Purpose:Primary osteosarcoma of the spine is a rare osseous tumour. En bloc resection, in contrast with intralesional resection, is the only procedure able to provide Enneking appropriate (EA) margins, which has improved local control and survival of patients with primary osteosarcoma of the spine. The objective of this study is to compare the risk of local recurrence, metastases development and survival in patients with primary osteosarcoma of the spine submitted to Enneking appropriate (EA) and Enneking inappropriate (EI) procedure. Methods:A systematic search was performed on EBSCO, PubMed and Web of Science, between 1966 and 2018, to identify studies evaluating patients submitted to resection of primary osteosarcoma of the spine. Two reviewers independently assessed all reports. The outcomes were local recurrence, metastases development and survival at 12, 24 and 60 months. Results:Five studies (108 patients) were included for systematic review. These studies support the conclusion that EA procedure has a lower local recurrence rate (RR: 0.33, 95% CI: 0.17-0.66), a lower metastases development rate
Bohler angle and the crucial angle of Gissane are used on the evaluation of calcaneus fractures. However, few authors have described the variation of the angles when the calcaneus is growing. In this study, Bohler angle and the crucial angle of Gissane in paediatric population were measured using lateral foot radiographs of 429 patients, from 0 to 16 years of age. The control group was composed of 70 adult patients. The sample had a mean Bohler angle of 35.4° ± 5.9° and a mean crucial angle of Gissane of 110.5° ± 7.4°. The greater mean difference was identified for Bohler angle (8°) in the age group of 5 to 8 years (39.6° ± 5.7°) and for the crucial angle of Gissane (5°-6°) in the age group of 0 to 4 years (115.8° ± 7.3) (P < .05). The influence of the ossification centres on the geometry of the calcaneus across age groups makes Bohler angle and the crucial angle of Gissane higher in young children. The increase in Bohler angle points out the relative development of the posterior facet in young children and the importance of the reconstruction of the posterior facet height in the intra-articular calcaneus fractures.Level of Evidence: Diagnostic study; Level III.
The posterior cruciate ligament index (PCL index) has been reported as a diagnostic and prognostic marker for anterior cruciate ligament (ACL) reconstruction. The clinical relevance of PCL index on the reconstruction of ACL with hamstring tendon autograft has not been described in the literature. The objective of this study is to evaluate the importance of the PCL index as a marker of anatomic reconstruction and of functional improvement of patients undergoing ACL reconstruction with HT autograft. Twenty-four patients were submitted to ACL reconstruction with HT autograft. The PCL index was assessed by magnetic resonance imaging before and after surgery. The functional evaluation was performed through the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form© and Knee Society Knee Scoring System© (IKS). Patients presented a significant positive variation of the PCL index, IKDC and IKS scores. There is no significant correlation between PCL index variation and IKDC and IKS scores (p > 0.05). Unlike other studies reporting a relationship between the PCL index, control of rotational kinematics, and functional improvement in patients undergoing ACL reconstruction with bone-patellar tendon-bone autograft, this study does not demonstrate this association. There is evidence in this study to show that the PCL index may be used as an anatomic reconstructive marker of ACL but not to predict the clinical outcome in this type of reconstruction.
INTRODUCTION: Fractures-detached is an injury in the place where the tendon or the ligament is inserted in the bear, in the plates of growth. Thus, in the offspring, or tendons or proximal ligaments of a growth plate, may provide sufficient force to cause a growth plate fracture. Single fractures of the apophysis are rare and rarely known lesions. In this article we present 3 clinical cases of patients with indirect trauma, such as the anterior fracture of the anterior tibial tuberosity, the anterior superior iliac spine fracture, and the small fracture of the femoral trochanter. METHOD: Retrospective descriptive of 3 clinical cases based on patients' electronic clinical processes. CASE 1: Male of 16 years old, victim of fracture-avulsion of the anterior tuberosity of the tibia (ATT). The injury occurred during football practice, immediately feeling intense knee pain associated with functional impairment of the left lower limb. The Emergency Service was used, with pain in the palpation of the left knee, edema, joint effusion, high patella and incapacity of active extension of the affected limb. The left knee radiograph showed a fracture of the ATT. Computed tomography (CT) revealed an extensive metaphyseal-epiphyseal vein, corresponding to a fracture-avulsion type IIIC in a context of previous Osgood-Schlatter disease. It was subjected to open reduction and internal fixation of the fracture with two cannulated screws, without complications. After surgery, the affected lower limb was immobilized for about 1 month, after which the patient started physiotherapy. After 3 months, the patient initiated complaints of contralateral knee pain related to ATT, with improvement after 3 months of conservative treatment. The patient restarted the sport activity at 6 months postoperatively, without complaints or limitations. After 2 years of follow-up, the patient did not present complaints or limitations of mobility bilaterally and resumed the activity level before the injury. CASE 2: The adolescent male, an occasional physical exercise student at school, turned to the US for pain on the right side of the basin, 4 days after a jump during a basketball game. The objective test revealed gait claudication, palpation of the right anterior superior iliac spine (ASIS) and limitation of right movements. The radiograph and CT of the basin, to diagnose a fracture-avulsion of right ASIS, with deviation less than 3 cm. Treatment of pain, relative rest and taking oral anti-inflammatories and discharge of the affected member for 4 weeks. X-ray and CT, at 6 weeks, did not show fracture healing. However, the patient recovers from physical activity after 8 weeks, remains asymptomatic and unrestricted in the practice of physical exercise. CASE 3: An 11-year-old male, he used the Urgency Service with pain at the level of the anterior inner side of the right thigh and functional impotence of the ipsilateral lower limb, after indirect trauma with hyperextension movement in soccer game. The radiographic examination revealed a fracture of the isola...
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