BACKGROUND Atlantoaxial rotatory subluxation(AARS)is an uncommon disease with a greater prevalence among children than adults,and it is mostly associated with trauma.Iatrogenic spinal injury accounts for a low percent...BACKGROUND Atlantoaxial rotatory subluxation(AARS)is an uncommon disease with a greater prevalence among children than adults,and it is mostly associated with trauma.Iatrogenic spinal injury accounts for a low percentage of injuries.However,in AARS,20%-40%of cases are associated with surgery,and 48%are caused by infection.Here,we describe our experience with a case of iatrogenic AARS after general anesthesia.CASE SUMMARY A 12-year-old girl presented with right-sided torticollis and cervical motion limit.The patient had undergone thyroidectomy 2 mo ago.Computed tomography revealed AARS with bilateral locked facets.Following the failure of repeated external reduction under general anesthesia,the patient underwent an open surgical reduction.The patient gained atlantoaxial alignment without any complications.Follow-up radiographs showed a normal appearance without instability.The cervical spine of children is more predisposed to injury due to anatomical and biomechanical differences.AARS secondary to infection and surgery is known as Grisel’s syndrome,which involves non-traumatic AARS.Several cases of AARS after surgery and other procedures with no evidence of inflammation have been reported.Our experience shows that surgery requiring hyperextension of the neck after general anesthesia should also be included as a risk factor.CONCLUSION Surgeons and anesthesiologists should be careful not to excessively extend the neck during pediatric surgery.Moreover,clinicians caring for pediatric patients with recent head and neck procedures must be aware of common AARS presentations.展开更多
AIM:To investigate the effect of Cionni-modified capsular tension ring(CTR)implantation in patients with severely traumatic subluxated cataracts.METHODS:All patients who totally had traumatic cataracts and lost zonule...AIM:To investigate the effect of Cionni-modified capsular tension ring(CTR)implantation in patients with severely traumatic subluxated cataracts.METHODS:All patients who totally had traumatic cataracts and lost zonule support and underwent cataract surgery were retrospectively analyzed.Corrected distance visual acuity(CDVA),extent of zonulysis,intraocular lens(IOL)position,intraoperative presentation,and complications were assessed.The primary outcomes included IOL centration stability and other postoperative complications.RESULTS:Twenty patients(20 eyes)were included in this study.The mean age in this study was 58.0±11.3y,and the average follow-up time was 17.3±12.8mo.Capsule bags were saved by Cionni-modified CTR.Nine eyes(45%)underwent simultaneously anterior vitrectomy due to the presence of vitreous in the anterior chamber.The preoperative mean CDVA was 0.83±0.24 log MAR,and the postoperative average CDVA was 0.23±0.30 log MAR(P<0.05).The horizontal and vertical IOL decentration after surgery was 0.27±0.12 mm and 0.41±0.19 mm,respectively;the vertical and horizontal IOL tilt after surgery was 5.5°±2.5°and 6.1°±2.2°,respectively.None of the eyes had obvious IOL decentration during the follow-up time.Eight eyes(40%)had posterior capsule opacification(PCO)that was severe enough to cause poor vision.Neodymium:YAG laser capsulotomy were performed on these eyes when the CTR was stabilized.CONCLUSION:With the help of Cionni-modified CTR,capsular bag preservation and better IOL concentration can be achieved without major complications in patients with severely traumatic subluxated cataracts.展开更多
AIM:To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma,and discuss the multiple treating methods of operation combined with primary...AIM:To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma,and discuss the multiple treating methods of operation combined with primary intraocular lens(IOL)implantation.METHODS:Non-comparativeretrospectiveobservational case series.Participants:30 cases(30 eyes)of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi'an No.4Hospital from 2007 to 2011.According to the different situations of lens subluxation/dislocation,various surgical procedures were performed such as crystalline lens phacoemulsification,crystalline lens phacoemulsification combined anterior vitrectomy,intracapsular cataract extraction combined anterior vitrectomy,lensectomy combined anterior vitrectomy though peripheral transparent cornea incision,pars plana lensectomy combined pars plana vitrectomy,and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy.And whether to implement trabeculectomy depended on the different situations of secondary glaucoma.The posterior chamber intraocular lenses(PC-IOLs)were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present.Main outcome measures:visual acuity,intraocular pressure,the situation of intraocular lens and complications after the operations.RESULTS:The follow-up time was 11-36mo(21.4±7.13).Postoperative visual acuity of all eyes were improved;28 cases maintained IOP below 21 mm Hg;2cases had slightly IOL subluxation,4 cases had slightlytilted lens optical area;1 case had postoperative choroidal detachment;4 cases had postoperative corneal edema more than 1wk,but eventually recovered transparent;2 cases had mild postoperative vitreous hemorrhage,and absorbed 4wk later.There was no postoperative retinal detachment,IOL dislocation,and endophthalmitis.CONCLUSION:To take early treatment of traumatic lens subluxation/dislocation in patients with secondary glaucoma by individual surgical plan based on the different eye conditions would be safe and effective,which can effectively control the intraocular pressure and restore some vision.展开更多
AIM:To investigate the safety and efficacy of phacoemulsification with capsular-tension-ring implantation and posterior chamber intraocular lens implantation combined with ophthalmic endoscope-controlled goniosynechia...AIM:To investigate the safety and efficacy of phacoemulsification with capsular-tension-ring implantation and posterior chamber intraocular lens implantation combined with ophthalmic endoscope-controlled goniosynechialysis(Phaco-CTR-IOL-OE-GSL)for treating secondary angle-closure glaucoma induced by traumatic lens subluxation.METHODS:A retrospective and descriptive study was performed on patients with lens subluxation,angle closure,goniosynechia,and evaluated intraocular pressure(IOP)that cannot be controlled with medication,who underwent Phaco-CTR-IOL-OE-GSL.The postoperative best-corrected visual acuity(BCVA),IOP,range of goniosynechia and complications were retrospectively observed.RESULTS:Nine patients with secondary angle-closure glaucoma induced by traumatic lens subluxation were included.The follow-up period was 51.1±8.6 mo.The preoperative range of zonule rupture was 158.2°±33.0°,and the range of goniosynechia was 220.0°±92.5°.The baseline BCVA was 0.9±1.0 logMAR,IOP was 30.7±17.3 mm Hg and number of anti-glaucoma medication was 3.2±1.1.Mild intraoperative hyphaemia with 8 eyes(88.8%)in the anterior chamber,and was absorbed two days postoperatively.One eye(11.1%)had postoperative ciliary body detachment and was recovered after five days of topical drug treatment.BCVA was 0.2±0.2 logMAR at 3 mo postoperatively.The average IOP at the last follow-up was 16.7±2.0 mm Hg,and no anti-glaucoma medications were used.The average range of recurrent goniosynechia was 54.9°±33°at the final postoperative gonioscopic examination.CONCLUSION:Phaco-CTR-IOL-OE-GSL is safe and effective in the treatment of secondary angle-closure glaucoma induced by traumatic lens subluxation.The use of an endoscope provides a more direct and clear examination for GSL,and 360°dissection is easily achieved.展开更多
BACKGROUND Synovial chondromatosis is a disease originating from the synovium and characterized by the presence of metaplastic cartilaginous nodules in synovial cavities.The exact prevalence of synovial chondromatosis...BACKGROUND Synovial chondromatosis is a disease originating from the synovium and characterized by the presence of metaplastic cartilaginous nodules in synovial cavities.The exact prevalence of synovial chondromatosis remains unknown,and the involvement of the shoulder joint is very rare.Synovial chondromatosis accompanied by subluxation of the humeral head without a history of trauma is rarely encountered,and to our knowledge,no published reports describe this condition.CASE SUMMARY We present two cases of synovial chondromatosis in the shoulder joint,accompanied by subluxation of the humeral head,in two arthroscopically managed adult patients.We performed arthroscopic labrum fixation and removal of the loose body from the shoulder joint.To identify primary and secondary categories,pathological analysis was arranged.Clinical and radiographic evaluations at the 1-mo follow-up were satisfactory.CONCLUSION The biomechanical function of the shoulder joint requires attention,especially following the detection of loose bodies,as observed with synovial chondroma occurring in rare sites.Arthroscopic management is successful in patients with synovial chondromatosis combined with shoulder subluxation.展开更多
Most cases of medial patella subluxation occur under iatrogenic conditions that are often associated with a prior excessive lateral retinacular release procedure. We report a case of medial subluxation following minor...Most cases of medial patella subluxation occur under iatrogenic conditions that are often associated with a prior excessive lateral retinacular release procedure. We report a case of medial subluxation following minor trauma with no history of previous lateral release. The abnormality was identified on magnetic resonance imaging and was successfully treated by direct repair of the lateral retinaculum. The recognition and treatment of medial subluxation of the patella without retinacular release can be difficult. Therefore, consideration of multiple causes through careful medical history taking, physical examination, and radiologic examination is needed for accurate diagnosis.展开更多
Objective To introduce a new procedure for treatment of rotatory subluxation of the scaphoid. Methods Eighteen patients with rotatory subluxation of the scaphoid were divided into five types according to clinical mani...Objective To introduce a new procedure for treatment of rotatory subluxation of the scaphoid. Methods Eighteen patients with rotatory subluxation of the scaphoid were divided into five types according to clinical manifestation and cause: type Ⅰ (predynamic) 1 case,type Ⅱ (dynamic) 2 cases, type Ⅲ (static) 7 cases, type Ⅳ (degenerative) 3 cases, type Ⅴ( secondary) 5 cases. All cases underwent scapho-trapezio-trapezoid limited wrist arthrodesis. Results The follow-up ranged from 6 months to 3 years. The results showed that the all rotatory subluxatiopn of scaphoid in the study had been corrected with satisfactory fusion and painless wrist. The average grip strength was 90% of the normal wrist, and the average range of motion was 62% of the opposite side. Conclusion Scapho-trapezio-trapezoid limited arthrodesis is a reliable and useful procedure for treatment of chronic andChina Medical Abstracts(Surgery) static rotatory subluxation of the scaphoid. 15 refs,2 figs.展开更多
AIM:To evaluate the visual and refractive outcomes in cases after sutured scleral fixation of existing subluxated or dislocated acrylic one-piece intraocular lenses(IOLs).METHODS:This study retrospectively enrolled a ...AIM:To evaluate the visual and refractive outcomes in cases after sutured scleral fixation of existing subluxated or dislocated acrylic one-piece intraocular lenses(IOLs).METHODS:This study retrospectively enrolled a consecutive series of patients who underwent a surgery of sutured existing subluxated or dislocated IOLs from October 2018 to June 2020.All patients underwent comprehensive preoperative and postoperative ophthalmologic examination,and data were collected including age,sex,surgical indications,best-corrected visual acuity,refractive error,intraocular pressure.Presence of intraoperative and postoperative surgical complications was documented.RESULTS:A total of 20 consecutive cases were enrolled for analysis with mean final follow-up period 9.8±5.3mo.Visual acuity improved from a mean of 0.35(0.46±0.32 logMAR)preoperatively to 0.61(0.21±0.18 logMAR)at the 3-month follow-up(P=0.002).The mean amount of preoperative keratometric astigmatism and total postoperative refractive astigmatism was-1.24±0.80 diopters(D)and-1.42±0.97 D,respectively.There was no statistically significant difference between preoperative and postoperative astigmatism(P=0.156).The mean IOL-induced astigmatism was-0.23±0.53 D.The mean spherical equivalent at the 3-month follow-up was-0.1±0.94 D.No major complications were noted during the follow-up period.CONCLUSION:Surgical techniques using sutured scleral fixation of existing subluxated or dislocated acrylic one-piece IOLs result in favorable visual and refractive outcomes without major complications.展开更多
Purpose:To investigate the characteristics of the onset and treatment of radial head subluxation(RHS)in pediatric clinics and emergency departments.Methods:A retrospective study was performed on 11,404 RHS cases in 98...Purpose:To investigate the characteristics of the onset and treatment of radial head subluxation(RHS)in pediatric clinics and emergency departments.Methods:A retrospective study was performed on 11,404 RHS cases in 9827 children who visited pediatric clinics and emergency departments from January 2015 to December 2018.The patients who with history of trauma and fracture of the affected limb were excluded.The following factors were examined:the mechanisms of RHS,the type of manual reduction,the attending physician's clinical background(emergency surgeon,junior pediatric orthopedic surgeon or senior pediatric orthopedic surgeon),and the epidemiological features(gender,age,climate and location)of the injury.Results:The mean age of the patients was 27.93±17.94 months(range 0.93-214.53 months),with a peak incidence of 10.73-44.53 months.Approximately two-thirds of RHS cases occurred in cold weather from January to March and from September to December.Females accounted for 53.81%(n=6137)of the cases,and left injuries were predominant(56.87%,n=6485)in all cases.Mechanisms of injury were classified as"pull"(90.57%,n=10,339),"fall"(1.56%,n=178),"hit"(0.75%,n=86)and"unknown"(7.02%,n=801).The overall success rate of manual reduction was 99.47%,and the success rate of reduction was higher for senior pediatric orthopedic surgeons than for emergency surgeons and junior pediatric orthopedic surgeons(p<0.05).However,there was still a recurrence rate of 12.16%in the 9827 patients.Conclusion:Younger children are predisposed to RHS,and there is a possibility of recurrence.Trained emergency doctors can handle it well,but it is essential to refer patients to specialists when manual reduction failed.展开更多
Rheumatoid arthritis is a chronic systemic inflammatory disease that often affects the cervical spine.While it was initially thought that cervical involvement was innocuous,natural history studies have substantiated t...Rheumatoid arthritis is a chronic systemic inflammatory disease that often affects the cervical spine.While it was initially thought that cervical involvement was innocuous,natural history studies have substantiated the progressive nature of untreated disease.Over the past 50 years,there has been further elucidation in the pathophysiology of the disease,as well as significant advancements in medical and surgical therapy.The introduction of disease modifying drugs and biologic agents has reduced the amount of patients with advanced stages of the disease needing surgery.Advancement in instrumentation techniques has improved patient outcomes and fusion rates.The introduction of endoscopic approaches for ventral decompression may further lower surgical morbidity.In this review,we give a brief overview of the pertinent positives of the disease.A discussion of historical techniques and the evolution of surgical therapy into the modern era is provided.With improved medical therapies and lessinvasive approaches,we will likely continue to see less advanced cases of disease and less surgical morbidity.Nonetheless,a thorough understanding of the disease is crucial,as its systemic involvement and need for continued medical therapy have tremendous impact on overall complications and outcomes even in patients being seen for standard degenerative disease with comorbid rheumatoid.展开更多
AIM To correlate the Pang and Lee class with the clinical course in a consecutive series of patients presenting with painful torticollis.METHODS Forty-seven dynamic rotational computed tomography(CT) scans in 35 patie...AIM To correlate the Pang and Lee class with the clinical course in a consecutive series of patients presenting with painful torticollis.METHODS Forty-seven dynamic rotational computed tomography(CT) scans in 35 patients were classified into one of the five types defined by Pang and Li, including types Ⅰ(atlantoaxial rotatopry fixation), Ⅱ("pathologic stickiness" without crossover of C1 on C2), Ⅲ("pathologic stickiness" with crossover of C1 on C2), Ⅳ(normal or muscular torticollis), and Ⅴ(diagnostic grey zone). The Pang and Li class was then compared with the radiologist's report, which was graded abnormal, diagnosis of rotatory subluxation or fixation, or non-diagnostic. Medical records were reviewed and the clinical course was compared among the five subtypes.RESULTS We reviewed 47 CT scans in 35 patients, and the majority were performed without sedation. The average age was 7.7 years(4-14 years old) and associated conditions included minor trauma(20%), surgical procedures around the head and neck(29%), and Grisels syndrome(20%). Twenty-six percent of our studies fell within the pathologic spectrum(5% type 1 or rotatory fixation, 21% types 2 and 3 or rotatory subluxation), while 45% were classified as muscular torticollis(45%) and 28% fell within the diagnostic grey zone. Seven radiologists interpreted these studies, and their interpretation was discordant in 45% of cases. Clinical resolution occurred in 27 of 29 cases for which follow-up was available. One of two patients with fixed rotatory subluxation required a C1-C2 arthrodesis.CONCLUSION The Pang and Li classification characterizes a spectrum of abnormalities in rotation to facilitate communication, although the indications for dynamic CT scan should be further defined.展开更多
The objective of this systematic literature review was to assess the incidence of DDH among the Saudi Arabian population. Methods: A systematic review was performed for all the published articles in the English langua...The objective of this systematic literature review was to assess the incidence of DDH among the Saudi Arabian population. Methods: A systematic review was performed for all the published articles in the English language literature on DDH in Saudi Arabia. Data sources were PubMed Medline (1980-2018) (http://www.ncbi.nlm.nih.gov/pubmed/), Ovid Medline (1980-2018), EMBASE MEDLINE (1980 to May 2018), EMBASE (1991 to May 2018), the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, the Science Citation Index (1966 to May 2018), published data from the Saudi Medical Journal (1985-2018) and Annals of Saudi Medicine (1985-2018). The author independently reviewed articles and abstracted the data. The key words used were Saudi Arabia developmental dysplasia of the hip ORDDH, congenital hip dislocation or congenital subluxation of the hip, and congenital dysplasia of the hip. Results: The authors identified 18 potentially relevant articles published in the last 38 years, and 10 met the inclusion criteria. The 10 studies analyzed included 2037 studies of infants diagnosed with DDH;and they gave an average incidence of 10.46/1000. Two studies (303 subjects) did not report the affected gender;in the remaining 338 were boys and 1396 were girls and one study did not report the side of affection. The majority presented after 12 months of age. The right side was affected in 532 (27.2%) affected, 734 (37.6%) were left side and 687 (35.2%) infants were affected bilaterally. Consanguinity, breech presentation, and family history were found to be the risk factors in 32.9%, 17.3%, and 23.6% of the patients, respectively. Conclusions: There is paucity of available literature on DDH in Saudi Arabia. New strategies have to be developed that include mandatory screening programs in all hospitals (private and public) so that more children can be treated by nonsurgical methods.展开更多
Lens-induced factors are important and common mechanisms causing acute elevation of intraocular pressure. While in most cases, the diagnosis and management are straight-forward, in others it is difficult and can lead ...Lens-induced factors are important and common mechanisms causing acute elevation of intraocular pressure. While in most cases, the diagnosis and management are straight-forward, in others it is difficult and can lead to improper procedures, complications and poor visual outcomes. This review was done with the aim of studying the various types of lens-induced glaucomas, classifying them in an easy way to understand manner, their clinical features, current management and future possibilities.展开更多
Background: Surgical treatment for neuromuscular (NM) hip subluxation or dislocation is undertaken to maintain functionality and decrease pain. Longterm complications are well described;however, the acute complication...Background: Surgical treatment for neuromuscular (NM) hip subluxation or dislocation is undertaken to maintain functionality and decrease pain. Longterm complications are well described;however, the acute complication profile is poorly understood. Questions/Purpose: The aim of this study was to identify the rate of and risk factors for complications following surgical treatment of hip subluxation/dislocation, especially as it relate to NM children. Methods: Hip reconstruction cases in patients with a NM diagnosis and non-NM patients were obtained from the 2015 American College of Surgeons NSQIP-Pediatric database by CPT code. 30-day postoperative complications were classified according to the Clavien-Dindo system as minor (grade 1 or 2) or major (grade 3+). Patient and surgical factors were assessed in univariate and multivariate logistic regression analyses for association with post-operative complications. Results: 1081 cases were identified (median age 7.7, 55% female), of whom 420 (39%) had a NM diagnosis. Overall complication rate was significantly higher in NM patients (33% vs. 19%, p < 0.001). Numerous factors were associated with postoperative complication on univariate analysis. Multivariate analysis identified NM diagnosis (OR 1.5), age > 6 years (OR 1.5), or pelvic osteotomy (OR 1.9) as independent risk factors for complication. Conclusion: In pediatric reconstructive hip surgery requiring pelvic osteotomy, a NM diagnosis is associated with an increased risk of 30-day postoperative complications. Older age and increasing surgical complexity were also independently associated with complications. These findings support special attention for the older patients undergoing concomitant pelvic osteotomies to minimize complication rate.展开更多
Grisel’s syndrome is a rare complication that is characterized by non-traumatic atlantoaxial subluxation. It is most commonly seen in children after an upper respiratory tract infection or neck surgery, such as an ad...Grisel’s syndrome is a rare complication that is characterized by non-traumatic atlantoaxial subluxation. It is most commonly seen in children after an upper respiratory tract infection or neck surgery, such as an adenoidectomy, tonsillectomy and mastoidectomy. Grisel’s Syndrome is characterized by torticollis and a limited range of motion of the neck with pain. Here the authors report a case of a Malian 5-year-old girl with Grisel’s syndrome following tonsillectomy. The patient’s complaints were fully resolved after 2 weeks of conservative treatment.展开更多
Development of total hip arthroplasty (THA) now spans more than 5 decades encompassing combinations of metal-on-metal (MOM), ceramic-on-metal (COM), metal-on-plastic (MOP), ceramic-on-plastic (COM), and ceramic-on-cer...Development of total hip arthroplasty (THA) now spans more than 5 decades encompassing combinations of metal-on-metal (MOM), ceramic-on-metal (COM), metal-on-plastic (MOP), ceramic-on-plastic (COM), and ceramic-on-ceramic (COC). In every arena of extensive technical development, there exists a data set that when viewed in isolation seemed of little import, but when assembled in-toto may produce a generational shift in perception. Our review focused on two such THA events. Firstly, COC retrieval studies (1999-2001) noted habitual wear patterns on heads and peripheral wear stripes, along with femoral-neck impingement, and ceramic surfaces stained gray by metal debris. These COC<span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">data indicated THA risks included, </span><span style="font-family:Verdana;">1</span><span style="font-family:Verdana;">) cup edge-loading (E/L) on heads producing </span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">stripe wear</span><span style="font-family:Verdana;">”</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> 2</span><span style="font-family:Verdana;">) component impingement releasing metal particles resulting in </span><span style="font-family:Verdana;">3</span><span style="font-family:Verdana;">) tissues contaminated by metal debris. A corresponding MOM impingement-debris mechanism was only perceived by Howie (2005) in a McKee-Farrar retrieval study. Our anticipation at LLUMC was that MOM retrievals would provide superior wear details to those seen on COC retrievals. We noted stripe wear in the polar zone of CoCr heads and basal stripes in the non-wear areas. The basal-polar stripe combinations were </span><span style="font-family:Verdana;">found in all MOM retrievals. Basal-polar stripe combinations followed cup-rim</span><span style="font-family:Verdana;"> profiles in our LLUMC simulations of prosthetic impingement. LPUH videos demonstrated the formation of stripe wear in functional-standing and functional-sitting postures for both impingement and subluxation episodes using THA and RA designs. The stripes on CoCr heads revealed the large scratches we now term </span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">microgrooves</span><span style="font-family:Verdana;">”</span><span style="font-family:Verdana;">. Microgroove width varied from 40</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">400</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">um with 100</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">um being typical. The longitudinal striations in microgrooves, the raised jagged lips, scratches with shallow entry and exit termini, were</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">all indicative of a classic 3</span><sup><span style="vertical-align:super;font-family:Verdana;">rd</span></sup><span style="font-family:Verdana;">-body wear mechanism. The THA</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">impingement simulations denoted four sites of edge-loading, </span><i><span style="font-family:Verdana;">i.e.</span></i><i><span style="font-family:Verdana;"> </span></i><span style="font-family:Verdana;">neck-E/L, inferior cup-E/L, superior cup-E/l and head-E/L, and ingress of Ti64 particles as a contaminating-roughness effect. Individual MOM cases referred to LLUMC demonstrated dramatic evidence of neck notching. At one end of the debris spectrum, a Ti64-notch model predicting a 6</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">mm</span><sup><span style="vertical-align:super;font-family:Verdana;">3</span></sup><span style="font-family:Verdana;"> annual wear-rate represented the release of 5700 particles of 126</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">um-size (approximating daily release of 16 particles). At the other end of the spectrum, if metal particles were crushed between MOM surfaces to the equivalent nanometer size found in tissues, our notch model represented approximately 22-trillion Ti64 particles annually deposited in tissues. The anatomical THA models represented in LPUH videos demonstrated that even 1-degree of head subluxation from a rigid cup created a cup </span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">lift-off</span><span style="font-family:Verdana;">”</span><span style="font-family:Verdana;"> scenario (CLO) that would open a gap of 250</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">400 microns between femoral head and cup. This would void all lubrication potential and focus the total hip-joint force along the beveled cup rim</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> </span><i><span style="font-family:Verdana;">i.e.</span></i><span style="font-family:Verdana;"> stripe wear. It is therefore interesting that MOM impingement/debris predictions by Howie </span><i><span style="font-family:Verdana;">et al</span></i><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;"> ha</span><span style="font-family:Verdana;">ve</span><span style="font-family:Verdana;"> not been confirmed until now or discussed in contemporary literature. Therefore, this review of 50</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">years of THA data demonstrated that hip impingement was always the trigger for adverse wear and that metal-backed cups represent the potential for release of metal debris at extremes of functional standing and sitting postures.</span>展开更多
AIM:To evaluate the effect of different elbow and forearm positions on radiocapitellar alignment.METHODS:Fifty-one healthy volunteers were recruited and bilateral elbow radiographs were taken to form a radiologic data...AIM:To evaluate the effect of different elbow and forearm positions on radiocapitellar alignment.METHODS:Fifty-one healthy volunteers were recruited and bilateral elbow radiographs were taken to form a radiologic database.Lateral elbow radiographs were taken with the elbow in five different positions:Maximal extension and forearm in neutral,maximal flexion and forearm in neutral,elbow at 90° and forearm in neutral,elbow at 90° and forearm in supination and elbow at 90° and forearm in pronation.A goniometer was used to verify the accuracy of the elbow's position for the radiographs at a 90° angle.The radiocapitellar ratio(RCR)measurements were then taken on the collected radiographs using the Slice Omatic software.An orthopedic resident performed the radiographic measurements on the 102 elbows,for a total of 510 lateral elbow radiographic measures.ANOVA paired t-tests and Pearson coefficients were used to assess the differences and correlations between the RCR in each position.RESULTS:Mean RCR values were-2% ± 7%(maximal extension),-5% ± 9%(maximal flexion),and for elbow at 90° and forearm in neutral-2% ± 5%,supination 1% ± 6% and pronation 1% ± 5%.ANOVA analyses demonstrated significant differences between the RCRin different elbow and forearm positions.Paired t-tests confirmed significant differences between the RCR at maximal flexion and flexion at 90°,and maximal extension and flexion.The Pearson coefficient showed significant correlations between the RCR with the elbow at 90°-maximal flexion;the forearm in neutralsupination;the forearm in neutral-pronation.CONCLUSION:Overall,95% of the RCR values are included in the normal range(obtained at 90° of flexion)and a value outside this range,in any position,should raise suspicion for instability.展开更多
AIM:To evaluate functional outcome of sutureless scleral tunnel intraocular lens(SSTIOL)in children with crystalline lens subluxation of more than 7 clock hours.METHODS:A prospective interventional study was conducted...AIM:To evaluate functional outcome of sutureless scleral tunnel intraocular lens(SSTIOL)in children with crystalline lens subluxation of more than 7 clock hours.METHODS:A prospective interventional study was conducted consisting of 45 eyes of 44 children in age group 6-18 y having>7 clock hours of lens subluxation who underwent lensectomy-vitrectomy followed by SSTIOL implantation.Primary outcome was improvement in best corrected visual acuity(BCVA)and secondary outcomes were assessment of intraocular lens(IOL)tilt using ultrasound biomicroscopy(UBM),mean change in astigmatism at last follow-up of 1 y and associated complications.RESULTS:The mean preoperative and postoperative BCVA was 1.05±0.28 and 0.64±0.45(log MAR)respectively(P=0.001)at last follow-up.The mean astigmatism preoperatively and postoperatively was-4.17±2.69 D and-1.86±1.25 D respectively(P=0.011).Significant IOL tilt(>5 degrees)was present in 5 cases.The mean percentage endothelial loss was 3.65%±1.92%.The most serious complication encountered was retinal detachment seen in 2 cases.CONCLUSION:SSTIOL implantation provides efficient visual rehabilitation in children provided there is stringent case selection.We recommend caution in children having white-to-white distance>12 mm and presence of peripheral retinal degenerations.展开更多
Background:To present a surgical technique using a rigid intraocular lens as endocapsular supporting device in manual small incision cataract surgery(MSICS)for treating mild-moderate subluxated cataracts.Methods:In ou...Background:To present a surgical technique using a rigid intraocular lens as endocapsular supporting device in manual small incision cataract surgery(MSICS)for treating mild-moderate subluxated cataracts.Methods:In our technique,a single-piece rigid polymethyl methacrylate(PMMA)lens was implanted in the bag following the nucleus removal,with its axis vertical to the zonular dialysis.This endocapsular-implanted IOL stretched the bag and provided sufficient stability and lens centration.This technique was performed in 19 eyes with subluxated cataracts,with zonulysis of≤120 degree and nuclear sclerosis of grade≤3.Mean follow-up time was 9.8 months.Results:All eyes had endocapsular IOL implantation during surgery.Intraoperative extension of the dialysis did not occur in any eye.The IOL was placed in the bag in all but 1 case,in which dislocation of the IOL haptic into the vitreous occurred.Though the IOL was slightly decentered in 3 cases,it kept stable.All patients were asymptomatic.Conclusions:This approach provides a simplified and practical strategy for surgically managing subluxation with mild-moderate zonular loss.展开更多
Background:Mallet fracture is avulsion of the terminal extensor tendon from the base of the distal phalangeal bone with a fragment.This study was performed to evaluate the anatomical characteristics of mallet fracture...Background:Mallet fracture is avulsion of the terminal extensor tendon from the base of the distal phalangeal bone with a fragment.This study was performed to evaluate the anatomical characteristics of mallet fractures,invest电ate a new mallet fracture classification system using anatomical and imaging methods,and discuss the treatment schemes for different types of mallet fracture.Methods:Sixty-four fresh cadaveric fingers were divided into four groups,and models of different types of mallet fracture with distal interphalangeal joint instability were established by dissecting 25%,50%,75%,and 100% of the bilateral collateral ligaments.The the stability of the distal interphalangeal joint was them observed.The lateral radiographs of mallet fractures in 168 patients were analyzed and classified according to the involvement of the joint surface in the fracture,the thickness of fracture,the untreated time after injury,and the complication of distal interphalangeal joint palmar subluxation.Forty-seven patients were surgically treated by reconstruction of extensor tendon insertion,the Ishiguro method,or single Kirschner wire fixation.Results:The established mallet fracture model showed that the distal interphalangeal joint was stable when the bilateral collateral effect of mallet fractures on was then observed.The lateral radiographs of mallet ligaments were cut off by 25%(t=-0.415,P=0.684)and significantly unstable when this range was≥50%(50% transection:t=-6.363,P<0.001;75% transection:t=-17.036,P<0.001;100%transection:t=-30.977,P<0.001,respectively).The mallet fractures were divided into Types Ⅰ,Ⅱ,and Ⅲ(fracture involving<20%,20%-50%,and>50% of the joint surface,respectively).Type Ⅱ was further divided into Tpes Ⅱa and Ⅱb according to whether the course of injury was<or≥2 weeks,respectively.The mean post-operative flexion of the distal interphalangeal joint was 63.4°±7.9°,and the mean extension lag was 6.7°±4.6°.Conclusions:The lateral collateral ligament is the main factor that maintains the stability of the distal interphalangeal joint.Type Ⅱ was further divided into Types Ⅱa and Ⅱb according to whether the course Classification that combines the involvement of the joint surface in the fracture,the thickness of the fracture,and the untreated time after injury is reasonable and will help to choose an appropriate operational method.展开更多
基金Supported by The Chonnam National University Hospital Biomedical Research Institute,No.BCRI22023。
文摘BACKGROUND Atlantoaxial rotatory subluxation(AARS)is an uncommon disease with a greater prevalence among children than adults,and it is mostly associated with trauma.Iatrogenic spinal injury accounts for a low percentage of injuries.However,in AARS,20%-40%of cases are associated with surgery,and 48%are caused by infection.Here,we describe our experience with a case of iatrogenic AARS after general anesthesia.CASE SUMMARY A 12-year-old girl presented with right-sided torticollis and cervical motion limit.The patient had undergone thyroidectomy 2 mo ago.Computed tomography revealed AARS with bilateral locked facets.Following the failure of repeated external reduction under general anesthesia,the patient underwent an open surgical reduction.The patient gained atlantoaxial alignment without any complications.Follow-up radiographs showed a normal appearance without instability.The cervical spine of children is more predisposed to injury due to anatomical and biomechanical differences.AARS secondary to infection and surgery is known as Grisel’s syndrome,which involves non-traumatic AARS.Several cases of AARS after surgery and other procedures with no evidence of inflammation have been reported.Our experience shows that surgery requiring hyperextension of the neck after general anesthesia should also be included as a risk factor.CONCLUSION Surgeons and anesthesiologists should be careful not to excessively extend the neck during pediatric surgery.Moreover,clinicians caring for pediatric patients with recent head and neck procedures must be aware of common AARS presentations.
基金Supported by the National Natural Science Foundation of China(No.82070968)China Postdoctoral Science Foundation(No.2022M712386)+4 种基金Tianjin Health Research Project(No.TJWJ2022MS040,No.ZC20166)Nankai University Eye Institute(No.NKYKK202203,No.NKYKK202206)Tianjin Eye Hospital Research Project(No.YKYB1902)Natural Science Foundation of Tianjin(No.20JCQNJC01860)Tianjin Key Medical Discipine(Specialty)Construction Project(No.TJYXZDXK-016A)。
文摘AIM:To investigate the effect of Cionni-modified capsular tension ring(CTR)implantation in patients with severely traumatic subluxated cataracts.METHODS:All patients who totally had traumatic cataracts and lost zonule support and underwent cataract surgery were retrospectively analyzed.Corrected distance visual acuity(CDVA),extent of zonulysis,intraocular lens(IOL)position,intraoperative presentation,and complications were assessed.The primary outcomes included IOL centration stability and other postoperative complications.RESULTS:Twenty patients(20 eyes)were included in this study.The mean age in this study was 58.0±11.3y,and the average follow-up time was 17.3±12.8mo.Capsule bags were saved by Cionni-modified CTR.Nine eyes(45%)underwent simultaneously anterior vitrectomy due to the presence of vitreous in the anterior chamber.The preoperative mean CDVA was 0.83±0.24 log MAR,and the postoperative average CDVA was 0.23±0.30 log MAR(P<0.05).The horizontal and vertical IOL decentration after surgery was 0.27±0.12 mm and 0.41±0.19 mm,respectively;the vertical and horizontal IOL tilt after surgery was 5.5°±2.5°and 6.1°±2.2°,respectively.None of the eyes had obvious IOL decentration during the follow-up time.Eight eyes(40%)had posterior capsule opacification(PCO)that was severe enough to cause poor vision.Neodymium:YAG laser capsulotomy were performed on these eyes when the CTR was stabilized.CONCLUSION:With the help of Cionni-modified CTR,capsular bag preservation and better IOL concentration can be achieved without major complications in patients with severely traumatic subluxated cataracts.
文摘AIM:To describe clinical findings and complications from cases of traumatic lens subluxation/dislocation in patients with secondary glaucoma,and discuss the multiple treating methods of operation combined with primary intraocular lens(IOL)implantation.METHODS:Non-comparativeretrospectiveobservational case series.Participants:30 cases(30 eyes)of lens subluxation/dislocation in patients with secondary glaucoma were investigated which accepted the surgical treatment by author in the Ophthalmology of Xi'an No.4Hospital from 2007 to 2011.According to the different situations of lens subluxation/dislocation,various surgical procedures were performed such as crystalline lens phacoemulsification,crystalline lens phacoemulsification combined anterior vitrectomy,intracapsular cataract extraction combined anterior vitrectomy,lensectomy combined anterior vitrectomy though peripheral transparent cornea incision,pars plana lensectomy combined pars plana vitrectomy,and intravitreal cavity crystalline lens phacofragmentation combined pars plana vitrectomy.And whether to implement trabeculectomy depended on the different situations of secondary glaucoma.The posterior chamber intraocular lenses(PC-IOLs)were implanted in the capsular-bag or trassclerally sutured in the sulus decided by whether the capsular were present.Main outcome measures:visual acuity,intraocular pressure,the situation of intraocular lens and complications after the operations.RESULTS:The follow-up time was 11-36mo(21.4±7.13).Postoperative visual acuity of all eyes were improved;28 cases maintained IOP below 21 mm Hg;2cases had slightly IOL subluxation,4 cases had slightlytilted lens optical area;1 case had postoperative choroidal detachment;4 cases had postoperative corneal edema more than 1wk,but eventually recovered transparent;2 cases had mild postoperative vitreous hemorrhage,and absorbed 4wk later.There was no postoperative retinal detachment,IOL dislocation,and endophthalmitis.CONCLUSION:To take early treatment of traumatic lens subluxation/dislocation in patients with secondary glaucoma by individual surgical plan based on the different eye conditions would be safe and effective,which can effectively control the intraocular pressure and restore some vision.
基金Wenzhou Municipal Science and Technology Bureau(No.Y20180712)。
文摘AIM:To investigate the safety and efficacy of phacoemulsification with capsular-tension-ring implantation and posterior chamber intraocular lens implantation combined with ophthalmic endoscope-controlled goniosynechialysis(Phaco-CTR-IOL-OE-GSL)for treating secondary angle-closure glaucoma induced by traumatic lens subluxation.METHODS:A retrospective and descriptive study was performed on patients with lens subluxation,angle closure,goniosynechia,and evaluated intraocular pressure(IOP)that cannot be controlled with medication,who underwent Phaco-CTR-IOL-OE-GSL.The postoperative best-corrected visual acuity(BCVA),IOP,range of goniosynechia and complications were retrospectively observed.RESULTS:Nine patients with secondary angle-closure glaucoma induced by traumatic lens subluxation were included.The follow-up period was 51.1±8.6 mo.The preoperative range of zonule rupture was 158.2°±33.0°,and the range of goniosynechia was 220.0°±92.5°.The baseline BCVA was 0.9±1.0 logMAR,IOP was 30.7±17.3 mm Hg and number of anti-glaucoma medication was 3.2±1.1.Mild intraoperative hyphaemia with 8 eyes(88.8%)in the anterior chamber,and was absorbed two days postoperatively.One eye(11.1%)had postoperative ciliary body detachment and was recovered after five days of topical drug treatment.BCVA was 0.2±0.2 logMAR at 3 mo postoperatively.The average IOP at the last follow-up was 16.7±2.0 mm Hg,and no anti-glaucoma medications were used.The average range of recurrent goniosynechia was 54.9°±33°at the final postoperative gonioscopic examination.CONCLUSION:Phaco-CTR-IOL-OE-GSL is safe and effective in the treatment of secondary angle-closure glaucoma induced by traumatic lens subluxation.The use of an endoscope provides a more direct and clear examination for GSL,and 360°dissection is easily achieved.
基金Supported by the Natural Science Foundation of Jilin Province,No.20200201536JC.
文摘BACKGROUND Synovial chondromatosis is a disease originating from the synovium and characterized by the presence of metaplastic cartilaginous nodules in synovial cavities.The exact prevalence of synovial chondromatosis remains unknown,and the involvement of the shoulder joint is very rare.Synovial chondromatosis accompanied by subluxation of the humeral head without a history of trauma is rarely encountered,and to our knowledge,no published reports describe this condition.CASE SUMMARY We present two cases of synovial chondromatosis in the shoulder joint,accompanied by subluxation of the humeral head,in two arthroscopically managed adult patients.We performed arthroscopic labrum fixation and removal of the loose body from the shoulder joint.To identify primary and secondary categories,pathological analysis was arranged.Clinical and radiographic evaluations at the 1-mo follow-up were satisfactory.CONCLUSION The biomechanical function of the shoulder joint requires attention,especially following the detection of loose bodies,as observed with synovial chondroma occurring in rare sites.Arthroscopic management is successful in patients with synovial chondromatosis combined with shoulder subluxation.
文摘Most cases of medial patella subluxation occur under iatrogenic conditions that are often associated with a prior excessive lateral retinacular release procedure. We report a case of medial subluxation following minor trauma with no history of previous lateral release. The abnormality was identified on magnetic resonance imaging and was successfully treated by direct repair of the lateral retinaculum. The recognition and treatment of medial subluxation of the patella without retinacular release can be difficult. Therefore, consideration of multiple causes through careful medical history taking, physical examination, and radiologic examination is needed for accurate diagnosis.
文摘Objective To introduce a new procedure for treatment of rotatory subluxation of the scaphoid. Methods Eighteen patients with rotatory subluxation of the scaphoid were divided into five types according to clinical manifestation and cause: type Ⅰ (predynamic) 1 case,type Ⅱ (dynamic) 2 cases, type Ⅲ (static) 7 cases, type Ⅳ (degenerative) 3 cases, type Ⅴ( secondary) 5 cases. All cases underwent scapho-trapezio-trapezoid limited wrist arthrodesis. Results The follow-up ranged from 6 months to 3 years. The results showed that the all rotatory subluxatiopn of scaphoid in the study had been corrected with satisfactory fusion and painless wrist. The average grip strength was 90% of the normal wrist, and the average range of motion was 62% of the opposite side. Conclusion Scapho-trapezio-trapezoid limited arthrodesis is a reliable and useful procedure for treatment of chronic andChina Medical Abstracts(Surgery) static rotatory subluxation of the scaphoid. 15 refs,2 figs.
文摘AIM:To evaluate the visual and refractive outcomes in cases after sutured scleral fixation of existing subluxated or dislocated acrylic one-piece intraocular lenses(IOLs).METHODS:This study retrospectively enrolled a consecutive series of patients who underwent a surgery of sutured existing subluxated or dislocated IOLs from October 2018 to June 2020.All patients underwent comprehensive preoperative and postoperative ophthalmologic examination,and data were collected including age,sex,surgical indications,best-corrected visual acuity,refractive error,intraocular pressure.Presence of intraoperative and postoperative surgical complications was documented.RESULTS:A total of 20 consecutive cases were enrolled for analysis with mean final follow-up period 9.8±5.3mo.Visual acuity improved from a mean of 0.35(0.46±0.32 logMAR)preoperatively to 0.61(0.21±0.18 logMAR)at the 3-month follow-up(P=0.002).The mean amount of preoperative keratometric astigmatism and total postoperative refractive astigmatism was-1.24±0.80 diopters(D)and-1.42±0.97 D,respectively.There was no statistically significant difference between preoperative and postoperative astigmatism(P=0.156).The mean IOL-induced astigmatism was-0.23±0.53 D.The mean spherical equivalent at the 3-month follow-up was-0.1±0.94 D.No major complications were noted during the follow-up period.CONCLUSION:Surgical techniques using sutured scleral fixation of existing subluxated or dislocated acrylic one-piece IOLs result in favorable visual and refractive outcomes without major complications.
文摘Purpose:To investigate the characteristics of the onset and treatment of radial head subluxation(RHS)in pediatric clinics and emergency departments.Methods:A retrospective study was performed on 11,404 RHS cases in 9827 children who visited pediatric clinics and emergency departments from January 2015 to December 2018.The patients who with history of trauma and fracture of the affected limb were excluded.The following factors were examined:the mechanisms of RHS,the type of manual reduction,the attending physician's clinical background(emergency surgeon,junior pediatric orthopedic surgeon or senior pediatric orthopedic surgeon),and the epidemiological features(gender,age,climate and location)of the injury.Results:The mean age of the patients was 27.93±17.94 months(range 0.93-214.53 months),with a peak incidence of 10.73-44.53 months.Approximately two-thirds of RHS cases occurred in cold weather from January to March and from September to December.Females accounted for 53.81%(n=6137)of the cases,and left injuries were predominant(56.87%,n=6485)in all cases.Mechanisms of injury were classified as"pull"(90.57%,n=10,339),"fall"(1.56%,n=178),"hit"(0.75%,n=86)and"unknown"(7.02%,n=801).The overall success rate of manual reduction was 99.47%,and the success rate of reduction was higher for senior pediatric orthopedic surgeons than for emergency surgeons and junior pediatric orthopedic surgeons(p<0.05).However,there was still a recurrence rate of 12.16%in the 9827 patients.Conclusion:Younger children are predisposed to RHS,and there is a possibility of recurrence.Trained emergency doctors can handle it well,but it is essential to refer patients to specialists when manual reduction failed.
文摘Rheumatoid arthritis is a chronic systemic inflammatory disease that often affects the cervical spine.While it was initially thought that cervical involvement was innocuous,natural history studies have substantiated the progressive nature of untreated disease.Over the past 50 years,there has been further elucidation in the pathophysiology of the disease,as well as significant advancements in medical and surgical therapy.The introduction of disease modifying drugs and biologic agents has reduced the amount of patients with advanced stages of the disease needing surgery.Advancement in instrumentation techniques has improved patient outcomes and fusion rates.The introduction of endoscopic approaches for ventral decompression may further lower surgical morbidity.In this review,we give a brief overview of the pertinent positives of the disease.A discussion of historical techniques and the evolution of surgical therapy into the modern era is provided.With improved medical therapies and lessinvasive approaches,we will likely continue to see less advanced cases of disease and less surgical morbidity.Nonetheless,a thorough understanding of the disease is crucial,as its systemic involvement and need for continued medical therapy have tremendous impact on overall complications and outcomes even in patients being seen for standard degenerative disease with comorbid rheumatoid.
文摘AIM To correlate the Pang and Lee class with the clinical course in a consecutive series of patients presenting with painful torticollis.METHODS Forty-seven dynamic rotational computed tomography(CT) scans in 35 patients were classified into one of the five types defined by Pang and Li, including types Ⅰ(atlantoaxial rotatopry fixation), Ⅱ("pathologic stickiness" without crossover of C1 on C2), Ⅲ("pathologic stickiness" with crossover of C1 on C2), Ⅳ(normal or muscular torticollis), and Ⅴ(diagnostic grey zone). The Pang and Li class was then compared with the radiologist's report, which was graded abnormal, diagnosis of rotatory subluxation or fixation, or non-diagnostic. Medical records were reviewed and the clinical course was compared among the five subtypes.RESULTS We reviewed 47 CT scans in 35 patients, and the majority were performed without sedation. The average age was 7.7 years(4-14 years old) and associated conditions included minor trauma(20%), surgical procedures around the head and neck(29%), and Grisels syndrome(20%). Twenty-six percent of our studies fell within the pathologic spectrum(5% type 1 or rotatory fixation, 21% types 2 and 3 or rotatory subluxation), while 45% were classified as muscular torticollis(45%) and 28% fell within the diagnostic grey zone. Seven radiologists interpreted these studies, and their interpretation was discordant in 45% of cases. Clinical resolution occurred in 27 of 29 cases for which follow-up was available. One of two patients with fixed rotatory subluxation required a C1-C2 arthrodesis.CONCLUSION The Pang and Li classification characterizes a spectrum of abnormalities in rotation to facilitate communication, although the indications for dynamic CT scan should be further defined.
文摘The objective of this systematic literature review was to assess the incidence of DDH among the Saudi Arabian population. Methods: A systematic review was performed for all the published articles in the English language literature on DDH in Saudi Arabia. Data sources were PubMed Medline (1980-2018) (http://www.ncbi.nlm.nih.gov/pubmed/), Ovid Medline (1980-2018), EMBASE MEDLINE (1980 to May 2018), EMBASE (1991 to May 2018), the Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews, the Science Citation Index (1966 to May 2018), published data from the Saudi Medical Journal (1985-2018) and Annals of Saudi Medicine (1985-2018). The author independently reviewed articles and abstracted the data. The key words used were Saudi Arabia developmental dysplasia of the hip ORDDH, congenital hip dislocation or congenital subluxation of the hip, and congenital dysplasia of the hip. Results: The authors identified 18 potentially relevant articles published in the last 38 years, and 10 met the inclusion criteria. The 10 studies analyzed included 2037 studies of infants diagnosed with DDH;and they gave an average incidence of 10.46/1000. Two studies (303 subjects) did not report the affected gender;in the remaining 338 were boys and 1396 were girls and one study did not report the side of affection. The majority presented after 12 months of age. The right side was affected in 532 (27.2%) affected, 734 (37.6%) were left side and 687 (35.2%) infants were affected bilaterally. Consanguinity, breech presentation, and family history were found to be the risk factors in 32.9%, 17.3%, and 23.6% of the patients, respectively. Conclusions: There is paucity of available literature on DDH in Saudi Arabia. New strategies have to be developed that include mandatory screening programs in all hospitals (private and public) so that more children can be treated by nonsurgical methods.
文摘Lens-induced factors are important and common mechanisms causing acute elevation of intraocular pressure. While in most cases, the diagnosis and management are straight-forward, in others it is difficult and can lead to improper procedures, complications and poor visual outcomes. This review was done with the aim of studying the various types of lens-induced glaucomas, classifying them in an easy way to understand manner, their clinical features, current management and future possibilities.
文摘Background: Surgical treatment for neuromuscular (NM) hip subluxation or dislocation is undertaken to maintain functionality and decrease pain. Longterm complications are well described;however, the acute complication profile is poorly understood. Questions/Purpose: The aim of this study was to identify the rate of and risk factors for complications following surgical treatment of hip subluxation/dislocation, especially as it relate to NM children. Methods: Hip reconstruction cases in patients with a NM diagnosis and non-NM patients were obtained from the 2015 American College of Surgeons NSQIP-Pediatric database by CPT code. 30-day postoperative complications were classified according to the Clavien-Dindo system as minor (grade 1 or 2) or major (grade 3+). Patient and surgical factors were assessed in univariate and multivariate logistic regression analyses for association with post-operative complications. Results: 1081 cases were identified (median age 7.7, 55% female), of whom 420 (39%) had a NM diagnosis. Overall complication rate was significantly higher in NM patients (33% vs. 19%, p < 0.001). Numerous factors were associated with postoperative complication on univariate analysis. Multivariate analysis identified NM diagnosis (OR 1.5), age > 6 years (OR 1.5), or pelvic osteotomy (OR 1.9) as independent risk factors for complication. Conclusion: In pediatric reconstructive hip surgery requiring pelvic osteotomy, a NM diagnosis is associated with an increased risk of 30-day postoperative complications. Older age and increasing surgical complexity were also independently associated with complications. These findings support special attention for the older patients undergoing concomitant pelvic osteotomies to minimize complication rate.
文摘Grisel’s syndrome is a rare complication that is characterized by non-traumatic atlantoaxial subluxation. It is most commonly seen in children after an upper respiratory tract infection or neck surgery, such as an adenoidectomy, tonsillectomy and mastoidectomy. Grisel’s Syndrome is characterized by torticollis and a limited range of motion of the neck with pain. Here the authors report a case of a Malian 5-year-old girl with Grisel’s syndrome following tonsillectomy. The patient’s complaints were fully resolved after 2 weeks of conservative treatment.
文摘Development of total hip arthroplasty (THA) now spans more than 5 decades encompassing combinations of metal-on-metal (MOM), ceramic-on-metal (COM), metal-on-plastic (MOP), ceramic-on-plastic (COM), and ceramic-on-ceramic (COC). In every arena of extensive technical development, there exists a data set that when viewed in isolation seemed of little import, but when assembled in-toto may produce a generational shift in perception. Our review focused on two such THA events. Firstly, COC retrieval studies (1999-2001) noted habitual wear patterns on heads and peripheral wear stripes, along with femoral-neck impingement, and ceramic surfaces stained gray by metal debris. These COC<span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">data indicated THA risks included, </span><span style="font-family:Verdana;">1</span><span style="font-family:Verdana;">) cup edge-loading (E/L) on heads producing </span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">stripe wear</span><span style="font-family:Verdana;">”</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> 2</span><span style="font-family:Verdana;">) component impingement releasing metal particles resulting in </span><span style="font-family:Verdana;">3</span><span style="font-family:Verdana;">) tissues contaminated by metal debris. A corresponding MOM impingement-debris mechanism was only perceived by Howie (2005) in a McKee-Farrar retrieval study. Our anticipation at LLUMC was that MOM retrievals would provide superior wear details to those seen on COC retrievals. We noted stripe wear in the polar zone of CoCr heads and basal stripes in the non-wear areas. The basal-polar stripe combinations were </span><span style="font-family:Verdana;">found in all MOM retrievals. Basal-polar stripe combinations followed cup-rim</span><span style="font-family:Verdana;"> profiles in our LLUMC simulations of prosthetic impingement. LPUH videos demonstrated the formation of stripe wear in functional-standing and functional-sitting postures for both impingement and subluxation episodes using THA and RA designs. The stripes on CoCr heads revealed the large scratches we now term </span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">microgrooves</span><span style="font-family:Verdana;">”</span><span style="font-family:Verdana;">. Microgroove width varied from 40</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">400</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">um with 100</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">um being typical. The longitudinal striations in microgrooves, the raised jagged lips, scratches with shallow entry and exit termini, were</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">all indicative of a classic 3</span><sup><span style="vertical-align:super;font-family:Verdana;">rd</span></sup><span style="font-family:Verdana;">-body wear mechanism. The THA</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">impingement simulations denoted four sites of edge-loading, </span><i><span style="font-family:Verdana;">i.e.</span></i><i><span style="font-family:Verdana;"> </span></i><span style="font-family:Verdana;">neck-E/L, inferior cup-E/L, superior cup-E/l and head-E/L, and ingress of Ti64 particles as a contaminating-roughness effect. Individual MOM cases referred to LLUMC demonstrated dramatic evidence of neck notching. At one end of the debris spectrum, a Ti64-notch model predicting a 6</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">mm</span><sup><span style="vertical-align:super;font-family:Verdana;">3</span></sup><span style="font-family:Verdana;"> annual wear-rate represented the release of 5700 particles of 126</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">um-size (approximating daily release of 16 particles). At the other end of the spectrum, if metal particles were crushed between MOM surfaces to the equivalent nanometer size found in tissues, our notch model represented approximately 22-trillion Ti64 particles annually deposited in tissues. The anatomical THA models represented in LPUH videos demonstrated that even 1-degree of head subluxation from a rigid cup created a cup </span><span style="font-family:Verdana;">“</span><span style="font-family:Verdana;">lift-off</span><span style="font-family:Verdana;">”</span><span style="font-family:Verdana;"> scenario (CLO) that would open a gap of 250</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">-</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">400 microns between femoral head and cup. This would void all lubrication potential and focus the total hip-joint force along the beveled cup rim</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> </span><i><span style="font-family:Verdana;">i.e.</span></i><span style="font-family:Verdana;"> stripe wear. It is therefore interesting that MOM impingement/debris predictions by Howie </span><i><span style="font-family:Verdana;">et al</span></i><span style="font-family:Verdana;">.</span><span style="font-family:Verdana;"> ha</span><span style="font-family:Verdana;">ve</span><span style="font-family:Verdana;"> not been confirmed until now or discussed in contemporary literature. Therefore, this review of 50</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">years of THA data demonstrated that hip impingement was always the trigger for adverse wear and that metal-backed cups represent the potential for release of metal debris at extremes of functional standing and sitting postures.</span>
基金Supported by Fondation de Recherche et d’éducation en Orthopédie de Montréal
文摘AIM:To evaluate the effect of different elbow and forearm positions on radiocapitellar alignment.METHODS:Fifty-one healthy volunteers were recruited and bilateral elbow radiographs were taken to form a radiologic database.Lateral elbow radiographs were taken with the elbow in five different positions:Maximal extension and forearm in neutral,maximal flexion and forearm in neutral,elbow at 90° and forearm in neutral,elbow at 90° and forearm in supination and elbow at 90° and forearm in pronation.A goniometer was used to verify the accuracy of the elbow's position for the radiographs at a 90° angle.The radiocapitellar ratio(RCR)measurements were then taken on the collected radiographs using the Slice Omatic software.An orthopedic resident performed the radiographic measurements on the 102 elbows,for a total of 510 lateral elbow radiographic measures.ANOVA paired t-tests and Pearson coefficients were used to assess the differences and correlations between the RCR in each position.RESULTS:Mean RCR values were-2% ± 7%(maximal extension),-5% ± 9%(maximal flexion),and for elbow at 90° and forearm in neutral-2% ± 5%,supination 1% ± 6% and pronation 1% ± 5%.ANOVA analyses demonstrated significant differences between the RCRin different elbow and forearm positions.Paired t-tests confirmed significant differences between the RCR at maximal flexion and flexion at 90°,and maximal extension and flexion.The Pearson coefficient showed significant correlations between the RCR with the elbow at 90°-maximal flexion;the forearm in neutralsupination;the forearm in neutral-pronation.CONCLUSION:Overall,95% of the RCR values are included in the normal range(obtained at 90° of flexion)and a value outside this range,in any position,should raise suspicion for instability.
文摘AIM:To evaluate functional outcome of sutureless scleral tunnel intraocular lens(SSTIOL)in children with crystalline lens subluxation of more than 7 clock hours.METHODS:A prospective interventional study was conducted consisting of 45 eyes of 44 children in age group 6-18 y having>7 clock hours of lens subluxation who underwent lensectomy-vitrectomy followed by SSTIOL implantation.Primary outcome was improvement in best corrected visual acuity(BCVA)and secondary outcomes were assessment of intraocular lens(IOL)tilt using ultrasound biomicroscopy(UBM),mean change in astigmatism at last follow-up of 1 y and associated complications.RESULTS:The mean preoperative and postoperative BCVA was 1.05±0.28 and 0.64±0.45(log MAR)respectively(P=0.001)at last follow-up.The mean astigmatism preoperatively and postoperatively was-4.17±2.69 D and-1.86±1.25 D respectively(P=0.011).Significant IOL tilt(>5 degrees)was present in 5 cases.The mean percentage endothelial loss was 3.65%±1.92%.The most serious complication encountered was retinal detachment seen in 2 cases.CONCLUSION:SSTIOL implantation provides efficient visual rehabilitation in children provided there is stringent case selection.We recommend caution in children having white-to-white distance>12 mm and presence of peripheral retinal degenerations.
基金The study was approved by IRB of The First People’s Hospital of Yunnan Province(No.2016031).
文摘Background:To present a surgical technique using a rigid intraocular lens as endocapsular supporting device in manual small incision cataract surgery(MSICS)for treating mild-moderate subluxated cataracts.Methods:In our technique,a single-piece rigid polymethyl methacrylate(PMMA)lens was implanted in the bag following the nucleus removal,with its axis vertical to the zonular dialysis.This endocapsular-implanted IOL stretched the bag and provided sufficient stability and lens centration.This technique was performed in 19 eyes with subluxated cataracts,with zonulysis of≤120 degree and nuclear sclerosis of grade≤3.Mean follow-up time was 9.8 months.Results:All eyes had endocapsular IOL implantation during surgery.Intraoperative extension of the dialysis did not occur in any eye.The IOL was placed in the bag in all but 1 case,in which dislocation of the IOL haptic into the vitreous occurred.Though the IOL was slightly decentered in 3 cases,it kept stable.All patients were asymptomatic.Conclusions:This approach provides a simplified and practical strategy for surgically managing subluxation with mild-moderate zonular loss.
基金This study was supported by the Beijing Health System Project for High-level Technical Scholars(No.2015-3-036).
文摘Background:Mallet fracture is avulsion of the terminal extensor tendon from the base of the distal phalangeal bone with a fragment.This study was performed to evaluate the anatomical characteristics of mallet fractures,invest电ate a new mallet fracture classification system using anatomical and imaging methods,and discuss the treatment schemes for different types of mallet fracture.Methods:Sixty-four fresh cadaveric fingers were divided into four groups,and models of different types of mallet fracture with distal interphalangeal joint instability were established by dissecting 25%,50%,75%,and 100% of the bilateral collateral ligaments.The the stability of the distal interphalangeal joint was them observed.The lateral radiographs of mallet fractures in 168 patients were analyzed and classified according to the involvement of the joint surface in the fracture,the thickness of fracture,the untreated time after injury,and the complication of distal interphalangeal joint palmar subluxation.Forty-seven patients were surgically treated by reconstruction of extensor tendon insertion,the Ishiguro method,or single Kirschner wire fixation.Results:The established mallet fracture model showed that the distal interphalangeal joint was stable when the bilateral collateral effect of mallet fractures on was then observed.The lateral radiographs of mallet ligaments were cut off by 25%(t=-0.415,P=0.684)and significantly unstable when this range was≥50%(50% transection:t=-6.363,P<0.001;75% transection:t=-17.036,P<0.001;100%transection:t=-30.977,P<0.001,respectively).The mallet fractures were divided into Types Ⅰ,Ⅱ,and Ⅲ(fracture involving<20%,20%-50%,and>50% of the joint surface,respectively).Type Ⅱ was further divided into Tpes Ⅱa and Ⅱb according to whether the course of injury was<or≥2 weeks,respectively.The mean post-operative flexion of the distal interphalangeal joint was 63.4°±7.9°,and the mean extension lag was 6.7°±4.6°.Conclusions:The lateral collateral ligament is the main factor that maintains the stability of the distal interphalangeal joint.Type Ⅱ was further divided into Types Ⅱa and Ⅱb according to whether the course Classification that combines the involvement of the joint surface in the fracture,the thickness of the fracture,and the untreated time after injury is reasonable and will help to choose an appropriate operational method.
