits(2.5-3.0kg), four normal and twenty two experimental, were used. The right disc of experimental animal was displaced anteriorly without sectioning the posterior attachment and tied to the zygomatic arch with nylon not to be reduced to the original position. The left TMJ was sham-operated to be compared with its right experimental one. Normal animals were sacrificed one day and eight weeks after experiment. Experimental animals were sacrificed one day, ten days, three weeks, five weeks and eight weeks after surgery respectively. They were fixed intravenously with 2% glutaldehyde under general anesthesia and the samples of them were processed for light and electron microscopic examination. The purpose of this experiment is to make a suitable animal model of disc displacement without reduction for studying and understanding the cellular and morphologic events in posterior attachment of TMJ including early changes which were difficult to be observed in human TMJs. The results of this investigation suggest the following conclusions: 1. Authors induced anterior disc displacement surgically in rabbits with new method to examine histologic changes of posterior attachment. Tissue reactions of this model seem to be similar to those observed in human disc displacement. We think this animal model for anterior disc displacement may be used to explore and evaluate objectively the effects of many treatment modalities in disc displacements. 2. The animal disease model showed inflammation at early stage(one and ten days). At this stage there were mild-to-severe mononuclear inflammatory cell infiltration, numerous newly formed vessels, vessel dilatation and engormement and many fibroblasts. 3. At middle stage(three weeks), fibrosis occurred, where fibroblasts decreased in number, but their cytoplasm was profuse indicating high activity. Collagen fibers increased in number and the tissue looked more dense. 4. At late stage(five weeks and eight weeks) showed degenerative changes including perforation of posterior attachment, disintegration of collagen fiber bundles, degeneration of fibroblasts, metastatic ossification, and dystrophic calcification.

Histopathologic Findings of Rabbit Cilia after Application of Radio Frequency Wave

As a modality of effective treatment for trichiasis, authors performed experimental study of the radio frequency application(Mehl's method) to the cilia of four rabbit eyes with the different application times(10, 30, 60, 180 seconds). For the control, electrolysis to the cilia of the two eyes, and two eyes without any application were observed histopathologically. Regardless of the radio frequency application time, the radio frequency applied eyelids did not reveal any gross changes, and the selective degenerative changes(pyknotic, vacuolar, and karyorrhaxis) were observed microscopically in the hair regeneration part(internal root sheath of hair, hair matrix, and papillae of hair). In the electrolysed eyelids, gross scar and severe necrotic changes were appeared in microscopic findings. As a result of our observation, it is indicated that the application of radio frequency as a treatment for trichiasis, in compare with the electrolysis, revealed less destructive to the adjacent tissue, with more selective changes on the portion for hair regeneration.