RESUMO
This retrospective study determined that the outcome from anteromedialization of the tibial tubercle correlates well with the location of patellar articular lesions. Detailed descriptions of patellar articular cartilage lesions were obtained from the operative reports of 36 patients who had anteromedialization performed between February 1984 and March 1994. The patterns fell into four distinct groups. Ten patients with type I (distal) patellar lesions and 13 patients with type II (lateral facet) patellar lesions had 87% good to excellent subjective results, and 100% of these patients said they would have the procedure done again. Nine patients with type III (medial facet) lesions had 55% good to excellent results, and 5 patients with type IV (proximal or diffuse) lesions had only 20% good to excellent results. Patients with type I or II lesions were significantly more likely to have good or excellent results than those with type III or IV lesions. Central trochlear lesions were associated with medial patellar lesions and all patients with central trochlear lesions had poor results. There was no significant correlation between the Outerbridge grading of the patellar lesion and the overall results. Workers' compensation issues diminished the likelihood of a satisfactory outcome by 19%; however, this was not statistically significant. This is the first study to correlate the patellar articular cartilage lesion with outcome after tibial tubercle transfer.
Assuntos
Cartilagem Articular/cirurgia , Patela/cirurgia , Tíbia/cirurgia , Atividades Cotidianas , Adolescente , Adulto , Doenças das Cartilagens/classificação , Doenças das Cartilagens/cirurgia , Cartilagem Articular/fisiopatologia , Desbridamento , Feminino , Seguimentos , Humanos , Luxações Articulares/cirurgia , Instabilidade Articular/etiologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteotomia/efeitos adversos , Osteotomia/métodos , Medição da Dor , Patela/lesões , Patela/fisiopatologia , Satisfação do Paciente , Amplitude de Movimento Articular , Recidiva , Reoperação , Estudos Retrospectivos , Esportes , Resultado do Tratamento , Indenização aos TrabalhadoresRESUMO
False aneurysms commonly present with a delay in symptoms of 3-6 weeks after the initial injury. These lesions may present as an enlarging nonpulsatile and painless mass causing neurologic symptoms. A review of the literature showed only 26 false aneurysms reported in the past 25 years with compression of the brachial plexus, median nerve, ulnar nerve, radial nerve, and sciatic nerves. This case is the first reported of compression of the posterior interosseus nerve by a false aneurysm and is also unusual in presenting 8 weeks after the initial injury.
Assuntos
Aneurisma/etiologia , Traumatismos do Braço/complicações , Ferimentos por Arma de Fogo/complicações , Adulto , Aneurisma/complicações , Aneurisma/cirurgia , Artéria Braquial/lesões , Humanos , Masculino , Paralisia/etiologia , Veia Safena/transplante , Artéria Ulnar/lesõesRESUMO
Dislocation of the interphalangeal joints of the lesser toes is an uncommon injury, and complex (irreducible) dislocation has rarely been reported. All previous reports note that, during open reduction, the volar plate is interposed within the joint, thereby blocking reduction. In this case, the medial collateral ligament was the primary obstruction to reduction. Clinically, these dislocations are difficult to appreciate. It is recommended that x-ray studies be performed so that this diagnosis is not overlooked.
