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Query: UMLS:C0028754 (obesity)
 124,988 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A young girl 12 old, sent to us for obesity, and coxa-epiphysiolysis showed signs of mental retardation and bilateral thumb ankylosis. The fact that the mother was also affected by both of these signs, led to a more detailed genetic research. The latter revealed that not only the daughter, the mother, but also their own mother and may be, the sister, the grand-mother and the great-aunt of the patient had a retardation, a slight dysmorphia, a type A brachydactylia, signs of obesity and an identical ankylosis of both thumbs. This vertical inheritance, affecting apparently females only, but not associated with a high rate of miscarriage, has, it seems, never been reported. The characteristics of this family are being considered and discussed.
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PMID:[Regular dominance of thumb ankylosis with mental retardation transmitted over 3 generations]. 663 21

For many years knee arthrodesis has been recommended for patients with severe degenerative disease complicated by obesity, venous insufficiency or old sepsis. Recently, failed total knee arthroplasties are being treated by arthrodesis, but these new indications entail new and difficult circumstances. A biplane fixation frame, more rigid than the Charnley clamp, and the instrumentation for producing absolutely flat opposing surfaces are important. The frame provides the advantages of good access to the wound and permits early ambulation. Pin tract loosening and infection are potential disadvantages, but in this small series were not significant.
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PMID:The biplane frame: modified compression arthrodesis of the knee. 728 20

Development of ankylosis of joints involved with gouty arthritis is an exceedingly rare event of which only ten examples have been reported. Most patients had chronic, tophaceous gout that had not received adequate medical attention. The authors report two new cases including one in a patient with no documented history of acute gout. The first patient was a 72 year old noninsulin-dependent diabetic male who had been given a diagnosis of gouty polyarthritis with tophi seven years earlier. The second was a 42 year old male with no history of acute gout in whom hyperuricemia had been diagnosed at the age of 22 years upon evaluation for obesity. Both patients had ankylosis of the ankles and proximal interphalangeal joints of the hands. A marked decrease in range of motion of the wrists was found in the second patient. Roentgenograms showed complete ankylosis of the tarsus and partial ankylosis of the tibiotarsal joints in both patients, as well as ankylosis of the carpus in the second patient. The pathophysiology of ankylosis during gouty arthritis is poorly understood. A pannus containing abundant urate crystals is found upon pathological examination. Antihyperuricemic agents can reverse urate deposition but have no effect on ankylosis.
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PMID:[Ankylosing gout. Apropos of 2 cases]. 800 Apr 1

Eighty-six patients had a total of eighty-eight primary attempts at repair of a pseudarthrosis that had developed after a localized arthrodesis in the lumbar spine. A follow-up questionnaire was sent to all patients at a mean of fifty-one months (range, twenty-five to seventy-eight months) after the operation; seventy-two patients (84 percent) completed to questionnaire. A solid fusion was ultimately achieved after the treatment of eighty-one (94 percent) of the eighty-six pseudarthroses for which radiographic data were available. With the numbers available, we could find no significant association between a solid fusion and the patient's age, gender, body-mass index, return to work, or outcome score. Despite the high rate of fusion after the index repair and subsequent procedures, only nineteen (26 percent) of the seventy-two patients who completed the questionnaire eventually had a good or excellent outcome. Seven (10 percent) had an excellent result (90 to 100 points), twelve (17 percent) had a good result (70 to 89 points), fourteen (19 percent) had a fair result (50 to 69 points), and thirty-nine (54 percent) had a poor result (less than 50 points). Nevertheless, fifty-one patients (71 percent) reported that the operation led to some improvement, and fifty-five (76 percent) said that they would have the operation again if the circumstances were similar to those before the repair of the pseudarthrosis. Thirty-four of the seventy-two patients were smokers and thirty-eight were non-smokers at the time of the operation. There was a negative linear association between the outcome scores and the number of pack-years (p = 0.02). Cessation of smoking before the operation positively affected the outcome; the patients who had stopped smoking had a mean outcome score of 65 points, compared with 45 points for those who had not stopped (p = 0.03). Patients who had stopped smoking were also more likely to return to work full time (p < 0.001). At the latest follow-up evaluation, twenty of the seventy-two patients had returned to full-time employment. Patients who had been receiving Workers' Compensation at the time of the operation generally did poorly on the outcome questionnaire, but, with the numbers available, they did not have a significantly different rate of solid fusion than patients who had not been receiving Workers' Compensation. Also, the outcome score and the rate of fusion were nor significantly affected by age or by obesity.
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PMID:Repair of a pseudarthrosis of the lumbar spine. A functional outcome study. 864 28

Tendinitis of the foot is frequent and is generally due to mechanical overload or inflammatory rheumatic disorders. It most often involves the posterior tibial tendon when obesity and calcaneus valgus combine to contribute to mechanical overwork, or in the early stages of rheumatoid arthritis. More rarely, the anterior tibial tendon or the fibular tendons are involved. The anatomic-clinical stages proceed from oedema to fissuration necrosis and ruptured tendon. The long-term risk is of a sinking internal arch and a fixed calcaneus valgus. A simple but effective treatment is the correction of the calcaneus valgus, but surgical arthrodesis may be necessary.
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PMID:[Tendinopathies of the foot]. 903 44

Thirty-two cases of ankle fractures associated with fibular fractures above the distal tibiofibular syndesmosis were studied. All were treated with open reduction and internal fixation. The average follow-up was 25 months. The results of the postoperative evaluation were rated, based on subjective clinical criteria, as good, fair, and poor. According to the Lauge-Hansen classification, there were 17 (53%) cases of supination-external rotation injury (2 stage 2 and 15 stage 4), 9 (28%) cases of stage 3 pronation-abduction injury, and 6 (19%) cases of pronation-external rotation injury (3 stage 3 and 3 stage 4). All cases could be classified as Weber type C or as suprasyndesmotic, fibular diaphyseal fracture (44-C) according to the Orthopaedic Trauma Association classification. In 18 (56%) cases, the fracture was associated with ankle dislocation. There were seven (22%) open fractures, (two grade I, four grade II, and one grade IIIA). Syndesmotic screws were used in 23 (72%) cases (12 supination-external rotation injury, 6 pronation-external rotation injury, and 5 pronation-abduction injury). The syndesmotic screw was removed after an average of 9 weeks. Four (13%) nonunions and two (6%) delayed unions of the fibula were treated with bone grafting and/or hardware revision and eventually healed. Three of the nonunions had poor clinical results because of degenerative ankle joint arthritis in two (one of them ended in arthrodesis) and deep infection, which was eventually cured, in the third. The fourth nonunion had a fair result. One of the delayed unions had a fair result (an obese patient) and the other had a good result. Two patients developed deep infections; one ended in gangrene and amputation in a diabetic patient, and the other was a patient with fibular nonunion that eventually healed. Three patients had superficial infections that were treated successfully. Of the 32 cases, 23 (72%) showed good results, 4 (13%) showed fair results, and 5 (16%) showed poor results. The cases with poor results included three fibular nonunions, one deep infection, and one recurrent superficial infection and wound dehiscence after hardware removal. A syndesmotic screw is usually needed in cases of fracture-dislocations. Two patients with occult fibular nonunions developed diastasis of the syndesmosis after removal of the syndesmotic screw. It was found that reduction and temporary pinning of the distal tibiofibular joint helps achieve fibular length, which is crucial to restoring the biomechanics of the ankle joint. It seems advisable not to remove the syndesmotic screw until there are signs of healing of fibular fracture to avoid diastasis of the distal tibiofibular joint. Bone grafting should be considered in high energy fractures with comminution. These complex injuries are associated with higher rates of complications. Poor results can be attributed to fracture factors, e.g., open fractures, infections; patient factors, e.g., obesity, lowered immunity as in diabetes, and noncompliance; and iatrogenic factors, e.g., early removal of syndesmotic screws.
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PMID:Ankle fractures involving the fibula proximal to the distal tibiofibular syndesmosis. 927 48

Metatarsophalangeal (MTP) arthrodesis was done in each of three dogs with end-stage degenerative joint disease resulting from trauma and osteomyelitis (n = 2) and immune-mediated disease (n = 1). In two cases, MTP arthrodesis proved to be a useful method of eliminating pain and salvaging limb function. In one case, concurrent injuries and obesity prevented full return to function. Arthrodesis was accomplished with autogenous cancellous bone grafts and bone plates (n = 2) and with transarticular K-wires (n = 1). External coaptation was a necessary adjunct to internal fixation in all cases.
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PMID:Metatarsophalangeal arthrodesis in three dogs. 950 29

Posterior tibial tendon dysfunction, once thought to be a rare clinical entity, has been observed to be a major cause of acquired flatfoot deformity in adults. Several risk factors have been identified, ranging from inflammatory conditions to obesity. A physical examination using a series of tests, including the single-limb rise, first-metatarsal rise sign, and the "too-many-toes" sign, used in combination with selected radiographic imaging techniques, allows classification of the severity of disease. This staging system then serves as the basis for formulating the treatment options, which include nonoperative as well as operative alternatives. Conservative treatment involves rest, anti-inflammatory medication, orthotic devices, and modifications to shoes. Operative options are numerous and include primary tendon repair, tendon transfer, osteotomies, and arthrodesis.
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PMID:Posterior tibial tendon insufficiency. Its Diagnosis, Management, and Treatment. 960 5

Knee arthrodesis using an intramedullary nail has gained acceptance as treatment in difficult cases such as infection after total knee arthroplasty (TKA), neuropathic joint, and obesity. A retrospective review of 22 cases treated at our institution using an intramedullary nail for knee arthrodesis was performed. Deep infection after primary (11) or revision (6) TKA was the most common indication for this procedure. A long intramedullary nail was used in 3 cases, a long nail with a proximal interlocking screw was used in 6 cases, and a customized nail with a valgus bend and a proximal interlocking screw was used in 11 cases. A modular knee fusion nail was used in 1 case. Successful fusion occurred in all cases, although 4 patients required additional surgery. Average operative blood loss was 748 mL, and average time to union was 7 months. Shortening of the extremity averaged 3.2 cm. Tibiofemoral alignment was improved by using a customized valgus nail (average, 3.1 valgus; range, 1-5) when compared with a straight nail (average, 0.2 valgus; range, 3 varus to 3 valgus). No patient developed infection in the hip or ankle region as a result of the long intramedullary nail. Intramedullary nailing is an excellent technique for knee arthrodesis in difficult cases. A customized proximal interlocking nail with 5 degrees to 7 degrees of valgus and 5 degrees of anterior angulation improves tibiofemoral alignment and is straightforward to insert or extract should it be necessary. Stability and pain relief are rapid, and the fusion rate is maximized.
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PMID:Arthrodesis of the knee: experience with intramedullary nailing. 1106 47

A chronic empyema of the ankle joint often develops after an open fracture or surgery. In the case of the destruction of the joint due to an infection, an arthrodesis should be performed. Normally we use an external fixator with two bone-nails placed into the calcaneus and two into the tibia. The arthrodesis is distracted and Septopal is permanently implemented. At 4-6 weeks after surgery the Septopal is removed, with distraction being reduced and a cancellous bone-graft taken from the dorsal iliac crest is performed to fill the bony defect. After bone healing, the external fixator is removed and the patient mobilized in a brace. Initially, weight-bearing is limited to 10 kg but is increased gradually to full weight. The brace is used for 6-9 months; later the patient is mobilized in orthopaedic shoes. In difficult cases, also in combination with a malposition which has to be corrected or a lengthening of the lower limb, we use the Ilizarov fixator. From 1993 to 2003 we performed arthrodeses of the ankle joint due to infectious destruction in 107 cases. In 82.2%, the empyema was caused by a fracture of the ankle joint and the following treatment. In 58% of the patients, we saw associated diseases such as obesity, alcohol abuse, diabetes and malposition of the foot. In 55% we found Staphylococcus aureus. In 86%, we used the external AO-fixator, in 14% the Ilizarov fixator. The patient retained the fixator for an average of 128 days. In our study, 92.1% of the 101 patients who had completed therapy showed a good stability an average of 4.5 years after the arthrodesis. In 5% we found partial stability, while three patients had to be amputated. In 57 patients (56.4), an arthrosis of the tarsal bones was found, and 38 patients (54.3%) of the 70 patients who at the time of the arthrodesis were still working could return to work.
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PMID:[Principles of OSG arthrodesis in cases of joint infection]. 1623 88


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