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1.
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
2.
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
3.
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
4.
Unfallchirurg ; 123(7): 547-559, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32577777

RESUMO

With a prevalence of approximately 0.4%, distal femoral fractures are a rare entity. Nevertheless, due to the high mortality rates, which are comparable to proximal femoral fractures, these fractures are highly important. The clinical symptoms are often quite striking. In combination with preoperative computed tomography (CT) and if necessary, supplemented by CT angiography, the morphological situation can be assessed and the decision making facilitated. There are several different treatment options and the appropriate one should be selected for each individual case. The use of external fixation of the complete knee joint in the sense of damage control surgery, is useful. For definitive treatment retrograde intramedullary nailing and locking plates with angle stable screws are the main options. Modern angle stable and anatomically preformed implants enable surgical treatment using minimally invasive approaches to protect the soft tissues, with a better overall outcome.


Assuntos
Fraturas do Fêmur , Fixação Intramedular de Fraturas , Placas Ósseas , Fixação de Fratura , Humanos
5.
Medicine (Baltimore) ; 99(25): e20139, 2020 Jun 19.
Artigo em Inglês | MEDLINE | ID: mdl-32569159

RESUMO

We aimed to assess the usefulness of slice-encoding metal artifact correction (SEMAC) for the evaluation of spinal metallic implants and peripheral soft tissue lesions at 3T magnetic resonance.Twenty-seven patients with spinal metal implants underwent both SEMAC and high bandwidth (HiBW) based sequences scanning for reduction artifacts. The area size and maximum longitude of artifacts, the peri-prosthetic soft tissue, and metal visualization were assessed by 2 independent doctors, as well as the lesions signs were reviewed by 2 senior readers. A paired 2-tailed t-test and McNemar test were used for statistical analysis.The size of artifacts on SEMAC images decreased by 37% and 24%, and the scores are higher than that on HiBW images. T1 weighted (T1W)-SEMAC acquired the highest score in metal prosthesis visualization, while short tau inversion recovery SEMAC showed more signs of lesions than clinical HiBW group.SEMAC effectively reduces the metal artifacts and is useful for assessing soft tissue lesions.


Assuntos
Imagem por Ressonância Magnética/métodos , Dispositivos de Fixação Ortopédica , Complicações Pós-Operatórias/diagnóstico por imagem , Lesões dos Tecidos Moles/diagnóstico por imagem , Coluna Vertebral/diagnóstico por imagem , Idoso , Artefatos , Feminino , Fixação de Fratura/instrumentação , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Melhoria de Qualidade , Fraturas da Coluna Vertebral/cirurgia
6.
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
7.
Niger J Clin Pract ; 23(5): 647-653, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32367871

RESUMO

Background: Supracondylar humerus (SCH) fractures are serious injuries due to the neighborhood of critical neural and vascular structures. One of the most devastating complications of SCH fractures is neurological damage, since it may cause permanent disability. The aim of this study is to categorize neurological complications, to report long-term functional outcomes, and to determine risk factors associated with childhood SCH fractures. Methods: The records of 375 children were reviewed retrospectively. Data about amount and direction of displacement, the shape of the fracture, age at the time of fracture, gender, time from impaction to surgery, time of surgery, type of neurological injury, and recovery time were recorded. Results: Neurological complications were seen in 37 (9.85%) children. Thirteen (35.1%) of the children had an iatrogenic nerve injury. All iatrogenic injuries were fully recovered in this study. However, 2 children who had combined neurological injury of radial, ulnar, and median nerves did not recover. Nearly 95% of all children who had neurological injury recovered fully. An anterior long and sharp bone fragment (spike) was observed in most of the children with neurological injury, and this spike was seen in 14 (58.3%) patients who had a trauma-related injury (n = 24). Conclusion: The prognosis of these nerve injuries is excellent, especially the iatrogenic ones. A long and sharp bone fragment (spike) may be responsible for nerve injuries in some children. Surgical exploration is not necessary after an iatrogenic nerve injury when there is no neurotmesis. Patience and care are utmost needed to handle neurological complications.


Assuntos
Fraturas do Úmero/complicações , Luxações Articulares/cirurgia , Traumatismos dos Nervos Periféricos/diagnóstico , Neuropatias Ulnares/etiologia , Criança , Pré-Escolar , Feminino , Fixação de Fratura/métodos , Humanos , Fraturas do Úmero/cirurgia , Úmero/lesões , Úmero/cirurgia , Doença Iatrogênica , Luxações Articulares/diagnóstico por imagem , Masculino , Nervo Mediano/lesões , Prognóstico , Nervo Radial/lesões , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Nervo Ulnar/lesões
8.
Bone Joint J ; 102-B(5): 627-631, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32349603

RESUMO

AIMS: The timing of surgical fixation in spinal fractures is a contentious topic. Existing literature suggests that early stabilization leads to reduced morbidity, improved neurological outcomes, and shorter hospital stay. However, the quality of evidence is low and equivocal with regard to the safety of early fixation in the severely injured patient. This paper compares complication profiles between spinal fractures treated with early fixation and those treated with late fixation. METHODS: All patients transferred to a national tertiary spinal referral centre for primary surgical fixation of unstable spinal injuries without preoperative neurological deficit between 1 July 2016 and 20 October 2017 were eligible for inclusion. Data were collected retrospectively. Patients were divided into early and late cohorts based on timing from initial trauma to first spinal operation. Early fixation was defined as within 72 hours, and late fixation beyond 72 hours. RESULTS: In total, 86 patients underwent spinal surgery in this period. Age ranged from 16 to 88 years. Mean Injury Severity Score (ISS) was higher in the early stabilization cohort (p = 0.020). Age was the sole significant independent variable in predicting morbidity on multiple regression analysis (p < 0.003). There was no significant difference in complication rates based on timing of surgical stabilization (p = 0.398) or ISS (p = 0.482). CONCLUSION: Our results suggest that these patients are suitable for early appropriate care with spinal precautions and delayed definitive surgical stabilization. Earlier surgery conferred no morbidity benefit and had no impact on length of stay. Cite this article: Bone Joint J 2020;102-B(5):627-631.


Assuntos
Fixação de Fratura/métodos , Fraturas da Coluna Vertebral/cirurgia , Tempo para o Tratamento , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Escala de Gravidade do Ferimento , Irlanda , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Zhongguo Gu Shang ; 33(4): 375-8, 2020 Apr 25.
Artigo em Chinês | MEDLINE | ID: mdl-32351095

RESUMO

OBJECTIVE: To observe the clinical effect of elastic intramedullary nail in minimally invasive treatment of floating knee injury in children. METHODS: From January 2009 to September 2017, 11 children with floating knee injury were treated with one-off open reduction and elastic intramedullary nail or external fixator fixation, including 7 males and 4 females, aged 5.0 to 11.0 years, with an average age of 8.3 years. The treatment results were evaluated according to karlstrom's standard. RESULTS: Eleven patients were followed up for 8 to 48 months, with an average of 28 months. All the fractures healed at one time, and there were no complications such as nonunion, malunion and serious dysfunction of knee joint. The length of the affected limb in 2 cases was 1.2 to 1.5 cm longer than that in the opposite side without shortening. According to Karlstrom scoring standard, 8 cases were excellent, 1 case was good and 2 cases were middle. CONCLUSION: Elastic intramedullary nail minimally invasive treatment of floating knee injury in children is a safe and effective treatment, which can effectively reduce the fracture and promote bone healing, which is conducive to early functional recovery.


Assuntos
Fixação Intramedular de Fraturas , Traumatismos do Joelho , Pinos Ortopédicos , Criança , Pré-Escolar , Fixadores Externos , Feminino , Fixação de Fratura , Consolidação da Fratura , Humanos , Fixadores Internos , Traumatismos do Joelho/cirurgia , Masculino , Resultado do Tratamento
10.
PLoS One ; 15(5): e0232153, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32469881

RESUMO

BACKGROUND: Distal radius fractures are common fractures and the cornerstone of treatment remains immobilization of the wrist in a cast. At present, there is a scarcity of studies that compare different cast immobilization methods. The objective of the study was therefore to compare volar-flexion and ulnar deviation cast to functional cast position in the treatment of dorsally displaced distal radius fracture among elderly patients. METHODS AND FINDINGS: We performed a pragmatic, randomized, controlled trial in three emergency centers in Finland. After closed reduction of the fracture, the wrist was placed in either volar-flexion and ulnar deviation cast or functional cast position. The follow-up was 12 months. The primary outcome was patient-rated wrist evaluation (PRWE) score at 12 months. The secondary outcomes were Quick-DASH score, grip strength, health-related quality of life (15D), and pain catastrophizing scale. The number of complications was also recorded. In total, 105 participants were included in the study. Of these, 88% were female and the mean age was 73.5 (range 65-94) years. In the primary analysis, the mean difference in patient-rated wrist evaluation measure between groups was -4.9 (95% CI: -13.1.- 3.4., p = .24) in favor of the functional cast position. Operative treatment due to loss of reduction of fracture was performed for four patients (8%) in the FC group and for seven patients (13%) in the volar-flexion and ulnar deviation cast group (OR: 0.63, 95% CI: 0.16-2.1). CONCLUSION: In this study, the data were consistent with a wide range of treatment effects when comparing two different cast positions in the treatment of distal radius fracture among elderly patients at 12-month follow-up. However, the functional cast is more likely to be superior when compared to volar-flexion and ulnar deviation cast. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02894983 Accessible: https://clinicaltrials.gov/ct2/show/NCT02894983.


Assuntos
Moldes Cirúrgicos , Fratura de Colles/cirurgia , Fixação de Fratura/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação de Fratura/efeitos adversos , Fixação de Fratura/instrumentação , Humanos , Masculino , Dor/etiologia , Medidas de Resultados Relatados pelo Paciente , Qualidade de Vida
11.
Zhongguo Gu Shang ; 33(3): 203-8, 2020 Mar 25.
Artigo em Chinês | MEDLINE | ID: mdl-32233244

RESUMO

OBJECTIVE: To compare clinical effects of calcaneal traction and external fixator fixation of fractional delayed surgery in treating type C Pilon fractures. METHODS: From January 2012 to December 2017, clinical data of 45 patients with tibial Pilon fractures were respectively analyzed. There were 24 patients in traction group, including 16 males and 8 females, aged from 21 to 57 years old with an average age of (38.6 ±10.5) years old; 18 patients caused by falling down, 6 patients caused by traffic accident; 15 patients on the left side and 9 patients on the right side; according to AO/OTA classification, 3 patients classified type C1, 9 patients classified type C2 and 12 patients classified type C3; treated by calcaneal traction on the first stage, and open reduction and internal fixation on the second stage. There were 21 patients in external fixation group, including 15 males and 6 females, aged from 19 to 58 years old with an average age of (37.8 ±11.2) years old; 17 patients caused by falling down, 4 patients caused by traffic accident; 11 patients on the left side and 10 patients on the right side; according to AO/OTA classification, 2 patients classified type C1, 8 patients classified type C2 and 11 patients classified type C3; treated by external fixator on the first stage, and open reduction and internal fixation on the second stage. All patients were closed fracture. Preoperative waiting time, hospital stays, operative time, postoperative complications, fracture reduction and healing time between two groups were compared, VAS score was used to evaluate relief of pain before internal fixation on the second stage, Burwell-Charnley radiological evaluation criteria was applied to evaluate fracture reduction after internal fixation, AOFAS score was used to evaluate recovery of ankle joint function. RESULTS: There were no statistical difference in operative time, following-up time and fracture healing time between two groups. VAS score before internal fixation in traction group was 3.73± 0.87, while in external fixation group was 2.67±0.69, there was statistical difference between two groups. Preoperative waiting time, and hospital stays in traction group were (9.20±1.40) d ,(12.30±3.60) d; while in external fixation group were (7.60± 1.50) d ,(10.80±2.60) d; and had significant difference between two groups. There was no difference in complications between two groups. According to Burwell-Charnley radiological evaluation criteria, 20 patients obtained anatomical reduction, and 4 patients received normal reduction in traction group; 18 patients obtained anatomical reduction, and 3 patients received normal reduction in external fixation group; while without difference between two groups. There was no difference between two groups in AOFAS score. CONCLUSION: For type C Pilon fractures, one-stage calcaneus traction or temporary external fixation also could achieve temporary fixation and provide better soft tissue conditions for the second stage internal fixation, and could receive better ankle joint function after internal fixation. The operation of calcaneus traction is simple, while external fixation may be increase the number of operation times, but external fixation has more advantages in reducing preoperative pain, shortening preoperative waiting days and hospitalization time than traction.


Assuntos
Traumatismos do Tornozelo , Calcâneo , Fraturas da Tíbia , Adulto , Estudos de Casos e Controles , Fixadores Externos , Feminino , Fixação de Fratura , Fixação Interna de Fraturas , Humanos , Masculino , Pessoa de Meia-Idade , Tração , Resultado do Tratamento , Adulto Jovem
12.
Ann R Coll Surg Engl ; 102(5): 348-354, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32233845

RESUMO

INTRODUCTION: Predicting when fracture incidence will rise assists in healthcare planning and delivery of preventative strategies. The aim of this study was to investigate the relationship between temperature and the incidence of hip and wrist fractures. METHODS: Data for adults presenting to our unit with a hip or wrist fracture over a seven and eight-year period respectively were analysed. Incidence rates were calculated and compared with meteorological records. A Poisson regression model was used to quantify the relationship between temperature and fracture rate. RESULTS: During the respective study periods, 8,380 patients presented with wrist fractures and 5,279 patients were admitted with hip fractures. All women (≥50 years: p<0.001; <50 years: p<0.001) and men aged ≥50 years (p=0.046) demonstrated an increased wrist fracture rate with reduced temperature. Men aged <50 years also had an increased wrist fracture rate with increased temperature (p<0.001).The hip fracture rate was highest in women aged ≥50 years but was not associated with temperature (p=0.22). In men aged ≥50 years, there was a significant relationship between reduced temperature and increased fracture rate (p<0.001). CONCLUSIONS: Fragility fracture of the wrist is associated with temperature. Compared with an average summer, an additional 840 procedures are performed for wrist fractures during an average winter in our trust with an additional 798 bed days taken up at a cost of £3.2 million. The winter increase seen in male hip fracture incidence requires approximately 888 surgical procedures, with 18,026 bed days, and costs £7.1 million. Hip fracture incidence in older women is not related to temperature.


Assuntos
Temperatura Baixa/efeitos adversos , Fraturas do Quadril/epidemiologia , Temperatura Alta/efeitos adversos , Fraturas por Osteoporose/epidemiologia , Fraturas do Rádio/epidemiologia , Traumatismos do Punho/epidemiologia , Acidentes por Quedas/prevenção & controle , Acidentes por Quedas/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Fixação de Fratura/estatística & dados numéricos , Fraturas do Quadril/cirurgia , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Fraturas por Osteoporose/cirurgia , Estudos Prospectivos , Fraturas do Rádio/cirurgia , Fatores de Risco , Estações do Ano , Fatores Sexuais , Traumatismos do Punho/cirurgia , Adulto Jovem
14.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi ; 34(3): 404-408, 2020 Mar 15.
Artigo em Chinês | MEDLINE | ID: mdl-32174091

RESUMO

Objective: To review the progress of hip fracture treatment in children. Methods: Literature about the hip fracture treatment in children was extensively reviewed and summarized in terms of anatomy and blood supply, fracture classification, surgical treatment principles, and complications. Results: The anatomical structure of children's hips and the characteristics of peripheral blood supply constantly change with age. Delbet classification is the most classic classification of hip fracture in children. Children's age and Delbet classification have significant effects on surgical treatment strategies and post-fracture complications. The timing of surgical treatment, accurate anatomical reduction, and appropriate internal fixation can effectively improve the prognosis and reduce the incidence of complications. Common complications include osteonecrosis of the femoral head, coxa vara, premature physeal closure, and nonunion. Conclusion: There are still some controversies on the treatment concept and internal fixation choice for children's hip fracture. So it is necessary to further study the anatomy and blood supply characteristics of children's hip, improve the selection and application skills of internal fixation devices, so as to avoid serious complications.


Assuntos
Fraturas do Colo Femoral/cirurgia , Fixação de Fratura , Fraturas do Quadril/cirurgia , Criança , Fixação Interna de Fraturas , Quadril , Humanos , Resultado do Tratamento
15.
Medicine (Baltimore) ; 99(9): e19328, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32118764

RESUMO

We assessed factors associated with premature physeal closure (PPC) and outcomes after closed reduction of Salter-Harris type II (SH-II) fractures of the distal tibia. We reviewed patients with SH-II fractures of the distal tibia treated at our center from 2010 to 2015 with closed reduction and a non-weightbearing long-leg cast. Patients were categorized by immediate postreduction displacement: minimal, <2 mm; moderate, 2 to 4 mm; or severe, >4 mm. Demographic data, radiographic data, and Lower Extremity Functional Scale (LEFS) scores were recorded.Fifty-nine patients (27 girls, 31 right ankles, 26 concomitant fibula fractures) were included, with a mean (±SD) age at injury of 12.0 ±â€Š2.2 years. Mean maximum fracture displacements were 6.6 ±â€Š6.5 mm initially, 2.7 ±â€Š2.0 mm postreduction, and 0.4 ±â€Š0.7 mm at final follow-up. After reduction, displacement was minimal in 23 patients, moderate in 21, and severe in 15. Fourteen patients developed PPC, with no significant differences between postreduction displacement groups. Patients with high-grade injury mechanisms and/or initial displacement ≥4 mm had 12-fold and 14-fold greater odds, respectively, of PPC. Eighteen patients responded to the LEFS survey (mean 4.0 ±â€Š2.1 years after injury). LEFS scores did not differ significantly between postreduction displacement groups (P = .61).The PPC rate in this series of SH-II distal tibia fractures was 24% and did not differ by postreduction displacement. Initial fracture displacement and high-grade mechanisms of injury were associated with PPC. LEFS scores did not differ significantly by postreduction displacement.Level of Evidence: Level IV, case series.


Assuntos
Fixação de Fratura/normas , Fraturas Salter-Harris/terapia , Adolescente , Criança , Feminino , Fixação de Fratura/métodos , Fixação de Fratura/estatística & dados numéricos , Humanos , Masculino , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/diagnóstico por imagem , Estudos Retrospectivos , Tíbia/anatomia & histologia , Tíbia/lesões , Tíbia/fisiopatologia , Resultado do Tratamento
16.
Medicine (Baltimore) ; 99(10): e19449, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32150100

RESUMO

Radial external fixator has been proposed to treat delayed irreducible Gartland type III supracondylar humeral fracture, and this study aims to compare its effects with crossed pinning in a retrospective fashion. Delayed supracondylar humeral fracture is defined as more than 72 hours after injury, 2 or more than 2 times failed attempts of closed reduction can be deemed as irreducible fracture.Between January 2010 and January 2017, patients of Gartland type III supracondylar fractures of the humerus receiving surgery were all selected and reviewed. Overall, 39 patients fitting the inclusion criteria were chosen for the External Fixator Group and patients for control group of crossed pinning with matched age, sex, and clinical parameters (fracture location, injured side, and fracture type) were selected from the database. Surgery duration, number of intraoperative X-ray images, incidence of ulnar nerve injury, postoperative redisplacement, and function of the elbow joint were recorded and analyzed.In this study, 39 patients treated with radial external fixator had significantly shorter surgery duration, fewer intraoperative X-ray images, and lower incidence of ulnar nerve injury, and postoperative redisplacement than those receiving crossed pinning. Patients in 2 groups displayed similar range of motion for elbow joint at follow-up.Radial external fixator is an effective and safe method to treat Gartland type III supracondylar fractures that were diagnosed late.


Assuntos
Pinos Ortopédicos , Fixadores Externos , Fixação de Fratura/instrumentação , Fraturas do Úmero/cirurgia , Criança , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Masculino , Amplitude de Movimento Articular , Estudos Retrospectivos , Resultado do Tratamento
17.
Orthop Clin North Am ; 51(2): 189-205, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32138857

RESUMO

Hip fractures are of great interest worldwide as the geriatric population continues to increase rapidly. Currently, surgeons prefer to use cephalomedullary nail for internal fixation of pertrochanteric/intertrochanteric fractures. This article summarizes 10 concepts in hip fracture treatment over the past 20 years, including fracture line mapping, proximal lateral wall and anterior cortex, posteromedial lesser trochanter-calcar fragment, anteromedial cortex support reduction, changes of fracture reduction after sliding and secondary stability, nail entry point and wedge-open deformity, tip-apex distance and calcar-referenced tip-apex distance, femoral anterior bowing and nail modification, long nails for wide medullary canal and large posterior coronal fragment, and postoperative stability score.


Assuntos
Fixação Interna de Fraturas/métodos , Fraturas do Quadril/cirurgia , Ásia , Fixação de Fratura , Fixação Interna de Fraturas/educação , Fixação Interna de Fraturas/instrumentação , Fraturas do Quadril/diagnóstico por imagem , Humanos
18.
Am J Phys Med Rehabil ; 99(4): 285-290, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32195715

RESUMO

OBJECTIVE: Distal radius fractures in the older population significantly impair grip strength. The aim of the study was to investigate whether a hand strength focused exercise program during the period of immobilization for nonoperatively managed distal radius fractures in this population improved grip strength and quality of life. DESIGN: This is a single-center randomized controlled trial with concealed allocation, assessor blinding, and intention-to-treat analysis. Fifty-two patients older than 60 yrs who experienced distal radius fractures managed nonoperatively with cast immobilization. The intervention group (n = 26) received a home hand strength-focused exercise program from 2 and 6 wks after injury while immobilized in a full short arm cast. The control group (n = 26) performed finger range of motion exercises as per protocol. Primary outcome was grip strength ratio of injured arm compared with uninjured arm. Secondary outcome included functional scores of the 11-item shortened version of the Disabilities of the Arm, Shoulder and Hand. Outcomes were measured at 2, 6, and 12 wks after injury. RESULTS: The intervention group significantly improved grip strength ratio at both 6 and 12 wks (6 wks: 40% vs 25%, P = 0.0044, and 12 wks: 81% vs 51%, P = 0.0035). The intervention group improved the 11-item Disabilities of the Arm, Shoulder and Hand score at 12 wks; however, this was not statistically significant (25 vs 40, P = 0.066). CONCLUSIONS: A hand strength-focused exercise program for elderly patients with distal radius fractures while immobilized significantly improved grip strength.


Assuntos
Terapia por Exercício/métodos , Fixação de Fratura/reabilitação , Força da Mão , Fraturas do Rádio/reabilitação , Traumatismos do Punho/reabilitação , Idoso , Moldes Cirúrgicos , Feminino , Humanos , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Fraturas do Rádio/fisiopatologia , Método Simples-Cego , Resultado do Tratamento , Traumatismos do Punho/fisiopatologia
19.
Plast Reconstr Surg ; 145(3): 780-789, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32097326

RESUMO

BACKGROUND: Facial fractures are painful injuries routinely managed by opioids after surgical repair. Studies have identified patient risk factors and prescribing patterns associated with opioid use in medicine and general surgery; however, little is known about these entities in the facial trauma population. METHODS: A retrospective cohort study of opioid-naive patients undergoing surgical repair of facial fractures was conducted using the Truven Health MarketScan Commercial Claims and Encounters (2006 to 2015) and Medicaid Multi-State Databases (2011 to 2015). Eligible procedures included nasal, nasoorbitoethmoid, orbital, mandible, and Le Fort fracture repair. Opioid type, daily dosage, and prescription duration were analyzed. Multivariable logistic regression was performed to determine independent predictors of prescription refill. RESULTS: A total of 20,191 patients undergoing surgical repair of facial fractures were identified. Of these, 15,861 patients (78.6 percent) filled a perioperative opioid prescription. Refill (58.7 percent) and potentially inappropriate prescribing (39.4 percent) were common among this population. Patient factors including prior substance use (adjusted OR, 1.84; 95 percent CI, 1.63 to 2.07) and history of mental health disorder (adjusted OR, 1.43; 95 percent CI, 1.06 to 1.91) were independent predictors of refill. Increased odds of refill were seen in patients prescribed tramadol (OR, 1.98; 95 percent CI, 1.48 to 2.66) and those who underwent multiple surgical repairs (OR, 3.38; 95 percent CI, 2.54 to 4.50). CONCLUSIONS: Refill and potentially inappropriate prescribing occurred at high rates in facial trauma patients undergoing surgical repair. Additional studies are needed to develop guidelines for proper opioid prescribing in this population. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Analgésicos Opioides/efeitos adversos , Ossos Faciais/lesões , Fixação de Fratura/efeitos adversos , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica/estatística & dados numéricos , Fraturas Cranianas/cirurgia , Adolescente , Adulto , Prescrições de Medicamentos/normas , Prescrições de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Prescrição Inadequada/prevenção & controle , Prescrição Inadequada/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Epidemia de Opioides/prevenção & controle , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Dor Pós-Operatória/etiologia , Período Pós-Operatório , Padrões de Prática Médica/normas , Estudos Retrospectivos , Fatores de Risco , Fraturas Cranianas/complicações , Tramadol/efeitos adversos , Estados Unidos , Adulto Jovem
20.
Cochrane Database Syst Rev ; 2: CD006080, 2020 02 07.
Artigo em Inglês | MEDLINE | ID: mdl-32032439

RESUMO

BACKGROUND: Fracture of the distal radius is a common clinical problem. A key method of surgical fixation is percutaneous pinning, involving the insertion of wires through the skin to stabilise the fracture. This is an update of a Cochrane Review published in 2007. OBJECTIVES: To assess the effects (benefits and harms) of percutaneous pinning versus cast immobilisation alone and of different methods and techniques of percutaneous pinning, modalities or duration of immobilisation after pinning, and methods or timing of pin or wire removal for treating fractures of the distal radius in adults. Our primary focus was on dorsally displaced fractures. SEARCH METHODS: We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials, MEDLINE, Embase, trial registers, conference proceedings and reference lists of articles up to June 2019. SELECTION CRITERIA: Randomised or quasi-randomised controlled clinical trials involving adults with a fracture of the distal radius, which compared percutaneous pinning with non-surgical treatment or different aspects of percutaneous pinning. Our main outcomes were patient-reported function at the short term (up to three months), medium term (three up to 12 months) and long term (greater than 12 months); overall numbers of participants with complications requiring secondary treatment and any complication; grip strength and health-related quality of life at 12 months. DATA COLLECTION AND ANALYSIS: At least two review authors independently performed study screening and selection, 'Risk of bias' assessment and data extraction. We pooled data where appropriate and used GRADE for assessing the quality of evidence for each outcome. MAIN RESULTS: We included 21 randomised controlled trials (RCTs) and five quasi-RCTs, involving 1946 generally older and female adults with dorsally displaced and potentially or evidently unstable distal radial fractures. Trial populations varied but the majority of studies reported mean ages in the sixth decade or older. All trials were at high risk of bias, invariably performance bias - which for most trials reflected the impracticality of blinding care providers or participants to treatment allocation - and often detection bias and selective reporting bias. Allocation concealment was secure in one trial only. All trials reported outcomes incompletely. The studies tested one of 10 comparisons. In the following, we report on those of the main outcomes for which evidence was available. No subgroup analysis, such as by pinning methods, was viable. Eleven heterogeneous trials involving 917 participants compared percutaneous pinning with plaster cast immobilisation after closed reduction of the fracture. The quality of the evidence was very low for all reported outcomes. Thus, we are uncertain if percutaneous pinning compared with plaster cast alone makes any difference to patient-reported function, measured using the DASH questionnaire, at six weeks or six months (incomplete data from one trial). Overall numbers of participants with complications were not reported. Redisplacement resulting in secondary treatment occurred on average in 12% (range 3.3% to 75%) of participants treated by cast alone (six trials) whereas pin tract infection requiring antibiotics and, often, early wire removal, occurred on average in 7.7% (range 0% to 15%) of pinning group participants (seven trials). We are uncertain whether pinning makes a difference to the incidence of complex regional pain syndrome, reported in four studies. Although two studies found finger stiffness after cast removal was less common after pinning (20% versus 36%), the treatment implications were not reported. Other reported complications were mainly surgery-related. Based on incomplete data or qualitative statements from only four studies, we are uncertain of the effects of pinning on grip strength at 12 months. We are uncertain if percutaneous pinning compared with plaster cast alone makes any difference to patient-reported quality of life at four months (one study). Five comparisons of different pinning methods were made by six trials in all. One of these trials, which reported results for 96 participants, compared Kapandji intrafocal pinning (2 or 3 wires) with early mobilisation versus trans-styloid fixation (2 wires) with six weeks cast immobilisation. We are uncertain whether Kapandji pinning slightly increases the risk of superficial radial nerve symptoms or complex regional pain syndrome, or whether it makes a difference in grip strength at 12 months (very low-quality evidence). Two small trials using two distinct pinning techniques compared biodegradable pins versus metal pins in 70 participants. Although very low-quality evidence, the extra demands at surgery of insertion of biodegradable pins and excess of serious complications (e.g. severe osteolytic reactions) associated with biodegradable material are important findings. Three poorly-reported trials involving 168 participants compared burying of wire ends versus leaving them exposed. We are uncertain whether burying of wires reduces the incidence of superficial infection (very low-quality evidence). There is low-quality evidence that burying of wires may be associated with a higher risk of requiring more invasive treatment for wire removal. Four small trials compared different types or duration of postoperative immobilisation. Very low-quality evidence of small between-group differences in individual complications and grip strength at 17 weeks, means we are uncertain of the effects of positioning the wrist in dorsiflexion versus palmar flexion during cast immobilisation following pinning of redisplaced fractures (one trial; 60 participants). Three small heterogeneous trials compared cast immobilisation for one week (early mobilisation) versus four or six weeks after percutaneous pinning in 170 people. Although we note one trial using Kapandji pinning reported more complications in the early group, the very low-quality evidence means there is uncertainty of the effects of early mobilisation on overall and individual complications, or grip strength at 12 months. No trials tested different methods for, or timing of, pin/wire removal. AUTHORS' CONCLUSIONS: Overall, there is insufficient RCT evidence to inform on the role of percutaneous pinning versus cast immobilisation alone or associated treatment decisions such as method of pinning, burying or not of wire ends, wrist position and duration of immobilisation after pinning. Although very low-quality evidence, the serious complications associated with biodegradable materials is noteworthy. We advise waiting on the results of a large ongoing study comparing pinning with plaster cast treatment as these could help inform future research.


Assuntos
Fixação de Fratura/instrumentação , Fixação de Fratura/métodos , Fraturas do Rádio/cirurgia , Traumatismos do Punho/cirurgia , Pinos Ortopédicos , Fios Ortopédicos , Moldes Cirúrgicos , Fratura de Colles/cirurgia , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
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