RESUMEN
Although osteochondral fractures of the lateral femoral condyle are uncommon, fixation of the fragments is recommended, mostly when is about young athletes with such post-traumatic pathology. We present a case of a professional handball player teenager female, with a lateral femur condylar osteochondral fracture after a fall with the right knee in extension and in internal rotation. Magnetic resonance imaging (MRI) showed an osteochondral fracture of the lateral femoral condyle, 34.6 mm on long axis, impossible to manage arthroscopically, because of the size and the location of the detached fragment. The solution was the lateral knee arthrotomy allowing the evacuation of the hemarthrosis and preparation of the fracture site, then reduction and fixation of the fracture with absorbable cannulated pins. This procedure is of choice only when is enough bone in the detached fragment to permit the internal fixation and bone-to-bone healing with cartilaginous tissue stabilization through the fibro-cartilaginous rim that would seal the cartilage surface. Postoperative MRI proves that the fragment is settled in its hooked position with repairing of the articular congruity, so the recovery exercises program allow the regaining of the knee mobility with a restart of her sportive activity later.
Asunto(s)
Fracturas del Fémur/patología , Fémur/patología , Adolescente , Femenino , Fracturas del Fémur/diagnóstico por imagen , Fracturas del Fémur/cirugía , Fémur/diagnóstico por imagen , Fémur/cirugía , Humanos , Imagen por Resonancia Magnética , Cuidados Posoperatorios , Tomografía Computarizada por Rayos XRESUMEN
Tendinopathy covers a range of several tendon conditions, mostly caused by overuse but at least in Achilles tendon pathology, favored by obesity, diabetes, inflammatory and autoimmune conditions. Subclinical tendon pathology is difficult to diagnose, as magnetic resonance imaging (MRI) examinations are sometimes inconclusive and not cost-effective. Elastography is an ultrasound examination method that uses mechanical impulses to produce shear waves in the tissue of interest, then measures the tissue displacement and calculates the shear wave speed or the elastic modulus of the examined tissue. We have used B-mode ultrasonography and shear wave elastography on 80 Achilles tendons from healthy volunteers with or without tendon pathology history, and correlated the data obtained with the clinical parameters of the volunteers, such as age, body mass index (BMI) and sports practice. We have shown that there is no significant correlation between the elastic modulus of the Achilles tendon and age, sports practice and body mass index with the exception of the correlation between the elastic modulus of the right Achilles tendon in men and age. Shear wave elastography has proved to be cost-effective for the evaluation of the Achilles tendon in healthy volunteers and was able to monitor the evolution of one patient with old tendon rupture treated by surgery. It can complete MRI investigation and it can replace B-mode ultrasonography particularly in monitoring the post-surgery evolution.
Asunto(s)
Tendón Calcáneo/patología , Sistemas de Computación , Diagnóstico por Imagen de Elasticidad/métodos , Adulto , Índice de Masa Corporal , Módulo de Elasticidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
Paget's disease of bone is a benign disease characterized by exaggerated remodeling of the bone matrix after osteoclast-mediated bone destruction. Its etiology is still unknown, despite the fact that it was discovered and described in 1877, but genetic factors and environmental triggers were shown to play their part in the pathogenesis of the disease. The main clinical presentations of the disease are related to bone pain and deformities. Radiological diagnosis is the main detection tool, though many monostotic Paget's disease cases may remain undiagnosed. We present the case of an 81-year-old male patient admitted to the Clinic of Orthopedics, Emergency County Hospital, Timisoara, Romania, with intense pain and deformity of the upper left thigh. Radiological examination performed shows a complete fracture of the upper third diaphysis of the left femur with suggestive signs for Paget's disease of the bone therefore a biopsy was taken and the patient was treated by surgical realignment with favorable evolution. He was discharged 13 days after surgery. The biopsy of the bone revealed extensive bone remodeling with numerous osteoclasts and extensive bone matrix deposition, unevenly stained and unevenly mineralized and reverse cement lines, which are consistent with the diagnosis of Paget's disease of the bone. Histomorphometric analysis show intense matrix deposition with a highly active remodeling process. Computed tomography (CT) scans were performed three years later and show the extension of the disease into the lower half of the left femur.
Asunto(s)
Fracturas del Fémur/complicaciones , Fracturas del Fémur/patología , Osteítis Deformante/complicaciones , Osteítis Deformante/patología , Anciano de 80 o más Años , Fracturas del Fémur/diagnóstico por imagen , Fémur/patología , Humanos , Masculino , Osteítis Deformante/diagnóstico por imagen , Osteoclastos/patología , Interpretación de Imagen Radiográfica Asistida por Computador , Tomografía Computarizada por Rayos XRESUMEN
Bone is the second tissue in terms of number of transplants after blood. There is an increased trend of incidence of severe bone lesions with comminuted fractures, with significant lack of substance, as well as an increased incidence of cancer types combined with therapeutic advances in recent decades, allowing for large surgical interventions that affect the bones and create significant defects in bone and contribute to the overall increase in the number and complexity of bone transplants. Autografts may be used singly or in various combinations, with significantly better effects than other implant materials. Use of autografts is limited by complications from the receptor site, mainly related to infections and undetectable necrotic areas on initial microscopic examination, which prevent proper incorporation of autografts, but also those of the donor situs. The aim of the study was to assess the integration of tibial bone grafts into the femur of Wistar rats by radiologic exam and histological evaluation. We concluded that the fixing of the graft to the host tissue may be subject to some microenvironment influences. The presence of the periosteum on the grafts is certainly an asset during transplantation. We confirm once again that the ability of transplanted periosteum of osteoformation and reactivation. Our observations regarding the contribution of bone marrow endorse the view of its active role in bone formation.