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1.
Rev. bras. ortop ; 55(6): 787-795, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156189

ABSTRACT

Abstract Evaluate the results of a series of 28 cases of high obstetric paralysis treated with the Sever-L'Episcopo technique modified by Hoffer, between 2003 and 2016. Children (mean age, four years and seven months) with adduction contracture and internal rotation of the shoulder without secondary bone deformities (Mallet class II) underwent lengthening of the pectoralis major muscle and tenotomy of the subscapularis muscle associated with transfer of the latissimus dorsi and teres major muscle to the infraspinatus muscle, moving to the function of external rotators and elevators. The mean follow-up was three years and 10 months. At the end of the study, 24 patients achieved excellent functional assessment scores, mainly of the abduction and external rotation, passing from Mallet class II to class IV. Four patients still demonstrated some degree of global movement limitation, passing from class II to class III. Regardless of the final functional gain, all patients were able to perform tasks that were previously difficult. The data from this study suggest that Hoffer's surgery is an effective method in the treatment of the sequelae of high obstetric paralysis without secondary bone deformities.


Resumo Avaliar os resultados de uma série de 28 casos de paralisia obstétrica alta tratadas com a técnica Sever-L'Episcopo modificada por Hoffer, entre 2003 e 2016. As crianças (idade média, quatro anos e sete meses) com contratura em adução e rotação interna do ombro sem deformidades ósseas secundárias (Mallet classe II) foram submetidas ao alongamento do músculo peitoral e tenotomia do músculo subescapular associada à transferência do latissimus dorsi e músculo redondo maior para o músculo infraespinhal, movendo-se para a função de rotadores externos e elevadores. O seguimento médio foi de 3 anos e 10 meses. Ao final do estudo, 24 pacientes obtiveram excelentes escores de avaliação funcional, principalmente de abdução e rotação externa, passando de Mallet classe II para classe IV. Quatro pacientes ainda demonstraram algum grau de limitação de movimento global, passando da classe II para a classe III. Independentemente do ganho funcional final, todos os pacientes foram capazes de realizar tarefas que antes eram difíceis. Os dados deste estudo sugerem que a cirurgia de Hoffer é um método eficaz no tratamento das sequelas de paralisia obstétrica alta sem deformidades ósseas secundárias.


Subject(s)
Humans , Male , Female , Child, Preschool , Paralysis, Obstetric , Pectoralis Muscles , Shoulder , Congenital Abnormalities , Rotator Cuff , Contracture , Tenotomy , Superficial Back Muscles , Movement , Muscles
2.
Rev. bras. ortop ; 55(5): 570-578, Sept.-Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1144217

ABSTRACT

Abstract Objective To demonstrate the clinical outcomes and complication rates of the surgical release with a single posterior approach in the treatment of post-traumatic elbow stiffness. Methods A prospective study with patients submitted to surgery between May 2013 and June 2018 in a single center. The access to the elbow was made through the posterior approach. The patients were followed up by an occupational therapy team, and were submitted to a standardized rehabilitation protocol, with static progressive orthoses and dynamic orthoses. The primary outcome was the range of flexion-extension of the elbow after 6 months. Results A total of 26 patients completed the minimum follow-up of 6-months. The mean range of flexion-extension of the elbow at the end of 6 months was of 98.3 ± 22.0°, with an amplitude gain of 40.0 ± 14.0° in relation to the pre-operative period (p< 0.001). The average flexion-extension gain at the end of 6 months was of 51.7% ± 17.1% (p< 0.001). The mean pronosupination at the end of 6 months was of 129.0 ± 42.7° (p< 0.001). Half of the cases had moderate and severe stiffness in the pre-operative period, compared with 7.7% at 6 months post-operatively (p< 0.001). The mean score for the Mayo Elbow Performance Score (MEPS) and Disabilities of the Arm, Shoulder and Hand (DASH) instruments was 74.4 ± 16.8 points and 31.7 ± 21.9 points respectively (p< 0.001 for both). The visual analogue scale (VAS) score presented no statistically significant difference compared to the pre-operative period (p= 0.096). Complications were observed in 6 (23%) patients, and no new surgical procedures were necessary. Conclusions The surgical release of the elbow associated with a rehabilitation protocol is a safe technique, with satisfactory results and low rate of complications.


Resumo Objetivo Demonstrar os resultados clínicos e a taxa de complicações da liberação cirúrgica por via única posterior no tratamento da rigidez pós-traumática de cotovelo. Métodos Estudo prospectivo, com pacientes submetidos a cirurgia entre maio de 2013 e junho de 2018 em um único centro. Foi realizado acesso ao cotovelo por via posterior. O seguimento dos pacientes foi feito por uma equipe de terapia ocupacional, e eles foram submetidos a um protocolo de reabilitação padronizado, com órteses estáticas progressivas e dinâmicas. O desfecho primário foi a amplitude de flexoextensão do cotovelo após 6 meses. Resultados Um total de 26 pacientes completaram o seguimento mínimo de 6 meses. A média de flexoextensão do cotovelo, ao final de 6 meses, foi de 98,3° ± 22,0°, com um ganho de amplitude de 40,0° ± 14,0° em relação ao pré-operatório (p< 0,001). A média de ganho relativo de flexoextensão, ao final de 6 meses, foi de 51,7% ± 17,1% (p< 0,001). A média de pronossupinação, ao final de 6 meses, foi de 129,0° ± 42,7° (p< 0,001). Metade dos casos apresentava rigidez moderada e grave no pré-operatório, contra 7,7% aos 6 meses de pós-operatório (p< 0,001). A pontuação nos instrumentos Mayo Elbow Performance Score (MEPS) e Disabilities of the Arm, Shoulder and Hand (DASH) apresentou melhora estatisticamente significativa em relação ao pré-operatório, atingindo 74,4 ± 16,8 pontos e 31,7 ± 21,9 pontos, respectivamente. A escala visual analógica (EVA) não apresentou diferença estatisticamente significativa em relação ao pré-operatório (p= 0,096). Complicações foram observadas em 6 (23%) pacientes, não sendo necessária nova abordagem cirúrgica em nenhum paciente. Conclusões A liberação cirúrgica do cotovelo associada a protocolo de reabilitação é técnica segura, com resultados satisfatórios e baixa taxa de complicações.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Rehabilitation , Splints , Prospective Studies , Contracture , Amplitude , Elbow Joint , Joint Capsule Release
3.
Rev. Eugenio Espejo ; 14(2): 61-70, jul. 2020.
Article in Spanish | LILACS | ID: biblio-1117282

ABSTRACT

Un futbolista resulta vulnerable a sufrir lesiones a lo largo de su carrera profesional, por lo que resulta importante la prevención y tratamiento efectivo al respecto. Se realizó un estudio con enfoque cuantitativo y de tipo observacional descriptivo. Los investigadores trabajaron con la totalidad de la población objeto de estudio, la que estuvo constituida por 21 jugadores de la categoría sub 14 de la FDCH, durante el período de competición junio­agosto 2018. Un 38,09% presentaron lesiones por contracturas musculares. La medición de la flexibilidad permitió apreciar que la mayoría de la población estuvo en las categorías de normal y deficiente (66,67%). En el 57,14% de los participantes se usó el KT para buscar relajación del tono muscular. Se estableció la existencia de un aumento de la flexibilidad en el 95,24% de los futbolistas. La evaluación pre y post competición del test sit and reach permitió determinar la importancia y viabilidad de la utilización del vendaje neuromuscular como una medida de intervención y prevención de lesiones, especialmente en la optimización de la flexibilidad isquiotibial y disminución de los factores de riesgo.


A footballer is predisposed to suffer injures throughout his professional career, it is important to perform a preventive approach in one of the most frequent affections that affect the athlete such as muscular distention. An analytical descriptive investigation was carried out. For demonstrating the importance of the use of the prevent neuromuscular bandage and its effects on the hamstring musculature. The population object of study was conformed, by 21 players of the category sub14 in Federación Deportiva de Chimborazo who during the year 2017 had incidence of 57% of hamstring atrain. At the end of the investigation 76% of footballer maintained good flexibility, decreasing the risk factors and reducing the incidence of the injury by 33 %.


Subject(s)
Humans , Male , Adolescent , Therapeutics , Bandages , Contracture , Athletic Tape , Athletes , Muscle Tonus
4.
Article in Chinese | WPRIM | ID: wpr-826548

ABSTRACT

OBJECTIVE@#To detect pathological variant in a Chinese pedigree affected with congenital contractural arachnodactyly (CCA).@*METHODS@#Next generation sequencing (NGS) was used to scan the whole exome of the proband. Potential variant of the FBN2 gene was also detected in all members of the pedigree and 100 healthy controls by Sanger sequencing. With the determination of the genotype, prenatal diagnosis was carried out by amniotic fluid sampling.@*RESULTS@#A c.3528C>A (p.Asn1176Lys) variant was identified in the FBN2 gene of the proband, other patients from this pedigree, as well as the fetus. The same variant was not found among healthy members from this pedigree and the 100 healthy controls.@*CONCLUSION@#The c.3528C>A (p.Asn1176Lys) variant of the FBN2 gene probably underlies the pathogenesis of CCA in our case. The new variant has enriched pathological spectrum of the FBN2 gene.


Subject(s)
Arachnodactyly , Genetics , Contracture , Genetics , Exome , Female , Fibrillin-2 , Genetics , Humans , Mutation , Pedigree , Pregnancy , Prenatal Diagnosis
5.
Article in Chinese | WPRIM | ID: wpr-828936

ABSTRACT

OBJECTIVE@#To investigate the protective effect of melatonin against myocardial ischemia reperfusion (IR) injury in isolated rat hearts and explore the underlying mechanisms.@*METHODS@#The isolated hearts from 40 male SD rats were randomly divided into 4 groups (=10): the control group, where the hearts were perfused with KH solution for 175 min; IR group, where the hearts were subjected to global ischemia for 45 min followed by reperfusion for 120 min; IR+melatonin (Mel+IR) group, where melatonin (5 μmol/L) was administered to the hearts 1 min before ischemia and during the first 5 min of reperfusion, followed by 115 min of reperfusion; and IR+2, 3-butanedione monoxime (IR+BDM) group, where the hearts were treated with BDM (20 mmol/L) in the same manner as melatonin treatment. Myocardial injury in the isolated hearts was assessed based on myocardial injury area, caspase-3 activity, and expressions of cytochrome C and cleaved caspase-3 proteins. Cardiac contracture was assessed using HE staining and by detecting lactate dehydrogenase (LDH) activity and the content of cardiac troponin I (cTnI) in the coronary outflow, measurement of left ventricular end-diastolic pressure (LVEDP) and electron microscopy. The content of ATP in the cardiac tissue was also determined.@*RESULTS@#Compared with those in the control group, the isolated hearts in IR group showed significantly larger myocardial injury area and higher caspase-3 activity and the protein expressions of cytochrome C and cleaved caspase-3 with significantly increased LDH activity and cTnI content in the coronary outflow and elevated LVEDP at the end of reperfusion; HE staining showed obvious fractures of the myocardial fibers and the content of ATP was significantly decreased in the cardiac tissue; electron microscopy revealed the development of contraction bands. In the isolated hearts with IR, treatment with Mel or BDM significantly reduced the myocardial injury area, caspase-3 activity, and protein expressions of cytochrome C and cleaved caspase-3, obviously inhibited LDH activity, lowered the content of cTnI and LVEDP, reduced myocardial fiber fracture, and increased ATP content in the cardiac tissue. Both Mel and BDM inhibited the formation of contraction bands in the isolated hearts with IR injury.@*CONCLUSIONS@#Mel can alleviate myocardial IR injury in isolated rat hearts by inhibiting cardiac contracture, the mechanism of which may involve the upregulation of ATP in the cardiac myocytes to lessen the tear of membrane and reduce cell content leakage.


Subject(s)
Animals , Contracture , Male , Melatonin , Myocardial Ischemia , Myocardial Reperfusion Injury , Myocardium , Myocytes, Cardiac , Rats , Rats, Sprague-Dawley
6.
Article in Chinese | WPRIM | ID: wpr-828205

ABSTRACT

Joint contracture is one of the common musculoskeletal disorders. It has seriously disturbed patients' activities of daily living in various aspects. The pathogenesis of it is eager to explore to distinct degree. Nowadays the thickeness and fibrosis of joint capsular is redarded as the major reason to joint contracture. It is reported that excessive fibroblasts and myofibroblasts activity, collagen hyperplasia, and extracellular matrix (ECM) deposition in these fibrotic condtions lead to the contracture. In addition, upregulators of myofibroblast and collagen synthesis, transforming growth factor-beta 1 (TGF-β1), and connective tissue growth factor (CTGF) were shown to be increased. Altered levels of cytokines were also thought to play a role in this process as elevated levelsof tumor necrosis factor-α(TNF-α), matrix metalloproteinases(MMPs) and abnormal distribution tissue inhibitors of MMPs(TIMPs) were demonstrated in contracted capsules. At present, the methods for clinical treatment of joint contracture mainly include two major categories:stretching therapy, physical factor therapy, exercise therapy, botulinum toxin injection and other non-surgical treatments, arthroscopic lysis, open lysis, and other surgical treatments. Surgical treatment is performed when non-surgical treatment is difficult to achieve further improvement. It has a good effect on mild to moderate joint contracture, but it is difficult to completely restore joint activity for serious joint contracture. Although clinical treatment methods are diverse, the clinical effects are staggered and the effectiveness of their treatment is controversial. Joint contracture is an important challenge faced by orthopedics and rehabilitation physicians, therapists and patients. The review summarized the pathogenesisand treatment of joint contracture and provided a theoretical basis for clinical diagnosis and treatment.


Subject(s)
Activities of Daily Living , Contracture , Fibroblasts , Fibrosis , Humans , Joint Capsule , Transforming Growth Factor beta1
9.
Article in Chinese | WPRIM | ID: wpr-781774

ABSTRACT

OBJECTIVE@#To compare the therapeutic effect of plum-blossom needle tapping at three meridians of wrist combined with rehabilitation training and simple rehabilitation training on wrist joint contracture after stroke.@*METHODS@#A total of 72 patients with wrist joint contracture after stroke were randomized into an observation group and a control group, 36 cases in each one. In the control group, simple rehabilitation training was applied, 5 times a week, 3 weeks as one course and totally 3 courses were required. On the basis of the treatment in the control group, plum-blossom needle tapping at three meridians of wrist was adopted in the observation group. The tapping regions were wrist traveling parts of three meridians of hand, ranging from up 3 to below 1 of wrist crease, 3 times a week, 3 weeks as one course and totally 3 courses were required. The active range of motion (AROM) of active wrist extension, Fugl-Meyer score (FMA) and Barthel index (BI) score were observed before and after treatment in the two groups.@*RESULTS@#The AROM, FMA scores and BI scores after treatment in the two groups were superior to before treatment (<0.05), and the improvements of 3 indexes in the observation group were superior to the control group (<0.05).@*CONCLUSION@#The therapeutic effect of plum-blossom needle tapping at three meridians of wrist combined with rehabilitation training is superior to simple rehabilitation training on wrist joint contracture after stroke.


Subject(s)
Acupuncture Therapy , Contracture , Therapeutics , Humans , Meridians , Stroke , Stroke Rehabilitation , Treatment Outcome , Wrist , Wrist Joint
10.
Fisioter. Bras ; 20(2): 185-195, Maio 1, 2019.
Article in Portuguese | LILACS | ID: biblio-1281144

ABSTRACT

Introdução: A contratura muscular ocorre quando o músculo se contrai de maneira incorreta e não volta ao seu estado normal de relaxamento, em resposta a uma sobrecarga de esforço. Objetivos: Comparou-se a utilização de duas técnicas e os benefícios proporcionados ao tratamento dos pacientes acometidos com contratura do músculo trapézio superior. Métodos: Tratou-se de um estudo transversal, intervencionista, comparativo e quantitativo no período de agosto de 2015 a junho de 2016, com 49 acadêmicos, que foram divididos em dois grupos (G1/G2). Os dados foram obtidos através da ficha de avaliação cinético-funcional desenvolvida para o estudo, que foi aplicada antes e ao término do tratamento fisioterapêutico, Escala dos Sintomas de Dyrek e Escala Visual Analógica. Resultados: Dos 49 acadêmicos, 80% eram do sexo feminino, sendo 95% solteiras, todos naturais de Fortaleza, todos cursando o ensino superior, com média de idade de 23,33 anos. No G1 (Compressão isquêmica) antes da aplicação a maior predominância foi a de nível de dor 7 e logo depois da aplicação o nível de maior predominância foi de dor 2, conforme Escala Visual Analógica. No G2 (Laserterapia) o nível de dor antes da aplicação foi de 7 e logo depois da aplicação, foi de dor 1 conforme Escala Visual Analógica. Conclusão: As técnicas de Laserterapia e a Compressão Isquêmica melhoraram o aporte sanguíneo da área tratada, porém na laserterapia houve a diminuição do limiar de dor e restabelecimento da normalidade funcional local. (AU)


Introduction: Muscle contracture occurs when the muscle contracts incorrectly and does not return to its normal state of relaxation in response to effort overload. Objectives: We compared the use of two techniques and the benefits provided to the treatment of patients with upper trapezius contracture. Methods: This was a cross-sectional, interventional, comparative and quantitative study between August 2015 and June 2016, with 49 academics divided into two groups (G1/G2). The data were obtained through the functional kinetic evaluation sheet developed for the study, which was applied before and at the end of the physiotherapeutic treatment, Dyrek Symptom Scale and Visual Analog Scale. Results: Of the 49 students, 80% were female, 95% single, all of them from Fortaleza/CE, all of them attending higher education, with a mean age of 23.33 years. In G1 (Ischemic Compression), before the application, the greatest predominance was pain level 7 and soon after the application the greater predominance was level pain 2, according to Visual Analog Scale. In G2 (Laser Therapy) the level of pain before the application was 7 and soon after the application was level pain 1 according to Visual Analog Scale. Conclusion: Laser therapy and ischemic compression improved the blood supply of the treated area, and laser therapy decreased th pain threshold and restored the local functional normality. (AU)


Subject(s)
Humans , Therapeutic Uses , Superficial Back Muscles , Lasers , Pain , Physical Therapy Modalities , Contracture , Laser Therapy , Trigger Points
11.
Article in English | WPRIM | ID: wpr-763581

ABSTRACT

BACKGROUND: Dupuytren disease is characterized by the development of palmar fibrous tissue that can lead to fixed flexion contracture (FFC) and contribute to functional loss of the involved digits. Our goal was to investigate rates of contracture resolution and recurrence in patients who underwent enzymatic fasciotomy for Dupuytren contracture consisting of collagenase clostridium histolyticum (CCH) injection followed by passive manipulation combined with splinting and home-based therapy. METHODS: We prospectively enrolled 34 patients (44 metacarpophalangeal [MCP] and 33 proximal interphalangeal [PIP] joints) treated by one orthopaedic hand surgeon between November 2010 and November 2014. On day 1, CCH was injected into a palpable fibrous cord of the involved fingers. The next day, the finger was passively extended to its maximal corrective position. FFC was measured for each joint before injection and immediately after manipulation. Patients were instructed to wear an extension splint at night and perform stretching exercises at home and were re-evaluated at 6 weeks, 4 months, 1 year, and 2 years. Resolution was defined as improvement of contracture to ≤ 5° of neutral. Recurrence was defined as an increase in FCC of ≥ 20° after treatment. RESULTS: Immediate contracture resolution occurred in 42 of 44 MCP joints (p < 0.001), improving from 50° to 1.5°, and in 14 of 33 PIP joints (p = 0.182), improving from 44° to 16°. Four joints had recurrence within 6 weeks. Of the 48 joints with minimum 4-month follow-up (mean, 26 months), 12 had recurrence at 2-year follow-up (MCP, 6; PIP, 6). At 2-year follow-up, MCP and PIP contractures measured 17° and 35.5°, respectively. Older age and multiple digit involvement were associated with higher recurrence rates. CONCLUSIONS: CCH offers a safe, nonoperative option to correct FCC in Dupuytren disease with greater success for MCP joints compared to PIP joints. There is a tendency of reoccurrence within 2 years of treatment. Further investigation is needed to determine optimal timing of repeat CCH injection to improve upon or extend the period of contracture resolution.


Subject(s)
Collagenases , Contracture , Dupuytren Contracture , Exercise , Fingers , Follow-Up Studies , Hand , Humans , Joints , Metacarpophalangeal Joint , Microbial Collagenase , Prospective Studies , Recurrence , Splints
12.
Yonsei Medical Journal ; : 395-398, 2019.
Article in English | WPRIM | ID: wpr-742542

ABSTRACT

Genitopatellar syndrome (GPS) is a rare disorder characterized by patellar hypoplasia, flexion contractures of the lower limbs, psychomotor retardation and genital and renal anomalies. We report the case of a female infant diagnosed with GPS to a KAT6B gene mutation, which was identified using whole exome sequencing.


Subject(s)
Contracture , Exome , Female , Humans , Infant , Korea , Lower Extremity
13.
Article in English | WPRIM | ID: wpr-765174

ABSTRACT

Spinal muscular atrophy with respiratory distress type 1 (SMARD1) is a rare autosomal recessive disorder caused by a defect in the immunoglobulin mu binding protein 2 (IGHMBP2) gene, leading to motor neuron degeneration. We identified an infant with SMARD1 by targeted exome sequencing from a consanguineous Syrian family having a history of recurrent infant deaths. The patient initially presented intrauterine growth retardation, poor sucking, failure to thrive, and respiratory failure at the age of two months, and an inborn error of metabolism was suspected at first. Over a period of one month, the infant showed rapid progression of distal muscular weakness with hand and foot contractures, which were suggestive of neuromuscular disease. Using targeted exome sequencing, the mutation in IGHMBP2 was confirmed, although the first report was normal. Targeted exome sequencing enabled identification of the genetic cause of recurrent mysterious deaths in the consanguineous family. Additionally, it is suggested that a detailed phenotypic description and communication between bioinformaticians and clinicians is important to reduce false negative results in exome sequencing.


Subject(s)
Carrier Proteins , Contracture , Exome , Failure to Thrive , Fetal Growth Retardation , Foot , Hand , Humans , Immunoglobulins , Infant Death , Infant , Metabolism , Motor Neurons , Muscle Weakness , Muscular Atrophy, Spinal , Neuromuscular Diseases , Respiratory Insufficiency
14.
Article in English | WPRIM | ID: wpr-739378

ABSTRACT

Robotic surgery facilitates surgical procedures by employing flexible arms with multiple degrees of freedom and providing high-quality 3-dimensional imaging. Robot-assisted nipplesparing mastectomy with immediate reconstruction is currently performed to avoid breast scars. Four patients with invasive ductal carcinoma underwent robot-assisted nipple-sparing mastectomy and immediate robot-assisted expander insertion. Through a 6-cm incision along the anterior axillary line, sentinel lymph node biopsy and nipple-sparing mastectomy were performed by oncologic surgeons. The pectoralis major muscle was elevated, an acellular dermal matrix (ADM) sling was created with robotic assistance, and an expander was inserted into the subpectoral, sub-ADM pocket. No patients had major complications such as hematoma, seroma, infection, capsular contracture, or nipple-areolar necrosis. The mean operation time for expander insertion was 1 hour and 20 minutes, and it became shorter with more experience. The first patient completed 2-stage prosthetic reconstruction and was highly satisfied with the unnoticeable scar and symmetric reconstruction. We describe several cases of immediate robot-assisted prosthetic breast reconstruction. This procedure is a feasible surgical option for patients who want to conceal surgical scars.


Subject(s)
Acellular Dermis , Arm , Breast Implants , Breast , Carcinoma, Ductal , Cicatrix , Contracture , Female , Freedom , Hematoma , Humans , Mammaplasty , Mastectomy , Necrosis , Robotic Surgical Procedures , Sentinel Lymph Node Biopsy , Seroma , Surgeons , Tissue Expansion Devices
15.
Article in English | WPRIM | ID: wpr-762806

ABSTRACT

BACKGROUND: Implant-related deformities in aesthetic rhinoplasty are a major problem for rhinoplasty surgeons. Capsular contracture is believed to be the pathological cause of delayed contour deformities, comparable to breast implant-related contracture. This study investigated the prevalence of bacterial biofilms and other epidemiological factors related to capsular contracture in cases of silicone augmentation rhinoplasty. METHODS: Thirty-three patients who underwent corrective rhinoplasty due to a delayed contour deformity or aesthetic revision after implant rhinoplasty were studied from December 2014 to December 2016. All recruited patients received surgical correction by the authors. The patients were categorized by clinical severity into four grades. Demographic data and related confounding factors were recorded. Samples of capsular tissue and silicone removed from each patient were analyzed for the presence of a biofilm by ultrasonication with bacterial culture and scanning electron microscopy. RESULTS: Thirty-three paired samples of capsular tissue and silicone implants from the study group were analyzed. Biofilms were detected in one of 10 subjects (10%) with grade 1 contracture, two of four (50%) with grade 2 contracture, 10 of 14 (71.40%) with grade 3 contracture, and four of five (80%) with grade 4 contracture (P<0.05). The organisms found were Staphylococcus epidermidis (47.10%), coagulase-negative staphylococci (35.30%), and Staphylococcus aureus (17.60%). CONCLUSIONS: As with breast implant-related capsular contracture, silicone nasal augmentation deformities likely result from bacterial biofilms. We demonstrated the prevalence of biofilms in patients with various degrees of contracture. Implant type and operative technique seemed to have only vague correlations with biofilm presence.


Subject(s)
Asymptomatic Infections , Biofilms , Breast , Congenital Abnormalities , Contracture , Humans , Microscopy, Electron, Scanning , Prevalence , Rhinoplasty , Silicon , Silicones , Staphylococcus aureus , Staphylococcus epidermidis , Surgeons
16.
Article in English | WPRIM | ID: wpr-762637

ABSTRACT

Joint contracture in chronic graft-versus-host disease (cGVHD) is refractory to treatment, and tends to deteriorate gradually over time. There is scant clinical research focusing on timing and intensity of rehabilitation on joint contractures in children with sclerodermoid cGVHD after hematopoietic stem cell transplantation. We retrospectively reviewed rehabilitative therapeutic effects in 6 children with sclerodermoid cGVHD, whose clinical records documented their condition, before and after rehabilitation therapies. Three children who started treatment within a mean of 2 months after the onset of joint symptoms, and who underwent home-based exercise twice daily for 30 minutes showed more prominent improvement in range of motion compared with the other 3 children, who started rehabilitation therapy later than 6 months after onset of joint symptoms, without regular home-based exercise.


Subject(s)
Child , Contracture , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Humans , Joints , Range of Motion, Articular , Rehabilitation , Retrospective Studies , Therapeutic Uses
17.
Article in English | WPRIM | ID: wpr-760093

ABSTRACT

BACKGROUND AND OBJECTIVES: Generally, the benign mixed tumors of the submandibular gland are successfully removed via transcervical approach. Recently, however, an alternative to the standard transcervical approach, such as an intraoral approach, has been reported. The surgical results of intraoral excisions for submandibular mixed tumors are discussed here. SUBJECTS AND METHOD: A retrospective review was carried out for 24 patients with submandibular mixed tumors who were past 3 years of follow-up. Surgical morbidities and benefits were studied using these data. RESULTS: All patients successfully received an excision of the submandibular gland with tumor via an intraoral approach. Early postoperative complications of temporary lingual sensory paresis were developed in 75% of patients, followed by 54% of patients with temporary limitation of tongue movement. In contrast, there were no permanent paresis. Late complications were developed in two cases of mild deviation of tongue due to scar contracture on the floor of mouth, whereas two cases of tumor recurrence and one case of post-gustatory sweating syndrome were observed after surgery. CONCLUSION: This approach might be safe, if used with proper expertise, for the treatment of submandibular mixed tumors. The main advantages of this approach are that no external scars nor permanent injury are incurred to the related nerves. However, disadvantages are temporary lingual paresis and temporary limitation of tongue movement. Unfortunately, there were two cases showing recurrence after surgery and thus required more follow-up.


Subject(s)
Cicatrix , Contracture , Follow-Up Studies , Humans , Methods , Mouth Floor , Paresis , Postoperative Complications , Recurrence , Retrospective Studies , Submandibular Gland , Sweat , Sweating , Tongue
18.
Article in English | WPRIM | ID: wpr-771633

ABSTRACT

The clinical treatment of joint contracture due to immobilization remains difficult. The pathological changes of muscle tissue caused by immobilization-induced joint contracture include disuse skeletal muscle atrophy and skeletal muscle tissue fibrosis. The proteolytic pathways involved in disuse muscle atrophy include the ubiquitin-proteasome-dependent pathway, caspase system pathway, matrix metalloproteinase pathway, Ca-dependent pathway and autophagy-lysosomal pathway. The important biological processes involved in skeletal muscle fibrosis include intermuscular connective tissue thickening caused by transforming growth factor-β1 and an anaerobic environment within the skeletal muscle leading to the induction of hypoxia-inducible factor-1α. This article reviews the progress made in understanding the pathological processes involved in immobilization-induced muscle contracture and the currently available treatments. Understanding the mechanisms involved in immobilization-induced contracture of muscle tissue should facilitate the development of more effective treatment measures for the different mechanisms in the future.


Subject(s)
Atrophy , Autophagy , Calcium , Metabolism , Caspases , Metabolism , Connective Tissue , Metabolism , Pathology , Contracture , Metabolism , Pathology , Therapeutics , Fibrosis , Humans , Immobilization , Joints , Lysosomes , Metabolism , Matrix Metalloproteinases , Metabolism , Muscle, Skeletal , Metabolism , Pathology , Proteasome Endopeptidase Complex , Metabolism , Proteolysis , Signal Transduction , Physiology , Transforming Growth Factor beta1 , Metabolism , Ubiquitin , Metabolism
19.
Article in Korean | WPRIM | ID: wpr-766412

ABSTRACT

PURPOSE: The aim of this study was to determine the outcomes of fixation of AO/OTA type C2 fractures among intra-articular fractures of the distal humerus using the paratricipital approach (side to side retraction of the triceps). MATERIALS AND METHODS: From June 2008 to January 2018, 12 patients underwent an open reduction and internal fixation with the paratricipital approach and were followed-up for more than 10 months after surgery. According to the AO/OTA classification, type C2 fractures were chosen among the intraarticular distal humerus fractures. An extended posterior incision was used over the olecranon in the prone position, preserving the insertion site of the triceps brachii muscle. The fracture site was exposed by retracting the muscle side-to side through a dissection of the medial and lateral intermuscular septum of the triceps brachii muscle. The therapeutic results were assessed by the anatomical reduction of the articular surface and integrity of the metaphyseal contour in postoperative simple radiographs, complications, such as neuropathy or non-union, and the Mayo elbow performance score (MEPS) were checked to estimate the functional outcome. RESULTS: In the postoperative simple radiographs, no case showed more than 1 mm step-off and the disrupted contour of the distal humerus was recovered to normal alignment in most cases. The range of elbow joint motion in the last follow-up was 133.8° on average with a mean flexion contracture of 5.0°. The clinical results depending on the MEPS were excellent, except for two cases, which were good. Neuropathy of the ulnar nerve was observed in one patient, which was resolved after metal removal. CONCLUSION: The paratricipital approach is useful technique in AO/OTA type C2 intra-articular distal humerus fractures that provides sufficient exposure of the surgical field, without injury to the triceps brachii muscle and postoperative complications associated with the trans-olecranon approach.


Subject(s)
Classification , Contracture , Elbow , Elbow Joint , Follow-Up Studies , Humans , Humerus , Intra-Articular Fractures , Olecranon Process , Postoperative Complications , Prone Position , Ulnar Nerve
20.
Article in Korean | WPRIM | ID: wpr-770069

ABSTRACT

PURPOSE: In the treatment of Dupuytren's contracture, the aim of optical treatment is to lower the recurrence rate and reduce complications. This paper reports the results of subtotal fasciectomy in Dupuytren's contracture, extending the excision of palmar fascial structures from the diseased to normal appearing adjacent fascial structure. MATERIALS AND METHODS: From 2007 to 2017, 45 patients with Dupuytren's contracture treated by subtotal fasciectomy were reviewed retrospectively. The mean follow-up period was 45.9 months. Ninety-two digits were involved (index: 2, middle: 10, ring: 44, little: 36). The predisposing factors and affected joint were reviewed and the preoperative and postoperative contracture was measured. For clinical results, quick disabilities of the arm, shoulder, and hand (quick DASH) were used. Complications, including wound or skin problems, nerve injuries, hematoma, and complex regional pain syndrome, were assessed. RESULTS: Preoperative flexion contracture was 43.2° in the proximal interphalangeal joint and 32.9° in the metacarpophalangeal joint. In nine cases, patients had residual contracture of 9.7° (range, 5°–20°) on average and if the total number of cases were included, the mean residual contracture was 2.3° on average. The quick DASH score at the 12 months follow-up was 12.4. The overall complication rate was 26.6%. CONCLUSION: Subtotal fasciectomy can be a good surgical treatment option for Dupuytren's contracture with a low recurrence and low complication rate compared to other open procedures.


Subject(s)
Arm , Causality , Contracture , Dupuytren Contracture , Follow-Up Studies , Hand , Hematoma , Humans , Joints , Metacarpophalangeal Joint , Recurrence , Retrospective Studies , Shoulder , Skin , Wounds and Injuries
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