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1.
Artigo em Inglês | MEDLINE | ID: mdl-39111688

RESUMO

BACKGROUND: Instabilities of the SC joint are a rare injury, accounting for only 3% of all injuries of the shoulder-girdle. While acute posterior dislocations are an emergency and require immediate surgical intervention, anterior instabilities (first and second degree according to Allman) can mostly be treated conservatively. Chronic and highly instable acute anterior instabilities often imposes a significant limitation on the lives of affected patients. Currently, there is no established therapeutic algorithm in place. METHODS: This retrospective case series with prospective collection of data was performed at a level-I trauma centre. Patients treated surgically for anterior SC joint instabilities between January 2013 and December 2019 and with a minimum follow-up of 24 months were included. The injuries comprised of six acute anterior dislocations treated with tape-cerclage in a "figure-of-8" configuration; twelve patients with chronic anterior SC instabilities were treated with autologous tendon grafts. For one highly unstable chronic anterior instability in addition to the tendon graft synthetic suture material was applied. The clinical evaluation consisted of a physical examination and a standardized questionnaire, which included subjective and objective shoulder scores. RESULTS: Out of 24, 19 patients (79%) with an average age of 32 years ± 15 were available for follow-up. 63% of the patients were male. After a mean follow-up of 57 months, the mean age- and sex-adapted Constant-Murley Shoulder Score (CS) of acute anterior luxations amounted to 90 points ± 20, Nottingham Clavicle Score (NCS) to 81 points ± 22 and DASH Score to 11 points ± 18. Chronic anterior instabilities had a mean CS of 90 points ± 12, NCS of 83 points ± 17 and DASH Score of 4 points ± 5. The study shows a complication rate of 10%. Two patients underwent revision surgery. CONCLUSION: To conlude, monocortical SCJ fixation in a "figure-of-8" fashion presents a low risk for complication and a low revision rate and can achieve equally good functional outcome after the treatment of highly unstable acute and chronic anterior SCJ instabilities than other published techniques. Our approach presents less risk to the neurovascular structures of the mediastinum than other published techniques requiring bicortical drilling, therefore making the technique more accessible to hospitals without a cardiothoracic surgical background.

2.
J Shoulder Elbow Surg ; 32(6): 1185-1195, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-36584871

RESUMO

BACKGROUND: Arthroscopy-assisted cortical fixation devices have been increasingly used in the operative management of both acute and chronic cases of acromioclavicular joint instability (ACJI). It has been hypothesized that delayed surgical management leads to inferior clinical and radiologic outcomes compared to acute treatment. The purpose of this study is to compare clinical and radiologic outcomes, scapula dyskinesia, and failure or revision rates of arthroscopically treated acute and chronic ACJI. METHODS: This retrospective study of prospectively collected data included all surgically treated patients with grade IIIb and V chronic ACJI between 2013 and 2017, matched 1:1 to a group of acute grade IIIb and V ACJI patients treated during the same time period. Chronic ACJI was defined as delayed surgical treatment >21 days after injury. Chronic cases received an additional hamstring autograft next to the suture pulley systems. Follow-up was obtained at an average of 3.2 years (range: 1.4-6.2). Clinical outcome scores included the Constant-Murley Score (CMS), Taft Score (TF), Nottingham Clavicle Score (NCS), ACJI Score, Sick Scapula Score (SSS), Subjective Shoulder Value (SSV), Subjective Shoulder Test (SST), American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, and the visual analog scale pain score. Radiologic follow-up was obtained pre- and postoperatively and at final follow-up. The 2-year results were compared to the results of a 1:1 matched-pair group comprising patients who were treated with an acute ACJI during the same period. RESULTS: Thirty-three (80.5%) of 41 chronic ACJI cases were available for follow-up and were compared with 33 matched-pair cases of acute ACJI (of 41). The clinical scores were significantly better in the acute cohort for the CMS (92 ± 8 vs. 88 ± 8, P = .030), ASES (91 ± 13 vs. 85 ± 13, P = .002), SSS (1.4 ± 1.6 vs. 3.4 ± 2.5, P = .0004), NCS (86 ± 13 vs. 81 ± 13, P = .049), TF (9.9 ± 1.9 vs. 9.0 ± 2.1, P = .030), and ACJI (83 ± 13 vs. 75 ± 1, P = .003). In contrast to the chronic cohort, the acute cohort illustrated a significant loss of reduction at follow-up (P = .020). CONCLUSION: Based on the results of this study, early arthroscopy-assisted operative treatment of grade IIIb and V ACJIs seems superior to delayed surgical intervention of grade IIIb and V ACJIs. Furthermore, an additional autograft loop leads to less loss of reduction compared with suture pulley/suspensory loop fixation standalones.


Assuntos
Articulação Acromioclavicular , Luxações Articulares , Instabilidade Articular , Humanos , Luxações Articulares/cirurgia , Articulação Acromioclavicular/cirurgia , Articulação Acromioclavicular/lesões , Resultado do Tratamento , Estudos Retrospectivos , Radiografia , Instabilidade Articular/cirurgia , Instabilidade Articular/diagnóstico por imagem , Artroscopia/métodos
3.
Eur J Orthop Surg Traumatol ; 33(4): 1307-1314, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-35622161

RESUMO

PURPOSE: The aim of this study was to analyse and compare the 24-month range of motion results of patients treated with CFR-PEEK2 versus conventional titanium plate osteosyntheses (TAL-P). We hypothesized similar clinical outcomes but a better range of motion in the CFR-PEEK2 group than the TAL-P group in the 2-year follow-up. METHODS: This retrospective study analysing prospectively collected data included all patients that presented with a PHF and were treated with CFR-PEEK2 between November 2016 and April 2018. Follow-up was performed after a minimum of 24 months, evaluating the functional degree of movement functional scores, including the Subjective Shoulder Value (SSV) as well as an age- and sex-adapted Constant-Murley score (CMS). The 2-year results were compared to the results of a matched pair group comprising patients that were treated with TAL-P during the same period. RESULTS: Of the 35 patients included (mean age: 61.2 [18-78] years), 30 (86%) patients completed the 24-month follow-up in the CFR-PEEK2-group. After 24 months, the mean CMS was 89.9 points (pt) (44.5-100 pt) and the mean SSV was 86.7% (35-100%). Compared to the matched-pair TAL-P cohort, the 24-month follow-up showed similar results (CMS: 88.6 pt. (40.5-100 pt.) [p = 0.9]; SSV: 76% (30-100%) [p = 0.05]). However, significantly better degrees of forward flexion and internal rotation as well as a better range of motion in abduction was recorded in patients treated with CFR-PEEK2 plates than TAL-P. CONCLUSION: At the 24-month follow-up, patients who received treatment with CFR-PEEK2 compared to those that received TAL-P showed enhanced range of motion whilst having similar clinical scores.


Assuntos
Polímeros , Fraturas do Ombro , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Benzofenonas , Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/métodos , Resultado do Tratamento
4.
Eur J Orthop Surg Traumatol ; 33(4): 1185-1192, 2023 May.
Artigo em Inglês | MEDLINE | ID: mdl-35523973

RESUMO

PURPOSE: Purpose of this study was to demonstrate that a single tunnel reconstruction of high-grade acromioclavicular (AC) joint instabilities with implants of the second generation is sufficient for stabilisation, especially in combination with an AC cerclage. METHODS: Patients with an acute AC-joint dislocation type Rockwood III-B and V were included. Besides clinical follow-up examination, radiographs were analysed. The functional outcome measures were Constant Score (CS), Taft score (TS), ACJI score and patient's satisfaction. Horizontal instability was evaluated by clinical examination and radiological with an Alexander view. RESULTS: Thirty-five patients with a mean follow-up of 29 months were included. Ninety-seven per cent were satisfied with their result, with an average Subjective Shoulder Value of 90%. The CS averaged at 90 ± 10 points, TS at 11 ± 1 points and ACJI at 78 ± 18 points. Radiologically, 3 of 29 patients (10%) showed a persisting horizontal instability. The coracoclavicular (CC) distance improved from 22 preoperative to 10 mm postoperative, which was comparable to the contralateral side (10 mm, p = 0.103). At follow-up the CC distance increased to 13 mm (p = 0.0001). CONCLUSION: AC-joint stabilisation with a single tunnel reconstruction using a second-generation implant results in good to excellent clinical results with high patient satisfaction. The additional AC augmentation improves stability in horizontal instable AC-joints and is recommended in all high-grade AC joint stabilisations. Nonetheless, reduction was slightly lost over time due to an elongation or suture failure of the coraco-clavicular fixation. LEVEL OF EVIDENCE: IV.


Assuntos
Articulação Acromioclavicular , Luxações Articulares , Instabilidade Articular , Luxação do Ombro , Humanos , Articulação Acromioclavicular/cirurgia , Resultado do Tratamento , Artroscopia/métodos , Luxação do Ombro/cirurgia , Instabilidade Articular/cirurgia , Luxações Articulares/cirurgia , Ligamentos Articulares
5.
Eur J Orthop Surg Traumatol ; 33(6): 2533-2540, 2023 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-36596884

RESUMO

INTRODUCTION: Despite ongoing discussions for the previous few decades, there is still no consensus regarding the optimal surgical technique for acromioclavicular joint instabilities. The purpose of this study was to determine the impact of various implant materials following arthroscopically assisted stabilization of acromioclavicular joint instabilities on tunnel widening and implant migration. We hypothesized an implant-dependent behavior for tunnel widening and implant migration with differences when comparing acute and chronic acromioclavicular joint instabilities. METHODS: This study compared 105 patients with acromioclavicular joint instabilities that were managed operatively with coracoclavicular double button constructs. Two of the groups containing acute cases were treated with either a double button construct with a wire (TR) or a tape (D) as a central pillar. The two groups with chronic cases were either treated with a wire (T+) or tape D+ as a central pillar and additional hamstring tendon augmentation (+). One central transclavicular-transcoracoidal drill channel was made in the acute cases, while additional medial and lateral drill channels to augment the central pillar with the hamstring tendon were made. The central drill channel in all cases and the medial/lateral drill channels in chronic cases were subsequently radiologically analyzed immediately postoperatively and at follow-up. Following this, additional radiological analysis of the implant migration of the clavicular button took place. RESULTS: All groups showed significant tunnel widening of the central drill channel at follow-up (p ≤ 0.001). The TR+ technique demonstrated significant widening in both the medial (p ≤ 0.001) and lateral (p ≤ 0.001) drill channels. The D and D+ group displayed significant higher rates of clavicular button migration to a cortical and intraosseous level (p ≤ 0.002). CONCLUSION: Tunnel widening and implant migration following arthroscopically assisted management of acromioclavicular joint instabilities are dependent on the chosen implant. The stable tape showed a significantly increased degree of tunnel widening with respect to the central drill channel in comparison with the wire. In contrast, a higher degree of load capacity of the tape ultimately favors a protected intraosseous graft healing for chronic cases, which leads to less tunnel widening of the medial and lateral drill channel. Finally, the D/D+ implant groups showed higher rates of implant migration due to lower contact surface area of the implant at the upper clavicular cortex.


Assuntos
Articulação Acromioclavicular , Luxações Articulares , Instabilidade Articular , Humanos , Articulação Acromioclavicular/cirurgia , Artroscopia/efeitos adversos , Artroscopia/métodos , Instabilidade Articular/etiologia , Instabilidade Articular/cirurgia , Instabilidade Articular/diagnóstico por imagem , Próteses e Implantes , Radiografia , Luxações Articulares/cirurgia
6.
Arch Orthop Trauma Surg ; 142(12): 3837-3844, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34988672

RESUMO

INTRODUCTION: Ligament bracing augments ligament repair using a non-absorbable suture tape. Although biomechanically an increase in primary stability has been proven, there is a lack of clinical evidence. Purpose of this study was to evaluate clinical results of patients treated with ligament bracing due to primary elbow instability, including an analysis of complications. Furthermore, clinical results for patients treated with and without early functional mobilization were compared. MATERIALS AND METHODS: This prospective case-series evaluated clinical and functional results from patients treated with ligament bracing due to primary elbow instability. Clinical outcome measures were range of motion (ROM) as well as objective and subjective elbow scores [Mayo Elbow Performance Score (MEPS); Disabilities of Arm, Shoulder and Hand Score (DASH score)]. Stability was evaluated sonographically by humero-radial gapping under varus stress. RESULTS: This study involved 34 patients treated with ligament bracing. After a mean follow-up of 12.9 months ROM was 112° ± 29, MEPS 88 ± 13 points, DASH 91 ± 11 points, and 84% were satisfied with their result. Lateral joint gapping was 2.4 mm. No significant difference was observed regarding a postoperative mobilization with and without limitations. Most common complication after ligament bracing was elbow stiffness including heterotopic ossifications in four patients (12%). CONCLUSION: Operatively treated elbow instability with additional ligament bracing results in good clinical outcomes with high patient satisfaction and recovery of elbow stability. The high primary stability of the ligament bracing allows early functional mobilization without bracing, which facilitates postoperative rehabilitation. Elbow stiffness with heterotopic ossification seems to be a potential complication. Furthermore, the optimal tensioning of the ligament bracing remains challenging, including the risk of an over tensioning. LEVEL OF EVIDENCE: III.


Assuntos
Ligamentos Colaterais , Articulação do Cotovelo , Instabilidade Articular , Ossificação Heterotópica , Humanos , Articulação do Cotovelo/cirurgia , Cotovelo , Instabilidade Articular/cirurgia , Instabilidade Articular/etiologia , Ligamentos Colaterais/cirurgia , Braquetes/efeitos adversos , Amplitude de Movimento Articular , Resultado do Tratamento
7.
Arch Orthop Trauma Surg ; 142(6): 1083-1090, 2022 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33944989

RESUMO

INTRODUCTION: There is no uniform approach to the management of lateral clavicle fractures. Recent studies have investigated additive coracoclavicular (CC) augmentation as a treatment option; however, it is unclear whether it is superior to conventional locking plate osteosynthesis. METHODS: We carried out a retrospective analysis of 40 patients with lateral clavicle fracture (Neer type IIb) who were treated between 2014 and 2017 with either a hybrid locking plate osteosynthesis/additive arthroscopy-assisted CC augmentation (HP) procedure or a locking plate osteosynthesis only (PO) approach to determine which strategy was more effective. At follow-up, subjective shoulder value, age- and sex-adjusted Constant-Murley score, Taft (TF) score, American Shoulder and Elbow score, Nottingham clavicle score, and Visual Analogue Scale score were compared between patient groups. A radiologic evaluation was also conducted. RESULTS: A total of 14/17 patients (83%; 9 male/5 female, mean age: 43 ± 15 years) were followed up in the PO group. The mean follow-up time was 29 ± 12.4 months. In the HP group, 17/23 patients (74%; 9 male/8 female, mean age: 43 ± 17 years) were followed up, with a mean follow-up time of 18 ± 7.1 months. There were no significant differences in clinical parameters between the HP and PO groups; notably, the shoulder girdle-specific TF score was comparable in the 2 groups (HP: 11.3 ± 1.1 points and PO: 10.9 ± 0.9 points). In the HP group, additional pathologies were identified and arthroscopically treated in 35% of cases. Radiologic examination revealed a significant difference between pre- and postoperative CC distance in the HP group (P = 0.001). CONCLUSION: Additive CC augmentation in combination with locking plate osteosynthesis seems to improve the vertical stability and reduces the revision rate in patients with a lateral clavicle fracture. Furthermore, an arthroscopy-assisted procedure allows for an intraoperative detection and single-step treatment of accompanying intraarticular pathologies.


Assuntos
Clavícula , Fraturas Ósseas , Adulto , Placas Ósseas , Clavícula/cirurgia , Feminino , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Humanos , Ligamentos Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
8.
Unfallchirurg ; 123(11): 879-889, 2020 11.
Artigo em Alemão | MEDLINE | ID: mdl-33048209

RESUMO

Injuries of the sternoclavicular joint (SCJ) are rare accounting for 3% of all injuries to the shoulder girdle and are often overlooked. The SCJ is surrounded by tight ligamentous structures, thus substantial energy with corresponding force vectors is needed to cause dislocation. Causative are mostly high-energy traumas. Anterior dislocation is most common but in rare cases potentially life-threatening posterior dislocation occurs, which requires immediate reduction. The established gold standard is 3D reconstruction in contrast-enhanced computed tomography (CT) for depiction of neurovascular structures. Low-grade instability can initially be treated conservatively. For unsuccessful attempts at reduction, high-grade instability and chronic instability various surgical techniques are established. Next to retentive augmentation with suture materials, in acute cases with chronic instability biological tendon augmentation is preferred. In cases of posttraumatic instability arthritis SCJ resection with or without additive biological augmentation can be carried out. Various study groups have shown good to very good midterm outcome.


Assuntos
Luxações Articulares , Procedimentos de Cirurgia Plástica , Articulação Esternoclavicular , Humanos , Luxações Articulares/diagnóstico por imagem , Luxações Articulares/cirurgia , Articulação Esternoclavicular/diagnóstico por imagem , Articulação Esternoclavicular/lesões , Articulação Esternoclavicular/cirurgia , Suturas , Tendões
9.
N Engl J Med ; 375(13): 1221-30, 2016 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-27571011

RESUMO

BACKGROUND: The benefit of an implantable cardioverter-defibrillator (ICD) in patients with symptomatic systolic heart failure caused by coronary artery disease has been well documented. However, the evidence for a benefit of prophylactic ICDs in patients with systolic heart failure that is not due to coronary artery disease has been based primarily on subgroup analyses. The management of heart failure has improved since the landmark ICD trials, and many patients now receive cardiac resynchronization therapy (CRT). METHODS: In a randomized, controlled trial, 556 patients with symptomatic systolic heart failure (left ventricular ejection fraction, ≤35%) not caused by coronary artery disease were assigned to receive an ICD, and 560 patients were assigned to receive usual clinical care (control group). In both groups, 58% of the patients received CRT. The primary outcome of the trial was death from any cause. The secondary outcomes were sudden cardiac death and cardiovascular death. RESULTS: After a median follow-up period of 67.6 months, the primary outcome had occurred in 120 patients (21.6%) in the ICD group and in 131 patients (23.4%) in the control group (hazard ratio, 0.87; 95% confidence interval [CI], 0.68 to 1.12; P=0.28). Sudden cardiac death occurred in 24 patients (4.3%) in the ICD group and in 46 patients (8.2%) in the control group (hazard ratio, 0.50; 95% CI, 0.31 to 0.82; P=0.005). Device infection occurred in 27 patients (4.9%) in the ICD group and in 20 patients (3.6%) in the control group (P=0.29). CONCLUSIONS: In this trial, prophylactic ICD implantation in patients with symptomatic systolic heart failure not caused by coronary artery disease was not associated with a significantly lower long-term rate of death from any cause than was usual clinical care. (Funded by Medtronic and others; DANISH ClinicalTrials.gov number, NCT00542945 .).


Assuntos
Estimulação Cardíaca Artificial , Desfibriladores Implantáveis , Insuficiência Cardíaca Sistólica/terapia , Idoso , Doenças Cardiovasculares/mortalidade , Morte Súbita Cardíaca/epidemiologia , Eletrocardiografia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Volume Sistólico
10.
Europace ; 21(6): 900-908, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-30796456

RESUMO

AIM: The Danish Study to Assess the Efficacy of Implantable Cardioverter-Defibrillators (ICD) in Patients with Non-ischaemic Systolic Heart Failure (HF) on Mortality (DANISH) found no overall effect on all-cause mortality. The effect of ICD implantation on health-related quality of life (HRQoL) remains to be established as previous trials have demonstrated conflicting results. We investigated the impact of ICD implantation on HRQoL in patients with non-ischaemic systolic HF, a prespecified secondary endpoint in DANISH. METHODS AND RESULTS: In DANISH, a total of 1116 patients with non-ischaemic systolic HF were randomly assigned (1:1) to ICD implantation or usual clinical care (control). Patients completed disease-specific HRQoL as assessed by Minnesota Living with Heart Failure Questionnaire (MLHFQ; 0-105, high indicating worse). Changes in HRQoL 8 months after randomization were assessed with a mixed-effects model. At randomization, MLHFQ was completed by 935 (84%) patients (n = 472 in the ICD group and n = 463 in the control group) and was reassessed in 274 (58%) and 292 (63%) patients, respectively after 8 months for the primary analysis. Patients in the ICD group vs. the control group had similar improvements in MLHFQ after 8 months [least square mean -7.0 vs. -4.2 (P = 0.13)]. A clinically relevant improvement (decrease ≥5) in the MLHFQ overall score at 8 months was observed in 151 patients in the ICD group and 148 patients in the control group [55% vs. 51%, respectively (P = 0.25)]. CONCLUSION: Implantable cardioverter-defibrillator implantation in patients with non-ischaemic systolic HF did not significantly alter HRQoL compared with patients randomized to usual clinical care.


Assuntos
Desfibriladores Implantáveis , Insuficiência Cardíaca/prevenção & controle , Qualidade de Vida , Idoso , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
11.
Europace ; 19(12): 1981-1987, 2017 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-28039212

RESUMO

AIMS: The DANPACE trial randomized patients with sick sinus syndrome (SSS) to single lead atrial (AAIR) or dual chamber (DDDR) pacemaker (PM). After 5 years follow-up, no difference in overall survival, stroke or heart failure (HF) was observed, whereas risk of atrial fibrillation (AF) and PM reoperation were increased in the AAIR group. The present study aimed to investigate very long term risk of death, AF hospitalization, stroke, HF and rate of change in pacing mode using national register-based data. METHODS AND RESULTS: The study population consisted of all 1384 patients included at Danish PM centres in the DANPACE trial randomized to AAIR (n = 696) or DDDR (n = 688). Long-term follow-up data was obtained from Danish national registers. Analysis was intention-to-treat. results: During mean follow-up of 8.9 years, 413 patients (59.3%) died in the AAIR-group compared to 367 (53.3%) in the DDDR-group (adjusted hazard ratio 1.03; 95% confidence interval 0.90-1.19; P = 0.65). We observed no difference in risk of AF hospitalization, stroke or HF. During extended follow-up, annual rate of pacing mode change to DDDR in the AAIR group was 4.5%, and higher than the 2.3% observed during trial conduct. CONCLUSION: This register-based long-term follow-up study indicates that there is no difference in mortality among patients with SSS randomized to AAIR or DDDR pacing, even with very long follow-up. Nor is there any difference in risk of AF hospitalization, stroke or HF. The higher rate of pacing mode-change to DDDR in the AAIR group suggests a different management of patients with an AAIR PM after the DANPACE trial.


Assuntos
Estimulação Cardíaca Artificial/métodos , Marca-Passo Artificial , Síndrome do Nó Sinusal/terapia , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/etiologia , Estimulação Cardíaca Artificial/efeitos adversos , Estimulação Cardíaca Artificial/mortalidade , Distribuição de Qui-Quadrado , Dinamarca , Feminino , Insuficiência Cardíaca/etiologia , Humanos , Análise de Intenção de Tratamento , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de Registros , Fatores de Risco , Síndrome do Nó Sinusal/complicações , Síndrome do Nó Sinusal/mortalidade , Síndrome do Nó Sinusal/fisiopatologia , Acidente Vascular Cerebral/etiologia , Fatores de Tempo , Resultado do Tratamento
12.
Int Orthop ; 41(8): 1633-1640, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28455736

RESUMO

PURPOSE: The purpose of this study was to identify the risk of concomitant glenohumeral pathologies with acromioclavicular joint injuries grade III and V. METHODS: Patients who underwent arthroscopically-assisted stabilization of acromioclavicular joint injuries grade III or grade V between 01/2007 and 12/2015 were identified in the patient databases of two surgical centres. Gender, age at index surgery, grade of acromioclavicular joint injury (Rockwood III or Rockwood V), and duration between injury and index surgery (classified as acute or chronic) were of interest. Concomitant glenohumeral pathologies were noted and their treatment was classified as debridement or reconstructive procedure. RESULTS: A total of 376 patients (336 male, 40 female) were included. Mean age at time of arthroscopic acromioclavicular joint reconstruction surgery was 42.1 ± 14.0 years. Overall, 201 patients (53%) had one or more concomitant glenohumeral pathologies. Lesions of the biceps tendon complex and rotator cuff were the most common. Forty-five patients (12.0%) had concomitant glenohumeral pathologies that required an additional repair. The remaining 156 patients (41.5%) received a debridement of their concomitant pathologies. Rockwood grade V compared to Rockwood grade III (p = 0.013; odds ratio 1.7), and chronic compared to acute injury were significantly associated with having a concomitant glenohumeral pathology (p = 0.019; odds ratio 1.7). The probability of having a concomitant glenohumeral pathology was also significantly associated with increasing age (p < 0.0001). CONCLUSIONS: Concomitant glenohumeral pathologies were observed in 53% of surgically treated patients with an acute or chronic acromioclavicular joint injury of either grade III or V. Twenty-two percent of these patients with concomitant glenohumeral pathologies received an additional dedicated repair procedure. Although a significant difference in occurrence of concomitant glenohumeral pathologies was seen between Rockwood grades III and V, and between acute and chronic lesions, increasing age was identified as the most dominant predictor. LEVEL OF EVIDENCE: Level IV, case series.


Assuntos
Articulação Acromioclavicular/lesões , Articulação Acromioclavicular/cirurgia , Lesões do Ombro , Doença Aguda , Adulto , Artroscopia , Doença Crônica , Feminino , Humanos , Luxações Articulares/patologia , Luxações Articulares/cirurgia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Lesões do Manguito Rotador/patologia , Lesões do Manguito Rotador/cirurgia , Articulação do Ombro/patologia
13.
J Orthop Traumatol ; 18(3): 265-274, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28421293

RESUMO

BACKGROUND: The aims of this study were to evaluate treatment failure and revision rates of proximal humeral fracture (PHF) treatment with a standardized treatment algorithm within the reality of a level-1 trauma center and to identify predictors of subsequent surgery. MATERIALS AND METHODS: The medical database of a level-1 trauma center was screened for all primary treatments of PHFs between January 2009 and June 2012. Medical records and imaging were analyzed to identify the fracture morphology, pre-existing diseases, revision surgeries and treatment failures (conversion to another treatment). The patients were asked about subsequent surgeries by phone. A functional outcome questionnaire was mailed to participating patients. RESULTS: Follow-up data were available for 423 of 521 patients (312 females, 111 males). The mean age at the time of primary treatment was 68.3 years; mean follow-up was 24.6 ± 12.3 months. The overall rate of mandatory re-operations was 15.6%, including a failure rate of 8.3%; another 7.6% of patients had additional arthroscopic surgeries. Treatment with anatomic hemi-prostheses was associated with the highest re-operation rates, and lowest outcomes. Involvement of the medial calcar region, complex fracture morphologies, cigarette smoking and alcohol-abuse were predictors for subsequent surgery. Patients without subsequent surgery had significantly higher functional outcome scores than patients with additional surgery. CONCLUSIONS: With the use of a standardized treatment algorithm no treatment modality was at significantly higher risk for having additional surgery. Complex fracture types, involvement of the medial calcar, cigarette-smoking and alcohol-abuse were associated with subsequent surgeries. LEVEL OF EVIDENCE: Level IV case series.


Assuntos
Fraturas do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Artroplastia de Substituição , Feminino , Fixação de Fratura , Humanos , Masculino , Pessoa de Meia-Idade , Reoperação , Estudos Retrospectivos , Fraturas do Ombro/classificação , Fraturas do Ombro/terapia , Inquéritos e Questionários , Centros de Traumatologia , Falha de Tratamento
14.
Am Heart J ; 179: 136-41, 2016 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-27595688

RESUMO

BACKGROUND: The effect of an implantable cardioverter defibrillator (ICD) in patients with symptomatic systolic heart failure (HF) caused by coronary artery disease is well documented. However, the effect of primary prophylactic ICDs in patients with systolic HF not due to coronary artery disease is much weaker. In addition, HF management has improved, since the landmark ICD trials and a large proportion of patients now receive cardiac resynchronization therapy (CRT) where the effect of ICD treatment is unknown. METHODS: In the DANISH study, 1,116 patients with symptomatic systolic HF not caused by coronary artery disease have been randomized to receive an ICD or not, in addition to contemporary standard therapy. The primary outcome of the trial is time to all-cause death. Follow-up will continue until June 2016 with a median follow-up period of 5 years. Baseline characteristics show that enrolled patients are treated according to current guidelines. At baseline, 97% of patients received an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker, 92% received a ß-blocker, 58% a mineralocorticoid receptor antagonist, and 58% were scheduled to receive CRT. Median age was 63 years (range, 21-84 years) at baseline, and 28% were women. CONCLUSION: DANISH will provide pertinent information about the effect on all-cause mortality of a primary prophylactic ICD in patients with symptomatic systolic HF not caused by coronary artery disease on contemporary standard therapy including CRT.


Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Insuficiência Cardíaca Sistólica/terapia , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia de Ressincronização Cardíaca , Morte Súbita Cardíaca/etiologia , Feminino , Insuficiência Cardíaca Sistólica/complicações , Doenças das Valvas Cardíacas/complicações , Humanos , Hipertensão/complicações , Masculino , Pessoa de Meia-Idade , Adulto Jovem
15.
Cardiology ; 133(3): 147-56, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-26583600

RESUMO

OBJECTIVE: The aim of this study was to determine the feasibility, reproducibility, safety and information obtained on exercise physiology from cardiopulmonary exercise testing (CPX) in patients with aortic stenosis. METHODS: Patients with an aortic valve area (AVA) <1.3 cm2 who were judged asymptomatic or equivocal symptomatic underwent CPX and an inert gas rebreathing test. Only those where comprehensive evaluation of CPX results indicated haemodynamic compromise from aortic stenosis were referred for valve replacement. RESULTS: The mean patient age was 72 (±9) years; an AVA index <0.6 cm2/m2 and equivocal symptomatic status were found in 90 and 70%, respectively. CPX was feasible in 130 of the 131 patients. The coefficients of repeatability by test-retest were 5.4% (pVO2) and 4.6% (peak O2 pulse). A pVO2 <83% of the expected was predicted by a lower stroke volume at exercise, lower peak heart rate and FEV1, and higher VE/VCO2, but not by AVA index. Equivocal symptomatic status and a low gradient but high valvulo-arterial impedance were associated with a lower pVO2, but not with an inability to increase stroke volume. In total, 18 patients were referred for valve replacement. At 1 year, no cardiovascular deaths had occurred. CONCLUSIONS: CPX was feasible and reproducible and provided comprehensive data on exercise physiology. A CPX-guided treatment strategy was safe up to 1 year.


Assuntos
Estenose da Valva Aórtica/fisiopatologia , Tolerância ao Exercício/fisiologia , Exercício Físico/fisiologia , Idoso , Idoso de 80 Anos ou mais , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/mortalidade , Estenose da Valva Aórtica/cirurgia , Dinamarca/epidemiologia , Ecocardiografia , Teste de Esforço/métodos , Feminino , Volume Expiratório Forçado , Próteses Valvulares Cardíacas , Hemodinâmica , Hospitais Universitários , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/complicações
16.
Int Orthop ; 39(4): 747-54, 2015 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25529403

RESUMO

PURPOSE: The purpose of this study was to evaluate and compare the results after double locking plate osteosynthesis (ORIF) and total elbow arthroplasty (TEA) in AO type C fractures of the distal humerus. METHODS: This retrospective study includes clinical results of 29 patients (9xTEA, 20xORIF) with a mean age of 62 years. The male to female ratio was 8:21. Range of motion, MEPS, DASH and complications were evaluated. Patients older than 60 years (n = 19) were filtered and compared statistically. RESULTS: After a mean follow-up of 25 months the ORIF-group reached an extension-flexion of 99°±23° and the TEA-group of 111°±13°. The ORIF-group vs. the TEA-group had a mean MEPS of 85±17 vs. 94±11 and DASH of 34±24 vs. 24±12. In patients older than 60 years extension-flexion was 97°±23° after ORIF and 110°±14 after TEA (p = 0.237). The ORIF-group vs. the TEA-group had a mean MEPS of 82±21 vs. 94±11 (p = 0.078) and DASH of 45±18 vs. 26±11 (p = 0.023). The ORIF-group had a 4.4 times higher risk for major complications. CONCLUSION: TEA and ORIF lead to comparable functional results, but major complications are more common after ORIF. Despite this, ORIF remains the gold standard for younger and older patients because of the lifelong loading limitation after TEA, unknown implant survival and problematic revision surgery. For patients older than 60 years a primary TEA can be recommended in exceptional cases, if the loading limitation is acceptable for the individual or the fracture is not reconstructable.


Assuntos
Artroplastia de Substituição do Cotovelo , Fixação Interna de Fraturas , Fraturas Cominutivas/cirurgia , Fraturas do Úmero/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Placas Ósseas , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Estudos Retrospectivos , Resultado do Tratamento , Lesões no Cotovelo
17.
Arthroscopy ; 30(9): 1061-7, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24939364

RESUMO

PURPOSE: The purpose of this study was to determine the outcomes of arthroscopy after proximal humeral plating and the occurrence of concomitant pathology and avascular necrosis. METHODS: Forty-five patients (28 women; median age, 58.5 years [range, 30 to 82 years]) underwent arthroscopies of 46 shoulders because of unsatisfactory results after locked plating of proximal humeral fractures. They were prospectively followed up for 3, 12, and 24 months postoperatively. Relevant intra-articular lesions were documented. The patients were assigned to 1 of the following groups: (1) articular screw perforation, (2) subacromial plate impingement, or (3) post-traumatic/postoperative shoulder stiffness. Shoulder range of motion and function as measured with the age- and gender-adjusted Constant-Murley score, as well as the Simple Shoulder Test, were compared among the groups. RESULTS: Concomitant lesions of the articular cartilage, long head of the biceps tendon, tuberosities, and rotator cuff were found in 34 patients (75%). Two-thirds of patients (n = 31) had a partial or complete 270° capsular release. Of the patients, 84% (n = 38) underwent 3 and 12 months' follow-up and 82% (n = 37) underwent 24 months' follow-up. The active range of abduction (P = .029), flexion (P = .048), and internal rotation (P = .0005) had improved significantly at 24 months' follow-up compared with the preoperative status. The mean adjusted Constant-Murley score of patients with post-traumatic shoulder stiffness (n = 15, 64.2% ± 7.9%) and articular screw perforation (n = 19, 73.3% ± 8.4%) was significantly lower (P = .0089 and P = .042, respectively) than that of patients with subacromial plate impingement (n = 12, 93.4% ± 4.3%). CONCLUSIONS: High rates of relevant articular pathologies and the necessity of capsular release in a majority of patients with unsatisfactory results after locked plating of proximal humeral fractures make arthroscopy a valuable revision tool with promising results in cases of high plate positioning, screw perforation, and postoperative/post-traumatic shoulder stiffness. LEVEL OF EVIDENCE: Level IV, therapeutic case series.


Assuntos
Artroscopia/métodos , Placas Ósseas , Remoção de Dispositivo/métodos , Fixação Interna de Fraturas/métodos , Fraturas do Ombro/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroscopia/efeitos adversos , Parafusos Ósseos/efeitos adversos , Feminino , Seguimentos , Fixação Interna de Fraturas/instrumentação , Humanos , Liberação da Cápsula Articular/estatística & dados numéricos , Artropatias/cirurgia , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Prospectivos , Amplitude de Movimento Articular , Reoperação/métodos , Rotação , Manguito Rotador/cirurgia , Ombro/cirurgia , Síndrome de Colisão do Ombro/etiologia , Síndrome de Colisão do Ombro/cirurgia , Articulação do Ombro/cirurgia , Resultado do Tratamento
18.
Knee Surg Sports Traumatol Arthrosc ; 22(2): 422-30, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-23124627

RESUMO

PURPOSE: The purpose of this study was to compare the results after arthroscopically assisted double TightRope(®)-(TR) reduction with results after clavicular hook plate (HP) fixation in acute high-grade acromioclavicular (AC) joint separations. METHODS: Between 2004 and 2010, 69 consecutive patients with acute AC joint separations type Rockwood III and V were subjected to surgical reconstruction. 56 patients (81 %) were available for evaluation. Thereof, 30 (median age: 39 years; n = 12 acute Rockwood III and n = 18 Rockwood V injuries) were treated by a clavicular HP and 26 (median age: 39 years; n = 10 acute Rockwood III and n = 16 Rockwood V injuries) using the double TR technique. Group HP was evaluated at a median of 48 (7-77) months after surgery and the TR group 17 (7-29) months after stabilization. Visual Analogue Scale (VAS) for Pain, Simple Shoulder Test (SST), Constant Score (CS) and Taft Score (TS) were assessed. Sonographic measurements were performed to evaluate recurrent instability. RESULTS: Clinical examination demonstrated comparable results without significant differences. In the groups HP and TR, the VAS was median 0.8 (range, 0.0-7.5) and 0.4 (range, 0.0-5.7), the SST reached median 11 (range, 0-12 points) and 12 points (range, 8-12 points). The CS was median 92.4 % (range, 21.5-105.4 %) and 94.0 % (range, 54.6-105.3 %) and the TS median 10 (range, 3-12 points) and 10 points (range, 5-12 points). Sonographic measurements showed a mean coracoclavicular (CC) distance of 25.3 ± 4.5 (HP) and 25.5 ± 4.3 mm (TR) (n.s.). In both groups, CC distance of the operated side was significantly higher compared to the uninjured side. The complication rate was 13 % in group HP and 12 % in group TR. CONCLUSIONS: In acute high-grade AC joint instabilities, both techniques lead to mostly good and excellent clinical results, although comparable partial recurrent vertical instability could be observed. Diagnosis and therapy of concomitant glenohumeral injuries and no obligatory implant removal are advantages of the arthroscopic procedure.


Assuntos
Articulação Acromioclavicular/cirurgia , Artroscopia/métodos , Luxações Articulares/cirurgia , Instabilidade Articular/cirurgia , Adolescente , Adulto , Idoso , Artroscopia/instrumentação , Placas Ósseas , Feminino , Seguimentos , Humanos , Fixadores Internos , Luxações Articulares/etiologia , Instabilidade Articular/complicações , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
19.
Artigo em Alemão | MEDLINE | ID: mdl-39143244

RESUMO

Injurie to the lateral clavicle and acromioclavicular joint (ACJ) are frequent events which are relevant to everyday life and particularly affect active adults at the age of 20-40 years. The Rockwood classification has been established for the classification of ACJ injuries. Lateral clavicle fractures are classified according to the Neer classification or the Jäger and Breitner classification. A newly established classification is the Cho classification. Depending on the injury pattern and in particular the presence of instability, various conservative and surgical care strategies are used. This article provides an overview of the various treatment concepts.

20.
Int Orthop ; 37(4): 631-9, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23271690

RESUMO

PURPOSE: Dislocations of components, loosening of the stem, overstuffing and removal in up to 24 % of common radial head prostheses (RHP) after implantation in complex elbow injuries signal the need for improvement. The latest biomechanical evidence shows advantages for monopolar designs. Clinical results after primary and secondary implantation of the newly designed press-fit monobloc monopolar RHP in cases of complex elbow injury are evaluated. METHODS: Twenty-nine patients [median age 60 years (29-86)] were followed up retrospectively for a median of 25 months (7-54) post-operatively. Subjective parameters, the Mayo Elbow Performance Score (MEPS), the Broberg and Morrey score (BMS), latest radiographs and complications were evaluated. RESULTS: MEPS and BMS averaged 87.2 ± 12.9 and 81.1 ± 11.9 points, respectively. No case of implant loosening was observed; the RHP had to be removed in one case (3 %). The overall complication and revision rate was higher after secondary (53 %) than after primary (19 %) implantation. CONCLUSIONS: Satisfactory clinical results and low short-term removal rates emphasise the practicality of monobloc monopolar RHP. Differentiated treatment of complex elbow fracture-dislocations is compulsory to avoid the need for secondary RHP implantation which carries a higher complication rate.


Assuntos
Artroplastia de Substituição do Cotovelo/métodos , Lesões no Cotovelo , Articulação do Cotovelo/cirurgia , Prótese de Cotovelo , Desenho de Prótese , Rádio (Anatomia) , Adulto , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Substituição do Cotovelo/instrumentação , Fenômenos Biomecânicos , Articulação do Cotovelo/fisiopatologia , Feminino , Seguimentos , Humanos , Luxações Articulares , Masculino , Pessoa de Meia-Idade , Falha de Prótese , Reoperação , Estudos Retrospectivos , Resultado do Tratamento
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