Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 20 de 726
Filter
1.
Rev. bras. ortop ; 57(1): 113-119, Jan.-Feb. 2022. tab, graf
Article in English | LILACS | ID: biblio-1365735

ABSTRACT

Abstract Objective The present study aimed to evaluate esthetic and functional outcomes from the surgical treatment of Madelung deformity in children. MethodThis is a retrospective study of pediatric patients with Madelung deformity who were surgically treated with dome osteotomy of the distal radius and Vickers ligament section from 2015 to 2018. Patients with a minimum postoperative follow-up period of 12 months were included. Demographic data, surgical technique, clinical and radiographic outcomes were analyzed. Pre and postoperative radiographic evaluation consisted of ulnar tilt, lunate subsidence lunate fossa angle, and palmar carpal displacement measurements. The postoperative clinical evaluation consisted of ranges of motion of the wrist, visual analog scale (VAS) and Disabilities of the Arm, Shoulder and Hand (DASH) score. Results Four patients were included, two with idiopathic Madelung deformity and two with bone dysplasia. All patients were females and presented bilateral disease. Six wrists were operated on. The median age at surgery was 15.5 years old, and the median postoperative follow-up time was of 37.5 months. The postoperative radiographic analysis revealed an average correction of 8.8 ± 7.5° for ulnar tilt, 3.0 ± 3.9 mm for lunate subsidence 8.2 ± 6.6° for lunate fossa angle, and 4.7 ± 2.6 mm for palmar carpal displacement. Average postoperative ranges of motion of the wrist joint were 75.8 ± 3.4° for flexion, 62.5 ± 14.1° for extension, 25.7 ± 2.9° for radial deviation, 40.0 ± 2.9° for ulnar deviation, 88.3 ± 2.4° for pronation, and 82.5 ± 2.5° for supination. The median VAS was 1 for residual pain, 0 for functional deficit, 0 for esthetic impairment, and 10 for recommending the surgical procedure. The median DASH score was 0. Conclusion Madelung deformity treatment using dome osteotomy of the distal radius and Vickers ligament section results in excellent esthetic and functional outcomes.


Resumo Objetivo Avaliar o resultado estético e funcional do tratamento cirúrgico da deformidade de Madelung em idade pediátrica. MétodoEstudo retrospectivo dos pacientes com deformidade de Madelung em idade pediátrica tratados cirurgicamente através de osteotomia em cúpula do rádio distal e secção do ligamento de Vickers entre 2015 e 2018. Foram incluídos doentes com tempo de seguimento pós-operatório mínimo de 12 meses. Foram analisados dados demográficos, técnica cirúrgica, resultados clínicos e radiográficos. A avaliação radiográfica pré e pós-operatória consistiu na medição da inclinação ulnar, do afundamento semilunar, do ângulo da fossa semilunar e do desvio palmar do carpo. A avaliação clínica pós-operatória consistiu na medição das amplitudes articulares do punho, escala visual analógica (EVA) e score Disabilities of the Arm, Shoulder and Hand (DASH). Resultados Foram incluídos quatro pacientes, dois com Madelung idiopática e dois com displasia óssea, todos do sexo feminino e com doença bilateral. Foram operados 6 punhos, a idade mediana à data de cirurgia foi 15,5 anos, e o tempo mediano de seguimento pós-operatório foi de 37,5 meses. Na análise radiográfica pós-operatória, verificou-se uma correção média de 8,8 ± 7,5° da inclinação ulnar, de 3 ± 3,9 mm do afundamento semilunar, de 8,2 ± 6,6° do ângulo da fossa semilunar e de 4,7 ± 2,6 mm do desvio palmar do carpo. Na avaliação da amplitude articular média pós-operatória, registrou-se uma flexão de 75,8 ± 3,4°; extensão de 62,5 ± 14,1°; desvio radial de 25,7 ± 2,9°; desvio cubital de 40,0 ± 2,9; pronação de 88,3 ± 2,4°; supinação de 82,5 ± 2,5°. Registou-se EVA mediana para dor residual = 1, défice funcional = 0, prejuízo estético = 0, e recomendação de procedimento cirúrgico = 10. A mediana do score DASH foi 0. Conclusão O tratamento da deformidade de Madelung através da osteotomia em cúpula do rádio distal e secção do ligamento de Vickers permite obter um excelente resultado estético e funcional.


Subject(s)
Humans , Female , Child , Osteotomy , Radius/anatomy & histology , Congenital Abnormalities , Ulna/abnormalities , Bone Diseases, Developmental , Retrospective Studies
2.
Arch. endocrinol. metab. (Online) ; 65(4): 505-511, July-Aug. 2021. tab, graf
Article in English | LILACS | ID: biblio-1339100

ABSTRACT

ABSTRACT Objective: To evaluate changes in bone density and architecture in postmenopausal women with breast cancer (BC) and use of aromatase inhibitor (AI). Subjects and methods: Thirty-four postmenopausal women with BC, without bone metastasis, renal function impairment and who were not receiving bone-active drugs were selected from a population of 523 outpatients treated for BC. According to the presence of hormonal receptors, HER2 and Ki67, seventeen had positive hormonal receptors and received anastrozole (AI group), and seventeen were triple-negative receptors (non-AI group), previously treated with chemotherapy. Areal bone mineral density (aBMD) and vertebral fracture assessment (VFA) analyses were performed by DXA; vBMD and bone microarchitecture were evaluated by HR-pQCT. Fracture risk was estimated using the FRAX tool. Results: No patient referred previous low-impact fracture, and VFA detected one moderate vertebral fracture in a non-AI patient. AI patients showed lower aBMD and BMD T-scores at the hip and 33% radius and a higher proportion of osteoporosis diagnosis on DXA (47%) vs non-AI (17.6%). AI group had significantly lower values for vBMD at the entire, cortical and trabecular bone compartments, cortical and trabecular thickness and BV/TV. They also had a higher risk for major fractures and for hip fractures estimated by FRAX. Several HR-pQCT parameters evaluated at distal radius and distal tibia were significantly associated with fracture risk. Conclusion: AI is associated with alterations in bone density and microarchitecture of both the cortical and trabecular compartments. These findings explain the overall increase in fracture risk in this specific population.


Subject(s)
Humans , Female , Osteoporosis , Breast Neoplasms/drug therapy , Radius , Tibia , Absorptiometry, Photon , Bone Density , Aromatase Inhibitors/adverse effects
3.
Rev. bras. ortop ; 56(2): 224-229, Apr.-June 2021. tab, graf
Article in English | LILACS | ID: biblio-1251345

ABSTRACT

Abstract Objective The present study aimed at analyzing the clinical, radiological and functional results of the reconstruction of the distal radius after tumor resection with a custom-made metal arthrodesis implant and compare them with other types of distal radius reconstruction, as presented in the literature. To our best knowledge, this is the first article describing this particular type of implant and patient functionality. Methods Functional outcomes of reconstruction of the distal radius were assessed in a series of 4 patients. Three of the patients having had resection of giant cell tumors (GCTs), one patient having had resection of osteosarcoma. Results There were no major implant-related complications like infection, nonunion or loosening. Two patients had to undergo further surgery for protruding metalwork. Overall function was good according to the Musculoskeletal Tumor Society MSTS and Disabilities of the Arm, Shoulder, and Hand (DASH) scores. Conclusion The present study shows that custom-made metal arthrodesis implant benefits from the fact that it can be used as a salvage option when other treatments have failed, or it can be used as a primary option in cases in which there is limited bone stock after distal radius tumor resection.


Resumo Objetivo O presente estudo teve como objetivo analisar os resultados clínicos, radiológicos e funcionais da reconstrução do rádio distal após a ressecção do tumor com implante metálico personalizado de artrodese e compará-los com outros tipos de reconstrução do rádio distal, conforme apresentado na literatura. Pelo que conhecemos, este é o primeiro artigo descrevendo esse tipo particular de implante e funcionalidade no paciente. Métodos Os desfechos funcionais de reconstrução do rádio distal foram avaliados em uma série de 4 pacientes. Três dos pacientes tiveram ressecção de tumores de células gigantes (TCGs), sendo um paciente com ressecção de osteossarcoma. Resultados Não houve complicações relacionadas ao implante, como infecção, não sindicalidade ou afrouxamento. Dois pacientes tiveram que passar por uma nova cirurgia para a protusão da prótese metálica. A função geral foi boa de acordo com as pontuações da Musculoskeletal Tumor Society (MSTS) e Disabilities of the Arm, Shoulder, and Hand (DASH). Conclusão O estudo mostra que o implante metálico personalizado de artrodese se beneficia do fato de que pode ser usado como opção de salvamento quando outros tratamentos falharam, ou pode ser usado como opção primária nos casos em que há estoque ósseo limitado após a ressecção do tumor do rádio distal.


Subject(s)
Humans , Male , Female , Adult , Arthrodesis , Prostheses and Implants , Radius/surgery , Sarcoma , Wrist , Osteosarcoma , Giant Cell Tumors
4.
Article in Chinese | WPRIM | ID: wpr-888329

ABSTRACT

OBJECTIVE@#To investigate the effect and safety of ulnar osteochondroma resection, ulnar minimally invasive osteotomy, external fixation and ulnar lengthening in the treatment of forearm deformity of metaphyseal extension of ulna.@*METHODS@#From August 2005 to December 2013, there were 20 cases of ulnar metaphyseal sequelae, including 15 males and 5 females, aged from 7 to 13(10.00±2.34) years, the course of disease ranged for 6 to 11(8.10±1.52) months. The clinical manifestations were shortening of the affected forearm and bending to the ulnar side. The postoperative evaluation included pain, activities of daily living, orthopedic effect and the range of motion of wrist, elbow and forearm. The radiological evaluation included ulnar length, radial joint inclination angle and wrist epiphysis growth.@*RESULTS@#All patients healed without infection. The only operation related to complications was ulnar lengthening, including 1 case of nonunion, 2 cases of ulnar lengthening callus fracture and 1 case of temporary radial nerve palsy. All patients were followed up for 4 to 7.5 years, with an average of (6.03±1.33) years. There were statistically significant differences in changes of wrist radial deviation, ulnar deviation, forearm pronation and supination in all cases (@*CONCLUSION@#Ulnar lengthening is not beneficial to prevent the development of long-term deformity. Simple resection of osteochondroma of distal ulna is beneficial to prevent the development of deformity. Patients with limited rotation of wrist joint and forearm and strong demand for improvement of appearance can be actively treated.


Subject(s)
Activities of Daily Living , Elbow Joint , Female , Humans , Male , Radius/surgery , Range of Motion, Articular , Treatment Outcome , Ulna/surgery , Wrist Joint/surgery
5.
Article in Chinese | WPRIM | ID: wpr-879388

ABSTRACT

OBJECTIVE@#To investigate specific technique and clinical effects of closed folding top consolidation maneuver combined with splint fixation maneuver for consolidation and cedar bark external fixation splint for the treatment of double fractures of distal ulna and radius in children.@*METHODS@#From January 2017 to December 2019, 17 children with double fractures of distal ulna and radius were treated with closed folded apex consolidation maneuver, including 13 males and 4 females, aged from 4 to 11 years old with an average of (7.29±2.34) years old. The fractures were fixed with cedar bark splint and followed up for 6 months, and alignment of fracture was evaluated according to the latest X-rays by follow up, and function of the affected limbs was evaluated by Anderson forearm function evaluation criteria.@*RESULTS@#Fifteen of 17 children were successfully reset immediately, and 2 children were successfully reset again. The average fixed time was (25.00±3.35) days. At 6 months of follow up, 12 patients got excellent results, 3 good, 2 fair, and 0 poor according to Anderson forearm function evaluation criteria. The position of all children were larger than 3/4, and 10 children were received anatomical reduction, alignment of 4 children was less than 10°, 3 children was less than 15°. No complications such as fracture displacement, nonunion, compartment syndrome, and forearm rotation dysfunction occurred.@*CONCLUSION@#Restoration of distal radius double fracture in children with the combination of the closed folding and top fixation maneuver and splint fixation maneuver has advantages of higher success rate, lower complications, which could reduce operating difficultyand pain of patients.


Subject(s)
Aged , Child , Child, Preschool , Female , Fracture Fixation , Fracture Fixation, Internal , Humans , Male , Radius , Radius Fractures/therapy , Splints , Treatment Outcome , Ulna , Ulna Fractures
6.
Rev. bras. ortop ; 55(6): 764-770, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156206

ABSTRACT

Abstract Objective To analyze the anatomical variations of the motor branches of the radial nerve in the elbow region. The origin, course, length, branches, motor points and relationships with neighboring structures were evaluated. Materials and Methods Thirty limbs from15 adult cadavers were dissected and prepared by intra-arterial injection of a 10% glycerin and formaldehyde solution. Results The first branch of the radial nerve in the forearm went to the brachioradialis muscle (BR), originating proximally to the division of the radial nerve into superficial branch of the radial nerve (SBRN) and posterior interosseous nerve (PIN) in all limbs. The branches to the extensor carpi radialis longus muscle (ECRL) detached from the proximal radial nerve to its division into 26 limbs, in 2, at the dividing points, in other 2, from the PIN. In six limbs, the branches to the BR and ECRL muscles originated from a common trunk. We identified the origin of the branch to the extensor carpi radialis brevis muscle (ECRB) in the PIN in 14 limbs, in the SBRN in 12, and in the radial nerve in only 4. The branch to the supinator muscle originated from the PIN in all limbs. Conclusion Knowledge of the anatomy of the motor branches of the radial nerve is important when performing surgical procedures in the region (such as the approach of the proximal third and the head of the radius, release of compressive syndromes of the posterior interosseous nerve and radial tunnel, and distal nerve transfers) in order to understand the order of recovery of muscle function after a nerve injury.


Resumo Objetivo Analisar as variações anatômicas dos ramos motores do nervo radial na região do cotovelo. Foram avaliadas a origem, curso, comprimento, ramificações, pontos motores e relações com estruturas vizinhas. Materiais e Métodos Foram dissecados 30 membros de 15 cadáveres adultos, preparados por injeção intra-arterial de uma solução de glicerina e formol a 10%. Resultados O primeiro ramo do nervo radial no antebraço foi para o músculo braquiorradial (BR), que se origina proximalmente à divisão do nervo radial em ramo superficial do nervo radial (RSNR) e nervo interósseo posterior (NIP) em todos os membros. Os ramos para o músculo extensor radial longo do carpo (ERLC) se desprenderam do nervo radial proximalmente à sua divisão em 26 membros, em 2, nos pontos de divisão, em outros 2, do NIP. Em seis, os ramos para os músculos BR e ERLC originavam-se de um tronco comum. Identificamos a origem do ramo para o músculo extensor radial curto do carpo (ERCC) no NIP em 14 membros, no RSNR em 12, e no nervo radial em apenas 4. O ramo para o músculo supinador originou-se do NIP em todos os membros. Conclusão O conhecimento da anatomia dos ramos motores do nervo radial é importante quando se realizam procedimentos cirúrgicos na região, como a abordagem do terço proximal e da cabeça do rádio, a liberação das síndromes compressivas do nervo interósseo posterior e do túnel radial, as transferências nervosas distais, e para entender a ordem de recuperação da função muscular após uma lesão nervosa.


Subject(s)
Radial Nerve , Radius , Surgical Procedures, Operative , Wrist , Cadaver , Nerve Transfer , In Situ Nick-End Labeling , Elbow , Extremities , Forearm , Forearm Injuries , Glycerol , Head , Anatomy , Injections, Intra-Arterial
7.
Rev. bras. ortop ; 55(6): 748-754, Nov.-Dec. 2020. tab, graf
Article in English | LILACS | ID: biblio-1156199

ABSTRACT

Abstract Objective To compare the functional results of patients with complex proximal humerus fracture submitted to total shoulder reverse arthroplasty with and without tuberosity healing. The secondary goal was to know the tuberosity healing rate after reverse shoulder arthroplasty with our surgical technique. Methods A retrospective, cohort type study, with a prospective database collection. In total, 28 patients fulfilled the inclusion criteria: age ≥ 65 years, reverse shoulder arthroplasty for complex proximal humerus fracture (type-3 or -4, according to Neer), and a minimum of 24 months of follow-up. At six months of follow-up, all of the patients were evaluated radiographically for tuberosity, and then they were divided into 2 groups: those with healed tuberosities and those with non-healed tuberosities. A clinical evaluation using the Constant score, active range of motion and the Visual Analog Scale (VAS) at the last follow-up was also performed. Results Tuberosity healing occurred in 21 patients (76.3%). There were statistically significant differences in the Constant scoring system (p < 0.001), forward elevation (p = 0.020), internal rotation (p = 0.001) and external rotation (p = 0.003) when comparing the group of healed tuberosities with the group of non-healed tuberosities. No differences were found regarding the VAS score. Conclusion Tuberosity healing results in an improvement of the functional outcomes of patients submitted to reverse shoulder arthroplasty as a treatment for complex proximal humeral fractures in the elderly.


Resumo Objetivo Comparar os resultados funcionais entre pacientes com fratura complexa do úmero proximal submetidos a artroplastia reversa com tubérculos consolidados e tubérculos não consolidados. O objetivo secundário foi determinar a taxa de consolidação dos tubérculos com este tipo de prótese. Métodos Estudo de tipo coorte, retrospectivo, com coleta prospectiva de dados. No total, 28 pacientes cumpriram os critérios de inclusão: idade superior a 65 anos, prótese reversa do ombro por fratura complexa do úmero proximal (3 ou 4 partes, segundo Neer), e tempo de seguimento mínimo de 24 meses. Aos seis meses, todos os pacientes foram avaliados radiograficamente quanto à consolidação dos tubérculos e divididos em dois grupos: grupo com tubérculos consolidados e grupo com tubérculos não consolidados. A avaliação funcional realizou-se segundo o sistema de pontuação de Constant, da amplitude de movimento ativo, e da Escala Visual Analógica (EVA) à data da última consulta. Registaram-se todas as complicações. Resultados A consolidação dos tubérculos ocorreu em 21 pacientes (76,3%). Verificou-se diferenças estatisticamente significativas no sistema de pontuação de Constant (p < 0.001), elevação anterior (p = 0.020), rotação interna (p = 0.001) e externa (p = 0.003), quando se comparou o grupo dos tubérculos consolidados com o grupo dos tubérculos não consolidados. Não houve diferenças significativas na EVA entre os 2 grupos. Conclusão A consolidação dos tubérculos traduz uma melhoria dos resultados funcionais em pacientes submetidos a artroplastia reversa do ombro como tratamento de fraturas complexas do úmero proximal em idosos.


Subject(s)
Humans , Male , Female , Aged , Prostheses and Implants , Radius , Shoulder Fractures , Range of Motion, Articular , Extravehicular Activity , Amplitude , Fractures, Bone , Arthroplasty, Replacement, Shoulder , Humerus , Movement
8.
Rev. bras. ortop ; 55(5): 605-611, Sept.-Oct. 2020. tab, graf
Article in English | LILACS | ID: biblio-1144212

ABSTRACT

Abstract Objective The present paper aims to present results from radiographic evaluations of patients with extra-articular distal radius fractures submitted to percutaneous fixation with a 3.5 mm solid screw. Methods Analytical, descriptive and retrospective case series of 16 patients with evaluation of the radiographic parameters. Results The average age of the study population was 46.5 years old (25-60 years old); 81.25% of the sample was female. The average time until surgery was 8.8 days (4-14 days). The mean preprocedural volar tilt was - 7.41° (−23.48°-5.29°, standard deviation [SD] ± 6.59°). The mean volar tilt immediately after surgery was 5.93° (SD ± 6.23°, p< 0.001). There was no statistical difference in volar tilt values after 6 months of follow-up. The mean preprocedural radial height was 4.13 mm (−7.8 mm-9.5 mm, SD ± 5.06 mm). There was a statistically significant increase at the immediate postoperative period to 10.04 mm (p= 0.002), and a significant reduction at 6 months to 9.55 mm (p= 0.012). The consolidation rate was 100% with the technique used, with a minimal complication rate. No patient had infection or required a reoperation. Conclusion The technique was effective for the treatment of distal radial extra-articular fractures at 6 months, with a low complication rate; radiographic parameters values were acceptable and close to the anatomical ones.


Resumo Objetivo Apresentar o resultado das avaliações radiográficas dos pacientes com fraturas extra-articulares do rádio distal submetidos a fixação percutânea com parafuso maciço de 3.5mm. Métodos Série de casos, analítica, descritiva e retrospectiva de 16 pacientes com avaliação dos parâmetros radiográficos da técnica utilizada. Resultados A média de idade da população estudada foi de 46,5 anos (25-60 anos), sendo 81,25% do sexo feminino. O tempo de espera até a cirurgia foi de 8,8 dias (4-14 dias). O tilt volar médio pré-procedimento foi - 7,41° (−23,48°-5,29°, desvio padrão [DP] ± 6,59°). O tilt volar imediatamente após o procedimento cirúrgico foi de 5,93° (DP ± 6,23°, p< 0,001). Sem diferença estatística nos valores de tilt volar ao final de 6 meses de evolução. A altura radial pré-procedimento foi de 4,13 mm (−7,8°-9,5°, DP ± 5,06°). Aumento estatisticamente significativo no pós-operatório imediato para 10,04 mm (p= 0,002). Redução significativa ao final de 6 meses para 9,55 mm (p= 0,012). Atingimos 100% de consolidação com a técnica utilizada, com índice mínimo de complicações. Nenhum paciente apresentou infecção ou precisou ser reoperado. Conclusão A técnica mostrou-se eficaz para o tratamento de fraturas extra-articulares da extremidade distal do rádio ao final de 6 meses, com baixo índice de complicações e parâmetros radiográficos aceitáveis e próximos dos valores anatômicos.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Radius Fractures/surgery , Radius Fractures/diagnostic imaging , Bone Screws , Fracture Fixation, Internal/methods , Radius/anatomy & histology , Retrospective Studies , Range of Motion, Articular , Minimally Invasive Surgical Procedures
9.
Article in Chinese | WPRIM | ID: wpr-879366

ABSTRACT

OBJECTIVE@#To establish an individualized Nomogram prediction model for predicting the postoperative recovery of patients with triad of elbow (TE) by analyzing risk factors of triad of elbow joint.@*METHODS@#From January 2012 to December 2018, 116 patients with TE who met the criteria were collected. The independent risk factors were screened by univariate Logistic regression analysis. The statistically significant risk factors were included in the multivariate Logistic regression model. The R software was used to establish the Nomogram diagram model to predict the postoperative recovery of TE patients. C index was used to verify the discrimination, Calibration plot of the model, and the decision curve (decision curve analysis, DCA) to verify the net clinical benefit rate of the model.@*RESULTS@#Forty-four of the 116 patients with TE developed symptoms after operation, with an incidence of 37.93%. Age (@*CONCLUSION@#The Nomogram for predicting postoperative results of TE patients based on six independent risk factors:age, work, smoking, Mason classification of radial head, Regan-Morrey classification of coronal process and immobilization time of elbow joint after operation, has good distinguishing capacity and consistency. Thepredictive model could help clinicians to identify high risk population and establish appropriate intervention strategies.


Subject(s)
Elbow , Elbow Joint , Humans , Radius , Radius Fractures , Retrospective Studies
10.
Article in Korean | WPRIM | ID: wpr-811281

ABSTRACT

Most distal radius fractures are currently being treated with anterior plating using anatomical precontoured locking compression plates via the anterior approach. However, it is difficult to fix the volar articular marginal fragment because these anatomical plates should be placed proximally to the watershed line. There were just a few methods of fixation for this fragment on medical literature. Herein, we introduced a tension band wiring technique for fixation of a volar articular marginal fragment in the distal radius.


Subject(s)
Radius Fractures , Radius
11.
Article in English | WPRIM | ID: wpr-811182

ABSTRACT

In terms of management of Paget's disease of bone (PDB), early diagnosis and proper management achieving remission is essential with lifelong specialist follow-up. We present the case of a 40-year-old woman with PDB affecting mainly the distal extremities (ankle and wrist). The patient visited our hospital in 2012 with heel pain. Plain radiography revealed osteoporosis, and a bone scan revealed hot uptake. Initial laboratory investigations showed normal serum calcium, 25-hydroxy-vitamin D, and parathyroid hormone levels; however, osteocalcin, C-terminal telopeptide of type I collagen, and bone alkaline phosphatase levels were elevated. A bone mineral density scan showed T- and Z-scores of −2.5 and −2.7, respectively, and bisphosphonate treatment was initiated. Biopsy performed on the calcaneal lateral wall revealed inconclusive findings. Follow-up biopsy on the left distal radius was performed 7 years later to investigate wrist pain, and this examination led to a final diagnosis as PDB. We suggest inconclusive biopsy result during the early phase of PDB and highly recommend follow-up evaluation in osteoporosis with atypical behavior.


Subject(s)
Adult , Alkaline Phosphatase , Biopsy , Bone Density , Calcium , Collagen Type I , Diagnosis , Diphosphonates , Early Diagnosis , Extremities , Female , Follow-Up Studies , Heel , Humans , Osteitis Deformans , Osteocalcin , Osteoporosis , Parathyroid Hormone , Radiography , Radius , Specialization , Wrist
12.
Article in English | WPRIM | ID: wpr-811128

ABSTRACT

Distal radius fractures (DRFs) are one of the most common fractures seen in elderly people. Patients with DRFs have a high incidence of osteoporosis and an increased risk of subsequent fractures, subtle early physical performance changes, and a high prevalence of sarcopenia. Since DRFs typically occur earlier than vertebral or hip fractures, they reflect early changes of the bone and muscle frailty and provide physicians with an opportunity to prevent progression of frailty and secondary fractures. In this review, we will discuss the concept of DRFs as a medical condition that is at the start of the fragility fracture cascade, recent advances in the diagnosis of bone fragility including emerging importance of cortical porosity, fracture healing with osteoporosis medications, and recent progress in research on sarcopenia in patients with DRFs.


Subject(s)
Aged , Diagnosis , Fracture Healing , Hip Fractures , Humans , Incidence , Osteoporosis , Osteoporotic Fractures , Porosity , Prevalence , Radius Fractures , Radius , Sarcopenia
13.
Article in English | WPRIM | ID: wpr-811127

ABSTRACT

BACKGROUND: We hypothesized that volar locking pate fixation using a minimum number of screws—four in the distal row and two in the shaft of the plate—will provide sufficient stability for unstable extra-articular fractures of the distal radius. We aimed to compare the biomechanical properties of different numbers and locations of screws in volar locking plate fixation and describe the clinical and radiological outcome of plate fixation using a minimum number of screws for distal radius fractures.METHODS: We divided 48 artificial radius fracture bones into four groups (group A–D) based on the number and location of screws used for fixation with volar locking plates. The artificial bone models were subjected to axial compression and volar bending load with a force of 250 N and 80 N, respectively, for 1,000 cycles at a frequency of 1 Hz. We also retrospectively reviewed 42 patients with unstable, extra-articular, distal radius fractures who were treated with volar locking plate fixation using a minimum number of screws.RESULTS: Group A (seven distal screws and three proximal screws) had the highest mean stiffness: 303.7 N/mm under axial compression and 61.1 N/mm under volar bending. Compared with group A, group D (four screws in the distal part and two screws in the shaft) showed significantly lower stiffness; therefore, group D was considered inferior in terms of stability. However, in the fatigue test, neither deformation of the metal plate nor detachment or breakage of the metal screws was observed in all groups. In the clinical study, all fractures united without displacement and satisfactory clinical outcome was obtained.CONCLUSIONS: In the dorsally comminuted, extra-articular, nonosteoporotic distal radius fractures, the minimum number of screws—four in the distal row and two in the shaft—in volar locking plate fixation can provide sufficient stability. Further biomechanical studies involving osteoporotic bone will be necessary to confirm the results because volar plate fixation is most commonly used in patients with osteoporosis.


Subject(s)
Bone Screws , Clinical Study , Fatigue , Humans , Osteoporosis , Palmar Plate , Radius Fractures , Radius , Retrospective Studies
14.
Article in English | WPRIM | ID: wpr-811112

ABSTRACT

Distal ulnar fractures are commonly accompanied by distal radial fractures, and several treatment options such as plate osteosynthesis and pinning with Kirschner's wires are used. In this study, we present a technique using headless compression screws to achieve bony union of distal ulnar fractures. From November 2016 to November 2018, we treated 11 patients with distal ulnar fractures combined with distal radial fractures with headless compression screws (DePuy Synthes). Patients were instructed to maintain a short-arm splint for less than two weeks after the treatment. The mean time to bony union was 6.5 weeks, mean Quick Disabilities of the Arm, Shoulder, and Hand score was 14.6 points, and mean visual analog scale score was 1.09 points. Full range of motion was possible in all directions after surgery and no specific complications were observed. The suggested technique allows minimal incision and minimally invasive intramedullary fixation and can promote bony union in a simple way without specific complications.


Subject(s)
Arm , Hand , Humans , Radius , Range of Motion, Articular , Shoulder , Splints , Ulna , Visual Analog Scale , Wrist
15.
Article in Chinese | WPRIM | ID: wpr-828290

ABSTRACT

OBJECTIVE@#To explore the clinical effect of the treatment of Fernandez type Ⅲ fracture of the distal radius with hyperextension traction prying, volar reduction, bone grafting and internal fixation.@*METHODS@#From February 2017 to March 2018, 11 cases of Fernandez type Ⅲ fracture of the distal radius were treated with intraoperative hyperextension traction and volar prying reduction and bone grafting and internal fixation, including 6 males and 5 females, aged 55 to 67 years. Preoperative X-ray and CT evaluated the distal radius fracture dorsal angulation with articular surface compression, collapse. According to Fernandez, all of them were type Ⅲ. After operation, the reduction of articular surface and fracture healing were evaluated. VAS score and Cooney wrist score were used to evaluate the curative effect.@*RESULTS@#All the patients were followed up for 12 to 14 months. All the fractures healed. Cooney wrist score scale was used to evaluate the curative effect, 9 cases were excellent, 1 case was good and 1 case was fair.@*CONCLUSION@#In the operation of Fernandez type Ⅲ fracture of the distal radius, hyperextension traction was used to enlarge the angle, and through the volar fracture end prying reduction and internal fixation with bone graft, the collapsed articular surface could be effectively reduced and fixed. The early functional exercise after the operation had satisfactory clinical effect.


Subject(s)
Aged , Bone Plates , Bone Transplantation , Female , Fracture Fixation, Internal , Humans , Male , Middle Aged , Radius , Radius Fractures , General Surgery , Range of Motion, Articular , Traction , Treatment Outcome , Wrist
16.
Rev. cuba. ortop. traumatol ; 33(2): e177, jul.-dic. 2019. ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1126739

ABSTRACT

RESUMEN El tumor de células gigantes se define como un tumor óseo benigno que invade las partes blandas localmente de forma agresiva. Se presenta una paciente con un tumor de células gigantes recidivante en el tercio distal del radio derecho, con signos de necrosis superficial e infección sobreañadidos, la cual, dada la magnitud y severidad de la lesión, requirió una amputación supracondílea de la extremidad. Presentó una evolución postoperatoria favorable, con recuperación física y psicológica(AU)


ABSTRACT Giant cell tumor is defined as a benign bone tumor that aggressively invades soft tissue locally. We present a patient with a recurrent giant cell tumor in the distal third of the right radius, showing signs of superimposed necrosis and infection, which, given the injury magnitude and severity, required supracondylar amputation of the limb. Her postoperative evolution was favorable, and this patient underwent physical and psychological recovery(AU)


RÉSUMÉ La tumeur à cellules géantes est définie comme une tumeur osseuse bénigne qui envahit agressivement les parties molles locales. Une patiente atteinte de tumeur récidivante à cellules géantes au niveau du tiers distal du radius droit, avec signes de nécrose superficielle et d'infection surajoutés, laquelle a requis une amputation supracondylienne du membre, due à la magnitude et à la sévérité de la lésion, est présentée. Elle a montré une évolution postopératoire favorable, avec une bonne récupération physique et psychologique.


Subject(s)
Humans , Female , Adult , Radius/surgery , Bone Neoplasms/surgery , Giant Cell Tumor of Bone/surgery , Amputation/methods
17.
Rev. bras. ortop ; 54(6): 746-750, Nov.-Dec. 2019. graf
Article in English | LILACS | ID: biblio-1057947

ABSTRACT

Abstract Isolated anterior dislocation of the radial head is rarely reported. To date, only five cases have been reported in the world literature. In all of these cases, the patients presented with restricted supination-pronation movements of the forearm with maintained elbow flexion-extension. We report an unusual case of isolated anterior radial head dislocation in an 18-year-old male, who presented with maintained supination-pronation movements of the forearm but restricted elbow flexion-extension. Closed reduction was attempted, but it failed. Hence, an open reduction was performed. However, the reduction was unstable due to rupture of the annular ligament. Hence, the repair of the annular ligament was performed, and a radio-ulnar Kirschner wire was passed to maintain the reduction of the proximal radio-ulnar joint, thus keeping the annular ligament stress-free, facilitating its healing. At 12 months of follow-up, the patient had normal elbow function and complete range of motion.


Resumo A literatura sobre a luxação anterior isolada da cabeça do rádio é escassa, com apenas cinco casos relatados no mundo inteiro até hoje. Em todos esses casos, os pacientes apresentaram movimentos de supinação-pronação restritos do antebraço, e manutenção da flexão-extensão do cotovelo. Os autores apresentam um caso incomum de luxação de cabeça radial anterior isolada em um paciente do sexo masculino de 18 anos, que apresentou movimentos de supinação-pronação no antebraço e restrição na flexão-extensão do cotovelo. A redução fechada foi tentada, mas sem sucesso. Assim, foi feita a redução aberta. No entanto, a redução foi instável devido à ruptura do ligamento anular. Por isso, o reparo do ligamento anular foi realizado, e um fio de Kirschner rádio-ulnar foi inserido para manter a redução da articulação rádio-ulnar proximal, evitando estresse sobre o ligamento anular, facilitando sua cicatrização. Aos 12 meses de acompanhamento, o paciente apresentava função normal do cotovelo e amplitude de movimento completa.


Subject(s)
Humans , Male , Adolescent , Radius , Amplitude , Joint Dislocations , Elbow Joint , Closed Fracture Reduction , Open Fracture Reduction , Ligaments, Articular
18.
Arq. bras. med. vet. zootec. (Online) ; 71(4): 1121-1130, jul.-ago. 2019. graf, ilus
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1038624

ABSTRACT

O objetivo do estudo foi avaliar o efeito da matriz porosa do biovidro 60S (BV60S) associada a células osteoprogenitoras (CO) alógenas no tratamento de defeitos ósseos críticos de cães. Foram utilizados 20 cães, machos, sem raça definida, com dois anos de idade e massa corporal média de 25kg. Com os cães sob anestesia geral, foram criados defeitos ósseos críticos no terço médio dos ossos rádios. Procedeu-se à fixação óssea com uma placa em ponte, e os defeitos foram tratados de acordo com cada grupo experimental. Constituíram-se três grupos experimentais, em que os defeitos ósseos foram preenchidos com: BV60S associado a CO alógenas (grupo BV60S+CO), osso autógeno (grupo C+), ou não preenchidos (grupo C-). A regeneração óssea foi avaliada por meio de exames radiográficos, densitométricos e histomorfométricos ao longo de 90 dias. Os grupos C- e BV60S+CO mostraram preenchimento ósseo parcial do defeito de, no máximo, 56,68% e 35,23%, respectivamente, sem a formação de ponte óssea entre as extremidades, e o controle positivo (C+) mostrou regeneração óssea completa. Conclui-se que a matriz porosa do BV60S associada às células osteoprogenitoras não é eficiente no tratamento de defeitos ósseos críticos em rádios de cães.(AU)


The objective of this study was to evaluate the effect of the porous matrix of bioglass 60S (BV60S) associated with allogenic osteoprogenitor cells (CO) in the treatment of critical bone defects of dogs. 20 male mongrel dogs at two years old and mean weight of 25kg were used. Dogs were anesthetized and critical bone defects were created in the middle third of the radios bones. With dogs under general anesthesia, critical bone defects were created in the middle third of bone radios. Bone fixation was done with a bridge plate and defects treated according to each experimental group. Three experimental groups were formed according to the treatment. The defects filled with BV60S associated with allogenic CO (Group-BV60S+CO), autogenous bone (Group-C+) or unfilled (Group-C-). Bone regeneration was evaluated by radiography, bone densitometry and histomorphometry over 90 days. The BV60S+CO and C- groups showed partial bone filling of the defect of at most 56.68% and 35.23%, respectively. No bone bridge formation was observed between the extremities in the BV60S+CO and C- groups. Positive control showed complete bone regeneration at 90 days. It was concluded that the porous matrix of BV60S associated with osteoprogenitor cells was not effective in the treatment of critical bone defects in the radius of dogs.(AU)


Subject(s)
Animals , Dogs , Radius/injuries , Biocompatible Materials/therapeutic use , Bone Regeneration , Cell- and Tissue-Based Therapy/methods , Cell- and Tissue-Based Therapy/veterinary
19.
Acta ortop. mex ; 33(2): 123-126, mar.-abr. 2019. graf
Article in Spanish | LILACS | ID: biblio-1248646

ABSTRACT

Resumen: Introducción: El síndrome del nervio interóseo posterior, rama del nervio radial a nivel del antebrazo se caracteriza por la pérdida de función motora de algunos o todos los músculos inervados distalmente. Caso clínico: Masculino de 26 años con antecedente de fractura de radio proximal manejado con osteosíntesis que cursó con lesión del nervio radial siete años antes con recuperación completa, acude con dolor intenso a 4 cm distal a cabeza radial, acompañado de parálisis del extensor largo y corto del pulgar y del abductor del pulgar, con paresia del extensor propio del índice, en el que se efectúa diagnóstico de síndrome de atrapamiento de la rama anterior descendente del nervio interóseo posterior (SNIP). Discusión: El manejo conservador del SNIP está indicado durante las primeras ocho a 12 semanas, de no mostrar mejoría la indicación de exploración quirúrgica está indicada, siendo el retiro de material de osteosíntesis controvertido.


Abstract: Introduction: Posterior interosseous nerve syndrome, a branch of the radial nerve at the level of the forearm, is characterized by the motor function loss of some or all of the muscles innervated distally. Clinical case: A 26-year-old male with a history of proximal radius fracture associated to radial nerve injury, treated with osteosynthesis 7 years earlier, with full recovery, who currently presented intense pain 4 cm distal to the radial head, accompanied by paralysis of Extensor pollicis longus , Extesnor pollicis brevis and Abductor pollicis longus, with paresis of the Extensor indicis propius , in which a diagnosis of entrapment syndrome of the anterior descending branch of the posterior interosseous nerve (SNIP) was performed. Discussion: The conservative management of SNIP is indicated during the first 8-12 weeks, if no improvement is found, the indication for surgical exploration is indicated, and the removal of osteosynthesis material is controversial.


Subject(s)
Humans , Male , Adult , Radial Nerve/surgery , Radial Nerve/injuries , Radius Fractures/complications , Elbow Joint , Forearm , Radius , Muscle, Skeletal
20.
Acta ortop. mex ; 33(2): 118-122, mar.-abr. 2019. graf
Article in Spanish | LILACS | ID: biblio-1248645

ABSTRACT

Resumen: Introducción: La luxación congénita de cabeza radial es un padecimiento que se ha descrito en contados casos en la literatura internacional, siendo la luxación anterior y lateral las formas de presentación menos frecuentes con 15% de los casos cada una y la luxación posterior la más frecuente con 70% del total de los casos reportados. Sin embargo, esta patología es considerada la patología congénita más frecuente del codo en el niño. Se presenta el caso de un paciente con luxación congénita de codo variedad anterior y otro caso con luxación variedad lateral, ambos diagnosticados a temprana edad, en los que se decidió realizar un manejo conservador y un seguimiento anual. Asimismo, se hizo una revisión bibliográfica del tema. Discusión: La luxación congénita de codo tiene por lo general una evolución benigna, siendo indolora y poco limitante para el paciente, por lo que puede ser manejada de manera conservadora. El dolor y la limitación de movimientos son indicativos de un tratamiento quirúrgico; sin embargo, no son ampliamente aceptados debido a las complicaciones y resultados deficientes que presentan.


Abstract: Introduction: Congenital dislocation of the Radial head is a condition that has been described in a few cases in the international literature, the anterior and lateral dislocation were the less frequent forms of presentation with 15% of cases, each, and the posterior dislocation the most frequent with 70% of the total cases reported. However, this pathology is considered the most frequent congenital pathology of the elbow in children. The present study describes the case of a patient with congenital dislocation of elbow anterior variety and another case with dislocation lateral variety, both diagnosed at an early age, in which it has been decided for conservative management and an annual follow-up. A bibliographic review of the subject is also carried out. Discussion: The congenital elbow dislocation usually has a benign evolution, being painless and not very limiting for the patient, so it can be managed conservatively. Pain and limited movement are indicative of surgical treatment. There are multiple surgical treatments for this entity, however they are not widely accepted due to the complications and poor results presented by them.


Subject(s)
Humans , Child , Joint Dislocations/complications , Joint Dislocations/congenital , Elbow Joint/pathology , Pain/etiology , Radius/pathology , Elbow
SELECTION OF CITATIONS
SEARCH DETAIL