RESUMO
Heterotopic ossification is a well-recognized complication of musculoskeletal trauma and elective orthopaedic surgery. A series of 10 cases of arthroscopic subacromial decompressions developed postoperative heterotopic bone. In eight, the ectopic bone caused recurrent shoulder impingement. These are the first reported cases in which heterotopic ossification compromised the results of an arthroscopic procedure. It is recommended that the patient at risk (e.g., with active spondolytic arthropathy or a profile of hypertrophic pulmonary osteoarthropathy--obesity, diabetes with a history of chronic pulmonary disease) be considered for heterotopic ossification prophylaxis.
Assuntos
Artropatias/cirurgia , Ossificação Heterotópica/diagnóstico por imagem , Complicações Pós-Operatórias/diagnóstico por imagem , Articulação do Ombro/cirurgia , Adulto , Artroscopia , Feminino , Humanos , Artropatias/diagnóstico por imagem , Artropatias/epidemiologia , Masculino , Ossificação Heterotópica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Radiografia , Recidiva , Estudos Retrospectivos , Fatores de Risco , Articulação do Ombro/diagnóstico por imagem , Fatores de TempoRESUMO
The cases of 127 patients who had an acute dislocation of the acromioclavicular joint were studied. Fifty-two patients, with an average follow-up of 10.8 years, were managed operatively, and seventy-five patients, with an average follow-up of 9.5 years, were managed non-operatively. Using a rating system that included subjective, objective, and roentgenographic criteria, it did not appear that reduction of the acromioclavicular joint was necessary to obtain consistently good results. Operative management, using either coracoclavicular or acromioclavicular fixation, was associated with a higher rate of complications than non-operative treatment. The use of a sling for four weeks without reduction of the joint, followed by a graduated exercise program, led to acceptable clinical results. In patients who had persistent pain and stiffness of the acromioclavicular joint, or in whom symptomatic post-traumatic arthritis developed, resection of the distal part of the clavicle reliably produced significant improvement.
Assuntos
Articulação Acromioclavicular/lesões , Luxações Articulares/terapia , Articulação Acromioclavicular/diagnóstico por imagem , Articulação Acromioclavicular/cirurgia , Adolescente , Adulto , Pinos Ortopédicos , Parafusos Ósseos , Clavícula/cirurgia , Feminino , Seguimentos , Humanos , Luxações Articulares/complicações , Luxações Articulares/cirurgia , Masculino , Aparelhos Ortopédicos , RadiografiaRESUMO
One hundred sixty total knee arthroplasties using the Walldius (90), geometric (31), and total condylar (39) prostheses were analyzed by standardized ratings. Patients with total condylar knees had the highest mean postoperative rating, although the patients with Walldius knees derived the greatest symptomatic relief from surgery. There were 12 failures. Varus placement of the prosthesis occurred in 11 patients; eight of these knees were symptomatic. There were six wound infections, five of which were salvaged. The unsolved problems of total knee arthroplasties are: malalignment, loosening, infection, wear, and balancing mobility with stability.
