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lunes, 7 de agosto de 2017

Primera técnica quirúrgica del fémur: un procedimiento inteligente no basado en computadoras para lograr la anteversión combinada en la artroplastia total primaria de cadera.

http://www.reemplazoprotesico.com.mx/academia/primera-tecnica-quirurgica-del-femur-un-procedimiento-inteligente-no-basado-en-computadoras-para-lograr-la-anteversion-combinada-en-la-artroplastia-total-primaria-de-cadera/

Femur first surgical technique: a smart non-computer-based procedure to achieve the combined anteversion in primary total hip arthroplasty.

Femur first surgical technique: a smart non-computer-based procedure to achieve the combined anteversion in primary total hip arthroplasty.

Fuente

Este artículo es originalmente publicado en:

https://www.ncbi.nlm.nih.gov/pubmed/28764697

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5539744/

https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-017-1688-9

De:

Loppini M^1,², Longo UG³, Caldarella E⁴, Rocca AD⁴, Denaro V³, Grappiolo G⁴.

Copyright © The Author(s). 2017

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/

), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.AbstractBACKGROUND:

The relevance of prosthetic component orientation to prevent dislocation and impingement following total hip arthroplasty (THA) has been widely accepted. We investigated the use of a non-computer-based surgery to address the reciprocal orientation of the acetabular and femoral components.

CONCLUSIONS:

Femur first technique allows the surgeon to achieve a combined anteversion ranging from 25° to 50° with a cup inclination ranging from 30° to 50°. The cup is positioned according to the functional plane of the patient regardless the preoperative pelvic tilt.

KEYWORDS:

Acetabular inclination; Arthroplasty; Combined anteversion; Femur first; Hip

Resumen

ANTECEDENTES:
La relevancia de la orientación de los componentes protésicos para prevenir la dislocación y el choque después de la artroplastia total de cadera (THA) ha sido ampliamente aceptada. Se investigó el uso de una cirugía no basada en computadoras para abordar la orientación recíproca de los componentes acetabular y femoral.

CONCLUSIONES:
La primera técnica del fémur permite al cirujano lograr una anteversión combinada que oscila entre 25 ° y 50 ° con una inclinación de copa que oscila entre 30 ° y 50 °. La copa se posiciona de acuerdo con el plano funcional del paciente independientemente de la inclinación pélvica preoperatoria.

PALABRAS CLAVE:
Inclinación acetabular; Artroplastia; Anteversión combinada; Fémur primero; Cadera

PMID: 28764697 PMCID: PMC5539744 DOI: 10.1186/s12891-017-1688-9

Free PMC Article

Fuente:reemplazoprotesico.com.mx

#fémur #cadera #Inclinación acetabular #artroplastia #Anteversión combinada

lunes, 19 de junio de 2017

Clasificación de la fractura del cuello femoral

http://www.ortopedistaseguro.com.mx/academia/clasificacion-de-la-fractura-del-cuello-femoral/

Femoral Neck fracture classification

Fuente
Este artículo es originalmente publicado en:

https://youtu.be/U4xqHvIkDUI

Courtesy: Prof Nabil Ebraheim, University of Toledo, Ohio, USA

Publicado el 5 may. 2017

Dr. Ebraheim’s educational animated video describes classifications of femoral neck fractures.

Femoral neck fractures can occur as a result of low energy trauma in the elderly. In this case you will need to get a medical consultation! Femoral neck fractures can also occur due to high energy trauma, such as with falls or motor vehicle accidents. Femoral neck fractures can occur in older as well as younger patients, and in these cases you need to apply the ATLS protocol. Femoral neck fractures can also occur due to insufficiency fractures. This occurs due to weak bones, because of osteoporosis or osteopenia. The patient will have groin pain, pain with axial compression and the x-ray may be normal (helpful in diagnosing insufficiency fracture). There may also be a stress fracture due to overuse and more loading on the hips. Stress fractures may occur in athletes, ballet dancers, or military recruits.
Anatomic classification
1. Subcapital – common
2. Transcervical
3. Basicervical
The subcapital fracture has two classifications: the garden classification and Pauwel’s classification. The garden classification system classifies the fracture according to the amount or degree of displacement. It relates the amount of displacement to the risk of vascular disruption. This classification applies to the geriatric and insufficiency fractures. It can then be classified into two groups: the nondisplaced and the displaced. Types I and II are nondisplaced, while types III and IV are displaced. Type I is incomplete and impacted in valgus. Type II is a complete fracture and nondisplaced on at least two planes (anteroposterior & lateral). Type III is a complete fracture and partially displaced. The trabecular pattern of the femoral head does not line up with the acetabular trabecular pattern. A type IV fracture is completely displaced with no continuity between the proximal and distal fragments. The trabecular pattern of the femoral head remains parallel with the acetabulum trabecular pattern.
The Pauwel’s Classification is classified into three fracture types. It classifies the fracture according to the orientation and direction of the fracture line across the femoral line. It related to the biomechanical stability. The more vertical the fracture, the more sheer forces and the more the complication rate. Type I is stable and has an obliquity ranging from 0-30 degrees. Type II is less stable and have an obliquity ranging from 30-50 degrees. Lastly, type III is unstable and has an obliquity between 50-70 degrees or more. As the fracture progresses from Type I – Type III, the obliquity of the fracture line increases. As the fracture line becomes more vertical, the sheer forces increase and the instability increases. A horizontal fracture is good and stable while a vertical fracture is bad and unstable. The more displaced the fracture, the more disruption of the blood supply and the chance of avascular necrosis and nonunion (can occur in about 25% of displaced fractures). In nonunion occurs in a younger patient, you may help the patient by doing a subtrochanteric osteotomy to reorient the fracture line from vertical to horizontal (will help the fracture healing).
Femoral Neck Fractures Associated with Femoral Shaft Fractures
The typical neck fracture is vertical and nondisplaced. It may require internal rotation view x-rays to see this hip fracture (fracture could be missed). Treatment of this fracture is to fix the femoral neck fracture first, followed by the femoral shaft fracture. The usual combination is parallel screws in the femoral neck and a retrograde femoral rod for the fractured femur.
Stress fractures are more common in females due to the female athletic triad. It can be a tension fracture. The fracture or callus is present on the superior aspect of the femoral neck. Adult bone is weak in tension, so stress fracture of the femoral neck needs to be fixed! This should be an emergency operation before the fracture displaces. With compression fractures, the compression or callus is present on the inferior aspect of the femoral neck. It is believed that if the compression fracture is less than 50% across the neck, then the fracture could be stable and you can do protected crutch ambulation. If the fracture is more than 50% across the neck, then the fracture is unstable and you will do an ORIF. Some surgeons fix all stress fractures of the femoral neck. A female runner with groin pain can indicated a stress fracture. Get an MRI, the fracture will probably need to be fixed.

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#cuello femoral #fémur #fracturas

lunes, 20 de febrero de 2017

Complicaciones con fracturas de fémur pediátricas

http://www.ortopediaenpediatrica.com.mx/academia/complicaciones-con-fracturas-de-femur-pediatricas/

Complications with Pediatric Femur Fractures

Fuente
Este artículo es originalmente publicado en:

https://youtu.be/fOZZLtUOQnY

Courtesy: Martin Herman, MD, Professor of Orthopaedic Surgery and Pediatrics, Program Director, Orthopaedic Surgery, Drexel University College of Medicine, St. Christophers Hospital for ChildrenSaqib Rehman MD

Director of Orthopaedic Trauma

Temple University

Philadelphia

Pennsylvania

USA

www.orthoclips.comPublicado el 19 jun. 2016

Martin Herman, MD, Professor of Orthopaedic Surgery and Pediatrics, Program Director, Orthopaedic Surgery, Drexel University College of Medicine, St. Christophers Hospital for Children.

From the 8th Annual Philadelphia Orthopaedic Trauma Symposium, June 10, 2016 at Lewis Katz School of Medicine at Temple University