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1.
Cuad. Hosp. Clín ; 62(1): 57-62, jun. 2021. ilus.
Article in Spanish | LILACS | ID: biblio-1284349

ABSTRACT

La rehabilitación de un paciente con fractura es progresivos y secuenciales para la mejora del foco de fractura, en especial en este tipo de fracturas con pérdida de sustancia ósea ya que suelen ser agresivas y de difícil resolución, por tanto, el tratamiento ortopédico es cuidadoso y complejo como la recuperación es prolongada sujeta a varios pasos según la progresión del paciente. El objetivo de este artículo es la de describir la secuencia de pasos en la rehabilitación de este tipo de fracturas, ya que no hay un manual claro para el manejo en rehabilitación de casos similares. El seguimiento y recuperación de este caso dura 8 meses dividida en 3 etapas de rehabilitación en un total de 122 sesiones, teniendo 4 evaluaciones en base a los tres parámetros de evaluación de ingreso: dolor, movimiento, postura y fuerza muscular, mejorando progresivamente estos aspectos.


The rehabilitation of a fractured patient is progressive and sequential for the improvement of the fracture focus, especially in this type of fractures with loss of bone substance since they are usually aggressive and difficult to resolve, so orthopedic treatment is careful and complex. as the recovery is prolonged subject to several steps depending on the patient's progression. The objective of this article is to describe the sequence of steps in the rehabilitation of this type of fractures, since there is no clear manual for the management in rehabilitation of similar cases. The follow-up and recovery of this case lasts 8 months divided into 3 stages of rehabilitation in a total of 122 sessions, having 4 evaluations based on the three parameters of admission assessment: pain, movement, posture and muscular strength, progressively improving these aspects.


Subject(s)
Humans , Male , Adult , Treatment Outcome , Fractures, Bone , Exercise Therapy , Diaphyses , Kinesiology, Applied , Femoral Fractures , Femur
2.
Arch. argent. pediatr ; 119(3): e239-e241, Junio 2021. ilus
Article in Spanish | LILACS, BINACIS | ID: biblio-1248152

ABSTRACT

La separación por fractura de la epífisis del fémur distal es una lesión relativamente poco frecuente en los recién nacidos, pero se ha documentado como una complicación del parto distócico. La mayoría de los casos ocurren a nivel distal del húmero y, de manera excepcional, afectan al fémur. La epifisiolisis distal del fémur casi no está descrita en la literatura. Se localizan normalmente en el tercio superior del fémur por un movimiento de torsión de este en los partos en posición podálica e incluso en cesáreas distócicas. El diagnóstico diferencial al inicio de la exploración suele ser con artritis séptica del recién nacido. A partir de un paciente de 3 días de vida que se presenta a su control posterior al alta con tumefacción en una de sus rodillas, se plantea este difícil e infrecuente diagnóstic


Fracture separation of the epiphysis from the distal femur is a relatively rare lesion in newborns, but it has been documented as a difficult complication of labor. Most of the cases occur at the distal humeral level and exceptionally affect the femur. Epiphysiolysis of the distal femur is practically not described. They are normally located in the upper third of the femur due to a twisting movement of the femur in breech deliveries and even in difficult caesarean sections. The differential diagnosis at the beginning of the examination is usually with septic arthritis of the newborn. This difficult and infrequent diagnosis arises from a 3-day-old baby who presents for his post-discharge check-up with swelling in one of his knees.


Subject(s)
Humans , Female , Infant, Newborn , Epiphyses, Slipped , Fractures, Bone/diagnostic imaging , Cesarean Section , Fractures, Bone/therapy , Femur
3.
Arq. bras. med. vet. zootec. (Online) ; 73(3): 571-582, May-June 2021. tab, graf, ilus
Article in English | ID: biblio-1278365

ABSTRACT

The outcome of total hip arthroplasty (THA) in dogs is directly related to surgical planning. Templating of radiographs prior to THA should help the surgeon anticipate prosthesis size and femoral shape allowing canal fill of the proximal metaphysis by the implant ensuring primary stable fixation. The canal flare index (CFI) obtained from radiograph has been used as a measure of risk of complications for the technique in human beings and dogs. However, standard radiographs only provide limited data for the selection of cementless prostheses and the assessment of their fit within the femoral canal, due to factors like radiographic magnification and femoral rotation. Therefore, three-dimensional evaluation based on computed tomography (CT) may be a better tool for CFI measurement. The aim of this study was to compare anatomical measurement with CFI values obtained from craniocaudal radiography and CT. Craniocaudal radiographs using a horizontal radiographic beam (CR), CT, and anatomical macroscopic measurements (A) were obtained from 45 femurs from 23 canine cadavers. The differences between the values of CFI obtained from radiograph (CFI-R), computed tomography on transverse (CFI- TT) and longitudinal axis (CFI-TL) compared to the CFI obtained from macroscopic measurements - gold standard - (CFI-A), and 95% limits of agreement (LOA) between the values, were evaluated by the Bland-Altman method. Dimensions obtained from CT techniques had a greatest mean difference from anatomical and CFI values were also different (P=0.032). Under the experimental conditions, the craniocaudal radiograph, provided the most accurate measurement of the CFI (mean difference: 0.087 ± 0.42).(AU)


O resultado da artroplastia total do quadril (ATQ) em cães está diretamente relacionado ao planejamento cirúrgico. O templating radiográfico pré-operatório da ATQ deve ajudar o cirurgião a prever o tamanho da prótese e o formato do fêmur, o que permitirá um preenchimento ideal da metáfise proximal pelo implante, garantindo, assim, fixação primária estável. O índice de alargamento do canal (Canal Flare Index - CFI) obtido em radiografias tem sido utilizado como fator de risco de complicações para a técnica em humanos e cães. No entanto, as radiografias podem fornecer apenas dados limitados para a seleção de próteses não cimentadas e a avaliação do seu encaixe no canal femoral, devido a fatores como ampliação radiográfica e rotação femoral. Portanto, a avaliação tridimensional baseada na tomografia computadorizada (TC) pode ser uma ferramenta vantajosa para a mensuração do CFI. O objetivo deste estudo foi comparar a medida anatômica com os valores de CFI obtidos na radiografia craniocaudal e na TC. Radiografias craniocaudais utilizando feixe radiográfico horizontal (CR), tomografia computadorizada e medidas macroscópicas anatômicas (A) foram obtidas de 45 fêmures de 23 cadáveres caninos. As diferenças entre os valores de CFI obtidos na radiografia (CFI-R), na tomografia computadorizada no eixo transversal (CFI-TT) e no eixo longitudinal (CFI-TL), em comparação com os valores de CFI obtidos nas medições macroscópicas - padrão-ouro - (CFI-A) e os limites de concordância de 95% (LOA) entre os valores, foram avaliadas pelo método de Bland-Altman. As dimensões obtidas pelas técnicas de TC apresentaram maior diferença média dos valores anatômicos, e as do CFI também foram diferentes (P=0,032). Nas condições experimentais, a radiografia craniocaudal forneceu a medida mais precisa do CFI (diferença média: 0,087 ± 0,42) para representar o padrão-ouro deste estudo.(AU)


Subject(s)
Animals , Dogs , Arthroplasty, Replacement, Hip/methods , Arthroplasty, Replacement, Hip/veterinary , Femur/surgery , Femur/diagnostic imaging , Tomography, X-Ray Computed/veterinary , Imaging, Three-Dimensional/veterinary
4.
Rev. cuba. reumatol ; 23(1): e776, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1280405

ABSTRACT

El tumor de células gigantes de hueso es un tumor raro de características benignas con un comportamiento agresivo localmente. Predomina en mujeres y por lo general se presenta en la epífisis y metáfisis de los huesos largos. El propósito de este estudio es presentar el caso de un paciente con una lesión tumoral de rodilla y muslo izquierdos de 2 años de evolución y señalar las características diagnósticas de este tumor al mismo tiempo que se revisan los métodos imagenológicos recientes para su confirmación. Se presenta a un paciente masculino de 19 años de edad, que comenzó con dolor, aumento de volumen de la rodilla y muslo izquierdos, acompañado de impotencia funcional. Se reportaron los hallazgos clínicos, radiográficos e histológicos. Debido a la demora entre el inicio de los síntomas y el diagnóstico se practicó el tratamiento quirúrgico del miembro afectado (amputación). Tras 10 meses de observación no se han presentado recidivas o metástasis. Se envió al Servicio de Oncología para valorar e tratamiento con radioterapia. El tumor de células gigantes del hueso es un tumor raro, de buen pronóstico, pero que puede recidivar y causar metástasis cuando se maligniza. Por la posibilidad de transformación en sarcoma requiere estudio y observación periódica. El tiempo para realizar el diagnóstico es fundamental y debe pensarse en este tumor en caso de lesiones líticas de hueso reportadas por imagenología(AU)


The giant cell tumor of bone is a rare benign tumor with a locally aggressive behavior. It predominates in women and usually occurs in the epiphysis and metaphysis of long bones. To present a patient with a tumor lesion left knee and thigh two years of evolution, also noted the diagnostic characteristics of this tumor while recent imaging methods are reviewed for confirmation. 19-year-old male who began with pain, increased volume of the knee and left thigh, accompanied by functional impotensia. clinical, radiological and histological findings were reported. Because of the delay between the onset of symptoms and diagnosis surgical treatment of the affected limb (amputation) was performed. After ten months of observation there have been no recurrences or metastases. The giant cell tumor of bone is a rare tumor with good prognosis but can recur and metastasize when it becomes malignant. The possibility of transformation in sarcoma requires periodic study and observation. The time for diagnosis is essential and should think of this tumor in case of lytic bone lesions reported by imaging(AU)


Subject(s)
Male , Young Adult , Thigh/injuries , Wounds and Injuries , Giant Cell Tumor of Bone/complications , Early Diagnosis , Epiphyses/injuries , Femur/diagnostic imaging , Neoplasm Metastasis/prevention & control , Giant Cell Tumor of Bone/diagnostic imaging , Amputation
5.
Article in Chinese | WPRIM | ID: wpr-879431

ABSTRACT

OBJECTIVE@#To investigate the clinical effect of double plate combined with iliac bone graft in the treatment of femoral nonunion after intramedullary nailing.@*METHODS@#From December 2008 to December 2017, double plate combined with autogenous iliac bone graft was used to treat femoral nonunion after intramedullary nailing. There were 11 cases, including 10 males and 1 female, aged 35 to 62 years, and the time from fracture to nonunion was 12 to 20 months. According to Judet classification, there were 8 cases of atrophic nonunion and 3 cases of proliferative nonunion. Regular follow-up was conducted after operation to record the fracture healing time, load-bearing activity time and complications, and to observe the repair effect of double plate fixation combined with iliac bone graft on nonunion after femoral shaft fracture operation.@*RESULTS@#All patients were followed up for 12 to 22 months. The operation time was 70 to 130 min and the blood loss was 180 to 350 ml. After operation, 2 cases had knee stiffness, which recovered after passive exercise with CPM machine for 2 weeks;1 case had pain in iliac bone donor area, which was relieved after 3 months. The time of fracture healing was 24 to 40 weeks, and the time of complete weight-bearing activity was 14 to 32 weeks. SF-36 quality of life score at the final follow-up:body pain 70 to 82, activty 70 to 82, social function 72 to 83, the overall health 72 to 82. At the end of the follow-up, there were no complications such as limb shortening, infection, poor wound healing, internal fixation failure (fracture, loosening).@*CONCLUSION@#It is an effective method to treat nonunion of femur after intramedullary nailing by using double plate combined with autogenous iliac bone graft.


Subject(s)
Adult , Bone Nails , Bone Plates , Bone Transplantation , Female , Femoral Fractures/surgery , Femur , Fracture Fixation, Intramedullary , Fracture Healing , Fractures, Ununited/surgery , Humans , Male , Middle Aged , Quality of Life , Treatment Outcome
6.
São Paulo; s.n; 2021. 99 p.
Thesis in Portuguese | LILACS | ID: biblio-1342174

ABSTRACT

Introdução - As elevadas taxas de mortalidade neonatal e a prevalência de bebês nascidos pequenos para idade gestacional (PIG) ainda apresentadas por regiões de baixa e média renda indicam a necessidade de investigação sobre fatores que influenciam o crescimento fetal. Medidas biométricas fetais

Introduction Elevated rates of neonatal mortality and small-for-gestational-age (SGA) babies in low- and middle-income regions indicate the need to investigate factors associated with fetal growth. Fetal biometric measurements below the 10th percentile for gestational age (GA) reflect failure in achieving growth potential and provide opportunities for prenatal interventions. Objective To investigate factors associated with fetal biometric measurements below the 10th percentile assessed at early third trimester among pregnant women in the MINA-Brazil study. Methods This was a prospective analysis of pregnant women living in the urban area of Cruzeiro do Sul (AC), followed up since the antenatal period. Screening of participants took place from February 2015 to January 2016. A sociodemographic and health history interview was carried out along with two clinical assessments, scheduled between the second and third trimesters of pregnancy, to collect data on lifestyle factors and complications during pregnancy, anthropometric evaluation, blood collection, and ultrasound scan assessing fetal biometric measurements of head circumference (HC), abdominal circumference (AC) and femoral length (FL). Poisson regression models with hierarchical selection of variables were fitted for factors associated with occurrence of fetal measurements below the 10th percentile at early third trimester. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were estimated. Results Among 426 participants (mean age 25 years (SD 6.4) and gestational age 27.8 weeks (SD 1.7)), 11.3%, 8.9% e 9.4% had fetuses with HC, AC, FL below the 10th percentile at early third trimester. Fetal biometric measurements below the 10th percentile were negatively associated with higher maternal education level, which denoted over 50% of protection (HC: PR 0.47, 95%CI 0.28; 0.81; AC: PR 0.48, 95%CI 0.26; 0.87; and FL: PR 0.48, 95%CI 0.27; 0.86). Adjusted for maternal education level, nulliparity (PR 1.94, 95%CI 1.10; 3.43), higher pre-gestational body mass index (BMI) (PR 1.06, 95%CI 1.01; 1.11), and pre-gestational alcohol consumption (PR 1.80, 95%CI 0.98; 3.30) were associated with HC measurements below the 10th percentile. Maternal height (p for trend 0.039) and pre-gestational alcohol consumption (PR 2.55, 95%CI 1.31; 4.96) were also associated with AC measurements below the 10th percentile. Association between higher average screen time per day during antenatal follow-up and FL measurements below the 10th percentile were observed as well (p for trend 0.031). Higher maternal education level, which may provide better material and non-material conditions, seems to protect fetal growth from failure to reach potential fetal size for GA. Positive associations observed with obstetric and antenatal conditions may be mediated by biological factors or gestational dysfunctions to incur in fetal measurements below the 10th percentile. Conclusion The occurrence of fetal biometric measurements below the 10th percentile for GA and their associated factors corroborate pre-pregnancy and antenatal care improvements anchored in equity policies, and for new strategies prior to birth that optimize the window of opportunity in the first thousand days of life.


Subject(s)
Infant, Small for Gestational Age , Cephalometry , Biometry , Abdominal Circumference , Femur/growth & development , Fetal Growth Retardation , Fetus
7.
Rev. bras. ortop ; 55(6): 771-777, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156205

ABSTRACT

Abstract Objective To evaluate different femoral fixation devices for medial patellofemoral ligament reconstruction and compare their effectiveness regarding fixation strength up to failure in porcine knees. Methods Thirty porcine knees were used, divided into three groups of 10 knees. The removed grafts were dissected from the extensor tendons of porcine feet. In each group, the graft was fixed to the femur with an interference screw, an anchor, or adductor tenodesis. The three methods were subjected to biomechanical tests using a universal Tensile testing machine at a speed of 20 mm/minute. Results The highest average linear resistance under lateral traction occurred in group 1, "screw fixation" (185.45 ± 41.22 N), followed by group 2, "anchor fixation" (152.97 ± 49, 43 N); the lower average was observed in group 3, "tenodesis fixation" (76.69 ± 18.90 N). According to the fixed error margin (5%), there was a significant difference between groups (p < 0.001); in addition, multiple comparison tests (between group pairs) also showed significant differences. Variability was small, since the variance coefficient was lower than 33.3%. Conclusion Interference screws in bone tunnels and mountable anchors fixation with high resistance wire are strong enough for femoral fixation in porcine medial patellofemoral ligament reconstruction. Adductor tenodesis, however, was deemed fragile for such purpose.


Resumo Objetivo Avaliar diferentes dispositivos de fixação femoral na reconstrução do ligamento patelofemoral medial para comparar sua eficácia quanto à força de fixação até a falha em joelhos suínos. Métodos Foram ensaiados 30 joelhos de suínos subdivididos em 3 grupos de 10 joelhos. Os enxertos retirados foram dissecados de tendões extensores das patas dos suínos. Cada grupo teve o enxerto fixado ao fêmur com parafuso de interferência, âncora, ou tenodese no tendão adutor. Os 3 métodos foram submetidos à testes biomecânicos utilizando uma máquina universal de ensaio de tração com uma velocidade de 20 mm/min. Resultados Verificamos que a média mais elevada da resistência linear sob tração lateral (185,45 ± 41,22 N) ocorreu no grupo 1: "fixação por parafuso," seguido do grupo 2: "fixação por âncora" (152,97 ± 49,43 N), e a média foi menor no grupo 3: "fixação por tenodese" (76,69 ± 18,90 N). Para a margem de erro fixada (5%), comprovou-se a diferença significativa entre os grupos (p < 0,001) e também através dos testes de comparações múltiplas (entre os pares de grupos) verificou-se a ocorrência de diferenças significativas. A variabilidade expressada por meio do coeficiente de variação mostrou-se reduzida, já que a referida medida foi inferior a 33,3%. Conclusão O uso de parafusos de interferência no túnel ósseo de joelhos porcinos é suficientemente forte para fixação femoral na reconstrução do ligamento patelofemoral medial, assim como a fixação com âncoras montáveis com fio de alta resistência. Entretanto, a tenodese no tendão adutor mostrou-se frágil para essa finalidade.


Subject(s)
Animals , Orthopedic Fixation Devices , Swine , Tendons , Traction , Effectiveness , Biomechanical Phenomena , Bone and Bones , Suture Techniques , Transplants , Models, Animal , Tenodesis , Patellofemoral Joint , Femur , Ligaments , Methods
8.
Rev. chil. ortop. traumatol ; 61(2): 60-68, oct. 2020. tab, ilus
Article in Spanish | LILACS | ID: biblio-1342413

ABSTRACT

OBJETIVOS: Mostrar resultados, complicaciones y lecciones aprendidas utilizando el clavo intramedular magnético (IML, Intramedullary Magnetic Lengthener) en un grupo de pacientes sometidos a alargamiento óseo. PACIENTES Y MÉTODOS: Entre enero 2017 y diciembre 2019, 9 pacientes (15 segmentos), edad entre 15 y 39 años, fueron sometidos a alargamiento óseo con IML: 5 pacientes tuvieron alargamiento femoral bilateral por talla baja, 1 paciente se sometió a alargamiento de Piernas bilateral por Tibia vara y acortamiento mesomélico y 3 recibieron alargamientos femorales unilaterales por discrepancia de longitud de extremidades. Todos fueron operados por el mismo cirujano, con técnica standard. Se indicó kinesiterapia al menos 5 veces por semana durante la fase de distracción. RESULTADOS: En todos se logró el objetivo de alargamiento planteado. No hubo complicaciones intra ni postoperatorias graves (TVP, TEP, Embolia grasa), ni fallas del sistema distractor. Un paciente desarrolló contracturas articulares de ambas rodillas por no adhesión a Kinesiterapia. Ninguno requirió aporte de injerto óseo, sin embargo en 2 pacientes de alargamiento de Fémur bilateral, se presentó deformidad en varo, que hizo necesario recambio a clavo convencional y un paciente desarrolló una parálisis transitoria del Nervio Peroneo común. CONCLUSIONES: El advenimiento de los IML significó un gran avance en el campo de la osteogénesis por distracción, sin embargo, aún se trata de un procedimiento complejo, que debe ser planificado cuidadosamente para minimizar los riesgos y complicaciones. Una selección meticulosa del paciente y la evaluación física y psicológica previa, son fundamentales para el éxito del procedimiento. Los casos bilaterales requieren de un seguimiento cercano, por el riesgo de falla del implante.


objective: We show our results, complications and lessons learned using the Intramedullary Magnetic Lengthener (IML) in a group of patients who were subjected to bone lengthening. PATIENTS AND METHODS: Between January 2017 and December 2019, 9 patients (15 segments), aged between 15 and 39 years, underwent bone lengthening with IML: 5 patients had bilateral femoral lengthening due to short stature, 1 patient had bilateral leg lengthening due to Tibia vara and mesomelic shortening and 3 had unilateral femoral lengthening for limb length discrepancy. All were operated by the same surgeon, with standard technique. Physical therapy was indicated at least 5 times per week during the distraction phase. RESULTS: In every case, the proposed lengthening amount was achieved. There were no serious intraoperative or postoperative complications (DVT, Pulmonary Embolism, Fat Embolism), nor failures of the distractor system. One patient developed knee joint contracture due to non-adherence to Physical therapy. None required bone grafting, however, in 2 patients with bilateral Femur, a varus deformity appeared, which required nail exchange with a conventional trauma nail. One case developed a transit common Peroneal Nerve palsy. CONCLUSIONS: IMLs represent a great advance in the bone lengthening realm, however, it is still a complex procedure, which must be carefully planned to minimize risks and complications. Meticulous patient selection and prior physical and psychological evaluation are essential to the success of the procedure. Bilateral cases need a closer follow up, because implant failure is a potential risk.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Bone Lengthening/methods , Bone Nails , Fracture Fixation, Intramedullary/methods , Postoperative Complications , Bone Lengthening/instrumentation , Treatment Outcome , Osteogenesis, Distraction/instrumentation , Osteogenesis, Distraction/methods , Femur , Fracture Fixation, Intramedullary/instrumentation , Leg Length Inequality
9.
Rev. bras. ortop ; 55(5): 518-522, Sept.-Oct. 2020. graf
Article in English | LILACS | ID: biblio-1144214

ABSTRACT

Abstract Femoroacetabular impingement (FAI) is an important cause of hip pain, and the main etiology of hip osteoarthritis in the young population. Femoroacetabular impingement is characterized by subtle alterations in the anatomy of the acetabulum and proximal femur, which can lead to labrum tearing. The acetabular labrum is essential to the stability of the hip joint. Three types of FAI were described: cam (anespherical femoral head), pincer (acetabular overcoverage) and mixed (characteristics of both cam and pincer). The etiology of FAI is related to genetic and environmental characteristics. Knowledge of this condition is essential to adequately treat patients presenting with hip pain.


Resumo O impacto femoroacetabular (IFA) é uma importante causa de dor no quadril, e a principal etiologia da osteoartrose do quadril no jovem. O IFA é caracterizado por alterações sutis da anatomia do acetábulo e do fêmur proximal que podem causar lesões do complexo condrolabial. O lábio é uma estrutura fibrocartilaginosa essencial na estabilidade articular. Três tipos de IFA são descritos: came (onde há uma anesfericidade da cabeça femoral), pincer (onde há uma sobrecobertura acetabular) e misto (que apresenta características de ambos). A etiologia do IFA está relacionada com características genéticas e ambientais. O conhecimento desta doença e sua fisiopatologia é essencial para o tratamento de pacientes que apresentam dor no quadril.


Subject(s)
Humans , Pain , Sports Medicine , Wounds and Injuries , Osteoarthritis, Hip , Femur , Femoracetabular Impingement , Hip , Acetabulum
10.
Int. j. morphol ; 38(5): 1311-1316, oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134441

ABSTRACT

SUMMARY: Blood supply to the diaphysis of long bones is majorly through nutrient artery, which enters the bone via nutrient foramen. The present study aims to identify morphological and morphometric variations of nutrient foramina of the femur, which is the largest long bone of the body extending from the pelvis to knee. A sample of 81 Sri Lankan adult femur were analyzed. The mean length of the femur analyzed was 436.93 mm and mean foramen index was 43.52. The majority of the bones had a single nutrient foramen. The predominant location of the nutrient foramen was on the posterior aspect of the bone in the middle third of the shaft according to the study. Majority of foramina were directed distally. The indices on nutrient foramen are important for procedures such as bone grafts and tumor resections, in managing trauma, orthopedic procedures and radiological interpretations.


RESUMEN: El suministro de sangre a la diáfisis de los huesos largos se realiza principalmente a través de la arteria nutricia, que ingresa al hueso a través del foramen nutricio diafisario. El presente estudio tiene como objetivo identificar las variaciones morfológicas y morfométricas del foramen nutricio del fémur, el hueso largo más grande del cuerpo que se extiende desde la pelvis hasta la rodilla. Se analizó una muestra de 81 fémures adultos de individuos de Sri Lanka. La longitud media de los fémures analizados fue de 436,93 mm y el índice de foramen medio fue de 43,52. La mayoría de los huesos tenían un solo foramen nutricio. Según el estudio, la ubicación predominante del foramen nutricio estaba en la cara posterior del hueso en el tercio medio del eje. La mayoría de los forámenes estaban dirigidos distalmente. Los índices sobre el foramen nutricio son importantes para procedimientos tales como injertos óseos y resecciones tumorales, en el manejo de traumatismos, procedimientos ortopédicos e interpretaciones radiológicas.


Subject(s)
Humans , Femur/anatomy & histology , Anatomic Variation , Sri Lanka , Diaphyses , Femur/blood supply
11.
Int. j. morphol ; 38(4): 909-913, Aug. 2020. tab, graf
Article in English | LILACS | ID: biblio-1124875

ABSTRACT

Porous titanium alloy scaffold was widely used in treating bone defect caused by traumatic injury and osteomyelitis, which was incapable of self-healing. The implantation of scaffold produced stress shielding thereby forming osteolysis. The objective of this study was to analysis trabecular morphological features of osseointegrated bone. 14 New Zealand rabbits were divided into two groups, surgery group and healthy control group. 7 rabbits in surgery group were selected to perform 3D printed porous titanium alloy scaffold implantation surgery with preload at the defect of femoral condyle for osseointegration. The other 7 rabbits in control group were feed free. After 90 days healing, femoral condyles were extracted to perform micro-CT scanning with hydroxyapatite calibration phantom. Mean bone mineral density (BMD), bone volume fraction (BV/TV), BS/TV (bone surface area ratio), Tb.Th (thickness of trabeculae), Tb.N (number of trabeculae), Tb.Sp (trabecular separation) and DA (degree of anisotropy) were calculated from micro-CT images. The results revealed that osseointegration inside and at the surface of scaffolds worked well from grey values of micro-CT images. After 12 weeks healing, mean bone mineral densities (BMD) in surgery group and healthy control group were calculated as 800±20mg/cm3 and 980±90mg/cm3, respectively. This revealed that the strength of trabeculae in surgery group might lower than that in the healthy group. Trabecular morphological parameters test showed that trabecular morphological parameters at the surface of scaffolds in the surgery group deteriorated significantly. It was found from micro-CT images that ingrowth bone was filled with pores of scaffold. Overall, the effect of osseointegration was promoted through the change of mechanical micro-environment in the scaffold region. Overall, preload could improve osseointegration effect in the long-term after surgery. However, the trabecular morphology in the surgery group was deteriorated, which might bring secondary fracture risk again.


La malla de aleación de titanio poroso se usó ampliamente en el tratamiento de defectos óseos causados por lesiones traumáticas y osteomielitis. El implante de la malla generó una protección contra el estrés, formando así osteolisis. El objetivo de este estudio fue analizar las características morfológicas trabeculares del hueso osteointegrado. Se dividieron 14 conejos (Neozelandeses) en dos grupos, grupo cirugía y grupo control saludable. Se seleccionaron 7 conejos en el grupo de cirugía para realizar una implantación de mallas de aleación de titanio poroso, impresas en 3D con precarga en el defecto del cóndilo femoral para la osteointegración. Los 7 conejos restantes del grupo control se mantuvieron sin alimentación. Después de 90 días de curación, se extrajeron los cóndilos femorales para realizar una exploración por micro-CT con un espectro de calibración de hidroxiapatita. Se calcularon a partir de imágenes de micro-CTDensidad mineral ósea media (DMO), fracción de volumen óseo (BV / TV), BS / TV (relación de área de superficie ósea), Tb.Th (espesor de trabéculas), Tb.N (número de trabéculas), Tb.Sp (trabecular separación) y DA (grado de anisotropía). Los resultados revelaron que la osteointegración dentro y en la superficie de los andamios funcionó bien a partir de los valores grises de las imágenes de micro-CT. Después de 12 semanas de curación, las densidades medias de minerales óseos (DMO) en el grupo cirugía y en el grupo control sano se calcularon como 800 ± 20 mg/cm3 y 980 ± 90 mg/cm3, respectivamente. Esto reveló que la fuerza de las trabéculas en el grupo de cirugía podría ser menor que la del grupo sano. La prueba de parámetros morfológicos trabeculares mostró que en el grupo de cirugía, la superficie de las mallas, se deterioraron significativamente. Se descubrió a partir de imágenes de microCT que el hueso en crecimiento estaba lleno de poros de andamio. En general, el efecto de la osteointegración se promovió mediante el cambio del microambiente mecánico en la región de la malla. En general, la precarga podría mejorar el efecto de osteointegración a largo plazo después de la cirugía. Sin embargo, la morfología trabecular en el grupo de cirugía se deterioró, lo que podría traer un nuevo riesgo de fractura secundaria.


Subject(s)
Animals , Rabbits , Bone Diseases/surgery , Osseointegration/physiology , Tissue Scaffolds/chemistry , Printing, Three-Dimensional , Prostheses and Implants , Titanium/chemistry , Porosity , Alloys , X-Ray Microtomography , Femur/surgery
12.
Int. j. morphol ; 38(1): 43-47, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1056395

ABSTRACT

Rheumatoid arthritis (RA) is a disease triggered by environmental and genetic factors. Research suggests that physical exercise has benefits such as delaying functional disability. In vivo studies using experimental models of arthritis can provide useful information about these benefits. to analyze the effects that different intensities of aquatic physical exercise have on the proprieties of the bones in induced arthritis in knees of Wistar rats. Male Wistar adults rats (n=20) were divided into 5 groups: Group Control Arthritis (GCA) n=4, Group control Placebo (GCP) n=4, Group Low Physical Activity (GB) n=4, Group Moderate Physical Activity (GM) n=4 and Group Intense Physical Activity (GI) n=4. The physical activity groups got an intra-articular injection of Zymosam on the right knee; the GCA received saline solution in the right knee; the GCP was submitted to the stress of the needle. The animals were submitted to aquatic activity for 30 minutes, 4 times a week for 5 weeks, and the intensity of the exercise was determined by a weight placed on their back: GB=1 %, GM=5 %, GI=15 % of their body weight. It was observed that the group GB, and the groups that did not exercise GCA and GCP, gained more weight compared to the group GM. In relation to the bone mineral content of the tibia, there was a decrease in the GM group when compared to the GCP group, whereas in the tibial bone mineral density there was a decrease in the GM group compared to the GCP, GCA, GB. As for the area of the femur, the GI group presented an increase of it compared to the GB and GM groups. It is concluded that the high intensity exercises promote better results in bone properties.


La investigación sugiere que el ejercicio físico tiene beneficios como retrasar la discapacidad funcional de la artritis reumatoide. Los estudios in vivo que utilizan modelos experimentales de artritis pueden proporcionar información útil sobre estos beneficios. Se analizaron los efectos de las intensidades del ejercicio físico acuático sobre las propiedades de los huesos, en la artritis inducida en las rodillas de ratas Wistar. Las ratas Wistar macho adultas (n = 20) se dividieron en 5 grupos: grupo de control artritis (ACG) n = 4, grupo control placebo (CGP) n = 4, grupo de actividad física baja (GB) n = 4, grupo de actividad física moderada (GM) n = 4 y grupo de actividad física intensa (GI) n = 4. Los grupos de actividad física recibieron una inyección intraarticular de Zymosam en la rodilla derecha; el GCA recibió solución salina en la rodilla derecha; el CGP fue sometido a la tensión de una aguja. Los animales fueron sometidos a actividad acuática durante 30 minutos, 4 veces a la semana durante 5 semanas, y la intensidad del ejercicio se determinó mediante un peso colocado sobre su espalda: GB = 1 %, GM = 5 %, GI = 15 % de su peso corporal. Se observó que el grupo GB, y los grupos que no ejercitaron GCA y CGP, ganaron más peso en comparación con el grupo GM. En relación con el contenido mineral óseo de la tibia, hubo una disminución en el grupo GM en comparación con el grupo GCP, mientras que en la densidad mineral del hueso tibial hubo una disminución en el grupo GM en comparación con el GCP, GCA, GB. En cuanto al área del fémur, el grupo GI presentó un aumento en comparación con los grupos GB y GM. En conclusión el ejercicio de alta intensidad promueve mejores resultados en las propiedades óseas.


Subject(s)
Animals , Male , Rats , Arthritis, Rheumatoid/pathology , Swimming/physiology , Tibia/pathology , Femur/pathology , Arthritis, Rheumatoid/physiopathology , Tibia/physiopathology , Body Weight , Exercise/physiology , Rats, Wistar , Disease Models, Animal , Femur/physiopathology
13.
Int. j. morphol ; 38(1): 193-198, Feb. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1056420

ABSTRACT

La Linea aspera localizada en el margen posterior de la diáfisis del fémur, es considerada una referencia topográfica, imagenológica y antropológica. Hacia la epífisis proximal, esta línea se divide en varias líneas divergentes. De ellas, la rama lateral da inserción al músculo glúteo máximo (Tuberositas glutea), mientras que la rama media da inserción al músculo pectíneo (Linea pectinea). Ambas estructuras se encuentran en Terminologia Anatomica (TA), sin embargo, la rama medial conocida como línea espiral, donde se origina el musculo vasto medial (VM), no se encuentra en TA. Se realizó una revisión de la literatura del área morfológica con el objetivo de recopilar, analizar y verificar el uso del término línea espiral en nóminas, terminologías, textos de anatomía y publicaciones científicas. Se revisaron la Nomina Anatomica de Basilea, Paris Nomina Anatomica y Terminologia anatomica FCAT (2001) y FIPAT (2011). También fueron seleccionados 45 libros y 20 artículos en idiomas inglés y español, con el fin de analizar textos, tablas e imágenes del fémur y/o VM. Se confeccionaron tablas para resumir la información obtenida. Su término no es mencionado en nóminas ni terminologías, sin embargo en la columna de inglés de TA, se utiliza como sinónimo de Linea pectinea. En algunos textos anatómicos y artículos científicos se observa que el término línea espiral se utiliza en relación a la descripción del fémur y/o al origen del VM. El uso del término en textos de anatomía y publicaciones científicas, con fines descriptivos, antropológicos y clínicos, sumado al hecho que dentro de los principios de TA el latín es el idioma oficial y se debe considerar un único nombre por término, con el fin de evitar confusiones, fundamentan la necesidad de incorporar a TA, el término línea espiral (Linea spiralis).


The Linea aspera located on the posterior margin of the femur diaphysis is considered a tomographic, imaging and anthropological reference. To the proximal epiphysis, this line is divided in several divergent lines. Of these, the lateral branch gives insertion to the gluteus maximus muscle (Tuberositas glutea), while the middle branch gives insertion to the pectineal muscle (pectinea line). Both structures are found in Terminologia Anatomica (TA), however the medial branch known as the Spiral Line, where the vastus medial muscle (VM) originates, is not found in TA. We aimed to collect, analyze and verify the level of use of the term Spiral line in terminologies, anatomy texts and scientific publications. Nomina Anatomica from Basilea (BNA), Paris Nomina Anatomica (PNA) y Terminologia anatomica FCAT (2001) and FIPAT (2011) were reviewed. In addition, 45 books and 20 articles in English and Spanish were also selected, in order to analyze text, tables and images of the femur and/or VM. Tables were made to summarize the information obtained. The term is not mentioned in payrolls or terminologies, however in the English column of TA, this term is used as a synonym for Linea pectinea. In some anatomical texts and scientific articles it is observed that the term spiral line is used in relation to the description of the femur and / or the origin of the vast medial. The use of the term in anatomy texts and scientific publications, for descriptive, anthropological and clinical purposes, added to the fact that within the principles of Anatomical Terminology Latin is the official language and should be considered a single name per term, in order to avoid confusion, they base the need to incorporate the term spiral line (Linea spiralis) into TA.


Subject(s)
Humans , Femur/anatomy & histology , Terminology as Topic
14.
Medisan ; 24(1)ene.-feb. 2020.
Article in Spanish | LILACS-Express | LILACS, CUMED | ID: biblio-1091170

ABSTRACT

La mala alineación patelofemoral tiene múltiples causas anatómicas y una de ellas es la displasia de la tróclea del fémur distal, por lo cual su tratamiento depende de varios factores. Para profundizar en los elementos esenciales de la técnica de trocleoplastia, se realizó una revisión bibliográfica exhaustiva donde se analizaron algunos aspectos de interés, a saber: clasificación más empleada para las displasias de la tróclea, elementos imagenológicos más importantes, indicaciones de la técnica quirúrgica, contraindicaciones, principales modalidades de trocleoplastia y vías de acceso quirúrgico. Se concluyó que este es un proceder con indicaciones muy específicas y puede realizarse mediante cirugía abierta o por vía artroscópica.


The poor patellofemoral alignment has multiple anatomical causes and one of them is the dysplasia of the distal femur trochlea, reason why its treatment depends on several factors. To deepen in the essential elements of the trochleoplasty technique, an exhaustive literature review was carried out where some aspects of interest were analyzed, that is: most used classification for the trochlear dysplasias, most important imagenologic elements, indications of the surgical technique, contraindications, main modalities of trochleoplasty and surgical approaches. It was concluded that this is a procedure with very specific indications and can be carried out by means of open surgery or arthroscopic way.


Subject(s)
Bone Malalignment , Femur/surgery , Patellofemoral Pain Syndrome/surgery
15.
Rev. bras. cir. cardiovasc ; 35(1): 28-33, Jan.-Feb. 2020. tab
Article in English | LILACS | ID: biblio-1092467

ABSTRACT

Abstract Introduction: One of the most important points of the acute type A aortic dissection surgery is how to perform cannulation regarding cerebral protection concerns and the conditions of arterial structures as a pathophysiological consequence of the disease. Objective: In this study, femoral and axillary cannulation methods were compared in acute type A aortic dissection operations. Methods: The study retrospectively evaluated 52 patients who underwent emergency surgery for acute type A aortic dissection. Patients without malperfusion according to Penn Aa classification were chosen for preoperative standardization of the study groups. The femoral arterial cannulation group was group 1 (n=22) and the axillary arterial cannulation group was group 2 (n=30). The groups were compared in terms of perioperative and postoperative results. Results: There was no statistically significant difference in terms of preoperative data. In terms of postoperative parameters, especially early mortality and new-onset cerebrovascular event, there was no statistically significant difference. Mortality rates in group 1 and group 2 were 13.6% (n=3) and 10% (n=3), respectively (P=0.685). Postoperative new-onset cerebral events ratio was found in 5 (22.7%) in the femoral cannulation group and 6 (20%) in the axillary cannulation group (P=0.812). Conclusion: Both femoral and axillary arterial cannulation methods can be safely performed in patients with acute type A aortic dissection, provided that cerebral protection strategies should be considered in the first place. The method to be performed may vary depending on the patient's current medical condition or the surgeon's preference.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Axillary Artery/surgery , Femoral Artery , Femur/surgery , Aneurysm, Dissecting , Vascular Surgical Procedures , Catheterization , Retrospective Studies , Treatment Outcome
17.
Braz. j. med. biol. res ; 53(6): e9237, 2020. tab, graf
Article in English | LILACS, ColecionaSUS | ID: biblio-1132520

ABSTRACT

We investigated changes in oxidative biomarkers in brain regions such as brainstem, cerebellum, and cerebral cortex of 3-, 6-, 18-, 24-, and 30-month-old rats. We also assessed the effects of low-intensity exercise on these biomarkers in these regions of 6-, 18-, and 24-month-old rats that started exercise on a treadmill at 3, 15, and 21 months of age, respectively. Radiographic images of the femur were taken for all rats. A total of 25 rats (age: twelve 6-, ten 18-, ten 24-, and three 30-month-old rats) were used. Lipid hydroperoxide levels increased in cerebellum at 18 months. Total antioxidant activity exhibited lowest values in brainstem at 3 months. Superoxide dismutase activity did not exhibit significant changes during aging. Total thiol content exhibited lowest values in brain regions of 24- and 30-month-old rats. Exercise reduced total thiol content in brainstem at 6 months, but no change occurred in other regions and other ages. Femur increased its length and width and cortical thickness with advancing age. No change occurred in medullary width. Radiolucency increased and sclerosis was found in cortical and medullary bone with advancing age. Exercise reduced radiolucency and medullary sclerosis. Therefore, aging differentially changed oxidative biomarkers in different brain regions and radiographic measures of the femur. Low-intensity exercise only ameliorated some radiographic measurements of femur. Since the present study possessed limitations (small number of rats per group), a beneficial effect of regular low-intensity exercise on oxidative markers in brain cannot be ruled out.


Subject(s)
Animals , Male , Rats , Physical Conditioning, Animal/physiology , Brain/metabolism , Aging/physiology , Oxidative Stress/physiology , Femur/diagnostic imaging , Lipid Peroxides/analysis , Oxidation-Reduction , Aging/metabolism , Biomarkers/analysis , Lipid Peroxidation , Rats, Wistar , Femur/chemistry
18.
Article in Chinese | WPRIM | ID: wpr-879372

ABSTRACT

OBJECTIVE@#A3 intertrochanteric fracture is an extremely unstable fracture, which is often treated with intramedullary nail, but the implant failure is common due to the posterior medial fragment cannot be reconstructed. A new medial sustainable nail (MSN-Ⅱ) which can reconstruct the femoral medial support by sustainable screw was introduced in this study. The mechanical effect was verified by biomechanical experiment.@*METHODS@#The loss medial support model of intertrochanteric fracture (A3) was made by artificial Sawbones model, fixed with MSN-Ⅱ and PFNA-Ⅱ, underwent axial loading and axial failure tests. The axial stiffness, yield load, displacement of head-neck fragment and torsional angle of fracture site of these nails were recorded and compared for biomechanical differences. The effect of early reconstruction of medial support with MSN-Ⅱ was determined.@*RESULTS@#The axial stiffness, yield load, the displacement of head and neck fragment when the axial load was 1 800 N and torsional angle of the fracture site after the axial failure test of MSN-Ⅱ were (222.76 ±62.46) N /mm, (4 241.71 ±847.42) N, (11.51 ±0.62) mm, (1.71 ±0.10)° respectively, while the PFNA -Ⅱ was (184.58±40.59) N /mm, (3 058.76±379.63) N, (16.15±1.36) mm, (2.52±0.26)°respectively. The difference between the two groups was statistically significant.@*CONCLUSION@#The axial stiffness of MSN-Ⅱ is better than that of PFNA-Ⅱ. The MSN-Ⅱ can bear more loads when fixed A3.3 intertrochanteric fracture and has greater axial and rotational stability. It is an effective means to reconstruct the medial support of A3 intertrochanteric fracture.


Subject(s)
Biomechanical Phenomena , Bone Nails , Bone Screws , Femur , Fracture Fixation, Intramedullary , Hip Fractures/surgery , Humans
19.
Chinese Medical Journal ; (24): 2682-2687, 2020.
Article in English | WPRIM | ID: wpr-877826

ABSTRACT

BACKGROUND@#The reverse obliquity inter-trochanteric fracture is a distinct fracture pattern that is mechanically different from most inter-trochanteric fractures and the optional treatment of it is still controversial. The purpose of this study was to compare differences in the efficacy of a novel nail (medial support nail [MSN-II]) and proximal femoral nail anti-rotation (PFNA-II) in the treatment of reverse obliquity inter-trochanteric fractures (Arbeitsgemeinschaft fur Osteosynthesfrogen/Orthopedic Trauma Association [AO/OTA] 31-A3.1) using finite-element analysis.@*METHODS@#Modeling software was used to establish a three-dimensional model of MSN-II and PFNA-II and an A3.1 inter-trochanteric fracture model. Abaqus software was used to implement different force loads to compare finite-element biomechanical parameters such as the maximum stress in implant and the displacement of fracture site.@*RESULTS@#The femoral stress, implant stress and fracture site displacement of MSN-II was less than that of PFNA-II. The results indicated that the maximal femoral stress was 581 MPa for PFNA-II and 443 MPa for the MSN-II. The maximum stress values in the PFNA-II and MSN-II models were 291 and 241 MPa, respectively. The maximal displacements of the fracture site were 1.47 and 1.16 mm in the PFNA-II and MSN-II models, respectively.@*CONCLUSION@#Compared with PFNA-II for inter-trochanteric fracture (AO/OTA 31-A3.1), MSN-II which was designed with a triangular stability structure can provide better biomechanical stability. The MSN-II may be a feasible option for the treatment of reverse obliquity inter-trochanteric fracture.


Subject(s)
Bone Nails , Femur , Finite Element Analysis , Fracture Fixation, Intramedullary , Hip Fractures/surgery , Humans , Treatment Outcome
20.
Yonsei Medical Journal ; : 201-209, 2020.
Article in English | WPRIM | ID: wpr-811476

ABSTRACT

Kinematically aligned total knee arthroplasty (TKA) is a new alignment technique. Kinematic alignment corrects arthritic deformity to the patient's constitutional alignment in order to position the femoral and tibial components, as well as to restore the knee's natural tibial-femoral articular surface, alignment, and natural laxity. Kinematic knee motion moves around a single flexion-extension axis of the distal femur, passing through the center of cylindrically shaped posterior femoral condyles. Since it can be difficult to locate cylindrical axis with conventional instrument, patient-specific instrument (PSI) is used to align the kinematic axes. PSI was recently introduced as a new technology with the goal of improving the accuracy of operative technique, avoiding practical issues related to the complexity of navigation and robotic system, such as the costs and higher number of personnel required. There are several limitations to implement the kinematically aligned TKA with the implant for mechanical alignment. Therefore, it is important to design an implant with the optimal shape for restoring natural knee kinematics that might improve patient-reported satisfaction and function.


Subject(s)
Arthroplasty, Replacement, Knee , Biomechanical Phenomena , Congenital Abnormalities , Femur , Knee
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