ABSTRACT
OBJETIVO: Neste trabalho, procuramos avaliar se existe relação entre o grau de deslizamento da epifisiólise femoral proximal (EFP) e a presença de impacto femoroacetabular (IFA). Ainda, analisou-se o arco de movimento do quadril (ADM) em relação ao IFA, além de revisar a literatura sobre o assunto. MÉTODO: Foram analisados 19 casos de EFP em 15 pacientes tratados cirurgicamente com epifisiodese in situ com um parafuso canulado, com seguimento médio de 27 meses. Realizou-se a análise do grau de deslizamento da EFP pelos ângulos epimetafisário (âEM) e coloepifisário (âCE) da radiografia em perfil, dos sinais de impacto radiográficos na incidência anteroposterior, dos sintomas clínicos e do ADM do quadril. RESULTADOS: Evidenciou-se que o grau de deslizamento da EFP (através do âEM) apresenta relação inversa estatisticamente significante com a presença de IFA no período médio de seguimento deste estudo. Ou seja, os pacientes que demonstraram um quadro sintomático de IFA apresentaram graus menores de deslizamento. Isso pode ser explicado pelo fato que o tipo de impacto que ocorre na EFP (came de inclusão ou de impacção) depende do grau de deslizamento, e estes se apresentam de forma e cronologia diferentes. O ADM do quadril não apresentou relação com o IFA. CONCLUSÃO: Há relação entre o grau de deslizamento e a presença de IFA clínicoradiológica após EFP.
OBJECTIVES: In this study, we sought to evaluate whether there is any relationship between the degree of epiphysiolysis of the proximal femur (EPF) and the presence of femoroacetabular impingement (FAI). Hip range of motion (ROM) was also analyzed in relation to FAI, and the literature on this topic was reviewed. METHODS: Nineteen cases of EPF in fifteen patients who had been treated surgically by means of in situ epiphysiodesis with a cannulated screw were evaluated. The mean follow-up was 27 months. The degree of EPF was analyzed using the epimetaphyseal and neck-epiphyseal angles on lateral-view radiographs, the radiographic signs of FAI on anteroposterior-view radiographs, clinic symptoms and hip ROM. RESULTS: It was found that the degree of EPF (through the epimetaphyseal angle) presented a statistically significant inverse relationship with the presence of FAI over the mean follow-up period of this study. In other words, the patients with symptoms of FAI presented lesser degrees of slippage. This can be explained by the fact that the types of impingement that occurs in cases of EPF (i.e. cam impaction or inclusion) depends on the degree of slippage, and these present different clinical forms and chronology. The ROM did not present any relationship with FAI. CONCLUSION: There is a relationship between the degree of slippage and the presence of clinical-radiological FAI after EPF.
Subject(s)
Humans , Male , Female , Child , Adolescent , Epiphyses, Slipped/complications , Epiphyses, Slipped/diagnosis , Epiphyses, Slipped/epidemiology , Hip JointABSTRACT
O autor realiza uma revisäo da literatura sobre o tema Epifisiólise Proximal do Fêmur, abordando principalmente os seguintes aspectos: epidemiologia, etiologia, patologia, diagnóstico e história natural
Subject(s)
Humans , Femur Neck/injuries , Epiphyses, Slipped , Epiphyses, Slipped/classification , Epiphyses, Slipped/diagnosis , Epiphyses, Slipped/epidemiology , Epiphyses, Slipped/etiology , Hip/injuriesABSTRACT
Bone injuries during the process of delivery were studied among 34, 946 live born babies over a 11 period. There were 35 cases of bone injuries giving an incidence of 1 per 1,000 live births. Clavicle was the commonest bone fractured (45.7%) followed by humerus (20%), femur (14.3%) and depressed skull fracture (11.4%) in the order of frequency. There was one case each of orbital fracture, epiphyseal separation of lower end of femur and dislocation of elbow joint. Lack of antenatal care, malpresentation often leading to obstructed labour and operative deliveries were found to be risk factors for bone injuries. Meconium stained liquor and birth asphyxia were more commonly associated with bone injuries than control cases. Cases with injuries had longer hospital stay and higher mortality. Improving the health infrastructure at the peripheral level with early identification of high risk mothers and their appropriate management can bring down the incidence of bone injuries.