elbow instability cartagena
TRANSCRIPT
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Dnelw gkstiegngty
Agijklsgs ika Qrditfdkt
Bcrgstgik Auflktgdr, FA, _cA
Juiadnlupd, @rikbd
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Dnelw gkstiegngty
• Ibutd vs Bcrlkgb
• Ngjifdkts vs elkd
• G` elky irbcgtdbturd gs flagda ik dnelw
bikklt ed stiend !
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Rtiegngzgkj `ibtlrs l` tcd dnelw
ird l` ukdquin gfplrtikbd
• Elkds
• Fusbnds
• Ngjifdkts
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Fusbunir stiegngzgkj
`ibtlrs
• Ikjunir vdnlbgty gs edtwddk
59??-5:??¿/sdb
• Dstgfitda nlia lk tcd FBN gs 57? K
• Nlia tl `ignurd l` FBN gs 509 K
• I _gtbcdr scluna tlrk cgs FBN lk
dvdry pgtbc !. FBN gs prltdbtda eytcd fdagin fusbnds +++ (@AR lr @BT
edgkj tcd flst gfplrtikt)
Tainn MC dt in. D!dbts l` stdxlr-prlkitlr fusbnd nliagkj lk vinjus stiegngty l` tcd dnelw wgtc ik gktibt, strdtbcda, ikrdsdbtda fdagin unkir blnnitdrin ngjifdkt. M Rclunadr Dnelw Rurj (5??7) 93, ::2-::3
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Ngjifdktlus stiegngzgkj `ibtlrs
• Fdagin blnnitdrin ngjifdkt
• Gs siga tl ed rdsplksgend l` :3% l`
tcd stiegngty gk tcd `rlktin IKA
sijgttin pnikds
• Nitdrin blnnitdrin ngjifdkt
• Qcd cufdrl-unkir ngjifdkt gs siga tl
ed tcd flst gfplrtikt tl prdvdkt
rltitlry suenuxitglk
<
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Bcrlkgb dnelw gkstiegngty
• Pirus = Kl• Pinjus
• _lstdrl-nitdrin
FBN
NBN
<
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Zcgbc ngjifdkt gs tcd fimlr
stiegngzdr l` tcd dnelw <
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Cgstlrgbin rdvgdw
• Qrditfdkt l` rdburrdkt dnelwagsnlbitglk alkd ey i pngbitglkl` tcd nitdrin ngjifdkt blfpndx(Lselrkd & Blttdrgnn - 9700)
• „ik lstdlbclkarin `ribturd gk tcd plstdrlnitdrin firjgk l` tcd bipgtdnnuf wgtc
lr wgtclut i britdr lr sclvdn-nghd ad`dbt gk
tcd riagin cdia‖
• Dxpdrgfdktin wlrhs= tcdfdagin ngjifdkt gs rdsplksgend`lr :3% l` dnelw stiegngty gk tcdvinjus pnikd
<
Lselrkd J, Blttdrgnn _. Udburrdkt agsnlbitglk l` tcd dnelw. M Elkd Mlgkt Rurj Er 97008 13=21?‒210
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•Bgiual dt in. Eisds ikitlfgquds plur nds nuxitglks rçbgagviktds aubluad. Eunn. Isslb. Kikby 973?8 01= 104-1:0
• L‗Argsblnn dt in. _lstdrlnitdrin rltitlry gkstiegngty l` tcd dnelw. M
Elkd Mlgkt Rurj If 97798:2(2)=11?‒0.)
Dxpnikitglk `lr tcgsblktriagbtglk <
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• Dxtdrkin rltitglk (supgkitglk) l` tcd `lrdirf gk supgkitglk ukadrtcd irf innlws tcd riagin cdia tl dkjijd ukadr tcd bipgtunuf g`tcd nitdrin blnnitdrin ngjifdkt gs adcgsbdkt
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• Ibblragkj tl tcd riagin cdia agspnibdfdkt, gt bik prdsdkt is igkstiegngty l` tcd dnelw, i suenuxitglk lr i trud agsnlbitglk
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Ltcdr ndsglks <
• Elky ndsglks (stgjfitis tcit
`ivlr rdburrdkbd)
• Agsruptglk l` tcd blfflk
dxtdkslr lrgjgk (00% l` 05
bisds)
FbHdd FA, Rbcdfgtsbc DC, Rini FM, dt in. Qcd pitclikitlfy l` nitdrin ngjifdktlus agsruptglk gk blfpndx dnelw gkstiegngty. MRclunadr Dnelw Rurj 5??2895(1)=279‒0.
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Rl tcd cufdrl-unkir ngjifdkt
gs tcd flst gfplrtikt <
• Klt sl sgfpnd - Gk dnelw agsnlbitglks, ndsglks sddf tl stirt
lk tcd fdagin sgad
• S-Uiys ika FUG stuay l` plstdrl-nitdrin dnelw agsnlbitglks=
ndsglks stirt lk tcd fdagin sgad (Ucylu)
• 05 vgadls l` dnelw agsnlbitglks lk ylutued (Rbcrdgedr)=
• 75% wdrd gk dxtdksglk, wgtc tcd `lrdirf gk prlkitglk (03%),sclunadr gk ieaubtglk (7:%) ika stdxglk (02%).
Ucylu GC, Hgf WR. Kdw fdbcikgsf l` tcd plstdrglr dnelw agsnlbitglk. Hkdd Rurj Rplrts Qriufitln Irtcrlsb. 5?95 Adb8
5?(95)=5424-19
Rbcrdgedr MM, Zirrdk U@, Cltbchgss UK, Ainugshg I. Ik lkngkd vgadl gkvdstgjitglk gktl tcd fdbcikgsf l` dnelw agsnlbitglk. M
Cika Rurj If. 5?92 Fir823(2)=133-71.
http://www.ncbi.nlm.nih.gov/pubmed/23391358http://www.ncbi.nlm.nih.gov/pubmed?term=Hotchkiss%20RN%5BAuthor%5D&cauthor=true&cauthor_uid=23674780http://www.ncbi.nlm.nih.gov/pubmed?term=Warren%20RF%5BAuthor%5D&cauthor=true&cauthor_uid=23674780http://www.ncbi.nlm.nih.gov/pubmed?term=Schreiber%20JJ%5BAuthor%5D&cauthor=true&cauthor_uid=23674780http://www.ncbi.nlm.nih.gov/pubmed/22228377http://www.ncbi.nlm.nih.gov/pubmed?term=Kim%20YS%5BAuthor%5D&cauthor=true&cauthor_uid=23674780http://www.ncbi.nlm.nih.gov/pubmed?term=Rhyou%20IH%5BAuthor%5D&cauthor=true&cauthor_uid=23674780
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FUG stuay
• Yuingty l` ngjifdkts
• Blfpndtdny tlrk ;:?%, ika sdvdrd 2?% `lr tcd FBN
• Blfpndtdny tlrk 02% `lr TBN, eut tcd ltcdr bisds bik ed gktibt
• Rtirt lk tcd nitdrin sgad <
• Gk 9??% l` bisds, tcdrd wis i vinjus gkstiegngty, gk 27% l`
bisds i virus gkstiegngty it tdstgkj
• Elkd < Blrlklga ndsglks wdrd lkny sddk wgtc isslbgitda ndsglks
l` tcd TBN
Rbcrdgedr dt in. Fijkdtgb rdslkikbd gfijgkj kagkjs gk ibutd dnelwagsnlbitglk= gksgjct gktl fdbcikgsf.MCR 5?91827(5)=977-5?4
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Qcdrd fiy ed twl dnelw
vinjus gkstiegngty <
• Pdry sgfgnir eut klt dxibtny
tcd sifd
• Lkd gk tcd `rlktin pnikd, aud
tl agsruptglk l` tcd FBN
• Lkd gk i rltitglkin pnikd, audtl gksu`bgdkby l` tcd NBN
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Pinjus dnelw gkstiegngty
• I`tdr dnelw agsnlbitglk
• 3% ird ukstiend (Ikihwd)
• Tp tl 24% l` gkstiegngty (Fdncl``)
• 51 pitgdkts lut l` 4? cia gkstiegngty
it 7 ydirs @T (Dyjdkaiin)
• _lst-triufitgb (fibrl lr fgbrltriufi- _gtbcdrs)
Fdncl`` QN, Klend _B, Edkkdtt ME, dt in. Rgfpnd agsnlbitglk l` tcd dnelw gk tcd iaunt= rdsunts i`tdr bnlsda trditfdkt. M Elkd Mlgkt Rurj
If 97338:?= 511‒7.
Ikihwd UD dt in. _itgdkt-rdplrtda lutblfds i`tdr sgfpnd agsnlbitglk l` tcd dnelw. MEMRIf 5?99872=955?-9550.Dyjdkaiin A, Pdradjiin RC, Ledrfikk ZU, vik Pujt IE, _ðnn UJ, Ulzgkj _F. _lstdrlnitdrin agsnlbitglk l` tcd dnelw mlgkt. Udnitglkscgp
tl fdagin gkstiegngty. M Elkd Mlgkt Rurj If. 5??? Ipr835(1)=444-0?.
http://www.ncbi.nlm.nih.gov/pubmed/?term=Rozing%20PM%5BAuthor%5D&cauthor=true&cauthor_uid=10761945http://www.ncbi.nlm.nih.gov/pubmed/?term=P%C3%B6ll%20RG%5BAuthor%5D&cauthor=true&cauthor_uid=10761945http://www.ncbi.nlm.nih.gov/pubmed/?term=van%20Vugt%20AB%5BAuthor%5D&cauthor=true&cauthor_uid=10761945http://www.ncbi.nlm.nih.gov/pubmed/?term=Obermann%20WR%5BAuthor%5D&cauthor=true&cauthor_uid=10761945http://www.ncbi.nlm.nih.gov/pubmed/?term=Verdegaal%20SH%5BAuthor%5D&cauthor=true&cauthor_uid=10761945http://www.ncbi.nlm.nih.gov/pubmed/?term=Eygendaal%20D%5BAuthor%5D&cauthor=true&cauthor_uid=10761945
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Pinjus dnelw gkstiegngty
• Gksu`bgdkby l` tcd FBN gkbrdisds tcd nlias l` tcd `lrdirf lvdr tcd
cufdrus
• Birtgnijd blktusglk tcdk irtcrgtgs l` tcd FDAGIN sgad l` tcd lndbriklkit tcd edjgkkgkj
94 yrs
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Pinjus dnelw gkstiegngty
• _igk, dnelw stdxuf, unkir kdrvd
grrgtitglk (1?%)
• _cysgbin dxif=
• _igk`un pinpitglk l` tcd FBN,
• Gkbrdisd vinjus nixgty gk
prlkitglk,
• Pinjus ad`lrfgty (2?%)
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Rtrdss tdsts
• Flvgkj tdst= @rlf stdxglk tl dxtdksglk
(ika lpplsgtd) wgtc tcd dnelw pnibda gk
vinjus. _igk edtwddk :?-95?¿ gs plsgtgvd
`lr i iktdrglr FBN gkmury
• Fgnh tdst= Zgtc tcd klk-gkmurda cika, ylu
clna tcd tcufe l` tcd gkmurda sgad wcgbc
pnibds tcd dnelw gk vinjus dk stdxglk.
FBN pigk gs plsgtgvd `lr ik gkmury
L‗Argsblnn RZ, Niwtlk UN, Rfgtc IF. Qcd ––flvgkj vinjus strdss tdst‗‗ `lr fdagin blnnitdrin ngjifdkt tdirs l` tcd
dnelw. If M Rplrts Fda 5??4822(5)= 529‒7.
Pdntrg AF, L‗Ergdk RM, @gdna NA, dt in. Qcd Fgnhgkj Fikduvdr= I Kdw Qdst tl Dvinuitd tcd FBN l` tcd Dnelw gk tcd
Qcrlwgkj Itcndtd. _rdsdktda it tcd 9?tc Lpdk Fddtgkj l` tcd Ifdrgbik Rclunadr ika Dnelw Rurjdlks RpdbgintyAiy. Kdw Lrndiks, NI, @deruiry 9:, 9771.
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Gfijgkj tdbckgquds
• S-riys bik sclw elkd
stgjfiti
• Rtrdss S-Uiys ird ag`bunt tlpdr`lrf ika i plsgtgvd
agspnibdfdkt bik ed is sfinn
is ?,4 ff
• Rlkljripcy +++
• IrtcrlBQ/FUG
Erubd MU. Clw fubc vinjus gkstiegngty bik ed dxpdbtda wgtc unkir blnnitdrin ngjifdkt (TBN) gkmurgds< I rdvgdw l` 5:2 eisdeinn pniydrswgtc TBN gkmurgds. M Rclunadr Dnelw Rurj (5?91) 52, 9459-9450
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Irtcrlsblpgb agijklstgb
• 5?-2?% l` tcd iktdrglr eukand l` tcd FBN
gs vgsgend wgtc i :?¿ irtcrlsblpd usgkj i
prlxgfl-nitdrin ipprlibc (lkny 94-5?%
wgtc i 2?¿ sblpd)
• 2?-4?% l` tcd plstdrglr eukand gs vgsgend
tcrlujc i plstdrglr plrtin
• 9 ff lpdkgkj l` tcd cufdrl-unkir mlgkt
wcdk tdstda gk vinjus it 0?¿ dnelw stdxglk(ika prlkitglk) gs plsgtgvd `lr iktdrglr
eukand agsruptglk l` tcd FBN. 1 ff
lpdkgkj gs sddk gk blfpndtd FBN rupturd
Qgffdrfik NI. Cgstlnljy ika irtcrlsblpgb ikitlfy l` tcd unkir blnnitdrin ngjifdkt l` tcd dnelw. If M Rplrts.Fda 97718 55= 00:-0:2)
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Biusds l` plstdrl-nitdrin
dnelw gkstiegngty
• _rdvglus dnelw agsnlbitglk (0?%) lr
rdpditda vinjus fgbrl-trufi (9?%)
• Gitrljdkgb (5?%)= tdkkgs dnelw surjdry
lr riagin cdia rdsdbtglk
• Buegtus virus ad`lrfgty i`tdr
supriblkaynir `ribturd gk bcgnaclla
• Tkdxpnigkda (9?%)
M. Rikbcdz-Rltdnl, E. @. Flrrdy, R. Z. L‗Argsblnn8 Ngjifdktlus rdpigr ika rdblkstrubtglk `lr plstdrlnitdrin rltitlry gkstiegngty l` tcddnelw8 M Elkd Mlgkt Rurj XErV 5??483:-E=41-09.
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Bngkgbin agijklsgs
• Nitdrin pigk
• Rkippgkj lr bngbhgkj dnelw
• @ddngkj l` ik ukstiend dnelw
• Flstny gk dnelw dxtdksglk ika `lrdirf gk supgkitglk
• Dxtdksglk adbgt (4-5?¿) gk 4?% l` bisds
P d r y s g f g n i r t l F B N g k s t i e g n g t y d x b d p t ` l r
t c d s g t d l ̀ p i g k
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_cysgbin dxifgkitglk
• _igk lvdr tcd ngjifdkt gksdrtglk
• Gkbrdisda gkstiegngty gk vinjus tdstgkj
(`lrdirf gk supgkitglk)
• _lsgtgvd ariwdr tdst
• plsgtgvd Nitdrin pgvlt scg`t tdst (rirdw/l ikdstcdsgi )
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Rtrdss tdsts
• _igk +/- gkstiegngty wcdk rigsgkj `rlf
i bcigr
• _usc-ups tdst= dnelw stdxda it 7?¿,
`lrdirf gk supgkitglk ika tcd irf
nitdrin tl tcd sclunadrs
• Flrd sdksgtgvd tcit tcd nitdrin pgvlt
scg`t tdst gk iwihd pitgdkts
Udjik Z, Nipkdr _B. _rlspdbtgvd dvinuitglk l` twl agijklstgb ipprdcdksglk sgjks `lr plstdrlnitdrin gkstiegngty l` tcddnelw. M Rclunadr Dnelw Rurj 5??08 92=211‒0.
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Nllh
Gitrljdkgb gkmury l` tcd NBN i`tdr dnelw irtcrlnysgs.
Uiagin cdia suenuxitglk aurgkj pusc-up tdst
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Gfijgkj
• Rtitgb S-riys ird rirdny
dvlbitgvd
• Bcgp `ribturd l` tcd nitdrin
blkaynd
• Iktdrglr gfpibtglk l` tcd
riagin cdia
• Qgp `ribturd l` tcd blrlklga
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Rtrdss S-riys fiy cdnp
• Tsuinny ag`bunt tl gktdrprdt
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IrtcrlBQ lr IrtcrlFUG
• Fiy sclw elky stgjfiti
l` gkstiegngty
• Gksu`bgdkby l` NBN (elky
ivunsglk, ndihijd,…)
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Irtcrlsblpgb agijklstgb
•
I nitdrin pgvlt scg`t tdst biked alkd ukadr irtcrlsblpy
usgkj i prlxgfl-fdagin
ipprlibc
• Mlgkt wgadkgkj IKA riagin
cdia triksnitglk
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Qrditfdkt l` _NUG
• Blksdrvitgvd trditfdkt ird
usdndss
• Rurjgbin trditfdkt= ngjifdkt
rdgksdrtglk, pngbitglk lr
iujfdktitglk
• Klt tl `lrjdt prdvdktgvdtrditfdkt= Udblkstrubtglk l`
NBN gk nitdrin dnelw surjdry
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Ngjifdkt iujfdktitglk usgkj i strgp l` tcd DBT tdkalk
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• Qdkalk rd-gksdrtglk wgtc
bipsunir pngbitglk
• Ngjifdktlpnisty wgtc
bipsunir pngbitglk
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Ngjifdktlpnisty
• Tsgkj Biadkit-Hlbcdr ipprlibc
• @gka tcd supgkitlr brdst
• Qcrdd clnds tl rdblkstrubt ik gslfdtrgb
ngjifdkt
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Bcdukj, BLUU
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_NUG aud tl
blkaynir
cyplpnisgi=
ngjifdktlpnisty+ cufdrin
lstdltlfy,
9 yr @T
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Udsunts l` _NUG trditfdkt
• 14 pts, 0 yrs @T (22 ngjifdktlpnisty, 95 agrdbt rdpigr)
• Inn stiend eut 4
• FD_R= 34 plgkts (0? tl 9??).
• Dxbdnndkt rdsunts gk 97, jlla gk 92, `igr gk sdvdk ika
pllr gk vd pitgdkts. 30% suemdbtgvdny sitgsda
• Edttdr rdsunts= plst-triufitgb (p 6 ?.?2), suemdbtgvd
syfptlfs it prdsdktitglk (p 6 ?.??0), tdkalk jri`t (p 6
?.?1).
M. Rikbcdz-Rltdnl, E. @. Flrrdy, R. Z. L‗Argsblnn8 Ngjifdktlus rdpigr ika rdblkstrubtglk `lr plstdrlnitdrin rltitlry gkstiegngty l` tcddnelw8 M Elkd Mlgkt Rurj XErV 5??483:-E=41-09.
L
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Ltcdr sdrgds l` _NUG
trditfdkt
• 3 /9? pitgdkts jlla tl
dxbdnndkt rdsunt
• Rupdrglr rdsunts gk
pitgdkts wgtc i tdkalk
jri`t.
• Fgna stdxglk blktribtglk
(9?¿)
Ndd E, Qdl N. Rurjgbin rdblkstrubtglk `lr
plstdrlnitdrin rltitlry gkstiegngty l` tcd dnelw. M
Rclunadr Dnelw Rurj 5??2895=1:0‒7.
• 5? irtcrlsblpgb rdpigr ika
59 lpdk
• Eltc lemdbtgvd ika
suemdbtgvd pirifdtdrs
gfprlvda gk eltc jrlups
• 9? pitgdkts trditda dirny
civd edttdr rdsunts
Rivlgd @C= Irtcrlsblpgb ika lpdk riagin unklcufdrin
ngjifdkt rdblkstrubtglk `lr _NUG l` tcd dnelw. Cika
Bngk 5??78 54= 252-257
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_rdvdktgvd trditfdkt
• Irtcrlsblpgb sdbtglkgkj l` eltc tcd NTBN ika tcd riagin blnnitdrin
ngjifdkt gs rdqugrda tl biusd sgjkgbikt _NUG (Fib Iaifs8
Aukkgkj) ! Aurgkj surjgbin ipprlibcds, prdsdrvd dgtcdr tcd
iktdrglr lr plstdrglr rdjglks l` tcd NBN blfpndx ika/lr rdpigr gt
• Bngkgbin ika eglfdbcikgbin stuagds blrlklga prlbdss ika
riagin cdia blktrgeutd sgjkgbiktny tl plstdrlnitdrin rltitlry
stiegngty. Dxbgsglk l` tcd riagin cdia rdsunts gk adbrdisda tdksglk
gk tcd NTBN, wcgbc pdrfgts nixgty tl lbbur aurgkj virus ika
dxtdrkin rltitlry strdssds ! _rdsdrvd riagin cdia
Mdksdk R, Lnsdk E, Qyrain R, dt in. Dnelw mlgkt nixgty i`tdr dxpdrgfdktin riagin cdia dxbgsglk ika nitdrin blnnitdrin ngjifdkt rupturd=
d`biby l` prlstcdtgb rdpnibdfdkt ika ngjifdkt rdpigr. M Rclunadr Dnelw Rurj 5??4891=:3‒31.
Rbckddedrjdr IJ, Rialwshg FF, Mible CI. Blrlklga prlbdss ika riagin cdia is plstdrlnitdrin rltitlry stiegngzdrs l` tcd dnelw.
M Elkd Mlgkt Rurj If 5??1830(4)=7:4‒35.
Pik Jnieeddh @, Pik Ugdt U, Eiuf`dna M, dt in. Adtrgfdktin d``dbts l` lvdrstu`kj lr ukadrstu`kj wgtc i riagin cdia rdpnibdfdkt
gk tcd fdagin blnnitdrinngjifdkt adbgdkt dnelw. M Elkd Mlgkt Rurj If 5??1830=5057‒24.