CT mapping for complex tibial pilon fractures: Understanding the injury pattern and its relation to the approach choice

OBJECTIVE

To map OTA/AO type 43C3 tibial pilon fractures by means of computed tomography and analyze the difference between varus and valgus fractures. We hypothesized that valgus fractures are less frequent than varus, and the affected zones of the tibial pilon are different among the patterns.

MATERIAL AND METHODS

Retrospective, cross-sectional, observational study, using images of 73 computed tomographies of patients who had presented OTA/AO type 43C3 tibial pilon fractures. The radiographs and computed tomography were subdivided into two groups: varus and valgus fractures. Also, the presence or absence of fibula fractures. Both groups were subdivided into eight zones: four lateral to the pilon and four medial.

RESULTS

The distribution of total affected zones is significantly different in the male and female subgroups (p = 0.027). The incidence of cases in zone 1 is significantly different in varus and valgus displacement subgroups (p = 0.002). In the patients with valgus displacements, 61.9% of the fractures affect zone 1; in the patients with varus displacements, only 25.8% of the fractures affect zone 1. In the patients without fibula fracture, 58.3% of the fractures affect zone 2; in the patients with fibula fracture, 24.6% of the fractures affect zone 2.

CONCLUSION

The typical profile of the patient with a pilon fracture is age ranging from 27 to 57 years, male, with fibular fracture, and the injury affecting two or three pilon zones, with zones 6, 1, and 3 being the most affected ones. There is no typicality regarding the valgus or varus fracture displacement, although a difference was found in zone 1.

Antibodies against Actinobacillus pleuropneumoniae, Mycoplasma hyopneumoniae and influenza virus and their relationships with risk factors, clinical signs and lung lesions in pig farms with one-site production systems in Brazil

A study was conducted on 21 pig herds using one-site production system in the southeast region of Brazil to assess the relationships among serological results for primary pathogens involved in respiratory diseases (Actinobacillus pleuropneumoniae, App; Mycoplasma hyopneumoniae, Mhyo; and swine influenza virus, SIV), cough index, pneumonia index, pleuritis and herd characteristics. The prevalence of antibodies against Mhyo and SIV increased throughout the raising phases, with the highest prevalence in slaughtered pigs (> 40%), while pigs in 65% (14/21) of nurseries demonstrated marked seroprevalence of App that decreased until the day of slaughter. Pleuritis and pulmonary consolidations were recorded in 9.0 and 72.4%, respectively, of the 908 evaluated lungs. Histopathological analysis of the lung lesions revealed suppurative bronchopneumonia in almost half of the lungs (48.9%). Regression analyses were conducted to identify risk factors associated with the cough index; pleuritis; pulmonary consolidation; and App, Mhyo and SIV serological results. All-in-all-out management in nursery buildings reduced the seroprevalence of Mhyo in herds. App seroprevalence was associated with pleuritis, and the presence of cough episodes in growing pigs was associated with SIV seropositivity in nursery pigs.

Prospective randomized study after the use of drains in total knee arthroplasty with implant

Objective

to compare the laboratorial results of opening suction drainage 6 hours and 12 hours after total knee arthroplasty surgery.

Methods

prospective and randomized study in 88 patients undergoing with total knee arthroplasty in two groups: in one group the opening suction drainage was performed 6 hours (n = 45) after the surgery and in the other 12 hours (n = 43) after the surgery.

Results

the outcome was a significant fall in the three laboratorial variables (hemoglobin, red blood cells and hematocrit) between the pre and post-operative in the total sample and in the six and 12 hour opening suction drainage groups. In the group with opening suction drainage after 12 hours, the drainage volume was significantly lower than in the group with opening suction drainage after 6 hours (p = 0.0003). However, no significant difference was observed in the absolute delta of the laboratorial variables between the two groups.

Concluasion

the opening suction drainage in six and 12 hours did not show significant difference from the laboratorial values although the volume of the blood drained was higher in the opening suction drainage in six hours.

Tratamento das fraturas distais da tíbia

OBJETIVO: comparar os resultados da fixação ou não da fíbula no tratamento das fraturas do terço distal da tíbia, com haste intramedular e placa em ponte. MÉTODOS: foram 47 fraturas em 47 pacientes, sendo que em 21 pacientes foi utilizada a haste intramedular bloqueada não fresada e em 26 a placa em ponte (placa de compressão dinâmica larga ou estreita) pela técnica minimamente invasiva. Todas as fraturas da fíbula se encontravam no mesmo nível ou abaixo da fratura da tíbia. RESULTADOS: No grupo tratado com fixação da fíbula, a média do tempo de consolidação foi de 14,6 semanas. No grupo tratado sem fixação da fíbula, a média do tempo de consolidação foi de 14,3 semanas. No grupo de pacientes tratados com fixação da fíbula observou-se uma proporção de desvio angular em varo (6,3%) significativamente menor que o subgrupo sem fixação de fíbula (32,3%), e com desvio angular em valgo (62,5%) significativamente maior que o grupo sem fixação de fíbula (32,3%). CONCLUSÃO: Os benefícios da fixação da fíbula permanecem ainda controversos quando ocorrem fraturas associadas com a tíbia Em relação à consolidação, não houve diferença significativa. Em relação à consolidação, não houve diferença significativa entre os grupos.

ANATOMIC STUDY OF THE PROXIMAL THIRD OF THE FEMUR: FEMOROACETABULAR IMPACT AND THE CAM EFFECT

To analyze anatomical variations of the proximal end of femur that could cause a femoroacetabular impact.

METHODS

199 skeletically mature anatomical specimens of femurs were used. The femurs were measured in order to determine the anteversion angle of the femoral neck, neckshaft angle, sphericity of the femoral head at anteroposterior and superoinferior, angle between epiphysis and the anterior femoral neck, angle between epiphysis and the neck at lateral plane, anteroposterior distance at 5mm of the head and neck junction and anteroposterior distance of the neck base.

RESULTS

we found that the impact subgroup presented a significantly larger junction diameter of 5mm (p = 0.0001) and cam-head (%) (p= 0.0001), while base-cam (%) (p = 0.0001) showed a significantly smaller diameter than the subgroup without impact. It was identified that cam-head (%) ≤ 80 e base-cam (%) ≤ 73 were identified as the optimal impact points.

CONCLUSION

our study showed that the effect cam, caused by anatomical variations of the proximal femoral end focused the head-neck junction and base of the neck-junction head-neck. These rates can be predictive factors of the impact.

Evaluation of Alzheimer's disease by analysis of MR images using multilayer perceptrons and committee machines

Alzheimer's disease is the most common cause of dementia, yet hard to diagnose precisely without invasive techniques, particularly at the onset of the disease. This work approaches image analysis and classification of synthetic multispectral images composed by diffusion-weighted magnetic resonance (MR) cerebral images for the evaluation of cerebrospinal fluid area and its correlation with the advance of Alzheimer's disease. The MR images were acquired from a unique volunteer with Alzheimer's, using an image system based on a clinical 1.5T tomographer. The classification methods are based on multilayer perceptrons and committee machines and the classification results are used to correlate clinical and imaging findings. The classification results are used to improve the usual analysis of the ADC map.