Assuntos
Pinos Ortopédicos , Fraturas do Fêmur/cirurgia , Fixação Intramedular de Fraturas/instrumentação , Osteomielite/etiologia , Complicações Pós-Operatórias/etiologia , Criança , Doença Crônica , Fraturas do Fêmur/complicações , Fraturas do Fêmur/diagnóstico por imagem , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Osteomielite/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , RadiografiaRESUMO
BACKGROUND: There are national guidelines issued by all hospital radiology departments concerning the use of gonadal protection shields for taking X-rays of the pelvis. It is important to follow these guidelines especially when paediatric X-rays are taken. Gonads are very susceptible to radiation as they fall directly in the line of radiation exposure when pelvic X-rays are taken. AIM: To examine whether these guidelines were being followed. METHODS: This audit considered 355 radiographs taken in a 6-month period on 149 patients, under the age of 16 years, attending the orthopaedic department at King's Mill Hospital. RESULTS: In only 23% of the cases studied, the correct use of gonad protection shields had been performed. In 67% of the unprotected patients, the shields were not used at all. In the remainder, the shield was incorrectly applied. Out of all the patients, 45% had more than one X-ray thus exposing the gonads to unnecessary radiation. In addition, 8% of patients had a CT scan, 6% had fluoroscopy and 42% had radiographs of other regions of the body. CONCLUSIONS: Guidelines should be adhered to as far as possible and efforts always be made to decrease radiation exposure. Application of the current guidelines excludes the first X-ray exposure of the female pelvis and of the pelvis of trauma patients from the use of shields, thus adding to the number of the X-rays done without protection.
Assuntos
Gônadas/efeitos da radiação , Pelve/diagnóstico por imagem , Lesões por Radiação/prevenção & controle , Proteção Radiológica/instrumentação , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , RadiografiaRESUMO
Post-operative hyponatraemia can be dangerous and can go unrecognised as the presenting signs and symptoms are often confused with post-operative or post-anaesthesia sequelae. Infusion of dextrose containing fluids in the peri-operative period is a well-documented cause of this electrolyte imbalance. We conducted a retrospective study to identify the incidence of hyponatraemia following surgery for orthopaedic injury. Medical notes and fluid charts of the patients were scrutinised. We detected 32 cases of post-operative hyponatraemia over a period of 1 year. Eleven hundred and thirty-one patients underwent orthopaedic surgery during this period. Calculated incidence of hyponatraemia was 2.8%. In the hyponatraemic group, the mean pre-operative sodium was 134 mmol/l and mean post-operative sodium was 126 mmol/l. There was a statistically significant difference between mean pre-operative and mean post-operative serum sodium concentration (P<0.0001, two sample t-test). The mean volume of dextrose containing fluids received by each patient was 3.26 l. There is a significant risk of hyponatraemia following orthopaedic surgery, especially in the elderly. Orthopaedic units need to be aware of this easily avoidable condition. Fluid infusion regimes should be carefully formulated with exclusion of dextrose containing fluids to prevent the danger of hyponatraemia.
Assuntos
Hiponatremia/etiologia , Procedimentos Ortopédicos , Complicações Pós-Operatórias/etiologia , Idoso , Idoso de 80 Anos ou mais , Osso e Ossos/lesões , Feminino , Fraturas do Colo Femoral/complicações , Fraturas do Colo Femoral/cirurgia , Humanos , Masculino , Estudos RetrospectivosRESUMO
In 170 total knee arthroplasties for osteoarthritis 71 did not receive a patellar replacement (group A), while 99 knees had a cemented polyethylene patella (group B). The mean follow-up time was 36 months (30-50 months). In group A 10 patients underwent second-stage patellar resurfacing and in group B 2 knees underwent revision of the patellar component. Radiologically the average patellar congruency was similar. In both groups there were 21 non-congruent knees. In group A 8 were symptomatic and had low scores compared to 2 in group B (P<0.05). The mean HSS score and patellar score were higher in group B than in group A (P<0.05).
Assuntos
Artroplastia do Joelho/métodos , Osteoartrite do Joelho/cirurgia , Patela , Idoso , Artroplastia do Joelho/instrumentação , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/diagnóstico , Probabilidade , Estudos Prospectivos , Desenho de Prótese , Falha de Prótese , Amplitude de Movimento Articular/fisiologia , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
A previously unreported overuse injury of the coracoid process in an eleven years old archer is presented. Diagnosis was made on clinical grounds in association with the radiographic appearance of the unfused physis. The pathology and the management are presented and discussed.
Assuntos
Transtornos Traumáticos Cumulativos/etiologia , Lesões do Ombro , Esportes , Criança , Transtornos Traumáticos Cumulativos/diagnóstico , Transtornos Traumáticos Cumulativos/terapia , Humanos , MasculinoRESUMO
Massive osteolysis is a rare condition and is very uncommon in the spine. The MRI appearance of Gorham's disease of the spine has not previously been reported. We present here a case of this condition with imaging details.
Assuntos
Osteólise Essencial/diagnóstico , Doenças da Coluna Vertebral/diagnóstico , Pré-Escolar , Humanos , Imageamento por Ressonância Magnética , Masculino , Coluna Vertebral/patologiaRESUMO
Osteogenesis imperfecta in its most severe forms has a devastating effect on the peripheral and central skeleton, and patients are unable to walk. Spinal deformity is common and causes difficulty in sitting, pain and potentially life-threatening complications. Instrumented spinal fusion might be considered the treatment of choice, but the bone may be too weak to sustain the implants and autogenous bone graft is poor in quantity and quality. We present the preliminary results of a technique of fusion without instrumentation and using Keil bone graft in 5 patients with severe osteogenesis imperfecta. The curve was stabilised and back pain relieved.
Assuntos
Osteogênese Imperfeita/cirurgia , Fusão Vertebral/métodos , Adulto , Transplante Ósseo/métodos , Criança , Pré-Escolar , Sobrevivência de Enxerto/fisiologia , Humanos , Osteogênese Imperfeita/diagnóstico , Osteogênese Imperfeita/fisiopatologia , Prognóstico , Resultado do TratamentoRESUMO
Fractures of the proximal femur frequently occur in children with osteogenesis imperfecta or fibrous dyplasia and may lead to progressive coxa vara and a "shepherds crook" deformity. We have found existing methods of fixation of the femoral neck in small children to be unsatisfactory. We have devised a method of fixation using a small signal arm nail. With a mean follow-up of 9.3 years there was a successful outcome in all 11 hips treated.
Assuntos
Displasia Fibrosa Óssea/complicações , Articulação do Quadril/cirurgia , Deformidades Articulares Adquiridas/cirurgia , Osteogênese Imperfeita/complicações , Pinos Ortopédicos , Criança , Feminino , Articulação do Quadril/diagnóstico por imagem , Humanos , Deformidades Articulares Adquiridas/diagnóstico por imagem , Deformidades Articulares Adquiridas/etiologia , Masculino , Osteotomia/métodos , RadiografiaAssuntos
Biópsia por Agulha/efeitos adversos , Neoplasias Femorais/diagnóstico por imagem , Recidiva Local de Neoplasia , Inoculação de Neoplasia , Osteossarcoma/diagnóstico por imagem , Adolescente , Neoplasias Femorais/patologia , Neoplasias Femorais/terapia , Humanos , Masculino , Osteossarcoma/patologia , Osteossarcoma/terapia , Tomografia Computadorizada por Raios XRESUMO
A prospective clinical trial has been conducted comparing the use of a hydoxyapatite-coated bipolar hemiarthroplasty and an uncemented bipolar prosthesis in the treatment of displaced subcapital fractures of the femur. The trial was conducted over 1 year, 82 patients suffering displaced subcapital fractures of the femur were included. The patients were followed up for 1 year postoperatively. The functional result was significantly superior in the hydroxyapatite-coated group. Characteristic changes were found on radiographs both proximally and distally, indicating that distal stem fixation with proximal stress shielding had occurred.
Assuntos
Fraturas do Colo Femoral/cirurgia , Prótese de Quadril/métodos , Hidroxiapatitas , Atividades Cotidianas , Idoso , Idoso de 80 Anos ou mais , Durapatita , Fraturas do Colo Femoral/diagnóstico por imagem , Fraturas do Colo Femoral/reabilitação , Colo do Fêmur/diagnóstico por imagem , Prótese de Quadril/efeitos adversos , Prótese de Quadril/reabilitação , Humanos , Tempo de Internação , RadiografiaRESUMO
To improve patient service and in an attempt to enhance the outcome of joint replacement an information booklet has been produced and supplied to all patients admitted for this procedure at Harlow Wood hospital. A postal questionnaire was sent to groups of patients before and after the introduction of the booklets, three months after operation. The level of patient satisfaction with the information given improved from 54% to 82%. A significant improvement was noted in the patient's understanding of the procedure and management of their joint replacement. However, only 53% of patients fully understood the possible complications of the procedure.
Assuntos
Prótese Articular , Educação de Pacientes como Assunto , Feminino , Humanos , Masculino , Folhetos , Educação de Pacientes como Assunto/métodos , Satisfação do Paciente , Inquéritos e QuestionáriosRESUMO
The aetiology of Osteochondritis Dissecans Patellae remains controversial. We present a family suffering from the condition in all members of one generation. Clinical data support the hypothesis that the aetiology of the disorder in this family is recurrent subluxation of the patella, the inherited predisposing factor being an abnormality of the mechanics of the knee.
Assuntos
Osteocondrite Dissecante/genética , Patela , Adolescente , Fenômenos Biomecânicos , Criança , Saúde da Família , Feminino , Humanos , Masculino , Osteocondrite Dissecante/diagnóstico por imagem , Osteocondrite Dissecante/fisiopatologia , Patela/diagnóstico por imagem , Patela/fisiopatologia , RadiografiaRESUMO
A poor outcome arising from a minimally displaced fracture of the neck of the humerus may be the result of a contracture of the capsule of the glenohumoral joint. Pulsed high frequency electromagnetic energy (PHFE) is an electrotherapy to reduce pain and swelling and to enhance healing. If PHFE is effective, early mobilization of the injured shoulder will be possible, reducing the risk of joint capsule contracture. We therefore conducted a double-blind trial of PHFE in minimally displaced fractures of the neck of the humerus. Early physiotherapy produced an excellent outcome in all cases. The functional outcome depended on age rather than time of starting treatment, although a relationship was found between the time of starting treatment and the duration of therapy required. The use of PHFE did not improve the result further.
Assuntos
Terapia por Estimulação Elétrica , Fraturas do Ombro/terapia , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Ombro/fisiopatologia , Articulação do Ombro/fisiopatologia , Fatores de TempoRESUMO
A strong clinical impression exists that joint lavage often provides symptomatic relief for painful osteoarthritis of the knee. A controlled trial was conducted to test this hypothesis. A group of 37 painful osteoarthritic knees were treated by arthroscopic lavage and physiotherapy, and a control group of 24 knees were treated by physiotherapy alone. There was better relief of pain in the lavage group, and the effect was still present at one year. An improvement in the signs of inflammation lasted for about three months. Pain was relieved more effectively in patients with slight radiographic changes than in those with advanced changes. Our results confirm the effectiveness of joint lavage in the management of painful osteoarthritis of the knee.
Assuntos
Articulação do Joelho , Osteoartrite/terapia , Cuidados Paliativos , Idoso , Artroscopia , Terapia Combinada , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Modalidades de Fisioterapia , Irrigação Terapêutica/métodosRESUMO
Seventeen patients who had suffered a Bennett's fracture-dislocation have been reviewed with an average follow up of 26 years. All were treated conservatively. At review, only seven patients had symptoms, but all had a decreased range of movement and grip strength. Twelve had a characteristic deformity in the hand. Radiographs showed persistent subluxation of the first carpo-metacarpal joint and marked degenerative changes. We suggest that, in the light of the poor long-term outcome, this injury should not be managed conservatively but by some operative means.