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Journal of Clinical Orthopaedics and... Aug 2022Chronic posterior dislocation of shoulder (PDS) is an uncommon injury and there are very few publications describing its different injury patterns and their treatment....
PURPOSE
Chronic posterior dislocation of shoulder (PDS) is an uncommon injury and there are very few publications describing its different injury patterns and their treatment. This study was carried out to study the associated injuries in chronic PDS, which can help to classify and guide the treatment.
METHODS
We retrospectively studied 16 chronic posterior dislocation of shoulder. CT scan was used to classify the injury based on the amount of bone loss in humeral head, malunion of greater tuberosity and malunion of proximal humerus metaphysis. Visual analogue score (VAS) for pain, university of California Los Angles (UCLA) shoulder score and American shoulder and elbow surgeon (ASES) shoulder score were recorded pre operatively and at an average of 27 months post operatively.
RESULTS
- Type A1 injury was PDS with <50% humeral head bone loss with intact greater tuberosity (GT). It was managed by modified McLaughlin procedure (MMP). Type A2 injury was PDS with >50% bone loss with intact GT. It was managed by hemi-replacement (HRA). Type B1 injury was PDS with <50% bone loss with severe GT malunion. It was managed by MMP and corrective osteotomy of GT. Type B2 injury was PDS with >50% bone loss and severe GT malunion. It was managed by reverse shoulder arthroplasty (RSA). Type C1 injury was PDS with <50% bone loss and metaphyseal malunion. It was managed by MMP and osteotomy of proximal humeral metaphysis. Type C2 injury was PDS with >50% bone loss and metaphyseal malunion. It was managed by HRA. The VAS, UCLA score and ASES score improved significantly after the surgery in all cases. There was no recurrence of the instability.
CONCLUSIONS
We concluded that chronic PDS could have fractures of tuberosities and/or proximal metaphysis in addition to bone loss in humeral head. The treatment is guided by all three factors-amount of bone loss in humeral head, malunion of GT and proximal humeral metaphysis. The proposed classification can help in choosing the optimum treatment out of joint salvage procedure, anatomic shoulder replacement and reverse shoulder arthroplasty.
PubMed: 35799881
DOI: 10.1016/j.jcot.2022.101926 -
Cureus May 2023Objectives The term "slipper fracture" is used to describe a fracture of the radius at the junction of the metaphysis and diaphysis. This fracture has an "evil"...
Objectives The term "slipper fracture" is used to describe a fracture of the radius at the junction of the metaphysis and diaphysis. This fracture has an "evil" reputation because it often angulates in the cast. Historically, there have been differing opinions on the optimal way to cast slipper fractures either with a long arm cast in pronation or a long arm cast in supination to prevent angulation. The purpose of this study is to report the outcomes of "slipper fractures" treated with casting. Methods Sixteen slipper fractures were retrospectively reviewed. Electronic medical records (EMRs) and radiographs were analyzed to gather data on body weight, cast type, cast position, cast index, loss of reduction, cast wedging, repeat reduction, surgery, and amount of remodeling. Results The average age of the patients was eight years old. The average body weight was 30.4 kg. Initial casting included 14 long arm casts in neutral, one short arm cast, and one sugar tong splint. The average cast index was 0.87. Only one cast had a cast index of less than 0.8. This fracture was treated with a long arm cast and did not displace. Of the fractures, 94% lost reduction in the cast and angulated an average of 26 degrees. Two cases were treated with a cast wedge; 13 were observed. Remodeling occurred at an average rate of 2.7 degrees/month. The average remodeling measured at the last follow-up was 15 degrees. Conclusion Slipper fractures are difficult to treat due to the angulation of the fracture in the cast. The current study indicates that a long arm cast, appropriate cast index, and cast position are key to preventing the loss of reduction or angulation of a slipper fracture.
PubMed: 37288176
DOI: 10.7759/cureus.38607 -
Orthopaedics & Traumatology, Surgery &... Feb 2021In France, 11,294 proximal tibia fractures occurred in 2018 and 6880 surgical procedures were done to treat them. Most of these were tibial plateau fractures, although... (Review)
Review
In France, 11,294 proximal tibia fractures occurred in 2018 and 6880 surgical procedures were done to treat them. Most of these were tibial plateau fractures, although fractures can occur in the metaphysis only or in the intercondylar eminence. The proximal tibia's poor vascularization justifies sparing it by doing a percutaneous treatment, setting the stage for bone union. The treatment must be based on rigorous planning with 3D imaging to determine the type of fracture accurately. The goals of treatment are first to realign the lower limb and then to reduce the articular surface, while addressing any associated injuries. Percutaneous reduction is based on ligamentotaxis and the use of spatulas or balloons that spare the vascularization. Surgical navigation and arthroscopy are precious tools for verifying the reduction. There are several options for stabilization, ranging from using polymethylmethacrylate cement for a Schatzker III fracture to applying a cannulated screw or doing MIPPO (Minimal Invasive Percutaneous Plate Osteosynthesis) with an anatomical plate and adjustable locking screws placed under the depression in complex fractures. Percutaneous surgery is not about the size of the incisions; the focus is on sparing the metaphysis and its vascularization to ensure high-quality and long-lasting stability. It appears to yield better functional outcomes than open reduction and internal fixation, not only for Schatzker type I, II and III fractures, but also for complex fractures where open fixation is more damaging and the source of complications.
Topics: Bone Plates; Bone Screws; Fracture Fixation, Internal; France; Humans; Tibial Fractures
PubMed: 33316447
DOI: 10.1016/j.otsr.2020.102753 -
Hand Surgery & Rehabilitation Oct 2023Osteoid osteoma is a benign bone tumor usually arising in the diaphysis and metaphysis of the long bones, with male predominance (sex ratio, 2:1). Despite being the most... (Review)
Review
Osteoid osteoma is a benign bone tumor usually arising in the diaphysis and metaphysis of the long bones, with male predominance (sex ratio, 2:1). Despite being the most common bone tumor in the wrist, it is still an atypical location for this lesion. The usual presentation is pain that is exacerbated at night and relieved by aspirin or non-steroidal anti-inflammatory drugs. This presentation is not always the case in the wrist, which leads to numerous differential diagnoses and often a delay in definitive diagnosis and treatment. Various imaging modalities can confirm the presence of the tumor and guide the surgical approach. Resection is the gold-standard, with radiofrequency gaining popularity in recent years.
Topics: Humans; Male; Female; Osteoma, Osteoid; Wrist; Wrist Joint; Pain; Bone Neoplasms
PubMed: 37182838
DOI: 10.1016/j.hansur.2023.05.002 -
Medical Science Monitor : International... Aug 2019Osteosarcoma is a malignant tumor that occurs most commonly in the metaphysis of the long bones in the limbs in children and adolescents. Even with surgery and... (Review)
Review
Osteosarcoma is a malignant tumor that occurs most commonly in the metaphysis of the long bones in the limbs in children and adolescents. Even with surgery and neoadjuvant chemotherapy, the therapeutic effect has reached a peak with 60-70% survival rates. Therefore, new biological targets or molecular mechanisms that enhance the efficacy of osteosarcoma treatments are needed. Circular RNAs (circRNAs) are useful biomarkers that have recently been recognized clinically and in medical research and have been of interest due to the use of next-generation sequencing and bioinformatics analysis. CircRNAs are involved in many diseases, including cancer. Therefore, this review aims to summarize the roles of circRNA in the diagnosis, progression, and prognosis of osteosarcoma.
Topics: Biomarkers, Tumor; Computational Biology; High-Throughput Nucleotide Sequencing; Humans; MicroRNAs; Osteosarcoma; Prognosis; RNA; RNA, Circular
PubMed: 31446435
DOI: 10.12659/MSM.915559 -
Radiographics : a Review Publication of... 2022The growing skeleton undergoes well-described and predictable normal developmental changes, which may be misinterpreted a as pathologic condition at imaging. Primary and...
The growing skeleton undergoes well-described and predictable normal developmental changes, which may be misinterpreted a as pathologic condition at imaging. Primary and secondary ossification centers (SOCs), which form the diaphysis and the epiphysis of long bones, respectively, are formed by endochondral and intramembranous ossification processes. During skeletal maturation, the SOCs may appear irregular and fragmented, which should not be confused with fractures, osteochondritis dissecans, and osteochondrosis. These normal irregularities are generally symmetric with a smooth, round, and sclerotic appearance, which are aspects that help in the differentiation. The metaphysis, epiphysis, and growth plates or physes are common sites of injuries and normal variants in the pediatric skeleton. The metaphysis contains the newly formed bone from endochondral ossification and is highly vascularized. It is predisposed to easy spread of infections and bone tumors. The physis is the weakest structure of the immature skeleton. Injuries to this location may disrupt endochondral ossification and lead to growth disturbances. Pathologic conditions of the epiphyses may extend into the articular surface and lead to articular damage. At MRI, small and localized foci of bone marrow changes within the epiphysis and metaphysis are also a common finding. These can be related to residual red marrow (especially in the metaphysis of long bones and hindfoot), focal periphyseal edema (associated with the process of physeal closure), and ultimately to a normal ossification process. The authors review the imaging appearance of normal skeletal maturation and discuss common maturation disorders on the basis of developmental stage and location. RSNA, 2022.
Topics: Child; Epiphyses; Growth Plate; Humans; Magnetic Resonance Imaging; Osteochondritis Dissecans; Osteogenesis
PubMed: 35213260
DOI: 10.1148/rg.210088 -
Clinical Rheumatology Sep 2021To estimate the prevalence of Kashin-Beck disease (KBD) among children in 2017 in Changdu of Tibet.
INTRODUCTION
To estimate the prevalence of Kashin-Beck disease (KBD) among children in 2017 in Changdu of Tibet.
METHODS
We adopted a four-step recruitment to include children aged 7-12 years from seven identified historically endemic counties in Changdu. Posterior-anterior radiographs of right hand and wrist were taken and were graded at four sites (metaphysis, epiphysis, and bony end of phalanges and metacarpal and carpal bones). Two trained researchers independently read the films. Inter-rater reliability was assessed using weighted Kappa and percentage agreement. We fitted logistic regression model to examine the association of age, sex, and altitude of residential village with prevalence of KBD. We examined association between site involvement and severity of KBD using chi-square test.
RESULTS
We recruited 13,573 children (mean age = 9.3 years, 48.40% girls) with a response rate of 95.81%. The overall prevalence of radiographic KBD was 0.26%. Luolong County had the highest prevalence (0.69%), followed by Bianba (0.26%), Basu (0.24%), Mangkang (0.14%), Zuogong (0.14%), Dingqing (0.07%), and Chaya (0.00%). A higher risk of radiographic KBD was associated with older age (P for trend <0.001) and girls (OR=1.86, 95% CI: 0.94, 3.70), but not the altitude of residential village (P for trend=0.957). Metaphysis was involved in all cases of KBD while lesions in epiphysis and bony end of phalanges and metacarpals were only observed in severe cases.
CONCLUSIONS
The prevalence of radiographic KBD among children aged 7-12 years was low in Changdu compared with previous census data, suggesting the effectiveness of preventative measures. Key Points • In this study, 13,573 Tibetan children were taken X-ray films of their hands and wrists. • The prevalence of radiographic KBD among children aged 7-12 years was low in Changdu of Tibet. • The preventative measures against KBD launched by Chinese government were effective in decreasing new onsets of KBD among Tibetan children.
Topics: Aged; Child; Female; Finger Phalanges; Humans; Kashin-Beck Disease; Male; Prevalence; Reproducibility of Results; Tibet
PubMed: 33674987
DOI: 10.1007/s10067-021-05669-9