ABSTRACT
Objetivos: Describir nuestra experiencia en el manejo de los pacientes afectos de osteogénesis imperfecta (OI). Material y métodos: Hemos realizado un estudio retrospectivo de una serie de casos afectos de OI tratados en la Clínica Universidad de Navarra desde 1980 hasta 2007 con un seguimiento medio de 17,3 años (7-27 años). Se han recogido los datos descriptivos, los referentes a las fracturas y a las deformidades observadas y los tratamientos realizados, las complicaciones presentadas y la capacidad funcional al final del seguimiento. Resultados: La muestra revisada consta de 10 pacientes. El 65% de las fracturas sufridas se encontraban en miembros inferiores. Un paciente recibió exclusivamente tratamiento médico. En 3 pacientes se asoció tratamiento médico y quirúrgico. En 6 pacientes se realizó algún tipo de tratamiento quirúrgico. La intervención quirúrgica más frecuente fue la de Sofield-Millar, realizada en 37 ocasiones. Un tercio de estas requirieron cirugía de revisión por migración de los clavos. Se observaron 17 episodios de refractura. Además, se han observado complicaciones como seudoartrosis, fracturas iatrogénicas e infecciones. La funcionalidad al final del seguimiento era de grado I o II según la escala de Hoffer y Bullock en 7 pacientes. Conclusiones: A pesar de la necesidad de múltiples intervenciones y de las complicaciones presentadas durante el seguimiento, el tratamiento adecuado de los pacientes afectos de OI puede proporcionar resultados funcionales aceptables (AU)
Objectives: To describe our experience in the management of patients with osteogenesis imperfect (OI). Material and methods: We conducted a retrospective study of a series of cases affected with OI treated in the Clínica Univesidad de Navarra from 1980 to 2007, with a mean follow up of 17.3 years (7-27 years). We collected descriptive data of the sample, the fractures and the deformities, and the treatments given. The complications presented and the functional outcomes at the end of follow-up were also reviewed. Results: The sample included ten patients. Approximately two-thirds (65%) of fractures were sustained in the lower limbs. One patient received medical treatment only. Three patients had combined medical and surgical treatment. Some type of surgical treatment was performed on 6 patients. The most common surgery was the Sofield-Millar performed on 37 occasions, with a third of them requiring revision surgery due to migration of the nails. There were 17 episodes of re-fracture. Complications such as non-union, iatrogenic fractures, and infections, were also observed. The functional outcome, according to the Hoffer-Bullock scale, at the end of follow-up was grade I / II in 7 patients. Conclusions: Despite the need for multiple interventions and complications presented during follow up, the appropriate treatment of patients with OI can provide acceptable functional outcomes (AU)
Subject(s)
Humans , Osteogenesis Imperfecta/therapy , Osteotomy/methods , Bone Nails , Orthopedic Procedures/methods , Treatment OutcomeABSTRACT
OBJECTIVES: To describe our experience in the management of patients with osteogenesis imperfect (OI). MATERIAL AND METHODS: We conducted a retrospective study of a series of cases affected with OI treated in the Clínica Univesidad de Navarra from 1980 to 2007, with a mean follow up of 17.3 years (7-27 years). We collected descriptive data of the sample, the fractures and the deformities, and the treatments given. The complications presented and the functional outcomes at the end of follow-up were also reviewed. RESULTS: The sample included ten patients. Approximately two-thirds (65%) of fractures were sustained in the lower limbs. One patient received medical treatment only. Three patients had combined medical and surgical treatment. Some type of surgical treatment was performed on 6 patients. The most common surgery was the Sofield-Millar performed on 37 occasions, with a third of them requiring revision surgery due to migration of the nails. There were 17 episodes of re-fracture. Complications such as non-union, iatrogenic fractures, and infections, were also observed. The functional outcome, according to the Hoffer-Bullock scale, at the end of follow-up was grade I/II in 7 patients. CONCLUSIONS: Despite the need for multiple interventions and complications presented during follow up, the appropriate treatment of patients with OI can provide acceptable functional outcomes.
Subject(s)
Osteogenesis Imperfecta/therapy , Adolescent , Adult , Child , Child, Preschool , Fractures, Bone/etiology , Humans , Osteogenesis Imperfecta/complications , Retrospective Studies , Treatment Outcome , Young AdultABSTRACT
Objetivo. Valorar la posibilidad de crear reglas de decisión clínica para el uso de la radiología convencional en los traumatismos agudos de muñeca.Material y método. Se desarrolló un estudio observacionalprospectivo. Se recogieron datos de pacientes que acudieron al Servicio de Urgencias de nuestro hospital tras sufrir un traumatismo agudo de muñeca; 179 pacientes fueron incluidos en el estudio. Se recogieron 46 variables de entrevista clínica y exploración física de cada paciente. Se analizó la concordancia inter-examinador de las variables, así como su asociación estadística con la radiología positiva de la muñeca.Los datos fueron posteriormente analizados mediante unanálisis multivariante.Resultados. Los 57 pacientes con imagen radiológica positiva de muñeca presentaron, al menos, una de las siguientes características: edad igual o superior a 35 años, edema en el dorso de la muñeca, limitación de la supinación o desviación radial activa y dolor o inestabilidad en la prueba del cajón radiocubital distal. Esta regla de decisión clínica es100% sensible y 37,7% específica para detectar pacientescon imagen radiológica positiva de muñeca en traumatismosagudos. Su uso en la muestra estudiada hubiera ahorradoun 15,6% de peticiones radiográficas.Conclusiones. Es necesario desarrollar un estudio más amplio para valorar la aceptación de unos criterios de decisión clínica para la realización de radiografías en los traumatismos agudos de muñeca
Purpose. To analyze the possibility of creating clinical decision- making rules to facilitate the assessment of conventional x-rays in acute wrist trauma.Materials and methods. This is a prospective observational study. Data was collected on patients treated at the Emergency Department of our hospital further to sustaining acute wrist trauma. 179 patients were included in the study. 46 clinical interview and physical examination variables were used for each patient. Inter-examiner concordance was analyzed for the variables, as well as their statistical associationwith positive wrist radiology. Data was subsequentlyanalyzed by means of multivariate analysis.Results. All 57 patients with positive wrist x-ray imagespresented with at least one of these characteristics: ageequal to or higher than 35, edema of the dorsum of thewrist; limited supination or active radial deviation; and pain or instability on the distal radioulnar drawer test. This clinical decision-making rule is 100% sensitive and 37.7% specific to detect patients with positive wrist x-ray images further to acute trauma. Its use in the sample under study would have reduced the number of x-ray requests by 15.6%.Conclusions. A broader study should be undertaken in order to assess the acceptance of a series of clinical decisionmaking criteria for the carrying out of radiographs further to acute wrist trauma (AU)
