Disastrous triad of femoral head:femoral neck fracture meeting fracture-dislocation of femoral head / 中国骨伤

Femoral head and ipsilateral femoral neck fractures are serious and complicated injuries, which usually yield unsatisfactory results using conventional hip-preserving surgery. The key point of the management and prognosis mainly lies in femoral neck fractures. An apparent and consecutive relationship exists between femoral neck fractures and femoral head fracture-hip dislocation in such injuries. It is believed that disastrous triad of femoral head (DTFH) could summarize these specific injuries, and reflect the injury mechanism and prognostic characteristics. Based on our clinical observation and literature review, DTFH could be divided into three subgroups:TypeⅠ, common DTFH, in which femoral neck fractures occur following femoral head fractures-hip dislocation due to the same trauma; TypeⅡ, iatrogenic DTFH, in which femoral neck fractures come out in the caring process of femoral head fractures-hip dislocation; Type Ⅲ, stressed DTFH, in which femoral neck fractures occur after the management of femoral head fractures-hip dislocation. In the scenario, the line of femoral neck fractures locates distally to the femoral head fractures. Herein, we will discuss clinical characteristics of these types of DTFH.

Traumatic recurrent hip dislocation associated with femoral head fracturere constructed with iliac crest autograft / Luxación recurrente de cadera asociada a fractura de cabeza femoral reconstruida con autoinjerto de cresta iliaca

Hip femoral head fractures are extremely uncommon, but likely associated with traumatic hip dislocations. Both lesions require emergent treatment to avoid further complications.19-year-old male patient was received after a high-energy motor vehicle accident with severe brain and thoraco-abdominal trauma and a displaced femoral head fracture with posterior hip dislocation with no acetabular fracture. An emergent open reduction and internal fixation with 2 headless screws was performed, as well as posterior capsule repair. After 1 month as an inpatient in Intensive Care Unit, he sustained a new episode of posterior hip dislocation. Consequently, a second successful surgical reduction was obtained, and hip stability was achieved by posterior reconstruction with iliac crest autograft fixed with cannulated screw and posterior structure repair. Two years later, he was able to walk independently and he does not present any signs of degenerative joint disease nor avascular necrosis.

Las fracturas de la cabeza femoral son extremadamente raras y están asociadas comúnmente con una luxación de cadera traumática. Ambas lesiones requieren tratamiento urgente con el objetivo de evitar complicaciones posteriores. Un paciente varón de 19 años fue trasladado tras un accidente de tráfico de alta energía en el que sufrió un traumatismo craneoencefálico y toracoabdominal grave, además de una fractura de cabeza femoral desplazada junto a una luxación posterior de cadera sin afectación acetabular. De manera urgente, fue intervenido mediante una reducción abierta y fijación interna de la fractura con dos tornillos canulados sin cabeza y reparación de la cápsula articular posterior. Tras un mes de ingreso en la unidad de cuidados intensivos, sufrió un nuevo episodio de luxación posterior de cadera. Debido a ello, se realiza una segunda intervención quirúrgica con reducción abierta y en la que se obtiene una adecuada estabilidad de la cadera mediante reconstrucción posterior con la adición de autoinjerto tricortical de cresta ilíaca y reparación capsular posterior. Después de dos años de seguimiento, el paciente deambula de manera independiente, sin dolor y sin signos degenerativos ni de necrosis avascular en las pruebas de imagen.

Implicancia de la radiografía con tracción y rotación interna en la evaluación de las fracturas de fémur proximal / Implication of internal rotation traction radiography in proximal femoral fracture evaluation

Introducción: La correcta valoración de las radiografías cuando ingresa un paciente con una fractura de fémur proximal tiene una implicancia directa en el tratamiento propuesto. Materiales y Métodos: Se evaluó consecutivamente a 100 pacientes con diagnóstico de fractura de fémur proximal. Se tomaron radiografías de pelvis de frente, de la cadera afectada de frente y de la cadera afectada de frente con tracción y rotación interna. Se comparó la clasificación realizada por residentes con la clasificación de los médicos senior, todos utilizaron las tres radiografías para evaluar las fracturas. Resultados: El resultado global de concordancia entre la clasificación inicial de los residentes con la de los médicos senior fue del 68,9%. Cuando los médicos residentes utilizaron la radiografía con tracción y rotación interna, la concordancia aumentó al 81,5%. Cincuenta y una respuestas cambiaron con respecto a la clasificación inicial. De estas, en 42 (82,4%) casos, la clasificación inicial era incorrecta y cambió a una correcta. En 9 (17,6%) casos, la clasificación inicial era correcta y cambió a una incorrecta. Conclusiones: La radiografía con tracción y rotación interna es un estudio simple, de bajo costo y bien tolerado por el paciente que facilita la correcta interpretación de las fracturas de fémur proximal, lo que tiene un impacto directo en la indicación del tratamiento y su resultado final. Nivel de Evidencia: IV

Introduction: The correct assessment of radiographs at the time of admission of a patient with proximal femoral fracture has a direct effect on the choice of treatment. Materials and Method: We consecutively evaluated 100 patients with a diagnosis of proximal femoral fracture. Antero-posterior pelvic radiographs (A-P), A-P radiographs of the affected hip, and internal rotation traction radiographs of the affected hip were taken. A comparison was made between the classifications made by residents and the classification of senior doctors, who used the 3 radiographs to classify all fractures. Results: The overall agreement score between the initial classification of residents and that of senior doctors was 68.9%. When the resident physicians used internal rotation traction radiography, agreement increased to 78.75%. 51 responses changed with respect to the initial classification. Of these, in 42 (82.4%) cases the initial classification was incorrect and changed to a correct classification. While in 9 (17.6%) cases the initial classification was correct and changed to an incorrect one. Conclusion: Internal rotation traction radiography is a simple, low-cost study that is well-tolerated by the patient and facilitates correct interpretation of proximal femoral fractures with a direct impact on the choice of treatment and its outcome. Level of Evidence: IV

Gaucher's disease in a patient presenting with hip and abdominal pain

Summary Gaucher's disease is characterized by glucocerebroside accumulation in the cells of the reticuloendothelial system. There are three subtypes. The most common is type 1, known as the non-neuropathic form. Pancytopenia, hepatosplenomegaly and bone lesions occur as a result of glucocerebroside accumulation in the liver, lung, spleen and bone marrow in these patients. Findings associated with liver, spleen or bone involvement may be seen at radiological analysis. Improvement in extraskeletal system findings is seen with enzyme replacement therapy. Support therapy is added in patients developing infection, anemia or pain. We describe a case of hepatosplenomegaly, splenic infarction, splenic nodules and femur fracture determined at radiological imaging in a patient under monitoring due to Gaucher's disease.

Subchondral Insufficiency Fractures of the Femoral Head

A subchondral insufficiency fracture (SIF) of the femoral head is a recently proposed concept, which needs to be differentiated from osteonecrosis. Clinically, SIF has generally been observed in the osteoporotic elderly women or renal transplant recipients. Radiographical changes are not obvious in its early phase, however, some cases undergo subchondral collapse (crescent sign). On the T1-weighted magnetic resonance images, a low intensity band is one of the characteristic imaging appearances, which corresponds histologically to the fracture line and associated fracture repair tissue. Therefore, the shape of the low intensity band generally tends to be irregular, disconnected, and convex to the articular surface. The prognosis of SIF is not clearly established. Some cases show resolution of the symptoms by the conservative treatments, while other cases show rapid progression of the collapse such as rapidly progressive arthrosis of the hip.

Fracturas de la cabeza femoral: ¿corresponden a lesiones catastróficasde la cadera? / Femoral head fractures: are they catastrophic hip injuries?

Objective: To describe the clinical results and complications of patients with femoral head fractures using the Pipkin classification. Materials and Methods: Retrospective and descriptive study. We analyzed the cases of femoral head fractures treated between 1992 and 2008. Medical history of hip surgery, associated injuries, Pipkin classification, type of treatment and complications were recorded from patients medical history. Results: We report 18 cases of femoral head fractures with clinical follow-up averaged 10.3 years (range from 2.3 to 18.7 years). 14 (78 percent) males with a mean age of 44.8 years without previous history of hip disease. In 17 (95 percent) patients the mechanism of injury was a traffic accident. Associated with posterior dislocation in 17 (94 percent) and anterior dislocation in 1 (6 percent) patient. 13 cases required closed reduction, 4 open reduction and in one case primary total hip arthroplasty was performed because of associated cervical hip fracture. There were 5 (28 percent) fractures Pipkin I, 4 (22 percent) Pipkin II, 1 (6 percent) Pipkin III and 8 (44 percent) Pipkin IV. Within the overall complication rates in our series, we had no cases of heterotopic ossification, there were 3 cases of postraumatic arthritis (16.5 percent) and 5 cases of femoral head avascular necrosis (27.5 percent). Seven patients (37.5 percent) required total hip arthroplasty during their evolution. Patients Pipkin III and IV were those with the highest complication rates, requiring total hip arthroplasty in 66 percent of cases. Conclusion: The fractures of the femoral head are associated with high energy mechanisms, generally with hip dislocation and present complications with significant impact for the patient’ship, becoming a catastrophic injury when they correspond to Types III and IV of Pipkin Classification.

Objetivo: Describir los resultados clínicos y complicaciones en pacientes con fracturas de cabeza femoral utilizando la clasificación de Pipkin. Materiales y Métodos: Estudio retrospectivo y descriptivo. Se analizaron los casos de fracturas de cabeza femoral tratadas entre los años 1992 y 2008. Se registraron los antecedentes médicos del paciente y quirúrgicos de la cadera, lesiones asociadas, clasificación de Pipkin, tipo de tratamiento y la aparición de complicaciones. Resultados: Presentamos 18 casos de fracturas de cabeza femoral con un seguimiento clínico promedio de 10,3 años (rango de 2,3-18,7 años). Nuestra serie presentó 14 (78 por ciento) hombres, una edad promedio de 44,8 años, sin casos de patología previa de cadera. En 17 (95 por ciento) pacientes el mecanismo de lesión fue un accidente de tránsito. Se asociaron a luxación posterior en 17 (94 por ciento) y luxación anterior en 1 (6 por ciento) paciente. En 13 casos se realizó una reducción cerrada, en 4 reducción abierta y en 1 se realizó artroplastía total de cadera primaria por fractura cervical asociada. Se presentaron 5 (28 por ciento) fracturas Pipkin I, 4 (22 por ciento) Pipkin II, 1 (6 por ciento) Pipkin III y 8 (44 por ciento) Pipkin IV. Dentro de las complicaciones globales de nuestra serie, no hubo casos de calcificaciones heterotópicas, hubo 3 casos de artrosis postraumática (16,5 por ciento) y 5 casos de necrosis avascular de cabeza femoral (27,5 por ciento). Siete pacientes (37,5 por ciento) requirieron de artroplastía total de cadera durante su evolución. Los pacientes Pipkin tipo III y IV fueron los que presentaron las mayores tasas de complicación, requiriendo de artroplastía total de cadera en 66 por ciento de los casos. Conclusión: Las fracturas de cabeza femoral son lesiones provocadas por mecanismos de alta energía, asociadas a luxación de la cadera y provocan complicaciones con repercusión importante para la cadera del paciente, constituyendo una lesión catastrófica cuan...

Tratamiento quirúrgico de fractura de cabeza femoral mediante luxación controlada de cadera: resultados a mediano plazo / Surgical treatment through controlled hip dislocation for femoral head fractures: mid term results

Femoral head fractures associated to hip dislocations are uncommon lesions. Most reports present only short-term results. Objectives: To show functional outcome after a mid term follow up of patients with Pipkin II femoral head fractures treated operatively. Materials and Methods: A retrospective and descriptive evaluation of a 4 consecutive case series (four men, mean age of 36.5 years) treated operatively with an 89-month average follow up (range form 72-108 month). Controlled femoral head dislocation was performed in all patients and two 2.4 mm screws were used for fixation. At final follow up, the Harris Hip Score (HHS) and complications were assessed. Results: No immediate or late complications were reported. The mean HHS was of 95 points (range from 89 to 100 points).No signs of postraumatic arthritis or femoral head osteonecrosis were seen at the last radiographic assessment. Conclusion: in this series of patients with Pipkin II femoral head fractures mid-term functional results are good and no postraumatic arthritis or femoral head osteonecrosis were observed at final follow-up.

Las fracturas de cabeza femoral, asociada a luxación de cadera, corresponden a lesiones infrecuentes. La mayoría de los estudios reportan resultados a corto plazo. Objetivo: Describir el resultado funcional de pacientes con fractura Pipkin II operados con seguimiento a mediano plazo. Material y Métodos: Evaluación retrospectiva y descriptiva de una serie consecutiva de 4 pacientes (cuatro hombres, mediana de edad 36,5 años) operados con un seguimiento de mediana de 89 meses (72-108 meses). En todos los casos se realizó luxación controlada de la cabeza femoral y se utilizaron 2 tornillos de 2,4 mm. Se evaluaron complicaciones y Harris Hip Score (HHS) al último control clínico. Resultados: No se presentaron complicaciones tempranas ni tardías. El HHS promedio fue de 95 puntos (89-100 puntos). La última evaluación radiográfica no demostró signos de artrosis postraumática ni signos de necrosis avascular de cabeza femoral. Conclusión: En este grupo de pacientes con fractura de Pipkin tipo II los resultados funcionales a mediano plazo son buenos, no registrándose en el seguimiento artrosis de cadera postraumática ni necrosis avascular de la cabeza femoral.

Femoral Head Fracture without Dislocation by Low-Energy Trauma in a Young Adult

We describe the case of a healthy young man with a femoral head fracture by low-energy trauma that occurred without evidence of hip dislocation. While plain radiographs showed no definite fracture or dislocation, computed tomography (CT) and magnetic resonance imaging (MRI) revealed a femoral head fracture with a wedge-shaped cortical depression at the superomedial aspect of the femoral head. Our patient reported feeling that the right hip had been displaced from its joint for a moment. This probably represented subluxation with spontaneous relocation. The characteristic findings and possible mechanisms of this fracture were postulated on the basis of the sequential 3 dimensional-CT and MRI. The clinical results of conservative treatment were better than those of previously reported indentation fractures.

Análisis experimental del desgaste entre UHMWPE y acero inoxidable 316l empleados en la manufactura de prótesis coxofemorales / Experimental wear analysis of UHMWPE and stainless 316l used in the manufacturing of coxofemoral prosthesis

La causa más común de falla en prótesis coxofemorales es el aflojamiento entre los componentes que conforman el sistema, de manera específica la copa acetabular y la cabeza femoral. En esta investigación se presenta un análisis tribológico del desgaste en los componentes mencionados, ya que cuando las superficies en contacto se desgastan, la funcionalidad mecánica del sistema se compromete, debido al cambio de geometría de los mismos, dando como resultado un juego mecánico entre la copa y la cabeza. Los materiales considerados en este estudio son el polietileno de ultra elevado peso molecular (UHMWPE, por sus siglas en inglés) para la copa acetabular, y acero inoxidable 316L para la cabeza femoral. Esta combinación de materiales representa hoy en día la recomendación más usual por parte de los cirujanos para pacientes de la tercera edad. La tasa anual de desgaste se determinó de manera experimental y se cuantificó la cantidad de material desprendido durante el contacto. Se establecieron las condiciones de carga de forma analítica, considerando las que actúan sobre la cabeza femoral a lo largo del área de desgaste durante la marcha humana. Posteriormente, se realizó el análisis experimental de desgaste utilizando una máquina tribológica de configuración perno-sobre-disco (pin-on-disk), diseñada de manera específica para este estudio. Las pruebas para determinar la pérdida volumétrica de los componentes se realizaron bajo tres condiciones de operación: en seco, lubricada con agua destilada y lubricada con suero bovino. El marco experimental considerado consistió en pernos de UHMWPE sobre discos de acero inoxidable 316l simulando el desgaste equivalente a diez años de uso de la prótesis. Finalmente, de los resultados obtenidos se puede establecer que el desgaste y la cantidad de partículas desprendidas disminuyen considerablemente cuando se utiliza suero bovino como lubricante para replicar las condiciones reales de operación del sistema...

The most common cause of failure in coxofemoral prostheses is the loosening between the components of the system, namely the acetabular cup and the femoral head. In this work a tribologic analysis of wear suffered in the components is presented, due to when the surfaces in contact are worn, the mechanical function of the system is compromised as the wearing implies a change in the geometry of the components, thus in their dimensions, resulting on a looseness between the cup and the head. The materials considered in this study are Ultra High Molecular Weight Polyethylene (UHMWPE) for the cup and 316L Stainless Steel for the femoral head, which represent the surgeons choice for elderly patients. The annual wearing rate between these components was experimentally determined, as well as the amount of debris produced during contact. Firstly, the loading conditions were determined analytically considering those acting on the femoral head taking into consideration the wearing area during human walk. Secondly, the experimental analysis consisted in wearing tests using a tribology pin-on-disk machine, specifically built for this study. The tests to determine the volumetric loss of the components were performed under three different operational conditions: dry, lubricated with bovine serum and lubricated with destilated water. The experimental set up consisted on UHMWPE pins and 316L Stainless steel discs simulating the equivalent wear of ten years of usage of the prostheses. Lastly, the obtained results proved that using the bovine serum as lubricant the wear and debris of the components was significantly reduced when compared with other cases, being the dry scenario where more damage was produced. It is important to point out that the bovine serum was chosen to simulate the synovial fluid in which the system is embedded.

Estudo do tratamento das fraturas da cabeça do fêmur / Study of the treatment of femoral head fractures

OBJETIVO: Estabelecer diretrizes para o tratamento das fraturas da cabeça femoral e determinar a melhor via de acesso nos casos tratados cirurgicamente. MÉTODOS: Avaliamos os resultados clínicos e radiográficos de 13 pacientes (13 fraturas) tratados cirurgicamente entre maio de 1986 e julho de 1996 no Departamento de Ortopedia e Traumatologia da Santa Casa de Misericórdia de São Paulo (SCMSP), Pavilhão "Fernandinho Simonsen". RESULTADOS: Entre as seis fraturas Pipkin 1, cinco foram submetidas à ressecção do fragmento, o que nos levou a quatro resultados excelentes e um bom, sendo este com fixação do fragmento. Três pacientes apresentaram fraturas Pipkin 2 e todas foram fixadas, observados dois excelentes resultados e um regular. Dois pacientes Pipkin 3 foram submetidos à artroplastia primária. Dos dois pacientes com lesão Pipkin 4, um foi tratado com redução e osteossíntese da fratura do acetábulo, sem abordar o fragmento da cabeça que estava bem reduzido e resultou em artrose precoce, e o outro foi submetido à artroplastia total como tratamento primário. CONCLUSÃO: Concluímos após comparação da revisão da literatura com a análise dos nossos casos, que o tratamento da fratura da cabeça femoral deve ser cirúrgico e a escolha da via de acesso vai depender do tipo de fratura.

OBJECTIVE: To establish guidelines for the treatment of femoral head fractures and to determine the best form of access in cases treated surgically. METHODS: We evaluated the clinical and radiological results of 13 patients (13 fractures) treated surgically, between May 1986 and July 1996, at the Department of Orthopedics and Traumatology at the Santa Casa de Misericórdia de São Paulo (SCMSP), Fernandinho Simonsen Pavillion. RESULTS: Among six Pipkin 1 fractures, five had resection of the fragment, resulting in four excellent and one good result. The good result had fixation of the fragment. All three Pipkin 2 fractures had fixation of the fragment, resulting in two excellent and one regular result. Two Pipkin 3 patients had primary arthroplasty. Among Two Pipkin 4 patients, one was treated with open reduction and internal fixation of the acetabulum, without addressing the head fragment that had reduced significantly, resulting in early arthrosis, and the other patient was treated with primary total hip replacement. CONCLUSION: Upon comparing the literature review and our patients' treatment results, we concluded that the femoral head fracture treatment must be surgical and that the choice surgical access depends on the type of fracture.

CT Evidence for Subchondral Trabecular Injury of the Femoral Head in Transient Osteoporosis of the Hip: A Case Report

A 28-yr-old woman presented with both hip pain that started sequentially during the peripartum period. Diagnosis of transient osteoporosis of the hip (TOH) was made based on typical findings of plain radiographs and magnetic resonance images. The subchondral trabeculae of the femoral head were evaluated on serially taken coronal multiplanar reformation computerized tomogram images. At 4 weeks after pain onset, marked decrease in the sclerotic density with irregular discontinuation was observed in the primary compression trabeculae. At 12 weeks, a focal area of irregular thickening of trabeculae was observed. At 20 weeks, sclerotic density of trabeculae recovered markedly and the focal area of irregular trabecular thickening disappeared. At 1 yr, subchondral trabeculae recovered almost completely. The evidence of subchondral trabecular injury was observed in the femoral heads of TOH.

Identification of poxvirus under transmission electron microscopy during outbreak period in wild birds, in São Paulo, Brazil / Identificación de poxvirus por microscopía electrónica de transmisión durante período de brote en aves silvestres en São Paulo, Brasil

Avianpox is a highly contagious disease infecting both commercial and wild birds, causing great damages to breeders and breeding. Caused by DNA viruses of the family Poxviridae, genus Avipoxvirus, if manifest through 3 forms, cutaneous, diphtheric and septicemic. In June 2003, during illegal commercialization of Brazilian birds, 800 wild birds (Paroaria dominicana, Sporophila caerulescens and Sporophila albogularis) were apprehended and being forwarded to the CRAS (Wild Animals Recovery Center), Tietê Ecological Park. After one month, birds presented cutaneous lesions in the beak and feet and anorexia, emaciation, locomotion difficulties, diarrhea, dehydration and death. Among the 800 birds, 500 died and 40 these (15 Paroaria dominicana, 15 Sporophila caerulescens and 10 Sporophila albogularis) were sent to the Electron Microscopy Laboratory of the Biology Institute of São Paulo, SP, to investigate viral agents. Scabs and fragments of skin lesions collected of theses birds were processed for transmission electron microscopy utilizing negative staining (rapid preparation), resin embedding and immunocitochemistry techniques. Under the transmission electron microscopy in all the analyzed samples it was visualized two types of poxvirus particles, M form, with regular spaced thread-like ridges comprising the exposed surface, measuring 280 x 230 nm; C form or stain-penetrated particle showing the dumbbell-shaped core surrounded by the outer envelope, measuring 360 x 330 nm. In the ultrathin sections obtained, three types of intracytoplasmic inclusion bodies were encountered: type A or Bollinger body, outlined by membrane, containing in its interior a great number of mature particles, measuring 200 x 300 nm, revealing the inner dumbbell-shaped core, two lateral bodies and an external envelope. In the type B electron dense inclusions bodies, viral particles budding of dense amorphous material were observed. Fibrillar inclusions constituted by ...

Avianpox es una enfermedad altamente contagiosa que infecta tanto aves comerciales como aves silvestres, causando grandes daños a lo ganadería y a la crianza. Causados por los virus de ADN de la familia Poxviridae, género Avipoxvirus, se manifiestan a través de 3 formas, cutánea, diftérica y septicémica. En junio del 2003, durante la comercialización ilegal de aves brasileñas, 800 aves silvestres (Paroaria dominicana; Sporophila caerulescens; Sporophila albogularis) fueron capturadas y remitidas al CRAS (Centro de Recuperación de Animales Silvestres), Parque Ecológico de Tietê. Después de un mes, las aves presentaron lesiones cutáneas en el pico y las patas, anorexia, adelgazamiento, dificultades de locomoción, diarrea, deshidratación y muerte. 500 de las 800 aves murieron, 40 de éstas (15 Paroaria dominicana, 15 Sporophila caerulescens y 10 Sporophila albogularis) fueron enviadas al Laboratorio de Microscopía Electrónica del Instituto de Biología de São Paulo, SP, para investigar agentes virales. Costras y fragmentos de lesiones en la piel de estas aves fueron recolectadas y se procesaron para microscopía electrónica de transmisión utilizando tinción negativa (preparación rápida), incrustación de resina y técnica inmunocitoquímica. Bajo la microscopía electrónica de transmisión en todas las muestras analizadas se encontraron dos tipos de partículas de poxvirus, Forma M, con espacios regulares como hilo que abarcan toda la superficie expuesta, midiendo 280 x 230 nm; Forma C o partícula teñida por penetración mostrando núcleo en forma de pesa rodeado por una envoltura externa, que medía 360 x 330 nm. Se encontraron en secciones ultrafinas, tres tipos de cuerpos de inclusión intracitoplásmica: el tipo A o cuerpo de Bollinger, esbozado por la membrana, que contiene en su interior un gran número de partículas maduras, que miden 200 x 300 nm, revelando núcleo interno en forma de pesa, dos cuerpos laterales y una envoltura externa. En el tipo ...

Femur mineral density of broilers with femoral degeneration fed high nutritional density diets / Densidad mineral del fémur de pollos de engorde con degeneración femoral alimentados con dietas de alta densidad nutricional

A study was carried out in the experimental facilities of FMVZ/UNESP-Botucatu, with the aim of following-up the development and the incidence of femoral degeneration (FD). A total of 305 one-day-old male broilers were housed in six pens of 5m² each. A completely randomized experimental design, with 3 treatments (T1traditional nutritional density diet; T2high nutritional density diet) of 3 replicates each was applied. Femoral head of the broilers were submitted to gross examination at 0, 7, 14, 21, 28, 35, and 42 days of aged. At 42 days of age, 60 birds (30 per treatment) were submitted to the Veterinary Hospital of FMVZ to determine bone mineral density by radiography. Birds were then sacrificed for gross examination of the legs, and FD scoring. Five legs per treatment within each FD score were submitted to computed tomography for femur head integrity and bone mineral density. Treatments did not influence FD incidence, and the first gross FD lesions appeared when birds were 28 days old. It was concluded that radiographic optical densitometry and computed tomography are efficient methods to evaluate femoral degeneration, and both techniques expressed the same profile. In addition, using radiographic optical densitometry and computed tomography, these results also allowed us to establish bone mineral density value ranges within each gross FD score. These finding may provide an excellent non-invasive tool to describe femoral degeneration.

Se realizó un estudio en las instalaciones experimentales de FMVZ/UNESP-Botucatu, con el objetivo de seguir el desarrollo y la incidencia de degeneración femoral en pollos. Se utilizaron 305 polluelos de un día, machos, distribuidos en seis corrales de 5m² cada uno. Se adoptó un delineamiento experimental totalmente al azar, con dos tratamientos de 3 repeticiones cada uno. Se alimentaron las aves del T1 con dietas con densidad nutricional convencional, mientras el T2 consistió de una dieta con alta densidad nutricional. Se realizaron análisis macroscópicos de la cabeza del fémur de aves de 0, 7, 14, 21, 28, 35 y 42 días de edad. A los 42 días de edad, se llevaron 60 aves (30 por tratamiento) al Hospital Veterinario de FMVZ, para hacer radiografías para el análisis de la densidad mineral ósea. Posteriormente, se sacrificaron los pollos para el análisis macroscópico de las piernas y se atribuyeron puntajes para DF. Se seleccionaron cinco muslos por tratamiento dentro de cada puntaje de DF, que fueron sometidas a tomografía para evaluación de la integridad y de la densidad ósea de la cabeza del fémur. Los tratamientos no tuvieron influencia en la incidencia de DF, y a partir de los 28 días de vida, las aves presentaron lesiones macroscópicas. Se estableció que la densitometría ósea y la tomografía son métodos eficaces para evaluar la DF, además que ambos expresan el mismo perfil. Por otra parte, se encontraron intervalos de valores para densidad mineral ósea obtenida por densitometría óptica radiográfica y por tomografía en función de los puntajes macroscópicos de DF. Esos hallazgos son una importante herramienta no invasiva para la caracterización de degeneración femoral.

Influência do ligamento da cabeça do fêmur na mecânica do quadril / Influence of the femoral head ligament on hip mechanical function

Investigamos a influência do ligamento da cabeça do fêmur no arco de movimento de flexão-extensão e de adução-abdução do quadril. Para isso foram realizadas medidas em 7 quadris de cadáveres humanos, inicialmente com os ligamentos íntegros; posteriormente com a artroscopia e a seguir com os ligamentos seccionados também através de técnica artroscópica. Foi utilizado para isso um dispositivo elaborado para se medir o arco de movimento submetido a um torque de 2,5 N.m . Foi observado aumento com significância estatística no arco de abdução-adução às custas de adução. Concluímos que o ligamento da cabeça do fêmur influi limitando a adução do quadril.

The authors investigated the femoral head ligament at hip flexion-extension and adduction-abduction ranges of motion. Seven human cadavers' hips were measured, initially with intact ligaments, and, subsequently, through arthroscopy, and then with sectioned ligaments also by means of arthroscopy. A specifically prepared device was used for measuring the range of motion which was submitted to a 2.5 N.m torque. An increased abduction-adduction range of motion was observed, which was statistically significant. We concluded that the femoral head ligament restricts hip adduction.

Método alternativo para fabricação de cabeça femoral cerâmica para próteses de quadril / Alternative manufacture method for ceramic femoral ball head applied in hip prostheses

O aumento da expectativa de vida da população e o crescente número de acidentes automobilísticos com lesões graves têm aumentado mundialmente o número de cirurgias de artroplastia total de quadril. A maior parte das cirurgias ortopédicas realizadas utiliza próteses com articulação cabeça/acetábulo tipo metal/polímero que tem demonstrado altos índices de falhas. A falha de um implante de quadril geralmente está associada ao processo de desgaste na articulação que libera partículas dos materiais envolvidos, causando reações biológicas de infecção e a perda de fixação do implante. Alumina tem sido utilizada com sucesso como cabeça femoral na indústria biomédica mundial. No entanto para a conformação de esferas cerâmicas, tem-se recorrido quase que sem exceção à prensagem isostática a quente, que exige alto custo em equipamentos e operação. Este estudo apresenta um processo alternativo de conformação de cabeças femorais cerâmicas. Este novo processo de fabricação de cabeças femorais cerâmicas para prótteses de quadril apresenta redução de custo considerável em comparação com a prensagem isostática a quente. O objetivo é apresentar um processo que permita chegar próximo ao formato final da peça. Isto traz como benefício redução de volume de material removido por desgaste e polimento promovendo aumento da produtividade. Aqui alguns critérios de seleção da alumina, complexidade do componente e viabilidade de execução foram abordados Neste trabalho foi possível a fabricação de componentes de quadril via processo de prensagem flutuante de duplo efeito. Os corpos cerâmicos obtidos apresentaram propriedades que satisfazem às exigências da norma ABNT NBR-ISO 6474 em termos de densificação, tamanho médio de grão e resistência mecânica.

Substituiçäo do ligamento da cabeça do fêmur com auto-enxerto de fáscia lata na luxaçäo coxofemoral em cäes / Substitution of femoral head ligament in dogs with fascia lata autograft for treatment of hip luxation

Uma técnica cirúrgica para o tratamento da luxaçäo coxofemoral que substituiu o ligamento da cabeça do fêmur por fáscia lata associada ao enxerto ósseo foi realizada em 20 cäes. Estes foram separados em cinco grupos e submetidos à eutanásia para realizaçäo dos exames macro e microscópicos aos 15, 30, 60, 90 e 120 dias do pós-operatório. Na macroscopia, näo foi observada luxaçäo da articulaçäo. Em 65 por cento dos animais, o enxerto de fáscia lata estava presente. Microscopicamente, a fáscia lata utilizada como substituto do ligamento da cabeça do fêmur näo desenvolveu reaçöes inflamatórias, permanecendo preservada e integrada ao tecido ósseo. O uso da fáscia lata como substituto do ligamento da cabeça do fêmur mostrou-se viável, podendo ser utilizada para reforçar a estabilidade articular.

Tratamiento de las fracturas subcapitales de fémur con hemiartroplastía Lazcano / Subcapital femur fracture treatment with Lazcano's hemiarthroplasty

Las prótesis parciales de Thompson y de Austin Moore fueron diseñadas en la era precemento. Las hemiartroplastias bipolares producen osteólisis por el desprendimiento de partículas de plástico y se convierten en monopolares; todas producen erosión y protrusión acetabular. Las copas de Smith Petersen generalmente no producen protrusión acetabular, en ellas se rima el cartílago acetabular. El autor principal ha diseñado una prótesis parcial monopolar cementada de cromo cobalto, con un tallo parecido al de Charnley tercera generación, con collar cervical y ceja posterior con ángulo cuello vástago diafisario de 140º con el objeto de valguizar la prótesis y cambiar la dirección de la erosión acetabular. El propósito de este trabajo fue estudiar la erosión y protrusión acetabular con el nuevo modelo para hemiartroplastia. De noviembre de 1991 a noviembre de 1997, se operaron 52 caderas en 51 pacientes, siete murieron antes de 24 meses y fueron excluidos del estudio, quedando 45 caderas con un seguimiento completo, incluyendo visitas a domicilio, valoradas en noviembre de 1999. La edad promedio fue de 74 años, 40 caderas correspondieron a mujeres y cinco a hombres. Hubo una con fractura bilateral. Los pacientes fueron operados por vía posterior de Gibson con prótesis parcial, rimando el acetábulo a hueso subcondral. Una fractura basicervical; nueve Garden II; cinco Garden III y 30 Garden IV. Los resultados clínicos de acuerdo a la tabla de Merle D'Aubigne Postel, en cuanto al dolor, fueron de 45 a 249; la movilidad de 45 a 224 y la marcha de 45 a 215. De acuerdo a la clasificación de Gruen, las zonas afectadas fueron la I, IV y VII. El espesor acetabular promedio fue de 13.12 mm con el método de Rosen; nueve caderas presentaron erosión acetabular (promedio de 3.45 mm) sin protrusión acetabular; en un caso de erosión de 5 mm del acetábulo se proyectó hacia el iliaco. Noventa y tres por ciento de los pacientes estaban satisfechos con la operación.

Lead poisoning after gunshot wound

CONTEXT: Despite the absence of symptoms in the majority of patients carrying lead bullet fragments in their bodies, there needs to be an awareness of the possible signs and symptoms of lead intoxication when bullets are lodged in large joints like knees, hips and shoulders. Such patients merit closer follow-up, and even surgical procedure for removing the fragments. OBJECTIVE: To describe a patient who developed clinical lead intoxication several years after a gunshot wound. DESIGN: Case report. CASE REPORT: A single white 23-year-old male, regular job as a bricklayer, with a history of chronic alcohol abuse, showed up at the emergency department complaining of abdominal pain with colic, weakness, vomiting and diarrhea with black feces. All the symptoms had a duration of two to three weeks, and had been recurrent for the last two years, with calming during interval periods of two to three weeks. Abdominal radiograms showed a bullet lodged in the left hip, with a neat bursogram of the whole synovial capsule. A course of chelating treatment using calcium versenate (EDTACaNa2) intravenously was started. After the chelation therapy the patient had recurrence of his symptoms and a radical solution for the chronic mobilization of lead was considered. A hip arthroplasty procedure was performed, leading to complete substitution of the left hip.

Osteotomia derrotatória varizante do fêmur no tratamento da moléstia de Legg-Calvé-Perthes / Varus derotation osteotomy of the femur in the treatment of Legg-Calvé-Perthes disease

Vinte quadris, em 19 pacientes portadores de moléstia de Legg-Calvé-Perthes, foram tratados cirurgicamente através da osteotomia derratatória varizante do fêmur. Todos os casos pertenciam aos grupos III e IV de Catterall, com mais de 50 por cento de envolvimento da epífise femoral. A indicaçao cirúrgica levou em conta a presença dos sinais de cabeça em risco, sobretudo da subluxaçao da cabeça femoral. Para o presente estudo, os pacientes foram examinados clínica e radiologicamente. Os resultados foram classificados como bons em 12 quadris (60 por cento0, regulars em 6 (30 por cento) e pobres em 2 (10 por cento). A osteotomia femoral como forma de conter a cabeça femoral subluxada durante a fase ativa da moléstia de Legg-Calvé-Perthes temse mostrado método eficiente, contando que as indicaçoes sejam precisas e alguns pré-requisitos fundamentais sejam observados.

Saturnismo causado por projétil de arma de fogo no quadril: relato de três casos / Lead poisoning from retained bullets in the hip: report of 3 cases

Säo descritos três casos de saturnismo causado por projétil de arma de fogo alojado na cabeça femoral. Säo feitas consideraçöes sobre a intoxicaçäo pelo chumbo de forma geral e abordada especificamente a intoxicaçäo que ocorre por projéteis alojados no organismo.