RESUMEN
Older adults with lower limb fractures often harbor concerns about losing their mobility, fearing a loss of independence. It is vital to develop strategies that foster their active engagement in the rehabilitation process. The present protocol aims to create a care pathway tailored to motivate individuals with lower limb fractures to adhere to rehabilitation. We will develop an observational, cross-sectional, and descriptive study using the Delphi data-gathering approach. Purposive sampling will recruit a panel of healthcare professionals and experts who care for patients with lower limb fractures. Aligned with the Delphi method, a series of iterative rounds will be developed to gather consensus around the motivational strategies used by health professionals in the rehabilitation of people with lower limb fractures. We will employ the Qualtrics platform for data collection and analysis, and a consensus target of 75% has been predetermined. For quantitative data analysis, we will use descriptive statistics encompassing a range of measures, including count, mean, standard deviation, median, minimum, maximum, and range. An inductive thematic analysis procedure will be employed to extract meaningful themes and patterns from qualitative data. The study results are expected to significantly impact clinical practice by creating a specialized care pathway to motivate individuals with lower limb fractures to adhere to rehabilitation. Adopting these explicit standards by professionals will ensure uniform and high-quality care.
Asunto(s)
Técnica Delphi , Fracturas Óseas , Motivación , Humanos , Estudios Transversales , Fracturas Óseas/rehabilitación , Consenso , Extremidad Inferior/lesiones , Masculino , FemeninoRESUMEN
Abstract Objective To evaluate the quality of life of patients using an Ilizarov type external fixator for the treatment of complicated fractures and their sequelae. Method This is an observational and cross-sectional study, in which the 36-item short form survey (SF-36) questionnaire (translated into Portuguese) was applied during outpatient consultations in 2 periods, in the months of July 2018 and January 2019. The patients who participated in the study underwent their surgical procedures between January and June 2018. Results We evaluated 36 patients using an external Ilizarov fixator. We observed a predominance of male patients, with a mean age of 37.9 years. Fractures of leg bones and their complications represented half of the sample. Improvement in functional capacity and emotional aspects of the patients was observed throughout the treatment. Conclusion The use of the circular external fixator is an important and effective method for the surgical treatment of complex fractures and their sequelae. This study allowed us to conclude that, after treatment, patients achieved functional return to daily activities with adequate quality of life.
Resumo Objetivo Avaliar a qualidade de vida dos pacientes em uso do fixador externo do tipo Ilizarov para tratamento de fraturas complexas e de suas sequelas Método Trata-se de um estudo observacional e transversal, em que foi aplicado o questionário 36-item short form survey (SF-36) (traduzido para a língua portuguesa) durante as consultas ambulatoriais em 2 períodos, nos meses de julho de 2018 e janeiro de 2019. Os pacientes que participaram do estudo realizaram seus procedimentos cirúrgicos no período de janeiro a junho de 2018. Resultados Foram avaliados 36 pacientes em uso de fixador externo do tipo Ilizarov. Foi observado predomínio do sexo masculino e idade média de 37,9 anos. As fraturas de ossos da perna e suas complicações representaram metade da amostra. Foi observada melhora na capacidade funcional e nos aspectos emocionais dos pacientes ao longo do tratamento. Conclusão O uso do fixador externo circular constitui um método importante e eficaz para o tratamento cirúrgico de fraturas complexas e de suas sequelas. Este trabalho permitiu concluir que, após o tratamento, os pacientes alcançaram retorno funcional às atividades diárias com adequada qualidade de vida.
Asunto(s)
Humanos , Masculino , Femenino , Adulto , Persona de Mediana Edad , Calidad de Vida , Actividades Cotidianas , Perfil de Impacto de Enfermedad , Técnica de Ilizarov/rehabilitación , Fracturas Óseas/rehabilitación , Encuestas y CuestionariosRESUMEN
BACKGROUND: Lower extremity fractures represent a high percentage of reported injuries in the United States military and can devastate a service member's career. A passive dynamic ankle-foot orthosis (PD-AFO) with a specialized rehabilitation program was initially designed to treat military service members after complex battlefield lower extremity injuries, returning a select group of motivated individuals back to running. For high-demand users of the PD-AFO, the spatiotemporal gait parameters, agility, and quality of life is not fully understood with respect to uninjured runners. QUESTIONS/PURPOSES: Do patients who sustained a lower extremity fracture using a PD-AFO with a specialized rehabilitation program differ from uninjured service members acting as controls, as measured by (1) time-distance and biomechanical parameters associated with running, (2) agility testing (using the Comprehensive High-level Activity Mobility Predictor performance test and Four Square Step Test), and (3) the Short Musculoskeletal Function Assessment score. METHODS: We conducted a retrospective data analysis of a longitudinally collected data registry of patients using a PD-AFO from 2015 to 2017 at a single institution. The specific study cohort were patients with a unilateral lower extremity fracture who used the PD-AFO for running. Patients had to be fit with a PD-AFO, have completed rehabilitation, and have undergone a three-dimensional (3-D) running analysis at a self-selected speed at the completion of the program. Of the 90 patients who used the PD-AFO for various reasons, 10 male service members with lower extremity fractures who used a PD-AFO for running (median [range] age 29 years [22 to 41], height 1.8 meters [1.7 to 1.9], weight 91.6 kg [70 to 112]) were compared with 15 uninjured male runners in the military (median age 33 years [21 to 42], height 1.8 meters [1.7 to 1.9], weight 81.6 kg [71.2 to 98.9]). The uninjured runners were active-duty service members who voluntarily participated in a gait analysis at their own self-selected running speeds; to meet eligibility for inclusion as an uninjured control, the members had to be fit for full duty without any medical restrictions, and they had to be able to run 5 miles. The controls were then matched to the study group by age, weight, and height. The primary study outcome variables were the running time-distance parameters and frontal and sagittal plane kinematics of the trunk and pelvis during running. The Four Square Step Test, Comprehensive High-level Activity Mobility Predictor scores, and Short Musculoskeletal Function Assessment scores were analyzed for all groups as secondary outcomes. Nonparametric analyses were performed to determine differences between the two groups at p < 0.05. RESULTS: For the primary outcome, patients with a PD-AFO exhibited no differences compared with uninjured runners in median (range) running velocity (3.9 meters/second [3.4 to 4.2] versus 4.1 meters/second [3.1 to 4.8], median difference 0.2; p = 0.69), cadence (179 steps/minute [169 to 186] versus 173 steps/minute [159 to 191], median difference 5.8; p = 0.43), stride length (2.6 meters [2.4 to 2.9] versus 2.8 meters [2.3 to 3.3], median difference 0.2; p = 0.23), or sagittal plane parameters such as peak pelvic tilt (24° [15° to 33°] versus 22° [14° to 28°], median difference 1.6°; p = 0.43) and trunk forward flexion (16.2° [7.3° to 23°) versus 15.4° [4.2° to 21°), median difference 0.8°; p > 0.99) with the numbers available. For the secondary outcomes, runners with a PD-AFO performed worse in Comprehensive High-level Activity Mobility Predictor performance testing than uninjured runners did, with their four scores demonstrating a median (range) single-limb stance of 35 seconds (32 to 58) versus 60 seconds (60 to 60) (median difference 25 seconds; p < 0.001), t-test result of 15 seconds (13 to 20) versus 13 seconds (10 to 14) (median difference 2 seconds; p < 0.001), and Illinois Agility Test result of 22 seconds (20 to 25) versus 18 seconds (16 to 20) (median difference 4; p < 0.001). Edgren side step test result of 20 meters (16 to 26) versus 24 meters (16 to 29) (median difference 4 meters; p = 0.11) and the Four Square Step Test of 5.5 seconds (4.1 to 7.2) versus 4.2 seconds (3.1 to 7.3) (median difference 1.3 seconds; p = 0.39) were not different between the groups with an effect size of 0.83 and 0.75, respectively. CONCLUSION: The results of our study demonstrate that service members run with discernible differences in high-level mobility and demonstrate inferior self-reported patient functioning while having no differences in speed and biomechanics compared with their noninjured counterparts with the sample size available. This study is an early report on functional gains of highly motivated service members with major lower extremity injuries who use a PD-AFO and formalized therapy program to run. LEVEL OF EVIDENCE: Level III, therapeutic study.
Asunto(s)
Ortesis del Pié , Fracturas Óseas/rehabilitación , Traumatismos de la Pierna/rehabilitación , Volver al Deporte/fisiología , Carrera/lesiones , Adulto , Tobillo/fisiopatología , Fenómenos Biomecánicos , Estudios de Casos y Controles , Evaluación de la Discapacidad , Pie/fisiopatología , Fracturas Óseas/fisiopatología , Marcha/fisiología , Análisis de la Marcha , Humanos , Traumatismos de la Pierna/fisiopatología , Estudios Longitudinales , Masculino , Personal Militar , Estudios Retrospectivos , Carrera/fisiología , Resultado del TratamientoRESUMEN
INTRODUCTION: This study aimed to analyze the clinical and radiological outcomes of early weight-bearing and rehabilitation after open reduction and internal fixation (OR/IF) of calcaneal fracture. MATERIALS AND METHODS: This retrospective study was conducted on 78 patients with unilateral calcaneal fracture who underwent OR/IF. A mean follow-up period was 45.8 months (range 12-135). Two weeks after surgery, the range of motion (ROM) exercise was started, brace or heel off shoe was applied, and forefoot weight-bearing was allowed. Four weeks after surgery, tolerable weight-bearing ambulation without crutch was allowed. When the patient was not walking, the braces were removed to perform peritalar ROM exercises. Radiologic evaluation was performed by measuring the Böhler angle and incongruency of the subtalar joint surface. Paley grade was used to assess traumatic arthritis. Clinical evaluation was performed by measuring the foot and ankle outcome score (FAOS) and ankle ROM. RESULTS: The mean postoperative Böhler angle was 31.7° (P < 0.001) at 2 weeks, 31.2° at 3 months, and 30.1° at the last (P = 0.4). The average Paley grade of the subtalar OA was 1.12. CT imaging revealed that the average step-off of the subtalar joint was 1.26 mm in coronal and 0.84 mm in sagittal. The average ROM results were as follows (contralateral, affected side): there was no significant difference in dorsiflexion [16.9° vs. 16° (P = 0.6)], whereas plantarflexion and inversion were significantly decreased [39.5° vs. 35.3° (P = 0.049) and 50.5° vs. 34.8° (P = 0.04)]. The average FAOS score was 86.1 points, and the highest score was "function" (mean 92.5 points). CONCLUSIONS: Earlier rehabilitation after OR/IF is recommended for the treatment of calcaneal fracture.
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Calcáneo/cirugía , Fijación Interna de Fracturas/rehabilitación , Fracturas Óseas , Reducción Abierta/rehabilitación , Fracturas Óseas/rehabilitación , Fracturas Óseas/cirugía , Humanos , Rango del Movimiento Articular , Estudios Retrospectivos , Tiempo de Tratamiento , Resultado del TratamientoRESUMEN
INTRODUCTION: Human Immunodeficiency Virus (HIV) infection remains prevalent co-morbidity, and among fracture patients. Few studies have investigated the role of exercise interventions in preventing bone demineralization in people who have fractures and HIV. If exercise exposed, HIV-infected individuals may experience improved bone health outcomes (BMD), function, quality of life (QoL). The study will aim to assess the impact of home based exercises on bone mineral density, functional capacity, QoL, and some serological markers of health in HIV infection among Nigerians and South Africans. METHODS AND DESIGN: The study is an assessor-blinded randomized controlled trial. Patients managed with internal and external fixation for femoral shaft fracture at the study sites will be recruited to participate in the study. The participants will be recruited 2 weeks post-discharge at the follow-up clinic with the orthopaedic surgeon. The study population will consist of all persons with femoral fracture and HIV-positive and negative (HIV-positive medically confirmed) aged 18 to 60 years attending the above-named health facilities. For the HIV-positive participants, a documented positive HIV result, as well as a history of being followed-up at the HIV treatment and care center. A developed home based exercise programme will be implemented in the experimental group while the control group continues with the usual rehabilitation programme. The primary outcome measures will be function, gait, bone mineral density, physical activity, and QoL. DISCUSSION: The proposed trial will compare the effect of a home-based physical exercise-training programme in the management of femoral fracture to the usual physiotherapy management programmes with specific outcomes of bone mineral density, function, and inflammatory markers. TRIAL REGISTRATION: The study was prospectively registered with the Pan African Clinical Trials Registry (Reference number - PACTR201910562118957) on October 21, 2019. (https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9425).
Asunto(s)
Ejercicio Físico/fisiología , Fracturas del Fémur/rehabilitación , Fracturas Óseas/etiología , Fracturas Óseas/rehabilitación , Infecciones por VIH/complicaciones , Adulto , Densidad Ósea/fisiología , Terapia por Ejercicio/métodos , Femenino , Fracturas del Fémur/cirugía , Fijación de Fractura/métodos , Fracturas Óseas/cirugía , Marcha/fisiología , Infecciones por VIH/sangre , Infecciones por VIH/epidemiología , Infecciones por VIH/virología , VIH-1/aislamiento & purificación , Humanos , Masculino , Persona de Mediana Edad , Nigeria/epidemiología , Evaluación de Resultado en la Atención de Salud , Prevalencia , Calidad de Vida , Sudáfrica/epidemiologíaRESUMEN
Glenoid fractures are unique in which they span the fields of orthopaedic traumatology and sports medicine. Treatment of glenoid fractures, whether surgical or nonsurgical, may be challenging and have long-term implications on pain and shoulder function. Plain radiographs are always indicated, and most glenoid fractures will require advanced imaging in the form of CT scan. Two general categories of glenoid fractures exist and differ in mechanism of injury, fracture morphology, and treatment. The first category is glenoid fractures with extension into the scapular neck and body. These fractures are typically from high-energy trauma and are often associated with other orthopaedic and nonorthopaedic injuries. The second category includes glenoid rim fractures, which are typically consequent of lower energy mechanisms and are associated with shoulder instability events. Treatment of glenoid rim fractures is dictated by the size and displacement of the fracture fragment and may be nonsurgical or surgical with either open and arthroscopic techniques. The purpose of this review was to discuss the current evidence on glenoid fractures regarding diagnosis, classification, management, and outcomes.
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Fijación de Fractura/métodos , Fracturas Óseas/cirugía , Cavidad Glenoidea/lesiones , Cavidad Glenoidea/cirugía , Artroscopía/métodos , Fracturas Óseas/clasificación , Fracturas Óseas/diagnóstico por imagen , Fracturas Óseas/rehabilitación , Cavidad Glenoidea/diagnóstico por imagen , Humanos , Radiografía , Tomografía Computarizada por Rayos XRESUMEN
There have been few reports on fixation of Rommens classification Type IIIA fragility fractures of the pelvis (FFPs). Here, we present our less invasive surgical technique, called iliac intramedullary stabilization (ILIS), for the internal fixation of Type IIIA FFPs. The technique involves a closed reduction, termed the femur internal rotation reduction method (FIRM), whereby the fracture fragments are repositioned using lateral rotators by internally rotating the femur while the patient is in the prone position. Two iliac screws are inserted on the ilium bilaterally via the supra-acetabular bone canal during FIRM and connected with two transverse rods and two cross connectors. We refer to this internal fixation procedure as ILIS. We retrospectively recruited patients with Type IIIA fractures, treated using this procedure, at our institute between October 2017 and October 2019. We evaluated operative and post-operative outcomes. We enrolled 10 patients (9 women and 1 man; mean age, 85.2 years) who were followed up for over 6 months. All patients suffered FFPs after falling from a standing position. The mean operative time was 145.1 (range, 94-217) minutes, and the mean blood loss was 258.5 (range, 100-684) ml. All patients were allowed full weight bearing from post-operative day 1. All patients achieved bone union and regained their pre-injury walking ability at 6 months after surgery without evident secondary displacement. In conclusion, our ILIS technique allows less invasive internal fixation of Type IIIA FFPs with adequate stability for full weight bearing from post-operative day 1.
Asunto(s)
Acetábulo/cirugía , Fijación Interna de Fracturas/métodos , Fracturas Óseas/cirugía , Ilion/cirugía , Pelvis/cirugía , Recuperación de la Función/fisiología , Acetábulo/irrigación sanguínea , Acetábulo/lesiones , Anciano , Anciano de 80 o más Años , Pérdida de Sangre Quirúrgica/estadística & datos numéricos , Tornillos Óseos , Femenino , Fijación Interna de Fracturas/rehabilitación , Curación de Fractura/fisiología , Fracturas Óseas/patología , Fracturas Óseas/rehabilitación , Humanos , Ilion/irrigación sanguínea , Ilion/lesiones , Masculino , Tempo Operativo , Pelvis/irrigación sanguínea , Pelvis/lesiones , Estudios Retrospectivos , Resultado del Tratamiento , Soporte de Peso/fisiologíaRESUMEN
Apresenta-se um modelo experimental de ostectomia de tíbia em coelhos para estudo de biomateriais em processos de reparação óssea. Foi realizada falha segmentar de 6mm de diâmetro na região metafisária medial proximal de tíbia de 72 coelhos as quais foram preenchidas com substituto ósseo e avaliadas clinicamente, por exame radiográfico e por meio de tomografia computadorizada feixe cônico, em diferentes tempos. Conclui-se que a metáfise medial proximal de tíbia de coelhos é adequada como modelo para estudos que avaliem o comportamento de enxertos e/ou biomateriais em falhas ósseas.
Is presented an experimental model of tibial ostectomy in rabbits to study biomaterials during bone repair process. Segmental failure of 6 mm diameter was performed in the medial proximal tibial metaphyseal region of 72 rabbits, which were filled with bone substitute and evaluated by clinical exam, X-ray, and cone beam computed tomography at different times. It is concluded that the medial proximal tibial metaphysis region of rabbits is suitable as a model for studies that evaluate the behavior of grafts and/or biomaterials on bone defects.
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Animales , Conejos , Conejos/cirugía , Materiales Biocompatibles/uso terapéutico , Sustitutos de Huesos/análisis , Tibia/cirugía , Trasplante Óseo/veterinaria , Fracturas Óseas/rehabilitaciónRESUMEN
STUDY DESIGN: This is a two-group randomized controlled trial. INTRODUCTION: Finger stiffness after treatment for metacarpal fractures often occurs due to poor compliance to the conventional rehabilitation programs. Gamification has shown success in improving adherence to and effectiveness of various therapies. PURPOSE OF THE STUDY: The purpose of this study was to evaluate whether gamification, using cost-effective devices was comparable with conventional physiotherapy in improving hand functions and adherence to rehabilitation in metacarpal fractures. METHODS: A 2-group randomized controlled trial involving 19 patients was conducted. Participants were randomized to a control (conventional physiotherapy, n = 10) or interventional group (gamification, n = 9). The grips strength and composite finger range of motion were measured at the baseline and each follow-up together with Patient-Rated Wrist and Hand Evaluation scores and compliance. RESULTS: There were no significant differences on improvements of grip strength (means difference 24.38 vs 20.44, P = .289) and composite finger range of motion (means difference 50.50 vs 51.11, P = .886). However, the gamification group showed better results in Patient-Rated Wrist and Hand Evaluation (mean 0.44 vs 8.45, P = .038) and compliance (P < .05). No adverse events were reported. DISCUSSION: Our results suggest that gamification using a cost-effective device demonstrated similar effectiveness as conventional physiotherapy in post-metacarpal fracture rehabilitation. CONCLUSIONS: Gamification using a mobile device is an inexpensive and safe alternative to conventional physiotherapy for hand rehabilitation after metacarpal fractures. It effectively serves as a guide for future development of cost-effective technology-enhanced therapy.
Asunto(s)
Terapia por Ejercicio , Fracturas Óseas/rehabilitación , Traumatismos de la Mano/rehabilitación , Huesos del Metacarpo/lesiones , Juegos de Video , Adulto , Análisis Costo-Beneficio , Femenino , Humanos , Masculino , Cooperación del Paciente , Rango del Movimiento Articular , Adulto JovenRESUMEN
Musculoskeletal (MSK) trauma is a major cause of disability and pain worldwide. Despite surgical advances following MSK injuries, poor functional outcomes following surgery remain a major public health concern. Traditional methods of rehabilitation involving bed rest and immobilization led to muscle weakness, joint stiffness, and an inability to return to previous levels of activity. Recent research has provided evidence that early rehabilitation with a multidisciplinary team can prevent these negative outcomes and improve functional outcomes following MSK trauma. In order to continue to optimize recovery, standardized rehabilitation protocols and technological advances are required.
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Fracturas Óseas/rehabilitación , Dolor Musculoesquelético/rehabilitación , Sistema Musculoesquelético/lesiones , Humanos , Manejo del Dolor , Grupo de Atención al Paciente/organización & administración , Calidad de Vida , Recuperación de la Función , Resultado del TratamientoAsunto(s)
Fracturas Osteoporóticas/rehabilitación , Soporte de Peso/fisiología , Anciano , Fracturas Óseas/fisiopatología , Fracturas Óseas/rehabilitación , Fracturas Óseas/cirugía , Anciano Frágil , Humanos , Inmovilización/efectos adversos , Fracturas Osteoporóticas/fisiopatología , Fracturas Osteoporóticas/cirugíaRESUMEN
The musculoskeletal system has an integral role throughout life, including structural support to the body, protection, and allowing a range of fine to complex movements for daily living to elite sporting events. At various times, injuries to the musculoskeletal system occur resulting in varying levels of impact to the person both acutely and chronically. Specifically, there is a spectrum of complexity in orthopedic injuries, with some such as common muscle strains, that while burdensome will have no impact on life-long functional ability, and others that can result in long lasting disability. Focusing on extremity injuries, this review highlights: i)the current impact of orthopedic injuries in sport and daily life; ii) the foundation of bone and skeletal muscle repair and regeneration; and iii) the disruptions in regenerative healing due to traumatic orthopedic injuries. This review seeks to maximize the broad and collective research impact on sport and traumatic orthopedic injuries in search of promoting ongoing innovation for treatment and rehabilitation approaches aimed to improve musculoskeletal health throughout life.
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Extremidad Inferior/lesiones , Extremidad Inferior/fisiopatología , Músculo Esquelético/lesiones , Músculo Esquelético/fisiopatología , Regeneración/fisiología , Extremidad Superior/lesiones , Extremidad Superior/fisiopatología , Actividades Cotidianas , Traumatismos en Atletas/fisiopatología , Traumatismos en Atletas/rehabilitación , Regeneración Ósea , Fracturas Óseas/fisiopatología , Fracturas Óseas/rehabilitación , Humanos , Inflamación/fisiopatología , Modalidades de Fisioterapia , Cicatrización de Heridas/fisiologíaAsunto(s)
Atención Ambulatoria/métodos , Fijación de Fractura/efectos adversos , Conocimientos, Actitudes y Práctica en Salud , Complicaciones Posoperatorias/prevención & control , Autocuidado/estadística & datos numéricos , Adulto , Anciano , Atención Ambulatoria/estadística & datos numéricos , China , Estudios Transversales , Fijadores Externos/efectos adversos , Femenino , Fijación de Fractura/instrumentación , Fracturas Óseas/rehabilitación , Fracturas Óseas/cirugía , Humanos , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Encuestas y Cuestionarios/estadística & datos numéricos , Adulto JovenRESUMEN
Treatment of trauma patients and fractures has changed dramatically throughout the years. From conservative methods to nowadays various kinds of screws, pins, plates and nails for optimal fixation of fractures. This lead to changes in post-operative management as well, from bedrest to (partial) weight bearing. Some patients however have very limited to no ability to mobilise, such as critical ill patients on the Intensive Care Unit, amputees or spinal cord injured patients. Due to innovations such as hydrotherapy, osseointegrated prosthesis and exoskeletons, even these people can mobilise. Thanks to innovations like these an increasing number of trauma patients are able to fully reintegrate into community life and get back to an active and independent life style.
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Amputados/rehabilitación , Ambulación Precoz/métodos , Fracturas Óseas/rehabilitación , Oseointegración/fisiología , Soporte de Peso/fisiología , Humanos , Hidroterapia , Modalidades de Fisioterapia , Implantación de PrótesisRESUMEN
Hematoma, inflamación, angiogénesis y osteogénesis son distintas etapas que se superponen durante el proceso de reparación de una fractura ósea. Durante las primeras etapas se liberan distintos factores de crecimiento quimioatractantes que producen el reclutamiento de diversas células para generar la formación de un hueso funcional con su respectiva vasculatura. Debido a la importancia que posee la angiogénesis en el desarrollo de una adecuada red vascular, tanto para la formación ósea como en su reparación, en los últimos años los especialistas en ingeniería de tejido óseo han estudiado la manera de fomentar tanto la osteogénesis como la angiogénesis durante la reparación ósea. En este trabajo de revisión, se recopilan y discuten los principales conceptos sobre distintas estrategias a fin de lograr un implante sintético con funcionalidad dual promoviendo los procesos que garanticen la angiogénesis y la osteogénesis en forma acoplada utilizando distintos tipos de scaffolds y sistemas de liberación de drogas osteoinductoras y angioinductoras. La liberación dual de factores osteoinductores y angioinductores debe producirse en forma témporo-espacial controlada para garantizar los efectos deseados sin producir efectos adversos como tumores o hueso ectópico. Se deben tener en cuenta varios factores como el tipo y la arquitectura de hueso, tipo de daño, edad, sexo y condiciones patológicas del paciente. En cuanto a los materiales se debe considerar el tipo de material para usar como scaffold, los factores inductores seleccionados, su combinación y sistemas de liberación. El avance en estos estudios hará que la Ingeniería de Tejido Óseo sea una alternativa terapéutica en el futuro. (AU)
Hematoma, inflammation, angiogenesis, and osteogenesis are different stages that overlap during the healing process of a bone fracture. During the first stages, different chemoattractant growth factors are released which produce the recruitment of various cells that will induce the formation of a functional bone with its respective vasculature. Due to the importance of angiogenesis for the development of an adequate vascular network in both bone formation and repair, in recent years specialists in bone tissue engineering have studied how to promote both osteogenesis and angiogenesis during bone repair. In this review, the main concepts on different strategies developed to achieve a synthetic implant with dual functionality, promoting processes that guarantee angiogenesis and osteogenesis in a coupled way using different types of scaffolds and osteo-drug delivery systems and angioinductors, are collected and discussed. The dual release for osteoinductive and angioinductive factors must ensure the release of them in a controlled time-space manner to guarantee the desired effects without producing adverse effects such as tumors or ectopic bone. Several factors must be taken into account, such as bone type and architecture, type of damage to be repaired, age, sex, and pathological conditions of the patient. Regarding the materials, the type of material to be used as scaffolds, selected inducing factors and drug release system must be considered. Advances in these studies will make Bone Tissue Engineering a therapeutic alternative in the future. (AU)
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Humanos , Ingeniería de Tejidos/tendencias , Fracturas Óseas/rehabilitación , Osteogénesis , Materiales Biocompatibles , Sistemas de Liberación de Medicamentos , Neovascularización Fisiológica , Péptidos y Proteínas de Señalización Intercelular , Andamios del TejidoRESUMEN
OBJECTIVE: To determine research priorities for the management of broken bones of the upper limb in people over 50, which represent the shared priorities of patients, their families, carers and healthcare professionals. DESIGN/SETTING: A national (UK) research priority setting partnership. PARTICIPANTS: People aged 50 and over who have experienced a fracture of the upper limb, carers involved in their care, family and friends of patients, healthcare professionals involved in the treatment of these patients. METHODS: Using a multiphase methodology in partnership with the James Lind Alliance over 15 months (September 2017 to December 2018), a national scoping survey asked respondents to submit their research uncertainties. These were amalgamated into a smaller number of research questions. The existing evidence was searched to ensure that the questions had not already been answered. A second national survey asked respondents to prioritise the research questions. A final shortlist of 25 questions was taken to a multi-stakeholder workshop where a consensus was reached on the top 10 priorities. RESULTS: There were 1898 original uncertainties submitted by 328 respondents to the first survey. These original uncertainties were refined into 51 research questions of which 50 were judged to be true uncertainties following a review of the research evidence. There were 209 respondents to the second (interim prioritisation) survey. The top 10 priorities encompass a broad range of uncertainties in management and rehabilitation of upper limb fractures. CONCLUSIONS: The top 10 UK research priorities highlight uncertainties in how we assess outcomes, provide information, achieve pain control, rationalise surgical intervention, optimise rehabilitation and provide psychological support. The breadth of these research areas highlights the value of this methodology. This work should help to steer research in this area for the next 5-10 years and the challenge for researchers now is to refine and deliver answers to these research priorities.
Asunto(s)
Investigación Biomédica , Fracturas Óseas/terapia , Encuestas Epidemiológicas , Extremidad Superior/lesiones , Factores de Edad , Cuidadores , Familia , Femenino , Fracturas Óseas/complicaciones , Fracturas Óseas/rehabilitación , Personal de Salud , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Resultado en la Atención de Salud , Manejo del Dolor , Educación del Paciente como Asunto , Participación del Paciente , Apoyo Social , Reino UnidoRESUMEN
A retrospective case series that included 253 free-ranging birds of prey admitted to a rehabilitation center was conducted to describe the treatment and outcome of antebrachial fractures. Medical records from birds of prey belonging to 21 species admitted with antebrachial fracture between 1989 and 2015 at the University of California, Davis, were reviewed. Species distribution on admission, treatment, outcome, and complications were described by fracture category and species. Among 134 birds treated after initial triage on the day of admission, 4 bone/ wing categories were identified: 83 birds had an ulnar fracture only; 18 birds had a radial fracture only; 28 birds had a concomitant fracture of the radius and ulna on the same wing; and 5 birds had bilateral antebrachial fractures. Logistic regressions were performed to determine which factors were associated with a positive outcome within each of these 4 categories. Among birds having only an ulnar fracture, those with a closed fracture were significantly more likely to be released than birds with open fractures (P = .03; odds ratio = 5.43, 95% confidence interval: 1.29-28.12). In addition, birds with a fracture of the middle third of the ulna were significantly more likely to be released than birds diagnosed with a single fracture of the proximal third of the ulna (P = .02; odds ratio = 4.54, 95% confidence interval: 1.35-16.64). No significant prognostic factor was detected in other fracture categories.