RESUMO
Slipped capital femoral epiphysis (SCFE) is a fairly common condition affecting older children and adolescents, and has the potential for long-term, crippling sequelae. Early recognition is the single most important controllable factor, but the diagnosis is often missed or delayed, resulting in progression of the slip. A SCFE should be suspected and promptly evaluated in any older child or adolescent presenting with a limp or complaints of hip, groin, thigh, or knee pain, especially if the patient is overweight. The diagnosis is usually made by anteroposterior and frog-leg lateral radiographs of the hips. Common errors at initial presentation include: not obtaining hip radiographs (due to either no hip pain or the lack of an impressive history and physical findings); misreading hip radiographs (the findings can be subtle); and lack of timely referral. Early involvement of and treatment by an orthopedic surgeon can greatly reduce the potential complications. We present three cases of SCFE that highlight common errors made at initial presentation, and a discussion that includes the differential diagnosis of an older child or adolescent with a painful limp.
Assuntos
Epifise Deslocada/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Adolescente , Pinos Ortopédicos , Criança , Diagnóstico Diferencial , Erros de Diagnóstico , Epifise Deslocada/cirurgia , Feminino , Articulação do Quadril/diagnóstico por imagem , Humanos , Masculino , RadiografiaRESUMO
Two patients with cervical plexiform neurofibromas are presented. Each of these patients had severe cervical kyphosis and has undergone anterior decompression, anterior reconstruction, and posterior stabilization. We discuss the surgical management of cervical kyphotic deformities associated with plexiform neurofibromas and review the factors associated with bony changes in neurofibromatosis.
Assuntos
Vértebras Cervicais/cirurgia , Cifose/cirurgia , Neurofibroma Plexiforme/cirurgia , Neoplasias da Coluna Vertebral/cirurgia , Adolescente , Adulto , Vértebras Cervicais/patologia , Criança , Feminino , Humanos , Cifose/diagnóstico , Cifose/patologia , Laminectomia , Imageamento por Ressonância Magnética , Masculino , Recidiva Local de Neoplasia/diagnóstico , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Neurofibroma Plexiforme/diagnóstico , Neurofibroma Plexiforme/patologia , Exame Neurológico , Reoperação , Compressão da Medula Espinal/diagnóstico , Compressão da Medula Espinal/patologia , Compressão da Medula Espinal/cirurgia , Fusão Vertebral , Neoplasias da Coluna Vertebral/diagnóstico , Neoplasias da Coluna Vertebral/patologiaAssuntos
Epifise Deslocada/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Colo do Fêmur/diagnóstico por imagem , Epifise Deslocada/cirurgia , Cabeça do Fêmur/cirurgia , Colo do Fêmur/cirurgia , Lâmina de Crescimento/diagnóstico por imagem , Lâmina de Crescimento/cirurgia , Humanos , RadiografiaAssuntos
Potenciais Somatossensoriais Evocados/fisiologia , Monitorização Intraoperatória/métodos , Córtex Motor/fisiologia , Paraplegia/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Adolescente , Potenciais Evocados/fisiologia , Humanos , Masculino , Traumatismos da Medula Espinal/cirurgia , Fraturas da Coluna Vertebral/cirurgia , Fusão Vertebral , Vértebras Torácicas/lesõesRESUMO
This is a study to demonstrate the biologic effect of a proximal femoral osteotomy in Perthes disease. Fifty-two hips in 49 patients treated with prolonged recumbency in a Robert Jones abduction frame were reviewed. Twenty-six of these hips had, in addition, a proximal femoral osteotomy. No significant relation between the treatment group and Mose rating (p greater than 0.05), epiphyseal quotient (p greater than 0.05), or healing rate (p greater than 0.05) was found. In the group of patients with Catterall III and IV disease, there were 44% good, 29% fair, and 29% poor results. Based on this study, the biologic aspect of the osteotomy probably does not influence the radiologic outcome or the healing rate in Perthes disease; hence, the beneficial effects of a containment osteotomy probably occur as a result of mechanical rather than biologic means.
