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1.
Arch Orthop Trauma Surg ; 144(1): 543-550, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-37971511

RESUMO

INTRODUCTION: The purpose of this study is to evaluate whether using a Fracture Healing Patch (FHP) device that generates pulsed electromagnetic fields (PEMF), applied at the fracture site immediately after open reduction and internal fixation surgery, can accelerate healing of acute distal radius fractures. METHODS: In a prospective, double-blind, randomized, and sham-controlled study, thirty-two patients with DRFs treated with ORIF were included. Patients were allocated to a PEMF (active) group (n = 15) or a control (sham) group (n = 17). All patients were assessed with regard to functional Patient-Rated Wrist Evaluation (PRWE), SF12, and radiological union outcomes (X-rays and computed tomography (CT) scans) at 2, 4, 6, and 12 weeks postoperatively. RESULTS: Patients treated with the FHP demonstrated significantly bone bridging at 4 weeks as assessed by CT (70% vs 54%, p = 0.05). Mean grip strength in the active group was significantly higher as compared to control (16 ± 9 kg vs 7 ± 3.5 kg, respectively, p = 0. 02). The function subscale of the PRWE was significantly better in PEMF-treated group at 6 weeks after surgery (27.2 VS 35.5, p = 0.04). No statistically significant differences were found in SF12. CONCLUSION: PEMF application after ORIF of DRFs is safe, may accelerate bone healing which could lead to an earlier return to daily life activities and work. LEVEL OF EVIDENCE: I.


Assuntos
Fraturas do Rádio , Fraturas do Punho , Humanos , Projetos Piloto , Campos Eletromagnéticos , Estudos Prospectivos , Resultado do Tratamento , Fixação Interna de Fraturas/métodos , Fraturas do Rádio/cirurgia
2.
Eur J Orthop Surg Traumatol ; 29(8): 1679-1685, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31280368

RESUMO

INTRODUCTION: Elbow joint stiffness is a common complication following elbow trauma or surgery. Current practices include first-line treatment with physiotherapy and various types of splints. In cases where early postoperative loss of elbow motion interferes with activities of daily living, manipulation under anesthesia (MUA) is considered a viable treatment option, but there is currently only limited data on the results of this procedure and its complications. MATERIALS AND METHODS: This retrospective study was comprised of 12 consecutive patients who underwent MUA for the treatment of postsurgical elbow stiffness in one institution between 2010 and 2017. Their pre- and post-manipulation range of motion and their functional scores were assessed. RESULTS: MUA was performed at a mean of 52 days (range 39-91 days) following the last surgical intervention, and the patients were followed for a mean of 3 years (range 0.75-7 years). The average flexion-extension arc of motion improved by 53.8°, and the average rotation arc improved by 57°. The average Mayo Elbow Performance Score was 73 (range 0-100) at the latest follow-up. Two patients eventually underwent an open elbow contracture release due to poor post-manipulation results. There were no post-MUA complications. CONCLUSIONS: MUA of a postoperative stiff elbow can improve both flexion-extension and rotatory arc of motion in cases of early evolving postoperative stiffness and should be part of the armamentarium for the treatment of this often debilitating condition.


Assuntos
Articulação do Cotovelo/fisiopatologia , Manipulação Ortopédica/métodos , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Amplitude de Movimento Articular , Atividades Cotidianas , Adulto , Idoso , Criança , Sedação Consciente , Feminino , Seguimentos , Humanos , Masculino , Manipulação Ortopédica/efeitos adversos , Pessoa de Meia-Idade , Bloqueio Nervoso , Rotação , Adulto Jovem
3.
Skeletal Radiol ; 47(6): 833-837, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29356843

RESUMO

OBJECTIVES: Intraoperative hairline longitudinal fractures were recently reported in association with distal radius volar plating. Our aim was to further analyze this newly described complication. METHODS: A retrospective radiographic and chart review was performed on 225 patients who underwent distal radius plating between June 2013 and June 2015. The Acu-Loc/Acu-Loc2© plating system (Acumed, Hillsboro, OR, USA) was used in 208 cases, and the VariAx© plating system (Stryker, Kalamazoo, MI, USA) was used in 17 cases. Three independent reviewers performed a blind evaluation of all relevant radiographs for the occurrence of longitudinal fractures around the plate, and validity was considered only when there was agreement among all three of them. RESULTS: Hairline longitudinal fractures were identified in 57 cases (25%), 55 with the Acu-Loc/Acu-Loc2© system and 2 with the VariAx© system. All fractures occurred with volar plating. Fracture occurrence was associated with age over 59 years, female gender, extra-articular fractures, and the use of Hexalobe screws (Acu-Loc/Acu-Loc2© system). CONCLUSIONS: We believe that the source of fracture occurrence lies within the screw design and that better screw design and possibly tapping in patients at risk may reduce the occurrence of intraoperative hairline longitudinal fractures. Further clinical and biomechanical research is needed to better understand this newly reported complication.


Assuntos
Placas Ósseas/efeitos adversos , Fixação Interna de Fraturas/efeitos adversos , Fixação Interna de Fraturas/instrumentação , Complicações Intraoperatórias/diagnóstico por imagem , Complicações Intraoperatórias/etiologia , Fraturas do Rádio/etiologia , Fraturas do Rádio/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fluoroscopia , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/diagnóstico por imagem , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento
4.
Arch Orthop Trauma Surg ; 138(4): 591-596, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29453642

RESUMO

INTRODUCTION: Repeated attempts of closed reduction of distal radius fractures (DRF) are performed in the emergency department setting to optimize fracture alignment and avoid surgery. The additional manipulation of the fracture may, however, increase dorsal comminution and lead to loss of reduction in the cast. This retrospective cohort study has investigated the effect of second reduction attempt on fracture alignment and comminution. MATERIALS AND METHODS: Six-hundred-eighteen patients with DRF were treated in the medical center in 2007-2010. Seventy-six (12.3%) DRF who underwent two reductions were included in the study. Radiographs taken after the first and second reduction attempts were reviewed for changes in fracture alignment parameters (radial height, radial inclination, volar tilt) and dorsal comminution length. Patients were also followed retrospectively to determine the rates of secondary displacement in a cast. RESULTS: A second closed reduction attempt improved mean radial height by 1.43 mm, mean radial inclination by 1.62° and mean volar tilt by 8.75°. Mean dorsal comminution length increased by 1.6 mm. Of the 19 (25%) patients with acceptable alignments after two reduction attempts, follow-up radiographs were available for 12, which showed successful reduction in four cases (33.3 or 5.2% of total 76 patients). CONCLUSIONS: A second closed reduction attempt improved immediate fracture alignment, but also worsened dorsal comminution. Only 5.2% of patients who underwent two reduction attempts had an acceptable final alignment and did not require surgery. Increased dorsal comminution may further compromise fracture stability, complicate surgery and have negative effect on the postoperative course.


Assuntos
Redução Fechada/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Fraturas do Rádio , Humanos , Radiografia , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/terapia , Estudos Retrospectivos
5.
J Pers Med ; 14(9)2024 Sep 21.
Artigo em Inglês | MEDLINE | ID: mdl-39338260

RESUMO

Introduction: Mason Type 3 radial-head fractures are typically treated with open reduction and internal fixation (ORIF) or radial-head arthroplasty (RHA). Prosthetic options include traditional monobloc implants and newer modular implants designed to match patient anatomy. While short- and medium-term outcomes of metallic RHA are generally favorable, this study aims to compare the long-term outcomes of patients treated with monobloc versus modular implants. Methods: The medical records of all the patients who underwent RHA at a level I trauma center between 2000 and 2011 were retrospectively reviewed. Patients who were available for follow-up were invited for reassessment, which included physical examination, questionnaires for the assessment of elbow pain and function, and follow-up radiographs. Results: Out of 35 patients who had RHA, 13 (37%) had a monobloc prosthesis and 22 (63%) had a modular prosthesis. Out of the patients that could be traced, 4 patients from the monobloc group and 10 patients from the modular group agreed to participate in the study. The mean follow-up time was 15 years in the monobloc group and 12.4 years in the modular group. Patients in the modular group demonstrated superior functional outcomes compared to the monobloc group, with statistically significant improvements in MEPS and DASH scores and a non-significant trend towards better ASES scores and VAS scores. Physical examination revealed a decline in function in the operated arm for both groups, with statistically significant differences favoring the modular group in elbow flexion and extension. Radiographic analysis showed varying degrees of implant loosening, with the modular group exhibiting less loosening compared to the monobloc group. Mild degenerative changes and heterotopic ossification were also observed, predominantly in the modular group. Conclusions: The results suggest that modular implants offer superior functional outcomes compared to monobloc implants. The modular group showed statistically significant improvements in elbow flexion and extension. These findings indicate that modular implants may be a more favorable option for enhancing patient outcomes. Further research with larger sample sizes is recommended to confirm these trends and to better understand the long-term benefits of modular implants.

6.
J Wrist Surg ; 13(2): 151-157, 2024 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-38505202

RESUMO

Background Open reduction and internal fixation of distal radius fractures is one of the most common procedures performed in wrist surgery. The use of volar locking plate has gained increasing interest in the past decade. Epiphyseal fixation can be done either with locking screws or smooth locking pegs, with no evidence supporting the use of one rather than the other. Purpose The aim of this study is to compare the stability of distal radius fixation by volar locking plate using locking screws or smooth locking pegs. Methods Adult patients with A2-A3 AO fractures treated with a volar plate with locking screws only or smooth locking pegs only were retrospectively included. Radiographic assessment was performed to evaluate extra-articular parameters in the intraoperative postreduction and fixation period and after bony healing. Forty-seven distal radius fractures were included. Results Twenty-four fractures had fixation with locking screws and 23 had fixation with smooth locking pegs. For both groups, all radiographic parameters measured showed a statistically significant difference between the intraoperative postreduction and fixation period and the remote postoperative period after union of the fracture ( p < 0.05) attesting a slight loss of reduction. Nevertheless, there were no significant differences between the groups in radiographic extra-articular parameters. Conclusion This clinical study shows that there is no difference in stability fixation between locking screws or smooth locking pegs in A2-A3 distal radius fractures. Clinical Relevance The use of smooth locking pegs only for epiphyseal fixation appears to be safe in volar plating of A2-A3 distal radius fractures in adult patients and could be an alternative to locking screws. More clinical data are needed to confirm these results. Level of Evidence Level III; retrospective comparative study.

7.
J Clin Med ; 12(5)2023 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-36902653

RESUMO

BACKGROUND: this pilot study aimed at determining whether the application of a novel new method of generating pulsed electromagnetic field (PEMF), the Fracture Healing Patch (FHP), accelerates the healing of acute distal radius fractures (DRF) when compared to a sham treatment. METHODS: 41 patients with DRFs treated with cast immobilization were included. Patients were allocated to a PEMF group (n = 20) or a control (sham) group (n = 21). All patients were assessed with regard to functional and radiological outcomes (X-rays and CT scans) at 2, 4, 6 and 12 weeks. RESULTS: fractures treated with active PEMF demonstrated significantly higher extent of union at 4 weeks as assessed by CT (76% vs. 58%, p = 0.02). SF12 mean physical score was significantly higher in PEMF treated group (47 vs. 36, p = 0.005). Time to cast removal was significantly shorter in PEMF treated patients, 33 ± 5.9 days in PEMF vs. 39.8 ± 7.4 days in sham group (p = 0.002). CONCLUSION: early addition of PEMF treatment may accelerate bone healing which could lead to a shorter cast immobilization, thus allowing an earlier return to daily life activities and work. There were no complications related to the PEMF device (FHP).

8.
J Orthop Trauma ; 36(12): 634-638, 2022 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-36399675

RESUMO

OBJECTIVES: To assess outcomes and complications of conservatively managed humeral diaphyseal fractures in elderly patients, with an emphasis on the subgroup diagnosed with dementia. DESIGN: Retrospective. SETTING: Upper extremity surgery unit at an academic Level I trauma center. PATIENTS/PARTICIPANTS: Consecutive patients 65 years of age and older who were managed conservatively for humeral diaphyseal fractures between 2007 and 2015. INTERVENTION: Conservatively managed humeral diaphyseal fractures. MAIN OUTCOME MEASUREMENTS: Complications and radiographic outcomes. RESULTS: One-hundred twenty-four patients who were conservatively managed for humeral diaphyseal fractures were identified. Their mean age was 77 (65-92) years, 36 (30%) of them were male and 88 (70%) were female. Fifty-seven (46%) patients experienced complications associated with their treatment, and 33 (27%) patients were eventually treated surgically. Seventeen (14%) patients were diagnosed with dementia. This subgroup had 64% fracture-related complications, and all of them were operated (P-value <0.01 compared with age-matched patients among the other 107 participants in the study). CONCLUSION: Conservative management of humeral diaphyseal fractures seems to be associated with greater morbidity in elderly patients, especially in those diagnosed with dementia. Therefore, early surgical treatment should be considered. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Demência , Fraturas do Úmero , Humanos , Masculino , Feminino , Idoso , Tratamento Conservador , Estudos Retrospectivos , Fraturas do Úmero/terapia , Fraturas do Úmero/cirurgia , Úmero , Demência/complicações
9.
Artigo em Inglês | MEDLINE | ID: mdl-19124552

RESUMO

To assess the efficacy in providing improved function and pain relief by administering 8 weeks of acupuncture as adjunctive therapy to standard care in elderly patients with OA of the knee. This randomized, controlled, blinded trial was conducted on 55 patients with OA of the knee. Forty-one patients completed the study (26 females, 15 males, mean age ± SD 71.7 ± 8.6 years). Patients were randomly divided into an intervention group that received biweekly acupuncture treatment (n = 28) and a control group that received sham acupuncture (n = 27), both in addition to standard therapy, for example, NSAIDS, cyclooxygenase-2 inhibitors, acetaminophen, intra-articular hyaluronic acid and steroid injections. Primary outcomes measures were changes in the Knee Society Score (KSS) knee score and in KSS function and pain ratings at therapy onset, at 8 weeks (closure of study) and at 12 weeks (1 month after last treatment). Secondary outcomes were patient satisfaction and validity of sham acupuncture. There was significant improvement in all three scores in both groups after 8 and 12 weeks compared with baseline (P < .05). Significant differences between the intervention and control groups in the KSS knee score (P = .036) was apparent only after 12 weeks. Patient satisfaction was higher in the intervention group. Adjunctive acupuncture treatment seems to provide added improvement to standard care in elderly patients with OA of the knee. Future research should determine the optimal duration of acupuncture treatment in the context of OA.

10.
Harefuah ; 150(1): 50-5, 67, 2011 Jan.
Artigo em Hebraico | MEDLINE | ID: mdl-21449158

RESUMO

Scaphoid fracture is the most common fracture in carpal bone of the wrist and represents 11% of all upper extremity fractures. In most cases, the mechanism of injury is a fall with an outstretched hand. Scaphoid fracture detection can be made by clinical examination and standard radiography. Computed tomography (CT), bone scan and MRI improve the sensitivity of the diagnosis. Non-displaced fractures of the scaphoid are treated with cast immobilization in most cases. Operative treatment should be considered in displaced fractures or non-displaced fractures in young active patients by using internal fixation with cannulated screw for definitive anatomic and stable fixation. The main goals of operative treatment are attempts to reduce immobilization time and enable earlier return to work and activity. Displaced fractures of scaphoid, should be treated operatively, as they carry a greater risk for nonunion and malunion, which are associated with the development of radiocarpal arthritis, stiffness and wrist instability. Computed tomography is more useful as an assessment tool in pre-operative planning to determine the fracture location and fragment displacement. Early detection and appropriate treatment of scaphoid fractures is the key to favorable outcome in the treatment of scaphoid fractures.


Assuntos
Fraturas Ósseas/cirurgia , Osso Escafoide/cirurgia , Parafusos Ósseos , Moldes Cirúrgicos , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/classificação , Fraturas Ósseas/diagnóstico , Fraturas Mal-Unidas/etiologia , Fraturas não Consolidadas/etiologia , Humanos , Imageamento por Ressonância Magnética , Osso Escafoide/lesões , Sensibilidade e Especificidade , Fatores de Tempo , Tomografia Computadorizada por Raios X , Resultado do Tratamento
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