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1.
J Orthop Trauma ; 38(8): 441-446, 2024 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-39007661

RESUMO

OBJECTIVES: To report a case series of extra-articular osteotomies for the management of intra-articular tibial plateau malunions and to assess the ability to correct deformity and improve knee range of motion (ROM). METHODS: . DESIGN: Retrospective case series. SETTING: Academic, tertiary, referral center. PATIENT SELECTION CRITERIA: Adult patients with tibial plateau fracture malunion treated with extra-articular osteotomy of the femur and/or tibia between 2014 and 2023. OUTCOME MEASURES AND COMPARISON: Mechanical axis deviation (MAD), medial proximal tibia angle (MPTA), lateral distal femoral angle (LDFA), and posterior proximal tibia angle (PPTA) correction; knee ROM; and time to weight bearing. RESULTS: There were 7 patients included, 6 (85.7%) were female and 1 (14.3%) were male. The median age was 43.5 years (IQR 38.5-51, range 32-62). Four (57.1%) patients were treated with a high tibial osteotomy (HTO), and 3 (42.9%) patients were treated with an HTO and distal femoral osteotomy. One patient had concomitant supramalleolar osteotomy with HTO to address distal tibia procurvatum and valgus. Four were treated with hexapod frames, and 3 were treated with plates and screws. Median follow-up was 22.5 months (IQR 10.5-107 months, range 7-148 months). Surgical intervention corrected median radiographic measures of valgus malalignment preoperatively relative to postoperative values. This included MAD (42.5 mm-0 mm), valgus angle (12.5 degrees-1.5 degrees), MPTA (95 degrees-88.0°), and LDFA (86.0°-87.3 degrees). Surgical intervention increased maximal knee range of motion preoperatively to postoperatively. Median time to full weight bearing was 81.5 days (IQR 46-57 days, range 41-184 days). Two patients were converted to total knee arthroplasty after 5 and 10 years following HTO with hexapod frame. CONCLUSIONS: Extra-articular osteotomy is an effective treatment for addressing intra-articular malunion after tibia plateau fractures. It is effective in correcting the MAD, valgus deformity, MPTA, LDFA, PPTA, and improving knee ROM (measured through knee extension and flexion). LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Fraturas Mal-Unidas , Osteotomia , Amplitude de Movimento Articular , Fraturas da Tíbia , Humanos , Osteotomia/métodos , Masculino , Feminino , Fraturas da Tíbia/cirurgia , Fraturas da Tíbia/diagnóstico por imagem , Pessoa de Meia-Idade , Adulto , Estudos Retrospectivos , Fraturas Mal-Unidas/cirurgia , Fraturas Mal-Unidas/diagnóstico por imagem , Resultado do Tratamento , Fraturas Intra-Articulares/cirurgia , Fraturas Intra-Articulares/diagnóstico por imagem , Fixação Interna de Fraturas/métodos , Tíbia/cirurgia , Tíbia/diagnóstico por imagem
2.
Ugeskr Laeger ; 186(15)2024 Apr 08.
Artigo em Dinamarquês | MEDLINE | ID: mdl-38708702

RESUMO

Clavicle fractures are a common injury in adults. Most patients are treated non-operatively. In this case report, a 53-year-old professional violinist had a midt shaft clavicula fracture and was treated non-operatively. The fracture healed, but the patient developed thoracic outlet syndrome (TOS) and a venous thrombosis when playing violin. Surgery with restoration of the normal anatomy alleviated the symptoms and six months later she was symptom free and playing violin again. TOS is a rare complication to clavicle fractures and the treating doctors should be aware of the diagnosis.


Assuntos
Clavícula , Fraturas Mal-Unidas , Síndrome do Desfiladeiro Torácico , Humanos , Clavícula/lesões , Síndrome do Desfiladeiro Torácico/etiologia , Síndrome do Desfiladeiro Torácico/cirurgia , Síndrome do Desfiladeiro Torácico/diagnóstico por imagem , Síndrome do Desfiladeiro Torácico/diagnóstico , Feminino , Pessoa de Meia-Idade , Fraturas Mal-Unidas/cirurgia , Fraturas Mal-Unidas/diagnóstico por imagem , Fraturas Mal-Unidas/complicações , Fraturas Ósseas/complicações , Fraturas Ósseas/cirurgia , Fraturas Ósseas/diagnóstico por imagem , Música
3.
J Plast Surg Hand Surg ; 59: 46-52, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38747532

RESUMO

Standard volar plates often do not fit the surface of the malunited distal radius after osteotomy, necessitating an offset angle for accurate volar tilt correction. The correction can be achieved if the plate is held at the correct angle when the distal screws are locked. With the advantage of 3D surgical planning and patient-specific instruments, we developed a shim instrument to assist the surgeon in securing the plate at the intended angle when locking the distal screws, and evaluated radiological results. Five female patients aged 63-74 with dorsally angulated extra-articular malunions underwent surgery using 3D-printed guides and the shim instrument. The plate position, drilling guide alignment, screw placements, and distal radius correction on postoperative CTs were compared with the surgical plans. Errors were measured using an anatomical coordinate system, and standard 2D radiographic measures were extracted. Preoperative dorsal tilt ranged from 16° to 35°, and postoperative volar tilt from 1° to 11°. 3D analysis revealed mean absolute correction errors of 6.1° in volar tilt, 1.6° in radial inclination, and 0.6 mm in ulnar variance. The volar tilt error due to the shim instrument, indicated by the mean angle error of the distal screws to the plate, was 2.1° but varied across the five patients. Settling of the distal radius, due to tension during and after reduction, further contributed to a mean loss of 3.5° in volar tilt. The shim instrument helped with securing plates at the intended angle; however, further correction improvements should consider the tension between the fragments of osteoporotic bone.


Assuntos
Placas Ósseas , Fixação Interna de Fraturas , Fraturas Mal-Unidas , Osteotomia , Fraturas do Rádio , Humanos , Feminino , Osteotomia/métodos , Osteotomia/instrumentação , Pessoa de Meia-Idade , Fraturas do Rádio/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Idoso , Fraturas Mal-Unidas/cirurgia , Fraturas Mal-Unidas/diagnóstico por imagem , Fixação Interna de Fraturas/instrumentação , Fixação Interna de Fraturas/métodos , Impressão Tridimensional , Cirurgia Assistida por Computador , Imageamento Tridimensional , Parafusos Ósseos , Tomografia Computadorizada por Raios X
4.
Int Orthop ; 48(7): 1849-1858, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38627330

RESUMO

PURPOSE: To introduce anterior peri-sacroiliac joint osteotomy (APSJO) through the lateral-rectus approach (LRA) for treating pelvic fracture malunion and nonunion, and to evaluate the safety, feasibility, and potential effectiveness. METHODS: Data of 15 patients with pelvic fracture malunion and nonunion who underwent treatment by APSJO were selected and analyzed. The reduction quality was assessed using the Mears and Velyvis criteria, while the pre-operative and post-operative function was revealed by the Majeed scoring system. The British Medical Research Council (BMRC) grading system was recruited for the evaluation of lumbosacral plexus function. RESULTS: The average operative duration was 264.00 ± 86.75 min, while the intra-operative blood loss was 2000 (600, 3000) mL. Anatomical reduction was complete in three cases, satisfactory in ten cases, and unsatisfactory in two cases. Among the seven patients with lumbosacral plexus injury, the pre-operative Majeed grades were good in two cases, fair in two cases, and poor in three cases, while the post-operative Majeed grades were excellent in three cases, good in three cases, and fair in one case. Muscle strength recovered to M5 in two cases, M4 in three cases, and showed no recovery in two cases. The pre-operative Majeed grades were good in five cases, fair in two cases, and poor in one case of the series without lumbosacral plexus injury, while the post-operative Majeed grades were excellent in seven cases and good in one case. CONCLUSION: APSJO through LRA may be a feasible strategy for treating pelvic fracture malunion and nonunion with promising application.


Assuntos
Fraturas Mal-Unidas , Fraturas não Consolidadas , Osteotomia , Ossos Pélvicos , Articulação Sacroilíaca , Humanos , Adulto , Feminino , Masculino , Osteotomia/métodos , Fraturas Mal-Unidas/cirurgia , Fraturas não Consolidadas/cirurgia , Ossos Pélvicos/lesões , Ossos Pélvicos/cirurgia , Pessoa de Meia-Idade , Articulação Sacroilíaca/cirurgia , Articulação Sacroilíaca/lesões , Resultado do Tratamento , Adulto Jovem , Fixação Interna de Fraturas/métodos , Fixação Interna de Fraturas/instrumentação , Fraturas Ósseas/cirurgia , Adolescente
5.
Eur J Orthop Surg Traumatol ; 34(4): 1893-1899, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38451337

RESUMO

PURPOSE: Rotational malalignment and leg length discrepancy after intramedullary nailing of femoral shaft are frequent. This study has three objectives: evaluate the rate of femoral rotational malalignment and leg length discrepancy using EOS imaging after antegrade intramedullary nailing of femoral shaft fracture, find a relevant clinical examination to detect malrotation and identified risk factors. METHODS: We performed a retrospective single-centre study between January 2014 and January 2022. Fifty-eight patients were clinically and radiographically assessed at a minimum of three months. RESULTS: The femoral rotation of the operated side was significantly greater by a mean of 15.4° in internal rotation compared to the healthy side. There was no statically significant difference for the femoral length (p = 0.08). CONCLUSION: When using EOS stereography following antegrade intramedullary nailing of post-traumatic diaphyseal femur fractures, a statistically significant difference of more than 15.4° in internal rotation was found for femoral rotation on the operated side compared to the healthy side.Please confirm if the author names are presented accurately and in the correct sequence (given name, middle name/initial, family name). Author 1 Given name: [B. Poirot] Last name [Seynaeve]. Also, kindly confirm the details in the metadata are correct.The last name of the first author was corrected : Given name = B. and last name = Poirot Seynaeve The details in matadata are correct LEVEL OF EVIDENCE: III.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Humanos , Fixação Intramedular de Fraturas/métodos , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/instrumentação , Fraturas do Fêmur/cirurgia , Fraturas do Fêmur/diagnóstico por imagem , Estudos Retrospectivos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Rotação , Desigualdade de Membros Inferiores/etiologia , Desigualdade de Membros Inferiores/diagnóstico por imagem , Fraturas Mal-Unidas/diagnóstico por imagem , Fraturas Mal-Unidas/cirurgia , Imageamento Tridimensional/métodos , Adulto Jovem , Mau Alinhamento Ósseo/diagnóstico por imagem , Mau Alinhamento Ósseo/etiologia , Idoso , Fêmur/diagnóstico por imagem , Fêmur/cirurgia
6.
Foot Ankle Surg ; 30(5): 406-410, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38429178

RESUMO

BACKGROUND: Many approaches to management of medial malleolar fractures are described in the literature however, their morphology is under investigated. The aim of this study was to analyse the morphology of medial malleolar fractures to identify any association with medial malleolar fracture non-union or malunion. METHODS: Patients who had undergone surgical fixation of their MMF were identified from 2012 to 2022, using electronic patient records. Retrospective analysis of their preoperative, intraoperative, and postoperative radiographs was performed to determine their morphology and prevalence of non-union and malunion. Lauge-Hansen classification was used to characterise ankle fracture morphology and Herscovici classification to characterise MMF morphology. RESULTS: A total of 650 patients were identified across a 10-year period which could be included in the study. The overall non-union rate for our cohort was 18.77% (122/650). The overall malunion rate was 6.92% (45/650). Herscovici type A fractures were significantly more frequently mal-reduced at time of surgery as compared to other fracture types (p = .003). Medial wall blowout combined with Hercovici type B fractures showed a significant increase in malunion rate. There is a higher rate of bone union in patients who had been anatomically reduced. CONCLUSION: The morphology of medial malleolar fractures does have an impact of the radiological outcome following surgical management. Medial wall blowout fractures were most prevalent in adduction-type injuries; however, it should not be ruled out in rotational injuries with medial wall blowouts combined with and Herscovici type B fractures showing a significant increase in malunions. Herscovici type A fractures had significantly higher malreductions. LEVEL OF EVIDENCE: Level 3 - Retrospective Cohort Study.


Assuntos
Fraturas do Tornozelo , Fixação Interna de Fraturas , Humanos , Fraturas do Tornozelo/cirurgia , Fraturas do Tornozelo/diagnóstico por imagem , Estudos Retrospectivos , Feminino , Masculino , Pessoa de Meia-Idade , Adulto , Idoso , Fraturas Mal-Unidas/epidemiologia , Fraturas Mal-Unidas/diagnóstico por imagem , Fraturas não Consolidadas/diagnóstico por imagem , Fraturas não Consolidadas/epidemiologia , Adulto Jovem , Consolidação da Fratura , Radiografia , Adolescente
7.
Sci Rep ; 14(1): 4930, 2024 02 28.
Artigo em Inglês | MEDLINE | ID: mdl-38418534

RESUMO

We examined the remains of an individual who was unearthed from the Tuchengzi site and was believed to be from the Warring States period in China. The remains exhibited segmental femoral fracture. We aimed to deduce the cause of fracture, medical interventions, healing process, and motion behavior after fracture healing using several techniques, including macroscopic observation, computed tomography (CT), and finite element analysis. Based on the morphology of the long bones, it appeared that the individual was male. The fractures resulted in an adduction angle of 5.47° and an anterior flexion angle of 21.34° in the proximal femur, while the femoral neck anteversion angle had been replaced by a retroversion angle of 10.74°. Additionally, the distal femur formed an abnormal anterior convex angle of 144.60°. CT revealed mature callus formation and visible trabecular bundles. The finite element analysis indicated that the maximum von Mises stress in the femur was 17.44 MPa during standing and 96.46 MPa during walking. We suggest that medical practitioners in the Warring States period possessed a good knowledge of thigh anatomy, enabling them to perform fracture reduction and fixation. Reasonable medical intervention facilitated fracture healing and load recovery. Satisfactory fracture healing ensured that the individual could engage in normal standing and walking activities after rehabilitation.


Assuntos
Fraturas do Fêmur , Fraturas Mal-Unidas , Masculino , Humanos , Fraturas Mal-Unidas/diagnóstico por imagem , Prognóstico , Fêmur/diagnóstico por imagem , Fraturas do Fêmur/diagnóstico por imagem , Fraturas do Fêmur/cirurgia , Colo do Fêmur , Fixação Interna de Fraturas/métodos , Consolidação da Fratura , Análise de Elementos Finitos , Fenômenos Biomecânicos
8.
Eur J Trauma Emerg Surg ; 50(1): 37-47, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38261077

RESUMO

PURPOSE: There is a debate whether corrective osteotomies of the distal radius should be performed using a 3D work-up with pre-contoured conventional implants (i.e., of-the-shelf) or patient-specific implants (i.e., custom-made). This study aims to assess the postoperative accuracy of 3D-assisted correction osteotomy of the distal radius using either implant. METHODS: Twenty corrective osteotomies of the distal radius were planned using 3D technologies and performed on Thiel embalmed human cadavers. Our workflow consisted of virtual surgical planning and 3D printed guides for osteotomy and repositioning. Subsequently, left radii were fixated with patient-specific implants, and right radii were fixated with pre-contoured conventional implants. The accuracy of the corrections was assessed through measurement of rotation, dorsal and radial angulation and translations with postoperative CT scans in comparison to their preoperative virtual plan. RESULTS: Twenty corrective osteotomies were executed according to their plan. The median differences between the preoperative plan and postoperative results were 2.6° (IQR: 1.6-3.9°) for rotation, 1.4° (IQR: 0.6-2.9°) for dorsal angulation, 4.7° (IQR: 2.9-5.7°) for radial angulation, and 2.4 mm (IQR: 1.3-2.9 mm) for translation of the distal radius, thus sufficient for application in clinical practice. There was no significant difference in accuracy of correction when comparing pre-contoured conventional implants with patient-specific implants. CONCLUSION: 3D-assisted corrective osteotomy of the distal radius with either pre-contoured conventional implants or patient-specific implants results in accurate corrections. The choice of implant type should not solely depend on accuracy of the correction, but also be based on other considerations like the availability of resources and the preoperative assessment of implant fitting.


Assuntos
Fraturas Mal-Unidas , Fraturas do Rádio , Cirurgia Assistida por Computador , Humanos , Rádio (Anatomia)/diagnóstico por imagem , Rádio (Anatomia)/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Cirurgia Assistida por Computador/métodos , Fraturas Mal-Unidas/cirurgia , Osteotomia/métodos
9.
J Hand Surg Eur Vol ; 49(3): 359-365, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37310077

RESUMO

The aim of this study was to assess bone healing and secondary fracture displacement after corrective osteotomy of the distal radius without any cortical contact using palmar locking plates without bone grafting. Between 2009 and 2021, 11 palmar corrective osteotomies of extra-articular malunited distal radius fractures and palmar plate fixations without the use of bone grafts and without cortical contact, were assessed. All patients showed complete osseous restoration and significant improvement in all radiographic parameters. Except for one patient, there were no secondary dislocations or loss of reduction in the postoperative follow-up. Bone grafts may not be mandatory for bone healing and prevention of secondary fracture displacement after palmar corrective osteotomy without cortical contact and fixation with palmar locking plate.Level of evidence: IV.


Assuntos
Fraturas Mal-Unidas , Placa Palmar , Fraturas do Rádio , Humanos , Rádio (Anatomia)/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Transplante Ósseo , Radiografia , Fixação Interna de Fraturas , Fraturas Mal-Unidas/diagnóstico por imagem , Fraturas Mal-Unidas/cirurgia , Osteotomia , Placas Ósseas , Seguimentos
10.
J Spinal Cord Med ; 47(2): 293-299, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-36977321

RESUMO

BACKGROUND: Nearly 50% of all persons with a spinal cord injury/disorder (SCI/D) will sustain an osteoporotic fracture sometime in their life, with lower extremity fractures being the most common. There are a number of complications that can occur post fracture, including fracture malunion. To date, there have been no dedicated investigations of malunions among persons with SCI/D. OBJECTIVES: The primary objective of this study was to identify risk factors associated with fracture malunion among fracture-related (type of fracture, fracture location, initial fracture treatment) and SCI/D-related factors. Secondary objectives were to describe treatment of fracture malunions and complications following these malunions. METHODS: Veterans with SCI/D with an incident lower extremity fracture and subsequent malunion from Fiscal Year (FY) 2005-2015 were selected from the Veteran Health Administration (VHA) databases using International Classification of Diseases, 9th edition (ICD-9) codes for lower extremity fractures and malunion. These fracture malunion cases underwent electronic health record (EHR) review to abstract information on potential risk factors, treatments and complications for malunion. Twenty-nine cases were identified with a fracture malunion with 28 of them successfully matched with Veterans with a lower extremity fracture during FY2005-FY2014 without a malunion (matched 1:4) based on having an outpatient utilization date of care within 30 days of the fracture case. There was trend towards more nonsurgical treatment in the malunion group (n = 27, 96.43%) compared to the control group (n = 101, 90.18%) (P = 0.05), though fracture treatment proved not to be not associated with developing a malunion in univariate logistic regression analyses (OR = 0.30; 95% CI: 0.08-1.09). In multivariate analyses, Veterans with tetraplegia were significantly less likely (approximately 3-fold) to have a fracture malunion (OR = 0.38; 95% CI: 0.14-0.93) compared to those with paraplegia. Fracture malunion was significantly less likely to occur for fractures of the ankle (OR = 0.02; 95% CI: 0-0.13) or the hip (OR = 0.15; 95% CI: 0.03-0.56) compared to femur fractures. Fracture malunions were rarely treated. The most common complications following malunions were pressure injuries (56.3%) followed by osteomyelitis (25.0%). CONCLUSIONS: Persons with tetraplegia as well as fractures of the ankle and hip (compared to the femur) were less likely to develop a fracture malunion. Attention to prevention of avoidable pressure injuries following a fracture malunion is important.


Assuntos
Fraturas do Fêmur , Fraturas Mal-Unidas , Úlcera por Pressão , Doenças da Medula Espinal , Traumatismos da Medula Espinal , Veteranos , Humanos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/epidemiologia , Fraturas Mal-Unidas/complicações , Fraturas Mal-Unidas/epidemiologia , Extremidade Inferior , Quadriplegia
12.
J Hand Surg Eur Vol ; 49(3): 329-333, 2024 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37694946

RESUMO

The aim of the present study was to explore the incidence of corrective osteotomies after conservatively treated distal radial fracture and the risk for late correction depending on the patient's age. Based on data from the Finnish National Care Register of Health Care, Specialist Care, on all corrective osteotomies carried out in Finland during 2015-2019 in adults aged ≥20 years, we calculated the mean annual incidence rates per 100,000 person-years, standardized with the European Standard Population 2013. Using multivariable logistic regression, we calculated the risk of corrective osteotomies in various age groups. In total, 41,418 distal radial fractures were identified. Of those, 10,577 received surgical treatment in the acute phase. The incidence rate of primary operations for distal radial fractures was 47.9 per 100, 000 person-years. A total of 321 conservatively treated fractures needed corrective osteoteomy, with a surprisingly low mean annual incidence rate of 1.5 per 100,000 person-years. The risk for this was highest in patients in their fourth or fifth decade.Level of evidence: III.


Assuntos
Fraturas Mal-Unidas , Fraturas do Rádio , Adulto , Humanos , Fraturas do Rádio/epidemiologia , Fraturas do Rádio/cirurgia , Fraturas Mal-Unidas/epidemiologia , Fraturas Mal-Unidas/cirurgia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Osteotomia , Resultado do Tratamento
13.
Tech Hand Up Extrem Surg ; 28(2): 74-79, 2024 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-38098299

RESUMO

Symptomatic varus malunion after proximal humeral fractures is associated with weakness and painful limitation of shoulder range of motion. When there is conformity of the articular surface and no avascular necrosis, a head-preserving procedure is best indicated. Arthroscopic arthrolysis, subacromial decompression, and tuberoplasty have been described for the treatment of mild deformity. In cases with more severe deformity, corrective extracapsular lateral closing wedge valgus osteotomy has been reported as a reliable treatment option, in terms of both pain relief and improved function. While this procedure adequately restores rotator cuff tensioning, it is associated with a shortening of the lever arm to the deltoid muscle, secondary to a loss of humeral length. We describe our technique and results with a vascular-sparing, medial open-wedge osteotomy, using a structural allograft and lateral locking plate. In our opinion, this procedure is safe and effective, with the potential to improve functional outcomes in young and active patients.


Assuntos
Osteotomia , Humanos , Osteotomia/métodos , Fraturas do Ombro/cirurgia , Placas Ósseas , Masculino , Úmero/cirurgia , Feminino , Fraturas Mal-Unidas/cirurgia , Pessoa de Meia-Idade , Adulto , Amplitude de Movimento Articular
14.
Injury ; 54(10): 110934, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37478691

RESUMO

BACKGROUND: Malunited posterior pilon fractures with talus dislocation (mPPFtd) are rare and there are no appropriate treatment strategies. The purpose of this study was to introduce a stepped strategy featuring preliminary soft tissue management according to the Ilizarov principle and delayed open reduction and internal fixation (ORIF) through a modified posteromedial approach to overcome rigid soft tissue contracture. METHOD: From February 2015 to August 2021, 12 selected patients with mPPFtd who were treated with the staged protocol (Group A) were retrospectively analysed. The clinical and radiographic outcomes were evaluated using the American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot score, the visual analogue scale (VAS) score, and the Burwell-Charnley score. Moreover, this case series was compared with some cases of fresh fracture (Group B) in patients that had the same baseline data from our previous study. RESULTS: In Group A, the average length of time between the date of injury and the date of surgery was 4.8 ± 3.3 months. The average time to external fixator distraction, as the first-stage treatment, was 13.4 ± 1.0 days. In the second stage of ORIF, the posterosuperior dislocation of the talus was corrected with osteotomy and leverage manoeuvres. According to the Burwell-Charnley score system, the reduction quality was excellent in 9 cases and good in 3 cases. After a mean follow-up of 3.8 ± 2.1 years, there were no infections, wound healing problems, or nerve injuries in our cohort, and union was observed in all fractures without a loss of reduction. The baseline data of the two groups were not significantly different (p>0.05). The mean AOFAS score in Group A was 85.0 ± 10.5 and that in Group B was 95.4 ± 6.1 (p<0.05). The mean VAS score in Group A was 1.7 ± 1.4 and that in Group B was 0.7 ± 0.9 (p<0.05). CONCLUSION: A staged surgical treatment strategy characterized by soft tissue management will improve the treatment of mPPFtd and produce satisfactory clinical outcomes. LEVEL OF EVIDENCE: Level IV, retrospective case series.


Assuntos
Fraturas do Tornozelo , Fraturas Mal-Unidas , Fraturas da Tíbia , Humanos , Estudos Retrospectivos , Fixação Interna de Fraturas/métodos , Resultado do Tratamento , Fraturas do Tornozelo/complicações , Fraturas do Tornozelo/diagnóstico por imagem , Fraturas do Tornozelo/cirurgia , Fraturas da Tíbia/diagnóstico por imagem , Fraturas da Tíbia/cirurgia , Fraturas Mal-Unidas/diagnóstico por imagem , Fraturas Mal-Unidas/cirurgia , Protocolos Clínicos
15.
Oper Orthop Traumatol ; 35(5): 258-269, 2023 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-37129610

RESUMO

OBJECTIVE: Restoration of the original anatomy with reduction of both current symptoms and risk of posttraumatic osteoarthritis. INDICATIONS: Symptomatic intra- or extra-articular malunion due to limitation of movement and/or painful function, intra-articular step of > 1 mm, instability of the distal radioulnar joint. CONTRAINDICATIONS: Minimal deformity. Pre-existing osteoarthritis Knirk and Jupiter II or higher. Simpler surgical alternative, e.g., ulna shortening osteotomy. Smoking or advanced age are not contraindications. SURGICAL TECHNIQUE: Preoperative assessment and performance of a bilateral computed tomography (CT). Three-dimensional (3D) malposition analysis and calculation of the correction. Planning of the corrective osteotomy on the 3D model and creation of patient-specific drilling and sawing guides. Performing the 3D-guided osteotomy. POSTOPERATIVE MANAGEMENT: Early functional unloaded mobilization with the splint for 8 weeks until consolidation control with CT. RESULTS: Significant reduction of the step to < 1 mm (p ≤ 0.05) can be achieved with intra-articular corrections. In extra-articular corrective osteotomies, a mean residual rotational malalignment error of 2.0° (±â€¯2.2°) and a translational malalignment error of 0.6 mm (±â€¯0.2 mm) is achieved. Single-cut osteotomies in the shaft region can be performed to within a few degrees for rotation (e.g., pronation/supination 4.9°) and for translation (e.g., proximal/distal, 0.8 mm). After surgery, a mean residual 3D angle of 5.8° (SD 3.6°) was measured. Furthermore, surgical time for 3D-assisted surgery is significantly reduced compared to the conventional technique (140 ± 37 vs 108 ± 26 min; p < 0.05). Thus, the progression of osteoarthritis can be reduced in the medium term and improved mobility and grip strength are achieved. The clinical outcome parameters based on patient-rated wrist evaluation (PRWE) and the disabilities of the arm, shoulder and hand (DASH) scores are roughly comparable.


Assuntos
Fraturas Mal-Unidas , Osteoartrite , Fraturas do Rádio , Humanos , Rádio (Anatomia) , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Resultado do Tratamento , Fraturas Mal-Unidas/diagnóstico por imagem , Fraturas Mal-Unidas/cirurgia , Osteotomia/métodos , Osteoartrite/diagnóstico por imagem , Osteoartrite/cirurgia , Amplitude de Movimento Articular
16.
J Nippon Med Sch ; 90(2): 141-148, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37258255

RESUMO

Posttraumatic malunion with combination of angular, rotational, and shortening deformity of the proximal phalanx may cause scissoring of a finger and impairment of hand function. Cosmetic disfigurement and severe dysfunction of fingers require surgical correction, most often via open corrective osteotomies and rigid fixation with a plate or screws. However, such an approach requires a longer incision, inevitably results in a scar, and has a higher potential for extensor tendon adhesion. Also, abruption of the periosteum and plating of the phalange requires longer bone healing time. Thus, we devised a technique of minimally invasive correction of phalangeal malunion using an external mini-fixator. We presented representative three cases of malunited fractures of phalanges treated with the Ilizarov mini-fixator in adolescence and review reports of similar cases. The usage of Ilizarov mini-fixator provided excellent outcomes for posttraumatic malunion of three fingers.


Assuntos
Falanges dos Dedos da Mão , Fraturas Mal-Unidas , Humanos , Adolescente , Fraturas Mal-Unidas/diagnóstico por imagem , Fraturas Mal-Unidas/cirurgia , Fixação Interna de Fraturas , Falanges dos Dedos da Mão/diagnóstico por imagem , Falanges dos Dedos da Mão/cirurgia , Osteotomia/métodos , Dedos
17.
Handchir Mikrochir Plast Chir ; 55(3): 211-215, 2023 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-37156512

RESUMO

PURPOSE: To evaluate and classify carpal alignment in malunited fractures of the distal radius. MATERIALS AND METHODS: On standardized lateral radiographs of the involved wrist of 72 patients with a symptomatic extra-articular malunion of the distal radius, 43 with a dorsal and 29 with a palmar angulation, radius tilt (RT), radiolunate (RL) and lunocapitate angle were measured. Malposition of the radius was defined as RT plus 11° in dorsal malunion and RT minus 11° in palmar malunion. A palmar tilt of the radius was marked with a minus sign. At the time of corrective osteotomy 9 dorsal malunions underwent for different reasons evaluation of the scapholunate ligament with 4 having a complete scapholunate ligament disruption. RESULTS: With respect to the RL-angle, carpal malalignment was categorized as follows: type P with a RL-angle less than -12°, type K with a RL-angle between -12 and 10°, type A with a RL-angle more than 10°, but less than the malposition of the radius, type D with a RL-angle greater than the malposition of the radius. All types of carpal malalignment were found in both, dorsally and palmarly tilted malunion. Type A carpal alignment was identified as the leading type in dorsal malunion (25 out of 43 patients), whilst in palmar malunion colinear subluxation of the carpus (type C) was the dominant type (12 out of 29 patients). To return the hand to a neutral position the rotation of the lunate was compensated by a contrarotation of the capitate in the dorsal malunion. In the palmar malunion a dorsal extension of the capitate returned the hand to a neutral position. In 4 of the 5 patients with type D carpal alignment, who had scapholunate ligament evaluation, a complete ligament tear was found. CONCLUSION: In this study four different types of carpal alignment in malunited extra-articular fractures of the distal radius were identified. Based on this data we suspect that type D carpal alignment in dorsal malunion may be associated with a scapholunate ligament tear. Therefore, we recommend wrist arthroscopy for this group of patients.


Assuntos
Ossos do Carpo , Fraturas Mal-Unidas , Artropatias , Fraturas do Rádio , Humanos , Rádio (Anatomia) , Fraturas Mal-Unidas/cirurgia , Fraturas do Rádio/cirurgia , Articulação do Punho
18.
JBJS Case Connect ; 13(2)2023 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-37235707

RESUMO

CASE: A 6-year-old girl who had midshaft forearm fractures treated conservatively had volar distal radioulnar joint (DRUJ) instability caused by radial malunion at the 1-year follow-up. Corrective osteotomy was planned using computer-aided design (CAD) software based on computed tomography images. According to the analysis, the radial bone had an 8° apex volar deformation in the sagittal plane. Corrective osteotomy was performed based on preoperative planning. After surgery, the patient regained full function of her right forearm without volar DRUJ instability. CONCLUSION: This case report shows that corrective osteotomy with 3D CAD analysis can help surgeons plan and accurately correct malunion.


Assuntos
Fraturas Mal-Unidas , Instabilidade Articular , Fraturas do Rádio , Feminino , Humanos , Criança , Antebraço , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/cirurgia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Fraturas Mal-Unidas/diagnóstico por imagem , Fraturas Mal-Unidas/cirurgia , Osteotomia/métodos , Ácido Dioctil Sulfossuccínico
19.
J Hand Surg Eur Vol ; 48(8): 798-802, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-36912106

RESUMO

Loss of anterior tilt after a distal radial fracture can lead to carpal malalignment, which may cause functional impairment. The aim of this study was to establish whether distal radial osteotomy for malunion, which primarily restores the dorsal tilt, will also improve carpal malalignment as measured by capitate shift. Radiographs of 67 patients who underwent osteotomy after malunion of a distal radial fracture were reviewed. Measurements of capitate shift and dorsal tilt were recorded. Linear regression modelling was used to assess the relationship between dorsal tilt and capitate shift. Change in capitate shift was strongly associated with change in dorsal tilt following osteotomy. This relationship was maintained on long-term radiographs. Capitate shift is strongly related to dorsal tilt following a distal radial fracture. Correcting the dorsal tilt during an osteotomy, therefore, will improve capitate shift and carpal malalignment. Capitate shift is unrelated to age, sex and is easy to visually assess.Level of evidence: IV.


Assuntos
Ossos do Carpo , Fraturas Mal-Unidas , Fraturas do Rádio , Humanos , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/cirurgia , Fraturas Mal-Unidas/diagnóstico por imagem , Fraturas Mal-Unidas/cirurgia , Articulação do Punho , Osteotomia
20.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 37(3): 296-301, 2023 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-36940987

RESUMO

Objective: To investigate the effectiveness of calcaneal V-shaped osteotomy combined with subtalar arthrodesis in the treatment of Stephens Ⅱand Ⅲ calcaneal fracture malunion. Methods: The clinical data of 24 patients with severe calcaneal fracture malunion treated by calcaneal V-shaped osteotomy combined with subtalar arthrodesis between January 2017 and December 2021 were retrospectively analyzed. There were 20 males and 4 females with an average age of 42.8 years (range, 33-60 years). Conservative treatment of calcaneal fracture failed in 19 cases and operation failed in 5 cases. Stephens classification of calcaneal fracture malunion was type Ⅱ in 14 cases, and type Ⅲ in 10 cases. Preoperative Böhler angle of calcaneus was 4.0°-13.5° (mean, 8.6°), Gissane angle was 100°-152° (mean, 119.3°). The time from injury to operation was 6-14 months (mean, 9.7 months). American Orthopedic Foot and Ankle Society (AOFAS) ankle and hindfoot score and visual analogue scale (VAS) score were used to evaluate the effectiveness before operation and at last follow-up. Bone healing was observed and the healing time was recorded. The talocalcaneal height, talus inclination angle, Pitch angle, calcaneal width, and hindfoot alignment angle were measured. Results: Necrosis of the cuticle edge of the incision occurred in 3 cases, which were cured by dressing change and oral administration of antibiotic therapy. The other incisions healed by first intention. All the 24 patients were followed up 12-23 months, with an average of 17.1 months. The foot shape of the patients recovered well, the shoes were restored to the size before injury, and there was no anterior ankle impingement. Bone union was achieved in all patients, and the healing time ranged from 12 to 18 weeks, with an average of 14.1 weeks. At last follow-up, no adjacent joint degeneration occurred in all patients; 5 patients had mild foot pain during walking, which had no significant impact on daily life and work; no patient needed revision surgery. The AOFAS ankle and hindfoot score was significantly higher than that before operation ( P<0.001), the results were excellent in 16 cases, good in 4 cases, and poor in 4 cases, and the excellent and good rate was 83.3%. The VAS score, talocalcaneal height, talus inclination angle, Pitch angle, calcaneal width, and hindfoot alignment angle were significantly improved after operation ( P<0.001). Conclusion: Calcaneal V-shaped osteotomy combined with subtalar arthrodesis can effectively relieve hindfoot pain, correct talocalcaneal height, restore talus inclination angle, and reduce the risk of nonunion after subtalar arthrodesis.


Assuntos
Traumatismos do Tornozelo , Calcâneo , Fraturas Ósseas , Fraturas Mal-Unidas , Masculino , Feminino , Humanos , Adulto , Fraturas Mal-Unidas/cirurgia , Calcâneo/cirurgia , Calcâneo/lesões , Estudos Retrospectivos , Resultado do Tratamento , Fraturas Ósseas/cirurgia , Artrodese/métodos , Osteotomia
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