ABSTRACT
INTRODUCTION: In patients who have hereditary multiple osteochondroma (HMO), progressive deformity of the forearm skeleton may lead to radial head dislocation. The latter is permanent, painful and causes weakness. HYPOTHESIS: There is a relationship between the amount of ulnar deformity and the presence of radial head dislocation in patients with HMO. MATERIALS AND METHODS: This was a cross-sectional radiographic study comprising an analysis of anterior-posterior (AP) and lateral x-rays of 110 forearms in children having a mean age of 8 years and 4 months who were followed for HMO between 1961 and 2014. Four factors reflecting on the ulnar deformity in the coronal plane were investigated on the AP view and three factors in the sagittal plane were investigated on the lateral view to identify any relationship between ulnar deformity and radial head dislocation. The forearms were separated into two groups: with radial head dislocation (26 cases) and without radial head dislocation (84 cases). RESULTS: Ulnar bowing, intramedullary angle of ulnar bowing, tangent ulnar angle and overall ulnar angle were significantly higher in the group of children who had a radial head dislocation (0.05 vs 0.03, p<.001; 161 vs 167, p<001; 156 vs 162, p<001; 50 vs 30, p<.001) in univariate and multivariate analyses. DISCUSSION: Ulnar deformity, evaluated using the method described here, is more often associated with radial head dislocation than other previously published radiological parameters. This provides new insight on this phenomenon and may help to determine which factors are associated with radial head dislocation and how to prevent it. CONCLUSION: Ulnar bowing in the context of HMO, especially when evaluated on AP radiographs, is significantly associated with radial head dislocation. LEVEL OF EVIDENCE: III; case-control study.
Subject(s)
Exostoses, Multiple Hereditary , Joint Dislocations , Child , Humans , Radius/diagnostic imaging , Radius/surgery , Exostoses, Multiple Hereditary/complications , Exostoses, Multiple Hereditary/diagnostic imaging , Exostoses, Multiple Hereditary/surgery , Case-Control Studies , Cross-Sectional Studies , Retrospective Studies , Ulna/diagnostic imaging , Ulna/surgery , Joint Dislocations/etiology , Joint Dislocations/complicationsABSTRACT
No período entre maio de 1985 e setembro de 1995 foram submetidos a tríplice artrodese 18 pacientes (21 pTs) portadores de paralisia cerebral espástica com deformidades rígidas dos pés, dos quais 16 (18 pés) retornaram para reavaliaçäo clínica e revisäo dos prontuários. Esse grupo foi constituído de 8 pacientes do sexo feminino e 8 do masculino, com idade média na ocasiäo da cirurgia de 15 anos e 11 meses e tempo de seguimento médio de 4 anos. A indicaçäo da tríplice artrodese foi baseada na avaliaçäo clínica e radiográfica objetivando a obtençäo de pé plantígrado, estável e indolor à marcha. Procedimentos associados foram necessários no mesmo tempo operatório para correçäo de outras deformidades; o mais comum foi o alongamento do tendäo de Aquiles. A análise dos resultados baseou-se em parâmetros clínicos, radiográficos e subjetivos. Os autores obtiveram 72 por cento de resultados satisfatórios e 28 por cento de insatisfatórios.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Arthrodesis , Cerebral Palsy/complications , Foot Deformities, Acquired/surgery , Foot Deformities, Acquired/etiology , Treatment OutcomeABSTRACT
Neste trabalho, a estabilidade lateral do tornozelo foi avaliada após ressecçao do terço distal da fíbula por sarcoma de Ewing, sem reconstruçao de nenhum dos elementos estabilizadores laterais. A técnica utilizada pelos autores foi comparada com as de reconstruçao lateral do tornozelo quanto à estabilidade, mostrando-se ser procedimento confiável, simples e de baixa morbidade. O seguimento pós-operatório de dois pacientes (cinco anos e nove meses e dois anos e oito meses) mostrou funçao satisfatória e estabilidade plena do tornozelo.
