RESUMO
Background Proximal row carpectomy (PRC) is contraindicated in wrists with preexisting arthritis of the proximal capitate or radiolunate fossa. Patients with these conditions frequently pursue wrist arthrodesis with its associated functional limitations. Questions/Purposes The purpose of this study was to evaluate the results of using lateral meniscal allograft interposition (LMAI), in combination with PRC, in patients with symptomatic wrist arthritis. The primary question is whether this allograft will allow wrist function comparable to that in patients having only a PRC. A secondary question was to determine the short-term longevity of the allograft. Patients/Method Between 2006 and 2012, nine wrists underwent PRC with LMAI. Patient demographics and rates of complication or graft failure were determined. During independent clinical exams, functional outcomes were reviewed, patients completed a Disabilities of the Arm, Shoulder, and Hand (DASH) scores, and radiographs were taken. Results Four patients met the inclusion criteria, having clinical follow-up at an average of 4.2 years. DASH scores at the time of follow-up ranged from 9 to 33, with an average of 24. Average radiocapitate joint space in the first postoperative radiograph was 2.8 mm compared with 1.8 mm at the time of final follow-up. No wrists went on to arthrodesis. Conclusion Early outcomes of PRC with LMAI are comparable to those results found in the literature of PRC alone. LMAI with PRC may be a valid short-term option as a motion-preserving procedure in those patients contraindicated to having a PRC alone. Level of Evidence Level IV.
RESUMO
Glenoid component loosening is the most common early mode of failure of total shoulder arthroplasty (TSA) We hypothesised that the use of a pegged glenoid component with a modern glenoid reaming system and an instrumented cement pressurization technique would achieve a low prevalence of early radiolucent lines. Of 81 patients having TSA with a cemented, all polyethylene, 3-peg glenoid component for primary glenohumeral osteoarthritis, 69 had high quality radiographs available for analysis. All preoperative and initial postoperative radiographs were reviewed and graded in a blinded manner using previously established criteria. When the radiolucency grade of cement fixation was converted to a numeric scale of 0 (no radiolucency) to 5 (grossly loose), the mean cementing score was 0.14 + 0.06. Of the 69 shoulders, 62 (90%) had no radiolucencies. These techniques to improve glenoid fixation resulted in a low incidence of early radiolucencies about the glenoid component in patients having TSA for primary glenohumeral osteoarthritis.
Assuntos
Artroplastia de Substituição/efeitos adversos , Prótese Articular , Osteoartrite/diagnóstico por imagem , Osteoartrite/cirurgia , Falha de Prótese , Cimentos Ósseos , Cimentação , Humanos , Incidência , Desenho de Prótese , Radiografia , Escápula , Método Simples-CegoRESUMO
The optimal choice for the treatment of end-stage primary glenohumeral osteoarthritis remains controversial, with alternatives including total shoulder replacement (TSR) and humeral head replacement (HHR). The objective of this review was to analyze the effect of TSR compared with HHR on rates of pain relief, range of motion, patient satisfaction, and revision surgery in patients with primary glenohumeral osteoarthritis. We searched computerized databases for clinical studies published between 1966 and 2004 that reported on shoulder replacement for primary glenohumeral osteoarthritis. Pain data were converted to a 100-point score. Outcome assessment data were pooled when possible, and analyses via normal test statistics were performed. We identified 23 studies, with a total of 1952 patients and mean follow-up of 43.4 months (range, 30-116.4 months). The mean level of evidence was 3.73. Among the 23 studies, 7 different outcome instruments were used. Of the 23 studies, 14 (n = 1185) reported pain relief, 15 (n = 1080) reported range of motion, 12 (n = 969) reported patient satisfaction, and 14 (n = 1474) reported revision surgery. Compared with HHR, TSR provided significantly greater pain relief (P < .0001), forward elevation (P < .0001), gain in forward elevation (P < .0001), gain in external rotation (P = .0002), and patient satisfaction (P < .0001). Furthermore, only 6.5% of all TSRs required revision surgery, which was significantly lower than the percentage for all patients undergoing HHR (10.2%) (P < .025). Only 1.7% of all-polyethylene glenoid components required revision. On the basis of this review and analysis, in comparison with HHR, TSR for the treatment of primary glenohumeral osteoarthritis significantly improves pain relief, range of motion, and satisfaction and has a significantly lower rate of revision surgery. Inconsistent outcome reporting and poor study design may warrant standardization of outcome instruments and improved study design in the future.
Assuntos
Artroplastia de Substituição , Úmero/cirurgia , Osteoartrite/cirurgia , Articulação do Ombro/cirurgia , Humanos , Dor , Satisfação do Paciente , Amplitude de Movimento Articular , ReoperaçãoRESUMO
PURPOSE OF REVIEW: Fracture of the tibia is a common occurrence in children. The operative treatment of pediatric tibia fractures has undergone a recent change. However, there is no clear consensus regarding the superiority of one treatment option. RECENT FINDINGS: The literature clearly supports the fact that the vast majority of pediatric tibia fractures can and should be managed nonoperatively. This is secondary to their inherent stability. A variety of factors including fracture type, location, severity and patient age determine the best treatment options for a particular fracture. A thorough understanding of these factors and how they affect outcome, help the clinician formulate the proper plan of treatment. SUMMARY: A randomized prospective controlled trial will be necessary to establish which surgical options are superior for which type of pediatric tibia fracture. Until then, recent studies have indicated that flexible intramedullary nails may lead to a shorter time to union and a decreased rate of refracture when compared with external fixation of unstable tibial shaft fractures. What remains unclear are the specific indications and contraindication for the use of flexible nails. External fixation still remains a successful treatment option for unstable tibial shaft fractures.