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1.
Arch Bone Jt Surg ; 4(4): 323-329, 2016 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-27847844

RESUMO

BACKGROUND: Effects of estrogen on bone metabolism and its protective role on prevention of osteoporosis are well documented. However, the efficacy of estrogen treatment on bone healing is not well investigated. The drug can be delivered both systemically or locally to the bone with differences in concentrations and side effects. The aim of this study was to investigate the effect of local and systemic administration of estrogen on the fracture healing process. METHODS: Standardized tibial fractures with 4 millimeter gaps were created in twenty four adult male Dutch rabbits. Fractures were fixed using intramedullary wires and long leg casts. Rabbits were randomly divided into three groups. Group A was treated with twice a week administration of long acting systemic estrogen; group B was treated with a similar regimen given locally at the fracture gap; and group C received sham normal saline injections (control). Fracture healing was assessed at six weeks post fracture by gross examination, radiographic and histomorphometric analysis. RESULTS: Group B had significantly higher gross stability, radiographic union and gap reduction than the two other groups. Histomorphometric analysis showed higher cartilaginous proportion of periosteal callus area in the control group. CONCLUSIONS: Our results showed that estrogen may enhance fracture healing of long bone in rabbits. Furthermore, local estrogen treatment might have better effect than systemic treatment.

2.
Open Orthop J ; 9: 475-9, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26587064

RESUMO

Management of unicameral bone cysts (UBC) remain controversial. These cysts seldom heal spontaneously or even after pathological fracture. Sometimes these cysts can be very large and incredibly troublesome to the patient. Various treatments exist with variable success rates. We present our experience of treating these lesions by continuous drainage. Over a seven year period, six patients with unicameral bone cysts were treated by inserting a modified drain into the wall of the cyst. The aim of surgery was to place the drain in a dependent area of the cyst, through the cortex allowing for continuous drainage. This was achieved through a small incision under radiographic control. A cement restrictor (usually used for femoral canal plugging during total hip replacements) was modified and inserted to prevent closure of the drain site. A redivac drain was passed through the plug into the cyst. The drain was left in place for a week to establish an epithelialized pathway which hopefully would remain patent, into the subcutaneous tissues, after the drain had been removed. There were four males and two females in the group and the age range was 6 -12 years. Four of the lesions were in the upper humerus, one in the proximal femur and the other one in the proximal tibia. Healing was rated according to the modified Neer classification. Grade 1 (healed) and Grade 2 (healed with defect) was defined as excellent outcome. Persistent /Recurrent cysts (Grade 3 and 4) were noted as unsatisfactory. Five cases were completely healed. Only one had a further fracture and there were no recurrent fractures. All the patients reported complete comfort and they all were able to re-engage in recreational activities without restriction. We think that reducing the intra-medullary pressure in these lesions will lead to healing. We report a safe and minimally invasive technique for the management of UBC.

3.
Open Orthop J ; 9: 499-503, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26587069

RESUMO

Bilateral total knee arthroplasty can be performed either as a staged or simultaneous procedure. We conducted a retrospective comparative study to compare the need for transfusion, the length of procedure, the length of stay, and complications of bilateral simultaneous knee arthroplasty with those of unilateral knee arthroplasty. Sixty-nine patients who underwent bilateral simultaneous knee arthroplasty procedures were compared with a matched control group of 69 patients who underwent unilateral knee arthroplasty. Receiver Operating Characteristic (ROC) curve was used to determine optimum cut-off values. Both groups of patients had a similar age and gender distribution, preoperative haemoglobin and ASA scores. Cumulative transfusion episodes were lower in the bilateral group than twice that of the unilateral group. In multivariate analysis the preoperative haemoglobin level and bilateral procedures were independent factors predicting the need for transfusion. The average length of procedure and length of hospital stay in the bilateral group was less than twice than that of the unilateral group. Advanced age and bilateral procedures were independent predictors of prolonged length of stay. A haemoglobin level of 12.5 g/dL and age of 70 were most suitable cut-off points to predict need for transfusion and occurrence of medical complications respectively. We conclude that bilateral simultaneous knee arthroplasties are safe and cost effective in appropriately selected patients. We recommend avoiding bilateral simultaneous procedures in patients over the age of 70 years and with significant comorbidities.

5.
Open Orthop J ; 8: 204-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25097675

RESUMO

Patients presenting to the emergency department with bite injuries to the hand sustain them through a number of causes including domesticated as well as stray animal bites, and human bites commonly sustained as a result of violence. The nature of the injuries sustained can be very deceptive. A small tooth mark on the exterior can be a fulminant infection in the tissues deeper down. Tendon injuries, fractures of the metacarpals and phalanges and management of the wound are critical issues faced by a surgeon in dealing with such patients. Similarly the less common bite injuries to the hand, often with disastrous and sometimes fatal complications, do also present to the emergency department. A high incidence of suspicion is needed in dealing with these injuries effectively. In our article we discuss the common as well as uncommon causes of bite injuries to the hand and their management. In addition to reviewing the literature to ascertain the management of such injuries, we also discuss interesting and rare case reports.

6.
Open Orthop J ; 8: 185-93, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25067973

RESUMO

Acute compartment syndrome (ACS) is a surgical emergency warranting prompt evaluation and treatment. It can occur with any elevation in interstitial pressure in a closed osseo-fascial compartment. Resultant ischaemic damage may be irreversible within six hours and can result in long-term morbidity and even death. The diagnosis is largely clinical with the classical description of 'pain out of proportion to the injury'. Compartment pressure monitors can be a helpful adjunct where the diagnosis is in doubt. Initial treatment is with the removal of any constricting dressings or casts, avoiding hypotension and optimizing tissue perfusion by keeping the limb at heart level. If symptoms persist, definitive treatment is necessary with timely surgical decompression of all the involved compartments. This article reviews the pathophysiology, diagnosis and current management of ACS.

7.
Open Orthop J ; 8: 215-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25067977

RESUMO

Multiligamentous knee injuries are rare but serious injuries that can threaten limb viability. As such, they require careful management to give patients the best chance of immediate and ultimate functional recovery. However, as these injuries are rare, there is paucity in prospective comparative studies large enough to provide high level evidence for best practice. This lack of comprehensive and convincing evidence has made the management of multiligamentous knee injuries an area of active debate and controversy. The debate on whether surgical management leads to better outcomes than non-operative management, the optimal timing of surgery after injury and whether repair is better than reconstruction is still ongoing. Using the Oxford Levels of Evidence, this review summarises the latest high level evidence to provide answers to these issues. Recommendations for practice have also been offered and assigned a grade using a published scale.

8.
Injury ; 45(4): 780-3, 2014 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-24388418

RESUMO

INTRODUCTION: Ankle fractures are among the most common injuries of the lower extremity encountered by orthopaedic surgeons. With increasing population age and osteoporosis, the prevalence of these fractures is expected to increase. The aim of this study was to evaluate complications and the need for revision surgery after the surgical treatment of ankle fractures in patients over 60 years of age. We report the outcomes of 186 consecutive patients who underwent operative treatment for rotational ankle fractures in our institution from 2007 to 2010. MATERIALS AND METHODS: Data were collected retrospectively for the purpose of this study. The outcome measures included minor complications which did not need further surgical intervention, that is, superficial wound infections, delayed wound healing, prominent implants and skin irritation, and major complications that prompted surgical intervention (due to deep wound infection, loosening of implants or loss of fixation). Medical complications were also recorded. Long-term complications (postoperative osteoarthritis) were not assessed in this study. Logistic regression analysis and Fisher's exact test were used to identify factors predicting higher risk of complications. RESULTS: The average age was 70.67 years (standard deviation (SD) 7.40). There were 132 (71%) females and 54 (29%) males. The overall rate of complications was 21.5% with 10.8% of them being major complications prompting surgical intervention for wound washout, removal of implants and revision of fixation. Statistical analysis showed that smoking, age, diabetes, local factors (osteopaenia, peripheral neuropathy, peripheral vascular disease, lymphoedema and venous insufficiency) and modified Charlson score were significantly associated with occurrence of complications. Gender had a marginally significant effect. Coronary artery disease and fracture type (Weber classification) did not have a significant effect on the outcome. DISCUSSION AND CONCLUSION: Our data show that surgical treatment of ankle fractures in the elderly is associated with a high rate of complications. The factors predicting a high rate of complications include smoking, age, diabetes, local factors and a higher modified Charlson score. It is important to bear the factors in mind whilst deciding whether surgical treatment should be used in the treatment of such fractures in the elderly and explains these to patients at the time of obtaining consent. Further large-scale studies are needed to validate the predictive value of the suggested modified Charlson score.


Assuntos
Traumatismos do Tornozelo/cirurgia , Fixação Interna de Fraturas/efeitos adversos , Fraturas Ósseas/cirurgia , Osteoporose/cirurgia , Complicações Pós-Operatórias/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Tornozelo/epidemiologia , Traumatismos do Tornozelo/fisiopatologia , Comorbidade , Feminino , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/fisiopatologia , Serviços de Saúde para Idosos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Osteoporose/epidemiologia , Osteoporose/fisiopatologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Infecção da Ferida Cirúrgica/epidemiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
10.
Acta Orthop Belg ; 79(1): 97-103, 2013 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23547523

RESUMO

Dynamic semirigid stabilization of the lumbar spine was introduced in 1994 in an attempt to overcome the drawbacks of fusion. It is supposed to preserve motion at the treated levels, while avoiding hypermobility and thus spondylosis at the adjacent levels. Although the early reports showed promising results, the long term effects are still debated. We retrospectively compared outcomes of Dynesys dynamic stabilization with those of the traditional fusion technique. Thirty-two patients who had undergone Dynesys between 2004 and 2006 (group 1) were compared to 32 patients who had been treated with fusion between 2005 and 2006 (group 2). VAS for back and leg pain, and ODI improved significantly in both groups (p < 0.001). These scores were all better in the fusion group, and even significantly so as far as VAS for back pain was concerned (p = 0.014). Similarly, more patients were satisfied or very satisfied after fusion than after Dynesys: 87.5% versus 68.8% (p = 0.04). Interestingly, in the Dynesys group scatter plot graphs showed a positive correlation between older age and improvement in the two VAS scores and in ODI. Dynamic stabilization with Dynesys remains controversial. Older patients are relatively more satisfied about it, probably because of their low level of demands.


Assuntos
Vértebras Lombares/cirurgia , Procedimentos Ortopédicos/métodos , Fusão Vertebral , Adulto , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Estudos Retrospectivos , Resultado do Tratamento
11.
Curr Stem Cell Res Ther ; 8(3): 185-91, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23317466

RESUMO

In orthopaedic tissue engineering, scaffolds may be viewed as a substitute for the extra-cellular matrix. Factors that contribute to an ideal scaffold include strength, degradation rate, porosity, surface property and immune response.Scaffolds may be composed of natural or synthetic polymers, each with its advantages and disadvantages. Composite scaffolds are utilised to alleviate the inherent issues with natural polymers whilst maintaining its benefits as well. This article reviews biomaterials and scaffolds in orthopaedic tissue engineering and covers clinical applications of scaffolds with particular emphasis on bone and cartilage tissue engineering.


Assuntos
Materiais Biocompatíveis/farmacologia , Osso e Ossos/efeitos dos fármacos , Sistema Musculoesquelético/efeitos dos fármacos , Engenharia Tecidual/métodos , Alicerces Teciduais/química , Animais , Humanos , Nanotecnologia
12.
Curr Stem Cell Res Ther ; 8(3): 222-31, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23317471

RESUMO

Meniscal injuries are one of the common sports injuries and their natural healing is limited. Removal of injured meniscus alters knee biomechanics and predisposes patients to osteoarthritis. Tissue engineered meniscus provides a novel approach for the treatment of severe meniscus injury. The aim of this review is to review preclinical studies that used cell based approaches for tissue engineered meniscus. Studies were assessed for inclusion following a search in PubMed, UK PubMed central and Embase. All preclinical studies that used cell based approaches for meniscus regeneration were included in the study. Nineteen articles that used cellular approaches were reviewed. The cell types used were mesenchymal stem cells (derived from bone marrow or synovium), meniscal fibrochondrocytes, chondrocytes and bone marrow stromal cells. One study used xenogeneic bone marrow derived mesenchymal stem cells. Sixteen out of nineteen studies showed better tissue regeneration with cell based approaches when compared to acellular controls. The review included preclinical studies. The diversity of the studies made it impossible to adhere to full guidelines or perform a meta-analysis. Overall,experiments have demonstrated superior tissue integration and favourable biochemical properties of the regenerated tissues compared to acellular techniques. Few approaches however, have measured the chondroprotective ability at preclinical testing.


Assuntos
Transplante de Células , Meniscos Tibiais/patologia , Modelos Biológicos , Engenharia Tecidual , Animais , Humanos
13.
Curr Stem Cell Res Ther ; 8(3): 232-42, 2013 May.
Artigo em Inglês | MEDLINE | ID: mdl-23317472

RESUMO

Meniscal injuries are among the common sports injuries and their natural healing is limited. Removal of injured meniscus impairs normal knee function and predisposes patients to osteoarthritis. Tissue engineering and replacement strategies provide a novel approach for the treatment of severe meniscus injury. The aim of this article is to review preclinical studies that used approaches for meniscal replacement including growth factors, synthetic and tissue engineered scaffolds and non-meniscal autografts. Medline, EMBASE and UK PubMed search was performed and articles were assessed for inclusion. Included articles were summarised and categorised. Forty seven articles matched the inclusion criteria.The studies were classified according to the approaches used for meniscus replacement. Overall most experiments have shown good tissue integration and biochemical properties of the regenerated tissues. However, only few approaches have demonstrated satisfactory chondroprotective function.


Assuntos
Meniscos Tibiais/patologia , Modelos Biológicos , Engenharia Tecidual , Humanos , Alicerces Teciduais/química , Transplante Autólogo
14.
J Arthroplasty ; 28(1): 197.e13-6, 2013 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22682039

RESUMO

We report a case of successful treatment of a high, stable intertrochanteric fracture (type 1) in a 59-year-old man. He sustained the injury 8 years after the resurfacing procedure. The fracture was fixed using three 6.5-mm cannulated screws, and he has returned to his normal level of activities 8 months after the fixation. We have shown that fixation with cannulated screws may be an acceptable option for treatment of high trochanteric fractures where a stable anatomical reduction can be obtained. We have also included a review of the literature for other reported surgical treatment options of this complication.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas , Hemiartroplastia , Fraturas do Quadril/cirurgia , Articulação do Quadril/cirurgia , Osteoartrite do Quadril , Fraturas Periprotéticas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/cirurgia
15.
Ortop Traumatol Rehabil ; 15(4): 341-6, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24431272

RESUMO

Olecranon fractures are common skeletal injuries accounting for approximately 10% of upper extremity fractures in adults. Simple non-comminuted fractures are traditionally fixed using the tension band wiring technique. This technique, however, has several complications, most commonly prominence of the metalwork frequently requiring surgery for removal. We describe a retrospective review of a new method of fixation for these fractures using partially threaded screws in an attempt to avoid these complications. We used two 3.5 and/or 4 mm partially threaded screws to fix seven simple olecranon fractures and two olecranon osteotomies. Notes and clinic letters of all nine patients were reviewed for demographic data, operation details and complications. Radiographs were reviewed at final clinical follow-up. The Mayo Elbow Performance Score was completed during a telephone consultation. One patient injured her elbow postoperatively, which resulted in fragmentation of the proximal segment and loss of fixation. In one patient the tip of the screws broke after a fall but this did not result in loss of fixation. There were no problems with metalwork prominence or skin irritation in any of the patients. Two patients had low scores due to loss of fixation, and severely comminuted supracondylar fracture of the humerus. Six patients had good scores. We believe that use of AO compression screws is a valid method for the fixation of simple fractures of the olecranon. It is a safe technique and has several advantages over tension band fixation. There is minimal tissue dissection and operating time is decreased. There is minimal risk of metalwork prominence as screws obtain good purchase in the anterior cortex of ulna. Good interfragmentary compression is achieved as screws are perpendicular to the fracture line and two screws provide good rotational stability. Protection of fixation for 1014 days does not result in significant loss of range of motion. Further clinical and biomechanical studies are suggested to compare this technique with other methods of fixation of olecranon fractures.


Assuntos
Parafusos Ósseos , Fixação Interna de Fraturas/instrumentação , Fixação de Fratura/métodos , Olécrano/lesões , Olécrano/cirurgia , Osteotomia/instrumentação , Adulto , Idoso , Feminino , Fixação de Fratura/instrumentação , Fixação Interna de Fraturas/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Olécrano/diagnóstico por imagem , Polônia , Radiografia , Recuperação de Função Fisiológica , Resultado do Tratamento , Fraturas da Ulna/cirurgia
16.
Foot Ankle Int ; 33(9): 722-6, 2012 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-22995258

RESUMO

BACKGROUND: The aim of this prospective study was to assess the effectiveness of a single ultrasound-guided steroid injection in the treatment of Morton's neuromas and whether the response to injection correlates with the size of the neuroma. METHODS: Forty-three patients with clinical features of Morton's neuroma underwent ultrasound scan assessment. Once the lesion was confirmed in the relevant web space, a single corticosteroid injection was given using 40 mg of methylprednisolone along with 1% lidocaine. All scans and injections were performed by a single musculoskeletal radiologist. Patients were divided into two groups on the basis of the size of the lesion measured on the scan. Group 1 included patients with neuromas of 5 mm or less and group 2 patients had neuromas larger than 5 mm. A visual analog scale (VAS) for pain (scale 0 to 10), the American Orthopaedic Foot and Ankle Society (AOFAS) score, and the Johnson satisfaction scale were used to assess patients before injection and then at 6 weeks, 6 months, and 12 months following the injection. Thirty-nine patients had confirmed neuromas. Group 1 (lesion ≤ 5 mm) included 17 patients (mean age, 30 years) (7 males, 10 females) and group 2 (lesion >5 mm) had 22 patients (mean age, 33 years) (8 males, 14 females). RESULTS: VAS scores, AOFAS scores, and Johnson scale improved significantly in both groups at 6 weeks (p < .0001). At 6 months postinjection, this improvement remained significant only in group 1 with all scores (p < . 001). At 12 months, there was no difference between both groups and outcome scores nearly approached preinjection scores. At the final review, two patients in group 1 and four patients in group 2 had severe recurrent symptoms and therefore underwent surgical excision of the neuroma after they rejected the offer for a repeat injection (p = 0.6). CONCLUSION: A single ultrasound-guided corticosteroid injection resulted in generally short-term pain relief for symptomatic Morton's neuromas. The effectiveness of the injection appears to be more significant and long-lasting for lesions smaller than 5 mm.


Assuntos
Corticosteroides/administração & dosagem , Doenças do Pé/tratamento farmacológico , Doenças do Pé/patologia , Neuroma/tratamento farmacológico , Neuroma/patologia , Adulto , Feminino , Humanos , Masculino , Medição da Dor , Satisfação do Paciente , Estudos Prospectivos , Resultado do Tratamento , Adulto Jovem
17.
Acta Orthop Belg ; 78(6): 757-63, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23409572

RESUMO

We measured the posterior tibial slope for the medial and lateral tibial plateau separately in MR images of 143 knees (71 women, 72 men) and compared the measurements between genders and different ethnic groups. For the whole population the mean medial slope was 5.7 degrees and the mean lateral slope 5.6 degrees. There was a significant difference between the medial and lateral posterior tibial slope in the Asian patients compared with other ethnic groups (p < 0.001). We have shown that measurement of the posterior tibial slope (PTS) could be reliably performed on MR images, revealing a gender difference. These findings might have clinical relevance when performing reconstructive surgery at the knee in determining ideal placement of the tibial component.


Assuntos
Articulação do Joelho/anatomia & histologia , Tíbia/anatomia & histologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Adulto Jovem
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