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1.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(9): 1125-1129, 2020 Sep 15.
Artigo em Chinês | MEDLINE | ID: mdl-32929905

RESUMO

Objective: To investigate the short-term effectiveness of arthroscopic assisted double Endobutton "8" buckle fixation in the treatment of Rockwood Ⅲ type acute acromioclavicular joint dislocation. Methods: The clinical data of 12 patients with Rockwood Ⅲ type acute acromioclavicular joint dislocation who were treated with arthroscopic assisted double Endobutton "8" buckle fixation between June 2016 and June 2019 were analyzed retrospectively. There were 8 males and 4 females, with an average age of 47.0 years (range, 36-58 years). There were 4 cases of left shoulder and 8 cases of right shoulder. The causes of injury included traffic accident injury in 7 cases and falling injury in 5 cases. The average time from injury to operation was 5.0 days (range, 3-14 days). Before operation and at last follow-up, the shoulder joint activity was recorded; the improvements of function and pain were evaluated by Constant score and visual analogue scale (VAS) score, respectively; the reduction was evaluated by measuring the coracoid spacing of the affected side on the anteroposterior X-ray film of shoulder joint. Results: All 12 cases were followed up 6-36 months, with an average of 20.6 months. All the incisions healed by first intention. There was no complications such as clavicle and coracoid fractures and Endobuton displacement. At last follow-up, the range of motion of the abduction improved from preoperative (77.5±4.5)° to (162.5±6.5)°, the range of motion of forward flexion improved from (84.1±5.2)° to (169.5±5.8)°, the Constant score improved from 42.5±2.3 to 92.4±2.3, the VAS score improved from 5.4±0.8 to 0.6±0.5, and the coracoid spacing reduced from (20.5±1.4) mm to (9.2±0.6) mm, all showing significant differences ( P<0.05). Conclusion: Arthroscopic assisted double Endobutton "8" buckle fixation for the treatment of Rockwood Ⅲ type acute acromioclavicular joint dislocation is safe, less invasive, and quicker recovery. It can effectively alleviate shoulder pain, significantly improve the mobility of the shoulder joint, and achieve good short-term effectiveness.


Assuntos
Articulação Acromioclavicular , Luxações Articulares , Luxação do Ombro , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
2.
Zhongguo Gu Shang ; 33(8): 696-702, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32875756

RESUMO

OBJECTIVE: To investigate the clinical effect of arthroscopic assisted TightRope plate, Triple-Endobutton plate and Double Endobutton plate in treating of Rockwood type Ⅲ-Ⅴ acromioclavicular dislocation. METHODS: From January 2014 to January 2018, 128 patients with acromioclavicular dislocation were treated by operation. According to the operation plan, the patients were divided into three groups:Double Endobutton group, Triple-Endobutton group and TightRope group. All patients with acromioclavicular dislocation were operated by the same operation team, and the chief surgeon was the same chief physician. General baseline data such as gender, age, operation time, incision length, intraoperative blood loss, VAS score of pain and Constant-Murley shoulder function score were recorded. RESULTS: The wound healed well and no recent complications occurred. One hundred and eleven patients were followed up for 6 to 12(9.1±3.1) months. There was no significant difference on general data among three groups (P >0.05). Among three groups, the operation time of Triple -Endobutton group was the longest, significantly higher than that of other two groups(P<0.05);the operation time of TightRope group was the shortest, significantly lower than that of other two groups (P<0.05). At 1 month after operation, VAS score comparison of three groups, TightRope group was significantly lower than other two groups, with statistical difference (P<0.05). At 12 months after operation of three groups, the Constant-Murley score of TightRope group was significantly higher than that of two group (P<0.05). The incidence of incision infectionin TightRope group was significantly lower than that of other two groups(P<0.05); the incidence of reduction loss in Double Endobton group was significantly higher than that of other two groups(P<0.05), the incidence of reduction loss in TightRope group was significantly higher than that of Triple endobton group(P<0.05);the incidence of joint adhesion in TightRope group was significantly lower than that of other two groups(P<0.05). CONCLUSION: TightRope plate fixation with arthroscopy is more advantageous than Double Endobutton plate fixation and Triple-Endobutton plate fixation.


Assuntos
Articulação Acromioclavicular , Luxações Articulares , Luxação do Ombro , Artroscopia , Placas Ósseas , Humanos , Resultado do Tratamento
3.
Zhongguo Gu Shang ; 33(8): 703-6, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32875757

RESUMO

OBJECTIVE: To explore the clinical effect of the modified double Endobutton technique combined with Nice node in the treatment of Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation. METHODS: From March 2016 to January 2019, 23 patients with Rockwood Ⅲ-Ⅴ acromioclavicular joint dislocation were treated with modified double Endobutton technique to reconstruct coracoclavicular ligament and Nice node to repair acromioclavicular ligament, including 18 males and 5 females, aged 31 to 53 (43.2±5.4) years, 9 on the left and 14 on the right, and the time from injury to operation was 1 to 10 days. Before operation, X-ray films and CT three-dimensional reconstruction of bilateral shoulder joint were performed. Postoperative complications were observed. Six months after operation, DASHand Constant-Murley scores were used to evaluate the treatment effect. RESULTS: The incision healed in one stage after operation, and no complications such as vascular and nerve injury and stress fracture occurred. All patients were followed up for 6 to 24 (12.0±4.9) months. At 6 months follow-up, the DASH score was 0.40±0.10 lower than that of 19.80±4.50 before operation, and the Constant-Murley score was 94.20±4.20 higher than that of 38.60±3.90 before operation. CONCLUSION: The treatment of Rockwood Ⅲ-Ⅴ dislocation of acromioclavicular joint with double Endobutton technique and nice knot is satisfactory in the early stage. The long-term effect and complications need further follow-up.


Assuntos
Articulação Acromioclavicular , Luxações Articulares , Luxação do Ombro , Adulto , Feminino , Humanos , Ligamentos Articulares , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
4.
Zhongguo Gu Shang ; 33(8): 707-11, 2020 Aug 25.
Artigo em Chinês | MEDLINE | ID: mdl-32875758

RESUMO

OBJECTIVE: To explore the method and effect of small incision TightRope fixation in the treatment of fresh acromioclavicular joint dislocation. METHODS: From January 2016 to May 2018, 28 cases of fresh acromioclavicular dislocation were treated, including 20 males and 8 females, aged 26 to 87 years with an average age of 51.3 years. The modified Rockwood classification included 1 case of typeⅡ, 22 cases of typeⅢand 4 cases of type V. The average time from injury to operation was 2.4 days. The operative time, shoulder function recovery time and postoperative complications were recorded, and the immediate reduction effect and Karlsson function of shoulder joint were evaluated. RESULTS: In 28 patients, only one Rockwood typeⅡ was used to reconstruct the pyramidal ligament, and the other 27 were used to reconstruct the pyramidal ligament and the trapezoid ligament. The average operation time was (66.50±12.62) min (including intraoperative fluoroscopy time). Twenty-eight cases were followed up for 11 to 20 (16.7±4.6) months. The recovery time of shoulder function was 2 to 7 months with an average of 4 months. During the follow-up period, 1 case had osteolysis and loss of reduction at the clavicular plate site, and the rest had no complications such as re-dislocation and button plate prolapse. Immediate reduction effect after operation:6 cases with reduction insufficiency, 17 cases with complete reduction and 5 cases with excessive reduction;Karlsson function evaluation of shoulder joint in the last follow-up:excellent in 21 cases, good in 6 cases and poor in 1 case;Pearson analysis r=0.060, suggesting that the immediate reduction effect of fresh acromioclavicular dislocation operation has no significant correlation with Karlsson function evaluationof shoulder joint in the last follow-up. CONCLUSION: TightRope fixation through a small incision in the base of coracoid process is a simple and effective method for the treatment of dislocation of acromioclavicular joint. There was no significant correlation between the slight difference of immediate reduction effect within 5 mm and Karlsson function evaluation of shoulder joint in the last follow-up. It is suggested to pay attention to the loss of reduction and osteolysis of clavicular plate in clinical follow-up.


Assuntos
Articulação Acromioclavicular , Luxações Articulares , Luxação do Ombro , Adulto , Idoso , Idoso de 80 Anos ou mais , Clavícula , Processo Coracoide , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
5.
Arthroscopy ; 36(9): 2533-2536, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32891253

RESUMO

Historically, a primary anterior instability event has been treated nonoperatively. In the literature, a multitude of outcome scores and definitions for recurrence of instability complicates the interpretation and synthesis of evidence-based recommendations. However, there is an emerging body of high-quality evidence that early surgical stabilization yields better overall outcomes. A wait-and-see approach would be acceptable if it was without detrimental effects, but there is a cost to recurrence of instability events, such as more extensive soft-tissue, cartilage, and bony lesions. Young age, male sex, and contact sport participation have been identified as risk factors for recurrence of anterior shoulder instability, and today, these patients are routinely recommended surgical treatment. It is also paramount to identify concomitant injury following the primary anterior instability event. The sensitivity, specificity, and reliability of radiographs is suboptimal, and the threshold to obtain advanced imaging such as computed tomography or magnetic resonance imaging with 3-dimensional reconstructions should be low. Taking into account the low non-recurrence complication rate following arthroscopic stabilization, early surgical intervention should be considered following the first instability event.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Artroscopia , Tratamento Conservador , Humanos , Masculino , Recidiva , Reprodutibilidade dos Testes , Ombro
6.
Arthroscopy ; 36(8): 2314-2315, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747069

RESUMO

Glenoid defects are important to consider when choosing the surgical stabilization technique in shoulder instability patients. Several measurement methods to determine the extent of glenoid bone loss have been proposed and their reliability or precision proved. However, it must be considered that these defect extent measurements are only surrogate parameters trying to express the loss of biomechanical stability generated by a glenoid defect, which in fact they do not do accurately. Current defect measurement techniques are either linear based (1-dimensional) or area based (2-dimensional) but do not take into account the 3-dimensional shape of the glenoid concavity, which creates stability by means of the concavity-compression effect. Furthermore, none of the current measurement methods take into account the native glenoid concavity shape, which significantly differs between patients and therefore also affects the biomechanical consequence a glenoid defect generates. To improve the accuracy of current glenoid defect measurement techniques in expressing the loss of biomechanical stability generated by a glenoid defect, measurements should take into account the concave shape of the glenoid (3-dimensional measurements) and account for the baseline shape of the native glenoid (4-dimensional measurements).


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Humanos , Reprodutibilidade dos Testes , Escápula , Ombro , Tomografia Computadorizada por Raios X
11.
J Shoulder Elbow Surg ; 29(9): 1737-1742, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32713663

RESUMO

BACKGROUND: Because of the rapid spread of COVID-19, on March 8, 2020 Italy became a "protected area": people were told not to leave their homes unless it was essential. The aim of this study was to evaluate the activity of our trauma center, relative to shoulder and elbow, in the 30 days starting from March 8, 2020, the first day of restrictions in Italy, and to compare it with the same days of 2019 to weigh the impact of COVID-19 on shoulder and elbow trauma. MATERIALS AND METHODS: Patients managed in our trauma center between March 8, 2020, and April 8, 2020 (COVID period), for shoulder and elbow trauma were retrospectively included and compared to patients admitted in the same period of 2019 (no-COVID period). Clinical records of all participants were examined to obtain information regarding age, sex, mechanism of injury, and diagnosis. RESULTS: During the no-COVID period, 133 patients were admitted for a shoulder or elbow trauma; in the COVID period, there were 47 patients (65% less first aid). In the no-COVID and COVID period, patients with shoulder contusion totaled 60 (14.78% of all; male [M]: 34; female [F]: 26; mean age 51.8 years, range 18-88) and 11 (12.09% of all contusions; M: 7, F: 4; mean age 43 years, range 24-60), respectively. In the no-COVID period, 27 fractures (9.34% of all fractures) involved the shoulder, whereas 18 fractures (8.69%) were registered in the COVID period. In the no-COVID period, 14 elbow fractures were treated (4.8% of all fractures), compared with 4 in the COVID period. In the no-COVID and COVID periods, 6 patients (M: 5, F: 1; mean age 42 years, range 21-64) and 2 patients (M: 1, F: 1; mean age 29.5 years, range 24-35) reported having a feeling of momentary post-traumatic shoulder instability, and 0 and 1 patients (M: 1, F: 0; age 56 years), respectively, reported similar symptoms at the elbow. Finally, first or recurrent dislocations in the no-COVID period were 10, and in the COVID period, 7; elbow dislocations in the no-COVID period were 2, and in the COVID period, there were 3. CONCLUSIONS: During the COVID period, we provided a reduced number of health services, especially for patients with low-energy trauma and for those who underwent sports and traffic accidents. However, during the COVID period, elderly subjects remain exposed to shoulder and elbow trauma due to low-energy (domestic) falls. The subsequent hospitalization of these patients has contributed to making it more difficult to manage the hospital wards that are partly occupied by COVID-19 patients.


Assuntos
Traumatismos do Braço/complicações , Betacoronavirus , Infecções por Coronavirus/complicações , Articulação do Cotovelo/lesões , Pneumonia Viral/complicações , Vigilância da População , Luxação do Ombro/complicações , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Traumatismos do Braço/epidemiologia , Infecções por Coronavirus/epidemiologia , Feminino , Humanos , Incidência , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Estudos Retrospectivos , Luxação do Ombro/epidemiologia , Adulto Jovem
12.
Bone Joint J ; 102-B(7): 918-924, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32600145

RESUMO

AIMS: There is a lack of long-term data for minimally invasive acromioclavicular (AC) joint repair. Furthermore, it is not clear if good early clinical results can be maintained over time. The purpose of this study was to report long-term results of minimally invasive AC joint reconstruction (MINAR) and compare it to corresponding short-term data. METHODS: We assessed patients with a follow-up of at least five years after minimally invasive flip-button repair for high-grade AC joint dislocation. The clinical outcome was evaluated using the Constant score and a questionnaire. Ultrasound determined the coracoclavicular (CC) distance. Results of the current follow-up were compared to the short-term results of the same cohort. RESULTS: A total of 50 patients (three females, 47 males) were successfully followed up for a minimum of five years. The mean follow-up was 7.7 years (63 months to 132 months). The overall Constant score was 94.4 points (54 to 100) versus 97.7 points (83 to 100) for the contralateral side showing a significant difference for the operated shoulder (p = 0.013) The mean difference in the CC distance between the operated and the contralateral shoulder was 3.7 mm (0.2 to 7.8; p = 0.010). In total, 16% (n = 8) of patients showed recurrent instability. All these cases were performed within the first 16 months after introduction of this technique. A total of 84% (n = 42) of the patients were able to return to their previous occupations and sport activities. Comparison of short-term and long-term results revealed no significant difference for the Constant Score (p = 0.348) and the CC distance (p = 0.974). CONCLUSION: The clinical outcome of MINAR is good to excellent after long-term follow-up and no significant differences were found compared to short-term results. We therefore suggest this is a reliable technique for surgical treatment of high-grade AC joint dislocation. Cite this article: Bone Joint J 2020;102-B(7):918-924.


Assuntos
Articulação Acromioclavicular/cirurgia , Ligamentos Articulares/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Luxação do Ombro/cirurgia , Articulação Acromioclavicular/diagnóstico por imagem , Adolescente , Adulto , Idoso , Feminino , Seguimentos , Humanos , Ligamentos Articulares/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Reconstrutivos/métodos , Recuperação de Função Fisiológica , Luxação do Ombro/diagnóstico por imagem , Ultrassonografia/métodos
13.
Orthop Clin North Am ; 51(3): 373-381, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32498956

RESUMO

Arthroscopic Latarjet is a relatively new, but viable option for the treatment of anterior shoulder instability. Arthroscopic Latarjet has the advantage of faster recovery, reduced stiffness, identification of additional shoulder pathology, and improved cosmesis when compared with open Latarjet. By the majority of clinical and radiographic parameters, arthroscopic Latarjet produces equivalent outcomes compared with open Latarjet. A relatively substantial learning curve for arthroscopic Latarjet exists at about 25 cases; however, multiple studies have demonstrated comparable outcomes and surgical time after the learning curve.


Assuntos
Artroscopia/métodos , Transplante Ósseo/métodos , Instabilidade Articular/cirurgia , Articulação do Ombro/cirurgia , Artroscopia/reabilitação , Transplante Ósseo/reabilitação , Humanos , Instabilidade Articular/diagnóstico por imagem , Luxação do Ombro , Articulação do Ombro/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
14.
Pol Merkur Lekarski ; 48(285): 184-187, 2020 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-32564044

RESUMO

Shoulder dislocation, i.e. loss of connection between the head of humerus and the glenoid cavity, is diagnosed in 15-25 patients per 100,000 people per year. The treatment consists, regardless of the methods, of repositioning as soon as possible i.e. restoring the correct position of the head in relation to the glenoid cavity. Some cases of dislocation, due to anatomical relations, may be complicated by damage to the brachial plexus branches. AIM: The aim of this study is to present epidemiological data, treatment methods and neurological complications in patients with diagnosed shoulder joint dislocation at the Mazovian Rehabilitation Center STOCER. MATERIALS AND METHODS: The basis for the analysis was a sample of 53795 patients, out of whom 424 patients were identified as having shoulder dislocation in the period 01.01.2015 - 31.12.2019. The examined group of patients was divided to the implemented therapeutic management, including neurological complications. RESULTS: 424 patients with diagnosed shoulder dislocation were analyzed. 217 patients required admission to the Trauma and Orthopedic Surgery Department. There was a statistically significant correlation between the occurrence of the dislocation and the gender and age of the patient. The reason for hospitalization was inability to reposition in Emergency Department (ED) conditions. Neurological complications presented 4.24% of patients with shoulder dislocation before reduction. The median time of hospitalization in the Trauma and Orthopedic Surgery Department was 1 day. CONCLUSIONS: None of the cases of successful repositioning in the ED required hospitalization due to neurological complications related to the dislocation repositioning. None of nerve impingement nor increasing of neurological complication related to shoulder repositioning apeared.


Assuntos
Doenças do Sistema Nervoso , Luxação do Ombro , Articulação do Ombro , Humanos , Úmero , Doenças do Sistema Nervoso/etiologia , Luxação do Ombro/complicações
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(5): 602-607, 2020 May 15.
Artigo em Chinês | MEDLINE | ID: mdl-32410428

RESUMO

Objective: To clarify the value of the cortical endo-button as an internal fixator in Latarjet procedure through biomechanical analysis. Methods: Ten pairs of shoulder joints from 6-7 months old male pigs were selected. Each pair was randomly divided into screw group and endo-button group. A 25% glenoid defect model was created, and the porcine infraspinatus tendon and its associated bone were used to simulate conjoint tendon and coracoid process in human body. The bone grafts were fixed with two 3.5 mm screws and double cortical endo-buttons with high-strength sutures in screw group and endo-button group, respectively. The prepared glenoid defect model was fixed on a biomechanical test bench and optical markers were fixed on the glenoid and the bone block, respectively. Then fatigue test was performed to observe whether the graft or internal fixator would failed. During the test, the standard deviations of the relative displacement between the graft and the glenoid of two groups were measured by optical motion measure system for comparison. Finally the maximum failure load comparison was conducted and the maximum failure loads of the two groups were measured and compared. Results: There was no tendon tear, bone fracture, and other graft or internal fixation failure in the two groups during the fatigue test. The standard deviation of the relative displacement of the screw group was (0.007 87±0.001 44) mm, and that of the endo-button group was (0.034 88±0.011 10) mm, showing significant difference between the two groups ( t=7.682, P=0.000). The maximum failure load was (265±39) N in screw group and (275±52) N in endo-button group, showing no significant difference between the two groups ( t=1.386, P=0.199). There were 3 ways of failure: rupture at bone graft's tunnel (6/10 from screw group, 3/10 from endo-button group), tendon tear at the cramp (2/10 from screw group, 2/10 from endo-button group), and tendon tear at the internal fixator interface (2/10 from screw group, 5/10 from endo-button group), showing no significant difference between the two groups ( P=0.395). Conclusion: Although the endo-button fixation fails to achieve the same strong fixation stability as the screw fixation, its fixation stability can achieve the clinical requirements. The two fixation methods can provide similar fixation strength when being used in Latarjet procedure.


Assuntos
Luxação do Ombro , Articulação do Ombro , Animais , Fenômenos Biomecânicos , Parafusos Ósseos , Humanos , Lactente , Masculino , Escápula , Suínos , Tendões
17.
Arthroscopy ; 36(5): 1271-1272, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370889

RESUMO

More than 100 surgical techniques have been described for the reconstruction of the coracoclavicular ligament complex. None of the techniques appears superior, but double-button fixation for acute high-grade acromioclavicular dislocations has become an attractive option. The clinical outcomes are good to excellent, and the return to physical activity and sport is above 90%. However, complications such as loss of reduction and tunnel widening have been described and can reach up to 80%. The load to failure of the native coracoclavicular complex is more than 600 N, and any surgical technique must surpass this figure. Single-button and loop techniques do not always sufficiently stabilize the acromioclavicular joint. Even double- and triple-button techniques may not restore vertical and horizontal stability of the acromioclavicular joint to its native normal state. Double-button technique restores both scapula and clavicular rotation closest to the native state, but still has lower stiffness and results in higher superior-inferior translation, which could cause ongoing vertical instability.


Assuntos
Articulação Acromioclavicular , Luxação do Ombro , Clavícula , Humanos , Ligamentos Articulares , Escápula
18.
FP Essent ; 491: 22-26, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32315145

RESUMO

Shoulder instability involves increased translation of the humeral head in relation to the glenoid that results in symptoms. Anterior dislocation is the most common type of traumatic instability and typically involves younger male athletes. A comprehensive patient history should include the mechanism of injury, number and severity of episodes, neurovascular symptoms, and personal or family history of connective tissue disorders. Tests to assess instability on physical examination include the anterior apprehension and Jobe relocation tests, load and shift test, sulcus sign, and jerk test. X-rays are the initial imaging modality of choice, followed by 3 T magnetic resonance arthrogram. If concerns exist about significant bone loss, computed tomography scan with 3-dimensional reconstruction can be considered. Multidirectional instability often can be managed with physical therapy. Surgery should be considered if there is no improvement after 3 months. Patients with traumatic dislocations may pursue conservative treatment, but the risk of recurrence and difficulty in returning to the prior level of sport indicate that surgical intervention may be more beneficial, particularly for younger active patients. Patients with significant bone loss may benefit from bone block surgery, such as the Latarjet procedure.


Assuntos
Instabilidade Articular , Luxação do Ombro , Articulação do Ombro , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/terapia , Masculino , Recidiva , Escápula , Ombro , Luxação do Ombro/diagnóstico por imagem , Luxação do Ombro/terapia
19.
Medicine (Baltimore) ; 99(9): e19387, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118789

RESUMO

BACKGROUND: The present study evaluated the functional and radiographic outcomes of acute acromioclavicular (AC) joint reconstruction performed using the mini-open technique and a knotless suspensory loop device METHODS:: A total of 25 patients (20 male and 5 female patients; mean age, 30.7 years; standard deviation, 10 years; range, 17-57 years) who fulfilled the inclusion criteria were included in the study. A functional assessment was performed using the Constant and University of California Los Angeles score. The radiologic assessment included standard anterior-posterior views of the AC and coracoclavicular (CC) distances. RESULTS: The mean follow-up period was 18.6 months (range, 12-23 months). The mean Constant score was 87.2 ±â€Š3.2, and the mean University of California Los Angeles score was 30.1 ±â€Š2.4 at the final follow-up. Radiological evaluation at the last follow-up of the patients: Although there was no statistically significant increase in the AC and CC values of the patients () at the last follow-up, the average CC value in 6 (24%) of the 25 patients was greater than 50% compared with the unaffected side CC and early postoperative CC values. However, there was no statistically significant difference in the Constant and UCLA scores between the 6 patients with reduction loss and the 19 patients with reduction maintenance (P = .86). CONCLUSIONS: Clinical results of fixation of acute AC joint dislocations using the ZipTight knotless suspensory loop device system and mini-open technique were favorable in terms of functional recovery and pain relief. However, the major disadvantage of this method was radiological loss of AC joint reduction when compared to the contralateral shoulder.


Assuntos
Articulação Acromioclavicular/cirurgia , Procedimentos Ortopédicos/instrumentação , Luxação do Ombro/cirurgia , Resultado do Tratamento , Articulação Acromioclavicular/fisiopatologia , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Los Angeles , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Luxação do Ombro/fisiopatologia
20.
Ann Emerg Med ; 76(2): 119-128, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32111508

RESUMO

STUDY OBJECTIVE: Shoulder dislocations are a common injury leading to emergency department presentations. Point-of-care ultrasonography has the potential to reduce radiation and time to diagnosis. We determine the accuracy of a novel point-of-care ultrasonographic technique to diagnose dislocated shoulders. We also investigate its accuracy to detect fractures, time to image acquisition, the optimal cutoff for the glenohumeral distance, and compare the time to diagnose dislocations from triage between point-of-care ultrasonography and radiography. METHODS: This was a multicenter prospective observational study. Ultrasonography fellows and fellowship-trained physicians enrolled a convenience sample of patients with suspected shoulder dislocation. Point-of-care ultrasonography was performed with a novel posterior approach with either a curvilinear or a linear transducer. Shoulder dislocation was confirmed with a 3-view radiograph interpreted by an independent radiologist. Sensitivity, specificity, positive predictive values, and negative predictive values were determined for point-of-care ultrasonography, with radiography as the criterion standard. Time to image acquisition, presence or absence of fracture, glenohumeral distance, sonographer confidence, and difference in time to diagnosis from triage for point-of-care ultrasonography and radiograph were also determined. A second investigator independently reviewed all images and interobserver agreement was calculated. RESULTS: Sixty-five patients were enrolled in the study. The sensitivity and specificity of point-of-care ultrasonography for identifying dislocations were 100% (95% confidence interval [CI] 87% to 100%) and 100% (95% CI 87% to 100%), respectively. Point-of-care ultrasonography was 92% sensitive (95% CI 60% to 99.6%) and 100% specific (95% CI 92% to 100%) for non-Hill-Sachs/Bankart's fractures of the humerus. Point-of-care ultrasonography was faster from triage than standard radiology in diagnosing dislocations (median difference 43 minutes; interquartile range [IQR] 23 to 60 minutes). The median total time required for diagnosis by point-of-care ultrasonography was 19 seconds (IQR 10 to 36 seconds). The median glenohumeral distance was -1.83 cm (IQR -1.98 to -1.41 cm) in anterior dislocations, 0.22 cm (IQR 0.10 to 0.35 cm) on nondislocated shoulders, and 3.30 cm (IQR 2.59 to 4.00 cm) in posterior dislocations. CONCLUSION: A posterior approach point-of-care ultrasonographic study is a quick and accurate tool to diagnose dislocated shoulders. Ultrasonography was also able to accurately identify humeral fractures and significantly reduce the time to diagnosis from triage compared with standard radiography.


Assuntos
Luxação do Ombro/diagnóstico por imagem , Fraturas do Ombro/diagnóstico por imagem , Ultrassonografia/métodos , Adulto , Estudos de Coortes , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Testes Imediatos , Valor Preditivo dos Testes , Estudos Prospectivos , Radiografia , Sensibilidade e Especificidade , Fatores de Tempo , Triagem
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