Complications after surgical treatment of jupiter's monteggia type ii fractures / Complicações após tratamento cirúrgico das fraturas de monteggia tipo ii de jupiter

ABSTRACT Monteggia fracture-dislocations are rare injuries, affecting about 2-5% of the population. Jesse Jupiter subdivided Bado's Type II fractures into four types, all of which presented an associated radial head fracture. Associated chondral and ligament injuries can evolve with postoperative complications. Objective: To evaluate the incidence of complications and risk factors that may influence the postoperative outcomes of Jupiter lesions. Methods: This retrospective study was conducted with surgically treated patients. The characteristics related to fractures and surgical approaches were evaluated and these variables were correlated with radiographic and functional postoperative complications. Results: A total of 15 patients were evaluated, mostly men and with a higher prevalence of Types IIA and IID. The most frequent complications were heterotopic ossification and osteolysis around the radial head prosthesis. Postoperative instability occurred only in the lateral collateral ligament. According to MEPS functional score, 53% of the patients evolved with unfavorable outcomes. Conclusion: The studied cases evolved with high rates of postoperative complications, mainly in Jupiter's Type IID fractures and associated coronoid fractures. Level of Evidence III, Therapeutic Study.

RESUMO A fratura-luxação de Monteggia é uma lesão rara que acomete cerca de 2-5% da população. Jesse Jupiter subdividiu as fraturas tipo II de Bado em quatro tipos, todos eles associados à fratura da cabeça do rádio. As lesões condral e ligamentares associadas podem evoluir com complicações pós-operatórias. Objetivo: Avaliar a incidência das complicações e os fatores de risco que podem influenciar os resultados pós-operatórios nas fraturas de Monteggia tipo II de Jupiter. Métodos: Estudo retrospectivo com pacientes tratados cirurgicamente. Avaliaram-se as características relacionadas às fraturas e as técnicas cirúrgicas utilizadas e, em seguida, tais variáveis foram correlacionadas com complicações pós-operatórias radiográficas e funcionais. Resultados: Foram avaliados 15 pacientes, havendo predomínio do sexo masculino e maior prevalência das fraturas tipo IIA e IID. As complicações mais frequentes foram a ossificação heterotópica e a osteólise ao redor da prótese da cabeça do rádio. A instabilidade pós-operatória ocorreu somente no complexo ligamentar lateral. Funcionalmente, segundo o Mayo Elbow Performance Score, 53% dos pacientes evoluíram com resultados desfavoráveis. Conclusão: Observou-se alta taxa de complicação pós-operatória, principalmente nas fraturas tipo II-D de Jupiter e naquelas com fratura do coronoide associada. Nível de Evidência III, Estudo Terapêutico.

The Hertel classification can't predict the risk of humeral head osteonecrosis after osteosynthesis using an anterolateral approach

ABSTRACT Background: Proximal humeral fractures can progress to osteonecrosis of the humeral head. Hertel developed a binary classification system (12 subtypes) and demonstrated that some patterns have more risk to develop osteonecrosis. Hertel described the prevalence and the risk factors for Humeral head osteonecrosis after osteosynthesis using a Deltopectoral approach. Few studies have evaluated the prevalence and the capacity of Hertel's classification to predict Humeral Head osteonecrosis following osteosynthesis of proximal Humeral fractures through the anterolateral approach. The objectives of this study were to correlate osteonecrosis predictors established by the Hertel classification with the risk of developing osteonecrosis and its prevalence after osteosynthesis using the anterolateral approach. Methods: This was a retrospective study of patients who underwent osteosynthesis of proximal humerus fractures using an anterolateral approach. Patients were divided into two groups: high risk for necrosis (group 1) and low risk for necrosis (group 2) according to Hertel's criteria. The overall prevalence of osteonecrosis and the prevalence in each group were calculated. A radiological examination was performed in the true anteroposterior (Grashey), scapular, and axillary views, before and after the operation (minimum 1 year after surgery). A KaplanMeier curve was used to assess the pattern of the temporal evolution of osteonecrosis. The groups were compared using the Chi-square test or Fisher's exact test. The unpaired t-test (parametric variables - age) and the MannWhitney test (non-parametric time between trauma and surgery) were used. Results: In total, 39 patients were evaluated. The postoperative follow-up time was 14.5 ± 3.3 months. The time to onset of necrosis was 14.1 ± 3.9 months. Sex, age, and time between trauma and surgery did not influence the risk of necrosis. Type 2, 9, 10, 11, and 12, or fractures with posteromedial head extension less than or equal to 8 mm, or diaphysis deviation greater than 2 mm, as well as grouping did not influence the risk for osteonecrosis. Conclusions: Hertel's criteria were not able to predict the development of osteonecrosis after osteosynthesis of proximal humerus fractures performed through the anterolateral approach. The total prevalence of osteonecrosis was 17.9% with a tendency toward an increased incidence after 1 year of surgical treatment.

Mortality after surgical treatment of proximal humerus fractures in older patients / Mortalidade após tratamento cirúrgico das fraturas proximais do úmero em pacientes idosos

ABSTRACT Mortality of patients after osteosynthesis of proximal humeral fractures (PHF) has been poorly studied in contrast to fractures of the proximal femur. Objective: To evaluate the mortality of older patients with PHF undergoing surgical treatment. Methods: Retrospective study of patients undergoing surgical treatment PHF between 2009-2019. Demographic data, Neer classification, and mortality of this cohort of patients were evaluated. Non-categorical variables were tested using the Kolmogorov-Smirnov test. The unpaired t-test (parametric variables) was used. Categorical variables were tested by Fisher's exact test. A Kaplan-Meier mortality curve was constructed. Results: 59 patients were evaluated. There was a predominance of females in the sixth decade of life. The most prevalent fractures were Neer's type III. The highest mortality occurred in the first 4 years after surgery (4.1 + 3.2 years). The only comorbidity capable of changing the survival curve was DM (p = 0.03) Conclusion: Overall mortality was 11.3%. The highest mortality occurred in the first 4 years of follow-up. Diabetic patients evolve with earlier mortality and have 7 times more chance of death. Level of Evidence III, Retrospective Study.

RESUMO A mortalidade de pacientes após osteossíntese de fratura de úmero proximal (FUP) é pouco estudada em comparação com as fraturas do fêmur proximal. Objetivo: Avaliar a mortalidade de pacientes idosos com FUP submetidos a tratamento cirúrgico. Métodos: Estudo retrospectivo de pacientes submetidos ao tratamento cirúrgico FUP entre 2009 e 2019. Foram avaliados dados demográficos, classificação de Neer e a mortalidade dessa coorte de pacientes. As variáveis não categóricas foram testadas pelo teste de Kolmogorov-Smirnov. Utilizou-se o teste t não pareado para variáveis paramétricas. As variáveis categóricas foram testadas pelo teste exato de Fisher. Construiu-se a curva de mortalidade pelo método de Kaplan-Meier. Resultados: Foram avaliados 59 pacientes, havendo predomínio do sexo feminino na faixa dos 60 anos. As fraturas mais prevalentes foram as do tipo III de Neer. A maior mortalidade ocorreu nos quatro primeiros anos pós-operatórios (4,1 + 3,2 anos). A única comorbidade capaz de mudar a curva de sobrevida foi o diabetes mellitus (p = 0,03). Conclusão: A mortalidade geral foi de 11,3%. A maior mortalidade ocorreu nos primeiros quatro anos de seguimento. Pacientes diabéticos evoluem com mortalidade mais precoce e possuem sete vezes mais chance de óbito. Nível de Evidência III, Estudo Retrospectivo.

Avaliação de crianças com fratura do colo do rádio tratadas com haste intramedular flexível / Evaluation of children with radial neck fractures treated with flexible intramedullary nail

Objetivo: Avaliar os resultados de fraturas de colo do rádio com desvioem crianças tratadas cirurgicamente com haste intra medular flexível de titânio. Método: Realizou-se estudo retrospectivo com levantamento de cinco casos de fratura de colo de rádio com desvios maiores do que 30° tratados com haste intra medular flexível. Os pacientesforam avaliados funcionalmente, através da amplitude de movimento e do Mayo Elbow Performance Score (MEPS), e radiograficamente. Resultados: Foram avaliados cinco pacientes com média de idadede 8,4 anos, e tempo de seguimento pós-operatório médio de 12,2meses. Redução aberta do foco de fratura foi necessária em três casos com desvio grave da fratura. Ao final do seguimento, 80% dos pacientes apresentaram resultados excelentes,20% resultados bons e todas as fraturas consolidaram. As complicações observadas foram: ossificação heterotópica, infecção superficial e osteonecrose da cabeça do rádio. Conclusões: Apesar do pequeno número de casos,nossos resultados sobre tratamento com haste intramedular flexível de titânio foram semelhantes aos de outros autores, com bons desfechos funcionais. Nível de Evidência III, Estudo Retrospectivo.

Objective: To evaluate the results of displaced radial neck fracturesin children trated surgically with flexible titanium intramedullarynails. Method: This is a retrospective study of fivecases of radial neck fractures with displacement greater than30° fixed with flexible intramedullary nails. Patients were evaluatedregarding functional outcome through range of motionand the Mayo Elbow Performance Score (MEPS), as well asradiographic exams. Results: Five patients, with a mean age of8.4 years were assessed, during a mean post-operative followup of 12.2 months. Open reduction was necessary in threecases with major displacement. At the end of the follow up,80% of the patients had excellent results, 20% good results,and all fractures healed. As complications we observed: heterotopicossification, superficial infection and radial head necrosis.Conclusions: In spite of the small sample, our results withflexible titanium intramedullary nails were similar to the currentliterature, with good functional outcomes. Level of Evidence III,Retrospective Study.

Avaliação funcional de pacientes com tríade terrível do cotovelo tratados cirurgicamente / Functional evaluation of patients with surgically treated terrible triad of the elbow

Objetivo: Avaliar os resultados funcionais de pacientes com tríade terrível do cotovelo tratados cirurgicamente. Métodos: Avaliação retrospectiva com utilização da escala MEPS (Mayo Elbow Performance Score) de pacientes diagnosticados com tríade terrível do cotovelo e submetidos a tratamento cirúrgico. Resultados: Foram avaliados 14 pacientes (nove homens e cinco mulheres) e 15cotovelos (um caso bilateral). Obtivemos a média de 78 pontos e86% de bons e excelentes resultados com a utilização da escala MEPS. Como complicações, tivemos um caso de infecção e três de neurapraxia do nervo ulnar. Conclusão: Os pacientes evoluíram com cotovelo estável, com boa função, porém, com diminuição do arco de movimento. Nível de Evidência IV, Série de Casos.

Objectives: To evaluate the functional outcome of patients with surgically treated terrible triad of the elbow. Methods: A retrospective evaluation was performed using the MEPS score (Mayo Elbow Performance Score) of patients diagnosed with terrible triad of the elbow who underwent surgical treatment. Results: 14 patients (nine men and five women) and 15 elbows (one bilateral case) were evaluated. A MEPS average score of 78 points and 86%good and excellent results was obtained. As complications, we had one case of infection and three of neuropraxia of the ulnarnerve. Conclusion: The patients had stable elbow with good function, however with reduced range of motion. Level of Evidence IV, Case Series.

Fracture of distal humerus: MIPO technique with visualization of the radial nerve

Avaliar os resultados de pacientes submetidos à osteossíntesede fraturas do terço distal do úmero, com técnica MIPO evisualização direta do nervo radial por via acessória, em pacientessem déficit neurológico pré-operatório. Métodos: Os pacientes foramsubmetidos à osteossíntese através da técnica MIPO. A visualizaçãoe isolamento do nervo radial foram realizados por abordagem entreo braquial e o braquiorradial, com incisão oblíqua, na face lateral dobraço. A avaliação funcional do cotovelo foi realizada por meio doescore de MEPS. Resultados: Sete pacientes foram avaliados, comidade media de 29,8 anos. O tempo de seguimento médio foi 29,85meses. A neuropraxia pós-operatória ocorreu em três pacientes.Houve recuperação sensitiva do nervo radial (M=3,16 meses) etambém motora (M=5,33 meses) em todos os pacientes. Observamosconsolidação da fratura em todos pacientes (M=4,22 meses).As médias de flexo-extensão e prono-supinação foram 112,85° e145°, respectivamente. A média do escore MEPS foi de 86,42. Nãohouve nenhum caso de infecção pós-operatória. Conclusão: Essaabordagem permitiu excluir a interposição do nervo radial no focode fratura e/ou na placa, apresentando alto índice de consolidaçãoda fratura e boa evolução do arco de movimento do cotovelo. Nívelde Evidência IV, Série de Casos...

To evaluate the outcomes in patients treated for humerusdistal third fractures with MIPO technique and visualizationof the radial nerve by an accessory approach, in those withoutradial palsy before surgery. Methods: The patients were treatedwith MIPO technique. The visualization and isolation of the radialnerve was done by an approach between the brachialis and thebrachiorradialis, with an oblique incision, in the lateral side of thearm. MEPS was used to evaluate the elbow function. Results: Sevenpatients were evaluated with a mean age of 29.8 years old. Theaverage follow up was 29.85 months. The radial neuropraxis aftersurgery occurred in three patients. The sensorial recovery occurredafter 3.16 months on average and also of the motor function,after 5.33 months on average, in all patients. We achieved fractureconsolidation in all patients (M=4.22 months). The averages forflexion-extension and prono-supination were 112.85° and 145°,respectively. The MEPS average score was 86.42. There was nocase of infection. Conclusion: This approach allowed excludinga radial nerve interposition on site of the fracture and/or under theplate, showing a high level of consolidation of the fracture and agood evolution of the range of movement of the elbow. Level ofEvidence IV, Case Series...