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Lu M, Chen Y, Chen W. [Case-control study on the occurrence of cubitus varus deformity after humeral supracondylar fractures treated with plaster fixation in pronated or supinated position in children]. Zhongguo Gu Shang 2014; 27:904-907. [PMID: 25577910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To retrospectively compare the occurrence of cubitus varus deformity after humeral supracondylar fractures treated with manipulative reduction and plaster fixation in pronated or supinated position in children, and to guide clinical treatment. METHODS From June 2009 to December 2011, the medical data of 64 children with humeral supracondylar fractures treated by manipulative reduction and plaster fixation were reviewed. All the patients were divided into two groups: group A and group B. The 30 patients in group A were treated with manipulative reduction and plaster fixation in pronation, including 18 males and 12 females, with a mean age of (7.5 ± 3.5) years old. The 34 patients in group B were treated with manipulative reduction and plaster fixation in supination, including 23 males and 11 females, with a mean age of (7.0 ± 2.6) years old. The occurrence rates of cubitus varus and decreases of carrying angle were compared between two groups before and after treatment. RESULTS There were 13 patients in group A and 16 patients in group B having cubitus varus,which had no statistical difference (χ2 = 0.089, P = 0.765). The decrease of carrying angle were (8 ± 4) degrees in group A and (9 ± 5) degrees in group B, which had no statistical difference (t = 0.584, P = 0.564). Within group A, the occurrence rate of cubitus varus and the decrease of carrying angle between the radial deviation and the ulnar deviation had statistically significant difference (χ2 = 6.160, P = 0.013; t = - 2.409, P = 0.035). Within group B, the occurrence rate of cubitus varus and the decrease of carrying angle between the radial deviation and the ulnar deviation had statistically significant difference (χ2 = 5.120, P = 0.024; t = -2.250, P = 0.041). The elbow function Flynn evaluation score had no significant difference between two groups (P = -0.822). CONCLUSION The occurrence rate of cybutys varys and the decrease of carrying angle have no obvious difference in children with humeral supracondylar fractures treated with fixation in pronated or supinated position. However, when treating with pediatrics humerus supracondylar fractures with ulnar deviation, the fixation in pronation is more helpful for reducing the occurrence rate of elbow varus and decrease of carrying angle. When treating with the pediatrics humerus supracondylar fractures with radial deviation, fixation in supination is helpful for reducing the occurrence rate of elbow varus and decrease of carrying angle.
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Affiliation(s)
- Min Lu
- Department of Orthopaedics, People's Hospital of Yinzhou, Nigbo, Zhejiang, China.
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Weinstein SL, Mubarak SJ, Wenger DR. Fundamental concepts of developmental dysplasia of the hip. Instr Course Lect 2014; 63:299-305. [PMID: 24720315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
To provide the best possible care to patients with developmental dysplasia of the hip, it is helpful to understand the normal growth and development of the hip joint; the pathoanatomy, epidemiology, and diagnosis of the condition; and the natural history of a missed diagnosis of dislocation, subluxation, and dysplasia.
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Affiliation(s)
- Stuart L Weinstein
- Ignacio V. Ponseti Chair and Professor of Orthopaedic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
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Attar SM, Al-Ghamdi A. Radiological changes in rheumatoid arthritis patients at a teaching hospital in Saudi Arabia. East Mediterr Health J 2010; 16:953-957. [PMID: 21218722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The frequency of radiological changes of the hands and the feet were investigated in a well-defined hospital population of patients with rheumatoid arthritis in Jeddah, Saudi Arabia. A total of 57 patients who fulfilled the American College of Rheumatology 1987 criteria for the diagnosis of rheumatoid arthritis were randomly chosen from the rheumatology outpatient clinic at King AbdulAziz University Hospital. Erosions were seen in 60% of the patients and periarticular osteopenia in 34%; deformity and soft tissue swelling were present in 26% and 14% of patients respectively. The proportion with erosions is lower than data reported from Western European and North American populations but higher than previous data from the Central region of Saudi Arabia.
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Affiliation(s)
- S M Attar
- Department of Rheumatology, King Abdul-Aziz University Hospital, Jeddah, Saudi Arabia.
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Skowrońska-Jóźwiak E, Płudowski P, Karczmarewicz E, Lorenc R, Lewiński A. Identification of vertebral deformities in the Polish population by morphometric X-ray absorptiometry - results of the EPOLOS study. Endokrynol Pol 2009; 60:68-75. [PMID: 19396748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION The aim of the study was the determination of the prevalence of asymptomatic vertebral deformities in healthy persons of the Polish population, based on morphometric X-ray absorptiometry (MXA), and comparison of the results with data from literature, obtained by other techniques. MATERIAL AND METHODS The study involved 829 persons, including 520 women and 309 men, aged 18-79 years, untreated for osteoporosis before. The Th(4) to L(4) vertebrae were examined. Lateral scans of the thoracic-lumbar spine were made by an Expert-XL densitometer. Six point digitization was used to calculate the anterior (Ha), central (Hc), and posterior (Hp) height of the Th(4)-L(4) vertebral bodies. The vertebrae were defined as having prevalent deformities when at least one ratio value (Ha/Hp, Hc/Hp, Hp/Hp up, or Hp/Hp low) fell 3 SDs below or even more than the reference mean of that ratio at any vertebral level. RESULTS The analysis was performed on 9629 vertebrae, of which 167 (1.75%), evaluated as deformed and considered as fractures, were observed in 113 patients (13.63 % of the examined patients). In 81 persons (74% of the patients with fractures; 9.7% of the studied population), single fractures were demonstrated, while in 28 persons, multiple deformities prevailed. Fractures occurred in 108 women (20.7% of the examined women) and 42 men (13.5% of the examined men). The highest incidence of deformities was observed in women over 55 years of age. First-degree deformities dominated. Deformities of the Th(8) and Th(6) vertebrae were most frequently observed. CONCLUSIONS 1. Using MXA, it was found that in the Polish population deformities of vertebrae are common, as was demonstrated in X-ray morphometric studies in the European Vertebral Observation Study (EVOS). 2. Densitometric morphometry, as a non-invasive technique, may become a useful tool in the diagnostics of vertebral fractures.
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Abstract
PURPOSES To study the incidence of femoral or tibial bowing in the coronal plane in a Chinese population, and how it affects the accuracy of bone cuts for total knee replacement when an intramedullary alignment system is used. METHODS Standing radiographs of the entire lower limb of each patient with end-stage primary osteoarthritis of the knee were analysed. All radiographs were digitised and the extent of bowing in the coronal plane measured. A bowing was marked if an angulation was more than 2 degrees. The projected error of cutting was then calculated. RESULTS Of 93 lower limbs, 58 (62%) of the femurs had marked bowing in the coronal plane; 41 (44%) had a mean lateral bowing of 5.3 (standard deviation [SD], 3.2) degrees; 17 (18%) had a mean medial bowing of 4.4 (SD, 1.9) degrees. Marked tibial bowing in the coronal plane was less common (30 tibias, 32%). If a cutting error of more than 2 degrees was considered unacceptable, significantly more unacceptable cuts would ensue in the groups with marked bowing (p=0.003 for femurs and p<0.001 for tibia, respectively). CONCLUSION The incidence of femoral or tibial bowing in the coronal plane was high in a Chinese population with end-stage osteoarthritis of the knee. This phenomenon may increase bone cut errors in total knee replacement if an intramedullary alignment system is used and the extent of bowing is not recognised.
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Affiliation(s)
- W P Yau
- Division of Joint Replacement Surgery, Department of Orthopedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong.
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Abstract
Internal rotation gait is common in children with cerebral palsy. Factors thought to contribute include femoral anteversion, hip flexor tightness, imbalance of hip rotators, and hamstring and adductor tightness. The exact cause of internal rotation must be defined before contemplating surgery. We investigated the prevalence of internal hip rotation and associated factors, which are considered to influence this walking pattern, in patients with cerebral palsy. Gait laboratory data of 222 patients with cerebral palsy were studied retrospectively. Two groups were selected; those with maximum dynamic hip internal rotation of more than 27 degrees and those with less than 20 degrees. Of 222 patients, 27.0% (diplegia, 61.7%; hemiplegia, 38.3%) had at least one hip with dynamic internal rotation of more than 27 degrees. This study suggests that dynamic hip internal rotation is multifactorial in origin. The most significant differences in clinical measures were found in values of passive hip external rotation range, femoral anteversion and hip flexor contracture. We discuss the role of early treatment of hip flexion contracture.
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Abstract
The etiology of genu varum in achondroplasia is the subject of much speculation. The purpose of the current study was to investigate the association between fibular overgrowth and genu varum in achondroplasia. A retrospective analysis was performed on the long-leg radiographs of 48 pediatric patients with achondroplasia. All patients were skeletally immature, and the average age was 7.7 years (range, 3-16 years). Boys were significantly more likely to have varus mechanical tibiofemoral angles than girls (Fisher exact test, P=0.038 for the right leg and P=0.008 for the left leg). The distance from the proximal and distal fibula to the proximal tibia knee and ankle joint orientation lines, respectively, was not associated with the alignment of the lower extremity. We conclude that fibular overgrowth does not correlate with the severity of genu varum.
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Affiliation(s)
- Michael C Ain
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD 21224-2780, USA.
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Dahaghin S, Bierma-Zeinstra SMA, Reijman M, Pols HAP, Hazes JMW, Koes BW. Prevalence and determinants of one month hand pain and hand related disability in the elderly (Rotterdam study). Ann Rheum Dis 2005; 64:99-104. [PMID: 15608306 PMCID: PMC1755169 DOI: 10.1136/ard.2003.017087] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To study the prevalence of hand pain and hand disability in an open population, and the contribution of their potential determinants. METHODS Baseline data were used from 7983 participants in the Rotterdam study (a population based study in people aged > or =55 years). A home interview was used to determine the presence of hand pain during the previous month, rheumatoid arthritis, osteoarthritis in any joint, diabetes, stroke, thyroid disease, neck/shoulder pain, gout, history of fracture in the past five years, and Parkinson's disease, as well as age, sex, and occupation. Hand disability was defined as the mean score of eight questions related to hand function. Body mass index was measured and hand x rays were taken. RESULTS The one month period prevalence of hand pain was 16.9%. The prevalence of hand disability was 13.6%. In univariate analysis for hand pain, rheumatoid arthritis had the highest explained variance (R(2)) and odds ratio. For hand disability, aging showed the highest explained variance and Parkinson's disease had the highest odds ratio. All determinants together showed an explained variance of 19.8% for hand pain and 25.2% for hand disability. In multivariate analysis, positive radiographic hand osteoarthritis was a poor explanation for hand pain (R(2) = 0.5%) or hand disability (R(2) = 0). CONCLUSIONS The contribution of available potential determinants in this study was about 20% for hand pain and 25% for hand disability in an unselected population of elderly people. Thus a greater part of hand pain/hand disability remains unexplained.
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Affiliation(s)
- S Dahaghin
- Department of General Practice, Erasmus Medical Centre, PO Box 1738, 3000 DR Rotterdam, Netherlands.
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Combe B. The French early arthritis registry. Clin Exp Rheumatol 2003; 21:S123-8. [PMID: 14969063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
This report is focused on two French multicenter cohorts of patients with early rheumatoid arthritis (RA). The first one is a community-based study which was started in 1993. It was mainly designed to identify prognostic factors of joint destruction, disability and remission in patients with early RA. The 3-year and 5-year results have been recently reported. Briefly, progression of joint damage was best predicted at baseline by radiographic scores, ESR, CRP, rheumatoid factor and DRB1*04 genes, and disability by disease activity including the HAQ score. Recently, the French Society of Rheumatology initiated a large national multicenter registry (800 patients), the "ESPOIR cohort study", that could serve as a database to allow investigations not only on diagnostic and prognostic markers, but also on etiologic, pathogenic and medico-economic factors among patients with early inflammatory arthritis who could later develop RA. The objectives, design and organization of this early arthritis registry are described.
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Affiliation(s)
- B Combe
- Service d'Immuno-Rhumatologie, Hôpital Lapeyronie, 34295 Montpellier, France
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Scott DL, Smith C, Kingsley G. Joint damage and disability in rheumatoid arthritis: an updated systematic review. Clin Exp Rheumatol 2003; 21:S20-7. [PMID: 14969046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Joint damage and disability in rheumatoid arthritis (RA) both increase with disease duration but the nature of their relationship is uncertain. This review updates knowledge of the progression and inter-relationship of joint damage and disability in treated RA and provides a synopsis of the main predictive factors for damage and disability. In early RA 39-73% of patients develop one or more erosions in their hands and wrists by 5 years. In established RA the average annual increase in radiological damage scores is 1.9% maximal damage. After 20 years RA patients have on average 43% of maximum possible damage. These data suggests that joint damage progresses constantly over the first 20 years of RA. The average annual increase in HAQ scores is 0.033 per year (1% of possible maximum disability). In the first years of disease there is a "J-shaped" curve with an initial fall in HAQ scores followed by an increase over the next four years. In cross-sectional studies there is either no correlation or a weak correlation between damage and disability in early RA; this absence of correlation is explained by the "J-shaped" curve of disability with disease duration in early RA. As disease duration increases the correlation between damage and disability becomes more obvious; 9 studies show correlation coefficients between 0.31 and 0.75. The most predictive factors of damage and disability are rheumatoid factor status and disease activity. The validity of our conclusions are limited by the potential indirect link between small joint damage and disability, with large joint damage being a more important predictor, and the presence of ceiling effects on X-rays. In conclusion, joint damage accounts for a substantial proportion of the disability associated with the disease.
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Affiliation(s)
- D L Scott
- Clinical and Academic Rheumatology, Kings College Hospital, Denmark Hill, London, SE5 9PT, UK
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Puccio M, Marino DJ, Stefanacci JD, McKenna B. Clinical Evaluation and Long-Term Follow-Up of Dogs Having Coronoidectomy for Elbow Incongruity. J Am Anim Hosp Assoc 2003; 39:473-8. [PMID: 14518656 DOI: 10.5326/0390473] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A retrospective study was performed describing the clinical presentations, radiographic findings, and surgical outcomes of 17 dogs (18 elbows) following medial coronoidectomy for the treatment of elbow joint incongruity as a sole disease entity. Complete resolution of lameness was achieved in 100% of the cases. The mean radiographic arthrosis grade progressed in 70% of the cases. Results of this study indicate that resolution of clinical lameness may be achieved with medial coronoidectomy in dogs with elbow incongruity; however, progression of degenerative joint disease with unknown, long-term clinical significance can be expected after surgery.
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Affiliation(s)
- Margaret Puccio
- Department of Surgery, Long Island Veterinary Specialists, PLLC, 163 South Service Road, Plainview, New York 11803, USA
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Abstract
BACKGROUND The purposes of this study were to determine the prevalence of and the association between shoulder contracture and osseous deformity in a cohort of children with an obstetrical brachial plexus injury and to identify the risk factors for these complications. METHODS In a retrospective cohort study, all children with an obstetrical brachial plexus injury who had been born between January 1991 and January 1998 at one academic medical center and all those with the same diagnosis who had been born elsewhere during the same period and were referred to the medical center within six weeks after delivery were evaluated at fixed time-intervals by one examiner. The patients underwent a final orthopaedic, neurological, and radiographic examination at a mean age of 3.7 years (range, one to seven years). Shoulder contracture was defined as a decrease in the passive range of motion in one or more directions compared with the range on the unaffected side. Osseous deformity was defined as a nonspherical humeral head or an abnormal glenoid. RESULTS The prevalence of a shoulder contracture of >10 degrees was 56% (twenty-nine of fifty-two patients), and the prevalence of an osseous deformity was 33% (sixteen of forty-eight patients with complete radiographic follow-up). In the children in whom complete neurological recovery was delayed (i.e., recovery was more than three weeks after birth), the prevalence of shoulder contracture was 54% (thirteen of twenty-four patients) and the prevalence of osseous deformity was 26% (six of twenty-three patients). A strong association was noted between shoulder contracture and osseous deformity (p = 0.004). Directly after birth, the presence of a clavicular fracture was the only factor that was associated (p = 0.016) with the development of an osseous deformity (but not with a shoulder contracture). At a later stage, speed and extent of neurological recovery were related to shoulder contracture and osseous deformity. An asymmetric appearance was noticed in children who had a contracture, including those who had complete neurological recovery. CONCLUSIONS The prevalence of shoulder contracture and osseous deformity in children with obstetrical brachial plexus injury was high, even in those with complete neurological recovery. These complications were strongly associated with one another. No symptom that appeared immediately after birth was identified as a factor that would predict the development of future shoulder contracture. A clavicular fracture was found to be significantly associated with the development of an osseous deformity at a later stage.
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Affiliation(s)
- Agnes F Hoeksma
- Department of Rehabilitation Medicine, Jan van Breeman Institute, The Netherlands.
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Grzegorzewski A, Bowen JR, Guille JT, Glutting J. Treatment of the collapsed femoral head by containment in Legg-Calve-Perthes disease. J Pediatr Orthop 2003; 23:15-9. [PMID: 12499936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
One hundred ninety-seven patients with unilateral Legg-Calve-Perthes disease (LCPD) were followed-up to skeletal maturity. According to the lateral pillar classification, 142 hips were classified as group B and 55 hips as group C. Radiographs were evaluated for percent of collapse of the femoral head, Waldenstrom stage of disease at diagnosis, Mose sphericity, hinge abduction, lateral acetabular shape, and limb-length discrepancy. The hips were treated either by bedrest and traction in abduction (76), Petrie cast (21), abduction brace (74), or by pelvic or femoral osteotomy (26). One hundred twenty-five hips had less than a 2-mm difference in Mose sphericity at followup. According to the classification of Stulberg et al., 89 hips (45%) were class I, 57 (29%) were class II, 35 (18%) were class III, 12 (6%) were class IV, and 4 (2%) were class V. Analyses revealed statistically significant differences between group B versus group C with regard to the classifications of Stulberg et al. and Mose, lateral acetabular shape, age at onset, and limb-length discrepancy. There was no significant statistical difference with regard to the types of treatment. Containment treatment of a deformed femoral head from LCPD improves the sphericity of the hip and gives 63% satisfactory results according to the Mose classification and 74% satisfactory results according to the Stulberg et al. classification.
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Payman KR, Patenall V, Borden P, Green T, Otsuka NY. Complications of tibial osteotomies in children with comorbidities. J Pediatr Orthop 2002; 22:642-4. [PMID: 12198468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Tibial osteotomies in children have been associated with a number of complications. A retrospective review of 116 children who had 129 tibial osteotomies was performed to assess these complications at our institution. Results showed that there were 35 cases of wound problems, 6 cases of recurrence/reoperation, 5 cases of delayed union, 2 cases with transient peroneal nerve palsy, 1 case of nonunion, and 1 case of mal-union. Patients having certain comorbidities had a higher frequency of complications. There were no significant differences between the location of the tibial osteotomy (proximal or distal) and the incidence of complication. External fixation was associated with a lower incidence of complications than the use of pins and casting. Although our results demonstrate an overall low complication rate, there is a significant association between complications and comorbid conditions. This highlights the need to recognize comorbidities preoperatively and the potential of increased postoperative complications.
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Affiliation(s)
- K Rad Payman
- Shriners Hospitals for Children, University of California, Los Angeles 90020-1199, California, USA.
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Cooke TDV, Harrison L, Khan B, Scudamore A, Chaudhary MA. Analysis of limb alignment in the pathogenesis of osteoarthritis: a comparison of Saudi Arabian and Canadian cases. Rheumatol Int 2002; 22:160-4. [PMID: 12172956 DOI: 10.1007/s00296-002-0218-7] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2002] [Accepted: 05/30/2002] [Indexed: 10/27/2022]
Abstract
A study was made of alignment abnormalities and bone deformities in Saudis with osteoarthritis (SOA). Data from standardized radiography of hips and knees were: hip-knee-ankle angle (HKA), condylar-hip angle (CH), tibial plateau-ankle angle (PA), and joint surface (condylar-plateau) angle (CP). Females dominated the <50 years SOA subgroup (1.8:1), having also early onset OA with severe bowlegged deformity (mean HKA -11 degrees) and major shifts in CH, PA, and CP relative to normal parameters. In the females, links were noted between severe disease and osteomalacia or osteoporosis, requiring prospective studies. An association between femoral deformity (CH) and OA, first reported in Canadians with OA (COA), was confirmed in SOA (especially in males of all ages). The condition implies heightened mechanical risk of onset or progression at medial joint surfaces. Further, it calls for the fresh appraisal of surgical options based on biomechanical analysis of each case, including femoral osteotomy where necessary.
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Lehtinen JT, Kaarela K, Belt EA, Kautiainen HJ, Kauppi MJ, Lehto MU. Incidence of acromioclavicular joint involvement in rheumatoid arthritis: a 15 year endpoint study. J Rheumatol Suppl 1999; 26:1239-41. [PMID: 10381036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To evaluate the incidence of involvement and nature of destruction of acromioclavicular joints (AC) in a prospectively followed cohort of 74 patients with rheumatoid factor positive and erosive rheumatoid arthritis (RA). METHODS At the 15 year followup, radiographs of 148 AC joints were evaluated, and the grade of destruction was assessed by the Larsen method. RESULTS No surgical procedures had been performed on the AC joints. Rheumatoid involvement (Larsen Grade > or = 2) was observed in 87/148 (59%) of the AC joints in 50/74 (68%) patients: 37 bilaterally and 13 unilaterally. Incidence of mild erosions (Larsen Grade 2) was 39%, and of severe (Larsen 3-5) 20%. Erosions were most often observed on the inferior edge of the clavicular joint margin. Degenerative features without rheumatoid changes were present in 11 joints. Larsen score (0-100) of peripheral joints correlated well with the AC joint Larsen Grade in both sides: right, r = 0.56 (95% CI 0.38 to 0.70), left, r = 0.49 (95% CI 0.30 to 0.65). CONCLUSION After 15 years two-thirds of the patients with RA showed involvement of the AC joints. Erosions were located most often on the inferior margin of the joint.
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Affiliation(s)
- J T Lehtinen
- Rheumatism Foundation Hospital, Heinola and Tampere University Hospital, Tampere, Finland
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Zhong Z, Luo F, Li R. [The epidemiological study on limb deformities among children in Guangdong Province]. Zhonghua Liu Xing Bing Xue Za Zhi 1999; 20:105-7. [PMID: 10682545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
OBJECTIVE To study the incidence of limb deformities of children in Guangdong province. METHODS Physical examination on lined-up students and looked over one by one. Detailed examinations of orthopaedics or related subjects were performed on those with susceptive deformity. RESULTS Results showed that there were 655 cases of limb deformities (0.64%) in 102,313 pupils of 7 to 14 years old, in which 550 cases (83.97%) needed surgical intervention. The incidence of deformity in economically poor areas was 2.88 times higher than those in advanced areas. CONCLUSION Prevention and cure of limb deformities of children, especially those in rural area, should be addressed and emphasized.
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Affiliation(s)
- Z Zhong
- Guangzhou Red Cross Hospital
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Yoshida M, Belt EA, Kaarela K, Kauppi MJ, Shimamura T. Prevalence of mutilans-like hand deformities in patients with seropositive rheumatoid arthritis. A prospective 20-year study. Scand J Rheumatol 1999; 28:38-40. [PMID: 10092163 DOI: 10.1080/03009749950155760] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study examined radiographically the prevalence of arthritis mutilans hand deformities in an inception cohort of 68 rheumatoid arthritis (RA) patients. Hand deformities of 103 RF-positive RA patients were evaluated after 8 years, 83 patients after 15 years and 68 patients 20 years after entry. The grade of destruction in the hand joints was assessed by the Larsen method and Larsen scores of 0-50 were determined for both PIP (+IP) and MCP joints. At the end point, 3 patients had Larsen scores > or =40 for both PIP and MCP joints. These three patients had severe resorption in most of the finger joints, but did not demonstrate classical opera-glass hand. The prevalence of mutilans-like hand deformities with RA was 3/68 (4.4%) in a prospective 20-year study.
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Affiliation(s)
- M Yoshida
- Department of Orthopaedic Surgery and Rheumatology, Iwate Medical University, Morioka, Japan
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Abstract
Meniscal tears do not always result from trauma. To elucidate other factors responsible for meniscal tears, we evaluated the axial alignment of the lower limb in 385 patients (385 menisci) with isolated meniscal tear who were examined between 1972 and 1994. The patients were aged 50 years or less and had no ulceration or defect of articular cartilage of the knee when examined arthroscopically. Of the 385 menisci, 90 were lateral complete discoid; 110, lateral incomplete discoid; 68, lateral semilunar; and 117, medial semilunar. Patients in each of these four groups were divided into four subgroups according to sex and whether there was an obvious history of trauma. The so-called Mikulicz's mechanical axis of the affected side was utilized to evaluate the alignment. The axial alignment of the lower limb was normal in the patients with isolated tears of lateral complete discoid meniscus, lateral incomplete discoid, or lateral semilunar. It appeared that the axial alignment of the lower limb did not have a relationship with the occurrence of these tears. Patients with isolated tears of medial semilunar meniscus without obvious trauma, showed varus deformity of the knee. This deformity appeared to be closely related to the presence of medial meniscal tear.
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Affiliation(s)
- T Habata
- Department of Orthopaedic Surgery, Nara Medical University, 840 Shijo, Kashihara, Nara 634, Japan
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20
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Abstract
To study the association between vertebral deformities and subjective health outcome indicators, including back pain and disability, a cross-sectional survey with spinal radiographs and personal interviews was carried out in 36 study centres in 19 European countries on a total of 15,570 men and women aged 50-79 years (population-based stratified random samples). No interventions were done. The main outcome measures were the presence and intensity of current and previous back pain, functional capacity (ADL questionnaire) and overall subjective health. The presence and intensity of back pain and functional and health impairments varied within wide ranges with no obvious regional pattern. However, the associations between negative health outcomes and vertebral deformity were homogeneous between countries and between centres within countries. In logistic regression analyses weak but significant associations between the presence of vertebral deformities and various health indicators were demonstrated. The magnitude of the associations increased with severity and number of deformities. Compared with subjects without deformities those with low-grade deformities had no or only a weakly elevated risk for back pain, disability and impaired subjective health (odds ratios (OR) 1.2-1.3). The odds ratios increased for individuals with single severe deformities (OR 1.3-2.1) and were highest in those with multiple severe deformities (OR 1.7-4.2). The associations between vertebral deformities and negative health outcomes were stronger in men than in women. In this cross-sectional study radiologically assessed vertebral deformities were therefore weakly associated with both current and previous back pain as well as with functional and health impairments in both women and men. Multiple severe deformities were associated with severe and disabling back pain with stronger effects in men.
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Affiliation(s)
- C Matthis
- Institute for Social Medicine, Medical University of Lubeck, Germany
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21
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Abstract
To evaluate the incidence of associated glenohumeral lesions in patients with a full-thickness rotator cuff tear, an arthroscopic examination of the glenohumeral joint was performed in 200 shoulders in 195 consecutive patients before arthroscopic rotator cuff repair. One hundred twenty-one (60.5%) had coexisting intraarticular abnormalities. Ninety-six (48%) had minor abnormalities, and 25 patients (12.5%) had major coexisting intraarticular abnormalities. Major lesions (that required operative treatment, changed postoperative rehabilitation, or altered the expected end result) noted at arthroscopic examination were osteoarthritis in nine patients, partial biceps tendon tears in three, labrum tears in three, Bankart lesions in two, superior labrum anterior posterior lesions in five, and glenohumeral synovitis in three patients. Glenohumeral arthroscopy can provide valuable information in patients with a complete rotator cuff tear.
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22
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Abstract
STUDY OBJECTIVE To determine the incidence of clinically significant fractures or other abnormalities seen on postreduction shoulder radiographs which were not seen on postreduction should radiographs which were not seen on the prereduction films obtained for anterior shoulder dislocations. METHODS Retrospective chart review of 131 patients who presented with a total of 175 anterior shoulder dislocations to the emergency department of an urban, university-affiliated, Level 1 Trauma Center with an emergency medicine residency program. All patients had complete medical records, radiographs before and after reduction, and no fractures reported on the prereduction films. RESULTS There were three avulsion fractures (1.7%; 95% confidence interval [CI], 0% to 4.5%) detected on postreduction radiographs. In all three cases, a radiologist who was blinded to the original interpretations and the purpose of the study also noted the fractures on the prereduction films, although these fractures were not detected on the original interpretations. There were 14 new Hill-Sachs deformities (8%; 95% CI, 4% to 12%). In one case (.6%; 95% CI, 0% to 2.8%), the postreduction radiograph demonstrated a persistent dislocation, which was subsequently reduced in the ED. This was the only postreduction finding that altered acute management. CONCLUSION Postreduction radiographs rarely reveal any clinically significant abnormality after an anterior shoulder dislocation has been reduced. Emergency physicians and orthopedic surgeons should question whether the time and expense of obtaining routine postreduction films in the ED for anterior shoulder dislocations is justified. A prospective study is needed to validate our findings.
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Affiliation(s)
- G W Hendey
- Department of Emergency Medicine, Valley Medical Center, Fresno, California, USA
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23
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Odding E, Valkenburg HA, Algra D, Vandenouweland FA, Grobbee DE, Hofman A. The association of abnormalities on physical examination of the hip and knee with locomotor disability in the Rotterdam Study. Br J Rheumatol 1996; 35:884-90. [PMID: 8810673 DOI: 10.1093/rheumatology/35.9.884] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
To assess the influence of abnormalities found on physical examination of the hips and knees on disability 1156 men and 1739 women aged > or = 55 yr (the Rotterdam Study) were asked about locomotor disability (LD) using six questions of the Health Assessment Questionnaire (HAQ). The prevalence of LD was 20.2% for men and 31.9% for women. Moderately restricted range of motion of the hips and knees occurred in 34.5% of the men and 38.6% of the women. The prevalence of instability of the knees was 12.5% for men and 16.8% for women. Varus deformity in men (10.1%) and valgus deformity in women (15.0%) were the most common deformities of the knees. Restricted flexion of the hips was the strongest determinant of LD. Age-adjusted odds ratios for restricted hip flexion of LD were 4.7% (95% CI: 3.2-6.8) for men and 3.5 (2.7-4.5) for women. Valgus deformity, knee instability and obliquity were risk factors only in women. Adjustment of these odds ratios for morning stiffness and joint pain did not alter the estimates.
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Affiliation(s)
- E Odding
- Department of Epidemiology & Biostatistics, Erasmus University Medical School, Rotterdam, The Netherlands
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24
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Kakourou T, Dacou-Voutetakis C, Kavadias G, Bakoula C, Aroni K. Limited joint mobility and lipodystrophy in children and adolescents with insulin-dependent diabetes mellitus. Pediatr Dermatol 1994; 11:310-4. [PMID: 7899179 DOI: 10.1111/j.1525-1470.1994.tb00094.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
One hundred forty-eight children, aged 11.9 +/- 3.7 years, who had insulin-dependent diabetes mellitus (IDDM) for 4.5 +/- 3.7 years and glycosylated Hb values (HbA1) of 10.5% +/- 4.5%, were examined for limited joint mobility (LJM) and lipodystrophy. In all diabetics, human biosynthetic insulin was used. Six hundred forty-eight pupils, aged 11.8 +/- 2.5 years, served as controls. LJM was found in 28.4% of the diabetics and in 7.5% of the controls (p < 0.001). The presence and severity of LJM was positively correlated with the duration of diabetes and negatively with height. There was no correlation between the presence of LJM and sex, chronological age, age of diabetes onset, HbA1 values, or retinopathy. Lipodystrophy at insulin injection sites was found in 37.1% of the diabetics. Hypertrophic lesions predominated. Our findings and those of the literature lead to the following conclusions: the prevalence of LJM in IDDM subjects of comparable age using Rosenbloom's criteria is almost uniform in all published studies (28%); the correlation, however, of prevalence and severity to different parameters presents discrepancies which cannot be interpreted at present. Human biosynthetic insulin does not protect from lipodystrophy and alterations of insulin injections still remain the only currently available preventive and therapeutic measure.
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Affiliation(s)
- T Kakourou
- First Department of Pediatrics, Athens University, Greece
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25
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Miller C, Savoie FH. Glenohumeral abnormalities associated with full-thickness tears of the rotator cuff. Orthop Rev 1994; 23:159-62. [PMID: 8196974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
One hundred consecutive patients with full-thickness tears of the rotator cuff were prospectively evaluated by glenohumeral arthroscopy to determine the incidence of associated intra-articular lesions. Seventy-four of the 100 patients had coexisting intra-articular abnormalities.
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Affiliation(s)
- C Miller
- Mississippi Sports Medicine and Orthopaedic Center, Jackson
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26
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Aggarwal A, Dabadghao S, Naik S, Misra R. Serum IgM rheumatoid factor by enzyme-linked immunosorbent assay (ELISA) delineates a subset of patients with deforming joint disease in seronegative juvenile rheumatoid arthritis. Rheumatol Int 1994; 14:135-8. [PMID: 7871331 DOI: 10.1007/bf00579698] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Using human IgG as an antigen in an enzyme-linked immunosorbent assay (ELISA), we looked for the presence of IgM rheumatoid factor (RF) in the sera of 74 children with juvenile rheumatoid arthritis (JRA). Nine children had RF detectable by both latex agglutination and ELISA. Forty-five percent (26 of 65) of the children who were seronegative by latex agglutination were found to be positive for IgM RF by ELISA. The prevalence of IgM RF was higher in patients with polyarticular onset disease (57.4%) than in those with pauciarticular onset (38.5%) or systemic onset (27.2%) disease. The prevalence of RF was higher in sera from patients with deforming joint disease than those without deformities (P < 0.01).
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Affiliation(s)
- A Aggarwal
- Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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