Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 16.559
Filtrar
1.
Bone Joint J ; 102-B(9): 1229-1241, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32862684

RESUMO

AIMS: The primary aim of this study was to address the hypothesis that fracture morphology might be more important than posterior malleolar fragment size in rotational type posterior malleolar ankle fractures (PMAFs). The secondary aim was to identify clinically important predictors of outcome for each respective PMAF-type, to challenge the current dogma that surgical decision-making should be based on fragment size. METHODS: This observational prospective cohort study included 70 patients with operatively treated rotational type PMAFs, respectively: 23 Haraguchi Type I (large posterolateral-oblique), 22 Type II (two-part posterolateral and posteromedial), and 25 (avulsion-) Type III. There was no standardized protocol on how to address the PMAFs and CT-imaging was used to classify fracture morphology and quality of postoperative syndesmotic reduction. Quantitative 3D-CT (Q3DCT) was used to assess the quality of fracture reduction, respectively: the proportion of articular involvement; residual intra-articular: gap, step-off, and 3D-displacement; and residual gap and step-off at the fibular notch. These predictors were correlated with the Foot and Ankle Outcome Score (FAOS) at two-years follow-up. RESULTS: Bivariate analyses revealed that fracture morphology (p = 0.039) as well as fragment size (p = 0.007) were significantly associated with the FAOS. However, in multivariate analyses, fracture morphology (p = 0.001) (but not fragment size (p = 0.432)) and the residual intra-articular gap(s) (p = 0.009) were significantly associated. Haraguchi Type-II PMAFs had poorer FAOS scores compared with Types I and III. Multivariate analyses identified the following independent predictors: step-off in Type I; none of the Q3DCT-measurements in Type II, and quality of syndesmotic reduction in small-avulsion Type III PMAFs. CONCLUSION: PMAFs are three separate entities based on fracture morphology, with different predictors of outcome for each PMAF type. The current debate on whether or not to fix PMAFs needs to be refined to determine which morphological subtype benefits from fixation. In PMAFs, fracture morphology should guide treatment instead of fragment size. Cite this article: Bone Joint J 2020;102-B(9):1229-1241.


Assuntos
Fraturas do Tornozelo/cirurgia , Fixação de Fratura , Adulto , Fraturas do Tornozelo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Resultado do Tratamento
2.
Medicine (Baltimore) ; 99(35): e22001, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871954

RESUMO

In adolescent patients, cannulated lag screw (CLS) is a widely accepted choice for fixation of the medial epicondylar fracture of the humerus (MEFH). Absorbable implants, including rod, screw, and mini-plate, have been reported in children. However, to the best of our understanding, this study is the first head-to-head comparative study of CLS versus bioabsorbable screw (BS) in the treatment of MEFH.Patients of MEFH operated at our institute, from January 2010 to January 2016, were reviewed retrospectively. The patients were divided into 2 groups, the CLS group and the BS group, as per the type of implant the patient received. The CLS group consisted of 35 patients, whereas the BS group consisted of 30 patients. Demographic data, including sex, age at the time of surgery, operated side, and implant material, were collected from the hospital database. Elbow range of motion (ROM), radiographic manifestation was recorded during the out-patient visit. The elbow joint function was evaluated according to the Broberg and Morrey elbow scale and Mayo elbow performance index score.Thirty patients, including 18 males and 12 females, were included in the CLS group, whereas 35 patients, including 21 males and 14 females, were included in the BS group. At 6-month follow-up, elbow range of motion, Broberg and Morrey elbow scale and Mayo elbow performance index scale showed no significant difference between the 2 groups. The carrying angle was within the normal range in both groups. There was no nonunion or malunion in either group. The rate of hypoplasia or hyperplasia was low in both groups, 3.3% in CLS and 2.9% in BS. The rate of implant prominence was significantly higher in the CLS group (33.3%) than BS (0%).Both CLS and BS are safe and effective choices for displaced MEFH in adolescents. The BS can produce a satisfactory clinical outcome and is comparable to the CLS. Besides, the BS has the advantage of not needing second surgery for implant removal.


Assuntos
Implantes Absorvíveis , Parafusos Ósseos , Articulação do Cotovelo/lesões , Fixação de Fratura/instrumentação , Fraturas do Úmero/cirurgia , Adolescente , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos
3.
Plast Reconstr Surg ; 146(2): 366-370, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740589

RESUMO

Computed tomographic scans are frequently obtained following craniomaxillofacial fracture reconstruction. The additive radiation from such scans is not trivial; cumulative radiation exposure poses stochastic health risks. In this article, the authors postulate that a low-dose computed tomography protocol provides adequate image quality for postoperative evaluation of reconstructed craniomaxillofacial fractures. This study included patients for whom a computed tomographic scan was indicated following craniomaxillofacial fracture repair at a Level I trauma center. Postoperative craniomaxillofacial computed tomography was performed using a low-dose protocol, rather than standard protocols. A craniomaxillofacial surgeon and a radiologist interpreted the images to determine whether they were of sufficient quality. It was decided a priori that any inadequate low-dose computed tomography would require repeated scanning using standard protocols. The primary endpoint was the need for repeated computed tomography. In addition, the clarity of clinically significant anatomical landmarks on the images was graded on a five-point Likert scale. Twenty patients were scanned postoperatively using the low-dose protocol. Mean radiation dose (total dose-length product) from the low-dose protocol was 71 mGy · cm versus 532 mGy · cm for the preoperative computed tomographic scans that were obtained using conventional protocols (p < 0.001). All 20 low-dose computed tomographic scans were determined to provide satisfactory image quality. No patients required repeated computed tomography secondary to poor image quality. Low-dose computed tomography received high image-quality scores. A low-dose computed tomography protocol that delivers approximately 7.5-fold less radiation than the standard protocols was found to be adequate for postoperative evaluation of craniomaxillofacial fractures. Larger prospective studies may be warranted. CLINICAL QUESTION/LEVEL OF EVIDENCE:: Therapeutic, IV.


Assuntos
Fixação de Fratura , Cuidados Pós-Operatórios/métodos , Doses de Radiação , Fraturas Cranianas/cirurgia , Tomografia Computadorizada por Raios X/métodos , Humanos , Projetos Piloto , Cuidados Pós-Operatórios/efeitos adversos , Fraturas Cranianas/diagnóstico por imagem , Tomografia Computadorizada por Raios X/efeitos adversos , Centros de Traumatologia , Resultado do Tratamento
4.
Lancet ; 396(10248): 390-401, 2020 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-32771106

RESUMO

BACKGROUND: Scaphoid fractures account for 90% of carpal fractures and occur predominantly in young men. The use of immediate surgical fixation to manage this type of fracture has increased, despite insufficient evidence of improved outcomes over non-surgical management. The SWIFFT trial compared the clinical effectiveness of surgical fixation with cast immobilisation and early fixation of fractures that fail to unite in adults with scaphoid waist fractures displaced by 2 mm or less. METHODS: This pragmatic, parallel-group, multicentre, open-label, two-arm, randomised superiority trial included adults (aged 16 years or older) who presented to orthopaedic departments of 31 hospitals in England and Wales with a clear bicortical fracture of the scaphoid waist on radiographs. An independent remote randomisation service used a computer-generated allocation sequence with randomly varying block sizes to randomly assign participants (1:1) to receive either early surgical fixation (surgery group) or below-elbow cast immobilisation followed by immediate fixation if non-union of the fracture was confirmed (cast immobilisation group). Randomisation was stratified by whether or not there was displacement of either a step or a gap of 1-2 mm inclusive on any radiographic view. The primary outcome was the total patient-rated wrist evaluation (PRWE) score at 52 weeks after randomisation, and it was analysed on an available case intention-to-treat basis. This trial is registered with the ISRCTN registry, ISRCTN67901257, and is no longer recruiting, but long-term follow-up is ongoing. FINDINGS: Between July 23, 2013, and July 26, 2016, 439 (42%) of 1047 assessed patients (mean age 33 years; 363 [83%] men) were randomly assigned to the surgery group (n=219) or to the cast immobilisation group (n=220). Of these, 408 (93%) participants were included in the primary analysis (203 participants in the surgery group and 205 participants in the cast immobilisation group). 16 participants in the surgery group and 15 participants in the cast immobilisation group were excluded because of either withdrawal, no response, or no follow-up data at 6, 12, 26, or 52 weeks. There was no significant difference in mean PRWE scores at 52 weeks between the surgery group (adjusted mean 11·9 [95% CI 9·2-14·5]) and the cast immobilisation group (14·0 [11·3 to 16·6]; adjusted mean difference -2·1 [95% CI -5·8 to 1·6], p=0·27). More participants in the surgery group (31 [14%] of 219 participants) had a potentially serious complication from surgery than in the cast immobilisation group (three [1%] of 220 participants), but fewer participants in the surgery group (five [2%]) had cast-related complications than in the cast immobilisation group (40 [18%]). The number of participants who had a medical complication was similar between the two groups (four [2%] in the surgery group and five [2%] in the cast immobilisation group). INTERPRETATION: Adult patients with scaphoid waist fractures displaced by 2 mm or less should have initial cast immobilisation, and any suspected non-unions should be confirmed and immediately fixed with surgery. This treatment strategy will help to avoid the risks of surgery and mostly limit the use of surgery to fixing fractures that fail to unite. FUNDING: National Institute for Health Research Health Technology Assessment Programme.


Assuntos
Moldes Cirúrgicos , Fixação Interna de Fraturas , Fraturas Ósseas/terapia , Osso Escafoide/lesões , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Parafusos Ósseos , Feminino , Fixação de Fratura , Fixação Interna de Fraturas/métodos , Fraturas Ósseas/cirurgia , Fraturas não Consolidadas/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Osso Escafoide/cirurgia , Tempo para o Tratamento , Adulto Jovem
5.
Bone Joint J ; 102-B(8): 1056-1061, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32731819

RESUMO

AIMS: Current American Academy of Orthopaedic Surgeons (AAOS) guidelines for treating femoral fractures in children aged two to six years recommend early spica casting although some individuals have recommended intramedullary stabilization in this age group. The purpose of this study was to compare the treatment and family burden of care of spica casting and flexible intramedullary nailing in this age group. METHODS: Patients aged two to six years old with acute, non-pathological femur fractures were prospectively enrolled at one of three tertiary children's hospitals. Either early closed reduction with spica cast application or flexible intramedullary nailing was accomplished under general anaesthesia. The treatment method was selected after discussion of the options by the surgeon with the family. Data were prospectively collected on patient demographics, fracture characteristics, complications, pain medication, and union. The Impact on Family Scale was obtained at the six-week follow-up visit. In all, 75 patients were included in the study: 39 in the spica group and 36 in the nailing group. The mean age of the spica group was 2.71 (2.0 to 6.9) years and the mean age of the nailing group was 3.16 (2.0 to 6.9) years. RESULTS: All fractures healed without evidence of malunion or more than 2.0 cm of shortening. The mean Impact on Family score was 70.2 for the spica group and 63.2 (55 to 99) for the nailing group, a statistically significant difference (p = 0.024) in a univariate analysis suggesting less impairment of the family in the intramedullary nailing group. There was no significant difference between pain medication requirements in the first 24 hours postoperatively. Two patients in the spica group and one patient in the intramedullary nailing group required additional treatment under anaesthesia. CONCLUSION: Both early spica casting and intramedullary nailing were effective methods for treating femoral fractures in children two to six years of age. Intramedullary stabilization provides an option in this age group that may be advantageous in some social situations that depend on the child's mobility. Fracture treatment should be individualized based on factors that extend beyond anatomical and biological factors. Cite this article: Bone Joint J 2020;102-B(8):1056-1061.


Assuntos
Moldes Cirúrgicos , Fraturas do Fêmur/terapia , Fixação Intramedular de Fraturas/métodos , Consolidação da Fratura/fisiologia , Manejo da Dor/métodos , Fatores Etários , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Seguimentos , Fixação de Fratura/métodos , Hospitais Pediátricos , Humanos , Masculino , Seleção de Pacientes , Estudos Prospectivos , Medição de Risco , Fatores de Tempo
9.
Plast Reconstr Surg ; 146(2): 248e-250e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740631
10.
J Pediatr Orthop ; 40(8): 380-386, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32776772

RESUMO

BACKGROUND: Pediatric ipsilateral supracondylar humerus and forearm fractures (floating elbow), are historically reported to have a high rate of complications, including pediatric acute compartment syndrome (PACS). As a result, treatment paradigms for these types of injuries differ in the urgency, extent of fixation, and type of immobilization than if each fracture were treated in isolation. We aimed to systematically review the literature on pediatric floating elbow injuries and assess the reported risk of PACS along with risk factors for poor outcomes. METHODS: A systematic review was performed in November 2019 in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. An exhaustive search of the PubMed and Embase databases was conducted for peer-reviewed literature between 1999 and 2019. Two reviewers filtered the results, looking for articles in English that reported >10 pediatric floating elbow cases. Primary outcomes were the rate and risk factors for developing PACS. Secondary outcomes included patient and injury characteristics, treatment strategies, other complications (eg, neurovascular injuries), and final outcomes. RESULTS: The initial search yielded a total of 150 studies. Following review, 11 studies were included, with 433 patients available for review. The mechanism of injury was a fall in 96% of cases. Closed reduction and percutaneous pinning was the most common treatment performed for both fractures. Only 8/433 patients (2%) developed PACS. The incidence of a pulseless limb at presentation was 4%, and all patients regained a pulse following reduction. Three cases of iatrogenic ulnar nerve injury were reported in the setting of medial pin placement. Good to excellent results were reported in 83% to 100% of patients, based on the modified Flynn criteria. CONCLUSIONS: Despite being limited to heterogenous and retrospective case series, the evidence reviewed in this study contradicts the current belief of a high risk of PACS or other complications in pediatric floating elbows. PACS is much more common with displaced fractures in the setting of delayed treatment. The rate of other complications is comparable to isolated supracondylar humerus fractures. Evidence supports treating these injuries in an urgent fashion in the setting of a displaced fracture, although fixation of both distal and proximal fractures is not supported by evidence. The outcomes of pediatric floating elbows are generally good and do not reflect the poor prognosis that adult floating elbows represent. LEVEL OF EVIDENCE: Level IV-systematic review of level IV studies.


Assuntos
Síndromes Compartimentais , Cotovelo/lesões , Traumatismos do Antebraço , Fixação de Fratura , Complicações Pós-Operatórias , Criança , Síndromes Compartimentais/etiologia , Síndromes Compartimentais/terapia , Traumatismos do Antebraço/complicações , Traumatismos do Antebraço/cirurgia , Fixação de Fratura/efeitos adversos , Fixação de Fratura/métodos , Humanos , Incidência , Avaliação de Processos e Resultados em Cuidados de Saúde , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Fatores de Risco
11.
J Bone Joint Surg Am ; 102(13): 1116-1122, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32618909

RESUMO

The SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2) was reported in Wuhan, Hubei Province, People's Republic of China, and, subsequently, in other provinces and regions across the People's Republic of China and >212 countries. COVID-19, the disease caused by this coronavirus, was declared a worldwide pandemic by the World Health Organization (WHO). The incidence of patients with fracture who are also positive for COVID-19 is on the rise. The diagnosis and management of such patients can be complicated as their clinical characteristics are heterogeneous. Furthermore, a surgical procedure can be particularly challenging given that the use of high-speed devices results in aerosol generation. In this study, we develop and propose globally applicable guidelines to fill this knowledge gap and we identify and propose the necessary protective strategies for medical personnel in an orthopaedic emergency department and in the inpatient wards. We also introduce diagnostic criteria, surgical complication management, and follow-up strategies for infected patients. These guidelines may be helpful to decrease the infection rate of orthopaedic trauma personnel and to provide diagnosis and treatment therapy for patients with fracture and COVID-19.


Assuntos
Infecções por Coronavirus/diagnóstico , Fixação de Fratura/normas , Fraturas Ósseas/diagnóstico , Fraturas Ósseas/cirurgia , Pandemias , Pneumonia Viral/diagnóstico , Betacoronavirus , Infecções por Coronavirus/complicações , Emergências , Fraturas Ósseas/complicações , Humanos , Assistência Perioperatória , Pneumonia Viral/complicações , Guias de Prática Clínica como Assunto
12.
Orthopade ; 49(8): 679-684, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-32671415

RESUMO

Open fractures involve a high risk of open fracture-associated infections (OFAIs), and the treatment can often be protracted and complicated. Thus, prevention of OFAIs in the acute and perioperative management of open fractures is of great importance. Through vigilance and thorough treatment planning, between the day of injury and the hospital discharge, the risk of OFAIs can be considerably reduced.


Assuntos
Infecções Bacterianas/prevenção & controle , Fixação de Fratura/métodos , Fraturas Expostas/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Infecção da Ferida Cirúrgica/prevenção & controle , Infecção dos Ferimentos/prevenção & controle , Fraturas Expostas/complicações , Humanos , Planejamento de Assistência ao Paciente , Estudos Retrospectivos
13.
Medicine (Baltimore) ; 99(27): e21053, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629731

RESUMO

Internal fixation such as elastic stable intramedullary(ESIN) nail and submuscular plate (SMP) is gaining popularity for femoral shaft fractures in school-aged children. However, external fixation (ExFix) might be a valuable option for the distal third femoral shaft fractures, where the fracture heals rapidly, but it is crucial to avoid angular malunion. This study aims to compare the clinical outcomes, postoperative complications of distal third femoral shaft fractures in school-aged children treated by ESIN versus ExFix.Patients aged 5 to 11 years with distal third femoral shaft fractures treated at our institute from January 2014 to January 2016 were included and categorized into ESIN (n = 33) and ExFix (n = 38) group. The preoperative data, including baseline information of the patients, radiographic parameters, and type of surgical procedure, were collected from the hospital database, and postoperative data, including complications, were collected during the follow-up visit.In all, 33 patients (average, 8.0 ±â€Š2.1 years, male 20, female 13) in the ESIN group and 38 patients (average, 8.3 ±â€Š2.3 years, male 23, female 15) in the ExFix group were included in this study. There was significantly less operative time for the ExFix group (45.4 ±â€Š7.8 min) as compared to the ESIN group (57.8 ±â€Š11.3 min) (P < .01), reduced estimated blood loss (EBL) in the ExFix group (9.9 ±â€Š3.5) as compared to the ESIN group (16.4 ±â€Š6.5) (P < .01). As for the frequency of fluoroscopy, there was a significant difference between the ExFix group (13.9 ±â€Š2.4) and the ESIN group (15.5 ±â€Š3.2) (P = .02). The rate of major complications was not significantly different between the 2 groups (P = .19). The rate of implant irritation was significantly higher in the ExFix group (28/38, 73.7%) than the ESIN group (12/33, 36.4%) (P < .01). The rate of surgical site infection (SSI) is significantly higher in the ExFix group (18/38, 47.4%)) than the ESIN group (1/33, 3%) (P < .01). The rate of scar concern was significantly higher in the ExFix (9/38, 23.7%) than the ESIN (2/33, 6.1%), (P = .04). According to the Flynn scoring system, 30(90.9%) patients in the ESIN group and 24(89.5%) patients in the ExFix group were rated as excellent. None of the patients had poor outcomes.Both ESIN and ExFix produced satisfactory outcomes in distal third femoral shaft fractures. ExFix remains a viable choice for selected cases, especially in resource-challenged and austere settings.


Assuntos
Pinos Ortopédicos/efeitos adversos , Placas Ósseas/efeitos adversos , Fixadores Externos/efeitos adversos , Fraturas do Fêmur/cirurgia , Assistência ao Convalescente , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Pinos Ortopédicos/normas , Placas Ósseas/normas , Criança , Pré-Escolar , China/epidemiologia , Diáfises/diagnóstico por imagem , Diáfises/patologia , Fixadores Externos/normas , Feminino , Fraturas do Fêmur/diagnóstico por imagem , Fluoroscopia/estatística & dados numéricos , Fixação de Fratura/métodos , Fixação de Fratura/tendências , Fixação Interna de Fraturas/métodos , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do Tratamento
14.
Medicine (Baltimore) ; 99(28): e20576, 2020 Jul 10.
Artigo em Inglês | MEDLINE | ID: mdl-32664061

RESUMO

Pilon fractures are always results of the high-energy trauma. They are often accompanied with serious soft tissue injury, and tension blisters happened in most cases. For comminuted fractures and poor soft tissue, how to select the incision is challenging. This study aimed to explore the outcomes of the treatment of ten 43-B/C pilon fractures using an anteromedial fibula approach.Ten closed pilon fractures combined with fibula fractures were treated in our hospital from January 2015 to July 2016. Six cases were AO/OTA type 43-B and 4 cases were 43-C, including 9 males and 1 female with a mean age of 36.3 years (range: 20-60 years). When the skin wrinkled, all patients were treated by the senior authors with open reduction and internal fixation using an anteromedial fibula approach. Postoperatively, patients were followed up at 1 month, 3 months, 6 months, 12 months, and 18 months, respectively. The incision healing, the American Orthopedic Foot and Ankle Society scores and fracture healing were recorded to get a comprehensive evaluation of the effect for the incision.All patients were followed from 9 to 18 months (average: 14.1 months). Anatomic reduction was achieved in 7 cases and satisfactory in 3 cases by the Burwell-Charnley radiological criteria evaluation. All patients had complete retention of the dorsal extensor tendon sheath. The most incisions had a good healing without necrosis at 2 weeks after surgery except 1 case. The factures were healed at a range of 12 to 18 weeks (average: 13.7 ±â€Š1.2 weeks). The American Orthopedic Foot and Ankle Society scores were excellent in 7 cases and good in 3 cases at 1 year after surgery (average: 85.6 ±â€Š4.2 points). The satisfactory outcomes were achieved in most patients.The anteromedial fibula approach used for pilon fractures can lead to an effective exposure and allow fixation of tibia and fibula fractures with minimal soft tissue injury. It is a safe, simple, and effective approach that allows for satisfactory functional rehabilitation of the ankle joint. LEVEL OF EVIDENCE:: therapeutic Level IV.


Assuntos
Traumatismos do Tornozelo/cirurgia , Fixação de Fratura/métodos , Fraturas da Tíbia/cirurgia , Adulto , Traumatismos do Tornozelo/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fraturas da Tíbia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto Jovem
15.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(7): 874-877, 2020 Jul 15.
Artigo em Chinês | MEDLINE | ID: mdl-32666731

RESUMO

Objective: To introduce the experience of intelligent monitoring system assisted pelvic fracture closed reduction to treat complex pelvic fracture in a minimally invasive method. Methods: A 30-year-old male patient with complex pelvic fracture caused by a falling injury was treated in December 2019. The pelvic fracture was diagnosed by X-ray film and CT three-dimensional reconstruction. The AO/Orthopaedic Trauma Association (AO/OTA) classification was 61-C3.3 type (H-shaped sacrum fracture with pubic symphysis separation). At 48 hours after injury, the vital signs were stable, and the operation was performed. The pelvic fracture was reduced with the help of pelvic reduction frame and skeletal traction, the intelligent monitoring system, and fixed with the channel screws. Results: The intraoperative blood loss was 50 mL, the operation time was 180 minutes, and the fluoroscopy time was 45 seconds. The incision healed well after operation. The X-ray film of pelvis was taken on the next day after operation, and the fracture reduction was evaluated as anatomical reduction according to Matta standard; CT three-dimensional reconstruction showed that the fixation screws were all located in the cortex of bone, without penetrating the cortex of bone. Conclusion: The intelligent monitoring system assisted pelvic fracture closed reduction is reliable in the minimally invasive treatment of complex pelvic fractures, which can achieve good results and reduce intraoperative fluoroscopy.


Assuntos
Fraturas Ósseas , Ossos Pélvicos , Adulto , Parafusos Ósseos , Redução Fechada , Feminino , Fixação de Fratura , Fixação Interna de Fraturas , Humanos , Masculino , Pelve , Resultado do Tratamento
16.
J Bone Joint Surg Am ; 102(13): e66, 2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32618914

RESUMO

BACKGROUND: Closed reduction and percutaneous pinning (CRPP) of supracondylar humeral fractures is one of the most common procedures performed in pediatric orthopaedics. The use of full, standard preparation and draping with standard personal protective equipment (PPE) may not be necessary during this procedure. This is of particular interest in the current climate as we face unprecedented PPE shortages due to the current COVID-19 pandemic. METHODS: This is a retrospective chart review of 1,270 patients treated with CRPP of a supracondylar humeral fracture at 2 metropolitan pediatric centers by 10 fellowship-trained pediatric orthopaedic surgeons. One surgeon in the group did not wear a mask when performing CRPP of supracondylar humeral fractures, and multiple surgeons in the group utilized a semisterile preparation technique (no sterile gown or drapes). Infectious outcomes were compared between 2 groups: full sterile preparation and semisterile preparation. We additionally analyzed a subgroup of patients who had semisterile preparation without surgeon mask use. Hospital cost data were used to estimate annual cost savings with the adoption of the semisterile technique. RESULTS: In this study, 1,270 patients who underwent CRPP of a supracondylar humeral fracture and met inclusion criteria were identified. There were 3 deep infections (0.24%). These infections all occurred in the group using full sterile preparation and surgical masks. No clinically relevant pin-track infections were noted. There were no known surgeon occupational exposures to bodily fluid. It is estimated that national adoption of this technique in the United States could save between 18,612 and 22,162 gowns and masks with costs savings of $3.7 million to $4.4 million annually. CONCLUSIONS: We currently face critical shortages of PPE due to the COVID-19 pandemic. Data from this large series suggest that a semisterile technique during CRPP of supracondylar humeral fractures is a safe practice. We anticipate that this could preserve approximately 20,000 gowns and masks in the United States over the next year. Physicians are encouraged to reevaluate their daily practice to identify safe opportunities for resource preservation. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Infecções por Coronavirus , Fixação de Fratura/normas , Alocação de Recursos para a Atenção à Saúde/organização & administração , Fraturas do Úmero/cirurgia , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral , Infecção da Ferida Cirúrgica/prevenção & controle , Betacoronavirus , Pinos Ortopédicos , Criança , Pré-Escolar , Redução Fechada/efeitos adversos , Redução Fechada/normas , Feminino , Fixação de Fratura/efeitos adversos , Alocação de Recursos para a Atenção à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/métodos , Humanos , Controle de Infecções/economia , Controle de Infecções/normas , Masculino , Equipamento de Proteção Individual/economia , Estudos Retrospectivos , Infecção da Ferida Cirúrgica/etiologia , Estados Unidos/epidemiologia
17.
Arthroscopy ; 36(6): 1722-1724, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32503780

RESUMO

The surgical management of ankle fractures can be an unforgiving endeavor. Subtle malreductions in fracture fragments lead to significant deviations in joint reactive forces and, consequently, accelerated arthritis. The diagnosis of associated ligamentous pathology, such as deltoid and syndesmotic injuries, is often difficult and ideal surgical management is debated. Ankle fractures that are seemingly optimally managed using traditional surgical techniques may remain persistently painful and function poorly-a scenario that begs the question, was there more to the injury than met the eye (or radiographs)? Here, unrecognized concomitant intra-articular injuries and subtle surgical malreductions have been implicated. In my practice, concurrent ankle arthroscopy at the time of definitive acute ankle fracture reduction and fixation results in improved accuracy of reduction, evaluation and management of concomitant syndesmotic and ligamentous injuries, assessment and treatment of occult intra-articular injuries, options for less-invasive fixation techniques through arthroscopic reduction, and a means to provide prognostic patient information. I typically reserve its use for fracture patterns that have been more closely associated with intra-articular injuries: high-energy mechanism injuries, Weber B and C fibula fractures, and those with a high likelihood of syndesmotic disruption based on preoperative imaging. Despite these intuitive advantages, concurrent ankle arthroscopy for acute fracture fixation is not routinely performed by most orthopedic surgeons, and a relative dearth of literature regarding its use and clinical impact remains.


Assuntos
Fraturas do Tornozelo , Traumatismos do Tornozelo , Articulação do Tornozelo , Artroscopia , Fixação de Fratura , Humanos
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA