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1.
Nan Fang Yi Ke Da Xue Xue Bao ; 40(8): 1220-1224, 2020 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895187

RESUMO

Orthopedic 3D printed surgical navigational template is an instrument that is prepared by 3D reconstruction based on preoperative radiological data of the patient using computer-aided design (CAD) and 3D printing techniques. The 3D printed navigational template allows accurate intra-operative assessment of the relative spatial distance, angular relationship, direction and depth. The application of 3D printed navigational template technique in orthopedics surgeries achieves the conversion of preoperative planning from 2/3D graphics to 3D models, and provides a new method for individualized and precise treatment. Herein we review the evolution, clinical application, and basic classification of 3D printed navigation template technique, analyze its advantages and disadvantages, and discuss the current problems and the future development of this technique.


Assuntos
Procedimentos Ortopédicos , Desenho Assistido por Computador , Humanos , Impressão Tridimensional
3.
Medicine (Baltimore) ; 99(35): e21468, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871869

RESUMO

Saline is a commonly used intravenous solvent, however, its excessive infusion may increase drug-induced sodium intake. To investigate the effects of saline infusion on blood pressure variability (BPV) in patients with hypertension, a retrospective study was performed in 1010 patients with hypertension. The patients who received saline infusion before surgery for continuous 3 to 5 days were divided into 2 groups according to the saline infusion volume during the hospitalization, which are >500 mL per day group and <500 mL per day group. The overall incidence of abnormal BPV was 11.58%. As for the incidence of abnormal BPV in the <500 mL per day group with 698 patients was 9.17%, while that in the >500 mL per day group with 312 patients was as high as 16.99%. Additionally, >500 mL of daily saline infusion for continuous 3 to 5 days (P for trend = .004, odds ratio [OR] = 1.911, 95% confidence interval [CI] for OR 1.226-2.977), medical history of diabetes mellitus (P < .001, OR = 4.856, 95% CI for OR 3.118-7.563) and cardiovascular diseases (P < .001, OR = 2.498, 95% CI for OR 1.549-4.029) may be risk factors of abnormal BPV; while anti-hypertensive therapy with diuretics (P < .001, OR = 0.055, 95% CI for OR 0.024-0.125) may be the protective factor. Our study suggests that >500 mL of daily saline infusion for continuous 3 to 5 days may have disadvantages in the blood pressure control for hypertensive patients, especially for the patients with diabetes mellitus and cardiovascular diseases.


Assuntos
Variação Biológica da População/fisiologia , Pressão Sanguínea/efeitos dos fármacos , Hipertensão/epidemiologia , Solução Salina/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/tendências , Doenças Cardiovasculares/epidemiologia , Estudos de Casos e Controles , China/epidemiologia , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/tratamento farmacológico , Incidência , Infusões Intravenosas , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/métodos , Procedimentos Ortopédicos/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Solução Salina/administração & dosagem
4.
Bone Joint J ; 102-B(9): 1248-1255, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862679

RESUMO

AIMS: The treatment of tibial aplasia is controversial. Amputation represents the gold standard with good functional results, but is frequently refused by the families. In these patients, treatment with reconstructive limb salvage can be considered. Due to the complexity of the deformity, this remains challenging and should be staged. The present study evaluated the role of femoro-pedal distraction using a circular external fixator in reconstructive treatment of tibial aplasia. The purpose of femoro-pedal distraction is to realign the limb and achieve soft tissue lengthening to allow subsequent reconstructive surgery. METHODS: This was a retrospective study involving ten patients (12 limbs) with tibial aplasia, who underwent staged reconstruction. During the first operation a circular hexapod external fixator was applied and femoro-pedal distraction was undertaken over several months. Subsequent surgery included reconstruction of the knee joint and alignment of the foot. RESULTS: The mean follow-up was 7.1 years (2 to 10). The mean age of the patients at the time of the application of the fixator was 2.3 years (1.1 to 5.0). The mean time under distraction was 139.7 days (81.0 to 177.0). A mean fibular distalization of 38.7 mm (14.0 to 67.0) was achieved. Pin infections occurred in four limbs (33.3%) and osteitis in one. A femoral fracture occurred in one patient. Premature removal of the frame was not required in any patient. Sufficient realignment of the leg as well as soft tissue lengthening was achieved in all patients, allowing subsequent reconstruction. All patients were able to mobilize fully weight bearing after reconstruction. Functional outcome was limited in all limbs, and five patients (50.0%) required additional reconstructive operations. CONCLUSION: Regarding the functional results in the treatment of tibial aplasia, amputation remains superior to limb salvage. The latter procedure should only be performed in patients whose parents refuse amputation. Femoro-pedal distraction efficiently prepares the limb by realigning the leg and soft tissue lengthening. Minor complications are frequent, but usually do not hinder the continuation of distraction. Even though a fully weight-bearing limb is achieved, the functional outcome of reconstructive treatment remains limited. Recurrent deformities frequently occur and may require further operations. Cite this article: Bone Joint J 2020;102-B(9):1248-1255.


Assuntos
Fixadores Externos , Osteogênese por Distração/métodos , Tíbia/anormalidades , Tíbia/cirurgia , Pré-Escolar , Feminino , Humanos , Lactente , Salvamento de Membro , Masculino , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos
5.
Bone Joint J ; 102-B(9): 1242-1247, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862682

RESUMO

AIMS: Guided growth has been used to treat coxa valga for cerebral palsy (CP) children. However, there has been no study on the optimal position of screw application. In this paper we have investigated the influence of screw position on the outcomes of guided growth. METHODS: We retrospectively analyzed 61 hips in 32 CP children who underwent proximal femoral hemi epiphysiodesis between July 2012 and September 2017. The hips were divided into two groups according to the transphyseal position of the screw in the coronal plane: across medial quarter (Group 1) or middle quarter (Group 2) of the medial half of the physis. We compared pre- and postoperative radiographs in head-shaft angle (HSA), Reimer's migration percentage (MP), acetabular index (AI), and femoral anteversion angle (FAVA), as well as incidences of the physis growing-off the screw within two years. Linear and Cox regression analysis were conducted to identify factors related to HSA correction and risk of the physis growing-off the screw. RESULTS: A total of 37 hips in Group 1 and 24 hips in Group 2 were compared. Group 1 showed a more substantial decrease in the HSA (p = 0.003) and the MP (p = 0.032). Both groups had significant and similar improvements in the AI (p = 0.809) and the FAVA (p = 0.304). Group 1 presented a higher incidence of the physis growing-off the screw (p = 0.038). Results of the regression analysis indicated that the eccentricity of screw position correlated with HSA correction and increases the risk of the physis growing-off the screw. CONCLUSION: Guided growth is effective in improving coxa valga and excessive femoral anteversion in CP children. For younger children, despite compromised efficacy of varus correction, we recommend a more centered screw position, at least across the middle quarter of the medial physis, to avoid early revision. Cite this article: Bone Joint J 2020;102-B(9):1242-1247.


Assuntos
Parafusos Ósseos , Coxa Valga/cirurgia , Lâmina de Crescimento/cirurgia , Paralisia Cerebral/complicações , Criança , Coxa Valga/etiologia , Feminino , Humanos , Masculino , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/métodos , Estudos Retrospectivos , Resultado do Tratamento
6.
Bone Joint J ; 102-B(9): 1122-1127, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862693

RESUMO

Evidence suggests that the alleviation of pain is enhancedby a strong patient-clinician relationship and attending to a patient's social and mental health. There is a limited role for medication, opioids in particular. Orthopaedic surgeons can use comprehensive biopsychosocial strategies to help people recover and can work with colleagues who have the appropriate expertise in order to maximize pain alleviation with optimal opioid stewardship. Preparing patients for elective surgery and caring for them after unplanned injury or surgery can benefit from planned and practiced strategies based in communication science. Cite this article: Bone Joint J 2020;102-B(9):1122-1127.


Assuntos
Manejo da Dor , Dor Pós-Operatória/terapia , Humanos , Procedimentos Ortopédicos , Resultado do Tratamento
7.
Arthroscopy ; 36(8): 2258-2259, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32747066

RESUMO

Multimodal analgesia protocols have been developed to reduce the number of opioids prescribed after orthopaedic surgery, although no previous studies have examined the effectiveness of a nonopioid multimodal analgesia protocol following common sports medicine procedures. Clinicians should feel assured that this type of strategy can be effective at reducing pain and the number of opioids needed for breakthrough pain with minimal side effects and without compromising patient satisfaction. The use of rescue opioids is associated with pain level, procedure type, and psychiatric illness.


Assuntos
Analgésicos não Entorpecentes , Procedimentos Ortopédicos , Analgésicos Opioides , Humanos , Manejo da Dor , Dor Pós-Operatória
9.
Plast Reconstr Surg ; 146(2): 177e-186e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740586

RESUMO

BACKGROUND: Evidence-based practices in medicine are linked with a higher quality of care and lower health care cost. For trigger finger, identifying patient factors associated with nonadherence to evidence-based practices will aid physicians in treatment decisions. The objectives were to (1) determine patient factors associated with treatment nonadherence, (2) examine the success rates of steroid injections, and (3) evaluate the economic consequences of nonadherence to treatment recommendations. METHODS: The authors used data from the Clinformatics DataMart database from 2010 to 2017 to conduct a population-based analysis of patients with single-digit trigger finger. The authors calculated rates of steroid injection success and examined associations between injection success and patient factors using chi-square tests. In addition, the authors analyzed differences in the cost to the insurer, the cost to the patient, and total cost. RESULTS: A total of 29,722 patients were included in this analysis. Injection success rates were similar for diabetic (72 percent) and nondiabetic patients (73 percent), women (73 percent), and men (73 percent). Nonetheless, diabetics (OR, 1.4; 95 percent CI, 1.4 to 1.5; p < 0.001) and women (OR, 1.2; 95 percent CI, 1.1 to 1.2; p < 0.001) were significantly more likely to receive nonadherent treatment. In total, $23 million (U.S. dollars) were spent on nonadherent trigger finger care. CONCLUSIONS: Diabetics and women have increased odds of having surgery without a prior steroid injection, despite similar success rates of steroid injections compared to nondiabetics and men. Because performing surgical release before any steroid injections may represent a higher cost treatment option, providers should provide steroid injections before surgery for all patients regardless of diabetes status or sex to minimize overtreatment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Diabetes Mellitus/epidemiologia , Glucocorticoides/administração & dosagem , Procedimentos Ortopédicos/economia , Cooperação do Paciente/estatística & dados numéricos , Dedo em Gatilho/terapia , Idoso , Custos e Análise de Custo/estatística & dados numéricos , Medicina Baseada em Evidências/economia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Feminino , Seguimentos , Glucocorticoides/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Injeções Intralesionais/economia , Injeções Intralesionais/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento , Dedo em Gatilho/economia
11.
Medicine (Baltimore) ; 99(32): e21679, 2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32769937

RESUMO

BACKGROUND: Syndesmotic injuries account for a significant number of ankle injuries. There is no consensus regarding the recommended method of treatment. The purpose of this study was to evaluate: METHODS:: This study was performed and reported in accordance with the Strengthening the Reporting of Observational studies in Epidemiology checklist. The records of 200 patients with ankle fractures who had undergone surgical treatment in our clinics between January 2014 and January 2018 were retrospectively investigated. This retrospective cohort study was approved by the institutional review board in the 2nd Hospital of Jilin University. The primary outcome measure was the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale and the Foot Function Index. Secondary outcome measures included visual analog scale score, complications, range of movement of ankle, reoperations, and radiologic outcomes. For statistical comparison of the clinical and radiologic findings between the 2 groups, we used SPSS, version 21.0 (SPSS, Chicago, IL), statistical software. P Values of < .05 were considered statistically significant. CONCLUSION: The hypothesis was that the SB technique would achieve better functional outcomes as compared to the syndesmotic screw technique after surgery. TRIAL REGISTRATION: This study protocol was registered in Research Registry (researchregistry5793).


Assuntos
Articulação do Tornozelo/cirurgia , Procedimentos Ortopédicos/instrumentação , Procedimentos Ortopédicos/normas , Adulto , Idoso , Traumatismos do Tornozelo/diagnóstico por imagem , Traumatismos do Tornozelo/cirurgia , Articulação do Tornozelo/anormalidades , Articulação do Tornozelo/diagnóstico por imagem , Estudos de Coortes , Feminino , Seguimentos , Humanos , Imobilização/instrumentação , Imobilização/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/estatística & dados numéricos , Estudos Retrospectivos , Estatísticas não Paramétricas , Resultado do Tratamento
16.
Knee Surg Sports Traumatol Arthrosc ; 28(9): 2730-2746, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32844246

RESUMO

PURPOSE: The Covid-19 pandemic has disrupted health care systems all over the world. Elective surgical procedures have been postponed and/or cancelled. Consensus is, therefore, required related to the factors that need to be in place before elective surgery, including hip and knee replacement surgery, which is restarted. Entirely new pathways and protocols need to be worked out. METHODS: A panel of experts from the European Hip Society and European Knee Association have agreed to a consensus statement on how to reintroduce elective arthroplasty surgery safely. The recommendations are based on the best available evidence and have been validated in a separate survey. RESULTS: The guidelines are based on five themes: modification and/or reorganisation of hospital wards. Restrictions on orthopaedic wards and in operation suite(s). Additional disinfection of the environment. The role of ultra-clean operation theatres. Personal protective equipment enhancement. CONCLUSION: Apart from the following national and local guidance, protocols need to be put in place in the patient pathway for primary arthroplasty to allow for a safe return.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/métodos , Pneumonia Viral/epidemiologia , Antropologia Médica , Betacoronavirus , Consenso , Assistência à Saúde/métodos , Desinfecção/métodos , Desinfecção/normas , Europa (Continente) , Unidades Hospitalares/organização & administração , Unidades Hospitalares/normas , Humanos , Salas Cirúrgicas/organização & administração , Salas Cirúrgicas/normas , Procedimentos Ortopédicos , Ortopedia , Pandemias , Equipamento de Proteção Individual , Inquéritos e Questionários
17.
J Am Acad Orthop Surg ; 28(15): e633-e641, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732651

RESUMO

Over recent months, coronavirus disease 2019 (COVID-19) has swept the world as a global pandemic, largely changing the practice of medicine as it was previously known. Physician trainees have not been immune to these changes-uncertainty during this time is undeniable for medical students at all levels of training. Of particular importance is the potential impact of COVID-19 on the upcoming residency application process for rising fourth-year students; a further source of added complexity in light of the newly integrated allopathic and osteopathic match in the 2020 to 2021 cycle. Owing to the impact COVID-19 could have on the residency match, insight regarding inevitable alterations to the application process and how medical students can adapt is in high demand. Furthermore, it is very possible that programs will inquire about how applicants spent their time while not in the hospital because of COVID-19, and applicants should be prepared to provide a meaningful answer. Although competitive at a basal level, the complexity of COVID-19 now presents an unforeseen, superimposed development in the quest to match. In this article, we aim to discuss and provide potential strategies for navigating the impact of COVID-19 on the residency application process for orthopaedic surgery.


Assuntos
Infecções por Coronavirus/epidemiologia , Educação de Pós-Graduação em Medicina , Internato e Residência , Procedimentos Ortopédicos/educação , Seleção de Pessoal , Pneumonia Viral/epidemiologia , Betacoronavirus , Humanos , Pandemias , Estados Unidos/epidemiologia
18.
J Am Acad Orthop Surg ; 28(15): e679-e685, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32732660

RESUMO

BACKGROUND: In response to COVID-19, American medical centers have enacted elective case restrictions, markedly affecting the training of orthopaedic residents. Residencies must develop new strategies to provide patient care while ensuring the health and continued education of trainees. We aimed to describe the evolving impact of COVID-19 on orthopaedic surgery residents. METHODS: We surveyed five Accreditation Council for Graduate Medical Education-accredited orthopaedic residency programs within cities highly affected by the COVID-19 pandemic about clinical and curricular changes. An online questionnaire surveyed individual resident experiences related to COVID-19. RESULTS: One hundred twenty-one resident survey responses were collected. Sixty-five percent of the respondents have cared for a COVID-19-positive patient. One in three reported being unable to obtain institutionally recommended personal protective equipment during routine clinical work. All programs have discontinued elective orthopaedic cases and restructured resident rotations. Most have shifted schedules to periods of active clinical duty followed by periods of remote work and self-isolation. Didactic education has continued via videoconferencing. DISCUSSION: COVID-19 has caused unprecedented changes to orthopaedic training; however, residents remain on the front lines of inpatient care. Exposures to COVID-19 are prevalent and residents have fallen ill. Programs currently use a variety of strategies to provide essential orthopaedic care. We recommend continued prioritization of resident safety and necessary training accommodations.


Assuntos
Infecções por Coronavirus/epidemiologia , Educação de Pós-Graduação em Medicina , Internato e Residência , Procedimentos Ortopédicos/educação , Pneumonia Viral/epidemiologia , Betacoronavirus , Cidades , Humanos , Pandemias , Inquéritos e Questionários , Estados Unidos/epidemiologia , Carga de Trabalho
20.
Orthopedics ; 43(4): 228-232, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32674173

RESUMO

The SARS-CoV-2 (COVID-19) pandemic has had a global influence on health care. The authors examined the early effect of hospital- and state-mandated restrictions on an orthopedic surgery department and hypothesized that the volume of ambulatory clinic encounters, office and surgical procedures, and cases would dramatically decrease. A retrospective review was performed of all encounters in an orthopedic surgery department at a level I academic trauma center during a 4-week period, from March 16, 2020, to April 12, 2020. The results were compared with two control 4-week periods, February 17, 2020, to March 15, 2020, and March 16, 2019, to April 12, 2019. Weekly volume and work relative value units (RVUs) of clinic encounters, office and surgical procedures, and cases were assessed. The type of ambulatory visit also was recorded. Comparisons of mean weekly volume and RVUs between the study and control periods were performed with Student's t test. Surgical cases were categorized into fracture or dislocation, acute soft tissue or nerve injury, infection, oncology, and elective or nonurgent. After implementation of hospital- and state-mandated restrictions on elective health care, the volume of ambulatory orthopedic surgery clinic encounters decreased by 74% to 77%, the volume of clinic procedures decreased by 95%, and the volume of surgical cases decreased by 88%. The percentage of clinic visits performed via telemedicine increased from 0.3% to 81.2%. Elective surgical cases ceased, and the volume of nonelective surgical cases decreased by 51%. During the first 4 weeks after COVID-19-related restrictions were imposed, an immediate and dramatic effect was observed. Compared with the control periods, significant reductions were seen in the volume of ambulatory encounters, office-based procedures, and surgical cases. In addition, the volume of nonelective surgical cases decreased by 51%. [Orthopedics. 2020;43(4):228-232.].


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Ortopédicos/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Telemedicina/estatística & dados numéricos , Centros Médicos Acadêmicos , Instituições de Assistência Ambulatorial , Betacoronavirus , Humanos , Massachusetts/epidemiologia , Pandemias , Estudos Retrospectivos , Centros de Traumatologia
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