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1.
Braz. dent. sci ; 25(2): 1-7, 2022. tab
Article in English | LILACS, BBO | ID: biblio-1363638

ABSTRACT

Objective: Bisphosphonates are anti-resorptive drugs used in the control and treatment of calcium and bone metabolism disorders. Despite their high clinical efficacy, these drugs have been associated with bisphosphonate-related osteonecrosis of the jaw. The goal of this study is to evaluate the knowledge of final year undergraduate dentistry students on bisphosphonate-related osteonecrosis of the jaw. Material and Methods: A sample of 100 students from private institutions in the state of São Paulo was invited to complete a questionnaire relating to bisphosphonates and the risk factors associated with the development of osteonecrosis of the jaws. Results: 66% of the students did not recognize any bisphosphonate (p=0.0019) and 79% did not recognize their trademark names (p<0.0001). 60% of the students recognized osteonecrosis of the jaws as a side effect of bisphosphonates (p<0.0001) and 56% identified at least one risk factor associated with the drug that may contribute to the side effect (p<0.0001). 66% of the students stated that their course did not provide any lectures on the topic (p<0.0001). Conclusion: The knowledge of dentistry students about bisphosphonates and bisphosphonate-related osteonecrosis of the jaw is variable. This may be related to an inadequate discussion of this topic during their undergraduate studies(AU)


Objetivo: Os bisfosfonatos são medicamentos antirreabsortivos utilizados no controle e tratamento de desordens do cálcio e do metabolismo ósseo. Apesar da elevada eficácia clínica, a terapia com estes medicamentos tem sido associada a uma importante complicação denominada de osteonecrose dos maxilares relacionada ao uso de bisfosfonatos. O objetivo deste estudo é avaliar conhecimento sobre a osteonecrose dos maxilares relacionada ao uso de bisfosfonatos entre os alunos do último ano do curso de graduação de Odontologia. Material e Métodos: Uma amostra de 100 alunos de instituições privadas do estado de São Paulo foi convidada a responder um questionário sobre as principais informações dos bisfosfonatos e fatores de risco associados com o desenvolvimento da osteonecrose dos maxilares. Resultados: Os 100 questionários foram respondidos: 66% dos estudantes não reconheceram algum bisfosfonato (p=0,0019), 79% não reconheceram seus nomes de marcas comerciais (p<0,0001); 60% dos alunos reconheceram a osteonecrose dos maxilares como um efeito colateral dos bisfosfonatos (p<0,0001) e 56% apontaram pelo menos um fator de risco associado com o medicamento que pode causar o desenvolvimento do efeito colateral (p<0,0001); 66% dos estudantes afirmaram que o curso não forneceu alguma aula abordando esta temática (p<0.0001). Conclusão: O grau de conhecimento dos alunos de Odontologia sobre bisfosfonatos e osteonecrose dos maxilares relacionada ao uso de bisfosfonatos é variável e está relacionado com a pouca discussão deste tema durante a graduação(AU)


Subject(s)
Humans , Osteonecrosis , Students, Dental , Diphosphonates
2.
Rev. bras. ortop ; 56(3): 394-398, May-June 2021. graf
Article in English | LILACS | ID: biblio-1288668

ABSTRACT

Abstract Osteonecrosis is a disease that rarely affects the bones of the foot. When present, it is more common in the talus and in the navicular. Cases of osteonecrosis of the intermediate cuneiform are extremely rare, and after a thorough bibliographic review, we found only five reports in the literature, all of them in pediatric patients. Below, we present the case of an adult patient with osteonecrosis of the intermediate cuneiform that was resistant to conservative treatment. Thus, we proposed a surgical approach with good results. Level of Evidence V; Therapeutic Studies; Expert Opinion.


Resumo A osteonecrose é uma doença que raramente afeta os ossos do pé. Quando presente, ela é mais comum no tálus e no navicular. Casos de osteonecrose do cuneiforme intermédio são extremamente raros, e após uma revisão bibliográfica minuciosa encontramos apenas cinco relatos na literatura, sendo todos eles em pacientes pediátricos. A seguir, apresentamos o caso de um paciente adulto com osteonecrose do cuneiforme intermédio resistente ao tratamento conservador. Portanto, propusemos uma abordagem cirúrgica com bom resultado. Nível de Evidência V; Estudos Terapêuticos; Opinião de Especialista.


Subject(s)
Humans , Adult , Osteonecrosis , Tarsal Bones , Conservative Treatment
3.
Rev. bras. ortop ; 56(2): 133-137, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1251352

ABSTRACT

Abstract Medial arthrosis of the knee is an evolutionary pathology that occurs due to progressive muscle imbalance. The muscles of the knee region have a large imbalance caused by the difference of power and lever arm. With the progression of life, this imbalance manifests itself more importantly, especially due to the loss of muscle strength due to aging. Pathological postures begin to occur and determine areas of support and pressure harmful to the joint. Meniscal injury is typical in the evolution of this pathology, as well as cartilage injury. The recognition of this pathology enables good results with less aggressive treatments, such as correction of muscle imbalance and consequent reeducation of joint support. Economic and partial meniscectomy brings good results in the early stages of the degenerative process. Progressive evolution leads to knee degeneration and the consequent need for broader surgeries.


Resumo A artrose medial do joelho é uma patologia evolutiva que ocorre em decorrência de desequilíbrio muscular progressivo. Os músculos da região do joelho têm um grande desequilíbrio, provocado pela diferença de potência e braço de alavanca. Com a progressão da vida, este desequilíbrio se manifesta de forma mais importante, especialmente em decorrência da perda de força muscular em função do envelhecimento. Posturas patológicas passam a ocorrer e determinar zonas de apoio e pressão lesivas para a articulação. A lesão meniscal é típica na evolução desta patologia, assim como a lesão da cartilagem. O reconhecimento desta patologia possibilita resultados bons com tratamentos menos agressivos, como a correção do desequilíbrio muscular e consequente reeducação do apoio da articulação. A meniscectomia econômica e parcial traz bons resultados nas fases iniciais do processo degenerativo. A evolução progressiva leva à degeneração do joelho e à consequente necessidade de cirurgias mais amplas.


Subject(s)
Osteoarthritis/diagnosis , Osteoarthritis/therapy , Osteonecrosis , Meniscus/injuries
4.
Rev. colomb. reumatol ; 28(1): 76-79, ene.-mar. 2021. graf
Article in Spanish | LILACS | ID: biblio-1341364

ABSTRACT

RESUMEN La enfermedad de Dieterich o necrosis avascular de la cabeza de los metacarpianos es una enfermedad muy poco frecuente, con poco más de 50 casos reportados en la literatura. De etiología desconocida, clínicamente se puede manifestar de forma variable, desde asintomática hasta con evidente inflamación y limitación funcional dolorosa de la articulación metacarpofalángica afectada. Presentamos el caso de un paciente de 82 anos que presentaba dolor a nivel de la articulación metacarpofalángica del tercer dedo de la mano derecha, de un año de evolución, sin causa aparente. La exploración física no evidenciaba limitación funcional, ni dolor; tampoco se objetivó eritema, tumefacción o efecto masa. Se realizó un estudio radiológico con diagnóstico de enfermedad de Dieterich avanzada, estableciendo tratamiento conservador con antiinflamatorios no esteroideos con mejoría clínica significativa.


ABSTRACT Dieterich's disease, or avascular necrosis of the metacarpal head, is a very rare disease, with just over 50 cases reported in the literature. Of unknown aetiology, it can manifest clinically in a variable way, from asymptomatic to obvious inflammation and painful functional limitation of the affected metacarpophalangeal joint. The case is presented of an 82-yearold patient who presented with pain at the level of the metacarpophalangeal joint of the third finger of the right hand of 1 year of duration without apparent cause. The physical examination showed no functional limitation or pain. Furthermore, no erythema, swelling, or mass effect was observed. A radiological study was carried out, leading to a diagnosis of advanced Dieterich's disease. Conservative treatment was started with nonsteroidal anti-inflammatory drugs, with a significant clinical improvement.


Subject(s)
Humans , Male , Aged, 80 and over , Osteonecrosis , Disease , Rare Diseases , Diagnosis , Conservative Treatment , Head , Metacarpophalangeal Joint
5.
Rev. bras. ortop ; 56(1): 91-97, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1288643

ABSTRACT

Abstract Objective To analyze long-term functional and radiographic results of partial shoulder replacement for humeral head osteonecrosis. Methods Retrospective review of thirteen cases, with a mean postoperative follow-up of 17 years (range 10 to 26 years). The findings from the last follow-up were compared to those in which the patients had one year of postoperative follow-up. Functional assessment consisted of shoulder movement measurements and application of the University of California, Los Angeles (UCLA) shoulder score. All patients underwent radiographic examination to measure glenoid erosion, proximal humeral migration and lateral glenohumeral dislocation. Results Glenoid erosion increased over time significantly (p < 0.05). Paradoxically, all active shoulder movements also improved (p < 0.05), while UCLA scores remained the same. Radiographic deterioration was not correlated with clinical function. We had an 84.7% survival rate for arthroplasties after a mean time of 16 years. Conclusions Early functional outcomes were maintained in the long run and do not correlate with radiographic deterioration (increased erosion of the glenoid).


Resumo Objetivo Analisar os resultados funcionais e radiográficos de longo prazo da artroplastia parcial do ombro para estosteonecrose da cabeça do úmero. Métodos Revisão retrospectiva de 13 casos, com seguimento pós-operatório médio de 17 anos (variação de 10 a 26 anos). Os achados do último seguimento foram comparados àqueles em que os pacientes tinham com 1 ano de acompanhamento pós-operatório. A avaliação funcional consistiu em medidas do movimento do ombro e aplicação do escore do ombro da Universidade da Califórnia, Los Angeles (UCLA). Todos os pacientes foram submetidos a exame radiografico para medir a erosão glenoidal, a migração umeral proximal, e o deslocamento glenoumeral lateral. Resultados A erosão da glenoide aumentou com o tempo significativamente (p < 0,05). Paradoxalmente, todos os movimentos ativos do ombro também melhoraram (p < 0,05), enquanto os escores da UCLA permaneceram os mesmos. A deterioração radiográfica não teve correlação com a função clínica. Tivemos uma taxa de sobrevida de 84,7% das artroplastias após tempo médio de 16 anos. Conclusões Os resultados funcionais precoces mantiveram-se a longo prazo e não se correlacionem com a deterioração radiográfica (aumento da erosão glenoidal).


Subject(s)
Humans , Osteonecrosis , Follow-Up Studies , Humeral Head
6.
Adv Rheumatol ; 61: 11, 2021. tab
Article in English | LILACS | ID: biblio-1152745

ABSTRACT

Abstract Background: Sickle cell disease (SCD) is an autosomal recessive genetic disease in which a mutation occurs in the β-globin chain gene, resulting in abnormal hemoglobin levels. In an environment with reduced oxygen concentration, red blood cells change their conformation, resulting in chronic hemolysis and consequent anemia and vaso-occlusive crises with injuries to several organs, with a significant impairment of the osteoarticular system. This study aimed to verify the chronic osteoarticular alterations and their association with clinical and laboratory characteristics of patients with SCD with a more severe phenotype (SS and Sβ0), on a steady-state fasis. Methods: Fifty-five patients were referred to a medical consultation with a specialized assessment of the locomotor system, followed by laboratory tests and radiographic examinations. Results: In total, 74.5% patients had hemoglobinopathy SS; 67.3% were female; and 78.2% were non-whites. The mean patient age was 30.5 years. Most patients (61.8%) reported up to three crises per year, with a predominance of high-intensity pain (65.5%). Radiographic alterations were present in 80% patients. A total of 140 lesions were identified, most which were located in the spine, femur, and shoulders. Most lesions were osteonecrosis and osteoarthritis and were statistically associated with the non-use of hydroxyurea. Conclusions: There was a high prevalence of chronic osteoarticular alterations, which was statistically associated only with the non-regular use of hydroxyurea.(AU)


Subject(s)
Humans , Osteoarthritis/etiology , Osteonecrosis/etiology , Bone Diseases, Metabolic/etiology , Hydroxyurea/administration & dosage , Anemia, Sickle Cell/physiopathology , Prognosis , Cross-Sectional Studies/instrumentation , Risk Factors , Hydroxyurea/adverse effects
7.
Article in Chinese | WPRIM | ID: wpr-879417

ABSTRACT

OBJECTIVE@#To study the relationship between osteonecrosis of femoral head after internal fixation of femoral neck fracture and serum bone metabolism, vascular active factors, and analyze the risk factors.@*METHODS@#Total 150 patients with femoral neck fracture who underwent reduction and internal fixation from April 2016 to April 2019 were selected, including 83 males and 67 females. According to whether there was necrosis of femoral head after operation, they were divided into necrosis group(32 cases) and non necrosis group (118 cases). Before operation and 1, 3, 5 days after operation, the serum levels of beta-C terminal cross-linked telopeptides of typeⅠ collagen(β-CTX), N-telopeptide of typeⅠ procollagen(PINP), nitric oxide (NO), Endothelin-1 (ET-1) were measured. The clinical characteristics of the two groups were compared. The risk factors of postoperative femoral head necrosis were analyzed by logistic regression model. The value of serum indexes in predicting postoperative femoral head necrosis was analyzed by ROC curve.@*RESULTS@#There was no significant difference in the levels of serum PINP and β-CTX between necrotic group and non necrotic group before operation and 1, 3 and 5 days after operation(@*CONCLUSION@#The content of serum NO and ET-1 on the first day after operation can predict the necrosis of femoral head.


Subject(s)
Female , Femoral Neck Fractures/surgery , Femur Head , Femur Head Necrosis/etiology , Fracture Fixation, Internal/adverse effects , Humans , Male , Osteonecrosis , Retrospective Studies , Risk Factors
8.
Rev. cuba. reumatol ; 22(3): e786, graf
Article in Spanish | LILACS, CUMED | ID: biblio-1144536

ABSTRACT

Introducción: La osteonecrosis es un trastorno asociado al déficit de riego sanguíneo con isquemia en los vasos nutricios de los huesos interesados, causa dolor crónico y discapacidad funcional. Con el desarrollo de la epidemia de VIH, se aprecia un marcado incremento de esta afección. Objetivo: Determinar la frecuencia y caracterizar clínica y epidemiológicamente a los pacientes cubanos con VIH/sida que desarrollaron osteonecrosis. Métodos: Estudio analítico prospectivo de pilotaje en una serie de 285 pacientes adultos, con infección por HIV/sida atendidos en el Instituto de Medicina Tropical Pedro Kourí en la era posterior a la terapia antirretroviral (TARVAE), años 2003-2018. Los pacientes ofrecieron su consentimiento informado. Se evaluaron variables epidemiológicas consideradas factores de riesgo (estatus procoagulante, alcoholismo, tabaquismo, hipercolesterolemia e hiperlipidemia, consumo de esteroides, conteo de células T, CD4+ y drogas antirretrovirales). Resultados: La edad promedio de la serie fue de 41 años, con una supervivencia de 12 años, marcado predominio del sexo masculino y piel blanca. El modo de adquisición del VIH prevaleciente fue la vía sexual y de hombres que tienen sexo con hombres (67,3 por ciento). Tres pacientes desarrollaron osteonecrosis (1,05 por ciento), necrosis avascular de caderas (2 casos en la derecha y uno bilateral), con cambios radiográficos por esta afección. Entre los factores asociados, un paciente tenía hiperlipidemia, dos eran fumadores, uno consumía alcohol, y los tres tenían conteo de células T CD4+ de más de 200. Todos tenían instaurada la TARVAE con inhibidores de proteasas y de la transcriptasa inversa, incluido tenofovir. Conclusiones: En esta serie de 285 pacientes con VIH, hubo una baja frecuencia de osteonecrosis. No se establecieron relaciones causales entre los factores de riesgo reconocidos en la literatura, la TARVAE y la aparición de osteonecrosis. Queda por definir el papel desempeñado por la infección VIH per se en el desarrollo de esta complicación, o develar si existen otras variables no exploradas en este estudio(AU)


Introduction: Avascular Necrosis or Osteonecrosis (ON) is a process associated with the blood supply deficit with ischemia in the nutritional vessels of the interested bones determining chronic pain, functional disability. In recent years with the growing development of the HIV epidemic, a marked increase in this condition has been observed. Objective: To determine an characterize in the clinical and epidemiological order the Cuban HIV + patients, who developed ON in the context of the HIV epidemic in a series of 285 HIV + cases with highly effective ARV therapy including tenofovir. Methods: Prospective analytical pilot study in a series of 285 patients, with HIV-AIDS infection adults treated in the IPK of Cuba in the later era (years 2003-17) to high-efficiency ARV therapy (TARVAE). Patients diagnosed with HIV / AIDS who offered their informed consent to participate in the study were included, and the research was approved by the IPK Ethics Committee. Results: Average age 41 (15-71) years (p <0.05). Survival 12 years by studies of Kaplan and Maier. Marked male predominance with 230 (81 percent), 55 (19.2 percent) women, white skin color, and 50-59 age group with 146 (51.2 percent) (p <0.05); data similar to the rest of the Cuban population according to other COPCORD Epidemiological studies. (18) Sexual and HIVH prevalent HIV acquisition mode with 192 (67.3 percent). 154 (54 percent) had an undetectable viral load. We found 3 (1.05 percent) patients who developed ON, with an average age of 52 (40-61a), 2 patients in right hip, and one bilateral avascular necrosis of the hips, all with radiological changes of this condition. As associated FR, one patient had hyperlipidemia, another 2 smoker, and 1 alcohol, all 3 with CD4 + T cell count <200 And high viral load. All cases had TARVAE with protease inhibitors, and reverse transcriptase, including Tenofovir. Conclusions: Our report is aimed at showing a low frequency of ON in our series of 285 patients studied in the Cuban HIV epidemic. The hips were the sites of ON, with 1 patients bilateral involvement. Hyperlipidemia, tabaquism and alcohol were the principal risk factors presented and low level of CD4 + T cels, and high viral load. We were unable to establish causal relationships between the recognized risk factors reported in the literature, HAART and the appearance of ON, all of which leave the role played by HIV infection per se in the development of this complication, or the effects of other variables that we have not explored in this preliminary study(AU)


Subject(s)
Humans , Middle Aged , Osteonecrosis/epidemiology , HIV Infections/complications , Anti-Retroviral Agents/therapeutic use , Epidemiologic Studies , Prospective Studies , Cuba/epidemiology
9.
Rev. argent. radiol ; 84(3): 93-106, ago. 2020. tab, graf, il.
Article in Spanish | LILACS | ID: biblio-1143921

ABSTRACT

Resumen El objetivo de este artículo es realizar una revisión de las localizaciones, causas y hallazgos radiológicos específicos de los procesos avasculares óseos. Se define como isquemia ósea a las alteraciones ocasionadas por déficit de irrigación, llevando a la destrucción del hueso. Existen diferencias entre necrosis isquémica e infarto óseo, en base al sitio óseo de afectación. La etiología traumática es la más frecuente y suele ser unilateral. Los sitios de presentación más frecuentes son: cabeza femoral y humeral, rodilla y semilunar. La resonancia magnética (RM) es considerada la modalidad de imagen más sensible y específica, tanto para el diagnóstico temprano como estadificación y control. El conocimiento de las causas, características radiológicas y sus diferentes fases evitan el diagnóstico erróneo de otras etiologías, como las primarias o infecciosas, facilitando un correcto algoritmo terapéutico.


Abstract The aim of this article is to review the locations, causes and specific radiological findings of avascular bone processes. Bone ischemia is defined as the alterations caused by irrigation deficit, leading into the bone destruction. However, there are differences between ischemic necrosis and bone infarction, based on the bone site of involvement. The most frequent etiology is traumatic and is usually unilateral. The most frequent sites of presentation are: femoral and humeral head, knee, and lunate. Magnetic resonance imaging (MRI) is considered the most sensitive and specific imaging modality for early diagnosis, staging and control. The knowledge of the causes, radiological findings and their different phases avoid the erroneous diagnosis of other lesions, such as primary or infectious, facilitating a correct therapeutic algorithm.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged , Aged, 80 and over , Bone and Bones/diagnostic imaging , Bone Diseases/etiology , Magnetic Resonance Spectroscopy/methods , Osteonecrosis/diagnostic imaging , Bone Diseases/classification , Bone Diseases/diagnostic imaging , Ischemia/diagnostic imaging
10.
Rev. méd. Chile ; 148(7): 983-991, jul. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1139400

ABSTRACT

Medication-related osteonecrosis of the jaw is a disease where there is necrotic bone exposed or that can be explored by means of a fistula in the maxillofacial region. It has been associated with the use Biphosphonates and denosumab for osteoporosis. Although its etiology is unclear, it may be related to a decrease in bone turnover produced by these drugs, rendering the bone more prone to generate cell necrosis during invasive dental procedures, especially in the posterior region of the jaw. There is no consensus about the prevention and treatment of this condition. The aim of this paper is to present a review of the literature with the main characteristics of osteonecrosis of the jaws associated with drugs, together with a proposal for prevention and treatment for these patients.


Subject(s)
Humans , Osteonecrosis/chemically induced , Osteonecrosis/prevention & control , Jaw Diseases/chemically induced , Jaw Diseases/prevention & control , Osteoporosis/drug therapy , Diphosphonates/adverse effects , Bisphosphonate-Associated Osteonecrosis of the Jaw/prevention & control , Denosumab/adverse effects
11.
Int. j. morphol ; 38(3): 683-688, June 2020. graf
Article in English | LILACS | ID: biblio-1098307

ABSTRACT

The aim was to evaluate bone repair and gingival tissue repair in osteopenic rats. Fifteen female wistar rats were included; in all of them ovariectomy was realized to induce osteopenia; after 45 days, the animals were submitted to 2 surgical techinques 1) dental extraction of the upper central incisor with no socket preservation and 2) 5 mm cranial defect in the calvarium; 5 rats were included in the control group (G1) withput alendronate application; in the group 2 (G2) was used subcutenous alendronate (0.5 mg/kg) once for three weeks and then was realizd the both surgical techniques. In group 3 (G3), after ovariectomy was realized the both dental extraction and the calvarium defect and after that was realized the alendronate protocol. In each group, after six week was realized euthanasia and descriptive histological analysis of the surgical areas involved. In bone formation of the 5 mm cranial defect was observed with good progression in the 3 experimental models and no modification in quality of bone repair was observed. For the gingival tissue in the extraction socket, no differences were observed between G1 and G3. On other hand, in G2 a thinner and reduced gingival epithelium was found. Our results showed that alendronate was not an obstacle for bone repair; deficiencies in re-epithelialization of oral mucosa show the impact of alendronate before dental extraction.


El objetivo fue evaluar la reparación ósea y gingival en ratas con osteopenia. Quince ratas wistar hembras fueron incluidas; en todas ellas se realizo ovarectomia y fue realizada la inducción de osteopenia; después de 45 días, los animales fueron sometidos a dos técnicas quirúrgicas 1) extracciones dentales del incisivo central superior sin preservación alveolar y 2) creación de un defecto craneano de 5 mm en la calota; 5 animales fueron incluidos como grupo control (G1) sin la aplicación de alendronato; en el grupo 2 (G2) se utilizó alendronato subcutáneo (0,5 mg/kg) una vez a la semana durante 3 semanas. En el grupo 3 (G3), después de la ovarectomia se realizó la exodoncia y el defecto en el cráneo y después de ello se inicio el protocolo con alendronato. En cada grupo, después de seis semanas se realizó la eutanasia con descripción histológica de los hallazgos. En el hueso formado en el defecto craneano de 5 mm se observó una adecuada progresión de reparación en los 3 modelos experimentales y no se observó cambios importantes en el modelo de reparación. Para el tejido gingival en el sitio de extracción, no se observaron diferencias entre el grupo G1 y G3. Por otra parte, el G2 presentó un tejido mas delgado con reducción del epitelio gingival; nuestros resultados demuestran que el alendronato no fue un obstáculo en la reparación ósea; deficiencias en la re epitelización de la mucosa oral muestran el impacto del alendronato después de la exodoncia.


Subject(s)
Animals , Female , Rats , Bone Diseases, Metabolic/drug therapy , Bone Regeneration/drug effects , Alendronate/administration & dosage , Gingiva/drug effects , Osteonecrosis/drug therapy , Osteoporosis/drug therapy , Bone Diseases, Metabolic/complications , Ovariectomy , Rats, Wistar , Diphosphonates/administration & dosage
12.
Rev. Asoc. Argent. Ortop. Traumatol ; 85(Supl. de Asociación Argentina de Cirugía de la Mano): S26-S35, 2020.
Article in Spanish | LILACS, BINACIS | ID: biblio-1352421

ABSTRACT

La osteonecrosis del semilunar o enfermedad de Kienböck es un cuadro progresivo y debilitante que puede llevar al dolor crónico y la pérdida de la función. Pese a que se conoce hace más de 100 años, la etiología todavía es incierta, si bien se la ha relaciona-do con factores mecánicos, vasculares y traumáticos. Su evolución natural está pobremente definida y los hallazgos radiográficos no siempre se correlacionan con los hallazgos clínicos. Se han logrado avances para identificar y entender la progresión del pro-ceso avascular y sus efectos nocivos sobre la mecánica de la muñeca. El tratamiento inicial es no quirúrgico. El perfeccionamiento de la técnica quirúrgica utilizando injertos óseos vascularizados de radio distal puede mejorar los resultados en los pacientes que cursan etapas tempranas de la enfermedad, aunque resta mucho trabajo para determinar si este tratamiento quirúrgico re-presenta una mejor opción que los tratamientos tradicionales. Reportes recientes de resultados a largo plazo de la osteotomía de acortamiento del radio para estadios tempranos de la enfermedad y la resección de la primera fila del carpo para estadios avan-zados revelan que estos procedimientos son una opción válida para el tratamiento a largo plazo de este cuadro de difícil manejo.


Osteonecrosis of the lunate or Kienböck's disease is a progressive, debilitating condition that can lead to chronic pain and function loss. Despite it was identified almost 100 years ago, the etiology remains unknown, although mechanical, vascular, and traumatic factors have been associated. The natural history of Kienböck's disease is poorly defined, and the radiographic findings do not always correlate with the clinical findings. There has been some progress in identifying and understanding the progression of the avascular process and its deleterious effects on wrist mechanics. Initial treatment is conservative. Improvement in surgical tech-niques with vascularized bone grafts from the distal radius may lead to an outcome improvement for patients in the early stages of disease. However, more research is still needed to determine whether this surgical treatment represents an improvement over conventional treatment alternatives. Recent reports of long-term outcomes for radial shortening osteotomy in osteonecrosis early stage patients and for proximal row carpectomy (PRC) in advanced Kienböck's disease patients reveal that these procedures provide reliable options for the long-term management of this challenging condition.


Subject(s)
Osteonecrosis , Wrist
13.
Article in English | WPRIM | ID: wpr-811265

ABSTRACT

OBJECTIVES: The discontinuation of bisphosphonate (BP) treatment before tooth extraction may induce medication-related osteonecrosis of the jaw (MRONJ). Whether the long-term discontinuation of BP treatment before tooth extraction affects the risk of developing MRONJ after tooth extraction or whether extended drug holidays induce systemic side effects remains unclear. The present study assessed the incidence of MRONJ among patients who underwent tooth extraction and did not discontinue BP therapy prior to the procedure.MATERIALS AND METHODS: Patients were classified according to whether or not they discontinued BP therapy before tooth extraction. Differences in the incidence of MRONJ after tooth extraction were compared between the two groups using the chi-squared test.RESULTS: The BP-continuation (BPC) and BP-discontinuation (BPDC) groups included 179 and 286 patients, respectively. One patient in the BPC group and no patients in the BPDC group developed MRONJ (P=0.385). The patients in the BPDC group stopped receiving BP therapy at a mean of 39.0±35.5 months prior to tooth extraction.CONCLUSION: The possibility of pre-existing MRONJ in the extraction area must be considered during the extraction procedure. Routine discontinuation of BP medications for several months before the extraction procedure should be carefully considered, as evidence of its efficacy in reducing the development of post-extraction MRONJ is limited.


Subject(s)
Holidays , Humans , Incidence , Jaw , Osteonecrosis , Tooth Extraction , Tooth
14.
Article in English | WPRIM | ID: wpr-811123

ABSTRACT

BACKGROUND: We aimed to confirm the long-term effect of patellar nonresurfacing (patellar decompression) in preventing anterior knee pain after total knee arthroplasty (TKA) and to investigate the possible complications.METHODS: Among patients who underwent primary TKA after being diagnosed as having advanced osteoarthritis (Kellgren-Lawrence grade 4) at our institution from January 2004 to December 2010, 121 patients who were followed up for more than 7 years were included in this study. Patients who underwent TKA with and without patellar decompression were classified as the study group and control group, respectively. A clinical knee rating score was used to compare the postoperative clinical outcomes between groups. To identify complications after patellar decompression, simple radiographs (weight-bearing anteroposterior and lateral views, patella in 30° and 45° axial views, and whole scanogram) were taken during follow-up.RESULTS: There were no complications such as patellar fracture, osteonecrosis, and subluxation. At 2 years after surgery, the prevalence of anterior knee pain was 12.7% and 18.0% in the study group and control group, respectively (p = 0.42), and the number of patients with patellofemoral osteoarthritis grade II or over was lower in the study group (p = 0.03). At 7 years after surgery, the prevalence of anterior knee pain was 18.3% and 24.0% in the study group and control group, respectively (p = 0.45), and there was no statistically significant intergroup difference in the number of patients with patellofemoral osteoarthritis grade II or over (p = 0.11).CONCLUSIONS: Patellar nonresurfacing TKA reduces anterior knee pain in the early postoperative period. The procedure can be considered a relatively safe option with fewer complications; however, its effectiveness appears to decrease over time.


Subject(s)
Arthroplasty, Replacement, Knee , Decompression , Follow-Up Studies , Humans , Knee , Osteoarthritis , Osteonecrosis , Patella , Postoperative Period , Prevalence
15.
Article in English | WPRIM | ID: wpr-811117

ABSTRACT

BACKGROUND: There is a paucity of literature on the use of hip arthroscopy for pathologic conditions in skeletally immature patients. Thus, the indications and safety of the procedure are still unclear. The purpose of this study was to investigate the safety and functional outcomes of hip arthroscopy for pediatric and adolescent hip disorders. We further attempted to characterize arthroscopic findings in each disease.METHODS: We retrospectively reviewed 32 children and adolescents with hip disorders who underwent 34 hip arthroscopic procedures at a tertiary care children's hospital from January 2010 to December 2016. We evaluated functional limitations and improvement after operation by using the modified Harris hip score (HHS), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), subjective pain assessment with a visual analog scale (VAS), and range of hip motion as well as the complications of hip arthroscopy. Arthroscopic findings in each disease were recorded.RESULTS: Hip arthroscopy was performed for Legg-Calvé-Perthes disease (n = 6), developmental dysplasia of the hip (n = 6), slipped capital femoral epiphysis (n = 5), idiopathic femoroacetabular impingement (n = 6), sequelae of septic arthritis of the hip (n = 3), hereditary multiple exostosis (n = 2), synovial giant cell tumor (n = 3), idiopathic chondrolysis (n = 2), and posttraumatic osteonecrosis of the femoral head (n = 1). Overall, there was a significant improvement in the modified HHS, WOMAC, VAS, and range of hip motion. Symptom improvement was not observed for more than 18 months in four patients who had dysplastic acetabulum with a labral tear (n = 2) or a recurrent femoral head bump (n = 2). There were no complications except transient perineal numbness in five patients.CONCLUSIONS: Our short-term follow-up evaluation shows that hip arthroscopy for pediatric and adolescent hip disorder is a less invasive and safe procedure. It appears to be effective in improving functional impairment caused by femoroacetabular impingement between the deformed femoral head and acetabulum or intra-articular focal problems in pediatric and adolescent hip disorders.


Subject(s)
Acetabulum , Adolescent , Arthritis, Infectious , Arthroscopy , Child , Exostoses, Multiple Hereditary , Femoracetabular Impingement , Follow-Up Studies , Giant Cell Tumors , Head , Hip , Humans , Hypesthesia , Legg-Calve-Perthes Disease , Ontario , Osteoarthritis , Osteonecrosis , Pain Measurement , Retrospective Studies , Slipped Capital Femoral Epiphyses , Tears , Tertiary Healthcare , Visual Analog Scale
16.
Article in Chinese | WPRIM | ID: wpr-828212

ABSTRACT

OBJECTIVE@#To explore the risk factors of osteonecrosis of femoral head after internal fixation of femoral neck fracture in young patients, to describe the quality of life of patients with surviving femoral head, and to quantify the predictive factors.@*METHODS@#From January 2013 to December 2016, 172 patients (174 hips) with femoral neck fracture treated by closed reduction and cannulated screw internal fixation were selected for retrospective analysis. The general data of the patients were summarized, including age, gender, body mass index, trauma mechanism, trauma operation interval, trauma season and whether the internal fixation was removed. The imaging data included the Garden classification and Pauwel classification of fractures, femoral head retroversion angle, postoperative fracture reduction, screw distribution. Single factor analysis and multi-factor Logistic regression analysis were carried out to explore the risk factors of femoral head necrosis and internal fixation failure. The patients who survived the internal fixation were followed up. The quality of life of the patients was evaluated by the health survey of SF-36. The Harris score of hip joint function was used to evaluate the hip joint function. The predictors of the quality of life of the patients after the operation of femoral neck fracture were analyzed by multiple linear regression analysis.@*RESULTS@#Total 172 patients(174 hips) were included in the study, 29 patients(16.67%) had necrosis of the femoral head. In multivariate Logistic regression analysis, the significant differences were reduction quality (=0.126, =0.027) and posterior inclination angle (=4.380, =0.010). One hundred and thirty six patients (137 hips) who survived the femoral head were included in the quality of life survey. Harris score was 90.14±7.92, including excellent 96 hips (70.07%), good 28 hips (20.44%), medium 13 hips (9.49%) and poor 0 hip. In SF-36 score, physical health summary (PCS) was 46.12±9.12, mental health summary(MCS) was 50.21±3.97, there was no linear correlation between them (>0.05). In multiple linear regression analysis, the variables with significant difference in PCS were reduction quality and retroversion angle, and the variables with significant difference in MCS were fracture displacement and trauma mechanism.@*CONCLUSION@#Poor reduction quality and posterior inclination angle>15° are the risk factors of femoral head necrosis. The function of hip joint and MCS of patients with femoral neck fracture recovered well, but PCS could not recover to the average level of normal people. The reduction quality and retroversion angle could be used as the predictors of PCS, and the displacement and trauma mechanism of fracture could be used as the predictors of MCS.


Subject(s)
Femoral Neck Fractures , Femur Head , Fracture Fixation, Internal , Humans , Osteonecrosis , Quality of Life , Retrospective Studies
17.
Rev. Ciênc. Plur ; 6(2): 205-219, 2020. ilus
Article in Portuguese | LILACS, BBO | ID: biblio-1100329

ABSTRACT

Introdução:Os bifosfonatos são medicamentos que objetivam reduzir a reabsorção óssea por provocarem a apoptose de osteoclastos. Por essa razão, são frequentemente empregados em pacientes com osteoporose e no tratamento do câncer. Contudo, apesar dos benefícios associados ao tratamento com bifosfonatos, esses medicamentos vêm sendo relacionados a osteonecrose maxilo-mandibular, materializando-se como um preocupante quadro de interesse à saúde pública. Objetivo:Apresentar um caso clínico de osteonecrose mandibular associada ao uso de bifosfanato, após extração de um elemento dentário, bem como contribuir com as discussões sobre as possibilidades terapêuticas desta enfermidade.Descrição do caso:Paciente do sexo masculino,com59 anosidade, encaminhado ao serviço de Cirurgia e Traumatologia Bucomaxilofacial,dois meses após a extração do elemento dentário 45.O diagnóstico foi de Osteonecrose Maxilomandibular Relacionada a Bifosfonatos, sendo realizado,inicialmente, a remoção dos traumas existentes, como também o cuidado com a área exposta. Posteriormente,optou-se pela remoção do segmento ósseo necrótico.Conclusões:A complexafisiopatologiado tipo de osteonecrose estudadaexige dos CirurgiõesDentistas a tomada de medidas em tempo oportuno e que cause o mínimo transtorno à vida dos pacientes.Assim, deve-se avaliar o estado da lesão, havendo indicação de terapia conservadora para os achados precoces. O desbridamento cirúrgico é aconselhado para o tratamento da doença avançada e não responsiva (AU).


Introduction:Bisphosphonates are medications that aim to reduce bone resorption by causing osteoclast apoptosis. For this reason, they are often used in patients with osteoporosis and in the treatment of cancer. However, despite the benefits associated with treatment with bisphosphonates, these drugs have been linked to maxillomandibular osteonecrosis, materializing as a worrying picture of public health concern. Objective:To present a clinical case of mandibular osteonecrosis associated with the use of bisphosphateafter extraction of a dental element, as well as to contribute to the discussions about the therapeutic possibilities of this disease. Case description:Male patient, 59 years old, referred to the Buccomaxillofacial Surgery and Traumatology service, two months after extraction of the dental element 45. The diagnosis was Bisphosphonate-Related Maxillomandibular Osteonecrosis, initially performed, the removal of existing traumas, as well as care for the exposed area. Subsequently, it was decided to remove the necrotic bone segment. Conclusions: The complex pathophysiology of the type of osteonecrosis studied requires that dental surgeons take measures in a timely manner and cause the least disturbance to patients' lives. Thus, the condition of the lesion should be assessed, with an indication for conservative therapy for early findings. Surgical debridement is recommended for the treatment of advanced and unresponsive diseases (AU).


Introducción: Los bisfosfonatos son medicamentos que tienen como objetivo reducir la resorción ósea al causar apoptosis de osteoclastos. Por esta razón, a menudo se usan en pacientes con osteoporosis y en el tratamiento del cáncer. Sin embargo, a pesar de los beneficios asociados con el tratamiento con bisfosfonatos, estos medicamentos se han relacionado con la osteonecrosis maxilomandibular, materializándose como un escenario preocupante de interés para la salud pública. Objetivo: Presentar un caso clínico de osteonecrosis mandibular asociada con el uso de bisfosfanato después de la extracción de un elemento dental, así como contribuir a las discusiones sobre las posibilidades terapéuticas de esta enfermedad. Descripción del caso: un paciente masculino de 59 años fue derivado del Departamento de Traumatología y Cirugía Buccomaxilofacial después de meses de extracción dental 45. El diagnóstico era de Osteonecrosis Maxilomandibular Relacionada con Bifosfonatos, inicialmente eligiendoeliminar los traumas existente, bien como delcuidado con el área expuesta. Posteriormente, elegimos eliminar el segmento óseo necrótico.Conclusiones: La compleja fisiopatología del tipo de osteonecrosis estudiada requiere que los cirujanos dentales tomen las medidas adecuadas y causen el menor inconveniente a la vida de los pacientes. Por lo tanto, se debe evaluar el estado de la lesión, con terapia conservadora indicada para hallazgos tempranos. El desbridamiento quirúrgico se recomienda para el tratamiento de enfermedades avanzadas y que no responden (AU).


Subject(s)
Humans , Male , Middle Aged , Osteonecrosis , Diphosphonates , Bisphosphonate-Associated Osteonecrosis of the Jaw , Mandible , Brazil , Tomography, X-Ray Computed/instrumentation
18.
Rev. colomb. anestesiol ; 47(4): 249-252, Oct-Dec. 2019.
Article in English | LILACS, COLNAL | ID: biblio-1042736

ABSTRACT

Abstract Sickle cell anemia or drepanocytosis is a hemoglobinopathy with autosomal recessive inheritance. A longer life expectancy of these patients and the fact that 50% have aseptic osteonecrosis of the hip make total hip arthroplasty a frequent procedure. We present the case of a 34-year-old male diagnosed with homozygous sickle cell disease scheduled for surgery in the operating room. Our aim is to offer perioperative strategies based on a multidisciplinary approach among anesthesiologists, surgeons, and hematologists to avoid complications of the disease itself, exacerbated by moderate-high risk surgeries.


Resumen La anemia de células falciformes o drepanocitosis es una hemoglobinopatía con herencia autosómica recesiva. La mayor esperanza de vida de estos pacientes y el hecho de que el 50% presenten osteonecrosis aséptica de cadera determinan que la artroplastia total de cadera sea un procedimiento frecuente. Presentamos el caso de un varón de 34 años diagnosticado de drepanocitosis homocigota programado en quirófano para dicha intervención quirúrgica. Nuestro objetivo es ofrecer unas estrategias perioperatorias basadas en un abordaje multidisciplinar entre anestesiólogos, cirujanos y hematólogos para evitar complicaciones propias de la enfermedad, exacerbadas por cirugías de riesgo moderado-alto.


Subject(s)
Humans , Male , Middle Aged , Osteonecrosis , Anesthesiologists , Hemoglobinopathies , Anemia, Sickle Cell , Operating Rooms , Surgical Procedures, Operative , Arthroplasty, Replacement, Hip , Surgeons
19.
Rev. MVZ Córdoba ; 24(3): 7372-7377, sep.-dic. 2019. graf
Article in Spanish | LILACS | ID: biblio-1115264

ABSTRACT

RESUMEN Se reporta el caso de una cabra macho de raza alpina de 7 meses de edad, que presentaba claudicación del miembro posterior derecho sin causa definida. Se realizaron los exámenes clínicos y radiográficos, sugiriendo luxación traumática o necrosis avascular de cabeza femoral con consecuente enfermedad degenerativa articular. Se realizó tratamiento quirúrgico mediante artroplastia por excisión de cabeza y cuello femoral. El estudio histopatológico mediante la coloración de hematoxilina y eosina describió: hueso necrótico, lagunas conteniendo osteocitos necróticos, además de médula ósea necrótica. Esta información comprobó el diagnóstico de necrosis avascular de la cabeza y cuello femoral. En el post quirúrgico, la recuperación clínica del paciente se consideró buena, mitigando el dolor y mejorando la función del miembro afectado. El presente caso se trata del primer reporte de esta enfermedad en caprinos en el Perú.


ABSTRACT It is reported the case of a 7-month-old male goat of alpine race, who presented claudication of the right hind limb without definite cause. Clinical and radiographic examinations were performed, suggesting traumatic dislocation or avascular necrosis of the femoral head with consequent degenerative joint disease. It was performed a surgical treatment by an arthroplasty by excision of the head and neck of femur. The histopathological study by staining hematoxylin and eosin described: necrotic bone, lacunae containing necrotic osteocytes, as well as necrotic bone marrow. This information proved the diagnosis of avascular necrosis of the femoral head and neck. In the post-surgical period, the clinical recovery of the patient was considered good, the pain was mitigated and the function of the affected limb was improved. The present case is the first report of this disease in goats in Peru.


Subject(s)
Animals , Goats , Osteoarthritis , Osteonecrosis , Femur Head Necrosis
20.
Einstein (Säo Paulo) ; 17(3): eRW4628, 2019. tab, graf
Article in English | LILACS | ID: biblio-1012000

ABSTRACT

ABSTRACT To establish the profile of patients who developed antiangiogenic agent-related osteonecrosis of the jaws, and identify the treatments currently used in dental management. We searched the PubMed®/Medline® and Scopus databases using the words "osteonecrosis AND antiangiogenic therapy", with the following inclusion criteria: articles published in English, case reports, available online, and for an unlimited period. Of the 209 articles retrieved, 18 were selected, for a total of 19 case reports, since one article included two cases that met the inclusion criteria for this study. Medication-related osteonecrosis of the jaws is characterized by exposure of necrotic bone in the oral cavity that does not heal over a period of 8 weeks in patients with no previous history of radiation therapy. Antiangiogenic drugs are indicated in the treatment of certain tumors, since they stop the formation of new blood vessels, controlling tumor growth and the chance of metastasis. Dental prevention is essential in patients who will be put on antiangiogenic agents, to minimize the risk for osteonecrosis.


RESUMO Traçar o perfil dos pacientes que desenvolveram osteonecrose dos maxilares associada a agentes antiangiogênicos e identificar os tratamentos realizados atualmente no manejo odontológico. Foi realizada busca nas bases de dados PubMed®/Medline® e Scopus por meio dos descritores "osteonecrosis AND antiangiogenic therapy", sendo utilizados os critérios de inclusão: artigos publicados em inglês, relato de caso, disponíveis on-line e por período ilimitado. Após análise dos 209 artigos encontrados, foram selecionados 18 artigos para este estudo, resultando em 19 relatos de caso, visto que um dos artigos apresentou dois casos que se enquadravam nos critérios de inclusão. A osteonecrose dos maxilares associada a medicamentos é caracterizada pela exposição de osso necrótico na cavidade oral que não cicatriza em um período de 8 semanas em pacientes que não foram submetidos à radioterapia. Os medicamentos antiangiogênicos são indicados no tratamento de alguns tumores, pois impedem o crescimento de novos vasos sanguíneos, controlando o crescimento do tumor e a chance de metastização. Torna-se imprescindível a realização de prevenção odontológica do paciente a ser submetido a uso de antiangiogênicos visando a minimizar as chances de desenvolvimento da osteonecrose.


Subject(s)
Humans , Male , Female , Osteonecrosis/chemically induced , Jaw Diseases/chemically induced , Angiogenesis Inhibitors/adverse effects , Risk Factors
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