ABSTRACT
BACKGROUND: The diagnose of Gartland Type-IV (G-IV) supracondylar humeral fractures (SCHF) has been reported to only be possible via fluoroscopy intra-operatively. HYPOTHESIS: A preoperative radiographic fracture pattern can indicate a G-IV SCHF. PATIENTS AND METHODS: Retrospective qualitative analysis of radiographs and reduction techniques used in twenty-seven GIV SCHF. RESULTS: Anterior-posterior radiographs demonstrated lateral translation or angulation in 21 cases (valgus type) and medial translation or angulation in 6 cases (varus type). In spite of a complete cortical disruption, lateral radiographs showed that the distal fragment was vertically aligned with the proximal fragment. Reduction was achieved in semi-extension, via supination in valgus type fracture and pronation for varus type fractures. DISCUSSION: Our conjecture is that a trauma vector in the coronal plane would result in a near-circumferential periosteal disruption, with which either a medial or lateral periosteal hinge remains. The distal fragment would be vertically aligned in lateral radiographs. LEVEL OF EVIDENCE: IV; Diagnostic.
Subject(s)
Humeral Fractures , Humans , Humeral Fractures/diagnostic imaging , Humeral Fractures/surgery , Radiography , Retrospective Studies , Treatment OutcomeABSTRACT
Introducción Actualmente no se encuentra bien establecida la prevalencia, diagnóstico y manejo de la IRCD postraumática en pacientes pediátricos, siendo escasa la literatura al respecto. el propósito del estudio es establecer objetivamente la sintomatología y la funcionalidad. Materiales & Métodos Presentamos un estudio de serie de casos en el cual se evaluaron 126 pacientes con fractura de antebrazo distal entre febrero y noviembre de 2017 que consultaron en el servicio de urgencias del Hospital Guillermo Grant Benavente, Concepción, Chile. Para la evaluación de los pacientes se utilizó el Quick-DASH, Mayo Wrist Score, Fuerza de prensión comparativa mediante dinamómetro y su correlación imagenológica mediante TAC abreviado de muñeca utilizando 3 métodos para evaluar la congruencia articular. Resultados 11 pacientes (8.7%) evolucionaron con IRCD postraumática sintomática, la mayoría de sexo masculino (83%), con media de edad de 10.4 años (4 a 14 años), 82% de los pacientes diestros, el 45% sufrió fractura de extremidad superior derecha, 92% de los pacientes tuvo una caída a nivel siendo 73% de baja energía y todos los pacientes fueron tratados con reducción Ortopédica y yeso braquipalmar con un promedio de 5.5 semanas (2-9 semanas) y un seguimiento total promedio de 10.2 semanas. Discusión la IRCD postraumática en pacientes pediátricos no se debe a una mala reducción de la fractura y un mal eje de alineación sino a una lesión ligamentaria sub-diagnosticada.
Background Currently, the prevalence, diagnosis and management of distal symptomatic post-traumatic radioulnar instability (DSPRI) in pediatric patients is not well established, and the literature on this is scarce. the purpose of the study is to objectively establish the symptoms and functionality. Methods We present a case series study in which 126 patients with a distal forearm fracture were evaluated between February and November 2017, who consulted the emergency department of the Guillermo Grant Benavente Hospital, Concepción, Chile. For the evaluation of the patients, the Quick-DASH, Mayo Wrist Score, comparative grip strength by dynamometer and its imaging correlation by abbreviated CAT scan of the wrist were used using 3 methods to evaluate joint congruence. Results 11 patients (8.7%) evolved with DSPRI, most of them male (83%), with a mean age of 10.4 years (4 to 14 years), 82% of right-handed patients, 45% suffered a fracture of the right upper limb, 92% of the patients had a level drop, 73% being low energy and all the patients were treated with orthopedic reduction and brachypalmar cast with an average of 5.5 weeks (2-9 weeks) and an average total follow-up. 10.2 weeks. Discussion Post-traumatic DSPRI in pediatric patients is not due to poor fracture reduction and poor alignment axis, but to underdiagnosed ligament injury.
Subject(s)
Humans , Fractures, Bone , Joint Instability , Pain , Radio , UlnaABSTRACT
Introducción Las fracturas de tobillo representan el 12% de las fracturas en la edad pediátrica. Planteamos la hipótesis que los pacientes con fracturas intraarticulares de tobillo tendrán un excelente resultado funcional y no presentarán cambios degenerativos articulares a los 6 meses post cirugía. El objetivo del estudio es realizar un analisis del resultado funcional, así como la presencia de cambios radiologicos degenerativos precoces en el seguimiento de pacientes con fracturas intra-articulares de tobillo tratadas en nuestro centro. Materiales y Métodos Estudio de Cohorte retrospectivo, se recolectaron datos de pacientes con fracturas intra-articulares de tobillo entre 2012 y 2016. Se clasificaron y evaluaron mediante score AOFAS y radiografías para clasificar según Van Dijk. Resultados La diferencia promedio de edad entre las fracturas triplanares y tillaux es de 17 meses (p: 0.038). La media de Score AOFAS fue de 85,2%. El 88.8% refiere dolor en relación a actividades cotidianas, a pesar de tener excelentes o buenos resultados funcionales. No hay correlación significativa entre los resultados de AOFAS en pacientes con fracturas transicionales y no transicionales., 43,4% presentaron estadio 0, 43,4% estadio I y 13% estadio II de Van Dijk. Ningún caso presento estadio III. Discusión En base a los hallazgos de este estudio, y al contrario de lo hipotetizado, la mayoría de los pacientes tienen un buen resultado funcional tras el manejo de las fracturas intraarticulares de tobillo y no excelente como se pensaba. Existe un grupo de pacientes que mostró cambios degenerativos precoces demostrables por radiografía.
Background Ankle fractures represent 12% of fractures in pediatric age. We hypothesized that patients with intra-articular ankle fractures will have an excellent functional result and will not present degenerative joint changes 6 months after surgery. The objective of the study is to carry out an analysis of the functional result, as well as the presence of early degenerative radiological changes in the follow-up of patients with intra-articular ankle fractures treated in our center. Methods Retrospective cohort study, data were collected from patients with intra-articular ankle fractures between 2012 and 2016. They were classified and evaluated using AOFAS score and radiographs to classify according to Van Dijk. Results The average age difference between triplanar and tillaux fractures is 17 months (p: 0.038). The mean AOFAS Score was 85.2%. 88.8% reported pain in relation to daily activities, despite having excellent or good functional results. There is no significant correlation between the AOFAS results in patients with transitional and non-transitional fractures. 43.4% had stage 0, 43.4% stage I, and 13% stage II Van Dijk. No case presented stage III. Discussion Based on the findings of this study, and contrary to the hypothesized, most patients have a good functional result after the management of intra-articular ankle fractures and not excellent as previously thought. There is a group of patients who showed early degenerative changes demonstrable by radiography.
Subject(s)
Humans , Infant , Child, Preschool , Child , Ankle Fractures , Tibial FracturesABSTRACT
Upon imbibition, epidermal cells of Arabidopsis thaliana seeds release a mucilage formed mostly by pectic polysaccharides. The Arabidopsis mucilage is composed mainly of unbranched rhamnogalacturonan-I (RG-I), with low amounts of cellulose, homogalacturonan, and traces of xylan, xyloglucan, galactoglucomannan, and galactan. The pectin-rich composition of the mucilage and their simple extractability makes this structure a good candidate to study the biosynthesis of pectic polysaccharides and their modification. Here, we characterize the mucilage phenotype of a mutant in the UDP-rhamnose/galactose transporter 2 (URGT2), which exhibits a reduction in RG-I and also shows pleiotropic changes, suggesting the existence of compensation mechanisms triggered by the lack of URGT2. To gain an insight into the possible compensation mechanisms activated in the mutant, we performed a transcriptome analysis of developing seeds using RNA sequencing (RNA-seq). The results showed a significant misregulation of 3149 genes, 37 of them (out of the 75 genes described to date) encoding genes proposed to be involved in mucilage biosynthesis and/or its modification. The changes observed in urgt2 included the up-regulation of UAFT2, a UDP-arabinofuranose transporter, and UUAT3, a paralog of the UDP-uronic acid transporter UUAT1, suggesting that they play a role in mucilage biosynthesis. Mutants in both genes showed changes in mucilage composition and structure, confirming their participation in mucilage biosynthesis. Our results suggest that plants lacking a UDP-rhamnose/galactose transporter undergo important changes in gene expression, probably to compensate modifications in the plant cell wall due to the lack of a gene involved in its biosynthesis.
