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1.
Orthopade ; 43(4): 347-52, 2014 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-24671347

RESUMO

BACKGROUND: In the context of osteoporotic fractures, injuries to the distal humerus are quite uncommon, meaning that each surgeon will have only limited experience. OBJECTIVE: This leads automatically to the question to what extent treatment recommendations can be transferred to the geriatric population. METHODS: Looking at the evidence-based literature, recommendations could be limited to three prospective studies. However, this only means that the remaining literature sources do not provide sufficient statistical power to be able to draw conclusions. RESULTS AND DISCUSSION: For the population of geriatric patients a thorough compilation of the contemporary literature is advisable. This review article on the currently available literature evaluates and individually discusses the relevant aspects of fracture treatment in order to develop recommendations for routine daily practice.


Assuntos
Lesões no Cotovelo , Articulação do Cotovelo/cirurgia , Fixação Interna de Fraturas/métodos , Fraturas do Úmero/cirurgia , Instabilidade Articular/prevenção & controle , Instabilidade Articular/cirurgia , Fraturas por Osteoporose/cirurgia , Idoso , Idoso de 80 Anos ou mais , Articulação do Cotovelo/diagnóstico por imagem , Medicina Baseada em Evidências , Feminino , Fixação Interna de Fraturas/instrumentação , Humanos , Fraturas do Úmero/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/diagnóstico por imagem , Radiografia , Resultado do Tratamento
2.
Orthopade ; 43(11): 1008-15, 2014 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-25348799

RESUMO

BACKGROUND: Lesions of the popliteal artery during high tibial osteotomy are rare complications, consequently the majority of publications are case related. The interval between surgery and diagnosis is reported to be as long 3 years; therefore, the current literature probably does not reflect the true incidence of vascular injuries. OBJECTIVE: The case reports published in the literature were further evaluated. The focus was on the normal vascular anatomy of the popliteal region and anatomical deviations that predispose to vascular injury. As the flexion angle of the knee joint is considered to be decisive for vascular injury, this aspect was also an additional focus. For the unlikely event of a vascular injury, recommendations are presented which indicate diagnostic and therapeutic decisions. METHODS: We analyzed the available literature and present own magnetic resonance imaging (MRI) investigations of the popliteal artery with different angles of flexion in six healthy volunteers. RESULTS AND DISCUSSION: A variation of the origin of the anterior tibial artery with a course between the posterior tibial cortex and the popliteal muscle was found in 6% of all patients and predisposes to an accidental injury during osteotomy. The results in the literature and our own MRI findings suggest that a flexion angle of 90° facilitates anatomical dissection and osteotomy but cannot be regarded as a reliable protection against vascular injury.


Assuntos
Osteoartrite do Joelho/cirurgia , Osteotomia/efeitos adversos , Artéria Poplítea/lesões , Tíbia/cirurgia , Lesões do Sistema Vascular/etiologia , Causalidade , Comorbidade , Humanos , Incidência , Articulação do Joelho/cirurgia , Osteoartrite do Joelho/epidemiologia , Osteotomia/métodos , Artéria Poplítea/anormalidades , Artéria Poplítea/anatomia & histologia , Artéria Poplítea/patologia , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Prevalência , Fatores de Risco , Tíbia/irrigação sanguínea , Lesões do Sistema Vascular/epidemiologia , Lesões do Sistema Vascular/cirurgia
3.
Orthopade ; 43(4): 365-73, 2014 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-24647771

RESUMO

BACKGROUND: The aim of open reduction and internal fixation (ORIF) of fractures around the knee joint is the exact anatomic reconstruction of joint surfaces in order to achieve an early and load stable bone situation. Primary endoprosthetics as the initial treatment can represent an alternative treatment option for a closely selected number of geriatric patients. OBJECTIVES: The chances and risks of primary endoprosthetics in comparison to ORIF as the gold standard for initial treatment of fractures close to the knee joint in the elderly are presented MATERIAL AND METHODS: A selective search of the literature was carried out in consideration of national recommendations and own experience gained as head of a center for geriatric traumatology. RESULTS: If the soft tissue coverage is not damaged by the injury, primary endoprosthetics can offer advantages compared to ORIF when a load stable joint is indispensable due to poor compliance, pre-existing arthritis and advanced age. DISCUSSION: The risk of postoperative loss of correction is minimized by the prosthesis but the revision possibilities are very limited due to voluminous prostheses with a high degree of coupling. The indications for primary prosthesis implantation for acute treatment of fractures close to the knee should therefore be closely controlled because this should be the first and last intervention for fracture treatment in geriatric patients.


Assuntos
Artroplastia do Joelho/estatística & dados numéricos , Fixação Interna de Fraturas/estatística & dados numéricos , Fraturas Ósseas/epidemiologia , Fraturas Ósseas/cirurgia , Traumatismos do Joelho/cirurgia , Fraturas por Osteoporose/epidemiologia , Fraturas por Osteoporose/cirurgia , Idoso , Idoso de 80 Anos ou mais , Medicina Baseada em Evidências , Feminino , Consolidação da Fratura , Humanos , Traumatismos do Joelho/epidemiologia , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Resultado do Tratamento
4.
Artigo em Inglês | MEDLINE | ID: mdl-25011200

RESUMO

The majority of fractures of the anterior pelvic ring is treated non-operatively. However, a number of patients do not get pain free and cannot be mobilized. Since the supra-acetabular external fixator is associated with significant complications we developed an alternative technique based on recent anatomical studies. This article is a clinical feasibility study to evaluate a novel stabilization technique for fractures of the anterior pelvic ring in the elderly patient. This technique obtains rapid pain reduction and early ambulation in this group of patients.


Assuntos
Placas Ósseas , Fixadores Externos , Procedimentos Ortopédicos/métodos , Fraturas por Osteoporose/cirurgia , Ossos Pélvicos/lesões , Acetábulo , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ossos Pélvicos/cirurgia
5.
Artigo em Inglês | MEDLINE | ID: mdl-38819678

RESUMO

PURPOSE: Despite the availability of clinical guidelines for hip fracture patients, adherence to these guidelines is challenging, potentially resulting in suboptimal patient care. The goal of this study was (1) to evaluate and benchmark the adherence to recently established quality indicators (QIs), and (2) to study clinical outcomes, in fragile hip fracture patients from different European countries. METHODS: This observational, cross-sectional multicenter study was performed in 10 hospitals from 9 European countries including data of 298 consecutive patients. RESULTS: A large variation both within and between hospitals were seen regarding adherence to the individual QIs. QIs with the lowest overall adherence rates were the administration of systemic steroids (5.4%) and tranexamic acid (20.1%). Indicators with the highest adherence rates (above 95%) were pre-operative (99.3%) and post-operative haemoglobin level assessment (100%). The overall median time to surgery was 22.6 h (range 15.7-42.5 h). The median LOS was 9.0 days (range 5.0-19.0 days). The most common complications were delirium (23.2%) and postsurgical constipation (25.2%). CONCLUSION: The present study shows large variation in the care for fragile patients with hip fractures indicating room for improvement. Therefore, hospitals should invest in benchmarking and knowledge-sharing. Large quality improvement initiatives with longitudinal follow up of both process and outcome indicators should be initiated.

6.
Artigo em Inglês | MEDLINE | ID: mdl-23362565

RESUMO

Postoperative deformities of the knee and sequaelae after intraarticular surgery can interfere with a standard parapetallar approach for intramedullary stabilisation of the tibia. Even the suprapatellar approach can be rendered impossible. For these rare indications we describe the patella osteotomy and transpatellar approach.


Assuntos
Fixação Intramedular de Fraturas/métodos , Patela , Tíbia/lesões , Fraturas da Tíbia/cirurgia , Doenças Ósseas Infecciosas/complicações , Doenças Ósseas Infecciosas/cirurgia , Humanos , Masculino , Osteomielite/complicações , Osteomielite/cirurgia , Osteotomia , Tíbia/cirurgia
7.
Artigo em Inglês | MEDLINE | ID: mdl-22272446

RESUMO

BACKGROUND AND PURPOSE: A thrust plate prosthesis can be used as an alternative to a conventional stem prosthesis, preserving the diaphyseal bone stock. Recent findings however predict a higher rate of aseptic loosening than with intramedullary devices. The purpose of our investigation was to compare the clinical outcome and radiological findings with a finite element analysis of bone remodeling. The hypothesis was that aseptic loosening after thrust plate prosthesis of the hip is inherent to the design. METHODS: From 1997 to 2001, 58 thrust plates were implanted in 52 patients. Average age at the time of surgery was 40.9 years. Ninety four percent returned for follow up at an average of 26 months. A finite element model of the thrust plate within the femur was developed and stress shielding as well as bone remodeling were analyzed. RESULTS: A total of 4 patients required revision surgery (6.9%). Data from the finite element analysis revealed an inherent failure mechanism to the implant, facilitating stress shielding and loosening. INTERPRETATION: Lacking the ideal total hip prosthesis in young patients, the thrust plate can still be regarded as a feasible implant. However, surgeons and patients should be aware of possible mechanical problems regarding the design of the thrust plate. There is evidence that thrust plate prostheses are prone to early aseptic loosening. Clinical and radiological observations are in agreement with the results from the numerical simulations. Stress concentrations computed at the leash are interpreted as an explanation for leash pain. The authors regard computational methods as an aid to improve existing prosthesis design and future developments.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Osteoartrite do Quadril/cirurgia , Adulto , Fenômenos Biomecânicos , Feminino , Análise de Elementos Finitos , Seguimentos , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/cirurgia , Humanos , Masculino , Radiografia , Reoperação
8.
Forensic Sci Int ; 131(2-3): 156-61, 2003 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-12590055

RESUMO

Fibronectin, MRP8, MRP14 and defensin were detected immunohistochemically in 46 surgically treated, fresh (hours old) human wounds and in wounds of 13 individuals who died immediately from fatal trauma (airplane crashes or train rollovers). In immediate fatal trauma, it was not possible to detect fibronectin outside of bleeding areas nor could inflammatory cells be visualized in the interstitium using MRP8, MRP14, or defensin antibodies. Fibronectin staining could be regularly demonstrated in wounds at least 20 min-old. Granulocytic infiltrates limited to the perivasal space could be detected 20-30 min after infliction of the wound expressing MRP8, MRP14 and defensin. It was also possible to detect fibronectin networks and MRP8-, MRP14-, and defensin-positive granulocytes and macrophages in particular wounds up to 30 days-old. No differences between the expression of MRP8 and MRP14 could be demonstrated in the wounds, the majority of which were only several hours old. As wound age increased, the number of defensin-positive granulocytes detected decreased. The immunohistochemical detection of fibronectin is a useful way to demonstrate vitality in fresh wounds, beginning about 20-30 min post-trauma. However, detection of MRP8, MRP14 and defensin provides no advantage over the routine histological detection of granulocytes and macrophages in wounds under 1-2 days old.


Assuntos
Calgranulina A/metabolismo , Calgranulina B/metabolismo , Defensinas/metabolismo , Fibronectinas/metabolismo , Ferimentos e Lesões/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Procedimentos Cirúrgicos Dermatológicos , Estudos de Viabilidade , Medicina Legal/métodos , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Pele/lesões , Pele/metabolismo , Fatores de Tempo , Ferimentos e Lesões/cirurgia
9.
J Orthop Trauma ; 16(3): 143-9, 2002 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-11880775

RESUMO

OBJECTIVE: To evaluate the potential benefit of a new injectable mineral bone cement (Norian SRS, Cupertino, CA, USA) for the treatment of tibial plateau fractures OTA types 41.B2-B3 and C3. DESIGN: Prospective study with established protocol. SETTING: University hospital; university teaching hospital. PATIENTS: Twenty-six patients gave informed consent to participate in this study and were available for follow-up examinations. All patients had sustained intraarticular tibial plateau fracture types OTA B2-B3 and C3. All cases were followed with a mean follow-up time of 19.7 months (6 to 36 months, median eighteen months). INTERVENTION: Twenty-five cases were treated with open reduction, osteosynthesis with screws or plate, and injection of Norian SRS in the subchondral bone defect. One case had closed reduction, screw osteosynthesis, and percutaneous cement injection. MAIN OUTCOME MEASUREMENTS: Radiographs in two planes were evaluated prospectively at six, twelve, and twenty-six weeks postoperatively and at last follow-up using Rasmussen's radiologic score. Clinical parameters were measured at the same time intervals using Lysholm's and Tegner's knee scores. RESULTS: Two cases required early wound revisions because of sterile drainage. Two cases developed partial loss of reduction of the fracture between four and eight weeks after surgery, requiring revision surgery in one case (total complication rate 15.3 percent). No other patients had complications, and all other fractures healed without any displacement. The high mechanical strength of the cement allowed early weight bearing after a mean postoperative period of 4.5 weeks (1 to 6 weeks). CONCLUSIONS: An injectable mineral bone cement with high initial mechanical strength was used to fill bone defects in unstable tibial plateau fractures with good success. This material offers new perspectives in the treatment of tibial plateau fractures.


Assuntos
Cimentos Ósseos , Fosfatos de Cálcio , Fixação de Fratura/métodos , Fraturas da Tíbia/cirurgia , Adulto , Idoso , Materiais Biocompatíveis/administração & dosagem , Fenômenos Biomecânicos , Fosfatos de Cálcio/administração & dosagem , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fraturas da Tíbia/reabilitação , Fatores de Tempo , Resultado do Tratamento , Suporte de Carga
10.
J Orthop Trauma ; 13(6): 426-31, 1999 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-10459602

RESUMO

OBJECTIVE: To evaluate arthroscopic versus fluoroscopic reduction and percutaneous fixation of lateral tibial plateau fractures of AO/OTA Types 41.B1 to 41.B3. DESIGN: Prospective study. SETTING: University hospital. PATIENTS AND INTERVENTION: One hundred sixty-eight patients underwent operative treatment for a tibial plateau fracture from 1988 to 1995. Thirty-three of these patients had monocondylar fractures of the lateral plateau that were treated by percutaneous reduction and fixation techniques. In the first ten cases, arthroscopic control of reduction was used. The following twenty-three consecutive cases were treated by reduction and fixation solely under fluoroscopic control. The arthroscopy group was followed for a mean of fifty-two months and the fluoroscopy group for thirty-eight months. RESULTS: Nine of ten cases of the arthroscopy group had an excellent or good result in Rasmussen's knee score at follow-up. One patient with an unreduced anterolateral depression zone despite arthroscopic surgery required a total knee prosthesis after eighteen months. Sixteen cases in the fluoroscopy group met the follow-up criteria. Fifteen were graded good or excellent in Rasmussen's clinical score; sixteen were excellent or good in the radiological score. One patient claimed chronic medial joint line pain after a lateral split fracture and had arthroscopy revealing chondral degeneration on the medial side but had no pathological findings in the lateral compartment. No secondary meniscus or ligament surgery was performed in the follow-up period. CONCLUSIONS: Percutaneous treatment of fractures of the tibial plateau can be performed using arthroscopy as well as image intensification to control reduction of the joint surface. We were not able to demonstrate any significant benefit from arthroscopy compared with fluoroscopic reduction. Reduction under image intensification is technically easier in our practice, especially in serial fractures and multiply injured patients. We reserve arthroscopy for cases with significant ligament injuries and for children with fractures of the median eminence.


Assuntos
Artroscopia , Fluoroscopia , Fixação de Fratura/métodos , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Parafusos Ósseos , Feminino , Seguimentos , Fixação de Fratura/classificação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Fraturas da Tíbia/classificação , Fraturas da Tíbia/diagnóstico por imagem , Resultado do Tratamento
11.
Lab Anim ; 36(4): 455-61, 2002 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-12396290

RESUMO

For the enhancement of fracture healing, either purified proteins or vectors for expression of growth factors in situ may be used. Adenoviral vectors directly convert cells to express a transgene. However, the cell types which are preferentially infected and the time of expression during fracture healing are currently not known. The adenoviral type 5 vectors used in this study are replication incompetent viruses, one encoding beta-galactosidase (beta-GAL) and one green fluorescent protein. Femora of 35 Sprague-Dawley rats were fractured. Three days after stabilization with Kirschner wire, 10(12) pfu viral suspension were injected into the fracture zone. As a control, five animals received injections of adenovirus type 2. Animals were sacrificed after 3 days, 1, 2 and 4 weeks. Fractures healed radiographically within 2-3 weeks. All specimens were examined for beta-GAL and green fluorescent protein (GFP) expression. Fibroblast and osteoblasts within callus tissue displayed a high transgene expression (week 1). A decrease of expression was observed during the observation period. In this experimental study, we have demonstrated that all cells of the primary callus can be transfected using adenoviral vectors, which provide a tool to further investigate adenoviral transfer of growth factors such as bone morphogenetic protein-2 (BMP-2).


Assuntos
Adenoviridae/genética , Fraturas do Fêmur/genética , Consolidação da Fratura/genética , Terapia Genética/métodos , Transfecção/métodos , Animais , Modelos Animais de Doenças , Fraturas do Fêmur/diagnóstico por imagem , Fibroblastos/metabolismo , Vetores Genéticos , Proteínas de Fluorescência Verde , Proteínas Luminescentes/genética , Proteínas Luminescentes/metabolismo , Masculino , Osteoblastos/metabolismo , Radiografia , Ratos , Ratos Sprague-Dawley , beta-Galactosidase/genética , beta-Galactosidase/metabolismo
12.
Wien Klin Wochenschr ; 109(11): 384-9, 1997 Jun 06.
Artigo em Alemão | MEDLINE | ID: mdl-9281228

RESUMO

Growth factors have the potential to enhance native repair responses in ligamentous and meniscal lesions. However, methods for applying these cytokines to sites of injury for extended periods are lacking. We suggest that local transfer of genes which encode the relevant healing factors merits investigation as a potential solution to this problem. In the present study different viral vectors and liposomes were evaluated for their ability to deliver genes to cells of ligamentous and meniscal origin. The anterior (ACL) and posterior (PCL) cruciate ligaments and the medial collateral ligament (MCL), semitendinosus tendon, patellar tendon, and menisci were removed from New Zealand white rabbits Cells grown from these tissues were then investigated for their susceptibility to genetic alteration by these vectors. Based upon the ability of these vectors to convert cells in culture to a lacZ(+) phenotype, adenovirus was the most effective vector in short-term experiments. However, expression was transient. Although retrovirus gave lower initial transduction efficiencies, the percentage of transduced cells was increased by the use of the selectable marker gene neo(r). Cells infected with adeno-associated virus containing the neo(r)-gene were also selected in this way. Liposomes showed low efficiency of gene transfer and expression. In an in vivo marker study we injected adenovirus into the rabbit patellar tendon. Transduced cells were observed mainly in the subsynovial layer at a declining frequency over a 6-week period. The allogeneic transplantation of retrovirally-transduced fibroblasts into the patellar tendon resulted in a greater number of transduced cells. Although the number of lacZ(+) cells declined with time, positive cells were still present 6 weeks after transplantation. Furthermore, the transplanted cells, unlike cells transduced in situ with adenovirus, migrated from the injection site and integrated into the crimp of the tendon.


Assuntos
Técnicas de Transferência de Genes , Substâncias de Crescimento/genética , Tendões/metabolismo , Adenoviridae/genética , Animais , Expressão Gênica/fisiologia , Vetores Genéticos , Óperon Lac/genética , Fenótipo , Coelhos , Tendões/patologia , Cicatrização/genética , Cicatrização/fisiologia
13.
Vet Rec ; 149(3): 80-4, 2001 Jul 21.
Artigo em Inglês | MEDLINE | ID: mdl-11497399

RESUMO

Haemodynamic responses are routinely used for monitoring anaesthesia, but they can be elicited at spinal or brainstem levels and therefore do not provide information on cerebrocortical activity. To test the possibility that electroencephalography (EEG) might provide an objective assessment of unconsciousness and depth of anaesthesia the haemodynamic and EEG data from 17 ewes anaesthetised with halothane were analysed. Data were recorded at least every five minutes. An increase of 10 per cent or more in heart rate, systolic arterial pressure (SAP), or mean arterial pressure (MAP) was defined as a positive haemodynamic response to surgical stimulation. Simultaneously recorded EEG variables included delta-, theta-, and beta-frequency band power, power ratios (theta/delta, alpha/delta, beta/delta), 80 per cent spectral edge frequency (SEF 80), and median frequency. In 11 of the ewes, a positive haemodynamic response was accompanied by a significant decrease in delta activity and significant increases in alpha/delta ratio, beta/delta ratio, and SEF 80, and there were significant correlations between the changes in heart rate, and delta activity and beta/delta ratio. In the other six ewes, there were no significant EEG responses in association with haemodynamic changes of less than 10 per cent.


Assuntos
Anestesia Geral/veterinária , Anestésicos Inalatórios/farmacologia , Pressão Sanguínea/efeitos dos fármacos , Halotano/farmacologia , Frequência Cardíaca/efeitos dos fármacos , Ovinos/fisiologia , Animais , Eletroencefalografia/efeitos dos fármacos , Masculino , Inconsciência/veterinária
14.
Orthopade ; 26(5): 450-458, 1997 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28246849

RESUMO

Soft tissue injuries often represent the greatest clinical problem. Not only do many of the most frequently injured tissues, such as the cruciate ligaments and articular cartilage, have very limited capabilities for spontaneous repair, but they also respond poorly to surgical or non-surgical intervention. In this article we try to define the role of growth factors in these conditions and to outline concepts for future treatment based upon modulation of the native repair response. We suggest that gene transfer could improve the management of such injuries, particularly when used as vehicles for the targetted delivery of growth factors.

15.
Sportverletz Sportschaden ; 8(1): 2-15, 1994 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-8197540

RESUMO

Two femoral fixation areas were defined in the distal iliotibial tract (ITT) system. They were named supracondylar insertion and insertion near the septum. Biomechanical studies on these insertions revealed tension peaks in the insertion near the septum with anterior translation of the knee, with varus stress and rotational movements. We conclude that the fibers inserting here are secondary restraints against anterior and lateral knee instability. 5 lateral extraarticular procedures were investigated to evaluate their biomechanical effect on knee instability. A standardized cadaver knee model was used with two basic experiments: an excentric quadriceps contraction from 0 to 90 degrees of flexion and an anterior translation with 100 N in 30 degrees of flexion. 5 knees were investigated for each procedure. Results from the excentric quadriceps contraction study imply reduced ACL strain with all extraarticular procedures except the Andrews tenodesis. The quantitative effect was related to the mechanical strength of the fixation of the ITT. All lateral procedures reduced ACL strain with anterior translation of the knee. The last part of the study included simultaneous registration of rotation and translation of the knee. We demonstrated a close relation of decreased ACL strain due to a lateral procedure and pathological external rotation of the knee. The knee no longer reached the physiological neutral rotation angle after an effective lateral tenodesis procedure. The significance of this effect is not clear at the present time.


Assuntos
Tecido Conjuntivo/cirurgia , Fêmur/cirurgia , Instabilidade Articular/cirurgia , Articulação do Joelho/cirurgia , Ligamento Cruzado Anterior/fisiopatologia , Fenômenos Biomecânicos , Tecido Conjuntivo/fisiopatologia , Fêmur/fisiopatologia , Humanos , Instabilidade Articular/fisiopatologia , Articulação do Joelho/fisiopatologia , Contração Muscular/fisiologia , Técnicas de Sutura
16.
Bone Joint Res ; 2(5): 79-83, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23673407

RESUMO

OBJECTIVES: Because of the contradictory body of evidence related to the potential benefits of helical blades in trochanteric fracture fixation, we studied the effect of bone compaction resulting from the insertion of a proximal femoral nail anti-rotation (PFNA). METHODS: We developed a subject-specific computational model of a trochanteric fracture (31-A2 in the AO classification) with lack of medial support and varied the bone density to account for variability in bone properties among hip fracture patients. RESULTS: We show that for a bone density corresponding to 100% of the bone density of the cadaveric femur, there does not seem to be any advantage in using a PFNA with respect to the risk of blade cut-out. On the other hand, in a more osteoporotic femoral head characterised by a density corresponding to 75% of the initial bone density, local bone compaction around the helical blade provides additional bone purchase, thereby decreasing the risk of cut-out, as quantified by the volume of bone susceptible to yielding. CONCLUSIONS: Our findings indicate benefits of using a PFNA over an intramedullary nail with a conventional lag screw and suggest that any clinical trial reporting surgical outcomes regarding the use of helical blades should include a measure of the femoral head bone density as a covariable.

17.
Z Orthop Unfall ; 150(6): 601-6, 2012 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-23296556

RESUMO

BACKGROUND: In patients with unilateral femoroacetabular impingement (FAI), bony characteristics predisposing to FAI (e.g., acetabular retroversion) are also commonly observed in the contralateral asymptomatic hip. This study investigated the prevalence of these characteristics in an asymptomatic population and the influence of pelvic inclination and tilt on acetabular anteversion. PATIENTS AND METHODS: In this study, patients with unspecific abdominal pain in whom CT including the hip was performed to aid diagnosis were included. Exclusion criteria were previous fractures of the acetabulum or the femur and surgical pretreatment of the hip. AV, CE angle, CCD angle and the distance between the anterior and posterior acetabular rims were determined. RESULTS: 11.5 % of the 400 included hip joints had a central AV of < 15°. A central retroversion was not found. Female patients had a significantly higher AV compared to males (p < 0.05). Pelvic tilt and inclination had a significant influence on the AV. CONCLUSION: Correct assessment of AV is dependent on a correct pelvic radiograph. 16.5 % of the hips of asymptomatic patients had at least one bony characteristic predisposing to FAI.


Assuntos
Acetábulo/anormalidades , Acetábulo/diagnóstico por imagem , Impacto Femoroacetabular/diagnóstico por imagem , Impacto Femoroacetabular/epidemiologia , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco
18.
Unfallchirurg ; 111(2): 107-11, 2008 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-17701151

RESUMO

Penetrating chest trauma involving the heart is usually known with a high mortality rate. Neither the absence of hemodynamic depression nor ECG changes exclude a potential fatal injury to the heart. We report on the diagnosis and definitive treatment of a stab wound injury with transected coronary artery, concomittant ventricular penetration, and pulmonary injury.A 37-year-old female was admitted to our emergency room with multiple left-sided gashes (cheek, neck, upper extremity) and a single stab wound in the left thorax. At the scene of the accident the patient's hemodynamic condition was stable with no signs of shock or shortness of breath. Auscultation revealed regular respiratory sound on both lung sides. Hospital transfer by ground was uneventful. Chest X-ray showed left pleural effusion with no signs of pneumothorax. ECG demonstrated regular sinus rhythm without repolarization changes or low voltage. Transthoracic echocardiography revealed pericardial effusion with a swinging heart. The patient was electively intubated in the emergency room and transferred to the operating room for pericardial paracentesis. Median sternotomy was necessary due to extensive bleeding in the drain. Examination of the heart showed a laceration of the left coronary artery (LAD), left ventricle, and upper lobe of the left lung. Cardiopulmonary bypass was instituted and the LAD was ligated proximal to the penetration. The left internal thoracic artery was used for coronary revascularization of the LAD. Postoperative ECG and creatine kinase evaluations excluded myocardial ischemia. The patient was discharged from hospital at POD 10 fully recovered. Transthoracic echocardiography in the emergency room is the diagnostic tool of choice to exclude/confirm a potential cardiac injury. In the case of pericardial effusion, paracentesis sometimes followed by thoracotomy should be performed. The importance of rapid diagnosis and intervention should be emphasized to reduce mortality due to cardiac tamponade or acute myocardial infarction as illustrated by this case.


Assuntos
Vasos Coronários/lesões , Ecocardiografia , Serviço Hospitalar de Emergência , Traumatismos Cardíacos/diagnóstico por imagem , Ventrículos do Coração/lesões , Traumatismos Torácicos/diagnóstico por imagem , Ferimentos Perfurantes/diagnóstico por imagem , Adulto , Artérias/transplante , Ponte de Artéria Coronária , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Diagnóstico Diferencial , Diagnóstico Precoce , Feminino , Traumatismos Cardíacos/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Pulmão/diagnóstico por imagem , Pulmão/cirurgia , Lesão Pulmonar , Derrame Pericárdico/diagnóstico por imagem , Derrame Pericárdico/cirurgia , Sensibilidade e Especificidade , Traumatismos Torácicos/cirurgia , Ferimentos Perfurantes/cirurgia
19.
Unfallchirurg ; 109(6): 457-62, 2006 Jun.
Artigo em Alemão | MEDLINE | ID: mdl-16773320

RESUMO

BACKGROUND: Clinical studies of the CLS expansion cup in hybrid hip arthroplasty generally show good results. However, follow-up times are limited to between 5 and 10 years. The aim of our study was to assess the clinical and radiological outcome of the CLS cup after more than 10 years. MATERIAL AND METHOD: After a follow-up of 13 years (10-15 years), 41 of 186 patients with a total of 41 CLS cups were available for clinical and radiological evaluation. In addition, a digital analysis of all radiographs was done. This included measurement of the migration, inclination, polyethylene wear, shaft subsidence, and osteolytic lesions. RESULTS: The average preoperative Harris hip score was 48, which increased to 81 at final follow-up. No acetabular loosening was found. Two cups (5%) showed osteolytic lesions not exceeding 50% of the specific zone according to DeLee and Charnley and were considered stable. There was no migration or inclination of the cups. The average polyethylene wear corresponded to 0.1 mm/year. Sixteen patients (39%) showed osteolyses around the stem and were considered loose. CONCLUSION: The CLS expansion cup provides excellent clinical results after 13 years in hybrid total hip arthroplasty. Time-correlative polyethylene wear and the extremely high rate of stem loosening have no consequences for the cup stability in our patient group. Acetabular osteolysis is rare.


Assuntos
Artroplastia de Quadril , Prótese de Quadril , Polietilenos , Falha de Prótese , Acetábulo , Idoso , Idoso de 80 Anos ou mais , Seguimentos , Humanos , Pessoa de Meia-Idade , Osteólise/etiologia , Fatores de Tempo
20.
Air Med J ; 25(6): 270-5, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-17071416

RESUMO

BACKGROUND: Cardiac output (CO) and systemic vascular resistance (SVR) are important hemodynamic parameters in emergency patients and for clinical early goal-directed therapy. This study evaluated the feasibility of CO and SVR determination using preclinical continuous wave Doppler ultrasound in a helicopter emergency medical service (HEMS) on emergency patients presenting with or without thoracic pain as a pilot observational study. METHODS: Forty-four consecutive medical emergency patients (62.8 +/- 22 years of age, 23 males) were classified at the scene as with (15 patients, 69 +/- 14 years of age, 40% male) or without (29 patients, 60 +/- 25 years of age, 59% male) thoracic pain by an emergency physician. Hemodynamic parameters were determined based on continuous wave Doppler noninvasively (USCOM, Sydney, Australia): stroke volume (SV), CO, cardiac index (CI), minute distance (MD), and SVR. RESULTS: Noninvasive SV, MD, CO, CI, and SVR determination is feasible using preclinical ultrasound in HEMS. Thoracic pain patients had higher SVR (2,709 +/- 891 vs 1,499 +/- 661 dyne*sec*cm-5) and lower CO/CI (3.37 +/- 1.1 vs 5.06 +/- 2.9 L/min, CI: 1.67 +/- 0.58 vs 3.18 +/- 1.34 L/min/m2) as well as a reduced aortic minute distance (11.2 +/- 3.3 m/min vs 19.1 +/- 8 m/min, P = .001) than patients without thoracic pain. Highest cardiac outputs were measured during and within 30 minutes after seizures (n = 5, 7.5 +/- 3.05 L/min). The range of CO measured in six cardiopulmonary resuscitation patients was 2.7 to 12 L/min; the level of CO was not associated with the establishing of sustained circulation. CONCLUSIONS: Determining SV, CO/CI, and SVR in different emergency situations in HEMS using rapid CW Doppler ultrasound is feasible. Thoracic pain patients have increased SVR and lower CO/CI and reduced aortic minute distance than do non-thoracic pain patients in the preclinical setting.


Assuntos
Resgate Aéreo , Débito Cardíaco/fisiologia , Monitorização Fisiológica/instrumentação , Dor , Tórax , Ultrassonografia , Resistência Vascular/fisiologia , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Tórax/fisiopatologia
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