PurposeTo introduce a new model of telescopic intramedullary rod (TIR), evaluate its effects on treating patients presenting with moderate and severe osteogenesis imperfecta (OI) and to compare the findings with those of other telescopic rods.MethodsA total of 21 patients (nine girls and 12 boys; mean age at first operation, 6.6 years, 1.52 to 13.18) who underwent 52 femoral operations were monitored during a mean of 9.96 years (3.39 to 14.54). Patient characteristics, telescoping rod capability and its complications were examined.ResultsAccording to the Sillence classification, we investigated one patient with type I, nine with type III and 11 with type IV OI. Revision rates at up to five years (36%) were inferior to those found for the Fassier-Duval rod (46%). The main cause of revision was fracture (15 patients), followed by rod migration (nine), and infection (two). The rod exhibited higher telescopic capacity in boys than girls. Type III most commonly required an operation; the age group with the highest number of procedures was five to ten years. Male migration was the main cause of rod migration.ConclusionThe TIR has a satisfactory cost-benefit ratio with less complication rates and low production costs. The TIR is a feasible alternative to the commonly used Fassier-Duval rod.Level of EvidenceIV
Objective: The purpose of this study was to systematically review the literature regarding the use of hamstring tendon (HT) autograft for extensor hallucis longus (EHL) reconstruction. Methods: A systematic search for studies addressing the use of HT autograft for reconstruction of nonrepairable EHL tendon injuries was performed in December 2021. The databases searched include Embase, Medline, Europe PMC, Cochrane, and Scopus. Predetermined inclusion and exclusion criteria were implemented, and appropriate studies were selected for review. Results: The database search resulted in one study that met the inclusion and exclusion criteria. Three additional studies met inclusion and exclusion criteria after screening the references of the selected study. A total of four studies were included in the final review. Clinical presentation, surgical technique, postoperative rehabilitation, clinical follow-up, and outcomes were recorded. All four studies reported single cases of EHL tendon reconstruction using a semitendinosus autograft with satisfactory clinical results and no complications. Patients may experience a five degrees decrease in range of motion or minimal decrease in hallux extension strength; however, all patients were asymptomatic and reported no limitations. Conclusion: Four case reports regarding EHL tendon reconstruction were reviewed and demonstrated using a semitendinosus autograft as a viable option with favorable outcomes and no complications. Level of Evidence IV; Systematic Review
Adult tendons are highly differentiated. In mature individuals, tendon healing after an injury occurs through fibrotic tissue formation. Understanding the intrinsic reparative properties of fetal tendons would help to understand the maturation tissue process and tendon tissue repair. The present study evaluated the evolution of histoarchitecture, cellularity and the distribution of collagens I, III and V in the posterior tibial tendon in human fetuses at different gestational ages. Morphological profiles were assessed in nine fresh spontaneously aborted fetuses (Group I: five fetuses aged between 22 and 28 weeks of gestation; Group II: four fetuses aged between 32 and 38 weeks of gestation), characterized by a combination of histology, fluorescence and immunohistochemistry. In Group I, the posterior tibial tendon showed statistically significant greater cellularity and presence of collagen III and V than in Group II tendon, which showed a predominance of collagenous I and a better organization of the extracellular matrix compared with Group I tendons. In addition, a statistically significant higher rate of CD90, a marker of mesenchymal cells, was found in Group I tendons. In fetuses with gestational age between 22 and 28 weeks, the posterior tibialis tendons showed a thin and disorganized fibrillar structure, with an increase in collagen III and V fibers and mesenchymal cells. In the posterior tibialis tendons of fetuses with gestational age between 32 and 38 weeks, the fibrillar structure was thicker with a statistically significant increase in type I collagen and decreased cellularity.
Background: Foot pathologies can affect the kinetic chain during gait, leading to altered loading at other joints that can lead to subsequent pathologies. Although hallux valgus is the most common foot disease, little has been discussed about the biokinetic effects of hallux valgus on the foot and lower limb. This systematic review evaluated the kinematic, kinetic, and pedobarographic changes of the hallux valgus foot compared to a healthy one. Methods: Several electronic databases were searched up to January 2022, including only cross-sectional studies with clearly defined isolated hallux valgus diseases and healthy groups. Two investigators independently rated studies for methodological quality using the NIH Study Quality Assessment Tool for cross-sectional studies. Kinetic data were extracted, including temporal data, kinematics of the foot joint, kinematics of the proximal lower limb, and pedobarography. We did meta-analyses tests with a random effects model using the metafor package in R. Results: Hallux valgus patients walk slower compared to a disease-free control group −0.16 m/s (95% CI −0.27, −0.05). Hallux valgus patients exhibited significantly reduced coronal plane motion of the hindfoot-shank during preswing 1.16 degrees (95% CI 0.31, 2.00). Hallux valgus patients generated less force in the hallux region 33.48 N (95% CI 8.62, 58.35) but similar peak pressures in the hallux compared to controls. Hallux valgus patients generated less peak pressure at the medial and lateral hindfoot as compared to controls: 8.28 kPa (95% CI 2.92, 13.64) and 8.54 kPa (95% CI 3.55, 13.52), respectively. Conclusion: Although hallux valgus is a deformity of the forefoot, the kinematic changes due to the pathology are associated with significant changes in the range of motion at other joints, underscoring its importance in the kinetic chain. This is demonstrated again with the changes of peak pressure. Nevertheless, more high-quality studies are still needed to develop a fuller understanding of this pathology.
Objective: Evaluate the effect of the SARS-CoV-2 pandemic in the two years since it started. Methods: Retrospective study to analyze the complex structured data set of high volume and variability (Big Data) publicly available on the TabNet platform (DATASUS) through artificial intelligence software. The results of foot and ankle fractures, all lower limb fractures, and all body fractures were analyzed comparatively from 2018-2019 to 2020-2021. Result: The isolated fibula fracture suffered the greatest decrease from 2018-2019 to 2020, and the malleolar fracture presented the highest increase in this period. All fractures showed an increase in 2021 compared to 2020. Except for the distal tibial articular and the talar fractures, the length of hospital stay decreased for all other fractures and the malleolar fracture, remaining up to 36% fewer days hospitalized. Conclusion: COVID-19 pandemic initially decreased the incidence of surgically treated fractures in most fracture patterns, but this effect was not maintained in the second year of the pandemic. The length of hospital stay of these patients decreased in the two years of the pandemic compared to 2018-2019. Level of Evidence II; Retrospective Study; Economic and Decision Analyses - Developing an Economic or Decision Model.
Type B hemophilia usually affects patients with a family history of this disease and has a typical clinical picture. However, in the present case it appeared in a patient outside the typical age with no family history of hematologic malignancies and with an unusual clinical picture.
The distal leg joint fractures are among the most common fractures in humans across all age groups, and 50% of them require surgical treatment. Few studies discuss the epidemiology and costs of this fracture in the global and national literature. Objective: To evaluate the annual incidence and reimbursement value of distal leg joint fractures requiring surgical treatment from 2008 to 2021. Methods: A retrospective study was conducted to analyze the complex structured data of high volume and high variability (Big Data), publicly available on the TabNet platform (DATASUS), via software with artificial intelligence. Data from 2008 to 2021 on surgical treatment for malleolar fracture, distal tibia fracture, and isolated fibula fracture were analyzed. Results: From 2008 to 2021, there was an average incidence of 28.8 fractures/105 inhabitants per year, representing 14.62% of all fractures. The total amount paid for hospitalizations due to these fractures was R$ 34,218,014.62 over these 14 years. Conclusion: The incidence of distal leg joint fractures follows the pattern of those recorded in other countries. The adjustment of reimbursement over the years was lower than the accumulated inflation. Level of Evidence II, Economic and Decision Analyses - Developing an Economic or Decision Model.
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