Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 2.103
Filtrar
2.
PLoS One ; 15(4): e0230862, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32236117

RESUMO

INTRODUCTION: The way strength recovers after reduction of pediatric fractures of the upper extremity has not previously been the specific scope of research. This is remarkable, since strength measurements are often used as an outcome measure in studies on trauma of the upper extremity. The aim of this study was to evaluate how strength recovers after sustainment of fractures of the forearm, wrist or hand treated by closed or open reduction in children and adolescents in the first 6 months after trauma. How much strength is lost at 6 weeks, 3 months and 6 months after trauma, and is this loss significant? Are there differences in the pattern of recovery between children who underwent a different treatment? And finally, which of the following factors are associated with an increase in the ratio between affected grip strength and expected strength: type of fracture, cast immobilization, occurrence of complications, and degree of pain? DESIGN: Prospective observational study. PARTICIPANTS: Children and adolescents aged 4-18 years with a reduced fracture of the forearm, wrist or hand. METHODS: Grip strength, key grip and three-jaw chuck grip were measured twice in each hand 6 weeks, 3 months and 6 months after trauma. Details on fracture type and location, treatment received, cast immobilization and complications were obtained. Hand-dominance and pain were verbally confirmed. RESULTS: Loss of strength was more prominent and prolonged the more invasive the treatment, hence most extensive in the group receiving open reduction with internal fixation (ORIF), intermediate in the group receiving closed reduction with percutaneous pinning (CRIF), and least extensive in the group undergoing closed reduction without internal fixation (CR). Besides time passed, gender and age were of significant influence on strength, although there was no difference in pattern of recovery over time between children who received a different treatment. In the period of 6 weeks to 3 months after trauma, female gender, type of fracture sustained and occurrence of an unwanted event were associated with an increased ratio between affected and expected grip strength. For the later phase of recovery, between 3 and 6 months, this was only true for the occurrence of an unwanted event.


Assuntos
Traumatismos do Antebraço/reabilitação , Força da Mão , Recuperação de Função Fisiológica/fisiologia , Adolescente , Criança , Pré-Escolar , Redução Fechada , Feminino , Antebraço , Traumatismos do Antebraço/cirurgia , Fixação Interna de Fraturas , Mãos , Humanos , Masculino , Redução Aberta , Estudos Prospectivos , Fraturas do Rádio/cirurgia , Punho
3.
Emerg Med Clin North Am ; 38(1): 81-102, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31757256

RESUMO

This article provides an updated review of the emergent evalution and treatment of elbow and forearm injuries in the emergency department. Clinically necessary imaging is discussed. Common and uncommon injuries of the elbow and forearm are reviewed with an emphasis on early recognition, efficient management, and avoidance of complications. The astute emergency physician will rely on a focused history and precise examination, applied anatomic knowledge, and strong radiographic interpretative skills to avoid missed injuries and complications.


Assuntos
Gerenciamento Clínico , Articulação do Cotovelo/lesões , Emergências , Traumatismos do Antebraço/diagnóstico , Procedimentos Ortopédicos/métodos , Radiografia/métodos , Articulação do Cotovelo/diagnóstico por imagem , Traumatismos do Antebraço/terapia , Humanos
4.
Medicine (Baltimore) ; 98(44): e17728, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689815

RESUMO

The effects of soft tissue damage and ulnar angulation deformity on radial head instability in Monteggia fractures are unclear. We tested the hypothesis that radial head instability correlates with the magnitude of ulnar angular deformity and the degree of proximal forearm soft tissue injury in Bado type I Monteggia fractures.We performed a biomechanical study in 6 fresh-frozen cadaveric upper extremities. Monteggia fractures were simulated by anterior ulnar angulation osteotomy and sequential sectioning of ligamentous structures. We measured radial head displacement during passive mobility testing in pronation, supination, and neutral rotation using an electromagnetic tracking device. Measurements at various ligament sectioning stages and ulnar angulation substages were statistically compared with those in the intact elbow.Radial head displacement increased with sequential ligament sectioning and increased proportionally with the degree of anterior ulnar angulation. Annular ligament sectioning resulted in a significant increase in displacement only in pronation (P < .05). When the anterior ulnar deformity was reproduced, the radial head displaced least in supination. The addition of proximal interosseous membrane sectioning significantly increased the radial head displacement in supination (P < .05), regardless of the degree of anterior ulnar angulation.Our Monteggia fracture model showed that radial head instability is influenced by the degree of soft tissue damage and ulnar angulation. Annular ligament injury combined with a minimal (5°) ulnar deformity may cause elbow instability, especially in pronation. The proximal interosseous membrane contributes to radial head stability in supination, regardless of ulnar angulation, and proximal interosseous membrane injury led to significant radial head instability in supination.


Assuntos
Articulação do Cotovelo/fisiopatologia , Traumatismos do Antebraço/fisiopatologia , Instabilidade Articular/fisiopatologia , Fratura de Monteggia/fisiopatologia , Lesões dos Tecidos Moles/fisiopatologia , Idoso , Idoso de 80 Anos ou mais , Fenômenos Biomecânicos , Cadáver , Articulação do Cotovelo/lesões , Feminino , Traumatismos do Antebraço/complicações , Humanos , Instabilidade Articular/etiologia , Masculino , Pessoa de Meia-Idade , Fratura de Monteggia/complicações , Rádio (Anatomia)/lesões , Amplitude de Movimento Articular , Lesões dos Tecidos Moles/complicações , Ulna/lesões
5.
Arch Osteoporos ; 14(1): 107, 2019 11 09.
Artigo em Inglês | MEDLINE | ID: mdl-31707587

RESUMO

Few studies have systematically evaluated the technical aspects of forearm bone mineral density (BMD) measurement. We found that BMD remained stable regardless of the reference point; however, the ROI identified was not always consistent. Our study highlights the importance of using the same reference point for serial measurements of forearm BMD. BACKGROUND: Forearm fractures are clinically important outcomes from the perspective of morbidity, health care costs, and interruption of work. BMD of the forearm, as derived by dual-energy x-ray absorptiometry (DXA), is a better predictor of fracture at the forearm compared with BMD measured at other sites. However, very few studies have evaluated the technical aspects of selecting the ROI for forearm BMD measurement. This study aimed to compare the BMD values measured at the 1/3 radius site using three different reference points: the ulnar styloid process, the radial endplate, and the bifurcation of the ulna and radius. METHODOLOGY: Healthy Chinese patients participating in the control group of an ongoing study at Zhejiang Provincial People's Hospital were recruited for this study. For each patient, a DXA scan (GE Lunar Prodigy) of the forearm was performed and BMD values were separately calculated using each of the three reference points to identify the ROI. Pearson correlation coefficients were calculated to examine the correlation between the BMD measures derived from each reference point. The F test and independent t test were applied for more robust analysis of the differences in the variances and means. RESULTS: Sixty-eight healthy Chinese volunteers agreed to participate in this study. The root mean square standard deviation (RMS-SD) percentages of BMD values measured at the 1/3 radius site were 2.19%, 2.23%, and 2.20% when using the ulnar styloid process, radial endplate, and the bifurcation of the ulna and radius as the reference points, respectively. Pearson's correlation coefficients for all pairwise comparisons among these three groups were greater than 0.99. F tests and independent t tests showed p values ranging from 0.92 to 0.99. However, we observed that among 10% of patients, choosing an ROI at the ulnar styloid process led to an inability to accurately determine the BMD at the ultra-distal radius. CONCLUSIONS: Given equal ability to determine BMD at the 1/3 radius accurately, the radial endplate or the bifurcation of the ulna and radius should be preferentially selected as the reference point for routine forearm BMD measurements in order to avoid situations in which the ultra-distal radius BMD cannot be determined.


Assuntos
Absorciometria de Fóton/normas , Densidade Óssea/fisiologia , Antebraço/diagnóstico por imagem , Rádio (Anatomia)/diagnóstico por imagem , Absorciometria de Fóton/métodos , Adulto , Idoso , Algoritmos , Feminino , Antebraço/fisiologia , Traumatismos do Antebraço/diagnóstico por imagem , Humanos , Masculino , Pessoa de Meia-Idade , Osteoporose/diagnóstico por imagem , Osteoporose/fisiopatologia , Fraturas por Osteoporose/diagnóstico por imagem , Rádio (Anatomia)/fisiologia , Reprodutibilidade dos Testes , Ulna/diagnóstico por imagem , Ulna/fisiologia
6.
Clin J Sport Med ; 29(6): 476-481, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688178

RESUMO

OBJECTIVE: To evaluate results of mini-open fasciotomy (MOF) in high-level motorcycling or motocross riders with chronic exertional compartment syndrome (CECS) at long-term follow-up (minimum 5 years). DESIGN: Case series. LEVEL OF EVIDENCE: IV. SETTING: University Hospital/Private Practice. PATIENTS: Fifty-four professional motorcycling riders treated with MOF for a CECS of the forearm from January 2006 to June 2011. Inclusion criteria comprised: high-level motorcycling or motocross riders, clinical symptoms of CECS for at least 6 months, diagnosis confirmed using preoperative compartment hydrostatic pressure measurement and/or magnetic resonance imaging of the forearm, minimum follow-up of 5 years. INTERVENTIONS: A MOF to obtain decompression of all compartments was performed in all patients. MAIN OUTCOME MEASURES: Visual analog scale; a subjective scale to measure strength; QuickDash functional scores. Time to resume full riding capacities as short-term evaluation. RESULTS: A total of 54 patients who underwent 77 MOF procedures overall (23 bilateral) were included. The mean age was 23.6 ± 5.2 years. Mean Visual Analog Scale decreased from a preoperative value of 68.2 to a 3-month postoperative value of 26 (P < 0.001). Mean QuickDash scale was 84 at preoperative registration, falling to 20, 3 months after surgery (P < 0.001) and down to 12 at 1-year follow-up (P = 0.017). The average time to return to full riding capacities was 3.5 ± 1 week. CONCLUSIONS: Mini-open fasciotomy resulted safe and effective for the treatment of chronic exertional compartment syndrome in high-level motorcycling or motocross riders. The good outcome at follow-up resulted stable at 5 years and the incidence of complications remained low. Our data demonstrate that the resolution of symptoms is reliable and durable. Pain recovery was immediate after surgery, instead functional scores showed a more gradual recovery throughout the 12 months after surgery. CLINICAL RELEVANCE: Mini-open fasciotomy is a reliable treatment for CECS of the forearm in professional motorcycling riders. This treatment should also be considered in young riders due to the absence of tardive relapse reported in this study.


Assuntos
Traumatismos em Atletas/cirurgia , Síndromes Compartimentais/cirurgia , Descompressão Cirúrgica/métodos , Fasciotomia/métodos , Traumatismos do Antebraço/cirurgia , Adolescente , Adulto , Doença Crônica , Descompressão Cirúrgica/efeitos adversos , Fasciotomia/efeitos adversos , Humanos , Masculino , Motocicletas , Esforço Físico/fisiologia , Complicações Pós-Operatórias , Resultado do Tratamento , Adulto Jovem
7.
Plast Reconstr Surg ; 144(5): 878e-911e, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31688770

RESUMO

LEARNING OBJECTIVES: After reading this article, participant should be able to: 1. Describe the technique of replantation for very distal amputation of the digit and salvage procedures for venous drainage. 2. Perform single-digit replantation after viewing the videos. 3. Recognize appropriate cases for joint salvage techniques in periarticular amputation at each joint of the digit and wrist. 4. Outline the methods of flexor and extensor tendon reconstruction in an avulsed amputation of the digit or thumb. 5. Understand the order of digital replantation and transpositional replantation for a restoration of pinch or grip in multiple-digit amputation. SUMMARY: This article provides practical tips and caveats for the latest replantation surgical techniques for digit, hand, and upper extremity amputation. Four videos, clinical photographs, and drawings highlight important points of operative technique and outcomes of replantation.


Assuntos
Amputação Traumática/cirurgia , Traumatismos dos Dedos/cirurgia , Reimplante/métodos , Adulto , Feminino , Traumatismos do Antebraço/cirurgia , Traumatismos da Mão/cirurgia , Força da Mão/fisiologia , Humanos , Masculino , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/cirurgia , Prognóstico , Recuperação de Função Fisiológica/fisiologia , Reoperação , Reimplante/efeitos adversos , Medição de Risco
8.
Medicine (Baltimore) ; 98(48): e18159, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770260

RESUMO

RATIONALE: Toothpick puncture (TPP) is a penetrating injury that can result in bringing pathogens to the deep space. Such penetrating wounds are typically of pinpoint size with initial symptoms appearing subtle. Consequently, the injury itself is often neglected by patients, or is not detected during physical examinations by medical doctors. Reported complications from such injuries include osteomyelitis and septic arthritis, mostly due to delayed treatment. PATIENT CONCERNS: A diabetic patient aged 83-year-old presented a 2-day history of skin redness, swelling, and tenderness over his forearm following a TPP a week earlier. Laboratory investigations showed leukocytosis with neutrophilic predominance and a high level of C-reactive protein. Before his operation, cultures of aspirated fluid from the injured site revealed the presence of Streptococcus anginosus, Streptococci viridans, Prevotella intermedia, and Pavimonas (Peptostreptococcus) micra. DIAGNOSIS: Intramuscular abscess associated with toothpick injury. INTERVENTIONS: Surgical irrigation with debridement and adjunctive antibiotics of ceftriaxone and clindamycin were given with a satisfactory response. Cultures of debrided tissue showed the presence of P intermedia and P (Peptostreptococcus) micra. OUTCOMES: A split-thickness skin graft was done. Patient was discharged on the 30th postoperative day. LESSONS: Toothpick injury, initial symptoms of which are subtle, can in some cases, lead to serious complications especially when managements are delayed. In such situations (including the present case), surgical irrigation and debridement are administrated for the eradication of infections, removal of potentially retained toothpick, and tissue cultures analyzed. Adjunctive antibiotics is recommended to combat both the aerobic and anaerobic microorganisms of the gastrointestinal tract, skin surface, and oral cavity.


Assuntos
Abscesso , Antibacterianos/administração & dosagem , Desbridamento/métodos , Dispositivos para o Cuidado Bucal Domiciliar/efeitos adversos , Traumatismos do Antebraço , Ferimentos Penetrantes , Abscesso/etiologia , Abscesso/terapia , Idoso de 80 Anos ou mais , Comorbidade , Diabetes Mellitus/epidemiologia , Traumatismos do Antebraço/diagnóstico , Traumatismos do Antebraço/etiologia , Traumatismos do Antebraço/terapia , Humanos , Masculino , Peptostreptococcus/isolamento & purificação , Prevotella intermedia/isolamento & purificação , Streptococcus anginosus/isolamento & purificação , Resultado do Tratamento , Estreptococos Viridans/isolamento & purificação , Ferimentos Penetrantes/complicações , Ferimentos Penetrantes/epidemiologia , Ferimentos Penetrantes/microbiologia , Ferimentos Penetrantes/terapia
9.
J Plast Reconstr Aesthet Surg ; 72(12): 1909-1916, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31564579

RESUMO

BACKGROUND: Complex soft-tissue defects of upper extremities still have a high rate of amputation, as the reconstruction of complex soft-tissue defects is always difficult even with the largest conventional free flap. The anterolateral thigh perforator (ALTP) flap is one of the most popular procedures used for the coverage of complex soft-tissue defects of extremities. However, problems associated with donor-site morbidity and inability to repair complex soft-tissue defects in a one-stage procedure persist. The purpose of this study was to present a novel design of using chain-linked bilateral ALTP flap and its various designs for customized reconstruction of complex soft-tissue defects in the hands and forearms. METHODS: From June 2009 to June 2017, we retrospectively analyzed 15 patients with complex soft-tissue defects in the hands and forearms. All patients in this series underwent extremity reconstruction using the chain-linked bilateral ALTP flaps. Three different types of chain-linked bilateral ALTP flaps were created in this study based on wound characteristics and the maximum available skin paddle size at all donor sites. RESULTS: The chain-linked bilateral ALTP flaps were successfully harvested for the reconstruction of complex soft-tissue defects in the hands and forearms. Among them, ten cases were repaired with chain-linked bipaddle ALTP flaps, two cases were treated with chain-linked tripaddle ALTP flaps, and the remaining three cases were used with chain-linked multi-lobed ALTP chimeric flaps. The sizes of the skin paddles ranged from 11 cm × 7 cm to 42 cm × 8 cm. The areas of the total flaps ranged from 245 cm2 to 650 cm2 (mean 419.6 cm2). Only one case required re-exploration because of the venous congestion. The donor sites were closed directly. The mean follow-up time was 16.4 months. Most cases showed satisfactory contour. CONCLUSION: The chain-linked bilateral ALTP flap is a reliable option for one-stage reconstruction of complex soft-tissue defects in the hands and forearms with limited donor-site morbidity. It also provides various flap designs, which allow for more individualized treatment approaches.


Assuntos
Traumatismos do Antebraço/cirurgia , Traumatismos da Mão/cirurgia , Retalho Perfurante , Transplante de Pele/métodos , Lesões dos Tecidos Moles/cirurgia , Acidentes de Trânsito , Adulto , Lesões por Esmagamento/cirurgia , Desenho de Equipamento , Feminino , Sobrevivência de Enxerto , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Coxa da Perna/cirurgia , Coleta de Tecidos e Órgãos/métodos , Resultado do Tratamento , Adulto Jovem
10.
Clinics (Sao Paulo) ; 74: e1076, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31508715

RESUMO

OBJECTIVES: Machinery injuries account for a substantial share of traumatic upper limb injuries (TULIs) affecting young active individuals. This study is based on the hypothesis that there is an important relationship between the improper use of power saws and TULIs. The aim of the study is to assess the prevalence and epidemiology of TULIs caused by power saws and determine the risks related to power saw use. METHODS: A cross-sectional evaluation of medical records from a two-year period was performed. Patients sustaining TULIs related to power saws were analyzed. Data on the epidemiology, site of injury, mechanism of trauma, technical specifications of the tool, cutting material, personal protective equipment, time lost and return to work were obtained. RESULTS: A database search retrieved 193 TULI records, of which 104 were related to power saws. The majority of patients were male (102/104; 98.1%), right-handed (97/104; 93.3%), and manual workers (46/104; 44.2%), with an average age of 46.8 years. The thumb was the most frequently injured site (32/93; 34.4%). Most of the injuries were caused by manual saws (85/104; 81.7%), and masonry saws accounted for 68.2% (58/85) of the cases. Masonry saws improperly used for woodwork resulted in 86.2% (50/58) of the injuries. TULI caused by masonry saws was 5 times higher in manual workers than in other patients. In addition, masonry saws had a risk of kickback 15 times higher than that of other saws, and the risk of injury increased by 5.25 times when the saws were used improperly for wood cutting. CONCLUSIONS: The profile of TULIs related to power saws was demonstrated and was mainly associated with manual saws operated by manual workers that inappropriately used masonry saws for woodworking.


Assuntos
Falha de Equipamento/estatística & dados numéricos , Traumatismos do Antebraço/etiologia , Traumatismos da Mão/etiologia , Acidentes de Trabalho/estatística & dados numéricos , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Estudos Transversais , Feminino , Traumatismos do Antebraço/epidemiologia , Traumatismos da Mão/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Adulto Jovem
11.
West J Emerg Med ; 20(5): 747-759, 2019 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-31539332

RESUMO

INTRODUCTION: Distal forearm fractures (DFF) account for 1.5% of emergency department (ED) visits in the United States. Clinicians frequently obtain imaging above/below the location of injury to rule out additional injuries. We sought to determine the incidence of associated proximal fractures (APF) in the setting of DFF and to evaluate the imaging practices in a nationally representative sample of EDs. METHODS: We queried the 2013 National Emergency Department Sample using International Classification of Diseases, 9th edition, diagnostic codes for DFF and APF. Current Procedural Technology codes identified associated imaging studies. We calculated national estimates using a weighted analysis of patient and hospital-level characteristics associated with APF and imaging practices. An analysis of costs estimated the financial impact of additional imaging in patients with DFF using Medicare reimbursement to approximate costs according to the 2018 Medicare Physician Fee Schedule. RESULTS: In 2013, an estimated 297,755 ED visits (weighted) were associated with a DFF, of which 1.6% (4836 cases) had an APF. The incidence of APF was lower among females (odds ratio [OR] (0.76); 95% confidence interval [CI], 0.64-0.91) but higher in metropolitan teaching hospitals compared to metropolitan non-teaching hospitals (OR [2.39]; 95% CI, 1.43-3.99) and Level 1 trauma centers (OR [3.9]; 95%, 1.91-7.96) compared to non-trauma centers. Approximately 40% (n = 117,948) of those with only DFF received non-wrist radiographs and 19% (n = 55,236) underwent non-wrist/non-forearm imaging. Factors independently associated with additional imaging included gender, payer, patient and hospital rurality, hospital region, teaching status, ownership, and trauma center level. Nearly $3.6 million (2018 U.S. dollars) was spent on the aforementioned additional imaging. CONCLUSION: Despite the frequency of proximal imaging in patients with DFF, the incidence of APF was low. Further study to identify risk factors for APF based on mechanism and physical examination factors may result in reduced imaging and decreased avoidable healthcare spending.


Assuntos
Traumatismos do Antebraço/epidemiologia , Fraturas do Rádio/epidemiologia , Centros de Traumatologia/estatística & dados numéricos , Fraturas da Ulna/epidemiologia , Adolescente , Adulto , Idoso , Estudos Transversais , Feminino , Traumatismos do Antebraço/diagnóstico , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Radiografia , Fraturas do Rádio/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Fraturas da Ulna/diagnóstico , Estados Unidos/epidemiologia , Adulto Jovem
12.
Acta Chir Orthop Traumatol Cech ; 86(4): 290-293, 2019.
Artigo em Eslovaco | MEDLINE | ID: mdl-31524592

RESUMO

Vascularized bone grafting was for the first time described in the 1970s. It has become a crucial component in the reconstruction of long bone defects and non-unions in a poorly vascularised environment. Although the vascularized bone is well described for the lower extremity and mandibular reconstructions, it started to be used for the upper extremity bone defects only recently. This publication presents a case of a young man with an open fracture of both the forearm bones. The treatment of the injury has been complicated with anaerobic gas gangrene of the forearm. This resulted in a non-union, radius shortening and necrosis of both the thumb extensors and flexors muscles. Once the acute infection was managed, the patient received a two-step treatment provided jointly by orthopaedic and plastic surgeons at the University Hospital in Bratislava. At the first stage auto transplantation of the vascularized fibula into the defect of radius was performed, with radial artery and radial veins being the recipient vessels. One year later, a tendon transfer was made in order to reconstruct the extension and flexion of the thumb. Donor tendons were the following: extensor indicis proprius and flexor digitorum superficialis for ring finger. The result of the reconstruction is the full incorporation of the fibular transplant (6 months after the primary operation) and the excellent range of motion of the hand and wrist. Thanks to the tendon transfer the function of the thumb, including the opposition, was achieved two months after the secondary surgery. Key words: defect of radius, tendon transfer, anaerobic infection, gas necrosis, microsurgery.


Assuntos
Fíbula/transplante , Traumatismos do Antebraço/cirurgia , Gangrena Gasosa/cirurgia , Fraturas do Rádio/cirurgia , Transferência Tendinosa/métodos , Fraturas da Ulna/cirurgia , Transplante Ósseo , Fíbula/irrigação sanguínea , Antebraço/irrigação sanguínea , Antebraço/cirurgia , Traumatismos do Antebraço/terapia , Fraturas Expostas/cirurgia , Fraturas Expostas/terapia , Gangrena Gasosa/terapia , Humanos , Masculino , Transplante Autólogo
13.
J Hand Surg Asian Pac Vol ; 24(3): 251-257, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31438785

RESUMO

Geometrically, rings distribute their stress along their arc instead of concentrating at any one point. The forearm ring is composed of the radius, ulna, proximal radioulnar joint, and distal radioulnar joint. The annular ligament, interosseous membrane, and triangular fibrocartilage complex link and stabilize the ring. Injuries to the forearm occur along a continuum with recognized patterns of ring disruption, including Galeazzi, Monteggia, and Essex-Lopresti injuries. The Darrach procedure causes a disruption to the forearm ring and can lead to painful convergence between the radius and distal ulnar stump. Injuries to the forearm ring are unstable. Management of forearm injuries is centered on the restoration of the anatomy and stability of the forearm ring. Forearm ring injuries and their treatment are discussed in this article.


Assuntos
Traumatismos do Antebraço/cirurgia , Procedimentos Ortopédicos , Articulação do Cotovelo/fisiologia , Fratura-Luxação/cirurgia , Humanos , Membrana Interóssea/lesões , Membrana Interóssea/fisiologia , Ligamentos Articulares/fisiologia , Rádio (Anatomia)/fisiologia , Fraturas do Rádio/cirurgia , Fibrocartilagem Triangular/lesões , Fibrocartilagem Triangular/fisiologia , Ulna/fisiologia , Articulação do Punho/fisiologia
14.
J Bone Joint Surg Am ; 101(15): e74, 2019 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-31393431

RESUMO

BACKGROUND: Salvaging the forearm is a major challenge in cases of massive bone loss from injuries in which the extremity is severely mangled or following bone resection secondary to pathological tissue excision. The purpose of this study was to evaluate the role of one-bone forearm (OBF) reconstruction as a salvage option in these difficult situations. METHODS: A total of 38 patients with forearm segmental bone loss (acute and chronic) treated between 1995 and 2014 were included (range of follow-up, 2 to 20 years). Sixteen of the patients, 8 with avulsion amputations and 8 with severely mangled extremities, were managed in the emergency department because they required immediate replantation and revascularization, respectively. In the chronic setting, bone loss was due to infection with nonunion in 16 patients, tumor of the radius in 2 patients, and pseudarthrosis of the forearm in 4 patients. The surgical technique included conversion to OBF by achieving union between the distal part of the radius and the proximal part of the ulna in the majority of cases, with distal radioulnar joint (DRUJ) fusion in 4 cases, and ulna to carpals in 5 cases. Direct bone contact was achieved in 16 patients, a free vascularized fibular graft was used to bridge the bone gap in 10 patients, and 12 patients required iliac crest bone-grafting. RESULTS: The mean patient age was 35.5 years (range, 6 to 87 years); there were 23 male and 15 female patients. Among those who underwent OBF for acute injuries, the mean time to union was 7.3 months; 14 patients had complete union, and 2 patients had infection with nonunion requiring secondary procedures. As assessed using the criteria of Chen, 10 patients had a grade-I functional outcome, 3 patients had a grade-II outcome, and 3 patients had a grade-III outcome. In the elective group of 22 patients, the average time to union was 7.1 months. Nonunion was reported for 2 patients. On the basis of the Peterson scoring system, the outcome was excellent for 12 patients, good for 6 patients, fair for 2 patients, and poor for 2 patients. CONCLUSIONS: OBF reconstruction is a viable surgical treatment alternative. It is a demanding reconstruction but functions better and is cosmetically more appealing than a forearm amputation. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Lesões por Esmagamento/cirurgia , Traumatismos do Antebraço/cirurgia , Salvamento de Membro/métodos , Procedimentos Cirúrgicos Reconstrutivos/métodos , Reimplante/métodos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Amputação Traumática/cirurgia , Artrodese/métodos , Transplante Ósseo/métodos , Criança , Estudos de Coortes , Avaliação da Deficiência , Feminino , Traumatismos do Antebraço/diagnóstico , Consolidação da Fratura/fisiologia , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Rádio (Anatomia)/lesões , Rádio (Anatomia)/cirurgia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Medição de Risco , Resultado do Tratamento , Ulna/lesões , Ulna/cirurgia , Cicatrização/fisiologia , Adulto Jovem
15.
Int J Surg ; 70: 19-24, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31408746

RESUMO

OBJECTIVE: The aim of the present study was to compare the clinical outcomes of hybrid fixation using elastic stable intramedullary nailing (ESIN) for the ulna and plate screw fixation for the radius (Hybrid group) with dual plating fixation for both-bone forearm fractures in children between 10 and 16 years of age. METHODS: Twenty-six patients were treated using a hybrid fixation struct and 30 patients were treated with dual plating fixation. The two groups were compared prospectively according to perioperative data and patient outcome measures. RESULT: The hybrid fixation construct group had 26 patients, with a mean age of 13.27 years (range, 10-16 years) and the dual plate group had 30 patients, with a mean age of 13.33 years (range, 10-16 years). The groups were similar for sex, arm injured, fracture location. Incision length of ulna, duration of surgery and hospital costs were significantly different between the two groups (P < 0.05). There was no significant difference in either time to union or Price scores for function evaluation between the 2 groups (P < 0.05). Complication rates were also similar between the groups. CONCLUSION: Hybrid fixation, using open reduction and internal fixation with a plate-and-screw construct on the radius and closed reduction and elastic intramedullary fixation of the ulna, is an acceptable method for treating both-bone diaphyseal forearm fractures in skeletally immature patients 10-16 years old. The small incision and less cost are the characteristics of this hybrid fixation.


Assuntos
Placas Ósseas , Traumatismos do Antebraço/cirurgia , Fixação Intramedular de Fraturas/métodos , Fraturas da Ulna/cirurgia , Adolescente , Parafusos Ósseos , Criança , Feminino , Humanos , Masculino , Estudos Prospectivos
16.
J Pediatr Orthop ; 39(7): 372-376, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31305381

RESUMO

BACKGROUND: The management of pediatric type I open fractures remains controversial. The aim of this study is to compare outcomes in type I open fractures managed with superficial wound debridement and antibiotics in the emergency department (ED) (nonoperative management) to patients managed with operative debridement and antibiotics (operative management). METHODS: A multicenter retrospective review was performed of all pediatric type I open forearm, wrist, and tibia fractures treated at 4 high volume pediatric centers between 2000 and 2015. Patients with multiple traumatic injuries, immunocompromised patients, or those without final radiographs indicating healing were excluded. RESULTS: In total, 219 patients met inclusion criteria. A total of 170 fractures were treated operatively (77.6%), 49 fractures were treated nonoperatively (22.4%). There was 1 infection in the nonoperative group (2.0% infection rate), and no infections in the operatively managed group (P=0.062). Cefazolin was the most commonly administered antibiotic (88.1% of patients). Duration of hospital-administered antibiotics was significantly different, with a mean of 10.9 hours in the nonoperative group and 41.6 hours in the operative group (P<0.001). Length of stay averaged 16.3 hours for nonoperative patients and 48.6 hours for the operatively treated patients (P<0.001). In the nonoperative group, 44/49 had documented superficial wound debridement in the ED utilizing, on an average, 1500 mL of irrigant. There were 10 other complications, 9 in the operative group (5.4%) and 2 in the nonoperative group (4.1%, P=0.107), including 2 compartment syndromes and 1 acute carpal tunnel syndrome all requiring immediate surgical release (1.8%) in the operative group. CONCLUSIONS: There was no significant difference in infection rate or complication rate in those managed with antibiotics and operative debridement versus those managed with superficial wound debridement and antibiotics in the ED. Consideration should be given to the similar safety profiles for these 2 treatment modalities when managing pediatric patients with type I open fractures. LEVEL OF EVIDENCE: Level III.


Assuntos
Antibacterianos/uso terapêutico , Cefazolina/uso terapêutico , Desbridamento/métodos , Fraturas Expostas/cirurgia , Infecção dos Ferimentos/prevenção & controle , Adolescente , Criança , Pré-Escolar , Serviço Hospitalar de Emergência , Feminino , Traumatismos do Antebraço/cirurgia , Fraturas Expostas/complicações , Humanos , Masculino , Salas Cirúrgicas , Estudos Retrospectivos , Fraturas da Tíbia/cirurgia , Infecção dos Ferimentos/etiologia , Traumatismos do Punho/cirurgia
17.
Medicine (Baltimore) ; 98(28): e16353, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305426

RESUMO

To review our institutional results and assess different surgical and non-surgical techniques for the treatment of displaced diametaphyseal forearm fractures in children and adolescents.Thirty-four children (25M, 9F) with a total of 36 diametaphyseal forearm fractures who underwent treatment under general anesthesia between July 2010 and February 2016 were recruited to this retrospective study. From October 2016 until March 2018 patients and/or parents were contacted by telephone and interviewed using a modified Pediatric Outcomes Data Collection Instrument (PODCI).Median age at the time of injury was 9.1 years (range, 1.9-14.6 years). Initial treatment included manipulation under anesthesia (MUA) and application of plaster of Paris (POP) (n = 9), elastic stable intramedullary nailing (ESIN) (n = 10), percutaneous insertion of at least one Kirschner wire (K-wire) (n = 16), and application of external fixation (n = 1). Eleven children (32%) experienced a total of 22 complications. Seven complications were considered as major, including delayed union (n = 1) and extensor pollicis longus (EPL) tendon injury (n = 1) following ESIN, as well as loss of reduction (n = 2) and refractures (n = 3) after MUA/POP. The median follow-up time was 28.8 months (range, 5.3-85.8 months). In 32 out of 34 cases (94%) patients and/or parents were contacted by telephone and a PODCI score was obtained. Patients who experienced complications in the course of treatment had a significantly lower score compared with those whose fracture healed without any sequelae (P = .001). There was a trend towards an unfavorable outcome following ESIN compared with K-wire fixation (P = .063), but not compared with POP (P = .553). No statistical significance was observed between children who were treated initially with a POP and those who had K-wire fixation (P = .216).There is no standard treatment for displaced pediatric diametaphyseal forearm fractures. Management with MUA/POP only is associated with an increased refracture rate. Based on our experience K-wire fixation including intramedullar positioning of at least one pin seems to be favorable compared with ESIN.


Assuntos
Traumatismos do Antebraço/terapia , Fraturas Ósseas/terapia , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Antebraço/diagnóstico por imagem , Antebraço/cirurgia , Traumatismos do Antebraço/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Humanos , Lactente , Tempo de Internação , Masculino , Estudos Retrospectivos , Resultado do Tratamento
18.
Med Leg J ; 87(2): 92-94, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31244405

RESUMO

Suicide notes are generally written on readily available materials, such as paper, notebook, wall or mirror by means of pen, pencil, marker or chalk. They can also be communicated by telephone, text messages, internet and digital media. A case has been reported where a note was written with henna. Suicide notes written on one's body are uncommon, and notes engraved on the body with a sharp metallic object are extremely rare. We present two cases where a sharp pointed metallic object was used to write suicide notes on the body.


Assuntos
Traumatismos do Antebraço/psicologia , Suicídio/psicologia , Redação , Adolescente , Adulto , Feminino , Antebraço/anormalidades , Antebraço/patologia , Humanos , Masculino
19.
Osteoporos Int ; 30(9): 1855-1864, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31201481

RESUMO

Upper limb fractures (including wrist, forearm, and humerus) represent a significant burden among postmenopausal women with osteoporosis. Up to 7 years of treatment with denosumab resulted in an increase in bone mineral density and decrease in fractures in upper limb sites. INTRODUCTION: Upper limb (wrist, forearm, and humerus) fractures are a significant burden in osteoporosis, associated with significant morbidity and mortality. Denosumab, a monoclonal antibody against RANK ligand, increases bone mineral density (BMD) and decreases vertebral, nonvertebral, and hip fractures. Here, we evaluated the long-term effect of denosumab treatment on upper limb fracture risk and BMD. METHODS: In the FREEDOM trial, subjects were randomized 1:1 to receive every-6-month denosumab 60 mg or placebo subcutaneously for 3 years, after which all subjects could receive denosumab for up to 7 years (Extension). Among placebo subjects who completed FREEDOM and enrolled in the Extension, wrist, forearm, humerus, and upper limb fracture rates and rate ratios between different time periods (FREEDOM years 1-3, Extension years 1-3, and Extension years 4-7) were computed. BMD at the ultradistal radius, 1/3 radius, and total radius was analyzed in a subset of subjects in a BMD substudy. RESULTS: This analysis included 2207 subjects (116 in the BMD substudy). Fracture rates decreased over the 7-year Extension; fracture rate ratios between Extension years 4-7 (denosumab) and FREEDOM years 1-3 (placebo) reduced significantly for the wrist (0.57), forearm (0.57), humerus (0.42), and upper limb (0.52; p < 0.05 for all). Percentage increase in BMD from Extension baseline at the ultradistal radius, 1/3 radius, and total radius was significant by Extension year 7 (p < 0.05 for all). CONCLUSIONS: Long-term treatment with denosumab decreases upper limb fracture risk and increases forearm BMD, suggesting beneficial effects on both cortical and trabecular bone accruing over time.


Assuntos
Conservadores da Densidade Óssea/uso terapêutico , Denosumab/uso terapêutico , Fraturas do Úmero/prevenção & controle , Osteoporose Pós-Menopausa/tratamento farmacológico , Fraturas por Osteoporose/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Densidade Óssea/efeitos dos fármacos , Conservadores da Densidade Óssea/administração & dosagem , Osso Cortical/efeitos dos fármacos , Estudos Cross-Over , Denosumab/administração & dosagem , Método Duplo-Cego , Esquema de Medicação , Feminino , Seguimentos , Traumatismos do Antebraço/prevenção & controle , Humanos , Injeções Subcutâneas , Pessoa de Meia-Idade , Osteoporose Pós-Menopausa/fisiopatologia , Rádio (Anatomia)/fisiopatologia , Traumatismos do Punho/prevenção & controle
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA