Lateral inverted osteochondral fracture of the talus (LIFT) is a rare variant of stage IV osteochondral lesion of the talus (OLT), where the fragment is inverted in situ by 180°. The management of ...LIFT lesion is very challenging and early recognition crucial, given that treatment options depend on the articular cartilage condition and sufficiency of the adjacent bone of the displaced fragment. We describe two LIFT cases referred from other institutions after unsuccessful conservative treatment of OLT. They presented with pain, swelling and tenderness over the anterolateral aspect of the right ankle. We recognized the LIFT lesion on the magnetic resonance imaging scans in patient 2, while in patient 1 the orientation of the fragment was recognized upon direct visualization during operative treatment. Both patients underwent arthroscopic procedure. Due to articular cartilage damage and insufficiency of the adjacent bone of the fragment, both patients were treated with excision fol-lowed by microfracture. Treatment of the LIFT lesion should start arthroscopically to allow clear evaluation of the osteochondral fragment, assessment of the talar defect and identification, as well as treatment of associated disorders. If the articular cartilage appears intact with sufficient subchondral bone, fixation of the fragment is optimal management, otherwise excision and microfracture can be the treatment of choice.
BACKGROUND:The literature on the osteochondral lesion of the talus (OLT) in skeletally immature children is scarce and little is known about the clinical outcomes and the radiologic appearance of ...these lesions after surgical treatment. The aim of this study was to assess mid-term clinical and magnetic resonance imaging (MRI) outcomes after arthroscopic microfracture (AM) of OLT in skeletally immature children.
METHODS:Thirteen patients with OLT treated by AM before skeletal maturity were included in the study. The Berndt and Harty outcome question, the Single Assessment Numeric Evaluation question, and the Martin questionnaire were used to obtain patients’ subjective satisfaction with their operated ankle. Functional outcomes preoperatively and postoperatively were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) score. MRI scans were performed postoperatively using a magnetic resonance observation of cartilage repair tissue (MOCART) scoring system for 11 ankles.
RESULTS:The median age was 15 years (range, 13 to 16 y) and the median follow-up period was 5.6 years (range, 3.8 to 13.6 y). According to the Berndt and Harty outcome question, good clinical results were reported in 10 (76.9%) and fair in 3 (23.1%) patients. The postoperative AOFAS score was significantly improved when compared with the preoperative AOFAS score, with a mean increase of 35 points (P<0.001). The overall MOCART score was 65 (range, 10 to 75). MRI variables of the MOCART scoring system showed no association with clinical outcomes.
CONCLUSIONS:AM seems to be an effective surgical method for the treatment of OLT in skeletally immature children.
LEVEL OF EVIDENCE:Level IV—therapeutic studies, case series.
Fibroblast growth factor 23 (FGF23) has been casually linked to numerous hypophosphatemic bone diseases, however connection with bone loss or fragility fractures is still a matter of debate. The ...purpose of this review is to explore and summarise the known actions of FGF23 in various pathological bone conditions. Besides implication in bone mineralisation, elevated FGF23 showed a pathological effecton bone remodelling, primarily by inhibiting osteoblast function. Unlike the weak association with bone mineral density, high values of FGF23 have been connected with fragility fracture prevalence. This review shows that its effects on bone are concomitantly present on multiple levels, affecting both qualitative and quantitative part of bone strength, eventually leading to impaired bone strength and increased tendency of fractures. Recognising FGF23 as a risk factor for the development of bone diseases and correcting its levels could lead to the reduction of morbidity and mortality in specific groups of patients.
Intra-articular calcaneal osteoid osteoma is a very rare condition and the diagnosis as well as the treatment is extremely challenging. We report a case of a 19-year-old male with intra-articular ...osteoid osteoma of the calcaneus, initially treated for peroneal tenosynovitis with unsatisfactory results. Thorough diagnostic procedure revealed the superolateral location of a calcaneal osteoid osteoma, near the sinus tarsi. A cherry-red elevated lesion typical of an osteoid osteoma nidus was completely removed arthroscopically using the anterolateral portal and the middle portal for subtalar arthroscopy. Histopathology confirmed the suspected diagnosis. The postoperative clinical course was uneventful with immediate pain relief and full weightbearing and movement allowed soon. The patient had no recurrent pain and normal joint mobility 8 months postoperatively. Considering the accessibility of the lesion, intra-articular osteoid osteoma of the calcaneus can be successfully treated arthroscopically using lateral approach for subtalar arthroscopy.
Levels of Evidence: Therapeutic, Level IV: Retrospective, Case report
Lateral inverted osteochondral fracture of the talus (LIFT) is a rare variant of stage IV osteochondral lesion of the talus (OLT), where the fragment is inverted in situ by 180degrees. The management ...of LIFT lesion is very challenging and early recognition crucial, given that treatment options depend on the articular cartilage condition and sufficiency of the adjacent bone of the displaced fragment. We describe two LIFT cases referred from other institutions after unsuccessful conservative treatment of OLT. They presented with pain, swelling and tenderness over the anterolateral aspect of the right ankle. We recognized the LIFT lesion on the magnetic resonance imaging scans in patient 2, while in patient 1 the orientation of the fragment was recognized upon direct visualization during operative treatment. Both patients underwent arthroscopic procedure. Due to articular cartilage damage and insufficiency of the adjacent bone of the fragment, both patients were treated with excision followed by microfracture. Treatment of the LIFT lesion should start arthroscopically to allow clear evaluation of the osteochondral fragment, assessment of the talar defect and identification, as well as treatment of associated disorders. If the articular cartilage appears intact with sufficient subchondral bone, fixation of the fragment is optimal management, otherwise excision and microfracture can be the treatment of choice.Okrenuti kostanohrskavicni fragment na lateralnoj plohi talusa (engl. lateral inverted osteochondral fracture of the talus, LIFT) je rijedak oblik IV. stupnja kostanohrskavicnog ostecenja talusa (engl. osteochondral lesion of the talus, OLT), pri cemu je kostanohrskavicni fragment okrenut u lezistu za 180degrees. Rano prepoznavanje LIFT-a je od presudne vaznosti, jer lijecenje ovisi o ocuvanosti zglobne hrskavice i pripadajuce kosti okrenutog kostanohrskavicnog fragmenta. U nasem radu prikazuj emo dva slucaja LIFT-a koji su upuceni iz drugih ustanova nakon neuspjesnog lijecenja OLT-a konzervativnim metodama. Kod oba bolesnika simptomi su bili bol, oteklina i osjetljivost anterolateralnog dijela desnog gleznja. Ostecenje LIFT je kod drugog bolesnika prepoznato tek na snimkama magnetne rezonance u nasoj ustanovi, dok je kod prvog bolesnika orijentacija fragmenta prepoznata tek za vrijeme operativnog zahvata. Oba bolesnika podrvgnuta su artroskopskom zahvatu. Buduci da su kod oba bolesnika zglobna hrskavica i pripadajuca kost kostanohrskavicnog fragmenta bile znatno ostecene, odlucili smo se za njihovo odstranjenje. Potom smo ocistili nastali defekt na talusu i nacinili mikrofrakture. Danas se savjetuje operativno lijecenje LIFT-a zapoceti artroskopski, jer se na taj nacin omogucava tocna procjena ocuvanosti kostanohrskavicnog fragmenta te se mogu lijeciti pridruzena unutarzglobna ostecenja. Ako je zglobna hrskavica fragmenta ocuvana i ima dovoljno pripadajuce kosti, metoda izbora je fiksacija kostanohrskavicnog fragmenta, dok je u suprotnom moguce odstraniti kostanohrskavicni fragment i naciniti mikrofrakture.Key words: Talus - injuries; Cartilage, Articular; Cartilage Diseases; Conservative Treatment; Magnetic Resonance Imaging; Arthroscopy; Case ReportsKljucne rijeci: talus - ozljede; hrskavica, zglobna; hrskavica, bolesti; konzervativno lijecenje; magnetska rezonancija, snimanje; artroskopija; prikazi slucaja
Cilj: Usporediti rezultate konzervativnog i operativnog liječenja prijeloma proksimalnog dijela pete metatarzalne (V MT) kosti kod sportaša. Ovi prijelomi predstavljaju velik dijagnostički i ...terapijski izazov. Uobičajeno su podijeljeni u 3 zone: tuberozitas (zona I), metafiza (zona II) i proksimalna dijafiza (zona III). Radi kompromitirane cirkulacije karakterizira ih otežano i dugotrajno cijeljenje koje nerijetko završava razvojem pseudartroze, naročito kod mladih i fizički aktivnih osoba. Ispitanici i metode: U Kliničkoj bolnici Merkur u periodu od 13 godina liječen je 61 sportaš s ukupno 65 prijeloma V MT kosti u zoni II i III. Svi ostali pacijenti isključeni su iz promatranja. Pacijenti su podijeljeni u 2 skupine: Skupina 1 – operativno liječeni i Skupina 2 – konzervativno liječeni prijelomi. U Skupini 1 bilo je 50 (77 %) prijeloma, a u Skupini 2 15 (23 %) prijeloma. Za osteosintezu je u početku studije korišten klasični maleolarni vijak koji je radi komplikacija u kasnijem tijeku studije zamijenjen debljim intramedularnim vijkom. Rezultati liječenja praćeni su radiološkim i kliničkim pregledom, a evaluirani Modified Foot scoreom (MFS). Rezultati: Period praćenja iznosio je u prosjeku 12 mjeseci. U Skupini 1 većina prijeloma je sanirana u periodu od 8 tjedana. Produženo cijeljenje bilo je prisutno kod 7 (14 %) prijeloma. U kasnijem rehabilitacijskom periodu 3 pacijenta (6 %) imala su refrakturu koja je riješena reoperacijom i postavljanjem jačeg vijka. U Skupini nisu zarasla 2 prijeloma, 7 (46 %) prijeloma zaraslo je u periodu od 6 mjeseci, a 5 (33 %) od njih naknadno je operirano. U konačnici su svi operirani prijelomi zarasli. S obzirom na MFS, Skupina 1 u odnosu na Skupinu 2 imala je statistički značajno (p < 0,01) bolji rezultat. Zaključak: Dobra dijagnostika i klasifikacija prijeloma te operativno liječenje prijeloma metafize i proksimalne dijafize garantira brzo cijeljenje i rani povratak punoj sportskoj aktivnosti.
Aim: To compare the results of conservative and surgical treatment of fractures of the proximal fifth metatarsal (V MT) bone in the athletes. These fractures represent a great diagnostic and therapeutic challenge. They are traditionaly divided into 3 zones: tuberosity (zone I), metaphysis (zone II), and proximal diaphysis (zone III). Due to the compromised circulation, these fractures are characterized by difficult and prolonged healing that ends with the development of pseudarthrosis, especially in young and physically active individuals. Patients and Methods: During the 13-year period in University Hospital Merkur 61 athletes with a total of 65 fractures of V MT bones in zone II and III were treated. All other patients were excluded from this study. The patients were divided into 2 groups: Group 1 - operatively treated and Group 2 - conservatively treated fractures.There were 50 (77%) fractures in Group 1 and 15 (23%) in Group 2. At the beginning of the study, a maleolar screw was used for osteosynthesis but due to complications it was later replaced by a stronger intramedullary screw. Treatment results were followed by radiological and clinical examination and evaluated by Modified Foot score (MFS). Results: The follow-up period averaged 12 months. In the Group 1 most fractures healed within 8 weeks. Prolonged healing were present in 7 (14%) fractures. In the later rehabilitation period 3 (6%) patients had refracture which was resolved by reopereting and installing a stronger screw.In the Group2, 7 (46%) fractures did not heal over a 6-month period and 5 (33%) of them underwent surgery. Finally, all operated fractures were healed. According to MFS, the Group1 had a significantly better result. Conclusion: Good diagnosis and classification of fractures, as well as surgical treatment of fractures of the metaphysis and proximal diaphysis, guarantee rapid fracture healing and early return to full sport activity.
U medicinskoj literaturi malo je dostupnih podataka o operacijskom liječenju koštanohrskavičnih oštećenja talusa (engl. Osteochondral
Lesion of the Talus, OLT) u djece. Cilj ovog istraživanja bio je ...evaluirati srednjoročne rezultate liječenja OLT-a artroskopskom
stimulacijom koštane srži (engl. Bone Marrow Stimulation, BMS) tehnikom mikrofraktura u djece kod koje u trenutku operacijskog
zahvata nije bila dostignuta koštana zrelost. U istraživanju je sudjelovalo 13-ero djece s dijagnosticiranim OLT-om koja su liječena
artroskopskom BMS tehnikom mikrofraktura, a kod koje su u trenutku operacijskog zahvata epifi zne pukotine rasta bile otvorene. Na
zadnjem kontrolnom pregledu ispitanici su procijenili stanje operiranog gležnja pomoću Berndt and Harty (BH), Single Assessment
Numeric Evaluation (SANE) i Martin upitnika. Funkcionalno stanje gležnja evaluirano je American Orthopaedic Foot and Ankle
Society (AOFAS) upitnikom. Upitnik Short Form 36 (SF 36) primjenjen je za procjenu kakvoće života povezane sa zdravljem. Medijan
životne dobi ispitanika u trenutku zahvata iznosio je 15 (13-16) godina, a medijan praćenja u poslijeoperacijskom razdoblju 5,6
(3,8-13,6) godina. Prema BH upitniku ishod liječenja je u 10-ero bolesnika ocijenjen kao dobar, a kod troje zadovoljavajući. Kod
11-ero ispitanika rezultati su prema SANE upitniku ocijenjeni kao izvrsni ili dobri. Utvrđeno je značajno poboljšanje poslijeperacijskog
AOFAS skora u odnosu na prijeoperacijski AOFAS skor, a prosječna razlika je iznosila 35 bodova. Medijan zbirne komponente tjelesnog
i mentalnog zdravlja SF 36 upitnika nalazio se u normalnim granicama za hrvatsku populaciju. Artroskopska BMS tehnika
mikrofraktura pouzdana je i učinkovita operacijska metoda za liječenje OLT-a u djece kod koje nije dostignuta koštana zrelost.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, UILJ, UKNU, UL, UM, UPUK
The real prevalence of resistant hypertension (RH) is unknown. Studies suggest that it affects 10%-15% of patients treated for hypertension by primary care physicians. RH is defined as blood pressure ...(BP) remaining above the goal despite the use of optimal doses of 3 or more medicines of different classes (including a diuretic). It means BP >140/90 mm Hg for the general population and >130/80 mm Hg for patients with diabetes or kidney disease. Prior to diagnosing a patient as having RH, it is important to document medication compliance and exclude white-coat hypertension, inaccurate BP measurement, and secondary causes. The role of aldosterone in RH has gained increasing recognition. There is strong evidence for the use of spironolactone as a highly effective antihypertensive agent. Aldosterone plays a significant role in RH pathogenesis, primarily due to its vasoconstrictive effects and the possibility of altering vascular compliance. In RH, there is a high prevalence of cardiac and extra-cardiac target organ damage. It is known that BP control in chronic kidney disease is the key factor for reducing cardiovascular risk and renal disease progression. The objective of the study was to evaluate the prevalence of RH in predialysis nondiabetic (CKD stage I-IV) patients.
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